Intended for healthcare professionals


Effect of altitude on physiological performance: a statistical analysis using results of international football games

BMJ 2007; 335 doi: (Published 20 December 2007) Cite this as: BMJ 2007;335:1278
  1. Patrick E McSharry, Royal Academy of Engineering research fellow
  1. 1Systems Analysis, Modelling, and Prediction Group, Department of Engineering Science, University of Oxford, Oxford OX1 3PJ
  1. patrick{at}
  • Accepted 16 October 2007


Objective To assess the effect of altitude on match results and physiological performance of a large and diverse population of professional athletes.

Design Statistical analysis of international football (soccer) scores and results.

Data resources FIFA extensive database of 1460 football matches in 10 countries spanning over 100 years.

Results Altitude had a significant (P<0.001) negative impact on physiological performance as revealed through the overall underperformance of low altitude teams when playing against high altitude teams in South America. High altitude teams score more and concede fewer goals with increasing altitude difference. Each additional 1000 m of altitude difference increases the goal difference by about half of a goal. The probability of the home team winning for two teams from the same altitude is 0.537, whereas this rises to 0.825 for a home team with an altitude difference of 3695 m (such as Bolivia v Brazil) and falls to 0.213 when the altitude difference is −3695 m (such as Brazil v Bolivia).

Conclusions Altitude provides a significant advantage for high altitude teams when playing international football games at both low and high altitudes. Lowland teams are unable to acclimatise to high altitude, reducing physiological performance. As physiological performance does not protect against the effect of altitude, better predictors of individual susceptibility to altitude illness would facilitate team selection.


  • Funding: This research was supported by the Royal Academy of Engineering and the Engineering and Physical Sciences Research Council (EPSRC) through the funding of a research fellowship.

  • Competing interests: None declared.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

  • Accepted 16 October 2007
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