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Since 2012, Lundby and Robach1–3 have consistently stated that ‘altitude training does not convincingly increase exercise performance and should not be recommended to elite (endurance) athletes’.2 This research group suggests3 that altitude training and particularly ‘live high–train low (LHTL) may only increase total haemoglobin mass (Hbmass) [and possibly maximal oxygen consumption (VO2max)] in athletes with an initial low Hbmass value’. This statement comes from the analysis of nine selected studies4–12 on the relationship between group mean pre-LHTL value of Hbmass and increase in Hbmass after LHTL.3 The inverse correlation (r=−0.86; P<0.01) between initial Hbmass value and percentage increase in Hbmass would suggest that athletes starting an intervention with high relative Hbmass levels have smaller chances to further increase their relative Hbmass following altitude training. The rationale behind was that those athletes had already maximised their Hbmass level by training at sea level.3
We have concerns that this statement does not seem to be supported by several other studies,13–21 done by well-respected research groups, using what are widely considered to be best-practice techniques and protocols. These studies with outcomes conflicting with works of Lundby and Robach1–3 include those with shorter time course13 14 or lower hypoxic exposures15 16 to moderate altitude (2500–3000 m), which showed Hbmass increases ranging between 2.1% and 3.7%. In fact, Lundby and Robach’s own work has shown a +5% Hbmass improvement after 17 days of altitude training in five male cross-country skiing Olympic medallists with already high initial value of 13.5 g/kg.1
However, the most problematic issue of this flawed analysis3 is that conclusions appear to rely on Hbmass measures that may be inaccurate. Indeed, three4 8 11 out of nine studies used for …
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