Dietary Recommendations for Cyclists during Altitude Training

Effects of Quercetin and Citrulline on Nitric Oxide Metabolites and Antioxidant Biomarkers in Trained Cyclists

BACKGROUND

Quercetin (QCT) and citrulline (CIT) have been independently associated with improved antioxidant capacity and nitric oxide (NO) production, potentially enhancing cardiovascular function and exercise performance. This study aimed to evaluate the combined and independent effects of QCT and CIT supplementation on NO metabolites and antioxidant biomarkers in 50 trained cyclists undergoing a 20 km cycling time trial (TT).

METHODS

In a randomized, double-blind, placebo-controlled design, forty-two male and eight female trained cyclists were assigned to QCT + CIT, QCT, CIT, or placebo (PL) groups. Supplements were consumed twice daily for 28 days. Biochemical assessments included NO metabolites (nitrate/nitrite), ferric reducing antioxidant power (FRAP), superoxide dismutase (SOD) activity, and antioxidant capacity, measured pre- and post-TT.

RESULTS

NO metabolites were significantly elevated post-supplementation (p = 0.03); however, no significant interaction effects were observed for NO metabolites, FRAP, SOD, or antioxidant capacity across the groups (p > 0.05). Post-hoc analyses revealed that QCT significantly reduced FRAP concentrations compared to PL (p = 0.01), while no significant changes in SOD or antioxidant capacity were found across any groups.

CONCLUSIONS

These findings suggest that combined and independent QCT and CIT supplementation did not significantly improve these biomarkers, suggesting that baseline training adaptations, supplementation timing, and individual variability may influence the efficacy of these compounds in enhancing exercise performance and oxidative stress markers. The ergogenic efficacy of QCT + CIT on antioxidant-related markers remains inconclusive.

The effect of quercetin and citrulline on cycling time trial performance

BACKGROUND

There is growing interest in the use of nutrition and dietary supplements to optimize training and time-trial (TT) performance in cyclists. Separately, quercetin (QCT) and citrulline (CIT) have been used as ergogenic aids to improve oxygen (VO2) kinetics, perceived effort, and cycling TT performance. However, whether the combination of QCT and CIT can provide additive benefits and further enhance cycling performance production is currently unknown.

METHODS

We examined 28-days of QCT + CIT supplementation on TT performance and several performance measures (i.e. mean power, VO2, respiratory exchange ratio (RER), and rate of perceived exertion (RPE)). Forty-eight highly trained cyclists were assigned to one of four supplementation groups: (1) QCT + CIT (QCT: 500 mg, CIT: 3000 g), (2) QCT (500 mg), (3) CIT (3000 mg), or (4) placebo (3500 mg of a zero-calorie flavored crystal light package). Supplements were consumed two times per day for 28 consecutive days. Participants performed a 20-km cycling time-trial race, pre- and post-supplementation to determine the impact of the combined effects of QCT + CIT.

RESULTS

There were no potential benefits of QCT +CIT supplementation on TT performance and several performance measures. However, there was an improvement in VO2 from pre-to-post-supplementation in QCT (p  = 0.05) and CIT (p  = 0.04) groups, but not in the QCT+CIT and PL groups.

CONCLUSIONS

QCT + CIT does not seem beneficial for 20-km TT performance; further exploration with a focus on an increase in cycling duration or QCT+CIT combined with additional polyphenols may amplify any perceived bioactive or metabolic effects on cycling performance. The efficacy of QCT + CIT supplementation to improve cycling performance remains ambiguous.

Immune consequences of exercise in hypoxia: A narrative review

Immune outcomes are key mediators of many health benefits of exercise and are determined by exercise type, dose (frequency/duration, intensity), and individual characteristics. Similarly, reduced availability of ambient oxygen (hypoxia) modulates immune functions depending on the hypoxic dose and the individual capacity to respond to hypoxia. How combined exercise and hypoxia (e.g., high-altitude training) sculpts immune responses is not well understood, although such combinations are becoming increasingly popular. Therefore, in this paper, we summarize the impact on immune responses of exercise and of hypoxia, both independently and together, with a focus on specialized cells in the innate and adaptive immune system. We review the regulation of the immune system by tissue oxygen levels and the overlapping and distinct immune responses related to exercise and hypoxia, then we discuss how they may be modulated by nutritional strategies. Mitochondrial, antioxidant, and anti-inflammatory mechanisms underlie many of the adaptations that can lead to improved cellular metabolism, resilience, and overall immune functions by regulating the survival, differentiation, activation, and migration of immune cells. This review shows that exercise and hypoxia can impair or complement/synergize with each other while regulating immune system functions. Appropriate acclimatization, training, and nutritional strategies can be used to avoid risks and tap into the synergistic potentials of the poorly studied immune consequences of exercising in a hypoxic state.

High or hot-Perspectives on altitude camps and heat-acclimation training as preparation for prolonged stage races

Adaptation to heat stress and hypoxia are relevant for athletes participating in Tour de France or similar cycling races taking place during the summertime in landscapes with varying altitude. Both to minimize detrimental performance effects associated with arterial desaturation occurring at moderate altitudes in elite athletes, respectively, reduce the risk of hyperthermia on hot days, but also as a pre-competition acclimatization strategy to boost blood volume in already highly adapted athletes. The hematological adaptations require weeks of exposure to manifest, but are attractive as an augmented hemoglobin mass may improve arterial oxygen delivery and hence benefit prolonged performances. Altitude training camps have in this context a long history in exercise physiology and are still common practice in elite cycling. However, heat-acclimation training provides an attractive alternative for some athletes either as a stand-alone approach or in combination with altitude. The present paper provides an update and practical perspectives on the potential to utilize hypoxia and heat exposure to optimize hematological adaptations. Furthermore, we will consider temporal aspects both in terms of onset and decay of the adaptations relevant for improved thermoregulatory capacity and respiratory adaptations to abate arterial desaturation during altitude exposure. From focus on involved physiological mechanisms, time course, and responsiveness in elite athletes, we will provide guidance based on our experience from practical implementation in cyclists preparing for prolonged stage races such as the Tour de France.

Effect of a four-week isocaloric ketogenic diet on physical performance at very high-altitude: a pilot study

BACKGROUND

A ketogenic diet (KD) reduces daily carbohydrates (CHOs) ingestion by replacing most calories with fat. KD is of increasing interest among athletes because it may increase their maximal oxygen uptake (VO2max), the principal performance limitation at high-altitudes (1500-3500 m). We examined the tolerance of a 4-week isocaloric KD (ICKD) under simulated hypoxia and the possibility of evaluating ICKD performance benefits with a maximal graded exercise bike test under hypoxia and collected data on the effect of the diet on performance markers and arterial blood gases.

METHODS

In a randomised single-blind cross-over model, 6 recreational mountaineers (age 24-44 years) completed a 4-week ICKD followed or preceded by a 4-week usual mixed Western-style diet (UD). Performance parameters (VO2max, lactate threshold [LT], peak power [Ppeak]) and arterial blood gases (PaO2, PaCO2, pH, HCO3-) were measured at baseline under two conditions (normoxia and hypoxia) as well as after a 4-week UD and 4-week ICKD under the hypoxic condition.

RESULTS

We analysed data for all 6 participants (BMI 19.9-24.6 kg m-2). Mean VO2max in the normoxic condition was 44.6 ml kg-1 min-1. Hypoxia led to decreased performance in all participants. With the ICKD diet, median values for PaO2 decreased by - 14.5% and VO2max by + 7.3% and Ppeak by + 4.7%.

CONCLUSION

All participants except one could complete the ICKD. VO2max improved with the ICKD under the hypoxia condition. Therefore, an ICKD is an interesting alternative to CHOs dependency for endurance performance at high-altitudes, including high-altitude training and high-altitude races. Nevertheless, decreased PaO2 with ICKD remains a significant limitation in very-high to extreme altitudes (> 3500 m). Trial registration Clinical trial registration Nr. NCT05603689 (Clinicaltrials.gov). Ethics approval CER-VD, trial Nr. 2020-00427, registered 18.08.2020-prospectively registered.

Nutrition and Hydration for High-Altitude Alpinism: A Narrative Review

This report aims to summarise the scientific knowledge around hydration, nutrition, and metabolism at high altitudes and to transfer it into the practical context of extreme altitude alpinism, which, as far as we know, has never been considered before in the literature. Maintaining energy balance during alpine expeditions is difficult for several reasons and requires a deep understanding of human physiology and the biological basis for altitude acclimation. However, in these harsh conditions it is difficult to reconcile our current scientific knowledge in sports nutrition or even for mountaineering to high-altitude alpinism: extreme hypoxia, cold, and the logistical difficulties intrinsic to these kinds of expeditions are not considered in the current literature. Requirements for the different stages of an expedition vary dramatically with increasing altitude, so recommendations must differentiate whether the alpinist is at base camp, at high-altitude camps, or attempting the summit. This paper highlights nutritional recommendations regarding prioritising carbohydrates as a source of energy and trying to maintain a protein balance with a practical contextualisation in the extreme altitude environment in the different stages of an alpine expedition. More research is needed regarding specific macro and micronutrient requirements as well as the adequacy of nutritional supplementations at high altitudes.

Vitamin D deficiency in athletes: Laboratory, clinical and field integration

Vitamin D deficiency is highly prevalent in athletes. Increased utilisation and storage depletion may be key contributing factor. We found a higher prevalence of vitamin D inadequacy (deficiency/ insufficiency) in power than endurance sport athletes, which may be related to vitamin D utilisation and reserve in skeletal muscles.

How Do Avalanche Dogs (and Their Handlers) Cope with Physical Exercise? Heart Rate Changes during Endurance in a Snowy Environment

Simple Summary

Search and rescue (SAR) dogs are irreplaceable support in natural disasters. Not only are these animals required to have optimal scenting capabilities, but they are also required to have excellent physical conditions. Implementing protocols to monitor their fitness would help to optimize their performance and welfare. This study evaluated heart rate (HR) changes in avalanche SAR dogs and handlers during a 5.5 km endurance exercise in the snow, at an altitude of approximately 2000 m.a.s.l., reflecting their usual working and workload conditions. Dogs’ and handlers’ HR and activities were monitored by a global positioning satellite (GPS)/HR system. Factors influencing dogs’ and handlers’ HR changes and their possible correlation were investigated. As expected, the dog’s HR changes during the endurance activity were affected by speed, gradient, altitude, and time. The handlers’ HR changes differed and were not correlated with those recorded in the dogs. Thus, SAR handlers may not perceive the physical stress of their dog in real-time. Findings indicate that GPS/HR monitoring systems could be utilized in field conditions for monitoring SAR units’ physical fitness. A “fitness index” could be developed by incorporating HR and velocity measurements in order to target training strategies and indicate risk factors for physical distress in working dogs.

Abstract

This study aimed to assess the heart rate (HR) responses of avalanche SAR dogs and handlers under working field conditions. Thirteen SAR units (dogs and handlers) performed an exercise (Endurance) consisting of approximately 5.5 km of rough tracks through deep snow, at an altitude of 1991–2250 m.a.s.l. The exercise was repeated twice for each of the two different tracks. Both handlers and dogs were equipped with a global positioning satellite/heart rate (GPS/HR) system (Polar^®). Multivariable models were used to evaluate the effects of environmental (i.e., gradient, altitude, track, and time) and intrinsic (i.e., speed, repetition, and breed) factors on changes from baseline HR (Δ%HR). The dog’s Δ%HR was greater in the flat and uphill compared with downhill, and increased progressively as the speed increased (p < 0.001). Moreover, it rose at altitudes above 2100 m.a.s.l. and peaked after 30 min of the Endurance activity (p < 0.01). These findings indicated that HR monitors could be a valuable tool to contribute to the evaluation of avalanche dogs’ fitness in their real working environment. In contrast, the lack of correlation between the dogs’ and handlers’ HR changes suggests that handlers might not perceive the physical conditions of their dog in real-time. Thus, implementing protocols to monitor avalanche SAR dogs’ fitness using a GPS/HR monitoring system could help handlers to tailor the training and workload and to detect the risk factors for physical distress of working dogs.

Effects of Short-Term Phosphate Loading on Aerobic Capacity under Acute Hypoxia in Cyclists: A Randomized, Placebo-Controlled, Crossover Study

The aim of this study was to evaluate the effects of sodium phosphate (SP) supplementation on aerobic capacity in hypoxia. Twenty-four trained male cyclists received SP (50 mg·kg-1 of FFM/day) or placebo for six days in a randomized, crossover study, with a three-week washout period between supplementation phases. Before and after each supplementation phase, the subjects performed an incremental exercise test to exhaustion in hypoxia (FiO2 = 16%). Additionally, the levels of 2,3-diphosphoglycerate (2,3-DPG), hypoxia-inducible factor 1 alpha (HIF-1α), inorganic phosphate (Pi), calcium (Ca), parathyroid hormone (PTH) and acid-base balance were determined. The results showed that phosphate loading significantly increased the Pi level by 9.0%, whereas 2,3-DPG levels, hemoglobin oxygen affinity, buffering capacity and myocardial efficiency remained unchanged. The aerobic capacity in hypoxia was not improved following SP. Additionally, our data revealed high inter-individual variability in response to SP. Therefore, the participants were grouped as Responders and Non-Responders. In the Responders, a significant increase in aerobic performance in the range of 3-5% was observed. In conclusion, SP supplementation is not an ergogenic aid for aerobic capacity in hypoxia. However, in certain individuals, some benefits can be expected, but mainly in athletes with less training-induced central and/or peripheral adaptation.

Nutrition in Cycling

Cycling is predominantly an endurance sport in which fuel utilization for energy production relies on the availability and delivery of oxygen to exercising muscle. Nutrition and training interventions to improve endurance performance are continually evolving, but ultimately, prescription should aim to generate improvements in cycling power and velocity while prioritizing athlete health and well-being. The wide range of cycling events and the different environments in which events take place pose a variety of nutrition-related challenges for cyclists. This review addresses some of these challenges and highlights recent advancements in nutrition for cycling performance.

Diet and redox state in maintaining skeletal muscle health and performance at high altitude

High altitude exposure leads to compromised physical performance with considerable weight loss. The major stressor at high altitude is hypobaric hypoxia which leads to disturbance in redox homeostasis. Oxidative stress is a well-known trigger for many high altitude illnesses and regulates several key signaling pathways under stressful conditions. Altered redox homeostasis is considered the prime culprit of high altitude linked skeletal muscle atrophy. Hypobaric hypoxia disturbs redox homeostasis through increased RONS production and compromised antioxidant system. Increased RONS disturbs the cellular homeostasis via multiple ways such as inflammation generation, altered protein anabolic pathways, redox remodeling of RyR1 that contributed to dysregulated calcium homeostasis, enhanced protein degradation pathways via activation calcium-regulated protein, calpain, and apoptosis. Ultimately, all the cellular signaling pathways aggregately result in skeletal muscle atrophy. Dietary supplementation of phytochemicals could become a safe and effective intervention to ameliorate skeletal muscle atrophy and enhance the physical performance of the personnel who are staying at high altitude regions. The present evidence-based review explores few dietary supplementations which regulate several signaling mechanisms and ameliorate hypobaric hypoxia induced muscle atrophy and enhances physical performance. However, a clinical research trial is required to establish proof-of-concept.

The influence of carbohydrate ingestion on peripheral and central fatigue during exercise in hypoxia: A narrative review

Hypoxia impairs aerobic performance by accelerating fatiguing processes. These processes may originate from sites either distal (peripheral) or proximal (central) to the neuromuscular junction, though these are not mutually exclusive. Peripheral mechanisms include decrements in muscle glycogen or fluctuations in intramuscular metabolites, whereas central responses commonly refer to reductions in central motor drive elicited by alterations in blood glucose and neurotransmitter concentrations as well as arterial hypoxemia. Hypoxia may accelerate both peripheral and central pathways of fatigue, with the level of hypoxia strongly dictating the degree and primary locus of impairment. As more people journey to hypoxic settings for work and recreation, developing strategies to improve work capacity in these environments becomes increasingly relevant. Given that sea level performance improves with nutritional interventions such as carbohydrate (CHO) ingestion, a similar strategy may prove effective in delaying fatigue in hypoxia, particularly considering how the metabolic pathways enhanced with CHO supplementation overlap the fatiguing pathways upregulated in hypoxia. Many questions regarding the relationship between CHO, hypoxia, and fatigue remain unanswered, including specifics on when to ingest, what to ingest, and how varying altitudes influence supplementation effectiveness. Therefore, the purpose of this narrative review is to examine the peripheral and central mechanisms contributing to fatigue during aerobic exercise at varying degrees of hypoxia and to assess the role of CHO ingestion in attenuating fatigue onset.

Der Eisenstoffwechsel und seine Bedeutung für das Höhentraining

Ein Eisenmangel und eine katabole Stoffwechsellage behindern die Zunahme des Gesamthämoglobins und damit einen Anstieg der Sauerstofftransportkapazität, sodass die Wirksamkeit des Höhentrainings herabgesetzt ist. Die Eisenhomöostase wird sehr fein durch das hepatische Hormon Hepcidin (HEPC) kontrolliert, welches die Eisenaufnahmefähigkeit der Darmzellen über ein spezielles Protein, dem Ferroportin, kontrolliert. Unter Hypoxie stimuliert das Protein HIF-1 α die Freisetzung des Erythropoitins (EPO). Unzureichende Eisenspeicher und/oder eine Vitamin-B12-Unterversorgung bei Athleten, besonders bei jungen Frauen, sind Wochen vor einem Höhentraining durch eine orale Eisen- und/oder Vitamin-B12-Substitution unter ärztlicher Kontrolle, aufzufüllen. Voraussetzung für eine leistungsfördernde Wirkung des Höhentrainings ist ein mehrmaliger Aufenthalt in mittleren Höhen von 1700 m bis 3000 m. Als Aufenthaltsdauer werden 350 h bis 500 h oder zwei bis drei Wochen empfohlen. Mangelnde Eisenverfügbarkeit und ein Energiedefizit können die Wirksamkeit des Höhentrainings negativ beeinflussen. Liegt aus medizinischer Sicht eine Eisenunterversorgung vor, dann wird zu einer oralen Supplementation vor und während des Höhentrainings geraten. Bei normaler Eisenverfügbarkeit führt die gesteigerte Hämatopoese durch EPO zur Zunahme des Gesamthämoglobins. Die Wirkung des hypoxieinduzierten Hämoglobinanstiegs ist nach dem Höhentraining auf drei bis vier Wochen begrenzt.

Feeding Your Himalayan Expedition: Nutritional Signatures and Body Composition Adaptations of Trekkers and Porters

High-altitude exposure leads to many physiological challenges, such as weight loss and dehydration. However, little attention has been posed to the role of nutrition and ethnic differences. Aiming to fulfill this gap, five Italian trekkers and seven Nepalese porters, all males, recorded their diet in diaries during a Himalayan expedition (19 days), and the average daily intake of micro and macro-nutrients were calculated. Bioimpedance analysis was performed five times during the trek; muscle ultrasound was performed before and after the expedition, only for the Italians. The Nepalese group consumed a lot of rice and only Italians consumed cheese. Water intake was slightly over 3000 g/d for both groups. Nepalese diet had a higher density of dietary fibre and lower density of riboflavin, vitamins A, K, and B12. Intake of calcium was lower than recommended levels. Body mass index, waist circumference, fat-free mass, and total body water decreased in both groups, whereas resistance (Rz) increased. Italians reactance (Xc) increased at day 9, whereas that of Nepalese occurred at days 5, 9, and 16. The cross-sectional area of the Vastus lateralis was reduced after the expedition. Specific nutritional and food-related risk factors guidance is needed for diverse expedition groups. Loss of muscle mass and balance of fluids both deserve a particular focus as concerns altitude expeditions.

Dietary Adjustments to Altitude Training in Elite Endurance Athletes; Impact of a Randomized Clinical Trial With Antioxidant-Rich Foods

Background: Altitude training stresses several physiological and metabolic processes and alters the dietary needs of the athletes. International Olympic Committee (IOC)'s Nutrition Expert Group suggests that athletes should increase intake of energy, carbohydrate, iron, fluid, and antioxidant-rich foods while training at altitude. Objective: We investigated whether athletes adjust their dietary intake according to the IOC's altitude-specific dietary recommendations, and whether an in-between meal intervention with antioxidant-rich foods altered the athletes' dietary composition and nutrition-related blood parameters (mineral, vitamin, carotenoid, and hormone concentrations). Design: The dietary adjustments to altitude training (3 weeks at 2,320 m) were determined for 31 elite endurance athletes (23 ± 5 years, 23 males, 8 females) by six interviewer-administered 24-h dietary recalls on non-consecutive days; three before and during the altitude camp. The additional effect of in -between meal intervention with eucaloric antioxidant-rich or control snacks (1,000 kcal/day) was tested in a randomized controlled trial with parallel design. Results: At altitude the athletes increased their energy intake by 35% (1,430 ± 630 kcal/day, p < 0.001), the provided snacks accounting for 70% of this increase. Carbohydrate intake increased from 6.5 ± 1.8 g/kg body weight (BW) (50 E%) to 9.3 ± 2.1 g/kg BW (53 E%) (p < 0.001), with no difference between the antioxidant and control group. Dietary iron, fluid, and antioxidant-rich food intake increased by 37, 38, and 104%, respectively, in the whole cohort. The intervention group had larger increases in polyunsaturated fatty acids (PUFA), ω3 PUFA (n-3 fatty acids), ω6 PUFA (n-6 fatty acids), fiber, vitamin C, folic acid, and copper intake, while protein intake increased more among the controls, reflecting the nutritional content of the snacks. Changes in the measured blood minerals, vitamins, and hormones were not differentially affected by the intervention except for the carotenoid; zeaxanthin, which increased more in the intervention group (p < 0.001). Conclusions: Experienced elite endurance athletes increased their daily energy, carbohydrate, iron, fluid, and antioxidant-rich food intake during a 3-week training camp at moderate altitude meeting most of the altitude-specific dietary recommendations. The intervention with antioxidant-rich snacks improved the composition of the athletes' diets but had minimal impact on the measured nutrition-related blood parameters. Clinical Trial Registry Number: NCT03088891 (www.clinicaltrials.gov), Norwegian registry number: 626539 (https://rekportalen.no/).

Effects of Sprint Interval Training at Different Altitudes on Cycling Performance at Sea-Level

BACKGROUND

Benefits of sprint interval training performed in hypoxia (SIH) compared to normoxia (SIN) have been assessed by studies mostly conducted around 3000 m of simulated altitude. The present study aims to determine whether SIH at an altitude as high as 4000 m can elicit greater adaptations than the same training at 2000 m, 3000 m or sea-level.

METHODS

Thirty well-trained endurance male athletes (18-35 years old) participated in a six-week repeated sprint interval training program (30 s all-out sprint, 4 min 30 s recovery; 4-9 repetitions, 2 sessions/week) at sea-level (SL, n = 8), 2000 m (FiO2 16.7%, n = 8), 3000 m (FiO2 14.5%, n = 7) or 4000 m (FiO2 13.0%, n = 7). Aerobic and anaerobic exercise components were evaluated by an incremental exercise test, a 600 kJ time trial and a Wingate test before and after the training program.

RESULTS

After training, peak power output (PPO) during the incremental exercise test increased (~6%) without differences between groups. The lactate threshold assessed by Dmax increased at 2000 m (+14 ± 12 W) and 4000 m (+12 ± 11 W) but did not change at SL and 3000 m. Mean power during the Wingate test increased at SL, 2000 m and 4000 m, although peak power increased only at 4000 m (+38 ± 38 W).

CONCLUSIONS

The present study indicates that SIH using 30 s sprints is as efficient as SIN for improving aerobic and anaerobic qualities. Additional benefits such as lactate-related adaptations were found only in SIH and Wingate peak power only increased at 4000 m. This finding is of particular interest for disciplines requiring high power output, such as in very explosive sports.

Antioxidants and Exercise Performance: With a Focus on Vitamin E and C Supplementation

Antioxidant supplementation, including vitamin E and C supplementation, has recently received recognition among athletes as a possible method for enhancing athletic performance. Increased oxidative stress during exercise results in the production of free radicals, which leads to muscle damage, fatigue, and impaired performance. Despite their negative effects on performance, free radicals may act as signaling molecules enhancing protection against greater physical stress. Current evidence suggests that antioxidant supplementation may impair these adaptations. Apart from athletes training at altitude and those looking for an immediate, short-term performance enhancement, supplementation with vitamin E does not appear to be beneficial. Moreover, the effectiveness of vitamin E and C alone and/or combined on muscle mass and strength have been inconsistent. Given that antioxidant supplements (e.g., vitamin E and C) tend to block anabolic signaling pathways, and thus, impair adaptations to resistance training, special caution should be taken with these supplements. It is recommended that athletes consume a diet rich in fruits and vegetables, which provides vitamins, minerals phytochemicals, and other bioactive compounds to meet the recommended intakes of vitamin E and C.

Nutrition and Altitude: Strategies to Enhance Adaptation, Improve Performance and Maintain Health: A Narrative Review

Training at low to moderate altitudes (~ 1600-2400 m) is a common approach used by endurance athletes to provide a distinctive environmental stressor to augment training stimulus in the anticipation of increasing subsequent altitude- and sea-level-based performance. Despite some scientific progress being made on the impact of various nutrition-related changes in physiology and associated interventions at mountaineering altitudes (> 3000 m), the impact of nutrition and/or supplements on further optimization of these hypoxic adaptations at low-moderate altitudes is only an emerging topic. Within this narrative review we have highlighted six major themes involving nutrition: altered energy availability, iron, carbohydrate, hydration, antioxidant requirements and various performance supplements. Of these issues, emerging data suggest that particular attention be given to the potential risk for poor energy availability and increased iron requirements at the altitudes typical of elite athlete training (~ 1600-2400 m) to interfere with optimal adaptations. Furthermore, the safest way to address the possible increase in oxidative stress associated with altitude exposure is via the consumption of antioxidant-rich foods rather than high-dose antioxidant supplements. Meanwhile, many other important questions regarding nutrition and altitude training remain to be answered. At the elite level of sport where the differences between winning and losing are incredibly small, the strategic use of nutritional interventions to enhance the adaptations to altitude training provides an important consideration in the search for optimal performance.

The effect of intermittent hypoxic exposure on erythropoietic response and hematological variables in elite athletes

This study aimed to evaluate the changes in the erythropoietin level and hematological variables in wrestlers after intermittent hypoxic exposure (IHE). Twelve wrestlers were assigned into two groups: hypoxia (sports training combined with IHE, n=6) and control (sports training, n=6). An IHE was performed for 10 days, with one day off after 6 days, once a day for about an hour. The concentrations of hydrogen peroxide ( H(2)O(2) ), nitric oxide (NO), vascular endothelial growth factor (VEGF) and erythropoietin (EPO), as well as total creatine kinase activity (CK) were measured. Also, the hematological markers (Hb - hemoglobin, Ht - hematocrit, RBC - red blood cell, WBC - white blood cell, Ret - reticulocytes) were analyzed. The 6-day IHE caused an increase in the levels of H(2)O(2), NO and VEGF. Similarly, the EPO level and WBC count reached the highest value after 6 days of IHE. The total Ret number increase constantly during 10 days of IHE. The hypoxia group showed a higher CK activity compared to the control. In conclusion, 10-day IHE in combination with wrestling training elevates levels of H(2)O(2), NO and VEGF, and improves the oxygen transport capacity by the release of EPO and Ret in circulation.

Liver-Metabolizing Genes and Their Relationship to the Performance of Elite Spanish Male Endurance Athletes; a Prospective Transversal Study

Background

The genetic profile that is needed to define an endurance athlete has been studied during recent years. The main objective of this work is to approach for the first time the study of genetic variants in liver-metabolizing genes and their role in endurance performance by comparing the allelic and genotypic frequencies in elite endurance athletes to the non-athlete population.

Methods

Genotypic and allelic frequencies were determined in 123 elite endurance athletes (75 professional road cyclists and 48 endurance elite runners) and 122 male non-athlete subjects (sedentary). Genotyping of cytochrome P450 family 2 subfamily D member 6 (CYP2D6 rs3892097), glutathione-S transferase mu isoform 1 (GSTM1), glutathione S-transferase pi (GSTP rs1695) and glutathione S-transferase theta (GSTT) genes was performed by polymerase chain reaction (PCR). The combination of the polymorphisms for the “optimal” polygenic profile has been quantified using the genotype score (GS).

Results

Statistical differences were found in the genetic distributions between elite endurance athletes and non-athletes in CYP2D6 (p < 0.001) and GSTT (p = 0.014) genes. The binary logistic regression model showed a favourable OR (odds ratio) of being an elite endurance runner against a professional road cyclist (OR: 2.403, 95% CI: 1.213–4.760 (p = 0.002)) in the polymorphisms studied.

Conclusions

Genotypic distribution of liver-metabolizing genes in elite endurance athletes is different to non-athlete subjects, with a favourable gene profile in elite endurance athletes in terms of detoxification capacity.

Changes in Triathletes' Performance and Body Composition During a Specific Training Period for a Half-Ironman Race

The number of recreational athletes completing a Half-Ironman triathlon has increased exponentially in recent years. However, there is a lack of research on how to train for this kind of an event. The purpose of this study was thus to analyse triathletes’ changes in performance and body composition following a triathlon-specific training period. Fourteen male amateur triathletes completed a 7-week period of general training and a 13-week period of specific training for a Half-Ironman triathlon. Anthropometric measures and performance tests were carried out to assess the effects of the specific training program. Results showed that the pre-test value of VO_2max for cycling was inversely correlated not only with the percentage of change in cycling performance, but also with the percentage change in several variables of running performance. In swimming, inverse correlations were observed between the time of the first 800 m test and the time percentage change for this test, but not with the percentage change in the performance of other segments of the race. Moreover, the somatotype component of endomorphy and the fat mass percentage of the first anthropometry were highly correlated with the percentage change in VO_2max in the run segment. These results highlight the importance of providing individualised training, considering that the same training program had a different impact on recreational triathletes belonging to the same group. Amateur athletes with higher initial performance levels probably need a greater amount of training to achieve improved adaptation.

Six Weeks of Calorie Restriction Improves Body Composition and Lipid Profile in Obese and Overweight Former Athletes

OBJECTIVE

The aim of the study was to compare the impact of 6 weeks of reducing daily caloric intake by 20% of total daily energy expenditure (TDEE)-CRI vs. reducing daily caloric intake by 30% of TDEE-CRII on body mass reduction and insulin metabolism in former athletes.

METHODS

94 males aged 35.7 ± 5.3 years, height 180.5 ± 4.1 cm, and body mass 96.82 ± 6.2 kg were randomly assigned to the CRI (n = 49) or CRII (n = 45) group. Thirty-one participants (18 subjects from CRI and 13 from CRII) resigned from the study. The effects of both diets on the body composition variables (body mass-BM; body fat-BF; fat free mass-FFM; muscle mass-MM; total body water-TBW), lipid profile (total lipids-TL; total cholesterol-TCh; HDL cholesterol-HDL; LDL cholesterol-LDL; triglycerides-TG), and glucose control variables (glucose-GL, insulin-I, HOMA-IR, insulin-like growth factor-1-IGF-1, leptin and adiponectin) were measured.

RESULTS

After adhering to the CR I diet, significant differences were observed in FFM, MM and TG. After adhering to the CR II diet, significant differences were registered in tCh, TL and LDL. Both diets had a significant influence on leptin and adiponectin concentrations. Significant differences in FFM, MM, and tCh were observed between the CR I and CR II groups. At the end of the dietary intervention, significant differences in BF, FFM, MM and TBW were observed between the CR I and CR II groups.

CONCLUSION

The 6 weeks of CR II diet appeared to be more effective in reducing BF and lipid profile and proved to be especially suitable for subjects with high body fat content and an elevated level of lipoproteins and cholesterol. Both reductive diets were effective in improving the levels of leptin and adiponectin in obese former athletes.

Entrenamiento de fuerza y resistencia en hipoxia: efecto en la hipertrofia muscular

El entrenamiento en altitud y el entrenamiento en hipoxia simulada producen adaptaciones fisiológicas y bioquímicas en el músculo esquelético como la capacidad oxidativa, así como modificaciones de la actividad mitocondrial, en el metabolismo aerobio y en el contenido de mioglobina.El propósito de esta revisión fue analizar las adaptaciones del músculo esquelético en respuesta a la exposición temporal a la hipoxia combinada con ejercicios de fuerza y resistencia. Según los hallazgos de numerosos autores, las adaptaciones estructurales del músculo son similares en la hipoxia y en la ‘normoxia’, con excepción de un aumento en el volumen muscular y en el área de la sección transversal de la fibra muscular, que son mayores en la hipoxia.En conclusión, la sinergia del entrenamiento de fuerza y resistencia y la hipoxia normobárica produce mejores y mayores adaptaciones, ganancias y cambios fisiológicos beneficiosos en el tejido muscular, lo cual genera cambios fenotípicos favorables, como la hipertrofia del músculo esquelético.

No Modification in Blood Lipoprotein Concentration but Changes in Body Composition after 4 Weeks of Low Carbohydrate Diet (LCD) Followed by 7 Days of Carbohydrate Loading in Basketball Players

Recently, low carbohydrate diets have become very popular due to their numerous health benefits. Unfortunately, little is known about their chronic effects on the blood lipid profile and other cardiovascular disease risk factors in athletic populations. We compared the results of a four week, well-planned low carbohydrate diet (LCD) followed by seven days of carbohydrate loading (Carbo-L) on fasting lipids - triacylglycerol's (TAG), LDL-C, HDL-C, total cholesterol (TCh), glucose, insulin and HOMA-IR levels in 11 competitive basketball players. During the experiment, we also measured body mass (BM) and body composition changes: body fat (BF), % of body fat (PBF), and fat free mass (FFM). Both diet procedures significantly changed the fasting serum concentration of TAG (p < 0.05) and body fat content (kg and %) (p < 0.05), without negative changes in FFM. The Carbo-L procedure increased (p < 0.05) fasting glucose levels significantly. A LCD may be suggested for athletes who want to reduce body mass and fat content without compromising muscle mass. Several weeks on a LCD does not change the lipoprotein - LDL-C and HDL-C level significantly, while a seven-day Carb-L procedure may increase body fat content and fasting glucose concentration. Such dietary procedures are recommended for team sport athletes to reduce fat mass, lipid profile disorders and insulin resistance.

Preparation for Endurance Competitions at Altitude: Physiological, Psychological, Dietary and Coaching Aspects. A Narrative Review

It was the Summer Olympic Games 1968 held in Mexico City (2,300 m) that required scientists and coaches to cope with the expected decline of performance in endurance athletes and to establish optimal preparation programs for competing at altitude. From that period until now many different recommendations for altitude acclimatization in advance of an altitude competition were proposed, ranging from several hours to several weeks. Those recommendations are mostly based on the separate consideration of the physiology of acclimatization, psychological issues, performance changes, logistical or individual aspects, but there is no review considering all these aspects in their entirety. Therefore, the present work primarily focusses on the period of altitude sojourn prior to the competition at altitude based on physiological and psychological aspects complemented by nutritional and sports practical considerations.

The Effects of Altitude Training on Erythropoietic Response and Hematological Variables in Adult Athletes: A Narrative Review

Background: One of the goals of altitude training is to increase blood oxygen-carrying capacity in order to improve sea-level endurance performance in athletes. The elevated erythropoietin (EPO) production in hypoxia is a key factor in the achievement of enhanced hematological variables. The level of the EPO increase and acceleration of erythropoiesis depend on the duration of exposure and degree of hypoxia. Furthermore, many other factors may affect the hematological response to altitude training.

Aim: The purpose of this narrative review was to: (1) analyze the kinetics of EPO and hematological variables during and after altitude training; (2) summarize the current state of knowledge about the possible causes of individual or cohort differences in EPO and hematological response to altitude training; (3) formulate practical guidelines for athletes to improve the efficiency of altitude training.

Methods: A narrative review was performed following an electronic search of the databases PubMed/MEDLINE and SPORTDiscus via EBSCO for all English-language articles published between 1997 and 2017.

Results: Complete unification of results from studies on EPO kinetics was difficult due to different time and frequency of blood sampling by different researchers during and after altitude training, but the data presented in the reviewed literature allowed us to detect certain trends. The results of the reviewed studies were divergent and indicated either increase or no change of hematological variables following altitude training. Factors that may affect the hematological response to altitude training include hypoxic dose, training content, training background of athletes, and/or individual variability of EPO production.

Conclusions: Despite the potential benefits arising from altitude training, its effectiveness in improving hematological variables is still debatable. Further research and better understanding of factors influencing the response to altitude, as well as factors affecting the suitable measurement and interpretation of study results, are needed.

Comparison of the effect of intermittent hypoxic training vs. the live high, train low strategy on aerobic capacity and sports performance in cyclists in normoxia

The aim of the study was to compare the effect of intermittent hypoxic training (IHT) and the live high, train low strategy on aerobic capacity and sports performance in off-road cyclists in normoxia. Thirty off-road cyclists were randomized to three groups and subjected to 4-week training routines. The participants from the first experimental group were exposed to normobaric hypoxia conditions (FiO₂ = 16.3%) at rest and during sleep (G-LH-TL; n=10; age: 20.5 ± 2.9 years; body height 1.81 ± 0.04 m; body mass: 69.6 ± 3.9 kg). Training in this group was performed under normoxic conditions. In the second experimental group, study participants followed an intermittent hypoxic training (IHT, three sessions per week, FiO2 = 16.3%) routine (G-IHT; n=10; age: 20.7 ± 3.1 years; body height 1.78 ± 0.05 m; body mass: 67.5 ± 5.6 kg). Exercise intensity was adjusted based on the lactate threshold (LT) load determined in hypoxia. The control group lived and trained under normoxic conditions (G-C; n=10; age: 21.8 ± 4.0 years; body height 1.78 ± 0.03 m; body mass: 68.1 ± 4.7 kg; body fat content: 8.4 ± 2.4%). The evaluations included two research series (S1, S2). Between S1 and S2, athletes from all groups followed a similar training programme for 4 weeks. In each research series a graded ergocycle test was performed in order to measure VO_2max and determine the LT and a simulated 30 km individual time trial. Significant (p<0.05) improvements in VO_2max, VO_2LT, WR_max and WR_LT were observed in the G-IHT (by 3.5%, 9.1%, 6.7% and 7.7% respectively) and G-LH-TL groups (by 4.8%, 6.7%, 5.9% and 4.8% respectively). Sports performance (TT) was also improved (p<0.01) in both groups by 3.6% in G-LH-TL and 2.5% in G-IHT. Significant changes (p<0.05) in serum EPO levels and haematological variables (increases in RBC, HGB, HCT and reticulocyte percentage) were observed only in G-LH-TL. Normobaric hypoxia has been demonstrated to be an effective ergogenic aid that can enhance the exercise capacity of cyclists in normoxia. Both LH-TL and IHT lead to improvements in aerobic capacity. The adaptations induced by both approaches are likely to be caused by different mechanisms. The evaluations included two research series (S1, S2). Between S1 and S2, athletes from all groups followed a similar training programme for 4 weeks. In each research series a graded ergocycle exercise test was performed in order to measure VO_2max and determine the lactate threshold as well as a simulated 30 km individual time trial.

Intermittent hypoxic training improves anaerobic performance in competitive swimmers when implemented into a direct competition mesocycle

The main objective of this research was to evaluate the efficacy of intermittent hypoxic training (IHT) on anaerobic and aerobic capacity and swimming performance in well-trained swimmers. Sixteen male swimmers were randomly divided into a hypoxia (H) group (n = 8), which trained in a normobaric hypoxia environment, and a control (C) group (n = 8), which exercised under normoxic conditions. However, one participant left the study without explanation. During the experiment group H trained on land twice per week in simulated hypoxia (FiO₂ = 15.5%, corresponding to 2,500 m a.s.l); however, they conducted swim training in normoxic conditions. Group C performed the same training program under normoxic conditions. The training program included four weekly microcyles, followed by three days of recovery. During practice sessions on land, the swimmers performed 30 second sprints on an arm-ergometer, alternating with two minute high intensity intervals on a lower limb cycle ergometer. The results showed that the training on land caused a significant (p<0.05) increase in absolute maximal workload (WR_max) by 7.4% in group H and by 3.2% in group C and relative values of VO_2max by 6.9% in group H and 3.7% in group C. However, absolute values of VO_2max were not significantly changed. Additionally, a significant (p<0.05) increase in mean power (P_mean) during the first (11.7%) and second (11.9%) Wingate tests was only observed in group H. The delta values of lactate concentration (ΔLA) after both Wingate tests were significantly (p<0.05) higher in comparison to baseline levels by 28.8% in group H. Opposite changes were observed in delta values of blood pH (ΔpH) after both Wingate tests in group H, with a significant decrease in values of ΔpH by 33.3%. The IHT caused a significant (p<0.05) improvement in 100m and 200m swimming performance, by 2.1% and 1.8%, respectively in group H. Training in normoxia (group C), resulted in a significant (p<0.05) improvement of swimming performance at 100m and 200m, by 1.1% and 0.8%, respectively. In conclusion, the most important finding of this study includes a significant improvement in anaerobic capacity and swimming performance after high-intensity IHT. However, this training protocol had no effect on absolute values of VO_2max and hematological variables.