Once the pre­serve of elites, al­ti­tude tech is now more ac­ces­si­ble than ever. We as­sess its ben­e­fits


The last time 220 tack­led al­ti­tude train­ing we led with the sug­ges­tive ti­tle ‘Two-mile high club’. For­give the artis­tic li­cence, but at that height of around 3,200m you can­not go hard enough for long enough – you need to lower your sights by at least 500m. At least that’s the view of James Barber, lead per­for­mance spe­cial­ist from The Al­ti­tude Cen­tre in Lon­don. “We set the cham­ber to 2,700m,” he says. “We be­lieve that’s the sweet spot to re­ceive the ben­e­fits of train­ing at al­ti­tude with­out im­pair­ing the qual­ity. If we took it to an ex­treme of 5,000m, ath­letes would strug­gle to ex­er­cise.”

It’s a phi­los­o­phy shared by two-time Olympic cham­pion Alistair Brown­lee, who has reg­u­larly spent a sum­mer’s month in St Moritz, us­ing the Swiss Alps re­sort as a trusted base to launch suc­cess­ful gold medal tilts at both Lon­don in 2012 and Rio four years later. “At about 1,800m it’s not too ex­treme and means I can still com­plete the re­ally tough track ses­sions,” Brown­lee says. “Go­ing higher is for the off-sea­son, not in July when I’m try­ing to get sharp for the Olympics.”

The point is that while train­ing, liv­ing or sleep­ing at al­ti­tude – con­sid­ered any­thing above 1,500m – can have per­for­mance-en­hanc­ing ef­fects, the ap­proach re­quires nu­ance and an un­der­stand­ing that not ev­ery­one is on a level. “There are big dif­fer­ences be­tween ath­letes,” Brown­lee con­tin­ues. “Jonny and I are broth­ers with a sim­i­lar train­ing his­tory and ge­net­ics, but there are mas­sive in­di­vid­ual dif­fer­ences to how we re­spond to al­ti­tude.”

Al­ti­tude con­di­tion­ing, in­clud­ing a por­ta­ble sleep­ing tent – more of which later – will form a key tenet of the Olympic prepa­ra­tion if Brown­lee de­cides to bid for a third Olympic Games ti­tle next sum­mer, but the 31-year-old York­shire­man also be­lieves the per­for­mance en­hance­ment isn’t purely down to the rar­efied at­mos­phere.

He adds: “I’ve used al­ti­tude since 2007 and, while the phys­i­o­log­i­cal stim­u­lus is valu­able, there are other in­tan­gi­ble ben­e­fits, such as be­ing in a quiet train­ing en­vi­ron­ment with a train­ing camp men­tal­ity.”


Be­fore get­ting ahead of our­selves, it’s im­por­tant to un­der­stand why al­ti­tude con­di­tion­ing is uni­ver­sally ac­cepted as ben­e­fi­cial to per­for­mance. “It has a num­ber of ef­fects on the body, which re­sults in im­proved ef­fi­ciency with oxy­gen,” Barber ex­plains. “At al­ti­tude, the par­tial pres­sure of oxy­gen in your lungs drops, which low­ers the amount of oxy­gen in your blood and this stim­u­lates the adap­ta­tions we’re look­ing for.”

Blood oxy­gen sat­u­ra­tion (SpO2) is the body’s ca­pac­ity to carry oxy­gen around the body in red blood cells via the pro­tein haemoglobi­n. As a per­cent­age, a healthy SpO2 will be in the high 90s at sea level, but dur­ing ex­er­cise at al­ti­tude will drop to the mid to low 80s. This trig­gers the body to pro­duce ery­thro­poi­etin (EPO). Many will be fa­mil­iar with the name from the syn­thetic ver­sion used by drug cheats in en­durance sport, but more nat­u­rally EPO is a hor­mone pro­duced by the kid­ney that pro­motes the for­ma­tion of red blood cells from the bone mar­row.

“But there are other non-haema­to­log­i­cal re­sponses that are just as im­por­tant,” Barber says. “Con­sider the whole process, called the oxy­gen cas­cade. It starts from ex­tract­ing the oxy­gen from the air we breathe through to it be­ing used for mi­to­chon­drial func­tion. Red blood cells car­ry­ing the oxy­gen is im­por­tant, but you also need to get more oxy­gen from your lungs into your blood, from your blood into your mus­cles, and then use it more ef­fec­tively. At al­ti­tude we also see an up­reg­u­la­tion of key en­zymes in­volved in these aer­o­bic and anaer­o­bic pro­cesses. Al­ti­tude train­ing also boosts clas­si­cal en­durance adap­ta­tions such as in­creased cap­il­lar­i­sa­tion, al­low­ing a greater flow of blood through the mus­cle, so there’s a greater sur­face area to dif­fuse both oxy­gen and nu­tri­ents.”


There are plenty of mea­sures to prove that it works. Barber might test an ath­lete’s func­tional thresh­old power – the av­er­age power he or she can hold for an hour – on a sta­tion­ary bike at the start of a six-week train­ing block and re­peat it at the end. Other tests in­clude mea­sur­ing peak power, or a se­ries of Win­gate anaer­o­bic tests that look at an ath­lete’s im­proved re­silience to fa­tigue.

Head­ing to St Moritz for six weeks isn’t prac­ti­cal for most work­ing age-groupers, but with fa­cil­i­ties such as the Al­ti­tude Cen­tre in Lon­don avail­able for bike, tread­mill or gym work, you can now have your head in a desk one minute and in the vir­tual clouds the next. While £20 a time, or £100 for a month, isn’t cheap, it prob­a­bly un­der­cuts over­seas ex­cur­sions – al­though you’ll have to com­pro­mise on the views.

“You can now have your head in a desk one minute and in the vir­tual clouds the next”

“The ethos is bring­ing al­ti­tude train­ing to any­one who wants it,” Barber says. “Un­til 2012, it was re­ally the pre­serve of the elite ath­lete. Now with the cham­ber and equip­ment avail­able, any­one who wants high-al­ti­tude ac­cli­ma­tion, or just wants to im­prove gen­eral health and well­be­ing, can ac­cess it as they would any other gym.”


Hop­ping on the bike or tread­mill three times a week (the min­i­mum rec­om­mended to see re­sults) helps, but phys­i­cal ex­er­cise can also be sup­ple­mented by in­ter­mit­tent hy­poxic ex­po­sure ses­sions, where the ath­lete will pas­sively breathe high-al­ti­tude air up­wards of 4,000m through a mask for 5mins six times an hour. Fixed up to a gen­er­a­tor, the sys­tem sucks the air from the room, re­moves oxy­gen and feeds it through tub­ing into the mask. Hy­pox­ico, a brand the Al­ti­tude Cen­tre dis­trib­utes, is also used by Britain’s three-time Iron­man worlds run­ner-up Lucy Charles-Bar­clay.

The same process is used to re­duce oxy­gen lev­els in al­ti­tude tents and Brown­lee even has one named af­ter him. ‘The Brown­lee’ from Affin­ity Al­ti­tude costs £2,250, comes with its own travel bag, and was borne out of years of per­sonal ex­pe­ri­ence. “I’ve slept in ev­ery kind of tent over the years. The tra­di­tional ones cover your whole bed, are hot and take twothree hours a night to get up to a de­cent al­ti­tude,” he says. “This one comes down to the waist and is cooler be­cause half of my body is out of it. It also gets up to al­ti­tude more quickly.”

Brown­lee be­lieves he can feel the ben­e­fits of us­ing the tent within four-to-six weeks and ad­justs its ‘al­ti­tude’ so his oxy­gen sat­u­ra­tion rests be­tween 9092%. “I haven’t used it re­cently, so if I went in tonight, it could be about 1,800m, but if I spend months us­ing it, it could get up to 3,000m,” he adds.

Tents aren’t the only op­tion. The more claus­tro­pho­bic among us could in­stead check in to the Elite Ath­lete Cen­tre and Ho­tel at Lough­bor­ough Univer­sity. Fa­cil­i­tated by Imago Venues, it opened in 2018 and offers 20 al­ti­tude bed­rooms, where each can be ad­justed for vary­ing al­ti­tudes. The higher you choose, the less oxy­gen in the air, which low­ers

the oxy­gen dif­fu­sion from the lungs into the blood, known as hy­poxia. A stay of four weeks is rec­om­mended and guests who wish to stay above 3,500m need a sports sci­en­tist in sup­port. Any­one suf­fer­ing from sickle cell anaemia is ruled out.

Tra­di­tion­ally favoured by en­durance ath­letes, the ben­e­fits of al­ti­tude have caught on to team sports, whose pock­ets also tend to be much deeper. Five of the top six Premier League foot­ball clubs use equip­ment from the Al­ti­tude Cen­tre, be that multi-ath­lete cham­bers or in­di­vid­ual pieces of kit. “We’ve seen a huge growth in team and com­bat sports us­ing al­ti­tude equip­ment to sup­port re­peat sprint train­ing, al­low­ing them the abil­ity to re­cover and go again,” Barber says. Given Liver­pool started the sea­son fac­ing a po­ten­tial 71 games, rapid re­cov­ery is para­mount.


If still con­fused whether it’s bet­ter to sleep or train at al­ti­tude, or both, you could be for­given. Both the Lough­bor­ough cen­tre and Barber agree the ‘sleep high, train low’ phi­los­o­phy is con­sid­ered the ‘gold stan­dard’, and given the lo­gis­ti­cal chal­lenges of de­scend­ing from the moun­tains to train and re­turn for bed­time, it’s lit­tle won­der the surge in pop­u­lar­ity of al­ti­tude tents.

But it is “still pos­si­ble” to ac­cu­mu­late enough time in a cham­ber to gain haema­to­log­i­cal re­sponses, Barber ar­gues. “It also works on slightly dif­fer­ent adap­ta­tions within our cen­tral ner­vous sys­tem and the mus­cles them­selves, so sleep­ing or train­ing at al­ti­tude tar­get slightly dif­fer­ent things.”

Is there a dan­ger of get­ting it wrong? Pre­vail­ing wis­dom has been to race im­me­di­ately post al­ti­tude train­ing, or de­lay for around three weeks. In 2012, Chris McCor­mack a two-time win­ner of the Iron­man world cham­pi­onships, pulled out dur­ing the bike leg in Kona, at­tribut­ing his “use­less” per­for­mance to com­ing down from Se­dona in Ari­zona 11 days be­fore the race. “I was tired, weak and just lost time all day,” he re­flected.

Brown­lee agrees to a point: “I’d say the safe pro­to­col is def­i­nitely to race two-to-three weeks af­ter al­ti­tude train­ing, but I don’t think that’s com­pletely nec­es­sary. Peo­ple get stressed about how soon to race, but the key is what you do at al­ti­tude. It’s an ex­tra stim­u­lus, so if you’ve done lots of train­ing and go straight into rac­ing, you’re prob­a­bly not go­ing to per­form that well just be­cause you’re a bit knack­ered.”

Leave it too long, though, and the ben­e­fits will even­tu­ally wear off, called de­cay ki­net­ics. Red blood cells die af­ter 90-120 days, and some are ac­tively de­stroyed within five-to-seven days of re­turn­ing to sea level in a process called neo­cy­tol­y­sis. This is an area where Barber be­lieves elite com­peti­tors are ahead of the sports sci­ence. “I don’t think there’s a lot un­der­stood about it at a group pop­u­la­tion level,” he adds. “Elite ath­letes prob­a­bly un­der­stand what

works for them, but to say in a team sport en­vi­ron­ment: ‘This is what you should all do…’ I just don’t think the sci­ence is there.”

In terms of stay­ing healthy, plac­ing more em­pha­sis on macro and mi­cro nu­tri­ents for re­cov­ery is en­cour­aged, par­tic­u­larly given stud­ies also show a po­ten­tial link be­tween trav­el­ling to lo­ca­tions and sup­pressed im­mune func­tions. Barber also cites re­views that sug­gest iron sup­ple­men­ta­tion of up to 200mg a day could help im­prove haemoglobi­n mass, al­though notes that much will de­pend on your ini­tial iron lev­els.


With many eyes trained on the swel­ter­ing heat and hu­mid­ity of the Tokyo Olympics, should heat ac­cli­ma­tion sup­plant al­ti­tude train­ing for 2021? “Heat adap­ta­tion will take prece­dent,”

Barber be­lieves. “But given you can heat ac­cli­ma­tise quite quickly, they should still be us­ing al­ti­tude dur­ing the early sea­son and Olympic build-up.

“There’s also re­search still to do in cross adap­ta­tion be­tween dif­fer­ent stres­sors. The cur­rent ad­vice is that to train in heat and al­ti­tude is too much and the ath­lete will re­spond to the stres­sor that’s worse – gen­er­ally heat and hu­mid­ity. But the pri­mary adap­ta­tion with heat is an in­crease in plasma vol­ume, with al­ti­tude train­ing it’s im­prov­ing red blood cell count. If you can in­crease the amount of blood that you have and the num­ber of cells within that, and then keep do­ing it, one af­ter the other… I def­i­nitely think there’s some­thing in that.”


There’s more evo­lu­tion in this space to come. Last year’s No­bel Prize for medicine was given to three re­searchers, in­clud­ing Sir Peter Rat­cliffe of Ox­ford Univer­sity, for their painstak­ing work on hy­poxia. They ex­plained how cells sense oxy­gen lev­els, and how they adapt to higher or lower amounts of the mol­e­cule in the at­mos­phere. While the work could have a crit­i­cal role in ad­dress­ing con­di­tions such as kid­ney can­cers and anaemia, un­der­stand­ing the in­flu­ence of a pro­tein called hy­poxia-in­ducible fac­tor (HIF), that rises when there’s less oxy­gen, could also give a per­for­mance boost to ath­letes.

For now, though, don’t drop all your train­ing plans and head straight to the hills: al­ti­tude sup­ple­men­ta­tion should just be the snow-capped peak of a well-planned and pe­ri­odised pro­gramme. “Make the al­ti­tude work for you, rather than chang­ing what you’re do­ing to ac­com­mo­date the al­ti­tude,” Barber cau­tions. With that knowl­edge, you can sleep soundly know­ing that even if you can’t al­ways reach heady heights, your per­for­mance still can.

“Al­ti­tude train­ing should just be the snow-capped peak of a well-planned pro­gramme”


At the Al­ti­tude Cen­tre, above, their ethos is to bring al­ti­tude train­ing to any­one who wants it

Tim­ing your race post-al­ti­tude train­ing is key as the ben­e­fits will even­tu­ally wear off

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