Exercise-induced oxyhemoglobin desaturation and pulmonary diffusing capacity during high-intensity exercise

An empirical study of indoor air quality in badminton stadiums in hot summer and cold winter regions of China during spring and fall seasons

The indoor air quality has a direct impact on human health. In order to obtain the current status of indoor air quality in typical sports buildings in hot summer and cold winter climate zones in China, indoor badminton courts in 10 cities in Hubei Province in this climate zone were selected as research objects for field testing of indoor environmental parameters in spring and autumn, and predict air quality parameters for non-testing times. All the tested stadiums are naturally ventilated in non-event conditions, and the average daily indoor CO2 concentration was 526.78 ppm in spring and 527.63 ppm in autumn, and the average daily PM2.5 concentration was 0.035 mg/m3 in spring and 0.024 mg/m3 in autumn, all of which met the requirements of GB/T 18883-2022, the average concentration of CO2 ≤ 1000 ppm and PM2.5 ≤ 0.05 mg/m3. The indoor CO2 concentration and PM2.5 concentration of the tested badminton halls under natural ventilation gradually increased with the accumulation of exercise time, making the indoor air quality of the badminton halls decrease, which would negatively affect the health of the people exercising in this environment.

Impact of air pollution on running performance

Air pollution exposures during training may impact race preformances. We aggregated data on 334 collegiate male track & field athletes from 46 universities across the United States over 2010-2014. Using distributed lag non-linear models, we analyzed the relationship between race time and PM_2.5, ozone, and two versions of the Air Quality Index (AQI) exposures up to 21 days prior to the race. We observed a 12.8 (95% CI: 1.3, 24.2) second and 11.5 (95% CI: 0.8, 22.1) second increase in race times from 21 days of PM_2.5 exposure (10.0 versus 5.0 μg/m³) and ozone exposure (54.9 versus 36.9 ppm), respectively. Exposure measured by the two-pollutant threshold (PM_2.5 and ozone) AQI was not significantly associated with race time; however, the association for summed two-pollutant AQI (PM_2.5 plus ozone) was similar to associations observed for the individual pollutants (12.4, 95% CI: 1.8, 23.0 s). Training and competing at elevated air pollution levels, even at exposures within AQI's good-to-moderate classifications, was associated with slower race times. This work provides an initial characterization of the effect of air pollution on running performance and a justification for why coaches should consider approaches to reduce air pollution exposures while training.

Athletes' exposure to air pollution during World Athletics Relays: A pilot study

Potential adverse consequences of exposure to air pollutants during exercise include decreased lung function, and exacerbation of asthma and exercise-induced bronchoconstriction. These effects are especially relevant for athletes and during international competitions, as they may impact athletic performance. Thus, assessing and mitigating exposure to air pollutants during exercising should be encouraged in sports venues. A comprehensive air quality assessment was carried out during the World Relays Yokohama 2019, in the stadium and the warm-up track. The pilot included on-line and off-line instrumentation for gaseous and particulate pollutants and meteorological parameters, and the comparison with local reference data. Air quality perception and exacerbation of symptoms of already-diagnosed diseases (mainly respiratory and cardiovascular) were assessed by athletes by means of questionnaires during training sessions. Median NO₂ concentrations inside the stadium (25.6-31.9 μgm^-3) were in the range of the Yokohama urban background, evidencing the impact of urban sources (e.g., traffic) on athletes' exposure during training and competition. The assessment of hourly air pollutant trends was identified as a valuable tool to provide guidance to reduce atheletes' exposure, by identifying the periods of the day with lowest ambient concentrations. This strategy could be adopted to define training and competition schedules, and would have special added value for athletes with respiratory conditions. Personal exposure to polycyclic aromatic hydrocarbons was quantified through wearable silicone wristbands, and showed highly variability across volunteers. The wristbands are a simple approach to assess personal exposure to potentially toxic organic compounds. Further research would be necessary with regard to specific air pollutants that may trigger or exacerbate respiratory conditions typical of the athlete community. The availability of high time-resolved exposure data in the stadiums opens up the possibility to calculate doses of specific pollutants for individual athletes in future athletics events, to understand the impact of environmental factors on athletic performance.

Arterial desaturation during exercise in man: implication for O2 uptake and work capacity

Exercise-induced arterial hypoxaemia is defined as a reduction in the arterial O2 pressure (PaO2) by more than 1 kPa and/or a haemoglobin O2 saturation (SaO2) below 95%. With blood gas analyses ideally reported at the actual body temperature, desaturation is a consistent finding during maximal ergometer rowing. Arterial desaturation is most pronounced at the end of a maximal exercise bout, whereas the reduction in PaO2 is established from the onset of exercise. Exercise-induced arterial hypoxaemia is multifactorial. The ability to maintain a high alveolar O2 pressure (PAO2) is critical for blood oxygenation and this appears to be difficult in large individuals. A large lung capacity and, in turn, diffusion capacity seem to protect PaO2. A widening of the PAO2-PaO2 difference does indicate that a diffusion limitation, a ventilation-perfusion mismatch and/or a shunt influence the transport of O2 from alveoli to the pulmonary capillaries. An inspired O2 fraction of 0.30 reduces the widened PAO2-PaO2 difference by 75% and prevents a reduction of PaO2 and SaO2. With a marked increase in cardiac output, diffusion limitation combined with a fast transit time dominates the O2 transport problem. Furthermore, a postexercise reduction in pulmonary diffusion capacity suggests that the alveolo-capillary membrane is affected. An antioxidant attenuates oxidative burst by neutrophilic granulocytes, but it does not affect PaO2, SaO2 or O2 uptake (VO2), and the ventilatory response to maximal exercise also remains the same. It is proposed, though, that increased concentration of certain cytokines correlates to exercise-induced hypoxaemia as cytokines stimulate mast cells and basophilic granulocytes to degranulate histamine. The basophil count increases during maximal rowing. Equally, histamine release is associated with hypoxaemia and when the release of histamine is prevented, the reduction in PaO2 is attenuated. During maximal exercise, an extreme lactate spill-over to blood allows pH decrease to below 7.1 and according to the O2 dissociation curve this is critical for SaO2. When infusion of sodium bicarbonate maintains a stable blood buffer capacity, acidosis is attenuated and SaO2 increases from 89% to 95%. This enables exercise capacity to increase, an effect also seen when O2 supplementation to inspired air restores arterial oxygenation. In that case, exercise capacity increases less than can be explained by VO2 and CaO2. Furthermore, the change in muscle oxygenation during maximal exercise is not affected when hyperoxia and sodium bicarbonate attenuate desaturation. It is proposed that other organs benefit from enhanced O2 availability, and especially the brain appears to increase its oxygenation during maximal exercise with hyperoxia.

Pulmonary disorders and exercise

The respiratory system rarely limits exercise in the normal subject. In patients with chronic pulmonary processes or in the elite athlete, however, the respiratory system may indeed be the limiting factor. Common respiratory disorders include chest pain syndromes, cough, exercise-induced asthma, and vocal cord dysfunction. Chronic lung diseases such as asthma, COPD, and interstitial lung disease impact exercise capacity and endurance. Exercise testing can be useful to distinguish acute and chronic pulmonary causes of dyspnea during exercise, as well as to differentiate between cardiac and pulmonary causes.

Exercise and outdoor ambient air pollution

OBJECTIVES

To establish by literature survey: (a) levels at which air pollutants are considered damaging to human health and to exercisers in particular; (b) the current ambient levels experienced in the United Kingdom; (c) whether athletes are especially at risk.

METHODS

Six major urban air pollutants were examined: carbon monoxide (CO); nitrogen oxides (NO(X)); ozone (O(3)); particulate matter (PM(10)); sulphur dioxide (SO(2)); volatile organic compounds (VOCs).

RESULTS

CO is detrimental to athletic performance. NO(2) is of concern to human health, but outdoor levels are low. O(3) poses a potentially serious risk to exercising athletes. Decrements in lung function result from exposure, and there is evidence that athletic performance may be affected. Detrimental effects may occur at low ambient levels, but there is no scientific consensus on this matter. PM(10) is causing concern in the scientific community. Blood lead accumulation during exercise indicates that personal exposure to toxic compounds associated with PM(10) may be magnified. Generally, outdoor ambient levels of SO(2) are too low to cause a problem to the athlete, except the asthmatic athlete. The few studies on exposure of exercisers to VOCs are reviewed.

CONCLUSIONS

Athletes and exercisers should avoid exercising by the road side even though levels of the more noxious air pollutants have been controlled in the United Kingdom. O(3) is particularly damaging to athletes; it reaches its highest concentrations on hot bright days in rural areas.

Expiratory flow limitation confounds ventilatory response during exercise in athletes

INTRODUCTION

A significant number of highly trained endurance runners have been observed to display an inadequate hyperventilatory response to intense exercise. Two potential mechanisms include low ventilatory responsiveness to hypoxia and ventilatory limitation as a result of maximum expiratory flow rates being achieved.

PURPOSE

To test the hypothesis that expiratory flow limitation can complicate determination of ventilatory responsiveness during exercise the following study was performed.

METHODS/MATERIALS

Sixteen elite male runners were categorized based on expiratory flow limitation observed in flow volume loops collected during the final minute of progressive exercise to exhaustion. Eight flow limited (FL) (VO2max, 75.9+/-2.4 mL x kg(-1) x min(-1); expiratory flow limitation, 47.3+/-20.4%) and eight non-flow limited subjects (NFL) (VO2max, 75.6+/-4.8 mL x kg(-1) x min(-1); expiratory flow limitation, 0.3+/-0.8%) were tested for hypoxic ventilatory responsiveness (HVR).

RESULTS

Independent groups ANOVA revealed no significant differences between FL and NFL for VO2max, VE max (136.2+/-16.0 vs 137.5+/-21.6 L x min(-1)), VE/VO2, (28.4+/-3.2 vs 27.6+/-2.9 L x lO2(-1)), VE/VCO2 (24.8+/-3.1 vs 24.4+/-2.0 L x lCO2(-1)), HVR (0.2+/-0.2 vs 0.3+/-0.1 L x %SaO2(-1)), or SaO2 at max (89.1+/-2.4 vs 86.6+/-4.1%). A significant relationship was observed between HVR and SaO2 (r = 0.92, P < or = 0.001) in NFL that was not present in FL. Conversely, a significant relationship between VE/VO2 and SaO2 (r = 0.79, P < or = 0.019) was observed in FL but not NFL. Regression analysis indicated that the HVR-SaO2 and SaO2-VE/VO2 relationships differed between groups.

DISCUSSION

When flow limitation is controlled for, HVR plays a more significant role in determining SaO2 in highly trained athletes than has been previously suggested.

Exercise-induced arterial hypoxaemia in athletes: a review

During exercise, healthy individuals are able to maintain arterial oxygenation, whereas highly-trained endurance athletes may exhibit an exercise-induced arterial hypoxaemia (EIAH) that seems to reflect a gas exchange abnormality. The effects of EIAH are currently debated, and different hypotheses have been proposed to explain its pathophysiology. For moderate exercise, it appears that a relative hypoventilation induced by endurance training is involved. For high-intensity exercise, ventilation/perfusion (V(A)/Q) mismatching and/or diffusion limitation are thought to occur. The causes of this diffusion limitation are still under debate, with hypotheses being capillary blood volume changes and interstitial pulmonary oedema. Moreover, histamine is released during exercise in individuals exhibiting EIAH, and questions persist as to its relationship with EIAH and its contribution to interstitial pulmonary oedema. Further investigations are needed to better understand the mechanisms involved and to determine the long term consequences of repetitive hypoxaemia in highly trained endurance athletes.

Ventilatory responses during experimental cycle-run transition in triathletes

PURPOSE AND METHODS

To determine the effects of cycling on a subsequent triathlon run, nine male triathletes underwent four successive laboratory trials: 1) an incremental treadmill test, 2) an incremental cycle test, 3) 30 min of cycling followed by 5 km of running (C-R), and 4) 30 min of running followed by 5 km of running (R-R). Before and 10 min after the third and fourth trials, the triathletes underwent pulmonary function testing including spirometry and diffusing capacity testing for carbon monoxide (DL(CO)). During the C-R and R-R trials, arterialized blood samples were obtained to measure arterial oxygen pressure (PaO2). During all trials, ventilatory data were collected every minute using an automated breath-by-breath system.

RESULTS

The results showed that 1) the oxygen uptake (VO2) observed during subsequent running was similar for the C-R and R-R trials; 2) the ventilatory response (VE) during the first 8 min of subsequent running was significantly greater in the C-R than in R-R trial (P < 0.05); 3) only the C-R trial induced a significant increase (P < 0.05) in residual volume (RV), functional residual capacity (FRC), and the ratio of residual volume to total lung capacity (RV/TLC); and 4) although a significant decrease (P < 0.05) in DL(CO) was noted after C-R, no difference between the two exercise trials was found for the maximal drop in PaO2.

CONCLUSIONS

We concluded that 1) the C-R trial induced specific alterations in pulmonary function that may be associated with respiratory muscle fatigue and/or exercise-induced hypoxemia, and 2) the greater VE observed during the first minute of running after cycling was due to the specificity of cycling. This reinforces the necessity for triathletes to practice multi-trial training to stimulate the physiological responses experienced during the swim-cycle and the cycle-run transitions.

The influence of PaO2, pH and SaO2 on maximal oxygen uptake

Influence of arterial oxygen pressure (PaO2) and pH on haemoglobin saturation (SaO2) and in turn on O2 uptake (VO2) was evaluated during ergometer rowing (156, 276 and 376 W; VO2max, 5.0 L min-1; n = 11). During low intensity exercise, neither pH nor SaO2 were affected significantly. In response to the higher work intensities, ventilations (VE) of 129 +/- 10 and 155 +/- 8 L min-1 enhanced the end tidal PO2 (PETO2) to the same extent (117 +/- 2 mmHg), but PaO2 became reduced (from 102 +/- 2 to 78 +/- 2 and 81 +/- 3 mmHg, respectively). As pH decreased during maximal exercise (7.14 +/- 0.02 vs. 7.30 +/- 0.02), SaO2 also became lower (92.9 +/- 0.7 vs. 95.1 +/- 0.1%) and arterial O2 content (CaO2) was 202 +/- 3 mL L-1. An inspired O2 fraction (F1O2) of 0.30 (n = 8) did not affect VE, but increased PETO2 and PaO2 to 175 +/- 4 and 164 +/- 5 mmHg and the PETO2-PaO2 difference was reduced (21 +/- 4 vs. 36 +/- 4 mmHg). pH did not change when compared with normoxia and SaO2 remained within 1% of the level at rest in hyperoxia (99 +/- 0.1%). Thus, CaO2 and VO2max increased to 212 +/- 3 mL L-1 and 5.7 +/- 0.2 L min-1, respectively. The reduced PaO2 became of importance for SaO2 when a low pH inhibited the affinity of O2 to haemoglobin. An increased F1O2 reduced the gradient over the alveolar-arterial membrane, maintained haemoglobin saturation despite the reduction in pH and resulted in increases of the arterial oxygen content and uptake.