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Altitude Training

Simulated Altitude Training induces physiological responses that are beneficial to healing and health which also results in athletic performance enhancements.

It's all about Winning!!

Performance sport of any type is all about winning!!  Nobody remembers the runners-up. Professional athletes have been travelling to altitude for training since the benefits were first recognised in 1968.  More recently keen amateurs have been following in their steps, but there is a cheaper way that is more convenient and confers additional benefits - Simulated Altitude Training.

Whether you're trying to beat your PB, either as a Pro or an amateur or just looking to improve health through the performance benefits that evolve from adaptation to altitude, then you should seriously consider getting your own SAT system for your home.


The 1968 Mexico Olympics forced the professional sporting world to sit up and acknowledge the advantages conferred by altitude training. Since then, many studies have categorically proven the benefits of altitude training. The most recent studies now concentrate on identifying the best regimes to maximise these benefits. Altitude training is now used by virtually all world class human athletes and by an increasing number of professional sports teams to not only attain peak performance, but also to reduce recovery periods and to retain high levels of fitness during injury rehab, and thereby accelerate the return to competition.

Since 1968, Simulated Altitude Training (SAT), also known as hypoxic training, has emerged as a better method of achieving the same or greater physiological benefits than actually going to altitude.

A new generation of equipment, designed and manufactured in the UK and patent protected, has a range of features and output capabilities suitable for increasing performance on a broad front and is especially suitable for personal use as well as for gyms. Chief engineer and CEO, Dave Vincent designs and installs this bespoke new generation of equipment according to your requirements. His systems are uniquely endorsed by The English Institute of Sport - who prepare some of our World Class/Olympic athletes. Dave has even been called on to provide hypoxic bedrooms for top flight business executives who report enhanced health and clarity of thought associated with higher blood Oxygen levels!

Most importantly this new equipment provides a level of safety, control and ease of use not previously available. Horses can be conditioned at rest in the stable although a more cost-effective and enhanced level of performance is best achieved through Intermittent Hypoxic Training (IHT) using a mask or tent system.

More specifically, hypoxic training results in increased speed, endurance and stamina, with improved recovery. Individual responses vary, but even elite athletes have consistently recorded improvements of up to 5% in closely controlled studies - which equates to a distance gain of 88 yards per mile. Time to exhaustion at maximum effort has frequently improved by more than 30%.

Altitude simulation delivers hypoxic (oxygen-reduced, but ultra pure) air to the athlete regardless of the training location. But amazingly, this technique offers considerable advantages over actually travelling to altitude - beyond the expense and inconvenience of travelling to unfamiliar surroundings. Research has consistently suggested that it is the alternation between hypoxic and normoxic air (normal oxygen content) that is a critical aspect in the success of the regime.

For those interested in anything from a personal human SAT all the way through to a full professional SAT gym, please contact my good friends Dave Vincent or Kevin Gillespie at Sporting Edge UK Ltd. You can visit their impressive Training with Altitude website here

Physiological Adaptations

The aim of hypoxic training is to increase oxygen utilisation by the muscles to delay the switch from aerobic respiration of muscle to anaerobic respiration that produces lactic acid which accumulates in muscles causing fatigue.

Hypoxic training is the only practice that leads to significant improvements in all 3 stages of oxygen transport.

  1. Extraction of oxygen from the air in the lungs to the blood.
  2. Combination of the oxygen with haemoglobin on the red blood cells (RBCs) to transport the oxygen to the working muscles.
  3. Uptake and utilisation of oxygen by the muscle.

On return to racing in normoxic conditions, the 'extra' oxygen is then made available for energy metabolism and performance. Exposure to hypoxia stimulates up-regulation of Hypoxia Inducible Factor (HIF-1), which promotes an improvement of the body’s oxygen utilisation system at every link in the chain. Initially, pulmonary oxygen absorption is enhanced to allow more oxygen to enter the system. At the same time the kidneys signal for an increase in Erythropoietin Hormone (EPO) which stimulates the production of Red Blood Cells (RBCs) providing increased transportation for the extra oxygen throughout the body. At the next level, certain growth factors (VEGF) trigger increased capillarisation, enabling increased blood flow to tissues, muscles and brain. Finally, hypoxic training causes a boost in production and rejuvenation of mitochondria (the body’s principle oxygen sink and the location of aerobic energy production) and mitochondrial enzymes, allowing more efficient use of oxygen for energy production and enhanced enzymatic anti-oxidative defence.

Aside from these primary systemic changes, exposure to hypoxia is known to have the following beneficial physiological effects:

  • Decreased average Heart Rate and Blood Pressure
  • Increased production and release of Growth Hormone
  • Stimulation of fat burning metabolism
  • Decreased oxidative stress from Free Radicals (Reactive Oxygen Species “ROS”)
  • Increased immune system response and improved cellular function and repair

Hypoxic training has revolutionised human athletic performance. It is an accepted training method that means anybody not using it immediately starts at a disadvantage.

Passive Hypoxic Conditioning

Often known as 'Sleep High, Train Low (SHTL)' this regime only requires the person to breathe hypoxic air whilst at rest, including when asleep. Just breathing hypoxic air lowers the oxygen level in the blood to much less than is possible even when exercising at maximum effort. Therefore, despite the fact that there is no physical activity, or feeling in any way uncomfortable, the hypoxic stress stimulates a cascade of physiological events which improve the entire oxygen delivery system. Many studies have shown that 8-12 hours of exposure per day or night for a period of three weeks will create sustainable benefits.

Beyond SHTL, Intermittent Hypoxic Training (IHT = Train High - breathing hypoxic air whilst on a treadmill or other static exerciser) can be used to specifically target core muscle groups. Research shows that this results in increased capillaries within the target muscles and increased mitochondria. The most effective regimes depend on the individual horse and the type of race or activity it will be participating in. Athletes already utilising hypoxic training to achieve performance benefits have reported help with

  • Accelerating pre-season fitness training;
  • Improved recovery;
  • Improved ability to maintain high levels of fitness;
  • Preventing or reducing respiratory problems;
  • Maintaining cardio-vascular fitness in injured or “at risk” athletes forced to reduce training intensity;
  • The final preparation for racing

With the ability to train the cardio-vascular system in hypoxic conditions rather than relying solely on long distance (and time) training sessions it is now possible to minimise the injury risk, ensuring that you will be more likely to compete in your target races.

New Generation SAT System Features

Dave Vincent of Sporting Edge UK Ltd provides a unique design-to-installation service to give you controlled performance-improving environments for gyms that are specifically tailored to your exact requirements. Of course similar systems can be installed to convert your bedroom into a sleep high chamber so that you too can experience the health and performance benefits associated with the phyiological adaptations to altitude.

Sleep High Systems are patent protected, designed and manufactured in the UK and comply with all European standards. These new generation systems are designed specifically for large volume gyms so there are no cumbersome masks or other impediments to comfort or training etc.

Simulated Altitude Systems can be supplied with integrated a Simulated Environmental System which controls not only oxygen levels but humidity and temperature to allow pre-conditioning to any climate in which human athletes might be expected to perform.

Systems can be supplied as personal tents that can be used in Sleep High (in the bedroom) or Train High (with exercise equipment) configurations. In fact a single system can be designed with the power and flexibility to provide you with both options giving you the ultimate performance enhancing regime.

New generation Simulated Altitude Systems feature

  • Oxygen (altitude) control accurate to 0.1%
  • Superb air quality - removes bacteria, pollens, fungal spores, odours and hydrocarbon
  • Fail safe operation - 0% chance of doing any harm through failure.
  • Fully automatic so no need to worry if someone remembered to switch it on

In addition to the above, Simulated Environmental Systems (primarily for gyms) provide

  • Temperature control from 10ºC to 40ºC
  • Humidity control from 10% to 90%

System options

  • System can be designed to do 1 stable/kennel or any number within a block for SH, or just for IHT
  • Oxygen levels can designed to be individually controlled in each stable/kennel or a uniform level throughout
  • Oxygen control is accurate in 0.1% increments to simulate whatever altitude you wish up to around 8000m, although we don't recommend the peak of Everest!!
  • Full safety - oxygen level indicators and system failure warning.
  • Compressor can be situated where noise and heat will not be an issue.

Research paper Summaries

Clanton TL, & PF Klatwitter. Adaptive responses of skeletal muscle to intermittent hypoxia. J Appl Physiol90(6):2476-2487, 2001.


Low level hypoxia shifts the metabolic enzyme activity of skeletal muscle towards greater aerobic poise, whereas extreme hypoxia shifts metabolism towards greater anaerobic potential. Some conditions of intermittent hypoxia inhibit lactate release during exercise. The net effect of a variety of skeletal muscle adaptive mechanisms to intermittent hypoxia is to preserve contractile function and cell integrity in hypoxia, and translates into improvements in exercise performance.

Liu Y, Steinacker JM, Dehnert C, et al. Effect of "living high - training low" on the cardiac functions at sea level. Int J Sports Med19:380-384, 1998.


Comparison of control (living and training at sea level) and treatment (living high, training at sea level) groups demonstrated that the high-low group had significant improvements in cardiac function. Stoke volume, cardiac output, shortening fraction, and ejection fraction all increased significantly in the high-low group. These results demonstrate that living high but training low produced a significant improvement in overall cardiac function and improved myocardial energy utilization.

More to come ...

Altitude Training or Hyperbaric

Trainers have realised for many years that oxygen is one of the core limitations on performance. There has been much speculation about how to increase oxygen levels within the body from bubbling gaseous oxygen through drinking water, to giving the banned EPO and blood doping to increase the number of RBCs in circulation in the blood to increase oxygen carrying capacity to muscles etc.

More recently there are products on the market that reputedly increase oxygen levels in much the same way as Aerobic Oxygen does - through the digestive tract. Hyperbaric chambers provide increased oxygen to the body at an increased pressure of more than 1 ATA and is referred to as hyperbaric oxygen therapy or HBOT. Research has demonstrated that the effects only last around 3 hours following exposure. HBOT has also been used to improve healing from injuries by reducing scar tissue formation, reducing swelling and pain and improving oxygen supply to damaged tissues by increasing plasma oxygen levels to enhance the rate of repair. It is important for maximum effectiveness that HBOT is provided ideally within 60-90 minutes post injury and at higher pressures ie 2.2 - 2.8 ATA. Hyperbaric treatment has also been found to help reduce infection by increasing body oxygen levels and boosting the immune system. HBOT has been used on an ongoing basis to speed up the healing process - most famously with footballers David Beckham and Wayne Rooney - both following a fracture to a metatarsal. It is interesting to note that whilst both players returned to playing football in record time, neither player showed particularly good form or energy levels on their return. There are sound scientific reasons as to why this happened.

On the face of it, oxygen-delivering compounds and HBOT sound like a good idea to enhance performance on an ongoing basis and to maintain higher levels of body repair purely by keeping body oxygen levels artificially high. It might also sound like a better option than SAT because body oxygen levels are raised immediately and do not require a 3 week initial SAT program followed by a week every month to maintain the effects.

However if we now consider the physiological adaptations to SAT and their reversal if SAT is not regularly boosted, we can see that ongoing HBOT or regular training on oxygen-rich compounds will actually have a detrimental effect over time.

The physiological adaptations to providing a higher oxygen supply on a regular basis are

  1. Reduced capillary density due to increased plasma and tissue oxygen levels negating their requirement
  2. Reduced muscle mitochondria
  3. Reduced RBC due to increased plasma levels
  4. Due to reduced capillaries, substrate delivery (other than oxygen) including stem cells to tissues is compromised and thus reduces repair in the long term.

In layman's terms, when oxygen is seemingly in plentiful supply the body reduces it's natural ability to absorb and distribute oxygen round the body. This is not a problem under normal conditions as it does not matter if the reserve capacity is reduced but during athletic duress when the requirement for oxygen increases substantially, the body cannot gear up to increase oxygen absorption in the lungs or oxygen carrying ability in the blood or oxygen utilisation in the muscles. This puts the cardiovascular system and especially the heart under much higher pressure to increase oxygen supply to muscles by increasing overall blood flow to lungs and muscles. This makes bleeding into the airway more likely and inevitably the blood supply to muscles is inadequate leading to increased lactate production and a greater risk of tying up. This compromises the heart muscle itself too as its own oxygen requirement is substantially raised.

There is also a reported low risk of CNS oxygen toxicity for pressures above 2 ATA. One study in Israel found that prolonged exposure to hyperoxia induces a reduction in the energetic efficiency of trained rats.

In Conclusion

Whilst ongoing HBOT and any other method that supplies extra oxygen to the body might seem to enhance performance, the effects are at best short-lived and limited to an initial period following the start of regular procedures. This initial improvement in performance and the reputation for short-term injury rehabilitiation may mean that as performance decreases over the long term and injuries and illness increases, the link may not be made as to the physiological adaptations to HBOT/oxygen-carrying compound being the root cause of the problem.

In order to increase the body's ability to absorb and utilise oxygen under athletic and injury circumstances, the ONLY way to safely achieve this with no long term side-effects is Simulated Altitude Training. There are no shortcuts to bypass this natural physiological adaptation which in addition to increased performance has increased healing, increased immunity and cardio-protective effects.

From a practical safety and financial perspective it is much safer to be working with a low oxygen environment that supports life than a high oxygen one that supports explosions!! SAT chambers and associated equipment is significantly cheaper with fewer restrictive regulations than similarly sized hyperbaric chambers.

Adaptation to interval normobaric hypoxia has been demonstrated to provide beneficial results in a wide spectrum of diseases and health-related conditions including: primary hypercholesterolemia, essential hypertension, ischemic heart disease (stable angina of effort and rehabilitation after myocardial infarction), neurocirculatory asthenia, idiopathic stress disorders of cardiac rhythm, bronchial asthma, chronic obstructive bronchitis, rheumatoid arthritis, autoimmune thyroiditis, dysfunctional uterine bleeding, chronic salpingo-ophoritis, prevention of early toxicosis, central chorioretinal dystrophy, allergic dermatoses, kinesia, protection of non-compromised tissues from the effect of radiation in the treatment of malignancy.

Adaptation to interval hypoxia is successfully used in surgery (preparation of patients for planned surgery) and in paediatrics (treatment of bronchial asthma and chronic obstructive bronchitis). Beneficial effects of adaptation to hypoxia were demonstrated in treatment of physical fitness loss in otherwise healthy people, training and conditioning of athletes, and altitude pre-acclimation. Concomitant with improving the efficiency of systems responsible for both oxygen transport and oxygen utilization at all levels of the organism, adaptation to interval hypoxia provides a broad spectrum of protective effects.

Interval Hypoxic Training/Hypoxic Therapy (IHT) is based on the principle of cyclic repetitions of brief, normobaric hypoxic episodes and subsequent re-oxygenation. The intensity and duration of the hypoxia/re-oxygenation cycles may be customized to suit the application of IHT for the treatment and prevention of specific conditions, as well as for general health and as prophylaxis.

The IHT is mediated by both central control mechanisms (involving primarily the hypothalamo-pituitary-adrenal axis) and numerous local mechanisms (e.g., prostaglandins, opioid peptides, etc.).

Mechanisms of the adaptation to IHT are evident at all levels of the organism (i.e., whole organism, organ systems, organs and tissues, cells, sub-cellular structures, macromolecules and their micro-environment). While many of these mechanisms remain obscure, some of them have been elucidated and proven experimentally in clinical studies and/or in animal experiments. It is important to note that different mechanisms are active at different stages of the process of adaptation to hypoxia.

Significant among these, the increased capacity of various antioxidant systems in the organism plays an important role in the potentiation of protective mechanisms. The superoxide dismutase activity in the brain of rats is significantly higher with IHT exposure relative to a control group. Lipid peroxidation in brain homogenates (thiobarbituric acid-reactive material) was significantly higher with IHT exposure compared with the control.

Thus, IHT exerts its action via initiation or de novo formation of potent adaptive mechanisms at different levels of the organism. This is precisely the characteristic that allows the use of IHT as an important component of therapeutic and/or prophylactic measures. Contra-indications of IHT include all acute somatic and infectious diseases; chronic disease decompensation; pregnancy of less than 16 weeks; pulmonary hypertension (clinical and/or ECG signs); SaO2 at rest 92% and less; age 70 and over (no research carried out).


IHT considerably decreases levels of total cholesterol and triglycerides in blood serum and reduces the index of atherogenicity. In addition, the IHT exerts a hypotensive effect, decreases nicotine dependence, and, by virtue of its hypocholesterolaemic effect, it can be used to counteract certain risk factors of ischemic heart disease.

Effects of IHT on lipid metabolism in patients with primary hypercholesterolaemia

% change of pre-IHT level
HDL Cholesterol
Cholic Acid
Chenodeoxycholic Acid
Deoxycholic acid

Ischemic heart disease (IHD)

After a course of IHT, patients with IHD who have had previous myocardial infarction and/or who have stable angina of effort display less frequent anginal attacks and an improved tolerance for exercise. They also display an increase of threshold potency of the threshold double product (HR x BPS) at the threshold load that correlates with the maximum oxygen uptake by the myocardium, while under a standard load the value of the double product decreases. At rest, both heart rate and the minute ventilation are decreased, breathing efficiency is increased, and oxygen consumption reduces. In addition, 24-hour ECG monitoring reveals a reduction in the amount and duration of both painful and silent periods of myocardial ischaemia. IHT has a pronounced anti-arrhythmic effect and may be used in patients with symptomatic extrasystole associated with psycho-emotional states.

Gynaecological diseases

IHT has been established to have beneficial effects on juvenile dysfunctional uterine bleeding. Bleeding was stopped and blood haemoglobin rose. Urinary pregnandiol and the number of keratosic cells in vaginal smears were increased. IHT normalized the course and outcome of labour in these women through stabilization of blood pressure, decrease in oedema, decrease in the mean duration of delivery, and abolishment of afterbirth complications and residual manifestations of gestosis. It also normalizes the principal parameters of platelet haemostasis in pregnant women with gestosis: ADP- and epinephrine-induced platelet aggregation decreases and the level of fibrin degradation products diminishes (from 7.82±0.01 to 2.56±0.02 mg/l).

Preparation of patients for surgery and anaesthesia

IHT can be beneficial in the preparation of patients for anaesthesia and surgery. Women who underwent a course of IHT prior to surgery for uterine myoma displayed an increase in relative volume of myometrium vasculature accompanied by a decrease in stroma volume, an improvement of blood and oxygen supply to the myometrium, and an improvement of their psycho-emotional status, including decreases in both mental strain and autonomic disorders. Wound healing also was improved in patients operated for uterine myoma.

An IHT-induced improvement in the function of external respiration suggests the usefulness of preoperative IHT for patients with initial forms of broncho-obstructive diseases or with impaired external respiration.

Chronic bronchitis and bronchial asthma

IHT is an effective treatment for chronic obstructive bronchitis and bronchial asthma in both adults and children. Clinical efficiency was observed in approximately 80% of patients with atopic bronchial asthma and in approximately 70% of patients with bacterial asthma and chronic obstructive bronchitis. On average the positive clinical effect has been seen to persist for a period of 4 months. In bronchial asthma clinical recovery is usually accompanied by improved external respiration and reduction of bronchial hyper-reactivity. The good clinical results observed in atopic bronchial asthma in children are accompanied by a decrease in circulating immune complexes and restoration of the initially reduced content of blood immunoglobulin M (Table below). An adaptation to hypoxia is accompanied by the improvement of respiration and circulation in patients with chronic obstructive bronchitis. The available data supports benefits of using the IHT in treatment programs of patients with bronchial asthma (excluding hormone-dependent asthma) and chronic obstructive bronchitis without initial manifestations of chronic respiratory insufficiency.

Table: Serum immunoglobulins in patients with bronchial asthma before and after IHT (M± S.E.M.) g/1.

Before IHT
After IHT
1.05 ± 0.3
1.0 ± 0.5
1.0 ± 0.3
1.71 ± 0.4*
11.0 ± 4.6
12.5 ± 4.4

* - p

Rheumatoid arthritis

IHT has been used with good clinical results in both adults and children with rheumatoid arthritis. The IHT course reduced the duration of morning stiffness and the number of involved joints and alleviated or abolished arthralgia. Furthermore, IHT positively influenced the general status of patients by improving their mood, sleep patterns, appetite and increasing their level of physical activity. The IHT-induced clinical improvement in patients with rheumatoid arthritis was accompanied by definite immunological changes, in particular, by an increase in the number of mature T-lymphocyte sub-populations, indicating a positive immuno-modulating effect of the IHT.

Hypoxic radiotherapy

Hypoxic radiotherapy is the administration of therapeutic radiation to patients while they are breathing a hypoxic gas mixture. It has been used successfully in the treatment of patients with malignant tumours with a variety of localization. This method is based on the observation that having the patient breath a gas mixture containing 9-10% of oxygen during irradiation of malignant tumours decreased the side effects of radiation exposure. A study performed on 974 patients has shown that the total number of radiation injuries was decreased to less than half of control levels and that the number of pronounced radiation responses was reduced to less than a third of control levels. In radioresistant tumours (e.g., carcinoma of the stomach and pancreas, retro-peritoneal tumours), inhalation of the hypoxic gas mixture by patients during independent and preoperative irradiation allows both single and total focal doses to be increased by 25-50%, which considerably extends the potency of irradiation.

Number of patients
General radiation side-effects, number of patients (%)
Of those with pronounced radiation side-effects, number of patients (%)
Control group (Radiation without hypoxia)
39 (61)
5 (7.8)
Radiation with HGM-10
20 (39.2)
4 (7.8)
Radiation with HGM-9
25 (37.3)
1 (1.5)
Radiation with HGM-9
30 (45.4)
4 (5.9)
114 (45.9)
14 (5.6)

Table: Responses in preoperative radiation therapy and hypoxic radiotherapy for cancer of the stomach. SFD, Gr (single focal dose); TFD, Gr (total focal dose); HGM - hypoxic gas mixture (10 and 9 are % concentrations of oxygen in HGM).

IHT in general health-promoting measures

IHT provides beneficial effects on health and physical conditions of children residing in ecologically unfavorable regions, including radiationally unfavorable environments. These benefits include an activation of neurodynamic processes, a decrease in psychomotor and autonomic correlates of psycho-emotional stress, an improvement in the parameters of bronchial potency, and a decrease in sympathotonic responses. Furthermore, IHT is beneficial for increasing the resistance and adaptive ability of children particularly susceptible to disease and allows them to improve their physical and mental capacities. Thus, the benefits provided by IHT—optimization of autonomic functions, decreased manifestations of psycho-emotional strain, and increased capacity for physical activity—indicate the usefulness of this method both for increasing adaptive potential and for correcting psycho-emotional disturbances. IHT influences the pattern of physiological responses (including those accompanying acute hypoxemia) providing for the optimization of oxygen homeostasis central regulation on both systemic and tissue levels. IHT significantly affects the time course of the decrease in oxygen saturation of blood.

IHT can be used for stimulation of adaptive and compensatory mechanisms in premature aging and in elderly people undergoing health-building measures.

Table: Changes of SaO2, heart rate (HR) and minute expiratory volume (VE) during hypoxic test (11% O2) before and after IHT (M± S.E.M.)

Before IHT
After IHT
SaO2, %
16.0 - 1.6 (80%)
12.5 - 1.3 (84%)*
VE, 1/min
0.76 - 0.20 (109%)
2.2 - 0.5 (123%)*
12.8 - 1.3(113%)
8.4 - 1.3 (108%)*

Differences of respective parameters during hypoxic test are presented (in parentheses - percent of the initial value); * - p

The effect of IHT on the efficiency of sport training

IHT improves the functional and psycho-physiological state of athletes and increases both their general and special physical capacity (in rowers, swimmers, bicyclists, skiers, volleyball players, track and field athletes, etc.). The efficiency of IHT in enhancing conditioning and performance is similar to those that follow high-altitude training, which makes the IHT an excellent substitute for altitude training for world-class athletes.

In summary, IHT is a promising trend in treatment, rehabilitation, and prophylaxis of a wide variety of diseases and physical conditions.

These results were obtained in collaboration with the Hypoxia Medical Academy Clinical Research Laboratory.