Difference between revisions of "Altitude Training Approaches"

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AltoLab is a cheap and effective way of [[Altitude Training]]. It uses a chemical (soda lime) to remove the CO<SUB>2</SUB> from your exhaled breath, allowing you to rebreathe the air that now has lower O<SUB>2</SUB>.
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This is a comparison of the various approaches to [[Altitude Training]], their pros and cons. Personally I use a [[DIY Altitude Training|home made altitude system]] for [[Intermittent Hypoxic Exposure]].  
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{{DISPLAYTITLE:AltoLab, A cheap [[Altitude Training]] system}}
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==Live High, Train High==
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==Introduction==
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By moving to altitude, you are exposed to lower oxygen all the time. While this approach can have a good effect on altitude acclimatization, it makes training much harder. Therefore the benefit of altitude on increased red blood cell count are offset by the reduced ability to train hard. There is also evidence that LHTH reduces [[Muscle|muscle]] mass<ref name="muscle"/>.
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The AltoLab consists of a [[Breathing]] tube and lid, a cylinder of CO<SUB>2</SUB> absorbent (Hypoxic Silo) and a series of tubes filled with foam cylinders that hold your exhaled breath for you to re-breathe (mixers). Each mixer is supposed to be around 5,000 feet of altitude, though this obviously varies a lot.
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==Live High, Train Low==
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Sleeping at altitude produces the increase in red blood cells, and training at low altitude provides optimum training benefits. This effect can be achieved by literally living at a high altitude and traveling to a lower level to train. However, this approach is also possible by using a hypoxia generator to reduce the level of O<sub>2</sub> in a tent. The downside to an altitude tent is that the quality of sleep can be degraded even more than living at altitude and the equipment is expensive.  
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[[File:AltoLab Components.JPG|thumb|none|200px|AltoLab components]]
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==Intermittent Hypoxic Exposure==
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IHE uses lower O<sub>2</sub> concentrations than LHTH or LHTL, but for shorter periods. Typical regimes are 5 min hypoxia + 5 min normal air, repeated 6 times. See [[Intermittent Hypoxic Exposure]] and [[The Science of Intermittent Hypoxic Exposure]].
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Below is a copy of the AltoLab manual page showing how the system works.
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==Intermittent Hypoxic Training==
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IHT uses O<sub>2</sub> similar to IHE, but unlike IHE exercise is undertaken while exposed to the low O<sub>2</sub> concentrations. This tends to significantly compromise training quality.  
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[[File:AltoLabHowItWorks.JPG|thumb|none|200px|How AltoLab Works (click for a larger image)]]
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==Summary==
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{| class="wikitable"
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==Results==
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| align="center" style="background:#f0f0f0;"|'''Type'''
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So far, I've used the AltoLab system for several bouts of training. The manual recommends using the system for 15 daily sessions, but I've found that I get better results from continued usage. I've found that training with AltoLab makes a difference to my performance both at altitude and at low levels. The training effect seems to build slowly, so it's not an obvious, dramatic change. However, I believe that the effect may compound over time, as the benefits of [[Altitude Training]] make me faster, which in turn allows for harder training as well as improved race performance.  
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| align="center" style="background:#f0f0f0;"|'''Pros'''
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== Observations==
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| align="center" style="background:#f0f0f0;"|'''Cons'''
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* The first training bout was the hardest to keep up. Each subsequent bout seems easier, but I'm not sure why. It may be that my body is remembering the adaptation, or it may be that I just know what to expect.
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|-
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* The manual suggests starting with 2 mixers, which should give a blood O<SUB>2</SUB> saturation of 90%. Mine dropped to below 80%, which may be part of the reason I do so badly at altitude. By the fifth session I found my [[Breathing]] pattern changed, and my saturation did not drop as far.
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| LHTH||Easy if you live at altitude||Reduced training benefits, loss of muscle mass
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* For the first few sessions of my first training bout, I ignored the manual and let my blood O<SUB>2</SUB> saturation drop to around 80%. This was enough to make me feel light headed and my vision to change. After 6-8 sessions, the saturation dropping to 80% did not cause the same problems.  
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|-
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* After the first training bout, I ignored the manual even further and went directly to 4 mixers, and let my O<SUB>2</SUB> saturation drop to around 75-70%.
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| LHTL||No detraining unlike LHTH, no extra time taken like IHT||Requires travel or altitude tent
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* One simple test I did to check the effectiveness of AltoLab was to check my O<sub>2</sub> saturation when flying. After using the AltoLab, I found that my O<sub>2</sub> saturation was noticeably higher than before. (I used a barometric altimeter to check the cabin pressure to make sure the circumstances were similar.)
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|-
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* After my first training bout I tended to ignore the slow, steady build up of intensity that the manual recommends and use four mixers (equiv 20,000ft) and aim to drop my O<sub>2</sub> saturation to around 70-75%.
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| IHE||No sleep issues like LHTL, No detraining unlike LHTH, equipment cheap||Takes time (~1 hour/day) where activity is limited
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* I use a different pattern of training than suggested by the manufacturer. I do 1 hour/day for 15 days, then change to half an hour each day thereafter, tapering for races. I find that 4x (6 min hypoxia + 2-3 min recovery) works quite well. 
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|-
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* It's important to let everything dry between uses, especially the bacterial filter. If it gets damp, it is hard to breathe through.
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| IHT||No sleep issues like LHTL||Detraining as with LHTH, equipment varies and requires a [[Treadmill|treadmill]] for runners
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* Air you breathe through the AltoLab is quite warm, partly due to rebreathing exhaled air, partly due to the heat from the CO<SUB>2</SUB> scrubber.  I tend to drink something in the rest periods.
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|}
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* The downside to using the AltoLab is probably similar to other [[Altitude Training]] systems; being in a low O<sub>2</sub> environment is unpleasant. I find myself struggling to perform the training sessions as the feeling of asphyxiation was off putting.
 
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* In theory you can watch TV while doing the AltoLab, and that’s how I used it, but the low O<sub>2</sub> saturation can make it hard to concentrate at times.  
 
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* If my O<sub>2</sub> saturation drops below about 65% I tend to phase out, and it’s easy to drop into a strange dream like state for a few moments. This is almost a shamanistic experience, but I try to avoid this situation as it's probably quite unhealthy.
 
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* Reading a book while using the AltoLab is tricky because you need to hold the tube in your mouth.
 
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* You need to keep the mouth piece angled upwards to prevent saliva flowing into the system. If you don't the anti-bacteria filter will be hard to breathe through and the tube will fill up!
 
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* For the first couple of bouts of AltoLab training, the initial sessions seemed to leave me a little weakened and slower than normal. I also found that the [[Altitude Training]] tended to give me a headache that would come back periodically.
 
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* I found there is quite a bit of lag in using AltoLab. When you start [[Breathing]] through the AltoLab, it will take a couple of minutes before your O<sub>2</sub> saturation drops, and when you have the rest period, it can also take a minute or more before your O<sub>2</sub> saturation returns to near normal. However, I also found that the feeling of low O<sub>2</sub> saturation seemed to lag even further behind the reading from the [[Pulse Oximeter]]. My assumption is that the O<sub>2</sub> saturation of your blood can change, but the tissues your blood is supplying will take time to change to match the O<sub>2</sub> saturation of your blood. The practical implication is that my blood O<sub>2</sub> saturation could drop to 65% quickly and I would feel more or less okay for a short time. Once my blood O<sub>2</sub> saturation had been low for a minute or so, the impact would kick in and I'd start to feel light headed. Likewise, when I had a rest period, my blood O<sub>2</sub> saturation would rise to normal but my head would still be feeling the effects.
 
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* I do not use the nose clip, as I found it uncomfortable. I find I can breathe through my mouth quite easily and do not require a nose clip.
 
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* I wrote some software ([[Hypoxic Timer]]) that would interface with a USB enabled [[Pulse Oximeter]]. This gave me a graph of how my blood O<sub>2</sub> saturation was changing over time. It also allowed me to calculate the 'Hypoxic Training Index' so I could compare different training sessions.
 
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==Conclusion==
 
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Overall, I think the AltoLab is a cost effective and useful way of training for high altitude conditions, and possibly for improvements at sea level. I suspect that the downsides of using other intermittent systems will be similar to AltoLab. From what I understand from other people who've slept in altitude tents, there are different, but equally significant downsides to that approach, including poor [[Zeo Sleep Monitor|sleep]] quality.
 
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==Usage==
 
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[[File:HypoxiaWithAltoLab.JPG|none|thumb|800px|Example of O2 saturation from an AltoLab training session. The green vertical line marks the end of the hypoxic time and the red vertical line marks the beginning of the hypoxic time. The red line is O2 saturation, with the green fill showing above 90%, blue fill showing 90-75% and the pink fill showing below 75%. The blue line is heart rate.]]
 
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==The parts ordered==
 
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I ordered the following components
 
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* The starter kit ($190) and which contains 3 mixers giving 5,000-15,000 ft of elevation, 2 CO<SUB>2</SUB> scrubbers proving 4 hours of usage, and the tubes.
 
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* Three extra mixers for $36
 
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* Six extra CO<SUB>2</SUB> scrubbers for $108 (I did not need these)
 
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* A [[Pulse Oximeter]] which are much cheaper than if you purchase them with the AltoLab.
 
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* Bulk CO<SUB>2</SUB> scrubber. Each 3 pound bag is $7.80 + $10 shipping.
 
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** I ordered 'JorVet J-553 Soda Lime', produced by Jorgensen Laboratories. I got mine from shopmedvet.com, and they tend to change their URLs so you may have to search for 'soda lime' on their site. As of 6/22/11 the link http://www.shopmedvet.com/product/soda-lime-3-lb-bag/jorgensen-products-anesthesia-products worked. I'm told that the original CO<SUB>2</SUB> scrubber in the AltoLab system is Spherasorb 405.
 
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* After some time, I ordered extra anti-bacterial filters, which cost less than $5 from a medical supplier. I got mine from [[http://www.allegromedical.com/respiratory-therapy-c534/main-flow-bacterial-viral-filter-p547468.html Allegro Medical]]
 
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Total cost was $306 (excluding the unused scrubbers). An alternative would be to buy
 
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* The [[Breathing]] kit for $89
 
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* Three extra mixers for $36
 
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* One or two scrubbers for $22 each
 
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* The [[Pulse Oximeter]] for $50
 
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With the scrubber, that works out as $214.80
 
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==CO<SUB>2</SUB> Scrubber==
 
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* The CO<SUB>2</SUB> scrubber lasted for two sessions of an hour, 6 minutes on, 3 minutes off. AltoLab claim 2-3 sessions.
 
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* The scrubber does not die quickly or obviously; I find my blood O<SUB>2</SUB> saturation not dropping as far each time, but the biggest indicator is that I'm struggling to breathe. This is because the CO<SUB>2</SUB> is building up in the blood and causing deeper [[Breathing]]. Swapping to a new scrubber returned to the original behavior.
 
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* The absorbent material (soda lime) has a color change that indicates when it is exhausted. However, the color change is only present immediately after use. If you leave the scrubber for a few hours, it will return to its original color, even though it is still expired.
 
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* I created a video of opening the silo for scrubber replacement at http://youtu.be/6uK1Ua8ENGU
 
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{{#evp:youtube|6uK1Ua8ENGU|How to open the AltoLab silos|none}}
 
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==Running Costs==
 
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Each CO<SUB>2</SUB> scrubber costs $22, or $18 when you by 6 at a time. This works out as a running cost of nearly $10 per hour, which can get a little pricey. I have found that the scrubbers open up quite easily, and can be refilled with a bulk CO<SUB>2</SUB> scrubber. I used JorVet soda lime (see above) which is $10 for 3 pounds. Each CO<SUB>2</SUB> scrubber holds about half a pound, and lasts for 3-4 sessions, rather than 2-3 for the original. This reduces the running cost less than $1 per hour.
 
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==What about just breathing through a tube?==
 
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Occasionally people ask if you can just breathe through a tube or snorkel rather than buying a system. Sadly, this does not work. All that happens is the CO2 in the tube builds up, so you breathe faster without lowering your O<SUB>2</SUB> saturation.
 
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==Pure DIY==
 
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Looking at the parts for the AltoLab, it seems possible to construct one out of PVC piping, some foam, CPAP tube, etc., but this may require some effort to find the right parts. Given that the AltoLab system is only the cost of a couple of pairs of good running [[Shoes]], it does not seem worth the effort.
 
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==Optional Oxygen Sensor==
 
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[[File:Altolab with OxyCheq.jpg|right|thumb|300px|My AltoLab system with the OxyCheq O<sub>2</sub> sensor attached. (Click for a larger image.)]]
 
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I added an oxygen sensor to my AltoLab set up to make it easier to control my [[SpO2|SpO<sub>2</sub>]] levels. I chose the OxyCheq oxygen sensor because it has a separate replaceable sensor and a remote display, and the price was reasonable ($250). I've found that knowing the oxygen level I'm [[Breathing]] gives me the finer control of how hypoxic I am as the [[Pulse Oximeter]] alone has a significant delay. If you start [[Breathing]] air with more or less oxygen it will sometimes take over a minute for this to affect the circulating blood in your fingertip that the [[Pulse Oximeter]] is monitoring. This delay makes it tricky to stay in the right [[SpO2|SpO<sub>2</sub>]] range. With the O<sub>2</sub> sensor I can see how the depth of my [[Breathing]] is affecting the oxygen level, and combined with the [[Pulse Oximeter]] I'm able to get a much more effective hypoxic exposure. The diagram to the right shows my current configuration:
 
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* I generally use six of the black foam filled mixers.
 
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* Attached to the black mixer is the green CO<sub>2</sub> scrubber, the end cap and the original hose.
 
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* Next the O2 sensor is attached to a blue "T" adapter. This is connected by a wire to the display unit. These sensors have an expected life of about two years, so it's handy for them to be easily replaceable.
 
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* Finally there is the viral filter, the optional expandable swivel tube and the mouthpiece.
 
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The cost of the Oxygen Sensor more than doubles the cost of the overall system, but this was worthwhile to me as I use the system on a regular basis. I would not recommend getting an Oxygen Sensor until you know how you get on with basic setup, but I've found it much easier to control my [[SpO2|SpO<sub>2</sub>]] than using the [[Pulse Oximeter]] alone.
 
  
 +
==Altitude Training for Sea Level Performance==
 +
An excellent meta-analysis<ref name="HypoxicMeta"/> (review of scientific studies) looked at how [[Altitude Training]] has been shown to improve sea level performance. The meta-analysis showed that:
 +
* For sub-elite athletes
 +
** IHE was very likely to improve performance
 +
** Natural LHTL was likely to improve performance (living at altitude rather than an altitude tent)
 +
** Artificial LHTL could possibly improve performance
 +
* For elite athletes only natural LHTL was likely to improve performance (living at altitude rather than an altitude tent)
 +
It should be noted that one of the most important conclusions of the meta-analysis is the lack of good quality studies. For instance, there were only two IHE studies for elite athletes, and one of these was flawed by providing far too low a level of hypoxia for most of the study.
 +
==Elevation Training Mask==
 +
The [http://www.trainingmask.com Elevation Training Mask] (ETM) is a device that covers the nose and mouth to restrict [[Breathing|breathing]]. The ETM claims that it "mimics the effects of High Altitude Training", and it even talks about equivalent altitudes of 12,000-18000ft. The ETM web site states "The Mask reduces the partial pressure of oxygen"<ref name="TrainingMaskCase"/>, but there is no supporting evidence, or any indication of any possible mechanism that would reduce the partial pressure of oxygen. The only mention of [[SpO2|SpO<sub>2</sub>]] indicated a low value of 96%, well within the range of normal sea level respiration and well above the level needed for  [[Intermittent Hypoxic Exposure| IHE]]. The manufacturer has a "clinical trial" that show ETM combined with [[High Intensity Interval Training]] (HIIT) improves [[VO2max|V̇O<sub>2</sub>max]]<ref name="TrainingMaskTrial"/>, but this trial did not have controls to see if the improvements where just due to the HIIT. The improvements in [[VO2max|V̇O<sub>2</sub>max]] shown in the studies are in line with other studies of HIIT alone, so the benefit of the ETM is unclear at best. Note that this trial was published as a blog entry, not published in peer reviewed journals. The ETM may improve the strength of the breathing muscles, but there is no evidence that this alone improves performance. I would not recommend the ETM, nor do I believe it constitutes 'altitude training' and it is only included in this section because it is a common question.
 
==See Also==
 
==See Also==
 
* [[The Science of Altitude Training]]
 
* [[The Science of Altitude Training]]
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* [[Altitude Training Approaches]]
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* [[Comparison of Altitude Training Systems]]
 
* [[Book Review - Altitude Training and Athletic Performance]]
 
* [[Book Review - Altitude Training and Athletic Performance]]
 
* [[Intermittent Hypoxic Exposure]] and [[The Science of Intermittent Hypoxic Exposure]]
 
* [[Intermittent Hypoxic Exposure]] and [[The Science of Intermittent Hypoxic Exposure]]
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* [[Comparison of Altitude Training Systems]]
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* [[AltoLab]]
 +
==References==
 +
<references>
 +
<ref name="muscle">http://www.hypoxico.com/images/pdfs/Response_of_skeletal_muscle_mitochondria_tohypoxia_Hoppel.pdf Response of skeletal muscle mitochondria to hypoxia</ref>
 +
<ref name="HypoxicMeta">Sea-level exercise performance following adaptatio... [Sports Med. 2009] - PubMed result http://www.ncbi.nlm.nih.gov/pubmed/19203133</ref>
 +
<ref name="TrainingMaskTrial">Elevation Training Mask Technical Report Clinical Trial http://blog.trainingmask.com/elevation-training-mask-technical-report-clinical-trial/ </ref>
 +
<ref name="TrainingMaskCase">Elevation Training Mask and The Effects: A Case Report http://blog.trainingmask.com/elevation-training-mask-and-the-effects-a-case-report/</ref>
 +
</references>

Latest revision as of 15:27, 29 July 2013

This is a comparison of the various approaches to Altitude Training, their pros and cons. Personally I use a home made altitude system for Intermittent Hypoxic Exposure.

1 Live High, Train High

By moving to altitude, you are exposed to lower oxygen all the time. While this approach can have a good effect on altitude acclimatization, it makes training much harder. Therefore the benefit of altitude on increased red blood cell count are offset by the reduced ability to train hard. There is also evidence that LHTH reduces muscle mass[1].

2 Live High, Train Low

Sleeping at altitude produces the increase in red blood cells, and training at low altitude provides optimum training benefits. This effect can be achieved by literally living at a high altitude and traveling to a lower level to train. However, this approach is also possible by using a hypoxia generator to reduce the level of O2 in a tent. The downside to an altitude tent is that the quality of sleep can be degraded even more than living at altitude and the equipment is expensive.

3 Intermittent Hypoxic Exposure

IHE uses lower O2 concentrations than LHTH or LHTL, but for shorter periods. Typical regimes are 5 min hypoxia + 5 min normal air, repeated 6 times. See Intermittent Hypoxic Exposure and The Science of Intermittent Hypoxic Exposure.

4 Intermittent Hypoxic Training

IHT uses O2 similar to IHE, but unlike IHE exercise is undertaken while exposed to the low O2 concentrations. This tends to significantly compromise training quality.

5 Summary

Type Pros Cons
LHTH Easy if you live at altitude Reduced training benefits, loss of muscle mass
LHTL No detraining unlike LHTH, no extra time taken like IHT Requires travel or altitude tent
IHE No sleep issues like LHTL, No detraining unlike LHTH, equipment cheap Takes time (~1 hour/day) where activity is limited
IHT No sleep issues like LHTL Detraining as with LHTH, equipment varies and requires a treadmill for runners

6 Altitude Training for Sea Level Performance

An excellent meta-analysis[2] (review of scientific studies) looked at how Altitude Training has been shown to improve sea level performance. The meta-analysis showed that:

  • For sub-elite athletes
    • IHE was very likely to improve performance
    • Natural LHTL was likely to improve performance (living at altitude rather than an altitude tent)
    • Artificial LHTL could possibly improve performance
  • For elite athletes only natural LHTL was likely to improve performance (living at altitude rather than an altitude tent)

It should be noted that one of the most important conclusions of the meta-analysis is the lack of good quality studies. For instance, there were only two IHE studies for elite athletes, and one of these was flawed by providing far too low a level of hypoxia for most of the study.

7 Elevation Training Mask

The Elevation Training Mask (ETM) is a device that covers the nose and mouth to restrict breathing. The ETM claims that it "mimics the effects of High Altitude Training", and it even talks about equivalent altitudes of 12,000-18000ft. The ETM web site states "The Mask reduces the partial pressure of oxygen"[3], but there is no supporting evidence, or any indication of any possible mechanism that would reduce the partial pressure of oxygen. The only mention of SpO2 indicated a low value of 96%, well within the range of normal sea level respiration and well above the level needed for IHE. The manufacturer has a "clinical trial" that show ETM combined with High Intensity Interval Training (HIIT) improves V̇O2max[4], but this trial did not have controls to see if the improvements where just due to the HIIT. The improvements in V̇O2max shown in the studies are in line with other studies of HIIT alone, so the benefit of the ETM is unclear at best. Note that this trial was published as a blog entry, not published in peer reviewed journals. The ETM may improve the strength of the breathing muscles, but there is no evidence that this alone improves performance. I would not recommend the ETM, nor do I believe it constitutes 'altitude training' and it is only included in this section because it is a common question.

8 See Also

9 References

  1. ↑ http://www.hypoxico.com/images/pdfs/Response_of_skeletal_muscle_mitochondria_tohypoxia_Hoppel.pdf Response of skeletal muscle mitochondria to hypoxia
  2. ↑ Sea-level exercise performance following adaptatio... [Sports Med. 2009] - PubMed result http://www.ncbi.nlm.nih.gov/pubmed/19203133
  3. ↑ Elevation Training Mask and The Effects: A Case Report http://blog.trainingmask.com/elevation-training-mask-and-the-effects-a-case-report/
  4. ↑ Elevation Training Mask Technical Report Clinical Trial http://blog.trainingmask.com/elevation-training-mask-technical-report-clinical-trial/
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