Introduction: Based on available scientific literature, training at natural altitude has failed so far to prove useful for the enhancement of sea level performance in swimmers 1, 2. This controlled nonrandomised four parallel groups trial examined the effects on performance, oxygen transport and total hemoglobin mass (tHbmassl of four training interventions: terrestrial living high-training high for 3 or 4 weeks (Hi-Hi3, Hi-Hi), living high-training high/low (Hi-Hilo), and living and training at sea level for 4 weeks (Lo-Lo). Methods: From 65 elite swimmers, 54 met all inclusion criteria and completed sea-level time trials over 50 and 400 m front crawl (TTSO, TT400), and 100 (sprinters) or 200 m (non-sprinters) at best personal stroke (TT100/TT200). VO2max was measured on an incremental 4x200-m front crawl test. Training load was estimated using TRIMP and session RPE assessment. Initial performance and measures (PRE) were repeated immediately after the camp (POST) and once weekly on return to SL during 4 weeks. tHbmass was measured in duplicate at PRE and once a week during the camp. Intervention effects were analysed using mixed linear modelling. Results: TI100 or TT200 improved by ~3.5% regardless of living or training at sea level or at altitude, but Hi-Hilo improved more two (5.3±1.6%) and four weeks (6.3±1.9%) after the intervention as compared to the other groups. Hi-Hilo and Hi-Hi improved more in TI400 (4.6±1.4% and 3.3±1.4%, respectively). There were no changes in VO2max in any of the groups after the intervention. tHbmass increased in Hi-Hi (6.2±2.6%) and Hi-Hi3 (3.8±5.6%), whereas no significant changes were noted in HiHila (1.3±4.3%). Conclusions: Hi-Hilo is an effective strategy to enhance performance in elite swimmers over a range of distances, clearly exceeding the smallest worthwhile enhancement effect for Olympic-standard swimmers (0.8-1%) 3 . This substantial performance improvement was not linked to changes in VO2max or tHbmass, hence could not be attributed to enhanced oxygen transport capacity.
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