Do Breathe Right nasal strips offer real performance benefits – or are they just a psychological prop? These sticking-plaster look-alikes were originally developed to help people with health problems like obstructive sleep apnea or excessive snoring, but have now found their way into sports bags. When placed over the bridge of the nose, the strip works by holding open the nostrils, so reducing resistance to nasal airflow and increasing nasal-route breathing. Because of its effects on nasal airway resistance, the device has gained a great deal of support among sportsmen and women and is now an extremely popular non-pharmacological ergogenic aid to exercise performance in a wide variety of sporting events. High-profile athletes are often seen wearing nasal strips during televised events: many athletes at the recent Commonwealth Games and European Championships, could clearly be seen sporting that little pink strip. What is it about the nasal strip that leads so many performers to believe that it will in some way enhance their performance? Having used nasal strips during competition myself, and experienced at first-hand how well they improve your ability to breathe through the nose, it is easy to understand how so many athletes buy into the idea that they can also boost performance. But are they fooling themselves? When you strip away all the hype, do nasal strips offer any real physiological benefits to the athlete?

To help us answer these questions, let’s take a look at respiratory physiology and how it impacts on performance, then at what some of the independent research trials have to say about nasal strips. The manufacturers of Breathe Right strips, CNS Inc, claim that the reduced airflow resistance associated with their use has beneficial effects on some of the physiological variables relating to exercise performance. To support these claims, extracts from research articles are listed on the Breathe Right website, along with many endorsements from élite athletes. The proposed benefits include decreased rate of perceived exertion (RPE), lowered heart rate, reduced ventilation, increased VO2max and improved exercise performance. Some of these claims appear credible, as you would instinctively assume that improving airflow and oxygen supply to the lungs would increase the amount of oxygen available for absorption into the blood and transport to the working muscles. However, on closer examination it is easy to shed doubt on these claims. Despite the manufacturers’ claims, there is little evidence in support of nasal strips from research published in peer-reviewed journals, although it has to be said that research in this area is not extensive.

Oxygen, not volume, is the key

Key to the claims made on behalf of nasal strips is the role nasal breathing plays in exercise. In fact, science tells us that in normal healthy individuals the respiratory system is not a limiting factor in maximum oxygen uptake (VO2max), one of the major determinants of exercise performance. In simple terms, it is the concentration of oxygen in the air we breathe, not the volume of air inhaled, that determines the amount of oxygen absorbed by the blood. Other factors that are more likely to influence VO2max are cardiac output, a function of heart rate and stroke volume, and the ability of the tissues to extract oxygen from the blood. Neither of these processes are affected by the volume of air inhaled.

Part of the work of the muscles involved in respiration is in overcoming the resistance to airflow in air passages: an increase in airway resistance would lead to an increase in the demand for oxygen and energy by the respiratory muscles. Nasal breathing alone results in increased airway resistance, although during exercise this resistance is reduced due to actions of the sympathetic nervous system. In any case airway resistance due to nasal breathing would not generally impact on exercise performance, as most people switch from nasal only to oro-nasal breathing as exercise intensity and the demand for oxygen increases. Independent trials into the proposed benefits of nasal strips seem to be limited. Luckily there are some which try to address the key questions about this device and its role in boosting exercise performance. In one study involving 16 college-age male athletes, various forms of data relating to oxygen consumption – including VO2max, peak VO2 and onset of anaerobic threshold – were collected and recorded during exercise with and without nasal strips. After careful analysis, the researchers concluded that nasal strips led to no improvements in any of the variables tested and so offered no benefits for performance.

There is a point during exercise when most people switch from nasal breathing to breathing through their mouths – sometimes referred to as the ‘switching point’. This change occurs as the athlete moves from low intensity exercise to higher-intensity efforts. It is possible that a delay in the switching point might offer some benefits to an athlete and one study has attempted to investigate this in relation to nasal strips. Researchers in this study found that nasal strips did indeed delay the switch between nasal and oral breathing, but it was not clear what, if any, benefits this offered to performance. So what is the final verdict on nasal strips? While there is no evidence that they offer any physiological benefits to athletes, the fact of allowing them to breathe more easily might offer a psychological edge during competition, especially for those with some kind of respiratory problem.

So, in answer to my original question, it is probably these psychological considerations that lead athletes to believe their performance is in some way boosted. And as long as it is legal and harmless, a psychological edge is worth having. In any case, until further research gives us a definite answer about nasal strips, word of mouth recommendation and the endorsement of sporting role models will ensure their increased use in future.

Ian Carlton