Laura A. Garvican-Lewis

Altitude training and haemoglobin mass from the optimised carbon monoxide rebreathing method determined by a meta-analysis

Objective To characterise the time course of changes in haemoglobin mass (Hbmass) in response to altitude exposure. Methods This meta-analysis uses raw data from 17 studies that used carbon monoxide rebreathing to determine Hbmass prealtitude, during altitude and postaltitude. Seven studies were classic altitude training, eight were live high train low (LHTL) and two mixed classic and LHTL. Separate linear-mixed models were fitted to the data from the 17 studies and the resultant estimates of the effects of altitude used in a random effects meta-analysis to obtain an overall estimate of the effect of altitude, with separate analyses during altitude and postaltitude. In addition, within-subject differences from the prealtitude phase for altitude participant and all the data on control participants were used to estimate the analytical SD. The ‘true’ between-subject response to altitude was estimated from the within-subject differences on altitude participants, between the prealtitude and during-altitude phases, together with the estimated analytical SD. Results During-altitude Hbmass was estimated to increase by ∼1.1%/100 h for LHTL and classic altitude. Postaltitude Hbmass was estimated to be 3.3% higher than prealtitude values for up to 20 days. The within-subject SD was constant at ∼2% for up to 7 days between observations, indicative of analytical error. A 95% prediction interval for the ‘true’ response of an athlete exposed to 300 h of altitude was estimated to be 1.1–6%. Conclusions Camps as short as 2 weeks of classic and LHTL altitude will quite likely increase Hbmass and most athletes can expect benefit.

Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers

Three weeks of intensified training and mild energy deficit in elite race walkers increases peak aerobic capacity independent of dietary support. Adaptation to a ketogenic low carbohydrate, high fat (LCHF) diet markedly increases rates of whole‐body fat oxidation during exercise in race walkers over a range of exercise intensities. The increased rates of fat oxidation result in reduced economy (increased oxygen demand for a given speed) at velocities that translate to real‐life race performance in elite race walkers. In contrast to training with diets providing chronic or periodised high carbohydrate availability, adaptation to an LCHF diet impairs performance in elite endurance athletes despite a significant improvement in peak aerobic capacity.

The impact of altitude on the sleep of young elite soccer players (ISA3600)

Background Altitude training is used by elite athletes to improve sports performance, but it may also disrupt sleep. The aim of this study was to examine the effects of 2 weeks at high altitude on the sleep of young elite athletes. Methods Participants (n=10) were members of the Australian under-17 soccer team on an 18-day (19-night) training camp in Bolivia, with six nights at near sea level in Santa Cruz (430 m) and 13 nights at high altitude in La Paz (3600 m). Sleep was monitored using polysomnography during a baseline night at 430 m and three nights at 3600 m (immediately after ascent, 1 week after ascent and 2 weeks after ascent). Data were analysed using effect size statistics. Results All results are reported as comparisons with baseline. Rapid eye movement (REM) sleep was likely lower immediately upon ascent to altitude, possibly lower after 1 week and similar after 2 weeks. On all three nights at altitude, hypopneas and desaturations were almost certainly higher; oxygen saturation was almost certainly lower; and central apnoeas, respiratory arousals and periodic breathing were very likely higher. The effects on REM sleep were common to all but one participant, but the effects on breathing were specific to only half the participants. Conclusions The immediate effects of terrestrial altitude of 3600 m are to reduce the amount of REM sleep obtained by young elite athletes, and to cause 50% of them to have impaired breathing during sleep. REM sleep returns to normal after 2 weeks at altitude, but impaired breathing does not improve.

Changes in blood gas transport of altitude native soccer players near sea-level and sea-level native soccer players at altitude (ISA3600)

Objectives The optimal strategy for soccer teams playing at altitude is not known, that is, ‘fly-in, fly-out’ versus short-term acclimatisation. Here, we document changes in blood gas and vascular volumes of sea-level (Australian, n=20) and altitude (Bolivian, n=19) native soccer players at 3600 m. Methods Haemoglobin-oxygen saturation (Hb-sO2), arterial oxygen content (CaO2), haemoglobin mass (Hbmass), blood volume (BV) and blood gas concentrations were measured before descent (Bolivians only), together with aerobic fitness (via Yo-YoIR1), near sea-level, after ascent and during 13 days at 3600 m. Results At baseline, haemoglobin concentration [Hb] and Hbmass were higher in Bolivians (mean±SD; 18.2±1.0 g/dL, 12.8±0.8 g/kg) than Australians (15.0±0.9 g/dL, 11.6±0.7 g/kg; both p≤0.001). Near sea-level, [Hb] of Bolivians decreased to 16.6±0.9 g/dL, but normalised upon return to 3600 m; Hbmass was constant regardless of altitude. In Australians, [Hb] increased after 12 days at 3600 m to 17.3±1.0 g/dL; Hbmass increased by 3.0±2.7% (p≤0.01). BV decreased in both teams at altitude by ∼400 mL. Arterial partial pressure for oxygen (PaO2), Hb-sO2 and CaO2 of both teams decreased within 2 h of arrival at 3600 m (p≤0.001) but increased over the following days, with CaO2 overcompensated in Australians (+1.7±1.2 mL/100 mL; p≤0.001). Yo-YoIR1 was lower on the 3rd versus 10th day at altitude and was significantly related to CaO2. Conclusions The marked drop in PaO2 and CaO2 observed after ascent does not support the ‘fly-in, fly-out’ approach for soccer teams to play immediately after arrival at altitude. Although short-term acclimatisation was sufficient for Australians to stabilise their CaO2 (mostly due to loss of plasma volume), 12 days appears insufficient to reach chronic levels of adaption.

Position statement—altitude training for improving team-sport players' performance: current knowledge and unresolved issues

Despite the limited research on the effects of altitude (or hypoxic) training interventions on team-sport performance, players from all around the world engaged in these sports are now using altitude training more than ever before. In March 2013, an Altitude Training and Team Sports conference was held in Doha, Qatar, to establish a forum of research and practical insights into this rapidly growing field. A round-table meeting in which the panellists engaged in focused discussions concluded this conference. This has resulted in the present position statement, designed to highlight some key issues raised during the debates and to integrate the ideas into a shared conceptual framework. The present signposting document has been developed for use by support teams (coaches, performance scientists, physicians, strength and conditioning staff) and other professionals who have an interest in the practical application of altitude training for team sports. After more than four decades of research, there is still no consensus on the optimal strategies to elicit the best results from altitude training in a team-sport population. However, there are some recommended strategies discussed in this position statement to adopt for improving the acclimatisation process when training/competing at altitude and for potentially enhancing sea-level performance. It is our hope that this information will be intriguing, balanced and, more importantly, stimulating to the point that it promotes constructive discussion and serves as a guide for future research aimed at advancing the bourgeoning body of knowledge in the area of altitude training for team sports.

Relationship between changes in haemoglobin mass and maximal oxygen uptake after hypoxic exposure

Background Endurance athletes have been using altitude training for decades to improve near sea-level performance. The predominant mechanism is thought to be accelerated erythropoiesis increasing haemoglobin mass (Hbmass) resulting in a greater maximal oxygen uptake (O2max). Not all studies have shown a proportionate increase in O2max as a result of increased Hbmass. The aim of this study was to determine the relationship between the two parameters in a large group of endurance athletes after altitude training. Methods 145 elite endurance athletes (94 male and 51 female) who participated in various altitude studies as altitude or control participants were used for the analysis. Participants performed Hbmass and O2max testing before and after intervention. Results For the pooled data, the correlation between per cent change in Hbmass and per cent change in O2max was significant (p<0.0001, r2=0.15), with a slope (95% CI) of 0.48 (0.30 to 0.67) intercept free to vary and 0.62 (0.46 to 0.77) when constrained through the origin. When separated, the correlations were significant for the altitude and control groups, with the correlation being stronger for the altitude group (slope of 0.57 to 0.72). Conclusions With high statistical power, we conclude that altitude training of endurance athletes will result in an increase in O2max of more than half the magnitude of the increase in Hbmass, which supports the use of altitude training by athletes. But race performance is not perfectly related to relative O2max, and other non-haematological factors altered from altitude training, such as running economy and lactate threshold, may also be beneficial to performance.

The sleep of elite athletes at sea level and high altitude: a comparison of sea-level natives and high-altitude natives (ISA3600)

Background Altitude exposure causes acute sleep disruption in non-athletes, but little is known about its effects in elite athletes. The aim of this study was to examine the effects of altitude on two groups of elite athletes, that is, sea-level natives and high-altitude natives. Methods Sea-level natives were members of the Australian under-17 soccer team (n=14). High-altitude natives were members of a Bolivian under-20 club team (n=12). Teams participated in an 18-day (19 nights) training camp in Bolivia, with 6 nights at near sea level in Santa Cruz (430 m) and 13 nights at high altitude in La Paz (3600 m). Sleep was assessed on every day/night using activity monitors. Results The Australians’ sleep was shorter, and of poorer quality, on the first night at altitude compared with sea level. Sleep quality returned to normal by the end of the first week at altitude, but sleep quantity had still not stabilised at its normal level after 2 weeks. The quantity and quality of sleep obtained by the Bolivians was similar, or greater, on all nights at altitude compared with sea level. The Australians tended to obtain more sleep than the Bolivians at sea level and altitude, but the quality of the Bolivians’ sleep tended to be better than that of the Australians at altitude. Conclusions Exposure to high altitude causes acute and chronic disruption to the sleep of elite athletes who are sea-level natives, but it does not affect the sleep of elite athletes who are high-altitude natives.

Soccer activity profile of altitude versus sea-level natives during acclimatisation to 3600 m (ISA3600)

Objectives We investigated the effect of high altitude on the match activity profile of elite youth high altitude and sea level residents. Methods Twenty Sea Level (Australian) and 19 Altitude-resident (Bolivian) soccer players played five games, two near sea level (430 m) and three in La Paz (3600 m). Match activity profile was quantified via global positioning system with the peak 5 min period for distance ((D5peak)) and high velocity running (>4.17 m/s, HIVR5peak); as well as the 5 min period immediately subsequent to the peak for both distance (D5sub) and high-velocity running (HIVR5sub) identified using a rolling 5 min epoch. The games at 3600 m were compared with the average of the two near sea-level games. Results The total distance per minute was reduced by a small magnitude in the first match at altitude in both teams, without any change in low-velocity running. There were variable changes in HiVR, D5peak and HiVR5peak from match to match for each team. There were within-team reductions in D5peak in each game at altitude compared with those at near sea level, and this reduction was greater by a small magnitude in Australians than Bolivians in game 4. The effect of altitude on HiVR5peak was moderately lower in Australians compared with Bolivians in game 3. There was no clear difference in the effect of altitude on maximal accelerations between teams. Conclusions High altitude reduces the distance covered by elite youth soccer players during matches. Neither 13 days of acclimatisation nor lifelong residence at high altitude protects against detrimental effects of altitude on match activity profile.

Wellness, fatigue and physical performance acclimatisation to a 2-week soccer camp at 3600 m (ISA3600)

Objectives To examine the time course of wellness, fatigue and performance during an altitude training camp (La Paz, 3600 m) in two groups of either sea-level (Australian) or altitude (Bolivian) native young soccer players. Methods Wellness and fatigue were assessed using questionnaires and resting heart rate (HR) and HR variability. Physical performance was assessed using HR responses to a submaximal run, a Yo-Yo Intermittent recovery test level 1 (Yo-YoIR1) and a 20 m sprint. Most measures were performed daily, with the exception of Yo-YoIR1 and 20 m sprints, which were performed near sea level and on days 3 and 10 at altitude. Results Compared with near sea level, Australians had moderate-to-large impairments in wellness and Yo-YoIR1 relative to the Bolivians on arrival at altitude. The acclimatisation of most measures to altitude was substantially slower in Australians than Bolivians, with only Bolivians reaching near sea-level baseline high-intensity running by the end of the camp. Both teams had moderately impaired 20 m sprinting at the end of the camp. Exercise HR had large associations (r>0.5–0.7) with changes in Yo-YoIR1 in both groups. Conclusions Despite partial physiological and perceptual acclimatisation, 2 weeks is insufficient for restoration of physical performance in young sea-level native soccer players. Because of the possible decrement in 20 m sprint time, a greater emphasis on speed training may be required during and after altitude training. The specific time course of restoration for each variable suggests that they measure different aspects of acclimatisation to 3600 m; they should therefore be used in combination to assess adaptation to altitude.

Ten days of simulated live high:train low altitude training increases Hbmass in elite water polo players

Objectives Water polo requires high aerobic power to meet the demands of match play. Live high:train low (LHTL) may enhance aerobic capacity at sea level. Before the Olympics, the Australian womens water polo team utilised LHTL in an attempt to enhance aerobic fitness. Methods Over 6 months, 11 players completed three normobaric LHTL exposures (block 1:11 days at 3000 m; block 2+3:9 days at 2500 m, 11 days normoxia, 10 days at 2800 m). Haemoglobin mass (Hbmass) was measured through carbon monoxide-rebreathing. Before each block, the relationship between Hbmass and water polo-specific aerobic fitness was investigated using the Multistage Shuttle Swim Test (MSST). Effect size statistics were adopted with likely, highly likely and almost certainly results being >75%, >95%, >99%, respectively. A Pearson product moment correlation was used to characterise the association between pooled data of Hbmass and MSST. Results Hbmass (mean±SD, pre 721±66 g) likely increased after block 1 and almost certainly after block 2+3 (% change; 90% confidence limits: block 1: 3.7%; 1.3–6.2%, block 2+3: 4.5%; 3.8–5.1%) and the net effect was almost certainly higher after block 2+3 than before block 1 (pre) by 8.5%; 7.3–9.7%. There was a very large correlation between Hbmass (g/kg) and MSST score (r=0.73). Conclusions LHTL exposures of <2 weeks induced approximately 4% increase in Hbmass of water polo players. Extra Hbmass may increase aerobic power, but since match performance is nuanced by many factors it is impossible to ascertain whether the increased Hbmass contributed to Australias Bronze medal.