Altitude Training for Cyclists Revisited

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This episode, the up to date science on the effectiveness of altitude training on cyclists.

“There is a need for prolonged exposure with access to different altitudes. Working off the evidence, it takes about 100 hours for each 1% in hemoglobin mass at real altitude. So if you are going to go to the trouble of going to planning altitude camps you have to define the level of altitude and the duration of the stay.”


— Damien Ruse on the current science surrounding the effectiveness of altitude training on endurance athletes.


The Feature

Back in 2014, on the Semi Pro Cycling Podcast we looked at the arguments for and against the three families of altitude training; Live High Train High, Live Low Train High, and Live High Train Low. What we learned then was that what you decide to be best for you might be completely different the next time you decide to do it.


Today we look at the developments in altitude training that have been made in the last 5 years. What has changed and what is now considered to be effective? That’s what we’re going to look at today.


If you’re interested in learning about up to date benefits of altitude training and what works best for you, then this is the show for you.


The Transcript

Damian: The thing about doing a podcast on the science of cycling is that it’s changing all the time. I did a show back in July, 2014 where I ran through the arguments for and against the 3 families of altitude training. My conclusions then, were that even if you were able to find something that worked – it’s not guaranteed to work again the next time you use it. The Head of Australian Institute of Sport Physiology summed up the current evidence at the time better than me, though.


Damian: Professor Chris Gore had this bleak conclusion after 20 years of studying altitude training. So, if a world renowned physiologist can’t prove that altitude training scientifically works beyond all doubt – then why should we try, right? Well that was March 2013 – what’s changed to make the science world think differently in March 2018? That’s on today’s show.


I’m Damian Ruse. This is the Semi-Pro Cycling podcast and today we look at the acceleration of altitude training science over the last 5 years and discuss the updates to the science and current evidence of its effectiveness. This is the most up to date information on altitude training that you’ll find online with some of the information not even published yet. So this is definitely a must listen for any serious cyclist or coach that’s looking for an extra 38%.


Damian: In 2013 there was a conference in Doha called the Altitude Training and Team Sports Conference. It brought together many views from experts from around the world. I referenced this conference a lot in my last episode on altitude training as it captured the panorama picture up until that point. What was going on behind the scenes, though, was setting the stage for the next 5 years – the results of which we’re seeing today. The big change that was made after the conference there was an update to the panorama of altitude training methods and what we’re seeing now 5 years later is that the combination of methods gives us the best of each method with limited drawbacks for each one.


But before 2013, actually back in 2007, a Randy Wilber paper put together the first panorama picture of the 3 altitude training families. I went over these in the last episode but as a refresher, the 3 main families of altitude training are Live High Train High, Live Low Train High, and Live High Train Low.


Live High Train High is the most historical family, these are the traditional altitude training camps you might of heard about or even tried to replicate. This family was developed in the 1960s for the Mexico Olympic games because the high elevation of Mexico City. Then in the late 90s, early 2000s was the introduction of hypoxic facilities which helped develop the Live Low Train High family. And finally in 1997 Ben Levine and James Stray-Gundersen published a study that changed the way athletes were training and a new family was born – Live High Train Low.


Screen Shot 2018 03 02 at 08.08.55

Between 2007 and 2013, with mounting evidence suggesting that Live Low Train High needed further differentiation, changes to Randy Wilber’s original panorama were beginning to be proposed, and a lot of the changes came down to the different physiological adaptations between being at altitude in the mountains and one of these…


Arthur: This is the machine, that gives me oxygen, I’m going to start it now…how am I going to sleep with this it makes so much noise.


Damian: This is Irish athlete, Arthur Lanigan O’Keeffe, firing up his altitude tent getting ready to spend the night in it – and there’s more to the differences between lying in a plastic tent with a pump sucking the oxygen out of it or training camps in snow-capped mountains – instead there are many differences between what we’ll call ‘fake’ altitude and real altitude. And this is where it started to get problematic because before 2007 you might have got a different answer to this question: Is the thin air you find on top of mountains equivalent to the air in an altitude tent for the purposes of stimulating physiological adaptations that will make you faster? This question turns out to be trickier than you might think.


We often think of altitude as simply having less oxygen, but that’s not quite right. The air at high altitude has the same percentage of oxygen, roughly 21% as everywhere else; it’s just that there’s less air overall, so the pressure is lower. That means you breathe in less oxygen with each breath. In altitude tents and altitude chambers, we can achieve the same goal, less oxygen going in with each breath, by a different method: keep the pressure the same, but reduce the percentage of oxygen in the air. For example, if you reduce the amount of oxygen in a altitude tent from, going 21% to 15%, it results in the same amount of oxygen reaching your lungs as going up to 3,000 meters (10,000 feet) above sea level.


This type of fake altitude stimulus is called normobaric hypoxia because there is normal pressure but low oxygen, while real altitude is called hypobaric hypoxia for its low pressure and low oxygen. This is important understand for a few reasons, the first being that some physiologists follow what’s called the Air Altitude Equivalent Model, where they believe there’s no difference between hypobaric and normobaric hypoxia when trying to induce beneficial adaptations. This school of thought is based on one mechanism – improving oxygen transport capacity – but new evidence found that hypobaric and normobaric hypoxia are not exactly the same and there are other mechanisms that will influence adaptations, for example:

  • There’s a difference in fluid balance and when athletes are preaclimitised in real altitude it is more effective than if athletes are preaclimitised in an altitude tent.
  • There’s oxidative stress when you manipulate oxygen percentage
  • Sleep quality and heart rate has reported to be different


The reason these discoveries are important is because these differences took a big chunk of altitude training in a new direction – away from being solely about aerobic performance. Traditionally, the aim of altitude training for endurance athletes has always been focussed on the basic theory of altitude training, which is, your body responds to hypoxia, the shortage of oxygen reaching your body tissues at high altitudes (<3000m or inspired fraction of oxygen >14.4%) by enhancing its ability to transport oxygen from the lungs to muscles. This helps you acclimatise and perform at altitude, like in Mexico or back at sea level this adaptation boosts your endurance. However, we are now seeing that combining hypoxic methods is maximising gains and the new Live High Train Low and High family is very useful for cyclists that need to use their aerobic and anaerobic systems to perform. Also, other innovative ‘live low-train high’ methods, have started to emerge that further improve performance of multiple sprints.


In 2010 the first update to the panorama was proposed by Dr. Grégoire Millet in a paper called Combining Hypoxic Methods for Peak Performance. He proposed to slightly modify the panorama by introducing the possibility of combining different hypoxic methods. New approaches included ‘Intermittent Hypoxic Exposure during interval-training’ and ‘live high-train low and high’.


But it wasn’t until December 2013, 9 months after the experts sat down at the conference in Doha that Randy Wilber’s panorama picture was updated in an editorial on the British Journal of Sports Medicine. Two main changes were made – firstly, dividing the Live Low Train High family in four subsets; that is, Intermittent Hypoxic Exposure, continuous >30 min low intensity training in hypoxia, interval-training in hypoxia and Repeated Sprint Training, and secondly the formal addition of Live High Train Low and High family.


Screen Shot 2018 03 01 at 11.03.58

I want to have a look at both these changes, so let’s start with one of the most promising findings in the last 5 years – Repeated Sprint Training in Hypoxia. This method falls under the Live High Train Low and High method and seems to work across different sports and genders. It was pioneered in a 2013 study. I actually brought the results of this study up in my last episode but it’s worth mentioning again because repeated sprint training in hypoxia has shown to enhance repeated sprint ability. Something that is crucial to almost every cyclist and compared to interval training in hypoxia there is mounting evidence of its benefit.


This study took 40 trained cyclists and split them into two groups that completed 8 cycling repeated sprint sessions in hypoxia where oxygen was set to 14.6% to simulate an altitude of 3000m or normoxia of 485 metres. These sessions were done over 4 weeks and included 120 sprints in 8 sessions. A session included a 10 minute warm up and cool down and 3 sets of 5 x 10 seconds ON (all out) / 20 seconds OFF (120W) with 5 minutes of recovery between sets. In total each session was less than 40 minutes.


journal.pone .0056522.g001

They were testing for a few different things but we’ll just focus on sprint repeatability.


They used a Repeated Sprint Ability Test like poor Sergio is going through in this clip – if you listen carefully you can hear a lab assistant put down a bucket right next to them.


In this test, subjects performed 10 second sprints with 20 seconds of rest and did as many sprints as possible until task failure which was indicated as a 30% drop from the power output of their first sprint. Both groups, the hypoxia and normoxia groups completed 9 sprints in total before the training. So what happened after the training? The normoxia group didn’t do more sprints but the average of each sprint was higher. In the hypoxia group the average sprint was also higher (+6%) and they were able to perform 13 sprints (38%) more. They didn’t improve V02max just the capacity to repeat more sprints. So the major finding here was that they were able to postpone the fatigue when sprinting. Encouraging but because it is still early days the optimal way to structure Repeated Sprint Training at Hypoxia is not yet known. I actually see this as a big opportunity for anyone to try variations of this using any of the well know high intensity training protocols like 30 on 15 off or 20 40s.


The best part of Repeated Sprint training is the similar results that are being reported in the literature. This was highlighted in August 2017 in a paper by Brocherie et al called Effects of Repeated-Sprint Training in Hypoxia on Sea-Level Performance: A Meta-Analysis. It shows 12 studies from 6 different research groups show that there’s a clear advantage to performing repeated sprint training in hypoxia.


Something which will interest people that don’t have access to an altitude chamber is that there is another way to simulate the same mechanisms during sprint training by using something that’s called, hypoventilation at low lung volume. But holding your breath while sprinting is another episode all together. Sorry for the tease.


Repeated Sprint Training is a method that was added to the existing Live Low Train High family and the new family Live High Train Low and High, and this was first explored in a 2015 study.


This study aimed to investigate physical performance and hematological changes in 32 elite male team-sport players after 14 days of “live high–train low” training in normobaric hypoxia (more than 14 hours day at 2800–3000 m) combined with repeated-sprint training (six sessions of four sets of 5 × 5-s sprints with 25 s of passive recovery) either in normobaric hypoxia at 3000 m or in normoxia compared with controlled “live low–train low” training.


Before, immediately after, and 3 weeks after the intervention, hemoglobin mass was measured, and repeated-sprint times.


Results – Both hypoxic groups similarly increased their hemoglobin mass immediately after the intervention and 3 weeks after, whereas no change occurred in live low–train low.  From before to immediately after, cumulated sprint time decreased in LHTLH and live high–train low, but not in live low–train low, and remained significantly reduced 3 weeks later in LHTLH only.


Conclusions – “Live high–train low and high” hypoxic training interspersed with repeated sprints in hypoxia for 14 days increases the hemoglobin mass and repeated-sprint ability with benefits lasting for at least 3 weeks postintervention. The best of both worlds!


Now, the changes to the panorama are far from over and it was updated again in October 2017 in a comprehensive review on the effects of altitude/hypoxia on sprint performance.


Screen Shot 2018 03 01 at 11.05.09

Three new methods were added to the altitude training panorama picture under Live Low Train High – Local Hypoxia. These were:

  • IPC – Hypoxic preconditioning
  • BFR – Blood flow restriction
  • RTH – Resistance training in hypoxi


We are going to take a quick look at Ischaemic Preconditioning today and Blood flow restriction on another day.


Ischaemic Preconditioning is where you put a cuff around your limb, in the cyclists case, you put it on one leg. You leave it for 5 minutes, then you remove it for 5 minutes by changing it to the other leg for 5 minutes. Do this for 30-40 minutes depending on how long you want a cycle to last. Then 30 to 45 minutes after this you do a workout. This exact protocol was done is a 2015 study where the subjects did 12 6 second sprints before and after Ischaemic Preconditioning. The result was after the Ischaemic Preconditioning the mean and peak power for the first 3 sprints were higher. This method is actually very controversial, though, because there are many studies that show it doesn’t work and some even show it hinders sprint performance. There are lots of potential reasons to explain these findings but overall it’s early days and even the precise mechanisms involved in the performance changes are not completely understood.


Ok – so where does this leaves us? From both the episodes I’ve done on altitude training, here are the main takeaways when trying to work out which method is right for your cycling.


The mechanisms for elite endurance athletes have traditionally been all about high oxygen transport capacity by increasing hemoglobin mass. And as long as you are in the right attitude, the longer you stay at altitude the more you will increase hemoglobin mass. For example, 3 weeks at 2200m will increase 3-4% in hemoglobin mass and one more week will increase a bit more (Levine and Stray-Gundersen 2006). And your total hemoglobin is strongly related to V02max.


There is a need of prolonged exposure with access to different altitudes. Working off the evidence, it takes about 100 hours for each 1% in hemoglobin mass at real altitude. So if you are going to go to the trouble of going to planning altitude camps you have to define the level of altitude and the duration of the stay. The perfect range to do live high / train high is 2200m and 2500m and when you try and find somewhere to do this – a lot of places are too low. If you want to go somewhere in this range you have to go to places like East Africa, Iten, Rocky Mountains, or the Sierra Nevada. But you can use other places that are lower when using the combined method but there has to be an established altitude chamber. And now it’s all about the combination because even places like Sierra Nevada have altitude chambers but understand that hypobaric hypoxia and normobaric hypoxia are not the same and hypobaric hypoxia is a more severe stimulus. So be careful.


But the new evidence is using the combination of both methods for aerobic and anaerobic performance gains. So using Live High Train High then Live High Train Low and High + Repeated Sprint Training in Hypoxia is recommended. Start with the protocol of 14.6% oxygen to simulate an altitude of 3000 m using the 10 seconds on / 20 seconds off and experiment from there. And let’s talk again about this in another 5 years.



Damian V/O: It’s time once again for the Radar. The segment of the show where I talk about something that has popped up on my radar – whether it’s a product, study or performance tip…


I came across an article on Cycling Weekly a few months back it’s an interview with Peter Sagan’s coach Patxi Vila where he describes Sagan’s schedule for November 20-26. With a total training volume of around 19 hours in one week, this is Sagan’s opening week of base-building, and a solid one at that. Let’s take a look at the Week in training: November 20-26 2017 with comments by Vila.




2hr ride and gym session


Week one of the base period is structured as one day of easy riding every other day. This is the beginning of the base period. In the morning, it will be an easy ride of two hours or so. The goal is mainly to spin the legs and make them ready for the evening. The ride will be followed by a gym session, which includes a circuit focused on speed. The goal of this workout is to engage the maximum number of muscle fibres working together.




3.5hr ride with long intervals


On the second day, the work on the bike becomes a little more specific. This is not a simple endurance ride or a steady-pace one. Instead, over a 3.5-hour ride, Peter will do four to six repetitions of 10 minutes at 85 per cent of his maximum aerobic power — not his FTP but rather his aerobic threshold (FTP indicates the anaerobic one). This aerobic power equates to around 60 to 70 per cent of his FTP.




4.5hr ride, including hills


This is the second endurance ride of the week.


It will be four to 4.5 hours long and will include two or three hills. Peter tackles each hill at 90 per cent of his maximum aerobic power. Again, the work done here is well below the FTP and even below the aerobic threshold, so it is an effort that’s sustainable for a long time. The hills will be 10 to 20 minutes long and the goal is to ride them at sweet-spot but no harder. It’s a nice, steady pace.




Recovery ride and gym session


Thursday will be the week’s recovery day. Recovery, in this case, doesn’t mean full rest, but active recovery. In the morning, Peter will have an easy coffee ride of 1.5 hours and in the afternoon he will hit the gym again, with the same programme as on Monday — the gym session is the most important part of the day’s training.




3.5hr ride, including short intervals


On Friday, the volume in the saddle rises again. Peter has three to 3.5 hours scheduled, including some short efforts. These workouts are aimed to boost his aerobic power. He will do two or three blocks consisting of 12 repetitions of one minute at 100-105 per cent of his max aerobic power, with two minutes’ rest in between. The goal is to introduce a small amount of intensity, pushing hard for short bursts. This is done on rolling hills.




Long ride


Saturday will be the longest endurance ride. The ride will be around four to five hours and will not have any specific workout within it. Peter needs that kind of freedom one or two days a week in order to ride with his friends and gruppetto. If he feels he needs to push on a bit, he will. Sometimes we add some torque efforts on the climbs, alternating three minutes at 50-60rpm and two minutes at 90rpm. This adds a strength element in an otherwise aerobic ride.




Rest day


It is important at this stage of the season that Peter rests at least one day a week, when he needs to take it easy, as we are working to re-activate his body. “During the rest day I try to sleep a little bit longer,” adds Sagan. “I’ll watch a movie on Netflix, read a little bit, and if possible play on the PlayStation.”


There you go – what are the takeaways. There’s no magic, even if you are the world champ. It’s all about work.


If you are new to Semi-Pro Cycling, check out the back catalogue of shows on all aspects of performance at or sign up for the Weekly Workout Stack – The guide that shows you how to structure your training week and use your training time more effectively, and I’ll also send you a best of our episodes straight to your inbox.


Alright, well, I’ll be back in 2 weeks. Thank for listening


The Facts

Hosted by Damian Ruse

Produced by Ciarán Mac Parland

Sound Engineer: Satyr Productions


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