Peak Eccentric Cycling Exercise and Cardiorespiratory Responses to Normobaric Hypoxia Versus Normobaric Normoxia in Healthy Adults: A Randomized, Controlled Crossover Trial

Background/Objectives: Pulmonary rehabilitation clinics are traditionally located at higher altitudes (HAs), where lower PO2 reduces exercise capacity and blood oxygenation. Eccentric cycling exercise (ECC), with its lower cardiorespiratory demand compared to concentric cycling (CON), might therefore be a potential advantageous training modality at HAs, particularly for individuals with reduced exercise capacity. This study aimed to compare the cardiorespiratory responses of ECC while breathing normoxic versus hypoxic gas in healthy participants. Methods: This randomized, controlled crossover trial involved healthy participants performing CON in normoxia (FiO2 = 0.21), followed by two incremental ECC tests until 70–100% of peak exercise, one with normoxia and one with normobaric hypoxia (FiO2 = 0.15), in a randomized order. Oxygen uptake (V’O2) and additional outcomes were measured breath-by-breath. Endpoints were defined at rest, 50%, 70%, peak exercise, and isotime. The trial is registered on clinicaltrails.gov (NCT05185895). Results: Twelve healthy participants (age: 30 ± 11 years, six females) completed the study. During both interventions, V’O2 increased linearly with exercise intensity, with no significant differences between normoxic and hypoxic conditions. At peak exercise, SpO2 and peak work rate were significantly lowered by 5% (95%CI: 3 to 8%, p < 0.001) and by 22 W (95%CI: 8 to 36 W, p = 0.009) in hypoxia compared to normoxia. Other outcomes were unchanged. When comparing CON to ECC in normoxia, the mean differences in V’O2 increased with higher loads. Conclusions: This study demonstrated that V’O2 and other cardiopulmonary parameters remain unchanged when performing ECC in hypoxia compared to normoxia. Comparing CON to ECC in normoxia, participants achieved higher workloads and greater V’O2 consumption during CON compared to ECC at comparable watts, confirming the higher metabolic cost associated with CON. We identified that the optimal submaximal ECC intensities, with the highest difference in V’O2 between CON versus ECC, are around 40% of peak V’O2.