Category Archives: High Altitude Training & Fitness

What are the challenges and benefits of recreation and training in a high altitude environment? How does it affect your body’s physiology? What are the inherent risks?

Athletes vs. Amateurs: Observations of an Altitude Expert

Ski America is a company that has organized accommodations and itinerary for international athletes and vacationers at ski areas around Colorado since 1988. The Omori family, Ski America’s founders, lead their clients on tours of Colorado’s most renowned mountains, including Aspen (8,040 ft.), Vail (8,120 ft.), Beaver Creek (8,100 ft.), Copper (9,712 ft.), Keystone (9,280 ft.), Breckenridge (9,600 ft.) and Arapahoe Basin (10,780 ft.).

Ryoko and Jimi Omori

Jimi Omori started Ski America as a tour operator for Japanese skiers and snowboarders. Ryoko joined in 2005, and now Ski America’s service is more than tour operating, assisting from first-time skiers of age 3 to professional racers. With over 30 years of experience guiding amateur skiers and international athletes alike, the Omori’s have made some fascinating observations of how people adjust to the high altitude environment of the Rocky Mountains.

The other day, Ryoko shared some of their valuable insight and experience with me over a cup of tea:

How long do your clients typically stay at altitude?

So we have two different kinds of customers. In November until early December, we have a lot of Japanese racers from Japan. They are high school kids, college students. They stay two to four weeks here, in Frisco or Copper Mountain. Then, from December to April, we have clients from Japan who stay in Vail or Aspen. Most of them are senior skiers, over 60 years old. They stay about a week in Vail or Aspen. Six nights is very average.

How often do you get repeat customers?

Quite a lot. Not all of them come back every year, but more than once. I would say, 70%.

Do you see new customers every year?

Yes.

How do you advertise in Japan?

Word of mouth.

How do you prepare your customers for the altitude?

When I set up the reservation for them, I send them the lodging confirmation and shuttle confirmation, how to get to the Colorado Mountain Express counter at Denver International Airport. With that information, I also send how to get ready for this altitude by e-mail to every customer: Don’t stay up all night before coming over here, don’t overwork before coming here, most importantly, don’t catch a cold before coming over here. That’s the most important thing. And keep yourself hydrated on the flight and on the shuttle. You can always stop at a restroom on the way from the airport to get here. Do not drink a lot [of alcohol] on the flight, and especially on the first night staying here. I encourage them to drink two liters of water a day.

They are so excited to be here, so they tend to forget about the altitude, because there are all the trees, it’s not above the tree line here. In Japan, [this elevation] is way over the tree line. So I always remind them, “You are going to be almost [at the elevation of] Mt. Fuji. So, move slow the first and second day of staying here.”

What about conditioning, physical exercise to prepare? Are they athletic?

They’re pretty much athletic. They’re avid skiers. They ski in Japan regularly. So I do not give them any athletic advice in Japan.

Do they come straight from Denver up to elevation, or do they stay in Denver a certain amount of time?

No. The flight arrives at 12:30 or 1 pm, so it’s very convenient for them to get on the shuttle in the afternoon, and they will be here before 5 or 6.

Do they ski the next day?

Most of them, yes.

What about oxygen or medication? Do you ever tell them to bring ibuprofen or anti-nausea medication?

No. But if anything happens here, I recommend taking [something] for a headache, like Advil.

What is the earliest sign that something might be wrong or that they need medical attention?

Headache. Or sometimes nausea. We had 150 racers last November, and out of 150, I took 5 kids to the clinic for altitude sickness symptoms.

Is it at the beginning of their stay?

Very beginning. [Typically] the second day of skiing. They are okay on the first day. They do not notice anything on the first morning, so they feel, “It’s okay, let’s go skiing!” and spend the day on the mountain, and they have jet-lag, and they can’t sleep well on the second night. And on the second morning most of them notice the symptoms. Those are the Copper clients. And I have 350 guests from Japan staying in Vail and Aspen. Last year, I didn’t see anyone get sick. So it’s only in Summit County, because it’s much higher.

Do you think there are any other correlating factors, like their age or where they’re from?

Age. The racers are from middle school to college, so they’re young. Their hormone level is not stable. And they are staying with their other teammates, apart from their parents, so it could have some emotional factors affecting them, too. But at the same time, the racers have a lot of muscle that needs a lot of oxygen. The higher metabolism that younger kids have [make them] more prone to high altitude sickness. The clients who stay in Vail or Aspen, they are much older, like, 40s, 50s, 60s. And they’re not as athletic as the racers. They do not do any training. So their basic metabolism is low, so I believe they do not need as much oxygen.

Does anyone come from a high elevation in Japan, or is it mostly sea level?

Mostly sea level. Only some of them are from Nozawa, it’s about 1000 m (3,280 ft.), so it’s much lower than Denver.

Nozawa, Japan

Is there a difference between the guests that come from Nozawa and the guests that come from sea level?

No. Whenever I see the doctor in the ER, or the Copper clinic, they always say it’s dehydration. No matter how much we tell them to keep hydrated, it’s not enough.

So what does the ER or clinic often give them besides fluids?

Oxygen. And they say it’s okay to take over-the-counter headache medication.

How long is their visit to the hospital? Is it just a couple hours, or do they stay overnight?

Just a couple of hours, or less than that.

Do they ski the next day?

Most of the time, the doctors say not to ski the next day. We carry a pulse oximeter in our office. We have 20 of them. We do not do this for the Vail clients, because they don’t get altitude sickness. So we only do this for the guests staying in Summit County. When we [check them in], we distribute pulse oximeters, one per room. We encourage them to measure [their oxygen level] every morning. Then, after the doctor’s visit, the doctors say it’s okay if your oxygen level is over 90%, 20 minutes after getting off oxygen.

What’s the lowest you’ve seen the oxygen level on any of your skiers?

38. [He was] 15. He was at the ER. He was transferred to Denver by ambulance. He was there about three nights, and he went back to Japan.

Was that the only time somebody had to go back to sea level?

Yes. But it sounds like he had a heart issue, which we didn’t know [about].

Have you witnessed any other factors that help them acclimate more effectively?

I encourage them to eat carbohydrates instead of getting a lot of oily foods. If you have a lot of french fries, it’s very oily, it will take more time and blood to get to the stomach. So the blood flow doesn’t go through the brain [well].

What about caffeine or other holistic remedies?

No. We have some repeating guests who had … symptoms in past years, and we encourage them to visit a doctor in Japan [who] can prescribe … Diamox. One of the ski coaches [from Japan] … has to be here with his team. He has no choice. And he’s [had] a lot of altitude sickness in the past. So we told him, “You should see a doctor and get Diamox prescribed, and start taking it before leaving Japan,” and it’s been working great.

A young skier shreds her way down a snowy back bowl on a powder day.

Is there a routine that your clients do to prevent feeling this sickness?

Just check blood oxygen level every morning.

Of the clients that come here regularly, do they acclimate quicker each time?

They learn. We always see lower numbers of altitude sickness patients, because they learn what they need to do, like drinking a lot of water and checking their blood oxygen level. And only the numbers can tell. Even if they feel good, if the numbers are bad, if they go skiing, they will have a problem. Especially for the young kids. They [don’t] trust what you say. As the years go by, the coaches will learn, and the kids will learn what they can and what they cannot do.

Is there anything different about the philosophy of treatment in Japan vs. the US?

You know what, we do not have altitude sickness in Japan. Only if you climb up Mt. Fuji, in one day, it could happen, but not everyone does that. The highest elevation of one ski area in Japan is about 2000 m (6,561 ft.). No one has experienced high altitude sickness in Japan.

When I climbed Mt. Fuji, I saw a lot of people with cans of oxygen that you can spray. Do you ever use or recommend that?

No. I don’t think it works. If you breathe it for five minutes, it will work for five minutes. So I guess it’s very effective if a ski racer uses it right before the start [of a race]. I believe some of our Vail clients [have seen] the bottle and have purchased it, but I’ve never heard anything about it, good or bad.

Smiles and high spirits all around

In closing, I asked Ryoko if she’d noticed a change in her own physiology since living at high altitude, to which she replied that she is always impressed by her increased stamina and speed when she steps on a treadmill back at sea level. I asked her if she ever experiences symptoms upon coming back to a high altitude from sea level. “No,” she says, laughing. She doesn’t typically engage in any strenuous activity the first day or two after travelling, “because I’m lazy,” she says.  

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.

The Benedict Excursion: Testing Your Limits at Altitude

In a previous blog, I described preparing for a trip to the Benedict huts above Aspen, Colorado. After over eight hours of skinning uphill in the snow and two hours snowboarding back down, we are all back home, and I’ve finally cleaned all the pistachios and cookie crumbs out of my car. And yes, it took me eight hours to reach the hut.

I’ve been on numerous hut trips in the Colorado Rockies year after year, and it’s safe to say the trek to the Benedict huts (there are two: Fritz and Fabi) is the most challenging, mentally, physically and emotionally. The winter trail descriptions on the 10th Mountain Division Huts Association website did provide some insight into navigating the route. However, we found the descriptions of elevation gains and mileage to be quite different from the route we took: a winter trail marked by blue diamonds and arrows (a pretty standard trail marking practice).

Even following the appropriate trail markers, there is a crossroads where, looking at a map, we could see that the recommended Smugglers Mountain Road trail was significantly longer than the 10th Mountain trail we decided to take. And even after having taken the shorter route, we hiked about two miles farther than the trail directions had described. Having started at Upper Hunter Creek trailhead, we’d expected to arrive in 4.8 miles, but had long passed 6.

The trail description listed an elevation gain of 2130′, but by the time we reached the hut, we’d gained over 2300′. This isn’t a gradual incline, either. It is important for anyone setting out on this trail to know that you will be climbing the grade of a ski hill the entire way.

Our team came from the Colorado high country and San Francisco. We are all fit, athletic and experienced in various kinds of outdoor recreation. After collecting the San Francisco constituency from the Denver airport, we made a point of allowing a full day to acclimate in Frisco, Colorado, at 9000 ft. Blood oxygen levels were quite normal for people coming from sea level, averaging around 90%. Those concerned about nausea and headaches started taking Diamox, and we all made sure to drink plenty of water and prioritize sleep before setting out on the trail the following day.

By the time we arrived at the hut, it was 8 pm, and the sun had just dipped below the mountains. Sore and sunburned in spite of multiple reapplications of sunscreen, the rest of our evening was devoted to self-care, recovery, and refueling. All the food we had painstakingly carried up was certainly worth it. Our epic journey up the mountain had been fueled by nuts, energy bars, stroop waffles, chocolate chip cookies, and a lot of water. So we immediately got to work lighting up fires to melt snow for our water filtering systems and cooking a hearty sausage and tomato pasta.

Classic hut breakfast on a propane stovetop.

We were sure to feed every craving for calories, because we weren’t about to pack it all back down after what we’d just been through to get it up there. Although I’d planned to do some snowboarding, the following day was mostly dedicated to resting, eating, reading, and games. Frittata with bacon, shiitake mushrooms, manchego and peppers (and of course, pancakes) for breakfast; the aforementioned epic sandwiches for lunch, and loco moco’s for dinner. Plenty of chocolate, cookies, coffee, beer and bourbon to close the calorie gap. And constant water intake. I refused nothing.

Epic hut sandwich.

Hut trips require considerable effort, not only for the traverse and recreation outdoors while you’re in residence, but also for basic necessities. With no running water, snow must be collected in the winter to be melted over a fire you have to build, then boiled and/or poured through a filtering system. There is typically a large supply of wood for these fires on hand, but for less-maintained structures, gathering and chopping wood will also claim a lot of calories.

Recovery on a hut trip must be efficient in order for you to enjoy your time there while also preparing for the trek back out. Stretching, hydrating, feeding your cells nutrients, and sleep are what it’s all about. While the rest seem simple enough, choosing foods to replenish your supply of nutrients and treat any ailments or injuries you may have may take some more thought. As I mentioned in the previous blog on Packing for a Spring Hut Trip, the intense physical challenge of these trips requires energy your body can quickly convert from sugars and caffeine, which make chocolate and coffee easy options. For the time I can give my body to rest and recuperate, I want to feed it denser meals with better nutrient-to-calorie ratios, and this is where I look for proteins and carbohydrates that will take my body a longer time to process.

Stuffing our faces with Dr. Chris. See above for sandwich.

My body will use all these nutrients (including fats) even as I sleep as it repairs and replenishes itself. The extremity of long exposure to the elements stresses your brain as well as the rest of your body, and well-hydrated sleep is one of the best things you can do for it.

Alcohol, as you know, dehydrates the body. But a hut trip without beer and whiskey is not something I’ve ever heard of, so I make sure I continue to hydrate with plenty of water as well. The sugar from alcohol, however, may contribute to your store of energy the following day, but there is definitely a threshold where the amount of consumption contributes more to a disabling hangover. I continue to do more research on the matter.

Being so sore the first night, I was a little concerned about being able to move the rest of the trip. As much as I wanted to just lie down, I know stretching is just as vital to healing muscle mass after strenuous activity, and the combination of ample hydration, nutrient intake and stretching gave our bodies the resources to maximize the time we did spend napping and sleeping the next day. I did manage to get out on my split-board for a mini-tour around the site in the afternoon before dinner the second night, but it hadn’t snowed in the area in a while, and the snowpack was very hard after so many days of warm Spring weather.

The hut sits at the top of the mountain we ascended, so the terrain immediately around it doesn’t get much higher. The area is also pretty heavily wooded in all directions, so building a kicker to snowboard off of was out of the question. The party in the Fabi hut next door invited us to some skiing just a 3-mile hike along a ridge away, but none of us felt like adding 6 more miles to what we’d already trekked.

#activerecovery

I am glad I made a point of skiing around the hut, though. It was a great way to get my blood and breath moving around my body with fresh nutrients. One of the best parts about going on a hut trip is how efficiently it makes you spend your time. Even time lying down doing nothing is just as valuable as time exercising.

Mountain Kate

We set back out to the trailhead early Easter morning. Two nights and two unforgettable days later. We didn’t get any new snow, so those of us who weren’t on snowshoes were skiing/snowboarding down hard-pack. Con – crete. A two hour ski run sounds amazing. This was like two hours of squats. With a backpack on. So that happened.

But it sure beat the hike up! In retrospect, I’d say we packed appropriately. We might have had some extra food for the way down, but we were fortunate that the weather was sunny and warm, and that no sort of emergency required extra rations. I was almost too warm between the daytime sun, and the wood stove at night. But again, the weather could have been worse, and I would have needed every single layer I’d brought. Not mad about that. In a word, “harrowing” was mentioned more than once while on the trip. But no one had to carry any beer or bourbon back.

The high altitude research team from San Francisco.

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.

Packing for a Spring Hut Trip

Another winter has come and gone, and now Spring is in Colorado. Which means Winter will be back a couple more times before the snow all melts.

We’ve organized a team of friends from San Francisco, Denver, and Colorado high country for a backcountry excursion to one of Colorado’s 10th Mountain Division huts. The Benedict huts, our dwelling for two nights tucked into the wilderness outside of Aspen, are almost 6 miles from the trailhead, with an elevation gain of over 2000 ft. : a formidable trek, even for the experienced. And experience in wilderness trekking is one thing, but altitude is a game-changer. We will be well over 8000 ft. long before we reach the huts, so preparation for such an undertaking requires as much attention to mental, physical and physiological condition as much as clothing, gear and rations.

Weather & Conditions

This has everything to do with the weather, so it’s important to be on top of tracking all the resources available to you. At the top of my list in this region is the Colorado Avalanche Information Center. They provide up-to-date reports for high-risk areas around the state according to a comprehensive and easy-to-understand rating system. When considering this information, I always remember that our trek will take us through several types of terrain, and thus, several types of conditions: in and out of trees, varying steepness and exposure (to sun, wind, precipitation, etc.), all kinds of microclimates and environments (wetlands, scree fields).

The Colorado Avalanche Information Center provides no shortage of visuals to aid your risk assessment.

As far as incoming weather patterns are concerned, one of the most popular and reliable forecasts endorsed by people who play outside in Colorado is Open Snow. Founding meteorologist Joel Gratz updates local forecasts regularly, and provides information on what to expect with the outdoor adventurers in mind.

For our upcoming hut trip, it looks like the storm we’re expecting will be warmer and milder than recent systems, with most of it heading toward the northern mountain region. That being said, however, I’m keeping in mind that any projected weather system can be just a few degrees colder, a few inches wetter, and a few miles closer and change conditions dramatically. So let’s talk about how we can anticipate this with …

Gear & Clothing

The Commute

In any season in Colorado, there are essential comforts I always pack to get me to and from any hut that requires a hike, and to keep me happy while I’m enjoying the site. Dead of Winter, Height of Summer alike, the sun and glare is liable to be more intense than anything you’ve ever experienced at sea-level, while at the same time, the temperature and lack of humidity can cool your body significantly, night or day. Depending on how strenuous the commute is or how active you intend to be even after arriving at your destination, you may be constantly shedding, then adding, then shedding, then adding layers, so keep it all very accessible.

For this particular trek, I’ll be in snow gear. Basically anything I’d wear snowboarding: snow pants, outer shell on top, hat, gloves. I want it to be warm and waterproof on the outside. Underneath this shell, I want layers that I can strip down to as soon as I start moving and sweating with a 40 -60 lb. pack on. Unless the storm turns out to be much more intense (in which case, I’ll keep the outer layers on), I expect my skin to be steaming, so I won’t want to be in much more than warm compression tights, a t-shirt, and a light pullover. Your outer shell is for blizzards and water-proofing, so whatever you are stripping down to should be significantly lighter. Also, sunglasses or goggles. The glare from snow is significant. I bring both, because goggles get way too hot while I’m trekking uphill.

Here’s the tricky part: What are you going to wear on your feet? This is where the weather forecast comes in. This time of year, after such a snowy winter, I’m expecting most of the trail to be covered in snow, and the storm moving in is likely to bring more. I will be scoping out the trail pre-storm, which will give me a much better idea of what to expect, but I’m preparing to have snowshoes or a split-board and skins strapped to my snowboard boots. Of course, skis with skins are another alternative. There is a very slim chance most of the snow on the trail will be melted down, in which case I would probably opt for waterproof boots instead, which I would expect to get pretty muddy.

Avalanche Gear

Whether it’s on the commute or while you explore terrain around the hut during your stay, there are some essentials you can pack for the worst-case scenario. I’ve gone into more detail in a previous blog, but standards that I will be keeping on me are a shovel, probe and beacon. But these tools are only a small part of avalanche preparedness. More important than the endless supply of technology you can invest in is knowing what conditions and natural phenomena to be aware of during your trek, and the Colorado Avalanche Information Center is a great place to start familiarizing yourself with these.

Cabin Comforts

There is only one limiting factor to this list, but it is considerable: how much you can carry. For six miles. Uphill. In snow.

Most of the huts in the 10th Mountain Division hut system are equipped with soft mattresses, small pillows, and blankets. The kitchens are stocked with utensils and dishes, there is toilet paper, paper towels, hand sanitizer and dish soap, as well as ample supplies of wood for burning in the wood stoves. So most of your weight will be food and drinks.

I always pack a sleeping bag and extra pillow, because the guaranteed warmth and comfort are worth it when you’ve spent your day being intensely active outdoors. And keep in mind you’ll want warm, dry layers to change into that you haven’t been hiking and sweating in all day. What do you want to be wearing when you’re lounging around the cabin reading, cooking, eating, playing cards, etc.? For me, this looks like socks, long underwear, a pullover and slippers that I can crush into my pack. And then what are you going to throw on when you have to go back outside into the dark cold of night to use the outhouse? Your Colorado uniform: a hoodie.

There won’t be running water, so you can’t expect to shower. When you’re in the wilderness for a long time and need to be discerning about how much weight you carry that isn’t food and water, bathing is of low priority. But for a short trip like this, I don’t mind bringing some form of wet wipes; they’re light-weight and take up very little space. Toothbrush and toothpaste should be obvious, though.

Medication & Acclimation

From climbing Mt. Fuji to Colorado’s 14er’s, I’ve noticed a lot of people bringing pressurized cans of oxygen. High altitude research has taught me just how temporary and unnecessary this trend is. Often, the most effective remedy for altitude sickness is 5 – 10 minutes on oxygen. I’m pretty sure you’ll blow through a whole can of gas-station aerosol oxygen before it does you any lasting good.

Avoid this by giving yourself time to acclimate before you get to extreme elevation. Ebert Family Clinic in Frisco, Colorado, specialists in high altitude research, always recommend keeping track of blood oxygen saturation with a pulse oximeter, and this is something small, inexpensive and very portable. Our team will be spending at least 24 hours at altitude before we embark on the trek to the hut. This way, members from lower elevations will have access to an oxygen concentrator to facilitate acclimation.

Physician and high altitude expert Dr. Christine Ebert-Santos recommends packing the following mediations for hut trips: Acetazolamide, Benadryl, Ibuprofen, an EpiPen, Acetaminophen, and topical antibiotic oinment. Of course, be aware of any allergies to medication in your party. It is also helpful to be aware of what symptoms you may expect to experience, should you start having trouble acclimating, including dizziness, nausea, hyperventilation, and fatigue.

Food & Water

This is where most of the weight you pack in will be. Again, no running water at the hut, so expect to boil all the water you need for drinking if you run out of what you bring. There are lots of compact water purification systems you can easily pack as well. For our six mile trek to the cabin, I will have a Camel Bak and a couple Nalgene-sized thermoses full of water tucked into my pack.

You don’t want to have to cook everything you bring, so snacks you can easily access and eat are essential, especially for the trail. For this particular hike, I expect to burn more calories more quickly than any other average day, so I want lots of nutrients per gram: pistachios, energy bars, jerky … And don’t underestimate the power of sugar and caffeine, this is precisely the kind of work your body acts quickly to convert these nutrients to energy for. And yes, I mean chocolate. (Fruit also contain a lot of valuable sugar, I’m told.)

While we’re at the cabin, we’ll have access to a propane stove, so we’ll be able to cook some hearty meals. Bacon, fruit, yogurt, bagels and cream cheese are all easy breakfast foods to pack. If you are fortunate enough to be on a hut trip with Dr. Chris herself, you will have pancakes at least once. It’s also easy enough to bring fixings for the most epic sandwich you’ve ever had: guacamole, sprouts, turkey, ham, greens, tomatoes, bread; and remember, it’s a good chance to justify all the calories you get from mayonnaise and mustard.

And speaking of calories and sugar, I feel like whiskey and beer were invented to accompany the warmth of a fire in a remote, mountain cabin. The good news is that you are sure to be carrying less out than you did in. The bad news is that hangovers are exacerbated by high altitude, so pay more attention to your consumption than you would at any lower elevation, and be sure to have plenty of drinkable water at hand.

Am I Ready?

Hut trips in Colorado are mentally and physically challenging, even in the best conditions. The more time you give yourself, the better. Know before you go and don’t go alone. And don’t be intimidated. I’ve successfully guided friends from sea-level who don’t consider themselves athletic to destinations well above the tree line without incident.

Always be checking in with your body, your team, and your environment.

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.

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

Resources:

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.).

References:

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

Slumber Up: Sleeping at High Altitude

 

Does high altitude affect sleep quality? The answer is that for some, it does. If you’ve ever quickly arrived to the mountains on a ski or summer getaway, you may have experienced fitful and non-restful sleep. Individual responses to high altitude may vary, however there is an understood physiological basis for sleep disruption at altitude.

 

A phenomenon known as “periodic breathing of altitude” is commonly experienced above 2500 m of elevation (about 8200 ft) in those not previously acclimatized [2]. This is a common sleep elevation in Colorado mountain towns such as Frisco, Colorado (proud home to this blog!). Periodic breathing of altitude may be more likely to occur as sleeping altitude increases. Here’s the science behind it:

 

The decreased atmospheric pressure at altitude results in less oxygen driven into the lungs and through to the bloodstream. The body attempts to compensate by increasing the rate of breathing (tachypnea), which also causes more carbon dioxide to be exhaled. Chemoreceptors sense the decrease in carbon dioxide and signal the body to stop breathing temporarily (apnea) to correct the imbalance. Alternating cycles of tachypnea and apnea continue to occur during sleep. The result is decreased REM sleep, which is a critical restful and rejuvenating phase [2].

 

Worried about your next sleepless night on a mountain trip? Fortunately, there’s acetazolamide (Diamox). It is a carbonic anhydrase inhibitor that works by eliminating bicarbonate in the urine, which is a base. The body subsequently becomes more acidic, and that acid in the bloodstream is readily converted to carbon dioxide. The body is “tricked” into thinking that there is plenty of carbon dioxide present in the bloodstream, and periods of apnea during sleep may be reduced or eliminated [3].

 

To help prevent periodic breathing of altitude, adults can take acetazolamide preferably starting on the day before ascent or on the first day at altitude. Adults typically take 125 mg twice a day until either 3 days at altitude has been reached or descent back down has occurred [1]. Ask your healthcare provider about what’s right for you. Consider acetazolamide next time you’re sleeping up high, and get that refreshing sleep that allows you to better enjoy the things you love at altitude!

 

-Justin Murphy, PA-S

Red Rocks Community College Physician Assistant Program

Clinical Rotation- May 2017

 

References

1) Athena Health (2017). Acetazolamide generic. Epocrates Online. Retrieved from: https://online.epocrates.com/drugs/12701/acetazolamide/Adult-Dosing

2) Gallagher, S. A., Hackett, P., & Rosen, J. M. (2017). High altitude illness: Physiology, risk factors and general prevention. Up To Date, Topic 181,  Version 20.0.  Retrieved from: https://www.uptodate.com/contents/high-altitude-illness-physiology-risk-factors-and-general-prevention?source=search_result&search=high%20altitude%20sleep&selectedTitle=2~150

3) Winter, C. (2016). Sleeping around: How to sleep at high altitude. Huffington Post. Retrieved from: http://www.huffingtonpost.com/entry/sleeping-around-how-to-sleep-at-high-altitude_us_5806da29e4b08ddf9ece1228?ncid=engmodushpmg00000006

Live High Train Low- What’s an athlete to do?

I just came across this study in the literature from a couple years ago

Optimizing Altitude for Live High-Train

Low (LHTL) Training

Chapman et al (2013) hypothesized that athletes living at

higher altitudes would experience greater improvements in sea

level performance, secondary to greater hematological acclimatization,

compared to athletes living at lower altitudes. After

4 weeks of group sea level training and testing, 48 collegiate

distance runners (32 men, 16 women) were randomly assigned

to one of four living altitudes (1780m, 2085m, 2454m, or

2800 m). All athletes trained together daily at a common altitude

from 1250m to 3000m following a modified LHTL

model. Subjects completed hematological, metabolic and

performance measures at sea level before and after altitude

training. Upon return from altitude, 3000m time-trial performance

was only significantly improved in groups living at the

middle two altitudes. EPO remained elevated after 72 h except

in the 1780m group. Erythrocyte volume was significantly

higher in all groups but not different between groups. These

data suggest that a 4 week LHTL altitude camp at 2000m to

2500m is optimal for sea level performance.

 

HIGH ALTITUDE MEDICINE & BIOLOGY

Volume 15, Number 1, 2014

ª Mary Ann Liebert, Inc.

DOI: 10.1089/ham.2014.1513

4

 

How Long With Low Oxygen?

We frequently measure oxygen levels on people of all ages here in our mountain clinics. We order nighttime oximetry and sleep studies and analyze hundreds of data points reflecting heart rate and oxygen levels over time. When we see someone with a low oxygen in clinic, there may be no way of knowing if they have been hypoxic for hours, days, weeks unless they have an illness with an abrupt onset, like influenza or pneumonia or they just returned from sea level. Babies during the first weeks may have low oxygen with no symptoms, since they are accustomed to this in the womb where oxygen saturations run 40-60 %.

A recent article in the Journal of the American Medical Association studied extremely premature babies at 18 months for adverse outcomes including vision, hearing, cognition, motor, and language. They correlated the degree of disability with the length of time the child was hypoxic during the first few months. One minute of hypoxia seemed to be the cut-off. Now this doesn’t tell us how low or how many but it may be a helpful guide when watching someone’s oxygen or analyzing a sleep study. Shorter episodes may be insignificant long term.

This is a complex article and the children with the poorer outcomes had more episodes of hypoxia at older ages- 9-10 weeks after birth. This could mean that the insult to the brain was contributing to the hypoxic episodes as well as the deficits.

 

Does sleeping on oxygen at high altitude improve athletic performance?

I have read many scientific studies on athletic performance at altitude. Active high altitude residents are always looking for ways to improve. As we age we experience a loss of speed and endurance, even with regular training. Some of this is inevitable, but how can we know if there is something else affecting our fitness?

I started sleeping on oxygen 9 months ago because of high blood pressure, which was instantly cured. Now I find that my strength and endurance have improved during the last few months. For example, I was rowing 13400 meters per hour with several brief pauses last fall, and now I am at an all-time high of 14100 m per hour with one pause. My running feels better, I’m back up to 6 miles from 4.

There are other factors that could influence this. In 2012-2013 I was on 17 pills including prednisone and had four surgeries for tongue cancer and myasthenia gravis. I was able to continue working out daily although part of that was less intense, such as yoga. I also had rotator cuff surgery. So my current fitness improvement could just be a rebound from overcoming those health conditions.

The only way to know for sure is to do a randomized controlled double blind study of athletes performance on and off nightly oxygen, or study the same athlete with and without oxygen. This is not an immediate effect, so months or years of observation and measurements would be needed.

In the meantime, if you live above 2500 meters/9000 feet and are losing stamina or strength consider having a night time pulse oximetry test to check for hypoxia during sleep.

Kilimanjaro

Overflow crowd tonight at St. John’s church where Katherine Jeter shared her story of climbing Mt Kilimanjaro with others from the county, celebrating her 75th birthday that year. I am so inspired by the people older than I am who are challenging themselves like this. This peak is a mile higher than our 14er’s! The average age in this group was 65. Using acetazolamide/Diamox helped many of the climbers.