Geert Kleinnibbelink

Acute Cardiac Responses vs. Cardiac Remodelling 3 69 RV functional responses to exercise to chronic RV adaptation after 12 weeks of hypoxic training. Visit 3 to 34 comprised the individual sessions of the hypoxic training program. Visit 35 comprised follow-up measurements, including echocardiographic assessment at rest and were performed under normoxic conditions. 1 2 35 3 - 34 Baseline measurements Visits (days) Height, body mass, SpO2, resting HR, resting BP, ECG, VO2max and rest echocardiogram Test day pre-training program Follow-up measurements Rest Echocardiogram Stress Echocardiogram Hypoxic training program 2x 45 min per week the rst four weeks and 3x the last eight weeks Body mass, resting HR, resting BP, VO2max and rest echocardiogram (Simulated altitude 3,000m; FiO2 14.5%) (Normoxia) (Hypoxia) (Normoxia) Figure 1 . Overview of study design. Longitudinal data assessment (baseline and follow-up measurements including echocardiography) were performed under normoxic conditions whereas the training program was performed under hypoxic conditions. Additionally, during visit 2, an echocardiographic assessment was performed (after 30 minutes of acclimation) to obtain acute exercise induced changes in cardiac function to relate to chronic structural remodelling to hypoxic training. Baseline and follow-up measurements . Participants were examined for height (SECA stadiometer, SECA GmbH, Germany), weight (SECA scale, SECA GmbH, Germany), oxygen saturation (SpO 2 , pulse oximetry; Ana Pulse 100, Ana Wiz Ltd., UK), 12-lead ECG (Cardiovit MS-2010, Schiller, Switzerland) and maximal oxygen consumption (VO 2 max). Resting heart rate (HR, Polar, Kempele, Finland) and resting blood pressure (BP, Dinamap V100, GE Medical, Norway) were determined at the end of ten minutes of quiet rest in supine position. A standardized maximal cardiopulmonary exercise test (CPET, Oxycon pro, CareFusion, VS) for VO 2 max assessment was conducted on a motorized treadmill (HP Cosmos, Nussdorf, Germany) after familiarization and a 10-min warm-up. VO 2 max was defined as the highest value of a 30-s average 14 , and attainment was verified according to previous recommend criteria. 15 Training program . Participants took part in a 12-week normobaric hypoxic endurance exercise training program consisting of 2x45 minute sessions a week in the first four weeks and 3x45 minute sessions in the last eight weeks. This running exercise was performed on