I love TQTs!





Living high and training low

[This article originally appeared in the September 2000 issue of Northwest Runner magazine.]

High-altitude training is admittedly a complex topic. At its core, however, it is basically a "natural" form of blood doping.

So what is blood doping? Does it really improve endurance performance? And is altitude training a sensible alternative? Let's address each of these questions in turn.

The term "blood doping" refers to the practice of increasing the number of red blood cells (RBCs) in one's circulatory system, either by receiving a blood transfusion or by taking erythropoietin ("epo" for short), a hormone that promotes RBC production. Since RBCs carry oxygen from the lungs to the rest of the body, adding more of them to one's circulation should enhance the delivery of oxygen to one's muscles. Improved oxygen delivery, in turn, might help the muscles perform better.

A substantial body of research has shown that blood doping does in fact improve endurance performance. Buick et al. (Journal of Applied Physiology 48: 636-42, 1980) and Spriet et al. (Journal of Applied Physiology 61: 1942-8, 1986) found that the VO2max (capacity to consume oxygen) of trained runners increased in response to a blood transfusion. In these studies and that of Williams et al. (Medicine and Science in Sports and Exercise 13: 169-75, 1981), the runners were also able to run faster and/or longer on treadmill endurance tests when they were blood-doped. And while all of this research was conducted on men, an investigation of active young women (Robertson et al., Journal of Applied Physiology 57: 568-75, 1984) has confirmed that they too perform better after blood doping.

The real world

A common critique of laboratory studies is that they don't reflect real-life situations. In this case, though, the lab results have been corroborated by a double-blind field study (Brien & Simon, Journal of the American Medical Association 257: 2761-5, 1987) in which runners performed better in an actual 10K race after blood doping. In addition, a study of cross-country skiers (Berglund & Hemmingsson, International Journal of Sports Medicine 8: 231-3, 1987) showed that doped skiers outperformed non-doped ones in a 15K race.

While the above paragraphs make blood doping sound wonderful, it has some serious drawbacks. It can be life-threatening if performed without appropriate medical supervision; it is generally considered to be a form of cheating; and it is forbidden by many athletics governing bodies. (Details can be found in the American College of Sports Medicine's position stand on "The Use of Blood Doping as an Ergogenic Aid" [Medicine and Science in Sports and Exercise 28: i-viii, 1996].) For these reasons, among others, many athletes have turned to altitude training as an alternative to blood transfusions and erythropoietin treatments.

It is well established that the human body responds to high-altitude, low-oxygen environments by producing more RBCs. Thus, by living well above sea level, athletes may improve their oxygen-carrying capacity -- and presumably their sea-level performances as well -- in a safe and ethical manner.

Contrary to the above logic, most carefully controlled studies of altitude training (Hansen et al., Journal of Applied Physiology 23: 511-22, 1967; Adams et al., Journal of Applied Physiology 39: 262-6, 1975; Svedenhag et al., Scandinavian Journal of Medicine and Science in Sports 1: 205-14, 1991) have found it to be no better than sea-level training in terms of improving sea-level VO2max or endurance performance. Levine & Stray-Gundersen (International Journal of Sports Medicine 13[Suppl. 1]: S209-12, 1992) have attributed these results to the fact that athletes can't do their normal fast-paced workouts while at high altitude. In other words, if your training goes downhill, you may forfeit the fitness that you would otherwise gain from living at altitude.

Given these complications, Levine & Stray-Gundersen have proposed a "live high, train low" model of altitude training in which athletes live at high altitude but drive down to lower elevations for their runs. The main goal of this model is to allow athletes to increase their RBC production while also allowing them to maintain the quality of their training.

The effectiveness of the "live high, train low" approach has now been verified in a thorough report (Levine & Stray-Gundersen, Journal of Applied Physiology 83: 102-12, 1997) based on several years of work. In this exhaustive study, 39 competitive runners (27 men and 12 women) were divided into three groups: "live low, train low," "live high, train high," and "live high, train low." While the methodological details are beyond the scope of this article, the key finding was that the "live high, train low" runners improved their 5K times by an average of 13 seconds after four weeks of living high and training low, whereas the other two groups did not get faster.

Individual results may vary

Although the "live high, train low" program appears to bolster the fitness of trained runners, a follow-up study (Chapman et al., Journal of Applied Physiology 85: 1448-56, 1998) revealed that individuals vary greatly in their responses to altitude. Thus, not all athletes will benefit equally from living high. Furthermore, it is possible that different individuals may be best suited to different elevations. In their 1992 article, Levine & Stray-Gundersen speculated that altitudes of 2,200 to 4,000 meters (7,200 to 13,100 feet) might be optimal for most athletes. They are continuing to explore this issue in their current research, however, and we can expect a more definitive recommendation from them within the next couple years.

Also yet to be resolved is the question of how long one should live at altitude in preparation for a subsequent sea-level race. The "live high, train low" studies mentioned above included four weeks of living high, so four weeks is evidently enough to benefit most athletes. Berglund (Sports Medicine 14: 289-303, 1992) has argued that sojourns of 10 to 12 weeks may permit more complete cardiovascular adaptations than can occur during a four-week training camp. This viewpoint is based on limited data, however, and has not yet been tested in a full-scale investigation. In addition, the ideal duration of a visit to high altitude may depend on the altitude at which one is staying.

A final point concerns the use of hypoxic (low-oxygen) chambers. Many top athletes sleep in these chambers in order to expose themselves to high-altitude conditions without having to move to the mountains. However, the efficacy of this tactic has been called into question by two recent studies (Ashenden et al., European Journal of Applied Physiology 80: 472-8, 1999; Ashenden et al., European Journal of Applied Physiology 80: 479-84, 1999) in which 12 to 23 nights in a low-oxygen "nitrogen house" failed to boost RBC production in a group of Australian cyclists, skiers, and triathletes. It is possible that spending eight to ten hours per day in high-altitude conditions is simply not enough to "trick" the body into adapting to high altitude. (For more on this topic, please see my July 2001 column.) Clearly, while much has been learned about altitude training, much remains to be discovered as well. Stay tuned; the next few years should be interesting!

Research-based coaching menu
overview  |  articles  |  links