Training in Hypoxic and

Hyperoxic Conditions

By: Adam Berrones

April 15, 2008

Exercise has the power to dramatically disrupt homeostatic conditions and place all

physiologic systems under great amounts of stress (6). However, individuals that can

adapt to this stress will be better prepared the next time physical activity is initiated.

Stress from atmospheric pressures, hot and cold temperatures, and air pollution affect the

body’s ability to maintain homeostasis and dictate the adaptation (6). It is possible that

you can use seemingly negative environmental conditions for positive training

adaptations. For example, many competitive athletes have trained at high altitudes it was

first realized in 1968 during the Mexico City Olympics (8). At that time, little was

known about the effects of training in high altitudes. The physiology of the adaptation

will be discussed.

Loading and unloading oxygen and carbon dioxide in the lungs and tissues is based on

the partial pressure of each gas (7). According to Dalton’s law, the product of the total

pressure of a gas-mixture (which is 760 mm HG in ambient air) and the percentage

concentration of a specific gas (.209 for oxygen) equals the normal partial pressure of

oxygen in the ambient air, which is 159 mm Hg. The alveolar sacs will never see

pressures as high as this. By the time oxygen has reached the alveoli, the pressure will

have reduced to 103 mm Hg (7). However, these values represent normoxic, normobaric

conditions that are seen at sea level. Higher altitudes have low atmospheric pressures

and low concentrations of oxygen in the ambient air (7). This is not inherently negative.

More than 40 million people live, work, and exercise at elevations between 3048 m and

6486 m above sea level (7).

It is possible to acclimatize yourself to the conditions that you are exposed to. This
concept is analogous to the physiological response of increasing the cross-sectional area

of a muscle fiber to better handle the stress from resistance training. The most beneficial

adaptation that can be seen from training in hypoxic conditions is an increase in red blood

cell mass (RBCM). Increasing how much space in the blood occupied by RBC is crucial

as this increases the oxygen-carrying capacity of the system and enhances the aerobic

potential of the individual (8). Red blood cell mass may increase by ~9% during altitude

training, which can translate into improvements in run performance of ~13.4 +/- 10 s over

5000 m (8). An increase in red blood cells directly correlates to enhanced aerobic

metabolism.

Many researchers have looked at the effects that altitude training has on performance and

have created training regimens in high altitudes. Drs Benjamin Levine and James Stray-

Gundersen first developed the model of “training high and living low” in the early

1990’s. The essence of LH+TL is that it allows athletes to live high for the purpose of

altitude acclimatization while simultaneously enabling them to train low to induce

beneficial metabolic and neuromuscular adaptations (13). This is not necessarily the best

model for training at altitude though. One of the potential limitations of LH+TH altitude

training is that many athletes are unable to produce the level of training intensity to

preserve the physiological changes that have a positive impact on performance (13).

Several modifications have been made to this model of training. They include: 1)

Nitrogen apartment: a normobaric hypoxic (2500 to 3000 m) living and sleeping

environment created via nitrogen dilution. 2) Hypoxic tent: a normobaric hypoxic (2000

to 4000 m) sleeping environment based on oxygen-filtration technology. 3) Supplemental

oxygen: a temporary (1- to 3-hour) normoxic training environment created by inhaling a

medical-grade gas with the appropriate fraction of inspired oxygen to simulate sea-level

conditions (13).

The need for increasing blood cell mass is great for aerobic exercise, but anaerobic

metabolism does not need molecular oxygen to generate ATP (1). Several investigators

have looked at the benefits of training in hypoxic conditions for the improvement of

anaerobic metabolism. Scientific advances in the field have developed various pieces of

equipment that can replicate the altered pressure gradients of higher/lower altitudes (7).

This would eliminate the difficulty of traveling to high altitudes for the beneficial

adaptations. This adaptation process, although similar to acclimatization, is characterized

as acclimation. Acclimation refers to adaptations produced in a controlled laboratory

environment (7). Several investigators from The Department of Sport Sciences at the

University of the Pacific simulated hypoxia by using a technique called controlled

frequency breathing (CFB) on collegiate-level swimmers (4). It was originally believed

that CFB training would limit oxygen delivery to working skeletal muscle and produce

metabolic adaptations characteristic of training at altitude (4). This technique, described

as “brutally hard” by the subjects, was beneficial at simulating higher intensities. The

VO2 of the swimmers using the controlled frequency breathing technique was lower than

the control group of swimmers who performed the same series of submaximal tests using

a normal breathing pattern. This indicates that there is an overall lower percentage of

oxygen being utilized by each swimmer and each performance diminishes at the same

relative intensity. The technique failed to reproduce altitude-like conditions and coaches
were informed of the potential drawbacks of this technique (4).

There are investigators that have had success at improving anaerobic metabolism in

hypoxic conditions utilizing the live high-train low philosophy (10). A study published

in the Journal of Sport Sciences entitled, “Acclimatization to altitude and normoxic

training improve 400-m running performance at sea level”, investigated the effects of

hypoxia on anaerobic performance (11). The LH+TL philosophy has proven itself to be

advantageous for endurance athletes but these Finnish researchers found that it can

improve your sprint time at sea level. The reasons for the improved 400-m race time in

this study may be related to the hypoxia-induced changes in anaerobic capacity, buffer

capacity, the effect of the training camp conditions, or to a placebo affect (11). The acid-

base balance was disrupted in the subjects and there were higher lactate concentrations

found as well. These disruptions are said to be the cause of several factors. A response

to living in this altitude house was an increased heart rate for the first five days. After

that time, the heart rate begin to level off and remained relatively stable the remainder of

the ten total days. Another noted change was in increase in pH, which was said to be

normal when a lowlander goes to moderate altitude. This condition will lead to mild

respiratory alkalosis in which the kidneys will respond to hypoxia by eliminating

bicarbonate ions, which will decrease the plasma bicarbonate to PCO2 ratio back to

normal (11).

The effects of hypoxic conditions have been well documented and various training

protocols have examined the aerobic and anaerobic benefits (3), but any changes in
substrate utilization are not well documented (9). Researchers from Denmark

hypothesized that increases in altitude will increase reliance on carbohydrates as a fuel

source (9). The most O2-efficient fuel is the carbohydrate and this fuel should be called

upon more as the intensity increases. This study selected six sea level residents during

60-minute absolute and relative submaximal exercise intensities at sea level, in acute

hypoxia, and after 3-4 weeks of acclimatization to 4100 m of altitude. The major

findings of the study were that submaximal substrate utilization remains unchanged with

acute and chronic hypoxia as well as no difference in substrate utilization between acute

hypoxia and four weeks of acclimatization to altitude (9). The importance of this study

cannot be understated. Hypoxia does not increase carbohydrate utilization.

“I had a big headache, I was short of air and I needed oxygen to breath”, a Brazilian

soccer player told reporters following Ecuador’s 1:0 win in Quito (2800 m) in November

2004 (2). This description characterizes the experience of athletes not acclimatized to

high altitude. That is why training at altitude should always be done with caution and

safety in mind. High altitude illnesses comprise a number of syndromes, including acute

mountain sickness (AMS), high altitude cerebral edema, and high altitude pulmonary

edema (2). Acute mountain sickness is defined as the presence of symptoms like

headache, loss of appetite, nausea, vomiting, weakness, dizziness, and difficulty

breathing. This appears 4-36 hours after traveling to high altitudes (2). Also, ambient air

in higher elevations is usually cool and dry, so body water evaporates as inspired air

becomes warmed and moistened (7). This fluid loss could lead to dehydration. Efforts to

stay hydrated should be maintained at all times during exercise as water affects athletic
performance more than any other nutrient (1). It is known that as altitude increases, your

ability to perform aerobic work decreases (9), and additionally, the more serious physical

illnesses you will experience (2). Therefore, if you need to travel to altitude for a sports

competition it is best to get there as early as possible to acclimatize to the lower oxygen

concentration (10).

The 1968 Mexico Olympics showed of the impairment of sports performance at moderate

altitude (10). These games were held at an altitude of 2240 m above sea level in which

the decrement in performance may reach up to 7% in endurance athletic events (10).

Arriving early enough to acclimatize to the change in partial pressure of O2 is therefore

crucial for successful athletic competition. Researchers from the University of Natal

Medical School in South Africa investigated the effects of moderate altitude on

submaximal exercise over the course of the first two days of exposure in order to make a

practical recommendation to sports competitors (10). They studied several modes of

exercise at various times of arrival to higher altitudes. The study showed that

performance detriments were greater at 6 hours than at 18 or 47 hours after arrival. This

goes against many coaches’ ideologies for pre-competition arrival. Many coaches

believe that the detrimental effects are more pronounced after two days of exposure than

on the first day and they delay arrival at altitude until the day of the event (10). Coaches

are not the only ones who create their own rituals before or during competition. Many

football players breathe oxygen-rich mixtures on the sidelines before returning to the

game and many swimmers take oxygen breaths before moving to the blocks (7).

However, after the player removes the O2 inhaler from his/her mouth, the lower partial
pressure will cause any additional oxygen in the blood to exit the body (7). The intended

goal is to create an over-supply of oxygen in the body, or hyperoxia. Unfortunately,

breathing air at sea-level results in hemoglobin oxygen saturation of 95%-98%. This

means that hyperoxic breathing during rest periods has little potential for increasing

oxygen saturation (1).

An article from the Scandinavian Journal of Medicine & Science in Sports entitled,

“Effect of hyperoxia on metabolic responses and recovery in intermittent exercise”,

uncovers some interesting truths from exercise in hyperoxic conditions (12). Nine well-

trained 400m runners ran 3 x 3 x 300 m on a treadmill at 66%, 76%, and 83% of their

velocity from their seasonal high 400 m. The group was tested on three different days in

three different conditions. In one condition, the subjects ran the 300 m in a normoxic

condition. In the second condition, the subjects ran while breathing through a valve that

contained 40% oxygen. The third condition supplied the runners with the hyperoxic gas

mixture during the recovery phase. The intended purpose of the study was to analyze the

effects of hemoglobin-oxygen saturation during recovery and exercise. The conclusions

of the study were that the hyperoxic gas mixture prevents decreases in hemoglobin

oxygen saturation during exercise and recovery. But the performance was not

significantly affected. The physical conditions of the athletes were hypothesized to be

the reason why performance did not increase.

The Department of Human and Engineered Environmental Studies in Japan also studied

the effects of hyperoxic conditions on exercise performance (5). The purpose of their
study was to investigate the effects of pre-exposure to hyperbaric/hyperoxic conditions

on high-intensity exercise. The subjects used in this study were twenty-one healthy men

and women who did not perform any additional exercise throughout the experimental

period. In the experiment, each subject sat in a hyperbaric/hyperoxic chamber for 80

minutes. Exactly five minutes after exiting the chamber a maximal knee extensor test

was administered. Results were compared with pre-chamber values and there were no

significant differences in strength from exposure to the hyperbaric chamber. Maximal

strength is not affected because the O2 content under hyperbaric/hyperoxic conditions is

released immediately under normal conditions.

The physiological systems responses to altered concentrations of oxygen have been

displayed. The human body requires an adaptation process for survival in stressful

environments (6). It is possible to utilize these adaptations for enhancing performance

during competition (11). However, it is also possible to experience decreased

performance from altitude exposure (3). It has been shown that there are many

misconceptions with training in hyperoxic conditions (5). As with any training regimen,

one should be informed of all the potential hazards of hypoxic and hyperoxic training

conditions. The boundaries to which one can simulate environmental conditions for

positive adaptations continue to be explored.

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