International Wellbeing

Issue 83, Feb-Mar 2001

INTERMITTENT
HYPOXIC
TRAINING
Rejuvenation, healing and
enhanced athletic
performance are just a few of
the benefits

by Rosalba Courtney

Only a few times in my adult life can I remember feeling the

unbounded exuberant energy of childhood and experiencing it
continuously for days at a time – a feeling of my body being
light and movement effortless, drawing energy from a
seemingly bottomless well. One of those times was when I was
trekking in the Himalayas, descending from an altitude of 5000
metres. Walking up had been a fairly gruelling experience, but
on the way down I felt like I could walk all day and never tire.

High altitude for health

Athletes have known for many years of the benefits of altitude
adaptation in enhancing performance. Using the principle of
'train high and live low', they have been able to perform better
at sea level when their bodies compensate for oxygen levels
lower than those found at altitude by becoming more efficient
at utilising oxygen. What's more, altitude adaptation has
implications well beyond giving elite athletes that extra edge.
Russian medical researchers and others are finding increasingly
that adaptation to altitude has tremendous potential for
enhancing the health of the average person and modifying the
course of many chronic illnesses. Are people who are
acclimatised and live at altitude healthier than those living at
sea level'? The answer seems to be a clear
 INTERMITTENT HYPOXIC TRAINING

diseases found commonly at lower altitudes occur less at weightlifters to lift unimaginable loads well beyond their
high altitude. The Indian Army recorded the incidence of own bodyweights. This is why our species (and all other
18 different diseases in 130,700 soldiers stationed at currently living species) has survived and even thrived
altitudes from 3692 to 5538 metres over a period of seven despite environment changes and times of extreme difficulty
years. When the rates of disease were compared to those and social upheaval. IHT forms an important branch of an
found in soldiers on the plains, almost all diseases had a emerging new discipline called Adaptive Medicine. The
lower incidence at altitude. The occurrence of bacterial, Russian Academy of Medical Sciences has a Department of
viral or protozoan infections was significantly lower Adaptive Medicine, one of its aims being to look at the
(except for amoebic hepatitis and lobar pneumonia). therapeutic potential of IHT. An International Academy of
Diabetes, hypertension, ischemic heart disease, asthma, Adaptive Medicine was formed in 1990 by an
rheumatoid arthritis, several types of gastric disorders, skin interdisciplinary group of scientists and clinicians from
diseases, psychiatric ailments (including neurosis and many countries including Japan, Australia, Germany and the
psychosis) and anaemia all occurred with much lower USA. Its aim is to develop further understanding and share
frequency when the soldiers were living at altitude. information about the ways in which the adaptive process
enables the body to respond to different stress stimuli, with a
Intermittent Hypoxic Training (IHT) view to treating and preventing different diseases. The
scientific definition of stress as given by Dr Hans Selye, one
Living continuously at altitude for a period of months or of the first researchers to really study stress in the laboratory,
years is not an option for most people. Russian doctors, in is: "A stressor is anything that challenges an organism to
trying to find a solution to acclimatising pilots, athletes, adapt." In this context, heat, cold, physical exercise,
mountaineers and cosmonauts to low-oxygen environments, electrical stress, lack of food, hypoxia of altitude and even
discovered that adaptation to low-oxygen environments emotional or psychological turmoil are stress factors that can
could occur rapidly in a clinical setting and without the side be used to strengthen us if we experience them in amounts
effects of altitude sickness. The oxygen levels found at we can tolerate and to which we scan adapt. Almost all of
altitude were administered in a controlled manner and given these factors have been used as means to help people restore
in measured intermittent doses. The technique became health. On the other hand, too much of any of these stress
know as Intermittent Hypoxic Training (IHT), whereby factors, carried on for too long without sufficient recovery
oxygen levels of between 10 and 15 per cent (equivalent to time, can exhaust the adaptive mechanism and contribute to
an altitude range of 2500-6000 metres) are administered by disease rather than health. If you fast, use saunas or cold
a machine known as a Hypoxicator, which separates air baths, begin an exercise program to get fit or undertake IHT,
through a semi-permeable membrane. The person is asked you are engaging the principles of adaptation for the
to breathe the high-altitude air for just a few minutes at a restoration of health. One of the amazing things about
time while their blood oxygen levels are continuously adaptation is what's known as 'cross adaptation'. Adaptation
monitored. They then breathe ambient or normal air for a to one type of stress or load will, to some extent, increase
few minutes, giving their body time to adjust back to the body's ability to cope with
normal conditions. The time spent alternating between low-
oxygen air and normal air is 60 to 90 minutes at a time. The
procedure is generally carried out once or twice a day for a Like a finely tuned motor vehicle, if
total of 16 to 30 sessions. Researchers found that this you are adapted to altitude with IHT
technique allowed adaptation to altitude to occur with less you can run on less fuel with less
stress to the body than continuous exposure to low oxygen.
Because the dose and the blood oxygen levels are totally wear and tear to your ‘motor’.
controlled, there is no danger of altitude sickness. The
intermittent nature of the hypoxic exposure means the stresses of another type. It is well know that a regular
adaptation to lowland is not lost, as is the case in normal exercise program is associated with an increased tolerance to
acclimatisation to altitude. Adaptation to intermittent stress. Stress-related diseases such as hypertension, heart
hypoxia has the unique attribute of activating the body's disease, ulceration of the stomach or duodenum, diabetes,
own internal production of antioxidants in the brain, liver dermatological diseases and disordered immunity have all
and heart as a result of the frequently repeated re- been shown to have improved outcome with both exercise
oxygenation that occurs on breathing room air. This differs and IHT. Protection comes because the body becomes more
from continuous hypoxia, which actually reduces tolerant and resistant to stress. Dr F Z Meerson, one of the
most prolific writers and researchers in the field of Adaptive
Adaptive Medicine and IHT Medicine, describes in his book Essentials of Adaptive
Since the beginning of time, living things, from simple
viruses and bacteria to humans, have shown the seemingly - Fade away of the stress reaction
miraculous ability to adapt to changes in their environment. - Increased activity of the central and peripheral stress
In humans the process of adaptation is more efficient and limiting systems
more fascinating than in any other species. Our genetic - Desensitisation of target organs
characteristics and potentials are not fully expressed until
something challenges us to adapt. In this way, challenges
and stresses help us to develop strengths and abilities we Using oxygen more efficiently
might not otherwise have developed. As we adapt to one Oxygen deficiency is associated with many diseases. It has
level of any environmental or even emotional stress, we been postulated to play a role in many metabolic diseases,
become capable of handling even larger doses in the future. including
This ability is what enables, for example,
cancer, fatigue, epilepsy and poor neurological functioning. the asthmatic will continue to hyperventilate. The improved
For this reason it might seem difficult to accept that hypoxia, oxygen capacity observed after adaptation to hypoxia results in
or lack of oxygen, might actually be a more powerful the oxygen required by the body being supplied with less
healing factor than therapies that promote giving oxygen. volume of air needing to be taken in and less hyperventilation
IHT increases the efficiency with which the body takes up, taking place. Recent experiences with patients on artificial
transports and utilises oxygen. The heart and lungs are ventilation indicate that the stress of breathing itself might
stimulated to increase their functions and even over the long adversely affect susceptible airways. Lower ventilation levels
term to increase in size. Blood vessels dilate and new are associated with a 30 per cent lower mortality rate in
capillaries are formed in the heart, brain and skeletal patients with severe lung disease.
muscles. In the blood, levels of erythropoietin (EPO),
haemoglobin and myoglobin increase. All these factors Effects on the brain
make the blood capable of carrying more oxygen. On a The effects of altitude on the functioning of the brain and
cellular level there is a growth of the cellular structures neuroendocrine system are very interesting. The Eastern
needed for the metabolism of oxygen. If you undergo IHT, tradition of spiritual aspirants going to the mountains to
the net effect is a decrease in the need for oxygen by about purify the mind and elevate the spirit might have a
20 per cent and an increase in the ability to use oxygen, as physiological basis. The neurotransmitters dopamine and
measured by VO2 max. Like a finely tuned motor vehicle, if seratonin, associated with positive mood and calmness,
you are adapted to altitude with IHT you can run on less fuel showed quite a significant increase in people who
with less wear and tear to your 'motor'. And when you need underwent a three-week course of intermittent hypoxic
to run in high gear you can do so and use all the fuel or acclimatisation. Norepinephrine, the neurotransmitter
oxygen you need to achieve maximum performance. Once associated with increased activity of the sympathetic
the body has built the structures such as new capillaries, new nervous system and the so-called 'fight or flight' response,
blood components, new cells for the heart and lungs, new was decreased.
mitochondria and enzymes for using oxygen, it has increased
its functional reserve and can extract more oxygen from
normal lowland atmospheric air. The body now has an Neurotransmitter (n = 5) (n = 10) p
increased functional reserve that can offset fatigue and Norepinephrine 186 150 <0.05
Dopamine 132 167 <0.05
enhance areas of functioning in the body that require Seratonin 108 238 <0.01
oxygen. If you were to rely on administered oxygen, like
hydrogen peroxide or oxygen administered in a hyperbaric
chamber, the effects might be available to the body for only Results from Russia
the short length of time the oxygen is in your system,
In Russia, IHT has been used and investigated for more than
20 years. The process of full acceptance and endorsement by
IHT for inflammatory conditions the Russian Ministry of Health has been slow and arduous.
Proponents of the technique had to prove in numerous
In general, IHT contributes to improved immunological clinical trials the efficacy of the technique for the
status. The occurrence of allergies and inflammatory diseases enhancement of general health. Clinical trials on more than
decreases. This has been observed in continuous exposure to 300,000 people suffering such varied conditions as neurotic
altitude, as well as with IHT. Studies have been able to show and psychiatric disturbance, heart disease, female
improvements to conditions of an inflammatory nature, such gynecological disease, paediatric diseases and many other
as arthritis, asthma, allergic rhinitis, auto-immune thyroiditis conditions were conducted over this time and showed
and inflammatory skin diseases. Even the difficult-to-treat positive results. One of the turning points in convincing
and disabling disease rheumatoid arthritis showed a positive authorities of the dramatic effects possible with this therapy
response, with seven out of 10 patients receiving IHT came with a trial involving 49 women with various
showing less inflamed joints, reduced pain and morning gynaecological conditions who had been unable to conceite
stiffness and reduced need for medication. All patients or carry through a full-term pregnancy. Amazingly, 48 of the
reported improved mood, sleep and appetite and increased . 49 women became pregnant and delivered healthy children.
physical activity. Asthma has received particular attention, The children and mothers were then followed for two years
with several studies showing significant improvement. and were found to be exceptionally healthy.
Observations made in the Netherlands have shown that
asthmatics treated in climatic chambers that simulated Improved athletic performance
altitudes of 1500 to 2550 metres improved rapidly, and with
60 to 100 treatments were 'cured'. This certainly fits with the At present in the western world, knowledge of IHT has been
common observation that asthmatics, despite their obvious mainly among elite athletes. In the Sydney 2000 Olympics,
fears about altitude, usually have less asthma and do much the Australian swimming team and various competing
better at altitude. I have taught the Buteyko method for the individual athletes had access to a Hypoxicator. Canadian
past nine years. This highly successful method (also Simon Whitfield, while he was not considered a contender,
originating in Russia) teaches that hyperventilation and loss surprised many by coming forward to win the men's
of carbon dioxide (which is anti- inflammatory and broncho- triathlon. 7ime Magazine reported that he "...ran the last 150
dilating) worsen the asthmatic condition. Inflammation in the metres as though he'd done nothing more strenuous that
lungs is one reason asthmatics hyperventilate. Another morning than taken a shower". Based on findings among
perpetuating factor to hyperventilation could be inefficient other athletes using IHT, it could be speculated that
oxygen metabolism. Until this is improved, incorporating IHT into his training during the 12 months
before the Olympics might have helped Simon give this
outstanding performance.
Athletes in New Zealand have had access to IHT for the
past 'Ovo years. A study by Dr John Hellemans, sports-
medicine doctor from Christchurch and a world triathlon
champion himself, showed that after 15 to 20 daily or twice-
daily sessions of IHT lasting 60 to 90 minutes, athletes'
performance improved by 2.9 per cent. Blood tests also
showed that IHT stimulated red blood cell and haemoglobin
levels and that this correlated with improvements in
performance. Dr Hellemans suggests, 'The method of IHT
can be strongly acommended for any serious athlete as part
of their training and preparation." Dr Hellemans found that
the results of using IHT were particularly successful for
athletes suffering from fatigue and overtraining in
recovering full functional capacity. One dramatic case study
of an elite triathlete incorporating IHT in his normal
training routine over a 14-day period showed a 7.25-second-
per-kilometre improvement in performance time. In
addition, his resting heart rate dropped from 35 to 28, his
weight dropped from 68.7 to 67.9 kilos and his red blood
cell .count increased from 44 to 51 per cent.

Getting fit for non-athletes consistently lower, at around 125/80 to 135/85, with fewer
Most of us are not elite athletes, therefore being a few fluctuations.
seconds faster has no real significance whatsoever. What we My own experience with IHT has been fantastic. In my late
do want, however, is to be able to carry out our day-to-day 40s I have achieved a level of fitness I did not enjoy even in
living without fatigue and with ease and enjoyment. Elite my younger days. There are days when I just feel
athletes balancing precariously on the pinnacle of human effervescent with energy and can work all day without total
achievement consider themselves lucky to increase fatigue waiting to meet me afterwards.
performance by three per cent. The good news is that After a stressful year of drama and tragedy, I found myself a
untrained people show an even more dramatic improvement year ago experiencing palpitations on just walking up a
in fitness, energy and endurance when given a course of small hill. I felt grief at my lost health and resolved to do
IHT. In one study with healthy but untrained men, what I could to regain it. I began a slow and careful exercise
adaptation increased the total amount of work performed on program and was gradually building up a program of
an ergometer by 27 per cent; the maximal output of their running and walking, combined with more time spent in
heart increased by 15 per cent; their lung capacity increased relaxation. Even though I was starting to become fitter and
by up to 40 per cent. the palpitations had gone, I still didn't have much endurance.
However, a few weeks after starting IHT I noticed the same
feeling I had experienced after trekking in the Himalayas: a
Increased energy and endurance combination of bliss and bouncy, resilient energy. I found
for the first time in my life I could run for 30 minutes
In my practice, the main consistent benefit of using a without stopping and without breathlessness or gasping. I
Hypoxicator is improved energy levels. Judith (not her real now go out and do this almost every day – because I want
name) was one of the first people to complete the course of to. I feel more confident that I will be able to remain fully
IHT at the clinic. She was generally healthy but suffered functional and vibrant as I get older.
from high blood pressure (which tended to always be a little
high even with medication), some asthma, fatigue and Hope for chronic fatigue sufferers
insomnia. Although she exercised regularly at the gym three
to four times a week and played golf at least twice a week, IHT might prove to be of tremendous help for sufferers of
she often felt extremely tired, after, even moderate exercise. chronic fatigue syndrome (CFS). People with CFS
After golf she always felt really exhausted and wondered if frequently suffer from breathlessness, poor aerobic
it was a symptom of menopause. Seeing octogenarians skip metabolism, lactic acid accumulation after exertion and
up the steps to the clubhouse, she wondered why she felt so other indicators of poor oxygen efficiency. Studies have
tired when she looked so healthy. Her gym sessions left her been conducted showing that improving fitness though
feeling really tired for about two hours. After completing 16 exercise therapy helps CFS suffers have more energy and
sessions of IHT, Judith finds she can do her exercise at a general improved functioning. The problem is that exercise,
more intense level than she could previously, and without if overdone, can also easily lead to incapacitation. IHT
any subsequent fatigue. She says: "My energy and might prove to be a stepping stone for increasing fitness and
performance levels have increased to a marked degree. Even functional capacity for people with CFS. The CFS sufferers
after extreme effort I am not as tired. I recently spent a few at our clinic who have completed their acclimatisation to 11
days cross-country skiing at a high altitude. Previously, it per cent oxygen have all shown marked and even
would have taken a couple of days for me to acclimatise. exceptional improvement in their condition over a few
After having IHT I found I did not experience the usual months.
headaches or tiredness. I also slept better than I did at
altitude." Also, throughout the period of having IHT, Judith Rosalba Courtney is an osteopath, naturopath and
monitored her blood pressure. Previously it was difficult to acupuncturist with a special interest in breathing therapies.
stabilise and 'tended to be 145/95 or sometimes up to She practises at Mona Vale, Sydney. Ph: (02) 9979 9444. For
155/100. Now it is more information about IHT go to: www.go2altitude.com