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Tomazin, K, Strojnik, V, Feriche, B, Garcia Ramos, A, Štrumbelj, B, and Stirn, I. Neuromuscular adaptations in elite swimmers during concurrent strength and endurance training at low and moderate altitudes. J Strength Cond Res36(4): 1111–1119, 2022—This study evaluated neuromuscular adaptations in elite swimmers during concurrent strength and endurance training (SET) at low (295 m) and moderate (2,320 m) altitudes. Sixteen elite swimmers took part in a 3-week SET during a general preparation phase. All neuromuscular tests were performed a week before and after a SET. In posttraining, maximal knee isometric torque (TMVC) and soleus H-reflex remained statistically unchanged for sea-level (SL) and for altitude (AL) training. Rate of torque development (RTD) decreased post-SL (−14.5%; p< 0.01) but not post-AL (−4.7%; p> 0.05) training. Vastus lateralis electromyographic (EMG) activity during RTD decreased post-SL (−17.0%; P= 0.05) but not post-AL (4.8%; p> 0.05) training. Quadriceps twitch torque (TTW) significantly increased post-AL (12.1%; p< 0.01) but not post-SL (−1.0%; p> 0.05; training × altitude: F1,15= 12.4; p< 0.01) training. Quadriceps twitch contraction time and M-wave amplitude remained statistically unchanged post-SL and post-AL training. After SL training, increment in TMVCwas accompanied with increment in vastus lateralis EMG (R= 0.76; p< 0.01) and TTW(R= 0.48; p< 0.06). Posttraining in AL, increment in TMVCwas accompanied with increment in TTW(R= 0.54; p< 0.05). Strength and endurance training at altitude seems to prompt adaptations in twitch contractile properties. In contrast, SET performed at SL may hamper the magnitude of neural adaptations to strength training, particularly during rapid voluntary contractions. In conclusion, SET at AL might benefit muscular adaptations in swimmers compared with training at SL.