The effect of a live high – train high sojourn at 3,860-4090m terrestrial altitude on physiological, psychological, body composition, and performance variables in a professional wheelchair marathoner
- Autores: Santiago José Sanz Quinto
- Directores de la Tesis: Manuel Moya Ramon (dir. tes.), Raúl Reina Vaíllo (tut. tes.)
- Lectura: En la Universidad Miguel Hernández de Elche ( España ) en 2020
- Idioma: español
- Tribunal Calificador de la Tesis: Eduardo Manuel Cervelló Gimeno (presid.), Francisco J. Vera García (secret.), José Antonio López Calbet (voc.), Javier Chavarren Cabrero (voc.), Florentino Huertas Olmedo (voc.)
- Programa de doctorado: Programa de Doctorado en Deporte y Salud por la Universidad Miguel Hernández de Elche
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- Resumen
Background: Since the late 60 ́s, altitude training has been a common method used among marathoners and middle/long distance athletes to enhance their maximal oxygen uptake (VO2max) by the concomitant increase in red cell volume (RCV) and hemoglobin mass (Hbmass) observed after returning from altitude. However, due to the performance impairment in the specific training sessions (i.e., speed maintained at the second ventilatory threshold intensity) observed at altitude relative to sea level (SL), which becomes worse as altitude increases, there are no studies in the literature, unless except one published 52 years ago, in which athletes were exposed to 4000 m terrestrial altitude. Moreover, no studies about altitude training in Paralympic Sport have been published. Considering this, the first aim of this research was to analyze the physiological and psychological response and, performance effects of a 5-week 3860-4090 m terrestrial altitude training camp in an elite-wheelchair athlete marathoner with Charcot Marie Tooth disease (CMT), previous to his participation in the Boston and London Marathons (studies 1 and 2).
On the other hand, and considering both altitude sojourns were programmed as preparation scenarios for the London and Boston Marathons, and also considering the practical application for coaches and physicians in charge of wheelchair athletes performance optimization, the second aim of this research was: 1) to analyze the autonomic nervous system response assessed non-invasively as cardiac autonomic vagal response oscillation with heart rate variability (HRV) assessment before, during and, after an international wheelchair marathon, comparing data to existing literature from able- bodied triathletes, athletes and XC skiers 2) to verify if HRV response after relocation in a new time-zone is similar to able-bodied athletes 3) to compare the cardiovascular response of a world-class wheelchair marathoner with world-class paraplegics and able- bodied marathoners (study 3) in the same athlete.
Methods: A professional wheelchair athlete diagnosed with CMT, featured by an affection in both, upper and lower limbs, completed two 5-week training camps at 3860- 4090 m terrestrial altitude in two consecutive years. In the first camp, named inflexible planning (IP), the athlete completed every predefined training session and the average weekly distance covered was 200 km. In the second camp, named flexible planning (FP), specific sessions were performed depending on a reference value (RV) of his HRV, but the weekly distance covered was less (140 km). Vagally-mediated-HRV markers as the root mean square of the successive differences (rMSSD), oxygen saturation (SO2) and resting heart rate (HRrest) fluctuations during normoxia and hypoxia conditions were studied, comparing differences between FP and IP. A pre- and post-altitude performance assessment was carried out in IP and FP with an incremental test in which power output and also a 3000 m time trial were estimated. In addition, the assessment of the following outcomes were carried out in FP (pre-altitude, during altitude sojourn, and post-altitude): systolic blood pressure (SP), diastolic blood pressure (DP), plasma erythropoietin (EPO), erythrocytes, reticulocytes count (Ret), hemoglobin (Hb), hematocrit (Hct), resting breathing rate (BF), profile of mood states, body mass, specific urine gravity upon wakening (SG AM) and pre-bed (SG PM), diuresis, daily Fluid intake, hydric balance (HB) after each training session, overall energy intake, overall carbohydrates (CHO), proteins and fat intake and daily sodium (Na+) intake.
Secondly, and regarding the marathon study, ten days before the marathon day (RD-10) an incremental ergometer test was performed to estimate the second ventilatory threshold (VT2) and the heart rate (HR) plus oxygen uptake at VT2 intensity. Six days before the marathon (RD-6), and two days after racing (RD+2), the day-to- day HRV upon awakening was measured and rMSSD was chosen as cardiac vagal autonomic control indicator. The logarithmic expression of the rMSSD (Ln rMSSD) was averaged across all days pre- travel (RD-6 – RD-2) to serve as baseline (BL). During the marathon, HR was monitored with a HR monitor, pooled every 5000 m (0-5, 5-10, 10-15, 15-20, 20-25, 25-30, 30- 35, 35-40) and the last 2195 m (40-42.2).
Results: A greater suppression, related to greater fatigue in vagally-mediated markers throughout altitude sojourn was observed by a greater coefficient of variation of the rMSSD (rMSSDCV) in IP compared to FP; in addition, FP showed faster restoration of rMSSD upon returning to SL. Moreover, after a significant decrease observed in SO2 in both models upon altitude arrival, there was a faster enhancement in SO2 in FP compared to IP in different time points of the sojourn, showing faster acclimatization in FP. HRrest increased at altitude in both models, showing a slight reduction after returning from altitude compared to pre-altitude. However, no within-models analysis differences were observed. Moreover, SP and DP were enhanced at altitude and went back to pre-altitude values after returning to SL. Both models facilitate an increase in the power output generated by the athlete, and also improve the 3000 m time trial, which it was slightly better after FP. Regarding blood marker results in FP, an increase in erythrocytes, Hb and Hct. was osbserved towards the end of the camp, which was even greater than at pre- altitude after arriving to SL. An increase over 200 % was observed in EPO 35-hours after arriving to altitude. However, a suppression in EPO was observed by mid-sojourn and it reached the lowest values after returning to SL. BF was enhanced at altitude compared to SL and a slight decrease was observed as hypoxic exposure became chronic. A decrease in vigor, and an increase in fatigue were observed at altitude compared to SL when SO2 and SP were considered as covariates. Moreover, total mood disturbance (TMD) increased significantly when the greatest training load (TL) was reached at SL, while it increased throughout altitude exposure, remaining high at post-altitude compared to pre- altitude. A decrease in body mass was observed after arriving to altitude. However, a significant increase was observed from the second to the fifth week of exposure. Moreover, body mass returned to within pre-altitude values after returning from altitude. Athlete ́s CHO and protein intake was significantly greater at altitude compared to SL, while no differences among lipids intake was observed among conditions. Both fluid intake and diuresis were enhanced at altitude, especially during early acclimatization. In fact, lower SG AM was observed during the first week at altitude relative to pre-altitude. SG PM, while not significantly, showed a lower trend than SG AM, and both were inside the range suggested for optimal hydration status (≤ 1.020). Sodium intake throughout the camp was inside the normal range suggested as optimal (1300 to 2500 mg · d-1); however, Na+ didn ́t reach the amounts recommended (0.5 to 0.7 g · L-1) for any type of training session. HB was positive after all sessions, except one resistance session in which ambient temperature was abnormally high. However, nine sessions in which HB was over the + 2 % body mass gain were observed, most of them occurred under cold ambient temperatures in which sweat rate might be diminished. Ultimately, we observed almost the same performance in 2000 m interval repetitions at altitude compared to SL.
In the study of the physiological assessment during a marathon, a slight decrease in the Ln RMSSD the day after arriving to new time-zone relative to BL was found. Moreover, rMSSD was suppressed the day after marathon and back within BL values 48-hours after the marathon. During the race the athlete showed similar heart rate to the one reported by elite-paraplegic and elite-able-bodied marathoners; however, the oxygen uptake (VO2) assessed in the incremental laboratory test before the marathon revealed greater values (relating to the marathon intensity sustained) compared to the values reported from paraplegic marathoners and lower to the ones reported by able-bodied athletes. Interestingly, from 30 km to the finish line the athlete was able to maintain an intensity over the second ventilatory threshold, fact that has not been reported in elite-able-bodied marathoners. Conclusions: Both training models, IP and FP set at 3860-4090 m terrestrial altitude, bring on an improvement in performance after returning from altitude; however, and despite a ~40 % lower TL imposed in FP, this model showed a slightly greater performance than IP, which might be attributed to a lower accumulated fatigue as reflected by the lower suppression of vagally-mediated HRV marker and its faster restoration after returning from altitude.
In the study of the marathon we observed: 1) similar HRV response after relocation in a new time-zone compared to able-bodied athletes; 2) similar pre-race HRV response to that observed in elite able-bodied triathletes and athletes; 3) similar HRV vagally- mediated marker suppression 24-hours after marathon compared to athletes participating in long-endurance events; 4) similar HRV vagally-mediated markers rebound as observed in cross-country skiers 48-hours after finishing the race; 5) similar HR response throughout the marathon than elite-paraplegics and elite-able-bodied marathoners. However, our athlete was able to maintain a HR corresponding to >VT2 from the 30 km to the end of the race (42.2 km).
