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

European Journal of Applied Physiology Aims and scope Submit manuscript

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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