Cerebral and muscle tissue oxygenation in acute hypoxic ventilatory response test

Cerebral and muscle tissue oxygenation during exercise in healthy adults: A systematic review

BACKGROUND

Near-infrared spectroscopy (NIRS) technology has allowed for the measurement of cerebral and skeletal muscle oxygenation simultaneously during exercise. Since this technology has been growing and is now successfully used in laboratory and sports settings, this systematic review aimed to synthesize the evidence and enhance an integrative understanding of blood flow adjustments and oxygen (O2) changes (i.e., the balance between O2 delivery and O2 consumption) within the cerebral and muscle systems during exercise.

METHODS

A systematic review was conducted using PubMed, Embase, Scopus, and Web of Science databases to search for relevant studies that simultaneously investigated cerebral and muscle hemodynamic changes using the near-infrared spectroscopy system during exercise. This review considered manuscripts written in English and available before February 9, 2023. Each step of screening involved evaluation by 2 independent authors, with disagreements resolved by a third author. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the methodological quality of the studies.

RESULTS

Twenty studies were included, of which 80% had good methodological quality, and involved 290 young or middle-aged adults. Different types of exercises were used to assess cerebral and muscle hemodynamic changes, such as cycling (n = 11), treadmill (n = 1), knee extension (n = 5), isometric contraction of biceps brachii (n = 3), and duet swim routines (n = 1). The cerebral hemodynamics analysis was focused on the frontal cortex (n = 20), while in the muscle, the analysis involved vastus lateralis (n = 18), gastrocnemius (n = 3), biceps brachii (n = 5), deltoid (n = 1), and intercostal muscle (n = 1). Overall, muscle deoxygenation increases during exercise, reaching a plateau in voluntary exhaustion, while in the brain, oxyhemoglobin concentration increases with exercise intensity, reaching a plateau or declining at the exhaustion point.

CONCLUSION

Muscle and cerebral oxygenation respond differently to exercise, with muscle increasing O2 utilization and cerebral tissue increasing O2 delivery during exercise. However, at the exhaustion point, both muscle and cerebral oxygenation become compromised. This is characterized by a reduction in blood flow and a decrease in O2 extraction in the muscle, while in the brain, oxygenation reaches a plateau or decline, potentially resulting in motor failure during exercise.

AltitudeOmics: effects of 16 days acclimatization to hypobaric hypoxia on muscle oxygen extraction during incremental exercise

Acute altitude exposure lowers arterial oxygen content ([Formula: see text]) and cardiac output ([Formula: see text]) at peak exercise, whereas O2 extraction from blood to working muscles remains similar. Acclimatization normalizes [Formula: see text] but not peak [Formula: see text] nor peak oxygen consumption (V̇o2peak). To what extent acclimatization impacts muscle O2 extraction remains unresolved. Twenty-one sea-level residents performed an incremental cycling exercise to exhaustion near sea level (SL), in acute (ALT1) and chronic (ALT16) hypoxia (5,260 m). Arterial blood gases, gas exchange at the mouth and oxy- (O2Hb) and deoxyhemoglobin (HHb) of the vastus lateralis were recorded to assess arterial O2 content ([Formula: see text]), [Formula: see text], and V̇o2. The HHb-V̇o2 slope was taken as a surrogate for muscle O2 extraction. During moderate-intensity exercise, HHb-V̇o2 slope increased to a comparable extent at ALT1 (2.13 ± 0.94) and ALT16 (2.03 ± 0.88) compared with SL (1.27 ± 0.12), indicating increased O2 extraction. However, the HHb/[Formula: see text] ratio increased from SL to ALT1 and then tended to go back to SL values at ALT16. During high-intensity exercise, HHb-V̇o2 slope reached a break point beyond which it decreased at SL and ALT1, but not at ALT16. Increased muscle O2 extraction during submaximal exercise was associated with decreased [Formula: see text] in acute hypoxia. The significantly greater muscle O2 extraction during maximal exercise in chronic hypoxia is suggestive of an O2 reserve.NEW & NOTEWORTHY During incremental exercise muscle deoxyhemoglobin (HHb) and oxygen consumption (V̇o2) both increase linearly, and the slope of their relationship is an indirect index of local muscle O2 extraction. The latter was assessed at sea level, in acute and during chronic exposure to 5,260 m. The demonstrated presence of a muscle O2 extraction reserve during chronic exposure is coherent with previous studies indicating both limited muscle oxidative capacity and decrease in motor drive.

Intensity-dependent acute aerobic exercise: Effect on reactive control of attentional functions in acclimatized lowlanders at high altitude

Human attentional function is sensitive to hypoxia. However, little is known about whether and how attentional function is altered after acute aerobic exercise at high altitude, especially for acclimatized lowlanders. In this study, we used the Attention Network Test (ANT) to measure alerting, orienting, and executive control functions and the Stroop Color and Word Test (SCWT) with a different proportion of incongruent trials to investigate proactive and reactive control of executive function. We randomly divided the sample of 160 Tibetan lowlanders who had lived in the highlands for more than two years into four groups. Each of three groups performed 20 min of low-, moderate-, or high-intensity acute aerobic exercise, separately, and a control group watched a 20-min documentary. The ANT and SCWT were conducted before and after exercise or watching the documentary. The results indicated that the executive control effects of the three experimental groups significantly decreased and, in the posttest, the executive control effects of the high-intensity group were lower than those of the low-intensity group. Furthermore, the accuracy of the moderate- and high-intensity groups was increased significantly in the blocks containing 25% incongruent trials of SCWT task. These results suggest that the acute aerobic exercise at high altitude will improve the reactive control of attentional functions in acclimatized lowlanders, and the intensity may play an important role in the exercise-cognition interaction at high altitude.

Low intensity exercise does not impact cognitive function during exposure to normobaric hypoxia

Exposure to hypoxia is associated with cognitive impairment, mediated by cerebral deoxygenation. This can be problematic for individuals who perform mental tasks at high altitude. Eight healthy men completed two experimental trials consisting of 5h of exposure to normobaric hypoxia (12.5% O2). In one of the experimental trials (Hypoxia) subjects remained resting in a seated position the entire 5h; in the other experimental trial (Hypoxia and Exercise) subjects rested 2h, cycled for 1h at constant wattage (workload equivalent to 50% of altitude adjusted VO2max), then rested the last 2h. Cerebral oxygenation was measured continuously via near-infrared spectroscopy and cognitive performance was assessed by Trail Making Test A and B. Cerebral oxygenation and cognitive performance both were impaired during exposure to hypoxia. In the Hypoxia and Exercise trial, subjects experienced further declinations in cerebral oxygenation without concomitant decreases in cognitive function. These data demonstrate that cognitive function declines during exposure to normobaric hypoxia and this decline is not exacerbated by low intensity exercise.

Peripheral fatigue is not critically regulated during maximal, intermittent, dynamic leg extensions

Central motor drive to active muscles is believed to be reduced during numerous exercise tasks to prevent excessive peripheral fatigue development. The purpose of the present study was to use hypoxia to exacerbate physiological perturbations during a novel, intermittent exercise task and to explore the time-course and interplay between central and peripheral neuromuscular adjustments. On separate days, 14 healthy men performed four sets of 6 × 5 maximal-intensity, isokinetic leg extensions (1 repetition lasting ∼7 s) at 300°/s (15 and 100 s of passive rest between repetitions and sets, respectively) under normoxia (NM, fraction of inspired O2 0.21), moderate (MH, 0.14), and severe normobaric hypoxia (SH, 0.10). Neuromuscular assessments of the knee extensors were conducted before and immediately after each set. There was an interaction between time and condition on the mean peak torque produced during each set (P < 0.05). RMS/M-wave activity of the rectus femoris decreased across the four sets of exercise, but there was no difference between conditions (8.3 ± 5.1% all conditions compounded, P > 0.05). Potentiated twitch torque decreased post set 1 in all conditions (all P < 0.05) with greater reductions following each set in SH compared with NM but not MH (end-exercise reductions 41.3 ± 3.0% vs. 28.0 ± 3.2%, P < 0.05 and 32.1 ± 3.3%, P > 0.05). In conclusion, severe hypoxia exacerbates both peripheral fatigue development and performance decrements during maximal, intermittent, dynamic leg extensions. In contrast to observations with other exercise modes, during exercise involving a single muscle group the attenuation of central motor drive does not appear to independently regulate the development of peripheral muscle fatigue.

Ventilatory chemosensitivity, cerebral and muscle oxygenation, and total hemoglobin mass before and after a 72-day mt. Everest expedition

BACKGROUND

We investigated the effects of chronic hypobaric hypoxic acclimatization, performed over the course of a 72-day self-supported Everest expedition, on ventilatory chemosensitivity, arterial saturation, and tissue oxygenation adaptation along with total hemoglobin mass (tHb-mass) in nine experienced climbers (age 37±6 years, [Formula: see text] 55±7 mL·kg(-1)·min(-1)).

METHODS

Exercise-hypoxia tolerance was tested using a constant treadmill exercise of 5.5 km·h(-1) at 3.8% grade (mimicking exertion at altitude) with 3-min steps of progressive normobaric poikilocapnic hypoxia. Breath-by-breath ventilatory responses, Spo2, and cerebral (frontal cortex) and active muscle (vastus lateralis) oxygenation were measured throughout. Acute hypoxic ventilatory response (AHVR) was determined by linear regression slope of ventilation vs. Spo2. PRE and POST (<15 days) expedition, tHb-mass was measured using carbon monoxide-rebreathing.

RESULTS

Post-expedition, exercise-hypoxia tolerance improved (11:32±3:57 to 16:30±2:09 min, p<0.01). AHVR was elevated (1.25±0.33 to 1.63±0.38 L·min(-1.)%(-1) Spo2, p<0.05). Spo2 decreased throughout exercise-hypoxia in both trials, but was preserved at higher values at 4800 m post-expedition. Cerebral oxygenation decreased progressively with increasing exercise-hypoxia in both trials, with a lower level of deoxyhemoglobin POST at 2400, 3500 and 4800 m. Muscle oxygenation also decreased throughout exercise-hypoxia, with similar patterns PRE and POST. No relationship was observed between the slope of AHVR and cerebral or muscle oxygenation either PRE or POST. Absolute tHb-mass response exhibited great individual variation with a nonsignificant 5.4% increasing trend post-expedition (975±154 g PRE and 1025±124 g POST, p=0.17).

CONCLUSIONS

We conclude that adaptation to chronic hypoxia during a climbing expedition to Mt. Everest will increase hypoxic tolerance, AHVR, and cerebral but not muscle oxygenation, as measured during simulated acute hypoxia at sea level. However, tHb-mass did not increase significantly and improvement in cerebral oxygenation was not associated with the change in AHVR.

Two-week normobaric intermittent hypoxia exposures enhance oxyhemoglobin equilibrium and cardiac responses during hypoxemia

Intermittent hypoxia (IH) is extensively applied to challenge cardiovascular and respiratory function, and to induce physiological acclimatization. The purpose of this study was to test the hypothesis that oxyhemoglobin equilibrium and tachycardiac responses during hypoxemia were enhanced after 14-day IH exposures. Normobaric-poikilocapnic hypoxia was induced with inhalation of 10% O2 for 5-6 min interspersed with 4 min recovery on eight nonsmokers. Heart rate (HR), arterial O2 saturation (SaO 2), and end-tidal O2 (PetO 2) were continuously monitored during cyclic normoxia and hypoxia. These variables were compared during the first and fifth hypoxic bouts between day 1 and day 14. There was a rightward shift in the oxyhemoglobin equilibrium response following 14-day IH exposures, as indicated by the greater PetO 2 (an index of arterial Po2) at 50% of SaO 2 on day 14 compared with day 1 [33.9 ± 1.5 vs. 28.2 ± 1.3 mmHg (P = 0.005) during the first hypoxic bout and 39.4 ± 2.4 vs. 31.4 ± 1.5 mmHg (P = 0.006) during the fifth hypoxic bout] and by the augmented gains of ΔSaO 2/ΔPetO 2 (i.e., deoxygenation) during PetO 2 from 65 to 40 mmHg in the first (1.12 ± 0.08 vs. 0.80 ± 0.02%/mmHg, P = 0.001) and the fifth (1.76 ± 0.31 vs. 1.05 ± 0.06%/mmHg, P = 0.024) hypoxic bouts. Repetitive IH exposures attenuated (P = 0.049) the tachycardiac response to hypoxia while significantly enhancing normoxic R-R interval variability in low-frequency and high-frequency spectra without changes in arterial blood pressure at rest or during hypoxia. We conclude that 14-day IH exposures enhance arterial O2 delivery and improve vagal control of HR during hypoxic hypoxemia.

Responses to exercise in normobaric hypoxia: comparison of elite and recreational ski mountaineers

PURPOSE

Hypoxia is known to reduce maximal oxygen uptake (VO(2max)) more in trained than in untrained subjects in several lowland sports. Ski mountaineering is practiced mainly at altitude, so elite ski mountaineers spend significantly longer training duration at altitude than their lower-level counterparts. Since acclimatization in hypobaric hypoxia is effective, the authors hypothesized that elite ski mountaineers would exhibit a VO2max decrement in hypoxia similar to that of recreational ski mountaineers.

METHODS

Eleven elite (E, Swiss national team) and 12 recreational (R) ski mountaineers completed an incremental treadmill test to exhaustion in normobaric hypoxia (H, 3000 m, F(1)O(2) 14.6% ± 0.1%) and in normoxia (N, 485 m, F(1)O(2) 20.9% ± 0.0%). Pulse oxygen saturation in blood (SpO(2)), VO(2max), minute ventilation, and heart rate were recorded.

RESULTS

At rest, hypoxic ventilatory response was higher (P < .05) in E than in R (1.4 ± 1.9 vs 0.3 ± 0.6 L · min⁻¹ · kg⁻¹). At maximal intensity, SpO(2) was significantly lower (P < .01) in E than in R, both in N (91.1% ± 3.3% vs 94.3% ± 2.3%) and in H (76.4% ± 5.4% vs 82.3% ± 3.5%). In both groups, SpO(2) was lower (P < .01) in H. Between N and H, VO(2max) decreased to a greater extent (P < .05) in E than in R (-18% and -12%, P < .01). In E only, the VO(2max) decrement was significantly correlated with the SpO(2) decrement (r = .74, P < .01) but also with VO(2max) measured in N (r = .64, P < .05).

CONCLUSION

Despite a probable better acclimatization to altitude, VO(2max) was more reduced in E than in R ski mountaineers, confirming previous results observed in lowlander E athletes.

Cerebral hemodynamic and ventilatory responses to hypoxia, hypercapnia, and hypocapnia during 5 days at 4,350 m

This study investigated the changes in cerebral near-infrared spectroscopy (NIRS) signals, cerebrovascular and ventilatory responses to hypoxia and CO2 during altitude exposure. At sea level (SL), after 24 hours and 5 days at 4,350 m, 11 healthy subjects were exposed to normoxia, isocapnic hypoxia, hypercapnia, and hypocapnia. The following parameters were measured: prefrontal tissue oxygenation index (TOI), oxy- (HbO2), deoxy- and total hemoglobin (HbTot) concentrations with NIRS, blood velocity in the middle cerebral artery (MCAv) with transcranial Doppler and ventilation. Smaller prefrontal deoxygenation and larger ΔHbTot in response to hypoxia were observed at altitude compared with SL (day 5: ΔHbO2-0.6±1.1 versus -1.8±1.3 μmol/cmper mm Hg and ΔHbTot 1.4±1.3 versus 0.7±1.1 μmol/cm per mm Hg). The hypoxic MCAv and ventilatory responses were enhanced at altitude. Prefrontal oxygenation increased less in response to hypercapnia at altitude compared with SL (day 5: ΔTOI 0.3±0.2 versus 0.5±0.3% mm Hg). The hypercapnic MCAv and ventilatory responses were decreased and increased, respectively, at altitude. Hemodynamic responses to hypocapnia did not change at altitude. Short-term altitude exposure improves cerebral oxygenation in response to hypoxia but decreases it during hypercapnia. Although these changes may be relevant for conditions such as exercise or sleep at altitude, they were not associated with symptoms of acute mountain sickness.

The effects of exercise under hypoxia on cognitive function

Increasing evidence suggests that cognitive function improves during a single bout of moderate exercise. In contrast, exercise under hypoxia may compromise the availability of oxygen. Given that brain function and tissue integrity are dependent on a continuous and sufficient oxygen supply, exercise under hypoxia may impair cognitive function. However, it remains unclear how exercise under hypoxia affects cognitive function. The purpose of this study was to examine the effects of exercise under different levels of hypoxia on cognitive function. Twelve participants performed a cognitive task at rest and during exercise at various fractions of inspired oxygen (FIO₂: 0.209, 0.18, and 0.15). Exercise intensity corresponded to 60% of peak oxygen uptake under normoxia. The participants performed a Go/No-Go task requiring executive control. Cognitive function was evaluated using the speed of response (reaction time) and response accuracy. We monitored pulse oximetric saturation (SpO₂) and cerebral oxygenation to assess oxygen availability. SpO₂ and cerebral oxygenation progressively decreased during exercise as the FIO₂ level decreased. Nevertheless, the reaction time in the Go-trial significantly decreased during moderate exercise. Hypoxia did not affect reaction time. Neither exercise nor difference in FIO₂ level affected response accuracy. An additional experiment indicated that cognitive function was not altered without exercise. These results suggest that the improvement in cognitive function is attributable to exercise, and that hypoxia has no effects on cognitive function at least under the present experimental condition. Exercise-cognition interaction should be further investigated under various environmental and exercise conditions.

Effects of hypoxia on cerebral and muscle haemodynamics during knee extensions in healthy subjects

A hypoxic model was used to investigate changes in localized cerebral and muscle haemodynamics during knee extension (KE) in healthy individuals. Thirty-one young healthy volunteers performed one set of KE until failure under hypoxia (14 % O(2)) or normoxia (21 % O(2)) at 50, 75 or 100 % of 1 repetition maximum, in random order, on three occasions. Prefrontal cerebral and vastus lateralis muscle oxygenation and blood volume (Cox, Mox, Cbv and Mbv, respectively) were recorded simultaneously by near-infrared spectroscopy. Hypoxia induced significant declines in Cox [-0.017 ± 0.016 optical density (OD) units] and Mox (-0.014 ± 0.026 OD units) and increases in Cbv (0.017 ± 0.027 OD units) and Mbv (0.016 ± 0.023 OD units) at rest. Hypoxia significantly reduced total work (TW) performed during KE at each exercise intensity. Cox, Cbv, Mox, and Mbv changes during KE did not differ between normoxia and hypoxia. Correlations between TW done and Cox changes under normoxia (r = 0.04, p = 0.182) and hypoxia (r = 0.05, p = 0.122) were not significant. However, TW was significantly correlated with Mox under both normoxia (R (2) = 0.24, p = 0.000) and hypoxia (R (2) = 0.15, p = 0.004). Since changes in Cox and Mox reflect alterations in the balance between oxygen delivery and extraction in these tissues, which, in the brain, is an index of neuronal activation, we conclude that: (1) limitation of KE performance was mediated peripherally under both normoxia and hypoxia, with no additional effect of hypoxia, and (2) because of the low common variance with Mox additional intramuscular factors likely play a role in limiting KE performance.

Cerebral perturbations during exercise in hypoxia

Reduction of aerobic exercise performance observed under hypoxic conditions is mainly attributed to altered muscle metabolism due to impaired O2 delivery. It has been recently proposed that hypoxia-induced cerebral perturbations may also contribute to exercise performance limitation. A significant reduction in cerebral oxygenation during whole body exercise has been reported in hypoxia compared with normoxia, while changes in cerebral perfusion may depend on the brain region, the level of arterial oxygenation and hyperventilation induced alterations in arterial CO2. With the use of transcranial magnetic stimulation, inconsistent changes in cortical excitability have been reported in hypoxia, whereas a greater impairment in maximal voluntary activation following a fatiguing exercise has been suggested when arterial O2 content is reduced. Electromyographic recordings during exercise showed an accelerated rise in central motor drive in hypoxia, probably to compensate for greater muscle contractile fatigue. This accelerated development of muscle fatigue in moderate hypoxia may be responsible for increased inhibitory afferent signals to the central nervous system leading to impaired central drive. In severe hypoxia (arterial O2 saturation <70–75%), cerebral hypoxia per se may become an important contributor to impaired performance and reduced motor drive during prolonged exercise. This review examines the effects of acute and chronic reduction in arterial O2 (and CO2) on cerebral blood flow and cerebral oxygenation, neuronal function, and central drive to the muscles. Direct and indirect influences of arterial deoxygenation on central command are separated. Methodological concerns as well as future research avenues are also considered.

Alveolar gas exchange and tissue deoxygenation during exercise in type 1 diabetes patients and healthy controls

We used near-infrared spectroscopy to investigate whether leg and arm skeletal muscle and cerebral deoxygenation differ during incremental cycling exercise in men with type 1 diabetes (T1D, n=10, mean±SD age 33±7 years) and healthy control men (matched by age, anthrometry, and self-reported physical activity, CON, n=10, 32±7 years) to seek an explanation for lower aerobic capacity (˙VO2peak) often reported in T1D. T1D had lower ˙VO2peak (35±4mlkg(-1)min(-1) vs. 43±8mlkg(-1)min(-1), P<0.01) and peak work rate (219±33W vs. 290±44W, P<0.001) than CON. Leg muscle deoxygenation (↑ [deoxyhemoglobin]; ↓ tissue saturation index) was greater in T1D than CON at a given absolute submaximal work rate, but not at peak exercise, while arm muscle and cerebral deoxygenation were similar. Thus, in T1D compared with CON, faster leg muscle deoxygenation suggests limited circulatory ability to increase O(2) delivery as a plausible explanation for lower ˙VO2peak and earlier fatigue in T1D.

Cerebral vasoreactivity during hypercapnia is reset by augmented sympathetic influence

Sympathetic nerve activity influences cerebral blood flow, but it is unknown whether augmented sympathetic nerve activity resets cerebral vasoreactivity to hypercapnia. This study tested the hypothesis that cerebral vasodilation during hypercapnia is restrained by lower-body negative pressure (LBNP)-stimulated sympathoexcitation. Cerebral hemodynamic responses were assessed in nine healthy volunteers [age 25 yr (SD 3)] during rebreathing-induced increases in partial pressure of end-tidal CO(2) (Pet(CO(2))) at rest and during LBNP. Cerebral hemodynamic responses were determined by changes in flow velocity of middle cerebral artery (MCAV) using transcranial Doppler sonography and in regional cerebral tissue oxygenation (ScO(2)) using near-infrared spectroscopy. Pet(CO(2)) values during rebreathing were similarly increased from 41.9 to 56.5 mmHg at rest and from 40.7 to 56.0 mmHg during LBNP of -15 Torr. However, the rates of increases in MCAV and in ScO(2) per unit increase in Pet(CO(2)) (i.e., the slopes of MCAV/Pet(CO(2)) and ScO(2)/Pet(CO(2))) were significantly (P ≤0.05) decreased from 2.62 ± 0.16 cm·s(-1)·mmHg(-1) and 0.89 ± 0.10%/mmHg at rest to 1.68 ± 0.18 cm·s(-1)·mmHg(-1) and 0.63 ± 0.07%/mmHg during LBNP. In conclusion, the sensitivity of cerebral vasoreactivity to hypercapnia, in terms of the rate of increases in MCAV and in ScO(2), is diminished by LBNP-stimulated sympathoexcitation.

Acute intermittent hypoxia exposures enhance arterial oxygen delivery

Physiological adaptations to intermittent hypoxia (IH) conditioning are based on the cumulative effect of repeated IH exposures. The present study sought to test the hypothesis that acute IH exposures would promote arterial O2 delivery and regional tissue oxygenation. Changes in arterial O2 saturation (SaO2, oximeter), forearm muscle and cerebral tissue oxygenations (SmO2 and ScO2, near-infrared spectroscopy) were compared during five repeated hypoxia exposures (10 ± 0.2% O2 for 5-min each) interposed with four-minute inhalation of room air in 11 healthy subjects (24 ± 0.9 y). Baseline, prehypoxia partial pressure of end-tidal O2 (PETO2, mass spectrometer) and SaO2 (107 ± 2 mmHg and 97.3 ± 0.3%) were decreased ( P < 0.05) after the first bout as compared with those during normoxia prior to the second (94 ± 2 mmHg and 96.2 ± 0.4%) and the fifth (92 ± 3 mmHg and 95.7 ± 0.7%) episodes of IH exposures, whereas partial pressure of end-tidal CO2, tidal volume and breathing frequency were similar. Arterial O2 dissociation in terms of per unit decrease in PETO2 during hypoxia, i.e. the slope of SaO2/PETO2, was augmented ( P = 0.0025) from 0.71 ± 0.09%/mmHg during the first hypoxia bout to 1.39 ± 0.15%/mmHg and 1.47 ± 0.16%/mmHg during the second and the fifth bouts, respectively. Fractional muscle tissue O2 extraction rate (SmO2D, i.e. normalized difference between SaO2 and SmO2) progressively decreased ( P < 0.01) during IH; however, fractional cerebral tissue O2 extraction rate (ScO2D, i.e. normalized difference between SaO2 and ScO2) did not decrease during hypoxia ( P = 0.94). ScO2D during normoxia tended to increase ( P = 0.089) following repeated IH exposures. We conclude that enhanced arterial O2 delivery with repeated IH exposures serves as a compensatory mechanism to potentiate O2 availability during hypoxia.

Reaction time to peripheral visual stimuli during exercise under hypoxia

The purpose of this study was to test the hypothesis that decrease in cerebral oxygenation compromises an individual's ability to respond to peripheral visual stimuli during exercise. We measured the simple reaction time (RT) to peripheral visual stimuli at rest and during and after cycling at three different workloads [40%, 60%, and 80% peak oxygen uptake (VO2)] under either normoxia [inspired fraction of oxygen (FIO2)=0.21] or normobaric hypoxia (FIO2=0.16). Peripheral visual stimuli were presented at 10 degrees to either the right or the left of the midpoint of the eyes. Cerebral oxygenation was monitored during the RT measurement over the right frontal cortex with near-infrared spectroscopy. We used the premotor component of RT (premotor time) to assess effects of exercise on the central process. The premotor time was significantly longer during exercise at 80% peak VO2 (normoxia: 214.2+/-33.0 ms, hypoxia: 221.5+/-30.1 ms) relative to that at rest (normoxia: 201.0+/-27.2 ms, hypoxia: 202.9+/-29.7 ms) (P<0.01). Under normoxia, cerebral oxygenation gradually increased up to 60% peak VO2 and then decreased to the resting level at 80% peak VO2. Under hypoxia, cerebral oxygenation progressively decreased as exercise workload increased. We found a strong correlation between increase in premotor time and decrease in cerebral oxygenation (r2=0.89, P<0.01), suggesting that increase in premotor time during exercise is associated with decrease in cerebral oxygenation. Accordingly, exercise at high altitude may compromise visual perceptual performance.

Frontal and motor cortex oxygenation during maximal exercise in normoxia and hypoxia

Reductions in prefrontal oxygenation near maximal exertion may limit exercise performance by impairing executive functions that influence the decision to stop exercising; however, whether deoxygenation also occurs in motor regions that more directly affect central motor drive is unknown. Multichannel near-infrared spectroscopy was used to compare changes in prefrontal, premotor, and motor cortices during exhaustive exercise. Twenty-three subjects performed two sequential, incremental cycle tests (25 W/min ramp) during acute hypoxia [79 Torr inspired Po(2) (Pi(O(2)))] and normoxia (117 Torr Pi(O(2))) in an environmental chamber. Test order was balanced, and subjects were blinded to chamber pressure. In normoxia, bilateral prefrontal oxygenation was maintained during low- and moderate-intensity exercise but dropped 9.0 +/- 10.7% (mean +/- SD, P < 0.05) before exhaustion (maximal power = 305 +/- 52 W). The pattern and magnitude of deoxygenation were similar in prefrontal, premotor, and motor regions (R(2) > 0.94). In hypoxia, prefrontal oxygenation was reduced 11.1 +/- 14.3% at rest (P < 0.01) and fell another 26.5 +/- 19.5% (P < 0.01) at exhaustion (maximal power = 256 +/- 38 W, P < 0.01). Correlations between regions were high (R(2) > 0.61), but deoxygenation was greater in prefrontal than premotor and motor regions (P < 0.05). Prefrontal, premotor, and motor cortex deoxygenation during high-intensity exercise may contribute to an integrative decision to stop exercise. The accelerated rate of cortical deoxygenation in hypoxia may hasten this effect.

Effect of severe hypoxia on prefrontal cortex and muscle oxygenation responses at rest and during exhaustive exercise

Near infrared spectroscopy (NIRS) may provide valuable insight into the determinants of exercise performance. We examined the effects of severe hypoxia on cerebral (prefrontal lobe) and muscle (gastrocnemius) oxygenation at rest and during a fatiguing task. After a 15-min rest, 15 healthy subjects (age 25.3 +/- 0.9 yr) performed a sustained contraction of the ankle extensors at 40% of maximal voluntary force until exhaustion. The contraction was performed at two different fractions of inspired O2 fraction (F(IO2) = 0.21/0.11) in randomized and single-blind fashion. Cerebral and muscle oxy-(HbO2) deoxy-(HHb) total-hemoglobin (HbTot) and tissue oxygenation index (TOI) were monitored continuously by NIRS. Arterial O2 saturation (SpO2) was estimated by pulse oximetry throughout the protocol. Muscle TOI did not differ between normoxia and hypoxia after the 15-min rest, whereas SpO2 and cerebral TOI significantly dropped (-6.5 +/- 0.9% and -3.9 +/- 1.0%, respectively, P<0.05) in hypoxia. The muscle NIRS changes during exercise were similar in normoxia and hypoxia, whereas the increased cerebral HbTot and HbO2 near exhaustion were markedly reduced in hypoxia. In conclusion, although F(IO2) had no significant effect on endurance time, NIRS patterns near exhaustion in hypoxia differed from normoxia.