Insufficient ventilation as a cause of impaired pulmonary gas exchange during submaximal exercise

The relationship between hemoglobin and [Formula: see text]: A systematic review and meta-analysis

OBJECTIVE

There is widespread agreement about the key role of hemoglobin for oxygen transport. Both observational and interventional studies have examined the relationship between hemoglobin levels and maximal oxygen uptake ([Formula: see text]) in humans. However, there exists considerable variability in the scientific literature regarding the potential relationship between hemoglobin and [Formula: see text]. Thus, we aimed to provide a comprehensive analysis of the diverse literature and examine the relationship between hemoglobin levels (hemoglobin concentration and mass) and [Formula: see text] (absolute and relative [Formula: see text]) among both observational and interventional studies.

METHODS

A systematic search was performed on December 6th, 2021. The study procedures and reporting of findings followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Article selection and data abstraction were performed in duplicate by two independent reviewers. Primary outcomes were hemoglobin levels and [Formula: see text] values (absolute and relative). For observational studies, meta-regression models were performed to examine the relationship between hemoglobin levels and [Formula: see text] values. For interventional studies, meta-analysis models were performed to determine the change in [Formula: see text] values (standard paired difference) associated with interventions designed to modify hemoglobin levels or [Formula: see text]. Meta-regression models were then performed to determine the relationship between a change in hemoglobin levels and the change in [Formula: see text] values.

RESULTS

Data from 384 studies (226 observational studies and 158 interventional studies) were examined. For observational data, there was a positive association between absolute [Formula: see text] and hemoglobin levels (hemoglobin concentration, hemoglobin mass, and hematocrit (P<0.001 for all)). Prespecified subgroup analyses demonstrated no apparent sex-related differences among these relationships. For interventional data, there was a positive association between the change of absolute [Formula: see text] (standard paired difference) and the change in hemoglobin levels (hemoglobin concentration (P<0.0001) and hemoglobin mass (P = 0.006)).

CONCLUSION

These findings suggest that [Formula: see text] values are closely associated with hemoglobin levels among both observational and interventional studies. Although our findings suggest a lack of sex differences in these relationships, there were limited studies incorporating females or stratifying results by biological sex.

The Modern Double-Poling Technique Is Not More Energy Efficient Than the Old-Fashioned Double-Poling Technique at a Submaximal Work Intensity

The purpose of the study was to investigate whether there are energy-efficiency differences between the execution of the old-fashioned double-poling technique (DP_OLD) and the modern double-poling technique (DP_MOD) at a submaximal work intensity among elite male cross-country skiers. Fifteen elite male cross-country skiers completed two 4-min tests at a constant mechanical work rate (MWR) using the DP_MOD and DP_OLD. During the last minute of each test, the mean oxygen uptake (VO₂) and respiratory exchange ratio (RER) were analyzed, from which the metabolic rate (MR) and gross efficiency (GE) were calculated. In addition, the difference between pretest and posttest blood-lactate concentrations (BLa_diff) was determined. For each technique, skiers' joint angles (i.e., heel, ankle, knee, hip, shoulder, and elbow) were analyzed at the highest and lowest positions during the double-poling cycle. Paired-samples t-tests were used to investigate differences between DP_MOD and DP_OLD outcomes. There were no significant differences in either VO₂mean, MR, GE, or BLa_diff (all P > 0.05) between the DP_MOD and DP_OLD tests. DP_MOD execution was associated with a higher RER (P < 0.05). Significant technique-specific differences were found in either the highest and/or the lowest position for all six analyzed joint angles (all P < 0.001). Hence, despite decades of double-poling technique development, which is reflected in the significant biomechanical differences between DP_OLD and DP_MOD execution, at submaximal work intensity, the modern technique is not more energy efficient than the old-fashioned technique.

The relationship between peak fat oxidation and prolonged double-poling endurance exercise performance

The peak fat oxidation rate (PFO) and the exercise intensity that elicits PFO (Fat_max ) are associated with endurance performance during exercise primarily involving lower body musculature, but it remains elusive whether these associations are present during predominant upper body exercise. The aim was to investigate the relationship between PFO and Fat_max determined during a graded exercise test on a ski-ergometer using double-poling (GET-DP) and performance in the long-distance cross-country skiing race, Vasaloppet. Forty-three healthy men completed GET-DP and Vasaloppet and were divided into two subgroups: recreational (RS, n = 35) and elite (ES, n = 8) skiers. Additionally, RS completed a cycle-ergometer GET (GET-Cycling) to elucidate whether the potential relationships were specific to exercise modality. PFO (r²  = .10, P = .044) and Fat_max (r²  = .26, P < .001) were correlated with performance; however, V ˙ O 2 peak was the only independent predictor of performance (adj. R²  = .36) across all participants. In ES, Fat_max was the only variable associated with performance (r²  = .54, P = .038). Within RS, DP V ˙ O 2 peak (r²  = .11, P = .047) and ski-specific training background (r²  = .30, P = .001) were associated with performance. Between the two GETs, Fat_max (r²  = .20, P = .006) but not PFO (r²  = .07, P = .135) was correlated. Independent of exercise mode, neither PFO nor Fat_max were associated with performance in RS (P > .05). These findings suggest that prolonged endurance performance is related to PFO and Fat_max but foremost to V ˙ O 2 peak during predominant upper body exercise. Interestingly, Fat_max may be an important determinant of performance among ES. Among RS, DP V ˙ O 2 peak , and skiing experience appeared as performance predictors. Additionally, whole-body fat oxidation seemed specifically coupled to exercise modality.

Determination and validation of peak fat oxidation in endurance-trained men using an upper body graded exercise test

Peak fat oxidation rate (PFO) and the intensity that elicits PFO (Fat_max ) are commonly determined by a validated graded exercise test (GE) on a cycling ergometer with indirect calorimetry. However, for upper body exercise fat oxidation rates are not well elucidated and no protocol has been validated. Thus, our aim was to test validity and inter-method reliability for determination of PFO and Fat_max in trained men using a GE protocol applying double poling on a ski-ergometer. PFO and Fat_max were assessed during two identical GE tests (GE1 and GE2) and validated against separated short continuous exercise bouts (SCE) at 35%, 50%, and 65% of V̇O_2peak on the ski-ergometer in 10 endurance-trained men (V̇O_2peak : 65.1 ± 1.0 mL·min^-1 ·kg^-1 , mean ± SEM). Between GE tests no differences were found in PFO (GE1: 0.42 ± 0.03; GE2: 0.45 ± 0.03 g·min^-1 , P = .256) or Fat_max (GE1: 41 ± 2%; GE2: 43 ± 3% of V̇O_2peak , P = .457) and the intra-individual coefficient of variation (CV) was 8 ± 2% and 11 ± 2% for PFO and Fat_max , respectively. Between GE and SCE tests, PFO (GE_avg : 0.44 ± 0.03; SCE; 0.47 ± 0.06 g·min^-1 , P = .510) was not different, whereas a difference in Fat_max (GE_avg : 42 ± 2%; SCE: 52 ± 4% of V̇O_2peak , P = .030) was observed with a CV of 17 ± 4% and 15 ± 4% for PFO and Fat_max , respectively. In conclusion, GE has a high day-to-day reliability in determination of PFO and Fat_max in trained men, whereas it is unclear if PFO and Fat_max determined by GE reflect continuous exercise in general.

Pronounced limb and fibre type differences in subcellular lipid droplet content and distribution in elite skiers before and after exhaustive exercise

KEY POINTS

Although lipid droplets in skeletal muscle are an important energy source during endurance exercise, our understanding of lipid metabolism in this context remains incomplete. Using transmission electron microscopy, two distinct subcellular pools of lipid droplets can be observed in skeletal muscle - one beneath the sarcolemma and the other between myofibrils. At rest, well-trained leg muscles of cross-country skiers contain 4- to 6-fold more lipid droplets than equally well-trained arm muscles, with a 3-fold higher content in type 1 than in type 2 fibres. During exhaustive exercise, lipid droplets between the myofibrils but not those beneath the sarcolemma are utilised by both type 1 and 2 fibres. These findings provide insight into compartmentalisation of lipid metabolism within skeletal muscle fibres.

ABSTRACT

Although the intramyocellular lipid pool is an important energy store during prolonged exercise, our knowledge concerning its metabolism is still incomplete. Here, quantitative electron microscopy was used to examine subcellular distribution of lipid droplets in type 1 and 2 fibres of the arm and leg muscles before and after 1 h of exhaustive exercise. Intermyofibrillar lipid droplets accounted for 85-97% of the total volume fraction, while the subsarcolemmal pool made up 3-15%. Before exercise, the volume fractions of intermyofibrillar and subsarcolemmal lipid droplets were 4- to 6-fold higher in leg than in arm muscles (P < 0.001). Furthermore, the volume fraction of intermyofibrillar lipid droplets was 3-fold higher in type 1 than in type 2 fibres (P < 0.001), with no fibre type difference in the subsarcolemmal pool. Following exercise, intermyofibrillar lipid droplet volume fraction was 53% lower (P = 0.0082) in both fibre types in arm, but not leg muscles. This reduction was positively associated with the corresponding volume fraction prior to exercise (R²  = 0.84, P < 0.0001). No exercise-induced change in the subsarcolemmal pool could be detected. These findings indicate clear differences in the subcellular distribution of lipid droplets in the type 1 and 2 fibres of well-trained arm and leg muscles, as well as preferential utilisation of the intermyofibrillar pool during prolonged exhaustive exercise. Apparently, the metabolism of lipid droplets within a muscle fibre is compartmentalised.

Assessment of Heart Rate Variability Thresholds from Incremental Treadmill Tests in Five Cross-Country Skiing Techniques

The assessment of heart rate variability (HRV) thresholds (HRVTs) as an alternative of Ventilatory thresholds (VTs) is a relatively new approach with increasing popularity which has not been conducted in cross-country (XC) skiing yet. The main purpose of the present study was to assess HRVTs in the five main XC skiing-related techniques, double poling (DP), diagonal striding (DS), Nordic walking (NW), V1 skating (V1), and V2 skating (V2).Ten competitive skiers completed these incremental treadmill tests until exhaustion with a minimum of one to two recovery days in between each test. Ventilatory gases, HRV and poling frequencies were measured. The first HRV threshold (HRVT₁) was assessed using two time-domain analysis methods, and the second HRV threshold (HRVT₂) was assessed using two non-time varying frequency-domain analysis methods. HRVT₁ was assessed by plotting the mean successive difference (MSD) and standard deviation (SD) of normalized R-R intervals to workload. HRVT₁ was assessed by plotting high frequency power (HFP) and the HFP relative to respiratory sinus arrhythmia (HFP_RSA) with workload. HRVTs were named after their methods (HRVT_1-SD; HRVT_1-MSD; HRVT_2-HFP; HRVT_2-HFP-RSA). The results showed that the only cases where the proposed HRVTs were good assessors of VTs were the HRVT_1-SD of the DS test, the HRVT_1-MSD of the DS and V2 tests, and the HRVT_2-HFP-RSA of the NW test. The lack of a wider success of the assessment of HRVTs was reasoned to be mostly due to the high entrainment between the breathing and poling frequencies. As secondary finding, a novel Cardiolocomotor coupling mode was observed in the NW test. This new Cardiolocoomtor coupling mode corresponded to the whole bilateral poling cycle instead of corresponding to each poling action as it was reported to the date by the existing literature.

Integrative Conductance of Oxygen During Exercise at Altitude

In the oxygen (O2) cascade downstream steps can never achieve higher flows of O2 than the preceding ones. At the lung the transfer of O2 is determined by the O2 gradient between the alveolar space and the lung capillaries and the O2 diffusing capacity (DLO2). While DLO2 may be increased several times during exercise by recruiting more lung capillaries and by increasing the oxygen carrying capacity of blood due to higher peripheral extraction of O2, the capacity to enhance the alveolocapillary PO2 gradient is more limited. The transfer of oxygen from the alveolar space to the hemoglobin (Hb) must overcome first the resistance offered by the alveolocapillary membrane (1/DM) and the capillary blood (1/θVc). The fractional contribution of each of these two components to DLO2 remains unknown. During exercise these resistances are reduced by the recruitment of lung capillaries. The factors that reduce the slope of the oxygen dissociation curve of the Hb (ODC) (i.e., lactic acidosis and hyperthermia) increase 1/θVc contributing to limit DLO2. These effects are accentuated in hypoxia. Reducing the size of the active muscle mass improves pulmonary gas exchange during exercise and reduces the rightward shift of the ODC. The flow of oxygen from the muscle capillaries to the mitochondria is pressumably limited by muscle O2 conductance (DmcO2) (an estimation of muscle oxygen diffusing capacity). However, during maximal whole body exercise in normoxia, a higher flow of O2 is achieved at the same pressure gradients after increasing blood [Hb], implying that in healthy humans exercising in normoxia there is a functional reserve in DmcO2. This conclusion is supported by the fact that during small muscle exercise in chronic hypoxia, peak exercise DmcO2 is similar to that observed during exercise in normoxia despite a markedly lower O2 pressure gradient driving diffusion.

The effects of prior high intensity double poling on subsequent diagonal stride skiing characteristics

PURPOSE

To investigate the influence of prior high intensity double poling (DP) on physiological and biomechanical responses during subsequent diagonal stride (DIA).

METHODS

Eight well-trained male cross-country skiers (age 22 ± 3 yr; VO2max 69 ± 3 ml · kg(-1) · min(-1)) roller-skied on a treadmill sequentially for 3 min at 90% DIA VO2max (DIA1), 3 min at 90% DP VO2peak and 3 min at 90% DIA VO2max (DIA2). Cardio-respiratory responses were monitored continuously and gases and metabolites in blood from the a. femoralis, v. femoralis and v. subclavia determined. Pole and plantar forces and EMG from 6 lower- and upper-body muscles were measured.

RESULTS

VO2 decreased from DIA1 to DP and increased again to DIA2 (both P < 0.05), with no difference between the DIA sessions. Blood lactate rose from DIA1 to DP to DIA2. O2 extraction was attenuated during DP (P < 0.05), but was the same during DIA1 and DIA2. EMGRMS for arm muscles during poling phase, as well as peak pole force and cycle rate were higher, while leg muscle activity was lower during DP than both sessions of DIA (all P < 0.05). The ratio of upper-/whole-body EMGRMS correlated negatively with O2 extraction in the arms during both sessions of DIA (P < 0.05).

CONCLUSIONS

In well-trained skiers skiing at high-intensity DP prior to DIA did not influence VO2, muscle activation or forces in the latter. At race intensity DP does not influence the distribution of work between upper- and lower-body during a subsequent bout of DIA. O2 extraction is coupled to technical skills during skiing.

Impact of the initial classic section during a simulated cross-country skiing skiathlon on the cardiopulmonary responses during the subsequent period of skate skiing

The aim of this study was to assess potential changes in the performance and cardiorespiratory responses of elite cross-country skiers following transition from the classic (CL) to the skating (SK) technique during a simulated skiathlon. Eight elite male skiers performed two 6 km (2 × 3 km) roller-skiing time trials on a treadmill at racing speed: one starting with the classic and switching to the skating technique (CL1-SK2) and another employing the skating technique throughout (SK1-SK2), with continuous monitoring of gas exchanges, heart rates, and kinematics (video). The overall performance times in the CL1-SK2 (21:12 ± 1:24) and SK1-SK2 (20:48 ± 2:00) trials were similar, and during the second section of each performance times and overall cardiopulmonary responses were also comparable. However, in comparison with SK1-SK2, the CL1-SK2 trial involved significantly higher increases in minute ventilation (V̇E, 89.8 ± 26.8 vs. 106.8 ± 17.6 L·min(-1)) and oxygen uptake (V̇O2; 3.1 ± 0.8 vs 3.5 ± 0.5 L·min(-1)) 2 min after the transition as well as longer time constants for V̇E, V̇O2, and heart rate during the first 3 min after the transition. This higher cardiopulmonary exertion was associated with ∼3% faster cycle rates. In conclusion, overall performance during the 2 time trials did not differ. The similar performance times during the second sections were achieved with comparable mean cardiopulmonary responses. However, the observation that during the initial 3-min post-transition following classic skiing cardiopulmonary responses and cycle rates were slightly higher supports the conclusion that an initial section of classic skiing exerts an impact on performance during a subsequent section of skate skiing.

Arm and leg substrate utilization and muscle adaptation after prolonged low-intensity training

This review will focus on current data where substrate metabolism in arm and leg muscle is investigated and discuss the presence of higher carbohydrate oxidation and lactate release observed during arm compared with leg exercise. Furthermore, a basis for a possible difference in substrate partitioning between endogenous and exogenous substrate during arm and leg exercise will be debated. Moreover the review will probe if differences between arm and leg muscle are merely a result of different training status rather than a qualitative difference in limb substrate regulation. Along this line the review will address the available studies on low-intensity training performed separately with arm or legs or as whole-body training to evaluate if this leads to different adaptations in arm and leg muscle resulting in different substrate utilization patterns during separate arm or leg exercise at comparable workloads. Finally, the influence and capacity of low-intensity training to influence metabolic fitness in the face of a limited effect on aerobic fitness will be challenged.

The effects of breathing a helium-oxygen gas mixture on maximal pulmonary ventilation and maximal oxygen consumption during exercise in acute moderate hypobaric hypoxia

To test the hypothesis that maximal exercise pulmonary ventilation (VE max) is a limiting factor affecting maximal oxygen uptake (VO2 max) in moderate hypobaric hypoxia (H), we examined the effect of breathing a helium-oxygen gas mixture (He-O(2); 20.9% O(2)), which would reduce air density and would be expected to increase VE max. Fourteen healthy young male subjects performed incremental treadmill running tests to exhaustion in normobaric normoxia (N; sea level) and in H (atmospheric pressure equivalent to 2,500 m above sea level). These exercise tests were carried out under three conditions [H with He-O(2), H with normal air and N] in random order. VO2 max and arterial oxy-hemoglobin saturation (SaO(2)) were, respectively, 15.2, 7.5 and 4.0% higher (all p < 0.05) with He-O(2) than with normal air (VE max, 171.9 ± 16.1 vs. 150.1 ± 16.9 L/min; VO2 max, 52.50 ± 9.13 vs. 48.72 ± 5.35 mL/kg/min; arterial oxyhemoglobin saturation (SaO(2)), 79 ± 3 vs. 76 ± 3%). There was a linear relationship between the increment in VE max and the increment in VO2 max in H (r = 0.77; p < 0.05). When subjects were divided into two groups based on their VO2 max, both groups showed increased VE max and SaO(2) in H with He-O(2), but VO2 max was increased only in the high VO2 max group. These findings suggest that in acute moderate hypobaric hypoxia, air-flow resistance can be a limiting factor affecting VE max; consequently, VO2 max is limited in part by VE max especially in subjects with high VO2 max.

On the mechanisms that limit oxygen uptake during exercise in acute and chronic hypoxia: role of muscle mass

Peak aerobic power in humans (VO2,peak) is markedly affected by inspired O2 tension (FIO2). The question to be answered in this study is what factor plays a major role in the limitation of muscle peak VO2 in hypoxia: arterial O2 partial pressure (Pa,O2) or O2 content (Ca,O2)? Thus, cardiac output (dye dilution with Cardio-green), leg blood flow (thermodilution), intra-arterial blood pressure and femoral arterial-to-venous differences in blood gases were determined in nine lowlanders studied during incremental exercise using a large (two-legged cycle ergometer exercise: Bike) and a small (one-legged knee extension exercise: Knee)muscle mass in normoxia, acute hypoxia (AH) (FIO2 = 0.105) and after 9 weeks of residence at 5260 m (CH). Reducing the size of the active muscle mass blunted by 62% the effect of hypoxia on VO2,peak in AH and abolished completely the effect of hypoxia on VO2,peak after altitude acclimatization. Acclimatization improved Bike peak exercise Pa,O2 from 34 +/- 1 in AH to 45 +/- 1 mmHg in CH(P <0.05) and Knee Pa,O2 from 38 +/- 1 to 55 +/- 2 mmHg(P <0.05). Peak cardiac output and leg blood flow were reduced in hypoxia only during Bike. Acute hypoxia resulted in reduction of systemic O2 delivery (46 and 21%) and leg O2 delivery (47 and 26%) during Bike and Knee, respectively, almost matching the corresponding reduction in VO2,peak. Altitude acclimatization restored fully peak systemic and leg O(2) delivery in CH (2.69 +/- 0.27 and 1.28 +/- 0.11 l min(-1), respectively) to sea level values (2.65 +/- 0.15 and 1.16 +/- 0.11 l min(-1), respectively) during Knee, but not during Bike. During Knee in CH, leg oxygen delivery was similar to normoxia and, therefore, also VO2,peak in spite of a Pa,O2 of 55 mmHg. Reducing the size of the active mass improves pulmonary gas exchange during hypoxic exercise, attenuates the Bohr effect on oxygen uploading at the lungs and preserves sea level convective O2 transport to the active muscles. Thus, the altitude-acclimatized human has potentially a similar exercising capacity as at sea level when the exercise model allows for an adequate oxygen delivery (blood flow x Ca,O2), with only a minor role of Pa,O2 per se, when Pa,O2 is more than 55 mmHg.

Effect of hypohydration on hyperthermic hyperpnea and cutaneous vasodilation during exercise in men

We tested the hypothesis that, in humans, hypohydration attenuates hyperthermic hyperpnea during exercise in the heat. On two separate occasions, thirteen male subjects performed a fluid replacement (FR) and a no-fluid replacement (NFR) trial in random order. The subjects performed two bouts of cycle exercise (Ex1 and Ex2, 30–60 min) at 50% peak oxygen uptake (V̇o2 peak) in 35°C separated by a 70- to 80-min rest period, during which they drank water containing 25 mosmol/l sodium in the FR trial but not the NFR trial. The drinking in the FR trial nearly restored the body fluid to the euhydrated condition, so that the body fluid status differed between the trials before Ex2 (the difference in plasma osmolality before Ex2 was 9.4 mosmol/kgH2O; plasma volume was 7.6%, and body weight was 2.5%). The slopes of the linear relationships between ventilatory variables (minute ventilation, ventilatory equivalents for oxygen uptake and carbon dioxide output, tidal volume, respiratory frequency, and end-tidal CO2 pressure) and esophageal temperature (Tes) did not significantly differ between Ex1 and Ex2, or between the FR and NFR trials. On the other hand, during Ex2 in the NFR trial, the Tes threshold for the onset of increased forearm vascular conductance (FVC) was higher, and the slope and peak values of the relationship between FVC and Tes were lower than during Ex1 in the NFR trial and during Ex2 in the FR trial. These findings suggest that hypohydration does not affect the hyperthermic hyperpnea during exercise, although it markedly attenuates the cutaneous vasodilatory response.

Is pulmonary gas exchange during exercise in hypoxia impaired with the increase of cardiac output?

During exercise in humans, the alveolar–arterial O2 tension difference ((A–a)DO2) increases with exercise intensity and is an important factor determining the absolute level of oxygen binding to hemoglobin and therefore the level of systemic oxygen transport. During exercise in hypoxia, the (A–a)DO2 is accentuated. Using the multiple inert gas elimination technique it has been shown that during exercise in acute hypoxia the contribution of ventilation–perfusion inequality to (A–a)DO2 is rather small and in the absence of pulmonary edema intrapulmonary shunts can be ruled out. This implies that the main mechanism limiting pulmonary gas exchange is diffusion limitation. It is presumed that an elevation of cardiac output during exercise in acute hypoxia should increase the (A–a)DO2. However, no studies have examined how variations in cardiac output independently affect pulmonary diffusion with increases in exercise intensity. We have consistently observed that during steady-state, submaximal (100–120 W) exercise on the cycle ergometer in hypoxia the lung can accommodate an increase in cardiac output of ~2 L·min–1 without any significant effect on pulmonary gas exchange. This result contrasts with the predicted effect of cardiac output on (A–a)DO2 using the model of Piiper and Scheid, and thus indicates that an elevation of cardiac output is not necessarily accompanied by a reduction of mean transit time and (or) diffusion limitation during submaximal exercise in acute hypoxia. It remains to be determined what is the influence of changes in cardiac output per se on pulmonary gas exchange during high-intensity exercise.