Effect of ventilation on cerebral oxygenation during exercise: insights from canonical correlation

CO2 supplementation dissociates cerebral oxygenation and middle cerebral artery blood velocity during maximal cycling

This study evaluated whether the reduction of prefrontal cortex oxygenation (ScO₂ ) during maximal exercise depends on the hyperventilation-induced hypocapnic attenuation of middle cerebral artery blood velocity (MCA V_mean ). Twelve endurance-trained males (age: 25 ± 3 years, height: 183 ± 8 cm, weight: 75 ± 9 kg; mean ± SD) performed in three separate laboratory visits, a maximal oxygen uptake (VO₂ max) test, an isocapnic (end-tidal CO₂ tension (PetCO₂ ) clamped at 40 ± 1 mmHg), and an ambient air controlled-pace constant load high-intensity ergometer cycling to exhaustion, while MCA V_mean (transcranial Doppler ultrasound) and ScO₂ (near-infrared spectroscopy) were determined. Duration of exercise (12 min 25 s ± 1 min 18 s) was matched by performing the isocapnic trial first. Pulmonary VO₂ was 90 ± 6% versus 93 ± 5% of the maximal value (P = .012) and PetCO₂ 40 ± 1 versus 34 ± 4 mmHg (P < .05) during the isocapnic and control trials, respectively. During the isocapnic trial MCA V_mean increased by 16 ± 13% until clamping was applied and continued to increase (by 14 ± 28%; P = .017) until the end of exercise, while there was no significant change during the control trial (P = .071). In contrast, ScO₂ decreased similarly in both trials (-3.2 ± 5.1% and -4.1 ± 9.6%; P < .001, isocapnic and control, respectively) at exhaustion. The reduction in prefrontal cortex oxygenation during maximal exercise does not depend solely on lowered cerebral blood flow as indicated by middle cerebral blood velocity.

Shining new light on mammalian diving physiology using wearable near-infrared spectroscopy

Investigation of marine mammal dive-by-dive blood distribution and oxygenation has been limited by a lack of noninvasive technology for use in freely diving animals. Here, we developed a noninvasive near-infrared spectroscopy (NIRS) device to measure relative changes in blood volume and haemoglobin oxygenation continuously in the blubber and brain of voluntarily diving harbour seals. Our results show that seals routinely exhibit preparatory peripheral vasoconstriction accompanied by increased cerebral blood volume approximately 15 s before submersion. These anticipatory adjustments confirm that blood redistribution in seals is under some degree of cognitive control that precedes the mammalian dive response. Seals also routinely increase cerebral oxygenation at a consistent time during each dive, despite a lack of access to ambient air. We suggest that this frequent and reproducible reoxygenation pattern, without access to ambient air, is underpinned by previously unrecognised changes in cerebral drainage. The ability to track blood volume and oxygenation in different tissues using NIRS will facilitate a more accurate understanding of physiological plasticity in diving animals in an increasingly disturbed and exploited environment.

The cerebral venous system and hypoxia

Most hypobaric hypoxia studies have focused on oxygen delivery and therefore cerebral blood inflow. Few have studied venous outflow. However, the volume of blood entering and leaving the skull (∼700 ml/min) is considerably greater than cerebrospinal fluid production (0.35 ml/min) or edema formation rates and slight imbalances of in- and outflow have considerable effects on intracranial pressure. This dynamic phenomenon is not necessarily appreciated in the currently taught static "Monro-Kellie" doctrine, which forms the basis of the "Tight-Fit" hypothesis thought to underlie high altitude headache, acute mountain sickness, and high altitude cerebral edema. Investigating both sides of the cerebral circulation was an integral part of the 2007 Xtreme Everest Expedition. The results of the relevant studies performed as part of and subsequent to this expedition are reviewed here. The evidence from recent studies suggests a relative venous outflow insufficiency is an early step in the pathogenesis of high altitude headache. Translation of knowledge gained from high altitude studies is important. Many patients in a critical care environment develop hypoxemia akin to that of high altitude exposure. An inability to drain the hypoxemic induced increase in cerebral blood flow could be an underappreciated regulatory mechanism of intracranial pressure.

Breathing Techniques Affect Female but Not Male Hip Flexion Range of Motion

Two protocols were undertaken to help clarify the effects of breathing techniques on hamstrings (hip flexion) range of motion (ROM). The protocols examined effects of breathing conditions on ROM and trunk muscle activity. Protocol 1: Thirty recreationally active participants (15 male, 15 female, 20-25 years) were monitored for changes in single-leg raise (SLR) ROM with 7 breathing conditions before or during a passive supine SLR stretch. Breathing conditions included prestretch inhale, prestretch exhale, inhale-during stretch, exhale-during stretch, neutral, hyperventilation, and hypoventilation before stretch. Protocol 2: Eighteen recreationally active participants (9 male, 9 female, 20-25 years) were monitored for electromyographic (EMG) activity of the rectus abdominus, external obliques, lower abdominal stabilizers, and lower erector spinae while performing the 7 breathing conditions before or during a passive SLR stretch. Control exhibited less ROM (p = 0.008) than the prestretch inhale (7.7%), inhale-during stretch (10.9%), and hypoventilation (11.2%) conditions with females. Protocol 3: Greater overall muscle activity in the prestretch exhale condition was found compared with inhale-during stretch (43.1%↓; p = 0.029) and hypoventilation (51.2%↓; p = 0.049) conditions. As the inhale-during stretch and hypoventilation conditions produced the lowest levels of muscle activity for both sexes and the highest ROM for the females, it can be assumed that both mechanical and neural factors affect female SLR ROM. Lesser male ROM might be attributed to anatomical differences such as greater joint stiffness. The breathing techniques may have affected intra-abdominal pressure, trunk muscle cocontractions, and sympathetic neural activity to enhance female ROM.

Peripheral circulation

Blood flow (BF) increases with increasing exercise intensity in skeletal, respiratory, and cardiac muscle. In humans during maximal exercise intensities, 85% to 90% of total cardiac output is distributed to skeletal and cardiac muscle. During exercise BF increases modestly and heterogeneously to brain and decreases in gastrointestinal, reproductive, and renal tissues and shows little to no change in skin. If the duration of exercise is sufficient to increase body/core temperature, skin BF is also increased in humans. Because blood pressure changes little during exercise, changes in distribution of BF with incremental exercise result from changes in vascular conductance. These changes in distribution of BF throughout the body contribute to decreases in mixed venous oxygen content, serve to supply adequate oxygen to the active skeletal muscles, and support metabolism of other tissues while maintaining homeostasis. This review discusses the response of the peripheral circulation of humans to acute and chronic dynamic exercise and mechanisms responsible for these responses. This is accomplished in the context of leading the reader on a tour through the peripheral circulation during dynamic exercise. During this tour, we consider what is known about how each vascular bed controls BF during exercise and how these control mechanisms are modified by chronic physical activity/exercise training. The tour ends by comparing responses of the systemic circulation to those of the pulmonary circulation relative to the effects of exercise on the regional distribution of BF and mechanisms responsible for control of resistance/conductance in the systemic and pulmonary circulations.

Cerebral blood flow and oxygenation at maximal exercise: the effect of clamping carbon dioxide

During exercise, as end-tidal carbon dioxide (P(ET)(CO₂)) drops after the respiratory compensation point (RCP), so does cerebral blood flow velocity (CBFv) and cerebral oxygenation. This low-flow, low-oxygenation state may limit work capacity. We hypothesized that by preventing the fall in P(ET)(CO₂) at peak work capacity (W(max)) with a newly designed high-flow, low-resistance rebreathing circuit, we would improve CBFv, cerebral oxygenation, and W(max). Ten cyclists performed two incremental exercise tests, one as control and one with P(ET)(CO₂) constant (clamped) after the RCP. We analyzed , middle cerebral artery CBFv, cerebral oxygenation, and cardiopulmonary measures. At W(max), when we clamped P(ET)(CO₂) (39.7 ± 5.2 mmHg vs. 29.6 ± 4.7 mmHg, P < 0.001), CBFv increased (92.6 ± 15.9 cm/s vs. 73.6 ± 12.5 cm/s, P < 0.001). However, cerebral oxygenation was unchanged (ΔTSI -21.3 ± 13.1% vs. -24.3 ± 8.1%, P = 0.33), and W(max) decreased (380.9 ± 20.4W vs. 405.7 ± 26.8 W, P < 0.001). At W(max), clamping P(ET)(CO₂) increases CBFv, but this does not appear to improve W(max).

Cerebral oxygenation decreases but does not impair performance during self-paced, strenuous exercise

AIM

The reduction in cerebral oxygenation (Cox) is associated with the cessation of exercise during constant work rate and incremental tests to exhaustion. Yet in exercises of this nature, ecological validity is limited due to work rate being either fully or partly dictated by the protocol, and it is unknown whether cerebral deoxygenation also occurs during self-paced exercise. Here, we investigated the cerebral haemodynamics during a 5-km running time trial in trained runners.

METHODS

Rating of perceived exertion (RPE) and surface electromyogram (EMG) of lower limb muscles were recorded every 0.5 km. Changes in Cox (prefrontal lobe) were monitored via near-infrared spectroscopy through concentration changes in oxy- and deoxyhaemoglobin (Delta[O(2)Hb], Delta[HHb]). Changes in total Hb were calculated (Delta[THb] = Delta[O(2)Hb] + Delta[HHb]) and used as an index of change in regional blood volume.

RESULTS

During the trial, RPE increased from 6.6 +/- 0.6 to 19.1 +/- 0.7 indicating maximal exertion. Cox rose from baseline to 2.5 km ( upward arrowDelta[O(2)Hb], upward arrowDelta[HHb], upward arrowDelta[THb]), remained constant between 2.5 and 4.5 km, and fell from 4.5 to 5 km ( downward arrowDelta[O(2)Hb], upward arrowDelta[HHb], <-->Delta[THb]). Interestingly, the drop in Cox at the end of the trial coincided with a final end spurt in treadmill speed and concomitant increase in skeletal muscle recruitment (as revealed by higher lower limb EMG).

CONCLUSION

Results confirm the large tolerance for change in Cox during exercise at sea level, yet further indicate that, in conditions of self-selected work rate, cerebral deoxygenation remains within a range that does not hinder strenuous exercise performance.