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Dra. Carmen Calderón Soto. Sport Medicine Unit
CAR Sierra Nevada. CSD. 2018-Nov.
Spanish High Altitude Training
CAR Sierra Nevada
� C.S.D.
� Sierra Nevada (Granada)
� 2320 m
� Founded1992
� 31 km Granada
� SL: 70 km
� Altitude training possibilities
* LHTH * LLTH
* LHTL * HiHiLow
CAR Sierra Nevada- Structure
Subdirector
Science Department
Biomechanicsand sport
performance
Sport Medicine and Physiology
Sport medicine Nurses Physiotherapy
AdministrationMarketing and
customer service department
General Services
WHY ALTITUDE?
Sports mountain
Alpinism
Altitude training
Sport performance
Health and
quality of life
Stimulus (hypoxia)
Acute respond
Adaptation
(chronic)
ALTITUDE TRAINING
Where?
When?
How?
How long?
Any risk?
Altitude levels
Altitude
HYPOXIA
Presión atmosférica
760
674.1
526462.5
405.4
236.3
596.3
354.2308.3
267.4
0
100
200
300
400
500
600
700
800
0 1000 2000 3000 4000 5000 6000 7000 8000 8848
Altitud
Pre
sión
(m
m H
g)
02/10/2018 – Pat: 588 mmHg – PiO 2: 123 – 16.2% O2
08/11
GR
SN
ALTITUDE TRAINING
� Increasing of red cells and hemoglobin
� Improvement in the capillary process of muscles
� Improvement of the muscle enzymatic activity
� Ventilation improvement
� Buffer capacity
� Higher Intensity in short term events
� Environmental conditions (temperature & humidity)
� The body is training even whilst resting (faster adaptation)
� Positive psychological and social atmosphere
� Adding new stimuli to training.
� …
Risk of altitude training• Environmental factors
• Overload
• Slower recovery – More fatigue
• Dehydration
• Nutritional deficits
• Sleep disorders
• Medical assistance difficulties
• ....
Altitude patology
AMS
Lower performanceRisk of accidents and sicknessWeight lostDe-trainingOvertrainingBiomechanical aspects
AIM
Health control
Functional recovery
I.-Sport Medicine and PhysiotherapyI.-Sport Medicine
and Physiotherapy
Check up
Medical test (EKG, esp…)
First treatment
Physical therapy
Manual therapy
……
III.-Anthropometry and Nutrition
III.-Anthropometry and Nutrition
IV.-PhysiologyIV.-Physiology
AIM
Body composition
Nutritional assessment
Weight control
Body measurements
Somatotype
Nutritional survey
Diet and ergogenic aids
……
AIM
Functional assessment
Control training
Stress test
(VO2max, ventilatory and
metabolic threshold)
Field test
Specific protocols
……
II.-Analysis and Laboratory
II.-Analysis and Laboratory
AIM
Clinical diagnosis
Control training
Hematology/biochemical
Urine test
CK and urea
Lactate
Specific test
……
Sport Medicine Unit
PerformanceHealth
Physiology and Sport Medicine Tests
Physiology and Sport Medicine Tests
Biomechanics and sport performance analysis
Biomechanics Tests
Health control
1.-Sport Medicine1.-Sport Medicine
Some experiences- CAR SN
� Clinical symptomatology during and stage Hi vs Lo
� AMS
Periodo altura (3 sem.) Hi Lo Total pSíntomas n % n % n %Generales 5 17,24 2 18,18 7 17,5 1Respiratorios 10 34,48 3 27,27 13 32,5 1Digestivos 5 17,24 2 18,18 7 17,5 1Cardiovasculares 0 0 0 0 0 0 -Musculoesqueléticos 8 27,59 0 0 8 20 0,08Alteraciones estado ánimo 4 13,79 0 0 4 10 0,56
% subjects
LL1 - headache 89.65
LL2 - GI symptoms 72.41
LL3 - fatigue / weakness 93.10
LL4 - dizziness 68.96
LL5 - difficulty sleeping 82.76
LL score 100
2,01*1,81
1,45
1,03
0
0,5
1
1,5
2
2,5
semana1 semana2 semana3 semana4
LLscore
• O2 saturation
• Ventilatory response
• Diuresis
• Headache
• GI Disorders
• Excessive fatigue
• Insomnia
• Dyspnea
Lake Louis score
Always keep in mindHighlight guidelines and recommendations
AMS symptomsAMS symptoms
Health Control / acclimatization process
n Med. Min. Max.
1200 13 96.5 95 98
2300 13 93.5 92 94
3600 13 90.5 88 92
4100 9 86.5 81 89
4850 13 86 77 89
5750 12 78.5 65 82
6400 4 71 71 79
7100 4 65 59 65
• Analytical test– When?
• Before (3-4 w)
• At the beginning and the end
• Always if pathology or drop in performance
– Parameters
• Hematology: Hb, Htc, leukocytes …..Hb mass
• Iron and reserves (ferritin)
• Hormones, EPO, vitamins…
• Control training: ck, urea
• Specific parameters..
Men Women
HB HTC Ferritin HB HTC Ferritin
Average 16,0 46,6 150,1 14,4 42,5 58,9
Std 1,1 2,7 127,5 0,83 2,1 35,1
Min 13,5 41,5 32,8 12,5 38,4 10,5
Max 18,5 55,7 669,4 16,2 47,3 140,1
2.-Laboratory2.-Laboratory
• Analytical testEvolución Hb
7,00
9,00
11,00
13,00
15,00
17,00
19,00
Hb
(mg/
dl)
Sujeto 1 14,00 12,70 13,90 14,30 12,60 12,40 13,60 12,70 13,80 14,20 14,20
Sujeto 2 16,20 14,70 15,10 15,90 15,60 14,00 16,40 15,00 13,40 16,10 16,10
5-12-07 23-6-08 29-8-08 29-12-08 20-6-09 10-8-09 6-12-09 24-6-10 6-8-10 11-12-10 23-2-11
Take into account-range-stability and variability (sport and athlete)-training season and microcycle-length of the stage-previous training-clinical status…
Fig. 6. Time course of percent changes in total hemoglobin mass (tHbmass) from pre-training (PRE) to week three or four (W1 to W3/W4) during the training camp. Symbols and error bars show mean and (+ or -) SD. Differences (P < 0.05) among groups are: Hi-HiLo vs. Hi-Hi (+) and Hi-Hi3 (), and Hi-Hi vs. Lo-Lo ().
Hb mass
1170
550
740700
139
373
221321
235297 219
389457
617637
0
150
300
450
600
750
900
1050
1200
D P D P D P D PC
K (
U/l)
Ck and urea capilar
Control training
Depending on season and microcycles
Sport profiles
Quantifying training /adapting loads
Depending on season and microcycles
Sport profiles
Quantifying training /adapting loads
3.-Anthropometry and nutrition
3.-Anthropometry and nutritionWeight control and
corporal composition
3.-Anthropometry and nutrition
3.-Anthropometry and nutrition
Peso4Peso3Peso2Peso
Med
ia
61,2
61,0
60,8
60,6
60,4
60,2
*†
*
†
BCM-kg4BCM-kg3BCM-kg2BCM-kg
Med
ia
30,5
30,0
29,5
29,0
28,5
28,0
27,5
* † ‡
* § ||
† §‡ ||
Total Weight (kg) BCM (kg)
TBW (L)
TBW-L4TBW-L3TBW-L2TBW-L
Med
ia
37,5
37,0
36,5
36,0
35,5
35,0
* † ‡
* § ||
† §
‡ ||
BIVA
Weight – FFM - TBW
Sport nutrition
IN ALTITUDE TAKE SPECIAL CARE OF
HYDRATIONANTIOXIDANT DIET QUALITY
MICRONUTRIENTS INTAKE: Fe, mineral salts…Nitrate ingestion
MACRONUTRIENTS (proteins and CH)TOTAL AMOUNT
……….and cooking
Modification of traditional recipes adapted to alti tude and nutritional requirements
Functional test (laboratory / Field)
• Health assessment (CV response)
• Quantification of specific physical condition
• Determination of training loads and recovery
• Changes and modifications (training, tto, acclimatization ....)
Intensityparameters
Indirect parameters
VO2
RPE
HR
LAc
4.-Physiology4.-Physiology
181
58
150164
169180
120
109109
127
4.0
9.08
2.42
12
6.6
2.672.22.29
1.91
11.5
50
70
90
110
130
150
170
190
210
Reposo 7 9 11 13 15 17 19 R3 R5
FC
0
2
4
6
8
10
12
14
La
cta
to
FC
Lactato
PE en TR incremental discontinua, escalones 3 min. Determinación umbrales método metabólico
VT1 VT2VT1 VT2
Prueba incremental máxima continua en TR. Determinación de umbrales método ventilatorio
-Specificity-Objective-Test Conditions-Altitude
-Specificity-Objective-Test Conditions-Altitude
Roller stress test
Heart Rate Variability
4.-Physiology4.-Physiology
C Calderón-Soto 1, AJ Morales 3, FA Rodríguez 2, X Iglesias 2, B Feriche 3, J Vázquez 2, L Rodríguez-Zamora 2, A Barrero 2, E Hynynen 4.
1: CAR Sierra Nevada, Granada (Spain), 2: INEFC, University of Barcelona (Spain), 3: FCAFD, University of Granada (Spain), 4:KIHU Research Institute for Olympic Sports, Jyväskylä (Finland).
HEART RATE VARIABILITY AND ACUTE MOUNTAIN SICKNESS DURING THE ACCLIMATIZATION PERIOD OF ALTITUDE TRAIN ING
CAMP IN ELITE SWIMMERS
All subjects experienced AMS symptoms with a medium score of 2.7± 2.3.Highest score was on day-1 (3.8 ± 2.6) while lowest was on 7th (1.1 ± 1.1).
Mean heart rate showed differences throughout the week (p<0.05) withmaximum values on day-3.
C Calderón-Soto 1, AJ Morales 3, FA Rodríguez 2, X Iglesias 2, B Feriche 3, J Vázquez 2, L Rodríguez-Zamora 2, A Barrero 2, E Hynynen 4.
1: CAR Sierra Nevada, Granada (Spain), 2: INEFC, University of Barcelona (Spain), 3: FCAFD, University of Granada (Spain), 4:KIHU Research Institute for Olympic Sports, Jyväskylä (Finland).
HEART RATE VARIABILITY AND ACUTE MOUNTAIN SICKNESS DURING THE ACCLIMATIZATION PERIOD OF ALTITUDE TRAIN ING
CAMP IN ELITE SWIMMERS
Absolute relaxation index and total power decreased up to day 3 whileno significance difference was found in RMSSD, LF/HFratio, HFnormalized and LF normalized.
Worst results for AMS were on day-1, and CV variables on day-3,there was not a good correlation. But HR was higher in swimmerswho experienced moderate or severe symptoms vs no/light
Future projects� New groups of athletes:
• Sport team
• Speed / strength sports
• Combat sport
� Consolidation / improvement of services:
• Increase staff workers in sport medicine
• Material resources –new equipments:
- Ultrasound
- Hb mass
• Recovery techniques
• Sport Nutrition Unit
� Enhance international contacts / relations
� Promote research in altitude training and sport physiology
� …..
Sport Users Overnights
Swimming 1670 (25,5%) 14088 (42,6%)
Handball 100 (1,5%) 791 (2,4%)
Winter sports 843 (12,9%) 2384 (7,2%)
Track and field 497 (7,6%) 2960 (9%)
Paralympics 203 (3,1%) 1463 (4,4%)
Cycling 427 (6,5%) 3335 (10,1%)
Combat sports 201 (3,1%) 1101 (3,3%)
Triathlon 180 (2,7%) 1186 (3,6%)
Rowing 215 (3,3%) 2044 (6,2%)
Mountain sports 249 (3,8%) 496 (1,5%)
…………
TOTAL 6547 33084
CAR - Statistics 2017
Statistics 2017Medial Services
Users:-Sport Medicine: 2186
2017 n
Reconocimientos médicos
Rec. médico reducido 34
Laboratorio
Hematologías 413
Reticulocitos 131
Bioquímicas 348
Bioquímica especial 669
Muestras de lactato (nº) 37
Test CK-urea 734
Urianálisis (tira de orina) 17
Fisiología del esfuerzo
Espirometrías 40
Pruebas de esfuerzo 41
Test anaeróbicos 2
Test de campo 4
Cardiologia
ECG 63
Variabilidad FC 44
Medicina deportiva
Consulta médica 627
Antropometría y Comp. corporal
Antropometrías 211
Bioimpedancia 121
TOTAL MEDICINA 3502
Fisioterapia 518
TOTAL 4020
Statistics 2017 Medial Services
25 Spanish Fed.25 Nationalities
CAR Sierra Nevada – 2320 m
• Instalaciones….
CAR Sierra Nevada – 2320 mFacilities
CAR Sierra Nevada – 2320 mFacilities
CAR Sierra Nevada – 2320 mFacilities
CAR Sierra Nevada – 2320 mFacilities
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