"Living High-Training Low" for Olympic Medal Performance: What Have We Learned 25 Years After Implementation?

Background: Altitude training is often regarded as an indispensable tool for the success of elite endurance athletes. Historically, altitude training emerged as a key strategy to prepare for the 1968 Olympics, held at 2300 m in Mexico City, and was limited to the "Live High-Train High" method for endurance athletes aiming for performance gains through improved oxygen transport. This "classical" intervention was modified in 1997 by the "Live High-Train Low" (LHTL) model wherein athletes supplemented acclimatization to chronic hypoxia with high-intensity training at low altitude.

Medical Care for Swimmers.

Swimming is one of the most popular sports worldwide. Competitive swimming is one of the most watched sports during the Olympic Games. Swimming has unique medical challenges as a result of a variety of environmental and chemical exposures.

Kenyan and Ethiopian distance runners: what makes them so good?

Since the 1968 Mexico City Olympics, Kenyan and Ethiopian runners have dominated the middle- and long-distance events in athletics and have exhibited comparable dominance in international cross-country and road-racing competition. Several factors have been proposed to explain the extraordinary success of the Kenyan and Ethiopian distance runners, including (1) genetic predisposition, (2) development of a high maximal oxygen uptake as a result of extensive walking and running at an early age, (3) relatively high hemoglobin and hematocrit, (4) development of good metabolic "economy/efficiency" based on somatotype and lower limb characteristics, (5) favorable skeletal-muscle-fiber composition and oxidative enzyme profile, (6) traditional Kenyan/Ethiopian diet, (7) living and training at altitude, and (8) motivation to achieve economic success. Some of these factors have been examined objectively in the laboratory and field, whereas others have been evaluated from an observational perspective.

The upper limit of aerobic power in humans.

Data on the upper limit of aerobic power in humans are scarce. Thus, here we demonstrate extraordinarily high V'O(2)max and submaximal exercise performance in a young elite cross country skier (22 years, 170 cm, 63 kg; hemoglobin: 16.8 g/dL) who was evaluated before winning an Olympic gold medal.

Hematological and physiological adaptations following 46 weeks of moderate altitude residence.

Although acclimatization to moderate altitude (MA) is thought to be unnecessary or to require minimal adaptation, retrospective data from the U.S. Air Force Academy (USAFA), a military college located at 2210 m, suggested otherwise.

Physical fitness and hematological changes during acclimatization to moderate altitude: a retrospective study.

While high altitude adaptations have been studied extensively, limited research has examined moderate altitude (MA: 1500 to 3000 m) adaptations and their time course, despite the fact that millions of people sojourn to or reside at MA. We retrospectively examined long-term MA acclimatization by analyzing recurring physical fitness test results and hematological data among 2147 college-age male cadets previously residing at either sea level (SL) or MA and currently attending the U.S.

Application of altitude/hypoxic training by elite athletes.

At the Olympic level, differences in performance are typically less than 0.5%. This helps explain why many contemporary elite endurance athletes in summer and winter sport incorporate some form of altitude/hypoxic training within their year-round training plan, believing that it will provide the "competitive edge" to succeed at the Olympic level.

Effect of hypoxic "dose" on physiological responses and sea-level performance.

Live high-train low (LH+TL) altitude training was developed in the early 1990s in response to potential training limitations imposed on endurance athletes by traditional live high-train high (LH+TH) altitude training. The essence of LH+TL is that it allows athletes to "live high" for the purpose of facilitating altitude acclimatization, as manifest by a profound and sustained increase in endogenous erythropoietin (EPO) and ultimately an augmented erythrocyte volume, while simultaneously allowing athletes 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 to conveniently bring the mountain to the athlete, including nitrogen apartments, hypoxic tents, and hypoxicator devices.

Introduction to altitude/hypoxic training symposium.

Altitude/hypoxic training has traditionally been an intriguing and controversial area of research and sport performance. This controversial aspect was evident recently in the form of scholarly debates in highly regarded professional journals, as well as the World Anti-Doping Agency's (WADA) consideration of placing "artificially-induced hypoxic conditions" on the 2007 Prohibited List of Substances/Methods. In light of the ongoing controversy surrounding altitude/hypoxic training, this symposium was organized with the following objectives in mind: 1) to examine the primary physiological responses and underlying mechanisms associated with altitude/hypoxic training, including the influence of genetic predisposition; 2) to present evidence supporting the effect of altitude/hypoxic acclimatization on both hematological and nonhematological markers, including erythrocyte volume, skeletal muscle-buffering capacity, hypoxic ventilatory response, and physiological efficiency/economy; 3) to evaluate the efficacy of several contemporary simulated altitude modalities and training strategies, including hypoxic tents, nitrogen apartments, and intermittent hypoxic exposure (IHE) or training, and to address the legal and ethical issues associated with the use of simulated altitude; and 4) to describe different altitude/hypoxic training strategies used by elite-level athletes, including Olympians and military special forces.

Effect of a global alteration of running technique on kinematics and economy.

In this study, we examined the consequences of a global alteration in running technique on running kinematics and running economy in triathletes. Sixteen sub-elite triathletes were pre and post tested for running economy and running kinematics at 215 and 250 m.min-1.

Effect of FIO2 on oxidative stress during interval training at moderate altitude.

Purpose: To evaluate the effect of different fractions of inspired oxygen (FIO2) on oxidative stress during a high-intensity interval workout in trained endurance athletes residing at altitude.

Methods: Subjects (N = 19) were trained male cyclists who were residents of moderate altitude (1800-1900 m). Testing was conducted at 1860 m (PB 610-612 torr, PIO2 approximately 128 torr).

Intermittent normobaric hypoxia does not alter performance or erythropoietic markers in highly trained distance runners.

This study was designed to test the hypothesis that intermittent normobaric hypoxia at rest is a sufficient stimulus to elicit changes in physiological measures associated with improved performance in highly trained distance runners. Fourteen national-class distance runners completed a 4-wk regimen (5:5-min hypoxia-to-normoxia ratio for 70 min, 5 times/wk) of intermittent normobaric hypoxia (Hyp) or placebo control (Norm) at rest. The experimental group was exposed to a graded decline in fraction of inspired O2: 0.

Effect of F(I)O(2) on physiological responses and cycling performance at moderate altitude.

Purpose: To evaluate physiological responses and exercise performance during a "live high-train low via supplemental oxygen" (LH + TLO(2)) interval workout in trained endurance athletes.

Methods: Subjects (N = 19) were trained male cyclists who were permanent residents of moderate altitude (1800-1900 m). Testing was conducted at 1860 m (P(B) 610-612 Torr, P(I)O(2) approximately 128 Torr).

Detection of DNA-recombinant human epoetin-alfa as a pharmacological ergogenic aid.

The use of DNA-recombinant human epoetin-alfa (rhEPO) as a pharmacological ergogenic aid for the enhancement of aerobic performance is estimated to be practised by at least 3 to 7% of elite endurance sport athletes. rhEPO is synthesised from Chinese hamster ovary cells, and is nearly identical biochemically and immunologically to endogenous epoetin-alfa (EPO). In a clinical setting, rhEPO is used to stimulate erythrocyte production in patients with end-stage renal disease and anaemia.