Recently got a great question from a bboy who lives in South Africa:
“In Johannesburg, it is said that because we are higher on the plateau that it is harder on our breathing when we break. So when bboys travel from the coast, is it harder for them to battle?” - Bboy Laba
This is true. For athletes who travel often for competition, altitude is something to keep in mind.
Let’s talk about how this works, how the body can adapt, and what can and can’t be done about this interesting phenomenon. Furthermore, is there any truth to the hype around “altitude training”?
This article ended up longer than expected, so check out the summary at the end!
- How Altitude Affects Performance
- Pre-Acclimatization Strategies
- Altitude Training
How Altitude Affects Performance
Most of the worlds population live near the ocean – living within about 1000 meters (m) of sea level. However, many cities further inland can reach elevations of 2000 – 4000m!
If you live near sea level, traveling to a city of much higher elevation (>2500m) can cause ‘acute mountain sickness’ (AMS) and cause a large decrease in endurance exercise performance! 1
How bad could it be? If you rapidly ascend to an elevation of 4300m, there’s an 80% chance you’ll get sick, and the endurance deficit can be 60% or greater! 1 Ouch!
Why? At high altitudes, both air pressure and oxygen is reduced. This lowers the ‘partial pressure’ of oxygen at these elevations. In these environments, you can’t take up oxygen from the air quite as well. If you’re a nerd and want to learn more, here’s a great webpage about the interesting physiology of the respiratory system.
Once again, don’t underestimate your body’s ability to adapt! Over time, the body deals with this through a number of physiological adaptations in a process called ‘acclimatization’ – for example: increasing red blood cell volume (RCV). 2 After a few days, you don’t get sick as easily, and after a few weeks, endurance increases significantly compared to when you first arrived.
When this became widely known, it was assumed that athletes living in higher altitudes have an advantage when competing at lower altitudes. Of course, athletes all over the world started “altitude training” – traveling to train at higher altitudes for the potential benefits. And when this wasn’t feasible, tents, masks, and entire training facilities have been built to mimic the environment.
All interesting stuff, but we must ask ourselves some important questions:
- What’s the best way to ‘acclimatize’?
- Does “altitude training” make you better at sea level?
- Should you spend any money on these devices or training facilities?
Let’s take a look at the latest research:
You could always just go right to the top and suck it up. Typically, it only takes a few days to get over the sickness, and a few weeks to improve your endurance. Of course, most athletes only have a weekend to travel to events, often competing on the same day!
To avoid the effects described above, there are a number of strategies that you can use to acclimatize yourself before you reach your destination.
Recently, a research review article was published in the journal Exercise and Sport Science Reviews 1 that looked at which pre-acclimatization strategy was most effective for people aiming to travel to an elevation of 4300m.The research studies involved either sending people to higher elevations, or using artificial rooms or ‘hypobaric chambers’.
The review found that pressure was an important factor. When athletes we’re subjected to a ‘hypoxic-normobaric’ or ‘HN’ (low in oxygen, normal air pressure) environment, the acclimatization was barely effective. But when the environment was both ‘hypoxic-hypobaric’ or ‘HH’ (low oxygen, low pressure), it was significantly effective.
Here are the strategies, in order of effectiveness:
- MAR – Moderate Altitude Residency – living for about two years at a moderate elevation (2000-3100m). Highly effective (significantly reducing AMS and the decrease in endurance upon arrival at 4300m), but not very realistic!
- IAE 15 – Intermittent altitude exposure – spending 4 hours each day in HH conditions for 15 days. Highly effective, and much more convenient than MAR!
- Staging – staying at a moderate altitude for a week before proceeding, or a slow gradual ascent to the target altitude. This strategy works well, but is time consuming.
- IAE 7 – Intermittent altitude exposure – spending 4 hours each day in HH conditions for 7 days. Just as effective as ‘Staging’.
- NH Sleep or NH Awake – Spending either 6 days, or 7 nights (sleeping) under NH conditions.
- As you can see, the most effective methods are the ones that expose you to lower pressure and lower oxygen for longer periods of time.
- However, hypobaric chambers are expensive and very uncommon (usually in research labs and military facilities). You can’t just book an appointment at your local gym like the tanning machine!
The good news:
There are very few cities of high elevation in which big athletic events occur. It seems things don’t become much of a problem until you reach 2500m and beyond – and not many cities reach these heights. Mexico city reaches 2240m, and Johannesburg reaches 1753m. Check out this Wikipedia list of large cities with high elevations. Unless you are traveling to Peru or Bolivia, you don’t have much to worry about.
If you are worried about your performance, travel to your destination as early as you can afford, and be sure to train there as well. Even one day can help you get over a lot of the elevation sickness.
So, we know that acclimatizing yourself to higher altitudes will cause adaptations to deal with the lower pressure and oxygen in the air. But does this mean these adaptations make you even better at sea level? Another research review article has been published, this time in the British Journal of Sports Medicine, named ‘Does ‘altitude training’ increase exercise performance in elite athletes?’. 2
The review covered research on four different strategies:
- Live high-train high – Athletes both live and train at a higher altitude to gain the adaptation benefits. It turns out that while adaptations do occur, the athletes can’t exercise as hard at the higher altitudes, so the effects we’re not that impressive. The lack of training intensity potentially cancels out the altitude adaptations!
- Live high-train low – This involves living at a higher altitude, but then returning to a lower altitude to train more intensely. The research is mixed, however, and most studies didn’t control for the placebo effect. Furthermore, it seems elite athletes don’t gain much, because they already have strong adaptations, such as high red blood cell volume (RCV) – especially for elite endurance athletes.
- Live low-train high – This involves living at a normal elevation, and then training at higher elevations or in special facilities. It’s the easiest method to sell, but there is no good evidence to suggest it works. Think about it: the typical amount of time spent at a training facility is not long enough to induce adaptations, and athletes can’t train as hard either!
- Intermittent hypoxia at rest – This involves repeated exposure to hypoxic air for relatively short durations throughout the day, or while sleeping. Another easy method to sell (masks, tents, etc.), but once again – no good evidence that it works. It seems these methods are missing the drop in air pressure that seems vital to making significant adaptations.
For lower or moderate level athletes, it seems “live high-train low” might actually work. But it’s very inconvenient, and the only people who would be willing to put themselves through it are elite athletes – who probably wouldn’t gain much from it anyway!
Now that we understand how acclimatization actually works, it’s no surprise that the research for hypoxic masks and tents seems unconvincing, and their use remains controversial. Maybe these things do work, and research studies haven’t been designed well enough to detect their benefit.
But here’s the thing – if there are any benefits, they shouldn’t be that hard to prove! And when something is controversial, is it worth the expense and inconvenience? Probably not.
- Altitude does matter, but only for very high altitudes of 2500m or more. Most major cities hosting athletic events do not reach these heights.
- For altitudes that are higher than you usual (but not reaching that 2500m mark), there may be small effects – most of which can be avoided by traveling to the destination 1-3 days early.
- If you have to go beyond 2500 m, it seems “staging” is the most practical method – spend a few days at an elevation that’s in the middle before heading to the top.
- Just because your body can adapt to high altitude, doesn’t mean it will make you even better near sea level – the scientific evidence for “altitude training” is underwhelming. Don’t believe the hype!
In conclusion, most athletes do not need to worry about these things (unless traveling for a marathon at an exceptionally high altitude).
I must admit, I’m no expert on this topic, so I learned a lot preparing for this article. I’d like to thank the man who asked me the question: good one Laba! And thank you everyone for reading. Keep asking great questions!
1. Fulco CS, Beidleman BA, & Muza SR (2012). Effectiveness of Pre-Acclimatization Strategies for High Altitude Exposure. Exercise and sport sciences reviews PMID: 22653279
2. Lundby C, Millet GP, Calbet JA, Bärtsch P, & Subudhi AW (2012). Does ‘altitude training’ increase exercise performance in elite athletes? British journal of sports medicine PMID: 22797528