Moderate altitude living (2,500m), combined with low altitude training (1,250m) (i.e. live high-train low), results in a significantly greater improvement in VO2max and performance over equivalent sea level training. Although the mean improvement in group response with this _high-low_ training model is clear, the individual response displays a wide variability. To determine the factors which contribute to this variability, 39 collegiate runners (27 M, 12 F) were retrospectively divided into Responders (n=17) and Non -Responders (n=15) to altitude training, based on the change in sea level 5,000m run time determined before and after 28 days of living at moderate altitude and training at either low or moderate altitude. In addition, 22 elite runners were examined prospectively to confirm the significance of these factors in a separate population. In the retrospective analysis, Responders displayed a significantly larger increase in erythropoietin concentration (EPO) after 30 hrs at altitude compared with Non-Responders. After 14 days at altitude, EPO was still elevated in Responders, but was not significantly different from sea level values in Non-Responders. The EPO response led to a significant increase in total red cell volume and VO2max in Responders; in contrast, Non-Responders did not show a difference in total red cell volume or VO2max after altitude training. Non -Responders demonstrated a significant slowing of interval training velocity at altitude, and thus achieved a smaller VO2 during those intervals, compared with Responders. The acute increase in EPO and VO2max was significantly higher in the prospective cohort of Responders, compared with Non-Responders to altitude training. Conclusion: after a 28 day altitude training camp, a significant improvement in 5,000m run performance is, in part, dependent on a) living at a high enough altitude to achieve a large acute increase in EPO, sufficient to increase the total red cell volume and VO2max; and b) training at a low enough altitude to maintain interval training velocity and O2 flux near sea level values.
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