Contribution of oxygen extraction fraction to maximal oxygen uptake in healthy young men

We analysed the importance of systemic and peripheral arteriovenous O2 difference (a- v− O2 and a-vf O2 difference, respectively) and O2 extraction fraction for maximal oxygen uptake ( V˙ O2max ). Fick law of diffusion and the Piiper and Scheid model were applied to investigate whether diffusion vs perfusion limitations vary with V˙ O2max . Articles (n=17) publishing individual data (n=154) on V˙ O2max , maximal cardiac output ( Q˙ max ; indicator-dilution or Fick method), a- v− O2 difference (catheters or Fick equation) and systemic O2 extraction fraction were identified. For the peripheral responses, group-mean data (articles: n=27; subjects: n=234) on leg blood flow (LBF; thermodilution), a-vf O2 difference and O2 extraction fraction (arterial and femoral venous catheters) were obtained. Q˙ max and two-LBF increased linearly by 4.9-6.0 L·min-1 per 1 L·min-1 increase in V˙ O2max (R2 =0.73 and R2 =0.67, respectively; both P<0.001). The a- v− O2 difference increased from 118-168 mL·L-1 from a V˙ O2max of 2-4.5 L·min-1 followed by a reduction (second-order polynomial: R2 =0.27). After accounting for a hypoxemia-induced decrease in arterial O2 content with increasing V˙ O2max (R2 =0.17; P<0.001), systemic O2 extraction fraction increased up to ~90% ( V˙ O2max : 4.5 L·min-1 ) with no further change (exponential decay model: R2 =0.42). Likewise, leg O2 extraction fraction increased with V˙ O2max to approach a maximal value of ~90-95% (R2 =0.83). Muscle O2 diffusing capacity and the equilibration index Y increased linearly with V˙ O2max (R2 =0.77 and R2 =0.31, respectively; both P<0.01), reflecting decreasing O2 diffusional limitations and accentuating O2 delivery limitations. In conclusion, although O2 delivery is the main limiting factor to V˙ O2max , enhanced O2 extraction fraction (≥90%) contributes to the remarkably high V˙ O2max in endurance-trained individuals.