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Aim High

High-altitude Training Brings Benefits To Athletes

The theory underlying the belief that training at high altitude can enhance athletic performance sounds reasonable enough: Work out in an environment that causes the body to produce more oxygen-carrying red blood cells and an athlete will be able to perform better than he or she can when trained at a lower elevation.

Proponents of this theory point to East African runners, who have dominated long-distance events in recent years, as proof that training at high altitudes pays off. But if that’s the case, why don’t runners from other high-altitude countries such as Peru and Mexico perform equally well? And why do some athletes excel in endurance sports despite having never trained at high altitude?

“[High-altitude training has] had so much press that certain athletes feel like they’re at a disadvantage if they’re not doing altitude training,” says Andrew Subudhi, a researcher at the Altitude Research Center in Denver and assistant professor of biology at the University of Colorado in Colorado Springs. “There’s a big movement for endurance athletes to move to high altitude if they’re serious about [improving their performance].”

Into Thin Air

But does it really help? Answering that question is harder than one might think, despite numerous scientific studies on the relationship between altitude and athletic performance. The issue reached prominence at the 1968 summer Olympics in Mexico City (elevation 7,349 feet), when questions arose about the best way to prepare for competing in the thin air, Subudhi says.

“Thin air” is a term used to describe air that contains less oxygen than air at sea level (20.9% at sea level compared with 15.3% at higher altitudes). The number of red blood cells found in the body of an endurance athlete who does not live and train at high altitudes may be insufficient to supply the amount of oxygen needed at higher altitudes.

To help deal with this problem, athletes may live and train at high altitudes several weeks before a competition to increase the number of red blood cells, which are produced in response to greater release of the hormone erythropoietin. More red blood cells allows a person’s blood to carry more oxygen, which partly makes up for the shortage of oxygen in the air.

Studies have found that athletes do perform better in competitions held at high altitudes if they live and train at high altitudes prior to competition, Subudhi says, but training at high altitudes does not necessarily help athletes perform better at low altitudes as one might assume.

“When you’re at altitude, you can’t train as hard, and when you’re not training as hard, you’re not getting the same training stimulus,” he says. “Training at altitude doesn’t mean you’ll do well at sea level.”

Then again, that doesn’t mean that you won’t, says Jack Daniels, PhD, head distance coach at the Center for High Altitude Training at Northern Arizona University. Daniels says the key benefit to training at higher than normal altitudes is that it teaches an athlete how to hurt, and learning to tolerate pain can help athletes push themselves harder than they would otherwise. “It’s good for an athlete to learn to really lay it out there, and it’s easy to do that [in high altitude] without working quite as hard,” says Daniels, who has coached 31 individual NCAA national champions in his career. Although there are benefits to training at altitude, Daniels says, the advantages one might gain are unimportant when compared with more mundane factors.

No matter where people train, he says, they want comfortable housing, healthy food, a friendly atmosphere, good training facilities, desirable weather, and adequate medical and therapy attention. “In other words, you train best where you are happiest,” Daniels says. “If you can have that at altitude, that's good, but if you do altitude-type things and don't have those other things, then you are wasting your time. It is very disturbing to me to hear people say, ‘If you don't train at altitude you may as well not bother trying.’ I think we have all the things an athlete would want right here, but anyone who comes here and is not happy, I encourage to leave.”

Live High, Train Low

Daniels also doesn’t believe in another philosophy that has gained considerable support in recent years from researchers who have studied the altitude-performance relationship. Known as “live high, train low,” this philosophy holds that endurance athletes benefit most from living in high-altitude conditions but training at low altitude where they are able to push themselves harder.

The term “live high, train low” came into being in 1996 when researchers James Stray-Gundersen and Benjamin Levine studied the relationship between altitude, training, and performance using three groups of endurance athletes. One group lived and trained in Park City, Utah, (elevation 7,000 feet) while another group lived there and trained at a lower altitude. A third group lived and trained in San Diego (elevation 72 feet). After the four-week training period ended, all were tested at a low altitude. “They found that the group that lived high but trained low got the best benefit; that was measured in 5-kilometer time trials.” Subudhi says.

The reason for the improved performance among the live-high, train-low group, researchers hypothesized, is that by living in high-altitude conditions, their bodies produced more red blood cells in response to the lower concentration of oxygen. And because these athletes trained at a lower elevation, they were able to push themselves harder than they would have at higher altitudes, resulting in a higher training stimulus.

The results of this and other studies received so much media attention that companies began manufacturing masks, tents, and rooms that would allow athletes to live anywhere in high-altitude conditions. Devices cost anywhere from hundreds to thousands to tens of thousands of dollars. Some companies convert entire houses to these conditions, and both Finland and the United States have outfitted dormitories in this way. Manufacturers claim benefits can occur from as little as six to eight hours of exposure.

But those claims are not supported by research, Subudhi says, who contends 15 to 16 hours per day exposure is supported by research. Exercise rooms designed to mimic high-altitude conditions can benefit athletes who live at low altitudes and are planning to compete at a high altitude, he says: “If your competition is at altitude, then you need to train at altitude.”

Altitude Advantage

The only danger associated with the use of such devices is reducing oxygen levels too quickly, and almost everyone will experience more difficulty sleeping, Subudhi says. However, it’s rare to see athletes suffering from acute mountain sickness, commonly known as altitude sickness, or from high-altitude pulmonary or cerebral edema among those who live at an 8,000- to 9,000-foot altitude, he says. Plus, benefits are temporary: An athlete who stops living under high-altitude conditions will begin to see a loss in benefits in about two weeks as extra red blood cells die off, he says.

Bob Cranny, PT, owner of Altitude Physical Therapy and Sports Medicine in Boulder, Colo., is a big believer in the benefits of training at altitudes of 2,500 feet or greater. He and his wife are both triathletes and marathon runners who moved to Boulder (elevation 5,430 feet) 12 years ago from Long Beach, Calif., because they believed the higher altitude would enhance their performance.

Many athletes in the area follow the live-high, train-low philosophy, although it might more accurately be described as “live high, train lower.” That’s because many athletes who train in Boulder live at elevations of around 9,000 feet and travel to Boulder’s 5,430-foot elevation to train, as opposed to sea level. “If you could live at 9,000 feet and train at sea level, that would be even better — that would be wonderful,” Cranny says.

So the answer to the question of whether training at high altitude will enhance an athlete’s performance is: maybe. Training at altitude will help some, while other athletes might benefit best from alternate training methods. “I see altitude as a type of training, and if this type suits you then it is good,” Daniels says.

Scott Williams is a medical writer for the Gannett Healthcare Group. To comment, e-mail