Effects of the 'live high-train low' method on prooxidant/antioxidant balance on elite athletes

Redox status biomarkers in the fast-twitch extensor digitorum longus resulting from the hypoxic exercise

The fast-twitch muscle may be affected from over-produced reactive oxygen species (ROS) during hypoxia/hypoxic exercise. The study aims to investigate redox status biomarkers in the fast-twitch extensor digitorum longus (EDL) muscle after hypoxic exercise. Male Sprague Dawley rats (eight-week-old) were randomly divided into six groups of the experimental "live high train high (LHTH), live high train low (LHTL) and live low train low (LLTL)" and their respective controls. Before the EDLs' extraction, the animals exercised for a 4-week familiarization period, then they exercised for four-weeks at different altitudes. The LHTH group had higher ratios of lipid hydroperoxides (LHPs) than the experimental groups of LHTL (p=0.004) and LLTL (p=0.002), while having no difference than its control 'LH'. Similarly, a higher percentage of advanced oxidation protein products (AOPP) was determined in the LHTH than the LHTL (p=0.041) and LLTL (p=0.048). Furthermore, oxidation of thiol fractions was the lowest in the LHTH and LH. However, redox biomarkers and thiol fractions illustrated no significant change in the LHTL and LLTL that might ensure redox homeostasis due to higher oxygen consumption. The study shows that not hypoxic exercise/exercise, but hypoxia might itself lead to a redox imbalance in the fast-twitch EDL muscle.

Acute Exhaustive Exercise under Normoxic and Normobaric Hypoxic Conditions Differentially Regulates Angiogenic Biomarkers in Humans

Background and Objectives: Angiogenesis describes the outgrowth of new capillaries from already existing ones. Different biomarkers regulate this process. Physical exercise and hypoxia are key stimuli for the activation of different angiogenic molecules, such as the vascular endothelial growth factor (VEGF). matrix metalloproteases (MMPs)-2 and -9 or the extracellular matrix cleavage fragment endostatin. The present study aimed to investigate influences of short-term, intensive cycling exercise under both normoxic and normobaric hypoxic conditions on the mentioned parameters. Materials and Methods: Twelve male subjects (age: 23.3 ± 2.0 years) participated in the study. All subjects conducted four intensive cycling tests until individual exhaustion in a randomized order under the following conditions: normoxia, 2000 m, 3000 m and 4000 m above sea level. Blood samples were taken before (pre) and 10 min, 30 min, 60 min and 240 min post exercise and were analyzed by ELISA. Results: VEGF showed a significantly reduced concentration compared to the pre-value solely under 4000 m at 10 min post exercise. MMP-2 showed significantly reduced concentrations at 240 min post exercise under 4000 m. MMP-9 increased at 240 min post exercise under both 2000 m and 4000 m conditions. Endostatin was significantly increased at 10 min post exercise independently of the applied stimulus. Conclusions: The presented data show that intensive short-term exercise bouts facilitate the bioavailability of angiogenic, ECM (extracellular matrix)-related biomarkers. This finding is interesting for both health- and performance-related research as it demonstrates the positive effects of intensive short exercise interventions.

Physical Activity and Male Reproductive Function: A New Role for Gamete Mitochondria

Several studies demonstrated that some types of physical exercise might affect male reproductive potential, even though the potential mechanisms involved in the modulation of sperm quality remain poorly understood. Therefore, we propose a new role for gamete mitochondria as a key hub that coordinates molecular events related to the effects induced by physical exercise.

Dietary Adjustments to Altitude Training in Elite Endurance Athletes; Impact of a Randomized Clinical Trial With Antioxidant-Rich Foods

Background: Altitude training stresses several physiological and metabolic processes and alters the dietary needs of the athletes. International Olympic Committee (IOC)'s Nutrition Expert Group suggests that athletes should increase intake of energy, carbohydrate, iron, fluid, and antioxidant-rich foods while training at altitude. Objective: We investigated whether athletes adjust their dietary intake according to the IOC's altitude-specific dietary recommendations, and whether an in-between meal intervention with antioxidant-rich foods altered the athletes' dietary composition and nutrition-related blood parameters (mineral, vitamin, carotenoid, and hormone concentrations). Design: The dietary adjustments to altitude training (3 weeks at 2,320 m) were determined for 31 elite endurance athletes (23 ± 5 years, 23 males, 8 females) by six interviewer-administered 24-h dietary recalls on non-consecutive days; three before and during the altitude camp. The additional effect of in -between meal intervention with eucaloric antioxidant-rich or control snacks (1,000 kcal/day) was tested in a randomized controlled trial with parallel design. Results: At altitude the athletes increased their energy intake by 35% (1,430 ± 630 kcal/day, p < 0.001), the provided snacks accounting for 70% of this increase. Carbohydrate intake increased from 6.5 ± 1.8 g/kg body weight (BW) (50 E%) to 9.3 ± 2.1 g/kg BW (53 E%) (p < 0.001), with no difference between the antioxidant and control group. Dietary iron, fluid, and antioxidant-rich food intake increased by 37, 38, and 104%, respectively, in the whole cohort. The intervention group had larger increases in polyunsaturated fatty acids (PUFA), ω3 PUFA (n-3 fatty acids), ω6 PUFA (n-6 fatty acids), fiber, vitamin C, folic acid, and copper intake, while protein intake increased more among the controls, reflecting the nutritional content of the snacks. Changes in the measured blood minerals, vitamins, and hormones were not differentially affected by the intervention except for the carotenoid; zeaxanthin, which increased more in the intervention group (p < 0.001). Conclusions: Experienced elite endurance athletes increased their daily energy, carbohydrate, iron, fluid, and antioxidant-rich food intake during a 3-week training camp at moderate altitude meeting most of the altitude-specific dietary recommendations. The intervention with antioxidant-rich snacks improved the composition of the athletes' diets but had minimal impact on the measured nutrition-related blood parameters. Clinical Trial Registry Number: NCT03088891 (www.clinicaltrials.gov), Norwegian registry number: 626539 (https://rekportalen.no/).

"Live High Train Low" Hypoxic Training Enhances Exercise Performance with Efficient Redox Homeostasis in Rats' Soleus Muscle

Çolak, Rıdvan, Eda Ağaşcıoğlu, and Ufuk Çakatay. "Live high train low" hypoxic training enhances exercise performance with efficient redox homeostasis in rats' soleus muscle. High Alt Med Biol. 22:77-86, 2021. Background: Different types of hypoxic training have been performed to improve exercise performance. Although both "live high train high" and "live high train low" techniques are commonly performed, it is still obscure as to which one is more beneficial. Materials and Methods: Eight-week-old male Sprague-Dawley rats were randomly divided into aforementioned experimental groups. After a familiarization exercise (4-week, ∼15-30 minutes/day) at normoxia, all rats exercised (4-week, ∼35 minutes/day) at hypoxia with their pre-evaluated maximal aerobic velocity test. The soleus was extracted after the test following 2 days of resting. Results: The live high trained low group displayed better performance than the live high trained high (p = 0.031) and the live low trained low (p = 0.017) groups. Redox status biomarkers were higher in the live high trained high group except for thiols, which were illustrated with no difference among the groups. Further, contrary to total and protein thiols (r = 0.57, p = 0.037; r = 0.55, p = 0.042 respectively), other redox status biomarkers were observed to be negatively correlated to exercise performance. Conclusions: The live high trained low group could consume more oxygen during exercise, which might lead to having a better chance to ensure cellular redox homeostasis. Therefore, this group could ensure an optimum exercise performance and anabolic metabolism.

Blood Biomarker Profiling and Monitoring for High-Performance Physiology and Nutrition: Current Perspectives, Limitations and Recommendations

Blood test data were traditionally confined to the clinic for diagnostic purposes, but are now becoming more routinely used in many professional and elite high-performance settings as a physiological profiling and monitoring tool. A wealth of information based on robust research evidence can be gleaned from blood tests, including: the identification of iron, vitamin or energy deficiency; the identification of oxidative stress and inflammation; and the status of red blood cell populations. Serial blood test data can be used to monitor athletes and make inferences about the efficacy of training interventions, nutritional strategies or indeed the capacity to tolerate training load. Via a profiling and monitoring approach, blood biomarker measurement combined with contextual data has the potential to help athletes avoid injury and illness via adjustments to diet, training load and recovery strategies. Since wide inter-individual variability exists in many biomarkers, clinical population-based reference data can be of limited value in athletes, and statistical methods for longitudinal data are required to identify meaningful changes within an athlete. Data quality is often compromised by poor pre-analytic controls in sport settings. The biotechnology industry is rapidly evolving, providing new technologies and methods, some of which may be well suited to athlete applications in the future. This review provides current perspectives, limitations and recommendations for sports science and sports medicine practitioners using blood profiling and monitoring for nutrition and performance purposes.

Nutrition and Altitude: Strategies to Enhance Adaptation, Improve Performance and Maintain Health: A Narrative Review

Training at low to moderate altitudes (~ 1600-2400 m) is a common approach used by endurance athletes to provide a distinctive environmental stressor to augment training stimulus in the anticipation of increasing subsequent altitude- and sea-level-based performance. Despite some scientific progress being made on the impact of various nutrition-related changes in physiology and associated interventions at mountaineering altitudes (> 3000 m), the impact of nutrition and/or supplements on further optimization of these hypoxic adaptations at low-moderate altitudes is only an emerging topic. Within this narrative review we have highlighted six major themes involving nutrition: altered energy availability, iron, carbohydrate, hydration, antioxidant requirements and various performance supplements. Of these issues, emerging data suggest that particular attention be given to the potential risk for poor energy availability and increased iron requirements at the altitudes typical of elite athlete training (~ 1600-2400 m) to interfere with optimal adaptations. Furthermore, the safest way to address the possible increase in oxidative stress associated with altitude exposure is via the consumption of antioxidant-rich foods rather than high-dose antioxidant supplements. Meanwhile, many other important questions regarding nutrition and altitude training remain to be answered. At the elite level of sport where the differences between winning and losing are incredibly small, the strategic use of nutritional interventions to enhance the adaptations to altitude training provides an important consideration in the search for optimal performance.

Effects of antioxidant-rich foods on altitude-induced oxidative stress and inflammation in elite endurance athletes: A randomized controlled trial

Background

Various altitude training regimes, systematically used to improve oxygen carrying capacity and sports performance, have been associated with increased oxidative stress and inflammation. We investigated whether increased intake of common antioxidant-rich foods attenuates these processes.

Methods

In a randomized controlled trial, 31 elite endurance athletes (23 ± 5 years), ingested antioxidant-rich foods (n = 16), (> doubling their usual intake), or eucaloric control foods (n = 15) during a 3-week altitude training camp (2320 m). Fasting blood and urine samples were collected 7 days pre-altitude, after 5 and 18 days at altitude, and 7 days post-altitude. Change over time was compared between the groups using mixed models for antioxidant capacity [uric acid-free (ferric reducing ability of plasma (FRAP)], oxidative stress (8-epi-PGF_2α) and inflammatory biomarkers (IFNγ, IL1α, IL1RA, IL1β, IL2, IL5, IL6, IL7, IL10, IL12p70, IL13, IL17, TNFα, MCP-1 and micro-CRP). The cytokine response to a stress-test (VO_2max ramp test or 100 m swimming) was assessed at pre- and post-altitude.

Results

FRAP increased more in the antioxidant compared to the control group (p = 0.034). IL13 decreased in the antioxidant group, while increasing in the controls (p = 0.006). A similar trend was seen for IL6 (p = 0.062). A larger decrease in micro-CRP was detected in the antioxidant group compared to controls (β: -0.62, p = 0.02). We found no group differences for the remaining cytokines. 8-epi-PGF_2α increased significantly in the whole population (p = 0.033), regardless group allocation. The stress response was significantly larger post-altitude compared with pre-altitude for IL1β, IL6, IL7, IL13, IL12p70 and TNFα, but we found no group differences.

Conclusions

Increased intake of antioxidant-rich foods elevated the antioxidant capacity and attenuated some of the altitude-induced systemic inflammatory biomarkers in elite athletes. The antioxidant intervention had no impact on the altitude-induced oxidative stress or changes in acute cytokine responses to exercise stress-tests.

Oxidative stress in elite athletes training at moderate altitude and at sea level

Using a controlled parallel group longitudinal trial design, we investigated the effects of different training interventions on the prooxidant/antioxidant status of elite athletes: living and training at moderate altitude for 3 (Hi-Hi3) and 4 weeks (Hi-Hi), and for 4 weeks too, living high and training high and low (Hi-HiLo) and living and training at sea level (Lo-Lo). From 61 swimmers, 54 completed the study. Nitrites, carbonyls, and lipid peroxidation (LPO) levels were assessed in plasma. Enzymatic antioxidants glutathione peroxidase (GPx) and glutathione reductase (GRd), and non-enzymatic antioxidants total glutathione (GST), reduced glutathione (GSH) and oxidized glutathione (GSSG) were analysed in the erythrocyte fraction. At the end of the intervention, nitrites levels were similar in all altitude groups but higher than in the Lo-Lo controls (P = .02). Hi-HiLo had greater GPx activity than Hi-Hi and Hi-Hi3 during most of the intervention (P ≤ .001). GRd activity was higher in Lo-Lo than in Hi-Hi at the end of the training camp (P ≤ .001). All groups showed increased levels of LPO, except Lo-Lo, and carbonyls at the end of the study (P ≤ .001). Training at altitude for 3 or 4 weeks drives oxidative stress leading to cellular damage mainly by worsening the antioxidant capacities. The GSSG/GSH ratio appears to be related to perceived exertion and fatigue. The stronger antioxidant defence showed by the Hi-HiLo group suggests an inverse relationship between redox alterations and performance. Further studies are required to investigate the role of oxidative stress in acclimatization, performance, and health.

Hypoxia-Induced Oxidative Stress Modulation with Physical Activity

Increased oxidative stress, defined as an imbalance between prooxidants and antioxidants, resulting in molecular damage and disruption of redox signaling, is associated with numerous pathophysiological processes and known to exacerbate chronic diseases. Prolonged systemic hypoxia, induced either by exposure to terrestrial altitude or a reduction in ambient O2 availability is known to elicit oxidative stress and thereby alter redox balance in healthy humans. The redox balance modulation is also highly dependent on the level of physical activity. For example, both high-intensity exercise and inactivity, representing the two ends of the physical activity spectrum, are known to promote oxidative stress. Numerous to-date studies indicate that hypoxia and exercise can exert additive influence upon redox balance alterations. However, recent evidence suggests that moderate physical activity can attenuate altitude/hypoxia-induced oxidative stress during long-term hypoxic exposure. The purpose of this review is to summarize recent findings on hypoxia-related oxidative stress modulation by different activity levels during prolonged hypoxic exposures and examine the potential mechanisms underlying the observed redox balance changes. The paper also explores the applicability of moderate activity as a strategy for attenuating hypoxia-related oxidative stress. Moreover, the potential of such moderate intensity activities used to counteract inactivity-related oxidative stress, often encountered in pathological, elderly and obese populations is also discussed. Finally, future research directions for investigating interactive effects of altitude/hypoxia and exercise on oxidative stress are proposed.

Does Swimming at a Moderate Altitude Favor a Lower Oxidative Stress in an Intensity-Dependent Manner? Role of Nonenzymatic Antioxidants

Casuso, Rafael A., Jerónimo Aragón-Vela, Gracia López-Contreras, Silvana N. Gomes, Cristina Casals, Yaira Barranco-Ruiz, Jordi J. Mercadé, and Jesus R. Huertas. Does swimming at a moderate altitude favor a lower oxidative stress in an intensity-dependent manner? Role of nonenzymatic antioxidants. High-Alt Med Biol. 18:46-55, 2017.-we aimed to describe oxidative damage and enzymatic and nonenzymatic antioxidant responses to swimming at different intensities in hypoxia. We recruited 12 highly experienced swimmers who have been involved in competitive swimming for at least 9 years. They performed a total of six swimming sessions carried out at low (LOW), moderate (MOD), or high (HIGH) intensity at low altitude (630 m) and at 2320 m above sea level. Blood samples were collected before the session (Pre), after the cool down (Post), and after 15 minutes of recovery (Rec). Blood lactate (BL) and heart rate were recorded throughout the main part of the session. Average velocities did not change between hypoxia and normoxia. We found a higher BL in response to MOD intensity in hypoxia. Plasmatic hydroperoxide level decreased at all intensities when swimming in hypoxia. This effect coincided with a lower glutation peroxidase activity and a marked mobilization of the circulating levels of α-tocopherol and coenzyme Q10 in an intensity-dependent manner. Our results suggest that, regardless of the intensity, no oxidative damage is found in response to hypoxic swimming in well-trained swimmers. Indeed, swimmers show a highly efficient antioxidant system by stimulating the mobilization of nonenzymatic antioxidants.

The blood antioxidant defence capacity during intermittent hypoxic training in elite swimmers

The main objective of this study was to examine the chronic effect of simulated intermittent normobaric hypoxia on blood antioxidant defence capacity in swimmers. The study included 14 male and 14 female competitive swimmers performing part of land training under simulated intermittent normobaric hypoxia (O₂ = 15.5%) or in normoxia. Land interval training took place twice per week, with a total of 8 training units during the study, performed with individualized intensity. The activities of blood antioxidant enzymes did not change significantly during the first and last training unit in the hypoxic and normoxic group. However, when comparing individual variables a significant effect of exercise was observed on GPx an CAT activities, whereas training units significantly differentiated GPx and GR activities. The oxygen conditions and gender had a significant influence on CAT activity. The total antioxidant capacity was not significantly affected. Only in male swimmers from the hypoxic group did the training significantly increase resting levels of MDA. In conclusion, training in normobaric hypoxia was not an adequate stimulus for the excessive response of the antioxidant defence system, despite increased oxidative stress in these conditions.

Dietary Recommendations for Cyclists during Altitude Training

The concept of altitude or hypoxic training is a common practice in cycling. However, several strategies for training regimens have been proposed, like "live high, train high" (LH-TH), "live high, train low" (LH-TL) or "intermittent hypoxic training" (IHT). Each of them combines the effect of acclimatization and different training protocols that require specific nutrition. An appropriate nutrition strategy and adequate hydration can help athletes achieve their fitness and performance goals in this unfriendly environment. In this review, the physiological stress of altitude exposure and training will be discussed, with specific nutrition recommendations for athletes training under such conditions. However, there is little research about the nutrition demands of athletes who train at moderate altitude. Our review considers energetic demands and body mass or body composition changes due to altitude training, including respiratory and urinary water loss under these conditions. Carbohydrate intake recommendations and hydration status are discussed in detail, while iron storage and metabolism is also considered. Last, but not least the risk of increased oxidative stress under hypoxic conditions and antioxidant supplementation suggestions are presented.

FemHab: The effects of bed rest and hypoxia on oxidative stress in healthy women

Independently, both inactivity and hypoxia augment oxidative stress. This study, part of the FemHab project, investigated the combined effects of bed rest-induced unloading and hypoxic exposure on oxidative stress and antioxidant status. Healthy, eumenorrheic women were randomly assigned to the following three 10-day experimental interventions: normoxic bed rest (NBR;n= 11; PiO2 = 133 mmHg), normobaric hypoxic bed rest (HBR;n= 12; PiO2 = 90 mmHg), and ambulatory hypoxic confinement (HAMB;n= 8: PiO2 = 90 mmHg). Plasma samples, obtained before (Pre), during (D2, D6), immediately after (Post) and 24 h after (Post+1) each intervention, were analyzed for oxidative stress markers [advanced oxidation protein products (AOPP), malondialdehyde (MDA), and nitrotyrosine], antioxidant status [superoxide dismutase (SOD), catalase, ferric-reducing antioxidant power (FRAP), glutathione peroxidase (GPX), and uric acid (UA)], NO metabolism end-products (NOx), and nitrites. Compared with baseline, AOPP increased in NBR and HBR on D2 (+14%; +12%;P< 0.05), D6 (+19%; +15%;P< 0.05), and Post (+22%; +21%;P< 0.05), respectively. MDA increased at Post+1 in NBR (+116%;P< 0.01) and D2 in HBR (+114%;P< 0.01) and HAMB (+95%;P< 0.05). Nitrotyrosine decreased (-45%;P< 0.05) and nitrites increased (+46%;P< 0.05) at Post+1 in HAMB only. Whereas SOD was higher at D6 (+82%) and Post+1 (+67%) in HAMB only, the catalase activity increased on D6 (128%) and Post (146%) in HBR and HAMB, respectively (P< 0.05). GPX was only reduced on D6 (-20%;P< 0.01) and Post (-18%;P< 0.05) in HBR. No differences were observed in FRAP and NOx. UA was higher at Post in HBR compared with HAMB (P< 0.05). These data indicate that exposure to combined inactivity and hypoxia impairs prooxidant/antioxidant balance in healthy women. Moreover, habitual activity levels, as opposed to inactivity, seem to blunt hypoxia-related oxidative stress via antioxidant system upregulation.

Effects of 12-Week Endurance Training at Natural Low Altitude on the Blood Redox Homeostasis of Professional Adolescent Athletes: A Quasi-Experimental Field Trial

This field study investigated the influences of exposure to natural low altitude on endurance training-induced alterations of redox homeostasis in professional adolescent runners undergoing 12-week off-season conditioning program at an altitude of 1700 m (Alt), by comparison with that of their counterparts completing the program at sea-level (SL). For age-, gender-, and Tanner-stage-matched comparison, 26 runners (n = 13 in each group) were selected and studied. Following the conditioning program, unaltered serum levels of thiobarbituric acid reactive substances (TBARS), total antioxidant capacity (T-AOC), and superoxide dismutase accompanied with an increase in oxidized glutathione (GSSG) and decreases of xanthine oxidase, reduced glutathione (GSH), and GSH/GSSG ratio were observed in both Alt and SL groups. Serum glutathione peroxidase and catalase did not change in SL, whereas these enzymes, respectively, decreased and increased in Alt. Uric acid (UA) decreased in SL and increased in Alt. Moreover, the decreases in GSH and GSH/GSSG ratio in Alt were relatively lower compared to those in SL. Further, significant interindividual correlations were found between changes in catalase and TBARS, as well as between UA and T-AOC. These findings suggest that long-term training at natural low altitude is unlikely to cause retained oxidative stress in professional adolescent runners.

Can clinicians and scientists explain and prevent unexplained underperformance syndrome in elite athletes: an interdisciplinary perspective and 2016 update

The coach and interdisciplinary sports science and medicine team strive to continually progress the athlete's performance year on year. In structuring training programmes, coaches and scientists plan distinct periods of progressive overload coupled with recovery for anticipated performances to be delivered on fixed dates of competition in the calendar year. Peaking at major championships is a challenge, and training capacity highly individualised, with fine margins between the training dose necessary for adaptation and that which elicits maladaptation at the elite level. As such, optimising adaptation is key to effective preparation. Notably, however, many factors (eg, health, nutrition, sleep, training experience, psychosocial factors) play an essential part in moderating the processes of adaptation to exercise and environmental stressors, for example, heat, altitude; processes which can often fail or be limited. In the UK, the term unexplained underperformance syndrome (UUPS) has been adopted, in contrast to the more commonly referenced term overtraining syndrome, to describe a significant episode of underperformance with persistent fatigue, that is, maladaptation. This construct, UUPS, reflects the complexity of the syndrome, the multifactorial aetiology, and that ‘overtraining’ or an imbalance between training load and recovery may not be the primary cause for underperformance. UUPS draws on the distinction that a decline in performance represents the universal feature. In our review, we provide a practitioner-focused perspective, proposing that causative factors can be identified and UUPS explained, through an interdisciplinary approach (ie, medicine, nutrition, physiology, psychology) to sports science and medicine delivery, monitoring, and data interpretation and analysis.

Prooxidant/Antioxidant Balance in Hypoxia: A Cross-Over Study on Normobaric vs. Hypobaric "Live High-Train Low"

"Live High-Train Low" (LHTL) training can alter oxidative status of athletes. This study compared prooxidant/antioxidant balance responses following two LHTL protocols of the same duration and at the same living altitude of 2250 m in either normobaric (NH) or hypobaric (HH) hypoxia. Twenty-four well-trained triathletes underwent the following two 18-day LHTL protocols in a cross-over and randomized manner: Living altitude (PIO2 = 111.9 ± 0.6 vs. 111.6 ± 0.6 mmHg in NH and HH, respectively); training "natural" altitude (~1000-1100 m) and training loads were precisely matched between both LHTL protocols. Plasma levels of oxidative stress [advanced oxidation protein products (AOPP) and nitrotyrosine] and antioxidant markers [ferric-reducing antioxidant power (FRAP), superoxide dismutase (SOD) and catalase], NO metabolism end-products (NOx) and uric acid (UA) were determined before (Pre) and after (Post) the LHTL. Cumulative hypoxic exposure was lower during the NH (229 ± 6 hrs.) compared to the HH (310 ± 4 hrs.; P<0.01) protocol. Following the LHTL, the concentration of AOPP decreased (-27%; P<0.01) and nitrotyrosine increased (+67%; P<0.05) in HH only. FRAP was decreased (-27%; P<0.05) after the NH while was SOD and UA were only increased following the HH (SOD: +54%; P<0.01 and UA: +15%; P<0.01). Catalase activity was increased in the NH only (+20%; P<0.05). These data suggest that 18-days of LHTL performed in either NH or HH differentially affect oxidative status of athletes. Higher oxidative stress levels following the HH LHTL might be explained by the higher overall hypoxic dose and different physiological responses between the NH and HH.

Alterations in redox homeostasis in the elite endurance athlete

BACKGROUND

The production of reactive oxygen (ROS) and nitrogen species (RNS) is a fundamental feature of mammalian physiology, cellular respiration and cell signalling, and essential for muscle function and training adaptation. Aerobic and anaerobic exercise results in alterations in redox homeostasis (ARH) in untrained, trained and well trained athletes. Low to moderate doses of ROS and RNS play a role in muscle adaptation to endurance training, but an overwhelming increase in RNS and ROS may lead to increased cell apoptosis and immunosuppression, fatigued states and underperformance.

OBJECTIVES

The objectives of this systematic review are: (a) to test the hypotheses that ARH occur in elite endurance athletes; following an acute exercise bout, in an endurance race or competition; across a micro-, meso- or macro-training cycle; following a training taper; before, during and after altitude training; in females with amenorrhoea versus eumenorrhoea; and in non-functional over-reaching (NFOR) and overtraining states (OTS); (b) to report any relationship between ARH and training load and ARH and performance; and (c) to apply critical difference values for measures of oxidative stress/ARH to address whether there is any evidence of ARH being of physiological significance (not just statistical) and thus relevant to health and performance in the elite athlete.

METHODS

Electronic databases, Embase, MEDLINE, and SPORTDiscus were searched for relevant articles. Only studies that were observational articles of cross-sectional or longitudinal design, and included elite athletes competing at national or international level in endurance sports were included. Studies had to include biomarkers of ARH; oxidative damage, antioxidant enzymes, antioxidant capacity, and antioxidant vitamins and nutrients in urine, serum, plasma, whole blood, red blood cells (RBCs) and white blood cells (WBCs). A total of 3,057 articles were identified from the electronic searches. Twenty-eight articles met the inclusion criteria and were included in the review.

RESULTS

ARH occurs in elite endurance athletes, after acute exercise, a competition or race, across training phases, and with natural or simulated altitude. A reduction in ARH occurs across the season in elite athletes, with marked variation around intensified training phases, between individuals, and the greatest disturbances (of physiological significance) occurring with live-high-train-low techniques, and in athletes competing. A relationship with ARH and performance and illness exists in elite athletes. There was considerable heterogeneity across the studies for the biomarkers and assays used; the sport; the blood sampling time points; and the phase in the annual training cycle and thus baseline athlete fitness. In addition, there was a consistent lack of reporting of the analytical variability of the assays used to assess ARH.

CONCLUSIONS

The reported biochemical changes around ARH in elite athletes suggest that it may be of value to monitor biomarkers of ARH at rest, pre- and post-simulated performance tests, and before and after training micro- and meso-cycles, and altitude camps, to identify individual tolerance to training loads, potentially allowing the prevention of non-functionally over-reached states and optimisation of the individual training taper and training programme.

Moderate exercise blunts oxidative stress induced by normobaric hypoxic confinement

PURPOSE

Both acute hypoxia and physical exercise are known to increase oxidative stress. This randomized prospective trial investigated whether the addition of moderate exercise can alter oxidative stress induced by continuous hypoxic exposure.

METHODS

Fourteen male participants were confined to 10-d continuous normobaric hypoxia (FIO2 = 0.139 ± 0.003, PIO2 = 88.2 ± 0.6 mm Hg, ∼4000-m simulated altitude) either with (HCE, n = 8, two training sessions per day at 50% of hypoxic maximal aerobic power) or without exercise (HCS, n = 6). Plasma levels of oxidative stress markers (advanced oxidation protein products [AOPP], nitrotyrosine, and malondialdehyde), antioxidant markers (ferric-reducing antioxidant power, superoxide dismutase, glutathione peroxidase, and catalase), nitric oxide end-products, and erythropoietin were measured before the exposure (Pre), after the first 24 h of exposure (D1), after the exposure (Post) and after the 24-h reoxygenation (Post + 1). In addition, graded exercise test in hypoxia was performed before and after the protocol.

RESULTS

Maximal aerobic power increased after the protocol in HCE only (+6.8%, P < 0.05). Compared with baseline, AOPP was higher at Post + 1 (+28%, P < 0.05) and nitrotyrosine at Post (+81%, P < 0.05) in HCS only. Superoxide dismutase (+30%, P < 0.05) and catalase (+53%, P < 0.05) increased at Post in HCE only. Higher levels of ferric-reducing antioxidant power (+41%, P < 0.05) at Post and lower levels of AOPP (-47%, P < 0.01) at Post + 1 were measured in HCE versus HCS. Glutathione peroxidase (+31%, P < 0.01) increased in both groups at Post + 1. Similar erythropoietin kinetics was noted in both groups with an increase at D1 (+143%, P < 0.01), a return to baseline at Post, and a decrease at Post + 1 (-56%, P < 0.05).

CONCLUSIONS

These data provide evidence that 2 h of moderate daily exercise training can attenuate the oxidative stress induced by continuous hypoxic exposure.

Vitamin C supplementation does not improve hypoxia-induced erythropoiesis

Hypoxia induces reactive oxygen species production. Supplements with antioxidant mixtures can compensate for the decline in red cell membrane stability following intermittent hypobaric hypoxia by decreasing protein and lipid oxidation. We aimed to determine whether supplementation with vitamin C is implicated in the regulation of erythropoiesis and in the oxygen-carrying capacity of the blood, and also whether antioxidant supplementation prevents the oxidative stress associated to intermittent hypoxia. Twenty-four male Wistar rats were randomly divided into four experimental groups: normoxia control (n=6), normoxia + vitamin C (n=6), hypoxia control (12 h pO(2) 12%/12 h pO(2) 21%) (n=6), and hypoxia + vitamin C (n=6). Animals were supplemented with vitamin C at a dose of 250 mg·kg(-1)·day(-1) for 21 days. Red blood cell count, hemoglobin, hematocrit, reticulocytes, erythropoietin, and oxidative stress parameters such as malondialdehyde and protein oxidation in plasma were analyzed at two different time points: basal sample (day zero) and final sample (day 21). Similar RBC, Hb, Hct, and Epo increments were observed in both hypoxic groups regardless of the vitamin C supplementation. There was no change on MDA levels after intermittent hypoxic exposure in any experimental group. However, we found an increase in plasma protein oxidation in both hypoxic groups. Vitamin C does not affect erythropoiesis and protein oxidation in rats submitted to intermittent hypoxic exposure.

Metabolic markers in sports medicine

Physical exercise induces adaptations in metabolism considered beneficial for health. Athletic performance is linked to adaptations, training, and correct nutrition in individuals with genetic traits that can facilitate such adaptations. Intense and continuous exercise, training, and competitions, however, can induce changes in the serum concentrations of numerous laboratory parameters. When these modifications, especially elevated laboratory levels, result outside the reference range, further examinations are ordered or participation in training and competition is discontinued or sports practice loses its appeal. In order to correctly interpret commonly used laboratory data, laboratory professionals and sport physicians need to know the behavior of laboratory parameters during and after practice and competition. We reviewed the literature on liver, kidney, muscle, heart, energy, and bone parameters in athletes with a view to increase the knowledge about clinical chemistry applied to sport and to stimulate studies in this field. In liver metabolism, the interpretation of serum aminotransferases concentration in athletes should consider the release of aspartate aminotransferase (AST) from muscle and of alanine aminotransferase (ALT) mainly from the liver, when bilirubin can be elevated because of continuous hemolysis, which is typical of exercise. Muscle metabolism parameters such as creatine kinase (CK) are typically increased after exercise. This parameter can be used to interpret the physiological release of CK from muscle, its altered release due to rhabdomyolysis, or incomplete recovery due to overreaching or trauma. Cardiac markers are released during exercise, and especially endurance training. Increases in these markers should not simply be interpreted as a signal of cardiac damage or wall stress but rather as a sign of regulation of myocardial adaptation. Renal function can be followed in athletes by measuring serum creatinine concentration, but it should be interpreted considering the athlete's body-mass index (BMI) and phase of the competitive season; use of cystatin C could be a reliable alternative to creatinine. Exercise and training induce adaptations in glucose metabolism which improve glucose utilization in athletes and are beneficial for reducing insulin insensitivity in nonathletes. Glucose metabolism differs slightly for different sports disciplines, as revealed in laboratory levels. Sport activities induce a blood lipid profile superior to that of sedentary subjects. There are few reports for a definitive conclusion, however. The differences between athletes and sedentary subjects are mainly due to high-density lipoprotein cholesterol (HDLC) concentrations in physically active individuals, although some differences among sport disciplines exist. The effect of sports on serum and urinary markers for bone metabolism is not univocal; further studies are needed to establish the real and effective influence of sport on bone turnover and especially to establish its beneficial effect.

The effect of exercise-induced hypoxemia on blood redox status in well-trained rowers

Exercise-induced arterial hypoxemia (EIAH), characterized by decline in arterial oxyhemoglobin saturation (SaO(2)), is a common phenomenon in endurance athletes. Acute intensive exercise is associated with the generation of reactive species that may result in redox status disturbances and oxidation of cell macromolecules. The purpose of the present study was to investigate whether EIAH augments oxidative stress as determined in blood plasma and erythrocytes in well-trained male rowers after a 2,000-m rowing ergometer race. Initially, athletes were assigned into either the normoxemic (n = 9, SaO(2) >92%, [Formula: see text]: 62.0 ± 1.9 ml kg(-1) min(-1)) or hypoxemic (n = 12, SaO(2) <92%, [Formula: see text]: 60.5 ± 2.2 ml kg(-1 )min(-1), mean ± SEM) group, following an incremental [Formula: see text] test on a wind resistance braked rowing ergometer. On a separate day the rowers performed a 2,000-m all-out effort on the same rowing ergometer. Following an overnight fast, blood samples were drawn from an antecubital vein before and immediately after the termination of the 2,000-m all-out effort and analyzed for selective oxidative stress markers. In both the normoxemic (SaO(2): 94.1 ± 0.9%) and hypoxemic (SaO(2): 88.6 ± 2.4%) rowers similar and significant exercise increase in serum thiobarbituric acid-reactive substances, protein carbonyls, catalase and total antioxidant capacity concentration were observed post-2,000 m all-out effort. Exercise significantly increased the oxidized glutathione concentration and decreased the ratio of reduced (GSH)-to-oxidized (GSSG) glutathione in the normoxemic group only, whereas the reduced form of glutathione remained unaffected in either groups. The increased oxidation of GSH to GSSG in erythrocytes of normoxemic individuals suggest that erythrocyte redox status may be affected by the oxygen saturation degree of hemoglobin. Our findings indicate that exercise-induced hypoxemia did not further affect the increased blood oxidative damage of lipids and proteins observed after a 2,000-m rowing ergometer race in highly-trained male rowers. The present data do not support any potential link between exercise-induced hypoxemia, oxidative stress increase and exercise performance.

Living at high altitude in combination with sea-level sprint training increases hematological parameters but does not improve performance in rats

The regimen of aerobic training at sea level with recovery at high altitude has been used by athletes to improve performance. However, little is known about the effects of hypoxia when combined with sprint interval training on performance. The aim of the present study was to determine the effect of a "living high-sprint training low" strategy on hemoglobin, hematocrit and erythropoietin levels in rats. We also wanted to test whether the addition of a hypoxic stress to the program of daily treadmill running at high speeds induces expressional adaptations in skeletal muscle and affects performance. The protein content of peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α), cytochrome C, pyruvate dehydrogenase kinase (PDK1), heat shock protein 70 (HSP70), manganese superoxide dismutase (MnSOD) and citrate synthase activity were determined in different muscle fiber types in our animals (red and white gastrocnemius muscle). We also determined the maximal aerobic velocity (MAV) before and after the training period. A total of 24 male Wistar rats (3 month old) were randomly divided into four experimental groups: the normoxic control group (n = 6), the normoxic trained group (n = 6), the hypoxic control group (12 h pO(2) 12%/12 h pO(2) 21%) (n = 6) and the hypoxic trained group (12 h pO(2) 12%/12 h pO(2) 21%). Living in normobaric hypoxia condition for 21 days significantly increased hemoglobin, hematocrit and erythropoietin levels in both the rest and the trained groups. The trained animals (normoxia and hypoxia) significantly increased their maximal aerobic velocity. No changes were found in the skeletal muscle in PGC-1α, cytochrome C, PDK1, HSP70, MnSOD protein content and in the citrate synthase activity in any experimental group. Regardless of whether it is combined with sprint interval training or not, after 21 days of living at high altitude we found a significant increase in the hematological values determined in our study. However, contrary to our starting hypothesis, the combination of normobaric hypoxia and sprint training did not improve MAV in our animals.

Oxidative stress status in rats after intermittent exposure to hypobaric hypoxia

OBJECTIVE

Programs of intermittent hypobaric hypoxia (IHH) exposure are used to raise hemoglobin concentration and erythrocyte mass. Although acclimation response increases blood oxygen transport capacity leading to a VO(2max) increase, the effects of reactive oxygen species (ROS) might determine the behavior of erythrocytes and plasma, thus causing a worse peripheral blood flow. The goals of the study were to establish the hematological changes and to discern whether an IHH protocol modifies the antioxidant/pro-oxidant balance in laboratory rats.

METHODS

Male rats were subjected to an IHH program consisting of a daily 4-hour session for 5 days/week until completing 22 days of hypoxia exposure in a hypobaric chamber at a simulated altitude of 5000 m. Blood samples were taken at the end of the exposure period (H) and at 20 (P20) and 40 (P40) days after the end of the program, and compared to control (C), maintained at sea-level pressure. Hematological parameters were measured together with several oxidative stress indicators: plasma thiobarbituric acid reactive substances (TBARS) and erythrocyte catalase (CAT) and superoxide dismutase (SOD).

RESULTS

Red blood cell (RBC) count, hemoglobin concentration and hematocrit were higher in H group as compared to all the other groups (p < 0.001). However, there were no significant differences between the 4 groups in any of the oxidative stress-related parameters.

CONCLUSIONS

The absence of significant differences between groups indicates that our IHH program has little impact on the general redox status, even in the laboratory rat, which is more sensitive to hypoxia than humans. We conclude that IHH does not increase oxidative stress.

Antioxidant status of elite athletes remains impaired 2 weeks after a simulated altitude training camp

BACKGROUND

It has been shown that the antioxidant status was altered by the "live high-train low" (LHTL) method, however, no information is available regarding the antioxidant restoration during the recovery period.

AIM OF THE STUDY

We tested the hypothesis that the antioxidant status is impaired by 18 days LHTL in elite athletes and remained altered after 14 days of recovery.

METHODS

Eleven elite cross-country skiers from the French Skiing Federation were submitted to 18-day endurance training. Six (hypoxic group; HG) trained at 1,200 m and lived in hypoxia (simulated altitude of 2,500 m-3,000 m-3,500 m) and 5 (control group; CG) trained and lived at 1,200 m. Plasma levels of advanced oxidation protein products (AOPP), malondialdehydes (MDA), ferric reducing antioxidant power (FRAP), trolox equivalent antioxidant capacity (TEAC) lipid-soluble antioxidants (alpha-tocopherol, beta-carotene and lycopene) were measured at rest, before (PRE), the first day after (POST1) and again 2 weeks (POST14) after the training. Intakes of vitamins A and E were evaluated from the dietary recording.

RESULTS

In POST1, FRAP and TEAC decreased in both groups, however, the TEAC decrease persisted in POST14 for HG only. Lycopene and beta-carotene decreased in POST1 for HG and remained lower in POST14. Finally, AOPP increased only for HG in POST1. The general decline of antioxidant status for both groups might result from insufficient intakes in vitamins A and E.

CONCLUSION

This is the first study to show that the antioxidant status did not return to baseline 2 weeks after 18 days of LHTL training.

Thirteen days of "live high-train low" does not affect prooxidant/antioxidant balance in elite swimmers

We investigated the impact of 13 days of "living high-training low" (LHTL) on the antioxidant/prooxidant balance in elite endurance swimmers. Eighteen elite swimmers from the French Swimming Federation were submitted to a 13-day endurance training and divided into two groups: one group trained at 1,200 m and lived in hypoxia (2,500-3,000 m simulated altitude) and the second group trained and lived at 1,200 m. The subjects performed an acute hypoxic test (10 min at 4,800 m) before and 1 day after the training period. Plasma levels of advanced oxidation protein products (AOPP), malondialdehydes (MDA), ferric reducing antioxidant power (FRAP), and lipid-soluble antioxidants were measured before and after the 4,800 m tests. After the training, MDA and AOPP responses to the 4,800 m test were lower than before training for both groups (+10 vs. +2%; P = 0.01 for MDA and +80 vs. +14%; P = 0.01 for AOPP). Thirteen days of LHTL did not modify antioxidant status (FRAP and lipid-soluble antioxidants) despite intakes in vitamins A and E below the recommended daily allowances. The LHTL did not affect the antioxidant status in elite swimmers; however, the normoxic endurance training induced preconditioning mechanisms in response to the 4,800 m test.