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Running Performance Digest: Altitude Training

Runners are always looking for ways to improve performance, and there are currently many different strategies that come to play, including diet, shoes, training regimes and changes in altitude (1–6). Despite many years of chasing performance enhancement, there are many questions on which is best to create a good runner. Although there are many different strategies, altitude training under certain conditions can result in improvements in performance, but there are number of variables that need to be considered (1–3).

Altitude training is used by athletes to stimulate physiological adaptations associated with the reduced oxygen availability with the intent to enhance performance when the athlete returns to sea level to compete (1–3). Altitude training can go up to 2000 – 8000 feet above sea level and variations include living high-training high (LHTH); living low-training high (LLTH), such as intermittent hypoxic exposure, continuous hypoxic training, interval hypoxic training (IHT), and repeated sprint training in hypoxia (RSH); living high- training low (LHTL); and living high-training low and high, such as LHTL + IHT or RSH. To date LHTL is widely recognized and relatively effective in improving performance (2), whilst living and training at a high altitude has not been proven to enhance performance when compared to sea level training (3). The LHTL approach allows the body to acclimatize to higher altitude, without resulting in any need to train at high altitudes. The problem that may arise when training at high altitude is a detraining effect (3). This is due to the hypoxic effect of training in an environment with very little partial pressure. Training in a hypoxic state can results in a reduced intensity during training sessions, which will subsequently result in deconditioning (3). When following the LHTL approach, athletes will live high, but remain to train at sea level to maintain regular training intensity and allow for adaptations to high altitude when “living” at increased heights, usually over night (1).

The most common adaptations to LHTL are increased erythropoiesis and capillary density (2). Primarily, the increased erythropoietic response boosts the amount of the oxygen-carrying protein haemoglobin. Together with increased capillary formation this increases the amount of oxygen that can be transported from your lungs to your muscles. Additionally, ‘non-haematological’ adaptations including increased mitochondrial protein synthesis, (oxidative metabolism) and enhanced muscle buffering capacity (helps maintain pH during intense exercise), improved exercise economy, increased storage of glycogen, utilisation of fatty acids, muscle buffer capacity, skeletal muscle oxygenation, and cardiovascular function (1,2).

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*Schematic time courses of various physiological responses to acute hypoxia (altitude) exposure and during acclimatization (7)

Extent of adaptation and performance enhancement depends on several factors, including duration and degree of exposure to low oxygen availability, intensity and distribution of training, scheduling of the altitude training relative to the event date, iron status of the athlete and variability between athletes. Previous studies have recommended altitude of no more than 3000m, with residence lasting for at least 18 days, with 12 hours a day of exposure (1,2).  This should be paired with 4 hours per day of sea level training for best results (2).

References

  1. Ploszczyca K, Langfort J, Czuba M. The Effects of altitude training on erythropoietic response and hematological variables in adult athletes: A narrative review. Front Physiol. 2018 Apr 11;9(APR).
  2. Park HY, Park W, Lim K. Days Enhances Exercise Economy, Hemodynamic Function, and Exercise Performance of Competitive Runners [Internet]. Vol. 18, ©Journal of Sports Science and Medicine. 2019. Available from: http://www.jssm.org
  3. Levine BD, Stray-gundersen J, Stray-Gundersen J. “‘Living high-training low’”: effect of moderate-altitude acclimatization with low-altitude training on performance [Internet]. 1997. Available from: http://www.jap.org
  4. Mills S, Candow DG, Forbes SC, Neary JP, Ormsbee MJ, Antonio J. Effects of creatine supplementation during resistance training sessions in physically active young adults. Nutrients. 2020 Jun 1;12(6):1–11.
  5. Stark M, Lukaszuk J, Prawitz A, Salacinski A. Protein timing and its effects on muscular hypertrophy and strength in individuals engaged in weight-training. Vol. 9, Journal of the International Society of Sports Nutrition. 2012.
  6. Shaw DM, Merien F, Braakhuis A, Maunder ED, Dulson DK. Effect of a Ketogenic Diet on Submaximal Exercise Capacity and Efficiency in Runners. Med Sci Sports Exerc. 2019 Oct 1;51(10):2135–46.
  7. Burtscher M, Millet GP, Burtscher J. Hypoxia Conditioning for High-Altitude Pre-acclimatization. Vol. 4, Journal of Science in Sport and Exercise. Springer; 2022. p. 331–45.