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The Health Effects of Intermittent Hypoxic Exposure in a Sedentary Population

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The Health Effects of Intermittent Hypoxic Exposure in a Sedentary Population Lincoln University Digital Thesis Copyright Statement The digital copy of this thesis is protected by the Copyright Act 1994 (New Zealand). This thesis may be consulted by you, provided you comply with the provisions of the Act and the following conditions of use: you will use the copy only for the purposes of research or private study you will recognise the author's right to be identified as the author of the thesis and due acknowledgement will be made to the author where appropriate you will obtain the author's permission before publishing any material from the thesis. The Health Effects of Intermittent Hypoxic Exposure in a Sedentary Population A thesis submitted in partial fulfilment of the requirements for the Degree of Doctor of Philosophy at Lincoln University by Catherine Anne Lizamore Lincoln University 2013 Abstract of a thesis submitted in partial fulfilment of the requirements for the Degree of Doctor of Philosophy. Abstract The Health Effects of Intermittent Hypoxic Exposure in a sedentary population by Catherine Anne Lizamore The use of simulated altitude is frequently used in an attempt to enhance athletic performance. Similar techniques have also recently been used in a clinical population to improve cardiovascular risk. However, the effects of different frequencies of simulated altitude per week, follow up assessments and the effects of passive simulated altitude in addition to exercise (rather than exercising in hypoxia) has not been tested in a sedentary, middle-aged population. To simulate altitude, an intermittent hypoxic exposure (IHE) protocol was used whereby 5-min of hypoxia was alternated with 5-min of normoxia for 1 hour. Heart rate variability (HRV), i.e. the beat- ˙ to-beat fluctuations between R-peaks, cardiovascular fitness (VO2peak), systolic blood presssure (SBP), highly-sensitive C-Reactive protein (hs-CRP, indicative of systemic inflammation associated with athlersclerosis), high density lipoprotein, total cholesterol, and arterial stiffness were used to assess cardiovascular health during 3 IHE studies. In the first study, 4 IHE sessions/week for 4 weeks resulted in increased HRV compared to a placebo treatment (71.6 ± 52.5%, mean between-group change from the natural logarithm 90% confidence interval), indicating increased parasympathetic activity. The second study assessed the effects of IHE frequency on selected risk factors. Following the 5-week intervention, HRV (during paced breathing) increased in participants given both 2-3 (IHE3) and 5 (IHE5) IHE sessions per week (IHE5: 47.3 41.6%; IHE3: 6.2 6.9%), thereby confirming the changes in HRV reported in Study 1. In addition, haemoglobin concentration (2.7 ± 2.8%), time taken to complete the maximal fitness assessment (34.5 ± 36.8%), and maximal workload (14.4 ± 14.9%) were increased in IHE5 compared to the control group, while changes in hs-CRP (12.7 ± 48.7%) were trivial. None of these changes were seen ˙ in IHE3. There was an increased VO2peak (12.6 ± 9.3%) in IHE3 compared to the Control, but not IHE5. ˙ Due to the benefical effects on VO2peak and HRV, 2-3 IHE sessions/week were used together with 3 exercise sessions/week (IHE3+Ex), and compared to exercise only (Ex) in the third study. Immediately ii post intervention, 4- and 8-wk follow up measurements were taken. Both groups showed a tendency ˙ to decrease total cholesterol, improve arterial compliance (pulse wave velocity) and increase VO2peak and HRV, but these changes were unclear. High density lipoprotein (Post: 8.0 8.0%; 8-wk: 10.0 ˙ 8.5%), SBP (Post: -3.4 3.4%; -3.5 3.7%) improved in IHE3+Ex more than Ex, and while VO2peak was qualitatively unclear at Post it was increased at the 4-wk (9.4 8.0%) and 8-wk (7.9 8.3) follow-up sessions. While differences in systemic arterial stiffness (augmentation index) was unclear between groups at Post, the augmentation index increased at 4- and 8-wk (4-wk: 11.8 18.4%; 8-wk: 24.8 19.7%) in the IHE3+Ex group compared to Ex. Overall, IHE appears to increase the parasympathetic contribution to the sympathovagal balance of the heart at rest in sedentary middle-aged participants, and may improve SBP and some fitness parameters, particularly with 4–5 IHE sessions/week. While the short-term effects of IHE on arterial health are promising, more research on the long-term effects of IHE treatments is needed before IHE can conclusively be considered ‘safe’. Keywords: Intermittent hypoxic exposure, heart rate variability, exercise, sedentary, health, cardiovascular risk, systolic blood pressure, total cholesterol, high density lipoprotein, highly sensitive C-Reactive protein, arterial stiffness iii Acknowledgements The road to submission has been a long winding one that has traversed steep inclines, unexpected challenges, long dry deserts, and amazing view-points. It has been a journey that could not have been completed, without the help and support of so many along the way. My supervisor, Associate Professor Mike Hamlin, has been a mentor in the truest sense of the word. Over the last 4 years, I have greatly appreciated his guidance, support, and critical insight. I could not have asked for a better (or more patient) collaborator and advisor. I also owe thanks to my associate supervisor, Dr Gary Steel, for planting the ‘why not apply to do a doctorate instead’ seed, and all his ongoing support in both thesis and work-related spheres. For the last 3 years I have received a stipend and contribution to university fees from The National Heart Foundation of New Zealand, for which I am incredibly grateful. I have been immensely fortunately to have been able to collaborate with researchers outside of Lincoln University, which has greatly contributed to the depth of investigation we were able to achieve. To Dr Lee Stoner, who has provided expert guidance, support and generous use of his equipment in the assessments of arterial stiffness in Study 3 (Appendix G) and Dr Sam Lucas, who so willingly drove up from the University of Otago to drop off NIRS equipment for each of the measurement time points, and for his critical analysis of the subsequent data analysis (Appendix G), I owe you both a great depth of gratitude. Dr Yaso Kathiravel and Dr John Elliott have both gone above and beyond the call of duty in volunteering their very busy time to medically assess the participants prior to inclusion into the study, and to Dr John Hellemans for his expert advice on both hypoxic training and medical matters. Then, to all the people who have helped with the long hours of exercise testing, specifically Adam Lucero, Meegan Fraser, Apiwan and Nuttaset Manimmanakorn, Darrell Lizamore, Sam Russell, and Helen Marshal. In a post-earthquake space-limited campus, the thinking-out-the-box can-do attitude of Marianne Richards and her team of ground staff at Lincworks was like a cool glass of water on a desert stretch of the road. Finally, I am indebted to all the participants for each of the studies who have so willingly and cheerfully volunteered their time to the project. On a personal note, I would like to extend my gratitude to David and Eriko Viviers, and the Metcalf family who have been like family to us since we arrived in New Zealand. To our family, the Rendalls, Lizamores, Simpkins, and Blacklaws, your thoughts, prayers and encouragement have been especially iv valuable. Then, to my Grandpa whose love for endurance running and recovery from cardiovascular disease have been two of the biggest sources of inspiration, both academically and personally, thanks. Finally, to my husband, Darrell Lizamore, who has been up front in the passenger seat and has shared all of the views, excitement and the detours along the way –all while negotiating a PhD of his own. I couldn’t have done this without all your encouragement, love and support. You are my sunshine, thank you. v Table of Contents Abstract ....................................................................................................................................... ii Acknowledgements ..................................................................................................................... iv List of Tables ................................................................................................................................ x List of Figures .............................................................................................................................. xi List of frequently used abbreviations .......................................................................................... xii Chapter 1 Introduction ............................................................................................................... 13 1.1 Thesis statement and aims .......................................................................................................... 14 1.2 Thesis format ............................................................................................................................... 16 1.3 An overview of the following thesis chapters .............................................................................. 16 1.3.1 Chapter 2: Literature Review on the effects of simulated altitude ................................ 16 1.3.2 Chapter 3: Study 1: The effect of intermittent hypoxic exposure on heart rate variability in a sedentary population .............................................................................. 17 1.3.3 Chapter 4: Study 2: The minimum dosage of intermittent hypoxic exposure per week for health improvement in sedentary,
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