Abstract
Recreational activities, training, and competition in altitude have become increasingly popular over the past 25 years. High altitude training represents a central component of athletic preparation nowadays, not only for endurance sports such as long and middle distance running, but also for team and anaerobic sports. Environmental factors and altitude do not represent the only concern for the athletes’ safety, but also the access to appropriate medical supervision in these conditions is often very difficult. Exercise and sport performed in high altitude have significant health consequences. Physiological adaptations within the athlete are induced and facilitated by the increased hypoxic stress in altitude that may bring improvements in the performance at sea levels. Despite there being a lot of articles and studies to date, the exact mechanisms which are responsible for such improvements remain to be fully explained. There is a high variability in individual response to altitude and this is dependent on several factors that range from fitness level, training load, nutritional habits, genetics, chemosensitivity to hypoxia and ventilatory responses, the oxygen carrying capacity of the blood, fatigue, and previous exposure to altitude.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Conkin J, Wessel JH. Critique of the equivalent air altitude model. Aviat Space Environ Med. 2008;79(10):975–82.
Favier FB, Britto FA, Freyssenet DG, Bigard XA, Benoit H. HIF-1-driven skeletal muscle adaptations to chronic hypoxia: molecular insights into muscle physiology. Cell Mol Life Sci. 2015;72(24):4681–96.
Hamlin MJ, Draper N, Hellemans J. Real and simulated altitude training and performance. In: Hamlin M, editor. Current issues in sports and exercise medicine. InTech; 2013. http://www.intechopen.com/books/current-issues-in-sports-and-exercise-medicine/real-and-simulated-altitude-training-and-performance.
Semenza GL. HIF-1: mediator of physiological and pathophysiological responses to hypoxia. J Appl Physiol. 2000;88(4):1474–80.
Lindholm ME, Rundqvist H. Skeletal muscle hypoxia-inducible factor-1 and exercise: skeletal muscle hypoxia-inducible factor-1 and exercise. Exp Physiol. 2016;101(1):28–32.
Chapman RF, Stray-Gundersen J, Levine BD. Individual variation in response to altitude training. J Appl Physiol. 1998;85(4):1448–56.
Wehrlin JP, Zuest P, Hallén J, Marti B. Live high-train low for 24 days increases hemoglobin mass and red cell volume in elite endurance athletes. J Appl Physiol. 2006;100(6):1938–45.
Jelkmann W. Regulation of erythropoietin production: erythropoietin production. J Physiol. 2011;589(6):1251–8.
Robach P, Fulla Y, Westerterp KR, Richalet JP. Comparative response of EPO and soluble transferrin receptor at high altitude. Med Sci Sports Exerc. 2004;36(9):1493–8.
Levine BD, Stray-Gundersen J. Point: positive effects of intermittent hypoxia (live high:train low) on exercise performance are mediated primarily by augmented red cell volume. J Appl Physiol. 2005;99(5):2053–5.
Stray-Gundersen J, Chapman RF, Levine BD. “Living high-training low” altitude training improves sea level performance in male and female elite runners. J Appl Physiol. 2001;91(3):1113–20.
Wilber RL, Stray-Gundersen J, Levine BD. Effect of hypoxic ‘dose’ on physiological responses and sea-level performance. Med Sci Sports Exerc. 2007;39(9):1590–9.
Whayne TF. Cardiovascular medicine at high altitude. Angiology. 2014;65(6):459–72.
Feriche B, Schoenfeld BJ, Bonitch-Gongora J, de la Fuente B, Almeida F, Argüelles J, et al. Altitude-induced effects on muscular metabolic stress and hypertrophy-related factors after a resistance training session. Eur J Sport Sci. 2020;20(8):1083–92.
Goldfarb-Rumyantzev AS, Alper SL. Short-term responses of the kidney to high altitude in mountain climbers. Nephrol Dial Transplant. 2014;29(3):497–506.
Penaloza D, Arias-Stella J. The heart and pulmonary circulation at high altitudes: healthy highlanders and Chronic Mountain sickness. Circulation. 2007;115(9):1132–46.
Zhang G, Zhou SM, Yuan C, Tian HJ, Li P, Gao YQ. The effects of short-term and long-term exposure to a high altitude hypoxic environment on neurobehavioral function. High Alt Med Biol. 2013;14(4):338–41.
Fulco CS, Beidleman BA, Muza SR. Effectiveness of Preacclimatization strategies for high-altitude exposure. Exerc Sport Sci Rev. 2013;41(1):55–63.
Koehle MS, Cheng I, Sporer B. Canadian academy of sport and exercise medicine position statement: athletes at high altitude. Clin J Sport Med. 2014;24(2):120–7.
Cheng I, Kiss A, Lilge L. An observational study of personal ultraviolet dosimetry and acute diffuse reflectance skin changes at extreme altitude. Wilderness Environ Med. 2013;24(4):390–6.
Rigel EG, Lebwohl MG, Rigel AC, Rigel DS. Ultraviolet radiation in alpine skiing: magnitude of exposure and importance of regular protection. Arch Dermatol. 2003;139(1):60–2.
Bloch KE, Buenzli JC, Latshang TD, Ulrich S. Sleep at high altitude: guesses and facts. J Appl Physiol. 2015;119(12):1466–80.
Tseng CH, Lin FC, Chao HS, Tsai HC, Shiao GM, Chang SC. Impact of rapid ascent to high altitude on sleep. Sleep Breath. 2015;19(3):819–26.
Weil JV. Sleep at high altitude. High Alt Med Biol. 2004;5(2):180–9.
Wing-Gaia SL. Nutritional strategies for the preservation of fat free mass at high altitude. Nutrients. 2014;6(2):665–81.
Kechijian D. Optimizing nutrition for performance at altitude: a literature review. J Spec Oper Med. 2011;11(2):12.
Saunders PU, Pyne DB, Gore CJ. Endurance training at altitude. High Alt Med Biol. 2009;10(2):135–48.
Girard O, Amann M, Aughey R, Billaut F, Bishop DJ, Bourdon P, et al. Position statement—altitude training for improving team-sport players’ performance: current knowledge and unresolved issues. Br J Sports Med. 2013;47(Suppl 1):i8–16.
Levine BD, Stray-Gundersen J, Mehta RD. Effect of altitude on football performance: football at altitude. Scand J Med Sci Sports. 2008;18:76–84.
Wilber RL. Application of altitude/hypoxic training by elite athletes. Med Sci Sports Exerc. 2007;39(9):1610–24.
Wachsmuth NB, Völzke C, Prommer N, Schmidt-Trucksäss A, Frese F, Spahl O, et al. The effects of classic altitude training on hemoglobin mass in swimmers. Eur J Appl Physiol. 2013;113(5):1199–211.
Bonne TC, Lundby C, Jørgensen S, Johansen L, Mrgan M, Bech SR, et al. “Live High–Train High” increases hemoglobin mass in Olympic swimmers. Eur J Appl Physiol. 2014;114(7):1439–49.
Siebenmann C, Cathomen A, Hug M, Keiser S, Lundby AK, Hilty MP, et al. Hemoglobin mass and intravascular volume kinetics during and after exposure to 3,454-m altitude. J Appl Physiol. 2015;119(10):1194–201.
Rodríguez FA, Iglesias X, Feriche B, Calderón-Soto C, Chaverri D, Wachsmuth NB, et al. Altitude training in elite swimmers for sea level performance (altitude project). Med Sci Sports Exerc. 2015;47(9):1965–78.
Mellerowicz H, Meller W, Wowerier J, Zerdick J, Ketusinh O, Kral B, et al. Comparative studies on the effect of high altitude training on permanent performance at lower altitudes. Schweiz Z Sportmed. 1971;Suppl:5–17.
McLean BD, Gore CJ, Kemp J. Application of ‘live low-train high’ for enhancing normoxic exercise performance in team sport athletes. Sports Med. 2014;44(9):1275–87.
Millet GP, Faiss R, Brocherie F, Girard O. Hypoxic training and team sports: a challenge to traditional methods? Br J Sports Med. 2013;47(Suppl 1):i6–7.
Lundby C, Millet GP, Calbet JA, Bärtsch P, Subudhi AW. Does ‘altitude training’ increase exercise performance in elite athletes? Br J Sports Med. 2012;46(11):792–5.
Millet G, Girard O, Beard A, Brocherie F. Repeated sprint training in hypoxia—an innovative method. Dtsch Z Für Sportmed. 2019;2019(5):115–22.
Vogt M, Puntschart A, Geiser J, Zuleger C, Billeter R, Hoppeler H. Molecular adaptations in human skeletal muscle to endurance training under simulated hypoxic conditions. J Appl Physiol. 2001;91(1):173–82.
Wilbur RL. Live high + train low: thinking in terms of an optimal hypoxic dose. Int J Sports Physiol Perform. 2007;2(3):223–38.
Chapman RF, Karlsen T, Resaland GK, Ge RL, Harber MP, Witkowski S, et al. Defining the “dose” of altitude training: how high to live for optimal sea level performance enhancement. J Appl Physiol. 2014;116(6):595–603.
Bonetti DL, Hopkins WG. Sea-level exercise performance following adaptation to hypoxia: a meta-analysis. Sports Med. 2009;39(2):107–27.
Saugy JJ, Schmitt L, Cejuela R, Faiss R, Hauser A, Wehrlin JP, et al. Comparison of “Live High-Train Low” in Normobaric versus Hypobaric Hypoxia. PLoS One. 2014;9(12):e114418.
Beidleman BA, Fulco CS, Staab JE, Andrew SP, Muza SR. Cycling performance decrement is greater in hypobaric versus normobaric hypoxia. Extreme Physiol Med. 2014;3(1):8.
Bailey DM, Davies B. Physiological implications of altitude training for endurance performance at sea level: a review. Br J Sports Med. 1997;31(3):183–90.
Saw A, Halson S, Mujika I. Monitoring athletes during training camps: observations and translatable strategies from elite road cyclists and swimmers. Sports. 2018;6(3):63.
Mujika I. Quantification of training and competition loads in endurance sports: methods and applications. Int J Sports Physiol Perform. 2017;12(s2):S2-9–S2-17.
Gore C, Hahn A, Burge C, Telford R. VO 2 max and Haemoglobin mass of trained athletes during high intensity training. Int J Sports Med. 1997;28(06):477–82.
Schmidt W, Prommer N. Effects of various training modalities on blood volume: Total hemoglobin mass and altitude training. Scand J Med Sci Sports. 2008;18:57–69.
Gore CJ, Sharpe K, Garvican-Lewis LA, Saunders PU, Humberstone CE, Robertson EY, et al. Altitude training and haemoglobin mass from the optimised carbon monoxide rebreathing method determined by a meta-analysis. Br J Sports Med. 2013;47(Suppl 1):i31–9.
Saunders PU, Garvican-Lewis LA, Schmidt WF, Gore CJ. Relationship between changes in haemoglobin mass and maximal oxygen uptake after hypoxic exposure. Br J Sports Med. 2013;47(Suppl 1):i26–30.
Govus AD, Garvican-Lewis LA, Abbiss CR, Peeling P, Gore CJ. Pre-altitude serum ferritin levels and daily oral iron supplement dose mediate iron parameter and hemoglobin mass responses to altitude exposure. PLoS One. 2015;10(8):e0135120.
Stellingwerff T, Peeling P, Garvican-Lewis LA, Hall R, Koivisto AE, Heikura IA, et al. Nutrition and altitude: strategies to enhance adaptation, improve performance and maintain health: a narrative review. Sports Med. 2019;49(S2):169–84.
Płoszczyca K, Langfort J, Czuba M. The effects of altitude training on Erythropoietic response and hematological variables in adult athletes: a narrative review. Front Physiol. 2018;9:375.
Chapman RF, Stager JM, Tanner DA, Stray-Gundersen J, Levine BD. Impairment of 3000-m run time at altitude is influenced by arterial oxyhemoglobin saturation. Med Sci Sports Exerc. 2011;43(9):1649–56.
Wehrlin JP, Hallén J. Linear decrease in.VO2max and performance with increasing altitude in endurance athletes. Eur J Appl Physiol. 2006;96(4):404–12.
Ferretti G, Moia C, Thomet JM, Kayser B. The decrease of maximal oxygen consumption during hypoxia in man: a mirror image of the oxygen equilibrium curve. J Physiol. 1997;498(1):231–7.
Saugy JJ, Rupp T, Faiss R, Lamon A, Bourdillon N, Millet GP. Cycling time trial is more altered in hypobaric than Normobaric hypoxia. Med Sci Sports Exerc. 2016;48(4):680–8.
Chapman RF. The individual response to training and competition at altitude. Br J Sports Med. 2013;47(Suppl 1):i40–4.
Mourot L, Millet GP. Is maximal heart rate decrease similar between Normobaric versus hypobaric hypoxia in trained and untrained subjects? High Alt Med Biol. 2019;20(1):94–8.
Sharma AP, Saunders PU, Garvican-Lewis LA, Clark B, Welvaert M, Gore CJ, et al. Improved performance in National-Level Runners with Increased Training Load at 1600 and 1800 m. Int J Sports Physiol Perform. 2019;14(3):286–95.
Schmitt L, Willis SJ, Coulmy N, Millet GP. Effects of different training intensity distributions between elite cross-country skiers and Nordic-combined athletes during live high-train low. Front Physiol. 2018;9:932.
Saw AE, Main LC, Gastin PB. Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review. Br J Sports Med. 2016;50(5):281–91.
Borg GAV. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81.
Levine BD, Stray-Gundersen J. “Living high-training low”: effect of moderate-altitude acclimatization with low-altitude training on performance. J Appl Physiol. 1997;83(1):102–12.
Bärtsch P, Saltin B, Dvorak J. Consensus statement on playing football at different altitude: consensus statement on playing football at different altitude. Scand J Med Sci Sports. 2008;18:96–9.
Bradley PS, Carling C, Archer D, Roberts J, Dodds A, Di Mascio M, et al. The effect of playing formation on high-intensity running and technical profiles in English FA premier league soccer matches. J Sports Sci. 2011;29(8):821–30.
Faude O, Koch T, Meyer T. Straight sprinting is the most frequent action in goal situations in professional football. J Sports Sci. 2012;30(7):625–31.
Wachsmuth N, Kley M, Spielvogel H, Aughey RJ, Gore CJ, Bourdon PC, et al. Changes in blood gas transport of altitude native soccer players near sea-level and sea-level native soccer players at altitude (ISA3600). Br J Sports Med. 2013;47(Suppl 1):i93–9.
Heinicke K, Wolfarth B, Winchenbach P, Biermann B, Schmid A, Huber G, et al. Blood volume and hemoglobin mass in elite athletes of different disciplines. Int J Sports Med. 2001;22(7):504–12.
Daniels J, Oldridge N. The effects of alternate exposure to altitude and sea level on world-class middle-distance runners. Med Sci Sports. 1970;2(3):107–12.
Tønnessen E, Sylta Ø, Haugen TA, Hem E, Svendsen IS, Seiler S. The road to gold: training and peaking characteristics in the year prior to a gold medal endurance performance. PLoS One. 2014;9(7):e101796.
Burtscher M, Niedermeier M, Burtscher J, Pesta D, Suchy J, Strasser B. Preparation for endurance competitions at altitude: physiological, psychological, dietary and coaching aspects. A narrative review. Front Physiol. 2018;9:1504.
Millet GP, Roels B, Schmitt L, Woorons X, Richalet JP. Combining hypoxic methods for peak performance. Sports Med. 2010;40(1):1–25.
Mujika I, Sharma AP, Stellingwerff T. Contemporary periodization of altitude training for elite endurance athletes: a narrative review. Sports Med. 2019;49(11):1651–69.
Chapman RF, Laymon AS, Levine BD. Timing of arrival and pre-acclimatization strategies for the endurance athlete competing at moderate to high altitudes. High Alt Med Biol. 2013;14(4):319–24.
Turner G, Fudge BW, Pringle JSM, Maxwell NS, Richardson AJ. Altitude training in endurance running: perceptions of elite athletes and support staff. J Sports Sci. 2019;37(2):163–72.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Motta, M., Ornon, G., Menetrey, J. (2023). Sports and Altitude. In: Rocha Piedade, S., Hutchinson, M.R., Parker, D., Espregueira-Mendes, J., Neyret, P. (eds) Sideline Management in Sports. Springer, Cham. https://doi.org/10.1007/978-3-031-33867-0_32
Download citation
DOI: https://doi.org/10.1007/978-3-031-33867-0_32
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-33866-3
Online ISBN: 978-3-031-33867-0
eBook Packages: MedicineMedicine (R0)