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Regulation of muscle potassium: exercise performance, fatigue and health implications

Abstract

This review integrates from the single muscle fibre to exercising human the current understanding of the role of skeletal muscle for whole-body potassium (K+) regulation, and specifically the regulation of skeletal muscle [K+]. We describe the K+ transport proteins in skeletal muscle and how they contribute to, or modulate, K+ disturbances during exercise. Muscle and plasma K+ balance are markedly altered during and after high-intensity dynamic exercise (including sports), static contractions and ischaemia, which have implications for skeletal and cardiac muscle contractile performance. Moderate elevations of plasma and interstitial [K+] during exercise have beneficial effects on multiple physiological systems. Severe reductions of the trans-sarcolemmal K+ gradient likely contributes to muscle and whole-body fatigue, i.e. impaired exercise performance. Chronic or acute changes of arterial plasma [K+] (hyperkalaemia or hypokalaemia) have dangerous health implications for cardiac function. The current mechanisms to explain how raised extracellular [K+] impairs cardiac and skeletal muscle function are discussed, along with the latest cell physiology research explaining how calcium, β-adrenergic agonists, insulin or glucose act as clinical treatments for hyperkalaemia to protect the heart and skeletal muscle in vivo. Finally, whether these agents can also modulate K+-induced muscle fatigue are evaluated.

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Abbreviations

ATP:

Adenosine triphosphate

[Ca2 +]i :

Intracellular calcium concentration

cAMP:

Cyclic adenosine monophosphate

[Cl]i :

Intracellular chloride concentration

ClC-1:

Skeletal muscle sarcolemmal chloride channel

ECFV:

Extracellular fluid volume

ECG:

Electrocardiogram

ICFV:

Intracellular fluid volume

KATP :

ATP-dependent potassium channel

KCa1.1 :

Delayed rectifier potassium channel

Kir :

Inward rectifier potassium channel

[K+]a :

Plasma arterial potassium concentration

[K+]i :

Intracellular potassium concentration

[K+]I :

Interstitial potassium concentration

[K+]o :

Extracellular potassium concentration

[K+]v :

Plasma venous potassium concentration

M-wave:

Compound extracellular muscle action potential

[Na+]i :

Intracellular sodium concentration

NKA:

Na+/K+ ATPase (sodium–potassium pump)

NKCC:

Na+-K+-2Cl cotransporter (sodium–potassium chloride cotransporter)

Resting EM :

Resting membrane potential

RPE:

Rating of perceived exertion

TBW:

Total body water

T-system:

Tubular system

VO2peak:

Peak oxygen consumption

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Lindinger, M.I., Cairns, S.P. Regulation of muscle potassium: exercise performance, fatigue and health implications. Eur J Appl Physiol 121, 721–748 (2021). https://doi.org/10.1007/s00421-020-04546-8

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Keywords

  • Skeletal muscle
  • Cardiac muscle
  • Hyperkalaemia
  • Hypokalaemia
  • Na+/K+-ATPase