Lifestyle management at altitude

Altitude training is forming an important part of the training programmes of many endurance athletes.  Living at altitude can pose a range of challenges, however, and particular aspects of lifestyle may need additional attention, particularly in relation to preventing overtraining and boredom.

Athletes may become lethargic because of the boredom, and those who fail to embrace the local culture may regret missing out on potentially inspiring and enjoyable experiences.  It would be a shame to fly all the way to South Africa, and never to see and animal in the wild!

Conversely, those to try to fit too much in, fail to recover adequately from training.  Attempting to fill the time between training with some more training will lead to burnout.  You could get addicted to computer games (or sudoko, strib scrabble, or poker for training kit) and delay or skip training as a result.  Spending all day visiting sites and attractions, may result in sore feet, tight muscles and increased risk of injury.

If you fill all your spare time with sleep, and may generally lethargic, or become unable to sleep at night.  You will need more sleep than normal at altitude, and afternoon naps are not only acceptable, but generally recommended.  But oversleeping, or sleeping to kill time may be detrimental to your training.

Spending all your time sunbathing isn’t the answer either.  The sun’s UV rays are stronger at altitude, and you will be more susceptible to sunburn than at sea level. 

You could also dragged into other people’s routine.  Having other people around you is a good thing, but remember that everyone responds to altitude different, and you may need more recovery time than others.  Finally, spending too much time with your friends or training partners can lead you to getting on each other’s nerves.

Of course, these factors may be similar to the challenges that full-time athletes face in their everyday lives.  We will revisit the pros and cons of being a full-time athlete in a future post, but in essence, athletes become full-time athletes when they go away on training camp, and that can have positive and negative aspects. It isn’t all bad of course, but care must be taken to not slip into the many pit falls.

Don't miss out on the opportunities that training abroad can offer

The training camp mentality

Training camps can be a great way of injecting a new impetus into training.  A new environment can be energising and brief, intense spells of training can help athletes reach a new level.  Athletes tend to be more motivated when they are training in a group and have no other distractions.  Training camps are not without their pitfalls, however, and being over motivated can be particularly detrimental when it comes to training stints at altitude.

Taking time to acclimatise to altitude can be the key to a successful training camp.  Too often I hear people saying that they’ve done their hardest ever week of training or hit new ‘personal best’ mileage figures while training at altitude, or tweeted about how much running at altitude has ‘kicked their asses’.  

At sea level, training in a group can help stretch most athletes to achieve their best.  Occasionally trying to keep up with better athletes can sometimes reap results.  Training in a group at altitude, however, is generally a bad thing.  Every athlete respond to altitude differently, and in addition to risking your physical health by working too hard, competing and measuring yourself against others can have detrimental effects on your mental performance. 

Key advice

• Work out your own programme with your coach and follow it
• Monitor your HR, RPE and general wellbeing, and adapt your programme if required
• Remember that less is more.  Just because you’re away on training camp, doesn’t mean that you have to train all the time.  Recovery is part of training too.
• Don’t get dragged into the group mentality
• Avoid going away with training partners that are overly competitive in training

Rest and recovery

We’ve all heard that resting is training too, but nowhere is the sentiment more true than when training at altitude.  Most of the physiological adaptations that occur at altitude, actually happen at rest.  Living at altitude is far more important than training at altitude (unless of course your training to compete at altitude). 

Basic acclimitisation to altitude takes approximately 14 days, though this varies depending on the individual.  During this time resting and training heart rates will be elevated, recovery times between intervals will be significantly increased, and more sleep will be required.  Your body will be working hard to increase EPO secretion, build new red blood cells, and to respond to the acute effects of the lower air pressure and oxygen availability.  Sometimes it’s best to just let the body get on with that.

Key advice

• Reduce overall training volume by 10-20 percent during the first week, and increased gradually over the next three to four weeks.
• Reduce the intensity of interval sessions by 5-10 percent initially, and increased gradually.  Intervals should be shorter than normal, and recovery time between them doubled. 
• Take an additional recovery day between hard workout days.  Use resting HR as an indicator of recovery, and skip any planned workout if the HR is elevated more than normal.
• Remember that there are huge individual variations in response to altitude.  Listen to your own body and don’t measure yourself against others.
• Remember, with altitude training, less is more, particularly during the first two weeks. 

The Grand Canyon makes a great day out when training at altitude in Flagstaff

The boredom factor

Boredom can be an issue when training at altitude, and striking a balance between killing time, relaxing, and embracing the sites and culture of your training environment, can be difficult.  Boredom can lead to depression, so susceptible athletes should take particular care.

If you’re in charge of your own travel plans, choose somewhere that will cater for your entertainment needs.  If you don’t like sitting around all day talking and drinking tea, then Kenya may not be for you.  Choose a big city if you like to have lots to do; and smaller towns if you prefer to be close to nature.

Key advice

• Decide on one or two things that you would really like to do while you’re away, and then decide where those activities will best fit into your training programme.  A safari might be a good way to recover from a long haul flight and adjust to altitude, while a trip to the grand canyon might be a suitable activity for a rest day. 
• Have one worthwhile task to do while you’re away. Catching up with university work, doing an online course, writing blogs or magazine articles, or updating your website are just some of the projects that you could complete.
• Enjoy your mealtimes; it’s not every day that you can take your time eating food.  Dining halls are also a good way to meet new people, and to soak in the culture of your surroundings. 
• Not everyone loves to eat, sleep and breathe their sport.  Find what works for you and plan accordingly.

Chess or draughts can be a great way to pass the time and keep the brain active

Nutrition and staying healthy

Diet is very important when training at altitude, and adjustments may have to be made to ensure that you are getting all the nutrients that you need.  

Since more oxygen is required to break down fat than carbohydrates, 80 percent of calories should be derived from low glycaemic carbohydrates.  Meals should be taken every 4 hr.  Increased carbohydrate utilization may result in glycogen store depletion, so make a conscious effort to replace carbohydrates during and after training.

Reduced nutrient absorption in the gut at altitude results in greater faecal losses.  Maintaining a high proportion of carbohydrate, and ensuring that overall calorie intake is adequate may reduce or offset this faecal loss.  Basal metabolic rate increases for the first 4 days of altitude exposure, particularly in females.  After 4 days metabolic rate begins to return to normal, but remains above sea level values. 

Some individuals may experience reduced appetite.  Small but regular meals, and eating a variety of fresh products, may help.  Apples and grapes in particular have natural chemicals which increase appetite.

 Iron is also very important and depleted iron stores is one of the reasons why some people do not respond to altitude.  Iron is a mineral that is essential in the production of haemoglobin.  Haemoglobin is the part of the red blood cell which attaches to oxygen and transports it around the body.  As the body turns iron stores into additional red blood cells in response to the hypoxic conditions and subsequent increased erythropoietin syntheses, the demand of iron rises, and with it the risk of developing anaemia, even in health runners.

There is risk of immunosuppression, and a subsequent increased risk of upper respiratory tract infections and gastrointestinal infections, at altitude.  It is important that you listen to your body, have adequate vitamins (A, folic acid, B₆, B₁₂, C and E) and minerals (copper, selenium and zinc) in your diet, and replace carbohydrates quickly after exercise.

Because of increased ventilation, increased urinary water loss, and low humidity at altitude, the potential for dehydration is increased.  Caffeine-free fluid intake should be increased by as much as 4 litres per day.  Monitor morning urine colour to ensure that fluid needs are being met, and reduce caffeine consumption.

Dealing with Injury

If you are training at altitude, and get an injury that prevents you from carrying out your normal training, it is best not to panic.  Depending on the severity of your injury, how far you are into your trip, and on the duration of your planned trip, you have a number of options.

The most important thing is that you get treatment for your injury.  If you do not have support personnel with you, cannot find access to a suitable physiotherapist, and do not know what your injury is and how to treat it, you may be best taking complete rest.  If you have a long trip planned, you could look at shortening your trip.

Even if your ability to train is severely hindered by your injury, you will still benefit from sleeping at altitude.  If you would have to rest even if you were at home, you may still be able get some benefit from your trip, and the solitude of altitude may help with adherence to rehab exercises.

Cross-training may be particularly beneficial at altitude and cycling, aquajogging, or even just walking, may be sufficient to raise the heart rate to sea level easy exercise levels in some individuals.

If you are susceptible to injury, or have a recurring injury, ensure that you have access to physiotherapy, and/or medical backup, have access to cross-training facilities if required, and have investigated if the trails are suitable for you.

If all else fails, and if it’s not practical for you to go home early, consider that your injury may be your body telling you to take a break.  Consider if you actually need a holiday.  Make a conscious effort to make the most of the trip, and add in some extra sightseeing, make some new friends, and relax.  Make the most of the hypoxic air!

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My recently published book, Notes from higher grounds, is available through Amazon (click on image below).  It is essentially a travel guide for those looking to arrange a trip to altitude, and covers 15 different venues in detail, but also includes practical advice on how to deal with travel and training at altitude.

Travel advice for athletes

The high performance athlete spends a considerable amount of time on the road.  With regular short trips to training, journey to compete at home and abroad, and flights away for warm-weather and altitude training trips, the miles, and time spent travelling, quickly add up.  For many people travel can be a stressful experience; something that is seen as a negative consequence of getting from one place to the next. Travel doesn’t have to be an additional stress in an athlete’s life, and when properly planned, it can be productive, motivational and even enjoyable!

The risks of long-haul flights: jet-lag, fatigue, stress and infection

There are a number of risks to health and performance associated with travel.  Trying to do a hard session straight after getting off a long-haul flight isn’t the brightest idea in the world; breathing recirculated cabin air when flying can increase the risk of infection; and rushing around and getting stressed can wear you down.  Here is some practical advice to help you get through long journeys:

• Be organised, and pack well in advance of your trip
• Get a good night’s sleep before you travel
• Complete the Travel Preparation Worksheet to ensure that you have everything covered
• Don’t do a heavy session immediately before or immediately after a long flight, as this will increase your injury and infection risks
• Pack plenty of food and snacks, and eat fresh healthy food where possible
• Check out the jet-lag factsheet for advice on coping with jetlag
• Add in additional time for things to go wrong when travelling to the airport
• Drink plenty of liquids, but avoid alcohol, on the plane
• Delays are a common part of travel.  Don’t let delays stress you out.  Use the time to stretch, walk out tired legs, read, and stock up on liquids and snacks.

Other essential travel advice

• Email a copy of all important travel documents (passport, visa, driving licence, travel vaccine records, itinerary, travel insurance and important telephone numbers) to yourself so that you can still access this information if all your belongings are stolen.
• Be aware of hand luggage allowances. Liquids greater than 100ml are not allowed in hand luggage and many budget airlines have a strict hand luggage allowance.
• Inform your bank of your planned trips to avoid your credit/debit card being blocked while you’re abroad.
• Pack important training or competition kit in your hand luggage so that you can still compete/train if your checked baggage doesn’t arrive.
• If you travel frequently duplicating toiletry items such as hairbrush, razor, toothbrush, shampoo can make packing and unpacking easier.
• Roll rather than fold cloths to prevent wrinkles and create more space.
• Label luggage clearly on both inside and outside to avoid confusion if outer label gets ripped off.
• When buying bus/train tickets in a country where you can’t speak the language use a phrasebook to write down the destination, ticket type and travel date in the native language before approaching ticket counters.
• If travelling with a group, don’t always depend on others.  Know the address of your accommodation or where you’re supposed to be in case you get detached from the group, or lost.  Take responsibility.
• Give yourself some peace of mind.  Travel insurance costs less than you think.  If you travel a lot consider annual multi-trip insurance.  It works out cheaper, and saves you having to worry about insurance every time you travel.
• Always pack toiletries in a plastic bag to prevent spillages in your luggage.
• If you find travel a useless waste of time, try to be productive. Listen to a language CD when driving; do some study on the plane; take up a needle craft, write your Christmas cards on the train, use the time to catch up on sleep.
• Enjoy!!!!!!!!

Essential preparation – things to do and plan well before your trip:

• Passport - does it have at least 6 months validity?
• Visa - do you need to apply in advance?
• What vaccine requirements are there?
• Arrange money/currency and alternative forms of money should anything go wrong
• Transport to/from airport
• Accommodation
• Check expected weather
• Inform bank of travels

Packing checklist

Before you embark on a trip, it’s a good idea to put together a list of everything that you need to pack.  Not only will this help prevent you forget important items, it will also make you more efficient and ensure that the correct items are in hand/hold luggage.  The beauty of making a list, is that next time you travel you only have to adjust the list rather than start from scratch.  Do this for short domestic trips as well as longer international trips.

Useful resources

www.fco.gov.uk

www.dh.gov.uk

www.wunderground.com

Jet-lag and travel fatigue, and travel nutrition factsheets, and travel preparation worksheet from AltitudeTrainingCamps.com

Travel Nutrition - The Basics

High performance athletes are constantly on the go, not only travelling around the country for competition and training, but often across the globe.  Managing your diet can be one of the most difficult things to do while you’re away, and your nutrition may need considerable planning and preparation before you travel.  This article aims to point out some of the common problems, and give advice on how to overcome them.

There are 3 main areas to consider:

Ensuring that you have adequate micro-nutrients to prevent illness (colds, virus, infections)

Ensuring that you have enough of the right calories to fuel performance and aid recover

Prevent traveler’s diarrhea, and other illnesses from unhygienic food preparation conditions and unfamiliar food.

Packing for your Trip

·   Pack as much food as reasonably possible for your outward journey.   Food should be a fresh as possible, bearing in mind that if you don’t like the food out there you may have to survive the remainder of the trip on processed foods such as cereal bars.

·    When packing foods keep airport restrictions on hand luggage allowance (flying from UK airports, you are only allowed 1 item of hand luggage), fluid restrictions (no liquids in hand luggage through security), and restrictions on exporting/importing meat products to/from other countries in mind.

·        Remember that if your flight is delayed you may not have time to eat in the airport before you catch your connecting flight.

·     Food available for sale at airports tends to be expensive and it can be difficult to find nutritious options.  It is always useful to have some supplies in case of unexpected delays.

·    If you have to buy food in the airport, buy the most nutritious available (e.g. fresh made sandwiches or rolls; fresh meat with salad) even if this is not the cheapest option.

·    Once you have cleared security, make sure that you buy adequate fluid supplies for your flight.

Good Foods to Pack

Dried fruit

Nuts and seeds

Tinned Fruit

Dutch breakfast cake (only 3% fat)

Cereal bars

Breakfast cereal

Crackers

Fig rolls, Jaffa cakes & other low fat biscuits

Rice cakes

Liga, Rusks and other dry baby food

Jam, honey, peanut butter

Instant noodles

Baked beans, tinned spaghetti

Powdered milk

Powdered sports drinks

Jellies and sweets                              

Concentrated fruit juice and fruit squash

Peanut butter

Plane Food

·        It is best to take your own supply of suitable snack foods to supplement the meals supplied on board.

·      The vegetarian meal choice on most airlines is usually rice or pasta based so is a good alternative if you are expected to train shortly after you arrive.

·       Long hours of travelling can upset your digestive system.  To minimise constipation, drink lots of fluids and eat fibre-rich foods such as fresh fruit, wholemeal bread, breakfast cereals and vegetables.  When flying, a vegetarian or low fat meal usually provides more fibre than the regular meals.

·       Fluids are very important.  The humidity in an aircraft is around 10-15%, which means that the moisture is literally drained from your body.  Drink water or fruit juice.  Travelling with your own drink bottle on long flights is a great idea.  Don’t be afraid to ask for extra water or other beverages

·        Don’t drink alcohol on the flight.

·        Avoid drinking too much tea, coffee and cola; all of these may increase dehydration

·        Avoid overeating to relieve boredom.  Drink fluid instead!

The Dining Hall

·       If you are going to be eating in a dining hall, try to get a copy of menu in advance.  Using sound nutrition principles elect what you want to eat and stick to it.  Avoid trying everything on the menu. 

·        In most instances your meal should mainly be carbohydrate based (noodles, potatoes, cereal, bread), with some protein (eggs, meat, fish, cheese), and ample fresh vegetables.

·        Avoid eating food that you are not used to.

·        Practice eating what you will eat on competition day as soon as you arrive.

·        Eat plenty of fresh fruit when available.

·        Don’t be afraid to ask for alternatives if your nutritional requirements are not being met.

Food Safety

·      Be particularly careful in African, Asian and South American countries where food hygiene may not meet ‘Western’ standards

·       The general rule in countries which has a reputation for food poisoning the general rule is: ‘Peel it, cook it, shell it, or forget it’

·        Do not eat from stalls.  Eat only in places well-known or recommended by a reliable person

·        Where possible, eat food that has been well cooked.  It should be hot too.

·        If the local water is unsafe to drink:

§  Drink only bottled water or drinks from sealed containers

§  Avoid ice in drinks

§  Clean teeth with bottled water

§  Avoid salad vegetables unless washed in bottled or boiled water

§  Only eat fruit if it can be peeled

·       If vomiting or diarrhea does occur, it is important to replace lost fluids and electrolytes.  Oral rehydration solutions and a safe water supply should be used.  A bland diet consisting of dry toast, crackers, biscuits and rice may help.  Avoid alcohol, fatty foods and dairy products until the diarrhea has ceased.  If you are using oral contraceptives, beware that absorption may not have occurred due to diarrhea.

Fluids

•      The importance of fluid, especially in the hot and humid weather, cannot be overemphasized — always have an adequate fluid supply with you.
•          Always make sure that bottles are sealed before you buy/use them.
•          Ensure that you are always drinking from your own bottle

Eating for Recovery

Plan a recovery strategy, do not leave it to chance.

·        The best time to start refuelling is as soon as possible after exercise, as glycogen storage is faster during this post-exercise ‘window’ than at any other stage.  Carbohydrate store replenishment during the first two hours post exercise is 1 and a half times faster than normal.  It continues to be faster than normal during the subsequent 4 hours.  Therefore, eating carbohydrate during this time speeds glycogen recover. 

·        Most researchers recommend consuming 1g carbohydrate per kg body weight during the 2-hour post-exercise period.  So, for example, if you weight 75 kg you need to consume 75g carbohydrate within 2 hours of exercise.   For efficient glycogen refuelling, you should continue to eat at least 50 g carbohydrate every 2 hours until your next  main meal.  If you leave long gaps without eating, glycogen storage and recovery will be slower.

·        Immediately post exercise, choose foods with a high or moderate glycaemic Index (GI) in either liquid or solid form (or a mixture of both).

·        Suitable foods include cereal bars, rice, sports drinks, breads

·        If exercise suppresses your appetite, try apples, grapes or other fruit.

·        Nutrient–rich carbohydrate foods and meals after exercise, not only help refuel, but also help boost the immune system which is suppressed immediately post exercise.

Another area to consider?

Meat production in some Asian, African and South American countries is not subjected to the same rigorous controls as in Europe.  Use of illegal hormones to aid lean meat production has been blamed for inadvertent doping offensives, particularly in the case of Clenbuterol.  Clenbuterol is a banned substance in sport, and levels can be raised by eating contaminated meat.  Mexico and China have both been associated with illegal Clenbuterol use.  Care should be taken when travelling to these countries.