Arterial desaturation during exercise in man: implication for O2 uptake and work capacity

A modelling approach to disentangle the factors limiting muscle oxygenation in smokers

Cigarette smoking is associated with a lower exercise capacity and lower muscle fatigue resistance. This is at least partly attributable to carboxyhaemoglobin (HbCO) in the blood that via reduction in the oxygen-carrying capacity, and the left-shift of the Hb-dissociation curve would reduce tissue oxygenation. On the other hand, a reduced oxygen uptake due to mitochondrial dysfunction would result in improved oxygenation. We used previously collected capillarisation, myoglobin and estimated cellular maximal muscle oxygen consumption data derived from succinate dehydrogenase-stained sections from the vastus lateralis muscle from six smokers and five non-smokers. These data were fed into an expanded Krogh tissue oxygenation model to assess whether an impaired muscle fatigue resistance in smokers is primarily due to HbCO or impaired mitochondrial respiration. The model showed that in smokers with 6% and 20% HbCO (causing a left-shift of the Hb-dissociation curve) average muscle oxygenation was reduced by 1.9% and 7.2%, respectively. Muscle oxygenation was increased by 13.3% when maximal mitochondrial respiration was reduced by 29%. A combination of a 29% reduction in maximal mitochondrial respiration and 20% HbCO led to no significant difference in muscle oxygenation from that in non-smokers. This indicates that while HbCO may explain the reduced exercise capacity after just one smoking session, in chronic smokers impaired mitochondrial respiration appears more important in reducing oxygen extraction and exercise capacity with only a small contribution of the left-shift of the Hb-dissociation curve.

John AL. Mast cell activation in lungs during SARS-CoV-2 infection associated with lung pathology and severe COVID-19

Lung inflammation is a hallmark of Coronavirus disease 2019 (COVID-19) in patients who are severely ill, and the pathophysiology of disease is thought to be immune mediated. Mast cells (MCs) are polyfunctional immune cells present in the airways, where they respond to certain viruses and allergens and often promote inflammation. We observed widespread degranulation of MCs during acute and unresolved airway inflammation in SARS-CoV-2-infected mice and nonhuman primates. Using a mouse model of MC deficiency, MC-dependent interstitial pneumonitis, hemorrhaging, and edema in the lung were observed during SARS-CoV-2 infection. In humans, transcriptional changes in patients requiring oxygen supplementation also implicated cells with a MC phenotype in severe disease. MC activation in humans was confirmed through detection of MC-specific proteases, including chymase, the levels of which were significantly correlated with disease severity and with biomarkers of vascular dysregulation. These results support the involvement of MCs in lung tissue damage during SARS-CoV-2 infection in animal models and the association of MC activation with severe COVID-19 in humans, suggesting potential strategies for intervention.

Plasma Acidosis and Peak Power after a Supramaximal Trial in Elite Sprint and Endurance Cyclists: Effect of Bicarbonate

PURPOSE

This study aimed to determine whether (i) a plasma acidosis contributes to a reduction of mechanical performance and (ii) bicarbonate supplementation blunts plasma acidosis and arterial oxygen desaturation to resist fatigue during the end spurt of a supramaximal trial in elite sprint and endurance cyclists.

METHODS

Elite/world-class cyclists ( n = 6 sprint, n = 6 endurance) completed two randomized, double-blind, crossover trials at 105%V̇O 2peak simulating 3 min of a 4-km individual pursuit, 90 min after ingestion of 0.3 g·kg -1 BM sodium bicarbonate (BIC) or placebo (PLA). Peak power output (PPO), optimal cadence and optimal peak torque, and fatigue were assessed using a 6-s "all-out sprint" before (PPO1) and after (PPO2) each trial. Plasma pH, bicarbonate, lactate - , K + , Na + , Ca 2+ , and arterial hemoglobin saturation (SpO 2 (%)), were measured.

RESULTS

Sprint cyclists exhibited a higher PPO, optimal pedal torque, and anaerobic power reserve (APR) than endurance cyclists. The trial reduced PPO (PLA) more for sprint (to 47% initial) than endurance cyclists (to 61% initial). Optimal cadence fell from ~151 to 92 rpm and cyclists with higher APR exhibited a reduced optimal peak torque. Plasma pH fell from 7.35 to 7.13 and plasma [lactate - ] increased from 1.2 to 19.6 mM (PLA), yet neither correlated with PPO loss. Sprint cyclists displayed a lesser plasma acidosis but greater fatigue than endurance cyclists. BIC increased plasma [HCO 3- ] (+6.8 mM) and plasma pH after PPO1 (+0.09) and PPO2 (+0.07) yet failed to influence mechanical performance. SpO 2 fell from 99% to 96% but was unrelated to the plasma acidosis and unaltered with BIC.

CONCLUSIONS

Plasma acidosis was not associated with the decline of PPO in a supramaximal trial with elite cyclists. BIC attenuated acid-base disturbances yet did not improve arterial oxygen desaturation or mechanical performance at the end-spurt stage.

Does the COVID-19 personal protective equipment impair the surgeon's performance?

INTRODUCTION

Despite increasing vaccination rates, new viral variants of SARS-CoV-2 (severe acute respiratory syndrome coronavirus type 2) are advancing the COVID 19 (coronavirus disease 2019) pandemic and continue to challenge the entire world. Surgical care of SARS-CoV-2 positive patients requires special protective measures. We hypothesized that "COVID-19" personal protective equipment (PPE) during surgery of SARS-CoV-2 positive or potentially positive patients would negatively affect the surgeon and thus the surgical outcome.

MATERIALS AND METHODS

Ten experienced trauma surgeons participated in the study. Each surgeon performed two simulated surgeries of a distal tibial fracture on a Sawbone® under standardized conditions either wearing regular PPE or special COVID-19 PPE. Baseline values at rest were acquired for heart rate, blood pressure, saturation of peripheral oxygen (SpO₂), respiratory rate and capillary blood gas (CBG) analysis including capillary partial pressure of oxygen (pO₂) and carbon dioxide (pCO₂), followed by four different standardized tests of attentional performance (TAP). Subsequently, the surgeon performed the first surgery according to a randomly determined order, with regular or COVID-19 PPE conditions in an operation theatre. After each surgery vital signs were acquired and CBG and TAP were performed again.

RESULTS

In our simulated surgical procedure heart rate, respiratory rate, systolic and diastolic blood pressure did not show relevant differences. Percutaneously measured SpO₂ decreased with additional layers of PPE, while CBG parameters were not affected. TAP tests showed a significant impairment of attention if PPEs were compared to the baseline, but both PPEs had similar results and no meaningful differences could be measured.

CONCLUSIONS

According to our results, for surgical procedures additional PPE required during COVID-19 pandemic does not relevant affect the surgeon's mental and physical performance. Surgeries under COVID-19 PPE conditions appear safe and do not increase patient risk.

LEVEL OF EVIDENCE

Level I.

Caffeine Increases Endurance Performance via Changes in Neural and Muscular Determinants of Performance Fatigability

PURPOSE

In the present study, we tested the hypothesis that caffeine would increase endurance performance via attenuation of neural and muscular determinants of performance fatigability during high-intensity, whole-body exercise.

METHODS

Ten healthy males cycled until exhaustion (89% ± 2% of V̇O2max) after the ingestion of caffeine or placebo. During another four visits, the same exercise was performed after either caffeine or placebo ingestion but with exercise discontinued after completing either 50% or 75% of the duration of placebo trial. An additional trial with caffeine ingestion was also performed with interruption at the placebo time to exhaustion (isotime). Performance fatigability was measured via changes in maximal voluntary contraction, whereas neural and muscular determinants of performance fatigability were quantified via preexercise to postexercise decrease in quadriceps voluntary activation (VA) and potentiated twitch force, respectively.

RESULTS

Compared with the placebo, caffeine increased time to exhaustion (+14.4 ± 1.6%, P = 0.017, 314.4 ± 47.9 vs 354.9 ± 40.8 s). Caffeine did not change the rate of decline in maximal voluntary contraction (P = 0.209), but caffeine reduced the twitch force decline at isotime when stimulating at single twitch (-58.6 ± 22.4 vs -45.7 ± 21.9%, P = 0.014) and paired 10 Hz electrical stimuli (-37.3 ± 13.2 vs -28.2 ± 12.9%, P = 0.025), and reduced the amplitude of electromyography signal during cycling at isotime (P = 0.034). The decline in VA throughout the trial was lower (P = 0.004) with caffeine (-0.5 ± 4.2%) than with placebo (-5.8 ± 8.5%). Caffeine also maintained peripheral oxygen saturation at higher levels (95.0 ± 1.9%) than placebo (92.0 ± 6.2%, P = 0.016).

CONCLUSIONS

Caffeine ingestion improves performance during high-intensity, whole-body exercise via attenuation of exercise-induced reduction in VA and contractile function.

Pulmonary Capacity, Blood Composition and Metabolism among Coal Mine Workers in High- and Low-Altitude Aboveground and Underground Workplaces

(1) Background: While previous studies revealed how underground mining might adversely affect the cardiopulmonary functions of workers, this study further investigated the differences between under- and aboveground mining at both high and low altitudes, which has received little attention in the literature. (2) Methods: Seventy-one healthy male coal mine workers were recruited, who had worked at least 5 years at the mining sites located above the ground at high (>3900 m; n = 19) and low (<120 m; n = 16) altitudes as well as under the ground at high (n = 20) and low (n = 16) altitudes. Participants’ heart rates, pulmonary functions, total energy expenditure and metabolism were measured over a 5-consecutive-day session at health clinics. (3) Results: Combining the results for both above- and underground locations, workers at high-altitude mining sites had significantly higher peak heart rate (HR), minimum average HR and training impulse as well as energy expenditure due to all substances and due to fat than those at low-altitude sites. They also had significantly higher uric acid, total cholesterol, creatine kinase and N-osteocalcin in their blood samples than the workers at low-altitude mining sites. At underground worksites, the participants working at high-altitude had a significantly higher average respiratory rate than those at low-altitude regions. (4) Conclusion: In addition to underground mining, attention should be paid to high-altitude mining as working under a hypoxia condition at such altitude likely presents physiological challenges.

Blood oxygenation response to aerobic exercise combined with breathing exercises in pregnant women: a randomized controlled trial

Background

There are many physiological changes occur during pregnancy that affect oxygenation of the pregnant women. It was considered that aerobic and breathing exercises are safe for the mother and the fetus especially moderate intensity exercise during pregnancy.

Objective

This study was designed to investigate the blood oxygenation response to aerobic exercise combined with breathing exercises in pregnant women.

Methodology

Forty pregnant women were selected from obstetrics and gynecology outpatient clinic at Kasr El Einy Hospital, Egypt, confidentiality was assured. They were ranged from 25 to 30 years old, with body mass index (BMI) less than 30 kg/m2 and at the beginning of 3rd trimester, this study was conducted from September 2019 to April 2020. They were assigned into two groups: group A performed aerobic exercise in a form of walking for 20 min. On the treadmill at 60–75% of the maximum heart rate (MHR) of each woman, three times per week in addition to deep breathing exercises in form of diaphragmatic and lateral costal breathing; group B who performed deep breathing exercises only in form of diaphragmatic and lateral costal breathing. The program continued for three months, three times per week. The oxygen saturation (SaO2) was measured twice time, firstly, at the beginning of 3rd trimester of pregnancy then after three months of treatment program.

Results

The results of this study revealed a statistically significant difference in the oxygen saturation in group A than in group B.

Conclusion

It could be concluded that there was significant statistical effect of aerobic exercise combined with breathing exercises on blood oxygenation in pregnant women. It improved the oxygen saturation in pregnant women.

Estimation of Cerebral Hemodynamics and Oxygenation During Various Intensities of Rowing Exercise: An NIRS Study

Purpose

This study aimed to investigate changes in cerebral hemodynamics and oxygenation at moderate, heavy, maximal and supramaximal intensities of rowing exercise. It also examined whether these changes reflect alterations in sensation of effort and mood. We also aimed to examine the effects of peak pulmonary oxygen consumption (V.O_2peak) on cerebral oxygenation.

Methods

Eleven rowers, consisting out of six athletes and five recreational rowers [two female; age, 27 ± 9 years; height, 171 ± 7 cm, body mass, 67 ± 9 kg; V.O_2peak, 53.5 ± 6.5 mL min^–1 kg^–1] rowed a 13-min session separated by 10 and 3 min, at 70 (Ex_70%) and 80% of V.O_2peak (Ex_80%), respectively, on a rowing ergometer, followed by three sessions of 1-min supramaximal exercise (ExSp). After a warm-up at 60% of V.O_2peak (ExM), seven male rowers performed a 2,000 m all-out test (Ex₂₀₀₀). Cardiovascular and respiratory variables were measured. Cerebral oxygenation was investigated by near-infrared time-resolved spectroscopy (TRS) to measure cerebral hemoglobin oxygen saturation (ScO₂) and total hemoglobin concentration ([HbT]) in the prefrontal cortex (PFC) quantitatively. We estimated the relative changes from rest in cerebral metabolic rate for oxygen (rCMRO₂) using TRS at all intensities. During Ex_70% and Ex_80%, ratings of perceived exertion (RPE) were monitored, and alteration of the subject’s mood was evaluated using a questionnaire of Positive-and-Negative-Affect-Schedule after Ex_70% and Ex_80%.

Results

When exercise intensity changed from Ex_70% to Ex_80%, the sense of effort increased while ScO₂ decreased. [HbT] remained unchanged. After Ex_70% and Ex_80%, a negative mood state was less prominent compared to rest and was accompanied by increases in both ScO₂ and [HbT]. At termination of Ex₂₀₀₀, ScO₂ decreased by 23% compared to rest. Changes in ScO₂ correlated with V.O_2peak only during Ex₂₀₀₀ (r = −0.86; p = 0.01). rCMRO₂ did not decrease at any intensities.

Conclusion

Our results suggest that alterations in the sense of effort are associated with oxygenation in the PFC, while positive changes in mood status are associated with cerebral perfusion and oxygen metabolism estimated by TRS. At exhaustion, the cerebral metabolic rate for oxygen is maintained despite a decrease in ScO₂.

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 (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\dot{V}}_{A}/{\dot{V}}_{R}{CO}_{2}$$\end{document}V˙A/V˙RCO2) 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 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\dot{V}}_{A}/{\dot{V}}_{R}{CO}_{2}$$\end{document}V˙A/V˙RCO2 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.

Caffeine Increases Exercise Performance, Maximal Oxygen Uptake, and Oxygen Deficit in Elite Male Endurance Athletes

PURPOSE

The aims of the present study were to test the hypothesis that caffeine increases maximal oxygen uptake (V˙O2max) and to characterize the physiological mechanisms underpinning improved high-intensity endurance capacity.

METHODS

Twenty-three elite endurance-trained male athletes were tested twice with and twice without caffeine (four tests) in a randomized, double-blinded, and placebo-controlled study with crossover design. Caffeine (4.5 mg·kg-1) or placebo was consumed 45 min before standardized warm-up. Time to exhaustion during an incremental test (running 10.5° incline, start speed 10.0 km·h-1, and 0.5 km·h-1 increase in speed every 30 s) determined performance. Oxygen uptake was measured continuously to determine V˙O2max and O2 deficit was calculated.

RESULTS

Caffeine increased time to exhaustion from 355 ± 41 to 375 ± 41 s (Δ19.4 ± 16.5 s; P < 0.001). Importantly, caffeine increased V˙O2max from 75.8 ± 5.6 to 76.7 ± 6.0 mL·kg-1·min-1 (Δ 0.9 ± 1.7 mL·kg-1·min-1; P < 0.003). Caffeine increased maximal heart rate (HRpeak) and ventilation (VEpeak). Caffeine increased O2 deficit from 63.1 ± 18.2 to 69.5 ± 17.5 mL·kg-1 (P < 0.02) and blood lactate compared with placebo. The increase in time to exhaustion after caffeine ingestion was reduced to 11.7 s after adjustment for the increase in V˙O2max. Caffeine did not significantly increase V˙O2max after adjustment for VEpeak and HRpeak. Adjustment for O2 deficit and lactate explained 6.2 s of the caffeine-induced increase in time to exhaustion. The increase in V˙O2max, VE, HR, O2 deficit, and lactate explained 63% of the increased performance after caffeine intake.

CONCLUSION

Caffeine increased V˙O2max in elite athletes, which contributed to improvement in high-intensity endurance performance. Increases in O2 deficit and lactate also contributed to the caffeine-induced improvement in endurance performance.

Oxygen in Metabolic Dysfunction and Its Therapeutic Relevance

Significance: In recent years, a number of studies have shown altered oxygen partial pressure at a tissue level in metabolic disorders, and some researchers have considered oxygen to be a (macro) nutrient. Oxygen availability may be compromised in obesity and several other metabolism-related pathological conditions, including sleep apnea-hypopnea syndrome, the metabolic syndrome (which is a set of conditions), type 2 diabetes, cardiovascular disease, and cancer. Recent Advances: Strategies designed to reduce adiposity and its accompanying disorders have been mainly centered on nutritional interventions and physical activity programs. However, novel therapies are needed since these approaches have not been sufficient to counteract the worldwide increasing rates of metabolic disorders. In this regard, intermittent hypoxia training and hyperoxia could be potential treatments through oxygen-related adaptations. Moreover, living at a high altitude may have a protective effect against the development of abnormal metabolic conditions. In addition, oxygen delivery systems may be of therapeutic value for supplying the tissue-specific oxygen requirements. Critical Issues: Precise in vivo methods to measure oxygenation are vital to disentangle some of the controversies related to this research area. Further, it is evident that there is a growing need for novel in vitro models to study the potential pathways involved in metabolic dysfunction to find appropriate therapeutic targets. Future Directions: Based on the existing evidence, it is suggested that oxygen availability has a key role in obesity and its related comorbidities. Oxygen should be considered in relation to potential therapeutic strategies in the treatment and prevention of metabolic disorders. Antioxid. Redox Signal. 35, 642-687.

Signatures of mast cell activation are associated with severe COVID-19

Lung inflammation is a hallmark of Coronavirus disease 2019 (COVID-19) in severely ill patients and the pathophysiology of disease is thought to be immune-mediated. Mast cells (MCs) are polyfunctional immune cells present in the airways, where they respond to certain viruses and allergens, often promoting inflammation. We observed widespread degranulation of MCs during acute and unresolved airway inflammation in SARS-CoV-2-infected mice and non-human primates. In humans, transcriptional changes in patients requiring oxygen supplementation also implicated cells with a MC phenotype. MC activation in humans was confirmed, through detection of the MC-specific protease, chymase, levels of which were significantly correlated with disease severity. These results support the association of MC activation with severe COVID-19, suggesting potential strategies for intervention.

An integrative approach to the pulmonary physiology of exercise: when does biological sex matter?

Historically, many studies investigating the pulmonary physiology of exercise (and biomedical research in general) were performed exclusively or predominantly with male research participants. This has led to an incomplete understanding of the pulmonary response to exercise. More recently, important sex-based differences with respect to the human respiratory system have been identified. The purpose of this review is to summarize current findings related to sex-based differences in the pulmonary physiology of exercise. To that end, we will discuss how morphological sex-based differences of the respiratory system affect the respiratory response to exercise. Moreover, we will discuss sex-based differences of the physiological integrative responses to exercise, and how all these differences can influence the regulation of breathing. We end with a brief discussion of pregnancy and menopause and the accompanying ventilatory changes observed during exercise.

Exercise-Induced Hypoxemia in Endurance Athletes: Consequences for Altitude Exposure

Exercise-induced hypoxemia (EIH) is well-described in endurance-trained athletes during both maximal and submaximal exercise intensities. Despite the drop in oxygen (O₂) saturation and provided that training volumes are similar, athletes who experience EIH nevertheless produce the same endurance performance in normoxia as athletes without EIH. This lack of a difference prompted trainers to consider that the phenomenon was not relevant to performance but also suggested that a specific adaptation to exercise is present in EIH athletes. Even though the causes of EIH have been extensively studied, its consequences have not been fully characterized. With the development of endurance outdoor activities and altitude/hypoxia training, athletes often train and/or compete in this stressful environment with a decrease in the partial pressure of inspired O₂ (due to the drop in barometric pressure). Thus, one can reasonably hypothesize that EIH athletes can specifically adapt to hypoxemic episodes during exercise at altitude. Although our knowledge of the interactions between EIH and acute exposure to hypoxia has improved over the last 10 years, many questions have yet to be addressed. Firstly, endurance performance during acute exposure to altitude appears to be more impaired in EIH vs. non-EIH athletes but the corresponding physiological mechanisms are not fully understood. Secondly, we lack information on the consequences of EIH during chronic exposure to altitude. Here, we (i) review research on the consequences of EIH under acute hypoxic conditions, (ii) highlight unresolved questions about EIH and chronic hypoxic exposure, and (iii) suggest perspectives for improving endurance training.

Conventional Testing Produces Submaximal Values for Oxygen Uptake in Elite Runners

PURPOSE

This study aimecd to investigate whether elite athletes could reach higher values of maximal oxygen uptake (V˙O2max) during a decremental exercise test in comparison with a traditional incremental test, as recently demonstrated in trained individuals.

METHODS

Nine male runners (age 25.8 [5.1] y, season best 10-km time 31:19 [1:50]) performed, on different days, 3 maximal uphill (5% grade) running exercise tests in fixed order: an incremental test (INC1), a V-shape exercise test (where speed started at 0.5 km·h-1 higher than the top stage finished during INC1 and was slowly decreased during 5.5 min, when it was again increased in similar fashion to the INC tests), and a final incremental test (INC2).

RESULTS

V˙O2max during the V-shape exercise test was higher than during INC1 (6.3% [3.0%], P = .01), although running speed was lower (16.6 [1.7] vs 17.9 [1.6] km·h-1, P = .01). Performance was similar between INC1 and INC2, but V˙O2max during INC2 was higher than INC1 (P < .001). During the V-shape exercise test, 5 participants reached the incremental part of the test, but V˙O2 did not increase (ΔV˙O2=52 [259] mL·min-1, P = .67), despite higher running speed (approximately 1.1 km·h-1, P < .01). Heart rate, pulmonary ventilation, breathing rate, and respiratory exchange ratio measured at V˙O2max were not different between tests.

CONCLUSION

A decremental exercise test of sufficient intensity can produce higher V˙O2max than a traditional incremental test, even in elite athletes, and this is maintained during a subsequent incremental test.

Pro-Oxidant/Antioxidant Balance during a Prolonged Exposure to Moderate Altitude in Athletes Exhibiting Exercise-Induced Hypoxemia at Sea-Level

This study examined to what extent athletes exhibiting exercise-induced hypoxemia (EIH) possess an altered redox status at rest, in response to exercise at sea level (SL) and during moderate altitude exposure. EIH was defined as a fall in arterial O₂ saturation of at least 4% during exercise. Nine endurance athletes with EIH and ten without (NEIH) performed a maximal incremental test under three conditions: SL, one (H1) and five (H2) days after arrival to 2400 m. Gas exchange and peripheral capillary oxygen saturation (SpO₂) were continuously monitored. Blood was sampled before exercise and after exercise cessation. Advanced oxidation protein products (AOPP), catalase, ferric-reducing antioxidant power, glutathione peroxidase, superoxide dismutase (SOD) and nitric oxide metabolites (NOx) were measured in plasma by spectrophotometry. EIH athletes had higher AOPP and NOx concentrations at pre- and post-exercise stages compared to NEIH at SL, H2 but not at H1. Only the EIH group experienced increased SOD activity between pre- and post-exercise exercise at SL and H2 but not at H1. EIH athletes had exacerbated oxidative stress compared to the NEIH athletes at SL and H2. These differences were blunted at H1. Oxidative stress did not alter the EIH groups’ aerobic performance and could lead to higher minute ventilation at H2. These results suggest that higher oxidative stress response EIH athletes could be involved in improved aerobic muscle functionality and a greater ventilatory acclimatization during prolonged hypoxia.

Contribution of oxygen extraction fraction to maximal oxygen uptake in healthy young men

We analysed the importance of systemic and peripheral arteriovenous O₂ difference ( a-v¯O2 difference and a‐v_fO₂ difference, respectively) and O₂ extraction fraction for maximal oxygen uptake ( V˙O2max). Fick law of diffusion and the Piiper and Scheid model were applied to investigate whether diffusion versus perfusion limitations vary with V˙O2max. Articles (n = 17) publishing individual data (n = 154) on V˙O2max, maximal cardiac output ( Q˙max; indicator‐dilution or the Fick method), a-v¯O2 difference (catheters or the Fick equation) and systemic O₂ extraction fraction were identified. For the peripheral responses, group‐mean data (articles: n = 27; subjects: n = 234) on leg blood flow (LBF; thermodilution), a‐v_fO₂ difference and O₂ extraction fraction (arterial and femoral venous catheters) were obtained. Q˙max and two‐LBF increased linearly by 4.9‐6.0 L · min^–1 per 1 L · min^–1 increase in V˙O2max (R² = .73 and R² = .67, respectively; both P < .001). The a-v¯O2 difference increased from 118‐168 mL · L^–1 from a V˙O2max of 2‐4.5 L · min^–1 followed by a reduction (second‐order polynomial: R² = .27). After accounting for a hypoxemia‐induced decrease in arterial O₂ content with increasing V˙O2max (R² = .17; P < .001), systemic O₂ extraction fraction increased up to ~90% ( V˙O2max: 4.5 L · min^–1) with no further change (exponential decay model: R² = .42). Likewise, leg O₂ extraction fraction increased with V˙O2max to approach a maximal value of ~90‐95% (R² = .83). Muscle O₂ diffusing capacity and the equilibration index Y increased linearly with V˙O2max (R² = .77 and R² = .31, respectively; both P < .01), reflecting decreasing O₂ diffusional limitations and accentuating O₂ delivery limitations. In conclusion, although O₂ delivery is the main limiting factor to V˙O2max, enhanced O₂ extraction fraction (≥90%) contributes to the remarkably high V˙O2max in endurance‐trained individuals.

Lung function and oxygen saturation after participation in Norseman Xtreme Triathlon

OBJECTIVES

To examine evidence of exercise-induced bronchoconstriction (EIB) defined as ≥10% reduction in forced expiratory volume in one second (FEV₁ ) and exercise-induced arterial hypoxemia (EIAH) defined as ≥4% reduction in oxygen saturation (SpO₂ ) from before to after participation in the Norseman Xtreme Triathlon. Secondarily, to assess whether changes in FEV₁ and SpO₂ are related to respiratory symptoms, training volume, and race time.

METHODS

In this quasi-experimental non-controlled study, we included 63 triathletes (50♂/13♀) aged 40.3 (±9.0) years (mean ± SD). Fifty-seven (46♂/11♀) measured lung function and 54 (44♂/10♀) measured SpO₂ before the race, 8-10 minutes after the race (post-test 1) and the day after the race (post-test 2). Respiratory symptoms and training volume were recorded with modified AQUA questionnaire. ANOVA for repeated measures was used to detect differences in lung function and SpO₂ . Statistical significance was accepted at 0.05 level.

RESULTS

Twenty-six participants (46%) presented with EIB at post-test 1 and 16 (28%) at post-test 2. Lung function variables were significantly reduced from baseline to post-test 1 and 2. Thirty-five participants (65%) showed evidence of mild to moderate EIAH. No significant correlations were observed except a weak correlation between maximal reduction in FEV₁ and respiratory symptoms (r = 0.35, P = .016).

CONCLUSION

Our results demonstrated that 46% of the participants presented with EIB and 65% showed evidence of EIAH after the Norseman Xtreme Triathlon. Changes in FEV₁ and SpO₂ were not correlated to weekly training hours or race time. We observed a weak correlation between maximal reduction in FEV₁ and respiratory symptoms.

Impact of a 10 km running trial on eryptosis, red blood cell rheology, and electrophysiology in endurance trained athletes: a pilot study

PURPOSE

Blood rheology is a key determinant of blood flow and tissue perfusion. There are still large discrepancies regarding the effects of an acute running exercise on blood rheological properties and red blood cell (RBC) physiology. We investigated the effect of a 10 km running trial on markers of blood rheology and RBC physiology in endurance trained athletes.

METHODS

Blood was sampled before and after the exercise to measure lactate and glucose, hematological and hemorheological parameters (blood viscosity, RBC deformability, and aggregation), eryptosis markers (phosphatidylserine and CD47 exposure, RBC reactive oxygen species), RBC-derived microparticles (RBC-MPs), and RBC electrophysiological activity. Weight was measured before and after exercise. Peripheral oxygen saturation and heart rate were monitored before and during the trial.

RESULTS

Blood lactate and glucose levels increased after exercise and subjects significantly lost weight. All athletes experienced a significant fall in oxygen saturation. Mean corpuscular volume (MCV) was increased from 95.1 ± 3.2 to 96.0 ± 3.3 and mean corpuscular hemoglobin concentration (MCHC) decreased after exercise suggesting a slight RBC rehydration. Exercise increased RBC deformability from 0.344 ± 0.04 to 0.378 ± 0.07, decreased RBC aggregates strength and blood viscosity, while hematocrit (Hct) remained unaffected. While RBC electrophysiological recording suggested a modulation in RBC calcium content and/or chloride conductance, eryptosis markers and RBC-MPs were not modified by the exercise.

CONCLUSION

A 10 km acute running exercise had no effect on RBC senescence and membrane blebbing. In contrast, this exercise increased RBC deformability, probably through rehydration process which resulted in a decrease in blood viscosity.

Influence of Hyperoxic-Supplemented High-Intensity Interval Training on Hemotological and Muscle Mitochondrial Adaptations in Trained Cyclists

Background: Hyperoxia (HYPER) increases O₂ carrying capacity resulting in a higher O₂ delivery to the working muscles during exercise. Several lines of evidence indicate that lactate metabolism, power output, and endurance are improved by HYPER compared to normoxia (NORM). Since HYPER enables a higher exercise power output compared to NORM and considering the O₂ delivery limitation at exercise intensities near to maximum, we hypothesized that hyperoxic-supplemented high-intensity interval training (HIIT) would upregulate muscle mitochondrial oxidative capacity and enhance endurance cycling performance compared to training in normoxia. Methods: 23 trained cyclists, age 35.3 ± 6.4 years, body mass 75.2 ± 9.6 kg, height 179.8 ± 7.9 m, and VO₂max 4.5 ± 0.7 L min^-1 performed 6 weeks polarized and periodized endurance training on a cycle ergometer consisting of supervised HIIT sessions 3 days/week and additional low-intensity training 2 days/week. Participants were randomly assigned to either HYPER (F_IO₂ 0.30; n = 12) or NORM (F_IO₂ 0.21; n = 11) breathing condition during HIIT. Mitochondrial respiration in permeabilized fibers and isolated mitochondria together with maximal and submaximal VO₂, hematological parameters, and self-paced endurance cycling performance were tested pre- and posttraining intervention. Results: Hyperoxic training led to a small, non-significant change in performance compared to normoxic training (HYPER 6.0 ± 3.7%, NORM 2.4 ± 5.0%; p = 0.073, ES = 0.32). This small, beneficial effect on the self-paced endurance cycling performance was not explained by the change in VO₂max (HYPER 1.1 ± 3.8%, NORM 0.0 ± 3.7%; p = 0.55, ES = 0.08), blood volume and hemoglobin mass, mitochondrial oxidative phosphorylation capacity (permeabilized fibers: HYPER 27.3 ± 46.0%, NORM 16.5 ± 49.1%; p = 0.37, ES = 3.24 and in isolated mitochondria: HYPER 26.1 ± 80.1%, NORM 15.9 ± 73.3%; p = 0.66, ES = 0.51), or markers of mitochondrial content which were similar between groups post intervention. Conclusions: This study showed that 6 weeks hyperoxic-supplemented HIIT led to marginal gain in cycle performance in already trained cyclists without change in VO₂max, blood volume, hemoglobin mass, mitochondrial oxidative phosphorylation capacity, or exercise efficiency. The underlying mechanisms for the potentially meaningful performance effects of hyperoxia training remain unexplained and may raise ethical questions for elite sport.

Exercise-induced arterial hypoxemia; some answers, more questions

Exercise-induced arterial hypoxemia (EIAH) is characterized by the decrease in arterial oxygen tension and oxyhemoglobin saturation during dynamic aerobic exercise. Since the time of the initial observations, our knowledge and understanding of EIAH has grown, but many unknowns remain. The purpose of this review is to provide an update on recent findings, highlight areas of disagreement, and identify where information is lacking. Specifically, this review will place emphasis on (i) the occurrence of EIAH during submaximal exercise, (ii) whether there are sex differences in the development and severity of EIAH, and (iii) unresolved questions and future directions.

Monitoring Exercise-Induced Muscle Fatigue and Adaptations: Making Sense of Popular or Emerging Indices and Biomarkers

Regular exercise with the appropriate intensity and duration may improve an athlete’s physical capacities by targeting different performance determinants across the endurance–strength spectrum aiming to delay fatigue. The mechanisms of muscle fatigue depend on exercise intensity and duration and may range from substrate depletion to acidosis and product inhibition of adenosinetriphosphatase (ATPase) and glycolysis. Fatigue mechanisms have been studied in isolated muscles; single muscle fibers (intact or skinned) or at the level of filamentous or isolated motor proteins; with each approach contributing to our understanding of the fatigue phenomenon. In vivo methods for monitoring fatigue include the assessment of various functional indices supported by the use of biochemical markers including blood lactate levels and more recently redox markers. Blood lactate measurements; as an accompaniment of functional assessment; are extensively used for estimating the contribution of the anaerobic metabolism to energy expenditure and to help interpret an athlete’s resistance to fatigue during high intensity exercise. Monitoring of redox indices is gaining popularity in the applied sports performance setting; as oxidative stress is not only a fatigue agent which may play a role in the pathophysiology of overtraining syndrome; but also constitutes an important signaling pathway for training adaptations; thus reflecting training status. Careful planning of sampling and interpretation of blood biomarkers should be applied; especially given that their levels can fluctuate according to an athlete’s lifestyle and training histories.

Inverse Association Between Metabolic Syndrome and Altitude: A Cross-Sectional Study in an Adult Population of Ecuador

Background: Metabolic syndrome (MetS) is characterized by the clustering of hyperglycemia, hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol levels and central adiposity. Altitude has been proposed as a protective factor to prevent the development of MetS and its components. Aim: To determine whether living at geographical elevation is associated with MetS and its individual components after adjustment for potential confounders in an Ecuadoran population. Methods: The study included 260 Ecuadoran university graduates over 20 years of age, from the coastal or the Andean Altiplano region. The altitude of residence was imputed with the postal code of each participant residence according to the data of the Ecuadoran Geophysical Institute of the National Polytechnic School. MetS was defined according to the harmonizing definition. Logistic regression models were fitted to assess the relationship between altitude level and the prevalence of MetS and its individual components. To test the internal validity, re-sampling techniques were used (1,000 bootstrap samples). Results: Living at high altitude was associated with less hypercholesterolemia (OR = 0.24; p < 0.001), hyperglycemia (OR = 0.25; p < 0.05) and MetS (OR = 0.24; p < 0.05), after adjusting for potential confounders. At high altitude the bootstrapped logistic regression models showed lower prevalence of hypercholesterolemia (OR = 0.30; p < 0.05), hyperglycemia (OR = 0.22; p < 0.001) and MetS (OR = 0.28; p < 0.05). The MetS score (0-5 points) showed a reduction in the number of MetS components at high altitude compared to sea level (B = -0.34; p = 0.002). A statistically significant lower self-reported energy intake was found in high altitude compared to sea level after adjustment for potential confounders (p < 0.001). Conclusion: In the present study concerning a small Ecuadoran population composed of highly educated adults living at the coast and the Andean Altiplano, living at high altitude (2,758-2,787 m) was associated with a lower prevalence of MetS, hypercholesterolemia and hyperglycemia, compared to the participants at sea level (4-6 m). In addition, an inverse association between altitude and self-reported energy intake was found after adjusting for covariates, suggesting a physiological role of appetite at high altitude even in acclimated subjects.

Systemic Oxygen Transport with Rest, Exercise, and Hypoxia: A Comparison of Humans, Rats, and Mice

The objective of this article is to compare and contrast the known characteristics of the systemic O₂ transport of humans, rats, and mice at rest and during exercise in normoxia and hypoxia. This analysis should help understand when rodent O₂ transport findings can-and cannot-be applied to human responses to similar conditions. The O₂ -transport system was analyzed as composed of four linked conductances: ventilation, alveolo-capillary diffusion, circulatory convection, and tissue capillary-cell diffusion. While the mechanisms of O₂ transport are similar in the three species, the quantitative differences are naturally large. There are abundant data on total O₂ consumption and on ventilatory and pulmonary diffusive conductances under resting conditions in the three species; however, there is much less available information on pulmonary gas exchange, circulatory O₂ convection, and tissue O₂ diffusion in mice. The scarcity of data largely derives from the difficulty of obtaining blood samples in these small animals and highlights the need for additional research in this area. In spite of the large quantitative differences in absolute and mass-specific O₂ flux, available evidence indicates that resting alveolar and arterial and venous blood PO₂ values under normoxia are similar in the three species. Additionally, at least in rats, alveolar and arterial blood PO₂ under hypoxia and exercise remain closer to the resting values than those observed in humans. This is achieved by a greater ventilatory response, coupled with a closer value of arterial to alveolar PO₂ , suggesting a greater efficacy of gas exchange in the rats. © 2018 American Physiological Society. Compr Physiol 8:1537-1573, 2018.

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

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

11β-hydroxysteroid dehydrogenase type-II activity is affected by grapefruit juice and intense muscular work

OBJECTIVE

The enzymatic activity of 11β-hydroxysteroid dehydrogenase-2 (11β-HSD2) is key to protecting mineral corticoid receptors from cortisol and has been implicated in blood pressure regulation. Grapefruit juice (GFJ) and acidity are thought to inhibit this enzyme in vitro. This study examines the effect of GFJ and intense exercise on 11β-HSD2 enzyme activity in vivo.

SUBJECTS AND METHODS

Eighteen subjects ingested GFJ or apple juice (CON) on separate days prior to reporting to the laboratory in a randomized order. Saliva (Sal) samples were obtained at baseline, 15 and 45 minutes post-treadmill stress test; Sal cortisone (E) and cortisol (F) levels were determined, and the Sal cortisone:cortisol (E:F) ratio was used as an index of 11β-HSD2 enzyme activity at rest and after intense muscular work.

RESULTS

GFJ treatment decreased baseline 11β-HSD2 enzyme activity (44%) and Sal-E (28%) compared to CON (both, p < 0.05). Sal-E (r = 0.61, p < 0.05) and Sal-F (r = 0.66, p < 0.05) were correlated with diastolic blood pressure (DBP) in GFJ-treated individuals. Treadmill stress significantly increased Sal-E and Sal-F but did not alter 11β-HSD2 enzyme activity regardless of treatment. When treatments were examined separately, CON 11β-HSD2 enzyme activity decreased by 36% (p < 0.05) from baseline to 15 post-treadmill exercise.

CONCLUSION

Our findings suggest that GFJ and intense muscular work decrease 11β-HSD-2 activity independently, and no additive effect was noted. The association between DBP and the levels of Sal-F and Sal-E during the GFJ trial should be interpreted cautiously and warrants further investigation.

Hemoconcentration During Maximum Exercise in Miners with Chronic Intermittent Exposure to Hypobaric Hypoxia (3800 m)

Moraga, Fernando A., Jorge Osorio, Rodrigo Calderón-Jofré, and Andrés Pedreros. Hemoconcentration during maximum exercise in miners with chronic intermittent exposure to hypobaric hypoxia (3800 m). High Alt Med Biol. 19:15-20, 2018.

OBJECTIVE

To evaluate the effect of maximum exercise on hemoconcentration in miners with chronic intermittent hypobaric hypoxia (CIHH) at 3800 m.

MATERIALS AND METHODS

Sixteen miners with CIHH at high altitude (3800 m) were subjected to maximum exercise levels on a cycle ergometer, increasing exercise load by 50 W every 3 minutes at sea level and high altitude (3800 m). During exercise, arterial oxygen saturation and heart rate were measured. Blood samples were taken at each step to measure hemoglobin concentration and hematocrit. Arterial blood oxygen content was also calculated.

RESULTS

At sea level, a decrease in arterial oxygen saturation to 92.1% ± 2.5% was observed at 150 W and the hematocrit, hemoglobin concentration and oxygen content were not altered. At high altitude, arterial oxygen saturation decreased, reaching 88.2% ± 4.9% at 50 W and remained constant during the entire exercise protocol. Hemoglobin concentration and hematocrit increased reaching 16.4 ± 0.9 g/dL and 48.8% ± 1.6%, respectively, at 100 W and were maintained until recovery. Arterial oxygen content was constant during exercise and increased in the recovery period.

CONCLUSION

An increase in hemoglobin concentration during exercise compensates for the decline in arterial oxygen saturation, meanwhile arterial oxygen content remains constant.

The training type influence on male elite athletes' ventilatory function

Background/aim

To assess and compare measured ventilatory volumes (forced expiratory volume in 1 s (FEV₁), peak expirium flow (PEF) and maximal voluntary ventilation (MVV)), ventilatory function capacities (forced vital capacity (FVC) and vital capacity (VC)) and FEV₁/VC ratio in a sample of power and endurance elite athletes and their age-matched and sex-matched sedentary control group.

Methods

A cross-sectional study was applied on male elite athletes (n=470) who were classified according to the type of the predominantly performed exercise in the following way: group 1: endurance group (EG=270), group 2: power athletes group (SG=200) and group 3: sedentary control group (CG=100). The lung VC, FVC, FEV₁, FEV₁/FVC ratio, PEF and MVV were measured in all of the observed subjects, who were also classified with regard to body mass index (BMI) and the percentage of the body fat (BF%).

Results

The CG had the highest BF% value, while the endurance group had the lowest BMI and BF% value, which is significantly different from the other two groups (p<0.05). The observed values of VC, FVC and FEV₁ in the EG were significantly higher than those from the other two groups (p<0.05). There were no differences concerning the observed FEV₁/FVC ratio.

Conclusions

A continued endurance physical activity leads to adaptive changes in spirometric parameters (VC, FVC and FEV₁), highlighting the fact that there is a need for specific consideration of different respiratory ‘pattern’ development in different types of sport, which also has to be further evaluated.

Effect of swim intensity on responses to dynamic apnoea

The aim of this study was to determine the influence of swim intensity on acute responses to dynamic apnoea. 9 swimmers performed one 50 m front crawl trial in four different conditions: at 400 m velocity (V₄₀₀) with normal breathing (NB), at V₄₀₀ in complete apnoea (Ap), at maximal velocity (V_max) with NB and at V_max in Ap. Peak heart rate (HR_peak), blood lactate concentration after exercise (Lac_{post ex}) and Borg rating of perceived exertion (RPE) were measured. Arterial oxygen saturation (SpO₂) was monitored with a pulse oximeter at forehead level during and after exercise. In Ap, swimming at V₄₀₀ induced a significantly lower HR_peak and Lac_{post ex} than swimming at V_max whilst RPE and the kinetics of SpO₂ were not different at V₄₀₀ and at V_max. The minimal value of SpO₂ in Ap was reached 10 to 11 s after the end of V₄₀₀ and V_max (81.7 ± 10.1% and 84.4 ± 10.6%, respectively). Swimming a 50 m front crawl in Ap resulted in a large decrease in SpO₂ which occurred only after the cessation of exercise. The higher duration of apnoea during submaximal exercise could explain why SpO₂ and RPE reached the same values as for maximal exercise.​.

Living at a Geographically Higher Elevation Is Associated with Lower Risk of Metabolic Syndrome: Prospective Analysis of the SUN Cohort

Living in a geographically higher altitude affects oxygen availability. The possible connection between environmental factors and the development of metabolic syndrome (MetS) feature is not fully understood, being the available epidemiological evidence still very limited. The aim of the present study was to evaluate the longitudinal association between altitude and incidence of MetS and each of its components in a prospective Spanish cohort, The Seguimiento Universidad de Navarra (SUN) project. Our study included 6860 highly educated subjects (university graduates) free from any MetS criteria at baseline. The altitude of residence was imputed with the postal code of each individual subject residence according to the data of the Spanish National Cartographic Institute and participants were categorized into tertiles. MetS was defined according to the harmonized definition. Cox proportional hazards models were used to assess the association between the altitude of residence and the risk of MetS during follow-up. After a median follow-up period of 10 years, 462 incident cases of MetS were identified. When adjusting for potential confounders, subjects in the highest category of altitude (>456 m) exhibited a significantly lower risk of developing MetS compared to those in the lowest tertile (<122 m) of altitude of residence [Model 2: Hazard ratio = 0.75 (95% Confidence interval: 0.58–0.97); p for trend = 0.029]. Living at geographically higher altitude was associated with a lower risk of developing MetS in the SUN project. Our findings suggest that geographical elevation may be an important factor linked to metabolic diseases.

Living at Higher Altitude and Incidence of Overweight/Obesity: Prospective Analysis of the SUN Cohort

BACKGROUND

Residence at high altitude has been associated with lower obesity rates probably due to hypoxia conditions. However, there is no evidence of this association in a free-living population.

OBJECTIVES

We assessed the association between the altitude where each participant of a Spanish cohort (the SUN Project) was living and the incidence of overweight/obesity.

METHODS

The SUN Project is a dynamic, prospective, multipurpose cohort of Spanish university graduates with a retention rate of 89%. We included in the analysis 9 365 participants free of overweight/obesity at baseline. At the baseline questionnaire, participants reported their postal code and the time they had been living in their city/village. We imputed the altitude of each postal code according to the data of the Spanish National Cartographic Institute and categorized participants in tertiles. We used Cox regression models to adjust for potential confounding variables.

RESULTS

During a median follow-up of 10 years, we identified 2 156 incident cases of overweight/obesity. After adjusting for sex, age, time of residence at current city, baseline body mass index, physical activity, sedentarism and years of education (≤ 3 years, ≥ 4 years, Master/PhD), those participants in the third tertile (>456 m) exhibited a statistically significant 14% reduction in the risk of developing overweight/obesity in comparison to those in the first tertile (<124 m) (adjusted HR = 0.86; 95% CI: 0.77, 0.96).

CONCLUSIONS

Living in cities of higher altitude was inversely associated with the risk of developing overweight/obesity in a cohort of Spanish university graduates.

Changes in Respiratory Parameters and Fin-Swimming Performance Following a 16-Week Training Period with Intermittent Breath Holding

The purpose of this study was to examine the effects of training with intermittent breath holding (IBH) on respiratory parameters, arterial oxygen saturation (SpO2) and performance. Twenty-eight fin-swimming athletes were randomly divided into two groups and followed the same training for 16 weeks. About 40% of the distance of each session was performed with self-selected breathing frequency (SBF group) or IBH (IBH group). Performance time of 50 and 400 m at maximum intensity was recorded and forced expired volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and SpO2 were measured before and after the 50 m test at baseline and post-training. Post-training, the respiratory parameters were increased in the IBH but remained unchanged in the SBF group (FEV1: 17 ±15% vs. -1 ±11%; FVC: 22 ±13% vs. 1 ±10%; PEF: 9 ±14% vs. -4 ±15%; p<0.05). Pre compared to post-training SpO2 was unchanged at baseline and decreased post-training following the 50 m test in both groups (p<0.05). The reduction was higher in the IBH compared to the SBF group (p<0.05). Performance in the 50 and 400 m tests improved in both groups, however, the improvement was greater in the IBH compared to the SBF group in both 50 and 400 m tests (p<0.05). The use of IBH is likely to enhance the load on the respiratory muscles, thus, contributing to improvement of the respiratory parameters. Decreased SpO2 after IBH is likely due to adaptation to hypoventilation. IBH favours performance improvement at 50 and 400 m fin-swimming.

Physiological characteristics of an aging Olympic athlete

PURPOSE

To investigate the physiological basis of continued world-class performance of a world-class rower who won medals (three gold and two bronze) at five consecutive Olympic Games.

METHODS

From the age of 19 to 40 yr, maximal oxygen uptake (VO2 max), peak HR, blood lactate, and rowing ergometer performance were assessed annually.

RESULTS

During the first years of his elite career (from age 19 to 24), VO2 max increased from 5.5 to approximately 5.9 L · min(-1) (78 mL · min(-1) · kg(-1)) and his average power during 6-min maximal rowing increased from 420 to approximately 460 W. Although his HRmax declined by approximately 20 bpm during the 20-yr period, maximal aerobic power, evaluated both as VO2 max and 6-min test performance, was maintained until the age of 40. Furthermore, peak lactate levels remained unchanged and average power outputs during 10-s, 60-s, and 60-min ergometer tests were all maintained at approximately 800 W, approximately 700 W, and approximately 350 W, respectively, indicating that he was able to preserve both aerobic and anaerobic exercise performances. Echocardiographic analyses revealed a left ventricular mass of 198 g and left ventricular end-diastolic diameter of 5.8 cm.

CONCLUSIONS

This longitudinal case indicates that until the age of 40 yr, a steady increase in the oxygen pulse may have compensated for the significant decline in the maximal heart frequency. Furthermore, the maintenance of aerobic and anaerobic exercise capacities allowed this Olympic athlete to compete at the highest level for almost two decades.

Changes in the acid-base balance and lactate concentration in the blood in amateur ultramarathon runners during a 100-km run

The aim of this study was to analyse the acid-base balance and partial pressure of blood gases of participants during a 100-km run. Fourteen experienced amateur ultramarathon runners (age: 43.36±11.83 years; height: 175.29±6.98 cm; weight: 72.12±7.36 kg) completed the 100-km run. Blood samples were taken before the run; after 25, 50, 75, and 100 km; and 12 and 24 hours after the run. There were significant differences (p<0.05) between the mean values registered for acid-alkaline balance, buffering alkalies, and current bicarbonate in each segment of the run, especially during the third, fourth, and fifth segments of the run (i.e., between 50 and 100 km), and there were only significant differences associated with buffering alkalies and current bicarbonate during the recovery. However, all the changes were within the physiological norm. A significant decrease in the compressibility of oxygen was observed after 100 km (from 92.80±15.67 to 88.36±13.71 mmHg) and continued during the recovery to 75.06±8.60 mmHg 12 h after the run. Also there was a decrease in saturation to a mean value of 93.78±3.10 at 12 h after the run. Generally the amateurs runners are able to adjust their running speed so as not to provoke a significant acid-base imbalance or lactate acid accumulation.

Developmental Effects Determine Submaximal Arterial Oxygen Saturation in Peruvian Quechua

Kiyamu, Melisa, Fabiola León-Velarde, María Rivera-Chira, Gianpietro Elías, and Tom D. Brutsaert. Developmental effects determine submaximal arterial oxygen saturation in Peruvian Quechua. High Alt Med Biol 16, 138-146, 2015.--Andean high altitude natives show higher arterial oxygen saturation (Sao(2)) during exercise in hypoxia, compared to acclimatized sojourners. In order to evaluate the effects of life-long exposure to high altitude on Sao(2), we studied two groups of well-matched, self-identified Peruvian Quechua natives who differed in their developmental exposure to hypoxia before and after a 2-month training period. Male and female volunteers (18-35 years) were recruited in Lima, Peru (150 m). The two groups were: a) Individuals who were born and raised at sea-level (BSL, n=34) and b) Individuals who were born and raised at high altitude (BHA, n=32), but who migrated to sea-level as adults (>16 years old). Exercise testing was conducted using a submaximal exercise protocol in normobaric hypoxia in Lima (BP=750 mmHg, Fio(2)=0.12), in order to measure Sao(2) (%), ventilation (VE L/min) and oxygen consumption (Vo(2), L/min). Repeated-measures ANOVA, controlling for VE/VO(2) (L/min) and sex during the submaximal protocol showed that BHA maintained higher Sao(2) (%) compared to BSL at all workloads before (p=0.005) and after training (p=0.017). As expected, both groups showed a decrease in Sao(2) (%) (p<0.001), as workload increased. Resting Sao(2) levels were not found to be different between groups. The results suggest that developmental exposure to altitude contributes to the maintenance of higher Sao(2) levels during submaximal exercise at hypoxia.

Oxygen desaturation in healthy subjects undergoing the incremental shuttle walk test

OBJECTIVE

To determine the probability of oxygen desaturation in healthy individuals undergoing the incremental shuttle walk test (ISWT).

METHODS

We enrolled 83 healthy subjects: 55 males (including 1 smoker) and 28 females. We determined pre-ISWT FEV1, FEV6, HR and SpO2, as well as post-ISWT HR and SpO2.

RESULTS

Mean values overall were as follows: age, 35.05 ± 12.53 years; body mass index, 24.30 ± 3.47 kg/m2; resting HR, 75.12 ± 12.48 bpm; resting SpO2, 97.96 ± 1.02%; FEV1, 3.75 ± 0.81 L; FEV6, 4.45 ± 0.87 L; FEV1/FEV6 ratio, 0.83 ± 0.08 (no restriction or obstruction); incremental shuttle walk distance, 958.30 ± 146.32 m; post-ISWT HR, 162.41 ± 18.24 bpm; and post-ISWT SpO2, 96.27 ± 2.21%. In 11 subjects, post-ISWT SpO2 was higher than was pre-ISWT SpO2. In 17 subjects, there was a 4% decrease in SpO2 after the ISWT. There were no statistically significant differences between the groups with and without post-ISWT oxygen desaturation in terms of age, gender, FEV1, FEV6, FEV1/FEV6, pre-ISWT SpO2, incremental shuttle walk distance, HR, or percentage of maximal HR. In the individuals with post-ISWT oxygen desaturation, the body mass index was higher (p = 0.01) and post-ISWT SpO2 was lower (p = 0.0001).

CONCLUSIONS

Healthy individuals can present oxygen desaturation after the ISWT. Using the ISWT to predict subtle respiratory abnormalities can be misleading. In healthy subjects, oxygen desaturation is common after the ISWT, as it is during any intense physical activity.

Prevalence of cardio-respiratory factors in the occurrence of the decrease in oxygen uptake during supra-maximal, constant-power exercise

Purpose

To investigate the physiological mechanisms that explain the end-exercise decrease in oxygen uptake during strenuous constant-power exercise, we recruited eleven trained, track cyclists.

Methods

On two separated days they performed 1) resting spirometric measures, followed by an incremental test on a cycle ergometer to determine the power output at and 2) an exhaustive isokinetic supramaximal cycling exercise (Tlim_supra) at 185 ± 24% of (i.e., 640.5 ± 50.8 W). During cycling exercise tests, , ventilation parameters, stroke volume (SV) and heart rate were continuously recorded. Furthermore, arterialised capillary blood samples were collected to measure blood pH, arterial oxygen saturation, lactate and bicarbonate concentration before and 5 min after Tlim_supra.

Results

A > 5% decrease in and/or SV was observed in 6 subjects, with 5 out of 6 subjects presenting both phenomena. The magnitude of the decrease was correlated with the magnitude of the SV decrease (R = 0.75, P < 0.01), the peak-exercise end-tidal O₂ partial pressure (R = 0.80, P < 0.005) and the resting, forced expiratory volume in 1 s (R = 0.72, P < 0.05), but not with any blood variables. The significant post-Tlim_supra decrease in forced vital capacity and forced inspiratory volume corroborate with a possible respiratory muscle fatigue.

Conclusion

Based on these findings, we demonstrate that the occurrence of decrease in more than half of our subjects, during a strenuous constant-power exercise leading to a mild-acidosis (pH = 7.21 ± 0.04), results mainly from cardio-respiratory factors and not from blood metabolic responses.

Red blood cell volume and the capacity for exercise at moderate to high altitude

Hypoxia-stimulated erythropoiesis, such as that observed when red blood cell volume (RCV) increases in response to high-altitude exposure, is well understood while the physiological importance is not. Maximal exercise tests are often performed in hypoxic conditions following some form of RCV manipulation in an attempt to elucidate oxygen transport limitations at moderate to high altitudes. Such attempts, however, have not made clear the extent to which RCV is of benefit to exercise at such elevations. Changes in RCV at sea level clearly have a direct influence on maximal exercise capacity. Nonetheless, at elevations above 3000 m, the evidence is not that clear. Certain studies demonstrate either a direct benefit or decrement to exercise capacity in response to an increase or decrease, respectively, in RCV whereas other studies report negligible effects of RCV manipulation on exercise capacity. Adding to the uncertainty regarding the importance of RCV at high altitude is the observation that Andean and Tibetan high-altitude natives exhibit similar exercise capacities at high altitude (3900 m) even though Andean natives often present with a higher percent haematocrit (Hct) when compared with both lowland natives and Tibetans. The current review summarizes past literature that has examined the effect of RCV changes on maximal exercise capacity at moderate to high altitudes, and discusses the explanation elucidating these seemingly paradoxical observations.

The effect of exercise-induced hypoxemia on blood redox status in well-trained rowers

Exercise-induced arterial hypoxemia (EIAH), characterized by decline in arterial oxyhemoglobin saturation (SaO(2)), is a common phenomenon in endurance athletes. Acute intensive exercise is associated with the generation of reactive species that may result in redox status disturbances and oxidation of cell macromolecules. The purpose of the present study was to investigate whether EIAH augments oxidative stress as determined in blood plasma and erythrocytes in well-trained male rowers after a 2,000-m rowing ergometer race. Initially, athletes were assigned into either the normoxemic (n = 9, SaO(2) >92%, [Formula: see text]: 62.0 ± 1.9 ml kg(-1) min(-1)) or hypoxemic (n = 12, SaO(2) <92%, [Formula: see text]: 60.5 ± 2.2 ml kg(-1 )min(-1), mean ± SEM) group, following an incremental [Formula: see text] test on a wind resistance braked rowing ergometer. On a separate day the rowers performed a 2,000-m all-out effort on the same rowing ergometer. Following an overnight fast, blood samples were drawn from an antecubital vein before and immediately after the termination of the 2,000-m all-out effort and analyzed for selective oxidative stress markers. In both the normoxemic (SaO(2): 94.1 ± 0.9%) and hypoxemic (SaO(2): 88.6 ± 2.4%) rowers similar and significant exercise increase in serum thiobarbituric acid-reactive substances, protein carbonyls, catalase and total antioxidant capacity concentration were observed post-2,000 m all-out effort. Exercise significantly increased the oxidized glutathione concentration and decreased the ratio of reduced (GSH)-to-oxidized (GSSG) glutathione in the normoxemic group only, whereas the reduced form of glutathione remained unaffected in either groups. The increased oxidation of GSH to GSSG in erythrocytes of normoxemic individuals suggest that erythrocyte redox status may be affected by the oxygen saturation degree of hemoglobin. Our findings indicate that exercise-induced hypoxemia did not further affect the increased blood oxidative damage of lipids and proteins observed after a 2,000-m rowing ergometer race in highly-trained male rowers. The present data do not support any potential link between exercise-induced hypoxemia, oxidative stress increase and exercise performance.