Hypoventilation Training: a Systematic Review

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Hypoventilation Training: a Systematic Review published online on 01.11.2019 https://doi.org/10.34045/SSEM/2018/23 REVIEW Hypoventilation Training: a systematic review EXERCISE PHYSIOLOGY / HYPOXIA / SPORTS SCIENCE / TRAINING Atemmangeltraining: eine systematische Übersichtsarbeit Holfelder B1, Becker F1 1 Institut für Sport- und Bewegungswissenschaft, Universität Stuttgart Abstract Background: High altitude training seems beneficial for many athletes. However, training in altitude is always associated with travel and high expenses. Thus, methods have been developed to achieve similar effects as with high altitude training. One method is voluntary hypoventilation training (VHT). Although published online on 01.11.2019 https://doi.org/10.34045/SSEM/2018/23 commonly used in training, the effectiveness of this method has not been analysed sufficiently. Methods: Intervention studies of voluntary hypoventilation training were identified from searches in PubMed, SciVerse Science Direct, Web of Science, Cochrane Library, EBSCOhost and Google Scholar. Results: Ten studies met the inclusion criteria. In seven studies, an intervention of VHT lead to greater improvements of the performance compared to a control programme. Conclusions: The overall positive study results support the usefulness of VHT for improving the performance and designing a varied training. Due to the limited numbers of intervention studies and the heterogeneous study designs, the outcomes must be interpreted with caution. Zusammenfassung Hintergrund: Höhentraining bietet einen wirkungsvollen Trainingsreiz für viele Sportler. Allerdings ist das Höhentraining mit logistischem und finanziellem Aufwand verbunden, sodass Trainingsmethoden wie das Atemmangeltraining entwickelt wurden, um vergleichbare Trainingseffekte wie durch Höhentraining zu erreichen. Die Wirksamkeit dieser Methode ist aber bisher nicht ausreichend untersucht. Methode: Zur Identifikation von Interventionsstudien zum Atemmangeltraining wurde in den sechs elektronischen Datenbanken PubMed, SciVerse Science Direct, Web of Science, Cochrane Library, EBSCOhost und Google Scholar recherchiert. Ergebnisse: Es konnten zehn Interventionsstudien identifiziert werden. In sieben Studien führte das Atemmangeltraining zu grösseren Verbesserungen der Leistungsfähigkeit als ein Kontrollprogramm. Schlussfolgerung: Die insgesamt positiven Ergebnisse sprechen für den Einsatz von Atemmangeltraining zur Verbesserung der Leistungsfähigkeit und zur Gestaltung eines abwechslungsreichen Trainings. Aufgrund der überschaubaren Anzahl an Interventionsstudien und der heterogenen Studiendesigns sind die Ergebnisse mit Vorsicht zu interpretieren. Einleitung Höhentraining stellt für viele Leistungssportler, insbesondere von Ausdauersportarten, eine erfolgsversprechende Trainingsmethode zur Verbesserung der Leistungsfähigkeit dar [1]. Da die Durchführung von Trainingseinheiten in realer Höhe oder in Höhenkammern mit einem grossen logistischen Aufwand und hohen Kosten verbunden ist, gibt es Bemühungen, ergänzende und alternative Trainingsmethoden zu entwickeln – eine davon ist das Atemmangeltraining. Bekannt wurde das Atemmangeltraining durch den Trainer und Wissenschaftler James Counsilman [2]. Diese Methode gewann vor allem im Rahmen der Olympischen Spiele 1968 in Mexico-Stadt (> 2200m ü. d. M.) an Bedeutung [3], nachdem insbesondere die Leistungen in Mittel- und Langstrecken stark abfielen [4]. Zu dieser Zeit wurde davon ausgegangen, dass es durch die gezielt verringerte Atmung zu einer reduzierten Sauerstoffkonzentration im Blut kommt und der Effekt eines Höhentrainings nachempfunden werden kann. Erste Untersuchungen zu Training mit reduzierter Atemfrequenz (RBF, engl. reduced breathing frequency) zeigten, dass es zwar zu einem Anstieg des Kohlenstoffdioxidgehalts (CO2) im Blut kommt, jedoch die Sauerstoffsättigung (sO2) nicht signifikant verringert wird [5,6,7]. Trotz dieser Ergebnisse wurde diese Trainingsform im Rahmen des Atemmangeltrainings als hypoxisches Training (engl. hypoxic training) bezeichnet. Aufgrund des erhöhten CO2-Gehalts betitelten Dicker et al. [6] das Training mit RBF als published online on 01.11.2019 https://doi.org/10.34045/SSEM/2018/23 hyperkapnisches Training. Mittlerweile konnte mehrfach gezeigt werden, dass Atemmangeltraining doch zu einer Abnahme des Sauerstoffpartialdrucks im Blut, also zu hypoxischen Zuständen, führen kann [3,4,8,9]. Das Atemmangeltraining verfolgt das Ziel, diese hyperkapnischen und hypoxischen Effekte zu kombinieren, die mitunter zu einer starken Übersäuerung des Organismus führen, wodurch es zu einem Abfall des pH-Wertes kommt [9,10,11]. Nach einem längeren Atemmangeltraining konnten höhere Laktatkonzentrationen festgestellt werden, wodurch möglicherweise der glykolytische Stoffwechsel verbessert werden kann [10,12]. Zusätzlich soll durch die verbesserte Pufferkapazität das Auftreten einer Übersäuerung hinausgezögert werden, was die auftretende Ermüdung der Muskeln verzögert und somit die Leistungsfähigkeit steigert [4,8,13]. Als ein weiteres Ziel des Atemmangeltrainings kann die Stärkung der Atemmuskulatur angesehen werden. Dadurch arbeitet die Atemmuskulatur stärker und ökonomischer, wodurch weniger Sauerstoff benötigt wird, der dadurch wiederum anderen Muskeln zur Verfügung steht [8]. Aus der Sicht von Henneberg und Rudolph [3] bringt ein Atemmangeltraining nach Counsilman für den Schwimmsport weniger physiologische, sondern mehr technisch-taktische Vorteile (Rennübersicht, ruhige Wasserlage). Darüber hinaus sehen West et al. [14] psychologische Effekte in Form einer verbesserten mentalen Belastungstoleranz als ein grosses Ziel des Atemmangeltrainings. Besonders in Sportarten, in denen Athleten mit akutem Atemmangel konfrontiert sind, wie beispielsweise bei den Unterwasserphasen und auf der letzten Bahn eines Schwimmwettbewerbs oder beim Massenstart im Triathlon, erscheint es sinnvoll, den Umgang mit diesem «Sauerstoffnotstand» zu trainieren [3,4]. Formen des Atemmangeltrainings Es gibt verschiedene Methoden, ein Atemmangeltraining durchzuführen. Die ursprüngliche Form ist die der kontrollierten (engl. controlled breathing frequency, CBF) oder reduzierten Atemfrequenz (engl. reduced breathing frequency, RBF). Diese finden aufgrund der Eigenschaft des Wassers vermehrt im Schwimmsport Anwendung. Hierbei wird das Verhältnis von Atemzug zu Armzügen von normalerweise 1:2 bzw. 1:3 auf 1:5 bis 1:9 erhöht oder eine Strecke von 25–50m ohne zu atmen geschwommen [2,4]. Woorons et al. [15] spezifizierten die ursprüngliche Form und nannten sie Training mit freiwilliger Hypoventilation (engl. voluntary hypoventilation training, VHT). Die weitere Entwicklung führte innerhalb des VHT zu der Differenzierung zwischen freiwilliger Hypoventilation auf hohen bzw. geringen Lungenvolumen (engl. voluntary hypoventilation at high lung volume, VHH; voluntary hypoventilation at low lung volume, VHL; siehe Abbildung 1) [10,12,13,16]. Beim VHH wird möglichst viel Luft zwischen zwei Atemzüge in der Lunge gehalten und somit bei fast vollständigem Lungenvolumen der Atem angehalten. Hingegen wird beim VHL die Luft bei geringem Lungenvolumen, d.h. bei funktionellem Residualvolumen angehalten. Kurz vor der nächsten Einatmung erfolgt eine zweite, schnelle, aktive Ausatmung bis nahe des Residualvolumens. Damit soll das während des Atemstillstandes angesammelte CO2 abgeatmet werden, um die Umsetzung der VHL über die geforderte Zeit zu gewährleisten [13]. Ziel dieser systematischen Übersichtsarbeit ist es, den aktuellen Forschungsstand von Interventionsstudien zum Atemmangeltraining vorzustellen. Auf der Basis der involvierten Studien soll analysiert werden, ob das Atemmangeltraining zu grösseren Verbesserungen der Leistungsfähigkeit führt als das Training mit «normaler» Atmung und welche physiologischen Effekte mögliche Erklärungsansätze liefern. Anlehnend an bisherige Forschungserkenntnisse [4] wird angenommen, dass durch published online on 01.11.2019 https://doi.org/10.34045/SSEM/2018/23 Atemmangeltraining zusätzliche trainingswirksame Reize gesetzt werden können. Abbildung 1: Hypoventilationstraining bei hohem Lungenvolumen (links) und bei geringem Lungenvolumen (rechts) im Vergleich (mod. nach Woorons et al. [13], S. 2). Methoden Suchstrategie Die systematische Literaturrecherche wurde in folgenden sechs Datenbanken durchgeführt: PubMed, SciVerse Science Direct, Web of Science, Cochrane Library, EBSCOhost und Google Scholar. Für alle Datenbanken wurden die englischen Suchbegriffe «hypoventilation training», «hypoventilation», «voluntary hypoventilation», «reduced breathing frequency», «controlled breathing frequency» und «apnea training», in Verbindung mit «competitive athletes», «sport» und «excercise» verwendet sowie die deutschen Begriffe «Hypoxietraining», «Atemmangeltraining» und «verringerte Atemfrequenz» in Verbindung mit «Leistungssport» und «Bewegung». Zur Optimierung des Rechercheprozesses wurden in den einzelnen Datenbanken einheitlich die Booleschen Operatoren «AND», «OR», «NOT» und «*» mitaufgenommen. Darüber hinaus wurden die Literaturverzeichnisse von relevanten Studien auf weitere potenzielle Studien durchsucht. Es gab keine Beschränkung für den Zeitraum der Veröffentlichung der Studien. Die Recherche wurde am 15. Juli 2017 beendet. Studienauswahl Titel und verfügbare Zusammenfassungen der recherchierten Studien wurden überprüft und als potenziell relevante Studien eingeordnet. Es wurden folgende Einschlusskriterien definiert: (a) VHT war explizit ein Untersuchungsgegenstand der Studie, das mit anderen Trainingsmethoden oder einer
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