This study examined effects of low altitude training and a live-high: train-low protocol (combining both natural and simulated modalities) on haemoglobin mass (Hb_mass), maximum oxygen consumption (VO_2max), time to exhaustion, and submaximal exercise measures. Eighteen elite-level race-walkers were assigned to one of two experimental groups; lowHH (low Hypobaric Hypoxia: continuous exposure to 1380 m for 21 consecutive days; n = 10) or a combined low altitude training and nightly Normobaric Hypoxia (lowHH+NHnight: living and training at 1380 m, plus 9 h.night^-1 at a simulated altitude of 3000 m using hypoxic tents; n = 8). A control group (CON; n = 10) lived and trained at 600 m. Measurement of Hb_mass, time to exhaustion and VO_2max was performed before and after the training intervention. Paired samples t-tests were used to assess absolute and percentage change pre and post-test differences within groups, and differences between groups were assessed using a one-way ANOVA with least significant difference post-hoc testing. Statistical significance was tested at p < 0.05. There was a 3.7% increase in Hb_mass in lowHH+NHnight compared with CON (p = 0.02). In comparison to baseline, Hb_mass increased by 1.2% (±1.4%) in the lowHH group, 2.6% (±1.8%) in lowHH+NHnight, and there was a decrease of 0.9% (±4.9%) in CON. VO_2max increased by ~4% within both experimental conditions but was not significantly greater than the 1% increase in CON. There was a ~9% difference in pre and post-intervention values in time to exhaustion after lowHH+NH-night (p = 0.03) and a ~8% pre to post-intervention difference (p = 0.006) after lowHH only. We recommend low altitude (1380 m) combined with sleeping in altitude tents (3000 m) as one effective alternative to traditional altitude training methods, which can improve Hb_mass.

• In some countries, it may not be possible to perform classical altitude training effectively, due to the low elevation at altitude training venues. An additional hypoxic stimulus can be provided by simulating higher altitudes overnight, using altitude tents.

• Three weeks of combined (living and training at 1380 m) and simulated altitude exposure (at 3000 m) can improve haemoglobin mass by over 3% in comparison to control values, and can also improve time to exhaustion by ~9% in comparison to baseline.

• We recommend that, in the context of an altitude training camp at low altitudes (~1400 m) the addition of a relatively short exposure to simulated altitudes of 3000 m can elicit physiological and performance benefits, without compromise to training intensity or competition preparation. However, the benefits will not be greater than conducting a traditional altitude training camp at low altitudes