The effect of repeat exercise on pulmonary diffusing capacity and EIH in trained athletes

Swimming exercise transiently decrease lung diffusing capacity in elite swimmers

BACKGROUND

Swimmers have larger lungs and a higher diffusion capacity than other athletes, but it remains unknown whether swimming exercise changes lung diffusing properties. This study aimed to evaluate modifications in pulmonary alveolar-capillary diffusion after swimming exercise.

METHODS

The participants were 21 elite level swimmers, including 7 females and 14 males, with a training volume of 45-70 kilometers of swimming per week. The single-breath method was used to measure the lung diffusing capacity for carbon monoxide (DLCO and the transfer coefficient of the lungs for carbon monoxide (K<inf>CO</inf>) before and after 10 training sessions over 4 weeks along 207 pre- to postevaluations.

RESULTS

Swimming training consistently decreased lung diffusion capacity during the follow-up period, both DL<inf>CO</inf> (44.4±8.1 to 43.3±8.9 mL·min-1·mmHg-1, P=0.047, ŋ²<inf>p</inf>=0.55) and K<inf>CO</inf> (5.92±0.79 to 5.70±0.81 mL·min-1·mmHg-1·L-1, P=0.003, ŋ²<inf>p</inf>=0.75).

CONCLUSIONS

Elite swimmers experience a subclinical impairment in lung diffusing capacity after swimming exercise, but the stress caused by swimming on the lungs and the acute reduction in DL<inf>CO</inf> does not lead to physiological dysfunction.

Changes in Lung Diffusing Capacity of Elite Artistic Swimmers During Training

Artistic swimmers (AS) are exposed to repeated apnoeas in the aquatic environment during high intensity exercise provoking specific physiological responses to training, apnoea, and immersion. This study aimed to evaluate the changes in lung diffusing capacity in AS pre-, mid- and post-training in a combined session of apnoeic swimming, figures and choreography. Eleven elite female AS from the Spanish national team were the study's participants. The single-breath method was used to measure lung diffusing capacity for carbon monoxide (DL_CO) and one-way repeated measures ANOVA was utilized to evaluate the statistical analysis. Basal values of DL_CO were higher than normal for their age and height (33.6±4.9 mL·min^-1·mmHg^-1; 139±19%) and there were a significant interaction between DL_CO and AS training (ŋ² _p=0.547). After the apnoeic swimming (mid-training) there was an increase in DL_CO from basal to 36.7±7.3 mL·min^-1·mmHg^-1 (p=0.021), and after the figures and choreography (post-training) there was a decrease compared to mid-training (32.3±4.6 mL·min^-1·mmHg^-1, p=0.013). Lung diffusing capacity changes occur during AS training, including a large increase after apnoeic swimming. There were no differences in lung diffusing capacity from pre- to post-training, although large inter-individual variability was observed.

Enhancement of Hippocampal Plasticity by Physical Exercise as a Polypill for Stress and Depression: A Review

Generation of newborn neurons that form functional synaptic connections in the dentate gyrus of adult mammals, known as adult hippocampal neurogenesis, has been suggested to play critical roles in regulating mood, as well as certain forms of hippocampus-dependent learning and memory. Environmental stress suppresses structural plasticity including adult neurogenesis and dendritic remodeling in the hippocampus, whereas physical exercise exerts opposite effects. Here, we review recent discoveries on the potential mechanisms concerning how physical exercise mitigates the stressrelated depressive disorders, with a focus on the perspective of modulation on hippocampal neurogenesis, dendritic remodeling and synaptic plasticity. Unmasking such mechanisms may help devise new drugs in the future for treating neuropsychiatric disorders involving impaired neural plasticity.

Noninvasive Pulmonary Hemodynamic Evaluation in Athletes With Exercise-Induced Hypoxemia

BACKGROUND

Pulmonary capillary stress failure is potentially involved in exercise-induced hypoxemia (ie, a significant fall in hemoglobin oxygen saturation [Spo₂]) during sea level exercise in endurance-trained athletes. It is unknown whether there are specific properties of pulmonary vascular function in athletes exhibiting oxygen desaturation.

METHODS

Ten endurance-trained athletes with exercise-induced hypoxemia (EIH), nine endurance-trained athletes with no exercise-induced hypoxemia (NEIH), and 10 untrained control subjects underwent an incremental exercise stress echocardiography coupled with lung diffusion capacity for carbon monoxide (Dlco) and lung diffusion capacity for nitric oxide (Dlno) testing. Functional adaptation of the pulmonary circulation was evaluated with measurements of mean pulmonary arterial pressure (mPAP), pulmonary capillary pressure, pulmonary vascular resistance (PVR), cardiac output (Qc), and pulmonary vascular distensibility (alpha) mathematically determined from the curvilinearity of the multi-point mPAP/Qc relation.

RESULTS

EIH athletes exhibited a lower exercise-induced PVR decrease compared with the untrained and NEIH groups (P < .001). EIH athletes showed higher maximal mPAP compared with NEIH athletes (45.4 ± 0.9 mm Hg vs 41.6 ± 0.9 mm Hg, respectively; P = .003); there was no difference between the NEIH and untrained subjects. Alpha was lower in the EIH group compared with the NEIH group (P < .05). Maximal mPAP, Pcap, and alpha were correlated with the fall of Spo₂ during exercise (P < .01, P < .01, and P < .05). Dlno and Dlco increased with exercise in all groups, with no differences between groups. Dlno/Qc was correlated to the exercise-induced Spo₂ changes (P < .05).

CONCLUSIONS

EIH athletes exhibit higher maximal pulmonary vascular pressures, lower vascular distensibility, or exercise-induced changes in PVR compared with NEIH subjects, in keeping with pulmonary capillary stress failure or intrapulmonary shunting hypotheses.

Diffusion capacity of carbon monoxide (DLCO) pre- and post-exercise in children in health and disease

RATIONALE

A decrease in diffusion capacity for carbon monoxide (DLCO) after exercise has been reported in healthy adults. There is limited information for post-exercise DLCO available in children either in health or in disease.

OBJECTIVES

To evaluate (1) reproducibility of DLCO measures in children, (2) differences in DLCO between elite athletic swimmers (AS), stable cystic fibrosis patients (CF), and healthy controls (Con) at rest; and (3) after a maximal treadmill exercise test.

METHODS

Participants performed spirometry and DLCO at baseline, a maximal treadmill exercise test and repeated DLCO measures for 2 hr after cessation of exercise.

RESULTS

The mean (SD) co-efficient of variation between baseline DLCO tests was 2.49% (1.86%). In girls, the mean baseline DLCO (ml/min/mmHg) was 18.61 (4.15) in CF, 22.32 (4.79) in controls and 27.18 (5.33) in AS. In boys: 23.68 (5.31) in CF, 28.09 (9.95) in controls and 37.75 (9.46) in AS. Baseline DLCO was significantly higher in AS than in CF patients (P < 0.01). In girls post-exercise, the greatest mean decrease in DLCO from baseline was -7.50% to -12.83% and in boys -6.92% to -17.71%. The decline in DLCO was less important in the athletes than the other groups (P < 0.05).

CONCLUSIONS

DLCO is highly repeatable in children. AS have an increased DLCO at rest compared to both children with CF and controls. There is a decline from baseline to post-exercise DLCO and while there are disease-specific differences, the general pattern of change in DLCO measures after exercise is similar in children to adults.

Respiratory disorders in endurance athletes - how much do they really have to endure?

Respiratory disorders are often a cause of morbidity in top level endurance athletes, more often compromising their performance and rarely being a cause of death. Pathophysiological events occurring during exercise, such as bronchospasm, are sometimes followed by clear pathological symptoms represented by asthma related to physical exertion or rarely by pulmonary edema induced by a strenuous effort. Both bronchospasm and the onset of interstitial edema induced by exercise cannot be considered pathological per se, but are more likely findings that occur in several healthy subjects once physical exhaustion during exertion has been reached. Consequently, we get a vision of the respiratory system perfectly tailored to meet the body's metabolic demands under normal conditions but which is limited when challenged by strenuous exercise, in particular when it happens in an unfavorable environment. As extreme physical effort may elicit a pathological response in healthy subjects, due to the exceeding demand in a perfectly functional system, an overview of the main tools both enabling the diagnosis of respiratory impairment in endurance athletes in a clinical and preclinical phase has also been described.

Diffusion capacity in children: what happens with exercise?

There is comparatively little data on diffusion capacity in children during exercise. With the advent of improved technology, there is an increasing interest in exercise testing of children in order to predict the evolution of lung disease. In addition to the standard measure of exercise capacity, the VO(2max), interest is evolving in the consequences of alterations in diffusion capacity which may be unmasked with exercise. This review will consider what is known about diffusion capacity with exercise in children with well documented lung disease in the form of cystic fibrosis, healthy controls and swimmers as elite athletes with the largest lung volumes.

Pulmonary gas exchange and acid-base balance during exercise

As the first step in the oxygen-transport chain, the lung has a critical task: optimizing the exchange of respiratory gases to maintain delivery of oxygen and the elimination of carbon dioxide. In healthy subjects, gas exchange, as evaluated by the alveolar-to-arterial PO2 difference (A-aDO2), worsens with incremental exercise, and typically reaches an A-aDO2 of approximately 25 mmHg at peak exercise. While there is great individual variability, A-aDO2 is generally largest at peak exercise in subjects with the highest peak oxygen consumption. Inert gas data has shown that the increase in A-aDO2 is explained by decreased ventilation-perfusion matching, and the development of a diffusion limitation for oxygen. Gas exchange data does not indicate the presence of right-to-left intrapulmonary shunt developing with exercise, despite recent data suggesting that large-diameter arteriovenous shunt vessels may be recruited with exercise. At the same time, multisystem mechanisms regulate systemic acid-base balance in integrative processes that involve gas exchange between tissues and the environment and simultaneous net changes in the concentrations of strong and weak ions within, and transfer between, extracellular and intracellular fluids. The physicochemical approach to acid-base balance is used to understand the contributions from independent acid-base variables to measured acid-base disturbances within contracting skeletal muscle, erythrocytes and noncontracting tissues. In muscle, the magnitude of the disturbance is proportional to the concentrations of dissociated weak acids, the rate at which acid equivalents (strong acid) accumulate and the rate at which strong base cations are added to or removed from muscle.

Exercise-induced arterial hypoxaemia in active young women

Studies examining pulmonary gas exchange during exercise have primarily focused on young healthy men, whereas the female response to exercise has received limited attention. Evidence is accumulating that the response of the lungs, airways, and (or) respiratory muscles to exercise is less than ideal and this may significantly compromise oxygen transport in certain groups of otherwise healthy, fit, active, male subjects. Women may be even more susceptible to exercise-induced pulmonary limitations than height-matched men, by virtue of their smaller lung volumes, lower maximal expiratory flow rates, and smaller diffusion surface areas. We have recently shown that exercise-induced arterial hypoxaemia (EIAH) is more prevalent and occurs at relatively lower fitness levels in females than in males. Despite this finding, few physiologically based mechanisms have been identified to explain why women may be more susceptible to EIAH than men. Potential mechanisms of EIAH include relative alveolar hypoventilation, ventilation–perfusion inequality, and diffusion limitation. Whether these mechanisms are different between sexes remains controversial. The primary purpose of this review is to summarize the available data on EIAH in women and to discuss potential sex-based mechanisms for gas exchange impairment. Furthermore, we discuss unresolved questions dealing with pulmonary system limitations during exercise in women.

Intense hypoxic cycle exercise does not alter lung density in competitive male cyclists

We tested the hypothesis that intense short duration hypoxic exercise would result in an increase in extravascular lung water (EVLW), as evidenced by an increase in lung density. Using computed tomography (CT), baseline lung density was obtained in eight highly trained male cyclists (mean +/- SD: age = 28 +/- 8 years; height = 180 +/- 9 cm; mass = 71.6 +/- 8.2 kg; VO2max= 65.0 +/- 5.2 ml kg min(-1)). Subjects then completed an intense hypoxic exercise challenge on a cycle ergometer and metabolic data, HR and %S(p)O2 were recorded throughout. While breathing 15% O2, subjects performed five 3 km cycling intervals (mean power, 286 +/- 20 W; HR = 91 +/- 4% HRmax) separated by 5 min of recovery. From a resting hypoxic S(p)O2 of 92 +/- 4%, subjects further desaturated during exercise to 76 +/- 3%. CT scans were repeated 76 +/- 10 min (range 63-88 min) following the completion of exercise. There was no change in lung density from pre (0.18 +/- 0.02 g ml(-1)) to post-exercise (0.18 +/- 0.04 g ml(-1)). The substantial reduction in S(p)O2 may be explained by a number of potential mechanisms, including decreased pulmonary diffusion capacity, alveolar hypoventilation, reduced red cell transit time, ventilation/perfusion inequality or a temperature and pH induced rightward-shift in the oxyhaemoglobin dissociation curve. Alternatively, the integrity of the blood gas barrier may have been disrupted without any measurable increase in lung density.

Pulmonary gas exchange does not worsen during repeat exercise in women

The purposes were to determine (1) if repeat exercise worsens pulmonary gas exchange in women, and, (2) if the level of pulmonary edema obtained in these same women is related to the gas exchange impairment during exercise. Fourteen women (27 +/- 4 yrs; maximal oxygen uptake = 3.12 +/- 0.42 L/min) with minimal arterial PO2 (PaO2) ranging from 76 to 104 mmHg with a maximal alveolar-arterial PO2 difference (AaDO2) ranging from 7 to 35 mmHg performed three bouts of near-maximal exercise on a cycle ergometer (236 +/- 27 W) for 5 min each with 10 min of rest between sets. Cardiorespiratory parameters and oxygenation were measured at rest, throughout exercise and recovery. Chest radiographs were obtained before and 30 min after the interval training session (see Respir Physiol Neurobiol, 153 (2006) 181-190). Repeat exercise did not affect pulmonary gas exchange between sets 1 and 3 (change in PaO2 = 3 +/- 2 mmHg; change in AaDO2 = 1 +/- 2 mmHg P > 0.05). Arterial PCO2 decreased by 4 +/- 2 mmHg (P < 0.05) between sets 1 and 2, which did not reduce further in set 3. The level of PaO2 or AaDO2 was not related to the change in edema score or the post-exercise edema score (P > 0.05). In conclusion, pulmonary gas exchange is not worsened in women during interval training despite the mild edema triggered by exercise.

Short-term hypoxic exposure at rest and during exercise reduces lung water in healthy humans

Hypoxia and hypoxic exercise increase pulmonary arterial pressure, cause pulmonary capillary recruitment, and may influence the ability of the lungs to regulate fluid. To examine the influence of hypoxia, alone and combined with exercise, on lung fluid balance, we studied 25 healthy subjects after 17-h exposure to 12.5% inspired oxygen (barometric pressure = 732 mmHg) and sequentially after exercise to exhaustion on a cycle ergometer with 12.5% inspired oxygen. We also studied subjects after a rapid saline infusion (30 ml/kg over 15 min) to demonstrate the sensitivity of our techniques to detect changes in lung water. Pulmonary capillary blood volume (Vc) and alveolar-capillary conductance (D(M)) were determined by measuring the diffusing capacity of the lungs for carbon monoxide and nitric oxide. Lung tissue volume and density were assessed using computed tomography. Lung water was estimated by subtracting measures of Vc from computed tomography lung tissue volume. Pulmonary function [forced vital capacity (FVC), forced expiratory volume after 1 s (FEV(1)), and forced expiratory flow at 50% of vital capacity (FEF(50))] was also assessed. Saline infusion caused an increase in Vc (42%), tissue volume (9%), and lung water (11%), and a decrease in D(M) (11%) and pulmonary function (FVC = -12 +/- 9%, FEV(1) = -17 +/- 10%, FEF(50) = -20 +/- 13%). Hypoxia and hypoxic exercise resulted in increases in Vc (43 +/- 19 and 51 +/- 16%), D(M) (7 +/- 4 and 19 +/- 6%), and pulmonary function (FVC = 9 +/- 6 and 4 +/- 3%, FEV(1) = 5 +/- 2 and 4 +/- 3%, FEF(50) = 4 +/- 2 and 12 +/- 5%) and decreases in lung density and lung water (-84 +/- 24 and -103 +/- 20 ml vs. baseline). These data suggest that 17 h of hypoxic exposure at rest or with exercise resulted in a decrease in lung water in healthy humans.

Radiographic evidence of pulmonary edema during high-intensity interval training in women

The purpose was to determine if an intense interval training session could produce transient pulmonary edema in women. Fourteen females [(27+/-4 years; body mass index of 21.6+/-1.5 kg/m(2)); maximal oxygen consumption = 3.12+/-0.42 L/min] performed three sets of 5 min sea-level cycling exercise with 10-min recovery between each set. Average oxygen consumption at minute 5 of each set was 96+/-5% of maximum and arterial plasma lactate concentration at minute 5 of each set was 16.0+/-3.3 mmol/L. Chest radiographs were obtained before and 33.2+/-6.1 min after exercise. Four different chest radiologists independently reviewed the radiographs for edema, and scored seven validated radiographic characteristics on a three-point scale (0-2). The overall edema score increased from 1.3+/-1.6 before exercise to 1.9+/-2.0 after exercise [P<0.05; Delta = +0.7+/-1.8, 95% CI, 0.2 to +1.1]. This study shows that an intense interval training session can cause mild, detectable pulmonary edema in some women.

Pulmonary Oedema following Exercise in Humans

Pulmonary physiologists have documented many transient changes in the lung and the respiratory system during and following exercise, including the incomplete oxygen saturation of arterial blood in some subjects, possibly due to transient pulmonary oedema. The large increase in pulmonary arterial pressure during exercise, leading to either increased pulmonary capillary leakage and/or pulmonary capillary stress failure, is likely to be responsible for any increase in extravascular lung water during exercise. The purpose of this article is to summarise the studies to date that have specifically examined lung water following exercise. A limited number of studies have been completed with the specific purpose of identifying pulmonary oedema following exercise or a similar intervention. Of these, approximately 50% have observed a positive change and the remaining have provided results that are either inconclusive or show no change in extravascular lung water. While it is difficult to draw a firm conclusion from these studies, we believe that pulmonary oedema does occur in some humans following exercise. As such, this is a phenomenon of significance to pulmonary and exercise physiologists. This possibility warrants further study in the area with more precise measurement tools than has previously been undertaken.

The effect of sustained heavy exercise on the development of pulmonary edema in trained male cyclists

To determine whether intense, prolonged activity can induce transient pulmonary edema, eight highly trained male cyclists (mean +/- S.D.: age, 26.9 +/- 3.0 years; height, 179.9 +/- 5.7 cm; weight, 76.1 +/- 6.5 kg) performed a 45-min endurance cycle test (ECT). V(O2,max) was determined (4.84 +/- 0.4 L min(-1), 63.7 +/- 2.6 ml min(-1) g(-1)) and the intensity of exercise for the ECT was set at 10% below ventilatory threshold (approximately 76% V(O2, max) 300 +/- 25 W). Pre- and post-exercise pulmonary diffusion (DL(CO)) measurements and magnetic resonance imaging of the lung were made. DL(CO) and pulmonary capillary blood volume (VC) decreased 1h post-exercise by 12% (P = 0.004) and 21% (P = 0.017), respectively, but no significant change in membrane diffusing capacity (DM) was found. The magnetic resonance scans demonstrated a 9.4% increase (P = 0.043) in pulmonary extravascular water 90 min post-exercise. These data support the theory that high intensity, sustained exercise in well-trained athletes can result in transient pulmonary edema.

Lung diffusion capacity for nitric oxide and carbon monoxide is impaired similarly following short-term graded exercise

Study aimed to determine whether short-term graded exercise affects single-breath lung diffusion capacity for nitric oxide (DLNO) and carbon monoxide (DLCO) similarly, and whether the DLNO/DLCO ratios during rest are altered post-exercise compared to pre-exercise. Eleven healthy subjects (age=29+/-6 years; weight=76.6+/-13.2 kg; height=177.9+/-13.2 cm; and maximal oxygen uptake or V(.-)(O(2max) = 52.7 +/- 9.3 ml kg(-1) min(-1))performed simultaneous single-breath DLNO and DLCO measurements at rest (inspired NO concentration=43.2+/-4.1 ppm, inspired CO concentration=0.30%) 15 min before and 2h after a graded exercise test to exhaustion (exercise duration=593+/-135 s). Resting DLNO and DLCO was similarly reduced 2h post-exercise (DLNO=-7.8+/-3.5%, DLCO=-10.3+/-6.9%, and P<0.05) due to reductions in pulmonary capillary blood volume (-11.3+/-9.0%, P<0.05) and membrane diffusing capacity for CO (-7.8+/-3.5%; P<0.05). The change in DLCO was reflected by the change in DLNO post-exercise such that 68% of the variance in the change in DLCO was accounted for by the variance in the change in DLNO (P<0.05). The DLNO/DLCO ratio was not altered post-exercise (5.87+/-0.37) compared to pre-exercise (5.70+/-0.34). We conclude that the decrease in single-breath DLNO and DLCO from pre- to post-exercise is similar, the magnitude of the change in DLCO closely reflects that of the change in DLNO, and single-breath DLNO/DLCO ratios are independent of the timing of measurement suggesting that using NO and CO transfer gases are valid in looking at short-term changes in lung diffusional conductance.

Effects of prolonged exercise to exhaustion on left-ventricular function and pulmonary gas exchange

The purpose of this study was to simultaneously examine left-ventricular (LV) function and pulmonary gas exchange during prolonged constant-rate cycling in an attempt to explain the exercise-induced impairment in gas exchange. Eleven competitive cyclists rode their racing bicycles on a computerized cycle trainer at 25 W below the lactate threshold until exhaustion (exercise time = 2.51 +/- 0.86 h). LV systolic function was evaluated with two-dimensional echocardiography while arterial blood gases were used to assess pulmonary gas exchange. All variables were assessed concurrently before, during, and after exercise. LV function and cardiac output increased at the onset of exercise and were maintained until exhaustion. The alveolar-arterial P(O(2)) difference (A-a D(O(2))) increased within 15 min of the onset of exercise, was unchanged through to exhaustion, and returned to baseline 5 min post-exercise. Gas exchange was not related to cardiovascular function at the onset, or at end exercise. The results indicate that the widening A-aD(O(2)) during exercise is due to a readily reversible change in gas exchange function.

Effect of High-Intensity Submaximal Work, with or without Rest, on Subsequent &OV0312;O2max

PURPOSE

In practice, tests of maximal oxygen uptake (.VO2max) are often preceded by a lactate profile, a highly intense but submaximal exercise bout. The .VO2max response to preceding high-intensity submaximal exercise, with or without a rest period, has not been determined. If .VO2max is limited after a lactate profile, exercise-induced hypoxemia (EIH) may explain the deficit. The purposes of this study were to: 1) examine the effects of high-intensity submaximal exercise, with or without rest, on subsequent .VO2max; and 2) evaluate the role of EIH in causing any observed changes.

METHODS

Ten healthy, well-trained, male cross-country skiers (age = 20.5 +/- 4.7 yr, height = 181.6 +/- 6.0 cm, mass = 72.1 +/- 5.7 kg) completed three exercise trials: an incremental run to fatigue (MAX), MAX preceded by a high-intensity submaximal run (lactate profile) and a 20-min rest period (discontinuous protocol [DC]), and MAX preceded by a high-intensity submaximal exercise run with no rest (continuous protocol [C]). .VO2max, minute ventilation, and arterial oxygen saturation were measured throughout, and diffusion capacity was evaluated 2 min postexercise. RESULTS No significant between trial differences were observed, although the difference between .VO2max determined during the MAX trial (62.7 +/- 6.7 mL.kg-1.min-1) and during the DC trial (58.3 +/- 4.4 mL.kg-1.min-1) approached significance (P = 0.059). DC .VO2max responses could be separated into two groups: five responders whose .VO2max suffered during the DC trial (decreased >7.5% from MAX) and five nonresponders, whose .VO2max was unaffected by preceding submaximal exercise and a rest period. Responders showed greater aerobic capacity during the MAX trial.

CONCLUSION

.VO2max is significantly reduced in approximately 50% of cross-country skiers when a maximal exercise test is preceded by high-intensity submaximal exercise and a 20 min rest period; the role of EIH in causing these reductions is unclear.

Arterial desaturation during exercise in man: implication for O2 uptake and work capacity

Exercise-induced arterial hypoxaemia is defined as a reduction in the arterial O2 pressure (PaO2) by more than 1 kPa and/or a haemoglobin O2 saturation (SaO2) below 95%. With blood gas analyses ideally reported at the actual body temperature, desaturation is a consistent finding during maximal ergometer rowing. Arterial desaturation is most pronounced at the end of a maximal exercise bout, whereas the reduction in PaO2 is established from the onset of exercise. Exercise-induced arterial hypoxaemia is multifactorial. The ability to maintain a high alveolar O2 pressure (PAO2) is critical for blood oxygenation and this appears to be difficult in large individuals. A large lung capacity and, in turn, diffusion capacity seem to protect PaO2. A widening of the PAO2-PaO2 difference does indicate that a diffusion limitation, a ventilation-perfusion mismatch and/or a shunt influence the transport of O2 from alveoli to the pulmonary capillaries. An inspired O2 fraction of 0.30 reduces the widened PAO2-PaO2 difference by 75% and prevents a reduction of PaO2 and SaO2. With a marked increase in cardiac output, diffusion limitation combined with a fast transit time dominates the O2 transport problem. Furthermore, a postexercise reduction in pulmonary diffusion capacity suggests that the alveolo-capillary membrane is affected. An antioxidant attenuates oxidative burst by neutrophilic granulocytes, but it does not affect PaO2, SaO2 or O2 uptake (VO2), and the ventilatory response to maximal exercise also remains the same. It is proposed, though, that increased concentration of certain cytokines correlates to exercise-induced hypoxaemia as cytokines stimulate mast cells and basophilic granulocytes to degranulate histamine. The basophil count increases during maximal rowing. Equally, histamine release is associated with hypoxaemia and when the release of histamine is prevented, the reduction in PaO2 is attenuated. During maximal exercise, an extreme lactate spill-over to blood allows pH decrease to below 7.1 and according to the O2 dissociation curve this is critical for SaO2. When infusion of sodium bicarbonate maintains a stable blood buffer capacity, acidosis is attenuated and SaO2 increases from 89% to 95%. This enables exercise capacity to increase, an effect also seen when O2 supplementation to inspired air restores arterial oxygenation. In that case, exercise capacity increases less than can be explained by VO2 and CaO2. Furthermore, the change in muscle oxygenation during maximal exercise is not affected when hyperoxia and sodium bicarbonate attenuate desaturation. It is proposed that other organs benefit from enhanced O2 availability, and especially the brain appears to increase its oxygenation during maximal exercise with hyperoxia.

Effects of the order of running and cycling of similar intensity and duration on pulmonary diffusing capacity in triathletes

To study the pathophysiological mechanisms involved in the decrease of post-triathlon diffusing capacity (DLco), blood rheologic properties (blood viscosity: eta(b); changes in plasma volume: deltaPV) and atrial natriuretic factor (ANF) were assessed in ten triathletes during cycle-run (CR) and run-cycle (RC) trials at a metabolic intensity of 75% of maximal oxygen consumption ( VO(2max)). The DLco was measured before and 10 min after trials. ANF and deltaPV were measured at rest, after the cycle and run of CR and RC trials, and at the end of and 10 min after exercise. RC led to a greater deltaDLco decrease, a lower ANF concentration and a lower deltaPV than did CR, whereas for both CR and RC eta(b) was increased throughout exercise and 10 min after. In addition, after CR the deltaDLco decrease was inversely correlated ( r=-0.764; P<0.01) with deltaPV. The association of decreased plasma volume, increased eta(b), and lower ANF concentrations after RC suggested that lower blood pulmonary volume may have caused the greater decrease in Dlco as compared with CR. The inverse correlation between deltaPV and deltaDLco reinforces the hypothesis that fluid shifts limit the post-exercise DLco decrease after the CR succession in triathletes. Lastly, cycling in the crouched position might increase intra-thoracic pressure, decrease thorax volume due to the forearm position on the handlebars, and weaken peripheral muscular pump efficacy, all of which would limit venous return to the heart, and thus result in low pulmonary blood volume. Compared with cycling, running appeared to induce the opposite effects.

The effects of cycle racing on pulmonary diffusion capacity and left ventricular systolic function

The purpose of this study was to examine the effects of a 20 km cycle race (TT) on left ventricular (LV) systolic and pulmonary function in 12 endurance cyclists. Spirometry, single-breath diffusion capacity (DLCO) with partitioning of membrane (DM) and capillary blood volume (Vc) components and 2-D echocardiograms were performed before and after the TT. During the TT mean oxygen consumption was 3.79 +/- 0.5 L x min(-1) (83 +/- 5.5% of VO2max) and mean blood lactate was 8.4 +/- 2.4 mM. Following the TT, spirometry values were unchanged, however, DLCO and DM were significantly (P<0.05) reduced. LV systolic function was increased (P<0.05) immediately after exercise, while end-diastolic area was decreased (P<0.05) at all points during recovery. The reduction in DM was correlated with LV systolic function following the TT. This relationship suggests a cardiovascular contribution to pulmonary diffusion impairment following exercise.

Recruitment of lung diffusing capacity: update of concept and application

Lung diffusing capacity (DL) for carbon monoxide (DLCO), nitric oxide (DLNO) or oxygen (DLO2) increases from rest to peak exercise without reaching an upper limit; this recruitment results from interactions among alveolar volume (VA), and cardiac output (q), as well as changing physical properties and spatial distribution of capillary erythrocytes, and is critical for maintaining a normal arterial oxygen saturation. DLCO and DLNO can be used to interpret the effectiveness of diffusive oxygen transport and track structural alterations of the alveolar-capillary barrier, providing sensitive noninvasive indicators of microvascular integrity in health and disease. Clinical interpretation of DL should take into account Q in addition to VA and hemoglobin concentration.

Exercise-induced arterial hypoxaemia in athletes: a review

During exercise, healthy individuals are able to maintain arterial oxygenation, whereas highly-trained endurance athletes may exhibit an exercise-induced arterial hypoxaemia (EIAH) that seems to reflect a gas exchange abnormality. The effects of EIAH are currently debated, and different hypotheses have been proposed to explain its pathophysiology. For moderate exercise, it appears that a relative hypoventilation induced by endurance training is involved. For high-intensity exercise, ventilation/perfusion (V(A)/Q) mismatching and/or diffusion limitation are thought to occur. The causes of this diffusion limitation are still under debate, with hypotheses being capillary blood volume changes and interstitial pulmonary oedema. Moreover, histamine is released during exercise in individuals exhibiting EIAH, and questions persist as to its relationship with EIAH and its contribution to interstitial pulmonary oedema. Further investigations are needed to better understand the mechanisms involved and to determine the long term consequences of repetitive hypoxaemia in highly trained endurance athletes.