Constantini, Keren, Daniel P. Wilhite, and Robert F. Chapman. A clinician guide to altitude training for optimal endurance exercise performance at sea level. High Alt Med Biol. 18:93–101, 2017.—For well over 50 years, endurance athletes have been utilizing altitude training in an effort to enhance performance in sea level competition. This brief review will offer the clinician a series of evidence-based best-practice guidelines on prealtitude and altitude training considerations, which can ultimately maximize performance improvement outcomes.
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References
1.
AshendenMJ, GoreCJ, DobsonGP, and HahnAG. (1999). “Live high, train low” does not change the total haemoglobin mass of male endurance athletes sleeping at a simulated altitude of 3000 m for 23 nights. Eur J Appl Physiol Occup Physiol, 80:479–484.
BonettiDL, and HopkinsWG. (2009). Sea-level exercise performance following adaptation to hypoxia. Sports Med, 39:107–127.
4.
BrocherieF, GirardO, FaissR, and MilletGP. (2017). Effects of repeated-sprint training in hypoxia on sea-level performance: A meta-analysis. Sports Med [Epub ahead of print]; DOI: 10.1007/s40279-017-0685-3.
5.
BrocherieF, MilletGP, HauserA, SteinerT, RysmanJ, WehrlinJP, and GirardO. (2015). Live high-train low and high hypoxic training improves team-sport performance. Med Sci Sports Exerc, 47:2140–2149.
6.
BrugniauxJV, SchmittL, RobachP, FouillotJ, NicoletG, LasneF, et al. (2004). Living high-training low: Effects on acclimatization, erythropoiesis and aerobic performance in elite middle distance runners. High Alt Med Biol, 5:477–478.
7.
BrugniauxJV, SchmittL, RobachP, NicoletG, FouillotJ-P, MoutereauS, et al. (2006). Eighteen days of “living high, training low” stimulate erythropoiesis and enhance aerobic performance in elite middle-distance runners. J Appl Physiol, 100:203–211.
8.
BuchheitM, RacinaisS, BilsboroughJ, HockingJ, Mendez-VillanuevaA, BourdonP, et al. (2013). Adding heat to the live-high train-low altitude model: A practical insight from professional football. Br J Sports Med, 47(Suppl 1):i59–i69.
9.
BuskirkE, KolliasJ, AkersR, ProkopE, and ReateguiE. (1967). Maximal performance at altitude and on return from altitude in conditioned runners. J Appl Physiol, 23:259–266.
10.
ChapmanRF. (2013). The individual response to training and competition at altitude. Br J Sports Med, 47(Suppl 1):i40–i44.
11.
ChapmanRF, KarlsenT, GeR-L, Stray-GundersenJ, and LevineBD. (2016). Living altitude influences endurance exercise performance change over time at altitude. J Appl Physiol, 120:1151–1158.
12.
ChapmanRF, KarlsenT, ResalandGK, GeR-L, HarberMP, WitkowskiS, et al. (2014). Defining the “dose” of altitude training: How high to live for optimal sea level performance enhancement. J Appl Physiol, 116:595–603.
13.
ChapmanRF, and LevineBD. (2007). Altitude training for the marathon. Sports Med, 37:392–395.
14.
ChapmanRF, StagerJM, TannerDA, Stray-GundersenJ, and LevineBD. (2011). Impairment of 3000-m run time at altitude is influenced by arterial oxyhemoglobin saturation. Med Sci Sports Exerc, 43:1649–1656.
15.
ChapmanRF, StickfordASL, LundbyC, and LevineBD. (2014). Timing of return from altitude training for optimal sea level performance. J Appl Physiol, 116:837–843.
16.
ChapmanRF, Stray-GundersenJ, and LevineBD. (1998). Individual variation in response to altitude training. J Appl Physiol, 85:1448–1456.
17.
ChatardJ-C, MujikaI, GuyC, and LacourJ-R. (1999). Anaemia and iron deficiency in athletes. Sports Med, 27:229–240.
18.
ClarkSA, QuodM, ClarkM, MartinD, SaundersP, and GoreC. (2009). Time course of haemoglobin mass during 21 days live high: Train low simulated altitude. Eur J Appl Physiol, 106:399–406.
19.
ClarksonPM, and HaymesEM. (1995). Exercise and mineral status of athletes: Calcium, magnesium, phosphorus, and iron. Med Sci Sports Exerc, 27:831–843.
20.
ClementD, and SawchukL. (1984). Iron status and sports performance. Sports Med, 1:65–74.
21.
CusterEM, FinchCA, SobelRE, and ZettnerA. (1995). Population norms for serum ferritin. J Lab Clin Med, 126:88–94.
22.
FriedmannB, FreseF, MenoldE, KauperF, JostJ, and BärtschP. (2005). Individual variation in the erythropoietic response to altitude training in elite junior swimmers. Br J Sports Med, 39:148–153.
23.
Garvican-LewisLA, SharpeK, and GoreCJ. (2016). Time for a new metric for hypoxic dose?. J Appl Physiol, 121:352–355.
24.
GavinTP, DerchakPA, and StagerJM. (1998). Ventilation's role in the decline in VO2max and SaO2 in acute hypoxic exercise. Med Sci Sports Exerc, 30:195–199.
25.
GoreCJ, ClarkSA, and SaundersPU. (2007). Nonhematological mechanisms of improved sea-level performance after hypoxic exposure. Med Sci Sports Exerc, 39:1600.
26.
GoreCJ, SharpeK, Garvican-LewisLA, SaundersPU, HumberstoneCE, RobertsonEY, et al. (2013). Altitude training and haemoglobin mass from the optimised carbon monoxide rebreathing method determined by a meta-analysis. Br J Sports Med, 47(Suppl 1):i31–i39.
27.
GovusAD, Garvican-LewisLA, AbbissCR, PeelingP, and GoreCJ. (2015). Pre-altitude serum ferritin levels and daily oral iron supplement dose mediate iron parameter and hemoglobin mass responses to altitude exposure. PLoS One, 10:e0135120.
28.
HallbergL, BruneM, and RossanderL. (1989). Iron absorption in man: Ascorbic acid and dose-dependent inhibition by phytate. Am J Clin Nutr, 49:140–144.
29.
HallbergL, Rossander-HultenL, BruneM, and GleerupA. (1992). Calcium and iron absorption: Mechanism of action and nutritional importance. Eur J Clin Nutr, 46(5), 317–327.
30.
HaymesEM, and LamancaJJ. (1989). Iron loss in runners during exercise implications and recommendations. Sports Med, 7:277–285.
31.
HeinickeK, HeinickeI, SchmidtW, and WolfarthB. (2005). A three-week traditional altitude training increases hemoglobin mass and red cell volume in elite biathlon athletes. Int J Sports Med, 26:350–355.
32.
HeinzerR, SaugyJJ, RuppT, TobbackN, FaissR, BourdillonN, et al. (2015). Comparison of sleep disorders between real and simulated 3,450-m altitude. Sleep, 39:1517–1523.
33.
LawlerJ, PowersSK, and ThompsonD. (1988). Linear relationship between VO2max and VO2max decrement during exposure to acute hypoxia. J Appl Physiol, 64:1486–1492.
34.
LevineBD. (2002). Intermittent hypoxic training: Fact and fancy. High Alt Med Biol, 3:177–193.
35.
LevineBD, and Stray-GundersenJ. (1997). “Living high-training low”: Effect of moderate-altitude acclimatization with low-altitude training on performance. J Appl Physiol, 83:102–112.
36.
LevineBD, and Stray-GundersenJ. (2006). Dose-response of altitude training: How much altitude is enough? In: Hypoxia and Exercise. RoachRC, WagnerPD, and HackettPH, eds. Springer, New York, NY. pp. 233–247.
37.
LundbyC, MilletGP, CalbetJA, BärtschP, and SubudhiAW. (2012). Does “altitude training” increase exercise performance in elite athletes?. Br J Sports Med, 46:792–795.
38.
LundbyC, and RobachP. (2016). Does “altitude training” increase exercise performance in elite athletes?. Exp Physiol, 101:783–788.
39.
MartinD, HahnA, LeeH, RobertsA, VictorJ, and GoreC. (2002). Effects of A 12-day “live-high, train low” cycling camp on 4-min and 30-min performance. In 49th Annual Meeting of the American College of Sports Medicine held in conjunction with the Sixth IOC (Inernational Olympic Committee) World Congress on Sport Sciences. Lippincott Williams & Wilkins, Baltimore, MD. Vol. 35, pp. 274–274.
40.
McDonaldR, and KeenCL. (1988). Iron, zinc and magnesium nutrition and athletic performance. Sports Med, 5:171–184.
41.
MilletGP, FaissR, and PialouxV. (2012). Point: Counterpoint: Hypobaric hypoxia induces/does not induce different responses from normobaric hypoxia. J Appl Physiol, 112:1783–1784.
42.
MorckTA, LynchS, and CookJ. (1983). Inhibition of food iron absorption by coffee. Am J Clin Nutr, 37:416–420.
43.
NielsenP, and NachtigallD. (1998). Iron supplementation in athletes. Sports Med, 26:207–216.
44.
PasrichaS-R, Flecknoe-BrownSC, AllenKJ, GibsonPR, McMahonLP, OlynykJK, et al. (2010). Diagnosis and management of iron deficiency anaemia: A clinical update. Med J Aust, 193:525–532.
45.
PrommerN, ThomaS, QueckeL, GutekunstT, VölzkeC, WachsmuthN, et al. (2010). Total hemoglobin mass and blood volume of elite Kenyan runners. Med Sci Sports Exerc, 42:791–797.
46.
Ri-Li GeS, WitkowskiS, ZhangY, AlfreyC, SivieriM, KarlsenT, et al. (2002). Determinants of erythropoietin release in response to short-term hypobaric hypoxia. J Appl Physiol, 92:2361–2367.
47.
RobachP, SchmittL, BrugniauxJV, NicoletG, DuvalletA, FouillotJ-P, et al. (2006). Living high–training low: Effect on erythropoiesis and maximal aerobic performance in elite Nordic skiers. Eur J Appl Physiol, 97:695–705.
48.
RobachP, SchmittL, BrugniauxJV, RoelsB, MilletG, HellardP, et al. (2006). Living high–training low: Effect on erythropoiesis and aerobic performance in highly-trained swimmers. Eur J Appl Physiol, 96:423–433.
49.
RodríguezFA, IglesiasX, FericheB, Calderón-SotoC, ChaverriD, WachsmuthNB, et al. (2015). Altitude training in elite swimmers for sea level performance (altitude project). Med Sci Sports Exerc, 47:1965–1978.
50.
RuskoHK, TikkanenH, PaavolainenL, HämäläinenI, KalliokoskiK, and PuranenA. (1999). Effect of living in hypoxia and training in normoxia on sea level VO2max and red cell mass. Med Sci Sports Exerc, 31:S86.
51.
RuskoHK, TikkanenHK, and PeltonenJ. (2004). Altitude and endurance training. J Sports Sci, 22:928–945.
52.
RuskoHK, TikkanenHO, and PeltonenJE. (2003). Oxygen manipulation as an ergogenic aid. Curr Sports Med Rep, 2:233–238.
53.
SaugyJJ, SchmittL, CejuelaR, FaissR, HauserA, WehrlinJP, et al. (2014). Comparison of “live high-train low” in normobaric versus hypobaric hypoxia. PLoS One, 9:e114418.
54.
SaugyJJ, SchmittL, HauserA, ConstantinG, CejuelaR, FaissR, et al. (2016). Same performance changes after live high-train low in normobaric vs. hypobaric hypoxia. Front Physiol, 7:138.
55.
SchmidtWF, HeinickeK, RojasJ, GomezJM, SerratoM, MoraM, et al. (2002). Blood volume and hemoglobin mass in endurance athletes from moderate altitude. Med Sci Sports Exerc, 34:1934–1940.
56.
SchmidtWF, and PrommerN. (2008). Effects of various training modalities on blood volume. Scand J Med Sci Sports, 18(s1):57–69.
57.
SchmidtWF, VölzkeC, WachsmuthN, WolfarthB, Schmidt-TrucksässA, SteinackerJ, et al. (2011). Variation of hemoglobin mass in elite endurance athletes: 2352: Board# 229 June 2 2: 00 PM-3: 30 PM. Med Sci Sports Exerc, 43:634.
58.
SchmittL, MilletG, RobachP, NicoletG, BrugniauxJV, FouillotJ-P, and RichaletJ-P. (2006). Influence of “living high–training low” on aerobic performance and economy of work in elite athletes. Eur J Appl Physiol, 97:627–636.
59.
SharpeLM, PeacockWC, CookeR, HarrisRS, LookhartH, YeeH, et al. (1950). The effect of phytate and other food factors on iron absorption. J Nutr, 41:433–446.
60.
ShaskeyDJ, and GreenGA. (2000). Sports haematology. Sports Med, 29:27–38.
61.
SiebenmannC. (2016). Hemoglobin mass expansion during 13 d of altitude training: Altitude or training?. Med Sci Sports Exerc, 48:1425.
62.
SiebenmannC, RobachP, JacobsRA, RasmussenP, NordsborgN, DiazV, et al. (2012). “Live high–train low” using normobaric hypoxia: A double-blinded, placebo-controlled study. J Appl Physiol, 112:106–117.
63.
SinexJA, and ChapmanRF. (2015). Hypoxic training methods for improving endurance exercise performance. J Sport Health Sci, 4:325–332.
64.
StickfordAS, WilhiteDP, and ChapmanRF. (2016). Live high–train low altitude training does not alter running mechanics in elite distance runners. Int J Sports Physiol Perform, 12:133–136.
65.
Stray-GundersenJ, AlexanderC, HochsteinA, LevineB, et al. (1992). Failure if red cell volume to increase with altitude exposure in iron deficient runners. Med Sci Sports Exerc, 24:S90.
66.
Stray-GundersenJ, ChapmanRF, and LevineBD. (2001). “Living high-training low” altitude training improves sea level performance in male and female elite runners. J Appl Physiol, 91:1113–1120.
67.
Stray-GundersenJ, and LevineB. (2008). Live high, train low at natural altitude. Scand J Med Sci Sports, 18(s1):21–28.
68.
SzygulaZ. (1990). Erythrocytic system under the influence of physical exercise and training. Sports Med, 10:181–197.
69.
WachsmuthN, VölzkeC, PrommerN, Schmidt-TrucksässA, FreseF, SpahlO, et al. (2013). The effects of classic altitude training on hemoglobin mass in swimmers. Eur J Appl Physiol, 113:1199–1211.
70.
WaltersG, MillerF, and WorwoodM. (1973). Serum ferritin concentration and iron stores in normal subjects. J Clin Pathol, 26:770–772.
71.
WehrlinJP, ZuestP, HallénJ, and MartiB. (2006). Live high-train low for 24 days increases hemoglobin mass and red cell volume in elite endurance athletes. J Appl Physiol, 100:1938–1945.
WilberRL. (2007). Application of altitude/hypoxic training by elite athletes. Med Sci Sports Exerc, 39:1610–1624.
74.
WilhiteDP, MickleboroughTD, LaymonAS, and ChapmanRF. (2013). Increases in VO2max with “live high–train low” altitude training: Role of ventilatory acclimatization. Eur J Appl Physiol, 113:419–426.
75.
World Health Organization. (2005). Assessing the iron status of populations: Report of a Joint World Health Organization/Centers for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level, Geneva, Switzerland, 6–8 April 2004. In: Assessing the iron status of populations: Report of a Joint World Health Organization/Centers for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level, Geneva, Switzerland, April6–8, 2004.
76.
WorwoodM. (1982). Ferritin in human tissues and serum. Clin Haematol, 11:275.
