HIGH ALTITUDE TRAINING – KEY TO EXCELLENCE IN

AEROBIC/ENDURANCE SPORTSDR NIKHIL KUMAR,

DM (CARDIOLOGY)

DIRECTOR, CARDIOLOGY

FORTIS MEMORIAL RESEARCH INSTITUTE

GURGAON

Hypoxia• The word hypoxia has its roots in the Greek language and describes the state of oxygen deficiency compared to normal conditions

• This state is caused by lowering the oxygen partial pressure (pO2) at sea level of about 212 hPa or by reducing the oxygen content of 20.94% in the air

• With increasing natural height, the air’s density declines–the oxygen partial pressure in the air decreases proportionately

• Now a days, artificially generated climate conditions achieve the same effects on the organism in the lowlands if the relation of oxygen and nitrogen is changed equivalently under air pressure conditions that remain the same

• Lowering the oxygen concentration in the air to 13.9vol.% in the lowlands corresponds to similar atmospheric conditions that exist in a natural height of 3000m

4.000 m

air pressure(hPa)

oxygen in relation to sea level

altitude

3.000 m

2.000 m

1.000 m

sea level

898 89 %

1.013 100 %

795 78 %

701 69 %

616 61 %

Physical Background of High Altitude Climate

Chronic Physiological Effects – HIF-α Hypoxia-inducible factors (HIFs) are transcription

factors that respond to changes in available oxygen in the cellular environment, specifically, to decreases in oxygen, or hypoxia

• Increase of erythropoietin (EPO) – development of erythrocytes

• Upregulation of several genes to promote survival in low-oxygen conditions, incl. glycolysis enzymes (anaerobic glycolysis, glucose absorption)

• Angiogenesis (growth of new blood vessels from pre-existing vessels) – improvement in oxygen transport

4

Physiological Adaptation of Training and Rest in Altitude

• Increase in erythrocytes and reticulocytes in response to greater release of the hormone erythropoietin (EPO) by the kidneys

• Production of new capillaries

• Oxygen absorption and transportation capacity increases

• Increase in oxygen utilization

• Increased economy of the cardiovascular system

• Optimization of heart rate at rest

• Improved aerobic and anaerobic endurance performance

• Exercising at altitude has been shown to cause muscular adjustments of selected gene transcripts, and improvement of mitochondrial properties in skeletal muscle 5

What is Altitude Training? Altitude training is the practice by some endurance athletes of training for several weeks at high altitude At this altitude the air still contains approximately 20.9% oxygen, but the barometric pressure and thus the partial pressure of oxygen is reduced Depending very much on the protocols used, the body may adapt to the relative lack of oxygen hypoxia When the 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 The increase in red blood cells can mean 3% - 5% more speed,

endurance, and power

Oxygen Saturation - SaO2

We receive the best results if the training takes place in an hypoxic environment where an arterial oxygen saturation (SpO2) of 82 - 88% SpO2 is present.

Above 90% the stimulus for an effective adaptation is too low

Below 80% the extreme reduction of the movement influences the performance results

HISTORY The study of altitude training was stimulated during and after the 1968

Olympics in Mexico City, Mexico at an elevation of 2,240 metres (7349 ft)

It was during these Olympic Games that endurance events saw significant below-record finishes and anaerobic and sprint events broke all types of records

These games inspired investigations into altitude training from which unique training principles were developed with the aim of avoiding underperformance

Kenyans tend to medal time after time in the Olympic track and field events (2012 medal count : 14)

Why the athletes who train there often cross the finish line first in major marathons? 

The answer may have far less to do with drive and determination—and everything to do with elevation! 

It’s possibly due to the fact that winning athletes often live or train at altitude

That effect only lasts around 10 days to two weeks, but that’s long enough to give most athletes the competitive edge in competition

Doping

Injections of synthetic EPO 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

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

Training Regimens Athletes or individuals who wish to gain a competitive edge for

endurance events can take advantage of exercising at high altitude 

Scientific studies on high-altitude training regimes were carried out on elite athletes close to their ultimate performance potential: these same training regimens are expected to be effective on ordinary athletes further from their peak potential

Altitude Exposure Techniques Various techniques have been devised in order to expose the

athlete to the beneficial effects of high altitude whilst not reducing their ability to train effectively

Live High – Train High Live Low – Train High Live High – Train Low The typical altitudes used are around 2000-2500m, which in

itself reduces the risk of some of the unhelpful effects of altitude exposure

Live-high, Train-high In the live-high, train-high regime, an athlete lives and trains at a desired

altitude The stimulus on the body is constant because the athlete is continuously in a

hypoxic environment Maximum exposure to altitude Evidence of a positive effect at sea level is controversial Less support for this method amongst experts After long periods of training at altitude, highly trained athletes returning to

sea level do not exhibit increased red blood cell count or improved performance on 4000m cycling tests

Live-low, Train-high The athlete is exercising in a low oxygen environment,

whilst resting in a normal oxygen environment Some interesting findings suggesting that this technique

might work No good studies showing that the technique makes any

difference to the ultimate competitive performance of the athlete at sea-level

Training intensity is reduced so some athletes may find that they actually lose fitness using this regime.

Live-high, Train-low The body will acclimatise to altitude by living there, whilst training

intensity can be maintained by training at (or near) sea level The beneficial effects of altitude exposure are harnessed whilst some of the

negative ones are avoided The residence at altitude must be for more than 12 hours per day and for at

least 3 weeks Improvements in sea-level performance have been shown in events lasting

between 8 and 20 minutes Athletes of all abilities are thought to benefit A non-training elevation of 2,100–2,500 metres (6,900–8,200 ft) and training

at 1,250 metres (4,100 ft) or less has shown to be the optimal approach for altitude training

The US Olympic speed skating team successfully integrated several LH+TL altitude-training methods in preparation for the 2002 Salt Lake City Winter Olympics

In recent years, the US speed skaters have worked out an agreement with several of the Scandinavian speed skating teams to use nitrogen apartments and dormitories located in those countries

As they did at the 2002 Winter Olympics, US speed skaters performed very well in the 2006 Torino Olympics, capturing three gold, three silver, and one bronze medal

.

Live-high, Train-low 2,000m-2,500m: The optimum altitude for acclimatisation 28 days: Number of days required for noticeable increase in

red blood cell count 22 hours: Daily exposure sufficient to boost performance

Good venues for live-high train-low– Mammoth Lakes, California– Flagstaff, Arizona– Sierra Nevada– Near Granada in Spain– Rift Valley in Kenya

Repeated sprints in hypoxia In repeated sprints in hypoxia (RSH), athletes run short sprints under 30 seconds

as fast as they can They experience incomplete recoveries in hypoxic conditions. The exercise to rest time ratio is less than 1:4, which means for every 30 second

all out sprint, there is less than 120 seconds of rest

When comparing RSH and repreated sprints in normoxia (RSN), studies show that RSH improved time to fatigue and power output

Possible physiological advantages from RSH include compensatory vasodilatation and regeneration of Phosphocreatine (PCr)

RSH is still a relatively new training method. For it to be fully understood and trusted, more double blind studies must be conducted

Problems of Altitude Exposure Acclimatisation to high altitude is not simple There are a number of other effects that could cancel out the above

benefits– Too many blood cells may make the blood thicker and can make blood flow sluggish– Can actually decrease the amount of oxygen getting to where it is needed

At very high altitudes (>5000m) weight loss is unavoidable because your body actually consumes your muscles in order to provide energy

Risk that the body’s immune system will become weakened - an increased risk of infections

The body cannot exercise as intensely at altitude - reduced training intensity - which can reduce performance in some sports

Problems of Altitude Exposure Adverse changes in the chemical make-up of the muscles Loss of appetite, inhibition of muscle repair processes and excessive work of

breathing Altitude illnesses can dramatically reduce the capacity to be active at altitude, or

foreshorten the exposure to high altitude altogether– Acute mountain sickness (AMS) is caused by acute exposure to low air pressure (usually

outdoors at high altitudes). It commonly occurs above 2,400 metres– Acute mountain sickness can progress to high altitude pulmonary edema or high altitude

cerebral edema Dehydration, often confused with altitude sickness, occurs due to the higher rate of

water vapor lost from the lungs at higher altitudes Tremendous expense and logistical problems

Artificial altitude

In an effort to reduce the financial and logistical challenges of traveling to altitude training sites, scientists and manufactures have developed artificial altitude environments that simulate the hypoxic conditions of moderate altitude

Altitude simulation systems have enabled protocols that do not suffer from the tension between better altitude physiology and more intense workouts

Such simulated altitude systems can be utilized closer to competition if necessary

Methods used for training in hypoxia

• Supplemental Oxygen

• Hypoxic Sleeping Devices

• CAT Hatch

• Hypoxic Tent System

• Intermittent Hypoxic Exposure (IHE)

• IHE at Rest

• IHE During Exercise

Supplemental Oxygen

•It is a modification of the ‘live high – train low’

•Is used by athletes that live in a natural terrestrial altitude environment but train at ‘sea level’ with the aid of supplemental oxygen

•Scientific data regarding the efficacy of hyperoxic training suggest that high-intensity workouts at moderate altitude (1860m/6100ft) and endurance performance at sea level, may be enhanced through the use of supplemental oxygen

Hypoxic Sleeping Devices

• This systems are designed to allow athletes to sleep high and train low

CAT Hatch• It is a cylindrical hypobaric chamber• Can simulate altitudes up to approximately 4575m

Hypoxico Tent System• This modality can be installed over a standard

double or queen-sized bed.• simulates elevations up to approximately

4270m

Intermittent Hypoxic Exposure (IHE)

•Is based on the fact that brief exposures to hypoxia (1.5 to 2.0 hours) stimulate the release of EPO

•Athletes typically use IHE while at rest or in conjunction with a training session

•The IHE allows the athlete to ‘live low-train high’

•Athletes typically use IHE while at rest, or in conjunction with a training session

•Data regarding the effect of IHE on hematological indices and athletic performance are minimal and inconclusive 

Application of Altitude/Hypoxic Training by Elite AthletesRANDALL L. WILBER Athlete Performance Laboratory, United States Olympic Committee,

Colorado Springs, COMed. Sci. Sports Exerc., Vol. 39, No. 9, pp. 1610–1624, 2007.

At the Olympic level, differences in performance are typically less than 0.5%. This helps explain why many contemporary elite endurance athletes in summer and winter sport incorporate some form of altitude/hypoxic training within their year-round training plan, believing that it will provide the competitive edge to succeed at the Olympic level.

This paper has presented both anecdotal and scientific evidence relative to the efficacy of several contemporary altitude/hypoxic training models and devices currently used by Olympic-level athletes for the purpose of legally enhancing performance.

Live high + train low altitude training is employed by elite athletes using:– Natural/terrestrial altitude– Normobaric hypoxia via nitrogen dilution (e.g., nitrogen apartment) or oxygen

filtration (e.g., hypoxic tent)– Hypobaric normoxia via supplemental oxygen

High Altitude or Nitrogen House In Finland, a Finnish sport physiologist Heikki Rusko had 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) - roughly equivalent to the amount of oxygen available at 2,500 m (8,200 ft) altitude

Athletes live and sleep inside the house, but perform their training outside (at normal oxygen concentrations at 20.9%)

Research conducted by Heikki Rusko on six elite cross-country skiers suggests that training in the nitrogen house is just as effective as training at altitude

He found that changes in critical blood markers and submaximal heart rateLactate were similar among athletes who trained in the nitrogen house compared

to athletes who trained at an altitude camp

Sea level

normobaric hypoxia

Sea level~ 13,9 Vol% O2

normobaric hypoxia

Mountainlow pressure chamber – 3.000 altitude hypobaric

hypoxia

20,9 % 78,1 % 0,96 % 0,03 %

(40-60% rel. steam)

1.013 hPa 212 hPa

791 hPa

OxygenNitrogennoble gas carbondioxidesteam

air pressure O2 - partial press.N2 - partial press.

13,9 % 84,4 % 0,96 %

< 0,07 % (40-60% rel. steam)

1.013 hPa 141 hPa

855 hPa

OxygenNitrogennoble gas carbondioxidesteam

air pressure O2 - partial press.N2 - partial press.

OxygenNitrogennoble gase carbondioxid steam

air pressure O2 - partial press.N2 - partial press.

20,9 % 78,1 % 0,96 %

0,03 % (reduced)

701 hPa 141 hPa

553 hPa

Physical Background of High Altitude Climate

Artificial altitude can also be used for hypoxic exercise, where athletes train in an altitude simulator which mimics the conditions a high altitude environment

Athletes are able to perform high intensity training at lower velocities and thus produce less stress on the musculoskeletal system

Beneficial to an athlete who suffered a musculoskeletal injury and is unable to apply large amounts of stress during exercise which would normally be needed to generate high intensity cardiovascular training

Hypoxia exposure for the time of exercise alone is not sufficient to induce changes in hematologic parameters

Hypoxico Inc pioneered the artificial altitude training systems in the mid 1990s

Innovation High Altitude

LOXYMED® Concept

This system is based on the technology that enables the creation of small high altitude training areas as room-in-room solution for active training and passive stay

Contain all the key technology

Excels by its compatibility and flexibility in terms of setup and utilization

The quality of the atmosphere generated by this technology is unmatched and has set a new standard in simulated altitude training

The athlete is confronted with the same anoxic effect (hypoxia) as is usually prevailing in natural heights

The training and stay in this system results in the same performance enhancing physical adaptations known from natural heights

Additional technical features present in the systems can raise the altitude limit stepwise to a training height of 4500m

Specially designed software ensures the effective use of high altitude climate

Assisted by the software and several sensors within the hypoxic training room a full automatic control panel processes the climate-data collected and ensures a consistent atmosphere in the cabin

The hypoxic training is fully acclimatized

The temperature within the hypoxic training room can be altered before and during the stay or training

 The system also automatically controls the carbon dioxide level in the room keeping the concentration below 0.5 vol % at all times

Very user friendly for the athletes

Establishing a pre-selected height in the hypoxic room takes about 30-40 min (for altitudinal levels above 3000m it may take longer but not more than 1 hour)

At any point of time 6-8 athletes can undergo altitude training within the room

Within the hypoxia room all types of training equipment can be placed

A group of athletes with similar physical, physiological & performance parameters can be subjected to altitude training and the response can be compared

Sport Science Research Center - Shanghai / China

High Altitude CenterTraining Area Room

Area 90 m2

Room Volume 320 m3

Max. Altitude 6.000 m

Max. Number of User 12

Realised 07/2004

6 Sleeping Areas Rooms

Area á 12 m2

Room Volume á 30 m3

Max. Altitude 4.000 m

Max. Number of User á 4

Realised 07/2004

Installation Plan

Sport Science Research Center - Shanghai / China

LOXYMED® - Centre for High-End Medical Care - Berlin / Germany

Rehabilitation Area

Cardio-Training Area incl. Multivision

Alpin Area

Sport University - Beijing / China

21 Sleeping Areas Rooms

Area á 13 m2

Room Volume á 40 m3

Max. Altitude 4.000 m

Max. Number of User á 2

Test Laboratory Room

Area 45 m2

Room Volume 135 m3

Max. Altitude 6.000 m

Max. Number of User 4

Training Area Room

Area 90 m2

Room Volume 270 m3

Max. Altitude 6.000 m

Max. Number of User 10

Army Sports Institute - Pune / India

Training Area Room

Area 43 m2

Room Volume 175 m3

Max. Altitude 6.000 m

Max. Number of User 6

Realised 10/2008

Training under artificial altitude conditions

Compared to the training in natural high-altitude settings, training in low-lands brings along the following advantages:

The habitual day-to-day life can be maintained An optimal nutrition can be kept up Medical and psychological assistance can be secured Independance of weather and climatical conditions Avoiding all physical complaints that are being related to low air

pressure and extremely dry mountain air

Avoidance of long travels and high travel costs

Providing innovative, methodological solutions for training

While endurance training can be performed under hypoxia, intensive

training can be performed just the same day under normal conditions

Prior to high-altitutde travels, the training provides the possibility to

specifically adapt to the respective atmospherical conditions

SLEEP HIGH, TRAIN LOW EVERYWHERE!

Training under artificial altitude conditions

The altitude house or nitrogen house can be used to simulate moderate altitude living atmosphere at sea level and to stimulate EPO at sea level in athletes, and the living high and training low approach seems to give all the benefits of altitude acclimatization and seems to have the potential to avoid the problems related to normal altitude training

It seems to provide the best approach for the enhancement of the sea-level performance in athletes

Can be built almost anywhere as a fixed or mobile facility It may be the most cost-effective way to deal with teams of athletes - they

offer the athlete a fair, safe and cost effective altitude training system

So, optimizing the altitude training formula of how high to go and how long to stay there could be the difference between ”Raising the Cup” or going home early