Altitude training is an established method to improve endurance performance, but also high intensity sports can benefit from it's use. There are a few important points to consider however to maximize it's effects and to become an altitude training responder !

1. Altitude Training
Tips & Tricks
To improve performance at sea-level
Michaël Bultheel
CPD 20/11/2015
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2. • History
• Effects / Benefits
• Who?
• Types
• Responder / Non-responder ?
• Practical issues
Overview

3. History

4. • Sprinting: world records
History

5. • Sprinting: world records
 Thin air, less resistance
• Endurance:
• Altitude born athletes (Kenya, Ethiopia, Mexico)
dominated.
• Non-altitude born athletes underperformed.
• Triggered research in effects of altitude on
performance
History

6. 1. Hematological
2. Non - hematological
Benefits / Effects

7. Altitude: PO2  diffusion to lungs/blood/cells
Benefits / Effects

8. Lower oxygen levels in blood the body tries to
adapt and compensate.
1. Kidneys  EPO
Benefits / Effects

9. Lower oxygen levels in blood the body tries to
adapt and compensate (‘acclimatisation’)
1. Kidneys  EPO  RBC
2. Cardio-vascular:
• Heart rate  cardiac output
• Cappilarisation
3. Respiratory
• Ventilation  Respiratory muscles ++ (efficiency)
4. Cellular
• Mitochondria ++
Benefits / Effects

10. • Endurance athletes
• Oxygen carrying capacity +++  aerobic peformance +++
• Anaerobic performance ?
Who?
• Changes in acid-base balance and lactate metabolism,
resulting in improvements in anaerobic capacity.
• Improved exercise efficiency (lower Vo2 at given work)
• Improved recovery
Nummela et al, J Sports Sci, 2000
Gore et al, MJ Acta Physiol Scand, 2001
Levine BD, Stray-Gundersen J. J Appl Physiol. 1997

11. • Endurance athletes
• Anaerobic performance ?
• Lactate shift
• Teams
Who?

12. Who?

13. 1. Live high, train high (LHTH)
2. Live high, train low (LHTL)
3. Intermittent hypoxic training (IHT)
Types

14. 1. Live high, train high (LHTH)
Types
• Meta analysis: some athletes show improved performance,
some not.
Better results if key parameters (altitude, # days, test day)
are well controlled!
• 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
Bonetti & Hopkins Sports Med 2009

15. 1. Live high, train high (LHTH)
2. Live high, train low (LHTL)
• How
• Research
Types

16. • Train in the valley
• Normobaric hypoxia
• Altitude tents, altitude house
Decrease the concentration of oxygen via nitrogen dilution or oxygen
filtration.
LHTL – How?

17. LHTL – How?

18. 1. Live high, train high (LHTH)
LHTL - Research
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
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.

19. Mixed results
• Statistical Significance:
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
• Placebo
• Neural recruitment and CNS may play a bigger role in fatigue
than oxygen supply model predicts.
LHTL - Research

20. 1. Live high, train high (LHTH)
2. Live high, train low (LHTL)
Most efficient
Types

21. • Genetics
• Negative effects of altitude
• 5 I’s
Responder vs non responder?

22. 1/ Genetics
• EPO gene
• ACE gene
• Wide inter-individual variability in erythropoietic response
to altitude training
• Altitude not high enough to stimulate EPO production in that
specific athlete?
• Does not allow prediction of the variation in the increase Hb mass
or sea-level performance
• Oxygen delivery not performance limiting factor in that
specific athlete
Friedmann et al, BJSM, 2005
Responder vs non responder?

23. 2/ Negative effects of altitude
• Decrease in maximum intensity workload
• Fatigue occurs with less muscle fatigue and at lower cardiac outputs
• Blood viscosity ++
• Recovery
• dehydration
 LIVE HIGH TRAIN LOW
Responder vs non responder?

24. 3/ 5 I’s
• Intensity
• Illness
• Intake
• Iron
• Injury
Altitude training is an important stressor !
Increased risk for overload
Responder vs non responder?

25. 3/ 5 I’s
• Intensity
• Progressive increase
• Recovery ++
• Illness
• Intake
• Iron
• Injury
Responder vs non responder?

26. Responder vs non responder?
Intensity

27. • 5 I’s
• Intensity
• Illness
• Immune suppression
• Prevention !! (probiotics, washing hands,…)
• URT / GI
• No altitude (if possible)
• Intake
• Iron
• Injury
Responder vs non responder?

28. • 5 I’s
• Intensity
• Infection
• Intake
• ++ protein
• ++ carbs
• Hydration
• Iron
• Injury
Responder vs non responder?

29. • 5 I’s
• Intensity
• Infection
• Intake
• Iron
• Lab: Ferritin
• Supplement 100mg/d (start 2-4w earlier) + vit C
(Garvican & Martin, PLOS ONE, 2012)
• Injury
Responder vs non responder?

30. • 5 I’s
• Intensity
• Infection
• Intake
• Iron
• Injury
• Prolonged inflammatory responses may interfere with
altitude adaptations
Responder vs non responder?

31. • How high?
• 2000 – 2500m
• Gradually (sleep quality)
• How long?
• Minimum 4 weeks to stimulate EPO production (hematological)
• 5 days in, 2 days off
• 10 hr/d
• < 3 weeks seems enough for valuable changes in muscle buffer
capacity, hypoxic ventilator response or NA+/K+ ATP-ase
capacity. (non-hematological)
• Rappels ?
• Compete
• 1 – 3 days
• 12 – 21 days
Practical issues
Millet et al., 2010
Suslov. 1994 Basic Principles of Altitude Training.

32. Testing the effects of altitude
1. Red cell volume
• Total Hb mass (CO rebreathing technique)
• 1% increase / 100h exposure
2. VO2 max
• 4ml O2/min per gram Hb
3. Performance
• Numerous other performance confounders
Gore, J Appl Phys, 2014
Practical issues

33. 1. Live high, train high (LHTH)
2. Live high, train low (LHTL)
3. Intermittent Hypoxic Training (IHT)
Types

34. • Training at simulated high altitude
• No effect on EPO or performance
Julian et al, 2004, J Appl Physiol
Intermittent Hypoxic Training

35. • Training at simulated high altitude
• No effect on EPO or performance
Julian et al, 2004, J Appl Physiol
Intermittent Hypoxic Training

36. Altitude Training has both positive and negative effects.
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
Responders vs. Non Responders
Future Considerations
neuromuscular mechanisms are more important for performance than
previously thought?
VO2max not be all end all.
SuSummary

40. Summary

41. 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
Responders vs. Non Responders
Future Considerations
neuromuscular mechanisms are more important for performance than
previously thought?
VO2max not be all end all.

42. 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
Responders vs. Non Responders
Future Considerations
neuromuscular mechanisms are more important for performance than
previously thought?
VO2max not be all end all.