Effects of Altitude/Hypoxia on Single- and Multiple-Sprint Performance: A Comprehensive Review

Effects of taurine combined with caffeine on repetitive sprint exercise performance and cognition in a hypoxic environment

The impact of hypoxic repetitive sprint training on the overall performance of team sports remains controversial due to the specific nature of the exercise capacity required for team sports. While taurine and caffeine are widely utilized as supplements for repetitive sprint exercise in normoxic environments, their efficacy in hypoxic environments remains to be fully understood. Therefore, additional research is needed to explore the role of supplementation in hypoxic conditions. This study was to investigate the effects of caffeine (C), taurine (T), caffeine, and taurine co-ingestion (TC) or placebo (P) on repetitive sprint exercise performance and related physiological responses after exhaustion exercise in team athletes under simulated hypoxic conditions. A double-blind crossover randomized controlled experimental design was employed. 16 male participants (Age:23.69 ± 2.15 years, Body mass: 75.04 ± 7.79 kg, Height:1.78 ± 0.06 m) volunteered to receive four different supplement ingestions to complete the exercise tests: (1) placebo (5 mg/kg maltodextrin), (2) taurine (50 mg/kg), (3) caffeine (5 mg/kg), (4) taurine + caffeine (50 mg/kg + 5 mg/kg). All selected participants were university football players who had undergone rigorous training regimens (85-95% of maximum heart rate, duration of 60 min, with more than five training sessions per week). All participants completed an exhaustion test and subsequent repetitive sprint exercise in a simulated hypoxic environment (A simulation of a soccer game in sports mode). Time to exhaustion (TTE), peak power (PP), and mean power (MP) were recorded at the end of the exhaustion test and during the repetitive sprint exercise, respectively. This study designed an exercise protocol for repetitive sprinting after exhaustion exercise based on the pattern of play in football. The following variables were monitored throughout the experiments: heart rate (HR), blood lactate (B[La]), arterial oxygen saturation (SpO2), dyspnea, and rating of perceived exhaustion (RPE). The Stroop Test was administered at three separate time points: pre-test, mid-test, and post-test, throughout the exercise trial. The countermovement jump test (CMJ) was carried out at three specific time points: before the test, 3 min after the test, and 6 min after the test. The caffeine (C:618.56 + 42.50 s, p = 0.027, d = 0.996) and taurine + caffeine (TC: 613.69 + 37.74 s, p = 0.041, d = 0.902) groups significantly improved time to exhaustion compared to the placebo group. Blood lactate was significantly higher in the taurine + caffeine group than in the placebo group after repetitive sprint exercise (P: 9.87 ± 1.97, TC: 12.31 ± 2.54, p = 0.016). The caffeine group significantly reduced dyspnea, and rating of perceived exhaustion after repetitive sprint exercise (p < 0.05). The taurine (T: 43.42 ± 3.46, p = 0.005), caffeine (C: 44.11 ± 4.72, p < 0.001), and taurine + caffeine (TC: 43.04 ± 3.30, p = 0.011) groups all showed an increase in pre-exercise countermovement jump height. The caffeine group significantly reduced the consistent response time (p = 0.023) and inconsistent response time (p < 0.001) in the Stroop Test compared to the placebo group. Caffeine, along with combined taurine, significantly prolonged the duration of exhaustion exercise in a hypoxic environment; however, it did not affect subsequent repetitive sprint performance. Additionally, caffeine supplementation had a positive impact on cognitive performance during hypoxic training.

Effects of blood flow restriction on internal and external training load metrics during acute and chronic short-term repeated-sprint training in team-sport athletes

This study examined internal, external training loads, internal:external ratios, and aerobic adaptations for acute and short-term chronic repeated-sprint training (RST) with blood flow restriction (BFR). Using randomised crossover (Experiment A) and between-subject (Experiment B) designs, 15 and 24 semi-professional Australian footballers completed two and nine RST sessions, respectively. Sessions comprised three sets of 5-7 × 5-second sprints and 25 seconds recovery, with continuous BFR (45% arterial occlusion pressure) or without (Non-BFR). Banister's, Edwards', Lucia's training impulse, and session rating of perceived exertion training load (sRPETL) were calculated. External training loads were determined by total work done (TWD). Ventilatory threshold power outputs were assessed during a graded exercise test post-RST. Internal training loads were comparable between conditions, though BFR reduced (p < 0.02) TWD during acute (-4.9%) and short-term chronic (-10.0%) RST compared to Non-BFR. Furthermore, BFR increased (p = 0.049) the sRPETL:TWD ratio during short-term chronic (+14.8%), but not acute RST. First and second ventilatory threshold power outputs improved (+8.3% and + 4.2%, respectively) similarly for both groups following RST. Repeated exposure to progressively overloaded RST with BFR increases internal demands for a given workload, which may promote beneficial physiological adaptations compared to Non-BFR, though aerobic performance was not further enhanced.

Dose-response effects of caffeine during repeated cycling sprints in normobaric hypoxia to exhaustion

PURPOSE

With limited studies exploring the dose-response of caffeine consumption on repeated sprint ability in hypoxia, this study aimed to determine the optimal caffeine dose (low, moderate or high) during repeated sprints in hypoxia to exhaustion.

METHODS

On separate visits, twelve active males randomly performed four experimental trials in normobaric hypoxia (inspired oxygen fraction: 16.5 ± 0.2%). Participants ingested placebo (PLA) or caffeine capsules (3, 6 or 9 mg/kg or LOW, MOD and HIGH, respectively) 1 h before exercise and then underwent a repeated cycling sprint test (10 s sprint/20 s active recovery) to exhaustion. Total sprint number and work done, peak and mean power output, blood lactate concentration, cardiorespiratory and perceptual responses were recorded.

RESULTS

Total sprint number was greater in MOD and HIGH compared to PLA (20 ± 7 and 18 ± 8 vs. 13 ± 4; all P < 0.05), with MOD also higher than LOW (15 ± 6; P = 0.02). Total work done was greater in MOD (111 ± 40 kJ) and HIGH (100 ± 35 kJ) compared to LOW (83 ± 29 kJ) and PLA (76 ± 25 kJ) (all P < 0.05). However, there were no significant differences in total sprint number or total work done between MOD and HIGH (all P > 0.05). Blood lactate concentration was higher in both MOD and HIGH compared to PLA (all P < 0.05). However, peak and mean power outputs, fatigue index, and ratings of perceived exertion did not differ across different caffeine dosages (all P > 0.05).

CONCLUSION

A moderate dose of caffeine (6 mg/kg) is the optimal amount for enhancing repeated cycling sprint ability when compared to low and high doses in moderate normobaric hypoxia.

Competing at Altitude Reduces In-Match Physical Demands of Professional Soccer Players Compared With Sea Level

PURPOSE

This study examined whether physical demands during soccer matches differ between sea level and altitude, considering variations by playing position.

METHODS

Thirty-seven professional players were monitored during 22 matches (11 at sea level and 11 at altitudes of 2200-4090 m) with global navigation satellite systems. Independent mean differences were used to compare in-match physical demands (ie, total distance, distance covered at specific speed intervals, accelerations [ACCs] and decelerations [DECs], and maximal speed) between locations for 5 playing positions (central defenders, fullbacks, central midfielders, wide midfielders, and forwards).

RESULTS

At altitude, players covered shorter total distances (P < .001) and less distance in the 14.4- to 19.8-km/h (P < .001), 19.8- to 25.2-km/h (P < .001), and >25.2-km/h (P < .001) speed ranges. They also performed fewer ACCs (2.0-3.5 m/s2, P < .001; 3.5-6.0 m/s2, P < .001) and DECs (-3.5 to -2 m/s2, P < .001; -6.0 to -3.5 m/s2, P < .001) and achieved lower maximal speeds (P < .001). The impact of altitude varied by position: Central midfielders showed reduced performance in all variables, while central defenders (distance > 25.2 km/h, ACCs [2.0 and 3.5 m/s2], DECs [-3.5 and -2.0 m/s2], and maximal speed), fullbacks (distance > 25.2 km/h, ACCs, and DECs [-3.5 and -2.0 m/s2]), and forwards (distances [total, 19.8-25.2 km/h, and >25.2 km/h] and ACCs [-3.5 and -6.0 m/s2]) presented unclear differences (P > .05) between locations.

CONCLUSION

Our study highlights the importance of considering playing positions when assessing the in-match activity profiles of sea-level resident soccer players competing at moderate to high altitudes.

Individual sex-based variability to altitude training in elite badminton players

To assess how altitude training impacts force-velocity-power (F-V-P) profiling and muscular power and anaerobic capacity in elite badminton players in reference to intra- and inter-individual sex-based variability. Following a quasi-experimental design, 14 players (6 females, 8 males) from the French national badminton singles and doubles teams performed a 3-week 'living high-training high' camp at natural altitude (2320 m). F-V-P profile and Wingate anaerobic test were assessed Pre- and Post-intervention, using ANOVA repeated measures conventional statistics, with further estimation statistics to show the magnitude of the testing condition and visualize intra- and inter-individual responses. No significant interaction nor time effect (Pre- vs. Post-) was observed for any variables (all p > 0.05), but a significant sex effect was observed for maximal theoretical velocity (p < 0.01), relative maximal theoretical power (Pmaxrel) (p = 0.02) and relative F-V-P profile and for peak and mean power outputs (both p < 0.001) during Wingate test. Pre-to-Post changes (from -11.0% to + 14.4%) did not significantly differ between sexes, except for Pmaxrel (p < 0.05) in favor of female athletes (+10.2% vs. -4.3% for male athletes). Hedge's g effect sizes (male minus female) revealed moderate and large effects for F-V-P profiling-derived variables. Mean conventional statistics did not reveal significant effect of altitude training, mainly due to high intra- and inter-variability across F-V-P profiling-derived variables and Wingate test. Substantial sex-based difference contributes to this variability, emphasizing the importance of individualized approach to enhance participant responsiveness to altitude training.

Effects of a Combined Method of Normobaric Hypoxia on the Repeated Sprint Ability Performance of a Nine-Time World Champion Triathlete: A Case Report

Elite athletes are an under-represented population in scientific studies, and there are no works analysing the influence of hypoxia in elite triathletes. The aim of this study was to analyse the influence of different methods of normobaric hypoxia on repeated sprint ability (RSA) performance. This study was a case study with an elite triathlete who has won nine triathlon world championships. The study used a combination of different methods of normobaric hypoxia. The three methods combined were as follows: live high-train low interspersed; intermittent hypoxic training; and intermittent hypoxic exposure. This study analysed the influence of these methods on RSA performance in variables such as power output, saturation of muscular oxygen, heart rate and ventilatory variables (VO2 and VCO2). The triathlete was measured before the training protocol (PRE), just after (POST-D3) and 21 days after the end of the protocol (POST-D21). This type of protocol has shown that it can lead to an improvement in RSA performance in the number of sprints (PRE vs. POST-D3 vs. POST-D21: 19 vs. 24 vs. 28), power output (PRE 615 W vs. POST-D3 685 W vs. POST-D21 683W) and efficiency of the triathlete. This work may be useful in improving power output and repeated sprint ability for elite triathletes.

Repeated-sprint training in hypoxia: A review with 10 years of perspective

Over the past decade, numerous studies have investigated an innovative "live low-train high" approach based on the repetition of short (<30 s) "all-out" sprints with incomplete recoveries in hypoxia; the so-called Repeated-Sprint training in Hypoxia (RSH). The aims of the present review are therefore threefold. First, this study summarizes the available evidence on putative additional performance enhancement after RSH comparing to the same training in normoxia (RSN). Second, a critical analysis of underpinning mechanisms discusses how advantages can be obtained through RSH for sea-level performance enhancement. An enhanced microcirculatory vasodilation leading to improved muscle perfusion and/or oxygenation and an increase in muscular phosphocreatine content may help explain the superiority of RSH vs. RSN. Third, the present review aims to provide guidelines for coaches, athletes and scientists to apply RSH interventions with regard to the interval duration, exercise-to-rest ratio and training volume. In conclusion, this review supports repeated-sprint training in hypoxia as an efficient (but not magic) training intervention with 77% of the controlled studies reporting an additional benefit with added hypoxia, mainly for team-, combat- and racket-sports athletes but also for all other sports (e.g. endurance) that require repeated accelerations with lesser fatigue.

Sprint training in hypoxia and with blood flow restriction: Controversies and perspectives

This narrative review assesses the effects of repeated sprint training (RST) in hypoxia (RSH) and blood flow restriction (BFR) methods on skeletal muscle adaptations and performance. Current literature suggests that RSH promotes metabolic modifications in muscle cells, especially driven by reactive oxygen species production, HIF-1α stabilization, and changes in metabolism. Training with BFR promotes metabolite accumulation in working muscles due to limited blood flow, however, cellular mechanisms affected by BFR during RST are less explored. Data highlight that RSH improves repeated sprint ability (RSA) in several sport disciplines (e.g. rugby, tennis, soccer, cross-country skiing). However, recent studies showed that addition of hypoxia or BFR during RST did not promote supplementary benefits on aerobic performance, force-velocity power profile, and V ˙ O 2 max . Nonetheless, gains in V ˙ O 2 max were observed during sprint interval training protocols when BFR was applied during recovery between sets. Finally, recent studies highlighted that RSH can improve RSA in a short period. Thus, RSH and sprint training with BFR may be useful for sports disciplines requiring high glycolytic demand and can promote gains in RSA in a short window. Further studies must be encouraged to better understand the biological consequences of adding such stimuli to exercise, especially BFR, on long-term adaptation.

Effects of concurrent heat and hypoxic training on cycling anaerobic capacity in men

Physical training in heat or hypoxia can improve physical performance. The purpose of this parallel group study was to investigate the concurrent effect of training performed simultaneously in heat (31 °C) and hypoxia (FIO2 = 14.4%) on anaerobic capacity in young men. For the study, 80 non-trained men were recruited and divided into 5 groups (16 participants per group): control, non-training (CTRL); training in normoxia and thermoneutral conditions (NT: 21 °C, FIO2 = 20.95%); training in normoxia and heat (H: 31 °C, FIO2 = 20.95%); training in hypoxia and thermoneutral conditions (IHT: 21 °C, FIO2 = 14.4%), and training in hypoxia and heat (IHT + H: 31 °C, FIO2 = 14.4%). Before and after physical training, the participants performed the Wingate Test, in which peak power and mean power were measured. Physical training lasted 4 weeks and the participants exercised 3 times a week for 60 min, performing interval training. Only the IHT and IHT + H groups showed significant increases in absolute peak power (p < 0.001, ES = 0.36 and p = 0.02, ES = 0.26, respectively). There were no significant changes (p = 0.18) after training in mean power. Hypoxia appeared to be an environmental factor that significantly improved peak power, but not mean power. Heat, added to hypoxia, did not increase cycling anaerobic power. Also, training only in heat did not significantly affect anaerobic power. The inclusion of heat and/or hypoxia in training did not induce negative effects, i.e., a reduction in peak and mean power as measured in the Wingate Test.

Hypoventilation training including maximal end-expiratory breath holding improves the ability to repeat high-intensity efforts in elite judo athletes

Purpose

To investigate the effects of a repeated-sprint training in hypoxia induced by voluntary hypoventilation at low lung volume (RSH-VHL) including end-expiratory breath holding (EEBH) of maximal duration.

Methods

Over a 4-week period, twenty elite judo athletes (10 women and 10 men) were randomly split into two groups to perform 8 sessions of rowing repeated-sprint exercise either with RSH-VHL (each sprint with maximal EEBH) or with unrestricted breathing (RSN, 10-s sprints). Before (Pre-), 5 days after (Post-1) and 12 days after (Post-2) the last training session, participants completed a repeated-sprint ability (RSA) test on a rowing ergometer (8 × 25-s "all-out" repetitions interspersed with 25 s of passive recovery). Power output (PO), oxygen uptake, perceptual-motor capacity (turning off a traffic light with a predetermined code), cerebral (Δ[Hbdiff]) and muscle (Δ[Hb/Mb]diff) oxygenation, cerebral total haemoglobin concentration (Δ[THb]) and muscle total haemoglobin/myoglobin concentration (Δ[THb/Mb]) were measured during each RSA repetition and/or recovery period.

Results

From Pre-to Post-1 and Post-2, maximal PO, mean PO (MPO) of the first half of the test (repetitions 1-4), oxygen uptake, end-repetition cerebral Δ[Hbdiff] and Δ[THb], end-repetition muscle Δ[Hb/Mb]diff and Δ[THb/Mb] and perceptual-motor capacity remained unchanged in both groups. Conversely, MPO of the second half of the test (repetitions 5-8) was higher at Post-1 than at Pre-in RSH-VHL only (p < 0.01), resulting in a lower percentage decrement score over the entire RSA test (20.4% ± 6.5% vs. 23.9% ± 7.0%, p = 0.01). Furthermore, MPO (5-8) was greater in RSH-VHL than in RSN at Post-1 (p = 0.04). These performance results were accompanied by an increase in muscle Δ[THb/Mb] (p < 0.01) and a concomitant decrease in cerebral Δ[THb] (p < 0.01) during the recovery periods of the RSA test at Post-1 in RSH-VHL.

Conclusion

Four weeks of RSH-VHL including maximal EEBH improved the ability of elite judo athletes to repeat high-intensity efforts. The performance improvement, observed 5 days but not 12 days after training, may be due to enhanced muscle perfusion. The unchanged oxygen uptake and the decrease in cerebral regional blood volume observed at the same time suggest that a blood volume redistribution occurred after the RSH-VHL intervention to meet the increase in muscle perfusion.

Combined intermittent hypoxic exposure at rest and continuous hypoxic training can maintain elevated hemoglobin mass after a hypoxic camp

Athletes use hypoxic living and training to increase hemoglobin mass (Hbmass), but Hbmass declines rapidly upon return to sea level. We investigated whether intermittent hypoxic exposure (IHE) + continuous hypoxic training (CHT) after return to sea level maintained elevated Hbmass, and if changes in Hbmass were transferred to changes in maximal oxygen uptake (V̇o2max) and exercise performance. Hbmass was measured in 58 endurance athletes before (PRE), after (POST1), and 30 days after (POST2) a 27 ± 4-day training camp in hypoxia (n = 44, HYP) or at sea level (n = 14, SL). After returning to sea level, 22 athletes included IHE (2 h rest) + CHT (1 h training) in their training every third day for 1 mo (HYPIHE + CHT), whereas the other 22 HYP athletes were not exposed to IHE or CHT (HYPSL). Hbmass increased from PRE to POST1 in both HYPIHE + CHT (4.4 ± 0.7%, means ± SE) and HYPSL (4.1 ± 0.6%) (both P < 0.001). Compared with PRE, Hbmass at POST2 remained 4.2 ± 0.8% higher in HYPIHE + CHT (P < 0.001) and 1.9 ± 0.5% higher in HYPSL (P = 0.023), indicating a significant difference between the groups (P = 0.002). In SL, no significant changes were observed in Hbmass with mean alterations between -0.5% and 0.4%. V̇o2max and time to exhaustion during an incremental treadmill test (n = 35) were elevated from PRE to POST2 only in HYPIHE + CHT (5.8 ± 1.2% and 5.4 ± 1.4%, respectively, both P < 0.001). IHE + CHT possesses the potential to mitigate the typical decline in Hbmass commonly observed during the initial weeks after return to sea level.NEW & NOTEWORTHY Sets of 2-h intermittent hypoxic exposure + 1-h continuous hypoxic training, every third day, possess the potential to mitigate the typical decline in Hbmass that is commonly observed during the initial weeks after return to sea level from an altitude camp. Inclusion of IHE + CHT in the training regimen was also accompanied by improvements in V̇o2max and exercise performance in most but not all Tier 3-Tier 5 level endurance athletes during the training season.

The Characteristics of Endurance Events with a Variable Pacing Profile-Time to Embrace the Concept of "Intermittent Endurance Events"?

A variable pacing profile is common in different endurance events. In these races, several factors, such as changes in elevation or race dynamics, lead participants to perform numerous surges in intensity. These surges are so frequent that certain events, such as cross-country (XC) skiing, mountain biking (MTB), triathlon, and road cycling, have been termed "intermittent endurance events". The characteristics of these surges vary depending on the sport: MTB and triathlon require athletes to perform numerous short (<10 s) bouts; XC skiing require periods of short- and moderate-(30 s to 2 min) duration efforts, while road cycling is comprised of a mix of short-, moderate-, and long-duration (>2 min) bouts. These bouts occur at intensities above the maximal metabolic steady state (MMSS), with many efforts performed at intensities above the athletes' maximal aerobic power or speed (MAP/MAS) (i.e., supramaximal intensities). Given the factors that influence the requirement to perform surges in these events, athletes must be prepared to always engage in a race with a highly stochastic pace. The aim of this review is to characterize the variable pacing profile seen in endurance events and to discuss how the performance of multiple maximal and supramaximal surges in intensity can affect how athletes fatigue during a race and influence training strategies that can lead to success in these races.

Review of Athletic Guidelines for High-Altitude Training and Acclimatization

Ramchandani, Rashi, Ioana Tereza Florica, Zier Zhou, Aziz Alemi, and Adrian Baranchuk. Review of athletic guidelines for high-altitude training and acclimatization. High Alt Med Biol. 00:000-000, 2024. Introduction: Exposure to high altitude results in hypobaric hypoxia with physiological acclimatization changes that are thought to influence athletic performance. This review summarizes existing literature regarding implications of high-altitude training and altitude-related guidelines from major governing bodies of sports. Methods: A nonsystematic review was performed using PubMed and OVID Medline to identify articles regarding altitude training and guidelines from international governing bodies of various sports. Sports inherently involving training or competing at high altitude were excluded. Results: Important physiological compensatory mechanisms to high-altitude environments include elevations in blood pressure, heart rate, red blood cell mass, tidal volume, and respiratory rate. These responses can have varying effects on athletic performance. Governing sport bodies have limited and differing regulations for training and competition at high altitudes with recommended acclimatization periods ranging from 3 days to 3 weeks. Discussion: Physiological changes in response to high terrestrial altitude exposure can have substantial impacts on athletic performance. Major sport governing bodies have limited regulations and recommendations regarding altitude training and competition. Existing guidelines are variable and lack substantial evidence to support recommendations. Additional studies are needed to clarify the implications of high-altitude exposure on athletic ability to optimize training and competition.

Effects of Hypoxia Severity on Muscle Oxygenation Kinetics Using Statistical Parametric Mapping During Repeated Treadmill Sprints

PURPOSE

We examined the effects of increasing hypoxia severity on oxygenation kinetics in the vastus lateralis muscle during repeated treadmill sprints, using statistical parametric mapping (SPM).

METHODS

Ten physically active males completed 8 sprints of 5 seconds each (recovery = 25 s) on a motorized sprint treadmill in normoxia (sea level; inspired oxygen fraction = 0.21), moderate hypoxia (inspired oxygen fraction = 0.17), and severe hypoxia (SH; inspired oxygen fraction = 0.13). Continuous assessment of tissue saturation index (TSI) in the vastus lateralis muscle was conducted using near-infrared spectroscopy. Subsequently, TSI data were averaged for the sprint-recovery cycle of all sprints and compared between conditions.

RESULTS

The SPM analysis revealed no discernible difference in TSI signal amplitude between conditions during the actual 5-second sprint phase. However, during the latter portion of the 25-second recovery phase, TSI values were lower in SH compared with both sea level (from 22 to 30 s; P = .003) and moderate hypoxia (from 16 to 30 s; P = .001). The mean distance covered at sea level (22.9 [1.0] m) was greater than for both moderate hypoxia (22.5 [1.2] m; P = .045) and SH (22.3 [1.4] m; P = .043).

CONCLUSIONS

The application of SPM demonstrated that only SH reduced muscle oxygenation levels during the late portion of the passive (recovery) phase and not the active (sprint) phase during repeated treadmill sprints. These findings underscore the usefulness of SPM for assessing muscle oxygenation differences due to hypoxic exposure and the importance of the duration of the between-sprints recovery period.

Recommendations for Women in Mountain Sports and Hypoxia Training/Conditioning

The (patho-)physiological responses to hypoxia are highly heterogeneous between individuals. In this review, we focused on the roles of sex differences, which emerge as important factors in the regulation of the body's reaction to hypoxia. Several aspects should be considered for future research on hypoxia-related sex differences, particularly altitude training and clinical applications of hypoxia, as these will affect the selection of the optimal dose regarding safety and efficiency. There are several implications, but there are no practical recommendations if/how women should behave differently from men to optimise the benefits or minimise the risks of these hypoxia-related practices. Here, we evaluate the scarce scientific evidence of distinct (patho)physiological responses and adaptations to high altitude/hypoxia, biomechanical/anatomical differences in uphill/downhill locomotion, which is highly relevant for exercising in mountainous environments, and potentially differential effects of altitude training in women. Based on these factors, we derive sex-specific recommendations for mountain sports and intermittent hypoxia conditioning: (1) Although higher vulnerabilities of women to acute mountain sickness have not been unambiguously shown, sex-dependent physiological reactions to hypoxia may contribute to an increased acute mountain sickness vulnerability in some women. Adequate acclimatisation, slow ascent speed and/or preventive medication (e.g. acetazolamide) are solutions. (2) Targeted training of the respiratory musculature could be a valuable preparation for altitude training in women. (3) Sex hormones influence hypoxia responses and hormonal-cycle and/or menstrual-cycle phases therefore may be factors in acclimatisation to altitude and efficiency of altitude training. As many of the recommendations or observations of the present work remain partly speculative, we join previous calls for further quality research on female athletes in sports to be extended to the field of altitude and hypoxia.

Three sessions of repeated sprint training in normobaric hypoxia improves sprinting performance

The objective of the present study was to evaluate the impacts of three-session repeated sprint training conducted in normobaric hypoxia with 48-h intervals on sprint performance, arterial oxygen saturation (SpO2), and rating of perceived exertion (RPE) scores. A total of 27 moderately trained male university students voluntarily took part in this study. In this single-blind placebo-controlled study, subjects were assigned into normobaric hypoxia (FiO2: 13.6%; HYP), normobaric normoxia (FiO2: 20.9%; PLA), and control group (CON). The HYP and PLA groups underwent three repeated sprint training sessions (a total of four sets of five times 5-s sprints with a 5-min rest between sets and a 30-s rest between each sprint) on a cycle ergometer in normobaric hypoxia or normoxia conditions. Pre- and post-tests were performed 72 h before and after the training period. Three participants were excluded from the study, and the data from twenty-four participants were analyzed. Contrary to what was observed in the pre and post tests, no time and condition interactions were observed in the relative peak power output (PPO), mean power output (MPO), percentage of sprint decrement score (Sdec%), and RPE parameters. Time effect was found in all observed variables respectively; relative PPO (F = 5.784, p = 0.045, η2 = 0.74), relative MPO (F = 3.927, p = 0.042, η2 = 0.66) and large time effect found for Sdec% (F = 11.430, p = 0.046, 0.83), and RPE (F = 14.990, p = 0.008, η2 = 0.96). A notable increase in relative peak power output (PPO) and mean power output (MPO) was observed in the post-test in comparison to the pre-test values, indicating statistical significance. The increase in PPO was in HYP 13.44% (p = 0.006), in PLA 7.48% (p = 0.264) and in CON 2.66% (p = 0.088). The decrease in Sdec% was in HYP -13.34%% (p = 0.048), PLA -10.54 (p = 0.577) and CON -4.83 (p = 0.644) at post-test. The results show that although there were no statistical differences between the groups, notable differences in performance-related variables were observed in the HYP group after 3 sessions of repetitive sprint training in hypoxia.

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

Objectives

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

Methods

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

Results

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

Conclusions

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

Acute Responses to Repeated-Sprint Training in Hypoxia Combined With Whole-Body Cryotherapy: A Preliminary Study

PURPOSE

This study aimed to investigate acute psychophysiological responses to repeated-sprint training in hypoxia (RSH) combined with whole-body cryotherapy (WBC).

METHOD

Sixteen trained cyclists performed 3 sessions in randomized order: RSH, WBC-RSH (WBC pre-RSH), and RSH-WBC (WBC post-RSH). RSH consisted of 3 sets of 5 × 10-second sprints with 20-second recovery at a simulated altitude of 3000 m. Power output, muscle oxygenation (tissue saturation index), heart-rate variability, and recovery perception were analyzed. Sleep quality was assessed on the nights following test sessions and compared with a control night using nocturnal ActiGraphy and heart-rate variability.

RESULTS

Power output did not differ between the conditions (P = .27), while the decrease in tissue saturation index was reduced for WBC-RSH compared to RSH-WBC in the last set. In both conditions with WBC, the recovery perception was higher compared to RSH (WBC-RSH: +15.4%, and RSH-WBC: +21.9%, P < .05). The number of movements during the RSH-WBC night was significantly lower than for the control night (-18.7%, P < .01) and WBC-RSH (-14.9%, P < .05). RSH led to a higher root mean square of the successive differences of R-R intervals and high-frequency band during the first hour of sleep compared to the control night (P < .05) and RSH-WBC (P < .01).

CONCLUSIONS

Inclusion of WBC in an RSH session did not modify the power output but could improve prolonged performance in hypoxia by maintaining muscle oxygenation. A single RSH session did not deteriorate sleep quality. WBC, particularly when performed after RSH, positively influenced recovery perception and sleep.

Use of Inter-Effort Recovery Hypoxia as a New Approach to Improve Anaerobic Capacity and Time to Exhaustion

Putti, Germano Marcolino, Gabriel Peinado Costa, Matheus Silva Norberto, Carlos Dellavechia de Carvalho, Rômulo Cássio de Moraes Bertuzzi, and Marcelo Papoti. Use of inter-effort recovery hypoxia as a new approach to improve anaerobic capacity and time to exhaustion. High Alt Med Biol. 25:68-76, 2024. Background: Although adding hypoxia to high-intensity training may offer some benefits, a significant problem of this training model is the diminished quality of the training session when performing efforts in hypoxia. The purpose of this study was to investigate the effects of training and tapering combined with inter-effort recovery hypoxia (IEH) on anaerobic capacity, as estimated by alternative maximum accumulated oxygen deficit (MAODALT) and time to exhaustion (TTE). Methods: Twenty-four amateur runners performed, for 5 weeks, 3 sessions per week of training consisted of ten 1-minute bouts at 120% (weeks 1-3) and 130% (weeks 4 and 5) of maximum velocity (VMAX) obtained in graded exercise test, separated by a 2-minute interval in IEH (IEH, n = 11, FIO2 = 0.136) or normoxia (NOR, n = 13, fraction of inspired oxygen = 0.209). Before training, after training, and after 1 week of tapering, a graded exercise test and a maximal effort to exhaustion at 120% of VMAX were performed to determine TTE and MAODALT. The results were analyzed using generalized linear mixed models, and a clinical analysis was also realized by the smallest worthwhile change. Results: MAODALT increased only in IEH after training (0.8 ± 0.5 eq.lO2) and tapering (0.8 ± 0.5 eq.lO2), with time x group interaction. TTE increased for the pooled groups after taper (23 ± 11 seconds) and only for IEH alone (29 ± 16 seconds). Clinical analysis revealed a small size increase for NOR and a moderate size increase for IEH. Conclusions: Although the effects should be investigated in other populations, it can be concluded that IEH is a promising model for improving anaerobic performance and capacity. World Health Organization Universal Trial Number: U1111-1295-9954. University's ethics committee registration number: CAAE: 32220020.0.0000.5659.

Physiological Responses to Supramaximal Running Exercise with End-Expiratory Breath Holding up to the Breaking Point

This study aimed to assess the physiological responses to repeated running exercise performed at supramaximal intensity and with end-expiratory breath holding (EEBH) up to the breaking point. Eight male runners participated in two running testing sessions on a motorized treadmill. In the first session, participants performed two sets of 8 repetitions at 125% of maximal aerobic velocity and with maximum EEBH. Each repetition started at the onset of EEBH and ended at its release. In the second session, participants replicated the same procedure, but with unrestricted breathing (URB). The change in cerebral and muscle oxygenation (Δ[Hbdiff]), total haemoglobin concentration (Δ[THb]) and muscle reoxygenation were continuously assessed. End-tidal oxygen (PETO2) and carbon dioxide pressure (PETCO2), arterial oxygen saturation (SpO2) and heart rate (HR) were also measured throughout exercise.On average, EEBH was maintained for 10.1 ± 1 s. At the breaking point of EEBH, PETO2 decreased to 54.1 ± 8 mmHg, whereas PETCO2 increased to 74.8 ± 3.1 mmHg. At the end of repetitions, SpO2 (nadir values 74.9 ± 5.0 vs. 95.7 ± 0.8%) and HR were lower with EEBH than with URB. Cerebral and muscle Δ[Hbdiff] were also lower with EEBH, whereas this condition induced higher cerebral and muscle Δ[THb] and greater muscle reoxygenation. This study showed that performing repeated bouts of supramaximal running exercises with EEBH up to the breaking point induced a fall in arterial, cerebral and muscle oxygenation compared with the URB condition. These phenomena were accompanied by increases in regional blood volume likely resulting from compensatory vasodilation to preserve oxygen delivery to the brain and muscles.

Can Hypoxia Alter the Anaerobic Capacity Measured by a Single Exhaustive Exercise?

The present study aimed to compare the MAODALT in situations of hypoxia and normoxia to confirm the method validity. Seventeen healthy and physically active men participated in this study, aged 25.2±3.2 years. All participants underwent four days of evaluation. The first day was performed a body composition test, an incremental test to exhaustion to determine the maximum oxygen uptake, familiarizing the hypoxia (H) and normoxia (N) situation and the equipment used. On the second, third and fourth days, supramaximal efforts were performed until exhaustion at 110% of maximum oxygen uptake, in a situation of hypoxia (FIO2=14.0%) and normoxia (FIO2=20.9%). The anaerobic capacity was considered the sum of energy supply of the alactic and lactic systens. The absolute or relative anaerobic capacity values were not different (H=3.9±1.1 L, N=3.8±0.9 L, p=0.69), similarly no differences were found for the alactic contribution (H=1.7±0.5 L, N=1.5±0.5 L, p=0.30) and lactic contribution (H=2.3±0.9 L, N=2.3±0.7 L, p=0.85). It can be concluded that the anaerobic capacity measured by a single exhaustive effort is not altered by hypoxia.

Physiological and performance effects of live high train low altitude training for elite endurance athletes: A narrative review

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.

Repeated-Sprint Training at 5000-m Simulated Altitude in Preparation for the World Rugby Women's Sevens Series: Too High?

PURPOSE

The objective of this study is to investigate the effectiveness of novel repeated-sprint training in hypoxia (RSH) protocol, likely maximizing hypoxic stimulus (higher than commonly used) while preserving training quality (interset rest in normoxia).

METHODS

Twenty-three world-class female rugby sevens players performed four repeated-sprint training sessions (4 sets of 5 × 5-s cycle sprints-25-s intersprint recovery and 3-min interset rest) under normobaric hypoxia (RSH, exercise and interset rest at FiO 2 of 10.6% and 20.9%, respectively; n = 12) or normoxia (repeated-sprint training in normoxia; exercise and interset rest at FiO 2 of 20.9%; n = 11) during a 9-d training camp before international competition. Repeated-sprint ability (8 × 5-s treadmill sprints-25-s recovery), on-field aerobic capacity, and brachial endothelial function were assessed pre- and postintervention.

RESULTS

Arterial oxygen saturation (pooled data: 87.0% ± 3.1% vs 96.7% ± 2.9%, P < 0.001) and peak and mean power outputs (sets 1 to 4 average decrease: -21.7% ± 7.2% vs -12.0% ± 3.8% and -24.9% ± 8.1% vs -14.9% ± 3.5%; both P < 0.001) were lower in RSH versus repeated-sprint training in normoxia. The cumulated repeated-sprint distance covered significantly increased from pre- to postintervention (+1.9% ± 3.0%, P = 0.019), irrespective of the condition ( P = 0.149). On-field aerobic capacity did not change (all P > 0.45). There was no significant interaction (all P > 0.240) or condition main effect (all P > 0.074) for any brachial artery endothelial function variable. Only peak diameter increased ( P = 0.026), whereas baseline and peak shear stress decreased ( P = 0.014 and 0.019, respectively), from pre- to postintervention.

CONCLUSIONS

In world-class female rugby sevens players, only four additional repeated-sprint sessions before competition improve repeated-sprint ability and brachial endothelial function. However, adding severe hypoxic stress during sets of repeated sprints only did not provide supplementary benefits.

Effects of simulated high altitude on body temperature and heart rate in pilot reserves during the hot-dry exposure

Recent research has primarily focused on human thermoregulatory responses at high altitudes, but investigations involving extremely high-temperature and hypobaric compound environments are currently lacking. To address this gap in knowledge, this study aimed to enhance the prediction of human heat sensation for pilot reserves while operating in extremely hot cabins with decompression. To achieve this, an improved Predicted Heat Strain (PHS) model was developed by incorporating the influence of air pressure on metabolic rate. The model's validity was assessed through experiments conducted at different altitudes (0m, 5000m, and 8000m) and varying environmental conditions (26°C and 45 °C, 10% RH and 40% RH) within an environmental simulation cabin. During these experiments, local skin temperature, core temperature, heart rate, and blood oxygen saturation were measured. The findings revealed distinct variations in the skin temperature of the hand and foot segments across different experimental stages, and significant correlations were observed between heart rate, core temperature, and local skin temperatures. Furthermore, regression models were established to explore the relationship between heart rate and local skin temperatures. By comparing simulated and experimental core and local skin temperatures, the enhanced PHS model was successfully validated. The conclusions drawn from this study provide valuable insights for predicting thermal physiological indices accurately and conveniently in hot-dry and hypobaric environments.

Validity and reliability of Polar M400 GPS watches for measuring distances covered by team sports players

Monitoring locomotor demands in team sports becomes popular in professional and recreational daily activities. Precise measurements are main of importance in training routine. The aim of this study is three-fold: (i) analyze the validity of Polar M400 Global Positioning System (GPS) watches for measuring distances covered in team sports simulation cycle; (ii) testing inter-unit reliability of two devices attached during testing; and (iii) testing inter-session reliability for the same simulation cycle. Methods: Twenty-one team athletes (age: 24.5 ± 5.2 years; body mass: 71.8 ± 5.7 kg; height: 176.5 ± 4.3 cm) were tested in the team sport simulation cycle (TSSC). Two Polar M400 sport watches were used by each player on their wrists at the same time. The data obtained from Polar M400 were compared to the reference fixed distance of the TSSC to determine the watch validity. Inter-session reliability was also tested using the two watches in two different sessions. Results: No significant differences between the reference value and the watches (F = 1.086; p = 0.368; η p 2 ≤0.042) were found. The %CV (0.03-0.05%) and SEM (0.05-0.09) values found for all considered groups confirmed good levels of reliability of the Polar M400 to measure total distance. Conclusions: The Polar M400 is a valid and reliable watch for measuring the distances covered by team sport athletes. Both coaches and athletes can monitor the distances covered with accuracy and precision, through the use of the Polar M400 sport watch.

Comparative efficacy of various hypoxic training paradigms on maximal oxygen consumption: A systematic review and network meta-analysis

Background

Enhancement in maximal oxygen consumption (VO2max) induced by hypoxic training is important for both athletes and non-athletes. However, the lack of comparison of multiple paradigms and the exploration of related modulating factors leads to the inability to recommend the optimal regimen in different situations. This study aimed to investigate the efficacy of seven common hypoxic training paradigms on VO2max and associated moderators.

Methods

Electronic (i.e., five databases) and manual searches were performed, and 42 studies involving 1246 healthy adults were included. Pairwise meta-analyses were conducted to compare different hypoxic training paradigms and hypoxic training and control conditions. The Bayesian network meta-analysis model was applied to calculate the standardised mean differences (SMDs) of pre-post VO2max alteration among hypoxic training paradigms in overall, athlete, and non-athlete populations, while meta-regression analyses were employed to explore the relationships between covariates and SMDs.

Results

All seven hypoxic training paradigms were effective to varying degrees, with SMDs ranging from 1.45 to 7.10. Intermittent hypoxia interval training (IHIT) had the highest probability of being the most efficient hypoxic training paradigm in the overall population and athlete subgroup (42%, 44%), whereas intermittent hypoxic training (IHT) was the most promising hypoxic training paradigm among non-athletes (66%). Meta-regression analysis revealed that saturation hours (coefficient, 0.004; P = 0.038; 95% CI [0.0002, 0.0085]) accounted for variations of VO2max improvement induced by IHT.

Conclusion

Efficient hypoxic training paradigms for VO2max gains differed between athletes and non-athletes, with IHIT ranking best for athletes and IHT for non-athletes. The practicability of saturation hours is confirmed with respect to dose-response issues in the future hypoxic training and associated scientific research.

Registration

This study was registered in the PROSPERO international prospective register of systematic reviews (CRD42022333548).

Acute performance, physiological, and perceptual changes in response to repeated cycling sprint exercise combined with systemic and local hypoxia in young males

This study investigated the acute performance, physiological, and perceptual changes during repeated sprint exercise (RSE) under normobaric hypoxia and with blood flow restriction (BFR). Fourteen active males completed standardized RSE (6 × 10s cycling sprints with 30s passive rest) in three randomized conditions: under normobaric hypoxia (F_iO₂∼14.4%, HYP), normoxia (F_iO₂∼20.9%, SHAM), and with BFR (40% arterial occlusion pressure). The percentage decrement score of power output (S_dec) was used to quantify motor performance fatigue. During RSE, muscle oxygenation and activity of the right quadriceps were measured. Perceived motor fatigue, physical strain, affective valence, and arousal were queried after each sprint. Blood lactate concentration (BLC) and peripheral oxygenation (S_pO₂) were measured before and after RSE. S_dec was greater in HYP and BFR compared to SHAM (p≤0.008). BFR decreased mean power output (p<0.001) and muscle activity (p=0.027) compared to SHAM. Muscle oxygenation was lower in BFR during each rest (p≤0.005) and in HYP during rest 4 (p=0.006) compared to SHAM. HYP increased BLC and decreased S_pO₂ compared to BFR (p<0.001) and SHAM (p=0.002). There were no differences between conditions for any rating scale (p≥0.060). HYP and BFR increased motor performance fatigue but with different physiological responses, whereas perceptual responses were unaffected during RSE.

A study of survival strategies for improving acclimatization of lowlanders at high-altitude

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.

Maximal pulmonary ventilation and lactate affect the anaerobic performance in young women exposed to hypobaric hypoxia

Background: Athletes, tourists, and mining workers from all over the world ascend daily to an altitude greater than 3.000 meters above sea level to perform different activities, all of which demand physical effort. A ventilation increase is the first mechanism once the chemoreceptors perceive hypoxia, and is key to maintaining blood oxygen levels during acute exposure to high altitudes and to buffering lactic acidosis during exercise. It has been observed that gender is a variable that can influence the ventilatory response. Still, the available literature is limited due to the few studies considering women as study subjects. The influence of gender on anaerobic performance and its effects under high altitudes (HA) environments have been poorly studied. Objective: The objectives of this study were to evaluate anaerobic performance in young women exposed to high altitudes and to compare the physiological response to multiple sprints between women and men measured by ergospirometry. Methodology: Nine women and nine men (22.9 ± 3.2 years old) carried out the multiple-sprint anaerobic tests under two conditions, sea level and high altitudes. Results: In the first 24 h of exposure to a high altitudes, lactate levels were higher in women than those in men (2.57 ± 0.4 Mmol/L, 2.18 ± 0.3 Mmol/L, respectively; p < 0.05). Second, women had a decreased ventilatory response in exposure to high altitudes compared to men (p > 0.005). Third, there is a positive correlation between lactate levels prior to an anaerobic test and the ventilatory response developed by subjects at high altitudes (R2 = 0.33, slope = -41.7, and p < 0.05). Lastly, this ventilatory response can influence VO_2peak (R2 = 0.60, slope = 0.02, and p < 0.001). Conclusion: This study provides insights into the mechanisms behind the reduced respiratory capacity observed in women during an anaerobic exercise test at high altitudes. An acute response to HA showed a greater work of breathing and increased the drive ventilatory response. It is possible to postulate the differences in the fatigue-induced metaboreflex of the respiratory muscles and aerobic-anaerobic transition between genders. These results on multiple sprint performance and the influences of gender in hypoxic environments deserve further investigation.

Combined Effects of Hypocapnic Hyperventilation and Hypoxia on Exercise Performance and Metabolic Responses During the Wingate Anaerobic Test

Hypoxia during supramaximal exercise reduces aerobic metabolism with a compensatory increase in anaerobic metabolism without affecting exercise performance. A similar response is elicited by preexercise voluntary hypocapnic hyperventilation, but it remains unclear whether hypocapnic hyperventilation and hypoxia additively reduce aerobic metabolism and increase anaerobic metabolism during supramaximal exercise. To address that issue, 12 healthy subjects (8 males and 4 females) performed the 30-second Wingate anaerobic test (WAnT) after (1) spontaneous breathing in normoxia (control, ∼21% fraction of inspired O2 [FiO2]), (2) voluntary hypocapnic hyperventilation in normoxia (hypocapnia, ∼21% FiO2), (3) spontaneous breathing in hypoxia (hypoxia, ∼11% FiO2), or (4) voluntary hypocapnic hyperventilation in hypoxia (combined, ∼11% FiO2). Mean power output during the 30-second WAnT was similar among the control (561 [133] W), hypocapnia (563 [140] W), hypoxia (558 [131] W), and combined (560 [133] W) trials (P = .778). Oxygen uptake during the 30-second WAnT was lower in the hypocapnia (1523 [318] mL/min), hypoxia (1567 [300] mL/min), and combined (1203 [318] mL/min) trials than in the control (1935 [250] mL/min) trial, and the uptake in the combined trial was lower than in the hypocapnia or hypoxia trial (all P < .001). Oxygen deficit, an index of anaerobic metabolism, was higher in the hypocapnia (38.4 [7.3] mL/kg), hypoxia (37.8 [6.8] mL/kg), and combined (40.7 [6.9] mL/kg) trials than in the control (35.0 [6.8] mL/kg) trial, and the debt was greater in the combined trial than in the hypocapnia or hypoxia trial (all P < .003). Our results suggest that voluntary hypocapnic hyperventilation and hypoxia additively reduce aerobic metabolism and increase anaerobic metabolism without affecting exercise performance during the 30-second WAnT.

High-Intensity Interval Training (HIIT) in Hypoxia Improves Maximal Aerobic Capacity More Than HIIT in Normoxia: A Systematic Review, Meta-Analysis, and Meta-Regression

The present study aimed to determine the effect of high intensity interval training (HIIT) in hypoxia on maximal oxygen uptake (VO_2max) compared with HIIT in normoxia with a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-accordant meta-analysis and meta-regression. Studies which measured VO_2max following a minimum of 2 weeks intervention featuring HIIT in hypoxia versus HIIT in normoxia were included. From 119 originally identified titles, nine studies were included (n = 194 participants). Meta-analysis was conducted on change in (∆) VO_2max using standardised mean difference (SMD) and a random effects model. Meta-regression examined the relationship between the extent of environmental hypoxia (fractional inspired oxygen [FiO₂]) and ∆VO_2max and intervention duration and ∆VO_2max. The overall SMD for ∆VO_2max following HIIT in hypoxia was 1.14 (95% CI = 0.56-1.72; p < 0.001). Meta-regressions identified no significant relationship between FiO₂ (coefficient estimate = 0.074, p = 0.852) or intervention duration (coefficient estimate = 0.071, p = 0.423) and ∆VO_2max. In conclusion, HIIT in hypoxia improved VO_2max compared to HIIT in normoxia. Neither extent of hypoxia, nor training duration modified this effect, however the range in FiO₂ was small, which limits interpretation of this meta-regression. Moreover, training duration is not the only training variable known to influence ∆VO_2max, and does not appropriately capture total training stress or load. This meta-analysis provides pooled evidence that HIIT in hypoxia may be more efficacious at improving VO_2max than HIIT in normoxia. The application of these data suggest adding a hypoxic stimuli to a period of HIIT may be more effective at improving VO_2max than HIIT alone. Therefore, coaches and athletes with access to altitude (either natural or simulated) should consider implementing HIIT in hypoxia, rather than HIIT in normoxia where possible, assuming no negative side effects.

Training at moderate altitude improves submaximal but not maximal performance-related parameters in elite rowers

Maximal oxygen consumption (V̇O_2max), physiological thresholds, and hemoglobin mass are strong predictors of endurance performance. High values of V̇O_2max, 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 V̇O_2max, ventilatory thresholds (VTs) and rowing economy/efficiency (ECR/GE%). LHTL training improves performance-related variables at sea level (V̇E_max: 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), V̇E_VT2: 6.4% (95% CI, 0.4–12.4); power at VT1: 7.3% (95% CI, 1.3–13.3), V̇E_VT1: 8.7% (95% CI, 1.6–15.8)) and economy/efficiency-related variables (ECR_VT2: 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 V̇O_2max 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.

High Dose of Acute Normobaric Hypoxia Does Not Adversely Affect Sprint Interval Training, Cognitive Performance and Heart Rate Variability in Males and Females

Although preliminary studies suggested sex-related differences in physiological responses to hypoxia, the effects of sex on sprint interval training (SIT) performance in different degrees of hypoxia are largely lacking. The aim of this study was to examine the acute effect of different doses of normobaric hypoxia on SIT performance as well as heart rate variability (HRV) and cognitive performance (CP) in amateur-trained team sport players by comparing potential sex differences. In a randomized, double-blind, crossover design, 26 (13 females) amateur team-sport (football, basketball, handball, rugby) players completed acute SIT (6 × 15 s all-out sprints, separated with 2 min active recovery, against a load equivalent to 9% of body weight) on a cycle ergometer, in one of four conditions: (I) normoxia without a mask (FiO2: 20.9%) (CON); (II) normoxia with a mask (FiO2: 20.9%) (NOR); (III) moderate hypoxia (FiO2: 15.4%) with mask (MHYP); and (IV) high hypoxia (FiO2: 13.4%) with mask (HHYP). Peak (PPO) and mean power output (MPO), HRV, heart rate (HR), CP, capillary lactate (BLa), and ratings of perceived exertion (RPE) pre- and post-SIT were compared between CON, NOR, MHYP and HHYP. There were no significant differences found between trials for PPO (p = 0.55), MPO (p = 0.44), RPE (p = 0.39), HR (p = 0.49), HRV (p > 0.05) and CP (response accuracy: p = 0.92; reaction time: p = 0.24). The changes in MP, PP, RPE, HR, CP and HRV were similar between men and women (all p > 0.05). While BLa was similar (p = 0.10) between MHYP and HHYP trials, it was greater compared to CON (p = 0.01) and NOR (p = 0.01), without a sex-effect. In conclusion, compared to normoxia, hypoxia, and wearing a mask, have no effect on SIT acute responses (other than lactate), including PP, MP, RPE, CP, HR, and cardiac autonomic modulation either in men or women.

Effects of Moderate-Intensity Training Under Cyclic Hypoxia on Cardiorespiratory Fitness and Hematological Parameters in People Recovered From COVID-19: The Aerobicovid Study

BACKGROUND

Recent studies have indicated that people who live at altitude have a lower incidence of coronavirus disease (COVID-19) and lesser severity in infection cases.

HYPOTHESIS

Hypoxia exposure could lead to health benefits, and it could be used in the recovery process as an additional stimulus to physical training to improve cardiorespiratory fitness (CRF).

STUDY DESIGN

Randomized controlled clinical trial.

LEVEL OF EVIDENCE

Level 2.

METHODS

The 43 participants, aged 30 to 69 years, were divided into control group (CG, n = 18) and 2 training groups: normoxia (NG, n = 9) and hypoxia (HG, n = 16). Before and after the intervention were evaluated the lactate threshold 2 (L2), peak oxygen uptake (VO_2peak), and a blood sample was collected at rest to evaluate hematological adaptation. Both groups performed an 8-week moderate-intensity physical training on a bike. The HG were trained under normobaric hypoxic conditions (fractional inspired oxygen [FiO₂] = 13.5%).

RESULTS

The 8-week intervention promoted a similar improvement in CRF of people recovered from COVID-19 in the HG (L2 = 34.6%; VO_2peak = 16.3%; VO_2peak intensity = 24.6%) and NG (L2 = 42.6%; VO_2peak = 16.7%; VO_2peak intensity = 36.9%). Only the HG presented differences in hematological variables (erythropoietin = 191.7%; reticulocytes = -32.4%; off-score = 28.2%) in comparison with the baseline.

CONCLUSION

The results of the present study provide evidence that moderate-intensity training in normoxia or hypoxia promoted similar benefits in CRF of people recovered from COVID-19. Furthermore, the hypoxia offered an additional stimulus to training promoting erythropoietin increase and hematological stimulation.

CLINICAL RELEVANCE

The present exercise protocol can be used for the rehabilitation of people recovered from COVID-19, with persistent low CRF. In addition, this is the first study demonstrating that physical training combined with hypoxia, as well as improving CRF, promotes greater hematological stimulation in people recovered from COVID-19.

Tetrahydrocurcumin Ameliorates Acute Hypobaric Hypoxia-Induced Cognitive Impairment in Mice

Ma, Xuexinyu, Yang Pan, Yuye Xue, Yao Li, Yan Zhang, Yani Zhao, Xingzhao Xiong, Jianbo Wang, and Zhifu Yang. Tetrahydrocurcumin ameliorates acute hypobaric hypoxia-induced cognitive impairment in mice. High Alt Med Biol. 23:264-272, 2022. Background: Hypobaric hypoxia (HH) impairs spatial learning and increases oxidative stress in rodents. We hypothesized that tetrahydrocurcumin (THC) may attenuate HH-induced neurobehavioral deficits by reducing HH-induced lipid peroxidation and increasing glycolytic activity. Materials and Methods: A C57BL/6 mouse model of acute high altitude brain injury was established using an animal decompression chamber for 24 hours. Cognitive and behavioral assessments were conducted using the Y-maze, open field, and Rotarod tests. We measured superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activity; malondialdehyde (MDA) and reactive oxygen species levels; anti-neuronal core antigen (NeuN) immunoreactivity; and active occludin, hypoxia-inducible factor-1α, glucose transporter 1 (GLUT1), and GLUT3 expression levels in mice brain tissue. Results: The mice in the THC group showed improved cognitive impairment compared with those in the HH group in cognitive and behavioral tests, but failed to show improvement in the decline in coordination. The mice in the THC group were more effected than those in the HH group in demonstrating alleviation of hyperemia in cortical vessels and cell voids, and cells in the CA1 region were more closely arranged. Compared with those in the mice of the HH group, the concentration of MDA decreased significantly, the expression of occludin, NeuN immunoreactivity, and the activities of SOD and GSH-Px significantly increased in the mice of the THC group. An increase in GLUT1 expression was observed in HH-exposed animals (N group vs. HH group: 0.4 ± 0.08 vs. 0.60 ± 0.07, p < 0.05), and this increase was enhanced in animals treated with THC (HH group vs. THC group: 0.60 ± 0.07 vs. 0.82 ± 0.08, p < 0.05). Conclusions: THC improved cognitive impairment in mice, accompanied by reduced oxidative stress and increased GLUT1 protein levels.

Pulmonary Capacity, Blood Composition and Metabolism among Coal Mine Workers in High- and Low-Altitude Aboveground and Underground Workplaces

(1) Background: While previous studies revealed how underground mining might adversely affect the cardiopulmonary functions of workers, this study further investigated the differences between under- and aboveground mining at both high and low altitudes, which has received little attention in the literature. (2) Methods: Seventy-one healthy male coal mine workers were recruited, who had worked at least 5 years at the mining sites located above the ground at high (>3900 m; n = 19) and low (<120 m; n = 16) altitudes as well as under the ground at high (n = 20) and low (n = 16) altitudes. Participants’ heart rates, pulmonary functions, total energy expenditure and metabolism were measured over a 5-consecutive-day session at health clinics. (3) Results: Combining the results for both above- and underground locations, workers at high-altitude mining sites had significantly higher peak heart rate (HR), minimum average HR and training impulse as well as energy expenditure due to all substances and due to fat than those at low-altitude sites. They also had significantly higher uric acid, total cholesterol, creatine kinase and N-osteocalcin in their blood samples than the workers at low-altitude mining sites. At underground worksites, the participants working at high-altitude had a significantly higher average respiratory rate than those at low-altitude regions. (4) Conclusion: In addition to underground mining, attention should be paid to high-altitude mining as working under a hypoxia condition at such altitude likely presents physiological challenges.

Altitude and Endurance Performance in Altitude Natives versus Lowlanders: Insights from Professional Cycling

INTRODUCTION

Acute altitude exposure influences exercise performance, although most research, especially regarding altitude natives, comes from laboratory data in nonathletes.

PURPOSE

We analyzed the influence of altitude on real-world cycling performance in top-level professional cyclists attending to whether they were altitude natives or not.

METHODS

Thirty-three male cyclists (29 ± 5 yr) were studied and were classified as lowlanders (n = 19) or altitude natives (n = 14) attending to the altitude of their place of birth (431 ± 380 and 2583 ± 334 meters above sea level (m a.s.l.), respectively). Both groups included top 3 finishers (including winners) in the general classification of Grand Tours and major races. Using data from both training and competitions during years 2013-2020 (8 ± 5 seasons per cyclist), we registered participants' mean maximal power (MMP) for efforts lasting 5 s, 30 s, 5 min, and 10 min, respectively, at altitudes ranging from 0-500 to >2000 m a.s.l.

RESULTS

A significant altitude-MMP interaction effect (two-factor repeated-measures ANOVA) was found in lowlanders (P < 0.001) but not in altitude natives (P = 0.150). In lowlanders, individual performance decreased in a dose-response manner with increasing altitudes compared with sea (or near-sea) level (0-500 m a.s.l.), whereas this trend was much less evident in natives. A significant altitude-MMP-group effect was found (P < 0.001), with nonsignificant (and overall trivial-to-small differences) between lowlanders and altitude natives for any effort duration at altitudes ≤1500 m a.s.l. but with significant differences at higher altitudes (≥1501 m a.s.l.).

CONCLUSIONS

Acute altitude exposure influences real-world performance differently in low landers and altitude natives, which might confer a competitive advantage to the latter, particularly in races including efforts at >1500 m a.s.l.

Effects of Intermittent Hypoxia-Hyperoxia on Performance- and Health-Related Outcomes in Humans: A Systematic Review

BACKGROUND

Intermittent hypoxia applied at rest or in combination with exercise promotes multiple beneficial adaptations with regard to performance and health in humans. It was hypothesized that replacing normoxia by moderate hyperoxia can increase the adaptive response to the intermittent hypoxic stimulus.

OBJECTIVE

Our objective was to systematically review the current state of the literature on the effects of chronic intermittent hypoxia-hyperoxia (IHH) on performance- and health-related outcomes in humans.

METHODS

PubMed, Web of Science™, Scopus, and Cochrane Library databases were searched in accordance with PRISMA guidelines (January 2000 to September 2021) using the following inclusion criteria: (1) original research articles involving humans, (2) investigation of the chronic effect of IHH, (3) inclusion of a control group being not exposed to IHH, and (4) articles published in peer-reviewed journals written in English.

RESULTS

Of 1085 articles initially found, eight studies were included. IHH was solely performed at rest in different populations including geriatric patients (n = 1), older patients with cardiovascular (n = 3) and metabolic disease (n = 2) or cognitive impairment (n = 1), and young athletes with overtraining syndrome (n = 1). The included studies confirmed the beneficial effects of chronic exposure to IHH, showing improvements in exercise tolerance, peak oxygen uptake, and global cognitive functions, as well as lowered blood glucose levels. A trend was discernible that chronic exposure to IHH can trigger a reduction in systolic and diastolic blood pressure. The evidence of whether IHH exerts beneficial effects on blood lipid levels and haematological parameters is currently inconclusive. A meta-analysis was not possible because the reviewed studies had a considerable heterogeneity concerning the investigated populations and outcome parameters.

CONCLUSION

Based on the published literature, it can be suggested that chronic exposure to IHH might be a promising non-pharmacological intervention strategy for improving peak oxygen consumption, exercise tolerance, and cognitive performance as well as reducing blood glucose levels, and systolic and diastolic blood pressure in older patients with cardiovascular and metabolic diseases or cognitive impairment. However, further randomized controlled trials with adequate sample sizes are needed to confirm and extend the evidence. This systematic review was registered on the international prospective register of systematic reviews (PROSPERO-ID: CRD42021281248) ( https://www.crd.york.ac.uk/prospero/ ).

Effects of Interval Training Under Hypoxia on Hematological Parameters, Hemodynamic Function, and Endurance Exercise Performance in Amateur Female Runners in Korea

Interval training under hypoxia (IHT) is commonly used to enhance endurance exercise performance. However, previous studies examining hematologic changes related to the immune system that affect health and conditioning are lacking. This study aimed to evaluate the effects of IHT for 6-weeks on hematological parameters, hemodynamic function, and endurance exercise performance in amateur Korean female runners. Twenty healthy amateur Korean female runners (age: 24.85 ± 3.84 years) were equally assigned to normoxic training group (NTG) for interval training under normoxia (760 mmHg) and hypoxic training group (HTG) for interval training under hypobaric hypoxia (526 mmHg, 3000 m simulated altitude) according to their body composition and endurance exercise performance. All participants performed 120-min of training sessions, consisting of 20-min of warm-up, 60-min of interval training, and 20-min of cool-down. The training program was performed 3-days per week for 6-weeks. Warm-up and cool-down were performed for 20-min at 60% maximal heart rate (HRmax). The interval training sessions comprised 10 repetitions of interval exercise (5-min of exercise corresponding to 90–95% HRmax and 1-min of rest) on a treadmill. All participants underwent measurements of hematological parameters, hemodynamic function, and endurance exercise performance before and after training. Both groups showed a significant increase in erythropoietin (EPO) level and a decrease in monocyte abundance, with EPO showing a greater increase in the HTG than in the NTG. B cell abundance significantly increased in the NTG; hematocrit and neutrophil counts significantly increased, and lymphocyte counts significantly decreased in the HTG. The HTG showed a significant improvement in oxygen uptake, stroke volume index, and end-diastolic volume index compared to the NTG. In addition, both groups showed significant improvements in heart rate, end-systolic volume index, and cardiac output index. The maximal oxygen uptake and 3000 m time trial record were significantly improved in both groups, and the HTG showed a tendency to improve more than the NTG. In conclusion, the IHT was effective in enhancing endurance exercise performance through improved hemodynamic function. Furthermore, hematological parameters of immune system showed a normal range before and after training and were not negatively affected.

Muscle Oxygenation during Repeated Cycling Sprints in a Combined Hot and Hypoxic Condition

The aim of the present study was to examine the effects of a combined hot and hypoxic environment on muscle oxygenation and performance during repeated cycling sprints. In a single-blind, counterbalanced, cross-over research design, 10 male athletes performed three sets of 3 × 10-s maximal pedaling interspersed with 40-s recovery between sprints under four different environments. Each condition consisted of a control (CON; 20°C, 20.9% FiO₂), normobaric hypoxia (HYP; 20°C, 14.5% FiO₂), hot (HOT; 35°C, 20.9% FiO₂), and combined hot and normobaric hypoxia (HH; 35°C, 14.5% FiO₂). Power output and vastus lateralis muscle oxygenation were measured. Peak power output was significantly higher in HOT (892±27 W) and HH (887±24 W) than in CON (866±25 W) and HYP (859±25 W) during the first set (p<0.05). The increase in total hemoglobin during recovery periods was larger in HH than in HYP (p<0.05), while change in tissue saturation index was smaller in HYP than in CON and HOT (p<0.05). The findings suggest that the combination of hot and hypoxia during repeated cycling sprints presented different characteristics for muscle metabolism and power output compared to temperature or altitude stressor alone.

Repeated sprint training under hypoxia improves aerobic performance and repeated sprint ability by enhancing muscle deoxygenation and markers of angiogenesis in rugby sevens

OBJECTIVE

To evaluate the effects of repeated sprint (RS) training in hypoxia on aerobic performance, repeated sprint ability (RSA), and muscle oxygenation in Rugby Sevens.

METHODS

Fourteen Rugby Sevens players were randomly allocated into hypoxic (RSH, F_IO₂ = 14.5%, n = 7) or normoxic (RSN, F_IO₂ = 20.9%, n = 7) groups. Both groups underwent RS training consisting of 3 sets of 6-s × 10 sprints at 140% of velocity at peak oxygen uptake ([Formula: see text]) on a motorized treadmill, 3 days/week for 6 weeks in addition to usual training. Hematological variables, hypoxia-inducible factor-1 alpha (HIF-1α), and vascular endothelial growth factor (VEGF) concentrations were measured. Aerobic performance, RSA, and muscle oxygenation during the running-based anaerobic sprint (RAS) test were analyzed.

RESULTS

RSH caused no changes in hemoglobin concentration and hematocrit but significant improvements in [Formula: see text] (7.5%, p = 0.03, ES = 1.07), time to exhaustion (17.6%, p = 0.05, ES = 0.92), and fatigue index (FI, - 12.3%, p = 0.01, ES = 1.39) during the RSA test compared to baseline but not RSN. While ∆deoxygenated hemoglobin was significantly increased both after RSH and RSN (p < 0.05), ∆tissue saturation index (- 56.1%, p = 0.01, ES = 1.35) and ∆oxygenated hemoglobin (- 54.7%, p = 0.04, ES = 0.97) were significantly decreased after RSH. These changes were concomitant with increased levels of HIF-1α and VEGF in serum after RSH with a strong negative correlation between ∆FI and ∆deoxygenated hemoglobin after RSH (r = - 0.81, p = 0.03).

CONCLUSION

There was minimal benefit from adding RSH to standard Rugby Sevens training, in eliciting improvements in aerobic performance and resistance to fatigue, possibly by enhanced muscle deoxygenation and increased serum HIF-1α and VEGF concentrations.

Similar Supine Heart Rate Variability Changes During 24-h Exposure to Normobaric vs. Hypobaric Hypoxia

Purpose: This study aimed to investigate the differences between normobaric (NH) and hypobaric hypoxia (HH) on supine heart rate variability (HRV) during a 24-h exposure. We hypothesized a greater decrease in parasympathetic-related parameters in HH than in NH.

Methods: A pooling of original data from forty-one healthy lowland trained men was analyzed. They were exposed to altitude either in NH (F_IO₂ = 15.7 ± 2.0%; PB = 698 ± 25 mmHg) or HH (F_IO₂ = 20.9%; PB = 534 ± 42 mmHg) in a randomized order. Pulse oximeter oxygen saturation (S_pO₂), heart rate (HR), and supine HRV were measured during a 7-min rest period three times: before (in normobaric normoxia, NN), after 12 (H12), and 24 h (H24) of either NH or HH exposure. HRV parameters were analyzed for time- and frequency-domains.

Results: S_pO₂ was lower in both hypoxic conditions than in NN and was higher in NH than HH at H24. Subjects showed similarly higher HR during both hypoxic conditions than in NN. No difference in HRV parameters was found between NH and HH at any time. The natural logarithm of root mean square of the successive differences (LnRMSSD) and the high frequency spectral power (HF), which reflect parasympathetic activity, decreased similarly in NH and HH when compared to NN.

Conclusion: Despite S_pO₂ differences, changes in supine HRV parameters during 24-h exposure were similar between NH and HH conditions indicating a similar decrease in parasympathetic activity. Therefore, HRV can be analyzed similarly in NH and HH conditions.

A Combined Hot and Hypoxic Environment during Maximal Cycling Sprints Reduced Muscle Oxygen Saturation: A Pilot Study

The present study investigated the effects of a combined hot and hypoxic environment on muscle oxygenation during repeated 15-s maximal cycling sprints. In a single-blind, cross-over study, nine trained sprinters performed three 15-s maximal cycling sprints interspersed with 7-min passive recovery in normoxic (NOR; 23℃, 50%, FiO₂ 20.9%), normobaric hypoxic (HYP; 23℃, FiO₂ 14.5%), and hot normobaric hypoxic (HH; 35℃, FiO₂ 14.5%) environments. Relative humidity was set to 50% in all trials. The vastus lateralis muscle oxygenation was evaluated during exercise using near-infrared spectroscopy. The oxygen uptake (VO₂) and arterial oxygen saturation (SpO₂) were also monitored. There was no significant difference in peak or mean power output among the three conditions. The reduction in tissue saturation index was significantly greater in the HH (-17.0 ± 2.7%) than in the HYP (-10.4 ± 2.8%) condition during the second sprint (p < 0.05). The average VO₂ and SpO₂ were significantly lower in the HYP (VO₂ = 980 ± 52 mL/min, SpO₂ = 82.9 ± 0.8%) and HH (VO₂ = 965 ± 42 mL/min, SpO₂ = 83.2 ± 1.2%) than in the NOR (VO₂ = 1149 ± 40 mL/min, SpO₂ = 90.6 ± 1.4%; p < 0.05) condition. In conclusion, muscle oxygen saturation was reduced to a greater extent in the HH than in the HYP condition during the second bout of three 15-s maximal cycling sprints, despite the equivalent hypoxic stress between HH and HYP.

Running exercise with end-expiratory breath holding up to the breaking point induces large and early fall in muscle oxygenation

PURPOSE

The goal of this study was to assess the effects of repeated running bouts with end-expiratory breath holding (EEBH) up to the breaking point on muscle oxygenation.

METHODS

Eight male runners participated in three randomised sessions each including two exercises on a motorised treadmill. The first exercise consisted in performing 10-12 running bouts with EEBH of maximum duration either (separate sessions) at 60% (active recovery), 80% (passive recovery) or 100% (passive recovery) of the maximal aerobic velocity (MAV). Each repetition started at the onset of EEBH and ended at its release. In the second exercise of the session, subjects replicated the same procedure but with normal breathing (NB). Arterial oxygen saturation (SpO₂), heart rate (HR) and the change in vastus lateralis muscle deoxy-haemoglobin/myoglobin (Δ[HHb/Mb]) and total haemoglobin/myoglobin (Δ[THb/Mb]) were continuously monitored throughout exercises.

RESULTS

On average, the EEBHs were maintained for 10.1 ± 1.1 s, 13.2 ± 1.8 s and 12.2 ± 1.7 s during exercise at 60%, 80% and 100% of MAV, respectively. In the three exercise intensities, SpO₂ (mean nadir values: 76.3 ± 2.5 vs 94.5 ± 2.5%) and HR were lower with EEBH than with NB at the end of the repetitions; whereas, the mean Δ[HHb/Mb] (12.6 ± 5.2 vs 7.7 ± 4.4 µm) and Δ[THb/Mb] (- 0.6 ± 2.3 vs 3.8 ± 2.6 µm) were, respectively, higher and lower with EEBH (p < 0.05).

CONCLUSION

This study showed that performing repeated bouts of running exercises with EEBH up to the breaking point induced a large and early drop in muscle oxygenation compared with the same exercise with NB. This phenomenon was probably the consequence of the strong arterial oxygen desaturation induced by the maximal EEBHs.

Effects of moderate-intensity intermittent hypoxic training on health outcomes of patients recovered from COVID-19: the AEROBICOVID study protocol for a randomized controlled trial

Background

Recent studies point to a lower number and reduced severity of cases in higher altitude cities with decreased oxygen concentration. Specific literature has shown several benefits of physical training, so, in this sense, physical training with hypoxic stimulus appears as an alternative that supports the conventional treatments of the COVID-19 patient’s recovery. Thus, this study’s primary aim is to analyze the effects of moderate-intensity intermittent hypoxic training on health outcomes in COVID-19 recovered patients.

Methods

A clinical trial controlled double-blind study was designed. Participants (30–69 years old) will be recruited among those with moderate to severe COVID-19 symptoms, approximately 30 days after recovery. They will be included in groups according to the training (T) and recovery (R) association with hypoxia (H) or normoxia (N): (a) T_H:R_H, (b) T_N:R_H, (c) T_N:R_N, and last (d) the control group. The 8-week exercise bike intervention will be carried out with a gradual load increase according to the established periods, three times a week in sets of 5 min, 90 to 100% of the anaerobic threshold (AT), and a 2.5-min break. Blood will be collected for genotyping. First, after 4 weeks (partial), after 8 weeks, and later, 4 weeks after the end of the physical training intervention, participants will perform assessments. The primary outcome is the maximum oxygen consumption (VO₂peak). The secondary outcomes include lung function, inflammatory mediators, hematological, autonomic parameters, AT, body composition analysis, quality of life, mental health, anthropometric measurements, and physical fitness. The statistical analysis will be executed using the linear regression model with mixed effects at a 5% significance level.

Discussion

This study is designed to provide evidence to support the clinical benefits of moderate-intensity intermittent hypoxic training as a part of the treatment of patients recovered from COVID-19. It may also provide evidence on the efficacy and safety of intermittent hypoxic training in different health conditions. Lastly, this study presents an innovative strategy enabling up to 16 participants in the same training session.

Trial registration

ClinicalTrials.gov RBR-5d7hkv. Registered after the start of inclusion on 3 November 2020 with the Brazilian Clinical Trials Registry

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05414-2.

Augmented muscle glycogen utilization following a single session of sprint training in hypoxia

PURPOSE

This study determined the effect of a single session of sprint interval training in hypoxia on muscle glycogen content among athletes.

METHODS

Ten male college track and field sprinters (mean ± standard error of the mean: age, 21.1 ± 0.2 years; height, 177 ± 2 cm; body weight, 67 ± 2 kg) performed two exercise trials under either hypoxia [HYPO; fraction of inspired oxygen (F_iO₂), 14.5%] or normoxia (NOR: F_iO₂, 20.9%). The exercise consisted of 3 × 30 s maximal cycle sprints with 8-min rest periods between sets. Before and immediately after the exercise, the muscle glycogen content was measured using carbon magnetic resonance spectroscopy in vastus lateralis and vastus intermedius muscles. Moreover, power output, blood lactate concentrations, metabolic responses (respiratory oxygen uptake and carbon dioxide output), and muscle oxygenation were evaluated.

RESULTS

Exercise significantly decreased muscle glycogen content in both trials (interaction, P = 0.03; main effect for time, P < 0.01). Relative changes in muscle glycogen content following exercise were significantly higher in the HYPO trial (- 43.5 ± 0.4%) than in the NOR trial (- 34.0 ± 0.3%; P < 0.01). The mean power output did not significantly differ between the two trials (P = 0.80). The blood lactate concentration after exercise was not significantly different between trials (P = 0.31).

CONCLUSION

A single session of sprint interval training (3 × 30 s sprints) in hypoxia caused a greater decrease in muscle glycogen content compared with the same exercise under normoxia without interfering with the power output.