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Altitude Training: Live High, Train Low, Or The Reverse?

There is great interest in the “live high, train low” method as a way of improving endurance performance.  The “living high” method doesn’t refer making a trip to a cannabis friendly state but instead living at a higher altitude to obtain the benefits (discussed later in the article) of being exposed to a lower partial pressure of oxygen.  On the other hand, “training low” pertains to doing endurance exercise at sea level or very low altitude, so the intensity and duration of workouts are not negatively affected compared to if they were performed at altitude.

The research and support for living high and training low is a bit conflicted due to the influence of a wide variety of factors such as who the subjects were, the length of the studies, the length of stay at altitude, the altitude itself, and the intensity and volume of training,

Chapman et al. (1998) tried to shed some light on why there might be such variability in response to the live high, train low approach. In the study thirty-nine elite level runners were divided into either a responder or non-responder group on the basis of changes in their 5000 meter run time following training at a high altitude training camp.  All the runners lived high (2500 meters), but some had trained at 2500 to 3000 m (high-high group), some at 1200 to 1400m (high-low group), and some had done low-intensity training at 2500 to 3000 m and interval work at low altitude (high-high-low group).

The responders were found to have an increase in plasma erythropoietin (EPO), red blood cell volume, and VO2 max.  As you can guess these three variables had a strong physiological connection tied to increases in 5000-meter performance after training at altitude.  So far the live high, train low looks pretty good but to confound matters the non-responders in the study also had an increase in EPO but DID NOT have increases in red blood cell mass or VO2 max.  Say what? To make matters more confusing, the researchers found significant differences between groups in their ability to maintain the quality of their workouts at altitude. Non-responders had a 9% reduction in interval training velocity and a significantly lower VO2 max during the intervals.

If the above information was hard to decipher the two take home messages from this study are:

  1. Live at a high enough altitude to elicit an increase in red blood cell mass(due to an acute increase in EPO).
  2. Train at a low enough altitude to maintain interval training velocity. For runners who experience a significant desaturation of hemoglobin at sea level, even low-altitude training may be inconsistent with maintaining interval-training velocity.

Because most scientists are “know it alls” and think they are the smartest one in the room, not everyone agrees with the results of the study above as it relates to improvements in red blood cell mass.  Other studies have shown that six weeks on intermittent hypoxia (deprived of adequate oxygen) during training improved VO2 max and muscle oxygen carrying potential, without a change in red blood cell mass. Scientists think this may be linked to improved mitochondrial function and increased muscle buffering capacity.

Now to the good part.  How long do you have to live at altitude to possibly get the potential performance benefits? Based on several studies, it appears that four weeks of altitude exposure of greater than 22 hours/day at 2000-2500 meters is needed to increase red blood cell mass, VO2 max, and performance. If simulated altitude is used (i.e., altitude tent) for fewer hours per day (12-16 hours), a higher elevation (2500-3000 meters) is needed. 

That said, and because scientific research sometimes doesn’t agree, a recent 4-week study using a 16 hour/day exposure at 3000 meters showed no impact on endurance performance or associated physiological variables (red blood cell mass & VO2). A similar study which did see an increase in red blood cell mass found that it rapidly returned to baseline values upon sea-level exposure, suggesting that timing is crucial if applied to competition. It goes to say that more research is needed to show the best way to increase VO2 max and performance with the live high, train low approach.

Although the live high, train low approach has been widely adopted, there is another school of thought that recommends a live low, train high approach.  With this method, subjects train at altitude but remain in low altitude the rest of the time. In this case, the low oxygen environment exists only during exercise and is viewed as an option to avoid the negative impacts of prolonged exposure to high altitudes mentioned earlier.

In general, VO2 max and hemoglobin levels are unchanged with this type of training. Further, researchers feel that it is difficult to draw strong conclusions regarding muscle adaptations due to this type of training because of the differences in the training state of subjects, the intensity, and duration of the training, and the simulated altitude used. However, there is some limited evidence that when an athlete must perform at altitude, this type of training is beneficial.

In conclusion, given the small potential gains (1-2%) and the considerable costs, difficulties, and potential risks (however small), associated with either living high and training low or the reverse, only elite endurance athletes should consider these types of training strategies.

Hopefully, you didn’t order that altitude tent from Amazon already.


Chapman, Robert F., James Stray-Gundersen, and Benjamin D. Levine. "Individual variation in response to altitude training." Journal of applied physiology 85.4 (1998): 1448-1456.

Dufour, S. P., Ponsot, E., Zoll, J., Doutreleau, S., Lonsdorfer-Wolf, E., Geny, B., ... & Mettauer, B. (2006). Exercise training in normobaric hypoxia in endurance runners. I. Improvement in aerobic performance capacity. Journal of applied physiology100(4), 1238-1248.

Gore, C. J., Clark, S. A., & Saunders, P. U. (2007). Nonhematological mechanisms of improved sea-level performance after hypoxic exposure. Medicine & Science in Sports & Exercise39(9), 1600-1609.

Gore, C. J., Rodriguez, F. A., Truijens, M. J., Townsend, N. E., Stray-Gundersen, J., & Levine, B. D. (2006). Increased serum erythropoietin but not red cell production after 4 wk of intermittent hypobaric hypoxia (4,000–5,500 m). Journal of Applied Physiology101(5), 1386-1393.

Ponsot, E., Dufour, S. P., Zoll, J., Doutrelau, S., N'Guessan, B., Geny, B., ... & Richard, R. (2006). Exercise training in normobaric hypoxia in endurance runners. II. Improvement of mitochondrial properties in skeletal muscle. Journal of applied physiology100(4), 1249-1257.

Rodríguez, F. A., Truijens, M. J., Townsend, N. E., Stray-Gundersen, J., Gore, C. J., & Levine, B. D. (2007). Performance of runners and swimmers after four weeks of intermittent hypobaric hypoxic exposure plus sea level training. Journal of Applied Physiology103(5), 1523-1535.

Siebenmann, C., Robach, P., Jacobs, R. A., Rasmussen, P., Nordsborg, N., Diaz, V., ... & Lundby, C. (2012). “Live high–train low” using normobaric hypoxia: a double-blinded, placebo-controlled study. Journal of Applied Physiology112(1), 106-117.

Vogt, M., & Hoppeler, H. (2010). Is hypoxia training good for muscles and exercise performance?. Progress in cardiovascular diseases52(6), 525-533.

Wilber, R. L., Stray-Gundersen, J., & Levine, B. D. (2007). Effect of hypoxic" dose" on physiological responses and sea-level performance. Medicine and science in sports and exercise39(9), 1590-1599.

Wolski, L. A., McKenzie, D. C., & Wenger, H. A. (1996). Altitude training for improvements in sea level performance. Sports Medicine22(4), 251-263.



  • Thank you for sharing this Ferran. Is my assumption correct that you are the 1st author on this study?

    EndurElite Admin
  • You may be interested in the largest controlled altitude training study with elite athletes including a Hi-Lo group:
    –Rodriguez et al. (2015) Altitude training in elite swimmers for sea level performance (Altitude Project). Med Sci Sports Exerc 47,(9): 1965-78.
    The study, disrupting in some key aspects, shows clear performance benefits of the Hi-HiLo (it combines Hi and Lo training) compared to other types of intervention.
    Kind regards

    Ferran A. Rodríguez

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