Hypoxic Training For Load Compromised Individuals

Altitude training has always been famed for its ability to give you more bang for your buck from a training session. Now, scientists are looking at this in a new light, with important applications in health & wellbeing and injury rehab which support the work we have been doing with our clients within elite sport and health settings for a number of years.

There are, unfortunately, many situations in which an individual may have difficulty improving or even maintaining fitness, due to an inability to perform the required intensity of exercise to meet their goals. Consider, for example, the injured athlete undergoing rehab, who cannot run with high enough intensity to maintain their pre-injury fitness, or the member of the general population for whom running is simply not possible due to osteoarthritis and so they are constrained to walking. We say that these individuals are ‘load compromised’ in that they are unable to train with the required training load to meet their fitness goals.

When injured, altitude training can help maintain or even improve fitness for athletes at all levels


Training Load

When we talk about training load we can interpret that two ways. External load is the mechanical load the body is under; for example the speed at which an individual is required to run. Meanwhile internal load is the measure of stress the body is under as a result of that mechanical load, for example the corresponding heart rate or concentration of lactate in the blood as a result of running at a given speed. For any individual, a given external workload is associated with a given cardiovascular workload. For example if Jess runs at 10 kph on the treadmill, her heart rate is 130 bpm, whereas at 12 kph it is 150 bpm.

What happens then, if Jess needs to reach a heart rate of 150 bpm to help meet her cardiovascular fitness goals, but her hamstring injury means she is unable to run at 12 kph? Or consider Steve, who has been advised by his doctor to exercise at a heart rate of 130 bpm to help loose weight and improve his cardio-metabolic health, but who’s osteoarthritis means that cycling at the power required to achieve 130 bpm is too painful. In both instances, a limit on the external workload means that achieving the required internal workload is simply not possible.

In both instances we have individuals who would benefit from high internal workloads, but are limited by their capacity to tolerate external load. What we therefore require, is an intervention which can dissociate the internal load from the external load: that is, increase the internal load while keeping the external load as low as possible. Enter hypoxic training.

Altitude Training For Load Compromised Individuals

The live low train high strategy of altitude training involves living life at sea level but stepping into an altitude chamber or using a hypoxic generator during training. Research shows that it offers the perfect solution for load compromised individuals to achieve the required internal workload without a corresponding increase in external load. As we know, heart rate will be higher for a given workload at altitude than it will be at sea level. This hypoxia induced dissociation between the internal and external workloads at altitude allows athletes who are unable to tolerate the mechanical load of their normal training, to still achieve a given internal workload to maintain their fitness whilst load compromised.


When training at altitude, cardio-metabolic workload can be maintained or even increased, whilst reducing mechanical workload. From Girard et al. (2020)


The same applies to those training for health outcomes. In one study, 4 weeks of training in hypoxia elicited greater improvements in body fat, triglycerides, insulin and glucose tolerance, all important markers of cardio-metabolic health, compared to those training at sea level. This was despite the fact that those training at altitude did so at a lower external workload, and required less physical effort and discomfort than those training at sea level. This has now been shown a number of times over in people exercising to reduce obesity, and in older populations, both of which would usually struggle to exercise at a high external workload.

Where physical training may still be a little too demanding, for example with severe injury, or in older people or those completely new to exercise, even passive exposure to altitude has significant benefits. Intermittent hypoxic exposure, or IHE, is a training tool whereby participants breath high altitude air in short bursts, alternated with sea level air. Research has shown the benefits of this type of training in injured athletes, improving their hormonal profile to accelerate healing, whilst also helping improve cardio-metabolic health in the general population.

Applying Altitude Training In The Real World

The question then is how do we go about applying this understanding? Well the good news is that at The Altitude Centre, we already are! Whether in our altitude chamber in London, or with equipment for home use, our clients are seeing the benefits of including altitude in their programs.

Our health and wellbeing program has seen clients improve muscle mass whilst dropping body fat and overall body mass in just 6 weeks, by including a combination of IHE sessions on the POD (perfect for those that are unable to load at all) and exercise sessions at altitude to progress this further. In the same time, everyday markers of strength improved significantly, improving quality of life and improving participants ability to complete activities of daily living like lifting shopping bags and climbing stairs.

We have previously written about altitude training in rehab, and our work with physios continues to show the utility of altitude in the rehab process. At elite level, many Premier League football clubs are using their altitude chambers to expedite return to fitness post-injury, and the same technology and knowledge that is available to them, is available to anyone on site or at home. Whether it be with bone, muscular or connective tissue injuries, the benefits of including both IHE and exercise at altitude are well known amongst our clients.

This new paradigm in altitude training really does support what we have been pushing; that it is a training methodology for everyone, whether elite athlete or looking for health and wellbeing improvement. Altitude training has never been more accessible, with our centre in London and systems available for use at home making it easy to include hypoxic training in your return to fitness or lifestyle program. To find out more, and discuss your options with our Performance Specialists, contact us today.


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