Impairment of 3000-m run time at altitude is influenced by arterial oxyhemoglobin saturation

Inter-individual variability in peripheral oxygen saturation and repeated sprint performance in hypoxia: an observational study of highly-trained subjects

Individual variations in peripheral oxygen saturation (SpO2) during repeated sprints in hypoxia and their impact on exercise performance remain unclear despite fixed external hypoxic stimuli (inspired oxygen fraction: FiO2). This study examined SpO2 individual variations during repeated sprints in hypoxia and their impact on exercise performance. Thirteen highly-trained sprint runners performed 10 × 10-s cycle sprints with 30-s passive recoveries in normobaric hypoxia (FiO2: 0.150). Mean power output (MPO), post-sprint SpO2, and heart rate for each sprint were assessed. Sprint decrement score (Sdec), evaluating fatigue development, was calculated using MPO variables. Participants were categorized into a high saturation group (HiSat, n = 7) or a low saturation group (LowSat, n = 6) based on their mean post-sprint SpO2 (measured 10-15 s after each sprint). Individual mean post-sprint SpO2 ranged from 91.6% to 82.2%. Mean post-sprint SpO2 was significantly higher (P < 0.001, d = 1.54) in HiSat (89.1% ± 1.5%) than LowSat (84.7% ± 1.6%). A significantly larger decrease in Sdec (P = 0.008, d = 1.68) occurred in LowSat (-22.3% ± 2.3%) compared to HiSat (-17.9% ± 2.5%). MPO (P = 0.342 d = 0.55) and heart rate (P = 0.225 d = 0.67) did not differ between groups. There was a significant correlation (r = 0.61; P = 0.028) between SpO2 and Sdec. In highly-trained sprint runners, individual responses to hypoxia varied widely and significantly affected repeated sprint ability, with greater decreases in SpO2 associated with larger performance alterations (i.e., larger decrease in Sdec).

Effects of three weeks base training at moderate simulated altitude with or without hypoxic residence on exercise capacity and physiological adaptations in well-trained male runners

Objectives

To test the hypothesis that 'live high-base train high-interval train low' (HiHiLo) altitude training, compared to 'live low-train high' (LoHi), yields greater benefits on performance and physiological adaptations.

Methods

Sixteen young male middle-distance runners (age, 17.0 ± 1.5 y; body mass, 58.8 ± 4.9 kg; body height, 176.3 ± 4.3 cm; training years, 3-5 y; training distance per week, 30-60 km.wk-1) with a peak oxygen uptake averaging ~65 ml.min-1.kg-1 trained in a normobaric hypoxia chamber (simulated altitude of ~2,500 m, monitored by heart rate ~170 bpm; thrice weekly) for 3 weeks. During this period, the HiHiLo group (n = 8) stayed in normobaric hypoxia (at ~2,800 m; 10 h.day-1), while the LoHi group (n = 8) resided near sea level. Before and immediately after the intervention, peak oxygen uptake and exercise-induced arterial hypoxemia responses (incremental cycle test) as well as running performance and time-domain heart rate variability (5-km time trial) were assessed. Hematological variables were monitored at baseline and on days 1, 7, 14 and 21 during the intervention.

Results

Peak oxygen uptake and running performance did not differ before and after the intervention in either group (all P > 0.05). Exercise-induced arterial hypoxemia responses, measured both at submaximal (240 W) and maximal loads during the incremental test, and log-transformed root mean square of successive R-R intervals during the 4-min post-run recovery period, did not change (all P > 0.05). Hematocrit, mean reticulocyte absolute count and reticulocyte percentage increased above baseline levels on day 21 of the intervention (all P < 0.001), irrespective of group.

Conclusions

Well-trained runners undertaking base training at moderate simulated altitude for 3 weeks, with or without hypoxic residence, showed no performance improvement, also with unchanged time-domain heart rate variability and exercise-induced arterial hypoxemia responses.

Exercise induced plasma volume expansion lowers cardiovascular strain during 15-km cycling time-trial in acute normobaric hypoxia

The purpose of our study was to assess the influence of a single high-intensity interval exercise (HIIE) bout in normoxia on plasma volume (PV) and consequent cycling performance in normobaric hypoxia (0.15 FiO2, simulating ~2,500 m). Eight males (VO2peak: 48.8 ± 3.4 mL/kg/min, 24.0 ± 1.6 years) completed a hypoxic 15 km cycling time trial (TT), followed by a crossover intervention of either HIIE (8x4 min cycling bouts at 85% of VO2peak) or CON (matched kJ production from HIIE at 50% of VO2peak). 48 hours post intervention, an identical TT was performed. Cardiovascular parameters were measured via impedance cardiography during each TT. Changes in PV was measured 24 and 48 hours post HIIE and CON. HIIE increased PV at 24 (4.1 ± 3.9%, P = 0.031) and 48 (6.7 ± 1.7, P = 0.006) hours post, while no difference was observed following the CON (1.3 ± 1.1% and 0.3 ± 2.8%). The higher PV led to an increased stroke volume (P = 0.03) and cardiac output (P = 0.02) during the hypoxic TT, while heart rate was not changed (P = 0.49). We observed no changes in time to completion (-0.63 ± 0.57 min, P = 0.054) and power output (7.37 ± 7.98 W, P = 0.078) between TTs. In the absence of environmental stress, a single bout of HIIE was an effective strategy to increase PV and reduce the cardiovascular strain during a cycling TT at moderate simulated altitude but did not impact hypoxic exercise performance. Trial registration: Clinical Trials ID: NCT05800808.

Caffeine intake enhances peak oxygen uptake and performance during high-intensity cycling exercise in moderate hypoxia

PURPOSE

We investigated whether caffeine consumption can enhance peak oxygen uptake ([Formula: see text]) by increasing peak ventilation during an incremental cycling test, and subsequently enhance time to exhaustion (TTE) during high-intensity cycling exercise in moderate normobaric hypoxia.

METHODS

We conducted a double-blind, placebo cross-over design study. Sixteen recreational male endurance athletes (age: 20 ± 2 years, [Formula: see text]: 55.6 ± 3.6 ml/kg/min, peak power output: 318 ± 40 W) underwent an incremental cycling test and a TTE test at 80% [Formula: see text] (derived from the placebo trial) in moderate normobaric hypoxia (fraction of inspired O2: 15.3 ± 0.2% corresponding to a simulated altitude of ~ 2500 m) after consuming either a moderate dose of caffeine (6 mg/kg) or a placebo.

RESULTS

Caffeine consumption resulted in a higher peak ventilation [159 ± 21 vs. 150 ± 26 L/min; P < 0.05; effect size (ES) = 0.31]. [Formula: see text] (3.58 ± 0.44 vs. 3.47 ± 0.47 L/min; P < 0.01; ES = 0.44) and peak power output (308 ± 44 vs. 302 ± 44 W; P = 0.02, ES = 0.14) were higher following caffeine consumption than during the placebo trial. During the TTE test, caffeine consumption enhanced minute ventilation (P = 0.02; ES = 0.28) and extended the TTE (426 ± 74 vs. 358 ± 75 s; P < 0.01, ES = 0.91) compared to the placebo trial. There was a positive correlation between the percent increase of [Formula: see text] following caffeine consumption and the percent increase in TTE (r = 0.49, P < 0.05).

CONCLUSION

Moderate caffeine consumption stimulates breathing and aerobic metabolism, resulting in improved performance during incremental and high-intensity endurance exercises in moderate normobaric hypoxia.

Effectiveness, implementation, and monitoring variables of intermittent hypoxic bicycle training in patients recovered from COVID-19: The AEROBICOVID study

Hypoxic exposure is safely associated with exercise for many pathological conditions, providing additional effects on health outcomes. COVID-19 is a new disease, so the physiological repercussions caused by exercise in affected patients and the safety of exposure to hypoxia in these conditions are still unknown. Due to the effects of the disease on the respiratory system and following the sequence of AEROBICOVID research work, this study aimed to evaluate the effectiveness, tolerance and acute safety of 24 bicycle training sessions performed under intermittent hypoxic conditions through analysis of peripheral oxyhemoglobin saturation (SpO₂), heart rate (HR), rate of perceived exertion (RPE), blood lactate concentration ([La^-]) and symptoms of acute mountain sickness in patients recovered from COVID-19. Participants were allocated to three training groups: the normoxia group (G_N) remained in normoxia (inspired fraction of O₂ (FiO₂) of ∼20.9%, a city with 526 m altitude) for the entire session; the recovery hypoxia group (G_HR) was exposed to hypoxia (FiO₂ ∼13.5%, corresponding to 3,000 m altitude) all the time except during the effort; the hypoxia group (G_H) trained in hypoxia (FiO₂ ∼13.5%) throughout the session. The altitude simulation effectively reduced SpO₂ mean with significant differences between groups G_N, G_HR, and G_H, being 96.9(1.6), 95.1(3.1), and 87.7(6.5), respectively. Additionally, the proposed exercise and hypoxic stimulus was well-tolerated, since 93% of participants showed no or moderate acute mountain sickness symptoms; maintained nearly 80% of sets at target heart rate; and most frequently reporting session intensity as an RPE of "3" (moderate). The internal load calculation, analyzed through training impulse (TRIMP), calculated using HR [TRIMP_HR = HR * training volume (min)] and RPE [TRIMP_RPE = RPE * training volume (min)], showed no significant difference between groups. The current strategy effectively promoted the altitude simulation and monitoring variables, being well-tolerated and safely acute exposure, as the low Lake Louise scores and the stable HR, SpO₂, and RPE values showed during the sessions.

Effects of Short-Term Phosphate Loading on Aerobic Capacity under Acute Hypoxia in Cyclists: A Randomized, Placebo-Controlled, Crossover Study

The aim of this study was to evaluate the effects of sodium phosphate (SP) supplementation on aerobic capacity in hypoxia. Twenty-four trained male cyclists received SP (50 mg·kg-1 of FFM/day) or placebo for six days in a randomized, crossover study, with a three-week washout period between supplementation phases. Before and after each supplementation phase, the subjects performed an incremental exercise test to exhaustion in hypoxia (FiO2 = 16%). Additionally, the levels of 2,3-diphosphoglycerate (2,3-DPG), hypoxia-inducible factor 1 alpha (HIF-1α), inorganic phosphate (Pi), calcium (Ca), parathyroid hormone (PTH) and acid-base balance were determined. The results showed that phosphate loading significantly increased the Pi level by 9.0%, whereas 2,3-DPG levels, hemoglobin oxygen affinity, buffering capacity and myocardial efficiency remained unchanged. The aerobic capacity in hypoxia was not improved following SP. Additionally, our data revealed high inter-individual variability in response to SP. Therefore, the participants were grouped as Responders and Non-Responders. In the Responders, a significant increase in aerobic performance in the range of 3-5% was observed. In conclusion, SP supplementation is not an ergogenic aid for aerobic capacity in hypoxia. However, in certain individuals, some benefits can be expected, but mainly in athletes with less training-induced central and/or peripheral adaptation.

Effects of graded hypoxia during exhaustive intermittent cycling on subsequent exercise performance and neuromuscular responses

PURPOSE

This study examined the effect of graded hypoxia during exhaustive intermittent cycling on subsequent exercise performance and neuromuscular fatigue characteristics in normoxia.

METHODS

Fifteen well-trained cyclists performed an exhaustive intermittent cycling exercise (EICE 1; 15 s at 30% of anaerobic power reserve interspersed with 45 s of passive recovery) at sea level (SL; FiO₂ ~ 0.21), moderate (MH; FiO₂ ~ 0.16) and severe hypoxia (SH; FiO₂ ~ 0.12). This was followed, after 30 min of passive recovery in normoxia, by an identical exercise bout in normoxia (EICE 2). Neuromuscular function of the knee extensors was assessed at baseline, after EICE 1 (post-EICE 1), and EICE 2 (post-EICE 2).

RESULTS

The number of efforts completed decreased with increasing hypoxic severity during EICE 1 (SL: 39 ± 30, MH: 22 ± 13, SH: 13 ± 6; p ≤ 0.02), whereas there was no difference between conditions during EICE 2 (SL: 16 ± 9, MH: 20 ± 14, SH: 24 ± 17; p ≥ 0.09). Maximal torque (p = 0.007), peripheral (p = 0.02) and cortical voluntary activation (p < 0.001), and twitch torque (p < 0.001) decreased from baseline to post-EICE 1. Overall, there were no significant difference in any neuromuscular parameters from post-EICE 1 to post-EICE 2 (p ≥ 0.08).

CONCLUSION

Increasing hypoxia severity during exhaustive intermittent cycling hampered exercise capacity, but did not influence performance and associated neuromuscular responses during a subsequent bout of exercise in normoxia performed after 30 min of rest.

Preparing for the Nordic Skiing Events at the Beijing Olympics in 2022: Evidence-Based Recommendations and Unanswered Questions

At the 2022 Winter Olympics in Beijing, the XC skiing, biathlon and nordic combined events will be held at altitudes of ~ 1700 m above sea level, possibly in cold environmental conditions and while requiring adjustment to several time zones. However, the ongoing COVID-19 pandemic may lead to sub-optimal preparations. The current commentary provides the following evidence-based recommendations for the Olympic preparations: make sure to have extensive experience of training (> 60 days annually) and competition at or above the altitude of competition (~ 1700 m), to optimize and individualize your strategies for acclimatization and competition. In preparing for the Olympics, 10-14 days at ~ 1700 m seems to optimize performance at this altitude effectively. An alternative strategy involves two-three weeks of training at > 2000 m, followed by 7-10 days of tapering off at ~ 1700 m. During each of the last 3 or 4 days prior to departure, shift your sleeping and eating schedule by 0.5-1 h towards the time zone in Beijing. In addition, we recommend that you arrive in Beijing one day earlier for each hour change in time zone, followed by appropriate timing of exposure to daylight, meals, social contacts, and naps, in combination with a gradual increase in training load. Optimize your own individual procedures for warming-up, as well as for maintaining body temperature during the period between the warm-up and competition, effective treatment of asthma (if necessary) and pacing at  ~ 1700 m with cold ambient temperatures. Although we hope that these recommendations will be helpful in preparing for the Beijing Olympics in 2022, there is a clear need for more solid evidence gained through new sophisticated experiments and observational studies.

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

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

Altitude Cardiomyopathy Is Associated With Impaired Stress Electrocardiogram and Increased Circulating Inflammation Makers

Many sea-level residents suffer from acute mountain sickness (AMS) when first visiting altitudes above 4,000 m. Exercise tolerance also decreases as altitude increases. We observed exercise capacity at sea level and under a simulated hypobaric hypoxia condition (SHHC) to explore whether the response to exercise intensity represented by physiological variables could predict AMS development in young men. Eighty young men from a military academy underwent a standard treadmill exercise test (TET) and biochemical blood test at sea level, SHHC, and 4,000-m altitude, sequentially, between December 2015 and March 2016. Exercise-related variables and 12-lead electrocardiogram parameters were obtained. Exercise intensity and AMS development were investigated. After exposure to high altitude, the count of white blood cells, alkaline phosphatase and serum albumin were increased (P < 0.05). There were no significant differences in exercise time and metabolic equivalents (METs) between SHHC and high-altitude exposures (7.05 ± 1.02 vs. 7.22 ± 0.96 min, P = 0.235; 9.62 ± 1.11 vs. 9.38 ± 1.12, P = 0.126, respectively). However, these variables were relatively higher at sea level (8.03 ± 0.24 min, P < 0.01; 10.05 ± 0.31, P < 0.01, respectively). Thus, subjects displayed an equivalent exercise tolerance upon acute exposure to high altitude and to SHHC. The trends of cardiovascular hemodynamics during exercise under the three different conditions were similar. However, both systolic blood pressure and the rate-pressure product at every TET stage were higher at high altitude and under the SHHC than at sea level. After acute exposure to high altitude, 19 (23.8%) subjects developed AMS. Multivariate logistic regression analysis showed that METs under the SHHC {odds ratio (OR) 0.355 per unit increment [95% confidence intervals (CI) 0.159-0.793], P = 0.011}, diastolic blood pressure (DBP) at rest under SHHC [OR 0.893 per mmHg (95%CI 0.805-0.991), P = 0.030], and recovery DBP 3 min after exercise at sea level [OR 1.179 per mmHg (95%CI 1.043-1.333), P = 0.008] were independently associated with AMS. The predictive model had an area under the receiver operating characteristic curve of 0.886 (95%CI 0.803-0.969, P < 0.001). Thus, young men have similar exercise tolerance in acute exposure to high altitude and to SHHC. Moreover, AMS can be predicted with superior accuracy using characteristics easily obtainable with TET.

Ventilatory Responsiveness during Exercise and Performance Impairment in Acute Hypoxia

INTRODUCTION

An adequate increase in minute ventilation to defend arterial oxyhemoglobin saturation (SpO2) during hypoxic exercise is commonly viewed as an important factor contributing to large inter-individual variations in the degree of exercise performance impairment in hypoxia. Although the hypoxic ventilatory response (HVR) could provide insight into the underpinnings of such impairments, it is typically measured at rest under isocapnic conditions. Thus, we aimed to determine whether 1) HVR at rest and during exercise are similar and 2) exercise HVR is related to the degree of impairment in cycling time trial (TT) performance from normoxia to acute hypoxia (∆TT).

METHODS

Sixteen endurance-trained men (V˙O2peak, 62.5 ± 5.8 mL·kg-1·min-1) performed two poikilocapnic HVR tests: one during seated rest (HVRREST) and another during submaximal cycling (HVREX). On two separate visits, subjects (n = 12) performed a 10-km cycling TT while breathing either room air (FiO2 = 0.21) or hypoxic gas mixture (FiO2 = 0.16) in a randomized order.

RESULTS

HVREX was significantly (P < 0.001) greater than HVRREST (1.52 ± 0.47 and 0.22 ± 0.13 L·min-1·%SpO2-1, respectively), and these measures were not correlated (r = -0.16, P = 0.57). ∆TT was not correlated with HVRREST (P = 0.70) or HVREX (P = 0.54), but differences in ventilation and end-tidal CO2 between hypoxic and normoxic TT and the ventilatory equivalent for CO2 during normoxic TT explained ~85% of the variance in performance impairment in acute hypoxia (P < 0.01).

CONCLUSION

We conclude that 1) HVR is not an appropriate measure to predict the exercise ventilatory response or performance impairments in acute hypoxia and 2) an adequate and metabolically matched increase in exercise ventilation, but not the gain in the ventilatory response to hypoxia, is essential for mitigating hypoxia-induced impairments in endurance cycling performance.

Endurance test selection optimized via sample size predictions

Selecting the most appropriate performance test is critical in detecting the effect of an intervention. In this investigation we 1) used time-trial (TT) performance data to estimate sample size requirements for test selection and 2) demonstrated the differences in statistical power between a repeated-measures ANOVA (RM-ANOVA) and analysis of covariance (ANCOVA) for detecting an effect in parallel group design. A retrospective analysis of six altitude studies was completed, totaling 105 volunteers. We quantified the test-retest reliability [i.e., intraclass correlation coefficient (ICC) and standard error of measurement (SEM)] and then calculated the standardized effect size for a 5-20% change in TT performance. With these outcomes, a power analysis was performed and required sample sizes were compared among performance tests. Relative to TT duration, the 11.2-km run had the lowest between-subject variance, and thus greatest statistical power (i.e., required smallest sample size) to detect a given percent change in performance. However, the 3.2-km run was the most reliable test (ICC: 0.89, SEM: 81 s) and thus better suited to detect the smallest absolute (i.e., seconds) change in performance. When TT durations were similar, a running modality (11.2-km run; ICC: 0.83, SEM: 422 s) was far more reliable than cycling (720-kJ cycle; ICC: 0.77, SEM: 480 s). In all scenarios, the ANCOVA provided greater statistical power than the RM-ANOVA. Our results suggest that running tests (3.2 km and 11.2 km) using ANCOVA analysis provide the greatest likelihood of detecting a significant change in performance response to an intervention, particularly in populations unaccustomed to cycling.NEW & NOTEWORTHY This is the first investigation to utilize time-trial (TT) data from previous studies in simulations to estimate statistical power. We developed an easy-to-use decision aid detailing the required sample size needed to detect a given change in TT performance for the purpose of test selection. Furthermore, our detailed methods can be applied to any scenario in which there is an impact of a stressor and the desire to detect a treatment effect.

Contemporary Periodization of Altitude Training for Elite Endurance Athletes: A Narrative Review

Since the 1960s there has been an escalation in the purposeful utilization of altitude to enhance endurance athletic performance. This has been mirrored by a parallel intensification in research pursuits to elucidate hypoxia-induced adaptive mechanisms and substantiate optimal altitude protocols (e.g., hypoxic dose, duration, timing, and confounding factors such as training load periodization, health status, individual response, and nutritional considerations). The majority of the research and the field-based rationale for altitude has focused on hematological outcomes, where hypoxia causes an increased erythropoietic response resulting in augmented hemoglobin mass. Hypoxia-induced non-hematological adaptations, such as mitochondrial gene expression and enhanced muscle buffering capacity may also impact athletic performance, but research in elite endurance athletes is limited. However, despite significant scientific progress in our understanding of hypobaric hypoxia (natural altitude) and normobaric hypoxia (simulated altitude), elite endurance athletes and coaches still tend to be trailblazers at the coal face of cutting-edge altitude application to optimize individual performance, and they already implement novel altitude training interventions and progressive periodization and monitoring approaches. Published and field-based data strongly suggest that altitude training in elite endurance athletes should follow a long- and short-term periodized approach, integrating exercise training and recovery manipulation, performance peaking, adaptation monitoring, nutritional approaches, and the use of normobaric hypoxia in conjunction with terrestrial altitude. Future research should focus on the long-term effects of accumulated altitude training through repeated exposures, the interactions between altitude and other components of a periodized approach to elite athletic preparation, and the time course of non-hematological hypoxic adaptation and de-adaptation, and the potential differences in exercise-induced altitude adaptations between different modes of exercise.

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

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

Inspiratory Muscle Training: Improvement of Exercise Performance With Acute Hypoxic Exposure

Endurance exercise performance in hypoxia may be influenced by an ability to maintain high minute ventilation (V˙E) in defense of reduced arterial oxyhemoglobin saturation. Inspiratory muscle training (IMT) has been used as an effective intervention to attenuate the negative physiological consequences associated with an increased V˙E, resulting in improved submaximal-exercise performance in normoxia. However, the efficacy of IMT on hypoxic exercise performance remains unresolved.

PURPOSE

To determine whether chronic IMT improves submaximal-exercise performance with acute hypoxic exposure.

METHODS

A total of 14 endurance-trained men completed a 20-km cycling time trial (TT) in normobaric hypoxia (fraction of inspired oxygen [FiO2] = 0.16) before and after either 6 wk of an IMT protocol consisting of inspiratory loads equivalent to 80% of sustained maximal inspiratory pressure (n = 9) or a SHAM protocol (30% of sustained maximal inspiratory pressure; n = 5).

RESULTS

In the IMT group, 20-km TT performance significantly improved by 1.45 (2.0%), P = .03, after the 6-wk intervention. The significantly faster TT times were accompanied by a higher average V˙E (pre vs post: 99.3 [14.5] vs 109.9 [18.0] L·min-1, P = .01) and absolute oxygen uptake (pre vs post: 3.39 [0.52] vs 3.60 [0.58] L·min-1, P = .010), with no change in ratings of perceived exertion or dyspnea (P > .06). There were no changes in TT performance in the SHAM group (P = .45).

CONCLUSION

These data suggest that performing 6 wk of IMT may benefit hypoxic endurance exercise performance lasting 30-40 min.

Synchronizing Gait with Cardiac Cycle Phase Alters Heart Rate Response during Running

Timing foot strike to occur in synchrony with cardiac diastole may reduce left ventricular afterload and promote coronary and skeletal muscle perfusion.

Expiratory flow limitation under moderate hypobaric hypoxia does not influence ventilatory responses during incremental running in endurance runners

We tested whether expiratory flow limitation (EFL) occurs in endurance athletes in a moderately hypobaric hypoxic environment equivalent to 2500 m above sea level and, if so, whether EFL inhibits peak ventilation ( V ˙ Epeak ), thereby exacerbating the hypoxia-induced reduction in peak oxygen uptake ( V ˙ O2peak ). Seventeen young male endurance runners performed incremental exhaustive running on separate days under hypobaric hypoxic (560 mmHg) and normobaric normoxic (760 mmHg) conditions. Oxygen uptake ( V ˙ O2 ), minute ventilation ( V ˙ E), arterial O2 saturation (SpO2 ), and operating lung volume were measured throughout the incremental exercise. Among the runners tested, 35% exhibited EFL (EFL group, n = 6) in the hypobaric hypoxic condition, whereas the rest did not (Non-EFL group, n = 11). There were no differences between the EFL and Non-EFL groups for V ˙ Epeak and V ˙ O2peak under either condition. Percent changes in V ˙ Epeak (4 ± 4 vs. 2 ± 4%) and V ˙ O2peak (-18 ± 6 vs. -16 ± 6%) from normobaric normoxia to hypobaric hypoxia also did not differ between the EFL and Non-EFL groups (all P > 0.05). No differences in maximal running velocity, SpO2 , or operating lung volume were detected between the two groups under either condition. These results suggest that under the moderate hypobaric hypoxia (2500 m above sea level) frequently used for high-attitude training, ~35% of endurance athletes may exhibit EFL, but their ventilatory and metabolic responses during maximal exercise are similar to those who do not exhibit EFL.

Is Maximal Heart Rate Decrease Similar Between Normobaric Versus Hypobaric Hypoxia in Trained and Untrained Subjects?

We compared the decrease in maximal heart rate (HRmax) from normoxia to normobaric (NH) and hypobaric (HH) hypoxia, respectively, in trained and untrained subjects (n = 187). HRmax data in normoxia and NH (n = 55) or HH (n = 26) were collected from 81 publications. No study directly compared HRmax in NH and HH. Concomitant arterial oxygen saturation (SaO₂) and HRmax data were found in 60 studies. Overall, the results showed that the higher the desaturation, the greater the decrease in HRmax. Since desaturation appeared to be slightly higher during HH versus NH and was higher in trained than in untrained subjects, the decrease in HRmax tended (p = 0.07) to be higher in trained subjects in HH than in NH (e.g., -12.7 bpm vs. -8.6 bpm at 4000 m), whereas in untrained subjects the difference was negligible (-9.9 bpm vs. -8.3 bpm). To conclude, when compared with normoxia, the decrease in HRmax was slightly higher in HH than in NH in trained subjects. However, this result has to be confirmed and from a practical point of view, one may question the significance of this difference as well as the relevance of using different HR values for prescribing training intensity during exercise performed in NH or in HH.

Supplemental Oxygen Does Not Influence Self-selected Work Rate at Moderate Altitude

INTRODUCTION

It is well known that supplemental oxygen can increase aerobic power output during high-intensity and/or maximal efforts at moderate altitude, yet the effects on self-selected work rate during lower-intensity, submaximal exercise are unknown. We reasoned that if the degree of arterial oxygen saturation (SaO2) influences teleoanticipatory regulation of power output, supplemental oxygen given at moderate altitude would increase average power output during exercise performed at self-selected work rates corresponding to RPE 9 (very light) and 13 (somewhat hard).

METHODS

Twenty-three subjects (17 males, 6 females) completed one familiarization [fraction of inspired O2 (FIO2) = 0.209] and two blinded, experimental trials (FIO2 = 0.209 and FIO2 = 0.267). In each trial, subjects self-regulated their work rate on a cycle ergometer to maintain RPE 9 for 5 min and RPE 13 for 10 min, before performing an incremental step test to exhaustion (25 W·min). Oxygen consumption (V˙O2) and SaO2 via pulse oximetry (SpO2) were continuously monitored. Subjects were asked to guess the experimental condition after each stage of the protocol.

RESULTS

Supplemental oxygen increased SpO2 throughout exercise (~4%; P < 0.001) and was associated with greater peak power output (4% ± 4%; P < 0.001) and V˙O2 (5% ± 10%; P = 0.010) during the incremental test, but did not increase average power output selected during exercise at RPE 9 (P = 0.235) or 13 (P = 0.992). Subjects were unable to perceive the difference in FIO2 at any stage (P > 0.14).

CONCLUSIONS

Small increases in inspired oxygen concentration at moderate altitude are imperceptible and do not appear to influence selection of submaximal work rates at RPE ≤ 13.

Quantifying the effects of acute hypoxic exposure on exercise performance and capacity: A systematic review and meta-regression

OBJECTIVE

To quantify the effects of acute hypoxic exposure on exercise capacity and performance, which includes continuous and intermittent forms of exercise.

DESIGN

A systematic review was conducted with a three-level mixed effects meta-regression. The ratio of means method was used to evaluate main effects and moderators providing practical interpretations with percentage change.

DATA SOURCES

A systemic search was performed using three databases (Google scholar, PubMed and SPORTDiscus). Eligibility criteria for selecting studies: Inclusion was restricted to investigations that assessed exercise performance (time trials (TTs), sprint and intermittent exercise tests) and capacity (time to exhaustion test, TTE) with acute hypoxic (<24 h) exposure and a normoxic comparator.

RESULTS

Eighty-two outcomes from 53 studies (N = 798) were included in this review. The results show an overall reduction in exercise performance/capacity -17.8 ± 3.9% (95% CI -22.8% to -11.0%), which was significantly moderated by -6.5 ± 0.9% per 1000 m altitude elevation (95% CI -8.2% to -4.8%) and oxygen saturation (-2.0 ± 0.4%; 95% CI -2.9% to -1.2%). TT (-16.2 ± 4.3%; 95% CI -22.9% to -9%) and TTE (-44.5 ± 6.9%; 95% CI -51.3% to -36.7%) elicited a negative effect, whilst indicating a quadratic relationship between hypoxic magnitude and both TTE and TT performance. Furthermore, exercise less than 2 min exhibited no ergolytic effect from acute hypoxia. Summary/Conclusion: This review highlights the ergolytic effect of acute hypoxic exposure, which is curvilinear for TTE and TT performance with increasing hypoxic levels, but short duration intermittent and sprint exercise seem to be unaffected.

A Clinician Guide to Altitude Training for Optimal Endurance Exercise Performance at Sea Level

Constantini, Keren, Daniel P. Wilhite, and Robert F. Chapman. A clinician guide to altitude training for optimal endurance exercise performance at sea level. High Alt Med Biol. 18:93-101, 2017.-For well over 50 years, endurance athletes have been utilizing altitude training in an effort to enhance performance in sea level competition. This brief review will offer the clinician a series of evidence-based best-practice guidelines on prealtitude and altitude training considerations, which can ultimately maximize performance improvement outcomes.

Thoraco-abdominal coordination and performance during uphill running at altitude

INTRODUCTION

Running races on mountain trails at moderate-high altitude with large elevation changes throughout has become increasingly popular. During exercise at altitude, ventilatory demands increase due to the combined effects of exercise and hypoxia.

AIM

To investigate the relationships between thoraco-abdominal coordination, ventilatory pattern, oxygen saturation (SpO2), and endurance performance in runners during high-intensity uphill exercise.

METHODS

Fifteen participants (13 males, mean age 42±9 yrs) ran a "Vertical Kilometer," i.e., an uphill run involving a climb of approximately 1000 m with a slope greater than 30%. The athletes were equipped with a portable respiratory inductive plethysmography system, a finger pulse oximeter and a global positioning unit (GPS). The ventilatory pattern (ventilation (VE), tidal volume (VT), respiratory rate (RR), and VE/VT ratio), thoraco-abdominal coordination, which is represented by the phase angle (PhA), and SpO2 were evaluated at rest and during the run. Before and after the run, we assessed respiratory function, respiratory muscle strength and the occurrence of interstitial pulmonary edema by thoracic ultrasound.

RESULTS

Two subjects were excluded from the respiratory inductive plethysmography analysis due to motion artifacts. A quadratic relationship between the slope and the PhA was observed (r = 0.995, p = 0.036). When the slope increased above 30%, the PhA increased, indicating a reduction in thoraco-abdominal coordination. The reduced thoraco-abdominal coordination was significantly related to reduced breathing efficiency (i.e., an increased VE/VT ratio; r = 0.961, p = 0.038) and SpO2 (r = -0.697, p<0.001). Lower SpO2 values were associated with lower speeds at 20%≥slope≤40% (r = 0.335, p<0.001 for horizontal and r = 0.36, p<0.001 for vertical). The reduced thoraco-abdominal coordination and consequent reduction in SpO2 were associated with interstitial pulmonary edema.

CONCLUSION

Reductions in thoraco-abdominal coordination are associated with a less efficient ventilatory pattern and lower SpO2 during uphill running. This fact could have a negative effect on performance.

Moderate exercise increases endotoxin concentration in hypoxia but not in normoxia: A controlled clinical trial

BACKGROUND

Hypoxia and high altitudes affect various organs, which impairs important physiological functions, such as a disruption of the intestinal barrier mediated by increased translocation of bacteria and increased circulating endotoxin levels. Physical exercise can alter endotoxin concentration in normoxia. The aim of this study is to evaluate the effects of moderate exercise on endotoxin concentration in normobaric hypoxia.

METHODS

Nine healthy male volunteers exercised on a treadmill for 60 minutes at an intensity of 50% VO2peak in normoxic or hypoxic conditions (4200 m). Blood was collected at rest, immediately after exercise and 1 hour after exercise to evaluate serum endotoxin levels.

RESULTS

Under hypoxic exercise conditions, SaO2% saturation was lower after exercise compared with resting levels (P < 0.05) and returned to the resting level during recovery in normoxia (P < 0.05). Endotoxin concentration increased after exercise in hypoxia (P < 0.05); it remained high 1 hour after exercise in hypoxia compared with normoxia (P < 0.05) and was higher after exercise and recovery compared with resting levels (P < 0.05). HR was higher during exercise in relation basal in both conditions (P < 0.05) and RPR increase after 60 minutes in comparison to 20 minutes in hypoxia (P < 0.05).

CONCLUSION

Moderate exercise performed in hypoxia equivalent to 4200 m increased endotoxin plasma concentration after exercise. One hour of rest in normoxic conditions was insufficient for the recovery of circulating endotoxins.

Cycling Time Trial Is More Altered in Hypobaric than Normobaric Hypoxia

PURPOSE

Slight physiological differences between acute exposure in normobaric hypoxia (NH) and hypobaric hypoxia (HH) have been reported. Taken together, these differences suggest different physiological responses to hypoxic exposure to a simulated altitude (NH) versus a terrestrial altitude (HH). For this purpose, in the present study, we aimed to directly compare the time-trial performance after acute hypoxia exposure (26 h, 3450 min) by the same subjects under three different conditions: NH, HH, and normobaric normoxia (NN). Based on all of the preceding studies examining the differences among these hypoxic conditions, we hypothesized greater performance impairment in HH than in NH.

METHODS

The experimental design consisted of three sessions: NN (Sion: FiO2, 20.93), NH (Sion, hypoxic room: FiO2, 13.6%; barometric pressure, 716 mm Hg), and HH (Jungfraujoch: FiO2, 20.93; barometric pressure, 481 mm Hg). The performance was evaluated at the end of each session with a cycle time trial of 250 kJ.

RESULTS

The mean time trial duration in NN was significantly shorter than under the two hypoxic conditions (P < 0.001). In addition, the mean duration in NH was significantly shorter than that in HH (P < 0.01). The mean pulse oxygen saturation during the time trial was significantly lower for HH than for NH (P < 0.05), and it was significantly higher in NN than for the two other sessions (P < 0.001).

CONCLUSION

As previously suggested, HH seems to be a more stressful stimulus, and NH and HH should not be used interchangeability when endurance performance is the main objective. The principal factor in this performance difference between hypoxic conditions seemed to be the lower peripheral oxygen saturation in HH at rest, as well as during exercise.

Living altitude influences endurance exercise performance change over time at altitude

For sea level based endurance athletes who compete at low and moderate altitudes, adequate time for acclimatization to altitude can mitigate performance declines. We asked whether it is better for the acclimatizing athlete to live at the specific altitude of competition or at a higher altitude, perhaps for an increased rate of physiological adaptation. After 4 wk of supervised sea level training and testing, 48 collegiate distance runners (32 men, 16 women) were randomly assigned to one of four living altitudes (1,780, 2,085, 2,454, or 2,800 m) where they resided for 4 wk. Daily training for all subjects was completed at a common altitude from 1,250 to 3,000 m. Subjects completed 3,000-m performance trials on the track at sea level, 28 and 6 days before departure, and at 1,780 m on days 5, 12, 19, and 26 of the altitude camp. Groups living at 2,454 and 2,800 m had a significantly larger slowing of performance vs. the 1,780-m group on day 5 at altitude. The 1,780-m group showed no significant change in performance across the 26 days at altitude, while the groups living at 2,085, 2,454, and 2,800 m showed improvements in performance from day 5 to day 19 at altitude but no further improvement at day 26. The data suggest that an endurance athlete competing acutely at 1,780 m should live at the altitude of the competition and not higher. Living ∼300-1,000 m higher than the competition altitude, acute altitude performance may be significantly worse and may require up to 19 days of acclimatization to minimize performance decrements.

Ventilatory acclimatisation is beneficial for high-intensity exercise at altitude in elite cyclists

AIM

The aim of this study was to examine the relationship between ventilatory adaptation and performance during altitude training at 2700 m.

METHODS

Seven elite cyclists (age: 21.2 ± 1.1 yr, body mass: 69.9 ± 5.6 kg, height 176.3 ± 4.9 cm) participated in this study. A hypoxic ventilatory response (HVR) test and a submaximal exercise test were performed at sea level prior to the training camp and again after 15 d at altitude (ALT15). Ventilation (VE), end-tidal carbon-dioxide partial pressure (PETCO2) and oxyhaemoglobin saturation via pulse oximetry (SpO2) were measured at rest and during submaximal cycling at 250 W. A hill climb (HC) performance test was conducted at sea level and after 14 d at altitude (ALT14) using a road of similar length (5.5-6 km) and gradient (4.8-5.3%). Power output was measured using SRM cranks. Average HC power at ALT14 was normalised to sea level power (HC%). Multiple regression was used to identify significant predictors of performance at altitude.

RESULTS

At ALT15, there was a significant increase in resting VE (10.3 ± 1.9 vs. 12.2 ± 2.4 L·min(-1)) and HVR (0.34 ± 0.24 vs. 0.71 ± 0.49 L·min(-1)·%(-1)), while PETCO2 (38.4 ± 2.3 vs. 32.1 ± 3.3 mmHg) and SpO2 (97.9 ± 0.7 vs. 94.0 ± 1.7%) were reduced (P < .05). Multiple regression revealed ΔHVR and exercise VE at altitude as significant predictors of HC% (adjusted r(2) = 0.913; P = 0.003).

CONCLUSIONS

Ventilatory acclimatisation occurred during a 2 wk altitude training camp in elite cyclists and a higher HVR was associated with better performance at altitude, relative to sea level. These results suggest that ventilatory acclimatisation is beneficial for cycling performance at altitude.

Stage racing at altitude induces hemodilution despite an increase in hemoglobin mass

Plasma volume (PV) can be modulated by altitude exposure (decrease) and periods of intense exercise (increase). Cycle racing at altitude combines both stimuli, although presently no data exist to document which is dominant. Hemoglobin mass (Hbmass), hemoglobin concentration ([Hb]), and percent reticulocytes (%Retics) of altitude (ALT; n = 9) and sea-level (SL; n = 9) residents were measured during a 14-day cycling race, held at 1,146–4120 m, as well as during a simulated tour near sea level (SIM; n = 12). Hbmass was assessed before and on days 9 and 14 of racing. Venous blood was collected on days 0, 3, 6, 10, and 14. PV was calculated from Hbmass and [Hb]. A repeated-measures ANOVA was used to assess the impact of racing at altitude over time, within and between groups. [Hb] decreased significantly in all groups over time ( P < 0.0001) with decreases evident on the third day of racing. %Retics increased significantly in SL only ( P < 0.0001), with SL values elevated at day 6 compared with prerace ( P = 0.02), but were suppressed by the end of the race ( P = 0.0002). Hbmass significantly increased in SL after 9 ( P = 0.0001) and 14 ( P = 0.008) days of racing and was lower at the end of the race than midrace ( P = 0.018). PV increased in all groups ( P < 0.0001). Multiday cycle racing at altitude induces hemodilution of a similar magnitude to that observed during SL racing and occurs in nonacclimatized SL residents, despite an altitude-induced increase in Hbmass. Osmotic regulatory mechanisms associated with intense exercise appear to supersede acute enhancement of oxygen delivery at altitude.

The individual response to training and competition at altitude

Performance in athletic activities that include a significant aerobic component at mild or moderate altitudes shows a large individual variation. Physiologically, a large portion of the negative effect of altitude on exercise performance can be traced to limitations of oxygen diffusion, either at the level of the alveoli or the muscle microvasculature. In the lung, the ability to maintain arterial oxyhaemoglobin saturation (SaO₂) appears to be a primary factor, ultimately influencing oxygen delivery to the periphery. SaO₂ in hypoxia can be defended by increasing ventilatory drive; however, during heavy exercise, many athletes demonstrate limitations to expiratory flow and are unable to increase ventilation in hypoxia. Additionally, increasing ventilatory work in hypoxia may actually be negative for performance, if dyspnoea increases or muscle blood flow is reduced secondary to an increased sympathetic outflow (eg, the muscle metaboreflex response). Taken together, some athletes are clearly more negatively affected during exercise in hypoxia than other athletes. With careful screening, it may be possible to develop a protocol for determining which athletes may be the most negatively affected during competition and/or training at altitude.

Responses to exercise in normobaric hypoxia: comparison of elite and recreational ski mountaineers

PURPOSE

Hypoxia is known to reduce maximal oxygen uptake (VO(2max)) more in trained than in untrained subjects in several lowland sports. Ski mountaineering is practiced mainly at altitude, so elite ski mountaineers spend significantly longer training duration at altitude than their lower-level counterparts. Since acclimatization in hypobaric hypoxia is effective, the authors hypothesized that elite ski mountaineers would exhibit a VO2max decrement in hypoxia similar to that of recreational ski mountaineers.

METHODS

Eleven elite (E, Swiss national team) and 12 recreational (R) ski mountaineers completed an incremental treadmill test to exhaustion in normobaric hypoxia (H, 3000 m, F(1)O(2) 14.6% ± 0.1%) and in normoxia (N, 485 m, F(1)O(2) 20.9% ± 0.0%). Pulse oxygen saturation in blood (SpO(2)), VO(2max), minute ventilation, and heart rate were recorded.

RESULTS

At rest, hypoxic ventilatory response was higher (P < .05) in E than in R (1.4 ± 1.9 vs 0.3 ± 0.6 L · min⁻¹ · kg⁻¹). At maximal intensity, SpO(2) was significantly lower (P < .01) in E than in R, both in N (91.1% ± 3.3% vs 94.3% ± 2.3%) and in H (76.4% ± 5.4% vs 82.3% ± 3.5%). In both groups, SpO(2) was lower (P < .01) in H. Between N and H, VO(2max) decreased to a greater extent (P < .05) in E than in R (-18% and -12%, P < .01). In E only, the VO(2max) decrement was significantly correlated with the SpO(2) decrement (r = .74, P < .01) but also with VO(2max) measured in N (r = .64, P < .05).

CONCLUSION

Despite a probable better acclimatization to altitude, VO(2max) was more reduced in E than in R ski mountaineers, confirming previous results observed in lowlander E athletes.

Defining the “dose” of altitude training: how high to live for optimal sea level performance enhancement

Chronic living at altitudes of ∼2,500 m causes consistent hematological acclimatization in most, but not all, groups of athletes; however, responses of erythropoietin (EPO) and red cell mass to a given altitude show substantial individual variability. We hypothesized that athletes living at higher altitudes would experience greater improvements in sea level performance, secondary to greater hematological acclimatization, compared with athletes living at lower altitudes. After 4 wk of group sea level training and testing, 48 collegiate distance runners (32 men, 16 women) were randomly assigned to one of four living altitudes (1,780, 2,085, 2,454, or 2,800 m). All athletes trained together daily at a common altitude from 1,250–3,000 m following a modified live high-train low model. Subjects completed hematological, metabolic, and performance measures at sea level, before and after altitude training; EPO was assessed at various time points while at altitude. On return from altitude, 3,000-m time trial performance was significantly improved in groups living at the middle two altitudes (2,085 and 2,454 m), but not in groups living at 1,780 and 2,800 m. EPO was significantly higher in all groups at 24 and 48 h, but returned to sea level baseline after 72 h in the 1,780-m group. Erythrocyte volume was significantly higher within all groups after return from altitude and was not different between groups. These data suggest that, when completing a 4-wk altitude camp following the live high-train low model, there is a target altitude between 2,000 and 2,500 m that produces an optimal acclimatization response for sea level performance.

Position statement--altitude training for improving team-sport players' performance: current knowledge and unresolved issues

Despite the limited research on the effects of altitude (or hypoxic) training interventions on team-sport performance, players from all around the world engaged in these sports are now using altitude training more than ever before. In March 2013, an Altitude Training and Team Sports conference was held in Doha, Qatar, to establish a forum of research and practical insights into this rapidly growing field. A round-table meeting in which the panellists engaged in focused discussions concluded this conference. This has resulted in the present position statement, designed to highlight some key issues raised during the debates and to integrate the ideas into a shared conceptual framework. The present signposting document has been developed for use by support teams (coaches, performance scientists, physicians, strength and conditioning staff) and other professionals who have an interest in the practical application of altitude training for team sports. After more than four decades of research, there is still no consensus on the optimal strategies to elicit the best results from altitude training in a team-sport population. However, there are some recommended strategies discussed in this position statement to adopt for improving the acclimatisation process when training/competing at altitude and for potentially enhancing sea-level performance. It is our hope that this information will be intriguing, balanced and, more importantly, stimulating to the point that it promotes constructive discussion and serves as a guide for future research aimed at advancing the bourgeoning body of knowledge in the area of altitude training for team sports.

Effect of altitude on football performance: analysis of the 2010 FIFA World Cup Data

Laboratory studies show that altitude ascent impairs endurance performance. Limited data exist on football, and information from official matches is very scarce even for other team sports. The aim of this study was to examine the effect of altitude on football performance during the 2010 World Cup in South Africa. It was hypothesized that (a) total distance covered, an index of endurance, would be reduced above the altitude of 580 m, and (b) technical skills would be affected because altitude alters ball flight characteristics. Physical performance, goals scored, and goalkeepers' errors that resulted in goals conceded were recorded from the official game statistics of Fédération Internationale de Football Association during the South Africa 2010 World Cup. Matches were played at sea level (altitude: 0 m), 660, 1200-1400, and 1401-1753 m. After testing for data normality, mean differences were checked with a one-way analysis of variance. Results show a 3.1% lower total distance that was covered by the teams during the matches played at 1200-1400 and 1401-1753 m (p < 0.05) compared with sea level. Indices of technical skills, including number of goals scored per game and errors made by the goalkeepers that resulted in goals conceded, did not differ with altitude. It is concluded that playing football above 1200 m had negative effects on endurance but not on technical skills during World Cup 2010 matches. It seems that teams should follow several days of acclimatization before playing at altitude as low as 1200 m, to ameliorate the negative effects of altitude on physical performance.

Exercise intensity typical of mountain climbing does not exacerbate acute mountain sickness in normobaric hypoxia

Physical exertion is thought to exacerbate acute mountain sickness (AMS). In this prospective, randomized, crossover trial, we investigated whether moderate exercise worsens AMS in normobaric hypoxia (12% oxygen, equivalent to 4,500 m). Sixteen subjects were exposed to altitude twice: once with exercise [3 × 45 min within the first 4 h on a bicycle ergometer at 50% of their altitude-specific maximal workload (maximal oxygen uptake)], and once without. AMS was evaluated by the Lake Louise score and the AMS-C score of the Environmental Symptom Questionnaire. There was no significant difference in AMS between the exposures with and without exercise, neither after 5, 8, nor 18 h (incidence: 64 and 43%; LLS: 6.5 ± 0.7 and 5.1 ± 0.8; AMS-C score: 1.2 ± 0.3 and 1.1 ± 0.3 for exercise vs. rest at 18 h; all P > 0.05). Exercise decreased capillary Po2 (from 36 ± 1 Torr at rest to 31 ± 1 Torr), capillary arterial oxygen saturation (from 72% at rest to 67 ± 2%), and cerebral oxygen saturation (from 49 ± 2% at rest to 42 ± 1%, as assessed by near-infrared spectroscopy; P < 0.05), and increased ventilation (capillary Pco2 27 ± 1 Torr; P < 0.05). After exercise, the increase in ventilation persisted for several hours and was associated with similar levels of capillary and cerebral oxygenation at the exercise and rest day. We conclude that moderate exercise at ∼50% maximal oxygen uptake does not increase AMS in normobaric hypoxia. These data do not exclude that considerably higher exercise intensities exacerbate AMS.