{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:47:35Z","timestamp":1792176455861,"version":"4.4.0"},"reference-count":62,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Fundamental Research Funds for Central Universities","award":["2025KYPTO9"],"award-info":[{"award-number":["2025KYPTO9"]}]},{"name":"State Sport General Administration","award":["24QN001"],"award-info":[{"award-number":["24QN001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute mountain sickness (AMS) commonly affects unacclimatized lowlanders travelling above 2500\u00a0m. Hypoxic pre-acclimatization may reduce AMS risk, but its effectiveness before rapid ascent and the relative merits of different protocols remain uncertain. Therefore, this study compared hypoxic pre-acclimatization strategies for AMS incidence, AMS severity and peripheral oxygen saturation (SpO2) after rapid ascent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase, Cochrane Library, SPORTDiscus and Web of Science were searched from inception to 2 December 2025. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension statement for network meta-analyses guidance. We included randomized controlled trials (RCTs) enrolling healthy adults without prior high-altitude acclimatization that evaluated hypoxic pre-acclimatization and reported AMS incidence or severity after rapid ascent. Two reviewers independently extracted data. Primary outcomes were AMS incidence and severity; SpO2 was the secondary outcome. Bayesian random-effects network meta-analyses estimated odds ratio (OR), standardized mean difference (SMD) and mean difference (MD) with 95% credible interval (CrI). Interventions were ranked using surface under the cumulative ranking curve values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirteen RCTs involving 576 participants were included. Point estimates for primary outcomes generally favoured hypoxic pre-acclimatization over control. Among statistically significant findings, staging at 4300\u00a0m showed the most favourable estimate for AMS incidence (OR, 0.02; 95% CrI, 0.001 to 0.33), and staging at 3500\u00a0m showed the most favourable estimate for AMS severity (SMD, \u22121.22; 95% CrI, \u22122.40 to \u22120.04). Several interventions increased post-ascent peripheral oxygen saturation. No consistent significant differences were observed between staging and intermittent hypoxic exposure (IHE) or among IHE modalities. Certainty of evidence for primary outcomes ranged from very low to moderate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hypoxic pre-acclimatization may prevent AMS and reduce its severity after rapid ascent. Staging effects may vary by implementation altitude, and IHE modalities showed generally consistent protective directions. The choice between IHE and staging should be guided by preparation time, individual tolerance and risk preferences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jtm\/taag087","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:46:13Z","timestamp":1790682373000},"source":"Crossref","is-referenced-by-count":0,"title":["Hypoxic pre-acclimatization strategies before rapid ascent for preventing acute mountain sickness: a systematic review and network meta-analysis"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3311-6280","authenticated-orcid":false,"given":"Shubao","family":"Chen","sequence":"first","affiliation":[{"name":"School of Strength and Conditioning Training, Beijing Sport University, Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Strength and Conditioning Training, Beijing Sport University, Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunlei","family":"Li","sequence":"additional","affiliation":[{"name":"School of Strength and Conditioning Training, Beijing Sport University, Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limingfei","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Strength and Conditioning Training, Beijing Sport University, Beijing ,","place":["China"]},{"name":"Key Laboratory for Performance Training and Recovery of General Administration of Sport of China , Beijing Sport University, Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"2026101614015789700_ref1","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.smhs.2021.04.001","article-title":"High-altitude illnesses: old stories and new insights into the pathophysiology, treatment and prevention","volume":"3","author":"Burtscher","year":"2021","journal-title":"Sports Med Health Sci"},{"key":"2026101614015789700_ref2","doi-asserted-by":"publisher","first-page":"d4943","DOI":"10.1136\/bmj.d4943","article-title":"Acute altitude illnesses","volume":"343","author":"Imray","year":"2011","journal-title":"BMJ"},{"key":"2026101614015789700_ref3","doi-asserted-by":"publisher","first-page":"160096","DOI":"10.1183\/16000617.0096-2016","article-title":"Acute high-altitude sickness","volume":"26","author":"Luks","year":"2017","journal-title":"Eur Respir Rev"},{"key":"2026101614015789700_ref4","first-page":"1209","article-title":"Altitude sickness","volume":"2010","author":"Murdoch","year":"2010","journal-title":"BMJ Clin Evid"},{"key":"2026101614015789700_ref5","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1038\/s41392-025-02531-1","article-title":"Altitude hypoxia and hypoxemia: pathogenesis and management","volume":"11","author":"Cai","year":"2026","journal-title":"Signal Transduct Target Ther"},{"key":"2026101614015789700_ref6","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1177\/1941738110373065","article-title":"Return to activity at altitude after high-altitude illness","volume":"2","author":"Deweber","year":"2010","journal-title":"Sports Health"},{"key":"2026101614015789700_ref7","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1089\/ham.2010.1006","article-title":"Altitude preexposure recommendations for inducing acclimatization","volume":"11","author":"Muza","year":"2010","journal-title":"High Alt Med Biol"},{"key":"2026101614015789700_ref8","doi-asserted-by":"publisher","first-page":"e14662","DOI":"10.1111\/cns.14662","article-title":"Intermittent hypoxia preconditioning can attenuate acute hypoxic injury after a sustained normobaric hypoxic exposure: a randomized clinical trial","volume":"30","author":"Wang","year":"2024","journal-title":"CNS Neurosci Ther"},{"key":"2026101614015789700_ref9","doi-asserted-by":"publisher","first-page":"Cd013315","DOI":"10.1002\/14651858.CD013315","article-title":"Interventions for preventing high altitude illness: part 3. 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