Oxygen Advantage® includes gentle breathing practices and more demanding training. They place different demands on the body, so the exercise needs to suit the person. This guide explains the approach and the precautions to read before joining Breathe Better.
Reviewed: 7 November 2026
What is Oxygen Advantage?
Developed by Patrick McKeown, Oxygen Advantage brings together functional breathing and advanced breath-hold training. Functional breathing focuses on how you breathe in everyday life: through the nose where comfortable, with efficient diaphragm movement and an appropriate breathing volume and rhythm.
Advanced exercises can include breath holds during movement. These deliberately change oxygen and carbon dioxide levels and require a different level of screening and supervision. You do not need to perform them to take part in gentler breathing practice.
The three pillars: Body, Mind and Sport
Body: everyday breathing
This pillar focuses on breathing patterns and mechanics. Practice may involve quieter nasal breathing, comfortable lower-rib movement and a less hurried rhythm. The emphasis is on breathing efficiently, rather than repeatedly taking large breaths.
Mind: attention and awareness
This pillar uses awareness of breathing as an attention practice. You notice the breath and return to it when your attention wanders. The intention is to support concentration and a calmer experience of practice, without forcing a particular feeling or breathing pattern.
Sport: more demanding training
The Sport pillar includes advanced methods used in exercise and performance training, including breath holds during movement. These are not a starting point for everyone. Their greater physiological demands make individual screening, appropriate progression and qualified supervision particularly important.
Three dimensions of functional breathing
The pillars describe areas of practice. The three dimensions describe different aspects of the breathing process:
Biochemical: breathing volume and the balance between ventilation, carbon dioxide and oxygen. “Light” breathing does not mean straining or depriving yourself of air.
Biomechanical: how the diaphragm, ribs and other breathing muscles move. “Deep” refers to the location and quality of movement, not necessarily a bigger volume of air.
Psychophysiological: the relationship between breathing, attention and physiological arousal. Rhythm should remain comfortable rather than become another target to push through.
Before you practise
Read the precautions for the specific exercise you intend to use. A gentle awareness exercise and an extended breath hold are not interchangeable. If you have a health condition, are pregnant, are recovering from illness or surgery, or are unsure about suitability, speak with your treating healthcare professional and your instructor first.
Practise breath holds, reduced breathing and deliberate overbreathing on dry land only, never in or under water. Do not practise breath holds while driving. Loss of consciousness can occur without enough warning to protect yourself.
“Air hunger” means the urge to breathe. Stronger air hunger is not a sign that an exercise is better for you. Stop if practice causes distress, severe discomfort or worsening symptoms, and return to comfortable, unforced breathing.
Pregnancy
Avoid breath holds and deliberate overbreathing throughout pregnancy. During the first trimester, also avoid reduced-breathing exercises that produce any air hunger. In the second and third trimesters, avoid moderate or strong air hunger. Keep any suitable practice gentle, such as comfortable nasal breathing and relaxation, with guidance appropriate to your pregnancy.
Health conditions and stronger exercises
Oxygen Advantage advises avoiding breath holds beyond mild air hunger and deliberate overbreathing with the following:
Serious illness; heart disease, arrhythmias or high or low blood pressure; obstructive sleep apnoea.
Anxiety or panic disorders; chronic fatigue syndrome, Long COVID or autonomic dysfunction.
Cancer or cancer treatment; diabetes; pulmonary hypertension; recent surgery or medical instability; severe migraines or vestibular disorders.
The same restrictions apply with a BOLT score below 12 seconds, and for people over 60 without clearance and supervision.
Additional restrictions on extended holds
Avoid extended holds and strong air hunger with a history of fainting, concussion or brain injury, stroke or cerebrovascular disease, severe POTS, uncontrolled asthma, severe COPD or unstable respiratory disease, active respiratory infections, eating disorders or sickle cell disease.
Oxygen Advantage’s app guidance also identifies epilepsy, schizophrenia, uncontrolled hyperthyroidism, chest pain, arterial aneurysm and kidney disease among contraindications for moderate or strong breath-hold exercises. Its workshop guidance includes depression among conditions requiring avoidance of long breath holds. Tell your instructor about relevant diagnoses and symptoms rather than assuming a condition is suitable because it is absent from one list.
Children and adolescents
Breath holds are unsuitable for children with epilepsy, diabetes, pulmonary hypertension, severe asthma, or serious or unstable illness. For other children, any breath-hold practice should be light and comfortable, with good breathing control and supervision from a qualified instructor. Adult challenges and targets should not be treated as instructions for children.
Understanding the BOLT score
The Body Oxygen Level Test, or BOLT, is used within Oxygen Advantage to help inform practice choices. It is not a competition, a diagnosis or medical clearance. A higher number does not override a contraindication. Do not attempt to improve a score by pushing through discomfort or extending a hold beyond the test’s intended comfortable endpoint.
Taking part in Breathe Better
Contact me before booking if you are pregnant, have a health condition or are unsure about participation. We can discuss the workshop format and whether advice from your treating healthcare professional is needed before you take part.
After booking, complete the private Oxygen Advantage intake form promptly. I will review your responses and discuss any adjustments. Please use that private process for detailed health information.
Breath holds are optional. You may be able to observe or listen while skipping exercises that are not appropriate for you. If I find the workshop is unsuitable, your workshop payment will be refunded in full.
This workshop provides education and coaching and does not replace clinical care. For people living with narcolepsy, breathing practice is not a treatment for the underlying condition and should not replace prescribed care.
Contact Paul about taking part
Sources and further reading
This guide draws on Oxygen Advantage’s safety guidelines, overview of the method, app precautions and client workshop manual. Exercise-specific restrictions still apply. Check the current guidance when choosing a practice.
Watch: an introduction to Oxygen Advantage
Patrick McKeown explains the method and who it is intended for in the video below.