Altitude Training

Altitude Training Steve Magness

Presentation goals
Early Interest
Theory behind Altitude Training
Effects of Altitude
Acute Effects
Acclimatization
Post Altitude Effects
Does it work? Why or why not?
Types of Altitude Training
Practical Applications for Altitude Training

Early Altitude Research
Early research almost all climbing based.
1968 Mexico City Olympics
1st major athletic event at high altitude
In endurance track events, altitude born athletes dominated.
Launched interest and research into altitude in regards to athletics.
"This isn't the Olympics—it's a triangular match between Kenya , Ethiopia and Mexico ." Ron Clarke

Fatigue Theory- Endurance events are limited by Oxygen supply to the working muscles.
Increase the oxygen supply to the muscles and fatigue is delayed.

Physiology of High Altitude:
At altitude, the partial pressure of oxygen (P O2) is lower than at sea level. Meaning there is less oxygen per volume of air.
Rate of diffusion depends on the pressure difference, moving from an area of high concentration to low concentration.
Oxygen cascade:
Is the oxygen driving force (partial pressure of oxygen) from the ambient air to lungs, blood, and cells. Driving force is diminished at altitude, thus rate of diffusion and oxygen cascade is slowed.

Oxygen Saturation Levels http://humboldt.edu/~pdb1/Audio_Visuals/Respiratory/resptrans.htm

EPO
Because of the lower oxygen levels, the body goes through a series of adaptations to try and compensate.
The key for improved endurance is an increase in EPO (Erythropoietin), which results in an increase in Red Blood Cells, hemoglobin mass, and thus an increase in oxygen carrying capacity. 2
EPO production is stimulated when the oxygen supply to the kidney is reduced, which happens when the oxygen content of the blood is reduced.
www.amgenrenaladvances.ca/patient/whatIsAnemia/causes.htm

Cardiovascular Response to Altitude
Heart Rate:
Acute response: Increase
Acclimatization response: Stays increased
Stroke Volume
Acute response: stays same
Acclimatization response: Decreases
Cardiac Output:
Acute response: Increase
Acclimatization Response: Decrease
Brooks, G. (2005). Exercise Physiology 4 th Ed . New York: Mcgraw-Hill.

Ventilatory Response
Ventilation increases at all intensities to increase oxygen pressure in lungs and force oxygen into the blood.
driven by hypoxia because at altitude ventilatory stimulation occurs at a lower level of Carbon Dioxide than at sea level.
Effect:
Increased alveolar Po2.
Left shift of oxyhemoglobin dissociation curve
Brooks, G. (2005). Exercise Physiology 4th Ed. New York: Mcgraw-Hill.

Post altitude effects:
Blood Lactate
Decreased blood lactate at submax intensities compared to pre-altitude.
Hemoglobin
Increases
RBC mass
Increases
Hematocrit
Increases
Rusko, et al.(2004). Altitude and endurance training. Journal of Sports Sciences, 22:10, 928 — 945

Post altitude effects:
Ventilatory acclimatization
Ventilation can stay elevated for several weeks
VO2max
May increase or stay the same, partly due to increased respiratory muscle use
Running Economy
Mixed results, may improve due to slow running improving RE, may decrease due to ventilatory increase.
-Neuromuscular changes
athletes routinely report loss of turnover.
Depressed motor recruitment patterns
Brooks, G. (2005). Exercise Physiology 4th Ed . New York: Mcgraw-Hill. WILBER, R. L (2007). Application of Altitude/Hypoxic Training by Elite Athletes. Medicine and Science in Sports and Exercise. 39 (9): 1610-1624 Rusko, et al.(2004). Altitude and endurance training. Journal of Sports Sciences, 22:10, 928 — 945

Does it work?
Athletes and Coaches
Many swear by it.
Out of the 215 performances by runners who have run under 13min for 5k, only one has come from an athletes who did NOT spend significant time training at altitude.

Types of Altitude Training

Traditional approach
Athletes both live and train at high altitudes.
Research: Most controlled , but not all, studies show no performance benefits
Studies without controls showed mixed benefits.

Controlled studies that showed No benefits

Controlled studies-Benefits Friedmann-Bette, B. Classical Altitude Training. Scand J Med Sci Sports 2008: 18 (Suppl. 1): 11–20

Live High- Train Low
Developed in early 1990’s by Dr. Stray-Gunderson and Dr. Levine.
Sleep high to get EPO, RBC mass increase.
Train low to keep intensity of training up, and keep neuromuscular adaptations
Research
After 4 wks, Increased VO2max, 5k performance, and RBC (Gunderson)
Also, a significant increase in serum EPO concentration, erythrocyte volume (5%) and hemoglobin concentration (9%)
All of which were statistically different than the control groups training at sea level or always at altitude.
Still, there is a very high individual response using this method.
WILBER, R. L. et al. (2007). Effect of Hypoxic "Dose" on Physiological Responses and Sea-Level Performance. Medicine and Science in Sports and Exercise. 39 (9):1590-1599

EPO changes comparison Rusko, Heikki, Tikkanen, Heikki and Peltonen, Juha(2004)'Altitude and endurance training',Journal of Sports Sciences,22:10,928 — 945

Live High-Train Low Rusko, Heikki, Tikkanen, Heikki and Peltonen, Juha(2004)'Altitude and endurance training',Journal of Sports Sciences,22:10,928 — 945

HiLo findings
WILBER, R. L (2007). Application of Altitude/Hypoxic Training by Elite Athletes. Medicine and Science in Sports and Exercise. 39 (9): 1610-1624

Comparison of HiHi and HiLo Levine, et al. (1997). ‘Living high–training low’: effect of moderate-altitude acclimatization with low altitude training on performance. Journal of Applied Physiology, 83, 102–112.

HiHiLo
Instead of doing all of the training at Low altitudes, athletes live at high altitude, do easy to moderate work at high altitude, and only come down for hard workouts (1-3x per week).
Almost identical results to live high, train low.
Means that at high altitude, the inability to do hard workouts at same intensity as at low altitudes, may be deciding factor in whether performance improves or not
Due to, at high altitude, depressed:
Motor unit recruitment
Cardiac output
VO2max
Rusko, Heikki, Tikkanen, Heikki and Peltonen, Juha(2004)'Altitude and endurance training',Journal of Sports Sciences,22:10,928 — 945
Stray-Gundersen, J., Chapman, R. and Levine, B.D. (2001). ‘Living high–training low’ altitude training improves sea level performance in male and female elite runners. Journal of Applied Physiology, 91, 1113–1120.

Simulated Altitude
Altitude Tents
Altitude House
Intermittent hypoxic Training (IHT)
Decrease the concentration of oxygen via nitrogen dilution or oxygen filtration.

Intermittent Hypoxic Training
Athletes train at simulated high altitudes
Most research has found that there was no increase in EPO or an improvement in endurance performance.
Glyde-Julian et al . (2004) Intermittent normobaric hypoxia does not alter performance or erythropoietic markers in highly trained distance runners. Journal of Applied Physiology 96(5): 1800-1807
Rodriquez,F. (2007). Performance of runners and swimmers after four weeks of intermittent hypobaric hypoxic exposure plus sea level training. J Appl Physiol. 103(5):1523-35
Roels, B. (2007). Effects of intermittent hypoxic training on cycling performance in well-trained athletes. Eur J Appl Physiol. 101(3):359-68

Does it work?
Reason’s for mixed results:
Statistical Significance issue:
A statistically insignificant improvement in studies might be substantial to an athlete. For example a few seconds in a 5k is a BIG deal to a world class runner, but may not be significant scientifically.
Responders vs. Non Responders
Response to altitude seems to be highly individual
Negative Consequences of altitude might overwhelm positive adaptations.
Neural recruitment and CNS may play a bigger role in fatigue than oxygen supply model predicts. Thus decrease in neural stimuli and recruitment at altitude may impair athletes with long term training at altitude.

Even with the same protocol in research the range of response varies widely to altitude.
That led Dr. Robert Chapman to classify athletes as responders vs. non responders based on changes in sea level performance after altitude training stint.
In this particular study, 17 out of 32 were responders, while 14 were non responders

Responders vs. Non Responders Chapman, R. et al. (1998). Individual variation in response to altitude training. J. Appl. Physiol. 85(4): 1448–1456

Reason for these differences?
A specific form of the EPO gene seems to help differentiate the athletes into responders vs. non responders.
Questions
Altitude not high enough to produce a stimulus on EPO production in some people?
Oxygen delivery not as much of a limiter to some athletes, therefore less adaptation?

Negative Effects of Altitude
Decrease in maximum intensity workload.
Can’t reach as high VO2max workloads.
At altitude fatigue occurs with less muscle fatigue and at lower cardiac outputs and HR.
no stimulus for muscle mitochondrial mass to increase.
At altitude brain can depress muscle recruitment.
iEMG activity decreased at max intensities at altitude
Peltonen, J. et al. (1997). Effects of oxygen fraction in inspired air on force production and electromyogram activity during ergometer rowing. European Journal of Applied Physiology, 76, 495– 503.

Decrease in plasma volume and increase in hematocrit (increases blood viscosity)
Decrease in alkaline reserve.
Increase in ventilatory response
Can’t train as hard or recover as quickly.

Negative effects could explain why the traditional (HiHi) approach does not improve performance at sea level as often.
HiLo provides the benefits of improved oxygen carrying capacity while allowing the athletes to train at a higher intensity at low elevations and not suffer neural consequences.

The Kenyan Problem
Many athletes and coaches point to the fact that athletes who were born at altitude dominate distance running, as a reason to train at altitude.
However, the response to altitude between athletes who were born at altitude compared to western athletes who were not is different.
Thus, because of this different response, the anecdotal evidence suggesting that Western athletes should copy the African’s in training at altitude does not hold up.

European vs. Kenyan Response to altitude upon arrival at Sea Level
The globular volume can decrease
The globular volume becomes stable after increase at altitude
Hematocirt increases
The hematocrit CAN increase
The amount of hemoglobin stays the same as altitude levels
The level of hemoglobin CAN increase
Number of erythrocytes increases
The number of erythrocytes increases
After Going to Sea Level (3 weeks) AFTER COMING BACK TO SEA LEVEL (3 weeks) STAYING AT SEA LEVEL (6-8 weeks) STAYING AT SEA LEVEL (4-8 weeks)
The globular volume decreases
The globular volume CAN decrease
The hematocrit increases
The hematocrit goes down
The level of hemoglobin increases
The level of hemoglobin goes down
The number of erythrocytes increases
The number of erythrocytes goes down
Kenyan Athletes European Athletes

Kenyan runners blood levels stay stable longer.
RBC, Hemoglobin, and Hematocrit all stay stable for up to 16 weeks, while the European athletes levels already started dropping at between 4-8 weeks post altitude.
Ethiopian runners
“ Furthermore, it has recently been reported that high-altitude natives of Ethiopia demonstrate a similar Hemoglobin, serum EPO concentration, and oxygen saturation within the normal sea-level range”
“ It seems that Ethiopian highlanders, like Tibetans, have exceptional adaptations of oxygen uptake or delivery that are not associated with an increased red blood cell production in the presence of a hypoxemic stimulus. The success of Ethiopian distance runners, who predominantly live in the highlands of Ethiopia, demonstrates the performance capabilities of these people, which is apparently not attributable to their increased red cell volume or superior Vo2max, as a result of residing at altitude.”
GORE, C. et al . Nonhematological Mechanisms of Improved Sea-Level Performance after Hypoxic Exposure. Med. Sci. Sports Exeir., Vol. 39, No. 9, pp. 1600-1609, 2007.

Practical Applications of Altitude Training

Optimal Dose of Altitude Training
How High?
2,000 to 2,500m
Less than 1,800m too low
More than 2,500m, no greater EPO response

How Long?
At least 4 weeks based on research data.
With EPO injections, it isn’t until the 3rd and 4th week in which there is accelerated increases in Hemoglobin and Hematocrit.

Training modifications
Drop in Volume
Drop in intensity
Increase in Recovery

Training Phases

Return to sea level
Best times to compete:
For some 1 st - 3 rd day down.
For most, research varies but most suggest some time between 12-21 days down

Return to sea level Suslov. (1994) Basic Principles of Altitude Training. New Science in Athletics. Pg 45-50

Summary
Altitude Training has both positive and negative effects.
Best approach seems to be to live high and train low to minimize the negative effects of altitude.
For individual athletes, must find a high enough altitude to elicit significant EPO production to lead to increased RBC mass.
Response to altitude is highly individualized
Future Considerations
Could there be another reason for improved performance after altitude training besides increased oxygen delivery?
Do results from altitude research show that neuromuscular mechanisms are more important for performance than previously thought?
VO2max not be all end all.

Fatigue Theory
Originally stated that:
Endurance events are limited by Oxygen supply to the working muscles. Increase the oxygen supply to the muscles and fatigue is delayed.
Exercise is Regulated, not limited
“ Exercise performance and VO2max, as well as the training response at sea level and at altitude, may not be dependent only on oxygen delivery and utilization, but also on other factors linked to the ability of the central nervous system to recruit the muscles.”
Rusko, Heikki, Tikkanen, Heikki and Peltonen, Juha(2004)'Altitude and endurance training',Journal of Sports Sciences,22:10,928 — 945

Brooks, G. (2005). Exercise Physiology 4 th Ed . New York: Mcgraw-Hill.
Cormie, P. et al. (2005, Summer). ALTITUDE TRAINING - DOES IT WORK? Current trends and research. Olympic Coach E-Magazine. http://coaching.usolympicteam.com/coaching/kpub.nsf/v/4jun05
Glyde-Julian C, et al. (2004). Intermittent normobaric hypoxia does not alter performance or erythropoietic markers in highly trained distance runners. Journal of Applied Physiology 96(5): 1800-1807
Rusko, et al.(2004). Altitude and endurance training. Journal of Sports Sciences, 22:10, 928 — 945
WILBER, R. L (2007). Application of Altitude/Hypoxic Training by Elite Athletes. Medicine and Science in Sports and Exercise. 39 (9): 1610-1624
GORE, C. J., et al. (2007). Nonhematological Mechanisms of Improved Sea-Level Performance after Hypoxic Exposure. Medicine and Science in Sports and Exercise. 39 (9):1600-1609
Chapman, R. et al. (1998). Individual variation in response to altitude training. J. Appl. Physiol. 85(4): 1448–1456
Rodriquez,F. (2007). Performance of runners and swimmers after four weeks of intermittent hypobaric hypoxic exposure plus sea level training. J Appl Physiol. 103(5):1523-35
Roels, B. (2007). Effects of intermittent hypoxic training on cycling performance in well-trained athletes. Eur J Appl Physiol. 101(3):359-68
Peltonen, J. et al. (1997). Effects of oxygen fraction in inspired air on force production and electromyogram activity during ergometer rowing. European Journal of Applied Physiology, 76, 495– 503.
Friedmann-Bette, B. (2008) Classical Altitude Training. Scand J Med Sci Sports. 18 (Suppl. 1): 11–20
Levine, et al. (1997). ‘Living high–training low’: effect of moderate-altitude acclimatization with low altitude training on performance. Journal of Applied Physiology, 83, 102–112.
GORE, C. et al . Nonhematological Mechanisms of Improved Sea-Level Performance after Hypoxic Exposure. Med. Sci. Sports Exeir., Vol. 39, No. 9, pp. 1600-1609, 2007.

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Altitude Training

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