Combined intermittent hypoxic exposure at rest and continuous hypoxic training can maintain elevated hemoglobin mass after a hypoxic camp.

Athletes use hypoxic living and training to increase hemoglobin mass (Hbmass), but Hbmass declines rapidly upon return to sea level. We investigated whether Intermittent Hypoxic Exposure (IHE) + Continuous Hypoxic Training (CHT) after return to sea level maintained elevated Hbmass, and if changes in Hbmass were transferred to changes in maximal oxygen uptake (V̇O2max) and exercise performance. Hbmass was measured in 58 endurance athletes before (PRE), after (POST1), and 30 days after (POST2) a 27 ± 4-day training camp in hypoxia (n=44, HYP) or at sea level (n=14, SL). After return to sea level, 22 athletes included IHE (2 h rest) + CHT (1 h training) into their training every third day for one month (HYPIHE+CHT), whereas the other 22 HYP athletes were not exposed to IHE or CHT (HYPSL). Hbmass increased from PRE to POST1 in both HYPIHE+CHT (4.4 ± 0.7%, mean ± SEM) and HYPSL (4.1 ± 0.6%) (both p<0.001). Compared to PRE, Hbmass at POST2 remained 4.2 ± 0.8% higher in HYPIHE+CHT (p<0.001) and1.9 ± 0.5% higher in HYPSL (p=0.023), indicating a significant difference between the groups (p=0.002). In SL, no significant changes were observed in Hbmass with mean alterations between -0.5% and 0.4%. V̇O2max and time to exhaustion during an incremental treadmill test (n=35) were elevated from PRE to POST2 only in HYPIHE+CHT (5.8 ± 1.2% and 5.4 ± 1.4%, respectively, both p<0.001). IHE+CHT possesses the potential to mitigate the typical decline in Hbmass commonly observed during the initial weeks after return to sea level.

Test-retest reliability of ski-specific aerobic, sprint, and neuromuscular performance tests in highly trained cross-country skiers.

PURPOSE: Laboratory tests are commonly performed by cross-country (XC) skiers due to the challenges of obtaining reliable performance indicators on snow. However, only a few studies have reported reliability data for ski-specific test protocols. Therefore, this study examined the test-retest reliability of ski-specific aerobic, sprint, and neuromuscular performance tests. METHODS: Thirty-nine highly trained XC skiers (26 men and 13 women, age: 22 ± 4 years, V̇O2max : 70.1 ± 4.5 and 58.8 ± 4.4 mL·kg-1 ·min-1 , respectively) performed two test trials within 6 days of a diagonal V̇O2max test, n = 27; skating graded exercise test to assess the second lactate threshold (LT2 ), n = 27; 24-min double poling time trial (24-min DP, n = 25), double poling sprint test (SprintDP1 , n = 27), and 1-min self-paced skating sprint test (Sprint1-min , n = 26) using roller skis on a treadmill, and an upper-body strength test (UB-ST, n = 27) to assess peak power (Ppeak ) with light, medium, and heavy loads. For each test, the coefficient of variation (CV), intraclass correlation coefficient (ICC), and minimal detectable change (MDC) were calculated. RESULTS: V̇O2max demonstrated good-to-excellent reliability (CV = 1.4%; ICC = 0.99; MDC = 112 mL·min-1 ), whereas moderate-to-excellent reliability was found for LT2 (CV = 3.1%; ICC = 0.95). Performance during 24-min DP, SprintDP1 , and Sprint1-min showed good-to-excellent reliability (CV = 1.0%-2.3%; ICC = 0.96-0.99). Absolute reliability for UB-ST Ppeak was poor (CV = 4.9%-7.8%), while relative reliability was excellent (ICC = 0.93-0.97) across the loads. CONCLUSION: In highly trained XC skiers, sport-specific aerobic and sprint performance tests demonstrated high test-retest reliability, while neuromuscular performance for the upper body was less reliable. Using the presented protocols, practitioners can assess within- and between-season changes in relevant performance indicators.

Do male athletes with already high initial haemoglobin mass benefit from 'live high-train low' altitude training?

NEW FINDINGS: What is the central question of this study? It has been assumed that athletes embarking on an 'live high-train low' (LHTL) camp with already high initial haemoglobin mass (Hbmass ) have a limited ability to increase their Hbmass further post-intervention. Therefore, the relationship between initial Hbmass and post-intervention increase was tested with duplicate Hbmass measures and comparable hypoxic doses in male athletes. What is the main finding and its importance? There were trivial to moderate inverse relationships between initial Hbmass and percentage Hbmass increase in endurance and team-sport athletes after the LHTL camp, indicating that even athletes with higher initial Hbmass can reasonably expect Hbmass gains post-LHTL. It has been proposed that athletes with high initial values of haemoglobin mass (Hbmass ) will have a smaller Hbmass increase in response to 'live high-train low' (LHTL) altitude training. To verify this assumption, the relationship between initial absolute and relative Hbmass values and their respective Hbmass increase following LHTL in male endurance and team-sport athletes was investigated. Overall, 58 male athletes (35 well-trained endurance athletes and 23 elite male field hockey players) undertook an LHTL training camp with similar hypoxic doses (200-230 h). The Hbmass was measured in duplicate pre- and post-LHTL by the carbon monoxide rebreathing method. Although there was no relationship (r = 0.02, P = 0.91) between initial absolute Hbmass (in grams) and the percentage increase in absolute Hbmass , a moderate relationship (r = -0.31, P = 0.02) between initial relative Hbmass (in grams per kilogram) and the percentage increase in relative Hbmass was detected. Mean absolute and relative Hbmass increased to a similar extent (P ≥ 0.81) in endurance (from 916 ± 88 to 951 ± 96 g, +3.8%, P < 0.001 and from 13.1 ± 1.2 to 13.6 ± 1.1 g kg-1 , +4.1%, P < 0.001, respectively) and team-sport athletes (from 920 ± 120 to 957 ± 127 g, +4.0%, P < 0.001 and from 11.9 ± 0.9 to 12.3 ± 0.9 g kg-1 , +4.0%, P < 0.001, respectively) after LHTL. The direct comparison study using individual data of male endurance and team-sport athletes and strict methodological control (duplicate Hbmass measures and matched hypoxic dose) indicated that even athletes with higher initial Hbmass can reasonably expect Hbmass gain post-LHTL.

Individual hemoglobin mass response to normobaric and hypobaric "live high-train low": A one-year crossover study.

The purpose of this research was to compare individual hemoglobin mass (Hbmass) changes following a live high-train low (LHTL) altitude training camp under either normobaric hypoxia (NH) or hypobaric hypoxia (HH) conditions in endurance athletes. In a crossover design with a one-year washout, 15 male triathletes randomly performed two 18-day LHTL training camps in either HH or NH. All athletes slept at 2,250 meters and trained at altitudes <1,200 meters. Hbmass was measured in duplicate with the optimized carbon monoxide rebreathing method before (pre) and immediately after (post) each 18-day training camp. Hbmass increased similarly in HH (916-957 g, 4.5 ± 2.2%, P < 0.001) and in NH (918-953 g, 3.8 ± 2.6%, P < 0.001). Hbmass changes did not differ between HH and NH (P = 0.42). There was substantial interindividual variability among subjects to both interventions (i.e., individual responsiveness or the individual variation in the response to an intervention free of technical noise): 0.9% in HH and 1.7% in NH. However, a correlation between intraindividual ΔHbmass changes (%) in HH and in NH (r = 0.52, P = 0.048) was observed. HH and NH evoked similar mean Hbmass increases following LHTL. Among the mean Hbmass changes, there was a notable variation in individual Hbmass response that tended to be reproducible.NEW & NOTEWORTHY This is the first study to compare individual hemoglobin mass (Hbmass) response to normobaric and hypobaric live high-train low using a same-subject crossover design. The main findings indicate that hypobaric and normobaric hypoxia evoked a similar mean increase in Hbmass following 18 days of live high-train low. Notable variability and reproducibility in individual Hbmass responses between athletes was observed, indicating the importance of evaluating individual Hbmass response to altitude training.

Same Performance Changes after Live High-Train Low in Normobaric vs. Hypobaric Hypoxia.

PURPOSE: We investigated the changes in physiological and performance parameters after a Live High-Train Low (LHTL) altitude camp in normobaric (NH) or hypobaric hypoxia (HH) to reproduce the actual training practices of endurance athletes using a crossover-designed study. METHODS: Well-trained triathletes (n = 16) were split into two groups and completed two 18-day LTHL camps during which they trained at 1100-1200 m and lived at 2250 m (P i O2 = 111.9 ± 0.6 vs. 111.6 ± 0.6 mmHg) under NH (hypoxic chamber; FiO2 18.05 ± 0.03%) or HH (real altitude; barometric pressure 580.2 ± 2.9 mmHg) conditions. The subjects completed the NH and HH camps with a 1-year washout period. Measurements and protocol were identical for both phases of the crossover study. Oxygen saturation (S p O2) was constantly recorded nightly. P i O2 and training loads were matched daily. Blood samples and VO2max were measured before (Pre-) and 1 day after (Post-1) LHTL. A 3-km running-test was performed near sea level before and 1, 7, and 21 days after training camps. RESULTS: Total hypoxic exposure was lower for NH than for HH during LHTL (230 vs. 310 h; P < 0.001). Nocturnal S p O2 was higher in NH than in HH (92.4 ± 1.2 vs. 91.3 ± 1.0%, P < 0.001). VO2max increased to the same extent for NH and HH (4.9 ± 5.6 vs. 3.2 ± 5.1%). No difference was found in hematological parameters. The 3-km run time was significantly faster in both conditions 21 days after LHTL (4.5 ± 5.0 vs. 6.2 ± 6.4% for NH and HH), and no difference between conditions was found at any time. CONCLUSION: Increases in VO2max and performance enhancement were similar between NH and HH conditions.

Similar Hemoglobin Mass Response in Hypobaric and Normobaric Hypoxia in Athletes.

PURPOSE: To compare hemoglobin mass (Hb(mass)) changes during an 18-d live high-train low (LHTL) altitude training camp in normobaric hypoxia (NH) and hypobaric hypoxia (HH). METHODS: Twenty-eight well-trained male triathletes were split into three groups (NH: n = 10, HH: n = 11, control [CON]: n = 7) and participated in an 18-d LHTL camp. NH and HH slept at 2250 m, whereas CON slept, and all groups trained at altitudes <1200 m. Hb(mass) was measured in duplicate with the optimized carbon monoxide rebreathing method before (pre-), immediately after (post-) (hypoxic dose: 316 vs 238 h for HH and NH), and at day 13 in HH (230 h, hypoxic dose matched to 18-d NH). Running (3-km run) and cycling (incremental cycling test) performances were measured pre and post. RESULTS: Hb(mass) increased similar in HH (+4.4%, P < 0.001 at day 13; +4.5%, P < 0.001 at day 18) and NH (+4.1%, P < 0.001) compared with CON (+1.9%, P = 0.08). There was a wide variability in individual Hb(mass) responses in HH (-0.1% to +10.6%) and NH (-1.4% to +7.7%). Postrunning time decreased in HH (-3.9%, P < 0.001), NH (-3.3%, P < 0.001), and CON (-2.1%, P = 0.03), whereas cycling performance changed nonsignificantly in HH and NH (+2.4%, P > 0.08) and remained unchanged in CON (+0.2%, P = 0.89). CONCLUSION: HH and NH evoked similar Hb(mass) increases for the same hypoxic dose and after 18-d LHTL. The wide variability in individual Hb(mass) responses in HH and NH emphasizes the importance of individual Hb(mass) evaluation of altitude training.

Association of Hematological Variables with Team-Sport Specific Fitness Performance.

PURPOSE: We investigated association of hematological variables with specific fitness performance in elite team-sport players. METHODS: Hemoglobin mass (Hbmass) was measured in 25 elite field hockey players using the optimized (2 min) CO-rebreathing method. Hemoglobin concentration ([Hb]), hematocrit and mean corpuscular hemoglobin concentration (MCHC) were analyzed in venous blood. Fitness performance evaluation included a repeated-sprint ability (RSA) test (8 x 20 m sprints, 20 s of rest) and the Yo-Yo intermittent recovery level 2 (YYIR2). RESULTS: Hbmass was largely correlated (r = 0.62, P<0.01) with YYIR2 total distance covered (YYIR2TD) but not with any RSA-derived parameters (r ranging from -0.06 to -0.32; all P>0.05). [Hb] and MCHC displayed moderate correlations with both YYIR2TD (r = 0.44 and 0.41; both P<0.01) and RSA sprint decrement score (r = -0.41 and -0.44; both P<0.05). YYIR2TD correlated with RSA best and total sprint times (r = -0.46, P<0.05 and -0.60, P<0.01; respectively), but not with RSA sprint decrement score (r = -0.19, P>0.05). CONCLUSION: Hbmass is positively correlated with specific aerobic fitness, but not with RSA, in elite team-sport players. Additionally, the negative relationships between YYIR2 and RSA tests performance imply that different hematological mechanisms may be at play. Overall, these results indicate that these two fitness tests should not be used interchangeably as they reflect different hematological mechanisms.

Influence of Hypoxic Interval Training and Hyperoxic Recovery on Muscle Activation and Oxygenation in Connection with Double-Poling Exercise.

Here, we evaluated the influence of breathing oxygen at different partial pressures during recovery from exercise on performance at sea-level and a simulated altitude of 1800 m, as reflected in activation of different upper body muscles, and oxygenation of the m. triceps brachii. Ten well-trained, male endurance athletes (25.3±4.1 yrs; 179.2±4.5 cm; 74.2±3.4 kg) performed four test trials, each involving three 3-min sessions on a double-poling ergometer with 3-min intervals of recovery. One trial was conducted entirely under normoxic (No) and another under hypoxic conditions (Ho; FiO2 = 0.165). In the third and fourth trials, the exercise was performed in normoxia and hypoxia, respectively, with hyperoxic recovery (HOX; FiO2 = 1.00) in both cases. Arterial hemoglobin saturation was higher under the two HOX conditions than without HOX (p<0.05). Integrated muscle electrical activity was not influenced by the oxygen content (best d = 0.51). Furthermore, the only difference in tissue saturation index measured via near-infrared spectroscopy observed was between the recovery periods during the NoNo and HoHOX interventions (P<0.05, d = 0.93). In the case of HoHo the athletes' Pmean declined from the first to the third interval (P < 0.05), whereas Pmean was unaltered under the HoHOX, NoHOX and NoNo conditions. We conclude that the less pronounced decline in Pmean during 3 x 3-min double-poling sprints in normoxia and hypoxia with hyperoxic recovery is not related to changes in muscle activity or oxygenation. Moreover, we conclude that hyperoxia (FiO2 = 1.00) used in conjunction with hypoxic or normoxic work intervals may serve as an effective aid when inhaled during the subsequent recovery intervals.

"Live High-Train Low and High" Hypoxic Training Improves Team-Sport Performance.

PURPOSE: This study aims to investigate physical performance and hematological changes in 32 elite male team-sport players after 14 d of "live high-train low" (LHTL) training in normobaric hypoxia (≥14 h·d at 2800-3000 m) combined with repeated-sprint training (six sessions of four sets of 5 × 5-s sprints with 25 s of passive recovery) either in normobaric hypoxia at 3000 m (LHTL + RSH, namely, LHTLH; n = 11) or in normoxia (LHTL + RSN, namely, LHTL; n = 12) compared with controlled "live low-train low" (LLTL; n = 9) training. METHODS: Before (Pre), immediately after (Post-1), and 3 wk after (Post-2) the intervention, hemoglobin mass (Hbmass) was measured in duplicate [optimized carbon monoxide (CO) rebreathing method], and vertical jump, repeated-sprint (8 × 20 m-20 s recovery), and Yo-Yo Intermittent Recovery level 2 (YYIR2) performances were tested. RESULTS: Both hypoxic groups similarly increased their Hbmass at Post-1 and Post-2 in reference to Pre (LHTLH: +4.0%, P < 0.001 and +2.7%, P < 0.01; LHTL: +3.0% and +3.0%, both P < 0.001), whereas no change occurred in LLTL. Compared with Pre, YYIR2 performance increased by ∼21% at Post-1 (P < 0.01) and by ∼45% at Post-2 (P < 0.001), with no difference between the two intervention groups (vs no change in LLTL). From Pre to Post-1, cumulated sprint time decreased in LHTLH (-3.6%, P < 0.001) and LHTL (-1.9%, P < 0.01), but not in LLTL (-0.7%), and remained significantly reduced at Post-2 (-3.5%, P < 0.001) in LHTLH only. Vertical jump performance did not change. CONCLUSIONS: "Live high-train low and high" hypoxic training interspersed with repeated sprints in hypoxia for 14 d (in season) increases the Hbmass, YYIR2 performance, and repeated-sprint ability of elite field team-sport players, with benefits lasting for at least 3 wk postintervention.

Comparison of "Live High-Train Low" in normobaric versus hypobaric hypoxia.

We investigated the changes in both performance and selected physiological parameters following a Live High-Train Low (LHTL) altitude camp in either normobaric hypoxia (NH) or hypobaric hypoxia (HH) replicating current "real" practices of endurance athletes. Well-trained triathletes were split into two groups (NH, n = 14 and HH, n = 13) and completed an 18-d LHTL camp during which they trained at 1100-1200 m and resided at an altitude of 2250 m (PiO2  = 121.7±1.2 vs. 121.4±0.9 mmHg) under either NH (hypoxic chamber; FiO2 15.8±0.8%) or HH (real altitude; barometric pressure 580±23 mmHg) conditions. Oxygen saturations (SpO2) were recorded continuously daily overnight. PiO2 and training loads were matched daily. Before (Pre-) and 1 day after (Post-) LHTL, blood samples, VO2max, and total haemoglobin mass (Hb(mass)) were measured. A 3-km running test was performed near sea level twice before, and 1, 7, and 21 days following LHTL. During LHTL, hypoxic exposure was lower for the NH group than for the HH group (220 vs. 300 h; P<0.001). Night SpO2 was higher (92.1±0.3 vs. 90.9±0.3%, P<0.001), and breathing frequency was lower in the NH group compared with the HH group (13.9±2.1 vs. 15.5±1.5 breath.min(-1), P<0.05). Immediately following LHTL, similar increases in VO2max (6.1±6.8 vs. 5.2±4.8%) and Hb(mass) (2.6±1.9 vs. 3.4±2.1%) were observed in NH and HH groups, respectively, while 3-km performance was not improved. However, 21 days following the LHTL intervention, 3-km run time was significantly faster in the HH (3.3±3.6%; P<0.05) versus the NH (1.2±2.9%; ns) group. In conclusion, the greater degree of race performance enhancement by day 21 after an 18-d LHTL camp in the HH group was likely induced by a larger hypoxic dose. However, one cannot rule out other factors including differences in sleeping desaturations and breathing patterns, thus suggesting higher hypoxic stimuli in the HH group.

Differences in horizontal vs. uphill running performance in male and female Swiss world-class orienteers.

In orienteering, athletes must choose the quickest route from point to point, considering if they want to run a longer flat distance rather than a shorter distance with an incline to reach the next point. Our aim was therefore, to determine an athlete's equivalence factor (EF, ratio between horizontal and uphill running performance) enabling coaches to provide individual route choice recommendations during orienteering competition. Ten male and 8 female orienteers performed 1 horizontal (MST(horizontal); 0% incline) and 1 uphill (MST(uphill); 22% incline) maximal running stage test to exhaustion on a treadmill in randomized order. The EFs were calculated based on maximal speeds achieved in both tests (MRV(horizontal/uphill)). In addition, VO2peak was measured. MRV(horizontal) was 20.4 ± 0.6 and 17.3 ± 0.8 km · h, and MRV(uphill) was 8.8 ± 0.7 and 7.2 ± 0.5 km · h (men and women). The EF was 6.3 ± 0.7 and ranged between 5.2 and 7.4. Relative VO2peak(uphill) was 69.2 ± 5.7 and 59.1 ± 3.7 m l · kg · min, whereas VO2peak(horizontal) was lower 66.4 ± 3.5 (p < 0.05) and 55.7 ± 3.1 ml · kg · min (p < 0.01) than in VO2peak(uphill). Relative VO2peak(uphill) correlated strongly with MRV(uphill) (men: r = 0.85, p < 0.01; women: r = 0.84, p < 0.01), whereas relative VO2peak(horizontal) showed no strong correlation with MRV(horizontal) (men: r = 0.51, p = 0.12; women: r = 0.41, p = 0.32). These data show that there are relevant differences in the relation between uphill and horizontal running capacity in these athletes. Tailoring the route selection to the athletes' advantage based on the relation between their uphill and horizontal running performance and individual EF may positively impact on overall performance in orienteering competition.

Comparability of haemoglobin mass measured with different carbon monoxide-based rebreathing procedures and calculations.

BACKGROUND: Measurements of haemoglobin mass (Hb(mass)) with the carbon monoxide (CO) rebreathing method provide valuable information in the field of sports medicine, and have markedly increased during the last decade. However, several different approaches (as a combination of the rebreathing procedure and subsequent calculations) for measuring Hb(mass) are used, and routine measurements have indicated that the Hb(mass) differs substantially among various approaches. Therefore, the aim of this study was to compare the Hb(mass) of the seven most commonly used approaches, and then to provide conversion factors for an improved comparability of Hb(mass) measured with the different approaches. METHODS: Seventeen subjects (healthy, recreationally active, male, age 27.1 ± 1.8 y) completed 3 CO-rebreathing measurements in randomized order. One was based on the 12-min original procedure (CO(original)), and two were based on the 2-min optimized procedure (CO(new)). From these measurements Hb(mass) for seven approaches (CO(originalA-E); CO(newA-B)) was calculated. RESULTS: Hb(mass) estimations differed among these approaches (p < 0.01). Hb(mass) averaged 960 ± 133 g (CO(newB)), 981 ± 136 g (CO(newA)), 989 ± 130 g (CO(originalE)), 993 ± 126 g (CO(originalA,D)), 1030 ± 130 g (CO(originalB)), and 1053 ± 133 g (CO(originalC)). Procedural variations had a minor influence on measured Hb(mass). CONCLUSIONS: The relevant discrepancies between the CO-rebreathing approaches originate mainly from different underlying calculations for Hb(mass). Provided Hb(mass) enabled the development of conversion factors to compare average Hb(mass) values measured with different CO-rebreathing approaches. These factors can be used to develop reasonable Hb(mass) reference ranges for both clinical and athletic purposes.