Association Between Ferritin Levels and Altitude-Dependent Cardiorespiratory Fitness in Mountain Guides

Pühringer, Reinhard, Martina Muckenthaler, and Martin Burtscher. Association between ferritin levels and altitude-dependent cardiorespiratory fitness in mountain guides. High Alt Med Biol. 24:139-143, 2023. Background: Higher ferritin levels may be associated with lower cardiorespiratory fitness (CRF; i.e., maximal oxygen uptake, VO2max) and may represent early markers of cardiovascular risk but may also support high-altitude acclimatization. To evaluate these potential associations, data recordings from a large sample of male mountain guides have been analyzed. Methods: A total of 154 data sets (including anthropometric data, VO2max, blood lipids, hemoglobin, ferritin, and transferrin levels) of regularly physically active and well-acclimatized mountain guides were available for analyses. Participants performed equal incremental cycle ergometer tests to exhaustion at low (600 m) and (∼1 week later) at moderate altitude (2,000 m). Results: Ferritin levels were positively correlated with levels of hemoglobin (r = 0.29, p < 0.01), total cholesterol (r = 0.18, p < 0.05), triglycerides (r = 0.23, p < 0.01), and low-density lipoprotein (r = 0.22, p < 0.01), and negatively with high-density lipoprotein levels (r = -0.16, p < 0.05) and also with baseline (taken at low altitude) VO2max values (r = -0.19, p < 0.05). In contrast, higher ferritin levels were associated with less VO2max decline from low-to-moderate altitude (r = 0.26, p < 0.01). Conclusion: Higher ferritin levels in male mountain guides are weakly associated with lower CRF and higher prevalence of cardiovascular risk factors but with slightly less reduction in VO2max when acutely exposed to moderate altitude. The clinical relevance of these observations needs further investigation.

Does Moderate Altitude Affect VO2max in Acclimatized Mountain Guides?

Pühringer, Reinhard, Hannes Gatterer, Martin Berger, Michael Said, Martin Faulhaber, and Martin Burtscher. Does moderate altitude affect VO₂max in acclimatized mountain guides? High Alt Med Biol 00:000-000, 2021. Background: Altitude exposure reduces maximal oxygen uptake (VO₂max). Usually, the reduction is not restored with acclimatization (at least at altitudes above 2,500 m) and is more pronounced in highly trained athletes compared to nonathletes. It still remains to be elucidated whether these also apply for well-acclimatized individuals (i.e., mountain guides) acutely exposed to moderate altitude (i.e., 2,000 m). Methods: A total of 128 acclimatized male mountain guides of the Austrian armed forces (42.2 ± 7.0 years, 177.8 ± 5.6 cm, 77.2 ± 7.0 kg) of different fitness levels performed 2 incremental cycle ergometer tests 1 week apart, one at low (600 m) and one at moderate altitude (2,000 m). Oxygen uptake, heart rate (HR), and lactate concentration were measured during the tests. Results: In acclimatized mountain guides, lower baseline VO₂max levels were associated with better preservation of VO₂max at moderate altitude compared to higher levels. At moderate altitude, physiological responses (HR and blood lactate at 100 W) at a submaximal exercise intensity of 100 W remained unchanged or were even slightly reduced in both groups. Conclusions: Long-term acclimatization to moderate altitude may prevent the VO₂max decline at a moderate altitude of 2,000 m particularly in subjects with lower VO₂max levels, that is, below the 80th percentile (for age and sex). In people with higher fitness levels, VO₂max may still be negatively affected. These results are of practical relevance, for example, for workers, athletes, ski and mountain guides, military staff, or rescue staff who regularly or continuously have to perform at moderate altitude.

Intermittent hypoxia increases exercise tolerance in elderly men with and without coronary artery disease

BACKGROUND

Intermittent hypoxia has been suggested to increase exercise tolerance by enhancing stress resistance and improving oxygen delivery. Because the improvement of exercise tolerance reduces mortality in the elderly with and without coronary artery disease intermittent hypoxia might be a valuable preventive and therapeutic tool. However, controlled studies are lacking.

METHODS AND RESULTS

Sixteen males (50-70 years, 8 with and 8 without prior myocardial infarction) were randomly assigned in a double-blind fashion to receive 15 sessions of passive intermittent hypoxia (hypoxia group) or normoxia (control group) within 3 weeks. For the hypoxia group each session consisted of three to five hypoxic (14-10% oxygen) periods (3-5 min) with 3-min normoxic intervals. Controls inhaled only normoxic air in the same way. Exercise tests were performed before and after the 3-week breathing program. After 3 weeks of intermittent hypoxia peak oxygen consumption had increased compared to normoxic conditions (+ 6.2% vs.-3%, p < 0.001). This improvement was closely related to the enhanced arterial oxygen content after hypoxia (r = 0.9, p < 0.001). Both higher haemoglobin concentration and less arterial oxygen desaturation during exercise contributed to the increase in arterial oxygen content. During sub-maximal exercise (cycling at 1 W/kg) heart rate, systolic blood pressure, blood lactate concentration, and the rating of perceived exertion were diminished after intermittent hypoxia compared to control conditions (all p < 0.05). Changes in responses to exercise after intermittent hypoxia were similar in subjects with and without prior myocardial infarction.

CONCLUSIONS

Three weeks of passive short-term intermittent hypoxic exposures increased aerobic capacity and exercise tolerance in elderly men with and without coronary artery disease.

Effects of aspirin during exercise on the incidence of high-altitude headache: a randomized, double-blind, placebo-controlled trial

OBJECTIVE

To evaluate the efficacy of aspirin for headache when exercising during acute high-altitude exposure.

BACKGROUND

Aspirin effectively prevents headache when mostly resting during acute high-altitude exposure. However, the majority of individuals exposed to high altitude perform mountaineering activities, which might trigger headache.

DESIGN

Randomized, double-blind, placebo-controlled trial.

METHODS

Thirty-one healthy volunteers (20 men, 11 women; aged 22 to 59 years) were transported to an altitude of about 3000 meters and climbed up to 3800 meters. They then descended to a mountain hut at 3480 meters and spent 2 nights there. Tablets (placebo or 320 mg aspirin) were administered three times at 4-hour intervals, beginning 2 hours before arrival at high altitude. Headache scoring and measurements of heart rate, blood pressure, and arterial oxygen saturation were performed.

RESULTS

Ninety-three percent (14 of 15) of the placebo group and 56% (9 of 16) of the aspirin group developed headache when mountaineering activities were performed during acute exposure to high altitude (P<.05). Five hours after arrival at high altitude, mean resting oxygen saturation was 86.1% +/- 2.1% with aspirin and 85.7 % +/- 2.8% with placebo (P =.66). However, subjects in the aspirin group developed headache at saturation values less than or equal to 86%, while those in the placebo group developed headache at saturation values less than 90%.

CONCLUSIONS

Although the prophylactic intake of about 1 gram of aspirin reduced the headache incidence when exercising during acute high-altitude exposure, the incidence of headache was higher than previously shown for resting conditions. Aspirin resulted in tolerance to lower arterial oxygen saturation without development of headache; exercise had the opposite effect.