How high-altitude training can benefit elite endurance athletes like runners and swimmers


Dr. Levine stands in front of the altitude chamber. Over the years, his team has used the chamber to research altitude training while developing the “live high, train low” program. The team also uses it as a hyperbaric chamber to treat patients with oxygen.

Seconds matter in competitive sports. In fact, less than 1 second separated Singapore swimmer Joseph Schooling’s gold medal from a three-way tie for silver in the 100-meter butterfly at the 2016 Rio Olympics.

With such intense competition, how can elite athletes legally gain a competitive advantage? One method I’ve studied extensively is altitude training. My colleague, Jim Stray-Gundersen, M.D., and I researched altitude training for 10 years with grants from the U.S. Olympic Committee and USA Track & Field (USATF). This was the longest sports medicine research grant in the history of the Olympic Committee, and it enabled us to publish the definitive study on altitude training in the Journal of Applied Physiology.

Elite American athletes, including Olympic runners Emma Coburn, Jenny Simpson, Galen Rupp, Paul Chelimo, Matthew Centrowitz, and Evan Jager, and Olympic swimmers Michael Phelps, Ryan Murphy, and Katie Ledecky, rely on altitude training to shave off precious seconds during their races. However, the benefits for noncompetitive athletes are far less noticeable – even though gimmicky products like “high elevation” training masks may try to convince you otherwise.

What is altitude training?

When we refer to “high altitude” in sports medicine, we generally mean 7,000 to 8,000 feet above sea level or higher. Low altitude is approximately 4,000 feet above sea level or lower.

In high-altitude environments, you draw in less oxygen per breath than you would at lower altitudes. That means each breath will deliver less oxygen to your muscles. This may sound like a negative thing, but living in higher altitudes and getting used to breathing “thinner” air can enhance elite athletes’ athletic performance in competitions at lower altitude.

During workouts at high altitude, athletes feel like they’re putting forth more effort to perform as well as they do closer to sea level. The increased rate of perceived exertion is caused by altitude-induced hypoxia, which is a decrease in the amount of oxygen being delivered to the muscles to burn fuel and create energy.

As elite athletes acclimate to high altitude, they acquire more red blood cells which allows their blood to carry more oxygen. When they compete at lower altitudes, they get a natural boost to the muscles when additional oxygen is available. This blood expanding effect can enhance performance in elite athletes by 1 to 2 percent. While that sounds like a tiny improvement, it can be the difference between missing the final cut for a competitive team and earning a medal.

Traditionally, elite athletes have lived and trained at high altitudes, such as Colorado Springs, Colo. However, our research has shown it’s more effective to follow what Dr. Stray-Gundersen and I call the “live high, train low” program. Elite athletes should live and lightly train in high-altitude areas to acclimate their bodies to lower oxygen levels. But they should train harder and compete in lower altitude areas, where the muscles can work harder with the maximal amount of oxygen available for aerobic performance.

How does ‘live high, train low’ work?

Our “live high, train low” research is the training platform for most American elite-athlete altitude programs. To benefit, athletes must spend the majority of their time – 12 to 16 hours a day – at the sweet spot of around 8,000 feet above sea level. If they get too much higher, they can develop altitude sickness, lower plasma volume levels, and suffer inadequate sleep patterns. Training should occur around or below 4,000 feet above sea level. Research is inconclusive as to exactly how long an athlete must train low for optimal benefit, though it is critical to conduct all high-intensity efforts at low altitude.

Many athletes who live high and train low commute to cities or neighborhoods nearby for training. For example, tenured running coach Alberto Salazar has trained many elite athletes in Utah. The runners lived in Park City, Utah, which is around 7,000 to 8,000 feet above sea level and commuted to nearby Salt Lake City, which is around 4,200 feet above sea level, for their hard training sessions. In fact, this was the region where we proved live high, train low is effective. Mo Farrah and Galen Rupp trained there, and many successful distance runners have used this paradigm. In fact, Rob Chapman, who is the director of sports science for the USATF was one of my former fellows. He wrote one of the definitive papers in our field and has been an active supporter of live high, train low for many years.

Randy Wilber, the senior sport physiologist for the U.S. Olympic Committee, has developed his own novel approach to our program. He lives in Colorado Springs where it’s difficult to get to lower altitudes. So a few days a week, his athletes train in “altitude rooms” where they work out on treadmills and breathe with supplemental oxygen. The U.S. Ski and Snowboard team lived and trained at high altitude but skated while breathing from portable oxygen canisters developed by Dr. Stray-Gundersen to simulate exercise at a lower elevation.

I’m in frequent contact with Rob and Randy, and every few years we attend high-altitude training summits run by the Olympic Committee. At these meetings, coaches, sports scientists, and others involved in altitude training convene to discuss the latest altitude research and proven techniques elite athletes can use. There are a growing number of influential people who subscribe to this program, which is one of the reasons more athletes are attracted to it. However, some sports authorities think athletes who use altitude training have an unfair advantage.

Why is altitude training controversial?

Altitude training does alter the physiology of the body for a competitive edge. However, it’s not appropriate to lump the program into the same class as doping. The way I look at it, altitude training gives elite athletes who want to play by the rules a chance to compete against the dopers.

The advantage of altitude training is that the muscles get a natural boost when more oxygen is available during lower-altitude competitions. The disadvantage is that athletes simply can’t train as hard at high altitude, even though the training may feel difficult. Many of the cues athletes use to judge how hard they’re training – tiredness of muscles, labored breath, how fast they’re covering ground – change at high altitude, making it easy to over train. But with carefully monitored training, plenty of rest, and proper time to acclimate, elite athletes can benefit from the live high, train low program.

Can the average person benefit from altitude training?

If you aren’t an elite athlete (a professional or an Olympian), you likely will not benefit substantially from altitude training, at least compared to the benefits that can obtained by optimizing all the other key components of a training plan. There is some evidence, however, that nonathletes who live in high-altitude areas may experience cardiovascular benefits, though exactly why remains uncertain. Summit County, Colo., which at its lowest point is just below 8,000 feet above sea level, is home to some of the longest-living populations in the United States.

While it’s tough to separate out all of the lifestyle factors that affect heart disease risk, such as diet, smoking, and exercise habits, we want to know whether living at this altitude contributes to the longevity in the region. This is one of the topics we’re examining at the Institute for Exercise and Environmental Medicine in regard to nonathletes.

For recreational athletes, altitude training is not the key to swimming faster or running farther. There are a lot of gimmicky items out there geared to mid-level swimmers and runners. Some of the top offenders include:

  • Elevation training masks: This is just resistance training for the respiratory muscles – it has nothing to do with altitude training. Labeling these masks with the word “elevation” is a marketing tactic and nothing more.
  • Hypoxia sleep chambers: This is intriguing, but it requires a lot of time in the hypoxic environment to achieve measureable results. No athlete wants to spend 12-plus hours every day hanging out in a sleep chamber when he or she could be working out – or enjoying a social life.
  • High-altitude training rooms: Oxygen deprivation rooms are ineffective when used exclusively for training. Athletes must spend upward of 12 hours every day in a high-altitude environment to experience benefits, which is just not feasible for most people.

Don’t waste your money on these gimmicks. Instead, invest in a running or swimming coach and work with a dietitian. The essential component of successful training for non-elite athletes is a well-designed program with coaching and appropriate buildups of intensity, duration, and recovery. This, paired with good nutrition, adequate hydration, and supportive training partners will help you achieve your goals.