Altitude training for improvements in sea level performance. Is the scientific evidence of benefit?

High-Intensity Interval Training (HIIT) in Hypoxia Improves Maximal Aerobic Capacity More Than HIIT in Normoxia: A Systematic Review, Meta-Analysis, and Meta-Regression

The present study aimed to determine the effect of high intensity interval training (HIIT) in hypoxia on maximal oxygen uptake (VO_2max) compared with HIIT in normoxia with a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-accordant meta-analysis and meta-regression. Studies which measured VO_2max following a minimum of 2 weeks intervention featuring HIIT in hypoxia versus HIIT in normoxia were included. From 119 originally identified titles, nine studies were included (n = 194 participants). Meta-analysis was conducted on change in (∆) VO_2max using standardised mean difference (SMD) and a random effects model. Meta-regression examined the relationship between the extent of environmental hypoxia (fractional inspired oxygen [FiO₂]) and ∆VO_2max and intervention duration and ∆VO_2max. The overall SMD for ∆VO_2max following HIIT in hypoxia was 1.14 (95% CI = 0.56-1.72; p < 0.001). Meta-regressions identified no significant relationship between FiO₂ (coefficient estimate = 0.074, p = 0.852) or intervention duration (coefficient estimate = 0.071, p = 0.423) and ∆VO_2max. In conclusion, HIIT in hypoxia improved VO_2max compared to HIIT in normoxia. Neither extent of hypoxia, nor training duration modified this effect, however the range in FiO₂ was small, which limits interpretation of this meta-regression. Moreover, training duration is not the only training variable known to influence ∆VO_2max, and does not appropriately capture total training stress or load. This meta-analysis provides pooled evidence that HIIT in hypoxia may be more efficacious at improving VO_2max than HIIT in normoxia. The application of these data suggest adding a hypoxic stimuli to a period of HIIT may be more effective at improving VO_2max than HIIT alone. Therefore, coaches and athletes with access to altitude (either natural or simulated) should consider implementing HIIT in hypoxia, rather than HIIT in normoxia where possible, assuming no negative side effects.

Age and Hydration of Competing Horses Influence the Outcome of Elite 160 km Endurance Rides

High elimination rates and the concern for horse welfare are important issues in endurance riding. An improved understanding of the causes of elimination could increase completion rates in this sport. We have identified pre-ride risk factors that allow an assessment of potential elimination before the ride. A longitudinal cohort study was performed among 49 healthy horses competing in the 160 km endurance ride at the 2016 World Championship of Endurance Riding in Samorin/Slovakia. Blood samples were drawn before the ride. For statistical evaluation, horses were categorized in three groups: finishers, lame and metabolically eliminated horses. Risk factors were calculated for each group using multinomial logistic regression. A 1% increase in hematocrit levels was associated with a higher OR for elimination (lameness: OR 1.26, p = 0.017; metabolic: OR 1.34, p = 0.010). Furthermore, increased potassium values correlated negatively with the race outcome. For a 1 mmol/l increase in potassium, the lameness OR was 4.21, p = 0.039 and metabolic OR was 1.15, p = 0.848. Eight-year-old horses had a 100% elimination rate and survival analyses showed a significantly higher hazard for elimination (p = 0.025). We thus conclude that age and hydration affect the outcome of elite endurance rides. Further investigation of age as a risk factor seems to be clinically relevant and adjustments of FEI qualification modes may be appropriate.

Intermittent hypoxic training for 6 weeks in 3000 m hypobaric hypoxia conditions enhances exercise economy and aerobic exercise performance in moderately trained swimmers

Athletic endurance performance at sea level can be improved via intermittent hypoxic training (IHT). However, the efficacy of IHT for enhancement of aerobic exercise performance at sea level is controversial because of methodological differences. Therefore, the aim of the study was to determine whether the IHT regimen ameliorates exercise economy and aerobic exercise performance in moderately trained swimmers. A total of 20 moderately trained swimmers were equally assigned to the control group (n=10) training in normoxic conditions and the IHT group (n=10) training at a simulated altitude of 3000 m. They were evaluated for metabolic parameters and skeletal muscle oxygenation during 30 min submaximal exercise on a bicycle, and aerobic exercise performance before and after 6 weeks of training composed of aerobic continuous exercise set at 80% maximal heart rate (HRmax) during 30 min and anaerobic interval exercise set at the exercise load with 90% HRmax measured in pre-test during 30 min (10 times 2 min exercise and 1 min rest). According to the results, the IHT group demonstrated greater improvement in exercise economy due to decreases in VO2 (p=.016) and HHb (p=.002) and increases in O₂Hb (p<.001) and TOI (p=.006). VCO₂ was decreased in the IHT group (p=.010) and blood lactate level was decreased in the control (p=.005) and IHT groups (p=.001). All aerobic exercise performance including VO_2max (p=.001) and the 400 m time trial (p<.001) were increased in the IHT group. The present findings indicate that the 6 week IHT regime composed of high-intensity aerobic continuous exercise and anaerobic interval exercise can be considered an effective altitude/hypoxic training method for improvement of exercise economy and aerobic exercise performance in moderately trained swimmers.

Comparison of the effect of intermittent hypoxic training vs. the live high, train low strategy on aerobic capacity and sports performance in cyclists in normoxia

The aim of the study was to compare the effect of intermittent hypoxic training (IHT) and the live high, train low strategy on aerobic capacity and sports performance in off-road cyclists in normoxia. Thirty off-road cyclists were randomized to three groups and subjected to 4-week training routines. The participants from the first experimental group were exposed to normobaric hypoxia conditions (FiO₂ = 16.3%) at rest and during sleep (G-LH-TL; n=10; age: 20.5 ± 2.9 years; body height 1.81 ± 0.04 m; body mass: 69.6 ± 3.9 kg). Training in this group was performed under normoxic conditions. In the second experimental group, study participants followed an intermittent hypoxic training (IHT, three sessions per week, FiO2 = 16.3%) routine (G-IHT; n=10; age: 20.7 ± 3.1 years; body height 1.78 ± 0.05 m; body mass: 67.5 ± 5.6 kg). Exercise intensity was adjusted based on the lactate threshold (LT) load determined in hypoxia. The control group lived and trained under normoxic conditions (G-C; n=10; age: 21.8 ± 4.0 years; body height 1.78 ± 0.03 m; body mass: 68.1 ± 4.7 kg; body fat content: 8.4 ± 2.4%). The evaluations included two research series (S1, S2). Between S1 and S2, athletes from all groups followed a similar training programme for 4 weeks. In each research series a graded ergocycle test was performed in order to measure VO_2max and determine the LT and a simulated 30 km individual time trial. Significant (p<0.05) improvements in VO_2max, VO_2LT, WR_max and WR_LT were observed in the G-IHT (by 3.5%, 9.1%, 6.7% and 7.7% respectively) and G-LH-TL groups (by 4.8%, 6.7%, 5.9% and 4.8% respectively). Sports performance (TT) was also improved (p<0.01) in both groups by 3.6% in G-LH-TL and 2.5% in G-IHT. Significant changes (p<0.05) in serum EPO levels and haematological variables (increases in RBC, HGB, HCT and reticulocyte percentage) were observed only in G-LH-TL. Normobaric hypoxia has been demonstrated to be an effective ergogenic aid that can enhance the exercise capacity of cyclists in normoxia. Both LH-TL and IHT lead to improvements in aerobic capacity. The adaptations induced by both approaches are likely to be caused by different mechanisms. The evaluations included two research series (S1, S2). Between S1 and S2, athletes from all groups followed a similar training programme for 4 weeks. In each research series a graded ergocycle exercise test was performed in order to measure VO_2max and determine the lactate threshold as well as a simulated 30 km individual time trial.

GXT responses in altitude-acclimatized cyclists during sea-level simulation

PURPOSE

This study examined the effects of gender on graded exercise stress test (GXT) response in moderate-altitude (MA)-acclimatized cyclists during sea-level (SL) simulation. It was hypothesized that alterations in arterial saturation would relate to changes in VO2peak.

METHODS

Twenty competitive cyclists (12 males, 8 females) who were residents of MA locations underwent two randomized bicycle GXTs: one under local normoxic hypobaria, and the other under simulated SL conditions.

RESULTS

Under the SL condition, the cyclists demonstrated a significant increase (2-3%) in absolute and relative VO2peak, improved (4%) economy at lactate threshold (LT), and time-adjusted peak power (7%); the range of improvement between individuals varied from -6% to +25%. Simulated SL also resulted in a greater arterial saturation (S(a)O2) at rest and VO2peak, and significantly less desaturation (4 vs 8%) from rest to VO2peak. The individual variability in the change (Delta) in VO2peak was not significantly correlated to SL S(a)O2 or any other S(a)O2 variable analyzed, regardless of whether we examined each gender individually or combined. Significant correlations were found between Delta-peak power and Delta-economy as well as Delta-VO2peak and Delta-GXT time. These correlations as well as degree of improvement varied by gender.

CONCLUSIONS

These data suggest that chronic residence at MA may attenuate the occurrence of exercise-induced arterial hypoxemia and eliminate the relationship between S(a)O2 and Delta-VO2peak that has been reported among SL residents acutely exposed to altitude. Additionally, the improvements that occur in predictors of aerobic performance when MA residents are exposed acutely to SL conditions have a large degree of individual variability, and the mechanism(s) for improvement may vary by gender.

Effect of hypoxic "dose" on physiological responses and sea-level performance

Live high-train low (LH+TL) altitude training was developed in the early 1990s in response to potential training limitations imposed on endurance athletes by traditional live high-train high (LH+TH) altitude training. The essence of LH+TL is that it allows athletes to "live high" for the purpose of facilitating altitude acclimatization, as manifest by a profound and sustained increase in endogenous erythropoietin (EPO) and ultimately an augmented erythrocyte volume, while simultaneously allowing athletes to "train low" for the purpose of replicating sea-level training intensity and oxygen flux, thereby inducing beneficial metabolic and neuromuscular adaptations. In addition to "natural/terrestrial" LH+TL, several simulated LH+TL devices have been developed to conveniently bring the mountain to the athlete, including nitrogen apartments, hypoxic tents, and hypoxicator devices. One of the key questions regarding the practical application of LH+TL is, what is the optimal hypoxic dose needed to facilitate altitude acclimatization and produce the expected beneficial physiological responses and sea-level performance effects? The purpose of this paper is to objectively answer that question, on the basis of an extensive body of research by our group in LH+TL altitude training. We will address three key questions: 1) What is the optimal altitude at which to live? 2) How many days are required at altitude? and 3) How many hours per day are required? On the basis of consistent findings from our research group, we recommend that for athletes to derive the physiological benefits of LH+TL, they need to live at a natural elevation of 2000-2500 m for >or=4 wk for >or=22 h.d(-1).

Live High + Train Low: Thinking in Terms of an Optimal Hypoxic Dose

“Live high-train low” (LH+TL) altitude training allows athletes to “live high” for the purpose of facilitating altitude acclimatization, as characterized by a significant and sustained increase in endogenous erythropoietin and subsequent increase in erythrocyte volume, while simultaneously enabling them to “train low” for the purpose of replicating sea-level training intensity and oxygen flux, thereby inducing beneficial metabolic and neuromuscular adaptations. In addition to natural/terrestrial LH+TL, several simulated LH+TL devices have been developed including nitrogen apartments, hypoxic tents, and hypoxicator devices. One of the key issues regarding the practical application of LH+TL is what the optimal hypoxic dose is that is needed to facilitate altitude acclimatization and produce the expected beneficial physiological responses and sea-level performance effects. The purpose of this review is to examine this issue from a research-based and applied perspective by addressing the following questions: What is the optimal altitude at which to live, how many days are required at altitude, and how many hours per day are required? It appears that for athletes to derive the hematological benefits of LH+TL while using natural/terrestrial altitude, they need to live at an elevation of 2000 to 2500 m for >4 wk for >22 h/d. For athletes using LH+TL in a simulated altitude environment, fewer hours (12-16 h) of hypoxic exposure might be necessary, but a higher elevation (2500 to 3000 m) is required to achieve similar physiological responses.

Performance of runners and swimmers after four weeks of intermittent hypobaric hypoxic exposure plus sea level training

This double-blind, randomized, placebo-controlled trial examined the effects of 4 wk of resting exposure to intermittent hypobaric hypoxia (IHE, 3 h/day, 5 days/wk at 4,000-5,500 m) or normoxia combined with training at sea level on performance and maximal oxygen transport in athletes. Twenty-three trained swimmers and runners completed duplicate baseline time trials (100/400-m swims, or 3-km run) and measures for maximal oxygen uptake (VO(2max)), ventilation (VE(max)), and heart rate (HR(max)) and the oxygen uptake at the ventilatory threshold (VO(2) at VT) during incremental treadmill or swimming flume tests. Subjects were matched for sex, sport, performance, and training status and divided randomly between hypobaric hypoxia (Hypo, n = 11) and normobaric normoxia (Norm, n = 12) groups. All tests were repeated within the first (Post1) and third weeks (Post2) after the intervention. Time-trial performance did not improve in either group. We could not detect a significant difference between groups for a change in VO(2max), VE(max), HR(max), or VO(2) at VT after the intervention (group x test interaction P = 0.31, 0.24, 0.26, and 0.12, respectively). When runners and swimmers were considered separately, Hypo swimmers appeared to increase VO(2max) (+6.2%, interaction P = 0.07) at Post2 following a precompetition taper and increased VO(2) at VT (+8.9 and +12.1%, interaction P = 0.007 and 0.006, at Post1 and Post2). We conclude that this "dose" of IHE was not sufficient to improve performance or oxygen transport in this heterogeneous group of athletes. Whether there are potential benefits of this regimen for specific sports or training/tapering strategies may require further study.

Effects of intermittent hypoxic training on aerobic and anaerobic performance

The aim of the present study was to determine whether short-term intermittent hypoxic training would enhance sea level aerobic and anaerobic performance over and above that occurring with equivalent sea level training. Over a 4-week period, two groups of eight moderately trained team sports players performed 30 min of cycling exercise three times per week. One group trained in normobaric hypoxia at a simulated altitude of 2750 m (F(I)O2= 0.15), the other group trained in a laboratory under sea level conditions. Each training session consisted of ten 1-min bouts at 80% maximum workload maintained for 2 min (Wmax) during the incremental exercise test at sea level separated by 2-min active recovery at 50% Wmax. Training intensities were increased by 5% after six training sessions and by a further 5% (of original Wmax) after nine sessions. Pre-training assessments of VO(2max), power output at onset of 4 mM blood lactate accumulation (OBLA), Wmax and Wingate anaerobic performance were performed on a cycle ergometer at sea level and repeated 4-7 d following the training intervention. Following training there were significant increases (p < 0.01) in VO(2max) (7.2 vs. 8.0%), Wmax (15.5 vs. 17.8%), OBLA (11.1 vs. 11.9%), mean power (8.0 vs. 6.5%) and peak power (2.9 vs. 9.3%) in both the hypoxic and normoxic groups respectively. There were no significant differences between the increases in any of the above-mentioned performance parameters in either training environment (p > 0.05). In addition, neither haemoglobin concentration nor haematocrit were significantly changed in either group (p > 0.05). It is concluded that acute exposure of moderately trained subjects to normobaric hypoxia during a short-term training programme consisting of moderate- to high-intensity intermittent exercise has no enhanced effect on the degree of improvement in either aerobic or anaerobic performance. These data suggest that if there are any advantages to training in hypoxia for sea level performance, they would not arise from the short-term protocol employed in the present study.

Chronic hypoxia exposure depresses aortic endothelium-dependent vasorelaxation in both sedentary and trained rats: involvement of l-arginine

This study was designed to test the hypothesis that the previously demonstrated training-induced improvement of the endothelium vasodilator function would be blunted under conditions of chronic hypoxia exposure as a result of deleterious effects of hypoxia per se on the nitric oxide pathway. Sea-level-native rats were randomly assigned to N (living in normoxia), NT (living and training 5 days/wk for 5 wk in normoxia), CH (living in hypoxia, 2,800 m), and CHT (living and training 5 days/wk for 5 wk in hypoxia, 2,800 m) groups. Concentration-response curves to acetylcholine (ACh; 10−9 to 10−4 M) with or without l-arginine (10−3 to 10−5 M) and/or nitro-l-arginine methyl ester (10−5 M) were assessed on aortic isolated rings. The main finding was that chronic hypoxia severely depressed maximal ACh-responses of aortic rings in both sedentary and trained groups. However, chronic hypoxia did not interfere with training-induced increases in maximal ACh responses, considering that maximal ACh vasorelaxation was improved in CHT rats to the same extent as in NT rats when both groups were directly compared with their sedentary counterparts. It should be pointed out that the vasodilator response to ACh was restored in CH and CHT rats to the level obtained in N and NT rats, respectively, by an in vitro l-arginine addition. A hypoxia-induced decrease in l-arginine bioavailability resulting from acclimatization at altitude may be involved in this limitation of the NO pathway in CH and CHT rats. These results are of importance for aerobic performance as the specific vascular adaptations to training at altitude could contribute to limit peripheral vasodilatation and subsequently blood flow during exercise.

Individual variation in the erythropoietic response to altitude training in elite junior swimmers

OBJECTIVES

Inter-individual variations in sea level performance after altitude training have been attributed, at least in part, to an inter-individual variability in hypoxia induced erythropoiesis. The aim of the present study was to examine whether the variability in the increase in total haemoglobin mass after training at moderate altitude could be predicted by the erythropoietin response after 4 h exposure to normobaric hypoxia at an ambient Po(2) corresponding to the training altitude.

METHODS

Erythropoietin levels were measured in 16 elite junior swimmers before and after 4 h exposure to normobaric hypoxia (Fio(2) 0.15, approximately 2500 m) as well as repeatedly during 3 week altitude training (2100-2300 m). Before and after the altitude training, total haemoglobin mass (CO rebreathing) and performance in a stepwise increasing swimming test were determined.

RESULTS

The erythropoietin increase (10-185%) after 4 h exposure to normobaric hypoxia showed considerable inter-individual variation and was significantly (p<0.001) correlated with the acute erythropoietin increase during altitude training but not with the change in total haemoglobin mass (significant increase of approximately 6% on average). The change in sea level performance after altitude training was not related to the change in total haemoglobin mass.

CONCLUSIONS

The results of the present prospective study confirmed the wide inter-individual variability in erythropoietic response to altitude training in elite athletes. However, their erythropoietin response to acute altitude exposure might not identify those athletes who respond to altitude training with an increase in total haemoglobin mass.

Training and performance characteristics among Norwegian international rowers 1970-2001

This study quantified changes in training volume, organization, and physical capacity among Norwegian rowers winning international medals between 1970 and 2001. Twenty-eight athletes were identified (27 alive). Results of physiological testing and performance history were available for all athletes. Twenty-one of 27 athletes responded to a detailed questionnaire regarding their training during their internationally competitive years. Maximal oxygen uptake (VO2 max) increased 12% (6.5+/- 0.4 vs. 5.8+/-0.2 L min(-1)) from the 1970s to the 1990s. Similarly, 6-min ergometer rowing performance increased almost 10%. Three major changes in training characteristics were identified: (1) training at a low blood lactate (< 2 mM) increased from 30 to 50 h month(-1) and race pace and supra-maximal intensity training (approximately 8-14 mM lactate) decreased from 23 to approximately 7 h month(-1); (2) training volume increased by approximately 20%, from 924 to 1128 h yr(-1); (3) altitude training was used as a pre-competition peaking strategy, but it is now integrated into the winter preparation program as periodic 2-3-week altitude camps. The training organization trends are consistent with data collected on athletes from other sports, suggesting a "polarized" pattern of training organization where a high volume of low intensity training is balanced against regular application of training bouts utilizing 90%-95% of VO2 max.

The Science of Cycling

This review presents information that is useful to athletes, coaches and exercise scientists in the adoption of exercise protocols, prescription of training regimens and creation of research designs. Part 2 focuses on the factors that affect cycling performance. Among those factors, aerodynamic resistance is the major resistance force the racing cyclist must overcome. This challenge can be dealt with through equipment technological modifications and body position configuration adjustments. To successfully achieve efficient transfer of power from the body to the drive train of the bicycle the major concern is bicycle configuration and cycling body position. Peak power output appears to be highly correlated with cycling success. Likewise, gear ratio and pedalling cadence directly influence cycling economy/efficiency. Knowledge of muscle recruitment throughout the crank cycle has important implications for training and body position adjustments while climbing. A review of pacing models suggests that while there appears to be some evidence in favour of one technique over another, there remains the need for further field research to validate the findings. Nevertheless, performance modelling has important implications for the establishment of performance standards and consequent recommendations for training.

Intermittent hypoxia improves endurance performance and submaximal exercise efficiency

The purpose of the present study was to elucidate the influence of intermittent hypobaric hypoxia at rest on endurance performance and cardiorespiratory and hematological adaptations in trained endurance athletes. Twelve trained male endurance runners were assigned to either a hypoxic group (n = 6) or a control group (n = 6). The subjects in the hypoxic group were exposed to a simulated altitude of 4500 m for 90 min, three times a week for 3 weeks. The measurements of 3000 m running time, running time to exhaustion, and cardiorespiratory parameters during maximal exercise test and resting hematological status were performed before (Pre) and after 3 weeks of intermittent hypoxic exposure (Post). These measurements were repeated after the cessation of intermittent hypoxia for 3 weeks (Re). In the control group, the same parameters were determined at Pre, Post, and Re for the subjects not exposed to intermittent hypoxia. The athletes in both groups continued their normal training together at sea level throughout the experiment. In the hypoxic group, the 3000 m running time and running time to exhaustion during maximal exercise test improved. Neither cardiorespiratory parameters to maximal exercise nor resting hematological parameters were changed in either group at Post, whereas oxygen uptake (.V(O2)) during submaximal exercise decreased significantly in the hypoxic group. After cessation of intermittent hypoxia for 3 weeks, the improved 3000 m running time and running time to exhaustion tended to decline, and the decreased .V(O2) during submaximal exercise returned to Pre level. These results suggest that intermittent hypoxia at rest could improve endurance performance and submaximal exercise efficiency at sea level in trained endurance athletes, but these improvements are not maintained after the cessation of intermittent hypoxia for 3 weeks.

The Tour de France: a physiological review

On 5 July 2003, the Tour de France (TDF) has celebrated 100th running. Instead of a chimney sweep competing during his free time (as in 1903), the recent winner is a highly trained, professional cyclist whose entire life-style has been dedicated to reach his pinnacle during this event. The TDF has been held successfully for 100 years, but the application of the physiologic sciences to the sport is a relatively recent phenomenon. Although some historical reports help to understand the unique physiological characteristics of this race, scientific studies were not available in Sports Science/Applied Physiology journals until the 1990s. The aim of this article is to review the history of the TDF. Special emphasis is placed on the last decade where classic physiology has been integrated into applied scientific cycling data.

Live high:train low increases muscle buffer capacity and submaximal cycling efficiency

This study investigated whether hypoxic exposure increased muscle buffer capacity (beta(m)) and mechanical efficiency during exercise in male athletes. A control (CON, n=7) and a live high:train low group (LHTL, n=6) trained at near sea level (600 m), with the LHTL group sleeping for 23 nights in simulated moderate altitude (3000 m). Whole body oxygen consumption (VO2) was measured under normoxia before, during and after 23 nights of sleeping in hypoxia, during cycle ergometry comprising 4 x 4-min submaximal stages, 2-min at 5.6 +/- 0.4 W kg(-1), and 2-min 'all-out' to determine total work and VO(2peak). A vastus lateralis muscle biopsy was taken at rest and after a standardized 2-min 5.6 +/- 0.4 W kg(-1) bout, before and after LHTL, and analysed for beta(m) and metabolites. After LHTL, beta(m) was increased (18%, P < 0.05). Although work was maintained, VO(2peak) fell after LHTL (7%, P < 0.05). Submaximal VO2 was reduced (4.4%, P < 0.05) and efficiency improved (0.8%, P < 0.05) after LHTL probably because of a shift in fuel utilization. This is the first study to show that hypoxic exposure, per se, increases muscle buffer capacity. Further, reduced VO2 during normoxic exercise after LHTL suggests that improved exercise efficiency is a fundamental adaptation to LHTL.

The effect of altitude on cycling performance: a challenge to traditional concepts

Acute exposure to moderate altitude is likely to enhance cycling performance on flat terrain because the benefit of reduced aerodynamic drag outweighs the decrease in maximum aerobic power [maximal oxygen uptake (VO2max)]. In contrast, when the course is mountainous, cycling performance will be reduced at moderate altitude. Living and training at altitude, or living in an hypoxic environment (approximately 2500 m) but training near sea level, are popular practices among elite cyclists seeking enhanced performance at sea level. In an attempt to confirm or refute the efficacy of these practices, we reviewed studies conducted on highly-trained athletes and, where possible, on elite cyclists. To ensure relevance of the information to the conditions likely to be encountered by cyclists, we concentrated our literature survey on studies that have used 2- to 4-week exposures to moderate altitude (1500 to 3000 m). With acclimatisation there is strong evidence of decreased production or increased clearance of lactate in the muscle, moderate evidence of enhanced muscle buffering capacity (beta m) and tenuous evidence of improved mechanical efficiency (ME) of cycling. Our analysis of the relevant literature indicates that, in contrast to the existing paradigm, adaptation to natural or simulated moderate altitude does not stimulate red cell production sufficiently to increase red cell volume (RCV) and haemoglobin mass (Hb(mass)). Hypoxia does increase serum erthyropoietin levels but the next step in the erythropoietic cascade is not clearly established; there is only weak evidence of an increase in young red blood cells (reticulocytes). Moreover, the collective evidence from studies of highly-trained athletes indicates that adaptation to hypoxia is unlikely to enhance sea level VO2max. Such enhancement would be expected if RCV and Hb(mass) were elevated. The accumulated results of 5 different research groups that have used controlled study designs indicate that continuous living and training at moderate altitude does not improve sea level performance of high level athletes. However, recent studies from 3 independent laboratories have consistently shown small improvements after living in hypoxia and training near sea level. While other research groups have attributed the improved performance to increased RCV and VO2max, we cite evidence that changes at the muscle level (beta m and ME) could be the fundamental mechanism. While living at altitude but training near sea level may be optimal for enhancing the performance of competitive cyclists, much further research is required to confirm its benefit. If this benefit does exist, it probably varies between individuals and averages little more than 1%.

Improving cycling performance: how should we spend our time and money

Cycling performance is dependent on physiological factors which influence mechanical power production and mechanical and environmental factors that affect power demand. The purpose of this review was to summarize these factors and to rank them in order of importance. We used a model by Martin et al. to express all performance changes as changes in 40 km time trial performance. We modelled the performance of riders with different ability ranging from novice to elite cyclists. Training is a first and most obvious way to improve power production and was predicted to have the potential to improve 40 km time trial performance by 1 to 10% (1 to 7 minutes). The model also predicts that altitude training per se can cause a further improvement of 23 to 34 seconds. Carbohydrate-electrolyte drinks may decrease 40 km time by 32 to 42 seconds. Relatively low doses of caffeine may improve 40 km time trial performance by 55 to 84 seconds. Another way of improving time trial performance is by reducing the power demand of riding at a certain velocity. Riding with hands on the brake hoods would improve aerodynamics and increase performance time by approximately 5 to 7 minutes and riding with hands on the handlebar drops would increase performance time by 2 to 3 minutes compared with a baseline position (elbows on time trail handle bars). Conversely, riding with a carefully optimised position could decrease performance time by 2 to 2.5 minutes. An aerodynamic frame saved the modelled riders 1:17 to 1:44 min:sec. Furthermore, compared with a conventional wheel set, an aerodynamic wheel set may improve time trial performance time by 60 to 82 seconds. From the analysis in this article it becomes clear that novice cyclists can benefit more from the suggested alterations in position, equipment, nutrition and training compared with elite cyclists. Training seems to be the most important factor, but sometimes large improvements can be made by relatively small changes in body position. More expensive options of performance improvement include altitude training and modifications of equipment (light and aerodynamic bicycle and wheels). Depending on the availability of time and financial resources cyclists have to make decisions about how to achieve their performance improvements. The data presented here may provide a guideline to help make such decisions.

Physiology of professional road cycling

Professional road cycling is an extreme endurance sport. Approximately 30000 to 35000 km are cycled each year in training and competition and some races, such as the Tour de France last 21 days (approximately 100 hours of competition) during which professional cyclists (PC) must cover >3500 km. In some phases of such a demanding sport, on the other hand, exercise intensity is surprisingly high, since PC must complete prolonged periods of exercise (i.e. time trials, high mountain ascents) at high percentages (approximately 90%) of maximal oxygen uptake (VO2max) [above the anaerobic threshold (AT)]. Although numerous studies have analysed the physiological responses of elite, amateur level road cyclists during the last 2 decades, their findings might not be directly extrapolated to professional cycling. Several studies have recently shown that PC exhibit some remarkable physiological responses and adaptations such as: an efficient respiratory system (i.e. lack of 'tachypnoeic shift' at high exercise intensities); a considerable reliance on fat metabolism even at high power outputs; or several neuromuscular adaptations (i.e. a great resistance to fatigue of slow motor units). This article extensively reviews the different responses and adaptations (cardiopulmonary system, metabolism, neuromuscular factors or endocrine system) to this sport. A special emphasis is placed on the evaluation of performance both in the laboratory (i.e. the controversial Conconi test, distinction between climbing and time trial ability, etc.) and during actual competitions such as the Tour de France.

Preferred pedalling cadence in professional cycling

PURPOSE

The aim of this investigation was to evaluate the preferred cycling cadence of professional riders during competition.

METHODS

We measured the cadence of seven professional cyclists (28 +/- 1 yr) during 3-wk road races (Giro d'Italia, Tour de France, and Vuelta a España) involving three main competition requirements: uphill cycling (high mountain passes of approximately 15 km, or HM); individual time trials of approximately 50 km on level ground (TT); and flat, long ( approximately 190 km) group stages (F). Heart rate (HR) data were also recorded as an indicator of exercise intensity during HM, TT, and F.

RESULTS

Mean cadence was significantly lower (P < 0.01) during HM (71.0 +/- 1.4 rpm) than either F and TT (89.3 +/- 1.0 and 92.4 +/- 1.3 rpm, respectively). HR was similar during HM and TT (157 +/- 4 and 158 +/- 3 bpm) and in both cases higher (P < 0.01) than during F (124 +/- 2 bpm).

CONCLUSION

During both F and TT, professional riders spontaneously adopt higher cadences (around 90 rpm) than those previously reported in the majority of laboratory studies as being the most economical. In contrast, during HM they seem to adopt a more economical pedalling rate (approximately 70 rpm), possibly as a result of the specific demands of this competition phase.

Impaired interval exercise responses in elite female cyclists at moderate simulated altitude

The effect of hypoxia on the response to interval exercise was determined in eight elite female cyclists during two interval sessions: a sustained 3 x 10-min endurance set (5-min recovery) and a repeat sprint session comprising three sets of 6 x 15-s sprints (work-to-relief ratios were 1:3, 1:2, and 1:1 for the 1st, 2nd, and 3rd sets, respectively, with 3 min between each set). During exercise, cyclists selected their maximum power output and breathed either atmospheric air (normoxia, 20.93% O(2)) or a hypoxic gas mix (hypoxia, 17.42% O(2)). Power output was lower in hypoxia vs. normoxia throughout the endurance set (244+/-18 vs. 226+/-17, 234+/-18 vs. 221+/-25, and 235+/-18 vs. 221+/-25 W for 1st, 2nd, and 3rd sets, respectively; P< 0.05) but was lower only in the latter stages of the second and third sets of the sprints (452+/-56 vs. 429+/-49 and 403+/-54 vs. 373+/- 43 W, respectively; P<0.05). Hypoxia lowered blood O(2) saturation during the endurance set (92.9+/-2.9 vs. 95.4+/-1.5%; P<0.05) but not during repeat sprints. We conclude that, when elite cyclists select their maximum exercise intensity, both sustained (10 min) and short-term (15 s) power are impaired during hypoxia, which simulated moderate ( approximately 2,100 m) altitude.

EPO, red cells, and serum transferrin receptor in continuous and intermittent hypoxia

PURPOSE

Erythropoietic response in 10 healthy nonsmoking volunteers exposed to normobaric hypoxia continuously or intermittently 12 h daily for 7 d was evaluated in a randomized cross-over study.

METHODS

An oxygen content of 15.4% corresponding to an altitude of 2500 m was created by adding nitrogen into room air in a flat. Venous blood samples for hemoglobin (Hb), hematocrit (Hct), reticulocytes, serum erythropoietin (S-EPO), red cell 2,3-diphosphoglycerate (2,3-DPG), serum ferritin (S-Ferrit), and serum soluble transferrin receptor (S-TransfR) were drawn at 8:00 a.m.

RESULTS

S-EPO was increased from baseline values of 22.9+/-9.6 and 20.5+/-10.1 U x L(-1) to 40.7+/-12.9 (P < 0.05) and 35+/-14.3 U x L(-1) (P < 0.05) after the first night in continuous and intermittent hypoxia, respectively, and remained elevated throughout both exposures. Hb and Hct values did not show any significant changes. Red cell 2,3-DPG rose from baseline a value of 5.0+/-0.8 to 5.9+/-0.7 mmol x L(-1) (P < 0.05) after the first day in continuous hypoxia and from 5.2+/-0.7 mmol x L(-1) to 6.1+/-0.5 mmol x L(-1) on day 3 (P < 0.05) during intermittent hypoxia. The reticulocyte count rose significantly (P < 0.05) after 5 d in both experiments. S-transferrin receptor level rose significantly from 2.2+/-0.4 and 2.1+/-0.5 mg x L(-1) to 2.6+/-0.5 mg x L(-1) and 2.3+/-0.6 mg x L(-1) on day 5 (P < 0.05), to 2.7+/-0.5 mg x L(-1) and 2.5+/-0.6 mg x L(-1) on day 7 (P < 0.05) under continuous and intermittent hypoxia, respectively.

CONCLUSIONS

We suggest that intermittent exposure to moderate normobaric hypoxia 12 h daily for 1 wk induces a similar stimulation of erythropoiesis as continuous exposure.

Physiological implications of altitude training for endurance performance at sea level: a review

Acclimatisation to environmental hypoxia initiates a series of metabolic and musculocardio-respiratory adaptations that influence oxygen transport and utilisation, or better still, being born and raised at altitude, is necessary to achieve optimal physical performance at altitude, scientific evidence to support the potentiating effects after return to sea level is at present equivocal. Despite this, elite athletes continue to spend considerable time and resources training at altitude, misled by subjective coaching opinion and the inconclusive findings of a large number of uncontrolled studies. Scientific investigation has focused on the optimisation of the theoretically beneficial aspects of altitude acclimatisation, which include increases in blood haemoglobin concentration, elevated buffering capacity, and improvements in the structural and biochemical properties of skeletal muscle. However, not all aspects of altitude acclimatisation are beneficial; cardiac output and blood flow to skeletal muscles decrease, and preliminary evidence has shown that hypoxia in itself is responsible for a depression of immune function and increased tissue damage mediated by oxidative stress. Future research needs to focus on these less beneficial aspects of altitude training, the implications of which pose a threat to both the fitness and the health of the elite competitor. Paul Bert was the first investigator to show that acclimatisation to a chronically reduced inspiratory partial pressure of oxygen (P1O2) invoked a series of central and peripheral adaptations that served to maintain adequate tissue oxygenation in healthy skeletal muscle, physiological adaptations that have been subsequently implicated in the improvement in exercise performance during altitude acclimatisation. However, it was not until half a century later that scientists suggested that the additive stimulus of environmental hypoxia could potentially compound the normal physiological adaptations to endurance training and accelerate performance improvements after return to sea level. This has stimulated an exponential increase in scientific research, and, since 1984, 22 major reviews have summarised the physiological implications of altitude training for both aerobic and anaerobic performance at altitude and after return to sea level. Of these reviews, only eight have specifically focused on physical performance changes after return to sea level, the most comprehensive of which was recently written by Wolski et al. Few reviews have considered the potentially less favourable physiological responses to moderate altitude exposure, which include decreases in absolute training intensity, decreased plasma volume, depression of haemopoiesis and increased haemolysis, increases in sympathetically mediated glycogen depletion at altitude, and increased respiratory muscle work after return to sea level. In addition, there is a risk of developing more serious medical complications at altitude, which include acute mountain sickness, pulmonary oedema, cardiac arrhythmias, and cerebral hypoxia. The possible implications of changes in immune function at altitude have also been largely ignored, despite accumulating evidence of hypoxia mediated immunosuppression. In general, altitude training has been shown to improve performance at altitude, whereas no unequivocal evidence exists to support the claim that performance at sea level is improved. Table 1 summarises the theoretical advantages and disadvantages of altitude training for sea level performance. This review summarises the physiological rationale for altitude training as a means of enhancing endurance performance after return to sea level. Factors that have been shown to affect the acclimatisation process and the subsequent implications for exercise performance at sea level will also be discussed. Studies were located using five major database searches, which included Medline, Embase, Science Citation Index, Sports Discus, and Sport, in