Training at altitude has become more popular during the past 2 decades as coaches and athletes look to use it for performance enhancement. There are different methods of altitude training depending on what the purpose of the training is and the desired outcome or goal. Altitude training can be undertaken with natural altitude (>2000m above sea level) or in simulated altitude rooms, which are becoming more prevalent in the general community.

Live high, train high (LHTH)

Originally training at altitude was only used to acclimatize to altitude prior to competing at altitude. When altitude training is used for acclimatisation, a period of 21 days at altitude is needed to increase the red cell mass and therefore oxygen carrying capacity of the blood and a minimum of 14 days residing at the competition altitude is needed to reduce the negative effects of altitude on performance.

This method involves living at high altitude and training at high altitude (LHTH) because the person moves to the attitude and stays there until the competition is over. This is the best way to prepare for performance at altitude. Adaptations to altitude require the appropriate altitude (2000 – 3000m) for long enough (>14-16 hours per day), for a sufficient period of time (>21 days) in order to increase the oxygen carrying capacity of the blood.

With increasing knowledge of the physiological benefits of training (and/or living) at altitude, athletes and coaches started to experiment with training at altitude for enhancement of performance at sea level. Altitude camps emerged as an ergogenic aid for endurance athletes to improve their performance just prior to competing at sea level. More recently, coaches of team sports have also started using altitude camps to try to get a winning edge on their opposition.

Live high, train low (LHTL)

Altitude camps for enhancing sea level performance started the same way as camps for altitude acclimatisation, with the athletes moving to altitude for a period of 2 -4 weeks and training there. It was quickly realized that the intensity of training at altitude is inferior to the intensity an athlete is able to sustain at sea level. Some athletes were actually getting a detraining effect instead of a performance enhancement because the athlete was unable to train hard enough to get the adaptations required for sea level performance due to hypoxia experienced during the training session. The live high, train low (LHTL) form of altitude training was developed specifically as a method for enhancing sea level performance. The athletes live at altitude (live high) to gain the physiological benefits from altitude exposure but train at low altitude (train low) to ensure adequate intensity of training is maintained. The increased oxygen transport capacity of the blood in response to living at altitude may allow for training at higher intensities during subsequent training at sea level, thereby prolonging the positive effects of performance from the altitude even after the physiological effects have worn off.

Live low, train high (LLTH)

With the advent of hypoxic rooms and simulated altitude chambers and gyms, a third form of altitude training was established – live low, train high (LLTH). The premise of LLTH altitude training regimes involve near or maximal-intensity efforts at simulated altitude (repeated sprint interval training in hypoxia) to enhance peripheral adaptations to training and therefore high intensity intermittent exercise performance. Coaches of team sports often utilize this method. A few blocks of LLTH altitude training during a long competitive season (2–3 sessions/week for 2–4 weeks at simulated altitude of 2500–3500 m with supra-maximal intensity workouts) can add variety to training and help maintain in season fitness and explosive power.