The Oxygen Advantage (Patrick McKeown) – Book Summary7 min read

The Oxygen Advantage by Patrick McKeown Book Cover

Three Sentence Summary

The only guide on breathwork you need to improve your overall health as well as your athletic performance. This book provides easy to follow techniques which are backed by scientific studies to improve the quality of your breathing. This can be implemented by a anyone to ensure a better quality of life.

My Top 3 Take Aways

  1. Over breathing and mouth breathing go hand in hand resulting in increased resting heart rates, poorer athletic performance and restricted airways and circulatory systems.
  2. Keep it nasal. Always breath through your nose just like nature intended to encourage airway and circulatory dilation, reduction in moisture loss and restriction in total volume of inhalation.
  3. Assess your BOLT score and utilise lighter nasal breathing breath holding to initiate a better tolerance to higher CO2 and lower O2 levels.

Who Do I Recommend This Book For?

Anyone who is intent on improving their health or athletic performance. All tasks can be scaled to your level so their is no excuse. The science may go over some peoples heads but the proof is in the pudding so by performing these exercises is the only way to know if this approach will work for you. 

Full Summary

You’re breathing wrong. Yes you read that right. How can an action as natural as breathing that is performed automatically by the body be done incorrectly? Well as this book explains its all down to the bad habits of many western cultures and what we’ve been taught about the breath.

The Science

The oxygen advantage is a slightly misleading title as the key player in breathing efficiency is CO2 a.k.a. carbon dioxide. Firstly, we all know that we breath in oxygen and breath out CO2. So far so good. As oxygen passes through our lungs it diffuses through alveoli into the capillaries where it combines with the haemoglobin in our red blood cells (RBCs). Now the RBCs act as transport moving the oxygen to where it is needed. For instance we’re being active and going for a run so our muscles require more oxygen. In order for the O2 to be released from the haemoglobin CO2 is needed. The presence of CO2 results in the disassociation of O2 so it can then be used for respiration to produce energy (ATP). This relationship of disassociation is known as the Bohr effect. Named after its discoverer Christian Bohr the father of renowned physicist Niels Bohr who you may have heard of recently in the Oppenheimer movie. This effect is covered now in GCSE and A-level biology and is the basis of respiration. So how does this effect you? Two words, chronic overbreathing. The majority of people take in more air than they require and so exhale too much as well. With lower levels of CO2, efficient oxygen disassociation cannot be achieved. Over-breathers also have very low tolerance to CO2 which results in a faster urge to breath after exhalation. In simple terms we need to breath less and at lower volumes.

Benefits of Better Quality Breathing

By doing breath work and focussing on how you breath you can retrain your body into breathing correctly. Oxygen is required for everything in your body and making this transfer more efficient can result in great improvements in your health including:

Benefits of Breathwork

  • Cardiovascular health.
  • Aerobic fitness.
  • Sleep quality and recovery.
  • Improvement in focus/less brain fog.
  • Dilate your sinuses, release nasal blockages.
  • Overall happy mood and reduced stress.


Whilst reading this book I had a mini epiphany. When identifying how to be healthier we spend a lot of time focussing on exercises, diet, and hydration but breathing is often forgotten. When the body cannot go longer than 4 minutes without oxygen before permanent brain damage it seemed crazy to me why I hadn’t thought of including breath training before.

The Oxygen Advantage Strategy

The main goal of this breathwork system is to increase your tolerance to CO2 and to reduce the volume and frequency of breathing. There are multiple strategies but first a quick assessment.

BOLT Score

Your tolerance to CO2 and your relative breathing volume can be assessed through the blood oxygen level test (BOLT). Its a simple breath holding test that can be performed anywhere and gives you a metric to improve upon. The higher the score the better with it representing your ability to tolerate high levels of CO2 and low levels of O2 which directly effects your fitness levels. A score of 20secs is a good initial target with 40secs+ being the end goal for athletes. This test should be performed in the morning after waking and with a stopwatch for the most accurate results.

Blood Oxygen Level Test (BOLT)

    • Perform a small breath in via the nose then equally lightly exhale (via the nose).
    • Pinch your nose after the exhale and time your breath.
    • Time until your first desire to breath occurs. This is not a maximum breath hold but the time it takes your body to react to the lack of air.
    • Release your nose and resume nasal breathing. This should be calm if not you have likely held your breath for too long.
Improving Your Bolt Score
Nasal Breathing & Reducing Carbon Dioxide Losses

As discussed prior CO2 is vital for oxygen disassociation therefore reducing these losses is vital. Primarily this revolves around inhaling and exhaling through your nose 24/7. Simple right? As it turns out the many people are mouth breathers especially during exercise, I myself included. By breathing through the nose it restricts the volume of air able to be inhaled. The nose is designed for the breathing where as the mouth is used for consuming food and water. You can’t smell through your mouth so why use it for breathing? You actively ensure throughout the day you are breathing through your nose but one issue is during sleep. For this the author suggests taping of the mouth with 3M micropore tape. This ensures nasal breathing at night and guarantees you are getting 8 hours of solid nasal breathing. It’s an interesting concept that I’m excited to try as apart of my breath training. Nasal breathing also has many benefits apart from volume reduction including:

Benefits of Nasal Breathing

    • Warms and humidifies incoming air to body temperature and reduces moisture loss.
    • Better protection against viruses and bacteria in the air.
    • Helps produce and distribute nitric acid which results in dilation of airways and blood vessels. Increases circulatory and respiratory health.
    • Reduced occurrence of snoring and sleep apnoea.

Other occurrences of CO2 loss are sighing and taking large breaths whilst yawning and talking. Be mindful of this and attempt to reduce the volume of air taken in. If you notice after perform a quick 10-15sec breath hold to compensate.

Carbon Dioxide Tolerance

Improving your tolerance to carbon dioxide can be achieved by reducing your breathing rate and volume to create a tolerable amount of air. These are 10 minute sessions concentrating on nasal breathing lightly via the abdomen. This ensure activation of the diaphragm which draws air down to the bottom of the lungs. This should be felt by no upper chest movement but the gentle outward motion of the abdomen upon inhalation and its retraction upon exhale. By doing this little and often your body will acclimatise to this level of CO2 and O2 which will result in light breathing throughout the day subconsciously.

Simulated High-altitude Training

This is achieved via short breath holds whilst performing exercise. This strong air shortage is an advanced technique to push from a BOLT score of 20 to 40 seconds. This puts the body under more pressure as there is a reduced presence of oxygen in the blood and increased presence of CO2. This triggers your body to produce EPO which results in the formation of more RBCs so that more oxygen can be carried in the short term. This is why people who live and regularly train at higher altitudes can be better at endurance based fitness.

Making it Actionable!

This method is something I will definitely be implementing into my current training to help expand my aerobic fitness. The main plan of action is to record my BOLT score daily to monitor progress whilst performing three 10minute sessions of light nasal breathing daily and breath holds during my training. This should enable my BOLT score to increase resulting in better performance. Nasal breathing will be actively performed 24/7. I will try mouth taping during sleep for at least a 6 week period and hopefully this will aide my recovery as well. I’m extremely excited to introduce this. It may not produce the huge results promised but as I have no health risks I’m more than happy to give this a try. It won’t make me an Olympian but surely training like one is a great place to start.



If you’ve read this book already I’d love to know your thoughts and how you’ve implemented its strategies. Let me know down below!

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