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Physiologic and Lactate Dynamics During Voluntary Breath-Hold: A Systematic Review and Meta-Analysis
Shih-Lei Lee1, Chyi-Huey Bai2, Chen-Te Hsu3,4
1Institute of Sports Sciences, University of Taipei, Taipei City, Taiwan (R.O.C.).
Wilderness & Environmental Medicine
|May 14, 2026
Summary
Voluntary breath-holding (BH) significantly increases blood lactate, indicating heightened anaerobic metabolism. Training status and apnea type influence lactate levels more than environment, with wet static apnea potentially stabilizing lactate.
Area of Science:
- Physiology
- Exercise Science
- Metabolic Studies
Background:
- Voluntary breath-holding (BH) elicits significant physiological responses.
- Understanding lactate concentration changes during BH is crucial for assessing anaerobic activation and metabolic strain.
- Existing research shows heterogeneity, necessitating subgroup analyses based on apnea type, training, and environment.
Purpose of the Study:
- To systematically analyze the effects of voluntary BH on blood lactate concentration.
- To classify data by apnea modality: static apnea (STA) and dynamic apnea (DYN).
- To explore physiological differences and the influence of the diving reflex on lactate metabolism.
Main Methods:
- Meta-analysis of 14 studies (2005-2024) with 315 participants.
- Data classified into dry static apnea (STA), wet STA, dynamic apnea (DYN), and depth diving.
- Random-effects model and subgroup analyses by apnea type, training status, and environment.
Main Results:
- BH significantly increased blood lactate (P<0.00001) with high heterogeneity (I²=79%).
- Significant differences observed between STA and DYN (P<0.01) and trained vs. untrained (P<0.05).
- Wet static apnea showed a negative correlation (r=-0.54, P=0.047), suggesting lactate stabilization.
Conclusions:
- Voluntary BH elevates blood lactate, reflecting anaerobic metabolism and adaptive responses.
- Training status and apnea modality are key determinants of lactate dynamics, more so than environmental factors.
- Wet static apnea may stabilize lactate via the diving reflex, potentially masking physiological strain and increasing risks.
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