The aim of this investigation was to study how the known dependence of working efficiency on pedaling frequency is influenced by the work load as well as by physical fitness. Oxygen uptake, CO2 output, ventilation, heart rate, and lactate concentration in capillary blood from the earlobe were determined at varying combinations of work loads and pedaling rates in road-racing cyclists and medical students. Respiratory exchange ratio, consumption of energy, gross efficiency, net efficiency, and delta efficiency (delta work rate/delta metabolic rate) were calculated. All parameters showed a nonlinear dependence on pedaling frequency. The lowest oxygen uptake and the highest efficiency shifted to higher frequencies with increasing work load. Delta efficiency increased with rising pedaling frequency. Differences of VO2 and efficiencies between trained and untrained subjects were only small. Most effects can be explained by variations in leg movement frequency and recruitment of muscle fibers. There is evidence that racing cyclists chose pedaling rates yielding optimal efficiency at any load.

The effect of three weeks ergometer training (Tr) 5 times a week for 45 min at 70% VO2max by 6 subjects on erythrocyte turnover and haemoglobin O2 affinity has been studied. Increased reticulocytosis could be observed from the second day after beginning Tr until a few days after its end, probably caused by increased erythropoietin release by the kidney. Erythrocyte destruction was most pronounced in the first and markedly reduced in the third week of Tr. Elevated glutamate oxalacetate transaminase activity and creatine as well as lowered mean corpuscular haemoglobin indicate a younger erythrocyte population in the first week of recovery. Total blood volume increased during the course of Tr by 700 ml, mainly caused by a raised plasma volume (74%). Red cell volume increased later with maximal values one week after Tr (+280 ml). In this week the standard oxygen dissociation curve was most shifted to the right (P50 increased from 3.77 +/- 0.05 kPa to 3.99 +/- 0.07 kPa) and the Bohr coefficients had their lowest values. Both effects are completely explainable by the haemoglobin O2 binding properties of young erythrocytes. After training, all parameters of physical performance (VO2max, maximal workload, heart rate during rest and exercise) were markedly improved, indicating fast adaptation mechanisms. The increased erythrocyte turnover, including higher erythropoiesis, seems to be one important part of these effects.

Fatigue and impaired physical performance are common and sometimes serious problems of cancer patients during and after treatment. To avoid fatigue, cancer patients are often advised to rest and downregulate their daily activities. However, these recommendations can cause paradoxical results. Since inactivity induces muscular wasting, prolonged rest can result in further loss of endurance. Recent studies suggest that exercise, as well as behavioral and some psychosocial interventions, may reduce fatigue and improve the performance status of cancer patients. In this paper, we review interventions proposed for the treatment of cancer-related fatigue and present the results of a study about the effects of exercise on the physical performance of patients with hematological malignancies. Sixty-six inpatients (34 men, 32 women) undergoing conventional ( n=45) or high-dose chemotherapy with stem cell rescue ( n=21) for the treatment of a hematological malignancy exercised daily on a treadmill. Physical performance was assessed on admission and once a week during hospitalization (30+/-10 days, range 10-49). Physical performance remained unchanged in a submaximal standard stress test (on admission: 5.5+/-1.4 km/h; midhospitalization: 5.3+/-1.3 km/h; at discharge: 5.5+/-1.3 km/h; p=0.60) despite chemotherapy and its related complications. A significant decrease in the mean hemoglobin concentration (from 10.3+/-2.0 g/dl on admission to 9.6+/-1.2 g/dl at discharge; p=0.03). We conclude that a daily endurance-training program reduces the treatment-related loss of physical performance in patients with hematological malignancies undergoing chemotherapy.

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We conclude that fatigue in relapse-free patients with hematological malignancies is associated with depressive mood and reduced physical performance, but not with impairment of thyroid function, anemia or persistent activation of the immune system.

Blood composition, hemoglobin mass (CO rebreathing method) and VO2peak were measured in 15 untrained (UT-Bogotá) and 14 trained males (TR-Bogotá) living at 2600 m of altitude, and in 14 untrained lowlanders (UT-Berlin). [Hb] amounted to 15.3 + 0.2(SE) g/dl in UT-Berlin, 17.4 + 0.2 g/dl in UT-Bogotá and 16.0 + 0.2 g/dl in TR-Bogotá. Hb mass was significantly higher in UT-Bogotá (13.2 + 0.4 g/kg, P < 0.01) and in TR-Bogotá (14.7 + 0.5 g/kg, P < 0.001) than in UT-Berlin (11.7 + 0.2 g/kg). In TR-Bogotá also plasma volume was expanded. Erythropoietin concentrations in UT-Bogotá and TR-Bogotá were not significantly increased. There was a positive correlation between blood volume and VO2peak for the pooled values of all subjects, if the oxygen uptake of UT-Berlin was corrected for an ascent to 2600 m. For the Hb mass - VO2peak relation two groups are indicated pointing to two types of altitude acclimatization with different Hb mass increases but similar distribution of aerobic performance capacity. We suggest that different genetic properties in a population of mixed ethnic origin might play a role.

COVID-19 hinders oxygen transport to the consuming tissues by at least 2 mechanisms: In the injured lung saturation of hemoglobin is compromised, in the tissues an associated anemia reduces the volume of delivered oxygen. For the first problem increased hemoglobin oxygen affinity (left shift of the oxygen dissociation curve ODC) is of advantage, for the 2nd, however, the contrary is the case. Indeed a right shift of the ODC has been found in former studies for anemia caused by reduced cell production or hemolysis. This resulted from increased 2,3-biphosphglycerate (2,3-BPG) concentration. In 3 investigations in COVID-19, however, no change of hemoglobin affinity was detected in spite of probably high [2,3-BPG]. The most plausible cause for this finding is formation of methemoglobin, which increases the oxygen affinity and thus apparently compensates for the 2,3-BPG effect. But this "useful effect" is cancelled by the concomitant reduction of functional hemoglobin. In the largest study on COVID-19 even a clear left shift of the ODC was detected when calculated from measurements in fresh blood rather than after equilibration with gases outside the body. This additional „in vivo" left shift possibly results from various factors (e. g. concentration changes of Cl-, 2,3-BPG, ATP, lactate, nitrocompounds, glutathione, glutamate, because of time delay between blood sampling and end of equilibration, or enlarged distribution space including interstitial fluid and is useful for O2 uptake in the lungs. Under discussion for therapy are the affinity-increasing 5-hydroxymethyl-2-furfural (5-HMF), erythropoiesis stimulating substances like erythropoietin, and methylene blue against MetHb formation.

All experiments demonstrate that the Hct is not a constant value but can be considerably changed by physiological measures. Clinical studies show that brain oxygen supply decreases with increasing Hct-values, which are also associated with a higher risk of stroke accidents. We therefore recommend to use a Hct-limit solely under strongly controlled standardized conditions to protect professional cyclists from hazardous manoeuvre until more appropriate methods to detect EPO-doping are developed.