Jon Peter Wehrlin - Effect of endurance training and altitude training on hemoglobin

1

Effect of Endurance Training and Altitude Training on Hemoglobin

Mass and Sea Level Endurance Performance

Jon Peter Wehrlin, PhD

Head Endurance Group, Section for Elite Sport,

Swiss Federal Institute of Sports, Magglingen, Switzerland

Elite Sport

Swiss Federal Institute of Sport, (University of Applied Sciences), Magglingen

=> Section for Elite Sport (Collaboration with Swiss Olympic Association)

Performance diagnosis

Research & Development

2Federal Office of Sport, Magglingen, Switzerland

Jon Peter Wehrlin, PhD, Section for Elite Sport

Teaching

- Bachelor- Master Elite Sport (Since 2008)- Coaches Education-Sport medicine education

2

Endurance Physiology Group

Severin Trösch,BSc ETH, 100%.Athletics

Beat MüllerEHSM,60%. CoachSwiss Cycling. MTB, Biathlon

Thomas SteinerPhD, 100%. XC Skiing, Triathlon

Sandra LauensteinMSc, 50%. OL,Biathlon, MTB

Kellie Prichard-Peschek, PhD,100%. Schwimming

Anna HauserMSc, 100%.PhD Student

Jon Peter WehrlinPhD, 100%.Head EndurancePhysiology Group



Endurance sport: VO2max - Possible limiting factors

Oxygen transportcapacity

Lung diffusion capacity

Heart capacity



Bassett DR and Howley ET. Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc. 2000; 32: 70-84.

Muscle capacity

3

Relationship between hemoglobin mass and VO2max



Schmidt & Prommer Exerc Sport Scie Rev, 2010

Endurance Sport: Blood Doping…

f 30th l t th di



..can move you from 30th place to the podium…

Stray-Gundersen J, Videman T, Penttilä L, Lereim I.Abnormal hematologic profiles in elite cross-countrySkiers: blood doping or? Clin J Sports Med,

2003, 132-7

4

Switzerland Spain

Importance of the hemoglobin mass: Blood doping

USA Denmark



…..etc.

Increase in Red cell volume (Hemoglobin mass)with rhEPO Doping



Lundby et al., J Physiol, 2007

5

1) Does hemoglobin mass increase with normal training?

- Training camp (Peaking and Tapering)- Training Season- Several years endurance training

Key Questions for elite endurance athletes:

- Differences: Adolescence vs adulthood- „Responder – Nonresponder“ => Talent diagnosis

2) Does Hbmass increase with altitude training (LHTL)?

- „Hypoxic dose“?- „Individual response“? (Swiss Projects)



3) Is performance after LHTL altitude training increased?

- Competitions at sea level (Swiss Projects)

Background:Classic blood parameter (hematocrit and hemoglobin)

Hematocrit (Hct; %)

Percent red blood cellsPercent red blood cells

Men ca. 45%

(Critical value men 50%)



Hemoglobin (Hb; g/dl)

Mean value ca. 15g/dl /

(critical value 17g/dl)

Red color in red blood cells, Binds the oxygen

6

Background: Classical blood paramters

7

8

9

er]

Hematocrit: 44%

rs)

Hb 15g/dl

2

3

4

5

6

7Blutvolumen [Lite

Red cell vol.

Blood plasma

Blood plasma

Hematocrit: 44%

Blo

od

vo

lum

e (l

ite Hb 15g/dl



0

1

Untrained XC skier

Red cell vol.

Problem: We do not know how the absolute values are!

7

Hct 45%

Hct 43%

Hb (g/dl) and Hct (%): Effects of changes in plasma volume

Important factors:

Background: Classical blood paramters

Blo

od

volu

me

(L)

2

3

4

5

6Hct 47%

- Position: (horizontal = ↓ vs vertical = Hct ↑

- Hydratation status (low = Hct ↑; high ↓)

- Training (acute = Hct ↑; after = Hct ↓)

- Altitude: (acute = Hct ↑)

- Heat: (acute = Hct ↑; chronic↓ )



0

1

7

Effect of drinking one liter of saline solution on hematocrit value

Background:Classic blood parameter (hematocrit)

49

50

He

ma

toc

rit

(%)

40

41

42

43

44

45

46

47

48



Modified after Schmidt W. et al. Int J Sports Med, 21: 133-138; 2000

Time (Minutes)

-15 -5 5 15 25 35 45 55 65 75 850

37

38

39

Before

Background:

Measurement of blood volume parameters

Hemoglobin mass:

1256 g

Red cell volume:

3520 ml

Plasma volume:

4480 ml

Blood volume:

8000 ml



8

=> Total amount of hemoglobin in g

Background:Measurement of hemoglobin mass

CO



O2

Key Questions for elite endurance athletes


- Training camp (Peaking and Tapering)- Training Season- Several years endurance training

Differences: Adolescence vs adulthood?- Differences: Adolescence vs adulthood?- „Responder – Nonresponder“ => Talent diagnosis?



9

ht)

19

20

21

22

Untrained subjects (28 +/-5 yearsTriathletes (German National Elite; 30 +/- 5 years)Runners (German National Elite; 24 +/- 6 years)Cycling (German Elite Professional Team; 27 +/- 3 years)

1) Does hemoglobin mass increase withnormal training?

mo

glo

bin

ma

ss (

g/k

g b

od

ywei

g

12

13

14

15

16

17

18

9

+ 40%

Key question:

Effect of „training“ or„talent“?



Hem

0

9

10

11or„talent ?

Modified after Heinicke et al. Int J Sports Med, 2001


Training camp

1300

1400

4 Weeks training in the heat4 Weeks training at sea level

Hem

oglo

bin

ma

ss

600

700

800

900

1000

1100

1200

4 Weeks training at sea level4 Weeks training at 1300m4 Weeks training at 1740m



Modified after Gore et al., Int J Sports Med, 1997

0

500

600

10


During a training season

Prommer: Hbmass

showed very low oscillations during a training year (<6%)



Prommer et al. Med Sci Sports & Exercise, 2008

Garvican et al. measured Hb mass in 10 elite Cyclists during 2-10 months: CV was 3.3% (Range 2.4.4%)

ass

(g/

kg)

15

16

17

18

19

mas

s (g

/kg

)

15

16

17

18

19P = 0.87


Several years of training

He

mo

glo

bin

ma

0

11

12

13

14

15

He

mo

glo

bin

m

0

11

12

13

14

15

bin

mas

s (g

)

1100

1200

1300

1400

1500

bin

mas

s (g

)

1100

1200

1300

1400

1500P = 0.29



He

mog

lob

0

700

800

900

1000

He

mog

lob

0

700

800

900

1000

2004 2007

Wehrlin, J.P., Hallén J. Marti B. Hypoxia Symposium, 2009, Chateau Lake Louise, Alberta, Canada)

11


Several years of training



Observation in routine hemoglobin mass measurement: Elite athletes show no big changes in hemoglobin mass with normal training

Possible to use it as “talent identification marker” in adolesence?




Wehrlin & Clénin ECSS, 2008 Steiner & Wehrlin. Med Sci Sports & Exercise, 2011

12









13

gh

t)

15

16

1) Does hemoglobin mass increase with normal training? Several years of training in adolesence

Controls

Hem

og

lob

in m

ass

(g/k

g b

od

ywe

ig

12

13

14

„Responder B“(low level)



Age (years)

10

11

16 1716.5 18 18.5 1917.5

Wehrlin & Steiner unpubl. data

„Nonresponder“

gh

t)

15

16

1) Does hemoglobin mass increase with normal training? Several years of training in adolesence

R d A“

Athletes

Hem

og

lob

in m

ass

(g/k

g b

od

ywei

12

13

14

„Responder B“(low level)

„Responder A“(high level)



Age (years)

H

10

11

16 16.5 17 17.5 18 18.5 19

Wehrlin & Steiner unpubl. data

„Nonresponder“

14


Conclusion I:

It seems like in elite endurance athletes (age > 20 y), we observe no

substantial increase in Hbmass with normal training camps or severalsubstantial increase in Hbmass with normal training camps or several

months of endurance training. However, it is possible to increase

Hbmass moderately over several years. We do not know the reasons for

this.

Conclusion II:

In adolescent endurance athletes and controls (age between 16 and 20),

we can observe a relevant increase in hemoglobin mass However



we can observe a relevant increase in hemoglobin mass . However,

these effects seem to be individually different but are not affected by

endurance training amount.


2) Does hemoglobin mass increase with altitude training (LHTL)?



15

20

22

24

26

28

30 Laitinen et al. 1995 (Abstract only; n=7Runners; LHTL; Simulated altitude: 2500m; 20-28 days; CG) Svedenhag et al. 1997 (n=7 XC-skiers; LHTH; Real altitude: 1900m; 30 days; EB)Levine et al. 1997 (n=13 Runners; LHTH; Real altitude: 2500m; 28 days; CG; EB)

Levine et al. 1997 (n=13 Runners; LHTL; Real altitude: 2500m; 28 days; CG; EB)Gore et al. 1998 (n=8 Cyclists; LHTH; Real altitude: 2690m; 31 days; CO) Rusko et al. 1999 (Abstract only; n=10 XC-Skiers/Triathletes; LHTL; Simulated altitude: 2500m; 25 days; CG; CO)

Ashenden et al. 1999b (n=7 Runners; LHTL; Simulated altitude: 2650m; 12 days; CG; CO) Ashenden et al. 1999a (n=6 Cyclists/Triathletes/XC-skiers; LHTL; Simulated altitude:3000m; 23 days; CG; CO)Dehnert et al. 2002 (n=11 Triathletes; LHTL; Real altitude: 1956m; 14 days; CG; CO) Saunders et al. 2004 (n=10 Runners; LHTL; Simulated altitude: 2000-3100m; 20 days; CG; CO) Friedmann et al. 2005 (n=16 Junior swimmers; LHTH; Real altitude: 2100-2300m; 21 days; CO) Heinicke et al. 2005 (n=10 Biathletes; LHTH; Real altitude: 2050; 21 days; CO) Brugniaux et al. 2006 (n=5; LHTL; Simulated altitude: 2500-3000m/1200m; 18 days; CG; CO)

2) Does hemoglobin mass increase with altitude training (LHTL)? Hypoxic dose?

Ch

ang

e in

Hb

mas

s /

RC

V (

%)

4

6

8

10

12

14

16

18Robach et al. 2006 (n=9 Swimmers; LHTL; Simulated altitude: 2500-3000m/1200m; 13 days; CG; CO) Robach et al. 2006 (n=6 XC-skiers; LHTL; Simulated altitude: 2500-3500m/1200m; 18 days; CG; CO)

Wehrlin & Marti 2006 (n=2 Runners; LHTL; Real altitude: 2456/1800m; 26 days; CO) Wehrlin et al. 2006 (n=10 Orienteers; LHTL; Real altitude: 2456m/1800m/1000m; 23 days; CG; CO) Neya et al. 2007 (n=10 runners; LHTL; Simulated altitude: 3000m; 29 days; CO)

Pottgiesser et al. 2008 (n=7 Cyclists; LHTH; Real altitude: 1816m; 21 days; CO)Saunders et al. 2009 (n=9 Runners; LHTL; Simulated altitude: 2860m; 46 days; CO)Wehrlin et al. 2009 (Submitted; n=7; Cross-country skiers; LHTL; Real altitude: 2590m; 21 days; CG) Clark et al. 2010 (n=12 cyclists; LHTL; Simulated altitude: 3000m) C

B

E

+ 1% per 100h at 2500m(maximum about 5-10%)



Time in hypoxia (hours)

0 100 200 300 400 500 600 700 800

-4

-2

0

2

4

A D

2) Does hemoglobin mass increase with altitude training (LHTL)? Individual Response?

1080

1100

Hem

og

lob

in m

ass

(g)

900

920

940

960

980

1000

1020

1040

1060

+ 4%

Tru

th

Tru

th



0

880

Pre Altitude Post Altitude

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1060

1080

1100H

emo

glo

bin

mas

s (g

)

900

920

940

960

980

1000

1020

1040+ 4%

Tru

th

Tru

th

Me

as

ure

d

Me

as

ure

d

+ 0%



0

880



1040

1060

1080

1100

Hem

og

lob

in m

ass

(g)

880

900

920

940

960

980

1000

1020

1040

Tru

th

Tru

th

+ 0%



0

880


17


1060

1080

1100

Hem

og

lob

in m

ass

(g)

900

920

940

960

980

1000

1020

1040

Tru

th

Tru

th

+ 0%

Me

asu

red

Mea

sure

d

+ 4%



0

880



1060

1080

1100

3 weeks at 1800m (St. Moritz Switzerland)

Hem

og

lob

in m

ass

(g

)

900

920

940

960

980

1000

1020

1040

Mea

sure

men

t I

Mea

sure

men

t II

Mea

sure

men

t II

Mea

sure

men

t I

+ 2.2%



0

880

900


18

2) Does hemoglobin mass increase with altitude training (LHTL)?

Conclusion:

Hemoglobin mass can increase with „Live high – train low“ or

Live high train high“ altitude training„Live high – train high“ altitude training

=> The effects seems to be dependent of the „hypoxic dose“

=> We recommend to spend at least 400h at an altitude of about 2500m

(2300- 2800) to reach a relevant increase of about 5% in hemoglobin mass

=> We recommend to measure the individual response with Double



=> We recommend to measure the individual response with „Double

measurements of Hbmass before and after Altitude Training Camp


3) Is performance after LHTL altitude training at sea level increased?



19


=> Keep in Mind:



Millet et al., Sports Med, 2010 (modified after Reiss)


=> Keep in Mind:

Range:+ 0.5 to + 6%

Peaking Tapering



Mujica 2009

20




=> In summary, natural LHTL currently provides the best protocol for enhancing endurance performance in elite and subelite athletes

Bonetti & Hopkins, Sea level Exercise performance following adaptation to Hypoxia, Sports Med, 2009

=> Statistical significance versus practical relevance?



Viktor Röthlin Swiss Marathon

21

2010: 1. Place, European Championships Barcelona



Live at 2307m

Train at 1800m

Train at 400m

Live at 2307m

Train at 1800m

Train at 400m

Marathon at the EuropeanChampionships

Barcelona (Spain)

Weeks

1 2 3 4 5 6 7 8 9 10 11 12

Swiss altitude project for the 2012 London Olympic games: Mountainbike

2010 Altitude Training „Best Practice“

2011 Individual Adaptations



2012 Olympic Games

22

Wo

rld

Cu

p/C

1C

ha

mb

éry

6.6

.201

0

C1

En

ge

lbe

rg ?

20

.6.2

01

0

Wo

rld

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p5

./6.6

.10

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orl

d C

up

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/2.5

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ffen

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rg22

./23

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get

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C2

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s?3

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01

0

C1

Pla

ffeie

n 3

0.5

.201

0

Swiss altitude project for the 2012 London Olympic games: Mountainbike

LHTL Bernina Hospiz

25.5 - 13.6.2010

EuropeanChampionshipsHaifa7.7. - 11.7.201023-28 days after LHTL)

Ful

l Te

st1

4.6

.20

10

Ful

l Tes

t2

5.6

.20

10

Ful

l Tes

t2

.7.2

010

Ful

l Te

st1

7.5

.20

10

W W 2

Wo

Alt

itu

de

gro

up

Weeks after LHTL

1 2 3

Tar

ge

t I T



Co

ntr

ol

gro

up

Ful

l Te

st1

8.5

.20

10

Fu

ll T

est

24.

6.2

010

Ful

l Tes

t1

.7.2

010

Fu

ll T

est

15.

6.2

010

3) Is performance after LHTL altitudetraining increased?

Conclusion:

It seems that performance after „Live high – train low“ altitude training can be

more increased than it would have been with normal training. However, this isg

really hard to prove…

=> natural LHTL currently provides the best protocol for enhancing

endurance performance in elite and subelite athletes

=> However, altitude training is not a „magic bullet“, there are also risks

(overtraining, ilness etc)



( g )

23

Thank‘s for yourattention!



2013

=> United States Olympic Committee (USOC)Altit de Training S mposi m 2013 October 9th 11th

2013



Altitude Training Symposium, 2013, October 9th – 11th

Colorado Springs, Colorado

Documents

Jon Peter Wehrlin - Effect of endurance training and altitude training on hemoglobin