Performance of runners and swimmers after four weeks of intermittent hypobaric hypoxic exposure plus sea level training

The effects of intermittent hypoxic training on the aerobic capacity of exercisers: a systemic review and meta-analysis

OBJECTIVE

To systematically review the effects of intermittent hypoxic training on the aerobic capacity of exercisers.

METHODS

PubMed, Embase, The Cochrane Library, and Web of Science databases were electronically searched to collect studies on the effects of intermittent hypoxic training on the aerobic capacity of exercisers from January 1, 2000, to January 12, 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Then, meta-analysis was performed by using Stata SE 16.0 software.

RESULTS

A total of 19 articles from 27 studies were included. The results of the meta-analysis showed that compared with the control group, the intermittent hypoxic training group had significantly increased maximal oxygen uptake [weighted mean difference = 3.20 (95%CI: 1.33 ~ 5.08)] and hemoglobin [weighted mean difference = 0.25 (95%CI: 0.04 ~ 0.45)].

CONCLUSION

Intermittent hypoxic training can significantly improve the aerobic capacity of exercisers. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Physiological and performance effects of live high train low altitude training for elite endurance athletes: A narrative review

Altitude training has become an important training application for athletes due its potential for altering physiology and enhancing performance. This practice is commonly used by athletes, with a popular choice being the live high - train low approach. This model recommends that athletes live at high altitude (1250-3000 m), but train at low altitude or sea-level (0-1200 m). Exposure to altitude often leads to hypoxic stress and in turn stimulates changes in total haemoglobin mass, erythropoietin, and soluble transferrin receptors, which alter further underlying physiology. Through enhanced physiology, improved exercise performance may arise through enhancement of the oxygen transport system which is important for endurance events. Previous investigations into the effects of altitude training on exercise performance have been completed in a range of contexts, including running, cycling, swimming, and triathlon. Often following a LHTL altitude intervention, athletes realise improvements in maximal oxygen consumption capacity, time trial performance and peak power outputs. Although heterogeneity exists among LHTL methodologies, i.e., exposure durations and altitude ranges, we synthesised this data into kilometre hours, and found that the most common hypoxic doses used in LHTL interventions ranged from ∼578-687 km h. As this narrative review demonstrates, there are potential advantages to using altitude training to enhance physiology and improve performance for endurance athletes.

Comparative efficacy of various hypoxic training paradigms on maximal oxygen consumption: A systematic review and network meta-analysis

Background

Enhancement in maximal oxygen consumption (VO2max) induced by hypoxic training is important for both athletes and non-athletes. However, the lack of comparison of multiple paradigms and the exploration of related modulating factors leads to the inability to recommend the optimal regimen in different situations. This study aimed to investigate the efficacy of seven common hypoxic training paradigms on VO2max and associated moderators.

Methods

Electronic (i.e., five databases) and manual searches were performed, and 42 studies involving 1246 healthy adults were included. Pairwise meta-analyses were conducted to compare different hypoxic training paradigms and hypoxic training and control conditions. The Bayesian network meta-analysis model was applied to calculate the standardised mean differences (SMDs) of pre-post VO2max alteration among hypoxic training paradigms in overall, athlete, and non-athlete populations, while meta-regression analyses were employed to explore the relationships between covariates and SMDs.

Results

All seven hypoxic training paradigms were effective to varying degrees, with SMDs ranging from 1.45 to 7.10. Intermittent hypoxia interval training (IHIT) had the highest probability of being the most efficient hypoxic training paradigm in the overall population and athlete subgroup (42%, 44%), whereas intermittent hypoxic training (IHT) was the most promising hypoxic training paradigm among non-athletes (66%). Meta-regression analysis revealed that saturation hours (coefficient, 0.004; P = 0.038; 95% CI [0.0002, 0.0085]) accounted for variations of VO2max improvement induced by IHT.

Conclusion

Efficient hypoxic training paradigms for VO2max gains differed between athletes and non-athletes, with IHIT ranking best for athletes and IHT for non-athletes. The practicability of saturation hours is confirmed with respect to dose-response issues in the future hypoxic training and associated scientific research.

Registration

This study was registered in the PROSPERO international prospective register of systematic reviews (CRD42022333548).

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.

The Emerging Role of Hypoxic Training for the Equine Athlete

This paper provides a comprehensive discussion on the physiological impacts of hypoxic training, its benefits to endurance performance, and a rationale for utilizing it to improve performance in the equine athlete. All exercise-induced training adaptations are governed by genetics. Exercise prescriptions can be tailored to elicit the desired physiological adaptations. Although the application of hypoxic stimuli on its own is not ideal to promote favorable molecular responses, exercise training under hypoxic conditions provides an optimal environment for maximizing physiological adaptations to enhance endurance performance. The combination of exercise training and hypoxia increases the activity of the hypoxia-inducible factor (HIF) pathway compared to training under normoxic conditions. Hypoxia-inducible factor-1 alpha (HIF-1α) is known as a master regulator of the expression of genes since over 100 genes are responsive to HIF-1α. For instance, HIF-1-inducible genes include those critical to erythropoiesis, angiogenesis, glucose metabolism, mitochondrial biogenesis, and glucose transport, all of which are intergral in physiological adaptations for endurance performance. Further, hypoxic training could conceivably have a role in equine rehabilitation when high-impact training is contraindicated but a quality training stimulus is desired. This is achievable through purpose-built equine motorized treadmills inside commercial hypoxic chambers.

Effects of Moderate-Intensity Training Under Cyclic Hypoxia on Cardiorespiratory Fitness and Hematological Parameters in People Recovered From COVID-19: The Aerobicovid Study

BACKGROUND

Recent studies have indicated that people who live at altitude have a lower incidence of coronavirus disease (COVID-19) and lesser severity in infection cases.

HYPOTHESIS

Hypoxia exposure could lead to health benefits, and it could be used in the recovery process as an additional stimulus to physical training to improve cardiorespiratory fitness (CRF).

STUDY DESIGN

Randomized controlled clinical trial.

LEVEL OF EVIDENCE

Level 2.

METHODS

The 43 participants, aged 30 to 69 years, were divided into control group (CG, n = 18) and 2 training groups: normoxia (NG, n = 9) and hypoxia (HG, n = 16). Before and after the intervention were evaluated the lactate threshold 2 (L2), peak oxygen uptake (VO_2peak), and a blood sample was collected at rest to evaluate hematological adaptation. Both groups performed an 8-week moderate-intensity physical training on a bike. The HG were trained under normobaric hypoxic conditions (fractional inspired oxygen [FiO₂] = 13.5%).

RESULTS

The 8-week intervention promoted a similar improvement in CRF of people recovered from COVID-19 in the HG (L2 = 34.6%; VO_2peak = 16.3%; VO_2peak intensity = 24.6%) and NG (L2 = 42.6%; VO_2peak = 16.7%; VO_2peak intensity = 36.9%). Only the HG presented differences in hematological variables (erythropoietin = 191.7%; reticulocytes = -32.4%; off-score = 28.2%) in comparison with the baseline.

CONCLUSION

The results of the present study provide evidence that moderate-intensity training in normoxia or hypoxia promoted similar benefits in CRF of people recovered from COVID-19. Furthermore, the hypoxia offered an additional stimulus to training promoting erythropoietin increase and hematological stimulation.

CLINICAL RELEVANCE

The present exercise protocol can be used for the rehabilitation of people recovered from COVID-19, with persistent low CRF. In addition, this is the first study demonstrating that physical training combined with hypoxia, as well as improving CRF, promotes greater hematological stimulation in people recovered from COVID-19.

Effects of Interval Training Under Hypoxia on Hematological Parameters, Hemodynamic Function, and Endurance Exercise Performance in Amateur Female Runners in Korea

Interval training under hypoxia (IHT) is commonly used to enhance endurance exercise performance. However, previous studies examining hematologic changes related to the immune system that affect health and conditioning are lacking. This study aimed to evaluate the effects of IHT for 6-weeks on hematological parameters, hemodynamic function, and endurance exercise performance in amateur Korean female runners. Twenty healthy amateur Korean female runners (age: 24.85 ± 3.84 years) were equally assigned to normoxic training group (NTG) for interval training under normoxia (760 mmHg) and hypoxic training group (HTG) for interval training under hypobaric hypoxia (526 mmHg, 3000 m simulated altitude) according to their body composition and endurance exercise performance. All participants performed 120-min of training sessions, consisting of 20-min of warm-up, 60-min of interval training, and 20-min of cool-down. The training program was performed 3-days per week for 6-weeks. Warm-up and cool-down were performed for 20-min at 60% maximal heart rate (HRmax). The interval training sessions comprised 10 repetitions of interval exercise (5-min of exercise corresponding to 90–95% HRmax and 1-min of rest) on a treadmill. All participants underwent measurements of hematological parameters, hemodynamic function, and endurance exercise performance before and after training. Both groups showed a significant increase in erythropoietin (EPO) level and a decrease in monocyte abundance, with EPO showing a greater increase in the HTG than in the NTG. B cell abundance significantly increased in the NTG; hematocrit and neutrophil counts significantly increased, and lymphocyte counts significantly decreased in the HTG. The HTG showed a significant improvement in oxygen uptake, stroke volume index, and end-diastolic volume index compared to the NTG. In addition, both groups showed significant improvements in heart rate, end-systolic volume index, and cardiac output index. The maximal oxygen uptake and 3000 m time trial record were significantly improved in both groups, and the HTG showed a tendency to improve more than the NTG. In conclusion, the IHT was effective in enhancing endurance exercise performance through improved hemodynamic function. Furthermore, hematological parameters of immune system showed a normal range before and after training and were not negatively affected.

Effects of moderate-intensity intermittent hypoxic training on health outcomes of patients recovered from COVID-19: the AEROBICOVID study protocol for a randomized controlled trial

Background

Recent studies point to a lower number and reduced severity of cases in higher altitude cities with decreased oxygen concentration. Specific literature has shown several benefits of physical training, so, in this sense, physical training with hypoxic stimulus appears as an alternative that supports the conventional treatments of the COVID-19 patient’s recovery. Thus, this study’s primary aim is to analyze the effects of moderate-intensity intermittent hypoxic training on health outcomes in COVID-19 recovered patients.

Methods

A clinical trial controlled double-blind study was designed. Participants (30–69 years old) will be recruited among those with moderate to severe COVID-19 symptoms, approximately 30 days after recovery. They will be included in groups according to the training (T) and recovery (R) association with hypoxia (H) or normoxia (N): (a) T_H:R_H, (b) T_N:R_H, (c) T_N:R_N, and last (d) the control group. The 8-week exercise bike intervention will be carried out with a gradual load increase according to the established periods, three times a week in sets of 5 min, 90 to 100% of the anaerobic threshold (AT), and a 2.5-min break. Blood will be collected for genotyping. First, after 4 weeks (partial), after 8 weeks, and later, 4 weeks after the end of the physical training intervention, participants will perform assessments. The primary outcome is the maximum oxygen consumption (VO₂peak). The secondary outcomes include lung function, inflammatory mediators, hematological, autonomic parameters, AT, body composition analysis, quality of life, mental health, anthropometric measurements, and physical fitness. The statistical analysis will be executed using the linear regression model with mixed effects at a 5% significance level.

Discussion

This study is designed to provide evidence to support the clinical benefits of moderate-intensity intermittent hypoxic training as a part of the treatment of patients recovered from COVID-19. It may also provide evidence on the efficacy and safety of intermittent hypoxic training in different health conditions. Lastly, this study presents an innovative strategy enabling up to 16 participants in the same training session.

Trial registration

ClinicalTrials.gov RBR-5d7hkv. Registered after the start of inclusion on 3 November 2020 with the Brazilian Clinical Trials Registry

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05414-2.

Aerobic Continuous and Interval Training under Hypoxia Enhances Endurance Exercise Performance with Hemodynamic and Autonomic Nervous System Function in Amateur Male Swimmers

Hypoxic training is often performed by competitive swimmers to enhance their performance in normoxia. However, the beneficial effects of aerobic continuous and interval training under hypoxia on hemodynamic function, autonomic nervous system (ANS) function, and endurance exercise performance remain controversial. Here we investigated whether six weeks of aerobic continuous and interval training under hypoxia can improve hematological parameters, hemodynamic function, ANS function, and endurance exercise performance versus normoxia in amateur male swimmers. Twenty amateur male swimmers were equally assigned to the hypoxic training group or normoxic training group and evaluated before and after six weeks of training. Aerobic continuous and interval training in the hypoxia showed a more significantly improved hemodynamic function (heart rate, −653.4 vs. −353.7 beats/30 min; oxygen uptake, −62.45 vs. −16.22 mL/kg/30 min; stroke volume index, 197.66 vs. 52.32 mL/30 min) during submaximal exercise, ANS function (root mean square of successive differences, 10.15 vs. 3.32 ms; total power, 0.72 vs. 0.20 ms²; low-frequency/high-frequency ratio, −0.173 vs. 0.054), and endurance exercise performance (maximal oxygen uptake, 5.57 vs. 2.26 mL/kg/min; 400-m time trial record, −20.41 vs. −7.91 s) than in the normoxia. These indicate that hypoxic training composed of aerobic continuous and interval exercise improves the endurance exercise performance of amateur male swimmers with better hemodynamic function and ANS function.

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.

Interval Hypoxic Training Enhances Athletic Performance and Does Not Adversely Affect Immune Function in Middle- and Long-Distance Runners

This study evaluated the effects of intermittent interval training in hypoxic conditions for six weeks compared with normoxic conditions, on hemodynamic function, autonomic nervous system (ANS) function, immune function, and athletic performance in middle- and long-distance runners. Twenty athletes were divided into normoxic training (normoxic training group (NTG); n = 10; residing and training at sea level) and hypoxic training (hypoxic training group (HTG); n = 10; residing at sea level but training in 526-mmHg hypobaric hypoxia) groups. All dependent variables were measured before, and after, training. The training frequency was 90 min, 3 d per week for six weeks. Body composition showed no significant difference between the two groups. However, the HTG showed more significantly improved athletic performance (e.g., maximal oxygen uptake). The hemodynamic function (e.g., oxygen uptake, oxygen pulse, and cardiac output) during submaximal exercise and ANS function (e.g., standard deviation and root mean square of successive differences, high frequency, and low/high frequency) improved more in the HTG. Immune function parameters were stable within the normal range before and after training in both groups. Therefore, hypoxic training was more effective in enhancing athletic performance, and improving hemodynamic and ANS function; further, it did not adversely affect immune function in competitive runners.

Efficacy of intermittent hypoxic training on hemodynamic function and exercise performance in competitive swimmers

PURPOSE

Hemodynamic function is a parameter indicating oxygen delivery and utilization capacity and is an important determinant of exercise performance. The present study aimed to determine whether intermittent hypoxic training (IHT) ameliorates hemodynamic function and exercise performance in competitive swimmers.

METHODS

Twenty competitive swimmers (10 men, 10 women) volunteered to participate in the study. Participants were divided into the normoxic training (NT) group and the hypoxic training (HT) group and were subjected to training in a simulated altitude of 3000 m. We evaluated hemodynamic function profiles over 30 min of submaximal exercise on a bicycle and exercise performance before and after 6 weeks of training, which involved continuous exercise at 80% maximal heart rate (HRmax) for 30 min and interval exercise at 90% of HRmax measured before training for 30 min (ten rounds comprising 2 min of exercise followed by 1 min of rest each round).

RESULTS

Significant changes in oxygen consumption (decrease) and end-diastolic volume (increase) were observed only in the HT group. Heart rate (HR), cardiac output (CO), and ejection fraction (EF) were significantly reduced in both groups, but the reduction rates of HR and CO were greater in the HT group than in the NT group. Exercise performance measures, including maximal oxygen consumption and 400-m time trial, were significantly increased only in the HT group.

CONCLUSION

Our findings suggested that 6 weeks of IHT, which involved high-intensity continuous and interval exercise, can effectively improve exercise performance by enhancing hemodynamic function in competitive swimmers.

Low Oxygen Post Conditioning as an Efficient Non-pharmacological Strategy to Promote Motor Function After Stroke

Low oxygen post conditioning (LOPC) has shown promising results in terms of neuroprotection after stroke, but the effects on motor function have not been considered. Cortical stroke targeting the motor and sensory cortex was induced by photothrombotic occlusion and after 48 h allocated to LOPC (11% O₂) for 2 weeks. Motor impairment was assessed using the cylinder and grid walk tests during the exposure period and for two further weeks upon completion of the intervention. Neuroprotection was evaluated by histological and molecular analysis at two time points. Two weeks of LOPC was sufficient to significantly reduce motor deficits and tissue loss after stroke. This functional improvement was associated with increased capillary density, enhanced levels of BDNF, decreased neuronal loss and decreased microglia activation. These improvements, in most instances, were maintained up to 2 weeks after the end of the treatment. To our knowledge, this is the first study to demonstrate that LOPC induces a persistent improvement in motor function and neuroprotection after stroke, and in doing so provides evidence to support a case for considering taking LOPC forward to early stage clinical research.

Physiological and Biological Responses to Short-Term Intermittent Hypobaric Hypoxia Exposure: From Sports and Mountain Medicine to New Biomedical Applications

In recent years, the altitude acclimatization responses elicited by short-term intermittent exposure to hypoxia have been subject to renewed attention. The main goal of short-term intermittent hypobaric hypoxia exposure programs was originally to improve the aerobic capacity of athletes or to accelerate the altitude acclimatization response in alpinists, since such programs induce an increase in erythrocyte mass. Several model programs of intermittent exposure to hypoxia have presented efficiency with respect to this goal, without any of the inconveniences or negative consequences associated with permanent stays at moderate or high altitudes. Artificial intermittent exposure to normobaric hypoxia systems have seen a rapid rise in popularity among recreational and professional athletes, not only due to their unbeatable cost/efficiency ratio, but also because they help prevent common inconveniences associated with high-altitude stays such as social isolation, nutritional limitations, and other minor health and comfort-related annoyances. Today, intermittent exposure to hypobaric hypoxia is known to elicit other physiological response types in several organs and body systems. These responses range from alterations in the ventilatory pattern to modulation of the mitochondrial function. The central role played by hypoxia-inducible factor (HIF) in activating a signaling molecular cascade after hypoxia exposure is well known. Among these targets, several growth factors that upregulate the capillary bed by inducing angiogenesis and promoting oxidative metabolism merit special attention. Applying intermittent hypobaric hypoxia to promote the action of some molecules, such as angiogenic factors, could improve repair and recovery in many tissue types. This article uses a comprehensive approach to examine data obtained in recent years. We consider evidence collected from different tissues, including myocardial capillarization, skeletal muscle fiber types and fiber size changes induced by intermittent hypoxia exposure, and discuss the evidence that points to beneficial interventions in applied fields such as sport science. Short-term intermittent hypoxia may not only be useful for healthy people, but could also be considered a promising tool to be applied, with due caution, to some pathophysiological states.

The blood antioxidant defence capacity during intermittent hypoxic training in elite swimmers

The main objective of this study was to examine the chronic effect of simulated intermittent normobaric hypoxia on blood antioxidant defence capacity in swimmers. The study included 14 male and 14 female competitive swimmers performing part of land training under simulated intermittent normobaric hypoxia (O₂ = 15.5%) or in normoxia. Land interval training took place twice per week, with a total of 8 training units during the study, performed with individualized intensity. The activities of blood antioxidant enzymes did not change significantly during the first and last training unit in the hypoxic and normoxic group. However, when comparing individual variables a significant effect of exercise was observed on GPx an CAT activities, whereas training units significantly differentiated GPx and GR activities. The oxygen conditions and gender had a significant influence on CAT activity. The total antioxidant capacity was not significantly affected. Only in male swimmers from the hypoxic group did the training significantly increase resting levels of MDA. In conclusion, training in normobaric hypoxia was not an adequate stimulus for the excessive response of the antioxidant defence system, despite increased oxidative stress in these conditions.

The effects of single versus twice daily short term heat acclimation on heat strain and 3000m running performance in hot, humid conditions

Endurance performances are impaired under conditions of elevated heat stress. Short term heat acclimation (STHA) over 4-6 days can evoke rapid adaptation, which mitigate decrements in performance and alleviate heat strain. This study investigated the efficacy of twice daily heat acclimation (TDHA) compared to single session per day heat acclimation (SDHA) and normothermic training, at inducing heat acclimation phenotype and its impact upon running performance in hot, humid conditions. Twenty one, moderately trained males were matched and assigned to three groups; SDHA (mean±SD) (peak oxygen consumption [V̇O2peak] 45.8±6.1mLkg(-1)min(-1), body mass 81.3±16.0kg, stature 182±3cm), TDHA (46.1±7.0mLkg(-1)min(-1), 80.1±11.9kg, 178±4cm) or control (CON) (47.1±3.5mLkg(-1)min(-1), 78.6±16.7kg, 178±4cm). Interventions consisted of 45min cycling at 50% V̇O2peak, once daily for 4d (SDHA) and twice daily for 2d (TDHA), in 35°C, 60% relative humidity (RH), and once daily for 4 days (CON) in 21°C, 40% RH. Participants completed a pre- and post-intervention 5km treadmill run trial in 30°C, 60% RH, where the first 2km were fixed at 40% V̇O2peak and the final 3km was self-paced. No statistically significant interaction effects occurred within- or between-groups over the 2-4 days intervention. While within-group differences were found in physiological and perceptual measures during the fixed intensity trial post-intervention, they did not statistically differ between-groups. Similarly, TDHA (-36±34s [+3.5%]) and SDHA (-26±28s [+2.8%]) groups improved 3km performances (p=0.35), but did not differ from CON (-6±44s [+0.6%]). This is the first study to investigate the effects of HA twice daily and compare it with traditional single session per day STHA. These STHA protocols may have the ability to induce partial adaptive responses to heat stress and possibly enhance performance in environmentally challenging conditions, however, future development is warranted to optimise the administration to provide a potent stimuli for heat adaptation in athletic and military personnel within a rapid regime.

Maximal oxygen consumption in healthy humans: theories and facts

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

Cyclic hypobaric hypoxia improves markers of glucose metabolism in middle-aged men

Chronic hypoxia increases dependence on glucose in men and increases insulin sensitivity in men and women. Cyclic Variations in Altitude Conditioning (CVAC) is a novel technology that provides exposure to rapidly fluctuating cyclic hypobaric hypoxia (CHH).

PURPOSE

To test the hypothesis that markers of glucose metabolism would change with CVAC CHH, two groups of middle-aged men were exposed to 10 weeks (40 min/day, 3 day/week) of either CHH or sham (SH) sessions.

METHODS

CHH subjects (age: 48 ± 6, weight: 86 ± 12 kg, BMI: 27.1 ± 3, n=11) experienced cyclic pressures simulating altitudes ranging from sea level to 3048 m (week 1) and progressing to 6096 m (by week 5 through week 10). SH subjects (age: 50 ± 4, weight: 89 ± 15 kg, BMI: 27.5 ± 3, n=10) were exposed to slowly-fluctuating pressures up to 607 m (all subjects blinded to elevation). Physical function and blood markers of glucose metabolism were measured at baseline, 3, 6, and 10 weeks.

RESULTS

Two CHH subjects were dropped from analysis for failure to progress past 3048 m (CHH: n=9). Weight and physical activity remained stable for both groups. There was a group-by-time interaction in fasting glucose (CHH: 96 ± 9 to 91 ± 7 mg/dL, SH: 94 ± 7 to 97 ± 9 mg/dL, p<0.05). Reduction in plasma glucose response to oral glucose tolerance test [area under the curve] was greater in CHH compared to SH after 10 weeks of exposure (p<0.03). Neither group experienced changes in fasting insulin, insulin response during the OGTT, or changes in a timed walk test.

CONCLUSION

Ten weeks of CVAC CHH exposure improves markers of glucose metabolism in middle-aged men at risk for metabolic syndrome.

Altitude training and its influence on physical endurance in swimmers

It is possible to plan an altitude training (AT) period in such a way that the enhanced physical endurance obtained as a result of adaptation to hypoxia will appear and can be used to improve performance in competition. Yet finding rationales for usage of AT in highly trained swimmers is problematic. In practice AT, in its various forms, is still controversial, and an objective review of research concentrating on the advantages and disadvantages of AT has been presented in several scientific publications, including in no small part the observations of swimmers. The aim of this article is to review the various methods and present both the advantageous and unfavourable physiological changes that occur in athletes as a result of AT. Moreover, AT results in the sport of swimming have been collected. They include an approach towards primary models of altitude/hypoxic training: live high + train high, live high + train low, live low + train high, as well as subsequent methods: Intermittent Hypoxic Exposure (IHE) and Intermittent Hypoxic Training (IHT). Apnoea training, which is descended from freediving, is also mentioned, and which can be used with, or as a substitute for, the well-known IHE or IHT methods. In conclusion, swimmers who train using hypoxia may be among the best-trained athletes, and that even a slight improvement in physical endurance might result in the shortening of a swimming time in a given competition, and the achievement of a personal best, which is hard to obtain by normal training methods, when the personal results of the swimmer have reached a plateau.

Intermittent hypoxic exposure does not improve endurance performance at altitude

PURPOSE

This study examined the effect of 1 wk of normobaric intermittent hypoxic exposure (IHE) combined with exercise training on endurance performance at a 4300-m altitude (HA).

METHODS

Seventeen male lowlanders were divided into an IHE (n = 11) or SHAM (n = 6) group. Each completed cycle endurance testing consisting of two 20-min steady state (SS) exercise bouts (at 40% and 60% V O2peak) followed by a 10-min break and then a 720-kJ cycle time trial at HA before IHE or SHAM treatment (Pre-T). IHE treatment consisted of a 2-h rest at a PO2 of 90 mm Hg followed by two 25-min bouts of exercise at approximately 80% of peak HR at a PO2 of 110 mm Hg for 1 wk in a hypoxia room. SHAM treatment was identical except that the PO2 was 148 mm Hg for both rest and exercise. After IHE or SHAM treatment (Post-T), all completed a second cycle endurance test at HA. HR, arterial oxygen saturation (SaO2), and RPE were obtained from the 10th to the 15th minute during the two SS exercise bouts and every 5 min during the time trial.

RESULTS

Seven volunteers in the IHE group could not finish the 720-kJ time trial either at Pre-T or at Post-T. Time trial analysis was limited, therefore, to the time to reach 360 kJ (halfway point) for all volunteers. From Pre-T to Post-T, there was no improvement in time trial performance (min +/- SE) in the IHE (62.0 +/- 4.8 to 63.7 +/- 5.2) or SHAM (60.9 +/- 6.3 to 54.2 +/- 6.8) group. There was no change from Pre-T to Post-T in HR, SaO2, and RPE during the two SS exercise bouts or time trial in either group.

CONCLUSIONS

One week of IHE combined with exercise training does not improve endurance performance at a 4300-m altitude in male lowlanders.

Daily hypoxia increases basal monocyte HSP72 expression in healthy human subjects

Heat shock protein 72 (HSP72) performs vital roles within the body at rest and during periods of stress. In vitro, research demonstrates HSP72 induction in response to hypoxia. Recently, in vivo, an acute hypoxic exposure (75 min at 2,980 m) was sufficient to induce significant increases in monocyte expressed HSP72 (mHSP72) and a marker of oxidative stress in healthy human subjects. The purpose of the current study was to identify the impact of 10 consecutive days of hypoxic exposures (75 min at 2,980 m) on mHSP72 and erythropoietin (EPO) expression, markers of oxidative stress, and maximal oxygen consumption in graded incremental aerobic exercise. Eight male subjects were exposed to daily normobaric hypoxic exposures for 75 min at 2,980 m for 10 consecutive days, commencing and ceasing at 0930 and 1045, respectively. This stressor was sufficient to induce significant increases in mHSP72, which was significantly elevated from day 2 of the hypoxic exposures until 48 h post-final exposure. Notably, this increase had an initial rapid (30% day on day compared to baseline) and final slow phase (16% day on day compared to baseline) of expression. The authors postulate that 7-day hypoxic exposure in this manner would be sufficient to induce near maximum hypoxia-mediated basal mHSP72 expression. Elevated levels of mHSP72 are associated with acquired thermotolerance and provide cross tolerance to non-related stressors in vivo, the protocol used here may provide a useful tool for elevating mHSP72 in vivo. Aside from these major findings, significant transient daily elevations were seen in a marker of oxidative stress, alongside sustained increases in EPO expression. However, no physiologically significant changes were seen in maximal oxygen consumption or time to exhaustion.

Effect of intermittent hypoxia on muscle and cerebral oxygenation during a 20-km time trial in elite athletes: a preliminary report

The effects of intermittent hypoxic exposure (IHE) on cerebral and muscle oxygenation, arterial oxygen saturation (SaO2), and respiratory gas exchange during a 20-km cycle time trial (20TT) were examined (n = 9) in a placebo-controlled randomized design. IHE (7:3 min hypoxia to normoxia) involved 90-min sessions for 10 days, with SaO2 clamped at ∼80%. Prior to, and 2 days after the intervention, a 20TT was performed. During the final minute of the 20TT, in the IHE group only, muscle oxyhemoglobin (oxy-Hb) was elevated (mean ± 95% confidence interval 1.3 ± 1.2 ΔµM, p = 0.04), whereas cerebral oxy-Hb was reduced (–1.9% ± 1.0%, p < 0.01) post intervention compared with baseline. The 20TT performance was unchanged between groups (p = 0.7). In the IHE group, SaO2 was higher (1.0 ± 0.7Δ%, p = 0.006) and end-tidal PCO2 was lower (–1.2 ± 0.1 mm Hg, p = 0.01) during the final stage of the 20TT post intervention compared with baseline. In summary, reductions in muscle oxy-Hb and systemic SaO2 occurring at exercise intensities close to maximal at the end of a 20TT were offset by IHE, although this was not translated into improved performance.

Reproducibility of performance changes to simulated live high/train low altitude

Elite athletes often undertake multiple altitude exposures within and between training years in an attempt to improve sea level performance.

PURPOSE

To quantify the reproducibility of responses to live high/train low (LHTL) altitude exposure in the same group of athletes.

METHODS

Sixteen highly trained runners with maximal aerobic power (VO2max) of 73.1 +/- 4.6 and 64.4 +/- 3.2 mL x kg(-1) x min(-1) (mean +/- SD) for males and females, respectively, completed 2 x 3-wk blocks of simulated LHTL (14 h x d(-1), 3000 m) or resided near sea level (600 m) in a controlled study design. Changes in the 4.5-km time trial performance and physiological measures including VO2max, running economy and hemoglobin mass (Hb(mass)) were assessed.

RESULTS

Time trial performance showed small and variable changes after each 3-wk altitude block in both the LHTL (mean [+/-90% confidence limits]: -1.4% [+/-1.1%] and 0.7% [+/-1.3%]) and the control (0.5% [+/-1.5%] and -0.7% [+/-0.8%]) groups. The LHTL group demonstrated reproducible improvements in VO2max (2.1% [+/-2.1%] and 2.1% [+/-3.9%]) and Hb(mass) (2.8% [+/-2.1%] and 2.7% [+/-1.8%]) after each 3-wk block. Compared with those in the control group, the runners in the LHTL group were substantially faster after the first 3-wk block (LHTL - control = -1.9% [+/-1.8%]) and had substantially higher Hb(mass) after the second 3-wk block (4.2% [+/-2.1%]). There was no substantial difference in the change in mean VO2max between the groups after the first (1.2% [+/-3.3%]) or second 3-wk block (1.4% [+/-4.6%]).

CONCLUSIONS

Three-week LHTL altitude exposure can induce reproducible mean improvements in VO2max and Hb(mass) in highly trained runners, but changes in time trial performance seem to be more variable. Competitive performance is dependent not only on improvements in physiological capacities that underpin performance but also on a complex interaction of many factors including fitness, fatigue, and motivation.

Improved race performance in elite middle-distance runners after cumulative altitude exposure

We quantified the effect of an extended live high-train low (LHTL) simulated altitude exposure followed by a series of training camps at natural moderate altitude on competitive performance in seven elite middle-distance runners (Vo2max 71.4 +/- 3.4 mL.min-1.kg-1, mean +/- SD). Runners spent 44 +/- 7 nights (mean +/- SD) at a simulated altitude of 2846 +/- 32 m, and a further 4 7- to 10-d training at natural moderate altitude (1700-2200 m) before racing. The combination of simulated LHTL and natural altitude training improved competitive performance by 1.9% (90% confidence limits, 1.3-2.5%). Middle-distance runners can confidently use a combination of simulated and natural altitude to stimulate adaptations responsible for improving performance.

Effects of various training modalities on blood volume

It is controversially discussed whether soccer games should be played at moderate (2001-3000 m) and high altitudes (3001-5500 m) or should be restricted to near sea level and low altitude (501-2000 m) conditions. Athletes living at altitude are assumed to have a performance advantage compared with lowlanders. One advantage of altitude adaptation concerns the expansion of total hemoglobin mass (tHb-mass), which is strongly related to endurance performance at sea level. Cross-sectional studies show that elite athletes posses approximately 35% higher tHb-mass than the normal population, which is further elevated by 14% in athletes native to altitude of 2600 m. Although the impact of this huge tHb-mass expansion on performance is not yet investigated for altitude conditions, lowland athletes seek for possibilities to increase tHb-mass to similar levels. At sea level tHb-mass is only moderately influenced by training and depends more on genetic predisposition. Altitude training in contrast, using either the conventional altitude training or the live high-train low (>14 h/day in hypoxia) protocol for 3-4 weeks above 2500 m leads to mean increases in tHb-mass of 6.5%. This increase is, however, not sufficient to close the gap in tHb-mass to elite athletes native to altitude, which may be in advantage when tHb-mass has the same strong influence on aerobic performance at altitude as it has on sea level.

Intermittent hypoxia at rest for improvement of athletic performance

Two modalities of applying hypoxia at rest are reviewed in this paper: intermittent hypoxic exposure (IHE), which consists of hypoxic air for 5-6 min alternating with breathing room air for 4-5 min during sessions lasting 60-90 min, or prolonged hypoxic exposure (PHE) to normobaric or hypobaric hypoxia over up to 3 h/day. Hypoxia with IHE is usually in the range of 12-10%, corresponding to an altitude of about 4000-6000 m. Normobaric or hypobaric hypoxia with PHE corresponds to altitudes of 4000-5500 m. Five of six studies applying IHE and all four well-controlled studies using PHE could not show a significant improvement with these modalities of hypoxic exposure for sea level performance after 14-20 sessions of exposure, with the exception of swimmers in whom there might be a slight improvement by PHE in combination with a subsequent tapering. There is no direct or indirect evidence that IHE or PHE induce any significant physiological changes that might be associated with improving athletic performance at sea level. Therefore, IHE and PHE cannot be recommended for preparation of competitions held at sea level.

The effect of intermittent hypobaric hypoxic exposure and sea level training on submaximal economy in well-trained swimmers and runners

To evaluate the effect of intermittent hypobaric hypoxia combined with sea level training on exercise economy, 23 well-trained athletes (13 swimmers, 10 runners) were assigned to either hypobaric hypoxia (simulated altitude of 4,000-5,500 m) or normobaric normoxia (0-500 m) in a randomized, double-blind design. Both groups rested in a hypobaric chamber 3 h/day, 5 days/wk for 4 wk. Submaximal economy was measured twice before (Pre) and after (Post) the treatment period using sport-specific protocols. Economy was estimated both from the relationship between oxygen uptake (V(.-)o2) and speed, and from the absolute V(.-)o2 at each speed using sport-specific protocols. V(.-)o2 was measured during the last 60 s of each (3-4 min) stage using Douglas bags. Ventilation (V(.-)E), heart rate (HR), and capillary lactate concentration ([La(-)]) were measured during each stage. Velocity at maximal V(.-)o2 (velocity at V(.-)o2max) was used as a functional indicator of changes in economy. The average V(.-)o2 for a given speed of the Pre values was used for Post test comparison using a two-way, repeated-measures ANOVA. Typical error of measurement of V(.-)o2 was 4.7% (95% confidence limits 3.6-7.1), 3.6% (2.8-5.4), and 4.2% (3.2-6.9) for speeds 1, 2, and 3, respectively. There was no change in economy within or between groups (ANOVA interaction P = 0.28, P = 0.23, and P = 0.93 for speeds 1, 2, and 3). No differences in submaximal HR, [La-], Ve, or velocity at V(.-)o2(max) were found between groups. It is concluded that 4 wk of intermittent hypobaric hypoxia did not improve submaximal economy in this group of well-trained athletes.