Hi-Low Explained

The concept is pretty simple:  Live High, Train Everywhere

How one gets that done is very complicated and almost each athlete is an individual case.  We have a variety of tools at our disposal to accomplish the goal.

The optimal situation is a natural altitude site that has all the living (reasonable accommodations, a “town”), weather (to be able to train), training (in the case of running, tracks at different altitudes and good running trails and surfaces, Alter-G’s) and support facilities (sports med, physiology, psychology, nutrition, technique) needed.

The “best” option is to live at natural altitude that is high enough to produce a robust increase in red cell mass (note: you have to be able to measure Hb mass and “that” altitude has to be right for the individual).  That altitude is 6500′ for a few, 7000′ for many and 8000′ for most and 9000′ for all.  The lower you live (assuming it is high enough to respond), the longer you have to be there to get an effect.  This ends up being the biggest “hypoxic tent” you can get and it is no big deal to spend 24/7/365 in this environment.  So there is a concept of how much space you confine the athlete to, to make the “mountain”.  It ranges from a natural altitude site down to a paper or plastic bag you put over your head. Park City, UT, at ~7,000′ is considered an ideal training ground.

Multiple axes of importance.

1. Degree of hypoxia (altitude) for living/sleeping.

2. Duration of hypoxia (hours out of 24 and days, weeks, months, years).

3. Space or volume of hypoxic environment (from a mask to the mountains).

4. Degrees of hyperoxia for training (from below sea level to 10,000′).

If one can’t relocate to Park City for whatever reason, then the next best option is to convert the athlete’s living space into a hypoxic environment.  In one athlete’s case, a 2012 London Olympic medalist, we converted his bedroom and living/dining room to hypoxic in his apartment.  With Norwegian and Canadian athletes, it was usually just the bedroom, but in two cases, it was a whole mobile home (note: things like Winnebagoes are relatively easy to convert because they are pretty “leak proof” for starters.)  This volume of space is not stressful for the athlete to confine themselves to for the percentage of the day required and the number of consecutive days.  Essentially, if you are able to sleep and spend some extra time in your own bedroom (watching TV or on your computer or eating a meal), it is no different than what your life would otherwise be.  The simplest and least expensive way of doing this is to “seal” the existing room and get enough nitrogen generators to reduce the oxygen concentration to ~14% (or raise the apparent altitude to 10,000′).

Note: the less time one can be in the environment, the more hypoxic it has to be because when they are out of the environment, the body reverts to a sea level physiology.

Anything less than a room is usually ineffective because the psychologic cost (from stale air, feelings of confinement, etc.) and the idea of restricting movement (confining someone to bedrest causes atrophy and disuse) ends up being too great over the longer term necessary to get the effect.  When traveling it is much easier to just take the canopy or a mask for the limited time they are away from home and out of altitude.  It also takes less of an altitude stimulus to maintain an altitude physiology than to build an altitude physiology.

The basic concept is simple and effective but application and monitoring are not.  Programs need to involve specific athletes and their coaches, and we are working on a number of methods to assist in monitoring athletes with more detail and granularity.

~Dr. James Stray-Gundersen


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