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Lloyd AB, Havenith G. Reply to Richalet and Hermand. Updating the CVR model for limitations in maximum myocardial contractility at high altitude. J Appl Physiol (1985) 2023; 134:148-149. [PMID: 36592409 DOI: 10.1152/japplphysiol.00678.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Alex B Lloyd
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, United Kingdom
| | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, United Kingdom
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Sanz-Quinto S, López-Grueso R, Brizuela G, Flatt AA, Moya-Ramón M. Influence of Training Models at 3,900-m Altitude on the Physiological Response and Performance of a Professional Wheelchair Athlete: A Case Study. J Strength Cond Res 2019; 33:1714-1722. [PMID: 29927887 DOI: 10.1519/jsc.0000000000002667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Sanz-Quinto, S, López-Grueso, R, Brizuela, G, Flatt, AA, and Moya-Ramón, M. Influence of training models at 3,900-m altitude on the physiological response and performance of a professional wheelchair athlete: A case study. J Strength Cond Res 33(6): 1715-1723, 2019-This case study compared the effects of two training camps using flexible planning (FP) vs. inflexible planning (IP) at 3,860-m altitude on physiological and performance responses of an elite marathon wheelchair athlete with Charcot-Marie-Tooth disease (CMT). During IP, the athlete completed preplanned training sessions. During FP, training was adjusted based on vagally mediated heart rate variability (HRV) with specific sessions being performed when a reference HRV value was attained. The camp phases were baseline in normoxia (BN), baseline in hypoxia (BH), specific training weeks 1-4 (W1, W2, W3, W4), and Post-camp (Post). Outcome measures included the root mean square of successive R-R interval differences (rMSSD), resting heart rate (HRrest), oxygen saturation (SO2), diastolic blood pressure and systolic blood pressure, power output and a 3,000-m test. A greater impairment of normalized rMSSD (BN) was shown in IP during BH (57.30 ± 2.38% vs. 72.94 ± 11.59%, p = 0.004), W2 (63.99 ± 10.32% vs. 81.65 ± 8.87%, p = 0.005), and W4 (46.11 ± 8.61% vs. 59.35 ± 6.81%, p = 0.008). At Post, only in FP was rMSSD restored (104.47 ± 35.80%). Relative changes were shown in power output (+3 W in IP vs. +6 W in FP) and 3,000-m test (-7s in IP vs. -16s in FP). This case study demonstrated that FP resulted in less suppression and faster restoration of rMSSD and more positive changes in performance than IP in an elite wheelchair marathoner with CMT.
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Affiliation(s)
| | | | - Gabriel Brizuela
- Department of Physical and Sports Education, University of Valencia, Valencia, Spain
| | - Andrew A Flatt
- Department of Health Science and Kinesiology, Georgia Southern University, Savannah, Georgia
| | - Manuel Moya-Ramón
- Sports Research Center, Miguel Hernandez University, Elche, Spain.,Department of Health Psychology, Miguel Hernandez University, Elche, Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
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Mourot L. Limitation of Maximal Heart Rate in Hypoxia: Mechanisms and Clinical Importance. Front Physiol 2018; 9:972. [PMID: 30083108 PMCID: PMC6064954 DOI: 10.3389/fphys.2018.00972] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/02/2018] [Indexed: 12/17/2022] Open
Abstract
The use of exercise intervention in hypoxia has grown in popularity amongst patients, with encouraging results compared to similar intervention in normoxia. The prescription of exercise for patients largely rely on heart rate recordings (percentage of maximal heart rate (HRmax) or heart rate reserve). It is known that HRmax decreases with high altitude and the duration of the stay (acclimatization). At an altitude typically chosen for training (2,000-3,500 m) conflicting results have been found. Whether or not this decrease exists or not is of importance since the results of previous studies assessing hypoxic training based on HR may be biased due to improper intensity. By pooling the results of 86 studies, this literature review emphasizes that HRmax decreases progressively with increasing hypoxia. The dose–response is roughly linear and starts at a low altitude, but with large inter-study variabilities. Sex or age does not seem to be a major contributor in the HRmax decline with altitude. Rather, it seems that the greater the reduction in arterial oxygen saturation, the greater the reduction in HRmax, due to an over activity of the parasympathetic nervous system. Only a few studies reported HRmax at sea/low level and altitude with patients. Altogether, due to very different experimental design, it is difficult to draw firm conclusions in these different clinical categories of people. Hence, forthcoming studies in specific groups of patients are required to properly evaluate (1) the HRmax change during acute hypoxia and the contributing factors, and (2) the physiological and clinical effects of exercise training in hypoxia with adequate prescription of exercise training intensity if based on heart rate.
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Affiliation(s)
- Laurent Mourot
- EA 3920 Prognostic Markers and Regulatory Factors of Cardiovascular Diseases and Exercise Performance, Health, Innovation Platform, University of Franche-Comté, Besançon, France.,Tomsk Polytechnic University, Tomsk, Russia
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McLaughlin CW, Skabelund AJ, George AD. Impact of High Altitude on Military Operations. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0181-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Crocker GH, Jones JH. Interactive effects of hypoxia, carbon monoxide and acute lung injury on oxygen transport and aerobic capacity. Respir Physiol Neurobiol 2016; 225:31-7. [DOI: 10.1016/j.resp.2016.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 11/24/2022]
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PÉRIARD JULIEND, RACINAIS SÉBASTIEN. Performance and Pacing during Cycle Exercise in Hyperthermic and Hypoxic Conditions. Med Sci Sports Exerc 2016; 48:845-53. [DOI: 10.1249/mss.0000000000000839] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Richalet JP. Physiological and Clinical Implications of Adrenergic Pathways at High Altitude. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 903:343-56. [DOI: 10.1007/978-1-4899-7678-9_23] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Stadheim HK, Nossum EM, Olsen R, Spencer M, Jensen J. Caffeine improves performance in double poling during acute exposure to 2,000-m altitude. J Appl Physiol (1985) 2015; 119:1501-9. [DOI: 10.1152/japplphysiol.00509.2015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/06/2015] [Indexed: 11/22/2022] Open
Abstract
There is limited research on the physiological effects of caffeine (CAF) ingestion on exercise performance during acute hypoxia. The aim of the present study was therefore to test the effect of placebo (PLA) and CAF (4.5 mg/kg) on double poling (DP) performance during acute hypoxia. Thirteen male subelite cross-country skiers (V̇o2max 72.6 ± 5.68 ml·kg−1·min−1) were included. Performance was assessed as 1) an 8-km cross-country DP time-trial (C-PT), and 2) time until task failure at a set workload equal to ∼90% of DP V̇o2max. Testing was carried out in a hypobaric chamber, at 800 mbar (Pio2: ∼125 mmHg) corresponding to ∼2,000 m above sea level in a randomized double-blinded, placebo-controlled, cross-over design. CAF improved time to task failure from 6.10 ± 1.40 to 7.22 ± 1.30 min ( P < 0.05) and velocity the first 4 km ( P < 0.05) but not overall time usage for the 8-km C-PT. During submaximal exercise subjects reported lower pain in arms and rate of perceived exertion (RPE) following CAF ingestion. Throughout C-PTs similar RPE and pain was shown between treatments. However, higher heart rate was observed during the CAF 8 km (187 ± 7 vs. 185 ± 7; P < 0.05) and 90% C-PT (185 ± 7 vs. 181 ± 9) associated with increased ventilation, blood lactate, glucose, adrenaline, decreased pH, and bicarbonate. The present study demonstrates for the first time that CAF ingestion improves DP time to task failure although not consistently time trial performance during acute exposure to altitude. Mechanisms underpinning improvements seem related to reduced pain RPE and increased heart rate during CAF C-PTs.
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Affiliation(s)
- H. K. Stadheim
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway; and
| | - E. M Nossum
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway; and
| | - R. Olsen
- Department of Chemical and Biological Working Environment, National Institute of Occupational Health, Oslo, Norway
| | - M. Spencer
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway; and
| | - J. Jensen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway; and
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Siebenmann C, Rasmussen P, Sørensen H, Bonne TC, Zaar M, Aachmann-Andersen NJ, Nordsborg NB, Secher NH, Lundby C. Hypoxia increases exercise heart rate despite combined inhibition of β-adrenergic and muscarinic receptors. Am J Physiol Heart Circ Physiol 2015; 308:H1540-6. [DOI: 10.1152/ajpheart.00861.2014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/15/2015] [Indexed: 11/22/2022]
Abstract
Hypoxia increases the heart rate response to exercise, but the mechanism(s) remains unclear. We tested the hypothesis that the tachycardic effect of hypoxia persists during separate, but not combined, inhibition of β-adrenergic and muscarinic receptors. Nine subjects performed incremental exercise to exhaustion in normoxia and hypoxia (fraction of inspired O2 = 12%) after intravenous administration of 1) no drugs (Cont), 2) propranolol (Prop), 3) glycopyrrolate (Glyc), or 4) Prop + Glyc. HR increased with exercise in all drug conditions ( P < 0.001) but was always higher at a given workload in hypoxia than normoxia ( P < 0.001). Averaged over all workloads, the difference between hypoxia and normoxia was 19.8 ± 13.8 beats/min during Cont and similar (17.2 ± 7.7 beats/min, P = 0.95) during Prop but smaller ( P < 0.001) during Glyc and Prop + Glyc (9.8 ± 9.6 and 8.1 ± 7.6 beats/min, respectively). Cardiac output was enhanced by hypoxia ( P < 0.002) to an extent that was similar between Cont, Glyc, and Prop + Glyc (2.3 ± 1.9, 1.7 ± 1.8, and 2.3 ± 1.2 l/min, respectively, P > 0.4) but larger during Prop (3.4 ± 1.6 l/min, P = 0.004). Our results demonstrate that the tachycardic effect of hypoxia during exercise partially relies on vagal withdrawal. Conversely, sympathoexcitation either does not contribute or increases heart rate through mechanisms other than β-adrenergic transmission. A potential candidate is α-adrenergic transmission, which could also explain why a tachycardic effect of hypoxia persists during combined β-adrenergic and muscarinic receptor inhibition.
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Affiliation(s)
- C. Siebenmann
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Zurich, Switzerland
- Department of Environmental Physiology, School of Technology and Health, Royal Institute of Technology, Solna, Sweden
| | - P. Rasmussen
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Zurich, Switzerland
- Department of Anesthesia, The Copenhagen Muscle Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - H. Sørensen
- Department of Anesthesia, The Copenhagen Muscle Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - T. C. Bonne
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark; and
| | - M. Zaar
- Department of Anesthesia, The Copenhagen Muscle Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - N. B. Nordsborg
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark; and
| | - N. H. Secher
- Department of Anesthesia, The Copenhagen Muscle Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - C. Lundby
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Zurich, Switzerland
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Kriemler S, Radtke T, Bürgi F, Lambrecht J, Zehnder M, Brunner-La Rocca HP. Short-term cardiorespiratory adaptation to high altitude in children compared with adults. Scand J Med Sci Sports 2015; 26:147-55. [PMID: 25648726 DOI: 10.1111/sms.12422] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 11/25/2022]
Abstract
As short-term cardiorespiratory adaptation to high altitude (HA) exposure has not yet been studied in children, we assessed acute mountain sickness (AMS), hypoxic ventilatory response (HVR) at rest and maximal exercise capacity (CPET) at low altitude (LA) and HA in pre-pubertal children and their fathers. Twenty father-child pairs (11 ± 1 years and 44 ± 4 years) were tested at LA (450 m) and HA (3450 m) at days 1, 2, and 3 after fast ascent (HA1/2/3). HVR was measured at rest and CPET was performed on a cycle ergometer. AMS severity was mild to moderate with no differences between generations. HVR was higher in children than adults at LA and increased at HA similarly in both groups. Peak oxygen uptake (VO2 peak) relative to body weight was similar in children and adults at LA and decreased significantly by 20% in both groups at HA; maximal heart rate did not change at HA in children while it decreased by 16% in adults (P < 0.001). Changes in HVR and VO2 peak from LA to HA were correlated among the biological child-father pairs. In conclusion, cardiorespiratory adaptation to altitude seems to be at least partly hereditary. Even though children and their fathers lose similar fractions of aerobic capacity going to high altitude, the mechanisms might be different.
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Affiliation(s)
- S Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
| | - T Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
| | - F Bürgi
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
| | - J Lambrecht
- Department of Preventive Cardiology and Sports Medicine, University Clinic for Cardiology, Inselspital, University Hospital, Berne, Switzerland
| | - M Zehnder
- Department of Clinical Research, University and Inselspital Berne, Berne, Switzerland
| | - H P Brunner-La Rocca
- Medical University Center Maastricht, Cardiology, University of Maastricht, Maastricht, The Netherlands
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The application of maximal heart rate predictive equations in hypoxic conditions. Eur J Appl Physiol 2014; 115:277-84. [PMID: 25294663 DOI: 10.1007/s00421-014-3007-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Peak heart rate (HRpeak) is a common tool used in exercise prescription for groups in which maximal exercise intensity is contraindicated; however, the application of this method in normobaric hypoxia is unknown. Therefore, this study investigated the response of HRpeak and the application of predictive HRpeak equations to prescribe exercise intensity in acute normobaric hypoxia. Results were used to examine whether age-derived HRpeak predictive equations are valid in hypoxic conditions. METHODS Fifteen untrained (eight men) volunteers (age 22 ± 2 years; peak rate of oxygen consumption 46.3 ± 7.0 ml kg(-1) min(-1)) completed incremental cycle ergometer tests (randomised order) to measure HRpeak at sea-level (SL (ambient inspiratory oxygen fraction (FIO2) 0.209)) and four normobaric hypoxic conditions FIO2: 0.185, 0.165, 0.142, 0.125 (≈1,000-4,000 m). RESULTS HRpeak was similar across all conditions (SL, 182 ± 13; 0.185, 178 ± 11; 0.165, 177 ± 9; 0.142, 178 ± 9; 0.125, 175 ± 10 b min(-1)) despite a reduction in oxygen saturation with increasing hypoxia (SL, 95 ± 5; 0.185, 95 ± 2; 0.165, 92 ± 2; 0.142, 88 ± 3; 0.125, 82 ± 4 %; P ≤ 0.05). The HRpeak was overestimated by all equations compared to the measured value (P < 0.05). Four equations overestimated HRpeak in all conditions (P < 0.01); two in four conditions (0.185, 0.165, 0.142, 0.125; P < 0.01); and two in three conditions (0.165, 0.142, 0.125; P < 0.01). CONCLUSION The overestimation of HRpeak by commonly used age-derived predictive equations in normobaric hypoxic conditions suggests that despite possible contraindications researchers should directly measure HRpeak whenever possible if it is to be used to prescribe exercise intensities.
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Evans CA, Selvadurai H, Baur LA, Waters KA. Effects of obstructive sleep apnea and obesity on exercise function in children. Sleep 2014; 37:1103-10. [PMID: 24882905 DOI: 10.5665/sleep.3770] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
STUDY OBJECTIVES Evaluate the relative contributions of weight status and obstructive sleep apnea (OSA) to cardiopulmonary exercise responses in children. DESIGN Prospective, cross-sectional study. Participants underwent anthropometric measurements, overnight polysomnography, spirometry, cardiopulmonary exercise function testing on a cycle ergometer, and cardiac doppler imaging. OSA was defined as ≥ 1 obstructive apnea or hypopnea per hour of sleep (OAHI). The effect of OSA on exercise function was evaluated after the parameters were corrected for body mass index (BMI) z-scores. Similarly, the effect of obesity on exercise function was examined when the variables were adjusted for OAHI. SETTING Tertiary pediatric hospital. PARTICIPANTS Healthy weight and obese children, aged 7-12 y. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Seventy-one children were studied. In comparison with weight-matched children without OSA, children with OSA had a lower cardiac output, stroke volume index, heart rate, and oxygen consumption (VO2 peak) at peak exercise capacity. After adjusting for BMI z-score, children with OSA had 1.5 L/min (95% confidence interval -2.3 to -0.6 L/min; P = 0.001) lower cardiac output at peak exercise capacity, but minute ventilation and ventilatory responses to exercise were not affected. Obesity was only associated with physical deconditioning. Cardiac dysfunction was associated with the frequency of respiratory-related arousals, the severity of hypoxia, and heart rate during sleep. CONCLUSIONS Children with OSA are exercise limited due to a reduced cardiac output and VO2 peak at peak exercise capacity, independent of their weight status. Comorbid OSA can further decrease exercise performance in obese children.
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Affiliation(s)
- Carla A Evans
- The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics & Child Health, Faculty of Medicine, The University of Sydney NSW Australia
| | - Hiran Selvadurai
- The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics & Child Health, Faculty of Medicine, The University of Sydney NSW Australia ; The Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead NSW Australia
| | - Louise A Baur
- The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics & Child Health, Faculty of Medicine, The University of Sydney NSW Australia ; Weight Management Service, The Children's Hospital at Westmead, Westmead NSW Australia
| | - Karen A Waters
- The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics & Child Health, Faculty of Medicine, The University of Sydney NSW Australia ; The Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead NSW Australia
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Hawkes LA, Butler PJ, Frappell PB, Meir JU, Milsom WK, Scott GR, Bishop CM. Maximum running speed of captive bar-headed geese is unaffected by severe hypoxia. PLoS One 2014; 9:e94015. [PMID: 24710001 PMCID: PMC3977980 DOI: 10.1371/journal.pone.0094015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 03/12/2014] [Indexed: 11/19/2022] Open
Abstract
While bar-headed geese are renowned for migration at high altitude over the Himalayas, previous work on captive birds suggested that these geese are unable to maintain rates of oxygen consumption while running in severely hypoxic conditions. To investigate this paradox, we re-examined the running performance and heart rates of bar-headed geese and barnacle geese (a low altitude species) during exercise in hypoxia. Bar-headed geese (n = 7) were able to run at maximum speeds (determined in normoxia) for 15 minutes in severe hypoxia (7% O2; simulating the hypoxia at 8500 m) with mean heart rates of 466±8 beats min−1. Barnacle geese (n = 10), on the other hand, were unable to complete similar trials in severe hypoxia and their mean heart rate (316 beats.min−1) was significantly lower than bar-headed geese. In bar-headed geese, partial pressures of oxygen and carbon dioxide in both arterial and mixed venous blood were significantly lower during hypoxia than normoxia, both at rest and while running. However, measurements of blood lactate in bar-headed geese suggested that anaerobic metabolism was not a major energy source during running in hypoxia. We combined these data with values taken from the literature to estimate (i) oxygen supply, using the Fick equation and (ii) oxygen demand using aerodynamic theory for bar-headed geese flying aerobically, and under their own power, at altitude. This analysis predicts that the maximum altitude at which geese can transport enough oxygen to fly without environmental assistance ranges from 6,800 m to 8,900 m altitude, depending on the parameters used in the model but that such flights should be rare.
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Affiliation(s)
- Lucy A. Hawkes
- School of Biological Sciences, Bangor University, Bangor, Gwynedd, United Kingdom
- University of Exeter, College of Life and Environmental Sciences, Penryn Campus, Penryn, Cornwall, United Kingdom
- * E-mail:
| | - Patrick J. Butler
- School of Biosciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Jessica U. Meir
- Department of Anesthesia, Critical care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - William K. Milsom
- Department of Zoology, University of British Columbia, Vancouver, Canada
| | - Graham R. Scott
- Department of Biology, McMaster University, Hamilton, Ontario, Canada
| | - Charles M. Bishop
- University of Exeter, College of Life and Environmental Sciences, Penryn Campus, Penryn, Cornwall, United Kingdom
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Calbet JAL, Joyner MJ. Disparity in regional and systemic circulatory capacities: do they affect the regulation of the circulation? Acta Physiol (Oxf) 2010; 199:393-406. [PMID: 20345408 DOI: 10.1111/j.1748-1716.2010.02125.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this review we integrate ideas about regional and systemic circulatory capacities and the balance between skeletal muscle blood flow and cardiac output during heavy exercise in humans. In the first part of the review we discuss issues related to the pumping capacity of the heart and the vasodilator capacity of skeletal muscle. The issue is that skeletal muscle has a vast capacity to vasodilate during exercise [approximately 300 mL (100 g)(-1) min(-1)], but the pumping capacity of the human heart is limited to 20-25 L min(-1) in untrained subjects and approximately 35 L min(-1) in elite endurance athletes. This means that when more than 7-10 kg of muscle is active during heavy exercise, perfusion of the contracting muscles must be limited or mean arterial pressure will fall. In the second part of the review we emphasize that there is an interplay between sympathetic vasoconstriction and metabolic vasodilation that limits blood flow to contracting muscles to maintain mean arterial pressure. Vasoconstriction in larger vessels continues while constriction in smaller vessels is blunted permitting total muscle blood flow to be limited but distributed more optimally. This interplay between sympathetic constriction and metabolic dilation during heavy whole-body exercise is likely responsible for the very high levels of oxygen extraction seen in contracting skeletal muscle. It also explains why infusing vasodilators in the contracting muscles does not increase oxygen uptake in the muscle. Finally, when approximately 80% of cardiac output is directed towards contracting skeletal muscle modest vasoconstriction in the active muscles can evoke marked changes in arterial pressure.
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Affiliation(s)
- J A L Calbet
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, Spain.
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Windsor JS, Rodway GW, Montgomery HE. A Review of Electrocardiography in the High Altitude Environment. High Alt Med Biol 2010; 11:51-60. [DOI: 10.1089/ham.2009.1065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jeremy S. Windsor
- UCL Centre for Altitude, Space and Extreme Environment Medicine, Institute of Human Health and Performance, University College London, London, UK
| | - George W. Rodway
- UCL Centre for Altitude, Space and Extreme Environment Medicine, Institute of Human Health and Performance, University College London, London, UK
- University of Utah, College of Nursing and School of Medicine, Salt Lake City, Utah, USA
| | - Hugh E. Montgomery
- UCL Centre for Altitude, Space and Extreme Environment Medicine, Institute of Human Health and Performance, University College London, London, UK
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de Vries ST, Komdeur P, Aalbersberg S, van Enst GC, Breeman A, van 't Hof AWJ. Effects of altitude on exercise level and heart rate in patients with coronary artery disease and healthy controls. Neth Heart J 2010; 18:118-21. [PMID: 20390061 PMCID: PMC2848353 DOI: 10.1007/bf03091749] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background. To evaluate the safety and effects of high altitude on exercise level and heart rate in patients with coronary artery disease compared with healthy controls.Methods. Eight patients with a history of an acute myocardial infarction (ejection fraction >5%) with a low-risk score were compared with seven healthy subjects during the Dutch Heart Expedition at the Aconcagua in Argentina in March 2007. All subjects underwent a maximum exercise test with a cycle ergometer at sea level and base camp, after ten days of acclimatisation, at an altitude of 4200 m. Exercise capacity and maximum heart rate were compared between groups and within subjects.Results. There was a significant decrease in maximum heart rate at high altitude compared with sea level in both the patient and the control group (166 vs. 139 beats/min, p<0.001 and 181 vs. 150 beats/min, p<0.001). There was no significant difference in the decrease of the exercise level and maximum heart rate between patients and healthy controls (-31 vs. -30%, p=0.673).Conclusion. Both patients and healthy controls showed a similar decrease in exercise capacity and maximum heart rate at 4200 m compared with sea level, suggesting that patients with a history of coronary artery disease may tolerate stay and exercise at high altitude similarly to healthy controls. (Neth Heart J 2010;18:118-21.).
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Affiliation(s)
- S T de Vries
- Department of Sports Medicine, Isala Clinics, Zwolle, the Netherlands
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Leissner KB, Mahmood FU. Physiology and pathophysiology at high altitude: considerations for the anesthesiologist. J Anesth 2009; 23:543-53. [DOI: 10.1007/s00540-009-0787-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 04/30/2009] [Indexed: 10/20/2022]
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Abstract
Aerobic exercise capacity decreases with exposure to hypoxia. This article focuses on the effects of hypoxia on nervous system function and the potential consequences for the exercising human. Emphasis is put on somatosensory muscle afferents due to their crucial role in the reflex inhibition of muscle activation and in cardiorespiratory reflex control during exercise. We review the evidence of hypoxia influences on muscle afferents and discuss important consequences for exercise performance. Efferent (motor) nerves are less affected at altitude and are thought to stay fairly functional even in severe levels of arterial hypoxemia. Altitude also alters autonomic nervous system functions, which are thought to play an important role in the regulation of cardiac output and ventilation. Finally, the consequences of hypoxia-induced cortical adaptations and dysfunctions are evaluated in terms of neurotransmitter turnover, brain electrical activity, and cortical excitability. Even though the cessation of exercise or the reduction of exercise intensity, when reaching maximum performance, implies reduced motor recruitment by the nervous system, the mechanisms that lead to the de-recruitment of active muscle are still not well understood. In moderate hypoxia, muscle afferents appear to play an important role, whereas in severe hypoxia brain oxygenation may play a more important role.
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Affiliation(s)
- Markus Amann
- University of Zürich , Institute of Physiology, and ETH Zürich, Exercise Physiology, Zürich, Switzerland.
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Rapidity of responding to a hypoxic challenge during exercise. Eur J Appl Physiol 2009; 106:493-9. [DOI: 10.1007/s00421-009-1036-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2009] [Indexed: 10/21/2022]
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Favret F, Richalet JP. Exercise and hypoxia: The role of the autonomic nervous system. Respir Physiol Neurobiol 2007; 158:280-6. [PMID: 17521971 DOI: 10.1016/j.resp.2007.04.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 03/14/2007] [Accepted: 04/05/2007] [Indexed: 10/23/2022]
Abstract
The reduction in maximal oxygen consumption in hypoxia can be due to physiological factors, the relative importance of which depends on the degree of hypoxia: the reduction in inspired PO2, the impairment of lung gas exchange contributing to an exercise-induced decrease in arterial O(2) saturation, the reduction in maximal cardiac output and the limitation in tissue diffusion. This paper focuses on two aspects of this oxygen cascade. First, the decrease in heart rate at maximal exercise in prolonged exposure to hypoxia is discussed and the role of changes in the autonomous nervous system is emphasised. The desensitization of the beta-adrenergic pathway and the upregulation of the muscarinic pathway, both using G-protein systems, contribute to limit the myocardial O(2) consumption in face of reduced O(2) availability during maximal exercise in hypoxia. The changes in O(2) diffusion to the tissues are discussed in relation to the expression of hypoxia inducible factor (HIF-1alpha) and vascular endothelial growth factor (VEGF) and their possible changes induced by training and/or hypoxic exposure.
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Affiliation(s)
- Fabrice Favret
- Université Paris 13, Laboratoire EA2363 Réponses Cellulaires et Fonctionnelles à l'hypoxie, 74 rue Marcel Cachin, Bobigny, France
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Schmid JP, Noveanu M, Gaillet R, Hellige G, Wahl A, Saner H. Safety and exercise tolerance of acute high altitude exposure (3454 m) among patients with coronary artery disease. Heart 2005; 92:921-5. [PMID: 16339809 PMCID: PMC1860700 DOI: 10.1136/hrt.2005.072520] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the safety and cardiopulmonary adaptation to high altitude exposure among patients with coronary artery disease. METHODS 22 patients (20 men and 2 women), mean age 57 (SD 7) years, underwent a maximal, symptom limited exercise stress test in Bern, Switzerland (540 m) and after a rapid ascent to the Jungfraujoch (3454 m). The study population comprised 15 patients after ST elevation myocardial infarction and 7 after a non-ST elevation myocardial infarction 12 (SD 4) months after the acute event. All patients were revascularised either by percutaneous coronary angioplasty (n = 15) or by coronary artery bypass surgery (n = 7). Ejection fraction was 60 (SD 8)%. beta blocking agents were withheld for five days before exercise testing. RESULTS At 3454 m, peak oxygen uptake decreased by 19% (p < 0.001), maximum work capacity by 15% (p < 0.001) and exercise time by 16% (p < 0.001); heart rate, ventilation and lactate were significantly higher at every level of exercise, except at maximum exertion. No ECG signs of myocardial ischaemia or significant arrhythmias were noted. CONCLUSIONS Although oxygen demand and lactate concentrations are higher during exercise at high altitude, a rapid ascent and submaximal exercise can be considered safe at an altitude of 3454 m for low risk patients six months after revascularisation for an acute coronary event and a normal exercise stress test at low altitude.
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Affiliation(s)
- J-P Schmid
- Swiss Cardiovascular Centre Bern, Cardiovascular Prevention & Rehabilitation, University Hospital (Inselspital), Bern, Switzerland.
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Woorons X, Mollard P, Lamberto C, Letournel M, Richalet JP. Effect of acute hypoxia on maximal exercise in trained and sedentary women. Med Sci Sports Exerc 2005; 37:147-54. [PMID: 15632681 DOI: 10.1249/01.mss.0000150020.25153.34] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to determine the physiological responses of sedentary and endurance-trained female subjects during maximal exercise at different levels of acute hypoxia. METHODS Fourteen women who were sea level residents were divided into two groups according to their level of fitness: 1) endurance-trained women (TW) (N = 7), VO(2max) = 56.3 +/- 4.7 mL.kg(-1).min(-1); and 2) sedentary women (SW) (N = 7), VO(2max) = 34.8 +/- 5.6 mL.kg(-1).min(-1). Subjects performed four maximal cycle ergometer tests in normoxia and under hypoxic conditions (F(I)O(2) = 0.187, 0.154, and 0.117, corresponding to altitudes of 1000, 2500, and 4500 m, respectively). RESULTS VO(2max) decreased significantly by 3.6 +/- 2.1, 14 +/- 2.5, and 27.4 +/- 3.6% in TW, and by 5 +/- 4, 9.4 +/- 6.4, and 18.7 +/- 7% in SW at 1000, 2500, and 4500 m, respectively. The drop of VO(2max) (DeltaVO(2max)) was greater in TW at and above 2500 m. Arterial O2 saturation (SpO(2)) at maximal exercise was lower in TW at every altitude (1000 m: 90.9 +/- 1.9 vs 94.6 +/- 1.4%; 2500 m: 82.8 +/- 2.8 vs 90.0 +/- 2.1%; 4500 m: 65.0 +/- 4.7 vs 73.6 +/- 4.5%). Maximal heart rate decreased significantly from 1000 m in the two groups. SpO(2) was correlated to DeltaVO(2max) at 4500 m (r = -0.81, P < 0.01) and 2500 m (r = -0.81, P < 0.01), but not below. Furthermore, we noted a relationship between SpO(2) and O2 pulse (VO(2)/HR) at every F(I)O(2). CONCLUSION These results demonstrate that endurance-trained women show a greater decrement in VO(2max) at high altitudes. This could be explained mainly by a higher arterial desaturation, which is largely caused, according to our results, by diffusion limitation.
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Affiliation(s)
- Xavier Woorons
- Laboratory of Functional and Cellular Responses to Hypoxia, UFR-SMBH Universite Paris, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France.
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Niess AM, Fehrenbach E, Strobel G, Roecker K, Schneider EM, Buergler J, Fuss S, Lehmann R, Northoff H, Dickhuth HH. Evaluation of stress responses to interval training at low and moderate altitudes. Med Sci Sports Exerc 2003; 35:263-9. [PMID: 12569215 DOI: 10.1249/01.mss.0000048834.68889.81] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of the present field study was to explore whether extensive interval training (IT) performed with a similar behavior of blood lactate (LA) at an altitude of 1800 m (ALT) and near sea level (SL) goes along with a comparable hormonal, metabolic, and acute phase response in highly trained endurance athletes. METHODS Twelve distance runners (VO2 64.6 +/- 6.9 mL.kg(-1) ) performed IT (10 x 1000 m, 2-min rest) at SL with a running velocity (V) corresponding to 112% of the individual anaerobic threshold (IAT). After an acclimatization period of 7 d, IT was repeated with a lower V (107% IAT) at ALT. Blood samples were drawn at rest, 0, 0.3, 3, and 24 h after IT. LA during IT was similar at SL and ALT (5.4 +/- 1.3/5.3 +/- 1.2 mmol.L(-1)), whereas HR tended to be higher at SL. RESULTS Postexercise rises in plasma noradrenaline (NA), NA sulfate, adrenaline, glucose, interleukin-6 (IL-6), and neutrophils were significantly more pronounced at ALT. The increase of cortisol and human growth hormone showed an insignificant trend toward higher values at ALT. A slight but significant increase of plasma erythropoietin was only apparent after IT at ALT. No differences between either condition were observed for exercise-related changes in free fatty acids, IL-8, lympho-, or monocyte counts. CONCLUSIONS In spite of a matched accumulation pattern of LA between ALT and N, stress responses, such as sympathetic activation and hepatic glucose release, still appear to be greater at ALT. This additional impact of moderate ALT on the stress response to IT should be taken into account if repeated training sessions are performed within a short period of time.
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Affiliation(s)
- Andreas Michael Niess
- Center of Internal Medicine, Department of Rehabilitative and Preventive Sports Medicine, University of Freiburg, Freiburg, Germany.
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