The influence of inspired oxygen on the oxygen uptake response to ramp exercise

Variations in exercise ventilation in hypoxia will affect oxygen uptake

Reports of VO2 response differences between normoxia and hypoxia during incremental exercise do not agree. In this study VO2 and VE were obtained from 15-s averages at identical work rates during continuous incremental cycle exercise in 8 subjects under ambient pressure (633 mmHg ≈1,600 m) and during duplicate tests in acute hypobaric hypoxia (455 mmHg ≈4,350 m), ranging from 49 to 100% of VO2 peak in hypoxia and 42-87% of VO2 peak in normoxia. The average VO2 was 96 mL/min (619 mL) lower at 455 mmHg (n.s. P = 0.15) during ramp exercises. Individual response points were better described by polynomial than linear equations (mL/min/W). The VE was greater in hypoxia, with marked individual variation in the differences which correlated significantly and directly with the VO2 difference between 455 mmHg and 633 mmHg (P = 0.002), likely related to work of breathing (Wb). The greater VE at 455 mmHg resulted from a greater breathing frequency. When a subject's hypoxic ventilatory response is high, the extra work of breathing reduces mechanical efficiency (E). Mean ∆E calculated from individual linear slopes was 27.7 and 30.3% at 633 and 455 mmHg, respectively (n.s.). Gross efficiency (GE) calculated from mean VO2 and work rate and correcting for Wb from a VE-VO2 relationship reported previously, gave corresponding values of 20.6 and 21.8 (P = 0.05). Individual variation in VE among individuals overshadows average trends, as also apparent from other reports comparing hypoxia and normoxia during progressive exercise and must be considered in such studies.

Spiroergometric measurements under increased inspiratory oxygen concentration (FIO2)-Putting the Haldane transformation to the test

Spiroergometric measurements of persons who require oxygen insufflation due to illness can be performed under conditions of increased inspiratory oxygen concentration (FIO2). This increase in FIO2, however, often leads to errors in the calculation of oxygen consumption ([Formula: see text]). These inconsistencies are due to the application of the Haldane Transformation (HT), an otherwise indispensable correction factor in the calculation of [Formula: see text] that becomes inaccurate at higher FIO2 concentrations. A possible solution to this problem could be the use of the 'Eschenbacher transformation' (ET) as an alternative correction factor. This study examines the concentration of FIO2 at which the HT and the ET are valid, providing plausible data of oxygen consumption corresponding to the wattage achieved during cycle ergometry. Ten healthy volunteers underwent spiroergometric testing under standard conditions (FIO2 = 20.9%), as well as at FIO2 = 40% and 80%. When compared with the predicted values of [Formula: see text], as calculated according to Wasserman et al. (2012), the data obtained show that both the HT and ET are valid under normal conditions and at an increased FIO2 of 40%. At FIO2 concentrations of 80%, however, the [Formula: see text] values provided by the HT begin to lose plausibility, whereas the ET continues to provide credible results. We conclude that the use of the ET in place of the HT in spiroergometric measurements with increased FIO2 allows a reliable evaluation of stress tests in patients requiring high doses of supplemental oxygen.

The Effects of Hyperoxia on Sea-Level Exercise Performance, Training, and Recovery: A Meta-Analysis

BACKGROUND

Acute exercise performance can be limited by arterial hypoxemia, such that hyperoxia may be an ergogenic aid by increasing tissue oxygen availability. Hyperoxia during a single bout of exercise performance has been examined using many test modalities, including time trials (TTs), time to exhaustion (TTE), graded exercise tests (GXTs), and dynamic muscle function tests. Hyperoxia has also been used as a long-term training stimulus or a recovery intervention between bouts of exercise. However, due to the methodological differences in fraction of inspired oxygen (F_iO₂), exercise type, training regime, or recovery protocols, a firm consensus on the effectiveness of hyperoxia as an ergogenic aid for exercise training or recovery remains unclear.

OBJECTIVES

The aims of this study were to (1) determine the efficacy of hyperoxia as an ergogenic aid for exercise performance, training stimulus, and recovery before subsequent exercise; and (2) determine if a dose-response exists between F_iO₂ and exercise performance improvements.

DATA SOURCE

The PubMed, Web of Science, and SPORTDiscus databases were searched for original published articles up to and including 8 September 2017, using appropriate first- and second-order search terms.

STUDY SELECTION

English-language, peer-reviewed, full-text manuscripts using human participants were reviewed using the process identified in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement.

DATA EXTRACTION

Data for the following variables were obtained by at least two of the authors: F_iO₂, wash-in time for gas, exercise performance modality, heart rate, cardiac output, stroke volume, oxygen saturation, arterial and/or capillary lactate, hemoglobin concentration, hematocrit, arterial pH, arterial oxygen content, arterial partial pressure of oxygen and carbon dioxide, consumption of oxygen and carbon dioxide, minute ventilation, tidal volume, respiratory frequency, ratings of perceived exertion of breathing and exercise, and end-tidal oxygen and carbon dioxide partial pressures.

DATA GROUPING

Data were grouped into type of intervention (acute exercise, recovery, and training), and performance data were grouped into type of exercise (TTs, TTE, GXTs, dynamic muscle function), recovery, and training in hyperoxia.

DATA ANALYSIS

Hedges' g effect sizes and 95% confidence intervals were calculated. Separate Pearson's correlations were performed comparing the effect size of performance versus F_iO₂, along with the effect size of arterial content of oxygen, arterial partial pressure of oxygen, and oxygen saturation.

RESULTS

Fifty-one manuscripts were reviewed. The most common F_iO₂ for acute exercise was 1.00, with GXTs the most investigated exercise modality. Hyperoxia had a large effect improving TTE (g = 0.89), and small-to-moderate effects increasing TTs (g = 0.56), GXTs (g = 0.40), and dynamic muscle function performance (g = 0.28). An F_iO₂ ≥ 0.30 was sufficient to increase general exercise performance to a small effect or higher; a moderate positive correlation (r = 0.47-0.63) existed between performance improvement of TTs, TTE, and dynamic muscle function tests and F_iO₂, but not GXTs (r = 0.06). Exercise training and recovery supplemented with hyperoxia trended towards a large and small ergogenic effect, respectively, but the large variability and limited amount of research on these topics prevented a definitive conclusion.

CONCLUSION

Acute exercise performance is increased with hyperoxia. An F_iO₂ ≥ 0.30 appears to be beneficial for performance, with a higher F_iO₂ being correlated to greater performance improvement in TTs, TTE, and dynamic muscle function tests. Exercise training and recovery supplemented with hyperoxic gas appears to have a beneficial effect on subsequent exercise performance, but small sample size and wide disparity in experimental protocols preclude definitive conclusions.

The Impact of Hyperoxia on Human Performance and Recovery

Hyperoxia results from the inhalation of mixtures of gas containing higher partial pressures of oxygen (O₂) than normal air at sea level. Exercise in hyperoxia affects the cardiorespiratory, neural and hormonal systems, as well as energy metabolism in humans. In contrast to short-term exposure to hypoxia (i.e. a reduced partial pressure of oxygen), acute hyperoxia may enhance endurance and sprint interval performance by accelerating recovery processes. This narrative literature review, covering 89 studies published between 1975 and 2016, identifies the acute ergogenic effects and health concerns associated with hyperoxia during exercise; however, long-term adaptation to hyperoxia and exercise remain inconclusive. The complexity of the biological responses to hyperoxia, as well as the variations in (1) experimental designs (e.g. exercise intensity and modality, level of oxygen, number of participants), (2) muscles involved (arms and legs) and (3) training status of the participants may account for the discrepancies.

Highs and lows of hyperoxia: physiological, performance, and clinical aspects

Molecular oxygen (O₂) is a vital element in human survival and plays a major role in a diverse range of biological and physiological processes. Although normobaric hyperoxia can increase arterial oxygen content ([Formula: see text]), it also causes vasoconstriction and hence reduces O₂ delivery in various vascular beds, including the heart, skeletal muscle, and brain. Thus, a seemingly paradoxical situation exists in which the administration of oxygen may place tissues at increased risk of hypoxic stress. Nevertheless, with various degrees of effectiveness, and not without consequences, supplemental oxygen is used clinically in an attempt to correct tissue hypoxia (e.g., brain ischemia, traumatic brain injury, carbon monoxide poisoning, etc.) and chronic hypoxemia (e.g., severe COPD, etc.) and to help with wound healing, necrosis, or reperfusion injuries (e.g., compromised grafts). Hyperoxia has also been used liberally by athletes in a belief that it offers performance-enhancing benefits; such benefits also extend to hypoxemic patients both at rest and during rehabilitation. This review aims to provide a comprehensive overview of the effects of hyperoxia in humans from the "bench to bedside." The first section will focus on the basic physiological principles of partial pressure of arterial O₂, [Formula: see text], and barometric pressure and how these changes lead to variation in regional O₂ delivery. This review provides an overview of the evidence for and against the use of hyperoxia as an aid to enhance physical performance. The final section addresses pathophysiological concepts, clinical studies, and implications for therapy. The potential of O₂ toxicity and future research directions are also considered.

Mechanisms of Improved Exercise Performance under Hyperoxia

BACKGROUND

The impact of hyperoxia on exercise limitation is still incompletely understood.

OBJECTIVES

We investigated to which extent breathing hyperoxia enhances the exercise performance of healthy subjects and which physiologic mechanisms are involved.

METHODS

A total of 32 healthy volunteers (43 ± 15 years, 12 women) performed 4 bicycle exercise tests to exhaustion with ramp and constant-load protocols (at 75% of the maximal workload [Wmax] on FiO2 0.21) on separate occasions while breathing ambient (FiO2 0.21) or oxygen-enriched air (FiO2 0.50) in a random, blinded order. Workload, endurance, gas exchange, pulse oximetry (SpO2), and cerebral (CTO) and quadriceps muscle tissue oxygenation (QMTO) were measured.

RESULTS

During the final 15 s of ramp exercising with FiO2 0.50, Wmax (mean ± SD 270 ± 80 W), SpO2 (99 ± 1%), and CTO (67 ± 9%) were higher and the Borg CR10 Scale dyspnea score was lower (4.8 ± 2.2) than the corresponding values with FiO2 0.21 (Wmax 257 ± 76 W, SpO2 96 ± 3%, CTO 61 ± 9%, and Borg CR10 Scale dyspnea score 5.7 ± 2.6, p < 0.05, all comparisons). In constant-load exercising with FiO2 0.50, endurance was longer than with FiO2 0.21 (16 min 22 s ± 7 min 39 s vs. 10 min 47 s ± 5 min 58 s). With FiO2 0.50, SpO2 (99 ± 0%) and QMTO (69 ± 8%) were higher than the corresponding isotime values to end-exercise with FiO2 0.21 (SpO2 96 ± 4%, QMTO 66 ± 9%), while minute ventilation was lower in hyperoxia (82 ± 18 vs. 93 ± 23 L/min, p < 0.05, all comparisons).

CONCLUSION

In healthy subjects, hyperoxia increased maximal power output and endurance. It improved arterial, cerebral, and muscle tissue oxygenation, while minute ventilation and dyspnea perception were reduced. The findings suggest that hyperoxia enhanced cycling performance through a more efficient pulmonary gas exchange and a greater availability of oxygen to muscles and the brain (cerebral motor and sensory neurons).

Prior upper body exercise reduces cycling work capacity but not critical power

PURPOSE

This study examined whether metabolite accumulation, induced by prior upper body exercise, affected the power-duration relationship for leg cycle ergometry.

METHODS

Seven males performed, to the limit of tolerance and both without (L) and with (AL) prior severe-intensity arm-cranking exercise, an incremental cycling test and four constant power cycling tests to determine the parameters of the power-duration relationship: critical power (CP) and W'.

RESULTS

At the onset of cycling exercise plasma lactate (L vs AL: 1.2 ± 0.1 vs 11.6 ± 2.9 mEq · L) and hydrogen ion (40.4 ± 1.3 vs 53.1 ± 4.3 nEq · L), concentrations were higher during AL compared with L, whereas the strong ion difference (37.8 ± 1.8 vs 32.4 ± 2.0 mEq · L) and bicarbonate concentration (25.7 ± 0.7 vs 18.3 ± 1.9 mEq · L) were lower during AL compared with L (P < 0.01). During incremental exercise, maximum cycling power (358 ± 15 vs 332 ± 21 W) and peak oxygen uptake (VO2peak) (4.31 ± 0.36 vs 3.71 ± 0.44 L · min) were lower during AL compared with L (P < 0.05). The rate of increase in plasma potassium concentration during constant power cycling was greater during AL compared with L (0.09 ± 0.08 vs 0.14 ± 0.13 mEq · L · min) (P < 0.05), and exercise duration was 35 ± 15% shorter (P < 0.01). CP was not different between L and AL (267 ± 19 vs 264 ± 20 W), whereas W' was lower in AL (17.3 ± 5.7 vs 11.8 ± 4.2 kJ) (P < 0.01).

CONCLUSION

The reduced W' after prior upper body exercise indicates that the magnitude of W' is partly dependent on metabolite accumulation.

Effect of Endurance Training on the &OV0312;O2???Work Rate Relationship in Normoxia and Hypoxia

PURPOSE

We postulated that the relationship between VO2 and work rate (VO2-WR relationship) during incremental exercise is dependent on O2 availability, and that training-induced adaptations alter this relationship. We therefore studied the effect of endurance training on VO2 response during incremental exercise in normoxia and hypoxia (FIO2=0.134).

METHODS

Before and after training (6 d.wk, 4 wk), eight subjects performed incremental exercises under normoxia and hypoxia and one constant-work rate exercise in normoxia at 80% of pretraining VO2max. The slopes of the VO2-WR relationship during incremental exercise were calculated using all the points (whole slope) or only points before the lactate threshold (pre-LT slope). The difference between VO2max measured and VO2max expected from the pre-LT slope (DeltaVO2) was determined, as was the difference between VO2 at minute 10 and VO2 at minute 4 during the constant-work rate exercise (DeltaVO2(10'-4')).

RESULTS

In normoxia, training induced a significant decrease in the whole slope (11.0+/-1.0 vs 9.9+/-0.4 mL.min.W, P<0.05). In hypoxia, training induced a significant increase in the pre-LT slope (8.7+/-1.2 vs 9.8+/-0.7 mL.min.W; P<0.05) and the whole slope (8.5+/-1.2 vs 9.4+/-0.5 mL.min.W; P<0.05). A significant correlation between the decrease of DeltaVO2 and the decrease of DeltaVO2(10'-4') with training was found in normoxia (P<0.01, r=0.79).

CONCLUSIONS

Taken together, these results indicate that adaptations induced by endurance training are associated with more efficient incremental and constant-workload exercise performed in normoxia. Moreover, training contributes to improved O2 delivery during moderate exercise performed in hypoxia, and to enhanced near-maximal exercise tolerance.

A high blood lactate induced by heavy exercise does not affect the increase in submaximal VO2 with hyperoxia

Few studies evidenced an enhancement in oxygen uptake (VO2) during submaximal exercise in hyperoxia. This O2 "overconsumption" seems to increase above the lactate threshold. The aim of this study was to determine whether the hyperoxia-induced enhancement in VO2 may be related to a higher metabolism of lactate. Nine healthy males (aged 23.1 years, mean VO2 max= 53.8 ml min-1 kg-1) were randomized to two series of exercise in either normoxia or hyperoxia corresponding to an inspired O2 fraction (FIO2) of 30%. Each series consisted of 6 min cycling at 50% VO2 max (Moderate1), 5 min cycling at 95%VO2 max (Near Max) and then 6 min at 50% VO2 max (Moderate2). In both series Near Max was performed in normoxia. VO2 was significantly greater under hyperoxia than in normoxia during Moderate1 (2192 +/- 189 vs. 2025 +/- 172 ml min-1) and during Moderate2 (2352 +/- 173 vs. 2180+ /- 193 ml min-1). However, the effect of the high FIO2 was not significantly different on VO2Moderate2 (+172+/-137 ml min-1 with [La] approximately 6 mmol l-1) compared to VO2Moderate1 (+166 +/- 133 ml min-1 with [La] approximately 2.4 mmol l-1). [La] at the onset of Moderate2 was not different between normoxia and hyperoxia (10.1 +/- 2.2 vs. 10.9 +/- 1.6 mmol l-1). The results show that VO2 is significantly increased during moderate exercise in hyperoxia. But this O2 overconsumption was not modified by a high [La] induced by a prior heavy exercise. It could be concluded that lactate accumulation is not directly responsible for the increase in O2 overconsumption with intensity during exercise in hyperoxia.

Nitric oxide synthase inhibition with L-NAME reduces maximal oxygen uptake but not gas exchange threshold during incremental cycle exercise in man

We hypothesized that the effective inhibition of nitric oxide synthase (NOS), achieved via systemic infusion of N(G)-nitro-l-arginine methyl ester (l-NAME), would reduce the gas exchange threshold (GET) and the maximal oxygen uptake (V(.)(O(2)max)) during incremental cycle exercise in man if NO is important in the regulation of muscle vasodilatation. Seven healthy males, aged 18-34 years, volunteered to participate in this ethically approved study. On two occasions, the subjects completed an incremental exercise test to exhaustion on an electrically braked cycle ergometer following the infusion of either l-NAME (4 mg kg(-1) in 50 ml saline) or placebo (50 ml saline, CON). At rest, the infusion of l-NAME resulted in a significant increase in mean arterial pressure (MAP; CON vs. l-NAME, 89 +/- 8 vs. 103 +/- 11 mmHg (mean +/- s.d.; P < 0.05)) and a significant reduction in heart rate (HR; CON vs. l-NAME, 60 +/- 12 vs. 51 +/- 8 beats min(-1); P < 0.01). At submaximal work rates, there was no significant difference in V(.)(O(2)) between the conditions and no difference in the GET (CON vs. l-NAME, 1.94 +/- 0.47 vs. 2.01 +/- 0.41 l min(-1)). However, at higher work rates, differences in V(.)(O(2)) between the conditions became more pronounced such that V(.)(O(2)max) was significantly lower with l-NAME (CON vs. l-NAME, 4.02 +/- 0.41 vs. 3.80 +/- 0.34 l min(-1); P < 0.05). The reduction in V(.)(O(2)max) was associated with a reduction in HR(max) (CON vs. l-NAME, 186 +/- 10 vs. 178 +/- 7 beats min(-1); P < 0.01). These results demonstrate that NOS inhibition with l-NAME has no effect on GET but reduces V(.)(O(2)max) during large muscle group exercise in man, presumably by direct or indirect effects on cardiac output and muscle blood flow.

Whole body fatigue and critical power: a physiological interpretation

Critical power (CP) is a fundamental concept describing fatigue and exhaustion. The main physiological determinant of CP is the ability to utilise oxygen. This in turn is dependent primarily on diffusion distance. During exercise, many different tissue systems must increase their metabolic demand. It is argued that each tissue system, such as cardiac, respiratory and leg muscles, has their own CP. Cardiac muscle has the greatest CP relative to its maximum power because it has the shortest diffusion distances. Respiratory muscle also has a substantially higher relative CP than leg muscle. The higher relative CPs of cardiac and respiratory muscle are due in part to the homeostatic functions these tissues provide. This built in protective design can be disrupted in certain conditions such as hypoxia. During high intensity exercise, fatigue and ensuing exhaustion will occur if any contributing physiological system functions above its CP.