Breathing at High Altitude during Tour de France

Tour de France 2019 is a gruelling event. The 21 stage race begins on the flat. But this isn’t for long. The race winds its way through flat, hilly and finally mountainous terrain. This year, we now know, is one of the most demanding Tour de France races. It includes 7 mountain stages with 5 mountain-top finishes. Because the seven mountain stages climb above 2,000 metres, it is one of the highest Tours for many years. This adds another challenge for the riders, that of breathing at high altitude. This is particularly challenging for riders of the 2019 Tour, as the highest point in the race, the Col de l’Iseran mountain pass has an altitude of 2,770m.

Breathing at high altitude

As a cyclist climbs to high altitude breathing increases. This happens automatically. The reason for this is because the body is responding to less oxygen in each breath. As a result, ventilation increases as they try to increase oxygen uptake. However, in spite of an increase in breathing, less oxygen will reach the working muscles, such as the legs. This is because signals are sent to the nervous system telling it to redirect oxygen from the legs to the diaphragm in order to keep up with breathing at altitude. Consequently, the cyclist’s leg muscles begin to suffer from fatigue. Inevitably, this affects performance.

Effects of high altitude breathing

Breathing harder and quicker is an automatic response to the fall in air pressure. In addition to this, the heart works harder too. It does this to try and increase the flow of oxygen-carrying red blood cells to the lungs. It’s a desperate bid to ensure the lungs don’t ‘steal’ the oxygen-carrying red blood cells from straining muscles.

In this article, 2018 Tour de France winner Geraint Thomas says,

“You just can’t do the same powers that you do at sea level… It is just like a thinner sort of air, really, up there. You can just tell, like, when you’re breathing, you’re just not getting quite as much oxygen in the lungs as you normally would.”

Another consequence of the challenges that breathing at high altitude inflicts on the body, is that of greater quantities of lactic acid. Cycling at altitude requires intense power and energy to climb the hills. But the body’s response to trying to produce energy with less oxygen is to produce larger amounts of lactic acid. It’s the build-up of lactic acid in the muscles that causes that feeling of ‘muscle burn’. It’s also responsible for slowing a cyclist down as it reduces the muscles ability to function. explain that lactic acid is the end product of anaerobic metabolism. It says that a build-up of lactic acid occurs when there is insufficient oxygen to produce the energy required by the exercise. Furthermore, they say that when a very high level of work is reached, as in the Tour, lactic acid production becomes constant. As a result, the cyclist will experience acute muscle fatigue.

Preparing for the challenges of breathing at altitude

This 2019 Review Article in Frontiers in Physiology investigates the use of respiratory muscle training (RMT), including inspiratory muscle training (IMT) with POWERbreathe, for acclimatising to the altitude. The review provides evidence that such training,

“…has the potential to minimize at least some of the limiting factors related to the respiratory system occurring during training / competition at altitude / in hypoxia.”

It goes on to suggest the expected benefits may include:

  1. A delay in the onset of premature fatigue.
  2. A delay in respiratory muscle metaboreflex onset/activation.
  3. An improvement in clearance and tolerance to anaerobic metabolite products.
  4. A decrease in the perception of dyspnea (‘air hunger’).
  5. An increase in oxygen saturation values.
  6. A more favourable blood redistribution to the locomotor muscles.

Recovering from high altitude breathing problems

By incorporating breathing exercises for high altitude before the Tour de France or Giro d’Italia, cyclists will cope better with the challenges of breathing at high altitude. Inspiratory Muscle Training, such as with POWERbreathe, increases the strength and stamina of the breathing muscles, reducing breathing fatigue. Even better would be to perform IMT during turbo training. This will target the inspiratory muscles in the hunched position the athlete will be in during cycling.

Recovering from high levels of lactic acid

For cyclists in the Tour de France and Giro d’Italia an IMT recovery session is proven to be beneficial as it:

Research shows that breathing against a small inspiratory load immediately after exercise reduces lactate by 16%. It also reduces lactate as soon as exercise finishes, unlike traditional active recovery which may take 5-minutes to clear lactate. Another bonus for Tour de France and Giro d’Italia riders is that subsequent research demonstrates a post-exercise inspiratory resistive loading (after a Wingate test) reduces post-exercise effort perception and improves peak power on subsequent all-out maximal-intensity exercise. This is obviously beneficial when riders need to perform at their best, day-after-day.


Acclimatisation to High Altitude – POWERbreathe IMT is Beneficial

There is a new Review Article in Frontiers in Physiology (January 2019) that looks into using respiratory/inspiratory muscle training for acclimatisation to altitude.

Respiratory muscle training

Respiratory muscle training, or RMT, is a programme of exercises that aim to improve the function of the respiratory muscles. Otherwise known as the ‘breathing pump’ muscles, the expiratory muscles and the inspiratory muscles make up the respiratory muscles. It’s the inspiratory muscles that we use when we breathe in. The main inspiratory muscle is the diaphragm, but to a lesser extent, the intercostal muscles also help with inhalation. To help improve the strength and stamina of these inspiratory muscles, respiratory muscle training will include Inspiratory Muscle Training (IMT).

Inspiratory Muscle Training

Inspiratory muscle training, such as with POWERbreathe, uses resistance to provide the training effect. When breathing in against the resistance, the breathing muscles have to work harder. As a result, they get stronger. Consequently, breathing stamina improves resulting in a reduction in breathing fatigue. There is numerous research validating this form of breathing training and, as a result, it is the most commonly used.

The review

For the review, researchers perform a comprehensive search, analysing seven appropriate studies. Three of these studies refer to using respiratory muscle endurance training (RME with isocapnic hyperpnea). However, the remaining four studies use respiratory muscle strength training (RMS with POWERbreathe IMT).

Acclimatisation to altitude

Studies suggest that respiratory muscle training with IMT is a useful preparatory method for enhancing respiratory muscle efficiency 4-6 weeks before being exposed to hypoxia/altitude.

It is evident that breathing during exercise in hypoxia is associated with increased energy costs (20–30%) when compared to normoxia. Therefore, it is more likely to cause respiratory muscle fatigue. However, inspiratory muscle training will help to combat this. This is because IMT trains the inspiratory muscles to become stronger, increasing stamina. Consequently, breathing muscle fatigue reduces.

It, therefore, seems apparent that breathing muscle training has the potential to minimise at least some of the limiting respiratory factors that occur during training and competition in hypoxia/at altitude.

Benefits of acclimatisation to altitude using IMT

The Review suggests that both elite athletes and non-elite individuals may benefit from RMT, including:

  1. A delay in the onset of premature fatigue.
  2. A delay in respiratory muscle metaboreflex onset/activation.
  3. An improvement in clearance and tolerance to anaerobic metabolite products.
  4. A decrease in the perception of dyspnea (‘air hunger’).
  5. An increase in oxygen saturation values.
  6. A more favourable blood redistribution to the locomotor muscles.

Finally, evidence from this review finds that respiratory muscle training is an effective stimulus for improving the strength and endurance of the respiratory muscles. In fact, it’s these adaptive responses that contribute to the improvement of ventilatory function and efficiency. In translation, this means that respiratory muscle training is very likely to improve exercise performance in normoxia and particularly in hypoxia/altitude.

Influence of IMT on Cycling Performance at altitude

This study, Influence of IMT on Ventilatory Efficiency & Cycling Performance in Normoxia and Hypoxia, is published in Frontiers in Physiology. The aim of the study is to analyse the influence of inspiratory muscle training (IMT) on ventilatory efficiency in normoxia and hypoxia. It also investigates the relationship between ventilatory efficiency and cycling performance.

The point of the study

The premise of the study is that IMT improves ventilatory efficiency in normoxia and hypoxia. It also reduces the metabolic demands of the respiratory muscles in both conditions. The study also hypothesizes that improvements in submaximal cycling performance can be linked to improvements in ventilatory efficiency in normoxia and hypoxia.

Study method

The study assigns participants, at random, to either a control group or an inspiratory muscle training (IMT) group. The IMT group were to complete 30 inhalations twice a day using the POWERbreathe K3. They were to do this 5 days a week for 6 weeks. Researchers set the POWERbreathe K3 to 50% of each participant’s Pimax (maximal inspiratory mouth pressure). By contrast, the control group did not perform any IMT.

To determine Pimax participants had to inspire through the K3 as quickly as possible. And in order to achieve a stable measurement they were perform this a few times.

Conclusions for training at altitude

The study suggests a possible positive effect of IMT on cycling time trial performance in both normoxic and hypoxic conditions. It also shows that hypoxia has a negative effect on ventilatory efficiency. It furthermore shows that IMT may reduce this effect.

Additionally the authors report that these findings may have relevance for athletes planning to train at a high altitude, or compete at high altitude.

Finally, the study suggests that Inspiratory Muscle Training before a competition at altitude might be a successful method to improve performance.

Mick on Everest – with POWERbreathe

What a great photo share from Mick on Everest – we don’t see many photos like this! Mick’s challenging himself to climb the North Side of Mount Everest without the aid of supplementary oxygen as a means of raising money for disadvantaged and disabled children in his local area in Cumbria. Mick’s been preparing for the challenge of breathing at altitude by training with his POWERbreathe Inspiratory Muscle Training device (IMT). In order to compensate for the thinner air at altitude Mick’s lungs will have to work much harder and his breathing will be pushed to its limits at high altitude, so training his breathing muscles with his POWERbreathe breathing trainer will improve his breathing strength and stamina and reduce breathing fatigue. This should also help reduce his physiological and perceptual stress during his ascent. POWERbreathe IMT high-altitude benefits: In a 2001 scientific study1 POWERbreathe IMT was shown to reduce the force/effort associated with ascent to high altitude. And in another scientific study (2000)2 it concluded that POWERbreathe IMT attenuates the impairment of inspiratory muscle strength induced by ascent to high altitude. Mick’s ‘summit window’ is around mid-May and he hopes to return in June, but now, as you can see in his photo, he’s at Base Camp, and we wish him much success and good luck for his ascent. References: 1 Nickol A, Romer L, McConnell A, Jones D. The effects of specific inspiratory muscle training upon respiratory muscle function and dyspnoea at high altitude. High Alt Med Biol. 2001;2:116. 2 Romer L, McConnell A, Jones D. Changes in respiratory and forearm-flexor muscle strength during exposure to high altitude. J Sports Sci. 2000;19:63-4.  

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Train with POWERbreathe to perform your best at altitude

An article in Outside magazine reviewed research that found that by training your respiratory muscles you can help yourself to perform better with less oxygen – a definite advantage if you’re planning a trip to altitude. The article refers to a study conducted in 2007 that revealed improvements in ‘exercise’ at an altitude of about 10,000 feet (3,048 metres) after 4 weeks of IMT. Results showed blood oxygen levels during exercise were higher and because the respiratory muscles were stronger the participants were able to handle the demands of breathing in thin air more easily which reduced their total oxygen usage. Participants also reported a reduction in breathing effort and discomfort. Dr. Mitch Lomax has lead several research studies in this area and states in the article, “Based on what we currently know, IMT is something that I would recommend prior to a trip to altitude.” In her studies Dr. Lomax used POWERbreathe IMT for respiratory muscle training. The respiratory muscles, primarily the diaphragm and intercostals weigh between 3 to 5 kilos (7 and 11 pounds) and consume energy and fatigue like any other muscle. And just like any other muscle they can be trained. By using POWERbreathe Inspiratory Muscle Training (IMT) devices you’ll be training in the most controlled, scientific manner, as POWERbreathe IMT has undergone scientific testing to establish the most beneficial protocol and all IMT devices are calibrated to provide reliable load testing time after time.

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Respiratory Muscle Training and Cognitive Function Exercising at Altitude


Respiratory Muscle Training and Cognitive Function Exercising at Altitude
Quackenbush J, Duquin A, Helfer S, Pendergast DR.

This study, published in Aerospace Medicine and Human Performance (AMHP), formerly Aviation, Space, and Environmental Medicine, examined the effects that voluntary isocapnic hyperventilatory training of the respiratory muscles (VIHT) has on selected measures of executive functioning, including working memory and processing speed at simulated altitude up to 12,000 ft.

The study concluded VIHT improved processing speed and working memory during exercise at altitude.

Read the full article here >

Turner Twins prepare for Mt Elbrus in Russia with POWERbreathe

Actually there’s a bit more to it than that. Ross and Hugo Turner are twin brothers who both share an interest in combining pioneering medical research and unique studies of historic expeditions. You’ve probably seen them on TV as they’ve filmed for the BBC, ITV, Channel 4 and Channel 5.

But Ross and Hugo will be climbing with a difference, and not with just the objective of reaching the summit! Hugo will be wearing and taking traditional clothing and equipment used by mountaineers 100 years ago, while Ross will be wearing and taking the contemporary equivalent.

Because they’re twins, researchers have the unique opportunity to directly compare themselves against each other and see how each reacts given their different clothing and equipment, with research carried out (pre and post expedition) by King’s College London’s, Department of Twin Research and GlaxoSmithKline’s, Human Performance Lab.

As their next challenge is to climb Mt Elbrus in Russia 5,642m (18,510ft) – a challenge taken on to help them prepare for high altitude and their ultimate goal of climbing Mt Cho Oyu (8,201m, 26,906 ft) – they realized that part of their preparation should really include some breathing training, specifically inspiratory muscle training (IMT) with POWERbreathe.

Preparing for high altitude with POWERbreathe IMT

Because the air contains less oxygen and becomes ‘thinner’ the higher they’ll climb, the more Ross and Hugo will notice the enormous demands placed on their breathing, and their breathing muscles in particular. Their lungs will have to work much harder to compensate for the thinner air, so the stronger their breathing muscles are before the climb, the better off they’ll be.

By training their inspiratory muscles before hand with POWERbreathe, they’ll lessen the increase in effort associated with ascending to a higher altitude, and they’ll also reduce the impairment of their breathing strength which is induced by an ascent to high altitude. In fact,

Inspiratory Muscle Training1:

  • Reduces oxygen requirement of exercise in simulated altitude by 8-12%
  • Reduces cardiac output requirement of exercise in simulated altitude by 14%
  • Reduces breathing requirement of exercise in simulated altitude by 25%
  • Increases arterial oxygen saturation by 4%
  • Increases lung diffusing capacity by 4%
  • Reduces perceived exertion
  • Reduces breathlessness

1 Effects of inspiratory muscle training on exercise responses in normoxia and hypoxia

Ross and Hugo’s expeditions raise money for charity, in particular for Spinal Research, which is close to the twins’ heart following Hugo’s broken neck in which he narrowly missed being paralysed.

You can find out more about the Turner Twins on their website, Facebook and Twitter, and we will of course keep you updated with news. Finally we’d like to wish good luck to both Ross and Hugo who have arrived at Mineralyne Vody in Russia, their base camp.

Ross’ feedback on the Turner Twins’ POWERbreathe training (September 2015):

‘The POWERbreathe allowed us to train in a way that was in-expensive, appropriate and the best in the market for mountaineering adventure (without actually training at altitude). It was easy enough to take travelling and use every day while allowing any level of cardiac fitness you wanted. This POWERbreathe was perfect for Mt Elbrus as the mountain had glacial rubble and ice – two very different terrains that affected the cardiac system in different ways. With more adventures coming that are not at altitude, we will carry on using the POWERbreathe as it is a great way to train the body in a very advantageous way so you can perform comfortably while working hard on expeditions.’

Train your diaphragm with POWERbreathe to perform your best at altitude

We’ve just come across this article online in Outside Magazine (February 2015), written by Alex Hutchinson in which it’s suggested that ‘by training your respiratory muscles, you can teach yourself to perform better with less oxygen.’

The article, ‘The Secret to Performing Your Best at Altitude? Train your Diaphragm’ begins by looking at a study conducted by exercise physiologist at the University of Portsmouth, Dr. Mitch Lomax. The study involved 14 members of a British military expedition who were trekking up the Barun Valley in Nepal toward 27,766-foot Makalu, the world’s fifth highest peak. Half of these 14 volunteers were randomly prescribed POWERbreathe inspiratory muscle training for 4-weeks prior to the expedition. After the expedition, results showed that when the IMT group arrived at Base Camp (18,000 feet), their arterial oxygen saturation was 14% lower than it had been at sea level, compared to the rest of group who’d desaturated by 20% – a not insignificant 6% advantage.

The article reveals even more interesting insights, facts and figures and is well worth a read, and here you can find out more about POWERbreathe for high-altitude training.

If you’ve used POWERbreathe prior to a high-altitude challenge of your own, then please leave a comment as we’d love to hear your experience.


Boston Marathon winner Meb Keflezighi does altitude training

PHOTO: Gr5 Licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license

Boston Marathon winner Meb Keflezighi does altitude training before major marathons, it’s been revealed.

This year (2014) Keflezighi ran the Boston Marathon with a time of 2:08:37, beating many of his competitors who had been averaging faster times.

But for Keflezighi, altitude training means travelling to Mammoth Lakes, CA, where he sleeps at 9,000 feet after which he drives several miles down the mountain to run at 4,000 feet. He does this to boost the production of his red cells which then increases the supply of oxygen around his body while he’s running the marathon.

He also incorporates cardio training into his workout, and claims that riding an elliptical bike is similar to the motion of running but has less impact on his joints than running.

But whereas Keflezighi has to travel to train, with POWERbreathe Altitude Training Systems (PBAS), there is no need for a drive into the mountains to train, as PBAS brings the mountains to you! With the POWERbreathe Altitude Systems Inflatable Sleeping Modules, the benefits of sleeping at altitude can be achieved without the need to travel. Sleeping in a PBAS Inflatable Sleeping Module helps the body to achieve some of the positive adaptations to altitude while still enabling the athlete to perform at an oxygen-rich lower altitude where muscles perform at their normal working level.

The PBAS Inflatable Running Tunnel Modules also allows an athlete to benefit from altitude training at a local level, and just as Keflezighi chooses to incorporate cardio training into his workout with the use of an exercise bike, so too does the PBAS Inflatable Cycling Modules allow for this, again at a local level, with rooms available for one person, two people, and then up to four people and their Monark elliptical trainers.

POWERbreathe Inspiratory Muscle Training is also beneficial for altitude training because at high altitude air is “thinner” and contains less oxygen than that at sea level, so your lungs must work much harder as your breathing is pushed to its limits.

POWERbreathe for altitude training:

  • Attenuates the increase in effort associated with ascent to high altitude1
  • Attenuates the impairment of inspiratory muscle strength induced by ascent to high altitude2

1 Nickol A, Romer L, McConnell A, Jones D. The effects of specific inspiratory muscle training upon respiratory muscle function and dyspnoea at high altitude. High Alt Med Biol. 2001;2:116.

2 Romer L, McConnell A, Jones D. Changes in respiratory and forearm-flexor muscle strength during exposure to high altitude. J Sports Sci. 2000;19:63-4.

Congratulations to Sam Lipscombe on his summit success

You may remember from his previous blogs that Sam had set himself the challenge of climbing Mount Everest in aid of raising money for Cure Rett and how he’d been using his POWERbreathe to help strengthen his breathing muscles for the challenges that the altitude will place on his breathing.

Well we are delighted to announce Sam’s success! He actually reached the summit on the 22nd May, but he didn’t really have the opportunity to write about his experience until later after the expedition.

Sam stumbled into high camp (8,300m) at 2pm on the 21st May saying, “I was exhausted, the three days of climbing from ABC as well as the altitude had taken its toll. Despite this exhaustion I knew that I was in good shape. I had no hacking cough and no signs of altitude sickness. I just needed to be careful not to make any stupid mistakes.”

He goes on to say, “High camp is just that, high. It is higher than most places in the world, with only 5 peaks that stand at a higher altitude – and the top is still way in the distance. We were now well inside the infamous ‘death zone’ – a height above which your body can’t function properly and is slowly dying.

To me things seemed normal, when I took off my oxygen mask I could breathe ok, the wind was still blowing and the clouds were still floating by. It almost felt I could stay there for ever.”

Sam’s blog is hard-hitting and it sounds as though the challenge is not just a physical one, but a mental challenge too. He shares his experiences which certainly remind us of what a dangerous challenge he has set himself.

“At the top of the rocks I was now on the final snow slope that ran to the summit. I could just make out the prayer flags in the distance. I knew this was it. As the summit approached I felt a huge sense of relief. I dragged myself to the prayer flags at the top, sat down and cried. I just couldn’t believe it, I was on top of the world.

Looking back on the experience it still seems like a formality, like we were meant to summit. But then, thinking about all those that tried and failed, I know it just wasn’t that straight forward. I have some fantastic memories of not just the summit but the whole experience, I understand I am incredibly lucky to have been able to step on the top of the world, something I think will stay with me forever.”

We’d like to congratulate Sam on this incredible achievement and look forward to hearing more from him and his fundraising. If you’d like to send your congratulations to Sam too, then please feel free to leave a comment here.

Read more about how POWERbreathe Inspiratory Muscle Training (IMT) could help prepare your breathing muscles for the rigours of breathing at altitude, however if you’re already using POWERbreathe for this reason, or have used it in the past to help cope with breathing at altitude then please leave a comment here on the POWERbreathe Forum, as we’d love to hear from you. You can also read more about POWERbreathe Inspiratory Muscle Training for breathing at altitude on our blog.