PT - JOURNAL ARTICLE AU - Chapman, Robert F TI - The individual response to training and competition at altitude AID - 10.1136/bjsports-2013-092837 DP - 2013 Dec 01 TA - British Journal of Sports Medicine PG - i40--i44 VI - 47 IP - Suppl 1 4099 - http://bjsm.bmj.com/content/47/Suppl_1/i40.short 4100 - http://bjsm.bmj.com/content/47/Suppl_1/i40.full SO - Br J Sports Med2013 Dec 01; 47 AB - Performance in athletic activities that include a significant aerobic component at mild or moderate altitudes shows a large individual variation. Physiologically, a large portion of the negative effect of altitude on exercise performance can be traced to limitations of oxygen diffusion, either at the level of the alveoli or the muscle microvasculature. In the lung, the ability to maintain arterial oxyhaemoglobin saturation (SaO2) appears to be a primary factor, ultimately influencing oxygen delivery to the periphery. SaO2 in hypoxia can be defended by increasing ventilatory drive; however, during heavy exercise, many athletes demonstrate limitations to expiratory flow and are unable to increase ventilation in hypoxia. Additionally, increasing ventilatory work in hypoxia may actually be negative for performance, if dyspnoea increases or muscle blood flow is reduced secondary to an increased sympathetic outflow (eg, the muscle metaboreflex response). Taken together, some athletes are clearly more negatively affected during exercise in hypoxia than other athletes. With careful screening, it may be possible to develop a protocol for determining which athletes may be the most negatively affected during competition and/or training at altitude.