ARE ELEVATION MASKS TOO GOOD TO BE TRUE?

Hello everyone,

I have been doing some research on the use of elevation masks for improved athletic performance. I believe I have remained fairly neutral in my research and stayed objective to the findings. What is surfacing is the lack of evidence to support spending upwards of $100 on such a device. I discovered some claims are true but the major claim of mimicking high elevation adaptations leaves room for skepticism.  

WHAT IS AN ELEVATION MASK?

One manufacturer describes it as a device designed to improve performance by increasing lung capacity and breathing strength by creating pulmonary resistance. This means that your inspiration muscles have to work harder to draw in breath. The company also claims an increase in maximal oxygen uptake (VO₂max), or the amount of oxygen consumed by the body. Oxygen consumed is not the same as oxygen inhaled. Consumed oxygen is only the amount actually used at the cellular level. 

WHERE DID THE IDEA ORIGINATE?

In 1968, the Olympics were held in Mexico City, Mexico. The elevation of Mexico City is around 5,280 feet (2,400 m) above sea level. To contrast, the elevation of New York City is 500 feet (227 m) above sea level. The endurance athletes had a difficult time performing in the increased elevation. In fact, some reports state no new endurance records were set that year. Believing the reduction in oxygen (and failure to successfully acclimatize) prevented the endurance athletes from performing at maximum, many teams developed altitude facilities. They hypothesized that elevation training would promote the formation of red blood cells. The increase in red blood cells would improve oxygen delivery and keep the athletes competitive at altitude.  

Theoretically this makes sense. Low atmospheric pressure and decreased oxygen in the blood forces the body to adapt the cardio-pulmonary system to the changes. The body increases blood plasma volume (PV) and the number of red blood cells (RBC) to maximize breathing capability. Hemoglobin (Hb) is the active protein inside RBC that transports oxygen from the lungs to body cells and carbon dioxide back for exhalation. Some of the athletes acclimatize to the higher elevations taking on the adaptations we discussed. When they return to sea level to train, they should have enhanced athletic performance.  

Sadly, there is little evidence showing repeated positive outcomes regarding this method. Only a handful of athletes return to sea level to break world records. I surmise a reason is the diversity of the individual. Not everyone will have a positive adaptation, and some will not change or may even decline. There are serious side effects for those who cannot adapt including shortness of breath, decreased exercise capacity, coughing, mental slowness (primarily affecting P3 brain activity), and changes in skin color. Long-term exposure leads to pulmonary hypertension and right ventricular failure of the heart.

Research has explored variations of altitude training. They include live high train high, live high train low, live low train low, and live low train high. 

WHAT DOES THIS HAVE TO DO WITH WEARING A MASK AT NORMAL ALTITUDE?

The designers of elevation masks base their claims on the theory I presented earlier (if not, why not call them resistance masks?). The idea is that the mask will simulate breathing at a given altitude. Here are a few problems with this idea. How do you know what altitude will elicit the greatest physiological response for you? I guess you could gauge it by how you feel. Then again, how many people felt great just before they suffer a heart attack? Better yet, have you even watched those "Gym Fail" videos on YouTube? I bet most of them believed they were exercising correctly.
The most important part of elevation training is (wait for it….) elevation. Remember atmosphere has weight. This is why divers must depressurize as they ascend. The weight of the water compresses everything in the body and alveoli gas diffusion is hindered. In contrast, the reduced pressure of elevation eases the ability of blood vessels to grow larger (vasodilation), and lungs to expand. Vasodilation enables the increase in plasma volume, which in turn enables substantial increases in RBC. However, uncontrolled reduction in oxygen getting to the body (hypoxia) has been shown to cause training maladaptation in some athletes. In other words, they became worse at their sport. Hypoxia has been shown to decrease endurance potential in some athletes by increasing carbohydrate demand for energy consumption.

part 2

OK, now I began to wonder about the constrictive properties of the mask. For them to mimic breathing at a given elevation, they have to reduce the amount of air getting to you, right? Research demonstrates that uncontrolled hypoxia can lead to damage. Here are some facts about blood oxygen levels and brain function. When blood oxygen levels drop to around 80%, it begins to interfere with cognitive abilities (the ability to reason, understand concepts, and thought). Extreme hypoxia can lead to balance issues, disability to stand, and muscle paralysis. Below 60% and most people will be unconscious. Near 40% death occurs. I’m not suggesting the mask will eliminate 80% of atmospheric oxygen in itself. I am suggesting decreased availability of oxygen and increased physical activity will deplete blood oxygen levels substantially. Dangerously low blood oxygen levels could result from the combination of the two.

WHAT BENEFIT IS THERE?

Research supports endurance training promotes increased oxygen absorption in cells.  The amount of oxygen consumed out of the blood is referred to as VO₂max. This number is different than how much oxygen we take into our lungs. This is where we introduce the role of the elevation mask.

POSITIVES

• There has been research that supports an increase in blood lactate tolerance. This improvement in anaerobic capacity may prove exceptional for short-term performance (10-30 seconds) like sprinting. However, this is not the same as increasing VO₂max or peak VO₂.
• Research also supports the development of inhalation musculature. Muscles involved in breathing work harder to draw in air. The increased effort strengthens the diaphragm, inspiratory intercostals, scalenes, and sternocleidomastoid (to a lesser degree). There is a definite increase in ability to breathe in.

NEGATIVES

• Most research does not look favorably upon normobaric hypoxia in training.
• The main reason to purchase an elevation mask is to mimic the physiological effects of high altitude adaptation. However, those effects are not fully replicated without reduced atmospheric pressure.
• Most likely any increase in red blood count will be minimal and lost during intravascular hemolysis since the cardiovascular system cannot expand to maintain the increased volume.
• None of these are permanent adaptations. Even Olympic athletes program the return to a normal elevation around competitions.
• Repeated hypoxic exposure can create permanent neurological damage similar to the effects of COPD. Chronic bouts of hypoxia damage areas of the brain responsible for balance, rational thought, and muscular control.  

FINAL THOUGHTS

I believe the use of elevation masks has some performance benefits, just not to the degree they advertise. I do not believe the mask is a worthwhile investment for the novice or seasoned athlete. There are far more effective and long term performance strategies to increase VO₂max and cardio-respiratory function. Ultimately, it is the choice of the individual to buy a mask or not.

I am confident continued research will produce similar findings on the subject. It is speculative that more controlled studies would reveal other benefits of elevation mask training. However, present available research does not support normobaric hypoxia training.

Stay healthy everyone,

-Reuben

References

Mairbaurl, H. (2013, November 12). Red blood cells in sports: effects of exercise and training on oxygen supply by red blood cells. (A. Bogdanova, Ed.) Frontiers in Physiology, 4, 1 to 13. doi: 10.3389/fphys.2013.00332

Ness, J. (n.d.). Live high train low. The ultimate endurance training model? Retrieved September 4, 2015, from The National Strength and Conditioning Association: http://www.nsca.com/uploadedFiles/NSCA/Resources/PDF/Education/Articles/Assoc_Publications_PDFs/live_high_train_low.pdf

Pierson, D. J. (2000, January). Pathophysiology and Clinical Effects of Chronic Hypoxia. Respiratory Care, 45(1), 39-51. Retrieved September 4, 2015, from http://jpck.zju.edu.cn/jcyxjp/files/ge/04/MT/0452.pdf

Robach, P., Lundby, F., & Lundby, C. (2015). Improving Endurnace Performance with "Live HIgh Train Low" Altitude Training: Relevance and Limits. Retrieved September 4, 2015, from ASPETAR Sports Medicine Journal: http://www.aspetar.com/journal/viewarticle.aspx?id=121#.VeozkfnBzGc

Training Mask: Clinical Study and Technical Report by NAIT University. (2014, February 23). Retrieved from Trainingmask.com: http://www.trainingmask.com/clinicals/clinical-study-and-technical-report-by-nait-university/

Training Mask: Dr.Joseph Training Mask Clinical Studies. (2012, October 31). Retrieved from Trainingmask.com: http://www.trainingmask.com/news/24/Dr.Joseph-Training-Mask-Clinical-Studies.html

Training Mask: The Science. (2015). Retrieved from Trainingmask.com: http://www.trainingmask.com/the-science/