Exercise-induced hypoxaemia in highly trained athletes

Traditionally, the pulmonary system has not been considered the limiting factor in determining maximal oxygen uptake (VO2max) in healthy individuals since arterial oxygen-haemoglobin saturation is thought to remain high during intense exercise. However, there appears to be a major exception to this rule. Recent evidence suggests that arterial hypoxaemia results during heavy exercise in well trained individuals with a high VO2max. Further, the degree of arterial desaturation is inversely related to VO2max. This exercise-induced hypoxaemia does not appear to be due to hypoventilation although athletes who have limited hyperventilation seem to exhibit the lowest arterial oxygen-haemoglobin saturation. A significant venoarterial shunt has been ruled out as a primary cause of the hypoxaemia based on both experimental and theoretical considerations. Therefore, it appears that the exercise-induced hypoxaemia seen in highly trained athletes during heavy exercise is primarily due to diffusion limitations and ventillation-perfusion inequality. It is postulated that incomplete diffusion in the healthy lung may be due to a rapid red blood cell transit time through the pulmonary capillary. In summary, recent findings suggest that the limits of the human pulmonary system may be reached or even exceeded during intense exercise in some individuals. In light of these findings the role of the pulmonary system as a limiting factor during maximal exercise in the highly trained endurance athlete warrants further investigation.