Altitude training methods are developed by a double-edge sword approach; evidence (i.e., lab findings) informs practice (i.e., in the field) and practice informs evidence. But if both sword edges are rapidly evolving, how do we, as firm users and believers of the benefits of altitude training, keep up with the developing methods? A group of researchers and applied practitioners at the US Olympic Committee have produced a guide to highlight the current research findings and practice-based evidence of altitude training for improving exercise performance, which is summarised below:

– Altitude training increases our ability to carry and deliver oxygen to the muscle, develop new blood vessels for the oxygen to travel through, and improve muscle efficiency in using oxygen.
– When beginning altitude training, it’s best to begin with a lower intensity of exercise and acclimate to the change in environment.
– To increase the total amount of red blood cells (i.e., oxygen carriers), one needs to spend at least 14 h per day in an altitude (real or simulated) environment.
Injury, illness and fatigue that occurs before or during altitude training may have negative effects on health and performance.
Iron status is important, due to its relationship with red blood cell production, when carrying out altitude training. One should self-assess iron levels where necessary, and supplementation is strongly suggested to prevent iron deficiency.
– Increasing altitude does not necessarily equate to increased performance. The ideal altitude level is ~2500 m for an optimal environment and performance gains. Performance markers are suggested to reduce when exercise is carried out in altitude environments above this level.
– To calculate the hypoxic dose, one can multiply the elevation of altitude (km) by the time (h) spent in this environment, to give an indication of the stimulus.
– Responses to altitude training on markers of physiology and performance are highly individual between one athlete and another.
VO2max is reduced more at altitude in highly trained individuals compared to less trained individuals, likely due to a reduced exchange between oxygen inhaled and carbon dioxide exhaled.

In summary, altitude training methods are forever developing and will continue to do so. At present, one should pay attention to this up-to-date guide to achieve the most benefits from carrying out altitude training for improving performance.

Study details
Constantini et al. (2017). A Clinician Guide to Altitude Training for Optimal Endurance Exercise Performance at Sea Level. High Alt Med Biol.