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Phys Act Nutr > Volume 20(4); 2016 > Article
Park, Sunoo, and Nam: The effect of 4 weeks fixed and mixed intermittent hypoxic training (IHT) on respiratory metabolic and acid-base response of capillary blood during submaximal bicycle exercise in male elite taekwondo players

Abstract

[Purpose]

The purpose of our study was to determine the effectiveness of 4 weeks fixed and mixed intermittent hypoxic training (IHT) and its difference from exercise training at sea-level on exercise load, respiratory metabolic and acid-base response of capillary blood during 80% maximal heart rate (HRmax) bicycle exercise in male elite Taekwondo players.

[Methods]

Male elite Taekwondo players (n = 25 out of 33) were randomly assigned to training at sea-level (n = 8, control group), training at 16.5%O2 (2000 m) simulated hypoxic condition (n = 9, fixed IHT group), and training at 14.5%O2 (3000 m) up to 2 weeks and 16.5%O2 (2000 m) simulated hypoxic condition (n = 8, mixed IHT group) for 3 weeks. We compared their average exercise load, respiratory metabolic, and acid-base response of the capillary blood during 80% HRmax submaximal bicycle exercise before and after 4 weeks training.

[Results]

Fixed and mixed IHT groups showed positive improvement in respiratory metabolic and acid-base response of the capillary blood during 80% HRmax submaximal bicycle exercise after 4 weeks training. However, all dependent variables showed no significant difference between fixed IHT and mix IHT.

[Conclusion]

Results suggested that mixed and fixed IHT is effective in improving respiratory metabolic and acid-base response of capillary blood in male elite Taekwondo players. Thus, IHT could be a novel and effective method for improving exercise performance through respiratory metabolic and acid-base response.

INTRODUCTION

Since the 1968 Olympic Games were held in Mexico City at 2240 m high altitude, altitude/hypoxic training has been studied for exercise performance in elite athletes29. Currently, this training is commonly applied to athletes and coaches with consequent improvement in exercise performance in individual and team sports1, 40. Erythropoiesis and exercise performance at sea-level can be improved by 2 methods through the living and training at altitude and hypoxic environments11, 40. First, living high training high (LHTH) was designed as way of living and training at 1,500-4,000 m high altitude environments to enhance red blood cell (RBC) count, hemoglobin (Hb) concentration, maximal oxygen consumption (VO2max), and exercise performance at sea-level. In particular, LHTH is the norm for enhanced performance in countries with natural altitude environments, including Kenya and Ethiopia29. Second, living high training low (LHTL) involves simultaneous beneficial effects of altitude/hypoxic acclimation (e.g., increased RBC count and Hb concentration) and sea-level training (i.e., maintenance of training intensity). In addition, LHTL has shown efficacy for enhancing athletic performance and records, resulting in positive hematological, metabolic, and neuromuscular adaptations2, 27. Elite athletes use living high at 2,000-3,000 m and simultaneously training low below 1,500 m 35, 39. However, LHTH and LHTL methods require a relatively long time (> 12 h/day and 2 weeks) in a hypoxic dose41. Also, LHTH is conducted in high altitude areas such as Chamonix in France, Albuquerque in United States, and Kunming in China; and LHTL is conducted with living at very expensive hypoxic accommodations and hotels3, 22, 29. Also, such domestic and foreign places and facilities are inadequate27, 29 .
In recent years, intermittent hypoxic training (IHT), a new training method at altitude/hypoxic environment, is gaining popularity. IHT involves living at sea-level and training (< 4 h/day, 2-5 times/week, and 2-4 weeks) using relatively inexpensive altitude/hypoxic environment device such as hypoxic mask and hypoxic exercise room. IHT does not improve oxygen transporting capacity of the blood by increased erythropoiesis because of exposure to relatively short interval1, 30. However, IHT reportedly may enhance exercise performance by stimulating an increase in glycolysis enzyme activity, glucose transporting capacity, acid-base balance capacity, skeletal muscle mitochondrial density, capillary-to-fiber ratio, and fiber cross-sectional area via upregulation of hypoxia-inducible factor 1α (HIF-1α)7, 19, 32, 34, 38. Therefore, IHT has an advantage of eliciting an enhanced exercise performance by positive physiological change though additional hypoxic stimulation in athletes who cannot attend altitude/hypoxic training during the season14. Levine20 and Wilber40 reported that IHT is more efficient in increasing exercise performance by reducing fatigue; it should be performed after reducing the hypoxic stimulation or exercise intensity at second half of training before post-test.
Besides, on exercise at high altitude and hypoxic environments, PO2 of the arterial blood decreases and this leads to metabolic acidosis through increased ATP synthesis by anaerobic metabolic process, increase of hydrogen ion, and decrease of pH10, 15, 21. In high intensity exercise, skeletal muscle fatigue is caused due to increase of hydrogen ion by response of CO2 and HCO3-, and damage to actin-myosin cross-bridge cycling by anaerobic glycolysis and accumulation of blood lactate, and lowering the sensitivity of calcium ion to troponin15, 25, 26, 36. Thus, it is important to review the pre and post changes in respiratory metabolic and acid-base response of the blood during submaximal exercise to explain the improved exercise performance. However, previous domestic and foreign studies on the effectiveness of IHT on acid-base response of the blood during submaximal exercise are inadequate.
Therefore, the purpose of our study was to determine the effectiveness of 4 weeks fixed and mixed IHT and its difference from exercise training at sea-level on exercise load, respiratory metabolic and acid-base response of the capillary blood during 80% HRmax bicycle exercise in male elite Taekwondo players.

METHODS

Participants

Our study included 33 male elite Taekwondo players who did not participate in any exercise and training program at hypobaric hypoxia and normobaric hypoxia environments in the previous 6 months. The participants were non-smokers, and without history of musculoskeletal, cardiovascular, or pulmonary disease. The participants received information about the purpose, process and, possible adverse effects and provided written consent prior to the start of the study. Participants were randomly assigned to training at sea-level during 4 weeks (n=8, control group), training at 16.5%O2 (2000 m) simulated hypoxic condition during 4 weeks (n = 9, fixed IHT group), and training at 14.5%O2 (3000 m) up to 2 weeks and 16.5%O2 (2000 m) simulated hypoxic condition (n = 8, mixed IHT group) for 3 weeks. Twenty-five of the participant completed the study (>95% compliance) and were subjected to analyses. Data from the remaining 5 subjects were discarded due to medication, withdrawal, and noncompliance. There were no significant differences in physical characteristics among groups before training (Table 1). All procedures were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration.
Table 1.

Participant characteristics

C group F group M group
N 8 9 8
Age (years) 20.50 ± 1.07 19.33 ± .87 19.88 ± .99
Height (cm) 175.50 ± 5.53 175.11 ± 4.70 171.25 ± 6.59
Weight (kg) 68.98 ± 7.13 67.97 ± 7.50 65.71 ± 6.39
Free fat mass (kg) 57.96 ± 7.84 55.90 ± 5.75 54.35 ± 6.47
Fat mass (kg) 11.01 ± 3.31 12.07 ± 6.86 11.36 ± 5.98

Experimental design

Twenty-five male elite Taekwondo players in control group (n = 8), fixed IHT group (n = 9), and mixed IHT group (n = 8) performed training session corresponding to 80% HRmax at each environment during 4 weeks. Training session consisted of treadmill (30 min) and bicycle (30 min) exercise at a total duration of 1 h, 3 days per week, for 4 weeks. The exercise intensity set to 80% HRmax can lead to physiological changes associated with exercise performance and improved time trial in exercise training at hypoxic condition22. HRmax was determined using the predicted HRmax formula (Male = 206 - 0.69 age)24. We designed a study to measure the effectiveness of IHT group vs. control group. Therefore, at pre and post, we analyzed average exercise load, respiratory metabolic (minute ventilation; VE, oxygen consumption; VO2, carbon dioxide excretion; VCO2, respiratory exchange rate; RER, lactate blood level) and acid-base response of the capillary blood (oxygen saturation; SCO2, oxygen partial pressure; PO2, carbon dioxide partial pressure; PCO2, potential of hydrogen; pH, bicarbonate ion; HCO3-) during 80% HRmax submaximal bicycle exercise (5, 10, 15, and 30 min).
A nitrogen generator (Separation & Filter Energy Technology Cooperation, Korea) was used to produce normobaric hypoxic environments. The various normobaric hypoxic conditions were simulated by introducing nitrogen into the environmental chamber (width 6.5 m × length 7.5 m × high 3 m), using a nitrogen generator with the capacity to simulate normobaric hypoxic conditions for altitudes of up to 6000 m. The temperature within the environmental chamber was maintained at 20 ± 2oC and the humidity was maintained at 60 ± 2% for all conditions.

Measurements

Body composition

All participants fasted overnight prior to measurement of body composition (i.e., height, weight, free fat mass, and body fat percentage). They wore lightweight clothing and were asked to remove any metal items. An X-SCAN PLUS (Jawon medical, Korea) was used to measure height and body composition.

Respiratory metabolic response

Respiratory metabolic response measurements were performed at 5 min, 10 min, 20 min, and 30 min over the duration of the exercise protocol. VE, VO2, VCO2, and RER were measured with the Vmax-229 breath-by-breath auto metabolism analyzer (SensorMedics, USA), the Combi 75XLⅡ(Combi, Japan) and breathing valve in the facemask form. For the blood lactate level, 80 μL blood was collected in a capillary tube using the fingertip method, and the sample was analyzed using the YSI-1500 lactate analyzer (YSI Inc., USA).

Acid-base response of the capillary blood

Acid-base response measurements were performed at 5 min, 10 min, 20 min, and 30 min over the duration of the exercise protocol. SCO2, PO2, PCO2, pH, and HCO3- were measured by using the Gem Premier 3000 blood gas analyzer (Radiometer, USA). For the analysis of acid-base response, we collected blood samples by finger-tip method in the capillary vessel. Acid-base response of the capillary blood is similar to the results of the arterial blood and guarantee the reliability of results36, 42; also, it is an easier sampling method, as compared to arterial blood6. We collected blood samples by finger-tip method after heating the capillary vessel to 43 o Celsius using electric pad and massage for influx of arterial blood, based on previous reports on heating the blood collection region and using stimulants such as irritant cream, glyceryl trinitrate paste, and nicotinate paste8, 9, 18, 31. Immediately after blood sampling, change of acid-base response was evaluated within 10 s of closing front and back of the collection tube to prevent reaction of blood sample with the gases in the atmosphere.

Statistical analysis

All data were presented as means ± standard deviations. Two-way repeated analysis of covariance (ANCOVA) was used to determine the interaction and main effects between times and groups during exercise. Post-hoc test between times in each group, and paired t-test and post hoc test between groups at each time was for LSD (least significant difference) was conducted. All statistical analyses were performed using SPSS version 22.0 (IBM Corp., Armonk, NY) for Windows. The level of significance was set at p < .05.

RESULTS

Change in bicycle exercise load

Bicycle exercise load to submaximal exercise at pre and post was presented in Table 2. No significant interaction and main effect was detected, and all groups showed a similar increasing rate (control group = 11.9%, fixed IHT group = 11.4%, mixed IHT group = 11.8%) in bicycle exercise load.
Table 2.

Changes in average load of the bike exercise in each group at pre and post

Group Pre Post F-value
C 134.54 ± 25.59 150.68 ± 29.86 Time 4.023
F 132.31 ± 26.00 147.38 ± 23.66 Group .020
M 133.09 ± 30.19 148.81 ± 30.20 Time×Group .020

Change in respiratory metabolic response

Respiratory metabolic response variables measured during submaximal exercise throughout the training were shown in Table 3-7. VE presented significant main effect within time and significant increase in control group at 10 min exercise. Overall, VE showed lower tendency of increase rate in fixed and mixed IHT groups, as compared with control group (Table 3). VO2 presented significant main effect within time at 10, 20, and 30 min exercise. Post-hoc analyses showed significantly increased VO2 in all groups at 10 and 30 min exercise and significant increase in control group and fixed IHT group at 20 min exercise (Table 4). VCO2 presented significant interaction between condition and time at 5, 10, and 20 min exercise and significant main effect within time at 10, 20, and 30 min exercise. The results of post-hoc were as follows. At 5 min exercise, fixed IHT group showed significantly lower value at post, as compared with control group. At 10 min exercise, VCO2 showed significant increase in control group and significantly higher value in control group, as compared with fixed and mixed IHT group at post. At 20 min exercise, VCO2 showed significant increase in control group and fixed IHT group, and significantly lower value in mixed IHT group, as compared with control group and fixed IHT group at post. At 30 min exercise, there was significant increase in control group and fixed IHT group (Table 5). RER presented significant main effect within time at all exercise times. By posthoc analyses, control group showed significant increase at 30 min exercise and fixed IHT group showed significant increase at 5 min exercise (Table 6). Blood lactate level presented significant main effect within time at 5 min and 20 min exercise. The results of post-hoc analyses indicated significant increase in blood lactate level in all groups at 5 min exercise (Table 7).
Table 3.

Changes in minute ventilation (L/min) during exercise in each group at pre and post

Group Pre Post F-value
Exercise 5 min C 43.97 ± 10.71 48.57 ± 9.45 Time 2.219
F 45.11 ± 7.97 43.22 ± 13.39 Group 1.538
M 39.80 ± 10.75 40.85 ± 7.81 Time×Group 1.538
Exercise 10 min C 73.43 ± 12.32 95.09 ± 23.66# Time 8.005*
F 78.18 ± 18.64 87.10 ± 11.98 Group 1.494
M 76.89 ± 28.61 86.31 ± 26.11 Time×Group 1.494
Exercise 20 min C 64.51 ± 8.37 84.26 ± 19.47 Time 2.478
F 67.37 ± 13.53 82.42 ± 13.51 Group 1.856
M 68.81 ± 24.80 76.53 ± 26.32 Time×Group 1.856
Exercise 30 min C 61.60 ± 14.34 80.78 ± 15.52 Time 3.545
F 63.31 ± 12.75 78.11 ± 14.08 Group 0.264
M 59.75 ± 18.70 75.62 ± 25.57 Time×Group 0.264

* : significant interaction or main effect

# : significant difference between pre and post

Table 4.

Changes in minute ventilation (L/min) during exercise in each group at pre and post

Group Pre Post F-value
Exercise 5 min C 25.63 ± 5.00 29.13 ± 2.26 Time 1.420
F 26.84 ± 5.14 26.27 ± 9.05 Group 1.720
M 25.91 ± 6.43 26.32 ± 5.33 Time×Group 1.720
Exercise 10 min C 37.16 ± 6.16 47.55 ± 6.33# Time 9.404*
F 40.26 ± 7.93 46.09 ± 8.41# Group 2.144
M 40.06 ± 9.89 44.85 ± 8.77# Time×Group 2.144
Exercise 20 min C 33.94 ± 5.39 42.53 ± 4.13# Time 4.944*
F 36.07 ± 6.02 42.55 ± 5.80# Group 2.158
M 36.83 ± 8.40 40.62 ± 10.27 Time×Group 2.158
Exercise 30 min C 31.86 ± 5.37 42.57 ± 6.24# Time 5.527*
F 35.48 ± 5.79 41.53 ± 6.59# Group 3.113
M 36.00 ± 9.31 40.05 ± 9.59# Time×Group 3.113

* : significant interaction or main effect

# : significant difference between pre and post

Table 5.

Changes in carbon dioxide excretion (L/min) during exercise in each group at pre and post

Group Pre Post F-value
Exercise 5 min C 1.59 ± 0.39 1.81 ± 0.34 Time 2.532
F 1.71 ± 0.34 1.54 ± 0.52a Group 3.671*
M 1.54 ± 0.45 1.58 ± 0.31 Time×Group 3.671*
Exercise 10 min C 2.71 ± 0.65 3.44 ± 0.73# Time 16.935*
F 2.76 ± 0.63 2.99 ± 0.46a Group 3.743*
M 2.68 ± 0.82 2.93 ± 0.49a Time×Group 3.743*
Exercise 20 min C 2.25 ± 0.37 2.77 ± 0.49# Time 8.199*
F 2.31 ± 0.38 2.64 ± 0.40# Group 4.520*
M 2.26 ± 0.63 2.40 ± 0.48a Time×Group 4.520*
Exercise 30 min C 2.11 ± 0.48 2.71 ± 0.54# Time 8.019*
F 2.16 ± 0.40 2.54 ± 0.49# Group 1.517
M 2.14 ± 0.69 2.46 ± 0.60 Time×Group 1.517

* : significant interaction or main effect

# : significant difference between pre and post

a : significant difference from C group

Table 6.

Changes in carbon dioxide excretion (L/min) during exercise in each group at pre and post

Group Pre Post F-value
Exercise 5 min C 0.942 ± 0.086 0.881 ± 0.056 Time 15.455*
F 0.910 ± 0.062 0.874 ± 0.067# Group 1.179
M 0.927 ± 0.096 0.915 ± 0.065 Time×Group 1.179
Exercise 10 min C 1.054 ± 0.065 1.023 ± 0.055 Time 56.715*
F 1.025 ± 0.060 1.008 ± 0.045 Group 0.499
M 1.021 ± 0.109 1.028 ± 0.022 Time×Group 0.499
Exercise 20 min C 0.963 ± 0.050 0.932 ± 0.041 Time 49.756*
F 0.931 ± 0.054 0.931 ± 0.030 Group 0.139
M 0.944 ± 0.100 0.940 ± 0.052 Time×Group 0.139
Exercise 30 min C 0.956 ± 0.037 0.902 ± 0.035# Time 66.460*
F 0.905 ± 0.056 0.912 ± 0.025 Group 2.547
M 0.912 ± 0.103 0.935 ± 0.044 Time×Group 2.547

* : significant interaction or main effect

# : significant difference between pre and post

Table 7.

Changes in blood lactate level (mmol/L) during exercise in each group at pre and post

Group Pre Post F-value
Exercise 5 min C 1.78 ± 0.35 1.10 ± 0.20# Time 4.745*
F 1.63 ± 0.43 1.15 ± 0.36# Group 0.308
M 1.69 ± 0.44 1.14 ± 0.32# Time×Group 0.308
Exercise 10 min C 3.84 ± 0.72 3.61 ± 1.06 Time 3.606
F 4.24 ± 1.36 3.55 ± 0.99 Group 0.871
M 4.40 ± 1.71 3.48 ± 1.21 Time×Group 0.871
Exercise 20 min C 3.21 ± 0.75 3.13 ± 0.91 Time 4.405*
F 3.50 ± 1.21 3.18 ± 0.94 Group 0.078
M 3.45 ± 1.61 3.11 ± 1.45 Time×Group 0.078
Exercise 30 min C 2.30 ± 0.66 2.54 ± 1.06 Time 3.096
F 2.56 ± 1.04 2.58 ± 0.91 Group 0.107
M 2.37 ± 1.07 2.69 ± 1.50 Time×Group 0.107

* : significant interaction or main effect

# : significant difference between pre and post

Change in acid-base response of the capillary blood

Acid-base response variables measured during submaximal exercise throughout the training were shown in Table 8-12. All acid-base response variables (SCO2, PO2, PCO2, pH, HCO3-) showed no significant interaction effect. SCO2 presented significant main effect within time at 20 and 30 min exercise. By post-hoc analyses, SCO2 showed significant decrease in control group at 20 and 30 min exercise (Table 8). PO2 presented significant main effect within time at 10, 20, and 30 min exercise. In addition, PO2 showed significant decrease in control group at 10 and 30 min exercise (Table 9). PCO2 presented significant main effect within time at 10 min exercise, without significant difference in all groups (Table 10). No significant interaction and main effect in pH was detected (Table 11). HCO3- presented significant main effect within time at 10 min exercise. Post-hoc analyses indicated significant decrease in HCO3- in control group at 10 min exercise (Table 12).
Table 8.

Changes in oxygen saturation (%) of the capillary blood during exercise in each group at pre and post

Group Pre Post F-value
Exercise 5 min C 95.25 ± 1.04 93.78 ± 1.76 Time 0.933
F 95.22 ± 1.39 94.78 ± 0.83 Group 0.966
M 94.50 ± 0.93 93.73 ± 2.25 Time×Group 0.966
Exercise 10 min C 95.13 ± 0.84 93.23 ± 1.48 Time 3.851
F 94.56 ± 1.59 93.98 ± 1.12 Group 1.116
M 93.62 ± 1.51 93.21 ± 2.11 Time×Group 1.116
Exercise 20 min C 95.38 ± 1.19 93.70 ± 1.88# Time 5.576*
F 94.56 ± 1.59 94.55 ± 0.73 Group 1.494
M 95.00 ± 0.93 93.91 ± 1.71 Time×Group 1.494
Exercise 30 min C 96.00 ± 0.76 94.13 ± 1.36# Time 14.078*
F 94.89 ± 1.76 94.44 ± 0.88 Group 1.217
M 94.88 ± 1.25 94.36 ± 1.07 Time×Group 1.217

* : significant interaction or main effect

# : significant difference between pre and post

Table 9.

Changes in oxygen partial pressure (mmHg) of the capillary blood during exercise in each group at pre and post

Group Pre Post F-value
Exercise 5 min C 78.63 ± 5.48 73.46 ± 6.14 Time 3.958
F 77.89 ± 5.71 74.11 ± 3.37 Group 0.193
M 75.00 ± 3.63 73.52 ± 7.92 Time×Group 0.193
Exercise 10 min C 81.75 ± 3.11 74.11 ± 3.93# Time 9.138*
F 78.33 ± 6.80 75.12 ± 5.28 Group 0.546
M 76.00 ± 5.37 73.63 ± 5.42 Time×Group 0.546
Exercise 20 min C 81.25 ± 5.95 75.67 ± 5.00 Time 34.861*
F 76.11 ± 6.01 76.55 ± 3.05 Group 0.270
M 78.38 ± 5.66 76.07 ± 3.55 Time×Group 0.270
Exercise 30 min C 80.75 ± 4.71 73.66 ± 3.94# Time 19.522*
F 76.33 ± 5.83 73.78 ± 3.80 Group 0.960
M 76.12 ± 4.22 74.33 ± 2.82 Time×Group 0.960

* : significant interaction or main effect

# : significant difference between pre and post

Table 10.

Changes in carbon dioxide partial pressure (mmHg) of the capillary blood during exercise in each group at pre and post

Group Pre Post F-value
Exercise 5 min C 43.88 ± 3.60 43.55 ± 2.95 Time 2.942
F 43.33 ± 2.06 41.00 ± 2.60 Group 2.027
M 44.25 ± 2.25 43.18 ± 3.09 Time×Group 2.027
Exercise 10 min C 40.38 ± 3.29 40.22 ± 3.52 Time 22.107*
F 38.78 ± 3.11 38.00 ± 1.32 Group 3.026
M 40.38 ± 4.98 40.87 ± 2.95 Time×Group 3.026
Exercise 20 min C 38.88 ± 3.40 37.47 ± 4.25 Time 3.595
F 38.33 ± 1.94 35.78 ± 1.39 Group 1.239
M 38.00 ± 4.69 37.30 ± 3.81 Time×Group 1.239
Exercise 30 min C 39.88 ± 2.85 37.55 ± 3.12 Time 2.373
F 38.33 ± 2.18 36.22 ± 1.64 Group 0.360
M 38.63 ± 3.8 5 37.21 ± 3.72 Time×Group 0.360

* : significant interaction or main effect

# : significant difference between pre and post

Table 11.

Changes in potential of hydrogen of the capillary blood during exercise in each group at pre and post

Group Pre Post F-value
Exercise 5 min C 7.383 ± 0.023 7.388 ± 0.013 Time 2.261
F 7.397 ± 0.026 7.401 ± 0.025 Group 1.160
M 7.388 ± 0.022 7.380 ± 0.037 Time×Group 1.160
Exercise 10 min C 7.336 ± 0.030 7.318 ± 0.038 Time 0.404
F 7.347 ± 0.033 7.348 ± 0.038 Group 0.909
M 7.347 ± 0.037 7.332 ± 0.054 Time×Group 0.909
Exercise 20 min C 7.378 ± 0.025 7.341 ± 0.039 Time 0.335
F 7.376 ± 0.035 7.359 ± 0.031 Group 0.912
M 7.371 ± 0.041 7.358 ± 0.062 Time×Group 0.912
Exercise 30 min C 7.395 ± 0.014 7.367 ± 0.032 Time 0.205
F 7.402 ± 0.033 7.380 ± 0.032 Group 0.169
M 7.404 ± 0.023 7.373 ± 0.052 Time×Group 0.169
Table 12.

Changes in bicarbonate ion (mmol/L) of the capillary blood during exercise in each group at pre and post

Group Pre Post F-value
Exercise 5 min C 26.33 ± 1.01 25.81 ± 1.33 Time 1.721
F 26.63 ± 1.47 25.44 ± 1.65 Group 0.300
M 26.71 ± 1.26 25.65 ± 2.01 Time×Group 0.300
Exercise 10 min C 21.95 ± 1.21 20.79 ± 1.84# Time 8.239*
F 21.66 ± 2.71 20.94 ± 2.13 Group 1.078
M 21.79 ± 3.94 21.76 ± 2.96 Time×Group 1.078
Exercise 20 min C 22.83 ± 1.46 20.83 ± 1.25 Time 2.423
F 22.51 ± 2.29 20.22 ± 1.81 Group 0.570
M 22.25 ± 4.16 20.87 ± 3.99 Time×Group 0.570
Exercise 30 min C 24.41 ± 1.53 21.51 ± 1.87 Time 1.023
F 23.91 ± 2.12 21.49 ± 1.97 Group 0.351
M 23.81 ± 3.76 21.93 ± 4.02 Time×Group 0.351

* : significant interaction or main effect

# : significant difference between pre and post

DISCUSSION

Exercise at high altitude and hypoxic environments, results in a decrease in PO2 of the arterial blood, which leads to metabolic acidosis through increase of ATP synthesis by anaerobic metabolic process, increase of hydrogen ion, and decrease of pH10, 15, 21. High intensity exercise causes skeletal muscle fatigue due to hydrogen ion increase by CO2 and HCO3- response, damage to actin-myosin cross-bridge cycling by anaerobic glycolysis and accumulation of blood lactate, and lowering the sensitivity of the calcium ion to troponin15, 25, 26, 36. Thus, review of the changes in respiratory metabolic and acid- base response of the blood during submaximal exercise at pre and post are important to explain the improved exercise performance. However, previous research regarding acid-base response of the blood has focused on changes in one-off exercise and effect of ergogenic acids such as L-carnitine, BCAA, and sodium bicarbonate during exercise and recovery in various participants17, 26. Also, previous studies on high altitude and hypoxic environments investigated difference between sea-level and various hypoxic conditions during exercise without change in hypoxic training such as LLTH, LHTL, IHT, and IHE4, 25, 37. Therefore, we investigated the effectiveness of 4 weeks fixed and mixed IHT on respiratory metabolic and acid- base response of the blood during 80% HRmax bicycle exercise in male elite Taekwondo players.
The results of our study indicated that bicycle exercise load to submaximal exercise showed a similar tendency toward increase in all groups (control group = 11.9%, fixed IHT group = 11.4%, mixed IHT group = 11.8%), with no difference between groups at pre and post. In respiratory metabolic response, fixed and mixed IHT groups presented significantly lower VCO2 at post, lower tendency for increase in VE and VO2, and higher tendency for decrease in blood lactate level, as compared with control group. In acid-base response of the blood, fixed and mixed IHT groups presented lower tendency for decrease in SCO2, PO2, and HCO3-, as compared with control group. However, PCO2 and pH showed no difference between groups.
Generally, IHT increases glycolysis enzyme activity, glucose transporting capacity, mitochondria density, capillary density, cross section area of skeletal muscle, and activity of the motor unit by stimulating the neuromuscular system. These positive changes improve the effectiveness of oxygen utilization12, 23, 32- 34, 38. Also, exercise performance is enhanced by improvement of inflow rate in oxygen to skeletal muscle tissue and oxygen utilization capacity in mitochondria13, 28. In our study, fixed and mixed IHT groups showed positive results in VE, VO2, VCO2, blood lactate level, PO2, SCO2, and HCO3- , as compared with control group despite same increase rate on bicycle exercise load at 80% HRmax through training in all groups. Especially, positive changes of VO2 and SCO2 during exercise of the same load in our study were consistent with results of previous studies that IHT improves exercise economy such as oxygen utilization capacity in skeletal muscle tissue12, 16, 28, 30. It is likely that enhanced exercise economy through IHT improves PO2, blood lactate level, and HCO3- by increased aerobic energy metabolic rate and consolidated tolerance and removal capacity to fatigue-causing substance during anaerobic energy metabolism26, 28, 30. Also, improvement of VE and HCO3- in mixed and fixed IHT groups was possibly caused by inhibition of sympathetic nervous system, hyperactivity of parasympathetic nervous system, and adaptation of chemical receptors (carotid bodies and aortic bodies) in the central and peripheral nerve through continuous stimulation of hypoxic ventilatory response4, 28.
We verified the effect of IHT on respiratory metabolic and acid-base response of the blood as well as efficiency difference between mixed IHT (training at 16.5%O2-2000 m simulated hypoxic condition during 4 weeks) and fixed IHT (training at 14.5%O2-3000 m up to 2 weeks and 16.5%O2-2000 m simulated hypoxic condition for 3 weeks). Our study was based on previous reports that the effect of IHT is greatly influenced by hypoxic environment condition and training intensity, and IHT should be performed after reducing hypoxic stimulation or exercise intensity at second half of training before post-test to reduce fatigue. However, no significant difference in all dependent variables occurred between fixed IHT group and mixed IHT group. These results are possibly due to mixed IHT group training at the more severe hypoxic condition (fixed IHT group = 2000 m vs mixed IHT = 3000 m) up to 2 weeks and training under the same hypoxic condition from 3 weeks to 4 weeks. Thus, it is likely that IHT group did not perform training after reduced hypoxic conditions or exercise intensity at second half of training before post-test to reduce fatigue, as compared with the control group.

CONCLUSION

Our results suggested that mixed and fixed IHT is effective in improving respiratory metabolic and acid-base response of the capillary blood in male elite Taekwondo players. Thus, IHT can be considered a novel and effective method for improving exercise performance through cardiopulmonary and acid-base response. However, no significant difference in all dependent variables was detected between fixed IHT group and mixed IHT group.

References

1.
Billaut F, Gore CJ, Aughey R. Enhancing team-sport athlete performance: is altitude training relevant? Sports Med. 2012; 42: 751-67.
crossref pdf
Billaut F, Gore CJ, Aughey R.. Enhancing team-sport athlete performance: is altitude training relevant? Sports Med. 2012;42:751-67. PMID: 10.1007/BF03262293. PMID: 22845561.
2.
Brugniaux JV, Schmitt L, Robach P, Jeanvoline H, Zimmermann H, Nicolet G, Duvallet A, Fouillot JP, Richalet JP. Living high-training low: tolerance and acclimatization in elite endurance athletes. Eur J Appl Physiol. 2006; 96: 66-77.
crossref pdf
Brugniaux JV, Schmitt L, Robach P, Jeanvoline H, Zimmermann H, Nicolet G, Duvallet A, Fouillot JP, Richalet JP.. Living high-training low: tolerance and acclimatization in elite endurance athletes. Eur J Appl Physiol. 2006;96:66-77. PMID: 10.1007/s00421-005-0065-9. PMID: 16307279.
3.
Buchheit M, Racinais S, Bilsborough JC. “Live high-train low in the heat: an efficient new training model” 17th Annual Congress of the European College of Sport Sciences. 2012.

Buchheit M, Racinais S, Bilsborough JC.. “Live high-train low in the heat: an efficient new training model” In: 17th Annual Congress of the European College of Sport Sciences; 2012.
4.
Cerretelli P, Samaja M. Acid-base balance at exercise in normoxia and in chronic hypoxia. Revisiting the “lactate paradox”. Eur J Appl Physiol. 2003; 90: 431-48.
crossref pdf
Cerretelli P, Samaja M.. Acid-base balance at exercise in normoxia and in chronic hypoxia. Revisiting the “lactate paradox”. Eur J Appl Physiol. 2003;90:431-48. PMID: 10.1007/s00421-003-0928-x. PMID: 14504942.
5.
Czuba M, Waskiewicz Z, Zajac A, Poprzecki S, Cholewa J, Roczniok R. The effects of intermittent hypoxic training on aerobic capacity and endurance performance in cyclists. J Sports Sci Med. 2011; 10: 175-83.

Czuba M, Waskiewicz Z, Zajac A, Poprzecki S, Cholewa J, Roczniok R.. The effects of intermittent hypoxic training on aerobic capacity and endurance performance in cyclists. J Sports Sci Med. 2011;10:175-83. PMID: 24149312.
6.
Dar K, Williams T, Aitken R, Woods KL, Fletcher S. Arterial versus capillary sampling for analysing blood gas pressures. Bmj. 1995; 310: 24-5.
crossref
Dar K, Williams T, Aitken R, Woods KL, Fletcher S.. Arterial versus capillary sampling for analysing blood gas pressures. Bmj. 1995;310:24-5. PMID: 10.1136/bmj.310.6971.24. PMID: 7827548.
7.
Desplanches D, Hoppeler H. Effects of training in normoxia and normobaric hypoxia on human muscle ultrastructure. Pflügers Arch. 1993; 425: 263-7.
crossref pdf
Desplanches D, Hoppeler H.. Effects of training in normoxia and normobaric hypoxia on human muscle ultrastructure. Pflügers Arch. 1993;425:263-7. PMID: 10.1007/BF00374176. PMID: 8309787.
8.
Eaton T, Rudkin S, Garrett JE. The clinical utility of arterialized earlobe capillary blood in the assessment of patients for longterm oxygen therapy. Respir Med. 2001; 95: 655-60.
crossref
Eaton T, Rudkin S, Garrett JE.. The clinical utility of arterialized earlobe capillary blood in the assessment of patients for longterm oxygen therapy. Respir Med. 2001;95:655-60. PMID: 10.1053/rmed.2001.1118. PMID: 11530953.
9.
Fajac I, Texereau J, Rivoal V, Dessanges JF, Dinh-Xuan AT, Dall’Ava-Santucci J. Blood gas measurement during exercise: a comparative study between arterialized earlobe sampling and direct arterial puncture in adults. Eur Respir J. 1998; 11: 712-5.

Fajac I, Texereau J, Rivoal V, Dessanges JF, Dinh-Xuan AT, Dall’Ava-Santucci J.. Blood gas measurement during exercise: a comparative study between arterialized earlobe sampling and direct arterial puncture in adults. Eur Respir J. 1998;11:712-5. PMID: 9596126.
10.
Gore CJ, Hahn AG, Aughey RJ, Martin DT, Ashenden MJ, Clark SA, Garnham AP, Roberts AD, Slater GJ, Mckenna MJ. Live high: train low increases muscle buffer capacity and submaximal cycling efficiency. Acta Physiol Scand. 2001; 173: 275-86.
crossref
Gore CJ, Hahn AG, Aughey RJ, Martin DT, Ashenden MJ, Clark SA, Garnham AP, Roberts AD, Slater GJ, Mckenna MJ.. Live high: train low increases muscle buffer capacity and submaximal cycling efficiency. Acta Physiol Scand. 2001;173:275-86. PMID: 10.1046/j.1365-201X.2001.00906.x. PMID: 11736690.
11.
Gore CJ, Sharpe K, Garvican-Lewis LA, Saunders PU, Humberstone CE, Robertson E Y, Wachsmuth NB, Clark SA, Mc- Lean BD, Friedmann-Bette B, Neya M, Pottgiesser T, Schumache YO, Schmidt WF. Altitude training and haemoglobin mass from the optimised carbon monoxide rebreathing method determined by a meta-analysis. Br J Sports Med. 2013; 47: 31-9.
crossref
Gore CJ, Sharpe K, Garvican-Lewis LA, Saunders PU, Humberstone CE, Robertson E Y, Wachsmuth NB, Clark SA, Mc- Lean BD, Friedmann-Bette B, Neya M, Pottgiesser T, Schumache YO, Schmidt WF.. Altitude training and haemoglobin mass from the optimised carbon monoxide rebreathing method determined by a meta-analysis. Br J Sports Med. 2013;47:31-9. PMID: 10.1136/bjsports-2013-092840.
12.
Green HJ, Roy B, Grant S, Hughson R, Burnett M, Otto C, Pipe A, McKenzie D, Johnson M. Increase in submaximal cycling efficiency mediated by altitude acclimatization. J Appl Physiol. 2000; 89: 1189-97.
crossref
Green HJ, Roy B, Grant S, Hughson R, Burnett M, Otto C, Pipe A, McKenzie D, Johnson M.. Increase in submaximal cycling efficiency mediated by altitude acclimatization. J Appl Physiol. 2000;89:1189-97. PMID: 10956368.
13.
Hamlin MJ, Marshall HC, Hellemans PN, Anglem AN. Effect of intermittent hypoxic training on 20km time trial and 30s anaerobic performance. Scand J Med Sci Sports. 2010; 20: 651-61.
crossref
Hamlin MJ, Marshall HC, Hellemans PN, Anglem AN.. Effect of intermittent hypoxic training on 20km time trial and 30s anaerobic performance. Scand J Med Sci Sports 2010;20:651-61. PMID: 10.1111/j.1600-0838.2009.00946.x. PMID: 19793215.
14.
Hendriksen IJ, Meeuwsen, T. The effect of intermittent training in hypobaric hypoxia on sea level exercise: a cross-over study in humans. Eur J Appl Physiol. 2003; 88: 396-403.
crossref pdf
Hendriksen IJ, Meeuwsen T.. The effect of intermittent training in hypobaric hypoxia on sea level exercise: a cross-over study in humans. Eur J Appl Physiol. 2003;88:396-403. PMID: 10.1007/s00421-002-0708-z. PMID: 12527969.
15.
Juel C, Lundby C, Sander M, Calbet JAL, van Hall G. Human skeletal muscle and erythrocyte proteins involved in acid-base homeostasis: adaptations to chronic hypoxia. J Physiol. 2003; 548: 639-48.
crossref
Juel C, Lundby C, Sander M, Calbet JAL, van Hall G.. Human skeletal muscle and erythrocyte proteins involved in acid-base homeostasis: adaptations to chronic hypoxia. J Physiol. 2003;548:639-48. PMID: 12611920.
16.
Katayama K, Matsuo M, Ishida K, Mori S, Miyamura M. Intermittent hypoxia improves endurance performance and submaximal efficiency. High Alt Med Bio. 2003; 4: 291-304.
crossref
Katayama K, Matsuo M, Ishida K, Mori S, Miyamura M.. Intermittent hypoxia improves endurance performance and submaximal efficiency. High Alt Med Bio. 2003;4:291-304. PMID: 10.1089/152702903769192250. PMID: 14561235.
17.
Kato T, Matsumura Y, Tsukanaka A, Harada T, Kosaka M, Matsui M. Effect of low oxygen inhalation on changes in blood pH, lactate, and ammonia due to exercise. Eur J Appl Physiol. 2004; 91: 296-302.
crossref pdf
Kato T, Matsumura Y, Tsukanaka A, Harada T, Kosaka M, Matsui M.. Effect of low oxygen inhalation on changes in blood pH, lactate, and ammonia due to exercise. Eur J Appl Physiol. 2004;91:296-302. PMID: 10.1007/s00421-003-0975-3. PMID: 14586585.
18.
Kirubakaran C, Gnananayagam JEJ, Sundaravalli EK. Comparison of blood gas values in arterial and venous blood. Indian J Pediatr. 2003; 70: 781-5.
crossref pdf
Kirubakaran C, Gnananayagam JEJ, Sundaravalli EK.. Comparison of blood gas values in arterial and venous blood. Indian J Pediatr. 2003;70:781-5. PMID: 10.1007/BF02723794. PMID: 14649471.
19.
Knaupp W, Khilnani S, Sherwood J, Scharf S, Steinberg H. Erythropoietin response to acute normobaric hypoxia in humans. J Appl Physiol. 1992; 73: 837-40.
crossref
Knaupp W, Khilnani S, Sherwood J, Scharf S, Steinberg H.. Erythropoietin response to acute normobaric hypoxia in humans. J Appl Physiol. 1992;73:837-40. PMID: 1400046.
20.
Levine BD. Intermittent hypoxic training: fact and fancy. High Alt Med Biol. 2002; 3: 177-93.
crossref
Levine BD.. Intermittent hypoxic training: fact and fancy. High Alt Med Biol. 2002;3:177-93. PMID: 10.1089/15270290260131911. PMID: 12162862.
21.
Mao TY, Fu LL, Wang JS. Hypoxic exercise training causes erythrocyte senescence and rheological dysfunction by depressed Gardos channel activity. J Appl Physiol. 2011; 111: 382-91.
crossref
Mao TY, Fu LL, Wang JS.. Hypoxic exercise training causes erythrocyte senescence and rheological dysfunction by depressed Gardos channel activity. J Appl Physiol. 2011;111:382-91. PMID: 10.1152/japplphysiol.00096.2011. PMID: 21551009.
22.
McLean BD, Buttifant D, Gore CJ. Physiological and performance responses to a pre-season altitude training camp in elite team sport athletes. Int J Sports Physiol Perform. 2013; 8: 391-9.
crossref
McLean BD, Buttifant D, Gore CJ.. Physiological and performance responses to a pre-season altitude training camp in elite team sport athletes. Int J Sports Physiol Perform 2013;8:391-9. PMID: 10.1123/ijspp.8.4.391. PMID: 23170749.
23.
Meeuwsen T, Hendriksen IJ, Holewijn M. Training-induced increase in sea-level performance are enhanced by acute intermittent hypobaric hypoxia. Eur J Appl Physiol. 2001; 84: 283-90.
crossref pdf
Meeuwsen T, Hendriksen IJ, Holewijn M.. Training-induced increase in sea-level performance are enhanced by acute intermittent hypobaric hypoxia. Eur J Appl Physiol. 2001;84:283-90. PMID: 10.1007/s004210000363. PMID: 11374111.
24.
Miyashita M, Mutoh Y, Yoshika Y, Sadamoto T. Effects of physical training. Med Sci Sports. 1985; 10: 3-5.

Miyashita M, Mutoh Y, Yoshika Y, Sadamoto T.. Effects of physical training. Med Sci Sports 1985;10:3-5.
25.
Moon HW, Sunoo S, Park HY, Ham JH, Nam SS. The acid- base response during absolutely intensity exercise at various normobaric hypoxic conditions. Kor J Sports Sci. 2015; 24: 1175-88.

Moon HW, Sunoo S, Park HY, Ham JH, Nam SS.. The acid- base response during absolutely intensity exercise at various normobaric hypoxic conditions. Kor J Sports Sci. 2015;24:1175-88.
26.
Nam S, Sunoo S. The effects of intermittent normobaric hypoxia training duration on aerobic performance and acid-base balance in blood. Exerc Sci. 2010; 19: 175-88.
crossref
Nam S, Sunoo S.. The effects of intermittent normobaric hypoxia training duration on aerobic performance and acid-base balance in blood. Exerc Sci. 2010;19:175-88. PMID: 10.15857/ksep.2010.19.2.175.
27.
Park HY, Nam SS, Choi WH, Sunoo S. Effects of 4 weeks living high training low (LHTL) on aerobic exercise capacity, concentration in oxygenated skeletal muscle, cardiac function and time trial in elite middle and long distance runners. Exerc Sci. 2011; 20: 425-40.
crossref
Park HY, Nam SS, Choi WH, Sunoo S.. Effects of 4 weeks living high training low (LHTL) on aerobic exercise capacity, concentration in oxygenated skeletal muscle, cardiac function and time trial in elite middle and long distance runners. Exerc Sci. 2011;20:425-40. PMID: 10.15857/ksep.2011.20.4.425.
28.
Park HY, Nam SS, Tanaka H, Lee DJ. Hemodynamic, hematological, and hormonal responses to submaximal exercise in normobaric hypoxia in pubescent girls. Pediatr Exerc Sci. 2016; 28: 417-22.
crossref
Park HY, Nam SS, Tanaka H, Lee DJ.. Hemodynamic, hematological, and hormonal responses to submaximal exercise in normobaric hypoxia in pubescent girls. Pediatr Exerc Sci. 2016;28:417-22. PMID: 10.1123/pes.2015-0176. PMID: 27045322.
29.
Park H, Hwang H, Park J, Lee S, Lim K. The effects of altitude/ hypoxic training on oxygen delivery capacity of the blood and aerobic exercise capacity in elite athletes - a meta analysis. J Exerc Nutrition Biochem. 2016; 20: 15-22.
crossref
Park H, Hwang H, Park J, Lee S, Lim K.. The effects of altitude/ hypoxic training on oxygen delivery capacity of the blood and aerobic exercise capacity in elite athletes - a meta analysis. J Exerc Nutrition Biochem. 2016;20:15-22. PMID: 10.20463/jenb.2016.03.20.1.3.
30.
Park HY, Sunoo S, Nam SS. The effect of fixed and mixed intermittent hypoxic training under normobaric hypoxic environments during 4 weeks on oxygen delivering capacity of the blood, energy metabolism, and skeletal muscle oxygenation. Kor J Sports Sci. 2016; 25: 1191-203.

Park HY, Sunoo S, Nam SS.. The effect of fixed and mixed intermittent hypoxic training under normobaric hypoxic environments during 4 weeks on oxygen delivering capacity of the blood, energy metabolism, and skeletal muscle oxygenation. Kor J Sports Sci. 2016;25:1191-203.
31.
Pitkin AD, Roberts CM, Wedzicha JA. Arterialised earlobe blood gas analysis: an underused technique. Thorax. 1994; 49: 364-6.
crossref
Pitkin AD, Roberts CM, Wedzicha JA.. Arterialised earlobe blood gas analysis: an underused technique. Thorax 1994;49:364-6. PMID: 10.1136/thx.49.4.364. PMID: 8202909.
32.
Powell FL, Garcia N. Physiological effects of intermittent hypoxia. High Alt Med Biol. 2000; 1: 125-36.
crossref
Powell FL, Garcia N.. Physiological effects of intermittent hypoxia. High Alt Med Biol. 2000;1:125-36. PMID: 10.1089/15270290050074279. PMID: 11256564.
33.
Saunders PU, Telford RD, Pyne DB, Cunningham RB, Gore CJ, Hahn AG, Hawley J A. Improved running economy in elite runners after 20days of simulated moderate altitude exposure. J Appl Physiol. 2003; 96: 931-7.
crossref
Saunders PU, Telford RD, Pyne DB, Cunningham RB, Gore CJ, Hahn AG, Hawley J A.. Improved running economy in elite runners after 20days of simulated moderate altitude exposure. J Appl Physiol. 2003;96:931-7. PMID: 10.1152/japplphysiol.00725.2003. PMID: 14607850.
34.
Schmidt W. Effects of intermittent exposure to high altitude on blood volume and erythropoietic activity. High Alt Med Biol. 2002; 3: 167-76.
crossref
Schmidt W.. Effects of intermittent exposure to high altitude on blood volume and erythropoietic activity. High Alt Med Biol. 2002;3:167-76. PMID: 10.1089/15270290260131902. PMID: 12162861.
35.
Stray-Gundersen J, Chapman RF, Levine BD. “Living high-training low” altitude training improves sea level performance in male and female elite runners. J Appl Physiol. 2001; 91: 1113-20.
crossref
Stray-Gundersen J, Chapman RF, Levine BD.. “Living high-training low” altitude training improves sea level performance in male and female elite runners. J Appl Physiol. 2001;91:1113-20. PMID: 10.1034/j.1600-0838.2002.120111_1.x. PMID: 11509506.
36.
Sunoo S, Nam S. The response of blood lactate concentration and blood gas during 80% HRmax cycle exercise at various conditions. Kor J Sports Sci. 2015; 24: 1437-48.

Sunoo S, Nam S.. The response of blood lactate concentration and blood gas during 80% HRmax cycle exercise at various conditions. Kor J Sports Sci. 2015;24:1437-48.
37.
Vega RS, Strüder HK, Wahrmann BV, Bloch W, Hollmann W. Bicarbonate reduces serum prolactin increase induced by exercise to exhaustion. Med Sci Sports Exerc. 2006; 38: 675-80.
crossref
Vega RS, Strüder HK, Wahrmann BV, Bloch W, Hollmann W.. Bicarbonate reduces serum prolactin increase induced by exercise to exhaustion. Med Sci Sports Exerc. 2006;38:675-80. PMID: 10.1249/01.mss.0000210195.94952.50. PMID: 16679982.
38.
Vogt M, Puntschart JG, Zuleger C, Billerter R, Hoppeler H. Molecular adaptations in human skeletal muscle to endurance training under simulated hypoxic conditions. J Appl Physiol. 2001; 91: 173-82.
crossref
Vogt M, Puntschart JG, Zuleger C, Billerter R, Hoppeler H.. Molecular adaptations in human skeletal muscle to endurance training under simulated hypoxic conditions. J Appl Physiol. 2001;91:173-82. PMID: 11408428.
39.
Wehrlin JP, Zuest P, Hallen J, Marti B. Live high-train low for 24 days increases hemoglobin mass and red cell volume in elite endurance athletes. J Appl Physiol. 2006; 100: 1938-45.
crossref pmid
Wehrlin JP, Zuest P, Hallen J, Marti B.. Live high-train low for 24 days increases hemoglobin mass and red cell volume in elite endurance athletes. J Appl Physiol 2006;100:1938-45. PMID: 10.1152/japplphysiol.01284.2005. PMID: 16497842.
40.
Wilber RL. Application of altitude/hypoxic training by elite athletes. Med Sci Sports Exerc. 2007; 39: 1610-24.
crossref
Wilber RL.. Application of altitude/hypoxic training by elite athletes. Med Sci Sports Exerc. 2007;39:1610-24. PMID: 10.1249/mss.0b013e3180de49e6. PMID: 17805095.
41.
Wilber RL, Stray-Gundersen J, Levine BD. Effect of hypoxic ‘‘dose’’ on physiological responses and sea-level performance. Med Sci Sports Exerc. 2007; 39: 1590-9.
crossref
Wilber RL, Stray-Gundersen J, Levine BD.. Effect of hypoxic ‘‘dose’’ on physiological responses and sea-level performance. Med Sci Sports Exerc. 2007;39:1590-9. PMID: 10.1249/mss.0b013e3180de49bd. PMID: 17805093.
42.
Zavorsky GS, Cao J, Mayo NE, Gabbay R, Murias JM. Arterial versus capillary blood gases: A meta-analysis. Respi Physiol Neurobio. 2007; 155: 268-79.
crossref
Zavorsky GS, Cao J, Mayo NE, Gabbay R, Murias JM.. Arterial versus capillary blood gases: A meta-analysis. Respi Physiol Neurobio 2007;155:268-79. PMID: 10.1016/j.resp.2006.07.002.
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