Guido Vroemen is a sports doctor and owner of sports medical advice center (SMA) Central Netherlands. In addition to being a sports doctor, Guido is also a Medical Biologist and a Triathlon Trainer. We asked Guido for it the operation & principles of altitude training to explain.
Many (top) athletes regularly stay at height to be able to perform optimally in competitions. Does this stay at altitude really make sense and what can you do as a hobby athlete with all the scientific knowledge in this area.
Your body's reaction is completely natural. The very first mountain climbers soon discovered that the higher they got on a mountain, the more trouble they had to keep going. In percentage terms, there is always almost 21% oxygen present in the air. As the altitude increases, the air pressure becomes lower. This also reduces oxygen pressure and the body has to work harder to get enough oxygen to deliver the same performance. You notice this by accelerated breathing and an increased heart rate during exercise and at rest.
When the 1968 Olympic Games were awarded to Mexico City, the question of how to prepare for sports performance at an altitude of 2240 metres arose. The knowledge about the functioning of the human body at altitude was rapidly expanded. Logically, one found a clear positive effect of altitude training on performance at altitude. Interestingly, this was also the case with simulated altitude training. The adaptations of the body by a long stay at altitude appear to be very similar to the effects of endurance training. The link was therefore quickly made between a possible positive effect of altitude training on performance at sea level.
Height adjustments of the body
At altitude the oxygen pressure in the air is lower. This makes the kidneys more of the world famous hormone erythropoietin or EPO. This stimulates the bone marrow to increase the production of young red blood cells (reticulocytes). Reticulocytes eventually become full red blood cells (erythrocytes). The minimum altitude to stimulate EPO production is around 2000 metres. At altitudes above 3000 metres, the increase in erythrocytes is clearly greater but the maximum oxygen uptake (VO2max) decreases to such an extent that it becomes difficult to provide an adequate training stimulus. At that altitude it is simply no longer possible to train at race pace. In addition, the risk of altitude sickness increases. After just three days, the EPO concentration increases by 50 to 100%. After a week, this gradually decreases to values slightly higher than at sea level. The increase in the quantity of erythrocytes also increases the quantity of haemoglobin as this is an important component of the erythrocytes. Haemoglobin can bind oxygen molecules and thus restore the oxygen supply to the muscles. Haemoglobin is a ferrous protein molecule. For an adequate production of haemoglobin, it is therefore wise to take extra iron in the diet during your stay at altitude. It is also good to take extra antioxidants in the form of vitamins C and E because of the increased stress on the body.
Training principles
Scientists have been struggling for decades with the results of studies on the effects of altitude training on sports performance. It is clear that the body adapts. The blood count in particular changes significantly. In addition, there is an increased production of small blood vessels (capillaries) and more mitochondria (the engine rooms of muscles) are observed in the muscles.
The maximum oxygen uptake (VO2max) is an important measure for the performance level of an endurance athlete. You would therefore expect that due to the adjusted oxygen supply through training and a long stay at altitude, a higher VO2max will be measured (than for altitude training) when an athlete returns to sea level. In practice, however, this rarely appears to be the case. This could be due to the fact that being able to train less intensively at heights will cancel out any gains from the adjustments in the blood.
A variant within the height training is the Live High and Train Low (LHTL) method. This method makes it possible to follow the normal training schedule under sea level conditions. The favorable adjustments of the body at height are then mainly achieved during rest and daily life. When staying in an area where this is possible, however, this can lead to logistical problems and stress by having to move continuously with, for example, the car. A variant of the LHTL principle is the use of a so-called hypobaric chamber. The atmospheric pressure is lowered in an enclosed space so that the oxygen pressure corresponds to that of the oxygen pressure at height. For example, if this is applied in the bedroom, you can sleep at a simulated height.
Another variant is to lower the oxygen concentration in a high altitude tent.
The last option is continuous stay at height and train with the addition of extra oxygen. The big disadvantage is that you have to train continuously with a mask.
A hypobaric room can of course also be used to train at heights. This Live Low Train High principle, however, appears to yield little or no change in blood values if training is done at a height of less than two hours. Longer training sessions also show an increase in, for example, EPO in the blood. Training in a hypobaric room therefore requires some discipline and perseverance in order to make sufficient training hours 'at height'.
Perform at height
Extensive research has shown that the body can adapt to stay at height. This is clear. You simply perform better at height if you stay there for a while. To get used to a height of over 2500 meters, you will soon have to stay at least ten days at that height. For a stay at 3500 meters you quickly have to count off twenty days. To be able to train well, you must not go higher than 2500 meters.
Perform at sea level
As mentioned, there seems to be a positive effect of altitude training when the LHTL method is applied. Within this method, it is possible to vary with additional high training blocks. Although the effects of this are difficult to prove scientifically, coaches and athletes with the necessary specialist knowledge and skills are able to achieve good results. In a large group, it may not be possible to demonstrate significantly on average that altitude training has a positive effect on performance at sea level, but individually large differences can be observed between individuals. There are people who feel a lot stronger and actually perform better. But there are also people who do not react at all to altitude training or even feel worse. The effect of altitude training cannot be estimated in advance. Everyone will have to try it out for themselves. Extensive objective testing is needed before and after the altitude training in order to assess the effect. A positive effect of altitude training on the performance level is simply the result of being able to train well for a period of time without the distractions of work and daily worries. A holiday at sea level with a well planned training load can have the same effect on a large group of athletes.
Conclusion
Does it make sense now to go on a height training internship? If you have a competition at a height it is essential to be able to reach your normal performance level. You will have to try out if an altitude training placement is useful to perform better at sea level. It is then wise to do this on the basis of a well-considered training schedule under the guidance of a specialist. Tests before and after the training period will then show how your body reacts. A relatively inexpensive way to see how your body responds to altitude training is, in collaboration with a specialist sports doctor, completing a training period in an altitude tent where there is a lower percentage of oxygen.
Guido Vroemen
Sports doctor, medical biologist and triathlon trainer
