Relationship between changes in haemoglobin mass and maximal oxygen uptake after hypoxic exposure

Association of iron supplementation, HFE and AMPD1 polymorphisms and biochemical iron metabolism parameters in the performance of a men's World Tour cycling team: A pilot study

BACKGROUND

Nutritional strategies with iron supplementation have been shown to be effective in preventing the decline of blood biochemical parameters and sports performance. The aim of the study was to describe biochemical iron metabolism parameters in association with iron supplementation and HFE and AMPD1 polymorphisms in a Union Cycliste Internationale (UCI) World Tour cycling team to evaluate performance during a whole season METHODS: Twenty-eight professional men cyclists took part in this longitudinal observational pilot study. AMPD1 c.34 C>T (rs17602729) and HFE c.187 C>G (rs1799945) polymorphisms were genotyped using Single Nucleotide Primer Extension (SNPE). All the professional cyclists took oral iron supplementation throughout the season. Four complete blood analyses were carried out corresponding to UCI controls in January (1st), April (2nd), June (3rd) and October (4th). Data on participation in three-week Grand Tours, kms of competition and wins were analyzed.

RESULTS

In performance, especially in wins, there was a significant effect in HFE on biochemical hemoglobin (F = 4.255; p = 0.021) and biochemical hematocrit (F = 5.335; p = 0.009) and a hematocrit biochemical × genotype interaction (F = 3.418; p = 0.041), with higher values in professional cyclist with GC genotype. In AMPD1 there were significant effects in the biochemical iron x genotype interaction in three-week Grand Tours (F = 3.874; p = 0.029) and wins (F = 3.930; p = 0.028) CONCLUSIONS: Blood biochemical iron metabolism parameters could be related to performance in the season due to increasing hemoglobin and hematocrit concentration under iron supplementation, associated with winning in the professional cyclists with GC genotype of the HFE polymorphism.

Repeated sprint training in hypoxia induces specific skeletal muscle adaptations through S100A protein signaling

Athletes increasingly engage in repeated sprint training consisting in repeated short all-out efforts interspersed by short recoveries. When performed in hypoxia (RSH), it may lead to greater training effects than in normoxia (RSN); however, the underlying molecular mechanisms remain unclear. This study aimed at elucidating the effects of RSH on skeletal muscle metabolic adaptations as compared to RSN. Sixteen healthy young men performed nine repeated sprint training sessions in either normoxia (FIO2 = 0.209, RSN, n = 7) or normobaric hypoxia (FIO2 = 0.136, RSH, n = 9). Before and after the training period, exercise performance was assessed by using repeated sprint ability (RSA) and Wingate tests. Vastus lateralis muscle biopsies were performed to investigate muscle metabolic adaptations using proteomics combined with western blot analysis. Similar improvements were observed in RSA and Wingate tests in both RSN and RSH groups. At the muscle level, RSN and RSH reduced oxidative phosphorylation protein content but triggered an increase in mitochondrial biogenesis proteins. Proteomics showed an increase in several S100A family proteins in the RSH group, among which S100A13 most strongly. We confirmed a significant increase in S100A13 protein by western blot in RSH, which was associated with increased Akt phosphorylation and its downstream targets regulating protein synthesis. Altogether our data indicate that RSH may activate an S100A/Akt pathway to trigger specific adaptations as compared to RSN.

Effects of three weeks base training at moderate simulated altitude with or without hypoxic residence on exercise capacity and physiological adaptations in well-trained male runners

Objectives

To test the hypothesis that 'live high-base train high-interval train low' (HiHiLo) altitude training, compared to 'live low-train high' (LoHi), yields greater benefits on performance and physiological adaptations.

Methods

Sixteen young male middle-distance runners (age, 17.0 ± 1.5 y; body mass, 58.8 ± 4.9 kg; body height, 176.3 ± 4.3 cm; training years, 3-5 y; training distance per week, 30-60 km.wk-1) with a peak oxygen uptake averaging ~65 ml.min-1.kg-1 trained in a normobaric hypoxia chamber (simulated altitude of ~2,500 m, monitored by heart rate ~170 bpm; thrice weekly) for 3 weeks. During this period, the HiHiLo group (n = 8) stayed in normobaric hypoxia (at ~2,800 m; 10 h.day-1), while the LoHi group (n = 8) resided near sea level. Before and immediately after the intervention, peak oxygen uptake and exercise-induced arterial hypoxemia responses (incremental cycle test) as well as running performance and time-domain heart rate variability (5-km time trial) were assessed. Hematological variables were monitored at baseline and on days 1, 7, 14 and 21 during the intervention.

Results

Peak oxygen uptake and running performance did not differ before and after the intervention in either group (all P > 0.05). Exercise-induced arterial hypoxemia responses, measured both at submaximal (240 W) and maximal loads during the incremental test, and log-transformed root mean square of successive R-R intervals during the 4-min post-run recovery period, did not change (all P > 0.05). Hematocrit, mean reticulocyte absolute count and reticulocyte percentage increased above baseline levels on day 21 of the intervention (all P < 0.001), irrespective of group.

Conclusions

Well-trained runners undertaking base training at moderate simulated altitude for 3 weeks, with or without hypoxic residence, showed no performance improvement, also with unchanged time-domain heart rate variability and exercise-induced arterial hypoxemia responses.

Circadian rhythm in sportspersons and athletic performance: A mini review

Circadian rhythms in the physiological and behavioral processes of humans play a crucial role in the quality of living and also in the magnitude of success and failure in various endeavors including competitive sports. The rhythmic activities of the body and performance in sportspersons do have a massive impact on their every cutthroat competition. It is essential to schedule sports activities and training of players according to their circadian typology and time of peak performance for improved performance and achievement. In this review, the focus is on circadian rhythms and diurnal variations in peak athletic performance in sportspersons. Accuracy and temporal variability in peak performance in an individual could be attributed to various factors, namely chronotype, time of the day, body temperature, jetlag, hormones, and prior light exposure. Circadian rhythm of mood, alertness, T-core, and ultimately athletic performance is not only affected by sleep but also by circadian variations in hormones, such as cortisol, testosterone, and melatonin. There are, however, a few reports that are not consistent with the conclusions drawn in this review. Nevertheless, circadian rhythm and performance among sportspersons and athletes are important areas of research. This review might be useful to the managers and policymakers associated with competitive sports and athletic events.

Iron Absorption in Highly Trained Male Runners: Does it Matter When and Where You Eat Your Iron?

PURPOSE

We examined iron absorption and its regulation during two common scenarios experienced by endurance athletes. Our aims were to: (i) compare the effects of preexercise versus postexercise iron intake on iron absorption; and (ii) compare the impact of training at altitude (1800 m) on iron absorption preexercise.

METHODS

Male runners (n = 18) completed three exercise trials over a 5-wk period, each preceded by 24 h of standardized low-iron diets. First, athletes completed two 60-min treadmill running trials at 65% V̇O2max at near sea-level (580 m). In a randomized order, preexercise and postexercise test meals labeled with 4 mg of 57Fe or 58Fe were consumed 30 min before or 30 min after exercise. Then, the same exercise trial was performed after living and training at altitude (~1800 m) for 7 d, with the labeled test meal consumed 30 min preexercise. We collected venous blood samples preexercise and postexercise for markers of iron status and regulation, and 14 d later to measure erythrocyte isotope incorporation.

RESULTS

No differences in fractional iron absorption were evident when test meals were consumed preexercise (7.3% [4.4, 12.1]) or postexercise (6.2% [3.1, 12.5]) (n = 18; P = 0.058). Iron absorption preexercise was greater at altitude (18.4% [10.6, 32.0]) than at near sea-level (n = 17; P < 0.001) and hepcidin concentrations at altitude were lower at rest and 3 h postexercise compared with near sea level (P < 0.001).

CONCLUSIONS

In an acute setting, preexercise and postexercise iron absorption is comparable if consumed within 30 min of exercise. Preexercise iron absorption increases 2.6-fold at altitude compared with near sea-level, likely due to the homeostatic response to provide iron for enhanced erythropoiesis and maintain iron stores.

Optimal type and dose of hypoxic training for improving maximal aerobic capacity in athletes: a systematic review and Bayesian model-based network meta-analysis

Objective: This study aimed to compare and rank the effect of hypoxic practices on maximum oxygen consumption (VO2max) in athletes and determine the hypoxic dose-response correlation using network meta-analysis. Methods: The Web of Science, PubMed, EMBASE, and EBSCO databases were systematically search for randomized controlled trials on the effect of hypoxc interventions on the VO2max of athletes published from inception until 21 February 2023. Studies that used live-high train-high (LHTH), live-high train-low (LHTL), live-high, train-high/low (HHL), intermittent hypoxic training (IHT), and intermittent hypoxic exposure (IHE) interventions were primarily included. LHTL was further defined according to the type of hypoxic environment (natural and simulated) and the altitude of the training site (low altitude and sea level). A meta-analysis was conducted to determine the standardized mean difference between the effects of various hypoxic interventions on VO2max and dose-response correlation. Furthermore, the hypoxic dosage of the different interventions were coordinated using the "kilometer hour" model. Results: From 2,072 originally identified titles, 59 studies were finally included in this study. After data pooling, LHTL, LHTH, and IHT outperformed normoxic training in improving the VO2max of athletes. According to the P-scores, LHTL combined with low altitude training was the most effective intervention for improving VO2max (natural: 0.92 and simulated: 0.86) and was better than LHTL combined with sea level training (0.56). A reasonable hypoxic dose range for LHTH (470-1,130 kmh) and HL (500-1,415 kmh) was reported with an inverted U-shaped curve relationship. Conclusion: Different types of hypoxic training compared with normoxic training serve as significant approaches for improving aerobic capacity in athletes. Regardless of the type of hypoxic training and the residential condition, LHTL with low altitude training was the most effective intervention. The characteristics of the dose-effect correlation of LHTH and LHTL may be associated with the negative effects of chronic hypoxia.

Cardiopulmonary exercise testing before and after intravenous iron in preoperative patients: a prospective clinical study

BACKGROUND

Anemia is associated with impaired physical performance and adverse perioperative outcomes. Iron-deficiency anemia is increasingly treated with intravenous iron before elective surgery. We explored the relationship between exercise capacity, anemia, and total hemoglobin mass (tHb-mass) and the response to intravenous iron in anemic patients prior to surgery.

METHODS

A prospective clinical study was undertaken in patients having routine cardiopulmonary exercise testing (CPET) with a hemoglobin concentration ([Hb]) < 130 g^.l^-1 and iron deficiency/depletion. Patients underwent CPET and tHb-mass measurements before and a minimum of 14 days after receiving intravenous (i.v.) Ferric derisomaltose (Monofer®) at the baseline visit. Comparative analysis of hematological and CPET variables was performed pre and post-iron treatment.

RESULTS

Twenty-six subjects were recruited, of whom 6 withdrew prior to study completion. The remaining 20 (9 [45%] male; mean ± SD age 68 ± 10 years) were assessed 25 ± 7 days between baseline and the final visit. Following i.v. iron, increases were seen in [Hb] (mean ± SD) from 109 ± 14 to 116 ± 12 g l^-1 (mean rise 6.4% or 7.3 g l^-1, p =  < 0.0001, 95% CI 4.5-10.1); tHb-mass from 497 ± 134 to 546 ± 139 g (mean rise 9.3% or 49 g, p =  < 0.0001, 95% CI 29.4-69.2). Oxygen consumption at anerobic threshold ([Formula: see text] O_{2 AT}) did not change (9.1 ± 1.7 to 9.8 ± 2.5 ml kg^-1 min^-1, p = 0.09, 95% CI - 0.13 - 1.3). Peak oxygen consumption ([Formula: see text] O_{2 peak}) increased from 15.2 ± 4.1 to 16 ± 4.4 ml^.kg^.-1 min^-1, p = 0.02, 95% CI 0.2-1.8) and peak work rate increased from 93 [67-112] watts to 96 [68-122] watts (p = 0.02, 95% CI 1.3-10.8).

CONCLUSION

Preoperative administration of intravenous iron to iron-deficient/deplete anemic patients is associated with increases in [Hb], tHb-mass, peak oxygen consumption, and peak work rate. Further appropriately powered prospective studies are required to ascertain whether improvements in tHb-mass and performance in turn lead to reductions in perioperative morbidity.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT 033 46213.

Hemoglobin mass and performance responses during 4 weeks of normobaric "live high-train low and high"

PURPOSE

To investigate whether 4 weeks of normobaric "live high-train low and high" (LHTLH) causes different hematological, cardiorespiratory, and sea-level performance changes compared to living and training in normoxia during a preparation season.

METHODS

Nineteen (13 women, 6 men) cross-country skiers competing at the national or international level completed a 28-day period (∼18 h day^-1 ) of LHTLH in normobaric hypoxia of ∼2400 m (LHTLH group) including two 1 h low-intensity training sessions per week in normobaric hypoxia of 2500 m while continuing their normal training program in normoxia. Hemoglobin mass (Hb_mass ) was assessed using a carbon monoxide rebreathing method. Time to exhaustion (TTE) and maximal oxygen uptake (VO_2max ) were measured using an incremental treadmill test. Measurements were completed at baseline and within 3 days after LHTLH. The control group skiers (CON) (seven women, eight men) performed the same tests while living and training in normoxia with ∼4 weeks between the tests.

RESULTS

Hb_mass in LHTLH increased 4.2 ± 1.7% from 772 ± 213 g (11.7 ± 1.4 g kg^-1 ) to 805 ± 226 g (12.5 ± 1.6 g kg^-1 ) (p < 0.001) while it was unchanged in CON (p = 0.21). TTE improved during the study regardless of the group (3.3 ± 3.4% in LHTLH; 4.3 ± 4.8% in CON, p < 0.001). VO_2max did not increase in LHTLH (61.2 ± 8.7 mL kg^-1  min^-1 vs. 62.1 ± 7.6 mL kg^-1  min^-1 , p = 0.36) while a significant increase was detected in CON (61.3 ± 8.0-64.0 ± 8.1 mL kg^-1  min^-1 , p < 0.001).

CONCLUSIONS

Four-week normobaric LHTLH was beneficial for increasing Hb_mass but did not support the short-term development of maximal endurance performance and VO_2max when compared to the athletes who lived and trained in normoxia.

Living high - training low model applied to C57BL/6J mice: Effects on physiological parameters related to aerobic fitness and acid-base balance

There is a scarcity of data regarding the acclimation to high altitude (hypoxic environment) accompanied by training at low altitude (normoxic conditions), the so-called "living high-training low" (LHTL) model in rodents. We aimed to investigate the effects of aerobic training on C57BL/6J mice living in normoxic (NOR) or hypoxic (HYP) environments on several parameters, including critical velocity (CV), a parameter regarded as a measure of aerobic capacity, on monocarboxylate transporters (MCTs) in muscles and hypothalamus, as well as on hematological parameters and body temperature. In each environment, mice were divided into non-trained (N) and trained (T). Forty rodents were distributed into the following experimental groups (N-NOR; T-NOR; N-HYP and T-HYP). HYP groups were in a normobaric tent where oxygen-depleted air was pumped from a hypoxia generator set an inspired oxygen fraction [FiO₂] of 14.5 %. The HYP-groups were kept (18 h per day) in a normobaric tent for consecutive 8-weeks. Training sessions were conducted in normoxic conditions ([FiO₂] = 19.5 %), 5 times per week (40 min per session) at intensity equivalent to 80 % of CV. In summary, eight weeks of LHTL did not promote a greater improvement in the CV, protein expression of MCTs in different tissues when compared to the application of training alone. The LHTL model increased red blood cells count, but reduced hemoglobin per erythrocyte was found in mice exposed to LHTL. Although the LHTL did not have a major effect on thermographic records, exercise-induced hyperthermia (in the head) was attenuated in HYP groups when compared to NOR groups.

Effects of six weeks of sub-plateau cold environment training on physical functioning and athletic ability in elite parallel giant slalom snowboard athletes

Background

Hypoxic and cold environments have been shown to improve the function and performance of athletes. However, it is unclear whether the combination of subalpine conditions and cold temperatures may have a greater effect. The present study aims to investigate the effects of 6 weeks of training in a sub-plateau cold environment on the physical function and athletic ability of elite parallel giant slalom snowboard athletes.

Methods

Nine elite athletes (four males and five females) participated in the study. The athletes underwent 6 weeks of high intensity ski-specific technical training (150 min/session, six times/week) and medium-intensity physical training (120 min/session, six times/week) prior to the Beijing 2021 Winter Olympic Games test competition. The physiological and biochemical parameters were collected from elbow venous blood samples after each 2-week session to assess the athletes' physical functional status. The athletes' athletic ability was evaluated by measuring their maximal oxygen uptake, Wingate 30 s anaerobic capacity, 30 m sprint run, and race performance. Measurements were taken before and after participating in the training program for six weeks. The repeated measure ANOVA was used to test the overall differences of blood physiological and biochemical indicators. For indicators with significant time main effects, post-hoc tests were conducted using the least significant difference (LSD) method. The paired-samples t-test was used to analyze changes in athletic ability indicators before and after training.

Results

(1) There was a significant overall time effect for red blood cells (RBC) and white blood cells (WBC) in males; there was also a significant effect on the percentage of lymphocytes (LY%), serum testosterone (T), and testosterone to cortisol ratio (T/C) in females (p < 0.001 - 0.015, η p 2 = 0 . 81 - 0 . 99 ). In addition, a significant time effect was also found for blood urea(BU), serum creatine kinase (CK), and serum cortisol levels in both male and female athletes (p = 0.001 - 0.029, η p 2 = 0 . 52 - 0 . 95 ). (2) BU and CK levels in males and LY% in females were all significantly higher at week 6 (p = 0.001 - 0.038), while WBC in males was significantly lower (p = 0.030). T and T/C were significantly lower in females at week 2 compared to pre-training (p = 0.007, 0.008, respectively), while cortisol (C) was significantly higher in males and females at weeks 2 and 4 (p _(male) = 0.015, 0.004, respectively; p _(female) = 0.024, 0.030, respectively). (3) There was a noticeable increase in relative maximal oxygen uptake, Wingate 30 s relative average anaerobic power, 30 m sprint run performance, and race performance in comparison to the pre-training measurements (p < 0.001 - 0.027).

Conclusions

Six weeks of sub-plateau cold environment training may improve physical functioning and promote aerobic and anaerobic capacity for parallel giant slalom snowboard athletes. Furthermore, male athletes had a greater improvement of physical functioning and athletic ability when trained in sub-plateau cold environments.

Hemoglobin modulation affects physiology and patient reported outcomes in anemic and non-anemic subjects: An umbrella review

Background: An abnormal hemoglobin concentration has a substantial effect on a person's quality of life and physiology. Lack of tools that effectively evaluate hemoglobin-related outcomes leads to uncertainty regarding optimal hemoglobin levels, transfusion thresholds and treatment targets. We therefore aim to summarize reviews that assess the effects of hemoglobin modulation on the human physiology at various baseline hemoglobin levels, and identify gaps in existing evidence. Methods: We conducted an umbrella review of systematic reviews. PubMed, MEDLINE (OVID), Embase, Web of Science, Cochrane Library and Emcare were searched from inception to the 15th of April 2022 for studies that reported on physiological and patient reported outcomes following a hemoglobin change. Results: Thirty-three reviews were included of which 7 were scored as of high quality and 24 of critically low quality using the AMSTAR-2 tool. The reported data generally show that an increase in hemoglobin leads to improvement of patient reported and physical outcomes in anaemic and non-anaemic subjects. At lower hemoglobin levels, the effect of a hemoglobin modulation on quality of life measures appears more pronounced. Conclusion: This overview has revealed many knowledge gaps due to a lack of high-quality evidence. For chronic kidney disease patients, a clinically relevant benefit of increasing the hemoglobin levels up until 12 g/dL was found. However, a personalized approach remains necessary due to the many patient-specific factors that affect outcomes. We strongly encourage future trials to incorporate physiological outcomes as objective parameters together with subjective, but still very important, patient reported outcome measures.

High-Intensity Interval Training (HIIT) in Hypoxia Improves Maximal Aerobic Capacity More Than HIIT in Normoxia: A Systematic Review, Meta-Analysis, and Meta-Regression

The present study aimed to determine the effect of high intensity interval training (HIIT) in hypoxia on maximal oxygen uptake (VO_2max) compared with HIIT in normoxia with a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-accordant meta-analysis and meta-regression. Studies which measured VO_2max following a minimum of 2 weeks intervention featuring HIIT in hypoxia versus HIIT in normoxia were included. From 119 originally identified titles, nine studies were included (n = 194 participants). Meta-analysis was conducted on change in (∆) VO_2max using standardised mean difference (SMD) and a random effects model. Meta-regression examined the relationship between the extent of environmental hypoxia (fractional inspired oxygen [FiO₂]) and ∆VO_2max and intervention duration and ∆VO_2max. The overall SMD for ∆VO_2max following HIIT in hypoxia was 1.14 (95% CI = 0.56-1.72; p < 0.001). Meta-regressions identified no significant relationship between FiO₂ (coefficient estimate = 0.074, p = 0.852) or intervention duration (coefficient estimate = 0.071, p = 0.423) and ∆VO_2max. In conclusion, HIIT in hypoxia improved VO_2max compared to HIIT in normoxia. Neither extent of hypoxia, nor training duration modified this effect, however the range in FiO₂ was small, which limits interpretation of this meta-regression. Moreover, training duration is not the only training variable known to influence ∆VO_2max, and does not appropriately capture total training stress or load. This meta-analysis provides pooled evidence that HIIT in hypoxia may be more efficacious at improving VO_2max than HIIT in normoxia. The application of these data suggest adding a hypoxic stimuli to a period of HIIT may be more effective at improving VO_2max than HIIT alone. Therefore, coaches and athletes with access to altitude (either natural or simulated) should consider implementing HIIT in hypoxia, rather than HIIT in normoxia where possible, assuming no negative side effects.

Effect of hypobaric hypoxia on hematological parameters related to oxygen transport, blood volume and oxygen consumption in adolescent endurance-training athletes

Objective

To analyze the effect of altitude on hematological and cardiorespiratory variables in adolescent athletes participating in aerobic disciplines.

Methods

21 females and 89 males participated in the study. All were adolescent elite athletes engaged in endurance sports (skating, running and cycling) belonging to two groups: permanent residents in either low altitude (LA, 966 m) or moderate altitude (MA, 2640 m). Hematocrit (Hct), hemoglobin concentration ([Hb]), total hemoglobin mass (Hbt), blood, plasma and erythrocyte volumes (BV, PV and EV), VO₂peak and other cardiorespiratory parameters were evaluated.

Results

Sex differences were evident both in LA and HA skating practitioners, the males having higher significant values than the females in oxygen transport-related hematological parameters and VO₂peak. The effect of altitude residence was also observed in Hct, [Hb], Hbt and EV with increased (14%–18%) values in the hematological parameters and higher EV (5%–24%). These results matched the significantly higher values of VO₂peak measured in MA residents. However, BV and PV did not show differences between LA and MA residents in any case. Sports discipline influenced neither the hematological variables nor most of the cardiorespiratory parameters.

Conclusions

LA and MA adolescent skaters showed sex differences in hematological variables. Endurance-trained male adolescent residents at MA had an increased erythropoietic response and a higher VO₂peak compared to their counterparts residing and training at LA. These responses are similar in the three aerobic sports studied, indicating that the variables described are highly sensitive to hypoxia irrespective of the sports discipline.

Altitude acclimatization, hemoglobin-oxygen affinity, and circulatory oxygen transport in hypoxia

In mammals and other air-breathing vertebrates that live at high altitude, adjustments in convective O₂ transport via changes in blood hemoglobin (Hb) content and/or Hb-O₂ affinity can potentially mitigate the effects of arterial hypoxemia. However, there are conflicting views about the optimal values of such traits in hypoxia, partly due to the intriguing observation that hypoxia-induced acclimatization responses in humans and other predominantly lowland mammals are frequently not aligned in the same direction as evolved phenotypic changes in high-altitude natives. Here we review relevant theoretical and empirical results and we highlight experimental studies of rodents and humans that provide insights into the combination of hematological changes that help attenuate the decline in aerobic performance in hypoxia. For a given severity of hypoxia, experimental results suggest that optimal values for hematological traits are conditional on the states of other interrelated phenotypes that govern different steps in the O₂-transport pathway.

Effects of bariatric surgery on cardiorespiratory fitness: A systematic review and meta-analysis

Although bariatric surgery (BS) is recognized as an effective strategy for body weight loss, its impact on cardiorespiratory fitness (CRF) is still unclear. We aimed to examine postoperative changes in CRF (VO_2max/peak ) and its relationship with weight loss among adults undergoing BS. We systematically searched the WoS, PubMed, MEDLINE, and Scopus databases. Observational and intervention studies were selected reporting the presurgery and postsurgery CRF, measured by breath-by-breath VO₂ or its estimation. Eleven articles (312 patients) revealed that BS leads to a reduction in absolute VO_2max/peak in the short term (effect size, ES = -0.539; 95%CI = -0.708, -0.369; p < 0.001), and those patients who suffered a more significant decrease in BMI after BS also had a greater loss of absolute VO_2max/peak . However, VO_2max/peak relative to body weight increased after surgery (ES = 0.658; 95%CI = 0.473, 0.842; p < 0.001). An insufficient number of studies were found investigating medium and long-term changes in CRF after BS. This study provides moderate-quality evidence that the weight loss induced by BS can reduce CRF in the short term, which represents a therapeutic target to optimize BS outcomes. More high-quality studies are needed to evaluate the impact of BS on VO_2max/peak in the short, medium, and long term including normalized values for fat-free mass.

Hypoxia Improves Endurance Performance by Enhancing Short Chain Fatty Acids Production via Gut Microbiota Remodeling

Hypoxia environment has been widely used to promote exercise capacity. However, the underlying mechanisms still need to be further elucidated. In this study, mice were exposed to the normoxia environment (21% O₂) or hypoxia environment (16.4% O₂) for 4 weeks. Hypoxia-induced gut microbiota remodeling characterized by the increased abundance of Akkermansia and Bacteroidetes genera, and their related short-chain fatty acids (SCFAs) production. It was observed that hypoxia markedly improved endurance by significantly prolonging the exhaustive running time, promoting mitochondrial biogenesis, and ameliorating exercise fatigue biochemical parameters, including urea nitrogen, creatine kinase, and lactic acid, which were correlated with the concentrations of SCFAs. Additionally, the antibiotics experiment partially inhibited hypoxia-induced mitochondrial synthesis. The microbiota transplantation experiment demonstrated that the enhancement of endurance capacity induced by hypoxia was transferable, indicating that the beneficial effects of hypoxia on exercise performance were partly dependent on the gut microbiota. We further identified that acetate and butyrate, but not propionate, stimulated mitochondrial biogenesis and promoted endurance performance. Our results suggested that hypoxia exposure promoted endurance capacity partially by the increased production of SCFAs derived from gut microbiota remodeling.

Genomic basis of evolutionary adaptation in a warm-blooded fish

Few fishes have evolved elevated body temperatures compared with ambient temperatures, and only in opah (Lampris spp) is the entire body affected. To understand the molecular basis of endothermy, we analyzed the opah genome and identified 23 genes with convergent amino acid substitutions across fish, birds, and mammals, including slc8b1, which encodes the mitochondrial Na⁺/Ca²⁺ exchanger and is essential for heart function and metabolic heat production. Among endothermic fishes, 44 convergent genes with suggestive metabolic functions were identified, such as glrx3, encoding a crucial protein for hemoglobin maturation. Numerous genes involved in the production and retention of metabolic heat were also found to be under positive selection. Analyses of opah's unique inner-heat-producing pectoral muscle layer (PMI), an evolutionary key innovation, revealed that many proteins were co-opted from dorsal swimming muscles for thermogenesis and oxidative phosphorylation. Thus, the opah genome provides valuable resources and opportunities to uncover the genetic basis of thermal adaptations in fish.

The Use of a Smartphone Application in Monitoring HRV during an Altitude Training Camp in Professional Female Cyclists: A Preliminary Study

Altitude training is a common strategy to improve performance in endurance athletes. In this context, the monitoring of training and the athletes’ response is essential to ensure positive adaptations. Heart rate variability (HRV) has been proposed as a tool to evaluate stress and the response to training. In this regard, many smartphone applications have emerged allowing a wide access to recording HRV easily. The purpose of this study was to describe the changes of HRV using a validated smartphone application before (Pre-TC), during (TC), and after (Post-TC) an altitude training camp in female professional cyclists. Training load (TL) and vagal markers of heart rate variability (LnRMSSD, LnRMSSDcv) of seven professional female cyclists before, during, and after and altitude training camp were monitored. Training volume (SMD = 0.80), LnRMSSD (SMD = 1.06), and LnRMSSDcv (SMD = −0.98) showed moderate changes from Pre-TC to TC. Training volume (SMD = 0.74), TL (SMD = 0.75), LnRMSSD (SMD = −1.11) and LnRMSSDcv (SMD = 0.83) showed moderate changes from TC to Post-TC. Individual analysis showed that heart rate variability responded differently among subjects. The use of a smartphone application to measure HRV is a useful tool to evaluate the individual response to training in female cyclists.

Exercise and Heat Stress: Inflammation and the Iron Regulatory Response

This study determined the impact of heat stress on postexercise inflammation and hepcidin levels. Twelve moderately trained males completed three, 60-min treadmill running sessions under different conditions: (a) COOL, 18 °C with speed maintained at 80% maximum heart rate; (b) HOTHR, 35 °C with speed maintained at 80% maximum heart rate; and (c) HOTPACE, 35 °C completed at the average running speed from the COOL trial. Venous blood samples were collected pre-, post-, and 3-hr postexercise and analyzed for serum ferritin, interleukin-6 (IL-6), and hepcidin concentrations. Average HR was highest during HOTPACE compared with HOTHR and COOL (p < .001). Running speed was slowest in HOTHR compared with COOL and HOTPACE (p < .001). The postexercise increase in IL-6 was greatest during HOTPACE (295%; p = .003). No differences in the IL-6 response immediately postexercise between COOL (115%) and HOTHR (116%) were evident (p = .992). No differences in hepcidin concentrations between the three trials were evident at 3 hr postexercise (p = .407). Findings from this study suggest the IL-6 response to exercise is greatest in hot compared with cool conditions when the absolute running speed was matched. No differences in IL-6 between hot and cool conditions were evident when HR was matched, suggesting the increased physiological strain induced from training at higher intensities in hot environments, rather than the heat per se, is likely responsible for this elevated response. Environmental temperature had no impact on hepcidin levels, indicating that exercising in hot conditions is unlikely to further impact transient alterations in iron regulation, beyond that expected in temperate conditions.

Effects of Ashwagandha (Withania somnifera) on Physical Performance: Systematic Review and Bayesian Meta-Analysis

Ashwagandha (Withania somnifera) is considered a potent adaptogen and anti-stress agent that could have some potential to improve physical performance. This preferred reporting items for systematic reviews and meta-analyses (PRISMA)-based comprehensive systematic review and Bayesian meta-analysis aimed to evaluate clinical trials up to 2020 from PubMed, ScienceDirect, and Google Scholar databases regarding the effect of Ashwagandha supplementation on physical performance in healthy individuals. Besides implementing estimation statistics analysis, we developed Bayesian hierarchical models for a pre-specified subgroup meta-analysis on strength/power, cardiorespiratory fitness and fatigue/recovery variables. A total of 13 studies met the requirements of this systematic review, although only 12 were included in the quantitative analysis. A low-to-moderate overall risk of bias of the trials included in this study was detected. All Bayesian hierarchical models converged to a target distribution (Ȓ = 1) for both meta-analytic effect size (μ) and between-study standard deviation (τ). The meta-analytic approaches of the included studies revealed that Ashwagandha supplementation was more efficacious than placebo for improving variables related to physical performance in healthy men and female. In fact, the Bayesian models showed that future interventions might be at least in some way beneficial on the analyzed outcomes considering the 95% credible intervals for the meta-analytic effect size. Several practical applications and future directions are discussed, although more comparable studies are needed in exercise training, and athletic populations are needed to derive a more stable estimate of the true underlying effect.

Using a Portable Near-infrared Spectroscopy Device to Estimate The Second Ventilatory Threshold

A breakpoint in a portable near-infrared spectroscopy (NIRS) derived deoxygenated haemoglobin (deoxy[Hb]) signal during an incremental VO2max running test has been associated with the second ventilatory threshold (VT2) in healthy participants. Thus, the aim was to examine the association between this breakpoint (NIRS) and VT₂ in well-trained runners. Gas exchange and NIRS data were collected during an incremental VO_2max running test for 10 well-trained runners. The breakpoint calculated in oxygen saturation (StO₂) and the VT₂ were determined and compared in terms relative to %VO_2max, absolute speed, VO₂, and maximum heart rate (HRmax). There were no significant differences (p>0.05) between the breakpoint in StO₂ and VT₂ relative to %VO_2max (87.00±6.14 and 88.28 ± 3.98 %), absolute speed (15.70±1.42 and 16.10±1.66 km·h^-1), VO₂ (53.71±15.17 and 54.66±15.57 ml·kg^-1·min^-1), and%HRmax (90.90±4.17 and 91.84±3.70%). There were large and significant correlations between instruments relative to%VO_2max (r=0.68, p<0.05), absolute speed (r=0.86, p<0.001), VO₂ (r=0.86, p<0.001), and %HR_max (r=0.69; p<0.05). A Bland and Altman analysis of agreement between instruments resulted in a mean difference of - 1.27±4.49%, -0.40±0.84 km·h^-1,-0.90±3.07 ml·kg^-1·min^-1, and - 0.94±3.14 for %VO_2max, absolute speed, VO_2, and %HR_max, respectively. We conclude that a portable NIRS determination of the StO₂ breakpoint is comparable with VT₂ using gas exchange and therefore appropriate for use in determining exercise training above VT₂ intensity. This is the first study to analyze the validity with the running mode using a NIRS portable device.

Hypoxic re-exposure retains hematological but not performance adaptations post-altitude training

PURPOSE

To test the hypothesis that hypoxic re-exposure after return from natural altitude training is beneficial in retaining hematological and performance adaptations.

METHODS

Eighteen mixed martial art fighters completed a 3-weeks natural altitude training camp at 2418 m. Afterwards, participants were randomly assigned to a living high-training low (12 h/d at a simulated altitude of 2800 m) group (LHTL, n = 9) or a living low-training low group (LLTL, n = 9) for a 3-week sea-level training period. At baseline and after return to sea level, hematological [hemoglobin mass (Hb_mass) on days 2, 6, 9, 12, 15 and 21] and performance (3000 m time trial and maximal oxygen uptake on days 4, 6, 9, 15 and 21) markers were assessed.

RESULTS

Mean Hb_mass increased from baseline to day 2 (11.7 ± 0.9 vs. 12.4 ± 1.3 g/kg; + 6.6 ± 7.5%; P < 0.05). While Hb_mass remained elevated above baseline in LHTL (P < 0.001), it returned near baseline levels from day 9 in LLTL. Irrespective of groups, mean V̇O_2max was only elevated above baseline at day 2 (+ 4.5 ± 0.8%) and day 9 (+ 3.8 ± 8.0%) (both P < 0.05). Compared to baseline, 3000 m running time decreased at day 4 (- 3.1 ± 3.3%; P < 0.05) and day 15 (- 2.8 ± 2.3%; P < 0.05) only.

CONCLUSIONS

Despite re-exposure to hypoxia allowing a recovery of the hypoxic stimulus to retain Hb_mass gains from previous altitude sojourn, there is no performance advantage of this practice above sea level residence. Our results also give support to empirical observations describing alternance of periods of optimal and attenuated performance upon return to sea level.

Association of red blood cell size and physical fitness in a military male cohort: The CHIEF study

Anemia manifested as reduced red blood cell (RBC) amounts or hemoglobin levels has been associated with lower cardiorespiratory fitness. However, the relationship of smaller RBC with physical fitness was unknown. We included 2933 non-anemic military males (hemoglobin levels: 11.1-15.9 g/dL and mean corpuscular volume (MCV) <100 fL) in Taiwan during 2014. Aerobic fitness was assessed by time for a 3000-meter run, and anaerobic fitness was evaluated by numbers of sit-ups and push-ups, each performed within 2 minutes. Multiple linear and logistic regression models adjusting for age, service specialty, lipid profiles, and hemoglobin levels were used to determine the associations. Microcytosis and normocytosis were defined as MCV ≤ 70 fL (n = 190) and MCV > 70 fL (n = 2743), respectively. The linear regression shows that as compared with microcytosis, normocytosis was associated with more numbers of sit-ups performed within 2 minutes (β = 1.51, P-value = 0.02). The logistic regression also reveals that those males with microcytosis had higher probability as the worst 10% performers in the 2-minute push-up test (odds ratio: 1.91, 95% confidence intervals: 1.18-3.12). By contrast, there was no association of microcytosis with 3000-meter running time. Our study suggests that non-anemic microcytosis was associated with lower anaerobic fitness but not with aerobic fitness. Whether the causative factors for microcytosis such as iron deficiency status and thalassemia trait unavailable in the study might account for the relationship needs further investigations.

Altitude and Heat Training in Preparation for Competitions in the Heat: A Case Study

PURPOSE

To quantify, for an elite-level racewalker, altitude training, heat acclimation and acclimatization, physiological data, and race performance from January 2007 to August 2008.

METHODS

The participant performed 7 blocks of altitude training: 2 "live high:train high" blocks at 1380 m (total = 22 d) and 5 simulated "live high:train low" blocks at 3000 m/600 m (total = 98 d). Prior to the 2007 World Championships and the 2008 Olympic Games, 2 heat-acclimation blocks of ~6 weeks were performed (1 session/week), with ∼2 weeks of heat acclimatization completed immediately prior to each 20-km event.

RESULTS

During the observation period, physiological testing included maximal oxygen uptake (VO2max, mL·kg-1·min-1), walking speed (km·h-1) at 4 mmol·L-1 blood lactate concentration [La-], body mass (kg), and hemoglobin mass (g), and 12 × 20-km races and 2 × 50-km races were performed. The highest VO2max was 67.0 mL·kg-1·min-1 (August 2007), which improved 3.1% from the first measurement (64.9 mL·kg-1·min-1, June 2007). The highest percentage change in any physiological variable was 7.1%, for 4 mmol·L-1 [La-] walking speed, improving from 14.1 (June 2007) to 15.1 km·h-1 (August 2007). Personal-best times for 20 km improved from (hh:mm:ss) 1:21:36 to 1:19:41 (2.4%) and from 3:55:08 to 3:39:27 (7.1%) in the 50-km event. The participant won Olympic bronze and silver medals in the 20- and 50-km, respectively.

CONCLUSIONS

Elite racewalkers who regularly perform altitude training may benefit from periodized heat acclimation and acclimatization prior to major international competitions in the heat.

Haemoglobin, iron status and lung function of adolescents participating in organised sports in the Finnish Health Promoting Sports Club Study

Objectives

To compare laboratory test results and lung function of adolescent organised sports participants (SP) with non-participants (NP).

Methods

In this cross-sectional study, laboratory tests (haemoglobin, iron status), and flow-volume spirometry were performed on SP youths (199 boys, 203 girls) and their NP peers (62 boys, 114 girls) aged 14–17.

Results

Haemoglobin concentration <120/130 g/L was found in 5.8% of SP and 5.1% NP (OR 1.20, 95% CI 0.54 to 2.68). Ferritin concentration below 15 µg/L was found in 22.7% of both SP and NP girls. Among boys ferritin <30 µg/L was found in 26.5% of SP and 30.2% of NP (OR 0.76, 95% CI 0.40 to 1.47). Among SP iron supplement use was reported by 3.5% of girls and 1.5% of boys. In flow-volume spirometry with bronchodilation test, 7.0% of SP and 6.4% of NP had asthma-like findings (OR 1.17, 95% CI 0.54 to 2.54); those using asthma medication, that is, 9.8% of SP and 5.2% of NP were excluded from the analysis.

Conclusions

Screening for iron deficiency is recommended for symptomatic persons and persons engaging in sports. Lung function testing is recommended for symptomatic persons and persons participating in sports in which asthma is more prevalent.

Impact of Bariatric Surgery on Women Aerobic Exercise Capacity

RATIONALE

Bariatric surgery has a considerable positive effect on weight loss and on metabolic and cardiovascular risks. It has therefore been extensively used this last decade to overcome obesity. However, the impact of this surgery on exercise capacity remains unclear. The aim of this study is to clarify the impact of a surgically induced weight loss on aerobic exercise capacity (VO₂max) in a specific middle-aged female population.

METHODS

Forty-two women with a body mass index > 40 kg/m² (age, 42 ± 13 years; weight, 117 ± 15 kg) underwent blood analyses and a cardiopulmonary exercise test (CPET) before and 1 year after bariatric surgery. CPET was performed on a cycloergometer. The first ventilatory threshold (VT1) was measured according to the V-slope method.

RESULTS

Absolute VO₂max was reduced by 10% after surgery (2.0 ± 0.4 vs 1.8 ± 0.4 l/min, p < 0.01) or increased when corrected for body weight (18 ± 4 vs 23 ± 4 l/min/kg, p < 0.001) or unchanged when expressed as percentage of predicted values (111 ± 21 vs 105 ± 22, p = 0.06). Weight loss did not affect ventilatory or chronotropic response but increased maximal respiratory exchange ratio (RER) (p < 0.001), decreased maximal O₂pulse (p < 0.05) and VT1 in milliliters per minute (p < 0.01). By multivariable analysis, decreased absolute VO₂max after weight loss was associated with increased maximal RER and reduced maximal O₂pulse (p < 0.05, p < 0.01 respectively), possibly related to a muscular mass limitation.

CONCLUSIONS

Weight loss induced by bariatric surgery may reduce aerobic capacity in women in relation to muscle mass loss.

Contemporary Periodization of Altitude Training for Elite Endurance Athletes: A Narrative Review

Since the 1960s there has been an escalation in the purposeful utilization of altitude to enhance endurance athletic performance. This has been mirrored by a parallel intensification in research pursuits to elucidate hypoxia-induced adaptive mechanisms and substantiate optimal altitude protocols (e.g., hypoxic dose, duration, timing, and confounding factors such as training load periodization, health status, individual response, and nutritional considerations). The majority of the research and the field-based rationale for altitude has focused on hematological outcomes, where hypoxia causes an increased erythropoietic response resulting in augmented hemoglobin mass. Hypoxia-induced non-hematological adaptations, such as mitochondrial gene expression and enhanced muscle buffering capacity may also impact athletic performance, but research in elite endurance athletes is limited. However, despite significant scientific progress in our understanding of hypobaric hypoxia (natural altitude) and normobaric hypoxia (simulated altitude), elite endurance athletes and coaches still tend to be trailblazers at the coal face of cutting-edge altitude application to optimize individual performance, and they already implement novel altitude training interventions and progressive periodization and monitoring approaches. Published and field-based data strongly suggest that altitude training in elite endurance athletes should follow a long- and short-term periodized approach, integrating exercise training and recovery manipulation, performance peaking, adaptation monitoring, nutritional approaches, and the use of normobaric hypoxia in conjunction with terrestrial altitude. Future research should focus on the long-term effects of accumulated altitude training through repeated exposures, the interactions between altitude and other components of a periodized approach to elite athletic preparation, and the time course of non-hematological hypoxic adaptation and de-adaptation, and the potential differences in exercise-induced altitude adaptations between different modes of exercise.

Psychophysiological Responses During a Cycling Test to Exhaustion While Wearing the Elevation Training Mask

López-Pérez, ME, Romero-Arenas, S, Colomer-Poveda, D, Keller, M, and Márquez, G. Psychophysiological responses during a cycling test to exhaustion while wearing the elevation training mask. J Strength Cond Res XX(X): 000-000, 2020-The aim of this study was to investigate the psychophysiological effects of wearing the elevation training mask (ETM). Twelve men performed time-to-exhaustion (TTE) tests at 75% of peak power output with and without wearing the ETM. Heart rate (HR), rating of perceived exertion (RPE), breathing discomfort (BD), and oxygen saturation (SpO2) were measured during the TTE. Prefrontal cortex (PFC) and vastus lateralis oxygenated, deoxygenated, and total hemoglobin were monitored using near-infrared spectroscopy. At the end of each test, blood lactate values (La-) were collected, and subjects completed the Beck Anxiety Inventory (BAI). The mask caused a reduction in the TTE (-37.7%; p < 0.001) and in the SpO2 (-2%; p < 0.001). Beck Anxiety Inventory scores were negatively correlated with the changes observed in the TTE (r = -0.77; p < 0.01). La-, HR, and muscle oxygenation displayed similar results across conditions. In conjunction with an increased hemodynamic response in the PFC, subjects reported higher RPE and BD values in the ETM condition (p < 0.01). Finally, BAI scores were negatively correlated with the changes observed in the TTE (r = -0.77; p < 0.01). This study suggests that wearing the ETM induces psychophysiological alterations affecting the exercise tolerance and limiting the performance.

Validation of Maximal, Submaximal, and Nonexercise Indirect [Formula: see text]O2max Estimations at 2600 m Altitude

Aim: To study the criterion validity of three indirect maximal oxygen uptake ([Formula: see text]O₂max) assessment equations at altitude. Methods: We studied 64 young adults (53% men) at Bogota, Colombia (2600 m altitude). Direct [Formula: see text]O₂max was measured by indirect calorimetry using a maximal incremental treadmill protocol. Indirect [Formula: see text]O₂max was estimated by two exercise field tests (the 20-m shuttle-run test [20-MST] and the 2-km walking test (UKK)) and one nonexercise method (the perceived functional ability-physical activity rating questionnaire [PFA-PAR]). Altitude-adjusted PFA-PAR was estimated as a 13% linear reduction in PFA-PAR. We calculated Lin concordance coefficients (LCC) and standard error of the estimates (SEEs), and we performed Bland-Altman analyses for each indirect method. Results: Mean [Formula: see text]O₂max was 41.2 ± 5.8 mL/kg/min in men and 32.2 ± 3.6 mL/kg/min in women. We found the highest agreement with direct [Formula: see text]O₂max for the 20-MST (LCC = 0.79, SEE = 3.91 mL/kg/min), followed in order by the altitude-adjusted PFA-PAR (LCC = 0.71, SEE = 4.12 mL/kg/min), the UKK (LCC = 0.67, SEE = 5.48 mL/kg/min), and the unadjusted PFA-PAR (LCC = 0.57, SEE = 4.75 mL/kg/min). The unadjusted PFA-PAR tended to overestimate [Formula: see text]O₂max, but Bland-Altman analysis showed that this bias disappeared after altitude adjustment. Conclusion: Several maximal, submaximal, and nonexercise methods provide estimates of [Formula: see text]O₂max with acceptable validity for use in epidemiological studies of populations living at moderate altitude.

Hematological status and endurance performance predictors after low altitude training supported by normobaric hypoxia: a double-blind, placebo controlled study

The benefits of altitude/hypoxic training for sea level performance are still under debate. This study examined the effects of low altitude training supported by normobaric hypoxia on hematological status and endurance performance predictors in elite female cyclists. Twenty-two female cyclists trained for 3 weeks at low altitude (<1100 m) and 2 weeks near sea level. During the first 3 weeks, 15 subjects stayed in hypoxic rooms simulating an altitude of 2200 m (+NH group, n = 8) or 1000 m (placebo group, n = 7), and 7 (control group) stayed in regular rooms. Significant increases in total hemoglobin mass (tHb-mass: p = 0.008, p = 0.025), power at 4 mmol·l^-1 lactate (PAT4: p = 0.004, p = 0.005) (in absolute and relative values, respectively) and maximal power (PF: p = 0.034) (in absolute values) were observed. However, these effects were not associated with normobaric hypoxia. Changes in tHb-mass were not associated with initial concentrations of ferritin or transferrin receptor, whereas changes in relative tHb-mass (r = -0.53, p = 0.012), PF (r = -0.53, p = 0.01) and PAT4 (r = -0.65, p = 0.001) were inversely correlated with initial values. Changes in tHb-mass and PAT4 were positively correlated (r = 0.50, p = 0.017; r = 0.47, p = 0.028). Regardless of normobaric hypoxia application, low altitude training followed by sea-level training might improve hematological status in elite female cyclists, especially with relatively low initial values of tHb-mass, which could translate into enhanced endurance performance.

The Potential to Change Pacing and Performance During 4000-m Cycling Time Trials Using Hyperoxia and Inspired Gas-Content Deception

PURPOSE

Determine if a series of trials with fraction of inspired oxygen (FiO2) content deception could improve 4000-m cycling time-trial (TT) performance.

METHODS

Fifteen trained male cyclists (mean ± SD: body mass 74.2 ± 8.0 kg; peak oxygen uptake 62 ± 6 mL.kg-1.min-1) completed six, 4000-m cycling TTs in a semi-randomised order. After a familiarisation TT, cyclists were informed in two initial trials they were inspiring normoxic air (NORM, FiO2: 0.21), however in one trial (deception condition) they inspired hyperoxic air (NORM-DEC, FiO2: 0.36). During two subsequent TTs, cyclists were informed they were inspiring hyperoxic air (HYPER, FiO2: 0.36), but in one trial normoxic air was inspired (HYPER-DEC). In the final TT (NORM-INFORM) the deception was revealed, and cyclists were asked to reproduce their best TT performance while inspiring normoxic air.

RESULTS

Greater power output and faster performances occurred when cyclists inspired hyperoxic air in both truthful (HYPER) and deceptive (NORM-DEC) trials compared to NORM (P < 0.001). However, performance only improved in NORM-INFORM (377 W [95% CI 325, 429]) vs NORM (352 W [299, 404]), P < 0.001) when participants (n = 4) completed the trials in the following order: NORM-DEC, NORM, HYPER-DEC, HYPER.

CONCLUSIONS

Cycling performance improved with acute exposure to hyperoxia. Mechanisms for the improvement were likely physiological, however improvement in a deception trial suggests an additional placebo effect may be present. Finally, a particular sequence of oxygen deception trials may have built psycho-physiological belief in cyclists such that performance improved in a subsequent normoxic trial.

Training to Compete at Altitude:Natural Altitude or Simulated Live High:Train Low?

PURPOSE

To compare the effects of natural altitude training (NAT) and simulated (SIM) live high:train low altitude training on road-race walking performance (min), as well as treadmill threshold walking speed (km·h^-1) at 4 mmol·L^-1 and maximal oxygen consumption, at 1380 m.

METHODS

Twenty-two elite-level male (n = 15) and female (n = 7) race walkers completed 14 d of NAT at 1380 m (n = 7), SIM live high:train low at 3000:600 m (n = 7), or control conditions (600-m altitude; CON, n = 8). All preintervention and postintervention testing procedures were conducted at 1380 m and consisted of an incremental treadmill test, completed prior to a 5 × 2-km road-race walking performance test. Differences between groups were analyzed via mixed-model analysis of variance and magnitude-based inferences, with a substantial change detected with >75% likelihood of exceeding the smallest worthwhile change.

RESULTS

The improvement in total performance time for the 5 × 2-km test in NAT was not substantially different from SIM but was substantially greater (85% likely) than CON. The improvement in percentage decrement in the 5 × 2-km performance test in NAT was greater than in both SIM (93% likely) and CON (93% likely). The increase in maximal oxygen consumption was substantially greater (91% likely) in NAT than in SIM. Improvement in threshold walking speed was substantially greater than CON for both SIM (91% likely) and NAT (90% likely).

CONCLUSIONS

Both NAT and SIM may allow athletes to achieve reasonable acclimation prior to competition at low altitude.

Improved Performance in National-Level Runners With Increased Training Load at 1600 and 1800 m

PURPOSE

To determine the effect of altitude training at 1600 and 1800 m on sea-level (SL) performance in national-level runners.

METHODS

After 3 wk of SL training, 24 runners completed a 3-wk sojourn at 1600 m (ALT1600, n = 8), 1800 m (ALT1800, n = 9), or SL (CON, n = 7), followed by up to 11 wk of SL racing. Race performance was measured at SL during the lead-in period and repeatedly postintervention. Training volume (in kilometers) and load (session rating of perceived exertion) were calculated for all sessions. Hemoglobin mass was measured via CO rebreathing. Between-groups differences were evaluated using effect sizes (Hedges g).

RESULTS

Performance improved in both ALT1600 (mean [SD] 1.5% [0.9%]) and ALT1800 (1.6% [1.3%]) compared with CON (0.4% [1.7%]); g = 0.83 (90% confidence limits -0.10, 1.66) and 0.81 (-0.09, 1.62), respectively. Season-best performances occurred 5 to 71 d postaltitude in ALT1600/1800. There were large increases in training load from lead-in to intervention in ALT1600 (48% [32%]) and ALT1800 (60% [31%]) compared with CON (18% [20%]); g = 1.24 (0.24, 2.08) and 1.69 (0.65, 2.55), respectively. Hemoglobin mass increased in ALT1600 and ALT1800 (∼4%) but not CON.

CONCLUSIONS

Larger improvements in performance after altitude training may be due to the greater overall load of training in hypoxia compared with normoxia, combined with a hypoxia-mediated increase in hemoglobin mass. A wide time frame for peak performances suggests that the optimal window to race postaltitude is individual, and factors other than altitude exposure per se may be important.

Physiological determinants of elite mountain bike cross-country Olympic performance

Detailed physiological phenotyping was hypothesized to have predictive value for Olympic distance cross-country mountain bike (XCO-MTB) performance. Additionally, mean (MPO) and peak power output (PPO) in 4 × 30 s all-out sprinting separated by 1 min was hypothesized as a simple measure with predictive value for XCO-MTB performance. Parameters indicative of body composition, cardiovascular function, power and strength were determined and related to XCO-MTB national championship performance (n = 11). Multiple linear regression demonstrated 98% of the variance (P < 0.001) in XCO-MTB performance (t_XCO-MTB; [min]) is explained by maximal oxygen uptake relative to body mass (VO_2peak,rel; [ml/kg/min]), 30 s all-out fatigue resistance (FI; [%]) and with a minor contribution from quadriceps femoris maximal torque (T_max; [Nm]): t_XCO-MTB = -0.217× VO_2peak,rel.-0.201× FI+ 0.012× T_max+ 85.4. Parameters with no additional predictive value included hemoglobin mass, leg peak blood flow, femoral artery diameter, knee-extensor peak workload, jump height, quadriceps femoris maximal voluntary contraction force and rate of force development. Additionally, multiple linear regression demonstrated parameters obtained from 4x30s repeated sprinting explained 88% of XCO-MTB variance (P < 0.001) with t_XCO-MTB = -5.7× MPO+ 5.0× PPO+ 55.9. In conclusion, XCO-MTB performance is predictable from VO_2peak,rel and 30 s all-out fatigue resistance. Additionally, power variables from a repeated sprint test provides a cost-effective way of monitoring athletes XCO-MTB performance.

Applying the Optimized CO Rebreathing Method for Measuring Blood Volumes and Hemoglobin Mass in Heart Failure Patients

Introduction: Determination of blood volume, red cell volume, and plasma volume contributes to the understanding of the pathophysiology in heart failure, especially concerning anemia and volume load. The optimized carbon monoxide (CO)-rebreathing method (oCORM) is used to determine these parameters and hemoglobin mass (Hbmass) in exercise physiology. The applicability of oCORM to determine the intravascular volumes and Hbmass in heart failure patients is currently undetermined because assumptions concerning CO kinetics with oCORM rely on healthy subjects with a normal ejection fraction. Therefore, the aim of the present study is to determine the applicability and the systematic error of oCORM arising from a reduced EF when oCORM is used for measurement of intravascular volumes and Hbmass in heart failure patients. Methods: oCORM was performed in 21 patients with heart failure and a reduced ejection fraction (EF) of < 30% (EFsev) and 25 controls (CONT). CO kinetics in capillary blood was studied 3-15 min after commencement of CO rebreathing. Differences in CO kinetics between the groups were assessed using a generalized linear model. The systematic error for determination of Hbmass with oCORM arising from differences in CO kinetics was assessed using the Monte Carlo method. Results: The CO kinetics was significantly different between EFsev and CONT. In both groups, exposure to CO led to a COHb increase to 6.0 ± 1.0% 3 min after CO rebreathing. There were no CO related side effects or any clinical symptoms. Monte Carlo simulation quantifies the systematic error for determination of Hbmass arising from an impaired ejection fraction to be -0.88%. Conclusion: Our results indicate an impaired vascular mixing of CO when EF is severely reduced. When Hbmass is determined using the original oCORM protocol in heart failure patients with a reduced EF, the systematic underestimation of about 1% should be considered. However, the error arising from this impaired vascular mixing appears small and clinically negligible. Furthermore, application of oCORM was safe and not related to any side effects resulting from CO exposure. In conclusion, oCORM can be used for assessing intravascular volumes and Hbmass in patients with a reduced EF.

Conventional or minimized cardiopulmonary bypass support during coronary artery bypass grafting? - An analysis by means of perfusion and body mass index

The use of minimized cardiopulmonary bypass support to reduce the side effects of extracorporeal circulation is still contradictorily discussed. This study compares perfusion operated by conventional (CCPB) and minimized (MCPB) cardiopulmonary bypass support during coronary artery bypass grafting (CABG). This study includes the data of 5164 patients treated at our department between 2004 and 2014. Tissue perfusion during cardiopulmonary bypass support and cardiac arrest was assessed by means of body mass index, hemodilution, blood pressure with corresponding pump flow and venous oxygen saturation, serum lactate, and serum pH. Hemodilution was more pronounced after CCPB: hemoglobin had dropped to 4.47 ± 0.142 g/dL after CCPB and to 2.77 ± 0.148 g/dL after MCPB (P = 0.0022). Despite the higher pump flow in conventional circuits (4.86-4.95 L/min vs. 4.1-4.18 L/min), mean blood pressure was higher during minimized bypass support (53 ± 10 vs. 56 ± 13 mm Hg [aortic clamping], 57 ± 9 vs. 61 ± 12 mm Hg [34°C], 55 ± 9 vs.59 ± 11 mm Hg [aortic clamp removal], P < 0.0001) at all time points. Venous oxygen saturation remained on comparable levels of >70% during both conventional and minimized cardiopulmonary bypass support. The increase in serum lactate was more pronounced after CCPB (8.98 ± 1.28 vs. 3.66 ± 1.25 mg/dL, P = 0.0079), corresponding to a decrease in serum pH to acidotic levels (7.33 ± 0.06 vs. 7.35 ± 0.06, P < 0.0001). These effects were evident in all BMI ranges. Minimized cardiopulmonary bypass support provides efficient perfusion in all BMI ranges and is thus equivalent to conventional circuits.

Effects of 3 Weeks of Oral Low-Dose Cobalt on Hemoglobin Mass and Aerobic Performance

Introduction: Cobalt ions (Co²⁺) stabilize HIFα and increase endogenous erythropoietin (EPO) production creating the possibility that Co²⁺ supplements (CoSupp) may be used as performance enhancing substances. The aim of this study was to determine the effects of a small oral dosage of CoSupp on hemoglobin mass (Hbmass) and performance with the objective of providing the basis for establishing upper threshold limits of urine [Co²⁺] to detect CoSupp misuse in sport.

Methods: Twenty-four male subjects participated in a double-blind placebo-controlled study. Sixteen received an oral dose of 5 mg of ionized Co²⁺ per day for 3 weeks, and eight served as controls. Blood and urine samples were taken before the study, during the study and up to 3 weeks after CoSupp. Hbmass was determined by the CO-rebreathing method at regular time intervals, and VO_2max was determined before and after the CoSupp administration period.

Results: In the Co²⁺ group, Hbmass increased by 2.0 ± 2.1% (p < 0.001) while all the other analyzed hematological parameters did not show significant interactions of time and treatment. Hemoglobin concentration ([Hb]) and hematocrit (Hct) tended to increase (p = 0.16, p = 0.1) and also [EPO] showed a similar trend (baseline: 9.5 ± 3.0, after 2 weeks: 12.4 ± 5.2 mU/ml). While mean VO_2max did not change, there was a trend for a positive relationship between changes in Hbmass and changes in VO_2max immediately after CoSupp (r = 0.40, p = 0.11). Urine [Co²⁺] increased from 0.4 ± 0.3 to 471.4 ± 384.1 ng/ml (p < 0.01) and remained significantly elevated until 2 weeks after cessation.

Conclusion: An oral Co²⁺ dosage of 5 mg/day for 3 weeks effectively increases Hbmass with a tendency to increase hemoglobin concentration ([Hb]) and hematocrit (Hct). Because urine Co²⁺ concentration remains increased for 2 weeks after cessation, upper limit threshold values for monitoring CoSupp can be established.

Altitude training in endurance running: perceptions of elite athletes and support staff

This study sought to establish perceptions of elite endurance athletes on the role and worth of altitude training. Elite British endurance runners were surveyed to identify the altitude and hypoxic training methods utilised, along with reasons for use, and any situational, cultural and behaviour factors influencing these. Prior to the 2012 Olympics Games, 39 athletes and 20 support staff (coaches/practitioners) completed an internet-based survey to establish differences between current practices and the accepted "best-practice". Almost all of the athletes (98%) and support staff (95%) surveyed had utilised altitude and hypoxic training, or had advised it to athletes. 75% of athletes believed altitude and hypoxia to be a "very important" factor in their training regime, with 50% of support staff believing the same. Athletes and support staff were in agreement of the methods of altitude training utilised (i.e. 'hypoxic dose' and strategy), with camps lasting 3-4 weeks at 1,500-2,500 m being the most popular. Athletes and support staff are utilising altitude and hypoxic training methods in a manner agreeing with research-based suggestions. The survey identified a number of specific challenges and priorities, which could provide scope to optimise future altitude training methods for endurance performance in these elite groups.

Autophagy Is a Promoter for Aerobic Exercise Performance during High Altitude Training

High altitude training is one of the effective strategies for improving aerobic exercise performance at sea level via altitude acclimatization, thereby improving oxygen transport and/or utilization. But its underlying molecular mechanisms on physiological functions and exercise performance of athletes are still vague. More recent evidence suggests that the recycling of cellular components by autophagy is an important process of the body involved in the adaptive responses to exercise. Whether high altitude training can activate autophagy or whether high altitude training can improve exercise performance through exercise-induced autophagy is still unclear. In this narrative review article, we will summarize current research advances in the improvement of exercise performance through high altitude training and its reasonable molecular mechanisms associated with autophagy, which will provide a new field to explore the molecular mechanisms of adaptive response to high altitude training.

Comprehensive overview of hemoglobin mass and blood volume in elite athletes across a wide range of different sporting disciplines

BACKGROUND

The aim of the study was to compare total hemoglobin mass (tHb-mass) and blood volume (BV) across elite athletes with different sporting specializations.

METHODS

The study enrolled 222 members of Russian national teams from 12 different sporting disciplines and non-Olympic sports. The athletes were tested in the middle of a competitive season for tHb-mass, BV, plasma volume (PV), hemoglobin concentration (Hb), and hematocrit level (Hct) determination. tHb-mass measurements were performed using CO- rebreathing technique, alongside Hb and Hct (capillary blood).

RESULTS

In elite endurance athletes both male and female values for tHb-mass, BV and PV, were significantly higher compared to anaerobic, technical sports and untrained subjects. The highest values of relative tHb-mass across all 15 groups were found in cross-country skiers (15.1±0.1 g/kg) and cyclists (15.0±0.5 g/kg). In the anaerobic group the highest value of tHb-mass was within the short-track group - i.e. 12.9±0.5 g/kg which was significantly lower than in cycling. In all aerobic groups, anaerobic and breath-hold divers we found significant difference in relative tHb-mass compared to untrained subjects. The difference between relative tHb-mass in the cycling group and untrained subjects was 31.3%, 17% for short track, 30.1% for handball and 33.5% for motor sport. For the largest group (biathlon) we performed correlation analysis for males and females with competitive performance and found relationship in both groups (P<0.05).

CONCLUSIONS

The study clearly demonstrates the difference between endurance and non-endurance athletes in tHb-mass for elite males and females athletes and its importance in competitive aerobic performance.

Hypoxic training increases maximal oxygen consumption in Thoroughbred horses well-trained in normoxia

Hypoxic training is effective for improving athletic performance in humans. It increases maximal oxygen consumption (V̇O₂max) more than normoxic training in untrained horses. However, the effects of hypoxic training on well-trained horses are unclear. We measured the effects of hypoxic training on V̇O₂max of 5 well-trained horses in which V̇O₂max had not increased over 3 consecutive weeks of supramaximal treadmill training in normoxia which was performed twice a week. The horses trained with hypoxia (15% inspired O₂) twice a week. Cardiorespiratory valuables were analyzed with analysis of variance between before and after 3 weeks of hypoxic training. Mass-specific V̇O₂max increased after 3 weeks of hypoxic training (178 ± 10 vs. 194 ± 12.3 ml O₂ (STPD)/(kg × min), P<0.05) even though all-out training in normoxia had not increased V̇O₂max. Absolute V̇O₂max also increased after hypoxic training (86.6 ± 6.2 vs. 93.6 ± 6.6 l O₂ (STPD)/min, P<0.05). Total running distance after hypoxic training increased 12% compared to that before hypoxic training; however, the difference was not significant. There were no significant differences between pre- and post-hypoxic training for end-run plasma lactate concentrations or packed cell volumes. Hypoxic training may increase V̇O₂max even though it is not increased by normoxic training in well-trained horses, at least for the durations of time evaluated in this study. Training while breathing hypoxic gas may have the potential to enhance normoxic performance of Thoroughbred horses.

Physiological Adaptations to Hypoxic vs. Normoxic Training during Intermittent Living High

In the setting of “living high,” it is unclear whether high-intensity interval training (HIIT) should be performed “low” or “high” to stimulate muscular and performance adaptations. Therefore, 10 physically active males participated in a 5-week “live high-train low or high” program (TR), whilst eight subjects were not engaged in any altitude or training intervention (CON). Five days per week (~15.5 h per day), TR was exposed to normobaric hypoxia simulating progressively increasing altitude of ~2,000–3,250 m. Three times per week, TR performed HIIT, administered as unilateral knee-extension training, with one leg in normobaric hypoxia (~4,300 m; TR_HYP) and with the other leg in normoxia (TR_NOR). “Living high” elicited a consistent elevation in serum erythropoietin concentrations which adequately predicted the increase in hemoglobin mass (r = 0.78, P < 0.05; TR: +2.6%, P < 0.05; CON: −0.7%, P > 0.05). Muscle oxygenation during training was lower in TR_HYP vs. TR_NOR (P < 0.05). Muscle homogenate buffering capacity and pH-regulating protein abundance were similar between pretest and posttest. Oscillations in muscle blood volume during repeated sprints, as estimated by oscillations in NIRS-derived tHb, increased from pretest to posttest in TR_HYP (~80%, P < 0.01) but not in TR_NOR (~50%, P = 0.08). Muscle capillarity (~15%) as well as repeated-sprint ability (~8%) and 3-min maximal performance (~10–15%) increased similarly in both legs (P < 0.05). Maximal isometric strength increased in TR_HYP (~8%, P < 0.05) but not in TR_NOR (~4%, P > 0.05). In conclusion, muscular and performance adaptations were largely similar following normoxic vs. hypoxic HIIT. However, hypoxic HIIT stimulated adaptations in isometric strength and muscle perfusion during intermittent sprinting.

Similar Hemoglobin Mass Response in Hypobaric and Normobaric Hypoxia in Athletes

PURPOSE

To compare hemoglobin mass (Hb(mass)) changes during an 18-d live high-train low (LHTL) altitude training camp in normobaric hypoxia (NH) and hypobaric hypoxia (HH).

METHODS

Twenty-eight well-trained male triathletes were split into three groups (NH: n = 10, HH: n = 11, control [CON]: n = 7) and participated in an 18-d LHTL camp. NH and HH slept at 2250 m, whereas CON slept, and all groups trained at altitudes <1200 m. Hb(mass) was measured in duplicate with the optimized carbon monoxide rebreathing method before (pre-), immediately after (post-) (hypoxic dose: 316 vs 238 h for HH and NH), and at day 13 in HH (230 h, hypoxic dose matched to 18-d NH). Running (3-km run) and cycling (incremental cycling test) performances were measured pre and post.

RESULTS

Hb(mass) increased similar in HH (+4.4%, P < 0.001 at day 13; +4.5%, P < 0.001 at day 18) and NH (+4.1%, P < 0.001) compared with CON (+1.9%, P = 0.08). There was a wide variability in individual Hb(mass) responses in HH (-0.1% to +10.6%) and NH (-1.4% to +7.7%). Postrunning time decreased in HH (-3.9%, P < 0.001), NH (-3.3%, P < 0.001), and CON (-2.1%, P = 0.03), whereas cycling performance changed nonsignificantly in HH and NH (+2.4%, P > 0.08) and remained unchanged in CON (+0.2%, P = 0.89).

CONCLUSION

HH and NH evoked similar Hb(mass) increases for the same hypoxic dose and after 18-d LHTL. The wide variability in individual Hb(mass) responses in HH and NH emphasizes the importance of individual Hb(mass) evaluation of altitude training.

Biochemical and functional modifications in biathlon athletes at medium altitude training / Modificările biochimice și funcționale ale atleților biatloniști după antrenament la altitudine medie

Objective: The aim of our research was to identify physiological and biochemical changes induced by training at medium altitude.

Methods: Ten biathlon athletes underwent 28-day training camp at medium altitude in order to improve their aerobic effort, following the living high-base train high-interval train low (Hi-Hi-Lo) protocol. There were investigated three categories of functional and biochemical parameters, targeting the hematological changes (RBC, HCT, HGB), the oxidative (lipoperoxid, free malondialdehyde and total malondialdehyde) and antioxidative balance (the hydrogen donor capacity, ceruloplasmin and uric acid) and the capacity of effort (the maximum aerobic power, the cardiovascular economy in effort, the maximum O2 consumption).

Results: All the biochemical and functional evaluated parameters showed significant increases between the pre-training testing and post-training testing (5.13 ± 0.11 vs. 6.50 ± 0.09, p < 0.0001 for RBC; 44.80 ± 1.22 vs. 51.31 ± 2.31, p < 0.0001 for HCT; 15.06 ± 0.33 vs. 17.14 ± 0.25, p < 0.0001 for HGB; 1.32 ± 0.04 vs.1.62 ± 0.01, p < 0.0001 for LPx; 1.61 ± 0.01 vs. 1.73 ± 0.01, p < 0.0001 for free MDA; 2.98 ± 0.08 vs. 3.37 ± 0.03, p < 0.0001 for total MDA; 45.92 ± 0.13 vs. 57.98 ± 0.12, p < 0.0001 for HD; 25.95 ± 0.13 vs. 31.04 ± 0.06, p < 0.0001 for Crp; 3.47 ± 0.03 vs.7.69 ± 0.02, p < 0.0001 for UA; 63.91 ± 1.00 vs. 81.53 ± 1.97, p < 0.0001 for MAP; 33.13 ± 0.57 vs. 57.41 ± 0.63, p < 0.0001 for CVEE; 4190 ± 50.45 vs. 5945 ± 46.48, p < 0.0001 for VO2max).

Conclusions: Aerobic effort capacity of biathlon athletes has increased in the post-training period, using Hi-Hi-Lo protocol.