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Amelia J. Carr, Laura A. Garvican-Lewis, Brent S. Vallance, Andrew P. Drake, Philo U. Saunders, Clare E. Humberstone and Christopher J. Gore

performing hypoxic training sessions. 15 Simulated (SIM) live high:train low altitude training presents an alternative to NAT, 2 , 16 whereby athletes train at or near sea level, but live and sleep in an hypoxic environment, 17 using altitude tents or similar modalities. 16 With SIM, all training is

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Erin L. McCleave, Katie M. Slattery, Rob Duffield, Philo U. Saunders, Avish P. Sharma, Stephen Crowcroft and Aaron J. Coutts

.4161/temp.29800 10.4161/temp.29800 8. Buchheit M , Racinais S , Bilsborough J , et al . Adding heat to the live-high train-low altitude model: a practical insight from professional football . Br J Sports Med . 2013 ; 47 ( suppl 1 ): i59 – i69 . PubMed ID: 24282209 doi:10.1136/bjsports-2013

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Louise M. Burke, John A. Hawley, Asker Jeukendrup, James P. Morton, Trent Stellingwerff and Ronald J. Maughan

coaches/athletes. For example, the term “train low” has been used to describe a single acute training session in which the availability of muscle CHO and/or exogenous CHO has been manipulated to “lower” levels before and/or during the session by a variety of techniques that have different metabolic and

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Randall L. Wilber

“Live high-train low” (LH+TL) altitude training allows athletes to “live high” for the purpose of facilitating altitude acclimatization, as characterized by a significant and sustained increase in endogenous erythropoietin and subsequent increase in erythrocyte volume, while simultaneously enabling them to “train low” for the purpose of replicating sea-level training intensity and oxygen flux, thereby inducing beneficial metabolic and neuromuscular adaptations. In addition to natural/terrestrial LH+TL, several simulated LH+TL devices have been developed including nitrogen apartments, hypoxic tents, and hypoxicator devices. One of the key issues regarding the practical application of LH+TL is what the optimal hypoxic dose is that is needed to facilitate altitude acclimatization and produce the expected beneficial physiological responses and sea-level performance effects. The purpose of this review is to examine this issue from a research-based and applied perspective by addressing the following questions: What is the optimal altitude at which to live, how many days are required at altitude, and how many hours per day are required? It appears that for athletes to derive the hematological benefits of LH+TL while using natural/terrestrial altitude, they need to live at an elevation of 2000 to 2500 m for >4 wk for >22 h/d. For athletes using LH+TL in a simulated altitude environment, fewer hours (12-16 h) of hypoxic exposure might be necessary, but a higher elevation (2500 to 3000 m) is required to achieve similar physiological responses.

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Abigail S.L. Stickford, Daniel P. Wilhite and Robert F. Chapman

Investigations into ventilatory, metabolic, and hematological changes with altitude training have been completed; however, there is a lack of research exploring potential gait-kinematic changes after altitude training, despite a common complaint of athletes being a lack of leg "turnover" on return from altitude training.


To determine if select kinematic variables changed in a group of elite distance runners after 4 wk of altitude training.


Six elite male distance runners completed a 28-d altitude-training intervention in Flagstaff, AZ (2150 m), following a modified “live high–train low” model, wherein higherintensity runs were performed at lower altitudes (945–1150 m) and low-intensity sessions were completed at higher altitudes (1950–2850 m). Gait parameters were measured 2–9 d before departure to altitude and 1 to 2 d after returning to sea level at running speeds of 300–360 m/min.


No differences were found in ground-contact time, swing time, or stride length or frequency after altitude training (P > .05).


Running mechanics are not affected by chronic altitude training in elite distance runners. The data suggest that either chronic training at altitude truly has no effect on running mechanics or completing the live high–train low model of altitude training, where higher-velocity workouts are completed at lower elevations, mitigates any negative mechanical adaptations that may be associated with chronic training at slower speeds.

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Alannah K. A. McKay, Ida A. Heikura, Louise M. Burke, Peter Peeling, David B. Pyne, Rachel P.L. van Swelm, Coby M. Laarakkers and Gregory R. Cox

Sleeping with low carbohydrate (CHO) availability is a dietary strategy that may enhance training adaptation. However, the impact on an athlete’s health is unclear. This study quantified the effect of a short-term “sleep-low” dietary intervention on markers of iron regulation and immune function in athletes. In a randomized, repeated-measures design, 11 elite triathletes completed two 4-day mixed cycle run training blocks. Key training sessions were structured such that a high-intensity training session was performed in the field on the afternoon of Days 1 and 3, and a low-intensity training (LIT) session was performed on the following morning in the laboratory (Days 2 and 4). The ingestion of CHO was either divided evenly across the day (HIGH) or restricted between the high-intensity training and LIT sessions, so that the LIT session was performed with low CHO availability (LOW). Venous blood and saliva samples were collected prior to and following each LIT session and analyzed for interleukin-6, hepcidin 25, and salivary immunoglobulin-A. Concentrations of interleukin-6 increased acutely after exercise (p < .001), but did not differ between dietary conditions or days. Hepcidin 25 increased 3-hr postexercise (p < .001), with the greatest increase evident after the LOW trial on Day 2 (2.5 ± 0.9 fold increase ±90% confidence limit). The salivary immunoglobulin-A secretion rate did not change in response to exercise; however, it was highest during the LOW condition on Day 4 (p = .046). There appears to be minimal impact to markers of immune function and iron regulation when acute exposure to low CHO availability is undertaken with expert nutrition and coaching input.

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Philo U. Saunders, Richard D. Telford, David B. Pyne, Christopher J. Gore and Allan G. Hahn

We quantified the effect of an extended live high-train low (LHTL) simulated altitude exposure followed by a series of training camps at natural moderate altitude on competitive performance in seven elite middle-distance runners (Vo2max 71.4 ± 3.4 mL·min−1·kg−1, mean ± SD). Runners spent 44 ± 7 nights (mean ± SD) at a simulated altitude of 2846 ± 32 m, and a further 4 X 7- to 10-d training at natural moderate altitude (1700–2200 m) before racing. The combination of simulated LHTL and natural altitude training improved competitive performance by 1.9% (90% confidence limits, 1.3-2.5%). Middle-distance runners can confidently use a combination of simulated and natural altitude to stimulate adaptations responsible for improving performance.

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Grégoire P. Millet and Kilian Jornet

Purpose: To present the acclimatization strategy employed by an elite athlete prior to 2 successful ascents to Mount Everest (including a “fastest known time”) in 1 wk. Methods: Training volume, training content, and altitude exposure were recorded daily. Vertical velocity was recorded by GPS (global positioning system) heart-rate monitor. Results: The subject first used a live high–train low and high preacclimatization method in normobaric hypoxia (NH). Daily, he combined sleeping in a hypoxic tent (total hours: ∼260) and exercising “as usual” in normoxia but also in NH (altitude >6000 m: 30 h), including at high intensity. The hypoxic sessions were performed at the second threshold on treadmill in NH at 6000 m, and the pulse saturation increased from 70% to 85% over 1 mo. Then, the subject was progressively exposed to hypobaric hypoxia, first in the Alps and then in the Himalayas. On day 18, he reached for the second time an altitude >8000 m with the fastest vertical velocity (350 m/h) ever measured between 6300 and 8400 m. Afterward, he climbed twice in a week to the summit of Mount Everest (8848 m, including a “fastest known time” of 26.5 h from Rongbuk Monastery, 5100 m). Conclusion: Overall, this acclimatization was successful and in line with the most recent recommendations: first, using live high–train low and high, and second, using hypobaric hypoxia at increasing altitudes for a better translation of the NH benefits to hypobaric hypoxia. This case study reports the preparation for the most outstanding performance ever acheived at an extreme altitude.

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Darrell L. Bonetti, Will G. Hopkins and Andrew E. Kilding


Live-high train-low altitude training produces worthwhile gains in performance for endurance athletes, but the benefits of adaptation to various forms of artificial altitude are less clear.


To quantify the effects of intermittent hypoxic exposure on kayak performance.


In a crossover design with a 6-week washout, we randomized 10 subelite male sprint kayak paddlers to hypoxia or control groups for 3 weeks (5 days/week) of intermittent hypoxic exposure using a nitrogen-filtration device. Each day's exposure consisted of alternately breathing hypoxic and ambient air for 5 minutes each over 1 hour. Performance tests were an incremental step test to estimate peak power, maximal oxygen uptake, exercise economy, and lactate threshold; a 500-m time trial; and 5 × 100-m sprints. All tests were performed on a wind-braked kayak ergometer 7 and 3 days pretreatment and 3 and 10 days post treatment. Hemoglobin concentration was measured at 1 day pretreatment, 5 and 10 days during treatment, and 3 days after treatment.


Relative to control, at 3 days post treatment the hypoxia group showed the following increases: peak power 6.8% (90% confidence limits, ± 5.2%), mean repeat sprint power 8.3% (± 6.7%), and hemoglobin concentration 3.6% (± 3.2%). Changes in lactate threshold, mean 500-m power, maximal oxygen uptake, and exercise economy were unclear. Large effects for peak power and mean sprint speed were still present 10 days posthypoxia.


These effects of intermittent hypoxic exposure should enhance performance in kayak racing. The effects might be mediated via changes in oxygen transport.

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Andrew J.R. Cochran, Frank Myslik, Martin J. MacInnis, Michael E. Percival, David Bishop, Mark A. Tarnopolsky and Martin J. Gibala

Commencing some training sessions with reduced carbohydrate (CHO) availability has been shown to enhance skeletal muscle adaptations, but the effect on exercise performance is less clear. We examined whether restricting CHO intake between twice daily sessions of high-intensity interval training (HIIT) augments improvements in exercise performance and mitochondrial content. Eighteen active but not highly trained subjects (peak oxygen uptake [VO2peak] = 44 ± 9 ml/kg/min), matched for age, sex, and fitness, were randomly allocated to two groups. On each of 6 days over 2 weeks, subjects completed two training sessions, each consisting of 5 × 4-min cycling intervals (60% of peak power), interspersed by 2 min of recovery. Subjects ingested either 195 g of CHO (HI-HI group: ~2.3 g/kg) or 17 g of CHO (HI-LO group: ~0.3 g/kg) during the 3-hr period between sessions. The training-induced improvement in 250-kJ time trial performance was greater (p = .02) in the HI-LO group (211 ± 66 W to 244 ± 75 W) compared with the HI-HI group (203 ± 53 W to 219 ± 60 W); however, the increases in mitochondrial content was similar between groups, as reflected by similar increases in citrate synthase maximal activity, citrate synthase protein content and cytochrome c oxidase subunit IV protein content (p > .05 for interaction terms). This is the first study to show that a short-term “train low, compete high” intervention can improve whole-body exercise capacity. Further research is needed to determine whether this type of manipulation can also enhance performance in highly-trained subjects.