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High Altitude Training

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Other Names

  • Altitude Training


  • This page is a review of the literature on training at altitude (work in progress)




  • Training
    • LHTL: Live high, train low (live at altitude, train at sea level)
    • LHTH: Live high, train high (live at altitude, train at altitude)
    • LLTH: Live low, train high (live at sea level, train at altitude)
    • IHT: intermittent hypoxic training
    • IHE: intermittent hypoxic exposure
  • Physiology
    • Hbmass: Hemoglobin mass


  • General
    • General assumption unacclimatized athlete is at a disadvantage compared to the acclimatized athlete competing at altitude
    • Utilizing physiologic effects of high altitude acclimatization on hypoxia and exercise performance at both altitude and sea level is the primary driver of utilization of altitude training among athletes.
  • Optimal Elevation
    • <2000 Meters: Not enough stimulus
    • 2000-2500 meters: 22+ hours per day
    • 2500-3000 meters: 12+ hours per day
    • 3000: no benefit above 3000 meters

Benefits of Training at Altitude

  • Improved aerobic capacity
  • Increased VO2 max
  • Increased erythropoietin (EPO)
    • Leads to corresponding increase in red blood cell mass
    • Theorized to be the key acclimatization response that enhances both VO2max and performance[1]
    • However, studies supporting this finding are variable and inconclusive
  • Increased Muscle buffer capacity
  • Improved pH regulation
  • More efficient exercise economy
  • Improved mitochondrial function and efficiency
  • Augmented skeletal muscle capillary-to-fiber ratio
  • Central factors (cerebral hypoxia)

Negative Effects of Altitude on Performance

  • Decreased Muscle Mass
  • Diminished efficiency of energy expenditure
  • Cardiac output decreases
  • Increased risk of dehydration
  • Decreased training intensity
  • Decreased power output
  • Longer recovery time

Practical Considerations

  • LHTH Model (live high, train high)
    • Investigation into this model has produced mixed results
      • Some show improved VO2max, performance
      • Others show athletes inability to maintain high intensity training at altitude with subsequent decline in performance[1]
    • Limitations may may result from tissue hypoxia and centrally induced reduction in exercise effort
  • LHTL Model (live high, train low)
    • Addresses the training intensity limitation seen with LHTH, still achieves benefits of acclimatization[2]
    • This model is most commonly adopted by elite athletes and teams
    • Overall conflicting evidence
      • Some studies show benefit with improved athletic performance, serum erythropoietin levels, VO2max
      • Other studies show no significant difference[1]
    • Artificial "altitude environments" have been created to simulate living high, including:
      • Nitrogen dilution apartments
      • Oxygen filtration apartments/tents
      • Training at altitude with the use of supplemental oxygen
  • LLTH Model (live low, train high)
    • Varies from other models in that the altitude/ hypoxic training period is smaller and more discrete
    • Hypoxia may be used during a resting state (IHE) or with exercise training (IHT)
    • Time is typically limited to 180 minutes or less
    • Hypoxia can be natural or artificial
    • Evidence for benefit to exercise performance is limited
    • Likely helps with pre-acclimatization prior to competition at altitude[1]
  • Optimal training strategy
    • Has yet to be totally delineated
    • Current best evidence states the recommendation for competing/participating in the high-altitude environment is to allow for adequate acclimatization over a period of weeks[3]
  • (Editors note: this section needs to be organized)
    • Mixed altitude strategies (such as LHTL plus train high) appear to increase Hbmass, V˙O2max, and endurance performance greater than typical LHTL.
    • Absolute changes in Hbmass and V˙O2max do not necessarily translate into proportional changes in endurance performance.
    • Absolute changes in Hbmass and V˙O2max appear to be repeatable as a result of LHTL, but performance improvements are far more variable.
    • LHTL may induce additional nonhematological improvements that transfer into cycling performance improvement.
    • Enhancement of Hbmass as a result of LHTL may improve repeat maximal cycling performance.
    • In elite athletes, sedentary and confined living conditions as a result of living in an altitude house may not provide an adequate stimulus for enhanced erythropoietic activity, leading to a substantial increase in Hbmass.
    • Consideration of current training phase is required when implementing an altitude training program designed to enhance specific endurance performance determinants, in particular, running economy.

Athlete Specific Considerations

  • Need to discuss sickle cell disease, trait, other hemoglobinopathies

See Also


  1. 1.0 1.1 1.2 1.3 Wilbur RL. Application of altitude/hypoxic training by elite athletes. Med. Sci. Sports Exerc. 2007; 39:1610Y24.
  2. Levine BD. Intermittent hypoxic training: fact and fancy. High Alt. Med. Biol. 2002; 3:177Y93.
  3. Subudhi AW, Roach RC. Endurance performance at altitude. Curr. Sport Med. Rep. 2008; 7:6Y7.
Created by:
John Kiel on 7 July 2019 22:12:03
Last edited:
24 April 2022 12:33:19