The physiological response to breath holding includes bradycardia and peripheral vasoconstriction, which contrasts with that of exercise which includes tachycardia and peripheral vasodilation. This raises the question as to what the physiological response is to breath holding during exercise. During low-intensity exercise, the breath holding response of bradycardia and peripheral vasoconstriction prevails over the exercise response of tachycardia and peripheral vasodilation, but nevertheless the exercise may be sustained. Due to the lack of availability of extrinsic oxygen (O 2 ) from the atmosphere during breath holding, the energy demands can be met by increased reliance on intrinsic O 2 stores (i.e., O 2 that was in the body before the breath hold) via increased O 2 extraction at the muscle compared with exercise while breathing, or increased contributions from anaerobic energy systems. During high intensity exercise of short duration, the exercise response may prevail over the breath holding response due to the increased parasympathetic withdrawal and sympathetic drive of higher intensity exercise. If breath holding during high-intensity exercise was sustained for long enough, the breath holding response may eventually overcome the exercise response, although this may be difficult due to the inverse relationship between exercise intensity and breath hold duration.

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An anterior cruciate ligament (ACL) tear is one of the most frequent injuries experienced by athletes of all levels. Because so many variables are at play, there is a great deal of controversy about how and why this occurs. In addition, there are various suggested appropriate steps to take to return to sport in the fastest and safest possible way. However, a major issue in injury recovery and return to sport practices is the lack of a gold-standard method or a consistent course of action that an athlete should undertake after suffering an ACL injury. Therefore, the purpose of this paper is to review the literature to determine evidence-based methods for return to sport after ACL reconstruction and provide practical recommendations to guide the process.