A novel mixed living high training low intervention and the hematological module of the athlete biological passport

Research output: Contribution to journalArticlepeer-review


  • Sven Voss
  • Khalifa Al-Hamad
  • Waseem Samsam
  • Anissa Cherif
  • Costas Georgakopoulos
  • Mohammed Al Maadheed
  • Pierre-Edouard Sottas
  • Mathew Wilson
  • Nathan Townsend

Colleges, School and Institutes

External organisations

  • Anti-Doping Laboratory Qatar, Doha, Qatar
  • CoreMedica Campus Biotech Geneva, Switzerland
  • Aspetar Orthopaedic and Sports Medicine Hospital


Exposure to either natural or simulated hypoxia induces hematological adaptations that may affect the parameters of the Athlete Biological Passport (ABP). The aim of the present study was to examine the effect of a novel, mixed hypoxic dose protocol on the likelihood of producing an atypical ABP finding. Ten well-trained middle-distance runners participated in a “live high, train low and high” (LHTLH) altitude training camp for 14 days. The participants spent ˜6 hr.d-1 at 3000–5400 m during waking hours and ˜10 h.d-1 overnight at 2400–3000 m simulated altitude. Venous blood samples were collected before (B0), and after 1 (D1), 4 (D4), 7 (D7), and 14 (D14) days of hypoxic exposure, and again 14 days post exposure (P14). Samples were analyzed for key parameters of the ABP including reticulocyte percentage (Ret%), hemoglobin concentration ([Hb]), and the OFF-score. The ABP adaptive model was administered at a specificity of 99% to test for atypical findings. We found significant changes in [Hb] and Ret% during the hypoxic intervention. Consequently, this led to ABP threshold deviations at 99% specificity in three participants. Only one of these was flagged as an “atypical passport finding” (ATPF) due to deviation of the OFF-score. When this sample was evaluated by ABP experts it was considered “normal”. In conclusion, it is highly unlikely that the present hypoxic exposure protocol would have led to a citation for a doping violation according to WADA guidelines.


Original languageEnglish
Pages (from-to)323-330
Number of pages8
JournalDrug Testing and Analysis
Issue number3
Early online date30 Dec 2019
Publication statusPublished - Mar 2020


  • altitude, athlete biological passport, hematological module, hypoxia