1. Chapter 8. Training and Performing at Moderate Altitude
Cheung SS. Advanced environmental exercise physiology

2. Role of red blood cell (erythrocyte)
Moderate altitude: M
local arterial hypoxia within the kidneys ↑secretion of erythropoietin (EPO)
↑ RBC production in marrow within the long bones
hematopoiesis: ↑ hemoglobin; Polycythemia: ↑ RBC mass
autologous blood transfusions (the reinfusion of own blood), ↑ VO2max and exercise tolerance times
confirms importance of erythrocyte levels in oxygen-carrying capacity and endurance performance
Artificial recombinant EPO (rhEPO).

3. hematoloical pathway for aerobic improvement from hypoxic exposure exposure

4. Other factors: ↑economy of movement
Andeans have ↑ Hb, but Tibetans have similar Hb to low-landers
Low correlation between changes in RBC volume and VO2max
↑economy of movement
↓ submaximal oxygen requirements of 3-10%
↑ Electron transport chain, ↓ H+ leakage through the mitochondrial membrane, ↓uncoupling protein 3 (UCP3) after training

5. Uncoupling protein

6. Other factors: ↑muscle buffer capacity
hyperventilation, attempt to maintain alveo1ar PO2 levels.
↑ removal of alveolar CO2
respiratory alkalosis (H+ + HCO3 -  H2CO3  H2O + CO2)
↑ muscle buffering capacity from ↑renal excretion of HCO3- (bicarbonate)
2-3 weeks at above 2000 m ↑ muscle buffering in trained individuals

9. Individual responses variations
Many non-responders in live high, train high
Insufficient training load?
Low association between EPO response to hypoxia and genetic markers linked to the EPO gene or its regulators
predicting individual suitability and customization of altitude training remain extremely difficult

10. Live and training in altitudes
live low, train high, has minimal ergogenic effect
Suitable for lowland athletes preparing for competitions at altitude
Live high, train high, for sea level performance remain equivocal
Live high, train low, effective
Maximize the physiological adaptation from exposure to hypoxia
minimize ↓ exercise capacity at altitude
8-10 hr/day in m, train at < 1000 m

12. Hyperoxia training Seems promising Result in higher training tolerance
Higher training load
Overtraining?
Research still equivocal

13. Practical considerations
Short-term (6-24 h) passive exposure at m required for EPO response
In LHTL, hr/day in hypoxia
At shorter durations, may require higher altitude
Decay of altitude adaptations
Some <1 week, but some maintained > 3 weeks
Periodic hypoxia boost to maintain adaptation?
How long is required to adapt for high-altitude competition?
47 hr insufficient
Arrive as early as possible, or using hypoxic facility