The effects of breathing a helium-oxygen gas mixture on maximal pulmonary ventilation and maximal oxygen consumption during exercise in acute moderate hypobaric hypoxia

A revision of maximal oxygen consumption and exercise capacity at altitude 70 years after the first climb of Mount Everest

On the 70th anniversary of the first climb of Mount Everest by Edmund Hillary and Tensing Norgay, we discuss the physiological bases of climbing Everest with or without supplementary oxygen. After summarizing the data of the 1953 expedition and the effects of oxygen administration, we analyse the reasons why Reinhold Messner and Peter Habeler succeeded without supplementary oxygen in 1978. The consequences of this climb for physiology are briefly discussed. An overall analysis of maximal oxygen consumption (V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ ) at altitude follows. In this section, we discuss the reasons for the non-linear fall ofV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ at altitude, we support the statement that it is a mirror image of the oxygen equilibrium curve, and we propose an analogue of Hill's model of the oxygen equilibrium curve to analyse theV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ fall. In the following section, we discuss the role of the ventilatory and pulmonary resistances to oxygen flow in limitingV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ , which becomes progressively greater while moving toward higher altitudes. On top of Everest, these resistances provide most of theV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ limitation, and the oxygen equilibrium curve and the respiratory system provide linear responses. This phenomenon is more accentuated in athletes with elevatedV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ , due to exercise-induced arterial hypoxaemia. The large differences inV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ that we observe at sea level disappear at altitude. There is no need for a very highV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ at sea level to climb the highest peaks on Earth.

Expiratory flow limitation under moderate hypobaric hypoxia does not influence ventilatory responses during incremental running in endurance runners

We tested whether expiratory flow limitation (EFL) occurs in endurance athletes in a moderately hypobaric hypoxic environment equivalent to 2500 m above sea level and, if so, whether EFL inhibits peak ventilation ( V ˙ Epeak ), thereby exacerbating the hypoxia-induced reduction in peak oxygen uptake ( V ˙ O2peak ). Seventeen young male endurance runners performed incremental exhaustive running on separate days under hypobaric hypoxic (560 mmHg) and normobaric normoxic (760 mmHg) conditions. Oxygen uptake ( V ˙ O2 ), minute ventilation ( V ˙ E), arterial O2 saturation (SpO2 ), and operating lung volume were measured throughout the incremental exercise. Among the runners tested, 35% exhibited EFL (EFL group, n = 6) in the hypobaric hypoxic condition, whereas the rest did not (Non-EFL group, n = 11). There were no differences between the EFL and Non-EFL groups for V ˙ Epeak and V ˙ O2peak under either condition. Percent changes in V ˙ Epeak (4 ± 4 vs. 2 ± 4%) and V ˙ O2peak (-18 ± 6 vs. -16 ± 6%) from normobaric normoxia to hypobaric hypoxia also did not differ between the EFL and Non-EFL groups (all P > 0.05). No differences in maximal running velocity, SpO2 , or operating lung volume were detected between the two groups under either condition. These results suggest that under the moderate hypobaric hypoxia (2500 m above sea level) frequently used for high-attitude training, ~35% of endurance athletes may exhibit EFL, but their ventilatory and metabolic responses during maximal exercise are similar to those who do not exhibit EFL.

Effect of hypobaria on maximal ventilation, oxygen uptake, and exercise performance during running under hypobaric normoxic conditions

During exposure to high altitude, hypoxia develops because of reductions in barometric pressure and partial pressure of O2 . Although several studies have examined the effects of hypoxia on exercise performance and physiological responses, such as maximal minute ventilation ( V · Emax ) and maximal oxygen uptake ( V · O2max ), how barometric pressure reduction (hypobaria) modulates them remains largely unknown. In this study, 11 young men performed incremental treadmill running tests to exhaustion under three conditions chosen at random: normobaric normoxia (NN; 763 ± 5 mmHg of barometric pressure, equivalent to sea level), hypobaric hypoxia (HH; 492 ± 1 mmHg of barometric pressure, equivalent to 3500 m above sea level (m a.s.l.)), and hypobaric normoxia (HN; 492 ± 1 mmHg of barometric pressure while breathing 32.2 ± 0.1% O2 to match the inspiratory O2 content under NN). V · Emax was higher in HN than in NN (160.9 ± 10.7 vs. 150.7 ± 10.0 L min-1 , P < 0.05). However, no differences in V · O2max and arterial oxyhemoglobin saturation were observed between NN and HN (all P > 0.05). Time to exhaustion was longer in HN than in NN (932 ± 83 vs. 910 ± 79 s, P < 0.05). These results suggest that reduced air density during exposure to an altitude of 3500 m a.s.l. increases maximal ventilation and extends time to exhaustion without affecting oxygen consumption or arterial oxygen saturation.

Limitation of Maximal Heart Rate in Hypoxia: Mechanisms and Clinical Importance

The use of exercise intervention in hypoxia has grown in popularity amongst patients, with encouraging results compared to similar intervention in normoxia. The prescription of exercise for patients largely rely on heart rate recordings (percentage of maximal heart rate (HR_max) or heart rate reserve). It is known that HR_max decreases with high altitude and the duration of the stay (acclimatization). At an altitude typically chosen for training (2,000-3,500 m) conflicting results have been found. Whether or not this decrease exists or not is of importance since the results of previous studies assessing hypoxic training based on HR may be biased due to improper intensity. By pooling the results of 86 studies, this literature review emphasizes that HR_max decreases progressively with increasing hypoxia. The dose–response is roughly linear and starts at a low altitude, but with large inter-study variabilities. Sex or age does not seem to be a major contributor in the HR_max decline with altitude. Rather, it seems that the greater the reduction in arterial oxygen saturation, the greater the reduction in HRmax, due to an over activity of the parasympathetic nervous system. Only a few studies reported HR_max at sea/low level and altitude with patients. Altogether, due to very different experimental design, it is difficult to draw firm conclusions in these different clinical categories of people. Hence, forthcoming studies in specific groups of patients are required to properly evaluate (1) the HR_max change during acute hypoxia and the contributing factors, and (2) the physiological and clinical effects of exercise training in hypoxia with adequate prescription of exercise training intensity if based on heart rate.

Maximal oxygen consumption in healthy humans: theories and facts

This article reviews the concept of maximal oxygen consumption ([Formula: see text]) from the perspective of multifactorial models of [Formula: see text] limitation. First, I discuss procedural aspects of [Formula: see text] measurement: the implications of ramp protocols are analysed within the theoretical work of Morton. Then I analyse the descriptive physiology of [Formula: see text], evidencing the path that led to the view of monofactorial cardiovascular or muscular [Formula: see text] limitation. Multifactorial models, generated by the theoretical work of di Prampero and Wagner around the oxygen conductance equation, represented a radical change of perspective. These models are presented in detail and criticized with respect to the ensuing experimental work. A synthesis between them is proposed, demonstrating how much these models coincide and converge on the same conclusions. Finally, I discuss the cases of hypoxia and bed rest, the former as an example of the pervasive effects of the shape of the oxygen equilibrium curve, the latter as a neat example of adaptive changes concerning the entire respiratory system. The conclusion is that the concept of cardiovascular [Formula: see text] limitation is reinforced by multifactorial models, since cardiovascular oxygen transport provides most of the [Formula: see text] limitation, at least in normoxia. However, the same models show that the role of peripheral resistances is significant and cannot be neglected. The role of peripheral factors is greater the smaller is the active muscle mass. In hypoxia, the intervention of lung resistances as limiting factors restricts the role played by cardiovascular and peripheral factors.