Siebenmann C, Robach P, Jacobs RA, Rasmussen P, Nordsborg N, Diaz V, Christ A, Olsen NV, Maggiorini M, Lundby C. "Live high-train low" using normobaric hypoxia: a double-blinded, placebo-controlled study. J Appl Physiol 112: 106 -117, 2012. First published October 27, 2011 doi:10.1152/japplphysiol.00388.2011The combination of living at altitude and training near sea level [live high-train low (LHTL)] may improve performance of endurance athletes. However, to date, no study can rule out a potential placebo effect as at least part of the explanation, especially for performance measures. With the use of a placebo-controlled, double-blinded design, we tested the hypothesis that LHTL-related improvements in endurance performance are mediated through physiological mechanisms and not through a placebo effect. Sixteen endurance cyclists trained for 8 wk at low altitude (Ͻ1,200 m). After a 2-wk lead-in period, athletes spent 16 h/day for the following 4 wk in rooms flushed with either normal air (placebo group, n ϭ 6) or normobaric hypoxia, corresponding to an altitude of 3,000 m (LHTL group, n ϭ 10). Physiological investigations were performed twice during the lead-in period, after 3 and 4 wk during the LHTL intervention, and again, 1 and 2 wk after the LHTL intervention. Questionnaires revealed that subjects were unaware of group classification. Weekly training effort was similar between groups. Hb mass, maximal oxygen uptake (VO 2) in normoxia, and at a simulated altitude of 2,500 m and mean power output in a simulated, 26.15-km time trial remained unchanged in both groups throughout the study. Exercise economy (i.e., VO 2 measured at 200 W) did not change during the LHTL intervention and was never significantly different between groups. In conclusion, 4 wk of LHTL, using 16 h/day of normobaric hypoxia, did not improve endurance performance or any of the measured, associated physiological variables.altitude; LHTL; performance; training OVER THE PAST FIVE DECADES, endurance athletes have attempted to improve sea-level performance by means of altitude training. In the early 1990s, Levine and Stray-Gundersen (36) introduced the "live high-train low" (LHTL) strategy, where athletes reside and spend the majority of the day at moderate altitude while training closer to sea level. This paradigm aims for athletes to benefit from physiological adaptation to hypoxia, while avoiding the detrimental impact of hypoxia on high-intensity endurance training. After an initial study had provided results indicating that LHTL enhances aerobic performance in competitive runners (34), a bulk of follow-up studies confirmed these benefits across a variety of endurance disciplines (7,50,57,59). None of them, however, used a double-blinded design, and thus it cannot be ruled out that the observed effects, especially on performance measures, were, at least in part, mediated by a placebo effect (11, 56). Our main aim with this study was therefore to investigate the effect of LHTL in a double-blinded, placebo-controlled study.A further aim was t...