Review
Altitude training for elite endurance athletes: A review for the travel medicine practitioner

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Summary

High altitude training is regarded as an integral component of modern athletic preparation, especially for endurance sports such as middle and long distance running. It has rapidly achieved popularity among elite endurance athletes and their coaches. Increased hypoxic stress at altitude facilitates key physiological adaptations within the athlete, which in turn may lead to improvements in sea-level athletic performance. Despite much research in this area to date, the exact mechanisms which underlie such improvements remain to be fully elucidated. This review describes the current understanding of physiological adaptation to high altitude training and its implications for athletic performance. It also discusses the rationale and main effects of different training models currently employed to maximise performance. Athletes who travel to altitude for training purposes are at risk of suffering the detrimental effects of altitude. Altitude illness, weight loss, immune suppression and sleep disturbance may serve to limit athletic performance. This review provides an overview of potential problems which an athlete may experience at altitude, and offers specific training recommendations so that these detrimental effects are minimised.

Section snippets

Literature search strategy

Medline and Pubmed databases were accessed to source relevant literature. The following key words were used as search terms: altitude, exercise, training, hypoxia, athletes, and endurance. Only articles published in the English language were selected. Preference was given to articles published in the previous 5–10 years. The reference lists of published articles were also examined to ensure all relevant articles were included in the review. Textbooks also provided an additional source of

Physiological responses to altitude

The partial pressure exerted by oxygen in the arterial blood (PaO2) decreases directly with ascent, due to progressively falling barometric pressure. At 2000 m for example, the alveolar partial pressure of oxygen (PAO2) decreases from its sea-level value of 100–78 mmHg, which causes a reduced haemoglobin-oxygen saturation and reduced total oxygen content of the blood. Therefore, a series of physiological adaptations must be initiated to compensate for this hypoxic stress.

Central to these

High altitude training models

Scientific evidence supporting the use of high altitude training models tends to be controversial, and the subject of intense debate amongst researchers. This reflects the difficulties associated with working in this field. Elite athletes may be required to improve performance by as little as 1% to succeed in competition [46], and the small sample sizes of athletes reported in these studies are inadequate for the purpose of detecting these changes. When the typical error of measurement in these

Possible harmful consequences of altitude training

Altitude illnesses, which are directly attributable to hypobaric hypoxia, may be divided into three broad categories: acute mountain sickness, high altitude cerebral oedema and high altitude pulmonary oedema. Diagnostic criteria for these conditions were established in 1991 at the International Hypoxia Symposium, held in Lake Louise in Alberta, Canada [57]. Table 4 summarises the risk factors, clinical features, treatment and preventive strategies for each condition. An excellent recent review

Athlete Biological Passport

The World Anti-Doping Agency (WADA) administers the Athlete Biological Passport (ABP) to monitor key biological parameters over time in an effort to detect violations of its doping code for elite athletes. The WADA guidelines for operation of the ABP came into effect on December 1st, 2009 [117]. The effect of altitude training on selected haematological indices such as the haemoglobin concentration has been studied. Bonne and colleagues compared the effects of a group of swimmers following the

Conclusions

The hypoxic stress imposed on physiological systems during altitude training promotes overall favourable adaptations for the elite athlete. Numerous altitude training paradigms exist, but most recently, the live high-train low model to altitude training has achieved significant popularity. This approach combines the advantageous changes which occur at altitude, with an undiminished exercise intensity stimulus at sea level. Current research supports its efficacy in improving sea-level athletic

Funding

None received.

Conflict of interest

The authors state that they have no conflict of interest to declare.

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