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Hypoxia and standing balance

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European Journal of Applied Physiology Aims and scope Submit manuscript

Abstract

Purpose

Standing balance control is important for everyday function and often goes unnoticed until impairments appear. Presently, more than 200 million people live at altitudes > 2500 m above sea level, and many others work at or travel to these elevations. Thus, it is important to understand how hypoxia alters balance owing to implications for occupations and travelers. Herein, the influence of normobaric and hypobaric hypoxia on standing balance control is reviewed and summarized. As postural control relies on the integration of sensorimotor signals, the potential hypoxic-sensitive neurophysiological factors that contribute to balance impairments are also reviewed. Specifically, we examine how hypoxia impairs visual, vestibular, and proprioceptive cues, and their integration within subcortical or cortical areas.

Methods

This systematic review included a literature search conducted via multiple databases with keywords related to postural balance, hypoxia, and altitude. Articles (n = 13) were included if they met distinct criteria.

Results

Compared to normoxia, normobaric hypoxia worsened parameters of standing balance by 2–10% and up to 83 and 240% in hypobaric hypoxia (high-altitude and lab-based, respectively). Although balance was only disrupted during normobaric hypoxia at FIO2 <  ~ 0.15, impairments consistently occurred during hypobaric hypoxia at altitudes > 1524 m (~ FIO2 < 0.18).

Conclusion

Hypoxia, especially hypobaric, impairs standing balance. The mechanisms underpinning postural decrements likely involve alterations to processing and integration of sensorimotor signals within subcortical or cortical structures involving visual, vestibular, and proprioceptive pathways and subsequent motor commands that direct postural adjustments. Future studies are required to determine the sensorimotor factors that may influence balance control in hypoxia.

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Abbreviations

AP:

Anterior–posterior

COP:

Center of pressure

COPF:

Center of pressure frequency of oscillation

COPL:

Total center of pressure path length

COPV:

Center of pressure velocity

COPvs:

Center of pressure variance of speed

DL:

Dominant leg

EC:

Eyes closed

EF:

Executive function

EEG:

Electroencephalogram

EO:

Eyes open

FA:

Feet apart

FIO2 :

Fraction of inspired oxygen

FT:

Feet together

GLUT:

Glutamate

HH:

Hypobaric hypoxia

HT:

Heel-to-toe

LL:

Left leg

MEP:

Motor evoked potential

MGEMG :

Medial gastrocnemius electromyography

ML:

Mediolateral

MUFR:

Motor unit firing rate

NCFT:

Neurocognitive function tasks

NDL:

Non-dominant leg

NH:

Normobaric hypoxia

NMDA:

N-methyl-D-aspartate

NOS:

Nitric oxide synthase

NR:

Not reported

NS:

Not significant

PB :

Barometric pressure

PCO2 :

Partial pressure of carbon dioxide

PH2O:

Water vapour pressure

PAO2 :

Partial pressure of alveolar oxygen

PaO2 :

Partial pressure of arterial oxygen

PIO2 :

Partial pressure of inspired oxygen

PO2 :

Partial pressure of oxygen

RL:

Right leg

SA:

Slowly adapting

SF:

Sensory function

SPO2 :

Oxygen saturation

SOT:

Sensory organizational test

SOT1–6:

Sensory organization test conditions 1–6

TVR:

Tonic tendon vibration reflex amplitude

VEP:

Visual evoked potentials

VN:

Vestibular nuclei

References

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Funding

This review was supported by the Natural Sciences and Engineering Research Council of Canada.

Author information

Authors and Affiliations

Authors

Contributions

All authors contributed to the conception and/or design of the work. MIBD drafted the manuscript and all other authors revised it critically for important intellectual content. All authors approved the final version of the manuscript. All authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Brian H. Dalton.

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Conflict of interest

No conflicts of interest, competing interest of any sort, financial or otherwise, are declared by the authors.

Additional information

Communicated by Michael Lindinger.

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Debenham, M.I.B., Smuin, J.N., Grantham, T.D.A. et al. Hypoxia and standing balance. Eur J Appl Physiol 121, 993–1008 (2021). https://doi.org/10.1007/s00421-020-04581-5

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  • DOI: https://doi.org/10.1007/s00421-020-04581-5

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