Replicating thin air

When Ed Moses goes to sleep at night, he breathes in mountain-thin air, almost as if he were snoozing at 9,000 feet. But when the 22-year-old Olympic swimmer walks out of his Burke, Va., home to train, he’s at sea level.

Moses is among an increasing number of top athletes, coaches and scientists who believe that living at a high altitude and training at a lower altitude can enhance performance, sometimes significantly. In top competition, every advantage helps.

Because traveling up and down a mountain every day would be impractical, if not impossible, in all but a few places, these swimmers, runners and cyclists are turning to so-called altitude technology. With oxygen-controlled tents or even entire rooms, the technology enables users to live high and train low.

“It’s a great addition to any endurance athlete’s toolbox,” said Chris Carmichael, owner of Carmichael Training Center in Colorado Springs, Colo., whose world-class endurance athlete clientele includes Tour de France champion Lance Armstrong. “Show me a top endurance athlete, and chances are they’re doing it.”

Studies have long shown that living at altitudes above 8,000 feet increases the body’s erythropoietin, or EPO, a hormone that helps produce red blood cells. Red blood cells carry oxygen to the lungs; the more oxygen-carrying capacity a body has, the greater its aerobic capacity.

The hormone got a bad name at recent world competitions, including the last 2002 Olympics in Salt Lake City, when athletes from Spain and Russia were found to have illegally injected it. But no rule prohibits the EPO boost one gets at high altitude, even if that altitude is artificially induced.

Living where less oxygen is available also increases VO2 max, sports medicine shorthand for the maximum volume of oxygen that a body can turn into work. Again, more is better, because the more oxygen the blood can transport, the longer and faster it can perform.

Although living at high altitude has proved beneficial, however, training at high altitudes has its problems. Because of the thin air, athletes can’t train as hard as they can at sea level. “You can’t achieve the same intensity you need to achieve your best competitive times,” said Christopher B. Cooper, pulmonologist, exercise physiologist and professor of medicine at the David Geffen School of Medicine at UCLA.

Furthermore, some studies have shown that training at very high altitudes can have a catabolic effect, causing a loss of muscle, which can offset the gains in aerobic capacity. When not enough oxygen is available to support working muscle tissue, the tissue breaks down, explained Dr. Benjamin D. Levine, a pioneer in the live-high, train-low method.

In a study during the mid-1990s, they sent one group of athletes to a sea-level training camp to live low and train low; another to live and train at Deer Valley, Utah, elevation 8,000 feet (the high-high group); and a third to live there but to drive 30 minutes to Salt Lake City, elevation 4,000 feet, for training (the high-low group).

The now well-known study, published in 1997 in the Journal of Applied Physiology, found that, compared with the other groups, “the high-low group had a 5% improvement in VO2 max and a 1.5% to 3% improvement in performance,” said Levine, a professor of medicine at the University of Texas Southwestern Medical Center at Dallas.

“That may not sound like a lot, but for elite athletes, that could mean the difference between a gold medal and not making the finals,” Levine said.

Once coaches and athletes learned the benefits of high-low altitude training, the problem became logistics. Few places in the world make the training method geographically easy. Enter altitude technology. Today many elite athletes are outfitting their bedrooms with equipment that changes the oxygen level of the air they breathe.

Colorado Altitude Training, the largest supplier of this equipment, sells both tents that cover beds and so-called mountain rooms. These environments can be adjusted to mimic any altitude between sea level and 15,000 feet, said Franko Vetterott, spokesperson for the company, based in Boulder, Colo. Costs run between $8,000 and $18,000.

The company outfitted Moses’ bedroom two years ago, sealing it so that it maintains a 15% oxygen level, equivalent to that at 9,000 feet. At sea level, the oxygen level is 21%. Moses spends 12 hours a day in this environment.

He says it’s made a difference. When he competed in the 2000 Sydney Olympics, where he swam breaststroke, Moses was not yet using altitude training. Still, he came home with two gold medals and one silver. Since then, however, he’s not only bested those times, he’s broken world records in the 50-, 100- and 200-meter short course and the 50- and 100-meter long course. Poised to compete in the 2004 Olympics in China, Moses is seeded first on the U.S. Olympic swim team for his events.

However, not everyone gets positive results, says Jonty Skinner, who has coached Moses and other members of the U.S. Olympic swim team to 13 gold medals and oversees research and development at the Olympic Training Center in Colorado Springs.

“Some people are considered responders,” Skinner said. “They gain a lot more than non-responders, which probably has more to do with genetics than with training.”

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Heading up? Try to take your time

Because all bodies react to dramatically different altitudes, even average athletes need to remember that their workouts will change in high altitudes. Lowlanders planning mountain trips this summer should remember these adaptation tips from exercise experts:

* If possible, go up slowly. Driving to a high-altitude destination is physically easier than flying, simply because your body will have more time to adjust.

* Don’t hit the ground running. It takes your body a few days to acclimatize, so allow time to adjust before setting out on that big bike ride or mountain climb.

* Drink lots of water. Most of the minor ill effects of high altitude can be reversed with hydration. Skip the alcohol, which will dehydrate you even more.

* Listen to your body. Everybody reacts to altitude differently. Even if everyone else in your group feels all right, you may not. If you start to experience symptoms of altitude sickness -- nausea, headache, dizziness -- back off.

* Have a way to descend quickly. Serious altitude sickness can be deadly.

* If you know you’re prone to altitude sickness, ask your doctor for acetazolamide (brand name Diamox). If you take it before you go, it can help your body adapt faster. The medication works by helping neutralize the blood’s alkaline, which changes in high altitude.

Source: Dr. Christopher B. Cooper, David Geffen School of Medicine at UCLA.