title: Intermittent altitude exposures reduce acute mountain sickness at 4300 m.
abstract: Acute mountain sickness (AMS) commonly occurs at altitudes exceeding 2000-2500 m and usually resolves after acclimatization induced by a few days of chronic residence at the same altitude. Increased ventilation and diuresis may contribute to the reduction in AMS with altitude acclimatization. The aim of the present study was to examine the effects of intermittent altitude exposures (IAE), in combination with rest and exercise training, on the incidence and severity of AMS, resting ventilation and 24-h urine volume at 4300 m. Six lowlanders (age, 23 +/- 2 years; body weight, 77 +/- 6 kg; values are means +/- S.E.M.) completed an Environmental Symptoms Questionnaire (ESQ) and Lake Louise AMS Scoring System (LLS), a resting end-tidal partial pressure of CO2 ( PETCO2) test and a 24-h urine volume collection at sea level (SL) and during a 30 h exposure to 4300 m altitude-equivalent (barometric pressure=446 mmHg) once before (PreIAE) and once after (PostIAE) a 3-week period of IAE (4 h.day(-1), 5 days.week(-1), 4300 m). The previously validated factor score, AMS cerebral score, was calculated from the ESQ and the self-report score was calculated from the LLS at 24 h of altitude exposure to assess the incidence and severity of AMS. During each IAE, three subjects cycled for 45-60 min.day(-1) at 60-70% of maximal O2 uptake (VO2 max) and three subjects rested. Cycle training during each IAE did not affect any of the measured variables, so data from all six subjects were combined. The results showed that the incidence of AMS (%), determined from both the ESQ and LLS, increased (P<0.05) from SL (0 +/- 0) to PreIAE (50 +/- 22) at 24 h of altitude exposure and decreased (P<0.05) from PreIAE to PostIAE (0 +/- 0). The severity of AMS (i.e. AMS cerebral symptom and LLS self-report scores) increased (P<0.05) from SL (0.02 +/- 0.02 and 0.17 +/- 0.17 respectively) to PreIAE (0.49 +/- 0.18 and 4.17 +/- 0.94 respectively) at 24 h of altitude exposure, and decreased (P<0.05) from PreIAE to PostIAE (0.03 +/- 0.02 and 0.83 +/- 0.31 respectively). Resting PETCO2 (mmHg) decreased (i.e. increase in ventilation; P<0.05) from SL (38 +/- 1) to PreIAE (32 +/- 1) at 24 h of altitude exposure and decreased further (P<0.05) from PreIAE to PostIAE (28 +/- 1). In addition, 24-h urine volumes were similar at SL, PreIAE and PostIAE. In conclusion, our findings suggest that 3 weeks of IAE provide an effective alternative to chronic altitude residence for increasing resting ventilation and reducing the incidence and severity of AMS.
authors.affiliation: Biophysics and Biomedical Modeling Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA. beth.beidleman@na.amedd.army.mil
authors.forename: Beth A
authors.initials: BA
authors.lastname: Beidleman
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Muza
authors.forename: Charles S
authors.initials: CS
authors.lastname: Fulco
authors.forename: Allen
authors.initials: A
authors.lastname: Cymerman
authors.forename: Dan
authors.initials: D
authors.lastname: Ditzler
authors.forename: Dean
authors.initials: D
authors.lastname: Stulz
authors.forename: Janet E
authors.initials: JE
authors.lastname: Staab
authors.forename: Gary S
authors.initials: GS
authors.lastname: Skrinar
authors.forename: Steven F
authors.initials: SF
authors.lastname: Lewis
authors.forename: Michael N
authors.initials: MN
authors.lastname: Sawka
mesh_terms: D000064:Acclimatization; D000208:Acute Disease; D000328:Adult; D000532:Altitude Sickness / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D000704:Analysis of Variance; D001642:Bicycling; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D012129:Respiratory Function Tests; D013997:Time Factors; D014554:Urination