Does Training at Altitude Truly Provide an Athletic Advantage?
Also: IT Band Syndrome! Patellar Tendon Debridement! And practicing on grass causes more ACL injuries?
One of the most common narratives in the athletic performance world is that athletes who live and train at altitude - think Denver, Mexico City, Salt Lake City, etc. - have an inherent advantage over their sea-level dwelling counterparts. The idea is that training higher up in the atmosphere improves an athlete’s cardiovascular capabilities to a greater extent and that the elevation itself makes it difficult to acclimate to the less dense air for those who are more used to playing lower down.
This concept reared its head - in an ironic way - this past week in the NBA’s bubble in Orlando, Florida as teams prepare to restart the season.
But does this theory hold water? The answer is surprisingly unclear. Let’s start by explaining the known physiology behind the theory.
As altitude increases the partial pressure of oxygen decreases. Think of this in a similar way to the ocean. The deeper you go in the ocean, the higher the pressure becomes due to all the water stacked on top of each other; the higher you go in the atmosphere, the lower the pressure becomes due to the lack of stacked air. This decreased pressure allows the oxygen molecules to spread out, so to speak, which decreases the amount molecules that are able to be breathed in.
The body naturally undergoes a few changes in order to compensate for this decrease in pressure. First, it increases your breathing rate - also called ventilation rate - as well as your heart rate. These changes accomplish two major goals: 1. It allows the body to bring in an equivalent amount of oxygen that it would nearer to sea level (i.e. if you’re breathing in half as much oxygen, you need to breathe twice as fast to compensate) and 2. It increases the heart’s cardiac output, which is calculated by multiplying the heart’s rate by its stroke volume, or the amount of blood it spurts out with each beat (i.e. there’s half as much oxygen in the blood, so the heart has to beat twice as fast to sufficiently distribute the oxygen). The “i.e.” examples provided are extreme, but they do an effective job of demonstrating why these changes are important and that they “normalize” the cardiopulmonary requirements the athlete needs between the two elevations.
The body is able to adjust to the “lack of oxygen” after about a week or two and it accomplishes this by producing a greater amount of red blood cells. This causes the athlete’s breathing and heart rate to return to their sea-level values (i.e. twice as many red blood cells mean twice as much oxygen as before being distributed throughout the body, so there’s no need for the heart or lungs to work as hard; again, it’s an extreme example, but it paints the picture). Additionally, some research has shown that athletes also grow more capillaries - very small blood vessels - to help deliver the oxygen-rich blood more efficiently throughout the body. The athlete’s body “de-acclimates” in approximately two-four weeks should they return to sea-level for the long-term.
The kicker is that most athletes who primarily play at lower elevations usually do not compete in higher elevations for prolonged periods (i.e. one to two weeks). To follow with the NBA example provided above, the Minnesota Timberwolves may play in Denver against the Nuggets one night and then in Oklahoma City against the Thunder two days later; in all, they’d spend no more than 24 hours at elevation. For most highly-trained athletes, the natural short-term increases in heart and breathing rate are enough to compensate for any decrease in oxygen consumption and aerobic, and thus athletic, performance.
But what about the Nuggets? Are they at an advantage because they live and train at altitude and often perform near sea-level? Well…that’s up for debate.
A research review conducted by Carsten Lundby and Paul Robach in Europe seems to point to training at altitude having a minimal overall impact on an athlete’s performance. They argue that “the foundation to recommend altitude training to athletes is weak” based on poorly conducted research; however, other reviews argue the opposite and others yet argue that Lundby and Robach’s reivew was “flawed analysis from inaccurate data.”
As for Kendra Andrews tweet above, it is possible that the Nuggets were able to more quickly get in game shape training in Florida versus Denver, but I’d say that the likelihood and advantage gained is minimal. Again, the athlete’s bodies will acclimate to their environment within a month when training at sea-level - though that’s assuming that the athletes were training at elevation ever since the NBA shut down in March - so by the time that the Nuggets are playing official games again, they’ll be on the same playing field as everyone else.
NEWS
American sports are back…pretty much! How will NBA players’ bodies handle the return?: https://theathletic.com/1945276/2020/07/23/how-will-nba-players-bodies-handle-the-return-to-high-intensity-games/
WNBA superstar Tina Charles will not play this season after being granted a medical waiver due to having a history of pulmonary conditions, such as asthma and pneumonia: https://thenext.substack.com/p/tina-charles-receives-medical-exemption
RESEARCH
Iliotibial Band Syndrome is a common - and painful - malady suffered by all kinds of athletes, but runners in particular. Frustratingly, there are few connections between the syndrome and causative factors in the literature: https://spts.org/docs/default-source/ijsptv15n3/ijspt-15_3-13-charles_abs.pdf?sfvrsn=714ff764_2
Patellar tendinopathy is common among athletes and is a difficult condition to treat effectively. However, ultrasound-guided debridement of the tendon is gaining traction as an effective treatment option: https://bmjopensem.bmj.com/content/6/1/e000803
Shoulder and elbow injuries get all the press in baseball, but calf injuries are common and can be difficult for athletes to overcome: https://journals.sagepub.com/doi/full/10.1177/0363546520938759
An interesting study with a perhaps counter-logical finding: ACL injuries among soccer players are more common when practicing on grass versus artificial turf: https://journals.sagepub.com/doi/full/10.1177/2325967120934434