Endocrine and metabolic responses to extreme altitude and physical exercise in climbers

Benso, Andrea; Broglio, Fabio; Aimaretti, Gianluca; Lucatello, Barbara; Lanfranco, Fabio; Ghigo, Ezio; Grottoli, Silvia

doi:10.1530/eje-07-0355

Cited by 107 publications

(126 citation statements)

References 34 publications

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“…Hereafter, normalization of glucose concentrations occurs again, and these changes in glucose concentrations are paralleled by similar changes in epinephrine concentrations (42). Cortisol concentrations seem to follow this same pattern, while growth hormone concentrations seem to be increased only after a prolonged stay at very high or extreme altitudes (39,45).…”

Section: Acclimatizationmentioning

confidence: 87%

Physical Activity at Altitude: Challenges for People With Diabetes

Mol

Vries²,

Koning

et al. 2014

Diabetes Care

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A growing number of subjects with diabetes take part in physical activities at altitude such as skiing, climbing, and trekking. Exercise under conditions of hypobaric hypoxia poses some unique challenges on subjects with diabetes, and the presence of diabetes can complicate safe and successful participation in mountain activities. Among others, altitude can alter glucoregulation. Furthermore, cold temperatures and altitude can complicate accurate reading of glucose monitoring equipment and storage of insulin. These factors potentially lead to dangerous hyperglycemia or hypoglycemia. Over the last years, more information has become available on this subject. PURPOSETo provide an up-to-date overview of the pathophysiological changes during physical activity at altitude and the potential problems related to diabetes, including the use of (continuous) blood glucose monitors and insulin pumps. To propose practical recommendations for preparations and travel to altitude for subjects with diabetes. DATA SOURCES AND SYNTHESISWe researched PubMed, medical textbooks, and related Internet sites, and extracted human studies and data based on relevance for diabetes, exercise, and altitude. LIMITATIONSGiven the paucity of controlled trials regarding diabetes and altitude, we composed a narrative review and filled in areas lacking diabetes-specific studies with data obtained from nondiabetic subjects. CONCLUSIONSSubjects with diabetes can take part in activities at high, and even extreme, altitude. However, careful assessment of diabetes-related complications, optimal preparation, and adequate knowledge of glycemic regulation at altitude and altitude-related complications is needed.An increasing number of subjects with diabetes reside at high altitude for short periods of time, partly for work, but mainly for recreational purposes such as skiing, trekking, and climbing. Exercise under conditions of hypobaric hypoxia poses some unique challenges for subjects with diabetes and could potentially lead to dangerous situations such as unexpected hypoglycemia and hyperglycemia, inaccurate

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Section: Acclimatizationmentioning

confidence: 87%

Physical Activity at Altitude: Challenges for People With Diabetes

Mol

Vries²,

Koning

et al. 2014

Diabetes Care

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“…Published data have been somewhat inconsistent reporting an increase (12,37), a decrease (38), or no change (13,39) in leptin after ascent to HA. However, hypoxia has been shown to clearly increase leptin gene expression in adipocyte studies (40).…”

Section: Discussionmentioning

confidence: 99%

“…Former studies, investigating either HA natives or climbers exposed to HA for 2 months, have shown increased IGF1 and IGFBP3 at HA (13,26). In contrast, studies on short-term effects from exercise under hypoxic conditions revealed either no significant change or a decrease in IGF1 respectively (25,27).…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, an increase in ghrelin levels associated with weight loss during exposure to HA would be expected. However, two studies investigating ghrelin adaptation to HA found a 30% decrease in ghrelin plasma levels in 30 lowlanders 48 h after being taken to 4300 m (12), and unchanged ghrelin levels among nine elite climbers after exposure to very HA respectively (13). Hence, as weight loss is an inevitable consequence from ascent to HA, it may be difficult to discriminate between secondary effects due to weight loss and direct change of endocrine regulation, e.g.…”

Section: Introductionmentioning

confidence: 99%

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Adaptation of ghrelin and the GH/IGF axis to high altitude

Riedl

Kluge²,

Schweitzer³

et al. 2012

European Journal of Endocrinology

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Objective: High altitude (HA) provokes a variety of endocrine adaptive processes. We investigated the impact of HA on ghrelin levels and the GH/IGF axis. Design: Observational study as part of a medical multidisciplinary project in a mountainous environment. Methods: Thirty-three probands (12 females) were investigated at three timepoints during ascent to HA (A: d K42, 120 m; B: d C4, 3440 m; C: d C14, 5050 m). The following parameters were obtained: ghrelin; GH; GH-binding protein (GHBP); IGF1; IGF2; IGF-binding proteins (IGFBPs) -1, -2, and -3; acid-labile subunit (ALS); and insulin. Weight was monitored and general well being assessed using the Lake Louise acute mountain sickness (AMS) score. Results: Ghrelin (150 vs 111 pg/ml; P!0.01) and GH (3.4 vs 1.7 mg/l; P!0.01) were significantly higher at timepoint C compared with A whereas GHBP, IGF1, IGF2, IGFBP3, ALS, and insulin levels did not change. IGFBP1 (58 vs 47 mg/l; P!0.05) and, even more pronounced, IGFBP2 (1141 vs 615 mg/l; P!0.001) increased significantly. No correlation, neither sex-specific nor in the total group, between individual weight loss (females: K2.1 kg; males: K5.1 kg) and rise in ghrelin was found. Five of the subjects did not reach investigation point C due to AMS. Conclusions: After 14 days of exposure to HA, we observed a significant ghrelin and GH increase without changes in GHBP, IGF1, IGF2, IGFBP3, ALS, and insulin. Higher GH seems to be needed for acute metabolic effects rather than IGF/IGFBP3 generation. Increased IGFBP1 and -2 may reflect effects from HA on IGF bioavailability. European Journal of Endocrinology 166 969-976

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“…Recent studies have also reported that hypoxic training could more effectively reduce arterial stiffness in postmenopausal women compared with that in normoxic training [17]. However, although body weight changes during high-altitude mountain expeditions have been described in several studies for healthy subjects [18,19], there have been very few reports on hypoxic training effects under controlled experimental conditions. The purpose of this study was to investigate the influence of hypoxic physical exercise on metabolic risk markers and to compare the effects on maximum oxygen uptake (VO 2max ), arterial stiffness, and several blood parameters related to MS to a control group training under normoxic conditions.…”

Section: Introductionmentioning

confidence: 99%

Effect of normobaric hypoxia on cardiorespiratory and metabolic risk markers in healthy subjects

Shi¹,

Watanabe²,

Shin³

et al. 2013

ABB

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The aims of this study were to investigate the influence of hypoxic physical exercise on metabolic risk markers and to compare the effects on maximum oxygen uptake (VO 2max ), arterial stiffness, and several blood parameters to a control group training under normoxic conditions. Eight healthy men were examined. Each participant performed exercise at a heart rate (HR) corresponding to 60% of the HR at VO 2max on a treadmill device for 50 min (including 5 min warm-up and 5 min cool-down) after 30 min rest, on 3 days per week, for 4 weeks, in either normobaric hypoxia or normobaric normoxia. Each participant performed the exercise program under both environmental conditions with a wash-out period of 4 months. Brachial ankle pulse wave velocity after training was significantly lower in the hypoxic group than in the normoxic group (P = 0.02). The VO 2max in the hypoxic group was significantly higher after than before training (P = 0.04). Our results suggest that hypoxic training may more effectively reduce arterial stiffness and improve cardiorespiratory function compared with training performed at the same relative exercise intensity under normoxic conditions.

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Endocrine and metabolic responses to extreme altitude and physical exercise in climbers

Cited by 107 publications

References 34 publications

Physical Activity at Altitude: Challenges for People With Diabetes

Physical Activity at Altitude: Challenges for People With Diabetes

Adaptation of ghrelin and the GH/IGF axis to high altitude

Effect of normobaric hypoxia on cardiorespiratory and metabolic risk markers in healthy subjects

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