Sports Medicine

, Volume 40, Issue 1, pp 1–25 | Cite as

Combining Hypoxic Methods for Peak Performance

  • Gregoire P. MilletEmail author
  • B. Roels
  • L. Schmitt
  • X. Woorons
  • J. P. Richalet
Review Article


New methods and devices for pursuing performance enhancement through altitude training were developed in Scandinavia and the USA in the early 1990s. At present, several forms of hypoxic training and/or altitude exposure exist: traditional ‘live high-train high’ (LHTH), contemporary ‘live high-train low’ (LHTL), intermittent hypoxic exposure during rest (IHE) and intermittent hypoxic exposure during continuous session (IHT). Although substantial differences exist between these methods of hypoxic training and/ or exposure, all have the same goal: to induce an improvement in athletic performance at sea level. They are also used for preparation for competition at altitude and/or for the acclimatization of mountaineers.

The underlying mechanisms behind the effects of hypoxic training are widely debated. Although the popular view is that altitude training may lead to an increase in haematological capacity, this may not be the main, or the only, factor involved in the improvement of performance. Other central (such as ventilatory, haemodynamic or neural adaptation) or peripheral (such as muscle buffering capacity or economy) factors play an important role.

LHTL was shown to be an efficient method. The optimal altitude for living high has been defined as being 2200–2500 m to provide an optimal erythropoietic effect and up to 3100m for non-haematological parameters. The optimal duration at altitude appears to be 4 weeks for inducing accelerated erythropoiesis whereas <3 weeks (i.e. 18 days) are long enough for beneficial changes in economy, muscle buffering capacity, the hypoxic ventilatory response or Na+/K+-ATPase activity. One critical point is the daily dose of altitude. A natural altitude of 2500 m for 20–22 h/day (in fact, travelling down to the valley only for training) appears sufficient to increase erythropoiesis and improve sea-level performance. ‘Longer is better’ as regards haematological changes since additional benefits have been shown as hypoxic exposure increases beyond 16 h/day. The minimum daily dose for stimulating erythropoiesis seems to be 12 h/day. For non-haematological changes, the implementation of a much shorter duration of exposure seems possible.

Athletes could take advantage of IHT, which seems more beneficial than IHE in performance enhancement. The intensity of hypoxic exercise might play a role on adaptations at the molecular level in skeletal muscle tissue. There is clear evidence that intense exercise at high altitude stimulates to a greater extent muscle adaptations for both aerobic and anaerobic exercises and limits the decrease in power. So although IHT induces no increase in V̇O2max due to the low‘altitude dose’, improvement in athletic performance is likely to happenwith high-intensity exercise (i.e. above the ventilatory threshold) due to an increase in mitochondrial efficiency and pH/lactate regulation. We propose a new combination of hypoxic method (which we suggest naming Living High-Training Low and High, interspersed; LHTLHi) combining LHTL (five nights at 3000 m and two nights at sea level) with training at sea level except for a few (2.3 per week) IHT sessions of supra-threshold training. This review also provides a rationale on how to combine the different hypoxic methods and suggests advances in both their implementation and their periodization during the yearly training programme of athletes competing in endurance, glycolytic or intermittent sports.


Elite Athlete Ventilatory Threshold Aerobic Performance Simulated Altitude Moderate Altitude 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article. The authors acknowledge the anonymous reviewers for their valuable comments and Dr V.E. Vleck who thoroughly reviewed the English manuscript.


  1. 1.
    Wilber RL. Application of altitude/hypoxic training by elite athletes. Med Sci Sports Exerc 2007 Sep; 39 (9): 1610–24PubMedCrossRefGoogle Scholar
  2. 2.
    Issurin V. Altitude training: an up-to-date approach and implementation in practice. Sporto Mokslas 2007; 1 (47): 12–9Google Scholar
  3. 3.
    Fuchs U, Reiss M. Höhentraining: das Erfolgskonzept der Ausdauersportarten. Trainerbibliothek 1990; 27: 128Google Scholar
  4. 4.
    Wilber RL. Altitude training and athletic performance. Champaign (IL): Human Kinetics, 2004Google Scholar
  5. 5.
    Wilber RL. Current trends in altitude training. Sports Med 2001; 31 (4): 249–65PubMedCrossRefGoogle Scholar
  6. 6.
    Hahn AG, Gore CJ. The effect of altitude on cycling performance: a challenge to traditional concepts. Sports Med 2001; 31 (7): 533–57PubMedCrossRefGoogle Scholar
  7. 7.
    Mollard P, Woorons X, Letournel M, et al. Determinants of maximal oxygen uptake in moderate acute hypoxia inendurance athletes. Eur J Appl Physiol 2007 Aug; 100 (6): 663–73PubMedCrossRefGoogle Scholar
  8. 8.
    Levine BD, Stray-Gundersen J, Duhaime G, et al. “Living high-training low”: the effect of altitude acclimatization/normoxic training in trained runners [abstract]. Med Sci Sports Exerc 1991; 23: S25Google Scholar
  9. 9.
    Levine BD, Stray-Gundersen J. “Living high-training low”: effect of moderate-altitude acclimatization with low-altitude training on performance. J Appl Physiol 1997 Jul; 83 (1): 102–12PubMedGoogle Scholar
  10. 10.
    Stray-Gundersen J, Chapman RF, Levine BD. HILO training improves performance in elite runners [abstract no. 198]. Med Sci Sports 1998; 30 (5): SupplGoogle Scholar
  11. 11.
    Dehnert C, Hutler M, Liu Y, et al. Erythropoiesis and performance after two weeks of living high and training low in well trained triathletes. Int J Sports Med 2002 Nov; 23 (8): 561–6PubMedCrossRefGoogle Scholar
  12. 12.
    Stray-Gundersen J, Chapman RF, Levine BD. “Living high-training low”altitude training improves sea level performance in male and female elite runners. J Appl Physiol 2001 Sep; 91 (3): 1113–20PubMedGoogle Scholar
  13. 13.
    Hahn AG, Gore CJ, Martin DT, et al. An evaluation of the concept of living at moderate altitude and training at sea level. Comp Biochem Physiol A Mol Integr Physiol 2001 Apr; 128 (4): 777–89PubMedCrossRefGoogle Scholar
  14. 14.
    Rusko HK, Leppavuori A, Makela P. Living high-training low: a new approach to altitude training at sea level in athletes [abstract]. Med Sci Sports 1995; 27 Suppl. 5: S6Google Scholar
  15. 15.
    Laitinen H, Apolaeus K, Heikkinen R. Acclimatization to living in normobaric hypoxia and training at sea level in runners [abstract]. Med Sci Sports 1995; 27 Suppl. 5: S109Google Scholar
  16. 16.
    Rusko HK, Tikkanen H, Paavolainen L. Effect of living in hypoxia and training in normoxia on sea level V̇O2max and red cell mass [abstract]. Med Sci Sports 1999; 31 Suppl. 5: S86Google Scholar
  17. 17.
    Koistinen PO, Rusko H, Irjala K, et al. EPO, red cells, and serum transferrin receptor in continuous and intermittent hypoxia. Med Sci Sports Exerc 2000 Apr; 32 (4): 800–4PubMedCrossRefGoogle Scholar
  18. 18.
    Phiel-Aulin K, Svedenhag J, Wide L. Short-term intermittent normobaric hypoxia: haematological, physiological and mental effects. Scand J Med Sci Sports 1998; 8: 132–7CrossRefGoogle Scholar
  19. 19.
    Ashenden MJ, Gore CJ, Martin DT, et al. Effects of a 12-day “live high, train low”camp on reticulocyte production and haemoglobin mass in elite female road cyclists. Eur J Appl Physiol Occup Physiol 1999 Oct; 80 (5): 472–8PubMedCrossRefGoogle Scholar
  20. 20.
    Ashenden MJ, Gore CJ, Dobson GP, et al. Simulated moderate altitude elevates serum erythropoietin but does not increase reticulocyte production in welltrained runners. Eur J Appl Physiol 2000 Mar; 81 (5): 428–35PubMedCrossRefGoogle Scholar
  21. 21.
    Ashenden MJ, Gore CJ, Dobson GP, et al. “Live high, train low”does not change the total haemoglobin mass of male endurance athletes sleeping at a simulated altitude of 3000m for 23 nights. Eur J Appl Physiol Occup Physiol 1999 Oct; 80 (5): 479–84PubMedCrossRefGoogle Scholar
  22. 22.
    Saunders PU, Telford RD, Pyne DB, et al. Improved running economy and increased hemoglobin mass in elite runners after extended moderate altitude exposure. J Sci Med Sport 2007 Dec 7Google Scholar
  23. 23.
    Tiollier E, Schmitt L, Burnat P, et al. Living high-training low altitude training: effects on mucosal immunity. Eur J Appl Physiol 2005 Jun; 94 (3): 298–304PubMedCrossRefGoogle Scholar
  24. 24.
    Schmitt L, Hellard P, Millet GP, et al. Heart rate variability and performance at two different altitudes in well-trained swimmers. Int J Sports Med 2006 Mar; 27 (3): 226–31PubMedCrossRefGoogle Scholar
  25. 25.
    Schmitt L, Millet G, Robach P, et al. Influence of “living high-training low”on aerobic performance and economy of work in elite athletes. Eur J Appl Physiol 2006 Jul; 97 (5): 627–36PubMedCrossRefGoogle Scholar
  26. 26.
    Roels B, Hellard P, Schmitt L, et al. Is it more effective for highly trained swimmers to live and train at 1200m than at 1850m in terms of performance and haematological benefits? Br J Sports Med 2006 Feb; 40 (2): e4CrossRefGoogle Scholar
  27. 27.
    Robach P, Schmitt L, Brugniaux JV, et al. Living hightraining low: effect on erythropoiesis andmaximal aerobic performance in elite Nordic skiers. Eur J Appl Physiol 2006 Aug; 97 (6): 695–705PubMedCrossRefGoogle Scholar
  28. 28.
    Robach P, Schmitt L, Brugniaux JV, et al. Living hightraining low: effect on erythropoiesis and aerobic performance in highly-trained swimmers. Eur J Appl Physiol 2006 Mar; 96 (4): 423–33PubMedCrossRefGoogle Scholar
  29. 29.
    Povea C, Schmitt L, Brugniaux J, et al. Effects of intermittent hypoxia on heart rate variability during rest and exercise. High Alt Med Biol 2005 Fall; 6 (3): 215–25PubMedCrossRefGoogle Scholar
  30. 30.
    Pialoux V, Mounier R, Ponsot E, et al. Effects of exercise and training in hypoxia on antioxidant/pro-oxidant balance. Eur J Clin Nutr 2006 Dec; 60 (12): 1345–54PubMedCrossRefGoogle Scholar
  31. 31.
    Mounier R, Pialoux V, Cayre A, et al. Leukocyte’s Hif-1 expression and training-induced erythropoietic response in swimmers. Med Sci Sports Exerc 2006 Aug; 38 (8): 1410–7PubMedCrossRefGoogle Scholar
  32. 32.
    Cornolo J, Fouillot JP, Schmitt L, et al. Interactions between exposure to hypoxia and the training-induced autonomic adaptations in a “live high-train low”session. Eur J Appl Physiol 2006 Mar; 96 (4): 389–96PubMedCrossRefGoogle Scholar
  33. 33.
    Brugniaux JV, Schmitt L, Robach P, et al. Living hightraining low: tolerance and acclimatization in elite endurance athletes. Eur J Appl Physiol 2006 Jan; 96 (1): 66–77PubMedCrossRefGoogle Scholar
  34. 34.
    Brugniaux JV, Schmitt L, Robach P, et al. Eighteen days of “living high, training low”stimulate erythropoiesis and enhance aerobic performance in elite middle-distance runners. J Appl Physiol 2006 Jan; 100 (1): 203–11PubMedCrossRefGoogle Scholar
  35. 35.
    Rusko HK, Tikkanen HO, Peltonen JE. Oxygen manipulation as an ergogenic aid. Curr Sports Med Rep 2003 Aug; 2 (4): 233–8PubMedGoogle Scholar
  36. 36.
    Gore CJ, Gawthorn KM, Clark S. Does intermittent normobaric hypoxic exposure uncouple submaximal V̇O2 and power [abstract]? Med Sci Sports 1999; 31 Suppl. 5: S190Google Scholar
  37. 37.
    Mattila V, Rusko HK. Effect of living high and training low on sea level performance in cyclists [abstract]. Med Sci Sports 1996; 28 Suppl. 5: S157Google Scholar
  38. 38.
    Gore CJ, Hopkins WG, Burge CM. Errors of measurement for blood volume parameters: a meta-analysis. J Appl Physiol 2005 Nov; 99 (5): 1745–58PubMedCrossRefGoogle Scholar
  39. 39.
    Chapman RF, Stray-Gundersen J, Levine BD. Individual variation in response to altitude training. J Appl Physiol 1998 Oct; 85 (4): 1448–56PubMedGoogle Scholar
  40. 40.
    Heinicke K, Wolfarth B, Winchenbach P, et al. Blood volume and hemoglobin mass in elite athletes of different disciplines. Int J Sports Med 2001 Oct; 22 (7): 504–12PubMedCrossRefGoogle Scholar
  41. 41.
    Myhre LG, Dill DB, Hall FG, et al. Blood volume changes during three-week residence at high altitude. Clin Chem 1970 Jan; 16 (1): 7–14PubMedGoogle Scholar
  42. 42.
    Schmidt W, Heinicke K, Rojas J, et al. Blood volume and hemoglobin mass in endurance athletes from moderate altitude. Med Sci Sports Exerc 2002 Dec; 34 (12): 1934–40PubMedCrossRefGoogle Scholar
  43. 43.
    Gore CJ, Hopkins WG. Counterpoint: positive effects of intermittent hypoxia (live high: train low) on exercise performance are not mediated primarily by augmented red cell volume. J Appl Physiol 2005 Nov; 99 (5): 2055–7; discussion 7-8PubMedCrossRefGoogle Scholar
  44. 44.
    Levine BD, Stray-Gundersen J. Point: positive effects of intermittent hypoxia (live high: train low) on exercise performance are mediated primarily by augmented red cell volume. J Appl Physiol 2005 Nov; 99 (5): 2053–5PubMedCrossRefGoogle Scholar
  45. 45.
    Gore CJ, Clark SA, Saunders PU. Nonhematological mechanisms of improved sea-level performance after hypoxic exposure. Med Sci Sports Exerc 2007 Sep; 39 (9): 1600–9PubMedCrossRefGoogle Scholar
  46. 46.
    Saunders PU, Telford RD, Pyne DB, et al. Improved running economy in elite runners after 20 days of simulated moderate-altitude exposure. J Appl Physiol 2004 Mar; 96 (3): 931–7PubMedCrossRefGoogle Scholar
  47. 47.
    Neya M, Enoki T, Kumai Y, et al. The effects of nightly normobaric hypoxia and high intensity training under intermittent normobaric hypoxia on running economy and hemoglobin mass. J Appl Physiol 2007 Sep; 103 (3): 828–34PubMedCrossRefGoogle Scholar
  48. 48.
    Gore CJ, Hahn AG, Aughey RJ, et al. Live high: train low increases muscle buffer capacity and submaximal cycling efficiency. Acta Physiol Scand 2001 Nov; 173 (3): 275–86PubMedCrossRefGoogle Scholar
  49. 49.
    Zoll J, Ponsot E, Dufour S, et al. Exercise training in normobaric hypoxia in endurance runners. III: Muscular adjustments of selected gene transcripts. J Appl Physiol 2006 Apr; 100 (4): 1258–66Google Scholar
  50. 50.
    Juel C, Lundby C, Sander M, et al. Human skeletal muscle and erythrocyte proteins involved in acid-base homeostasis: adaptations to chronic hypoxia. J Physiol 2003 Apr 15; 548 (Pt 2): 639–48PubMedCrossRefGoogle Scholar
  51. 51.
    Mizuno M, Juel C, Bro-Rasmussen T, et al. Limb skeletal muscle adaptation in athletes after training at altitude. J Appl Physiol 1990 Feb; 68 (2): 496–502PubMedGoogle Scholar
  52. 52.
    Westerblad H, Allen DG, Lannergren J. Muscle fatigue: lactic acid or inorganic phosphate the major cause? News Physiol Sci 2002 Feb; 17: 17–21PubMedGoogle Scholar
  53. 53.
    Pedersen TH, Nielsen OB, Lamb GD, et al. Intracellular acidosis enhances the excitability of working muscle. Science 2004 Aug 20; 305 (5687): 1144–7PubMedCrossRefGoogle Scholar
  54. 54.
    Batterham AM, Hopkins WG. Making meaningful inferences aboutmagnitudes. Int J Sports Physiol Perform 2006; 1: 50–7PubMedGoogle Scholar
  55. 55.
    Paton CD, Hopkins WG. Variation in performance of elite cyclists from race to race. Eur J Sport Sci 2006; 6: 1–7CrossRefGoogle Scholar
  56. 56.
    Hopkins WG. Competitive performance of elite trackand-field athletes: variability and smallest worthwhile enhancements. Sportscience 2005; 9: 17–20Google Scholar
  57. 57.
    Pyne D, Trewin C, Hopkins W. Progression and variability of competitive performance of Olympic swimmers. J Sports Sci 2004 Jul; 22 (7): 613–20PubMedCrossRefGoogle Scholar
  58. 58.
    Jensen K, Nielsen TS, Fiskestrand A, et al. High-altitude training does not increase maximal oxygen uptake or work capacity at sea level in rowers. Scand J Med Sci Sports 1993; 3: 256–62CrossRefGoogle Scholar
  59. 59.
    Green HJ, Sutton JR, Cymerman A, et al. Operation Everest II: adaptations in human skeletal muscle. J Appl Physiol 1989 May; 66 (5): 2454–61PubMedGoogle Scholar
  60. 60.
    Hoppeler H, Kleinert E, Schlegel C, et al. Morphological adaptations of human skeletal muscle to chronic hypoxia. Int J Sports Med 1990 Feb; 11 Suppl. 1: S3–9CrossRefGoogle Scholar
  61. 61.
    Roels B, Millet GP, Marcoux CJ, et al. Effects of hypoxic interval training on cycling performance. Med Sci Sports Exerc 2005 Jan; 37 (1): 138–46PubMedCrossRefGoogle Scholar
  62. 62.
    Martin DT, Hahn AG, Lee H, et al. Effects of q 12-day “live high, train low”cycling camp on 4-min and 30-min performance. Med Sci Sports 2002; 34 Suppl. 5: S274Google Scholar
  63. 63.
    Roberts AD, Clark SA, Townsend NE, et al. Changes in performance, maximal oxygen uptake and maximal accumulated oxygen deficit after 5, 10, and 15 days of live high: train low altitude exposure. Eur J Appl Physiol 2003; 88: 390–5PubMedCrossRefGoogle Scholar
  64. 64.
    Witkowski S, Karlsen T, Resaland G, et al. Optimal altitude for “living high-training low”. Med Sci Sports Exerc 2002; 33 Suppl. 5: S292Google Scholar
  65. 65.
    Nummela A, Rusko H. Acclimatization to altitude and normoxic training improve 400-m running performance at sea level. J Sports Sci 2000 Jun; 18 (6): 411–9PubMedCrossRefGoogle Scholar
  66. 66.
    Wilber RL, Shannon MP, Kearney JT, et al. Operational characteristics of a normobaric hypoxic system: proceedings of the Sixth International Olympic Committee World Congress on Sport Sciences. Med Sci Sports Exerc 2002; 34 Suppl. 5: 92Google Scholar
  67. 67.
    Shannon MP, Wilber RL, Kearney JT. Normobarichypoxia: performance characteristics of simulated altitude tents. Med Sci Sports Exerc 2001; 33 Suppl. 5: S60Google Scholar
  68. 68.
    Wilber RL. Live high-train low: thinking in terms of an optimal hypoxic dose. Int J Sports Physiol Performance 2007; 2: 223–38Google Scholar
  69. 69.
    Ge RL, Witkowski S, Zhang Y, et al. Determinants of erythropoietin release in response to short-term hypobaric hypoxia. J Appl Physiol 2002 Jun; 92 (6): 2361–7PubMedGoogle Scholar
  70. 70.
    Anchisi S, Moia C, Ferretti G. Oxygen delivery and oxygen return in humans exercising in acute normobaric hypoxia. Pflugers Arch 2001 Jun; 442 (3): 443–50PubMedCrossRefGoogle Scholar
  71. 71.
    Woorons X, Mollard P, Pichon A, et al. Moderate exercise in hypoxia induces a greater arterial desaturation in trained than untrained men. Scand J Med Sci Sports 2007 Aug; 17 (4): 431–6PubMedGoogle Scholar
  72. 72.
    Townsend NE, Gore CJ, Hahn AG, et al. Living hightraining low increases hypoxic ventilatory response of well-trained endurance athletes. J Appl Physiol 2002 Oct; 93 (4): 1498–505PubMedGoogle Scholar
  73. 73.
    Aughey RJ, Clark SA, Gore CJ, et al. Interspersed normoxia during live high, train low interventions reverses an early reduction in muscle Na+, K+ ATPase activity in well-trained athletes. Eur J Appl Physiol 2006 Oct; 98 (3): 299–309PubMedCrossRefGoogle Scholar
  74. 74.
    Aughey RJ, Gore CJ, Hahn AG, et al. Chronic intermittent hypoxia and incremental cycling exercise independently depress muscle in vitro maximal Na+-K+-ATPase activity in well-trained athletes. J Appl Physiol 2005 Jan; 98 (1): 186–92PubMedCrossRefGoogle Scholar
  75. 75.
    Girard O, Millet GP. Neuromuscular fatigue in racquet sports. Neurologic Clin 2008; 26 (1): 181–94CrossRefGoogle Scholar
  76. 76.
    Powell FL, Garcia N. Physiological effects of intermittent hypoxia. High Alt Med Biol 2000 Summer; 1 (2): 125–36PubMedCrossRefGoogle Scholar
  77. 77.
    Rodriguez FA, Casas H, Casas M, et al. Intermittent hypobaric hypoxia stimulates erythropoiesis and improves aerobic capacity. Med Sci Sports Exerc 1999 Feb; 31 (2): 264–8PubMedCrossRefGoogle Scholar
  78. 78.
    Rodriguez FA, Ventura JL, Casas M, et al. Erythropoietin acute reaction and haematological adaptations to short, intermittent hypobaric hypoxia. Eur J Appl Physiol 2000 Jun; 82 (3): 170–7PubMedCrossRefGoogle Scholar
  79. 79.
    Eckardt KU, Boutellier U, Kurtz A, et al. Rate of erythropoietin formation in humans in response to acute hypobaric hypoxia. J Appl Physiol 1989 Apr; 66 (4): 1785–8PubMedGoogle Scholar
  80. 80.
    Hellemans J. Intermittent hypoxic training: a pilot study. Proceedings of the Second Annual International Altitude Training Symposium; 1999 Feb 18-20; Flagstaff (AZ); 145–54Google Scholar
  81. 81.
    Knaupp W, Khilnani S, Sherwood J, et al. Erythropoietin response to acute normobaric hypoxia in humans. J Appl Physiol 1992 Sep; 73 (3): 837–40PubMedGoogle Scholar
  82. 82.
    Abellan R, Remacha AF, Ventura R, et al. Hematologic response to four weeks of intermittent hypobaric hypoxia in highly trained athletes. Haematologica 2005 Jan; 90 (1): 126–7PubMedGoogle Scholar
  83. 83.
    Ricart A, Casas H, Casas M, et al. Acclimatization near home? Early respiratory changes after short-term intermittent exposure to simulated altitude. Wilderness Environ Med 2000 Summer; 11 (2): 84–8Google Scholar
  84. 84.
    Frey WO, Zenhausern R, Colombani PC. Influence of intermittent exposure to normobaric hypoxia on hematological indexes and exercise performance [abstract]. Med Sci Sports 2000; 32 Suppl. 5: S65Google Scholar
  85. 85.
    Rodriguez FA, Murio J, Ventura JL. Effects of intermittent hypobaric hypoxia and altitude training on physiological and performance parameters in swimmers [abstract]. Med Sci Sports Exerc 2003; 35: S115Google Scholar
  86. 86.
    Julian CG, Gore CJ, Wilber RL, et al. Intermittent normobaric hypoxia does not alter performance or erythropoietic markers in highly trained distance runners. J Appl Physiol 2004 May; 96 (5): 1800–7PubMedCrossRefGoogle Scholar
  87. 87.
    Tadibi V, Dehnert C, Menold E, et al. Unchanged anaerobic and aerobic performance after short-term intermittent hypoxia. Med Sci Sports Exerc 2007 May; 39 (5): 858–64PubMedCrossRefGoogle Scholar
  88. 88.
    Woorons X, Mollard P, Lamberto C, et al. Effect of acute hypoxia on maximal exercise in trained and sedentary women. Med Sci Sports Exerc 2005 Jan; 37 (1): 147–54PubMedCrossRefGoogle Scholar
  89. 89.
    Mollard P, Woorons X, Letournel M, et al. Role of maximal heart rate and arterial O2 saturation on the decrement of V̇O2max in moderate acute hypoxia in trained and untrained men. Int J Sports Med 2007 Mar; 28 (3): 186–92PubMedCrossRefGoogle Scholar
  90. 90.
    Vogt M, Puntschart A, Geiser J, et al. Molecular adaptations in human skeletal muscle to endurance training under simulated hypoxic conditions. J Appl Physiol 2001 Jul; 91 (1): 173–82PubMedGoogle Scholar
  91. 91.
    Vallier JM, Chateau P, Guezennec CY. Effects of physical training in a hypobaric chamber on the physical performance of competitive triathletes. Eur J Appl Physiol Occup Physiol 1996; 73 (5): 471–8PubMedCrossRefGoogle Scholar
  92. 92.
    Truijens MJ, Toussaint HM, Dow J, et al. Effect of highintensity hypoxic training on sea-level swimming performances. J Appl Physiol 2003 Feb; 94 (2): 733–43PubMedGoogle Scholar
  93. 93.
    Emonson DL, Aminuddin AH, Wight RL, et al. Training induced increases in sea level V̇O2max and endurance are not enhanced by acute hypobaric exposure. Eur J Appl Physiol Occup Physiol 1997; 76 (1): 8–12PubMedCrossRefGoogle Scholar
  94. 94.
    Siri WE, Van Dyke DC, Winchell HS, et al. Early erythropoietin, blood, and physiological responses to severe hypoxia in man. J Appl Physiol 1966 Jan; 21 (1): 73–80PubMedGoogle Scholar
  95. 95.
    Levine BD, Stray-Gundersen J. A practical approach to altitude training: where to live and train for optimal performance enhancement. Int J Sports Med 1992 Oct; 13 Suppl 1: S209–12CrossRefGoogle Scholar
  96. 96.
    Engfred K, Kjaer M, Secher NH, et al. Hypoxia and training-induced adaptation of hormonal responses to exercise in humans. Eur J Appl Physiol Occup Physiol 1994; 68 (4): 303–9PubMedCrossRefGoogle Scholar
  97. 97.
    Terrados N, Melichna J, Sylven C, et al. Effects of training at simulated altitude on performance and muscle metabolic capacity in competitive road cyclists. Eur J Appl Physiol Occup Physiol 1988; 57 (2): 203–9PubMedCrossRefGoogle Scholar
  98. 98.
    Schmidt W, Eckardt KU, Hilgendorf A, et al. Effects of maximal and submaximal exercise under normoxic and hypoxic conditions on serum erythropoietin level. Int J Sports Med 1991 Oct; 12 (5): 457–61PubMedCrossRefGoogle Scholar
  99. 99.
    Casas M, Casas H, Pages T, et al. Intermittent hypobaric hypoxia induces altitude acclimation and improves the lactate threshold. Aviat Space Environ Med 2000 Feb; 71 (2): 125–30PubMedGoogle Scholar
  100. 100.
    Meeuwsen T, Hendriksen IJ, Holewijn M. Traininginduced increases in sea-level performance are enhanced by acute intermittent hypobaric hypoxia. Eur J Appl Physiol 2001 Apr; 84 (4): 283–90PubMedCrossRefGoogle Scholar
  101. 101.
    Melissa L, MacDougall JD, Tarnopolsky MA, et al. Skeletal muscle adaptations to training under normobaric hypoxic versus normoxic conditions. Med Sci Sports Exerc 1997 Feb; 29 (2): 238–43PubMedCrossRefGoogle Scholar
  102. 102.
    Terrados N, Jansson E, Sylven C, et al. Is hypoxia a stimulus for synthesis of oxidative enzymes and myoglobin? J Appl Physiol 1990 Jun; 68 (6): 2369–72PubMedGoogle Scholar
  103. 103.
    Green H, MacDougall J, Tarnopolsky M, et al. Downregulation of Na+-K+-ATPase pumps in skeletal muscle with training in normobaric hypoxia. J Appl Physiol 1999 May; 86 (5): 1745–8PubMedGoogle Scholar
  104. 104.
    Desplanches D, Hoppeler H, Linossier MT, et al. Effects of training in normoxia and normobaric hypoxia on human muscle ultrastructure. Pflugers Arch 1993 Nov; 425 (3-4): 263–7PubMedCrossRefGoogle Scholar
  105. 105.
    Hoppeler H, Vogt M, Weibel ER, et al. Response of skeletal muscle mitochondria to hypoxia. Exp Physiol 2003 Jan; 88 (1): 109–19PubMedCrossRefGoogle Scholar
  106. 106.
    Geiser J, Vogt M, Billeter R, et al. Training high-living low: changes of aerobic performance andmuscle structure with training at simulated altitude. Int J Sports Med 2001 Nov; 22 (8): 579–85PubMedCrossRefGoogle Scholar
  107. 107.
    Ponsot E, Dufour SP, Zoll J, et al. Exercise training in normobaric hypoxia in endurance runners. II: Improvement of mitochondrial properties in skeletal muscle. J Appl Physiol 2006 Apr; 100 (4): 1249–57Google Scholar
  108. 108.
    Coffey VG, Hawley JA. The molecular bases of training adaptation. Sports Med 2007; 37 (9): 737–63PubMedCrossRefGoogle Scholar
  109. 109.
    Dufour SP, Ponsot E, Zoll J, et al. Exercise training in normobaric hypoxia in endurance runners. I: Improvement in aerobic performance capacity. J Appl Physiol 2006 Apr; 100 (4): 1238–48Google Scholar
  110. 110.
    Roels B, Bentley DJ, Coste O, et al. Effects of intermittent hypoxic training on cycling performance in well-trained athletes. Eur J Appl Physiol 2007 Oct; 101 (3): 359–68PubMedCrossRefGoogle Scholar
  111. 111.
    Roels B, Thomas C, Bentley DJ, et al. Effects of intermittent hypoxic training on amino and fatty acid oxidative combustion in human permeabilized muscle fibers. J Appl Physiol 2007 Jan; 102 (1): 79–86PubMedCrossRefGoogle Scholar
  112. 112.
    Morton JP, Cable NT. Effects of intermittent hypoxic training on aerobic and anaerobic performance. Ergonomics 2005 Sep 15-Nov 15; 48 (11-14): 1535–46PubMedCrossRefGoogle Scholar
  113. 113.
    Woorons X, Mollard P, Pichon A, et al. Effects of a 4-week training with voluntary hypoventilation carried out at low pulmonary volumes. Respir Physiol Neurobiol 2008 Feb 1; 160 (2): 123–30PubMedCrossRefGoogle Scholar
  114. 114.
    Woorons X, Mollard P, Pichon A, et al. Prolonged expiration down to residual volume leads to severe arterial hypoxemia in athletes during submaximal exercise. Respir Physiol Neurobiol 2007 Aug 15; 158 (1): 75–82PubMedCrossRefGoogle Scholar
  115. 115.
    Hoppeler H, Vogt M. Muscle tissue adaptations to hypoxia. J Exp Biol 2001 Sep; 204 (Pt 18): 3133–9PubMedGoogle Scholar
  116. 116.
    Katayama K, Matsuo H, Ishida K, et al. Intermittent hypoxia improves endurance performance and submaximal exercise efficiency. High Alt Med Biol 2003 Fall; 4 (3): 291–304PubMedCrossRefGoogle Scholar
  117. 117.
    Wilber RL, Stray-Gundersen J, Levine BD. Effect of hypoxic “dose” on physiological responses and sea-level performance. Med Sci Sports Exerc 2007 Sep; 39 (9): 1590–9PubMedCrossRefGoogle Scholar
  118. 118.
    Sevre K, Bendz B, Hanko E, et al. Reduced autonomic activity during stepwise exposure to high altitude. Acta Physiol Scand 2001 Dec; 173 (4): 409–17PubMedCrossRefGoogle Scholar
  119. 119.
    Fiskerstrand A, Seiler KS. Training and performance characteristics among Norwegian international rowers 1970- 2001. Scand J Med Sci Sports 2004 Oct; 14 (5): 303–10PubMedCrossRefGoogle Scholar
  120. 120.
    Seiler KS, Kjerland GO. Quantifying training intensity distribution in elite endurance athletes: is there evidence for an “optimal” distribution? Scand J Med Sci Sports 2006 Feb; 16 (1): 49–56PubMedCrossRefGoogle Scholar
  121. 121.
    Seiler S, Haugen O, Kuffel E. Autonomic recovery after exercise in trained athletes: intensity and duration effects. Med Sci Sports Exerc 2007 Aug; 39 (8): 1366–73PubMedCrossRefGoogle Scholar
  122. 122.
    Esteve-Lanao J, Foster C, Seiler S, et al. Impact of training intensity distribution on performance in endurance athletes. J Strength Cond Res 2007 Aug; 21 (3): 943–9PubMedGoogle Scholar
  123. 123.
    Esteve-Lanao J, San Juan AF, Earnest CP, et al. How do endurance runners actually train? Relationship with competition performance. Med Sci Sports Exerc 2005 Mar; 37 (3): 496–504Google Scholar
  124. 124.
    Yamamoto K, Miyachi M, Saitoh T, et al. Effects of endurance training on resting and post-exercise cardiac autonomic control. Med Sci Sports Exerc 2001 Sep; 33 (9): 1496–502PubMedCrossRefGoogle Scholar
  125. 125.
    Bernardi L, Passino C, Serebrovskaya Z, et al. Respiratory and cardiovascular adaptations to progressive hypoxia: effect of interval hypoxic training. Eur Heart J 2001 May; 22 (10): 879–86PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2010

Authors and Affiliations

  • Gregoire P. Millet
    • 1
    Email author
  • B. Roels
    • 2
  • L. Schmitt
    • 3
  • X. Woorons
    • 4
  • J. P. Richalet
    • 4
  1. 1.ISSUL, Institute of Sport Science, University of LausanneLausanneSwitzerland
  2. 2.ORION, Clinical Services LtdUK
  3. 3.National Nordic Ski CentreFrance
  4. 4.Université Paris 13, Laboratoire ‘Réponses cellulaires et fonctionnelles à l’hypoxie’, EA2363 ARPEFrance

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