A machine being used by Australian footballers, which is designed to imitate the effects of high altitude training and enhance performance has prompted an investigation by the Australian Football League (AFL) and sparked debate in the media. The AFL decided not to ban the machine but a sense of unease about its use remains and there seems to be some difficulty in articulating the cause of that unease. The league’s medical officers say the hypoxicators do not contravene their antidoping code or the league’s rules,^1,2 but according to at least one AFL official, the use of the machines is “sending the wrong message concerning the image of our game”.¹

The hypoxic air machine provides nitrogen rich air which is thought to boost the oxygen carrying capacity of the blood, which in turn boosts the production of red blood cells—in much the same way as the banned drug erythropoietin (EPO).^3,4 There is a lack of scientific evidence to support the comparison with EPO but the comparison is troubling for some. Others are concerned about the fact that the machine provides an artificial aid to athletes. According to one AFL medical commission member: “It is the sort of thing, which makes you a little bit uncomfortable, because it is trying to use an artificial means to gain an advantage in a contest where you really want man against man”.⁵

Many in the sports science community are sceptical of the supposed benefits and reject worries about hypoxic air machines being an artificial aid.⁶ A study conducted at the Australian Institute of Sport (AIS) found that hypoxic devices produce on average, an 0.8 per cent improvement in endurance—the same as could be achieved by swallowing a placebo.⁵ One AFL club doctor argues that it would be “a lot cheaper to give them a Smartie”.³ Professor Allan Hahn, head of physiology at the Australian Institute of Sport dismisses as “illogical” the argument that hypoxic air machines should be banned. Banning them because they provide an “artificial environment” would mean also banning heat chambers and weight training facilities.⁵ Furthermore, altitude or hypoxic training is “widespread” in sport. Most endurance athletes at the Victorian Institute of Sport undertake some sort of altitude training as part of their training programme. The athletes sleep in altitude tents and train at sea level in order to improve performance.⁷ The chief executive of Port Adelaide defends use of the machine by asking if the AFL would be concerned if he trained the squad at a higher altitude.⁸

Brisbane player Jason Akermanis who owns and has been using the hypoxicator since 1999 is adamant that use of the machine does not amount to cheating⁸: “Exercise is performance enhancing, eating the right diet is performance enhancing”. And, he added: the AFL “can’t take away someone’s right to breathe”.⁶

Arguments in support of the machine suggest that enhancement by itself is not a problem. Some forms of performance enhancement in sport are accepted and some are considered cheating. In particular, an advantage gained chemically rather than by training is considered improper because it is viewed as a “biomedical short cut” that diminishes the value of the achievement.⁹ It Is not clear however, into which category the hypoxic air machine really falls. Defenders of the machine argue that it merely reproduces a high altitude training environment. Training is still necessary but it becomes more effective. Paradoxically, the appeal of the machine is that it is thought to boost the oxygen carrying capacity of the blood and the production of red blood cells—this suggests it offers a chemical improvement to performance.

The argument that hypoxic air machines should not be used because they constitute a form of technology that enhances performance by artificial means, is complicated by the news that another AFL club, which is undertaking hypoxic training to build endurance, does this without the use of technology. The Sydney Swans swim laps holding their breath and this is said to have a similar effect to that achieved with the hypoxicator.²

The interesting thing that comes out of the debate about hypoxic air machines and whether they should be banned, is that there is nothing wrong with performance enhancement in itself. It is also evident that a distinction between natural and artificial means to gain an advantage is neither clear cut nor morally significant. There do not seem to be any risks associated with using the machines, and given that the decision to use it is voluntary, the only remaining justification for banning the machine would be on grounds of fairness—specifically in relation to fair rules of competition.