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Whats with Altitude Training

By: Jason Blackham

Imagine yourself running a trail along a trickling stream in the mountains.  It is a bright sunny day with a few white clouds in the deep blue sky.  The flowers in the meadows flash brilliant color.  However, you can hardly enjoy it because you feel like your heart is pounding out of your chest and you are panting worse than a dog as you go up the ridge.  You can’t enjoy it until you stop at the top to see the vista.  As you stop, you think to yourself, at what altitude should I be training?

Much research has been done to determine optimum elevation for training to enhance performance.  The model that has been shown to be best is to live high and train low.  The premier initial studies were performed with athletes living in Park City and training in Salt Lake compared to living and training in Park City and those living and training in San Diego.  It was found that living in Park City and training in Salt Lake increased performance the best.  Athletes train with altitude by high altitude training camps, living at higher altitude and training at lower altitude or by sleeping in tents that simulate higher altitude such as at the Nike training camp.

Without getting into too much physiology, exposure to high altitudes over time increases red blood cells thereby increasing hemoglobin, the molecule that transports oxygen in the blood.  Other things change as well such as a molecule called 2, 3 bisphosphonate which aids in unloading oxygen from hemoglobin.  There are increases in blood vessels in muscle and probably changes in mitochondria energy uses as well.  All of these changes occur due to extreme elevation changes causing a low oxygen state.  It is why traveling to sea level from Utah feels like you can run forever or traveling to high in the mountains feels like you get winded.  

What is the elevation needed and how long does it take?  General concepts are that it takes 2 weeks of exposure time at an elevation over 2500m or 8000 feet.  The effects seem to last about 4 weeks.  However there are probably advantages to living at our altitude in Ogden of 4400 to 4800 feet depending on bench or valley floor then racing near sea level.  A recent article in Medicine & Science in Sports and Exercise in September 2013 entitled Red Blood Cell Expansion at Altitude: A Meta-analysis and Monte Carlo Simulation recommends that 35 to 56 days at live high train low or 25 to 47 days constant above 2500m or near 8000 feet.  

However, altitude training may not be for everyone.  Those most likely to not have better performance are those who are iron deficient, or those who already have a high amount of red blood cells or high hemoglobin.  

The problems with living high and training high or just training high, in the case of trail running, is it takes about 2 weeks to acclimatize to the new training environment.  Increasing altitude raises the resting heart rate thereby raising the exercise heart rate so that more effort is required to reach the same training times.  With less oxygen due to the lower barometric pressure, higher elevations lead to breathlessness.  Therefore, recovery times increase which can limit interval repetitions or amount of hard workouts that can be done per week.  Above 10,000 feet, people sleep poorly and don’t cope as well physically and emotionally.  There may be a limit to altitude training in that elevations higher than 10,000 feet may cause the red blood cell levels to be higher than allowed causing positive tests for blood doping.  Another risk above 10,000 feet is that the blood may become thickened due to all the changes causing hyperviscosity syndrome.  The thickened blood may cause clotting such as strokes, clots to lungs, fluid in the lungs, and heart attacks.  

How does all this apply to trail running?  Obviously many trail races are at higher altitudes with many in the west going above or near 10,000 feet.  Therefore, one needs to train at those levels in order to understand how the environment changes your experience in order to cope such as slowing down because of increases in your heart rate and breathing rate.  There are cases of lungs filling with fluid, a condition called pulmonary edema, due to elevation.  It could be due to altitude illness, too low sodium in the blood (called hyponatremia usually from drinking too much water), or decreased barometric pressure and increased strain on the heart causing back filling into the lungs.  Thankfully, it isn’t very common.  

Altitude training may depend on the individual as to what altitude is optimal.  For example, the great American mile runner, Jim Ryan, didn’t like altitude training.  He felt like he couldn’t recover and that he couldn’t do the same workouts at altitude due to the limitations.  He preferred to train at sea level.  When I ran in college, we usually did a high altitude training camp for a week.  I could definitely feel the difference running between 9000 and 10,000 feet!  I was tired and definitely couldn’t run as fast at that altitude.  However, when we went back to 5,200 feet, it felt like I could run forever and didn’t feel high any longer.  Therefore, there is a large psychological impact of it which is difficult to measure in studies.

Jason Blackham – MD, Sports Medicine, Competitive Runner

Jason Blackham, MD, Internal Medicine Sports Medicine specialist ran cross country and track for Mountain View High in Orem, Ut, where he was All-State, and for Southern Utah University. He continues to run marathons and road races. He was a team physician for University of Iowa before moving to Ogden at Intermountain Sports Medicine at McKay Dee Hospital, Calton-Harrison clinic.

He is a team physician for area high schools, marathon and other race events, Snowbasin Clinic, and Weber State teams. He has given talks at national sports medicine meetings and running symposiums as well as written book chapters on stress fractures, shin splints and calf muscle strains. He practices non-surgical sports medicine. He treats bone, joint, muscle and tendon injuries and medical issues related to sports with emphasis on running injuries, endurance medicine and medical problems with sports participation. He specializes in overuse injuries and prevention of running related injuries as well as ultrasound guided procedures.

He also specializes in sports related medical problems such as exercise induced asthma, concussion, heart issues, diabetes in athletes, and more. He knows how to keep runners training while rehabbing injuries.

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This entry was posted on Tuesday, June 13th, 2017 at 2:22 pm and is filed under Exercise Physiology, Expert Answers, Training, Training Plans. You can follow any responses to this entry through the RSS 2.0 feed.

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