Factors Affecting Sea-Level Performance Following Altitude Training in Elite Athletes

Live high train high (LHTH) is the original method of altitude training used by elite athletes to enhance sea-level performance. Whilst many anecdotal reports featuring world-class performances of elite athletes at sea-level following LHTH exist, well-controlled studies of elite athletes using altitude training under ecologically valid conditions with training well characterised are still lacking. The literature is equivocal when considering the ergogenic potential of LHTH, and given the majority of controlled studies do not report enhanced sea-level performance, some scepticism regarding the efficacy of LHTH persists. Despite this, LHTH remains a popular form of altitude training utilised by elite athletes, with numerous case studies of champion athletes employing LHTH solidifying the rationale for its use during preparation for competition. Discussion of factors affecting the response to LHTH are often related to compromising either the hypoxia induced acceleration of erythropoiesis and production of red blood cells, or the maintenance of oxygen flux and training intensity at altitude. Regarding the former, iron status and supplementation, as well as hypoxic dose are often mentioned. Concerning the latter, reduced oxygen availability at altitude leading to athletes training at lower absolute intensities and the relative intensity of training sessions being clamped as equivalent to sea-level, thus also reducing absolute training intensity are frequently discussed. Other factors including immune function and the timing of competition following LHTH may also contribute to an observed performance. Less considered in the literature are those factors specific to elite athletes, namely the repeated use of altitude camps throughout a season, and the influence this may have on subsequent performance. The current narrative review aimed to summarise the current literature pertaining to LHTH in elite athletes, and furthermore describe several factors affecting performance following altitude training.