Sports Medicine

, Volume 38, Issue 1, pp 1–8 | Cite as

Physiological Responses to Exercise at Altitude

An Update
  • Robert S. MazzeoEmail author
Leading Article


Studies performed over the past decade have yielded new information related to the physiological and metabolic adjustments made in response to both shortand long-term high-altitude exposure. These investigations have examined the potential mechanisms responsible for the alterations observed in such key variables as heart rate, stroke volume, cardiac output, muscle blood flow, substrate utilization and mitochondrial function, both at rest and during exercise of varying intensities. Additionally, the occurrence and mechanisms related to the ‘lactate paradox’ continues to intrigue investigators. It is apparent that exposure to high altitude is an environmental stressor that elicits a robust sympathoadrenal response that contributes to many of the critical adjustments and adaptations mentioned above. Furthermore, as some of these important physiological adaptations are known to enhance performance, it has become popular to incorporate an aspect of altitude living/training into the training regimens of endurance athletes (e.g. ‘live high-train low’). Finally, it is important to note that many factors influence the extent to which individuals adjust and adapt to the stress imposed by exposure to high altitude. Included among these are (i) the degree of hypoxia; (ii) the duration of exposure to hypoxic conditions; (iii) the exercise intensity (absolute vs relative workload); and (iv) the inter-individual variability in adapting to hypoxic environments (‘responders’ vs ‘non-responders’).


Stroke Volume Oxygen Delivery Submaximal Exercise Muscle Blood Flow Fractional Oxygen Extraction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Mazzeo RS, Bender PR, Brooks GA, et al. Arterial catecholamine responses during exercise with acute and chronic high altitude exposure. Am J Physiol 1991; 261: E419–24PubMedGoogle Scholar
  2. 2.
    Mazzeo RS, Brooks GA, Butterfield GE, et al. Acclimatization to high altitude increases muscle sympathetic activity both at rest and during exercise. Am J Physiol 1995; 269: R201–7PubMedGoogle Scholar
  3. 3.
    Wolfel EE, Groves BM, Brooks GA, et al. Oxygen transport during steady-state submaximal exercise in chronic hypoxia. J Appl Physiol 1991; 70: 1129–36PubMedGoogle Scholar
  4. 4.
    Wolfel EE, Selland MA, Cymerman A, et al. O2 extraction maintains O2 uptake during submaximal exercise with ß-adrenergic blockade at 4,300 m. J Appl Physiol 1998; 85: 1092–102PubMedGoogle Scholar
  5. 5.
    Hansen J, Sanders M. Sympathetic neural overactivity in healthy humans after prolonged exposure to hypobaric hypoxia. J Physiol 2003; 546: 921–9PubMedCrossRefGoogle Scholar
  6. 6.
    Hopkins SR, Bogaard HJ, Niizeki K, et al. ß-Adrenergic or parasympathetic inhibition, heart rate, and cardiac output during normoxic and acute hypoxic exercise in humans. J Physiol 2003; 550 (2): 605–15PubMedCrossRefGoogle Scholar
  7. 7.
    Mazzeo RS, Wolfel EE, Butterfield GE, et al. Sympathetic responses during 21 days at high altitude (4,300 m) as determined by urinary and arterial catecholamines. Metabolism 1994; 43: 1226–32PubMedCrossRefGoogle Scholar
  8. 8.
    Cornolo J, Mollard P, Brugniaux JV, et al. Autonomic control of the cardiovascular system during acclimatization to high altitude: effects of sildenafil. J Appl Physiol 2004; 97: 935–40PubMedCrossRefGoogle Scholar
  9. 9.
    Hughson RL, Yamamoto Y, McCullough RE, et al. Sympathetic and parasympathetic indicators of heart rate control at altitude studied by spectral analysis. J Appl Physiol 1994; 77: 2537–42PubMedGoogle Scholar
  10. 10.
    Grover RF, Weil JV, Reeves JT. Cardiovascular adaptation to exercise at high altitude. Exerc Sport Sci Rev 1986; 14: 269–302PubMedCrossRefGoogle Scholar
  11. 11.
    Reeves JT, Groves BM, Sutton JR, et al. OEII: preservation of cardiac function at extreme altitude. J Appl Physiol 1987; 63: 531–9PubMedGoogle Scholar
  12. 12.
    Calbet JA, Boushel R, Radegran G, et al. Why is. Am J Physiol Regul Integr Comp Physiol 2003; 284 (2): R304–16PubMedGoogle Scholar
  13. 13.
    Lundby C, Sander M, van Hall G, et al. Maximal exercise and muscle oxygen extraction in acclimatizing lowlanders and high altitude natives. J Physiol 2006; 573 (2): 535–47PubMedCrossRefGoogle Scholar
  14. 14.
    Roach RC, Koskolou MD, Calbet JA, et al. Arterial O. Am J Physiol 1999; 276 (2 Pt 2): H438–45PubMedGoogle Scholar
  15. 15.
    Richalet JP, Larmignat P, Rathat C, et al. Decreased human cardiac response to isoproterenol infusion in acute and chronic hypoxia. J Appl Physiol 1998; 65: 1957–61Google Scholar
  16. 16.
    Wagner PD. Reduced maximal cardiac output at altitude: mechanisms and significance. Respir Physiol 2000; 120: 1–11PubMedCrossRefGoogle Scholar
  17. 17.
    Calbet JA, Radegran G, Boushel R, et al. Plasma volume expansion does not increase maximal cardiac output or V? O2max in lowlanders acclimatized to altitude. Am J Physiol 2004; 287: H1214–24Google Scholar
  18. 18.
    Bender PR, Groves BM, McCullough RE, et al. Oxygen transport to exercising leg in chronic hypoxia. J Appl Physiol 1988; 65: 2592–7PubMedGoogle Scholar
  19. 19.
    Braun B, Mawson JT, Muza SR, et al. Women at altitude: carbohydrate utilization during exercise at 4300 m. J Appl Physiol 2000; 88: 246–56PubMedGoogle Scholar
  20. 20.
    Brooks GA, Butterfield GE, Wolfe RR, et al. Decreased reliance on lactate during exercise after acclimatization to 4,300 m. J Appl Physiol 1991; 71: 333–41PubMedGoogle Scholar
  21. 21.
    Brooks GA, Wolfel EE, Groves BM, et al. Muscle accounts for glucose disposal but not blood lactate appearance during exercise after acclimatization to 4,300 m. J Appl Physiol 1992; 72: 2435–45PubMedGoogle Scholar
  22. 22.
    Roberts AC, Reeves JT, Butterfield GE, et al. Altitude and ß-blockade augment glucose utilization during submaximal exercise. J Appl Physiol 1996; 80: 605–15PubMedGoogle Scholar
  23. 23.
    Lundby C, Van Hall G. Substrate utilization in sea level residents during exercise in acute hypoxia and after 4 weeks ofacclimatization to 4100 m. Acta Physiol Scand 2002; 176: 195–201PubMedCrossRefGoogle Scholar
  24. 24.
    Brooks GA, Mercier J. The balance of carbohydrate and lipid utilization during exercise: the crossover concept. J ApplPhysiol 1994; 76: 2253–61PubMedGoogle Scholar
  25. 25.
    Romijn JA, Coyle EF, Sidossis S, et al. Regulation of endogenous fat and carbohydrate metabolism in relation to exercise intensity and duration. Am J Physiol 1993; 265: E380–91PubMedGoogle Scholar
  26. 26.
    Butterfield GE, Gates J, Fleming S, et al. Increased energy intake minimizes weight loss in men at high altitude. J Appl Physiol 1992; 72: 1741–8PubMedGoogle Scholar
  27. 27.
    Cartee GD, Douen AG, Ramlal T, et al. Stimulation of glucose transport in skeletal muscle by hypoxia. J Appl Physiol 1991; 70: 1593–600PubMedGoogle Scholar
  28. 28.
    Tarnopolsky LJ, MacDougall JD, Atkinson SA, et al. Gender differences in substrate for endurance exercise. J Appl Physiol 1990; 68: 302–8PubMedGoogle Scholar
  29. 29.
    Kayser B. Lactate during exercise at high altitude. Eur J Appl Physiol 1996; 74: 195–205CrossRefGoogle Scholar
  30. 30.
    Mazzeo RS, Brooks GA, Butterfield GE, et al. ß-Adrenergic blockade does not prevent the lactate response to exercise after acclimatization to high altitude. J Appl Physiol 1994; 76: 610–5PubMedGoogle Scholar
  31. 31.
    Pronk M, Tiemessen I, Hupperets MD, et al. Persistence of the lactate paradox over 8 weeks at 3,8000 m. High Alt Med Biol 2003; 4: 431–43PubMedCrossRefGoogle Scholar
  32. 32.
    Hochachka PW, Beatty CL, Burelle Y, et al. The lactate paradox in human high-altitude performance. News Physiol Sci 2002; 17: 122–6PubMedGoogle Scholar
  33. 33.
    Van Hall G, Calbet JAL, SØndergaard H, et al. The re-establishment of the normal blood lactate response to exercise in humans after prolonged acclimatization to altitude. J Physiol 2001; 563: 963–75CrossRefGoogle Scholar
  34. 34.
    Van Hall G. Point: the lactate paradox does not occur during exercise at high altitude. J Appl Physiol 2007; 102 (6): 2399–401PubMedCrossRefGoogle Scholar
  35. 35.
    West J. Point: the lactate paradox does occur during exercise at high altitude. J Appl Physiol 2007; 102 (6): 2398–9PubMedCrossRefGoogle Scholar
  36. 36.
    Levine BD, Stray-Gundersen J. “Living high-training low”: effect of moderate-altitude acclimatization with low-altitude training on performance. J Appl Physiol 1997; 83 (1): 102–12PubMedGoogle Scholar
  37. 37.
    Levine BD, Stray-Gundersen J. A practical approach to altitude training: where to live and train for optimal performance enhancement. Int J Sports Med 1992; 13: S209–12PubMedCrossRefGoogle Scholar
  38. 38.
    Stray-Gundersen J, Chapman RF, Levine BD. ‘Living high-training low’ altitude training improves sea level performance in male and female elite runners. J Appl Physiol 2001; 91: 1113–20PubMedGoogle Scholar
  39. 39.
    Brugniaux JV, Schmitt L, Robach P, et al. Eighteen days of ‘living high, training low’ stimulate erythropoiesis and enhance aerobic performance in elite middle-distance runners. J Appl Phsyiol 2006; 100: 203–11CrossRefGoogle Scholar
  40. 40.
    Levine BD, Stray-Gundersen J. Point: positive effects of intermittent hypoxia (live high:train low) on exercise performance are mediated primarily by augmented red cell volume. J Appl Physiol 2005; 99: 2053–5PubMedCrossRefGoogle Scholar
  41. 41.
    Robach P, Schmitt L, Brugniaux JV, et al. Living high-training low: effect on erythropoiesis and aerobic performance in high-ly-trained swimmers. Eur J Appl Physiol 2006; 96: 423–33PubMedCrossRefGoogle Scholar
  42. 42.
    Gore CJ, Hopkins WG. Counterpoint: positive effects of intermittent hypoxia (live high:train low) on exercise performance are not mediated primarily by augmented red cell volume. J Appl Physiol 2005; 99: 2055–7PubMedCrossRefGoogle Scholar
  43. 43.
    Schmitt L, Millet G, Robach P, et al. Influence of ‘living high-training low’ on aerobic performance and economy of work in elite athletes. Eur J Appl Physiol 2006; 97: 627–36PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV. 2008

Authors and Affiliations

  1. 1.Department of Integrative PhysiologyUniversity of ColoradoBoulderUSA

Personalised recommendations