ISSN: 2469-5718 Konstantinidou and Chairopoulou. Int J Sports Exerc Med 2017, 3:073 DOI: 10.23937/2469-5718/1510073 Volume 3 | Issue 5 International Journal of Open Access Sports and Exercise Medicine CASE STUDY Apnea Training Specificity and its Implications for Performance in Aquatic Sports: Case Study Reports Sylvia Konstantinidou* and Chrysoula Chairopoulou School of Physical Education & Sports Sciences, National & Kapodistrian University of Athens, Greece *Corresponding author: Sylvia Konstantinidou, School of Physical Education and Sports Sciences, National & Kapo- distrian University of Athens, Division of Aquatic Sports, Ethnikis Antistasis 41, Dafni 17237, Athens, Greece, E-mail: [email protected] breathing air with O concentration 12.67% are also ex- Abstract 2 periencing hypoxia corresponding to an elevation level Apnea training forms an essential drill used by athletes in of ~4,500 m (460 × 20.93%/760 = 12.67%). aquatic sports such as diving, underwater rugby but also in swimming particularly fin and synchronized swimming. Apnea is allegedly trainable as manifested in extend- Literature suggests a number of long-term adaptations ob- ed apnea duration supplemented by stronger diving re- served in apnea-conditioned athletes compared to controls. Unique responses to acute apneas have also been man- sponse-an oxygen conservation mechanism due to con- ifested by athletes with minimum apnea exposure though ditioning. In the long-term, apnea training may enhance arguably to a lesser extent. The actual benefits of apnea individuals’ aerobic capacity through improved aerobic training on athlete’s performance in aquatic sports have not enzymes, increased capillary vessels and mitochondria yet been fully established. Perhaps, the type of apnea train- ing might determine its impact on performance contingent [4]. However, both the trainability of apnea and its ben- to sport particularities. Three pilot case studies concerning efits with respect to performance on aquatic sports Sport Science student responses to alternative forms of are not clearly established particularly for competitive apnea after following a 13 ± 2 day apnea-training protocol events at sea level [5]. is presented. Results suggest that the specificity of apnea drills might provide an explanation of the inconclusive re- Three Sports Science students at the University of sults on apnea training benefits in aquatic sports. Athens, one male, two females, accustomed to apnea Keywords to a different degree, volunteered to participate in a pi- lot study aimed at testing the trainability of apnea and Apnea training, Aquatic sports performance, Hypoxia its potential implications on sports performance. Con- sidering the long duration of synchronized swimmers’ Introduction training sessions, we wanted to test whether a quick Apnea training constitutes a form of hypoxic train- dry apnea drill to be applied at their spare time, could ing; the latter being applied to a wide diversity of sports be potentially beneficial for their performance. Study demanding aerobic capacity though results concerning participants followed a 13 ± 2 day of Dry Apnea Training its importance are inconclusive [1]. Hypoxia relates to Programme (DATP) exhibiting diverse apnea duration improvements as measured under alternative testing reduced Oxygen (O2) in the environmental air due to conditions. However, all participants manifested rela- the fall of its partial pressure i.e. PO2 < 150 mmHg [2] caused by a fall of the barometric Pressure (Pb)-Boyle’s tively higher apnea duration increases under «dry apnea Law. For example an ascent at high altitude (Pb < 760 in supine position». Results support the apnea-training mmHg) exposes us to hypoxia leading to hypoxemia i.e. specificity argument as participants performed max- imum breath hold sessions lying in a supine position. reduced O2 circulating in our blood [3]. However, divers Citation: Konstantinidou S, Chairopoulou C (2017) Apnea Training Specificity and its Implications for Performance in Aquatic Sports: Case Study Reports. Int J Sports Exerc Med 3:073. doi.org/10.23937/2469- 5718/1510073 Received: April 17, 2017; Accepted: September 16, 2017; Published: September 18, 2017 Copyright: © 2017 Konstantinidou S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Konstantinidou and Chairopoulou. Int J Sports Exerc Med 2017, 3:073 • Page 1 of 7 • DOI: 10.23937/2469-5718/1510073 ISSN: 2469-5718 Further research is warranted using alternative apnea blood acidosis and oxidative stress which may positive- training protocols but also examining the potential long- ly affect performance [17,19]. Further, apnea triggers a term physiological impact of apnea-conditioning on in- temporary rise in haemoglobin which is higher in divers dividuals’ aerobic capacity and anaerobic power. compared to skiers and controls [20]. Actually, apnea Methods triggers spleen contraction and a consequent rise in EPO and red blood cells [21,22]. This “artificial” elevation of Study participants were briefed and asked to com- hemoglobin and hematocrit lasts approximately for ten plete a health screening questionnaire before giving minutes which suffice for boosting swimmers’ perfor- their written consent to participate in the study [6]. The mance when applied prior to a race [23]. study was conducted in accordance with the Declara- Apnea training apparently prompts higher apnea du- tion of Helsinki and following School’s ethical approval. ration [20] but also, higher tolerance to hypoxic condi- We measured and recorded individual’s anthropometric tions [24]. This may be attributed to athletes’ increased variables (SECA, USA) and assessed their fitness level [7] mitochondria, capillary vessels and aerobic enzymes, and anxiety status in general and before apnea sessions. leading to an increased VO and O saturation [25,26]. Anxiety assessments were performed using two scales 2max 2 Overall, elite divers develop protective mechanisms validated in the Greek population namely, the STAI-Trait against hypoxia including a reduced oxygen consump- and the STAI-State (Form X) [8-10]. tion compared to controls. Study participants were asked to follow a supervised Results on dynamic apnea training on swimmers [27] daily Dry Apnea Training Protocol (DATP) consisting of and hypoxic training [28] have shown no discernible five consecutive maximum apneas lying in a supine po- effect on performance. However, improved swimming sition with a two-minute rest interval in between apnea technique and VO2max have been recorded respectively. bouts, for a period of two weeks [4]. Despite the min- In contrast, others report improved performance for imum duration of the DATP considering its analogy to swimmers that undertook hypoxic training [29,30]. Fur- altitude acclimatization it is acceptable for the purpos- ther, evidence suggests that apnea training improves es of a preliminary investigation [11]. Apnea durations respiratory muscle performance by delaying fatigue in alternative testing conditions (static/dynamic and during continuous exercise at maximum effort [31]. dry/wet) were measured before (baseline) and after Apparently, apnea training causes physiological adapta- the DATP which lasted for 13 ± 2 days. After each ap- tions allowing individuals not only to exert an improved nea trial, a 3-minute rest interval (Speedo stopwatch, breath control but also, to cope with conditions of hy- SD50588, China) elapsed during which participants in- poxia in an effective and efficient manner although con- dicated their level of Perceived Exertion (RPE) and their tradictory evidence exists [32-34]. Perceived Dyspnea (RPD - modified Borg’s scale [12]. Arterial blood pressure (Fora P91, For a Care Suisse AG), This study purports to determine whether apnea is oxygen saturation (pulse oximeter A320-OPE, Ver. 5.1, trainable using an apnea drill, with a view to establish- Inter fox, Greece) and heart rates (Polar, S610i, Finland) ing its potential benefits for improved performance in were recorded within the last 10 seconds before and af- aquatic sports and particularly in synchronized swim- ter each apnea. All apnea trials were conducted at the ming where repeated bouts of short dynamic apneas School’s indoor 25 m swimming pool with water tem- are prevalent during competitive events. perature 26.2 ± 0.2 °C and ambient temperature at 25 Case Series ± 1 °C. Anthropometric measurements were conducted at the Schools’ Aquatics Division Laboratory while fit- Case 1 ness tests were performed in the Apparatus Gymnastics AP a 29-year-old male is a folklore dancing teacher room. Running tests were conducted at the Schools out- and a recreational diver both in free and autonomous doors track and field. diving for the past 3 years. Upon completion of the Potential benefits of Hypoxic training for Aquat- DATP for 2 weeks his dry apnea duration more than ic Sports tripled. Although his dynamic apnea duration showed minimal improvement compared to static apneas, his Voluntary apnea bouts, particularly involving face apnea swimming distance increased considerably (Ta- immersion may trigger the diving reflex characterized ble 1). Table 2 presents AP’s noticeable heart rate drop by bradycardia, a fall in the cardiac output and periph- and arterial blood pressure rise after apnea periods eral blood flow leading to oxygen conservation