‘‘Beet-ing’’ the Mountain: A Review of the Physiological and Performance Effects of Dietary Nitrate Supplementation at Simulated and Terrestrial Altitude

Exposure to altitude results in multiple physiological consequences. These include, but are not limited to, a reduced maximal oxygen consumption, drop in arterial oxygen saturation, and increase in muscle metabolic perturbations at a fixed sub-maximal work rate. Exercise capacity during fixed work rate or incremental exercise and time-trial performance are also impaired at altitude relative to sea-level. Recently, dietary nitrate (NO3-) supplementation has attracted considerable interest as a nutritional aid during altitude exposure. In this review, we summarise and critically evaluate the physiological and performance effects of dietary NO3- supplementation during exposure to simulated and terrestrial altitude. Previous investigations at simulated altitude indicate that NO3- supplementation may reduce the oxygen cost of exercise, elevate arterial and tissue oxygen saturation, improve muscle metabolic function, and enhance exercise capacity/ performance. Conversely, current evidence suggests that NO3- supplementation does not augment the training response at simulated altitude. Few studies have evaluated the effects of NO3- at terrestrial altitude. Current evidence indicates potential improvements in endothelial function at terrestrial altitude following NO3- supplementation. No effects of NO3- supplementation have been observed on oxygen consumption or arterial oxygen saturation at terrestrial altitude, although further research is warranted. Limitations of the present body of literature are discussed, and directions for future research are provided

Exercise induce hemoconcentration following spleen contraction in subjects with COPD

The blood-boosting spleen contraction represents a potential protective response to hypoxia by raising the blood gas storage capacity. Human spleen contraction has been observed during exercise, apnea and simulated altitude resulting in ejection of stored red blood cells into circulation. High-altitude exposure has been shown to increase spleen contraction suggesting that long-term hypoxia may improve the response in humans. Subjects with COPD are often exposed to hypoxia, which limits their physical performance. However, it is not known if spleen contraction occurs in subjects with COPD. Our aim was to reveal whether subjects with COPD recruit the spleen erythrocyte reserve during mild exercise. Methods SpO2, spleen volume and Hb were measured before and after 6 min walking test (6MWT) in 24 subjects with COPD. Results were analyzed for all subjects pooled and for subject groups with resting SpO2 above and below 90 % separated and expressed as mean. Results 6MWT reduced SpO2 from 91 to 83 % and spleen volume from 254 to 181 mL, while Hb increased from 150 to 154 g/L (p = 0.001 for all). Compared to subjects with SpO2 > 90 %, the group with SpO2 < 90 % displayed the largest resting spleen volume (339 vs 202 mL; p = 0.001) and the most pronounced spleen volume reduction (139 vs 40 mL; p = 0.007). Conclusion Exercise with hypoxia evokes spleen contraction in subjects with COPD and may represent a protective response during periods of hypoxia. The larger spleen volume and more pronounced contraction in the most hypoxic subjects may suggest long-term adaptation to hypoxia