Dr. Guido Vroemen: Operation & principles for altitude training

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 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.

With the award of the 1968 Olympic Games to Mexico City, the question arose how to prepare for sports performances at an altitude of 2240 meters. The knowledge about the functioning of the human body at height was greatly expanded in a short time. Logically, a clear positive effect was found altitude training on the performance at height. It was interesting that this was also the case with simulated altitude training. The adaptations of the body due to a prolonged stay at a height seem to largely correspond with the effects of endurance training. The link was therefore quickly made between a possible positive effect of altitude training on sea level performance.

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 either EPO produce. This stimulates the bone marrow to increase the production of young red blood cells (reticulocytes). Reticulocytes eventually become full-fledged red blood cells (erythrocytes). The minimum height to stimulate the production of EPO is around 2000 meters. Higher than 3000 meters, the increase in erythrocytes is clearly larger, but the maximum oxygen uptake (VO2max) drops to such an extent that it becomes difficult to administer an adequate training stimulus. At that level, it is simply no longer possible to train at a competitive pace. In addition, the chance increases altitude sickness to. Already after three days, the EPO concentration has increased by as much as 50 to 100%. After a week this gradually drops again to values that are slightly higher than at sea level. The increase in the amount of erythrocytes also increases the amount of hemoglobin because this is an important component of the erythrocytes. Hemoglobin can bind oxygen molecules to itself, so that the oxygen supply to the muscles is restored. Hemoglobin is an iron-containing protein molecule. For an adequate production of the hemoglobin, it is therefore wise to include extra iron in the diet during your stay at height. In addition, it is good to take extra anti-oxidants 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 one 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 appears to be a positive effect of altitude training when the LHTL method is applied. Within this, you can again vary with additional high training blocks. Although the effects of this are scientifically difficult to demonstrate, coaches and athletes with the necessary specialist knowledge and skills are still achieving good results. In a large group, on average, it may not be possible to demonstrate significantly that altitude training has a positive effect on performance at sea level, but there are large differences between individuals individually. There are people who feel a lot stronger and actually perform better. Even so, there are also people who do not respond at all to the altitude internship or even feel a bit worse. The effect of an altitude training cannot be estimated in advance. Everyone should try this for themselves. Extensive objective testing must then be carried out both before and after the height training placement to be able to assess the effect. A positive effect of a height internship on the performance level is simply also often the result of being able to train well without distraction from work and daily worries. A holiday at sea level with a well-planned training load can have the same effect for a large group of athletes.


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