Work performance of high-altitude Aymara males

Why Are High Altitude Natives So Strong at High Altitude? Nature vs. Nurture: Genetic Factors vs. Growth and Development

Among high-altitude natives there is evidence of a general hypoxia tolerance leading to enhanced performance and/or increased capacity in several important domains. These domains likely include an enhanced physical work capacity, an enhanced reproductive capacity, and an ability to resist several common pathologies of chronic high-altitude exposure. The "strength" of the high-altitude native in this regard may have both a developmental and a genetic basis, although there is better evidence for the former (developmental effects) than for the latter. For example, early-life hypoxia exposure clearly results in lung growth and remodeling leading to an increased O2 diffusing capacity in adulthood. Genetic research has yet to reveal a population genetic basis for enhanced capacity in high-altitude natives, but several traits are clearly under genetic control in Andean and Tibetan populations e.g., resting and exercise arterial O2 saturation (SaO2). This chapter reviews the effects of nature and nurture on traits that are relevant to the process of gas exchange, including pulmonary volumes and diffusion capacity, the maximal oxygen consumption (VO2max), the SaO2, and the alveolar-arterial oxygen partial pressure difference (A-aDO2) during exercise.

Aerobic capacity of Peruvian Quechua: a test of the developmental adaptation hypothesis

High altitude natives are reported to have outstanding work capacity in spite of the challenge of oxygen transport and delivery in hypoxia. To evaluate the developmental effect of lifelong exposure to hypoxia on aerobic capacity, VO2peak was measured on two groups of Peruvian Quechua subjects (18-35 years), who differed in their developmental exposure to altitude. Male and female volunteers were recruited in Lima, Peru (150 m), and were divided in two groups, based on their developmental exposure to hypoxia, those: a) Born at sea-level individuals (BSL), with no developmental exposure to hypoxia (n = 34) and b) Born at high-altitude individuals (BHA) with full developmental exposure to hypoxia (n = 32), but who migrated to sea-level as adults (>16-years-old). Tests were conducted both in normoxia (BP = 750 mm Hg) and normobaric hypoxia at sea-level (BP = 750 mm Hg, FiO2  = 0.12, equivalent to 4,449 m), after a 2-month training period (in order to control for initial differences in physical fitness) at sea-level. BHA had a significantly higher VO2peak at hypoxia (40.31 ± 1.0 ml/min/kg) as compared to BSL (35.78 ± 0.96 ml/min/kg, P = 0.001), adjusting for sex. The decrease of VO2peak at HA relative to SL (ΔVO2peak ) was not different between groups, controlling for baseline levels (VO2peak at sea-level) and sex (BHA = 0.35 ± 0.04 l/min, BSL = 0.44 ± 0.04 l/min; P = 0.12). Forced vital capacity (controlling for height) and the residuals of VO2peak (controlling for weight) had a significant association in the BHA group only (r = 0.155; P = 0.031). In sum, results indicate that developmental exposure to altitude constitutes an important factor to determine superior exercise performance.

Maximal oxygen consumption in healthy humans: theories and facts

This article reviews the concept of maximal oxygen consumption ([Formula: see text]) from the perspective of multifactorial models of [Formula: see text] limitation. First, I discuss procedural aspects of [Formula: see text] measurement: the implications of ramp protocols are analysed within the theoretical work of Morton. Then I analyse the descriptive physiology of [Formula: see text], evidencing the path that led to the view of monofactorial cardiovascular or muscular [Formula: see text] limitation. Multifactorial models, generated by the theoretical work of di Prampero and Wagner around the oxygen conductance equation, represented a radical change of perspective. These models are presented in detail and criticized with respect to the ensuing experimental work. A synthesis between them is proposed, demonstrating how much these models coincide and converge on the same conclusions. Finally, I discuss the cases of hypoxia and bed rest, the former as an example of the pervasive effects of the shape of the oxygen equilibrium curve, the latter as a neat example of adaptive changes concerning the entire respiratory system. The conclusion is that the concept of cardiovascular [Formula: see text] limitation is reinforced by multifactorial models, since cardiovascular oxygen transport provides most of the [Formula: see text] limitation, at least in normoxia. However, the same models show that the role of peripheral resistances is significant and cannot be neglected. The role of peripheral factors is greater the smaller is the active muscle mass. In hypoxia, the intervention of lung resistances as limiting factors restricts the role played by cardiovascular and peripheral factors.

A cross-sectional study of differences in 6-min walk distance in healthy adults residing at high altitude versus sea level

Background

We sought to determine if adult residents living at high altitude have developed sufficient adaptation to a hypoxic environment to match the functional capacity of a similar population at sea level. To test this hypothesis, we compared the 6-min walk test distance (6MWD) in 334 residents living at sea level vs. at high altitude.

Methods

We enrolled 168 healthy adults aged ≥35 years residing at sea level in Lima and 166 individuals residing at 3,825 m above sea level in Puno, Peru. Participants completed a 6-min walk test, answered a sociodemographics and clinical questionnaire, underwent spirometry, and a blood test.

Results

Average age was 54.0 vs. 53.8 years, 48% vs. 43% were male, average height was 155 vs. 158 cm, average blood oxygen saturation was 98% vs. 90%, and average resting heart rate was 67 vs. 72 beats/min in Lima vs. Puno. In multivariable regression, participants in Puno walked 47.6 m less (95% CI -81.7 to -13.6 m; p < 0.01) than those in Lima. Other variables besides age and height that were associated with 6MWD include change in heart rate (4.0 m per beats/min increase above resting heart rate; p < 0.001) and percent body fat (-1.4 m per % increase; p = 0.02).

Conclusions

The 6-min walk test predicted a lowered functional capacity among Andean high altitude vs. sea level natives at their altitude of residence, which could be explained by an incomplete adaptation or a protective mechanism favoring neuro- and cardioprotection over psychomotor activity.

Do high-altitude natives have enhanced exercise performance at altitude?

Natives of high altitude (HA) may have enhanced physical work capacity in hypoxia due to growth and development at altitude or, in the case of indigenous Andean and Himalayan residents, due to population genetic factors that determine higher limits to exercise performance. There is a growing scientific literature in support of both hypotheses, although the specific developmental vs. genetic origins of putative population trait differences remain obscure. Considering whole-body measures of exercise performance, a review of the literature suggests that indigenous HA natives have higher mean maximal oxygen consumption (VO(2) (max)) in hypoxia and smaller VO(2) (max) decrement with increasing hypoxia. At present, there is insufficient information to conclude that HA natives have enhanced work economy or greater endurance capacity, although for the former a number of studies indicate that this may be the case for Tibetans. At the physiological level, supporting the hypothesis of enhanced pulmonary gas exchange efficiency, HA natives have smaller alveolar-arterial oxygen partial pressure difference ((A-a)DO(2)), lower pulmonary ventilation (VE), and likely higher arterial O(2) saturation (SaO(2)) during exercise. At the muscle level, a handful of studies show no differences in fiber-type distributions, capillarity, oxidative enzymes, or the muscle response to training. At the metabolic level, a few studies suggest differences in lactate production/removal and (or) lactate buffering capacity, but more work is needed in this area.

Growth among Tibetans at high and low altitudes in India

In India, Tibetans have been living at different altitudes for more than 40 years. This study describes physical growth in terms of height, weight, sitting height, skinfold thickness at triceps and upper arm circumference of Tibetans born and raised at three Tibetan refugee settlements (3,521; 970; and 800 m) from the view point of the hypothesis that growth is retarded at high altitude. Samples consist of individuals between the ages of 2 and 40 years. Tibetans at high altitude in India show a growth pattern similar to that previously observed among Tibetans in Tibet. Tibetans at high altitude are taller and heavier compared to Andean highlanders. The general trends show that Tibetan children and adults of both sexes at low altitude in India are advanced in terms of height, weight, skinfold thickness at triceps and upper arm circumference compared to Tibetans at high altitude. Trunk length (sitting height) is similar at the two altitudes but relative sitting height is greater at high altitude. Greater relative sitting height and lesser leg length at high altitude than at low altitudes is discussed in terms of effect of altitude, temperature, and nutritional status.

Inca Trail porters: the health of local tourism employees as a challenge for travel medicine

BACKGROUND

Trekking is an activity that forms part of the increasing adventure and outdoor tourism. High altitude trekking in the Himalayas or Andes has been popular for some time. For longer treks, porters are employed to carry necessary equipment. Porters' working conditions are unfortunate and subsequent health problems considerable. Although Himalayan porters have received some attention in the press and research literature, porters on the popular Inca Trail in Peru have been neglected. In light of the growing awareness of health problems of local tourism employees, the purpose of this study was to describe Inca Trail porters' working conditions and their reports on their related health status to provide baseline information for further research and strategies for improvement.

METHOD

For this descriptive study, 101 Inca Trail porters were interviewed (August/September 2001) using a structured interview schedule.

RESULTS

Porters were between 17 and 68 years old; estimated body weight ranged from 50 kg to 76 kg. The usual portering job lasts for 4 days with 9 to 10 hours of carrying per day. Estimated weight of loads ranged from 20 kg to 45 kg. Major concerns were lack of fuel, clothes, shelter, and equipment but foremost the lack of sufficient food provisions. A third described their general health as poor or very poor and attributed this to work. Health complaints included respiratory infections, kidney problems, or rheumatism. Thirty-eight porters recalled injuries while on the trail and over 90% had fallen ill on the job with cold, "majurki," and stomach pain due to lack of food or cold food being named most often. Porters' demands for improvement included increased pay and appropriate and sufficient food.

CONCLUSIONS

The porters' working conditions and subsequent health problems need to be addressed. A range of stakeholders is responsible for the porters' conditions and are in a position to improve current situations. Specific responsibility for health care lies with travel health professionals and local health authorities since the health of host communities has been acknowledged as an important area within travel medicine.

Genetic and environmental adaptation in high altitude natives. Conceptual, methodological, and statistical concerns

A great number of physiological and anthropological studies have investigated Andean and Himalayan populations native to high altitude (HA). A non-scientific survey of the extant literature reveals a relatively liberal tradition of inferring genetic (evolutionary) adaptation to HA in these groups, often based on limited evidence and/or based on study designs insufficient to fully address the issue. Rather than review the evidence for or against genetic adaptation, and in order to provide some perspective, this paper will review relevant conceptual, methodological, and statistical issues that are germane to the study of HA native human groups. In particular, focus will be on the limitations of the most common research approach which bases evolutionary inference on the comparison of phenotypic mean differences between highland and lowland native populations. The migrant study approach is discussed, as is a relatively new approach based on genetic admixture in hybrid populations.

Commercial porters of eastern Nepal: health status, physical work capacity, and energy expenditure

The purpose of the study was to compare full-time hill porters in eastern Nepal with part-time casual porters engaged primarily in subsistence farming. The 50 porters selected for this study in Kenja (elevation 1,664 m) were young adult males of Tibeto-Nepali origin. Following standardized interviews, anthropometry, and routine physical examinations, the porters were tested in a field laboratory for physiological parameters associated with aerobic performance. Exercise testing, using a step test and indirect calorimetry, included a submaximal assessment of economy and a maximal-effort graded exercise test. Energy expenditure was measured in the field during actual tumpline load carriage. No statistically significant differences were found between full-time and part-time porters with respect to age, anthropometric characteristics, health, nutritional status, or aerobic power. Mean VO2 peak was 2.38 +/- 0.27 L/min (47.1 +/- 5.3 ml/kg/min). Load-carrying economy did not differ significantly between porter groups. The relationship between VO2 and load was linear over the range of 10-30 kg with a slope of 9 +/- 4 ml O2/min per kg of load. During the field test of actual work performance, porters expended, on average, 348 +/- 68 kcal/hr in carrying loads on the level and 408 +/- 60 kcal/hr in carrying loads uphill. Most porters stopped every 2 min, on average, to rest their loads briefly on T-headed resting sticks (tokmas). The technique of self-paced, intermittent exercise together with the modest increase in energy demands for carrying increasingly heavier loads allows these individuals to regulate work intensity and carry extremely heavy loads without creating persistent medical problems.

Commercial porters of eastern Nepal: health status, physical work capacity, and energy expenditure

The purpose of the study was to compare full-time hill porters in eastern Nepal with part-time casual porters engaged primarily in subsistence farming. The 50 porters selected for this study in Kenja (elevation 1,664 m) were young adult males of Tibeto-Nepali origin. Following standardized interviews, anthropometry, and routine physical examinations, the porters were tested in a field laboratory for physiological parameters associated with aerobic performance. Exercise testing, using a step test and indirect calorimetry, included a submaximal assessment of economy and a maximal-effort graded exercise test. Energy expenditure was measured in the field during actual tumpline load carriage. No statistically significant differences were found between full-time and part-time porters with respect to age, anthropometric characteristics, health, nutritional status, or aerobic power. Mean VO2 peak was 2.38 +/- 0.27 L/min (47.1 +/- 5.3 ml/kg/min). Load-carrying economy did not differ significantly between porter groups. The relationship between VO2 and load was linear over the range of 10-30 kg with a slope of 9 +/- 4 ml O2/min per kg of load. During the field test of actual work performance, porters expended, on average, 348 +/- 68 kcal/hr in carrying loads on the level and 408 +/- 60 kcal/hr in carrying loads uphill. Most porters stopped every 2 min, on average, to rest their loads briefly on T-headed resting sticks (tokmas). The technique of self-paced, intermittent exercise together with the modest increase in energy demands for carrying increasingly heavier loads allows these individuals to regulate work intensity and carry extremely heavy loads without creating persistent medical problems.

Physiological variation and adaptability in human populations

This review traces some of the developments in population physiology based on contributions to the Annals over the last 25 years. Two broad themes are evident, physiological systems variation and adaptation, and by way of introduction an historical perspective of their relationship within human ecology is explored. Studies of physical fitness and work capacity, and the efforts to create standardized field procedures make up a number of the early papers. Longitudinal studies have provided reliable reference standards for Westernized populations, but are virtually non-existent for primitive groups. The relative importance of phenotypic and genotypic variations in working capacity have yet to be clearly defined. The level of habitual activity during childhood contributes to the development of ventilatory capacity though constitutional influences are of major importance. Variability in strength and motor performance of skeletal muscles are shown to have a direct bearing on aspects of growth, development and biological maturation. Physical and psychological stress in communities have been investigated. These and other studies contribute valuable data on the issue of stress, hypertension and cardiovascular morbidity and mortality. On the theme of human adaptability, high altitude populations, variations in thermal tolerance and adaptations in ageing populations have all received recent investigation. Highland people of all ages have considerably larger lung volumes than coastal dwellers. Haematological, biochemical and pulmonary function show adaptive phenomena that vary in different highland groups. In the tropical biome, more recent work includes the functional consequences of malnutrition, ethnic and cultural differences in work capacity, and the effects of endemic disease on physical performance. Annals of Human Biology papers have more recently contributed to investigations on morphological and physiological changes with human ageing. Though there is a decline in the ability to adapt to environmental stresses with age this may be met by changes in adaptational strategy in physiological systems.

Developmental, genetic, and environmental components of aerobic capacity at high altitude

The aerobic capacity of 268 subjects (158 males and 110 females) was evaluated in La Paz, Bolivia situated at 3,750 m. The sample included 1) 39 high altitude rural natives (all male); 2) 67 high altitude urban natives (32 male, 35 female); 3) 69 Bolivians of foreign ancestry acclimatized to high altitude since birth (37 male, 32 female); 4) 50 Bolivians of foreign ancestry acclimatized to high altitude during growth (25 male, 25 female); and 5) 42 non-Bolivians of either European or North American ancestry acclimatized to high altitude during adulthood (25 male, 18 female). Data analyses indicate that 1) high altitude urban natives, acclimatized to high altitude since birth or during growth, attained higher aerobic capacity than subjects acclimatized to high altitude during adulthood; 2) age at arrival to high altitude is inversely related to maximum oxygen consumption (VO2 max) expressed in terms L/min or ml/min/kg of lean body mass, but not in terms of ml/min/kg of body weight; 3) among subjects acclimatized to high altitude during growth, approximately 25% of the variability in aerobic capacity can be explained by developmental factors; 4) as inferred from evaluations of skin color reflectance and sibling similarities, approximately 20 to 25% of the variability in aerobic capacity at high altitude can be explained by genetic factors; 5) except among the non-Bolivians acclimatized to high altitude during adulthood, the aerobic capacity of individuals with high occupational activity level is equal to the aerobic capacity of high altitude rural natives; and 6) the relationship between occupational activity level and aerobic capacity is much greater among subjects acclimatized to high altitude before the age of 10 years than afterwards. Together these data suggest that the attainment of normal aerobic capacity at high altitude is related to both developmental acclimatization and genetic factors but its expression is highly mediated by environmental factors, such as occupational activity level and body composition.

Maximal aerobic power in high-altitude runners

Maximal aerobic power (VO2max) was assessed in seven male and one female middle- and long-distance recreational runners residing in La Paz, Bolivia (3600 m). All runners were born and raised at high altitudes (> 2500). Mean VO2max in the male runners was 60.8 ml/kg/min while VO2max in the female runner was 55.5 ml/kg/min. These values are higher than in any previously reported sample of either trained or untrained high-altitude natives. In addition, mean VO2max in the La Paz male runners and VO2max in the La Paz female runner were very similar to those found in comparable low-altitude samples of recreational athletes, suggesting that the cardiorespiratory systems of both normally active and highly active native Andean highlanders are capable of successfully responding to the stress of hypobaric hypoxia. This ability may have both developmental and genetic components.

The physical growth of urban children at high altitude

The physical growth of urban Aymara children residing in La Paz, Bolivia (3,600 m) is described and compared with Amerindian children residing at low and high altitudes and with low-altitude U.S. children. The sample consists of 227 males (10.6-19.7 yr) and 219 females (11.2-19.8 yr). The urban La Paz children were taller at all ages than rural high altitude Amerindian children but similar in stature to urban high altitude children from Peru. The variation in stature among the high altitude populations was considerable, amounting to average differences between the tallest and shortest samples of about 10 cm in males and 8 cm in females. In addition, stature in the two urban high altitude samples was similar to that of rural low-altitude Amerindians. This overlapping of the distributions of stature in high- and low-altitude populations could easily confound comparisons designed to determine the effects of hypoxia on physical growth. La Paz Aymara children had considerably smaller chest sizes relative to stature than high-altitude Quechua children. However, the available data indicates that relative chest sizes are similar in Aymara and Quechua adults, suggesting that the process by which large chests are achieved may differ between these Andean populations.