Should you wear an elevation training mask?

I’m a lung doc and have spent more hours than I can count studying cardiovascular and pulmonary physiology. This makes it nearly impossible for me to ignore all the attention that elevation training masks are getting.

elevation mask really

Source: Obstacle Racing Media

Before we delve into the merits of these masks, I’d first like to review a bit of physiology to highlight why altitude even potentially matters. In the best-case scenario it will help to provide groundwork for discussing training masks. In the worst-case scenario discussing this topic will allow me to feel better about paying six figures to protract my adolescence by studying well into my thirties.

At sea level we inspire air that has 21% oxygen and as you gain in altitude the partial pressure of oxygen decreases. Once inhaled, oxygen is taken into the lungs and is loaded onto red blood cells, which carry oxygen to every cell of the body to help turn our food into cellular energy. The physiological term for this is called cellular respiration -where cells use oxygen to catalyze macronutrients (carbohydrates, amino acids, and fatty acids) into cellular energy (ATP). Breath is literally life.

A person’s efficiency in utilizing oxygen is called their VO2max – a marker of aerobic fitness. Our bodies are used to experiencing a “normal” amount of atmospheric oxygen, but we often hear that training at altitude improves cardiovascular performance. We see several top distance runners, cyclists, and obstacle course racers living at high altitude for extended amounts of time. Many of these athletes take part in the live-high and train-low philosophy by training closer to sea level 1-2 hours a day (to maximize their workouts) and then spending the bulk of the day at altitude (to reap the potential benefits of living at altitude). Others incorporate high altitude training, but this may limit actual performance.

Spending extended amounts of time at high altitude can, if the oxygen content of the atmosphere is low enough, result in the kidney’s increased production of a hormone called EPO, which stimulates the bone marrow to produce more red blood cells to compensate for the lower atmospheric oxygen. Low levels of oxygen in the blood (hypoxemia) can also lead to a process called angiogenesis where new blood vessels are created in an effort to improve oxygen delivery. You have to live at high altitude for weeks to months to undergo these physiologic changes, and they are quickly lost after returning to sea level.

So, does living at altitude at places like Mammoth, Denver, and Tahoe for months lead to advantages so that you have a better chance at crushing your race because you have an enhanced capacity to deliver oxygen to your cells? Maybe.

Let’s assume that altitude training improves performance across the board (a major assumption). For those of us who live at sea level, what resources do we have to simulate high altitude? I live in Philadelphia. What can I do to simulate training in Tahoe? Not much. One option is that I could drop several hundred to a few thousand dollars and sleep in an altitude tent. These are airtight tents that decrease the oxygen content in the air you breathe so that you can spend the hours that you sleep at a simulated high altitude. Aside from not being very consumer friendly, altitude tents make it pretty challenging to snuggle and may be challenging for those of us who may be claustrophobic. So what are we left with?

Enter the aggressively marketed elevation mask.

 

bain 2.png

 

The internet would have you believe that all you need to do is strap on one of these masks and it will transform you into Bane from Batman (your brain) or an over compensating attention seeker (my brain) and BOOM – you are now able to shave minutes off your race times because you just simulated high altitude training. Right? Wrong.

I’m not going into tremendous detail on the physiology, but lets just say that putting on an elevation mask and hitting your rower for 40 minutes three times per week at your Gold’s gym in Houston is not the same thing as living at high altitude and putting in some solid trail runs. It’s more like running with a kazoo in your mouth at sea level a few times per week.

Wearing an elevation-training mask does not lower the oxygen content of the air you breathe. That means that it won’t simulate high altitude at all. Period. It just won’t. All it does is increase the resistance your breathing muscles work against.

Oxygen delivery is determined by your cardiac output (a function of your heart rate and how much blood each beat produces), red blood cell count, and a negligible amount of dissolved oxygen in your blood. When you run hard, your blood is shunted to your legs and breathing muscles (your diaphragm and accessory muscles) because both of these muscular groups are working full tilt and demand more oxygen. This shunting is even more extreme in obstacle course racing where you feel like your entire body is begging for more blood flow (well, hopefully not your genitals) as a result of combining full body strength obstacles with technical trail running.

This shunting of blood can result in tension between your lungs and legs. Most of you that have really pushed it in a race or on a progression run know exactly what I’m talking about. You also know that, in pretty much in every case where this tension is heightened, you feel like your lungs grind you to a screeching halt while your heart races to catch your breath. You don’t pant because of weak lungs. You pant because of a build up of metabolic waste products (carbon dioxide, lactic acid) that occurs with strenuous exercise. This includes the respiratory muscles, which can fatigue long before the leg muscles do.

Maybe if you improve the fitness of your breathing muscles then you can create a scenario where they demand less oxygen per unit of time? Perhaps this will then decrease some of that tension between the legs and breathing muscles? This thinking makes some sense, but I’m not sure that wearing a mask results in a meaningful improvement. There is no consistent evidence to suggest that improving things like lung capacity or diaphragmatic strength translates to a greater running economy.

In fact, there is very good reason to think that wearing these masks may actually impair your fitness by wasting your energy on working to inhale instead of putting that same energy towards finding your optimal performance. When you are racing hard you are never faced with a scenario where you are limited by your ability to inhale. You are limited by your ability to take easily inhaled air and deliver it to your cells. The best endurance athletes have an amazing efficiency in their breathing – and these masks likely do not do a thing to improve that. But that’s just my opinion. What does the evidence suggest?

The studies that associate training benefits to wearing these masks have very small sample sizes and mostly lack control groups. Without a control group, you can’t tell if, over time, it is the exercise itself or the addition of the mask to the exercise that provides a “benefit.” Tie a ribbon around a couch potato’s finger and make them run for two weeks and their VO2max will improve. It wasn’t the ribbon that improved the VO2max. It was the running. Most studies show no improvement in VO2max and overstate the benefits of improving things like lung capacity. Of the few studies that show small effects on VO2max, there’s too much variation in who was studied (e.g. sedentary vs. those in shape, cyclists vs. runners, etc) and for how long they used the mask. Many choose to focus on various physiologic metrics that may not translate into improved racing performance. Association is not causation.

To make things more potentially dubious, makers of these products like this often finance several of the studies that are positive (a clear conflict of interest) and may be less likely to publish studies that are negative (something commonly referred to as publication bias). When I read medical literature to stay on my game at work the first thing that I read after the title are the financial disclosures. Lots of studies are funded by industry and I don’t want to be a pawn by taking things at face value. When there is a profit to be made there are potentially perverse incentives at play.

In my opinion, these masks are just another case of misleading marketing when it comes to elevation training. We all know that Red bull doesn’t give you wings. We also know that beets do not guarantee elite status (though I’m intrigued by increased nitric oxide boosting short-term performance). There’s nothing magically intravenous about some salty potion you drink orally. So it shouldn’t be surprising that masks do not make you elevate in altitude.

Perhaps you do not care if these masks do what they suggest. Maybe you just want to look like a badass and gain some sort of inner psychological advantage from looking like a comic book villain. Wearing these masks makes for some fantastic Instagram pics. I just spent a solid 15 minutes perusing IG after searching #elevationmask. Bored at your job? Search and take a gander at the plethora of mask-wearing badasses taking selfies and getting it done (sarcasm). You’ll see all sorts of Bane look-a-likes running around tracks and up hills. Strangely, you’ll see posts of brawny Banes doing heavy resistance/anaerobic work. It makes no sense to me.

Save your cash and focus on training smart and optimizing your nutrition. Take a look at what people like Ryan Atkins, Lindsay Webster, Jon Albon, and Amelia Boone are doing to not only crush OCR, but also venture into well-established road and trail running endurance events to put in truly impressive performances. They run, a lot. They run up and down mountains, a lot. They have phenomenal aerobic capacity and a great economy in their breathing. While several of these top performing OCR athletes spend a good deal of time at high altitude, not all of them do. Amelia, up until last year, lived in Chicago for goodness sake.

So what is the bottom line?

– Elevation masks do not simulate high altitude. They may improve respiratory muscle strength, but there are no consistent meaningful improvements in aerobic capacity or actual athletic performance.

– If you want to simulate high altitude then shell out money for an altitude tent and spend a significant amount of time in it. Otherwise, do not shell out money for one of these masks.

– Instead of prioritizing looking like a badass by wearing an elevation-training mask, commit to a comprehensive training plan that includes a focus on improving your aerobic capacity. Slowly increase your mileage and incorporate long trail runs, hill repeats, and speed work.

 

IG: @jwag511      |      Twitter: @theobstacledoc

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13 Responses to Should you wear an elevation training mask?

  1. Thomas A Dreyer says:

    Love the article. For the longest time I wanted one due to athletes like Marshawn Lynch wearing them. I did similar research and came to the same conclusion that the only way to go, if possible, are the tents. One part of your article stuck out to me though about respiratory muscles giving way before the leg muscles. I just did the NJ Beast on Sunday and a couple of half-marathons during the previous weeks and for every race, my heart rate stayed in check, I kept breathing steady and paced, but (and this could be due to joint pain and compensating with other muscles from it) my legs were exhausted WAY before my heart and lungs. I’m intrigued by this and if knowing that will help me since I have the Colorado Super at 6,000ft. elevation in a week and a half. Again though, really great information here.

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    • Hi Thomas, thanks for the comment. Sorry for the confusion. I was trying to discuss how, with exercise, oxygen consumption is increased predominantly in the leg muscles and respiratory muscles that participate in inspiration (also those that participate in expiration consume more O2 when you are really pushing it hard). Depending on relative fitness, the respiratory muscles increase their workload to the point where they fatigue resulting in increased carbon dioxide production and metabolic acids. This, in turn, results in the brain telling the lungs to work harder to breathe off that carbon dioxide – which is a real struggle when your respiratory muscles are fatigued and part of the problem. It’s never just solely the respiratory muscles being fatigued, but is more so asking tired respiratory muscles to breathe harder as they themselves generate lactic acid, carbon dioxide, etc. Basically, sucking wind is often a bigger problem than cramping or burning legs. Hope that helps.

      Liked by 1 person

  2. Amanda says:

    Great post. Loved the science and physiology aspect. I figured that these masks were a marketing gimmick and that there’s more to increasing red cell production than just wearing a mask. Lol. Oh if they only knew. The way you describe them sounds a lot like how an asthma attack feels. The straining to take a full breath. That’s awfully uncomfortable, I don’t understand why somebody would inflict that on themselves! I guess I’m just not hardcore enough /sarcasm. Just an asthmatic that likes to run : )

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    • Amanda, thanks for reading and commenting! Asthma, which is a problem breathing out, definitely feels like you are having a hard time inhaling! Has to do with trapping air in the chest and making the breathing muscles work from a disadvantaged position..And nope, poorly controlled asthma doesn’t simulate altitude either 🙂

      Like

  3. Peter Dobos says:

    Our pet peeves sync up nicely, sir. I write for Obstacle Course Training, working alongside Ryan and Jonathan, and have poked my own holes at the bullshit “altitude” mask. If you search for #chokemonkey on Facebook you’ll find my swipes at this derpy woo, which parallel yours.

    Your solution of running with a kazzoo is more economical and practical than mine, but I maintain that having a small monkey sitting on your shoulder and choking you whilst you train is funnier.

    Cheers

    Peter Dobos

    Like

  4. Peter Dobos says:

    A far cheaper and more effective way to challenge your muscles of inspiration is to stand or sit upright and neck deep in a pool or lake. The water pressure will make it surprisingly difficult to get a full breath, and, unlike the mask, it provides constant pressure, meaning you can work on controlling your exhalation. If you want to ramp it up, get a snorkel.

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  5. Pingback: Dr. Jason Wagner Talks Elevation Training Masks - Obstacle Racing Media

  6. Janice says:

    I have trouble breathing when I do high intensity intervals–example, top speed 100, 200 and 400 repeats. It is debilitating. I begin to wheeze and just can’t control it. I feel like I am having an asthma attack. I start to panic, and I have to have someone talk me down from it.

    My doctor gave me an inhaler, but it doesn’t help.

    I have been thinking about these masks and if they could help me retrain the way I breathe? I feel I may not be breathing deep enough?

    Like

  7. Beast Lawler says:

    Yeah don’t simulate high allitude but fuck did it force my brain and lung to work together to control my breaths instead of panting when I run to control…..if you don’t think about your breathing and control it….you don’t breath

    My situation it helped me conquer that problem

    Like

    • There definitely may be something to training masks drawing your attention to your breath. That said, if you intentionally go into your runs to work on finding your optimal breathing pattern relative to your running cadence it very likely is sufficient. Glad you found that it helped you.

      Like

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