Effect of exercise on serum calcium and parathyroid hormone

Independent associations of serum calcium with or without albumin adjustment and serum phosphorus with nonalcoholic fatty liver disease: results from NHANES 1999-2018

Background

The associations of serum calcium and phosphorus with nonalcoholic fatty liver disease (NAFLD) remain unclear. In addition, there may be an effect of albumin correction on the association between serum calcium and NAFLD. We aimed to explore these relationships in the National Health and Nutrition Examination Survey (NHANES).

Methods

Eligible adult individuals from NHANES 1999-2018 were recruited for the study. We explored the associations of serum calcium, albumin-adjusted serum calcium, and serum phosphorus with NAFLD in multivariable-adjusted regression models. In addition, restricted cubic spline (RCS), stratified analysis, and multiple sensitivity analyses were used for further elaboration.

Results

The study sample consisted of 20,900 participants, with an observed NAFLD prevalence of 44.65%. Fully adjusted models indicated that serum calcium was inversely associated with NAFLD (odds ratio [OR] and 95% confidence interval [CI] = 0.70 (0.62, 0.78), p<0.0001), whereas albumin-adjusted serum calcium was positively associated with NAFLD (OR and 95% CI=1.59 (1.41, 1.79), p<0.0001). RCS modeling indicated that serum calcium without and with albumin adjustment was linearly(p nonlinear = 0.083) and nonlinearly (p nonlinear < 0.0001) associated with NAFLD, respectively, whereas serum phosphorus showed a U-shaped relationship with NAFLD(p nonlinear < 0.0001). Gender is a significant influence in all associations, and other variables may also have an effect. Sensitivity analyses indicated that these associations were independent of additional significant confounders.

Conclusion

Serum calcium and phosphorus were significantly associated with the development of NAFLD. These findings suggest the potential clinical significance of serum calcium/phosphorus and albumin levels in individuals at high risk for NAFLD. Our study supports the potential role of serum calcium/phosphorus homeostasis in the pathophysiology of NAFLD and could serve as NAFLD-related biomarkers.

Bone Turnover Alterations after Completing a Multistage Ultra-Trail: A Case Study

A series of case studies aimed to assess bone and stress fractures in a 768-km ultra-trail race for 11 days. Four nonprofessional male athletes completed the event without diagnosing any stress fracture. Bone turnover markers (osteocalcin (OC), serum C-terminal cross-linking telopeptide of type I collagen (CTX), bone-specific alkaline phosphatase (BALP), and serum turnover calcium (Ca²⁺)) were assessed before (pre) and after the race (post) and on days two and nine during the recovery period (rec2 and rec9), respectively. Results showed: post-pre-OC = −45.78%, BALP = −61.74%, CTX = +37.28% and Ca²⁺ = −3.60%. At rec2 and rec9, the four parameters did not return to their pre-run levels: OC, −48.31%; BALP, −61.66%; CTX, +11.93% and Ca²⁺, −3.38%; and OC = −25.12%, BALP = −54.65%, CTX = +93.41% and Ca²⁺ = +3.15%), respectively. Our results indicated that the ultra-trail race induced several changes in bone turnover markers, uncoupling of bone metabolism, increased bone resorption: OC and BALP and suppressed bone formation: CTX and Ca²⁺. Bone turnover markers can help determine the response of bone to extreme effort and might also help predict the risk of stress fractures.

Environmental Factors That Affect Parathyroid Hormone and Calcitonin Levels

Calciotropic hormones, parathyroid hormone (PTH) and calcitonin are involved in the regulation of bone mineral metabolism and maintenance of calcium and phosphate homeostasis in the body. Therefore, an understanding of environmental and genetic factors influencing PTH and calcitonin levels is crucial. Genetic factors are estimated to account for 60% of variations in PTH levels, while the genetic background of interindividual calcitonin variations has not yet been studied. In this review, we analyzed the literature discussing the influence of environmental factors (lifestyle factors and pollutants) on PTH and calcitonin levels. Among lifestyle factors, smoking, body mass index (BMI), diet, alcohol, and exercise were analyzed; among pollutants, heavy metals and chemicals were analyzed. Lifestyle factors that showed the clearest association with PTH levels were smoking, BMI, exercise, and micronutrients taken from the diet (vitamin D and calcium). Smoking, vitamin D, and calcium intake led to a decrease in PTH levels, while higher BMI and exercise led to an increase in PTH levels. In terms of pollutants, exposure to cadmium led to a decrease in PTH levels, while exposure to lead increased PTH levels. Several studies have investigated the effect of chemicals on PTH levels in humans. Compared to PTH studies, a smaller number of studies analyzed the influence of environmental factors on calcitonin levels, which gives great variability in results. Only a few studies have analyzed the influence of pollutants on calcitonin levels in humans. The lifestyle factor with the clearest relationship with calcitonin was smoking (smokers had increased calcitonin levels). Given the importance of PTH and calcitonin in maintaining calcium and phosphate homeostasis and bone mineral metabolism, additional studies on the influence of environmental factors that could affect PTH and calcitonin levels are crucial.

Response of parathyroid hormone to exercise and bone mineral density in adolescent female athletes

BACKGROUND

This study investigates 1) the effects of amount of exercise on levels of serum parathyroid hormone (PTH) and calcium, and 2) the relationship between PTH response and bone mineral density in adolescent female athletes.

SUBJECTS

Twenty-one female athletes on a top-ranked high school basketball team in Japan participated in a one-month intensive basketball program. Subjects were divided into moderate-exercise and strenuous-exercise groups.

METHODS

The amount of exercise was quantified using estimated metabolic equivalent (METs) and exercise hours. Levels of serum intact-PTH and calcium were examined five times: twice before training to establish a baseline (T(-1) and T(0)), once 3rd week of the training period (T(1), once immediately at the end of the program (T(2)), and again one week later(3)). Bone mineral density of forearm (distal-BMD) was measured one week after the end of the program. PTH levels at T(1), T(2) and(3) were regressed on PTH at baseline (T(0)) for both groups and examined for statistical significance. Multiple regression analyses of the changes of PTH and distal-BMD were conducted.

RESULTS

1) Strenuous-exercise subjects showed both increased and decreased PTH levels, while moderate-exercise subjects showed a uniform decrease in PTH throughout the exercise period. 2) Increased PTH was an independent negative predictor of distal-BMD, while high lean body mass, increased serum Ca, and exercise volume were positive predictors.

CONCLUSION

The amount of exercise affects PTH response: moderate exercise suppresses PTH secretion, while strenuous exercise is apt to induce continuous secretion, which has a negative effect on BMD.

Combined effects of exercise and propranolol on bone tissue in ovariectomized rats

The bone response to physical exercise may be under control of the SNS. Using a running session in rats, we confirmed that exercise improved trabecular and cortical properties. SNS blockade by propranolol did not affect this response on cortical bone but surprisingly inhibited the trabecular response. This suggests that the SNS is involved in the trabecular response to exercise but not in the cortical response.

INTRODUCTION

Animal studies have suggested that bone remodeling is under beta-adrenergic control through the sympathetic nervous system (SNS). However, the SNS contribution to bone response under mechanical loading remains unclear. The purpose of this study was to examine the preventive effect of exercise coupled with propranolol on cancellous and cortical bone compartments in ovariectomized rats.

MATERIALS AND METHODS

Six-month-old female Wistar rats were ovariectomized (OVX, n = 44) or sham-operated (n = 24). OVX rats received subcutaneous injections of propranolol 0.1 mg/kg/day or vehicle and were submitted or not submitted to treadmill exercise (13 m/minute, 60 minutes/day, 5 days/week) for 10 weeks. Tibial and femoral BMD was analyzed longitudinally by DXA. At death, the left tibial metaphysis and L(4) vertebrae were removed, and microCT was performed to study trabecular and cortical bone structure. Histomorphometric analysis was performed on the right proximal tibia.

RESULTS

After 10 weeks, BMD and trabecular strength decreased in OVX rats, whereas bone turnover rate and cortical porosity increased compared with the Sham group (p < 0.001). Either propranolol or exercise allowed preservation of bone architecture by increasing trabecular number (+50.35% versus OVX; p < 0.001) and thickness (+16.8% versus OVX; p < 0.001). An additive effect of propranolol and exercise was observed on cortical porosity but not on trabecular microarchitecture or cortical width. Biomechanical properties indicated a higher ultimate force in the OVX-propranolol-exercise group compared with the OVX group (+9.9%; p < 0.05), whereas propranolol and exercise alone did not have any significant effect on bone strength.

CONCLUSIONS

Our data confirm a contribution of the SNS to the determinants of bone mass and quality and show a antagonistic effect of exercise and a beta-antagonist on trabecular bone structure.

Evaluation of hormonal response and ultrasonic changes in the heel bone by aquatic exercise in sedentary postmenopausal women

OBJECTIVE

This study is based on whether moderate increased physical activity as aquatic exercise has anabolic effects on bone and evaluates this in terms of quantitative ultrasound and hormonal variables.

DESIGN

In this study, 41 postmenopausal sedentary women were admitted to Atatürk Balneotherapy and Rehabilitation Center, according to T scores of broadband ultrasound attenuation. Subjects were followed for 6 mos in aquatic exercise and control groups. The subjects were told to perform the aerobic exercises according to the Borg Scale. Ultrasonic and hormonal evaluation was done before and after the 6-mo training study.

RESULTS

In the exercise group, there were 36%, 75%, and 54% increases in the serum levels of insulin-like growth factor-1, growth hormone, and calcitonin, respectively. In addition, a 31% decrease was found in the serum levels of parathormone compared with the initial values. In the control group, serum levels of growth hormone decreased by 61%, but there were no statistically significant changes in the serum levels of insulin-like growth factor-1, calcitonin, or parathormone. T scores of broadband ultrasound attenuation and speed of sound increased by 19% and 63% in the exercise group, respectively, whereas there were decreases in the control group for the same variables. There were statistically significant differences between the control and the aquatic exercise groups for the 6-mo percentage of changes in broadband ultrasound attenuation and speed-of-sound T scores, insulin-like growth factor-1, growth hormone, parathormone, and calcitonin.

CONCLUSIONS

Aquatic exercise was determined to be effective to make an anabolic effect on the bone of the postmenopausal, sedentary subjects.

Regulation of brain function by exercise

The effect of excercise on brain function was investigated through animal experiments. Exercise leads to increased serum calcium levels, and the calcium is transported to the brain. This in turn enhances brain dopamine synthesis through a calmodulin-dependent system, and increased dopamine levels regulate various brain functions. There are abnormally low levels of dopamine in the neostriatum and nucleus accumbens of epileptic mice (El mice strain) and spontaneously hypertensive rats (SHR). The low dopamine levels in those animals were improved following intracerebroventricular administration of calcium chloride. Dopamine levels and blood pressure in SHR were also normalized by exercise. In epileptic El mice, convulsions normalized dopamine levels and physiologic function. These findings suggest that exercise or convulsions affect brain function through calcium/calmodulin-dependent dopamine synthesis. This leads to the possibility that some symptoms of Parkinson's disease or senile dementia might be improved by exercise.

Response of parathyroid hormone to anaerobic exercise in adolescent female athletes

It has been shown that moderate exercise suppresses parathyroid hormone (PTH) secretion, while strenuous exercise is apt to induce continuous secretion, which has a negative effect on bone mineral densities (BMD). The present study investigated a typical response of PTH to brief exercise. The study group comprised six adolescent female basketball players whose BMD were within normal limits. Maximal anaerobic power by three-step cycling was loaded on each subject. The first blood sample was drawn 30 min prior to testing test, the second was immediately following, the third was 15 min after, and the fourth was 30 min after. The proportional change in plasma volume was -11.5% immediately following (P < 0.05), +2.1% 15 min after, and +5.5% at 30 min after exercise (P < 0.05). The expected value was calculated on the assumption of no effect, except changes in plasma volume, by exercise. The measured values of PTH and calcium (Ca) immediately after exercise were lower than each of the expected values (P < 0.05 for both). At 15 min after, there was no significant difference between expected and measured values of PTH, Ca and magnesium (Mg), respectively. At 30 min after, the measured value of Ca and Mg was higher than each expected value (P < 0.05 for both). It was concluded that PTH secretion is suppressed transiently immediately after maximal anaerobic exercise and is then stimulated during the recovery time in normal BMD subjects.

Regulation of blood pressure with calcium-dependent dopamine synthesizing system in the brain and its related phenomena

The effects of calcium on blood pressure regulation remain controversial. Although the mechanism by which calcium increases blood pressure when it is given intravenously and acutely has been elucidated, that by which calcium reduces blood pressure when it is supplemented chronically and slightly through daily diet is unclear. From a number of animal experiments concerning the effects of calcium on blood pressure, we believe that calcium ions have two separate roles in the regulation of blood pressure through both central and peripheral systems: (1) calcium ions reduce blood pressure through a central, calcium/calmodulin-dependent dopamine-synthesizing system and (2) calcium ions increase blood pressure through an intracellular, calcium-dependent mechanism in the peripheral vasculature. These concepts were applied to elucidate the mechanisms underlying hypertension in spontaneously hypertensive rats (SHR) and changes in blood pressure in other experimental animals, and the following conclusions were reached. The decrease of the serum calcium level in spontaneously hypertensive rats (SHR) causes a decrease in calcium/calmodulin-dependent dopamine synthesis in the brain. The subsequent low level of brain dopamine induces hypertension. The increase in susceptibility to epileptic convulsions and the occurrence of hypertension in epileptic mice (El mice) may be linked through a lowering of calcium-dependent dopamine synthesis in the brain, and epilepsy and hypertension may be associated. Exercise leads to increases in calcium-dependent dopamine synthesis in the brain, and the increased dopamine levels induce physiological changes, including a decrease in blood pressure. Cadmium which is not distinguished from calcium by calmodulin, activates calmodulin-dependent functions in the brain, and increased dopamine levels may decrease blood pressure. In this report, our studies are considered in light of reports from many other laboratories.

Effect of acute endurance and strength exercise on circulating calcium-regulating hormones and bone markers in young healthy males

Physical activity plays a role in the maintenance of the skeleton but the mechanical, metabolic and hormonal mechanisms involved are largely unknown. The influence of acute endurance and strength exercise on circulating levels of calcitonin, parathyroid hormone (PTH), PTH-related peptide (PTHrP), osteocalcin, carboxyterminal cross-linked telopeptide of type I collagen (ICTP) and ionized calcium (Ca2+) was therefore evaluated. Eight healthy young males performed three exercise bouts on separate occasions: endurance exercise, i.e. cycling on a cycle ergometer for 45 min at 55% of Vo2max (E55%) and 15 min at 85% of Vo2max (E85%) and strength exercise at 85% of three repetitions maximum using a leg-press device (STR). Control experiments included the same subjects with the same time schedule but without exercise. Blood samples were taken before, immediately after exercise and during the recovery period. Hormones and bone markers were measured by use of various immunoassays. There was no obvious influence on calcitonin and PTHrP levels, whereas PTH was increased after strength exercise. ICTP and osteocalcin levels correlated positively at all times and showed regular variations. In comparison with the controls, ICTP levels showed a more pronounced decrease following physical activity whereas osteocalcin followed the same pattern as the controls except for after prolonged endurance exercise when a decrease was abolished. In conclusion, an increase in PTH after strength exercise and a pronounced decrease in ICTP after all exercise together with a relative increase in osteocalcin after prolonged endurance exercise might reflect some mechanisms involved in the positive effect of physical activity on bone mass.

Homeostatic control of plasma calcium concentration

Due to the importance of Ca2+ in the regulation of vital cellular and tissue functions, the concentration of Ca2+ in body fluids is closely guarded by an efficient feedback control system. This system includes Ca(2+)-transporting subsystems (bone, and kidney), Ca2+ sensing, possibly by a calcium-sensing receptor, and calcium-regulating hormones (parathyroid hormone [PTH], calcitonin [CT], and 1,25-dihydroxyvitamin D3 [1,25(OH)2D3]). In humans and birds, acute Ca2+ perturbations are handled mainly by modulation of kidney Ca2+ reabsorption and by bone Ca2+ flow under PTH and possibly CT regulation, respectively. Chronic perturbations are also handled by the more sluggish but economic regulatory action of 1,25(OH2)D3 on intestinal calcium absorption. Peptide hormone secretion is modulated by Ca2+ and several secretagogues. The hormones' signal is produced by interaction with their respective receptors, which evokes the cAMP and phospholipase C-IP3-Ca2+ signal transduction pathways. 1,25 (OH)2D3 operates through a cytoplasmic receptor in controlling transcription and through a membrane receptor that activates the Ca2+ and phospholipase C messenger system. The calciotropic hormones also influence processes not directly associated with Ca2+ regulation, such as cell differentiation, and may thus affect the calcium-regulating subsystems also indirectly.

[Physical exercise and the skeleton]

The skeleton provides more than only a framework for the body. Bone is a calcified conjunctive tissue sensitive to various mechanical stimuli, mainly to those resulting from gravity and muscular contractions. Numerous animal and human studies demonstrate the importance of weight-bearing physical activity as well as mechanical loading for maintaining skeletal integrity. Lack of weight-bearing activity is dangerous for the skeleton: a decrease in bone mineral density (BMD) has been demonstrated in animals and humans under conditions of weightlessness or immobilization. Other studies have also reported a lower vertebral BMD among young amenorrheic athletes than among athletes with regular cycles and/or non athletes. The main factor responsible for this lower BMD in the amenorrheic athletes is the persistent low level of endogenous estrogen observed among these women. However this does not represent a premature and irreversible loss of bone mass since the resumption of menses following a decrease in training is the primary factor for a significant increase in vertebral BMD in these formerly amenorrheic athletes. A weight-bearing exercise is likely to be more beneficial at weight-bearing than at non weight-bearing sites, and hypogonadism resulting from very intensive training and exercise is more detrimental to trabecular than cortical bone. Bone deficit at non weight-bearing sites may be attenuated by maintenance of body weight. Nevertheless the etiology of "stress fractures" among athletes remains poorly understood, and the exact relationship between soft tissue mass and BMD is not clear. Osteoporosis, the most common bone disorder in France, is a pathological condition associated with increased loss of bone mass, resulting in a greater risk of fracture. Although symptoms of osteoporosis do not generally occur until after menopause, recent evidence suggests that bone loss starts much earlier in life. Therefore osteoporosis might be prevented by increasing peak bone mass and/or by slowering bone loss after menopause. Exercise such as resistance training or weight-bearing activities like running or walking have an osteogenic effect on increasing BMD in young people, and the decrease in BMD is slower in exercised than in non-exercised post-menopausal women. Nevertheless the influence of the length and of the intensity of such physical activities remain to be determined.

Intact serum parathyroid hormone levels increase during running exercise in well-trained men

The purpose of this study was to examine the influence of exercise on the serum concentrations of intact parathyroid hormone (PTH). Serum PTH and plasma lactate were measured in 15 well-trained men, 9 long-distance runners and 6 fire-fighters, during two running exercises. Test one consisted of 40-minute treadmill running with a step-wise increased load and test two consisted of 50-minute treadmill running with a constant velocity. When the load was step-wise increased, the PTH concentrations increased moderately at the slower running paces but reached a final value that was about 50% higher than the starting value. This rise occurred despite a concomitant increase of total serum calcium from 2.38 +/- 0.06 to 2.49 +/- 0.05 mmol/liter (P < 0.01). During the constant running exercise, the long-distance runners, but not the fire-fighters, displayed a significant increase in PTH concentrations although the rise in total serum calcium was similar in both groups. There was a weak correlation between the changes in PTH and lactate in both exercises. The findings demonstrate that both high and low intensity exercise enhance release of PTH in long-distance runners through a mechanism that does not involve serum calcium. This relationship might be of importance for bone mass in men performing long-distance training.

Marathon running accompanied by transient decreases in urinary calcium and serum osteocalcin levels

We evaluated the effects of marathon running on bone metabolism in 23 noncompetitive athletes (15 women, 8 men, age range 23-55 years). The volunteers were studied 10 days before, immediately after, and 1, 3, and 5 days after the run. Serum osteocalcin levels were decreased on average by 20% (from 4.9 to 3.9 micrograms/liter, P = 0.005) in men and by 10% (from 4.9 to 4.4 micrograms/liter, P < 0.05) in women at the end of the marathon, with lowest osteocalcin levels (67-55% of the prerun levels) encountered 1 day after the marathon. The activity of bone alkaline phosphatase was decreased in women (from 66.3 to 62.3 U/liter, P < 0.05) after the run, and this drop was detectable at each checkup after the run. Urinary excretion of calcium was lowered on average by 82% in men (from 2.8 to 0.5 mumol/minute, P < 0.05) and by 76% in women (from 2.5 to 0.6 mumol/minute, P < 0.005) after the run, but had already returned to prerun levels 1 day after the marathon. Urinary excretion of hydroxyproline tended to rise in both men and women, but the change did not reach statistical significance in either sex. These changes suggest a transient suppression in osteoblast function during the marathon.

Effect of physical activity on calciotropic hormones and calcium balance in rats

The response of calciotropic hormones and bone turnover to exercise and immobilization was examined by the measurement of calcium balance, bone turnover indexes, levels of parathyroid hormone, nephrogenous adenosine 3',5'-cyclic monophosphate (cAMP), and 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] weekly for 6 wk in three groups of rats: control, exercise trained, and immobilized. Early in the experiment, increases were observed in excretion of urinary calcium, hydroxyproline, and in serum alkaline phosphatase after both exercise and immobilization. It was not until the latter part of the experimental period that changes were observed in nephrogenous cAMP and intestinal absorption efficiency of calcium. In the fasting state, the exercise group had a drop in serum calcium and phosphate and a rise in nephrogenous cAMP and serum 1,25(OH)2D3 compared with the control group. The exercised animals experienced an increase in bone mass, whereas the immobilized animals had a decline in bone mass. Thus exercise stimulates bone growth, resulting in an increased demand for minerals that is satisfied by an increase in serum 1,25(OH)2D3 levels and increased intestinal absorption of calcium. The increase in calcium absorption suppresses parathyroid hormone production (nephrogenous cAMP) in the exercised animal. Immobilization resulted in increased bone resorption that suppressed parathyroid hormone, nephrogenous cAMP, and the intestinal absorption of calcium.

Response of muscle protein turnover to insulin after acute exercise and training

To determine whether the enhanced insulin-sensitivity of glucose metabolism in muscle after acute exercise also extends to protein metabolism, untrained and exercise-trained rats were subjected to an acute bout of exercise, and the responses of protein synthesis and degradation to insulin were measured in epitrochlearis muscles in vitro. Acute exercise of both untrained and trained rats decreased protein synthesis in muscle in the absence or presence of insulin, but protein degradation was not altered. Exercise training alone had no effect on protein synthesis or degradation in muscle in the absence or presence of insulin. Acute exercise or training alone enhanced the sensitivities of both protein synthesis and degradation to insulin, but the enhanced insulin-sensitivities from training alone were not additive to those after acute exercise. These results indicate that: a decrease in protein synthesis is the primary change in muscle protein turnover after acute exercise and is not altered by prior exercise training, and the enhanced insulin-sensitivities of metabolism of both glucose and protein after either acute exercise or training suggest post-binding receptor events.

Prolonged low-intensity exercise raises the serum parathyroid hormone levels

Twelve healthy males performed 5 h exercise on a bicycle ergometer at a constant work load of approximately 50% of their maximum capacity. The serum concentrations of parathyroid hormone (PTH) increased after the first hour and were continuously elevated throughout the exercise period. The rise in PTH was 5-7% above pre-exercise levels, corresponding to 20-30% of the maximal increase obtained by the same assay during prolonged hypocalcaemia. The probable cause for the rise in PTH was that the plasma ionized calcium tended to be lowered during exercise. Since the total serum calcium concentrations were raised (by 3-5%) during exercise the reduction of the free, ionized, fraction was presumably largely due to increased complex-binding although an outward transport from plasma was not excluded. The serum concentrations of magnesium were gradually reduced during exercise while those of phosphate and potassium were raised throughout, probably as a result of leakage from the working muscle.

Effect of heavy exercise on mineral metabolism and calcium regulating hormones in humans

The relationship between acid base status and mineral metabolism after heavy exercise has been examined in 12 healthy subjects. Following burst exercise (duration 60-130 sec) to the point of exhaustion, blood pH had decreased (7.42 +/- 0.01 vs. 7.18 +/- 0.02, P less than 0.001) and plasma ionized calcium had increased (1.09 +/- 0.01 vs. 1.22 +/- 0.02 mmol/liter, P less than 0.001). Log ionized calcium concentration showed a significant negative correlation with pH (r = -0.90). Although plasma total calcium increased after exercise (2.47 +/- 0.05 vs. 2.67 +/- 0.04 mmol/liter, P less than 0.001), this change was not seen if the observed values were corrected for the accompanying increase in plasma protein concentration, suggesting that hemoconcentration accounted for these increments. Significant increases were also seen in plasma inorganic phosphate concentration, though not in plasma magnesium. Radioimmunoassay of parathyroid hormone using two different region-specific assays, one directed at the mid-region/carboxy-terminal and the other at the amino-terminal portion of the molecule, and of calcitonin, showed no change during exercise-induced hypercalcemia. The results do not suggest significant skeletal buffering of this type of acidosis and indicate that the changes in ionized calcium associated with short bursts of intense exercise are directly related to acidosis and that those in total calcium are a consequence of hemoconcentration.

Regional and systemic effects of short-term intense muscular work on plasma concentration and content of total and ionized calcium

Isokinetic work with one leg was carried out with maximal force for 2 min by five healthy subjects. The concentrations of plasma total calcium and of ionized calcium in the effluent from the leg increased by a mean of 13.6 +/- 1.8% (SD) and 16.2 +/- 2.0%, respectively. The corresponding rises in the resting arm were 7.7 +/- 4.3% and 8.1 +/- 3.0%. There was a close correlation (r = 0.86; P less than 0.001) between the degree of exercise-induced acidosis and the rise in plasma ionized calcium. However, the calcium values normalized both in the leg and in the arm within 5 min after the exercise and were similar at the two measuring sites despite a lower pH in the leg sample. During work there was a reduction of the plasma volume of 11.2 +/- 6.0% in the regional (femoral) and 12.4 +/- 4.2% in the systemic (antecubital) sample (P less than 0.001 compared to baseline values for both measurements). When adjustments were made for the reduction in plasma volume as well as for acidosis it was evident that, despite the apparent increases in the calcium concentrations, there was a net reduction of the plasma ionized calcium content (the total amount of plasma ionized calcium). This decrease was significantly (P less than 0.05) more pronounced in the exercising leg than in the systemic circulation but the difference could largely be explained by higher calcium-lactate complex formation in the leg.

Effects of physical exercise on serum calcium and parathyroid hormone

The effects of physical exercise on plasma ionized calcium, total serum calcium and parathyroid hormone (PTH) concentrations were evaluated in healthy subjects submitted to work on an ergometer bicycle. When the workload was increased stepwise there was a significant increase (P less than 0.001) in the calcium concentrations (ionized calcium from 1.13 +/- 0.03 (SD) to 1.24 +/- 0.03 mmol 1(-1) and total calcium from 2.35 +/- 0.07 to 2.48 +/- 0.07 mmol 1(-1] when the workload exceeded approximately 65% of the estimated maximum--i.e. a load that caused accumulation in blood of lactic acid. The rise in plasma ionized calcium was, therefore, presumably largely attributed to the acidosis but reduction of plasma volume and influx from extracellular sources might also have contributed. Beta blockade (with oral intake of propranolol) reduced physical capacity, shortened the duration of work and caused less acidosis. These factors were probably responsible for a smaller rise in ionized calcium during beta blockade (7 +/- 4%) than in control studies (21 +/- 5%) without medication in subjects examined during short-term maximal exercise. Long-term (1 h) steady-state work which caused fatigue without producing lactic acidosis did not affect the calcium concentrations. Despite the effects of work on calcium levels there was no discernible suppression of the PTH concentrations. This might have been due to a concomitant stimulation of PTH secretion by work.