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Keramidas ME, Kölegård R, Mekjavic IB, Eiken O. PlanHab: hypoxia exaggerates the bed-rest-induced reduction in peak oxygen uptake during upright cycle ergometry. Am J Physiol Heart Circ Physiol 2016; 311:H453-64. [PMID: 27342877 DOI: 10.1152/ajpheart.00304.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/20/2016] [Indexed: 11/22/2022]
Abstract
The study examined the effects of hypoxia and horizontal bed rest, separately and in combination, on peak oxygen uptake (V̇o2 peak) during upright cycle ergometry. Ten male lowlanders underwent three 21-day confinement periods in a counterbalanced order: 1) normoxic bed rest [NBR; partial pressure of inspired O2 (PiO2 ) = 133.1 ± 0.3 mmHg]; 2) hypoxic bed rest (HBR; PiO2 = 90.0 ± 0.4 mmHg), and 3) hypoxic ambulation (HAMB; PiO2 = 90.0 ± 0.4 mmHg). Before and after each confinement, subjects performed two incremental-load trials to exhaustion, while inspiring either room air (AIR), or a hypoxic gas (HYPO; PiO2 = 90.0 ± 0.4 mmHg). Changes in regional oxygenation of the vastus lateralis muscle and the frontal cerebral cortex were monitored with near-infrared spectroscopy. Cardiac output (CO) was recorded using a bioimpedance method. The AIR V̇o2 peak was decreased by both HBR (∼13.5%; P ≤ 0.001) and NBR (∼8.6%; P ≤ 0.001), with greater drop after HBR (P = 0.01). The HYPO V̇o2 peak was also reduced by HBR (-9.7%; P ≤ 0.001) and NBR (-6.1%; P ≤ 0.001). Peak CO was lower after both bed-rest interventions, and especially after HBR (HBR: ∼13%, NBR: ∼7%; P ≤ 0.05). Exercise-induced alterations in muscle and cerebral oxygenation were blunted in a similar manner after both bed-rest confinements. No changes were observed in HAMB. Hence, the bed-rest-induced decrease in V̇o2 peak was exaggerated by hypoxia, most likely due to a reduction in convective O2 transport, as indicated by the lower peak values of CO.
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Affiliation(s)
- Michail E Keramidas
- Department of Environmental Physiology, Swedish Aerospace Physiology Center, School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden;
| | - Roger Kölegård
- Department of Environmental Physiology, Swedish Aerospace Physiology Center, School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden
| | - Igor B Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia; and Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ola Eiken
- Department of Environmental Physiology, Swedish Aerospace Physiology Center, School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden
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52
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Knapp AE, Goldberg D, Delavar H, Trisko BM, Tang K, Hogan MC, Wagner PD, Breen EC. Skeletal myofiber VEGF regulates contraction-induced perfusion and exercise capacity but not muscle capillarity in adult mice. Am J Physiol Regul Integr Comp Physiol 2016; 311:R192-9. [PMID: 27225953 DOI: 10.1152/ajpregu.00533.2015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/17/2016] [Indexed: 11/22/2022]
Abstract
A single bout of exhaustive exercise signals expression of vascular endothelial growth factor (VEGF) in the exercising muscle. Previous studies have reported that mice with life-long deletion of skeletal myofiber VEGF have fewer capillaries and a severe reduction in endurance exercise. However, in adult mice, VEGF gene deletion conditionally targeted to skeletal myofibers limits exercise capacity without evidence of capillary regression. To explain this, we hypothesized that adult skeletal myofiber VEGF acutely regulates skeletal muscle perfusion during muscle contraction. A tamoxifen-inducible skeletal myofiber-specific VEGF gene deletion mouse (skmVEGF-/-) was used to reduce skeletal muscle VEGF protein by 90% in adult mice. Three weeks after inducing deletion of the skeletal myofiber VEGF gene, skmVEGF-/- mice exhibited diminished maximum running speed (-10%, P < 0.05) and endurance capacity (-47%; P < 0.05), which did not persist after 8 wk. In skmVEGF-/- mice, gastrocnemius complex time to fatigue measured in situ was 71% lower than control mice. Contraction-induced perfusion measured by optical imaging during a period of electrically stimulated muscle contraction was 85% lower in skmVEGF-/- than control mice. No evidence of capillary rarefication was detected in the soleus, gastrocnemius, and extensor digitorum longus (EDL) up to 8 wk after tamoxifen-induced VEGF ablation, and contractility and fatigue resistance of the soleus measured ex vivo were also unchanged. The force-frequency of the EDL showed a small right shift, but fatigue resistance did not differ between EDL from control and skmVEGF-/- mice. These data suggest myofiber VEGF is required for regulating perfusion during periods of contraction and may in this manner affect endurance capacity.
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Affiliation(s)
- Amy E Knapp
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Daniel Goldberg
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Hamid Delavar
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Breanna M Trisko
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Kechun Tang
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Michael C Hogan
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Peter D Wagner
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Ellen C Breen
- Department of Medicine, University of California, San Diego, La Jolla, California
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53
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Crocker GH, Jones JH. Interactive effects of hypoxia, carbon monoxide and acute lung injury on oxygen transport and aerobic capacity. Respir Physiol Neurobiol 2016; 225:31-7. [DOI: 10.1016/j.resp.2016.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 11/24/2022]
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54
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Ade CJ, Broxterman RM, Barstow TJ. VO(2max) and Microgravity Exposure: Convective versus Diffusive O(2) Transport. Med Sci Sports Exerc 2016; 47:1351-61. [PMID: 25380479 DOI: 10.1249/mss.0000000000000557] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Exposure to a microgravity environment decreases the maximal rate of O2 uptake (VO(2max)) in healthy individuals returning to a gravitational environment. The magnitude of this decrease in VO(2max) is, in part, dependent on the duration of microgravity exposure, such that long exposure may result in up to a 38% decrease in VO(2max). This review identifies the components within the O(2) transport pathway that determine the decrease in postmicrogravity VO(2max) and highlights the potential contributing physiological mechanisms. A retrospective analysis revealed that the decline in VO(2max) is initially mediated by a decrease in convective and diffusive O(2) transport that occurs as the duration of microgravity exposure is extended. Mechanistically, the attenuation of O(2) transport is the combined result of a deconditioning across multiple organ systems including decreases in total blood volume, red blood cell mass, cardiac function and mass, vascular function, skeletal muscle mass, and, potentially, capillary hemodynamics, which become evident during exercise upon re-exposure to the head-to-foot gravitational forces of upright posture on Earth. In summary, VO(2max) is determined by the integration of central and peripheral O(2) transport mechanisms, which, if not maintained during microgravity, will have a substantial long-term detrimental impact on space mission performance and astronaut health.
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Affiliation(s)
- Carl J Ade
- 1Department of Health and Exercise Science, University of Oklahoma, Norman, OK; 2Department of Kinesiology, Kansas State University, Manhattan, KS; and 3Department of Anatomy and Physiology, Kansas State University, Manhattan, KS
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55
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McKeever KH, McNally BA, Hinchcliff KW, Lehnhard RA, Poole DC. Effects of erythropoietin on systemic hematocrit and oxygen transport in the splenectomized horse. Respir Physiol Neurobiol 2016; 225:38-47. [PMID: 26853328 DOI: 10.1016/j.resp.2016.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 01/30/2016] [Accepted: 02/02/2016] [Indexed: 11/16/2022]
Abstract
To test the hypotheses that erythropoietin (rhuEPO) treatment increases systemic hematocrit, maximal O2 uptake (VO2max, by elevated perfusive and diffusive O2 conductances) and performance five female horses (4-13 years) received 15 IU/kg rhuEPO (erythropoietin) three times per week for three weeks. These horses had been splenectomized over 1 year previously to avoid confounding effects from the mobilization of splenic red blood cell reserves. Each horse performed three maximal exercise tests (one per month) on an inclined (4°) treadmill to the limit of tolerance; two control trials and one following EPO treatment. Measurements of hemoglobin concentration ([Hb] and hematocrit), plasma and blood volume, VO2, cardiac output as well as arterial and mixed venous blood gases were made at rest and during maximal exercise. EPO increased resting [Hb] by 18% from 13.3 ± 0.6 to 15.7 ± 0.8 g/dL (mean ± SD) corresponding to an increased hematocrit from 36 ± 2 to 46 ± 2% concurrent with 23 and 10% reductions in plasma and blood volume, respectively (all P<0.05). EPO elevated VO2max by 20% from 25.7 ± 1.7 to 30.9 ± 3.4 L/min (P<0.05) via a 17% increase in arterial O2 content and 18% greater arteriovenous O2 difference in the face of an unchanged cardiac output. To achieve the greater VO2max after EPO, diffusive O2 conductance increased ∼ 30% (from 580 ± 76 to 752 ± 166 mL O2/mmHg/min, P<0.05) which was substantially greater than the elevation of perfusive O2 conductance. These effects of EPO were associated with an increased exercise performance (total running time: control, 216 ± 72; EPO, 264 ± 48 s, P<0.05). We conclude that EPO substantially increases VO2max and performance in the splenectomized horse via improved perfusive and diffusive O2 transport.
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Affiliation(s)
- Kenneth H McKeever
- Department of Animal Science, Rutgers the State University of New Jersey, New Brunswick, NJ 08903, United States.
| | - Beth A McNally
- School of Health, Physical Education and Recreation, The Ohio State University, Columbus, OH 43210, United States
| | - Kenneth W Hinchcliff
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | - Robert A Lehnhard
- Department of Kinesiology, University of Maine, Orono, ME, United States
| | - David C Poole
- Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, United States
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56
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Ferguson C, Wylde LA, Benson AP, Cannon DT, Rossiter HB. No reserve in isokinetic cycling power at intolerance during ramp incremental exercise in endurance-trained men. J Appl Physiol (1985) 2015; 120:70-7. [PMID: 26565019 DOI: 10.1152/japplphysiol.00662.2015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/11/2015] [Indexed: 11/22/2022] Open
Abstract
During whole body exercise in health, maximal oxygen uptake (V̇o2max) is typically attained at or immediately before the limit of tolerance (LoT). At the V̇o2max and LoT of incremental exercise, a fundamental, but unresolved, question is whether maximal evocable power can be increased above the task requirement, i.e., whether there is a "power reserve" at the LoT. Using an instantaneous switch from cadence-independent (hyperbolic) to isokinetic cycle ergometry, we determined maximal evocable power at the limit of ramp-incremental exercise. We hypothesized that in endurance-trained men at LoT, maximal (4 s) isokinetic power would not differ from the power required by the task. Baseline isokinetic power at 80 rpm (Piso; measured at the pedals) and summed integrated EMG from five leg muscles (ΣiEMG) were measured in 12 endurance-trained men (V̇o2max = 4.2 ± 1.0 l/min). Participants then completed a ramp incremental exercise test (20-25 W/min), with instantaneous measurement of Piso and ΣiEMG at the LoT. Piso decreased from 788 ± 103 W at baseline to 391 ± 72 W at LoT, which was not different from the required ramp-incremental flywheel power (352 ± 58 W; P > 0.05). At LoT, the relative reduction in Piso was greater than the relative reduction in the isokinetic ΣiEMG (50 ± 9 vs. 63 ± 10% of baseline; P < 0.05). During maximal ramp incremental exercise in endurance-trained men, maximum voluntary power is not different from the power required by the task and is consequent to both central and peripheral limitations in evocable power. The absence of a power reserve suggests both the perceptual and physiological limits of maximum voluntary power production are not widely dissociated at LoT in this population.
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Affiliation(s)
- Carrie Ferguson
- School of Biomedical Sciences and Multidisciplinary Cardiovascular Research Centre, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom;
| | - Lindsey A Wylde
- School of Biomedical Sciences and Multidisciplinary Cardiovascular Research Centre, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Alan P Benson
- School of Biomedical Sciences and Multidisciplinary Cardiovascular Research Centre, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Daniel T Cannon
- Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; and School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California
| | - Harry B Rossiter
- School of Biomedical Sciences and Multidisciplinary Cardiovascular Research Centre, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom; Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; and
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57
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Laughlin MH. Physical activity-induced remodeling of vasculature in skeletal muscle: role in treatment of type 2 diabetes. J Appl Physiol (1985) 2015; 120:1-16. [PMID: 26472876 DOI: 10.1152/japplphysiol.00789.2015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/08/2015] [Indexed: 01/15/2023] Open
Abstract
This manuscript summarizes and discusses adaptations of skeletal muscle vasculature induced by physical activity and applies this understanding to benefits of exercise in prevention and treatment of type 2 diabetes (T2D). Arteriolar trees of skeletal muscle are heterogeneous. Exercise training increases capillary exchange and blood flow capacities. The distribution of vascular adaptation to different types of exercise training are influenced by muscle fiber type composition and fiber recruitment patterns that produce different modes of exercise. Thus training-induced adaptations in vascular structure and vascular control in skeletal muscle are not homogeneously distributed throughout skeletal muscle or along the arteriolar tree within a muscle. Results summarized indicate that similar principles apply to vascular adaptation in skeletal muscle in T2D. It is concluded that exercise training-induced changes in vascular gene expression differ along the arteriolar tree and by skeletal muscle fiber type composition. Results suggest that it is unlikely that hemodynamic forces are the only exercise-induced signals mediating the regulation of vascular gene expression. In patients with T2D, exercise training is perhaps the most effective treatment of the many related symptoms. Training-induced changes in the vasculature and in insulin signaling in the muscle fibers and vasculature augment glucose and insulin delivery as well as glucose uptake. If these adaptations occur in a sufficient amount of muscle mass, exposure to hyperglycemia and hyperinsulinemia will decrease along with the risk of microvascular complications throughout the body. It is postulated that exercise sessions in programs of sufficient duration, that engage as much skeletal muscle mass as possible, and that recruit as many muscle fibers within each muscle as possible will produce the greatest benefit. The added benefit of combined resistance and aerobic training programs and of high-intensity exercise programs is not simply "more exercise is better".
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Affiliation(s)
- M Harold Laughlin
- Department of Biomedical Sciences, Department of Medical Pharmacology & Physiology, and Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri
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58
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Hedrick MS, Hancock TV, Hillman SS. Metabolism at the Max: How Vertebrate Organisms Respond to Physical Activity. Compr Physiol 2015; 5:1677-703. [DOI: 10.1002/cphy.c130032] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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59
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Calbet JAL, Losa-Reyna J, Torres-Peralta R, Rasmussen P, Ponce-González JG, Sheel AW, de la Calle-Herrero J, Guadalupe-Grau A, Morales-Alamo D, Fuentes T, Rodríguez-García L, Siebenmann C, Boushel R, Lundby C. Limitations to oxygen transport and utilization during sprint exercise in humans: evidence for a functional reserve in muscle O2 diffusing capacity. J Physiol 2015; 593:4649-64. [PMID: 26258623 DOI: 10.1113/jp270408] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/05/2015] [Indexed: 12/14/2022] Open
Abstract
To determine the contribution of convective and diffusive limitations to V̇(O2peak) during exercise in humans, oxygen transport and haemodynamics were measured in 11 men (22 ± 2 years) during incremental (IE) and 30 s all-out cycling sprints (Wingate test, WgT), in normoxia (Nx, P(IO2): 143 mmHg) and hypoxia (Hyp, P(IO2): 73 mmHg). Carboxyhaemoglobin (COHb) was increased to 6-7% before both WgTs to left-shift the oxyhaemoglobin dissociation curve. Leg V̇(O2) was measured by the Fick method and leg blood flow (BF) with thermodilution, and muscle O2 diffusing capacity (D(MO2)) was calculated. In the WgT mean power output, leg BF, leg O2 delivery and leg V̇(O2) were 7, 5, 28 and 23% lower in Hyp than Nx (P < 0.05); however, peak WgT D(MO2) was higher in Hyp (51.5 ± 9.7) than Nx (20.5 ± 3.0 ml min(-1) mmHg(-1), P < 0.05). Despite a similar P(aO2) (33.3 ± 2.4 and 34.1 ± 3.3 mmHg), mean capillary P(O2) (16.7 ± 1.2 and 17.1 ± 1.6 mmHg), and peak perfusion during IE and WgT in Hyp, D(MO2) and leg V̇(O2) were 12 and 14% higher, respectively, during WgT than IE in Hyp (both P < 0.05). D(MO2) was insensitive to COHb (COHb: 0.7 vs. 7%, in IE Hyp and WgT Hyp). At exhaustion, the Y equilibration index was well above 1.0 in both conditions, reflecting greater convective than diffusive limitation to the O2 transfer in both Nx and Hyp. In conclusion, muscle V̇(O2) during sprint exercise is not limited by O2 delivery, O2 offloading from haemoglobin or structure-dependent diffusion constraints in the skeletal muscle. These findings reveal a remarkable functional reserve in muscle O2 diffusing capacity.
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Affiliation(s)
- José A L Calbet
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, Canary Islands, 35017, Spain.,Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain
| | - José Losa-Reyna
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, Canary Islands, 35017, Spain.,Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Rafael Torres-Peralta
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, Canary Islands, 35017, Spain.,Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Peter Rasmussen
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - Jesús Gustavo Ponce-González
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, Canary Islands, 35017, Spain.,Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain
| | - A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaime de la Calle-Herrero
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, Canary Islands, 35017, Spain
| | - Amelia Guadalupe-Grau
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, Canary Islands, 35017, Spain.,Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain
| | - David Morales-Alamo
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, Canary Islands, 35017, Spain.,Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Teresa Fuentes
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, Canary Islands, 35017, Spain
| | - Lorena Rodríguez-García
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, Canary Islands, 35017, Spain
| | - Christoph Siebenmann
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - Robert Boushel
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Åstrand Laboratory, Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Carsten Lundby
- Center for Integrative Human Physiology, Institute of Physiology, University of Zürich, Zürich, Switzerland
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60
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Broxterman RM, Craig JC, Ade CJ, Wilcox SL, Barstow TJ. The effect of resting blood flow occlusion on exercise tolerance and W'. Am J Physiol Regul Integr Comp Physiol 2015. [PMID: 26224689 DOI: 10.1152/ajpregu.00283.2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It has previously been postulated that the anaerobic work capacity (W') may be utilized during resting blood flow occlusion in the absence of mechanical work. We tested the hypothesis that W' would not be utilized during an initial range of time following the onset of resting blood flow occlusion, after which W' would be utilized progressively more. Seven men completed blood flow occlusion constant power severe intensity handgrip exercise to task failure following 0, 300, 600, 900, and 1,200 s of resting blood flow occlusion. The work performed above critical power (CP) was not significantly different between the 0-, 300-, and 600-s conditions and was not significantly different from the total W' available. Significantly less work was performed above CP during the 1,200-s condition than the 900-s condition (P < 0.05), while both conditions were significantly less than the 0-, 300-, and 600-s conditions (P < 0.05). The work performed above CP during these conditions was significantly less than the total W' available (P < 0.05). The utilization of W' during resting blood flow occlusion did not begin until 751 ± 118 s, after which time W' was progressively utilized. The current findings demonstrate that W' is not utilized during the initial ∼751 s of resting blood flow occlusion, but is progressively utilized thereafter, despite no mechanical work being performed. Thus, the utilization of W' is not exclusive to exercise, and a constant amount of work that can be performed above CP is not the determining mechanism of W'.
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Affiliation(s)
- Ryan M Broxterman
- Department of Kinesiology, Kansas State University, Manhattan, Kansas; Department of Anatomy and Physiology, Kansas State University, Manhattan, Kansas; and
| | - Jesse C Craig
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
| | - Carl J Ade
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma
| | - Samuel L Wilcox
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
| | - Thomas J Barstow
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
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61
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Wagenmakers AJM, Strauss JA, Shepherd SO, Keske MA, Cocks M. Increased muscle blood supply and transendothelial nutrient and insulin transport induced by food intake and exercise: effect of obesity and ageing. J Physiol 2015; 594:2207-22. [PMID: 25627798 DOI: 10.1113/jphysiol.2014.284513] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/20/2015] [Indexed: 01/07/2023] Open
Abstract
This review concludes that a sedentary lifestyle, obesity and ageing impair the vasodilator response of the muscle microvasculature to insulin, exercise and VEGF-A and reduce microvascular density. Both impairments contribute to the development of insulin resistance, obesity and chronic age-related diseases. A physically active lifestyle keeps both the vasodilator response and microvascular density high. Intravital microscopy has shown that microvascular units (MVUs) are the smallest functional elements to adjust blood flow in response to physiological signals and metabolic demands on muscle fibres. The luminal diameter of a common terminal arteriole (TA) controls blood flow through up to 20 capillaries belonging to a single MVU. Increases in plasma insulin and exercise/muscle contraction lead to recruitment of additional MVUs. Insulin also increases arteriolar vasomotion. Both mechanisms increase the endothelial surface area and therefore transendothelial transport of glucose, fatty acids (FAs) and insulin by specific transporters, present in high concentrations in the capillary endothelium. Future studies should quantify transporter concentration differences between healthy and at risk populations as they may limit nutrient supply and oxidation in muscle and impair glucose and lipid homeostasis. An important recent discovery is that VEGF-B produced by skeletal muscle controls the expression of FA transporter proteins in the capillary endothelium and thus links endothelial FA uptake to the oxidative capacity of skeletal muscle, potentially preventing lipotoxic FA accumulation, the dominant cause of insulin resistance in muscle fibres.
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Affiliation(s)
- Anton J M Wagenmakers
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Juliette A Strauss
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Sam O Shepherd
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Michelle A Keske
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Matthew Cocks
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
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62
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Broxterman RM, Ade CJ, Craig JC, Wilcox SL, Schlup SJ, Barstow TJ. Influence of blood flow occlusion on muscle oxygenation characteristics and the parameters of the power-duration relationship. J Appl Physiol (1985) 2015; 118:880-9. [PMID: 25663673 DOI: 10.1152/japplphysiol.00875.2014] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/29/2015] [Indexed: 11/22/2022] Open
Abstract
It was previously (Monod H, Scherrer J. Ergonomics 8: 329-338, 1965) postulated that blood flow occlusion during exercise would reduce critical power (CP) to 0 Watts (W), while not altering the curvature constant (W'). We empirically assessed the influence of blood flow occlusion on CP, W', and muscle oxygenation characteristics. Ten healthy men (age: 24.8 ± 2.6 yr; height: 180 ± 5 cm; weight: 84.6 ± 10.1 kg) completed four constant-power handgrip exercise tests during both control blood flow (control) and blood flow occlusion (occlusion) for the determination of the power-duration relationship. Occlusion CP (-0.7 ± 0.4 W) was significantly (P < 0.001) lower than control CP (4.1 ± 0.7 W) and significantly (P < 0.001) lower than 0 W. Occlusion W' (808 ± 155 J) was significantly (P < 0.001) different from control W' (558 ± 129 J), and all 10 subjects demonstrated an increased occlusion W' with a mean increase of ∼49%. The present findings support the aerobic nature of CP. The findings also demonstrate that the amount of work that can be performed above CP is constant for a given condition, but can vary across conditions. Moreover, this amount of work that can be performed above CP does not appear to be the determinant of W', but rather a consequence of the depletion of intramuscular energy stores and/or the accumulation of fatigue-inducing metabolites, which limit exercise tolerance and determine W'.
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Affiliation(s)
- R M Broxterman
- Department of Kinesiology, Kansas State University, Manhattan, Kansas; Department of Anatomy and Physiology, Kansas State University, Manhattan, Kansas; and
| | - C J Ade
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma
| | - J C Craig
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
| | - S L Wilcox
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
| | - S J Schlup
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
| | - T J Barstow
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
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Martin DS, Cobb A, Meale P, Mitchell K, Edsell M, Mythen MG, Grocott MPW. Systemic oxygen extraction during exercise at high altitude. Br J Anaesth 2014; 114:677-82. [PMID: 25501722 PMCID: PMC4364061 DOI: 10.1093/bja/aeu404] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Classic teaching suggests that diminished availability of oxygen leads to increased tissue oxygen extraction yet evidence to support this notion in the context of hypoxaemia, as opposed to anaemia or cardiac failure, is limited. Methods At 75 m above sea level, and after 7–8 days of acclimatization to 4559 m, systemic oxygen extraction [C(a−v)O2] was calculated in five participants at rest and at peak exercise. Absolute [C(a−v)O2] was calculated by subtracting central venous oxygen content (CcvO2) from arterial oxygen content (CaO2) in blood sampled from central venous and peripheral arterial catheters, respectively. Oxygen uptake (V˙O2) was determined from expired gas analysis during exercise. Results Ascent to altitude resulted in significant hypoxaemia; median (range) SpO2 87.1 (82.5–90.7)% and PaO2 6.6 (5.7–6.8) kPa. While absolute C(a−v)O2 was reduced at maximum exercise at 4559 m [83.9 (67.5–120.9) ml litre−1vs 99.6 (88.0–151.3) ml litre−1 at 75 m, P=0.043], there was no change in oxygen extraction ratio (OER) [C(a−v)O2/CaO2] between the two altitudes [0.52 (0.48–0.71) at 4559 m and 0.53 (0.49–0.73) at 75 m, P=0.500]. Comparison of C(a−v)O2 at peak V˙O2 at 4559 m and the equivalent V˙O2 at sea level for each participant also revealed no significant difference [83.9 (67.5–120.9) ml litre1vs 81.2 (73.0–120.7) ml litre−1, respectively, P=0.225]. Conclusion In acclimatized individuals at 4559 m, there was a decline in maximum absolute C(a−v)O2 during exercise but no alteration in OER calculated using central venous oxygen measurements. This suggests that oxygen extraction may have become limited after exposure to 7–8 days of hypoxaemia.
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Affiliation(s)
- D S Martin
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK
| | - A Cobb
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK
| | - P Meale
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK
| | - K Mitchell
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Mailpoint 810, Sir Henry Wellcome Laboratories, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK Anaesthesia and Critical Care Research Unit, GICU, Mailpoint 27, Level D, Centre Block, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
| | - M Edsell
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK Department of Anaesthesia, St George's Hospital, London, UK
| | - M G Mythen
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK
| | - M P W Grocott
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Mailpoint 810, Sir Henry Wellcome Laboratories, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK Anaesthesia and Critical Care Research Unit, GICU, Mailpoint 27, Level D, Centre Block, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
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64
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Ferretti G. Maximal oxygen consumption in healthy humans: theories and facts. Eur J Appl Physiol 2014; 114:2007-36. [PMID: 24986693 DOI: 10.1007/s00421-014-2911-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/12/2014] [Indexed: 12/17/2022]
Abstract
This article reviews the concept of maximal oxygen consumption ([Formula: see text]) from the perspective of multifactorial models of [Formula: see text] limitation. First, I discuss procedural aspects of [Formula: see text] measurement: the implications of ramp protocols are analysed within the theoretical work of Morton. Then I analyse the descriptive physiology of [Formula: see text], evidencing the path that led to the view of monofactorial cardiovascular or muscular [Formula: see text] limitation. Multifactorial models, generated by the theoretical work of di Prampero and Wagner around the oxygen conductance equation, represented a radical change of perspective. These models are presented in detail and criticized with respect to the ensuing experimental work. A synthesis between them is proposed, demonstrating how much these models coincide and converge on the same conclusions. Finally, I discuss the cases of hypoxia and bed rest, the former as an example of the pervasive effects of the shape of the oxygen equilibrium curve, the latter as a neat example of adaptive changes concerning the entire respiratory system. The conclusion is that the concept of cardiovascular [Formula: see text] limitation is reinforced by multifactorial models, since cardiovascular oxygen transport provides most of the [Formula: see text] limitation, at least in normoxia. However, the same models show that the role of peripheral resistances is significant and cannot be neglected. The role of peripheral factors is greater the smaller is the active muscle mass. In hypoxia, the intervention of lung resistances as limiting factors restricts the role played by cardiovascular and peripheral factors.
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Affiliation(s)
- Guido Ferretti
- Département des Neurosciences Fondamentales, Université de Genève, 1 Rue Michel Servet, 1211, Geneva 4, Switzerland,
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65
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Roy TK, Secomb TW. Theoretical analysis of the determinants of lung oxygen diffusing capacity. J Theor Biol 2014; 351:1-8. [PMID: 24560722 DOI: 10.1016/j.jtbi.2014.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 02/06/2014] [Accepted: 02/10/2014] [Indexed: 10/25/2022]
Abstract
The process of pulmonary oxygen uptake is analyzed to obtain an explicit equation for lung oxygen diffusing capacity in terms of hematocrit and pulmonary capillary diameter. An axisymmetric model with discrete cylindrical erythrocytes is used to represent radial diffusion of oxygen from alveoli through the alveolar-capillary membrane into pulmonary capillaries, through the plasma, and into erythrocytes. Analysis of unsteady diffusion due to the passage of the erythrocytes shows that transport of oxygen through the alveolar-capillary membrane occurs mainly in the regions adjacent to erythrocytes, and that oxygen transport through regions adjacent to plasma gaps can be neglected. The model leads to an explicit formula for diffusing capacity as a function of geometric and oxygen transport parameters. For normal hematocrit and a capillary diameter of 6.75 μm, the predicted diffusing capacity is 102 ml O₂ min⁻¹ mmHg⁻¹. This value is 30-40% lower than values estimated previously by the morphometric method, which considers the total membrane area and the specific uptake rate of erythrocytes. Diffusing capacity is shown to increase with increasing hematocrit and decrease with increasing capillary diameter and increasing thickness of the membrane. Simulations of pulmonary oxygen uptake in humans under conditions of exercise or hypoxia based show closer agreement with experimental data than previous models, but still overestimate oxygen uptake. The remaining discrepancy may reflect effects of heterogeneity of perfusion and ventilation in the lung.
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Affiliation(s)
- Tuhin K Roy
- Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Timothy W Secomb
- Department of Physiology, University of Arizona, Tucson, AZ 85724-5051, USA
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66
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Adami A, Fagoni N, Ferretti G. The Q˙-V˙O2 diagram: an analytical interpretation of oxygen transport in arterial blood during exercise in humans. Respir Physiol Neurobiol 2014; 193:55-61. [PMID: 24440436 DOI: 10.1016/j.resp.2014.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
A new analysis of the relationship between cardiac output (Q˙) and oxygen consumption V˙O2 is presented (Q˙-V˙O2 diagram). Data from different sources in the literature have been used for validation in three conditions: exercise and rest in normoxia, and exercise in hypoxia. The effects of changes in arterial oxygen concentration CaO2 on Q˙ are discussed, as well as the effects of predominant sympathetic or vagal stimulation. Differences appear depending on whether CaO2 is varied by means of changes in blood haemoglobin concentration or changes in arterial oxygen saturation. The present Q˙-V˙O2 diagram allows comprehensive description of oxygen transport in exercising humans; it expands applicability of the historical Q˙-V˙O2 relationship to include CaO2 variations; it opens new pathways for understanding underlying mechanisms; it allows computation of Q˙ from CaO2 and V˙O2 measurements, when Q˙ cannot be measured.
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Affiliation(s)
- Alessandra Adami
- Département de Neurosciences Fondamentales, Université de Genève, 1 Rue Michel Servet, CH-1211 Genève 4, Switzerland
| | - Nazzareno Fagoni
- Dipartimento di Scienze Cliniche e Sperimentali, Università di Brescia, Viale Europa 11, I-25123 Brescia, Italy
| | - Guido Ferretti
- Département de Neurosciences Fondamentales, Université de Genève, 1 Rue Michel Servet, CH-1211 Genève 4, Switzerland; Dipartimento di Scienze Cliniche e Sperimentali, Università di Brescia, Viale Europa 11, I-25123 Brescia, Italy.
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67
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Hypoxia and CO alter O2 extraction but not peripheral diffusing capacity during maximal aerobic exercise. Eur J Appl Physiol 2014; 114:837-45. [DOI: 10.1007/s00421-013-2799-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/12/2013] [Indexed: 11/26/2022]
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68
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Abstract
The activities of daily living typically occur at metabolic rates below the maximum rate of aerobic energy production. Such activity is characteristic of the nonsteady state, where energy demands, and consequential physiological responses, are in constant flux. The dynamics of the integrated physiological processes during these activities determine the degree to which exercise can be supported through rates of O₂ utilization and CO₂ clearance appropriate for their demands and, as such, provide a physiological framework for the notion of exercise intensity. The rate at which O₂ exchange responds to meet the changing energy demands of exercise--its kinetics--is dependent on the ability of the pulmonary, circulatory, and muscle bioenergetic systems to respond appropriately. Slow response kinetics in pulmonary O₂ uptake predispose toward a greater necessity for substrate-level energy supply, processes that are limited in their capacity, challenge system homeostasis and hence contribute to exercise intolerance. This review provides a physiological systems perspective of pulmonary gas exchange kinetics: from an integrative view on the control of muscle oxygen consumption kinetics to the dissociation of cellular respiration from its pulmonary expression by the circulatory dynamics and the gas capacitance of the lungs, blood, and tissues. The intensity dependence of gas exchange kinetics is discussed in relation to constant, intermittent, and ramped work rate changes. The influence of heterogeneity in the kinetic matching of O₂ delivery to utilization is presented in reference to exercise tolerance in endurance-trained athletes, the elderly, and patients with chronic heart or lung disease.
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Affiliation(s)
- Harry B Rossiter
- Institute of Membrane and Systems Biology, University of Leeds, Leeds, United Kingdom.
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69
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Crocker GH, Toth B, Jones JH. Combined effects of inspired oxygen, carbon dioxide, and carbon monoxide on oxygen transport and aerobic capacity. J Appl Physiol (1985) 2013; 115:643-52. [DOI: 10.1152/japplphysiol.01407.2012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We hypothesized that breathing hypoxic, hypercapnic, and CO-containing gases together reduces maximal aerobic capacity (V̇o2max) as the sum of each gas' individual effect on V̇o2max. To test this hypothesis, goats breathed combinations of inspired O2fraction (FiO2) of 0.06–0.21 and inspired CO2fraction of 0.00 or 0.05, with and without inspired CO that elevated carboxyhemoglobin fraction (FHbCO) to 0.02–0.45, while running on a treadmill at speeds eliciting V̇o2max. Individually, hypoxia and elevated FHbCOdecreased fractional V̇o2max(FV̇o2max, fraction of a goat's V̇o2maxbreathing air) in linear, dose-dependent manners; hypercapnia did not change V̇o2max. Concomitant hypoxia and elevated FHbCOdecreased V̇o2maxless than the individual gas effects summed, indicating their combined effects on V̇o2maxare attenuated, fitting the following regression: FV̇o2max= 4.24 FiO2+ 0.519 FHbCO− 8.22 (FiO2× FHbCO) + 0.117, ( R2= 0.965, P < 0.001). The FV̇o2maxcorrelated highly with total cardiopulmonary O2delivery, not peripheral diffusing capacity, and with arterial O2concentration (CaO2), not cardiac output. Hypoxia and elevated FHbCOdecreased CaO2by different mechanisms: hypoxia decreased arterial O2saturation (SaO2), whereas elevated FHbCOdecreased O2capacitance {concentration of hemoglobin (Hb) available to bind O2([Hbavail])}. When breathing hypoxic gas (FiO20.12), CaO2did not change with increasing FHbCOup to 0.30 because higher SaO2of Hbavailoffset decreased [Hbavail] due to the following: 1) hyperventilation with hypoxia and/or elevated FHbCO; 2) increased Hb affinity for O2due to both Bohr and direct carboxyhemoglobin effects; and 3) the sigmoid relationship between O2saturation and partial pressure elevating SaO2more with hypoxia than normoxia.
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Affiliation(s)
- George H. Crocker
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California
| | - Balazs Toth
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California
| | - James H. Jones
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California
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70
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Ohmura H, Matsui A, Hada T, Jones JH. Physiological responses of young thoroughbred horses to intermittent high-intensity treadmill training. Acta Vet Scand 2013; 55:59. [PMID: 23957961 PMCID: PMC3765425 DOI: 10.1186/1751-0147-55-59] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/12/2013] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Training of young Thoroughbred horses must balance development of cardiopulmonary function and aerobic capacity with loading of the musculoskeletal system that can potentially cause structural damage and/or lameness. High-speed equine treadmills are sometimes used to supplement exercise on a track in the training of young Thoroughbreds because the horse can run at high speeds but without the added weight of a rider. We tested the hypothesis that intermittent high-intensity exercise on a treadmill of young Thoroughbred horses entering training can enhance development of aerobic capacity (VO2max) and running performance more than conventional training under saddle, and do so without causing lameness. RESULTS Twelve yearling Thoroughbreds trained for 8 months with conventional riding (C) only, conventional riding plus a short (2 month, S) interval of once-per-week high-intensity treadmill exercise, or a long (8 month, L) interval of once-per-week high-intensity treadmill exercise. Three treadmill exercise tests evaluated VO2max, oxygen transport and running performance variables in June of the yearling year (only for L), October of the yearling year and April of the 2-year-old year. No horses experienced lameness during the study. Aerobic capacity increased in all groups after training. In both October and April, VO2max in L was higher than in C, but did not differ between L and S or S and C. Running speeds eliciting VO2max also increased in all groups after training, with S (809±3 m/s) and L (804±9 m/s) higher than C (764±27 m/s). Maximum heart rate decreased for all groups after training. Hematocrit and hemoglobin concentration increased for L throughout training. CONCLUSIONS Young Thoroughbred horses can increase aerobic capacity and running performance more than by strictly using track training under saddle with the addition of intermittent high-intensity treadmill exercise, and they can do so without experiencing lameness. This finding suggests that young racehorses might be able to achieve higher aerobic fitness during training without subjecting their musculoskeletal systems to increased loading and risk of developing lameness. The findings of this preliminary study do not indicate a specific protocol to best achieve this goal.
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71
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Spires J, Gladden LB, Grassi B, Saidel GM, Lai N. Model analysis of the relationship between intracellular PO2 and energy demand in skeletal muscle. Am J Physiol Regul Integr Comp Physiol 2012; 303:R1110-26. [PMID: 22972834 DOI: 10.1152/ajpregu.00106.2012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
On the basis of experimental studies, the intracellular O(2) (iPo(2))-work rate (WR) relationship in skeletal muscle is not unique. One study found that iPo(2) reached a plateau at 60% of maximal WR, while another found that iPo(2) decreased linearly at higher WR, inferring capillary permeability-surface area (PS) and blood-tissue O(2) gradient, respectively, as alternative dominant factors for determining O(2) diffusion changes during exercise. This relationship is affected by several factors, including O(2) delivery and oxidative and glycolytic capacities of the muscle. In this study, these factors are examined using a mechanistic, mathematical model to analyze experimental data from contracting skeletal muscle and predict the effects of muscle contraction on O(2) transport, glycogenolysis, and iPo(2). The model describes convection, O(2) diffusion, and cellular metabolism, including anaerobic glycogenolysis. Consequently, the model simulates iPo(2) in response to muscle contraction under a variety of experimental conditions. The model was validated by comparison of simulations of O(2) uptake with corresponding experimental responses of electrically stimulated canine muscle under different O(2) content, blood flow, and contraction intensities. The model allows hypothetical variation of PS, glycogenolytic capacity, and blood flow and predictions of the distinctive effects of these factors on the iPo(2)-contraction intensity relationship in canine muscle. Although PS is the main factor regulating O(2) diffusion rate, model simulations indicate that PS and O(2) gradient have essential roles, depending on the specific conditions. Furthermore, the model predicts that different convection and diffusion patterns and metabolic factors may be responsible for different iPo(2)-WR relationships in humans.
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Affiliation(s)
- Jessica Spires
- Dept. of Biomedical Engineering, Case Western Reserve Univ., 10900 Euclid Ave., Wickenden Bldg. Rm. 524, Cleveland, OH 44106-7207, USA
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72
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A comparative meta-analysis of maximal aerobic metabolism of vertebrates: implications for respiratory and cardiovascular limits to gas exchange. J Comp Physiol B 2012; 183:167-79. [DOI: 10.1007/s00360-012-0688-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 06/13/2012] [Accepted: 06/18/2012] [Indexed: 10/27/2022]
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73
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Effect of high-intensity interval training on the profile of muscle deoxygenation heterogeneity during incremental exercise. Eur J Appl Physiol 2012; 113:249-57. [DOI: 10.1007/s00421-012-2430-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 05/19/2012] [Indexed: 10/27/2022]
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74
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Spurway NC, Ekblom B, Noakes TD, Wagner PD. What limits[Vdot]O2max?A symposium held at the BASES Conference, 6 September 2010. J Sports Sci 2012; 30:517-31. [DOI: 10.1080/02640414.2011.642809] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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75
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Santos JC. Fast molecular evolution associated with high active metabolic rates in poison frogs. Mol Biol Evol 2012; 29:2001-18. [PMID: 22337863 DOI: 10.1093/molbev/mss069] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Molecular evolution is simultaneously paced by mutation rate, genetic drift, and natural selection. Life history traits also affect the speed of accumulation of nucleotide changes. For instance, small body size, rapid generation time, production of reactive oxygen species (ROS), and high resting metabolic rate (RMR) are suggested to be associated with faster rates of molecular evolution. However, phylogenetic correlation analyses failed to support a relationship between RMR and molecular evolution in ectotherms. In addition, RMR might underestimate the metabolic budget (e.g., digestion, reproduction, or escaping predation). An alternative is to test other metabolic rates, such as active metabolic rate (AMR), and their association with molecular evolution. Here, I present comparative analyses of the associations between life history traits (i.e., AMR, RMR, body mass, and fecundity) with rates of molecular evolution of and mitochondrial loci from a large ectotherm clade, the poison frogs (Dendrobatidae). My results support a strong positive association between mass-specific AMR and rates of molecular evolution for both mitochondrial and nuclear loci. In addition, I found weaker and genome-specific covariates such as body mass and fecundity for mitochondrial and nuclear loci, respectively. No direct association was found between mass-specific RMR and rates of molecular evolution. Thus, I provide a mechanistic hypothesis of the link between AMRs and the rate of molecular evolution based on an increase in ROS within germ line cells during periodic bouts of hypoxia/hyperoxia related to aerobic exercise. Finally, I propose a multifactorial model that includes AMR as a predictor of the rate of molecular evolution in ectothermic lineages.
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Affiliation(s)
- Juan C Santos
- Section of Integrative Biology, The University of Texas at Austin, Austin, TX, USA.
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76
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Wagner PD. Muscle intracellular oxygenation during exercise: optimization for oxygen transport, metabolism, and adaptive change. Eur J Appl Physiol 2011; 112:1-8. [PMID: 21512800 DOI: 10.1007/s00421-011-1955-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 03/29/2011] [Indexed: 01/11/2023]
Abstract
Exercise is the example par excellence of the body functioning as a physiological system. Conventionally we think of the O(2) transport process as a major manifestation of that system linking and integrating pulmonary, cardiovascular, hematological and skeletal muscular contributions to the task of getting O(2) from the air to the mitochondria, and this process has been well described. However, exercise invokes system responses at levels additional to those of macroscopic O(2) transport. One such set of responses appears to center on muscle intracellular PO(2), which falls dramatically from rest to exercise. At rest, it approximates 4 kPa, but during heavy endurance exercise it falls to about 0.4-0.5 kPa, an amazingly low value for a tissue absolutely dependent on the continual supply of O(2) to meet very high energy demands. One wonders why intracellular PO(2) is allowed to fall to such levels. The proposed answer, to be presented in the review, is that a low intramyocyte PO(2) is pivotal in: (a) optimizing oxygen's own physiological transport, and (b) stimulating adaptive gene expression that, after translation, enables greater exercise capacity-all the while maintaining PO(2) at levels sufficient to allow oxidative phosphorylation to operate sufficiently fast enough to support intense muscle contraction. Thus, during exercise, reductions of intracellular PO(2) to less than 1% of that in the atmosphere enables an integrated response that fundamentally and simultaneously optimizes physiological, biochemical and molecular events that support not only the exercise as it happens but the adaptive changes to increase exercise capacity over the longer term.
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77
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Laughlin MH, Korthuis RJ, Duncker DJ, Bache RJ. Control of Blood Flow to Cardiac and Skeletal Muscle During Exercise. Compr Physiol 2011. [DOI: 10.1002/cphy.cp120116] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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78
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Frisbee JC, Goodwill AG, Butcher JT, Olfert IM. Divergence between arterial perfusion and fatigue resistance in skeletal muscle in the metabolic syndrome. Exp Physiol 2010; 96:369-83. [PMID: 21123363 DOI: 10.1113/expphysiol.2010.055418] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The metabolic syndrome is associated with elevated peripheral vascular disease risk, characterized by mismatched blood flow delivery/distribution and local metabolism. The obese Zucker rat (OZR) model of the metabolic syndrome exhibits myriad vascular impairments, although their integrated impact on functional hyperaemia remains unclear. In this study, arterial pressor responses and skeletal muscle perfusion were assessed in lean Zucker rats (LZRs) and OZRs during adrenergic stimulation (phenylephrine), challenge with thromboxane (U46619) and endothelium-dependent dilatation (methacholine). The OZRs were hypertensive compared with the LZRs, but this was abolished by adrenoreceptor blockade (phentolamine); pressor responses to U46619 were similar between strains and were abolished by blockade with the prostaglandin H(2)/thromboxane A(2) receptor antagonist, SQ-29548. Depressor reactivity to methacholine was impaired in OZRs, but was improved by antioxidant treatment (TEMPOL). Across levels of metabolic demand, blood flow to in situ gastrocnemius muscle was restrained by adrenergic constriction in OZRs, although this diminished with increased demand. Oxygen extraction, reduced in OZRs compared with LZRs across levels of metabolic demand, was improved by TEMPOL or SQ-29548; treatment with phentolamine did not impact extraction, and neither TEMPOL nor SQ-29548 improved muscle blood flow in OZRs. While oxygen uptake and muscle performance were consistently reduced in OZRs versus LZRs, treatment with all three agents improved outcomes, while treatment with individual agents was less effective. These results suggest that contributions of vascular dysfunction to perfusion, oxygen uptake and muscle performance are spatially distinct, with adrenergic constriction impacting proximal resistance and endothelial dysfunction impacting distal microvessel-tissue exchange. Further, these data suggest that increasing skeletal muscle blood flow in OZRs is not sufficient to improve performance, unless distal perfusion inhomogeneities are rectified.
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Affiliation(s)
- Jefferson C Frisbee
- Center for Cardiovascular and Respiratory Sciences, Department of Physiology and Pharmacology, West Virginia University Health Sciences Center, 3152 HSN, 1 Medical Center Drive, Morgantown, WV 26506, USA.
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Abstract
In October 1985, 25 years ago, 8 subjects and 27 investigators met at the United States Army Research Institute for Environmental Medicine (USARIEM) altitude chambers in Natick, Massachusetts, to study human responses to a simulated 40-day ascent of Mt. Everest, termed Operation Everest II (OE II). Led by Charlie Houston, John Sutton, and Allen Cymerman, these investigators conducted a large number of investigations across several organ systems as the subjects were gradually decompressed over 40 days to the Everest summit equivalent. There the subjects reached a V(O)(2)max of 15.3 mL/kg/min (28% of initial sea-level values) at 100 W and arterial P(O(2)) and P(CO(2)) of approximately 28 and approximately 10 mm Hg, respectively. Cardiac function resisted hypoxia, but the lungs could not: ventilation-perfusion inequality and O(2) diffusion limitation reduced arterial oxygenation considerably. Pulmonary vascular resistance was increased, was not reversible after short-term hyperoxia, but was reduced during exercise. Skeletal muscle atrophy occurred, but muscle structure and function were otherwise remarkably unaffected. Neurological deficits (cognition and memory) persisted after return to sea level, more so in those with high hypoxic ventilatory responsiveness, with motor function essentially spared. Nine percent body weight loss (despite an unrestricted diet) was mainly (67%) from muscle and exceeded the 2% predicted from energy intake-expenditure balance. Some immunological and lipid metabolic changes occurred, of uncertain mechanism or significance. OE II was unique in the diversity and complexity of studies carried out on a single, courageous cohort of subjects. These studies could never have been carried out in the field, and thus complement studies such as the American Medical Research Expedition to Everest (AMREE) that, although more limited in scope, serve as benchmarks and reality checks for chamber studies like OE II.
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The Physiological Basis of Reduced \documentclass{aastex}\usepackage{amsbsy}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{bm}\usepackage{mathrsfs}\usepackage{pifont}\usepackage{stmaryrd}\usepackage{textcomp}\usepackage{portland,xspace}\usepackage{amsmath,amsxtra}\pagestyle{empty}\DeclareMathSizes{10}{9}{7}{6}
\begin{document}
$$\dot{{\rm V}}{\sc o}_2{\rm max}$$
\end{document} in Operation Everest II. High Alt Med Biol 2010; 11:209-15. [DOI: 10.1089/ham.2009.1058] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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81
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Martin DS, Goedhart P, Vercueil A, Ince C, Levett DZH, Grocott MPW. Changes in sublingual microcirculatory flow index and vessel density on ascent to altitude. Exp Physiol 2010; 95:880-91. [PMID: 20418348 DOI: 10.1113/expphysiol.2009.051656] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We hypothesized that ascent to altitude would result in reduced sublingual microcirculatory flow index (MFI) and increased vessel density. Twenty-four subjects were studied using sidestream dark-field imaging, as they ascended to 5300 m; one cohort remained at this altitude (n = 10), while another ascended higher (maximum 8848 m; n = 14). The MFI, vessel density and grid crossings (GX; an alternative density measure) were calculated. Total study length was 71 days; images were recorded at sea level (SL), Namche Bazaar (3500 m), Everest base camp (5300 m), the Western Cwm (6400 m), South Col (7950 m) and departure from Everest base camp (5300 m; 5300 m-b). Peripheral oxygen saturation (SpO2), heart rate and blood pressure were also recorded. Compared with SL, altitude resulted in reduced sublingual MFI in small (<25 microm; P < 0.0001) and medium vessels (26-50 microm; P = 0.006). The greatest reduction in MFI from SL was seen at 5300 m-b; from 2.8 to 2.5 in small vessels and from 2.9 to 2.4 in medium-sized vessels. The density of vessels <25 microm did not change during ascent, but those >25 microm rose from 1.68 (+/- 0.43) mm mm(-2) at SL to 2.27 (+/- 0.57) mm mm(-2) at 5300 m-b (P = 0.005); GX increased at all altitudes (P < 0.001). The reduction in MFI was greater in climbers than in those who remained at 5300 m in small and medium-sized vessels (P = 0.017 and P = 0.002, respectively). At 7950 m, administration of supplemental oxygen resulted in a further reduction of MFI and increase in vessel density. Thus, MFI was reduced whilst GX increased in the sublingual mucosa with prolonged exposure to hypoxia and was exaggerated in those exposed to extreme altitude.
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Affiliation(s)
- Daniel S Martin
- UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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82
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Meir JU, Champagne CD, Costa DP, Williams CL, Ponganis PJ. Extreme hypoxemic tolerance and blood oxygen depletion in diving elephant seals. Am J Physiol Regul Integr Comp Physiol 2009; 297:R927-39. [PMID: 19641132 DOI: 10.1152/ajpregu.00247.2009] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Species that maintain aerobic metabolism when the oxygen (O(2)) supply is limited represent ideal models to examine the mechanisms underlying tolerance to hypoxia. The repetitive, long dives of northern elephant seals (Mirounga angustirostris) have remained a physiological enigma as O(2) stores appear inadequate to maintain aerobic metabolism. We evaluated hypoxemic tolerance and blood O(2) depletion by 1) measuring arterial and venous O(2) partial pressure (Po(2)) during dives with a Po(2)/temperature recorder on elephant seals, 2) characterizing the O(2)-hemoglobin (O(2)-Hb) dissociation curve of this species, 3) applying the dissociation curve to Po(2) profiles to obtain %Hb saturation (So(2)), and 4) calculating blood O(2) store depletion during diving. Optimization of O(2) stores was achieved by high venous O(2) loading and almost complete depletion of blood O(2) stores during dives, with net O(2) content depletion values up to 91% (arterial) and 100% (venous). In routine dives (>10 min) Pv(O(2)) and Pa(O(2)) values reached 2-10 and 12-23 mmHg, respectively. This corresponds to So(2) of 1-26% and O(2) contents of 0.3 (venous) and 2.7 ml O(2)/dl blood (arterial), demonstrating remarkable hypoxemic tolerance as Pa(O(2)) is nearly equivalent to the arterial hypoxemic threshold of seals. The contribution of the blood O(2) store alone to metabolic rate was nearly equivalent to resting metabolic rate, and mean temperature remained near 37 degrees C. These data suggest that elephant seals routinely tolerate extreme hypoxemia during dives to completely utilize the blood O(2) store and maximize aerobic dive duration.
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Affiliation(s)
- Jessica U Meir
- Center for Marine Biotechnology and Biomedicine, Scripps Institution of Oceanography, University of California San Diego, La Jolla 92093-0204, USA.
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83
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Abstract
Exercise tolerance reflects the integrative capacity of components in the oxygen cascade to supply adequate oxygen for ATP resynthesis. Conventional cancer therapies can simultaneously affect one or more components of this cascade and reduce the body's ability to deliver or utilise oxygen and substrate, leading to exercise intolerance. We propose that molecularly-targeted therapy is associated with a further, more subtle, negative effect on the components that regulate exercise limitation. We outline possible causes of exercise intolerance in patients with cancer and the role of exercise therapy to mitigate or prevent dysfunction. We also discuss possible implications for exercise-regulated gene expression for cancer biology and treatment efficacy. A better understanding of these issues might lead to more effective integration of exercise therapy to optimise the treatment and management of patients with cancer.
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84
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Bourdillon N, Mollard P, Letournel M, Beaudry M, Richalet JP. Non-invasive evaluation of the capillary recruitment in the human muscle during exercise in hypoxia. Respir Physiol Neurobiol 2009; 165:237-44. [DOI: 10.1016/j.resp.2008.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 11/10/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
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85
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Marcora SM. Commentaries on Viewpoint: Evidence that reduced skeletal muscle recruitment explains the lactate paradox during exercise at high altitude. J Appl Physiol (1985) 2009; 106:743-4. [DOI: 10.1152/japplphysiol.zdg-8397-vpcomm.2008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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86
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Howlett RA, Kirkton SD, Gonzalez NC, Wagner HE, Britton SL, Koch LG, Wagner PD. Peripheral oxygen transport and utilization in rats following continued selective breeding for endurance running capacity. J Appl Physiol (1985) 2008; 106:1819-25. [PMID: 18420720 DOI: 10.1152/japplphysiol.00914.2007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Untrained rats selectively bred for either high (HCR) or low (LCR) treadmill running capacity previously demonstrated divergent physiological traits as early as the seventh generation (G7). We asked whether continued selective breeding to generation 15 (G15) would further increase the divergence in skeletal muscle capillarity, morphometry, and oxidative capacity seen previously at G7. At G15, mean body weight was significantly lower (P < 0.001) in the HCR rats (n = 11; 194 +/- 3 g) than in LCR (n = 12; 259 +/- 9 g) while relative medial gastrocnemius muscle mass was not different (0.23 +/- 0.01 vs. 0.22 +/- 0.01% total body weight). Normoxic (Fi(O(2)) = 0.21) Vo(2max) was 50% greater (P < 0.001) in HCR despite the lower absolute muscle mass, and skeletal muscle O(2) conductance (measured in hypoxia; Fi(O(2)) = 0.10) was 49% higher in HCR (P < 0.001). Muscle oxidative enzyme activities were significantly higher in HCR (citrate synthase: 16.4 +/- 0.4 vs. 14.0 +/- 0.6; beta-hydroxyacyl-CoA dehydrogenase: 5.2 +/- 0.2 vs. 4.2 +/- 0.2 mmol.kg(-1).min(-1)). HCR rats had approximately 36% more total muscle fibers and also 36% more capillaries in the medial gastrocnemius. Because average muscle fiber area was 35% smaller, capillary density was 36% higher in HCR, but capillary-to-fiber ratio was the same. Compared with G7, G15 HCR animals showed 38% greater total fiber number with an additional 25% decrease in mean fiber area. These data suggest that many of the skeletal muscle structural and functional adaptations enabling greater O(2) utilization in HCR at G7 continue to progress following additional selective breeding for endurance capacity. However, the largest changes at G15 relate to O(2) delivery to skeletal muscle and not to the capacity of skeletal muscle to use O(2).
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87
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Abstract
This short review addresses modern concepts of oxygen transport and utilization. It consists of two sections. The first deals with the underlying concepts and is largely theoretical. It first presents the transport pathway components as a linked in series system. Then, the way in which the components are integrated to set limits to overall O(2) availability to tissue mitochondria is discussed. It therefore presents a framework for interpreting O(2) transport limitations, both in health and disease. The second section deals with experimental outcomes of studies that address the pathway components and the limitations they may impose on O(2) availability using that framework. Most of these studies have involved exercise in healthy subjects, but some have examined the relationship between O(2) supply and utilization in critically ill patients. An application suitable for intact transgenic mouse phenotyping studies is also proposed.
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Affiliation(s)
- P D Wagner
- Division of Physiology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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88
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Cabrales P, Tsai AG, Intaglietta M. Modulation of perfusion and oxygenation by red blood cell oxygen affinity during acute anemia. Am J Respir Cell Mol Biol 2007; 38:354-61. [PMID: 17884988 PMCID: PMC2258455 DOI: 10.1165/rcmb.2007-0292oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Responses to exchange transfusion using red blood cells (RBCs) with modified hemoglobin (Hb) oxygen (O(2)) affinity were studied in the hamster window chamber model during acute anemia to determine its role on microvascular perfusion and tissue oxygenation. Allosteric effectors were introduced in the RBCs by electroporation. Inositol hexaphosphate (IHP) and 5-hydroxymethyl-2-furfural (5HMF) were used to decrease and increase Hb-O(2) affinity. In vitro P50s (partial pressure of O(2) at 50% Hb saturation) were modified to 10, 25, 45, and 50 mm Hg (normal P50 is 32 mm Hg). Allosteric effectors also decreased the Hill coefficient. Anemic condition was induced by isovolemic hemodilution exchanges using 6% dextran 70 kD to 18% hematocrit (Hct). Modified RBCs (at 18% Hct in 5% albumin solution) were infused by exchange transfusion of 35% of blood volume. Systemic parameters, microvascular perfusion, capillary perfusion (functional capillary density, FCD), and microvascular Po(2) levels were measured. RBcs with P50 of 45 mm Hg increased tissue Po(2) and decreased O(2) delivery (Do(2)) and extraction (Vo(2)) and RBCs with P50 of 60 mmHg reduced FCD, microvascular flow, tissue Po(2), Do(2) and Vo(2). Erythrocytes with increased Hb-O(2) affinity maintained hemodynamic conditions, Do(2) and decreased tissue Po(2). This study shows that in an anemic condition, maximal tissue Po(2) does not correspond to maximal Do(2) and Vo(2).
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Affiliation(s)
- Pedro Cabrales
- La Jolla Bioengineering Institute, 505 Coast Boulevard South, Suite #405, La Jolla, CA 92037, USA.
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89
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Hsia CCW, Johnson RL, Dane DM, Wu EY, Estrera AS, Wagner HE, Wagner PD. The canine spleen in oxygen transport: gas exchange and hemodynamic responses to splenectomy. J Appl Physiol (1985) 2007; 103:1496-505. [PMID: 17673565 DOI: 10.1152/japplphysiol.00281.2007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In athletic animals the spleen induces acute polycythemia by dynamic contraction that releases red blood cells into the circulation in response to increased O(2) demand and metabolic stress; when energy demand is relieved, the polycythemia is rapidly reversed by splenic relaxation. We have shown in adult foxhounds that splenectomy eliminates exercise-induced polycythemia, thereby reducing peak O(2) uptake and lung diffusing capacity for carbon monoxide (DL(CO)) as well as exaggerating preexisting DL(CO) impairment imposed by pneumonectomy (Dane DM, Hsia CC, Wu EY, Hogg RT, Hogg DC, Estrera AS, Johnson RL Jr. J Appl Physiol 101: 289-297, 2006). To examine whether the postsplenectomy reduction in DL(CO) leads to abnormalities in O(2) diffusion, ventilation-perfusion inequality, or hemodynamic function, we studied these animals via the multiple inert gas elimination technique at rest and during exercise at a constant workload equivalent to 50% or 80% of peak O(2) uptake while breathing 21% and 14% O(2) in balanced order. From rest to exercise after splenectomy, minute ventilation was significantly elevated with respect to O(2) uptake compared with exercise before splenectomy; cardiac output, O(2) delivery, and mean pulmonary and systemic arterial blood pressures were 10-20% lower, while O(2) extraction was elevated with respect to O(2) uptake. Ventilation-perfusion inequality was unchanged, but O(2) diffusing capacities of lung (DL(O2)) and peripheral tissue during exercise were lower with respect to cardiac output postsplenectomy by 32% and 25%, respectively. The relationship between DL(O2) and DL(CO) was unchanged by splenectomy. We conclude that the canine spleen regulates both convective and diffusive O(2) transport during exercise to increase maximal O(2) uptake.
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Affiliation(s)
- Connie C W Hsia
- Dept. of Internal Medicine, Univ. of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9034, USA
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Mollard P, Woorons X, Letournel M, Lamberto C, Favret F, Pichon A, Beaudry M, Richalet JP. Determinant factors of the decrease in aerobic performance in moderate acute hypoxia in women endurance athletes. Respir Physiol Neurobiol 2007; 159:178-86. [PMID: 17766196 DOI: 10.1016/j.resp.2007.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 06/23/2007] [Accepted: 06/23/2007] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to evaluate the limiting factors of maximal aerobic performance in endurance trained (TW) and sedentary (UW) women. Subjects performed four incremental tests on a cycle ergometer at sea level and in normobaric hypoxia corresponding to 1000, 2500 and 4500 m. Maximal oxygen uptake decrement (Delta VO2 max) was larger in TW at each altitude. Maximal heart rate and ventilation decreased at 4500 m in TW. Maximal cardiac output remained unchanged. In both groups, arterialized oxygen saturation (Sa'O2 max) decreased at and above 2500 m and maximal O2 transport (QaO2 max) decreased from 1000 m. At 4500 m, there was no more difference in QaO2 max between TW and UW. Mixed venous O2 pressure (PvO2 max) was lower and O2 extraction (O2ERmax) greater in TW at each altitude. The primary determinant factor of VO2 max decrement in moderate acute hypoxia in trained and untrained women is a reduced maximal O2 transport that cannot be compensate by tissue O2 extraction.
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Affiliation(s)
- Pascal Mollard
- Université Paris 13, Laboratoire Réponses cellulaires et fonctionnelles à l'hypoxie, EA2363, ARPE, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France.
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91
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Mollard P, Woorons X, Letournel M, Lamberto C, Favret F, Pichon A, Beaudry M, Richalet JP. Determinants of maximal oxygen uptake in moderate acute hypoxia in endurance athletes. Eur J Appl Physiol 2007; 100:663-73. [PMID: 17534646 DOI: 10.1007/s00421-007-0457-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2007] [Indexed: 10/23/2022]
Abstract
The factors determining maximal oxygen consumption were explored in eight endurance trained subjects (TS) and eight untrained subjects (US) exposed to moderate acute normobaric hypoxia. Subjects performed maximal incremental tests at sea level and simulated altitudes (1,000, 2,500, 4,500 m). Heart rate (HR), stroke volume (SV), cardiac output (.Q), arterialized oxygen saturation (Sa'O2), oxygen uptake (.VO2max), ventilation (.VE, expressed in normobaric conditions) were measured. At maximal exercise, ventilatory equivalent (.VE/.VO2max), O2 transport (.QaO2max) and O2 extraction (O2ERmax) were calculated. In TS, .Qmax remained unchanged despite a significant reduction in HRmax at 4,500 m. SVmax remained unchanged. .VEmax decreased in TS at 4,500 m, .VE/.VO2max was lower in TS and greater at 4,500 m vs. sea level in both groups. Sa'O2max decreased at and above 1,000 m in TS and 2,500 m in US, O2ERmax increased at 4,500 m in both groups. .QaO2max decreased with altitude and was greater in TS than US up to 2,500 m but not at 4,500 m. .VO2max decreased with altitude but the decrement (Delta.VO2max) was larger in TS at 4,500 m. In both groups Delta.VO2max in moderate hypoxia was correlated with Delta.QaO2max. Several differences between the two groups are probably responsible for the greater Delta.VO2max in TS at 4,500 m : (1) the relative hypoventilation in TS as shown by the decrement in .VEmax at 4,500 m (2) the greater.QaO2max decrement in TS due to a lower Sa'O2max and unchanged .Qmax 3) the smaller increase in O2ERmax in TS, insufficient to compensate the decrease in .QaO2max.
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Affiliation(s)
- Pascal Mollard
- Laboratoire Réponses cellulaires et fonctionnelles à l'hypoxie, Université Paris 13, 74 rue Marcel Cachin, EA2363, ARPE, 93017 Bobigny Cedex, France.
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92
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Wagner PD, Wagner HE, Groves BM, Cymerman A, Houston CS. Hemoglobin P(50) during a simulated ascent of Mt. Everest, Operation Everest II. High Alt Med Biol 2007; 8:32-42. [PMID: 17394415 DOI: 10.1089/ham.2006.1049] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The amount of O(2) available to tissues is essentially the product of cardiac output, [Hb], and O(2) saturation. Saturation depends on P(O2) and the O(2)Hb dissociation curve. With altitude, increased [2,3-DPG] shifts the dissociation curve rightward, but hypocapnia and alkalosis move it leftward. We determined both standard and in vivo P(50) in 5 fit subjects decompressed over 42 days in an altitude chamber to the equivalent of the Mt. Everest summit (Operation Everest II). Arterial and venous blood was sampled at five "altitudes " (P(B) = 760, 429, 347, 282, 253 mmHg), and P(O2), P(CO2), pH, O(2) saturation, [Hb] and [2,3-DPG] were measured. As reported previously, 2,3-DPG levels increased from 1.7 (P(B) = 760) to 3.8 mmol/L (P(B) = 282). Standard P(50) also increased (from 28.2 mmHg at sea level to 33.1 on the summit, p<0.001). Alone, this would have lowered saturation by 12 percentage points at a summit arterial P(O2) of approximately 30 mmHg. However, in vivo P(50) remained between 26 and 27 mmHg throughout due to progressive hypocapnia and alkalosis. Calculations suggest that the increase in standard P(50) did not affect summit V(O2 MAX)), alveolar, arterial and venous P(O2)'s, but reduced arterial and venous O(2) saturations by 8.4 and 17.4 points, respectively, and increased O(2) extraction by 7.9 percentage points. Reduced saturation was balanced by increased extraction, resulting in no significant overall O(2) transport benefit, thus leaving unanswered the question of the purpose of increased [2,3-DPG] concentrations at altitude.
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Affiliation(s)
- Peter D Wagner
- Department of Medicine, University of California, San Diego, La Jolla, California 92093-0623, USA.
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93
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Wagner PD. Counterpoint: in health and in normoxic environment VO2max is limited primarily by cardiac output and locomotor muscle blood flow. J Appl Physiol (1985) 2006; 100:745-7; discussion 747-8. [PMID: 16468127 DOI: 10.1152/japplphysiol.01395a.2005] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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94
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Arthur Woods H, Bonnecaze RT. Insect eggs at a transition between diffusion and reaction limitation: Temperature, oxygen, and water. J Theor Biol 2006; 243:483-92. [PMID: 16930626 DOI: 10.1016/j.jtbi.2006.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 06/30/2006] [Accepted: 07/11/2006] [Indexed: 12/01/2022]
Abstract
In diverse animal taxa, eggs and embryos are incapable of transporting oxygen by convection. In such cases, internal oxygen distributions are determined jointly by rates of oxygen consumption and diffusive transport. Here we develop a mathematical model of oxygen consumption and transport in insect eggs, with the goal of understanding-for eggs in variable-temperature environments-the interactive effects of the two processes on development. We fit the model to previously published data on development time of eggs of a sphingid moth, Manduca sexta. The fitted coefficients suggest that eggs develop at a transition point between reaction- and diffusion-limitation. We test then this conclusion with independent data on development times of eggs distributed across a set of temperatures generated by a thermal gradient bar. Finally, we develop an extension of the model that considers tradeoffs between oxygen transfer to eggs versus water loss from them. The model results provide both a rationale for why development is often mass-transfer limited and a set of new predictions about oxygen-water tradeoffs.
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Affiliation(s)
- H Arthur Woods
- Section of Integrative Biology, The University of Texas at Austin, Austin, TX 78712, USA
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95
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Gonzalez NC, Kirkton SD, Howlett RA, Britton SL, Koch LG, Wagner HE, Wagner PD. Continued divergence in VO2max of rats artificially selected for running endurance is mediated by greater convective blood O2 delivery. J Appl Physiol (1985) 2006; 101:1288-96. [PMID: 16777999 DOI: 10.1152/japplphysiol.01527.2005] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We previously showed that after seven generations of artificial selection of rats for running capacity, maximal O2 uptake (VO2max) was 12% greater in high-capacity (HCR) than in low-capacity runners (LCR). This difference was due exclusively to a greater O2 uptake and utilization by skeletal muscle of HCR, without differences between lines in convective O2 delivery to muscle by the cardiopulmonary system (QO2max). The present study in generation 15 (G15) female rats tested the hypothesis that continuing improvement in skeletal muscle O2 transfer must be accompanied by augmentation in QO2max to support VO2max of HCR. Systemic O2 transport was studied during maximal normoxic and hypoxic exercise (inspired PO2 approximately 70 Torr). VO2max divergence between lines increased because of both improvement in HCR and deterioration in LCR: normoxic VO2max was 50% higher in HCR than LCR. The greater VO2max in HCR was accompanied by a 41% increase in QO2max: 96.1 +/- 4.0 in HCR vs. 68.1 +/- 2.5 ml stpd O2 x min(-1) x kg(-1) in LCR (P < 0.01) during normoxia. The greater G15 QO2max of HCR was due to a 48% greater stroke volume than LCR. Although tissue O2 diffusive conductance continued to increase in HCR, tissue O2 extraction was not significantly different from LCR at G15, because of the offsetting effect of greater HCR blood flow on tissue O2 extraction. These results indicate that continuing divergence in VO2max between lines occurs largely as a consequence of changes in the capacity to deliver O2 to the exercising muscle.
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Affiliation(s)
- Norberto C Gonzalez
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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96
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Saltin B, Calbet JAL. Point: In health and in a normoxic environment, V̇o2 max is limited primarily by cardiac output and locomotor muscle blood flow. J Appl Physiol (1985) 2006; 100:744-5. [PMID: 16421282 DOI: 10.1152/japplphysiol.01395.2005] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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97
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Richardson RS, Duteil S, Wary C, Wray DW, Hoff J, Carlier PG. Human skeletal muscle intracellular oxygenation: the impact of ambient oxygen availability. J Physiol 2006; 571:415-24. [PMID: 16396926 PMCID: PMC1796788 DOI: 10.1113/jphysiol.2005.102327] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Intracellular oxygen (O2) availability and the impact of ambient hypoxia have far reaching ramifications in terms of cell signalling and homeostasis; however, in vivo cellular oxygenation has been an elusive variable to assess. Within skeletal muscle the extent to which myoglobin desaturates (deoxy-Mb) and the extent of this desaturation in relation to O2 availability provide an endogenous probe for intracellular O2 partial pressure (P(iO2)). By combining proton nuclear magnetic resonance spectroscopy (1H NMRS) at a high field strength (4 T), assessing a large muscle volume in a highly efficient coil, and extended signal averaging (30 min) we assessed the level of skeletal muscle deoxy-Mb in 10 healthy men (30 +/- 4 years) at rest in both normoxia and hypoxia (10% O2). In normoxia there was an average deoxy-Mb signal of 9 +/- 1%, which, when converted to P(iO2) using an O2/Mb half-saturation (P50) of 3.2 mmHg, revealed an P(iO2) of 34 +/- 6 mmHg. In ambient hypoxia the deoxy-Mb signal rose to 13 +/- 3% (P(iO2) = 23 +/- 6 mmHg). However, intersubject variation in the defence of arterial oxygenation (S(aO2)) in hypoxia (S(aO2) range: 86-67%) revealed a significant relationship between the changes in S(aO2) and P(iO2)(r2 = 0.5). These data are the first to document resting intracellular oxygenation in human skeletal muscle, highlighting the relatively high P(iO2) values that contrast markedly with those previously recorded during exercise (approximately 2-5 mmHg). Additionally, the impact of ambient hypoxia on P(iO2) and the relationship between changes in S(aO2) and P(iO2) stress the importance of the O2 cascade from air to cell that ultimately effects O2 availability and O2 sensing at the cellular level.
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Affiliation(s)
- Russell S Richardson
- Department of Medicine, Physiology Division, 9500 Gilman Drive, University of California, San Diego, La Jolla, CA 92093-0623, USA.
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98
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Ferretti G, Licker MJ, Anchisi S, Moia C, Susta D, Morel DR. The effects of beta1-adrenergic blockade on cardiovascular oxygen flow in normoxic and hypoxic humans at exercise. Eur J Appl Physiol 2005; 95:250-9. [PMID: 16200423 DOI: 10.1007/s00421-005-1393-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2005] [Indexed: 10/25/2022]
Abstract
At exercise steady state, the lower the arterial oxygen saturation (SaO(2)), the lower the O(2) return (QvO(2)). A linear relationship between these variables was demonstrated. Our conjecture is that this relationship describes a condition of predominant sympathetic activation, from which it is hypothesized that selective beta1-adrenergic blockade (BB) would reduce O(2) delivery (QaO(2)) and QvO(2). To test this hypothesis, we studied the effects of BB on QaO(2) and QvO(2) in exercising humans in normoxia and hypoxia. O(2) consumption VO(2), cardiac output Q, CO(2) rebreathing), heart rate, SaO(2) and haemoglobin concentration were measured on six subjects (age 25.5 +/- 2.4 years, mass 78.1 +/- 9.0 kg) in normoxia and hypoxia (inspired O(2) fraction of 0.11) at rest and steady-state exercises of 50, 100, and 150 W without (C) and with BB with metoprolol. Arterial O(2) concentration (CaO(2)), QaO(2) and QvO(2) were then computed. Heart rate, higher in hypoxia than in normoxia, decreased with BB. At each VO(2), Q was higher in hypoxia than in normoxia. With BB, it decreased during intense exercise in normoxia, at rest, and during light exercise in hypoxia. SaO(2) and CaO(2) were unaffected by BB. The QaO(2) changes under BB were parallel to those in Q.QvO(2) was unaffected by exercise in normoxia. In hypoxia the slope of the relationship between QaO(2) and VO(2) was lower than 1, indicating a reduction of QvO(2) with increasing workload. QvO(2) was a linear function of SaO(2) both in C and in BB. The line for BB was flatter than and below that for C. The resting QvO(2) in normoxia, lower than the corresponding exercise values, lied on the BB line. These results agree with the tested hypothesis. The two observed relationships between QvO(2) and SaO(2) apply to conditions of predominant sympathetic or vagal activation, respectively. Moving from one line to the other implies resetting of the cardiovascular regulation.
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Affiliation(s)
- Guido Ferretti
- Département de Physiologie, Centre Médical Universitaire, Geneva, Switzerland.
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Ferreira LF, Poole DC, Barstow TJ. Muscle blood flow–O2 uptake interaction and their relation to on-exercise dynamics of O2 exchange. Respir Physiol Neurobiol 2005; 147:91-103. [PMID: 15848127 DOI: 10.1016/j.resp.2005.02.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Revised: 01/01/2005] [Accepted: 02/04/2005] [Indexed: 11/19/2022]
Abstract
A computer model was developed to provide a theoretical framework for interpreting the dynamics of muscle capillary O(2) exchange in health and disease. We examined the effects of different muscle oxygen uptake (V O(2m)) and CvO(2) profiles on muscle blood flow (Q (m)) kinetics (Q (m)=V O(2m)/[CaO(2)-CvO(2)]). Further, we simulated V O(2m) and Q (m) responses to predict the CvO(2) profile and the underlying dynamics of capillary O(2) exchange (CvO(2)=CaO(2)-V O(2m)/Q (m)). Exponential equations describing V O(2m), CvO(2) and Q (m) responses in vivo were used in the simulations. The results indicated that Q (m) kinetics were relatively insensitive to CvO(2) parameters, but directly associated with V O(2m) kinetics. The biphasic Q (m) response produced a substantial fall in CvO(2) within the first 15-20s of the exercise transition (phase 1 of Q (m)). These results revealed that the main determinant of CvO(2) (or O(2) extraction) kinetics was the dynamic interaction of Q (m) and V O(2m) kinetics during phase 1 of Q (m).
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Affiliation(s)
- Leonardo F Ferreira
- Department of Kinesiology, 1A Natatorium, Kansas State University, Manhattan, KS 66506-0302, USA
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100
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Mortensen SP, Dawson EA, Yoshiga CC, Dalsgaard MK, Damsgaard R, Secher NH, González-Alonso J. Limitations to systemic and locomotor limb muscle oxygen delivery and uptake during maximal exercise in humans. J Physiol 2005; 566:273-85. [PMID: 15860533 PMCID: PMC1464731 DOI: 10.1113/jphysiol.2005.086025] [Citation(s) in RCA: 172] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Reductions in systemic and locomotor limb muscle blood flow and O2 delivery limit aerobic capacity in humans. To examine whether O2 delivery limits both aerobic power and capacity, we first measured systemic haemodynamics, O2 transport and O2 uptake during incremental and constant (372 +/- 11 W; 85% of peak power; mean +/- S.E.M.) cycling exercise to exhaustion (n = 8) and then measured systemic and leg haemodynamics and during incremental cycling and knee-extensor exercise in male subjects (n = 10). During incremental cycling, cardiac output and systemic O2 delivery increased linearly to 80% of peak power (r2 = 0.998, P < 0.001) and then plateaued in parallel to a decline in stroke volume (SV) and an increase in central venous and mean arterial pressures (P < 0.05). In contrast, heart rate and increased linearly until exhaustion (r2 = 0.993; P < 0.001) accompanying a rise in systemic O2 extraction to 84 +/- 2%. In the exercising legs, blood flow and O2 delivery levelled off at 73-88% of peak power, blunting leg per unit of work despite increasing O2 extraction. When blood flow increased linearly during one-legged knee-extensor exercise, per unit of work was unaltered on fatigue. During constant cycling, , SV, systemic O2 delivery and reached maximal values within approximately 5 min, but dropped before exhaustion (P < 0.05) despite increasing or stable central venous and mean arterial pressures. In both types of maximal cycling, the impaired systemic O2 delivery was due to the decline or plateau in because arterial O2 content continued to increase. These results indicate that an inability of the circulatory system to sustain a linear increase in O2 delivery to the locomotor muscles restrains aerobic power. The similar impairment in SV and O2 delivery during incremental and constant load cycling provides evidence for a central limitation to aerobic power and capacity in humans.
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Affiliation(s)
- Stefan P Mortensen
- The Copenhagen Muscle Research Centre, Rigshospitalet, University of Copenhagan, Section 7652, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
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