Exercise-induced hypoxaemia in highly trained athletes

Traditionally, the pulmonary system has not been considered the limiting factor in determining maximal oxygen uptake (VO2max) in healthy individuals since arterial oxygen-haemoglobin saturation is thought to remain high during intense exercise. However, there appears to be a major exception to this rule. Recent evidence suggests that arterial hypoxaemia results during heavy exercise in well trained individuals with a high VO2max. Further, the degree of arterial desaturation is inversely related to VO2max. This exercise-induced hypoxaemia does not appear to be due to hypoventilation although athletes who have limited hyperventilation seem to exhibit the lowest arterial oxygen-haemoglobin saturation. A significant venoarterial shunt has been ruled out as a primary cause of the hypoxaemia based on both experimental and theoretical considerations. Therefore, it appears that the exercise-induced hypoxaemia seen in highly trained athletes during heavy exercise is primarily due to diffusion limitations and ventillation-perfusion inequality. It is postulated that incomplete diffusion in the healthy lung may be due to a rapid red blood cell transit time through the pulmonary capillary. In summary, recent findings suggest that the limits of the human pulmonary system may be reached or even exceeded during intense exercise in some individuals. In light of these findings the role of the pulmonary system as a limiting factor during maximal exercise in the highly trained endurance athlete warrants further investigation.     

Ventilatory threshold in various groups of highly trained athletes

The ventilatory threshold (VT) was determined on a treadmill in highly trained male marathon, male and female long-distance, young male long-distance, adult male and female and young female middle-distance runners, modern pentathlonists, adult canoeists of both sexes, young male canoeists and football players, and on a bicycle ergometer in table tennis players, water slalom paddlers, young female canoeists rowers, and ice hockey players. Young female canoeists were also examined on the paddling ergometer and rowers on the rowing ergometer. VT expressed in %VO2 max was higher the longer the duration of racing performance (in marathoners 86.7%). %VO2 max at the VT level depends on the type of load and is higher the better the organism is adapted to a load. In young female canoeists and rowers examined on the bicycle ergometer, we found the VT level at 74.2% and 74.6% of %VO2 max, respectively. In the case of specific loading, we recorded 84.8% and 85.0% of %VO2 max, respectively, in the same athletes. In the case of nonspecific loading highly trained individuals may have low VT values close to the level characteristic for normal subjects. In relatively equally trained young and adult athletes we did not find significant differences in %VO2 max at the VT level (for long-distance runners, 85.2% and 85.3%, respectively, in female middle-distance runners, 82.8% and 82.7%, respectively, and in canoeists 81.3% and 78.9% of %VO2 max, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Hemoglobin desaturation in highly trained athletes during heavy exercise

It has been generally accepted that during exercise at sea level, the pulmonary system of normal, healthy individuals is capable of maintaining arterial oxygen tension at near resting levels. However, recent evidence questions whether this generalization applies to the highly trained endurance athlete who is capable of achieving very high levels of metabolic demand. Hence, the purpose of these experiments was to examine the relationship between maximal oxygen consumption (VO2max) and arterial oxygen-hemoglobin saturation (%SaO2) during short-term heavy exercise in trained athletes and untrained individuals. Ten trained distance runners and 7 untrained males exercised at 95% of VO2max for 3 min. Minute-by-minute measurement of %SaO2 was obtained via ear oximetry. The correlation coefficients between %SaO2 and VO2max during exercise were r = -0.68, r = -0.74, and r = -0.72 (P less than 0.05) for minutes 1 through 3, respectively. In general those individuals with the highest VO2max showed the greatest decrease in %SaO2. By comparison there was no difference (P greater than 0.05) in resting %SaO2 between the trained (96.3 +/- 0.2% [SE]) and the untrained (96.3 +/- 0.4%) subjects. However, at minute 3 of exercise, %SaO2 was significantly lower (P less than 0.05) in the trained subjects (87.0 +/- 0.7%) than in the untrained subjects (92.6 +/- 0.7%). These data demonstrate that arterial desaturation occurs in healthy, highly trained endurance athletes during heavy exercise and that the level of the arterial desaturation is inversely related to VO2max.     

Electrocardiographic changes in 1000 highly trained junior elite athletes

OBJECTIVES: To evaluate the spectrum of electrocardiographic (ECG) changes in 1000 junior (18 or under) elite athletes. METHODS: A total of 1000 (73% male) junior elite athletes (mean (SD) age 15.7 (1.4) years (range 14-18); mean (SD) body surface area 1.73 (0.17) m2 (range 1.09-2.25)) and 300 non-athletic controls matched for gender, age, and body surface area had a 12 lead ECG examination. RESULTS: Athletes had a significantly higher prevalence of sinus bradycardia (80% v 19%; p<0.0001) and sinus arrhythmia (52% v 9%; p<0.0001) than non-athletes. The PR interval, QRS, and QT duration were more prolonged in athletes than non-athletes (153 (20) v 140 (18) milliseconds (p<0.0001), 92 (12) v 89 (7) milliseconds (p<0.0001), and 391 (27) v 379 (29) milliseconds (p = 0.002) respectively). The Sokolow voltage criterion for left ventricular hypertrophy (LVH) and the Romhilt-Estes points score for LVH was more common in athletes (45% v 23% (p<0.0001) and 10% v 0% (p<0.0001) respectively), as were criteria for left and right atrial enlargement (14% v 1.2% and 16% v 2% respectively). None of the athletes with voltage criteria for LVH had left axis deviation, ST segment depression, deep T wave inversion, or pathological Q waves. ST segment elevation was more common in athletes than non-athletes (43% v 24%; p<0.0001). Minor T wave inversion (less than -0.2 mV) in V2 and V3 was present in 4% of athletes and non-athletes. Minor T wave inversion elsewhere was absent in non-athletes and present in 0.4% of athletes. CONCLUSIONS: ECG changes in junior elite athletes are not dissimilar to those in senior athletes. Isolated Sokolow voltage criterion for LVH is common; however, associated abnormalities that indicate pathological hypertrophy are absent. Minor T wave inversions in leads other than V2 and V3 may be present in athletes and non-athletes less than 16 but should be an indication for further investigation in older athletes.     

Basophil releasability in young highly trained and older athletes

PURPOSE: Exercise-induced hypoxemia in highly trained athletes is associated with an increase in histamine release during exercise. The cells most implicated in blood histamine release are basophils. The aim of this study was to determine whether high-level endurance training induces modifications in histamine releasability from human basophils. METHODS: Seven young highly trained athletes (YA) [aged 26.1+/-1.3 yr (mean +/- SEM)] and seven master athletes (MA) (64.4+/-4.1 yr), all known to develop exercise-induced hypoxemia, were respectively compared with seven young untrained men (YC) (23.0+/-1.5 yr) and seven older untrained men (OC) (61.6+/-1.3 yr). During an incremental exhaustive exercise, blood samples for measurement of anti-IgE-induced histamine release from leukocytes were drawn at rest, VO2max, and recovery. RESULTS: Basophils from "leukocyte-rich" supernatant in YA and MA showed significantly higher histamine release induced by anti-IgE (1 microg x mL(-1) than, respectively, YC (P<0.01) and OC (P<0.05) at rest, VO2ax (P<0.01), and recovery (P<0.01). Basophils in YA and MA also showed a histamine release induced by anti-IgE that was higher at VO2max than at rest (respectively. P<0.01 and P<0.05), but this change was not found in the control groups. CONCLUSION: In conclusion, the basophils in highly trained endurance athletes, both young and older, showed higher anti-IgE-induced histamine release than those of untrained men. This effect of high-level training seemed to be potentiated by exercise.     

Natural killer cell activity in peripheral blood of highly trained and untrained persons

Natural killer (NK) cell activity and concentration of CD16+ cells (NK cells) and CD20+ cells (monocytes) in peripheral blood were measured in highly trained racing cyclists and in age- and sex-matched untrained controls. Median NK cell activity was 38.1% (range 20.0%-57.1%) in trained vs 30.3% (range 19.7%-43.1%) in untrained (P = 0.008). Median %CD16+ cells was 17% (range 7%-33%) in trained vs 11% (3%-29%) in untrained (P = 0.007). Indomethacin in vitro enhanced the NK cell activity in both groups. There was, however, no significant difference between the NK cell activity in trained and untrained after exposure to indomethacin in vitro. Indomethacin-enhanced NK cell activity was 45.9% (range 24.4%-67.5%) in trained and 40.0% (range 23.9%-68.5%) in untrained (P = 0.138). Mean %CD14+ cells was 8.3% (range 2%-15%) in trained vs 3.8% (2%-8%) in untrained (P less than 0.0001). The increased NK cell function thus demonstrated in highly trained persons might result in better resistance against infectious disease.     

Red blood cell pulmonary capillary transit time during exercise in athletes.

The purpose of this study was to test the hypothesis that the exercise-induced hypoxemia observed in endurance athletes is due to a reduction in the mean red blood cell pulmonary capillary transit time consequent to a plateau in pulmonary capillary blood volume (Vc) as exercise intensity progresses from moderate to heavy levels. Measurements of Vc, mean transit time, arterial O2 tension (PaO2), and end tidal-arterial O2 tension difference (AaDO2) were made in 16 subjects (mean maximal oxygen uptake (VO2max) = 4.90 l.min-1) at rest and during five cycle exercise bouts designed to elicit 55, 65, 75, 85, and 95% VO2max. Mean PaO2 fell from 101 mm Hg at rest to 85 mm Hg during heavy exercise. Mean AaDO2 increased linearly from one stage to the next and at the highest work rate equaled 22.3 mm Hg. Mean Vc failed to plateau with increasing exercise intensity and increased on average by 16 ml from one stage to the next. Mean transit time, on average, dropped from 1.05 s at rest to 0.46 s at the lowest work rate. Mean transit time did not decrease further with increasing exercise intensity (range, 0.42-0.46 s). We conclude that, under the conditions of this study, the AaDO2 increases and PaO2 decreases observed in endurance athletes during exercise of increasing intensity is not caused by a plateau in Vc and a consequent reduction in mean transit time.     

Physiological variables to use in the gender comparison in highly trained runners

AIM: The aims of this investigation were to compare physiological characteristics between highly trained middle-distance and marathon male (n=17) and female (n=11) runners; to determine the most suitable variables to use in the gender comparison in these subjects, considering physical difference between genders; and to indicate some of the best predictors of performance in running events in which oxidative metabolism prevails. METHODS: Subjects performed a progressive maximal exercise on the treadmill to determine maximal oxygen uptake (VO(2max)) and velocities corresponding to a blood lactate concentration of 4 mmol x L(-1) (upsilon(OBLA)) and to the lactate threshold (upsilon(LT)). Cost of running (Cr) and maximal aerobic velocity (upsilon(a max)) were calculated from VO(2) measurements. RESULTS: Males presented higher VO(2max), upsilon(a max), upsilon(OBLA), upsilon(LT), and VO(2) @ upsilon(OBLA) and upsilon(LT) (p<0.001), but females had higher upsilon(OBLA) and upsilon(LT) (p<0.01) expressed as %VO(2max). upsilon(a max) correlated with performance time relative to the world record in both, females (r=-0.77, p<0.01) and males (r=-0.58, p<0.05); and upsilon(LT) with performance only in males (r=-0.59, p<0.05). CONCLUSION: In conclusion, female athletes seemed to compensate partly their aerobic profile with higher %VO(2max) @ u(OBLA) and u(LT), suggesting that both maximal and submaximal physiological variables should be considered when evaluating and comparing highly trained athletes of both genders. upsilon(a max) is one of the best predictors of performance in running events in which oxidative metabolism prevails.     

Induction and decay of short-term heat acclimation in moderately and highly trained athletes

A rethinking of current heat-acclimation strategies is required as most research and advice for improving physiological strain in the heat includes maintaining hydration using long-term acclimation protocols (>10 days). Furthermore, these strategies have tended to use untrained and moderately trained participants. Therefore, the aims of this review were to (i) investigate the effectiveness of short-term heat acclimation (STHA) with moderately and highly trained athletes; (ii) determine the importance of fluid regulatory strain, which has a thermally independent role in heat adaptation; (iii) assess the impact of STHA on a marker of thermotolerance (inducible heat-shock protein 70 [HSP70]); and (iv) provide further information on the decay of acclimation to heat. The review suggests that 5-day STHA is effective, and adaptations may be more pronounced after fluid regulatory strain from a dehydration-acclimation regimen. Furthermore, highly trained athletes may have similar physiological gains to those who are less trained using STHA. However, research has tended to focus on untrained or moderately trained participants and more information is required for highly trained populations. HSP70 response is upregulated across STHA. This indicates increased thermotolerance and protective adaptive change that may indicate HSP70 response as a useful marker of heat acclimation. Physiological adaptations after heat acclimation are relatively short term and may vanish only a few days or weeks after removal from heat exposure. From a practical perspective 5-day STHA may be the preferred acclimation regimen for moderately and highly trained athletes as it has been shown to be effective, less expensive and less likely to disrupt the tapering for competition in elite performers. Furthermore, updated information on the time course of acclimation decay may allow a reliable estimate of how long individuals can be free from heat exposure before reacclimation is required. This is particularly pertinent in present times as many athletes, civilians and military personnel increasingly have to relocate to different climates of the world, often within a short period of time.     

Sex, sport, and body-size dependency of hematology in highly trained athletes

Blood hemoglobin concentration, hematocrit, red cell count, white cell count (WBC), and plasma ferritin concentration were measured on 1604 occasions from 706 nationally ranked athletes in 12 sports. The blood samples were taken from a forearm vein amidst periods of moderate to intense training but at least 6 h after a training session. A multiple regression model, accounting for correlations between variables and incorporating the categorical variables of sex and sport revealed the following. Each blood variable was found to be dependent on body mass index, (mass/height2, BMI), with the exception of WBC in the males. As BMI increased so did the magnitude of these blood variables (P less than 0.01). Each blood variable was also dependent on the sport (P less than 0.01), significant differences being observed between several sports in each case. Furthermore, as has been previously reported, the magnitude of the blood variables was dependent on the sex of the athlete, each being significantly greater in males (P less than 0.01), with the exception of the WBC, which was greater in females (P less than 0.01). These data indicate that the rationality of interpreting the hematology in highly trained athletes may be increased by taking BMI and sport into account, as well as gender.     

Body composition measurement in highly trained male athletes. A comparison of three methods

BACKGROUND: The purpose of the present study was to evaluate the differences in the body composition estimate of highly trained male athletes by three different methods: dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA) and skinfold thickness measurement (SFT). METHODS: The study occurred during a non-intensive training period. The measurements were performed at the Human Physiology laboratory. Participants: forty-three male athletes (19 waterpolo, 9 judo, 15 karate) who exercised regularly at least three hours per day, six days per week. Measurements: DXA, BIA and SFT measurements of percentage fat mass (%FM) and the amount of fat-free mass (FFM) were performed. Statistical analyses: the different %FM estimates by the three methods were compared using a one-way ANOVA, with posthoc Bonferroni test when values were significantly different. The same test was used to compare FFM values. The coefficient of variation (CV%=100xSD/mean) was calculated for each methods. Methodological differences among the various methods were analysed with the method of Bland-Altman. RESULTS: ANOVA test showed significant differences among the three methods. In particular, DXA significantly (p<0.001) overestimated %FM (12.4+/-4.1%) and underestimate FFM (67.0+/-6.9 kg) respect to SFT (7.8+/-0.9 % and 71.0+/-8.2 kg) and BIA (9.9+/-1.4% and 69.4+/-7.9 kg). Also Bland-Altman comparison among the estimates indicated wide differences between methods. CONCLUSIONS: DXA provides different body composition estimates than those derived from skinfold thickness measurement and BIA, so that the methods should not be used interchangeably.     

Effects of different sports on bone density and muscle mass in highly trained athletes

PURPOSE: It is known that participating in sports can have a beneficial effect on bone mass. However, it is not well established which sport is more beneficial for increased bone mineral density (BMD) and appendicular muscle mass (AMM). This study investigated the effects of different high-intensity activities on BMD and AMM in highly trained athletes. MATERIALS AND METHODS: Sixty-two male subjects aged 18--25 yr participated in the study. The sample included judo (J; N = 21), karate (K; N = 14), and water polo (W; N = 24) athletes who all competed at national and international level. Twelve age-matched nonathletic individuals served as the control group (C). All athletes exercised regularly for at least 3 h x d(-1), 6 d x wk(-1). Segmental, total BMD, and AMM were measured with a dual-energy x-ray (DXA) absorptiometry (Lunar Corp., Madison, WI). DXA analysis also includes bone mineral content (BMC) and fat and lean masses. RESULTS: Total BMD(C) was significantly lower (mean +/- SD: 1.27 +/- 0.06 g x cm(-2), P < 0.05) than either judo or karate athletes (total BMD(J) (1.4 +/- 0.06 g x cm(-2)) and total BMD(K) (1.36 +/- 0.08 g x cm(-2))) but not different from the W athletes (total BMD(W) (1.31 +/- 0.09 g x cm(-2))). AMM was significantly lower in the C group compared with the three athletic groups (P < 0.05). Fat mass was higher in the W versus J and K athletes but not different from the C group (P < 0.05). CONCLUSIONS: This cross-sectional study has shown that athletes, especially those engaged in high-impact sports, have significantly higher total BMD and AMM than controls. These results suggest that the type of sport activity may be an important factor in achieving a high peak bone mass and reducing osteoporosis risk.     

Energy system contribution during 200- to 1500-m running in highly trained athletes

PURPOSE: The purpose of the present study was to profile the aerobic and anaerobic energy system contribution during high-speed treadmill exercise that simulated 200-, 400-, 800-, and 1500-m track running events. METHODS: Twenty highly trained athletes (Australian National Standard) participated in the study, specializing in either the 200-m (N = 3), 400-m (N = 6), 800-m (N = 5), or 1500-m (N = 6) event (mean VO2 peak [mL x kg(-1)-min(-1)] +/- SD = 56+/-2, 59+/-1, 67+/-1, and 72+/-2, respectively). The relative aerobic and anaerobic energy system contribution was calculated using the accumulated oxygen deficit (AOD) method. RESULTS: The relative contribution of the aerobic energy system to the 200-, 400-, 800-, and 1500-m events was 29+/-4, 43+/-1, 66+/-2, and 84+/-1%+/-SD, respectively. The size of the AOD increased with event duration during the 200-, 400-, and 800-m events (30.4+/-2.3, 41.3+/-1.0, and 48.1+/-4.5 mL x kg(-1), respectively), but no further increase was seen in the 1500-m event (47.1+/-3.8 mL x kg(-1)). The crossover to predominantly aerobic energy system supply occurred between 15 and 30 s for the 400-, 800-, and 1500-m events. CONCLUSIONS: These results suggest that the relative contribution of the aerobic energy system during track running events is considerable and greater than traditionally thought.     

Montelukast does not affect exercise performance at subfreezing temperature in highly trained non-asthmatic endurance athletes

Anti-leukotriene therapy represents a new principle in asthma treatment. As elite athletes can have asthma, this double-blind, placebo-controlled, randomised cross-over study investigated the effect of 10 mg oral montelukast, a specific and potent cysteinyl leukotriene receptor antagonist, on physiological responses to submaximal and maximal aerobic exercise at -15 degrees C in 14 non-asthmatic highly trained endurance male athletes (maximal oxygen uptake [VO2 max] > 70 ml x kg(-1) x min(-1)). Heart rate, capillary blood lactate, minute ventilation with tidal volume and breathing frequency, respiratory exchange ratio and oxygen uptake were measured during the warm-up run of 10 min at 50%, runs of 10 min at 90% and 5 min at 80% VO2max, and a timed run to exhaustion. Spirometry was performed at baseline, at four hours after tablet ingestion, after warm-up and exercise at 80% VO2max, and in the post exercise period. Compared to placebo, montelukast did not increase baseline FEV1, have a beneficial effect on physiological performance variables, or increase the mean (SD) running time to exhaustion (montelukast: 332.3 [45.8] s, placebo: 340.1 [53.3] s, P = 0.22). These findings do not suggest the need for disallowing the use of this drug by asthmatic athletes.     

Moment-knee angle relation in well trained athletes

The purpose of this work was to investigate whether different modes of long-term competitive physical activity cause functional differences in the moment-knee angle relation of the M. quadriceps femoris (QF). Therefore, a sample (n = 40) of young male competitive endurance runners, cyclists, triathletes and tennis players performed isometric maximal voluntary knee extensions (MVC) with their stronger leg at six different knee joint angles while keeping the hip joint angle constant. Muscle activation of QF-muscles during MVC was estimated using surface electromyography (EMG). Moments and EMG data of each subject were normalized to the largest value produced at any knee joint position [% Max.]. No significant differences in the normalized [% Max.] moment-knee angle relation of the QF were found between endurance runners, cyclists and triathletes. Despite few unsystematic exceptions, no functional differences in the normalized moment-knee angle relation of the QF occurred among tennis players and the endurance-oriented athletic groups. Obtained by curve fitting, the optimal knee joint angle for moment production was not significantly different among all athletic groups. We conclude that long-term competitive endurance running, cycling, triathlon and tennis do not provoke functional differences in the moment-knee angle relation of the whole QF.     

Effects of blood transfusions on some hematological variables in endurance athletes

Selected hematological variables (blood hemoglobin concentration [Hb], serum (s-) iron, s-bilirubin, s-ferritin, blood lactate, and s-erythropoietin [Epo]) were analyzed before and for 4 wk after autologous blood transfusions. A group of well-trained (8 male and 4 female) former endurance athletes was phlebotomized and 3-4 months later reinfused with the freezer-stored autologous red blood cells (RBC) from 1350 ml of blood. The [Hb] increased significantly (P less than 0.001 for both sexes) from 146.7 +/- 5.31 and 131.7 +/- 11.20 g. l-1 immediately before reinfusion to maximum values of 163.5 +/- 7.47 and 155.9 +/- 11.43 g.l-1 (mean +/- SD) in males and females, respectively, 2 d after reinfusion. S-iron increased transiently 5 h after reinfusion. S-bilirubin remained unchanged throughout the study. S-ferritin increased gradually (P less than 0.02) from 48 +/- 32.91 mmol.l-1 before reinfusion to a maximum of 80.8 +/- 39.52 mmol.l-1 2 wk after reinfusion. S-[Epo] increased transiently (P less than 0.01) from 8.83 +/- 2.51 (mean +/- SD) to 12.36 +/- 5.64 U.l-1, (mean +/- SD) 5 h after reinfusion. Subsequently, there was a significant marked decrease in s-[Epo] to 5.85 +/- 1.32 U.l-1, (mean +/- SD) 1 d after reinfusion (P less than 000.1, as compared to before reinfusion). Thereafter, s-[Epo] remained low throughout the study. Blood lactate was significantly decreased only the first 2 d after reinfusion (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)