-
PloS One 2023There is widespread agreement about the key role of hemoglobin for oxygen transport. Both observational and interventional studies have examined the relationship between... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
There is widespread agreement about the key role of hemoglobin for oxygen transport. Both observational and interventional studies have examined the relationship between hemoglobin levels and maximal oxygen uptake ([Formula: see text]) in humans. However, there exists considerable variability in the scientific literature regarding the potential relationship between hemoglobin and [Formula: see text]. Thus, we aimed to provide a comprehensive analysis of the diverse literature and examine the relationship between hemoglobin levels (hemoglobin concentration and mass) and [Formula: see text] (absolute and relative [Formula: see text]) among both observational and interventional studies.
METHODS
A systematic search was performed on December 6th, 2021. The study procedures and reporting of findings followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Article selection and data abstraction were performed in duplicate by two independent reviewers. Primary outcomes were hemoglobin levels and [Formula: see text] values (absolute and relative). For observational studies, meta-regression models were performed to examine the relationship between hemoglobin levels and [Formula: see text] values. For interventional studies, meta-analysis models were performed to determine the change in [Formula: see text] values (standard paired difference) associated with interventions designed to modify hemoglobin levels or [Formula: see text]. Meta-regression models were then performed to determine the relationship between a change in hemoglobin levels and the change in [Formula: see text] values.
RESULTS
Data from 384 studies (226 observational studies and 158 interventional studies) were examined. For observational data, there was a positive association between absolute [Formula: see text] and hemoglobin levels (hemoglobin concentration, hemoglobin mass, and hematocrit (P<0.001 for all)). Prespecified subgroup analyses demonstrated no apparent sex-related differences among these relationships. For interventional data, there was a positive association between the change of absolute [Formula: see text] (standard paired difference) and the change in hemoglobin levels (hemoglobin concentration (P<0.0001) and hemoglobin mass (P = 0.006)).
CONCLUSION
These findings suggest that [Formula: see text] values are closely associated with hemoglobin levels among both observational and interventional studies. Although our findings suggest a lack of sex differences in these relationships, there were limited studies incorporating females or stratifying results by biological sex.
Topics: Humans; Male; Female; Oxygen Consumption; Oxygen
PubMed: 37824583
DOI: 10.1371/journal.pone.0292835 -
PloS One 2023To determine the feasibility and effect of high-intensity interval training (HIIT) in individuals with Parkinson's and their effect on symptom modification and... (Meta-Analysis)
Meta-Analysis
Feasibility and effect of high-intensity training on the progression of motor symptoms in adult individuals with Parkinson's disease: A systematic review and meta-analysis.
BACKGROUND
To determine the feasibility and effect of high-intensity interval training (HIIT) in individuals with Parkinson's and their effect on symptom modification and progression.
METHODS
We conducted this systematic review following the Preferred Reporting Items for systematic review and meta-analysis (PRISMA). All studies were searched in seven databases: MEDLINE (PubMed), Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, SPORTDiscus, Virtual Health Library (VHL) and SCOPUS in September 2020 and updated in June 2023. The risk of bias was assessed by the Cochrane Collaboration tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. We used standardized mean difference (SMD) with a 95% confidence interval (CI) and random effects models, as well as the non-parametric Cochran's Q test and I2 inconsistency test to assess heterogeneity.
RESULTS
A total of 15 randomized clinical trials with 654 participants (mean age, 65.4 years). The majority of studies included high intensity training interventions versus moderate intensity, usual care, or control group. The meta-analysis comparing high-intensity exercise versus control group showed an improvement in the disease severity (MD = -4.80 [95%CI, -6.38; -3.21 high evidence certainty); maximum oxygen consumption (MD = 1.81 [95%CI, 0.36; 3.27] very low evidence certainty) and quality of life (MD = -0.54 [95%CI, -0.94; -0.13] moderate evidence certainty). The results showed that high-intensity exercise compared with moderate intensity exercise group showed a improve motor function and functional mobility measured by the TUG test (MD = -0.38 [95%CI, -0.91; 0.16] moderate evidence certainty) with moderate heterogeneity between studies.
CONCLUSION
High-intensity exercise performed in both continuous and interval modes when compared with control groups may provide motor function benefits for individuals with Parkinson's disease. HIIT may be feasible, but the intensity of the exercise may influence individuals with Parkinson's disease. However, there was a lack of evidence comparing high intensity and moderate intensity for this population, as the results showed heterogeneity.
Topics: Humans; Adult; Aged; Parkinson Disease; Quality of Life; Feasibility Studies; Exercise
PubMed: 37948405
DOI: 10.1371/journal.pone.0293357 -
Journal of Strength and Conditioning... Dec 2023Doma, K, Matoso, B, Protzen, G, Singh, U, and Boullosa, D. The repeated bout effect of multiarticular exercises on muscle damage markers and physical performances: a... (Meta-Analysis)
Meta-Analysis
Doma, K, Matoso, B, Protzen, G, Singh, U, and Boullosa, D. The repeated bout effect of multiarticular exercises on muscle damage markers and physical performances: a systematic review and meta-analyses. J Strength Cond Res 37(12): 2504-2515, 2023-This systematic review and meta-analysis compared muscle damage markers and physical performance measures between 2 bouts of multiarticular exercises and determined whether intensity and volume of muscle-damaging exercises affected the outcomes. The eligibility criteria consisted of (a) healthy male and female adults; (b) multiarticular exercises to cause muscle damage across 2 bouts; (c) outcome measures were compared at 24-48 hours after the first and second bouts of muscle-damaging exercise; (d) at least one of the following outcome measures: creatine kinase (CK), delayed onset of muscle soreness (DOMS), muscle strength, and running economy. Study appraisal was conducted using the Kmet tool, whereas forest plots were derived to calculate standardized mean differences (SMDs) and statistical significance and alpha set a 0.05. After screening, 20 studies were included. The levels of DOMS and CK were significantly greater during the first bout when compared with the second bout at T24 and T48 (p < 0.001; SMD = 0.51-1.23). Muscular strength and vertical jump performance were significantly lower during the first bout compared with the second bout at T24 and T48 (p ≤ 0.05; SMD = -0.27 to -0.40), whereas oxygen consumption and rating of perceived exertion were significantly greater during the first bout at T24 and T48 (p < 0.05; SMD = 0.28-0.65) during running economy protocols. The meta-analyses were unaffected by changes in intensity and volume of muscle-damaging exercises between bouts. Multiarticular exercises exhibited a repeated bout effect, suggesting that a single bout of commonly performed exercises involving eccentric contractions may provide protection against exercise-induced muscle damage for subsequent bouts.
Topics: Adult; Humans; Male; Female; Muscle, Skeletal; Exercise; Myalgia; Running; Creatine Kinase; Physical Functional Performance; Muscle Contraction
PubMed: 38015738
DOI: 10.1519/JSC.0000000000004628 -
Rheumatology (Oxford, England) Nov 2023JIA is the most common type of arthritis in children and adolescents, causing joint damage, chronic pain and disability. Deconditioning is also prevalent in patients... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
JIA is the most common type of arthritis in children and adolescents, causing joint damage, chronic pain and disability. Deconditioning is also prevalent in patients with JIA due to both inactivity and the disease progression, resulting in reduced cardiorespiratory fitness (CRF). We aimed to evaluate CRF of patients with JIA compared with healthy controls.
METHODS
This is a systematic review and meta-analysis of studies using cardiopulmonary exercise testing (CPET) to examine differences in determinants of CRF between patients with JIA vs healthy controls. The primary outcome was peak oxygen uptake (VO2peak). Literature search involved PubMed, Web of Science and Scopus databases, manual search of article references and grey literature. Quality assessment was undertaken with Newcastle-Ottawa Scale.
RESULTS
From 480 literature records initially retrieved, eight studies (538 participants) were included in final meta-analysis. VO2peak was significantly lower in patients with JIA compared with controls [weighted mean difference (WMD): -5.95 ml/kg/min (95% CI -9.26, -2.65)]. Exercise duration and VO2peak (% predicted) were found to be significantly impaired in patients with JIA compared with controls [standardized mean difference: -0.67 (95% CI -1.04, -0.29) and WMD: -11.31% (95% CI -20.09, -2.53), respectively], while no significant differences were found in maximum heart rate.
CONCLUSION
VO2peak and other CPET variables were lower in patients with JIA compared with controls, indicating reduced CRF in the former. Overall, exercise programs for patients with JIA should be promoted as part of their treatment to improve physical fitness and reduce muscle atrophy.
PROSPERO REGISTRATION
CRD42022380833.
Topics: Child; Adolescent; Humans; Exercise Test; Cardiorespiratory Fitness; Arthritis, Juvenile; Oxygen Consumption; Exercise
PubMed: 37280055
DOI: 10.1093/rheumatology/kead272 -
PloS One 2023High intensity interval training (HIIT) is considered as an alternative exercise modality to moderate intensity continuous training (MICT) for heart failure (HF)... (Meta-Analysis)
Meta-Analysis
Effects of high intensity interval training versus moderate intensity continuous training on exercise capacity and quality of life in patients with heart failure: A systematic review and meta-analysis.
INTRODUCTION AND AIMS
High intensity interval training (HIIT) is considered as an alternative exercise modality to moderate intensity continuous training (MICT) for heart failure (HF) patients. Yet a growing number of trials demonstrated inconsistent findings about the effectiveness of HIIT versus MICT until SMARTEX study and OptimEx-Clin study have made a consistent negative conclusion that HIIT was not superior to MICT. The aim of this study was to conduct a meta-analysis involving a subgroup analysis of total exercise time (TET) and disease categories of HF to investigate if TET could affect the superiority of HIIT when compared with MICT.
METHODS AND RESULTS
An electronic literature search of Pubmed, Embase, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov was performed for this review. 16 studies of 661 patients were finally pooled into quantitative synthesis. The weighted mean difference (WMD) and standard mean difference (SMD) with 95% confidence interval (CI) were calculated for quantitative synthesis of outcomes. HIIT was superior to MICT in improving peak oxygen consumption (Peak VO2) (WMD: 1.68 ml · kg-1 · min-1 95% CI: 0.81 to 2.55 n = 661). The subgroup analysis of TET showed that HIIT was superior to MICT in improving Peak VO2 in "short time" subgroup (WMD: 1.61 ml · kg-1 · min-1 95% CI: 0.45 to 2.77 n = 166) and in "medium time" subgroup (WMD: 1.74 ml · kg-1 · min-1 95% CI: 0.53 to 2.95 n = 420), and that there was no significant difference between HIIT and MICT in improving Peak VO2 in "long time" subgroup (WMD: 0.62 ml · kg-1 · min-1 95% CI: -1.34 to 2.58 n = 75).
CONCLUSIONS
The superiority of HIIT to MICT in improving Peak VO2 arose in a short to medium length of TET whereas it was effaced by an increment of TET. This "paradox" of TET on HIIT versus MICT might be due to the increasing poor adherence to target exercise intensity over time.
TRIAL REGISTRATION
PROSPERO registration number: CRD42022375076.
Topics: Humans; Quality of Life; High-Intensity Interval Training; Exercise Tolerance; Heart Failure; Electronics
PubMed: 37590312
DOI: 10.1371/journal.pone.0290362 -
Physical Therapy Nov 2023The purpose of this study was to systematically review and conduct a meta-analysis to examine the impact of comprehensive outpatient cardiac rehabilitation on exercise... (Meta-Analysis)
Meta-Analysis
Effects of Comprehensive Outpatient Cardiac Rehabilitation on Exercise Capacity, Functional Status, and Quality of Life in People With Heart Failure: A Systematic Review and Meta-Analysis.
PURPOSE
The purpose of this study was to systematically review and conduct a meta-analysis to examine the impact of comprehensive outpatient cardiac rehabilitation on exercise capacity, functional status, and quality of life in patients with heart failure.
METHODS
PubMed, Embase, and CINAHL were searched using keywords and MeSH terms on heart failure and cardiac rehabilitation. Randomized clinical trials published in English using outpatient exercise-based cardiac rehabilitation in patients with heart failure were included. The Grading of Recommendations Assessment, Development, and Evaluation was utilized for quality appraisal. Pooled estimates were computed using standardized mean differences (SMDs) and 95% CIs. Primary outcomes were functional status (6-minute walk distance, quality of life, exercise capacity using peak oxygen consumption, muscle strength, and endurance).
RESULTS
Eleven randomized controlled trials including 1523 participants ranging from 45 to 80 years old and an intervention duration ranging from 2 to 26 weeks were analyzed. Pooled results indicated significant improvements with comprehensive cardiac rehabilitation on 6-minute walk distance (SMD = 0.30; 95% CI = 0.06 to 0.54) and oxygen consumption (SMD = 0.23; 95% CI = 0.06 to 0.40). However, there was no additional benefit for the quality of life beyond that seen in the comparison groups.
CONCLUSION
Results of this study suggest that comprehensive outpatient cardiac rehabilitation is associated with significantly better clinical outcomes than single-component exercise programs in cardiac rehabilitation settings, multicomponent exercise in noncardiac rehabilitation settings, or no exercise.
IMPACT
Heart failure is significantly associated with an increased risk of poor exercise tolerance. Despite the proven benefit of cardiac rehabilitation on exercise tolerance and physical activities from individual randomized clinical trials, questions regarding its impact on clinical outcomes such as exercise capacity, functional status, and quality of life remain inadequate. This systematic review and meta-analysis provides strong evidence supporting comprehensive outpatient cardiac rehabilitation for improving clinical outcomes in heart failure.
Topics: Humans; Middle Aged; Aged; Aged, 80 and over; Quality of Life; Cardiac Rehabilitation; Exercise Tolerance; Outpatients; Functional Status; Heart Failure; Exercise Therapy
PubMed: 37658777
DOI: 10.1093/ptj/pzad119 -
PloS One 2023Exercise capacity should be determined in all patients undergoing lung resection for lung cancer surgery and cardiopulmonary exercise testing (CPET) remains the gold... (Meta-Analysis)
Meta-Analysis
The association between cardiopulmonary exercise testing and postoperative outcomes in patients with lung cancer undergoing lung resection surgery: A systematic review and meta-analysis.
BACKGROUND
Exercise capacity should be determined in all patients undergoing lung resection for lung cancer surgery and cardiopulmonary exercise testing (CPET) remains the gold standard. The purpose of this study was to investigate associations between preoperative CPET and postoperative outcomes in patients undergoing lung resection surgery for lung cancer through a review of the existing literature.
METHODS
A search was conducted on PubMed, Scopus, Cochrane Library and CINAHL from inception until December 2022. Studies investigating associations between preoperative CPET and postoperative outcomes were included. Risk of bias was assessed using the QUIPS tool. A random effect model meta-analysis was performed. I2 > 40% indicated a high level of heterogeneity.
RESULTS
Thirty-seven studies were included with 6450 patients. Twenty-eight studies had low risk of bias. [Formula: see text] peak is the oxygen consumption at peak exercise and serves as a marker of cardiopulmonary fitness. Higher estimates of [Formula: see text] peak, measured and as a percentagege of predicted, showed significant associations with a lower risk of mortality [MD: 3.66, 95% CI: 0.88; 6.43 and MD: 16.49, 95% CI: 6.92; 26.07] and fewer complications [MD: 2.06, 95% CI: 1.12; 3.00 and MD: 9.82, 95% CI: 5.88; 13.76]. Using a previously defined cutoff value of > 15mL/kg/min for [Formula: see text] peak, showed evidence of decreased odds of mortality [OR: 0.55, 95% CI: 0.28-0.81] and but not decreased odds of postoperative morbidity [OR: 0.82, 95% CI: 0.64-1.00]. There was no relationship between [Formula: see text] slope, which depicts ventilatory efficiency, with mortality [MD: -9.60, 95% CI: -27.74; 8.54] however, patients without postoperative complications had a lower preoperative [Formula: see text] [MD: -2.36, 95% CI: -3.01; -1.71]. Exercise load and anaerobic threshold did not correlate with morbidity or mortality. There was significant heterogeneity between studies.
CONCLUSIONS
Estimates of cardiopulmonary fitness as evidenced by higher [Formula: see text] peak, measured and as a percentage of predicted, were associated with decreased morbidity and mortality. A cutoff value of [Formula: see text] peak > 15mL/kg/min was consistent with improved survival but not with fewer complications. Ventilatory efficiency was associated with decreased postoperative morbidity but not with improved survival. The heterogeneity in literature could be remedied with large scale, prospective, blinded, standardised research to improve preoperative risk stratification in patients with lung cancer scheduled for lung resection surgery.
Topics: Humans; Exercise Test; Lung Neoplasms; Prospective Studies; Oxygen Consumption; Lung
PubMed: 38060569
DOI: 10.1371/journal.pone.0295430 -
ESC Heart Failure Aug 2023The clinical value of cardiopulmonary exercise testing (CPET) in cardiac amyloidosis (CA) is uncertain. Due to the growing prevalence of the disease and the current... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The clinical value of cardiopulmonary exercise testing (CPET) in cardiac amyloidosis (CA) is uncertain. Due to the growing prevalence of the disease and the current availability of disease-modifying drugs, prognostic stratification is becoming fundamental to optimizing the cost-effectiveness of treatment, patient phenotyping, follow-up, and management. Peak VO and VE/VCO slope are currently the most studied CPET variables in clinical settings, and both demonstrate substantial, independent prognostic value in several cardiovascular diseases. We aim to study the association of peak VO and VE/VCO slope with prognosis in patients with CA.
METHODS AND RESULTS
We performed a systematic review and searched for clinical studies performing CPET for prognostication in patients with transthyretin-CA and light-chain-CA. Studies reporting hazard ratio (HR) for mortality and peak VO or VE/VCO slope were further selected for quantitative analysis. HRs were pooled using a random-effect model. Five studies were selected for qualitative and three for quantitative analysis. A total of 233 patients were included in the meta-analysis. Mean peak VO resulted consistently depressed, and VE/VCO slope was increased. Our pooled analysis showed peak VO (pooled HR 0.89, 95% CI 0.84-0.94) and VE/VCO slope (pooled HR 1.04, 95% CI 1.01-1.07) were significantly associated with the risk of death in CA patients, with no significant statistical heterogeneity for both analyses.
CONCLUSIONS
CPET is a valuable tool for prognostic stratification in CA, identifying patients at increased risk of death. Large prospective clinical trials are needed to confirm this exploratory finding.
Topics: Humans; Exercise Test; Prospective Studies; Oxygen Consumption; Prognosis; Amyloidosis; Cardiomyopathies
PubMed: 37264762
DOI: 10.1002/ehf2.14406 -
Sports Medicine (Auckland, N.Z.) Aug 2023Repeated-sprint training (RST) involves maximal-effort, short-duration sprints (≤ 10 s) interspersed with brief recovery periods (≤ 60 s). Knowledge about the... (Meta-Analysis)
Meta-Analysis
The Acute Demands of Repeated-Sprint Training on Physiological, Neuromuscular, Perceptual and Performance Outcomes in Team Sport Athletes: A Systematic Review and Meta-analysis.
BACKGROUND
Repeated-sprint training (RST) involves maximal-effort, short-duration sprints (≤ 10 s) interspersed with brief recovery periods (≤ 60 s). Knowledge about the acute demands of RST and the influence of programming variables has implications for training prescription.
OBJECTIVES
To investigate the physiological, neuromuscular, perceptual and performance demands of RST, while also examining the moderating effects of programming variables (sprint modality, number of repetitions per set, sprint repetition distance, inter-repetition rest modality and inter-repetition rest duration) on these outcomes.
METHODS
The databases Pubmed, SPORTDiscus, MEDLINE and Scopus were searched for original research articles investigating overground running RST in team sport athletes ≥ 16 years. Eligible data were analysed using multi-level mixed effects meta-analysis, with meta-regression performed on outcomes with ~ 50 samples (10 per moderator) to examine the influence of programming factors. Effects were evaluated based on coverage of their confidence (compatibility) limits (CL) against elected thresholds of practical importance.
RESULTS
From 908 data samples nested within 176 studies eligible for meta-analysis, the pooled effects (± 90% CL) of RST were as follows: average heart rate (HR) of 163 ± 9 bpm, peak heart rate (HR) of 182 ± 3 bpm, average oxygen consumption of 42.4 ± 10.1 mL·kg·min, end-set blood lactate concentration (B[La]) of 10.7 ± 0.6 mmol·L, deciMax session ratings of perceived exertion (sRPE) of 6.5 ± 0.5 au, average sprint time (S) of 5.57 ± 0.26 s, best sprint time (S) of 5.52 ± 0.27 s and percentage sprint decrement (S) of 5.0 ± 0.3%. When compared with a reference protocol of 6 × 30 m straight-line sprints with 20 s passive inter-repetition rest, shuttle-based sprints were associated with a substantial increase in repetition time (S: 1.42 ± 0.11 s, S: 1.55 ± 0.13 s), whereas the effect on sRPE was trivial (0.6 ± 0.9 au). Performing two more repetitions per set had a trivial effect on HR (0.8 ± 1.0 bpm), B[La] (0.3 ± 0.2 mmol·L), sRPE (0.2 ± 0.2 au), S (0.01 ± 0.03) and S (0.4; ± 0.2%). Sprinting 10 m further per repetition was associated with a substantial increase in B[La] (2.7; ± 0.7 mmol·L) and S (1.7 ± 0.4%), whereas the effect on sRPE was trivial (0.7 ± 0.6). Resting for 10 s longer between repetitions was associated with a substantial reduction in B[La] (-1.1 ± 0.5 mmol·L), S (-0.09 ± 0.06 s) and S (-1.4 ± 0.4%), while the effects on HR (-0.7 ± 1.8 bpm) and sRPE (-0.5 ± 0.5 au) were trivial. All other moderating effects were compatible with both trivial and substantial effects [i.e. equal coverage of the confidence interval (CI) across a trivial and a substantial region in only one direction], or inconclusive (i.e. the CI spanned across substantial and trivial regions in both positive and negative directions).
CONCLUSIONS
The physiological, neuromuscular, perceptual and performance demands of RST are substantial, with some of these outcomes moderated by the manipulation of programming variables. To amplify physiological demands and performance decrement, longer sprint distances (> 30 m) and shorter, inter-repetition rest (≤ 20 s) are recommended. Alternatively, to mitigate fatigue and enhance acute sprint performance, shorter sprint distances (e.g. 15-25 m) with longer, passive inter-repetition rest (≥ 30 s) are recommended.
Topics: Humans; Team Sports; Running; Fatigue; Athletes; Lactic Acid; Athletic Performance
PubMed: 37222864
DOI: 10.1007/s40279-023-01853-w -
Frontiers in Physiology 2023This study aimed to compare and rank the effect of hypoxic practices on maximum oxygen consumption (VOmax) in athletes and determine the hypoxic dose-response... (Review)
Review
This study aimed to compare and rank the effect of hypoxic practices on maximum oxygen consumption (VOmax) in athletes and determine the hypoxic dose-response correlation using network meta-analysis. The Web of Science, PubMed, EMBASE, and EBSCO databases were systematically search for randomized controlled trials on the effect of hypoxc interventions on the VOmax of athletes published from inception until 21 February 2023. Studies that used live-high train-high (LHTH), live-high train-low (LHTL), live-high, train-high/low (HHL), intermittent hypoxic training (IHT), and intermittent hypoxic exposure (IHE) interventions were primarily included. LHTL was further defined according to the type of hypoxic environment (natural and simulated) and the altitude of the training site (low altitude and sea level). A meta-analysis was conducted to determine the standardized mean difference between the effects of various hypoxic interventions on VOmax and dose-response correlation. Furthermore, the hypoxic dosage of the different interventions were coordinated using the "kilometer hour" model. From 2,072 originally identified titles, 59 studies were finally included in this study. After data pooling, LHTL, LHTH, and IHT outperformed normoxic training in improving the VOmax of athletes. According to the P-scores, LHTL combined with low altitude training was the most effective intervention for improving VOmax (natural: 0.92 and simulated: 0.86) and was better than LHTL combined with sea level training (0.56). A reasonable hypoxic dose range for LHTH (470-1,130 kmh) and HL (500-1,415 kmh) was reported with an inverted U-shaped curve relationship. Different types of hypoxic training compared with normoxic training serve as significant approaches for improving aerobic capacity in athletes. Regardless of the type of hypoxic training and the residential condition, LHTL with low altitude training was the most effective intervention. The characteristics of the dose-effect correlation of LHTH and LHTL may be associated with the negative effects of chronic hypoxia.
PubMed: 37745240
DOI: 10.3389/fphys.2023.1223037