An attempt to quantify the placebo effect from a three-week simulated altitude training camp in elite race walkers

PURPOSE

To quantify physiological and performance effects of hypoxic exposure, a training camp, the placebo effect, and a combination of these factors.

METHODS

Elite Australian and International race walkers (n = 17) were recruited, including men and women. Three groups were assigned: 1) Live High:Train Low (LHTL, n = 6) of 14 h/d at 3000 m simulated altitude; 2) Placebo (n = 6) of 14 h/d of normoxic exposure (600 m); and 3) Nocebo (n = 5) living in normoxia. All groups undertook similar training during the intervention. Physiological and performance measures included 10-min maximal treadmill distance, peak oxygen uptake (VO2peak), walking economy, and hemoglobin mass (Hbmass).

RESULTS

Blinding failed, so the Placebo group was a second control group aware of the treatment. All three groups improved treadmill performance by approx. 4%. Compared with Placebo, LHTL increased Hbmass by 8.6% (90% CI: 3.5 to 14.0%; P = .01, very likely), VO2peak by 2.7% (-2.2 to 7.9%; P = .34, possibly), but had no additional improvement in treadmill distance (-0.8%, -4.6 to 3.8%; P = .75, unlikely) or economy (-8.2%, -24.1 to 5.7%; P = .31, unlikely). Compared with Nocebo, LHTL increased Hbmass by 5.5% (2.5 to 8.7%; P = .01, very likely), VO2peak by 5.8% (2.3 to 9.4%; P = .02, very likely), but had no additional improvement in treadmill distance (0.3%, -1.9 to 2.5%; P = .75, possibly) and had a decrease in walking economy (-16.5%, -30.5 to 3.9%; P = .04, very likely).

CONCLUSION

Overall, 3-wk LHTL simulated altitude training for 14 h/d increased Hbmass and VO2peak, but the improvement in treadmill performance was not greater than the training camp effect.

Altitude, gun ownership, rural areas, and suicide

OBJECTIVE

The authors recently observed a correlation between state altitude and suicide rate in the United States, which could be explained by higher rates of gun ownership and lower population density in the intermountain West. The present study evaluated the relationship between mean county and state altitude in the United States and total age-adjusted suicide rates, firearm-related suicide rates, and non-firearm-related suicide rates. The authors hypothesized that altitude would be significantly associated with suicide rate.

METHOD

Elevation data were calculated with an approximate spatial resolution of 0.5 km, using zonal statistics on data sets compiled from the National Geospatial-Intelligence Agency and the National Aeronautics and Space Administration. Suicide and population density data were obtained through the Centers for Disease Control and Prevention (CDC) WONDER database. Gun ownership data were obtained through the CDC's Behavioral Risk Factor Surveillance System.

RESULTS

A significant positive correlation was observed between age-adjusted suicide rate and county elevation (r=0.51). Firearm (r=0.41) and non-firearm suicide rates (r=0.32) were also positively correlated with mean county elevation.

CONCLUSIONS

When altitude, gun ownership, and population density are considered as predictor variables for suicide rates on a state basis, altitude appears to be a significant independent risk factor. This association may be related to the effects of metabolic stress associated with mild hypoxia in individuals with mood disorders.

Effectiveness of intermittent training in hypoxia combined with live high/train low

Elite athletes often undertake altitude training to improve sea-level athletic performance, yet the optimal methodology has not been established. A combined approach of live high/train low plus train high (LH/TL+TH) may provide an additional training stimulus to enhance performance gains. Seventeen male and female middle-distance runners with maximal aerobic power (VO2max) of 65.5 +/- 7.3 mL kg(-1) min(-1) (mean +/- SD) trained on a treadmill in normobaric hypoxia for 3 weeks (2,200 m, 4 week(-1)). During this period, the train high (TH) group (n = 9) resided near sea-level (approximately 600 m) while the LH/TL+TH group (n = 8) stayed in normobaric hypoxia (3,000 m) for 14 hours day(-1). Changes in 3-km time trial performance and physiological measures including VO2max, running economy and haemoglobin mass (Hb(mass)) were assessed. The LH/TL+TH group substantially improved VO2max (4.8%; +/-2.8%, mean; +/-90% CL), Hb(mass) (3.6%; +/-2.4%) and 3-km time trial performance (-1.1%; +/-1.0%) immediately post-altitude. There was no substantial improvement in time trial performance 2 weeks later. The TH group substantially improved VO2max (2.2%; +/-1.8%), but had only trivial changes in Hb(mass) and 3-km time-trial performance. Compared with TH, combined LH/TL+TH substantially improved VO2max (2.6%; +/-3.2%), Hb(mass) (4.3%; +/-3.2%), and time trial performance (-0.9%; +/-1.4%) immediately post-altitude. LH/TL+TH elicited greater enhancements in physiological capacities compared with TH, however, the transfer of benefits to time-trial performance was more variable.

Is hypoxia training good for muscles and exercise performance?

Altitude training has become very popular among athletes as a means to further increase exercise performance at sea level or to acclimatize to competition at altitude. Several approaches have evolved during the last few decades, with "live high-train low" and "live low-train high" being the most popular. This review focuses on functional, muscular, and practical aspects derived from extensive research on the "live low-train high" approach. According to this, subjects train in hypoxia but remain under normoxia for the rest of the time. It has been reasoned that exercising in hypoxia could increase the training stimulus. Hypoxia training studies published in the past have varied considerably in altitude (2300-5700 m) and training duration (10 days to 8 weeks) and the fitness of the subjects. The evidence from muscle structural, biochemical, and molecular findings point to a specific role of hypoxia in endurance training. However, based on the available performance capacity data such as maximal oxygen uptake (Vo(2)max) and (maximal) power output, hypoxia as a supplement to training is not consistently found to be advantageous for performance at sea level. Stronger evidence exists for benefits of hypoxic training on performance at altitude. "Live low-train high" may thus be considered when altitude acclimatization is not an option. In addition, the complex pattern of gene expression adaptations induced by supplemental training in hypoxia, but not normoxia, suggest that muscle tissue specifically responds to hypoxia. Whether and to what degree these gene expression changes translate into significant changes in protein concentrations that are ultimately responsible for observable structural or functional phenotypes remains open. It is conceivable that the global functional markers such as Vo(2)max and (maximal) power output are too coarse to detect more subtle changes that might still be functionally relevant, at least to high-level athletes.

Training in hypoxia fails to further enhance endurance performance and lactate clearance in well-trained men and impairs glucose metabolism during prolonged exercise

The aim of this study was to investigate the synergistic effects of endurance training and hypoxia on endurance performance in normoxic and hypoxic conditions (approximately 3000 m above sea level) as well as on lactate and glucose metabolism during prolonged exercise. For this purpose, 14 well-trained cyclists performed 12 training sessions in conditions of normobaric hypoxia (HYP group, n = 7) or normoxia (NOR group, n = 7) over 4 weeks. Before and after training, lactate and glucose turnover rates were measured by infusion of exogenous lactate and stable isotope tracers. Endurance performance was assessed during incremental tests performed in normoxia and hypoxia and a 40 km time trial performed in normoxia. After training, performance was similarly and significantly improved in the NOR and HYP groups (training, P < 0.001) in normoxic conditions. No further effect of hypoxic training was found on markers of endurance performance in hypoxia (training x hypoxia interaction, n.s.). In addition, training and hypoxia had no significant effect on lactate turnover rate. In contrast, there was a significant interaction of training and hypoxia (P < 0.05) on glucose metabolism, as follows: plasma insulin and glucose concentrations were significantly increased; glucose metabolic clearance rate was decreased; and the insulin to glucagon ratio was increased after training in the HYP group. In conclusion, our results show that, compared with training in normoxia, training in hypoxia has no further effect on endurance performance in both normoxic and hypoxic conditions or on lactate metabolic clearance rate. Additionally, these findings suggest that training in hypoxia impairs blood glucose regulation in endurance-trained subjects during exercise.

Improved race performance in elite middle-distance runners after cumulative altitude exposure

We quantified the effect of an extended live high-train low (LHTL) simulated altitude exposure followed by a series of training camps at natural moderate altitude on competitive performance in seven elite middle-distance runners (Vo2max 71.4 +/- 3.4 mL.min-1.kg-1, mean +/- SD). Runners spent 44 +/- 7 nights (mean +/- SD) at a simulated altitude of 2846 +/- 32 m, and a further 4 7- to 10-d training at natural moderate altitude (1700-2200 m) before racing. The combination of simulated LHTL and natural altitude training improved competitive performance by 1.9% (90% confidence limits, 1.3-2.5%). Middle-distance runners can confidently use a combination of simulated and natural altitude to stimulate adaptations responsible for improving performance.