Pro Mask and aerobic exercise


Provide assessment of the use of the military Pro Mask as a respiratory muscle training device to enhance aerobic training in a military population.


  1. Respiratory muscles can be trained to increase their strength and aerobic performance. Respiratory muscle training (RMT) can be achieved using several methods including upper body strength conditioning, whole body aerobic exercise, pressure-loading breathing devices, and added airflow resistance breathing devices.
  2. Numerous studies over the last 50 years have examined whether the addition of RMT will improve aerobic performance in healthy individuals, and patients with respiratory diseases. A recent review and meta-analysis1 found that RMT improved endurance exercise performance ~11%, and that less fit subjects benefited more from RMT then highly trained athletes. Based on this recent finding, and considering that the US military population is aerobically fit to highly fit, military personnel utilizing RMT are likely to experience less than the 11% improvement in aerobic exercise performance when RMT protocols are maximally utilized.
  3. Commercial RMT devices are designed to substantially increase the intrathoracic pressures generated by the inspiratory and expiratory muscles in order to produce a training effect. Numerous studies have shown that the pressure increase required to achieve a training effect are large, and substantially greater than the pressures developed by the military Pro Mask2, 3. Thus, the military Pro Mask does not provide a sufficient level of airflow resistance to induce significant RMT in physically fit individuals.
  4. A claim has been made by a commercial RMT device vendor that using their device will improve aerobic performance at high altitudes. There are no peer-reviewed studies supporting this claim. Added airflow resistance does not simulate the effects of increased altitude on the cardio-respiratory system. While shortness of breath is a common symptom during physical exertion at high altitudes, this symptom is not related to impaired respiratory muscle performance. RMT is not a substitute for using established and effective altitude acclimatization protocols4.
  5. The US military has a long history of respiratory protective device research and development. Two reviews2,3 are attached. The recent RMT review and metaanalysis1 includes an excellent list of pertinent references on this topic.


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  1. Illi, S. K., Held, U., Frank, I., & Spengler, C. M. (2012). Effect of respiratory muscle training on exercise performance in healthy individuals: A systematic review and meta-analysis. Sports Medicine, 42(8), 707–724. doi:10.2165/11631670-000000000-00000.
  2. Muza, S. R. (1986). A review of biomedical aspects of CB masks and their relationshp to military performance (T1-87). U.S. Army Research Institute of Environment Medicine (USARIEM), Natick, MA, Retrieved from:
  3. Muza, S. R., Banderet, L. E., & Cadarette, B. (2002). Protective uniforms for nuclear, biological, and chemical warfare: Metabolic, thermal, respiratory, and psychological issues. In K. B. Pandolf & R. E. Burr (Eds.), Medical Aspects of Harsh Environments, Volume 2 (pp. 1084–1127). Washington, DC: Office of the Surgeon General, Department of the Army,
  4. Headquarters, Department of the Army (2010). Altitude Acclimatization and Illness Management. TB MED 505, United States Army, Falls Church, VA, Retrieved from: