CONFERENCE PAPER

Sports Med 2007; 37 (4-5): 392-395

0112-1642/07/0004-0392/$44.95/0

 2007 Adis Data Information BV. All rights reserved.

Altitude Training for the Marathon

Robert Chapman1 and Benjamin D. Levine2
1 Department of Kinesiology, Indiana University, Bloomington, Indiana, USA
2 Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical
Center at Dallas, Dallas, Texas, USA

Abstract For nearly 40 years, scientists and elite endurance athletes have been investi-
gating the use of altitude in an effort to enhance exercise performance. While the
results of many early studies on the use of altitude training for sea level perform-
ance enhancement have produced equivocal results, newer studies using the ‘live
high, train low’ altitude training model have demonstrated significant improve-
ments in red cell mass, maximal oxygen uptake, oxygen uptake at ventilatory
threshold, and 3000m and 5000m race time. For the marathoner looking to add
altitude training to their peak performance plans, residence at an altitude of
2000–2500m, a minimum of 20 hours per day, for 4 weeks, appears to hold the
greatest potential for performance enhancement.
Based on published mathematical models of marathon performance, a
marathoner with a typical or average running economy who performed ‘live high,
train low’ altitude training could experience an improvement of nearly 8.5
minutes (or ≈5%) over the 26.2-mile race distance.

Beginning with the lead-up to the 1968 Olympic
Games in Mexico City, scientists and elite endur-
ance athletes have become enamored with training
at altitude. The first altitude training studies were
born out of necessity; a need to determine how best
to acclimatise, so as to maximise racing perform-
ance in a hypoxic environment. Future studies de-
veloped out of the experience of some athletes that
their individual sea level performance was aug-
mented after altitude training sojourns. In the nearly
40 years that have followed, researchers have
worked to elucidate the mechanisms behind, and the
best practices for, improving performance in endur-
ance events with altitude training.
While the results of many early altitude training
studies, which formed the knowledge base at the
time of the original Marathon Conference in 1976,
may be challenged as a result of a lack of proper
controls, small sample sizes and other technical
issues,[1-3] one result is clear: competitive perform-
ance in endurance events at altitude is improved
after acclimatisation to altitude. Recent data indi-
cates 3000m race performance at an altitude of
1800m improves on the order of 0.4–1.4% per week,
over a 3-week altitude camp (Levine BD and Stray-
Gundersen J, unpublished observations). However,
since very few elite, competitive marathons take
place at altitude, most marathoners are interested
Altitude Training for the Marathon
more in the physiology and potential of altitude
training for sea level performance enhancements.
For altitude training to enhance performance,
there must be an altitude acclimatisation effect
which either: (i) improves oxygen delivery to work-
ing muscles (primarily through an increase in red
blood cell mass); or (ii) improves oxygen utilisation
through training in a hypoxic environment.[4] While
the increase in red cell mass with chronic, full time
altitude exposure has become widely accepted (as-
suming certain conditions, such as adequate iron
stores, absence of concurrent illness, and sufficient
duration and intensity of altitude exposure), the ef-
fect of hypoxic training on maximal oxygen uptake
(V̇O2max) remains equivocal. In whole-body endur-
ance exercise activities, the reduction of oxygen flux
from capillary to mitochondria during chronic hyp-
oxic training may reduce the adaptive stimulus to
improve oxygen extraction capabilities in skeletal
muscle.[4,5] This reduction in oxygen flux during
training in hypoxia may, in fact, cause a detraining
effect in the muscle. Perhaps for this reason, even
the most controlled early studies examining altitude
training either had mixed results or found no signifi-
cant differences in performance upon return to sea
level.[1-3]
In the mid-1990s, a novel approach to altitude
training, the ‘live high, train low’ model was
researched in a series of studies with multiple itera-
tions and the most stringent set of controls to
date.[4,5] The ‘high-low’ model proposed that, simi-
lar to traditional altitude training, exposure to a high
enough altitude for an adequate amount of time
would induce erythropoiesis. However, the unique
feature of the high-low model is the inclusion of
daily sojourns to lower altitudes for training. By
going ‘low’ for training, the athlete is better able to
maintain training velocities near that achieved dur-
ing training at sea level. Perhaps more importantly,
the oxygen flux in skeletal muscle during training is
also increased at lower altitudes compared with
 2007 Adis Data Information BV. All rights reserved.
393
higher altitudes. This augmented oxygen flux is
thought to help maintain the overall training stimu-
lus and thereby the structural machinery (‘sym-
morphosis’) that comes from chronic endurance
training. Future iterations have shown that simply
going to low altitude for high intensity interval
sessions, while staying at high altitude for ‘base’ or
gentle training (‘high-high-low’) is just as effective
in augmenting performance as ‘complete’ high-low
training.
In a series of studies by Levine and Stray-Gun-
derson[4], Levine[5] and Chapman et al.,[6] athletes
who lived at an altitude of 2500m for 4 weeks
demonstrated:
• increased red cell mass (≈7–8%) over sea level
baseline, as well as sea level controls;
• increased V̇O2max (≈6%) over sea level baseline,
as well as sea level controls.
However, of these athletes who ‘lived high’, only
the athletes who trained at a lower altitude of 1250m
(either for all daily training sessions or only interval
training sessions) demonstrated:
• a maintenance of oxygen flux during base train-
ing and interval training;
• an increase in the oxygen uptake (V̇O2) at the
ventilatory threshold (≈7%);
• an improvement in 3000m (≈1.5%) or 5000m run
performance (≈3%).
For the marathon event, the fact that ventilatory
threshold improved in the high-low group, but not in
the high-high group may be a key factor for mara-
thon athletes looking to use altitude training to en-
hance their performance in the event. Although the
effect of altitude training on marathon performance
has not been examined explicitly, mathematical
modelling[7] indicates three physiological compo-
nents appear to have the largest effect on marathon
performance: (i) V̇O2 at lactate (or ventilatory)
threshold; (ii) V̇O2max; and (iii) running economy.
In the work of Levine and Stray-Gundersen, both the
high-high and high-low groups demonstrated simi-
Sports Med 2007; 37 (4-5)
394
lar improvements in V̇O2max and no change in run-
ning economy after 4 weeks at altitude.[5] However,
matching one published mathematical model[7] to
the ventilatory threshold improvements demonstrat-
ed only by the high-low group, predicts that a
marathoner with a typical or average running econo-
my would experience an improvement of nearly
8.5 minutes (or ≈5%) over the 26.2-mile race dis-
tance. Just how strong, in competitive terms, is this
potential improvement in performance? Consider
that in the 2000 and 2004 Olympic marathons, a
total of 42 men and 23 women finished within 5% of
the gold medalist’s time. The improvements seen
with the high-low model have the potential to dra-
matically affect the outcomes of championship mar-
athon and other endurance events.
For the marathoner looking to add altitude train-
ing to their peak performance plans, it is important
to be aware of the strong inter-individual variation
in response to training at altitude. Some athletes
demonstrate a strong erythropoietic response to alti-
tude, while others see little or no gain in red cell
mass with chronic exposure.[6] Similarly, many ath-
letes see significant impairment of training speed
and oxygen uptake at altitude, while others are able
to maintain training near what they would be able to
at sea level. These factors, and other individual
acclimatisation responses to altitude, will ultimately
determine how specific athletes will respond.
For the marathoner looking to train at altitude,
often logistical concerns, not physiological ones, are
paramount in using the high-low training model. For
many athletes, leaving their coach, spouse, family,
job and regular training environment can be prob-
lematic. Additionally, the cost of travel and housing
at altitude impairs many athletes from completing an
altitude camp, despite the powerful potential im-
provements in performance that high-low may pro-
vide.
In an effort to minimise these logistical concerns
and perhaps make altitude access more convenient
 2007 Adis Data Information BV. All rights reserved.
Chapman & Levine
for more athletes, the use of nitrogen-based enclo-
sures and intermittent hypoxic exposure has been
attempted. With the ‘nitrogen house’ model, con-
centrated nitrogen is added to room air, in an effort
to lower the inspired partial pressure of oxygen to
match what would be found in the lower atmospher-
ic pressure of altitude. In this case, the athlete is
‘living high’ in the simulated hypoxic environment
of their house or altitude tent and is ‘training low’
simply by stepping outside the enclosure. While this
approach may minimise logistical issues with hav-
ing to relocate to altitude, the potential erythropoiet-
ic response with this model is dependent on the daily
length of hypoxic exposure. Athletes who spend
between 20 and 24 hours a day at 2500m have
shown an average 8% improvement in red cell
mass.[4,5] Using a nitrogen house model at an
equivalent altitude, 16 hours per day of hypoxic
exposure over 3 weeks has produced mean increases
in red cell mass of ≈5%.[8] However, with just 8–10
hours of daily sleeping in a nitrogen tent over 3
weeks, no change was observed in red cell mass.[9]
So, while this artificial altitude model may provide
more convenience for the athlete, true residence at
altitude appears to provide greater erythropoietic
benefit.
Other studies have attempted to use even shorter
time frames of intermittent hypoxic exposure, by
having athletes breathe hypoxic gas mixtures at rest
for 1.5–5 hours per day over a course of 9–21 days.
With this lower time course of hypoxic exposure,
researchers have increased the severity of the hyp-
oxic inspirate in an attempt to equate the ‘dose’ of
hypoxic exposure to that similar to traditional full
time altitude relocation. In one randomised, double-
blind, placebo-controlled study in a group of swim-
mers and runners, intermittent hypoxic exposure has
shown, despite an increase in erythropoietin release,
(i) no increase in erythropoiesis; (ii) no change in
haemoglobin levels; (iii) no change in maximal aer-
obic power or economy; and (iv) no changes in
Sports Med 2007; 37 (4-5)
Altitude Training for the Marathon
either running or swimming performance.[10] While
intermittent hypoxic exposure may be logistically
easier for the athlete than relocating to an altitude
site, the data suggests this methodology, in its cur-
rent application, is futile in augmenting an increase
in oxygen delivery or exercise performance.[4]
From the available literature, a series of recom-
mendations can be made to the marathoner looking
to train at altitude.
• Living high. A living altitude of between 2000m
and 2500m appears to be best to maximise the
erythropoietic response while minimising the
complementary acclimatisation responses, which
can negatively affect performance. A minimum
of 12–16 hours per day appears to be required;
however, longer daily exposures are ideal. While
3 weeks of chronic altitude or normobaric hypox-
ia exposure has been demonstrated to significant-
ly increase red cell mass, studies with 4 weeks of
altitude exposure show mean increases in red cell
mass that are nearly doubled compared with 3
weeks. For that reason, a minimum of 4 weeks of
altitude exposure is recommended.
• Training low. High intensity training, such as
interval training or continuous work faster than
lactate threshold pace, should take place at as low
an altitude as possible. By training low, increases
in V̇O2max and V̇O2 at ventilatory threshold are
maximised over training solely at high altitude.
Acknowledgements
The authors have indicated that they have no affiliation or
financial interest in any organisation(s) that may have a direct
interest in the subject matter of this article.
 2007 Adis Data Information BV. All rights reserved.
395
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Correspondence: Dr Benjamin D. Levine, Institute for Exer-
cise and Environmental Medicine, University of Texas
Southwestern Medical Center at Dallas, 7232 Greenville
Avenue, Suite 435, Dallas, TX 75231, USA.
E-mail: benjaminlevine@texashealth.org
Sports Med 2007; 37 (4-5)