ALTITUDE TRAINING IN ENDURANCE ATHLETES: PHYSIOLOGICAL ADAPTATIONS, TRAINING MODELS, AND CLINICAL RISKS
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5888Keywords:
Altitude Training; Hypoxic Training; Haemoglobin Mass; Erythropoietin; VO₂max; Endurance PerformanceAbstract
Background and Objectives: Altitude training is widely used by endurance athletes to improve aerobic performance through haematological and non-haematological adaptations. Optimal training models and determinants of individual response remain debated. The aim of this review is to summarise current evidence on the physiological adaptations, training models, and clinical risks associated with altitude training in adult endurance athletes.
Methods: Literature from 2019 to 2025 was reviewed using PubMed/MEDLINE, Google Scholar, Scopus, and Web of Science. A total of 42 sources were included.
Key Findings: Altitude training at ≥2000 m for ≥3 weeks consistently increases haemoglobin mass and haemoglobin concentration, an effect replicated across multiple randomised trials [1, 6]. Improvements in VO₂max are variable and not always statistically significant [6]. Living at altitude while training at lower elevation has the strongest evidence base among available models [14]. Iron status critically moderates the response: athletes with low pre-camp ferritin show blunted adaptations regardless of altitude dose [7]. Sex differences in hypoxic physiology remain an important and understudied area [8, 19].
Conclusions: Altitude training, when properly implemented, is one of the more reliable tools available to endurance athletes. The data supports its use, but only if iron status is optimized beforehand, protocols are personalized to the individual, and clinical risks are managed carefully. More standardized studies are still required, especially in female athletes.
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Copyright (c) 2026 Nikola Murawska, Aleksandra Iga Pociej, Natalia Lewińska, Aneta Synakiewicz, Weronika Olech, Wiktor Kowalczyk, Julia Kępska, Kamil Wójcik, Arina Drobashko, Karina Brzózka
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