Physiological characteristics of elite high-altitude climbers.

Factors underlying the amplitude of exercise performance reduction at altitude and the development of high-altitude illnesses are not completely understood. To better describe these mechanisms, we assessed cardiorespiratory and tissue oxygenation responses to hypoxia in elite high-altitude climbers. Eleven high-altitude climbers were matched with 11 non-climber trained controls according to gender, age, and fitness level (maximal oxygen consumption, VO2 max ). Subjects performed two maximal incremental cycling tests, in normoxia and in hypoxia (inspiratory oxygen fraction: 0.12). Cardiorespiratory measurements and tissue (cerebral and muscle) oxygenation were assessed continuously. Hypoxic ventilatory and cardiac responses were determined at rest and during exercise; hypercapnic ventilatory response was determined at rest. In hypoxia, climbers exhibited similar reductions to controls in VO2 max (climbers -39 ± 7% vs controls -39 ± 9%), maximal power output (-27 ± 5% vs -26 ± 4%), and arterial oxygen saturation (SpO2 ). However, climbers had lower hypoxic ventilatory response during exercise (1.7 ± 0.5 vs 2.6 ± 0.7 L/min/%; P < 0.05) and lower hypercapnic ventilatory response (1.8 ± 1.4 vs 3.8 ± 2.5 mL/min/mmHg; P < 0.05). Finally, climbers exhibited slower breathing frequency, larger tidal volume and larger muscle oxygenation index. These results suggest that elite climbers show some specific ventilatory and muscular responses to hypoxia possibly because of genetic factors or adaptation to frequent high-altitude climbing.

Difference of catecholamine responses to exercise in men with trisomy 21, with or without chronotropic incompetence.

OBJECTIVE: Our purpose was to analyse if catecholamine responses to exercise would be different in Down syndrome (DS) with or without chronotropic incompetence. RESEARCH DESIGN AND METHODS: Twenty five men with DS (mean age 22.2 ± 3.2) and twenty six controls (CONT, mean age 22.5 ± 1.4) participated in the study, and are divided into 3 groups: CONT, DS with chronotropic incompetence (DS+) and DS without chronotropic incompetence (DS-). During two treadmill incremental tests, blood samples were collected for the determination of hormonal and metabolic variables. RESULTS: Ten out of 25 DS had chronotropic incompetence whereas no CONT. At rest, compared to CONT, despite similar physical activity, DS with chronotropic incompetence had significantly higher subcutaneous fat mass (p<0.001), lower epinephrine concentration (p<0.01), and higher leptin (p<0.01) and insulin concentrations (p<0.05). At peak exercise, all DS had lower heart rate, oxygen uptake and blood lactate concentrations than controls (p<0.001). During a 'Submaximal incremental test', DS with chronotropic incompetence had lower HR and lactate values (p<0.001) compared to CONT and DS without chronotropic incompetence (p<0.01). They also had blunted epinephrine and impaired norepinephrine responses to exercise compared to DS without chronotropic incompetence and CONT (p<0.01 and p<0.05 respectively). CONCLUSIONS: Our results indicate that catecholamine adaptations to exercise are not adequate in DS+ and are associated with exercise intolerance. Thus, this endocrine profile at rest and during exercise may limit endurance performance of DS.

Impact of exercise training without caloric restriction on inflammation, insulin resistance and visceral fat mass in obese adolescents.

BACKGROUND: Exercise training has been shown to improve cardiometabolic health in obese adolescents. OBJECTIVES: Evaluate the impact of a 12-week exercise-training programme (without caloric restriction) on obese adolescents' cardiometabolic and vascular risk profiles. METHODS: We measured systemic markers of oxidation, inflammation, metabolic variables and endothelial function in 20 obese adolescents (OB) (age: 14.5 ± 1.5 years; body mass index: 34.0 ± 4.7 kg m(-2) ) and 20 age- and gender-matched normal-weight adolescents (NW). Body composition was assessed by magnetic resonance imagery. Peak aerobic capacity and maximal fat oxidation were evaluated during specific incremental exercise tests. OB participated in a 12-week exercise-training programme. RESULTS: OB presented lower peak aerobic capacity (24.2 ± 5.9 vs. 39.8 ± 8.3 mL kg(-1) min(-1) , P < 0.05) and maximal fat oxidation compared with NW (P < 0.05). OB displayed greater F2t-Isoprostanes (20.5 ± 6.7 vs. 13.4 ± 4.2 ng mmol(-1) creatinine), Interleukin-1 receptor antagonist (IL-1Ra) (1794.8 ± 532.2 vs. 835.1 ± 1027.4 pg mL(-1) ), Tumor Necrosis Factor-α (TNF-α) (2.1 ± 1.2 vs. 1.5 ± 1.0 pg mL(-1) ), Soluble Tumor Necrosis Factor-α Type II Receptor (sTNFαRII), leptin, insulin, homeostasis model assessment of insulin resistance, version 2 (HOMA2-IR), high-sensitive C-reactive protein, triglycerides and lower adiponectin and high-density lipoprotein cholesterol (all P < 0.05). After exercise training, despite lack of weight loss, VO2peak (mL.kg(-1) .min(-1) ) and maximal fat oxidation increased (P < 0.05). IL-1Ra and IFN-gamma-inducible protein 10 (IP-10) decreased (P < 0.05). Insulin and HOMA2-IR decreased (14.8 ± 1.5 vs. 10.2 ± 4.2 µUI mL(-1) and 1.9 ± 0.8 vs. 1.3 ± 0.6, respectively, P < 0.05). Change in visceral fat mass was inversely associated with change in maximal fat oxidation (r = -0.54; P = 0.024). The subgroup of participants that lost visceral fat mass showed greater improvements in triglycerides, insulin resistance and maximal fat oxidation. CONCLUSION: Our data confirms the role of exercise training on improving the inflammatory profile and insulin resistance of OB in the absence of weight loss. However, those who lost a greater amount of visceral fat mass showed greater benefits in terms of insulin profile, triglycerides and maximal fat oxidation.

Methodological aspects of crossover and maximum fat-oxidation rate point determination.

AIM: Indirect calorimetry during exercise provides two metabolic indices of substrate oxidation balance: the crossover point (COP) and maximum fat oxidation rate (LIPOXmax). We aimed to study the effects of the analytical device, protocol type and ventilatory response on variability of these indices, and the relationship with lactate and ventilation thresholds. METHODS: After maximum exercise testing, 14 relatively fit subjects (aged 32+/-10 years; nine men, five women) performed three submaximum graded tests: one was based on a theoretical maximum power (tMAP) reference; and two were based on the true maximum aerobic power (MAP). Gas exchange was measured concomitantly using a Douglas bag (D) and an ergospirometer (E). RESULTS: All metabolic indices were interpretable only when obtained by the D reference method and MAP protocol. Bland and Altman analysis showed overestimation of both indices with E versus D. Despite no mean differences between COP and LIPOXmax whether tMAP or MAP was used, the individual data clearly showed disagreement between the two protocols. Ventilation explained 10-16% of the metabolic index variations. COP was correlated with ventilation (r=0.96, P<0.01) and the rate of increase in blood lactate (r=0.79, P<0.01), and LIPOXmax correlated with the ventilation threshold (r=0.95, P<0.01). CONCLUSION: This study shows that, in fit healthy subjects, the analytical device, reference used to build the protocol and ventilation responses affect metabolic indices. In this population, and particularly to obtain interpretable metabolic indices, we recommend a protocol based on the true MAP or one adapted to include the transition from fat to carbohydrate. The correlation between metabolic indices and lactate/ventilation thresholds suggests that shorter, classical maximum progressive exercise testing may be an alternative means of estimating these indices in relatively fit subjects. However, this needs to be confirmed in patients who have metabolic defects.

Maximal and submaximal treadmill tests in a young adult with fragile-X syndrome.

Fragile X syndrome is associated with expansion of a CGG triplet repeat in the FMR1 gene, which abolishes production of the FMRP protein. This abnormality is expressed as a number of neuro-endocrine disorders (the adrenal axis, macroorchidism) and the emergence of significant behavioural stress. Here, we report on the hormonal status of a young adult with fragile X syndrome, with a focus on catecholamine and cortisol changes during a submaximal treadmill test. The patient showed abnormally high epinephrine and norepinephrine concentrations. During a submaximal incremental test, cortisol levels were higher than the laboratory reference range. Although the submaximal incremental test has a significant "stressful" effect, this young adult was able to complete the entire protocol without any maladaptive behaviour or withdrawal.

A fatigue questionnaire (QFES) for child athletes: a four-year follow-up study in young skiers.

BACKGROUND: The use of a fatigue monitoring questionnaire is an increasingly widespread practice in sports medicine. OBJECTIVE: To evaluate variations in the QFES fatigue questionnaire score according to periods of rest, training or competition. METHODS: Sixty-six skiers (either alpine or cross-country skiers, aged between 11 and 14 years and training for between 12 and 18 hours per week) filled out a total of 400 fatigue questionnaires over a four-year follow-up period. RESULTS: Our analysis of the QFES fatigue scores showed that only a small proportion of the skiers (5.25%, on average) exceeded the fatigue alert threshold at some point during the longitudinal follow-up; periods of competition correspond to rising fatigue scores, in comparison with the beginning of season and girls always have higher scores than boys (25.32+/-0.90 versus 20.46+/-0.91, respectively; p<0.0002). In contrast, there was no correlation between fatigue levels and the type of skiing discipline practiced. CONCLUSION: Our main results show that the QFES fatigue questionnaire is a sensitive tool for tracking down particular periods of fatigue (competition, intense training). Even though the mechanism of fatigue is still not fully understood (highlighting the complexity of this syndrome), the systematic use of a fatigue questionnaire when monitoring children performing competitive sport and high volumes of training confirms the possible preventive role of this type of tool.

Use of the fatigue questionnaire (QFES) in child athletes for individual follow-up: two cases.

BACKGROUND: Fatigue is one of the multiple components of the life of an athlete. It may have adverse consequences on the health of child athletes in particular in the short or long term. For the trainer or medical staff, detecting fatigue as fast as possible is therefore advisable. OBSERVATIONS: Two young skiers beginning a sports class at age 11 were followed for 3 years within the framework of their practice for sport competition (1 alpine and 1 cross-country skier). At the same time as medical follow-up organized within the sports classes of the school they attended, the children completed at six times a questionnaire about fatigue, the QFES, (in French: Questionnaire de fatigue de l'enfant sportif). At one precise time during this follow-up, the QFES score for each child, both at age 12, clearly increased, by 175% and 133.3%, respectively, from previous scores. A thorough analysis of data gathered by the QFES allowed for revealing particular parameters of the fatigue: decreased sports performance, difficulties in relations and sleep disorders. CONCLUSIONS: Systematic use of the QFES in parallel with medical consultations for children participating in sport may be an efficient tool to detect the early appearance of fatigue and may therefore be integrated in preventive guidance to protect children in sports practice.

Exhaled nitric oxide in single and repetitive prolonged exercise.

This study was performed to determine the influence of single and repetitive exercise on nitric oxide (NO) concentration in the lung. Exhaled NO concentration (FE(NO)) was measured during a constant-flow exhalation manoeuvre (170 ml x s(-1), against a 10 cmH2O resistance) in healthy individuals (a) during and after a 100-min square-wave exercise of between 25 and 60% of maximal power output (n = 18) and (b) before and after five successive prolonged exercises (90-120 min, 75-85% of maximal heart rate) separated by 48 or 24 h (n = 8). The FE(NO0.170) was decreased during and after the 100-min exercise test (mean +/- s(x): 58.5 +/- 3.7% and 76.7 +/- 5.2% of resting value at 90 min of exercise and 15 min post-exercise, respectively; P < 0.05). The five successive exercise sessions induced a similar post-exercise FE(NO0.170) decrement (73.1 +/- 2.9% of resting value 15 min post-exercise), while basal FE(NO0.170) values were not different between the five sessions (P > 0.05). These results suggest that prolonged exercise induces a reduction in NO concentration within the lung that lasts for several minutes after the end of exercise. However, repetitive exercises (at least every 24 h) allow complete NO recovery from one session to another. The implication of such a decrease in NO availability within the lung remains to be clarified.

[Utilisation of a questionnaire of fatigue in sport children: effect of sport, age and gender]. / Utilisation du questionnaire de fatigue chez de jeunes enfants sportifs: effets de l'activité sportive, de l'âge et du sexe.

In children, fatigue induced by regular sport activity with important training sessions and competitions is still difficult to objective. The purpose of this study was to evaluate the fatigue induced by intensive training, with an auto-questionnaire of fatigue specially elaborated for sport children aged in 8 to 16 year-old, and the incidence of age, sex and the type of sport practiced. A study was conducted on 780 auto-questionnaires (QFES) distributed to 581 children, during 24 months in France (Rhône-Alpes-Auvergne). Results to the QFES are equivalent between sedentary and sport children. For 84.1% of them, no significant sign of fatigue was detected. No age effect has be seen, but girls presented a greater score of fatigue (+5.5%) compared to boys. When considering the specificity of sport, sex difference disappeared. On the contrary, in children with elevated score of fatigue, three domains were principally affected: physical signs, symptoms and motivation. The results obtained in this study assess the relevance of this questionnaire in evaluating sport induced fatigue. Prevention should mainly focus in sport children, in order to reduce potential risks of a sport activity practiced in exhausting conditions.

Laboratory running test vs. field roller skiing test in cross-country skiers: a longitudinal study.

Laboratory treadmill running tests are commonly used to assess the effect of training programs and to prescribe training intensity for cross-country skiers. The present study compared the physiological parameters during a treadmill running (R) test and a field roller skiing (RS) test both at the beginning (Beg) and at the end (End) of a 6-month specific training program in seven competitive cross-country skiers. Oxygen uptake (VO2) and blood lactate concentration ([La]) were assessed for exercise intensity corresponding to 70%, 80%, 90% of maximal heart rate (HRmax) and to HRmax.VO2 was lower for the RS test compared to the R test at any HR levels at Beg only (p<0.05). Maximal VO2 increased from Beg to End for the RS test only (+23.7+/-10.4; p<0.05). [La] was lower for the R test compared to the RS test during both testing periods at 90% HRmax (p<0.05), and no significant modification in [La] from Beg to End at any HR levels was observed (p>0.05). The [La]/V.O2 curve shifted toward the right from Beg to End to a greater extent for the RS test compared to the R test. The present study emphasised the importance of exercise specificity in order to assess the effect of specific training program in competitive cross-country skiers.

[Creation and validation of a questionnaire for diagnosing sport fatigue in children]. / Elaboration et validation d'un questionnaire de fatigue chez l'enfant sportif.

Fatigue induced by regular sport activity in children with important training sessions and competitions has not received an important attention from researchers. In this context, we developed an auto-questionnaire of fatigue, especially for athletic children of 8 to 15 years old. We tested this questionnaire for the following psychometric properties: comprehension, construct validity, sensibility and reproducibility. These criteria were evaluated by specific and reliable statistic analysis. Results of this validation were sterling (compliance=98.48%, confidence interval superior to 95%, homogeneity of the analysis by principal components and Cronbach coefficient superior 95%). These first analyses of sport child's fatigue enables us to confirm its feasibility, on the condition of using specific tools, for the clinician or for the professionals involved in sport medicine, and its relevance as an element for evaluating the needs linked with the health of the young sport population.

Exhaled nitric oxide during normoxic and hypoxic exercise in endurance athletes.

AIM: Endogenous nitric oxide (NO) through its relaxing effect on smooth muscle cells may be involved in pulmonary gas exchange as well as in the modulation of the hypoxic pulmonary vasoconstriction. As athletes with exercise-induced hypoxaemia (EIH) present pulmonary gas exchange abnormalities in normoxia that could be even greater in hypoxia, we hypothesized that pulmonary NO may be lower in such athletes with EIH. METHODS: Eleven athletes with EIH [decrease in arterial oxygen blood partial pressure (PaO2) > 12 mmHg] and 9 without EIH (NEIH) exercised at 40%, 60% (10 min) and 90% (5 min) of normoxic maximal power output (Pmax) in normoxia, and at 40% and 60% (10 min) of Pmax in hypoxia (FiO2 = 15%). Exhaled NO concentration during a constant flow exhalation (FENO(0.170)) and arterialized blood gases were measured at every power output. RESULTS: FENO(0.170) decreased from rest to exercise both in normoxia (-27.8 +/- 22.8% at 90% Pmax, P < 0.001) and hypoxia (-23.8 +/- 17.5% at 60% Pmax, P < 0.001). At 90% Pmax in normoxia, EIH athletes showed lower PaO2 (76.7 +/- 5.4 vs. 82.8 +/- 4.4 mmHg, P = 0.013) and greater FENO(0.170) decrement (-37.0 +/- 24.7% vs. -16.6 +/- 14.6%, P = 0.042) than NEIH athletes. During hypoxic exercise, P(a)O(2) and FENO(0.170) decreases were similar in both groups (P > 0.05). CONCLUSION: The present study shows lower pulmonary NO in athletes with gas exchange abnormalities during intense exercise in normoxia, while EIH and NEIH athletes have similar decreases in blood gases and pulmonary NO during hypoxic exercise. Decreased pulmonary NO in such conditions may contribute to ventilation-perfusion inequality and/or increase pulmonary vascular tone in athletes.

Blood lactate concentration/heart rate relationship: laboratory running test vs field roller skiing test.

Laboratory treadmill running tests are commonly used to assess the effects of training programs and to prescribe training intensity for cross-country skiers. The present study compared the blood lactate concentration ([La])/heart rate (HR) relationship obtained during a laboratory treadmill running test and used to prescribe training intensities, to the same relationship obtained during a field roller skiing test in ten young male cross-country skiers of national level. The laboratory test consisted of a maximal incremental protocol involving 3 min steps during which metabolic and cardio-respiratory parameters were measured. The field test comprised four loops (4 km long) at different intensities from warm-up speed to maximum aerobic speed during which HR and [La] were measured. For a given HR, [La] values obtained during the field test were significantly higher compared with those measured in the laboratory test (mean difference from 0.2 mmol x l -1 for HR = 147 bpm, to 4.9 mmol x l -1 for HR = 182 bpm; p < 0.05). Exercise specificity, i. e. upper body involvement for roller skiing, as well as protocol characteristics, particularly longer step duration, could explain this discrepancy. The results of the present study highlight the importance of exercise and protocol specificity for [La]/HR relationship currently used to prescribe exercise intensity in cross-country skiing.

Bronchial obstruction and exhaled nitric oxide response during exercise in cold air.

This study examines whether exhausting exercise in cold air induces bronchial obstruction and changes in exhaled [NO] and in exhaled NO output (V'NO). Thus, eight well-trained males performed two incremental exercise tests until exhaustion, followed by 5 min of recovery in temperate (22 degrees C) and cold (-10 degrees C) environments, at random. At -10 degrees C, they were dressed in warm clothes. Ventilation (V'E), oxygen consumption (V'O2), carbon dioxide production, cardiac frequency (fC), and [NO] and V'NO were measured continuously. Before and after each test, the subjects' maximal expiratory flow-volume curves and peak expiratory flow, forced expiratory volume in one second (FEV1) and forced expiratory flow at 25 (FEF25), 50 (FEF50) and 75% (FEF75) of forced vital capacity were determined. At -10 degrees C, significant decreases in FEV1 and FEF75 were observed after exercise. At rest and at the same submaximal intensity, V'O2, V'E and fC did not differ significantly. At rest and up to approximately 50% peak V'O2, [NO] and V'NO values were lower at -10 degrees C than at 22 degrees C. Thereafter, and during recovery, the V'NO response became similar at both -10 and 22 degrees C. This study confirms that considerable hyperpnoea in cold air causes a detectable airway obstruction. This airway cooling also induces an initial decrease in the exhaled NO response. Since endogenous NO-production is involved in bronchial dilation, it cannot be excluded that this lack of production may favour the appearance of airway obstruction.

Air contamination with nitric oxide: effect on exhaled nitric oxide response.

This study examines the response of exhaled nitric oxide (NO) concentration (ECNO) and quantity of exhaled NO over time (EVNO) in 10 healthy subjects breathing into five polyethylene bags, one in which synthetic air was free of NO and four in which NO was diluted to concentrations of 20 +/- 0.6, 49 +/- 0.8, 98 +/- 2, and 148 +/- 2 ppb, respectively. Each subject was connected to each bag for 10 min at random. Minute ventilation and ECNO were measured continuously, and EVNO was calculated continuously. ECNO and EVNO values were significantly higher for an inhaled NO concentration of 20 ppb than for NO-free air. Above 20 ppb, ECNO and EVNO increased linearly with inhaled NO concentration. It is reasonable to assume that a share of the quantity of inspired NO over time (InspVNO) because of air contamination by pollution is rejected by the ventilatory pathway. Insofar as InspVNO does not affect endogenous production or the metabolic fate of NO in the airway, this share may be estimated as being approximately one third of InspVNO, the remainder being taken by the endogenous pathway. Thus, air contamination by the NO resulting from pollution greatly increases the NO response in exhaled air.

Nitric oxide response in exhaled air during an incremental exhaustive exercise.

This study examines the response of the exhaled nitric oxide (NO) concentration (CNO) and the exhaled NO output (VNO) during incremental exercise and during recovery in six sedentary women, seven sedentary men, and eight trained men. The protocol consisted of increasing the exercise intensity by 30 W every 3 min until exhaustion, followed by 5 min of recovery. Minute ventilation (VE), oxygen consumption (VO2), carbon dioxide production, heart rate, CNO, and VNO were measured continuously. The CNO in exhaled air decreased significantly provided that the exercise intensity exceeded 65% of the peak VO2. It reached similar values, at exhaustion, in all three groups. The VNO increased proportionally with exercise intensity up to exhaustion and decreased rapidly during recovery. At exhaustion, the mean values were significantly higher for trained men than for sedentary men and sedentary women. During exercise, VNO correlates well with VO2, carbon dioxide production, VE, and heart rate. For the same submaximal intensity, and thus a given VO2 and probably a similar cardiac output, VNO appeared to be similar in all three groups, even if the VE was different. These results suggest that, during exercise, VNO is mainly related to the magnitude of aerobic metabolism and that this relationship is not affected by gender differences or by noticeable differences in the level of physical training.

Discrimination between cross-country and downhill skiers by pulmonary and local 31PNMR evaluations.

The purpose of the present study was to correlate data on calf muscle metabolism using 31P nuclear magnetic resonance spectroscopy with measurements of whole body maximal oxygen consumption and maximal power output, and to determine whether the combination of these data could be used to predict athletic ability. Experiments were performed in a 2.35 Tesla, 35 cm diameter electromagnet on the leg muscle of sedentary human subjects (N = 6) and groups of athletes trained for endurance (cross-country skiers, N = 7) or strength performance (downhill skiers, N = 5). The exercise protocol consisted of successive plantar flexions performed at graded fractions of the maximal voluntary contraction (MVC). The results obtained from NMR investigation (changes in content of inorganic phosphate: Pi, phosphocreatine: PC and muscle ATP, and intracellular pH) were then compared with those of maximal O2 consumption (VO2max) and maximal power (MP). When the data on athletes were compared with those obtained on sedentary subjects, the curves illustrating the relationship between the imposed load and the Pi/PC ratio were significantly shifted toward high output power for a given Pi/PC value. It also appeared from this study that specific training in force development (downhill skiing) induced a slighter decrease in PC level than for endurance (cross-country skiers) despite improvement in physical performance. A slight but significant intracellular acidification was observed in the muscles of sedentary subjects and downhill skiers for contraction at, respectively, 50% and 80% of MVC, but not in the skeletal muscles of cross-country skiers.(ABSTRACT TRUNCATED AT 250 WORDS)

Muscle bioenergetics in skiers: studies using NMR spectroscopy.

Sedentary human subjects (n = 6) and two homogeneous groups of athletes, trained for down-hill skiing (n = 5) and cross-country skiing (n = 7), were subjected to cardiorespiratory testing and to evaluation of the bioenergetics of calf muscles by means of Phosphorus Nuclear Magnetic Resonance Spectroscopy. The exercise consisted of successive plantar flexions performed at graded fractions of the maximal voluntary contraction force. It appears from this study that the decrease in phosphocreatine level induced by exercise at 80% of maximal voluntary contraction, was smaller in the muscles of athletes who trained for cross-country skiing, than in the muscles of down-hill skiers and control subjects. Intracellular acidosis was virtually absent in cross-country athletes. The rate of restitution of phosphocreatine, after the exercise, was higher in both groups of skiers, compared to sedentary subjects. The maximal oxygen consumption and the maximal alactic power were higher in athletes than in sedentary subjects. NMR data and mechanical measurements are used in consideration with functional systemic indexes to characterize the capabilities of skiers.