Wagner diagram for modeling O2 pathway—calculation and graphical display by the Helsinki O2 Pathway Tool

Rissanen A;  Foundation for Sports and Exercise Medicine (HULA), Helsinki, Finland
Mikkola T; Gagnon D; Lehtonen E; Lukkarinen S; Peltonen J;

Physiol. Meas. 45 (2024) 055028

Objective. Maximal O2 uptake ( ˙VO2max) reflects the individual’s maximal rate of O2 transport and
utilization through the integrated whole-body pathway composed of the lungs, heart, blood,
circulation, and metabolically active tissues. As such, ˙VO2max is strongly associated with physical
capacity as well as overall health and thus acts as one predictor of physical performance and as a
vital sign in determination of status and progress of numerous clinical conditions. Quantifying the
contribution of single parts of the multistep O2 pathway to ˙VO2max provides mechanistic insights
into exercise (in)tolerance and into therapy-, training-, or disuse-induced adaptations at individual
or group levels. We developed a desktop application (Helsinki O2 Pathway Tool—HO2PT) to
model numerical and graphical display of the O2 pathway based on the ‘Wagner diagram’
originally formulated by Peter D. Wagner and his colleagues. Approach. The HO2PT was developed
and programmed in Python to integrate the Fick principle and Fick’s law of diffusion into a
computational system to import, calculate, graphically display, and export variables of the Wagner
diagram. Main results. The HO2PT models O2 pathway both numerically and graphically according
to the Wagner diagram and pertains to conditions under which the mitochondrial oxidative
capacity of metabolically active tissues exceeds the capacity of the O2 transport system to deliver O2
to the mitochondria. The tool is based on the Python open source code and libraries and freely and
publicly available online for Windows, macOS, and Linux operating systems.
Significance. The HO2PT offers a novel functional and demonstrative platform for those interested
in examining ˙VO2max and its determinants by using the Wagner diagram. It will improve access to
and usability of Wagner’s and his colleagues’ integrated physiological model and thereby benefit
users across the wide spectrum of contexts such as scientific research, education, exercise testing,
sports coaching, and clinical medicine.