High Altitude Training for Better Sea Level Performance

High altitude training has become very popular among endurance athletes over the past few years. This trend has developed due to emerging evidence that chronic exposure to altitude improves overall performance at sea level. There have been multiple peer reviewed studies proving that physiologic changes which occur with high altitude training are beneficial for low altitude performance. The physiological changes that occur in response to decreased oxygen availability include increased erythropoietin response, leading to an increase in red blood cell production. These physiological changes lead to an improvement in oxygen carrying capacity and the delivery of oxygen to muscles. The ability to store iron is also increased. Even though these physiological responses appear to have beneficial effects, they can also be detrimental. Some studies have indicated a “detraining effect” associated with long term high altitude training. The low oxygen available at high altitude impairs the ability to train at high intensity, which can in turn negate the improvement in VO2 max.

Given the most recent data collection, the mantra of “Live High, Train Low” has been adapted. The idea behind this thought process is that the athlete is able to gain all of the beneficial physiological changes of training at high altitude, while still being able to train at high intensities at a lower elevation. In order to gain the highest advantage from high altitude training, a series of clinical guidelines has been published. The guidelines state that the optimal altitude at which to live and train is between 2000-2500m. Although altitudes about 2500m provide the beneficial physiologic effects previously stated, they are also associated with negative effects such as decrease in quality of sleep. The guidelines also recommend all training performed at altitude to be of low intensity, and to reserve high intensity workouts for lower altitudes. Furthermore, it is recommended that in order to maximize the benefits of altitude training, one should remain at altitude for a minimum of 21 days. Finally, it is recommended to compete either within 48-72 hours after returning to sea level or to wait approximately 14 days before competing.

Altitude training is nothing new to the elite athlete. This has been a tool used by many top athletes over the years in order to gain as much advantage as they can on the day of a competition. It is these specific guidelines which have been recently been published that give more precise strategies to optimize sea level performance. It is, however, always important to keep in mind that although the above guidelines can give both professional endurance and everyday athletes the best chance of improving their competitive performances, the response to high altitude training can vary from one individual to another.

Anna Miller, PA-S

Carly Stillman, PA-S

Red Rocks Community College Physician Assistant Program


Constantini, K., Wilhite, D. P., & Chapman, R. F. (2017). A Clinician Guide to Altitude Training for Optimal Endurance Exercise Performance at Sea Level. High Altitude Medicine & Biology. 18(2), 93-101.

Can I take my child up a 14er?

There are over fifty 14ers in Colorado. A 14er is a mountain with an elevation of at least 14,000 feet. If summited, these majestic peaks afford their climbers spectacular views of the surrounding landscape. Being that many people within Colorado – and those who come to visit – are active, a question often voiced by parents is: “Can my child hike up a 14er with me?” Unfortunately, there is no straightforward answer to this question and the simplest response is: it depends.

According to recent research, it appears that children are largely similar to adults when it comes to adapting to higher elevations. Research examined children’s short-term cardiorespiratory adaptation, incidence of acute mountain sickness, hypoxic ventilatory response, and maximal exercise capacity and found little variance between adults and children (Garlick, O’Connor, & Shubkin, 2017).

When CAN you take your child up a 14er? There are a multitude of factors that affect when and if a child can climb a 14er. For example, children develop and mature at different rates. This might affect whether your 11-year-old is able to climb a 14er, compared to someone else’s 11-year-old. Additionally, some children grow up being exposed to technical hikes and climbs, while others are not. This affects ability level and is certainly something to keep in mind (Provance, n.d.). Another factor to keep in mind is whether you’re child has an underlying condition. For example, conditions such as congenital heart disease, asthma, sickle cell anemia, an upper respiratory infection, or an ear infection can significantly increase the risk for high altitude illnesses (Garlick, O’Connor, & Shubkin, 2017, p. 6). Yet another factor is whether you live at altitude or are visiting from a lower elevation. There is a strong recommendation for those individuals traveling from a lower altitude to take some time to acclimate. Spending a night or two at an intermediate altitude is recommended. Additionally, be mindful not to overdo it when you do ascend to a higher elevation: stay hydrated and don’t overexert yourself. If you decide to climb a 14er, it is imperative that you give your body at least a few days to acclimate to the altitude (“How can I optimize my health at high altitude?”, 2016).

So, what’s the bottom line? Since it isn’t possible to place a concrete age on when it’s okay for your child to climb a 14er, it is ultimately up to you to know you’re child’s limits and to decide if such a challenging hike is right for you and them. The most important thing is to make sure that everyone remains safe.

If you do decide to set out on the challenge of hiking up a 14er, there are some things to remember in order to keep yourself and your child as safe as possible and ensure that the hike is an enjoyable experience for all (Kirkland, 2015):

  • Set out early: Summiting the peak by noon is recommended in order to avoid afternoon weather, thunderstorms, and potential lightning strikes.
  • Start slow and easy: It’s important for you to determine whether or not you’re child will be able to summit a 14er. Start with easy hikes and build up over time so that you have a good understanding of your child’s abilities.
  • Know the weather forecast: Check the weather before you set out to prevent getting stuck in a storm.
  • Clothing: Wear appropriate clothing. It is important to layer since it can be colder on top of the mountain. Additionally, it is important to wear clothing that protects you from the elements (including the sun!).
  • Protect yourself from the sun: The sun can be very strong when one is high up. It is very important to ensure that your child is adequately protected from the sun: sunscreen, clothing, etc.
  • Food and Fluids: Bring adequate nutrition and hydration.
  • Be prepared to turn around ahead of time: There are many things that could cause you to turn around. It’s very important to accept ahead of time that you might not manage to summit the peak and to accept that’s okay.
  • High altitude illness: It is incredibly important for you to know the symptoms of high altitude illness and be prepared to turn around should your child exhibit any of them. Symptoms of high altitude illness include: fussiness or irritability, refusal to eat, lack of energy, nausea and/or vomiting, dizziness, and light headedness (Provance, n.d.).


Garlick, V., O’Connor, A., & Shubkin, C. D. (2017). High-altitude illness in the pediatric population: A review of the literature on prevention and treatment. Current Opinion in Pediatrics, doi:10.1097/MOP.0000000000000519

How can I optimize my health at high altitude? (2016). Retrieved from http://www.altitudemedicine.org/optimizing-health-at-altitude/

Kirkland, E. (2015, May). Taking kids to new heights: Hiking Colorado’s “14er” mountains. Retrieved from http://www.outdoorfamiliesonline.com/hiking-colorados-14er-mountains/

Provance, A.J. (n.d.). What age can my child start hiking fourteeners? Retrieved from https://www.childrenscolorado.org/conditions-and-advice/new-and-featured-articles/sports-safety/when-can-kids-start-hiking-fourteeners/

Rianne Smeele, BSN, RN, Regis University FNP Student