Increased dependence on blood glucose after acclimatization to 4,300 m

To evaluate the hypothesis that altitude exposure and acclimatization result in increased dependency on blood glucose as a fuel, seven healthy males (23 +/- 2 yr, 72.2 +/- 1.6 kg, mean +/- SE) on a controlled diet were studied in the postabsorptive condition at sea level (SL), on acute altitude exposure to 4,300 m (AA), and after 3 wk of chronic altitude exposure to 4,300 m (CA). Subjects received a primed continuous infusion of [6,6-2D]glucose and rested for a minimum of 90 min, followed immediately by 45 min of exercise at 101 +/- 3 W, which elicited 51.1 +/- 1% of the SL maximal O2 consumption (VO2 max; 65 +/- 2% of altitude VO2 max). At SL, resting arterial glucose concentration was 82.4 +/- 3.2 mg/dl and rose significantly to 91.2 +/- 3.2 mg/dl during exercise. Resting glucose appearance rate (Ra) was 1.79 +/- 0.02 mg.kg-1.min-1; this increased significantly during exercise at SL to 3.71 +/- 0.08 mg.kg-1.min-1. On AA, resting arterial glucose concentration (85.8 +/- 4.1 mg/dl) was not different from sea level, but Ra (2.11 +/- 0.14 mg.kg-1.min-1) rose significantly. During exercise on AA, glucose concentration rose to levels seen at SL (91.4 +/- 3.0 mg/dl), but Ra increased more than at SL (to 4.85 +/- 0.15 mg.kg-1.min-1; P less than 0.05). Resting arterial glucose was significantly depressed with CA (70.8 +/- 3.8 mg/dl), but resting Ra increased to 3.59 +/- 0.08 mg.kg-1.min-1, significantly exceeding SL and AA values.(ABSTRACT TRUNCATED AT 250 WORDS)     

Decreased exercise muscle lactate release after high altitude acclimatization

Blood lactate concentration during exercise decreases after acclimatization to high altitude, but it is not clear whether there is decreased lactate release from the exercising muscle or if other mechanisms are involved. We measured iliac venous and femoral arterial lactate concentrations and iliac venous blood flow during cycle exercise before and after acclimatization to 4,300 m. During hypoxia, at a given O2 consumption the venous and arterial lactate concentrations, the venous and arterial concentration differences, and the net lactate release were lower after acclimatization than during acute altitude exposure. While breathing O2-enriched air after acclimatization at a given O2 consumption the venous and arterial lactate concentrations and the venous and arterial concentration differences were significantly lower, and the net lactate release tended to be lower than while breathing ambient air at sea level before acclimatization. We conclude that the lower lactate concentration in venous and arterial blood during exercise after altitude acclimatization reflected less net release of lactate by the exercising muscles, and that this likely resulted from the acclimatization process itself rather than the hypoxia per se.     

Internal carotid flow velocity with exercise before and after acclimatization to 4,300 m.

Cerebral blood flow and O2 delivery during exercise are important for well-being at altitude but have not been studied. We expected flow to increase on arrival at altitude and then to fall as O2 saturation and hemoglobin increased, thereby maintaining cerebral O2 delivery. We used Doppler ultrasound to measure internal carotid artery flow velocity at sea level and on Pikes Peak, CO (4,300 m). In an initial study (1987, n = 7 men) done to determine the effect of brief (5-min) exercises of increasing intensity, we found at sea level that velocity [24.8 +/- 1.4 (SE) cm/s rest] increased by 15 +/- 7, 30 +/- 6, and 22 +/- 8% for cycle exercises at 33, 71, and 96% of maximal O2 uptake, respectively. During acute hypobaric hypoxia in a decompression chamber (inspired PO2 = 83 Torr), velocity (23.2 +/- 1.4 cm/s rest) increased by 33 +/- 6, 20 +/- 5, and 17 +/- 9% for exercises at 45, 72, and 98% of maximal O2 uptake, respectively. After 18 days on Pikes Peak (inspired PO2 = 87 Torr), velocity (26.6 +/- 1.5 cm/s rest) did not increase with exercise. A subsequent study (1988, n = 7 men) of the effect of prolonged exercise (45 min at approximately 100 W) found at sea level that velocity (24.8 +/- 1.7 cm/s rest) increased by 22 +/- 6, 13 +/- 5, 17 +/- 4, and 12 +/- 3% at 5, 15, 30, and 45 min.(ABSTRACT TRUNCATED AT 250 WORDS)     

Increased exercise SaO2 independent of ventilatory acclimatization at 4,300 m

Arterial O2 saturation (Sao2) decreases in hypoxia in the transition from rest to moderate exercise, but it is unknown whether other several weeks at high altitude SaO2 in submaximal exercise follows the same time course and pattern as that of ventilatory acclimatization in resting subjects. Ventilatory acclimatization is essentially complete after approximately 1 wk at 4,300 m, such that improvement in submaximal exercise SaO2 would then require other mechanisms. On days 2, 8, and 22 on Pikes Peak (4,300 m), 6 male subjects performed prolonged steady-state cycle exercise at 79% maximal O2 uptake (VO2 max). Resting SaO2 rose from day 1 (78.4 +/- 1.6%) to day 8 (87.5 +/- 1.4%) and then did not increase further by day 20 (86.4 +/- 0.6%). During exercise, SaO2 values (mean of 5-, 15-, and 30-min measurements) were 72.7% (day 2), 78.6% (day 8), and 82.3% (day 22), meaning that all of the increase in resting SaO2 occurred from day 1 to day 8, but exercise SaO2 increased from day 2 to day 8 (5.9%) and then increased further from day 8 to day 22 (3.7%). On day 22, the exercise SaO2 was higher than on day 8 despite an unchanged ventilation and O2 consumption. The increased exercise SaO2 was accompanied by decreased CO2 production. The mechanisms responsible for the increased exercise SaO2 require further investigation.     

Women at altitude: ventilatory acclimatization at 4,300 m.

Women living at low altitudes or acclimatized to high altitudes have greater effective ventilation in the luteal (L) compared with follicular (F) menstrual cycle phase and compared with men. We hypothesized that ventilatory acclimatization to high altitude would occur more quickly and to a greater degree in 1) women in their L compared with women in their F menstrual cycle phase, and 2) in women compared with men. Studies were conducted on 22 eumenorrheic, unacclimatized, sea-level (SL) residents. Indexes of ventilatory acclimatization [resting ventilatory parameters, hypoxic ventilatory response, hypercapnic ventilatory response (HCVR)] were measured in 14 women in the F phase and in 8 other women in the L phase of their menstrual cycle, both at SL and again during a 12-day residence at 4,300 m. At SL only, ventilatory studies were also completed in both menstrual cycle phases in 12 subjects (i.e., within-subject comparison). In these subjects, SL alveolar ventilation (expressed as end-tidal PCO(2)) was greater in the L vs. F phase. Yet the comparison between L- and F-phase groups found similar levels of resting end-tidal PCO(2), hypoxic ventilatory response parameter A, HCVR slope, and HCVR parameter B, both at SL and 4,300 m. Moreover, these indexes of ventilatory acclimatization were not significantly different from those previously measured in men. Thus female lowlanders rapidly ascending to 4,300 m in either the L or F menstrual cycle phase have similar levels of alveolar ventilation and a time course for ventilatory acclimatization that is nearly identical to that reported in male lowlanders.     

Alterations in the serum electrolyte levels of women during high altitude (4,300 m) acclimatization

Eight, University of Missouri (230 m) college women were exposed for a period of 65 days to an elevation of 4,300 m on Pikes Peak. During the first week of altitude exposure marked increases in the serum levels of chloride, phosphate, proteinate and calcium and marked decreases in the serum levels of sodium, potassium, magnesium and estimated bicarbonate were observed. During the remainder of the altitude sojourn chloride, phosphate, potassium and magnesium reverted toward the initial low altitude value. Serum calcium levels, however, remained elevated during this latter period while sodium levels continued to decrease and proteinate levels continued to increase. There was little or no recovery of the estimated bicarbonate decrement as the period of exposure was prolonged. Two weeks after the subjects returned to Missouri some but not all of the electrolytes returned to their initial levels. Those not recovering completely included calcium, chloride, proteinate and estimated bicarbonate.

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Zusammenfassung Bei acht Studentinnen der Universität von Missouri (230 m) wurden 65 Tage in der Station Pikes Peak (4.300 m) die Elektrolyte im Serum untersucht. Während der 1. Höhenwoche wurde ein deutlicher Anstieg des Chlorids, Phosphats, Proteinats und Calciums und ein deutlicher Abfall des Natriums, Kaliums, Magnesiums und berechneten Bikarbonats im Serum gefunden. In den folgenden Wochen kehrten die Werte des Chlorids, Phosphats, Kalium und Magnesium zu den Werten vor dem Übergang in die Höhe zurück. Der Calciumspiegel blieb dauernd erhöht, der Natriumspiegel fiel weiter ab, und der Proteinatspiegel stieg weiter an. Eine Verbesserung des Bikarbonatspiegels fand nicht statt. Zwei Wochen nach Rückkehr von der Höhe waren fast alle Elektrolytwerte wieder normal ausser Calcium Chlorid, Proteinat und Bikarbonat im Serum.

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Resume Huit étudiantes de l'université du Missouri (230 m d'altitude) ont séjourné durant 65 jours à Pikes Peak (4.300 m d'altitude). Durant ce laps de temps, on a analysé régulièrement les électrolytes du sérum sanguin. Durant la première semaine de leur séjour en altitude, on a constaté une nette augmentation des chlorires, des phosphates, des protéinates et du calcium ainsi qu'une diminution marquée du sodium, de la potasse, du magnésium et de la valeur calculée du bicarbonate. Au cours des semaines suivantes, la valeur des chlorures, des phosphates, de la potasse et du magnésium s'est rétablie au niveau précédant la montée en altitude. Le taux de calcium est resté élevé alors que celui du sodium a continué de baisser et celui des protéinates à s'élever. On n'a pas constaté d'amélioration du taux de bicarbonate. Deux semaines après le retour en plaine, presque toutes les valeurs des électrolytes étaient redevenues normales dans le sérum, à l'exception de celles du chlorure de calcium, des proteinates et du bicarbonate.

     

Acclimatization to 4,300-m altitude decreases reliance on fat as a substrate

Roberts, A. C., G. E. Butterfield, A. Cymerman, J. T. Reeves, E. E. Wolfel, and G. A. Brooks. Acclimatization to 4,300-m altitude decreases reliance on fat as a substrate. J. Appl. Physiol. 81(4): 1762-1771, 1996.We testedthe hypothesis that exposure to altitude decreases reliance on freefatty acids (FFA) as substrates and increases dependency on bloodglucose. Therefore, the effects of exercise, hypobaric hypoxia, andaltitude acclimatization on FFA, glycerol and net glucose uptake andrelease [ = 2(leg blood flow)(arteriovenous concentration)]and on fatty acid (FA) consumption by the legs (= 3 × glycerolrelease + FFA uptake) were measured. Because sympathetic responses havebeen implicated, we utilized nonspecific -blockade and observedresponses to exercise, altitude, and altitude acclimatization. Westudied six healthy -blocked men () and five matched controls (C)during rest and cycle ergometry exercise (88 W) at 49% of sea-level(SL) peak O₂ uptake at the sameabsolute power output on acute altitude exposure (A1; barometric pressure = 430 Torr) and after 3 wk of chronic altitude exposure to4,300 m (A2). During exercise at SL, FA consumption rates increased (P < 0.05). On arrival at 4,300 m,resting leg FFA uptake and FA consumption rates were not significantlydifferent from those at SL. However, after acclimatization to altitude,at rest leg FA consumption decreased to essentially zero in both C and groups. During exercise at altitude after acclimatization, leg FAconsumption increased significantly, but values were less than at SL orA1 (P < 0.05), whereas glucoseuptake increased relative to SL values. Furthermore, -blockadesignificantly increased glucose uptake relative to control. We concludethat 1) chronic altitude exposure decreases leg FA consumption during rest and exercise;2) relative to SL, FFA uptakedecreases while glucose uptake increases during exercise at altitude;and 3) -blockade potentiatesthese effects.

     

Decreased exercise blood lactate concentrations after respiratory endurance training in humans

For many years, it was believed that ventilation does not limit performance in healthy humans. Recently, however, it has been shown that inspiratory muscles can become fatigued during intense endurance exercise and decrease their exercise performance. Therefore, it is not surprising that respiratory endurance training can prolong intense constant-intensity cycling exercise. To investigate the effects of respiratory endurance training on blood lactate concentration and oxygen consumption (VO2) during exercise and their relationship to performance, 20 healthy, active subjects underwent 30 min of voluntary, isocapnic hyperpnoea 5 days a week, for 4 weeks. Respiratory endurance tests, as well as incremental and constant-intensity exercise tests on a cycle ergometer, were performed before and after the 4-week period. Respiratory endurance increased from 4.6 (SD 2.5) to 29.1 (SD 4.0) min (P < 0.001) and cycling endurance time was prolonged from 20.9 (SD 5.5) to 26.6 (SD 11.8) min (P < 0.01) after respiratory training. The VO2 did not change at any exercise intensity whereas blood lactate concentration was lower at the end of the incremental [10.4 (SD 2.1) vs 8.8 (SD 1.9) mmol x l(-1), P < 0.001] as well as at the end of the endurance exercise [10.4 (SD 3.6) vs 9.6 (SD 2.7) mmol x l(-1), P < 0.01] test after respiratory training. We speculate that the reduction in blood lactate concentration was most likely caused by an improved lactate uptake by the trained respiratory muscles. However, reduced exercise blood lactate concentrations per se are unlikely to explain the improved cycling performance after respiratory endurance training.     

O2 extraction maintains O2 uptake during submaximal exercise with beta -adrenergic blockade at 4,300m

Wholebody O₂ uptake (O₂)during maximal and submaximal exercise has been shown to be preservedin the setting of -adrenergic blockade at high altitude, despitemarked reductions in heart rate during exercise. An increase in strokevolume at high altitude has been suggested as the mechanism thatpreserves systemic O₂ delivery (blood flow × arterialO₂ content) and thereby maintains O₂ at sea-level values. To test thishypothesis, we studied the effects of nonselective -adrenergicblockade on submaximal exercise performance in 11 normal men(26 ± 1 yr) at sea level and on arrival and after 21 days at 4,300 m. Six subjects received propranolol (240 mg/day), and five subjectsreceived placebo. At sea level, during submaximal exercise, cardiacoutput and O₂ delivery were significantly lower inpropranolol- than in placebo-treated subjects. Increases instroke volume and O₂ extraction were responsible for themaintenance of O₂. At 4,300 m,-adrenergic blockade had no significant effect onO₂, ventilation, alveolarPO₂, and arterial blood gases duringsubmaximal exercise. Despite increases in stroke volume, cardiac outputand thereby O₂ delivery were still reduced inpropranolol-treated subjects compared with subjects treated withplacebo. Further reductions in already low levels of mixed venousO₂ saturation were responsible for the maintenance ofO₂ on arrival and after 21 days at4,300 m in propranolol-treated subjects. Despite similarworkloads and O₂,propranolol-treated subjects exercised at greater perceived intensitythan subjects given placebo at 4,300 m. The values for mixed venousO₂ saturation during submaximal exercise inpropranolol-treated subjects at 4,300 m approached thosereported at simulated altitudes >8,000 m. Thus -adrenergicblockade at 4,300 m results in significant reduction in O₂delivery during submaximal exercise due to incomplete compensation bystroke volume for the reduction in exercise heart rate. Total bodyO₂ is maintained at a constant levelby an interaction between mixed venous O₂ saturation, thearterial O₂-carrying capacity, and hemodynamics duringexercise with acute and chronic hypoxia.

     

Effects of exercise training on acclimatization to hypoxia: systemic O2 transport during maximal exercise.

Acclimatization to hypoxia has minimal effect on maximal O2 uptake (Vo2 max). Prolonged hypoxia shows reductions in cardiac output (Q), maximal heart rate (HR-max), myocardial beta-adrenoceptor (beta-AR) density, and chronotropic response to isoproterenol. This study tested the hypothesis that exercise training (ET), which attenuates beta-AR downregulation, would increase HRmax and Q of acclimatization and result in higher Vo2 max. After 3 wk of ET, rats lived at an inspired Po2 of 70 Torr for 10 days (acclimatized trained rats) or remained in normoxia, while both groups continued to train in normoxia. Controls were sedentary acclimatized and nonacclimatized rats. All rats exercised maximally in normoxia and hypoxia (inspired Po2 of 70 Torr). Myocardial beta-AR density and the chronotropic response to isoproterenol were reduced, and myocardial cholinergic receptor density was increased after acclimatization; all of these receptor changes were reversed by ET. Normoxic Vo2 max (in ml.min-1.kg-1) was 95.8 +/- 1.0 in acclimatized trained (n = 6), 87.7 +/- 1.7 in nonacclimatized trained (P < 0.05, n = 6), 74.2 +/- 1.4 in acclimatized sedentary (n = 6, P < 0.05), and 72.5 +/- 1.2 in nonacclimatized sedentary (n = 8; P > 0.05 acclimatized sedentary vs. nonacclimatized sedentary). A similar distribution of Vo2 max values occurred in hypoxic exercise. Q was highest in trained acclimatized and nonacclimatized, intermediate in nonacclimatized sedentary, and lowest in acclimatized sedentary groups. ET preserved Q in acclimatized rats thanks to maintenance of HRmax as well as of maximal stroke volume. Q preservation, coupled with a higher arterial O2 content, resulted in the acclimatized trained rats having the highest convective O2 transport and Vo2 max. These results show that ET attenuates beta-AR downregulation and preserves Q and Vo2 max after acclimatization, and support the idea that beta-AR downregulation partially contributes to the limitation of Vo2 max after acclimatization in rats.     

Effect of exercise duration on lactate kinetics after short muscular exercise

Arterial blood lactate concentrations were measured in six normal males before, during and after 3- and 6-min bicycle exercises performed at three different work rates. The lactate recovery curves were fitted to a bi-exponential time function consisting of a rapidly increasing and a slowly decreasing component, which supplied an accurate representation of the changes in lactate concentration. Variations in the parameters of this mathematical model have been studied as a function of the duration of exercise and of the work rate, showing a clear dependence on exercise duration such that increasing exercise length decreases the velocity constants of the fitted curves. In terms of the functional meaning which can be given to these constants, this result indicates that extending exercise duration from 3 to 6 min reduces the ability of the whole body to exchange and remove lactate. This effect did not qualitatively modify the one already described, which is due to increased work rates, but it shifted the ability to exchange and remove lactate towards lower values. The main conclusion of the study is that lactate kinetic data vary as a function of time during exercise. This inference must be accounted for in the interpretation of lactate data obtained during muscular exercise.