Effect of intermittent hypoxia on oxygen uptake during submaximal exercise in endurance athletes

Exploring the Potential Benefits of Interventions When Addressing Simulated Altitude Hypoxia during Male Cyclist Sports: A Systematic Review

Training in hypoxic environments enhances endurance, but the various influences of training protocols and supplementation for efficient performance are not yet clear. This systematic review explored the effects of different supplementations and interventions used to optimize the aerobic and anaerobic performance of cyclists. Data were collected from the following sources: PubMed, Google Scholar, EMBASE, WOS, Cochrane Central Register of Controlled Trials, and randomized controlled trials (RCTs). Studies that explored the effects of supplementation or intervention during cycling were selected for analysis. Five studies (67 male cyclists; mean age, 23.74–33.56 years) reported different outcomes from supplementation or intervention during the acute hypoxia of cyclists. Three studies (42 male cyclists; mean age, 25.88–36.22 years) listed the benefits of beetroot juice in preserving SpO2 (pulse oxygen saturation) and enhancing high-intensity endurance performance, effectively preventing the reduction in power output. This systematic review provided evidence that the different effects of ischemic preconditioning (IPC), sildenafil, and beetroot (BR) supplementation and intervention did not present a statistically greater benefit than for normoxia groups, but BR supplementation promoted the benefits of SpO2. Future research should evaluate the duration and higher FiO2 (simulated altitude, hypoxia) levels of hypoxia in training protocols for cyclists. This is important when determining the effectiveness of supplements or interventions in hypoxic conditions and their impact on sports performance, particularly in terms of power output.

Physiological and performance effects of live high train low altitude training for elite endurance athletes: A narrative review

Altitude training has become an important training application for athletes due its potential for altering physiology and enhancing performance. This practice is commonly used by athletes, with a popular choice being the live high - train low approach. This model recommends that athletes live at high altitude (1250-3000 m), but train at low altitude or sea-level (0-1200 m). Exposure to altitude often leads to hypoxic stress and in turn stimulates changes in total haemoglobin mass, erythropoietin, and soluble transferrin receptors, which alter further underlying physiology. Through enhanced physiology, improved exercise performance may arise through enhancement of the oxygen transport system which is important for endurance events. Previous investigations into the effects of altitude training on exercise performance have been completed in a range of contexts, including running, cycling, swimming, and triathlon. Often following a LHTL altitude intervention, athletes realise improvements in maximal oxygen consumption capacity, time trial performance and peak power outputs. Although heterogeneity exists among LHTL methodologies, i.e., exposure durations and altitude ranges, we synthesised this data into kilometre hours, and found that the most common hypoxic doses used in LHTL interventions ranged from ∼578-687 km h. As this narrative review demonstrates, there are potential advantages to using altitude training to enhance physiology and improve performance for endurance athletes.

Simulated Altitude Training and Sport Performance: Protocols and Physiological Effects

This article explores the physiological mechanisms and effects of simulated hypoxia environment training on sports performance. Different training protocols, including hypoxia high-intensity interval training (HHIIT), incremental hypoxia training, hypoxia submaximal exercise training and combined training, and hypoxia training in the recovery and sleep states, are discussed. HHIIT combines intermittent hypoxia exposure with high-intensity interval training, and has been shown to increase the maximum oxygen intake compare to the state of normoxia, improving cardiorespiratory fitness, skeletal muscle oxygen utilization, power performance, hematological adaptations, and sports performance. Incremental hypoxia training involves the gradual decrease in oxygen concentration while maintaining exercise intensity. It has been found to improve aerobic capacity; however, fewer effects were observed in hematological variables. Hypoxia submaximal exercise training and combined training in a hypoxia environment has shown to increase VO2 and VE, and only improve hemodynamic function in combined training with hypoxia. Hypoxia during the recovery state has been associated with improvements in maximum oxygen uptake, also providing benefits to sports performance. Overall, exposure to a hypoxia environment has been demonstrated to improve cardiorespiratory endurance, power performance, and specific physiological adaptations in training and resting states. However, the optimal training protocols and their effects on different sports and athlete proficiency require further research to optimize training and enhance athletic performance in hypoxia environments.

Effects of Interval Training Under Hypoxia on Hematological Parameters, Hemodynamic Function, and Endurance Exercise Performance in Amateur Female Runners in Korea

Interval training under hypoxia (IHT) is commonly used to enhance endurance exercise performance. However, previous studies examining hematologic changes related to the immune system that affect health and conditioning are lacking. This study aimed to evaluate the effects of IHT for 6-weeks on hematological parameters, hemodynamic function, and endurance exercise performance in amateur Korean female runners. Twenty healthy amateur Korean female runners (age: 24.85 ± 3.84 years) were equally assigned to normoxic training group (NTG) for interval training under normoxia (760 mmHg) and hypoxic training group (HTG) for interval training under hypobaric hypoxia (526 mmHg, 3000 m simulated altitude) according to their body composition and endurance exercise performance. All participants performed 120-min of training sessions, consisting of 20-min of warm-up, 60-min of interval training, and 20-min of cool-down. The training program was performed 3-days per week for 6-weeks. Warm-up and cool-down were performed for 20-min at 60% maximal heart rate (HRmax). The interval training sessions comprised 10 repetitions of interval exercise (5-min of exercise corresponding to 90–95% HRmax and 1-min of rest) on a treadmill. All participants underwent measurements of hematological parameters, hemodynamic function, and endurance exercise performance before and after training. Both groups showed a significant increase in erythropoietin (EPO) level and a decrease in monocyte abundance, with EPO showing a greater increase in the HTG than in the NTG. B cell abundance significantly increased in the NTG; hematocrit and neutrophil counts significantly increased, and lymphocyte counts significantly decreased in the HTG. The HTG showed a significant improvement in oxygen uptake, stroke volume index, and end-diastolic volume index compared to the NTG. In addition, both groups showed significant improvements in heart rate, end-systolic volume index, and cardiac output index. The maximal oxygen uptake and 3000 m time trial record were significantly improved in both groups, and the HTG showed a tendency to improve more than the NTG. In conclusion, the IHT was effective in enhancing endurance exercise performance through improved hemodynamic function. Furthermore, hematological parameters of immune system showed a normal range before and after training and were not negatively affected.

The Effect of Normobaric Hypoxia in Middle- and/or Long-Distance Runners: Systematic Review

BACKGROUND

The use of normobaric hypoxia can bring benefits to sports performance because it improves haematological parameters and/or physical activity tests. Our objective was to conduct a systematic review so as to analyse the methods used in hypoxia and to detect its effects on middle- and/or long-distance runners.

METHODS

Research was conducted using five electronic databases (PubMed, SportDiscus, Cochrane Library, Scopus and PEDro) until December 2021. The methodological quality of the included studies was assessed using the PEDro scale.

RESULTS

Having analysed 158 studies, 12 were chosen for the qualitative and quantitative synthesis. A significant improvement on time until exhaustion was detected, and oxygen saturation decreased after the intervention. There were no significant changes in the 3000-metre time trial or in the haematocrit percentage. The changes in percentage of reticulocytes, heart rate, maximal heart rate, lactate concentration and erythropoietin were heterogeneous between the different research studies.

CONCLUSION

short exposure (less than 3 h to normobaric hypoxia significantly increases the time to exhaustion). However, longer exposure times are necessary to increase haemoglobin. Altitude and exposure time are highly heterogeneous in the included studies.

Repeated sprint training under hypoxia improves aerobic performance and repeated sprint ability by enhancing muscle deoxygenation and markers of angiogenesis in rugby sevens

OBJECTIVE

To evaluate the effects of repeated sprint (RS) training in hypoxia on aerobic performance, repeated sprint ability (RSA), and muscle oxygenation in Rugby Sevens.

METHODS

Fourteen Rugby Sevens players were randomly allocated into hypoxic (RSH, F_IO₂ = 14.5%, n = 7) or normoxic (RSN, F_IO₂ = 20.9%, n = 7) groups. Both groups underwent RS training consisting of 3 sets of 6-s × 10 sprints at 140% of velocity at peak oxygen uptake ([Formula: see text]) on a motorized treadmill, 3 days/week for 6 weeks in addition to usual training. Hematological variables, hypoxia-inducible factor-1 alpha (HIF-1α), and vascular endothelial growth factor (VEGF) concentrations were measured. Aerobic performance, RSA, and muscle oxygenation during the running-based anaerobic sprint (RAS) test were analyzed.

RESULTS

RSH caused no changes in hemoglobin concentration and hematocrit but significant improvements in [Formula: see text] (7.5%, p = 0.03, ES = 1.07), time to exhaustion (17.6%, p = 0.05, ES = 0.92), and fatigue index (FI, - 12.3%, p = 0.01, ES = 1.39) during the RSA test compared to baseline but not RSN. While ∆deoxygenated hemoglobin was significantly increased both after RSH and RSN (p < 0.05), ∆tissue saturation index (- 56.1%, p = 0.01, ES = 1.35) and ∆oxygenated hemoglobin (- 54.7%, p = 0.04, ES = 0.97) were significantly decreased after RSH. These changes were concomitant with increased levels of HIF-1α and VEGF in serum after RSH with a strong negative correlation between ∆FI and ∆deoxygenated hemoglobin after RSH (r = - 0.81, p = 0.03).

CONCLUSION

There was minimal benefit from adding RSH to standard Rugby Sevens training, in eliciting improvements in aerobic performance and resistance to fatigue, possibly by enhanced muscle deoxygenation and increased serum HIF-1α and VEGF concentrations.

The Use of Artificial Hypoxia in Endurance Training in Patients after Myocardial Infarction

The presence of a well-developed collateral circulation in the area of the artery responsible for the infarction improves the prognosis of patients and leads to a smaller area of infarction. One of the factors influencing the formation of collateral circulation is hypoxia, which induces angiogenesis and arteriogenesis, which in turn cause the formation of new vessels. The aim of this study was to assess the effect of endurance training conducted under normobaric hypoxia in patients after myocardial infarction at the level of exercise tolerance and hemodynamic parameters of the left ventricle. Thirty-five patients aged 43–74 (60.48 ± 4.36) years who underwent angioplasty with stent implantation were examined. The program included 21 training units lasting about 90 min. A statistically significant improvement in exercise tolerance assessed with the cardiopulmonary exercise test (CPET) was observed: test duration (p < 0.001), distance covered (p < 0.001), HRmax (p = 0.039), maximal systolic blood pressure (SBPmax) (p = 0.044), peak minute ventilation (VE) (p = 0.004) and breathing frequency (BF) (p = 0.044). Favorable changes in left ventricular hemodynamic parameters were found for left ventricular end-diastolic dimension LVEDD (p = 0.002), left ventricular end-systolic dimension LVESD (p = 0.015), left ventricular ejection fraction (LVEF) (p = 0.021), lateral e’ (p < 0.001), septal e’ (p = 0.001), and E/A (p = 0.047). Endurance training conducted in hypoxic conditions has a positive effect on exercise tolerance and the hemodynamic indicators of the left ventricle.

The Effects of Intermittent Hypoxic Training on Anaerobic and Aerobic Power in Boxers

BACKGROUND

The aim of the study was to evaluate the effects of intermittent hypoxic training (IHT) on anaerobic and aerobic fitness in elite, national boxers.

METHODS

The study was conducted over a period of 6 weeks. It comprised 30 national championship boxers, divided into 2 groups: the experimental and control. Both groups performed the same boxing training twice a day (morning and afternoon training). In the afternoon, the experimental group performed training under normobaric conditions in a hypoxic chamber (IHT), while the control group undertook exercise in standard normoxic conditions. In both groups, before and after the 6-week programme, basic anthropometric indices as well as anaerobic (Wingate Test) and aerobic (graded test) fitness were assessed.

RESULTS

There was a significant increase in anaerobic peak power (988.2 vs. 1011.8 W), mean anaerobic power (741.1 vs. 764.8 W), total work (22.84 vs. 22.39 kJ), and a decrease in fatigue index (20.33 vs. 18.6 W·s-1) as well as time to peak power (5.01 vs. 4.72 s). Such changes were not observed in the control group. In both groups, no significant changes in endurance performance were noted after the training session - peak oxygen uptake did not significantly vary after IHT.

CONCLUSIONS

Our results have practical application for coaches, as the IHT seems to be effective in improving anaerobic performance among boxers.

Determining the time needed for workers to acclimatize to hypoxia

This study aimed to determine the influence of intermittent hypoxia and the days required for a worker to be acclimatized in high-altitude countries. We conducted an experimental study. Ten nonsmoking male students were randomly recruited from King Saud University. Fourteen days of exposure to intermittent normobaric hypoxia (15%) was the independent variable. Heart rate (HR), respiratory frequency (RF), minute ventilation (VE), respiratory exchange ratio (RER), tidal volume (VT), oxygen uptake (VO₂),VO₂/kg, VO₂/HR, VE/VO₂, and VE/VCO₂ were the dependent variables. Our results showed that 12 days of exposure to intermittent hypoxia were sufficient for workers to acclimatize to hypoxia based on their respiratory responses (i.e., HR, RF, VE). This type of acclimatization session is very important for workers who are suddenly required to work in such an environment, because prolonged exposure to high altitude without acclimatization leads to cell death due to a lack of oxygen, and this, in turn, puts workers' lives at risk.

Epigenetic control of exercise adaptations in the equine athlete: Current evidence and future directions

Horses (Equus ferus caballus) have evolved over the past 300 years in response to man-made selection for particular athletic traits. Some of the selected traits were selected based on the size and horses' muscular power (eg Clydesdales), whereas other breeds were bred for peak running performance (eg Thoroughbred and Arabian). Although the physiological changes and some of the cellular adaptations responsible for athletic potential of horses have been identified, the molecular mechanisms are only just beginning to be comprehensively investigated. The purpose of this review was to outline and discuss the current understanding of the molecular mechanisms underpinning the athletic performance and cardiorespiratory fitness in athletic breeds of horses. A brief review of the biology of epigenetics is provided, including discussion on DNA methylation, histone modifications and small RNAs, followed by a summary and critical review of the current work on the exercise-induced epigenetic and transcriptional changes in horses. Important unanswered questions and currently unexplored areas that deserve attention are highlighted. Finally, a rationale for the analysis of epigenetic modifications in the context with exercise-related traits and ailments associated with athletic breeds of horses is outlined in order to help guide future research.

Intermittent hypoxia modulates redox homeostasis, lipid metabolism associated inflammatory processes and redox post-translational modifications: Benefits at high altitude

Intermittent hypoxia, initially associated with adverse effects of sleep apnea, has now metamorphosed into a module for improved sports performance. The regimen followed for improved sports performance is milder intermittent hypoxic training (IHT) as compared to chronic and severe intermittent hypoxia observed in sleep apnea. Although several studies have indicated the mechanism and enough data on physiological parameters altered by IH is available, proteome perturbations remain largely unknown. Altitude induced hypobaric hypoxia is known to require acclimatization as it causes systemic redox stress and inflammation in humans. In the present study, a short IHT regimen consisting of previously reported physiologically beneficial FIO2 levels of 13.5% and 12% was administered to human subjects. These subjects were then airlifted to altitude of 3500 m and their plasma proteome along with associated redox parameters were analyzed on days 4 and 7 of high altitude stay. We observed that redox stress and associated post-translational modifications, perturbed lipid metabolism and inflammatory signaling were induced by IHT exposure at Baseline. However, this caused activation of antioxidants, energy homeostasis mechanisms and anti-inflammatory responses during subsequent high-altitude exposure. Thus, we propose IHT as a beneficial non-pharmacological intervention that benefits individuals venturing to high altitude areas.

Contemporary Periodization of Altitude Training for Elite Endurance Athletes: A Narrative Review

Since the 1960s there has been an escalation in the purposeful utilization of altitude to enhance endurance athletic performance. This has been mirrored by a parallel intensification in research pursuits to elucidate hypoxia-induced adaptive mechanisms and substantiate optimal altitude protocols (e.g., hypoxic dose, duration, timing, and confounding factors such as training load periodization, health status, individual response, and nutritional considerations). The majority of the research and the field-based rationale for altitude has focused on hematological outcomes, where hypoxia causes an increased erythropoietic response resulting in augmented hemoglobin mass. Hypoxia-induced non-hematological adaptations, such as mitochondrial gene expression and enhanced muscle buffering capacity may also impact athletic performance, but research in elite endurance athletes is limited. However, despite significant scientific progress in our understanding of hypobaric hypoxia (natural altitude) and normobaric hypoxia (simulated altitude), elite endurance athletes and coaches still tend to be trailblazers at the coal face of cutting-edge altitude application to optimize individual performance, and they already implement novel altitude training interventions and progressive periodization and monitoring approaches. Published and field-based data strongly suggest that altitude training in elite endurance athletes should follow a long- and short-term periodized approach, integrating exercise training and recovery manipulation, performance peaking, adaptation monitoring, nutritional approaches, and the use of normobaric hypoxia in conjunction with terrestrial altitude. Future research should focus on the long-term effects of accumulated altitude training through repeated exposures, the interactions between altitude and other components of a periodized approach to elite athletic preparation, and the time course of non-hematological hypoxic adaptation and de-adaptation, and the potential differences in exercise-induced altitude adaptations between different modes of exercise.

Interval Hypoxic Training Enhances Athletic Performance and Does Not Adversely Affect Immune Function in Middle- and Long-Distance Runners

This study evaluated the effects of intermittent interval training in hypoxic conditions for six weeks compared with normoxic conditions, on hemodynamic function, autonomic nervous system (ANS) function, immune function, and athletic performance in middle- and long-distance runners. Twenty athletes were divided into normoxic training (normoxic training group (NTG); n = 10; residing and training at sea level) and hypoxic training (hypoxic training group (HTG); n = 10; residing at sea level but training in 526-mmHg hypobaric hypoxia) groups. All dependent variables were measured before, and after, training. The training frequency was 90 min, 3 d per week for six weeks. Body composition showed no significant difference between the two groups. However, the HTG showed more significantly improved athletic performance (e.g., maximal oxygen uptake). The hemodynamic function (e.g., oxygen uptake, oxygen pulse, and cardiac output) during submaximal exercise and ANS function (e.g., standard deviation and root mean square of successive differences, high frequency, and low/high frequency) improved more in the HTG. Immune function parameters were stable within the normal range before and after training in both groups. Therefore, hypoxic training was more effective in enhancing athletic performance, and improving hemodynamic and ANS function; further, it did not adversely affect immune function in competitive runners.

Efficacy of Shenqi Pollen Capsules for High-Altitude Deacclimatization Syndrome via Suppression of the Reoxygenation Injury and Inflammatory Response

High-altitude deacclimatization syndrome (HADAS) is involved in hypoxia-reoxygenation injury and inflammatory response, induced a series of symptoms, and has emerged as a severe public health issue. Here, we investigated the mechanism as well as potential means to prevent HADAS using Shenqi pollen capsules (SPCs) in subjects with HADAS in a multicenter, double-blinded, randomized, placebo-controlled study. All subjects were at the same high altitude (3650 m) for 4-8 months before returning to lower altitudes. Subjects (n = 288) in 20 clusters were diagnosed with mild or moderate HADAS on the third day of the study. We randomly allocated 20 clusters of subjects (1 : 1) to receive SPCs or a placebo for 7 weeks, and they were then followed up to the 14^th week. The primary endpoints were subjects' HADAS scores recorded during the 14 weeks of follow-up. Compared with the placebo, SPC treatment significantly decreased the subjects' HADAS scores and reduced the incidence of symptom persistence. SPC therapy also reduced the serum levels of CK, CK-MB, LDH, IL-17A, TNF-α, and miR-155 and elevated IL-10 and miR-21 levels. We thus demonstrate that SPCs effectively ameliorated HADAS symptoms in these subjects via suppression of the hypoxia-reoxygenation injury and inflammatory response.

Effects of exercise training with short-duration intermittent hypoxia on endurance performance and muscle metabolism in well-trained mice

The author previously reported that short-duration intermittent hypoxia had additive effects on improvements in endurance capacity by enhancing fatty acid metabolism. The present study was designed to investigate the effects of short-duration intermittent hypoxia on endurance capacity, metabolic enzyme activity, and protein levels associated with mitochondrial biogenesis in well-trained mice. Mice in the training group were housed in a cage with a running wheel for 7 weeks from 5 weeks old. Voluntary running markedly increased maximal work values by 5.0-fold. Trained mice were then subjected to either endurance treadmill training (ET) for 60 min or hybrid training (HT, ET for 30 min followed by sprint interval exercise (5-sec run-10-sec rest) for 30 min) with (H-ET or H-HT) or without (ET or HT) short-duration intermittent hypoxia (4 cycles of 12-13% O2 for 15 min and 20.9% O2 for 10 min) for 4 weeks. Maximal endurance capacity was markedly greater in the H-ET and H-HT than ET and HT groups, respectively. H-ET and H-HT increased activity levels of 3-hydroxyacyl-CoA-dehydrogenase in oxidative muscle portion and pyruvate dehydrogenase complex in glycolytic muscle portion. These activity levels were significantly correlated with maximal endurance capacity. Protein levels of dynamin-related protein-1 were increased more by H-ET and H-HT than by ET and HT, but were not significantly correlated with maximal work. These results suggest that intermittent hypoxic exposure has beneficial effects on endurance and hybrid training to improve the endurance capacity via improving fatty acid and pyruvate oxidation in highly trained mice.

Are changes in running economy associated with changes in performance in runners? A systematic review and meta-analysis

Improvements in running economy (RE) are thought to lead to improvements in running performance (P). Multiple interventions have been designed with the aim of improving RE in middle and long-distance runners. The aim of this study was to assess the effect of interventions of at least 2-weeks' duration on RE and P and to determine whether there is a relationship between changes in RE (ΔRE) and changes in running performance (ΔP). A database search was carried out in Web of Science, Scopus and SPORTDiscus. In accordance with a PRISMA checklist 10 studies reporting 12 comparisons between interventions and controls were included in the review. There was no correlation between percentage ΔRE and percentage ΔP (r = 0.46, P = 0.936, 12 comparisons). There was a low risk of reporting bias but an unclear risk of bias for other items. Meta-analyses found no statistically significant differences between interventions and controls for RE (SMD (95% CI) = -0.37 (-1.43, 0.69), 204 participants, p = 0.49) or for P (SMD (95% CI) = -0.65 (-26.02, 24.72, 204 participants, p = 0.99). There is a need for studies of greater statistical power, methodological quality, duration and homogeneity of intervention and population. Standardised measures of performance and greater control over non-intervention training are also required.

Efficacy of intermittent hypoxic training on hemodynamic function and exercise performance in competitive swimmers

PURPOSE

Hemodynamic function is a parameter indicating oxygen delivery and utilization capacity and is an important determinant of exercise performance. The present study aimed to determine whether intermittent hypoxic training (IHT) ameliorates hemodynamic function and exercise performance in competitive swimmers.

METHODS

Twenty competitive swimmers (10 men, 10 women) volunteered to participate in the study. Participants were divided into the normoxic training (NT) group and the hypoxic training (HT) group and were subjected to training in a simulated altitude of 3000 m. We evaluated hemodynamic function profiles over 30 min of submaximal exercise on a bicycle and exercise performance before and after 6 weeks of training, which involved continuous exercise at 80% maximal heart rate (HRmax) for 30 min and interval exercise at 90% of HRmax measured before training for 30 min (ten rounds comprising 2 min of exercise followed by 1 min of rest each round).

RESULTS

Significant changes in oxygen consumption (decrease) and end-diastolic volume (increase) were observed only in the HT group. Heart rate (HR), cardiac output (CO), and ejection fraction (EF) were significantly reduced in both groups, but the reduction rates of HR and CO were greater in the HT group than in the NT group. Exercise performance measures, including maximal oxygen consumption and 400-m time trial, were significantly increased only in the HT group.

CONCLUSION

Our findings suggested that 6 weeks of IHT, which involved high-intensity continuous and interval exercise, can effectively improve exercise performance by enhancing hemodynamic function in competitive swimmers.

Effects of Altitude/Hypoxia on Single- and Multiple-Sprint Performance: A Comprehensive Review

Many sport competitions, typically involving the completion of single- (e.g. track-and-field or track cycling events) and multiple-sprint exercises (e.g. team and racquet sports, cycling races), are staged at terrestrial altitudes ranging from 1000 to 2500 m. Our aim was to comprehensively review the current knowledge on the responses to either acute or chronic altitude exposure relevant to single and multiple sprints. Performance of a single sprint is generally not negatively affected by acute exposure to simulated altitude (i.e. normobaric hypoxia) because an enhanced anaerobic energy release compensates for the reduced aerobic adenosine triphosphate production. Conversely, the reduction in air density in terrestrial altitude (i.e. hypobaric hypoxia) leads to an improved sprinting performance when aerodynamic drag is a limiting factor. With the repetition of maximal efforts, however, repeated-sprint ability is more altered (i.e. with earlier and larger performance decrements) at high altitudes (>3000-3600 m or inspired fraction of oxygen <14.4-13.3%) compared with either normoxia or low-to-moderate altitudes (<3000 m or inspired fraction of oxygen >14.4%). Traditionally, altitude training camps involve chronic exposure to low-to-moderate terrestrial altitudes (<3000 m or inspired fraction of oxygen >14.4%) for inducing haematological adaptations. However, beneficial effects on sprint performance after such altitude interventions are still debated. Recently, innovative 'live low-train high' methods, in isolation or in combination with hypoxic residence, have emerged with the belief that up-regulated non-haematological peripheral adaptations may further improve performance of multiple sprints compared with similar normoxic interventions.

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.

Comparison of the effect of intermittent hypoxic training vs. the live high, train low strategy on aerobic capacity and sports performance in cyclists in normoxia

The aim of the study was to compare the effect of intermittent hypoxic training (IHT) and the live high, train low strategy on aerobic capacity and sports performance in off-road cyclists in normoxia. Thirty off-road cyclists were randomized to three groups and subjected to 4-week training routines. The participants from the first experimental group were exposed to normobaric hypoxia conditions (FiO₂ = 16.3%) at rest and during sleep (G-LH-TL; n=10; age: 20.5 ± 2.9 years; body height 1.81 ± 0.04 m; body mass: 69.6 ± 3.9 kg). Training in this group was performed under normoxic conditions. In the second experimental group, study participants followed an intermittent hypoxic training (IHT, three sessions per week, FiO2 = 16.3%) routine (G-IHT; n=10; age: 20.7 ± 3.1 years; body height 1.78 ± 0.05 m; body mass: 67.5 ± 5.6 kg). Exercise intensity was adjusted based on the lactate threshold (LT) load determined in hypoxia. The control group lived and trained under normoxic conditions (G-C; n=10; age: 21.8 ± 4.0 years; body height 1.78 ± 0.03 m; body mass: 68.1 ± 4.7 kg; body fat content: 8.4 ± 2.4%). The evaluations included two research series (S1, S2). Between S1 and S2, athletes from all groups followed a similar training programme for 4 weeks. In each research series a graded ergocycle test was performed in order to measure VO_2max and determine the LT and a simulated 30 km individual time trial. Significant (p<0.05) improvements in VO_2max, VO_2LT, WR_max and WR_LT were observed in the G-IHT (by 3.5%, 9.1%, 6.7% and 7.7% respectively) and G-LH-TL groups (by 4.8%, 6.7%, 5.9% and 4.8% respectively). Sports performance (TT) was also improved (p<0.01) in both groups by 3.6% in G-LH-TL and 2.5% in G-IHT. Significant changes (p<0.05) in serum EPO levels and haematological variables (increases in RBC, HGB, HCT and reticulocyte percentage) were observed only in G-LH-TL. Normobaric hypoxia has been demonstrated to be an effective ergogenic aid that can enhance the exercise capacity of cyclists in normoxia. Both LH-TL and IHT lead to improvements in aerobic capacity. The adaptations induced by both approaches are likely to be caused by different mechanisms. The evaluations included two research series (S1, S2). Between S1 and S2, athletes from all groups followed a similar training programme for 4 weeks. In each research series a graded ergocycle exercise test was performed in order to measure VO_2max and determine the lactate threshold as well as a simulated 30 km individual time trial.

Effects of 10 days of separate heat and hypoxic exposure on heat acclimation and temperate exercise performance

Adaptations to heat and hypoxia are typically studied in isolation but are often encountered in combination. Whether the adaptive response to multiple stressors affords the same response as when examined in isolation is unclear. We examined 1) the influence of overnight moderate normobaric hypoxia on the time course and magnitude of adaptation to daily heat exposure and 2) whether heat acclimation (HA) was ergogenic and whether this was influenced by an additional hypoxic stimulus. Eight males [V̇o2max = 58.5 (8.3) ml·kg−1·min−1] undertook two 11-day HA programs (balanced-crossover design), once with overnight normobaric hypoxia (HAHyp): 8 (1) h per night for 10 nights [[Formula: see text] = 0.156; SpO2 = 91 (2)%] and once without (HACon). Days 1, 6, and 11 were exercise-heat stress tests [HST (40°C, 50% relative humidity, RH)]; days 2–5 and 7–10 were isothermal strain [target rectal temperature (Tre) ~38.5°C], exercise-heat sessions. A graded exercise test and 30-min cycle trial were undertaken pre-, post-, and 14 days after HA in temperate normoxia (22°C, 55% RH; FIO2 = 0.209). HA was evident on day 6 (e.g., reduced Tre, mean skin temperature (T̄sk), heart rate, and sweat [Na+], P < 0.05) with additional adaptations on day 11 (further reduced T̄sk and heart rate). HA increased plasma volume [+5.9 (7.3)%] and erythropoietin concentration [+1.8 (2.4) mIU/ml]; total hemoglobin mass was unchanged. Peak power output [+12 (20) W], lactate threshold [+15 (18) W] and work done [+12 (20) kJ] increased following HA. The additional hypoxic stressor did not affect these adaptations. In conclusion, a separate moderate overnight normobaric hypoxic stimulus does not affect the time course or magnitude of HA. Performance may be improved in temperate normoxia following HA, but this is unaffected by an additional hypoxic stressor.

Intermittent hypoxic training improves anaerobic performance in competitive swimmers when implemented into a direct competition mesocycle

The main objective of this research was to evaluate the efficacy of intermittent hypoxic training (IHT) on anaerobic and aerobic capacity and swimming performance in well-trained swimmers. Sixteen male swimmers were randomly divided into a hypoxia (H) group (n = 8), which trained in a normobaric hypoxia environment, and a control (C) group (n = 8), which exercised under normoxic conditions. However, one participant left the study without explanation. During the experiment group H trained on land twice per week in simulated hypoxia (FiO₂ = 15.5%, corresponding to 2,500 m a.s.l); however, they conducted swim training in normoxic conditions. Group C performed the same training program under normoxic conditions. The training program included four weekly microcyles, followed by three days of recovery. During practice sessions on land, the swimmers performed 30 second sprints on an arm-ergometer, alternating with two minute high intensity intervals on a lower limb cycle ergometer. The results showed that the training on land caused a significant (p<0.05) increase in absolute maximal workload (WR_max) by 7.4% in group H and by 3.2% in group C and relative values of VO_2max by 6.9% in group H and 3.7% in group C. However, absolute values of VO_2max were not significantly changed. Additionally, a significant (p<0.05) increase in mean power (P_mean) during the first (11.7%) and second (11.9%) Wingate tests was only observed in group H. The delta values of lactate concentration (ΔLA) after both Wingate tests were significantly (p<0.05) higher in comparison to baseline levels by 28.8% in group H. Opposite changes were observed in delta values of blood pH (ΔpH) after both Wingate tests in group H, with a significant decrease in values of ΔpH by 33.3%. The IHT caused a significant (p<0.05) improvement in 100m and 200m swimming performance, by 2.1% and 1.8%, respectively in group H. Training in normoxia (group C), resulted in a significant (p<0.05) improvement of swimming performance at 100m and 200m, by 1.1% and 0.8%, respectively. In conclusion, the most important finding of this study includes a significant improvement in anaerobic capacity and swimming performance after high-intensity IHT. However, this training protocol had no effect on absolute values of VO_2max and hematological variables.

No Influence of Transcutaneous Electrical Nerve Stimulation on Exercise-Induced Pain and 5-Km Cycling Time-Trial Performance

Introduction: Afferent information from exercising muscle contributes to the sensation of exercise-induced muscle pain. Transcutaneous electrical nerve stimulation (TENS) delivers low–voltage electrical currents to the skin, inhibiting nociceptive afferent information. The use of TENS in reducing perceptions of exercise-induced pain has not yet been fully explored. This study aimed to investigate the effect of TENS on exercise-induced muscle pain, pacing strategy, and performance during a 5-km cycling time trial (TT).

Methods: On three separate occasions, in a single-blind, randomized, and cross-over design, 13 recreationally active participants underwent a 30-min TENS protocol, before performing a 5-km cycling TT. TENS was applied to the quadriceps prior to exercise under the following conditions; control (CONT), placebo with sham TENS application (PLAC), and an experimental condition with TENS application (TENS). Quadriceps fatigue was assessed with magnetic femoral nerve stimulation assessing changes in potentiated quadriceps twitch force at baseline, pre and post exercise. Subjective scores of exertion, affect and pain were taken every 1-km.

Results: During TTs, application of TENS did not influence pain perceptions (P = 0.68, ηp2 = 0.03). There was no significant change in mean power (P = 0.16, ηp2 = 0.16) or TT duration (P = 0.17, ηp2 = 0.14), although effect sizes were large for these two variables. Changes in power output were not significant but showed moderate effect sizes at 500-m (ηp2 = 0.10) and 750-m (ηp2 = 0.10). Muscle recruitment as inferred by electromyography data was not significant, but showed large effect sizes at 250-m (ηp2 = 0.16), 500-m (ηp2 = 0.15), and 750-m (ηp2 = 0.14). This indicates a possible effect for TENS influencing performance up to 1-km.

Discussion: These findings do not support the use of TENS to improve 5-km TT performance.

Dietary fish oil delays hypoxic skeletal muscle fatigue and enhances caffeine-stimulated contractile recovery in the rat in vivo hindlimb

Oxygen efficiency influences skeletal muscle contractile function during physiological hypoxia. Dietary fish oil, providing docosahexaenoic acid (DHA), reduces the oxygen cost of muscle contraction. This study used an autologous perfused rat hindlimb model to examine the effects of a fish oil diet on skeletal muscle fatigue during an acute hypoxic challenge. Male Wistar rats were fed a diet rich in saturated fat (SF), long-chain (LC) n-6 polyunsaturated fatty acids (n-6 PUFA), or LC n-3 PUFA DHA from fish oil (FO) (8 weeks). During anaesthetised and ventilated conditions (normoxia 21% O₂ (SaO₂-98%) and hypoxia 14% O₂ (SaO₂-89%)) the hindlimb was perfused at a constant flow and the gastrocnemius-plantaris-soleus muscle bundle was stimulated via sciatic nerve (2 Hz, 6-12V, 0.05 ms) to established fatigue. Caffeine (2.5, 5, 10 mM) was supplied to the contracting muscle bundle via the arterial cannula to assess force recovery. Hypoxia, independent of diet, attenuated maximal twitch tension (normoxia: 82 ± 8; hypoxia: 41 ± 2 g·g^-1 tissue w.w.). However, rats fed FO sustained higher peak twitch tension compared with the SF and n-6 PUFA groups (P < 0.05), and the time to decline to 50% of maximum twitch tension was extended (SF: 546 ± 58; n-6 PUFA: 522 ± 58; FO: 792 ± 96 s; P < 0.05). In addition, caffeine-stimulated skeletal muscle contractile recovery was enhanced in the FO-fed animals (SF: 41 ± 3; n-6 PUFA: 40 ± 4; FO: 52 ± 7% recovery; P < 0.05). These results support a physiological role of DHA in skeletal muscle membranes when exposed to low-oxygen stress that is consistent with the attenuation of muscle fatigue under physiologically normoxic conditions.

Effects of Acutely Intermittent Hypoxic Exposure on Running Economy and Physical Performance in Basketball Players

Kilding, AE, Dobson, BP, and Ikeda, E. Effects of acutely intermittent hypoxic exposure on running economy and physical performance in basketball players. J Strength Cond Res 30(7): 2033-2042, 2016-The aim of this study was to determine the effect of short duration intermittent hypoxic exposure (IHE) on physical performance in basketball players. Using a single-blind placebo-controlled group design, 14 trained basketball players were subjected to 15 days of passive short duration IHE (n = 7), or normoxic control (CON, n = 7), using a biofeedback nitrogen dilution device. A range of physiological, performance, and hematological variables were measured at baseline, and 10 days after IHE. After intervention, the IHE group, relative to the CON group, exhibited improvements in the Yo-Yo intermittent recovery level 1 (+4.8 ± 1.6%; effect size [ES]: 1.0 ± 0.4) and repeated high-intensity exercise test performance (-3.5 ± 1.6%; ES: -0.4 ± 0.2). Changes in hematological parameters were minimal, although soluble transferrin receptor increased after IHE (+9.2 ± 10.1%; ES: 0.3 ± 0.3). Running economy at 11 km·h (-9.0 ± 9.7%; ES: -0.7 ± 0.7) and 13 km·h was improved (-8.2 ± 6.9%; ES: -0.7 ± 0.5), but changes to V[Combining Dot Above]O2peak, HRpeak, and lactate were unclear. In summary, acutely IHE resulted in worthwhile changes in physical performance tests among competitive basketball players. However, physiological measures explaining the performance enhancement were in most part unclear.

Short-duration intermittent hypoxia enhances endurance capacity by improving muscle fatty acid metabolism in mice

This study was designed to (1) investigate the effects of acute short-duration intermittent hypoxia on musclemRNAand microRNAexpression levels; and (2) clarify the mechanisms by which short-duration intermittent hypoxia improves endurance capacity. Experiment-1: Male mice were subjected to either acute 1-h hypoxia (12% O2), acute short-duration intermittent hypoxia (12% O2for 15 min, room air for 10 min, 4 times, Int-Hypo), or acute endurance exercise (Ex). The expression of vascular endothelial growth factor-AmRNAwas significantly greater than the control at 0 h post Ex and 6 h post Int-Hypo in the deep red region of the gastrocnemius muscle. miR-16 expression levels were significantly lower at 6 and 10 h post Int-Hypo. Peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α)mRNAlevels were significantly greater than the control at 3 h post Ex and 6 h post Int-Hypo. miR-23a expression levels were lower than the control at 6-24 h post Int-Hypo. Experiment-2: Mice were subjected to normoxic exercise training with or without intermittent hypoxia for 3 weeks. Increases in maximal exercise capacity were significantly greater by training with short-duration intermittent hypoxia (IntTr) than without hypoxia. Both 3-Hydroxyacyl-CoA-dehydrogenase and total carnitine palmitoyl transferase activities were significantly enhanced in IntTr. Peroxisome proliferator-activated receptor delta andPGC-1α mRNAlevels were both significantly greater in IntTr than in the sedentary controls. These results suggest that exercise training under normoxic conditions with exposure to short-duration intermittent hypoxia represents a beneficial strategy for increasing endurance performance by enhancing fatty acid metabolism in skeletal muscle.

Association between Serum Interleukin-17A Level and High-Altitude Deacclimatization Syndrome

High-altitude deacclimatization syndrome (HADAS) is emerging as a severe public health issue that threatens the quality of life of individuals who return to lower altitude from high altitude. In this study, we measured serum levels of SOD, MDA, IL-17A, IL-10, TNF-α, and HADAS score in HADAS subjects at baseline and 50th and 100th days and to evaluate the relationship between interleukins, including IL-17A, and HADAS. Our data showed that and the serum IL-17A levels and HADAS score decreased over time in the HADAS group, and serum IL-17A levels were significantly higher in the HADAS group at baseline and 50th day compared with controls (p < 0.05). Furthermore, baseline serum levels of MDA and TNF-α were significantly higher, while SOD and IL-10 levels were lower in HADAS subjects compared with controls (p < 0.05). It is interesting that serum levels of IL-17A were clearly interrelated with HADAS incidence and severity (p < 0.05). ROC curve analysis showed that combined serum IL-17A and IL-10 levels were a better predictor of HADAS incidence than serum levels of IL-17A or IL-10 alone. These data suggest that serum levels of IL-17A are a novel predictive index of HADAS.

Po2 cycling protects diaphragm function during reoxygenation via ROS, Akt, ERK, and mitochondrial channels

Po2 cycling, often referred to as intermittent hypoxia, involves exposing tissues to brief cycles of low oxygen environments immediately followed by hyperoxic conditions. After experiencing long-term hypoxia, muscle can be damaged during the subsequent reintroduction of oxygen, which leads to muscle dysfunction via reperfusion injury. The protective effect and mechanism behind Po2 cycling in skeletal muscle during reoxygenation have yet to be fully elucidated. We hypothesize that Po2 cycling effectively increases muscle fatigue resistance through reactive oxygen species (ROS), protein kinase B (Akt), extracellular signal-regulated kinase (ERK), and certain mitochondrial channels during reoxygenation. Using a dihydrofluorescein fluorescent probe, we detected the production of ROS in mouse diaphragmatic skeletal muscle in real time under confocal microscopy. Muscles treated with Po2 cycling displayed significantly attenuated ROS levels (n = 5; P < 0.001) as well as enhanced force generation compared with controls during reperfusion (n = 7; P < 0.05). We also used inhibitors for signaling molecules or membrane channels such as ROS, Akt, ERK, as well as chemical stimulators to close mitochondrial ATP-sensitive potassium channel (KATP) or open mitochondrial permeability transition pore (mPTP). All these blockers or stimulators abolished improved muscle function with Po2 cycling treatment. This current investigation has discovered a correlation between KATP and mPTP and the Po2 cycling pathway in diaphragmatic skeletal muscle. Thus we have identified a unique signaling pathway that may involve ROS, Akt, ERK, and mitochondrial channels responsible for Po2 cycling protection during reoxygenation conditions in the diaphragm.

The Effects of Backwards Running Training on Forward Running Economy in Trained Males

Backwards running (BR) results in greater cardiopulmonary response and muscle activity compared with forward running (FR). BR has traditionally been used in rehabilitation for disorders such as stroke and lower leg extremity injuries, as well as in short bursts during various athletic events. The aim of this study was to measure the effects of sustained backwards running training on forward running economy in trained male athletes. Eight highly trained, male runners (26.13 ± 6.11 years, 174.7 ± 6.4 cm, 68.4 ± 9.24 kg, 8.61 ± 3.21% body fat, 71.40 ± 7.31 ml·kg(-1)·min(-1)) trained with BR while harnessed on a treadmill at 161 m·min(-1) for 5 weeks following a 5-week BR run-in period at a lower speed (134 m·min(-1)). Subjects were tested at baseline, postfamiliarized, and post-BR training for body composition, a ramped VO2max test, and an economy test designed for trained male runners. Subjects improved forward running economy by 2.54% (1.19 ± 1.26 ml·kg(-1)·min(-1), p = 0.032) at 215 m·min(-1). VO2max, body mass, lean mass, fat mass, and % body fat did not change (p > 0.05). Five weeks of BR training improved FR economy in healthy, trained male runners without altering VO2max or body composition. The improvements observed in this study could be a beneficial form of training to an already economical population to improve running economy.

Strategies to improve running economy

Running economy (RE) represents a complex interplay of physiological and biomechanical factors that is typically defined as the energy demand for a given velocity of submaximal running and expressed as the submaximal oxygen uptake (VO2) at a given running velocity. This review considered a wide range of acute and chronic interventions that have been investigated with respect to improving economy by augmenting one or more components of the metabolic, cardiorespiratory, biomechanical or neuromuscular systems. Improvements in RE have traditionally been achieved through endurance training. Endurance training in runners leads to a wide range of physiological responses, and it is very likely that these characteristics of running training will influence RE. Training history and training volume have been suggested to be important factors in improving RE, while uphill and level-ground high-intensity interval training represent frequently prescribed forms of training that may elicit further enhancements in economy. More recently, research has demonstrated short-term resistance and plyometric training has resulted in enhanced RE. This improvement in RE has been hypothesized to be a result of enhanced neuromuscular characteristics. Altitude acclimatization results in both central and peripheral adaptations that improve oxygen delivery and utilization, mechanisms that potentially could improve RE. Other strategies, such as stretching should not be discounted as a training modality in order to prevent injuries; however, it appears that there is an optimal degree of flexibility and stiffness required to maximize RE. Several nutritional interventions have also received attention for their effects on reducing oxygen demand during exercise, most notably dietary nitrates and caffeine. It is clear that a range of training and passive interventions may improve RE, and researchers should concentrate their investigative efforts on more fully understanding the types and mechanisms that affect RE and the practicality and extent to which RE can be improved outside the laboratory.

The effects of high intensity interval training in normobaric hypoxia on aerobic capacity in basketball players

The aim of the present study was to evaluate the efficacy of 3-week high intensity interval training in normobaric hypoxia (IHT) on aerobic capacity in basketball players. Twelve male well trained basketball players, randomly divided into a hypoxia (H) group (n=6; age: 22±1.6 years; VO2max: 52.6±3.9 ml/kg/min; body height - BH: 188.8±6.1 cm; body mass - BM: 83.9±7.2 kg; % of body fat - FAT%: 11.2±3.1%), and a control (C) group (n=6; age: 22±2.4 years; VO2max: 53.0±5.2 ml/kg/min; BH: 194.3 ± 6.6 cm; BM: 99.9±11.1 kg; FAT% 11.0±2.8 %) took part in the study. The training program applied during the study was the same for both groups, but with different environmental conditions during the selected interval training sessions. For 3 weeks, all subjects performed three high intensity interval training sessions per week. During the interval training sessions, the H group trained in a normobaric hypoxic chamber at a simulated altitude of 2500 m, while the group C performed interval training sessions under normoxia conditions also inside the chamber. Each interval running training sessions consisted of four to five 4 min bouts at 90% of VO2max velocity determined in hypoxia (vVO2max-hyp) for the H group and 90% of velocity at VO2max determined in normoxia for the group C. The statistical post-hoc analysis showed that the training in hypoxia caused a significant (p<0.001) increase (10%) in total distance during the ramp test protocol (the speed was increased linearly by 1 km/h per 1min until volitional exhaustion), as well as increased (p<0.01) absolute (4.5%) and relative (6.2%) maximal workload (WRmax). Also, the absolute and relative values of VO2max in this group increased significantly (p<0.001) by 6.5% and 7.8%. Significant, yet minor changes were also observed in the group C, where training in normoxia caused an increase (p<0.05) in relative values of WRmax by 2.8%, as well as an increase (p<0.05) in the absolute (1.3%) and relative (2.1%) values of VO2max. This data suggest that an intermittent hypoxic training protocol with high intensity intervals (4 to 5 × 4 min bouts at 90% of vVO2max-hyp) is an effective training means for improving aerobic capacity at sea level in basketball players.

Analysis of high-altitude de-acclimatization syndrome after exposure to high altitudes: a cluster-randomized controlled trial

The syndrome of high-altitude de-acclimatization commonly takes place after long-term exposure to high altitudes upon return to low altitudes. The syndrome severely affects the returnee's quality of life. However, little attention has been paid to careful characterization of the syndrome and their underlying mechanisms. Male subjects from Chongqing (n = 67, 180 m) and Kunming (n = 70, 1800 m) visited a high-altitude area (3650 m) about 6 months and then returned to low-altitude. After they came back, all subjects were evaluated for high-altitude de-acclimatization syndrome on the 3^rd, 50^th, and 100^th. Symptom scores, routine blood and blood gas tests, and myocardial zymograms assay were used for observation their syndrome. The results showed that the incidence and severity of symptoms had decreased markedly on the 50^th and 100^th days, compared with the 3^rd day. The symptom scores and incidence of different symptoms were lower among subjects returning to Kunming than among those returning to Chongqing. On the 3^rd day, RBC, Hb, Hct, CK, CK-MB, and LDH values were significantly lower than values recorded at high altitudes, but they were higher than baseline values. On the 50^th day, these values were not different from baseline values, but LDH levels did not return to baseline until the 100^th day. These data show that, subjects who suffered high-altitude de-acclimatization syndrome, the recovery fully processes takes a long time (≥100^th days). The appearance of the syndrome is found to be related to the changes in RBC, Hb, Hct, CK, CK-MB, and LDH levels, which should be caused by reoxygenation after hypoxia.

Enhancing team-sport athlete performance: is altitude training relevant?

Field-based team sport matches are composed of short, high-intensity efforts, interspersed with intervals of rest or submaximal exercise, repeated over a period of 60-120 minutes. Matches may also be played at moderate altitude where the lower oxygen partial pressure exerts a detrimental effect on performance. To enhance run-based performance, team-sport athletes use varied training strategies focusing on different aspects of team-sport physiology, including aerobic, sprint, repeated-sprint and resistance training. Interestingly, 'altitude' training (i.e. living and/or training in O(2)-reduced environments) has only been empirically employed by athletes and coaches to improve the basic characteristics of speed and endurance necessary to excel in team sports. Hypoxia, as an additional stimulus to training, is typically used by endurance athletes to enhance performance at sea level and to prepare for competition at altitude. Several approaches have evolved in the last few decades, which are known to enhance aerobic power and, thus, endurance performance. Altitude training can also promote an increased anaerobic fitness, and may enhance sprint capacity. Therefore, altitude training may confer potentially-beneficial adaptations to team-sport athletes, which have been overlooked in contemporary sport physiology research. Here, we review the current knowledge on the established benefits of altitude training on physiological systems relevant to team-sport performance, and conclude that current evidence supports implementation of altitude training modalities to enhance match physical performances at both sea level and altitude. We hope that this will guide the practice of many athletes and stimulate future research to better refine training programmes.

Metabolic adaptations may counteract ventilatory adaptations of intermittent hypoxic exposure during submaximal exercise at altitudes up to 4000 m

Intermittent hypoxic exposure (IHE) has been shown to induce aspects of altitude acclimatization which affect ventilatory, cardiovascular and metabolic responses during exercise in normoxia and hypoxia. However, knowledge on altitude-dependent effects and possible interactions remains scarce. Therefore, we determined the effects of IHE on cardiorespiratory and metabolic responses at different simulated altitudes in the same healthy subjects. Eight healthy male volunteers participated in the study and were tested before and 1 to 2 days after IHE (7×1 hour at 4500 m). The participants cycled at 2 submaximal workloads (corresponding to 40% and 60% of peak oxygen uptake at low altitude) at simulated altitudes of 2000 m, 3000 m, and 4000 m in a randomized order. Gas analysis was performed and arterial oxygen saturation, blood lactate concentrations, and blood gases were determined during exercise. Additionally baroreflex sensitivity, hypoxic and hypercapnic ventilatory response were determined before and after IHE. Hypoxic ventilatory response was increased after IHE (p<0.05). There were no altitude-dependent changes by IHE in any of the determined parameters. However, blood lactate concentrations and carbon dioxide output were reduced; minute ventilation and arterial oxygen saturation were unchanged, and ventilatory equivalent for carbon dioxide was increased after IHE irrespective of altitude. Changes in hypoxic ventilatory response were associated with changes in blood lactate (r = −0.72, p<0.05). Changes in blood lactate correlated with changes in carbon dioxide output (r = 0.61, p<0.01) and minute ventilation (r = 0.54, p<0.01). Based on the present results it seems that the reductions in blood lactate and carbon dioxide output have counteracted the increased hypoxic ventilatory response. As a result minute ventilation and arterial oxygen saturation did not increase during submaximal exercise at simulated altitudes between 2000 m and 4000 m.

Exercise increases the frequency of circulating hematopoietic progenitor cells, but reduces hematopoietic colony-forming capacity

Circulating hematopoietic progenitor cells (CPCs) may be triggered by physical exercise and/or normobaric hypoxia from the bone marrow. The aim of the study was to investigate the influence of physical exercise and normobaric hypoxia on CPC number and functionality in the peripheral blood as well as the involvement of oxidative stress parameters as possibly active agents. Ten healthy male subjects (25.3±4.4 years) underwent a standardized cycle incremental exercise test protocol (40 W+20 W/min) under either normoxic (FiO2 ∼0.21) or hypoxic conditions (FiO2<0.15, equals 3,500 m, 3 h xposure) within a time span of at least 1 week. Blood was drawn from the cubital vein before and 10, 30, 60, and 120 min after exercise. The number of CPCs in the peripheral blood was analyzed by flow cytometry (CD34/CD45-positive cells). The functionality of cells present was addressed by secondary colony-forming unit-granulocyte macrophage (CFU-GM) assays. To determine a possible correlation between the mobilization of CPCs and reactive oxygen species, parameters for oxidative stress such as malondialdehyde (MDA) and myeloperoxidase (MPO) were obtained. Data showed a significant increase of CPC release under normoxic as well as hypoxic conditions after 10 min of recovery (P<0.01). Most interestingly, although CD34+/CD45dim cells increased in number, the proliferative capacity of CPCs decreased significantly 10 min after cessation of exercise (P<0.05). A positive correlation between CPCs and MDA/MPO levels turned out to be significant for both normoxic and hypoxic conditions (P<0.05/P<0.01). Hypoxia did not provoke an additional effect. Although the CPC frequency increased, the functionality of CPCs decreased significantly after exercise, possibly due to the influence of increased oxidative stress levels.

Mitochondrial function in human skeletal muscle following high-altitude exposure

Studies regarding mitochondrial modifications in human skeletal muscle following acclimatization to high altitude are conflicting, and these inconsistencies may be due to the prevalence of representing mitochondrial function through static and isolated measurements of specific mitochondrial characteristics. The aim of this study, therefore, was to investigate mitochondrial function in response to high-altitude acclimatization through measurements of respiratory control in the vastus lateralis muscle. Skeletal muscle biopsies were obtained from 10 lowland natives prior to and again after a total of 9-11 days of exposure to 4559 m. High-resolution respirometry was performed on the muscle samples to compare respiratory chain function and respiratory capacities. Respirometric analysis revealed that mitochondrial function was largely unaffected, because high-altitude exposure did not affect the capacity for fat oxidation or individualized respiration capacity through either complex I or complex II. Respiratory chain function remained unaltered, because neither coupling nor respiratory control changed in response to hypoxic exposure. High-altitude acclimatization did, however, show a tendency (P = 0.059) to limit mass-specific maximal oxidative phosphorylation capacity. These data suggest that 9-11 days of exposure to high altitude do not markedly modify integrated measures of mitochondrial functional capacity in skeletal muscle despite significant decrements in the concentrations of enzymes involved in the tricarboxylic acid cycle and oxidative phosphorylation.

"Live high-train low" using normobaric hypoxia: a double-blinded, placebo-controlled study

The combination of living at altitude and training near sea level [live high-train low (LHTL)] may improve performance of endurance athletes. However, to date, no study can rule out a potential placebo effect as at least part of the explanation, especially for performance measures. With the use of a placebo-controlled, double-blinded design, we tested the hypothesis that LHTL-related improvements in endurance performance are mediated through physiological mechanisms and not through a placebo effect. Sixteen endurance cyclists trained for 8 wk at low altitude (<1,200 m). After a 2-wk lead-in period, athletes spent 16 h/day for the following 4 wk in rooms flushed with either normal air (placebo group, n = 6) or normobaric hypoxia, corresponding to an altitude of 3,000 m (LHTL group, n = 10). Physiological investigations were performed twice during the lead-in period, after 3 and 4 wk during the LHTL intervention, and again, 1 and 2 wk after the LHTL intervention. Questionnaires revealed that subjects were unaware of group classification. Weekly training effort was similar between groups. Hb mass, maximal oxygen uptake (VO(2)) in normoxia, and at a simulated altitude of 2,500 m and mean power output in a simulated, 26.15-km time trial remained unchanged in both groups throughout the study. Exercise economy (i.e., VO(2) measured at 200 W) did not change during the LHTL intervention and was never significantly different between groups. In conclusion, 4 wk of LHTL, using 16 h/day of normobaric hypoxia, did not improve endurance performance or any of the measured, associated physiological variables.

Altitude training and its influence on physical endurance in swimmers

It is possible to plan an altitude training (AT) period in such a way that the enhanced physical endurance obtained as a result of adaptation to hypoxia will appear and can be used to improve performance in competition. Yet finding rationales for usage of AT in highly trained swimmers is problematic. In practice AT, in its various forms, is still controversial, and an objective review of research concentrating on the advantages and disadvantages of AT has been presented in several scientific publications, including in no small part the observations of swimmers. The aim of this article is to review the various methods and present both the advantageous and unfavourable physiological changes that occur in athletes as a result of AT. Moreover, AT results in the sport of swimming have been collected. They include an approach towards primary models of altitude/hypoxic training: live high + train high, live high + train low, live low + train high, as well as subsequent methods: Intermittent Hypoxic Exposure (IHE) and Intermittent Hypoxic Training (IHT). Apnoea training, which is descended from freediving, is also mentioned, and which can be used with, or as a substitute for, the well-known IHE or IHT methods. In conclusion, swimmers who train using hypoxia may be among the best-trained athletes, and that even a slight improvement in physical endurance might result in the shortening of a swimming time in a given competition, and the achievement of a personal best, which is hard to obtain by normal training methods, when the personal results of the swimmer have reached a plateau.

Intermittent hypoxic exposure does not improve endurance performance at altitude

PURPOSE

This study examined the effect of 1 wk of normobaric intermittent hypoxic exposure (IHE) combined with exercise training on endurance performance at a 4300-m altitude (HA).

METHODS

Seventeen male lowlanders were divided into an IHE (n = 11) or SHAM (n = 6) group. Each completed cycle endurance testing consisting of two 20-min steady state (SS) exercise bouts (at 40% and 60% V O2peak) followed by a 10-min break and then a 720-kJ cycle time trial at HA before IHE or SHAM treatment (Pre-T). IHE treatment consisted of a 2-h rest at a PO2 of 90 mm Hg followed by two 25-min bouts of exercise at approximately 80% of peak HR at a PO2 of 110 mm Hg for 1 wk in a hypoxia room. SHAM treatment was identical except that the PO2 was 148 mm Hg for both rest and exercise. After IHE or SHAM treatment (Post-T), all completed a second cycle endurance test at HA. HR, arterial oxygen saturation (SaO2), and RPE were obtained from the 10th to the 15th minute during the two SS exercise bouts and every 5 min during the time trial.

RESULTS

Seven volunteers in the IHE group could not finish the 720-kJ time trial either at Pre-T or at Post-T. Time trial analysis was limited, therefore, to the time to reach 360 kJ (halfway point) for all volunteers. From Pre-T to Post-T, there was no improvement in time trial performance (min +/- SE) in the IHE (62.0 +/- 4.8 to 63.7 +/- 5.2) or SHAM (60.9 +/- 6.3 to 54.2 +/- 6.8) group. There was no change from Pre-T to Post-T in HR, SaO2, and RPE during the two SS exercise bouts or time trial in either group.

CONCLUSIONS

One week of IHE combined with exercise training does not improve endurance performance at a 4300-m altitude in male lowlanders.

Intermittent hypoxia does not affect endurance performance at moderate altitude in well-trained athletes

In this study, we examined the effects of a pre-acclimatization programme on endurance performance at moderate altitude using a resting intermittent hypoxia protocol. The time-trial performance of 11 cyclists was determined at low altitude (600 m). Athletes were randomly assigned in a double-blind fashion to the hypoxia or the control group. The pre-acclimatization programme consisted of seven sessions each lasting 1 h in normobaric hypoxia (inspired fraction of oxygen of 12.5%, equivalent to approximately 4500 m) for the hypoxia group (n = 6) and in normoxia (inspired fraction of oxygen of 20.9%) for the control group (n = 5). The time-trials were repeated at moderate altitude (1970 m). Mean power output during the time-trial at moderate altitude was decreased in the hypoxia group (-0.26 +/- 0.11 W x kg(-1)) and in the control group (-0.13 +/- 0.04 W x kg(-1)) compared with at low altitude but did not differ between groups (P = 0.13). Our results suggest that the applied protocol of intermittent hypoxia had no positive effect on endurance performance at moderate altitude. Whether different intermittent hypoxia protocols are advantageous remains to be determined.

Daily hypoxia increases basal monocyte HSP72 expression in healthy human subjects

Heat shock protein 72 (HSP72) performs vital roles within the body at rest and during periods of stress. In vitro, research demonstrates HSP72 induction in response to hypoxia. Recently, in vivo, an acute hypoxic exposure (75 min at 2,980 m) was sufficient to induce significant increases in monocyte expressed HSP72 (mHSP72) and a marker of oxidative stress in healthy human subjects. The purpose of the current study was to identify the impact of 10 consecutive days of hypoxic exposures (75 min at 2,980 m) on mHSP72 and erythropoietin (EPO) expression, markers of oxidative stress, and maximal oxygen consumption in graded incremental aerobic exercise. Eight male subjects were exposed to daily normobaric hypoxic exposures for 75 min at 2,980 m for 10 consecutive days, commencing and ceasing at 0930 and 1045, respectively. This stressor was sufficient to induce significant increases in mHSP72, which was significantly elevated from day 2 of the hypoxic exposures until 48 h post-final exposure. Notably, this increase had an initial rapid (30% day on day compared to baseline) and final slow phase (16% day on day compared to baseline) of expression. The authors postulate that 7-day hypoxic exposure in this manner would be sufficient to induce near maximum hypoxia-mediated basal mHSP72 expression. Elevated levels of mHSP72 are associated with acquired thermotolerance and provide cross tolerance to non-related stressors in vivo, the protocol used here may provide a useful tool for elevating mHSP72 in vivo. Aside from these major findings, significant transient daily elevations were seen in a marker of oxidative stress, alongside sustained increases in EPO expression. However, no physiologically significant changes were seen in maximal oxygen consumption or time to exhaustion.

Effect of intermittent hypoxia on muscle and cerebral oxygenation during a 20-km time trial in elite athletes: a preliminary report

The effects of intermittent hypoxic exposure (IHE) on cerebral and muscle oxygenation, arterial oxygen saturation (SaO2), and respiratory gas exchange during a 20-km cycle time trial (20TT) were examined (n = 9) in a placebo-controlled randomized design. IHE (7:3 min hypoxia to normoxia) involved 90-min sessions for 10 days, with SaO2 clamped at ∼80%. Prior to, and 2 days after the intervention, a 20TT was performed. During the final minute of the 20TT, in the IHE group only, muscle oxyhemoglobin (oxy-Hb) was elevated (mean ± 95% confidence interval 1.3 ± 1.2 ΔµM, p = 0.04), whereas cerebral oxy-Hb was reduced (–1.9% ± 1.0%, p < 0.01) post intervention compared with baseline. The 20TT performance was unchanged between groups (p = 0.7). In the IHE group, SaO2 was higher (1.0 ± 0.7Δ%, p = 0.006) and end-tidal PCO2 was lower (–1.2 ± 0.1 mm Hg, p = 0.01) during the final stage of the 20TT post intervention compared with baseline. In summary, reductions in muscle oxy-Hb and systemic SaO2 occurring at exercise intensities close to maximal at the end of a 20TT were offset by IHE, although this was not translated into improved performance.

High-intensity kayak performance after adaptation to intermittent hypoxia

CONTEXT

Live-high train-low altitude training produces worthwhile gains in performance for endurance athletes, but the benefits of adaptation to various forms of artificial altitude are less clear.

PURPOSE

To quantify the effects of intermittent hypoxic exposure on kayak performance.

METHODS

In a crossover design with a 6-week washout, we randomized 10 subelite male sprint kayak paddlers to hypoxia or control groups for 3 weeks (5 days/week) of intermittent hypoxic exposure using a nitrogen-filtration device. Each day's exposure consisted of alternately breathing hypoxic and ambient air for 5 minutes each over 1 hour. Performance tests were an incremental step test to estimate peak power, maximal oxygen uptake, exercise economy, and lactate threshold; a 500-m time trial; and 5 x 100-m sprints. All tests were performed on a wind-braked kayak ergometer 7 and 3 days pretreatment and 3 and 10 days posttreatment. Hemoglobin concentration was measured at 1 day pretreatment, 5 and 10 days during treatment, and 3 days after treatment.

RESULTS

Relative to control, at 3 days posttreatment the hypoxia group showed the following increases: peak power 6.8% (90% confidence limits, + or - 5.2%), mean repeat sprint power 8.3% (+ or - 6.7%), and hemoglobin concentration 3.6% (+ or - 3.2%). Changes in lactate threshold, mean 500-m power, maximal oxygen uptake, and exercise economy were unclear. Large effects for peak power and mean sprint speed were still present 10 days posthypoxia.

CONCLUSION

These effects of intermittent hypoxic exposure should enhance performance in kayak racing. The effects might be mediated via changes in oxygen transport.

Effect of intermittent hypoxic training on 20 km time trial and 30 s anaerobic performance

This study aimed to verify whether the "live low, train high" approach is beneficial for endurance and/or anaerobic cycling performance. Sixteen well-trained athletes completed 90 min of endurance training (60-70% of heart rate reserve), followed by two 30-s all-out sprints (Wingate test), daily, for 10 consecutive days. Nine subjects [intermittent hypoxic training (IHT) group] trained with an F(I)O(2) set to produce arterial oxygen saturations of approximately 88-82%, while seven subjects (placebo group) trained while breathing a normal gas mixture (F(I)O(2)=0.21). Four performance tests were conducted at sea level including a familiarization and baseline trial, followed by repeat trials at 2 and 9 days post-intervention. Relative to the placebo group, the mean power during the 30-s Wingate test increased by 3.0% (95% confidence limits, CL +/- 3.5%) 2 days, and 1.7% (+/- 3.8%) 9 days post-IHT. Changes in other performance variables (30 s peak power, 20 km mean power and 20 km oxygen cost) were unclear. During the time trial, the IHT participants' blood lactate concentration, respiratory exchange ratio, and SpO(2), relative to the placebo group, was substantially increased at 2 days post-intervention. The addition of IHT to the normal training program of well-trained athletes produced worthwhile gains in 30 s sprint performance possibly through enhanced glycolysis.

Intermittent hypoxia at rest for improvement of athletic performance

Two modalities of applying hypoxia at rest are reviewed in this paper: intermittent hypoxic exposure (IHE), which consists of hypoxic air for 5-6 min alternating with breathing room air for 4-5 min during sessions lasting 60-90 min, or prolonged hypoxic exposure (PHE) to normobaric or hypobaric hypoxia over up to 3 h/day. Hypoxia with IHE is usually in the range of 12-10%, corresponding to an altitude of about 4000-6000 m. Normobaric or hypobaric hypoxia with PHE corresponds to altitudes of 4000-5500 m. Five of six studies applying IHE and all four well-controlled studies using PHE could not show a significant improvement with these modalities of hypoxic exposure for sea level performance after 14-20 sessions of exposure, with the exception of swimmers in whom there might be a slight improvement by PHE in combination with a subsequent tapering. There is no direct or indirect evidence that IHE or PHE induce any significant physiological changes that might be associated with improving athletic performance at sea level. Therefore, IHE and PHE cannot be recommended for preparation of competitions held at sea level.