Martin Burtscher

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• MD, PhD
• Professor at University of Innsbruck

Objectives: The ability to efficiently regulate body temperature is crucial during endurance activities such as trail running, especially during competitive events in hot conditions. Over the past decade, passive hyperthermia exposure has grown significantly in popularity as a means of improving acclimatization and performance in hot environments....

Background/Objectives: Cycling has become a popular recreational sport, but it can lead to injuries and overload syndromes. The goal of this study is to evaluate the effectiveness of a training-accompanied myofascial self-massage intervention on two primary outcomes: injury occurrence and perceived training intensity. Methods: To achieve this goal,...

Background/Objectives: Cycling became a popular recreational sport, but it can lead to injuries and overload syndromes. The goal of this study is to evaluate the effectiveness of a training-accompanying myofascial self-massage intervention on two primary outcomes: injury occurrence and perceived training intensity. Methods: To achieve this goal we...

Living low–training high may promote favourable physiological adaptations and improvement of exercise performance in normoxia following training at altitudes above 1500 m. Whether and how physiological adaptations to training high interact with the perception of effort remains unknown. This perspective article aims to carve out potential contributo...

Epidemiological data of populations living at moderate altitudes between 1000 and 2000 m suggest healthier aging when compared to people living in lower regions. Besides social determinants of health, lifestyle and cardiovascular risk factors, environmental conditions such as ambient temperature, air pollution and aeroallergens, solar radiation and...

Recently, an elevated rear component of the ski binding has been associated with a reduced ACL injury risk. However, the underlying mechanism is unknown. This study aimed to evaluate the impact of elevated rear components of the ski binding on lower extremity joint angles and the center of mass (COM) in recreational skiers. To evaluate ankle, knee...

We read with interest the paper on “Smartwatch measurement of blood oxygen saturation for predicting acute mountain sickness: Diagnostic accuracy and reliability” recently published by Zeng and colleagues in Digital Health. This study demonstrated good reliability and high precision for measuring peripheral oxygen saturation (SpO2) using Huawei sma...

The ability to perform steady-state submaximal exercise at a certain intensity (exercise tolerance) predicts endurance performance in athletes, but also the quality of life and the capability to perform daily living activities in older people and patients suffering from chronic diseases. Improvements in exercise tolerance following exercise trainin...

Background Neurological symptoms are common in acute mountain sickness (AMS); however, the extent of neuroaxonal damage remains unclear. Neurofilament light chain (NfL) is an established blood biomarker for neuroaxonal damage. Objective To investigate whether plasma (p) NfL levels increase after simulated altitude exposure, correlate with the occu...

Hand-grip strength was evaluated in 757 recreational downhill skiers and compared to 1021 community-dwellers. Findings are reported for age and sex categories consistent with community-dwelling norms. Effect size (Cohen's d) was calculated to estimate the clinical relevance of strength differences between populations. Most male and half of the fema...

Background The amount of regular physical activity (PA) can modulate the prevalence of traditional risk factors for cardiovascular disease (CVD) such as obesity, systemic hypertension, hypercholesterolemia, and type 2 diabetes (T2D). However, how different PA levels either below (< 600 MET min/week), within (600–1200 MET min/week), or above (> 1200...

Metabolic disorders like metabolic syndrome and type 2 diabetes are public health concerns seriously impacting human life and health expenditures. Unhealthy lifestyle behaviors (diet and physical inactivity) are major risk factors for developing these disorders. Individuals suffering from metabolic syndrome are at high risk of developing cardiovasc...

In the present case study, the gut microbiota (GM) profile of a male Elite Mountain Runner (34 years, 171cm, 59 kg, VO2max: 92 mL·min−1 ·kg−1) was analyzed over 5 months competitive period (6 samples). The GM diversity increased through the season coinciding higher levels to the peak performance and shorter and longer race (42 vs. 172 km) produced...

It is a common misconception that cognitive function is impaired in a linear fashion by declining oxygen availability (e.g. at altitude). While this may apply for prolonged exposures to high altitudes (>2500 m), moderate altitude (1500–2500 m) or short intermittent hypoxic episodes can even be beneficial for the brain.

Every year millions of people fly to high-altitude destinations. They thereby expose themselves to specific high-altitude conditions. The hypoxic environment (low ambient oxygen availability) constitutes a major factor affecting health and well-being at high altitude. While the oxygen availability is already moderately reduced inside the aircraft c...

Introduction: High altitude regions are characterized by harsh conditions (environmental, rough terrain, natural hazards, and limited hygiene and health care), which all may contribute to the risk of accidents/emergencies when trekking or climbing. Exposure to hypoxia, cold, wind, and solar radiation are typical features of the high altitude enviro...

Millions of people visit high-altitude regions annually and more than 80 million live permanently above 2,500 m. Acute high-altitude exposure can trigger high-altitude illnesses (HAIs), including acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). Chronic mountain sickness (CMS) can affect...

Millions of people visit high-altitude regions annually and more than 80 million live permanently above 2,500 m. Acute high-altitude exposure can trigger high-altitude illnesses (HAIs), including acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). Chronic mountain sickness (CMS) can affect...

Hypoxia is more and more perceived as pivotal physiological driving force, allowing cells in the brain and elsewhere to acclimate to lowered oxygen (O2), and abridged metabolism. The mediating transcription program is induced by inspiratory hypoxia but also by intensive motor‐cognitive tasks, provoking a relative decrease in O2 in relation to the a...

Prominent pathological features of Huntington’s disease (HD) are aggregations of mutated Huntingtin protein (mHtt) in the brain and neurodegeneration, which causes characteristic motor (such as chorea and dystonia) and non-motor symptoms. However, the numerous systemic and peripheral deficits in HD have gained increasing attention recently, since t...

Background: This study aimed to evaluate age-specific variations in the blood levels of micronutrients, homocysteine, and CoQ10, along with physical activity (PA) patterns, among 123 Austrian adult bankers in operational and frontline roles (mean age: 43 years; 50% female). Methods: Blood analysis was conducted to assess micronutrients and the seru...

Background and Objectives: Despite the importance of nutritional status and a healthy lifestyle in shaping overall well-being, little is known about examining gender-specific differences and trends in health, lifestyle, and nutritional status. The present study aimed to evaluate blood levels of micronutrients, homocysteine, and CoQ10, as well as ph...

Parkinson’s disease (PD) is associated with various deficits in sensing and responding to reductions in oxygen availability (hypoxia). Here we summarize the evidence pointing to a central role of hypoxia in PD, discuss the relation of hypoxia and oxygen dependence with pathological hallmarks of PD, including mitochondrial dysfunction, dopaminergic...

Objectives Respiratory muscle weakness with higher ventilatory demands were reported even in patients recovering from only mild COVID-19 symptoms. Aim of this study was to assess the function of phrenic nerve and inspiratory respiratory muscle as well as cardiopulmonary exercise capacity in patients with prolonged exertional dyspnea after COVID-19...

Type 2 diabetes mellitus (T2DM) heightens dementia and cognitive decline risk, notably impacting working memory and executive functions. This study investigates the impact of 8 weeks of qigong training on cognitive functions, blood pressure, plasma brain-derived neurotrophic factor (pBDNF), antioxidant, and biochemical outcomes in sedentary middle-...

The (patho-)physiological responses to hypoxia are highly heterogeneous between individuals. In this review, we focused on the roles of sex differences, which emerge as important factors in the regulation of the body’s reaction to hypoxia. Several aspects should be considered for future research on hypoxia-related sex differences, particularly alti...

Background: Favorable health benefits of an active lifestyle have been clearly documented within the context of occupational health. However, a knowledge gap exists regarding the monitoring and comparison of micronutrient status across varying levels of physical activity (PA). This study aimed to investigate the association of PA level with micronu...

Purpose : One hundred years ago, Hill and Lupton introduced the concept of maximal oxygen uptake ( ), which is regarded as “the principal progenitor of sports physiology.” We provide a succinct overview of the evolvement of research on , from Hill and Lupton‘s initial findings to current debates on limiting factors for and the associated role of co...

Sex differences in physiological responses to various stressors, including exercise, have been well documented. However, the specific impact of these differences on exposure to hypoxia, both at rest and during exercise, has remained underexplored. Many studies on the physiological responses to hypoxia have either excluded women or included only a l...

Intermittent hypoxia (IH) is commonly associated with pathological conditions, particularly obstructive sleep apnoea. However, IH is also increasingly used to enhance health and performance and is emerging as a potent non‐pharmacological intervention against numerous diseases. Whether IH is detrimental or beneficial for health is largely determined...

In recreational alpine skiing, an ACL injury represents the most common injury. Skiing is a complex activity where the skier interacts with the environment, such as weather, snow conditions, temperature, etc. Thus, the aim of this study was to evaluate the potential impact of environmental factors on ACL injury risk in recreational alpine skiers. A...

Background: Qigong exercise training has been suggested to elicit beneficial effects on physical functioning, reduction of oxidative stress, and improved antioxidant capacity in women. However, regular exercise training may support the development of antioxidant defense mechanisms and beneficially modulate oxidant/antioxidant responses. Objective:...

Immune outcomes are key mediators of many health benefits of exercise and are determined by exercise type, dose (frequency/duration, intensity), and individual characteristics. Similarly, reduced availability of ambient oxygen (hypoxia) modulates immune functions depending on the hypoxic dose and the individual capacity to respond to hypoxia. How c...

Reduced oxygen availability (hypoxia) can lead to cell and organ damage. Therefore, aerobic species depend on efficient mechanisms to counteract detrimental consequences of hypoxia. Hypoxia inducible factors (HIFs) and mitochondria are integral components of the cellular response to hypoxia and coordinate both distinct and highly intertwined adapta...

Older individuals represent a growing population, in industrialized countries, particularly those with cardiovascular diseases, which remain the leading cause of death in western societies. Aging constitutes one of the largest risks for cardiovascular diseases. On the other hand, oxygen consumption is the foundation of cardiorespiratory fitness, wh...

The year 2023 marks the 100th anniversary of the ‘maximum oxygen intake’ (VO2max), first described by Hill and Lupton in the QJM in 1923.¹ These authors suggested an upper limit to oxygen intake depending on the capability of the cardiorespiratory system to deliver inspired oxygen to the working muscles. Since then, whether the cardiorespiratory sy...

Background In recreational alpine skiing ACL injury risk depends on the interaction of individual characteristics and behaviours as well as on equipment-related factors. Aim to evaluate if and to what extent personal characteristics and equipment-related parameters are associated with ACL injury risk in cautious and risk-taking recreational alpine...

Pühringer, Reinhard, Martina Muckenthaler, and Martin Burtscher. Association between ferritin levels and altitude-dependent cardiorespiratory fitness in mountain guides. High Alt Med Biol. 00:000-000, 2023. Background: Higher ferritin levels may be associated with lower cardiorespiratory fitness (CRF; i.e., maximal oxygen uptake, VO2max) and may re...

INTRODUCTION: Ski geometry parameters can influence ACL injury risk in recreational alpine skiing, e.g., the likelihood of an ACL injury increases with a wider ski tip and decreases with a wider ski waist (Ruedl et al. 2022). This study aims to evaluate the impact of ratios between tip, waist and tail widths of the carving ski on ACL injury risk in...

Background In recreational alpine skiing, the anterior cruciate ligament (ACL) is affected in approximately 50% of serious knee injuries. There are established sex-based and skill-based differences in ACL injury risk, but the potential impact of equipment used (eg, skis, bindings, and boots) has not been evaluated. Purpose To evaluate individual a...

Hypoxia is increasingly recognized as an important physiological driving force. A specific transcriptional program, induced by a decrease in oxygen (O2) availability, for example, inspiratory hypoxia at high altitude, allows cells to adapt to lower O2 and limited energy metabolism. This transcriptional program is partly controlled by and partly ind...

Background: Altitude sojourns increasingly attract individuals of all ages and different health status due to the appeal of high-altitude destinations worldwide and easy access to air travel. The risk of acute mountain sickness (AMS) when flying to high altitude destinations remains underemphasized. Thus, this mini-review aims to evaluate the alti...

High-altitude illnesses (HAIs) result from acute exposure to high altitude/hypoxia. Numerous molecular mechanisms affect appropriate acclimatization to hypobaric and/or normobaric hypoxia and curtail the development of HAIs. The understanding of these mechanisms is essential to optimize hypoxic acclimatization for efficient prophylaxis and treatmen...

Mitokines are signaling molecules that enable communication of local mitochondrial stress to other mitochondria in distant cells and tissues. Among those molecules are FGF21, GDF15 (both expressed in the nucleus) and several mitochondrial-derived peptides, including humanin. Their responsiveness to mitochondrial stress induces mitokine-signaling in...

Moderate altitude (1000–2000 m above sea level) residence is emerging as a protective factor from the mortality of various causes, including of cardiovascular diseases. Conversely, mortality from certain respiratory diseases is higher at these altitudes than in lowlands. These divergent outcomes could indicate either beneficial or detrimental effec...

This study investigated the effect of a new type of ear pads for ski helmets on the hearing performance of 13 young adults (mean age: 22 years). Free-field hearing thresholds and sound localization performance of the subjects were assessed in three conditions: without helmet, with a conventional helmet and with the modified helmet. Results showed t...

One may ask if the transition to bipedalism from the condition of quadrupedalism, which occurred about 7 million years ago, has been the cause or consequence of a series of fundamental physiological muscular aspects including the cost of locomotion, a crucial determinant of endurance, which has been found to be significantly lower in humans than in...

Maximal values of aerobic power (VO2max) and peripheral oxygen saturation (SpO2max) decline in parallel with gain in altitude. Whereas this relationship has been well investigated when acutely exposed to high altitude, potential benefits of acclimatization on SpO2 and related VO2max in healthy and diseased individuals have been much less considered...

Highlights •Resistance exercise (RE) is an important physical activity modality conferring major health benefits that are partially complementary to benefits from endurance exercise. •Recent meta-analyses reveal a U-shaped relationship between RE volumes and mortality, with optimal benefits achieved at about 60 min of RE per week. •The mechanisms f...

Introduction: A lack of knowledge among laypersons about the hazards of high-altitude exposure contributes to morbidity and mortality from acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE) among high-altitude travelers. There are guidelines regarding the recognition, prevention, and treatme...

Aim: to evaluate if ACL injuries are associated with recreational skiers using rented skis and whether individual factors, ski geometry parameters and standing heights differ between skiers who rented or owned skis. A retrospective questionnaire-based, case-control study of ACL-injured and uninjured recreational skiers was conducted during six win...

Elite masters endurance athletes are considered models of optimal healthy aging due to the maintenance of high cardiorespiratory fitness (CRF) until old age. Whereas a drop in VO2max in masters athletes has been broadly investigated, the modifying impact of training still remains a matter of debate. Longitudinal observations in masters endurance at...

Mountain sports are continuously gaining popularity, currently fueled by the post-pandemic period expanding travel opportunities and the desire to escape the increasingly hot environmental conditions of urban areas—ambient temperature decreases by about 6.5 °C per 1000 m gain in altitude. [...]

Regular exercise confers multifaceted and well-established health benefits. Yet, transient and asymptomatic increases in markers of cardio-renal injury are commonly observed in ultra-endurance athletes during and after competition. This has raised concerns that chronic recurring insults could cause long-term cardiac and/or renal damage. Indeed, ext...

This editorial of the Special Issue "Clinical and Physiological Consequences of Hypoxia/Hypoxemia in Healthy Subjects and Patients" aims to draw more attention to the broad and diverse field of hypoxia research and serves as an invitation for research groups to share their most recent findings with the medical community [...].

Fatalities on ski slopes are very rare, with about one death per one million skier days. Whether the fatality rate is affected by substantial changes in the number of skier days and potentially associated alterations in the structure of the skier population is unknown. Thus, we compared the fatality rate on Austrian ski slopes in the winter season...

Adequate oxygen supply is essential for the human brain to meet its high energy demands. Therefore, elaborate molecular and systemic mechanism are in place to enable adaptation to low oxygen availability. Anxiety and depressive disorders are characterized by alterations in brain oxygen metabolism and of its components, such as mitochondria or hypox...

Kong, Zhaowei, Qian Yu, Shengyan Sun, On Kei Lei, Yu Tian, Qingde Shi, Jinlei Nie, and Martin Burtscher. The impact of sprint interval exercise in acute severe hypoxia on executive function. High Alt Med Biol. xx:xxx-xxx, 2022. Objective: The present study evaluated executive performance responses to sprint interval exercise in normoxia and relativ...

Although preliminary studies suggested sex-related differences in physiological responses to altitude/hypoxia, controlled studies from standardised exposures to normobaric hypoxia are largely lacking. Hence, the goals of this study were to provide information on cardiorespiratory responses to a 7-h normobaric hypoxia exposure and to explore potenti...

Objectives: To evaluate the impact of ski geometry data and standing height ratio on anterior cruciate ligament (ACL) injury risk of male and female recreational skiers. Methods: A retrospective questionnaire-based, case-control study of ACL-injured and uninjured recreational skiers was conducted during six consecutive winter seasons. Ski geomet...

Whereas the negative effects of aging and smoking on pulmonary function are undisputed, the potential favorable effects of physical activity on the aging process of the otherwise healthy lung remain controversial. This question is of particular clinical relevance when reduced pulmonary function compromises aerobic exercise capacity (maximal oxygen...

Several publications and random observations have reported weight loss in high-altitude sojourners of both sexes. This could be a result of multiple adaptations, which hypoxia and mountaineering provoke on a cellular and organic level. Several publications have discussed the effect on appetite-regulating hormones to be one of the main contributing...

When interpreting sex differences in the injury risk during sport activities, potential gender effects are often overlooked. This might actually be the case with regard to the higher injury risk of the anterior cruciate ligament (ACL) in female skiers. A higher failure rate of ski binding releases has been suggested at least partly to explain the m...

Significance: Oxygen is indispensable for aerobic life but its utilization exposes cells and tissues to oxidative stress; thus, tight regulation of cellular, tissue and systemic oxygen concentrations is crucial. Here, we review the current understanding of how the human organism (mal-)adapts to low (hypoxia) and high (hyperoxia) oxygen levels and...

Four-movement Qigong is a new and easy-to-perform type of exercise which is becoming increasingly popular among elderly individuals. Although beneficial health effects might be expected, data on such effects of this type of exercise, derived from controlled studies, are lacking. Therefore, the purpose of the present study was to assess effects of 4...