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Delayed parasympathetic reactivation and sympathetic withdrawal following maximal cardiopulmonary exercise testing (CPET) in hypoxia



This study investigated the effects of acute hypoxic exposure on post-exercise cardiac autonomic modulation following maximal cardiopulmonary exercise testing (CPET).


Thirteen healthy men performed CPET and recovery in normoxia (N) and normobaric hypoxia (H) (FiO2 = 13.4%, ≈ 3500 m). Post-exercise cardiac autonomic modulation was assessed during recovery (300 s) through the analysis of fast-phase and slow-phase heart rate recovery (HRR) and heart rate variability (HRV) indices.


Both short-term, T30 (mean difference (MD) 60.0 s, 95% CI 18.2–101.8, p = 0.009, ES 1.01), and long-term, HRRt (MD 21.7 s, 95% CI 4.1–39.3, p = 0.020, ES 0.64), time constants of HRR were higher in H. Fast-phase (30 and 60 s) and slow-phase (300 s) HRR indices were reduced in H either when expressed in bpm or in percentage of HRpeak (p < 0.05). Chronotropic reserve recovery was lower in H than in N at 30 s (MD − 3.77%, 95% CI − 7.06 to − 0.49, p = 0.028, ES − 0.80) and at 60 s (MD − 7.23%, 95% CI − 11.45 to − 3.01, p = 0.003, ES − 0.81), but not at 300 s (p = 0.436). Concurrently, Ln-RMSSD was reduced in H at 60 and 90 s (p < 0.01) but not at other time points during recovery (p > 0.05).


Affected fast-phase, slow-phase HRR and HRV indices suggested delayed parasympathetic reactivation and sympathetic withdrawal after maximal exercise in hypoxia. However, a similar cardiac autonomic recovery was re-established within 5 min after exercise cessation. These findings have several implications in cardiac autonomic recovery interpretation and in HR assessment in response to high-intensity hypoxic exercise.

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Fig. 1



Analysis of variance


Autonomic nervous system


Cardiopulmonary exercise testing


Chronotropic reserve recovery


Excess of post-exercise oxygen consumption time constant


Excess of post-exercise oxygen consumption magnitude


Low-frequency spectral power


Natural logarithm transformation


High-frequency spectral power


Heart rate


Heart rate recovery


Long-term time constant of heart rate recovery


Heart rate variability


Root mean square of successive differences of R–R intervals


Short-term time constant of heart rate recovery


Total spectral power


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The authors would like to thank the subjects for their time and enthusiasm. The research was supported by the Ministry for Higher education, Research Innovation (France) and Tomsk Polytechnic University Competitiveness Enhancement Program Grant (Project No. ВИУ-ИСГТ-108/2017 - TPU CEP-HSTI-108/2017).

Author information

AF, AS, SS, LB, LM and BP participated in study conception and design. AF, AS and SS participated in data acquisition. AF, FSt, GB and AZ participated in data analysis. AF and LM were responsible for data interpretation. AF, AS, SS, GB, AZ, LM and BP contributed to the draft of the paper. AF, AS, SS, GB, AZ, FSc, LM and BP critically reviewed the manuscript. All authors approved the final version of the manuscript.

Correspondence to Alessandro Fornasiero.

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Communicated by I. Mark Olfert.

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Fornasiero, A., Savoldelli, A., Skafidas, S. et al. Delayed parasympathetic reactivation and sympathetic withdrawal following maximal cardiopulmonary exercise testing (CPET) in hypoxia. Eur J Appl Physiol 118, 2189–2201 (2018). https://doi.org/10.1007/s00421-018-3945-5

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  • Heart rate recovery
  • Hypoxia
  • Post-exercise recovery
  • Hypoxic exercise
  • Cardiac autonomic activity