Hypoxia and standing balance.

PURPOSE

Standing balance control is important for everyday function and often goes unnoticed until impairments appear. Presently, more than 200 million people live at altitudes > 2500 m above sea level, and many others work at or travel to these elevations. Thus, it is important to understand how hypoxia alters balance owing to implications for occupations and travelers. Herein, the influence of normobaric and hypobaric hypoxia on standing balance control is reviewed and summarized. As postural control relies on the integration of sensorimotor signals, the potential hypoxic-sensitive neurophysiological factors that contribute to balance impairments are also reviewed. Specifically, we examine how hypoxia impairs visual, vestibular, and proprioceptive cues, and their integration within subcortical or cortical areas.

METHODS

This systematic review included a literature search conducted via multiple databases with keywords related to postural balance, hypoxia, and altitude. Articles (n = 13) were included if they met distinct criteria.

RESULTS

Compared to normoxia, normobaric hypoxia worsened parameters of standing balance by 2-10% and up to 83 and 240% in hypobaric hypoxia (high-altitude and lab-based, respectively). Although balance was only disrupted during normobaric hypoxia at FO <  ~ 0.15, impairments consistently occurred during hypobaric hypoxia at altitudes > 1524 m (~ FO < 0.18).

CONCLUSION

Hypoxia, especially hypobaric, impairs standing balance. The mechanisms underpinning postural decrements likely involve alterations to processing and integration of sensorimotor signals within subcortical or cortical structures involving visual, vestibular, and proprioceptive pathways and subsequent motor commands that direct postural adjustments. Future studies are required to determine the sensorimotor factors that may influence balance control in hypoxia.