Stress, Anxiety, CO2 Tolerance and Teens.


Current data shows that 1 in 3 American adolescents meet the criteria for anxiety, and suicide is the second leading cause of death globally among 15-29-year-olds. There is no better time than present history to learn how to better deal with stress and anxiety.  

Why not learn these skills early? What better or more appropriate place for students to learn than in your classroom? And what more readily available tool do we have to manage stress than our own Breath!


The Backstory

Over the past 5 years or so, I have been teaching my students as well as integrating in my personal life, different breath practices.  I have exposed kids to techniques like 4-7-8 Breathing and the Wim Hof Method. In the Fall of 2019, I took the online version of the Art of Breath Course (taught by Brian MacKenzie and Rob Wilson, via PowerSpeedEndurance).  I highly recommend this course!  After learning more- how the breath is so connected to our physical performance and mental wellbeing, I knew that I wanted to push this information and practices out to my students in a more consistent manner.

I reached out through email to PowerSpeedEndurance and explained that I was a Health and Physical Educator and wanted to use information learned from the AOB course with my students. I inquired as to whether or not they were doing any research dealing with breath work- as I would have students each semester who could possibly contribute to their data. I was soon connected to Rob Wilson and Dr. Tanya Bentley on a conference call.  Rob is co-founder of the Art of Breath course and Director of Operations for PowerSpeedEndurance. Tanya is co-founder and CEO of the Health and Human Performance Foundation (HHPF) based in Los Angeles, CA. During our meeting, I told them a little about myself and how I implement breath work with my students. I found out about the HHP Foundation and the fantastic research they are not only advocating but implementing to help optimize human potential as it relates to performance and stress-related conditions.

A couple of months went by and after checking in to see how my implementation of breath practice was going, Dr. Bentley emailed me with a protocol for a breath program designed for my high school students. I quickly put together a plan and started implementing the program with my students the following week.  

The Program

We began the 6-week program with a Trait Anxiety scale; 20 questions to score students’ “overall” Anxiety, as a baseline. Phrases such as “I feel secure,” or “I have disturbing thoughts” were self-rated. Over the next 6 weeks, the students in grades 10-12 participated in a breathing practice 3 times per week. During each 5-minute slow-breath session, students performed 12 cycles of slow-breathing, comprising a 5 second inhale, a 5-second breath hold, a 10 second exhale, and a 5-second breath hold-all breaths through the nose.

One day per week (usually mid-week) students performed two CO2 Tolerance (CO2T) Tests. (Take your own CO2T test here!). One test was done before the breath session and one followed.  CO2T tests are used to measure how one can tolerate the buildup of CO2 in the blood and also correlates directly to how well we handle stress.  Additionally, during the mid-week session, a “state” anxiety scale which measures “at-the-moment” stress was implemented and tracked.  Phrases like “I am worried,” or “I am calm” were scored on a scale of 1-4 and tracked. This was done twice during the mid-week session; once before the slow-breath session and once after the breath session.  Finally, at the end of the 6-week program, a second Trait Anxiety Scale was given to students.


The results of the program proved to be very encouraging!  You can read the abstract in its entirety here, but a few key findings are below.


  • Trait (overall anxiety): after 6 weeks, trait anxiety scores were significantly improved among all students. In other words, they felt better about themselves overall. 

  • State (at-the-moment stress): State anxiety improved immediately following the breathing exercises in most weeks. Students overall felt more calm, relaxed, and stress-free after the breath session.

  • CO2T: during the 6 weeks, CO2T scores improved.  Plainly, after 6 weeks, students were able to better manage the build-up of CO2 in their blood, thus having a more favorable stress-response. 

Findings from this program were presented virtually (due to the Covid-19 pandemic), at the 2020 International Congress on Integrative Medicine and Health and will be published in the June issue of the Journal of Alternative and Complementary Medicine. You can view the presented Poster here

Not only was this breath program relevant to students, but it was also very easy for me to implement and was quite feasible.  The 5-minute slow-breath session can readily be done as part of a cool down at the end of a class or you can use it as an introduction to the day’s activities. Brain breaks, student de-escalation, and improving performance are other promising uses.

My perspective today in teaching is such: gone are the days of sport-skills only based PE (I still use sports sparingly, and always with an emphasis on fitness). I strongly focus on skills that anyone and everyone can use for the rest of their life.  My classes target these Living Well components which include Stress-management through Breath Work, Mindfulness and Gratitude; Lifetime Cardio Activities; Resistance Training; Mobility, and the Outdoors. Health topics such as Nutrition and Sleep are addressed throughout my classes.  

Helping students achieve wellness takes a multi-faceted approach. Breath Work in this instance proves to be a valuable asset to any HPE program and to the well-being of you and your students’ mental and physical health. It’s one more “tool” for students to add to their wellness tool belt and also a practice that educators can use to combat the epidemic of stress-related conditions.

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