Runners love talking about running. The euphoria they describe differs from person to person with some describe running as a drug, others a hobby, and some just love the thrill of racing. Depending on how much time you have allocated, there is bound to be conversation on shoes, clothes, foods and the training locations with conversations bouncing like a pin ball due to the level of excitement. However, throw the dreaded “I” word in their (injury) and the conversation tone slowly takes a dive. When assessing runners, you have to be always thinking ahead and considering the physiological and metabolic requirements of running. This is especially the case when you are aiming to return an elite runner back into their normal training environment. We aim to have such a minute strength and conditioning gap that this transition is made easily when patients discharge from our care. It is our goal that when the runner returns to the outdoors, they are ready in every sense of the word. One day in clinic I was observing one of our patients complete a running session on our Anti-Gravity treadmill. This particular patient was using the Anti-Gravity treadmill to return from a tendon injury, as this state-of-the-art equipment provides a great platform for runners of all ages to make a progressive return to loading and full training. With the aim of always going one better, I did wonder if we were getting enough bang-for-buck with an anti-gravity only approach. On reflection, although the altered weight loads on the treadmill were appropriate for their specific injury, we often found that to get the same demands and output from a cardiovascular stance-point we would have to manipulate session time or speeds. Even still, we were still getting significantly reduced outputs compared to what a “normal” session on the track would usually provide. How could we make this transition process even better? Enter Rico Rogers from Box Altitude. Initially coming from a physiology, sports science background prior to physiotherapy, I have long known that some athletes and teams travel the world to sleep and train in hypoxic/altitude environment. This is because altitude training has the potential to assist in increasing aerobic performance. Whilst at altitude (>2500m above sea level) for over 24 days the body - increases red blood cell count - increase hemoglobin mass - Leading to oxygen having more binding sites on blood - Meaning more oxygen can be delivered to working muscle under aerobic conditions, so the working muscle can maintain a higher workload for longer periods of time (Lundby, Millet, Calbet, Bartsch, & Subudhi, 2012; Saunders, Garvican-Lewis, Schmidt, & Gore, 2013; Wehrlin, Zuest, Hallen, & Marti, 2006) However, the side effect of altitude exposure that got us interested was that while at altitude (in our case for short periods of time) there would be: - Increased stress on the cardiovascular system - Increased respiratory rate - Increased heart rate Could it be possible to blend a highly tuned hypoxic trainer and anti-gravity treadmill together? Yes. At clinic we now find the gap from rehabilitation to normal training has diminished significantly. Now what we find is: - Pathology can still be rehabilitated - Strength and conditioning gains can be maintained or improved - Running activities and loads on non-injured sites can be maintained to reduce the risk of further injury Although evidence is inconclusive, it has been suggested that prolonged exposure to a hypoxic environment can delay bone healing. It is important to note that not all injuries are appropriate for management with altitude training and prior to commencing this training we recommend an assessment with a trained health practitioner. Nicholas Cross B.Ex.Sci, M.Ap.Sci(Ex.Rehab), DPT(Melb) Physiotherapist, Exercise Physiologist Melbourne CBD Physiotherapy and Sports Medicinetherapy and Sports Medicine

Lundby, C., Millet, G. P., Calbet, J. A., Bartsch, P., & Subudhi, A. W. (2012). Does 'altitude training' increase exercise performance in elite athletes? Br J Sports Med, 46(11), 792-795. Saunders, P. U., Garvican-Lewis, L. A., Schmidt, W. F., & Gore, C. J. (2013). Relationship between changes in haemoglobin mass and maximal oxygen uptake after hypoxic exposure. Br J Sports Med, 47 Suppl 1, i26-30. Wehrlin, J. P., Zuest, P., Hallen, J., & Marti, B. (2006). Live high-train low for 24 days increases hemoglobin mass and red cell volume in elite endurance athletes. J Appl Physiol (1985), 100(6), 1938-1945. 5