Sports Medicine

, Volume 14, Issue 5, pp 289–303 | Cite as

High-Altitude Training

Aspects of Haematological Adaptation
  • Bo Berglund
Review Article


Physical training at high altitude improves performance at high altitude. However, studies assessing performance improvements at sea level after training at higher altitudes have produced ambiguous and inconclusive results. Hypoxia-induced secondary polycythemia is a major contributor to increased work capacity at altitude.

The common finding upon exposure to hypoxia is a transient increase in haemoglobin concentration and haematocrit because of a rapid decrease in plasma volume followed by an increase in erythropoiesis per se. Both nonathletes and elite endurance athletes have maximal reticulo-cytosis after about 8 to 10 days at moderate altitude. Training periods of 3 weeks at moderate altitudes result in individual increase of haemoglobin concentration of about 1 to 4%. A more accentuated increase in haemoglobin can be obtained with longer sojourns at moderate altitude.

The normal erythropoietin reaction upon exposure to hypoxia comprises initially increased levels followed by a decrease after about 1 week. Thus, the maintenance of a high erythropoietin concentration is not a prerequisite for a sustained increase in erythrocyte formation at high altitude. The main pharmacological modulator of erythropoietin production seems to be adenosine. But modulators such as growth hormone and catecholamines may also potentiate the effect of hypoxia per se on erythropoietin production. On the other hand, there is a risk that the stress hormones may induce a relative depression of the bone marrow particularly in the early phase of altitude training when the adaptation is minimal and the stress reaction is most accentuated.

The most important ‚erythropoiesis-specific’ nutrition factor is iron availability which can modulate erythropoiesis over a wide range in humans. Adequate iron stores are a necessity for haematological adaptation to hypoxia. However, at moderate altitude, there is a need for rapid mobilisation of iron and even if the stores are normal there is a risk that they cannot be mobilised fast enough for an optimal synthesis of haemoglobin.

Data from healthy athletes training at moderate altitudes suggest a true increase in haemoglobin concentration of about 1% per week. Complete haematological adaptation occurred when sea level residents have similar haemoglobin concentrations at moderate altitude compared with residents. The normal difference in haemoglobin concentrations can be estimated to be about 12% between permanent residents at sea level and at 2500m above sea level. This difference indicates a necessary adaptation time of about 12 weeks. If the training period at moderate altitude must be shorter, several sojourns at short intervals are recommended. The important factor in haematological adaptation in athletes at moderate altitude is hypoxia. Training itself, particularly intense training, can constitute a risk early on during adaptation, but it is necessary for optimal long term adaptation to secure a possible synergistic effect of hypoxia and physical training on the erythropoietic response.


High Altitude Erythropoietin Serum Ferritin Apply Physiology Endurance Athlete 
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  1. Abbrecht PH, Littell JK. Plasma erythropoietin in men and mice during acclimatization to different altitudes. Journal of Applied Physiology 32: 54–58, 1972PubMedGoogle Scholar
  2. Altenkirch HU, Gerzer R, Kirsch KA, Well J, Heyduck B, et al. Effect of prolonged physical exercise on fluid regulating hormones. European Journal of Applied Physiology 61: 209–213, 1990CrossRefGoogle Scholar
  3. Anagoustou A, Schade S, Ashkinez M, Barone J, Fried W. Effect of protein deprivation on erythropoiesis. Blood 50: 1093–1097, 1977Google Scholar
  4. Bakris GL, Sauter ER, Hussey JL, Fisher JW, Gaber AO, et al. Effects of theophylline on erythropoietin production in patients with erythrocytosis after renal transplantation. New England Journal of Medicine 323: 86–90, 1990PubMedCrossRefGoogle Scholar
  5. Bauer CH, Kurtz A. Oxygen sensing in the kidney and its relation to erythropoietin production. Annual Review of Physiology 51: 845–856, 1989PubMedCrossRefGoogle Scholar
  6. Berglund B, Birgegard G, Hemmingsson P. Serum erythropoietin in cross-country skiers. Medicine and Science in Sports and Exercise 20: 208–209, 1988PubMedCrossRefGoogle Scholar
  7. Berglund B, Birgegard G, Wide L, Pihlstedt P. Effects of blood transfusions on some haematological variables in endurance athletes. Medicine and Science in Sports and Exercise 21: 637–642, 1989PubMedCrossRefGoogle Scholar
  8. Berglund B, Ekblom B. Effect of recombinant human erythropoietin administration on blood pressure and some haematological parameters in healthy males. Journal of Internal Medicine 229: 125–130, 1991PubMedCrossRefGoogle Scholar
  9. Berglund B, Hemmingsson P. Effect of reinfusion of autologous blood on exercise performance in cross-country skiers. International Journal of Sports Medicine 8: 231–233, 1987PubMedCrossRefGoogle Scholar
  10. Berglund B, Hemmingsson P, Birgegard G. Detection of autologous blood transfusions in cross-country skiers. International Journal of Sports Medicine 8: 66–70, 1987PubMedCrossRefGoogle Scholar
  11. Berglund B, Fleck SJ, Kearney JT, Wide L. Serum erythropoietin in athletes at moderate altitudes. Scandinavian Journal of Medicine and Science in Sports 2: 21–25, 1992CrossRefGoogle Scholar
  12. Bigard X, Satabin P, Leger C, Louisy F, Guezennec C. Effects of polyunsaturated fatty acids on physical performance at high altitude. Proceedings from Second IOC World Congress on Sports Sciences, Barcelona, pp. 260–261, 1991Google Scholar
  13. Birgegard G, Hogman C, Killander A, Levander H, Simonsson B, Serum ferritin and erythrocyte 2,3-DPG during quantified phlebotomy and iron treatment. Scandinavian Journal of Haematology 19: 327–333, 1977PubMedCrossRefGoogle Scholar
  14. Birgegard G, Miller O, Caro J, Erslev A. Serum erythropoietin levels by radioimmunoassay in polycythemia. Scandinavian Journal of Haematology 29: 161–167, 1982PubMedCrossRefGoogle Scholar
  15. Brien AJ, Simon TL. The effect of red blood cell reinfusion on 10-km race time. Journal of the American Medical Association 257: 2761–2765, 1987PubMedCrossRefGoogle Scholar
  16. Buhl H, Dannenberg R, Schober F. The central nervous and meta-bolic control of prolonged exercise in hypoxia. Abstract from the XXIV FIMS World Congress of Sports Medicine, Amsterdam, 1990Google Scholar
  17. Cannon JG, Evans WJ, Hughes VA, Meredith CN, Dinarello CA. Physiological mechanisms contributing to increased interleukin-1 secretion. Journal of Applied Physiology 61: 1869–1874, 1986PubMedGoogle Scholar
  18. Cavill I, MacDougall IC. Erythropoiesis and iron supply in patients treated with erythropoietin. Erythropoiesis 3: 50–55, 1992Google Scholar
  19. Celsing F, Svedenhag J, Pihlstedt P, Ekblom B. Effects of anaemia and stepwise induced polycythaemia on aerobic power in individuals with high and low hemoglobin concentrations. Acta Physiologica Scandinavica 127: 47–57, 1987CrossRefGoogle Scholar
  20. Chesner IM, Small NA, Dykes PW. Intestinal absorption at high altitude. Journal of Postgraduate Medicine 63: 173–175, 1987CrossRefGoogle Scholar
  21. Clement DB, Asmundson RC, Medhurst CW. Hemoglobin values: comparative survey of the 1976 Canadian Olympic team. Journal of the Canadian Medical Association 117: 614–616, 1977Google Scholar
  22. Clyne N, Jogestrand, T. The effect of erythropoietin treatment on physical exercise capacity and on renal function in predailytic uremic patients. Nephron 60: 390–396, 1992PubMedCrossRefGoogle Scholar
  23. Colice GL, Ramirez G. Effect of hypoxemia on the renin-angiotensin-aldosterone system in humans. Journal of Applied Physiology 58: 724–730, 1985PubMedGoogle Scholar
  24. Convertino VA. Blood volume: its adaptation to endurance training. Medicine and Science and Sports and Exercise 23: 1338–1348, 1992Google Scholar
  25. Daniels J, Oldridge N. The effect of alternate exposure to altitude and sea level on world-class and middle-distance runners. Medicine and Science in Sports and Exercise 2: 107–12, 1970CrossRefGoogle Scholar
  26. Dill DB, Adams WC. Maximal oxygen uptake at sea-level and at 3090m altitude in high school champion runners. Journal of Applied Physiology 30: 854–859, 1971PubMedGoogle Scholar
  27. Dill DB, Braithwaite K, Adams WC, Bernauer EM. Blood volume of middle-distance runners: effect of 2300m altitude and comparison with non-athletes. Medicine and Science in Sports and Exercise 6: 1–7, 1974Google Scholar
  28. Documenta Geigy. Scientific tables, 7th ed., Ciba-Geigy Limited, Basel, 1977Google Scholar
  29. Dudrik SJ, O’Donnel JJ, Raleigh DP, Matheney RG, Unkel SP. Rapid restoration of red blood cell mass in severely anemic surgical patients who refuse transfusion. Archives of Surgery 120: 721–727, 1985CrossRefGoogle Scholar
  30. Dufaux B, Hoederrath A, Streitberg I, Hollman W, Assman G. Serum ferritin, transferrin, haptoglobin, and iron in middle- and long distance runners, elite rowers, and professional racing cyclists. International Journal of Sports Medicine 2: 43–46, 1981PubMedCrossRefGoogle Scholar
  31. Eschbach JW, Egrie JC, Downing ME, Browne JK, Adamson JW. Correction of the anemia of end-stage renal disease with recombinant human erythropoietin. New England Journal of Medicine 316: 73–78, 1987PubMedCrossRefGoogle Scholar
  32. Eckardt K-U, Boutellier U, Kurtz A, Schopen M, Koller EA, et al. Rate of erytropoietin formation in response to acute hypobaric hypoxia. Journal of Applied Physiology 66: 1785–1788, 1989PubMedGoogle Scholar
  33. Eckardt K-U, Dittmer J, Neuman R, Bauer C, Kurtz A. Decline in erythropoietin formation at continious hypoxia is not due to feedback inhibition. American Journal of Physiology 258: F1432–F1437, 1990PubMedGoogle Scholar
  34. Ekblom B, Berglund B. Effect of erythropoietin administration on maximal aerobic power. Scandinavian Journal of Medicine and Science in Sports 1: 88–93, 1991CrossRefGoogle Scholar
  35. Endsjo T-O, Rokke K-O. Hojdetrening. Annual Meeting of Nor-wegian Society of Sports Medicine, Tromso, 1991Google Scholar
  36. Erslev A, Caro J, Birgegard G, Silver R, Miller O. The biogenesis of erythropoietin. Experimental Haematology 8 (Suppl. 8): 1–13, 1980Google Scholar
  37. Erslev A, Wilson J, Caro J. Erythropoietin titers in anemic, non-uremic patients Journal of Laboratory and Clinical Medicine 109: 429–433, 1987PubMedGoogle Scholar
  38. Erslev A. Erythropoietin. New England Journal of Medicine 324: 1339–1344, 1991PubMedCrossRefGoogle Scholar
  39. Faura J, Ramos J, Reynafarje C, English E, Finne P, Finch CA. Effect of altitude on erythropoiesis. Blood 323: 668–676, 1969Google Scholar
  40. Fellmann N. Hormonal and plasma volume alterations following endurance exercise. Sports Medicine 13: 37–49, 1992PubMedCrossRefGoogle Scholar
  41. Fisher JW. Pharmacologic modulation of erythropoietin production. Annual Review of Pharmacology and Toxicology 28: 101–122, 1988PubMedCrossRefGoogle Scholar
  42. Hannon JP, Shields JL, Harris CW. High altitude acclimatization in women. Proceedings of international symposium on the effects of altitude on physical performance, Athletic Institute, Chicago, pp. 37–44, 1967Google Scholar
  43. Hannon JP, Shields JL, Harris CW. Effects of altitude acclimatization on blood composition of women. Journal of Applied Physiology 26: 540–547, 1969PubMedGoogle Scholar
  44. Hartmann U, Burrichter H, Glaser D, Mader A, Oette K. Changing in ergometer power outputs and peripheral blood during several high altitude training camps of top class sportsmen and sportswomen. Abstract, XXIV FIMS World Congress of Sports Medicine, Amsterdam, 1990Google Scholar
  45. Haymes EM, Puhl JL, Temples TE. Training for cross country skiing and iron status. Medicine and Science in Sports and Exercise 18: 162–167, 1986PubMedCrossRefGoogle Scholar
  46. Hebbel PR, Eaton JW, Kronenberg RS, Zanjani ES, Moore LG, et al. Human Ilamas — adaptation to altitude in subjects with high hemoglobin oxygen affinity. Journal of Clinical Investigation 62: 593–600, 1978PubMedCrossRefGoogle Scholar
  47. Hemmingsson P, Bauer M, Birgegard G. Iron status in elite skiers. Scandinavian Journal of Medicine Science in Sports 1: 174–179, 1991CrossRefGoogle Scholar
  48. Hillman RS, Henderson PA. Control of marrow production by the level of iron supply. Journal of Clinical Investigation 48: 454–460, 1969PubMedCrossRefGoogle Scholar
  49. Hogan RP, Kotchen TA, Boyd III, AE, Hartley, LH. Effect of altitude on renin-aldosterone system and metabolism of water and electrolytes. Journal of Applied Physiology 35: 385–390, 1973PubMedGoogle Scholar
  50. Holmgren A, Mossfeldt F, Sjostrand T, Strom G. Effect of training on work capacity, total haemoglobin, blood volume, heart volume and pulse rate in recumbent and upright positions. Acta Physiologica Scandinavica 50: 72–83, 1960PubMedCrossRefGoogle Scholar
  51. Horstman D, Weiskopf R, Jackson RE. Work capacity during 3-wk sojourn at 4300m: effects of relative polycythemia. Journal of Applied Physiology 49: 311–318, 1980PubMedGoogle Scholar
  52. Hultgren HN. High altitude medical problem. In Sutton et al. (Eds) Hypoxia: man at altitude, pp. 161–167, Thieme-Stratton, New York, 1982Google Scholar
  53. International Olympic Committee (IOC). List of doping classes and methods. Lausanne, May, 1992Google Scholar
  54. Jansson E, Terrados N, Norman B, Kaijser L. Effect of training at simulated altitude on exercise at sea level. Scandinavian Journal of Medicine and Science in Sports 2: 2–6, 1992Google Scholar
  55. Jin HK, Chen YF, Yang RH, McKenna TM, Jackson RM, et al. Vasopressin lowers pulmonary artery pressure in hypoxic rats by releasing atrial natriuric peptide. American Journal of the Medical Sciences 298: 227–236, 1989PubMedCrossRefGoogle Scholar
  56. Kaijser L, Grubbstrom J, Berglund B. Coronary circulation in acute hypoxia. Clinical Physiology 10: 259–263, 1990PubMedCrossRefGoogle Scholar
  57. Keynes RJ, Smith GW, Slater JDH, Brown MM, et al. Renin and aldosterone at high altitude in man. Journal of Endocrinology 92: 131–140, 1982PubMedCrossRefGoogle Scholar
  58. Klausen K, Robinson S, Micahel ED, Myhre LG. Effect of high altitude on maximal working capacity. Journal of Applied Physiology 21: 1191–94, 1966PubMedGoogle Scholar
  59. Kosunen K, Pakarinen A, Kuoppasalmi K, Naveri H, Rehunen S, et al. Cardiovascular function and the renin-angiotensin-aldosterone system in long-distance runners during various training periods. Scandinavian Journal of Clinical and Laboratory Investigation 40: 429–435, 1980PubMedCrossRefGoogle Scholar
  60. Krantz SB. Erythropoietin. Blood 77: 419–434, 1991PubMedGoogle Scholar
  61. Kvernmo H, Olsen JO, Osterud B. Changes in blood cell response following strenous physical exercise. European Journal of Applied Physiology 64: 318–322, 1992CrossRefGoogle Scholar
  62. Lenfant C, Torrance J, English E, Finch CA, Reynafarje C, et al. Effect of altitude on oxygen binding by hemoglobin and on organic phosphate levels. Journal of Clinical Investigation 47: 2652–2656, 1968PubMedCrossRefGoogle Scholar
  63. Levine BD, Stray-Gundersen J, Duhaime G, Schnell PG, Friedman DB. ‚Living high — training low’: the effect of altitude ac-climatization/normoxic training in trained runners. Medicine and Science in Sports and Exercise 23 (Suppl.): S25, 1991Google Scholar
  64. Lewis SM. Erythropoiesis. In Postgraduate haematology, Heineman Professional Publishing, 1989Google Scholar
  65. Liesen H, Dufaux B, Hollman W. Modifications of serum glyco-proteins the day following a prolonged physical exercise and the influence of physical training. European Journal of Applied Physiology 37: 243–254, 1977CrossRefGoogle Scholar
  66. Lipschitz DA, Cook JD, Finch CA. A clinical evaluation of serum ferritin as an index of iron stores. New England Journal of Medicine 290: 1213–1216, 1974PubMedCrossRefGoogle Scholar
  67. MacDougall IC, Hutton RD, Cavill GA, Coles GA, Williams JD. Poor response to treatment of renal anaemia with erythropoietin corrected by iron given intravenously. British Medical Journal 299: 157–158, 1989PubMedCrossRefGoogle Scholar
  68. Macintyre JG. Growth hormone and athletes. Sports Medicine 4: 129–142, 1987PubMedCrossRefGoogle Scholar
  69. Mader A, Hartmann A, Hollman W. Einfluss eines Hohentrainings auf die kardiepulmonale Leistundsfähigkeit in meereshöhe, dargestellt am Beispiel der deutschen Ruder-nationalmannschaft. In Hollman (Ed.) Zentrale thaemen der sportmedizin, pp. 276–290, Springer, Berlin, 1986CrossRefGoogle Scholar
  70. Mader A, Hartmann A, Fisher HG, Reinhards-Mader G, Bohnert KJ, et al. Magnesiumsubstitutionen im Hohentraining der Ruder-nationalmannschaft in Vorbereitung auf die olympischen Spiele — ergebnisse einer kontrollierten Studie. Magnesium-Bulletin 12: 69–78, 1990Google Scholar
  71. Magnusson B, Hallberg L, Rossander L, Swolin B. Iron metabolism and ‚sports anaemia’. Acta Medica Scandinavica 216: 149–164, 1984PubMedCrossRefGoogle Scholar
  72. Mairbaurl H, Schobersberger W, Humpeler E, Hasibeder W, Fisher W, et al. Beneficial effects of exercising at moderate altitudes on red cell oxygen transport and on exercise performance. Pflugers Archiv. European Journal of Physiology 406: 594–599, 1986PubMedCrossRefGoogle Scholar
  73. Maher JT, Jones LG, Hartley LH, Williams GO, Rose LR. Aldosterone dynamics during graded exercise at sea level and high altitude. Journal of Applied Physiology 39: 18–22, 1975PubMedGoogle Scholar
  74. Maury CPJ. Anaemia in reumatoid arthritis: role of cytokines. Scandinavian Journal of Rheumatology 18: 3–5, 1989PubMedCrossRefGoogle Scholar
  75. Merino CF, Reynafarje C. Bone marrow studies of the polycythemia of high altitudes. Journal of Laboratory and Clinical Medicine 34: 637–647, 1949PubMedGoogle Scholar
  76. Milledge JS, Cattley DM. Renin, aldosterone, and converting enzyme during exercise and acute hypoxia in humans. Journal of Applied Physiology 52: 320–323, 1982PubMedGoogle Scholar
  77. Milledge JS, Cotes PM. Serum erythropoietin in humans at high altitude and its relation to plasma renin. Journal of Applied Physiology 59: 360–364, 1985PubMedGoogle Scholar
  78. Mizuno M, Juel C, Bro-Rasmussen T, Mygind E, Schibye B, et al. Limb skeletal muscle adaptation in athletes after training at altitude. Journal of Applied Physiology 68: 496–502, 1990PubMedGoogle Scholar
  79. Neff MS, Goldberg J, Slifkin RF, Eiser AR, Calamia V, et al. A comparison of androgens for anemia in patients on haemodi-alysis. New England Journal of Medicine 304: 871–875, 1981PubMedCrossRefGoogle Scholar
  80. Newhouse IJ, Clement DB. Iron status in athletes: an update. Sports Medicine 5: 337–352, 1988PubMedCrossRefGoogle Scholar
  81. Oscai LB, Williams BT, Hertig BA. Effects of exercise on blood volume. Journal of Applied Physiology 24: 622–624, 1968PubMedGoogle Scholar
  82. O’Toole ML, Hiller WDB, Douglas PS. Serum ferritin as a measure of triathlon stress. Proceedings from First IOC World Congress on Sports Sciences, Colorado Springs, pp. 85–86, 1989Google Scholar
  83. Pace N, Lozner EL, Consolatio WV, Pitts GC, Pecora LJ. The increase in hypoxia tolerance of normal men accompanying the polycythemia induced by transfusion of erythrocytes. American Journal of Physiology 148: 152–163, 1947PubMedGoogle Scholar
  84. Paul P, Rothman SA, Meager R. Modulation of erythropoietin production by adenosine. Journal of Labortatory and Clinical Medicine 112: 168–173, 1988Google Scholar
  85. Perrault H, Cantin M, Thibault G, Brisson GR, Beland M. Plasma atriopeptin response to prolonged cycling in humans. Journal of Applied Physiology 70: 979–987, 1991PubMedGoogle Scholar
  86. Pigman EC. Acute mountain sickness: effects and implications for exercise at intermediate altitudes. Sports Medicine 12: 71–79, 1991PubMedCrossRefGoogle Scholar
  87. Ratzin Jackson CG, Sharkey BJ. Altitude, training and human performance. Sports Medicine 6: 279–284, 1988CrossRefGoogle Scholar
  88. Reynafarje C, Lozano R, Valdivieso J. The polycythemia of high altitudes: iron metabolism and related aspects. Blood 14: 433–455, 1959PubMedGoogle Scholar
  89. Reynafarje C, Ramos J. The influence of altitude changes on intestinal iron absorption. Journal of Laboratory and Clinical Medicine 57: 848, 1961PubMedGoogle Scholar
  90. Robertson RJ, Gilcher R, Metz KF, Caspersen CJ, Allison TG, et al. Effect of simulated altitude erythrocythemia in women on haemoglobin flow rate during exercise. Journal of Applied Physiology 64: 1644–1649, 1988PubMedGoogle Scholar
  91. Rowell LB, Saltin B, Kiens B, Christensen NJ. Is peak quadriceps blood flow in humans even higher during exercise with hypoxemia? American Journal of Physiology 251: H1038–H1044, 1986PubMedGoogle Scholar
  92. Sawka MN, Young AJ. Acute polycytemia and human performance during exercise and exposure to extreme environments. In Pandolf KB (Ed.) Exercise and sport sciences reviews, Vol. 17, pp. 265–293, Williams & Wilkins, Baltimore, 1989PubMedGoogle Scholar
  93. Schmidt W, Maasen N, Trost F, Boening D. Training induced effects on blood volume, erythrocyte turnover and haemoglobin oxygen binding properties. European Journal of Applied Physiology 57: 490–498, 1988CrossRefGoogle Scholar
  94. Schmidt W. Erythropoietin und Sport — Grundlagen und Meinungen. Sportmedizin 41: 304–312, 1990Google Scholar
  95. Shigeoka JV, Colice GL, Ramirez G. Effect of normoxemic and hypoxemic exercise on renin and aldosterone. Journal of Applied Physiology 59: 142–148, 1985PubMedGoogle Scholar
  96. Shiraki K, Yoshimura H, Yamada T. Anemia during physical training and physical performance. Proceedings of the XX FIMS World Congress of Sports Medicine, Melbourne, pp. 410–415, 1974Google Scholar
  97. Sjödin B, Hellsten-Westing Y, Apple FS. Biochemical mechanisms for oxygen free radical formation during exercise. Sports Medicine 10: 236–254, 1990PubMedCrossRefGoogle Scholar
  98. Sjostrand, T. Effects of physical training. In Sjostrand (Ed.) Clinical Physiology, pp. 206–213, Bonniers, Stockholm, 1967Google Scholar
  99. Smith MH, Sharkey BJ. Altitude training: who benefits? Physician and Sportsmedicine 12: 48–62, 1984Google Scholar
  100. Spriet LL, Gledhill N, Froese AB, Wilkies DL. Effect of graded erythrocythemia on cardiovascular and metabolic response to exercise. Journal of Applied Physiology 61: 1942–1948, 1986PubMedGoogle Scholar
  101. Stray-Gundersen, Alexander C, Hochstein A, deLomos D, Levine BD. Failure of red cell volume to increase to altitude exposure in iron deficient runners. Medicine and Science in Sport and Exercise 24 (Suppl.): S90, 1992Google Scholar
  102. Suarez J, Alexander JK, Houston CS. Enhanced left ventricular systolic performance at high altitude during Operation Everest II. American Journal of Cardiology 60: 137–142, 1987PubMedCrossRefGoogle Scholar
  103. Sutton J. The hormonal responses to exercise at sea level and at altitude. In Hypoxia, exercise, and altitude: Proceedings of the Third Banff International Hypoxia Symposium, pp. 325–338, Alan R Liss Inc., New York, 1983Google Scholar
  104. Svedenhag J, Saltin B, Johanson C, Kaijser L. Aerobic and anaerobic exercise capacities of elite middle-distance runners after two weeks of training at moderate altitudes. Scandinavian Journal of Medicine and Science in Sports 1: 205–214, 1991CrossRefGoogle Scholar
  105. Szygula Z. Erythrocytic system under the influence of physical training and exercise. Sports Medicine 10: 181–197, 1990PubMedCrossRefGoogle Scholar
  106. Tasaki T, Ohto H, Hashimoto C, Abe R, Saitoh A, et al. Recombinant human erythropoietin for autologous blood donation: effects on perioperative red blood cell and serum erythropoietin production. Lancet 339: 773–775, 1992PubMedCrossRefGoogle Scholar
  107. Terrados N, Jansson E, Norman B, Kaijser L. Increased inosine 5-monophosphate accumulation despite no sign of increased glyclytic rate during one-legged exercise at simulated high altitude. Scandinavian Journal of Medicine and Science in Sports 2: 7–9, 1992CrossRefGoogle Scholar
  108. Terrados N, Melichna J, Sylven C, Jansson E, Kajiser L. Effects of training at simulated altitude on performance and muscle metabolic eapacity in competitive road cyclists. European Journal of Applied Physiology 57: 203–209, 1988CrossRefGoogle Scholar
  109. Terrados N, Mizuno M, Andersen H. Reduction of maximal oxygen uptake at low altitudes; role of training status and lung function. Clinical Physiology, Oxford 5 (Suppl. 3): 75–79, 1985CrossRefGoogle Scholar
  110. Walker BR, Haynes Jr J, Wang HL, Voekel NF. Vasopressin induced pulmonary vasodilatation in rats. American Journal of Physiology 257: H415–H422, 1989PubMedGoogle Scholar
  111. Wide L, Bengtsson C, Birgegård G. Circadian rhythm of eryth-ropoietin in human serum. British Journal of Haematology 72: 85–90, 1989PubMedCrossRefGoogle Scholar
  112. Winslow RM, Monge CC. Hypoxia, polycythemia, and chronic mountain sickness. John Hopkins University Press, Baltimore, 1987Google Scholar
  113. Winslow RM, Chapman KW, Gibson CC, Samaja M, Monge CC, et al. Different hematologic responses to hypoxia in Sherpas and Quechua Indians. Journal of Applied Physiology 66: 1561–1569, 1989PubMedGoogle Scholar
  114. von Bormann B. Autologous blood predonation: erythropoietin in normal hematocrit patients. The potential use of erythropoietin to diminish the need for homologous blood in surgery. Abstract from symposium by Cilag Ortho Biotech, Chairman S.E. Bergentz, International Surgical Week, Stockholm, 1991Google Scholar
  115. Vreugdenhil G, Swaak AJG. Anemia of rheumatoid arthritis: current concepts and recent developments. Erythropoiesis 2: 2–15, 1991Google Scholar
  116. Young AJ, Young PM. Human acclimatization to high terrestrial altitude. In Pandolf et al. (Eds) Human performance physiology and environmental medicine at terrestrial extremes, pp. 497–543, Benchmark Press, Indianapolis, 1988Google Scholar

Copyright information

© Adis International Limited 1992

Authors and Affiliations

  • Bo Berglund
    • 1
  1. 1.Department of MedicineKarolinska HospitalStockholmSweden

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