Variations in Hypoxia Impairs Muscle Oxygenation and Performance during Simulated Team-Sport Running

Muscle Oximetry in Sports Science: An Updated Systematic Review

BACKGROUND

In the last 5 years since our last systematic review, a significant number of articles have been published on the technical aspects of muscle near-infrared spectroscopy (NIRS), the interpretation of the signals and the benefits of using the NIRS technique to measure the physiological status of muscles and to determine the workload of working muscles.

OBJECTIVES

Considering the consistent number of studies on the application of muscle oximetry in sports science published over the last 5 years, the objectives of this updated systematic review were to highlight the applications of muscle oximetry in the assessment of skeletal muscle oxidative performance in sports activities and to emphasize how this technology has been applied to exercise and training over the last 5 years. In addition, some recent instrumental developments will be briefly summarized.

METHODS

Preferred Reporting Items for Systematic Reviews guidelines were followed in a systematic fashion to search, appraise and synthesize existing literature on this topic. Electronic databases such as Scopus, MEDLINE/PubMed and SPORTDiscus were searched from March 2017 up to March 2023. Potential inclusions were screened against eligibility criteria relating to recreationally trained to elite athletes, with or without training programmes, who must have assessed physiological variables monitored by commercial oximeters or NIRS instrumentation.

RESULTS

Of the identified records, 191 studies regrouping 3435 participants, met the eligibility criteria. This systematic review highlighted a number of key findings in 37 domains of sport activities. Overall, NIRS information can be used as a meaningful marker of skeletal muscle oxidative capacity and can become one of the primary monitoring tools in practice in conjunction with, or in comparison with, heart rate or mechanical power indices in diverse exercise contexts and across different types of training and interventions.

CONCLUSIONS

Although the feasibility and success of the use of muscle oximetry in sports science is well documented, there is still a need for further instrumental development to overcome current instrumental limitations. Longitudinal studies are urgently needed to strengthen the benefits of using muscle oximetry in sports science.

AZU1 (HBP/CAP37) and PRKCG (PKC-gamma) may be candidate genes affecting the severity of acute mountain sickness

BACKGROUND

Acute Mountain Sickness (AMS) is one of the diseases that predispose to sudden ascent to high altitudes above 2500 m. Among the many studies on the occurrence and development of AMS, there are few studies on the severity of AMS. Some unidentified phenotypes or genes that determine the severity of AMS may be vital to elucidating the mechanisms of AMS. This study aims to explore the underlying genes or phenotypes associated with AMS severity and to provide evidence for a better understanding of the mechanisms of AMS.

METHODS

GSE103927 dataset was downloaded from the Gene Expression Omnibus database, and a total of 19 subjects were enrolled in the study. Subjects were divided into a moderate to severe AMS (MS-AMS, 9 subjects) group and a no or mild AMS (NM-AMS, 10 subjects) group based on the Lake Louise score (LLS). Various bioinformatics analyses were used to compare the differences between the two groups. Another dataset, Real-time quantitative PCR (RT-qPCR), and another grouping method were used to validate the analysis results.

RESULT

No statistically significant differences in phenotypic and clinical data existed between the MS-AMS and NM-AMS groups. Eight differential expression genes are associated with LLS, and their biological functions are related regulating of the apoptotic process and programmed cell death. The ROC curves showed that AZU1 and PRKCG had a better predictive performance for MS-AMS. AZU1 and PRKCG were significantly associated with the severity of AMS. The expression of AZU1 and PRKCG were significantly higher in the MS-AMS group compared to the NM-AMS group. The hypoxic environment promotes the expression of AZU1 and PRKCG. The results of these analyses were validated by an alternative grouping method and RT-qPCR results. AZU1 and PRKCG were enriched in the Neutrophil extracellular trap formation pathway, suggesting the importance of this pathway in influencing the severity of AMS.

CONCLUSION

AZU1 and PRKCG may be key genes influencing the severity of acute mountain sickness, and can be used as good diagnostic or predictive indicators of the severity of AMS. Our study provides a new perspective to explore the molecular mechanism of AMS.

The Methodological Quality of Studies Investigating the Acute Effects of Exercise During Hypoxia Over the Past 40 years: A Systematic Review

Exercise under hypoxia and the physiological impact compared to normoxia or hypoxia has gained attention in the last decades. However, methodological quality assessment of articles in this area is lacking in the literature. Therefore, this article aimed to evaluate the methodologic quality of trials studying exercise under hypoxia. An electronic search was conducted until December 2021. The search was conducted in PubMed, CENTRAL, and PEDro using the PICO model. (P) Participants had to be healthy, (I) exercise under normobaric or hypobaric hypoxia had to be (C) compared to exercise in normoxia or hypoxia on (O) any physiological outcome. The 11-item PEDro scale was used to assess the methodological quality (internal validity) of the studies. A linear regression model was used to evaluate the evolution of trials in this area, using the total PEDro score of the rated trials. A total of n = 81 studies met the inclusion criteria and were processed in this study. With a mean score of 5.1 ± 0.9 between the years 1982 and 2021, the mean methodological quality can be described as “fair.” Only one study reached the highest score of 8/10, and n = 2 studies reached the lowest observed value of 3/10. The linear regression showed an increase of the PEDro score of 0.1 points per decade. A positive and small tendency toward increased methodologic quality was observed. The current results demonstrate that a positive and small tendency can be seen for the increase in the methodological quality in the field of exercise science under hypoxia. A “good” methodological quality, reaching a PEDro score of 6 points can be expected in the year 2063, using a linear regression model analysis. To accelerate this process, future research should ensure that methodological quality criteria are already included during the planning phase of a study.

Acute performance responses to repeated treadmill sprints in hypoxia with varying inspired oxygen fractions, exercise-to-recovery ratios and recovery modalities

PURPOSE

For optimizing the quality of repeated-sprint training in hypoxia, the differences in the acute performance responses to a single session of repeated-sprint exercise with various (i) inspired oxygen fractions; (ii) exercise-to-recovery (E:R) ratios and (iii) recovery modalities were examined.

METHODS

Ten male participants performed three sets, 5 × 5-s all-out treadmill sprints, E:R ratio of 1:5, passive recovery, in seven trials randomly. In four of the seven trials, hypoxic levels were set corresponding to sea level (SL_1:5P), 1500 (1.5K_1:5P), 2500 (2.5K_1:5P), and 3500 m (3.5K_1:5P), respectively. In a further two trials, the hypoxic level of 3.5K_1:5P was maintained, while the E:R ratio was reduced to 1:4 (3.5K_1:4P) and 1:3 (3.5K_1:3P), respectively. In the last trial, the passive recovery mode of 3.5K_1:5P was changed to active (3.5K_1:5A).

RESULTS

In comparison to SL_1:5P, the averaged peak velocity (P-Vel), mean velocity (M-Vel), and velocity decrement score (Sdec) of the sprints, and the cumulative HR-based training impulse (cTRIMP) in 1.5K_1:5P and 2.5K_1:5P were well maintained. Minor decrement in the M-Vel was found in 3.5K_1:5P. Conversely, lowered E:R ratio in 3.5K_1:4P and 3.5K_1:3P significantly reduced the P-Vel (≥ -2.3%, Cohen's d ≥ 0.43) and M-Vel (≥ -2.4%, ≥ 0.49), and in 3.5K_1:3P altered the Sdec (107%, ≥ 0.96), and cTRIMP (-16%, 1.39), when compared to 3.5K_1:5P. Furthermore, mild reductions in M-Vel (-2.6%, 0.5) was observed in 3.5K_1:5A using the active recovery mode. Other variables did not change.

CONCLUSION

The findings suggest that a 3.5K_1:5P marginally maintained sea-level training loads, and as a result, could maximally optimize the training stress of hypoxia.

Alterations in acid-base balance and high-intensity exercise performance after short-term and long-term exposure to acute normobaric hypoxic conditions

This investigation assessed the course of renal compensation of hypoxia-induced respiratory alkalosis by elimination of bicarbonate ions and impairments in anaerobic exercise after different durations of hypoxic exposure. Study A: 16 participants underwent a resting 12-h exposure to normobaric hypoxia (3,000 m). Blood gas analysis was assessed hourly. While blood pH was significantly increased, PO2, PCO2, and SaO2 were decreased within the first hour of hypoxia, and changes remained consistent. A substantial reduction in [HCO3-] levels was observed after 12 h of hypoxic exposure (- 1.35 ± 0.29 mmol/L, p ≤ 0.05). Study B: 24 participants performed in a randomized, cross-over trial portable tethered sprint running (PTSR) tests under normoxia and after either 1 h (n = 12) or 12 h (n = 12) of normobaric hypoxia (3,000 m). No differences occurred for PTSR-related performance parameters, but the reduction in blood lactate levels was greater after 12 h compared with 1 h (- 1.9 ± 2.2 vs 0.0 ± 2.3 mmol/L, p ≤ 0.05). These results indicate uncompensated respiratory alkalosis after 12 h of hypoxia and similar impairment of high-intensity exercise after 1 and 12 h of hypoxic exposure, despite a greater reduction in blood lactate responses after 12 h compared with 1 h of hypoxic exposure.

Effects of an Alkalizing or Acidizing Diet on High-Intensity Exercise Performance under Normoxic and Hypoxic Conditions in Physically Active Adults: A Randomized, Crossover Trial

Pre-alkalization caused by dietary supplements such as sodium bicarbonate improves anaerobic exercise performance. However, the influence of a base-forming nutrition on anaerobic performance in hypoxia remains unknown. Herein, we investigated the effects of an alkalizing or acidizing diet on high-intensity performance and associated metabolic parameters in normoxia and hypoxia. In a randomized crossover design, 15 participants (24.5 ± 3.9 years old) performed two trials following four days of either an alkalizing (BASE) or an acidizing (ACID) diet in normoxia. Subsequently, participants performed two trials (BASE; ACID) after 12 h of normobaric hypoxic exposure. Anaerobic exercise performance was assessed using the portable tethered sprint running (PTSR) test. PTSR assessed overall peak force, mean force, and fatigue index. Blood lactate levels, blood gas parameters, heart rate, and rate of perceived exertion were assessed post-PTSR. Urinary pH was analyzed daily. There were no differences between BASE and ACID conditions for any of the PTSR-related parameters. However, urinary pH, blood pH, blood bicarbonate concentration, and base excess were significantly higher in BASE compared with ACID (p < 0.001). These findings show a diet-induced increase in blood buffer capacity, represented by blood bicarbonate concentration and base excess. However, diet-induced metabolic changes did not improve PTSR-related anaerobic performance.

Neuromuscular and perceptual responses during repeated cycling sprints-usefulness of a "hypoxic to normoxic" recovery approach

PURPOSE

We investigated the consequence of varying hypoxia severity during an initial set of repeated cycling sprints on performance, neuromuscular fatigability, and exercise-related sensations during a subsequent set of repeated sprints in normoxia.

METHODS

Nine active males performed ten 4-s sprints (recovery = 30 s) at sea level (SL; FiO₂ ~ 0.21), moderate (MH; FiO₂ ~ 0.17) or severe normobaric hypoxia (SH; FiO₂ ~ 0.13). This was followed, after 8 min of passive recovery, by five 4-s sprints (recovery = 30 s) in normoxia.

RESULTS

Mean power decrement during Sprint 10 was exacerbated in SH compared to SL and MH (- 34 ± 12%, - 22 ± 13%, - 25 ± 14%, respectively, p < 0.05). Sprint performance during Sprint 11 recovered to that of Sprint 1 in all conditions (p = 0.267). All exercise-related sensations at Sprint 11 recovered significantly compared to Sprint 1, with no difference for Set 2 (p > 0.05). Ratings of overall perceived discomfort, difficulty breathing, and limb discomfort were exacerbated during Set 1 in SH versus SL (p < 0.05). Compared to SL, the averaged MPO value for Set 2 was 5.5 ± 3.0% (p = 0.003) lower in SH. Maximal voluntary force and twitch torque decreased similarly in all conditions immediately after Set 1 (p < 0.05), without further alterations after Set 2. Peripheral and cortical voluntary activation values did not change (p > 0.05).

CONCLUSION

Exercise-related sensations, rather than neuromuscular function integrity, may play a pivotal role in influencing performance of repeated sprints and its recovery.

Quantifying the effects of acute hypoxic exposure on exercise performance and capacity: A systematic review and meta-regression

OBJECTIVE

To quantify the effects of acute hypoxic exposure on exercise capacity and performance, which includes continuous and intermittent forms of exercise.

DESIGN

A systematic review was conducted with a three-level mixed effects meta-regression. The ratio of means method was used to evaluate main effects and moderators providing practical interpretations with percentage change.

DATA SOURCES

A systemic search was performed using three databases (Google scholar, PubMed and SPORTDiscus). Eligibility criteria for selecting studies: Inclusion was restricted to investigations that assessed exercise performance (time trials (TTs), sprint and intermittent exercise tests) and capacity (time to exhaustion test, TTE) with acute hypoxic (<24 h) exposure and a normoxic comparator.

RESULTS

Eighty-two outcomes from 53 studies (N = 798) were included in this review. The results show an overall reduction in exercise performance/capacity -17.8 ± 3.9% (95% CI -22.8% to -11.0%), which was significantly moderated by -6.5 ± 0.9% per 1000 m altitude elevation (95% CI -8.2% to -4.8%) and oxygen saturation (-2.0 ± 0.4%; 95% CI -2.9% to -1.2%). TT (-16.2 ± 4.3%; 95% CI -22.9% to -9%) and TTE (-44.5 ± 6.9%; 95% CI -51.3% to -36.7%) elicited a negative effect, whilst indicating a quadratic relationship between hypoxic magnitude and both TTE and TT performance. Furthermore, exercise less than 2 min exhibited no ergolytic effect from acute hypoxia. Summary/Conclusion: This review highlights the ergolytic effect of acute hypoxic exposure, which is curvilinear for TTE and TT performance with increasing hypoxic levels, but short duration intermittent and sprint exercise seem to be unaffected.

Non-motorized Treadmill Running Is Associated with Higher Cardiometabolic Demands Compared with Overground and Motorized Treadmill Running

The aim of this study was to compare the cardiometabolic demands of running on a curved non-motorized treadmill (cNMT) with overground (OVR) and motorized treadmill (MOT) running. Fourteen trained male (n = 7) and female (n = 7) runners (V·O2peak 56.6 ± 4.0 mL.kg⁻¹.min⁻¹) participated in the study. Each experimental session consisted of 5 × 6-min bouts of running at progressively higher speeds, separated by 6-min rest (females 9–15 km.h⁻¹; males 10.5–16.5 km.h⁻¹). Oxygen consumption (V·O2) and heart rate (HR) during the last 2 min of each bout were measured using a portable metabolic cart. Running at a set speed on the cNMT required a higher percentage of V·O2peak than OVR (mean ± 90% CI, 22 ± 6%; ES ± 90% CI, 1.87 ± 0.15) and MOT (16 ± 6%; ES 1.50 ± 0.15) running. Similarly, HR during the cNMT was higher compared to OVR (25 ± 9 beats.min⁻¹, ES 1.23 ± 0.14) and MOT (22 ± 9 beats.min⁻¹, ES 1.35 ± 0.13) trials. The decline in running economy observed during the cNMT trial was negatively related to body mass (R² 0.493, P = 0.01), indicating lighter runners were required to work at a higher relative intensity to overcome treadmill belt resistance. These data demonstrate the higher cardiometabolic demand associated with running at a given speed on the cNMT. It is critical these differences are taken into account when prescribing training intensities on the cNMT or translating data from the laboratory to an athletic setting.

Changes in Muscle and Cerebral Deoxygenation and Perfusion during Repeated Sprints in Hypoxia to Exhaustion

During supramaximal exercise, exacerbated at exhaustion and in hypoxia, the circulatory system is challenged to facilitate oxygen delivery to working tissues through cerebral autoregulation which influences fatigue development and muscle performance. The aim of the study was to evaluate the effects of different levels of normobaric hypoxia on the changes in peripheral and cerebral oxygenation and performance during repeated sprints to exhaustion. Eleven recreationally active participants (six men and five women; 26.7 ± 4.2 years, 68.0 ± 14.0 kg, 172 ± 12 cm, 14.1 ± 4.7% body fat) completed three randomized testing visits in conditions of simulated altitude near sea-level (~380 m, F_IO₂ 20.9%), ~2000 m (F_IO₂ 16.5 ± 0.4%), and ~3800 m (F_IO₂ 13.3 ± 0.4%). Each session began with a 12-min warm-up followed by two 10-s sprints and the repeated cycling sprint (10-s sprint: 20-s recovery) test to exhaustion. Measurements included power output, vastus lateralis, and prefrontal deoxygenation [near-infrared spectroscopy, delta (Δ) corresponds to the difference between maximal and minimal values], oxygen uptake, femoral artery blood flow (Doppler ultrasound), hemodynamic variables (transthoracic impedance), blood lactate concentration, and rating of perceived exertion. Performance (total work, kJ; −27.1 ± 25.8% at 2000 m, p < 0.01 and −49.4 ± 19.3% at 3800 m, p < 0.001) and pulse oxygen saturation (−7.5 ± 6.0%, p < 0.05 and −18.4 ± 5.3%, p < 0.001, respectively) decreased with hypoxia, when compared to 400 m. Muscle Δ hemoglobin difference ([Hbdiff]) and Δ tissue saturation index (TSI) were lower (p < 0.01) at 3800 m than at 2000 and 400 m, and lower Δ deoxyhemoglobin resulted at 3800 m compared with 2000 m. There were reduced changes in peripheral [Δ[Hbdiff], ΔTSI, Δ total hemoglobin ([tHb])] and greater changes in cerebral (Δ[Hbdiff], Δ[tHb]) oxygenation throughout the test to exhaustion (p < 0.05). Changes in cerebral deoxygenation were greater at 3800 m than at 2000 and 400 m (p < 0.01). This study confirms that performance in hypoxia is limited by continually decreasing oxygen saturation, even though exercise can be sustained despite maximal peripheral deoxygenation. There may be a cerebral autoregulation of increased perfusion accounting for the decreased arterial oxygen content and allowing for task continuation, as shown by the continued cerebral deoxygenation.