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The Actual Science Of Altitude Training With John Wakefield – What Works And What Doesn’t

by | Nov 14, 2022 | Training Insights, Bike, Sports, Training

Altitude training and exposure is becoming ever more important in today’s times of training application. Coach John Wakefield gets to the truth of the matter.

How Altitude Training Can Benefit You

Altitude training and exposure is becoming ever more important in today’s times of training application as it has significant benefits which include a reduction in lactate build up, increase in aerobic capacity or V02Max, and an increase in the muscle protein myoglobin. 

The most common benefit when anyone thinks about altitude, is the increase in erythropoietin or EPO. This is the hormone that stimulates red blood cell production. Having a prolonged decreased partial pressure of oxygen stimulates the kidneys to produce erythropoietin (EPO). EPO then stimulates the marrow in the long bones to produce more red blood cells and therefore increases blood volume and oxygen carrying capacity, thereby enhancing cycling performance as the end result.

While this sounds all easy, like you just packing your bag to stay at altitude and come back having a significant gain, there are a few protocols, durations and locations that will need to be considered before heading off and leaving the kids to the Mrs (or vice versa) for a few days.

“In South Africa I often hear riders say, “We are going on an altitude camp for the week to Graskop” Sure, it’s a good training area and Harries pancakes are great, but it’s just under 1500m and 5-7 days does nothing in the way of adaptation from altitude.”

Individual Response to Altitude Training

An important factor to consider is whether or not you are a responder to altitude. By this I mean, does your body adapt and respond in a positive manner or does your body not respond well to altitude? Not everyone is a responder and if not, this can and often lead to negative physiological gains and even result in an athlete detraining. If this is the case, it’s better to not go to altitude and rather do your quality training where the air is thick. 

Altitude Training On The Stelvio Pass
John Wakefield and Team UAE Riders altitude training on the iconic Stelvio Pass

Training Or Sleeping At Altitude

Next, one must consider if you are going to only train or only sleep at altitude? Or are you going to both train and sleep at altitude? As the research has highlighted, these are all critically important components of designing an altitude training block. The primary models which have been investigated include:

  • Live High, Train High (LHTH)
  • Live Low, Train High (LLTH) 
  • Live high, Train Low (LHTL)

(High = at altitude)

While I am not going to go into each one of these in detail, I will go into the most common of the options being:

Live high, Train Low (LHTL)

This is a common and favored method of altitude training and it’s pretty simple – the lower the altitude the more oxygen the air contains. Yes, at an altitude of 2000m+ there is oxygen in the air, but it is less compressed and therefore makes it harder to breathe; this makes it harder to produce power while training or racing at high altitude. While you benefit from the physiological response of erythropoietin production for one, your muscles will detrain at altitude. Where you win you also lose.

By going lower to train, you are still able to train at maximal capacity at a lower altitude or even at sea level where possible.

A classical study by Levine and Gundersen compared the LHTL model to the LHTH and Live Low, Train Low models. 

The results demonstrated far greater performance benefits to LHTL. The LHTL model demonstrated increases in VO2 max, exercise performance, red blood cell and haemoglobin mass. A further study proposed further benefit to performing all “base” training sessions at altitude and only very hard interval sessions at or near to sea level. 

Now that we have that out the way, location and durations are important due to altitude. 

How High Should I Be And For How Long?

In South Africa I often hear riders say, “We are going on an altitude camp for the week to Graskop” Sure, it’s a good training area and Harries pancakes are great, but it’s just under 1500m and 5-7 days does nothing in the way of adaptation from altitude.

Stimulus at altitude starts after 10 days from above 2000m but no higher than 3000m and no more than 21 days. For me personally with athletes, 16-17 days has returned good overall adaptations, on some athletes the extra week into 21 days sees a drop off in performance and values.

Going above 3000m, we have found impacts on sleep and recovery in a negative manner. For me, being at a camp at 2800m, I was having the most incredible dreams; it was out of this world!

In South Africa this is a hard find unless you go into Lesotho, however at the start of 2020 we had come over from Europe to benefit from the South African summer and spent 3 weeks in Clarens. Yes, this is 1800m, but we stayed a little longer in duration and did time across the border into Lesotho.

Lesotho Is A Great Place For Altitude Training
Lesotho is the only place in and around South Africa where you can get realistic altitude exposure. (c) Jared Paisley

When Should I Get high?

With that all out the way, timing of the altitude exposure into your race or target event is important. The effects or window of the adaptations last 3 weeks when done correctly. However, you feel good the 1st 2- or 3-days post exposure and sometimes a week once you return. In the shorter time with day 4/5 bringing on feelings of fatigue. In some cases, even falling ill for the athlete.

Once these sensations are past, the athlete will have another window period of 2 sometimes 3 weeks of good effects. This should benefit an athlete doing a 3-week racing block or Tour for example. 

“Power production or producing power at altitude will always feel harder, often in training logic, people think the harder your training is the better it is for you (especially from the JHB Engen to Engen group.)“

Other Factors To Consider

There are additional factors to be considered when going to train at altitude, adaptation to altitude, intensity of training, supplementation and duration to name a few.

Taking this into consideration you need to factor in 3 days of adaptation when you arrive. You cannot simply go out on day 1 and smash it with intensity. This will have a negative effect and put you at a deficit for the remainder of your time.


The body will excrete water for the first 72 hours. This results in lowered fluid volume in the blood, which in turn results in an inefficient cardiovascular system. This limits your maximum cardiac output, and can result in increased breathlessness and heart rate for the same level of exertion. After 72 hours, your liver begins to produce an additional blood protein, which progressively restores the blood volume to pre-altitude levels in and around day 6-7.

Monitoring Blood Oxygen

Ways of monitoring would be to use a Pulse Oximetry Meter; this is a non-invasive tool that would attach to your finger. This reads the wavelengths of light reflected from the blood. Once values return to normal it would read between 96-100%. 

Pulse Oximetry Meter For Altitude Training
Pulse Oximetry Meter

Another or additional method would be to do a blood count. This would be done before arrival at altitude. Follow up testing would be done at the end of each week or every 7 days with the last count done on the final day. This is not always the easiest to do in terms of locating a clinic or hospital in the area you are at.

Iron Absorption and Supplementation

An additional reason for the blood monitoring is that Iron absorption is poor at altitude and therefore supplementation is important. 1.5-2 weeks before arriving at altitude, 90mg of Iron supplement to start is sufficient and then increasing to 100mg a day. 100mg is enough to prevent ferritin dropping massively but there is still a drop. 
Often you would think more is better, so 200mg would be better? It was found in a recent study that there was no difference in haemoglobin concentration after altitude between 100mg and 200mg of Iron supplementation. However, with no Iron supplementation the value was much lower.

Take away info is that if you arrive at altitude with insufficient iron levels/stores your body won’t be able to produce the much needed red blood cells. Further from that, an athlete may even become anaemic.

Iron Absorption Data
Iron Absorption Data

Carbohydrate Intake

Making sure that your carbohydrate intake is also taken note of, when at altitude the body’s carbohydrate metabolism will increase yet slow down the fat metabolism. This is often seen when athletes return from bouts of altitude very lean.

Monitoring Your Carbohydrate Intake Is Important When Altitude Training
Monitoring your Carbohydrate intake is important when altitude training. (c) Craig Kolesky

How Hard You Should Train At Altitude

Power production or producing power at altitude will always feel harder, often in training logic, people think the harder your training is the better it is for you (especially from the JHB Engen to Engen group.) When at altitude this may not be the stimulus or gains are made and as mentioned earlier in the article this can lead to de-training. 

When at altitude camp locations, I use and implement a table based off of the athlete’s Functional Threshold Power (FTP) at sea level. This is derived from the studies of Bassett.1 and Peronett.2

These equations from Bassett et al.1 were generated from four groups of highly trained or elite runners, this is obviously population-specific to that group. However, this estimate can be used for aerobic power at a given altitude. This, as a percentage y of what is normally available at sea level, where x = elevation above sea level in km.

for acclimatised athletes (several weeks at altitude): y = -1.12×2 – 1.90x + 99.9 (R2 = 0.973

non-acclimatized athletes (1-7 days at altitude): y = 0.178×3 – 1.43×2 – 4.07x + 100 (R2 = 0.974)

Where Peronnett et al.2 had found the following formula 

y = -0.003×3 + 0.0081×2 – 0.0381x + 1

At Science to Sport, the following table has been created and implemented when athletes go to altitude.

The Actual Science Of Altitude Training With John Wakefield - What Works And What Doesn'T
Altitude Training Table

In a typical 1st week I would prescribe to an athlete in their 1st week would like the following: (please consider your own personal level, and adjust the hours accordingly)
Easy riding the 1st 3 days and then from day 5 you can have your 1st key session.

The Actual Science Of Altitude Training With John Wakefield - What Works And What Doesn'T
Altitude Training Block Plan

From the 1st week you can then carry-on training as per normal. Good blocks of training with adequate recovery would be 2 days on with work and 1-day recovery or 3 days on with work and 1 off day recovery. Personally, I prefer the 2 days on 1 day recovery and no maximal efforts during training unless you can go down as low as possible below 1000m. 

Is Altitude Training Worth It? 

I often get asked the advantages of altitude training and if it is good to include into an annual plan for the athlete’s season. This is dependent on the athlete, their level, and goals. If you are World Tour or athlete on a similar level or going to win the Cape Epic for example, it’s a disadvantage if you don’t go, I think. 

In closing I hope this answers the thoughts and questions you have about altitude, its ins and outs, and helps you be able to prepare specifically going forward!

John Wakefield is a director at Science2Sport. In addition, John works as Head of Coaching and Performance Co-ordinator for UAE Team Emirates World Tour Cycling. With a successful history in motocross, his cycling focus has carried over and found success in a World Championship Title, World Tour and World Cup wins and Multiple National Titles

The Actual Science Of Altitude Training With John Wakefield - What Works And What Doesn'T
Coach John Wakefield. PC: Phot Fizza / Team UAE Emirates

Post Tags: Altitude Training, Cycling Training, John Wakefield, Running Training, ScienceToSport

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