Q: I have a client who is training to do a summit of Mount Kilamanjaro. What are some of the exercise considerations to help her with the differences in altitude so she can have a better chance of making it without any issues?

So here’s a big situation in which the gym can only go so far. The majority of the features that can be trained in the gym involve general physical preparation, such as increasing strength, neural tone, flexibility, metabolic conditioning, or movement competency, it’s going to be very hard to replicate or even simulate the specific considerations of an environment such as a playing field – which is essentially organized chaos with some elements of programmed randomness – to environmental considerations such as extreme heat or cold, wind or rain, and in this instance altitude.

There is a body of research that shows that those who live at altitude or spend considerable time at altitude have improved oxygen delivery into their muscles for utilization, which makes sense since there’s less oxygen in the air compared to sea level concentrations. The downside is there is still some dispute as to whether training bouts done at altitude for relatively short time frames provide any actual athletic benefit.

Most people who try to summit one of the high peaks have to spend a few weeks at a base camp to acclimatize, or they may run the risk of developing altitude sickness, which can involve a lot of very negative side effects such as reduced plasma volume, depression of red blood cell creation and increased rate of red blood cell lysis, increased sympathetic nervous system activity at rest, which affects respiratory muscles and metabolism. Essentially, you’re always trying to catch your breath and just can’t, so your tissues are slowly starving for oxygen. These can lead to very severe things like pulmonary edema, cerebral hypoxia, and heart rhythm irregularities that each could be fatal.

Most of the benefits for altitude training seem to take weeks or even months, whereas most of the negative aspects of altitude training, like oxidative stress and dehydration could occur almost immediately.

What if you used one of those hypoxic masks that look like Bane from the Dark Knight, or maybe hit up some workouts in a hypobaric chamber (if you’re fortunate enough to have one handy. They’re only about $300,000 to build)?

 

When I first saw these, I immediately thought of the respiration masks I used when I was working on the body of my old Ford Escort with the Tempo engine in it, and also when I was working on cleaning big rigs with a caustic chemical that was hazardous to breathe and wearing one of those was necessary. It sucked because you essentially had to work harder for the same amount of air, and considering work output for most performance aspects is directly dependent on the amount of oxygen you can take in and utilize, limiting your oxygen intake just makes you really efficient at being slow and weak.

Plus the garage respirators cost about half as much and probably clean the air a lot more too.

If it were true that intaking less oxygen was the same as altitude, swimmers would be awesome at summiting mountains. They only breathe about half to one third as many times as the average runner or cyclist in the same time frame, and have to hold their breaths for longer.

Maybe it’s a pressure thing when it comes to altitude. In commercial air travel, there’s lots of oxygen, and it’s typically pressurized to match an altitude of about 2500 m above sea level, but that doesn’t mean it’s without fault. The risks of exposure to this pressure in a rapid manner can increase the risk of developing things like deep vein thrombosis, emotional hyperventilation, edema around the heart and lungs, and even some cerebral distortion. A sudden decrease in pressure can present similar issues as with deep sea diving.

Pressure is determined not merely by the concentration of oxygen, but by the total weight of air in a vertical column above the individual. Most of the time this column of air is heavier at sea level due to the longer column, under a higher temperature, and experiencing a greater gravitational pull from the earth.

 

Air density tends to be significantly lower at altitude, which means the pressure of that gas acting on the body is very different than when at sea level. It’s like walking around with a 30 pound weighted vest all day. Sure you breathe harder, but your knees will hurt, your back will be sore, your muscles will never be without loading, and it will change things in a different manner than just through increasing the demand for oxygen.

The point of all this is to say there’s nothing you can do in a gym at sea level, whether it’s wearing an elevation mask or entering a hypobaric chamber, that can adequately prepare you for life at altitude without actually being at altitude. The impact of altitude goes beyond the concentration of oxygen and involves the pressure of air acting on the body and to how the body deals with those alterations.

The fittest person at sea level will still struggle at altitude.

The best recommendations you could make in regards to their training would be the same as anyone else looking to be ready for a physical challenge. Ensure they have the physical strength to do the activity, with enough endurance to complete the task, and work on improving their VO2 max to support a greater ability to intake and utilize oxygen. These are all general traits, but the goal of any fitness program is to have the general traits transfer over into specific events.

Take for example the trait of strength. Bodybuilders get a lot of flak for being “unfunctional,” as they use machines and train for size versus strength, but let’s be honest, there aren’t many bodybuilders with some sort of size to them who aren’t ridiculously strong. Take for example this “unfunctional” Jay Cutler winning a tug of war against 6 other people (even though a few of them thought they should do it in high heels):

Maybe consider these “old school” unfunctional bodybuilders helping a motorist out of a parking jam.

Strength always seems to transfer to a lot of different activities.

Likewise, improving work capacity in one discipline with a higher VO2 max seems to have a lot of transferability to other activities. The use of an elliptical was even found to be similar in effect to maintain VO2 max training compared with running, based on Bruce treadmill protocol testing, which shows how much the transferability between activities can be. In fact, when intensity matched, there was significant improvements in performance outcomes following training in treadmill, elliptical and stairclimbing, but no significant differences between each modality when tested on a bike. The max loading used was even similar.

So to wrap up this long-winded explanation, you can’t train for altitude in a gym. You can help improve general physical characteristics, but the best hope your client would have to get acclimated to altitude would be to move to altitude for an extended period of at least 21 days, ideally over 3500 m (13000 feet), and best if over 4000m (14000 feet) to see the best adaptations. This is usually basecamp, so make sure they’re spending time there before they try to summit and they should be able to make it alright.