Importance of hemoglobin concentration to exercise: acute manipulations

Effects of Swimming Exercise on Early Adolescents' Physical Conditioning and Physical Health: A Systematic Review

BACKGROUND/OBJECTIVES

Swimming is a popular and cost-effective way to prevent sedentary behavior and improve physical conditioning and health during early adolescence. However, information on its impact and benefits on daily life activities is lacking. This systematic review aims to summarize the chronic effects of swimming on physical conditioning and physical health outcomes in early adolescents.

METHODS

The PRISMA 2020 guidelines were followed and PubMed, Scopus, Web of Science, and International Symposium of Biomechanics and Medicine in Swimming proceedings databases were searched. Eligibility criteria were defined on the PICOS framework (healthy adolescents in early puberty, swimming programmes or training, passive or active control groups, general effects on physical conditioning or health, longitudinal) and risk of bias was assessed using RoBANS 2.

RESULTS

From 2365 records, 20 non-randomized studies met the defined criteria. High heterogeneity in sample size and intervention was observed. While studies related to physical conditioning (n = 5) focused on physiological variables and muscular function, the evidence regarding physical health outcomes (n = 15) explored bone accrual, haemodynamics, body composition, musculoskeletal system, and lung growth. High overall risk of bias (70%) was observed due to strict criteria.

CONCLUSIONS

Swimming exercise seems to improve cardiorespiratory fitness, cardiac output, haemodynamics, heart growth, motor performance, and body composition of early adolescents. Despite clear evidence that exists on these chronic effects, research on bone health, postural deficit, motor skills, and sleep quality is still missing.

Impact of a single blood donation on hemoglobin mass, iron stores, and maximum oxygen uptake in pre-menopausal women-A pilot study

BACKGROUND

During whole blood donation (BD), 500 mL of blood is drawn. The time interval between two BDs is at least 8-12 weeks. This period might be insufficient for restoring hemoglobin mass (Hbmass) and iron especially in women, who generally have lower Hbmass and iron availability. Since both variables influence physical performance, this pilot study aimed to monitor Hbmass, iron status, and maximum oxygen uptake (V̇O2max) recovery in women after a single BD.

STUDY DESIGN AND METHODS

In 10 women (24.7 ± 1.7 years), Hbmass, hemoglobin concentration [Hb], iron status, and V̇O2max were assessed before and up to 12 weeks after a single BD.

RESULTS

BD reduced Hbmass from 562 ± 70 g to 499 ± 64 g (p < .001). Although after 8 weeks no significant mean difference was detected, 7 women had not returned to baseline after 12 weeks. [Hb] did not return to initial values (13.4 ± 0.7 g/dL) after 12 weeks (12.9 ± 0.7 g/dL, p < .01). Ferritin decreased from baseline until week 6 (40.9 ± 34.2 ng/mL vs. 12.1 ± 6.9 ng/mL, p < .05) and was not restored after 12 weeks (18.4 ± 12.7 ng/mL, p < .05), with 6 out of 10 women exhibiting iron deficiency (ferritin <15 ng/mL). V̇O2max was reduced by 213 ± 47 mL/min (7.2 ± 1.2%; p < .001) and remained below baseline after 12 weeks (3.2 ± 1.4%, p < .01).

DISCUSSION

For most pre-menopausal women, 12 weeks were not sufficient to recover from BD and achieve baseline Hbmass and iron stores resulting in prolonged reduction of aerobic capacity. A subsequent BD might lead to a severe anemia.

Effect of exercise intensity and apnea on splenic contraction and hemoglobin increase in well-trained cross-country skiers

The human spleen acts as a reservoir for red blood cells, which is mobilized into the systemic circulation during various conditions such as hypoxia and physical exertion. Cross-country (XC) skiers, renowned for their exceptional aerobic capacity, are regularly exposed to high-intensity exercise and local oxygen deficits. We investigated a putative dose-dependent relationship between splenic contraction and concomitant hemoglobin concentration ([Hb]) elevation across four exercise intensities in well-trained XC skiers. Fourteen male XC skiers voluntarily participated in a 2-day protocol, encompassing a serial apnea test and a V ˙ O2max test (day 1), followed by three submaximal exercise intensities on a roller skiing treadmill corresponding to 55, 70, and 85% of V ˙ O2max (day 2). Spleen volume was measured via ultrasonic imaging, and venous blood samples were used to determine [Hb] levels. Baseline spleen volume was similar (266(35) mL) for all conditions (NS). Notably, all conditions induced significant splenic contractions and transient [Hb] elevations. The V ˙ O2max test exhibited the most pronounced splenic contraction (35.8%, p < 0.001) and a [Hb] increase of 8.1%, while the 85% exercise intensity led to 27.1% contraction and the greatest [Hb] increase (8.3%, < 0.001) compared to baseline. The apnea test induced relatively smaller responses (splenic contraction: 20.4%, [Hb] = 3.3%, p < 0.001), akin to the response observed at the 70% exercise intensity (splenic contraction = 23%, [Hb] = 6.4%, p < 0,001) and 55% (splenic contraction = 20.0%, [Hb] = 4.8%, p < 0.001). This study shows a discernible dose-dependent relationship between splenic contraction and [Hb] increase with levels of exercise, effectively distinguishing between submaximal and maximal exercise intensity.

Physiological determinants of decreased peak leg oxygen uptake in chronic disease: a systematic review and meta-analysis

This systematic review and meta-analysis examined the physiological mechanisms responsible for lower peak exercise leg oxygen uptake (V̇o2) in patients with chronic disease. Studies measuring peak leg V̇o2 (primary outcome) and its physiological determinants during large (cycle) or small muscle mass exercise (single-leg knee extension, SLKE) in patients with chronic disease were included in this meta-analysis. Pooled estimates for each outcome were reported as a weighted mean difference (WMD) between chronic disease and controls. We included 10 studies that measured peak leg V̇o2 in patients with chronic disease (n = 109, mean age: 45 yr; encompassing chronic obstructive pulmonary disease, COPD, heart failure with reduced ejection fraction, HFrEF, or chronic renal failure, RF) and age-matched controls (n = 88). In pooled analysis, peak leg V̇o2 (WMD; -0.23 L/min, 95% CI: -0.32 to -0.13), leg oxygen (O2) delivery (WMD: -0.27 L/min, 95% CI: -0.37 to -0.17), and muscle O2 diffusive conductance (WMD: -5.2 mL/min/mmHg, 95% CI: -7.1 to -3.2) were all significantly lower during cycle and SLKE exercise in chronic disease versus controls. These results highlight that during large and small muscle mass exercise in patients with COPD, HFrEF, or RF, there is no single factor causing peak V̇o2 limitations. Specifically, the lower peak V̇o2 in these pathologies is due to not only the expected impairments in convective O2 delivery but also impairments in muscle oxygen diffusive transport from capillary to mitochondria. Whether impaired muscle O2 transport is caused solely by inactivity or additional muscle pathology remains in question.NEW & NOTEWORTHY Peripheral (skeletal muscle and vasculature) factors contribute significantly to reduced exercise capacity during both large and small muscle mass exercise in chronic diseases such as COPD, HFrEF, or RF and should be important targets of therapy in addition to the primary organs (lungs, heart, and kidneys) affected by disease.

The effects of diet-shifting from invertebrates towards fruit on the condition of autumn-migrant Catharus thrushes

Migration is an energetically challenging and risky life history stage for many animals, but could be supported by dietary choices en route, which may create opportunities to improve body and physiological condition. However, proposed benefits of diet shifts, such as between seasonally available invertebrates and fruits, have received limited investigation in free-living animals. We quantified diet composition and magnitude of autumn diet shifts over two time periods in two closely-related species of migratory songbirds on stopover in the northeastern U.S. (Swainson's thrush [Catharus ustulatus], long-distance migrant, N = 83; hermit thrush [C. guttatus], short-distance migrant, N = 79) and used piecewise structural equation models to evaluate the relationships among (1) migration timing, (2) dietary behavior, and (3) morphometric and physiological condition indices. Tissue isotope composition indicated that both species shifted towards greater fruit consumption. Larger shifts in recent weeks corresponded to higher body condition in Swainson's, but not hermit thrushes, and condition was more heavily influenced by capture date in Swainson's thrushes. Presence of "high-antioxidant" fruits in fecal samples was unrelated to condition in Swainson's thrushes and negatively related to multiple condition indices in hermit thrushes, possibly indicating the value of fruits during migration is related more to their energy and/or macronutrient content than antioxidant content. Our results suggest that increased frugivory during autumn migration can support condition, but those benefits might depend on migration strategy: a longer-distance, more capital-dependent migration strategy could require stricter regulation of body condition aided by increased fruit consumption.

Polysaccharides from Brassica rapa root: Extraction, purification, structural features, and biological activities. A review

Brassica rapa (B. rapa) roots are attracting increased attention from nutritionists and health-conscious customers because of their remarkable performance in supplying necessary nutrients. Polysaccharides are major biologically active substances in B. rapa roots, which come in a variety of monosaccharides with different molar ratios and glycosidic bond types. Depending on the source, extraction, separation, and purification methods of B. rapa roots polysaccharides (BRP); different structural features, and pharmacological activities are elucidated. Polysaccharides from B. rapa roots possess a range of nutritional, biological, and health-enhancing characteristics, including anti-hypoxic, antifatigue, immunomodulatory, hypoglycemic, anti-tumor, and antioxidant activities. This paper reviewed extraction and purification methods, structural features, and biological activities as well as correlations between the structural and functional characteristics of polysaccharides from the B. rapa roots. Ultimately, this work will serve as useful reference for understanding the connections between polysaccharide structure and biological activity and developing novel BRP-based functional foods.

Salivary proteomic profile of response to different resistance training protocols: A case report

Resistance training (RT) with blood flow restriction (BFR) or high intensity (HI) are effective to increase muscle mass. To understand this effect, techniques known as "omics" are used to identify possible biomarkers. This study analyzed the salivary proteomic profile of healthy individuals trained before and after two RT protocols both designed with eight exercises for upper- and lower-limbs, one performed at low percentage of one-maximum repetition (%1RM) with BFR technique, and other at high %1RM (HI) without BRF technique. Four healthy males between 18 and 28 years participated in the study. Stimulated saliva was collected before (BBFR/BHI) and immediately after (ABFR/AHI) the two RT protocols. All protein-related processing was performed using label-free proteomic. The difference in expression between groups was expressed as p < .05 for downregulated proteins and 1-p > .95 for upregulated proteins. There was difference in salivary flow between ABFR and BBFR (p = .005). For HI, 87 proteins were found after the practice and 119 before. Three hemoglobin isoforms were increased in AHI compared with BHI. In the BFR comparison, 105 proteins were identified after (ABFR) and 70 before (BBFR). Among those increased ABFR, we highlight five hemoglobin isoforms and Deleted in malignant brain tumors 1 protein. Between ABFR and AHI, 17 isoforms of histones, Transaldolase, Transketolase, Glyceraldehyde-3-phosphate dehydrogenase, and Antileukoproteinase were decreased ABFR. For HI, there was an increase in proteins related to oxidative stress and metabolism of the musculoskeletal system, compared with BFR. HI seems to induce higher anabolic signaling to muscle mass increase and antiatherosclerotic effects.

Omics-driven investigation of the biology underlying intrinsic submaximal working capacity and its trainability

Submaximal exercise capacity is an indicator of cardiorespiratory fitness with clinical and public health implications. Submaximal exercise capacity and its response to exercise programs are characterized by heritability levels of about 40%. Using physical working capacity (power output) at a heart rate of 150 beats/min (PWC150) as an indicator of submaximal exercise capacity in subjects of the HERITAGE Family Study, we have undertaken multi-omics and in silico explorations of the underlying biology of PWC150 and its response to 20 wk of endurance training. Our goal was to illuminate the biological processes and identify panels of genes associated with human variability in intrinsic PWC150 (iPWC150) and its trainability (dPWC150). Our bioinformatics approach was based on a combination of genome-wide association, skeletal muscle gene expression, and plasma proteomics and metabolomics experiments. Genes, proteins, and metabolites showing significant associations with iPWC150 or dPWC150 were further queried for the enrichment of biological pathways. We compared genotype-phenotype associations of emerging candidate genes with reported functional consequences of gene knockouts in mouse models. We investigated the associations between DNA variants and multiple muscle and cardiovascular phenotypes measured in HERITAGE subjects. Two panels of prioritized genes of biological relevance to iPWC150 (13 genes) and dPWC150 (6 genes) were identified, supporting the hypothesis that genes and pathways associated with iPWC150 are different from those underlying dPWC150. Finally, the functions of these genes and pathways suggested that human variation in submaximal exercise capacity is mainly driven by skeletal muscle morphology and metabolism and red blood cell oxygen-carrying capacity.NEW & NOTEWORTHY Multi-omics and in silico explorations of the genes and underlying biology of submaximal exercise capacity and its response to 20 wk of endurance training were undertaken. Prioritized genes were identified: 13 genes for variation in submaximal exercise capacity in the sedentary state and 5 genes for the response level to endurance training, with no overlap between them. Genes and pathways associated with submaximal exercise capacity in the sedentary state are different from those underlying trainability.

The relationship between hemoglobin and [Formula: see text]: A systematic review and meta-analysis

OBJECTIVE

There is widespread agreement about the key role of hemoglobin for oxygen transport. Both observational and interventional studies have examined the relationship between hemoglobin levels and maximal oxygen uptake ([Formula: see text]) in humans. However, there exists considerable variability in the scientific literature regarding the potential relationship between hemoglobin and [Formula: see text]. Thus, we aimed to provide a comprehensive analysis of the diverse literature and examine the relationship between hemoglobin levels (hemoglobin concentration and mass) and [Formula: see text] (absolute and relative [Formula: see text]) among both observational and interventional studies.

METHODS

A systematic search was performed on December 6th, 2021. The study procedures and reporting of findings followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Article selection and data abstraction were performed in duplicate by two independent reviewers. Primary outcomes were hemoglobin levels and [Formula: see text] values (absolute and relative). For observational studies, meta-regression models were performed to examine the relationship between hemoglobin levels and [Formula: see text] values. For interventional studies, meta-analysis models were performed to determine the change in [Formula: see text] values (standard paired difference) associated with interventions designed to modify hemoglobin levels or [Formula: see text]. Meta-regression models were then performed to determine the relationship between a change in hemoglobin levels and the change in [Formula: see text] values.

RESULTS

Data from 384 studies (226 observational studies and 158 interventional studies) were examined. For observational data, there was a positive association between absolute [Formula: see text] and hemoglobin levels (hemoglobin concentration, hemoglobin mass, and hematocrit (P<0.001 for all)). Prespecified subgroup analyses demonstrated no apparent sex-related differences among these relationships. For interventional data, there was a positive association between the change of absolute [Formula: see text] (standard paired difference) and the change in hemoglobin levels (hemoglobin concentration (P<0.0001) and hemoglobin mass (P = 0.006)).

CONCLUSION

These findings suggest that [Formula: see text] values are closely associated with hemoglobin levels among both observational and interventional studies. Although our findings suggest a lack of sex differences in these relationships, there were limited studies incorporating females or stratifying results by biological sex.

Oxidative physiology of two small and highly migratory Arctic seabirds: Arctic terns (Sterna paradisaea) and long-tailed jaegers (Stercorarius longicaudus)

Arctic ecosystems are changing rapidly. The tundra supports nesting migratory seabirds that spend most of their year over the ocean. Migrations are demanding, but it is unclear how physiological capability may equip organisms to respond to their changing environments. For two migratory seabird species nesting in Alaska, USA, the Arctic tern (n = 10) and the long-tailed jaeger (n = 8), we compared oxidative physiology and aerobic capacity measured during incubation and we recorded individual movement paths using electronic tracking tags. Within species, we hypothesized that individuals with longer-distance migrations would show higher oxidative stress and display better aerobic capacity than shorter-distance migrants. We examined blood parameters relative to subsequent fall migration in jaegers and relative to previous spring migration in terns. We present the first measurements of oxidative stress in these species and the first migratory movements of long-tailed jaegers in the Pacific Ocean. Arctic terns displayed positive correlation of oxidative variables, or better integration than jaegers. Relative to physiological sampling, pre-breeding northward migration data were available for terns and post-breeding southward data were available for jaegers. Terns reached a farther maximum distance from the colony than jaegers (16 199 ± 275 km versus 10 947 ± 950 km) and rate of travel northward (447 ± 41.8 km/day) was positively correlated with hematocrit, but we found no other relationships. In jaegers, there were no relationships between individuals' physiology and southward rate of travel (193 ± 52.3 km/day) or migratory distance. While it is not clear whether the much longer migrations of the terns is related to their better integration, or to another factor, our results spark hypotheses that could be evaluated through a controlled phylogenetic study. Species with better integration may be less susceptible to environmental factors that increase oxidative stress, including thermal challenges or changes in prey distribution as the Arctic climate changes rapidly.

A comprehensive review of natural products with anti-hypoxic activity

Natural products exhibit substantial impacts in the field of anti-hypoxic traetment. Hypoxia can cause altitude sickness and other negative effect on the body. Headache, coma, exhaustion, vomiting and, in severe cases, death are some of the clinical signs. Currently, hypoxia is no longer just a concern in plateau regions; it is also one of the issues that can not be ignored by urban residents. This review covered polysaccharides, alkaloids, saponins, flavonoids, peptides and traditional Chinese compound prescriptions as natural products to protect against hypoxia. The active ingredients, effectiveness and mechanisms were discussed. The related anti-hypoxic mechanisms involve increasing the hemoglobin (HB) content, glycogen content and adenosine triphosphate (ATP) content, removing excessive reactive oxygen species (ROS), reducing lipid peroxidation, regulating the levels of related enzymes in cells, protecting the structural and functional integrity of the mitochondria and regulating the expression of apoptosis-related genes. These comprehensive summaries are beneficial to anti-hypoxic research and provide useful information for the development of anti-hypoxic products.

Hemoglobin modulation affects physiology and patient reported outcomes in anemic and non-anemic subjects: An umbrella review

Background: An abnormal hemoglobin concentration has a substantial effect on a person's quality of life and physiology. Lack of tools that effectively evaluate hemoglobin-related outcomes leads to uncertainty regarding optimal hemoglobin levels, transfusion thresholds and treatment targets. We therefore aim to summarize reviews that assess the effects of hemoglobin modulation on the human physiology at various baseline hemoglobin levels, and identify gaps in existing evidence. Methods: We conducted an umbrella review of systematic reviews. PubMed, MEDLINE (OVID), Embase, Web of Science, Cochrane Library and Emcare were searched from inception to the 15th of April 2022 for studies that reported on physiological and patient reported outcomes following a hemoglobin change. Results: Thirty-three reviews were included of which 7 were scored as of high quality and 24 of critically low quality using the AMSTAR-2 tool. The reported data generally show that an increase in hemoglobin leads to improvement of patient reported and physical outcomes in anaemic and non-anaemic subjects. At lower hemoglobin levels, the effect of a hemoglobin modulation on quality of life measures appears more pronounced. Conclusion: This overview has revealed many knowledge gaps due to a lack of high-quality evidence. For chronic kidney disease patients, a clinically relevant benefit of increasing the hemoglobin levels up until 12 g/dL was found. However, a personalized approach remains necessary due to the many patient-specific factors that affect outcomes. We strongly encourage future trials to incorporate physiological outcomes as objective parameters together with subjective, but still very important, patient reported outcome measures.

Exercise Capacity, Iron Status, Body Composition, and Mediterranean Diet in Patients with Chronic Heart Failure

In addition to drug therapy, lifestyle modification, including physical activity, and nutrition management are an integral part of current guidelines for patients with chronic heart failure (CHF). However, evidence on which clinical parameters are most influenced by nutritional behaviour, exercise capacity, or iron status is scarce. For a multicenter intervention study, we included participants with diagnosed CHF (n = 165) as well as participants with elevated NT-proBNP values and risk factors for CHF (n = 74). Cardiorespiratory fitness was tested with a bicycle test, and adherence to the Mediterranean diet (MedDiet) was assessed with the MDS questionnaire. Our data strengthened previous results confirming that the higher a person's adherence to MedDiet, the higher the cardiorespiratory fitness and the lower the body fat. Furthermore, our results showed that anemia in patients with CHF has an impact in terms of cardiorespiratory fitness, and functional outcomes by questionnaire. Since our data revealed gaps in iron supply (37.9% with iron deficiency), malnutrition (only 7.8% with high adherence to MedDiet), and both symptomatic and non-symptomatic study participants failed to meet reference values for physical performance, we encourage the enforcement of the guidelines in the treatment of CHF more strongly.

The potential of Curcuma extract to alleviate muscle damage in amateur soccer players

Compounds with high bioactive are commonly used as a nutritional approach for accelerating muscle damage recovery after strenuous exercise. There are still inconsistent results of post-exercise antioxidant supplementation on the circulating muscle damage biomarker. This study aimed to examine the effect of post-exercise Curcuma extract supplementation in ice cream on muscle damage and inflammatory markers in amateur soccer players. Male amateur soccer athletes (aged 14 – 18 years) participated in a randomized double-blind placebo-controlled study under two conditions: control group (n = 10) and treatment group (n = 10). The treatment group was treated with Curcuma extract ice cream (250 mg/100 g) for 21 days. Blood samples were drawn before training, considered baseline, and 3 h after training on day 21. The level of creatine kinase, IL-6, haemoglobin (Hb), and lactic acid were quantified. There was a significant decrease in creatine kinase change in the treatment group compared to the control group (p <0.05). No change in IL-6 and Hb levels in the treatment group. Lactic acid decreased by 16.3% from baseline in the treatment group (p <0.05). Curcuma extract ice cream potentiates to ameliorate exercise-induced muscle damage.

Marked improvements in cardiac function in postmenopausal women exposed to blood withdrawal plus endurance training

The cardiac phenotype of a substantial fraction of the population, i.e., mature women, is mainly unresponsive to endurance training (ET), the most effective intervention to improve cardiorespiratory fitness. This study assessed whether a novel intervention comprising additional haemodynamic stimuli may overcome the generalized limitations to modify the cardiac phenotype of middle-aged and older women. Fifteen healthy postmenopausal women (52-75 yr) were recruited. Transthoracic echocardiography and central haemodynamics were assessed during incremental cycle ergometry (i) in baseline conditions, (ii) after standard (10%) blood withdrawal and (iii) subsequent 8-week ET. Main outcomes such as left ventricular (LV) function and structure and blood volume (BV) were determined. Phlebotomy induced a 0.5 ± 0.1 l reduction of BV, which was re-established after ET. Decrements in LV end-systolic volume (-27%) and increments in LV ejection fraction (+8%) during exercise as well as improved E/A ratio were detected after ET compared with baseline. In parallel, ET induced a 10% increment in LV mass without a concomitant increase in LV size. In conclusion, postmenopausal women exhibit large improvements in cardiac systolic and diastolic functions along with LV concentric remodelling in response to the sequenced combination of blood withdrawal and ET.

A century of exercise physiology: key concepts on coupling respiratory oxygen flow to muscle energy demand during exercise

After a short historical account, and a discussion of Hill and Meyerhof's theory of the energetics of muscular exercise, we analyse steady-state rest and exercise as the condition wherein coupling of respiration to metabolism is most perfect. The quantitative relationships show that the homeostatic equilibrium, centred around arterial pH of 7.4 and arterial carbon dioxide partial pressure of 40 mmHg, is attained when the ratio of alveolar ventilation to carbon dioxide flow ([Formula: see text]) is - 21.6. Several combinations, exploited during exercise, of pertinent respiratory variables are compatible with this equilibrium, allowing adjustment of oxygen flow to oxygen demand without its alteration. During exercise transients, the balance is broken, but the coupling of respiration to metabolism is preserved when, as during moderate exercise, the respiratory system responds faster than the metabolic pathways. At higher exercise intensities, early blood lactate accumulation suggests that the coupling of respiration to metabolism is transiently broken, to be re-established when, at steady state, blood lactate stabilizes at higher levels than resting. In the severe exercise domain, coupling cannot be re-established, so that anaerobic lactic metabolism also contributes to sustain energy demand, lactate concentration goes up and arterial pH falls continuously. The [Formula: see text] decreases below - 21.6, because of ensuing hyperventilation, while lactate keeps being accumulated, so that exercise is rapidly interrupted. The most extreme rupture of the homeostatic equilibrium occurs during breath-holding, because oxygen flow from ambient air to mitochondria is interrupted. No coupling at all is possible between respiration and metabolism in this case.

Altitude acclimatization, hemoglobin-oxygen affinity, and circulatory oxygen transport in hypoxia

In mammals and other air-breathing vertebrates that live at high altitude, adjustments in convective O₂ transport via changes in blood hemoglobin (Hb) content and/or Hb-O₂ affinity can potentially mitigate the effects of arterial hypoxemia. However, there are conflicting views about the optimal values of such traits in hypoxia, partly due to the intriguing observation that hypoxia-induced acclimatization responses in humans and other predominantly lowland mammals are frequently not aligned in the same direction as evolved phenotypic changes in high-altitude natives. Here we review relevant theoretical and empirical results and we highlight experimental studies of rodents and humans that provide insights into the combination of hematological changes that help attenuate the decline in aerobic performance in hypoxia. For a given severity of hypoxia, experimental results suggest that optimal values for hematological traits are conditional on the states of other interrelated phenotypes that govern different steps in the O₂-transport pathway.

Six weeks of static apnea training does not affect Hbmass and exercise performance

PURPOSE

Acute apnea is known to induce decreases in oxyhemoglobin desaturation (SpO₂) and increases in erythropoietin concentration ([EPO]). This study examined the potential of an apnea training program to induce erythropoiesis and increase hematological parameters and exercise performance.

METHODS

Twenty-two male subjects were randomly divided into an apnea and control group. The apnea group performed a 6-week apnea training program consisting of a daily series of 5 maximal static apneas. Before and after training, subjects visited the lab on three test days to perform 1) a ramp incremental test measuring V̇O_2peak, 2) CO-rebreathing for Hb mass determination and a 3-km time trial and 3) an apnea test protocol with continuous finger SpO₂ registration. Venous blood samples were drawn before and 180 minutes after the apnea test for analysis of [EPO].

RESULTS

Minimal SpO₂ reached during the apnea test protocol was 91 ±7% pre and 82 ±7% post apnea training. The apnea test protocol did not elicit an acute increase in [EPO] (p=0.685) before nor after the training program. Consequently, resting [EPO] (p=0.170), Hbmass (p=0.134), V̇O_2peak (p=0.796) and 3-km cycling time trial performance (p=0.509) were not affected either.

CONCLUSION

The apnea test and training protocol, consisting of 5 maximal static apneas, did not induce a sufficiently strong hypoxic stimulus to cause erythropoiesis and therefore did not result in an increase in resting [EPO], Hbmass, V̇O_2peak or time trial performance. Longer and/or more intense training sessions inducing a stronger hypoxic stimulus are probably needed to obtain changes in hematological and exercise parameters.

Repeated Ischemic Preconditioning Effects on Physiological Responses to Hypoxic Exercise

INTRODUCTION: Repeated ischemic preconditioning (IPC) can improve muscle and pulmonary oxygen on-kinetics, blood flow, and exercise efficiency, but these effects have not been investigated in severe hypoxia. The aim of the current study was to evaluate the effects of 7 d of IPC on resting and exercising muscle and cardio-pulmonary responses to severe hypoxia.METHODS: A total of 14 subjects received either: 1) 7 d of repeated lower-limb occlusion (4 × 5 min, 217 ± 30 mmHg) at limb occlusive pressure (IPC) or SHAM (4 × 5 min, 20 mmHg). Subjects were tested for resting limb blood flow, relative microvascular deoxyhemoglobin concentration ([HHB]), and pulmonary oxygen (Vo_2p) responses to steady state and incremental exercise to exhaustion in hypoxia (fractional inspired O₂ = 0.103), which was followed by 7 d of IPC or SHAM and retesting 72 h post-intervention.RESULTS: There were no effects of IPC on maximal oxygen consumption, time to exhaustion during the incremental test, or minute ventilation and arterial oxygen saturation. However, the IPC group had higher delta efficiency based on pooled results and lower steady state Δ[HHB] (IPC ∼24% vs. SHAM ∼6% pre to post), as well as slowing the [HHB] time constant (IPC ∼26% vs. SHAM ∼3% pre to post) and reducing the overshoot in [HHB]: Vo₂ ratio during exercise onset.CONCLUSIONS: Collectively, these results demonstrate that muscle O₂ efficiency and microvascular O₂ distribution can be improved by repeated IPC, but there are no effects on maximal exercise capacity in severe hypoxia.Chopra K, Jeffries O, Tallent J, Heffernan S, Kilduff L, Gray A, Waldron M. Repeated ischemic preconditioning effects on physiological responses to hypoxic exercise. Aerosp Med Hum Perform. 2022; 93(1):13-21.

How important is V̇O2max when climbing Mt. Everest (8,849 m)?

The maximal rate of oxygen uptake (V̇O₂max) of humans declines with increasing altitude, but represents the upper limit of aerobic endurance performance at low and high altitude as well. Before Reinhold Messner and Peter Habeler climbed Mt. Everest first (1978) without supplemental oxygen, physiologists have doubted whether this would be possible due to insufficient V̇O₂max remaining when approaching the summit (8849 m). Subsequently, several studies evaluated the decline in the V̇O₂max levels at real and simulated extreme altitudes. However, the potential influence of the preexisting individual sea level V̇O₂max remained largely unconsidered. Based on available studies and case observations, here we discuss the observed and expected decline of V̇O₂max up to 8849 m dependent on the individual sea level V̇O₂max. It is concluded that a high sea level V̇O₂max and an only moderate decline of arterial oxygen saturation and associated V̇O₂max with increasing altitude, due to appropriate acclimatization and ascent strategies, enable certain mountaineers to climb 8,000er summits and even the Everest without supplemental oxygen.

Intermittent Hypoxia Exposure Helps to Restore the Reduced Hemoglobin Concentration During Intense Exercise Training in Trained Swimmers

In prolonged intense exercise training, the training load of athletes may be reduced once their hemoglobin concentrations ([Hb]s) are decreased dramatically. We previously reported that intermittent hypoxia exposure (IHE) could be used to alleviate the decrease of [Hb] and help to maintain the training load in rats. To further explore the feasibility of applying IHE intervention to athletes during prolonged intense exercise training, 6 trained swimmers were recruited to conduct a 4-week IHE intervention at the intervals after their [Hb] dropped for 10% or more during their training season. IHE intervention lasted 1 h and took place once a day and five times a week. Hematological and hormonal parameters, including [Hb], red blood cells (RBC), hematocrit (Hct), reticulocytes, serum erythropoietin (EPO), testosterone (T) and cortisol (C) were examined. After the IHE intervention was launched, [Hb], RBC and Hct of the subjects were increased progressively with their maximum levels (P < 0.01) showing at the third or fourth week, respectively. An increase in reticulocyte count (P < 0.01) suggests that IHE intervention promotes erythropoiesis to increase [Hb]. Besides, serum level of EPO, the hormone known to stimulate erythropoiesis, was overall higher than that before the IHE intervention, although it was statistically insignificant. Furthermore, the serum level of T, another hormone known to stimulate erythropoiesis, was increased progressively with the maximum level showing at the fourth week. Collectively, this study further confirms that IHE intervention may be used as a new strategy to prevent intense exercise training-induced reductions in [Hb].

The Impact of Vegan and Vegetarian Diets on Physical Performance and Molecular Signaling in Skeletal Muscle

Muscular adaptations can be triggered by exercise and diet. As vegan and vegetarian diets differ in nutrient composition compared to an omnivorous diet, a change in dietary regimen might alter physiological responses to physical exercise and influence physical performance. Mitochondria abundance, muscle capillary density, hemoglobin concentration, endothelial function, functional heart morphology and availability of carbohydrates affect endurance performance and can be influenced by diet. Based on these factors, a vegan and vegetarian diet possesses potentially advantageous properties for endurance performance. Properties of the contractile elements, muscle protein synthesis, the neuromuscular system and phosphagen availability affect strength performance and can also be influenced by diet. However, a vegan and vegetarian diet possesses potentially disadvantageous properties for strength performance. Current research has failed to demonstrate consistent differences of performance between diets but a trend towards improved performance after vegetarian and vegan diets for both endurance and strength exercise has been shown. Importantly, diet alters molecular signaling via leucine, creatine, DHA and EPA that directly modulates skeletal muscle adaptation. By changing the gut microbiome, diet can modulate signaling through the production of SFCA.

Effects of blood withdrawal on cardiac, hemodynamic, and pulmonary responses to a moderate acute workload in healthy middle-aged and older females

OBJECTIVES

To investigate the effects of blood withdrawal on cardiac, hemodynamic, and pulmonary responses to submaximal exercise in females.

DESIGN AND METHODS

30 healthy females (63.8 ± 8.3 years) were recruited for this experimental study. Transthoracic echocardiography, non-invasive blood pressure monitoring, and oxygen uptake were assessed during a fixed submaximal workload (100 W) prior to (day 1) and immediately after (day 2) a 10% reduction of blood volume. Main measurements included left ventricular end-diastolic volume, stroke volume, cardiac output, mean arterial pressure, systolic blood pressure, diastolic blood pressure, and oxygen uptake. Blood volume was determined via carbon monoxide rebreathing.

RESULTS

Participant's blood volume ranged from 3.8 to 6.6 L. Following 10% reduction in blood volume (0.5 ± 0.1 L), left ventricular end-diastolic volume (p ≤ 0.030) and stroke volume (p < 0.019) were reduced during submaximal exercise while cardiac output was unchanged (p = 0.139) due to increased heart rate (p < 0.026). Hemodynamic variables including mean arterial pressure (p < 0.015), systolic blood pressure (p < 0.005), and diastolic blood pressure (p < 0.038) were reduced while oxygen uptake was unaltered (p = 0.250).

CONCLUSIONS

Blood withdrawal results in marked reductions in cardiac filling with compensatory chronotropic responses that preserve cardiac output at a moderate submaximal workload in healthy females. Thus, blood volume determines the relative exercise intensity, as typically determined by heart rate, of submaximal efforts in this population.

Lifelong Endurance Exercise as a Countermeasure Against Age-Related [Formula: see text] Decline: Physiological Overview and Insights from Masters Athletes

Maximum oxygen consumption ([Formula: see text]) is not only an indicator of endurance performance, but also a strong predictor of cardiovascular disease and mortality. This physiological parameter is known to decrease with aging. In turn, physical exercise might attenuate the rate of aging-related decline in [Formula: see text], which in light of the global population aging is of major clinical relevance, especially at advanced ages. In this narrative review, we summarize the evidence available from masters athletes about the role of lifelong endurance exercise on aging-related [Formula: see text] decline, with examples of the highest [Formula: see text] values reported in the scientific literature for athletes across different ages (e.g., 35 ml·kg^-1·min^-1 in a centenarian cyclist). These data suggest that a linear decrease in [Formula: see text] might be possible if physical exercise loads are kept consistently high through the entire life span, with [Formula: see text] values remaining higher than those of the general population across all ages. We also summarize the main physiological changes that occur with inactive aging at different system levels-pulmonary and cardiovascular function, blood O₂ carrying capacity, skeletal muscle capillary density and oxidative capacity-and negatively influence [Formula: see text], and review how lifelong exercise can attenuate or even prevent most-but apparently not all (e.g., maximum heart rate decline)-of them. In summary, although aging seems to be invariably associated with a progressive decline in [Formula: see text], maintaining high levels of physical exercise along the life span slows the multi-systemic deterioration that is commonly observed in inactive individuals, thereby attenuating age-related [Formula: see text] decline.

Impact of Low Hemoglobin on Body Composition, Strength, and Redox Status of Older Hemodialysis Patients Following Resistance Training

INTRODUCTION

The purpose of this study was to: (i) investigate the effect of six months of resistance training (RT) on body composition, muscle strength, hematological patterns, and redox profile in maintenance hemodialysis (HD) patients, and; (ii) evaluate the effects of baseline concentrations of hemoglobin on the RT response.

METHODS

One hundred fifty-seven subjects with chronic kidney disease (CKD) were randomly allocated into two groups: Control [CTL, (n = 76)] and RT (n = 81). A first visit was required for anamnesis and anthropometric measurements. Venous blood samples were collected at baseline and after twenty-four weeks of training in all patients for the analysis of clinical and redox balance markers. The RT program spanned six months and consisted of three sets of 8-12 repetitions with a rating of perceived exertion between 5 and 8 for three weekly sessions. Each exercise session was performed in twelve resistance exercises and it least for approximately 40 min.

RESULTS

The main results demonstrated that RT decreased waist circumference by 3%, and decreased thiobarbituric reactive species (TBARS) by 28%. Moreover, RT increased handgrip strength by 28.4%, fat-free mass by 4.1%, hemoglobin by 5%, iron by 33.4%, glutathione by 121%, and Trolox equivalent antioxidant capacity by 14.2% (p < 0.05). Low hemoglobin concentrations impaired the effect of RT on fat-free mass gain.

CONCLUSION

Six months of RT in HD patients improved clinical parameters, such as hemoglobin, iron, body composition, and redox balance, while low hemoglobin concentration impaired exercise-benefits on fat-free mass in patients with CKD. These findings can contribute to a better clinical application of RT in the maintenance of hemodialysis patients.

Prognostic impact of peak oxygen uptake and heart rate reserve in patients after off-pump coronary artery bypass grafting

BACKGROUND

Peak oxygen uptake (peak VO₂ ) and heart rate reserve (HRR) are independent prognostic markers of cardiovascular disease. However, the impact of peak VO₂ and HRR on long-term prognosis after off-pump coronary artery bypass grafting (OP-CABG) remains unclear.

HYPOTHESIS

To determine the prognostic impact of peak VO₂ and HRR in patients after OP-CABG.

RESULTS

We enrolled 327 patients (mean age, 65.1 ± 9.3 years; male, 80%) who underwent OP-CABG and participated in early phase II cardiac rehabilitation. All participants underwent cardiopulmonary exercise testing (CPET) at the beginning of such rehabilitation. Overall, 48 (14.6%) patients died during the median follow-up period of 103 months. The non-survivor had significantly lower levels of peak VO₂ (10.6 ± 0.5 vs. 13.7 ± 0.2 ml/kg/min, p < .01) and HRR (24.2 ± 1.8 vs. 32.7 ± 0.8 beats/min, p < .01) than the survivor. In both groups, peak VO₂ significantly correlated with HRR (p < .01). Moreover, patients were divided into four groups according to the peak VO₂ and HRR levels for predicting total mortality. The low-peak VO₂ /low-HRR group had a significantly higher mortality risk than the other groups (hazards ratio, 5.61; 95% confidence interval, 2.59-12.16; p < .01). After adjusted the confounding factors, peak VO₂ and HRR were independently associated with total mortality (both p < .05).

CONCLUSIONS

HRR is a simple parameter of CPET and an important prognostic marker for the risk stratification of total mortality even in patients with low-peak VO₂ after OP-CABG.

Effects of Ashwagandha (Withania somnifera) on Physical Performance: Systematic Review and Bayesian Meta-Analysis

Ashwagandha (Withania somnifera) is considered a potent adaptogen and anti-stress agent that could have some potential to improve physical performance. This preferred reporting items for systematic reviews and meta-analyses (PRISMA)-based comprehensive systematic review and Bayesian meta-analysis aimed to evaluate clinical trials up to 2020 from PubMed, ScienceDirect, and Google Scholar databases regarding the effect of Ashwagandha supplementation on physical performance in healthy individuals. Besides implementing estimation statistics analysis, we developed Bayesian hierarchical models for a pre-specified subgroup meta-analysis on strength/power, cardiorespiratory fitness and fatigue/recovery variables. A total of 13 studies met the requirements of this systematic review, although only 12 were included in the quantitative analysis. A low-to-moderate overall risk of bias of the trials included in this study was detected. All Bayesian hierarchical models converged to a target distribution (Ȓ = 1) for both meta-analytic effect size (μ) and between-study standard deviation (τ). The meta-analytic approaches of the included studies revealed that Ashwagandha supplementation was more efficacious than placebo for improving variables related to physical performance in healthy men and female. In fact, the Bayesian models showed that future interventions might be at least in some way beneficial on the analyzed outcomes considering the 95% credible intervals for the meta-analytic effect size. Several practical applications and future directions are discussed, although more comparable studies are needed in exercise training, and athletic populations are needed to derive a more stable estimate of the true underlying effect.

On-Glass Integrated SU-8 Waveguide and Amorphous Silicon Photosensor for On-Chip Detection of Biomolecules: Feasibility Study on Hemoglobin Sensing

An optoelectronic, integrated system-on-glass for on-chip detection of biomolecules is here presented. The system’s working principle is based on the interaction, detected by a hydrogenated amorphous silicon photosensor, between a monochromatic light travelling in a SU-8 polymer optical waveguide and the biological solution under analysis. Optical simulations of the waveguide coupling to the thin-film photodiode with a specific design were carried out. A prototype was fabricated and characterized showing waveguide optical losses of about 0.6 dB/cm, a photodiode shot noise current of about 2.5 fA/Hz and responsivity of 495 mA/W at 532 nm. An electro-optical coupling test was performed on the fabricated device to validate the system. As proof of concept, hemoglobin was studied as analyte for a demonstration scenario, involving optical simulations interpolated with experimental data. The calculated detection limit of the proposed system for hemoglobin concentration in aqueous solution is around 100 ppm, in line with colorimetric methods currently on the market. These results show the effectiveness of the proposed system in biological detection applications and encourage further developments in implementing these kinds of devices in the biomedical field.

Hematocrit, age, and survival in a wild vertebrate population

Understanding trade-offs in wild populations is difficult, but important if we are to understand the evolution of life histories and the impact of ecological variables upon them. Markers that reflect physiological state and predict future survival would be of considerable benefit to unraveling such trade-offs and could provide insight into individual variation in senescence. However, currently used markers often yield inconsistent results. One underutilized measure is hematocrit, the proportion of blood comprising erythrocytes, which relates to the blood's oxygen-carrying capacity and viscosity, and to individual endurance. Hematocrit has been shown to decline with age in cross-sectional studies (which may be confounded by selective appearance/disappearance). However, few studies have tested whether hematocrit declines within individuals or whether low hematocrit impacts survival in wild taxa. Using longitudinal data from the Seychelles warbler (Acrocephalus sechellensis), we demonstrated that hematocrit increases with age in young individuals (<1.5 years) but decreases with age in older individuals (1.5-13 years). In breeders, hematocrit was higher in males than females and varied relative to breeding stage. High hematocrit was associated with lower survival in young individuals, but not older individuals. Thus, while we did not find support for hematocrit as a marker of senescence, high hematocrit is indicative of poor condition in younger individuals. Possible explanations are that these individuals were experiencing dehydration and/or high endurance demands prior to capture, which warrants further investigation. Our study demonstrates that hematocrit can be an informative metric for life-history studies investigating trade-offs between survival, longevity, and reproduction.

Lysophosphatidic acid receptors 2 and 3 regulate erythropoiesis at different hematopoietic stages

Hematopoiesis, the complex developmental process that forms blood components and replenishes the blood system, involves multiple intracellular and extracellular mechanisms. We previously demonstrated that lysophosphatidic acid (LPA), a lipid growth factor, has opposing regulatory effects on erythrocyte differentiation through activation of LPA receptors 2 and 3; yet the mechanisms underlying this process remain unclear. In this study, LPA₂ is observed that highly expressed in common myeloid progenitors (CMP) in murine myeloid cells, whereas the expression of LPA₃ displaces in megakaryocyte-erythroid progenitors (MEP) of later stage of myeloid differentiation. Therefore, we hypothesized that the switching expression of LPA₂ and LPA₃ determine the hematic homeostasis of mammalian megakaryocytic-erythroid lineage. In vitro colony-forming unit assays of murine progenitors reveal that LPA₂ agonist GRI reduces the erythroblast differentiation potential of CMP. In contrast, LPA₃ agonist OMPT increases the production of erythrocytes from megakaryocyte-erythrocyte progenitor cells (MEP). In addition, treatment with GRI reduces the erythroid, CMP, and MEP populations in mice, indicating that LPA₂ predominantly inhibits myeloid differentiation at an early stage. In contrast, activation of LPA₃ increases the production of terminally differentiated erythroid cells through activation of erythropoietic transcriptional factor. We also demonstrate that the LPA₃ signaling is essential for restoration of phenylhydrazine (PHZ)-induced acute hemolytic anemia in mice and correlates to erythropoiesis impairment of Hutchinson-Gilford progeria Symptom (HGPS) premature aging expressed K562 model. Our results reveal the distinct roles of LPA₂ and LPA₃ at different stages of hematopoiesis in vivo, providing potentiated therapeutic strategies of anemia treatment.

Trade-off between aerobic performance and egg production in migratory macaroni penguins

When successive stages of an organism's life-history overlap, conflicts and trade-offs can emerge due to competition among physiological pathways. For example, long periods of sustained locomotion in migrating birds are supported by the androgenic up-regulation of aerobic factors, such as new red blood cell production and hematocrit. However, towards the end of migration, many female birds begin up-regulating 17ß-estradiol (E₂) to support vitellogenesis and egg production, but E₂ secretion is known to have suppressive effects on red blood cell production (anti-erythropoiesis). We explored potential trade-offs between factors related to aerobic performance (hematocrit, reticulocyte index) and the expression of factors related to E₂-mediated vitellogenesis (i.e. yolk precursor production) in female macaroni penguins (Eudyptes chrysolophus), a species in which the physiologies controlling egg production and migratory activity run simultaneously (e.g. females experience a migratory conflict). We collected blood samples from penguins immediately upon their return to the colony, prior to egg laying. Hematocrit was elevated when the penguins returned to the colony (50.05% ± 3.40 SD), which is similar to pre-laying values observed in other migratory bird species. Furthermore, mean reticulocyte levels were elevated (34.87% ± 2.34), which is the highest level yet recorded in birds. Similarly, both plasma vitellogenin and yolk-targeted very low density lipoprotein levels were upregulated (2.30 ± 0.06 μg Zn ml^-1, and 9.70 ± 0.19 mmol l^-1, respectively), indicating that penguins were reproductively active and producing eggs during migration and upon arrival on land. As predicted, a negative relationship between hematocrit and plasma vitellogenin was found, but we found no evidence to suggest that birds were experiencing reproductive anemia. Alternatively, we attribute the negative relationship to a hemodilution effect of yolk precursor secretion into circulation. It appears that female macaroni penguins are able to preserve hematocrit levels and new red blood cell production when migratory activity overlaps with reproductive processes.

Impact of Preoperative Anemia on Postoperative Kidney Function Following Laparoscopic Bariatric Surgery

BACKGROUND

Preoperative anemia is a risk factor for acute kidney failure after high-risk surgeries. We assessed the impact of preoperative anemia on kidney function in an obese Asian population after laparoscopic bariatric surgery.

METHODS

Patient characteristics, comorbidities, type of surgery, perioperative profiles, eGFR, and micronutrition were retrospectively reviewed in 341 patients with obesity undergoing bariatric surgery. All patients, who had a preoperative estimated glomerular filtration rates (eGFR) ≥ 90 mL/min/1.73 m², were followed for 1 year and assigned to one of two groups: anemia or non-anemia group. Preoperative anemia was determined based on hemoglobin concentration.

RESULTS

The Pearson's correlation coefficient between preoperative body mass index (BMI) and preoperative eGFR of all patients was 0.169 (p = 0.005). Preoperatively, there were no significant differences in age, BMI, and eGFR between the anemia (n = 38) and non-anemia groups (n = 303). Patients in the anemia group had lower hemoglobin concentration at baseline, 1 month, and 12 months after surgery than those in the non-anemia group. Postoperative eGFR levels at 1 month (p = 0.993) and 1 year (p = 0.118) as well as hospital stay (p = 0.941) were comparable between the two groups. However, the percentage weight loss was significantly higher in the non-anemia group than that in the anemia group 1 year after bariatric surgery (30.0 ± 7.3% vs. 27.0 ± 8.1%; p = 0.041).

CONCLUSIONS

Preoperative anemia did not negatively impact kidney function following laparoscopic bariatric surgery during the 12-month follow-up. Considering the potential adverse impact of anemia on postoperative weight loss, preoperative correction of anemia may be recommended.

Influencing factors of cardiorespiratory fitness in allogeneic stem cell transplant candidates prior to transplantation

PURPOSE

Cardiorespiratory fitness (CRF) seems to be prognostic prior to allogeneic stem cell transplantation (allo-HSCT). Influencing factors of CRF in allo-HSCT candidates have not been studied so far. Aim was to identify potentially influencing factors on CRF.

METHODS

To assess CRF, a maximal cardiopulmonary exercise test (CPET) was performed on average 2.6 ± 7.2 days prior to admission. A regression analysis was conducted, with the following predictors: gender, age, body mass index (BMI), time between last therapy and allo-HSCT (t_Therapies), number of cardiotoxic therapies (n_Cardiotox), number of transplantations (n_Transplantations), comorbidity index (HCT-CI), hemoglobin level of the last 3 months (area under the curve), and physical activity.

RESULTS

A total of 194 patients performed a CPET. VO_2peak was significantly reduced compared with reference data. In total, VO_2peak was 21.4 ml/min/kg (- 27.5%, p < 0.05). Men showed a significant larger percentage difference from reference value (- 29.1%, p < 0.05) than women (- 24.4%). VO_2peak was significantly (p < 0.05) influenced by age (β = - 0.11), female gender (β = - 3.01), BMI (β = - 0.44), n_Cardiotox (β = - 0.73), hemoglobin level (β = 0.56), and physical activity prior to diagnosis (β = 0.10).

CONCLUSIONS

Our study demonstrates a decreased CRF indicating the potential need of prehabilitative exercise. We revealed some influencing factors on CRF. Those patients could benefit the most from exercise.

Assessment of the Effects of Aerobic Fitness on Cerebrovascular Function in Young Adults Using Multiple Inversion Time Arterial Spin Labeling MRI

This cross-sectional study investigated the effects of aerobic fitness on cerebrovascular function in the healthy brain. Gray matter cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) were quantified in a sample of young adults within a normal fitness range. Based on existing Transcranial Doppler ultrasound and fMRI evidence, we predicted a positive relationship between fitness and resting gray matter CBF and CVR. Exploratory hypotheses that higher V . O2peak would be associated with higher GM volume and cognitive performance were also investigated. 20 adults underwent a V . O2peak test and a battery of cognitive tests. All subjects also underwent an MRI scan where multiple inversion time (MTI) pulsed arterial spin labeling (PASL) was used to quantify resting CBF and CVR to 5% CO2. Region of interest analysis showed a non-significant inverse correlation between whole-brain gray matter CBF and V . O2peak; r = -0.4, p = 0.08, corrected p (p') = 0.16 and a significant positive correlation between V . O2peak and whole-brain averaged gray matter CVR; r = 0.62, p = 0.003, p' = 0.006. Voxel-wise analysis revealed a significant inverse association between V . O2peak and resting CBF in the left and right thalamus, brainstem, right lateral occipital cortex, left intra-calcarine cortex and cerebellum. The results of this study suggest that aerobic fitness is associated with lower baseline CBF and greater CVR in young adults.

Alterations in the innate immune system due to exhausting exercise in intensively trained rats

It is known that intensive physical activity alters the immune system's functionality. However, the influence of the intensity and duration of exercise needs to be studied in more depth. We aimed to establish the changes in the innate immune response induced by two programmes of intensive training in rats compared to sedentary rats. A short training programme included 2 weeks of intensive training, ending with an exhaustion test (short training with exhaustion, S-TE). A second training programme comprised 5-week training including two exhaustion tests and three trainings per week. In this case, immune status was assessed before (T), immediately after (TE) and 24 h after (TE24) an additional final exhaustion test. Biomarkers such as phagocytic activity, macrophage cytokine and reactive oxygen species (ROS) production, and natural killer (NK) cell activity were quantified. S-TE was not enough to induce changes in the assessed innate immunity biomarkers. However, the second training was accompanied by a decrease in the phagocytic activity, changes in the pattern of cytokine secretion and ROS production by macrophages and reduced NK cell proportion but increased NK cytotoxic activity. In conclusion, a 5-week intense training programme, but not a shorter training, induced alterations in the innate immune system functionality.

Predictors of pre-rehabilitation exercise capacity in elderly European cardiac patients – The EU-CaRE study

Aims

Functional capacity is an important endpoint for therapies oriented to older adults with cardiovascular diseases. The literature on predictors of exercise capacity is sparse in the elderly population. In a longitudinal European study on effectiveness of cardiac rehabilitation of seven European countries in elderly (>65 years) coronary artery disease or valvular heart disease patients, predictors for baseline exercise capacity were determined, and reference ranges for elderly cardiac patients provided.

Methods

Mixed models were performed in 1282 patients (mean age 72.9 ± 5.4 years, 79% male) for peak oxygen consumption relative to weight (peak VO2; ml/kg per min) with centre as random factor and patient anthropometric, demographic, social, psychological and nutritional parameters, as well as disease aetiology, procedure, comorbidities and cardiovascular risk factors as fixed factors.

Results

The most important predictors for low peak VO2 were coronary artery bypass grafting or valve surgery, low resting forced expiratory volume, reduced left ventricular ejection fraction, nephropathy and peripheral arterial disease. Each cumulative comorbidity or cardiovascular risk factors reduced exercise capacity by 1.7 ml/kg per min and 1.1 ml/kg per min, respectively. Males had a higher peak VO2 per body mass but not per lean mass. Haemoglobin was significantly linked to peak VO2 in both surgery and non-surgery patients.

Conclusions

Surgical procedures, cumulative comorbidities and cardiovascular risk factors were the factors with the strongest relation to reduced exercise capacity in the elderly. Expression of peak VO2 per lean mass rather than body mass allows a more appropriate comparison between sexes. Haemoglobin is strongly related to peak VO2 and should be considered in studies assessing exercise capacity, especially in studies on patients after cardiac surgery.

Association of preoperative hemoglobin with weight loss after bariatric surgery: a retrospective study

BACKGROUND

Despite the known positive correlation between exercise and weight loss after bariatric surgery as well as the established association of hemoglobin level with maximal aerobic power and endurance performance, the correlation between preoperative hemoglobin concentration (pre-Hb) and postoperative weight loss remains unknown.

OBJECTIVE

This study aimed at assessing the association of pre-Hb with postoperative percentage weight loss (%WL) at 3, 6, 12, and 24 months after surgery.

SETTING

A single tertiary referral center.

METHODS

Outcomes of 282 patients undergoing laparoscopic sleeve gastrectomy at the 4 timepoints within a 24-month follow-up period were assessed. The primary study endpoint was the relationship between pre-Hb and postoperative %WL at 12-month follow-up.

RESULTS

The 282 patients had a mean preoperative body mass index of 39.0 ± 4.5 kg/m² with a slight female predominance (57.4%). Follow-up data were available for 221 of 282 (78.4%) patients (mean %WL: 30.9% ± 6.6%) at 1 year. Pearson's correlation showed that pre-Hb correlated positively with post-Hb (r = 0.778, P < .001) and %WL (r = .237, P < .001) at 12-month follow-up but not at 24 months (r = .145, P = .331). Multiple linear regression analyses including baseline variables of age, sex, preoperative body mass index, and diabetes revealed that pre-Hb, age, and preoperative body mass index were independent predictors of %WL. There was no evidence of multicollinearity among these variables.

CONCLUSION

The present study showed a potential positive relationship between pre-Hb and postoperative weight loss. More well-designed, large-scale studies are warranted to clarify the effect of hemoglobin level on postoperative weight loss in this patient population.

Haematological traits co-vary with migratory status, altitude and energy expenditure: a phylogenetic, comparative analysis

Aerobic capacity is assumed to be a main predictor of workload ability and haematocrit (Hct) and haemoglobin (Hb) have been suggested as key determinants of aerobic performance. Intraspecific studies have reported increases in Hct and Hb in response to increased workload. Furthermore, Hct and Hb vary markedly among individuals and throughout the annual cycle in free-living birds and it has been suggested that this variation reflects adaptive modulation of these traits to meet seasonal changes in energy demands. We used a comparative dataset of haematological traits, measures of metabolic rate (57 species), and life-history traits (160 species) to test several hypotheses for adaptive variation in haematology in relation to migration and altitude. We then extended these general ideas to test relationships between Hct and basal metabolic rate, daily energy expenditure and activity energy expenditure, using the 57 species that we have metabolic rate information for. We found that at the interspecific level, full migrants have higher Hct and Hb than partial migrants and non-migrants, and that altitude is positively correlated with Hb but not Hct. Hct is positively associated with activity energy expenditure (energy spent specifically on costly activities), suggesting that haematological traits could be adaptively modulated based on life-history traits and that Hct is a potential physiological mediator of energetic constraint.

The acute effects of whole blood donation on cardiorespiratory and haematological factors in exercise: A systematic review

BACKGROUND

This systematic review aimed to collect the relevant historical and current literature to produce an informed analysis of the acute effects on cardiorespiratory and haematological factors following whole blood donation (~ 470 ml) during exercise. Testing the hypothesises that blood donation produces either no changes (Null) or produces significant changes (alternate) in haematology, [Formula: see text], heart rate, exercising power and time.

METHODS

Four databases of medical and science orientations were searched with terms sensitive to connections regarding exercise, blood donation (400-500 ml)/haematology, [Formula: see text], heart rate, exercising power and time. The study retrieval process utilised the PRISMA approach and selection was via an adapted scoring method according to the Consensus based Standards for the selection of health Measurements Instruments (COSMIN). Systematic review focused on 24-48 hrs post donation. Details of the PRSIMA checklist can be found in the accompanying online document.

RESULTS

Following scrutiny of 48 research papers by two independent assessors 8 experimental studies were included. Four studies showed a mean reduction for difference in [Formula: see text] (- 2.4 ± 1.4 ml∙kg-1∙min-1) and a medium effect size (-0.26). No statistical significance was present at the mean meta-analysis level, also the case for heart rate, time to exhaustion and power. A mean reduction was seen in haemoglobin (- 1.05 g.dL-1), haematocrit (- 3.71%) and red blood cells (- 0.44 Mio μL-1), very large effect size was observed (Cohen's d, -0.75, -1.16 and -4.23 respectively) and statistical significance (95% CI, -2.04, -0.54; -4.59, 2.28 and -4.37, -4.10 respectively).

CONCLUSION

Although individual studies show that [Formula: see text] Is reduced from blood donation pooled results show that [Formula: see text] is indeed not significantly reduced from blood donation 24-48 hrs post donation. Additionally sub-maximally there isn't enough data to produce substantial comparatives. Furthermore, this systematic review demonstrates that there are not enough high-quality studies regarding cardiorespiratory outcomes following blood donation.

Muscle mass and inspired oxygen influence oxygen extraction at maximal exercise: Role of mitochondrial oxygen affinity

AIM

We examined the Fick components together with mitochondrial O₂ affinity (p50_mito ) in defining O₂ extraction and O₂ uptake during exercise with large and small muscle mass during normoxia (NORM) and hyperoxia (HYPER).

METHODS

Seven individuals performed 2 incremental exercise tests to exhaustion on a bicycle ergometer (BIKE) and 2 on a 1-legged knee extension ergometer (KE) in NORM or HYPER. Leg blood flow and VO₂ were determined by thermodilution and the Fick method. Maximal ADP-stimulated mitochondrial respiration (OXPHOS) and p50_mito were measured ex vivo in isolated mitochondria. Mitochondrial excess capacity in the leg was determined from OXPHOS in permeabilized fibres and muscle mass measured with magnetic resonance imaging in relation to peak leg O₂ delivery.

RESULTS

The ex vivo p50_mito increased from 0.06 ± 0.02 to 0.17 ± 0.04 kPa with varying substrate supply and O₂ flux rates from 9.84 ± 2.91 to 16.34 ± 4.07 pmol O₂ ·s^-1 ·μg^-1 respectively. O₂ extraction decreased from 83% in BIKE to 67% in KE as a function of a higher O₂ delivery and lower mitochondrial excess capacity. There was a significant relationship between O₂ extraction and mitochondrial excess capacity and p50_mito that was unrelated to blood flow and mean transit time.

CONCLUSION

O₂ extraction varies with mitochondrial respiration rate, p50_mito and O₂ delivery. Mitochondrial excess capacity maintains a low p50_mito which enhances O₂ diffusion from microvessels to mitochondria during exercise.

Total haemoglobin mass, but not haemoglobin concentration, is associated with preoperative cardiopulmonary exercise testing-derived oxygen-consumption variables

Background

Cardiopulmonary exercise testing (CPET) measures peak exertional oxygen consumption ( V˙O2peak ) and that at the anaerobic threshold ( V˙O2 at AT, i.e. the point at which anaerobic metabolism contributes substantially to overall metabolism). Lower values are associated with excess postoperative morbidity and mortality. A reduced haemoglobin concentration ([Hb]) results from a reduction in total haemoglobin mass (tHb-mass) or an increase in plasma volume. Thus, tHb-mass might be a more useful measure of oxygen-carrying capacity and might correlate better with CPET-derived fitness measures in preoperative patients than does circulating [Hb].

Methods

Before major elective surgery, CPET was performed, and both tHb-mass (optimized carbon monoxide rebreathing method) and circulating [Hb] were determined.

Results

In 42 patients (83% male), [Hb] was unrelated to V˙O2 at AT and V˙O2peak ( r =0.02, P =0.89 and r =0.04, P =0.80, respectively) and explained none of the variance in either measure. In contrast, tHb-mass was related to both ( r =0.661, P <0.0001 and r =0.483, P =0.001 for V˙O2 at AT and V˙O2peak , respectively). The tHb-mass explained 44% of variance in V˙O2 at AT ( P <0.0001) and 23% in V˙O2peak ( P =0.001).

Conclusions

In contrast to [Hb], tHb-mass is an important determinant of physical fitness before major elective surgery. Further studies should determine whether low tHb-mass is predictive of poor outcome and whether targeted increases in tHb-mass might thus improve outcome.

Effects of experimental manipulation of hematocrit on avian flight performance in high- and low-altitude conditions

Despite widely held assumptions that hematocrit (Hct) is a key determinant of aerobic capacity and exercise performance, this relationship has not often been tested rigorously in birds and results to date are mixed. Migration in birds involves high-intensity exercise for long durations at various altitudes. Therefore, it provides a good model system to examine the effect of Hct on flight performance and physiological responses of exercise at high altitude. We treated yellow-rumped warblers (Setophaga coronata) with avian erythropoietin (EPO) and anti-EPO to experimentally manipulate Hct and assessed flight performance at low and high altitudes using a hypobaric wind tunnel. We showed that anti-EPO-treated birds had lower Hct than vehicle- and EPO--treated birds post-treatment. Anti-EPO-treated birds also had marginally lower exercise performance at low altitude, committing a higher number of strikes (mistakes) in the first 30 min of flight. However, anti-EPO-treated birds performed significantly better at high altitude, attaining a higher altitude in a ramped altitude challenge to 3000 m equivalent altitude, and with a longer duration of flight at high altitude. Birds exercising at high altitude showed decreased Hct, increased glucose mobilization and decreased antioxidant capacity, regardless of treatment. In summary, we provide experimental evidence that the relationship between Hct and exercise performance is dependent on altitude. Future studies should investigate whether free-living birds adaptively modulate their Hct, potentially through a combination of erythropoiesis and plasma volume regulation (i.e. hemodilution), based on the altitude they fly at during migratory flight.

The effect of chronic soluble keratin supplementation in physically active individuals on body composition, blood parameters and cycling performance

Background

Keratins are structural, thiol-rich proteins, which comprise 90% of total poultry feather weight. Their favourable amino acid profile suggests the potential for use as a protein source and ergogenic aid for endurance athletes, following treatment to increase digestibility. This study investigated whether 4 weeks of soluble keratin (KER) consumption (0.8 g/kg bodyweight/day) by 15 endurance-trained males would have favourable effects on body composition, blood and cardiorespiratory variables, and cycling performance, compared to casein protein (CAS).

Methods

Supplementation was randomized, blinded and balanced, with a minimum eight-week washout period between trials. An exercise test to measure oxygen consumption during submaximal and maximal cycling exercise was completed at the start at and end of each intervention. Anthropometric (DEXA) and blood measures were made prior to and following each intervention period.

Results

Total body mass and percentage body fat did not change significantly (p > 0.05). However, a significantly greater increase in bone-free lean mass (LM) occurred with KER compared to CAS (0.88 kg vs 0.07 kg; p < 0.05). While no change in LM was evident for the trunk and arms, leg LM increased (0.45 ± 0.54 kg; p = 0.006) from baseline with KER. KER was not associated with changes in blood parameters, oxygen consumption, or exercise performance (p > 0.05).

Conclusions

These data suggest that KER is not useful as an ergogenic aid for endurance athletes but may be a suitable protein supplement for maximizing increases in lean body mass.

Antihypoxic activities of constituents from Arenaria kansuensis

BACKGROUND

In previous investigation, we have identified antioxidative effects of water-soluble ethanolic extracts (named as AKE) from Arenaria kansuensis and inferred that these extracts or their constituents may also have antihypoxic activity. A. kansuensis has been widely used in traditional Tibetan medicine for altitude sickness (AS) and has been known as the herb of anti-inflammatory and hypoxia resistance for a long time.

PURPOSE

The purpose of this study is to evaluate protective effects of AKE and its major constituents against hypoxia-induced lethality in mice and RSC96 cells.

STUDY DESIGN AND METHODS

Hypoxia-induced lethality in mice was investigated by 3 experimental animal models of hypoxia. Meanwhile, we established a RSC96 cell model of hypoxia which applied to screen and assess the anti-hypoxic activity of compounds isolated from A. kansuensis.

RESULTS

Results indicated that AKE dose-dependently prolonged survival time of hypoxia induced lethality in mice compared to vehicle group and exhibited significantly anti-hypoxic effect. AKE also enhanced the number of red blood cells (RBC) and the concentration of hemoglobin (HB). 8 compounds were bio-guided separated and purified from AKE based on the animal model and cell model of hypoxia. Among which pyrocatechol (C16) and tricin 7-O-β-d-glucopyranoside (C13) were confirmed to express better protective effects on cell damage induced by hypoxia, suggesting that these two compounds are major active constituents of AKE for anti-hypoxia.

CONCLUSION

This study demonstrated that pyrocatechol and tricin 7-O-β-d-glucopyranoside could be therapeutic candidates for treatment of AS. It is the first time to find the major active constituents of AKE for anti-hypoxia. Meanwhile, a RSC96 cell model of hypoxia was established to screen anti-hypoxic activity of compounds for the first time.

Enhanced Strength and Sprint Levels, and Changes in Blood Parameters during a Complete Athletics Season in 800 m High-Level Athletes

The purpose of this study was to analyze changes in sprint, strength, hematological, and hormonal parameters in high-level 800 m athletes during a complete athletics season. Thirteen male athletes of national and international level in 800 m (personal best ranging from 1:43 to 1:58 min:ss) participated in this study. A total of 5 tests were conducted during a complete athletics season. Athletes performed sprint tests (20 and 200 m), countermovement jump (CMJ), jump squat (JS), and full squat (SQ) tests. Blood samples (red and white blood profile) and hormones were collected in test 1 (T1), test 3 (T3), and test 5 (T5). A general increase in the performance of the strength and sprint parameters analyzed (CMJ, JS, SQ, 20 m, and 200 m) during the season was observed, with a significant time effect in CMJ (P < 0.01), SQ (P < 0.01), and 200 m (P < 0.05). This improvement was accompanied by a significant enhancement of the 800 m performance from T3 to T5 (P < 0.01). Significant changes in some hematological variables: hematocrit (Hct) (P < 0.01), mean corpuscular volume (MCV) (P < 0.001), mean corpuscular hemoglobin content (MCHC) (P < 0.001), white blood cells count (WBC) (P < 0.05), neutrophils (P < 0.05), monocytes (P < 0.05), and mean platelet volume (MPV) (P < 0.05) were observed throughout the season. The hormonal response and creatin kinase (CK) did not show significant variations during the season, except for insulin-like growth factor I (IGF-1) (P < 0.05). In conclusion, our results suggest the importance of strength levels in middle-distance athletes. On the other hand, variations in some hematological parameters and a depression of the immune system occurred during the season. Therefore, monitoring of the mechanical, hematological and hormonal response in athletes may help coaches and athletes to optimize the regulation of training contents and may be useful to diagnose states of overreaching or overtraining in athletes throughout the season.

Biology of VO2 max: looking under the physiology lamp

In this review, we argue that several key features of maximal oxygen uptake (VO₂ max) should underpin discussions about the biological and reductionist determinants of its interindividual variability: (i) training-induced increases in VO₂ max are largely facilitated by expansion of red blood cell volume and an associated improvement in stroke volume, which also adapts independent of changes in red blood cell volume. These general concepts are also informed by cross-sectional studies in athletes that have very high values for VO₂ max. Therefore, (ii) variations in VO₂ max improvements with exercise training are also likely related to variations in these physiological determinants. (iii) All previously untrained individuals will respond to endurance exercise training in terms of improvements in VO₂ max provided the stimulus exceeds a certain volume and/or intensity. Thus, genetic analysis and/or reductionist studies performed to understand or predict such variations might focus specifically on DNA variants or other molecular phenomena of relevance to these physiological pathways.