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Seiler T, Nakas CT, Brill AK, Hefti U, Hilty MP, Perret-Hoigné E, Sailer J, Kabitz HJ, Merz TM, Pichler Hefti J. Do cardiopulmonary exercise tests predict summit success and acute mountain sickness? A prospective observational field study at extreme altitude. Br J Sports Med 2023:bjsports-2022-106211. [PMID: 36898769 DOI: 10.1136/bjsports-2022-106211] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE During a high-altitude expedition, the association of cardiopulmonary exercise testing (CPET) parameters with the risk of developing acute mountain sickness (AMS) and the chance of reaching the summit were investigated. METHODS Thirty-nine subjects underwent maximal CPET at lowlands and during ascent to Mount Himlung Himal (7126 m) at 4844 m, before and after 12 days of acclimatisation, and at 6022 m. Daily records of Lake-Louise-Score (LLS) determined AMS. Participants were categorised as AMS+ if moderate to severe AMS occurred. RESULTS Maximal oxygen uptake (V̇O2max) decreased by 40.5%±13.7% at 6022 m and improved after acclimatisation (all p<0.001). Ventilation at maximal exercise (VEmax) was reduced at 6022 m, but higher VEmax was related to summit success (p=0.031). In the 23 AMS+ subjects (mean LLS 7.4±2.4), a pronounced exercise-induced oxygen desaturation (ΔSpO2exercise) was found after arrival at 4844 m (p=0.005). ΔSpO2exercise >-14.0% identified 74% of participants correctly with a sensitivity of 70% and specificity of 81% for predicting moderate to severe AMS. All 15 summiteers showed higher V̇O2max (p<0.001), and a higher risk of AMS in non-summiteers was suggested but did not reach statistical significance (OR: 3.64 (95% CI: 0.78 to 17.58), p=0.057). V̇O2max ≥49.0 mL/min/kg at lowlands and ≥35.0 mL/min/kg at 4844 m predicted summit success with a sensitivity of 46.7% and 53.3%, and specificity of 83.3% and 91.3%, respectively. CONCLUSION Summiteers were able to sustain higher VEmax throughout the expedition. Baseline V̇O2max below 49.0 mL/min/kg was associated with a high chance of 83.3% for summit failure, when climbing without supplemental oxygen. A pronounced drop of SpO2exercise at 4844 m may identify climbers at higher risk of AMS.
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Affiliation(s)
- Thomas Seiler
- Department of Pulmonary Medicine, Inselspital,Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christos T Nakas
- Institute of Clinical Chemistry, Inselspital University Hospital, University of Bern, Bern, Switzerland.,Laboratory of Biometry, University of Thessaly, Volos, Greece
| | - Anne-Kathrin Brill
- Department of Pulmonary Medicine, Inselspital,Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Hefti
- Swiss Sportclinic, Bern, Switzerland
| | - Matthias Peter Hilty
- Department of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Eveline Perret-Hoigné
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jannis Sailer
- Swiss Sportclinic, Bern, Switzerland.,Orthopedics and Traumatology, Hospital Nidwalden, Stans, Switzerland
| | - Hans-Joachim Kabitz
- Department of Internal Medicine II Pneumology Cardiology Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany
| | - Tobias M Merz
- Cardiovascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, University of Bern, Bern, Switzerland
| | - Jacqueline Pichler Hefti
- Department of Pulmonary Medicine, Inselspital,Bern University Hospital, University of Bern, Bern, Switzerland .,Swiss Sportclinic, Bern, Switzerland
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Chao CC, Chen LH, Lin YC, Wang SH, Wu SH, Li WC, Huang KF, Chiu TF, Kuo IC. Impact of a 3-Day High-Altitude Trek on Xue Mountain (3886 m), Taiwan, on the Emotional States of Children: A Prospective Observational Study. High Alt Med Biol 2018; 20:28-34. [PMID: 30543474 DOI: 10.1089/ham.2018.0086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Changes in emotions associated with mountain treks have rarely been reported. This study examined emotional state changes in sixth-grade elementary school students before and after a 3-day high-altitude mountain trek from the trailhead (2140 m) to Xue Mountain (3886 m) in Taiwan. METHODS In June 2011, 201 students participated in the trek. The round-trip distance was 21.8 km. The age, gender, blood group, and family configuration of the participants were documented before the trek. A 36-item short-form survey instrument, including the Mood and Anxiety Symptom Questionnaire and the Positive and Negative Affect Scale for Children, was used to evaluate the participants' emotional states (happiness, anticipation, sadness, and anger). The participants answered the questionnaires 1 month before and 1 week after the trek. A Likert scale was used to evaluate individual items (range 1-4; from strongly disagree to strongly agree). We calculated scores for each index before and after the trek. The incidence and presentation of acute mountain sickness (AMS) among the participants was also studied and published previously. RESULTS In total, 187 (112 boys and 75 girls) participants (mean age 11.9 ± 0.4 years) completed the trek and the survey. The sadness and anger scores (negative emotions) were significantly lower after than before the trek (39.5 vs. 36.6; p < 0.01). The happiness and anticipation scores (positive emotions) before and after the trek did not differ significantly (49.9 vs. 48.9; p = 0.11). No participant used AMS prophylaxis, while 78 participants met the AMS criteria. Negative emotions decreased more in those with AMS than without AMS (-4.6 vs. -1.8; p = 0.04), and the use of medications or acetazolamide did not alter the emotions. CONCLUSIONS A 3-day high-altitude mountain trek can reduce children's negative emotions. Negative emotions decreased more in those with AMS, whereas medications or acetazolamide did not alter their emotions.
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Affiliation(s)
- Chun-Chieh Chao
- 1 Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University , Taipei, Taiwan .,2 Department of Emergency Medicine, Taipei Medical University Hospital , Taipei, Taiwan .,3 Graduate Institute of Clinical Medicine, School of Medicine, College of Medicine, Taipei Medical University , Taipei, Taiwan
| | - Lung Hung Chen
- 4 Department of Recreation and Leisure Industry Management, College of Management, National Taiwan Sport University , Taoyuan, Taiwan
| | - Yin-Chou Lin
- 5 Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan , Taoyuan, Taiwan
| | - Shih-Hao Wang
- 6 Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Chiayi , Chiayi, Taiwan .,7 Taiwan Wilderness Medical Association , New Taipei City, Taiwan
| | - Shih-Hao Wu
- 8 Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou , Taoyuan, Taiwan .,9 Department of Emergency Medicine, Chang Gung University College of Medicine , Taoyuan, Taiwan
| | - Wen-Cheng Li
- 8 Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou , Taoyuan, Taiwan .,10 Department of Health Management, Xiamen Chang Gung Hospital , Xiamen, China
| | - Kuo-Feng Huang
- 7 Taiwan Wilderness Medical Association , New Taipei City, Taiwan .,11 Department of Physical Education, National Taitung University , Taitung, Taiwan .,12 Department of Emergency Medicine, West Garden Hospital , Taipei, Taiwan
| | - Te-Fa Chiu
- 13 Department of Emergency Medicine, China Medical University Hospital , Taichung, Taiwan .,14 School of Medicine, China Medical University , Taichung, Taiwan
| | - I-Chih Kuo
- 15 Department of Microbiology and Immunology, University of British Columbia , Vancouver, Canada
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Wu Y, Zhang C, Chen Y, Luo YJ. Association between acute mountain sickness (AMS) and age: a meta-analysis. Mil Med Res 2018; 5:14. [PMID: 29747689 PMCID: PMC5946480 DOI: 10.1186/s40779-018-0161-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute mountain sickness (AMS) is a potentially lethal condition caused by acute hypoxia after ascending to altitudes higher than 2500 m in a short time. The main symptom of AMS is headache. Numerous risk factors of AMS have been examined, including gender, obesity, ascent rate, age and individual susceptibility. In previous studies, age was considered a predisposing factor for AMS. However, different opinions have been raised in recent years. To clarify the association between AMS and age, we conducted this meta-analysis. METHODS We obtained observational studies that explored risk factors for AMS by searching PubMed, Embase, China National Knowledge Internet (CNKI), the Wanfang database and CQVIP for articles published before March 2017. The studies included were required to provide the mean age and its standard deviation for subjects with and without AMS, the maximum altitude attained and the mode of ascent. The Lake Louse Score (LLS) or the Chinese AMS score (CAS) was used to judge the severity of AMS symptoms and incidence. Studies were pooled for the analysis by using a random effects model in RevMan 5.0. Meta-regression and subgroup analyses were conducted to identify sources of heterogeneity using Stata 14.2 and RevMan 5.0. RESULTS In total, 17 studies were included, and the overall number of subjects with and without AMS was 1810 and 3014, respectively. The age ranged from 10 to 76 years. Analysis of the 17 included studies showed that age was not associated with AMS (mean difference (MD) = 0.10; 95% CI: -0.38-0.58; P = 0.69). CONCLUSION This meta-analysis suggests that there is no association between age and the risk of AMS. Race, age, and ascent mode are common sources of heterogeneity, which may provide an analytical orientation for future heterogeneity analyses.
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Affiliation(s)
- Yu Wu
- Department of Military Medical Geography, Army Medical Service Training Base, Army Medical University, Chongqing, 400038, China.,Battalion 5 of Cadet Brigade, Army Medical University, Chongqing, 400038, China
| | - Chi Zhang
- Department of Military Medical Geography, Army Medical Service Training Base, Army Medical University, Chongqing, 400038, China.,Key Laboratory of High Altitude Environmental Medicine of PLA, Army Medical University, Chongqing, 400038, China
| | - Yu Chen
- Department of Military Medical Geography, Army Medical Service Training Base, Army Medical University, Chongqing, 400038, China.,Key Laboratory of High Altitude Environmental Medicine of PLA, Army Medical University, Chongqing, 400038, China
| | - Yong-Jun Luo
- Department of Military Medical Geography, Army Medical Service Training Base, Army Medical University, Chongqing, 400038, China. .,Key Laboratory of High Altitude Environmental Medicine of PLA, Army Medical University, Chongqing, 400038, China.
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Abstract
CONTEXT Athletes at different skill levels perform strenuous physical activity at high altitude for a variety of reasons. Multiple team and endurance events are held at high altitude and may place athletes at increased risk for developing acute high altitude illness (AHAI). Training at high altitude has been a routine part of preparation for some of the high level athletes for a long time. There is a general belief that altitude training improves athletic performance for competitive and recreational athletes. EVIDENCE ACQUISITION A review of relevant publications between 1980 and 2015 was completed using PubMed and Google Scholar. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3. RESULTS AHAI is a relatively uncommon and potentially serious condition among travelers to altitudes above 2500 m. The broad term AHAI includes several syndromes such as acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE). Athletes may be at higher risk for developing AHAI due to faster ascent and more vigorous exertion compared with nonathletes. Evidence regarding the effects of altitude training on athletic performance is weak. The natural live high, train low altitude training strategy may provide the best protocol for enhancing endurance performance in elite and subelite athletes. High altitude sports are generally safe for recreational athletes, but they should be aware of their individual risks. CONCLUSION Individualized and appropriate acclimatization is an essential component of injury and illness prevention.
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Affiliation(s)
- Morteza Khodaee
- Department of Family Medicine, University of Colorado School of Medicine, Denver, Colorado
- Morteza Khodaee, MD, MPH, Department of Family Medicine, University of Colorado School of Medicine, AFW Clinic, 3055 Roslyn Street, Denver, CO 80238 ()
| | - Heather L. Grothe
- Department of Family Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Jonathan H. Seyfert
- Department of Family Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Karin VanBaak
- Department of Family Medicine, University of Colorado School of Medicine, Denver, Colorado
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