Professional athletes, Olympic athletes and those serious-minded athletes who seek to improve their performance often train at mountain resorts where thin air, less oxygen, demands strenuous training to attain desired results. Indeed, high altitude visits have an established prominence in overall condition and endurance but also have applications for asthmatic patients and those individuals with illnesses having an underlying allergic component as well as disorders unrelated to allergy. While trips to high altitude resorts for extended periods may be impractical for most people, simulated exposures to the low pressure of high altitude in an altitude chamber merits serious consideration and the availability of these chambers is expected to increase over the next decade.

A brief review of the history of simulated high altitude as a therapy and for conditioning is in order. In the late 1940s the scientist Solco W. Tromp, Ph.D., a Dutch geologist by training and co-founder of the prestigious International Society of Biometeorology (biometeorology.org – 1956), made a curious observation. He noted that children with asthma were relieved of their symptoms whenever they skied downhill but not cross country. As a scientist he surprised if this simple observation could have been verified under controlled clinical conditions. For this purpose he retrofitted altitude chambers imported from Germany and in cooperation with the medical school and hospital in Leiden, The Netherlands conducted research that lasted more than 30 years and is today documented with 41 papers by Tromp in the Medline index of the PubMed archives of the National Library of Medicine (pubmed.gov – enter: tromp sw). A link referencing Tromp's basic protocol is provided below. This does not take into account the numerous out of print books and texts Tromp authored on the pioneering science of Human Biometeorology (ref: Google.com). His prolific contributions to the literature of health and science are best appreciated by entering his name, as SW Tromp, in amazon.com (books), used.addall.com, and the Google search engine. Neverheless, as with many non-medical, non-surgical therapeutic modalities Tromp's work went largely ignored by establishment medicine which advocated then as now pharmacological-reviewed therapy.

Although commonly known as altitude chambers they are more appropriately called hypobaric (low pressure) chambers. Hypobaric chambers should not be confused with the more widely utilized hyperbaric (high pressure) chambers. When compared, hypobaric exposure simulates ascending in an aircraft while hyperbaric exposure simulates descending in a submarine requiring oxygen administration and both chambers have similar yet different physiological benefits for users. The late F. Joseph Whelan, MD, a neuropsychiatrist and clinician long associated with the hypobaric technology, coined the term “cellular calisthenics” to describe the effects of controlled pressure exposures on cells. As a result of the normal aging process, disease or injury some cellular workings diminish while adjunct cells function adequately to sustain life. When all cells are simultaneously stressed by prescribed pressure and / or temperature changes they respond or improve their roles by re-establishing normal expansion-contraction of their membranous cell walls to initiate and enhance metabolic functions that include respiration, circulation, digestion, assimilation, reproduction , excretion etc. This process is thought common to both the hypobaric and hyperbaric chamber sojourns and since cellular improvement results from prescribed pressure changes the condition and the therapeutic applications are theoretically far reaching.

This writer has no experience with hyperbaric chambers or hyperbaric oxygenation protocols and nothing written further should be constrained to refer to such uses.

Whelan's theory of “cellular calisthenics,” in collaboration with this writer, takes on its greatest significance with the fact that the human body is composed of 75 trillion cells ranging from the simplest epithelial cells to highly specialized organ cells. While each cell performs its metabolic functions the cell's most important process is the production of adenosine triphosphate (ATP) that immediately breaks down to adenosine diphosphate (ADP) to release energy which is defined as “The ability to do work.” As cells improve their function “to do work” the realization becomes apparent that cells collectively compose tissues which make up organs that in turn comperse systems and extremely systems that function to capacity actually improve their “interface of interdependence” for maximum efficiency. It follows that immunologic function improves as the management of stressful demands. Whelan further believed that with significant objective improvement (based on the PubMed archived Tromp protocol expressed in the paper, “Influence of weather and climate on asthma and bronchitis,” http://www.ncbi.nlm.nih.gov/pubmed/5702098 , a trial of antibiotic therapy would assist the metabolic function of excretion (bacterial reduction) and Applied Kinesiology (AK) testing and techniques could accurately monitor the efficacy of this trial.

The effects on human physiology at high altitude are unique since healthy athletes and individuals with varying conditions benefit from its exposure whether simulated or natural. As an example, the natural parallel to hypobaric usage would occur on the Hawaiian island of Maui where an individual would start at sea level then drive up the inactive volcano Mt. Haleakala (a tourist attraction), remain at its summit of 10,000 feet (3048 meters) for one full hour then drive back down to sea level. This is a very safe procedure that has no harmful effects for most tourists who travel this journey daily. The first observable physiological change occurs before and after sojourn measurements of urinary pH with a post shift to the alkaline right. Excessive acetic diets can occasionally affect this finding.

In high altitude physiology, whether simulated or natural, oxygen availability decreases. This decrease in oxygen reflexively stimulates the kidneys to increase their normal production of the human growth hormone erythropoeitin, EPO. Synthetic EPO is an invaluable therapy for the dialysis patient but EPO has been unscrupulously administrated by prescribing doctors in what is now commonly known as “blood doping” to maximize athletic performance.

Overall conditioning and endurance improve when elevated EPO levels migrate to the long bones (arms and legs) to stimulate additional production of red blood cells (RBCs) from bone marrow. These RBCs then circulate to the lungs to improve pulmonary function thus resulting in chest wall expansion and an increased transport of RBCs through the body. This phenomenon has such therapeutic and conditioning implications that it is nothing short of being termed a “biological classic” that has yet to be fully realized and appreciated. It is noteworthy that EPO production is increased naturally up to 50 times with chamber usage and more than a thousand times by its synthetic administration.

The major difference between visits to a high altitude resort and hypobaric chamber exposures is that with the former after a short period of time the body only acclimates to the atmospheric altitude pressure change while with chamber exposures “cellular calisthenics” occurs making it analogous to a regimented exercise routine. By a series of innovative experiments involving the body's thermoregulatory response, Tromp provided that these repeated exposures resolved in significant corrections and what appeared to be improvements or cures in compliant patients.

During his lifetime of research Tromp concluded that hypobaric exposures were made optimally therapeutic with a prescribed pressure simulating 8200 feet (2500 meters) for one full hour duration three or four times a week until a minimum of 50 sojourns to an optimal 100 sojourns was accomplished. For those rare patients unable to tolerate this pressure or where otherwise contraindicated Tromp realized that pressure simulating 5000 feet (1525 meters) provided a minimal therapeutic threshold. Pressure below 5000 feet was of no conditioning or therapeutic value while that above 8200 feet prepared mountain climbers and personnel involved in aerospace programs to tolerate the significantly lower pressure of higher altitudes.

The distinguished scientist and philanthropist Shelley Krasnow, founder and president of Gaurator Corporation, Manassas, Virginia, is singlehandedly credited for importing this technology to the United States. His second medical paper indexed in PubMed entitled, “Geographic patterns of large intestine and rectal malignancy mortality in Virginia,” http://www.ncbi.nlm.nih.gov/pubmed/5528099 , was preceded by his equally intriguing analysis in the research paper, “Physiological chilling as a possible factor in mortality from neoplasia” that parallel the work of Tromp and resolved in close personal friendship that lasted until Tromp's passing. Through his non-profit corporation, Medical Progress, Inc., Shelley Krasnow provided all patients (especially pediatric asthmatics) with free access to benefit from the complete chamber conditioning protocol.

This writer is honored and privileged to have worked closely with Shelley Krasnow from 1982 until his passing in 1989 and still contains the protocols established by Tromp.

As a final thought the cases of my first two patients who completed and actually exceeded the chamber protocol is offered to illustrate the diversity of patients / clients who can be assisted with this conditioning procedure. The first involved a divorced 28 year old female without children who chief complaint was progressive unilateral upper and lower extremity weakness. Objective examination confirmed her complaint which failed to respond to conservative chiropractic management. A neurological consultant was ordered with a suspected impression of possible demyelenating disease as the cause for her symptoms. As neither CAT nor MRI scans were readily available (1982) she indicated to decline any invasive confirmatory procedure instead opting to try the chamber conditioning protocol. As the sessions increased in number her symptoms very slowly improved which inspired her to seek additional complementary therapies. These included acupuncture, Applied Kinesiology (AK), homeopathy and lifestyle changes that when integrated continued to improve her condition. Today she is fully functional, gainfully employed, but on occasion experiences minimal to moderate discomforts.

In the second case a young man who served in the navy as an aircraft carrier jet mechanic continued this occupation into civil life. It was while working for a major airline in Chicago years later that he and a colleague served an aircraft on the tarmac at night in subzero weather. Both men collapsed on the job and were rushed to the ER for evaluation where a diagnosis of sudden sunset of asthma was established. They were treated accordingly. When this individual became my patient for non-related musculoskeletal complaints I proposed a trial in the chamber which he read agreed to pursue. Within a short period subjective and objective pulmonary improvements became evident. He had always maintained consultation with his pulmonologist until he always relocated to Hawaii where I'm certain he's a regular and frequent visitor to Mt. Haleakala.

Not unlike my predecessors I have often tried and failed to create interest within the healing arts community to this conditioning technology. But it seems that well meaning docs are more interested in maintaining their own specialized turf than referring patients to trial an unfamiliar but safe procedure. And so I'm left to imagine if victims of such catastrophes as Gulf War Syndrome, Legionnaires' Disease or respiratory disorders afflicting first responders to the horrors of 9/11 could have been saved by a technology that succeeds with clinically verifiable outcomes. I suspect professional athletes in their quest to legally attain the competitive edge will one day be first on line to embrace hypobaric chamber conditioning.