I visited Beech Mountain, North Carolina, on a family trip this past weekend. The mountain scenery was a refreshing change from city life in Atlanta --- and so was the altitude. Beech Mountain is 5,500 feet above sea level, compared to 370 in Atlanta.

During my morning run, I wondered if my mountain stay could work as altitude training for runners. I am running a summer marathon this year. Could I reap benefits from a stay at altitude before the race? If so, how would I construct such a trip?

High Altitude Training Benefits for Runners

Many world-class runners live at altitude: Kenyans in the Rift Valley (6,000 ft above sea level) and top American marathoners in Flagstaff, AZ (6,900 feet), Mammoth, CA (7,881) and Colorado Springs, CO (6,000 feet).

The purpose of altitude training is to stimulate favorable endurance adaptations in your blood. At higher elevations, the air is thinner, and less air resistance is favorable to runners, sprinters, jumpers, cyclists, and baseball players smashing home runs at Mile High Stadium. But thinner air also means less atmospheric oxygen, challenging endurance athletes that rely on high oxygen consumption. Your body compensates by producing more red blood cells in response to lower oxygen levels. The kidney-produced hormone EPO (erythropoietin) is the mechanism that signals your body to make more red blood cells. Red blood cells carry oxygen from your lungs to your muscles. More red blood cells help offset the shortage of oxygen in the air.

Clinical Research Evidence

I sleuthed leading running, science, and high-altitude training sites to answer my questions. One of my favorites is this scientific paper on Altitude Training for Sea-Level Competition. I summarized my key insights below.

• How High Up Should You Go?

The article cites two research studies. The first demonstrated no increase in red blood cells for a 4-week stay at 5,700 feet above sea level. It seems the idea elevation must be higher but is capped, as indicated in the second study, around 9,800 feet due to side effects from altitude sickness. The Rift Valley of Kenya and the popular stopping grounds of American marathoners are empirically in the elevation sweet spot.

• How Long Should You Stay?

Ideally, you would live at altitude to reap the most significant benefits; however, that is not always practical with life. The article cites evidence that EPO (erythropoietin) increases on the first day of altitude exposure through two weeks. It then declines, returning to baseline levels after four weeks. Therefore, a three to four-week altitude stay would reap the greatest benefit, but a one to two-week stay is also beneficial. 

• How To Train?

How to train is my favorite section of the article as a former engineer. Check out the below summary graph:

The articles cite a study that tested three training methods:

1. Live at low altitude and Train at low altitudes (e.g., live in Atlanta and train in Atlanta)
2. Live at high altitude and Train at high altitudes (e.g., live in Flagstaff and train in Flagstaff)
3. Live at high altitude and Train at low altitudes (e.g., live in Flagstaff and drive to a lower elevation for workouts)

All groups performed a 5K time trial test at sea level in Dallas, TX (week 2 data points). The groups continued training and tested at sea level (week 6 data points) to mark the baseline before heading to elevation. For the next four weeks, the groups split based on their training method, with two groups proceeding to altitude. After altitude exposure, the groups tested three more times.

Compared to the low/low control group, the live high/train high group improved 5K times an additional 2-3%. The live high/train low group improved by 3-5%. (Note that the control group performed worse in the final tests. The study attributes the difference to heat acclimatization. The tests were performed in hot, humid Dallas, while the training camps were held in cool, dry conditions for the low/low and altitude groups. Consequently, the study compares times versus the low/low control group.)

Living at elevation but driving to a lower elevation for training seems the best method. You reap the blood adaptations from living and sleeping at elevation but can maintain quality workouts by training at lower elevations with higher atmospheric oxygen.

• How Long Do Benefits Last?

Referring back to the chart, we see that 5K improves continued to improve three weeks after returning from elevation. Unfortunately, no studies that have studied longer than three weeks seem to exist. The articles make an estimate based on the understanding of physiology.

“If we assume the increase in mass of red blood cells is the main factor accounting for increased performance and that production of red cells returns to normal soon after return from altitude, the effect should last the lifetime of the cells. The lifetime is about four months in the average adult, but apparently only 2-3 months in athletes training hard (reviewed by Szygula, 1990, but he does not cite accessible references). So we expect the benefits to begin to wane by the end of the second month after altitude exposure, and to have disappeared completely after three or four months. Studies in which athletes have received infusions of extra red cells provide indirect evidence for and against this estimate. In one study, the infusions produced an enhancement of endurance performance that had returned to baseline after 16 weeks, although maximum oxygen uptake remained high (Buick et al., 1980).  In another study, published only as an abstract, maximum oxygen uptake and performance had returned to normal after four weeks (Goforth et al., 1982).

Will My Plan Work?

Beech Mountain, North Carolina, seems too low of elevation based on the 5,700 feet elevation minimum threshold. It’s close, though. Sadly, Beech Mountain is the highest-elevation town on the East Coast. Even the East Coast-based running team ZAP Endurance in nearby Blowing Rock, NC, heads out West for a proper altitude camp of +6,000 feet. My best option is visiting one of many +6,000 feet places in the West.

The ideal duration is 3 to 4 weeks. I don’t have that vacation flexibility with work and family, so that’s not an option. A one-week trip would reap some (albeit more limited).

Net altitude camp is not likely in my future anytime soon. However, I am discovering similarly beneficial endurance adaptations from training in heat and humidity. Atlanta has a lot of that! More to come…

 -George

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