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Yet, as many as 67% of medalists in the 2020 men's and women's Olympic marathon, and 100% of medalists in the 2020 men's and women's Olympic 5000\u00a0m track race may have been born or raised above this otherwise rare threshold. As a possible explanation, research spanning nearly a quarter of a century demonstrates that indigenous highlanders exhibit pulmonary adaptations distinct from their lowland counterparts. These adaptations may then promote endurance performance. Indeed, healthy indigenous highlanders often exhibit a larger aerobic exercise capacity compared to sea\u2010level residents who travel to high altitude. However, questions remain on whether high\u2010altitude birth is advantageous for sea\u2010level competitions. In this review, we ask whether being born at a high altitude generates an ergogenic advantage for endurance performance in the Summer Olympics\u2014a venue that is generally held at sea level. In so doing, we distinguish between three groups of high\u2010altitude residents: (i) the indigenous highlander, (ii) the highland newcomer, and (iii) the highland sojourner. Concentrating specifically on altitude\u2010induced alterations to pulmonary physiology beginning in the perinatal period, we propose that if altitude\u2010related maladaptations are avoided, genomic and developmental alterations accompanying highland birth may present benefits for endurance competitions at sea level.<\/jats:p>","DOI":"10.1113\/ep091830","type":"journal-article","created":{"date-parts":[[2024,11,22]],"date-time":"2024-11-22T13:38:42Z","timestamp":1732282722000},"page":"1625-1638","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Born high, born fast: Does highland birth confer a pulmonary advantage for sea level endurance?"],"prefix":"10.1113","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4153-7053","authenticated-orcid":false,"given":"Hunter L.","family":"Paris","sequence":"first","affiliation":[{"name":"Division of Natural Sciences Pepperdine University  Malibu California 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