Muscle adaptation to altitude: tissue capillarity and capacity for aerobic metabolism

Prolonged exposure to high altitude leads to reduced muscle mass and performance. The fall in muscle mass follows a reduction in fiber size, which at first was believed to be accompanied by increased fiber capillarization and aerobic enzymes. Subsequent studies showed that hypoxia alone does not alter capillary number and geometry in skeletal muscles of mammals at altitude. It was also found that alterations in fiber size and aerobic enzymes depend on a number of additional factors, including animal activity and the level of hypoxia (e.g., moderate vs. extreme altitude). With training at altitude, fiber capillary number and aerobic enzymes are increased, indicating that muscle potential for plasticity is conserved in hypoxia. Recent studies have also shown that capillary number and geometry are altered in muscles of several species of birds native or exposed to higher altitude; that is, that capillary growth can occur in skeletal muscle in response to chronic exposure to high altitude. In this mini review, we summarize these data and current knowledge on muscle capillary to fiber structural relationships and their implications for muscle aerobic function at altitude.