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DR Z’S
CORNER

ELEVATION MASK & ALTITUDE TRAINING
Hypoxic Dose on Exercise-Hype, Hope of Height?

Mimi Zumwalt, MD
Sports Medicine Specialistt

T

raining at elevated altitudes is becoming more and more
popular as a mode of exercising in an environment of
low oxygen, as an attempt to improve cardiorespiratory
condition in hopes of enhancing athletic performance.
Researchers began to study high altitude training in the late
1960s, especially after the Olympics in Mexico City being held
at over 7300ft elevation. World-class elite athletes participating
in anaerobic, sprint-type events broke all sorts of records, while
those competing in endurance Olympic Games finished way below
prior recorded times. Speculations arose out of these differing
competition results center on the air being less dense, therefore
providing less resistance during motion, along with shorter duration
of non-aerobic events contributing to the overall final advantage.
So what are the principles/mechanisms behind altitude
training? The atmospheric pressure between high altitude and
sea level differs by the former having less molecules of gas (~4/5
nitrogen-~1/5 oxygen), thus being thinner and exerting less force
in the body. This decrease in air resistance causes different physiological changes. The higher elevation results in less oxygenation
of blood, causing an increase in EPO-erythropoietin (produced in
the kidneys). This hormonal production sends signals to the bone
marrow to make more red blood cells (RBCs), but this adaptive
effect is variable in different athletes, according to their body’s natural limits of natural EPO secretion. Another bodily change occurs
from increasing workout intensity from elevated respiratory/heart
rates, causing an improvement in the training effect, which can last
up to a couple of weeks after returning to sea level. Similarly, other
research has shown that hypoxic training stimulates muscles to
use oxygen more efficiently, contributing to improved endurance/
duration of activity. In addition, by exercising at higher altitudes,
muscle fiber types eventually switch towards better aerobic capacity/performance, due to alteration of cellular metabolism.
How can someone then go about using altitude-training effect
to his/her advantage? Few techniques exist to help an athlete
achieve the natural condition of hypoxic atmosphere. One such
condition is living high (~7000 to 8000ft above sea level) and
exercising low ~4000ft or less, is optimal for altitude-type training.
One must be exposed to higher altitudes of at least 12hrs/day for
about 3 weeks, before physiological changes occur to make a
positive difference in performance, which can persist as long as 2
weeks at sea level. The gains in speed, strength, endurance, plus
recovery are variable according to time spent along with training
program type. These physical effects are also less evident in
athletes engaged in primarily anaerobic activity, since they don’t

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Natural Muscle Magazine

rely on oxygen as fuel for energy. However, it’s not recommended
to train at altitudes higher than 16000ft, since this degree of extreme exposure to hypoxia can deteriorate soft tissues, resulting in
10-15% muscle loss. Other methods of hypoxic exercising include
using artificial altitude training systems (Hypoxico, Inc) or working
out inside altitude simulators/barometric chambers, first introduced
in mid 1990s. Since then, respiratory muscle training (RMT)/resistive breathing while exercising has surfaced as another tool to train
similar to simulated altitude environment, via usage of a mask-like
device with valves providing resistance with each breath.
The elevation-training mask (ETM) is a new product on the
market composed of a multi-level resistance system, supposedly
designed to help with sports performance. This wearable device
has adjustable opening/valves to increase resistance to respiration,
which makes breathing more difficult. Individualized adjustments
allows the athlete to purportedly control simulated levels between
~3000-18000ft altitude range. A recent study on cyclists did show
some differences in respiratory muscle endurance parameters,

November 2016

Celebrating 21 Years!

but not comparable to working out at naturally elevated height
conditions.
In summary, results of high altitude training via natural or
artificial/simulated elevated height hypoxic environmental conditions, including devices touting potential positive effects on sports
performance, are negligible at best. Positive physiological changes
do occur in the body dependent on frequency/duration of exposure.
As far as better oxygen utilization and/or improved respiratory
muscle function are co