Hypoxia is an essential topic in medical or biological sciences. The main aims of the present study were to examine the most important medical articles (i.e., the top 100 most cited) on hypoxia. We examine how the Nobel-prize awarded hypoxia inducible factor (HIF)-pathway discovery in the early 1990s has changed the thematic composition of this body of literature, with a special emphasis on the studies linking hypoxia and cancer. We searched Pubmed for articles with the terms #Hypox, #Altitude, or #Mountain in the title that have been published in biomedical journals and ranked the articles on their number of citations in Web of Science. A second search was performed in all journals for articles related to hypoxia and cancer. Strikingly, only 12 of the top-100 most-cited articles on hypoxia and only 3 articles of the top-100 articles related to cancer were published before 1995. Moreover, only 5 articles from prior 1995 reached 1000 citations, while 27 articles published in 1995 or later were cited more than 1000 times, most of them on the HIF-1 pathway. Eighty percent of the top-100 articles were related to the HIF pathway, while there were no articles on the application of hypoxia either for therapeutic use (i.e., hypoxic conditioning in patients) or for performance enhancement (i.e., altitude training in athletes). In conclusion, the early-1990s discovery of the HIF pathway and of its molecular regulation has shifted the focus of hypoxia research towards molecular mechanisms and consequences of tissue hypoxia, most notably in cancer. The importance of studies focusing on clinical and performance applications of systemic hypoxia is relatively lower.
The Elevation Training Mask (ETM) has been assessed for its impact on exercise performance using acute and training protocols. Although the ETM is widely available to consumers, little research exists for validation of the ETM mask settings. Therefore, the purpose of this study was to compare physiological responses during exercise for the ETM mask settings against moderate hypobaric hypoxia.
Nine participants living at moderate altitude (1600–1650 m) rested (10 min) and cycled in hypobaric hypoxia simulating 2743 m (ALT), in hypobaric hypoxia simulating 1829 m with the ETM set to 914 m (ALT + ETM), and with the ETM set to 2743 m (ETM) in a randomized order. Participants cycled for 20 min at 60% VO2 max as determined by a maximal exertion test (VO2 max) at baseline altitude. Oxygen consumption was measured throughout each test.
There were no differences between conditions at rest. Repeated measures ANOVA showed the ALT condition elicited significantly greater VO2 compared to the ETM condition and 60% VO2 max at baseline altitude (P < 0.05).
When cycling at a matched workload, the exercising VO2 was higher in the ALT condition than at the ETM mask setting of 2743 m and exercising VO2 during the ETM condition was similar to 60% VO2 max at baseline altitude. The results of this study indicate that the ETM did not produce additional metabolic stress compared to hypobaric hypoxia during steady-state exercise in moderate-altitude living individuals.