When I started developing TRB, I was all about managing chronic stress and wasn’t thinking about blood pressure. I’m 63 years old, fit, but in long-term remission from rheumatoid arthritis (RA), with degenerative joint disease, multiple joint replacements and fusions, and a significant history of trauma, anxiety, insomnia, and pain. This is why I care so much about managing chronic stress. But the relationship between blood pressure and chronic stress is strong, and the mitigation of chronic stress can significantly lower your blood pressure, which as you will see, can do wonderful things for your healthspan, as you confront the diseases of aging.

Back In The Day

I’ve always had good heart health. For a while, that’s all I had. Back in the 90s, in between my hip replacement and my bilateral knee replacement, I was having my foot fused in three places. I was about to have a cancer scare as well, but that’s a different story. Anyway, after four and a half hours of surgery, awake, I was watching the team rushing around finishing up, all except for the anesthesiologist, who was staring at his monitor, unmoving. Then he said, “wow.”

“What’s wow?” I asked, more than curious. “You were on the table for four and a half hours and your blood oxygenation level never dropped below 99%,” he responded. “I’ve never seen that before.” I didn’t know much about blood oxygenation, but I took this as a good sign. At the lowest point of my life, my heart health gave me a ray of hope.

Covid

Since then, at my annual physicals, my blood pressure has been about 120/80, with some minor swings. My doctors saw this as good. Because of Covid restrictions, I missed my annual blood pressure check for a few years. When I got Covid, my feet went numb, and the numbness spread up to my knees, and I didn’t know if it would go away. This was especially stressful for someone with my history, which motivated me to make my breathwork more rigorous, which evolved into TRB.

On my first year back in the doctor’s office, my first as a TRB practitioner, my blood pressure was 106/72, quite a bit lower. I noticed but didn’t think about it much, still focused on chronic stress. But this year, at the first of two pre-surgical clearance physicals, when my blood pressure was 106/61, I started thinking about it. At my annual checkup a few weeks later, I made a point of sitting still while they checked me. It was 104/68. Two months later, at the pre-clearance for my next surgery, I sat still and closed my eyes, but no breathwork tricks. 100/62, while still recovering from the first surgery. That’s an unusually low number.

Hypo?

All this got my doctor’s attention. She checked me for any symptoms of low blood pressure (hypotension). Hypotension is too low, and tends to be more of a systemic problem than a cardio one, but it comes with symptoms that are easy to diagnose:

• Lightheadedness or dizziness

• Weakness

• Blurry vision

• Pale, clammy skin

• Fatigue or lethargy

• Confusion

• Nausea

• Fainting

• Unsteadiness

• In severe cases: agitation, cold skin, weak pulse, and breathing problems1

I had none of these. I was fit, working out regularly, and getting about 15,000 steps per day, walking my dogs in the woods on my 110 year old feet. After much questioning and a thorough exam, my doctor determined that my blood pressure was likely optimal, better than good.

TRB?

By now I was curious. Could TRB lower my already good blood pressure 20 points? Besides TRB, most every aspect of my life was the same, with these three exceptions:

• I was a few years older;

• I switched from mostly high intensity interval training (cardio) to mostly low impact resistance training (not cardio);

• I had to start walking slower because of my feet (even less cardio);

As you can see, none of these would’ve lowered my blood pressure. If anything, they should’ve raised it. TRB was the only other change and my blood pressure dropped 20 points. You could add the data point that, since beginning TRB, I’ve also raised my morning Heart Rate Variability (HRV) up to above 80ms (very good), which puts me well above the 95th percentile for men my age, despite decreasing my cardiovascular exercise. The simplest answer is that practicing TRB both raised my HRV and lowered my blood pressure 20 points2.

My experience is well supported by the science. A study by Zou et al, "Meta-Analysis of Effects of Voluntary Slow Breathing Exercises for Control of Heart Rate and Blood Pressure in Patients With Cardiovascular Diseases," analyzed the effects of slow breathing exercises on heart rate and blood pressure in individuals with cardiovascular conditions. They found that slow breathing exercises significantly reduced both systolic (the first number) and diastolic (the second number) blood pressure. TRB is essentially slow breathing taken to the next next level, with progressive resistance, deliberate practice, immediate expert feedback, driven by data.

Autonomic Balance with Parasympathetic Resilience

In previous posts, I’ve made a big deal about restoring autonomic balance with parasympathetic resilience. One of its nice benefits is that it’s taught my body how to relax. If I close my eyes and breathe normally, for the 10-15 seconds of a blood pressure check, my body relaxes into a parasympathetic state, quickly and deeply. My breath naturally slows, my heart rate decreases, and my HRV increases. It’s no longer something I consciously do. My nervous system has learned where this relaxed state is within me, and it goes there if I close my eyes and still myself, without my telling it to. That’s why my eyes-closed blood pressure was 100/62. Because I have healed my chronic stress, and because my parasympathetic system is resilient and strong, my body can relax in a moment, naturally.

This fluid response is the whole point of autonomic balance. When one is confronted with challenges, one’s body fully engages. When given an opportunity to rest and recover, one’s body fully relaxes. If your body can do this, without you telling it to, then among a whole slate of positive things, you probably have very good blood pressure3.

Autonomic balance is not that hard to achieve. TRB can get you there in a few months, if you stick with it.

HRV and Blood Pressure

Along with resilience, I’ve spent a lot of time talking about the benefits of having a higher Heart Rate Variability (HRV). HRV numbers have an inverse relationship with blood pressure numbers: People with higher (good) HRV tend to have lower (good) blood pressure, especially their diastolic (the second number); while lower HRV was correlated with a 38% increase in developing heart disease over the next four years4. High HRV is a measure of autonomic balance, which correlates with a healthy heart, which correlates with very good blood pressure, which is a foundational measure of overall health and well being5.

Chronic Stress

If, as I’ve hypothesized in previous posts, that TRB is essentially resistance training for your autonomic nervous system, and if a direct intervention of resistance training can make a body system stronger and more resilient, then it’s likely that practicing TRB lowered my blood pressure by 20 points. Over the course of a year or so, it probably strengthened my parasympathetic nervous system, healed my chronic stress, and restored me to autonomic balance with parasympathetic resilience6.

Optimal?

This got me thinking. If being physically fit – with bigger stronger muscles and denser bones, but not too much – is better than just being healthy, could optimal blood pressure – lower than good but not too low – be better than good7?

If so, and if high blood pressure was a foundational factor in the biggest diseases of aging, would getting one’s blood pressure down to optimal slow the progression of heart, neurodegenerative, and metabolic disease, even more than good BP would8?

Optimal blood pressure, beyond good, is not well studied, because medicine’s focus is on lowering high blood pressure. The studies suggest a benefit, but are somewhat confounded, because when most researchers say low, they mean hypo low, instead of optimal low, which is rare and would be hard to study.

Important Point

When I say Optimal, I mean your optimal. Everyone is different, age, fitness, genetics, but for your unique neurophysiology, at this point in time, there is a dialed in number you could achieve, and for many it will be below 120/80. Also, your optimal number is dynamic, which means it can and will change over time, potentially for the better.

The Law of Diminishing Returns – Your New Best Friend

About now, many of you are saying, congratulations, you’re a neuro-cardio superstar, but what about me? My blood pressure is 140/90 (or higher). What can you do for me? Well friends, I have good news! Starting from higher might make it easier.

The Law of Diminishing Returns tells us that, in any pursuit, the biggest, easiest gains tend to come at the beginning. Typically, it’s much easier to go from beginner to intermediate than from intermediate to advanced. It doesn’t matter whether it’s lifting weights, playing the violin, or optimizing your blood pressure. The less you start with, the more you have to gain, until you reach your unique potential9.

When my blood pressure was 120/80, I was essentially an intermediate, because I was active and fit, with good habits, and probably some good cardiovascular genetics. When I got it down to 100/62, I was advanced. 95/60 might be my fully optimized, olympic caliber score, but because I have already achieved most of my potential, it might take a lot of work just to drop those last few points10.

If you’re starting well above 120/80, you’re more like a beginner. Because you have realized very little of your blood pressure potential, you might have more room for growth than I did, especially easy growth. And even if your potential low is not as low as mine, you may be able to lower your score by more points than I did, potentially quite a few more.

Sam – Advanced Beginner

The typical person my age might have a blood pressure of about 133/87. Let’s call them Sam. Sam’s 133/87 BP is considered normal to high, so they’re essentially an advanced beginner11. Sam is probably healthy but well short of fit. With Sam’s age, and mild BP elevation, Sam may be experiencing cardiovascular changes, such as increased sympathetic activity (stressed), arterial stiffening and narrowing, and decreased vascular elasticity, which could be early indicators of atherosclerosis. While all of these changes are consistent with normal aging, they might limit Sam’s potential some12. If Sam’s artery walls have these changes, Sam may not be able to get down to 100/62, but a 20 point drop would get Sam down to 113/76. That’s an excellent number and might make Sam’s doctor do the happy dance. I would speculate that, if Sam kept practicing TRB, and achieved full autonomic balance with parasympathetic resilience, Sam could possibly get even lower than that, and potentially heal some of that cardiovascular damage13.

Morgan – Beginner

Sam’s friend Morgan, also 63, has a BP of 150/100, which is considered high. Morgan’s cardiovascular changes are probably more concerning, and qualify as Stage 2 hypertensive14. But starting from that high, Morgan may have the potential to lower by more points than Sam can. Along with other negative changes, Morgan’s nervous system is probably in a more advanced state of chronic stress, low (bad) HRV with high (bad) BP15. If Morgan commits to TRB, and eventually restores autonomic balance, Morgan’s blood pressure could come down to a number approaching Sam’s. Even if the number is not quite as low, Morgan may be able to reduce by more points than Sam, because Morgan started so high. By no means is this guaranteed, and there are genetic and other factors beyond your control, but everything else being equal, the further you are from autonomic balance, the greater your potential to improve both your blood pressure and HRV, as your autonomic balance is restored16.

Diminishing returns also tells us that going from advanced to optimized is not as important as going from intermediate to advanced, which is less important than the big jump from beginner to intermediate. Going from high blood pressure to good, the easiest part, has the biggest impact on health outcomes17. But why stop there? If you commit to TRB, your unique optimized BP is definitely attainable. Plus full autonomic balance with parasympathetic resilience will give your body the capacity to finally relax.

Heart Health – A Microcosm of You

Just like you, your heart wants to live in Autonomic Balance with Parasympathetic Resilience. Your heart should be able to work hard to achieve your goals, followed by complete recoveries, so it can fully repair the stress and minor damage from the day’s challenges, and be ready to embrace the challenges to come18.

If your heart doesn’t get a complete recovery before your next set of challenges, it won’t be able to restore itself completely, so it won’t be fully ready to get its job done19. This means that the next day, it will have to work harder to do the same amount of work, which will incur even more damage. This damage will require extra time to recover from, which your heart won’t get, because like you, it will still be under chronic stress. Over the course of years, this pattern will gradually damage your heart and its arteries, reduce its capacity to work, and cause it to age beyond its years20. This aging will decrease the function of every organ system in your body, including your brain. If your heart is aging prematurely, then you are too21. You are steepening the decline of your aging curve. You don’t want a steep aging curve.

What Optimizing Really Means

With TRB, when I talk about getting your blood pressure below 120/80, what I’m really saying is, your heart is fully recovering from it’s stressors, because you’ve achieved autonomic balance with parasympathetic resilience22. This allows you to fully engage in your life’s passions, every day, because you’re getting a full recovery, every night. Because your autonomic nervous system is in near-optimal balance, stress with full recovery, your heart is both strong and well rested, which over time gives you your optimal blood pressure23. Because your nervous system is optimized, so is your heart, which gives every organ system in your body a chance to function at its optimal level24.

High Blood Pressure and The Major Diseases of Aging

As you age, your body become more susceptible to the major diseases and conditions of aging: Heart disease, stroke, neurodegenerative disease, diabetes, kidney disease, metabolic syndrome, cancer, atrial fibrillation, and others. While diverse, all of these diseases share a common thread – their close causal relationship with high blood pressure25.

Optimizing your blood pressure can be a powerful tool for preventing and managing these major diseases of aging26. In the following sections, we'll explore each of these diseases, their relationship to blood pressure, and how optimizing your blood pressure can improve your chances.

It's important to note that while blood pressure is a critical factor, it's not the only one. Genetics, lifestyle choices, and other health conditions all play roles in these diseases. However, blood pressure is one of the most modifiable risk factors, offering you an actionable way to improve your health prospects.

As we consider each disease, I'll provide clear, evidence-based information on how blood pressure affects its development and progression. I'll also share insights on how optimizing your blood pressure could potentially reduce your risk or improve your prognosis if you're already managing one of these conditions.

Remember, the goal isn't just to lower blood pressure, but to find the optimal range for your unique neurophysiology. Always check with your doctor to determine the best approach for you.

Heart Disease (Hypertension)

Heart disease encompasses a range of conditions affecting the heart, including coronary artery disease, heart failure, and arrhythmias. These conditions can lead to reduced heart function, chest pain, and potentially life-threatening events like heart attacks and strokes. Hypertension, or high blood pressure, is both a type of heart disease and a major risk factor for other cardiovascular problems.

High blood pressure is often called the silent killer, because you typically feel no symptoms as it develops, but it causes significant damage to the heart and blood vessels over time. High blood pressure increases the workload on the heart, leading to thickening of the heart muscle and potential heart failure. Hypertension also contributes to the buildup of plaque in the arteries, increasing the risk of heart attacks and strokes27. Lowering blood pressure has a profound impact on heart health. Research shows that for every 10 mmHg reduction in systolic blood pressure, the risk of major cardiovascular events is reduced by 20%28. If you lower your blood pressure significantly, you can lower your risk of developing heart failure by as much as 64%29. Maintaining optimal blood pressure can significantly decrease the risk of heart disease, potentially preventing up to 50% of heart attacks and strokes30.

Stroke:

Stroke, a sudden interruption of blood flow to the brain, is similar to heart disease, but targets different organs and mechanisms. While heart disease primarily affects coronary arteries, stroke damages cerebral blood vessels, leading to potentially devastating neurological consequences. As with heart disease, reducing high blood pressure is the most modifiable risk factor for stroke31.

Ischemic Stroke

Ischemic strokes, about 87% of all strokes, occur when a blood clot blocks a cerebral artery, cutting off oxygen supply to brain tissue. High blood pressure significantly increases the risk of ischemic stroke by promoting atherosclerosis in brain arteries and contributing to the formation of emboli from carotid plaques. Research has shown that for every 10 mmHg reduction in systolic blood pressure, the risk of ischemic stroke decreases by 27%32. This underscores the critical importance of blood pressure management in stroke prevention.

Intensive blood pressure control has shown significant benefits for reducing stroke risk. The SPRINT trial, a landmark clinical study that investigated the effects of intensive blood pressure control on cardiovascular and cognitive outcomes, demonstrated that targeting a systolic blood pressure below 120 mmHg led to a 41% reduction in stroke risk compared to standard treatment33. Moreover, maintaining optimal blood pressure is crucial not only for prevention but also for improving outcomes in the critical golden hour post-stroke, where proper management can enhance recovery by up to 35%34.

Hemorrhagic Stroke

Hemorrhagic strokes, though less common, are often more severe and account for about 13% of all strokes. They occur when a weakened blood vessel ruptures, causing bleeding into or around the brain. Chronic high blood pressure is a primary cause in weakening cerebral artery walls, significantly increasing the risk of hemorrhagic stroke.

Effective blood pressure control is particularly important in preventing hemorrhagic strokes. Studies have found that individuals with untreated hypertension have up to four times the risk of hemorrhagic stroke compared to those with normal blood pressure35. Furthermore, managing blood pressure in the long term can help prevent the formation of cerebral microbleeds and other silent brain changes that increase future stroke risk. Even small reductions in blood pressure can have substantial benefits. A reduction of just 2 mmHg in diastolic blood pressure could result in a 15% decrease in the risk of hemorrhagic stroke36.

Atrial Fibrillation (AFib)

While technically not one of the major diseases of aging, we’ve included AFib because of its prevalence, strong link to high blood pressure, and interconnectedness with the other diseases. In AFib, the most common type of cardiac arrhythmia, the upper chambers of the heart (atria) beat irregularly and out of sync with the lower chambers (ventricles), which disrupts normal blood flow through the heart. AFib is a serious condition which increases your risk of stroke, heart failure, and other complications.

High blood pressure is the most common risk factor for developing AFib. Up to 80% of all AFib patients have high blood pressure. Controlling one’s blood pressure is foundational to both preventing AFib and of treating it once it’s diagnosed37.

Neurodegenerative Diseases:

The Neurodegenerative diseases, including Alzheimer's, Parkinson's, and various forms of dementia, are characterized by the progressive loss of structure or function of neurons in the brain. This significantly impacts your cognitive abilities, motor functions, and overall quality of life as you age. While the exact mechanisms vary, there seems to be a strong link between blood pressure and the development and progression of neurodegenerative diseases. High blood pressure, especially when sustained over time, can damage the delicate blood vessels in the brain, potentially accelerating cognitive decline and increasing the risk of various neurodegenerative conditions. Optimizing your blood pressure could be crucial to preventing and treating neurodegenerative disease.

Alzheimer's Disease

Alzheimer's disease is a progressive brain disorder that slowly destroys memory and thinking skills. It's the most common cause of dementia in older adults, characterized by the accumulation of abnormal protein deposits in the brain, leading to neuron death and brain tissue loss. As the disease advances, it significantly impairs a person's ability to carry out daily tasks.

High blood pressure, especially in midlife, is a significant risk factor for developing Alzheimer's disease. Studies have shown that midlife hypertension can lead to a 25% increased risk of Alzheimer's disease38. High blood pressure can damage small blood vessels in the brain, reducing blood flow and oxygen supply to brain cells39. Studies have shown that people with untreated high blood pressure have a 42% greater risk of developing Alzheimer's compared to those with treated hypertension40. Controlling high blood pressure, particularly from middle age onward, can significantly decrease one's chances of developing dementia.

Parkinson's Disease

Parkinson's disease is a progressive nervous system disorder that affects movement. It's characterized by tremors, stiffness, and difficulty with balance and coordination. The disease results from the loss of dopamine-producing brain cells, which leads to a decrease in dopamine levels, which impairs our ability to control our movement and coordination.

While the direct link between blood pressure and Parkinson's is less clear than with Alzheimer's, hypertension can play a significant role in the disease's progression and management. High blood pressure can increase the risk of small vessel disease in the brain, potentially exacerbating Parkinson's symptoms41. Managing blood pressure effectively can help reduce the risk of falls, cognitive decline, and cardiovascular complications in Parkinson's patients, potentially slowing disease progression42.

Diabetes

Diabetes is a chronic condition characterized by high blood sugar levels, resulting from either the body's inability to produce insulin (Type 1) or its ineffective use of insulin (Type 2). Diabetes affects how the body processes glucose, leading to various complications, including cardiovascular disease, kidney damage, and nerve problems.

High blood pressure and diabetes often coincide, with up to 75% of adults with diabetes also having hypertension43. The combination significantly increases the risk of heart disease, stroke, and kidney problems. Controlling blood pressure in diabetic patients is crucial for reducing these risks. Studies have shown that for every 10 mmHg reduction in systolic blood pressure, the risk of diabetic complications decreases by 12%44. Maintaining healthy blood pressure can significantly improve outcomes, reducing the risk of heart attacks, strokes, and kidney disease45.

Metabolic Syndrome

More than a disease, Metabolic syndrome is a cluster of interconnected conditions that increase the risk of heart disease, stroke, and type 2 diabetes. We’ve included metabolic syndrome due to its prevalence and significant impact on overall health. Metabolic syndrome is diagnosed when a person has at least three of the following five risk factors: abdominal obesity; high blood pressure; high blood sugar; high triglycerides; and low HDL (good) cholesterol. About one in three American adults have metabolic syndrome, making it a critical health concern as you age.

High blood pressure is a central component of metabolic syndrome and plays a crucial role in its development and progression. Studies show that hypertension is present in more than 90% of individuals with metabolic syndrome46. Insulin resistance, a key feature of metabolic syndrome, can lead to hypertension through several mechanisms, including increased sodium retention, sympathetic nervous system activation, and endothelial dysfunction. Conversely, high blood pressure can exacerbate insulin resistance and contribute to the worsening of other metabolic syndrome components.

The other risk factors of metabolic syndrome interact closely with blood pressure, creating a kind of vicious cycle. Abdominal obesity is associated with increased inflammation and oxidative stress, which can damage blood vessels and lead to hypertension. High blood sugar levels can cause arterial stiffness, further elevating blood pressure. Having high triglycerides (bad) with low HDL cholesterol (also bad) contributes to endothelial dysfunction and atherosclerosis, both of which can raise blood pressure.

Managing blood pressure is crucial in treating metabolic syndrome and reducing its associated risks. Research has shown that intensive blood pressure control in people with metabolic syndrome can significantly lower the risk of cardiovascular events. For every 10 mmHg reduction in systolic blood pressure, the risk of major cardiovascular events is reduced by 20%47. Moreover, lowering high blood pressure often leads to improvements in the other components of metabolic syndrome, because they are so interconnected.

TRB would seem to be uniquely well suited for preventing and managing metabolic syndrome, but as always, please check with your doctor before practicing TRB.

Kidney Disease

Chronic kidney disease (CKD) is a condition characterized by gradual loss of kidney function over time. The kidneys play a crucial role in filtering waste and excess fluids from the blood, regulating blood pressure, and producing hormones that help manage other bodily functions. As CKD progresses, it can lead to complications like high blood pressure, anemia, weak bones, poor nutritional health, and nerve damage. In its most severe form, end-stage renal disease, artificial filtering (dialysis) or a kidney transplant becomes necessary for survival.

Hypertension is both a cause and a consequence of kidney disease, creating another vicious cycle. Uncontrolled high blood pressure can damage the blood vessels in and leading to the kidneys, reducing their ability to function properly. Conversely, as kidney function declines, it becomes harder for the body to regulate blood pressure, which can lead to hypertension. Studies have shown that people with hypertension are at a significantly higher risk of developing CKD, with one large-scale study finding that individuals with high blood pressure were 81 percent more likely to develop kidney disease compared to those with normal blood pressure48. Effective blood pressure management is crucial in both preventing and slowing the progression of kidney disease. Research shows that intensive blood pressure control (getting systolic pressure below 120 mmHg) can reduce the risk of developing kidney failure by up to 32% compared to standard blood pressure treatment49.

Cancer

Cancer is a group of diseases characterized by abnormal cell growth that can invade or spread to other parts of the body. It can affect most any part of the body and is a leading cause of death worldwide. The development of cancer involves complex interactions between genetic factors and environmental influences.

The relationship between blood pressure and cancer is less direct, but emerging research suggests a connection. High blood pressure may increase the risk of certain cancers, particularly kidney and endometrial cancer. A large-scale study found that for every 10 mmHg increase in systolic blood pressure, there was a 10-20% higher risk of developing kidney cancer50. While the mechanisms aren't fully understood, it's thought that the hypertension that causes chronic inflammation and oxidative stress may contribute to cancer development through DNA damage, genomic instability, and tumor-promoting microenvironments5152. Lowering one’s blood pressure may potentially reduce cancer risk, though more research is needed to quantify this benefit precisely.

Inflammation – A Pattern Emerges

In all of these diseases, the body endures chronic stress, which causes damage from which it cannot fully recover, which induces a chronic inflammation response53. It is this inflammation response that is at the root of the diseases themselves54.

If the body was able to fully recover from the stressors that correlate with high blood pressure, before that stress became chronic, then the inflammation response could then stop, before it caused the problems associated with each disease, and all would be good. But because the stress is chronic, too much for the body to recover from, the inflammation response becomes chronic as well55. It is this continual inflammation response that fuels the conditions that lead to the disease.

By restoring autonomic balance with parasympathetic dominance, TRB has the potential to heal your stress before it becomes chronic. By potentially preventing the chronic immune response, TRB could potentially heal the damage that causes the chronic response before that response causes the disease56. This is a big claim, and would require significant testing to be proved true. But the science supports its potential. I’ll have more on this in future posts.

Bringing It Back to Blood Pressure

A blood pressure check is a simple, elegant, and accessible tool both to measure the the stress your body is experiencing and the completeness of its recoveries, over time. If you have good blood pressure, then your body is making good recoveries. If your blood pressure is optimized, then you are making complete recoveries, and you are greatly increasing your chances to delay the major diseases of aging, and potentially avoiding them entirely.

Lowering High Blood Pressure – Endogenous vs Exogenous

When it comes to medical interventions, there are two primary approaches: endogenous and exogenous. Understanding these concepts can help us appreciate different treatment strategies and their potential impacts on our health.

Endogenous approaches work within the body's natural systems, encouraging and optimizing internal processes to achieve health benefits. These methods empower the body's innate healing mechanisms. Endogenous interventions restore balance and function by strengthening the body's own capabilities. Because endogenous treatments work with your body’s systems, they tend to induce minimal side effects. Endogenous treatments can be quite powerful, but for maximum effect, one needs to start treatment before problems become chronic.

Exogenous treatments put external substances or forces into your body. These interventions often involve medications, supplements, or devices that are not naturally produced. While exogenous treatments can be highly effective, they usually don’t start until the problem becomes chronic, and they often come with side effects.

Both approaches have their place in modern medicine, and for many, the most effective treatments combine elements of both, but as a rule, the sooner you begin, the more endogenous you can be.

Anti-Hypertensive Medications – The Go-to Exogenous Approach

Anti-hypertensive medications are drugs designed to lower high blood pressure, once it is already too high. They play a crucial role in managing hypertension and reducing the risk of associated complications such as heart disease, stroke, neurodegenerative, metabolic, and kidney problems. These medications work through various mechanisms to help the body maintain healthier blood pressure levels.

There are several classes of anti-hypertensive drugs, including ACE Inhibitors, ARBs, Calcium Channel Blockers, Diuretics, and Beta-Blockers, which target different aspects of blood pressure regulation. The choice of medication depends on various factors, including the severity of hypertension, other medical conditions, and potential side effects. Often, a combination of different anti-hypertensive drugs is used to affect blood pressure control, alongside lifestyle modifications.

While anti-hypertensive medications can be effective in managing high blood pressure, because they are exogenous, they often create nasty side effects, such as:

• Dizziness or lightheadedness

• Fatigue or weakness

• Headache

• Dry cough

• Swelling in hands, feet, or ankles

• Constipation or diarrhea

• Erectile dysfunction or decreased sexual drive

• Increased urination

• Sleep disturbances or insomnia

• Dry mouth

• Nausea

• Mood changes or depression

• Cold hands and feet

• Slow or irregular heartbeat

• Low blood pressure

These side effects can be severe. Many patients report feeling disoriented, like strangers in their own bodies: Mentally foggy from beta-blockers, physically drained by diuretics, or emotionally flattened by ACE inhibitors. Despite this, once symptoms reach a certain level, anti-hypertensives become a necessary treatment.

Why Wait?

The big flaw with the exogenous approach is that it waits until you are already sick. For years, while high blood pressure damages most every organ system in your body, your doctor and you will do nothing, beyond some gentle scolding about diet and exercise, until you have so much damage that you qualify for a diagnosis of hypertension. Once you’re diagnosed, your doctor will have no choice but to put you on anti-hypertensives, which will help your blood pressure, but the damage to most every organ system in your body will be done.

The ideal solution would be an endogenous approach, one that works with the body's natural systems to regulate blood pressure. An endogenous method utilizes the body's own mechanisms to achieve balance, potentially avoiding the side effects of anti-hypertensives, but you have to start today.

With TRB, you can heal the chronic stress that damages your heart and arteries, before you get sick. While exogenous approaches are effective at managing symptoms, TRB restores your autonomic balance and could prevent hypertension from developing in the first place. Why wait?

What If I Already Waited?

Start today. It’s never too late to start TRB. Even if your blood pressure is high, you can still lower it significantly with TRB, maybe even more than I did, even if you’re already on anti-hypertensives. TRB works through a completely different mechanism than the blood pressure meds, so there should be no overlap, but please check with your doctor before starting TRB.

TRB and VMNs – an Endogenous Solution to High Blood Pressure

With TRB, you restore your nervous system to autonomic balance with parasympathetic resilience, before you get sick. This optimizes your blood pressure now, while your heart is still healthy, and potentially delays or prevents your getting sick. Compare this with waiting until you are sick, taking an exogenous chemical, and keeping yourself alive but without ever restoring your health. It’s our hypothesis that, by providing these two minute doses of resistance training for your nervous system several times per day, TRB is stimulating your vagus nerve to a level well above its baseline. This causes it to release and/or modulate a network of Vagus Mediated Neuromodulators (VMNs), specifically acetylcholine, norepinephrine, serotonin, brain derived neurotrophic factor (BDNF), and possibly GABA and oxytocin, endogenously, but at levels well beyond what your body would otherwise produce57. Your body then uses these VMNs to heal the damage from your chronic stress and restore your nervous system to autonomic balance58. This network of VMNs doesn't just lower BP, it restores the parasympathetic resilience you need to maintain optimal blood pressure naturally, much like resistance exercise builds muscle. TRB gives your nervous system the neuro tools it needs to heal your body by its own mechanisms, as opposed to introducing an exogenous chemical. This allows your nervous system to fully heal itself, and in turn your whole body, which over time will raise your HRV and lower your blood pressure to levels that will make your doctor smile59.

Proof

Blood Pressure is very easy to measure. You can do it at your doctor’s office or at home with inexpensive equipment. If you practice TRB every day, as your parasympathetic nervous system gets stronger, you should see significant improvements in your blood pressure within a few months, and even more over time. If you are tracking your HRV, through a morning test or overnight with your device, you should see that improving as well.

As your blood pressure comes down, you will feel your chronic stress easing. Your energy level, cognition, sex drive, sleep, mood, and patience will all improve. Your sense of dread when facing challenges will gradually be replaced with one of opportunity and excitement. If you’re trying to lose weight, you may find it a bit easier to turn down empty calories, because your body no longer needs to fuel your state of chronic arousal.

If a person with very good blood pressure can lower their blood pressure 20 points, practicing TRB 8 minutes per day, then a person with higher blood pressure can do so as well and quite likely do better.

The diseases of aging are coming for us all. By restoring and maintaining your nervous system’s autonomic balance with parasympathetic resilience, TRB could optimize your blood pressure, help you delay these conditions, and potentially avoid them entirely.

Restoring your nervous system to autonomic balance could initiate a virtuous cycle. Combine TRB with moderate resistance and cardiovascular exercise, a healthy diet, quality sleep, engaging work, and a community of family and friends, and you have maximized your chances for a long, healthy life.

In our next post, I will talk about TRB and Building World-class Resilience. Once life stops wearing you down, challenges can become opportunities. No matter how stressful today was, you can still wake up fully recovered tomorrow morning. TRB will get you there and I will show you how. As you may have noticed, I have quite a bit of personal experience!

Bernadette Charland, Consulting Editor

Extended by perplexity.ai

Medical Disclaimer

Please consult with your licensed health care professional before beginning this or any other breathwork protocol.

All content and information on this website is for informational and educational purposes only, does not constitute medical advice, and does not establish any kind of patient-client relationship by your choice to use it. Although we strive to provide accurate general information, the information presented here is not a substitute for any kind of professional advice, and you should not rely solely on this information.

• Long aligned spine

• Breathe from your diaphragm

• Inhale through your nose

• Exhale through pursed lips

• Deep sense of calm

• Avoid pushing, forcing, or straining

Step 2: Diaphragmatic Breathing

• Sit up straight with back support

• Tactile feedback:

  • Back expands into chair

  • Front expands into crossed arms

• 4.1.8.1 Breathing Pattern:

  • Inhale through the nose

  • Exhale through pursed lips

• Practice for 2 minutes, up to 4 times per day

Step 3: Diffusing Your Attention

• Visualize breathing into your whole body (head, neck, and torso)

• Whole body expanding and releasing with each breath

Step 4: Targeted Resisted Breathing

• 4.1.8.1 count with a fuller inbreath

• Calmly resist the outbreath without pushing or straining

• Just diaphragm and lips working

  • Rest of your body stays out of the way

  • Aligned, released, calm, and still

• Focus on sensations but don’t attach to them

Step 5: Immediate Expert Feedback

• Use a smart device to measure HRV.

• Practice, make small changes, check HRV score

• Internalize feedback and adjust as needed

Step 6: Application

• Can control effort but cannot control score

• Moderate resistance

  • Blowing across a hot drink

• Practice for 2 minutes

  • Establish baseline HRV score.

• Gradually increase resistance by about 5% every few days

• Avoid overtraining

Topping Out

• Blowing as well as you currently can, without stressing or straining

  • Zero strain

• Maintain this level

• Avoid overtraining

General Guidelines

• Up to 4 times daily for 2 minutes each.

• 2-minute morning HRV check.

• 10 minutes total

  ---

  Medical Disclaimer

  Please consult with your licensed health care professional before beginning this or any other breathwork protocol.

  All content and information on this website is for informational and educational purposes only, does not constitute medical advice, and does not establish any kind of patient-client relationship by your choice to use it. Although we strive to provide accurate general information, the information presented here is not a substitute for any kind of professional advice, and you should not rely solely on this information.

Over time this stress becomes toxic and damages your health, which can lead to attention and emotional challenges, diabetes, heart disease, and even dementia.

Targeted Resisted Breathing (TRB) gets you unstuck and restores your natural balance of stress and recovery, so you can function at your highest level.

There are six quick steps to mastering TRB, but the whole thing is pretty simple; you can get good in a week, and the benefits start on the first day. Here we go!

Step 1: Imagine Yourself Optimized

Even though this is brand new, you probably have a good idea of what optimizing yourself will look like. You close your eyes and picture yourself with a long, aligned spine, breathing from your diaphragm, in through your nose, out through your pursed lips, and enjoying a deep sense of calm...

…You feel no need to push, force, or strain. You know that all those things are stressors, they activate a stress response. You don’t want that now. Optimizing yourself is about mastering calm…

If that doesn’t work for you, you can simply take a moment to remember why you are doing this, how you’ re sick of feeling run down and stressed all the time, and how much you want to feel rested and calm.

If your brain prefers details, try rehearsing the steps. Close your eyes and remember the six steps, or maybe just the steps you’ve completed.

That’s it for Step 1!

Call up this visualization when you practice. If you start each session with this visualization, even for 10 seconds, you will progress further and faster.

Once you have your visualization, you're ready for Step 2, Diaphragmatic Breathing. It’s pretty quick.

Step 2: Diaphragmatic Breathing

Keep everything you learned in Step 1.

   -Visualize yourself optimized

Your diaphragm is a sheet of muscle that sits horizontally under your lungs, at the base of your ribs. As your diaphragm pulls down, it makes space, and your lungs fill up with air, which makes your ribs expand in all directions. It’s this feeling of your ribs expanding that lets you know that you’re breathing diaphragmatically.

This is the way your body wants to breathe, so mastering diaphragmatic breathing is about getting out of your body's way, so it can breathe the way it wants to.

You sit up straight in a chair with back support, but don’t lean back. Instead, let your back lightly touch the chair, When you breathe correctly, the middle of your back should expand into the chair, tilting you slightly forward. This will give you a tactile reinforcement from the back whenever you breathe correctly.

Cross your arms loosely over the front of your ribs. One forearm should be touching the space between your ribs, just below your breastbone. Your diaphragm is right behind this spot. When you breathe correctly, your ribs should expand into your crossed arms, pushing them slightly forward. This gives you a tactile reinforcement from the front whenever you breathe correctly. The expansions from the front and back happen at the same time. It's all one thing.

It's important to note that you don’t expand your back and front, the breath does. Your job is to breathe and then stay out of your body's way.

4.1.8.1 Breathing

For this example, start with a 4.1.8.1. Breathing Pattern, where the outbreath is twice as long as the in.

In through your nose for 4.

Pause for 1.

Gently out through pursed lips for 8.

Pause for 1.

And repeat.

Breathe with your diaphragm, but don’t force a big breath, in or out.

Count silently, in your head. Focus on the counting, but don’t think about it too much, or worry about being exact. Trust your body – it knows what it’s doing.

That’s it! Practice this for 2 minutes.

Make sure that you don’t have to strain to complete an extended breath. Forcing or straining activates a stress response, fight or flight. TRB is all about recovery, so we don’t need that now.

If an 8 second out-breath seems too long for you to sustain, then you can let your breath taper off after 4 seconds, but still take the full 8 seconds before you pause and breath in. Over time, as you get better, and your breathing muscles gets stronger, you can try tapering after 5 seconds, then 6, and maybe get up to a full 8 second outbreath, but only go as far as you can without straining.

Practice this for a day or two, 2 minutes at a time, up to 4 times per day. When you get it right about 80% of the time, you’re ready for Step 2, Diffusing Your Attention. It’s very quick.

Step 2: Diffusing your Attention

Keep everything you learned through Step 1:

-Visualize yourself optimized.

-Breathe from the diaphragm:

   -In through the nose for 4;

   -Out through pursed lips for 8;

If I asked you to visualize where in your body you're breathing in, you might picture your nose.

Instead, I want you to expand this image, to include your nose, entire head, neck, and torso.

As you breathe in, visualize breathing into your whole body, from the top of your head through the base of your torso.

As you breathe out, visualize breathing out with your whole body, from the base of your torso through the top of your head, the reverse of your inbreath.

When you breathe in, visualize your whole body gently expanding to make space for the air, which just happens to come in through your nose.

When you breathe out, visualize your expanded body gently releasing as the air flows out through your pursed lips.

Your nose is a point. A point is a stress.

Your whole body is a space. A space calms. By diffusing your attention, and visualizing a space, you activate a state of calm.

Practice this for a day or two, for 2 minutes at a time. When you get it right 80% of the time, You’re ready for Step 3, Targeted Resisted Breathing. It’s a big one, with Mindfulness!

Step 3: Targeted Resisted Breathing

Keep everything you learned through Step 2.

-Visualize yourself optimized.

-Breathe from the diaphragm:

   -In through your nose for 4;

  -Out through pursed lips for 8;

-Diffuse your attention;

   -Breathing in and out with your whole body.

The key to Targeted Resisted Breathing is calmly resisting your outbreath, without pushing, forcing, or straining.

You do this by pursing your lips and making a very small hole. Your diaphragm pushes the air out through this small hole, which creates some resistance, while the rest of your body stays out of the way, aligned, released, calm, and still, with no strain or stress.

Technically, because your lips are resisting the outbreath, your diaphragm will have to work some to push the air out in 8 seconds.

But even though you feel some effort, you don’t have to attach to that effort. You can simply notice that your body is working a bit harder, feel the sensations inside you. If you don’t attach to the effort, don’t have an emotional reaction to it, then your nervous system won’t experience it as a stress.

It’s the mastery of this juxtaposition, your nervous system responding calmly as your diaphragm pushes air out with increased volume and power, that produces elevated HRV scores, essentially as high as you want. You can then target and measure your efforts to dial in your effort, and optimize your results, for your unique body, nervous system, and goals.

You’re going to continue with the same 4.1.8.1 count, but with a bigger inbreath, full but not forced. Your intent is a fuller breath, but you trust whatever you get. Forcing the breath to be bigger than it’s ready to be would trigger a stress response. Targeted Resisted Breathing is all about calm.

You may feel a stretch as your ribs expand in all directions, like a balloon inflating. The pause is the same as in previous Steps. Your shoulders and neck have no role in breathing, so if you feel them rising or tightening on the in-breath, then you’re probably holding onto them, so let your shoulders and neck go.

On the outbreath, you’re going to resist the air some as your diaphragm pushes it out. You do this by pursing your lips and concentrating the air into a stream. Purse your lips on the out, especially on the sides. It makes a difference.

Also, you don’t need to push all the air out of your lungs.

Your body would experience fully emptying your lungs as a stress. There's a place for that in other techniques, but you don’t want that now.

That’s it.

Practice Targeted Resisted Breathing until you have all the elements down. When it’s working for you 80% of the time, You’re ready for Step 4, Immediate Expert Feedback. It’s also a big one.

Step 4: Immediate Expert Feedback

It’s said that mastering meditation takes about 27,000 hours,1 while mastering the violin takes closer to 10,000 hours;2 so learning the violin goes almost three times faster, even though it’s about 100 times more challenging to learn. Hmmm.

Why does meditation take so long? Because meditation mostly uses a method called trial and error, one of the least efficient learning modalities there is. You get a small amount of instruction at the beginning, some conceptual support as your get more advanced, and otherwise you’re mostly stumbling through on your own, not really sure if the adjustments you’re making are helping or not. No feedback. That’s a big part of why it takes 27,000 hours.

The violin uses a method called Deliberate Practice. You start with the most basic step, holding the violin, then progress to the next most basic only when you have mastered the previous one, then the next, and the next, all the way through to playing Paganini’s Caprice Number 24, and you get Immediate Expert Feedback at every step of the way.

The expert violin teacher watches and listens to you perform the movement, sees and hears your mistakes, and offers immediate feedback, correction when you’re off, confirmation when you’re on, and keeps reinforcing the practice until that correct way is in your body, internalized in your nervous system and muscle memory.

Now the meditation teachers were not being lazy or stupid, they just had no way to look inside your body, at your brain and nervous system, to see if you were activating the right parts in the right way, if what you were doing was working and if you were ready for the next step, so their guidance tends to be more general and conceptual. Sadly, instead of filling this void with neuroscience-based strategies, modern meditation teachers tend to look to the past. TRB chooses to look forward, and fills the void with Deliberate Practice and Immediate Expert Feedback.

In TRB, we need to know when your Vagus Nerve is fully activated, rest, recovery, and calm, but not over-activated; that’s a stress. We do this by measuring your HRV while you practice.

A Smart Device, whether watch, ring, or band, can be a fantastic tool for measuring HRV. It’s an expert at measuring this one thing, and after you finish a session, its app can tell you what your HRV was, immediately.

It can tell you if the adjustments you made to your practice increased or decreased your HRV score. The app is the expert at HRV, so for this one thing, it can play the role of your master teacher, giving you Immediate Expert Feedback.

You practice, make small changes, and the app tells you if the changes worked, if they raised your HRV score, but not too much. You finish a session, have a sense of how it went, how you feel, then check your HRV. If the changes you made felt right, and if your HRV score went up, it confirms that the changes worked. The app looked inside your body, at the activation of your Vagus nerve, saw improvement, and immediately told you about it. You then internalize that feedback: “That's it. That's how I do it." It’s a simple thing, but Immediate Expert Feedback transforms your practice.

Unfortunately, not everyone can afford a smart device, and not all devices can track TRB, yet. If you don’t have a device, you can still master TRB. Most of it will be the same. The big difference is you won’t get your HRV score after your session, so you’ll have to be super deliberate about increasing your effort gradually and pulling back if you experience any symptoms of overtraining.

Okay, that was a lot. Your head may be spinning.

Review to this Step as many times as you need. When you feel like you get it, enough to start practicing with an app, move on to Step 5, Application. I will take you through it.

Step 5: Application

In any scientific procedure, we have an independent variable, and a dependent variable. We change our action, the independent, which changes the outcome, the dependent.

In TRB, how strong and well you blow is the independent variable. You change it. Your HRV score is the dependent variable, it changes, based on your effort and progress, plus elements outside of your control, like how well you slept or stressors at work.

So even though you want a higher HRV score, the dependent, you can't just raise it, you can only change how strong and well you blow, the independent, which will tend to raise your HRV, over time.

I say this because, if you're anything like me, you're going to want to chase higher HRV scores, but mastery doesn't work that way. Chasing results ultimately brings stagnation and frustration.

Your HRV score is something you notice. It's not something you chase.

You Breathe well, get your HRV score, make adjustments, and Breathe again with even more correct form. You then check the app, and with insights from your score, you learn to TRB harder and better, without forcing it, which will make your HRV go up, over time. Even if you're casual about the whole mastery thing, you'll still get more out of TRB if you don't chase HRV scores.

Before we start, I want to tell you that, as of July 2024, this is a very new idea, so your device won’t have a TRB app, yet. You'll be using the breathwork/meditation app it already has, so you may have to turn off some of its sounds and haptics to do TRB. This is very easy to do. I use the Apple Watch this way and it works perfectly. The other high-end devices should work, they have all the necessary tech, but I haven't yet confirmed that. [I will explain this better in a follow-up post]

The tech is changing fast, and if your device can't do TRB yet, it will be able to soon, because it won't want to be left behind.

For this example, you’l use 4181 breathing for 2 minutes, with a moderately resisted out-breath, but this time, you’re going to use an app.

Here's how hard you blow:

Imagine you’re drinking your morning beverage. It's delicious, and you don't want to spill a drop, but it's too hot, and very full, so carefully, deliberately, you purse your lips and blow across the top of your cup, enough to make ripples in the liquid and swirl the steam off, but not enough to spill anything. That's how hard you blow, to start.

You take a few seconds to call up your visualization, then you begin:

In through the nose for 4, pause for 1, out through your pursed lips for 8, pause for 1…

…you repeat this for 2 minutes… and the app gives you an HRV score, maybe 60 milliseconds. Again, results will vary.

The app is telling you that, during this session, there were about 60 milliseconds of variability between heartbeats, using a standard measure. This is your baseline, your starting point. You notice the score, but focus more on how strong and well you blew, how it felt.

That’s it.

You stay at this Baseline Level until you feel ready to progress. Generally, it’s a good idea to stay at each new level for a day or two.

Don't worry about matching your HRV score. HRV varies throughout the day. This is normal. Remember what I said about more variation is better? This is part of that. If you practice, your HRV will tend to go up over time.

As you practice, tune into your Breathing. Are you breathing from your diaphragm? Are you Diffusing Your Attention? When you breath out, are you consistently pursing your lips? Is the rest of your body aligned, released, and out of the way? Is there any strain, especially towards the end of the outbreath? Does it feel like you’re going a bit too hard? Or not quite hard enough? Do you feel tension in your head? Your neck? Your shoulders? If so, just let it go. And when it comes back, notice, and let it go again. and when you feel frustration, notice, and let that go, too; It's turtles all the way down.3

You don't have to attach to your struggles. And when you attach even though you know better, notice that too, and remind yourself that you're human, and that change is hard, so why not be kind to yourself?

These are the adjustments you make to improve your mastery of TRB, with the biggest adjustment being your relationship with your struggles, and you confirm that the adjustments worked with Feedback from the App.

In a couple of days, if it feels right, blow about 5% harder. Just change this one thing; everything else stays the same, and see what you get for a score.

When you make it harder, there’s a period of adjustment. It may feel a bit unsettled at first, and your scores may decrease some, but as long as there isn’t a big drop, and you don’t feel any strain or symptoms such as lightheadedness, you can stick with it. Moderate discomfort, full but not forced, is the path to raising your HRV.

Now I appreciate that you can’t measure a 5% increase in your out-breath, at least with the current technology. What you’re doing is increasing the outbreath by a little bit, enough to feel the difference, but no more, and the app will tell you if you went too far.

This may seem overly deliberate, but the science shows that, when learning a new skill, increasing by a moderate amount, enough to notice some effort and discomfort, but not enough to induce strain, is the best way to make long term growth.

Topping Out

As you follow this gradual progression, blowing 5% harder with good form, every couple of days, in a few weeks you’ll Top Out. This is a good thing.

You Top Out when you're blowing as strong as you currently can, at your age and fitness level, with good form, without stressing or straining. Zero strain. That's all it is.

You’ll activate your vagus nerve, as much as you can, with your current breathwork skill and cardiovascular fitness levels, which activates your body’s rest and recovery mode, as much as you currently can. This shouldn’t feel like exertion. You produce a fluid, focused stream of air. Only your diaphragm and lips are working. Everything else is aligned, released, and out of the way, especially your worrying about getting it right.

This makes your Parasympathetic Nervous System grow stronger, with better Vagal Tone, without overdoing it. This is a very good thing for your health and well being.

If you push past this point, before you’re ready, you may overtrain your vagus nerve. Overtraining is bad. When you overtrain, you may experience a short term gain, but your body can’t fully recover from the stress, and if you keep pushing, you can get overtraining symptoms, such as brain fog, jittery nerves, anxiety, and sleep struggles. You don’t want this. That’s why you target your efforts, to produce enough stress to induce growth, but not so much that you induce symptoms.

I should also say that going a bit over is probably not a big deal. Going a bit over and feeling energized, a bit up, is not really overtraining, which happens when you go over and keep going over. I just want to make clear that staying at or just below your Top is not just safer, it’s also where you make the best long-term gains.

So when you Top Out, and experience the feeling of calm and serenity, level off your efforts, and stay at this calm-inducing place for a while. Put your ambition aside and remember that this feeling is why you do TRB.

When you finish a session, tune into your body. Do you feel peaceful and calm, or a bit jittery and distracted? Tuning in may sound a bit groovy, but even if you’re here for purely health optimization reasons, learning to tune into what’s going on inside your body will greatly increase your progress over the long term, and deliver synergies beyond mastering TRB.

Topping Out is the end of the beginning of TRB. Congratulations;  you're now a TRB practitioner, building an exceptional breathwork practice, raising your HRV, optimizing your vagal tone, and helping yourself to live a longer, healthier life.

If you don’t yet have questions, you probably will soon. For now, you have everything you need to get started. I can answer your questions in follow-up posts.

Bernadette Charland, Consulting Editor

Extended by perplexity.ai

Our next post will be a Cheat Sheet, a quick reference as you’re working through the Steps.

Medical Disclaimer

Please consult with your licensed health care professional before beginning this or any other breathwork protocol.

All content and information on this website is for informational and educational purposes only, does not constitute medical advice, and does not establish any kind of patient-client relationship by your choice to use it. Although we strive to provide accurate general information, the information presented here is not a substitute for any kind of professional advice, and you should not rely solely on this information.

It’s said that resistance training is a wonder drug for health and longevity.1

Resistance training, lifting heavy weights for a measured number of sets and reps, makes you leaner and stronger, which makes your body healthier and more vital. Resistance training does wonderful things for your muscles and bones, so what if there’s a way to apply resistance training to your nervous system?

Homeostasis

Your Autonomic Nervous System’s (ANS) primary job is to maintain homeostasis in your body.2 Homeostasis is your body regulating all the systems that keep you alive, stable, and functioning, as you move through the world and encounter opportunities and challenges.3 A decline in your ANS affects your body’s ability to regulate cardiovascular, respiratory, digestive, immune, and metabolic functions, and recover from the stressors they face. This decline is at the root of all the major diseases correlated with aging.4

We know that techniques like meditation and deep breathing can reduce your stress and help you relax, which helps your ANS, but beyond that: What if we could directly exercise your ANS to make it stronger?

What if we could strengthen your ANS’s capacity to maintain homeostasis, and recover to above your 95th percentile?

What if making your nervous system that strong caused it to produce and modulate vital neurotransmitters like acetylcholine, norepinephrine, and brain derived neurotrophic factor (BDNF)5 – all of which decline with aging6 – potentially at levels closer to your 24 year old self?

What if reversing this gradual decline in your nervous system’s ability to produce and modulate these vagus-mediated neuromodulators7 correlated with reducing your risk for dementia, heart disease, and metabolic disorder?89

What if increasing the production of these neuromodulators could potentially play a significant role in delaying the progress of most every medical condition of aging, including cancer?101112

The Role of the Autonomic Nervous System

Your ANS has two branches, the sympathetic branch and the parasympathetic branch. The sympathetic branch is responsible for pursuing your passions, positive stress, and keeping you going when life gets tough, chronic stress.13 Your parasympathetic branch is responsible for rest, healing, digestion, reflection, and sex, recovery.14 When stimulated, your ANS releases acetylcholine and norepinephrine, and modulates brain-derived neurotrophic factor, contributing to the maintenance of homeostasis and fostering recovery.15 Ideally, your ANS moves fluidly between its two branches, as opportunities present, having full recoveries before facing new stresses.16 Think dogs: When something interesting is going on, they are all in, but once it’s over, they tend to lie down and snooze.

In our evolutionary past, humans could be more like dogs, acute stressors with complete recoveries, but in the modern age, our challenges are chronic; they never really let up, and many of us are stuck in a sympathetic state.17 We’ve overtaxed our ability to move between stress and recovery. We get worn down, stressed out, and everything we care about suffers. Life becomes all fight or flight, with no rest and recover.18

Over time this stress becomes toxic, damages your health, and limits your body’s ability to maintain homeostasis and to recover, which can lead to heart disease, dementia, metabolic disorder, and attention and emotional challenges.19 Add to this the fact that we live much longer than our ancestors, which means more gradual decline, stoked by this toxic stress.20

Heart Rate Variability (HRV) and Vagal Tone

The ability to move fluidly between stress and recovery is called heart rate variability, or HRV.21 As your heart beats, it responds to stressors in your environment by speeding up or slowing down: variability. When you have more variability, you’re better able to respond to challenges, and then recover, making you more healthy, resilient, and calm.22 Variability turns challenges into opportunities.

Between the ages of 24 and 64, a typical person’s HRV declines by about 50%.23 This means that their ability to pursue opportunities, respond to challenges, and recover from the stresses of life also declines by about 50%. But this decline can be slowed and potentially even reversed – I’ve raised my HRV to above my 95th percentile.24

You raise your HRV by strengthening your parasympathetic branch, which makes your body better at maintaining homeostasis and responding to challenges. We call this vagal tone. Higher HRV is a measure of stronger, healthier vagal tone.2526

Techniques like meditation and deep breathing can lower your stress level, which incrementally improves your vagal tone, but they only go so far. What we want is a kind of resistance training for your parasympathetic branch. We want to make it as strong as it can be, for your age and fitness level. But it’s not just tone, we want to build your parasympathetic branch’s capacity to produce high frequency vagal power, the most direct measure of your vagal activation.27 We achieve this through Targeted Resisted Breathing.

Targeted Resisted Breathing

Targeted Resisted Breathing (TRB) applies a measured dose of resistance training to your parasympathetic branch, to increase your vagal tone.28 TRB does this by extending and resisting your outbreath a measured, targeted amount which induces a significant stimulation to your vagus nerve. This produces a surge in a metric called high frequency power, which significantly raises your HRV. We are applying a measured stimulus to the nerve most responsible for your body’s ability to recover, to increase your ANS’s capacity to recover. While the mechanisms are completely different, the systemic effect of TRB on your parasympathetic branch is analogous to that of weight resistance on your muscles; by progressively increasing the stimulation to the system, it will get progressively stronger.

While we can confirm TRB’s effectiveness with two minutes of practice, research on the mechanisms which underlie this phenomenon is slim. But given what we do know about respiratory physiology, we can speculate the following:

Increased Vagal Stimulation

It’s likely that resisting the outbreath increases pressure in the chest cavity. Increasing intra-thoracic pressure may stimulate baroreceptors and stretch receptors in the lungs and blood vessels, which might cause some of the increased vagal nerve activation.29

Respiratory Sinus Arrhythmia Enhancement

By extending and resisting the exhalation phase, we may be amplifying your body’s natural Respiratory Sinus Arrhythmia (RSA), which is when your heart rate naturally decreases during exhalation. It’s possible that this decrease could play a role in increasing HRV.30

Parasympathetic Activation

The extended resisted outbreath likely increases parasympathetic activation and dominance, which would tend to increase HRV.31

Baroreflex Sensitivity

By resisting the outbreath, we could be improving baroreflex sensitivity, which is a measure of how well your ANS responds to changes in your blood pressure. This could lead to more efficient heart rate modulation, which would produce higher HRV.32

Mechanical Stress on the Vagus Nerve

The physical act of resisting the outbreath could apply mechanical stress to the vagus nerve, making it work harder, which could potentially be stimulating it directly.33

Increased CO2 Levels

Extending and resisting the outbreath might elevate CO2 levels, which might shift autonomic balance towards parasympathetic dominance.34

Greater Mechanical Stimulation

Increasing outbreath resistance might increase the mechanical stimuli on baroreceptors and the vagus nerve.

Increased Parasympathetic Challenge

Increasing outbreath resistance could challenge the parasympathetic nervous system to work harder, which could induce a stronger adaptive response.35

Enhanced Interoceptive Awareness

Increased outbreath resistance might cause you to become more aware of what’s going inside your body, which could have an indirect influence on your ANS.36

It’s likely that some combination of these speculations explains TRB’s effectiveness. Over time, the underlying mechanisms of TRB will need to be thoroughly researched, but in the short term, we know from empirical experience that extending and resisting the outbreath produces a significant increase in high frequency power and HRV.

Mechanisms of TRB

Through TRB, we stimulate your parasympathetic branch to a level just higher37 than your morning resting rate,38 progressive overload, to increase vagal activation,39 but not enough to incur overtraining.40 We push your parasympathetic branch just beyond its current level, into moderate discomfort, which stimulates your body to make the system a bit stronger. This increase in high frequency power increases your vagal tone and your HRV.41 Over the course of months, this process can increase your HRV significantly, potentially above your 95th percentile.

Practical Application of TRB

We measure your body’s production of high frequency power with specific metrics of HRV, ideally your unprocessed RMSSD42 score, but also with the SDNN43 metric. We can do this with many smart devices, including the Apple Watch. Using progressive overload, we briefly raise your high frequency power a targeted amount, as measured by your device, several times per day, and we see how your body responds.44

If the new level goes well, we raise it an increment more, see how you do, and keep repeating this process,45 until your progress levels out, usually within a few weeks. At that point, your vagus nerve is getting activated an optimal amount, for your age and current fitness level, which challenges it enough for growth, but not too much.46 You then note your typical raw RMSSD or SDNN score with this level of effort, as measured by your device. This score becomes your target. You want to go about this hard for at least a few weeks. The score acts as your expert coach, telling you when you are going just hard enough, but not too hard.47 As your HRV improves over time, this score may continue to rise, though at a reduced rate. This is roughly analogous to the fast gains of a beginning weight trainer versus the slower gains of an advanced lifter.

Resisted breathing raises your HRV and more resistance produces higher scores. But as with weight training, too much resistance before your body is ready produces overtraining.48 When you overtrain, your body can’t fully recover from the stimulus, and if you keep pushing, you can get overtraining symptoms, such as brain fog, jittery nerves, anxiety, and sleep struggles. We don’t want this. That’s why we target your efforts, to produce enough stress to induce growth, but not so much that you induce symptoms.

An episode of TRB can stimulate your Vagus quickly – two minutes works well – and because your nervous system tends to recover much faster than your muscles do, we can repeat this stimulus up to four times per day. Add in a two-minute HRV check first thing in the morning to measure your progress over time and your total commitment is 10 minutes per day.

TRB and your ANS

How could two minutes of resistance have so much impact? It goes back to the nature of your nervous system, and how it utilizes these vagus-mediated neuromodulators, that are so crucial to maintaining homeostasis, deep recovery, and healing.

When your Vagus Nerve is stimulated, your ANS releases acetylcholine and norepinephrine, and modulates BDNF.4950 Even though your vagus nerve is very long, it starts at the base of your brain and touches most every organ system in your body. Its delivery is very fast, think milliseconds,51 and your body’s reaction to the neuromodulators is similarly quick.52 Once they bind to the receptors the vagus touches, the job is done.53

The upshot of all this is that not only can you can achieve an optimal stimulation in two minutes,54 you can also stimulate multiple times per day.55 This not only makes your parasympathetic branch much stronger, but also releases an optimized endogenous bolus of vagus-mediated neuromodulators,56 restoring your body’s ability to maintain homeostasis and recover at well-spaced intervals throughout your day.

Potential Benefits of TRB

The diseases correlated with aging – heart disease, dementia, and metabolic disorder – all feature a gradual decline in both your body’s production of vagus-mediated neuromodulators and in the vitality of the receptors they bind to.5758 These neuromodulators are delivered throughout your body by your vagus nerve. Using TRB, we can slow or even reverse this decline, while endogenously dosing your body with an optimized bolus of vagus-mediated neuromodulators, multiple times per day.

While well short of a cure, raising the strength and function of your ANS above your 95th percentile, for your age and fitness level, is not only a powerful preventative for the diseases that correlate with aging, but potentially the most promising adjuvant therapy to any treatment program for these devastating conditions.59 We are strengthening your body’s ability to maintain homeostasis, rebuild, and recover, in conjunction with the treatment protocol administered by your doctors. Whatever regimen your doctor chooses, it will go better if your ability to recover is above your 95th percentile, as opposed to under your 5th, for your age and fitness level.60

Imagine a 68 year old woman with stage 2 cancer, facing surgery, chemotherapy, and radiation. Imagine the potential difference in her outcome if, as she began her treatment, her HRV was above the 95th percentile for 68 year old Stage 2 cancer patients. After the surgery, her HRV would be down significantly, but what if she could maintain the 95th percentile for post-surgical patients? Then for patients undergoing chemotherapy and radiation? Then for patients two weeks, two months, and two years out? What would be the difference in the survival rate for this woman? And for all 95th percentile patients?61

This is what TRB is about. We get your vagal tone above your 95th percentile, now, when you are well, and we keep it there as you age, and face the diseases of aging. Combine TRB with moderate resistance and cardiovascular training, a healthy diet, quality sleep, engaging work, and a community of family and friends, and you have maximized your chances for a long, healthy life.

Conclusion

TRB uses progressive overload and deliberate practice to actively strengthen your body’s ability to recover from chronic stress and maintain homeostasis. By applying a targeted dose of resistance to your outbreath, TRB increases vagal tone, improves HRV, and restores your body’s production of vagus-mediated neuromodulators, all potentially to your body’s 95th percentile, which may significantly delay your progression towards the major diseases of aging.

Beyond personal wellness, TRB could serve as a near-universal adjuvant medical therapy. By significantly increasing a patient’s HRV, TRB could greatly improve the patient’s capacity to recover. This would happen in conjunction with whatever treatment protocol their doctor implemented, without interfering in any way.

While TRB’s benefit is easily producible, and the mechanisms that underlie its effectiveness are well established in respiratory physiology, the specific mechanism is not yet well understood. But given TRB’s potential to improve health outcomes, along with its non-invasive nature, TRB presents a very promising opportunity for both application and further study.

As we face the challenges of an aging population and the increasing prevalence of chronic diseases, we will need to move toward a more patient-centered approach, where you take a more active role in maintaining your health. There is no more universal benefit that you can cultivate than to optimize your body’s ability to recover from chronic stress, maintain homeostasis, and delay your progression towards the diseases correlated with aging. TRB empowers you to take charge of your health, to strengthen your ANS and get your vagal tone above your 95th percentile, now, when you are well, and keep it there as you age.

Targeted Resisted Breathing, resistance training for your nervous system, can heal your chronic stress, reverse the gradual decline in the strength of your nervous system, delay your progression towards the diseases correlated with aging, and optimize your body’s ability to recover when they finally arrive.

Bernadette Charland, Consulting Editor

Extended by perplexity.ai

Medical Disclaimer

Please consult with your licensed health care professional before beginning this or any other breathwork protocol.

All content and information on this website is for informational and educational purposes only, does not constitute medical advice, and does not establish any kind of patient-client relationship by your choice to use it. Although we strive to provide accurate general information, the information presented here is not a substitute for any kind of professional advice, and you should not rely solely on this information.

1. Acetylcholine: A neurotransmitter released by the parasympathetic nervous system that plays a role in various bodily functions, including slowing heart rate and promoting relaxation.

2. Autonomic Nervous System (ANS): The part of the nervous system responsible for controlling involuntary bodily functions, such as heart rate, digestion, and breathing.

3. Baroreflex Sensitivity: The ability of the body to respond to changes in blood pressure by adjusting heart rate and blood vessel constriction.

4. Brain-Derived Neurotrophic Factor (BDNF): A protein that supports the survival of existing neurons and encourages the growth and differentiation of new neurons and synapses.

5. Heart Rate Variability (HRV): The variation in time between successive heartbeats, which is an indicator of the body's ability to adapt to stress and environmental changes.

6. High Frequency Power: A measure of parasympathetic nervous system activity, typically assessed through HRV analysis.

7. Homeostasis: The body's ability to maintain a stable internal environment despite changes in external conditions.

8. Interoceptive Awareness: The ability to perceive and understand internal bodily sensations.

9. Neuromodulators: Substances that can alter the way neurons respond to neurotransmitters, influencing various brain functions.

10. Norepinephrine: A neurotransmitter and hormone involved in the body's "fight or flight" response.

11. Parasympathetic Nervous System: The branch of the autonomic nervous system responsible for "rest and digest" functions, promoting relaxation and recovery.

12. Progressive Overload: A training principle where the difficulty or intensity of an exercise is gradually increased over time to continue improving performance.

13. Respiratory Sinus Arrhythmia (RSA): The natural variation in heart rate that occurs during the breathing cycle.

14. RMSSD (Root Mean Square of Successive Differences): A time-domain measure of heart rate variability that reflects parasympathetic nervous system activity.

15. SDNN (Standard Deviation of Normal-to-Normal intervals): Another time-domain measure of heart rate variability that reflects overall autonomic nervous system activity.

16. Sympathetic Nervous System: The branch of the autonomic nervous system responsible for the "fight or flight" response, activating the body for action and stress response.

17. Targeted Resisted Breathing (TRB): A technique that applies a controlled resistance to the outbreath to stimulate the vagus and increase parasympathetic activity, potentially improving overall autonomic nervous system function.

18. Vagal Tone: The activity level of the vagus nerve, which is a key component of the parasympathetic nervous system.

19. Vagus Nerve: The longest cranial nerve, responsible for various parasympathetic functions and playing a crucial role in the body's relaxation response.

20. Vagus-mediated Neuromodulators: Substances released or influenced by vagus nerve stimulation that can affect various bodily functions and potentially impact health and aging processes.

Future Posts

In our next post, I will take you through Targeted Resisted Breathing step by step. I will also include a cheat sheet.

In near-future posts, I will explain the potential role of Targeted Resisted Breathing in the delaying and mitigating the diseases of aging, and explain it’s adjuvant role in fighting specific diseases like Heart Disease, Dementia, Metabolic Disorder, and Cancer.

Medical Disclaimer

Please consult with your licensed health care professional before beginning this or any other breathwork protocol.

All content and information on this website is for informational and educational purposes only, does not constitute medical advice, and does not establish any kind of patient-client relationship by your choice to use it. Although we strive to provide accurate general information, the information presented here is not a substitute for any kind of professional advice, and you should not rely solely on this information.

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