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Randall L. Wilber

“Live high-train low” (LH+TL) altitude training allows athletes to “live high” for the purpose of facilitating altitude acclimatization, as characterized by a significant and sustained increase in endogenous erythropoietin and subsequent increase in erythrocyte volume, while simultaneously enabling them to “train low” for the purpose of replicating sea-level training intensity and oxygen flux, thereby inducing beneficial metabolic and neuromuscular adaptations. In addition to natural/terrestrial LH+TL, several simulated LH+TL devices have been developed including nitrogen apartments, hypoxic tents, and hypoxicator devices. One of the key issues regarding the practical application of LH+TL is what the optimal hypoxic dose is that is needed to facilitate altitude acclimatization and produce the expected beneficial physiological responses and sea-level performance effects. The purpose of this review is to examine this issue from a research-based and applied perspective by addressing the following questions: What is the optimal altitude at which to live, how many days are required at altitude, and how many hours per day are required? It appears that for athletes to derive the hematological benefits of LH+TL while using natural/terrestrial altitude, they need to live at an elevation of 2000 to 2500 m for >4 wk for >22 h/d. For athletes using LH+TL in a simulated altitude environment, fewer hours (12-16 h) of hypoxic exposure might be necessary, but a higher elevation (2500 to 3000 m) is required to achieve similar physiological responses.

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Torben Pottgiesser, Laura A. Garvican, David T. Martin, Jesse M. Featonby, Christopher J. Gore, and Yorck O. Schumacher

Hemoglobin mass (tHb) is considered to be a main factor for sea-level performance after “live high–train low” (LHTL) altitude training, but little research has focused on the persistence of tHb following cessation of altitude exposure. The aim of the case study was to investigate short-term effects of various hematological measures including tHb upon completion of a simulated altitude camp. Five female cyclists spent 26 nights at simulated altitude (LHTL, 16.6 ± 0.4 h/d, 3000 m in an altitude house) where tHb was measured at baseline, at cessation of the camp, and 9 d thereafter. Venous blood measures (hemoglobin concentration, hematocrit, %reticulocytes, serum erythropoietin, ferritin, lactate dehydrogenase, and haptoglobin) were determined at baseline; on day 21 during LHTL; and at days 2, 5, and 9 after LHTL. Hemoglobin mass increased by 5.5% (90% confidence limits [CL] 2.5 to 8.5%, very likely) after the LHTL training camp. At day 9 after simulated LHTL, tHb decreased by 3.0% (90%CL −5.1 to −1.0%, likely). There was a substantial decrease in serum EPO (−34%, 90%CL −50 to −12%) at 2 d after return to sea level and a rise in ferritin (23%, 90%CL 3 to 46%) coupled with a decrease in %reticulocytes (−23%, 90%CL −34 to −9%) between day 5 and 9 after LHTL. Our findings show that following a hypoxic intervention with a beneficial tHb outcome, there may be a high probability of a rapid tHb decrease upon return to normoxic conditions. This highlights a rapid component in red-cell control and may have implications for the appropriate timing of altitude training in relation to competition.

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Malcolm T. Whitehead, Tyler D. Martin, Timothy P. Scheett, and Michael J. Webster

The purpose of this investigation was to determine whether echinacea supplementation results in alterations of erythroid growth factors and erythropoietic status. Twenty-four men age 24.9 ± 4.2 y, height 1.7 ± 0.8 m, weight 87.9 ± 14.6 kg, and 19.3% ± 6.5% body fat were grouped using a double-blind design and self-administered an 8000-mg/d dose of either echinacea (ECH) or placebo (PLA) in 5 × 400 mg × 4 times/d for 28 d. Blood samples were collected and analyzed for red blood cells (RBCs), hematocrit (Hct), hemoglobin (Hb), mean corpuscular volume, mean corpuscular hemoglobin content, prostaglandin E2, ferritin, erythropoietin (EPO), interleukin 3 (IL-3), and granulocyte-macrophage-colony-stimulating factor using automated flow cytometry and ELISA. ANOVA was used to determine significant differences (P ≤ 0.05). EPO was greater (P < 0.001) in ECH at Days 7, 14, and 21 and refected a 44%, 63%, and 36% increase, respectively. IL-3 was greater (P = 0.011) in ECH at Days 14 and 21, which indicated a 65% and 73% increase, respectively. These data indicate that ECH supplementation resulted in an increase in EPO and IL-3 but did not significantly alter RBCs, Hb, or Hct.

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Gordon Sleivert, Val Burke, Craig Palmer, Alan Walmsley, David Gerrard, Stephen Haines, and Roger Littlejohn

To determine the effects of deer antler velvet on maximal aerobic performance and the trainability of muscular strength and endurance, 38 active males were randomly assigned in a double-blind fashion to either deer antler velvet extract (n = 12), powder (n = 13), or placebo groups (n = 13). Subjects were tested prior to beginning supplementation and a 10-week strength program, and immediately post-training. All subjects were measured for circulating levels of testosterone, insulin-like growth factor, erythropoietin, red cell mass, plasma volume, and total blood volume. Additionally, muscular strength, endurance, and VO2max were determined. All groups improved 6 RM strength equivalently (41 ± 26%, p < .001), but there was a greater increase in isokinetic knee extensor strength (30 ± 21% vs. 13 ± 15%, p = .04) and endurance (21 ± 19% vs. 7 ± 12%, p = .02) in the powder compared to placebo group. There were no endocrine, red cell mass or VO2max changes in any group. These findings do not support an erythropoetic or aerobic ergogenic effect of deer antler velvet. Further, the inconsistent findings regarding the effects of deer antler velvet powder supplementation on the development of strength suggests that further work is required to test the robustness of the observation that this supplement enhances the strength training response and to ensure this observation is not a type I error.

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Laura A. Garvican, David T. Martin, Sally A. Clark, Walter F. Schmidt, and Christopher J. Gore

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Alan D. Rogol

Most hormonal agents used for nonmedical purposes in athletes have legitimate medical uses. This review introduces each compound by its pharmacology, clinical pharmacology, and legitimate medical use and reviews information on its abuse. Human growth hormone is presently available in virtually unlimited quantities due to its production by recombinant DNA technology. Its use in athletes is considered for its muscle-building, fat-depleting properties. Erythropoietin is a kidney hormone that increases red cell mass. It is used for renal dialysis patients to avoid blood transfusions. Its use in athletes is to raise red blood cell mass in an attempt to augment maximal oxygen capacity and the ability to do endurance work. Human chorionic gonadotropin has the biological activity of luteinizing hormone to increase testosterone synthesis and to maintain (partially) testicular volume when exogenous androgens are taken. Clenbuterol is a beta2 adrenergic agonist with muscle-building properties that are seemingly specific to striated muscle; clenbuterol may cause reduction in body fat.

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Mitsuo Neya, Taisuke Enoki, Nao Ohiwa, Takashi Kawahara, and Christopher J. Gore


To quantify the changes of hemoglobin mass (Hbmass) and maximum oxygen consumption (VO2max) after 22 days training at 1300–1800 m combined with nightly exposure to 3000-m simulated altitude. We hypothesized that with simulated 3000-m altitude, an adequate beneficial dose could be as little as 10 h/24 h.


Fourteen male collegiate runners were equally divided into 2 groups: altitude (ALT) and control (CON). Both groups spent 22 days at 1300–1800 m. ALT spent 10 h/night for 21 nights in simulated altitude (3000 m), and CON stayed at 1300 m. VO2max and Hbmass were measured twice before and once after the intervention. Blood was collected for assessment of percent reticulocytes (%retics), serum erythropoietin (EPO), ferritin, and soluble transferrin receptor (sTfR) concentrations.


Compared with CON there was an almost certain increase in absolute VO2max (8.6%, 90% confidence interval 4.8–12.6%) and a likely increase in absolute Hbmass (3.5%; 0.9–6.2%) at postintervention. The %retics were at least very likely higher in ALT than in CON throughout the 21 nights, and sTfR was also very likely higher in the ALT group until day 17. EPO of ALT was likely higher than that of CON on days 1 and 5 at altitude, whereas serum ferritin was likely lower in ALT than CON for most of the intervention.


Together the combination of the natural and simulated altitude was a sufficient total dose of hypoxia to increase both Hbmass and VO2max.

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Yuki Kokubo, Yuri Yokoyama, Kumiko Kisara, Yoshiko Ohira, Ayaka Sunami, Takahiro Yoshizaki, Yuki Tada, Sakuko Ishizaki, Azumi Hida, and Yukari Kawano

This cross-sectional study explored the prevalence of iron deficiency (ID) and associations between dietary factors and incidence of ID in female rhythmic gymnasts during preseason periods. Participants were 60 elite collegiate rhythmic gymnasts (18.1 ± 0.3 years [M ± SD]) who were recruited every August over the course of 8 years. Participants were divided into 2 groups according to the presence or absence of ID. Presence of ID was defined either by ferritin less than 12 µg/L or percentage of transferrin saturation less than 16%. Anthropometric and hematologic data, as well as dietary intake, which was estimated via a semiquantitative food frequency questionnaire, were compared. ID was noted in 48.3% of participants. No significant group-dependent differences were observed in physical characteristics, red blood cell counts, hemoglobin, hematocrit, haptoglobin, or erythropoietin concentrations. The ID group had a significantly lower total iron-binding capacity; serum-free iron; percentage of transferrin saturation; ferritin; and intake of protein, fat, zinc, vitamin B2, vitamin B6, beans, and eggs but not iron or vitamin C. The recommended dietary allowance for intake of protein, iron, zinc, and various vitamins was not met by 30%, 90%, 70%, and 22%–87% of all participants, respectively. Multiple logistic analysis showed that protein intake was significantly associated with the incidence of ID (odds ratio = 0.814, 95% confidence interval [0.669, 0.990], p = .039). Participants in the preseason’s weight-loss periods showed a tendency toward insufficient nutrient intake and were at a high risk for ID, particularly because of lower protein intake.

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.1123/ijsnem.17.4.364 The Effect of 4 Wk of Oral Echinacea Supplementation on Serum Erythropoietin and Indices of Erythropoietic Status Malcolm T. Whitehead * Tyler D. Martin * Timothy P. Scheett * Michael J. Webster * 8 2007 17 17 4 4 378 378 390 390 10.1123/ijsnem.17.4.378 A Meta-Analysis of the

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. Vleck * 9 2007 2 3 315 322 10.1123/ijspp.2.3.315 Technical Reports The Time Course for Changes in Plasma [H+] After Sodium Bicarbonate Ingestion Andrew Renfree * 9 2007 2 3 323 326 10.1123/ijspp.2.3.323 Case Studies Variability of Erythropoietin Response to Sleeping at Simulated Altitude: A Cycling