Hemoglobin Mass and Aerobic Performance at Moderate Altitude in Elite Athletes

Recommendations for Women in Mountain Sports and Hypoxia Training/Conditioning

The (patho-)physiological responses to hypoxia are highly heterogeneous between individuals. In this review, we focused on the roles of sex differences, which emerge as important factors in the regulation of the body's reaction to hypoxia. Several aspects should be considered for future research on hypoxia-related sex differences, particularly altitude training and clinical applications of hypoxia, as these will affect the selection of the optimal dose regarding safety and efficiency. There are several implications, but there are no practical recommendations if/how women should behave differently from men to optimise the benefits or minimise the risks of these hypoxia-related practices. Here, we evaluate the scarce scientific evidence of distinct (patho)physiological responses and adaptations to high altitude/hypoxia, biomechanical/anatomical differences in uphill/downhill locomotion, which is highly relevant for exercising in mountainous environments, and potentially differential effects of altitude training in women. Based on these factors, we derive sex-specific recommendations for mountain sports and intermittent hypoxia conditioning: (1) Although higher vulnerabilities of women to acute mountain sickness have not been unambiguously shown, sex-dependent physiological reactions to hypoxia may contribute to an increased acute mountain sickness vulnerability in some women. Adequate acclimatisation, slow ascent speed and/or preventive medication (e.g. acetazolamide) are solutions. (2) Targeted training of the respiratory musculature could be a valuable preparation for altitude training in women. (3) Sex hormones influence hypoxia responses and hormonal-cycle and/or menstrual-cycle phases therefore may be factors in acclimatisation to altitude and efficiency of altitude training. As many of the recommendations or observations of the present work remain partly speculative, we join previous calls for further quality research on female athletes in sports to be extended to the field of altitude and hypoxia.

Three sessions of repeated sprint training in normobaric hypoxia improves sprinting performance

The objective of the present study was to evaluate the impacts of three-session repeated sprint training conducted in normobaric hypoxia with 48-h intervals on sprint performance, arterial oxygen saturation (SpO2), and rating of perceived exertion (RPE) scores. A total of 27 moderately trained male university students voluntarily took part in this study. In this single-blind placebo-controlled study, subjects were assigned into normobaric hypoxia (FiO2: 13.6%; HYP), normobaric normoxia (FiO2: 20.9%; PLA), and control group (CON). The HYP and PLA groups underwent three repeated sprint training sessions (a total of four sets of five times 5-s sprints with a 5-min rest between sets and a 30-s rest between each sprint) on a cycle ergometer in normobaric hypoxia or normoxia conditions. Pre- and post-tests were performed 72 h before and after the training period. Three participants were excluded from the study, and the data from twenty-four participants were analyzed. Contrary to what was observed in the pre and post tests, no time and condition interactions were observed in the relative peak power output (PPO), mean power output (MPO), percentage of sprint decrement score (Sdec%), and RPE parameters. Time effect was found in all observed variables respectively; relative PPO (F = 5.784, p = 0.045, η2 = 0.74), relative MPO (F = 3.927, p = 0.042, η2 = 0.66) and large time effect found for Sdec% (F = 11.430, p = 0.046, 0.83), and RPE (F = 14.990, p = 0.008, η2 = 0.96). A notable increase in relative peak power output (PPO) and mean power output (MPO) was observed in the post-test in comparison to the pre-test values, indicating statistical significance. The increase in PPO was in HYP 13.44% (p = 0.006), in PLA 7.48% (p = 0.264) and in CON 2.66% (p = 0.088). The decrease in Sdec% was in HYP -13.34%% (p = 0.048), PLA -10.54 (p = 0.577) and CON -4.83 (p = 0.644) at post-test. The results show that although there were no statistical differences between the groups, notable differences in performance-related variables were observed in the HYP group after 3 sessions of repetitive sprint training in hypoxia.

Women at Altitude: Sex-Related Physiological Responses to Exercise in Hypoxia

Sex differences in physiological responses to various stressors, including exercise, have been well documented. However, the specific impact of these differences on exposure to hypoxia, both at rest and during exercise, has remained underexplored. Many studies on the physiological responses to hypoxia have either excluded women or included only a limited number without analyzing sex-related differences. To address this gap, this comprehensive review conducted an extensive literature search to examine changes in physiological functions related to oxygen transport and consumption in hypoxic conditions. The review encompasses various aspects, including ventilatory responses, cardiovascular adjustments, hematological alterations, muscle metabolism shifts, and autonomic function modifications. Furthermore, it delves into the influence of sex hormones, which evolve throughout life, encompassing considerations related to the menstrual cycle and menopause. Among these physiological functions, the ventilatory response to exercise emerges as one of the most sex-sensitive factors that may modify reactions to hypoxia. While no significant sex-based differences were observed in cardiac hemodynamic changes during hypoxia, there is evidence of greater vascular reactivity in women, particularly at rest or when combined with exercise. Consequently, a diffusive mechanism appears to be implicated in sex-related variations in responses to hypoxia. Despite well-established sex disparities in hematological parameters, both acute and chronic hematological responses to hypoxia do not seem to differ significantly between sexes. However, it is important to note that these responses are sensitive to fluctuations in sex hormones, and further investigation is needed to elucidate the impact of the menstrual cycle and menopause on physiological responses to hypoxia.

Construction of a Machine Learning Model to Estimate Physiological Variables of Speed Skating Athletes Under Hypoxic Training Conditions

ABSTRACT

Han, J, Liu, M, Shi, J, and Li, Y. Construction of a machine learning model to estimate physiological variables of speed skating athletes under hypoxic training conditions. J Strength Cond Res 37(7): 1543-1550, 2023-Monitoring changes in athletes' physiological variables is essential to create a safe and effective hypoxic training plan for speed skating athletes. This research aims to develop a machine learning estimation model to estimate physiological variables of athletes under hypoxic training conditions based on their physiological measurements collected at sea level. The research team recruited 64 professional speed skating athletes to participate in a 10-week training program, including 3 weeks of sea-level training, followed by 4 weeks of hypoxic training and then a 3-week sea-level recovery period. We measured several physiological variables that could reflect the athletes' oxygen transport capacity in the first 7 weeks, including red blood cell (RBC) count and hemoglobin (Hb) concentration. The physiological variables were measured once a week and then modeled as a mathematical model to estimate measurements' changes using the maximum likelihood method. The mathematical model was then used to construct a machine learning model. Furthermore, the original data (measured once per week) were used to construct a polynomial model using curve fitting. We calculated and compared the mean absolute error between estimated values of the 2 models and measured values. Our results show that the machine learning model estimated RBC count and Hb concentration accurately. The errors of the estimated values were within 5% of the measured values. Compared with the curve fitting polynomial model, the accuracy of the machine learning model in estimating hypoxic training's physiological variables is higher. This study successfully constructed a machine learning model that used physiological variables measured at the sea level to estimate the physiological variables during hypoxic training.

Proper use of light environments for mitigating the effects of COVID-19 and other prospective public health emergency lockdowns on sleep quality and fatigue in adolescents

Coronavirus disease 2019 (COVID-19) remains a public health emergency of international concern, and some countries still implement strict regional lockdowns. Further, the upcoming 2023 Asian Games and World University Games will implement a closed-loop management system. Quarantine can harm mental and physical health, to which adolescents are more vulnerable compared with adults. Previous studies indicated that light can affect our psychology and physiology, and adolescents were exposed to the artificial light environment in the evening during the lockdown. Thus, this study aimed to establish and assess appropriate residential light environments to mitigate the effects of lockdowns on sleep quality and fatigue in adolescents. The participants were 66 adolescents (12.15 ± 2.45 years of age) in a closed-loop management environment, who participated in a 28-day (7-day baseline, 21-day light intervention) randomized controlled trial of a light-emitting diode (LED) light intervention. The adolescents were exposed to different correlated color temperature (CCT) LED light environments (2000 K or 8000 K) for 1 h each evening. The results for self-reported daily sleep quality indicated that the low CCT LED light environment significantly improved sleep quality (p < 0.05), and the blood test results for serum urea and hemoglobin indicated that this environment also significantly reduced fatigue (p < 0.05) and moderately increased performance, compared to the high CCT LED light environment. These findings can serve as a springboard for further research that aims to develop interventions to reduce the effects of public health emergency lockdowns on mental and physical health in adolescents, and provide a reference for participants in the upcoming Asian Games and World University Games.

Effects of Acute Exposure and Acclimatization to High-Altitude on Oxygen Saturation and Related Cardiorespiratory Fitness in Health and Disease

Maximal values of aerobic power (VO₂max) and peripheral oxygen saturation (SpO₂max) decline in parallel with gain in altitude. Whereas this relationship has been well investigated when acutely exposed to high altitude, potential benefits of acclimatization on SpO₂ and related VO₂max in healthy and diseased individuals have been much less considered. Therefore, this narrative review was primarily aimed to identify relevant literature reporting altitude-dependent changes in determinants, in particular SpO₂, of VO₂max and effects of acclimatization in athletes, healthy non-athletes, and patients suffering from cardiovascular, respiratory and/or metabolic diseases. Moreover, focus was set on potential differences with regard to baseline exercise performance, age and sex. Main findings of this review emphasize the close association between individual SpO₂ and VO₂max, and demonstrate similar altitude effects (acute and during acclimatization) in healthy people and those suffering from cardiovascular and metabolic diseases. However, in patients with ventilatory constrains, i.e., chronic obstructive pulmonary disease, steep decline in SpO₂ and V̇O₂max and reduced potential to acclimatize stress the already low exercise performance. Finally, implications for prevention and therapy are briefly discussed.

Adaptive Responses to Hypoxia and/or Hyperoxia in Humans

Significance: Oxygen is indispensable for aerobic life, but its utilization exposes cells and tissues to oxidative stress; thus, tight regulation of cellular, tissue, and systemic oxygen concentrations is crucial. Here, we review the current understanding of how the human organism (mal-)adapts to low (hypoxia) and high (hyperoxia) oxygen levels and how these adaptations may be harnessed as therapeutic or performance enhancing strategies at the systemic level. Recent Advances: Hyperbaric oxygen therapy is already a cornerstone of modern medicine, and the application of mild hypoxia, that is, hypoxia conditioning (HC), to strengthen the resilience of organs or the whole body to severe hypoxic insults is an important preparation for high-altitude sojourns or to protect the cardiovascular system from hypoxic/ischemic damage. Many other applications of adaptations to hypo- and/or hyperoxia are only just emerging. HC-sometimes in combination with hyperoxic interventions-is gaining traction for the treatment of chronic diseases, including numerous neurological disorders, and for performance enhancement. Critical Issues: The dose- and intensity-dependent effects of varying oxygen concentrations render hypoxia- and/or hyperoxia-based interventions potentially highly beneficial, yet hazardous, although the risks versus benefits are as yet ill-defined. Future Directions: The field of low and high oxygen conditioning is expanding rapidly, and novel applications are increasingly recognized, for example, the modulation of aging processes, mood disorders, or metabolic diseases. To advance hypoxia/hyperoxia conditioning to clinical applications, more research on the effects of the intensity, duration, and frequency of altered oxygen concentrations, as well as on individual vulnerabilities to such interventions, is paramount. Antioxid. Redox Signal. 37, 887-912.

High-Intensity Interval Training (HIIT) in Hypoxia Improves Maximal Aerobic Capacity More Than HIIT in Normoxia: A Systematic Review, Meta-Analysis, and Meta-Regression

The present study aimed to determine the effect of high intensity interval training (HIIT) in hypoxia on maximal oxygen uptake (VO_2max) compared with HIIT in normoxia with a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-accordant meta-analysis and meta-regression. Studies which measured VO_2max following a minimum of 2 weeks intervention featuring HIIT in hypoxia versus HIIT in normoxia were included. From 119 originally identified titles, nine studies were included (n = 194 participants). Meta-analysis was conducted on change in (∆) VO_2max using standardised mean difference (SMD) and a random effects model. Meta-regression examined the relationship between the extent of environmental hypoxia (fractional inspired oxygen [FiO₂]) and ∆VO_2max and intervention duration and ∆VO_2max. The overall SMD for ∆VO_2max following HIIT in hypoxia was 1.14 (95% CI = 0.56-1.72; p < 0.001). Meta-regressions identified no significant relationship between FiO₂ (coefficient estimate = 0.074, p = 0.852) or intervention duration (coefficient estimate = 0.071, p = 0.423) and ∆VO_2max. In conclusion, HIIT in hypoxia improved VO_2max compared to HIIT in normoxia. Neither extent of hypoxia, nor training duration modified this effect, however the range in FiO₂ was small, which limits interpretation of this meta-regression. Moreover, training duration is not the only training variable known to influence ∆VO_2max, and does not appropriately capture total training stress or load. This meta-analysis provides pooled evidence that HIIT in hypoxia may be more efficacious at improving VO_2max than HIIT in normoxia. The application of these data suggest adding a hypoxic stimuli to a period of HIIT may be more effective at improving VO_2max than HIIT alone. Therefore, coaches and athletes with access to altitude (either natural or simulated) should consider implementing HIIT in hypoxia, rather than HIIT in normoxia where possible, assuming no negative side effects.

Does Altitude of Birth Influence the Performance of National- to Elite-Level Colombian Cyclists?

Objective: To determine whether the altitude of birth/childhood influences the values in peak power output (PPO) and estimated maximum oxygen uptake (estVO2max) in male Colombian road cyclists of different performance levels. This study also aimed to determine whether cyclists born at high altitudes tend to be more successful. Methods: Eighty riders aged between 17 and 22 years of 3 performance levels (U23 world-class level, WC, n = 8; U23 national level, N23, n = 41; junior national level, J, n = 31) and 3 altitude levels (<800 m, low; 800–2000 m, moderate; >2000 m, high) performed an ergocycle maximal incremental test to exhaustion at an altitude of 2570 m. Results: Altogether, while cyclists born at an altitude >2000 m represented ∼50% of the analyzed sample, there was a significantly higher proportion (84%) of these cyclists who had participated as professionals in a Grand Tour (χ2[1, N = 80] = 4.58, P < .05). Riders of the low group had lower values of PPO and estVO2max than cyclists of moderate and high altitudes, while no differences were noted between moderate- and high-altitude groups. In N23, PPO and estVO2max were lower in the low- than in the moderate-altitude group, while in the J cyclists, PPO and estVO2max were lower in the low-altitude compared with both moderate- and high-altitude groups. Discussion: Among the cyclists tested at altitude in junior and U23, there is an overrepresentation of individuals who reached an elite level and were born at a high altitude (>2000 m). As no clear differences were observed between moderate- and high-altitude cyclists, the higher prevalence of elite cyclists in the latter group may originate from various—still unclear—mechanisms.

Pre-acclimation to altitude in young adults: choosing a hypoxic pattern at sea level which provokes significant haematological adaptations

PURPOSE

This single-blind, repeated measures study evaluated adaptive and maladaptive responses to continuous and intermittent hypoxic patterns in young adults.

METHODS

Changes in haematological profile, stress and cardiac damage were measured in ten healthy young participants during three phases: (1) breathing normoxic air (baseline); (2) breathing normoxic air via a mask (Sham-controls); (3) breathing intermittent hypoxia (IH) via a mask, mean peripheral oxygen saturation (SpO₂) of 85% ~ 70 min of hypoxia. After a 5-month washout period, participants repeated this three-phase protocol with phase, (4) consisting of continuous hypoxia (CH), mean SpO₂ = 85%, ~ 70 min of hypoxia. Measures of the red blood cell count (RBCc), haemoglobin concentration ([Hb]), haematocrit (Hct), percentage of reticulocytes (% Retics), secretory immunoglobulin A (S-IgA), cortisol, cardiac troponin T (cTnT) and the erythropoietic stimulation index (calculated OFF-score) were compared across treatments.

RESULTS

Despite identical hypoxic durations at the same fixed SpO₂, no significant effects were observed in either CH or Sham-CH control, compared to baseline. While IH and Sham-IH controls demonstrated significant increases in: RBC_c; [Hb]; Hct; and the erythropoietic stimulation index. Notably, the % Retics decreased significantly in response to IH (-31.9%) or Sham-IH control (-23.6%), highlighting the importance of including Sham-controls. No difference was observed in S-IgA, cortisol or cTnT.

CONCLUSION

The IH but not CH pattern significantly increased key adaptive haematological responses, without maladaptive increases in S-IgA, cortisol or cTnT, indicating that the IH hypoxic pattern would be the best method to boost haematological profiles prior to ascent to altitude.

The Mediterranean dietary pattern for optimising health and performance in competitive athletes: a narrative review

Nutrition plays a key role in training for, and competing in, competitive sport, and is essential for reducing risk of injury and illness, recovering and adapting between bouts of activity, and enhancing performance. Consumption of a Mediterranean diet (MedDiet) has been demonstrated to reduce risk of various non-communicable diseases and increase longevity. Following the key principles of a MedDiet could also represent a useful framework for good nutrition in competitive athletes under most circumstances, with potential benefits for health and performance parameters. In this review, we discuss the potential effects of a MedDiet, or individual foods and compounds readily available in this dietary pattern, on oxidative stress and inflammation, injury and illness risk, vascular and cognitive function, and exercise performance in competitive athletes. We also highlight potential modifications which could be made to the MedDiet (whilst otherwise adhering to the key principles of this dietary pattern) in accordance with contemporary sports nutrition practices, to maximise health and performance effects. In addition, we discuss potential directions for future research.

Haematological responses to repeated sprints in hypoxia across different sporting modalities

The aim was to determine the effects of repeated-sprint training in hypoxia on haematocrit and haemoglobin in different sporting modalities. Seventy-two participants were randomly allocated to Active-Repeated sprint in hypoxia (A-RSH, n= 8); Active-Repeated sprint in normoxia (A-RSN, n= 8); Active-Control (A-CON, n= 8); Team Sports-RSH (T-RSH, n= 8); Team Sports-RSN (T-RSN, n= 8); Team Sports-Control (T-CON, n= 8); Endurance-RSH (E-RSH, n= 8); Endurance-RSN (E-RSN, n= 8); Endurance-Control (E-CON, n= 8). Sessions consisted of two sets of five sprints of 10 swith recovery of 20 sbetween sprints and 10 min between sets. Blood samples for haematocrit and haemoglobin concentrations were obtained before and after, and 2 weeks after cessation. Haematocrit and haemoglobin were lower for the E-RSN group following 2 weeks of cessation of protocol compared with E-RSH (p = 0.035) and E-CON (p = 0.045). Haematocrit of the A-RSH group was higher compared with baseline (p = 0.05) and Post (p = 0.05). Similarly, the T-RSH group demonstrated increases in haematocrit following 2 weeks of cessation compared with Post (p = 0.04). Repeated Sprint Training in Hypoxia had different haematological effects depending on sporting modality.

Is Hemoglobin Mass at Age 16 a Predictor for National Team Membership at Age 25 in Cross-Country Skiers and Triathletes?

We recently measured the development of hemoglobin mass (Hb_mass) in 10 Swiss national team endurance athletes between ages 16–19. Level of Hb_mass at age 16 was an important predictor for Hb_mass and endurance performance at age 19. The aim was to determine how many of these young athletes were still members of Swiss national teams (NT) at age 25, how many already terminated their career (TC), and whether Hb_mass at ages 16 and 19 was different between the NT and TC group. We measured Hb_mass using the optimized carbon monoxide re-breathing technique in 10 high-performing endurance athletes every 0.5 years beginning at age 16 and ending at age 19. At age 25, two athletes were in the NT group and eight athletes in the TC group. Mean absolute, body weight-, and lean body mass (LBM) related Hb_mass at age 16 was 833 ± 61 g, 13.7 ± 0.2 g/kg and 14.2 ± 0.2 g/kg LBM in the NT group and 742 ± 83 g, 12.2 ± 0.7 g/kg and 12.8 ± 0.8 g/kg LBM in the TC group. At age 19, Hb_mass was 1,042 ± 89 g, 14.6 ± 0.2 g/kg and 15.4 ± 0.2 g/kg LBM in the NT group and 863 ± 109 g, 12.7 ± 1.1 g/kg and 13.5 ± 1.1 g/kg LBM in the TC group. Body weight- and LBM related Hb_mass were higher in the NT group than in the TC group at ages 16 and 19 (p < 0.05). These results indicate, that Hb_mass at ages 16 and 19 possibly could be an important predictor for later national team membership in endurance disciplines.

The effects of normoxic endurance exercise on erythropoietin (EPO) production and the impact of selective β1 and non-selective β1 + β2 adrenergic receptor blockade

PURPOSE

Habitual endurance exercise results in increased erythropoiesis, which is primarily controlled by erythropoietin (EPO), yet studies demonstrating upregulation of EPO via a single bout of endurance exercise have been equivocal. This study compares the acute EPO response to 30 min of high versus 90 min of moderate-intensity endurance exercise and whether that response can be upregulated via selective adrenergic receptor blockade.

METHODS

Using a counterbalanced, cross-over design, fifteen participants (age 28 ± 8) completed two bouts of running (30-min, high intensity vs 90-min, moderate intensity) matched for overall training stress. A separate cohort of fourteen participants (age 31 ± 6) completed three bouts of 30-min high-intensity cycling after ingesting the preferential β₁-adrenergic receptor (AR) antagonist bisoprolol, the non-preferential β₁ + β₂ antagonist nadolol or placebo. Venous blood was collected before, during, and after exercise, and serum EPO levels were determined by ELISA.

RESULTS

No detectable EPO response was observed during or after high intensity running, however, in the moderate-intensity trial EPO was significantly elevated at both during-exercise timepoints (+ 6.8% ± 2.3% at 15 min and + 8.7% ± 2.2% at 60 min). No significant change in EPO was observed post-cycling or between the trials involving βAR blockade.

CONCLUSION

Neither training mode (running or cycling), nor beta-blockade significantly influenced the EPO response to 30 min of high-intensity exercise, however, 90 min of moderate-intensity running elevated EPO during exercise, returning to baseline immediately post-exercise. Identifying the optimal mode, duration and intensity required to evoke an EPO response to exercise may help tailor exercise prescriptions designed to maximize EPO response for both performance and clinical applications.

Der Eisenstoffwechsel und seine Bedeutung für das Höhentraining

Ein Eisenmangel und eine katabole Stoffwechsellage behindern die Zunahme des Gesamthämoglobins und damit einen Anstieg der Sauerstofftransportkapazität, sodass die Wirksamkeit des Höhentrainings herabgesetzt ist. Die Eisenhomöostase wird sehr fein durch das hepatische Hormon Hepcidin (HEPC) kontrolliert, welches die Eisenaufnahmefähigkeit der Darmzellen über ein spezielles Protein, dem Ferroportin, kontrolliert. Unter Hypoxie stimuliert das Protein HIF-1 α die Freisetzung des Erythropoitins (EPO). Unzureichende Eisenspeicher und/oder eine Vitamin-B12-Unterversorgung bei Athleten, besonders bei jungen Frauen, sind Wochen vor einem Höhentraining durch eine orale Eisen- und/oder Vitamin-B12-Substitution unter ärztlicher Kontrolle, aufzufüllen. Voraussetzung für eine leistungsfördernde Wirkung des Höhentrainings ist ein mehrmaliger Aufenthalt in mittleren Höhen von 1700 m bis 3000 m. Als Aufenthaltsdauer werden 350 h bis 500 h oder zwei bis drei Wochen empfohlen. Mangelnde Eisenverfügbarkeit und ein Energiedefizit können die Wirksamkeit des Höhentrainings negativ beeinflussen. Liegt aus medizinischer Sicht eine Eisenunterversorgung vor, dann wird zu einer oralen Supplementation vor und während des Höhentrainings geraten. Bei normaler Eisenverfügbarkeit führt die gesteigerte Hämatopoese durch EPO zur Zunahme des Gesamthämoglobins. Die Wirkung des hypoxieinduzierten Hämoglobinanstiegs ist nach dem Höhentraining auf drei bis vier Wochen begrenzt.

Antioxidant-rich foods and response to altitude training: A randomized controlled trial in elite endurance athletes

High doses of isolated antioxidant supplements such as vitamin C and E have demonstrated the potential to blunt cellular adaptations to training. It is, however, unknown whether intake of high doses of antioxidants from foods has similar effects. Hence, the aim of the study was to investigate whether intake of antioxidant-rich foods affects adaptations to altitude training in elite athletes. In a randomized controlled trial, 31 national team endurance athletes (23 ± 5 years) ingested antioxidant-rich foods (n = 16) or eucaloric control foods (n = 15) daily during a 3-week altitude training camp (2320 m). Changes from baseline to post-altitude in hemoglobin mass (Hb_mass ; optimized CO rebreathing), maximal oxygen uptake (VO_2max ; n = 16) or 100 m swimming performance (n = 10), and blood parameters were compared between the groups. The antioxidant group significantly increased total intake of antioxidant-rich foods (~118%) compared to the control group during the intervention. The total study population improved VO_2max by 2.5% (1.7 mL/kg/min, P = .006) and Hb_mass by 4.7% (48 g, P < .001), but not 100 m swimming performance. No difference was found between the groups regarding changes in Hb_mass , VO_2max or swimming performance. However, hemoglobin concentration increased more in the antioxidant group (effect size = 0.7; P = .045) with a concomitantly larger decrease in plasma and blood volumes compared to control group. Changes in ferritin and erythropoietin from pre- to post-altitude did not differ between the groups. Doubling the intake of antioxidant-rich foods was well tolerated and did not negatively influence the adaptive response to altitude training in elite endurance athletes.

The Effects of Altitude Training on Erythropoietic Response and Hematological Variables in Adult Athletes: A Narrative Review

Background: One of the goals of altitude training is to increase blood oxygen-carrying capacity in order to improve sea-level endurance performance in athletes. The elevated erythropoietin (EPO) production in hypoxia is a key factor in the achievement of enhanced hematological variables. The level of the EPO increase and acceleration of erythropoiesis depend on the duration of exposure and degree of hypoxia. Furthermore, many other factors may affect the hematological response to altitude training.

Aim: The purpose of this narrative review was to: (1) analyze the kinetics of EPO and hematological variables during and after altitude training; (2) summarize the current state of knowledge about the possible causes of individual or cohort differences in EPO and hematological response to altitude training; (3) formulate practical guidelines for athletes to improve the efficiency of altitude training.

Methods: A narrative review was performed following an electronic search of the databases PubMed/MEDLINE and SPORTDiscus via EBSCO for all English-language articles published between 1997 and 2017.

Results: Complete unification of results from studies on EPO kinetics was difficult due to different time and frequency of blood sampling by different researchers during and after altitude training, but the data presented in the reviewed literature allowed us to detect certain trends. The results of the reviewed studies were divergent and indicated either increase or no change of hematological variables following altitude training. Factors that may affect the hematological response to altitude training include hypoxic dose, training content, training background of athletes, and/or individual variability of EPO production.

Conclusions: Despite the potential benefits arising from altitude training, its effectiveness in improving hematological variables is still debatable. Further research and better understanding of factors influencing the response to altitude, as well as factors affecting the suitable measurement and interpretation of study results, are needed.

Effects of intermittent hypoxic training performed at high hypoxia level on exercise performance in highly trained runners

This study exanimated the effects of intermittent hypoxic training (IHT) conducted at a high level of hypoxia with recovery at ambient air on aerobic/anaerobic capacities at sea level and hematological variations. According to a double-blind randomized design, fifteen highly endurance-trained runners completed a 6-weeks regimented training with 3 sessions per week consisting of intermittent runs (6x work-rest ratio of 5':5') on a treadmill at 80-85% of maximal aerobic speed ([Formula: see text]). Nine athletes (hypoxic group, HG) performed the exercise bouts at FI0₂ = 10.6-11.4% while six athletes (normoxic group, NG) exercised at ambient air. Running time to exhaustion at a velocity corresponding to 95% [Formula: see text] significantly increased for HG while no effect was found for NG. Regarding [Formula: see text], no significant effects were found in either training group. In addition, the decline of jumping performances over a 45s-continuous maximal vertical jump test (i.e. anaerobic capacity index) tended to be lower in HG compared to NG. The levels of the studied hematological variables, including erythropoietin and hematocrit, did not significantly change for either HG or NG. These results highlight that our IHT protocol may induce additional effects on aerobic performance without compromising the anaerobic capacity index in highly-trained athletes.

Do male athletes with already high initial haemoglobin mass benefit from 'live high-train low' altitude training?

NEW FINDINGS

What is the central question of this study? It has been assumed that athletes embarking on an 'live high-train low' (LHTL) camp with already high initial haemoglobin mass (Hb_mass ) have a limited ability to increase their Hb_mass further post-intervention. Therefore, the relationship between initial Hb_mass and post-intervention increase was tested with duplicate Hb_mass measures and comparable hypoxic doses in male athletes. What is the main finding and its importance? There were trivial to moderate inverse relationships between initial Hb_mass and percentage Hb_mass increase in endurance and team-sport athletes after the LHTL camp, indicating that even athletes with higher initial Hb_mass can reasonably expect Hb_mass gains post-LHTL. It has been proposed that athletes with high initial values of haemoglobin mass (Hb_mass ) will have a smaller Hb_mass increase in response to 'live high-train low' (LHTL) altitude training. To verify this assumption, the relationship between initial absolute and relative Hb_mass values and their respective Hb_mass increase following LHTL in male endurance and team-sport athletes was investigated. Overall, 58 male athletes (35 well-trained endurance athletes and 23 elite male field hockey players) undertook an LHTL training camp with similar hypoxic doses (200-230 h). The Hb_mass was measured in duplicate pre- and post-LHTL by the carbon monoxide rebreathing method. Although there was no relationship (r = 0.02, P = 0.91) between initial absolute Hb_mass (in grams) and the percentage increase in absolute Hb_mass , a moderate relationship (r = -0.31, P = 0.02) between initial relative Hb_mass (in grams per kilogram) and the percentage increase in relative Hb_mass was detected. Mean absolute and relative Hb_mass increased to a similar extent (P ≥ 0.81) in endurance (from 916 ± 88 to 951 ± 96 g, +3.8%, P < 0.001 and from 13.1 ± 1.2 to 13.6 ± 1.1 g kg^-1 , +4.1%, P < 0.001, respectively) and team-sport athletes (from 920 ± 120 to 957 ± 127 g, +4.0%, P < 0.001 and from 11.9 ± 0.9 to 12.3 ± 0.9 g kg^-1 , +4.0%, P < 0.001, respectively) after LHTL. The direct comparison study using individual data of male endurance and team-sport athletes and strict methodological control (duplicate Hb_mass measures and matched hypoxic dose) indicated that even athletes with higher initial Hb_mass can reasonably expect Hb_mass gain post-LHTL.