Fast Talk Femmes: Optimizing Altitude Training with Dr. Trent Stellingwerff

Dr. Trent Stellingwerff reviews the research and gives practical tips on how to optimize altitude training in preparation for events both at altitude or at sea level.

In this week’s episode, we have a conversation with Dr. Trent Stellingwerff, Research & Development Advisor at the Canadian Sport Institute Pacific. We dive into the physiological changes that occur during altitude training and explore various research papers Dr. Stellingwerff has authored. 

Tune in to discover how to optimize training at altitude for competitions both at sea level or at altitude. Gain insights into the timing and structure of altitude camps; the use of hypoxic tents, chambers, and rooms; as well as the incorporation of supplemental oxygen. We also discuss nutritional and supplemental considerations, along with strategies to avoid common pitfalls. 

So listen in and let’s elevate your altitude training! 

Catch up on previous episodes of Fast Talk Femmes and subscribe for episodes on Apple Podcasts, Google Podcasts, Overcast, Soundcloud, Spotify, Stitcher, or wherever you listen to your podcasts! 

Episode Transcript

Dede Barry  00:04

Hi and welcome to Fast Talk Femme with Dede Barry and Julie Young. In this episode, we will discuss altitude training, and our guest is Dr. Trent Stellingwerff. Trent serves as a research and development advisor at the Canadian Sport Institute.

Dede Barry  00:18

In this role, he directs several different research projects across different sport performance discipline areas. He also provides physiology expertise to Canada’s national athletics rowing trough on a mountain bike teams his primary sport and research focuses are in the field of physiology and nutrition interactions as well as environmental altitude and heat expertise. Trent has co-authored a research paper, “Nutrition and Altitude: Strategies to Enhance Adaptation, Improve Performance and Maintain Health – A Narrative Review”, which is linked in our show notes. Our discussion with Trent focuses on how to optimize altitude training for improved performance. Welcome to Fast Talk Femme.

Rob Pickels  01:00

If you’re an endurance athlete, the status of your GI system stretches further than just your overall health. It directly impacts athletic performance, tune in to fast doc femmes, Episode 123 To listen as Dr. Alan Lim sheds light on groundbreaking gi information that every coach and athlete can benefit from to leverage and optimize their nutrition plan. Check it out at fast talk

Julie Young  01:27

Hey, Trent, thanks for joining us again on fast talk them.

Rob Pickels  01:31

Great to be back. Thanks for having me.

Julie Young  01:33

Trent was one of our first guests on episode 111 When we discussed how to avoid overtraining. Trent, what have you been up to? Since we last chatted with you?

Rob Pickels  01:44

Oh boy. Life goes fast with two young boys and working at the Canadian sport Institute Pacific and coaching a little bit more my wife and I have an elite women’s running group that we coach and then various research and development programs. We just finished up a hand Canadian relative energy deficiency and sport research project that featured 250 Canadian Olympian and Paralympians being tested. So working on reading up that and to publish that research. And then I heard there’s a big event in Paris next summer. So yeah, never a dull moment over here.

Julie Young  02:15

No. Yeah, so we chatted in our last episode with you, you’re in such a unique position, being in research, and then also having the opportunity to apply that into practice. Yeah,

Rob Pickels  02:26

it sometimes feels like two jobs. And it certainly is a lot coming at you. But I do feel very privileged to have that research component to what I do. And there’s many times I can pause and say, Hey, like there’s a research question right there in my coaching or physiology practice. So it is neat that way to be able to pursue those questions. Yep.

Julie Young  02:45

And then also figure out if it works in research. does it actually work in practice? Both directions? Exactly. Yep. Yeah. Well, I’ve personally been really looking forward to this conversation today, I think, more and more we hear about the professional or the elite athletes incorporating altitude training camps into their yearly training. And I’m excited to hear more precisely why of altitude training, and then understand the intricacies of the altitude camp. Exactly what that looks like. So to start things off, Trent, I think just to give us some context, and some kind of big picture understanding, can you tell us at altitude, like why is altitude training advantageous to performance from a physiologic and metabolic perspective?

Rob Pickels  03:34

Yeah, you bet. And even before I get to that, maybe we’ll just level set on what we mean by altitude, like, how high is that? And what does that mean for the athlete perspective. And so the altitude ranges, actually, the ideal altitude for athletes is around 2000 meters or 7000 feet, give or take about 1000 feet of altitude. And that is just moderate altitude, obviously, of high altitude and extreme altitudes and mountaineering altitudes. And I just wanted to highlight that the vast majority of our altitude research is done at 4300 meters, which happens to be the US Army facility up at Pikes Peak. And so when you read hundreds of papers, you’ll see Oh, at 4300 meters, and that is almost irrelevant to what we’re talking about today, which is, you know, 2000 meters of altitude or approximately 7000 feet. And when we look closely at the amount of evidence and research at moderate altitudes or the altitudes that most athletes use, there’s actually not that much information and not that many well known studies and a lot of the studies actually used artificial altitude, which we’ll get to, I just wanted to level set that this is the altitude band that we’re kind of talking about, and when you go around the world and whether it’s, you know Flagstaff, Arizona, or it’s Albuquerque or it’s St. Moritz or it’s full Remo or Boulder, they’re all sitting in that little band of altitude that I’ve just mentioned that kind of 2000 meters seven 8000 foot ideal space Where there’s enough altitude to provide a stimulus for hypoxia, but it’s not so high that it completely pretty much debilitates the person from doing high quality training. So there’s a sweet spot there. So coming back to your question about, you know why altitude is advantageous to performance from a physiology and metabolic perspective, I could probably answer that with three main points. And one really is the hematological, or blood changes that occur at altitudes. So when you’re at altitude, there’s less pressure, partial pressure of oxygen at altitude, which results in less oxygen in the blood. If you use an SPO, two meter, many watches have it now or you know your doctor’s office where you’re doing oxygen saturation on your finger, it’ll be much lower at altitude, especially when exercising well under 90%. Or even under 80%, when exercising hard, which stimulates the body and the EPO gene and the hip one Alpha gene to make new red blood cells through the natural release of EPO. And those increases in red blood cells or hemoglobin take two to three weeks. And that is the primary probably physiological response or the classic altitude training response that most athletes are after they’re trying to get that increase in hemoglobin and red blood cells. And it is the easiest thing for us to measure as scientists because we just need blood draws, we don’t need muscle biopsies, we don’t need specialist tests. And so most of the altitude research out there is about characterizing those changes in the blood, those hemoglobin changes. And those take, you know, three, four weeks to probably get a four to 5% increase in hemoglobin, you know, there’s a bit of a rule that every 100 hours at altitude, you can expect a 1% increase in hemoglobin give or take. The second though, is non hematological, or non blood responses. And this comes from a very small handful of studies and taking muscle biopsies and looking at the responses that occur in the muscle with hypoxia or altitude. And I had mentioned this before, there is this gene called HIF. One Alpha hypoxic inducing factor HIF. And it is a gene that is probably at the crossroads of metabolism in terms of cancer in terms of oxygen sensor in the muscle. And in the blood, the person that found that actually has won the Nobel Prize, it is a very important gene. But if we look at what that gene signals, it signals, things like capillary activation in the muscle, making new mitochondria and the muscle, and all these other muscle adaptations that are really quite valuable from an endurance perspective, but again, there’s probably only three or four papers that have taken muscle biopsies without the two training that have looked at that response. And so it occurs, but it’s a bit of a black box. And it’s something that a lot of coaches don’t think I think enough about in terms of what adaptations are happening in the muscle as well. And then finally, a long answer the third bit of other potential mechanisms a why an athlete goes to altitude, I’m just going to put these in the other bucket and there’s a bunch of them. So things like gross efficiency and running economy have been shown to improve at altitude or swimming economy, both muscle and blood buffering. So the ability to handle lactate or acidosis seems to be improved at altitude. And in the blood, it might be improved in as little as seven to 10 days at altitude. Again, not well characterized. There’s changes in breathing, economy and breathing regulation. I don’t think we can dismiss the training camp belief effect, you’re going somewhere exotic and spending a lot of money to go train. That belief effect is really important. And the fact that most altitude trading locations, they’re beautiful spots, and they are really great places to train emotionally and spiritually. And then finally, psychologically, I think there’s different benefits because things do feel harder. Your perception of paces and discomfort kind of gets reregulated so that when you come back down to sea level, your perception of the discomfort of endurance sport is different. So there’s a lot there because it is a really big topic. I think a lot of people just jump on Oh, it’s EPO driving red blood cells. And that is one thing, but I’ve just listed about eight or nine other things that also concurrently occur with altitude and hypoxia.

Julie Young  09:13

When was that gene discovered?

Rob Pickels  09:15

Oh, boy, if one Alpha gene, I bet you it’s like 20 or 30 years ago, there’s a really neat data to showing it seems to have a memory. So if you go to multiple altitude camps or multiple hypoxic exposures, you will adapt more quickly. But it is been involved in things like inflammation and cancer and it is one of the master regulators of human metabolism in terms of just how many associations it has with I think it stimulates about 60 other genes, like I said before, things like capillary activation or mitochondria and some of these other elements.

Julie Young  09:47

And what’s interesting, I think, I don’t know what DD thinks but like when we were doing training camps, I always really kind of appreciated just the simplicity of all you were doing, you know, everything else moved to the periphery you were At home having to do other things, and you could just like eat, train, sleep, repeat. And so that’s really nice.

Rob Pickels  10:08

That training camp effect is important in a lot of the research is confounded and altitude training because they’ll take a group of people and bring them up to altitude for the training camp. But the control group is usually people just left at home, they should have the budget, which is really easy to say and hard to do to take those people somewhere exotic at sea level, and isolate them and have just what you said, Eat, sleep, train, repeat, because then maybe the effect sizes would be a little more normalized.

Julie Young  10:34

Now it’d be an interesting study. So yeah, let’s now look talk in detail about a training camp and what a good training camp looks like. So I have a few questions for you. How long would the optimal training camp be, I’d love to understand what the training actually looks like during that training camp, timing before a key competition. And how often during a season, would athletes do these altitude camps? That’s

Rob Pickels  11:02

a big question. And almost could be a podcast on its own. Because it’s similar to how we’re all the different ways you would train an endurance athlete. And so we could talk hours on that. And I think there’s probably four main types of altitude camps, what I would say is a kind of aerobic season boost and fitness camp where you go up for three or four weeks, and maybe it’s in the fall, and you’re just looking to put in, you know, big work, it’s not necessarily aligned to a competition. So that’s one type of training camp, you know, the goals of that training cramp are just really put in a huge block of of aerobic type work, the intensities are a little bit lower, but the volumes that you hit are gonna be as high as sea level. So that’s one type of camp, I think there’s a camp that’s done right prepping for key competition, right prior to sea level. So that may be a spring camp leading into some early summer races, that type of camp might be there to boost sea level performance. The other one is a camp right before competitions, but the competition is at altitude. So that’s a little bit different again, and then the last type of camp I’ll highlight is a kind of reboost, or re acclimation camp in the middle of a competition season. So a lot of athletes might do camps two or three times throughout the year, do the classic three or four weeks, maybe in the fall, a classic three or four weeks in the spring, and then one or two top up camps where they just go up for 10 to 14 days, and maybe in July or August in certain spots, midseason to again, re acclimate and get some of those adaptations. So each of those four camps I’ve just mentioned, all have slightly different goals and slightly different approaches. Yeah, unless we had hours to talk and dig into each and every one of them. And to be honest, a lot of it is just my experience, because there’s not a lot of data and science on this, it would be challenging, but I’ll highlight I think some really key commonalities that I’ve seen that make us successful camp across all four of those camps. And then we’ll dig a little bit into some generalities. I’ve seen around training, too, that I think can point people in the right direction. So number one is, especially if you’re new or newer to altitude training, probably, you know, four to six weeks before going into the camp, it’s really important that at sea level, you get really good baseline data on an internal and external load metric, and some kind of fatigue tracking. So an internal load metric is heart rate, rating, their perceived exertion. Lactate sampling, an external load metric is running speed, swimming speed, power on your bike. So you’re calibrating those a little bit at sea level, what are your norms for your different training zones, and then a bit of a fatigue and recovery questionnaire that you can use. And it’s really good to get that well sorted at sea level so that when you go to altitude, you have something easy to compare to in terms of just tracking your altitude training number to about four to six weeks before altitude, I would take the time to get some blood work done, especially again if you’re new to altitude. And so that bloodwork really includes your CBC complete blood count, and hopefully, an entire spectrum of the iron studies and especially ferritin to make sure we understand and know where your iron sits. If you’re deficient or have a ferritin. Under 35, you probably want to start to supplement already with an iron supplement prior to altitude. If you’re between 35 and 100, you can probably wait until you get to altitude and I can send you guys this to put with your show notes. We recently while in 2019 wrote a altitude nutrition paper where we’ve highlighted the all the bloodwork to do and the associated recommendations for iron supplementation at altitude. And I think we’ll dig on that a little bit more in this podcast three. When you get to altitude you implement an increased level of monitoring. And so that can include some elements of hydration, perhaps body composition or body weight. You don’t want that it may be in some instances not to go down you got to make sure you feel properly as I mentioned before a fatigue and recovery tracking tool and potentially morning heart rate as well just upon arrival. And then finally getting, you know, into the nuts and bolts of training is adapting the training a little bit upon arrival to altitude, especially that first week, probably in the first three or four days, it is good to back off the training a little bit, probably a 25 to 40% reduction in total training, volume and intensity, just let your body adapt initially, over the first three or four days to altitude. There is an initial adaptation period of hyperventilation and poor sleep and increased dehydration that will settle you know halfway through that first week, you’re going to want intensities probably lower in terms of the anaerobic stimulus, you can do shorter stuff on lots of rest. So a lactic work, that’s fine, but pull back a little bit on your anaerobic work for sure in that first week, and then use your C level, especially internal load metrics to help guide what athletes do for intensity up at altitude. So for example, if your zone one training, whether it’s running or cycling, you know your heart rates 140 At sea level will then aim for 140 at altitude, yes, your waters and speeds are going to be five to 10% Lower, that’s okay, the internal load is the same, especially in that first week. So let an internal load metric guide the intensity a little bit more early on in the altitude camp, and you’re much less likely to overdo it and get into trouble with an illness or sickness or maladaptation. By the time you get to week two and three. Training volumes can certainly be back up to normal and high compared to sea level. And you can start to do more anaerobic work, for sure. But the types of intervals you do are probably two or three minutes or less. And you probably need to increase the rest intervals by 50%, maybe sometimes even double to 100%. It really depends on what you’re doing for high quality work. And by weeks three and four, you can train pretty similarly to sea level other than it’s important to recognize that most hard intervals from about three minutes duration to 10 minutes duration, you may never fully get the water does or speeds that you had at sea level at altitude. They’re just too intense and too hard. Your longer work wattage is in speeds, one to two hour type efforts and three, four hour aerobic rides or runs for sure. After three weeks, four weeks, you can probably have pretty close to similar speeds and wattage as a sea level. But the high end vo to max anaerobic work will always be a little bit compromised and challenge just because the intensity is so high, the oxygen delivery is already limited at sea level. Now you add altitude to it. And so at that time of the year, if it’s a spring camp or that type of works really important, where you choose your altitude camp becomes more important because then having an opportunity to go lower to do those types of training sessions, race cottages and philosophies becomes a lot more important. So places like Flagstaff, we can go down into Sedona or down into Phoenix, a place like St. Margaret’s we can go down into chi have in Italy, almost to sea level places like boulder that that’s almost impossible. It’s harder to drop down to be able to do that kind of work. So there was a lot of words, it was a big question. So I’ll pause

Dede Barry  18:11

there. What about using supplemental oxygen?

Rob Pickels  18:15

Yeah, so actually a couple projects in my PhD looked at hyperoxia. So supplemental oxygen, and the effects on metabolism and performance there. We have done that with some of our athletes over the years and it is certainly a modality that can be used. So for the listener, what that basically is, is you spend a bunch of money in a lab situation should be at a controlled lab situation where they buy 100% Oxygen canisters, we usually bleed in 21% Oxygen ambient air, because the hyperoxic data, if you’re at about 50 or 60% of inspired oxygen, your body will behave the same as 100. And those cylinders are really expensive. So when you bleed in the 21% area, they last a little longer. And you can then circumvent some of the hypoxic effects on those really high intensity intervals by having supplemental oxygen. We’ve done that at sea level at certain times, because it almost takes the limitation off your central capacity, completely awake because oxygen is almost no longer limiting. And so then puts the limitation of performance almost directly on your peripheral system or musculature. And so I’ve seen situations where you can do on 60% Oxygen, five or six times three minute reps at a wattage or speed that is your three minute PB but you do it five times in a row. It is a massive neuromuscular training stimulus. It is really easy to overcook people with it. You need to think very carefully about how much you do. How often do you do it and be very careful with your recovery. I would extend recovery by up to four days after a session like that

Dede Barry  19:53

I can remember in 1995 I use supplemental oxygen to prepare for the world cycling championships and do Retama Columbia 2500 meters and in the lead up, I was training with the US National Team and Winter Park, Colorado, we slept at about 2800 meters. And we did most of our high intensity efforts with supplemental oxygen on indoor trainers. I believe all of our endurance rods, though were on the road without supplemental oxygen, but unfortunately, I overcooked it for worlds. I was okay at Worlds but not as good as I’d been all season. Yeah. So but yeah, so could you speak a little bit to in what situations you feel like it would be ideal to do that.

Rob Pickels  20:34

It takes us first of all, a significant amount of financial infrastructure to implement that. So it’s probably more about national sport organizations and pro teams having a physiologist to help implement that. So that’s first and foremost. Secondly, situations that we’ve seen are advantageous are one exactly what you just talked about is native sea level folks who have to then compete at altitude where the holding camp might be at altitude and an events where maybe it’s velodrome based event or high intensity event. And the only way that you can deliver that high intensity neuromuscular effort is that right there, but it’s lab based, you know, there is some situations I’ve seen where, in speedskating, they put a cylinder on the back of an athlete and have them breathe 100% Oh to while they’re on the ice, that’s an interesting paradigm that would not work in running, it would just bounce around and be way too awkward. The other instances we have, although not recently, this is more like six to 10 years ago is used it in some athletes as part of their taper strategy as a neuromuscular overload stimulus to really push that muscle up to the next level as part of a taper. And so there’s probably the two main areas that you would consider doing that,

Julie Young  21:44

what are the lasting adaptations to doing something like that? We

Rob Pickels  21:49

don’t really know, there’s only about four or five papers, really, in elite athletes that have done hyperoxia. We did two in my PhD, where we took muscle biopsies and looked at the change in metabolism in the muscle, but it was an acute effect. And so basically, you produce way less lactate, you’re way more aerobic at a given output. And it instantly looks like you just put a year of training in your muscles, because you have all this oxygen permeating through your muscles. Finally, I know some International Federations have banned all elements of altered hypoxia and hyperoxia. So the world cross country ski federations have banned that at competitions because it was just getting out of control, like people are pulling up with trailers, and they’re doing Hypoxi and hyperoxia. At some point, the Yeah, train hard, eat hard, sleep hard. Take your iron supplement, let’s bang the gun and see and I love the simplicity of sport in many ways that to me, even as a sports scientist starts to get just a little

Julie Young  22:44

over the top. And then it becomes about finances to right the teams that are well financed. Yeah,

Rob Pickels  22:51

I mean, it’s very true. That said, I’m pretty sure the Olympic medal count is correlated to a country’s GDP since the 1960s. So part of me is like yeah, I get it a Suffolk archers time trial bike for sale for $30,000 in cycling news yesterday, too, right. So there’s some sports you need money to play in, right. And there’s other sports that you need less money. That’s it.

Trevor Connor  23:15

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Julie Young  23:41

I have a few follow up questions to the altitude camps. And when an athlete does become adjusted to altitude. Do you readjust their heart rate zones? Yeah,

Rob Pickels  23:50

so No, not necessarily. Because what’ll happen is those zones will still stay pretty static. But the speeds and the powers in those zones just get better and better. And the lactates in those zones will stay relatively the same. But again, the powers and the speeds get faster and faster, you can see that quite quickly. In fact, and that’s another positive feedback loop, like the paces that you run at, say 150 heart rate or the wattage is that you do at 150 heart rate by week two, or three or five to 10% Better than in week one. And that’s a nice feedback loop for the athlete to see as well. And then you’d

Julie Young  24:20

mentioned like different scenarios and potentially an athlete going TO to bigger camps, like maybe spring and fall and then doing those mid season shorter camps does that allow that athlete it’s kind of less stressful for them than to go mid season for that 10 to 14 days.

Rob Pickels  24:38

So there’s the stress piece and then there’s also the competition piece. It’s in many instances, pretty challenging to find a three or four week block mid competition season to be able to do that. Even if you have the finances. I just especially for international athletes, in most endurance sports just have to compete in those areas. So almost by necessity, you end up with some smaller blocks. That said the few papers that have looked at changes in muscle buffering. So with the biopsies so that your muscles can buffer higher lactate and higher acidosis and blood buffering do appear that those adaptations might be much shorter than the red blood cell adaptations of three to four weeks, they might be more on the order of 1014 days, a couple of weeks. And so I’ve especially seen middle distance like 800 meter, 1500 meter runners get a very, like kind of midseason boost. And I do wonder, hypothesize that a lot of that in just a 10 day camp might be an improve muscle and blood buffering capacity when they then go into the racist.

Julie Young  25:40

And if an athlete has invested like spring fall, they kind of do that big bunch of work kind of aerobic work. Do you find that those athletes then just adjust better to that altitude at the 10 to 14 days?

Rob Pickels  25:53

Yes, there’s a few papers, Philo Sanders, that are the Australian Institute of Sport where they’ve looked at multiple Ultra two camps over like a two year three year period. And there does seem to be a physiological and maybe psychological acceleration of adaptation. So the camp that I described, it really taken it easy on week one is really more for a newcomer that’s exploring altitude for the first or second or third time. And I think for those that have used it much more often or just been at a camp two or three months ago, and have generally adjusted really well, you can get into your work a little quicker. And again, going back to that hip, one Alpha gene, there is cell culture work that does suggest that there is a memory effect, it seems like and some of the genetic responses to altitude so that if you’ve used it more often, you may benefit more quickly from it or adapt more effectively.

Julie Young  26:42

Interesting. So in these mid season 10 to 14 day camps, how would you time that before a key event? Great

Rob Pickels  26:49

question. So one of the camps that we mentioned is using altitude prior to competition. And the art and science of the taper is more art and less science, I believe. And if there’s any time of the year that you as a coach are individualizing, the training, it’s usually around taper time. And I always use the somewhat jokey analogy, but it’s true, like when a major key competition, you want your athletes to show up as a nice yellow banana, they don’t want to be a green banana, they don’t want to be a brown banana Diddy, you’re a little bit brown at those World Championships, you maybe overcooked it a little bit, you weren’t rotten, but you’re just to touch brown there. And that’s that balance of fitness and fatigue that you’re trying to monitor and just titrate in. So nailing a taper at sea level is already tricky. nailing a taper now that you’ve put hypoxia on top of it gets even trickier. And so generally the kind of rule of thought, and there’s been some papers published on this, but they’re more like hypothetical papers, and there’s a few performance papers, or that you either come right out of altitude and try to compete within a day or two, or you come out of altitude, hit a bit more training at sea level and then compete maybe a couple of weeks later, you know, 10 days, 14 days later, for a lot of athletes, there does seem to be this kind of blob period, somewhere around days, like three or four, up to maybe day seven, or eight or nine where they’ve just come down and they’re still feeling the residual fatigue from the training camp, some of their breathing. As you come back down to sea level, you’re still hyperventilating a little bit from altitude takes a little while to readjust. And so I think those rules of window time competition also depend on whether or not you’re in an event or sport where you compete at maximal breathing rates versus submaximal. And so if you’re a marathon runner and submaximal breathing rates, I see much less of an issue in terms of when your time your competitions versus a middle distance runner or power athlete or velodrome cyclists where you’re at maximal breathing rates where there might still be this hyper ventilatory cost of the altitude. So long story short is what I’m saying there is that it’s either compete right away, or probably compete after 10 days and get to sea level and get a few training sessions in you. I think those two windows though personally tend to be a little bit over religious or over prescriptive. And I think a much bigger part is what the coach does with the athlete during the taper and their last week at altitude. And I think a lot of us forget, at times, most coaches and athletes have their kind of tapers sequence all written out, they know that this works. Let’s go with this. And I get that you want something that’s predictable, so you can tweak it and work on it. But that’s going to look different at altitude than sea level. And I think a lot of coaches forget that and just take their sea level taper, plunk it into altitude. Oh, you know, five days out. We usually do six by one minute and did an almost forget oh wait, the altitude is a little more stressful is it got a higher recovery cost? Maybe I should dial that back. 20%. So I do think if you take your taper, you dial it back a bit at altitude then I’ve seen athletes compete lights out on days from one to 14 and everything in between. It just really depends on what the residual fatigue Eat from the altitude campus. And then you can layer in like, where are you traveling? What’s the jetlag? What’s the travel fatigue, good competition? Are you in Europe? Is it a European competition? All those other confounding factors of when and where to try to race? Yeah, it’s complex. Yeah.

Julie Young  30:15

Well, it is interesting. So I’ve personally experienced feeling kind of crummy coming out altitude. But to your point, I’ve never really considered what I was doing right before coming down out altitude. That’s interesting. So last question about training camps. At what age would an altitude training camp or altitude training be appropriate?

Rob Pickels  30:36

Well, there’s kids born every day at altitude that are, you know, they’re that just fine, and they’re pregnant, and they’re fine. And you know, I think at moderate altitudes, like Flagstaff, and everywhere else, I think the answer for me is more around what’s age appropriate for these types of big, audacious camps? Like, I’m not going to send my nine year old at an altitude camp, that seems a little bit crazy and not thinking very long term athlete development. Has he been to altitude five times where this has a family member? You bet. Does he do a lot of activity up there and playing? Yep. But he’s not going there for a training camp. And so I think it really depends on where the athlete is and where they’re tracking. And, and it might depend a little bit on where the competition is. So you know, if World Juniors were at a location of altitude, and you had the resources to take your junior team to go a couple of weeks early, and know this is all kind of mythical and theoretical, yeah, that might be indicated, they’re gonna perform a lot better if they’ve been up there a couple of weeks and just coming in fresh and solo. But for most sports, you know, would I be doing three or four altitude camps and some 16 year old kid who doesn’t have their sleep mastered, can’t work their way around the kitchen yet hasn’t maximized sea level training responses, has another 10 years of good work to put into that body before we think about altitude. Now, it doesn’t make sense. I think there’s much bigger rocks to focus on first,

Dede Barry  31:59

try and you touched earlier on the difference between athletes training at altitude in order to gain a boost before they compete at sea level versus athletes training at altitude to acclimatized and prepare to compete at altitude and event like Leadville, 100, takes place at approximately 3000 meters, what do you think is the ideal way to acclimate for an athlete who’s coming from sea level and wants to be able to compete at 3000 meters?

Rob Pickels  32:23

So first of all, using altitude to enhance performance at sea level, the data on that and the meta analysis of performance does suggest about a 1.5 to 2% increase in performance at sea level. But it’s plus or minus 2%. There’s huge variability there. And so you know, some people argue that the cost benefit for sea level enhancement of performance is a bit questionable. So for your question, for sure, there’s no doubt that preparing for performance at altitude by using altitude will enhance performance, I was just making the reference of the comparison that it doesn’t always enhance performance at sea level. So there’s no doubt that you will enhance performance at altitude by using altitude prior that is an absolute for sure. And so there are a handful of papers that have looked at the timing, say prior to Leadville and the timing you need to kind of maximize those at altitude benefits. And a lot of those projects were started because the Bolivian soccer team, when you have to go there and try to make your World Cup soccer, you’re at 3000 plus meters of altitude. And do you fly in the night before? Do you fly in two weeks out? Do you fly in the day of with the idea being that there is this initial adaptation period where you don’t sleep? Well, you’re a little bit dehydrated, you’re hyperventilating, maybe you mitigate some of those outcomes by just coming in right before because you’re still going to be compromised some performance either way. So long story short is the outcome is that it doesn’t really seem to matter. And that probably the logistics around cost and trade offs of cost, travel fatigue, family lifestyle job outcomes are as important in that decision matrix. Unless you can go to altitude probably for a good two weeks prior. If you can go for up to two weeks prior, you will absolutely get a performance benefit. If you can’t, then arriving two hours before or the night before or five days out doesn’t make a huge difference on the performance benefit. You’re going to be compromised at altitude because you just haven’t had time to adapt. So usually if an athlete or coach asked me that question, I’m firing right back to talk about things like okay, where are you based? What are the travel costs? What are the travel fatigue? What’s your lifestyle? Can you take time off work? If you can go up there for two or three weeks before and get acclimated awesome. It will help for sure. But if you can’t, then anything in the last week, as long as you’re optimizing all those other recovery things that I’ve just mentioned, then you’re probably my experience is you’re going to be compromised. optimize all the other things and do your very best and other people will be compromised too.

Dede Barry  35:05

So if an athlete has a competition at 3000 meters, and they’re not actually able to travel and train to prepare for that event ahead of time, is it a worthwhile investment if they have access to an altitude tent or an altitude chamber to use that to begin to prepare and start some of these physiological adaptations? And if so, like, what would that look like? Ideally,

Rob Pickels  35:30

so yes, there does seem to be some evidence that an altitude 10 at the front end can help stimulate or get some of the adaptations going for altitude, as well as off the back end, there’s one paper at a China where they host altitude had people in a tent and they were able to maintain their red blood cells longer. So the tricky piece with a tent is that the total hypoxic dose is just significantly less. So if you go to altitude for the week, there’s 168 hours in the week, you got 168 hours of hypoxia, you’re lucky to get half of that in the tent, maybe 70 hours in the week, 80 hours, maybe if you go back in for your afternoon naps, you set it up. So you can have a desk in there, maybe it’s a bigger tent that goes over a bed and has space. So you can do some afternoon work in there and get more accumulated time. Accumulated hypoxic time is a major driver. That said, using a tent for two or three weeks will help with some of those adaptations, the increase in hemoglobin or red blood cells will be a little bit less, but it’s still helpful. And then finally, if you have a larger tent again, and there’s an ability to both sleep in it, or work in it, but also do some training boats in it that can help as well prior to altitude. So you just have to look at all those things. And again, it’s a cost benefit analysis of how much you’re gonna pay or not. For example, like for a lot of athletes that aren’t acclimated to 3000 meters, it’s probably a hill, it’s individual, but it might be an eight to 15% drop in performance at 3000 meters, just to put that into the ballpark. Trent,

Julie Young  37:02

I have a follow up question on the altitude chamber. So when I was racing, I had a coach that actually built me an out to chamber and this Saturday, I can’t believe I actually crawled into this thing. It was like for lack of better word, a big PVC pipe. And we had literally no protocol whatsoever. Like I’d go in there in probably I think an hour in the morning and an hour in the evening and put it to like 12,000 feet, and I was absolutely exhausted. And we were doing this somewhat in preparation for the healer, which is at altitude, and I felt lousy there. And then we went to France and race tour to load and I actually felt great there but I just can’t imagine that was the right protocol. So I’m kind of interested to hear like if someone is using a chamber or a tent, what is the kind of elevation protocol

Rob Pickels  37:49

Yeah, so unfortunately, or fortunately, the body adapts really quickly to altitude. So if we look at the EPO response, and you go to natural altitude for example, your EPO is almost back to sea level EPO by week two, week three, or if we look at the EPO response and attend to goes up and down each night. And in many instances if you don’t increase the altitude on the 10 by night seven the EPO responses like a third of what it was on the first night. So that’s great, your body adapts really quickly. But if we want EPO to remain high, it does mean that again desaturate your finger oxygen saturation or your blood saturation to derive the EPO response, then generally speaking, what we’ll do is, is say you got to commit to three or four weeks in the tent, you got to commit to 70 to 100 hours a week if possible in the tent. So have a setup so that you can accumulate quite a bit of time. So the altitude houses that they have a say at the Australian Institute of Sport people live in there, they make food they’re almost continuously in altitude or as much as possible. Three, usually in week one, you might do something like 3000 meters of sleeping high. And potentially if you’re adapting well, by week three, it might be up at four to 5000 meters of altitude, again to get that continual hypoxic response. So those are probably the key pieces. Usually we layer something together. If you know in your trading cycle. There’s like a really massive workout, you know, every five to 10 days like a really big monster one. Maybe on that night, you sleep at sea level and then you go back in because you’re also teetering on recovery. The massive thing with tents is that we know hypoxia and altitude disrupt sleep in attended tends to be even worse because there’s a generator running they tend to be hot and humid and sticky in there. So usually what I’ll recommend is absolutely crank the generator to max and then when you’re like looking for your altitude as a percent saturation vent as much as possible to let as much air in that you can still hit your numbers because you’ve got the generator on it Max in week one you’re venting more and as week two you was event then by week three, and then you have a fan in there as well because the sleep quality is if you’re just totally compromising that then it’s almost pointless and useless.

Dede Barry  40:09

So try it I had leading up to the 2004 Olympics, I actually had an altitude company sponsorship, which is great. And my husband was also training for that Olympics, but we shared our time between a house in Boulder and a house and Gerona, Spain. And we had altitude rooms built into both of the houses, which was a much better solution, because we had shortly experimented with a tent and found it like unlivable. But the rooms that we had had air conditioning scrubbers, it was actually a really comfortable environment with a lot of white noise, which I sleep really well with. And yeah, I mean, I would generally sleep between 1012 1000 feet, but I would adjust it based on how hard I was training during that cycle and how my recovery was, I was towards the end of my career. So I was super in tune and had really good intuition around my sensations by that point. But I felt like it was hugely beneficial for me, ya

Rob Pickels  41:07

know, it sounds like you have the wherewithal to make the room and then through trial and error, you had a great sensation, because that’s functionally the roll call I just kind of gave you Yeah, so

Dede Barry  41:16

I pretty much like I would travel the races occasionally. But I wasn’t racing as many number of days at that point, I was trying to focus my training a bit more and stay home more. But when I went away to races, obviously I was down at sea level, most of the time very few other races were at altitude, if any, but it so I did have breaks where I wasn’t at altitude, but I was actually pretty consistently sleeping at altitude over like a year and a half, two year period. And then before the Olympics came down, you know, completely out of it to fully recover with a good period. But I felt like that ended up being a super good protocol for me. Whereas my husband, who having to race and travel quite a bit more often didn’t have enough time, like in the altitude room, like he was coming in and out so much, and racing so much and traveling so much that he felt like his recovery was really compromised, and he wasn’t able to benefit from it the way that I was. That’s

Rob Pickels  42:11

great practical insights. And that’s why right up front, I said if you can commit to having like a three week block or four week block that it’s it’s quite worked out, if you’re traveling and you’re in and out and in and out, you got to balance that fatigue profile.

Julie Young  42:24

So Trent, it does seem just kind of based on what you know, you and DD are chatting about, like there’s definitely trade offs to being in the altitude full time in terms of certain capacities being diminished, and, and others, you know, being increased. And so I mean, I guess maybe it is the best of both worlds. If you can do something like what DD did, you know, have that have that opportunity to be at altitude during rest and sleep but being able to be out training in at sea level? Like what are those different capacities that are increased and diminished at altitude? Yeah, I

Rob Pickels  42:58

think the concept of trade offs is applicable to every aspect of training. You know, when you’re recovering sitting on the couch, there’s the stuff going up and down, there’s trade offs occurring to and altitude is just another way to think about the trade off decisions that coaches and athletes have to make. And so I had hinted at that earlier is one of the big compromises or trade offs is that ability to do really high end, anaerobic quality training at altitude at higher altitudes is really tough, especially longer boats, you gotta break them up with more rest, and in the fall, or if you’re away from competition season, it doesn’t matter as much hits, you’re not doing that anyways. But if it’s right before a really key competition, you gotta be you gotta be aware of that. And so the live high train low, it becomes a lot more relevant. Another piece is that, especially if you’re just not used to it as much there can be an increased risk of illness, just with the stress, the fatigue and the altitude. And, you know, initially the lack of sleep, resting metabolic rate does appear to go up so there can be increased risk for potentially under fueling or not eating enough at altitude. That’s something to consider as well. And so there are there are a few, you know, trade offs that you need to need to think about when you also think about different events in different sports, it’s quite a lot different. So let’s just compare swimming and cycling, the ability to swim in Zone One and altitude. For some, even the Olympic swimmers is really challenging and to have their lactate under for they’re already hypoxic because their faces in the pool. Now you’ve added altitude, you could only swim so slow before you sink that I go slow down your lactate, I can’t go any slower. I don’t have the technical or I’m not fit enough to actually hit zone one versus on a bike where you can just soft pedal or cruise or switch gears right it’s it’s a completely different paradigm for cyclists and swimmers at altitude it high velocity low velocity like there’s just it’s just come pletely different. The other thing I’ll highlight about altitude is, you know, every world record, it doesn’t count for all the speed events at altitude because air is thinner. So high end speed work is awesome at altitude your all your middle and long distance runners all their personal best to hundreds are always at altitude. But what was really interesting, I’m not involved with the program at all. But I know I think it was a lead into sosi as the US speed skaters didn’t do well at Soshi, the Dutch did really well. And part of the thought was the speed skaters did too much altitude and their velocities and speeds are so high at altitude mechanically biomechanically, when they came down to sea level they or maybe it was Torino Olympics. Anyways, they did, they had a really poor games, and the Dutch are like, Oh, well, we’re below sea level. We’re used to speed skating through the thick air, it just toughen us up, right? Like there was this whole discussion. And I think the Dutch won like 10 medals and the US won won or something. And so all I’m saying here is that there’s trade offs, and it depends on the sport, the mode of exercise, how technical it is, what’s the velocity of the sport, is there biomechanical changes that occur and, and so I think it’s just important to think all these things through and it gets tricky in something like triathlon, where it’s a multimode sport, and you’re balancing out all those scenarios across three different sports. Just have

Julie Young  46:18

one quick follow up to that. So where I live in Truckee is about 6200 feet. And it’s only about an hour down to sea level. And so people will, you know, go down and work for, say, three days and come back up, and they’re back and forth a lot. Are they losing quite a bit of those adaptations in those three days? And then how long does it take them to fully acclimate again.

Rob Pickels  46:41

So there’s an obscure study done in Chile on miners that go up three days to work and then back down to sea level for three days, up three days to work back down to sea level for three days, and they’ve done it for a decade. And there does seem to be a disruption in the altitude adaptation that occurs and that when you go up and down, you’re just not there long enough to accumulate enough of the benefits versus if the miners just went up and then stayed for like a month, the blood values are completely different. And so So yes, you do need to consider that. The constant up and down makes a difference. But it’s different, I believe, where, you know, again, you’re a saint muret. So you’re up there 168 hours a week, and then you go down to chi event for sessions, and maybe you miss 15 hours a week of sea level training, and everything else you do up top I that stimulus certainly works as we’ve we’ve done the blood measurements. So at some point, there’s going to be a tipping point where you’re just not accumulating enough hypoxic stress to really to get the response. Trent,

Dede Barry  47:42

are there any specific strategies around nutrition or supplements that you recommend for athletes training at altitude? And then also like, Are there any specific to females? Yeah,

Rob Pickels  47:52

I mean, the big one is iron, iron, iron, iron. So to make new hemoglobin, red blood cells, you need iron, because every single hemoglobin has four irons associated on the hemoglobin that that bind the oxygen directly. And so if you’re in a referral, quick response, you’re in a response where you’re going to want to make more red blood cells and hemoglobin, you, you do need enough iron available and iron stored as well as iron supplementation to augment that. So we’ve done some research on this and published it for most athletes who have a ferritin render 150, we recommend 200 milligrams of elemental iron per day at altitude and taking it as one single dose not a split dose. So we’ve looked at that as well as you will get slightly better hemoglobin responses with a single dose, I won’t go into the rabbit hole of why but that seemed to help as a single dose. And so that really is the biggie and there’s some dose response relationships were actually out of Australia that took a whole bunch of data put it together. And those athletes had about 200 milligrams of elemental iron had nearly double the hemoglobin response as the athletes at 100 milligrams of elemental iron, and again, a much greater response and those on zero milligrams of elemental iron. So know where your ferritin is at. And supplement judiciously is a biggie for females because anemia is even greater, it’s even more important and more emphasis and more focus. The other things at altitude is to consider is hydration. It is normally a drier environment is much easier to have levels of of dehydration. I think the three easiest ways to sort out hydration status are three simple things is a little bit of day to day weight. Like if you’re having a massive fluctuations that can be energy, but if it’s massively up and down, it’s probably hydration status, your urine color and your thirst, just try triangulating those three things. And if your urines generally clear, you’re not that thirsty all the time and your weight stable, you’re probably doing a pretty good job with your hydration status. The third major thing that I’ll highlight is just total energy intake. There is an increase in resting metabolic rate Did altitude altitude training also causes an increased use of carbohydrate calories because you’re slightly more anaerobic? And so you just have to be the a little bit more on top of your caloric intake and specifically carbohydrate or it can take.

Dede Barry  50:14

So Trent for some people altitude makes it really difficult to get quality sleep too. Do you have any suggestions around like improving sleep quality at altitude,

Rob Pickels  50:26

we have a tracking questionnaire that I use with athletes and the questionnaire is part the Lake Louise altitudes, mountain sickness questions, along with some fatigue questions that asleep question and just put it together and it kind of gives plus and minuses scores. So I can just look click on a graph and how people are tracking. It’s just something I made up and sleep certainly is compromised, especially in that first week. So you get for some individuals increase headaches, sometimes some GI issues are up a little more often. The Sleep recommendation to delta due to be the exact same sleep recommendation as sea level is work really good on sleep hygiene, making a routine getting laid off your eyes, all the same types of recommendations. I’m unaware of anything specific to altitude, you know, melatonin can help it’s usually a pretty natural and easy to implement the 30 to 60 minutes before you’re going to sleep. But at the same time, don’t be on your phone and have light on your eyes because that for sure delays. sleep onset. Certainly, you know, some physician is in extreme conditions might have a prescription tablet for for sleep aid. We’re not a fan of that. That tends to indicate other and bigger issues and problems. But that is something to chat with a physician about.

Dede Barry  51:37

Yeah, and when you’re monitoring recovery during an altitude camp, or just generally when an athlete’s tread altitude, are you looking at resting heart rate or HRV? Or both? Yeah,

Rob Pickels  51:48

so we’ve tracked a lot of things. Three main things on the cardiac side would be resting heart rate, we’ve done HRV. And we’ve actually done percent oxygen saturation. So you again using that fingertip SPO to meter most athletes upon arrival to altitude from sea level will have a five to 10 increase in resting heart rate. So it is it is a good jump up. Usually by the end of the first week, it’s come back down to baseline except for usually at the end of the first week, if you’re really hard for a session and that next day, it’s going to be up again by five or 10 beats, that’s okay, as long as it comes back down the day after your SPO to your oxygen saturation at rest, a lot of athletes will drop from about 99 or 100% at sea level down to the low 90s. And then you’ll see that over week one and two creep back up to 100%. That is a good again, a really good sign of adaptation. And then for a lot of some athletes that use HRV, you do get a 20 or 30% increase on average in HRV or RM SSD. Again, that tends to settle out again after about one week, you’ll definitely get spikes after hard sessions. But again, if those spikes come back down on the recovery days, then you know you’re tracking okay. Yeah,

Dede Barry  52:58

that’s interesting. To wrap up Trent, if you were to give three pieces of advice to an endurance athlete considering altitude training, what would they be? Be

Rob Pickels  53:06

really patient with your training and intensities have very good intensity discipline, especially early in the camp kind of respect the altitude stick to those internal load metrics that you’ve used at sea level hammerheads get in trouble at altitude. So intensity discipline placed a little more focus than you normally do on aspects of recovery. So if that’s nutrition, if that’s sleep, if that’s hydration, if it’s taking an extra afternoon nap, just layer those things in ideally then take take that new three or four weeks of habit that you’ve done it and apply it at sea level two, because it won’t hurt there either. And then number three is just do your homework prior to the camp to make sure that you have a good sense of your iron and your blood iron and your your hemoglobins so that you know what to supplement. You know if you’re healthy coming in. That’s just low hanging fruit that a lot of people just don’t do. Those would be bad. Probably my big three.

Dede Barry  53:59

That’s super good advice. Thanks. You bet. Well, it’s been great having you on and talking about this. We appreciate you taking the time to join us. Oh, good. Thanks, Trent.

Julie Young  54:07

Great to see you again. You

Rob Pickels  54:09

bet Julie bet, didi. That

Dede Barry  54:11

That was another episode of Fast Talk Femme. Subscribe to Fast Talk Femme wherever you prefer to find your favorite podcasts. Be sure to leave us a rating and review. The thoughts and opinions expressed on Fast Talk them are those of the individual. As always, we’d love your feedback, and any thoughts you have on topics or guests that may be of interest for you get in touch via social. You can find Fast Talk Labs on Twitter and Instagram @fasttalklabs where you’ll also find all of our episodes. You can also check them out on the web at For Dr. Trent Stellingwerff and Julie Young, I’m Dede Barry. Thank you for listening!