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Pulmonary Function

  • Michael S. Sagiv
Chapter

Abstract

The purpose of respiration is to provide oxygen to the tissues and to remove CO2 from the tissues [1]. Humans are able to extract oxygen from the atmosphere and transport it to their cells where it is utilized for essential metabolic processes. The oxygen pathway from environment to mitochondria can be viewed as a cascade of resistances in chain, each one being overcome by a specific pressure gradient (Fig. 2.1). However, there are several elements in the oxygen transport pathway from mouth to mitochondria that have the individual potential to limit oxygen supply during exercise and therefore VO2max [2]. Changes of VO2 could be induced by altering the blood oxygen-carrying capacity, peripheral function, or both.

Keywords

Oxygen Partial Pressure Oxygen Delivery Maximal Exercise Anaerobic Threshold Elite Athlete 
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.

References

  1. 1.
    Guyton AC, Hall JE. Textbook of medical physiology. 9th ed. Philadelphia: Saunders; 1996.Google Scholar
  2. 2.
    Vogiatzis I, Zakynthinos S, Boushel R, et al. The contribution of intrapulmonary shunts to the alveolar-to-arterial oxygen difference during exercise is very small. J Physiol. 2008;586:2381–91.PubMedCrossRefGoogle Scholar
  3. 3.
    Zuurbier M, Hoek G, Oldenwening M, Lenters V, Meliefste K, van den Hazel P, Brunekreef B. Commuters’ exposure to particulate matter air pollution is affected by mode of transport, fuel type, and route. Environ Health Perspect. 2010;118:783–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Johnson BD, Saupe KW, Dempsey JA. Mechanical constraints on exercise hyperpnea in endurance athletes. J Appl Physiol. 1992;73:874–86.PubMedGoogle Scholar
  5. 5.
    Baker SE, Wheatley CM, Cassuto NA, Foxx-Lupo WT, Sprissler R, Snyder EM. Genetic variation of αENaC influences lung diffusion during exercise in humans. Respir Physiol Neurobiol. 2011;179:212–8.PubMedCrossRefGoogle Scholar
  6. 6.
    O’Neill JO, Young JB, Pothier CE, Lauer MS. Peak oxygen consumption as a predictor of death in patients with heart failure receiving beta-blockers. Circulation. 2005;111:2313–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Woods PR, Bailey KR, Wood CM, Johnson BD. Submaximal exercise gas exchange is an important prognostic tool to predict adverse outcomes in heart failure. Eur J Heart Fail. 2011;13:303–10.PubMedCrossRefGoogle Scholar
  8. 8.
    Robbins M, Francis G, Pashkow FJ, et al. Ventilatory and heart rate responses to exercise: better predictors of heart failure mortality than peak oxygen consumption. Circulation. 1999;100:2411–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Lang CC, Karlin P, Haythe J, Lim TK, Mancini DM. Peak cardiac power output, measured noninvasively, is a powerful predictor of outcome in chronic heart failure. Circ Heart Fail. 2009;2:33–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Dufour Doiron M, Prud’homme D, Boulay P. Time-of-day variation in cardiovascular response to maximal exercise testing in coronary heart disease patients taking a beta-blocker. Appl Physiol Nutr Metab. 2007; 32:664–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Sagiv M, Amir O, Goldhammer E, Ben-Sira D, Amir R. Left ventricular contractility in response to upright isometric exercise in heart transplant recipients and healthy men. J Cardiopulm Rehabil Prev. 2008;28: 17–23.PubMedGoogle Scholar
  12. 12.
    Gabbett TJ, Johns J, Riemann M. Performance changes following training in junior rugby league players. J Strength Cond Res. 2008;22:910–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Kemps HM, Schep G, Zonderland ML, et al. Are oxygen uptake kinetics in chronic heart failure limited by oxygen delivery or oxygen utilization? Int J Cardiol. 2010;142:138–44.PubMedCrossRefGoogle Scholar
  14. 14.
    González-Alonso J, Calbet JA. Reductions in systemic and skeletal muscle blood flow and oxygen delivery limit maximal aerobic capacity in humans. Circulation. 2003;107:824–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Bassett DR Jr, Howley ET. Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc. 2000;32:70–84, Tolle J, Waxman A, Systrom D. Impaired systemic oxygen extraction at maximum exercise in pulmonary hypertension. Med Sci Sports Exec. 2008;40:3–8.Google Scholar
  16. 16.
    Sheel AW, MacNutt MJ, Querido JS. The pulmonary system during exercise in hypoxia and the cold. Exp Physiol. 2010;95:422–30.PubMedCrossRefGoogle Scholar
  17. 17.
    Van de Veirea NR, Van Laethemb C, Philippéc J, De Winterd O, De Backere G, Vanderheyden M, De Suttere J. VE/VCO2 slope and oxygen uptake efficiency slope in patients with coronary artery disease and intermediate peakVO2. Eur J Cardiovasc Prev Rehabil. 2006;13:916–23.CrossRefGoogle Scholar
  18. 18.
    Casaburi R, Patessio A, Ioli F, Zanaboni S, Donner CF, Wasserman K. Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am Rev Respir Dis. 1991;143:9–18.PubMedGoogle Scholar
  19. 19.
    Koga S, Poole DC, Shiojiri T, Kondo N, Fukuba Y, Miura A, Barstow TJ. Comparison of oxygen uptake kinetics during knee extension and cycle exercise. Am J Physiol Regul Integr Comp Physiol. 2005;288: R212–20.PubMedCrossRefGoogle Scholar
  20. 20.
    Wilmore JH, Costill DL. Physiology of sport and exercise: rate of reaction. 3rd ed. Champaign: Human Kinetics; 2005.Google Scholar
  21. 21.
    Billat V, Beillot J, Jan J, Rochcongar P, Carre F. Gender effect on the relationship of time limit at 100% VO2max with other bioenergetic characteristics. Med Sci Sports Exerc. 1996;28:1049–55.PubMedCrossRefGoogle Scholar
  22. 22.
    Bassett Jr DR, Howley ET. Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc. 2000; 32:70–84.PubMedGoogle Scholar
  23. 23.
    Bassett Jr DR, Howley ET. Maximal oxygen uptake: “classical” versus “contemporary” viewpoints. Med Sci Sports Exerc. 1997;29:591–603.PubMedCrossRefGoogle Scholar
  24. 24.
    Wagner PD. New ideas on limitations to VO2max. Exerc Sport Sci Rev. 2000;28:10–4.PubMedGoogle Scholar
  25. 25.
    Noakes T. The lore of running. 4th ed. Oxford: Oxford University Press; 2003.Google Scholar
  26. 26.
    Jensen FB. Red blood cell pH, the Bohr effect, and other oxygenation-linked phenomena in blood O2 and CO2 transport. Acta Physiol Scand. 2004;182: 215–27.PubMedCrossRefGoogle Scholar
  27. 27.
    Barbier J, Ville N, Kervio G, Walther G, Carre F. Sports-specific features of athlete’s heart and their relation to echocardiographic parameters. Herz. 2006;31:531–43.PubMedCrossRefGoogle Scholar
  28. 28.
    Argyropoulos G, Stütz AM, Ilnytska O, et al. KIF5B gene sequence variation and response of cardiac stroke volume to regular exercise. Physiol Genomics. 2009;36:79–88.PubMedGoogle Scholar
  29. 29.
    Bouchard C, Dionne FT, Simoneau JA, Boulay MR. Genetics of aerobic and anaerobic performances. Exerc Sport Sci Rev. 1992;20:27–58.PubMedCrossRefGoogle Scholar
  30. 30.
    Shadel GS, Clayton DA. Mitochondrial DNA maintenance in vertebrates. Ann Rev Biochem. 1997; 66:409–35.PubMedCrossRefGoogle Scholar
  31. 31.
    Hagberg JM, Moore GE, Ferrell RE. Specific genetic markers of endurance performance and VO2max. Exerc Sport Sci Rev. 2001;29:15–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Bouchard C, Rankinen T, Chagnon YC, et al. Genomic scan for maximal oxygen uptake and its response to training in the HERITAGE Family Study. J Appl Physiol. 2000;88:551–9.PubMedGoogle Scholar
  33. 33.
    Amir O, Amir R, Yamin C, et al. The ACE deletion allele is associated with Israeli elite endurance athletes. Exp Physiol. 2007;92:881–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Scott CB. Re-interpreting anaerobic metabolism: an argument for the application of both anaerobic glycolysis and excess post-exercise oxygen consumption (EPOC) as independent sources of energy expenditure. Eur J Appl Physiol Occup Physiol. 1998;77: 200–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Jones A, Woods DR. Skeletal muscle RAS and exercise performance. Int J Biochem Cell Biol. 2003;35: 855–66.PubMedCrossRefGoogle Scholar
  36. 36.
    Danser AH, Schalekamp MADH, Bax WA, et al. Angiotensin-converting enzyme in the human heart. Effect of the deletion/insertion polymorphism. Circulation. 1995;92:1387–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Rankinen T, Perusse L, Gagnon J, et al. Angiotensin-converting enzyme ID polymorphism and fitness phenotype in the HERITAGE Family Study. J Appl Physiol. 2000;88:1029–35.PubMedGoogle Scholar
  38. 38.
    Gordon S, Davis BS, Carlson CJ, et al. Ang II is required for optimal overload-induced skeletal muscle hypertrophy. Am J Physiol Endocrinol Metab. 2001; 280:E150–9.PubMedGoogle Scholar
  39. 39.
    Cassis L, Helton M, English V, et al. Angiotensin II regulates oxygen consumption. Am J Physiol Regul Integr Comp Physiol. 2002;282:R445–53.PubMedGoogle Scholar
  40. 40.
    Endo MY, Kobayakawa M, Kinugasa R, et al. Thigh muscle activation distribution and pulmonary VO2 kinetics during moderate, heavy, and very heavy intensity cycling exercise in humans. Am J Physiol Regul Integr Comp Physiol. 2007;293:R812–20.PubMedCrossRefGoogle Scholar
  41. 41.
    Ben-Sira D, Sagiv M. The effect of gender on left ventricular systolic function at Peak Wingate Anaerobic Test. Eur J Appl Physiol. 1977;75:549–53.CrossRefGoogle Scholar
  42. 42.
    Astrand P-O, Rodahl K, Dahl HA, Stromme SB. Textbook of work physiology: physiological bases of exercise. 4th ed. Champaign: Human Kinetics; 2003.Google Scholar
  43. 43.
    Pardaens K, Van Cleemput J, Vanhaecke J, Fagard RH. Peak oxygen uptake better predicts outcome than submaximal respiratory data in heart transplant candidates. Circulation. 2000;101:1152–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Lindqvist P, Mörner S, Henein MY. Cardiac mechanisms underlying normal exercise tolerance: gender impact. Eur J Appl Physiol. 2012;112(2):451–9. Epub 2011 May 17.PubMedCrossRefGoogle Scholar
  45. 45.
    Batterham A, George K, Mullineaux D. Allometric scaling of left ventricular mass by body dimensions in males and females. Med Sci Sports Exerc. 1997;29:181–6.PubMedGoogle Scholar
  46. 46.
    Nybo L, Jensen T, Nielsen B, et al. Effects of marked hyperthermia with and without dehydration on VO2 kinetics during intense exercise. J Appl Physiol. 2001;90:1057–64.PubMedGoogle Scholar
  47. 47.
    Febbraio MA, Snow RJ, Stathis CG, Hargreaves M, Carey MF. Effect of heat stress on muscle energy metabolism during exercise. J Appl Physiol. 1994;77: 2827–31.PubMedGoogle Scholar
  48. 48.
    Drinkwater E. Effects of peripheral cooling on characteristics of local muscle. Med Sport Sci. 2008; 53:74–88.PubMedCrossRefGoogle Scholar
  49. 49.
    Comeau MJ, Potteiger JA, Brown LE. Effects of environmental cooling on force production in the quadriceps and hamstrings. J Strength Cond Res. 2003; 17:279–84.PubMedGoogle Scholar
  50. 50.
    West JB. American medical research expedition to Everest. High Alt Med Biol. 2010;11:103–10.PubMedCrossRefGoogle Scholar
  51. 51.
    di Prampero PE. Factors limiting maximal performance in humans. Eur J Appl Physiol. 2003;90:420–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Wagner PD. Muscle O2 transport and O2 dependent control of metabolism. Med Sci Sports Exerc. 1995; 27:47–53.PubMedGoogle Scholar
  53. 53.
    Noakes TD, Peltonen JE, Rusko HK. Evidence that a central governor regulates exercise performance during acute hypoxia and hyperoxia. J Exp Biol. 2001; 204:3225–34.PubMedGoogle Scholar
  54. 54.
    Whipp BJ, Higgenbotham MB, Cobb FC. Estimating exercise stroke volume from asymptotic oxygen pulse in humans. J Appl Physiol. 1996;81:2674–9.PubMedGoogle Scholar
  55. 55.
    Tolle J, Waxman A, Systrom D. Impaired systemic oxygen extraction at maximum exercise in pulmonary hypertension. Med Sci Sports Exec. 2008;40:3–8.Google Scholar
  56. 56.
    Vella CA, Robergs RA. A review of the stroke volume response to upright exercise in healthy subjects. Br J Sports Med. 2005;39:190–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Richardson RS, Leigh JS, Wagner PD, Noyszewski EA. Cellular PO2 as a determinant of maximal mitochondrial O2 consumption in trained human skeletal muscle. J Appl Physiol. 1999;87:325–31.PubMedGoogle Scholar
  58. 58.
    Evans AM, Mustard KJW, Wyatt CN, et al. Does AMP-activated protein kinase couple inhibition of mitochondrial oxidative phosphorylation by hypoxia to calcium signaling in O2-sensing cells? J Biol Chem. 2005;280:41504–11.PubMedCrossRefGoogle Scholar
  59. 59.
    Gledhill N. The influence of altered blood volume and oxygen transport capacity on aerobic performance. Exerc Sport Sci Rev. 1985;13:75–93.PubMedCrossRefGoogle Scholar
  60. 60.
    Duncker DJ, Bache RJ. Regulation of coronary blood flow during exercise. Physiol Rev. 2008;88:1009–86.PubMedCrossRefGoogle Scholar
  61. 61.
    Green HJ, Roy B, Grant S, et al. Increases in submaximal cycling efficiency mediated by altitude acclimatization. J Appl Physiol. 2001;89:1189–97.Google Scholar
  62. 62.
    Brink-Elfegoun T, Holmberg HC, Ekblom MN, Ekblom B. Neuromuscular and circulatory adaptation during combined arm and leg exercise with different maximal workloads. Eur J Appl Physiol. 2007; 101:603–11.PubMedCrossRefGoogle Scholar
  63. 63.
    Barker AR, Williams CA, Jones AM, Armstrong N. Establishing maximal oxygen uptake in young people during a ramp cycle test to exhaustion. Br J Sports Med. 2011;45:498–503.PubMedCrossRefGoogle Scholar
  64. 64.
    Mortensen SP, Damsgaard R, Dawson EA, Secher NH, González-Alonso J. Restrictions in systemic and locomotor skeletal muscle perfusion, oxygen supply and VO2 during high-intensity whole-body exercise in humans. J Physiol. 2008;586:2621–35.PubMedCrossRefGoogle Scholar
  65. 65.
    Calbet JA, Rådegran G, Boushel R, Saltin B. On the mechanisms that limit oxygen uptake during exercise in acute and chronic hypoxia: role of muscle mass. J Physiol. 2009;587:477–90.PubMedCrossRefGoogle Scholar
  66. 66.
    Nielsen HB. Arterial desaturation during exercise in man: implication for O2 uptake and work capacity. Scand J Med Sci Sports. 2003;13:339–58.PubMedCrossRefGoogle Scholar
  67. 67.
    Nanas SN, Terrovitis JV, Charitos C, et al. Ventilatory response to exercise and kinetics of oxygen recovery are similar in cardiac transplant recipients and patients with mild chronic heart failure. J Heart Lung Transplant. 2004;23:1154–9.PubMedCrossRefGoogle Scholar
  68. 68.
    Hawkins MN, Barnes Q, Purkayastha S, Eubank W, Ogoh S, Raven PB. The effects of aerobic fitness and beta1-adrenergic receptor blockade on cardiac work during dynamic exercise. J Appl Physiol. 2009;106: 486–93.PubMedCrossRefGoogle Scholar
  69. 69.
    Sillanpää E, Häkkinen A, Nyman K, et al. Body composition and fitness during strength and/or endurance training in older men. Med Sci Sports Exerc. 2008;40: 950–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Costill DL. Inside running: basics of sports physiology. Indianapolis: Benchmark Press; 1986.Google Scholar
  71. 71.
    Gormley SE, Swain DP, High R, Spina RJ, Dowling EA, Kotipalli US, Gandrakota R. Effect of intensity of aerobic training on VO2max. Med Sci Sports Exerc. 2008;40:1336–43.PubMedCrossRefGoogle Scholar
  72. 72.
    Gergley JC. Comparison of two lower-body modes of endurance training on lower-body strength development while concurrently training. J Strength Cond Res. 2009;23:979–87.PubMedCrossRefGoogle Scholar
  73. 73.
    Kraemer WJ, Patton JF, Gordon SE, et al. Compatibility of high-intensity strength and endurance training on hormonal and skeletal muscle adaptations. J Appl Physiol. 1995;78:976–89.PubMedGoogle Scholar
  74. 74.
    Van Zant RS, Bouillon LE. Strength cycle training: effects on muscular strength and aerobic conditioning. J Strength Cond Res. 2007;21:178–82.PubMedCrossRefGoogle Scholar
  75. 75.
    Vincent KR, Braith RW, Feldman RA, Kallas HE, Lowenthal DT. Improved cardiorespiratory endurance following 6 months of resistance exercise in elderly men and women. Arch Intern Med. 2002;162:673–8.PubMedCrossRefGoogle Scholar
  76. 76.
    Costanzo LS. Physiology. Hagerstwon: Lippincott Williams & Wilkins; 2007.Google Scholar
  77. 77.
    Mortensen SP, Dawson EA, Yoshiga CC, Dalsgaard MK, Damsgaard R, Secher NH, González-Alonso J. Limitations to systemic and locomotor limb muscle oxygen delivery and uptake during maximal exercise in humans. J Physiol. 2005;566:273–85.PubMedCrossRefGoogle Scholar
  78. 78.
    Murray, RK, Granner DK, Mayes PA, Rodwell VW. (2003). Harper’s Illustrated Biochemistry (LANGE Basic Science) (26th ed). McGraw-Hill Medical. pp. 44–45.Google Scholar
  79. 79.
    Grippi MA. Pulmonary pathophysiology. Philadelphia: JB Lippincott Company; 1995.Google Scholar
  80. 80.
    Tanaka H, Seals DR. Endurance exercise performance in Masters athletes: age-associated changes and underlying physiological mechanisms. J Physiol. 2008; 586:55–63.PubMedCrossRefGoogle Scholar
  81. 81.
    Lang CC, Agostoni P, Mancini DM. Prognostic significance and measurement of exercise-derived hemodynamic variables in patients with heart failure. J Card Fail. 2007;13:672–9.PubMedCrossRefGoogle Scholar
  82. 82.
    Sun XG, Hansen JE, Garatachea N, Storer TW, Wasserman K. Ventilatory efficiency during exercise in healthy subjects. Am J Respir Crit Care Med. 2002;166:1443–8.PubMedCrossRefGoogle Scholar
  83. 83.
    Eckardt KU. Anaemia in end-stage renal disease: pathophysiological considerations. Nephrol Dial Transplant. 2001;16 Suppl 7:2–8.PubMedCrossRefGoogle Scholar
  84. 84.
    Koskolou MD, Roach RC, Calbet JA, Rådegran G, Saltin B. Cardiovascular responses to dynamic exercise with acute anemia in humans. Am J Physiol. 1997;273:H1787–93.PubMedGoogle Scholar
  85. 85.
    Mancini DM, Kunavarapu C. Effect of erythropoietin on exercise capacity in anemic patients with advanced heart failure. Kidney Int. 2003;64:S48–52.CrossRefGoogle Scholar
  86. 86.
    Huang YC, O’Brien SR, MacIntyre NR. Intrabreath diffusing capacity of the lung in healthy individuals at rest and during exercise. Chest. 2002;122:177–85.PubMedCrossRefGoogle Scholar
  87. 87.
    Keslacy S, Matecki S, Carra J, Borrani F, Candau R, Prefaut C, Ramonatxo M. Effect of inspiratory ­threshold loading on ventilatory kinetics during ­constant-load exercise. Am J Physiol Regul Integr Comp Physiol. 2005;289:R1618–24.PubMedCrossRefGoogle Scholar
  88. 88.
    Wasserman K, Hansen JE, Sue DY, Stringer WW, Whipp BJ. Principles of exercise testing and interpretation. 4th ed. Philadelphia: Lippincott, Williams and Wilkins Publications; 2005.Google Scholar
  89. 89.
    Hoppeler H, Weibel ER. Structural and functional limits for oxygen supply to muscle. Acta Physiol Scand. 2000;168:445–56.PubMedCrossRefGoogle Scholar
  90. 90.
    Olfert IM, Balouch J, Kleinsasser A, Knapp A, Wagner H, Wagner PD, Hopkins SR. Does gender affect human pulmonary gas exchange during exercise? J Physiol. 2004;557:529–41.PubMedCrossRefGoogle Scholar
  91. 91.
    Harms CA. Does gender affect pulmonary function and exercise capacity? Respir Physiol Neurobiol. 2006;151:124–31.PubMedCrossRefGoogle Scholar
  92. 92.
    Stager JM, Tanner DA. Swimming: 2nd edition; An International Olympic Committee Publication. Oxford: Blackwell Science Ltd.; 2005.Google Scholar
  93. 93.
    Guenette JA, Witt JD, McKenzie DC, Road JD, Sheel AW. Respiratory mechanics during exercise in endurance-trained men and women. J Physiol. 2007;581: 1309–22.PubMedCrossRefGoogle Scholar
  94. 94.
    Harms CA, Rosenkranz S. Sex differences in pulmonary function during exercise. Med Sci Sports Exerc. 2008;40:664–8. Harms CA, Rosenkranz S. Sex differences in pulmonary function during exercise. Med Sci Sports Exerc. 2008;40:664–8.Google Scholar
  95. 95.
    Umar S, van der Laarse A. Nitric oxide and nitric oxide synthase isoforms in the normal, hypertrophic, and failing heart. Mol Cell Biochem. 2010;333:191–201.PubMedCrossRefGoogle Scholar
  96. 96.
    Zavorsky GS, Walley KR, Russell JA. Red cell pulmonary transit times through the healthy human lung. Exp Physiol. 2003;88:191–200.PubMedCrossRefGoogle Scholar
  97. 97.
    McClaran SR, Harms CA, Pegelow DF, Dempsey JA. Smaller lungs in women affect exercise hyperpnea. J Appl Physiol. 1998;84:1872–81.PubMedGoogle Scholar
  98. 98.
    Rohrbach MC, Perret C, Kayser B, Boutellier U, Spengler CM. Task failure from inspiratory resistive loaded breathing: a role for inspiratory muscle fatigue? Eur J Appl Physiol. 2003;90:405–10.PubMedCrossRefGoogle Scholar
  99. 99.
    Ng LJ, Sih BL, Stuhmiller JH. An integrated exercise response and muscle fatigue model for performance decrement estimates of workloads in oxygen-limiting environments. Eur J Appl Physiol. 2011 Jul 19. [Epub ahead of print].Google Scholar
  100. 100.
    Grocott MP, Martin DS, Levett DZ, McMorrow R, Windsor J, Montgomery HE, Caudwell Xtreme Everest Research Group. Arterial blood gases and oxygen content in climbers on Mount Everest. N Engl J Med. 2009;360:140–9.PubMedCrossRefGoogle Scholar
  101. 101.
    Bartsch P, Gibbs R. Effect of altitude on the heart and the lungs. Circulation. 2007;116: 2191–202.PubMedCrossRefGoogle Scholar
  102. 102.
    Marshall JM. Peripheral chemoreceptors and cardiovascular regulation. Physiol Rev. 1994;74:543–94.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2012

Authors and Affiliations

  1. 1.Wingate CollegeNetanyaIsrael

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