Endurance exercise training is associated with elevated basal sympathetic nerve activity in healthy older humans

The effect of chronic exercise training and acute exercise on power spectral analysis of heart rate variability

Moderate to vigorous physical activity performed regularly is cardioprotective and reduces all-cause mortality, concomitant with increased resting heart rate variability (HRV). However, there are contradictory reports regarding the effects of chronic and acute exercise on nocturnal HRV in those performing exercise well-beyond physical activity guidelines. Therefore, the purpose of this study was to compare the power spectral analysis components of HRV in middle-aged endurance athletes (EA) and recreationally active individuals (REC) and explore acute exercise effects in EA. A total of 119 EA (52, 49-57 years) and 32 REC (56, 52-60 years) were recruited to complete 24 h Holter monitoring (GE SEER 1000) in the absence of exercise. Fifty one EA (52, 49-57 years) then underwent 24 h Holter monitoring following an intense bout of endurance exercise. Power spectral HRV analysis was completed hourly and averaged to quantify morning (1000-1200 h), evening (1900-2100 h), and nocturnal (0200-0400 h) HRV. EA had greater very low frequency (VLF) and low frequency (LF) (both p < 0.001) compared to REC. LF/high frequency (HF) was greater in EA at 0200-0400 h (p = 0.04). Among all participants, the change in HR and HF from 1000-1200 to 0200-0400 h was negatively correlated (r = -0.47, p < 0.001). Following acute exercise in EA, only nocturnal HRV was assessed. VLF (p < 0.001) and HF (p = 0.008) decreased, while LF/HF increased (p = 0.02). These results suggest that in EA, both long-term and acute exercises increase nocturnal sympathovagal activity through an increase in LF and decrease in HF, respectively. Further work is required to understand the mechanism underlying reduced nocturnal HRV in middle-aged EA and the long-term health implications.

Influence of sex and age on the relationship between aerobic fitness and muscle sympathetic nerve activity in healthy adults

We examined the influence of sex and age on the relationship between aerobic fitness and muscle sympathetic nerve activity (MSNA) in healthy adults. Data were assessed from 224 volunteers (88 females), aged 18-76 yr, in whom resting MSNA (microneurography) and peak oxygen uptake (V̇o_2peak; incremental exercise test) were evaluated. When separated into younger (<50 yr) and older (≥50 yr) subgroups, there were inverse relationships between relative V̇o_2peak (mL·kg^-1·min^-1) and MSNA burst frequency in younger males (R² = 0.21, P < 0.0001) and older females (R² = 0.36, P < 0.01), but not older males (R² = 0.05, P = 0.08) or younger females (R² = 0.03, P = 0.14). Similar patterns were observed with absolute V̇o_2peak (L·min^-1) and percent-predicted (based on age, sex, weight, height, and modality), and with burst incidence. Sex and age influence the relationship between aerobic fitness and resting MSNA, and, thus, must be considered as key variables when studying these potential associations; inverse relationships are strongest in younger males and older females.NEW & NOTEWORTHY Our data reveal for the first time that associations between aerobic fitness and resting muscle sympathetic nerve activity are sex and age specific; inverse relationships are evident in younger males (<50 yr) and older females (≥50 yr), but absent in younger females (<50 yr) and older males (≥50 yr).

The association of elevated blood pressure during ischaemic exercise with sport performance in Master athletes with and without morbidity

Background

An exaggerated exercise blood pressure (BP) is associated with a reduced exercise capacity. However, its connection to physical performance during competition is unknown.

Aim

To examine BP responses to ischaemic handgrip exercise in Master athletes (MA) with and without underlying morbidities and to assess their association with athletic performance during the World Master Track Cycling Championships 2019.

Methods

Forty-eight Master cyclists [age 59 ± 13yrs; weekly training volume 10.4 ± 4.1 h/week; handgrip maximum voluntary contraction (MVC) 46.3 ± 11.5 kg] divided into 2 matched groups (24 healthy MA and 24 MA with morbidity) and 10 healthy middle-aged non-athlete controls (age 48.3 ± 8.3 years; MVC 40.4 ± 14.8 kg) performed 5 min of forearm occlusion including 1 min handgrip isometric contraction (40%MVC) followed by 5 min recovery. Continuous beat-by-beat BP was recorded using finger plethysmography. Age-graded performance (AGP) was calculated to compare race performances among MA. Healthy Master cyclists were further grouped into middle-age (age 46.2 ± 6.4 years; N:12) and old-age (age 65.0 ± 7.7 years; N:12) for comparison with middle-aged non-athlete controls.

Results

Healthy and morbidity MA groups showed similar BP responses during forearm occlusion and AGP (90.1 ± 4.3% and 91.0 ± 5.3%, p > 0.05, respectively). Healthy and morbidity MA showed modest correlation between the BP rising slope for 40%MVC ischaemic exercise and AGP (r = 0.5, p < 0.05). MA showed accelerated SBP recovery after cessation of ischaemic handgrip exercise compared to healthy non-athlete controls.

Conclusion

Our findings associate long-term athletic training with improved BP recovery following ischaemic exercise regardless of age or reported morbidity. Exaggerated BP in Master cyclists during ischaemic exercise was associated with lower AGP during the World Master Cycling Championships.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00421-021-04828-9.

Sympathetic vasoconstriction in skeletal muscle: Modulatory effects of aging, exercise training, and sex

The sympathetic nervous system (SNS) is a critically important regulator of the cardiovascular system. The SNS controls cardiac output and its distribution, as well as peripheral vascular resistance and blood pressure at rest and during exercise. Aging is associated with increased blood pressure and decreased skeletal muscle blood flow at rest and in response to exercise. The mechanisms responsible for the blunted skeletal muscle blood flow response to dynamic exercise with aging have not been fully elucidated; however, increased muscle sympathetic nerve activity (MSNA), elevated vascular resistance and a decline in endothelium-dependent vasodilation are commonly reported in older adults. In contrast to aging, exercise training has been shown to reduce blood pressure and enhance skeletal muscle vascular function. Exercise training has been shown to enhance nitric oxide-dependent vascular function and may improve the vasodilatory capacity of the skeletal muscle vasculature; however, surprisingly little is known about the effect of exercise training on the neural control of circulation. The control of blood pressure and skeletal muscle blood flow also differs between males and females. Blood pressure and MSNA appear to be lower in young females compared to males. However, females experience a larger increase in MSNA with aging compared to males. The mechanism(s) for the altered SNS control of vascular function in females remain to be determined. Novelty: • This review will summarize our current understanding of the effects of aging, exercise training and sex on sympathetic vasoconstriction at rest and during exercise. • Areas where additional research is needed are also identified.

Aerobic fitness is inversely associated with neurohemodynamic transduction and blood pressure variability in older adults

Higher aerobic fitness is independently associated with better cardiovascular health in older adults. The transduction of muscle sympathetic nerve activity (MSNA) into mean arterial pressure (MAP) responses provides important insight regarding beat-by-beat neural circulatory control. Aerobic fitness is negatively associated with peak MAP responses to spontaneous MSNA in young males. Whether this relationship exists in older adults is known. We tested the hypothesis that aerobic fitness was inversely related to sympathetic neurohemodynamic transduction and blood pressure variability (BPV) in older adults. Relative peak oxygen consumption (V̇O₂peak, indirect calorimetry) was assessed in 22 older adults (13 males, 65 ± 5 years, 36.3 ± 11.5 ml/kg/min). Peroneal MSNA (microneurography) and arterial pressure (finger photoplethysmography) were recorded during ≥ 10-min of rest. BPV was assessed using the average real variability index. MAP was tracked for 12 cardiac cycles following heartbeats associated with MSNA bursts (i.e., peak ΔMAP). Peak ΔMAP responses (0.9 ± 0.6 mmHg) were negatively associated (all, P < 0.04) with resting burst frequency (30 ± 11 bursts/min; R = -0.47) and burst incidence (54 ± 22 bursts/100 heartbeats; R = -0.51), but positively associated with BPV (ρ = 0.47). V̇O₂peak was inversely related to the pressor responses to spontaneous bursts (R = -0.47, P = 0.03) and BPV (ρ = -0.54, P = 0.01), positively related to burst incidence (R = 0.42, P = 0.05), but unrelated to MSNA burst frequency (P = 0.20). The V̇O₂peak-BPV relationship remained after controlling for burst frequency, peak ΔMAP, age, and sex. Lower V̇O₂peak was associated with augmented neurohemodynamic transduction and BPV in older adults. These negative hemodynamic outcomes highlight the importance of higher aerobic fitness with ageing for optimal cardiovascular health.

Low ventilatory responsiveness to transient hypoxia or breath-holding predicts fast marathon performance in healthy middle-aged and older men

The aim of this study was to test the utility of haemodynamic and autonomic variables (e.g. peripheral chemoreflex sensitivity [PCheS], blood pressure variability [BPV]) for the prediction of individual performance (marathon time and VO_2max) in older men. The post-competition vasodilation and sympathetic vasomotor tone predict the marathon performance in younger men, but their prognostic relevance in older men remains unknown. The peripheral chemoreflex restrains exercise-induced vasodilation via sympathetically-mediated mechanism, what makes it a plausible candidate for the individual performance marker. 23 men aged ≥ 50 year competing in the Wroclaw Marathon underwent an evaluation of: resting haemodynamic parameters, PCheS with two methods: transient hypoxia and breath-holding test (BHT), cardiac barosensitivity, heart rate variability (HRV) and BPV, plasma renin and aldosterone, VO_2max in a cardiopulmonary exercise test (CPET). All tests were conducted twice: before and after the race, except for transient hypoxia and CPET which were performed once, before the race. Fast marathon performance and high VO_2max were correlated with: low ventilatory responsiveness to hypoxia (r =  - 0.53, r = 0.67, respectively) and pre-race BHT (r =  - 0.47, r = 0.51, respectively), (1) greater SD of beat-to-beat SBP (all p < 0.05). Fast performance was related with an enhanced pre-race vascular response to BHT (r =  - 0.59, p = 0.005). The variables found by other studies to predict the marathon performance in younger men: post-competition vasodilation, sympathetic vasomotor tone (LF-BPV) and HRV were not associated with the individual performance in our population. The results suggest that PCheS (ventilatory response) predicts individual performance (marathon time and VO_2max) in men aged ≥ 50 yeat. Although cause-effect relationship including the role of peripheral chemoreceptors in restraining the post-competition vasodilation via the sympathetic vasoconstrictor outflow may be hypothesized to underline these findings, the lack of correlation between individual performance and both, the post-competition vasodilation and the sympathetic vasomotor tone argues against such explanation. Vascular responsiveness to breath-holding appears to be of certain value for predicting individual performance in this population, however.

Greater Influence of Aerobic Fitness on Autonomic Support of Blood Pressure in Young Women Than in Older Women

Aging increases autonomic support of blood pressure; however, the impact of aerobic fitness on autonomic support of blood pressure has not been addressed in women. As such, we hypothesized that aerobic fitness would be related to the change in blood pressure during ganglionic blockade such that women with greater aerobic fitness would have a blunted fall in blood pressure during ganglionic blockade due to increased vagal tone. Thirteen young premenopausal and 13 older postmenopausal women completed a screening visit where aerobic fitness (maximal oxygen consumption, VO_2max) was measured. On a separate study day, participants were instrumented for assessment of muscle sympathetic nerve activity, heart rate (electrocardiography), and beat by beat blood pressure (arterial catheter and pressure transducer) and underwent pharmacological blockade of the autonomic ganglia using trimethaphan camyslate. Heart rate, blood pressure, and muscle sympathetic nerve activity were analyzed before and during ganglionic blockade. In young women, there was a significant relationship between aerobic fitness and the change in blood pressure during ganglionic blockade (r=0.761, P=0.003). In older women, there was no relationship between aerobic fitness and the change in blood pressure during ganglionic blockade (r=-0.106, P=0.73). Measures of heart rate variability were related to fitness in young women, but not older women (root mean square of successive differences between normal heartbeats, r=0.713, P=0.006 versus r=-0.172, P=0.575). Our data suggest that in young women, autonomic support of blood pressure is attenuated in those that are highly fit; however, this relationship is not significant in older women.

Heart rate variability and recovery following maximal exercise in endurance athletes and physically active individuals

The purpose of this study was to determine potential adverse cardiac effects of chronic endurance training by comparing sympathovagal modulation via heart rate variability (HRV) and heart rate recovery (HRR) in middle-aged endurance athletes (EA) and physically active individuals (PA) following maximal exercise. Thirty-six (age, 53 ± 5 years) EA and 19 (age, 56 ± 5 years) PA were recruited to complete a 2-week exercise diary and graded exercise to exhaustion. Time domain and power spectral HRV analyses were completed on recorded R-R intervals. EA had a greater HRR slope following exercise (95% confidence interval, 0.0134-0.0138 vs. 0.0101-0.0104 beats/s; p < 0.001). While EA had greater HRR at 1-5 min after exercise (all p < 0.01), PA and EA did not differ when expressed as a percentage of baseline heart rate (130 ± 19 vs. 139 ± 19; p = 0.2). Root mean square of successive differences in R-R intervals (rest and immediately after exercise) were elevated in EA (p < 0.05). Low-frequency (LF) and high-frequency (HF) spectral components were nonsignificantly elevated after exercise (p = 0.045-0.147) in EA while LF/HF was not different (p = 0.529-0.986). This data suggests greater HRR in EA may arise in part due to a lower resting HR. While nonsignificant elevations in HF and LF in EA produces a LF/HF similar to PA, absolute spectral component modulation differed. These observations require further exploration. Novelty Acute effects of exercise on HRV in EA compared with a relevant control group, PA, are unknown. EA had greater HRR and nonsignificant elevations in LF and HF compared with PA, yet LF/HF was not different. Future work should explore the implications of this observation.

Generalized Poincaré plots analysis of heart period dynamics in different physiological conditions: Trained vs. untrained men

Background

Recently we proposed a new method called generalized Poincaré plot (gPp) analysis which gave a new insight into the pattern of neurocaridac control. In this study we examined potential of gPp method to reveal changes in cardiac neural control in young athletes during three conditions: supine rest, running and relaxation, with respect to untrained subjects.

Methods

This method is based on the quantification of Pearson’s correlation coefficients r(j, k), between symmetrical (j = k) and asymmetrical summed j previous and k following RR intervals up to the 100th order (j,k≤100).

Results

Differences between groups were obtained at all levels of this analysis. The main result is the significant difference of NAI, normalized index of asymmetry, between groups in running, which was originated in different positions of local maxima of r(j, k). Compared with untrained subjects, these findings indicate modified neural control and altered intrinsic heart rate behavior in athletes which are related to some kind of memory mechanism between RR intervals.

Conclusion

Obtained results provide great potential of gPp method analysis in the recognition of changes in neurocardiac control in healthy subjects. Further studies are needed for identification of altered cardiac regulatory mechanisms whose background may be useful in the evaluation of genesis of athletes neurocardiovascular pathology.

Upward resetting of the vascular sympathetic baroreflex in middle-aged male runners

This study focused on the influence of habitual endurance exercise training (i.e., committed runner or nonrunner) on the regulation of muscle sympathetic nerve activity (MSNA) and arterial pressure in middle-aged (50 to 63 yr, n = 23) and younger (19 to 30 yr; n = 23) normotensive men. Hemodynamic and neurophysiological assessments were performed at rest. Indices of vascular sympathetic baroreflex function were determined from the relationship between spontaneous changes in diastolic blood pressure (DBP) and MSNA. Large vessel arterial stiffness and left ventricular stroke volume also were measured. Paired comparisons were performed within each age category. Mean arterial pressure and basal MSNA bursts/min were not different between age-matched runners and nonrunners. However, MSNA bursts/100 heartbeats, an index of baroreflex regulation of MSNA (vascular sympathetic baroreflex operating point), was higher for middle-aged runners (P = 0.006), whereas this was not different between young runners and nonrunners. The slope of the DBP-MSNA relationship (vascular sympathetic baroreflex gain) was not different between groups in either age category. Aortic pulse wave velocity was lower for runners of both age categories (P < 0.03), although carotid β-stiffness was lower only for middle-aged runners (P = 0.04). For runners of both age categories, stroke volume was larger, whereas heart rate was lower (both P < 0.01). In conclusion, we suggest that neural remodeling and upward setting of the vascular sympathetic baroreflex compensates for cardiovascular adaptations after many years committed to endurance exercise training, presumably to maintain arterial blood pressure stability. NEW & NOTEWORTHY Exercise training reduces muscle sympathetic burst activity in disease; this is often extrapolated to infer a similar effect in health. We demonstrate that burst frequency of middle-aged and younger men committed to endurance training is not different compared with age-matched casual exercisers. Notably, well-trained, middle-aged runners display similar arterial pressure but higher sympathetic burst occurrence than untrained peers. We suggest that homeostatic plasticity and upward setting of the vascular sympathetic baroreflex maintains arterial pressure stability following years of training.

Relationship between maximum oxygen uptake and peripheral vasoconstriction in a cold environment

Background

Various individual characteristics affect environmental adaptability of a human. The present study evaluates the relationship between physical fitness and peripheral vasoconstriction in a cold environment.

Methods

Seven healthy male students (aged 22.0 years) participated in this study. Cold exposure tests consisted of supine rest for 60 min at 28 °C followed by 90 min at 10 °C. Rectal and skin temperatures at seven sites, oxygen consumption, and the diameter of a finger vein were measured during the experiment. Metabolic heat production, skin heat conductance, and the rate of vasoconstriction were calculated. Individual maximum oxygen consumption, a direct index of aerobic fitness, was measured on the day following the cold exposure test.

Results

Decreases in temperature of the hand negatively correlated with the changes in rectal temperature. Maximum oxygen consumption and the rate of vasoconstriction are positively correlated. Furthermore, pairs of the following three factors are also significantly correlated: rate of metabolic heat production, skin heat conductance, and the rate of vasoconstriction.

Conclusion

The results of this study suggested that the capacity for peripheral vasoconstriction can be improved by physical exercise. Furthermore, when exposed to a cold environment, fitter individuals could maintain metabolic heat production at the resting metabolic level of a thermoneutral condition, as they correspondingly lost less heat.

Impact of lifelong exercise training on endothelial ischemia-reperfusion and ischemic preconditioning in humans

Reperfusion is essential for ischemic tissue survival, but causes additional damage to the endothelium [i.e., ischemia-reperfusion (I/R) injury]. Ischemic preconditioning (IPC) refers to short repetitive episodes of ischemia that can protect against I/R. However, IPC efficacy attenuates with older age. Whether physical inactivity contributes to the attenuated efficacy of IPC to protect against I/R injury in older humans is unclear. We tested the hypotheses that lifelong exercise training relates to 1) attenuated endothelial I/R and 2) maintained IPC efficacy that protects veteran athletes against endothelial I/R. In 18 sedentary male individuals (SED, <1 exercise h/wk for >20 yr, 63 ± 7 yr) and 20 veteran male athletes (ATH, >5 exercise h/wk for >20 yr, 63 ± 6 yr), we measured brachial artery endothelial function with flow-mediated dilation (FMD) before and after I/R. We induced I/R by 20 min of ischemia followed by 20 min of reperfusion. Randomized over 2 days, participants underwent either 35-min rest or IPC (3 cycles of 5-min cuff inflation to 220 mmHg with 5 min of rest) before I/R. In SED, FMD decreased after I/R [median (interquartile range)]: [3.0% (2.0–4.7) to 2.1% (1.5–3.9), P = 0.046] and IPC did not prevent this decline [4.1% (2.6–5.2) to 2.8% (2.2–3.6), P = 0.012]. In ATH, FMD was preserved after I/R [3.0% (1.7–5.4) to 3.0% (1.9–4.1), P = 0.82] and when IPC preceded I/R [3.2% (1.9–4.2) to 2.8% (1.4–4.6), P = 0.18]. These findings indicate that lifelong exercise training is associated with increased tolerance against endothelial I/R. These protective, preconditioning effects of lifelong exercise against endothelial I/R may contribute to the cardioprotective effects of exercise training.

Cardiovascular Adaptations to Exercise Training

Aerobic exercise training leads to cardiovascular changes that markedly increase aerobic power and lead to improved endurance performance. The functionally most important adaptation is the improvement in maximal cardiac output which is the result of an enlargement in cardiac dimension, improved contractility, and an increase in blood volume, allowing for greater filling of the ventricles and a consequent larger stroke volume. In parallel with the greater maximal cardiac output, the perfusion capacity of the muscle is increased, permitting for greater oxygen delivery. To accommodate the higher aerobic demands and perfusion levels, arteries, arterioles, and capillaries adapt in structure and number. The diameters of the larger conduit and resistance arteries are increased minimizing resistance to flow as the cardiac output is distributed in the body and the wall thickness of the conduit and resistance arteries is reduced, a factor contributing to increased arterial compliance. Endurance training may also induce alterations in the vasodilator capacity, although such adaptations are more pronounced in individuals with reduced vascular function. The microvascular net increases in size within the muscle allowing for an improved capacity for oxygen extraction by the muscle through a greater area for diffusion, a shorter diffusion distance, and a longer mean transit time for the erythrocyte to pass through the smallest blood vessels. The present article addresses the effect of endurance training on systemic and peripheral cardiovascular adaptations with a focus on humans, but also covers animal data.

Endurance training and maximal oxygen consumption with ageing: Role of maximal cardiac output and oxygen extraction

BACKGROUND

The increase in maximal oxygen consumption (VO2max) with endurance training is associated with that of maximal cardiac output (Qmax), but not oxygen extraction, in young individuals. Whether such a relationship is altered with ageing remains unclear. Therefore, we sought systematically to review and determine the effect of endurance training on and the associations among VO2max, Qmax and arteriovenous oxygen difference at maximal exercise (Ca-vO2max) in healthy aged individuals.

DESIGN AND METHODS

We conducted a systematic search of MEDLINE, Scopus and Web of Science, from their inceptions until May 2015 for articles assessing the effect of endurance training lasting 3 weeks or longer on VO2max and Qmax and/or Ca-vO2max in healthy middle-aged and/or older individuals (mean age ≥40 years). Meta-analyses were performed to determine the standardised mean difference (SMD) in VO2max, Qmax and Ca-vO2max between post and pre-training measurements. Subgroup and meta-regression analyses were used to evaluate the associations among SMDs and potential moderating factors.

RESULTS

Sixteen studies were included after systematic review, comprising a total of 153 primarily untrained healthy middle-aged and older subjects (mean age 42-71 years). Endurance training programmes ranged from 8 to 52 weeks of duration. After data pooling, VO2max (SMD 0.89; P < 0.0001) and Qmax (SMD 0.61; P < 0.0001) were increased after endurance training; no heterogeneity among studies was detected. Ca-vO2max was only increased with endurance training interventions lasting more than 12 weeks (SMD 0.62; P = 0.001). In meta-regression, the SMD in Qmax was positively associated with the SMD in VO2max (B = 0.79, P = 0.04). The SMD in Ca-vO2max was not associated with the SMD in VO2max (B = 0.09, P = 0.84).

CONCLUSIONS

The improvement in VO2max following endurance training is a linear function of Qmax, but not Ca-vO2max, through healthy ageing.

Sex differences with aging in nutritive skeletal muscle blood flow: impact of exercise training, nitric oxide, and α-adrenergic-mediated mechanisms

The incidence of cardiovascular disease increases progressively with age, but aging may affect men and women differently. Age-associated changes in vascular structure and function may manifest in impaired nutritive blood flow, although the regulation of nutritive blood flow in healthy aging is not well understood. The purpose of this study was to determine if nitric oxide (NO)-mediated or α-adrenergic-mediated regulation of nutritive skeletal muscle blood flow is impaired with advanced age, and if exercise training improves age-related deficiencies. Nutritive blood flow was monitored in the vastus lateralis of healthy young and aged men and women via the microdialysis-ethanol technique prior to and following seven consecutive days of exercise training. NO-mediated and α-adrenergic-mediated regulation of nutritive blood flow was assessed by microdialysis perfusion of acetylcholine, sodium nitroprusside, N(G)-monomethyl-L-arginine, norepinephrine, or phentolamine. Pretraining nutritive blood flow was attenuated in aged compared with young women (7.39 ± 1.5 vs. 15.5 ± 1.9 ml·100 g(−1)·min(−1), P = 0.018), but not aged men (aged 13.5 ± 3.7 vs. young 9.4 ± 1.3 ml·100 g(−1)·min(−1), P = 0.747). There were no age-associated differences in NO-mediated or α-adrenergic-mediated nutritive blood flow. Exercise training increased resting nutritive blood flow only in young men (9.4 ± 1.3 vs. 19.7 ml·100 g(−1)·min(−1), P = 0.005). The vasodilatory effect of phentolamine was significantly reduced following exercise training only in young men (12.3 ± 6.14 vs. −3.68 ± 3.26 ml·100 g(−1)·min(−1), P = 0.048). In conclusion, the age-associated attenuation of resting nutritive skeletal muscle blood flow was specific to women, while the exercise-induced alleviation of α-adrenergic mediated vasoconstriction that was specific to young men suggests an age-associated modulation of the sympathetic response to exercise training.

Effects of acute and chronic exercise in patients with essential hypertension: benefits and risks

The importance of regular physical activity in essential hypertension has been extensively investigated over the last decades and has emerged as a major modifiable factor contributing to optimal blood pressure control. Aerobic exercise exerts its beneficial effects on the cardiovascular system by promoting traditional cardiovascular risk factor regulation, as well as by favorably regulating sympathetic nervous system (SNS) activity, molecular effects, cardiac, and vascular function. Benefits of resistance exercise need further validation. On the other hand, acute exercise is now an established trigger of acute cardiac events. A number of possible pathophysiological links have been proposed, including SNS, vascular function, coagulation, fibrinolysis, and platelet function. In order to fully interpret this knowledge into clinical practice, we need to better understand the role of exercise intensity and duration in this pathophysiological cascade and in special populations. Further studies in hypertensive patients are also warranted in order to clarify the possibly favorable effect of antihypertensive treatment on exercise-induced effects.

BP regulation VI: elevated sympathetic outflow with human aging: hypertensive or homeostatic?

Though conventional wisdom suggests that a rise in blood pressure is a reality of advancing age, in fact, it appears that progressive elevation in sympathetic activity, not necessarily accompanied by increased blood pressure, is intrinsic to cardiovascular aging in humans. The mechanism behind this elevation would seem to reside in homeostatic cardiovascular regulation; nonetheless, the balance of factors that result in elevated sympathetic outflow with age remains elusive. Age-related increases in sympathetic nervous outflow cannot be fully explained by increases in body mass, body adiposity, or other metabolic factors; interrelations among cardiac output, peripheral resistance, and blood pressure may not reflect a determinative hemodynamic interrelation but rather parallel phenomena; and there is no simple linear relationship between baroreflex control and resting levels of sympathetic activity. In contrast to systemic relationships, available data suggest that elevated sympathetic outflow may derive from the inter-relationship between centrally driven sympatho-excitation and a decline in the ability of sympathetic outflow to effect peripheral vascular responses. This review aims to integrate the current knowledge of mechanisms underlying elevated sympathetic outflow with age. It seeks to synthesize these data in the context of proposing that an age-related decline in the ability of sympathetic outflow to effect regional vascular responses incites a compensatory elevation in resting sympathetic activity to maintain homeostatic balance, presumably to maintain adequate control of blood pressure.

Augmented limb blood flow during neurovascular stress in physically fit women

The study examined whether cardiorespiratory fitness modifies cardiovascular responses by normotensive men and women during the Stroop color-word interference test. Independent of age and an estimate of body fatness, fitness level was positively related (R²  = .39 and .51) to increases in limb blood flow and vascular conductance, coherent with cardiac-vagal withdrawal and a decrease in heart period, among women but not men. Fitness was unrelated to changes in systolic and diastolic blood pressures and muscle sympathetic nerve activity. The augmented hemodynamic responses among fitter women were not consistent with passive vasodilation via withdrawal of sympathetic neural tone. The results encourage further gender comparisons testing whether fitness augments limb blood flow during mental stress by neurohumoral and flow-mediated vasodilatory mechanisms or by increased cardiac output.

Comparison of brachial artery vasoreactivity in elite power athletes and age-matched controls

Elite endurance athletes typically have larger arteries contributing to greater skeletal muscle blood flow, oxygen and nutrient delivery and improved physical performance. Few studies have examined structural and functional properties of arteries in power athletes.

PURPOSE

To compare the size and vasoreactivity of the brachial artery of elite power athletes to age-matched controls. It was hypothesized brachial artery diameters of athletes would be larger, have less vasodilation in response to cuff occlusion, but more constriction after a cold pressor test than age-matched controls.

METHODS

Eight elite power athletes (age = 23 ± 2 years) and ten controls (age = 22 ± 1 yrs) were studied. High-resolution ultrasonography was used to assess brachial artery diameters at rest and following 5 minutes of forearm occlusion (Brachial Artery Flow Mediated Dilation = BAFMD) and a cold pressor test (CPT). Basic fitness measures included a handgrip test and 3-minute step test.

RESULTS

Brachial arteries of athletes were larger (Athletes 5.39 ± 1.51 vs.

CONTROLS

3.73 ± 0.71 mm, p<0.05), had greater vasodilatory (BAFMD%: Athletes: 8.21 ± 1.78 vs.

CONTROLS

5.69 ± 1.56%) and constrictor (CPT %: Athletes: -2.95 ± 1.07 vs.

CONTROLS

-1.20 ± 0.48%) responses, compared to controls. Vascular operating range (VOR = Peak dilation+Peak Constriction) was also greater in athletes (VOR: Athletes: 0.55 ± 0.15 vs.

CONTROLS

0.25 ± 0.18 mm, p<0.05). Athletes had superior handgrip strength (Athletes: 55.92 ± 17.06 vs.

CONTROLS

36.77 ± 17.06 kg, p<0.05) but similar heart rate responses at peak (Athletes: 123 ± 16 vs.

CONTROLS

130 ± 25 bpm, p>0.05) and 1 minute recovery (Athletes: 88 ± 21 vs.

CONTROLS

98 ± 26 bpm, p>0.05) following the step test.

CONCLUSION

Elite power athletes have larger brachial arteries, and greater vasoreactivity (greater vasodilatory and constrictor responses) than age-matched controls, contributing to a significantly greater VOR. These data extend the existence of an 'athlete's artery' as previously shown for elite endurance athletes to elite power athletes, and presents a hypothetical explanation for the functional significance of the 'power athlete's artery'.

Short-term exercise training augments sympathetic vasoconstrictor responsiveness and endothelium-dependent vasodilation in resting skeletal muscle

We tested the hypotheses that 4 wk of exercise training would diminish the magnitude of vasoconstriction in response to sympathetic nerve stimulation and augment endothelium-dependent vasodilation (EDD) in resting skeletal muscle in a training intensity-dependent manner. Sprague-Dawley rats were randomly assigned to sedentary time-control (S), mild- (M; 20 m/min, 5% grade), or heavy-intensity (H; 40 m/min, 5% grade) treadmill exercise groups. Animals trained 5 days/wk for 4 wk with training volume matched between groups. Rats were anesthetized and instrumented for study 24 h after the last training session. Arterial pressure and femoral artery blood flow were measured, and femoral vascular conductance (FVC) was calculated. Lumbar sympathetic chain stimulation was delivered continuously at 2 Hz and in patterns at 20 and 40 Hz. EDD was assessed by the vascular response to intra-arterial bolus injections of ACh. The response (% change FVC) to sympathetic stimulation increased ( P < 0.05) in a training intensity-dependent manner at 2 Hz (S: −20.2 ± 9.8%, M: −34.0 ± 6.7%, and H: −44.9 ± 2.0%), 20 Hz (S: −22.0 ± 10.6%, M: −31.2 ± 8.4%, and H: −42.8 ± 5.9%), and 40 Hz (S: H −24.5 ± 8.5%, M: −35.1 ± 8.9%, H: −44.9 ± 6.5%). The magnitude of EDD also increased in a training intensity-dependent manner ( P < 0.05). These data demonstrate that short-term exercise training augments the magnitude of vasoconstriction in response to sympathetic stimulation and EDD in resting skeletal muscle in a training intensity-dependent manner.

Effect of fitness on reflex sympathetic neurovascular transduction in middle-age men

PURPOSE

Muscle sympathetic nerve activity (MSNA) is increased in older endurance-trained men, yet the reflex sympathetic forearm vasoconstrictor response to graded lower body negative pressure (LBNP) diminishes with age. The aim of this study was to assess the influence of aerobic exercise capacity on this altered neurovascular coupling. We hypothesized that during graded LBNP, the forearm vascular resistance (FVR)-MSNA relationship would be steeper in sedentary versus fit men.

METHODS

We therefore studied 20 healthy middle-age men (age = 52 ± 2 yr, mean ± SE), 10 physically active (FIT) and 10 sedentary (SED) (129% ± 4% vs 85% ± 3% of predicted peak oxygen uptake) during 4 min each of LBNP at -5, -10, -20, and -40 mm Hg, applied in a random order. We determined HR, plasma norepinephrine, and MSNA (microneurography) and derived FVR from blood pressure and forearm blood flow (plethysmography). The FVR-MSNA relationship was determined by linear regression in each group separately, and groups were compared using multiple linear regression.

RESULTS

MSNA burst frequency and FVR at rest and during LBNP (P < 0.003) were similar in the two groups, whereas HR was significantly lower (P < 0.002) both at rest and during LBNP in FIT men (P < 0.05). FVR during LBNP correlated positively with MSNA in the SED group (r = 0.44, P < 0.001) but not in the FIT group (r = 0.19, P = 0.10). Multiple linear regression confirmed that both MSNA (P < 0.001) and fitness level (P = 0.04) contribute to the forearm vascular response.

CONCLUSIONS

Thus, during simulated orthostasis, middle-age SED men exhibit a significant FVR-MSNA relationship, which is not evident in age-matched FIT men. This alteration in neurovascular coupling may potentially affect cardiovascular risk in middle-age men.

Impact of exercise training on arterial wall thickness in humans

Thickening of the carotid artery wall has been adopted as a surrogate marker of pre-clinical atherosclerosis, which is strongly related to increased cardiovascular risk. The cardioprotective effects of exercise training, including direct effects on vascular function and lumen dimension, have been consistently reported in asymptomatic subjects and those with cardiovascular risk factors and diseases. In the present review, we summarize evidence pertaining to the impact of exercise and physical activity on arterial wall remodelling of the carotid artery and peripheral arteries in the upper and lower limbs. We consider the potential role of exercise intensity, duration and modality in the context of putative mechanisms involved in wall remodelling, including haemodynamic forces. Finally, we discuss the impact of exercise training in terms of primary prevention of wall thickening in healthy subjects and remodelling of arteries in subjects with existing cardiovascular disease and risk factors.

Differences in energy expenditure between high- and low-volume training

Several studies have examined energy expenditure in various sports but there is a lack of research on the contribution of exercise and habitual activity during different training periods. This study examined changes in total daily energy expenditure (TDEE) and its components during high- and low-volume training periods. Further, changes in time spent in sedentary, light, moderate and vigorous activity in response to different training volumes were explored. Energy expenditure was measured in 15 male endurance athletes during 2 non-consecutive weeks - 1 week of high volume (>13 hours) training and another week of low volume (<7 hours) training. The SenseWear Pro 3 Armband, individual heart-rate-oxygen consumption regression and indirect calorimetry was used to measure non-exercise activity thermogensis (NEAT), exercise energy expenditure (EEE) and resting metabolic rate, respectively. Time spent at different intensities was assessed using previously established MET cutpoints. TDEE as well as EEE increased significantly with higher training volume, while no difference in NEAT occurred. Further, significantly less time was spent in sedentary activities during the high-volume week. These results suggest that highly trained athletes do not compensate for increased training volume and reduce sedentary activities to allow for more training time.

Age- and fitness-related alterations in vascular sympathetic control

In the current study we explored (1) if there were differences in sympathetic activity and baroreflex function by age, sex, or physical activity status, (2) if any aspect of baroreflex function related to differences in resting sympathetic activity, and (3) if mechanical and/or neural baroreflex components related to differences in integrated baroreflex gain. Electrocardiogram, blood pressure, carotid diameter and muscle sympathetic nerve activity were recorded continuously at rest and during sequential bolus injections of sodium nitroprusside and phenylephrine in 22 young, 21 older sedentary and 10 older trained individuals. Analyses of co-variance were used to examine age, sex and training status differences and to explore the explanatory power of integrated baroreflex gain and its mechanical and neural components. Training status and sex influenced neither resting sympathetic outflow nor sympathetic baroreflex gain components. Older subjects had a smaller mechanical component and a strong tendency towards a greater neural component of the sympathetic baroreflex during both pressure falls and pressure rises. Opposing age-related changes in mechanical and neural components resulted in a smaller integrated gain during pressure falls, but a greater integrated gain during pressure rises in older subjects. Thus, in older individuals, compromised sympathetic activation to pressure falls was owing to the stiffening of barosensory vessels, whereas the more sensitive sympathoinhibition to pressure rise was due to an increased neural control. Enhanced neural control with age, however, did not contribute the increased resting sympathetic outflow, which indicates that these two changes are probably driven by distinct neural mechanisms.

Reduction in alpha-adrenergic receptor-mediated vascular tone contributes to improved arterial compliance with endurance training

BACKGROUND

Regular aerobic exercise improves large artery compliance in middle-aged and older humans. However, the underlying mechanisms are unknown. We tested the hypothesis that the improved central arterial compliance with endurance training is mediated by decreased alpha-adrenergic tone and/or increased endothelial function.

METHODS

Seven sedentary healthy adults (60+/-3 years) underwent systemic alpha-adrenergic blockade (phentolamine) and nitric oxide synthase (NOS) inhibition using N(G)-monomethyl-L-arginine in sequence before and after a 3-month moderate endurance training (walk/jog, 4-5 days/week). Phentolamine was given first to isolate the contribution of nitric oxide to arterial compliance by minimizing reflex suppression of sympathetic tone resulting from systemic NOS inhibition as well as to assess the alpha-adrenergic receptor-mediated modulation of arterial compliance.

RESULTS

Baseline arterial compliance (via simultaneous ultrasound and applanation tonometry on the carotid artery) increased 34+/-12% after exercise training (P<0.01). When alpha-adrenergic blockade was performed, arterial compliance increased 37+/-6% (P<0.01) before the exercise training but did not change significantly after the training. Decreases in arterial compliance from the alpha-adrenergic blockade to the subsequent additional NOS blockade were not different before and after exercise training.

CONCLUSION

Our results suggest that the reduction in alpha-adrenergic receptor-mediated vascular tone contributes to the improved central arterial compliance with endurance training.

Physically Active Lifestyle Enhances Vagal-Cardiac Function but Not Central Autonomic Neural Interaction in Elderly Humans

The cause of the age-related impairment of arterial baroreflex function remains ill-defined; moreover, it is unknown whether this impairment results from aging per se or from an inactive lifestyle associated with aging. In this study, we sought to: 1) determine whether elderly individuals who maintained an active lifestyle had an enhanced carotid baroreflex function as compared with their sedentary counterparts; and 2) determine whether this difference was due in part to altered function of the arterial baroreceptor and/or altered central modulation. Eight healthy, sedentary (SED, 68 ± 2 yr) and eight physically active (ACT, 68 ± 1 yr) elderly men with peak O2 consumption 25.5 ± 1.2 vs 35.7 ± 2.4 ml/min/kg (P < 0.01), respectively, were assessed with carotid baroreceptor (CBR) function using 5s pulses of neck pressure or suction (ranging from +40 to −80 Torr) delivered to the carotid sinus region at rest and during lower body negative pressure (LBNP) of −15 and −40 Torr. Changes in heart rate (HR) and mean arterial pressure (MAP) were assessed for CBR-HR and CBR-MAP gains, respectively. Overall CBR-HR gains in a range of ∼ 120 mmHg of carotid sinus pressure were greater (P < 0.01) in ACT than SED at rest and during LBNP. The derived peak CBR-HR slopes between ACT and SED at rest were −0.32 ± 0.07 vs −0.11 ± 0.02 bpm/mmHg (P = 0.007), respectively. However, there was no statistical difference (P = 0.37) in CBR-MAP gains between the groups. Neither CBR-MAP (P = 0.08) nor CBR-HR (P = 0.41) gain was augmented by LBNP in the elderly. Conclusion: Active lifestyle enhances the CBR-HR reflex sensitivity as a result of the improved vagal-cardiac function in elderly people. Aging is associated with an absence of central autonomic interaction in the control of blood pressure regardless of physical fitness.

Exercise training and sympathetic nervous system activity: evidence for physical activity dependent neural plasticity

1. It has been generally accepted that regular physical activity is associated with beneficial effects on the cardiovascular system. In fact, the idea that exercise maintains cardiovascular health is evident by the direct links between a sedentary lifestyle and the risk of cardiovascular and other disease states. 2. Cardiovascular diseases, such as hypertension and heart failure, are often associated with sympathetic nervous system (SNS) overactivity. Conversely, exercise has been shown to reduce hypertension and decrease elevated SNS activity. In addition, there is evidence that exercise may reduce resting blood pressure and sympathetic outflow in normal individuals. 3. Although somewhat controversial in humans, evidence from animal studies also indicates that exercise training reduces baroreflex-mediated and other forms of sympathoexcitation in normal individuals. Collectively, these data are consistent with the hypothesis that physical activity may decrease, and physical inactivity may increase, the incidence of cardiovascular disease via alterations in SNS activity. Despite the important clinical implications of this possibility, the mechanisms by which exercise alters control of SNS activity remain to be fully elucidated. 4. Recent evidence suggests that central nervous system (CNS) plasticity occurs under a variety of conditions, including varying levels of physical activity. The purpose of the present brief review is to provide evidence that changes within the CNS contribute importantly to altered regulation of the SNS observed following exercise training. The primary hypothesis is that physical activity versus inactivity produces plasticity within neural networks that regulate SNS activity. This hypothesis is supported by published and preliminary data that suggest that exercise training may reduce sympathoexcitation by reducing activation of neurons within cardiovascular regions of the brain. These mechanisms are likely to be important in disease states of sympathetic overactivity and in normal healthy individuals whose risk of cardiovascular disease is reduced by leading an active versus sedentary lifestyle.

Systemic alpha-adrenergic and nitric oxide inhibition on basal limb blood flow: effects of endurance training in middle-aged and older adults

Endurance training improves endothelium-dependent vasodilation, yet it does not increase basal blood flow in the legs. We determined the effects of a 3-mo aerobic exercise intervention on basal leg blood flow and alpha-adrenergic vasoconstriction and nitric oxide (NO) release in seven apparently healthy middle-aged and older adults (60 +/- 3 yr). Basal femoral artery blood flow (via Doppler ultrasound) (pretraining: 354 +/- 29; posttraining: 335 +/- 34 ml/min) and vascular conductance did not change significantly with the exercise training. Before the exercise intervention, femoral artery blood flow increased 32 +/- 16% with systemic alpha-adrenergic blockade (with phentolamine) (P < 0.05), and the addition of nitric oxide synthase (NOS) inhibition using N(G)-monomethyl-L-arginine (L-NMMA) did not affect femoral artery blood flow. After training was completed, femoral artery blood flow increased 47 +/- 7% with alpha-adrenergic blockade (P < 0.01) and then decreased 18 +/- 7% with the subsequent administration of L-NMMA (P < 0.05). Leg vascular conductance showed a greater alpha-adrenergic blockade-induced vasodilation (+1.7 +/- 0.5 to +3.0 +/- 0.5 units, P < 0.05) as well as NOS inhibition-induced vasoconstriction (-0.8 +/- 0.4 to -2.7 +/- 0.7 units, P < 0.05) after the exercise intervention. Resting plasma norepinephrine concentration significantly increased after the training. These results suggest that regular aerobic exercise training enhances NO bioavailability in middle-aged and older adults and that basal limb blood flow does not change with exercise training because of the contrasting influences of sympathetic nervous system activity and endothelium-derived vasodilation on the vasculature.

Regulation of cardiac function during a cold pressor test in athletes and untrained subjects

By using (dP/dt)/P of carotid artery pulse, a non-invasive index of cardiac contractility, we examined the regulatory mechanism of cardiac function during a cold pressor test in athletes and untrained subjects. Twenty-four healthy subjects (9 athletes, 8 untrained subjects, and 7 hyperreactors of 4 athletes and 3 untrained subjects with a rise of 15 mmHg or greater in systolic and/or diastolic blood pressure) underwent the cold pressor test according to Hines and Brown (Am Heart J 11:1-9, 1936): immersion of the right hand in 4 degrees C water for 1 min. Although mean blood pressure increased during the cold stress in all the groups, cardiac function differed. In athletes, heart rate and cardiac contractility caused cardiac output to increase while total peripheral resistance (TPR) did not change. In untrained subjects, however, heart rate and cardiac contractility tended to decrease cardiac output and thus TPR increased. In hyperreactors, heart rate and cardiac contractility increased during cold stress, and also TPR increased. After the end of the test, heart rate and cardiac contractility decreased only in untrained group. The findings that during a cold pressor test heart rate and cardiac contractility are enhanced in athletes but depressed in untrained subjects indicate that the state of physical training influences cardiac sympathetic neural reactivity to cold stress, except for hyperreactors.

Acute sympathetic vasoconstriction at rest and during dynamic exercise in cyclists and sedentary humans

The impact of exercise training on sympathetic activation is not well understood, especially across untrained and trained limbs in athletes. Therefore, in eight sedentary subjects (maximal oxygen consumption = 40 ± 2 ml·kg−1·min−1) and eight competitive cyclists (maximal oxygen consumption= 64 ± 2 ml·kg−1·min−1), we evaluated heart rate, blood pressure, blood flow, vascular conductance, and vascular resistance in the leg and arm during acute sympathetic stimulation [cold pressor test (CPT)]. The CPT was also performed during dynamic leg (knee extensor) or arm (handgrip) exercise at 50% of maximal work rate (WRmax) with measurements in the exercising limb. At rest, the CPT decreased vascular conductance similarly in the leg and arm of sedentary subjects (−33 ± 8% leg, −38 ± 6% arm) and cyclists (−34 ± 4% leg, −31 ± 9% arm), and during exercise CPT-induced vasoconstriction was blunted (i.e., sympatholysis) in both the leg and arm of both groups. However, the magnitude of sympatholysis was significantly different between the arm and leg of the sedentary group (−47 ± 11% arm, −25 ± 8% leg), and it was less in the arm of cyclists (−28 ± 11%) than sedentary controls. Taken together, these data provide evidence that sympathetically mediated vasoconstriction is expressed equally and globally at rest in both sedentary and trained individuals, with a differential pattern of vasoconstriction during acute exercise according to limb and exercise training status.

Increased resting energy expenditure after 40 minutes of aerobic but not resistance exercise

OBJECTIVE

Resting energy expenditure (REE) is increased 24 hours after high-intensity aerobic exercise lasting 60 minutes, whereas results have been inconsistent after resistance training and aerobic exercise of shorter duration. The objective of the study was to compare the effects of 40 minutes of high-intensity aerobic vs. resistance exercise on REE 19 to 67 hours after exercise.

RESEARCH METHODS AND PROCEDURES

REE was compared 19, 43, and 67 hours after 40 minutes of aerobic training (AT; 80% maximum heart rate) or resistance training (RT; 10 repetitions at 80% maximum strength, two sets and eight exercises). Twenty-three black and 22 white women were randomly assigned to AT, RT, or no training (controls). Exercisers trained 25 weeks. REE was measured after a 12-hour fast.

RESULTS

There was a significant time x group interaction for REE when adjusted for fat-free mass and fat mass, with post hoc tests revealing that the 50-kcal difference between 19 and 43 hours (1310 +/- 196 to 1260 +/- 161 kcal) and the 34-kcal difference between 19 and 67 hours (1310 +/- 196 to 1276 +/- 168 kcal) were significant for AT. No other differences were found, including RT (19 hours, 1256 +/- 160; 43 hours, 1251 +/- 160; 67 hours, 1268 +/- 188 kcal). Urine norepinephrine increased with training only in AT. After adjusting for fat-free mass, REE Delta between 19 and both 43 and 67 hours was significantly related to urine norepinephrine (r = 0.76, p < 0.01 and 0.68, p < 0.03, respectively).

DISCUSSION

Consistent with findings on longer duration AT, these results show that 40 minutes of AT elevates REE for 19 hours in trained black and white women. This elevation did not occur with 40 minutes of RT. Results suggest that differences are, in part, due to increased sympathetic tone.

Cardiorespiratory fitness and laboratory stress: a meta-regression analysis

We performed a meta-regression analysis of 73 studies that examined whether cardiorespiratory fitness mitigates cardiovascular responses during and after acute laboratory stress in humans. The cumulative evidence indicates that fitness is related to slightly greater reactivity, but better recovery. However, effects varied according to several study features and were smallest in the better controlled studies. Fitness did not mitigate integrated stress responses such as heart rate and blood pressure, which were the focus of most of the studies we reviewed. Nonetheless, potentially important areas, particularly hemodynamic and vascular responses, have been understudied. Women, racial/ethnic groups, and cardiovascular patients were underrepresented. Randomized controlled trials, including naturalistic studies of real-life responses, are needed to clarify whether a change in fitness alters putative stress mechanisms linked with cardiovascular health.

Chemoreflex and metaboreflex responses to static hypoxic exercise in aging humans

PURPOSE

We tested the hypothesis that aging decreases the contribution of metaboreceptors to sympathetic responses during exercise in hypoxia.

METHODS

We recorded sympathetic nerve traffic to muscle circulation (MSNA), heart rate (HR), blood pressure (BP), minute ventilation (VE), and blood lactate (BL) in 12 older (55 +/- 10 yr) and 12 younger (22 +/- 2 yr) normal subjects during three randomized interventions: isocapnic hypoxia (chemoreflex activation), isometric handgrip exercise (HG) in normoxia (metaboreflex activation), and HG during isocapnic hypoxia (concomitant metaboreflex and chemoreflex activation). All interventions were followed by a forearm circulatory arrest period to allow metaboreflex activation in the absence of exercise and chemoreflex activation.

RESULTS

Older subjects had higher resting MSNA (38 +/- 12 vs 23 +/- 9 bursts per minute; P < 0.01) and BP (P < 0.001). Heart rate, minute ventilation, and blood lactate did not differ (all P > 0.5). MSNA responses to HG in normoxia (P < 0.05) and in hypoxia (P < 0.05) were smaller in the older subjects, but were similar during hypoxia alone. The increase in HR was smaller in the older subjects for all interventions (all P < 0.05). In contrast, the increase in systolic and diastolic BP, VE, and BL were similar in both groups (P > 0.05). During the local circulatory arrest, MSNA and BP remained elevated in both groups after HG in normoxia (P < 0.01) and in hypoxia (P < 0.01), but MSNA changes were smaller in the older subjects (P < 0.05).

CONCLUSION

Aging reduces sympathetic reactivity to isometric handgrip, but does not prevent the metaboreceptors to remain the main determinant of sympathetic activation during exercise in hypoxia.

Reversibility of exercise-induced dendritic attenuation in brain cardiorespiratory and locomotor areas following exercise detraining

It has been shown previously that dendritic branching in cardiorespiratory and locomotor brain areas can be attenuated with exercise training (ET). It was not known whether this process was reversible. Twenty-three (n = 23) male Sprague-Dawley rats were individually caged and divided into two groups: untrained (UN; n = 11) and detrained (DTR; n = 12). DTR were provided with a running wheel at 21 days of age and exercised spontaneously. After 120 days (70 days of ET followed by 50 days of detraining), ET indexes were obtained, including maximal oxygen uptake, percent body fat, resting heart rate, and heart weight-to-body weight ratios. The brain was processed according to a modified Golgi-Cox procedure. Impregnated neurons from the periaqueductal gray (PAG), posterior hypothalamic area (PH), nucleus of the tractus solitarius (NTS), and cuneiform nucleus (CfN) were examined in coronal sections. Neurons were traced using a camera lucida technique and analyzed using the Sholl concentric ring analysis of dendritic branching. t-Tests compared the mean number of intersections per neuron by grouping inner rings, outer rings, and total number of intersections per animal. There were no significant differences between UN and DTR in PH, PAG, CfN, and NTS in the inner rings, outer rings, and total number of intersections per animal. A separate group of animals was used to show that a training effect in the CfN and NTS was present at 56 days of ET. Our results show that dendritic attenuation resulting from 70 days of ET in PH, PAG, CfN, and NTS is completely reversed with 50 days of detraining.

Neuroplastic adaptations to exercise: neuronal remodeling in cardiorespiratory and locomotor areas

Neuronal activity has been shown to be attenuated in cardiorespiratory and locomotor centers of the brain in response to a single bout of exercise in trained (TR) vs. untrained (UN) animals, but the mechanisms remain obscure. Based on this finding, dendritic branching patterns of seven brain areas associated with cardiorespiratory and locomotor activity were examined in TR and UN animals. Twenty-eight male Sprague-Dawley rats were kept in individual cages and divided into TR and UN. TR were provided with a running wheel and exercised spontaneously. After 85 or 120 days, exercise training indexes were obtained, including maximal oxygen consumption, percent body fat, resting heart rate, and heart weight-to-body weight ratios. The brain was removed and processed according to a modified Golgi-Cox procedure. Impregnated neurons from seven brain areas were examined in coronal sections: the periaqueductal gray, posterior hypothalamic area, nucleus of the tractus solitarius, rostral ventrolateral medulla, cuneiform nucleus, nucleus cuneatus, and cerebral cortex. Neurons were traced using a camera lucida technique and analyzed using the Sholl analysis of dendritic branching. t-tests were conducted to compare the mean number of intersections per neuron by grouping inner rings and outer rings and also comparing the total number of intersections per animal. There were significant differences between groups in the posterior hypothalamic area, periaqueductal gray, cuneiform nucleus, and nucleus of the tractus solitarius in the inner rings, outer rings, and the total number of intersections per animal. Our results show that dendritic fields of neurons in important cardiorespiratory and locomotor centers of the brain are attenuated in TR animals.

Sympathetic neural regulation in endurance-trained humans: fitness vs. fatness

We tested the hypothesis that muscle sympathetic nerve activity (MSNA) would be higher in endurance-trained (ET) compared with sedentary (Sed) men with similar levels of total body and abdominal adiposity. We further hypothesized that sympathetic baroreflex gain would be augmented in ET compared with Sed men independent of the level of adiposity. To address this, we measured MSNA (via microneurography), sympathetic and vagal baroreflex responses (the modified Oxford technique), body composition (dual-energy X-ray absorptiometry), and waist circumference (Gulick tape) in Sed ( n = 22) and ET men ( n = 8). The ET men were also compared with a subgroup of Sed men ( n = 6) with similar levels of total body and abdominal adiposity. Basal MSNA was greater in the ET compared with Sed men with similar levels of total body and abdominal adiposity (28 ± 2.0 vs. 21 ± 2.0 bursts/min; P < 0.05) but similar to the larger group of Sed men ( n = 22) with higher total body and abdominal adiposity (vs. 26 ± 3 bursts/min; P > 0.05). In contrast to our hypothesis, sympathetic baroreflex gain was lower in the ET compared with Sed men (−6.4 ± 0.8 vs. −8.4 ± 0.4 arbitrary integrative units·beat−1·mmHg−1; P < 0.05) regardless of the level of adiposity. Taken together, the results of the present study suggest that MSNA is higher in ET compared with Sed men with similar levels of total body and abdominal adiposity. In addition, sympathetic baroreflex gain is lower in ET compared with Sed men. That sympathetic baroreflex gain was lower in ET compared with Sed men regardless of the level of adiposity suggests an influence of the ET state per se.

High energy flux mediates the tonically augmented beta-adrenergic support of resting metabolic rate in habitually exercising older adults

The sympathetic nervous system contributes to resting metabolic rate (RMR) via beta-adrenergic receptor (beta-AR) stimulation of energy metabolism. RMR and beta-AR support of RMR are greater in habitually exercising compared with sedentary older adults possibly due to greater energy flux (magnitude of energy intake and energy expenditure during energy balance). In 10 older adults regularly performing aerobic endurance exercise (mean +/- se, 66 +/- 1 yr) compared with baseline, a reduction in energy flux (via abstention of exercise and proportional reduction in dietary intake) decreased (P < 0.05) energy expenditure (7746 +/- 440 vs. 9630 +/- 662 kJ.d(-1)), caloric intake (7808 +/- 431 vs. 9433 +/- 528 kJ.d(-1)), RMR (5192 +/- 167 vs. 5401 +/- 209 kJ.d(-1)), and skeletal muscle sympathetic nervous system activity (36 +/- 2 vs. 42 +/- 2 bursts.min(-1)). Significant beta-AR support of RMR was observed at baseline (167 +/- 42 kJ.d(-1)) but not during reduced energy flux. The change in RMR from baseline to reduced energy flux was related to the corresponding change in beta-AR support of RMR (r = 0.77, P = 0.009). No changes were observed in seven time controls (69 +/- 3 yr) who maintained energy flux. High energy flux is a key mechanism contributing to the elevated RMR and beta-AR support of RMR in habitually exercising older adults. Maintenance of high energy flux via regular exercise may be an effective strategy for maintaining energy expenditure and preventing age-associated obesity.

Chronic sympathetic activation: consequence and cause of age-associated obesity?

Primary aging in adult humans is associated with a progressive, tonic activation of the peripheral sympathetic nervous system (SNS). The purpose of this SNS activation and its physiological impact are, however, unknown. We hypothesize that the chronic stimulation of the SNS with aging is driven in part by a progressive accumulation of body fat. This "error" is sensed by the central nervous system via increases in adiposity-sensitive humoral signals (e.g., leptin, insulin) that cross the blood-brain barrier, activate subcortical areas involved in the regulation of energy balance (e.g., ventromedial hypothalamus), and stimulate SNS outflow to peripheral tissues. The SNS activation is intended to increase beta-adrenergic thermogenesis in order to expend excess energy as heat rather than by storage of fat. Recent evidence, however, indicates that these adjustments are not effective in augmenting energy expenditure with aging. Indeed, older sedentary adults demonstrate reduced, not increased, beta-adrenergic stimulation of metabolic rate because of reduced tissue responsiveness, presumably mediated by SNS-induced impairment of beta-adrenergic signaling. As a result, age-associated SNS activation, initiated as a consequence of accumulating adiposity with the intent of preventing further fat storage, ironically, may in time evolve into a potential mechanism contributing to the development of obesity with aging.

Pathophysiological changes in the elderly

Demographic data indicate an increasing workload of geriatric anaesthesia due to advancing life expectancy and reduced thresholds for high-invasive and high-risk surgery in the elderly. Chronological and biological age may be inconsistent, and the existence of age-related changes may vary between organ systems in the same individual. Age itself is not an illness, but is the most important contributing factor for perioperative complications and adverse outcome when the overall narrowed margins of organ function reserve are transgressed during the perioperative period. Age-related changes in the cardiovascular, pulmonary, nervous, metabolic and locomotive systems that are frequently present in the elderly are discussed with regard to their potential relevance to anaesthesiology. In conclusion, listing current diagnoses will not be sufficient in the assessment of the geriatric patient because age-related changes do not necessarily manifest as pathological entities. Rather, pre-operative examination should focus on determination of individual margins of organ function reserve.

Baroreflex buffering in sedentary and endurance exercise-trained healthy men

Baroreflex buffering plays an important role in arterial blood pressure control. Previous reports suggest that baroreflex sensitivity may be altered in endurance exercise-trained compared with untrained subjects. It is unknown, however, if in vivo baroreflex buffering is altered in the endurance exercise-trained state in humans. Baroreflex buffering was determined in 36 healthy normotensive men (18 endurance exercise-trained, 41+/-5 [SEM] years; 18 untrained, 41+/-4 years) by measuring the potentiation of the systolic blood pressure responses to a phenylephrine bolus and to incremental phenylephrine infusion during compared with before ganglionic blockade with trimethaphan. The exercise-trained men had a lower resting heart rate and higher maximal oxygen consumption and heart rate variability than the sedentary control subjects (all P=0.01). Mean levels and variability of blood pressure, cardiovagal baroreflex sensitivity (change in heart rate/change in systolic blood pressure), and basal muscle sympathetic nerve activity were not different in the two groups. The systolic blood pressure responses to phenylephrine were not different in the endurance-trained and untrained men before or during ganglionic blockade (P>0.6). Measures of baroreflex buffering with the use of a phenylephrine bolus (3.9+/-0.8 versus 4.0+/-0.7, trained versus untrained, P=0.85) and incremental infusion (2.8+/-0.4 versus 2.5+/-0.6, P=0.67) were similar in the two groups. Baroreflex buffering does not differ in endurance exercise-trained compared with untrained healthy men. These results support the concept that habitual vigorous endurance exercise does not modulate in vivo baroreflex buffering in healthy humans.

Influence of regular exercise on age-related changes in arterial elasticity: mechanistic insights from wall compositions in rat aorta

Arterial stiffness increases with age in healthy sedentary adults. We previously reported that the age-related increases in arterial stiffness are absent or attenuated in regularly exercising adults. However, the mechanism underlying this training effect is unknown. One possibility is that regular exercise minimizes age-related changes in the arterial wall composition of elastin and collagen. To gain insight into this issue, we studied four groups of rats (N = 23): young (42-46 wks) and old (80-84 wks), sedentary and exercise-trained. The exercise group swam 1 hr.d-1, 6 d.wk-1 for 17-21 weeks. There was no significant difference in the incremental elastic modulus between young sedentary and exercise-trained rats. The elastic moduli of the old exercise-trained rats were 31% lower than in the old sedentary controls. As such, the magnitude of age-related increase in the elastic modulus was smaller in the exercise-trained (110%) vs. the sedentary group (151%) (p < 0.05). In both activity groups, elastin content was lower and collagen content was higher in old vs. young rats (p < 0.05). However, there were no significant differences between the two activity groups. These results are not consistent with the hypothesis that regular physical exercise minimizes age-related compositional changes in the arterial wall and attenuates the age-related increase in arterial stiffness.

Sympathetic activity and the heterogenous blood pressure response to exercise training in hypertensives

To test whether changes in sympathetic nervous system (SNS) activity or insulin sensitivity contribute to the heterogeneous blood pressure response to aerobic exercise training, we used compartmental analysis of [3H]norepinephrine kinetics to determine the extravascular norepinephrine release rate (NE2) as an index of systemic SNS activity and determined the insulin sensitivity index (S(I)) by an intravenous glucose tolerance test, before and after 6 mo of aerobic exercise training, in 30 (63 +/- 7 yr) hypertensive subjects. Maximal O2 consumption increased from 18.4 +/- 0.7 to 20.8 +/- 0.7 ml x kg(-1) x min(-1) (P = 0.02). The average mean arterial blood pressure (MABP) did not change (114 +/- 2 vs. 114 +/- 2 mmHg); however, there was a wide range of responses (-19 to +17 mmHg). The average NE2 did not change significantly (2.11 +/- 0.15 vs. 1.99 +/- 0.13 microg x min(-1) x m(-2)), but there was a significant positive linear relationship between the change in NE2 and the change in MABP (r = 0.38, P = 0.04). S(I) increased from 2.81 +/- 0.37 to 3.71 +/- 0.42 microU x 10(-4) x min(-1) x ml(-1) (P = 0.004). The relationship between the change in S(I) and the change in MABP was not statistically significant (r = -0.03, P = 0.89). When the changes in maximal O2 consumption, percent body fat, NE2, and S(I) were considered as predictors of the change in MABP, only NE2 was a significant independent predictor. Thus suppression of SNS activity may play a role in the reduction in MABP and account for a portion of the heterogeneity of the MABP response to aerobic exercise training in older hypertensive subjects.

Tonic sympathetic support of metabolic rate is attenuated with age, sedentary lifestyle, and female sex in healthy adults

We recently demonstrated in young adult humans that the sympathetic nervous system contributes to the control of resting metabolic rate via tonic beta-adrenergic receptor stimulation. In the present follow-up study we determined the respective effects of age, habitual exercise status, and sex on this regulatory mechanism. Resting metabolic rate (ventilated hood, indirect calorimetry) was determined in 55 healthy sedentary or endurance exercise-trained adults, aged 18-35 or 60-75 yr (29 men and 26 women), before (baseline) and during the infusion of either a nonselective beta-adrenergic receptor antagonist (propranolol) or saline (control). Relative to baseline values, during beta-adrenergic receptor antagonism resting metabolic rate adjusted for fat-free mass was reduced to a lesser extent in older (mean +/- SE, -130 +/- 46 kJ/d) compared with young (-297 +/- 46) adults, sedentary (-151 +/- 50) compared with endurance exercise-trained (-268 +/- 46) adults, and women (-105 +/- 33) compared with men (-318 +/- 50; all P < 0.01). Reductions in resting metabolic rate during beta-adrenergic receptor antagonism were positively related to higher baseline resting metabolic rate and plasma catecholamine concentrations and negatively related to adiposity (all P < 0.05). Resting metabolic rate was unchanged in response to saline control in all groups. These results provide experimental support for the hypothesis that aging, sedentary living, and female sex are associated with attenuated sympathetic nervous system support of resting metabolic rate in healthy adult humans.