Effect of acute normobaric hypoxia on quadriceps integrated electromyogram and blood metabolites during incremental exercise to exhaustion

The Methodological Quality of Studies Investigating the Acute Effects of Exercise During Hypoxia Over the Past 40 years: A Systematic Review

Exercise under hypoxia and the physiological impact compared to normoxia or hypoxia has gained attention in the last decades. However, methodological quality assessment of articles in this area is lacking in the literature. Therefore, this article aimed to evaluate the methodologic quality of trials studying exercise under hypoxia. An electronic search was conducted until December 2021. The search was conducted in PubMed, CENTRAL, and PEDro using the PICO model. (P) Participants had to be healthy, (I) exercise under normobaric or hypobaric hypoxia had to be (C) compared to exercise in normoxia or hypoxia on (O) any physiological outcome. The 11-item PEDro scale was used to assess the methodological quality (internal validity) of the studies. A linear regression model was used to evaluate the evolution of trials in this area, using the total PEDro score of the rated trials. A total of n = 81 studies met the inclusion criteria and were processed in this study. With a mean score of 5.1 ± 0.9 between the years 1982 and 2021, the mean methodological quality can be described as “fair.” Only one study reached the highest score of 8/10, and n = 2 studies reached the lowest observed value of 3/10. The linear regression showed an increase of the PEDro score of 0.1 points per decade. A positive and small tendency toward increased methodologic quality was observed. The current results demonstrate that a positive and small tendency can be seen for the increase in the methodological quality in the field of exercise science under hypoxia. A “good” methodological quality, reaching a PEDro score of 6 points can be expected in the year 2063, using a linear regression model analysis. To accelerate this process, future research should ensure that methodological quality criteria are already included during the planning phase of a study.

Electromyography: A Simple and Accessible Tool to Assess Physical Performance and Health during Hypoxia Training. A Systematic Review

Hypoxia causes reduced partial pressure of oxygen in arterial blood and induces adaptations in skeletal muscle that may affect individuals’ physical performance and muscular health. These muscular changes are detectable and quantifiable by electromyography (EMG), an instrument that assesses electrical activity during active contraction at rest. EMG is a relatively simple and accessible technique for all patients, one that can show the degree of the sensory and motor functions because it provides information about the status of the peripheral nerves and muscles. The main goal of this review is to evaluate the scientific evidence of EMG as an instrument for monitoring different responses of skeletal muscles subjected to external stimuli such as hypoxia and physical activity. A structured search was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines in Medline/PubMed, Scielo, Google Scholar, Web of Science, and Cochrane Library Plus. The search included articles published in the last 25 years until May 2020 and was restricted to English- and Spanish-language publications. As such, investigators identified nine articles that met the search criteria. The results determined that EMG was able to detect muscle fatigue from changes in the frequency spectrum. When a muscle was fatigued, high frequency components decreased and low frequency components increased. In other studies, EMG determined muscle activation increased during exercise by recruiting motor units and by increasing the intensity of muscle contractions. Finally, it was also possible to calculate the mean quadriceps quadratic activity used to obtain an image of muscle activation. In conclusion, EMG offers a suitable tool for monitoring the different skeletal muscle responses and has sufficient sensitivity to detect hypoxia-induced muscle changes produced by hypoxic stimuli. Moreover, EMG enhances an extension of physical examination and tests motor-system integrity.

Isometric-based EMG threshold in girls and women

BACKGROUND

The electromyographic threshold (EMG_Th) has been suggested to indicate the onset of accelerated higher-threshold (type-II) MU recruitment. Previous research has demonstrated that boys' EMG_Th occurs at higher relative exercise intensities than men's in both cycling- and isometric-based testing. Girls‒women EMG_Th differences were demonstrated only in cycling, but findings were clouded by low EMG_Th-detection rates in women (68%) and particularly in girls (45%) PURPOSE: To examine the EMG_Th, in girls and women, using the same males-employed isometric-based test protocol, and compare the females' findings with those previously obtained in the males.

METHODS

Seventeen girls and 17 women had their EMG_Th determined as well as their one-repetition-maximum isometric knee-extension strength (1RM). Vastus-lateralis sEMG root mean square was recorded and the EMG_Th was defined as the exercise intensity (%1RM) at the bi-segmental point of the least sum of squares.

RESULTS

EMG_Th was detected in 88.2% of girls and 94.1% of women and occurred at higher relative intensities in the girls than in women (56.0 ± 11.1 vs. 47.7 ± 8.0% 1RM). The girls' 1RM (normalized to lean body mass) was only 69.1% that of the women.

CONCLUSIONS

Girls' EMG_Th values are higher compared with women's, possibly reflecting lower ability to activate higher-threshold (type-II) motor units. The females' EMG_Th and detection-rate values were similar to the corresponding values previously observed in males. The females' age-related difference in the recruitment of higher-threshold motor units, as reflected by the EMG_Th, appears to be on par with the males.

Isometric-based test improves EMG-threshold determination in boys vs. men

BACKGROUND

Children have been hypothesized to utilize higher-threshold (type-II) motor units (MUs) to a lesser extent than adults. Two recent studies, using a cycling-based EMG-threshold (EMG_Th) protocol, supported the hypothesis, showing children's EMG_Th intensities to be higher than adults'. Conclusions, however, were hampered by children's low EMG_Th detection rates. Insufficiently high contractile forces at exhaustion were postulated as the reason for non-detection, predominantly in children. An intermittent isometric contraction test (IICT) protocol facilitates higher contractile forces prior to exhaustion and was shown effective in EMG_Th testing of adults.

PURPOSE

Determine whether an IICT protocol would enhance EMG_Th detection in children, and consequently increase the magnitude of the previously observed child-adult EMG_Th differences.

METHODS

18 boys and 21 men completed one-repetition-maximum (1RM) isometric knee-extension test. The IICT protocol followed, commencing at 25%1RM and comprising five isometric contractions per load, incremented by ~ 3%1RM to exhaustion. Vastus lateralis surface EMG was recorded and EMG_Th, expressed as %1RM, was defined as the onset of the EMG-response's steeper segment.

RESULTS

EMG_Th was detected in 88.9% of boys and 95.2% of men, and occurred at higher relative intensities in boys (56.4 ± 9.2%1RM) than in men (46.0 ± 6.8%1RM). This 10.4% difference was 57% greater than the corresponding, previously reported cycling-based age-related difference.

CONCLUSIONS

With the boys' detection rate nearly on par with the men's, the IICT protocol appears to overcome much of the intensity limitation of cycling-based protocols and provide a more sensitive EMG_Th detection tool, thus extending the previously observed boys‒men difference. This difference adds supports to the notion of children's more limited type-II MU recruitment capacity.

Assessment of Muscle Contractile Properties at Acute Moderate Altitude Through Tensiomyography

Under hypoxia, alterations in muscle contractile properties and faster fatigue development have been reported. This study investigated the efficacy of tensiomyography (TMG) in assessing muscle contractile function at acute moderate altitude. Biceps femoris (BF) and vastus lateralis (VL) muscles of 18 athletes (age 20.1 ± 6.1 years; body mass 65.4 ± 13.9 kg; height 174.6 ± 9.5 cm) were assessed at sea level and moderate altitude using electrically evoked contractions on two consecutive days. Maximum radial displacement (Dm), time of contraction (Tc), reaction time (Td), sustained contraction time (Ts), and relaxation time (Tr) were recorded at 40, 60, 80, and 100 mA. At altitude, VL showed lower Dm values at 40 mA (p = 0.008; ES = -0.237). Biceps femoris showed Dm decrements in all electrical stimulations (p < 0.001, ES > 0.61). In VL, Tc was longer at altitude at 40 (p = 0.031, ES = 0.56), and 100 mA (p = 0.03, ES = 0.51). Regarding Td, VL showed significant increases in all electrical intensities under hypoxia (p ≤ 0.03, ES ≥ 0.33). TMG appears effective at detecting slight changes in the muscle contractile properties at moderate altitude. Further research involving TMG along with other muscle function assessment methods is needed to provide additional insight into peripheral neuromuscular alterations at moderate altitude.

Muscle activation during exercise in severe acute hypoxia: role of absolute and relative intensity

The aim of this study was to determine the influence of severe acute hypoxia on muscle activation during whole body dynamic exercise. Eleven young men performed four incremental cycle ergometer tests to exhaustion breathing normoxic (FIO2=0.21, two tests) or hypoxic gas (FIO2=0.108, two tests). Surface electromyography (EMG) activities of rectus femoris (RF), vastus medialis (VL), vastus lateralis (VL), and biceps femoris (BF) were recorded. The two normoxic and the two hypoxic tests were averaged to reduce EMG variability. Peak VO2 was 34% lower in hypoxia than in normoxia (p<0.05). The EMG root mean square (RMS) increased with exercise intensity in all muscles (p<0.05), with greater effect in hypoxia than in normoxia in the RF and VM (p<0.05), and a similar trend in VL (p=0.10). At the same relative intensity, the RMS was greater in normoxia than in hypoxia in RF, VL, and BF (p<0.05), with a similar trend in VM (p=0.08). Median frequency increased with exercise intensity (p<0.05), and was higher in hypoxia than in normoxia in VL (p<0.05). Muscle contraction burst duration increased with exercise intensity in VM and VL (p<0.05), without clear effects of FIO2. No significant FIO2 effects on frequency domain indices were observed when compared at the same relative intensity. In conclusion, muscle activation during whole body exercise increases almost linearly with exercise intensity, following a muscle-specific pattern, which is adjusted depending on the FIO2 and the relative intensity of exercise. Both VL and VM are increasingly involved in power output generation with the increase of intensity and the reduction in FIO2.

Effect of hypoxia on the dynamic response of hyperaemia in the contracting human calf muscle

Although systemic hypoxia increases the muscle hyperaemic response during 'steady-state' exercise, its effect on the dynamic characteristics of this response is not clear. In the present study, we first established that hypoxia increases the steady-state hyperaemic response at low workloads during calf exercise. To study dynamic aspects of this response, eight subjects performed eight exercise trials while breathing a normoxic (fractional inspired O(2) = 0.2094) or hypoxic gas mixture (fractional inspired O(2) = 0.105). Subjects performed intermittent contractions (1 s) of the calf muscle at 20% maximal voluntary contraction, and the leg blood flow (LBF), leg vascular conductance (LVC) and EMG activities of the triceps surae muscles were measured during each contraction-relaxation period (3 s). The LBF and LVC responses were averaged for each subject and fitted using a four-phase, exponential growth and decay function. Hypoxia evoked significant increases in the change in LBF (15%) and LVC (23%) from the start to the end of exercise, as well as the amplitude of the rapid growth phase of LBF and LVC (21%). Similar, but non-significant, effects on the amplitude of the slow growth phase of LBF (P = 0.08) and LVC (P = 0.10) were observed. By contrast, hypoxia had no effect on temporal parameters of these growth phases, parameters defining the decay phases or EMG activities. These results suggest that the effect of hypoxia on exercise hyperaemia is targeted at the rapid and perhaps the slow growth phase of the response, and is not mediated by a change in the level of muscle activation.

Effects of acute moderate hypoxia on anaerobic capacity in endurance-trained runners

While there is some controversy whether anaerobic capacity might be improved after altitude training little is known about changes in anaerobic capacity during hypoxic exposure in highly trained athletes. In order to analyze the effects of acute moderate normobaric hypoxia on anaerobic capacity, 18 male competitive triathletes, middle- and long-distance runners VO2max 67.4 +/- 3.8 ml kg min(-1) performed 2 supra-VO2max treadmill runs with the same speed, one in normoxia and one after 4 h exposure to normobaric hypoxia (FiO(2) 0.15), for estimation of their maximal accumulated oxygen deficit (MAOD) and measurement of peak capillary lactate and peak capillary ammonia concentration. MAOD was not significantly different in normoxia and in moderate hypoxia while time to exhaustion and accumulated O(2) uptake were significantly (P < 0.001) reduced in hypoxia compared to normoxia by 28 and 45%, respectively. The reduction in time to exhaustion was significantly correlated to the decrement in accumulated O(2) uptake (R = 0.730, P = 0.001). In hypoxia, there was a tendency for peak capillary lactate concentration to be decreased compared to normoxia (12.9 +/- 2.1 vs. 13.8 +/- 2.2 mmol l(-1), P = 0.082); peak capillary ammonia concentration was significantly decreased in hypoxia (97 +/- 52 vs. 121 +/- 44 micromol l(-1), P = 0.032). In conclusion, anaerobic capacity is not significantly changed during acute exposure to moderate hypoxia in endurance-trained athletes. The performance reduction during all-out exercise of short duration has to be attributed to the decrement in aerobic capacity.

Effect of acute severe hypoxia on peripheral fatigue and endurance capacity in healthy humans

We hypothesized that severe hypoxia limits exercise performance via decreased contractility of limb locomotor muscles. Nine male subjects [mean ± SE maximum O2 uptake (V̇o2 max) = 56.5 ± 2.7 ml·kg−1·min−1] cycled at ≥90% V̇o2 max to exhaustion in normoxia [NORM-EXH; inspired O2 fraction (FiO2) = 0.21, arterial O2 saturation (SpO2) = 93 ± 1%] and hypoxia (HYPOX-EXH; FiO2 = 0.13, SpO2 = 76 ± 1%). The subjects also exercised in normoxia for a time equal to that achieved in hypoxia (NORM-CTRL; SpO2 = 96 ± 1%). Quadriceps twitch force, in response to supramaximal single (nonpotentiated and potentiated 1 Hz) and paired magnetic stimuli of the femoral nerve (10–100 Hz), was assessed pre- and at 2.5, 35, and 70 min postexercise. Hypoxia exacerbated exercise-induced peripheral fatigue, as evidenced by a greater decrease in potentiated twitch force in HYPOX-EXH vs. NORM-CTRL (−39 ± 4 vs. −24 ± 3%, P < 0.01). Time to exhaustion was reduced by more than two-thirds in HYPOX-EXH vs. NORM-EXH (4.2 ± 0.5 vs. 13.4 ± 0.8 min, P < 0.01); however, peripheral fatigue was not different in HYPOX-EXH vs. NORM-EXH (−34 ± 4 vs. −39 ± 4%, P > 0.05). Blood lactate concentration and perceptions of limb discomfort were higher throughout HYPOX-EXH vs. NORM-CTRL but were not different at end-exercise in HYPOX-EXH vs. NORM-EXH. We conclude that severe hypoxia exacerbates peripheral fatigue of limb locomotor muscles and that this effect may contribute, in part, to the early termination of exercise.

Effect of hypercapnia on changes in blood pH, plasma lactate and ammonia due to exercise

The present study examined the effects of hypercapnia on changes in blood pH, plasma lactate and ammonia due to exhaustive exercise. Six male subjects underwent exercise of increasing intensity until exhaustion: (1) breathing air = MAX (maximal exercise), or (2) under hypercapnia (HC: 21% O(2), 6% CO(2)) that had been maintained from 60 min before to 30 min after exercise = HC; and (3) exercise of the same intensity as HC in air = SUB (submaximal exercise). Arterialized blood was drawn from a superficial vein. Blood pH in HC was significantly lower than in MAX or SUB at rest, at the end of exercise and throughout recovery (P<0.05). Plasma lactate and ammonia concentration in HC was significantly lower than in MAX (P<0.05), and similar to that in SUB at the end of exercise and throughout recovery. Respiratory acidosis resulting from hypercapnia shifted the linear lactate to blood pH relationship during exhaustive exercise below that at normocapnia (P<0.001). The reduced slope of linear blood pH to ammonia relationship under hypercapnia (P<0.001) is attributed to lactic acidosis that is less, due to the lesser work intensity at the end of exhaustion, than that of normocapnia. From these results we conclude that (1) hypercapnia-induced respiratory acidosis promoted the decrease in blood pH due to lactate production throughout recovery; (2) plasma lactate concentration at maximal exercise was lowered under hypercapnia; (3) plasma ammonia concentration at maximal exercise was reduced, probably due to a less intense lactic acidosis.

Effects of blackcurrant anthocyanin intake on peripheral muscle circulation during typing work in humans

This double-blind, placebo-controlled, crossover study investigated the effect of blackcurrant anthocyanin (BCA) intake on peripheral circulation during rest and during typing work by using near-infrared spectroscopy (NIRS), and it also assessed improvement in shoulder stiffness caused by poor local circulation. In a resting circulation study, nine healthy male subjects took capsules of BCA at a dosage of 17 mg kg(-1) or placebo (isoenergetic sugar). NIRS was used to measure left forearm blood flow (FBF) following venous occlusion and muscle oxygen consumption following arterial occlusion prior to and hourly for 4 h after ingestion of BCA. Plasma anthocyanin concentration was measured prior to ingestion and 1, 2, and 4 h later. FBF increased significantly 2 h after BCA ingestion [BCA 1.22 (0.13)-fold increase relative to pre-values vs placebo 0.83 (0.06) of pre-values; P < 0.05] and then tended to increase for a further 3 h after ingestion [BCA 1.26 (0.15)-fold increase relative to pre-values vs placebo 0.82 (0.07) of pre-values; P = 0.078]. There was, however, no significant difference in muscle oxygen consumption between BCA and placebo intake at any time point. In a typing work study, 11 healthy subjects took capsules of BCA (7.7 mg kg(-1)) or placebo (isoenergetic sugar) daily for 2 weeks. The subjects then performed intermittent typing workload for 30 min in order to induce acute shoulder stiffness. During the workload, total hemoglobin and oxygenated hemoglobin (oxy-Hb) were determined using NIRS and myoelectric signals measured in the right trapezius muscle using electromyography (EMG). The viscoelasticity of the trapezius muscle was also evaluated using a muscle stiffness meter before and after the typing workload. BCA intake prevented the decrease in oxy-Hb significantly (P < 0.05), and also tended to alleviate the increase in root mean square (RMS) of the EMG during the typing workload, and also muscle stiffness after the workload. There was no improvement in typing performance with BCA intake. The results of this study suggest that intake of BCA may improve shoulder stiffness caused by typing work by increasing peripheral blood flow and reducing muscle fatigue.

Increased blood ammonia in hypoxia during exercise in humans

The effect of acute hypoxia on blood concentration of ammonia ([NH3]b) and lactate (la-]b) was studied during incremental exercise(IE), and two-step constant workload exercises (CE). Fourteen endurance-trained subjects performed incremental exercise on a cycle ergometer under normoxic (21% O2) and hypoxic (10.4% O2) conditions. Eight endurance-trained subjects performed two-step constant workload exercise at sea level and at a simulated altitude of 5000 m (hypobaric chamber, P(B)=405 Torr; P(O2)=85 Torr) in random order. In normoxia, the first step lasted 25 minutes at an intensity of 85 % of the individual ventilatory anaerobic threshold (AT(vent), ind) at sea level. This reduced workload was followed by a second step of 5 minutes at 115% of their AT(vent), ind. This test was repeated into a hypobaric chamber, at a simulated altitude of 5,000 m. The first step in hypoxia was at an intensity of 65 % of AT(vent), ind., whereas workload for the second step at simulated altitude was the same as that of the first workload in normoxia (85 % of AT(vent), ind). During IE, [NH3]b and [la-]b were significantly higher in hypoxia than in normoxia. Increases in these metabolites were highly correlated in each condition. The onset of [NH3]b and [la-]b accumulation occurred at different exercise intensity in normoxia (181W for lactate and 222W for ammonia) and hypoxia (100W for lactate and 140W for ammonia). In both conditions, during CE, [NH3]b showed a significant increase during each of the two steps, whereas [la-]b increased to a steady-state in the initial step, followed by a sharp increase above 4 mM x L(-1) during the second. Although exercise intensity was much lower in hypoxia than in normoxia, [NH3]b was always higher at simulated altitude. Thus, for the same workload, [NH3]b in hypoxia was significantly higher (p<0.05) than in normoxia. Our data suggest that there is a close relationship between [NH3]b and [la-]b in normoxia and hypoxia during graded intensity exercises. The accumulation of ammonia in blood is independent of that of lactate during constant intense exercise. Hypoxia increases the concentration of ammonia in blood during exercise.

Analysis of the aerobic-anaerobic transition in elite cyclists during incremental exercise with the use of electromyography

OBJECTIVES

To investigate the validity and reliability of surface electromyography (EMG) as a new non-invasive determinant of the metabolic response to incremental exercise in elite cyclists. The relation between EMG activity and other more conventional methods for analysing the aerobic-anaerobic transition such as blood lactate measurements (lactate threshold (LT) and onset of blood lactate accumulation (OBLA)) and ventilatory parameters (ventilatory thresholds 1 and 2 (VT1 and VT2)) was studied.

METHODS

Twenty eight elite road cyclists (age 24 (4) years; VO2MAX 69.9 (6.4) ml/kg/min; values mean (SD)) were selected as subjects. Each of them performed a ramp protocol (starting at 0 W, with increases of 5 W every 12 seconds) on a cycle ergometer (validity study). In addition, 15 of them performed the same test twice (reliability study). During the tests, data on gas exchange and blood lactate levels were collected to determine VT1, VT2, LT, and OBLA. The root mean squares of EMG signals (rms-EMG) were recorded from both the vastus lateralis and the rectus femoris at each intensity using surface electrodes.

RESULTS

A two threshold response was detected in the rms-EMG recordings from both muscles in 90% of subjects, with two breakpoints, EMGT1 and EMGT2, at around 60-70% and 80-90% of VO2MAX respectively. The results of the reliability study showed no significant differences (p > 0.05) between mean values of EMGT1 and EMGT2 obtained in both tests. Furthermore, no significant differences (p > 0.05) existed between mean values of EMGT1, in the vastus lateralis and rectus femoris, and VT1 and LT (62.8 (14.5) and 69.0 (6.2) and 64.6 (6.4) and 68.7 (8.2)% of VO2MAX respectively), or between mean values of EMGT2, in the vastus lateralis and rectus femoris, and VT2 and OBLA (86.9 (9.0) and 88.0 (6.2) and 84.6 (6.5) and 87.7 (6.4)% of VO2MAX respectively).

CONCLUSION

rms-EMG may be a useful complementary non-invasive method for analysing the aerobic-anaerobic transition (ventilatory and lactate thresholds) in elite cyclists.