Physiological changes induced by pre-adaptation to high altitude

To study the physiological effects of pre-adaptation to high altitude, seven subjects were submitted to acclimatization at 4350 m followed by intermittent acclimation in a low barometric pressure chamber (5000 m to 8500 m). The subjects then spent 25 days in the Himalayas. Ventilatory and cardiac responses were studied during a hypobaric poikilocapnic hypoxic test performed both at rest and during exercise (100 W) in normoxia and in hypoxia (barometric pressure: 589 hPa, altitude: 4500 m). Haemoglobin, erythrocytes, reticulocytes, packed cell volume, 2,3-diphosphoglycerate (2,3-DPG) and erythropoietin (EPO) were measured. All variables were studied before pre-adaptation to high altitude (A), after the acclimatization period (B), after the acclimation period (C) and after the expedition (D). The ventilatory and cardiac responses were characterized by an increased tidal volume in hypoxia (+ 33% during exercise in B,P < 0.05; + 100% at rest and + 33% during exercise in C,P < 0.05) without any change in respiratory frequency, whereas an increased systolic blood pressure was only observed in C during exercise in hypoxia [+23 mmHg (3.07 kPa),P<0.01]. Arterial O2 saturation was higher in hypoxia in C and D, both at rest (+8.2% and +4.7%,P<0.01, respectively), and during exercise (+6.3% and +6.3%,P<0.01, respectively). Erythrocytes, haemoglobin and packed cell volume did not vary significantly. The number of reticulocytes was higher in B (+172%,P<0.05) and in C (+249%,P<0.05). EPO and 2,3-DPG increased only in C (+ 770%,P<0.01 and +23%,P<0.05, respectively). These results showed that a combination of continuous pre-acclimatization on Mont Blanc and intermittent acclimation in the hypobaric chamber triggered efficient pre-adaptation mechanisms allowing climbers to save 1 to 2 weeks of acclimatization on the mountain without clinical inconvenience.