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Altitude training traditionally referred to as altitude camp, is the practice by some endurance athletes of training for several weeks at high altitude, preferably over 2,500 m (8,000 ft) above sea level, though more commonly at intermediate altitudes due to the shortage of suitable high-altitude locations. At intermediate altitudes, the air still contains approximately 20.9% oxygen, but the barometric pressure and thus the partial pressure of oxygen is reduced.[1][2]

Depending very much on the protocols used, the body may adapt to the relative lack of oxygen hypoxia in one or more ways such as increasing the mass of red blood cells and hemoglobin, and non-hematolological responses.[3][4][5] Proponents claim that when such athletes travel to competitions at lower altitudes they will still have a higher concentration of red blood cells for 10-14 days, and this gives them a competitive advantage. Some athletes live permanently at high altitude, only returning to sea level to compete, but their training may suffer due to less available oxygen for workouts.

Altitude training can be simulated through use of an altitude simulation tent, altitude simulation room, or mask-based hypoxicator system where the barometric pressure is kept the same, but the oxygen content is reduced which also reduces the partial pressure of oxygen.


Background history

The study of altitude training was heavily delved into during and after the 1968 Olympics, which took place in Mexico City, Mexico: elevation 7,349 feet (2,240 m). It was during these Olympic Games that endurance events saw significant below-record finishes and anaerobic, sprint events broke all types of records[6] It was speculated prior to these events how the altitude might affect performances of these elite, world-class athletes and most of the conclusions drawn were equivalent to those hypothesized: that endurance events would suffer and that short events would not see significant negative changes. This was attributed not only to less resistance during movement — due to the less dense air[7] — but also to the anaerobic nature of the sprint events. Ultimately, these games inspired investigations into altitude training from which unique training principles were developed with the aim of avoiding underperformance.

Principles and mechanisms

Athletes or individuals who wish to gain a competitive edge for endurance events tend to take advantage of exercising at high altitude due to the physiological changes that occur from the environmental differences compared to that at sea level. High altitude is typically defined as any elevation above 5,000 feet (1,500 m). It is further broken down that elevations above 11,500 feet (3,510 m) are very high altitude and elevations at or above 18,000 feet (5,500 m) are extreme altitude. The differences between sea level and high altitude relate to the density of air and atmospheric pressure. Because atmospheric pressure is higher at sea level, air is denser and there are more molecules of gas per liter of air. Because atmospheric pressure is lower at high altitudes, air is less dense and there are fewer molecules of gas per liter of air; this causes a decrease in partial pressures of gases in the body, which elicits a variety of physiological changes in the body that occur at high altitude.[8]

One suggestion for optimizing adaptations and maintaining performance is the live-high, train-low principle. This training idea involves living at higher altitudes in order to experience the physiological adaptations that occur, such as increased Erythropoietin(EPO) levels, increased Red Blood Cell levels, and higher VO2 max, while maintaining the same exercise intensity during training at sea level. Due to the environmental differences at high altitude, it may be necessary to decrease the intensity of workouts. Studies examining the live-high, train-low theory have produced varied results, which may be dependent on a variety of factors such as individual variability, time spent at high altitude, and the type of training program.[9][10] For example, it has been shown that athletes performing primarily anaerobic activity do not necessarily benefit from altitude training as they do not rely on oxygen to fuel their performances.

Synthetic EPO also exists. Injections of synthetic EPO and blood doping are illegal in athletic competition because they cause an increase in red blood cells beyond the individual athlete's natural limits. This increase, unlike the increase caused by altitude training, can be dangerous to an athlete's health as the blood may become too thick and cause heart failure (see polycythemia). The natural secretion of EPO by the human kidneys can be increased by altitude training, but the body has limits on the amount of natural EPO that it will secrete, thus avoiding the harmful side effects of the illegal doping procedures.

Scientific studies[citation needed] have shown that altitude training can produce increases in speed, strength, endurance, and recovery. Opponents of altitude training argue that an athlete's red blood cell concentration returns to normal levels within days of returning to sea level and that it is impossible to train at the same intensity that one could at sea level, reducing the training effect and wasting training time due to altitude sickness. Altitude simulation systems have enabled protocols that do not suffer from such compromises, and can be utilized closer to competition if necessary. Some devices would be considered portable.

A 2005 study showed that although the boosted VO2 max had returned to normal 15 days after the conclusion of an 18 day live-high train-low protocol, the submaximal performance at ventilatory threshold was enhanced upon initial return to sea-level, and was even greater 15 days later.[11]

Numerous other responses to altitude training have also been identified, including angiogenesis, glucose transport, glycolysis, and pH regulation, each of which may partially explain improved endurance performance independent of a larger number of red blood cells.[4] Furthermore, exercising at high altitude has been shown to cause muscular adjustments of selected gene transcripts, and improvement of mitochondrial properties in skeletal muscle.[12][13]

In Finland, a scientist named Heikki Rusko has designed a "high-altitude house." The air inside the house, which is situated at sea level, is at normal pressure but modified to have a low concentration of oxygen, about 15.3% (below the 20.9% at sea level), which is similar to the concentrations at the high altitudes often used for altitude training. Athletes live and sleep inside the house, but perform their training outside (at normal oxygen concentrations at 20.9%). Rusko's results show improvements of EPO and red-cell levels. His technology has been commercialized and is being used by thousands of competitive athletes in cycling, triathlon, olympic endurance sports, professional football, basketball, hockey, soccer, and many other sports that can take advantage of the improvements in strength, speed, endurance, and recovery.

Physiological adaptations

While performing endurance activities it has been observed that maximal and submaximal aerobic power and capacity decreases with increasing elevation. Submaximal endurance activities at high altitude reveal an increase in heart rate and respiratory ventilation in order to compensate for the lesser availability of oxygen.[14] At high altitudes, there is a decrease in oxygen hemoglobin saturation. In order to compensate for this, erythropoietin (EPO), a hormone secreted by the kidneys, stimulates red blood cell production from bone marrow in order to increase hemoglobin saturation and oxygen delivery. While EPO occurs naturally in the body, it is also made synthetically to help treat patients suffering from kidney failure and to treat patients during chemotherapy. Over the past thirty years, EPO has become frequently abused by competitive athletes through blood doping and injections in order to gain advantages in endurance events. Abuse of EPO, however, increases RBC counts beyond normal levels (polycythemia) and increases the viscosity of blood, possibly leading to hypertension and increasing the likelihood of a blood clot, heart attack or stroke. Though at high altitudes, it is known that EPO stimulates production of RBCs, it is uncertain how long this adaptation takes because various studies have found different conclusions based on the amount of time spent at high altitudes.[15] One study concluded that individuals who lived at sea level and came to live at high altitude had lower VO2max compared with individuals who had lived at high altitude their entire lives.[16] This implies a more significant adaptation to high altitude in individuals who have been at high elevations for most of their lives, allowing for more complete adaptations.

VO2max also decreases with increasing altitude. This decrease in VO2 at altitude is likely due to the decrease in arterial oxygen saturation, possibly causing a decrease in cardiac output.[17] This decrease in cardiac output occurs as a means to compensate for the decreased availability of oxygen to the working muscles.

In addition to cardiovascular and respiratory adaptations, significant changes in the musculature have also been observed with adjustments to high altitude living. In a study comparing rats active at high altitude versus rats active at sea level, with two sedentary control groups, it was observed that muscle fiber types changed according to homeostatic challenges which led to an increased metabolic efficiency during the beta oxidative cycle and citric acid cycle, showing an increased utilization of ATP for aerobic performance.[18]

See also


  1. ^ West JB (October 1996). "Prediction of barometric pressures at high altitude with the use of model atmospheres". J. Appl. Physiol. 81 (4): 1850–4. PMID 8904608. Retrieved 2009-03-05. 
  2. ^ Online high-altitude oxygen and pressure calculator
  3. ^ Wehrlin JP, Zuest P, Hallén J, Marti B (June 2006). "Live high—train low for 24 days increases hemoglobin mass and red cell volume in elite endurance athletes". J. Appl. Physiol. 100 (6): 1938–45. doi:10.1152/japplphysiol.01284.2005. PMID 16497842. Retrieved 2009-03-05. 
  4. ^ a b Gore CJ, Clark SA, Saunders PU (September 2007). "Nonhematological mechanisms of improved sea-level performance after hypoxic exposure". Med Sci Sports Exerc 39 (9): 1600–9. doi:10.1249/mss.0b013e3180de49d3. PMID 17805094. Retrieved 2009-03-05. 
  5. ^ Muza, SR; Fulco, CS; Cymerman, A (2004). "Altitude Acclimatization Guide.". US Army Research Inst. of Environmental Medicine Thermal and Mountain Medicine Division Technical Report (USARIEM-TN-04-05). Retrieved 2009-03-05. 
  6. ^ " Website of the Olympic Movement". 
  7. ^ Ward-Smith, AJ (1983). "The influence of aerodynamic and biomechanical factors on long jump performance". Journal of Biomechanics 16 (8): 655–658. doi:10.1016/0021-9290(83)90116-1. PMID 6643537. 
  8. ^ "A High Altitude Resource". 
  9. ^ Levine, B.D.; J. Stray-Gunderson (2001). "The effects of altitude training are mediated primarily by acclimatization rather than by hypoxic exercise". Advances in Experimental Medicine and Biology 502: 75–88. PMID 11950157. 
  10. ^ Stray-Gundersen, J.; Chapman RF, Levine BD (2001). "“Living high — training low" altitude training improves sea level performance in male and female elite runners". Journal of Applied Physiology 91 (3): 1113–1120. PMID 11509506. 
  11. ^ Brugniaux JV, Schmitt L, Robach P, Nicolet G, Fouillot JP, Moutereau S, Lasne F, Pialoux V, Saas P, Chorvot MC, Cornolo J, Olsen NV, Richalet JP. (January 2006). "Eighteen days of "living high, training low" stimulate erythropoiesis and enhance aerobic performance in elite middle-distance runners". J. Appl. Physiol. 100 (1): 203–11. doi:10.1152/japplphysiol.00808.2005. PMID 16179396. Retrieved 2009-03-05. 
  12. ^ Zoll J, Ponsot E, Dufour S, Doutreleau S, Ventura-Clapier R, Vogt M, Hoppeler H, Richard R, Flück M. (April 2006). "Exercise training in normobaric hypoxia in endurance runners. III. Muscular adjustments of selected gene transcripts". J. Appl. Physiol. 100 (4): 1258–66. doi:10.1152/japplphysiol.00359.2005. PMID 16540710. Retrieved 2009-03-05. 
  13. ^ Ponsot E, Dufour SP, Zoll J, Doutrelau S, N'Guessan B, Geny B, Hoppeler H, Lampert E, Mettauer B, Ventura-Clapier R, Richard R. (April 2006). "Exercise training in normobaric hypoxia in endurance runners. II. Improvement of mitochondrial properties in skeletal muscle". J. Appl. Physiol. 100 (4): 1249–57. doi:10.1152/japplphysiol.00361.2005. PMID 16339351. Retrieved 2009-03-05. 
  14. ^ Pugh, L. G. C. E.; Gill MB, Lahiri SJ, Milledge S, Ward MP, and West JB (1964). "Muscular exercise at great altitudes". Journal of Applied Physiology 19: 431–440. PMID 14173539. 
  15. ^ Rupert, J. L.; P. W. Hochanchka (2001). "Genetic approaches to understanding human adaptation to altitude in the Andes". Journal of Experimental Biology 204 (18): 3151-60. 
  16. ^ Frisancho, A.R.; Martinez, C; Velasquez, T; Sanchez, J; Montoye, H (1973). "Influence of Developmental adaptation on aerobic capacity at high altitude". Journal of Applied Physiology 34 (2): 176–80. PMID 4686351. 
  17. ^ Kollias, J; Powers, SK; Thompson, D (1968). "Work capacity of long-time residents and newcomers to altitude". Journal of Applied Physiology 64 (4): 1486–92. PMID 3378983. 
  18. ^ Bigard, AX; Brunet A, Guezennec, CY and Monod, H (1991). "Skeletal muscle changes after endurance training at high altitude". Journal of Applied Physiology 71 (6): 2114–2121. PMID 1778900. 

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