Romer LM, Haverkamp HC, Amann M, Lovering AT, Pegelow DF, Dempsey JA. Effect of acute severe hypoxia on peripheral fatigue and endurance capacity in healthy humans. Am J Physiol Regul Integr Comp Physiol 292: R598 -R606, 2007. First published September 7, 2006; doi:10.1152/ajpregu.00269.2006.-We hypothesized that severe hypoxia limits exercise performance via decreased contractility of limb locomotor muscles. Nine male subjects [mean Ϯ SE maximum O 2 uptake (V O2 max) ϭ 56.5 Ϯ 2.7 ml ⅐ kg Ϫ1 ⅐ min Ϫ1 ] cycled at Ն90% V O2 max to exhaustion in normoxia [NORM-EXH; inspired O 2 fraction (FIO 2 ) ϭ 0.21, arterial O2 saturation (SpO 2 ) ϭ 93 Ϯ 1%] and hypoxia (HYPOX-EXH; FI O 2 ϭ 0.13, SpO 2 ϭ 76 Ϯ 1%). The subjects also exercised in normoxia for a time equal to that achieved in hypoxia (NORM-CTRL; Sp O 2 ϭ 96 Ϯ 1%). Quadriceps twitch force, in response to supramaximal single (nonpotentiated and potentiated 1 Hz) and paired magnetic stimuli of the femoral nerve (10 -100 Hz), was assessed pre-and at 2.5, 35, and 70 min postexercise. Hypoxia exacerbated exercise-induced peripheral fatigue, as evidenced by a greater decrease in potentiated twitch force in HYPOX-EXH vs. NORM-CTRL (Ϫ39 Ϯ 4 vs. Ϫ24 Ϯ 3%, P Ͻ 0.01). Time to exhaustion was reduced by more than two-thirds in HYPOX-EXH vs. NORM-EXH (4.2 Ϯ 0.5 vs. 13.4 Ϯ 0.8 min, P Ͻ 0.01); however, peripheral fatigue was not different in HYPOX-EXH vs. NORM-EXH (Ϫ34 Ϯ 4 vs. Ϫ39 Ϯ 4%, P Ͼ 0.05). Blood lactate concentration and perceptions of limb discomfort were higher throughout HYPOX-EXH vs. NORM-CTRL but were not different at end-exercise in HYPOX-EXH vs. NORM-EXH. We conclude that severe hypoxia exacerbates peripheral fatigue of limb locomotor muscles and that this effect may contribute, in part, to the early termination of exercise. hypoxemia; muscle fatigue; exercise performance WHOLE BODY EXERCISE PERFORMANCE in aerobic activities is impaired in hypoxia (19). The physiological mechanisms underpinning this impairment are not fully understood, but multiple "peripheral" and "central" mechanisms have been proposed. We have shown recently that preventing the mild arterial O 2 desaturation that occurred in endurance-trained subjects during sustained, heavy-intensity exercise in normoxia (Ϫ6% arterial O 2 saturation from baseline) significantly attenuated peripheral fatigue of the quadriceps muscle as assessed via femoral nerve stimulation (41). Electromyographic evidence suggests that, for the same exercise duration, the magnitude of peripheral fatigue during lower-limb cycle exercise is greater in severe hypoxia than in normoxia (3,46,47). In contrast, other reports have not found a cumulative effect of exercise and severe hypoxia on peripheral fatigue of the locomotor muscles, despite equal exercise durations (29,34,43). These latter findings (29,34,43) are compatible with the hypothesis that systemic hypoxemia has inhibitory effects on central motor output to locomotor muscles to ensure that a catastrophic failure of homeostasis does not occur during exercise (8,24).We expl...