Skeletal muscle adaptations to training under normobaric hypoxic versus normoxic conditions

Effects of various living-low and training-high modes with distinct training prescriptions on sea-level performance: A network meta-analysis

This study aimed to separately compare and rank the effect of various living-low and training-high (LLTH) modes on aerobic and anaerobic performances in athletes, focusing on training intensity, modality, and volume, through network meta-analysis. We systematically searched PubMed, Web of Science, Embase, EBSCO, and Cochrane from their inception date to June 30, 2023. Based on the hypoxic training modality and the intensity and duration of work intervals, LLTH was divided into intermittent hypoxic exposure, continuous hypoxic training, repeated sprint training in hypoxia (RSH; work interval: 5-10 s and rest interval: approximately 30 s), interval sprint training in hypoxia (ISH; work interval: 15-30 s), short-duration high-intensity interval training (s-IHT; short work interval: 1-2 min), long-duration high-intensity interval training (l-IHT; long work interval: > 5 min), and continuous and interval training under hypoxia. A meta-analysis was conducted to determine the standardized mean differences (SMDs) among the effects of various hypoxic interventions on aerobic and anaerobic performances. From 2,072 originally identified titles, 56 studies were included in the analysis. The pooled data from 53 studies showed that only l-IHT (SMDs: 0.78 [95% credible interval; CrI, 0.52-1.05]) and RSH (SMDs: 0.30 [95% CrI, 0.10-0.50]) compared with normoxic training effectively improved athletes' aerobic performance. Furthermore, the pooled data from 29 studies revealed that active intermittent hypoxic training compared with normoxic training can effectively improve anaerobic performance, with SMDs ranging from 0.97 (95% CrI, 0.12-1.81) for l-IHT to 0.32 (95% CrI, 0.05-0.59) for RSH. When adopting a program for LLTH, sufficient duration and work intensity intervals are key to achieving optimal improvements in athletes' overall performance, regardless of the potential improvement in aerobic or anaerobic performance. Nevertheless, it is essential to acknowledge that this study incorporated merely one study on the improvement of anaerobic performance by l-IHT, undermining the credibility of the results. Accordingly, more related studies are needed in the future to provide evidence-based support. It seems difficult to achieve beneficial adaptive changes in performance with intermittent passive hypoxic exposure and continuous low-intensity hypoxic training.

Acute physiological responses and muscle recovery in females: a randomised controlled trial of muscle damaging exercise in hypoxia

BACKGROUND

Studies have investigated the effects of training under hypoxia (HYP) after several weeks in a male population. However, there is still a lack of knowledge on the acute hypoxic effects on physiology and muscle recovery in a female population.

METHODS

This randomized-controlled trial aimed to investigate the acute effects of muscle damaging exercise, performed in HYP and normoxia (CON), on physiological responses and recovery characteristics in healthy females. Key inclusion criteria were recreationally active female participants between the age of 18 to 35 years without any previous surgeries and injuries, whilst key exclusion criteria were acute pain situations, pregnancy, and medication intake. The females conducted a muscle-damaging protocol, comprising 5 × 20 drop-jumps, in either HYP (FiO2: 12%) or CON (FiO2: 21%). Physiological responses, including capillary oxygenation (SpO2), muscle oxygenation (SmO2), heart rate (HR), core- (Tcore) and skin- (Tskin) temperature were assessed at the end of each exercise set. Recovery characteristics were quantified by taking venous blood samples (serum creatine-kinase [CK], C-reactive protein [CRP] and blood sedimentation rate [BSR]), assessing muscle swelling of the quadriceps femoris muscle, maximum voluntary isometric contraction (MVIC) of the knee extensor muscles, countermovement jump (CMJ) performance and muscle soreness ratings (DOMS) at 24-, 48- and 72-hrs post-exercise.

RESULTS

SpO2 (HYP: 76.7 ± 3.8%, CON: 95.5 ± 1.7%, p < 0.001) and SmO2 (HYP: 60.0 ± 9.3, CON: 73.4 ± 5.8%, p = 0.03) values were lower (p < 0.05) in HYP compared to CON at the end of the exercise-protocol. No physiological differences between HYP and CON were observed for HR, Tcore, and Tskin (all p > 0.05). There were also no differences detected for any recovery variable (CK, CRP, BSR, MVIC, CMJ, and DOMS) during the 72-hrs follow-up period between HYP and CON (all p > 0.05).

CONCLUSION

In conclusion, our results showed that muscle damaging exercise under HYP leads to reduced capillary and muscle oxygenation levels compared to normoxia with no difference in inflammatory response and muscle recovery during 72 h post-exercise.

TRIAL REGISTRATION

NCT04902924, May 26th 2021.

Intermittent hypoxia in sport nutrition, performance, health status and body composition

Introduction

Intermittent hypoxia refers to the discontinuous use of low oxygen levels in normobaric environment. These conditions can be reproduced in hypoxic tents or chambers while the individual is training in different physical activity protocols. Intermittent hypoxia can affect several body systems, impacting nutrition, physical performance, health status and body composition. Therefore, it is necessary to assess protocols, regarding time and frequency of exposure, passive exposure or training in hypoxia, and the simulated altitude. At the molecular level, the hypoxia-inducible factor-1α is the primary factor mediating induction of target genes, including vascular endothelial growth factor and erythropoietin. The goal of these molecular changes is to preserve oxygen supply for cardiac and neuronal function. In addition, hypoxia produces a sympathetic adrenal activation that can increase the resting metabolic rate. Altogether, these changes are instrumental in protocols designed to improve physical performance as well as functional parameters for certain pathological disorders. In addition, nutrition must adapt to the increased energy expenditure. In this last context, performing physical activity in intermittent hypoxia improves insulin sensitivity by increasing the presence of the glucose transporter GLUT-4 in muscle membranes. These changes could also be relevant for obesity and type 2 diabetes treatment. Also, the anorectic effect of intermittent hypoxia modulates serotonin and circulating leptin levels, which may contribute to regulate food intake and favor body weight adaptation for optimal sport performance and health. All these actions suggest that intermittent hypoxia can be a very effective tool in sports training as well as in certain clinical protocols.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Impact of Hypoxic Exercise Recovery on Skeletal Muscle Glycogen and Gene Expression

Slivka, Dustin, Charles Dumke, Walter Hailes, and Brent Ruby. Impact of hypoxic exercise recovery on skeletal muscle glycogen and gene expression. High Alt Med Biol. 22:300-307, 2021. Background: The impact of altitude during recovery from exercise is largely unknown. The purpose of this study was to determine the acute gene response and muscle glycogen re-synthesis after exercise when exposed to simulated high altitude during recovery. Materials and Methods: Twelve male participants (age, 25 ± 2 years; height, 178 ± 7 cm; weight, 78.8 ± 7.8 kg; VO₂peak, 4.25 ± 0.59 l/min; Wpeak 307 ± 44 W; and body fat, 13.1% ± 1.2%) completed two trials (random order), which consisted of cycling for 90 minutes in laboratory conditions and then recovering for 6 hours in laboratory conditions (975 m; normoxia) or at a high simulated altitude (5,000 m; hypoxia). Results: Skeletal muscle biopsies from the vastus lateralis were obtained before exercise, after exercise, and 6 hours after exercise for the measurement of metabolic gene expression and muscle glycogen. Muscle glycogen decreased with exercise (61% ± 13%, p < 0.05) and increased with recovery (78% ± 35%, p < 0.05) with no difference between trials (p > 0.05). Hypoxia-inducible factor (HIF)-1α, HIF-2α, optic atrophy gene 1 (OPA-1), mitofusin 2 (MFN-2), and peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PGC-1α) gene expression were suppressed after altitude exposure (p < 0.05), while mitochondrial fission 1 protein (FIS-1), phosphofructokinase (PFK), Cytochrome c oxidase (COX), and hexokinase (HK) were unaffected by altitude exposure (p > 0.05). Conclusions: High-altitude exposure during recovery from exercise inhibits gene expression associated with mitochondrial development without affecting muscle glycogen re-synthesis.

Endurance Is Improved in Female Rats After Living High-Training High Despite Alterations in Skeletal Muscle

Altitude camps are used during the preparation of endurance athletes to improve performance based on the stimulation of erythropoiesis by living at high altitude. In addition to such whole-body adaptations, studies have suggested that high-altitude training increases mitochondrial mass, but this has been challenged by later studies. Here, we hypothesized that living and training at high altitude (LHTH) improves mitochondrial efficiency and/or substrate utilization. Female rats were exposed and trained in hypoxia (simulated 3,200 m) for 5 weeks (LHTH) and compared to sedentary rats living in hypoxia (LH) or normoxia (LL) or those that trained in normoxia (LLTL). Maximal aerobic velocity (MAV) improved with training, independently of hypoxia, whereas the time to exhaustion, performed at 65% of MAV, increased both with training (P = 0.009) and hypoxia (P = 0.015), with an additive effect of the two conditions. The distance run was 7.98 ± 0.57 km in LHTH vs. 6.94 ± 0.51 in LLTL (+15%, ns). The hematocrit increased >20% with hypoxia (P < 0.001). The increases in mitochondrial mass and maximal oxidative capacity with endurance training were blunted by combination with hypoxia (−30% for citrate synthase, P < 0.01, and −23% for Vmax _glut−succ, P < 0.001 between LHTH and LLTL). A similar reduction between the LHTH and LLTL groups was found for maximal respiration with pyruvate (−29%, P < 0.001), for acceptor-control ratio (−36%, hypoxia effect, P < 0.001), and for creatine kinase efficiency (−48%, P < 0.01). 3-hydroxyl acyl coenzyme A dehydrogenase was not altered by hypoxia, whereas maximal respiration with Palmitoyl-CoA specifically decreased. Overall, our results show that mitochondrial adaptations are not involved in the improvement of submaximal aerobic performance after LHTH, suggesting that the benefits of altitude camps in females relies essentially on other factors, such as the transitory elevation of hematocrit, and should be planned a few weeks before competition and not several months.

Effects of Power-Oriented Resistance Training During an Altitude Camp on Strength and Technical Performance of Elite Judokas

This study investigated the effect of a 3-week power-oriented resistance training program performed at moderate altitude on leg power output variables in a countermovement jump, a related judo technique (ippon-seoi-nage) and the relationship between them. Twenty-four elite male judokas were randomly assigned to a hypobaric hypoxia or normoxia group. Mechanical outputs from an incremental loaded countermovement jump test and the kinematic variables transferred to a dummy during an ippon-seoi-nage test (time to execution and movement accelerations) were assessed before, after, 1 and 2 weeks after training. Results indicated an increase in explosive leg capacity both at moderate altitude (2320 m.a.s.l.) and sea level. The hypoxia group showed additional benefits when compared to normoxia group for peak velocities with different percentages of the body weight, maximal theoretical velocity and jump height after the training period, and these additional benefits in jump height were maintained 2 weeks after training. The hypoxia group achieved a higher peak performance in peak velocity and jump height than normoxia group (peak velocity: 8.8 vs. 5.6%, jump height: 8.2 vs. 1.4%, respectively) and was achieved earlier in hypoxia (after training) than in normoxia (1 week after training). However, there was a detrimental effect for the hypoxia group on the times of execution and acceleration of the ippon-seoi-nage compared to the normoxia group. These results suggest that altitude training may induce faster and greater improvements in explosive leg extension capacity. Specific technique-oriented training should be included at altitude to prevent technique impairment.

Short-term hypoxic training increases monocarboxylate transporter 4 and phosphofructokinase activity in Thoroughbreds

The aim of this study was to investigate effects of short-term hypoxic training on lactate metabolism in the gluteus medius muscle of Thoroughbreds. Using crossover design (3 months washout), eight Thoroughbred horses were trained for 2 weeks in normoxia (FI O2  = 21%) and hypoxia (FI O2  = 18%) each. They ran at 95% maximal oxygen consumption (V̇O2max ) on a treadmill inclined at 6% for 2 min (3 days/week) measured under normoxia. Before and after each training period, all horses were subjected to an incremental exercise test (IET) under normoxia. Following the 2-week trainings, V̇O2max in IET increased significantly under both oxygen conditions. The exercise duration in IET increased significantly only after hypoxic training. The monocarboxylate transporter (MCT) 1 protein levels remained unchanged after training under both oxygen conditions, whereas MCT4 protein levels increased significantly after training in hypoxia but not after training in normoxia. Phosphofructokinase activity increased significantly only after hypoxic training, whereas cytochrome c oxidase activity increased significantly only after normoxic training. Our results suggest that hypoxic training efficiently enhances glycolytic capacity and levels of the lactate transporter protein MCT4, which facilitates lactate efflux from the skeletal muscle.

High-intensity training in normobaric hypoxia enhances exercise performance and aerobic capacity in Thoroughbred horses: A randomized crossover study

We examined the effects of high-intensity training in normobaric hypoxia on aerobic capacity and exercise performance in horses and the individual response to normoxic and hypoxic training. Eight untrained horses were studied in a randomized, crossover design after training in hypoxia (HYP; 15.0% inspired O2 ) or normoxia (NOR; 20.9% inspired O2 ) 3 days/week for 4 weeks separated by a 4-month washout period. Before and after each training period, incremental treadmill exercise tests were performed in normoxia. Each training session consisted of 1 min cantering at 7 m/s and 2 min galloping at the speed determined to elicit maximal oxygen consumption ( V ˙ O2 max) in normoxia. Hypoxia increased significantly more than NOR in run time to exhaustion (HYP, +28.4%; NOR, +10.4%, p = .001), V ˙ O2 max (HYP, +12.1%; NOR, +2.6%, p = .042), cardiac output ( Q ˙ ; HYP, +11.3%; NOR, -1.7%, p = .019), and stroke volume (SV) at exhaustion (HYP, +5.4%; NOR, -5.5%, p = .035) after training. No significant correlations were observed between NOR and HYP for individual changes after training in run time (p = .21), V ˙ O2 max (p = .99), Q ˙ (p = .19), and SV (p = .46) at exhaustion. Arterial O2 saturation during exercise in HYP was positively correlated with the changes in run time (r = .85, p = .0073), Q ˙ (r = .72, p = .043) and SV (r = .77, p = .026) of HYP after training, whereas there were no correlations between these parameters in NOR. These results suggest that high-intensity training in normobaric hypoxia improved exercise performance and aerobic capacity of horses to a greater extent than the same training protocol in normoxia, and the severity of hypoxemia during hypoxic exercise might be too stressful for poor responders to hypoxic training.

Influences of Hypoxia Exercise on Whole-Body Insulin Sensitivity and Oxidative Metabolism in Older Individuals

CONTEXT

Aging is a primary risk factor for most chronic diseases, including type 2 diabetes. Both exercise and hypoxia regulate pathways that ameliorate age-associated metabolic muscle dysfunction.

OBJECTIVE

We hypothesized that the combination of hypoxia and exercise would be more effective in improving glucose metabolism than normoxia exercise.

DESIGN AND PARTICIPANTS

We randomized 29 older sedentary individuals (62 ± 6 years; 14 women, 15 men) to bicycle exercise under normobaric hypoxia (fraction of inspired oxygen = 15%) or normoxia (fraction of inspired oxygen = 21%).

INTERVENTION

Participants trained thrice weekly for 30 to 40 minutes over 8 weeks at a heart rate corresponding to 60% to 70% of peak oxygen update.

MAIN OUTCOME MEASURES

Insulin sensitivity measured by hyperinsulinemic-euglycemic glucose clamp and muscle protein expression before and after hyperinsulinemic-euglycemic glucose clamp.

RESULTS

Heart rate and perceived exertion during training were similar between groups, with lower oxygen saturation when exercising under hypoxia (88.7 ± 1.5 vs 96.2 ± 1.2%, P < 0.01). Glucose infusion rate after 8 weeks increased in both the hypoxia (5.7 ± 1.1 to 6.7 ± 1.3 mg/min/kg; P < 0.01) and the normoxia group (6.2 ± 2.1 to 6.8 ± 2.1 mg/min/kg; P = 0.04), with a mean difference between groups of -0.44 mg/min/kg; 95% CI, -1.22 to 0.34; (P = 0.25). Markers of mitochondrial content and oxidative capacity in skeletal muscle were similar after training in both groups. Changes in Akt phosphorylation and glucose transporter 4 under fasting and insulin-stimulated conditions were not different between groups over time.

CONCLUSIONS

Eight weeks of hypoxia endurance training led to similar changes in insulin sensitivity and markers of oxidative metabolism compared with normoxia training. Normobaric hypoxia exercise did not enhance metabolic effects in sedentary older women and men beyond exercise alone.

The Maximal Mechanical Capabilities of Leg Muscles to Generate Velocity and Power Improve at Altitude

García-Ramos, A, Štirn, I, Padial, P, Argüelles-Cienfuegos, J, De la Fuente, B, Strojnik, V, and Feriche, B. The maximal mechanical capabilities of leg extensors muscles to generate velocity and power improve at altitude. J Strength Cond Res 32(2): 475-481, 2018-This study aimed (a) to analyze the effect of an acute exposure to terrestrial altitude on the force-velocity relationship parameters (maximum force [F0], maximum velocity [V0], and maximum power [P0]) during a loaded squat jump (SJ), and (b) to compare unloaded SJ and countermovement jump (CMJ) performance between sea level and altitude conditions. Seventeen international swimmers were tested at sea level (295 m asl) and 7 days later at terrestrial altitude (2,320 m asl) during their first 24 hours of altitude exposure. The maximum values of force and velocity were recorded during a loaded SJ (25-100% of body weight) to determine F0, V0, and P0 parameters. Inconsequential differences between environmental conditions were found for F0 (p = 0.993, 0.02%). However, V0 (p = 0.038, 7.6%) and P0 (p = 0.004, 6.8%) were higher at altitude. Peak values of force (SJ: p = 0.420, 1.19%; CMJ: p = 0.010, 3.6%), power (SJ: p = 0.028, 3.5%; CMJ: p = 0.005, 3.82%), and take-off velocity (SJ: p = 0.071, 1.6%; CMJ: p = 0.009, 1.9%) recorded during the SJ and CMJ were also higher at altitude. These results highlight the potential effect of an acute exposure to terrestrial altitude on enhancing vertical jump performance. The increase in maximal power of the leg muscles at altitude is caused by an improvement in the theoretical maximal velocity at which lower limbs can extend with no significant changes in the theoretical maximal force.

Contractile Activity Is Necessary to Trigger Intermittent Hypobaric Hypoxia-Induced Fiber Size and Vascular Adaptations in Skeletal Muscle

Altitude training has become increasingly popular in recent decades. Its central and peripheral effects are well-described; however, few studies have analyzed the effects of intermittent hypobaric hypoxia (IHH) alone on skeletal muscle morphofunctionality. Here, we studied the effects of IHH on different myofiber morphofunctional parameters, investigating whether contractile activity is required to elicit hypoxia-induced adaptations in trained rats. Eighteen male Sprague-Dawley rats were trained 1 month and then divided into three groups: (1) rats in normobaria (trained normobaric inactive, TNI); (2) rats subjected daily to a 4-h exposure to hypobaric hypoxia equivalent to 4,000 m (trained hypobaric inactive, THI); and (3) rats subjected daily to a 4-h exposure to hypobaric hypoxia just before performing light exercise (trained hypobaric active, THA). After 2 weeks, the tibialis anterior muscle (TA) was excised. Muscle cross-sections were stained for: (1) succinate dehydrogenase to identify oxidative metabolism; (2) myosin-ATPase to identify slow- and fast-twitch fibers; and (3) endothelial-ATPase to stain capillaries. Fibers were classified as slow oxidative (SO), fast oxidative glycolytic (FOG), fast intermediate glycolytic (FIG) or fast glycolytic (FG) and the following parameters were measured: fiber cross-sectional area (FCSA), number of capillaries per fiber (NCF), NCF per 1,000 μm² of FCSA (CCA), fiber and capillary density (FD and CD), and the ratio between CD and FD (C/F). THI rats did not exhibit significant changes in most of the parameters, while THA animals showed reduced fiber size. Compared to TNI rats, FOG fibers from the lateral/medial fields, as well as FIG and FG fibers from the lateral region, had smaller FCSA in THA rats. Moreover, THA rats had increased NCF in FG fibers from all fields, in medial and posterior FIG fibers and in posterior FOG fibers. All fiber types from the three analyzed regions (except the posterior FG fibers) displayed a significantly increased CCA ratio compared to TNI rats. Global capillarisation was also increased in lateral and medial fields. Our results show that IHH alone does not induce alterations in the TA muscle. The inclusion of exercise immediately after the tested hypoxic conditions is enough to trigger a morphofunctional response that improves muscle capillarisation.

Effects of Exercise Training in Hypoxia Versus Normoxia on Vascular Health

BACKGROUND

Exercise training (ExT) prompts multiple beneficial adaptations associated with vascular health, such as increases in skeletal muscle capillarization and vascular dilator function and decreases in arterial stiffness. However, whether ExT performed in hypoxic conditions induces enhanced effects is unclear.

OBJECTIVE

We sought to systematically review the literature and determine whether hypoxic ExT leads to superior vascular adaptations compared with normoxic ExT.

METHODS

We searched MEDLINE, Scopus, and Web of Science from their inception until September 2015 for articles assessing vascular adaptations to ExT performed under hypoxic and normoxic conditions. We performed meta-analyses to determine the standardized mean difference (SMD) between the effects of ExT performed in hypoxia versus normoxia on vascular adaptations. We assessed heterogeneity among studies using I ² statistics and evaluated publication bias via the Begg and Mazumdar's rank correlation test and Egger's regression test.

RESULTS

After systematic review, we included 21 controlled studies, including a total of 331 individuals (mean age 19-57 years, 265 males). ExT programs primarily consisted of cycling endurance training performed in normobaric hypoxia or normoxia; duration ranged from 3 to 10 weeks. The exercise intensity was similar in relative terms in the groups trained in hypoxia and normoxia in the majority of studies (17 of 21). After data pooling, skeletal muscle capillarization (n = 182, SMD = 0.40, 95 % confidence interval [CI] 0.10-0.70; P = 0.01) and vascular dilator function (n = 71, SMD = 0.67, 95 % CI 0.17-1.18; P = 0.009) but not arterial stiffness (n = 112, SMD = -0.03, 95 % CI -0.69 to 0.63; P = 0.93), were enhanced with ExT performed in hypoxia versus normoxia. We only found heterogeneity among studies assessing arterial stiffness (I ² = 63 %, P = 0.02), and no publication bias was detected.

CONCLUSION

Based on current published studies, hypoxic ExT potentiates vascular adaptations related to skeletal muscle capillarization and dilator function. These findings may contribute to establishing effective exercise programs designed to enhance vascular health.

Adaptations in muscle oxidative capacity, fiber size, and oxygen supply capacity after repeated-sprint training in hypoxia combined with chronic hypoxic exposure

In this study, we investigate adaptations in muscle oxidative capacity, fiber size and oxygen supply capacity in team-sport athletes after six repeated-sprint sessions in normobaric hypoxia or normoxia combined with 14 days of chronic normobaric hypoxic exposure. Lowland elite field hockey players resided at simulated altitude (≥14 h/day at 2,800-3,000 m) and performed regular training plus six repeated-sprint sessions in normobaric hypoxia (3,000 m; LHTLH; n = 6) or normoxia (0 m; LHTL; n = 6) or lived at sea level with regular training only (LLTL; n = 6). Muscle biopsies were obtained from the m. vastus lateralis before (pre), immediately after (post-1), and 3 wk after the intervention (post-2). Changes over time between groups were compared, including likelihood of the effect size (ES). Succinate dehydrogenase activity in LHTLH largely increased from pre to post-1 (~35%), likely more than LHTL and LLTL (ESs = large-very large), and remained elevated in LHTLH at post-2 (~12%) vs. LHTL (ESs = moderate-large). Fiber cross-sectional area remained fairly similar in LHTLH from pre to post-1 and post-2 but was increased at post-1 and post-2 in LHTL and LLTL (ES = moderate-large). A unique observation was that LHTLH and LHTL, but not LLTL, improved their combination of fiber size and oxidative capacity. Small-to-moderate differences in oxygen supply capacity (i.e., myoglobin and capillarization) were observed between groups. In conclusion, elite team-sport athletes substantially increased their skeletal muscle oxidative capacity, while maintaining fiber size, after only 14 days of chronic hypoxic residence combined with six repeated-sprint training sessions in hypoxia. NEW & NOTEWORTHY Our novel findings show that elite team-sport athletes were able to substantially increase the skeletal muscle oxidative capacity in type I and II fibers (+37 and +32%, respectively), while maintaining fiber size after only 14 days of chronic hypoxic residence combined with six repeated-sprint sessions in hypoxia. This increase in oxidative capacity was superior to groups performing chronic hypoxic residence with repeated sprints in normoxia and residence at sea level with regular training only.

Exercise during short-term exposure to hypoxia or hyperoxia - novel treatment strategies for type 2 diabetic patients?!

Both hypoxia (decreased oxygen availability) and hyperoxia (increased oxygen availability) have been shown to alter exercise adaptations in healthy subjects. This review aims to clarify the possible benefits of exercise during short-term exposure to hypoxia or hyperoxia for patients with type 2 diabetes mellitus (T2DM). There is evidence that exercise during short-term exposure to hypoxia can acutely increase skeletal muscle glucose uptake more than exercise in normoxia, and that post-exercise insulin sensitivity in T2DM patients is more increased when exercise is performed under hypoxic conditions. Furthermore, interventional studies show that glycemic control can be improved through regular physical exercise in short-term hypoxia at a lower workload than in normoxia, and that exercise training in short-term hypoxia can contribute to increased weight loss in overweight/obese (insulin-resistant) subjects. While numerous studies involving healthy subjects report that regular exercise in hypoxia can increase vascular health (skeletal muscle capillarization and vascular dilator function) to a higher extent than exercise training in normoxia, there is no convincing evidence yet that hypoxia has such additive effects in T2DM patients in the long term. Some studies indicate that the use of hyperoxia during exercise can decrease lactate concentrations and subjective ratings of perceived exertion. Thus, there are interesting starting points for future studies to further evaluate possible beneficial effects of exercise in short-term hypoxia or hyperoxia at different oxygen concentrations and exposure durations. In general, exposure to hypoxia/hyperoxia should be considered with caution. Possible health risks-especially for T2DM patients-are also analyzed in this review.

Physiological Adaptations to Hypoxic vs. Normoxic Training during Intermittent Living High

In the setting of “living high,” it is unclear whether high-intensity interval training (HIIT) should be performed “low” or “high” to stimulate muscular and performance adaptations. Therefore, 10 physically active males participated in a 5-week “live high-train low or high” program (TR), whilst eight subjects were not engaged in any altitude or training intervention (CON). Five days per week (~15.5 h per day), TR was exposed to normobaric hypoxia simulating progressively increasing altitude of ~2,000–3,250 m. Three times per week, TR performed HIIT, administered as unilateral knee-extension training, with one leg in normobaric hypoxia (~4,300 m; TR_HYP) and with the other leg in normoxia (TR_NOR). “Living high” elicited a consistent elevation in serum erythropoietin concentrations which adequately predicted the increase in hemoglobin mass (r = 0.78, P < 0.05; TR: +2.6%, P < 0.05; CON: −0.7%, P > 0.05). Muscle oxygenation during training was lower in TR_HYP vs. TR_NOR (P < 0.05). Muscle homogenate buffering capacity and pH-regulating protein abundance were similar between pretest and posttest. Oscillations in muscle blood volume during repeated sprints, as estimated by oscillations in NIRS-derived tHb, increased from pretest to posttest in TR_HYP (~80%, P < 0.01) but not in TR_NOR (~50%, P = 0.08). Muscle capillarity (~15%) as well as repeated-sprint ability (~8%) and 3-min maximal performance (~10–15%) increased similarly in both legs (P < 0.05). Maximal isometric strength increased in TR_HYP (~8%, P < 0.05) but not in TR_NOR (~4%, P > 0.05). In conclusion, muscular and performance adaptations were largely similar following normoxic vs. hypoxic HIIT. However, hypoxic HIIT stimulated adaptations in isometric strength and muscle perfusion during intermittent sprinting.

Resistance Training Using Different Hypoxic Training Strategies: a Basis for Hypertrophy and Muscle Power Development

The possible muscular strength, hypertrophy, and muscle power benefits of resistance training under environmental conditions of hypoxia are currently being investigated.Nowadays, resistance training in hypoxia constitutes a promising new training strategy for strength and muscle gains. The main mechanisms responsible for these effects seem to be related to increased metabolite accumulation due to hypoxia. However, no data are reported in the literature to describe and compare the efficacy of the different hypertrophic resistance training strategies in hypoxia.Moreover, improvements in sprinting, jumping, or throwing performance have also been described at terrestrial altitude, encouraging research into the speed of explosive movements at altitude. It has been suggested that the reduction in the aerodynamic resistance and/or the increase in the anaerobic metabolism at higher altitudes can influence the metabolic cost, increase the take-off velocities, or improve the motor unit recruitment patterns, which may explain these improvements. Despite these findings, the applicability of altitude conditions in improving muscle power by resistance training remains to be clarified.This review examines current knowledge regarding resistance training in different types of hypoxia, focusing on strategies designed to improve muscle hypertrophy as well as power for explosive movements.

Modulation of mitochondrial biomarkers by intermittent hypobaric hypoxia and aerobic exercise after eccentric exercise in trained rats

Unaccustomed eccentric contractions induce muscle damage, calcium homeostasis disruption, and mitochondrial alterations. Since exercise and hypoxia are known to modulate mitochondrial function, we aimed to analyze the effects on eccentric exercise-induced muscle damage (EEIMD) in trained rats using 2 recovery protocols based on: (i) intermittent hypobaric hypoxia (IHH) and (ii) IHH followed by exercise. The expression of biomarkers related to mitochondrial biogenesis, dynamics, oxidative stress, and bioenergetics was evaluated. Soleus muscles were excised before (CTRL) and 1, 3, 7, and 14 days after an EEIMD protocol. The following treatments were applied 1 day after the EEIMD: passive normobaric recovery (PNR), 4 h daily exposure to passive IHH at 4000 m (PHR) or IHH exposure followed by aerobic exercise (AHR). Citrate synthase activity was reduced at 7 and 14 days after application of the EEIMD protocol. However, this reduction was attenuated in AHR rats at day 14. PGC-1α and Sirt3 and TOM20 levels had decreased after 1 and 3 days, but the AHR group exhibited increased expression of these proteins, as well as of Tfam, by the end of the protocol. Mfn2 greatly reduced during the first 72 h, but returned to basal levels passively. At day 14, AHR rats had higher levels of Mfn2, OPA1, and Drp1 than PNR animals. Both groups exposed to IHH showed a lower p66shc(ser³⁶)/p66shc ratio than PNR animals, as well as higher complex IV subunit I and ANT levels. These results suggest that IHH positively modulates key mitochondrial aspects after EEIMD, especially when combined with aerobic exercise.

Intermittent hypobaric hypoxia combined with aerobic exercise improves muscle morphofunctional recovery after eccentric exercise to exhaustion in trained rats

Unaccustomed eccentric exercise leads to muscle morphological and functional alterations, including microvasculature damage, the repair of which is modulated by hypoxia. We present the effects of intermittent hypobaric hypoxia and exercise on recovery from eccentric exercise-induced muscle damage (EEIMD). Soleus muscles from trained rats were excised before (CTRL) and 1, 3, 7, and 14 days after a double session of EEIMD protocol. A recovery treatment consisting of one of the following protocols was applied 1 day after the EEIMD: passive normobaric recovery (PNR), a 4-h daily exposure to passive hypobaric hypoxia at 4,000 m (PHR), or hypobaric hypoxia exposure followed by aerobic exercise (AHR). EEIMD produced an increase in the percentage of abnormal fibers compared with CTRL, and it affected the microvasculature by decreasing capillary density (CD, capillaries per mm²) and the capillary-to-fiber ratio (CF). After 14 days, AHR exhibited CD and CF values similar to those of CTRL animals (789 and 3.30 vs. 746 and 3.06) and significantly higher than PNR (575 and 2.62) and PHR (630 and 2.92). Furthermore, VEGF expression showed a significant 43% increase in AHR when compared with PNR. Moreover, after 14 days, the muscle fibers in AHR had a more oxidative phenotype than the other groups, with significantly smaller cross-sectional areas (AHR, 3,745; PNR, 4,502; and PHR, 4,790 µm²), higher citrate synthase activity (AHR, 14.8; PNR, 13.1; and PHR, 12 µmol·min^-1·mg^-1) and a significant 27% increment in PGC-1α levels compared with PNR. Our data show that hypoxia combined with exercise attenuates or reverses the morphofunctional alterations induced by EEIMD.NEW & NOTEWORTHY Our study provides new insights into the use of intermittent hypobaric hypoxia combined with exercise as a strategy to recover muscle damage induced by eccentric exercise. We analyzed the effects of hypobaric exposure combined with aerobic exercise on histopathological features of muscle damage, fiber morphofunctionality, capillarization, angiogenesis, and the oxidative capacity of damaged soleus muscle. Most of these parameters were improved after a 2-wk protocol of intermittent hypobaric hypoxia combined with aerobic exercise.

The Effect of an Altitude Training Camp on Swimming Start Time and Loaded Squat Jump Performance

This study evaluated the influence of an altitude training (AT) camp on swimming start time and loaded squat jump performance. To accomplish this goal, 13 international swimmers (8 women, 5 men) were allocated to both the control (Sea Level Training, SLT) and experimental conditions (AT, 2320 m above sea level) that were separated by a one year period. All tests (15 m freestyle swimming start and loaded squat jumps with additional loads of 25%, 50%, 75%, and 100% of swimmers' body weight) were performed before and after a concurrent 3-week strength and endurance training program prescribed by the national coach. Following the SLT camp, significant impairments in swimming start times to 10 (+3.1%) and 15 m (+4.0%) were observed (P < 0.05), whereas no significant changes for the same distances were detected following the AT camp (-0.89%; P > 0.05). Trivial changes in peak velocity were obtained during the loaded squat jump after both training periods (effect sizes: < 0.20). Based on these results we can conclude that a traditional training high-living high strategy concurrent training of 3 weeks does not adversely affect swimming start time and loaded squat jump performance in high level swimmers, but further studies are necessary to assess the effectiveness of power-oriented resistance training in the development of explosive actions.

Factors limiting maximal oxygen uptake in exertional monoparesis

Strength and maximal oxygen uptake (VO2max) for each leg were compared in a trained multiple sclerosis (MS) patient with exertional left monoparesis. Left quadriceps strength and left leg VO2max were 22% and 30% lower, respectively, compared to the right (control) leg. Because the same O2 delivery system served each leg during exercise, VO2max of the paretic leg was not limited by cardiorespiratory factors but rather by strength and/or muscle oxidative capacity. However, training with monoparesis likely enhanced O2 extraction and aerobic work capacity of the right leg.

Nitrate Intake Promotes Shift in Muscle Fiber Type Composition during Sprint Interval Training in Hypoxia

Purpose: We investigated the effect of sprint interval training (SIT) in normoxia, vs. SIT in hypoxia alone or in conjunction with oral nitrate intake, on buffering capacity of homogenized muscle (βhm) and fiber type distribution, as well as on sprint and endurance performance.

Methods: Twenty-seven moderately-trained participants were allocated to one of three experimental groups: SIT in normoxia (20.9% F_iO₂) + placebo (N), SIT in hypoxia (15% F_iO₂) + placebo (H), or SIT in hypoxia + nitrate supplementation (HN). All participated in 5 weeks of SIT on a cycle ergometer (30-s sprints interspersed by 4.5 min recovery-intervals, 3 weekly sessions, 4–6 sprints per session). Nitrate (6.45 mmol NaNO₃) or placebo capsules were administered 3 h before each session. Before and after SIT participants performed an incremental VO_2max-test, a 30-min simulated cycling time-trial, as well as a 30-s cycling sprint test. Muscle biopsies were taken from m. vastus lateralis.

Results: SIT decreased the proportion of type IIx muscle fibers in all groups (P < 0.05). The relative number of type IIa fibers increased (P < 0.05) in HN (P < 0.05 vs. H), but not in the other groups. SIT had no significant effect on βhm. Compared with H, SIT tended to enhance 30-s sprint performance more in HN than in H (P = 0.085). VO_2max and 30-min time-trial performance increased in all groups to a similar extent.

Conclusion: SIT in hypoxia combined with nitrate supplementation increases the proportion of type IIa fibers in muscle, which may be associated with enhanced performance in short maximal exercise. Compared with normoxic training, hypoxic SIT does not alter βhm or endurance and sprinting exercise performance.

Hypoxic training: effect on mitochondrial function and aerobic performance in hypoxia

PURPOSE

The effects of hypoxic training on exercise performance remain controversial. Here, we tested the hypotheses that i) hypoxic training possesses ergogenic effects at sea level and altitude and ii) the benefits are primarily mediated by improved mitochondrial function of the skeletal muscle.

METHODS

We determined aerobic performance (incremental test to exhaustion and time trial for a set amount of work) in moderately trained subjects undergoing 6 wk of endurance training (3-4 times per week, 60 min per session) in normoxia (placebo, n = 8) or normobaric hypoxia (FIO2 = 0.15, n = 9) using a double-blind and randomized design. Exercise tests were performed in normoxia and acute hypoxia (FIO2 = 0.15). Skeletal muscle mitochondrial respiratory capacities and electron coupling efficiencies were measured via high-resolution respirometry. Total hemoglobin mass was assessed by carbon monoxide rebreathing.

RESULTS

Skeletal muscle respiratory capacity was not altered by training or hypoxia; however, electron coupling control respective to fat oxidation slightly diminished with hypoxic training. Hypoxic training did increase total hemoglobin mass more than the placebo (8.4% vs 3.3%, P = 0.02). In normoxia, hypoxic training had no additive effect on maximal measures of oxygen uptake or time trial performance. In acute hypoxia, hypoxic training conferred no advantage on maximal oxygen uptake but tended to enhance time trial performance more than normoxic training (52% vs 32%, P = 0.09).

CONCLUSIONS

Our data suggest that, in moderately trained subjects, 6 wk of hypoxic training possesses no ergogenic effect at sea level. It is not excluded that hypoxic training might facilitate endurance capacity at moderate altitude; however, this issue is still open and needs to be further examined.

Eight weeks of intermittent hypoxic training improves submaximal physiological variables in highly trained runners

It is unclear whether intermittent hypoxic training (IHT) results in improvements in physiological variables associated with endurance running. Twelve highly trained runners (VO2peak 70.0 ± 3.5 ml·kg-1·min-1) performed incremental treadmill tests to exhaustion in normobaric normoxia and hypoxia (16.0% FIO2) to assess submaximal and maximal physiological variables and the limit of tolerance (T-Lim). Participants then completed 8 weeks of moderate to heavy intensity normoxic training (control [CONT]) or IHT (twice weekly 40 minutes runs, in combination with habitual training), in a single blinded manner, before repeating the treadmill tests. Submaximal heart rate decreased significantly more after IHT (-5 ± 5 b·min-1; p = 0.001) than after CONT ( -1 ± 5 b·min-1; p = 0.021). Changes in submaximal V[Combining Dot Above]O2 were significantly different between groups (p ≤ 0.05); decreasing in the IHT group in hypoxia (-2.6 ± 1.7 ml·kg-1·min-1; p = 0.001) and increasing in the CONT group in normoxia (+1.1 ± 2.1 ml·kg-1·min-1; p = 0.012). There were no VO2peak changes within either group, and while T-Lim improved post-IHT in hypoxia (p = 0.031), there were no significant differences between groups. Intermittent hypoxic training resulted in a degree of enhanced cardiovascular fitness that was evident during submaximal, but not maximal intensity exercise. These results suggest that moderate to heavy intensity IHT provides a mean of improving the capacity for submaximal exercise and may be useful for pre-acclimatization for subsequent exercise in hypoxia, but additional research is required to establish its efficacy for athletic performance at sea level.

Hypoxia and resistance exercise: a comparison of localized and systemic methods

It is generally believed that optimal hypertrophic and strength gains are induced through moderate- or high-intensity resistance training, equivalent to at least 60% of an individual's 1-repetition maximum (1RM). However, recent evidence suggests that similar adaptations are facilitated when low-intensity resistance exercise (~20-50% 1RM) is combined with blood flow restriction (BFR) to the working muscles. Although the mechanisms underpinning these responses are not yet firmly established, it appears that localized hypoxia created by BFR may provide an anabolic stimulus by enhancing the metabolic and endocrine response, and increase cellular swelling and signalling function following resistance exercise. Moreover, BFR has also been demonstrated to increase type II muscle fibre recruitment during exercise. However, inappropriate implementation of BFR can result in detrimental effects, including petechial haemorrhage and dizziness. Furthermore, as BFR is limited to the limbs, the muscles of the trunk are unable to be trained under localized hypoxia. More recently, the use of systemic hypoxia via hypoxic chambers and devices has been investigated as a novel way to stimulate similar physiological responses to resistance training as BFR techniques. While little evidence is available, reports indicate that beneficial adaptations, similar to those induced by BFR, are possible using these methods. The use of systemic hypoxia allows large groups to train concurrently within a hypoxic chamber using multi-joint exercises. However, further scientific research is required to fully understand the mechanisms that cause augmented muscular changes during resistance exercise with a localized or systemic hypoxic stimulus.

Human skeletal muscle mRNAResponse to a single hypoxic exercise bout

BACKGROUND

The ability to physically perform at high altitude may require unique strategies to acclimatize before exposure. The effect of acute hypoxic exposure on the metabolic response of the skeletal muscle may provide insight into the value of short-term preacclimatization strategies.

OBJECTIVE

To determine the human skeletal muscle response to a single acute bout of exercise in a hypoxic environment on metabolic gene expression.

METHODS

Eleven recreationally active male participants (24 ± 4 years, 173 ± 20 cm, 82 ± 12 kg, 15.2 ± 7.1% fat, 4.0 ± 0.6 L/min maximal oxygen consumption) completed two 1-hour cycling exercise trials at 60% of peak power followed by 4 hours of recovery in ambient environmental conditions (975 m) and at normobaric hypoxic conditions simulating 3000 m in a randomized counterbalanced order. Muscle biopsies were obtained from the vastus lateralis before exercise and 4 hours after exercise for real-time polymerase chain reaction analysis of select metabolic genes.

RESULTS

Gene expression of hypoxia-inducible factor 1 alpha, cytochrome c oxidase subunit 4, peroxisome proliferator-activated receptor gamma coactivator 1 alpha, hexokinase, phosphofructokinase, mitochondrial fission 1, and mitofusin-2 increased with exercise (P < .05) but did not differ with hypoxic exposure (P > .05). Optic atrophy 1 did not increase with exercise or differ between environmental conditions (P > .05).

CONCLUSIONS

The improvements in mitochondrial function reported with intermittent hypoxic training may not be explained by a single acute hypoxic exposure, and thus it appears that a longer period of preacclimatization than a single exposure may be required.

Determinants of team-sport performance: implications for altitude training by team-sport athletes

Team sports are increasingly popular, with millions of participants worldwide. Athletes engaged in these sports are required to repeatedly produce skilful actions and maximal or near-maximal efforts (eg, accelerations, changes in pace and direction, sprints, jumps and kicks), interspersed with brief recovery intervals (consisting of rest or low-intensity to moderate-intensity activity), over an extended period of time (1–2 h). While performance in most team sports is dominated by technical and tactical proficiencies, successful team-sport athletes must also have highly-developed, specific, physical capacities. Much effort goes into designing training programmes to improve these physical capacities, with expected benefits for team-sport performance. Recently, some team sports have introduced altitude training in the belief that it can further enhance team-sport physical performance. Until now, however, there is little published evidence showing improved team-sport performance following altitude training, despite the often considerable expense involved. In the absence of such studies, this review will identify important determinants of team-sport physical performance that may be improved by altitude training, with potential benefits for team-sport performance. These determinants can be broadly described as factors that enhance either sprint performance or the ability to recover from maximal or near-maximal efforts. There is some evidence that some of these physical capacities may be enhanced by altitude training, but further research is required to verify that these adaptations occur, that they are greater than what could be achieved by appropriate sea-level training and that they translate to improved team-sport performance.

Sprint interval training in hypoxia stimulates glycolytic enzyme activity

PURPOSE

In this study, we compared the effect of sprint interval training (SIT) in normoxia versus hypoxia on muscle glycolytic and oxidative capacity, monocarboxylate transporter content, and endurance exercise performance.

METHODS

Healthy male volunteers (18-30 yr) performed 6 wk of SIT on a cycling ergometer (30-s sprints vs 4.5-min rest intervals; 3 d · wk(-1)) in either normobaric hypoxia (HYP, FiO2 = 14.4%, n = 10) or normoxia (NOR, FiO2 = 20.9%, n = 9). The control group did not train (CON, n = 10). Training load was increased from four sprints per session in week 1 to nine sprints in week 6. Before and after SIT, subjects performed a maximal incremental exercise test plus a 10-min simulated time trial on a cycle ergometer in both normoxia (MAX nor and TT nor) and hypoxia (MAX hyp and TT hyp). A needle biopsy was taken from musculus vastus lateralis at rest 5-6 d after the last exercise session.

RESULTS

SIT increased muscle phosphofructokinase activity more in HYP (+59%, P < 0.05) than that in NOR (+17%), whereas citrate synthase activity was similar between groups. Compared with the pretest, power outputs corresponding to 4 mmol blood lactate in HYP during MAX nor (+7%) and MAX hyp (+9%) were slightly increased (P < 0.05), whereas values were constant in NOR. V·O 2max in MAX nor and TT performance in TT nor and TT hyp were increased by ≈ 6%-8% (P < 0.05) in either group. The training elevated monocarboxylate transporter 1 protein content by ≈ 70% (P < 0.05). In CON, all measurements were constant throughout the study.

CONCLUSION

SIT in hypoxia up-regulated muscle phosphofructokinase activity and the anaerobic threshold more than SIT in normoxia but did not enhance endurance exercise performance.

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

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

Modified ventilatory response characteristics to exercise in breath-hold divers

Specific adjustments to repeated extreme apnea are not fully known and understood. While a blunted ventilatory chemosensitivity to CO2 is described for elite breath-hold divers (BHDs) at rest, it is unclear whether specific adaptations affect their response to dynamic exercise. Eight elite BHDs with a previously validated decrease in CO2 chemosensitivity, 8 scuba divers (SCDs), and 8 matched control subjects were included in a study where markers of ventilatory response, Fowler's dead space, partial pressure of carbon dioxide (pCO2), and blood lactate concentrations during cycle exercise were measured. Maximal power output did not differ between the groups, but lactate threshold (θL) appeared at a significantly lowered respiratory compensation point (RCP) and at a higher VO2 for the BHDs. End-tidal (petCO2) and estimated arterial pCO2 (paCO2) were significantly higher in BHDs at θL, the RCP, and maximum exhaustion. BHDs showed a significantly (P < .01) slower breathing pattern in relation to a given tidal volume at a specific work rate. In summary, BHDs presented signs of a metabolic shift from aerobic to anaerobic energy supply, decreased chemosensitivity during exercise, and a distinct ventilatory-response pattern during cycle exercise that differs from SCDs and controls.

Acute physiological and performance responses to repeated sprints in varying degrees of hypoxia

OBJECTIVES

Our aim was to determine the effects of different inspired oxygen fractions on repeated sprint performance and cardiorespiratory and neuromuscular responses, to construct a hypoxic dose response.

DESIGN

Nine male well-trained multi-sport athletes completed 10×6s all-out running sprints with 30s recovery in 5 conditions with different inspired oxygen fraction (FIO2: 12%, 13%, 14%, 15%, 21%).

METHODS

Peak running speed was measured in each sprint and electromyography data were recorded from m. vastus lateralis in parallel with heart rate and blood oxygen saturation. Cardiorespiratory response was assessed via breath by breath expired air analysis and muscle oxygenation status was evaluated via near infrared spectroscopy.

RESULTS

In parallel with the higher heart rate, minute ventilation, blood lactate concentration, and muscle deoxygenation; lower blood oxygen saturation, pulmonary oxygen uptake and integrated EMG (all p<0.05) were registered in all hypoxic conditions, with the greatest changes from baseline observed during the 13% trial. However, fatigue index and speed decrement were significantly greater only during the 12% vs 21% trial (p<0.05).

CONCLUSIONS

Physiological responses associated with performing 10×6s sprints interspersed with 30s passive recovery was incrementally greater as FIO2 decreased to 13%, yet fatigue development was significantly exacerbated relative to normoxia (FIO2: 21%) only at the 12% FIO2.

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

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

Effects of resistance training combined with vascular occlusion or hypoxia on neuromuscular function in athletes

The aim was to investigate the effects of low-load resistant training combined with vascular occlusion or normobaric hypoxic exposure, on neuromuscular function. In a randomised controlled trial, well-trained athletes took part in a 5-week training of knee flexor/extensor muscles in which low-load resistant exercise (20% of one repetition maximum, 1-RM) was combined with either (1) an occlusion pressure of approximately 230 mmHg (KT, n = 10), (2) hypoxic air to generate an arterial blood oxygen saturation of ~80% (HT, n = 10), or (3) with no additional stimulus (CT, n = 10). Before and after training, participants completed the following tests: 3-s maximal voluntary contraction (MVC₃), 30-s MVC, and an endurance test (maximal number of repetitions at 20% 1-RM, Reps₂₀). Electromyographic activity (root mean square, RMS) was measured during tests and the cross-sectional area (CSA) of the quadriceps and hamstrings was measured pre- and post-training. Relative to CT, KT, and HT showed likely increases in MVC₃ (11.0 ± 11.9 and 15.0 ± 13.1%, mean ± 90% confidence interval), MVC₃₀ (10.2 ± 9.0 and 18.3 ± 17.4%), and Reps₂₀ (28.9 ± 23.7 and 23.3 ± 24.0%). Compared to the CT group, CSA increased in the KT (7.6 ± 5.8) and HT groups (5.3 ± 3.0). KT had a large effect on RMS during MVC₃, compared to CT (effect size 0.8) and HT (effect size 0.8). We suspect hypoxic conditions created within the muscles during vascular occlusion and hypoxic training may play a key role in these performance enhancements.

Effects of low-load resistance training combined with blood flow restriction or hypoxia on muscle function and performance in netball athletes

OBJECTIVES

To investigate the effect of blood flow restriction or normobaric hypoxic exposure combined with low-load resistant exercise (LRE), on muscular strength and endurance.

DESIGN

A randomised controlled trial.

METHODS

Well-trained netball players (n=30) took part in a 5 weeks training of knee flexor and extensor muscles in which LRE (20% of one repetition maximum) was combined with (1) an occlusion pressure of approximately 230mmHg around the upper thigh (KT, n=10), (2) hypoxic air to generate blood oxyhaemoglobin levels of approximately 80% (HT, n=10) or (3) with no additional stimulus (CT, n=10). The training was of the same intensity and amount in all groups. One to five days before and after training, participants performed a series of strength and endurance tests of the lower limbs (3-s maximal voluntary contraction [MVC3], area under 30-s force curve [MVC30], number of repetitions at 20% 1RM [Reps201RM]). In addition, the cross-sectional area (CSA) of the quadriceps and hamstrings were measured.

RESULTS

Relative to CT, KT and HT increased MVC3 (11.0±11.9% and 15.0±13.1%), MVC30 (10.2±9.0% and 18.3±17.4%) and Reps201RM (28.9±23.7% and 23.3±24.0%, mean±90% confidence interval) after training. CSA increased by 6.6±4.5%, 6.1±5.1% and 2.9±2.7% in the KT, HT and CT groups respectively.

CONCLUSIONS

LRE in conjunction with KT or HT can provide substantial improvements in muscle strength and endurance and may be useful alternatives to traditional training practices.

Augmentation of aerobic respiration and mitochondrial biogenesis in skeletal muscle by hypoxia preconditioning with cobalt chloride

High altitude/hypoxia training is known to improve physical performance in athletes. Hypoxia induces hypoxia inducible factor-1 (HIF-1) and its downstream genes that facilitate hypoxia adaptation in muscle to increase physical performance. Cobalt chloride (CoCl₂), a hypoxia mimetic, stabilizes HIF-1, which otherwise is degraded in normoxic conditions. We studied the effects of hypoxia preconditioning by CoCl₂ supplementation on physical performance, glucose metabolism, and mitochondrial biogenesis using rodent model. The results showed significant increase in physical performance in cobalt supplemented rats without (two times) or with training (3.3 times) as compared to control animals. CoCl₂ supplementation in rats augmented the biological activities of enzymes of TCA cycle, glycolysis and cytochrome c oxidase (COX); and increased the expression of glucose transporter-1 (Glut-1) in muscle showing increased glucose metabolism by aerobic respiration. There was also an increase in mitochondrial biogenesis in skeletal muscle observed by increased mRNA expressions of mitochondrial biogenesis markers which was further confirmed by electron microscopy. Moreover, nitric oxide production increased in skeletal muscle in cobalt supplemented rats, which seems to be the major reason for peroxisome proliferator activated receptor-gamma coactivator-1α (PGC-1α) induction and mitochondrial biogenesis. Thus, in conclusion, we state that hypoxia preconditioning by CoCl₂ supplementation in rats increases mitochondrial biogenesis, glucose uptake and metabolism by aerobic respiration in skeletal muscle, which leads to increased physical performance. The significance of this study lies in understanding the molecular mechanism of hypoxia adaptation and improvement of work performance in normal as well as extreme conditions like hypoxia via hypoxia preconditioning.

Muscle cellular properties in the ice hockey player: a model for investigating overtraining?

In this study, we hypothesized that athletes involved in 5-6 months of sprint-type training would display higher levels of proteins and processes involved in muscle energy supply and utilization. Tissue was sampled from the vastus lateralis of 13 elite ice hockey players (peak oxygen consumption = 51.8 ± 1.3 mL·kg(-1)·min(-1); mean ± standard error) at the end of a season (POST) and compared with samples from 8 controls (peak oxygen consumption = 45.5 ± 1.4 mL·kg(-1)·min(-1)) (CON). Compared with CON, higher activities were observed in POST (p < 0.05) only for succinic dehydrogenase (3.32 ± 0.16 mol·(mg protein)(-1)·min(-1) vs. 4.10 ± 0.11 mol·(mg protein)(-1)·min(-1)) and hexokinase (0.73 ± 0.05 mol·(mg protein)(-1)·min(-1) vs. 0.90 ± 0.05mol·(mg protein)(-1)·min(-1)) but not for phosphorylase, phosphofructokinase, and creatine phosphokinase. No differences were found in Na(+),K(+)-ATPase concentration (β(max): 262 ± 36 pmol·(g wet weight)(-1) vs. 275 ± 27 pmol·(g wet weight)(-1)) and the maximal activity of the sarcoplasmic reticulum Ca(2+)-ATPase (98.1 ± 6.1 µmol·(g protein)(-1)·min(-1) vs. 102 ± 3.3 µmol·(g protein)(-1)·min(-1)). Cross-sectional area was lower (p < 0.05) in POST but only for the type IIA fibres (6312 ± 684 μm(2) vs. 5512 ± 335 μm(2)), while the number of capillary counts per fibre and the capillary to fibre area ratio were generally higher (p < 0.05). These findings suggest that elite trained ice hockey players display elevations only in support of glucose-based aerobic metabolism that occur in the absence of alterations in excitation-contraction processes.

Cellular responses in skeletal muscle to a season of ice hockey

We hypothesized that a season of ice hockey would result in extensive remodeling of muscle. Tissue sampled from the vastus lateralis of 15 players (age = 20.6 ± 0.4 years; mean ± SE) prior to (PRE) and following (POST) a season was used to characterize specific adaptations. Measurement of representative metabolic pathway enzymes indicated higher maximal activities in POST than in PRE (p < 0.05) for succinic dehydrogenase (3.26 ± 0.31 vs. 3.91 ± 0.11 mol mg protein(-1) min(-1)), citrate synthase (7.26 ± 0.70 vs. 8.70 ± 0.55 mol mg protein(-1) min(-1)), and phosphofructokinase (12.8 ± 1.3 vs. 14.4 ± 0.96 mol mg protein(-1) min(-1)) only. The season resulted in an increase in Na+-K+-ATPase concentration (253 ± 6.3 vs. 265 ± 6.0 pmol g(-1) wet weight), a decrease (p < 0.05) in maximal activity of the sarcoplasmic reticulum Ca2+-ATPase (107 ± 4.2 micromol g protein(-1) min(-1) vs. 92.0 ± 4.6 micromol g protein(-1) min(-1)), and no change in the distribution (%) of fibre types. A smaller (p < 0.05) cross-sectional area (CSA) for both type I (-11.7%) and type IIA (-18.2%) fibres and a higher (p < 0.05) capillary count/CSA for type I (+17.9%) and type IIA (+17.2%) were also found over the season. No changes were found in peak oxygen consumption (51.4 ± 1.2 mL kg(-1) min(-1) vs. 52.3 ± 1.3 mL kg(-1) min(-1)). The results suggest, based on the alterations in oxidative and perfusion potentials and muscle mass, that the dominant adaptations are in support of oxidative metabolism, which occurs at the expense of fibre CSA and possibly force-generating potential.

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

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

Is hypoxia training good for muscles and exercise performance?

Altitude training has become very popular among athletes as a means to further increase exercise performance at sea level or to acclimatize to competition at altitude. Several approaches have evolved during the last few decades, with "live high-train low" and "live low-train high" being the most popular. This review focuses on functional, muscular, and practical aspects derived from extensive research on the "live low-train high" approach. According to this, subjects train in hypoxia but remain under normoxia for the rest of the time. It has been reasoned that exercising in hypoxia could increase the training stimulus. Hypoxia training studies published in the past have varied considerably in altitude (2300-5700 m) and training duration (10 days to 8 weeks) and the fitness of the subjects. The evidence from muscle structural, biochemical, and molecular findings point to a specific role of hypoxia in endurance training. However, based on the available performance capacity data such as maximal oxygen uptake (Vo(2)max) and (maximal) power output, hypoxia as a supplement to training is not consistently found to be advantageous for performance at sea level. Stronger evidence exists for benefits of hypoxic training on performance at altitude. "Live low-train high" may thus be considered when altitude acclimatization is not an option. In addition, the complex pattern of gene expression adaptations induced by supplemental training in hypoxia, but not normoxia, suggest that muscle tissue specifically responds to hypoxia. Whether and to what degree these gene expression changes translate into significant changes in protein concentrations that are ultimately responsible for observable structural or functional phenotypes remains open. It is conceivable that the global functional markers such as Vo(2)max and (maximal) power output are too coarse to detect more subtle changes that might still be functionally relevant, at least to high-level athletes.

Combining hypoxic methods for peak performance

New methods and devices for pursuing performance enhancement through altitude training were developed in Scandinavia and the USA in the early 1990s. At present, several forms of hypoxic training and/or altitude exposure exist: traditional 'live high-train high' (LHTH), contemporary 'live high-train low' (LHTL), intermittent hypoxic exposure during rest (IHE) and intermittent hypoxic exposure during continuous session (IHT). Although substantial differences exist between these methods of hypoxic training and/or exposure, all have the same goal: to induce an improvement in athletic performance at sea level. They are also used for preparation for competition at altitude and/or for the acclimatization of mountaineers. The underlying mechanisms behind the effects of hypoxic training are widely debated. Although the popular view is that altitude training may lead to an increase in haematological capacity, this may not be the main, or the only, factor involved in the improvement of performance. Other central (such as ventilatory, haemodynamic or neural adaptation) or peripheral (such as muscle buffering capacity or economy) factors play an important role. LHTL was shown to be an efficient method. The optimal altitude for living high has been defined as being 2200-2500 m to provide an optimal erythropoietic effect and up to 3100 m for non-haematological parameters. The optimal duration at altitude appears to be 4 weeks for inducing accelerated erythropoiesis whereas <3 weeks (i.e. 18 days) are long enough for beneficial changes in economy, muscle buffering capacity, the hypoxic ventilatory response or Na(+)/K(+)-ATPase activity. One critical point is the daily dose of altitude. A natural altitude of 2500 m for 20-22 h/day (in fact, travelling down to the valley only for training) appears sufficient to increase erythropoiesis and improve sea-level performance. 'Longer is better' as regards haematological changes since additional benefits have been shown as hypoxic exposure increases beyond 16 h/day. The minimum daily dose for stimulating erythropoiesis seems to be 12 h/day. For non-haematological changes, the implementation of a much shorter duration of exposure seems possible. Athletes could take advantage of IHT, which seems more beneficial than IHE in performance enhancement. The intensity of hypoxic exercise might play a role on adaptations at the molecular level in skeletal muscle tissue. There is clear evidence that intense exercise at high altitude stimulates to a greater extent muscle adaptations for both aerobic and anaerobic exercises and limits the decrease in power. So although IHT induces no increase in VO(2max) due to the low 'altitude dose', improvement in athletic performance is likely to happen with high-intensity exercise (i.e. above the ventilatory threshold) due to an increase in mitochondrial efficiency and pH/lactate regulation. We propose a new combination of hypoxic method (which we suggest naming Living High-Training Low and High, interspersed; LHTLHi) combining LHTL (five nights at 3000 m and two nights at sea level) with training at sea level except for a few (2.3 per week) IHT sessions of supra-threshold training. This review also provides a rationale on how to combine the different hypoxic methods and suggests advances in both their implementation and their periodization during the yearly training programme of athletes competing in endurance, glycolytic or intermittent sports.

The response of human skeletal muscle tissue to hypoxia

Hypoxia refers to environmental or clinical settings that potentially threaten tissue oxygen homeostasis. One unique aspect of skeletal muscle is that, in addition to hypoxia, oxygen balance in this tissue may be further compromised when exercise is superimposed on hypoxia. This review focuses on the cellular and molecular responses of human skeletal muscle to acute and chronic hypoxia, with emphasis on physical exercise and training. Based on published work, it is suggested that hypoxia does not appear to promote angiogenesis or to greatly alter oxidative enzymes in skeletal muscle at rest. Although the HIF-1 pathway in skeletal muscle is still poorly documented, emerging evidence suggests that muscle HIF-1 signaling is only activated to a minor degree by hypoxia. On the other hand, combining hypoxia with exercise appears to improve some aspects of muscle O(2) transport and/or metabolism.

Plasticity of the muscle proteome to exercise at altitude

The ascent of humans to the summits of the highest peaks on Earth initiated a spurt of explorations into the physiological consequences of physical activity at altitude. The past three decades have demonstrated that the resetting of respiratory and cardiovascular control with chronic exposure to altitudes above 4000 m is accompanied by important structural-functional adjustments of skeletal muscle. The fully altitude-adapted phenotype preserves energy charge at reduced aerobic capacity through the promotion of anaerobic substrate flux and tighter metabolic control, often at the expense of muscle mass. In seeming contrast, intense physical activity at moderate hypoxia (2500 to 4000 m) modifies this response in both low and high altitude natives through metabolic compensation by elevating local aerobic capacity and possibly preventing muscle fiber atrophy. The combined use of classical morphometry and contemporary proteomic technology provides a highly resolved picture of the temporal control of hypoxia-induced muscular adaptations. The muscle proteome signature identifies mitochondrial autophagy and protein degradation as prime adaptive mechanisms to passive altitude exposure and ascent to extreme altitude. Protein measures also explain the lactate paradox by a sparing of glycolytic enzymes from general muscle wasting. Enhanced mitochondrial and angiogenic protein expression in human muscle with exercise up to 4000 m is related to the reduction in intramuscular oxygen content below 1% (8 torr), when the master regulator of hypoxia-dependent gene expression, HIF-1alpha, is stabilized. Accordingly, it is proposed here that the catabolic consequences of chronic hypoxia exposure reflect the insufficient activation of hypoxia-sensitive signaling and the suppression of energy-consuming protein translation.

Influences of normobaric hypoxia training on metabolic risk markers in human subjects

PURPOSE

Endurance exercise and hypoxia regulate pathways that are crucial to glucose and lipid metabolism. We hypothesized that training under hypoxia results in similar or even greater metabolic improvement compared with exercise under normoxia at a lower workload.

METHODS

We randomly assigned 20 healthy men to single blind training under hypoxia (FiO2 = 15%) or normoxia (FiO2 = 21%). Subjects trained thrice weekly for 60 min over a 4-wk period at a heart rate measured at 3 mmol x L(-1) lactate during pretraining exercise testing. Before and after the training period, we determined body composition, venous blood parameters, oral glucose tolerance, and blood pressure. Furthermore, we assessed oxygen uptake (VO2), lactate, and respiratory quotient, and heart rate (HR) during incremental exercise testing, both in hypoxia and in normoxia. Training workload was 1.39 +/- 0.2 W x kg(-1) in the hypoxia and 1.67 +/- 0.15 W x kg(-1) in the normoxia group (P< 0.001) with an identical training heart rate in both groups.

RESULTS

Exercise capacity improved similarly with both interventions. With hypoxia training, body fat content, triglycerides, HOMA-Index, fasting insulin (P < 0.05), and area under the curve for insulin (P < 0.01) during the oral glucose tolerance test improved more than with the training in normoxia. We did not observe major changes in adipokine measurements.

CONCLUSION

Endurance training in hypoxia over a 4-wk period elicits a similar or even better response in terms of cardiovascular and metabolic risk factors than endurance exercise in normoxia. The fact that workload and, therefore, mechanic strain can be reduced in hypoxia could be particularly beneficial in obese patients and in patients with orthopedic conditions.