SummaryThe concentrations of extracellular and intracellular potassium (K+) in skeletal muscle influence muscle cell function and are also important determinants of cardiovascular and respiratory function.Several studies over the years have shown that exercise results in a release of K+ions from contracting muscles which produces a decrease in intracellular K+concentrations and an increase in plasma K+concentrations. Following exercise there is a recovery of intracellular K+concentrations in previously contracting muscle and plasma K+concentrations rapidly return to resting values.The cardiovascular and respiratory responses to K+released by contracting muscle produce some changes which aid exercise performance. Increases in the interstitial K+concentrations of contracting muscles stimulate CIII and CIV afferents to directly stimulate heart rate and the rate of ventilation. Localised K+release causes a vasodilatation of the vascular bed within contracting muscle. This, together with the increase in cardiac output (through increased heart rate), results in an increase in blood flow to isometrically contracted muscle upon cessation of contraction and to dynamically contracting muscle. This exercise hyperaemia aids in the delivery of metabolic substrates to, and in the removal of metabolic endproducts from, contracting and recovering muscle tissues.In contrast to the beneficial respiratory and cardiovascular effects of elevations in interstitial and plasma K+concentrations, the responses of contracting muscle to decreases in intracellular K+concentrations and increases in intracellular Na+concentrations and extracellular K+concentrations contribute to a reduction in the strength of muscular contraction. Muscle K+loss has thus been cited as a major factor associated with or contributing to muscle fatigue.The sarcolemma, because of changes in intracellular and extracellular K+concentrations and Na+concentrations on the membrane potential and cell excitability, contributes to a fatigue ‘safety mechanism’. The purpose of this safety mechanism would be to prevent the muscle cell from the self-destruction which is evident upon overload (metabolic insufficiency) of the tissues. The net loss of K+and associated net gain of Na+by contracting muscles may contribute to the pain and degenerative changes seen with prolonged exercise.During exercise, mechanisms are brought into play which serve to regulate cellular and whole body K+homeostasis. Increased rates of uptake of K+by contracting muscles and inactive tissues through activation of the Na+-K+pump serve to restore active muscle intracellular K+concentrations towards precontraction levels and to prevent plasma K+concentrations from rising to toxic levels. These effects are at least partially mediated by exercise-induced increases in plasma catecholamines, particularly adrenaline. Upon cessation of exercise intracellular K+concentrations rapidly recover towards resting values, and this is associated with improvements in muscle contraction.Training may result in an increase in intracellular K+concentrations of resting muscle and relatively lower plasma K+concentrations compared to values reported in untrained individuals. Also, a blunting of the exercise-induced hyperkalaemia in trained individuals is associated with a decrease in the net loss of K+from contracting muscle; these observations have been attributed to an upregulation of Na+-K+pump activity in both inactive tissues and active muscle.