Altitude Training

Unquestionably, acclimatization to altitude improves performance at high levels but can altitude training improve an athlete’s performance at sea-level?

The research is inconclusive. In theory, some adaptations that take place during prolonged exposure to the hypoxic conditions at 1500 m (4921 ft) or more above sea-level, should improve VO2 max and endurance performance at sea-level. Recall from the acclimatization to altitude article, that staying for a period of time at altitude increases the blood’s oxygen carrying capacity.

However, maximal cardiac output is also decreased with exposure to altitude. Along with dehydration and a loss of lean muscle mass these detrimental effects may explain why living and training at altitude does not improve VO2 max or endurance performance on a return to sea-level (1).

Those few studies that have shown altitude training to have an ergogenic effect on sea-level performance are easy to criticize (2). Subjects have not usually reached a training peak so it becomes difficult to determine whether increases in aerobic power and / or endurance performance are the result of the adaptations to altitude or intensive training.

The major problem athletes living at altitude face is a significant reduction in training intensity. At 4000 m (13,122 ft) athletes can only exercise at 40% of their sea-level VO2 max compared to 80% at sea-level for example. Breathing hypoxic gases significantly reduces power output (3) and this could lead to substantial detraining negating any of the ergogenic effects associated with acclimatization.

Live High – Train Low

Is it possible to induce the positive changes associated with altitude acclimatization without the associated negative effects? One banned and potentially dangerous tactic is blood doping and erythropoietin injections, which increase the blood’s oxygen carrying capacity.

In an attempt to curb the detraining effect of reduced exercise intensity at altitude, Levine and Stray-Gundersen (4) studied the effect of living high and training low on endurance performance. A group of 39 middle-distance runners were split into three altitude training groups – a “live high – train low” group, a “live high – train high” group and a “live low – train low” control group.

Unlike the control group, both “live high” groups increased their VO2 max on a return to sea-level by 5%. This was in direct proportion to the increase in red cell mass volume. However, only the “live high – train low” group improved their endurance performance as measured by a 5km time trial. Velocity at VO2 max and maximal steady state also improved in this group helping to shave an average of 13.4 seconds off their time.

The same researchers carried out a further altitude training study on elite male and female runners and found similar performance enhancing effects of living high and training low (5). The athletes’ 3km time was measured before and after a period of 27 days living at altitude (2500m, 8200ft) interspersed with training sessions at sea-level. VO2 max increased an average of 3.2% and performance by an average of 1.1%. While this may seem like a negligible improvement, 1.1% at an elite level translates into a significant performance advantage.

Further altitude training studies, both at real altitude and simulated altitude, have shown that living high and training low can improve running economy (6), 800m, 1500m 3km performance (7), 400m performance (8,9), submaximal cycling performance (10) and muscle buffer capacity (10).

These favorable results have stimulated interest in how athletes can “live high – train low” without having to actually move to high elevations. Several methods exist for artificially re-creating the hypoxic environment at altitude. These include hypobaric chambers, increasing the air’s nitrogen content and altitude sleeping tents.

Sleeping tents are likely to be the most affordable and accessible option and don’t seem to disrupt normal sleep quality (11,12). However, more research is needed to confirm whether these apartments do indeed improve performance (13).


1) Adams WC, Bernauer EM, Dill DB, Bomar JB Jr. Effects of equivalent sea-level and altitude training on VO2max and running performance. J Appl Physiol. 1975 Aug;39(2):262-6

2) McArdle WD, Katch FI and Katch VL. (2000) Essentials of Exercise Physiology: 2nd Edition Philadelphia, PA: Lippincott Williams & Wilkins

3) Brosnan MJ, Martin DT, Hahn AG, Gore CJ, Hawley JA. Impaired interval exercise responses in elite female cyclists at moderate simulated altitude. J Appl Physiol. 2000 Nov;89(5):1819-24

4) Levine BD, Stray-Gundersen. “Living high-training low”: effect of moderate-altitude acclimatization with low altitude training on performance. J. J Appl Physiol. 83(1):102-112, 1997

5) Stray-Gundersen J, Chapman RF, Levine BD. “Living high-training low” altitude training improves sea level performance in male and female elite runners. J Appl Physiol. 2001 Sep;91(3):1113-20

6) Saunders PU, Telford RD, Pyne DB, Cunningham RB, Gore CJ, Hahn AG, Hawley JA. Improved running economy in elite runners after 20 days of moderate simulated altitude exposure. J Appl Physiol. 2003 Nov

7) HincksonE A and Hopkins WG. Changes in running performance following intermittent altitude exposure simulated with tents. Medicine and Science in Sports and Exercise. 2005 37(5), Supplement abstract 262

8) Nummela A and Rusko HJ. Acclimatization to altitude and normoxic training improve 400m running performance at sea level. Sports Sci. 18(6):411-419, 2000

9) Nummela, A., Jouste, P., & Rusko, H. Effect of living high and training low on sea level performance in runners. Medicine and Science in Exercise and Sports. 1996 28(5), Supplement abstract 740

10) Gore CJ, Hahn AG, Aughey RJ, Martin DT, Ashenden MJ, Clark SA, Garnham AP, Roberts AD, Slater GJ, McKenna MJ. Live high-train low increases muscle buffer capacity and submaximal cycling efficiency. Acta Physiol Scand. 173(3):275-286, 2001

11) Degia A, Emegbo S, Stanley N, Pedlar C, Whyte G. Effect of acute normobaric hypoxia on cognitive and psychomotor function in recreational athletes. Medicine and Science in Sports and Exercise 2003 35(5)

12) Emegbo S, Pedlar C, Stanley N, Whyte G. Acute Normobaric Hypoxia And Its Effects On Measures Of Sleep Quality In Recreational Athletes (Using Altitude Tents.). Medicine & Science in Sports & Exercise: 2003 35(5) Supplement 1 May p S162

13) Wilber RL. Current trends in altitude training. Sports Med. 2001;31(4):249-65.