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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

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
Lower partial pressure of O2 stimulates an up
regulation of erythrocyte production (RBC)
thus increasing the hemoglobin content of the

Hemoglobin carries O2
in the blood to working
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 its 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
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:

O2 is normal



Higher O2
in the blood
to kidneys

When O2 is LOW

Bone (marrow
not shown)

Use of EPO for athletic performance:

same premise as high altitude training




Use among athletes began in the 1980s

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 1990s 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
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

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

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

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.