This High-Tech Breath Test Gave Me Insights to Hack My Training Plan
HOW MUCH DO you know about your body?
Yes, you're intimately familiar with all of the unique features and quirks that make your body you—the scar on your shin from the box jump accident in the gym, the hunger pangs you get before a run, the moment you know you'll break out into a sweat during a hard workout. But how much do you know about how your body works—as in, how well you're able to use the air you breathe, for example, or how efficiently you convert the food you eat into energy, and how that energy is in turn used to power your body when you run, jump, and lift? Unless you're a high-level pro athlete with access to a performance lab, the answer is probably very little. At least it was for me.
I take my fitness seriously—it's in my job description here at Men's Health, after all—and I'm currently training to run the NYC Marathon. I can glean a fair amount of insight from the fitness wearables I typically use to track my workouts (most often an Apple Watch, WHOOP strap, and Oura Ring) to know how my physical training affects my body and performance, but I find myself coming up short once I need to put that data into practice. I want to best my previous marathon time of 3:15:17, which I logged in 2019 on a wet, miserable race day. But my training splits have been consistently slower than the 7:27 per mile pace I'll need to beat my PR even when I push hard; I feel like I'm holding myself back from hitting my athletic potential. I'd ideally like my runs to be closer to seven minutes flat, or even in the high sixes. I've run faster than this before (my half-marathon PR is 1:29:55, just over 6:51 per mile), so I know I have it in me to pick up the pace. But how?
The answer comes through a high-tech fitness test that can provide reams of data beyond the typical wrist-bound wearable and an actionable plan to put all that info to work: PNOÉ. I heard about the protocol from the team at Bespoke Treatments, the top-notch NYC performance physical therapy center that also helps to provide some of our best PT advice. I got hooked up with Cameron Yuen, DPT, C.S.C.S., a DPT at Bespoke who led me through the whole process, which is one of the high-level performance tests offered through the practice.
What Is PNOÉ?
PNOÉ—whose name comes from the ancient Greek word for breath—is a service that provides high-level cardiorespiratory and metabolic analysis via a two-part breath test.
You might be familiar with VO2 max, a measure that can help patients understand their cardiovascular fitness, essentially how efficiently the body uses oxygen. That's part of PNOÉ—but this next-level service also provides more data and context than a standard VO2 max test.
"With this test, I can see exactly what your body is using for fuel and where limitations are in three of your physiologic systems: you cardiovascular, your respiratory, and your metabolic [systems]," Yuen told me when I met him at the Bespoke office.
The results of the test would provide my insights about biometric data points and details that my wearables could only dream about, from my aerobic health and cardiovascular fitness levels to the breakdown of how my uses fuel during exercise, down to the exact point in my workouts I switch from using fats to carbohydrates. A more complete list of the biomarkers captured:
Resting Metabolic Rate
Fat-Max Zone
Calorie Burn
VO2max
Fat / Carbohydrate Burn
Movement Economy
Heart Fitness
Lung Fitness
Cellular Fitness
But as my experiences with fitness tracking and sifting through context-free biometric information have taught me, I need extra help to actually understand what I can do to put all that data into practice. The PNOÉ system doesn't solely rely on cutting-edge AI and context-free reports to do this; instead, the protocol is designed specifically to be used with a qualified medical provider, like Yuen, to provide guidance to understanding the results and a performance plan to put the data into action.
"Understanding your physiology is not something that can be bucketed in a faceless mobile application or a one-stop shop process," says Panos Papadiamantis, co-founder of PNOÉ. He views his company's product as a valuable tool for healthcare providers to have in their arsenal to give patients better care—whether they're high-level athletes or just normal people aiming to maximize their quality of life. Papadiamantis says that among PNOÉ's nearly 3,000 clients are plenty of performance coaches and sports PTs, but also doctors who focus on weight loss and functional health.
What makes PNOÉ special, according to Papadiamantis, is this combination of portability—similar tests typically only exist in specialized clinical settings, while PNOÉ's small briefcase of gear and tablet setup can be undertaken anywhere there's a treadmill or stationary bike—and dedicated service. Once the breath test data is recorded, PNOÉ's software builds out a detailed report, which the health professional interprets for the patient, like Yuen would for me. PNOÉ also provides training and support for its medical clients to help wade through the data to determine the best path forward for each patient.
Taking the PNOÉ Test
Administrating PNOÉ is broken down into two very different portions. "One test is the easiest test you'll ever do in your life," Yuen told me. "The second test will be the hardest test you've ever done in your life." Consider me intimidated.
Resting Metabolic Rate Test
Thankfully, the first portion of the test was there to ease me into the process. I showed up at Bespoke on an empty stomach; Yuen told me not to eat anything the day of the testing. Once everything had been set up, he outfitted me with a chest strap heart monitor and face mask, which would record my breaths and was attached to a small power pack by a cord. After breathing out hard into the mask to check that the seal was tight, I laid down on the ground for the resting metabolic rate test.
Resting metabolic rate (RMR) is a measure used to understand how much energy your body needs to function while at rest, usually calculated manually using a formula or via testing (like I was doing for PNOÉ). Yuen told me that we were specifically looking to determine what fuel sources my body uses at rest to determine how healthy my metabolic system is. After being down on the floor for 10 minutes, I was relaxed.
VO2 Max Test
Now, the hard part. If you've ever seen a sports science special on ESPN, you've likely seen the basics of the VO2 max test I was about to take. The pack attached to the face mask went onto a shoulder strap rig, and I mounted the treadmill. Yuen took me though a three-minute walking warmup to establish a baseline. Easy. But then, I had to run. Yuen progressively increased the machine's speed, and I was forced to keep up. The goal was to ramp up my heart rate to its maximum level after running for 12 to 15 minutes, so that Yuen could use the data collected to understand what limiting factors might be keeping me from peak performance at all points of my training.
I kept up the pace for a few segments, running increasingly faster. Breathing in the mask didn't bother me—I got used to running with stuff on my face during the peak of the pandemic—but I did feel pushed to my limits. Shortly after Yuen told me that I had done all of the running I absolutely needed to do for the test, and that continuing would be to reach my true max, I tapped out and jumped off the treadmill. I was sweating, breathing heavy, and tired. It was definitely not easy.
PNOÉ's Results and a New Training Plan
A few days later, PNOÉ's software had crunched the data and returned a pair of super-detailed reports based on the tests, which Yuen then shared with me. I learned from the RMR report that my metabolism uses an energy mix of 64 percent fats and 36 percent carbohydrates to produce energy, which is a fairly healthy ratio.
More pressingly, the VO2 max portion of the testing turned over some unexpected information about my performance. Most of the measures were high, which I was anticipating as someone who trains five to six days a week. I found out my biological age (three years lower than my actual age), the exact heart rate training zone ranges for me, and more.
But some of my marks related to my breathing were alarmingly low. This didn't mean there was anything wrong with my body internally, Yuen assured me; the issue was in how I was using it. Essentially, he found that my max lung capacity should be around five liters of oxygen. But when I was running on the treadmill during the test, I wasn't even coming close to using all of the air that should've been at my disposal. Typically, he would expect an athlete to be able to use around 80 percent of their capacity. "What we found was that you actually hit a peak of two liters, so you're not even using 50 percent of your total lung volume," he said. What this meant in practice was that I hyperventilate through my workouts, using the air inefficiently and limiting my potential.
Thankfully, making some improvements wouldn't require anything other than some good old-fashioned hard work. Yuen gave me a simple plan to follow, consisting of two stretches to help me breathe better and two 45-minute runs following a breathing protocol per week
I've put them into practice since then—even though the stretches look simple, let me assure you, they are not easy or comfortable—and I'm looking forward to seeing the results on my race day later this year. In a few months, I can go back to the Bespoke office to retest to learn exactly how much I've improved.
Without the test, I would never have known that I'm not living up to my full performance potential. Now, with the data—and more importantly, a training protocol to put it into practice—I feel more empowered to go break my marathon PR.
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