Altitude Training and EPO
Lecture 19
The practice of altitude training and
synthetic EPO doping is usually done by
endurance athletes.
Altitude training has been shown to improve
aerobic capacity and enhance recovery.
This would be extremely important to an
athlete competing in a multi-stage event
like the Tour de France.
• Altitude training:
– Traditionally athletes would live at High
Altitude camps (8000ft above sea level) for
several weeks before the event)
– More common practice now is to have
athletes sleep in high altitude tents or live in
high altitude houses.
• How does high altitude training improve
performance?
– At an altitude of 8000ft the air has ~75% of
the O2 at sea level.
– Lower O2 concentrations in the air means that
the partial pressure of O2 in the blood
decreases.
– Lower partial pressure of O2 stimulates an up
regulation of erythrocyte production (RBC)
thus increasing the hemoglobin content of the
blood
Hemoglobin carries O2
in the blood to working
muscles.
Athletes that live high and compete low (at
sea level where there is normal O2 in the
air) have increased carrying capacity of O2
and consequently greater O2 delivery to
tissues. This increases aerobic performance
and speeds up the recovery process.
• Many studies have shown the benefit of
altitude training on:
– Speed, power, endurance and recovery
• Optimally: Live HIGH, train LOW
– This is tough because it’s a long way up and
down the mountain to get 8000ft down and
back up.
• More Common: Live HIGH, train HIGH
– Also tough because training intensity is
impaired by the altitude. Athletes are also atrisk for altitude sickness.
• Instead of trying to trying to manage living
at high altitude companies commercially
manufacture/sell high altitude systems.
– “tents” or houses that athletes live in or bring
with them that simulate a high altitude
environment (sleep for 10-12 hours)
• Tents have normal sea level pressure but reduced
O2 in the air (15.3% vs. 21% O2)
• High altitude products have shown increases in
RBC and EPO concentrations in the body.
• The use of high altitude performance strategy,
although accepted to benefit performance, is
controversial because the effect on RBC count
decreases within several days at sea level.
• To counteract the “acuteness” of high altitude
training elite athletes often travel with their high
altitude gear to sleep in so they can maintain
their higher hematocrit levels.
• Erythropoietin (EPO)
– Glycoprotein hormone that stimulates
erythrocyte (RBC) precursors in the bone
marrow.
– Produced by our kidney
– Regulates RBC production
Synthetic EPO is available as a therapeutic
agent produced by recombinant DNA
technology in mammalian cell culture
- used traditionally to treat anemia (decrease
in the number of healthy RBC) as a result of
cancer or chronic renal failure
- also used as a common blood doping agent
in endurance sports
Increased aerobic capacity
Altitude Training
Hypoxia: when O2
availability is limited.
• How EPO works:
Kidney
O2 is normal
EPO
EPO
EPO
EPO
EpoR
EpoR
EpoR
EpoR
Higher O2
in the blood
feedbacks
to kidneys
When O2 is LOW
Bone (marrow
not shown)
• Use of EPO for athletic performance:
same premise as high altitude training
strategies.
O2
Performance
Muscle
• Use among athletes began in the 1980’s
but there was no test for it.
• Excessive use of EPO leads to an
overproduction of RBC that the blood
becomes so thick it puts too much strain
on the heart.
• Evidence of EPO overuse among cyclists
surfaced in the early 1990’s when more
than a dozen cyclists dies of heart failure
in their sleep.
• In 1998 a huge doping scandal at the Tour
de France tainted the sport and forced
cycling federations to implement more
stringent testing measures.
• EPO use was initially tested for by
measuring hematocrit concentrations. (this
is the proportion of blood volume that is
RBC)
– Normal is 41-50% for men.
– WADA enforced the legal limit of 50%
– Cyclists employed great doctors to keep their
hematocrit levels at 49.9% with blood thinning
infusions.
• In 2000, a urine test for EPO was used to detect
residues of pharmaceutical EPO
– Test is controversial: several athletes that have tested
positive for EPO use have successfully had their
cases overturned with a defense that the test was
unreliable.
• In 2006 new pharmaceutical EPO (Dynepo) is
expected to be on the market. It is manufactured
in human cells and would have an identical
pattern to human glycosylation that is seen on
natural EPO
– It would be undetectable with the current method of
testing.
The illegal “blood doping” era is likely over
but legal ways to increase whole body
hemoglobin levels to the ceiling of 49.9%
as permitted will continue in the future.