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Is it possible to physically simulate hypoxic training by doing periodic breath holds or breath regulation during aerobic activity?

Ideally, it ought to be done in a hypobaric/hypoxic chamber whilst strapped to some monitors. But short of that, I can think of two ways -

  1. While running, every few minutes, I can try to hold my breath for a couple of steps initially and gradually increase it to 8-10 steps
  2. if I normally run say 6 steps per inhalation+exhalation cycle and I try to increase it to 7 and further on.

What I would like to understand is

  1. if it will work?
  2. the risks involved, and how to mitigate them (e.g. a pulse oximeter on a finger to monitor?)

I considered posting this question on the physical fitness SE, but did it here instead considering that I would prefer an answer by someone trained in the medical sciences.

In general, based on past work (ref: 1, 2, 3, and 4) it seems that intermittent hypoxic training is indeed beneficial. But most "professional" work (both researchers and athletes) in the area uses hypoxic chambers - which is not practical for the average internet user.

What is less clear is if breath control is an adequate method of simulating hypoxic training. The only reliable references (the runnbetternow website and an NIH publication by a yoga center) I could find aren't exactly by medical professionals. FWIW, these references are in favor of the method. The question is if medical practitioners agree.

The end goal here is to prepare for mountain activities. As it is not practical to move one's permanent base to a mountain top, one would like to be able to somehow simulate high altitude training whilst still living at sea level. Of course, this will be in addition to (not in lieu of) actually periodically training at altitude.

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    What has your research revealed so far? – Carey Gregory Oct 29 '19 at 4:13
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    Research by medicine professionals indicates that hypoxic training is beneficial. But my question is about if breath control is a good of simulating that - on this subtopic, the only good references I had found weren't by medical professionals... just updated the question with further details. – Yogesch Oct 29 '19 at 5:47
  • Might sound unusual, but what do you want to achieve and how you believe would that be good for you? There are many physical exercises, meditation, mind-related and dietary practices that can help achieve people to achieve something, but I believe this can only work if you know what exactly do you want to achieve. – Jan Oct 30 '19 at 15:58
  • @Jan Perhaps I should have mentioned this in the question itself (just updated it) - the goal is to simulate high altitude training (to prepare for mountain activities) whilst still living at sea level. Of course, this will be in addition to (not in lieu of) actually training at altitude. – Yogesch Oct 31 '19 at 4:25
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The approach you describe most likely will not work, and could be detrimental to your training.

The main benefit of training at altitude is that the body will adapt to the lower concentration of oxygen by stimulating the production of erythropoietin which in turn causes the body to produce more red blood cells.

What you are describing is a very limited version of intermittent hypoxic training (IHT). In subelite athletes, this has been shown to have some effect, however it was 60 minutes of training using a protocol of 3-5 minutes of hypoxia followed by the same amount of time of normoxia (normal breathing). (Also cited here.)

In a study of male subelite competitive cyclists and triathletes, athletes were exposed to intermittent hypoxia (artificial brief intermittent LHTL) for 15 days over 3 weeks for 60 min per day with either 3 or 5 min periods of hypoxia followed by the same duration in normoxia. Cycling performance improved during incremental step exercise, including increases of 4.7% ± 3.1% in peak aerobic power, 4.4% ± 3.0% in lactate profile power, and 6.5% ± 5.3% in heart rate profile power compared to control measured 3 days post-intervention.35 Fourteen days after treatment, differences between the hypoxia groups were unclear, suggesting that intermittent hypoxia training should be timed for competitive events to take place within a few days following treatment. In a similar study, performance did not improve among elite athletes,36 suggesting that artificial brief intermittent LHTL should be considered mainly by subelite athletes.

The most common method of attempting to achieve this is a training mask, which restricts air flow. Most studies (like this one) reject the claim that it helps by actually simulating altitude, but they do note that it helps train the respiratory muscles and may help improve lung usage.

The short period that you describe really won't have enough of an impact on the body to stimulate altitude related changes in blood and plasma.

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  • Hi John, on further reflection, I think it does make sense that very brief periods might not be effective. Might I request to elaborate a bit further on why the training mask wouldn't/doesn't simulate altitude? The body only knows that it is getting less O2 for a prolonged period of physical activity, and probably should start making more RBCs. Why does it matter if the reduced O2 is because of the lower atmospheric pressure or because of the mask? – Yogesch Nov 3 '19 at 3:22
  • On closer look, I believe the Porcari et al paper actually mentions "It has been suggested that in order to obtain the benefits of acclimatized altitude training the athlete must spend at least 12 hours a day for at least 3 weeks at an altitude of 2100-2500m". So it is likely the mask doesn't simulate altitude in their experiment mainly because it just isn't used for 12+ hours/day. – Yogesch Nov 3 '19 at 4:06
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Since there is a good answer already I'll just add my two cents from my understanding of physiology: Hypoventilation has two effects during exercise:

  1. Less available oxygen in your lungs and a somewhat less amount of oxygen in the blood that comes out of your lungs, which is not as big a difference as you might expect because hemoglobin is incredibly efficient at sucking up all available oxygen. Under stress conditions (heat, acid metabolites and CO2 all inhibit the binding of oxygen to hemoglobin) this sucking up is somewhat dampened but if the gradient is large enough large quantities of oxygen are still easily captured in the lungs.
  2. A large increase of CO2 in your blood, which in turn stimulates your breathing reflex, making it near impossible to force yourself to breathe less. This effect would be much larger.

Furthermore, to be successful at high altitude survival there is one key aspect that needs to be there, and I'm not sure if it can be trained: Hyperventilation is essential to get enough oxygen into your blood under hypoxic conditions. Most people don't have a strong enough breathing reflex though to breath more when oxygen is low and CO2 is normal or low. It's not natural to hyperventilate, and not very healthy either. Maybe it can be trained at sea level to compensate for the stress that hyperventilation causes on your body?

Interestingly, the people of Tibetan descent that lived in the Himalaya evolved a protecting mechanism against the increase of red blood cells during long stays at high altitudes. Other peoples that live at high altitude, for example those that live in the Andes lack this protection and their blood thickens up to a point where it causes serious health problems.

Dehydration is another serious threat at high altitude: hyperventilation makes you lose plenty of water through your breath. And brain swelling is also a nasty complication of stays at very high altitudes...

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  • Thank you for the good explanation, Michael. "near impossible to force yourself to breathe less" I am already trying this, and I agree this is really really hard, but not actually impossible. Similar to breath holding training exercises for diving/surfing. When training at actual high altitude, I do/did in fact notice a decent level of hyperventilation. A follow up question if I may... would a hypoxic mask be a better tool for stimulating hyperventilation? – Yogesch Nov 3 '19 at 3:16
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    Breathing normobaric hypoxic air would simulate high altitude much better than exercise with hypoventilation! I highly recommend this lecture by John West to go into more detail: youtu.be/QRN124iuqZ8 – Michael Paul Nov 3 '19 at 8:37
  • @Michael, hyperventilation makes you lose more water, but you can compensate this by drinking more water. It's like sweating makes you lose more water but you can easily correct that. So, hyperventilation does not automatically cause dehydration. Just sitting at the desk and not drinking for a while can make you dehydrated. I mean, dehydration occurs just with time, so I don't think this needs to be emphasized here. Also, staying at high altitude by itself does not cause brain edema, but just as part of altitude sickness. I want to say that I didn't see the need for your last paragraph. – Jan Nov 4 '19 at 8:01
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    @Yogesch, I'm not sure if this is relevant for you, but hyperventilation is only a temporary compensation, which allows more oxygen to enter your blood. The repeated episodes of hyperventilation by themselves do not make your blood or body better adjusted to hypoxic environment. Of course, they will be other results of training that can help you adjust, for example, gradually more developing capillary network in your muscles. – Jan Nov 4 '19 at 8:11

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