Live High, Train Low- Lessons from 25 years of Practice with Olivier Girard, PhD | KoopCast Episode #191

trail and ultra runners what is going on what's happening welcome to another episode of the KoopCast as always i am your humble host coach Jason Koop and this episode of the podcast deals with a training intervention that i have a long history with and that is using altitude to improve athletes performance and specifically using a live high train low intervention to prepare for races both at sea level and at altitude this is an intervention that i've used for a long time and it's also an intervention that has changed in terms of its application how much of an impact that we actually think it makes as well as how we arrange the intervention in the first place and there's a great paper that i just happened to come across that encapsulates how this has changed over the course of the last couple decades the title of which is living high training low for olympic medal performance what have we learned 25 years after implementation it's a free and open access paper in the international journal of sport physiology and performance and the lead author of that paper is my guest today it is oliver gerard and he encapsulates what we have learned over the last 25 years in 10 different lessons we go over each of them during the course of this podcast and i have

to say that it honestly reflects a lot of how i have changed my thinking process when we're trying to implement these live high train low interventions i hope at the end of this podcast you guys can come away with a blueprint for if you are going to do a live high train low intervention and if so how you are going to arrange it all right folks with that as a backdrop i'm getting right out of the way here's my conversation with oliver gerard all about live high train low strategies oliver welcome to the podcast um i appreciate you coming on we're going to discuss a topic today that is going to be very close to the hearts of a lot of individuals as they're preparing for their summer races and they live in you know some place that is not high altitude and they're either going to go up and train at a place that's high altitude either for a short term or a long term camp and or they're going to compete at altitude so it's always very topical uh during the summer and and i hope the listeners can can appreciate that but first and foremost thanks for coming on the podcast yeah thanks jason for the opportunity i listened to your podcast and like you know i always enjoy the conversation that you have with with practitioners so really thank you for the opportunity well we'll take definitely a practitioner's point of view from this even though the centerpiece of it is going to be based on a paper that you wrote and the reason i think this might actually come to light is i had to dig back in

into my memory banks into the first high altitude conference that the u.s olympic training center put on here in colorado springs colorado and it was very early on in my coaching career uh 2007 were all the papers that i could find from it they might have had one before that but the first one in my coaching career recollection was 2007 so well over 15 years ago um uh and uh randy wilbur just happened to be one of your co-authors happened to be the person who was kind of leading the charge of this uh of this whole deal and so i took the liberty last night and a little bit this morning before we got on the horn today to kind of review some of my notes from that because i still i still have it and i was reminded that one of the reasons that they put this conference on in the first place was not just to kind of collect everybody and discuss best practices with this uh training technique of living high and training low that was starting to become more and more common but i had forgotten that the world anti-doping association started to have some conversations of if they were going to ban hypoxic tents and they're i'm not going to get into the politics of why that they were trying to do that but it just it's something that i had completely forgotten because it's so commonplace now and it's right here in my notes like almost like on the first page of of some of the things that we're discussing so needless to say we've gone around and around and around and around for for a few

decades now on best practices and how to actually leverage these types of training interventions and just now we're here to this you know paper that you uh very poignantly penned which leverages the last 25 years of use that's a long time for a training intervention to exist to finally come out with okay i think we have a good we've got a good grasp on it yeah well you know like altitude training is not something that is new uh like it came around you know like just before the 1968 olympics in in mexico where like the scientific community realized that you know like well that's going to be a challenge right for for the athletes so i guess the first like scientific conference we organized at the time you know like in 1966 and 1967 you know this is where like you know like really the scientific community like we're aware of like what's going to happen to the athletes and this is where right like that like we had the first evidence of like you know like the first like training studies that have been documented systematically and so on and this is at the time you know like that around the world like many like uh countries started to build attitude facilities you know like for example in france in former like you know like the national training center that should open in 1967 you know like in the preparation of of these olympics um and and you know like after that you know like uh the interest from the athletes you know like continue to grow you know like uh and it's been using for a long time what we call the leave high train high but then we realized that like there are some limitations and

drawback with these methods and one of them is that you know like when you spend a few weeks at altitude that's great to get some adaptation but some athletes might struggle to get uh and to maintain the training intensity and i guess this is where like ben liby and james stray goodenson came up with this idea of like oh what can we do you know actually try to um maintain the oxygen flux and for that like you might want to you know like run some training session at lower elevation you know like hence why you know like the leave high train low so leaving high to get the adaptation but training low to maintain the training intensity right and the training stimulus so i guess the concept was born like about 25 years ago right when they came up with this idea yeah yeah absolutely and you know here living in colorado springs we have a lot of different permutations of that you know we just happen to live in an area where it's not that difficult to actually live at i'm going to do it in feet and not in meters and we're we're welcome to switch back and forth i think the audience will get the gist of it where um you can easily go up to 8 000 or even 8 500 feet and live and then within a 30 minute drive come down to 6 000 feet or even 5 000 feet and actually train to take advantage of some of the of some of the training adaptations and then you add into that the use of artificial hypoxia altitude tents and things like that that can even enable that even further whether it's a tent that somebody puts over their bed or they convert a room in their house there's all different types of it and um you know once again it's been a long time in the making and so for the to add some guardrails to this

conversation we're probably going to predominantly and i say probably predominantly because we always take tangents but we're probably going to predominantly talk about the live high train low strategy so not intermittent hypoxia not going to altitude for a short period of time for you know short-term training camp and things like that and i know that presents some limitations but i really kind of want to dive deep into these best practices because it as as we have both mentioned it is a common training interventions for a training intervention for athletes to use regardless of if they're part of a national team or they're just a normal athlete and they want to go and live somewhere else for the summer to kind of prepare for their uh to prepare for their race the first thing and you guys in the paper which i appreciate very much go for the jugular with that everybody puts a big spotlight on when they're trying to uh when they're trying to determine how the intervention is structured is what is the optimal dose and the the i think the title of this particular bullet point within the paper illustrates it very well and i'm going to put my own emphasis on it and you're welcome to put your emphasis on it afterwards but the title of this bullet is lesson one there may be a relatively narrow window for optimal dose of altitude to be used with live high train low and i'm slowing down during the narrow window piece of it

that has been a subject of great consternation and i want you to like take me through the dialogue of what that let what the lesson we have learned is on what this narrow window for this intervention might actually be sure so i believe like we are defining what is the appropriate hypoxic dose and for that we need to talk about two things and one is the like altitude severity so the elevation and the second one is like how long you're exposed to the stimulus when i say how long is like how long every day and then for like the total duration of the intervention right and then the combination of of both and you're right there is a sweet spot you know where like we might get the adaptation and this is when we get a sufficient stimulus when we hit the threshold but also that like it's not becoming detrimental for performance you know like so i guess the take-home message number one here is that the higher is not the better right like you know like surely you know like if you go to high altitude you get a stronger physical stimulation but then with that comes some drawback right and then like uh yes we might get higher like physical adaptation but then like the side effect is that you're going to decrease the training quality you're going to accumulate fatigue and at the end of the day if the main purpose of the camp is to improve performance then you are missing the mark right so uh yes and the same is true for the lower level right like there is a certain trestle where like if you don't uh if you're not exposed to minimum altitude which we believe is around 800 meters uh

1800 meters then you might not like you know like get the adaptation that that you want so i guess the sweet spot is probably between 800 meters and 2500 meters this is probably like the spot where you'll get sufficient stimulation but not you know like the drawback and in terms of duration um so uh obviously it depends on the on the stimulus that you use when you spend time in the mountain it's easier to accumulate number of hours as compared to you know like if you sleep in the tent right where like of course you're not going to spend 24 hours of the day you're like in the tent um so we know and depends on on the period of the season as well you know like usually like the camp will last somewhere between two to four weeks um two weeks might be really the minimum you know like exposure time and then again the longer is not the better you know like after you know like when you spend more than four to five weeks you know like there is boredom and and fatigue accumulated so you know like probably the sweet spot i would say it's between like 800 to 2500 meters duration between three or four weeks ideally and then if you use the simulated altitude i would say that you need to spend 12 to 14 hours a day you know like in in the tent and ideally not to spend all the time in bed you know like otherwise you're going to get uh reducing the plasma volume because of the mo concentration so this is where like you know the use of the tent might be somehow limited and then like if you have access to a bigger space you know like that that would be better yeah well so here's why the guardrails are important from my perspective is because it's the psychology of endurance athletes

more is better more time training more uh volume of intensity if we want to go to like a training prescription uh type of vocabulary that is the mindset that we typically use with with just training interventions right here there is something where you mentioned there's a there's a minimum effective dose so i'm gonna convert it to feet for the american audience 6 000 feet for two to three weeks and there's also a maximum dose to where beyond that it might actually be deleterious so over eight over 8 000 feet 2500 meters or possibly over four weeks you get within the sweet spot and as we're going to get into you may get some positive adaptations outside of that sweet spot you and i think i want you to describe how it's how it could be potentially different on the low side of that sweet spot so not enough not not a high enough environment and or a long enough exposure and how that's different from being outside of the sweet spot on the high side where it's too high as you just mentioned it might induce a negative adaptation and or for two and or for too long why are each one of those different in terms of the error that you actually could make yeah that's a good question i mean lower than uh 6 000 feet if i understood the conversion uh yeah so you will not get the epo stimulation and if you don't have the epo stimulation you're like you're not going to

create like more red blood cell and you're not going to increase the total hemoglobin mass you know like so this is why you need to hit this minimum threshold of 6 000 feet and then uh you know like altitude exposure is quite a slow process you know like so you need to accumulate a certain number of hours you know like to this stimulus so spend some time in this environment if you want to expect an increase in the mobile mass and the the the rough figure is that like you can expect about one percent increment in the mobile mass for about every 100 hours of exposure so uh if you don't spend at least 200 hours you're not going to get like any increment in in the mobile mass so 200 hours of exposure if you use like a tent it's uh it's hard to do two and a half free for exposure yeah it's hard to get and it's just because like this is a quite slow process you know like so you need to accumulate time to expect you know like uh descent increasing more green mass yeah no no on the other side of the spectrum then like you know like why a higher altitude is that better because uh for example this is affecting your recovery you know like so if you accumulate fatigue you know like you're not going to tolerate you know like the the training and then you need to make some modification but then you're going to decrease the training quality and then um also you will affect your sleep you know like uh which like affect the recovery as well of course you know like so um yeah if you sleep at high altitude many of the athletes will not tolerate this well you know like and then you know like you will enter this vicious circle and then at the end of the day you know like uh the the benefits that you may get from a

physical point of view you will lose all of that you know like from like a recovery and perceptual and you know like a workout will feel more difficult you like to conduct and and so on you know like so hence why we need to uh achieve this like sweet spot which like it's not an easy thing to do because everybody's different right so like uh we need to understand like how each other is going to respond you know like and then make some contextual adjustment you know like so that like everyone can get the best adaptation you know like from these stimulus okay you gave me a great lead in and i'm trying not to belabor i knew this was going to happen i'm trying not to belabor the first lesson we've got 10 to go through and some of them are going to go pretty quickly but you already mentioned this this kind of like golden ratio that has been thrown around a lot mainly from the practitioner circles right how much can i actually expect to improve you use this term of one percent improvement and i'm going to slow down and emphasize this one percent improvement in hemoglobin mass for every hundred hours of exposure and not to not to drag that in the through the weeds too much that is significant at the very tip of the spear from an athletic context if you are trying to win an olympic gold medal versus an olympic bronze medal that could potentially make a difference as long as it doesn't screw anything else up as long as you don't make that adaptation and then lose it some and we're going to talk about that in a second and then lose it either to the same extent or a greater extent because of because of that effort and that's

no different than any other training event intervention but since we're up we're since we're talking about the optimal dose we would be remiss not to also mention what's the reasonable response right what's the reasonable amount of adaptation that you can expect at the end of the day and there's kind of two pieces of this there's the functional uh there's the functional performance improvement that we're going to mention in what is it lesson seven i can't i don't have them all memorized in order there's the functional performance improvement side of it but then there's also the physiological side of it as well without giving away too much of that future lesson can we kind of encapsulate that really quick quickly in terms of is it a really big change a really small change or or what does it mean practically for athletes yeah that's a good question so i get what you can expect in terms of like increasing the mogulubus is something between three percent to seven percent i would say like you know like 90 percent of the athletes if they like you know like follow the the principle you know like of like having like optimal dose they probably can expect somewhere between three to seven percent increase in the mogul mass you will always have some athletes that like will have like less than that or like even a decrement and then we can talk about the reason one would be like you know like low iron stuff for example or like uh you know embarking on the camp while being sick and at the end of the day you know like you don't get the training response that you expect you did train and that's why you know

like and then some might respond like more than that you know and then can achieve like up to like about 10 percent which like we will still consider like physiological response you know like after like you know like a really decent like exposure time you know yeah okay so we've got the guard rail so far two to four weeks 800 to 2500 meters in altitude 6 000 feet to 8 000 feet for our american audience now we're going to start to get into i feel like the whole host an array of caveats and things to take into consideration before people start to arrange this the first one that we started to recognize very very early going uh going back to ben levine's work i remember talking to him about this when i was a teenager and just as a quick personal backstory he did a graded exercise test on me when i was like 15 years old or something like that like what i shouldn't have been doing created a graded exercise test and i remember talking to him about some of the altitude training studies that he was actually performing at the time which would have been in the mid 90s and one of the things that he brought up that i still remember to this day one of the few things that i remember from that time frame to this day is that for whatever reason i'm using his voice now for whatever reason some people react really well to this and some people actually react negatively to it and so we're now terming this we're we are now using the vocabulary there are either responders or non-responders and there's nuance in that that they just respond differently so i want you to explain lesson two uh and within the

paper the the vocabulary is large individual variability of response exists and the mechanism behind responders versus non-responders to live high train low remains obscure i think that's a good that's a good that's a good title but let's explain it further how how do people respond differently and then why do we really not know why that is the case yeah that's another good question i mean obviously like there are some guiding principle and like you asked me before you know like what could you expect in terms of immoglobin mass and i say well like somewhere like between like three to seven percent with probably like a group average mean of like four to five percent but like who is the athlete that is right like no one right like you know like every athlete is different and the thing with attitude training is that like we normally expose a bunch of athletes doing the same training camp you know to the same altitude and like we are all different right so yes i believe that uh there are some like genetic predisposition and this may explain why you know like some like have like a better physiology than others but there are like so many contextual factors that will also explain you're like once someone will get a stronger response than someone else you know like and at the end of the day i think like everybody is a responder you know like it's just that like when you give the same stimulus to everybody like guess what like of course you know like some will adapt with a stronger response than others you know like and

you know if like actually like you individualize the doors you know like you modify the training i feel like everybody responds it's just that like some might respond quicker than others you know some they might require higher dose than others you know like some require different training adaptation and so on but the problem in scientific studies is that like we don't do this adaptation you know like academic studies is different from real life right like you know like the problem is that like like in most of these academic studies there is no adjustment so like this is why we often see like this widespread of response and then we say just like oh there are some responder and some that are not responder well i think if we do that things properly you know like we like check again you're like the iron level and and we respect the principle that we are discussing you know like i feel like everybody my response is just that like you know like some are slower than others some need a better dose some accumulate fatigue you know so if you test them immediately after the camp like maybe they don't see the adaptation that you're expecting but you know like once they absorb the fatigue phase if you test them you know like a few days after then like you might see the same respond that the one we considered responded before or even a better response you know like so it's just because we test them often immediately after the camp and this is just a snapshot but actually you know like if we had more time point like we might actually figure out that like everybody respond but just like uh at a different time course you know like so i'm not strong believer of responder and wrong responder i think you could measure yeah well so okay since you're not a strong believer in that this is your first challenge question

where we can really put our practitioner hat on right one of the one of the fundamental components of training is the aspect of individualization as a coach i have an athlete stable not every athlete is going to get the exact same workout even if they're very similar and even if they are very similar and training for the same race i'm still going to individualize the training prescription that i use for them based on a whole a whole host of things and just as a as a very coarse example one of the ways i get a fix on that is i look at their previous training and i just ask them hey when were you doing really well and when were you doing really poorly and i use that as some directional arrows to what their strengths and weaknesses are and what they might need more or less of to highlight this individualization component can we do that with altitude prescription and if we could what might that look like like we have this range of two to four weeks of six thousand to eight thousand feet right eight hundred to twenty five hundred meters that's a pretty big range can we use something within the athlete's own internal physiology and or their previous experience to at altitude to potentially individualize and a live high train low camp for an individual and what what do you think that that would look like yes i think altitude training is a long-term commitment and i feel again you know like most of our knowledge is derived from you know like academic study and then academic studies

usually like involve like athletes that are not familiar with the hypoxic environment and then they are like difficulty you know like to pace the efforts and so on and then probably that's why you know like the training is not prescribed like as you would expect you know but then in terms of the athletes you know like uh they have this knowledge you know like they are exposed to hypoxia you know like during camp like several times during the year so like you know like they have less difficulty of like understanding when they're exposed to hypoxia you know like how they need to modify you know like the the race intensity you know like at a certain altitude you know like by how much they need to slow down and all these sort of things you know like so i think like with this previous learning you know like we can take this and and then make the necessary adjustments you know like so that like they are better able to you know like regulate their like training intensity while at altitude in terms of the physiology well uh the bad news is that like there is no like magic screening you know like you do a test and then it will tell us you know like this is how you're going to respond you know like and then this is what you need to do you know like uh so yeah that's the way it is but having said that you know like we can still measure things you know like we can still measure you know like the ventilation response and then like those with a strong ventilation response might tolerate better the insult of hypoxia but also we can measure simple things you know like heart rate but also like the arterial oxygen saturation with the pulse oximeter you know at the end of the finger and then you know like uh obviously like you will have the drop you know when you're exposed to hypoxia but then like you know like if you expose daily to hypoxia then like you will have a partial recovery

of the saturation so let's say you know like the first time you exposed to hypoxia at uh 2500 meters you might be like you know like in the mid 80s but then after like two weeks being exposed to hypoxia then like it will partially recover and now like you know like saturation will be sitting somewhere at the low 90s you know like so and this comes well with also the vo2 max you know that will be accurately decrease you know like when you're exposed to hypoxia but then uh after one week we'll kind of like recover uh it will never get back to the same level near sea level so this needs to be factoring when you prescribe exercise of course you know like because uh when you run at a given intensity of course the relative intensity is going to be increased you know like because of the stress of hypoxia but again you know like uh the decrement in vo2 max that two athletes will have you know like at the given altitude it's not going to be the same right like you know like so this is why you need to understand you know like uh like uh how your athletes respond so that you can make like individual adjustments you know and not something that like you will base on the group mean and from the scientific really which like for your athletes has no meaning right yeah i mean here i've always struggled with this as a practitioner uh whenever i have athletes either do a natural intervention or an artificial intervention and now that i'm recollecting on it i am typically modifying the exercise prescription way more so than the actual altitude intervention the alt and what i mean by that is the altitude intervention in terms of just as you mentioned earlier the the altitude that they're exposed to

the time that they're exposed to per day and the total duration of weeks that they're exposed that tends to be fairly standard like i might move it a little bit around the edges or if they're using a natural environment that you got what you got at that point it's the training prescription and it's mainly how much you feather the intensity and how you kind of like ramp them back up into some some semblance of a normal uh training volume that piece of it has always been more variable or more individually variable than the actual altitude prescription part of it and funny enough this is probably the part that we understand the least you know like to be able to successfully prescribe you know like an altitude training camp you're completely right you know like we know the guiding principle in terms of what we discussed for the dose but like with that in mind after like half of each athletes we modify you know like the training workout like this is really the piece that's like uh we need to to do more work on on obviously you know yeah yeah okay we're gonna move on because here's something that is definitive and i i really appreciate the way you worded this so once again i'm going to put my emphasis on it because i think it accentuates the uh the definitiveness of it so lesson number four is if oh sorry we're on lesson number three lesson number three iron deficiency impairs the erythropoietic response to altitude so that screening athletes for iron status before embarking on a live high train low camp is an absolute necessity in the last two pete the last two words there i think are

extremely impactful absolute necessity meaning you have to do some sort of blood profiling beforehand before you even take it into consideration and this is something that i don't think we appreciated as much going back to 2007 when i was first exposed to it that now it is a hard stop from a practitioner standpoint so explain explain to listeners what that means and then why we actually have this as an absolute necessity yes it's because the oxygen binds to the hemoglobin and then you're like if you don't have like sufficient iron store you know you're not going to produce like a new red blood cell and you're not going to increase like hemoglobin mass you know like as simple as that so it's been largely documented now that like if your athletes are iron deficient before they embark the camp you know like it's highly likely that they will not see the expected increase in the mobile miles as we described right like one percent for every hundred dollars of exposure you know like and the reality is that there are some population that are more vulnerable and uh endurance athletes in particular like they are very well known to have like low host of like iron and also the female athletes you know like they're like typically described as being more vulnerable um so yes we can do some blood testing like measuring the ferritin level for example in the two to three weeks before embarking in the camp and try to normalize that you know like uh depending on the time you know like if we have enough time we can do that with like oral supplement otherwise you know like you can have like blood infusion you know like uh but also

it's not enough you know like to normalize before the camp because when you're exposed to hypoxia you know like it's a stress on the body and then it let the stuff like iron will become even more important so it's also important while you're exposed to hypoxia also you know like to maintain the supplementation of of iron so it's not only before but also you know like during the actual camp you know like if you want to have this adaptation but also you know like iron is not only the hemoglobin you know like it's like affecting like so many processes in the body and that's going to affect you like the energy like availability like you know like so uh for all this reason you know like we we can all agree that like you know like you need to double check your like store before you embark on the camp but also while you're in the camp you know like the question that we don't really know now is like what's the best way to to do that you know like do you need to do that like with a single dose with a split dose you know like every day every second day you know like this is where like i guess like we need to get more answer from from the science but the general principle is quite clear right like if you don't have like a sufficient iron store level you're not going to benefit you know like from a physical point of view you're like you're not going to get the adaptation that you're expecting to tease a future podcast which i've been known to do on this podcast i actually have a episode queued up on iron supplementation in the preparation for that one of the one of the things that is abundantly clear both the preparation for that and the just experience with my athletes to your point is

extremely tricky in terms of what type of supplemental pattern and strategy to actually use we're going to table that for another day i want to get back to an important point on here which is or kind of the cutoffs and uh most most athletes who are familiar in this area will will be familiar that there's been a ferritin level serum ferritin level that's been thrown thrown around within the practitioner community and the scientific community as to which if you can eclipse it then you might be a good candidate for an altitude intervention if you can eclipse it once again it's absolutely necessary so don't even start and i wanted to get your opinion and maybe some dialogue around this since there are varying numbers from different practitioners that i've seen throughout the years and it's uh 20 it's 20 for the females and 30 for the males is what you propose in the paper and there's i wouldn't say i wouldn't say it's a heated debate about it or whatever but there are coaches out there who regularly use altitude enough that have a little bit of a different threshold and so i wanted to get your perspective on that in terms of how like we recognize it as an absolute must to go into an altitude intervention camp but how hard should that line actually be yeah that's a good question you know like uh we always need to be careful you know like with like fixed threshold you know like once again yeah i i feel like you know like it just depends on the context you know like you know like what i actually your actual

value you know like it's really low like it's close to be stressful you know like to know like you know like how much supplementation you need to consider you know like it depends you know like what will be the like stimulus as well you know like uh it depends on so many factors so i don't know like yes we have to put some some value again you know like kind of like guiding principle but again like everybody is different you know like so i think like one important take on message is that like you need to to try things you know like how you're gonna respond you know like and like if you didn't respond well then like maybe we we need to have like higher dose you know like and and you need to see if you get some side effect as well you know like so it's kind of like always balancing things out right so you know like to to get adaptation that you want but not the drawbacks so yes we put those number but you know like once again i think yeah everywhere is different so yeah you need to to pilot what's the the good dose for you know that you're gonna tolerate and benefit from yeah i i hate i always i always hate to try to back people into corners with like these yes and no answers so let me clarify a little bit with just what what i do and i and this is particularly for the females i think that the male cut off 30 they're a good candidate they're training well and everything else is in line great we'll go ahead and see if this is good at an invention but for the females i use between 25 and 30 and then i like to have a reasonable training history leading into it and the reason i the reason i say that there's a reasonable training history is i still have to look at the value proposition of how much can you potentially improve with altitude stimulus

we're going to take something off the table and that's lesson four that we're going to get into in a second and is that in the correct balance meaning what we could take off the table just by leaving everything alone do you still have a lot to gain from that and if the answer to that is yes then it's like okay let's just keep training but the answer to it is no you're starting to get to this maximum limit of you know potential adaptation that you could which is really hard to do to be honest with you then and you cleared the blood values that's when i consider somebody a good uh a good candidate so i would always i would always add that yes the iron deficiency piece of it is an initial hurdle to go over but then i also look at it from a training perspective as how much can you potentially gain from the camp versus how could you how much could you potentially gain just from continuing to train that's very true and you know like a number is like you can only interpret this number if you have the whole context right you know like so like a number on its own like he has no meaning you know like so you're perfectly right you need to get the whole training history to see if this update is kind of like chronically like you know like low in value or like if just something happened and try to understand what that might be the case so i think the best is just that you have the holistic view so that you can really understand you're like what's going on with these athletes and how much you can you know like intervene yeah okay lesson lesson four if performance is the key outcome training load meaning volume and intensity

must be monitored and adjusted accordingly before during and after the live high train low intervention sounds like a lot of sounds like a lot of caveats you're training that you're changing the training what what does this last 25 years of experience tell us and i want to get a little bit more specific about this in terms of what specifically we should be changing is it both the volume and intensity at the same time or is one more important than the other or is that different at those three points the before during and then the after piece yes uh so when you embark in the training camp you know like you want to make sure that your athletes are well rested you know like there is no accumulated fatigue and so on so like you need to have like a kind of a taper before you embark into the camp otherwise you know like being exposed to hypoxia is an additional stress you know like additional to the training you know and another layer of complexity that you need to carefully manage you know like in order to to cope well with the stress of of the environment you know like um so the first point i would like to make i guess in terms of intensity is that um uh actually like you can maintain intensity you know like being exposed to hypoxia you know like it's just like you know like uh up to like 60 seconds effort you know like the performance you know like if you do an allowed effort will not be any different you know at normoxia and up to like quite severe hypoxia you know like it's just because you know like

the glycolytic contribution is going to increase so that you are able to maintain your output you know like so what you would need to do like when you start to repeat this effort or if you need to extend you know like this workout duration uh it's just to modify the nature of the of the workouts you know like you may want to increase the recovery uh but you might not need to change the actual intensity you know like you can maintain the actual intensity for like a shorter duration up to 60 seconds or up to like i would say like 600 meters race pace you know like for middle distance uh even you know like in terms of of the volume you know like because you need to manage the like all the side effects of you know like you might not be sleeping well you know like you might be more dehydrated and so on so creates more stress on the body so like usually like there's a requirement to reduce the the volume you like of the training especially in the first week until you see that your athlete is coping well with with the stress and then like it can be somewhere between like 10 to 20 percent ish i would say like you know like this is what we normally do like you know like again that's big that's big that's big and worth going over 10 to 20 percent volume reduction in the first week of an altitude exposure it's big but you know like at the beginning uh when an athlete is new to the attitude training you know like we use a conservative approach you know like this is maybe why like we decrease training volume by this much but and again you're like when your athletes is familiar to to this environment you know like and then like being exposed like multiple times during the season and you

know how they're gonna respond you like then like you can like modify that and then maybe you don't need to have like a reduction of volume by 10 to 20 percent you know like but usually like the first time it's around that like you know like 10 to 20 percent and then after like uh later during the camp and after like it just depends you know like the purpose of the camp you know like if the camp is just to achieve peak performance immediately after the camp uh of course you can accumulate fatigue so um you may want to during the last week before you like descend you know like and then you copy it you may want to reduce also the training you know like acting like as a tapper but then if the competition is just kidding you know like a few weeks after you return to to sea level then i guess you can continue and maintain the higher volume than if the performance was right immediately after the camp so again it's just context dependent right like it just depends you know like uh when is the competition and and what you want to achieve and i guess in which phase of the season but i would imagine that's the the next question well i'm gonna skip forward to lesson six if you're keeping order here so if somebody's reading the paper while while we're actually going through this because i think that that's a good segue into it but i want to go back to this training load reduction because it's not immaterial right it's a material decrease in the total amount of training load and the main way that you can do that through volume you probably also need to do it through intensity especially if it's an intensified training phase but it shouldn't be lost on the athletes and the coaches that are out there listening to this

that it's probably not zero meaning you're just maintaining your normal level of training and it might be up to 20 percent that's a significant that's a significant reduction in training volume and we talk and when we talk about the potential costs and benefits of going up to altitude altitude the missing out of training needs to absolutely be taken into consideration when you're when you're even thinking about doing this in the first place yeah it's like the success of altitude training is just balancing you know like the acclimation response and then maintaining the training like quality you know like so as you say like you know like uh if you don't do some adjustments like you might induce some extra fatigue and like potentially overreaching and then like at the end of the day you know like you might not benefit but again i guess it just depends on the experience of of your athletes but then i measure that like for some sport like when i say like up to 20 percent that might look scary right yeah a hundred percent and there's a big confidence piece of that too like you go into an altitude camp and this is why i always work through these things with athletes beforehand when we're arranging this and they have to look at that and kind of be okay with a little bit of that ding it's the same thing with the heat training intervention we always take some training off of the table when we do a heat acclimation uh protocol a they have to be kind of prepared for it but b since the altitude is it really is a take it or leave it thing nobody's going to force an athlete to do an altitude training

intervention because you're talking this is like icing on top of the cake right to use a food analogy with a heat training intervention you might actually need to do that if you're going into something like bad water or western states or some hot weather event with an altitude camp even if you're going to hard rock right which is a very famous you know 100 mile race uh here in the united states it's contested at very high altitudes you don't need to do an altitude camp in advance of that your fitness can just kind of take care of the you know take care of the gig there and so when you're talking about these very real uh uh training adjustments that you need to make before and during some sometimes that actually brings it into into reality of if the intervention is going to be even worthwhile or not because you're having to take so much training load off of the table um let's skip since we're talking a little bit about kind of the orchestration and and kind of the context around taking training off off of the table let's skip to some of the timing pieces of this so this is lesson six for the people that are following along which is consideration of current training and competitive phase so where you are at in in your whole training architecture your whole periodization structure consideration of that periodization structure and the timing of the performance evaluation post intervention directly influences the outcome so basically where you're plopping this in the middle of hate to use plopping like you're you know haphazardly doing this but where you're placing this intervention within the whole

context of training is is is a big deal that's essentially the summary of this particular lesson yes and the problem that we have is that like most of knowledge again is derived from academic studies so in academic studies the participants were not necessarily trained but also they are tested with no consideration about being in a specific period of the season you're like so there are no boundaries so this is why it's difficult and then like when you work with athletes uh it's more anecdotal evidence you know like smaller group and so on so at the end of the day like you know we we don't really have like a lot of background about you know like how someone may respond differently in different phases of the season what we know is that like when you expose the same group of athletes you know like to the same training camp in uh two consecutive years for example like yes the group mean will be about the same you know like in terms of increasing hemoglobin mass but then like if you start to correlate you know like the change from year one to year two you will see that the correlation is quite weak so what it means is that like if one athlete was benefiting a lot from the first first camp like in the year one like might not be the same athletes you know like in year two that also benefit the most and actually there was some study from my colleagues here in australia the ais and they showed that probably like one third of participants you know when exposed like to the same camp two years in a row about one third will benefit like every time you know like and there might be like about 50 percent that's like my benefit like one year or the other and then like maybe

like about 20 percent that like might not benefit at all like in the year you know like so that's like complicated you know like after maybe to go back to your question i guess it just depends again what what you want to achieve like you know like are using if i train low you like to get better when you want to train and compete at altitude uh or do you want to train you're like this way you know like in the preparation phase you know like when you can accumulate more volume you know just to prepare you know like for for the season or is it that you want to use that you know like just before competition you're like so during during the season you're like so obviously depending on what you want to achieve like you might structure you know like the the intervention quite quite differently right like it might be a longer intervention if it was during the preparation phase you know like it can be like three to four weeks you know like but then if it's like in season you know like that might be much shorter you know like that might be only only two weeks right you know so again context dependent yeah and so this is what athletes and coaches are going through right so i want to do this and i want to do it in order to get some improvement immediately before race that's one context i'm going to do this intervention this altitude intervention i'm going to let a period of time elapse and then i'm going to race and the theory is is whatever adaptations that are occurring during this altitude camp that i'm doing they translate to better race performance that's that that's one theory i'm going to set that aside and come back to it second theory is is i'm going to do it way early and try six months six months before my critical race i'm going to get

some adaptation and that adaptation is going to enable better training somehow harder training more training i've got more blood red blood cells and therefore i get a more robust response from the training that comes out of the altitude camp so two very different very very very very different contexts contexts contexts the the compare and contrast is the first one is really risky to do that especially if you don't have history with an athlete going to altitude it's very risky to do to introduce a novel intervention immediately before an event because you really don't know what the adaptive curve actually looks like but the potential reward is high because there's not a lot of time between the intervention and the race so it could be quite fruitful the second one is far enough away from the race that that altitude intervention directly is not pro it's probably not going to impact the race there's six months in between right the whatever hat whatever has happened has washed out so you're waiting for a second step effect to really be the improvement that the athlete is actually getting and i have coaches and athletes ask me this all the time which flavor should i pick not that they're mutually exclusive or anything like that but sometimes logistics and time dictate that that they are they can only get like one shot at it for whatever reason and my you know my my conservative nature i kind of don't want i kind of don't want to screw it up i tend to lean towards the latter the one

that's done far in advance of a race just to almost act as like a learning lesson first and then once we have a pattern of the adaptive process then you can consider either doing both or the one that's butted up to a race from a practitioner standpoint that's what i've always leaned on now there's a whole host of things that like complicate that but whenever i've had the ideal situation workout when i know i'm going to be working with an athlete for three or four years we know we're going to kind of continue to come back to altitude as long as it's fruitful that's the one step two step process that i take the low risk thing first to make sure that we're not screwing it up and i'm laughing because i've seen people screw it up all the time the low risk piece first to see if we don't screw it up and then potentially the higher risk higher reward piece maybe year two or maybe even year three yes i would agree with with what you said and i think you know like when you implement attitude training it will be like risky and i don't know many like any that is that will kind of like implement something that you know like they didn't experience before you know just before competition as you say like you know like there's a bit of like a learning curve with that you know like you need to you know like try this out you know like well before the competition like maybe the year before so you're in the same condition you know like and then you can learn from that you know like whether like first you believe that you benefit from that you know how you felt if you needed to make some adjustments you know like and then if that's the case then okay like you can try that again until like you nail it you know like because

you don't know like you say like you use that maybe for like having competition right after the camp but then like you know like uh the decay of performance you know like and of the physiology is highly individual so we don't know you know like how you're going to respond you know like so this is something that you need to better understand before you want to to to adopt that so surely i i had this this year to kind of bring in just a very personal uh experience with it where a number of my athletes uh who were on the who were sponsored by solomon uh they have a guillemius uh he's kind of taking control of their sports science services that they're offering to their elite athletes and what one of the the component of those services was doing a high altitude camp in advance of of of some of the races and so this is a case where you have an elite athlete that has all the access in the world if i got all the time in the world to travel and things like that and one of the bigger points of consternation was we potentially would be introducing an uh an altitude intervention a novel altitude intervention to these athletes within six weeks from six if you want to kind of chronologically back it up from six weeks to two weeks in advance of their race is that the best thing for that novel intervention regardless if it's an altitude intervention or not would you do it in a novel perspective and the lens that i looked at it through the very practical lens that i looked at it through was what is their previous exposure to altitude tell me about their response and so we just dug up when did

you go to altitude when did you compete at altitude when have you lived at altitude for a period of time when have you gone up to altitude during a race because in these trail you know ultra marathons like the altitude varies greatly from one point of the course to the other using all of that as clues to a either do this or not and then b if we do end up doing it kind of like what are the guard rails or kind of how much do we want to push them what's the training adjustment that we need to go into doing it so it's a very it's a very real consideration because particularly once you have instantaneous access to it like in an elite athlete context the tendency is always yes yes i want to do this novel thing yes i want to introduce this like new wrinkle to my program to get an advantage and i think that that's a good coaches and in geese and in geese case as well a good physiologist role to say let's the answer is not an automatic yes let's kind of like look at the context surrounding it um that's very true you know like attitude training this is as much as an art that's a science you know like and then like in order to like master the art you know like then you need to have a bit of like background information to make your own informed judgment and i agree like you know like just few weeks before the actual race or competition i think it's sounds unreasonable and then usually you will pilot that like months you know like before you know like but the good thing as you say is that like you can also use attitude training to increase like the training responsiveness right so that like you

get a better training block afterwards you're like so that can be also one benefits of attitude training not only to get better during competition but then you know like to train better or harder or or whatever but also like something i like to mention is that like there is some sort of memory so now like and this is many anecdotal but like i've been talking to many like coaches and and they all tell me the same thing it's just like you know like it seems like when you like have a first phase of altitude training when you expose you know the second time or the third time you know like what happens is that you know like you seems to adapt quicker you know like so you might not need to get the same stimulus to get to the same point you're like so this is also one of the benefits of having what we call re-exposure during the year you know and not only one big block but you know like if you do that regularly It seems like, you know, like maybe because your athletes, you know, like they know better, like, you know, like how to tolerate and manage the training and so on.

It might be part of this. Like, you know, like, I don't know. But it seems like from the conversation that can get, you know, like that's happening, you know, like and that's quite interesting, right? Yeah. Well, certainly, and this is why these 10 lessons are going to take 10 hours. Certainly, there's both what I would, well, not certainly. Anecdotally, there is a physiological learning effect to your point, meaning the actual physiological response, if we were to measure every single point of it, is different with subsequent exposures. And the theme of that is it takes less dose to achieve the same response. But also, I view this through the lens of a learning effect as well. The athlete learns how to meter their efforts and how to recover better in between the exercises that they're doing or in between the training that they're doing.

They learn how to manage their life, hydrate more, rest more, things like that at altitude, the subsequent interventions. And I think that has a big impact. And I'm going to use this as a great segue back to lesson five, which is there are things that are going on in between the training, in between the week one to week four intervention that you're actually using, that you absolutely need to monitor in order to extract the most out of it and prevent that you're in and potentially prevent the negative. So lesson five is successful live high, train low implementation requires careful monitoring of sleep quality, fatigue, hydration status to avoid developing infections, illness and or overreaching overtraining states.

So that means you need to watch out for this additional fatigue to make sure that you're not robbing Peter to pay Paul or robbing Sally to pay Susie if you're a female athlete. Meaning these altitude interventions, you can screw it up during the intervention itself very quickly as if you only take one small step back. Yes. What I would like to say is that like altitude will expose your weaknesses exponentially, you know, like. So, you know, like if you're not threatening well, you know, like the training that you're exposed to, you know, like then like by supplementing that with hypoxia, it can only get worse, you know, like. So hence why, you know, like we need to nail all the basic. And I think this is probably one of the most important take on message.

Many times, you know, athletes think that like, oh, I'm going to be exposed to hypoxia. So I will surely get better. It will solve all my problems. And actually, that's just the other way around, you know, like that's just like silly, right? Then this is just the other way around. So like what you can get with hypoxia can be meaningful or even substantial, you know, like. But then like, let's be clear, you know, like if you don't have like proper preparation, you recover well, you know, like you sleep well, you know, like what's what you're going to get with hypoxia is going to be lost. You're like, and then like, you know, like you would not get any benefits from the actual training camps. And I guess that was the main take on with this message is that like, you know, like naming all the basic, it's probably more important than like what you can expect, you know, like from like additional hypoxic exposure.

So it's very important that you continue to do what you do with your athletes, like what you can measure, like regular monitoring so that you can, you know, like make the informed decision to adjust, you know, like your training, you know, like during the camp. So I cleverly rephrase this to something that you mentioned. And altitude will expose your weaknesses because of the continued stress on it. And a lot of times we think about this in a race day perspective, but it's absolutely true from a training intervention. So from a race day perspective, if you if your weakness is nutrition, altitude is just going to expose it. That nutrition issue is going to show up earlier in the race. It's going to be a bigger problem from a magnitude perspective as compared to a sea level race, because your physiology is taken up, you know, to use a layman's type of.

Your physiology is taken up by the fact that you are constantly exposed to this altitude. Well, same thing is in a training intervention. I'll give you a really, really easy example. If your weakness is sleep, right, for whatever reason, your lifestyle, your sleep habits, whatever is going on. If your weakness is sleep, you can only get seven or six hours of sleep a night. That is going to be exposed during an altitude camp and become a bigger problem. If your weakness is hydration for whatever reason, day to day, you're just not hydrated. Altitude is physiologically going to expose that because you're going to literally physiologically require more hydration at altitude as compared to sea level. So this point that you need to monitor what's going on during and put a bigger magnifying glass on it during the altitude camp itself is absolutely, I agree with you, absolutely imperative.

And coming from a practitioner's lens, again, I have pulled people out of altitude camps because of something that I was seeing, not only in the training, but also just during the day to day stuff. Their sleep was kind of crap and for a few days, they, and I just, I just pull them out to say, you know what, you're, I have a, I just have a feeling. It's a feeling at that point. And maybe there's some physiological rationale behind it with some of the monitor monitoring that we can use. I have a feeling that you're going to get sick. I don't think it's worth it. Let's just train. There's nothing wrong with that. You're just going to train anyway. Yeah, you know, that was absolutely the right decision. Okay, let's move on to seven. Live high train. And this is, um, this is really pertinent because of the devices that are out there and the ways that you can, uh, the ways that you can actually achieve pulling off an altitude camp.

Live high train, low strategies can be successfully implemented to increase red cell mass and maximum aerobic power with both natural and artificial altitude. Meaning you can use a natural altitude camp. You can literally live high, drive up the mountain, live at a higher altitude and literally drive down to do your workouts. Or you can use a tent within a room goes over your bed. There's a number of different contraptions for, and both, both of those are effective. Yes. So, um, I think like each methods, if you use natural altitude or simulated attitude, uh, pro and cons, you know, like, of course, you know, like when you go to natural altitude, it's easier to accumulate a larger number of hours.

But then, you know, like, uh, you have side effects. You need to travel to the mountain. So there's a cost associated with that. You know, like, of course he might go, he might be far away from home, you know, like for some athletes, you know, like spending like four weeks being away from the relatives, the family, you know, like that might be stressful. You know, like, uh, if you put them outside the, the environment, you know, like, uh, at natural altitude, uh, you need to take into consideration the environment, you know, like most of the time it's cold, you know, like, so that might also affect, you know, like, uh, how they cope, you know, like, and all the surroundings, you know, like, uh, because of budget restriction, then you might have to share your room, you know, like with another athletes, which like for some athletes, it might be a problem and then affect, you know, like also their wellbeing and, and sleep. Like, uh, so there are a lot of things that you need to consider, you know, like just outside, you know, like, is the stimulus really the same or not?

You know, like, I think like everything around that is even playing a much bigger, different, like, um, impact, you know, like, than just like, you know, like whether the stimulus is, is the same or, or not, you know, like, uh, so, um, yeah, I think like now with the technology, we are kind of like able to simulate an altitude and then we might need to make some small difference, you know, to try to achieve the same physical stimulus. So, you know, like if you want to simulate a real altitude of 2000 meter, we know that you may want to simulate actually a bit higher, like probably like around 2200 or 2300, you like to kind of like get the same actual physical stimulation. But again, there are so many other factors, you know, like that come into the equation, you know, like to try to decide whether like you want to go with the natural altitude or, you know, like the simulated altitude, you know, like, uh, access to resource.

So many things. Is it a, is it a reasonable, uh, synopsis that if you're using an artificial environment, you just need a little more like every, cause every time I look at this, when we compare natural to artificial environments, I try to just apply a simple summary to it. And I keep coming back to that conclusion, but I, like, I don't, I don't fully buy into it because of all of the other things that are, that are, that are kind of go on. Is, is that like just a reasonable synopsis of it or reasonable summary of the natural versus the artificial piece of it? That if you're using artificial, it just might take a little more higher for longer periods of time, both during the day and longer total camp time.

Well, the beauty of like the, like simulated altitude is that like, if you use the tent, you can stay at home, you know, like, which has so many benefits because you can still like, you know, like stay in your natural environment for training, you know, like, so it's a massive benefit. You know, you can still receive the same support, you know, like from the coach, from the nutrition, from the medical support and, and so on, you know, like, so, um, yeah, like, I think the take on message for me is that like all the surrounding, you know, like will help you to make the decision whether you want to go, you know, like with the natural or the similar attitude, right? Like, as you say, like, you know, with small adjustment, like, you know, we are able to replicate the stimulus, I guess, you know, like by spending a bit more time by making the attitude a bit higher, you know, like we are able to do that. But I think like all the other factors play a much stronger role, you know, in the decision making.

Yeah, because where this comes through from a practical perspective is, I personally have had athletes that have done what I'll call an altitude camp in a natural environment. So they're going to drive with the mountain, drive down the mountain, and they've had opportunity to have an altitude camp with simulated altitude. And going back to my earlier point that you're using previous lessons to drive the intervention going forward, like one of the things is, is you can't treat them as equal from a prescription standpoint, you have to kind of like look at the things that are around them that might enable them to tolerate more, tolerate less. And I just don't, I don't have a better, I don't, I don't have a better summary than when I'm trying to translate one to the other.

You just need a little bit more when it's artificial, yet it's harder to get because you're stuck in a room or stuck in your bed or something like that. Yeah. One of the benefits also with the simulated attitude is that you can adjust, you know, like the, the attitude, like as opposed to when you go to the mountain, right? Yeah. You're not stuck. Kind of like, yeah. Yeah. Yeah. Okay. So we'll, we'll, we'll table that and we'll go on to this. We'll go on to this next one. And I love this next one as, as a coach. And I'm going to re I'm going to rephrase it because I think it'll, it'll make a little bit more sense to the audience. The next lesson, lesson eight is, is the specific physiological adaptations. And we spent a lot of time talking about red cell mass and hemoglobin as a result of live high, train low are often more robust and repeatable than the actual performance piece of it.

And this is true with any intervention. We can always look at the physiological underpinnings. And in almost all cases, we can identify the changes in those to a greater extent than we can the changes in performance. And there was a whole host of reasons for this, but I want to get your perspective on this. We, we can see the physiological underpinnings change that may not translate to performance in every single case. Yeah. Well, otherwise it will be too simple, right? Everybody would just like come into that, you know, if it was magical. It's magic. Yeah. Well, I mean, like, I don't need to convince you that performance is way more complex than just physiology, right? Like, you know, like if it was a direct relationship, then like it would be quite simple equation, but like, that's not the case, right?

Like when you like do an intervention, you're like, you accumulate fatigue and then you need to go over that, you know, like, so hence why I guess, you know, like the performance is kind of like having an undulating nature, you know, like. Like, so, and yes, maybe the physiology is a bit more robust, but to be fair, like, you know, like I think like the physiology is not that strong, you know, like you, like the decay is really individual and depends on different factors, you know, like for the attitude training in particular, it depends on, you know, like the neosetalysis, you know, the destruction of the cell. That's quite individual. It depends on the pattern of like ventilation, how you read that, you know, like to like a normal oxygen level. And it might depend also on some neuromuscular consideration, right?

Like if you're adjusting, you know, like your running velocity and so on. So, and I think each of these three, like has a specific time course of adaptation, you know, like, so it's really hard, you know, like to pick, you know, to, to decide when will be the best time for you to, you know, like plan your performance, you know, because like it's hard, you know, like to get the three together to just kind of like, this is the sweet spot. This is the right time for you, you know, like to, to perform, you know, like, so yeah, it's quite complicated. Performance is multifactorial. I tell our coaches that all the time we can bring somebody into a lab and we can measure them eight ways from Sunday. Your VO2 max is improved here. Your power at lactate threshold is improved there, like all of these different variables. And they might just go out and perform better on race day. In fact, you hope that that's the, you hope that that's the case.

You hope that improving these physiological variables result in some meaningful performance improvement. But that being said, there's a whole host of things that go into performance that are outside of physiology. And the physiology is more or less, more or less meaningful depending upon the context of the actual race and the individual athlete. I wanted to use this particular lesson to talk about another thing that really it's touched on a little bit in the paper, but I want to bring it to light a lot more. And this is something that we recognized mainly with the first altitude camps going back to Ben Levine's, you know, versions of this, where they would literally bring in 20 people to a high altitude environment and they would all train together. And then they would go back out to their individual training locations that a lot of the performance improvements to link it back to this particular lessons that we saw were more of a byproduct of the training camp itself.

You're bringing everybody together, at least in the, a lot of the earlier contexts, you're bringing everybody together. There's this camp effect that happens on a training level that the altitude is really indifferent to. Like if you just took a magic eraser and you erase the part about, they went up to altitude, you could look at the athletes training and say, they're just training harder and they're getting a bump from the harder training. They're training with people. They're training faster. They're cajoling each other into doing more training. And that's, that could be good or bad, you know, in a training environment. But there's this very real second order effect that exists in a lot of the altitude studies that have now been recognized to where this group camp environment from a training perspective somewhat influences the way that we view the outcome of these, uh, of this particular type of training intervention.

And I wanted to get your, your like very realistic thoughts on that. Now there've been a number of different studies that have tried to isolate this, but a lot of times when we look at the research, we can't ignore the fact that the training is actually different either on an individual basis or because of the second order group effect. Yeah. I can only agree with you. Like, I mean, like, let's be honest, you know, like the, the placebo effect, like he's just like so strong, you know, like, you know, like when you have like a bunch of athletes, you know, like you change them from the natural environment, you know, like, and then they train harder, you know, like, and, uh, yeah, just, just, you know, like might explain you like why it actually get better, you know, like just outside, like any like hypoxic exposure, right. You know, like just, just this might explain. And then in the early study, of course, it's very difficult to blind people, you know, when you take it to the mountain, you cannot tell them why they're at sea level, right.

So, you know, so now with the technology, we're able somehow, you know, like to kind of conduct this type of study, you know, like, but like, you're, you're, you're, you're completely right. You know, like, you know, like the placebo effect, you know, like it's very strong in this type of study, uh, for sure. And the same would apply in like for heat stress and all this sort of like, you know, like, uh, intervention, you know, like, yeah. Yeah. Okay. We're going to, I think nine might be pretty quick in the way that I want to talk about this is mainly a personal fascination of mine. So I am a huge mixed martial arts fan, the long time listeners of this podcast will, will readily recognize that I bring in a lot of obscure analogies to that sport when there probably shouldn't be just because of my personal fascination of it. But lesson nine has a little bit to do with that in, in the fact that traditionally these types of interventions were almost exclusively reserved for the endurance sports, for the triathletes, for the cyclists, for the runners, track and field athletes, marathoners, and things like that.

But we're starting to see more and more other types of athletes use these altitude interventions. And I'm more in, in where I'm coming with this from my personal fascination is, is I watched the, uh, every before every UFC card, they have an embedded series where they follow the fighters around within their training camps. I'm starting to see it crop up more and more where they're using an altitude intervention in the several weeks before their actual, you know, like big fight or whatever. And I always think to myself, I'm like, is this really necessary? But that's neither here nor there. I wanted to get your thoughts on the expansion of this into other sports. And if there's anything we can actually learn from those other sports that we can bring back into the endurance realm where the application has been at least more traditional or more established.

Yes. Yes. I mean, like it's because I guess like, you know, like endurance sports, you know, like the performance is closely related to the VO2 max. And, you know, like we know that the increasing demograble mass might benefit demograble mass VO2 max. Sorry. So this is why I guess, you know, like athletes engage in like, you know, like, uh, endurance discipline, as you say, like, you know, like runners, cyclists and swimmers, like in particular, you know, like they're the main focus of altitude training for many, many years. But then I would say like probably like 15 years ago, you know, like when I was in Qatar, like, you know, like, uh, I organized, uh, conference that was team around, uh, team sport, you know, like actually training for team sports where we just discussed, you know, like how this field might evolve.

And like, whether like, you know, like maybe athletes that are not like, you know, endurance athletes, can they also benefit from, from altitude, you know, like, and then like, uh, we, we, we come up with the consensus that like, uh, for some athletes, you might help them during the recovery process, you know, like, and then you mentioned MMA and I'm sure that's the case, you know, like the, the team sport and the racket sport athlete as well, you know, like, uh, having a high view to max is not a decisive factor, but certainly, you know, like it doesn't hurt, you know, like you can help them to, to better recover and so on. So they can also benefit from this traditional, like, uh, like leave high, train high or leave high, train low. But then for those athletes, you know, like what we now realize is that like, uh, they are like a new method. And thanks to the technology where we can use the leave low, train high, you know, when you just live in your environment and then just a few sessions during the week, you go inside the climatic chamber or use a portable hypoxicator, and then you do, uh, like, uh, uh, interval training in hypoxia or repeated sprint training in hypoxia.

And then the idea is that like, you're not going to increase, you know, like the central adaptation because the exposure time is going to be too short, right? Like it's going to be only a few hours during the week. So of course you're not going to increase, you know, like the hemoglobin mass, but then what will happen is that like, you will postpone the fatigue at the muscle level, you know, like you might increase, you know, like the, like, uh, mitochondrial biogenesis, you know, like, and create like some specific adaptation. That will postpone the fatigue, which like for all this activity that you mentioned high intensity, like surely they will benefit from, from that, you know, like, and then I guess in the past 10 years, this is where like the research in this field is going. Is try to expand, you know, the reach for attitude training, but then like, uh, by using some innovative method that will benefit the need of, of this, uh, intermittent sport, you know, like, and then I guess this is bring us to the last point where we can also try to combine, you know, like the different, uh, methods, you know, so that we can get some central adaptation and some like, uh, peripheral adaptation for, for some activities like intermittent sport.

Okay. So you talked about the intermittent hypoxic training. We're just going to jump right in, right into it rather than satiate my own curiosity about why MMA fighters need to be using hypoxic tents or intermittent hypoxic training. And this is the last piece. And this is, this is the one that starts to get, I would say the most specific and also has the biggest potential to go awry. And I'm going to read it verbatim this time. Lesson 10 is additional hypoxic and or heat exposure in parentheses. If well managed, I love your caveat there. If well managed may boost live high, train low benefits, meaning you can get even more adaptation if you use these very specific techniques. So for first off, let's explain like what those specific techniques are kind of within the live high, train low, uh, intervention that we might be using.

And then we can get into why that actually might be of additional benefit. So I think we need to separate two types of adaptation, what we call the hematological adaptation and what we call the non-hematological adaptation. So the hematological adaptation that will be the hemoglobin mass increase that you can achieve, as we said, by spending some time at altitude. So it can be by going to the mountain, you know, like, and then spending a few weeks, the live high, train high, or as we discussed today, the live high, train low, right? When you also go down for a few sessions to better maintain the oxygen flux. This, we know that's working pretty well, as long as you like follow the principle. But then, uh, in the past, I would say like 15 years, you know, like the live low, train high methods. I'm not saying that was born 15 years ago. Like it's been used for a long time, you know, like, uh, like in Russia, you know, like, uh, like right after the second world war, you know, like they're already using that, you like for acclimatizing the pilot, you know, like, uh, so this is not new, but just thanks to the technology.

Now, like where it's like very, I would say easy, you know, like now to implement hypoxic exposure during your training session. So we could see a large development of new, like training methods by using hypoxic exposure. So of course you can do that continuously during intervals, as I mentioned, during a sprint training in hypoxia. So you just do like all outs printing, you know, like in this deprived oxygen condition, you can even do like resistance training in hypoxia, where like the expectation is that you're going to like further increase, you know, like muscle strength because you get like, uh, uh, larger, like, uh, uh, muscle mass, you know, like thanks to the stress of hypoxia at the muscle level. If again, this is well managed where you take advantage of hypoxia. So it's not that easy to implement, but we can get there, you know, like, and I guess, uh, for like the team sports, uh, then like they might benefit from like, uh, you know, like hematological and non hematological adaptation.

So maybe for them, you know, like we can combine methods to try to get the best of the two worlds, right? Like, you know, so that we can increase the hemoglobin mass, you know, like, so they like carry the oxygen better, like around the body, but also like, you know, like create some specific muscular adaptation, you know, like, so that they can better tolerate, you know, like the high burst of like power that are generated during sprint action. And, and so on. So this is where, for example, you can come up with the new method that we call the leave high trend, low and high. So it means that you do the leave high trend, low, right? Like to get the central adaptation, but also during the, let's say like two or three weeks, like training camp, you can also supplement, you know, like your training with some session where you're going to do some all out sprinting in the chamber, you know, like at maximal intensity.

And then we know that this is creating some specific muscle adaptation from the muscle biopsy study that we have been conducting. Yeah. I think it's important to say, what is the altitude that you are performing the sprint training at? It's important to clarify that when people are trying to think about, okay, I'm going to do live high, train low, that I'm also going to come back and train high for these specific sessions. Does that need to be at a specific altitude that's more or less than the living high piece? Yeah, that's a good question. Like, I guess the idea is that you try to increase the training stimulus, but you want to maintain the training cavity. So what you want is not to decrease, you know, like the power that you're going to produce during the sprint, because what if you don't get, you know, like the, like stimulation at the muscle level, you know?

So that's important that you maintain that, but then that you create like, you know, like an additional stimulus thanks to hypoxia. Yeah. So to answer your question, I think like the answer is around 3000 meter, I would say like, you know, like, which is a fraction of inspired oxygen about like 14 to 15%. You know, like, I think again, this is probably like this trade-off, you know, like to get some additional stimulation. But at the same time, you know, you preserve training quality, right? Like, yeah. Actually, like we've been doing some study where we try to play with that. And then we try to increase the hypoxia severity. Like when I say increase, we try like up to 10% oxygen, which is like, you know, 5,000 meters. So it's a very big stress for the muscle. But the drawback is that you decrease the training quality. So what we did is that we had the recovery outside the chamber, like in normoxia.

And then they just come back in, you know, like just during the sprinting at very severe hypoxia. And then again, try to recover outside the chamber, you know, to preserve the training quality. So now we're trying to play around, you know, like the best way to kind of prescribe this to maximize the stimulus again and then preserve the training quality. Yeah. So, but if we want to kind of make it relative to a traditional live high train, train low exposure, it's higher than the altitude that you are living at. So if the upper end of that altitude is 2,500 meters or 8,000 feet, it's higher than that. 3,000 meters or about 10,000 feet. That's Leadville, Colorado, right? For everybody who's training for Leadville. And then you're also manipulating the workout such that you can still achieve the same quality of the workout.

And what I mean by manipulating the workout is essentially your work to rest ratio and or the total amount of work that you are actually doing. Achieving those might actually provide additional compensation or additional adaptation when you're doing a live high train low session. However, that's not easy to orchestrate, right? Because you either have to go up to a different altitude, you have to use a chamber like my colleague Lindsey Gullich has over at the Olympic Training Center. It's one of those things that just logistically, you start to narrow down the field of people who can actually pull this thing off. And then you start to narrow down the use cases of it. It becomes something that's just so incredibly specific that it's hard for a lot of people to actually pull off, even when they do have the resources.

Yes, I wouldn't disagree with this, of course. You need more resources and more logistics to be able to successfully implement that. But then if you work with elite athletes and you have access to a training chamber at a natural altitude, like in Colorado Springs, or for example, in France, in Fort Romer, or in China or Japan, different places I've been. And you're like, yes, you can implement that. But yes, for the sprint part of the training, you need to go higher than the altitude residents, like about 3,000 to 3,500 meters, I would say. Even so, you modify the workout. I understand that. But still, you need to have a certain stimulation. So, let's talk about heat as well, because this has been something that's proposed with two flavors to it.

The first flavor is during the live high, train low intervention and using a heat exposure to achieve additional physiological adaptation. The second one is to use it in advance, or the second use case is to use it in advance of a live high, train low session to almost pre-acclimatize. I think that might be the best word for it, so that the jump up to altitude isn't as physiologically stressful. Why don't we kind of go over the use cases of this, both the during and before? And I want to hear your opinion on it, just having been in the field for so long and having written this paper. Is there a place for heat training interventions, either during or before an altitude training intervention? Or maybe even after.

Yes, I think we recently reviewed the literature to see how heat and hypoxia were combined in the studies. And then this is something that is quite new. I guess the first study just came out 20 years ago. And then after, there was nothing about combining the two stressors for about a decade. And then just in the past, I would say five to seven years, we could see an explosion of studies with about 15 studies published about how we can combine these two stressors. So as you mentioned, the first way to do that would be to do the live high, train low camp, and then also to have heat acclimation session during the actual camp. But I think we reviewed probably like a half dozen of studies, and then we didn't see any beneficial adaptation.

It means the englobin mass will not be higher when you superimpose heat. Another way to do that would be to combine heat and hypoxia in the same session. But again, studies have been doing that, didn't see any additional benefits compared to just doing hypoxic exposure alone. So yes, in the paper, we mentioned that maybe rather than to do that simultaneous exposure, so it means the two stressors at the same time, whether during the session or during the same intervention, what if we just have a concurrent approach, right? Like doing one stressor and then the other one, right? So yes, we know that when you're exposed to hypoxia, there is an MO concentration.

You know, like the plasma volume will decrease in the first week. And then we know that heat exposure has the opposite effect, right? What we can expect with heat exposure in expansion of plasma volume. So then it seems like quite logical that like, hey, maybe, you know, in order to compensate for like the MO concentration during the actual exposure, what if you're exposed to heat stress, you know, like beforehand to raise the plasma volume, so that maybe like the effect of hypoxia will be less. But as far as I know that there is no studies, you know, that have like measured that, like if it's really all true or like if it's just like hypothetical, we don't know that kind of makes sense from a physiological point of view. But like whether it's true, we don't really know. But maybe something that like we didn't mention in the paper, but that could also work well.

But again, like as far as I know, it's been verified is maybe to do an epoxic exposure intervention to increase hemoglobin mass and then after like to have a heat block for a few weeks because now we know like from studies from Carsten Lundby and his group that like, actually like if you do some heat exposure like for a few weeks and then this is a long process, you need at least five to six weeks, you can see an increase in hemoglobin mass as well. You know, like so maybe we can think about having heat exposure after the leave high trend. Just to be able to like as a retention, if you like, you like to try to like maintain, you like the increase in hemoglobin mass, you know, like and this is might be just like two to three session a week, you know, like and maybe that work well, you know, to extend, you know, like the benefits in terms of the physiology.

But again, it's very early day, you know, like and we need to run this sort of study. But as you can measure, you know, like having two intervention of this kind, you know, like it's quite demanding, logistically complex, you know, like. So I think it's coming, you know, like, but like as of today, you know, like this is just like hypothetical, but then like I can see the, you know, like the benefits at least like from physical point of view. Yeah. And here, I mean, once again, I've had athletes that have done this either deliberate, both of those flavors, excuse me, both of those flavors. So having heat exposure and then going to altitude and going to altitude and then having a chronic heat exposure afterwards, mainly just from that's where they were training, you know, and not versus having a, we're going to put you in the sauna for 10 days before going to altitude.

I actually, I actually have done that, but it's mainly from the perspective of that's the natural training flow anyway. And I have noticed, this is the anecdote for what it's worth, that those athletes handle the altitude better. Meaning if they do a heat exposure or are exposed to natural heat environment, they train in a hot weather environment. And so they get some of, some of that natural acclimatization and then they go to altitude. They somehow just handle it better versus if they didn't have that beforehand, even within the same individual, I've noticed that. And then on the retention effect, I've noticed that as well. We go to altitude, they come back down to sea level and the sea level just happens to be hot. They live in Florida, they live in Texas or whatever. They feel better, they perform better for a longer period of time after that altitude, after that altitude exposure.

I don't know if I would go to the extent to intentionally doing it right now, but whenever it's happened naturally, I take it, you know, I mean, it's just one of those things. It's like, if that's an additional benefit for doing the heat side of it, it's just something that, yeah, great. We'll, we'll freaking take every, everything that, everything that we can get ahold of. Mm-hmm good to hear. Yeah. For sure. Like anecdotal evidence, you know, often driving, you know, like scientific investigation. So like, that would be good to verify, you know, like with some studies, you know, like what you describe is, is surely true. Yeah. Okay. So let's kind of come back to the beginning, which I think is, is the general value proposition, as well as the guardrails of a live high, train low intervention that can be effective for a majority of people, or at least, at least some people, I don't even know if we could say the majority or not.

If we want to kind of bring it back to the beginning and summarize it in just a couple of minutes, what are some key features of this live high, of a live high, train low camp that people can implement if they want to try one of these strategies? Yes. Yes. So one of them is just to make sure that you're well prepared, you know, like, so like, as we discussed, you know, like you need to make sure that like, you're not like, overtrained before you embark on the camp that like, all your like, are installed level at the level that like, will you consider normal for, for your athletes that like, you have an idea of what's going to happen, you know, like ideally you pilot that before, you know, like, so you already have experience of like, uh, the training camps.

So, you know, what will be like the stress on the body. So, you know, how to manage the basic, you know, like in terms of like sleep, hydration, nutrition, and, and so on. And then most importantly, like the training component, as we discussed, that's really the part that like, you know, like we love the most effect to dictate whether or not, like the camp is, is successful, you know, like, so knowing how you can adjust your workout, like that's, that's important. And, uh, if this is well managed after like, let's talk about the physiology. So the physiology, we said that we need to hit the sweet spot that for most athletes will be between 800 meters to 2,500 meters in terms of the severity of altitude. Lower than that, you might not hit the threshold. So you might not get like the EPO secretion and the increasing the hemoglobin mass.

Higher than that, like, as we say, like you might have some drawback in terms of like, you know, like how you cope with the altitude and then how you're going to recover. And then manage all the sites, you know, uh, what's happening during the camp, um, in terms of like the time that you need to spend, uh, it depends if it's done during the early phase of the season, or if something that is done like, you know, like, uh, as a re-exposure during the season, but we know that like less than two weeks, it's quite unlikely that like you might get any like hematological adaptation, you know, like, so ideally like you would like to spend about three weeks and then maybe up to four weeks, if it's to be done during the pre-season. If you're exposed to natural altitude, it's way easier to accumulate hours, you know, like, because you're going to spend most of your time, you know, in this environment.

But then if you were to do that at home in your natural environment, using a tent, you know, like, or like an altitude hotel, you may want to spend 12 to 14 hours, you know, like, uh, at least I would say, you know, like, so yes, less than 200 hours of altitude exposure. Like you might not get any meaningful gain in terms of hemoglobin mass, you know, like it would be in the noise, you know, like, so like what you really expect, you know, like in terms of the physiology is somewhere between three to seven percent of hemoglobin mass increase, you know, like if it's done according to the principle I just described now. And again, um, after like, you might adjust, you know, like the content of stream based on like what's happening next, you know, like whether like you're going to compete immediately after the camp, or if it's just like to build your training base, like your training responsiveness, then that's a different story. You can manage the fatigue after the camp, you know, and let's be worried about, you know, like the fatigue accumulated during the camp, you know, like, um, so I think these are some of the important principle that's like, uh, you need to consider, right? Like when you embark in the high training methodology.

I think that that's a great synopsis before, during, after, and then during you have these particular guide rails, that's going to hit the bell curve of people that are thinking about doing an intervention like this. And it's reasonable that they get some adaptation from it, as long as those are managed correctly. There's a whole lot of additional detail, but those basics, I think we can, they can provide a really good platform for a lot of athletes. Oliver, this has been great. I hope the listeners got a lot from it. I got a lot from it as well, as well as it reconjured a lot of the practice that, uh, we were currently doing. And, uh, I guess, reinforced a lot of the practice that we currently are doing in this space. I'm going to leave a link in the show notes to the paper. It's open access to an international journal of sports physiology and performance, but outside of the link that I leave in the show notes, how can they learn a little bit more about you and your research or altitude in general?

Yes. Uh, so they can always, uh, visit my website. So the website is pretty simple. It's triple W like an Olivier Girard, like one world.com, you know, like, so on my website, uh, you can find like, you know, like my background in terms of like education, like, you know, where, like, you know, have been working. And then also you can find all the publication. It's kind of an online CV where you also have some picture about, you know, like all the different experimentation that we have been conducted and so on. And then from that website, you can find my Twitter handle and also my email address. So like, if you have some question or if you like to connect, then like, feel free to do so. That was perfect. I will leave a link in the show notes to that website as well. Oliver, thanks for coming on the podcast and thanks for this fantastic paper. I think it's a great resource for both athletes and coaches alike and elite and normal athletes alike that are thinking about choosing to do a live high, train low intervention. Thanks Jason.

All right, folks, there you have it. There you go. Much thanks to Oliver for coming on the podcast today. And I hope at the end of this podcast, you listeners out there that are thinking about using a live high, train low intervention or any type of altitude intervention for your training. I hope that you come away with this podcast with some parameters and guardrails for how to actually implement that. Because as we went through throughout the course of this podcast, there are ways that you can do it where it can be efficacious and advantageous to your training. But there are also ways that you can screw it up and hopefully you have enough information to land in the former category and not the latter.

In the show notes, you will find links to the open access paper that we used as the framework for this discussion, as well as a link to Oliver's website. And if you want to satiate your research curiosity even more, how about I suggest that you become a subscriber to my new research newsletter, Research Essentials for Ultra Running. For only $9.99 a month, you can get access to three papers that are crack expert team review that are that is specific to ultra marathon. We put these research papers through the ringer through the ringer and come up with practical ways that you can implement this research in your day to day training that is written in everyday English. I don't need to tell you that sometimes reading through research can be confusing and often conflicting. And we try to sift through all of that with expert analysis and plain English that is delivered in a visually pleasing format as well, that you can get every single month just by subscribing. You can go to my website and find that I will leave a link to that subscription in the show notes as well. It's a product that I am really proud of and one that is resonating with a lot of coaches and athletes out there. So if you are not a subscriber, go and check it out this month. We just happen to have a really cool paper that we reviewed on ketones and their effect on cognitive function specifically during an ultra marathon, which I

know a lot of you guys are curious about. All right, folks, that is it for today. And as always, we will see you out on the trails.