A theoretical analysis of factors determining VO2 MAX at sea level and altitude.

When maximal VO2 (VO2 MAX) is limited by O2 supply, it is generally thought that cardiac output (QT) is mostly responsible, but other O2 transport conductances [ventilation (VA); [Hb]; pulmonary (DLO2) and muscle (DMO2) diffusion capacities] may also influence VO2 MAX. A numerical analysis interactively linking the lungs, circulation and muscles was designed to compare the influences of each conductance component on VO2 MAX at three altitudes: PB = 760, 464 and 253 Torr. For any given set of conductances the analysis simultaneously solved six equations for alveolar, arterial, and venous PO2 and PcO2. The equations represent pulmonary mass balance, pulmonary diffusion, and muscle diffusion for both gases. At PB = 760, [Hb], DLO2 and DMO2 were as influential as QT in limiting VO2 MAX. With increasing altitude, the influence of QT and [Hb] fell while that of VA, DLO2 and DMO2 progressively increased until at PB = 253, VO2 MAX was independent of QT and [Hb]. Neither the fall in maximal QT nor rise in [Hb] with chronic hypoxia therefore appear to affect VO2 MAX. However, high values of ventilation, DLO2 and DMO2 appear to be advantageous for exercise at altitude.