Among the myriad challenges facing England as they attempt to win a second World Cup after 44 years, is the unknown factor of how altitude might affect Fabio Capello's players, and their opponents. Of England's three group games, only the opener against the USA on Saturday in Rustenburg is on the Highveld, but should England progress their last‑16 game will be back at altitude, a factor which has influenced their preparation.
With seven of the 10 stadiums used in the World Cup at altitude (only Durban, Cape Town and Port Elizabeth are not), how teams perform depends on their level of acclimatisation in the thin, dry air.
"For the South Africa team it will be an advantage but I think [the rest] will adapt," said Lucas Radebe, the former captain of Bafana Bafana and Leeds United. "Most of the teams will struggle at first but as time goes on they'll manage. That's why many came here early – to acclimatise. It's quite difficult for some of the individuals. But it's a World Cup so each team has to make sure they do."
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At the Royal Bafokeng Stadium on Saturday England play the USA at 1,500m, a few minutes' drive from the Rustenburg training base used by Capello's team. Before flying to the country the Italian and his opposite number, Bob Bradley, chose contrasting approaches.
The USA decided not to train at altitude before departing, while England spent two weeks playing and training in the Austrian Alps. The director of London's Altitude Centre, Richard Pullen, who advised Capello and the Football Association on how best to prepare the England squad, said: "The Americans have not done any preparation at all. This is so that they could have full‑on training sessions and arrive very fit, yet unacclimatised. They have taken a gamble on their fitness being enough to see them through.
"The other way [is to] get acclimatised to altitude so your training and recovery can be impaired and when [the team] arrive you're not completely as fit as you might be. But you are adapted."
It is 24 years since a World Cup featured stadiums above sea level and Diego Maradona's Argentina – who unlike some nations at Mexico '86 played all their games at altitude – emerged as eventual winners. As every nation during the group phase will play games at sea level and on the Highveld all have had to ensure preparation has been thorough this time.
"If you see a map of where all teams are based you'll see it's at altitude," Pullen said. "For England or any team that goes to altitude – the first couple of days the training load is reduced while the players get used to it and then [they] slowly increase the load to the maximum."
Pullen does say that despite the fortnight in the Alps, conditions were not perfect as the ideal stepping stone to Rustenburg, which is much higher than Irdning. "Austria was in all the newspapers as being an altitude training camp. In reality they were at 600m. But they did use an altitude kit, which simulates higher altitudes. So in Austria they had access to testing equipment to have their bodies physiologically adapted to the higher altitude they'll experience in South Africa. But what they haven't done is prepare for the dynamics of how the ball will move differently, and the drier air – the environmental conditions they'll find in Rustenburg."
Becoming familiar with a faster, more unpredictable ball is as imperative as ensuring Capello's squad rest correctly. "Recovery is not just about sleeping, it is about active recovery, about making sure players have recovered from training sessions," Pullen said. "There will be monitoring to make sure players are eating properly, hydrating properly, because at altitude you can lose appetite. It's very important that they look after their health properly."
Players and footballs have altered experiences in rarefied air due to the reduction in oxygen found at altitude. "Basically as you go up your body tries to produce more red blood cells to be able to transport oxygen around the body," said Oxford University's Dr Patrick McSharry. "This means that at high altitudes some people get acute symptoms like nausea, sickness, headaches, lots of horrible things that wouldn't make it easy to compete in football."
But it is difficult to know which players will suffer more. "One of the problems is that it seems to vary greatly from person to person so you can't just predict what will happen to the whole team," McSharry said. "Some members may be completely fine, others severely impacted."
Whatever the vagaries Pullen is confident that Capello and England have prepared correctly by leaving themselves nine days between arrival and kicking off against the USA. "They've been doing the training in Austria with our equipment and have gone there with plenty of time ahead of the first match," he said. "And, they're playing it at the same altitude as where they're based – so it's very good."
Radebe, however, suggested that the USA may still have an edge because of their experience when reaching the Confederations Cup final in South Africa last summer. "America have been here before and the coach knows the conditions," he said. On Saturday England will begin to find out how well they are adapted.
