Response to “Prohibition of artificial hypoxic environments in sports: health risks rather than ethics”

We appreciate the comments made by Dr. Lippi, Dr. Franchini, and Dr. Guidi in response to our article ‘‘The spirit of sport, morality, and hypoxic tents: logic and authenticity’’ (Malloy et al. 2007). In their response, Lippi et al. have made a case for a prospective health risk associated with ‘‘excessive exposure to hypobaric hypoxia’’. The scientific evidence they report indicates that exposure to hypoxic environments — be they natural or artificial — beyond 3000 m presents a potential for significant physical risk. However, Levine and Stray-Gundersen (1992) suggest that an altitude of up to 4000 m is safe to facilitate the necessary physiological adjustments that improve sport performance. Consistent with the logic of the argument we presented, any training regime that places athletes in danger would be condemned. That is, teleologically, sleeping in a tent that replicates a dangerous environment (e.g., >4000 m) would be unacceptable — as would sleeping in the naturally, yet dangerously high, hypoxic environment of a mountain 5000 m above sea level to achieve the similar physiological adaptation. Both of these extremes take the hypoxic training strategy to a hazardous level and are therefore unacceptable. Having said this, extremes in training of any kind are potentially dangerous. For example, a progression of training volume (e.g., kilometres per week) or intensity is used by athletes as a necessary part of the training regime. However, if the progression in volume or intensity is too great, the athlete will be at an increased risk of injury. Thus, too much training too quickly is detrimental to both athletic performance and health. Some of the negative health outcomes associated with an inappropriate progression in training is an elevated resting heart rate, shin splints, decreased appetite, low energy levels, and depression. Reason seems to dictate that athletes are to avoid these dangerous extremes and seek what Aristotle (1968) would argue as ‘‘virtuous’’ training. He describes virtue as the mean between excess and deficit. To occupy either extreme is not only to choose badly, but also to damage the individual’s ‘‘soul’’. He states that

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