The physiological response to submaximal and maximal exercise was assessed in lowlanders and Tibetans at low (500 m above sea level) and high altitude (HA, 3,680 m). The times spent at HA by the lowland migrators was 8 days (n = 60), 7 months (n = 60, same group), 15 months (n = 29) and 27 months (n = 29). After the 15-month stay at HA, the maximal oxygen uptake (VO2max) and maximal heart rate of the lowland migrators almost reached those of the HA native residents (Tibetans, n = 57), but their total work capacity and the gross efficiency (eta) of mechanical work remained lower than those of the Tibetans. The rate of VO2max achieved at 90 W by the Tibetans was lower than that of the lowland migrators. It was concluded that, at HA, the lowlanders regained much of the aerobic capacity which they had lost initially. However, they did not attain the same gross mechanical efficiency as the Tibetans, who seemed to be at an advantage in respect of work at HA.