What’s the Best Type of Altitude Training for Athletes?
Live high, train low (LHTL) with low altitude training is the most effective approach. This network meta-analysis of 59 studies found LHTL combined with low altitude training ranked highest for improving VO2max, with a P-score of 0.92 for natural altitude and 0.86 for simulated altitude.
Athletes have used altitude training since the 1968 Mexico Olympics. But with so many different approaches available today, which one works best? This comprehensive analysis compared multiple hypoxic training methods to find the optimal type and dose.
What the Data Show
Researchers analyzed 59 randomized controlled trials comparing different altitude training methods:
Effectiveness ranking (by P-score):
- LHTL with natural altitude + low altitude training: 0.92 (most effective)
- LHTL with simulated altitude + low altitude training: 0.86
- LHTL with sea level training: 0.56
- LHTH (live high, train high): Also effective but lower ranked
- IHT (intermittent hypoxic training): Also effective
Key finding: LHTL, LHTH, and IHT all outperformed normal training for improving VO2max. The critical factor was training at low altitude rather than sea level during LHTL.
Dr. Kumar’s Take
This is a landmark study because it finally gives us a clear ranking of altitude training methods. For years, coaches and athletes have debated which approach works best. Now we have data from 59 studies pointing to the same conclusion: live high, train low, with your training site at low altitude (not sea level). The dose-response data is equally valuable because it shows there’s an optimal range beyond which more altitude exposure doesn’t help and may even hurt.
The Different Approaches Explained
Live High, Train High (LHTH): Athletes live and train at altitude throughout the day. This was the traditional approach from the 1960s.
Live High, Train Low (LHTL): Athletes sleep at altitude (or simulated altitude) but train at lower elevations. This allows adaptation to low oxygen while maintaining high training intensity.
Intermittent Hypoxic Training (IHT): Short bursts of hypoxic exposure during training sessions, with recovery in normal oxygen conditions.
Intermittent Hypoxic Exposure (IHE): Hypoxic exposure during rest rather than exercise.
The Dose-Response Relationship
The researchers used a “kilometer hour” model to quantify hypoxic dose. They found an inverted U-shaped curve:
- LHTH optimal range: 470-1,130 kilometer hours
- LHTL optimal range: 500-1,415 kilometer hours
Below these ranges, the dose may be insufficient. Above these ranges, the negative effects of chronic hypoxia may outweigh benefits. Athletes can experience altitude sickness, particularly above 1,000 meters.
Why Low Altitude Training Matters
A surprising finding was the importance of training altitude during LHTL. Training at low altitude (rather than sea level) produced better results. This suggests that even the mild hypoxia during training adds value, as long as athletes aren’t sleeping in hypoxia all day.
Important Considerations
The research has some limitations:
- Altitude training is expensive and logistically challenging
- Individual responses vary significantly
- The optimal protocol may differ by sport and athlete
- Most studies involved endurance athletes
Practical Takeaways
- LHTL with low altitude training is the most effective approach for improving VO2max
- Simulated altitude (altitude tents, hypoxic chambers) works nearly as well as natural altitude
- There’s an optimal dose range beyond which more altitude doesn’t help
- Training at low altitude (not sea level) during LHTL produces better results
Related Studies and Research
- Hyperbaric oxygen suppressed tumor progression through the improvement of tumor hypoxia and induction of tumor apoptosis in A549-cell-transferred lung cancer
- Hypoxia metabolism in ageing
- Hypoxia and inflammation: two sides of the same coin
- Effects of Hyperoxic Training on Human Performance
FAQs
What does “live high, train low” mean?
Athletes sleep at high altitude (or in simulated altitude environments like altitude tents) to stimulate physiological adaptations, but travel to lower elevations to train at high intensity.
Can I use altitude tents instead of actual mountains?
Yes. This study found simulated altitude (P-score 0.86) was nearly as effective as natural altitude (P-score 0.92) for LHTL training.
How much altitude training is too much?
The study found an inverted U-shaped relationship. For LHTH, the optimal range is 470-1,130 kilometer hours. Beyond this, benefits plateau or decline.
Does altitude training work for all athletes?
The studies focused on endurance athletes. While the principles should apply broadly, optimal protocols may vary by sport and individual response.
Bottom Line
This network meta-analysis of 59 studies provides the clearest guidance yet on altitude training for athletes. Live high, train low (LHTL) with training at low altitude ranks as the most effective approach for improving VO2max. Both natural and simulated altitude environments work well. Importantly, there’s an optimal dose range, and more altitude exposure isn’t always better. These findings can help athletes and coaches design more effective altitude training programs while avoiding the negative effects of excessive hypoxic exposure.
