{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T05:10:17Z","timestamp":1791954617681,"version":"4.3.4"},"reference-count":54,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,10,5]]},"abstract":"<jats:p xml:lang=\"en\">An increasing number of individuals travel to mountainous environments for work and pleasure. However, oxygen availability declines at altitude, and hypoxic environments place unique stressors on the cardiovascular system. These stressors may be exacerbated by exercise at altitude, because exercise increases oxygen demand in an environment that is already relatively oxygen deplete compared with sea\u2010level conditions. Furthermore, the prevalence of cardiovascular disease, as well as diseases such as hypertension, heart failure, and lung disease, is high among individuals living in the United States. As such, patients who are at risk of or who have established cardiovascular disease may be at an increased risk of adverse events when sojourning to these mountainous locations. However, these risks may be minimized by appropriate pretravel assessments and planning through shared decision\u2010making between patients and their managing clinicians. This American Heart Association scientific statement provides a concise, yet comprehensive overview of the physiologic responses to exercise in hypoxic locations, as well as important considerations for minimizing the risk of adverse cardiovascular events during mountainous excursions.<\/jats:p>","DOI":"10.1161\/jaha.121.023225","type":"journal-article","created":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T04:58:42Z","timestamp":1631163522000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":61,"title":["Clinical Implications for Exercise at Altitude Among Individuals With Cardiovascular Disease"],"prefix":"10.1161","volume":"10","author":[{"suffix":"III","given":"William K.","family":"Cornwell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron L.","family":"Baggish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yadav Kumar Deo","family":"Bhatta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Joan","family":"Brosnan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Dehnert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Sawalla","family":"Guseh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra","family":"Hammer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D.","family":"Levine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianfranco","family":"Parati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene E.","family":"Wolfel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the American Heart Association Exercise, Cardiac Rehabilitation, and Secondary Prevention Committee of the Council on Clinical Cardiology; and Council on Arteriosclerosis, Thrombosis and Vascular Biology","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1089\/ham.2015.0043"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.650796"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-8772-2_6"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.04.003"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1982.03320430039028"},{"key":"e_1_3_1_7_2","first-page":"793","article-title":"Maximal and submaximal exercise performance at altitude","volume":"69","author":"Fulco CS","year":"1998","unstructured":"Fulco CS, Rock PB, Cymerman A. Maximal and submaximal exercise performance at altitude. Aviat Space Environ Med. 1998;69:793\u2013801.","journal-title":"Aviat Space Environ Med"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.96.4.1224"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(97)00901-6"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000087432.63671.2E"},{"key":"e_1_3_1_11_2","first-page":"71","article-title":"Electrocardiographic changes caused by induced anoxemia in normal persons and in patients with disease of the coronary arteries","volume":"54","author":"Levy RL","year":"1938","unstructured":"Levy RL, Bruenn HG, Russell N. Electrocardiographic changes caused by induced anoxemia in normal persons and in patients with disease of the coronary arteries. Trans Am Clin Climatol Assoc. 1938;54:71\u201375.","journal-title":"Trans Am Clin Climatol Assoc"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2005.072520"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1580\/0953-9859-1.3.147"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF03091749"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-09-0004"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu275"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs140"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.114.05003"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejheart.2006.02.001"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e3283409014"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx720"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1985.58.3.785"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03500050065015"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1992.03490070086048"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00749.2002"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1089\/ham.2009.1056"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4939-3023-4_12"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(90)91358-D"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1159\/000127445"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1990.00390180045007"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1089\/ham.2007.1015"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-964850"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2017.01.010"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2008.01098.x"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1089\/ham.2010.1024"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1089\/ham.2012.1117"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32339-4"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00115.2018"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(00)00532-5"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.227"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.hjr.0000220583.27140.9b"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-5922.2011.00261.x"},{"key":"e_1_3_1_43_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200507-1035OC"},{"key":"e_1_3_1_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmaid.2014.02.004"},{"key":"e_1_3_1_45_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00052606"},{"key":"e_1_3_1_46_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-141-3-200408030-00005"},{"key":"e_1_3_1_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.05.127"},{"key":"e_1_3_1_48_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005768-199902000-00011"},{"key":"e_1_3_1_49_2","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2013-203280"},{"key":"e_1_3_1_50_2","doi-asserted-by":"publisher","DOI":"10.1113\/expphysiol.2009.047571"},{"key":"e_1_3_1_51_2","doi-asserted-by":"publisher","DOI":"10.1513\/pats.200709-155MG"},{"key":"e_1_3_1_52_2","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.1708"},{"key":"e_1_3_1_53_2","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2009.125849"},{"key":"e_1_3_1_54_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.94847"},{"key":"e_1_3_1_55_2","doi-asserted-by":"publisher","DOI":"10.1089\/ham.2015.0016"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.121.023225","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T07:59:47Z","timestamp":1715587187000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.121.023225"}},"subtitle":["A Scientific Statement From the American Heart Association"],"short-title":[],"issued":{"date-parts":[[2021,10,5]]},"references-count":54,"journal-issue":{"issue":"19","published-print":{"date-parts":[[2021,10,5]]}},"alternative-id":["10.1161\/JAHA.121.023225"],"URL":"https:\/\/doi.org\/10.1161\/jaha.121.023225","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,5]]},"assertion":[{"value":"2021-09-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e023225"}}