The Effects of Intermittent Hypoxic Training Strategies on Maximal Oxygen Uptake in Healthy Humans: A Meta-analysis with Meta-regression.

Authors

Dario Kohlbrenner, Abdallah Ghaith, Joey Fournier, Charles Khouri, Antonin Bordas, Samarmar Chacaroun, Monique Mendelson, Patrice Flore, Mathieu Marillier, Julien Brugniaux, Jean-Louis Pépin, Renaud Tamisier, Samuel Verges

Published in

Sports medicine (Auckland, N.Z.). Sep 15, 2026. Epub Sep 15, 2026.

Abstract

Intermittent hypoxic training aims to enhance exercise performance and health, commonly assessed through maximal oxygen uptake (VO₂max). Currently applied methods are live-high train-low (LHTL), live-low train-high (LLTH) and passive hypoxic conditioning (PHC). However, within these methods, numerous modes of application exist, and effectiveness is debated.
To determine the effect of LHTL, LLTH and PHC on VO₂max in healthy participants, and identify factors associated with the amplitude of change in VO₂max.
We conducted a systematic review with random-effects meta-analysis and meta-regression. Studies were identified through PubMed, EMBASE and Web of Science. We included controlled studies, calculating between-group standardised mean differences. Athlete and non-athlete populations were analysed separately. RoB2 was used to assess study quality and publication bias was investigated with funnel plots and the Egger's test.
Of the 5244 identified studies, 62 were included for analysis, resulting in a sample size of 1332 participants (610 athletes, 722 non-athletes). LHTL increased VO₂max significantly more than control in athletes (mean difference [MD] = 2.17; 95% CI = 0.77, 3.56) but not in non-athletes (MD = 3.1; 95% CI =  - 0.23, 6.43). LLTH did not increase VO₂max significantly more than control in athletes (MD = 0.89; 95% CI =  - 0.27, 2.05) but it did in non-athletes (MD = 1.70; 95% CI = 0.85, 2.54). PHC did not increase VO₂max significantly more than control in athletes (MD =  - 1.07; 95% CI =  - 3.51, 1.37) but it did in non-athletes (MD = 2.26; 95% CI = 1.00, 3.52). Multivariate meta-regressions identified the severity, duration, and frequency of hypoxic exposure to be significantly associated with the change in VO₂max.
LHTL showed a significant effect on VO₂max in athletic populations while LLTH and PHC showed a significant effect on VO₂max in non-athletic populations only. Future studies should target investigating which characteristics (e.g. severity, duration) of the hypoxic exposure are most beneficial.

PMID:
42742930
Bibliographic data and abstract were imported from PubMed on 16 Sep 2026.

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