Importance of pH regulation and lactate/H+transport capacity for work production during supramaximal exercise in humans

Oral but Not Topical Sodium Bicarbonate Improves Repeated Sprint Performance During Simulated Soccer Match Play Exercise in Collegiate Athletes

This study investigated the effect of oral and topical sodium bicarbonate (SB) on soccer-specific performance during simulated soccer exercise. In a block randomized, double-blind, crossover design, 10 collegiate male soccer players (stature: 181.7 ± 3.2 cm, body mass: 81.7 ± 10.5 kg) performed soccer-specific performance tests (countermovement jumps, Illinois agility, 8 × 25 m repeated sprints) throughout a 90-min soccer-specific aerobic field test (SAFT90) following 0.3 g/kg body mass SB in capsules (SB-ORAL), 0.9036 g/kg body mass PR Lotion (SB-LOTION), or placebo capsules and lotion (PLA). Soccer-specific performance tests were conducted pre-SAFT90, during half-time and post-SAFT90. Blood samples were analyzed for acid-base balance (pH; bicarbonate, HCO3-) and strong ions (sodium, Na+; potassium, K+). Average sprint times were quicker for SB-ORAL than PLA during half-time (3.7%; p = .049; g = .57) and post-SAFT90 (4.9%; p = .041; g = .66). SB-ORAL increased pH and HCO3- prewarm-up and during half-time (p < .05), and lowered K+ during half-time (p = .035) compared with PLA. SB-LOTION increased pH (p = .019) and lowered K+ (p = .012) during half-time compared with PLA. SB-LOTION increased Na+ postexercise compared with PLA (p = .008). Repeated sprint times during simulated soccer exercise improved for SB-ORAL, which might have been mechanistically underpinned by elevated blood buffering capacity and greater regulation of strong ion concentration. Consuming SB in capsules is a more effective strategy than topical SB application for improving blood buffering capacity and repeated sprint performance throughout competitive soccer matches.

Stimuli-Responsive Silica Silanol Conjugates: Strategic Nanoarchitectonics in Targeted Drug Delivery

The design of novel drug delivery systems is exceptionally critical in disease treatments. Among the existing drug delivery systems, mesoporous silica nanoparticles (MSNs) have shown profuse promise owing to their structural stability, tunable morphologies/sizes, and ability to load different payload chemistry. Significantly, the presence of surface silanol groups enables functionalization with relevant drugs, imaging, and targeting agents, promoting their utility and popularity among researchers. Stimuli-responsive silanol conjugates have been developed as a novel, more effective way to conjugate, deliver, and release therapeutic drugs on demand and precisely to the selected location. Therefore, it is urgent to summarize the current understanding and the surface silanols' role in making MSN a versatile drug delivery platform. This review provides an analytical understanding of the surface silanols, chemistry, identification methods, and their property-performance correlation. The chemistry involved in converting surface silanols to a stimuli-responsive silica delivery system by endogenous/exogenous stimuli, including pH, redox potential, temperature, and hypoxia, is discussed in depth. Different chemistries for converting surface silanols to stimuli-responsive bonds are discussed in the context of drug delivery. The critical discussion is culminated by outlining the challenges in identifying silanols' role and overcoming the limitations in synthesizing stimuli-responsive mesoporous silica-based drug delivery systems.

Enhancing exercise performance and recovery through sodium bicarbonate supplementation: introducing the ingestion recovery framework

Sodium bicarbonate (SB) supplementation is an ergogenic strategy for athletes competing in high-intensity exercise, but the efficacy of SB for accelerating recovery from exercise and thus improving performance during repeated bouts of exercise is not fully understood. In a similar fashion to using SB as a pre-exercise buffer, it is possible accelerated restoration of blood pH and bicarbonate following an exercise bout mechanistically underpins the use of SB as a recovery aid. Physiological mechanisms contributing to beneficial effects for SB during repeated bout exercise could be more far-reaching however, as alterations in strong ion difference (SID) and attenuated cellular stress response might also contribute to accelerated recovery from exercise. From inspection of existing literature, ingestion of 0.3 g kg-1 body mass SB ~60-90 min pre-exercise seems to be the most common dosage strategy, but there is evidence emerging for the potential application of post-exercise supplementation timing, gradual SB doses throughout a competition day, or even ingestion during exercise. Based on this review of literature, an SB ingestion recovery framework is proposed to guide athletes and practitioners on the use of SB to enhance performance for multiple bouts of exercise.

Endurance Training Improves Leg Proton Release and Decreases Potassium Release During High-Intensity Exercise in Normoxia and Hypobaric Hypoxia

AIM

To assess the impact of endurance training on skeletal muscle release of H+ and K+.

METHODS

Nine participants performed one-legged knee extension endurance training at moderate and high intensities (70%-85% of Wpeak), three to four sessions·week-1 for 6 weeks. Post-training, the trained and untrained (control) leg performed two-legged knee extension at low, moderate, and high intensities (40%, 62%, and 83% of Wpeak) in normoxia and hypoxia (~4000 m). The legs were exercised simultaneously to ensure identical arterial inflow concentrations of ions and metabolites, and identical power output was controlled by visual feedback. Leg blood flow was measured (ultrasound Doppler), and acid-base variables, lactate- and K+ concentrations were assessed in arterial and femoral venous blood to study K+ and H+ release. Ion transporter abundances were assessed in muscle biopsies.

RESULTS

Lactate-dependent H+ release was similar in hypoxia to normoxia (p = 0.168) and was lower in the trained than the control leg at low-moderate intensities (p = 0.060-0.006) but similar during high-intensity exercise. Lactate-independent and total H+ releases were higher in hypoxia (p < 0.05) and increased more with power output in the trained leg (leg-by-power output interactions: p = 0.02). K+ release was similar at low intensity but lower in the trained leg during high-intensity exercise in normoxia (p = 0.024) and hypoxia (p = 0.007). The trained leg had higher abundances of Na+/H+ exchanger 1 (p = 0.047) and Na+/K+ pump subunit α (p = 0.036).

CONCLUSION

Moderate- to high-intensity endurance training increases lactate-independent H+ release and reduces K+ release during high-intensity exercise, coinciding with increased Na+/H+ exchanger 1 and Na+/K+ pump subunit α muscle abundances.

Summatory Effects of Anaerobic Exercise and a 'Westernized Athletic Diet' on Gut Dysbiosis and Chronic Low-Grade Metabolic Acidosis

Anaerobic exercise decreases systemic pH and increases metabolic acidosis in athletes, altering the acid-base homeostasis. In addition, nutritional recommendations advising athletes to intake higher amounts of proteins and simple carbohydrates (including from sport functional supplements) could be detrimental to restoring acid-base balance. Here, this specific nutrition could be classified as an acidic diet and defined as 'Westernized athletic nutrition'. The maintenance of a chronic physiological state of low-grade metabolic acidosis produces detrimental effects on systemic health, physical performance, and inflammation. Therefore, nutrition must be capable of compensating for systemic acidosis from anaerobic exercise. The healthy gut microbiota can contribute to improving health and physical performance in athletes and, specifically, decrease the systemic acidic load through the conversion of lactate from systemic circulation to short-chain fatty acids in the proximal colon. On the contrary, microbial dysbiosis results in negative consequences for host health and physical performance because it results in a greater accumulation of systemic lactate, hydrogen ions, carbon dioxide, bacterial endotoxins, bioamines, and immunogenic compounds that are transported through the epithelia into the blood circulation. In conclusion, the systemic metabolic acidosis resulting from anaerobic exercise can be aggravated through an acidic diet, promoting chronic, low-grade metabolic acidosis in athletes. The individuality of athletic training and nutrition must take into consideration the acid-base homeostasis to modulate microbiota and adaptive physiological responses.

Sodium Bicarbonate and Time-to-Exhaustion Cycling Performance: A Retrospective Analysis Exploring the Mediating Role of Expectation

BACKGROUND

Research has shown that ingesting 0.3 g·kg^-1 body mass sodium bicarbonate (NaHCO₃) can improve time-to-exhaustion (TTE) cycling performance, but the influence of psychophysiological mechanisms on ergogenic effects is not yet understood.

OBJECTIVE

This study retrospectively examined whether changes in TTE cycling performance are mediated by positive expectations of receiving NaHCO₃ and/or the decline in blood bicarbonate during exercise.

METHODS

In a randomised, crossover, counterbalanced, double-blind, placebo-controlled design, 12 recreationally trained cyclists (maximal oxygen consumption, 54.4 ± 5.7 mL·kg·min^-1) performed four TTE cycling tests 90 min after consuming: (1) 0.3 g·kg^-1 body mass NaHCO₃ in 5 mL·kg^-1 body mass solution, (2) 0.03 g·kg^-1 body mass sodium chloride in solution (placebo), (3) 0.3 g·kg^-1 body mass NaHCO₃ in capsules and (4) cornflour in capsules (placebo). Prior to exercise, participants rated on 1-5 Likert type scales how much they expected the treatment they believe had been given would improve performance. Capillary blood samples were measured for acid-base balance at baseline, pre-exercise and post-exercise.

RESULTS

Administering NaHCO₃ in solution and capsules improved TTE compared with their respective placebos (solution: 27.0 ± 21.9 s, p = 0.001; capsules: 23.0 ± 28.1 s, p = 0.016). Compared to capsules, NaHCO₃ administered via solution resulted in a higher expectancy about the benefits on TTE cycling performance (Median: 3.5 vs. 2.5, Z = 2.135, p = 0.033). Decline in blood bicarbonate during exercise was higher for NaHCO₃ given in solution compared to capsules (2.7 ± 2.1 mmol·L^-1, p = 0.001). Mediation analyses showed that improvements in TTE cycling were indirectly related to expectancy and decline in blood bicarbonate when NaHCO₃ was administered in solution but not capsules.

CONCLUSIONS

Participants' higher expectations when NaHCO₃ is administered in solution could result in them exerting themselves harder during TTE cycling, which subsequently leads to a greater decline in blood bicarbonate and larger improvements in performance.

KEY POINTS

Ingesting 0.3 g·kg^-1 body mass sodium bicarbonate in solution and capsules improved time-to-exhaustion cycling performance Positive expectancy about the benefits of sodium bicarbonate and decline in blood bicarbonate were higher when sodium bicarbonate was administered in solution compared with capsules Improvements in time-to-exhaustion cycling performance for sodium bicarbonate administered in solution were related to expectancy and the enhanced extracellular buffering response.

The Impact of Acetazolamide and Methazolamide on Exercise Performance in Normoxia and Hypoxia

Doherty, Connor J., Jou-Chung Chang, Benjamin P. Thompson, Erik R. Swenson, Glen E. Foster, and Paolo B. Dominelli. The impact of acetazolamide and methazolamide on exercise performance in normoxia and hypoxia. High Alt Med Biol. 24:7-18, 2023.-Carbonic anhydrase (CA) inhibitors are commonly prescribed for acute mountain sickness (AMS). In this review, we sought to examine how two CA inhibitors, acetazolamide (AZ) and methazolamide (MZ), affect exercise performance in normoxia and hypoxia. First, we briefly describe the role of CA inhibition in facilitating the increase in ventilation and arterial oxygenation in preventing and treating AMS. Next, we detail how AZ affects exercise performance in normoxia and hypoxia and this is followed by a discussion on MZ. We emphasize that the overarching focus of the review is how the two drugs potentially affect exercise performance, rather than their ability to prevent/treat AMS per se, their interrelationship will be discussed. Overall, we suggest that AZ hinders exercise performance in normoxia, but may be beneficial in hypoxia. Based upon head-to-head studies of AZ and MZ in humans on diaphragmatic and locomotor strength in normoxia, MZ may be a better CA inhibitor when exercise performance is crucial at high altitude.

The effects of enteric-coated sodium bicarbonate supplementation on 2 km rowing performance in female CrossFit® athletes

PURPOSE

Sodium bicarbonate (SB) supplementation can improve exercise performance, but few studies consider how effective it is in female athletes. The aim of the study was to establish the effect of individually timed pre-exercise SB ingestion on 2 km rowing time trial (TT) performance in female athletes.

METHODS

Eleven female CrossFit® athletes (mean ± SD age, 29 y ± 4 y, body mass, 64.5 kg ± 7.1 kg, height, 1.7 m ± 0.09 m, peak oxygen uptake [VO_2peak], 53.8 ± 5.7 mL·kg^-1∙min^-1). An initial trial identified individual time-to-peak [HCO₃^-] following enteric-coated 0.3 g·kg^-1 BM SB ingestion_. Participants then completed a 2 km TT familiarisation followed by a placebo (PLA) or SB trial, using a randomised cross-over design.

RESULTS

The ingestion of SB improved rowing performance (514.3 ± 44.6 s) compared to the PLA (529.9 ± 45.4 s) and FAM trials (522.2 ± 43.1 s) (p = 0.001, pη² = 0.53) which represents a 2.24% improvement compared to the PLA. Individual time-to-peak alkalosis occurred 102.3 ± 22.1 min after ingestion (range 75-150 min) and resulted in increased blood [HCO_3-] of 5.5 ± 1.5 mmol⋅L^-1 (range = 3.8-7.9 mmol⋅L^-1). The change in blood [HCO_3-] was significantly correlated with the performance improvement between PLA and SB trials (r = 0.68, p = 0.020).

CONCLUSIONS

Ingesting a 0.3 g·kg^-1 BM dose of enteric-coated SB improves 2 km rowing performance in female athletes. The improvement is directly related to the extracellular buffering capacity even when blood [HCO_3-] does not change ≥ 5.0 mmol⋅L^-1.

The effects of sodium bicarbonate supplementation at individual time-to-peak blood bicarbonate on 4-km cycling time trial performance in the heat

The purpose of this study was to explore the effect of individualised sodium bicarbonate (NaHCO₃) supplementation according to a pre-established individual time-to-peak (TTP) blood bicarbonate (HCO₃^-) on 4-km cycling time trial (TT) performance in the heat. Eleven recreationally trained male cyclists (age: 28 ± 6 years, height: 180 ± 6 cm, body mass: 80.5 ± 8.4 kg) volunteered for this study in a randomised, crossover, triple-blind, placebo-controlled design. An initial visit was conducted to determine TTP HCO₃^- following 0.2 g.kg^-1 body mass (BM) NaHCO₃ ingestion. Subsequently, on three separate occasions, participants completed a 4-km cycling TT in the heat (30 degrees centigrade; °C) (relative humidity ∼40%) following ingestion of either NaHCO₃ (0.2 g.kg^-1 body mass), a sodium chloride placebo (0.2 g.kg^-1 BM; PLA) at the predetermined individual TTP HCO₃^-, or no supplementation (control; CON) . Absolute peak [HCO₃^-] prior to the 4-km cycling TT's was elevated for NaHCO₃ compared to PLA (+2.8 mmol.l^-1; p = 0.002; g = 2.2) and CON (+2.5 mmol.l^-1; p < 0.001; g = 2.1). Completion time following NaHCO₃ was 5.6 ± 3.2 s faster than PLA (1.6%; CI: 2.8, 8.3; p = 0.001; g = 0.2) and 4.7 ± 2.8 s faster than CON (1.3%; CI: 2.3, 7.1; p = 0.001; g = 0.2). These results demonstrate that NaHCO₃ ingestion at a pre-established individual TTP HCO₃^- improves 4-km cycling TT performance in the heat, likely through enhancing buffering capacity.Highlights This is the first time NaHCO₃ ingestion has been shown to improve 4-km cycling TT performance in conditions of high ambient heat.A smaller dose of NaHCO₃ (0.2 g.kg^-1 BM) is ergogenic in the heat, which is smaller than the dose typically ingested for sports performance (0.3 g.kg^-1 BM). This is important, as gastrointestinal discomfort is typically lower as the dose reduces.This study suggests that the individualised time-to-peak HCO₃^- ingestion strategy with lower doses of NaHCO₃ is an ergogenic strategy in conditions of high ambient heat.

Acute effects of sodium bicarbonate ingestion on cycling time-trial performance: A systematic review and meta-analysis of randomized controlled trials

This study aimed to investigate the isolated effects of NaHCO₃ on cycling time-trial performance. Furthermore, we investigated whether the ingestion time of NaHCO₃, standardized or individualized based on time to peak, could be effective in improving cycling time-trial performance. A systematic review was carried out on randomized placebo-controlled studies. A random-effects meta-analysis assessed the standardized mean difference (SMD) between NaHCO₃ and placebo conditions. Eighteen studies were qualitatively (systematic review) and quantitatively (meta-analysis) analysed concerning mean power output (W_mean) (n = 182) and time performance (n = 201). The reviewed studies showed a low risk of bias and homogenous results for W_mean (I² = 0%) and performance time (I²= 0%). Overall, when compared to placebo, the NaHCO₃ ingestion improved the W_mean (SMD: 0.42; 95% CI: 0.21-0.63; P = 0.001) and performance time (SMD: 0.22; 95% CI: 0.02-0.43; P = 0.03). Similarly, the NaHCO₃ ingestion using a time-to-peak strategy improved the W_mean (SMD: 0.39; 95% CI: 0.03-0.75; P = 0.04; I²= 15%) and performance time (SMD: 0.34; 95% CI: 0.07-0.61, P = 0.01, I²= 0%). The present findings reveal that NaHCO₃ ingestion has the potential to increase the overall performance time and W_mean in cycling time trials. HighlightsNaHCO₃ is an effective strategy to increase cycling time-trial performance.The standardized protocol did not improve the cycling time-trial performance parameters.The individualized time-to-peak NaHCO₃ ingestion has a positive effect on time and W_mean during cycling time-trial performance.

Extracellular Buffering Supplements to Improve Exercise Capacity and Performance: A Comprehensive Systematic Review and Meta-analysis

BACKGROUND

Extracellular buffering supplements [sodium bicarbonate (SB), sodium citrate (SC), sodium/calcium lactate (SL/CL)] are ergogenic supplements, although questions remain about factors which may modify their effect.

OBJECTIVE

To quantify the main effect of extracellular buffering agents on exercise outcomes, and to investigate the influence of potential moderators on this effect using a systematic review and meta-analytic approach.

METHODS

This study was designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases were searched for articles that were screened according to inclusion/exclusion criteria. Bayesian hierarchical meta-analysis and meta-regression models were used to investigate pooled effects of supplementation and moderating effects of a range of factors on exercise and biomarker responses.

RESULTS

189 articles with 2019 participants were included, 158 involving SB supplementation, 30 with SC, and seven with CL/SL; four studies provided a combination of buffering supplements together. Supplementation led to a mean estimated increase in blood bicarbonate of + 5.2 mmol L^-1 (95% credible interval (CrI) 4.7-5.7). The meta-analysis models identified a positive overall effect of supplementation on exercise capacity and performance compared to placebo [ES_0.5 = 0.17 (95% CrI 0.12-0.21)] with potential moderating effects of exercise type and duration, training status and when the exercise test was performed following prior exercise. The greatest ergogenic effects were shown for exercise durations of 0.5-10 min [ES_0.5 = 0.18 (0.13-0.24)] and > 10 min [ES_0.5 = 0.22 (0.10-0.33)]. Evidence of greater effects on exercise were obtained when blood bicarbonate increases were medium (4-6 mmol L^-1) and large (> 6 mmol L^-1) compared with small (≤ 4 mmol L^-1) [β_Small:Medium = 0.16 (95% CrI 0.02-0.32), β_Small:Large = 0.13 (95% CrI - 0.03 to 0.29)]. SB (192 outcomes) was more effective for performance compared to SC (39 outcomes) [β_SC:SB = 0.10 (95% CrI - 0.02 to 0.22)].

CONCLUSIONS

Extracellular buffering supplements generate large increases in blood bicarbonate concentration leading to positive overall effects on exercise, with sodium bicarbonate being most effective. Evidence for several group-level moderating factors were identified. These data can guide an athlete's decision as to whether supplementation with buffering agents might be beneficial for their specific aims.

Lower Muscle and Blood Lactate Accumulation in Sickle Cell Trait Carriers in Response to Short High-Intensity Exercise

It remains unclear whether sickle cell trait (SCT) should be considered a risk factor during intense physical activity. By triggering the polymerization-sickling-vaso-occlusion cascade, lactate accumulation-associated acidosis in response to high-intensity exercise is believed to be one of the causes of complications. However, our understanding of lactate metabolism in response to high-intensity exercise in SCT carriers is incomplete. Thirty male SCT carriers (n = 15) and healthy subjects (n = 15) with and without α-thalassemia performed a 2-min high-intensity exercise. Blood and muscle lactate concentrations were measured at exercise completion. Time courses of blood lactate and glucose concentrations were followed during the subsequent recovery. Additional biochemical analyses were performed on biopsies of the vastus lateralis muscle. SCT was associated with lower blood and muscle lactate concentrations in response to the short high-intensity exercise. Compared to controls, the muscle content among SCT carriers of lactate transporter MCT4 and β2-adrenergic receptor were higher and lower, respectively. During recovery, the lactate removal ability was higher in SCT carriers. In the present study, no effect of α-thalassemia was observed. The lower blood and muscle lactate accumulations in SCT carriers may, to some extent, act as protective mechanisms: (i) against exercise-related acidosis and subsequent sickling, that may explain the relatively rare complications observed in exercising SCT carriers; and (ii) against the deleterious effects of intracellular lactate and associated acidosis on muscle function, that might explain the elevated presence of SCT carriers among the best sprinters.

Delayed Rebound of Glycemia During Recovery Following Short-Duration High-Intensity Exercise: Are There Lactate and Glucose Metabolism Interactions?

Lactate constitutes the primary gluconeogenic precursor in healthy humans at rest and during low-intensity exercise. Data on the interactions between lactate and glucose metabolisms during recovery after short-duration high-intensity exercise are sparse. The aim of the present study was to describe blood glucose ([glucose]_b) and lactate ([lactate]_b) concentration curves during recovery following short-duration high-intensity exercise. Fifteen healthy Cameroonian subjects took part in the study and performed successively (i) an incremental exercise to exhaustion to determine maximal work rate (P_max) and (ii) a 2-min 110% P_max exercise after which blood lactate and glucose concentrations were measured during the 80-min passive recovery. In response to the 2-min 110% P_max exercise, [glucose]_b remained stable (from 4.93 ± 1.13 to 4.65 ± 0.74 mmol^.L⁻¹, NS) while [lactate]_b increased (from 1.35 ± 0.36 to 7.87 ± 1.66 mmol^.L⁻¹, p < 0.0001). During recovery, blood lactate concentrations displayed the classic biphasic curve while blood glucose concentrations displayed a singular shape including a delayed and transitory rebound of glycemia. This rebound began at 27.7 ± 6.2 min and peaked at 6.78 ± 0.53 mmol^.L⁻¹ at 56.3 ± 9.7 min into recovery. The area under the curve (AUC) of [lactate]_b during the rebound of glycemia was positively correlated with the peak value of glycemia and the AUC of [glucose]_b during the rebound. In conclusion, the delayed rebound of glycemia observed in the present study was associated with lactate availability during this period.

Maximal muscular power: lessons from sprint cycling

Maximal muscular power production is of fundamental importance to human functional capacity and feats of performance. Here, we present a synthesis of literature pertaining to physiological systems that limit maximal muscular power during cyclic actions characteristic of locomotor behaviours, and how they adapt to training. Maximal, cyclic muscular power is known to be the main determinant of sprint cycling performance, and therefore we present this synthesis in the context of sprint cycling. Cyclical power is interactively constrained by force-velocity properties (i.e. maximum force and maximum shortening velocity), activation-relaxation kinetics and muscle coordination across the continuum of cycle frequencies, with the relative influence of each factor being frequency dependent. Muscle cross-sectional area and fibre composition appear to be the most prominent properties influencing maximal muscular power and the power-frequency relationship. Due to the role of muscle fibre composition in determining maximum shortening velocity and activation-relaxation kinetics, it remains unclear how improvable these properties are with training. Increases in maximal muscular power may therefore arise primarily from improvements in maximum force production and neuromuscular coordination via appropriate training. Because maximal efforts may need to be sustained for ~15-60 s within sprint cycling competition, the ability to attenuate fatigue-related power loss is also critical to performance. Within this context, the fatigued state is characterised by impairments in force-velocity properties and activation-relaxation kinetics. A suppression and leftward shift of the power-frequency relationship is subsequently observed. It is not clear if rates of power loss can be improved with training, even in the presence adaptations associated with fatigue-resistance. Increasing maximum power may be most efficacious for improving sustained power during brief maximal efforts, although the inclusion of sprint interval training likely remains beneficial. Therefore, evidence from sprint cycling indicates that brief maximal muscular power production under cyclical conditions can be readily improved via appropriate training, with direct implications for sprint cycling as well as other athletic and health-related pursuits.

Muscle Ionic Shifts During Exercise: Implications for Fatigue and Exercise Performance

Exercise causes major shifts in multiple ions (e.g., K⁺ , Na⁺ , H⁺ , lactate^- , Ca²⁺ , and Cl^- ) during muscle activity that contributes to development of muscle fatigue. Sarcolemmal processes can be impaired by the trans-sarcolemmal rundown of ion gradients for K⁺ , Na⁺ , and Ca²⁺ during fatiguing exercise, while changes in gradients for Cl^- and Cl^- conductance may exert either protective or detrimental effects on fatigue. Myocellular H⁺ accumulation may also contribute to fatigue development by lowering glycolytic rate and has been shown to act synergistically with inorganic phosphate (Pi) to compromise cross-bridge function. In addition, sarcoplasmic reticulum Ca²⁺ release function is severely affected by fatiguing exercise. Skeletal muscle has a multitude of ion transport systems that counter exercise-related ionic shifts of which the Na⁺ /K⁺ -ATPase is of major importance. Metabolic perturbations occurring during exercise can exacerbate trans-sarcolemmal ionic shifts, in particular for K⁺ and Cl^- , respectively via metabolic regulation of the ATP-sensitive K⁺ channel (K_ATP ) and the chloride channel isoform 1 (ClC-1). Ion transport systems are highly adaptable to exercise training resulting in an enhanced ability to counter ionic disturbances to delay fatigue and improve exercise performance. In this article, we discuss (i) the ionic shifts occurring during exercise, (ii) the role of ion transport systems in skeletal muscle for ionic regulation, (iii) how ionic disturbances affect sarcolemmal processes and muscle fatigue, (iv) how metabolic perturbations exacerbate ionic shifts during exercise, and (v) how pharmacological manipulation and exercise training regulate ion transport systems to influence exercise performance in humans. © 2021 American Physiological Society. Compr Physiol 11:1895-1959, 2021.

Type 2 Diabetes Mellitus Patients Manifest Greater Muscle Fatigability Than Healthy Individuals During Dynamic Fatigue Protocol

OBJECTIVE

The present study aimed to investigate the electromyographic (EMG) indices of muscle fatigue along with biochemical marker of fatigue-that is, blood lactate-during a dynamic fatigue protocol in individuals with type 2 diabetes mellitus (T2DM) vs a healthy control group. Secondarily, it aimed to examine the association between EMG indices of muscle fatigue and blood lactate in these patients.

METHODS

Thirty-four participants took part in the study: 19 individuals with T2DM (age, 53.5 ± 6.85 years) and 15 age-matched healthy controls (age, 50.2 ± 3.55 years). Participants performed a dynamic fatigue protocol consisting of 5 sets of 10 repetitions each at an intensity of the 10-repetition maximum. Surface EMG of the vastus medialis and vastus lateralis muscles was recorded during the dynamic fatigue protocol, and EMG indices such as median frequency (MF), slope of MF (MF_slope), Dimitrov muscle fatigue spectral index, and root-mean-square were evaluated for each contraction across all the 5 sets. Blood lactate concentrations were also assessed 3 times during the fatigue protocol.

RESULTS

Findings revealed that EMG muscle fatigue indices such as MF, MF_slope, and Dimitrov muscle fatigue spectral index were significantly altered in individuals with T2DM vs healthy individuals across the sets and repetitions for both the vastus medialis (P < .001) and vastus lateralis muscles (P < .001). There was a significantly greater rise in blood lactate in individuals with T2DM than in healthy individuals (P < .001), which was not found to be associated with changes in EMG indices of muscle fatigue.

CONCLUSION

Findings suggest the existence of significantly greater fatigue in the knee extensor muscles of individuals with T2DM than healthy individuals.

Effect of Warm-Up and Sodium Bicarbonate Ingestion on 4-km Cycling Time-Trial Performance

PURPOSE

To examine whether an ecologically valid, intermittent, sprint-based warm-up strategy impacted the ergogenic capacity of individualized sodium bicarbonate (NaHCO3) ingestion on 4-km cycling time-trial (TT) performance.

METHODS

A total of 8 male cyclists attended 6 laboratory visits for familiarization, determination of time to peak blood bicarbonate, and 4 × 4-km cycling TTs. Experimental beverages were administered doubleblind. Treatments were conducted in a block-randomized, crossover order: intermittent warm-up + NaHCO3 (IWSB), intermittent warm-up + placebo, control warm-up + NaHCO3 (CWSB), and control warm-up + placebo (CWP). The intermittent warm-up comprised exercise corresponding to lactate threshold (5 min at 50%, 2 min at 60%, 2 min at 80%, 1 min at 100%, and 2 min at 50%) and 3 × 10-second maximal sprints. The control warm-up comprised 16.5 minutes cycling at 150 W. Participants ingested 0.3 g·kg body mass-1 NaHCO3 or 0.03 g·kg body mass-1 sodium chloride (placebo) in 5 mL·kg body mass-1 fluid (3:2, water and sugar-free orange squash). Paired t tests were conducted for TT performance. Hematological data (blood bicarbonate and blood lactate) and gastrointestinal discomfort were analyzed using repeated-measures analysis of variance.

RESULTS

Performance was faster for CWSB versus IWSB (5.0 [6.1] s; P = .052) and CWP (5.8 [6.0] s; P = .03). Pre-TT bicarbonate concentration was elevated for CWSB versus IWSB (+9.3 mmol·L-1; P < .001) and CWP (+7.1 mmol·L-1; P < .001). Post-TT blood lactate concentration was elevated for CWSB versus CWP (+2.52 mmol·L-1; P = .022). Belching was exacerbated pre-warm-up for IWSB versus intermittent warm-up +placebo (P = .046) and CWP (P = .027).

CONCLUSION

An intermittent, sprint-based warm-up mitigated the ergogenic benefits of NaHCO3 ingestion on 4-km cycling TT performance.

Effects of post-exercise sodium bicarbonate ingestion on acid-base balance recovery and time-to-exhaustion running performance: a randomised crossover trial in recreational athletes

This study investigated the effect of post-exercise sodium bicarbonate (NaHCO₃) ingestion on acid-base balance recovery and time-to-exhaustion (TTE) running performance. Eleven male runners (stature, 1.80 ± 0.05 m; body mass, 74.4 ± 6.5 kg; maximal oxygen consumption, 51.7 ± 5.4 mL·kg^-1·min^-1) participated in this randomised, single-blind, counterbalanced and crossover design study. Maximal running velocity (v-V̇O_2max) was identified from a graded exercise test. During experimental trials, participants repeated 100% v-V̇O_2max TTE protocols (TTE1, TTE2) separated by 40 min following the ingestion of either 0.3 g·kg^-1 body mass NaHCO₃ (SB) or 0.03 g·kg^-1 body mass sodium chloride (PLA) at the start of TTE1 recovery. Acid-base balance (blood pH and bicarbonate, HCO₃^-) data were studied at baseline, post-TTE1, after 35 min recovery and post-TTE2. Blood pH and HCO₃^- concentration were unchanged at 35 min recovery (p > 0.05), but HCO₃^- concentration was elevated post-TTE2 for SB vs. PLA (+2.6 mmol·L^-1; p = 0.005; g = 0.99). No significant differences were observed for TTE2 performance (p > 0.05), although a moderate effect size was present for SB vs. PLA (+14.3 s; g = 0.56). Post-exercise NaHCO₃ ingestion is not an effective strategy for accelerating the restoration of acid-base balance or improving subsequent TTE performance when limited recovery is available. Novelty: Post-exercise sodium bicarbonate ingestion did not accelerate the restoration of blood pH or bicarbonate after 35 min. Performance enhancing effects of sodium bicarbonate ingestion may display a high degree of inter-individual variation. Small-to-moderate changes in performance were likely due to greater up-regulation of glycolytic activation during exercise.

The effect of blood-flow-restricted interval training on lactate and H+ dynamics during dynamic exercise in man

AIM

To assess how blood-flow-restricted (BFR) interval-training affects the capacity of the leg muscles for pH regulation during dynamic exercise in physically trained men.

METHODS

Ten men (age: 25 ± 4y; V ˙ O 2 max : 50 ± 5 mL∙kg^-1 ∙min^-1 ) completed a 6-wk interval-cycling intervention (INT) with one leg under BFR (BFR-leg; ~180 mmHg) and the other without BFR (CON-leg). Before and after INT, thigh net H⁺ -release (lactate-dependent, lactate-independent and sum) and blood acid/base variables were measured during knee-extensor exercise at 25% (Ex25) and 90% (Ex90) of incremental peak power output. A muscle biopsy was collected before and after Ex90 to determine pH, lactate and density of H⁺ -transport/buffering systems.

RESULTS

After INT, net H⁺ release (BFR-leg: 15 ± 2; CON-leg: 13 ± 3; mmol·min^-1 ; Mean ± 95% CI), net lactate-independent H⁺ release (BFR-leg: 8 ± 1; CON-leg: 4 ± 1; mmol·min^-1 ) and net lactate-dependent H⁺ release (BFR-leg: 9 ± 3; CON-leg: 10 ± 3; mmol·min^-1 ) were similar between legs during Ex90 (P > .05), despite a ~142% lower muscle intracellular-to-interstitial lactate gradient in BFR-leg (-3 ± 4 vs 6 ± 6 mmol·L^-1 ; P < .05). In recovery from Ex90, net lactate-dependent H⁺ efflux decreased in BFR-leg with INT (P < .05 vs CON-leg) owing to lowered muscle lactate production (~58% vs CON-leg, P < .05). Net H⁺ gradient was not different between legs (~19%, P > .05; BFR-leg: 48 ± 30; CON-leg: 44 ± 23; mmol·L^-1 ). In BFR-leg, NHE1 density was higher than in CON-leg (~45%; P < .05) and correlated with total-net H⁺ -release (r = 0.71; P = .031) and lactate-independent H⁺ release (r = 0.74; P = .023) after INT, where arterial [ HCO 3 - ] and standard base excess in Ex25 were higher in BFR-leg than CON-leg.

CONCLUSION

Compared to a training control, BFR-interval training increases the capacity for pH regulation during dynamic exercise mainly via enhancement of muscle lactate-dependent H⁺ -transport function and blood H⁺ -buffering capacity.

In vivo muscle function and energetics in women with sickle cell anemia or trait: a 31P-magnetic resonance spectroscopy study

Sickle cell anemia (SCA) is a genetic hemoglobinopathy associated with an impaired oxygen delivery to skeletal muscle that could alter ATP production processes and increase intramuscular acidosis. These alterations have been already reported in the Townes mouse model of SCA but the corresponding changes in humans have not been documented. In the present study, we used 31-phosphorus magnetic resonance spectroscopy to investigate in vivo the metabolic changes induced by a moderate-intensity exercise in twelve SCA patients, eight sickle cell trait (SCT) carriers, and twelve controls women. The rest-exercise-recovery protocol disclosed slight differences regarding phosphocreatine (PCr) consumption and lactate accumulation between SCA patients and controls but these differences did not reach a statistical significance. On that basis, the in vivo metabolic changes associated with a moderate-intensity muscle exercise were slightly altered in SCA patients and SCT carriers but within a normal range. The present results strongly support the fact that a moderate-intensity exercise is safe and could be recommended in stable SCA patients and SCT subjects.NEW & NOTEWORTHY The main finding of the present study was that the metabolic changes associated with a moderate-intensity muscle exercise were slightly modified in stable sickle cell anemia patients and sickle cell trait carriers as compared to controls but still in the normal range. The present results strongly support the safety of a moderate-intensity exercise for stable sickle cell anemia patients and sickle cell trait carriers.

Evidence-based post exercise recovery in combat sports: a narrative review

INTRODUCTION

Some methods such as ergo nutritional aids, cooling or massage among others could improve recovery in combat sports (CS). The effects, doses, duration, and timing of these methods remains unknown. Nowadays, there is no clear consensus regarding the recovery strategies and it is necessary to understand the type of fatigue induced in CS and its underlying mechanisms. The main aim of this article is to review the update literature related to recovery strategies in CS.

EVIDENCE ACQUISITION

A literature search was conducted following preferred reporting items for review statement on the topic of: "combat sports," "recovery," "nutrition," "fatigue," "ergogenic aids," "weight cutting" and "hydration."

EVIDENCE SYNTHESIS

The initial search of the literature detected 369 articles about CS. Later, 307 were excluded after being determined unrelated to recovery or after failure to fulfill the inclusion criteria. Of the 80 included articles, 19 satisfied the final inclusion criteria.

CONCLUSIONS

To optimize CS performance, adequate recovery is required during training and competition processes. Traditional ergo nutritional supplementation of carbohydrates and proteins combined. Besides, the consumption of evidence supported supplementation (green tea, beetroot gels, creatine or alkaline water) improve recovery processes. Further methods of recovery including physical (cold water immersion, massage or photobiomodulation) and physiological (types of active recovery, sleep and rest) therapies have also been shown useful. This narrative review elucidates the important role of recovery techniques in CS.

Acute effect of inspiratory resistive loading on sprint interval exercise performance in team-sport athletes

This study examined acute effects of inspiratory resistive loading (IRL) during rest intervals on sprint interval exercise (SIE) performance. In a randomized crossover design, nine collegiate basketball players performed IRL (15 cmH₂O) or passive recovery (CON) at 5-min rest intervals during and immediately after 6 sets of a 30-s SIE test. Performance, muscular oxygenation of vastus lateralis, blood lactate and pH were measured at each condition. Blood lactate at 5-min (-20.5 %) and 20-min (-21.3 %) after SIE were significantly lower in IRL than in CON. The pH at 5-min after SIE was significantly higher in IRL than in CON (+0.8 %, p <  0.05). However, the total work in IRL was significantly lower than in CON (-2.7 %, p <  0.05). Average changes in total hemoglobin at rest intervals in IRL were significantly lower than in CON (-34.5 %, p <  0.05). The IRL could attenuate exercise-induced metabolic acidosis; however, the decreased blood flow at rest intervals might increase the physical challenge in SIE.

Early pH Changes in Musculoskeletal Tissues upon Injury-Aerobic Catabolic Pathway Activity Linked to Inter-Individual Differences in Local pH

Local pH is stated to acidify after bone fracture. However, the time course and degree of acidification remain unknown. Whether the acidification pattern within a fracture hematoma is applicable to adjacent muscle hematoma or is exclusive to this regenerative tissue has not been studied to date. Thus, in this study, we aimed to unravel the extent and pattern of acidification in vivo during the early phase post musculoskeletal injury. Local pH changes after fracture and muscle trauma were measured simultaneously in two pre-clinical animal models (sheep/rats) immediately after and up to 48 h post injury. The rat fracture hematoma was further analyzed histologically and metabolomically. In vivo pH measurements in bone and muscle hematoma revealed a local acidification in both animal models, yielding mean pH values in rats of 6.69 and 6.89, with pronounced intra- and inter-individual differences. The metabolomic analysis of the hematomas indicated a link between reduction in tricarboxylic acid cycle activity and pH, thus, metabolic activity within the injured tissues could be causative for the different pH values. The significant acidification within the early musculoskeletal hematoma could enable the employment of the pH for novel, sought-after treatments that allow for spatially and temporally controlled drug release.

Ischemic Preconditioning Improves Strength Endurance Performance

Carvalho, L and Barroso, R. Ischemic preconditioning improves strength endurance performance. J Strength Cond Res 33(12): 3332-3337, 2019-Ischemic preconditioning (IPC) has been used to improve performances in aerobic and anaerobic activities. However, a few studies aimed at observing the effects of IPC on resistance training. The purpose of this study is to examine the effects of IPC on the number of repetitions performed during high-load resistance training. We also aimed at investigating blood lactate concentration and muscle activation in an attempt to understand the physiological mechanisms that may be caused by IPC. Ten resistance-trained participants performed four 5-minute cycles of either IPC (250 mm Hg) or Placebo (10 mm Hg) before performing a single set to failure of knee extension exercise with 85% of 1 repetition maximum. We also assessed muscle activation during the set (EMGRMS), median power frequency (EMGMPF), and blood lactate concentration before, 3, 7, and 11 minutes after (peak value was identified and used to calculate delta to prevalues, Δlactate). Data are presented as mean, 90% confidence intervals (CIs), and were analyzed with paired t-test. The level of significance was set at p < 0.05. Participants performed on average 3.9 repetitions (90% CI = 2.4-5.4; p = 0.01), which is ∼20%, more in the IPC condition. There were no significant differences between IPC and Placebo for EMGMPF (5.0%; 90% CI = -5.2 to 15; p = 0.50), EMGRMS (4.5%; 90% CI = -8.8 to 17; p = 0.78), and Δlactate (44%; 90% CI = 11-144; p = 0.16). Our results demonstrate the effect of IPC just on the number of repetitions performed in high-load resistance exercise compared with the Placebo condition.

Carnitine in Human Muscle Bioenergetics: Can Carnitine Supplementation Improve Physical Exercise?

l-Carnitine is an amino acid derivative widely known for its involvement in the transport of long-chain fatty acids into the mitochondrial matrix, where fatty acid oxidation occurs. Moreover, l-Carnitine protects the cell from acyl-CoA accretion through the generation of acylcarnitines. Circulating carnitine is mainly supplied by animal-based food products and to a lesser extent by endogenous biosynthesis in the liver and kidney. Human muscle contains high amounts of carnitine but it depends on the uptake of this compound from the bloodstream, due to muscle inability to synthesize carnitine. Mitochondrial fatty acid oxidation represents an important energy source for muscle metabolism particularly during physical exercise. However, especially during high-intensity exercise, this process seems to be limited by the mitochondrial availability of free l-carnitine. Hence, fatty acid oxidation rapidly declines, increasing exercise intensity from moderate to high. Considering the important role of fatty acids in muscle bioenergetics, and the limiting effect of free carnitine in fatty acid oxidation during endurance exercise, l-carnitine supplementation has been hypothesized to improve exercise performance. So far, the question of the role of l-carnitine supplementation on muscle performance has not definitively been clarified. Differences in exercise intensity, training or conditioning of the subjects, amount of l-carnitine administered, route and timing of administration relative to the exercise led to different experimental results. In this review, we will describe the role of l-carnitine in muscle energetics and the main causes that led to conflicting data on the use of l-carnitine as a supplement.

Post-exercise Supplementation of Sodium Bicarbonate Improves Acid Base Balance Recovery and Subsequent High-Intensity Boxing Specific Performance

The aim of this study was to assess the effects of post-exercise sodium bicarbonate (NaHCO₃) ingestion (0.3 g.kg⁻¹ body mass) on the recovery of acid-base balance (pH, HCO3-, and the SID) and subsequent exercise performance in elite boxers. Seven elite male professional boxers performed an initial bout of exhaustive exercise comprising of a boxing specific high-intensity interval running (HIIR) protocol, followed by a high-intensity run to volitional exhaustion (T_LIM1). A 75 min passive recovery then ensued, whereby after 10 min recovery, participants ingested either 0.3 g.kg⁻¹ body mass NaHCO₃, or 0.1 g.kg⁻¹ body mass sodium chloride (PLA). Solutions were taste matched and administered double-blind. Participants then completed a boxing specific punch combination protocol, followed by a second high-intensity run to volitional exhaustion (T_LIM2). Both initial bouts of T_LIM1 were well matched between PLA and NaHCO₃ (ICC; r = 0.94, p = 0.002). The change in performance from T_LIM1 to T_LIM2 was greater following NaHCO₃ compared to PLA (+164 ± 90 vs. +73 ± 78 sec; p = 0.02, CI = 45.1, 428.8, g = 1.0). Following ingestion of NaHCO₃, pH was greater prior to T_LIM2 by 0.11 ± 0.02 units (1.4%) (p < 0.001, CI = 0.09, 0.13, g = 3.4), whilst HCO3- was greater by 8.8 ± 1.5 mmol.l⁻¹ (26.3%) compared to PLA (p < 0.001, CI = 7.3, 10.2, g = 5.1). The current study suggests that these significant increases in acid base balance during post-exercise recovery facilitated the improvement in the subsequent bout of exercise. Future research should continue to explore the role of NaHCO₃ supplementation as a recovery aid in boxing and other combat sports.

N-acetyl-L-cysteine Prevents Lactate-Mediated PGC1-alpha Expression in C2C12 Myotubes

Background: Exercise induces many physiological adaptations. Recently, it has been proposed that some of these adaptations are induced by exercise-mediated lactate production. In this study, we aimed to investigate in vitro the effect of lactate in cultured myotubes and whether antioxidants could inhibit the effect. Methods: Differentiated myotubes were cultured at different concentrations of L-lactate (0, 10, 30, 50 mM) in the absence or presence of an antioxidant, N-acetyl-L-cysteine (Nac). The temporal effect of lactate exposure in myotubes was also explored. Results: Two hours of exposure to 50 mM L-lactate and six hours of exposure to 30 or 50 mM L-lactate caused a significant increase in PGC1-alpha (peroxisome proliferator-activated receptor γ coactivator-1α) expression in the myotubes. This up-regulation was suppressed by 2 mM Nac. Intermittent and continuous lactate exposure caused similar PGC1-alpha up-regulation. These results suggest that the increase in PGC1-alpha expression is mediated by reactive oxygen species (ROS) production from lactate metabolism and that both continuous and intermittent exposure to L-lactate can cause the up-regulation.

Blood Biomarkers in Sports Medicine and Performance and the Future of Metabolomics

The field of sports medicine and performance has undergone an important transformation in the past years where the scientific approach is becoming increasingly more important for teams and athletes. Physical and physiological fitness, nutrition, fatigue and recovery, as well as injury prevention are key elements of the scientific monitoring of athletes nowadays. Many different methods are used nowadays as part of the scientific monitoring and testing of the competitive athlete. Among them, physiological and metabolic testing, biomechanical and movement assessments, GPS-based tracking systems, heart rate monitors, power meters, and training software are an integrative part of the scientific monitor program of many teams and athletes.Blood biomarkers through traditional blood analysis have been used for over three decades (mainly in Europe) to monitor athletic performance. In the same manner that different cells in the body respond to the stress of an infection or a disease, cells in athletes respond to the stress of competition and training. Nowadays, the area of blood biomarkers is an emerging field in the US offering important level of possibilities to monitor athletes. The field of metabolomics can offer a significantly higher level of blood biomarkers for sports medicine and performance monitoring.

Acute caffeine supplementation in combat sports: a systematic review

Caffeine used as a supplement has been shown to improve physical and cognitive performance in several sport modalities due to its effects on the central nervous system. This review assesses the direct effects of caffeine supplementation on performance in combat sports. Using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines, relevant studies were identified through the Medline, Scopus and SPORTDiscus databases. Of 1053 search results, only 9 articles fulfilled the inclusion criteria. Of these, three studies detected no ergogenic effect of caffeine supplementation, while six studies did observe a significant positive effect. Supplementation with 3-6 mg/kg of caffeine was found to increase the glycolytic contribution to energy metabolism during the execution of real or simulated combats, as indicated by elevated blood lactate concentrations. Caffeine intake was also noted to improve levels of strength, power and upper arm muscular endurance. These effects were not paralleled by an increase in the exertion perceived by the athlete.

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

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

Chronic Ketogenic Low Carbohydrate High Fat Diet Has Minimal Effects on Acid-Base Status in Elite Athletes

Although short (up to 3 days) exposure to major shifts in macronutrient intake appears to alter acid-base status, the effects of sustained (>1 week) interventions in elite athletes has not been determined. Using a non-randomized, parallel design, we examined the effect of adaptations to 21 days of a ketogenic low carbohydrate high fat (LCHF) or periodized carbohydrate (PCHO) diet on pre- and post-exercise blood pH, and concentrations of bicarbonate (HCO₃-) and lactate (La-) in comparison to a high carbohydrate (HCHO) control. Twenty-four (17 male and 7 female) elite-level race walkers completed 21 days of either LCHF (n = 9), PCHO (n = 7), or HCHO (n = 8) under controlled diet and training conditions. At baseline and post-intervention, blood pH, blood [HCO₃-], and blood [La-] were measured before and after a graded exercise test. Net endogenous acid production (NEAP) over the previous 48-72 h was also calculated from monitored dietary intake. LCHF was not associated with significant differences in blood pH, [HCO₃-], or [La-], compared with the HCHO diet pre- or post-exercise, despite a significantly higher NEAP (mEq·day-1) (95% CI = [10.44; 36.04]). Our results indicate that chronic dietary interventions are unlikely to influence acid-base status in elite athletes, which may be due to pre-existing training adaptations, such as an enhanced buffering capacity, or the actions of respiratory and renal pathways, which have a greater influence on regulation of acid-base status than nutritional intake.

Effects of beetroot juice supplementation on intermittent high-intensity exercise efforts

Beetroot juice contains high levels of inorganic nitrate (NO3-) and its intake has proved effective at increasing blood nitric oxide (NO) concentrations. Given the effects of NO in promoting vasodilation and blood flow with beneficial impacts on muscle contraction, several studies have detected an ergogenic effect of beetroot juice supplementation on exercise efforts with high oxidative energy metabolism demands. However, only a scarce yet growing number of investigations have sought to assess the effects of this supplement on performance at high-intensity exercise. Here we review the few studies that have addressed this issue. The databases Dialnet, Elsevier, Medline, Pubmed and Web of Science were searched for articles in English, Portuguese and Spanish published from 2010 to March 31 to 2017 using the keywords: beet or beetroot or nitrate or nitrite and supplement or supplementation or nutrition or "sport nutrition" and exercise or sport or "physical activity" or effort or athlete. Nine articles fulfilling the inclusion criteria were identified. Results indicate that beetroot juice given as a single dose or over a few days may improve performance at intermittent, high-intensity efforts with short rest periods. The improvements observed were attributed to faster phosphocreatine resynthesis which could delay its depletion during repetitive exercise efforts. In addition, beetroot juice supplementation could improve muscle power output via a mechanism involving a faster muscle shortening velocity. The findings of some studies also suggested improved indicators of muscular fatigue, though the mechanism involved in this effect remains unclear.

Moderate and intense muscular exercises induce marked intramyocellular metabolic acidosis in sickle cell disease mice

Sickle cell disease (SCD) is associated with an impaired oxygen delivery to skeletal muscle that could alter ATP production processes. The present study aimed to determine the effects of sickle hemoglobin (HbS) on muscle pH homeostasis in response to exercise in homozygous (HbSS, n = 9) and heterozygous (HbAS, n = 10) SCD (Townes) mice in comparison to control (HbAA, n = 10) littermates. Magnetic resonance spectroscopy of phosphorus 31 enabled to measure intramuscular pH and phosphocreatine (PCr) concentration during rest-stimulation-recovery protocols at two different intensities. Maximal activity of some enzymes involved in muscle energetics and content of proteins involved in pH regulation were also investigated. HbSS mice presented a more pronounced exercise-induced intramuscular acidosis, whatever the intensity of exercise. Moreover, the depletion of PCr was also exacerbated in HbSS mice in response to intense exercise as compared with both HbAA and HbAS mice ( P < 0.01). While no difference was observed concerning proteins involved in muscle pH regulation, the activity of enolase (a glycolytic enzyme) was higher in both HbSS and HbAS mice as compared with controls ( P < 0.05). Interestingly, HbAS mice presented also metabolic impairments as compared with their control counterparts. This study has identified for the first time an exacerbated exercise-induced intramuscular acidosis in SCD mice.

NEW & NOTEWORTHY The main finding of the present study was that the exercise-induced intramuscular acidosis was systematically more pronounced in sickle cell disease (SCD) mice as compared with their control counterparts. This result is important since it has been demonstrated in vitro that acidosis can trigger hemoglobin polymerization. From that point of view, our results tend to support the idea that high-intensity exercise may increase the risk of hemoglobin polymerization in SCD.

Role of MCT1 and CAII in skeletal muscle pH homeostasis, energetics, and function: in vivo insights from MCT1 haploinsufficient mice

The purpose of this study was to investigate the effects of a partial suppression of monocarboxylate transporter (MCT)-1 on skeletal muscle pH, energetics, and function (MCT1^+/- mice). Twenty-four MCT1^+/- and 13 wild-type (WT) mice were subjected to a rest-exercise-recovery protocol, allowing assessment of muscle energetics (by magnetic resonance spectroscopy) and function. The study included analysis of enzyme activities and content of protein involved in pH regulation. Skeletal muscle of MCT1^+/- mice had lower MCT1 (-61%; P < 0.05) and carbonic anhydrase (CA)-II (-54%; P < 0.05) contents. Although intramuscular pH was higher in MCT1^+/- mice at rest (P < 0.001), the mice showed higher acidosis during the first minute of exercise (P < 0.01). Then, the pH time course was similar among groups until exercise completion. MCT1^+/- mice had higher specific peak (P < 0.05) and maximum tetanic (P < 0.01) forces and lower fatigability (P < 0.001) when compared to WT mice. We conclude that both MCT1 and CAII are involved in the homeostatic control of pH in skeletal muscle, both at rest and at the onset of exercise. The improved muscle function and resistance to fatigue in MCT1^+/- mice remain unexplained.-Chatel, B., Bendahan, D., Hourdé, C., Pellerin, L., Lengacher, S., Magistretti, P., Fur, Y. L., Vilmen, C., Bernard, M., Messonnier, L. A. Role of MCT1 and CAII in skeletal muscle pH homeostasis, energetics, and function: in vivo insights from MCT1 haploinsufficient mice.

Limitations in intense exercise performance of athletes - effect of speed endurance training on ion handling and fatigue development

Mechanisms underlying fatigue development and limitations for performance during intense exercise have been intensively studied during the past couple of decades. Fatigue development may involve several interacting factors and depends on type of exercise undertaken and training level of the individual. Intense exercise (½-6 min) causes major ionic perturbations (Ca²⁺ , Cl^- , H⁺ , K⁺ , lactate^- and Na⁺ ) that may reduce sarcolemmal excitability, Ca²⁺ release and force production of skeletal muscle. Maintenance of ion homeostasis is thus essential to sustain force production and power output during intense exercise. Regular speed endurance training (SET), i.e. exercise performed at intensities above that corresponding to maximum oxygen consumption (V̇O2, max ), enhances intense exercise performance. However, most of the studies that have provided mechanistic insight into the beneficial effects of SET have been conducted in untrained and recreationally active individuals, making extrapolation towards athletes' performance difficult. Nevertheless, recent studies indicate that only a few weeks of SET enhances intense exercise performance in highly trained individuals. In these studies, the enhanced performance was not associated with changes in V̇O2, max and muscle oxidative capacity, but rather with adaptations in muscle ion handling, including lowered interstitial concentrations of K⁺ during and in recovery from intense exercise, improved lactate^- -H⁺ transport and H⁺ regulation, and enhanced Ca²⁺ release function. The purpose of this Topical Review is to provide an overview of the effect of SET and to discuss potential mechanisms underlying enhancements in performance induced by SET in already well-trained individuals with special emphasis on ion handling in skeletal muscle.

Lactate as a Signaling Molecule That Regulates Exercise-Induced Adaptations

Lactate (or its protonated form: lactic acid) has been studied by many exercise scientists. The lactate paradigm has been in constant change since lactate was first discovered in 1780. For many years, it was unfairly seen as primarily responsible for muscular fatigue during exercise and a waste product of glycolysis. The status of lactate has slowly changed to an energy source, and in the last two decades new evidence suggests that lactate may play a much bigger role than was previously believed: many adaptations to exercise may be mediated in some way by lactate. The mechanisms behind these adaptations are yet to be understood. The aim of this review is to present the state of lactate science, focusing on how this molecule may mediate exercise-induced adaptations.

Airflow-Restricting Mask Reduces Acute Performance in Resistance Exercise

BACKGROUND

The aim of this study was to compare the number of repetitions to volitional failure, the blood lactate concentration, and the perceived exertion to resistance training with and without an airflow-restricting mask.

METHODS

Eight participants participated in a randomized, counterbalanced, crossover study. Participants were assigned to an airflow-restricting mask group (MASK) or a control group (CONT) and completed five sets of chest presses and parallel squats until failure at 75% one-repetition-maximum test (1RM) with 60 s of rest between sets. Ratings of perceived exertion (RPEs), blood lactate concentrations (Lac^-), and total repetitions were taken after the training session.

RESULTS

MASK total repetitions were lower than those of the CONT, and (Lac^-) and MASK RPEs were higher than those of the CONT in both exercises.

CONCLUSIONS

We conclude that an airflow-restricting mask in combination with resistance training increase perceptions of exertion and decrease muscular performance and lactate concentrations when compared to resistance training without this accessory. This evidence shows that the airflow-restricting mask may change the central nervous system and stop the exercise beforehand to prevent some biological damage.

Nutritional Strategies to Modulate Intracellular and Extracellular Buffering Capacity During High-Intensity Exercise

Intramuscular acidosis is a contributing factor to fatigue during high-intensity exercise. Many nutritional strategies aiming to increase intra- and extracellular buffering capacity have been investigated. Among these, supplementation of beta-alanine (~3–6.4 g/day for 4 weeks or longer), the rate-limiting factor to the intramuscular synthesis of carnosine (i.e. an intracellular buffer), has been shown to result in positive effects on exercise performance in which acidosis is a contributing factor to fatigue. Furthermore, sodium bicarbonate, sodium citrate and sodium/calcium lactate supplementation have been employed in an attempt to increase the extracellular buffering capacity. Although all attempts have increased blood bicarbonate concentrations, evidence indicates that sodium bicarbonate (0.3 g/kg body mass) is the most effective in improving high-intensity exercise performance. The evidence supporting the ergogenic effects of sodium citrate and lactate remain weak. These nutritional strategies are not without side effects, as gastrointestinal distress is often associated with the effective doses of sodium bicarbonate, sodium citrate and calcium lactate. Similarly, paresthesia (i.e. tingling sensation of the skin) is currently the only known side effect associated with beta-alanine supplementation, and it is caused by the acute elevation in plasma beta-alanine concentration after a single dose of beta-alanine. Finally, the co-supplementation of beta-alanine and sodium bicarbonate may result in additive ergogenic gains during high-intensity exercise, although studies are required to investigate this combination in a wide range of sports.

Lactate recovery kinetics in response to high-intensity exercises

PURPOSE

The aim of this study was to investigate lactate recovery kinetics after high-intensity exercises.

METHODS

Six competitive middle-distance runners performed 500-, 1000-, and 1500-m trials at 90 % of their current maximal speed over 1500 m. Each event was followed by a passive recovery to obtain blood lactate recovery curves (BLRC). BLRC were fitted by the bi-exponential time function: La(t) = La(0) + A 1(1-e (-γ1t) ) + A 2(1-e (-γ2t) ), where La(0) is the blood lactate concentration at exercise completion, and γ 1 and γ 2 enlighten the lactate exchange ability between the previously active muscles and the blood and the overall lactate removal ability, respectively. Applications of the model provided parameters related to lactate release, removal and accumulation rates at exercise completion, and net amount of lactate released during recovery.

RESULTS

The increase of running distance was accompanied by (1) a continuous decrease in γ 1 (p < 0.05), (2) a primary decrease (p < 0.05) and then a stabilization of γ 2, and (3) a constant increase in blood concentrations (p < 0.05) and whole body accumulation of lactate (p < 0.05). Estimated net lactate release, removal and accumulation rates at exercise completion, as well as the net amount of lactate released during recovery were not significantly altered by distance.

CONCLUSION

Alterations of lactate exchange and removal abilities have presumably been compensated by an increase in muscle-to-blood lactate gradient and blood lactate concentrations, respectively, so that estimated lactate release, removal and accumulation rates remained almost stable as distance increased.

Muscle MCT4 Content Is Correlated with the Lactate Removal Ability during Recovery Following All-Out Supramaximal Exercise in Highly-Trained Rowers

The purpose of this study was to test if the lactate exchange (γ₁) and removal (γ₂) abilities during recovery following short all-out supramaximal exercise correlate with the muscle content of MCT1 and MCT4, the two isoforms of the monocarboxylate transporters family involved in lactate and H⁺ co-transport in skeletal muscle. Eighteen lightweight rowers completed a 3-min all-out exercise on rowing ergometer. Blood lactate samples were collected during the subsequent passive recovery to assess an individual blood lactate curve (IBLC). IBLC were fitted to the bi-exponential time function: La(t) = [La](0) + A₁(1 − e-γ1t) + A₂(1 − e-γ2t) where [La](0) is the blood lactate concentration at exercise completion and the velocity constants γ₁ and γ₂ denote the lactate exchange and removal abilities, respectively. An application of the bi-compartmental model of lactate distribution space allowed estimation of the lactate removal rate at exercise completion [LRR(0)]. Biopsy of the right vastus lateralis was taken at rest to measure muscle MCT1 and MCT4 content. Fiber type distribution, activity of key enzymes and capillary density (CD) were also assessed. γ₁ was correlated with [La](0) (r = −0.54, P < 0.05) but not with MCT1, MCT4 or CD. γ₂ and LRR(0) were correlated with MCT4 (r = 0.63, P < 0.01 and r = 0.73, P < 0.001, respectively) but not with MCT1 or cytochrome c oxidase activity. These findings suggest that the lactate exchange ability is highly dependent on the milieu so that the importance of the muscle MCT1 and MCT4 content in γ₁ was hidden in the present study. Our results also suggest that during recovery following all-out supramaximal exercise in well-trained rowers, MCT4 might play a significant role in the distribution and delivery of lactate for its subsequent removal.

Physiological responses at the lactate-minimum-intensity with and without prior high-intensity exercise

This study examined the physiological responses during exercise-to-exhaustion at the lactate-minimum-intensity with and without prior high-intensity exercise. Eleven recreationally trained males performed a graded exercise test, a lactate minimum test and two constant-load tests at lactate-minimum-intensity until exhaustion, which were applied with or without prior hyperlactatemia induction (i.e., 30-s Wingate test). The physiological responses were significantly different (P < 0.05) between constant-load tests for pulmonary ventilation ([Formula: see text]), blood-lactate-concentration ([La(-)]), pH, bicarbonate concentration ([HCO3]) and partial pressure of carbon dioxide during the initial minutes. The comparisons within constant-load tests showed steady state behaviour for oxygen uptake and the respiratory exchange ratio, but heart rate and rating of perceived exertion increased significantly during both exercise conditions, while the [Formula: see text] increased only during constant-load effort. During effort performed after high-intensity exercise: [Formula: see text], [La(-)], pH and [HCO3] differed at the start of exercise compared to another condition but were similar at the end (P > 0.05). In conclusion, the constant-load exercises performed at lactate-minimum-intensity with or without prior high-intensity exercise did not lead to the steady state of all analysed parameters; however, variables such as [La(-)], pH and [HCO3] - altered at the beginning of effort performed after high-intensity exercise - were reestablished after approximately 30 min of exercise.

Effects of G-trainer, cycle ergometry, and stretching on physiological and psychological recovery from endurance exercise

The purpose of this study was to compare the effectiveness of 3 treatment modes (Anti-Gravity Treadmill [G-trainer], stationary cycling [CompuTrainer], and static stretching) on the physiological and psychological recovery after an acute bout of exhaustive exercise. In a crossover design, 12 aerobically trained men (21.3 ± 2.3 years, 72.1 ± 8.1 kg, 178.4 ± 6.3 cm, (Equation is included in full-text article.): 53.7 ± 6.3 ml·kg·min) completed a 29-km stationary cycling time trial. Immediately after the time trial, subjects completed 30 minutes of G-trainer or CompuTrainer (40% (Equation is included in full-text article.)) or static stretching exercises. A significant time effect was detected for plasma lactate (p = 0.010) and serum cortisol (p = 0.039) after exercise. No treatment or treatment by time interaction was identified for lactate or cortisol, respectively. No main effects for time, treatment, or treatment by time interaction were identified for interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α). No differences were observed among treatments in skeletal muscle peak power output, mean power output, time to peak power, and rate to fatigue at 24 hours postexercise bout. Finally, no significant changes in mood status were observed after exercise and between treatment groups. When compared with stationary cycling and static stretching, exercise recovery performed on the G-trainer was unable to reduce systemic markers of stress and inflammation, blood lactate, or improve anaerobic performance and psychological mood states after an exhaustive bout of endurance exercise. Further research is warranted that includes individualized recovery modalities to create balances between the stresses of training and competition.

Increased Carbonic Anhydrase Activity is Associated with Sleep Apnea Severity and Related Hypoxemia

STUDY OBJECTIVES

The catalytic function of the enzyme carbonic anhydrase (CA) plays a fundamental role in carbon dioxide (CO2), proton (H(+)), and bicarbonate (HCO3(-)) homeostasis. Hypoxia and tissue acidosis have been proposed to increase physiological CA activity in various compartments of the body. We hypothesized that CA activity in blood is upregulated in patients with obstructive sleep apnea (OSA).

DESIGN

Cross-sectional analysis of a sleep clinic cohort.

SETTINGS

Sleep laboratory at a university hospital.

PARTICIPANTS

Seventy referred patients with suspected OSA (48 males, age 54 ± 13 y, apnea-hypopnea index (AHI) median [interquartile range] 21 [8-41] n/h).

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

In-laboratory cardiorespiratory polygraphy was used to assess OSA. CA activity was determined by an in vitro assay that quantifies the pH change reflecting the conversion of CO2 and H2O to HCO3(-) and H(+). CA activity was positively associated with AHI and 4% oxygen desaturation index (ODI4) (Spearman correlation r = 0.44 and 0.47, both P < 0.001). The associations (CA activity versus logAHI and CA versus logODI4) were independent of sex, age, body mass index, presleep oxygen saturation, nocturnal oxygen saturation, hypertension status, and use of diuretic medication in two generalized linear models (P = 0.007 and 0.011, respectively). Sitting diastolic blood pressure was associated with CA activity after adjustment of sex, age, body mass index, mean oxygen saturation, and AHI (P = 0.046).

CONCLUSIONS

Carbonic anhydrase (CA) activity increased with apnea-hypopnea index and related nocturnal hypoxemia measures in patients with obstructive sleep apnea (OSA). Altered CA activity may constitute a component that modulates respiratory control and hemodynamic regulation in patients with OSA.

Abnormal Lactate Levels Affect Motor Performance in Myotonic Dystrophy Type 1

Myotonic Dystrophy type 1 (DM1) is a dominantly inherited disease comprehending multiple features. Fatigue and exhaustion during exercise often represent significant factors able to negatively influence their compliance to rehabilitation programs. Mitochondrial abnormalities and a significant increase in oxidative markers, previously reported, suggest the hypothesis of a mitochondrial functional impairment. The study aims at evaluating oxidative metabolism efficiency in 18 DM1 patients and in 15 healthy subjects, through analysis of lactate levels at rest and after an incremental exercise test. The exercise protocol consisted of a submaximal incremental exercise performed on an electronically calibrated treadmill, maintained in predominantly aerobic condition. Lactate levels were assessed at rest and at 5, 10 and 30 minutes after the end of the exercise. The results showed early exercise-related fatigue in DM1 patients, as they performed a mean number of 9 steps, while controls completed the whole exercise. Moreover, while resting values of lactate were comparable between the patients and the control group (p=0.69), after the exercise protocol, dystrophic subjects reached higher values of lactate, at any recovery time (p<0,05). These observations suggest an early activation of anaerobic metabolism, thus evidencing an alteration in oxidative metabolism of such dystrophic patients. As far as intense aerobic training could be performed in DM1 patients, in order to improve maximal muscle oxidative capacity and blood lactate removal ability, then, this safe and validate method could be used to evaluate muscle oxidative metabolism and provide an efficient help on rehabilitation programs to be prescribed in such patients.

Repeated sprint performance and metabolic recovery curves: effects of aerobic and anaerobic characteristics

To examine the influence of aerobic and anaerobic indices on repeated sprint (RS) performance and ability (RSA), 8 sprinters (SPR), 8 endurance runners (END), and 8 active participants (ACT) performed the following tests: (i) incremental test; (ii) 1-min test to determine first decay time constant of pulmonary oxygen uptake off-kinetics and parameters related to anaerobic energy supply, lactate exchange, and removal abilities from blood lactate kinetics; and (iii) RS test (ten 35-m sprints, departing every 20 s) to determine best (RSbest) and mean (RSmean) sprint times and percentage of sprint decrement (%Dec). While SPR had a 98%-100% likelihood of having the fastest RSbest (Cohen's d of 1.8 and 1.4 for ACT and END, respectively) and RSmean (2.1 and 0.9 for ACT and END, respectively), END presented a 97%-100% likelihood of having the lowest %Dec (0.9 and 2.2 for ACT and SPR, respectively). RSmean was very largely correlated with RSbest (r=0.85) and moderately correlated with estimates of anaerobic energy supply (r=-0.40 to -0.49). RSmean adjusted for RSbest (which indirectly reflects RSA) was largely correlated with lactate exchange ability (r=0.55). Our results confirm the importance of locomotor- and anaerobic-related variables to RS performance, and highlight the importance of disposal of selected metabolic by-products to RSA.

Neuromuscular responses to simulated brazilian jiu-jitsu fights

The aim of this study was to investigate the neuromuscular performance responses following successive Brazilian Jiu-Jitsu (BJJ) fights. Twenty-three BJJ athletes (age: 26.3 ± 6.3 years; body mass: 79.4 ± 9.7 kg; body height: 1.80 ± 0.1 m) undertook 3 simulated BJJ fights (10 min duration each separated by 15 min of rest). Neuromuscular performance was measured by the bench press throw (BPT) and vertical counter movement jump (VCMJ) tests, assessed before the 1st fight (Pre) and after the last one (Post). Blood lactate (LA) was measured at Pre, 1 min Post, and 15 min Post fights. Paired t-tests were employed in order to compare the BPT and VCMJ results. One-way ANOVA with Bonferroni post hoc tests were utilized to compare LA responses. The results revealed a significant (p < 0.05) increase in VCMJ performance (40.8 ± 5.5 cm Pre vs. 42.0 ± 5.8 cm Post), but no significant changes in the BPT (814 ± 167 W Pre vs. 835 ± 213 W Post) were observed. LA concentration increased significantly (p < 0.05) at Post, both in the 1st min (10.4 ± 2.7 mmol L-1) and the 15th min (6.4 ± 2.5 mmol L-1) of recovery. We concluded that successive simulated BJJ fights demanded considerable anaerobic contribution of ATP supply, reinforcing the high-intensity intermittent nature of the sport. Nevertheless, no negative impact on acute neuromuscular performance (power) was observed.

MCT1 and MCT4 kinetic of mRNA expression in different tissues after aerobic exercise at maximal lactate steady state workload

We evaluate the mRNA expression of monocarboxylate transporters 1 and 4 (MCT1 and MCT4) in skeletal muscle (soleus, red and white gastrocnemius), heart and liver tissues in mice submitted to a single bout of swimming exercise at the maximal lactate steady state workload (MLSSw). After 72 h of MLSS test, the animals were submitted to a swimming exercise session for 25 min at individual MLSSw. Tissues and muscle samples were obtained at rest (control, n=5), immediately (n=5), 5 h (n=5) and 10 h (n=5) after exercise for determination of the MCT1 and MCT4 mRNA expression (RT-PCR). The MCT1 mRNA expression in liver increased after 10 h in relation to the control, immediate and 5 h groups, but the MCT4 remained unchanged. The MCT1 mRNA expression in heart increased by 31 % after 10 h when compared to immediate, but no differences were observed in relation to the control group. No significant differences were observed for red gastrocnemius in MCT1 and MCT4 mRNA expression. However, white gastrocnemius increased MCT1 mRNA expression immediately when compared to rest, 5 and 10 h test groups. In soleus muscle, the MCT1 mRNA expression increased immediately, 5 and 10 h after exercise when compared to the control. In relation to MCT4 mRNA expression, the soleus increased immediately and 10 h after acute exercise when compared to the control group. The soleus, liver and heart were the main tissues that showed improved the MCT1 mRNA expression, indicating its important role in controlling MLSS concentration in mice.

A novel model of chronic wounds: importance of redox imbalance and biofilm-forming bacteria for establishment of chronicity

Chronic wounds have a large impact on health, affecting ∼6.5 M people and costing ∼$25B/year in the US alone. We previously discovered that a genetically modified mouse model displays impaired healing similar to problematic wounds in humans and that sometimes the wounds become chronic. Here we show how and why these impaired wounds become chronic, describe a way whereby we can drive impaired wounds to chronicity at will and propose that the same processes are involved in chronic wound development in humans. We hypothesize that exacerbated levels of oxidative stress are critical for initiation of chronicity. We show that, very early after injury, wounds with impaired healing contain elevated levels of reactive oxygen and nitrogen species and, much like in humans, these levels increase with age. Moreover, the activity of anti-oxidant enzymes is not elevated, leading to buildup of oxidative stress in the wound environment. To induce chronicity, we exacerbated the redox imbalance by further inhibiting the antioxidant enzymes and by infecting the wounds with biofilm-forming bacteria isolated from the chronic wounds that developed naturally in these mice. These wounds do not re-epithelialize, the granulation tissue lacks vascularization and interstitial collagen fibers, they contain an antibiotic-resistant mixed bioflora with biofilm-forming capacity, and they stay open for several weeks. These findings are highly significant because they show for the first time that chronic wounds can be generated in an animal model effectively and consistently. The availability of such a model will significantly propel the field forward because it can be used to develop strategies to regain redox balance that may result in inhibition of biofilm formation and result in restoration of healthy wound tissue. Furthermore, the model can lead to the understanding of other fundamental mechanisms of chronic wound development that can potentially lead to novel therapies.