The physiological rationale for altitude training is discussed in the article. Acclimatisation to high altitude is accompanied by increases in haematocrit and haemoglobin concentrations, primarily due to a reduction in plasma volume but also to increased erythropoiesis as a result of enhanced erythropoietin release. Owing to the reduction of training load during acclimatisation, maximal aerobic capacity is not necessarily enhanced after high altitude training. However, the increase in the blood lactate concentration during standardised submaximal work has been shown to be significantly reduced--reflecting improved ability to exercise at higher submaximal workloads, as compared with previous ability at lower altitudes. An increase in buffer capacity may be responsible. The importance of a reduced training load and individualised control of training intensity during the acclimatisation period is emphasised. This control takes the form of regular heart rate monitoring and comparison of the blood lactate concentration during training sessions with the individual's pre-established 'lactate profile'. The Norwegian Altitude training project, including the various routines, procedures and problems involved in three successive sojourns at moderate altitudes, is briefly discussed. Finally, a practical approach to altitude training is presented--dealing with training control, iron demand, nutritional advice, fluid intake and recovery. Only top athletes should be selected for training at high altitudes.