高原运动对认知功能的影响

doi:10.3724/SP.J.1042.2024.00800

摘要/Abstract

摘要： 高原地区低压低氧的环境特点, 会给机体生理功能带来挑战, 对认知表现产生影响。有氧运动能够增加神经可塑性, 改善认知功能, 但能否适用于高原环境, 受认知任务类型、海拔高度、运动强度和暴露类型等因素的调节。目前用于解释高原运动影响认知表现涉及的因素包括: 脑氧合、神经营养因子、氧化应激与神经免疫。未来研究应关注不同运动类型和运动强度对高原移、世居人群的影响, 并采用神经生理手段进一步探究高原运动对认知功能的影响机制, 为开具“高原运动处方”提供依据。

关键词: 高原, 高原运动, 认知功能, 调节因素, 作用机制

Abstract: High-altitude (HA) environments are characterized by significant hypobaric hypoxia, and are both physiologically challenging and frequently associated with cognitive impairment. Conversely, aerobic exercise is documented to enhance cognitive function by the promotion of neural plasticity and improvement in brain functioning, thus enhancing overall cognitive performance. However, it is not clear whether the positive effects of exercise on cognition extend to the complex conditions associated with HA environments. Furthermore, the potential modulation of these effects by the type of cognitive task, exercise duration and intensity, and different altitudes and exposure types (real HA environment vs. simulated HA condition; acute exposure vs. long-term exposure) warrants further investigation.
This comprehensive review explores the influence of aerobic exercise on cognitive performance under conditions of both acute and long-term HA exposure. It is proposed that factors, such as hypoxia dose, specific cognitive function, exercise intensity, and type of exposure, modulate the interactive effects of HA hypoxia and exercise on cognitive function. The potential physiological mechanisms are also discussed, suggesting that changes in cerebral oxygenation, levels of neurotrophic factors, oxidative stress, and neuro-immunity may account for the combined effects of HA hypoxia and exercise on cognitive performance.
The findings indicate that HA exercise has a positive influence on psychomotor abilities, attention, working memory, and inhibitory control, and that these effects are modulated by the type of exposure, hypoxia dose, and exercise intensity. Specifically, while exercise may enhance cognitive performance under conditions of acute hypoxia exposure, positive effects during chronic HA exposure require adaptation to the hypoxic conditions of HA environments. While exercise influences cognitive function positively under low levels of hypoxia, it has little effect or even adverse effects on cognitive function when the hypoxia level is high. Furthermore, the intensity of exercise has a variable influence on cognitive function under HA conditions, seen in an inverted U-shaped relationship between exercise intensity and cognitive performance in acute HA exposure conditions, where moderate intensity maximizes cognitive performance. Both moderate and high exercise intensities under conditions of long-term HA exposure positively affect executive control, although the latter can lead to a reduction in aerobic exercise capacity.
Although HA exercise can improve cognitive function by upregulating the expression of neurotrophic factors, it may also reduce brain oxygenation and thus contribute to oxidative stress and neuroimmune responses that could adversely affect cognitive function. Increased expression of BDNF induced by hypoxic exercise can ensure adequate neuronal capacity and improve cognitive function. Nevertheless, exercise undertaken under acute HA exposure could reduce both blood and brain oxygen saturation, potentially impairing cognitive function. Moreover, high intensity exercise can intensify the levels of oxidative stress, disrupting the redox balance, and triggering an inflammatory response affecting the immune activity in the central nervous system and thus influencing cognitive performance.
Although this review provides substantial evidence of the relationship between HA exercise and cognitive performance, several controversial issues, contradictory conclusions, and unexplored topics remain. To formulate a specific "HA exercise prescription" for mitigating cognitive impairment under HA conditions, several directions for future research are proposed. These are 1) further clarification of the modulating effects of exposure type, hypoxia dose and exercise intensity, 2) consideration of demographic factors such as sex and age, 3) the application of advanced scientific techniques to explore the underlying neurological and molecular mechanisms, and 4) investigation of the effects of aerobic exercise on cognitive function in patients with chronic mountain sickness.
In conclusion, this review discusses the effects of HA exercise on different cognitive functions, summarizes the moderating variables and potential physiological mechanisms, and offers future perspectives. As the influx of individuals to HA areas for various purposes rises, addressing the adverse effects of HA on cognitive function has become crucial. This review indicates the significance of understanding the potential effects of HA exercise on cognitive function and provides insights into future research directions for the effective prevention of cognitive impairment.

Key words: high altitudes, high-alitude exercise, cognitive function, moderator, mechanisms

苏瑞, 王成志, 李昊, 马海林, 苏彦捷. (2024). 高原运动对认知功能的影响. 心理科学进展 , 32(5), 800-812.

SU Rui, WANG Chengzhi, LI Hao, MA Hailin, SU Yanjie. (2024). The effect of high-altitude exercise on cognitive function. Advances in Psychological Science, 32(5), 800-812.

参考文献

[1] 安心, 马海林, 韩布新, 刘冰, 王妍.(2017). 高海拔驻留时间对注意网络的影响. 中国临床心理学杂志, 25(3), 502-506. https://doi.org/10.16128/j.cnki.1005-3611.2017.03.023
[2] 毕存箭. (2021). 高海拔地区藏族儿童青少年心肺耐力和执行功能的关系及其运动干预研究 (博士学位论文). 华东师范大学, 上海. https://doi.org/10.27149/d.cnki.ghdsu.2021.002854
[3] 陈爱国, 殷恒婵, 颜军, 杨钰. (2011). 不同强度短时有氧运动对执行功能的影响.心理学报, 43(9), 1055-1062.
[4] 马海林, 党鹏, 苏瑞, 李昊.(2022). 高海拔暴露时间对工作记忆的影响——一项追踪研究. 高原科学研究, 6(2), 42-50. https://doi.org/10.16249/j.cnki.2096-4617.2022.02.005
[5] 马强, 侯会生, 李佳鑫. (2020). 高海拔环境中短时有氧运动与大学生执行功能的实验研究.中央民族大学学报(自然科学版), 29(1), 81-86.
[6] 钱令嘉. (2011). 关于应激与认知的思考. 军事医学, 35(9), 658-662. https://doi.org/10.3969/j.issn.1674-9960.2011.09.006
[7] 王成志. (2023). 不同强度有氧运动对高原移居者注意功能的影响 (硕士学位论文). 西藏大学, 拉萨.
[8] 张斌, 刘莹.(2019). 急性有氧运动对认知表现的影响. 心理科学进展, 27(6), 1058-1071. https://doi.org/10.3724/SP.J.1042.2019.01058
[9] Aboouf M. A., Thiersch M., Soliz J., Gassmann M., & Schneider Gasser, E. M. (2023). The brain at high altitude: From molecular signaling to cognitive performance. International Journal of Molecular Sciences, 24(12), 10179. https://doi.org/10.3390/IJMS241210179
[10] Ando S., Hatamoto Y., Sudo M., Kiyonaga A., Tanaka H., & Higaki Y. (2013). The effects of exercise under hypoxia on cognitive function. PloS One, 8(5), e63630. https://doi.org/10.1371/journal.pone.0063630
[11] Ando S., Komiyama T., Sudo M., Higaki Y., Ishida K., Costello J. T., & Katayama K. (2020). The interactive effects of acute exercise and hypoxia on cognitive performance: A narrative review. Scandinavian Journal of Medicine & Science in Sports, 30(3), 384-398. https://doi.org/10.1111/sms.13573
[12] Ando S., Yamada Y., & Kokubu M. (2010). Reaction time to peripheral visual stimuli during exercise under hypoxia. Journal of Applied Physiology, 108(5), 1210-1216. https://doi.org/10.1152/japplphysiol.01115.2009
[13] Attwell D., Buchan A. M., Charpak S., Lauritzen M., MacVicar B. A., & Newman E. A. (2010). Glial and neuronal control of brain blood flow. Nature, 468(7321), 232-243. https://doi.org/10.1038/nature09613
[14] Bayer U., Likar R., Pinter G., Stettner H., Demschar S., Trummer B., .. Burtscher M. (2017). Intermittent hypoxic-hyperoxic training on cognitive performance in geriatric patients. Alzheimer's & Dementia: Translational Research & Clinical Interventions, 3(1), 114-122. https://doi.org/10.1016/j.trci.2017.01.002
[15] Becke A., Müller P., Dordevic M., Lessmann V., Brigadski T.,& Müller, N. G.(2018). Daily intermittent normobaric hypoxia over 2 weeks reduces BDNF plasma levels in young adults - A randomized controlled feasibility study. Frontiers in Physiology, 9, 1337-1337. https://doi.org/10.3389/fphys.2018.01337
[16] Bigham, A. W., & Lee, F. S. (2014). Human high-altitude adaptation: Forward genetics meets the hif pathway. Genes & Development, 28(20), 2189-2204. 2014). Human high-altitude adaptation: Forward genetics meets the hif pathway. Genes & Development, 28(20), 2189-2204. http://www.genesdev.org/cgi/doi/10.1101/gad.250167.114
[17] Bliemsrieder K., Weiss E. M., Fischer R., Brugger H., Sperner-Unterweger B., & Hüfner K. (2022). Cognition and neuropsychological changes at altitude—A systematic review of literature. Brain Sciences, 12(12), 1736. https://doi.org/10.3390/brainsci12121736
[18] Bolmont B., Thullier F., & Abraini J. H. (2000). Relationships between mood states and performances in reaction time, psychomotor ability, and mental efficiency during a 31-day gradual decompression in a hypobaric chamber from sea level to 8848 m equivalent altitude. Physiology & Behavior, 71(5), 469-476. https://doi.org/10.1016/S0031-9384(00)00362-0
[19] Bouak F., Vartanian O., Hofer K., & Cheung B. (2018). Acute mild hypoxic hypoxia effects on cognitive and simulated aircraft pilot performance. Aerospace Medicine and Human Performance, 89(6), 526-535. https://doi.org/10.3357/AMHP.5022.2018
[20] Castellani G., Croese T., Peralta Ramos J. M., & Schwartz M. (2023). Transforming the understanding of brain immunity. Science, 380(6640), 7649-7649. https://doi.org/10.1126/science.abo7649
[21] Chang Y. K., Labban J. D., Gapin J. I.,& Etnier, J. L.(2012). The effects of acute exercise on cognitive performance: A meta-analysis. Brain Research, 1453, 87-101. https://doi.org/10.1016/j.brainres.2012.02.068
[22] de Aquino-Lemos, V., Santos, R. V. T., Antunes, H. K. M., Lira, F. S., Luz Bittar, I. G., Caris, A. V., Tufik, S., & de Mello, M. T.(2016). Acute physical exercise under hypoxia improves sleep, mood and reaction time. Physiology & Behavior, 154, 90-99. https://doi.org/10.1016/j.physbeh.2015.10.028
[23] Dobashi S., Horiuchi M., Endo J., Kiuchi M.,& Koyama, K.(2016). Cognitive function and cerebral oxygenation during prolonged exercise under hypoxia in healthy young males. High Altitude Medicine & Biology, 172016.0036
[24] Dosek A., Ohno H., Acs Z., Taylor A. W., & Radak Z. (2007). High altitude and oxidative stress. Respiratory Physiology & Neurobiology, 158(2-3), 128-131. https://doi.org/10.1016/j.resp.2007.03.013
[25] Dykiert D., Hall D., van Gemeren N., Benson R., Der G., Starr J. M., & Deary I. J. (2010). The effects of high altitude on choice reaction time mean and intra-individual variability: Results of the Edinburgh altitude research expedition of 2008. Neuropsychology, 24(3), 391-401. https://doi.org/10.1037/a0018502
[26] Enette L., Vogel T., Fanon J. L., & Lang P. O. (2017). Effect of interval and continuous aerobic training on basal serum and plasma brain-derived neurotrophic factor values in seniors: A systematic review of intervention studies. Rejuvenation Research, 20(6), 473-483. https://doi.org/10.1089/rej.2016.1886
[27] Hackett, P. H., & Roach, R. C. (2001). High-altitude illness. The New England Journal of Medicine, 345(2), 107-114. https://doi.org/10.1056/NEJM200107123450206
[28] Helan M., Aravamudan B., Hartman W. R., Thompson M. A., Johnson B. D., Pabelick C. M., & Prakash Y. S. (2014). BDNF secretion by human pulmonary artery endothelial cells in response to hypoxia. Journal of Molecular and Cellular Cardiology, 68, 89-97. https://doi.org/10.1016/j.yjmcc.2014.01.006
[29] Hornbein T. F., Townes B. D., Schoene R. B., Sutton J. R., & Houston C. S. (1989). The cost to the central nervous system of climbing to extremely high altitude. The New England Journal of Medicine, 321(25), 1714-1719. https://doi.org/10.1056/NEJM198912213212505
[30] Jansen G. F., Krins A., Basnyat B., Odoom J. A., & Ince C. (2007). Role of the altitude level on cerebral autoregulation in residents at high altitude. Journal of Applied Physiology, 103(2), 518-523. https://doi.org/10.1152/japplphysiol.01429.2006
[31] Joanny P., Steinberg J., Robach P., Richalet J. P., Gortan C., Gardette B., & Jammes Y. (2001). Operation everest III (comex'97): The effect of simulated severe hypobaric hypoxia on lipid peroxidation and antioxidant defence systems in human blood at rest and after maximal exercise. Resuscitation, 49(3), 307-314. https://doi.org/10.1016/S0300-9572(00)00373-7
[32] Jung M., Zou L., Yu J. J., Ryu S., Kong Z. W., Yang L.,… Loprinzi, P. D.(2020). Does exercise have a protective effect on cognitive function under hypoxia? A systematic review with meta-analysis. Journal of Sport and Health Science, 92020.04.004
[33] Kim C., Ryan E. J., Seo Y., Peacock C., Gunstad J., Muller M. D., Ridgel A. L.,& Glickman, E. L.(2015). Low intensity exercise does not impact cognitive function during exposure to normobaric hypoxia. Physiology & Behavior, 151, 24-28. https://doi.org/10.1016/j.physbeh.2015.07.003
[34] Kitaoka Y., Hoshino D., & Hatta H. (2012). Monocarboxylate transporter and lactate metabolism. The Journal of Physical Fitness and Sports Medicine, 1(2), 247-252. https://doi.org/10.7600/jpfsm.1.247
[35] Komiyama T., Katayama K., Sudo M., Ishida K., Higaki Y., & Ando S. (2017). Cognitive function during exercise under severe hypoxia. Scientific Reports, 7(1), 10000. https://doi.org/10.1038/s41598-017-10332-y
[36] Komiyama T., Sudo M., Higaki Y., Kiyonaga A., Tanaka H.,& Ando, S.(2015). Does moderate hypoxia alter working memory and executive function during prolonged exercise? Physiology & Behavior, 139, 290-296. https://doi.org/10.1016/j.physbeh.2014.11.057
[37] Krzeszowiak J., Zawadzki M., Markiewicz-Górka I., Kawalec A., & Pawlas K. (2014). The influence of 9-day trekking in the alps on the level of oxidative stress parameters and blood parameters in native lowlanders. Annals of Agricultural and Environmental Medicine, 21(3), 585-589. https://doi.org/10.5604/12321966.1120607
[38] Lambourne K.,& Tomporowski, P.(2010). The effect of exercise-induced arousal on cognitive task performance: A meta-regression analysis. Brain Research, 1341, 12-24. https://doi.org/10.1016/j.brainres.2010.03.091
[39] Lefferts W. K., Babcock M. C., Tiss M. J., Ives S. J., White C. N., Brutsaert T. D.,& Heffernan, K. S.(2016). Effect of hypoxia on cerebrovascular and cognitive function during moderate intensity exercise. Physiology & Behavior, 165, 108-118. https://doi.org/10.1016/j.physbeh.2016.07.003
[40] Li, Y., & Wang, Y. (2022). Effects of long-term exposure to high altitude hypoxia on cognitive function and its mechanism: A narrative review. Brain Sciences, 12(6), 808. https://doi.org/10.3390/brainsci12060808
[41] Li Y., Wang Y., Yu F., & Chen A. (2021). Large‐scale reconfiguration of connectivity patterns among attentional networks during context-dependent adjustment of cognitive control. Human Brain Mapping, 42(12), 3821-3832. https://doi.org/10.1002/hbm.25467
[42] Ludyga S., Gerber M., Pühse U., Looser V. N., & Kamijo K. (2020). Systematic review and meta-analysis investigating moderators of long-term effects of exercise on cognition in healthy individuals. Nature Human Behaviour, 4(6), 603-612. https://doi.org/10.1038/s41562-020-0851-8
[43] Luks, A. M., & Hackett, P. H. (2022). Medical conditions and high-altitude travel. The New England Journal of Medicine, 386(4), 364-373. https://doi.org/10.1056/NEJMra2104829
[44] Ma H., Huang X., Liu M., Ma H., & Zhang D. (2018). Aging of stimulus-driven and goal-directed attentional processes in young immigrants with long-term high altitude exposure in Tibet: An ERP study. Scientific Reports, 8(1), 17417. https://doi.org/10.1038/s41598-018-34706-y
[45] Mancini A., Bellingacci L., Canonichesi J., & Di Filippo, M. (2023). Immunity and cognition. In N. Rezaei, & N. Yazdanpanah (Eds). Translational neuroimmunology, (Volume 7, pp.129-149). Academic Press. https://doi.org/10.1016/B978-0-323-85841-0.00017-1
[46] McMorris T., Hale B. J., Barwood M., Costello J., & Corbett J. (2017). Effect of acute hypoxia on cognition: A systematic review and meta-regression analysis. Neuroscience and Biobehavioral Reviews, 74(Pt A), 225-232. https://doi.org/10.1016/j.neubiorev.2017.01.019
[47] Medawar, P. (1961). Immunological Tolerance.Nature, 189, 14-17. https://doi.org/10.1038/189014a0
[48] Millet G. P., Faiss R., & Pialoux V. (2012). Point: Counterpoint: Hypobaric hypoxia induces/does not induce different responses from normobaric hypoxia. Journal of Applied Physiology(1985), 112org/10.1152/japplphysiol.00067.2012
[49] Miller L. E., McGinnis G. R., Kliszczewicz B., Slivka D., Hailes W., Cuddy J., .. Quindry J. C. (2013). Blood oxidative-stress markers during a high-altitude trek. International Journal of Sport Nutrition and Exercise Metabolism, 23(1), 65-72. https://doi.org/10.1123/ijsnem.23.1.65
[50] Milusheva E. A., Doda M., Baranyi M., & Vizi E. S. (1996). Effect of hypoxia and glucose deprivation on ATP level, adenylate energy charge and [ca2+] o-dependent and independent release of [3H] dopamine in rat striatal slices. Neurochemistry International, 28(5-6), 501-507. https://doi.org/10.1016/0197-0186(95)00129-8
[51] Moreau, D., & Chou, E. (2019). The acute effect of high-intensity exercise on executive function: A meta- analysis. Perspectives on Psychological Science, 14(5), 734-764. https://doi.org/10.1177/1745691619850568
[52] Northey J. M., Cherbuin N., Pumpa K. L., Smee D. J., & Rattray B. (2018). Exercise interventions for cognitive function in adults older than 50: A systematic review with meta-analysis. British Journal of Sports Medicine, 52(3), 154-160. https://doi.org/10.1136/bjsports-2016-096587
[53] Nybo, L., & Rasmussen, P. (2007). Inadequate cerebral oxygen delivery and central fatigue during strenuous exercise. Exercise and Sport Sciences Reviews, 35(3), 110-118. https://doi.org/10.1097/jes.0b013e3180a031ec
[54] Ochi G., Yamada Y., Hyodo K., Suwabe K., Fukuie T., Byun K., Dan I.,& Soya, H.(2018). Neural basis for reduced executive performance with hypoxic exercise. NeuroImage, 171, 75-83. https://doi.org/10.1016/j.neuroimage.2017.12.091
[55] Peltonen J. E., Paterson D. H., Shoemaker J. K.,DeLorey, D. S., duManoir, G. R., Petrella, R. J., & Kowalchuk, J. M.(2009). Cerebral and muscle deoxygenation, hypoxic ventilatory chemosensitivity and cerebrovascular responsiveness during incremental exercise. Respiratory Physiology & Neurobiology, 169 2009.08.013
[56] Quindry J., Dumke C., Slivka D., & Ruby B. (2016). Impact of extreme exercise at high altitude on oxidative stress in humans. The Journal of Physiology, 594(18), 5093-5104. https://doi.org/10.1113/JP270651
[57] Raichle M. E.(2010). Two views of brain function. Trends in Cognitive Sciences, 14(4), 180-190. https://doi.org/10.1016/j.tics.2010.01.008
[58] Regard M., Oelz O., Brugger P., & Landis T. (1989). Persistent cognitive impairment in climbers after repeated exposure to extreme altitude. Neurology, 39(2), 210. https://doi.org/10.1212/WNL.39.2.210
[59] Robinet C.,& Pellerin, L.(2010). Brain-derived neurotrophic factor enhances the expression of the monocarboxylate transporter 2 through translational activation in mouse cultured cortical neurons. Journal of Cerebral Blood Flow and Metabolism, 302009.208
[60] Schega L., Peter B., Brigadski T., Leßmann V., Isermann B., Hamacher D.,& Törpel, A.(2016). Effect of intermittent normobaric hypoxia on aerobic capacity and cognitive function in older people. Journal of Science and Medicine in Sport, 192016.02.012
[61] Shannon O. M., Duckworth L., Barlow M. J., Deighton K., Matu J., Williams E. L., .. O'Hara, J. P.(2017). Effects of dietary nitrate supplementation on physiological responses, cognitive function, and exercise performance at moderate and very-high simulated altitude. Frontiers in Physiology, 8, 401-401. https://doi.org/10.3389/fphys.2017.00401
[62] Simonson T. S., Yang Y., Huff C. D., Yun H., Qin G., Witherspoon D. J., .. Ge R. (2010). Genetic evidence for high-altitude adaptation in Tibet. Science, 329(5987), 72-75. https://doi.org/10.1126/science.1189406
[63] Sinha S., Ray U. S., Saha M., Singh S. N., & Tomar O. S. (2009). Antioxidant and redox status after maximal aerobic exercise at high altitude in acclimatized lowlanders and native highlanders. European Journal of Applied Physiology, 106, 807-814. https://doi.org/10.1007/s00421-009-1082-x
[64] Sorond F. A., Hurwitz S., Salat D. H., Greve D. N., & Fisher, N. D. L. (2013). Neurovascular coupling, cerebral white matter integrity, and response to cocoa in older people. Neurology, 81(10), 904-909. https://doi.org/10.1212/WNL.0b013e3182a351aa
[65] Steele A. R., Tymko M. M., Meah V. L., Simpson L. L., Gasho C., Dawkins T. G., .. Steinback C. D. (2021). Global REACH 2018: Volume regulation in high-altitude andeans with and without chronic mountain sickness. American Journal of Physiology- Regulatory, Integrative and Comparative Physiology, 321(3), 504-512. https://doi.org/10.1152/ajpregu.00102.2021
[66] Stillman C. M.,Esteban-Cornejo, I., Brown, B., Bender, C. M., & Erickson, K. I.(2020). Effects of exercise on brain and cognition across age groups and health states. Trends in Neurosciences, 432020.04.010
[67] Su R., Wang C., Liu W., Han C., Fan J., Ma H., .. Zhang, D.(2022). Intensity-dependent acute aerobic exercise: Effect on reactive control of attentional functions in acclimatized lowlanders at high altitude. Physiology & Behavior, 250, 113785. https://doi.org/10.1016/j.physbeh.2022.113785
[68] Subudhi A. W., Dimmen A. C., & Roach R. C. (2007). Effects of acute hypoxia on cerebral and muscle oxygenation during incremental exercise. Journal of Applied Physiology, 103(1), 177-183. https://doi.org/10.1152/japplphysiol.01460.2006
[69] Sun S., Loprinzi P. D., Guan H., Zou L., Kong Z., Hu Y., Shi Q., & Nie J. (2019). The effects of high-intensity interval exercise and hypoxia on cognition in sedentary young adults. Medicina (Kaunas, Lithuania), 55(2), 43. https://doi.org/10.3390/medicina55020043
[70] Sweller, J. (2016). Working memory, long-term memory, and instructional design. Journal of Applied Research in Memory and Cognition, 5(4), 360-367. https://doi.org/10.1016/j.jarmac.2015.12.002
[71] Taylor L., Watkins S. L., Marshall H., Dascombe B. J.,& Foster, J.(2016). The impact of different environmental conditions on cognitive function: A focused review. Frontiers in Physiology, 6, 372-372. https://doi.org/10.3389/fphys.2015.00372
[72] Vermehren-Schmaedick,A., Jenkins, V. K., Knopp, S. J., Balkowiec, A., & Bissonnette, J. M.(2012). Acute intermittent hypoxia-induced expression of brain-derived neurotrophic factor is disrupted in the brainstem of methyl-CpG-binding protein 2 null mice. Neuroscience, 206, 1-6. https://doi.org/10.1016/j.neuroscience.2012.01.017
[73] Vij A. G., Dutta R.,& Satija, N. K.(2005). Acclimatization to oxidative stress at high altitude. High Altitude Medicine & Biology, 6 2005.6.301
[74] Villafuerte F. C.,& Corante, N.(2016). Chronic mountain sickness: Clinical aspects, etiology, management, and treatment. High Altitude Medicine & Biology, 172016.0031
[75] Villafuerte F. C., Cardenas R., & Monge-C C. (2004). Optimal hemoglobin concentration and high altitude: A theoretical approach for andean men at rest. Journal of Applied Physiology, 96(5), 1581-1588. https://doi.org/10.1152/japplphysiol.00328.2003
[76] Virués-Ortega J., Garrido E., Javierre C., & Kloezeman K. C. (2006). Human behaviour and development under high-altitude conditions. Developmental Science, 9(4), 400-410. https://doi.org/10.1111/j.1467-7687.2006.00505.x
[77] Walsh J. J., Drouin P. J., King T. J.,D'Urzo, K. A., Tschakovsky, M. E., Cheung, S. S., & Day, T. A.(2020). Acute aerobic exercise impairs aspects of cognitive function at high altitude. Physiology & Behavior, 223, 112979-112979. https://doi.org/10.1016/j.physbeh.2020.112979
[78] Wang N. N., Yu S. F., Dang P., Hu Q. L., Su R., Li H., .. Zhang, D. L.(2023). Association between the acceleration of access to visual awareness of grating orientation with higher heart rate at high-altitude. Physiology & Behavior, 268, 114235. https://doi.org/10.1016/j.physbeh.2023.114235
[79] Welford, A. T. (1984). Psychomotor performance.Annual Review of Gerontology and Geriatrics, 4(1), 237-273.
[80] West, J. B. (1984). Human physiology at extreme altitudes on mount everest. Science, 223(4638), 784-788. https://doi.org/10.1126/science.6364351
[81] Wu T.,& Kayser, B.(2006). High altitude adaptation in Tibetans. High Altitude Medicine & Biology, 72006.7.193
[82] Xue X. J., Su R., Li Z. F., Bu X. O., Dang P., Yu S. F., .. Zhang D. L. (2022). Oxygen metabolism-induced stress response underlies heart-brain interaction governing human consciousness-breaking and attention. Neuroscience Bulletin, 38(2), 166-180. https://10.1007/s12264-021-00761-1
[83] Yu S., Wang N., Hu Q., Dang P., Chang S., Huang X.,… Zhang, D.(2023). Neurodynamics of awareness detection in Tibetan immigrants: Evidence from electroencephalography analysis. Neuroscience, 522, 69- 80. https://doi.org/10.1016/j.neuroscience.2023.04.025
[84] Zhang D., Zhang X., Ma H., Wang Y., Ma H., & Liu M. (2018). Competition among the attentional networks due to resource reduction in Tibetan indigenous residents: Evidence from event-related potentials. Scientific Reports, 8(1), 610. https://doi.org/10.1038/s41598-017-18886-7
[85] Zhang X., Xie W., Du W., Liu Y., Lin J., Yin W., .. Zhang J. (2023). Consistent differences in brain structure and functional connectivity in high-altitude native Tibetans and immigrants. Brain Imaging and Behavior, 17, 271-281. https://doi.org/10.1007/s11682-023-00759-5
[86] Zhang X.,& Zhang, J.(2022). The human brain in a high altitude natural environment: A review. Frontiers in Human Neuroscience, 16, 915995. https://doi.org/10.3389/fnhum.2022.915995
[87] Zubieta-Calleja G. R., Paulev P., Zubieta-Calleja L., & Zubieta-Castillo G. (2007). Altitude adaptation through hematocrit changes.Journal of Physiology and Pharmacology, 58(5), 811-818.