Acetazolamide reduces exercise capacity following a 5-day ascent to 4559 m in a randomised study

Bradwell, Arthur R.; Ashdown, Kimberley; Rue, Carla A.; Delamere, J P; Thomas, Owen R.T.; Lucas, Samuel J. E.; Wright, Alex; Harris, Stephen; Myers, Stephen D.

doi:10.1136/bmjsem-2017-000302

Cited by 13 publications

(14 citation statements)

References 29 publications

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“…Reductions in post-exercise α1-AGP by acetazolamide were unrelated to the significant improvements in exercise SpO 2 at similar intensity (these effects of acetazolamide on exercise performance were previously published and support previous findings) 26 39. On its own, this would provide further support indicating that hypoxia is not the primary mechanism of post-exercise proteinuria.…”

Section: Discussionsupporting

confidence: 86%

Hypoxia is not the primary mechanism contributing to exercise-induced proteinuria

Joyce

Delamere

Bradwell

et al. 2020

BMJ Open Sport Exerc Med

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IntroductionProteinuria increases at altitude and with exercise, potentially as a result of hypoxia. Using urinary alpha-1 acid glycoprotein (α1-AGP) levels as a sensitive marker of proteinuria, we examined the impact of relative hypoxia due to high altitude and blood pressure-lowering medication on post-exercise proteinuria.MethodsTwenty individuals were pair-matched for sex, age and ACE genotype. They completed maximal exercise tests once at sea level and twice at altitude (5035 m). Losartan (100 mg/day; angiotensin-receptor blocker) and placebo were randomly assigned within each pair 21 days before ascent. The first altitude exercise test was completed within 24–48 hours of arrival (each pair within ~1 hour). Acetazolamide (125 mg two times per day) was administrated immediately after this test for 48 hours until the second altitude exercise test.ResultsWith placebo, post-exercise α1-AGP levels were similar at sea level and altitude. Odds ratio (OR) for increased resting α1-AGP at altitude versus sea level was greater without losartan (2.16 times greater). At altitude, OR for reduced post-exercise α1-AGP (58% lower) was higher with losartan than placebo (2.25 times greater, p=0.059) despite similar pulse oximetry (SpO2) (p=0.95) between groups. Acetazolamide reduced post-exercise proteinuria by approximately threefold (9.3±9.7 vs 3.6±6.0 μg/min; p=0.025) although changes were not correlated (r=−0.10) with significant improvements in SpO2 (69.1%±4.5% vs 75.8%±3.8%; p=0.001).DiscussionProfound systemic hypoxia imposed by altitude does not result in greater post-exercise proteinuria than sea level. Losartan and acetazolamide may attenuate post-exercise proteinuria, however further research is warranted.

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Section: Discussionsupporting

confidence: 86%

Hypoxia is not the primary mechanism contributing to exercise-induced proteinuria

Joyce

Delamere

Bradwell

et al. 2020

BMJ Open Sport Exerc Med

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“…Acetazolamide (AZ) is a carbonic-anhydrase (CA) inhibitor commonly used for prevention and/or treatment of symptoms of acute mountain sickness (AMS) during ascent to high altitude (8,25). For recreational climbers and for those who work at altitude, such as the military and emergency medical responders, the use of AZ allows for the completion of tasks or missions that can be made more difficult by AMS symptoms (e.g., fatigue, headache, nausea, etc.).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…AZ has been shown to decrease exercise performance at sea level (27,29); however, studies examining the impact of AZ on exercise at altitude have reported conflicting results (8,9,25). Some authors report that AZ decreased performance (8,15), whereas others have reported that AZ has no impact on performance (12,14). However, the varying doses of AZ (250 -750 mg/day), modes of exercise (cycling, treadmill, leg extension), and elevations (3,500 -6,300 m) make it difficult to compare results among the studies (14,25).…”

Section: Introductionmentioning

confidence: 99%

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Acetazolamide does not alter endurance exercise performance at 3,500-m altitude

Bradbury

Yurkevicius

Mitchell

et al. 2020

Journal of Applied Physiology

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Acetazolamide (AZ) is a medication commonly used to prevent acute mountain sickness (AMS) during rapid ascent to high altitude. However, it is unclear whether AZ use impairs exercise performance; previous literature regarding this topic is equivocal. The purpose of this study was to evaluate the impact of AZ on time-trial (TT) performance during a 30-h exposure to hypobaric hypoxia equivalent to 3,500-m altitude. Ten men [sea-level peak oxygen consumption (VO2peak): 50.8 ± 6.5 mL·kg−1·min−1; body fat %: 20.6 ± 5.2%] completed 2 30-h exposures at 3,500 m. In a crossover study design, subjects were given 500 mg/day of either AZ or a placebo. Exercise testing was completed 2 h and 24 h after ascent and consisted of 15-min steady-state treadmill walking at 40%–45% sea-level VO2peak, followed by a 2-mile self-paced treadmill TT. AMS was assessed after ~12 h and 22 h at 3,500 m. The incidence of AMS decreased from 40% with placebo to 0% with AZ. Oxygen saturation was higher ( P < 0.05) in AZ versus placebo trials at the end of the TT after 2 h (85 ± 3% vs. 79 ± 3%) and 24 h (86 ± 3% vs. 81 ± 4%). There was no difference in time to complete 2 miles between AZ and PL after 2 h (20.7 ± 3.2 vs. 22.7 ± 5.0 min, P > 0.05) or 24 h (21.5 ± 3.4 vs. 21.1 ± 2.9 min, P > 0.05) of exposure to altitude. Our results suggest that AZ (500 mg/day) does not negatively impact endurance exercise performance at 3,500 m. NEW & NOTEWORTHY To our knowledge, this is the first study to examine the impact of acetazolamide (500 mg/day) versus placebo on self-paced, peak-effort exercise performance using a short-duration exercise test in a hypobaric hypoxic environment with a repeated-measures design. In the present study, acetazolamide did not impact exercise performance after 2-h or 24-h exposure to 3,500-m simulated altitude.

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“…In some papers the acetazolamide was proven way to prevent or cure mountain sickness even though Bradwell and al. (2018) found in a randomized study that it reduces exercise capacity following a 5-day ascent to 4559 m. Even though the acetalazomid might reduce the symptoms of acute mountain sickness ( Hung et al, 2019, Gonzales et al, 2018 none of the subjects in this study used any drugs of that type in order to prevent or cure mountain sickness.…”

Section: Discussionmentioning

confidence: 99%

Aerobic Capacity and Altitude Sickness During Himalayas Trek

Ružić¹,

Assaf²

2019

Proceeding Book

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The aim was to determine relations of physical fitness and high-altitude sickness symptoms and drug usage in nonathletes visiting hypoxic environment. Subjects, 17 males (age 47.8 ±10.65), participated in 26-days trek (2500-6476m). Before the trip an all-out treadmill test was performed (maximal speed/ grade and estimated VO2max recorded). At every new sleeping altitude, the information about drug consumption and altitude sickness symptoms was noted. There were 7 subjects without symptoms. Others had headaches, insomnia and breathing distress. The used drugs were paracetamol, propyphenazone caffeine mixture, ibuprofen and aspirin. There were significant correlations between the occurrence of the symptoms and time on the treadmill (-0.504), achieved speed (-0.601) and grade of treadmill (-0.601), while no correlations between the physical fitness parameters and drug usage was confirmed. Then the subjects were divided in 2 groups according to VO2max (age adjusted). The age and the BMI of both groups were not significantly different (p=0.576 and 0.758, respectively). The Mann Whitney-U test showed the differences in both, the altitude sickness symptoms and in drug usage. The group with better estimated aerobic capacity had significantly less symptoms (Z=2.44; p=0.012) and consumed expectedly less drugs (Z=2.08; p=0.030). Altogether, the presence of the high-altitude sickness symptoms was not high apart from the expected tiredness. The level of physical fitness seems to be related to lower chance of highaltitude sickness, but it is not a guarantee to avoid it. Still an improvement in aerobic capacity before the ascent should still be considered.

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Acetazolamide reduces exercise capacity following a 5-day ascent to 4559 m in a randomised study

Cited by 13 publications

References 29 publications

Hypoxia is not the primary mechanism contributing to exercise-induced proteinuria

Hypoxia is not the primary mechanism contributing to exercise-induced proteinuria

Acetazolamide does not alter endurance exercise performance at 3,500-m altitude

Aerobic Capacity and Altitude Sickness During Himalayas Trek

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