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peripheral capillary oxygen saturation and performance among endurance runners. Twelve endurance male runners (age: 24 yrs ± 3 yrs, height: 180.5 cm ± 4.2 cm, weight: 66.7 kg ± 3 kg, Body mass index: 20.5 ± 1.0) among Iranian national team were randomly divided into case and control group in hypoxic condition. Exhaustive testing free 1500 m, strength Index and arterial oxygen saturation tests were taken before and 24 h after training period. Training program include same continues, interval, aerobic and resistance training for two groups. Runners performed 16 training session per week in high altitude within four weeks. Data were analyzed

randomly divided into case and control group in hypoxic condition. Exhaustive testing free 1500 m, strength Index and arterial oxygen saturation tests were taken before and 24 h after training period. Training program include same continues, interval, aerobic and resistance training for two groups. Runners performed 16 training session per week in high altitude within four weeks. Data were analyzed by analysis of variance (P ≤ 0.05). Inspiratory muscle training at hypoxia due to significant decrease in 1500 m running performance, inspiratory muscle strength and peak inspiratory flow in both group, but the differences in volume and peripheral capillary oxygen saturation were not significant (P ≤ 0.05). This study suggests that using inspiratory muscle training along with specified training in hypoxia increases inspiratory muscle strength and peak inspiratory flow pressure meanwhile it decreases ventilation and 1500 m running time in lower altitude.

© ½ º à » ³ ffi Ú œ Á Á à ³ Ú ffi  £ à º » ¥ ³ Á ¾ · À ³ ² œ ¦ ¦ ¡ fi ffi «  £ ¥ ¯ ¼ ½ ¾ ³ ¼ ¯ ± ± ³ Á Á ¸ ½ à À ¼ ¯ º Citation: Roohollah MM, Shadmehr M (2016) The Effect of an Inspiratory Muscle Training Period at High Altitude on Arterial Oxygen Saturation and Performance of Iran’s National Team Endurance Runners. J Pulm Respir Med 6: 356. doi:10.4172/2161-105X.1000356 Page 2 of 5 of group and training protocol type, 1500 m running time performance showed significant difference (T=838/65, P=0/01). Post hoc Bonferroni test showed significant difference (1%) between experiment group and control group (p ≤ 0.05). Statistical assessment of S-Index (T=26/13, P=0/01) and PIF (T=7/33, P=0/02) showed significant difference in duration of being exposed to Altitude condition (P ≤ 0.05). But no significant differences between groups was indicated by post hoc Bonferroni tests (P ≤ 0.05). Results also indicated that excepting SpO 2 (T=1/31, P=0/27) and Volume (T=0/643, P=0/44) there were no significant difference in other variables in both groups (P ≥ 0.05) (Table 3 and Figures 1-3). Discussion Current study mainly shows that IMT significantly increased inspiratory muscle strength (S-Index) and PIF (EXP=18.48%, CON=15.60%). At the same time it significantly decreased 1500 m running time after hypoxic period. Even though significant differences of between-group S-Index and PIF were expected, but there were no statistical significant differences in these cases. These findings are consistent with results of McConnell [28] and Kilding et al. [29] studies and show inconsistency with Nicks et al. [30] and Wylegala et al. [31] results. McConnell [28] and Kilding et al. [29] showed that S-Index and PIF had been improved by IMT in every sport filed excepting snorkeling and swimming. The main reason for not being effective on swimmers might be related to water pressure on their chest during exercise. Besides, elite swimmers may have reached to their own optimum level of respiratory muscle functioning therefore they won’t increase their PIF after

showed that S-Index and PIF had been improved by IMT in every sport filed excepting snorkeling and swimming. The main reason for not being effective on swimmers might be related to water pressure on their chest during exercise. Besides, elite swimmers may have reached to their own optimum level of respiratory muscle functioning therefore they won’t increase their PIF after IMT anymore. Our study indicated the importance of exposure to hypoxia despite of IMT device impact for both groups. Hypoxia itself can cause hyper- ventilation, tachypnea and consequently hyper-respiratory function, so muscular endurance will be improved as result of higher blood flow. Brown et al. [32] have reported significant increase of S-Index and PIF fifty male after IMT which is admitting the results of current study. According to Brown et al. [33,34] study skeletal and respiratory muscle’s endurance decrease in older age and respiratory muscle alterations in elderly people are similar with musculoskeletal changes during weight training. Nicks [30] has reported the same result. He has suggested the reason of better outcomes amongst rowers might be related to physiological and mechanical nature of their exercise. It is pertinent to mention that not only the main respiratory muscles and accessories are deploying for ventilation during rowing but also they have considerable role in terms of stabilizing the chest and transferring the force throughout the paddling process. These dual demands from respiratory muscles creates respiratory pattern for keeping performance for rowers [30]. This shows a close relation between running and rowing as both need frequent constrictions along with high intensity. We didn’t observe any alteration in SpO 2 during relax time after IMT in hypoxic condition. Downey et al. [22] have assessed IMT effect on physiological variables and observed SpO 2 alterations in hypoxic condition. Mitch Lomax [20] has obtained about 6% O 2 Sat in 4880 m and 5550 m altitudes among his study group. This is not admitting the results of current study. Because SpO 2 decreases in higher altitude this inconsistency might be due to higher altitude in Mitch Lomax [20] study. On one hand, being in high altitude

in hypoxic condition. Mitch Lomax [20] has obtained about 6% O 2 Sat in 4880 m and 5550 m altitudes among his study group. This is not admitting the results of current study. Because SpO 2 decreases in higher altitude this inconsistency might be due to higher altitude in Mitch Lomax [20] study. On one hand, being in high altitude enhances SpO 2 and on the other hand it decreases at higher altitude than 2500 m, so the reason of not changing SpO2 can be justified in this way. EXP (n=6) CON (n=6) Parameter Pre- altitudePost-altitudePre- altitudePost- altitude Age 2.8 ± 23.12.8 ± 23.13.1 ± 25.6 3.1 ± 25.6 Height (cm)4.0 ± 178.34.0 ± 178.33.3 ± 182.63.3 ± 182.6 Body mass (kg)3.1 ± 67.52.6 ± 66.13.8 ± 66.0 3.4 ± 65.5 BMI (kg.m 2 ) 0.3 ± 21.20.4 ± 20.8 1 ± 20.7 1 ± 19.7 Table 1: Pre- and post-altitude anthropometric characteristics of the subjects in the Experimental (EXP) and in the Control (CON) groups (mean ± SD). smoking or supplemental use were other excluding criterion. Written consents were taken from all participants. Experimental design Study was conducted after competitive season and during their period of rest. First, all participants were called to Olympic camp for checking their height, weight, body mass index (BMI). After getting familiar with Power Breath device (K5 model, UK) and SPIROLAB pulse oximeter device (MIR, Italy) they were randomly divided to experimental group (EXP) (n=6) and placebo or control group (CON) (n=6). Then functional performances in 1500 m were taken place in 200 m standard indoor track at 1400 m altitude from both groups. Power Breath was used for inspiratory indexes measurement such as maximum inspiratory pressure (MIP) and peak inspiratory flow (PIF) as well as inspiratory volume. SpO 2 in altitude was measured by pulse oximeter. Then Runners performed special training by R2M method at 2500 m altitude in Delfan camp at Zagros Mountain. They trained in combinational sessions including endurance, speed, power and plyometric trainings with different volumes and intensities. All inspiratory indexes were measured and 1500 m executive function performance test

well as inspiratory volume. SpO 2 in altitude was measured by pulse oximeter. Then Runners performed special training by R2M method at 2500 m altitude in Delfan camp at Zagros Mountain. They trained in combinational sessions including endurance, speed, power and plyometric trainings with different volumes and intensities. All inspiratory indexes were measured and 1500 m executive function performance test were taken right 24 h after the end of the forth week. Field trainings such as altitude living-training and live high train high (LHTH) were done (Table 2). Inspiratory muscle training First of all, we measured the maximum muscular power (cm H 2 O) for an inspiration (S-Index) which is considered equal with MIP. Training protocol was considered including thirty deep inspirations with closed nose with Power Breath device for EXP group within seven days. Altitude training intervention All participants performed the altitude program. Similar training program such as interval, aerobic and resistance training have been conducted for both groups. The runners performed 16 training session per week within four weeks in high altitude (just three tracks training sessions per week at seven days performed at low altitude). SpO 2 measurement was carried out only in altitude at least for three minutes in flat position and just during night time. Data collection and statistical analyses Data were collected and analyzed by SPSS software (version 21.0, SPSS, Chicago, Illinois) parametric data assumptions were met (Shapiro-Wilks test), pre training, post training and group interactions results were statistically compared using two-ways repeated measures analyses of variance (ANOVA) and post hoc Bonferroni tests of Honestly Significant Difference as appropriate. Probability values of less than 0.05 were considered significant. All results were expressed as mean standard deviation (SD) unless otherwise stated. Results Results driven by ANOVA repeated measurements of altitude’s effect on variables along with between-group factor revealed that despite

© ½ º à » ³ 5 Ú œ Á Á à ³ 2 Ú 0 245  £ à º » ¥ ³ Á ¾ · À ³ ² œ ¦ ¦ ¡9 1050,0 4 «  £ ¥ ¯ ¼ ½ ¾ ³ ¼ ¯ ± ± ³ Á Á ¸ ½ à À ¼ ¯ º Citation: Roohollah MM, Shadmehr M (2016) The Effect of an Inspiratory Muscle Training Period at High Altitude on Arterial Oxygen Saturation and Performance of Iran’s National Team Endurance Runners. J Pulm Respir Med 6: 356. doi:10.4172/2161-105X.1000356 Page 3 of 5 Training load Very high high Medium low Very low Training Intensity Int ≤ VT1 MHR ≤ 160 Int ≤ VT1 Int ≤ VT2 MHR ≤ 160-170 Int ≤ VT1 Int ≤ VT2 Int ≤ MAP1 MHR ≤ 170-180 Int ≤ VT1 Int ≤ VT2 Int ≤ MAP2 MHR ≤ 180-190 Training type Speed endurance Strength endurance Tempo endurance Running endurance Power speed Speed Strength Plyometric Isodynamic Speed endurance Strength endurance Tempo endurance Running endurance Power speed Speed Strength Plyometric Isodynamic Competition strategy Speed endurance Strength endurance Tempo endurance Running endurance Power speed Speed Strength Plyometric Isodynamic Competition strategy Speed endurance Strength endurance Tempo endurance Running endurance Power speed Speed Strength Plyometric Isodynamic Competition strategy Season week 18 18 16 15 IMT 50% S-Index 30 breaths morning and evening 30 breaths morning and evening 30 breaths morning and evening 30 breaths morning and evening Measure at high altitude S-index, SpO 2 S-index, SpO 2 Measure at low altitude 1500 m 1500 m days 1 7 7 7 7+2 taiper 1 Measure pre post Table 2: IMT plan and training system R2M (this is an acronym for running at middle distance to marathon) at altitude. Quantities of training intensity (Int), maximal aerobic power (MAP), Maximal heart rate (MHR), first Ventilatory threshold (VT1) and second Ventilatory threshold (VT2) [1,44-48]. CON group EXP group indexes PRE POST PRE POST S-Index (cm H 2 O) 110/23 ± 22/3 10/8 ± 130/60 22 ± 122/45 18/35 ± 141/54 PIF (L/sec) 1/14 ± 5/980/62 ± 6/191/14 ± 6/780/96

at altitude. Quantities of training intensity (Int), maximal aerobic power (MAP), Maximal heart rate (MHR), first Ventilatory threshold (VT1) and second Ventilatory threshold (VT2) [1,44-48]. CON group EXP group indexes PRE POST PRE POST S-Index (cm H 2 O) 110/23 ± 22/3 10/8 ± 130/60 22 ± 122/45 18/35 ± 141/54 PIF (L/sec) 1/14 ± 5/980/62 ± 6/191/14 ± 6/780/96 ± 6/97 Volume (liter) 0/63 ± 2/831/02 ± 2/990/59 ± 3/540/44 ± 3/54 SpO 2 (%) 0/32 ± 94/300/22 ± 94/330/24 ± 94/350/62 ± 94/58 Performance 1500 m (min) 0/18 ± 4:03:29 0/30 ± 3:56:52 0/20 ± 4:01:20 0/50 ± 3:52:31 Table 3: Pre- and post-training characteristics in experiment and in control group. Not being exposed to hypoxic condition probably lead to minute hyperventilation as primary response. Consequently peripheral chemo- receptors in respiratory system may cope with hypoxia. However respiratory organs are ultra-structured against any applied changes in 0 50 100 150 PRE POST S-Index(cmH2o) EXP CON * Figure 1: Mean pre- to post-training S-Index for EXP and CON groups. *significant post-training S-Index increase in, EXP (p=0.01). Post-training S-Index Significantly increased in EXP (p=0.05). 4:01 3:52 4:03 3:56 3:36 3:43 3:50 3:57 4:04 4:12 PRE POST performance 1500m(min/sec) EXP CON * Figure 2: Mean pre- to post-training 1500 m performance times for EXP and CON groups. *significant post-training increase in performance (p=0.00). Post-training performance significantly increased in EXP group (p=0.05). * 5 5.5 6 6.5 7 7.5 PRE POST PIF (Lit/sec) EXP CON * Figure 3: Mean pre- to post-training PIF for EXP and CON groups. *significant post-training change in PIF, (p=0.02). PIF significant increase post-training change in EXP group (p=0.05).

© ½ º à » ³ 5 Ú œ Á Á à ³ 2 Ú 0 245  £ à º » ¥ ³ Á ¾ · À ³ ² œ ¦ ¦ ¡9 1050,0 4 «  £ ¥ ¯ ¼ ½ ¾ ³ ¼ ¯ ± ± ³ Á Á ¸ ½ à À ¼ ¯ º Citation: Roohollah MM, Shadmehr M (2016) The Effect of an Inspiratory Muscle Training Period at High Altitude on Arterial Oxygen Saturation and Performance of Iran’s National Team Endurance Runners. J Pulm Respir Med 6: 356. doi:10.4172/2161-105X.1000356 Page 4 of 5 different environmental conditions. SpO 2 reduction due to climbing from sea level will decrease SaO 2 [10]. Long alkalosis that occurs in high altitude as well as increasing 2,3-diphosphoglycerate (dpg) concentration won’t lead to complete respiratory compensation, but will navigate the balance between extra oxygen loading in lung, oxygen tissue proliferation and ultimately minimum pH disturbance. IMT may modify natural hyper-ventilation in response to hypoxia through such process [10-12]. In our study IMT in hypoxic condition made significant difference in pre-test and post-test PIF among experimental group (3.5%). Haung (2003) has also reported PIF increase (45%) after eleven weeks IMT. This higher percentage surely is related to longer training period. We did not find any significant difference in PIF between both groups under hypoxic condition which is inconsistent with results of Mazzeo and Fulco [35], and Brown et al. [33]. This contradiction might be due to training protocol or even we did not set training protocol specifically for endurance runners. Our results show significant decrease in 1500 m between-group running time among experimental group (3.65%). Astinchap et al. [36] and Behparvar (2015) also have reported that IMT in hypoxic condition is effective in 25 m length amongst female swimmers. But this effect was not significant in 50 m and 100 m length. One of the probable reasons for this outcome may be depended on stronger respiratory system in swimmers [36]. Likewise, McConnell and Romer [37] have shown that IMT improves time trail performance, accelerates recovery period, decreases lactate blood level and

effective in 25 m length amongst female swimmers. But this effect was not significant in 50 m and 100 m length. One of the probable reasons for this outcome may be depended on stronger respiratory system in swimmers [36]. Likewise, McConnell and Romer [37] have shown that IMT improves time trail performance, accelerates recovery period, decreases lactate blood level and delays muscles fatigue [37-44]. Verges et al. [45] have shown that exposure to hypoxia lead to improve endurance performance, The mechanism of the improvement appear to be a stimulation of erythropoiesis leading to an apparent increase in oxygen delivery to peripheral tissues as evidenced by a near doubling of plasma erythropoietin concentration, a rise in soluble transferrin receptor concentration and increase in hemoglobin concentration and hematocrit with chronic exposure to altitude on return to sea level [45]. Martin et al. (2012) have shown a significant effect of BMI on the performance of male long distance runners. BMI influenced the performance, yielding a positive correlation with the race time, the speed being higher in athletes from the underweight to the overweight [46]. In fact, chronic exposure to reduced partial pressure of oxygen as it is the case at high altitude, decreases arterial oxygen saturation, provoking shifts in substrate metabolism. This increases the difficulty for the body to use oxidative phosphorylation to produce the energy needed for endurance exercise; the glycolytic pathway is therefore favored rather than other catabolic pathways, including fat catabolism for energy production, because it has the lowest oxygen cost [47]. It should be noted that unlike swimming, there is no perceived exertion throughout the running. Utilizing IMT under hypoxia can reduce perceived exertion and improve performance without any side effects on respiration indexes. Some reports admit that time trial performance and maximal oxygen uptake (VO 2 max) get better amongst cyclists after IMT [37,38]. The significant increase of running performance after training in high altitude is not consistence with Siebenmann et al. [39] findings. They assessed LHTL in sixteen male endurance cyclists and did not observe any significant difference in 26 km time trial performance among them under