effect of endurance training and altitude training on ...oxygen transport capacity ventilation &...

Effect of endurance training and altitude training on hemoglobin mass and performance

-

A Swiss perspective

Jon Peter Wehrlin, PhD

Head Endurance Department, Section for Elite Sport

Swiss Federal Institute of Sports, Magglingen, Switzerland

Thank you

for the invitation!

3Federal Office of Sport FOSPO

Swiss Federal Institute of Sport Magglingen SFISM

Swiss Federal Institute of Sport, Magglingen, Switzerland (950m above sea level)



View from Magglingen on the Swiss Alps



Federal Office of Sport

Federal Office of Sport

Swiss Federal Institute

of Sport

National Training Center

Youth Sport & Training Center

Sport Politics & Ressources

Section for Elite Sport

Sport Studies

Sport & Education

Sport & Society



Swiss Federal Institute of Sport Magglingen

Section for Elite Sport (Staff = 60)

Sport Physiology Group

(Endurance Sports)


(Team Sports)


(Force Sports)

Training Science

Sport Psychology

Sports Medicine

Sports Physiotherapy



Elite Sports

Services Research & Development

Education

Swiss Federal Institute of Sports

- Master elite sports

- Bachelor course

- Coaches education

- SGSM etc.

Swiss Federal Institute of Sports: Section for Elite Sport



Section for Elite Sport Laboratories

Cross-Country Skiing

Laboratory

(Endurance Physiology)

Hemoglobin mass /

Blood volume

Laboratory


Mountainbike

Laboratory

(Endurance

Physiology)

Exercise Physiology

Laboratory




Section for Elite Sport Laboratories

Heat & Humidity

Laboratory


Track Cycling

Laboratory


Muscle Power

Laboratory

(Strength Physiology;

Alpine Skiing, Ski jump,

Snowboard etc.)



Research & Development

Applied ResearchGoal: Answer applied research questions (ideally from the athletes

and coaches) to improve performance….

Mountainbike: What is faster 26 or

29inch wheel?

Track cycling: Which helmet is the

best for my athlete?

Can my athlete profite from altitude training?

Effect of precooling on performance in the Tokyo heat?

Effect of endurance training and altitude training on hemoglobin mass and performance

-

A Swiss perspective

Jon Peter Wehrlin, PhD

Head Endurance Department, Section for Elite Sport

Swiss Federal Institute of Sports, Magglingen, Switzerland



Oxygen transport

capacity

Ventilation & Lung diffusion capacity

Heart capacity

Bassett DR and Howley ET. Limiting factors for maximum oxygen

uptake and determinants of endurance performance.

Med Sci Sports Exerc. 2000; 32: 70-84.

Muscle capacity

Endurance sport: VO2max - Important limiting factors



Oxygen (O2)

Endurance sport: VO2max - Limiting factor oxygen transport capacity

Hemoglobin molecule: Transport of oxygen



Developing performance diagnostic services: Cross-country skiing

Performance

Relevant Constructs

(General)

Ranking / Time / Points

Psychological

Factors

Technical

Performance

Tactical

Performance

Material (Skis /

Wax)

Critical Success Factors

(Sport Specific)

Key Performance

Indicator (KPI)High V̇O2max

(> 80 mL·kg-1·min-1)

Important Factors

Prolonged high

skating velocity

Physical

Performance

Hemoglobin mass /

Blood volume



Schmidt & Prommer Exerc Sport Scie Rev, 2010

VO2max - Limiting factor oxygen transport capacity: Hemoglobin mass



Endurance Sport: Problem «Blood Doping»

….can move you from 30th place to the podium…

Stray-Gundersen J, Videman T, Penttilä L, Lereim I; Abnormal hematologic profiles in elite cross-country Skiers:

blood doping or? Clin J Sports Med, 2003, 132-7



Switzerland Spain

Importance of the hemoglobin mass: Blood doping

USA

…..etc.

Denmark



Lundby et al., J Physiol, 2007

Importance of the hemoglobin mass:

=> Blood doping with rhEPO



Nordic World Ski Championships 2019: Max Hauke (Austria)

Importance of the hemoglobin mass:

=> Problem: Blood doping with low volume autologous blood transfusion

135ml red blood cells



Key Questions for elite endurance athletes, coaches & scientists



1) Does hemoglobin mass increase with endurance training?

- Training camp (Peaking and Tapering)

- Training Season

- Several years endurance training

Key Questions for elite endurance athletes and coaches

2) Can hemoglobin mass be used as a «talent marker» for endurance sports?- Differences in hemoglobin mass between adolescent and elite athletes

- Long term development in hemoglobin mass in adolescent athletes

- Prediction of hemoglobin mass at elite age based on hemoglobin mass at age 16? Who did it?

- Minimal hemoglobin mass neeed for elite endurance athletes?

0) Introduction: Hemoglobin concentration vs hemoglobin mass

4) Does a small increase in hemoglobin mass increase endurance performance?- Effect of low volume autologous blood doping on performance (increase like LHTL training)

3) Does hemoglobin mass increase with live high-train low (LHTL) altitude training?- „Hypoxic dose“?

- „Individual response“?

- Can hypoxic tents be used?

- How long is hemoglobin mass increased after the altitude training?

7) Conclusions

5) Does LHTL increase endurance performance? What are important limiting factors?

6) A Swiss perspective – How do we support athletes and coaches?



0) Introduction: Hemoglobin concentration (g/dl) vs hemoglobin mass (g)



Introduction: Hemoglobin concentration (g/dl) vs hemoglobin mass (g)

Hematocrit (Hct; %)

Percent red blood cells

Men ca. 45%

(Critical value men 50%)

Hemoglobin (Hb; g/dl)

Mean value ca. 15g/dl /

(critical value 17g/dl)

Red color in red blood cells, Binds

the oxygen



0

1

2

3

4

5

6

7

8

9

Blu

tvo

lum

en

[Li

ter]

Untrained XC skier

Red cell vol.

Blood plasma

Hematocrit: 44%

Blood plasma

Hematocrit: 44%

Red cell vol.

Problem: We do not know how the absolute values are!

Blo

od

vo

lum

e (

lite

rs)

Hb 15g/dl

Hb 15g/dl




Blo

od

vo

lum

e (

L)

0

1

2

3

4

5

6

7

Hct 45%

Hct 47%

Hct 43%

Hb (g/dl) and Hct (%): Effects of changes in plasma volume

Important factors:

- Position: (horizontal = ↓ vs vertical = Hct ↑

- Hydratation status (low = Hct ↑; high ↓)

- Training (acute = Hct ↑; after = Hct ↓)

- Altitude: (acute = Hct ↑)

- Heat: (acute = Hct ↑; chronic↓ )


Hb 15g/dl

Hb 16g/dl

Hb 14g/dl



Modified after Schmidt W. et al. Int J Sports Med, 21: 133-138; 2000

Effect of drinking one liter of saline solution on hematocrit value

Time (Minutes)

-15 -5 5 15 25 35 45 55 65 75 85

Hem

ato

cri

t (%

)

037

38

39

40

41

42

43

44

45

46

47

48

49

50

Before




Modified after Schmidt W. et al. Int J Sports Med, 21: 133-138; 2000

=> Effect of a ten days cycling competition on hematocrit value (identical withHb g/dl)

Time (days)

-2 0 2 4 6 8 10 12 14

Hem

ato

cri

t (%

)

0

38

39

40

41

42

43

44

45

46

47

48

49

50

Before 2 days after




Hemoglobin mass:

1256 g

Red cell volume:

3520 ml

Plasma volume:

4480 ml

Blood volume:

8000 ml


=> Important to measure absolute values!



Schmidt & Prommer Exerc Sport Sci Rev, 2010


=> Relation to VO2max



Hbmass RCV PV BV

CV 1.37% 1.89% 2.62% 1.86%

R 0.991 0.981 0.968 0.980

Range 822-1264 g 2161-3456 ml 3185 – 5740 ml 5610 – 9197 ml

CO-rebreathing method (100 years):

- Revived by Fogh-Andersen et al. (1990) and Thomsen

et al. (1991) and is now frequently used in Sports

Science and Sports Medicine:

- “Optimized method” by

Schmidt and Prommer (2005)

- with minor modifications

(Prommer & Schmidt 2007)

Meta-Analysis about Error Measurement for blood

volume paramters (Gore et al. 2005):

=> CO-rebreathing-method has the lowest error

Values from our Laboratory, (n=17)


Measurement of hemoglobin mass



Introduction: Hemoglobin

concentration (g/dl) vs

hemoglobin mass (g)

=> Measurement of

hemoglobin mass



Key Questions for elite endurance athletes and coaches


- Training camp (Peaking and Tapering)

- Training season

- Several years endurance training



He

mo

glo

bin

ma

ss

(g

/kg

bo

dyw

eig

ht)

0

9

10

11

12

13

14

15

16

17

18

19

20

21

22

Untrained subjects (28 +/-5 years

Triathletes (German National Elite; 30 +/- 5 years)

Runners (German National Elite; 24 +/- 6 years)

Cycling (German Elite Professional Team; 27 +/- 3 years)

+ 40%

Key question:

Effect of „training“

or„talent“?

Modified after Heinicke et al. Int J Sports Med, 2001

1) Does hemoglobin mass increase with normal training?



Modified after Gore et al., Int J Sports Med, 1997

Hem

og

lobin

mass

0

500

600

700

800

900

1000

1100

1200

1300

1400

4 Weeks training in the heat

4 Weeks training at sea level

4 Weeks training at 1300m

4 Weeks training at 1740m


=> Changes during a training camp



He

mo

glo

bin

ma

ss

(g

)

0

600

650

700

750

800

850

900

950

1000

1050

1100

1150

1200

Athlete 1

Athlete 2

Athlete 3

Athlete 4

Athlete 5

Athelte 6

Athlete 7

Athlete 8

Mean

Weeks

0 1 2 3 4 5 6 7 8 9 10

Tra

inin

g l

oa

d (

Fo

ste

r)

0

500

1000

1500

2000

2500 Mara

thon

Normal Training

Peaking Tapering

Wehrlin et al., 1. World Congress of Triathlon, Alicante, Spain 2011


=> Changes with a peaking and tapering period



Prommer et al. Med Sci Sports & Exercise, 2008


=> Changes during a training season

Prommer: Hbmass

showed very low

oscillations during a

training year (<6%)

Garvican et al. measured Hb mass in 10 elite Cyclists during 2-10 months:

CV was 3.3% (Range 2.4.4%)



Hem

oglo

bin

mass (

g/k

g)

0

11

12

13

14

15

16

17

18

19

Hem

oglo

bin

mass (

g/k

g)

0

11

12

13

14

15

16

17

18

19

Hem

oglo

bin

mass (

g)

0

700

800

900

1000

1100

1200

1300

1400

1500

Hem

oglo

bin

mass (

g)

0

700

800

900

1000

1100

1200

1300

1400

1500

P = 0.87

P = 0.29

2004 2007

Wehrlin, J.P., Hallén J. Marti B. Adv Exp Med Biol. 2016;903:357-74.


=> Changes with several years of training




=> Several years of endurance training

Observation in routine hemoglobin mass measurement:

Elite athletes show no big changes in hemoglobin mass with normal training

Possible to use it as “talent identification marker” in adolesence?



Key Questions for elite endurance athletes, coaches and scientists

2) Can hemoglobin mass be used as a «talent marker» for endurance sports?

- Differences in hemoglobin mass between adolescent and elite athletes?

- Long term development in hemoglobin mass in adolescent athletes





Steiner & Wehrlin. Med Sci Sports & Exercise, 2011


=> Differences in hemoglobin mass between

adolescent and elite national team athletes?






adolescent and elite national team athletes?






adolescent and elite athletes?






adolescent and elite athletes?

«Golden age» between 16 and 21 to increase hemoglobin mass

with endurance training?





Longitudinal study over 3 years




=> Long term development of hemoglobin mass in adolescent athletes?

Steiner T, Maier T, Wehrlin JP. Med Sci Sports Exerc. 2019 May: 51(5):912-919




=> Long term development of hemoglobin mass in adolescent athletes?

Project with same athletes and controls over 3 years (age 16 to age 19):

Age 16

Age 19




=> Long term develepment of hemoglobin mass in adolescent athletes?

Steiner T, Maier T, Wehrlin JP.

Med Sci Sports Exerc. 2019

May: 51(5):912-919







May: 51(5):912-919




=> Minimal hemoglobin mass needed for elite endurance athletes?

Men: National team: > 14g/kg bodyweight

World class: > 15g-16g/kg bodyweight

Women: National team: > 12g/kg bodyweight

World class: > 13-14g/kg bodyweight

High prediction of hemoglobin mass at at 20 already at age 16!




=> Minimal hemoglobin mass needed for elite endurance athletes?

Men: National team: > 14g/kg bodyweight

World class: > 15g-16g/kg bodyweight

Women: National team: > 12g/kg bodyweight

World class: > 13-14g/kg bodyweight

=> High prediction of hemoglobin mass at at 20 already at age 16!

However, we do not systematically use Hbmass for Talent identification – we do not have enough talents!




3) Does hemoglobin mass increase with altitude training (LHTL)?- „Hypoxic dose“?

- Can hypoxic tents be used?






3) Does hemoglobin mass increase with altitude training (LHTL)?- „Hypoxic dose“?



Atm

osp

he

ric

Pre

ssu

re

O2 transport capacity of the blood ↑

Low OxygenPIO2 ↓

Kidney

HIF-2αEpo ↑

Arterial hypoxemiaSaO2 ↓

Aerobic performance ↑VO2max

Bone marrow

Erythrocytes

Hemoglobin

Erythropoesis ↑Hemoglobin mass ↑

Levine & Stray-Gundersen, 2005

3) Does hemoglobin mass increase with altitude training (LHTL)? What’s the plan?

http://www.google.ch/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&docid=NGbdgHlkHq6PLM&tbnid=q88rz_vbrPjWIM:&ved=0CAUQjRw&url=http://www.newhealthguide.org/Low-Hemoglobin.html&ei=kIoxU9m8I4iNtQbApoE4&bvm=bv.63587204,d.bGQ&psig=AFQjCNH7DFR7U3ZbZ2dH4e8UCD1OvxHTug&ust=1395841985341975



Hypobaric

hypoxia (HH)

Normobaric

hypoxia (NH)

Altitude/ Hypoxic training

LH + TH LH + TL

Natural/

TerrestrialNitrogen

dilution

LL + TH

Oxygen

filtration

Supplemental

Oxygen

LHTLH

IHT

IHIT

IHE RSHCHT

Wilber 2007; Millet et al. 2010 & 2013

=?≠

FIO2 = 20.9%

PB < 760 mmHg

FIO2 < 20.9%

PB = 760 mmHg

PIO2 < 150 mmHg

LH = live high; TH = train high; TL = train low; LL = live

low; LHTLH = live high-train low and high; IHE =

intermittent hypoxic exposure; CHT = continuous

hypoxic training; IHT = intermittent hypoxic training;

RSH = repeated sprint training in hypoxia; IHIT =

intermittent hypoxic exposure during interval training.

3) Does hemoglobin mass increase with altitude training (LHTL)?



Time in hypoxia (hours)

0 100 200 300 400 500 600 700 800

Ch

an

ge i

n H

bm

ass /

RC

V (

%)

-4

-2

0

2

4

6

8

10

12

14

16

18

20

22

24

26

28

30 Laitinen et al. 1995 (Abstract only; n=7Runners; LHTL; Simulated altitude: 2500m; 20-28 days; CG)

Svedenhag et al. 1997 (n=7 XC-skiers; LHTH; Real altitude: 1900m; 30 days; EB)

Levine et al. 1997 (n=13 Runners; LHTH; Real altitude: 2500m; 28 days; CG; EB)

Levine et al. 1997 (n=13 Runners; LHTL; Real altitude: 2500m; 28 days; CG; EB)

Gore et al. 1998 (n=8 Cyclists; LHTH; Real altitude: 2690m; 31 days; CO)

Rusko et al. 1999 (Abstract only; n=10 XC-Skiers/Triathletes; LHTL; Simulated altitude: 2500m; 25 days; CG; CO)

Ashenden et al. 1999b (n=7 Runners; LHTL; Simulated altitude: 2650m; 12 days; CG; CO)

Ashenden et al. 1999a (n=6 Cyclists/Triathletes/XC-skiers; LHTL; Simulated altitude:3000m; 23 days; CG; CO)

Dehnert et al. 2002 (n=11 Triathletes; LHTL; Real altitude: 1956m; 14 days; CG; CO)

Saunders et al. 2004 (n=10 Runners; LHTL; Simulated altitude: 2000-3100m; 20 days; CG; CO)

Friedmann et al. 2005 (n=16 Junior swimmers; LHTH; Real altitude: 2100-2300m; 21 days; CO)

Heinicke et al. 2005 (n=10 Biathletes; LHTH; Real altitude: 2050; 21 days; CO)

Brugniaux et al. 2006 (n=5; LHTL; Simulated altitude: 2500-3000m/1200m; 18 days; CG; CO)

Robach et al. 2006 (n=9 Swimmers; LHTL; Simulated altitude: 2500-3000m/1200m; 13 days; CG; CO)

Robach et al. 2006 (n=6 XC-skiers; LHTL; Simulated altitude: 2500-3500m/1200m; 18 days; CG; CO)

Wehrlin & Marti 2006 (n=2 Runners; LHTL; Real altitude: 2456/1800m; 26 days; CO)

Wehrlin et al. 2006 (n=10 Orienteers; LHTL; Real altitude: 2456m/1800m/1000m; 23 days; CG; CO)

Neya et al. 2007 (n=10 runners; LHTL; Simulated altitude: 3000m; 29 days; CO)

Pottgiesser et al. 2008 (n=7 Cyclists; LHTH; Real altitude: 1816m; 21 days; CO)

Saunders et al. 2009 (n=9 Runners; LHTL; Simulated altitude: 2860m; 46 days; CO)

Wehrlin et al. 2009 (Submitted; n=7; Cross-country skiers; LHTL; Real altitude: 2590m; 21 days; CG)

Clark et al. 2010 (n=12 cyclists; LHTL; Simulated altitude: 3000m) C

A

B

E

D


3) Does hemoglobin mass increase with altitude training (LHTL)? Hypoxic dose?



Time in hypoxia (hours)

0 100 200 300 400 500 600 700 800

Ch

an

ge

in

Hb

ma

ss

/ R

CV

(%

)

-4

-2

0

2

4

6

8

10

12

14

16

18

20

22

24

26

28

30 Laitinen et al. 1995 (Abstract only; n=7Runners; LHTL; Simulated altitude: 2500m; 20-28 days; CG)

Svedenhag et al. 1997 (n=7 XC-skiers; LHTH; Real altitude: 1900m; 30 days; EB)

Levine et al. 1997 (n=13 Runners; LHTH; Real altitude: 2500m; 28 days; CG; EB)

Levine et al. 1997 (n=13 Runners; LHTL; Real altitude: 2500m; 28 days; CG; EB)

Gore et al. 1998 (n=8 Cyclists; LHTH; Real altitude: 2690m; 31 days; CO)

Rusko et al. 1999 (Abstract only; n=10 XC-Skiers/Triathletes; LHTL; Simulated altitude: 2500m; 25 days; CG; CO)

Ashenden et al. 1999b (n=7 Runners; LHTL; Simulated altitude: 2650m; 12 days; CG; CO)

Ashenden et al. 1999a (n=6 Cyclists/Triathletes/XC-skiers; LHTL; Simulated altitude:3000m; 23 days; CG; CO)

Dehnert et al. 2002 (n=11 Triathletes; LHTL; Real altitude: 1956m; 14 days; CG; CO)

Saunders et al. 2004 (n=10 Runners; LHTL; Simulated altitude: 2000-3100m; 20 days; CG; CO)

Friedmann et al. 2005 (n=16 Junior swimmers; LHTH; Real altitude: 2100-2300m; 21 days; CO)

Heinicke et al. 2005 (n=10 Biathletes; LHTH; Real altitude: 2050; 21 days; CO)

Brugniaux et al. 2006 (n=5; LHTL; Simulated altitude: 2500-3000m/1200m; 18 days; CG; CO)

Robach et al. 2006 (n=9 Swimmers; LHTL; Simulated altitude: 2500-3000m/1200m; 13 days; CG; CO)

Robach et al. 2006 (n=6 XC-skiers; LHTL; Simulated altitude: 2500-3500m/1200m; 18 days; CG; CO)

Wehrlin & Marti 2006 (n=2 Runners; LHTL; Real altitude: 2456/1800m; 26 days; CO)

Wehrlin et al. 2006 (n=10 Orienteers; LHTL; Real altitude: 2456m/1800m/1000m; 23 days; CG; CO)

Neya et al. 2007 (n=10 runners; LHTL; Simulated altitude: 3000m; 29 days; CO)

Pottgiesser et al. 2008 (n=7 Cyclists; LHTH; Real altitude: 1816m; 21 days; CO)

Saunders et al. 2009 (n=9 Runners; LHTL; Simulated altitude: 2860m; 46 days; CO)

Wehrlin et al. 2009 (Submitted; n=7; Cross-country skiers; LHTL; Real altitude: 2590m; 21 days; CG)

Clark et al. 2010 (n=12 cyclists; LHTL; Simulated altitude: 3000m) C

A

B

E

D

+ 1 – 1.5% / 100hours

(>2200m)





Gore et al., Br J Sports Med, 2013


+ 1 – 1.5% / 100hours

(>2200m)




Millet GP, Chapman RF, Girard O, Brocherie F. Br J Sports Med, 2017



Schmidt W & Prommer N. Exercise and Sport Sciences Reviews, 2010, 68-75






- Can altitude tents be used?



=?≠

Hypobaric Hypoxia (HH)

Natural Altitude

Normobaric Hypoxia (NH)

Artificial Altitude

Live High - Train Low (LHTL)


=> can altitude tents be used?



Hauser A, Schmitt L, Troesch S, Saugy JJ, Cejulea RC, Faiss R, Robinson N, Millet GP and Wehrlin JP

(JAP, 2017)






(JAP, 2017)



Individual response?!



Friedmann et al. 2005

Classic altitude training▪ 3 weeks; 2100-2300 m▪ 16 elite junior swimmers


Individual response?

=> What is technical variation and what is a real physiological change?

What is the problem when I want to consult athletes individually?



Did MY Hemoglobin Mass increase with MY LHTL Regimen?






Hem

og

lob

in m

ass (

g)

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Pre Altitude Post Altitude






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Naef N, Steiner T, Wehrlin JP. Int J Sports Med, 2015.

Duplicate measures:

▪ Reduce error by a factor of 1/√2 (30%) Hopkins, 2000

▪ Outliers can be identified!

▪ Within 6h

▪ Results are averaged





He

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)

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as

ure

me

nt

II

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as

ure

me

nt

I

+ 2.2%

3 weeks at 1800m (St. Moritz Switzerland)






Variation between 0 to + 10%


(JAP, 2017)





Slide adapted from Garvican (USOC IATS 2013 Conference)


Individual response? (Can be different with each LHTL camp)





Example

2015: Live high-train low altitude training camp

400hours at 2500m

=> Hemoglobin mass +5%

2016: Identical live high-train low altitude training camp

400hours at 2500m

=> Hemoglobin mass +0.2%



3) Is the increase in Hbmass different between normobaric and hypobaric hypoxia?

=> How long is hemoglobin mass increased after altitude training?

Prommer et al., Med Sci Sports Exerc, 2010, 42(4):791-797.

- 5.5% Hemoglobin mass after 33 days

Living altitude Kenyan Runners:

Before 2090m, then travelled to 340m asl.




4) Does a small increase in hemoglobin mass increase endurance performance?

- Effect of low volume autologous blood doping on performance (increase like LHTL altitude training)



4) Does a small increase in hemoglobin mass increase performance (like with LHTL)?

=> Effect of a low-volume autologous blood transfusion?

135ml RBC = 300ml Blood (Hct 45%)

Hct 45% = Hb 15g/dl

3dl Blood * 15g/dl = 45g Hemoglobin




Low-dose

Autologous

Blood transfusion

Bejder et al. MSSE

2019

4) Does a small increase in hemoglobin mass increase performance?




135ml RBC =300ml Blood (Hct 45%)

Hct 45% = Hb 15g/dl


If the Athlete has 1000g hemoglobin mass

45g = 4.5% increase in Hemoglobin mass

Performane in time trial + 5%

4) Does a small increase in hemoglobin mass increase performance (Like with LHTL)?




Bejder et al., Med Sci Sports Exerc, 2019, 51(4):692-700.

4) Does a small increase in hemoglobin mass increase performance?




135ml RBC =300ml Blood (Hct 45%)

Hct 45% = Hb 15g/dl


If the Athlete has 1000g hemoglobin mass

45g = 4.5% increase in Hemoglobin mass

Performane in time trial + 5%

4) Does a small increase in hemoglobin mass increase performance (Like with LHTL)?


Nordic World Ski

Championships 2019:

Max Hauke (Austria)

Same amount as used

as low volume autologousb

blood transfusion




5) Does live high-train low (LHTL) altitude training increase endurance performance at sea level?

=> What are important limiting factors?




5) Does LHTL increase endurance perfrormance?

Control all confounding factors (increase in Hbmass)!




(JAP, 2017)


Individual response (Increase in Hbmass)!



Hauser A, Schmitt L, Troesch S, Saugy JJ, Cejulea RC, Faiss R, Robinson N, Millet GP and Wehrlin JP. (MSSE, 2017)


Individual response (Increase in Hbmass)!



5) Does LHTL increase endurance perfrormance at sea level?

Planning of training load and training intensity!



Millet et al., Sports Med, 201021 days

after

LHTL

5) Does LHTL increase endurance performance at sea level?

Planning of training load and training intensity!



Millet et al., Sports Med, 2010 (modified after Reiss)


Timing of posttest!



Chapman RF, 2011

5) Does LHTL increase endurance performance at sea level?

Timing of posttest!




5) Does live high-train low (LHTL) altitude training increase endurance performance?

=> Results of studies with elite athletes?



=> it is very hard (impossible) to prove that a preparation with elite endurance athletes for an

important competition at sea level is better to prepare with LHTL than sea level training!

Millet G, Brocherie F.





=> Impossible to prove – but not so important for elite sport athletes.

Subjects:

- World class elite endurance athletes (high n)

- Willing to perform best at pre- and posttest of a study and not at a competition

- «Responder» for hemoglobin mass increases with altitude training (genetic predisposition)

=> Succesful increase in hemoglobin mass with LHTL (double measurements)

Study design / Method:

- Athletes are their own controls (individual responses)

- Cross over design over one year (same training period) (BUT Athletes will be one year older!)

- YES, Blinded for the treatment (LHTL or sea level) => Placebo Effect

- NOT Blinded for the treatment => Training has to be adjusted to altitude or sea level conditions

- High enough hypoxic dose (Individually different)?

- Optimal preparation for the pre- and posttests (Peaking and Tapering)

=> Time of best performance should be at the posttests (not at races of the athletes)

- Optimal timing of the pre- and posttests («best time man»)

- Optimal iron availability

- Optimal energy balance

- No negative effects (inflamation, ilness, injury, overreaching, overtraining) during both periods

- Very precise and valide tests (hemoglobin mass) and performance

- etc.






=> Does the elite athlete needs this perfect study to prove better performance?




Does the elite athlete himself needs this perfect study to prove better performance?

NO




Low-dose

Autologous

Blood transfusion

Bejder et al. MSSE

2019





Example:

2015: Live high-train low altitude training camp

400hours at 2500m

=> Hemoglobin mass +5%

2016: Identical live high-train low altitude training camp

400hours at 2500m

=> Hemoglobin mass +0.2%






6) A Swiss perspecitive – How do we supported athletes and coaches – Swiss Examples



b) Plan altitude training camp perfectly (timing in season, hypoxic dose, training, Nutrition,

Recovery, Supplemtents (iron, vitamin b12, folic acid etc.) on individual base

a) Build a team: Athlete, Coach, Physician, Nutrician, Scientist.




c) Help with installation of altitude room at athlete’s home (very easy with generators)



Individualize altitude

6) A Swiss perspecitive – How do we supported athletes

and coaches – Swiss Examples



d) Plan double measurement of hemoglobin mass



e) Control everything during the altitude training period

- Training and training quality

- Hours at altitude (hypoxic dose)

- Sleep and sleep quality

- Profile of Mood State

- Body weight

- Rest heart rate

- Oxygen saturation during sleep

- Overall state of the athlete ++, +, +/-, -, --

- Competition after the LHTL camp (14 – 24 days after)

- etc.

f) Evalutate the altitude training camp in the team (4 weeks after)

- How was it?

- What did work, what did not work, why?

- What could we improve/change (hypoxic dose etc.)

- Does the athlete coach want to do it again



=> Statistical significance versus practical relevance?

Viktor Röthlin

Swiss Marathon Runner



=> Competition preparation at Muottas Muragl 2456m) (Engadin, Switzerland)



Wehrlin J, Marti, B. Br J Sports Med. (2006)




5000m

tim

e (

min

ute

s:s

econds)

M

ara

thon tim

e (

hours

:min

ute

s:s

econds)

12:40

13:00

13:20

13:40

14:00

14:20

14:40

15:00

15:20

2:10:40

2:12:00

2:12:20

2:12:40

2:13:00

2:13:20

2:11:20

2:11:40

2:11:00Live high (2456m) and

train "low" (1800m) for

26 days

Zürich

Mara

thon 2

:11:0

5

WC

Paris

Mara

thon 2

:11:1

4

5000m

13:5

2:6

9

5000m

13:3

5:5

0

WC

Paris

5000m

Fin

al 1

3:2

6:0

6

WC

Paris

5000m

Qualif

icatio

n 1

3:3

6:5

4

5000m

13:1

2:1

6

Three months before LHTL

Day 1 before LHTL

Day 1 after L

HTL

Day 14 after L

HTL

Day 25 - 29 afte

r LHTL




Beijing 2008

6. Place

=>prepared with LHTL altitude training



2010: 1. Place, European Championships Barcelona

Live at 2307m

Train at 1800m

Train at 400m a

Live at 2307m

Train at 1800m

Train at 400m a

Marathon at the EuropeanChampionships

Barcelona (Spain)

Weeks

1 2 3 4 5 6 7 8 9 10 11 12

6) A Swiss perspecitive – How do we supported athletes

and coaches – Swiss Examples



2010 Altitude Training „Best Practice“

2011 Individual Adaptations

2012 Olympic Games London




LHTL Bernina Hospiz

25.5 - 13.6.2010

Worl

d C

up/C

1C

ham

béry

6.6

.201

0

C1 E

nge

lberg

?20.6

.201

0

Worl

d C

up

5./6.6

.10?

EuropeanChampionshipsHaifa7.7. - 11.7.201023-28 days after LHTL)

Full

Test

14.6

.201

0

Full

Test

25.6

.201

0

Full

Test

2.7

.201

0

Full

Test

17.5

.201

0

Wo

rld

Cu

p H

ou

ffali

ze

1./2.5

.201

0

Wo

rld

Cu

p O

ffen

bu

rg

22./23.5

.201

0

Wo

rld

Cu

p /

C1

Alt

itu

de

gro

up

Co

ntr

ol

gro

up

Full

Test

18.5

.201

0

Full

Test

24.6

.201

0

Full

Test

1.7

.201

0

Full

Test

15.6

.201

0

Weeks after LHTL

1 2 3

Ta

rge

t I Ta

rge

t II

C2 F

lims?

3.7

.201

0

C1

Pla

ffeie

n 3

0.5

.201

0




Performance:

Capicity test with

Self selected Speed

AG: 6023m => 6221m

(+3.3%)

CG: 5244m => 5406m

(+3.1%)


Typical «study» with elite athletes



Slide adaptad from Garvican (USOC IATS 2013 Conference)




Judo: Preparation for a hard training period:

OSHTPLHTL

LHTL: Live high – train low

HTP: Hard training period

OS: Olympic games




Everybody ok?




6) Conclusions




- Training camp (Peaking and Tapering): No

- Training Season: No

- Several years endurance training: No

Conclusion:



- Differences in hemoglobin mass between adolescent and elite athletes => Yes

- Long term development in hemoglobin mass in adolescent athletes =>Yes


=> Those with already high hemoglobin mass at age 16


=> 14g/kg males; 12g/kg females (national level)

=> 15-16g/kg males; 13-14g/kg females (world class level)



4) Does a small increase in hemoglobin mass increase endurance performance?

- Effect of low volume autologous blood doping on performance

Yes, a small amount of hemoglobin mass (like we reach with altitude training (5%)) increases

endurance performance (time trial)

Conclusion:



- „Hypoxic dose“? 400hours at 2500m

- „Individual response“? Yes, the increase ranges between 0% and 10%

- Can hypoxic tents be used? Yes, similar response in hemoglobin mass increase

- How long is hemoglobin mass increased after the altitude training? 4 (- 6) weeks



6) A Swiss perspective – How do we support athletes and coaches?

Since 15years, we support Swiss national team endurance athletes mostly on an individual base

However, it is not a magical tool, it is all about hard work.

Conclusion:


5) Does LHLT altitude training increase endurance performance?

We think yes, scientifically it is very hard to prove (but also, that it does not work). Most studies showed increased performance.

Elite sport does not need the perfect study, due to individual different adaptations, every athlete has to try him-/herself

(For competitions at altitude, you have to prepare with altitude (Olympics Beijing 2022)



Thanks for your attention!

Questions?

http://www.iaaf.org/mm/photo/competitions/competition/rothlin-4x6_839.jpg

Thank you for the invitation!

Kiitos kutsusta!

And all the best for you and your athletes!

Kiitos kutsusta

Kiitos kutsusta

effect of endurance training and altitude training on ...oxygen transport capacity ventilation &...

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