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science+triathlon, Magglingen, 2013
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1
Effect of Endurance Training and Altitude Training on Hemoglobin
Mass and Sea Level Endurance Performance
Jon Peter Wehrlin, PhD
Head Endurance Group, Section for Elite Sport,
Swiss Federal Institute of Sports, Magglingen, Switzerland
Elite Sport
Swiss Federal Institute of Sport, (University of Applied Sciences), Magglingen
=> Section for Elite Sport (Collaboration with Swiss Olympic Association)
Performance diagnosis
Research & Development
2Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Teaching
- Bachelor- Master Elite Sport (Since 2008)- Coaches Education-Sport medicine education
2
Endurance Physiology Group
Severin Trösch,BSc ETH, 100%.Athletics
Beat MüllerEHSM,60%. CoachSwiss Cycling. MTB, Biathlon
Thomas SteinerPhD, 100%. XC Skiing, Triathlon
Sandra LauensteinMSc, 50%. OL,Biathlon, MTB
Kellie Prichard-Peschek, PhD,100%. Schwimming
Anna HauserMSc, 100%.PhD Student
Jon Peter WehrlinPhD, 100%.Head EndurancePhysiology Group
3Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Endurance sport: VO2max - Possible limiting factors
Oxygen transportcapacity
Lung diffusion capacity
Heart capacity
4Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Bassett DR and Howley ET. Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc. 2000; 32: 70-84.
Muscle capacity
3
Relationship between hemoglobin mass and VO2max
5Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Schmidt & Prommer Exerc Sport Scie Rev, 2010
Endurance Sport: Blood Doping…
f 30th l t th di
6Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
..can move you from 30th place to the podium…
Stray-Gundersen J, Videman T, Penttilä L, Lereim I.Abnormal hematologic profiles in elite cross-countrySkiers: blood doping or? Clin J Sports Med,
2003, 132-7
4
Switzerland Spain
Importance of the hemoglobin mass: Blood doping
USA Denmark
7Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
…..etc.
Increase in Red cell volume (Hemoglobin mass)with rhEPO Doping
8Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Lundby et al., J Physiol, 2007
5
1) Does hemoglobin mass increase with normal training?
- Training camp (Peaking and Tapering)- Training Season- Several years endurance training
Key Questions for elite endurance athletes:
- Differences: Adolescence vs adulthood- „Responder – Nonresponder“ => Talent diagnosis
2) Does Hbmass increase with altitude training (LHTL)?
- „Hypoxic dose“?- „Individual response“? (Swiss Projects)
9Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
3) Is performance after LHTL altitude training increased?
- Competitions at sea level (Swiss Projects)
Background:Classic blood parameter (hematocrit and hemoglobin)
Hematocrit (Hct; %)
Percent red blood cellsPercent red blood cells
Men ca. 45%
(Critical value men 50%)
10Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Hemoglobin (Hb; g/dl)
Mean value ca. 15g/dl /
(critical value 17g/dl)
Red color in red blood cells, Binds the oxygen
6
Background: Classical blood paramters
7
8
9
er]
Hematocrit: 44%
rs)
Hb 15g/dl
2
3
4
5
6
7Blutvolumen [Lite
Red cell vol.
Blood plasma
Blood plasma
Hematocrit: 44%
Blo
od
vo
lum
e (l
ite Hb 15g/dl
11Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
0
1
Untrained XC skier
Red cell vol.
Problem: We do not know how the absolute values are!
7
Hct 45%
Hct 43%
Hb (g/dl) and Hct (%): Effects of changes in plasma volume
Important factors:
Background: Classical blood paramters
Blo
od
volu
me
(L)
2
3
4
5
6Hct 47%
- Position: (horizontal = ↓ vs vertical = Hct ↑
- Hydratation status (low = Hct ↑; high ↓)
- Training (acute = Hct ↑; after = Hct ↓)
- Altitude: (acute = Hct ↑)
- Heat: (acute = Hct ↑; chronic↓ )
12Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
0
1
7
Effect of drinking one liter of saline solution on hematocrit value
Background:Classic blood parameter (hematocrit)
49
50
He
ma
toc
rit
(%)
40
41
42
43
44
45
46
47
48
13Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Modified after Schmidt W. et al. Int J Sports Med, 21: 133-138; 2000
Time (Minutes)
-15 -5 5 15 25 35 45 55 65 75 850
37
38
39
Before
Background:
Measurement of blood volume parameters
Hemoglobin mass:
1256 g
Red cell volume:
3520 ml
Plasma volume:
4480 ml
Blood volume:
8000 ml
14Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
8
=> Total amount of hemoglobin in g
Background:Measurement of hemoglobin mass
CO
15Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
O2
Key Questions for elite endurance athletes
1) Does hemoglobin mass increase with normal training?
- Training camp (Peaking and Tapering)- Training Season- Several years endurance training
Differences: Adolescence vs adulthood?- Differences: Adolescence vs adulthood?- „Responder – Nonresponder“ => Talent diagnosis?
16Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
9
ht)
19
20
21
22
Untrained subjects (28 +/-5 yearsTriathletes (German National Elite; 30 +/- 5 years)Runners (German National Elite; 24 +/- 6 years)Cycling (German Elite Professional Team; 27 +/- 3 years)
1) Does hemoglobin mass increase withnormal training?
mo
glo
bin
ma
ss (
g/k
g b
od
ywei
g
12
13
14
15
16
17
18
9
+ 40%
Key question:
Effect of „training“ or„talent“?
17Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Hem
0
9
10
11or„talent ?
Modified after Heinicke et al. Int J Sports Med, 2001
1) Does hemoglobin mass increase withnormal training?
Training camp
1300
1400
4 Weeks training in the heat4 Weeks training at sea level
Hem
oglo
bin
ma
ss
600
700
800
900
1000
1100
1200
4 Weeks training at sea level4 Weeks training at 1300m4 Weeks training at 1740m
18Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Modified after Gore et al., Int J Sports Med, 1997
0
500
600
10
1) Does hemoglobin mass increase withnormal training?
During a training season
Prommer: Hbmass
showed very low oscillations during a training year (<6%)
19Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Prommer et al. Med Sci Sports & Exercise, 2008
Garvican et al. measured Hb mass in 10 elite Cyclists during 2-10 months: CV was 3.3% (Range 2.4.4%)
ass
(g/
kg)
15
16
17
18
19
mas
s (g
/kg
)
15
16
17
18
19P = 0.87
1) Does hemoglobin mass increase withnormal training?
Several years of training
He
mo
glo
bin
ma
0
11
12
13
14
15
He
mo
glo
bin
m
0
11
12
13
14
15
bin
mas
s (g
)
1100
1200
1300
1400
1500
bin
mas
s (g
)
1100
1200
1300
1400
1500P = 0.29
20Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
He
mog
lob
0
700
800
900
1000
He
mog
lob
0
700
800
900
1000
2004 2007
Wehrlin, J.P., Hallén J. Marti B. Hypoxia Symposium, 2009, Chateau Lake Louise, Alberta, Canada)
11
1) Does hemoglobin mass increase with normal training?
Several years of training
21Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Observation in routine hemoglobin mass measurement: Elite athletes show no big changes in hemoglobin mass with normal training
Possible to use it as “talent identification marker” in adolesence?
1) Does hemoglobin mass increase with normal training?
22Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Wehrlin & Clénin ECSS, 2008 Steiner & Wehrlin. Med Sci Sports & Exercise, 2011
12
1) Does hemoglobin mass increase with normal training?
23Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Wehrlin & Clénin ECSS, 2008 Steiner & Wehrlin. Med Sci Sports & Exercise, 2011
1) Does hemoglobin mass increase with normal training?
24Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Wehrlin & Clénin ECSS, 2008 Steiner & Wehrlin. Med Sci Sports & Exercise, 2011
13
gh
t)
15
16
1) Does hemoglobin mass increase with normal training? Several years of training in adolesence
Controls
Hem
og
lob
in m
ass
(g/k
g b
od
ywe
ig
12
13
14
„Responder B“(low level)
25Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Age (years)
10
11
16 1716.5 18 18.5 1917.5
Wehrlin & Steiner unpubl. data
„Nonresponder“
gh
t)
15
16
1) Does hemoglobin mass increase with normal training? Several years of training in adolesence
R d A“
Athletes
Hem
og
lob
in m
ass
(g/k
g b
od
ywei
12
13
14
„Responder B“(low level)
„Responder A“(high level)
26Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Age (years)
H
10
11
16 16.5 17 17.5 18 18.5 19
Wehrlin & Steiner unpubl. data
„Nonresponder“
14
1) Does hemoglobin mass increase withnormal training?
Conclusion I:
It seems like in elite endurance athletes (age > 20 y), we observe no
substantial increase in Hbmass with normal training camps or severalsubstantial increase in Hbmass with normal training camps or several
months of endurance training. However, it is possible to increase
Hbmass moderately over several years. We do not know the reasons for
this.
Conclusion II:
In adolescent endurance athletes and controls (age between 16 and 20),
we can observe a relevant increase in hemoglobin mass However
27Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
we can observe a relevant increase in hemoglobin mass . However,
these effects seem to be individually different but are not affected by
endurance training amount.
Key Questions for elite endurance athletes
2) Does hemoglobin mass increase with altitude training (LHTL)?
28Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
15
20
22
24
26
28
30 Laitinen et al. 1995 (Abstract only; n=7Runners; LHTL; Simulated altitude: 2500m; 20-28 days; CG) Svedenhag et al. 1997 (n=7 XC-skiers; LHTH; Real altitude: 1900m; 30 days; EB)Levine et al. 1997 (n=13 Runners; LHTH; Real altitude: 2500m; 28 days; CG; EB)
Levine et al. 1997 (n=13 Runners; LHTL; Real altitude: 2500m; 28 days; CG; EB)Gore et al. 1998 (n=8 Cyclists; LHTH; Real altitude: 2690m; 31 days; CO) Rusko et al. 1999 (Abstract only; n=10 XC-Skiers/Triathletes; LHTL; Simulated altitude: 2500m; 25 days; CG; CO)
Ashenden et al. 1999b (n=7 Runners; LHTL; Simulated altitude: 2650m; 12 days; CG; CO) Ashenden et al. 1999a (n=6 Cyclists/Triathletes/XC-skiers; LHTL; Simulated altitude:3000m; 23 days; CG; CO)Dehnert et al. 2002 (n=11 Triathletes; LHTL; Real altitude: 1956m; 14 days; CG; CO) Saunders et al. 2004 (n=10 Runners; LHTL; Simulated altitude: 2000-3100m; 20 days; CG; CO) Friedmann et al. 2005 (n=16 Junior swimmers; LHTH; Real altitude: 2100-2300m; 21 days; CO) Heinicke et al. 2005 (n=10 Biathletes; LHTH; Real altitude: 2050; 21 days; CO) Brugniaux et al. 2006 (n=5; LHTL; Simulated altitude: 2500-3000m/1200m; 18 days; CG; CO)
2) Does hemoglobin mass increase with altitude training (LHTL)? Hypoxic dose?
Ch
ang
e in
Hb
mas
s /
RC
V (
%)
4
6
8
10
12
14
16
18Robach et al. 2006 (n=9 Swimmers; LHTL; Simulated altitude: 2500-3000m/1200m; 13 days; CG; CO) Robach et al. 2006 (n=6 XC-skiers; LHTL; Simulated altitude: 2500-3500m/1200m; 18 days; CG; CO)
Wehrlin & Marti 2006 (n=2 Runners; LHTL; Real altitude: 2456/1800m; 26 days; CO) Wehrlin et al. 2006 (n=10 Orienteers; LHTL; Real altitude: 2456m/1800m/1000m; 23 days; CG; CO) Neya et al. 2007 (n=10 runners; LHTL; Simulated altitude: 3000m; 29 days; CO)
Pottgiesser et al. 2008 (n=7 Cyclists; LHTH; Real altitude: 1816m; 21 days; CO)Saunders et al. 2009 (n=9 Runners; LHTL; Simulated altitude: 2860m; 46 days; CO)Wehrlin et al. 2009 (Submitted; n=7; Cross-country skiers; LHTL; Real altitude: 2590m; 21 days; CG) Clark et al. 2010 (n=12 cyclists; LHTL; Simulated altitude: 3000m) C
B
E
+ 1% per 100h at 2500m(maximum about 5-10%)
29Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Time in hypoxia (hours)
0 100 200 300 400 500 600 700 800
-4
-2
0
2
4
A D
2) Does hemoglobin mass increase with altitude training (LHTL)? Individual Response?
1080
1100
Hem
og
lob
in m
ass
(g)
900
920
940
960
980
1000
1020
1040
1060
+ 4%
Tru
th
Tru
th
30Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
0
880
Pre Altitude Post Altitude
16
2) Does hemoglobin mass increase with altitude training (LHTL)? Individual Response?
1060
1080
1100H
emo
glo
bin
mas
s (g
)
900
920
940
960
980
1000
1020
1040+ 4%
Tru
th
Tru
th
Me
as
ure
d
Me
as
ure
d
+ 0%
31Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
0
880
Pre Altitude Post Altitude
2) Does hemoglobin mass increase with altitude training (LHTL)? Individual Response?
1040
1060
1080
1100
Hem
og
lob
in m
ass
(g)
880
900
920
940
960
980
1000
1020
1040
Tru
th
Tru
th
+ 0%
32Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
0
880
Pre Altitude Post Altitude
17
2) Does hemoglobin mass increase with altitude training (LHTL)? Individual Response?
1060
1080
1100
Hem
og
lob
in m
ass
(g)
900
920
940
960
980
1000
1020
1040
Tru
th
Tru
th
+ 0%
Me
asu
red
Mea
sure
d
+ 4%
33Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
0
880
Pre Altitude Post Altitude
2) Does hemoglobin mass increase with altitude training (LHTL)? Individual Response?
1060
1080
1100
3 weeks at 1800m (St. Moritz Switzerland)
Hem
og
lob
in m
ass
(g
)
900
920
940
960
980
1000
1020
1040
Mea
sure
men
t I
Mea
sure
men
t II
Mea
sure
men
t II
Mea
sure
men
t I
+ 2.2%
34Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
0
880
900
Pre Altitude Post Altitude
18
2) Does hemoglobin mass increase with altitude training (LHTL)?
Conclusion:
Hemoglobin mass can increase with „Live high – train low“ or
Live high train high“ altitude training„Live high – train high“ altitude training
=> The effects seems to be dependent of the „hypoxic dose“
=> We recommend to spend at least 400h at an altitude of about 2500m
(2300- 2800) to reach a relevant increase of about 5% in hemoglobin mass
=> We recommend to measure the individual response with Double
35Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
=> We recommend to measure the individual response with „Double
measurements of Hbmass before and after Altitude Training Camp
Key Questions for elite endurance athletes
3) Is performance after LHTL altitude training at sea level increased?
36Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
19
3) Is performance after LHTL altitude training increased?
=> Keep in Mind:
37Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Millet et al., Sports Med, 2010 (modified after Reiss)
3) Is performance after LHTL altitude training increased?
=> Keep in Mind:
Range:+ 0.5 to + 6%
Peaking Tapering
38Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Mujica 2009
20
3) Is performance after LHTL altitude training increased?
39Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
=> In summary, natural LHTL currently provides the best protocol for enhancing endurance performance in elite and subelite athletes
Bonetti & Hopkins, Sea level Exercise performance following adaptation to Hypoxia, Sports Med, 2009
=> Statistical significance versus practical relevance?
40Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Viktor Röthlin Swiss Marathon
21
2010: 1. Place, European Championships Barcelona
41Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Live at 2307m
Train at 1800m
Train at 400m
Live at 2307m
Train at 1800m
Train at 400m
Marathon at the EuropeanChampionships
Barcelona (Spain)
Weeks
1 2 3 4 5 6 7 8 9 10 11 12
Swiss altitude project for the 2012 London Olympic games: Mountainbike
2010 Altitude Training „Best Practice“
2011 Individual Adaptations
42Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
2012 Olympic Games
22
Wo
rld
Cu
p/C
1C
ha
mb
éry
6.6
.201
0
C1
En
ge
lbe
rg ?
20
.6.2
01
0
Wo
rld
Cu
p5
./6.6
.10
?W
orl
d C
up
Ho
uff
aliz
e1.
/2.5
.20
10
Wo
rld
Cu
p O
ffen
bu
rg22
./23
.5.2
01
0
rld
Cu
p /
C1
Tar
get
II
C2
Flim
s?3
.7.2
01
0
C1
Pla
ffeie
n 3
0.5
.201
0
Swiss altitude project for the 2012 London Olympic games: Mountainbike
LHTL Bernina Hospiz
25.5 - 13.6.2010
EuropeanChampionshipsHaifa7.7. - 11.7.201023-28 days after LHTL)
Ful
l Te
st1
4.6
.20
10
Ful
l Tes
t2
5.6
.20
10
Ful
l Tes
t2
.7.2
010
Ful
l Te
st1
7.5
.20
10
W W 2
Wo
Alt
itu
de
gro
up
Weeks after LHTL
1 2 3
Tar
ge
t I T
43Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Co
ntr
ol
gro
up
Ful
l Te
st1
8.5
.20
10
Fu
ll T
est
24.
6.2
010
Ful
l Tes
t1
.7.2
010
Fu
ll T
est
15.
6.2
010
3) Is performance after LHTL altitudetraining increased?
Conclusion:
It seems that performance after „Live high – train low“ altitude training can be
more increased than it would have been with normal training. However, this isg
really hard to prove…
=> natural LHTL currently provides the best protocol for enhancing
endurance performance in elite and subelite athletes
=> However, altitude training is not a „magic bullet“, there are also risks
(overtraining, ilness etc)
44Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
( g )
23
Thank‘s for yourattention!
45Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
2013
=> United States Olympic Committee (USOC)Altit de Training S mposi m 2013 October 9th 11th
2013
46Federal Office of Sport, Magglingen, Switzerland
Jon Peter Wehrlin, PhD, Section for Elite Sport
Altitude Training Symposium, 2013, October 9th – 11th
Colorado Springs, Colorado