Limiting factors to oxygen transport on Mount Everest 30 years after: A critique of Paolo Cerretelli's contribution to the study of altitude physiology

In 1976, Paolo Cerretelli published an article entitled "Limiting factors to oxygen transport on Mount Everest" in the Journal of Applied Physiology. The paper demonstrated the role of cardiovascular oxygen transport in limiting maximal oxygen consumption (VO2max). In agreement with the predominant view of VO2max limitation at that time, however, its results were taken to mean that cardiovascular oxygen transport does not limit VO2max at altitude. So it was argued that the limiting factor could be in the periphery, and muscle blood flow was proposed as a possible candidate. Despite this suggestion, the conclusion generated a series of papers on muscle structural characteristics. These experiments demonstrated a loss of muscle oxidative capacity in chronic hypoxia, and thus provided an unambiguous refutation of the then widespread hypothesis that an increased muscle oxidative capacity is needed at altitude to compensate for the lack of oxygen. This analysis is followed by a short account of Cerretelli's more recent work, with a special attention to the subject of the so-called "lactate paradox".