D R Appleton
What statistics should we teach medical undergraduates and graduates?
Statistics in medicine
development acidosis intense exercise traditionally explained increased production lactic acid causing release proton formation acid salt sodium lactate basis explanation rate lactate production high enough cellular proton buffering capacity exceeded resulting decrease cellular ph biochemical events termed lactic acidosis lactic acidosis exercise classic explanation biochemistry acidosis 80 years belief led interpretation lactate production causes acidosis turn increased lactate production one several causes muscle fatigue intense exercise review presents clear evidence biochemical support lactate production causing acidosis lactate production retards causes acidosis similarly wealth research evidence show acidosis caused reactions lactate production every time atp broken adp pi proton released atp demand muscle contraction met mitochondrial respiration proton accumulation cell protons used mitochondria oxidative phosphorylation maintain proton gradient intermembranous space exercise intensity increases beyond steady state need greater reliance atp regeneration glycolysis phosphagen system atp supplied nonmitochondrial sources eventually used fuel muscle contraction increases proton release causes acidosis intense exercise lactate production increases cellular conditions prevent pyruvate accumulation supply nad needed phase 2 glycolysis thus increased lactate production coincides cellular acidosis remains good indirect marker cell metabolic conditions induce metabolic acidosis muscle produce lactate acidosis muscle fatigue would occur quickly exercise performance would severely impaired