Effect of altitude training on the aerobic capacity of athletes: A systematic review and meta-analysis

Purpose: With a growing number of athletes and coaches adopting altitude training, the importance for rationalizing and optimizing such training has been emphasized. We conducted a metaanalysis to evaluate the influence of altitude training on athletes' aerobic capacity and to explore the best altitude training method to improve this capacity. Methods: We searched Web of Science, SpringerLink, Science Direct, EBSCO, and PubMed databases combined with manual search of the references to collect studies indexed from 1979 to September 2020 on the effect of altitude training on athletes' aerobic capacity. Data from experimental studies that reported hemoglobin levels and maximum oxygen uptake in athletes before and after altitude training, or in athletes performing altitude training in comparison with a control group were analyzed. Data of the populations, intervention, comparison, outcomes and study design were extracted. Review Manager software 5.3 was used for bias evaluation. Results: 17 publications were included. In our meta-analysis, altitude training led to higher maximum oxygen uptake [standardized mean difference (SMD) = 0.67, 95% confidence interval (CI) 0.35-1.00, P < 0.001] and hemoglobin level (SMD = 0.50, 95% CI 0.11-0.90, P = 0.013) than training at lower altitude. The result of sensitivity analysis showed that results of metaanalysis were relatively stable, and there was no bias or change in the result of effect size according to the bias test. The results of subgroup analysis showed that high-altitude living and lowaltitude training ("Hi-Lo" regime), with a training cycle of about three weeks at an altitude around 2500 m, had better effects than other regimes on the athletes' aerobic capacity. Conclusions: Altitude training can improve athletes' aerobic capacity in terms of maximum oxygen uptake and hemoglobin level. Our results are limited by the number and quality of available studies. Therefore, more high-quality studies are needed to verify and extend these findings. Our study can provide scientific suggestions for the training of athletes.