Eight weeks of static apnea training increases spleen volume but not acute spleen contraction

Larger spleens and greater splenic contraction during exercise may be an adaptive characteristic of Nepali Sherpa at high-altitude

OBJECTIVES

The Sherpa ethnic group living at altitude in Nepal may have experienced natural selection in response to chronic hypoxia. We have previously shown that Sherpa in Kathmandu (1400 m) possess larger spleens and a greater apnea-induced splenic contraction compared to lowland Nepalis. This may be significant for exercise capacity at altitude as the human spleen responds to stress-induced catecholamine secretion by an immediate contraction, which results in transiently elevated hemoglobin concentration ([Hb]).

METHODS

To investigate splenic contraction in response to exercise at high-altitude (4300 m; Pb = ~450 Torr), we recruited 63 acclimatized Sherpa (29F) and 14 Nepali non-Sherpa (7F). Spleen volume was measured before and after maximal exercise on a cycle ergometer by ultrasonography, along with [Hb] and oxygen saturation (SpO2).

RESULTS

Resting spleen volume was larger in the Sherpa compared with Nepali non-Sherpa (237 ± 62 vs. 165 ± 34 mL, p < .001), as was the exercise-induced splenic contraction (Δspleen volume, 91 ± 40 vs. 38 ± 32 mL, p < .001). From rest to exercise, [Hb] increased (1.2 to 1.4 g.dl-1), SpO2 decreased (~9%) and calculated arterial oxygen content (CaO2) remained stable, but there were no significant differences between groups. In Sherpa, both resting spleen volume and the Δspleen volume were modest positive predictors of the change (Δ) in [Hb] and CaO2 with exercise (p-values from .026 to .037 and R2 values from 0.059 to 0.067 for the predictor variable).

CONCLUSIONS

Larger spleens and greater splenic contraction may be an adaptive characteristic of Nepali Sherpa to increase CaO2 during exercise at altitude, but the direct link between spleen size/function and hypoxia tolerance remains unclear.

Hemoglobin concentration and blood shift during dry static apnea in elite breath hold divers

Introduction

Elite breath-hold divers (BHD) enduring apneas of more than 5 min are characterized by tolerance to arterial blood oxygen levels of 4.3 kPa and low oxygen-consumption in their hearts and skeletal muscles, similar to adult seals. Adult seals possess an adaptive higher hemoglobin-concentration and Bohr effect than pups, and when sedated, adult seals demonstrate a blood shift from the spleen towards the brain, lungs, and heart during apnea. We hypothesized these observations to be similar in human BHD. Therefore, we measured hemoglobin- and 2,3-biphosphoglycerate-concentrations in BHD (n = 11) and matched controls (n = 11) at rest, while myocardial mass, spleen and lower extremity volumes were assessed at rest and during apnea in BHD.

Methods and results

After 4 min of apnea, left ventricular myocardial mass (LVMM) determined by 15O-H2O-PET/CT (n = 6) and cardiac MRI (n = 6), was unaltered compared to rest. During maximum apnea (∼6 min), lower extremity volume assessed by DXA-scan revealed a ∼268 mL decrease, and spleen volume, assessed by ultrasonography, decreased ∼102 mL. Compared to age, BMI and VO2max matched controls (n = 11), BHD had similar spleen sizes and 2,3- biphosphoglycerate-concentrations, but higher total hemoglobin-concentrations.

Conclusion

Our results indicate: 1) Apnea training in BHD may increase hemoglobin concentration as an oxygen conserving adaptation similar to adult diving mammals. 2) The blood shift during dry apnea in BHD is 162% more from the lower extremities than from the spleen. 3) In contrast to the previous theory of the blood shift demonstrated in sedated adult seals, blood shift is not towards the heart during dry apnea in humans.

Differential splenic responses to hyperoxic breathing at high altitude in Sherpa and lowlanders

The human spleen contracts in response to stress-induced catecholamine secretion, resulting in a temporary rise in haemoglobin concentration ([Hb]). Recent findings highlighted enhanced splenic response to exercise at high altitude in Sherpa, possibly due to a blunted splenic response to hypoxia. To explore the potential blunted splenic contraction in Sherpas at high altitude, we examined changes in spleen volume during hyperoxic breathing, comparing acclimatized Sherpa with acclimatized individuals of lowland ancestry. Our study included 14 non-Sherpa (7 female) residing at altitude for a mean continuous duration of 3 months and 46 Sherpa (24 female) with an average of 4 years altitude exposure. Participants underwent a hyperoxic breathing test at altitude (4300 m; barrometric pressure = ∼430 torr;P O 2 ${P_{{{\mathrm{O}}_{\mathrm{2}}}}}$  = ∼90 torr). Throughout the test, we measured spleen volume using ultrasonography and monitored oxygen saturation (S p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ ). During rest, Sherpa exhibited larger spleens (226 ± 70 mL) compared to non-Sherpa (165 ± 34 mL; P < 0.001; effect size (ES) = 0.95, 95% CI: 0.3-1.6). In response to hyperoxia, non-Sherpa demonstrated 22 ± 12% increase in spleen size (35 ± 17 mL, 95% CI: 20.7-48.9; P < 0.001; ES = 1.8, 95% CI: 0.93-2.66), while spleen size remained unchanged in Sherpa (-2 ± 13 mL, 95% CI: -2.4 to 7.3; P = 0.640; ES = 0.18, 95% CI: -0.10 to 0.47). Our findings suggest that Sherpa and non-Sherpas of lowland ancestry exhibit distinct variations in spleen volume during hyperoxia at high altitude, potentially indicating two distinct splenic functions. In Sherpa, this phenomenon may signify a diminished splenic response to altitude-related hypoxia at rest, potentially contributing to enhanced splenic contractions during physical stress. Conversely, non-Sherpa experienced a transient increase in spleen size during hyperoxia, indicating an active tonic contraction, which may influence early altitude acclimatization in lowlanders by raising [Hb].

Physiological responses during static apnoea efforts in elite and novice breath-hold divers before and after two weeks of dry apnoea training

This study examined the effect of breath-hold (BH) training on apnoeic performance in novice BH divers (NBH:n = 10) and compared them with data from elite BH divers (EBH:n = 11). Both groups performed 5-maximal BHs (PRE). The NBH group repeated this protocol after two weeks of BH training (POST). The NBH group during BH efforts significantly increased red blood cell concentration (4.56 ± 0.16Mio/μl) by 5.06%, hemoglobin oxygen saturation steady state duration (110.32 ± 29.84 s) by 15.48%, and breath-hold time (BHT:144.19 ± 47.35 s) by 33.77%, primarily due to a 59.70% increase in struggle phase (71.85 ± 30.89 s), in POST. EBH group exhibited longer BHT (283.95 ± 36.93 s) and struggle-phase (150.10 ± 34.69 s) than NBH (POST). Elite divers recorded a higher peak MAP (153.18 ± 12.28 mmHg) compared to novices (PRE:123.70 ± 15.65 mmHg, POST:128.30 ± 19.16 mmHg), suggesting that a higher peak MAP is associated with a better BHT. The concurrent abrupt increase of diaphragmatic activity and MAP, seen only in the EBH group, suggests a potential interaction. Additionally, apnoea training increases red blood cells concentration in repeated apnoea efforts and increases BH stamina.

Larger splenic emptying correlate with slower EPOC kinetics in healthy men and women during supine cycling

PURPOSE

The present study investigated whether larger splenic emptying augments faster excess post-exercise O2 consumption (EPOC) following aerobic exercise cessation.

METHODS

Fifteen healthy participants (age 24 ± 4, 47% women) completed 3 laboratory visits at least 48-h apart. After obtaining medical clearance and familiarizing themselves with the test, they performed a ramp-incremental test in the supine position until task failure. At their final visit, they completed three step-transition tests from 20 W to a moderate-intensity power output (PO), equivalent to [Formula: see text]O2 at 90% gas exchange threshold, where data on metabolic, cardiovascular, and splenic responses were recorded simultaneously. After step-transition test cessation, EPOCfast was recorded, and the first 10 min of the recovery period was used for further analysis. Blood samples were collected before and immediately after the end of exercise.

RESULTS

In response to moderate-intensity supine cycling ([Formula: see text]O2 = ~ 2.1 L·min-1), a decrease in spleen volume of ~ 35% (p = 0.001) was observed, resulting in a transient increase in red cell count of ~ 3-4% (p = 0.001) in mixed venous blood. In parallel, mean blood pressure, heart rate, and stroke volume increased by 30-100%, respectively. During recovery, mean τ[Formula: see text]O2 was 45 ± 18 s, the amplitude was 2.4 ± 0.5 L·min-1, and EPOCfast was 1.69 L·O2. Significant correlations were observed between the percent change in spleen volume and (i) EPOCfast (r = - 0.657, p = 0.008) and (ii) τ[Formula: see text]O2 (r = - 0.619, p = 0.008), but not between the change in spleen volume and (iii) [Formula: see text]O2 peak (r = 0.435, p = 0.105).

CONCLUSION

Apparently, during supine cycling, individuals with larger spleen emptying tend to have slower [Formula: see text] O2 recovery kinetics and a greater EPOCfast.

Training methods for maximal static apnea performance: a systematic review and meta-analysis

INTRODUCTION

Currently, there is an increase in people practicing freediving (FD) both in competition and leisure. As a sports practice, its modalities are grouped into static, dynamic, and constant weight apnea. The aim of this systematic review and meta-analysis (PROSPERO-CRD42021230322) was to identify the training methods used to improve the static apnea time (AT) performance.

EVIDENCE ACQUISITION

Ten training protocols were analyzed from eight studies published until March 09, 2022. The effect size (Hedge's g) and its confidence interval (CI<inf>95%</inf>) were calculated from the AT measured pre- and post-training.

EVIDENCE SYNTHESIS

Three different apnea training methods were verified, the breath-hold (BH) that uses BH exercises, physical training with strength and cardiorespiratory exercises, and cross training that combines BH exercises with physical training. These training methods were applied to 138 participants of both sexes with or without experience in apnea episode or diving practice. In general, the AT improvement showed a large effect after the interventions (g=1.30, CI<inf>95%</inf>=0.85-1.76, P<0.01).

CONCLUSIONS

All three methods were effective in improving static AT, however from the existing protocols is not possible to recommend an ideal to improve AT and therefore FD performance.

Splenic contraction and cardiovascular responses are augmented during apnea compared to rebreathing in humans

The spleen contracts during apnea, releasing stored erythrocytes, thereby increasing systemic hemoglobin concentration (Hb). We compared apnea and rebreathing periods, of equal sub-maximal duration (mean 137 s; SD 30), in eighteen subjects to evaluate whether respiratory arrest or hypoxic and hypercapnic chemoreceptor stimulation is the primary elicitor of splenic contraction and cardiovascular responses during apnea. Spleen volume, Hb, cardiovascular variables, arterial (SaO₂), cerebral (ScO₂), and deltoid muscle oxygen saturations (SmO₂) were recorded during the trials and end-tidal partial pressure of oxygen (P_ETO₂) and carbon dioxide (P_ETCO₂) were measured before and after maneuvers. The spleen volume was smaller after apnea, 213 (89) mL, than after rebreathing, 239 (95) mL, corresponding to relative reductions from control by 20.8 (17.8) % and 11.6 (8.0) %, respectively. The Hb increased 2.4 (2.0) % during apnea, while there was no significant change with rebreathing. The cardiovascular responses, including bradycardia, decrease in cardiac output, and increase in total peripheral resistance, were augmented during apnea compared to during rebreathing. The P_ETO₂ was higher, and the P_ETCO₂ was lower, after apnea compared to after rebreathing. The ScO₂ was maintained during maneuvers. The SaO₂ decreased 3.8 (3.1) % during apnea, and even more, 5.4 (4.4) %, during rebreathing, while the SmO₂ decreased less during rebreathing, 2.2 (2.8) %, than during apnea, 8.3 (6.2) %. We conclude that respiratory arrest per se is an important stimulus for splenic contraction and Hb increase during apnea, as well as an important initiating factor for the apnea-associated cardiovascular responses and their oxygen-conserving effects.

Increased spleen volume provoked by temperate head-out-of-water immersion

This study tested the hypotheses that 1) spleen volume increases during head-out-of-water immersion (HOWI) and returns to pre-HOWI values postdiuresis, and 2) the magnitude of apnea-induced spleen contraction increases when preapnea spleen volume is elevated. Spleen volume was measured before and after a set of five apneas in 12 healthy adults (28 ± 5 yr, 3 females) before, during (at 30 and 150 min), and 20 min after temperate temperature (36 ± 1°C) HOWI. At each time point, spleen length, width, and thickness were measured via ultrasound, and spleen volume was calculated using the Pilström equation. Compared with pre-HOWI (276 ± 88 mL), spleen volume was elevated at 30 (353 ± 94 mL, P < 0.01) and 150 (322 ± 87 mL, P < 0.01) min of HOWI but returned to pre-HOWI volume at post-HOWI (281 ± 90 mL, P = 0.58). Spleen volume decreased from pre- to postapnea bouts at each time point (P < 0.01). The magnitude of reduction in spleen volume from pre- to postapneas was elevated at 30 min of HOWI (-69 ± 24 mL) compared with pre-HOWI (-52 ± 20 mL, P = 0.04) but did not differ from pre-HOWI at 150 min of HOWI (-54 ± 16 mL, P = 0.99) and post-HOWI (-50 ± 18 mL, P = 0.87). Thus, spleen volume is increased throughout 180 min of HOWI, and whereas apnea-induced spleen contraction is augmented after 30 min of HOWI, the magnitude of spleen contraction is unaffected by HOWI thereafter.

Eight weeks of dry dynamic breath-hold training results in larger spleen volume but does not increase haemoglobin concentration

Purpose: It has previously been reported that repeated exposure to hypoxia increases spleen size and haemoglobin (HGB) level and recent reports on the effect apnoea has on spleen size and haematological parameters are contradictory. Therefore, this study aims to evaluate the effect apnoea training has on spleen size and haematological parameters.

Methods: The breath-holding (BH) group was comprised of 12 local student-athletes with no BH exercise experience who performed BH jogging and BH jumping rope dynamic apnoea protocols, five times weekly for 8 weeks. The BH event duration was progressively increased as the apnoea tolerance of the athletes improved (20 to 35 s). The same training task was performed by the control group (n = 10) without BH. Spleen sizes were measured with an ultrasound system and a complete blood cell analysis was performed on the median cubital venous blood.

Results: Spleen volume in the BH group increased from 109 ± 13 ml to 136 ± 13 ml (p < 0.001), and bulky platelets decreased from 70.50 ± 5.83 to 65.17 ± 5.87 (p = 0.034), but no changes were recorded for erythrocytes (p = 0.914), HGB (p = 0.637), PLTs (p = 0.346) and WBC (p = 0.532). No changes were recorded for the control group regarding spleen size or haematological parameters.

Conclusion: Eight weeks of dry dynamic apnoea training increased spleen size and decreased the number of circulating bulky platelets in the athletes who were assessed in this study. However, the baseline RBC counts and HGB levels of the athletes were not altered by the training programme.

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.

No differences in splenic emptying during on-transient supine cycling between aerobically trained and untrained participants

Purpose

The role of splenic emptying in O₂ transport during aerobic exercise still remains a matter of debate. Our study compared the differences in spleen volume changes between aerobically trained and untrained individuals during step-transition supine cycling exercise at moderate-intensity. We also examined the relationship between spleen volume changes, erythrocyte release, and O₂ uptake parameters.

Methods

Fourteen healthy men completed all study procedures, including a detailed medical examination, supine maximal O₂ uptake (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\dot{\text{V}}\text{O}}_{2}$$\end{document}V˙O2 max.) test, and three step-transitions from 20 W to a moderate-intensity power output, equivalent to \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\dot{\text{V}}\text{O}}_{2}$$\end{document}V˙O2 uptake at 90% gas exchange threshold. During these step-transitions pulmonary \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\dot{\text{V}}\text{O}}_{{2{\text{p}}}}$$\end{document}V˙O2p, near-infrared spectroscopy of the vastus lateralis, and cardiovascular responses were continuously measured. In parallel, minute-by-minute ultrasonic measurements of the spleen were performed. Blood samples were taken before and immediately after step-transition cycling.

Results

On average, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\dot{\text{V}}\text{O}}_{2}$$\end{document}V˙O2 max. was 10 mL kg min⁻¹ (p = 0.001) higher in trained compared to their aerobically untrained peers. In response to supine step-transition cycling, the splenic volume was significantly reduced, and the largest reduction (~ 106 to 115 mL, ~ 38%, p = 0.001) was similar in both aerobically trained and untrained individuals. Erythrocyte concentration and platelet count transiently increased after exercise cessation, with no differences observed between groups. However, the vastus lateralis deoxygenation amplitude was 30% (p = 0.001) greater in trained compared to untrained individuals. No associations existed between: (i) spleen volumes at rest (ii) spleen volume changes (%), (iii) resting hematocrit and oxygen uptake parameters.

Conclusion

Greater splenic emptying and subsequent erythrocyte release do not lead to a slower \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\tau {\dot{\text{V}}\text{O}}_{{2{\text{p}}}}$$\end{document}τV˙O2p, regardless of individual \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\dot{\text{V}}\text{O}}_{2}$$\end{document}V˙O2 max. readings.

Effects of dynamic apnea training on diving bradycardia and short distance swimming performance

BACKGROUND

Apnea training enhances bradycardia and improves competitive apnea performance, and has been proposed as a training method for other sports, such as swimming. We evaluated the effects of apneic underwater swimming, i.e. dynamic apnea (DYN), in 9 competitive swimmers (TR) who completed ten DYN sessions over 2 weeks.

METHODS

TR performed pre- and post-training tests including a static apnea test with continuous heart rate (HR) and peripheral oxygen saturation measurements, all-out 50m and 100m freestyle tests and an all-out DYN test. Control groups were competitive swimmers (SC; n=10) that trained swimming without DYN, and a non-swimmer group (AC; n=10) performing only static apnea tests.

RESULTS

Post-training, TR mean±SD time for 50m freestyle improved from 25.51±2.01s to 24.64±2.02s (p<0.01) and for 100m from 55.5±4.2s to 54.1±4.4s (p<0.05). SC also improved their 100m time from 56.7±3.3s to 56.0±3.1s (p<0.01; p=0.07 between groups). Only TR performed DYN tests; DYN distance increased from 62.1±11.5m to 70.9±18.9m (p<0.05) while DYN speed decreased from 0.74±0.14m/s to 0.64±0.18m/s (p<0.01). Static apnea duration did not change in any of the groups, but HR-reduction was enhanced posttraining only in TR (24.8±14.8% to 31.1±10.9%, p<0.01; p<0.001 between groups).

CONCLUSIONS

We conclude that 2 weeks of DYN training enhanced DYN performance, which may be caused by the enhanced apnea-induced diving bradycardia. Further research is required to determine whether DYN training enhances short distance freestyle swimming performance.

Spleen Emptying Does Not Correlate With Faster Oxygen Kinetics During a Step-Transition Supine Cycling

This manuscript quantified spleen volume changes and examined the relationship between those changes and V̇O2 kinetics during supine cycling. Ten volunteers (age=22±3), completed three step-transitions from 20 W to their power output at 90% gas exchange threshold. Ultrasonic measurements of the spleen were performed each minute. The largest spleen volume reduction was 105 mL (p=.001). No associations existed between: i) spleen volumes at rest ii) spleen volume changes (%) and τV̇O2p. Larger resting spleen volume and greater emptying do not correlate with a faster τV̇O2p. Novelty: • Greater splenic contractions do not augment τV̇O2p, irrespective of spleen emptying and subsequent erythrocyte release.

Enhanced splenic volume and contraction in elite endurance athletes

Splenic contraction, which leads to ejection of stored erythrocytes, is greater in athletes involved in regular freediving or high-altitude activities. As this response facilitates oxygen-carrying capacity, similar characteristics may be expected of elite endurance athletes. Therefore, our aims were to compare resting and apnea-induced splenic volume in endurance athletes and untrained individuals, and to assess the athletes' exercise-induced splenic volume. Twelve elite biathletes (7 women) and 12 controls (6 women) performed a maximal effort apnea in a seated position. In addition, the biathletes completed a maximal roller-skiing time trial. Splenic dimensions were measured by ultrasonic imaging for subsequent volume calculations, whereas Hb was analyzed from capillary blood samples and cardiorespiratory variables were monitored continuously. Baseline splenic volume was larger in the biathletes (214 ± 56 mL) compared with controls (157 ± 39 mL, P = 0.008) and apnea-induced splenic contraction was also greater in the biathletes (46 ± 20 mL vs. 30 ± 16 mL, P = 0.035). Hb increased immediately after apnea in the biathletes (4.5 ± 4.8%, P = 0.029) but not in the controls (-0.7 ± 3.1%, P = 0.999). Increases in exercise-induced splenic contraction (P = 0.008) and Hb (P = 0.001) were greater compared with the apnea-induced responses among the athletes. Baseline splenic volume tended to be correlated with V̇o_2max (r = 0.584, P = 0.059). We conclude that elite biathletes have greater splenic volume with a greater ability to contract and elevate Hb compared with untrained individuals. These characteristics may transiently enhance O₂-carrying capacity and possibly increase O₂ uptake, thereby helping biathletes to cope with high intermittent O₂ demands and severe O₂ deficits that occur during biathlon training and competition.NEW & NOTEWORTHY This study demonstrates that elite biathletes have larger splenic volume, apnea-induced splenic contraction, and Hb elevation compared with untrained individuals, which is likely functional to cope with high O₂ demands and substantial O₂ deficits. We believe that enhanced splenic contraction may be of importance during competitions involving cross-country skiing, to regulate circulating Hb and enhance O₂-carrying capacity, which may protect [Formula: see text] and increase O₂ uptake.

Spleen Volume and Contraction During Apnea in Mt. Everest Climbers and Everest Base Camp Trekkers

The human spleen can contract and transiently boost the blood with stored erythrocytes. We measured spleen volume and contraction during apneas in two groups, each containing 12 Caucasian participants (each 3 women): one group planning to summit Mt. Everest (8848 m; "Climbers") and another trekking to Everest Base Camp (5300 m; "Trekkers"). Tests were done in Kathmandu (1370 m) 1-3 days after arrival, before the Climb/Trek. Age, height, weight, vital capacity, resting heart rate, and arterial oxygen saturation were similar between groups (not significant). After 15 minutes of sitting rest, all participants performed a 1-minute apnea and, after 2 minutes of rest, 1 maximal duration apnea was performed. Six of the climbers did a third apnea and hemoglobin concentration (Hb) was measured. Three axial spleen diameters were measured by ultrasonic imaging before and after the apneas for spleen volume calculation. Mean (standard deviation) baseline spleen volume was larger in Climbers [367 (181) mL] than in Trekkers [228 (70) mL; p = 0.022]. Spleen contraction occurred during apneas in both groups, with about twice the magnitude in Climbers. Three apneas in six of the Climbers resulted in a spleen volume reduction from 348 (145) to 202 (91) mL (p = 0.005) and an Hb elevation from 147.9 (13.1) to 153.3 (11.3) g/L (p = 0.024). Maximal apneic duration was longer in Climbers [88 (23) seconds vs. 67 (18) seconds in Trekkers; p = 0.023]. We concluded that a large spleen characterizes Climbers, suggesting that spleen function may be important for high-altitude climbing performance.

Physiology, pathophysiology and (mal)adaptations to chronic apnoeic training: a state-of-the-art review

Breath-hold diving is an activity that humans have engaged in since antiquity to forage for resources, provide sustenance and to support military campaigns. In modern times, breath-hold diving continues to gain popularity and recognition as both a competitive and recreational sport. The continued progression of world records is somewhat remarkable, particularly given the extreme hypoxaemic and hypercapnic conditions, and hydrostatic pressures these athletes endure. However, there is abundant literature to suggest a large inter-individual variation in the apnoeic capabilities that is thus far not fully understood. In this review, we explore developments in apnoea physiology and delineate the traits and mechanisms that potentially underpin this variation. In addition, we sought to highlight the physiological (mal)adaptations associated with consistent breath-hold training. Breath-hold divers (BHDs) are evidenced to exhibit a more pronounced diving-response than non-divers, while elite BHDs (EBHDs) also display beneficial adaptations in both blood and skeletal muscle. Importantly, these physiological characteristics are documented to be primarily influenced by training-induced stimuli. BHDs are exposed to unique physiological and environmental stressors, and as such possess an ability to withstand acute cerebrovascular and neuronal strains. Whether these characteristics are also a result of training-induced adaptations or genetic predisposition is less certain. Although the long-term effects of regular breath-hold diving activity are yet to be holistically established, preliminary evidence has posed considerations for cognitive, neurological, renal and bone health in BHDs. These areas should be explored further in longitudinal studies to more confidently ascertain the long-term health implications of extreme breath-holding activity.

Six weeks of dynamic apnoeic training stimulates erythropoiesis but does not increase splenic volume

Purpose

This study examined the influence of dynamic apnoea training on splenic volume and haematological responses in non-breath-hold divers (BHD).

Methods

Eight non-BHD performed ten maximal dynamic apnoeas, four times a week for  six weeks. Splenic volumes were assessed ultrasonically, and blood samples were drawn for full blood count analysis, erythropoietin, iron, ferritin, albumin, protein and osmolality at baseline, 24 h post the completion of each week’s training sessions and seven days post the completion of the training programme. Additionally, blood samples were drawn for haematology at 30, 90, and 180 min post session one, twelve and twenty-four.

Results

Erythropoietin was only higher than baseline (6.62 ± 3.03 mlU/mL) post session one, at 90 (9.20 ± 1.88 mlU/mL, p = 0.048) and 180 min (9.04 ± 2.35 mlU/mL, p = 0.046). Iron increased from baseline (18 ± 3 µmol/L) post week five (23 ± 2 µmol/L, p = 0.033) and six (21 ± 6 µmol/L; p = 0.041), whereas ferritin was observed to be lower than baseline (111 ± 82 µg/L) post week five (95 ± 75 µg/L; p = 0.016), six (84 ± 74 µg/L; p = 0.012) and one week post-training (81 ± 63 µg/L; p = 0.008). Reticulocytes increased from baseline (57 ± 12 × 10⁹/L) post week one (72 ± 17 × 10⁹/L, p = 0.037) and six (71 ± 17 × 10⁹/L, p = 0.021) while no changes were recorded in erythrocytes (p = 0.336), haemoglobin (p = 0.124) and splenic volumes (p = 0.357).

Conclusions

Six weeks of dynamic apnoeic training increase reticulocytes without altering mature erythrocyte concentration and splenic volume.

Hold your breath: peripheral and cerebral oxygenation during dry static apnea

PURPOSE

Acute breath-holding deprives the human body from oxygen. In an effort to protect the brain, the diving response is initiated, coupling several physiological responses. The aim of this study was to describe the physiological responses to apnea at the cardiac, peripheral and cerebral level.

METHODS

31 physically active subjects (17 male, 14 female, 23.3 ± 1.8 years old) performed a maximal static breath-hold in a seated position. Heart rate (HR), muscle and cerebral oxygenation (by means of near-infrared spectroscopy, NIRS) were continuously measured. RM MANOVA's were used to identify changes in HR, peripheral (mTOI) and cerebral (cTOI) tissue oxygenation and oxygenated (O₂Hb) and deoxygenated (HHb) hemoglobin during apnea.

RESULTS

Average apnea duration was 157 ± 41 s. HR started decreasing after 10 s (p < 0.001) and dropped on average by 27 ± 14 bpm from baseline (p < 0.001). mTOI started decreasing 10 s after apnea (p < 0.001) and fell by 8.6 ± 4.0% (p < 0.001). Following an immediate drop after 5 s (p < 0.001), cTOI increased continuously, reaching a maximal increase of 3.7 ± 2.4% followed by a steady decrease until the end of apnea. cTOI fell on average 5.4 ± 8.3% below baseline (p < 0.001).

CONCLUSION

During apnea, the human body elicits several protective mechanisms to protect itself against the deprivation of oxygen. HR slows down, decreasing O₂ demand of the cardiac muscle. The decrease in mTOI and increase in cTOI imply a redistribution of blood flow prioritizing the brain. However, this mechanism is not sufficient to maintain cTOI until the end of apnea.

Spleen Size and Function in Sherpa Living High, Sherpa Living Low and Nepalese Lowlanders

High-altitude (HA) natives have evolved some beneficial responses leading to superior work capacity at HA compared to native lowlanders. Our aim was to study two responses potentially protective against hypoxia: the spleen contraction elevating hemoglobin concentration (Hb) and the cardiovascular diving response in Sherpa highlanders, compared to lowlanders. Male participants were recruited from three groups: (1) 21 Sherpa living at HA (SH); (2) seven Sherpa living at low altitude (SL); and (3) ten native Nepalese lowlanders (NL). They performed three apneas spaced by a two-min rest at low altitude (1370 m). Their peripheral oxygen saturation (SpO₂), heart rate (HR), and spleen volume were measured across the apnea protocol. Spleen volume at rest was 198 ± 56 mL in SH and 159 ± 35 mL in SL (p = 0.047). The spleen was larger in Sherpa groups compared to the 129 ± 22 mL in NL (p < 0.001 compared to SH; p = 0.046 compared to SL). Spleen contraction occurred in all groups during apnea, but it was greater in Sherpa groups compared to NL (p < 0.001). HR was lower in Sherpa groups compared to NL both during rest (SL: p < 0.001; SH: p = 0.003) and during maximal apneas (SL: p < 0.001; SH: p = 0.06). The apnea-induced HR reduction was 8 ± 8% in SH, 10 ± 4% in SL (NS), and 18 ± 6% in NL (SH: p = 0.005; SL: p = 0.021 compared to NL). Resting SpO₂ was similar in all groups. The progressively decreasing baseline spleen size across SH, SL, and NL suggests a role of the spleen at HA and further that both genetic predisposition and environmental exposure determine human spleen size. The similar HR responses of SH and SL suggest that a genetic component is involved in determining the cardiovascular diving response.

Splenic responses to a series of repeated maximal static and dynamic apnoeas with whole-body immersion in water

NEW FINDINGS

What is the central question of this study? Splenic contractions occur in response to apnoea-induced hypoxia with and without face immersion in water. However, the splenic responses to a series of static or dynamic apnoeas with whole-body water immersion in non-divers and elite breath-hold divers are unknown. What is the main finding and its importance? Static and dynamic apnoeas were equally effective in stimulating splenic contractions across non-divers and elite breath-hold divers. These findings demonstrate that the magnitude of the splenic response is largely dictated by the degree of the hypoxemic stress encountered during voluntary apnoeic epochs.

ABSTRACT

Splenic contractions occur in response to apnoea-induced hypoxia with and without facial water immersion. However, the splenic responses to a series of static (STA) or dynamic (DYN) apnoeas with whole-body water immersion in non-divers (NDs) and elite breath-hold divers (EBHDs) are unknown. EBHD (n = 8), ND (n = 10) and control participants (n = 8) were recruited. EBHD and ND performed a series of five maximal DYN or STA on separate occasions. Control performed a static eupnoeic (STE) protocol to control against any effects of water immersion and diurnal variation on splenic volume and haematology. Heart rate (HR) and peripheral oxygen saturation (SpO₂ ) were monitored for 30 s after each apnoea. Pre- and post-apnoeic splenic volumes were quantified ultrasonically, and blood samples were drawn for haematology. For EBHD and ND end-apnoeic HR was higher (P < 0.001) and SpO₂ was lower in DYN (P = 0.024) versus STA. EBHD attained lower end-apnoeic SpO₂ during DYN and STA than NDs (P < 0.001). Splenic contractions occurred following DYN (EBHD, -47 ± 6%; ND, -37 ± 4%; P < 0.001) and STA (EBHD, -26 ± 4%; ND, -26 ± 8%; P < 0.01). DYN-associated splenic contractions were greater than STA in EBHD only (P = 0.042). Haemoglobin concentrations were higher following DYN only (EBHD, +5 ± 8g/L  , +4 ± 2%; ND, +8 ± 3 g/L , +4.9 ± 3%; P = 0.019). Haematocrit remained unchanged after each protocol. There were no between group differences in post-apnoeic splenic volume or haematology. In both groups, splenic contractions occurred in response to STA and DYN when combined with whole-body immersion. DYN apnoeas, were effective at increasing haemoglobin concentrations but not STA apnoeas. Thus, the magnitude of the splenic response relates to the hypoxemic stress encountered during apnoeic epochs.