Point: positive effects of intermittent hypoxia (live high:train low) on exercise performance are mediated primarily by augmented red cell volume.

@article{Levine2005PointPE,
  title={Point: positive effects of intermittent hypoxia (live high:train low) on exercise performance are mediated primarily by augmented red cell volume.},
  author={Benjamin D. Levine and J. Stray-gundersen},
  journal={Journal of applied physiology},
  year={2005},
  volume={99 5},
  pages={
          2053-5
        }
}
To engage in this debate we will address the following questions: what is the change in performance after adaptation to living high and training low (LHTL); what physiological mechanisms could be responsible; what is the evidence that a change in red cell volume (RCV) is one such mechanism; and what 
Comment on Point:Counterpoint "positive effects of intermittent hypoxia (live high:train low) on exercise performance are/are not mediated primarily by augmented red cell volume".
The following letter is in response to the Point:Counterpoint series “Positive effects of intermittent hypoxia (live high:train low) on exercise performance are/are not mediated primarily by
Comments on Point:Counterpoint "Positive effects of intermittent hypoxia (live high:train low) on exercise performance are/are not mediated primarily by augmented red cell volume".
  • T. Noakes
  • Medicine
    Journal of applied physiology
  • 2005
The following letters are in response to the Point:Counterpoint series “Positive effects of intermittent hypoxia (live high:train low) on exercise performance are/are not mediated primarily by
Commentary on Point-Counterpoint
This letter is in response to the Point:Counterpoint series “Positive effects of intermittent hypoxia (live high:train low) on exercise performance are/are not mediated primarily by augmented red
Impact of Alterations in Total Hemoglobin Mass on V˙O2max
TLDR
Training and hypoxia-associated changes in maximal oxygen uptake are mediated by different blood adaptations, which mimics the altitude effects, however, by far exceeding its magnitude.
Live high + train low: thinking in terms of an optimal hypoxic dose.
TLDR
This review examines the issue of what the optimal hypoxic dose is that is needed to facilitate altitude acclimatization and produce the expected beneficial physiological responses and sea-level performance effects by addressing the following questions.
Live high + train low: thinking in terms of an optimal hypoxic dose.
  • R. L. Wilbur
  • Medicine
    International journal of sports physiology and performance
  • 2007
TLDR
It appears that for athletes to derive the hematological benefits of LH+TL while using natural/terrestrial altitude, they need to live at an elevation of 2000 to 2500 m for =4 wk for =22 h/d.
Sea-Level Exercise Performance Following Adaptation to Hypoxia
TLDR
It is concluded that natural LHTL currently provides the best protocol for enhancing endurance performance in elite and subelite athletes, while some artificial protocols are effective in subelites and erythropoietic and other physiological mediators provided little additional insight into mechanisms.
The role of haemoglobin mass on VO2max following normobaric ‘live high–train low’ in endurance-trained athletes
TLDR
The present results suggest that LHTL has no positive effect on VO2max in endurance-trained athletes because (i) muscle maximal oxidative capacity is not improved following L HTL and (ii) erythrocyte volume expansion after LHTl, if any, is too small to alter O2 transport.
Heat Versus Altitude Training for Endurance Performance at Sea-Level.
TLDR
Data is reviewed in support of the novel hypothesis, which proposes altitude as the preferred environmental training stimulus for elite endurance athletes preparing to compete in temperate, sea-level climates (5-18°C).
The impact of hypoxia on aerobic exercise capacity
TLDR
It is concluded that hypoxic pulmonary vasoconstriction may contribute to the reduced VO2max in acute hypoxia potentially by increasing right ventricular afterload and thereby attenuating cardiac output.
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References

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Effect of high-intensity hypoxic training on sea-level swimming performances
The objective of this study was to test the hypothesis that high-intensity hypoxic training improves sea-level performances more than equivalent training in normoxia. Sixteen well-trained collegiat...
Live high:train low increases muscle buffer capacity and submaximal cycling efficiency.
TLDR
Reduced VO2 during normoxic exercise after LHTL suggests that improved exercise efficiency is a fundamental adaptation to L HTL, and is the first study to show that hypoxic exposure, per se, increases muscle buffer capacity.
Effects of live high, train low hypoxic exposure on lactate metabolism in trained humans.
TLDR
It is concluded that 20 consecutive nights of hypoxia exposure decreased whole body Ra during intense exercise in well-trained athletes and muscle markers of lactate metabolism and pH regulation were unchanged by the LHTL intervention.
Effect of intermittent hypoxia on oxygen uptake during submaximal exercise in endurance athletes
TLDR
The results from the present study suggest that the enhanced running economy resulting from intermittent hypoxia could, in part, contribute to improved endurance performance in trained athletes.
Intermittent normobaric hypoxia does not alter performance or erythropoietic markers in highly trained distance runners.
TLDR
Four weeks of a 5:5-min normobaric hypoxia exposure at rest for 70 min, 5 days/wk, is not a sufficient stimulus to elicit improved performance or change the normal level of erythropoiesis in highly trained distance runners.
Altitude and endurance training
TLDR
Exposure to hypoxia appears to have some positive transfer effects on subsequent training in normoxia during and after HiLo, thereby increasing the potential to improve some neuromuscular and cardiovascular determinants of endurance performance.
Intermittent hypoxia improves endurance performance and submaximal exercise efficiency.
TLDR
It is suggested that intermittent hypoxia at rest could improve endurance performance and submaximal exercise efficiency at sea level in trained endurance athletes, but these improvements are not maintained after the cessation of intermittent Hypoxia for 3 weeks.
An evaluation of the concept of living at moderate altitude and training at sea level.
TLDR
It is concluded that sleeping in moderate hypoxia (2650-3000 m) for up to 23 days may offer practical benefit to elite athletes, but that any effect is not likely due to increased Hb(mass) or VO2max.
Intermittent hypoxic training: fact and fancy.
  • B. Levine
  • Medicine
    High altitude medicine & biology
  • 2002
TLDR
The primacy of the altitude acclimatization effect in IHT is demonstrated by the following facts: living high-training low clearly improves performance in athletes of all abilities, and the mechanism of this improvement is primarily an increase in erythropoietin, leading to increased red cell mass, V(O2max), and running performance.
A practical approach to altitude training: where to live and train for optimal performance enhancement.
TLDR
For performance at altitude, acclimatization and/or hypoxic exercise is preferable; for performance at sea level, living at altitude (acclimatization) with sea level training may be the optimal strategy.
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