Journal of Strength and Conditioning Research Publish Ahead of Print

DOI: 10.1519/JSC.0000000000002308

The Acute Effects of the Elevation Training Mask on Strength Performance in

Recreational Weightlifters

Andrew R. Jagim1, Trevor A. Dominy2, Clayton L. Camic3, Glenn Wright2, Scott Doberstein2,

D
Margaret T. Jones4, and Jonathan M. Oliver5

TE
Exercise Science Department, Lindenwood University, St. Charles, MO, 63301
2
Exercise and Sport Science Department, University of Wisconsin – La Crosse, La Crosse, WI
54601
3
Department of Kinesiology and Physical Education, Northern Illinois University, DeKalb, IL
60115
EP
4
Division of Health and Human Performance, George Mason University, Manassas, VA, 20110
5
Kinesiology Department, Texas Christian University, Fort Worth, TX, 76129.
C

Brief Running Title: Restricted breathing and exercise performance

Corresponding Author:
C

Andrew Jagim, PhD, CSCS, CISSN

School of Health Sciences
Lindenwood University
A

St. Charles, MO 63301

Email: ajagim@lindenwood.edu
Phone: 701-730-4842

Funding: No external funding was received for the study.

Copyright ª 2017 National Strength and Conditioning Association

ABSTRACT

The Elevation Training Mask 2.0 (ETM) is a novel device that purportedly simulates altitude

training. The purpose of this study was to investigate the acute effects of the ETM on resistance

exercise performance, metabolic stress markers, and ratings of mental fatigue. Twenty male

recreational weightlifters completed two training sessions of back squat and bench press (6 sets

D
of 10 repetitions at 85% of 5RM, 7th set to failure) as well as a maximal effort sprint test (18%

body mass) with the mask (ETM) and without the mask (NM). Training evaluation included

TE
baseline and post exercise blood lactate and oxygen saturation measures. Performance evaluation

included peak and average velocity bar velocity, total volume load, total work, total repetitions

completed and sprint performance. Adverse side-effects were reported in 12% (n=3) of

participants; which included feelings of light-headedness, anxiety and discomfort. No differences

EP
were found in repetitions or total workload in back squat (p=0.07) or bench press (p=0.08)

between conditions. A lower peak velocity was identified during the back squat, bench press, and

sprint test the ETM condition (p=0.04). Blood lactate values were lower post bench press and
C

sprint during the ETM condition (p<0.001). Significantly lower ratings of alertness and focus for

task were found post squat, bench press, and sprint test in the ETM condition compared to the
C

NM condition (p<0.001). Wearing the ETM during bouts of resistance training did not hinder the

ability to achieve desired training volumes during the resistance training session. However,
A

wearing the ETM does appear to attenuate the ability to maintain working velocity during

training bouts and negatively influence ratings of alertness and focus for task.

Key Words: Restricted breathing, weightlifting, metabolic stress

Copyright ª 2017 National Strength and Conditioning Association

INTRODUCTION

The use of ergogenic aids to augment training adaptations is a popular strategy among

athletes and fitness enthusiasts. Recently, respiratory muscle training and elevation-simulating

masks have gained popularity as a means to enhance athletic performance and fitness by

simulating altitude-like conditions. Specifically, the Elevation Training Mask is a device worn

D
during training and that the manufacturer describes as an “adjustable inhalation resistance

exercise device.” It is designed to simulate altitude training (approximately 914 to 5,486 m) via

TE
oxygen restriction as the flux valves are designed to limit the amount of air entering the mask

(13). However, a common misconception among consumers wearing the “elevation mask” is that

the ETM simulates altitude by creating a hypobaric (reduced partial pressure of oxygen)

environment when in fact there are limited supporting data (4). Although modest hypoxemia
EP
created by the ETM during exercise has been demonstrated (4), the mechanism of oxygen

desaturation does not mimic that of altitude and more research is needed to identify the specific

physiological mechanism. A reduced breathing frequency imparted by the mask’s flux valve
C

system and resistance caps, while wearing the ETM during exercise, is considered a potential

factor resulting in arterial hypoxemia. This, in addition to a rebreathing of expired carbon

C

dioxide, are likely responsible rather than a reduced partial pressure of oxygen in the atmosphere

and a subsequent shift of the oxygen-dissociation curve (4). Additionally, the magnitude of
A

oxygen desaturation is less than that of terrestrial altitude, suggesting that wearing the ETM does

not produce a hypoxic stimulus great enough to elicit physiologic responses within the body that

would be experienced at true elevation (4).

Rather than acting as a hypoxic altitude simulator, the peripheral air resistance generated

by ETM intake flux valves may directly stress breathing musculature, thereby identifying the

ETM as more of a respiratory muscle trainer (RMT). In theory, a RMT may induce respiratory
2

Copyright ª 2017 National Strength and Conditioning Association

muscle fatigue and increase respiratory muscle strength, lung capacity, and oxygen efficiency

over time. Respiratory muscle fatigue has been identified as a major factor contributing to

exercise limitation during short-term maximal exercise and, thus, highlights the potential benefit

of increasing respiratory muscle strength through RMT (10). As indicated by Porcari et al. (18),

six weeks of high-intensity interval training while wearing an ETM resulted in significant

D
increases in ventilatory threshold (VT) and power output at VT. However, no changes were

found in hematological variables pre to post training, suggesting that the ETM functions more

TE
like a RMT than a tool that simulates high-altitude training (18).

Limited research is available regarding adaptations in strength performance when an

ETM is combined with a resistance exercise program (18). Acute hypoxic exposure combined

with resistance training has been shown to optimize muscle growth due to the increased
EP
accumulation of certain hormones and metabolites that serve as key components in the signaling

of critical anabolic pathways (12, 21). Additionally, resistance training during hypoxic exposure

has been shown to contribute to advanced fiber type recruitment that may contribute to greater
C

increases in maximal strength (23). The ETM manufacturers also claim to benefit high intensity,

high volume resistance training performance under the assumption that oxygen restriction may
C

result in adaptations relating to an enhanced buffering capacity (13). In theory, an improved

buffering capacity could augment muscular endurance and improve high-intensity exercise
A

tolerance however, it is not currently known if the ETM would compromise the ability to train at

high enough intensities to elicit said adaptations. Regardless, the ETM has been heavily

marketed towards anaerobic activities of short-term maximal intensity such as short-distance

sprints, football, basketball, and mixed martial arts (MMA).

Copyright ª 2017 National Strength and Conditioning Association

 Given that the acute impact on the physiological responses resulting from use of the ETM

have yet to be evaluated in a controlled, laboratory environment, the purpose of the present study

was to investigate the acute effects of the ETM on resistance exercise performance, markers of

metabolic stress, and ratings of mental fatigue in recreational weightlifters. We hypothesized that

wearing the ETM during bouts of resistance training would diminish the subject’s potential of

D
achieving a desired total volume of work during the back squat, bench press, and maximal effort

sprint while hindering the ability to complete desired workloads great enough to achieve

TE
muscular strength, hypertrophy and peak anaerobic power. Additionally, we hypothesized that

the restriction of breathing would provide sufficient psychological discomfort to diminish

feelings of mental alertness, energy, and focus during the resistance training bouts.
EP
METHODS

Experimental Approach to the Problem

Resistance-trained males were recruited to participate in a randomized, cross-over design

C

study to examine the acute effects of wearing an ETM on strength and anaerobic sprint

performance. Subjects first completed a familiarization session prior to the start of the study in
C

order to gain familiarity with the strength training equipment, non-motorized treadmill and the

training and testing exercise protocols. Informed consent, medical history, and personal
A

information were also collected during this time. Subjects reported to the Human Performance

Laboratory within one week of the familiarization session for baseline testing which included

body composition analysis and maximal strength testing for the bench press and back squat

exercises. Subjects then completed the first of two experimental testing sessions on a non-

consecutive day (within 3-7 days of baseline testing). Subjects were randomly assigned to

complete the first of two experimental conditions wearing either the mask (ETM) or no mask

Copyright ª 2017 National Strength and Conditioning Association

(NM) so that an equal number of subjects completed either the ERM or NM condition first. The

ETM consists of a silicone mask and flexible neoprene head strap that covers the nose and mouth

and utilizes an adjustable flux valve system with multi-level resistance caps (See Figure 1.).

Insert Figure 1 Here

During each experimental testing session, baseline measures for blood lactate, oxygen

D
saturation and subjective measures of fatigue were assessed prior to performance testing.

Subjects then completed a 10-minute dynamic warm-up and then wore either the mask (ETM) or

TE
nothing to serve as the control (NM) during the performance testing. Subjects then completed a

standardized exercise protocol for the bench press, back squat and sprint exercises. One week

following the first testing session, subjects completed the second experimental testing session

utilizing an identical testing protocol under the opposite treatment condition.

EP
Subjects

Twenty-five healthy resistance trained males were initially recruited to participate in this
C

study. Five subjects did not complete both experimental trials, and were dropped from the final

data analysis. Descriptive statistics of the subjects who completed both conditions are presented
C

in Table 1.

Insert Table 1 here.

A

All subjects were initially recruited on the basis of their prior resistance training

experience and were selected to participate if entrance criteria were met. Subjects were allowed

to participate in the study if they had been regularly participating in a resistance training program

for at least 2 years and were able to bench press at least their body weight and back squat >1.5

times their body weight. Prior to testing, subjects provided written informed consent in

Copyright ª 2017 National Strength and Conditioning Association

accordance with the University of Wisconsin-La Crosse Institutional Review Board for

Protection of Human Subjects.

Procedures

Session 1: Familiarization

D
During the familiarization session, subjects completed 2 sets of 10 repetitions using

approximately 50% of their estimated 5-repetition maximum (5RM) for the back squat and

TE
bench press exercises, respectively. Subjects completed sets both with and without the ETM to

familiarize themselves with the equipment. Subjects also completed a practice 25-second sprint

test (100% effort) on a non-motorized treadmill (NMT-Force II Treadmill) (Woodway USA,

Waukesha, WI) both with and without the ETM.

EP
Session 2: Baseline

During the baseline testing session, subjects were assessed for height, weight and body

composition using air displacement plethysmography (BODPOD, Cosmed, USA). Baseline

C

measurements of maximal strength in the back squat and bench press exercises were evaluated

using a 5-repetition (5RM) test on a Smith Machine (Plyopower Technologies, Lismore,

C

Australia) and supervised by the same researcher.

Body Composition
A

Subjects were instructed to drink only water and not to eat or exercise for the preceding two

hours. Upon arrival to the laboratory, height and body mass were recorded to the nearest 0.01 cm

and 0.02 kg, respectively using a stadiometer and digital scale (Bod Pod; Cosmed, Chicago, IL).

Body composition was then assessed using air displacement plethysmography (Bod Pod;

Cosmed, Chicago, IL). Previous studies indicate air displacement plethysmography to be an

Copyright ª 2017 National Strength and Conditioning Association

accurate and reliable means to assess changes in body composition (25). Body mass and body

volume were then used to estimate body fat percentage (% fat) based upon the Brozek equation

(7).

Strength Testing

First, subjects completed 2 warm-up sets of 5-10 repetitions at a load corresponding to

D
approximately 50% of their estimated 5RM with 3 minutes of rest allowed between sets.

Subjects then began performing sets of 5 repetitions of increasing weight with 3 minutes of

TE
recovery between attempts until determination of their 5RM using methods modified from the

National Strength & Conditioning Association guidelines for maximal strength testing (24) . All

5RM determinations were made within 5 attempts. To be considered a successful back squat

attempt, subjects were instructed to squat down until the tops of the thighs were parallel to the
EP
floor. For a repetition to be considered successful during the bench press, subjects were

instructed to lower the bar to their chest during the eccentric phase and return to full-extension

during the concentric phase. These values were also used to validate the entrance criteria
C

regarding minimal strength requirements for participation in the study. Following maximal

strength testing, subjects completed an additional 25-second practice sprint test (100% effort) on
C

the NMT to gain further familiarity with the equipment and protocols as previously described

(14).
A

Sessions 3, 4: Experimental Testing

During the ETM condition, the mask was adjusted according to the manufacturer’s

recommendations for a setting to simulate an “altitude resistance” of 2,743 m based on previous

pilot work. Prior to the testing session, subjects completed a questionnaire to assess their baseline

Copyright ª 2017 National Strength and Conditioning Association

subjective feelings of focus, energy, alertness, and fatigue using a 5-point Likert scale which has

been previously used in our laboratory (8). Baseline fingertip blood samples were taken and

assessed for lactate (La) using a handheld lactate analyzer (Lactate Plus, Nova Biomedical, MA,

USA). Test-to-test reliability with this device in our laboratory has yielded high reliability with a

mean intra-class coefficient of 0.977. Baseline oxygen saturation (Sp02) was assessed using a

D
finger pulse oximeter (Allegiance, McGaw, IL, USA) prior to testing. Subjects then completed a

5-minute standardized warm-up consisting of dynamic movements similar to the familiarization

TE
session.

Immediately following the warm-up, subjects were instructed to complete 6 sets of 10

repetitions (or as many as possible) of back squat at a load corresponding to 85% of their

predetermined 5RM with 2 minutes of rest between each set. Subjects were instructed to
EP
complete each repetition as explosively as possible. Subjects then completed a 7th set to failure

using the same load. During the ETM trial, subjects wore the ETM during all testing periods and

during rest periods between sets. Total training volume completed was recorded. Bar velocity
C

was assessed using a linear position transducer (Tendo Fitrodyne, Sports Machines, Trencin

Slocak Republic) which was attached to the right side of the bar. Peak and average velocity were
C

recorded for each repetition completed during the protocol. The Fitrodyne is a reliable measure

of velocity yielding a high intraclass correlation coefficient (ICC) of R=0.97 (95% CI, 0.95-0.98)
A

in resistance trained males for lower body exercises (9).

The subjective questionnaire was administered and blood lactate was evaluated

approximately one minute following the last repetition of the 7th set. Oxygen saturation was

recorded at 1, 2 and 3 minutes following the last repetition of the 7th set. Subjects were instructed

to continue wearing the ETM until all data was collected at which time they were allowed to

Copyright ª 2017 National Strength and Conditioning Association

remove the ETM and rest for 10 minutes. Following the rest period, subjects completed the same

protocol for the bench press exercise. Following the bench press data collection, subjects were

allowed to remove the ETM and rest.

Following a twenty-minute rest period, subjects put the mask on and completed a 25-

second maximal effort sprint test on the NMT against a workload set to 18% of the subject’s

D
body mass. Subjects were given a 5-second countdown and instructed to sprint as fast as possible

for the entire 25-seconds. All sprints were started from a self-selected crouched, split stance

TE
position as previously described (14). Dependent variables for the sprint test included peak

velocity, average velocity, and total work completed over the 25-second sprint. Peak velocity

values were determined by isolating the greatest peak velocity across individual running strides

using Pacer Performance Software (Innervations, Perth, Western Australia). MATLAB

EP
(MathWorks, Natick, MA, USA) software was used to determine the average velocity as well as

total work achieved during the sprint test utilizing measurements acquired from each individual

running stride.
C

Blood lactate levels were assessed immediately following the 25-second sprint test

followed by the completion of the subjective questionnaire. Oxygen saturation levels were
C

recorded at 1, 2, and 3 minutes post-sprint. Subjects were instructed to continue wearing the

ETM until data was collected. Subjects were allowed to return to normal activity habits with the
A

exception of performing back squat and bench press exercises 72 hours prior to testing. Subjects

were instructed to complete a 2-day food log prior to each testing session that was analyzed for

total energy and macronutrient intake using the commercially available nutrition analysis

program (MyFitnessPal©, USA). Subjects were instructed to consume the same food prior to

each testing session to ensure exercise performance was not influenced by acute dietary changes.

Copyright ª 2017 National Strength and Conditioning Association

Statistical Analysis

Standard descriptive characteristics were used to describe the subject population and to

evaluate the responses to wearing the ETM. Differences in total repetitions and volume achieved

during the squat and bench press exercises as well as differences in peak velocity, average

velocity, and total work during sprint tests between conditions were compared using paired-

D
samples t-tests.

Differences in peak velocity, repetitions, and volume achieved per set of back squat and

TE
bench press exercises between conditions were analyzed using a two-way (treatment x set)

analysis of variance (ANOVA) with repeated measures for each set. Differences in blood lactate,

oxygen saturation, as well as differences in energy, alertness, focus, and fatigue between

conditions were also analyzed using two-way (treatment x time) ANOVA with repeated
EP
measures for time. Pairwise comparisons were made using Tukey’s post-hoc procedures. The

alpha level was set at p<0.05 to achieve statistical significance for all analyses. All analyses were

conducted using the Statistical Package for the Social Sciences (SPSS version 23; SPSS Inc.,
C

Chicago, IL).
C

RESULTS

Some adverse side-effects were reported throughout the study in relation to wearing the
A

ETM. Two subjects voluntarily terminated testing reporting that the physiological discomfort

associated with the breathing restriction of the ETM hindered the ability to complete the testing

sessions. Additionally, one subject experienced severe dizziness and lightheadedness while

wearing the ETM and was also excluded from the study. One subject was not able to complete

the first testing session due to aggravation of a previous injury and one subject was not able to

10

Copyright ª 2017 National Strength and Conditioning Association

complete the last testing session due to a scheduling conflict. Additionally, only data from 19 of

the 20 subjects were included in the analysis of the sprint test as a technical issue produced

improper data recording.

A summary of the number of repetitions completed during the back squat and bench press

exercise protocols are presented in Table 2. The number of repetitions completed during the

D
bench press significantly declined (p<0.001) during subsequent sets for both conditions

beginning at set 3 with no significant set by condition interaction observed (p= 0.08).

TE
Insert Table 2 here.

A summary of peak velocities achieved per set for the back squat and bench press

exercises are presented in Figure 2 and 3, respectively. Peak velocity declined in both the back

squat (p<0.001) and bench press (p<0.001) during subsequent sets for both conditions beginning
EP
at set 5 when repetitions were collapsed and expressed as an average for sets 1-6. Peak velocity

was greater during the NM condition (p<0.001) for the bench press with post-hoc analysis

revealing these differences occurred beginning at set 5 when repetitions were collapsed and
C

expressed as an average for sets 1-6. When repetitions were expanded to include peak velocities

across all 7 sets, a main effect for condition was observed and the peak velocity achieved during
C

the NM condition was greater for both back squat (p= 0.04) and bench press (p= 0.04). A greater

peak velocity (p= 0.04) was achieved during the sprint test in the NM condition compared to the
A

ETM. There was no difference in the average velocity (p= 0.85) or total work completed (p=

0.81) between conditions during the sprint test.

Insert Figures 2,3 here.

11

Copyright ª 2017 National Strength and Conditioning Association

 A summary of blood lactate measurements throughout the experimental protocol is

included in Table 3. When compared between conditions, blood lactate values were higher

following the bench press (p<0.001) and sprint test (p<0.001) in the NM condition.

Insert Table 3 here.

A summary of oxygen saturation measurements following the back squat, bench press,

D
and sprint test, can be seen if Figures 4, 5 and 6, respectively. Oxygen saturation levels were

lower (p<0.001) than baseline measurements at minutes 1, 2 and 3 following the back squat,

TE
bench press, and sprint test during both conditions. Lower oxygen saturation levels (p= 0.00)

were observed at 1-minute post squat during the ETM condition when compared to the NM

condition.

Insert Figures 4,5,6 here.

EP
A main effect for time was observed regarding ratings of energy as evidenced by

decreases in ratings of energy post bench press and sprint test (p<0.001) when compared to

baseline for both conditions. No significant condition x time interaction was observed (p= 0.75)
C

for ratings of energy. A main effect for time was observed for fatigue as evidenced by increases

in ratings of fatigue post squat, bench press, and sprint test (p<0.001) when compared to baseline
C

for both conditions with no significant condition x time interaction observed (p= 0.52).

Significantly lower ratings of alertness and focus for task were found post squat, bench press,
A

and sprint test in the ETM condition compared to the No ETM condition as evidenced by a

significant time x condition interaction (p<0.001).

12

Copyright ª 2017 National Strength and Conditioning Association

DISCUSSION

The primary purpose of the current study was to investigate the acute effects of the ETM

on resistance exercise performance, maximal effort sprint performance, and markers of

metabolic stress in trained recreational weightlifters. A secondary aim was to examine the effects

of the ETM on ratings of mental alertness, energy, and focus. To the best of our knowledge, this

D
is the first study to examine the effects of the ETM on resistance exercise performance. The

study utilized a protocol designed to elicit a high degree of fatigue as well as a protocol that may

TE
be used in a hypertrophy-focused program (i.e., 6 sets of 10 repetitions, 85% of 5RM) (22).

According to the results of the current study, the use of the ETM did not attenuate the total

training volume achieved by the participants. Contrary to our preliminary hypotheses, no

difference was observed in repetitions achieved per set, repetitions achieved to failure, nor total
EP
repetitions across all sets in the back squat and bench press exercise protocols. Additionally,

wearing the ETM did not affect total volume load (repetitions x workload) achieved in either

back squat or bench press, suggesting that wearing the ETM does not hinder the ability to
C

complete a desired workload when using a muscle hypertrophy-focused protocol.

Previous research has indicated that declines in peak velocity during resistance training
C

offer a strong indicator of muscle fatigue and is the primary driving force behind reductions in

power output (16, 17, 20). In the present study, a decrease in peak velocity was observed during
A

set 5 and subsequent sets in the back squat and bench press for both conditions, suggesting the

onset of muscular fatigue. When expressed as an average across all sets for both back squat and

bench press, peak velocity was found to be lower in the ETM condition. The ability to maintain a

higher working velocity output during multiple sets throughout a training session could

potentially result in enhanced training adaptations in muscular strength and power over time as

13

Copyright ª 2017 National Strength and Conditioning Association

described by Oliver et al. (16). Therefore, wearing the ETM may hinder long-term training

adaptations by diminishing velocity and subsequent power output during single training sessions.

Analysis of performance during the maximal effort sprint test yielded similar results to that of

the resistance training session as peak velocity achieved under the ETM condition was lower

than the peak velocity achieved without the ETM. However, the ETM did not appear to

D
negatively influence average velocity or total work achieved during the sprint test. In summary,

the use of the ETM for speed and power development may attenuate training outcomes as the

TE
potential to achieve maximal velocity during training may be compromised.

Previous research has demonstrated that blood lactate values can be used as an indicator

of exercise intensity because increased levels suggest a greater reliance on the anaerobic energy

and coincide with the onset of metabolic acidosis (3, 19). The results of the current study suggest
EP
that wearing the ETM during resistance training sessions may result in diminished metabolic

stress, as evidenced by lower blood lactate levels. Specifically, blood lactate values collected

upon completion of each exercise were found to be lower in the ETM condition post squat
C

(6.6%; although non-significant), post bench press (20.0%) and post sprint (12.3%) compared to

lactate values in the No ETM condition. Since total number of back squat and bench press
C

repetitions did not differ between conditions, the differences in blood lactate were not likely a

result of training volume differences. Further, the similar SpO2 level between conditions
A

eliminates decreases in arterial oxygen saturation or oxygen availability as possible explanations

for the differing blood lactate values. It is possible that differences in muscle fiber recruitment

patterns during the different conditions may have influenced blood lactate levels. The observed

differences in bar velocity may be indicative of shifts in fiber recruitment, specifically a

reduction of fast-twitch muscle fiber utilization. This in turn may have led to decreases in blood

14

Copyright ª 2017 National Strength and Conditioning Association

lactate levels as fast twitch muscle fibers produce the greatest lactate response due to a greater

reliance on anaerobic glycolysis (5-7). Therefore, a reduction in fast-twitch fiber recruitment, as

evidenced by the lower velocity of movement, may explain the reduction in blood lactate values

observed in the ETM condition. The lower peak velocity in tandem with lower blood lactate

values suggests that wearing the ETM may have diminished training intensity.

D
While limitation of muscle fiber recruitment resulting from the ETM provides a plausible

explanation for the direct relationship between lower peak velocities and concomitantly lower

TE
blood lactate values, the reason why muscle fiber recruitment may have been limited when

wearing the ETM is not clear and warrants further investigation. A possible explanation,

however, lies within a body of evidence that demonstrates motor performance can be directly

influenced by focus of attention (15, 25). The ‘constrained action hypothesis’ suggests that
EP
holding an external focus during activity facilitates motor performance via promotion of

automatic control of the movement being performed (11). By contrast, adopting an internal focus

of attention induces more deliberate and conscious control of the movement, thereby
C

constraining or disrupting ‘normal’ automatic control processes (11). Although subjects were

instructed to perform each repetition as explosively as possible, it is possible that when subjects
C

performed the back squat and bench press while wearing the ETM, their external focus of

pressing the barbell shifted to an internal focus of controlling breathing against the restriction of
A

the ETM ultimately distracting them. Likewise, during the sprint test, subjects likely focused

more on breathing rather than sprinting as a fast as possible. Such a shift of focus towards

breathing rather than pressing the barbell or sprinting as explosively as possible may have

contributed to the lack of significant differences observed in performance.

15

Copyright ª 2017 National Strength and Conditioning Association

 Analysis of oxygen saturation was performed in the current study to further examine the

influence of ETM on the potential states of hypoxia created during resistance training. The

results of the current study suggest that the ETM may serve more as a RMT rather than a

hypoxic training device. Oxygen saturation levels recorded at 1, 2, and 3 minutes post exercise

were found to be lower when compared to baseline for the No ETM and ETM conditions during

D
the back squat, bench press, and sprint test. It should be noted that the observed reductions in

SpO2 represent a normal drop in SpO2 that can be expected during high intensity exercise (2). A

TE
lower SpO2 was found at 1-minute post squat as the ETM produced an oxygen saturation level

lower than that observed with No ETM. However, this oxygen saturation was less than 1% lower

than that observed without the ETM and continued to fit within the range of normal SpO2 values

during high-intensity exercise. Granados et al. (4) found similar responses in oxygen saturation
EP
levels in a study comparing the physiologic responses of the ETM and a sham mask. When worn

during a 20-minute treadmill workout (60% of VO2 max), SpO2 levels averaged 94%, 91%, and

89% for the sham, 2,743m, and 4,572m altitude settings, respectively. It should be noted that the
C

present study also utilized an altitude setting of 2,743m. Granados et al. (4) observed lower SpO2

values compared to the present study, however, the nature of the exercise performed and type of
C

training, (i.e. anaerobic vs. continuous aerobic training), likely contributed to such differences as

the resistance training protocol used allowed for rest periods between sets that permitted SpO2
A

values to recover. Nonetheless, SpO2 levels observed in the present study and the study by

Granados et al. (4) were much less than what occurs at terrestrial altitude as oxygen saturation

levels at 2,743m of altitude typically fall to 89% (1) compared to the average 96.7% observed in

the current study while wearing the ETM. Granados et al. (4) postulated that the modest

hypoxemia observed while wearing the ETM was likely due to a combination of reduced

16

Copyright ª 2017 National Strength and Conditioning Association

breathing frequency imparted by the ETM resistance caps and the rebreathing of expired carbon

dioxide that accumulated in the mask’s large dead space (~240 ml) rather than hypoxia shifting

the oxygen-dissociation curve leading to reduced arterial oxygen saturation. It can then be

assumed that, such SpO2 levels, whether classified as hypoxemic or not, are not comparable to

that of true altitude exposure and are presumably not great enough to elicit metabolite buildup on

D
the same order of magnitude as true elevation. Therefore, the ETM likely does not provide any

additional benefit to the signaling of anabolic factors necessary to optimize muscle growth (12,

TE
21) as has been previously theorized, based upon the results of the current study.

To our surprise, analysis of questionnaire ratings scored on the Likert scale did not

provide evidence that wearing the ETM during bouts of resistance training impacts mental

factors of exercise performance. In fact, no differences were found in ratings of energy, fatigue,
EP
alertness, or focus for task for any exercise between conditions. These findings revealed that

wearing the ETM during high intensity resistance training was not well-tolerated which is in

opposition to findings by Granados et al. (4) who found only modest elevations in RPE and
C

anxiety while wearing the ETM. It should also be noted that three subjects were excluded from

the study due to excessive side effects and psychological discomfort associated with restriction
C

of breathing or overwhelming feelings of claustrophobia associated with full coverage of the

nose and mouth. It is highly recommended that individuals wishing to exercise with the ETM
A

allow appropriate familiarization with wearing the mask to reduce the likelihood of adverse

responses to the ETM.

A major limitation of the present study lies in the fact that a sham mask was not included

as a condition. Inclusion of a sham mask may have provided insight as to whether the

constrained action hypothesis was a predominant factor contributing to lower peak velocities

17

Copyright ª 2017 National Strength and Conditioning Association

achieved while wearing the mask. Although the ETM is commonly interpreted as a hypoxic

training device, results indicate that the ETM did not produce any differences in oxygen

saturation when compared to sprint or resistance training without the use of ETM and do not

reflect SpO2 levels associated with true elevation. Therefore, it was suggested that the ETM

functions more as an RMT device. Additional research that includes short-term training studies

D
are also warranted to provide support for this phenomenon and to identify if continued training

with the ETM would minimize the observed reductions in peak velocity and how it would

TE
influence training adaptations over time. It is also worth mentioning the use of the ETM during

resistance exercise and sprint training was not well-tolerated as three subjects were unable to

complete the protocol while wearing the ETM. Additionally, the ETM negatively influenced

subjective ratings of alertness and focus for task during the training session.
EP
PRACTICAL APPLICATIONS

Results of the current study suggest that use of the ETM during resistance training does
C

not hinder the ability to achieved desired workloads or training volume during resistance

training. However, the use of the ETM does appear to negatively influence peak velocity during
C

both the back squat and bench press exercises, which may attenuate training outcomes over time.

The ETM may also negatively impact subjective ratings of focus and alertness during strenuous
A

bouts of activity. Therefore, athletes who are training for maximal power development may want

to exercise caution when considering implementing an ETM into a training program as it may

hinder velocity of movement during training and result in physical discomfort. Further, the use of

an ETM during training may impose a risk of adverse events which should also be considered

prior to implementing the device into a training program.

18

Copyright ª 2017 National Strength and Conditioning Association

REFERENCES

1. www.altitude.org. Accessed December 19th, 2016/2016.

2. Benoit H, Costes F, Feasson L, Lacour JR, Roche F, Denis C, Geyssant A, and
Barthelemy JC. Accuracy of pulse oximetry during intense exercise under severe hypoxic
conditions. European journal of applied physiology and occupational physiology 76:
260-263, 1997.
3. Gastin PB. Energy system interaction and relative contribution during maximal exercise.
Sports medicine 31: 725-741, 2001.
4. Granados J, Gillum TL, Castillo W, Christmas KM, and Kuennen MR. "Functional"

D
Respiratory Muscle Training During Endurance Exercise Causes Modest Hypoxemia but
Overall is Well Tolerated. Journal of strength and conditioning research 30: 755-762,
2016.
5. Holloszy JO. Muscle metabolism during exercise. Archives of physical medicine and

TE
rehabilitation 63: 231-234, 1982.
6. Hultman E. Energy metabolism in human muscle. The Journal of physiology 231: 56P,
1973.
7. Hultman E, Sjoholm H, Sahlin K, and Edstrom L. Glycolytic and oxidative energy
metabolism and contraction characteristics of intact human muscle. Ciba Foundation
symposium 82: 19-40, 1981.
8. Jagim AR, Jones MT, Wright GA, St Antoine C, Kovacs A, and Oliver JM. The acute
EP
effects of multi-ingredient pre-workout ingestion on strength performance, lower body
power, and anaerobic capacity. Journal of the International Society of Sports Nutrition
13: 11, 2016.
9. Jennings CL, Viljoen W, Durandt J, and Lambert MI. The reliability of the FitroDyne as
a measure of muscle power. Journal of strength and conditioning research 19: 859-863,
2005.
10. Johnson BD, Babcock MA, Suman OE, and Dempsey JA. Exercise-induced
C

diaphragmatic fatigue in healthy humans. The Journal of physiology 460: 385-405, 1993.
11. Kal EC, van der Kamp J, and Houdijk H. External attentional focus enhances movement
automatization: a comprehensive test of the constrained action hypothesis. Human
C

movement science 32: 527-539, 2013.

12. Kon M, Ikeda T, Homma T, Akimoto T, Suzuki Y, and Kawahara T. Effects of acute
hypoxia on metabolic and hormonal responses to resistance exercise. Medicine and
science in sports and exercise 42: 1279-1285, 2010.
A

13. www.trainingmask.com. Accessed December 13th, /2016.

14. McLain TA, Wright GA, Camic CL, Kovacs AJ, Hegge JM, and Brice GA. Development
of an Anaerobic Sprint Running Test Using a Nonmotorized Treadmill. Journal of
strength and conditioning research 29: 2197-2204, 2015.
15. McNevin NH, Shea CH, and Wulf G. Increasing the distance of an external focus of
attention enhances learning. Psychological research 67: 22-29, 2003.
16. Oliver JM, Jagim AR, Sanchez AC, Mardock MA, Kelly KA, Meredith HJ, Smith GL,
Greenwood M, Parker JL, Riechman SE, Fluckey JD, Crouse SF, and Kreider RB.
Greater gains in strength and power with intraset rest intervals in hypertrophic training.
Journal of strength and conditioning research 27: 3116-3131, 2013.

19

Copyright ª 2017 National Strength and Conditioning Association

17. Oliver JM, Kreutzer A, Jenke SC, Phillips MD, Mitchell JB, and Jones MT. Velocity
Drives Greater Power Observed During Back Squat Using Cluster Sets. Journal of
strength and conditioning research 30: 235-243, 2016.
18. Porcari JP, Probst L, Forrester K, Doberstein S, Foster C, Cress ML, and Schmidt K.
Effect of Wearing the Elevation Training Mask on Aerobic Capacity, Lung Function, and
Hematological Variables. Journal of sports science & medicine 15: 379-386, 2016.
19. Robergs RA, Ghiasvand F, and Parker D. Biochemistry of exercise-induced metabolic
acidosis. American journal of physiology Regulatory, integrative and comparative
physiology 287: R502-516, 2004.
20. Sanchez-Medina L and Gonzalez-Badillo JJ. Velocity loss as an indicator of

D
neuromuscular fatigue during resistance training. Medicine and science in sports and
exercise 43: 1725-1734, 2011.
21. Schoenfeld BJ. The mechanisms of muscle hypertrophy and their application to
resistance training. Journal of strength and conditioning research 24: 2857-2872, 2010.

TE
22. Schoenfeld BJ, Ogborn D, and Krieger JW. The dose-response relationship between
resistance training volume and muscle hypertrophy: are there really still any doubts?
Journal of sports sciences: 1-3, 2016.
23. Scott BR, Slattery KM, Sculley DV, and Dascombe BJ. Hypoxia and resistance exercise:
a comparison of localized and systemic methods. Sports medicine 44: 1037-1054, 2014.
24. Triplett JMSaTN. Program Design for Resistance Training, in: Essentials of Strength
Training and Conditioning. GHaTNT Gregory, ed. Champaign, IL: Human Kinetics,
EP
2016, p 453.
25. Wulf G and Prinz W. Directing attention to movement effects enhances learning: a
review. Psychonomic bulletin & review 8: 648-660, 2001.
C

Figure Legend
C

Figure 1. Elevation training mask.

Figure 2. Peak velocity achieved per set in the back squat

A

Figure 3. Peak velocity achieved per set in the bench press

Figure 4. Oxygen saturation levels during the back squat

Figure 5. Oxygen saturation levels during the bench press

Figure 6. Oxygen saturation levels during the sprint test

20

Copyright ª 2017 National Strength and Conditioning Association

Table 1. Descriptive characteristics of subjects (N=20).
Variable Mean ± SD
Age (yrs.) 21.4 ± 2.1
Height (cm) 180.7 ± 8.8
Weight (kg) 85.5 ± 12.1
Body Fat (%) 13.5 ± 4.9
Fat-free Mass (kg) 75.7 ± 6.5
Back Squat 5RM (kg) 119.3 ± 24.2
Bench Press 5RM (kg) 103.5 ± 23.4

D
Values represent mean ± standard deviation

TE
Table 2. Repetitions achieved per set during the back squat and bench press (N=20)
Set Back Squat Bench Press
No Mask Mask No Mask Mask
Set 1 10.0 ± 0.00 10.0 ± 0.00 10.0 ± 0.00 9.9 ± 0.22
Set 2 10.0 ± 0.00 10.0 ± 0.00 9.6 ± 0.89 9.5 ± 1.28
EP
Set 3 10.0 ± 0.00 9.9 ± 0.2 8.4 ± 2.18* 8.1 ± 2.26*
Set 4 9.9 ± 0.67 9.8 ± 0.89 6.9 ± 2.25* 6.3 ± 2.74*
Set 5 9.6 ± 2.06 9.2 ± 1.79 6.0 ± 2.43* 6.2 ± 2.26*
Set 6 9.1 ± 2.06 9.1 ± 2.04 5.9 ± 2.40* 5.6 ± 2.19*
Set 7 11.1 ± 5.32 10.7 ± 4.69 6.1 ± 3.52* 5.6 ± 4.20*
Total 69.6 ± 7.86 68.6 ± 8.29 52.8 ± 11.62 51.2 ± 12.78
Values represent mean ± standard deviation
C

*Significantly different from set 1 (p<0.05).

C

Table 3. Comparison of blood lactate measurements (N=20).

Time Point
Baseline Post Squat Post Bench Press Post Sprint
A

No Mask 1.6 ± 0.31 13.3 ± 2.63 14.5 ± 3.33* 17.2 ± 1.66*

Mask 1.6 ± 0.48 12.5 ± 4.15 11.6 ± 2.30 15.1 ± 2.41
Values represent mean ± standard deviation
*Significantly greater than mask condition at same time point (p<0.05).

Copyright ª 2017 National Strength and Conditioning Association

Figure 1

D
TE
EP
C
C
A
Copyright ª 2017 National Strength and Conditioning Association
Figure 2

D
TE
EP
C
C
A

Copyright ª 2017 National Strength and Conditioning Association

Figure 3

D
TE
EP
C
C
A

Copyright ª 2017 National Strength and Conditioning Association

Figure 4

D
TE
EP
C
C
A

Copyright ª 2017 National Strength and Conditioning Association

Figure 5

D
TE
EP
C
C
A

Copyright ª 2017 National Strength and Conditioning Association

Figure 6

D
TE
EP
C
C
A

Copyright ª 2017 National Strength and Conditioning Association