News & Comment / Performance

Highlights of the Third Annual International Altitude-Training Symposium

Peter Pfitzinger, MSc

Sport and Exercise Science Department, University of Auckland, Auckland, New Zealand. Email:

Sportscience 4(1),, 2000 (1565 words)

Reviewed by Ben D Levine MD, Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center at Dallas, Texas 75231, USA


Altitude exposure combined with training near sea level (living high, training low) enhances endurance performance at sea level by increasing oxygen transport to muscles. The optimal altitude for daily exposures of 20 hours per day is about 2,100 to 2,500 meters. There is a large variation in benefit between athletes. Altitude exposure can be included in the training program in the peak phase or at the end of the base phase. A potential nutritional problem is loss of muscle mass resulting from insufficient energy intake. Iron deficiency can also reduce the benefit of altitude exposure. Hypobaric chambers, nitrogen houses, and nitrogen tents appear to simulate altitude exposure successfully. Use of supplemental oxygen to achieve high-intensity training at altitude appears to be more stressful than training low. Reprint  Help


KEYWORDS: EPO, erythropoetin, hypoxia, live high train low, nutrition, simulated altitude


The third international symposium on altitude training was held at the High Altitude Sports Training Complex ( at Northern Arizona University, Flagstaff, on February 23-26, 2000. I was able to attend the meeting, thanks to support from the NZ Sports Foundation and the NZ Triathlon Academy. I present here a summary of the presentations on the physiology of altitude training (Robert Chapman), nutritional requirements of altitude training (Barry Braun), new approaches to altitude training (Randy Wilber), and the state of the altitude art (Ben Levine).

Physiology of Altitude Training
Robert Chapman, PhD

Robert's credentials in the area of applied altitude training include: past project co-ordinator for the USOC's high/low altitude camp; earned his PhD working with Ben Levine; first author on several papers on the live high/train low model. He is currently cross country and track coach at Indiana University.

Robert first explained the need for high aerobic power in an elite runner competing in events lasting 2 min or longer. He then posed and answered a series of questions relating altitude exposure to performance of such events at sea level.

What are the effects of altitude?

Living at altitude increases aerobic power at sea level primarily by increasing the ability of the circulatory system to transport oxygen to the muscles. The increase comes about through an increase in the number of red cells in the blood. The extra red cells are produced in response to an increase in release of erythropoetin (EPO) primarily during the first three weeks at altitude. Changes in buffering capacity of blood and muscles also occur, but these may be beneficial or harmful. Changes also occur in the respiratory system, but these are still under investigation. The physiological adaptations to training at altitude are apparently not beneficial, although there is no harm in doing low-intensity training at altitude.

Who benefits from altitude?

There is a large variation between athletes in the response to living at altitude. Some athletes have much larger increases in EPO than others at a given elevation. Athletes who have a low EPO response may need to live at a higher altitude.

When should altitude be used?

Traditionally it is used in the peak phase of training before competitions, but Robert made a case for using it at the end of the base phase, just prior to high-intensity training. The increased oxygen-carrying capacity then allows higher intensity training, so the performance enhancement can outlast the life of the extra red blood cells. The benefits of altitude training probably last for 4-6 weeks after return to sea level.

Nutritional Requirements at Altitude
Barry Braun, PhD

Barry researches fuel metabolism at high altitude. He is currently assistant professor in the Department of Exercise Science, University of Massachusetts, Amherst.

The extra stress of altitude leaves less room for error in nutrition and other lifestyle factors. Athletes need to be more vigilant with their intake of nutrients. Iron deficiency can also reduce the benefit of altitude exposure, particularly in female athletes.

Hypoxia leads to appetite suppression. Athletes tend to eat smaller meals, for a typical reduction in caloric intake of about 200 to 300 kcal per day. Basal metabolic rate increases at altitude, especially during the first few days. Depending on the altitude and the athlete's individual metabolism, the increase may be 100 to 200 kcal per day. The result of decreased energy intake and increased basal metabolic rate is gradual reduction in body weight. The contributions of fat and muscle to the weight loss depend on the energy deficit. When energy intake is insufficient, the body metabolizes protein to provide additional energy, so the larger the deficit, the more muscle is lost. Athletes at altitude need to maintain sufficient energy intake to limit the loss of muscle.

High altitude living may raise the need for B vitamins, but this is not a major consideration for anyone with a good diet or taking a daily multi-vitamin. Anecdotal evidence and some empirical data suggest that oxidative stress increases at altitude. Although the body's antioxidant system adapts to changes in stress such as altitude, it may be beneficial to increase intake of vitamin E and vitamin C.

Athletes also tend to get dehydrated at altitude. They should deliberately drink more fluid, in the form of diluted fruit juice or sports drink.

New Approaches to Altitude Training
Randy Wilber, PhD

BRandy is Physiologist at the US Olympic Training Center in Colorado Springs. He works with national team athletes in a wide variety of sports, and has recently completed a book titled Altitude Training and Athletic Performance.

Live high, train low

The benefits of living high and training low (the high/low model) are now well established. It is also reasonably clear that athletes need to come down the mountain only for high-intensity workouts (the high/high/low model).

Simulated Altitude

Altitude houses and tents are becoming popular as a convenient way to live high and train low. The effect of altitude is simulated by reducing the pressure or by diluting the oxygen with extra nitrogen. In several studies of simulated altitude, there have been significant increases in EPO and red-cell mass. Athletes in these studies experienced at least 12 hours per day in simulated altitude. Exposures of 8-10 hours per day did not result in changes in blood parameters in a recent Australian study.

Use of Supplemental Oxygen at Altitude

At the US Olympic Training Center at Colorado Springs (altitude 2,000 m), cyclists, triathletes, and other athletes use supplemental oxygen for high-intensity training. By breathing through an oxygen mask while training at altitude, athletes are able to work at higher intensity than would otherwise be possible at altitude. The oxygen concentration is set to 26.5%, which recreates the same oxygen content as at sea level.

Athletes experience pronounced local muscle fatigue and psychological stress following supplemental oxygen workouts, so extra recovery should be built into the training program. Adequate warm-up and gradual increase in intensity are also important to prevent injury, especially for treadmill running. The US cycling team used supplemental oxygen to train for the 1996 Olympics, but they competed better two weeks after the Olympics. Randy believes the cyclists may have worked too hard and did not recover fully for the Olympics.

State of the Altitude Art
Ben Levine, MD

Ben is Associate Professor of Medicine at the University of Texas Southwestern Medical Center, and Director of the Institute for Exercise and Environmental Medicine at Presbyterian Hospital in Dallas. He and Jim Stray-Gundersen have published a definitive series of studies on living high and training low.

Ben first gave an overview of how living and training high has a detraining effect, owing to a reduction in training intensity. Living high and training low provides the benefit of altitude exposure without detraining.

He pointed out that athletes with inadequate iron stores (serum ferritin less than 30 ug/L) will not get an increase in performance with altitude exposure. Any new red cells will have low hemoglobin content and will not function properly.

Even with adequate iron stores, not all athletes benefit equally from altitude exposure. In one of Ben and Jim's studies, non-responders (athletes who did not show an improvement in performance) had a smaller and less sustained increase in EPO than responders. Athletes may also differ in their sensitivity to increased EPO.

He finished his talk with the issue of the optimal dose of altitude exposure. He presented prelminary data from a recent ongoing study, in which four groups of runners trained at 1,200 meters and lived for about 20 hours a day at 1,800, 2,100, 2,500, or 2,800 meters. In general, the runners who lived at 1,800 or 2,800 meters showed small improvements in 3-km run time, but there were greater improvements for those who lived at 2,100 or 2,500 meters. Individual variability in the response to altitude was substantial. Shorter exposures may not reduce the benefit: in unpublished research of Rusko and coworkers, the increase in mass of red cells was similar for exposures of 12-16 and 24 hours a day. Whether athletes would gain extra benefit from higher altitudes for less hours per day is not known. It is also unclear whether there is any real difference in the response to normobaric hypoxia (nitrogen houses or tents) versus hypobaric hypoxia (mountains or depressurized chambers).


Edit Edited by Will Hopkins.
Webmastered by Matt Kerner.
Published April 2000.