10 Lessons From 25 Years of Live High Train Low

Joe Vigil knows a thing or two about altitude training. He’s a doctor, which is your first clue, and he was the USA Olympic Team running coach for the 2008 games, coaching the likes of Deena Kastor and Meb Keflezighi, bronze and silver medalists respectively at the Athens games. So when he talks about altitude, you listen;

“The record has shown that since 1968, 95% of all Olympic and World Championship medals from the 800 through the Marathon were won by athletes who lived or trained at altitude. It can therefore be concluded that altitude training is necessary for success in endurance events.”

However the altitude training landscape has shifted monumentally since 1968. At that time, it was commonplace for athletes to head to the mountains for long periods of time to live and train. While effective, it wasn’t a perfect solution, often bringing with it cost, extended time away from family, friends & training partners, and a negative influence on training quality. It was this final point that two scientists in Dallas, Texas, were keen to resolve.

Ben Levine and Jim Stray-Gunderson knew that when you train in the mountains, the amount of oxygen in your blood is significantly reduced. They noticed that for every 100 m above 1500 m an athlete trains, their maximal aerobic power (think FPT, half marathon pace etc) drops by 1%, and this was even greater for well trained athletes and who were also more vulnerable to lower altitudes. By their estimation, this meant that athletes’ ability to perform high intensity work while on altitude training camps would be impaired, and if an athlete were to spend too long at altitude then their ability to access high intensities on race day might be reduced. They set out to investigate whether sleeping altitude but training closer to sea level would allow an athlete to gain the performance benefits of altitude acclimation without the training drawbacks of traditional altitude training. The answer was a resounding yes, the methodology became known as live high train low (LHTL) and we haven’t looked back since.

The Altitude Centre has worked with Team GB Olympians and first timers alike to provide altitude training solutions.


That is until earlier this year, when friend of The Altitude Centre Dr. Olivier Girard sat down with Levine and a few of their friends to look back at the last 25 years of LHTL application and research to see what we’ve learnt, and what we still need to learn. Here were their findings:

Lesson 1: There May Be a Relatively Narrow Window for “Optimal Dose” of Altitude to Be Used With LHTL

It makes sense that we need to be high enough to get the benefits of altitude training, but not so high that there is a chance of impairing the training stimulus and adaptation. The sweetspot is probably 1,800 to 3,000 meters. The other factor in dose is time at altitude (again, not enough and you won’t see the benefits!) Data from athletes and the literature show that at least 200, but preferably more than 300 hours are required.

Lesson 2: Large Individual Variability of the Responses Exists and the Mechanisms Behind Responders Versus Nonresponders to LHTL Remain Obscure

If you put a group of athletes through an identical LHTL program, not all will see the same change in physiology or performance. The authors suggest that everyone will adapt to altitude, but there might be ‘slow’ or ‘fast’ responders, and while it’s tricky to predict who will fall into each group, it’s on us as sport scientists to track the athletes’ rate of adaptation to optimise performance.

Lesson 3: Iron Deficiency Impairs the Erythropoietic Response to Altitude So That Screening Athletes for Iron Status Before Embarking on a LHTL Camp Is an Absolute Necessity

This one almost speaks for itself. Iron is an essential building block of red blood cells, and we’re looking to build a lot of red blood cells through LHTL. Endurance athletes are often deficient or low in iron, especially vegetarian or vegan endurance athletes, so it’s worth having a blood test done to check your levels before a long term altitude exposure. Ideally we want iron to be stable at normal levels 2-3 weeks before LHTL, and for supplementation to continue during the exposure.

Lesson 4: If Performance Is the Key Outcome, Training Load (Volume/Intensity) Must Be Monitored and Adjusted Accordingly Before, During, and After the LHTL Intervention

Altitude training can be hard. It’s probably worth having what the authors call a mini taper coming into LHTL so that you are a little more fresh for the training block, and to gradually build intensity and volume of training through the early part of a block. Volume may need to drop by as much as 25% to reduce the likelihood of undue fatigue or overtraining.

Lesson 5: Successful LHTL Implementation Requires Careful Monitoring of Sleep Quality, Fatigue, and Hydration Status to Avoid Developing Infections, Illnesses, or Overreaching/Overtraining States

If you become ill or injured, you cannot train. The additional strain of altitude can increase the likelihood of these developing if you aren’t careful about implementation. Sleeping well, managing training load, and looking after hygiene and nutrition can be useful defences against training interuptions.

Lesson 6: Consideration of Current Training/Competitive Phase and Timing of Performance Evaluation Postintervention Directly Influences LHTL Outcomes

The most frequently asked questions we field regarding LHTL are around timing. When should I use it for optimal performance. The authors cite practitioners who have found performance improvements immediately after the camp (first week) followed by a brief period of attenuated performance (second week) and then a third, longer period of improved performance between three and five weeks after return to normal training. However, there are a number of factors to balance including the training itself and tapering amongst others. They also note that while research often focusses on a single LTHL ‘camp’, in practice we actually see athletes utilise LHTL a number of times throughout a year, each with a different focus.

Lesson 7: LHTL Strategies Can Be Successfully Implemented to Increase Red Cell Mass and Maximal Aerobic Power With Both Natural and Artificial Altitude

Altitude tents are a straightforward way of getting long duration altitude exposure overnight

The original LHTL study saw athletes live at 2500 m and train in Deer Valley, Utah, dropping down to Salt Lake City to train. There are very few places in the world that allow such terrestrial LHTL (often when you are in the mountains, you are in the mountains!). To get around this, and allow accessibility to LHTL for a greater range of athletes who would otherwise not be able to go on altitude training camps, we have developed altitude tents, that allow us to simulate altitude as someone sleeps in their normal bed, at home! The punchline is that this is still highly effective, and byremoving financial, time and logistical challenges of altitude sojourns, it is often considered a gold standard for altitude training. You must maximise time spent in the altitude tent to see the greatest results, but when they come, they are highly impactful on performance.

Lesson 8: Putative Adaptive Mechanisms (Hbmass, Oxygen Cost of Breathing) as a Result of LHTL Are Often More Robust/ Repeatable Than Performance Changes

Your body will change during and after an altitude exposure, but that is not always enough to see marked improvements in performance. That’s because performance is multi-factoral, and may be influenced by things like fatigue from a training camp and training in the time between altitude exposure and performance testing or racing. This is where science meets art, and it is down to the multi-disciplinary team to prepare the athlete best for competition.

Lesson 9: Despite Endurance Athletes (eg, Swimmers, Runners, Cyclists) Being the Most Common Users of Altitude Training Approaches, LHTL Is Now Increasingly Popular in a Wider Range of Athletes (eg, Team and Racket Sports)

Team sports athletes like Courtney Lawes (pictured) stand to gain a lot from altitude training

Team and racket sports have huge aerobic demands, and the athletes involved often have relatively low red blood cell counts. Research has therefore shown it is possible to significantly improve red blood cell count (and therefore oxygen carrying capacity) of team and racket sport athletes via short, simulated LHTL training blocks, and this translates into improved sport specific fitness tests like the Yo-Yo test, or in one interesting study, a water polo specific swimming test. With the rise in use of altitude training for repeat sprint ability in these athletes, this seems like an area where we can expect to see a growth in the research and application of altitude training in team sports.


Lesson 10: Additional Hypoxic and/or Heat Exposure (if Well Managed) May Boost LHTL Benefits

Adding other hypoxic exposure, for example completing repeat sprint training in hypoxia, or heat exposure, may complement the adaptations from LHTL and further enhance the performance response. However, it is important to note that too much environmental stress may overstress the body and lead to maladaption, or may detract from the actual training stimulus such that the athlete fails to complete enough quality training. These should be considered only under guidance.

There is often a huge gap between the research and applied practice; a gap that the authors have tried to fill. In their eyes, these lessons serve as important points of consideration for anyone looking to optimise an altitude training camp and get the most from their LHTL. To us as practitioners, it is imperative we take the learnings from the last 25 years and continue to refine them as we push performance to ever higher levels, and help athletes of all kinds achieve their Everest.