Increases in submaximal cycling efficiency mediated by altitude acclimatization

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

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

Optimal type and dose of hypoxic training for improving maximal aerobic capacity in athletes: a systematic review and Bayesian model-based network meta-analysis

Objective: This study aimed to compare and rank the effect of hypoxic practices on maximum oxygen consumption (VO2max) in athletes and determine the hypoxic dose-response correlation using network meta-analysis. Methods: The Web of Science, PubMed, EMBASE, and EBSCO databases were systematically search for randomized controlled trials on the effect of hypoxc interventions on the VO2max of athletes published from inception until 21 February 2023. Studies that used live-high train-high (LHTH), live-high train-low (LHTL), live-high, train-high/low (HHL), intermittent hypoxic training (IHT), and intermittent hypoxic exposure (IHE) interventions were primarily included. LHTL was further defined according to the type of hypoxic environment (natural and simulated) and the altitude of the training site (low altitude and sea level). A meta-analysis was conducted to determine the standardized mean difference between the effects of various hypoxic interventions on VO2max and dose-response correlation. Furthermore, the hypoxic dosage of the different interventions were coordinated using the "kilometer hour" model. Results: From 2,072 originally identified titles, 59 studies were finally included in this study. After data pooling, LHTL, LHTH, and IHT outperformed normoxic training in improving the VO2max of athletes. According to the P-scores, LHTL combined with low altitude training was the most effective intervention for improving VO2max (natural: 0.92 and simulated: 0.86) and was better than LHTL combined with sea level training (0.56). A reasonable hypoxic dose range for LHTH (470-1,130 kmh) and HL (500-1,415 kmh) was reported with an inverted U-shaped curve relationship. Conclusion: Different types of hypoxic training compared with normoxic training serve as significant approaches for improving aerobic capacity in athletes. Regardless of the type of hypoxic training and the residential condition, LHTL with low altitude training was the most effective intervention. The characteristics of the dose-effect correlation of LHTH and LHTL may be associated with the negative effects of chronic hypoxia.

Effects of Moderate Altitude Training Combined with Moderate or High-altitude Residence

We aimed to identify potential physiological and performance differences of trained cross-country skiers (V˙o_2max=60±4 ml ∙ kg^-1 ∙ min^-1) following two, 3-week long altitude modalities: 1) training at moderate altitudes (600-1700 m) and living at 1500 m (LMTM;N=8); and 2) training at moderate altitudes (600-1700 m) and living at 1500 m with additional nocturnal normobaric hypoxic exposures (FiO₂ =0.17;LHTM; N=8). All participants conducted the same training throughout the altitude training phase and underwent maximal roller ski trials and submaximal cyclo-ergometery before, during and one week after the training camps. No exercise performance or hematological differences were observed between the two modalities. The average roller ski velocities were increased one week after the training camps following both LMTM (p=0.03) and LHTM (p=0.04) with no difference between the two (p=0.68). During the submaximal test, LMTM increased the Tissue Oxygenation Index (11.5±6.5 to 1.0±8.5%; p=0.04), decreased the total hemoglobin concentration (15.1±6.5 to 1.7±12.9 a.u.;p=0.02), and increased blood pH (7.36±0.03 to 7.39±0.03;p=0.03). On the other hand, LHTM augmented minute ventilation (76±14 to 88±10 l·min^-1;p=0.04) and systemic blood oxygen saturation by 2±1%; (p=0.02) with no such differences observed following the LMTM. Collectively, despite minor physiological differences observed between the two tested altitude training modalities both induced comparable exercise performance modulation.

Global REACH 2018: increased adrenergic restraint of blood flow preserves coupling of oxygen delivery and demand during exercise at high-altitude

Chronic exposure to hypoxia (high-altitude, HA; >4000 m) attenuates the vasodilatory response to exercise and is associated with a persistent increase in basal sympathetic nerve activity (SNA). The mechanism(s) responsible for the reduced vasodilatation and exercise hyperaemia at HA remains unknown. We hypothesized that heightened adrenergic signalling restrains skeletal muscle blood flow during handgrip exercise in lowlanders acclimatizing to HA. We tested nine adult males (n = 9) at sea-level (SL; 344 m) and following 21-28 days at HA (∼4300 m). Forearm blood flow (FBF; duplex ultrasonography), mean arterial pressure (MAP; brachial artery catheter), forearm vascular conductance (FVC; FBF/MAP), and arterial and venous blood sampling (O₂ delivery ( DO2${D}_{{{\rm{O}}}_{\rm{2}}}$ ) and uptake ( V̇O2${\dot{V}}_{{{\rm{O}}}_{\rm{2}}}$ )) were measured at rest and during graded rhythmic handgrip exercise (5%, 15% and 25% of maximum voluntary isometric contraction; MVC) before and after local α- and β-adrenergic blockade (intra-arterial phentolamine and propranolol). HA reduced ΔFBF (25% MVC: SL: 138.3 ± 47.6 vs. HA: 113.4 ± 37.1 ml min^-1 ; P = 0.022) and Δ V̇O2${\dot{V}}_{{{\rm{O}}}_{\rm{2}}}$ (25% MVC: SL: 20.3 ± 7.5 vs. HA: 14.3 ± 6.2 ml min^-1 ; P = 0.014) during exercise. Local adrenoreceptor blockade at HA restored FBF during exercise (25% MVC: SL_{α-β blockade} : 164.1 ± 71.7 vs. HA_{α-β blockade} : 185.4 ± 66.6 ml min^-1 ; P = 0.947) but resulted in an exaggerated relationship between DO2${D}_{{{\rm{O}}}_{\rm{2}}}$ and V̇O2${\dot{V}}_{{{\rm{O}}}_{\rm{2}}}$ ( DO2${D}_{{{\rm{O}}}_{\rm{2}}}$ / V̇O2${\dot{V}}_{{{\rm{O}}}_{\rm{2}}}$ slope: SL: 1.32; HA: slope: 1.86; P = 0.037). These results indicate that tonic adrenergic signalling restrains exercise hyperaemia in lowlanders acclimatizing to HA. The increase in adrenergic restraint is necessary to match oxygen delivery to demand and prevent over perfusion of contracting muscle at HA. KEY POINTS: In exercising skeletal muscle, local vasodilatory signalling and sympathetic vasoconstriction integrate to match oxygen delivery to demand and maintain arterial blood pressure. Exposure to chronic hypoxia (altitude, >4000 m) causes a persistent increase in sympathetic nervous system activity that is associated with impaired functional capacity and diminished vasodilatation during exercise. In healthy male lowlanders exposed to chronic hypoxia (21-28 days; ∼4300 m), local adrenoreceptor blockade (combined α- and β-adrenergic blockade) restored skeletal muscle blood flow during handgrip exercise. However, removal of tonic adrenergic restraint at high altitude caused an excessive rise in blood flow and subsequently oxygen delivery for any given metabolic demand. This investigation is the first to identify greater adrenergic restraint of blood flow during acclimatization to high altitude and provides evidence of a functional role for this adaptive response in regulating oxygen delivery and demand.

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

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

Reactive Strength Index and its Associations with Measures of Physical and Sports Performance: A Systematic Review with Meta-Analysis

BACKGROUND

Reactive strength index (RSI) is used frequently in the testing and monitoring of athletes. Associations with sports performance measures may vary dependent on the task but a literature synthesis has not been performed.

OBJECTIVES

The aim of this meta-analysis was to examine associations between RSI measured during rebound jumping tasks and measures of strength, linear and change of direction speed, and endurance performance.

METHODS

A systematic literature search with meta-analysis was conducted using databases PubMed, SPORTDiscus, Web of Science, and Ovid. Inclusion criteria required studies to (1) examine the relationship between RSI and an independent measure of physical or sporting performance for at least one variable; and (2) provide rebound test instructions to minimise ground contact time and maximise displacement of the jump. Methodological quality was assessed using a modified version of the Downs and Black Quality Index tool. Heterogeneity was examined via the Q statistic and I². Pooled effect sizes were calculated using a random-effects model, with Egger's regression test used to assess small study bias (inclusive of publication bias).

RESULTS

Of the 1320 citations reviewed, a total of 32 studies were included in this meta-analysis. RSI was significantly and moderately associated with strength (isometric: r = 0.356 [95% CI 0.209-0.504]; isotonic: r = 0.365 [0.075-0.654]; pooled strength measures: r = 0.339 [0.209-0.469]) and endurance performance (r = 0.401 [0.173-0.629]). Significant moderate and negative associations were indicated for acceleration (r = - 0.426 [- 0.562 to - 0.290]), top speed (r = - 0.326 [- 0.502 to - 0.151]), and significant large negative associations were noted for change of direction speed (r = - 0.565 [- 0.726 to - 0.404]). Heterogeneity was trivial to moderate across all measures (I² = 0-66%), and significant for isotonic strength and change of direction speed (p < 0.1). Evidence of small study bias was apparent for both acceleration and change of direction speed (p < 0.05).

CONCLUSIONS

We identified primarily moderate associations between RSI and independent measures of physical and sporting performance, and the strength of these relationships varied based on the task and physical quality assessed. The findings from this meta-analysis can help practitioners to develop more targeted testing and monitoring processes. Future research may wish to examine if associations are stronger in tasks that display greater specificity.

Fifteen days of moderate normobaric hypoxia does not affect mitochondrial function, and related genes and proteins, in healthy men

PURPOSE

To investigate within the one study potential molecular and cellular changes associated with mitochondrial biogenesis following 15 days of exposure to moderate hypoxia.

METHODS

Eight males underwent a muscle biopsy before and after 15 days of hypoxia exposure (FiO₂ = 0.140-0.154; ~ 2500-3200 m) in a hypoxic hotel. Mitochondrial respiration, citrate synthase (CS) activity, and the content of genes and proteins associated with mitochondrial biogenesis were investigated.

RESULTS

Our main findings were the absence of significant changes in the mean values of CS activity, mitochondrial respiration in permeabilised fibers, or the content of genes and proteins associated with mitochondrial biogenesis, after 15 days of moderate normobaric hypoxia.

CONCLUSION

Our data provide evidence that 15 days of moderate normobaric hypoxia have negligible influence on skeletal muscle mitochondrial content and function, or genes and proteins content associated with mitochondrial biogenesis, in young recreationally active males. However, the increase in mitochondrial protease LON content after hypoxia exposure suggests the possibility of adaptations to optimise respiratory chain function under conditions of reduced O₂ availability.

Aerobic Continuous and Interval Training under Hypoxia Enhances Endurance Exercise Performance with Hemodynamic and Autonomic Nervous System Function in Amateur Male Swimmers

Hypoxic training is often performed by competitive swimmers to enhance their performance in normoxia. However, the beneficial effects of aerobic continuous and interval training under hypoxia on hemodynamic function, autonomic nervous system (ANS) function, and endurance exercise performance remain controversial. Here we investigated whether six weeks of aerobic continuous and interval training under hypoxia can improve hematological parameters, hemodynamic function, ANS function, and endurance exercise performance versus normoxia in amateur male swimmers. Twenty amateur male swimmers were equally assigned to the hypoxic training group or normoxic training group and evaluated before and after six weeks of training. Aerobic continuous and interval training in the hypoxia showed a more significantly improved hemodynamic function (heart rate, −653.4 vs. −353.7 beats/30 min; oxygen uptake, −62.45 vs. −16.22 mL/kg/30 min; stroke volume index, 197.66 vs. 52.32 mL/30 min) during submaximal exercise, ANS function (root mean square of successive differences, 10.15 vs. 3.32 ms; total power, 0.72 vs. 0.20 ms²; low-frequency/high-frequency ratio, −0.173 vs. 0.054), and endurance exercise performance (maximal oxygen uptake, 5.57 vs. 2.26 mL/kg/min; 400-m time trial record, −20.41 vs. −7.91 s) than in the normoxia. These indicate that hypoxic training composed of aerobic continuous and interval exercise improves the endurance exercise performance of amateur male swimmers with better hemodynamic function and ANS function.

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

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

Gross Efficiency and The Relationship with Maximum Oxygen Uptake in Young Elite Cyclists During the Competitive Season

This study assessed gross efficiency (GE) during a single competitive season and determined the relationship between GE and maximum oxygen uptake (V̇O_2max) in young elite cyclists (n = 15, 20.1 ± 1.4 yrs, 177.5 ± 5.7 cm, 68.3 ± 6.2 kg, 45.2 ± 7.5 mm of six skinfolds) during a competitive season. Participants completed at two occasions (T1 = April; T2 = July), a progressive bike protocol (initial intensity = 100 W, 35 W increments every 3 min) until volitional exhaustion to assess V̇O_2max and submaximal variables. A single capillary blood sample was drawn from the left earlobe immediately after completion of each exercise load to determine lactate thresholds. Cyclists' GE was calculated as ([work accomplished/energy expended] x 100). No significant differences were obtained in GE at any workload between T1 and T2 or in the mean GE between T1 (19.3%) and T2 (19.4%) testing (p = 0.93). No significant association was found between mean GE and V̇O_2max at either T1 (r = -0.28, p = 0.30), or T2 (r = -0.27, p = 0.32). GE of young elite cyclists might not vary during the most important phase of the training season and GE was not related to V̇O_2max. A lower accumulated volume and intensity of training of these cyclists may account for their lower GE in comparison to older professional cyclists and might not have been enough to foster higher increases of GE in cyclists with lower V̇O_2max.

Aerobic Capacity, Lactate Concentration, and Work Assessment During Maximum Exercise at Sea Level and High Altitude in Miners Exposed to Chronic Intermittent Hypobaric Hypoxia (3,800 m)

We previously showed that arterial oxygen content during maximum exercise remains constant at high altitude (HA) in miners exposed to chronic intermittent hypobaric hypoxia (CIHH). Nevertheless, information about VO₂, lactate concentration [Lac], and work efficiency are absent in this CIHH miner population. Our aim was to determine aerobic capacity, [Lac], and work efficiency at sea level (SL) and HA during maximum exercise in miners acclimatized to CIHH at 3,800 m. Eight volunteer miners acclimatized to CIHH at HA (> 4 years) performed an exercise test at SL and HA. The test was performed on the 4th day at HA or SL and consisted of three phases: Rest (5 min); Exercise test, where the load was increased by 50 W every 3 min until exhaustion; and a Recovery period of 30 min. During the procedure VO₂, transcutaneous arterial saturation (SpO₂, %), and HR (bpm) were assessed at each step by a pulse oximeter and venous blood samples were taken to measure [Lac] and hemoglobin concentration. No differences in VO₂ and [Lac] in SL vs. HA were observed in this CIHH miner population. By contrast, a higher HR and lower SpO₂ were observed at SL compared with HA. During maximum exercise, a reduction in VO₂ and [Lac] was observed without differences in intensity (W) and HR. A decrease in [Lac] was observed at maximum effort (250 W) and recovery at HA vs. SL. These findings are related to an increased work efficiency assessment such as gross and net efficiency. This study is the first to show that miners exposed to CIHH maintain their work capacity (intensity) with a fall in oxygen consumption and a decrease in plasmatic lactate concentration at maximal effort at HA. These findings indicate that work efficiency at HA is enhanced.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Intermittent hypoxic training for 6 weeks in 3000 m hypobaric hypoxia conditions enhances exercise economy and aerobic exercise performance in moderately trained swimmers

Athletic endurance performance at sea level can be improved via intermittent hypoxic training (IHT). However, the efficacy of IHT for enhancement of aerobic exercise performance at sea level is controversial because of methodological differences. Therefore, the aim of the study was to determine whether the IHT regimen ameliorates exercise economy and aerobic exercise performance in moderately trained swimmers. A total of 20 moderately trained swimmers were equally assigned to the control group (n=10) training in normoxic conditions and the IHT group (n=10) training at a simulated altitude of 3000 m. They were evaluated for metabolic parameters and skeletal muscle oxygenation during 30 min submaximal exercise on a bicycle, and aerobic exercise performance before and after 6 weeks of training composed of aerobic continuous exercise set at 80% maximal heart rate (HRmax) during 30 min and anaerobic interval exercise set at the exercise load with 90% HRmax measured in pre-test during 30 min (10 times 2 min exercise and 1 min rest). According to the results, the IHT group demonstrated greater improvement in exercise economy due to decreases in VO2 (p=.016) and HHb (p=.002) and increases in O₂Hb (p<.001) and TOI (p=.006). VCO₂ was decreased in the IHT group (p=.010) and blood lactate level was decreased in the control (p=.005) and IHT groups (p=.001). All aerobic exercise performance including VO_2max (p=.001) and the 400 m time trial (p<.001) were increased in the IHT group. The present findings indicate that the 6 week IHT regime composed of high-intensity aerobic continuous exercise and anaerobic interval exercise can be considered an effective altitude/hypoxic training method for improvement of exercise economy and aerobic exercise performance in moderately trained swimmers.

Effects of 2-week intermittent training in hypobaric hypoxia on the aerobic energy metabolism and performance of cycling athletes with disabilities

[Purpose] The present study aimed at examining changes in aerobic energy metabolism and performance in cycling athletes after 2 weeks of intermittent training in a multistep hypobaric hypoxia environment. [Subjects and Methods] We also aimed at using the findings to propose an efficient training program in hypobaric hypoxia for endurance athletes with disabilities. The study participants were three cycling athletes with physical disabilities from the Korean national team (A, B, and C athletes). They underwent complex (repetition, interval, and continued) training with a roller-type cycle in a multistep hypobaric hypoxia environment (simulated altitude, 4,000 m above sea level). The training was conducted in twelve 60-min sessions for 2 weeks and it was based on the ventilatory threshold intensity, measured in an exercise stress test, conducted prior to training, at constant temperature (23 °C ± 2 °C) and humidity conditions (50% ± 5%). [Results] B and C athletes showed no noticeable changes in relative VO₂max and HRmax values after training. A, B, and C athletes all showed increases in all-out time, 2′09″ (13.1%), 2′43″ (18.7%), and 1′22″ (7.4%), respectively after training. Although the relative VO₂max and HRmax values were not improved, submaximal exercise performance ability was improved. [Conclusion] Therefore, 2 weeks of intermittent training in a hypobaric hypoxia environment positively affected aerobic energy metabolism and performance.

Acute Normobaric Hypoxia Increases Post-exercise Lipid Oxidation in Healthy Males

The primary objective of the current study was to determine the effect of moderate normobaric hypoxia exposure during constant load cycling on post-exercise energy metabolism recorded in normoxia. Indirect calorimetry was used to examine whole body substrate oxidation before, during, 40–60 min post, and 22 h after performing 60 min of cycling exercise at two different fractions of inspired oxygen (F_IO₂): (i) F_IO₂ = 0.2091 (normoxia) and (ii) F_IO₂ = 0.15 (hypoxia). Seven active healthy male participants (26 ± 4 years of age) completed both experimental trials in randomized order with a 7-day washout period to avoid carryover effects between conditions. Resting energy expenditure was initially elevated following cycling exercise in normoxia and hypoxia (Δ 0.14 ± 0.05, kcal min⁻¹, p = 0.037; Δ 0.19 ± 0.03 kcal min⁻¹, p < 0.001, respectively), but returned to baseline levels the next morning in both conditions. Although, the same absolute workload was used in both environmental conditions (157 ± 10 W), a shift in resting substrate oxidation occurred after exercise performed in hypoxia while post-exercise measurements were similar to baseline after cycling exercise in normoxia. The additional metabolic stress of hypoxia exposure was sufficient to increase the rate of lipid oxidation (Δ 42 ± 11 mg min⁻¹, p = 0.019) and tended to suppress carbohydrate oxidation (Δ −55 ± 26 mg min⁻¹, p = 0.076) 40–60 min post-exercise. This shift in substrate oxidation persisted the next morning, where lipid oxidation remained elevated (Δ 9 ± 3 mg min⁻¹, p = 0.0357) and carbohydrate oxidation was suppressed (Δ −22 ± 6 mg min⁻¹, p = 0.019). In conclusion, prior exercise performed under moderate normobaric hypoxia alters post-exercise energy metabolism. This is an important consideration when evaluating the metabolic consequences of hypoxia exposure during prolonged exercise, and future studies should evaluate its role in the beneficial effects of intermittent hypoxia training observed in persons with obesity and insulin resistance.

Four-week "living high training low" program enhances 3000-m and 5000-m time trials by improving energy metabolism during submaximal exercise in athletes

[Purpose]

This study aimed to determine the effect of a 4-week living high training low (LHTL) versus a living low training low (LLTL) program on energy metabolism during submaximal exercise and 3000-m and 5000-m time trial (TT) in athletes.

[Methods]

Male athletes (n = 20) were randomly assigned to the LLTL (n = 10, living at 1000 m and training at 700–1330 m) and LHTL (n = 10, living at simulated 3000 m and training at 700–1330 m) groups. We compared energy metabolisms during submaximal exercise on a treadmill and aerobic exercise performance (3000 m and 5000 m TT) before and after 4 weeks of training.

[Results]

As expected, the LHTL group demonstrated enhanced energy metabolism during submaximal exercise via significant interaction (time × group) in heart rate, oxygen consumption, and carbon dioxide excretion; these variables were significantly decreased in the LHTL group compared with the LLTL group. Additionally, both training groups revealed significantly decreased blood lactate levels during submaximal exercise, 3000 m TT, and 5000 m TT but significant interactions (time × group) in the 3000 m and 5000 m TT. Thus, the LHTL group demonstrated greater improvements in 3000 m and 5000 m TT than the LLTL group via significant interactions.

[Conclusion]

Our results suggest that 4-week LHTL intervention enhances 3000 m and 5000 m TT by improving energy metabolism during submaximal exercise. The proposed LHTL intervention in this study is a novel and effective method for improving aerobic exercise performance in male athletes.

The Effect of 4 Weeks Fixed and Mixed Intermittent Hypoxic Training (IHT) on Respiratory Metabolic and Acid-base Response of Capillary Blood During Submaximal Bicycle Exercise in Male Elite Taekwondo Players

[Purpose]

The purpose of our study was to determine the effectiveness of 4 weeks fixed and mixed intermittent hypoxic training (IHT) and its difference from exercise training at sea-level on exercise load, respiratory metabolic and acid-base response of capillary blood during 80% maximal heart rate (HRmax) bicycle exercise in male elite Taekwondo players.

[Methods]

Male elite Taekwondo players (n = 25 out of 33) were randomly assigned to training at sea-level (n = 8, control group), training at 16.5%O2 (2000 m) simulated hypoxic condition (n = 9, fixed IHT group), and training at 14.5%O2 (3000 m) up to 2 weeks and 16.5%O2 (2000 m) simulated hypoxic condition (n = 8, mixed IHT group) for 3 weeks. We compared their average exercise load, respiratory metabolic, and acid-base response of the capillary blood during 80% HRmax submaximal bicycle exercise before and after 4 weeks training.

[Results]

Fixed and mixed IHT groups showed positive improvement in respiratory metabolic and acid-base response of the capillary blood during 80% HRmax submaximal bicycle exercise after 4 weeks training. However, all dependent variables showed no significant difference between fixed IHT and mix IHT.

[Conclusion]

Results suggested that mixed and fixed IHT is effective in improving respiratory metabolic and acid-base response of capillary blood in male elite Taekwondo players. Thus, IHT could be a novel and effective method for improving exercise performance through respiratory metabolic and acid-base response.

Dietary Recommendations for Cyclists during Altitude Training

The concept of altitude or hypoxic training is a common practice in cycling. However, several strategies for training regimens have been proposed, like "live high, train high" (LH-TH), "live high, train low" (LH-TL) or "intermittent hypoxic training" (IHT). Each of them combines the effect of acclimatization and different training protocols that require specific nutrition. An appropriate nutrition strategy and adequate hydration can help athletes achieve their fitness and performance goals in this unfriendly environment. In this review, the physiological stress of altitude exposure and training will be discussed, with specific nutrition recommendations for athletes training under such conditions. However, there is little research about the nutrition demands of athletes who train at moderate altitude. Our review considers energetic demands and body mass or body composition changes due to altitude training, including respiratory and urinary water loss under these conditions. Carbohydrate intake recommendations and hydration status are discussed in detail, while iron storage and metabolism is also considered. Last, but not least the risk of increased oxidative stress under hypoxic conditions and antioxidant supplementation suggestions are presented.

Strategies to improve running economy

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

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.

Running economy and maximal oxygen consumption after 4 weeks of oral Echinacea supplementation

The purpose of this investigation was to determine the effects of 4 weeks of oral Echinacea (ECH) supplementation on erythropoietin (EPO), red blood cell (RBC) count, running economy (RE), and VO2max. Twenty-four men aged 24.9 ± 4.2 years, height 178.9 ± 7.9 cm, weight 87.9 ± 14.6 kg, body fat 19.3 ± 6.5% were grouped using a double-blind design and self-administered an 8,000-mg·d(-1) dosage of either ECH or placebo (PLA) in 5 × 400 mg × 4 times per day for 28 days. Blood samples were collected and analyzed for RBCs and EPO using automated flow cytometery and enzyme-linked immunosorbent assay. Maximal graded exercise tests (GXTs) were administered to measure VO2max, RE, and heart-rate responses. Analysis of variance was used to determine statistically significant differences (P ≤ 0.05). The EPO increased significantly in ECH at 7 days (ECH: 15.75 ± 0.64, PLA: 10.01 ± 0.73 mU·ml(-1)), 14 days (ECH: 18.88 ± 0.71, PLA: 11.02 ± 0.69 mU·ml(-1)), and 21 days (ECH: 16.06 ± 0.55, PLA: 9.20 ± 0.55 mU·ml(-1)). VO2max increased significantly in ECH (ECH: 1.47 ± 1.28, PLA: -0.13 ± 0.52%). Running economy improved significantly in ECH as indicated by a decrease in submaximal VO2max during the first 2 stages of the GXT (stage 1: ECH -1.50 ± 1.21, PLA 0.60 ± 1.95%; stage 2: ECH -1.67 ± 1.43, PLA 0.01 ± 1.03%). These data suggest that ECH supplementation results in significant increases in EPO, VO2max, and running economy.

Mitochondrial function in human skeletal muscle following high-altitude exposure

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

Cardiopulmonary response and body composition changes after prolonged high altitude exposure in women

Weight loss in men is commonly observed during prolonged high altitude exposure as a result of a daily negative energy balance. Its amount depends mainly on duration of exposure, altitude reached, and level of physical activity. This reduction in body weight often comes with a loss of muscular mass, likely contributing to the decreased physical performance generally reported. Limited data is, however, available on body composition, functional capacity, and cardiopulmonary response to exercise after high altitude exposure in women. The aim of this study was to evaluate the effects of prolonged high altitude exposure on body composition and on cardiopulmonary response to maximal exercise in a group of young, moderately active women. Twelve female subjects, aged 21.5 ± 3.1 (mean ± SD), BMI 22.1 ± 1.9 kg · m(-2) and Vo(2max) 33.8 ± 3.5 mL · kg(-1) · min(-1), participated in this study, by residing for 21 days at high altitude (5050 m, Pyramid, EV-K(2)-CNR laboratory). Before and after high altitude exposure, all subjects underwent both a body composition evaluation using two methods (bioimpedance analysis and DEXA) and a functional evaluation based on a maximal exercise test on a cycle ergometer with breath-by-breath gas analysis. After high altitude exposure, data showed a slight, nonsignificant reduction in body weight, with an average 3:2 reduction ratio between fat and fat-free mass evaluated by DEXA, in addition to a significant decrease in Vo(2max) on the cycle ergometer test (p<0.01). Changes in Vo(2max) correlated to changes of leg muscle mass, evaluated by DEXA (r(2) = 0.72; p<0.0001). No changes were observed in the maximal heart rate, work capacity, and ventilatory thresholds, while the Vo(2)/W slope was significantly reduced (p<0.05). Finally, Ve/Vo(2) and VE/Vco(2max) slopes were increased (p<0.01), suggesting a possible long-term modulation of the exercise ventilatory response after prolonged high altitude exposure.

Acclimatization improves submaximal exercise economy at 5533 m

We tested whether the better subjective exercise tolerance perceived by mountaineers after altitude acclimatization relates to enhanced exercise economy. Thirty-two mountaineers performed progressive bicycle exercise to exhaustion at 490 m and twice at 5533 m (days 6-7 and day 11), respectively, during an expedition to Mt. Muztagh Ata. Maximal work rate (W(max)) decreased from mean ± SD 356 ± 73 watts at 490 m to 191 ± 49 watts and 193 ± 45 watts at 5533 m, days 6-7 and day 11, respectively; corresponding maximal oxygen uptakes (VO2max ) were 50.7 ± 9.5, 26.3 ± 5.6, 24.7 ± 7.0 mL/min/kg (P = 0.0001 5533 m vs 490 m). On days 6-7 (5533 m), VO(2) at 75% W(max) (152 ± 37 watts) was 1.75 ± 0.45 L/min, oxygen saturation 68 ± 8%. On day 11 (5533 m), at the same submaximal work rate, VO(2) was lower (1.61 ± 0.47 L/min, P < 0.027) indicating improved net efficiency; oxygen saturation was higher (74 ± 7%, P < 0.0004) but ratios of VO(2) to work rate increments remained unchanged. On day 11, mountaineers climbed faster from 4497 m to 5533 m than on days 5-6 but perceived less effort (visual analog scale 50 ± 15 vs 57 ± 20, P = 0.006) and reduced symptoms of acute mountain sickness. We conclude that the better performance and subjective exercise tolerance after acclimatization were related to regression of acute mountain sickness and improved submaximal exercise economy because of lower metabolic demands for non-external work-performing functions.

Altitude training and its influence on physical endurance in swimmers

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

Effects of combined aerobic and resistance exercise training in adults with and without Down syndrome

OBJECTIVE

To determine whether adults with Down syndrome (DS) could improve their submaximal and peak exercise capacity, as for adults without disabilities, after 12 weeks of combined (aerobic and resistance) exercise training.

DESIGN

Prospective study comparing the effects of a 12-week combined exercise program on submaximal and peak exercise capacity of adults with and without DS.

SETTING

University facilities.

PARTICIPANTS

Participants with DS (n=13; mean ± SD age, 36.5±5.5y) and participants without disabilities (n=12; mean age, 38.7±8.3y).

INTERVENTIONS

Combined exercise training for 12 weeks. Endurance training was performed 3 days a week for 30 minutes at 65% to 85% of peak oxygen consumption (Vo₂peak). Resistance training was prescribed for 2 days a week and consisted of 2 rotations in a circuit of 9 exercises at 12-repetition maximum.

MAIN OUTCOME MEASURES

Submaximal and maximal graded exercise tests with metabolic and heart rate measurements. Walking economy and Vo₂peak were considered the main outcomes.

RESULTS

Participants with DS and those without disabilities showed similar values for body mass index and relative fat mass at pre- and posttraining periods. Walking economy and Vo₂peak overall were lower in participants with DS than participants without disabilities (P<.05). Training improved walking economy and Vo₂peak in participants with DS and those without disabilities (P<.05); additionally, the magnitude of changes induced by training was similar between groups.

CONCLUSIONS

Overall, a 12-week combined exercise regimen induced gains of similar magnitude between adults with and without DS for submaximal and peak exercise capacity.

High-intensity kayak performance after adaptation to intermittent hypoxia

CONTEXT

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Inspiratory flow resistive loading improves respiratory muscle function and endurance capacity in recreational runners

The purpose of this study was to assess the efficacy of inspiratory flow resistive loading (IFRL) on respiratory muscle function, exercise performance and cardiopulmonary and metabolic responses to exercise. Twenty-four recreational road runners (12 male) were randomly assigned from each gender into an IFRL group (n=8) and sham-IFRL group (n=8), which performed IFRL for 6 weeks, or a control group (n=8). Strength (+43.9%Delta), endurance (+26.6%Delta), maximum power output (+41.9%Delta) and work capacity (+38.5%Delta) of the inspiratory muscles were significantly increased (P<0.05) at rest following the study period in IFRL group only. In addition, ventilation (-25.7%Delta), oxygen consumption (-13.3%Delta), breathing frequency (-11.9%Delta), tidal volume (-16.0%Delta), heart rate (HR) (-13.1%Delta), blood lactate concentration (-38.9%Delta) and the perceptual response (-33.5%Delta) to constant workload exercise were significantly attenuated (P<0.05), concomitant with a significant improvement (P<0.05) in endurance exercise capacity (+16.4%Delta) during a treadmill run set at 80% VO2max in IFRL group only. These data suggest that IFRL can alter breathing mechanics, attenuate the oxygen cost, ventilation, HR, blood lactate and the perceptual response during constant workload exercise and improve endurance exercise performance in recreational runners.

Effects of high altitude on substrate use and metabolic economy: cause and effect?

In a variety of experimental models, hypoxia causes a shift in substrate use to favor increased dependence on glucose. One explanation for this phenomenon is a selective advantage derived from the increased metabolic economy (more ATP derived per unit oxygen consumed) that results when glucose is oxidized rather than lipid. In support of this hypothesis, after acclimatization to hypoxia, lower oxygen consumption at a given submaximal workload has often been reported. However, evidence from several experimental models is inconsistent with the idea that the increase in glucose use is causally related to greater metabolic economy.

Training to maximize economy of motion in running gait

Recent reviews of how training affects running performance have indicated, to varying degrees, that running economy (RE) is a determinant of running performance. However, the literature suggests that the relationship between training-induced changes in biomechanics and RE is still largely unknown. While there is some evidence that high intensity interval training, plyometrics, and altitude/hypoxia training can improve economy, it remains unclear how these improvements are mediated. In addition, although it is clear from the literature that meaningful differences in RE exist among runners, the causes for the inherent differences are not clear. Consequently, suggestions are made to explore more individualized and integrated models of the determinants of performance that might better explain the interrelatedness of gait, RE, V.O2max, and peak performance.

Respiratory control during air-breathing exercise in humans following an 8 h exposure to hypoxia

Hypoxic exposure lasting a few hours results in an elevation of ventilation and a lowering of end-tidal PCO2(PETCO2) that persists on return to breathing air. We sought to determine whether this increment in ventilation is fixed (hypothesis 1), or whether it increases in proportion to the rise in metabolic rate associated with exercise (hypothesis 2). Ten subjects were studied on two separate days. On 1 day, subjects were exposed to 8 h of isocapnic hypoxia (end-tidal PO2 55 Torr) and on the other day to 8 h of euoxia as a control. Before and 30 min after each exposure, subjects undertook an incremental exercise test. The best fit of a model for the variation in PETCO2 with metabolic rate gave a residual squared error that was ∼20-fold less for hypothesis 2 than for hypothesis 1 (p < 0.005, F-ratio test). We conclude that the alterations in respiratory control induced during early ventilatory acclimatization to hypoxia better reflect those associated with hypothesis 2 rather than hypothesis 1.

Seven intermittent exposures to altitude improves exercise performance at 4300 m

PURPOSE

The purpose of this study was to determine whether seven intermittent altitude exposures (IAE), in combination with either rest or exercise training, improves time-trial exercise performance and induces physiologic adaptations consistent with chronic altitude adaptation at 4300 m.

METHODS

Ten adult lowlanders (26 +/- 2 yr; 78 +/- 4 kg; means +/- SE) completed cycle endurance testing during an acute exposure to a 4300-m-altitude equivalent (446 mm Hg) once before (pre-IAE) and once after (post-IAE) 7 d of IAE (4h x d(-1), 5 d x wk(-1), 4300 m). Cycle endurance testing consisted of two consecutive 15-min constant-work rate exercise bouts followed immediately by a time-trial exercise performance test. During each IAE, five subjects performed exercise training, and the other group of five subjects rested.

RESULTS

Both groups demonstrated similar improvements in time-trial cycle exercise performance and physiologic adaptations during constant-work rate exercise from pre-IAE to post-IAE. Thus, data from all subjects were combined. Seven days of IAE resulted in a 16% improvement (P < 0.05) in time-trial cycle exercise performance (min) from pre-IAE (35 +/- 3) to post-IAE (29 +/- 2). During the two constant-work rate exercise bouts, there was an increase (P < 0.05) in exercise arterial O2 saturation (%) from pre-IAE (77 +/- 2; 75 +/- 1) to post-IAE (80 +/- 2; 79 +/- 1), a decrease (P < 0.05) in exercise heart rate (bpm) from pre-IAE (136 +/- 6; 162 +/- 5) to post-IAE (116 +/- 6; 153 +/- 5), and a decrease (P < 0.05) in exercise ratings of perceived exertion from pre-IAE (10 +/- 1; 14+/- 1) to post-IAE (8 +/- 1; 11 +/- 1).

CONCLUSIONS

Our findings indicate that 7 d of IAE, in combination with either rest or exercise training, improves time-trial cycle exercise performance and induces physiologic adaptations during constant-work rate exercise consistent with chronic altitude adaptation at 4300 m.

Improved running economy and increased hemoglobin mass in elite runners after extended moderate altitude exposure

There is conflicting evidence whether hypoxia improves running economy (RE), maximal O(2) uptake (V(O)(2max)), haemoglobin mass (Hb(mass)) and performance, and what total accumulated dose is necessary for effective adaptation. The aim of this study was to determine the effect of an extended hypoxic exposure on these physiological and performance measures. Nine elite middle distance runners were randomly assigned to a live high-train low simulated altitude group (ALT) and spent 46+/-8 nights (mean+/-S.D.) at 2860+/-41m. A matched control group (CON, n=9) lived and trained near sea level ( approximately 600m). ALT decreased submaximal V(O)(2) (Lmin(-1)) (-3.2%, 90% confidence intervals, -1.0% to -5.2%, p=0.02), increased Hb(mass) (4.9%, 2.3-7.6%, p=0.01), decreased submaximal heart rate (-3.1%, -1.8% to -4.4%, p=0.00) and had a trivial increase in V(O)(2max) (1.5%, -1.6 to 4.8; p=0.41) compared with CON. There was a trivial correlation between change in Hb(mass) and change in V(O)(2max) (r=0.04, p=0.93). Hypoxic exposure of approximately 400h was sufficient to improve Hb(mass), a response not observed with shorter exposures. Although total O(2) carrying capacity was improved, the mechanism(s) to explain the lack of proportionate increase in V(O)(2max) were not identified.

GXT responses in altitude-acclimatized cyclists during sea-level simulation

PURPOSE

This study examined the effects of gender on graded exercise stress test (GXT) response in moderate-altitude (MA)-acclimatized cyclists during sea-level (SL) simulation. It was hypothesized that alterations in arterial saturation would relate to changes in VO2peak.

METHODS

Twenty competitive cyclists (12 males, 8 females) who were residents of MA locations underwent two randomized bicycle GXTs: one under local normoxic hypobaria, and the other under simulated SL conditions.

RESULTS

Under the SL condition, the cyclists demonstrated a significant increase (2-3%) in absolute and relative VO2peak, improved (4%) economy at lactate threshold (LT), and time-adjusted peak power (7%); the range of improvement between individuals varied from -6% to +25%. Simulated SL also resulted in a greater arterial saturation (S(a)O2) at rest and VO2peak, and significantly less desaturation (4 vs 8%) from rest to VO2peak. The individual variability in the change (Delta) in VO2peak was not significantly correlated to SL S(a)O2 or any other S(a)O2 variable analyzed, regardless of whether we examined each gender individually or combined. Significant correlations were found between Delta-peak power and Delta-economy as well as Delta-VO2peak and Delta-GXT time. These correlations as well as degree of improvement varied by gender.

CONCLUSIONS

These data suggest that chronic residence at MA may attenuate the occurrence of exercise-induced arterial hypoxemia and eliminate the relationship between S(a)O2 and Delta-VO2peak that has been reported among SL residents acutely exposed to altitude. Additionally, the improvements that occur in predictors of aerobic performance when MA residents are exposed acutely to SL conditions have a large degree of individual variability, and the mechanism(s) for improvement may vary by gender.

Gross cycling efficiency is not altered with and without toe-clips

The aim of this study was to examine the claim that reductions of 8-18% in submaximal oxygen consumption (VO2) could be due to changing components on a Monark ergometer, from standard pedals without toe-clips or straps (flat pedals) to racing pedals of that era, which included toe-clips and straps (toe-clip pedals). This previously untested assertion was evaluated using 11 males (mean age 22.3 years, s= 1.2; height 1.82 m, s= 0.07; body mass 82.6 kg, s= 8.8) who completed four trials in a randomized, counterbalanced order at 60 rev min(-1) on a Monark cycle ergometer. Two trials were completed on flat pedals and two trials on toe-clip pedals. The Douglas bag method was used to assess VO2 and gross efficiency during successive 5-min workloads of 60, 120, 180, and 240 W. The mean VO2 was 2.1% higher for toe-clip pedals than flat pedals and there was a 99% probability that toe-clip pedals would not result in an 8% lower VO2. These results indicate that toe-clip pedals do not reduce VO2.

The effect of intermittent hypobaric hypoxic exposure and sea level training on submaximal economy in well-trained swimmers and runners

To evaluate the effect of intermittent hypobaric hypoxia combined with sea level training on exercise economy, 23 well-trained athletes (13 swimmers, 10 runners) were assigned to either hypobaric hypoxia (simulated altitude of 4,000-5,500 m) or normobaric normoxia (0-500 m) in a randomized, double-blind design. Both groups rested in a hypobaric chamber 3 h/day, 5 days/wk for 4 wk. Submaximal economy was measured twice before (Pre) and after (Post) the treatment period using sport-specific protocols. Economy was estimated both from the relationship between oxygen uptake (V(.-)o2) and speed, and from the absolute V(.-)o2 at each speed using sport-specific protocols. V(.-)o2 was measured during the last 60 s of each (3-4 min) stage using Douglas bags. Ventilation (V(.-)E), heart rate (HR), and capillary lactate concentration ([La(-)]) were measured during each stage. Velocity at maximal V(.-)o2 (velocity at V(.-)o2max) was used as a functional indicator of changes in economy. The average V(.-)o2 for a given speed of the Pre values was used for Post test comparison using a two-way, repeated-measures ANOVA. Typical error of measurement of V(.-)o2 was 4.7% (95% confidence limits 3.6-7.1), 3.6% (2.8-5.4), and 4.2% (3.2-6.9) for speeds 1, 2, and 3, respectively. There was no change in economy within or between groups (ANOVA interaction P = 0.28, P = 0.23, and P = 0.93 for speeds 1, 2, and 3). No differences in submaximal HR, [La-], Ve, or velocity at V(.-)o2(max) were found between groups. It is concluded that 4 wk of intermittent hypobaric hypoxia did not improve submaximal economy in this group of well-trained athletes.

The effect of acute simulated moderate altitude on power, performance and pacing strategies in well-trained cyclists

Athletes regularly compete at 2,000-3,000 m altitude where peak oxygen consumption (VO2peak) declines approximately 10-20%. Factors other than VO2peak including gross efficiency (GE), power output, and pacing are all important for cycling performance. It is therefore imperative to understand how all these factors and not just VO2peak are affected by acute hypobaric hypoxia to select athletes who can compete successfully at these altitudes. Ten well-trained, non-altitude-acclimatised male cyclists and triathletes completed cycling tests at four simulated altitudes (200, 1,200, 2,200, 3,200 m) in a randomised, counter-balanced order. The exercise protocol comprised 5 x 5-min submaximal efforts (50, 100, 150, 200 and 250 W) to determine submaximal VO2 and GE and, after 10-min rest, a 5-min maximal time-trial (5-minTT) to determine VO2peak and mean power output (5-minTT(power)). VO2peak declined 8.2 +/- 2.0, 13.9 +/- 2.9 and 22.5 +/- 3.8% at 1,200, 2,200 and 3,200 m compared with 200 m, respectively, P < 0.05. The corresponding decreases in 5-minTT(power) were 5.8 +/- 2.9, 10.3 +/- 4.3 and 19.8 +/- 3.5% (P < 0.05). GE during the 5-minTT was not different across the four altitudes. There was no change in submaximal VO2 at any of the simulated altitudes, however, submaximal efficiency decreased at 3,200 m compared with both 200 and 1,200 m. Despite substantially reduced power at simulated altitude, there was no difference in pacing at the four altitudes for athletes whose first trial was at 200 or 1,200 m; whereas athletes whose first trial was at 2,200 or 3,200 m tended to mis-pace that effort. In conclusion, during the 5-minTT there was a dose-response effect of hypoxia on both VO2peak and 5-minTT(power) but no effect on GE.

Effect of l-Carnitine Supplementation on Endurance Exercise in Normobaric/Normoxic and Hypobaric/Hypoxic Conditions

OBJECTIVE

To evaluate the effect of L-carnitine supplementation on improving endurance exercise in normobaric/normoxic and hypobaric/hypoxic environments.

METHODS

Six-week-endurance-trained male Sprague-Dawley rats (n = 24) were randomly divided into 2 groups: control and experimental; the latter group was supplemented with L-carnitine, administered orally in a dose of 100 mg x kg(-1) body weight. The animals were supplemented for 25 days under ambient normobaric/normoxic conditions and thereafter were exposed to 72 hours of hypobaric hypoxia equivalent to 6100 m. The supplementation was continued during the exposure. "Run to exhaustion" was recorded on day 1 (R1) (presupplementation) and on days 7 (R2), 14 (R3), 21 (R4), and 28 (R5, which followed the last 72 hours of hypoxic exposure) of supplementation. Food intake, body weight, and the biochemical measures of plasma glucose, total cholesterol, and high-density lipoprotein (HDL) cholesterol were recorded.

RESULTS

There was a significant improvement in endurance exercise, as indicated by an increase in run to exhaustion following L-carnitine supplementation under normobaric normoxia (36%-39%) and hypobaric hypoxia (50%). L-carnitine supplementation had no effect on plasma glucose levels either at sea level or after hypoxic exposure. Total cholesterol was decreased in normoxic and HDL cholesterol was increased in normoxic and hypoxic conditions, indicating a beneficial effect of exercise.

CONCLUSION

L-carnitine supplementation improved exercise endurance in rats exposed to normobaric normoxic and hypobaric hypoxic conditions. Such supplementation would be beneficial in delaying the onset of fatigue during prolonged exercise in both conditions, indicating its potentially beneficial use at high altitude.

Nonhematological Mechanisms of Improved Sea-Level Performance after Hypoxic Exposure

Altitude training has been used regularly for the past five decades by elite endurance athletes, with the goal of improving performance at sea level. The dominant paradigm is that the improved performance at sea level is due primarily to an accelerated erythropoietic response due to the reduced oxygen available at altitude, leading to an increase in red cell mass, maximal oxygen uptake, and competitive performance. Blood doping and exogenous use of erythropoietin demonstrate the unequivocal performance benefits of more red blood cells to an athlete, but it is perhaps revealing that long-term residence at high altitude does not increase hemoglobin concentration in Tibetans and Ethiopians compared with the polycythemia commonly observed in Andeans. This review also explores evidence of factors other than accelerated erythropoiesis that can contribute to improved athletic performance at sea level after living and/or training in natural or artificial hypoxia. We describe a range of studies that have demonstrated performance improvements after various forms of altitude exposures despite no increase in red cell mass. In addition, the multifactor cascade of responses induced by hypoxia includes angiogenesis, glucose transport, glycolysis, and pH regulation, each of which may partially explain improved endurance performance independent of a larger number of red blood cells. Specific beneficial nonhematological factors include improved muscle efficiency probably at a mitochondrial level, greater muscle buffering, and the ability to tolerate lactic acid production. Future research should examine both hematological and nonhematological mechanisms of adaptation to hypoxia that might enhance the performance of elite athletes at sea level.

Exercise economy does not change after acclimatization to moderate to very high altitude

For more than 60 years, muscle mechanical efficiency has been thought to remain unchanged with acclimatization to high altitude. However, recent work has suggested that muscle mechanical efficiency may in fact be improved upon return from prolonged exposure to high altitude. The purpose of the present work is to resolve this apparent conflict in the literature. In a collaboration between four research centers, we have included data from independent high-altitude studies performed at varying altitudes and including a total of 153 subjects ranging from sea-level (SL) residents to high-altitude natives, and from sedentary to world-class athletes. In study A (n=109), living for 20-22 h/day at 2500 m combined with training between 1250 and 2800 m caused no differences in running economy at fixed speeds despite low typical error measurements. In study B, SL residents (n=8) sojourning for 8 weeks at 4100 m and residents native to this altitude (n=7) performed cycle ergometer exercise in ambient air and in acute normoxia. Muscle oxygen uptake and mechanical efficiency were unchanged between SL and acclimatization and between the two groups. In study C (n=20), during 21 days of exposure to 4300 m altitude, no changes in systemic or leg VO(2) were found during cycle ergometer exercise. However, at the substantially higher altitude of 5260 m decreases in submaximal VO(2) were found in nine subjects with acute hypoxic exposure, as well as after 9 weeks of acclimatization. As VO(2) was already reduced in acute hypoxia this suggests, at least in this condition, that the reduction is not related to anatomical or physiological adaptations to high altitude but to oxygen lack because of severe hypoxia altering substrate utilization. In conclusion, results from several, independent investigations indicate that exercise economy remains unchanged after acclimatization to high altitude.

The effects of nightly normobaric hypoxia and high intensity training under intermittent normobaric hypoxia on running economy and hemoglobin mass

We investigated the effects of nightly intermittent exposure to hypoxia and of training during intermittent hypoxia on both erythropoiesis and running economy (RE), which is indicated by the oxygen cost during running at submaximal speeds. Twenty-five college long- and middle- distance runners [maximal oxygen uptake (Vo(2max)) 60.3 +/- 4.7 ml x kg(-1) x min(-1)] were randomly assigned to one of three groups: hypoxic residential group (HypR, 11 h/night at 3,000 m simulated altitude), hypoxic training group (HypT), or control group (Con), for an intervention of 29 nights. All subjects trained in Tokyo (altitude of 60 m) but HypT had additional high-intensity treadmill running for 30 min at 3,000 m simulated altitude on 12 days during the night intervention. Vo(2) was measured at standing rest during four submaximal speeds (12, 14, 16, and 18 km/h) and during a maximal stage to volitional exhaustion on a treadmill. Total hemoglobin mass (THb) was measured by carbon monoxide rebreathing. There were no significant changes in Vo(2max), THb, and the time to exhaustion in all three groups after the intervention. Nevertheless, HypR showed approximately 5% improvement of RE in normoxia (P < 0.01) after the intervention, reflected by reduced Vo(2) at 18 km/h and the decreased regression slope fitted to Vo(2) measured during rest position and the four submaximal speeds (P < 0.05), whereas no significant corresponding changes were found in HypT and Con. We concluded that our dose of intermittent hypoxia (3,000 m for approximately 11 h/night for 29 nights) was insufficient to enhance erythropoiesis or Vo(2max), but improved the RE at race speed of college runners.

Physiological characteristics of the best Eritrean runners—exceptional running economy

Despite their young age, limited training history, and lack of running tradition compared with other East African endurance athletes (e.g., Kenyans and Ethiopians), male endurance runners from Eritrea have recently attained important running successes. The purposes of our study were (i) to document the main physical and physiological characteristics of elite black Eritrean distance runners (n = 7; age: 22 ± 3 years) and (ii) to compare them with those of their elite white Spanish counterparts. For this second purpose we selected a control group of elite Spanish runners (n = 9; 24 ± 2 years), owing to the traditionally high success of Spanish athletes in long-distance running compared with other white runners, especially in cross-country competitions. The subjects’ main anthropometric characteristics were determined, together with their maximum oxygen uptake (VO2 max) and VO2 (mL·kg–1·min–1), blood lactate, and ammonia concentrations while running at 17, 19, or 21 km·h–1. The body mass index (18.9 ± 1.5 kg·m–2) and maximal calf circumference (30.9 ± 1.5 cm) was lower in Eritreans than in Spaniards (20.5 ± 1.7 kg·m–2 and 33.9 ± 2.0 cm, respectively) (p < 0.05 and p < 0.01, respectively) and their lower leg (shank) length was longer (44.1 ± 3.0 cm vs. 40.6 ± 2.7 cm, respectively) (p < 0.05). VO2 max did not differ significantly between Eritreans and Spaniards (73.8 ± 5.6 mL·kg–1·min–1 vs. 77.8 ± 5.7 mL·kg–1·min–1, respectively), whereas the VO2 cost of running was lower (p < 0.01) in the former (e.g., 65.9 ± 6.8 mL·kg–1·min–1 vs. 74.8  ± 5.0 mL·kg–1·min–1 when running at 21 km·h–1). Our data suggest that the excellent running economy of Eritreans is associated, at least partly, with anthropometric variables. Comparison of their submaximal running cost with other published data suggests that superior running economy, rather than enhanced aerobic capacity, may be the common denominator in the success of black endurance runners of East African origin.

Influence of "living high-training low" on aerobic performance and economy of work in elite athletes

This study tested the effects of "living high-training low" (Hi-Lo) on aerobic performance and economy of work in elite athletes. Forty endurance athletes (cross-country skiers, swimmers, runners) performed 13-18 consecutive days of training at 1,200 m altitude, by sleeping at 1,200 m (LL, n = 20) or in hypoxic rooms with 5-6 nights at 2,500 m followed by 8-12 nights at 3,000-3,500 m (HL, n = 20). The athletes were evaluated before (pre-), one (post-1) and 15 days (post-15) after Hi-Lo. Economy was assessed from two sub-maximal tests, one non-specific (cycling) and one specific (running or swimming). From pre- to post-1: V(O2)max increased both in HL (+ 7.8%, P < 0.01) and in LL (+ 3.3%, P < 0.05), peak power output (PPO) tended to increase more (P=0.06) in HL (+ 4.1%, P < 0.01) than in LL (+ 1.9%). At post-15, V(O2)max has returned to pre-values in both groups, PPO increased more (P < 0.05) in HL (+ 8.3%, P < 0.01) than in LL (+ 3.8%), V(O2) and power at respiratory compensation point (RCP) increased more (P < 0.05) in HL (+ 9.5%, P < 0.01 and + 11.2%, P < 0.01) than in LL (+ 3.2 and + 3.3%). Cycling mechanical efficiency (8-5%) and economy during specific locomotion (7-7%) increased (P < 0.05) in both groups. This study shows that, for a similar increase in V(O2)max HL had a greater increase in PPO than LL. The efficiency of Hi-Lo is also evidenced 15 days later by higher V(O2) and power at RCP. This study emphasizes that during the post-altitude period, economy of work greatly increases in both groups.

Effects of prior exercise and a low-carbohydrate diet on muscle sarcoplasmic reticulum function during cycling in women

The effects of exercise and diet on sarcoplasmic reticulum Ca(2+)-cycling properties in female vastus lateralis muscle were investigated in two groups of women following four different conditions. The conditions were 4 days of a low-carbohydrate (Lo CHO) and glycogen-depleting exercise plus a Lo CHO diet (Ex + Lo CHO) (experiment 2) and 4 days of normal CHO (Norm CHO) and glycogen-depleting exercise plus Norm CHO (Ex + Norm CHO) (experiment 1). Peak aerobic power (Vo2peak)) was 38.1 +/- 1.4 (SE); n = 9 and 35.6 +/- 1.4 ml.kg(-1).min(-1); n = 9, respectively. Sarcoplasmic reticulum properties measured in vitro in homogenates (micromol.g protein(-1).min(-1)) indicated exercise-induced reductions (P < 0.05) in maximal Ca(2+)-ATPase activity (0 > 30, 60 min > fatigue), Ca(2+) uptake (0 > 30 > 60 min, fatigue), and Ca(2+) release, both phase 1 (0, 30 > 60 min, fatigue) and phase 2 (0 > 30, 60 min, fatigue; 30 min > fatigue) in Norm CHO. Exercise was without effect in altering the Hill slope (n(H)), defined as the slope of relationship between Ca(2+)-ATPase activity and Ca(2+) concentration. No differences were observed between Norm CHO and Ex+Norm CHO. Compared with Norm CHO, Lo CHO resulted in a lower (P < 0.05) Ca(2+) uptake, phase 1 Ca(2+) release (30 min), and n(H). Ex + Lo CHO resulted in a greater (P < 0.05) Ca(2+) uptake and n(H) compared with Lo CHO. The results demonstrate that Lo CHO alone can disrupt SR Ca(2+) cycling and that, with the exception of Ca(2+) release, a glycogen-depleting session of exercise before Lo CHO can reverse the effects.