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Nafi'an MRT, Sabirin RM, Wibowo RA, Sofyana M, Zahra IH, Wiryawan DA, Wijayatno QJ, Rohman A. Effect of nitrate supplementation on oxygen saturation levels for acute mountain sickness prevention: A systematic review and meta-analysis. Nitric Oxide 2024; 150:27-36. [PMID: 39002891 DOI: 10.1016/j.niox.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/27/2024] [Accepted: 07/04/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE This study aimed to systematically review the effect of nitrate supplementation on blood oxygen saturation. METHODS We searched PubMed, Scopus, and Cochrane Library databases from their inception up to October 2022. Two reviewers independently conducted two stages of the screening process to include a randomized controlled trial with nitrate supplementation versus placebo intervention assessing oxygen saturation among lowlanders going to either real or simulated high altitude environments. We used the Cochrane Risk of Bias 2.0 tool to assess the risk of bias in the included studies. Fixed-effect model meta-analyses were conducted for laboratory-based studies. Random-effect meta-analyses were conducted for real-world studies. RESULTS We found 7 trials that met the eligibility criteria. A meta-analysis of studies with some bias concerns showed an increase of 1.26 % in the SpO2 with 44 % I2 during submaximal exercise at simulated high altitudes (GRADE: low). On the contrary, a meta-analysis of studies without heterogeneity showed that nitrate supplementation aggravated oxygen saturation decline (-2.64 %, p = 0.03, GRADE: high) during rest in real high-altitude environments. A meta-analysis also showed that nitrate supplementation did not affect Acute Mountain Sickness (AMS) symptoms (GRADE: high). CONCLUSION Our results suggest that nitrate supplementation did not provide benefits for AMS prevention during rest at high altitudes. The low-quality evidence showing small beneficial effects of nitrate supplementation during exercise calls for further studies.
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Affiliation(s)
| | - Rahmaningsih Mara Sabirin
- Department of Physiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jakarta, Indonesia.
| | - Rakhmat Ari Wibowo
- Department of Physiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jakarta, Indonesia; Physical Activity for Health Research Centre, Institute of Sport, Physical Education, and Health Sciences, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Meida Sofyana
- Department of Physiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jakarta, Indonesia; School of Physiology, Pharmacology, & Neuroscience, University of Bristol, Bristol, England, UK
| | - Imtiyaz Hafizah Zahra
- School of Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Danindra Ario Wiryawan
- School of Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Qonita Jayanti Wijayatno
- School of Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Abdul Rohman
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
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Beever AT, Zhuang AY, Murias JM, Aboodarda SJ, MacInnis MJ. Effects of acute simulated altitude on the maximal lactate steady state in humans. Am J Physiol Regul Integr Comp Physiol 2024; 327:R195-R207. [PMID: 38842515 DOI: 10.1152/ajpregu.00065.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/03/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024]
Abstract
We sought to determine the effects of acute simulated altitude on the maximal lactate steady state (MLSS) and physiological responses to cycling at and 10 W above the MLSS-associated power output (PO) (MLSSp and MLSSp+10, respectively). Eleven (4 females) participants (means [SD]; 28 [4] yr; V̇o2max: 54.3 [6.9] mL·kg-1·min-1) acclimatized to ∼1,100 m performed 30-min constant PO trials in simulated altitudes of 0 m sea level (SL), 1,111 m mild altitude (MILD), and 2,222 m moderate altitude (MOD). MLSSp, defined as the highest PO with stable (<1 mM change) blood lactate concentration ([BLa]) between 10 and 30 min, was significantly lower in MOD (209 [54] W) compared with SL (230 [56] W; P < 0.001) and MILD (225 [58] W; P = 0.001), but MILD and SL were not different (P = 0.12). V̇o2 and V̇co2 decreased at higher simulated altitudes due to lower POs (P < 0.05), but other end-exercise physiological responses (e.g., [BLa], ventilation [V̇e], heart rate [HR]) were not different between conditions at MLSSp or MLSSp + 10 (P > 0.05). At the same absolute intensity (MLSSp for MILD), [BLa], HR, and V̇E and all perceptual variables were exacerbated in MOD compared with SL and MILD (P < 0.05). Maximum voluntary contraction, voluntary activation, and potentiated twitch forces were exacerbated at MLSSp + 10 relative to MLSSp within conditions (P < 0.05); however, condition did not affect performance fatiguability at the same relative or absolute intensity (P > 0.05). As MLSSp decreased in hypoxia, adjustments in PO are needed to ensure the same relative intensity across altitudes, but common indices of exercise intensity may facilitate exercise prescription and monitoring in hypoxia.NEW & NOTEWORTHY This study demonstrates the power output and metabolic rate associated with the maximal lactate steady-state (MLSS) decline in response to simulated altitude; however, common indices of exercise intensity remained unchanged when cycling was performed at the work rate associated with MLSS at each simulated altitude. These results support previous studies that investigated the effects of hypoxia on alternative measures of the critical intensity of exercise and will inform exercise prescription/monitoring across altitudes.
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Affiliation(s)
- Austin T Beever
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Y Zhuang
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Juan M Murias
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Saied J Aboodarda
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Martin J MacInnis
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Alvarez-Araos P, Jiménez S, Salazar-Ardiles C, Núñez-Espinosa C, Paez V, Rodriguez-Fernandez M, Raberin A, Millet GP, Iturriaga R, Andrade DC. Baroreflex and chemoreflex interaction in high-altitude exposure: possible role on exercise performance. Front Physiol 2024; 15:1422927. [PMID: 38895516 PMCID: PMC11184637 DOI: 10.3389/fphys.2024.1422927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024] Open
Abstract
The hypoxic chemoreflex and the arterial baroreflex are implicated in the ventilatory response to exercise. It is well known that long-term exercise training increases parasympathetic and decreases sympathetic tone, both processes influenced by the arterial baroreflex and hypoxic chemoreflex function. Hypobaric hypoxia (i.e., high altitude [HA]) markedly reduces exercise capacity associated with autonomic reflexes. Indeed, a reduced exercise capacity has been found, paralleled by a baroreflex-related parasympathetic withdrawal and a pronounced chemoreflex potentiation. Additionally, it is well known that the baroreflex and chemoreflex interact, and during activation by hypoxia, the chemoreflex is predominant over the baroreflex. Thus, the baroreflex function impairment may likely facilitate the exercise deterioration through the reduction of parasympathetic tone following acute HA exposure, secondary to the chemoreflex activation. Therefore, the main goal of this review is to describe the main physiological mechanisms controlling baro- and chemoreflex function and their role in exercise capacity during HA exposure.
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Affiliation(s)
- Pablo Alvarez-Araos
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó, Chile
| | - Sergio Jiménez
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó, Chile
| | - Camila Salazar-Ardiles
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
| | - Cristian Núñez-Espinosa
- Escuela de Medicina de la Universidad de Magallanes, Punta Arenas, Chile
- Centro Asistencial de Docencia e Investigación (CADI-UMAG), Santiago, Chile
| | - Valeria Paez
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria Rodriguez-Fernandez
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antoine Raberin
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Gregoire P. Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Rodrigo Iturriaga
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
- Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
| | - David C. Andrade
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
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Burtscher J, Pasha Q, Chanana N, Millet GP, Burtscher M, Strasser B. Immune consequences of exercise in hypoxia: A narrative review. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:297-310. [PMID: 37734549 PMCID: PMC11116970 DOI: 10.1016/j.jshs.2023.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023]
Abstract
Immune outcomes are key mediators of many health benefits of exercise and are determined by exercise type, dose (frequency/duration, intensity), and individual characteristics. Similarly, reduced availability of ambient oxygen (hypoxia) modulates immune functions depending on the hypoxic dose and the individual capacity to respond to hypoxia. How combined exercise and hypoxia (e.g., high-altitude training) sculpts immune responses is not well understood, although such combinations are becoming increasingly popular. Therefore, in this paper, we summarize the impact on immune responses of exercise and of hypoxia, both independently and together, with a focus on specialized cells in the innate and adaptive immune system. We review the regulation of the immune system by tissue oxygen levels and the overlapping and distinct immune responses related to exercise and hypoxia, then we discuss how they may be modulated by nutritional strategies. Mitochondrial, antioxidant, and anti-inflammatory mechanisms underlie many of the adaptations that can lead to improved cellular metabolism, resilience, and overall immune functions by regulating the survival, differentiation, activation, and migration of immune cells. This review shows that exercise and hypoxia can impair or complement/synergize with each other while regulating immune system functions. Appropriate acclimatization, training, and nutritional strategies can be used to avoid risks and tap into the synergistic potentials of the poorly studied immune consequences of exercising in a hypoxic state.
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Affiliation(s)
- Johannes Burtscher
- Institute of Sport Sciences, University of Lausanne, Lausanne 1015, Switzerland
| | - Qadar Pasha
- Institute of Hypoxia Research, New Delhi 110067, India
| | - Neha Chanana
- Department of Biochemistry, Jamia Hamdard, New Delhi 110062, India
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne 1015, Switzerland
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck 6020, Austria.
| | - Barbara Strasser
- Faculty of Medicine, Sigmund Freud Private University, Vienna 1020, Austria; Ludwig Boltzmann Institute for Rehabilitation Research, Vienna 1100, Austria
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Yi L, Wu J, Yan B, Wang Y, Zou M, Zhang Y, Li F, Qiu J, Girard O. 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. PeerJ 2024; 12:e17166. [PMID: 38563004 PMCID: PMC10984165 DOI: 10.7717/peerj.17166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
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.
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Affiliation(s)
- Longyan Yi
- China Institute of Sport and Health Sciences, Beijing Sport University, Beijing, China
| | - Jian Wu
- School of Kinesiology and Health, Capital University of Physical Education and Sports, Beijing, China
| | - Bing Yan
- China Institute of Sport and Health Sciences, Beijing Sport University, Beijing, China
| | - Yang Wang
- China Institute of Sport and Health Sciences, Beijing Sport University, Beijing, China
| | - Menghui Zou
- China Athletics School, Beijing Sport University, Beijing, China
| | - Yimin Zhang
- China Institute of Sport and Health Sciences, Beijing Sport University, Beijing, China
- Key Laboratory of Exercise and Physical Fitness (Beijing Sport University), Ministry of Education, Beijing, China
| | - Feifei Li
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Beijing, China
| | - Junqiang Qiu
- Department of Exercise Biochemistry, Exercise Science School, Beijing Sport University, Beijing, China
| | - Olivier Girard
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia.
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6
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Bonato G, Goodman S, Tjh L. Physiological and performance effects of live high train low altitude training for elite endurance athletes: A narrative review. Curr Res Physiol 2023; 6:100113. [PMID: 38107789 PMCID: PMC10724230 DOI: 10.1016/j.crphys.2023.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023] Open
Abstract
Altitude training has become an important training application for athletes due its potential for altering physiology and enhancing performance. This practice is commonly used by athletes, with a popular choice being the live high - train low approach. This model recommends that athletes live at high altitude (1250-3000 m), but train at low altitude or sea-level (0-1200 m). Exposure to altitude often leads to hypoxic stress and in turn stimulates changes in total haemoglobin mass, erythropoietin, and soluble transferrin receptors, which alter further underlying physiology. Through enhanced physiology, improved exercise performance may arise through enhancement of the oxygen transport system which is important for endurance events. Previous investigations into the effects of altitude training on exercise performance have been completed in a range of contexts, including running, cycling, swimming, and triathlon. Often following a LHTL altitude intervention, athletes realise improvements in maximal oxygen consumption capacity, time trial performance and peak power outputs. Although heterogeneity exists among LHTL methodologies, i.e., exposure durations and altitude ranges, we synthesised this data into kilometre hours, and found that the most common hypoxic doses used in LHTL interventions ranged from ∼578-687 km h. As this narrative review demonstrates, there are potential advantages to using altitude training to enhance physiology and improve performance for endurance athletes.
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Affiliation(s)
- G. Bonato
- Exercise and Sports Science, School of Science and Technology, The University of New England, Armidale, 2350, Australia
- College of Arts, Society and Education, James Cook University, Townsville, 4811, Australia
| | - S.P.J Goodman
- Exercise and Sports Science, School of Science and Technology, The University of New England, Armidale, 2350, Australia
| | - Lathlean Tjh
- Exercise and Sports Science, School of Science and Technology, The University of New England, Armidale, 2350, Australia
- The Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, 5000, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, 5000, Australia
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7
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Feng X, Zhao L, Chen Y, Wang Z, Lu H, Wang C. Optimal type and dose of hypoxic training for improving maximal aerobic capacity in athletes: a systematic review and Bayesian model-based network meta-analysis. Front Physiol 2023; 14:1223037. [PMID: 37745240 PMCID: PMC10513096 DOI: 10.3389/fphys.2023.1223037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
Objective: This study aimed to compare and rank the effect of hypoxic practices on maximum oxygen consumption (VO2max) in athletes and determine the hypoxic dose-response correlation using network meta-analysis. Methods: The Web of Science, PubMed, EMBASE, and EBSCO databases were systematically search for randomized controlled trials on the effect of hypoxc interventions on the VO2max of athletes published from inception until 21 February 2023. Studies that used live-high train-high (LHTH), live-high train-low (LHTL), live-high, train-high/low (HHL), intermittent hypoxic training (IHT), and intermittent hypoxic exposure (IHE) interventions were primarily included. LHTL was further defined according to the type of hypoxic environment (natural and simulated) and the altitude of the training site (low altitude and sea level). A meta-analysis was conducted to determine the standardized mean difference between the effects of various hypoxic interventions on VO2max and dose-response correlation. Furthermore, the hypoxic dosage of the different interventions were coordinated using the "kilometer hour" model. Results: From 2,072 originally identified titles, 59 studies were finally included in this study. After data pooling, LHTL, LHTH, and IHT outperformed normoxic training in improving the VO2max of athletes. According to the P-scores, LHTL combined with low altitude training was the most effective intervention for improving VO2max (natural: 0.92 and simulated: 0.86) and was better than LHTL combined with sea level training (0.56). A reasonable hypoxic dose range for LHTH (470-1,130 kmh) and HL (500-1,415 kmh) was reported with an inverted U-shaped curve relationship. Conclusion: Different types of hypoxic training compared with normoxic training serve as significant approaches for improving aerobic capacity in athletes. Regardless of the type of hypoxic training and the residential condition, LHTL with low altitude training was the most effective intervention. The characteristics of the dose-effect correlation of LHTH and LHTL may be associated with the negative effects of chronic hypoxia.
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Affiliation(s)
- Xinmiao Feng
- Sports Coaching College, Beijing Sports University, Beijing, China
| | - Linlin Zhao
- Sports Coaching College, Beijing Sports University, Beijing, China
| | | | - Zihao Wang
- Capital Institute of Physical Education and Sports, Beijing, Beijing, China
| | - Hongyuan Lu
- Sports Coaching College, Beijing Sports University, Beijing, China
| | - Chuangang Wang
- Sports Coaching College, Beijing Sports University, Beijing, China
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Pühringer R, Muckenthaler M, Burtscher M. Association Between Ferritin Levels and Altitude-Dependent Cardiorespiratory Fitness in Mountain Guides. High Alt Med Biol 2023; 24:139-143. [PMID: 37134197 DOI: 10.1089/ham.2023.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Pühringer, Reinhard, Martina Muckenthaler, and Martin Burtscher. Association between ferritin levels and altitude-dependent cardiorespiratory fitness in mountain guides. High Alt Med Biol. 24:139-143, 2023. Background: Higher ferritin levels may be associated with lower cardiorespiratory fitness (CRF; i.e., maximal oxygen uptake, VO2max) and may represent early markers of cardiovascular risk but may also support high-altitude acclimatization. To evaluate these potential associations, data recordings from a large sample of male mountain guides have been analyzed. Methods: A total of 154 data sets (including anthropometric data, VO2max, blood lipids, hemoglobin, ferritin, and transferrin levels) of regularly physically active and well-acclimatized mountain guides were available for analyses. Participants performed equal incremental cycle ergometer tests to exhaustion at low (600 m) and (∼1 week later) at moderate altitude (2,000 m). Results: Ferritin levels were positively correlated with levels of hemoglobin (r = 0.29, p < 0.01), total cholesterol (r = 0.18, p < 0.05), triglycerides (r = 0.23, p < 0.01), and low-density lipoprotein (r = 0.22, p < 0.01), and negatively with high-density lipoprotein levels (r = -0.16, p < 0.05) and also with baseline (taken at low altitude) VO2max values (r = -0.19, p < 0.05). In contrast, higher ferritin levels were associated with less VO2max decline from low-to-moderate altitude (r = 0.26, p < 0.01). Conclusion: Higher ferritin levels in male mountain guides are weakly associated with lower CRF and higher prevalence of cardiovascular risk factors but with slightly less reduction in VO2max when acutely exposed to moderate altitude. The clinical relevance of these observations needs further investigation.
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Affiliation(s)
- Reinhard Pühringer
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Austrian Society for Alpine- and High-Altitude Medicine, Innsbruck, Austria
| | - Martina Muckenthaler
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Centre for Translational Biomedical Iron Research, Molecular Medicine Partnership Unit (MMPU) Group Leader, University Hospital Heidelberg, Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Austrian Society for Alpine- and High-Altitude Medicine, Innsbruck, Austria
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Sharma P, Mohanty S, Ahmad Y. A study of survival strategies for improving acclimatization of lowlanders at high-altitude. Heliyon 2023; 9:e14929. [PMID: 37025911 PMCID: PMC10070159 DOI: 10.1016/j.heliyon.2023.e14929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Human Acclimatization and therapeutic approaches are the core components for conquering the physiological variations at high altitude (≥2500 m) exposure. The declined atmospheric pressure and reduced partial pressure of oxygen at high altitudes tend to decrease the temperature by several folds. Hypobaric hypoxia is a major threat to humanity at high altitudes, and its potential effects include altitude mountain sickness. On severity, it may lead to the development of conditions like high-altitude cerebral edema (HACE) or high-altitude pulmonary edema (HAPE) and cause unexpected physiological changes in the healthy population of travelers, athletes, soldiers, and low landers while sojourning at high altitude. Previous investigations have been done on long-drawn-out acclimatization strategies such as the staging method to prevent the damage caused by high-altitude hypobaric Hypoxia. Inherent Limitations of this strategy hamper the daily lifestyle and time consuming for people. It is not suitable for the rapid mobilization of people at high altitudes. There is a need to recalibrate acclimatization strategies for improving health protection and adapting to the environmental variations at high altitudes. This narrative review details the geographical changes and physiological changes at high altitudes and presents a framework of acclimatization, pre-acclimatization, and pharmacological aspects of high-altitude survival to enhance the government efficacy and capacity for the strategic planning of acclimatization, use of therapeutics, and safe de-induction from high altitude for minimizing the life loss. It's simply too ambitious for the importance of the present review to reduce life loss, and it can be proved as the most essential aspect of the preparatory phase of high-altitude acclimatization in plateau regions without hampering the daily lifestyle. The application of pre-acclimatization techniques can be a boon for people serving at high altitudes, and it can be a short bridge for the rapid translocation of people at high altitudes by minimizing the acclimatization time.
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Affiliation(s)
- Poornima Sharma
- Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
| | - Swaraj Mohanty
- Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
| | - Yasmin Ahmad
- Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
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10
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Viscor G, Corominas J, Carceller A. Nutrition and Hydration for High-Altitude Alpinism: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3186. [PMID: 36833880 PMCID: PMC9965509 DOI: 10.3390/ijerph20043186] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
This report aims to summarise the scientific knowledge around hydration, nutrition, and metabolism at high altitudes and to transfer it into the practical context of extreme altitude alpinism, which, as far as we know, has never been considered before in the literature. Maintaining energy balance during alpine expeditions is difficult for several reasons and requires a deep understanding of human physiology and the biological basis for altitude acclimation. However, in these harsh conditions it is difficult to reconcile our current scientific knowledge in sports nutrition or even for mountaineering to high-altitude alpinism: extreme hypoxia, cold, and the logistical difficulties intrinsic to these kinds of expeditions are not considered in the current literature. Requirements for the different stages of an expedition vary dramatically with increasing altitude, so recommendations must differentiate whether the alpinist is at base camp, at high-altitude camps, or attempting the summit. This paper highlights nutritional recommendations regarding prioritising carbohydrates as a source of energy and trying to maintain a protein balance with a practical contextualisation in the extreme altitude environment in the different stages of an alpine expedition. More research is needed regarding specific macro and micronutrient requirements as well as the adequacy of nutritional supplementations at high altitudes.
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Affiliation(s)
- Ginés Viscor
- Secció de Fisiologia, Departament de Biologia Cel·Lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, 08028 Barcelona, Spain
| | - Jordi Corominas
- International Federation of Mountain Guide Associations (UIAGM/IFMGA), CH-1920 Bern, Switzerland
| | - Anna Carceller
- Secció de Fisiologia, Departament de Biologia Cel·Lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, 08028 Barcelona, Spain
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11
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Haugen T, Sandbakk Ø, Seiler S, Tønnessen E. The Training Characteristics of World-Class Distance Runners: An Integration of Scientific Literature and Results-Proven Practice. SPORTS MEDICINE - OPEN 2022; 8:46. [PMID: 35362850 PMCID: PMC8975965 DOI: 10.1186/s40798-022-00438-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/22/2022] [Indexed: 11/23/2022]
Abstract
In this review we integrate the scientific literature and results-proven practice and outline a novel framework for understanding the training and development of elite long-distance performance. Herein, we describe how fundamental training characteristics and well-known training principles are applied. World-leading track runners (i.e., 5000 and 10,000 m) and marathon specialists participate in 9 ± 3 and 6 ± 2 (mean ± SD) annual competitions, respectively. The weekly running distance in the mid-preparation period is in the range 160–220 km for marathoners and 130–190 km for track runners. These differences are mainly explained by more running kilometers on each session for marathon runners. Both groups perform 11–14 sessions per week, and ≥ 80% of the total running volume is performed at low intensity throughout the training year. The training intensity distribution vary across mesocycles and differ between marathon and track runners, but common for both groups is that volume of race-pace running increases as the main competition approaches. The tapering process starts 7–10 days prior to the main competition. While the African runners live and train at high altitude (2000–2500 m above sea level) most of the year, most lowland athletes apply relatively long altitude camps during the preparation period. Overall, this review offers unique insights into the training characteristics of world-class distance runners by integrating scientific literature and results-proven practice, providing a point of departure for future studies related to the training and development in the Olympic long-distance events.
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Furian M, Tannheimer M, Burtscher M. Effects of Acute Exposure and Acclimatization to High-Altitude on Oxygen Saturation and Related Cardiorespiratory Fitness in Health and Disease. J Clin Med 2022; 11:jcm11226699. [PMID: 36431176 PMCID: PMC9697047 DOI: 10.3390/jcm11226699] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Maximal values of aerobic power (VO2max) and peripheral oxygen saturation (SpO2max) decline in parallel with gain in altitude. Whereas this relationship has been well investigated when acutely exposed to high altitude, potential benefits of acclimatization on SpO2 and related VO2max in healthy and diseased individuals have been much less considered. Therefore, this narrative review was primarily aimed to identify relevant literature reporting altitude-dependent changes in determinants, in particular SpO2, of VO2max and effects of acclimatization in athletes, healthy non-athletes, and patients suffering from cardiovascular, respiratory and/or metabolic diseases. Moreover, focus was set on potential differences with regard to baseline exercise performance, age and sex. Main findings of this review emphasize the close association between individual SpO2 and VO2max, and demonstrate similar altitude effects (acute and during acclimatization) in healthy people and those suffering from cardiovascular and metabolic diseases. However, in patients with ventilatory constrains, i.e., chronic obstructive pulmonary disease, steep decline in SpO2 and V̇O2max and reduced potential to acclimatize stress the already low exercise performance. Finally, implications for prevention and therapy are briefly discussed.
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Affiliation(s)
- Michael Furian
- Pulmonary Division, University Hospital Zurich, 8092 Zurich, Switzerland
- Research Department, Swiss University of Traditional Chinese Medicine, 5330 Bad Zurzach, Switzerland
| | - Markus Tannheimer
- Department of Sport and Rehabilitation Medicine, University of Ulm, 89075 Ulm, Germany
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
- Correspondence:
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13
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Cerda-Kohler H, Haichelis D, Reuquén P, Miarka B, Homer M, Zapata-Gómez D, Aedo-Muñoz E. Training at moderate altitude improves submaximal but not maximal performance-related parameters in elite rowers. Front Physiol 2022; 13:931325. [PMID: 36311238 PMCID: PMC9614325 DOI: 10.3389/fphys.2022.931325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Maximal oxygen consumption (V̇O2max), physiological thresholds, and hemoglobin mass are strong predictors of endurance performance. High values of V̇O2max, maximal aerobic power (MAP), and power output at anaerobic thresholds are key variables in elite rowers. Endurance athletes often use altitude training as a strategy to improve performance. However, no clear evidence exists that training at natural altitude enhances sea-level performance in elite rowers. This study aimed to evaluate the effect of altitude training on rowing-performance parameters at sea level. The study was conducted on eleven rowers (Six females, five males) from the Chilean National Team during a 3-week moderate altitude training (∼2,900 m. a.s.l.) under the live high-train high (LHTH) model. It included a rowing ergometer maximal incremental test and blood analysis (pre and post-altitude). Gas exchange analysis was performed to measure V̇O2max, ventilatory thresholds (VTs) and rowing economy/efficiency (ECR/GE%). LHTL training improves performance-related variables at sea level (V̇Emax: 3.3% (95% CI, 1.2–5.5); hemoglobin concentration ([Hb]): 4.3% (95% CI, 1.7–6.9); hematocrit (%): 4.5% (95% CI, 0.9–8.2); RBC (red blood cells) count: 5.3% (95% CI, 2.3–8.2); power at VT2: 6.9% (95% CI, 1.7–12.1), V̇EVT2: 6.4% (95% CI, 0.4–12.4); power at VT1: 7.3% (95% CI, 1.3–13.3), V̇EVT1: 8.7% (95% CI, 1.6–15.8)) and economy/efficiency-related variables (ECRVT2: 5.3% (95% CI, −0.6 to −10.0); GE(%): 5.8% (95% CI, 0.8–10.7)). The LHTH training decreased breathing economy at MAP (−2.8% (95% CI, 0.1–5.6)), pVT2 (−9.3% (95% CI, −5.9 to −12.7)), and pVT1 (−9.3% (95% CI, −4.1 to −14.4)). Non-significant changes were found for V̇O2max and MAP. This study describes the effects of a 3-week moderate altitude (LHTH training) on performance and economy/efficiency-related variables in elite rowers, suggesting that it is an excellent option to induce positive adaptations related to endurance performance.
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Affiliation(s)
- Hugo Cerda-Kohler
- Escuela de Ciencias del Deporte y Actividad Física, Facultad de Salud, Universidad Santo Tomás, Santiago, Chile
- Departamento de Educación Física, eporte y Recreación, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
- Laboratory of Psychophysiology and Performance in Sports and Combats, Postgraduate Program in Physical Education, School of Physical Education and Sport, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Unidad de Fisiología del Ejercicio, Centro de Innovación, Clínica MEDS, Santiago, Chile
| | - Danni Haichelis
- Unidad de Fisiología del Ejercicio, Centro de Innovación, Clínica MEDS, Santiago, Chile
- Unidad de Ciencias Aplicadas al Deporte, Instituto Nacional de Deportes, Santiago, Chile
| | - Patricia Reuquén
- Unidad de Ciencias Aplicadas al Deporte, Instituto Nacional de Deportes, Santiago, Chile
- Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, Santiago, Chile
- Laboratorio de Ciencias de la Actividad Física, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Bianca Miarka
- Laboratory of Psychophysiology and Performance in Sports and Combats, Postgraduate Program in Physical Education, School of Physical Education and Sport, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mark Homer
- School of Human and Social Sciences, Buckinghamshire New University, Buckinghamshire, United Kingdom
| | - Daniel Zapata-Gómez
- Unidad de Ciencias Aplicadas al Deporte, Instituto Nacional de Deportes, Santiago, Chile
| | - Esteban Aedo-Muñoz
- Laboratory of Psychophysiology and Performance in Sports and Combats, Postgraduate Program in Physical Education, School of Physical Education and Sport, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Unidad de Ciencias Aplicadas al Deporte, Instituto Nacional de Deportes, Santiago, Chile
- Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, Santiago, Chile
- *Correspondence: Esteban Aedo-Muñoz,
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14
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Palmo T, Abbasi BA, Chanana N, Sharma K, Faruq M, Thinlas T, Abdin MZ, Pasha Q. The EDN1 Missense Variant rs5370 G > T Regulates Adaptation and Maladaptation under Hypobaric Hypoxia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11174. [PMID: 36141455 PMCID: PMC9517604 DOI: 10.3390/ijerph191811174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
Endothelin 1 (EDN1) encodes a potent endogenous vasoconstrictor, ET1, to maintain vascular homeostasis and redistribution of tissue blood flow during exercise. One of the EDN1 missense polymorphisms, rs5370 G/T, has strongly been associated with cardiopulmonary diseases. This study investigated the impact of rs5370 polymorphism in high-altitude pulmonary oedema (HAPE) disorder or maladaptation and adaptation physiology in a well-characterized case-control study of high-altitude and low-altitude populations comprising 310 samples each of HAPE-patients, HAPE-free controls and native highlanders. The rs5370 polymorphism was genotyped, and the gene expression and plasma level of EDN1 were evaluated. The functional relevance of each allele was investigated in the human embryonic kidney 293 cell line after exposure to hypoxia and computationally. The T allele was significantly more prevalent in HAPE-p compared to HAPE-f and HLs. The EDN1 gene expression and ET1 bio-level were significantly elevated in HAPE-p compared to controls. Compared to the G allele, the T allele was significantly associated with elevated levels of ET-1 in all three study groups and cells exposed to hypoxia. The in silico studies further confirmed the stabilizing effect of the T allele on the structural integrity and function of ET1 protein. The ET1 rs5370 T allele is associated with an increased concentration of ET-1 in vivo and in vitro, establishing it as a potent marker in the adaptation/maladaptation physiology under the high-altitude environment. This could also be pertinent in endurance exercises at high altitudes.
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Affiliation(s)
- Tsering Palmo
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Delhi 110007, India
- Department of Biotechnology, Jamia Hamdard, New Delhi 110062, India
| | - Bilal Ahmed Abbasi
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Delhi 110007, India
| | - Neha Chanana
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Delhi 110007, India
| | - Kavita Sharma
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Delhi 110007, India
| | - Mohammed Faruq
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Delhi 110007, India
| | - Tashi Thinlas
- Sonam Norboo Memorial Hospital, Leh 194101, Ladakh, India
| | - Malik Z. Abdin
- Department of Biotechnology, Jamia Hamdard, New Delhi 110062, India
| | - Qadar Pasha
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Delhi 110007, India
- Institute of Hypoxia Research, New Delhi 110067, India
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15
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Jolicoeur Desroches A, Goulet EDB. Is a sub 7-h Ironman TM possible? Front Sports Act Living 2022; 4:866599. [PMID: 36091871 PMCID: PMC9453846 DOI: 10.3389/fspor.2022.866599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/19/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
| | - Eric D. B. Goulet
- Faculty of physical activity sciences, University of Sherbrooke, Sherbrooke, QC, Canada
- Research Centre on Aging, University of Sherbrooke, Sherbrooke, QC, Canada
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Hydration Strategies for Physical Activity and Endurance Events at High (>2500 m) Altitude: A Practical Management Article. Clin J Sport Med 2022; 32:407-413. [PMID: 33852437 DOI: 10.1097/jsm.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/11/2021] [Indexed: 02/02/2023]
Abstract
A growing number of adventurous athletes are seeking new challenges through endurance events or physical activities held at high altitude (>2500 m). This coincides with a significant increase in the numbers of trekkers who ascend into the world's mountains. Altitude itself influences and complicates the athlete's effective and safe hydration. This article considers the physiology of adaptation to altitude and the effects on hydration at altitude compared with sea level, reviews the "ad libitum versus programmed hydration" controversy in conventional endurance event hydration, examines the evidence for extrapolation of sea level hydration strategies to the high-altitude environment, and synthesizes these disparate factors into a set of practical recommendations for hydration management during high-altitude physical activity. The guidelines will be relevant to participants of physical activity at altitude and health care staff who may care for them in the preparation or performance phases of their adventure.
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Štirn I, Garcia-Ramos A, Feriche B, Strojnik V, Tomažin K. Influence of an Acute Exposure to a Moderate Real Altitude on Motoneuron Pool Excitability and Jumping Performance. Front Physiol 2022; 13:861927. [PMID: 35547581 PMCID: PMC9081365 DOI: 10.3389/fphys.2022.861927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
The aim of the study was to test whether ascending to a moderate real altitude affects motoneuron pool excitability at rest, as expressed by a change in the H-reflex amplitude, and also to elucidate whether a possible alteration in the motoneuron pool excitability could be reflected in the execution of lower-body concentric explosive (squat jump; SJ) and fast eccentric-concentric (drop jump; DJ) muscle actions. Fifteen participants performed four experimental sessions that consisted of the combination of two real altitude conditions [low altitude (low altitude, 690 m), high altitude (higher altitude, 2,320 m)] and two testing procedures (H-reflex and vertical jumps). Participants were tested on each testing day at 8, 11, 14 and 17 h. The only significant difference (p < 0.05) detected for the H-reflex was the higher H-reflex response (25.6%) obtained 15 min after arrival at altitude compared to baseline measurement. In terms of motor behavior, DJ height was the only variable that showed a significant interaction between altitude conditions (LA and HA) and time of measurement (8, 11, 14 and 17 h) as DJ height increased more during successive measurements at HA compared to LA. The only significant difference between the LA and HA conditions was observed for DJ height at 17 h which was higher for the HA condition (p = 0.04, ES = 0.41). Although an increased H-reflex response was detected after a brief (15–20 min) exposure to real altitude, the effect on motorneuron pool excitability could not be confirmed since no significant changes in the H-reflex were detected when comparing LA and HA. On the other hand, the positive effect of altitude on DJ performance was accentuated after 6 h of exposure.
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Affiliation(s)
- Igor Štirn
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Amador Garcia-Ramos
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Department of Sports Sciences and Physical Conditioning, Faculty of Education, Universidad Catolica de la Santisima Concepcion, Concepción, Chile
| | - Belen Feriche
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Vojko Strojnik
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Tomažin
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
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18
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Karlsson Ø, Laaksonen MS, McGawley K. Monitoring Acclimatization and Training Responses Over 17–21 Days at 1,800 m in Elite Cross-Country Skiers and Biathletes. Front Sports Act Living 2022; 4:852108. [PMID: 35647539 PMCID: PMC9130592 DOI: 10.3389/fspor.2022.852108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To monitor the daily variations and time course of changes in selected variables during a 17–21-day altitude training camp at 1,800 m in a group of elite cross-country skiers (9 women, 12 men) and biathletes (7 women, 4 men). Methods Among other variables, resting peripheral oxygen saturation (SpO2rest), resting heart rate (HRrest) and urine specific gravity (USG) were monitored daily at altitude, while illness symptoms were monitored weekly. Before and after the camp, body composition (i.e., lean and fat mass) and body mass were assessed in all athletes, while roller-skiing speed at a blood lactate concentration of 4 mmol·L−1 (Speed@4mmol) was assessed in the biathletes only. Results Neither SpO2rest, HRrest nor USG changed systematically during the camp (p > 0.05), although some daily time points differed from day one for the latter two variables (p < 0.05). In addition, body composition and body mass were unchanged from before to after the camp (p > 0.05). Eleven out of 15 illness episodes were reported within 4 days of the outbound or homebound flight. The five biathletes who remained free of illness increased their Speed@4mmol by ~ 4% from before to after the camp (p = 0.031). Conclusions The present results show that measures typically recommended to monitor acclimatization and responses to altitude in athletes (e.g., SpO2rest and HRrest) did not change systematically over time. Further research is needed to explore the utility of these and other measures in elite endurance athletes at altitudes typical of competition environments.
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19
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High altitude is associated with pTau deposition, neuroinflammation, and myelin loss. Sci Rep 2022; 12:6839. [PMID: 35477957 PMCID: PMC9046305 DOI: 10.1038/s41598-022-10881-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/14/2022] [Indexed: 11/30/2022] Open
Abstract
Mammals are able to adapt to high altitude (HA) if appropriate acclimation occurs. However, specific occupations (professional climbers, pilots, astronauts and other) can be exposed to HA without acclimation and be at a higher risk of brain consequences. In particular, US Air Force U2-pilots have been shown to develop white matter hyperintensities (WMH) on MRI. Whether WMH are due to hypoxia or hypobaria effects is not understood. We compared swine brains exposed to 5000 feet (1524 m) above sea level (SL) with 21% fraction inspired O2 (FiO2) (Control group [C]; n = 5) vs. 30,000 feet (9144 m) above SL with 100% FiO2 group (hypobaric group [HYPOBAR]; n = 6). We performed neuropathologic assessments, molecular analyses, immunohistochemistry (IHC), Western Blotting (WB), and stereology analyses to detect differences between HYPOBAR vs. Controls. Increased neuronal insoluble hyperphosphorylated-Tau (pTau) accumulation was observed across different brain regions, at histological level, in the HYPOBAR vs. Controls. Stereology-based cell counting demonstrated a significant difference (p < 0.01) in pTau positive neurons between HYPOBAR and C in the Hippocampus. Higher levels of soluble pTau in the Hippocampus of HYPOBAR vs. Controls were also detected by WB analyses. Additionally, WB demonstrated an increase of IBA-1 in the Cerebellum and a decrease of myelin basic protein (MBP) in the Hippocampus and Cerebellum of HYPOBAR vs. Controls. These findings illustrate, for the first time, changes occurring in large mammalian brains after exposure to nonhypoxic-hypobaria and open new pathophysiological views on the interaction among hypobaria, pTau accumulation, neuroinflammation, and myelination in large mammals exposed to HA.
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Sousa A, Viana JL, Milheiro J, Reis VM, Millet GP. Dietary Nitrate Supplementation Is Not Helpful for Endurance Performance at Simulated Altitude Even When Combined With Intermittent Normobaric Hypoxic Training. Front Physiol 2022; 13:839996. [PMID: 35360239 PMCID: PMC8964050 DOI: 10.3389/fphys.2022.839996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionTraining intensity and nutrition may influence adaptations to training performed in hypoxia and consequently performance outcomes at altitude. This study investigates if performance at simulated altitude is improved to a larger extent when high-intensity interval training is performed in normobaric hypoxia and if this is potentiated when combined with chronic dietary nitrate (NO3−) supplementation.MethodsThirty endurance-trained male participants were allocated to one of three groups: hypoxia (13% FiO2) + NO3−; hypoxia + placebo; and normoxia (20.9% FiO2) + placebo. All performed 12 cycling sessions (eight sessions of 2*6 × 1 min at severe intensity with 1 min recovery and four sessions of 4*6*10 s all-out with 20 s recovery) during a 4-week period (three sessions/week) with supplementation administered 3–2.5 h before each session. An incremental exhaustion test, a severe intensity exercise bout to exhaustion (Tlim) and a 3 min all-out test (3AOT) in hypoxia (FiO2 = 13%) with pulmonary oxygen uptake (V˙O2), V˙O2 kinetics, and changes in vastus lateralis local O2 saturation (SmO2) measured were completed by each participant before and after training.ResultsIn all tests, performance improved to the same extent in hypoxia and normoxia, except for SmO2 after Tlim (p = 0.04, d = 0.82) and 3AOT (p = 0.03, d = 1.43) which were lower in the two hypoxic groups compared with the normoxic one. Dietary NO3− supplementation did not bring any additional benefits.ConclusionPerformance at simulated altitude was not improved to a larger extent when high-intensity interval training was undertaken in normobaric hypoxic conditions, when compared with normoxic training. Additionally, dietary NO3− supplementation was ineffective in further enhancing endurance performance at simulated altitude.
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Affiliation(s)
- Ana Sousa
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Trás-Os-Montes and Alto Douro, Vila Real, Portugal
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Instituto Universitário da Maia (ISMAI), Maia, Portugal
- *Correspondence: Ana Sousa,
| | - João L. Viana
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Instituto Universitário da Maia (ISMAI), Maia, Portugal
| | - Jaime Milheiro
- CMEP - Exercise Medical Center & Spa, Porto, Portugal
- Olympic Committee of Portugal, Lisbon, Portugal
| | - Vítor M. Reis
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Trás-Os-Montes and Alto Douro, Vila Real, Portugal
| | - Grégoire P. Millet
- ISSUL, Institute of Sport Sciences and Physical Education (ISSEP), University of Lausanne, Lausanne, Switzerland
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Fagher K, Baumgart JK, Solli GS, Holmberg HC, Lexell J, Sandbakk Ø. Preparing for snow-sport events at the Paralympic Games in Beijing in 2022: recommendations and remaining questions. BMJ Open Sport Exerc Med 2022; 8:e001294. [PMID: 35295372 PMCID: PMC8867376 DOI: 10.1136/bmjsem-2021-001294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 12/24/2022] Open
Abstract
During the 2022 Winter Paralympic Games in Beijing, the Para snow-sport events will be held at high altitudes and in possibly cold conditions while also requiring adjustment to several time zones. Furthermore, the ongoing COVID-19 pandemic may lead to suboptimal preparations. Another concern is the high rate of injuries that have been reported in the Para alpine and snowboard events. In addition to these challenges, Para athletes various impairments may affect both sports-specific demands and athlete health. However, the group of Para snow-sport athletes is an understudied population. Accordingly, this perspective paper summarises current knowledge to consider when preparing for the Paralympic Games in Beijing and point out important unanswered questions. We here focus specifically on how sport-specific demands and impairment-related considerations are influenced by altitude acclimatisation, cold conditions, travel fatigue and jetlag, complications due to the COVID-19 pandemic, and injury prevention and sports safety considerations. As Para athletes with spinal cord injury, limb deficiency, cerebral palsy and visual impairment account for the majority of the Para snow-sport athletes, the focus is mainly on these impairment groups. In brief, we highlight the extra caution required to ensure athlete health, performance and sports safety among Para athletes participating in the snow-sport events in the 2022 Beijing Paralympic Games. Although there is an urgent need for more high-quality research focusing on Para winter athletes, we hope these non-consensus recommendations will help prepare for the 2022 Beijing Paralympic Winter Games.
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Affiliation(s)
- K Fagher
- Department of Health Sciences, Lund University, Lund, Sweden
- The Swedish Paralympic Committee, Stockholm, Sweden
| | - J K Baumgart
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - G S Solli
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Sports Science and Physical Education, Nord University, Bodo, Norway
| | - H C Holmberg
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
- Department of Physiology and Pharmacology, Biomedicum C5, Karolinska Institutet, Stockholm, Sweden
| | - J Lexell
- Department of Health Sciences, Lund University, Lund, Sweden
- The Medical Committee, The International Paralympic Committee, Bonn, Germany
| | - Ø Sandbakk
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
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22
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Figueiredo PS, Sils IV, Staab JE, Fulco CS, Muza SR, Beidleman BA. Acute mountain sickness and sleep disturbances differentially influence cognition and mood during rapid ascent to 3000 and 4050 m. Physiol Rep 2022; 10:e15175. [PMID: 35133088 PMCID: PMC8822873 DOI: 10.14814/phy2.15175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 12/04/2022] Open
Abstract
The impact of acute mountain sickness (AMS) and sleep disturbances on mood and cognition at two altitudes relevant to the working and tourist population is unknown. Twenty unacclimatized lowlanders were exposed to either 3000 m (n = 10; 526 mmHg) or 4050 m (n = 10; 460 mmHg) for 20 h in a hypobaric chamber. AMS prevalence and severity was assessed using the Environmental Symptoms Questionnaire (ESQ) and an AMS‐C score ≥ 0.7 indicated sickness. While sleeping for one night both at sea level (SL) and high altitude (HA), a wrist motion detector was used to measure awakenings (Awak, events/h) and sleep efficiency (Eff, %). If Eff was ≥85%, individuals were considered a good sleeper (Sleep+). Mood and cognition were assessed using the Automated Neuropsychological Assessment Metric and Mood Scale (ANAM‐MS). The ESQ and ANAM‐MS were administered in the morning both at SL and after 20 h at HA. AMS severity (mean ± SE; 1.82 ± 0.27 vs. 0.20 ± 0.27), AMS prevalence (90% vs. 10%), depression (0.63 ± 0.23 vs. 0.00 ± 0.24) Awak (15.6 ± 1.6 vs. 10.1 ± 1.6 events/h), and DeSHr (38.5 ± 6.3 vs. 13.3 ± 6.3 events/h) were greater (p < 0.05) and Eff was lower (69.9 ± 5.3% vs. 87.0 ± 5.3%) at 4050 m compared to 3000 m, respectively. AMS presence did not impact cognition but fatigue (2.17 ± 0.37 vs. 0.58 ± 0.39), anger (0.65 ± 0.25 vs. 0.02 ± 0.26), depression (0.63 ± 0.23 vs. 0.00 ± 0.24) and sleepiness (4.8 ± 0.4 vs. 2.7 ± 0.5) were greater (p < 0.05) in the AMS+ group. The Sleep− group, compared to the Sleep+ group, had lower (p < 0.05) working memory scores (50 ± 7 vs. 78 ± 9) assessed by the Sternberg 6‐letter memory task, and lower reaction time fatigue scores (157 ± 17 vs. 221 ± 22), assessed by the repeated reaction time test. Overall, AMS, depression, DeSHr, and Awak were increased (p < 0.05) at 4050 m compared to 3000 m. In addition, AMS presence impacted mood while poor sleep impacted cognition which may deteriorate teamwork and/or increase errors in judgement at HA.
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Affiliation(s)
- Peter S. Figueiredo
- Biophysics and Biomedical Modeling Division U.S. Army Research Institute of Environmental Medicine Natick Massachusetts USA
| | - Ingrid V. Sils
- Thermal and Mountain Medicine Division U.S. Army Research Institute of Environmental Medicine Natick Massachusetts USA
| | - Janet E. Staab
- Military Performance Division U.S. Army Research Institute of Environmental Medicine Natick Massachusetts USA
| | - Charles S. Fulco
- Thermal and Mountain Medicine Division U.S. Army Research Institute of Environmental Medicine Natick Massachusetts USA
| | - Stephen R. Muza
- Strategic Science and Development Office U.S. Army Research Institute of Environmental Medicine Natick Massachusetts USA
| | - Beth A. Beidleman
- Biophysics and Biomedical Modeling Division U.S. Army Research Institute of Environmental Medicine Natick Massachusetts USA
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Płoszczyca K, Chalimoniuk M, Przybylska I, Czuba M. Effects of Short-Term Phosphate Loading on Aerobic Capacity under Acute Hypoxia in Cyclists: A Randomized, Placebo-Controlled, Crossover Study. Nutrients 2022; 14:236. [PMID: 35057416 PMCID: PMC8778537 DOI: 10.3390/nu14020236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/01/2022] [Accepted: 01/03/2022] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
- Kamila Płoszczyca
- Department of Kinesiology, Institute of Sport, 01-982 Warsaw, Poland
| | - Małgorzata Chalimoniuk
- Department of Physiotherapy, Faculty of Physical Education and Health in Biala Podlaska, Jozef Pilsudski University of Physical Education in Warsaw, 21-500 Biala Podlaska, Poland
| | - Iwona Przybylska
- Department of Physiotherapy, Faculty of Physical Education and Health in Biala Podlaska, Jozef Pilsudski University of Physical Education in Warsaw, 21-500 Biala Podlaska, Poland
| | - Miłosz Czuba
- Department of Kinesiology, Institute of Sport, 01-982 Warsaw, Poland
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland
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Exogenous Ketone Supplements in Athletic Contexts: Past, Present, and Future. Sports Med 2022; 52:25-67. [PMID: 36214993 PMCID: PMC9734240 DOI: 10.1007/s40279-022-01756-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 12/15/2022]
Abstract
The ketone bodies acetoacetate (AcAc) and β-hydroxybutyrate (βHB) have pleiotropic effects in multiple organs including brain, heart, and skeletal muscle by serving as an alternative substrate for energy provision, and by modulating inflammation, oxidative stress, catabolic processes, and gene expression. Of particular relevance to athletes are the metabolic actions of ketone bodies to alter substrate utilisation through attenuating glucose utilisation in peripheral tissues, anti-lipolytic effects on adipose tissue, and attenuation of proteolysis in skeletal muscle. There has been long-standing interest in the development of ingestible forms of ketone bodies that has recently resulted in the commercial availability of exogenous ketone supplements (EKS). These supplements in the form of ketone salts and ketone esters, in addition to ketogenic compounds such as 1,3-butanediol and medium chain triglycerides, facilitate an acute transient increase in circulating AcAc and βHB concentrations, which has been termed 'acute nutritional ketosis' or 'intermittent exogenous ketosis'. Some studies have suggested beneficial effects of EKS to endurance performance, recovery, and overreaching, although many studies have failed to observe benefits of acute nutritional ketosis on performance or recovery. The present review explores the rationale and historical development of EKS, the mechanistic basis for their proposed effects, both positive and negative, and evidence to date for their effects on exercise performance and recovery outcomes before concluding with a discussion of methodological considerations and future directions in this field.
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Hrozanova M, Talsnes R, Karlsson Ø, McGawley K, Moen F. An observational study of sleep characteristics in elite endurance athletes during an altitude training camp at 1800 m. Sleep Health 2021; 7:691-698. [PMID: 34635445 DOI: 10.1016/j.sleh.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/05/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To observe changes in sleep from baseline and during an altitude training camp in elite endurance athletes. DESIGN Prospective, observational. SETTING Baseline monitoring at <500 m for 2 weeks and altitude monitoring at 1800 m for 17-22 days. PARTICIPANTS Thirty-three senior national-team endurance athletes (mean age 25.8 ± S.D. 2.8 years, 16 women). MEASUREMENTS Daily measurements of sleep (using a microwave Doppler radar at baseline and altitude), oxygen saturation (SpO2), training load and subjective recovery (at altitude). RESULTS At altitude vs. baseline, sleep duration (P = .036) and light sleep (P < .001) decreased, while deep sleep (P < .001) and respiration rate (P = .020) increased. During the first altitude week vs. baseline, deep sleep increased (P = .001). During the first vs. the second and third altitude weeks, time in bed (P = .005), sleep duration (P = .001), and light sleep (P < .001) decreased. Generally, increased SpO2 was associated with increased deep sleep while increased training load was associated with increased respiration rate. CONCLUSION This is the first study to document changes in sleep from near-sea-level baseline and during a training camp at 1800 m in elite endurance athletes. Ascending to altitude reduced total sleep time and light sleep, while deep sleep and respiration rate increased. SpO2 and training load at altitude were associated with these responses. This research informs our understanding of the changes in sleep occurring in elite endurance athletes attending training camps at competition altitudes.
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Affiliation(s)
- Maria Hrozanova
- Center for Elite Sports Research, Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Rune Talsnes
- Meråker High School, Trøndelag County Council, Meråker, Norway; Department of Sports Science and Physical Education, Nord University, Bodø, Norway
| | - Øyvind Karlsson
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Kerry McGawley
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Frode Moen
- Faculty of Social and Educational Sciences, Department of Education and Lifelong Learning, Norwegian University of Science and Technology, Trondheim, Norway
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Jeffries AC, Marcora SM, Coutts AJ, Wallace L, McCall A, Impellizzeri FM. Development of a Revised Conceptual Framework of Physical Training for Use in Research and Practice. Sports Med 2021; 52:709-724. [PMID: 34519982 DOI: 10.1007/s40279-021-01551-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 01/26/2023]
Abstract
A conceptual framework has a central role in the scientific process. Its purpose is to synthesize evidence, assist in understanding phenomena, inform future research and act as a reference operational guide in practical settings. We propose an updated conceptual framework intended to facilitate the validation and interpretation of physical training measures. This revised conceptual framework was constructed through a process of qualitative analysis involving a synthesis of the literature, analysis and integration with existing frameworks (Banister and PerPot models). We identified, expanded, and integrated four constructs that are important in the conceptualization of the process and outcomes of physical training. These are: (1) formal introduction of a new measurable component 'training effects', a higher-order construct resulting from the combined effect of four possible responses (acute and chronic, positive and negative); (2) explanation, clarification and examples of training effect measures such as performance, physiological, subjective and other measures (cognitive, biomechanical, etc.); (3) integration of the sport performance outcome continuum (from performance improvements to overtraining); (4) extension and definition of the network of linkages (uni and bidirectional) between individual and contextual factors and other constructs. Additionally, we provided constitutive and operational definitions, and examples of theoretical and practical applications of the framework. These include validation and conceptualization of constructs (e.g., performance readiness), and understanding of higher-order constructs, such as training tolerance, when monitoring training to adapt it to individual responses and effects. This proposed conceptual framework provides an overarching model that may help understand and guide the development, validation, implementation and interpretation of measures used for athlete monitoring.
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Affiliation(s)
- Annie C Jeffries
- Faculty of Health, Human Performance Research Centre, University of Technology Sydney, Sydney, NSW, Australia.
| | - Samuele M Marcora
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Canterbury, UK.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Aaron J Coutts
- Faculty of Health, Human Performance Research Centre, University of Technology Sydney, Sydney, NSW, Australia
| | - Lee Wallace
- Faculty of Health, Human Performance Research Centre, University of Technology Sydney, Sydney, NSW, Australia
| | - Alan McCall
- Faculty of Health, Human Performance Research Centre, University of Technology Sydney, Sydney, NSW, Australia.,Arsenal Performance and Research Team, Arsenal Football Club, London, UK
| | - Franco M Impellizzeri
- Faculty of Health, Human Performance Research Centre, University of Technology Sydney, Sydney, NSW, Australia
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Mallet RT, Burtscher J, Richalet JP, Millet GP, Burtscher M. Impact of High Altitude on Cardiovascular Health: Current Perspectives. Vasc Health Risk Manag 2021; 17:317-335. [PMID: 34135590 PMCID: PMC8197622 DOI: 10.2147/vhrm.s294121] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Globally, about 400 million people reside at terrestrial altitudes above 1500 m, and more than 100 million lowlanders visit mountainous areas above 2500 m annually. The interactions between the low barometric pressure and partial pressure of O2, climate, individual genetic, lifestyle and socio-economic factors, as well as adaptation and acclimatization processes at high elevations are extremely complex. It is challenging to decipher the effects of these myriad factors on the cardiovascular health in high altitude residents, and even more so in those ascending to high altitudes with or without preexisting diseases. This review aims to interpret epidemiological observations in high-altitude populations; present and discuss cardiovascular responses to acute and subacute high-altitude exposure in general and more specifically in people with preexisting cardiovascular diseases; the relations between cardiovascular pathologies and neurodegenerative diseases at altitude; the effects of high-altitude exercise; and the putative cardioprotective mechanisms of hypobaric hypoxia.
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Affiliation(s)
- Robert T Mallet
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Johannes Burtscher
- Department of Biomedical Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
- Institute of Sport Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
| | - Jean-Paul Richalet
- Laboratoire Hypoxie & Poumon, UMR Inserm U1272, Université Sorbonne Paris Nord 13, Bobigny Cedex, F-93017, France
| | - Gregoire P Millet
- Department of Biomedical Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
- Institute of Sport Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, A-6020, Austria
- Austrian Society for Alpine and High-Altitude Medicine, Mieming, Austria
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28
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Sandbakk Ø, Solli GS, Talsnes RK, Holmberg HC. Preparing for the Nordic Skiing Events at the Beijing Olympics in 2022: Evidence-Based Recommendations and Unanswered Questions. JOURNAL OF SCIENCE IN SPORT AND EXERCISE 2021; 3:257-269. [PMID: 38624672 PMCID: PMC8107804 DOI: 10.1007/s42978-021-00113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/26/2021] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Øyvind Sandbakk
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Guro Strøm Solli
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Sports Science and Physical Education, Nord University, Bodø, Norway
| | - Rune Kjøsen Talsnes
- Department of Sports Science and Physical Education, Nord University, Bodø, Norway
- Meråker High School, Trøndelag County Council, Steinkjer, Norway
| | - Hans-Christer Holmberg
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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29
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Dünnwald T, Kienast R, Niederseer D, Burtscher M. The Use of Pulse Oximetry in the Assessment of Acclimatization to High Altitude. SENSORS 2021; 21:s21041263. [PMID: 33578839 PMCID: PMC7916608 DOI: 10.3390/s21041263] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 02/07/2023]
Abstract
Background: Finger pulse oximeters are widely used to monitor physiological responses to high-altitude exposure, the progress of acclimatization, and/or the potential development of high-altitude related diseases. Although there is increasing evidence for its invaluable support at high altitude, some controversy remains, largely due to differences in individual preconditions, evaluation purposes, measurement methods, the use of different devices, and the lacking ability to interpret data correctly. Therefore, this review is aimed at providing information on the functioning of pulse oximeters, appropriate measurement methods and published time courses of pulse oximetry data (peripheral oxygen saturation, (SpO2) and heart rate (HR), recorded at rest and submaximal exercise during exposure to various altitudes. Results: The presented findings from the literature review confirm rather large variations of pulse oximetry measures (SpO2 and HR) during acute exposure and acclimatization to high altitude, related to the varying conditions between studies mentioned above. It turned out that particularly SpO2 levels decrease with acute altitude/hypoxia exposure and partly recover during acclimatization, with an opposite trend of HR. Moreover, the development of acute mountain sickness (AMS) was consistently associated with lower SpO2 values compared to individuals free from AMS. Conclusions: The use of finger pulse oximetry at high altitude is considered as a valuable tool in the evaluation of individual acclimatization to high altitude but also to monitor AMS progression and treatment efficacy.
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Affiliation(s)
- Tobias Dünnwald
- Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT—Private University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria;
| | - Roland Kienast
- Department of Biomedical and Health Technology, Federal Higher Technical Institute for Education and Experimentation—HTL Anichstraße, 6020 Innsbruck, Austria;
| | - David Niederseer
- Department of Cardiology, University Hospital Zurich, University Heart Center Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
- Correspondence:
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Constantini K, Bouillet AC, Wiggins CC, Martin BJ, Chapman RF. Ventilatory Responsiveness during Exercise and Performance Impairment in Acute Hypoxia. Med Sci Sports Exerc 2021; 53:295-305. [PMID: 32694376 PMCID: PMC8058857 DOI: 10.1249/mss.0000000000002466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
| | - Anna C Bouillet
- Department of Kinesiology, Indiana University, Bloomington, IN
| | - Chad C Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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31
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Ghaleb AM, Ramadan MZ, Badwelan A, Mansour L, Al-Tamimi J, Aljaloud KS. Determining the time needed for workers to acclimatize to hypoxia. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:1995-2005. [PMID: 32794023 DOI: 10.1007/s00484-020-01989-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 07/27/2020] [Accepted: 08/05/2020] [Indexed: 06/11/2023]
Abstract
This study aimed to determine the influence of intermittent hypoxia and the days required for a worker to be acclimatized in high-altitude countries. We conducted an experimental study. Ten nonsmoking male students were randomly recruited from King Saud University. Fourteen days of exposure to intermittent normobaric hypoxia (15%) was the independent variable. Heart rate (HR), respiratory frequency (RF), minute ventilation (VE), respiratory exchange ratio (RER), tidal volume (VT), oxygen uptake (VO2),VO2/kg, VO2/HR, VE/VO2, and VE/VCO2 were the dependent variables. Our results showed that 12 days of exposure to intermittent hypoxia were sufficient for workers to acclimatize to hypoxia based on their respiratory responses (i.e., HR, RF, VE). This type of acclimatization session is very important for workers who are suddenly required to work in such an environment, because prolonged exposure to high altitude without acclimatization leads to cell death due to a lack of oxygen, and this, in turn, puts workers' lives at risk.
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Affiliation(s)
- Atef M Ghaleb
- Department of Industrial Engineering, College of Engineering, King Saud University, Riyadh, Saudi Arabia.
| | - Mohamed Z Ramadan
- Department of Industrial Engineering, College of Engineering, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Badwelan
- Department of Industrial Engineering, College of Engineering, King Saud University, Riyadh, Saudi Arabia
| | - Lamjed Mansour
- Department of Zoology , College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
| | - Jameel Al-Tamimi
- Department of Zoology , College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
| | - Khalid Saad Aljaloud
- Department of Exercise Physiology, College of Sport Sciences & Physical Activity, King Saud University, Riyadh, Saudi Arabia
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32
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A Focused Review on the Maximal Exercise Responses in Hypo- and Normobaric Hypoxia: Divergent Oxygen Uptake and Ventilation Responses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145239. [PMID: 32698542 PMCID: PMC7400084 DOI: 10.3390/ijerph17145239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/26/2022]
Abstract
The literature suggests that acute hypobaric (HH) and normobaric (NH) hypoxia exposure elicits different physiological responses. Only limited information is available on whether maximal cardiorespiratory exercise test outcomes, performed on either the treadmill or the cycle ergometer, are affected differently by NH and HH. A focused literature review was performed to identify relevant studies reporting cardiorespiratory responses in well-trained male athletes (individuals with a maximal oxygen uptake, VO2max > 50 mL/min/kg at sea level) to cycling or treadmill running in simulated acute HH or NH. Twenty-one studies were selected. The exercise tests in these studies were performed in HH (n = 90) or NH (n = 151) conditions, on a bicycle ergometer (n = 178) or on a treadmill (n = 63). Altitudes (simulated and terrestrial) varied between 2182 and 5400 m. Analyses (based on weighted group means) revealed that the decline in VO2max per 1000 m gain in altitude was more pronounced in acute NH vs. HH (-7.0 ± 1.4% vs. -5.6 ± 0.9%). Maximal minute ventilation (VEmax) increased in acute HH but decreased in NH with increasing simulated altitude (+1.9 ± 0.9% vs. -1.4 ± 1.8% per 1000 m gain in altitude). Treadmill running in HH caused larger decreases in arterial oxygen saturation and heart rate than ergometer cycling in acute HH, which was not the case in NH. These results indicate distinct differences between maximal cardiorespiratory responses to cycling and treadmill running in acute NH or HH. Such differences should be considered when interpreting exercise test results and/or monitoring athletic training.
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Doria C, Verratti V, Pietrangelo T, Fanò-Illic G, Bisconti AV, Shokohyar S, Rampichini S, Limonta E, Coratella G, Longo S, Cè E, Esposito F. Changes in energy system contributions to the Wingate anaerobic test in climbers after a high altitude expedition. Eur J Appl Physiol 2020; 120:1629-1636. [PMID: 32494861 DOI: 10.1007/s00421-020-04392-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 05/12/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The Wingate anaerobic test measures the maximum anaerobic capacity of the lower limbs. The energy sources of Wingate test are dominated by anaerobic metabolism (~ 80%). Chronic high altitude exposure induces adaptations on skeletal muscle function and metabolism. Therefore, the study aim was to investigate possible changes in the energy system contribution to Wingate test before and after a high-altitude sojourn. METHODS Seven male climbers performed a Wingate test before and after a 43-day expedition in the Himalaya (23 days above 5.000 m). Mechanical parameters included: peak power (PP), average power (AP), minimum power (MP) and fatigue index (FI). The metabolic equivalents were calculated as aerobic contribution from O2 uptake during the 30-s exercise phase (WVO2), lactic and alactic anaerobic energy sources were determined from net lactate production (WLa) and the fast component of the kinetics of post-exercise oxygen uptake (WPCr), respectively. The total metabolic work (WTOT) was calculated as the sum of the three energy sources. RESULTS PP and AP decreased from 7.3 ± 1.1 to 6.7 ± 1.1 W/kg and from 5.9 ± 0.7 to 5.4 ± 0.8 W/kg, respectively, while FI was unchanged. WTOT declined from 103.9 ± 28.7 to 83.8 ± 17.8 kJ. Relative aerobic contribution remained unchanged (19.9 ± 4.8% vs 18.3 ± 2.3%), while anaerobic lactic and alactic contributions decreased from 48.3 ± 11.7 to 43.1 ± 8.9% and increased from 31.8 ± 14.5 to 38.6 ± 7.4%, respectively. CONCLUSION Chronic high altitude exposure induced a reduction in both mechanical and metabolic parameters of Wingate test. The anaerobic alactic relative contribution increased while the anaerobic lactic decreased, leaving unaffected the overall relative anaerobic contribution to Wingate test.
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Affiliation(s)
- Christian Doria
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via G. Colombo 71, 20133, Milan, Italy.
| | - V Verratti
- Department of Psychological Sciences, Health and Territory, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - T Pietrangelo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - G Fanò-Illic
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - A V Bisconti
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - S Shokohyar
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via G. Colombo 71, 20133, Milan, Italy
| | - S Rampichini
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via G. Colombo 71, 20133, Milan, Italy
| | - E Limonta
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via G. Colombo 71, 20133, Milan, Italy.,IRCCS, Istituto Ortopedico Galeazzi, Milan, Italy
| | - G Coratella
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via G. Colombo 71, 20133, Milan, Italy
| | - S Longo
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via G. Colombo 71, 20133, Milan, Italy
| | - E Cè
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via G. Colombo 71, 20133, Milan, Italy.,IRCCS, Istituto Ortopedico Galeazzi, Milan, Italy
| | - F Esposito
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via G. Colombo 71, 20133, Milan, Italy.,IRCCS, Istituto Ortopedico Galeazzi, Milan, Italy
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Burtscher J, Gatterer H, Burtscher M. Is it time to revise the acclimatization schedule at high altitude? Med J Armed Forces India 2020; 76:120-121. [PMID: 32020982 DOI: 10.1016/j.mjafi.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Johannes Burtscher
- Laboratory of Molecular and Chemical Biology of Neurodegeneration, École Polytechnique Fédérale de Lausanne (EPFL), Switzerland.,Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy.,Department of Sport Science, University of Innsbruck, Austria.,Austrian Society for Alpine and Mountain Medicine, Austria
| | - Hannes Gatterer
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy.,Department of Sport Science, University of Innsbruck, Austria.,Austrian Society for Alpine and Mountain Medicine, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Austria.,Austrian Society for Alpine and Mountain Medicine, Austria
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Intermittent Hypoxic Training at Lactate Threshold Intensity Improves Aiming Performance in Well-Trained Biathletes with Little Change of Cardiovascular Variables. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1287506. [PMID: 31662969 PMCID: PMC6778904 DOI: 10.1155/2019/1287506] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/13/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023]
Abstract
The main objective of this research was to evaluate the efficacy of intermittent hypoxic training (IHT) on aiming performance and aerobic capacity in biathletes. Fourteen male biathletes were randomly divided into a hypoxia group (H) (n = 7), which trained three times per week in a normobaric hypoxic environment (FiO2 = 16.5%, 2000 m a.s.l.) with lactate threshold intensity (LT) determined in hypoxia, and a control group (C) (n = 7), which exercised under normoxic conditions with LT intensity determined in normoxia. The training program included three weekly microcycles, followed by three days of recovery. The main part of the interval workout consisted of four 7 min (1st week), 8 min (2nd week), or 9 min (3rd week) running bouts at treadmill separated by 2 minutes of active recovery. After the warm-up and during the rest between the bouts, the athletes performed aiming to the target in the standing position with a sporting rifle (20 s). The results showed that the IHT caused a significant (p < 0.05) increase in retention time in the target at rest (RT9rest) by 14.4% in hypoxia, whereas RT postincremental test (RT9post) increased by 27.4% in normoxia and 26.7% in hypoxia. No significant changes in this variable were found in group C. Additionally, the capillary oxygen saturation at the end of the maximal effort (SO2capillary max) in hypoxia increased significantly (p < 0.001) by ∼4% after IHT. The maximal workload during the incremental test (WRmax) in normoxia also increased significantly (p < 0.001) by 6.3% after IHT. Furthermore, in absolute and relative values of VO2max in normoxia, there was a propensity (p < 0.07) for increasing this value by 5% in group H. In conclusion, the main findings of this study showed a significant improvement in resting and postexercise aiming performance in normoxia and hypoxia. Furthermore, the results demonstrated beneficial effects of the IHT protocol on aerobic capacity of biathletes.
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Edouard P, Richardson A, Murray A, Duncan J, Glover D, Kiss M, Depiesse F, Branco P. Ten Tips to Hurdle the Injuries and Illnesses During Major Athletics Championships: Practical Recommendations and Resources. Front Sports Act Living 2019; 1:12. [PMID: 33344936 PMCID: PMC7739783 DOI: 10.3389/fspor.2019.00012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/31/2019] [Indexed: 12/17/2022] Open
Abstract
Participating or winning a medal in major track and field (athletics) competitions is the goal of every athlete. However, health problems can impair sports performance and affect this dream. Therefore, we present ten tips to help hurdle the challenges of illness/injury at major athletics championships: (1) Prepare for travel (medical checking, vaccine, time-zone, jet lag, culture, food habits…), (2) Respect athlete characteristics and discipline specificity (sex, endurance/explosive), (3) Educate athletes and their entourages regarding prevention, (4) Vigilance of painful symptoms and subclinical illness markers, (5) Avoid infection risk (washing hands, safe food and drink, avoid contact with sick people…), (6) Train appropriately and optimally (physical conditioning, technical training, load management, and psychological preparation), (7) Health status (history of previous injuries, well-being in the month before championships), (8) Lifestyle (good sleep, regular hydration and nutrition with safe water/food, regular fruits and vegetables, improve recovery strategies…), (9) Environmental considerations (heat, cold, air cleaning, changes or climatic conditions…), (10) Safety (equipment, rules, own-practice in athletics, and extra-sport activities). These ten tips “PREVATHLES” are based on our field experience in addition to existing epidemiological and experimental literature in athletics and other sports. Although there is currently no scientific evidence for their efficacy, sound judgement, and logical practice provide a strong basis, and given the low risk of using them in the benefit/risk balance, we suggest athletes and those around them follow these ten tips to limit the impact of injury/illness on championship performance.
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Affiliation(s)
- Pascal Edouard
- Inter-University Laboratory of Human Movement Science (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint-Étienne, France.,Sports Medicine Unit, Department of Clinical and Exercise Physiology, Faculty of Medicine, University Hospital of Saint-Etienne, Saint-Étienne, France.,Medical Commission, French Athletics Federation (FFA), Paris, France.,Division de Médecine Physique et Réadaptation, Swiss Olympic Medical Centre, Centre de Médecine du Sport, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,European Athletics Medical & Anti-doping Commission, European Athletics Association (EAA), Lausanne, Switzerland
| | - Andy Richardson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew Murray
- Knowledge Translation Team, Sport and Exercise, University of Edinburgh, Edinburgh, United Kingdom.,Human Performance Science Research Group, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer Duncan
- Knowledge Translation Team, Sport and Exercise, University of Edinburgh, Edinburgh, United Kingdom
| | - Danny Glover
- Knowledge Translation Team, Sport and Exercise, University of Edinburgh, Edinburgh, United Kingdom.,Health Education Yorkshire and the Humber, Leeds, United Kingdom
| | - Marianna Kiss
- Hungarian Athletics Federation (Magyar Atlétikai Szovetség), Budapest, Hungary.,National Institute for Sport Medicine, Budapest, Hungary
| | - Frédéric Depiesse
- Medical Commission, French Athletics Federation (FFA), Paris, France.,European Athletics Medical & Anti-doping Commission, European Athletics Association (EAA), Lausanne, Switzerland.,Department of Physical Medicine and Rehabilitation, University Hospital of Martinique, Le Lamentin, France.,Health and Science Commission, International Association of Athletics Federations (IAAF), Monaco, Monaco
| | - Pedro Branco
- European Athletics Medical & Anti-doping Commission, European Athletics Association (EAA), Lausanne, Switzerland.,Health and Science Commission, International Association of Athletics Federations (IAAF), Monaco, Monaco
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