How to Exercise with Oxygen Therapy (EWOT)

Exercising with oxygen therapy (also known as EWOT) has many potential benefits and can be a great way to reduce the physical stress of exercise. This is especially true if you have the chronic obstructive pulmonary disease (COPD) or any other respiratory illness that affects your ability to receive oxygen.

In this blog post, we will discuss how oxygen therapy can reduce the physical stress of exercise. We will also give you some practical tips on how to maximize your oxygen intake during exercise.

First, let us talk about how your body reacts to exercise and what it does to compensate for low oxygen levels.

How Your Body Reacts to Low Oxygen Levels During Exercise

During exercise, your body uses a lot more oxygen and requires fast replenishment. In response, your heart rate and breathing rate increase to transport more oxygen to your muscles and surrounding tissues.

However, if you have a chronic respiratory illness like COPD, your body’s ability to absorb oxygen is impaired. With COPD, your lungs are unable to absorb oxygen sufficiently, so even the most basic activities like taking out the trash or washing the car can make you feel winded and fatigued.

Moreover, if you also have a concurrent heart condition such as congestive heart failure or atrial fibrillation, your heart has to pump even harder to get sufficient oxygen during exercise. And if you also have low oxygen levels in your blood, that puts additional stress on your heart.

So, while exercise is a good thing for general health, there is a dilemma: How do you get adequate exercise without exacerbating underlying cardiac or respiratory illnesses?

The answer is surprisingly simple—oxygen therapy.

How Oxygen Therapy Can Improve Your Exercise Regimen

Dr. Johnathan Edwards, a sports medicine physician, and anesthesiologist in Las Vegas demonstrated how surgery patients can retain 100% oxygen levels in their blood for up to 5 minutes with only a single breath. During his surgeries, Dr. Edwards routinely increases the blood oxygen concentration of his patients to 100% to maximize oxygen delivery and can do so at very low breathing rates.

How Oxygen Therapy Can Improve Your Exercise Regimen

What this means is that your body can hold on to oxygen for a lot longer than most people think. Once you get the oxygen into your bloodstream, it can stay present and available for up to 5 minutes. So, if you were to use oxygen therapy during exercise, theoretically, you could maximize your body’s oxygen levels for the duration of your training.

Here is why this is so important: If you have COPD, your blood oxygen level can become dangerously low during exercise. Thus, by providing supplemental oxygen, you could bring your oxygen levels back up to normal, or even better than normal, for the entire workout. You could potentially avoid the dangers of overexerting yourself and maintain a steady supply of oxygen to your muscles.

Oxygen Can Reduce the Inflammatory Response Associated with Exercise

When you exercise, your capillaries (small blood vessels) expand with inflammatory cells. This is a natural process that everyone experiences. However, this normal inflammation paired with persistent low oxygen levels is a dangerous combination.

The good news is that oxygen can constrict your blood vessels and counteract that inflammation the moment it begins. This is important because persistent inflammation has been linked to cancer, heart disease, and a host of other problems. So, whatever can be done to reduce the adverse side effects of inflammation is worth exploring.

5 Ways to Maximize Your Oxygen Levels During Exercise With Oxygen Therapy

Now that we have discussed how your body reacts to exercise and how oxygen therapy can help, here are 5 ways to increase your oxygen levels during exercise:

  1. Focus on Your Breathing
    Supplemental oxygen is useless if your breathing technique is incorrect. That might sound harsh, but it is very much the truth. During exercise, it is too easy to shift your focus toward other things and lose sight of your breathing technique.

    Many people work out with music or TV in the background, and that is perfectly acceptable. However, you might want to try exercising without any distractions for the first week to get used to staying present and focused on your breathing. Concentrating on each breath during exercise alone can make a big difference in your oxygen levels.

  2. Maximize Your Oxygen Levels During Exercise With Oxygen Therapy - Focus on Your Breathing

  3. Breathe Through Your Nose
    Most people who use supplemental oxygen use a nasal cannula because it is more practical to wear than a face mask. However, during exercise, it is that much more important to focus on how you breathe. Inhaling through your nose does not come naturally, but it is more effective when using a nasal cannula because the oxygen is delivered through your nose first.

    Remember: Even though your concentrator or tank is releasing oxygen, that does not guarantee you will get everything that comes out of the concentrator. You still must use proper technique (like focused nasal breathing) to maximize what you are getting.

  4. Avoid Pulse-Dose Settings During Exercise
    Many oxygen concentrators have a built-in setting called pulse-dose, which only delivers oxygen when you inhale. While this is a great way to preserve oxygen during regular use, it may not give you what you need during a workout. The reason is that your breathing pattern changes with increased exertion, as well as your body’s oxygen demand. These variables can affect oxygen delivery and the efficiency of pulse-dose settings during exercise.

    So to avoid insufficient oxygen levels, it is better to keep your unit on continuous flow during your workout to get a constant stream of oxygen. This will ensure that you get enough oxygen to keep up with your body’s increased demand. (Please note: Always consult with your physician first to make sure this approach will fit with your medical needs.)

  5. Take Breaks
    Working out is hard for everyone, so it is perfectly acceptable to take breaks during your routine. The great thing about taking breaks while using supplemental oxygen is that you can replenish your blood oxygen levels at regular intervals—and be ready for the next round. Every break will give your body a chance to recharge.

    If using weights, the best approach is to take a break after every set. If you are doing aerobic exercises like jogging or cycling, start by taking more frequent breaks. You could always work your way up based on how you feel and your oxygen saturation percentage (using a pulse oximeter).

  6. Use Oxygen During Your Cool-Down
    After each workout, it is a good habit to decrease your heart rate gradually with a cool-down phase. This can be as simple as reducing your perceived effort by half every minute until your heart rate is closer to your baseline. Cool-downs can also help you relax and even prevent muscle soreness.
    Interestingly, oxygen can also do the same thing. When your body has enough oxygen, you will feel more relaxed, your heart rate will slow down, and your body will have enough oxygen to counteract the inflammation that leads to muscle soreness.
    So when you perform a cool-down, continue to use supplemental oxygen, so your body has enough to recover appropriately.

Final Thoughts

Exercising with oxygen therapy (EWOT) is a great way to increase your blood oxygen levels during exercise. It can help you stave off the adverse effects of working out and keep you motivated to continue. If you are discouraged about the inability to exercise as you once did due to COPD, oxygen therapy is a great way to manage the symptoms so you can focus on your exercise routine.

Information on this page is for reference and educational purposes only. For more information talk to your doctor or primary care provider.

Updated: February 7, 2020
Published: November 11, 2018


About Ryan Anthony: Ryan Anthony, BS, RRT is a registered respiratory therapist and content writer and medical blogger currently located in Los Angeles, California. As a Respiratory Therapist, he performs a wide range of hospital duties including adult and neonatal intensive care, nitric oxide therapy, high-frequency oscillatory ventilation, conventional mechanical ventilation, noninvasive ventilation, BiPAP, CPAP, intubation assistance, bronchoscopy assistance, cardiopulmonary resuscitation, chest physiotherapy, and nebulizer therapy.

10 thoughts on “How to Exercise with Oxygen Therapy (EWOT)”

  • Dennis Rosemier

    What portable machines are available that provide a constant. Flow?

    • Margaret Goodman
      Margaret Goodman November 12, 2018 at 8:36 am

      Hi Dennis, We have a couple of options for you that provide constant flow. The SimplyGo and the Eclipse 5 are good options. I have passed along your information to one of our oxygen specialists who can best assist you by talking to you about your oxygen needs, your lifestyle and what you would like to spend. If you like you may also reach out to us at 888-360-9829 or if you prefer email [email protected] We look forward to helping you with your oxygen needs.

  • Bob Stowell

    The Inogen one has no continues flow. Beside using a small tank in a backpack what else would work. I have a floor model with tubes I can ride the bike on a wind trainer with continues flow. What for walking?

    • Margaret Goodman
      Margaret Goodman March 12, 2019 at 6:38 am

      We offer several options that are a continuous flow and are on a wheeled cart that may work for you. Please give us a call, and one of our experienced oxygen specialists would love to talk with you about your needs and find a unit that would work for you. You can reach us at 888-360-9628 or if you prefer [email protected]

  • Sandy

    I'm not sure if my previous.comment went through or not.... if someone us already on oxygen vasialy 24/7, when preparing to exercise, should the 02 setting be increased?

    • Margaret Goodman
      Margaret Goodman March 12, 2019 at 5:47 am

      Before starting any exercise program, you should consult with your doctor. You can also wear pulse oximeter to monitor your oxygen level while doing your exercises and adjust your oxygen accordingly.

  • Bobby

    Question - I have heard that EWOT therapy wake up brain cells that is laying dormant after a stroke like hbot is that true?

  • Dr Smita Jain
    Dr Smita Jain July 13, 2019 at 6:10 am


    I’m very keen on getting a continuous/ constant supply system for personal use

    Kindly advise with costing


    Dr Jain

    • Ed Rodgers

      Hello, The oxygen concentrators do require a prescription for oxygen therapy. The cost of the machines vary related to the output (continuous vs pulse) as well as a stationary or potable models. If you want to find out more about a specific machine our oxygen specialist are great at explaining and helping align a patient's needs to the machine that will deliver the right level of oxygen and features. Give them a call at 888-743-0156.


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