Fatigue and Exhaustion in Hypoxia: The Role of Cerebral Oxygenation

No sex differences in performance and perceived fatigability during a self-paced endurance exercise performed under moderate hypoxia

This study examined potential sex differences in performance and perceived fatigability during a whole body endurance exercise performed under normoxia or moderate hypoxia. Nine males and eight females cyclists performed a 4-km cycling time trial under normoxia or hypoxia conditions. Performance fatigability and its central and peripheral determinants were measured via pre- to post-exercise changes in maximal voluntary isometric contraction (IMVC), voluntary activation (VA), and potentiated twitch force (TwPt) of knee extensors, respectively. Perceived fatigability was characterized via a rating of perceived exertion (RPE). Time to complete the trial was longer in hypoxia than normoxia in females (482 ± 24 vs. 465 ± 21 s) and males (433 ± 30 vs. 408 ± 31 s) (P = 0.039). There was no effect of sex or condition (P ≥ 0.370) for the magnitude of decrease in IMVC (female: normoxia = -14.3 ± 4.4%, hypoxia = -11.8 ± 5.2% vs. male: normoxia = -13.1 ± 9.4%, hypoxia = -12.9 ± 9.8%), TwPt (female: normoxia = -34.4 ± 11.4%, hypoxia = -31.8 ± 18.9% vs. male: normoxia = -30.5 ± 17.9%, hypoxia = -31.9 ± 20.9%), and VA (female: normoxia = -0.5 ± 2.3%, hypoxia = -1.6 ± 1.6% vs. male: normoxia = 0.8 ± 2.2%, hypoxia = -0.5 ± 1.3%). RPE was higher in hypoxia than in normoxia for both groups (P = 0.002). In conclusion, moderate hypoxia similarly impairs performance and perceived fatigability development in females and males during a 4-km cycling time trial.NEW & NOTEWORTHY In this study, we showed that females and males develop a similar hypoxia-induced impairment in endurance performance, perceived and performance fatigability during a 4-km cycling time trial. These novel findings indicate that females and males regulate their power output similarly during a 4-km cycling time trial under moderate hypoxia, likely to avoid prematurely exacerbating metabolic disturbances and thereby reaching comparable levels of performance fatigability by the end of the task.

Thoracic load carriage impairs the acute physiological response to hypoxia in healthy males

To assess the impact of thoracic load carriage on the physiological response to exercise in hypoxia. Healthy males (n = 12) completed 3 trials consisting of 45 min walking in the following conditions: (1) unloaded normoxia (UN; FIO2:20.93%); (2) unloaded hypoxia (UH; FIO2:~13.0%); and (3) loaded hypoxia (LH; 29.5 kg; FIO2:~13.0%). Intensity was matched for absolute VO2 (2.0 ± 0.2 L·min-1) across conditions and relative VO2 (64.0 ± 2.6 %VO2max) across hypoxic conditions. With LH versus UH, there were increases in breathing frequency (5-11 breaths·min-1; p < 0.05) and decreases in tidal volume (10%-18%; p < 0.05) throughout exercise due to reductions in end inspiratory lung volumes (p < 0.05). Consequently, deadspace (11%-23%; p < 0.05) and minute ventilation (7%-11%; p < 0.05) were increased starting at 20 and 30 min, respectively. In addition, LH increased perceived exertion/dyspnea and induced inspiratory (~12%; p < 0.05 vs. UN) and expiratory (~10%; p < 0.05 vs. pre-exercise) respiratory muscle fatigue. Expiratory flow limitation was present in 50% of subjects during LH. Cardiac output and muscle oxygenation were maintained during LH despite reduced stroke volume (6%-8%; p < 0.05). Finally, cerebral oxygenated/total hemoglobin were elevated in the LH condition versus UH starting at 15 min (p < 0.05). Thoracic load carriage increases physiological strain and interferes with the compensatory response to hypoxic exposure.

New insights into the cellular and molecular mechanisms of skeletal muscle fatigue: the Marion J. Siegman Award Lectureships

Skeletal muscle fibers need to have mechanisms to decrease energy consumption during intense physical exercise to avoid devastatingly low ATP levels, with the formation of rigor cross bridges and defective ion pumping. These protective mechanisms inevitably lead to declining contractile function in response to intense exercise, characterizing fatigue. Through our work, we have gained insights into cellular and molecular mechanisms underlying the decline in contractile function during acute fatigue. Key mechanistic insights have been gained from studies performed on intact and skinned single muscle fibers and more recently from studies performed and single myosin molecules. Studies on intact single fibers revealed several mechanisms of impaired sarcoplasmic reticulum Ca2+ release and experiments on single myosin molecules provide direct evidence of how putative agents of fatigue impact myosin's ability to generate force and motion. We conclude that changes in metabolites due to an increased dependency on anaerobic metabolism (e.g., accumulation of inorganic phosphate ions and H+) act to directly and indirectly (via decreased Ca2+ activation) inhibit myosin's force and motion-generating capacity. These insights into the acute mechanisms of fatigue may help improve endurance training strategies and reveal potential targets for therapies to attenuate fatigue in chronic diseases.

Fast Competitive Swimmers Demonstrate a Diminished Diving Reflex

Competitive swimmers complete 50-m front crawl swimming without breathing or with a limited number of breaths. Breath holding during exercise can trigger diving reflex including bradycardia and diminished active muscle blood flow, whereas oxygen supply to vital organ such as brain is maintained. We hypothesized that swimmers achieving faster time in 50-m front crawl with limited number of breaths demonstrate a blunted diving reflex of cardiac and active muscle blood flow responses with elevated cerebral perfusion to counteract peripheral and central fatigues. Twenty-eight competitive swimmers (12 females) underwent a 50-m front crawl swimming time trial with minimum respiratory interruptions, following which they were categorized into two groups: Fast (n = 13) and Slow (n = 15). Additionally, they performed knee extension exercises with maximal voluntary breath- holding, wherein leg blood flow (Doppler ultrasound), cardiac output (Modelflow), heart rate (electrocardiogram), and middle cerebral artery mean blood velocity (transcranial Doppler ultrasound) were evaluated. The pattern of leg blood flow response differed between the two groups (p = 0.031) with the Fast group experiencing a delayed onset of reductions in leg blood flow (p = 0.035). The onset of bradycardia was also delayed in the Fast group (p = 0.014), with this group demonstrating a higher value of the lowest heart rate (between-trial difference in average: 15.9 [3.73, 28.2] beats/min) and cardiac output (between-trial difference in median: 2.84 L/min) (both, p ≤ 0.013). Middle cerebral artery mean blood velocity was similar between the groups (all p ≥ 0.112). We show that swimmers with superior performance in 50-m front crawl swim with limited breaths display a diminished diving reflex.

Caffeine intake enhances peak oxygen uptake and performance during high-intensity cycling exercise in moderate hypoxia

PURPOSE

We investigated whether caffeine consumption can enhance peak oxygen uptake ([Formula: see text]) by increasing peak ventilation during an incremental cycling test, and subsequently enhance time to exhaustion (TTE) during high-intensity cycling exercise in moderate normobaric hypoxia.

METHODS

We conducted a double-blind, placebo cross-over design study. Sixteen recreational male endurance athletes (age: 20 ± 2 years, [Formula: see text]: 55.6 ± 3.6 ml/kg/min, peak power output: 318 ± 40 W) underwent an incremental cycling test and a TTE test at 80% [Formula: see text] (derived from the placebo trial) in moderate normobaric hypoxia (fraction of inspired O2: 15.3 ± 0.2% corresponding to a simulated altitude of ~ 2500 m) after consuming either a moderate dose of caffeine (6 mg/kg) or a placebo.

RESULTS

Caffeine consumption resulted in a higher peak ventilation [159 ± 21 vs. 150 ± 26 L/min; P < 0.05; effect size (ES) = 0.31]. [Formula: see text] (3.58 ± 0.44 vs. 3.47 ± 0.47 L/min; P < 0.01; ES = 0.44) and peak power output (308 ± 44 vs. 302 ± 44 W; P = 0.02, ES = 0.14) were higher following caffeine consumption than during the placebo trial. During the TTE test, caffeine consumption enhanced minute ventilation (P = 0.02; ES = 0.28) and extended the TTE (426 ± 74 vs. 358 ± 75 s; P < 0.01, ES = 0.91) compared to the placebo trial. There was a positive correlation between the percent increase of [Formula: see text] following caffeine consumption and the percent increase in TTE (r = 0.49, P < 0.05).

CONCLUSION

Moderate caffeine consumption stimulates breathing and aerobic metabolism, resulting in improved performance during incremental and high-intensity endurance exercises in moderate normobaric hypoxia.

Monocarboxylate transporter-dependent mechanism is involved in the adaptability of the body to exercise-induced fatigue under high-altitude hypoxia environment

Under high-altitude hypoxia environment, the body is more prone to fatigue, which occurs in both peripheral muscles and the central nervous system (CNS). The key factor determining the latter is the imbalance of brain energy metabolism, which makes it difficult to maintain the central nervous system to send peripheral nerve impulse continuously. During strenuous exercise, lactate released from astrocytes is taken up by neurons stored for energy to maintain synaptic transmission, a process mediated by monocarboxylate transporters (MCTs) in CNS. The present study investigated the correlation among the adaptability to exercise-induced fatigue, brain lactate metabolism and neuronal hypoxia injury under high-altitude hypoxia environment. Rats were subjected to exhaustive incremental load treadmill exercise under either normal pressure and normoxic conditions or simulated high-altitude low pressure and hypoxic conditions, with subsequent evaluation of the average exhaustive time as well as the expression of monocarboxylate transporters 2 (MCT2), MCT4, the average neuronal density in the cerebral motor cortex, and the lactate content in rat brain. At the early stage of simulated high-altitude environment, the average exhaustive time and neuronal density of rats decreased rapidly, then gradually recovered to some extent with the extension of altitude acclimatization time. The expression of MCT2, MCT4 and the lactate content in rat brain also increased gradually with the extension of altitude acclimatization time. After the application of lactate transport inhibitor, the recovery of exercise capacity of rats after altitude acclimatization was quickly blocked, and the neuronal injury in the cerebral motor cortex of rats was also significantly aggravated. These findings demonstrate that MCT-dependent mechanism is involved in the adaptability of the body to central fatigue, and provide a potential basis for medical intervention for exercise-induced fatigue under high-altitude hypoxia environment.

A monocarboxylate transporter-dependent mechanism confers resistance to exercise-induced fatigue in a high-altitude hypoxic environment

The body is more prone to fatigue in a high-altitude hypoxic environment, in which fatigue occurs in both peripheral muscles and the central nervous system (CNS). The key factor determining the latter is the imbalance in brain energy metabolism. During strenuous exercise, lactate released from astrocytes is taken up by neurons via monocarboxylate transporters (MCTs) as a substrate for energy metabolism. The present study investigated the correlations among the adaptability to exercise-induced fatigue, brain lactate metabolism and neuronal hypoxia injury in a high-altitude hypoxic environment. Rats were subjected to exhaustive incremental load treadmill exercise under either normal pressure and normoxic conditions or simulated high-altitude, low-pressure and hypoxic conditions, with subsequent evaluation of the average exhaustive time as well as the expression of MCT2 and MCT4 in the cerebral motor cortex, the average neuronal density in the hippocampus, and the brain lactate content. The results illustrate that the average exhaustive time, neuronal density, MCT expression and brain lactate content were positively correlated with the altitude acclimatization time. These findings demonstrate that an MCT-dependent mechanism is involved in the adaptability of the body to central fatigue and provide a potential basis for medical intervention for exercise-induced fatigue in a high-altitude hypoxic environment.

Post-COVID-19 Syndrome is Rarely Associated with Damage of the Nervous System: Findings from a Prospective Observational Cohort Study in 171 Patients

INTRODUCTION

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect multiple organs. Reports of persistent or newly emergent symptoms, including those related to the nervous system, have increased over the course of the pandemic, leading to the introduction of post-COVID-19 syndrome. However, this novel syndrome is still ill-defined and structured objectification of complaints is scarce. Therefore, we performed a prospective observational cohort study to better define and validate subjective neurological disturbances in patients with post-COVID-19 syndrome.

METHODS

A total of 171 patients fulfilling the post-COVID-19 WHO Delphi consensus criteria underwent a comprehensive neurological diagnostic work-up including neurovascular, electrophysiological, and blood analysis. In addition, magnetic resonance imaging (MRI) and lumbar puncture were conducted in subgroups of patients. Furthermore, patients underwent neuropsychological, psychosomatic, and fatigue assessment.

RESULTS

Patients were predominantly female, middle-aged, and had incurred mostly mild-to-moderate acute COVID-19. The most frequent post-COVID-19 complaints included fatigue, difficulties in concentration, and memory deficits. In most patients (85.8%), in-depth neurological assessment yielded no pathological findings. In 97.7% of the cases, either no diagnosis other than post COVID-19 syndrome, or no diagnosis likely related to preceding acute COVID-19 could be established. Sensory or motor complaints were more often associated with a neurological diagnosis other than post-COVID-19 syndrome. Previous psychiatric conditions were identified as a risk factor for developing post-COVID-19 syndrome. We found high somatization scores in our patient group that correlated with cognitive deficits and the extent of fatigue.

CONCLUSIONS

Albeit frequently reported by patients, objectifiable affection of the nervous system is rare in post-COVID-19 syndrome. Instead, elevated levels of somatization point towards a pathogenesis potentially involving psychosomatic factors. However, thorough neurological assessment is important in this patient group in order to not miss neurological diseases other than post-COVID-19.

Pharmaceutical Potential of High-Altitude Plants for Fatigue-Related Disorders: A Review

Natural plants from plateaus have been the richest source of secondary metabolites extensively used in traditional and modern health care systems. They were submitted to years of natural selection, co-evolved within that habitat, and show significant anti-fatigue-related pharmacological effects. However, currently, no review on high-altitude plants with anti-fatigue related properties has been published yet. This study summarized several Chinese traditional high-altitude plants, including Rhodiola rosea L., Crocus sativus L., Lepidium meyenii W., Hippophaerhamnoides L., which are widely used in the Qinghai–Tibet Plateau and surrounding mountains, as well as herbal markets in the plains. Based on phytopharmacology studies, deeper questions can be further revealed regarding how these plants regulate fatigue and related mental or physical disease conditions. Many active derivatives in high-altitude medical plants show therapeutic potential for the management of fatigue and related disorders. Therefore, high-altitude plants significantly relieve central or peripheral fatigue by acting as neuroprotective agents, energy supplements, metabolism regulators, antioxidant, and inflammatory response inhibitors. Their applications on the highland or flatland and prospects in natural medicine are further forecast, which may open treatments to reduce or prevent fatigue-related disorders in populations with sub-optimal health.

CO2-Enriched Air Inhalation Modulates the Ventilatory and Metabolic Responses of Endurance Runners During Incremental Running in Hypobaric Hypoxia

Cao, Yinhang, Naoto Fujii, Tomomi Fujimoto, Yin-Feng Lai, Takeshi Ogawa, Tsutomu Hiroyama, Yasushi Enomoto, and Takeshi Nishiyasu. CO₂-enriched air inhalation modulates the ventilatory and metabolic responses of endurance runners during incremental running in hypobaric hypoxia. High Alt Med Biol. 23:125-134, 2022. Aim: We measured the effects of breathing CO₂-enriched air on ventilatory and metabolic responses during incremental running exercise under moderately hypobairc hypoxic (HH) conditions. Materials and Methods: Ten young male endurance runners [61.4 ± 6.0 ml/(min·kg)] performed incremental running tests under three conditions: (1) normobaric normoxia (NN), (2) HH (2,500 m), and (3) HH with 5% CO₂ inhalation (HH+CO₂). The test under NN was always performed first, and then, the two remaining tests were completed in random and counterbalanced order. Results: End-tidal CO₂ partial pressure (55 ± 3 vs. 35 ± 1 mmHg), peak ventilation (163 ± 14 vs. 152 ± 12 l/min), and peak oxygen uptake [52.3 ± 5.5 vs. 50.5 ± 4.9 ml/(min·kg)] were all higher in the HH+CO₂ than HH trial (all p < 0.01), respectively. However, the duration of the incremental test did not differ between HH+CO₂ and HH trials. Conclusion: These data suggest that chemoreflex activation by breathing CO₂-enriched air stimulates breathing and aerobic metabolism during maximal intensity exercise without affecting exercise performance in male endurance runners under a moderately hypobaric hypoxic environment.

Neuromuscular fatigability at high altitude: Lowlanders with acute and chronic exposure, and native highlanders

Ascent to high altitude is accompanied by a reduction in partial pressure of inspired oxygen, which leads to interconnected adjustments within the neuromuscular system. This review describes the unique challenge that such an environment poses to neuromuscular fatigability (peripheral, central and supraspinal) for individuals who normally reside near to sea level (SL) (<1000 m; ie, lowlanders) and for native highlanders, who represent the manifestation of high altitude-related heritable adaptations across millennia. Firstly, the effect of acute exposure to high altitude-related hypoxia on neuromuscular fatigability will be examined. Under these conditions, both supraspinal and peripheral fatigability are increased compared with SL. The specific mechanisms contributing to impaired performance are dependent on the exercise paradigm and amount of muscle mass involved. Next, the effect of chronic exposure to high altitude (ie, acclimatization of ~7-28 days) will be considered. With acclimatization, supraspinal fatigability is restored to SL values, regardless of the amount of muscle mass involved, whereas peripheral fatigability remains greater than SL except when exercise involves a small amount of muscle mass (eg, knee extensors). Indeed, when whole-body exercise is involved, peripheral fatigability is not different to acute high-altitude exposure, due to competing positive (haematological and muscle metabolic) and negative (respiratory-mediated) effects of acclimatization on neuromuscular performance. In the final section, we consider evolutionary adaptations of native highlanders (primarily Himalayans of Tibet and Nepal) that may account for their superior performance at altitude and lesser degree of neuromuscular fatigability compared with acclimatized lowlanders, for both single-joint and whole-body exercise.

Effects of Transcranial Direct Current Stimulation on Upper Limb Muscle Strength and Endurance in Healthy Individuals: A Systematic Review and Meta-Analysis

Objective

Whether transcranial direct current stimulation (tDCS) can improve upper limb muscle strength and endurance in healthy subjects is still controversial. This article reviews the relevant literature on the use of tDCS to improve upper limb muscle strength and endurance in healthy individuals.

Methods

We systematically searched the Cochrane Library, PubMed, EMBASE, and the Web of Science until September 4, 2021. Randomized parallel or crossover experimental studies on the effects of tDCS on upper limb muscle strength and endurance in healthy individuals were included. Review Manager 5.3 software was used to evaluate methodological quality and analyze the combined effect of the included literature.

Results

Twelve studies (189 participants) were included in the qualitative synthesis, and nine studies (146 participants) were included in the meta-analysis. Compared with the control group, the tDCS intervention had no significant effect on improving upper limb muscle strength [I² = 0%, 95% CI (−0.79, 0.23), p = 0.98, MD = 0.01]. In this analysis, tDCS had a significant heterogeneity (I² = 87%) in improving upper limb muscle endurance compared with the control group. After the subgroup analysis and the sensitivity analysis, the source of heterogeneity was excluded. The final results showed that tDCS had a significant effect on improving upper limb muscle endurance [I² = 0%, 95% CI (1.91, 4.83), p < 0.00001, MD = 3.37].

Conclusions

tDCS has no significant effect on improvement of upper limb muscle strength, but has a significant effect on improving upper limb endurance performance (especially on the non-dominant side).

Self-Selected Motivational Music Enhances Physical Performance in Normoxia and Hypoxia in Young Healthy Males

Humans exposed to hypoxia are susceptible to physiological and psychological impairment. Music has ergogenic effects through enhancing psychological factors such as mood, emotion, and cognition. This study aimed to investigate music as a tool for mitigating the performance decrements observed in hypoxia. Thirteen males (mean ± SD; 24 ± 4 years) completed one familiarization session and four experimental trials; (1) normoxia (sea level, 0.209 FiO₂) and no music; (2) normoxia (0.209 FiO₂) with music; (3) normobaric hypoxia (∼3800 m, 0.13 FiO₂) and no music; and (4) normobaric hypoxia (0.13 FiO₂) with music. Experimental trials were completed at 21°C with 50% relative humidity. Music was self-selected prior to the familiarization session. Each experimental trial included a 15-min time trial on an arm bike, followed by a 60-s isometric maximal voluntary contraction (MVC) of the biceps brachii. Supramaximal nerve stimulation quantified central and peripheral fatigue with voluntary activation (VA%) calculated using the doublet interpolation method. Average power output (W) was reduced with a main effect of hypoxia (p = 0.02) and significantly increased with a main effect of music (p = 0.001). When combined the interaction was additive (p = 0.87). Average MVC force (N) was reduced in hypoxia (p = 0.03) but VA% of the biceps brachii was increased with music (p = 0.02). Music reduced subjective scores of mental effort, breathing discomfort, and arm discomfort in hypoxia (p < 0.001). Music increased maximal physical exertion through enhancing neural drive and diminishing detrimental mental processes, enhancing performance in normoxia (6.3%) and hypoxia (6.4%).

Measures of excess V ˙ CO2 and recovery V ˙ CO2 as indices of performance fatigability during exercise: a pilot study

BACKGROUND

The severity of performance fatigability and the capacity to recover from activity are profoundly influenced by skeletal muscle energetics, specifically the ability to buffer fatigue-inducing ions produced from anaerobic metabolism. Mechanisms responsible for buffering these ions result in the production of excess carbon dioxide (CO2) that can be measured as expired CO2 (V ˙ CO2) during cardiopulmonary exercise testing (CPET). The primary objective of this study was to assess the feasibility of select assessment procedures for use in planning and carrying out interventional studies, which are larger interventional studies investigating the relationships between CO2 expiration, measured during and after both CPET and submaximal exercise testing, and performance fatigability.

METHODS

Cross-sectional, pilot study design. Seven healthy subjects (30.7±5.1 years; 5 females) completed a peak CPET and constant work-rate test (CWRT) on separate days, each followed by a 10-min recovery then 10-min walk test. Oxygen consumption (V ˙ O2) andV ˙ CO2 on- and off-kinetics (transition constant and oxidative response index), excess-V ˙ CO2, and performance fatigability severity scores (PFSS) were measured. Data were analyzed using regression analyses.

RESULTS

All subjects that met the inclusion/exclusion criteria and consented to participate in the study completed all exercise testing sessions with no adverse events. All testing procedures were carried out successfully and outcome measures were obtained, as intended, without adverse events. Excess-V ˙ CO2 accounted for 61% of the variability in performance fatigability as measured byV ˙ O2 on-kinetic ORI (ml/s) (R2=0.614; y = 8.474x - 4.379, 95% CI [0.748, 16.200]) and 62% of the variability as measured by PFSS (R2=0.619; y =  - 0.096x + 1.267, 95% CI [-0.183, -0.009]). During CPET,V ˙ CO2 -off ORI accounted for 70% (R2=0.695; y = 1.390x - 11.984, 95% CI [0.331, 2.449]) andV ˙ CO2 -off Kt for 73% of the variability in performance fatigability measured byV ˙ O2 on-kinetic ORI (ml/s) (R2=0.730; y = 1.818x - 13.639, 95% CI [0.548, 3.087]).

CONCLUSION

The findings of this study suggest that utilizingV ˙ CO2 measures may be a viable and useful addition or alternative toV ˙ O2 measures, warranting further study. While the current protocol appeared to be satisfactory, for obtaining select cardiopulmonary and performance fatigability measures as intended, modifications to the current protocol to consider in subsequent, larger studies may include use of an alternate mode or measure to enable control of work rate constancy during performance fatigability testing following initial CPET.

Psychophysiological data-driven multi-feature information fusion and recognition of miner fatigue in high-altitude and cold areas

Fatigue-induced human error is a leading cause of accidents. The purpose of this exploratory study in China was to perform field tests to measure fatigue psychophysiological parameters, such as electrocardiography (ECG), electromyography (EMG), pulse, blood pressure, reaction time and vital capacity (VC), in miners in high-altitude and cold areas and to perform multi-feature information fusion and fatigue identification. Forty-five miners were randomly selected as subjects for a field test, and feature signals were extracted from 90 psychophysiological features as basic signals for fatigue analysis. Fatigue sensitivity indices were obtained by Pearson correlation analysis, t-test and receiver operating characteristic (ROC) curve performance evaluation. The ECG time-domain, ECG frequency-domain, EMG, VC, systolic blood pressure (SBP), and pulse were significantly different after miner fatigue. The support vector machine (SVM) and random forest (RF) techniques were used to classify and identify fatigue by information fusion and factor combination. The optimal fatigue classification factors were ECG-FD (CV Accuracy = 85.0%) and EMG (CV Accuracy = 90.0%). The optimal combination of factors was ECG-TD + ECG-FD + EMG (CV accuracy = 80.0%). Furthermore, SVM machine learning had a good recognition effect. This study shows that SVM and RF can effectively identify miner fatigue based on fatigue-related factor combinations. ECG-FD and EMG are the best indicators of fatigue, and the best performance and robustness are obtained with three-factor combination classification. This study on miner fatigue identification provides a reference for research on clinical medicine and the identification of human fatigue under high-altitude, cold and low-oxygen conditions.

Differential Brain and Muscle Tissue Oxygenation Responses to Exercise in Tibetans Compared to Han Chinese

The Tibetans’ better aerobic exercise capacity at altitude remains ill-understood. We tested the hypothesis that Tibetans display better muscle and brain tissue oxygenation during exercise in hypoxia. Using near-infrared spectrometry (NIRS) to provide indices of tissue oxygenation, we measured oxy- and deoxy-hemoglobin ([O₂Hb] and [HHb], respectively) responses of the vastus lateralis muscle and the right prefrontal cortex in ten Han Chinese and ten Tibetans during incremental cycling to exhaustion in a pressure-regulated chamber at simulated sea-level (air at 1 atm: normobaric normoxia) and 5,000 m (air at 0.5 atm: hypobaric hypoxia). Hypoxia reduced aerobic capacity by ∼22% in both groups (d = 0.8, p < 0.001 vs. normoxia), while Tibetans consistently outperformed their Han Chinese counterpart by ∼32% in normoxia and hypoxia (d = 1.0, p = 0.008). We found cerebral [O₂Hb] was higher in Tibetans at normoxic maximal effort compared Han (p = 0.001), while muscle [O₂Hb] was not different (p = 0.240). Hypoxic exercise lowered muscle [O₂Hb] in Tibetans by a greater extent than in Han (interaction effect: p < 0.001 vs. normoxic exercise). Muscle [O₂Hb] was lower in Tibetans when compared to Han during hypoxic exercise (d = 0.9, p = 0.003), but not during normoxic exercise (d = 0.4, p = 0.240). Muscle [HHb] was not different between the two groups during normoxic and hypoxic exercise (p = 0.778). Compared to Han, our findings revealed a higher brain tissue oxygenation in Tibetans during maximal exercise in normoxia, but lower muscle tissue oxygenation during exercise in hypoxia. This would suggest that the Tibetans privileged oxygenation of the brain at the expense of that of the muscle.

Angina Simultaneously Diagnosed with the Recurrence of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) mainly affects young adults and can have a potential impact on social functioning. As this syndrome is associated with endothelial dysfunction, the heart can be damaged via ischemia due to endothelial damage. This might potentially lead to heart failure, which accounts for approximately 20% of deaths among patients with ME/CFS. While cardiac ischemia is thought be a pathophysiologically important manifestation of this syndrome, this is not yet reported. Herein, we present a case of a young female with newly diagnosed vasospastic or microvascular angina and concurrent exacerbation of ME/CFS severity. Her anginal symptoms, including exertional chest pain and transient chest discomfort, mimicked those of ME/CFS but were relieved after the administration of a calcium channel blocker. We emphasize the possibility of concurrent angina and exacerbation of ME/CFS and the importance of detecting cardiac ischemia to avoid unfavorable outcomes.

Linear and nonlinear analyses of normal and fatigue heart rate variability signals for miners in high-altitude and cold areas

BACKGROUND AND OBJECTIVE

Fatigue is an important cause of operational errors, and human errors are the main cause of accidents. This study is an exploratory study in China. Field tests were conducted on heart rate variability (HRV) parameters and physiological indicators of fatigue among miners in high-altitude, cold and low-oxygen areas. This paper studies heart activity patterns during work fatigue in miners.

METHODS

Fatigue affects both the sympathetic and parasympathetic nervous systems, and it is expressed as an abnormal pattern of HRV parameters. Thirty miners were selected as subjects for a field test, and HRV was extracted from 60 groups of electrocardiography (ECG) datasets as basic signals for fatigue analysis. Then, we analyzed the HRV signals of the miners using linear (time domain and frequency domain) and nonlinear dynamics (Poincaré plot and sample entropy (SampEn)), and a Pearson's correlation coefficient analysis and t-tests were performed on the measured indices.

RESULTS

The results showed that the time-domain indices (SDNN, RMSSD, SDSD, pNN50, RRn, heart rate (HR), R-wave humps (RH)) and the coefficient of variation (CV)) and the frequency-domain indices (low frequency/high frequency (LF/HF), LFnorm and HFnorm) clearly changed after fatigue. These features were selected using a Poincaré plot, sample entropy, Pearson's correlation coefficient and a t-test for further analysis. The fatigue characteristics and sensitivity parameters of miners in a high-altitude, cold and hypoxic environment were obtained.

CONCLUSIONS

This study provides deep insight into the use of linear and nonlinear fatigue characteristics to effectively and reliably identify miner fatigue. Furthermore, the study provides a reference for clinical studies of acute mountain sickness in high-altitude, cold and hypoxic environments.

The physiology of rowing with perspective on training and health

PURPOSE

This review presents a perspective on the expansive literature on rowing.

METHODS

The PubMed database was searched for the most relevant literature, while some information was obtained from books.

RESULTS

Following the life span of former rowers paved the way to advocate exercise for health promotion. Rowing involves almost all muscles during the stroke and competition requires a large oxygen uptake, which is challenged by the pulmonary diffusion capacity and restriction in blood flow to the muscles. Unique training adaptations allow for simultaneous engagement of the legs in the relatively slow movement of the rowing stroke that, therefore, involves primarily slow-twitch muscle fibres. Like other sport activities, rowing is associated with adaptation not only of the heart, including both increased internal diameters and myocardial size, but also skeletal muscles with hypertrophy of especially slow-twitch muscle fibres. The high metabolic requirement of intense rowing reduces blood pH and, thereby, arterial oxygen saturation decreases as arterial oxygen tension becomes affected.

CONCLUSION

Competitive rowing challenges most systems in the body including pulmonary function and circulatory control with implication for cerebral blood flow and neuromuscular activation. Thus, the physiology of rowing is complex, but it obviously favours large individuals with arms and legs that allow the development of a long stroke. Present inquiries include the development of an appropriately large cardiac output despite the Valsalva-like manoeuvre associated with the stroke, and the remarkable ability of the brain to maintain motor control and metabolism despite marked reductions in cerebral blood flow and oxygenation.

The effects of hypoxia and fatigue on skeletal muscle electromechanical delay

NEW FINDINGS

What is the central question of this study? What are the mechanisms underlying impaired muscular endurance and accelerated fatigue during acute hypoxia? What is the main finding and its importance? Hypoxia had no effect on the electrochemical latency associated with muscle contraction elicited by supramaximal electrical motor nerve stimulation in vivo. This provides greater insight into the effects of hypoxia and fatigue on the mechanisms of muscle contraction in vivo.

ABSTRACT

Acute hypoxia impairs muscle endurance and accelerates fatigue, but the underlying mechanisms, including any effects on muscle electrical activation, are incompletely understood. Electromyographic, mechanomyographic and force signals, elicited by common fibular nerve stimulation, were used to determine electromechanical delay (EMD_TOT ) of the tibialis anterior muscle in normoxia and hypoxia ( F I O 2 0.125) at rest and following fatiguing ankle dorsiflexor exercise (60% maximum voluntary contraction, 5 s on, 3 s off) in 12 healthy participants (mean (SD) age 27.4 (9.0) years). EMD_TOT was determined from electromyographic to force signal onset, electrical activation latency from electromyographic to mechanomyographic (EMD_E-M ) and mechanical latency from mechanomyographic to force (EMD_M-F ). Twitch force fell significantly following fatiguing exercise in normoxia (46.8 (14.7) vs. 20.6 (14.3) N, P = 0.0002) and hypoxia (52.9 (15.4) vs. 28.8 (15.2) N, P = 0.0006). No effect of hypoxia on twitch force at rest was observed. Fatiguing exercise resulted in significant increases in mean (SD) EMD_TOT in normoxia (Δ 4.7 (4.57) ms P = 0.0152) and hypoxia (Δ 3.7 (4.06) ms P = 0.0384) resulting from increased mean (SD) EMD_M-F only (normoxia Δ 4.1 (4.1) ms P = 0.0391, hypoxia Δ 3.4 (3.6) ms P = 0.0303). Mean (SD) EMD_E-M remained unchanged during normoxic (Δ 0.6 (1.08) ms) and hypoxic (Δ 0.25 (0.75) ms) fatiguing exercise. No differences in percentage change from baseline for twitch force, EMD_TOT , EMD_E-M and EMD_M-F between normoxic and hypoxic fatigue conditions were observed. Hypoxia in isolation or in combination with fatigue had no effect on the electrochemical latency associated with electrically evoked muscle contraction.

Changes in spatio-temporal gait parameters and vertical speed during an extreme mountain ultra-marathon

The aim of the present study was to investigate the effects of altitude and distance on uphill vertical speed (VS) and the main spatio-temporal gait parameters during an extreme mountain ultra-marathon. The VS, stride height (SH) and stride frequency (SF) of 27 runners were measured with an inertial sensor at the shank for two different altitude ranges (low 1300-2000 m vs high 2400-3200 m) of 10 mountains passes distributed over a 220 km course. There was a significant interaction (F(4,52) = 4.04, p < 0.01) for the effect of altitude and distance on VS. During the first passes, the mean VS was faster at lower altitudes, but this difference disappeared at a quarter of the race length, suggesting that neuromuscular fatigue influenced the uphill velocity to a larger extent than the oxygen delivery. The average VS, SH and SF were 547 ± 135 m/h, 0.23 ± 0.05 m and 0.66 ± 0.09 Hz. The individual VS change for each uphill portions was more strongly correlated with the changes in SH (r = 0.80, P < 0.001, n = 321) than SF (r = 0.43, P < 0.001, n = 321). This suggests a large effect of the knee extensors strength loss on the diminution of VS.

Muscle and cerebral oxygenation during exercise in athletes with exercise-induced hypoxemia: A comparison between sea level and acute moderate hypoxia

The objective of the present study was to evaluate the influence of exercise-induced hypoxemia (EIH) on muscle and cerebral oxygenation responses during maximal exercise in normoxia and in acute moderate hypoxia (fraction of inspired oxygen: 15.3%, 2400 m). EIH was defined as a drop in hemoglobin saturation of at least 4% for at least three consecutive minutes during maximal exercise at sea level. Twenty-five athletes performed incremental treadmill tests to assess maximal oxygen consumption (VO_2max) in normoxia and in hypoxia. Oxygenation of the vastus lateralis muscle and the left prefrontal cortex of the brain was monitored using near-infrared spectroscopy. During the normoxic test, 15 athletes exhibited EIH; they displayed a larger change in muscle levels of oxyhemoglobin (ΔO₂Hb) (p = 0.04) and a greater change in cerebral levels of deoxyhemoglobin (ΔHHb) (p = 0.02) than athletes without EIH (NEIH group). During the hypoxic test, muscle ΔO₂Hb was lower in the EIH group than in the NEIH group (p = 0.03). At VO_2max, hypoxia was associated with a smaller cerebral ΔO₂Hb in both groups, and a greater cerebral ΔHHb compared to normoxia in the NEIH group only (p = 0.02). No intergroup differences in changes in muscle oxygenation were observed. The severity of O₂ arterial desaturation was negatively correlated with changes in total muscle hemoglobin in normoxia (r = -0.48, p = 0.01), and positively correlated with the cerebral ΔHHb in normoxia (r = 0.45, p = 0.02). The occurrence of EIH at sea level was associated with specific muscle and cerebral oxygenation responses to exercise under both normoxia and moderate hypoxia.

Intermittent Hypoxic Training at Lactate Threshold Intensity Improves Aiming Performance in Well-Trained Biathletes with Little Change of Cardiovascular Variables

The main objective of this research was to evaluate the efficacy of intermittent hypoxic training (IHT) on aiming performance and aerobic capacity in biathletes. Fourteen male biathletes were randomly divided into a hypoxia group (H) (n = 7), which trained three times per week in a normobaric hypoxic environment (FiO₂ = 16.5%, 2000 m a.s.l.) with lactate threshold intensity (LT) determined in hypoxia, and a control group (C) (n = 7), which exercised under normoxic conditions with LT intensity determined in normoxia. The training program included three weekly microcycles, followed by three days of recovery. The main part of the interval workout consisted of four 7 min (1^st week), 8 min (2^nd week), or 9 min (3^rd week) running bouts at treadmill separated by 2 minutes of active recovery. After the warm-up and during the rest between the bouts, the athletes performed aiming to the target in the standing position with a sporting rifle (20 s). The results showed that the IHT caused a significant (p < 0.05) increase in retention time in the target at rest (RT9_rest) by 14.4% in hypoxia, whereas RT postincremental test (RT9_post) increased by 27.4% in normoxia and 26.7% in hypoxia. No significant changes in this variable were found in group C. Additionally, the capillary oxygen saturation at the end of the maximal effort (SO_{2capillary max}) in hypoxia increased significantly (p < 0.001) by ∼4% after IHT. The maximal workload during the incremental test (WR_max) in normoxia also increased significantly (p < 0.001) by 6.3% after IHT. Furthermore, in absolute and relative values of VO_2max in normoxia, there was a propensity (p < 0.07) for increasing this value by 5% in group H. In conclusion, the main findings of this study showed a significant improvement in resting and postexercise aiming performance in normoxia and hypoxia. Furthermore, the results demonstrated beneficial effects of the IHT protocol on aerobic capacity of biathletes.

Fast skeletal muscle troponin activator CK-2066260 increases fatigue resistance by reducing the energetic cost of muscle contraction

Key points

Skeletal muscle fatigue limits performance in various physical activities, with exercise intolerance being a key symptom in a broad spectrum of diseases.

We investigated whether a small molecule fast skeletal troponin activator (FSTA), CK‐2066260, can mitigate muscle fatigue by reducing the cytosolic free [Ca²⁺] required to produce a given submaximal force and hence decreasing the energy requirement.

Isolated intact single mouse muscle fibres and rat muscles in‐situ treated with CK‐2066260 showed improved muscle endurance., which was accompanied by decreased ATP demand and reduced glycogen usage.

CK‐2066260 treatment improved in‐vivo exercise capacity in healthy rats and in a rat model of peripheral artery insufficiency.

In conclusion, we show that the FSTA CK‐2066260 effectively counteracts muscle fatigue in rodent skeletal muscle in vitro, in situ, and in vivo. This may translate to humans and provide a promising pharmacological treatment to patients suffering from severe muscle weakness and exercise intolerance.

Abstract

Skeletal muscle fatigue limits performance during physical exercise and exacerbated muscle fatigue is a prominent symptom among a broad spectrum of diseases. The present study investigated whether skeletal muscle fatigue is affected by the fast skeletal muscle troponin activator (FSTA) CK‐2066260, which increases myofibrillar Ca²⁺ sensitivity and amplifies the submaximal force response. Because more force is produced for a given Ca²⁺, we hypothesized that CK‐2066260 could mitigate muscle fatigue by reducing the energetic cost of muscle activation. Isolated single mouse muscle fibres were fatigued by 100 repeated 350 ms contractions while measuring force and the cytosolic free [Ca²⁺] or [Mg²⁺] ([Mg²⁺]_i). When starting fatiguing stimulation at matching forces (i.e. lower stimulation frequency with CK‐2066260): force was decreased by ∼50% with and by ∼75% without CK‐2066260; [Mg²⁺]_i was increased by ∼10% with and ∼32% without CK‐2066260, reflecting a larger decrease in [ATP] in the latter. The glycogen content in in situ stimulated rat muscles fatigued by repeated contractions at matching forces was about two times higher with than without CK‐2066260. Voluntary exercise capacity, assessed by rats performing rotarod exercise and treadmill running, was improved in the presence of CK‐2066260. CK‐2066260 treatment also increased skeletal muscle fatigue resistance and exercise performance in a rat model of peripheral artery insufficiency. In conclusion, we demonstrate that the FSTA CK‐2066260 mitigates skeletal muscle fatigue by reducing the metabolic cost of force generation.

Skeletal muscle fatigue limits performance in various physical activities, with exercise intolerance being a key symptom in a broad spectrum of diseases.

We investigated whether a small molecule fast skeletal troponin activator (FSTA), CK‐2066260, can mitigate muscle fatigue by reducing the cytosolic free [Ca²⁺] required to produce a given submaximal force and hence decreasing the energy requirement.

Isolated intact single mouse muscle fibres and rat muscles in‐situ treated with CK‐2066260 showed improved muscle endurance., which was accompanied by decreased ATP demand and reduced glycogen usage.

CK‐2066260 treatment improved in‐vivo exercise capacity in healthy rats and in a rat model of peripheral artery insufficiency.

In conclusion, we show that the FSTA CK‐2066260 effectively counteracts muscle fatigue in rodent skeletal muscle in vitro, in situ, and in vivo. This may translate to humans and provide a promising pharmacological treatment to patients suffering from severe muscle weakness and exercise intolerance.

Liver CEBPβ Modulates the Kynurenine Metabolism and Mediates the Motility for Hypoxia-Induced Central Fatigue in Mice

Central fatigue is defined as a failure of the central nervous system to adequately drive the muscle, manifesting limited development, and maintenance of locomotor activity. A plateau in hypoxia leads to central fatigue and followed by maximal motility recession. However, the underlying mechanism is still unclear. The present study describes a mechanism by which liver CEBPβ (CCAAT/enhancer-binding protein beta) induced by hypoxic environment alters the kynurenine (KYN) metabolism and causes the suppression of motility function recession. The activation of CEBPβ under hypoxia increases the liver expression of tryptophan dioxygenase, thereby enhancing the conversion of tryptophan into KYN; the KYN metabolite can traverse the blood-brain barrier and result in the suppression of motility function. However, the knockdown of CEBPβ by injecting pAAV-shRNA-CEBPβ via the hepatic portal vein reduces the KYN production and improves the motility function. KYN is a neurochemical that which restricts the exercise capacity after injection in the basal ganglia in mice. Reducing the plasma KYN protects the brain from hypoxia-induced changes associated with fatigue, and the knockdown liver of CEBPβ in mice renders resistance to fatigue post-acute hypoxia or tryptophan treatment. This study reveals resistance to central fatigue as a strategy for acclimatization to hypoxia mediated by transcription factor CEBPβ in the liver.

Neuronal and vascular deficits following chronic adaptation to high altitude

We sought to understand the mechanisms underlying cognitive deficits that are reported to affect non-native subjects following their prolonged stay and/or work at high altitude (HA). We found that mice exposed to a simulated environment of 5000 m exhibit deficits in hippocampal learning and memory accompanied by abnormalities in brain MR imaging. Exposure (1-8 months) to HA led to an increase in brain ventricular volume, a reduction in relative cerebral blood flow and changes in diffusion tensor imaging (DTI) derived parameters within the hippocampus and corpus callosum. Furthermore, neuropathological examination revealed significant expansion of the neurovascular network, microglia activation and demyelination within the corpus callosum. Electrophysiological recordings from the corpus callosum indicated that axonal excitabilities are increased while refractory periods are longer despite a lack of change in action potential conduction velocities of both myelinated and unmyelinated fibers. Next generation RNA-sequencing identified alterations in hippocampal and amygdala transcriptome signaling pathways linked to angiogenesis, neuroinflammation and myelination. Our findings reveal that exposure to hypobaric-hypoxia triggers maladaptive responses inducing cognitive deficits and suggest potential mechanisms underlying the adverse impacts of staying or traveling at high altitude.

Oral Nitrate Supplementation Differentially Modulates Cerebral Artery Blood Velocity and Prefrontal Tissue Oxygenation During 15 km Time-Trial Cycling in Normoxia but Not in Hypoxia

Background: Nitrate is a precursor of nitric oxide (NO), an important regulator of cerebral perfusion in normoxic and hypoxic conditions. Nitrate supplementation could be used to improve cerebral perfusion and oxygenation during exercise in hypoxia. The effects of dietary nitrate supplementation on cerebral haemodynamics during exercise in severe hypoxia (arterial O₂ saturation < 70%) have not been explored.

Methods: In twelve trained male cyclists, we measured blood pressure (BP), middle cerebral artery blood velocity (MCAv), cerebrovascular resistance (CVR) and prefrontal oxyhaemoglobin and deoxyhaemoglobin concentration (O₂Hb and HHb, respectively) during 15 km cycling time trials (TT) in normoxia and severe hypoxia (11% inspired O₂, peripheral O₂ saturation ∼66%) following 3-day oral supplementation with placebo or sodium nitrate (0.1 mmol/kg/day) in a randomised, double-blinded manner. We tested the hypothesis that dietary nitrate supplementation increases MCAv and cerebral O₂Hb during TT in severe hypoxia.

Results: During TT in normoxia, nitrate supplementation lowered MCAv by ∼2.3 cm/s and increased cerebral O₂Hb by ∼6.8 μM and HHb by ∼2.1 μM compared to normoxia placebo (p ≤ 0.01 for all), while BP tended to be lowered (p = 0.06). During TT in severe hypoxia, nitrate supplementation elevated MCAv (by ∼2.5 cm/s) and BP (by ∼5 mmHg) compared to hypoxia placebo (p < 0.01 for both), while it had no effect on cerebral O₂Hb (p = 0.98), HHb (p = 0.07) or PETCO₂ (p = 0.12). Dietary nitrate had no effect of CVR during TT in normoxia or hypoxia (p = 0.19).

Conclusion: Our findings indicate that during normoxic TT, the modulatory effect of dietary nitrate on regional and global cerebral perfusion is heterogeneous. Meanwhile, the lack of major changes in cerebral perfusion with dietary nitrate during hypoxic TT alludes to an exhausted cerebrovascular reserve.

Exercise-induced Fatigue in Severe Hypoxia after an Intermittent Hypoxic Protocol

PURPOSE

Exercise-induced central fatigue is alleviated after acclimatization to high altitude. The adaptations underpinning this effect may also be induced with brief, repeated exposures to severe hypoxia. The purpose of this study was to determine whether (i) exercise tolerance in severe hypoxia would be improved after an intermittent hypoxic (IH) protocol and (ii) exercise-induced central fatigue would be alleviated after an IH protocol.

METHODS

Nineteen recreationally active men were randomized into two groups who completed ten 2-h exposures in severe hypoxia (IH: partial pressure of inspired O2 82 mm Hg; n = 11) or normoxia (control; n = 8). Seven sessions involved cycling for 30 min at 25% peak power (W˙peak) in IH and at a matched heart rate in normoxia. Participants performed baseline constant-power cycling to task failure in severe hypoxia (TTF-Pre). After the intervention, the cycling trial was repeated (TTF-Post). Before and after exercise, responses to transcranial magnetic stimulation and supramaximal femoral nerve stimulation were obtained to assess central and peripheral contributions to neuromuscular fatigue.

RESULTS

From pre- to postexercise in TTF-Pre, maximal voluntary contraction (MVC), cortical voluntary activation (VATMS), and potentiated twitch force (Qtw,pot) decreased in both groups (all P < 0.05). After IH, TTF-Post was improved (535 ± 213 s vs 713 ± 271 s, P < 0.05) and an additional isotime trial was performed. After the IH intervention only, the reduction in MVC and VATMS was attenuated at isotime (P < 0.05). No differences were observed in the control group.

CONCLUSIONS

Whole-body exercise tolerance in severe hypoxia was prolonged after a protocol of IH. This may be related to an alleviation of the central contribution to neuromuscular fatigue.

Molecular Basis for Exercise-Induced Fatigue: The Importance of Strictly Controlled Cellular Ca2+ Handling

The contractile function of skeletal muscle declines during intense or prolonged physical exercise, that is, fatigue develops. Skeletal muscle fibers fatigue acutely during highly intense exercise when they have to rely on anaerobic metabolism. Early stages of fatigue involve impaired myofibrillar function, whereas decreased Ca²⁺ release from the sarcoplasmic reticulum (SR) becomes more important in later stages. SR Ca²⁺ release can also become reduced with more prolonged, lower intensity exercise, and it is then related to glycogen depletion. Increased reactive oxygen/nitrogen species can cause long-lasting impairments in SR Ca²⁺ release resulting in a prolonged force depression after exercise. In this article, we discuss molecular and cellular mechanisms of the above fatigue-induced changes, with special focus on multiple mechanisms to decrease SR Ca²⁺ release to avoid energy depletion and preserve muscle fiber integrity. We also discuss fatigue-related effects of exercise-induced Ca²⁺ fluxes over the sarcolemma and between the cytoplasm and mitochondria.

Sodium bicarbonate supplementation improves severe-intensity intermittent exercise under moderate acute hypoxic conditions

Acute moderate hypoxic exposure can substantially impair exercise performance, which occurs with a concurrent exacerbated rise in hydrogen cation (H⁺) production. The purpose of this study was therefore, to alleviate this acidic stress through sodium bicarbonate (NaHCO₃) supplementation and determine the corresponding effects on severe-intensity intermittent exercise performance. Eleven recreationally active individuals participated in this randomised, double-blind, crossover study performed under acute normobaric hypoxic conditions (FiO₂% = 14.5%). Pre-experimental trials involved the determination of time to attain peak bicarbonate anion concentrations ([HCO₃⁻]) following NaHCO₃ ingestion. The intermittent exercise tests involved repeated 60-s work in their severe-intensity domain and 30-s recovery at 20 W to exhaustion. Participants ingested either 0.3 g kg bm⁻¹ of NaHCO₃ or a matched placebo of 0.21 g kg bm⁻¹ of sodium chloride prior to exercise. Exercise tolerance (+ 110.9 ± 100.6 s; 95% CI 43.3–178 s; g = 1.0) and work performed in the severe-intensity domain (+ 5.8 ± 6.6 kJ; 95% CI 1.3–9.9 kJ; g = 0.8) were enhanced with NaHCO₃ supplementation. Furthermore, a larger post-exercise blood lactate concentration was reported in the experimental group (+ 4 ± 2.4 mmol l⁻¹; 95% CI 2.2–5.9; g = 1.8), while blood [HCO₃⁻] and pH remained elevated in the NaHCO₃ condition throughout experimentation. In conclusion, this study reported a positive effect of NaHCO₃ under acute moderate hypoxic conditions during intermittent exercise and therefore, may offer an ergogenic strategy to mitigate hypoxic induced declines in exercise performance.

Cerebral blood flow, frontal lobe oxygenation and intra-arterial blood pressure during sprint exercise in normoxia and severe acute hypoxia in humans

Cerebral blood flow (CBF) is regulated to secure brain O₂ delivery while simultaneously avoiding hyperperfusion; however, both requisites may conflict during sprint exercise. To determine whether brain O₂ delivery or CBF is prioritized, young men performed sprint exercise in normoxia and hypoxia (P_IO₂ = 73 mmHg). During the sprints, cardiac output increased to ∼22 L min^-1, mean arterial pressure to ∼131 mmHg and peak systolic blood pressure ranged between 200 and 304 mmHg. Middle-cerebral artery velocity (MCAv) increased to peak values (∼16%) after 7.5 s and decreased to pre-exercise values towards the end of the sprint. When the sprints in normoxia were preceded by a reduced P_ETCO₂, CBF and frontal lobe oxygenation decreased in parallel ( r = 0.93, P < 0.01). In hypoxia, MCAv was increased by 25%, due to a 26% greater vascular conductance, despite 4-6 mmHg lower PaCO₂ in hypoxia than normoxia. This vasodilation fully accounted for the 22 % lower CaO₂ in hypoxia, leading to a similar brain O₂ delivery during the sprints regardless of P_IO₂. In conclusion, when a conflict exists between preserving brain O₂ delivery or restraining CBF to avoid potential damage by an elevated perfusion pressure, the priority is given to brain O₂ delivery.

Are There Critical Fatigue Thresholds? Aggregated vs. Individual Data

The mechanisms underlying task failure from fatiguing physical efforts have been the focus of many studies without reaching consensus. An attractive but debated model explains effort termination with a critical peripheral fatigue threshold. Upon reaching this threshold, feedback from sensory afferents would trigger task disengagement from open-ended tasks or a reduction of exercise intensity of closed-ended tasks. Alternatively, the extant literature also appears compatible with a more global critical threshold of loss of maximal voluntary contraction force. Indeed, maximal voluntary contraction force loss from fatiguing exercise realized at a given intensity appears rather consistent between different studies. However, when looking at individual data, the similar maximal force losses observed between different tasks performed at similar intensities might just be an “artifact” of data aggregation. It would then seem possible that such a difference observed between individual and aggregated data also applies to other models previously proposed to explain task failure from fatiguing physical efforts. We therefore suggest that one should be cautious when trying to infer models that try to explain individual behavior from aggregated data.