This post is inspired by my recent Leadville Trail Marathon which began at over 10,000 feet elevation and topped out at 13,185 feet.
We arrived in Breckenridge, Colorado, (9,600 feet) a couple days before the race and I could tell immediately that the air is a lot thiner than I’m used to. I struggled to run even a mile and climbing stairs left me out of breath.
Running at elevation can be tricky. Here’s how to do it safely.
How to Run at Elevation
According to Running Times Magazine, 95 percent of all medalists at the world championships and the Olympic Games since 1968 have either lived or trained at altitude. 
Professional athletes often have the resources and time to live at altitude or simulated altitude over the course of weeks or months (several studies say it takes 21 to 28 days for the body to make adaptations).
They often come down to sea level to train following the “Live High, Train Low” method shown to produce the greatest benefits in physiological adaptation.
- Many of the famous elite running programs in the US are located at elevation: Bend, Oregon (3,620 ft), Boulder, Colorado (5,400 ft), Colorado Springs, Colorado (6,035 ft), Flagstaff, Arizona (7,000 ft), Mammoth, California (7,880 ft). 
Runner’s like Ryan and Sara Hall have been known to travel to the Rift Valley in South Kenya at 6,000 ft to train periodically.
8,000 feet is often thought to be the ideal training elevation that produces the best results.
“Immediately upon arrival at altitude, the kidneys react to send erythropoietin (EPO) to the bone marrow, which produces new red blood cells to carry more oxygen,”
says Greg McMillan, an exercise scientist from Flagstaff, AZ.
EPO gains can be seen in 3-7 days and level out at 25-30 days. You’ll still experience benefits from training at altitude after that point but won’t see the dramatic EPO gains.
Here are Some Elevation Training Guidelines:
- Be careful about training easy for the first week at altitude. Decrease your distance and intensity by 25-50%. No hill repeats of speed work at first.
- Hydration is vital because the body needs more fluids as the blood plasma volume increases and because the air is thinner and the environment is typically dry. This causes shallow more frequent breathing leading to greater fluid loss through respiration. Avoid alcohol and large amounts of caffeine because it can dehydrate the body.
- Consider a high altitude training camp. Allow 3-4 weeks for the best results in training. It may result in a race PR.
- Other ways to increase your strength without training at altitude include using an altitude training mask where you can adjust the resistance, running hills, running stairs, wearing a weighted pack, and doing lower body strength training.
- If you’re running a race at elevation here are some other ways to prepare. Arrive 7-10 days before race if possible or right before race (within 18-47 hours).
- Focus on increasing your iron levels by supplementation if indicated. Taking iron with vitamin C makes it more available to your body. Also consider taking an antioxidant to combat the stress from elevation and taking branched chain amino acids to make up for the increase in basal metabolic rate (BMR) and loss of appetite that often occurs at elevation. Make sure the calories you do consume are healthy and packed with nutrients.
- Get extra sleep. You often wake up more frequently during the night at altitude so it’s important to get more sleep to help with recovery.
- Carefully consider your race strategy: listen to your body, start conservatively, use walk intervals for hills and steep parts, and focus on extra hydration and electrolytes.
Troubleshooting Elevation Problems:
Symptoms of mild to moderate acute elevation sickness include difficulty sleeping, dizziness or light-headedness, fatigue, headache, loss of appetite, nausea or vomiting, rapid heart rate, and shortness of breath with exertion. 
Elevation sickness is more common in those going above 8,000 feet (2,400 meters). More severe symptoms can include blue color to the skin (cyanosis), chest tightness or congestion, confusion, cough, coughing up blood, decreased consciousness or withdrawal from social interaction, gray or pale complexion, cannot walk in a straight line, or walk at all, and shortness of breath at rest.
Eventually this can lead to pulmonary edema (fluid on the lungs), cerebral edema (brain swelling) and death.
It’s important to recognize these symptoms early on and get treatment:
- Getting to lower altitude
- Supplemental oxygen
- Hydration and electrolytes
- Medications to treat symptoms
- Hyperbaric chamber
My marathon at elevation was definitely my hardest race yet. I saw a few people vomiting on the side of the trail and having a really rough time. Thankfully I made it up the mountain and back without any mishaps.
I have a renewed resect for runners who live and train in the mountains and those hardcore athletes who run 100 mile races at elevation!