Type 2 diabetes mellitus and obesity in young adults: the extreme phenotype with early cardiovascular dysfunction.

AIM: A pilot study to phenotype young adults (< 40 years) with Type 2 diabetes mellitus. METHODS: Twenty people with Type 2 diabetes (aged 18-40 years), 10 lean and 10 obese control subjects underwent detailed assessment, including tagged cardiac magnetic resonance imaging, inflammatory proteins, lipids, vitamin D and maximal oxygen uptake. Outcomes were compared between the group with Type 2 diabetes and the control group. RESULTS: Mean (standard deviation) age, Type 2 diabetes duration and BMI in the group with Type 2 diabetes were 31.8 (6.6) years, 4.7 (4.0) years and 33.9 (5.8) kg/m(2) respectively. Compared with lean control subjects, those with Type 2 diabetes had more deleterious profiles of hyperlipidaemia, vitamin D deficiency, inflammation and maximal oxygen uptake relative to body mass. However, there was no difference between the group with Type 2 diabetes and the obese control group. The group with Type 2 diabetes had a higher left ventricular mass and a trend towards concentric remodelling compared with the lean control group (P = 0.002, P = 0.052) but not the obese control group (P > 0.05). Peak early diastolic strain rate was reduced in the group with Type 2 diabetes [1.51 (0.24)/s] compared with the lean control [1.97 (0.34)/s, P = 0.001] and obese control [1.78 (0.39)/s, P = 0.042] group. CONCLUSIONS: Young adults with Type 2 diabetes and those with obesity have similar adverse cardiovascular risk profiles, higher left ventricular mass and a trend towards left ventricular concentric remodelling. In addition, those with Type 2 diabetes demonstrate diastolic dysfunction, a known risk marker for future heart failure and mortality.

Interleukin-6 in combination with the interleukin-6 receptor stimulates glucose uptake in resting human skeletal muscle independently of insulin action.

AIM: To examine if the physiological concentrations of both interleukin-6 (IL-6), in combination with IL-6 receptor (IL-6R), are able to stimulate glucose uptake in human skeletal muscle and to identify the associated signalling pathways. METHODS: Skeletal muscle tissue (~60 mg) obtained from healthy female volunteers via muscle biopsy was subjected to incubation in the absence or presence of insulin (60 µU/ml), recombinant human IL-6 (rhIL-6) (4 ng/ml) or a combination of rhIL-6 (4 ng/ml) and rhIL-6R (100 ng/ml) for 30 min, with glucose transport measured for each incubation. Western blot analysis was conducted on key signalling proteins, protein kinase B (PKB/Akt), adenosine monophosphate kinase (AMPK) and mammalian target of rapamycin (mTOR) to gain an early insight into any differing transport mechanisms. RESULTS: Human skeletal muscle exhibited increased glucose uptake with insulin (1.85-fold; p < 0.05) and stimulated phosphorylation of PKB/Akt and AMPK (0.98 ± 0.23 and 1.49 ± 0.13, respectively, phosphorylated: total; p < 0.05). IL-6/IL-6R increased phosphorylation of mTOR (fourfold, p < 0.05) compared to insulin, IL-6 alone and basal control. IL-6 did not stimulate glucose uptake but combined with IL-6R, induced 1.5-fold increase in glucose uptake (p < 0.05) and phosphorylation of AMPK (0.95 ± 0.19; phosphorylated: total, p < 0.05). CONCLUSIONS: IL-6 in combination with IL-6R and not IL-6 alone increased glucose uptake in human skeletal muscle. IL-6/IL-6R-mediated glucose uptake occurred independently of PKB/Akt phosphorylation, showing that IL-6/IL-6R-induced glucose uptake is dependent on a divergent pathway.

Dynamic changes in dna methylation status in peripheral blood Mononuclear cells following an acute bout of exercise: Potential impact of exercise-induced elevations in interleukin-6 concentration.

The aim of the present study was to examine the relationship between interleukin (IL)-6 concentrations and DNA methylation in the peripheral blood mononuclear cells (PBMCs) of trained runners after a bout of prolonged, strenuous exercise. Eight healthy trained males completed a treadmill run at 60% vVO(2max) for 120 min followed by a 5-km time trial in a fasted condition. Whole blood samples were taken prior to, immediately before and 24 h following exercise. From these samples, PBMCs were isolated for analysis and plasma IL-6 concentrations were measured. The methylation status of DNA extracted from PBMCs was analysed using the Illumina 27k methylation beadchip platform. Global DNA methylation status was unaltered immediately and up to 24 hours following a bout of prolonged exercise in comparison to pre-exercise. Despite no change in global DNA methylation, plasma IL-6 concentrations were significantly related to the DNA methylation status of 11 genes. Our study demonstrates that the methylome is stable, while discovering a novel link between exercise-induced increases in circulating IL-6 and the DNA methylation status of 11 individual genes. Based on our preliminary findings, the mechanisms by which changes in plasma IL-6 concentrations and DNA methylation in response to exercise interact require further study.

Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health.

AIMS/HYPOTHESIS: The study aimed to examine the associations between objectively measured sedentary time, breaks in sedentary time, moderate-to-vigorous physical activity (MVPA) and total physical activity with markers of cardiometabolic health in a population with known risk factors for type 2 diabetes mellitus. METHODS: This study reports data from two ongoing diabetes prevention programmes. Participants with known risk factors were recruited from primary care practices located within the East Midlands, UK, over the period 2010-2011. ActiGraph GT3X accelerometers (15 s epochs) were used to assess sedentary time (<25 counts per 15 s), MVPA (≥ 488 counts per 15 s) and total physical activity (total counts). A break was considered as any interruption in sedentary time (≥ 25 counts per 15 s). Linear regression examined the independent association of sedentary time, breaks in sedentary time, MVPA and total physical activity with markers of cardiometabolic health. RESULTS: The sample comprised 878 participants; 153 from Project STAND (Sedentary Time And Diabetes) (age 32.9 ± 5.6 years, 28.8% male) and 725 from Walking Away from Diabetes (age 63.7 ± 7.8 years, 64.8% male). Following adjustment for various covariates, including MVPA and BMI, there were detrimental linear associations of sedentary time with 2 h plasma glucose (standardised beta coefficient) (ß = 0.220, p < 0.001), triacylglycerol (ß = 0.206, p = 0.001) and HDL-cholesterol (ß = -0.123, p = 0.029). Breaks in sedentary time, total physical activity and MVPA were significantly inversely associated with measures of adiposity, but not with any other cardiometabolic variables after adjustment for sedentary time and BMI. CONCLUSIONS/INTERPRETATION: In adults at high risk of type 2 diabetes mellitus, time spent sedentary is strongly and adversely associated with cardiometabolic health and may be a more important indicator of poor health than MVPA.

Prevalence of diabetes and impaired glucose metabolism in younger 'at risk' UK adults: insights from the STAND programme of research.

AIMS: Rising rates of obesity have led to an increasing prevalence of Type 2 diabetes mellitus in young people. Uncertainty exists over the utility of screening younger adults for Type 2 diabetes, as existing data sets have focused on mature (> 40 years) cohorts. The aim of this study was to determine the prevalence of impaired glucose metabolism in higher risk younger adults. METHODS: Overweight (with an additional risk factor) or obese adults (18-40 years) were recruited for the Sedentary Time And Diabetes (STAND) randomized controlled trial. Measures included an oral glucose tolerance test, HbA1c , biochemical and anthropometric data. RESULTS: One hundred and ninety-three individuals (68% female; median age 33.8 years; median BMI 33.9 kg/m²) were recruited. Forty-three per cent had a first-degree family history of Type 2 diabetes. Previously undiagnosed Type 2 diabetes was present in 4.7% (n = 9). Of participants, 18.1% (n = 35) had impaired glucose metabolism: 4.7% (n = 9) HbA1c ≥ 48 mmol/mol (6.5%); 9.3% (n = 18) HbA1c 42-46 mmol/mol (6.0-6.4%); 3.1% (n = 6) Type 2 diabetes on oral glucose tolerance test; 6.2% (n = 12) isolated impaired glucose tolerance; 2.1% (n = 4) isolated impaired fasting glucose; 1% (n = 2) both impaired fasting glucose and impaired glucose tolerance. Of participants, 58.5% (n = 113) had dyslipidaemia, 28.0% (n = 54) had hypertension, 31.1% (n = 60) were vitamin D deficient and 7.3% (n = 14) had abnormal liver function. CONCLUSIONS: This study identified a high prevalence of Type 2 diabetes and impaired glucose regulation in overweight and obese younger adults. These findings require confirmation in a larger, representative, population.

The effect of physical activity on mediators of inflammation.

Being physically active and undertaking exercise on a regular basis are critical lifestyle behaviours which protect against the development of numerous chronic metabolic conditions. One of the key mechanisms by which physical activity exerts favourable health effects appears to be due to its capacity to reduce chronic low-grade inflammation. Single bouts of exercise have a potent anti-inflammatory influence with recent advances describing important effects of acute exercise on inflammatory mediators produced within skeletal muscle (myokines), adipose tissue (adipokines) and leucocytes. The accumulated effects of physical activity or exercise training on systemic inflammation have been studied widely within epidemiological research; however, information from intervention trials is still emerging. Current data suggest that the most marked improvements in the inflammatory profile are conferred with exercise performed at higher intensities, with combined aerobic and resistance exercise training potentially providing the greatest benefit. The purpose of this review is to describe recent advances in our understanding surrounding the acute and chronic effects of physical activity on key mediators of inflammation. Within this, particular attention is given to the interleukin-6 system owing to its apparent centrality in mediating the anti-inflammatory effects of exercise.

Plasma IL-6, its soluble receptors and F2-isoprostanes at rest and during exercise in chronic fatigue syndrome.

The aim of the current study was to investigate the levels of interleukin-6 (IL-6), its soluble receptors (sIL-6R and sgp130) and F(2)-isoprostanes, at rest and during exercise, in patients with chronic fatigue syndrome (CFS). Six male CFS patients and six healthy controls performed an incremental exercise test to exhaustion and a submaximal exercise bout to exhaustion. Blood samples taken in the submaximal test at rest, immediately post-exercise and 24 h post-exercise were analyzed for IL-6, sIL-6R, sgp130 and F(2)-isoprostanes. A further 33 CFS and 33 healthy control participants gave a resting blood sample for IL-6 and sIL-6R measurement. During the incremental exercise test only power output at the lactate threshold was lower (P<0.05) in the CFS group. F(2)-isoprostanes were higher (P<0.05) in CFS patients at rest and this difference persisted immediately and 24 h post-exercise. The exercise study found no differences in IL-6, sIL-6R or sgp130 at any time point between groups. In the larger resting group, there were no differences in IL-6 and sIL-6R between CFS and control groups. This investigation has demonstrated that patients with CFS do not have altered plasma levels of IL-6, sIL-6R or sgp130 either at rest or following exercise. F(2)-isoprostanes, however, were consistently higher in CFS patients.

The response of circulating levels of the interleukin-6/interleukin-6 receptor complex to exercise in young men.

The formation of an interleukin-6/IL-6 receptor (IL-6/IL-6R) complex increases the biological activity and half-life of IL-6, with its response to exercise currently unknown. The aim of the present study was to determine the response of circulating levels of the IL-6/IL-6R complex to exercise. Nine healthy male participants performed 1h of cycling exercise at a workload required to elicit 90% lactate threshold. Venous blood samples were taken at rest, immediately post-exercise and after 1.5 h rest. Hemoglobin concentration and hematocrit were measured to estimate changes in plasma volume during exercise. The concentrations of IL-6, sIL-6R and the IL-6/IL-6R complex were measured via ELISA and corrected for changes in plasma volume. A single bout of acute exercise resulted in a 5-fold increase (P<0.05) in IL-6 and a 1.2-fold increase (P<0.05) in sIL-6R immediately after exercise. These returned to baseline at 1.5 h after the cessation of exercise. There was a 2.1-fold increase (P<0.05) in the levels of the IL-6/IL-6R complex post-exercise with levels remaining 1.8 times elevated (P<0.05) after 1.5 h rest. The present study has demonstrated, for the first time, that circulating levels of the IL-6/IL-6R complex are increased in response to acute exercise in young males.

The effect of exercise training on intrahepatic triglyceride and hepatic insulin sensitivity: a systematic review and meta-analysis.

This systematic review and meta-analysis determined the impact of structured exercise training, and the influence of associated weight loss, on intrahepatic triglyceride (IHTG) in individuals with non-alcoholic fatty liver disease (NAFLD). It also examined its effect on hepatic insulin sensitivity in individuals with or at increased risk of NAFLD. Analyses were restricted to studies using magnetic resonance spectroscopy or liver biopsy for the measurement of IHTG and isotope-labelled glucose tracer for assessment of hepatic insulin sensitivity. Pooling data from 17 studies (373 exercising participants), exercise training for one to 24 weeks (mode: 12 weeks) elicits an absolute reduction in IHTG of 3.31% (95% CI: -4.41 to -2.22%). Exercise reduces IHTG independent of significant weight change (-2.16 [-2.87 to -1.44]%), but benefits are substantially greater when weight loss occurs (-4.87 [-6.64 to -3.11]%). Furthermore, meta-regression identified a positive association between percentage weight loss and absolute reduction in IHTG (ß = 0.99 [0.62 to 1.36], P < 0.001). Pooling of six studies (94 participants) suggests that exercise training also improves basal hepatic insulin sensitivity (mean change in hepatic insulin sensitivity index: 0.13 [0.05 to 0.21] mg m-2  min-1 per µU mL-1 ), but available evidence is limited, and the impact of exercise on insulin-stimulated hepatic insulin sensitivity remains unclear.

Spontaneous activity responses to exercise in males and females.

OBJECTIVE: This study examines the impact of a short-term exercise programme, prescribed on the basis of current exercise recommendations, on energy balance in males and females to assess whether this type of exercise induces compensatory changes in spontaneous activity energy expenditure (SAEE) and energy intake (EI). DESIGN: Individuals were monitored for 16 days, 8 days of habitual physical activity (C) and 8 days when exercise was imposed (E). Total energy expenditure (TEE) was calculated from individual relationships of VO2 and VCO2 to heart rate (HR) records of HR and physical activity obtained during waking hours of the C and E periods and basal metabolic rate (BMR) measurements (Deltatrac System, Datex Instrumentation). Changes in nude body mass (BM) were estimated by using a digital scale (Sartorius AG, Gottigen, Germany). SETTING: Laboratory and free-living. SUBJECTS: Eight lean females (body fat: 17.5+/-4.5%) and eight males of similar percentage body fat participated in this study. All subjects were Caucasian and aged between 20 and 25 years. INTERVENTION: During the E period, a supervised exercise session was conducted every second day, each consisting of a total net energy expenditure of 2092 kJ+BMR at 90% lactate threshold. RESULTS: During the E period, TEE was higher than C in males and females (exercise: 95.2+/-13.9, 78.3+/-15.9 MJ; control: 82.4+/-10.4, 68.8+/-16.7 MJ, respectively; P<0.00; P=0.02). SAEE, calculated as TEE minus the energy expended during exercise, was not significantly different between C (males: 82.4+/-4.8 MJ; females: 68.8+/-7.6 MJ) and E (males: 86.8+/-6.3 MJ; females: 70.0+/-7.2 MJ) periods in either gender. Males showed no change in BM over the C (pre-intervention: 83.4+/-7.2 kg; post-intervention: 83.1+/-6.8 kg) or E (pre-intervention: 83.4+/-6.8 kg; post-intervention: 83.4+/-6.8 kg) periods. Females' BM over the C period did not alter (pre-intervention: 63.3+/-2.8 kg; post-intervention 63.7+/-3.1 kg); however, there was a significant decrease (P<0.00) in BM over the E period (pre-intervention: 63.0+/-2.7 kg; post-intervention: 62.4+/-2.7 kg). CONCLUSION: The exercise programme was achieved in males and females without any impact on SAEE. Therefore, differences between genders in relation to BM reduction can be explained by differences in the EI response to exercise.

Intermittent running: muscle metabolism in the heat and effect of hypohydration.

PURPOSE: This study reports two studies that investigated the reason for a poorer intermittent supramaximal running performance previously found in the heat (Maxwell et al., The effect of climatic heat stress on intermittent supramaximal running performance in humans. Exp. Physiol. 81:833-845, 1996). The first study tested the hypothesis that it was due to different rates of substrate metabolism. The second study tested whether a greater level of hypohydration led to an earlier exhaustion time. METHODS: A maximal anaerobic running test (MART) was the exercise model used. This involved repeated 20-s runs, each at increasing intensities, with 100 s of passive recovery between runs. RESULTS: In study 1, eight male subjects performed the MART on two occasions at either 32.8+/-0.3 degrees C, 80.5+/-1.6% relative humidity (RH), or 21.3+/-0.4 degrees C, 48.8+/-2.2% RH. Needle biopsy samples were taken from the vastus lateralis muscle before and immediately after the MART. In study 2, 11 male subjects performed the MART in a moderately hypohydrated (HYPO) and euhydrated (EUH) state while in a cool environment. In study 1, performance was significantly worse in the hot compared with the cool environment (138+/-7 vs. 150+/-6 s, respectively, P<0.05). No differences were observed in the change in muscle glycogen (100.3+/-15.1 vs. 107.0+/-15.6 mmol glucosyl units x kg dry muscle(-1)) or muscle lactate (102.9+/-18.2 vs. 100.5+/-16.6 mmol x kg dry muscle(-1)) between the hot and cool environments, respectively. In study 2, performance was worse in the HYPO (148+/-9 s) compared with the EUH (154+/-9 s) trial (P<0.05). CONCLUSIONS: These results indicate that a reduced intermittent supramaximal running performance in the heat is not caused by greater muscle glycogenolysis or lactate accumulation. Further, a poorer intermittent sprinting performance is experienced in a hypohydrated compared with a euhydrated state.

Effects of central sympathetic inhibition on heart rate variability during steady-state exercise in healthy humans.

The profound reduction in heart rate variability (HRV) that occurs during exercise is thought to be, at least in part, the result of sympathetic nervous system activation. Moxonidine is a centrally acting anti-sympathetic drug, which suppresses sympathetic nervous system outflow by stimulation of central imidazoline receptors located in the rostral ventro-lateral medulla. This study was designed to investigate the combined effects of central sympathetic inhibition with moxonidine and steady-dynamic exercise on HRV. Ten normal males participated in a double-blind cross-over study, taking either placebo or 0.4 mg of moxonidine. The subjects were studied at rest and during steady-state exercise. HRV was measured considering both time and frequency domain parameters. As a non-linear measure, the Poincaré scatter-plot was measured and analysed quantitatively. Ventilation and gas exchange were also measured during exercise. In addition, plasma catecholamines were measured at rest and during exercise. The only parameter changed, at rest, by moxonidine was the blood pressure which was reduced. During exercise, moxonidine reduced plasma noradrenaline (NA), compared with the placebo (P<0.01). The only change observed in HRV during exercise was a significant reduction of the continuous long-term standard deviation (SD2) of the Poincaré scatter-plot of the R-R interval (P<0.05). However, the potential and prognostic significance of this result needs to be further assessed.

Effects of nandrolone phenylpropionate in the horse: (1) resting animal.

The effects of 7 weekly injections of the anabolic steroid nandrolone phenylpropionate (400 mg) were investigated in 4 healthy, mature geldings. Measurement of body weight, nitrogen retention and plasma urea failed to demonstrate a consistent anabolic effects. Examination of biopsies from the semitendinosus and biceps femoris muscles showed no alteration in water content or glycogen concentration with treatment. Similarly no changes were found in the activities of 6 muscle enzymes. However, a significant increase in the proportion of fast twitch low oxidative fibres of the biceps femoris was observed. The effects of the treatment on a wide range of plasma biochemical constituents were investigated. The occurrence of some components of stallion behaviour in the geldings was taken to reflect a residual androgenic activity in the compound.

Effects of nandrolone phenylpropionate in the horse: (2) general effects in animals undergoing training.

The effect of 11 weekly injections of nandrolone phenylpropionate (400 mg) was investigated by a crossover trial (2 training periods) in 6 Thoroughbred geldings undergoing training. A decrease in body weight and flank measurement occurred only during the first training period and was not modified by the anabolic steroid. Urinary nitrogen excretion was lower in the anabolic treated animals only in the first training period. Neither training nor training plus nandrolone phenylpropionate administration caused any marked alteration in blood biochemistry or haematology. A significant decrease in plasma chloride and increase in haematocrit occurred independent of treatment in the latter, more extensive anaerobic training of both parts of the crossover. No change in urinary pH or specific gravity was found throughout the study. No evidence of improved racing performance due to nandrolone phenylpropionate administration was observed. Behavioural changes attributed to the drug could be detected for at least 6 weeks after the cessation of treatment.

Effects of nandrolone phenylpropionate in the horse: (3) skeletal muscle composition in the exercising animal.

The effect of 11 weekly injections of nandrolone phenylpropionate (400 mg) on some skeletal muscle parameters was investigated in 6 Thoroughbred geldings undergoing training. Three muscles were sampled, the middle gluteal, the biceps femoris and the semitendinosus. Training alone produced increases in the percentage of fast twitch high oxidative fibres (FTH), glycogen content and the activities of citrate synthase, 3-hydroxyacl CoA dehydrogenase and cytochrome oxidase. In contrast the training programme did not alter water content, total protein content, the activities of lactate dehydrogenase, phosphofructokinase of beta glucuronidase, fibre area ratios or the number of capillaries per unit fibre area. Nandrolone phenylpropionate given in conjunction with the training programme only resulted in changes in 2 of these parameters. There was no increase in the percentage of FTH fibres in the biceps femoris with anaerobic training and the fibre area ratio increased significantly in this muscle.

Response of plasma IL-6 and its soluble receptors during submaximal exercise to fatigue in sedentary middle-aged men.

The pleiotropic cytokine interleukin-6 (IL-6) has been demonstrated to increase during exercise. Little is known regarding the response of the soluble IL-6 receptors (sIL-6R and sgp130) during such exercise. The aim of the current study was to investigate the response of plasma IL-6, sIL-6R and sgp130 during fatiguing submaximal exercise in humans. Twelve participants underwent an incremental exercise test to exhaustion and one week later performed a submaximal exercise bout (96 +/- 6% lactate threshold) to volitional exhaustion. Blood samples taken at rest and immediately post exercise were analyzed for IL-6, sIL-6R and sgp130. IL-6 increased (P < 0.01) by 8.4 +/- 8.9 pg ml(-1) (75.7%) during the exercise period. sIL-6R and sgp130 also increased (P < 0.05) by 2.7 +/- 3.9 ng ml(-1) (9.6%) and 37.7 +/- 55.6 ng ml(-1) (9.6%), respectively. The current study is the first investigation to demonstrate that alongside IL-6, acute exercise stress results in an increase in both sIL-6R and sgp130.

Effect of moderate-intensity exercise session on preprandial and postprandial responses of circulating ghrelin and appetite.

Responses of plasma total ghrelin and appetite were investigated during preprandial and postprandial stages of recovery from a moderate-intensity cycling session. Healthy recreationally active men underwent one exercise and one control trial. In the exercise trial, subjects exercised for approximately 60 minutes, while in the control trial they rested quietly for the same duration. After the intervention, subjects rested for 120 minutes and then consumed a test meal. Measurements were obtained immediately and 120 minutes after the intervention and then during 180 minutes of the postprandial period. The post-intervention concentration of total ghrelin was lower (p<0.05) in the exercise than in the control trial. The modulating effect of exercise was related to the reduction in the postprandial rather than preprandial concentration. Post-intervention scores of appetite were not different between the two trials, but when preprandial and postprandial responses were considered separately, postprandial hunger and desire to eat was higher (p<0.05) in the exercise trial. In summary, during recovery from moderate-intensity exercise, total ghrelin does not respond in a compensatory manner to disturbances in energy balance. Thus, an exercise-induced increase in appetite during the later stages of recovery coinciding with the postprandial state cannot be explained by changes in the plasma concentration of total ghrelin.

Fatigue and illness in athletes.

Adequate nutrition before, during, and after training and competition is a key element to maintaining health. During both sprint and endurance exercise, the availability of glycogen is fundamental to performance and any deficit will lead to early fatigue. In addition, strategies to offset the negative effects of the products of metabolism are presented. Although nutritional strategies can attenuate the immunosuppressive effects of exercise, there remains a period of susceptibility to infection after a hard exercise session and when this is repeated without sufficient recovery an athlete can enter a period of "overtraining" during which performance deteriorates. The aetiology and identification of this state is not clear and some current ideas are discussed. Finally, gastrointestinal problems during running can negate any training benefits and we propose some suggestions to reduce this problem.

Monitoring altitude acclimatization--a case study of an élite woman athlete.

A simple study monitoring altitude acclimatization, which is not intrusive to the athlete's training, is described. Particular attention is drawn to the change in production of lactate in response to steady state exercise, before and after altitude. The results suggest that a more thorough assessment of aerobic ability at altitude is required than that described in the British Association of Sports and Exercise Science (BASES) guidelines. It is also relevant to note that elevations in haemoglobin, promoted by altitude, can mask iron abnormalities. It is therefore recommended to assay for iron in addition to haemoglobin.