Gender differences in cardiovascular regulation during recovery from exercise

Sex-Specific Differences in Cardiovascular Adaptations and Risks in Elite Athletes: Bridging the Gap in Sports Cardiology

BACKGROUND

The growing participation of women in competitive sports necessitates a comprehensive understanding of sex-specific cardiovascular adaptations and risks. Historically, research has predominantly focused on male athletes, leaving a gap in knowledge about the unique cardiovascular dynamics of female peers.

HYPOTHESIS

we hypothesized that female athletes exhibit distinct cardiovascular adaptations and face different risks, influenced by physiological, hormonal, and structural differences.

METHODS

A systematic review of the literature was conducted, analyzing studies on cardiovascular responses and adaptations in athletes. Data were extracted on hemodynamic changes, autonomic and neural reflex regulation, cardiac remodeling, and arrhythmias. Comparative analyses were performed to identify sex-specific patterns and discrepancies in cardiovascular health outcomes.

RESULTS

We revealed considerable sex differences in cardiovascular adaptations to athletic training. Female athletes generally have longer QT intervals, greater sinoatrial node automaticity, and enhanced atrioventricular node function compared to males. They also exhibit lower sympathetic activity, lower maximal stroke volumes, and a tendency toward eccentric cardiac remodeling. Conversely, male athletes are more prone to concentric hypertrophy and higher incidences of bradyarrhythmia and accessory pathway arrhythmias. Female athletes are more likely to experience symptomatic atrial fibrillation and face higher procedural complications during catheter ablation.

CONCLUSIONS

Our findings underscore the necessity for sex-specific approaches in sports cardiology. Recognizing and addressing these differences could enhance performance and reduce adverse cardiac events in athletes. Future research should focus on developing tailored screening, prevention, and treatment strategies to bridge the knowledge gap and promote cardiovascular health in both male and female athletes.

The variability of physical enjoyment, physiological responses, and technical-tactical performance according to the bout duration of small-sided games: a comparative study between female and male soccer players

BACKGROUND

This study aimed to compare various factors, namely perceived enjoyment (PE), percentage of peak heart rate (%HRpeak), blood lactate (La), rating of perceived exertion (RPE), and technical-tactical performance among soccer players across different bout durations (CB: continuous bout, MIB: medium intermittent bouts, and SIB: short intermittent bouts) and between male and female players during four-a-side (4vs4) small-sided games (SSGs) including goalkeepers.

METHODS

sixteen female soccer players (age: 20.1 ± 0.5 years old) and sixteen professional male adults (age: 20.7 ± 0.7 years old) participated in the study. SSGs (4vs4) were performed in a CB: (1 × 12 min), and in an interval format: MIB: (2 × 6 min), and SIB: (3 × 4 min) with 2 min of passive recovery. PE was collected after each SSGs. The players' heart rate (HR) was continuously measured, whereas ratings of perceived exertion (RPE) and, blood lactate concentration ([La]) were determined at the end of each SSGs. Technical-tactical performance were analyzed during each session of SSGs. Pitch dimensions were (length x width) (25 × 32 m), and relative space per players was 100 m2.

RESULTS

For female soccer players, medium intermittent bouts (MIB) elicited significantly higher perceived enjoyment (PE) compared to continuous bouts (CB) (p < 0.001) and short intermittent bouts (SIB) (p < 0.01). Conversely, for male soccer players, CB resulted in higher PE compared to MIB (p < 0.001) and SIB (p < 0.001). During CB and MIB, peak heart rate (PeakHR) and percentage of peak heart rate (%HRpeak) were significantly higher in female players compared to SIB (PeakHR: CB: p < 0.001; PeakHR: MIB: p < 0.01; %HRpeak: CB: p < 0.001; %HRpeak: MIB: p < 0.01). Blood lactate (La) and rating of perceived exertion (RPE) were significantly greater in CB compared to MIB (La: p < 0.001; RPE: p < 0.01) and SIB (La: p < 0.001; RPE: p < 0.001) for female players only. For male players, CB resulted in significantly higher PeakHR, %HRpeak, La, and RPE compared to MIB (peak HR: p < 0.01, dunb = 1.35; %HR: p < 0.01; La: p < 0.01; RPE: p < 0.01) and SIB (peak HR: p < 0,01; %HR: p < 0.01; RPE: md = 0.87, p < 0.05). Regarding technical-tactical performance, in female players, the % of successful passes, successful tackles, and successful duels were higher during SIB compared to CB (p < 0.01; p < 0.001; p < 0.001) and MIB compared to CB (p < 0.01; p < 0.001; p < 0.001), while ball loss was lower during SIB compared to CB (p < 0.001) and MIB compared to CB (p < 0.001). In male players, % of successful passes and tackles were higher during CB compared to MIB (p < 0.001 and p < 0.05) and SIB (p < 0.001 and p < 0.05), while CB had a lower % of ball loss compared to MIB (p < 0.01) and SIB (p < 0.001). There was no significant difference in the % of successful duels between the bouts for either gender.

CONCLUSION

This study showed a difference in physical enjoyment between male and female soccer players depending on the bout duration of SSGs. For that, trainers should consider intermittent bouts for female soccer players and continuous bouts for male soccer players when designing SSGs-based training in order to significantly improve PE, training load, and technical-tactical performance.

Effects of intermittent pneumatic compression on the recovery of cardiovascular parameters after repeated sprint exercise

PURPOSE

Intermittent pneumatic compression (IPC) applies gradual pressure to facilitate lymph and blood flow movement to reduce exercise-induced tissue fluid accumulation and plasma volume loss. This study aimed to evaluate the cardiovascular system response during the recovery with IPC compared with passive recovery (Sham).

METHODS

Sixteen volunteers (7 females and 9 males) executed a cycling-based exhausting sprint interval exercise (8 × 20 s all out), followed by a 30-min IPC or Sham condition. Participants performed two trials in a randomised, counterbalanced, and crossover design. Several cardiovascular parameters (blood pressure, heart function, and peripheral vascular resistance) were recorded at baseline (5'), through the recovery protocol (30'), and afterwards (5').

RESULTS

The use of IPC during the recovery phase led to a faster recovery, stated in relative values to pre-exercise, in mean blood pressure (102.5 ± 19.3% vs. 92.7 ± 12.5%; P < 0.001), and cardiac output (139.8 ± 30.0% vs. 146.2 ± 40.2%; P < 0.05) in comparison to Sham condition. Furthermore, during the IPC-based recovery, there was a slower recovery in cardiac pressure change over time (92.5 ± 25.8% vs. 100.5 ± 48.9%; P < 0.05), and a faster return to pre-exercise values in the peripheral vascular resistance (75.2 ± 25.5% vs. 64.8 ± 17.4%; P < 0.001) compared to Sham.

CONCLUSION

The application of IPC after high-intensity exercise promotes the recovery of the cardiovascular system, reducing cardiovascular strain. Future investigations should consider the effects on the sympathetic-parasympathetic balance, such as heart rate variability, to assess further bonds between the use of IPC and autonomous control.

Cardiovascular responses to combined mechanoreflex and metaboreflex activation in healthy adults: effects of sex and low- versus high-hormone phases in females

Females generally have smaller blood pressure (BP) responses to isolated muscle mechanoreflex and metaboreflex activation compared with males, which may explain sex differences in BP responses to voluntary exercise. The mechanoreflex may be sensitized during exercise, but whether mechanoreflex-metaboreflex interactions differ by sex or variations in sex hormones remains unknown. Thirty-one young healthy subjects (females, n = 16) performed unilateral passive cycling (mechanoreflex), active cycling (40% peak Watts), postexercise circulatory occlusion (PECO; metaboreflex), and passive cycling combined with PECO (combined mechanoreflex and metaboreflex activation). Beat-to-beat BP, heart rate, inactive leg vascular conductance, and active leg muscle oxygenation were measured. Ten females underwent exploratory testing during low- and high-hormone phases of their self-reported menstrual cycle or oral contraceptive use. Systolic BP and heart rate responses did not differ between sexes during active cycling [Δ30 ± 9 vs. 29 ± 11 mmHg (males vs. females), P = 0.9; Δ33 ± 8 vs. 35 ± 6 beats/min, P = 0.4] or passive cycling with PECO (Δ26 ± 11 vs. 21 ± 10 mmHg, P = 0.3; Δ14 ± 7 vs. 18 ± 15 beats/min, P = 0.3). Passive cycling with PECO revealed additive, not synergistic, effects for systolic BP [males: Δ23 ± 14 vs. 26 ± 11 mmHg (sum of isolated passive cycling and PECO vs. combined activation); females: Δ26 ± 11 vs. 21 ± 12 mmHg, interaction P = 0.05]. Results were consistent in subset analyses with sex differences in active cycling BP (P > 0.1) and exploratory analyses of hormone phase (P > 0.4). Despite a lack of statistical equivalence, no differences in cardiovascular responses were found during combined mechanoreflex-metaboreflex activation between sexes or hormone levels. These results provide preliminary data regarding the involvement of muscle mechanoreflex-metaboreflex interactions in mediating sex differences in voluntary exercise BP responses.NEW & NOTEWORTHY The muscle mechanoreflex may be sensitized by metabolites during exercise. We show that cardiovascular responses to combined mechanoreflex (passive cycling) and metaboreflex (postexercise circulatory occlusion) activation are primarily additive and do not differ between males and females, or across variations in sex hormones in females. Our findings provide new insight into the contributions of muscle mechanoreflex-metaboreflex interactions as a cause for prior reports that females have smaller blood pressure responses to voluntary exercise.

Sex differences in post-exercise fatigue and function in myalgic encephalomyelitis/chronic fatigue syndrome

To assess biobehavioral sex differences in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) utilizing a low burden exercise protocol, 22 females and 15 males with ME/CFS and 14 healthy controls underwent two six-min walk tests. Fifteen daily assessments were scheduled for fatigue and function ratings and heart monitoring. Six-min walk tests were conducted on days 8 and 9. The ME/CFS group showed high self-report fatigue and impaired physical function, whereas healthy controls did not show fatigue or function abnormalities. In patients, no significant post-exercise changes were found for heart rate variability (HRV); however, heart rate decreased in ME/CFS males from Day 14 to Day 15 (p = 0.046). Female patients showed increased fatigue (p = 0.006) after the initial walk test, but a downward slope (p = 0.008) in fatigue following the second walk test. Male patients showed a decrease in self-report work limitation in the days after exercise (p = 0.046). The healthy control group evidenced a decrease in HRV after the walk tests from Day 9-14 (p = 0.038). This pilot study did not confirm hypotheses that females as compared to males would show slower exercise recovery on autonomic or self-report (e.g. fatigue) measures. A more exertion-sensitive test may be required to document prolonged post-exertional abnormalities in ME/CFS.Trial registration: NCT NCT03331419.

Lean body mass and the cardiovascular system constitute a female-specific relationship

Recent evidence points toward a link between lean body mass (LBM) and cardiovascular capacity in women. This study aimed at determining the sex-specific relationship of LBM with central and peripheral circulatory variables in healthy women and men (n=70) matched by age (60±12 years versus 58±15 years), physical activity, and cardiovascular risk factors. Regional (legs, arms, and trunk) and whole-body (total) body composition were assessed via dual-energy x-ray absorptiometry. Cardiac structure, function, and central/peripheral hemodynamics were measured via transthoracic echocardiography and the volume-clamp method at rest and peak incremental exercise. Regression analyses determined sex-specific relationships between LBM and cardiovascular variables. Regional and total LBM were lower in women than men (P<0.001), with little overlap between sexes. Leg and arm LBM positively associated with left ventricular (LV) internal resting dimensions in women (r≥0.53, P≤0.002) but not men (P≥0.156). Leg, arm, and total LBM only associated with LV relaxation in women (r≥0.43, P≤0.013). All LBM variables strongly associated with LV volumes at peak exercise in women (r≥0.54, P≤0.001) but not men and negatively associated with total peripheral resistance at peak exercise in women (r≥0.43, P≤0.023). Adjustment by adiposity-related or cardiovascular risk factors did not alter results. In conclusion, leg and arm LBM independently associate with internal cardiac dimensions, ventricular relaxation, and systemic vascular resistance in a sex-specific manner, with these relationships exclusively present in women.

Considerations for Sex-Cognizant Research in Exercise Biology and Medicine

As the fields of kinesiology, exercise science, and human movement developed, the majority of the research focused on male physiology and extrapolated findings to females. In the medical sphere, basing practice on data developed in only males resulted in the removal of drugs from the market in the late 1990s due to severe side effects (some life-threatening) in females that were not observed in males. In response to substantial evidence demonstrating exercise-induced health benefits, exercise is often promoted as a key modality in disease prevention, management, and rehabilitation. However, much like the early days of drug development, a historical literature knowledge base of predominantly male studies may leave the exercise field vulnerable to overlooking potentially key biological differences in males and females that may be important to consider in prescribing exercise (e.g., how exercise responses may differ between sexes and whether there are optimal approaches to consider for females that differ from conventional approaches that are based on male physiology). Thus, this review will discuss anatomical, physiological, and skeletal muscle molecular differences that may contribute to sex differences in exercise responses, as well as clinical considerations based on this knowledge in athletic and general populations over the continuum of age. Finally, this review summarizes the current gaps in knowledge, highlights the areas ripe for future research, and considerations for sex-cognizant research in exercise fields.

Exercise Recovery Practices of Wheelchair Court Sports Athletes

ABSTRACT

Murphy, CJ, Mason, BS, and Goosey-Tolfrey, VL. Exercise recovery practices of wheelchair court sports athletes. J Strength Cond Res 35(2): 366-372, 2021-Research that describes the recovery practices of Para-athletes around training and competition is limited. This study investigated if and why athletes in wheelchair court sports (basketball, rugby, and tennis) use recovery strategies, what type of strategies are used, and whether the period of the season influences the prevalence of use. A cross-sectional questionnaire was developed to acquire data pertaining to individual characteristics, recovery habits, reasons for use/nonuse, the use of specific recovery strategies, and lifestyle habits. One hundred forty-four athletes (92 = international and 52 = national/club) completed the questionnaire online. In total, 85% (n = 122) of athletes reported using at least one type of recovery strategy, yet most specific types of recovery strategies were not popular (<34% of recovery strategy users). The most commonly used type of recovery strategy was stretching (n = 117), whereas both stretching and heat-related recovery were the most highly rated types of recovery strategies (μ = 4.2/5). The 3 most prevalent reasons for use across all strategies were "reduces muscle soreness," "reduces muscle tightness," and "reduces muscle spasms." The prevalence of sleep complaints was apparent with 38% (n = 55) of respondents reporting difficulties sleeping. This study highlights that although the frequent use of well-known recovery practices is positive, the lack of diversity in strategies implemented may have implications due to the specific requirements of exercise recovery. Therefore, strength and conditioning professionals should educate wheelchair athletes further around this area and increase the range of recovery-specific and impairment-specific strategies used.

Cardiac sympathetic activity during recovery as an indicator of sympathetic activity during task performance

The goals of this research were to analyze cardiac sympathetic recovery patterns and evaluate whether sympathetic cardiac responses to a task challenge can be predicted using residual cardiac activity measured directly after the task (that is, during the recovery period). In two studies (total N = 181), we measured cardiac sympathetic activity, quantified as pre-ejection period and RB interval, during both task performance and the 2-min recovery period following the task. Additional analyses examined effects on the RZ interval. We found that sympathetic recovery from a task was rather quick: Cardiovascular recovery occurred within the first 30 s of the recovery period. Nevertheless, residual cardiac activity during the recovery period had predictive power for task-related cardiac activity. This suggests that sympathetic cardiac activity during recovery may serve as a useful indicator of task-related cardiac sympathetic activity. We discuss the implications of these findings for practical applications and the design of future studies.

Effects of ACEi and ARB on post-exercise hypotension induced by exercises conducted at different times of day in hypertensive men

BACKGROUND

Post-exercise hypotension (PEH) is greater after evening than morning exercise, but antihypertensive drugs may affect the evening potentiation of PEH. Objective: To compare morning and evening PEH in hypertensives receiving angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB).

METHODS

Hypertensive men receiving ACEi (n = 14) or ARB (n = 15) underwent, in a random order, two maximal exercise tests (cycle ergometer, 15 watts/min until exhaustion) with one conducted in the morning (7 and 9 a.m.) and the other in the evening (8 and 10 p.m.). Auscultatory blood pressure (BP) was assessed in triplicate before and 30 min after the exercises. Changes in BP (post-exercise - pre-exercise) were compared between the groups and the sessions using a two-way mixed ANOVA and considering P < .05 as significant.

RESULTS

In the ARB group, systolic BP decrease was greater after the evening than the morning exercise, while in the ACEi group, it was not different after the exercises conducted at the different times of the day. Additionally, after the evening exercise, systolic BP decrease was lower in the ACEi than the ARB group (ARB = -11 ± 8 vs -6 ± 6 and ACEi = -6 ± 7 vs. -8 ± 5 mmHg, evening vs. morning, respectively, P for interaction = 0.014).

CONCLUSIONS

ACEi, but not ARB use, blunts the greater PEH that occurs after exercise conducted in the evening than in the morning.

Gender Differences in Hemodynamic Regulation and Cardiovascular Adaptations to Dynamic Exercise

Exercise is a major challenge for cardiovascular apparatus since it recruits chronotropic, inotropic, pre-load, and afterload reserves. Regular physical training induces several physiological adaptations leading to an increase in both cardiac volume and mass. It appears that several gender-related physiological and morphological differences exist in the cardiovascular adjustments and adaptations to dynamic exercise in humans. In this respect, gender may be important in determining these adjustments and adaptations to dynamic exercise due to genetic, endocrine, and body composition differences between sexes. Females seem to have a reduced vasoconstriction and a lower vascular resistance in comparison to males, especially after exercise. Significant differences exist also in the cardiovascular adaptations to physical training, with trained women showing smaller cardiac volume and wall thickness compared with male athletes. In this review, we summarize these differences.

Heart Rate Recovery After Exercise in Outpatients with Coronary Heart Disease: Role of Depressive Symptoms and Positive Affect

Heart rate recovery after 1 min of exercise cessation (HRR-1) is an important prognostic factor in patients with cardiovascular disease (CVD). We aimed to further elucidate the association between HRR-1 and known psychosocial risk factors in patients referred for comprehensive cardiac rehabilitation. We examined 521 patients with coronary heart disease in the first week of an outpatient cardiac rehabilitation program. Depressive and anxiety symptoms were measured with the Hospital Anxiety and Depression Scale, and positive (PA) and negative affect were rated with the Global Mood Scale. Depressive symptoms showed a significant inverse relationship with HRR-1 (p < .05), controlling for sociodemographic and medical covariates, whereas anxiety symptoms did not show a significant association. PA made a significant contribution to HRR-1 as well (p < .05). Our findings suggest an independent association between HRR-1 and psychosocial risk factors of CVD.

Physical Demands of Multimodal Training Competitions and Their Relationship to Measures of Performance

Jagim, AR, Rader, O, Jones, MT, and Oliver, JM. Physical demands of multimodal training competitions and their relationship to measures of performance. J Strength Cond Res 31(5): 1212-1220, 2017-The purpose of this study was to identify the physical demands of multimodal training (MMT) competitions and to determine the extent of their relationship to select measures of performance. Eighteen (>1.5 years of strength training experience) men (n = 10) and women (n = 8) (mean ± SD; age: 37.8 ± 10.6 years, height: 172.8 ± 8 cm, weight: 77.4 ± 13.2 kg, 16.6 ± 6% body fat) with experience performing MMT participated in a simulated MMT competition. All participants were assessed for body composition, countermovement vertical jump, and aerobic capacity during baseline testing. All participants then participated in a simulated MMT-style competition on a separate day within 10 days of baseline testing. The simulated MMT-style competition consisted of 3 events with 90 minutes of recovery allowed in between events. During the events, changes in blood lactate (La), heart rate (HR), and estimated V[Combining Dot Above]O2 were recorded. Bivariate (Pearson) correlations were computed to determine if a relationship existed between traditional measures of performance and those of the MMT-style competition. Significance was set at p ≤ 0.05. Mean change in La ranged between 9 and 12 mmol·L during the events. Mean HR and estimated V[Combining Dot Above]O2 values ranged from 145 to 172 b·min and 24 to 35 ml·kg·min, respectively, during the events. A strong correlation was observed (r = -0.722; p < 0.001) between aerobic capacity and time to completion for event 1. There was a strong correlation between lean body mass and lower-body strength performance (r = 0.882; p < 0.001) and time to completion for event 3 (r = -0.792; p < 0.001). A strong correlation was observed between lower-body power and time to completion for event 1 (r = -0.755; p < 0.001) and event 3 (r = -0.818; p < 0.001). Based on the results of this study, MMT-style competitions appear to be physically demanding activities performed at a high intensity with a great involvement of the anaerobic energy system and that some measures of aerobic capacity and power correlate with performance. When training for MMT-style competitions, it may be beneficial to focus on improving lower-body power and/or aerobic capacity.

Sex comparisons in muscle sympathetic nerve activity and arterial pressure oscillations during progressive central hypovolemia

Increased tolerance to central hypovolemia is generally associated with greater sympathoexcitation, high-frequency oscillatory patterns of mean arterial pressure (MAP), and tachycardia. On average, women are less tolerant to central hypovolemia than men; however, the autonomic mechanisms governing these comparisons are not fully understood. We tested the hypothesis that women with relatively high tolerance (HT) to central hypovolemia would display similar physiological reserve capacity for sympathoexcitation and oscillations in MAP at presyncope compared to HT men. About 10 men and five women were exposed to progressive lower body negative pressure (LBNP) until the presence of presyncopal symptoms. Based on our previous classification system, all subjects were classified as HT because they completed at least −60 mmHg LBNP. Muscle sympathetic serve activity (MSNA) was measured directly from the peroneal nerve via microneurography and arterial pressure (AP) was measured at the finger by photoplethysmography. LBNP time to presyncope was less (P < 0.01) in women (1727 ± 70 sec) than in men (2022 ± 201 sec). At presyncope, average MSNA in men (50 ± 12 bursts/min) and women (51 ± 7 bursts/min) was similar (P = 0.87). Coincident with similar stroke volume (SV) at presyncope, women had similar MAP and heart rates. However, women had less physiological reserve capacity for SV, AP-MSNA coherence, and oscillations in the high-frequency (HF) components of arterial pressure compared to men. Contrary to our hypothesis, lower tolerance to central hypovolemia in women was not associated with sympathoexcitation, but can be explained, in part by lower physiological reserve to elicit oscillatory patterns in AP, maintenance of AP-MSNA coherence and SV when compared to men.

Influence of population and exercise protocol characteristics on hemodynamic determinants of post-aerobic exercise hypotension

Due to differences in study populations and protocols, the hemodynamic determinants of post-aerobic exercise hypotension (PAEH) are controversial. This review analyzed the factors that might influence PAEH hemodynamic determinants, through a search on PubMed using the following key words: “postexercise” or “post-exercise” combined with “hypotension”, “blood pressure”, “cardiac output”, and “peripheral vascular resistance”, and “aerobic exercise” combined only with “blood pressure”. Forty-seven studies were selected, and the following characteristics were analyzed: age, gender, training status, body mass index status, blood pressure status, exercise intensity, duration and mode (continuous or interval), time of day, and recovery position. Data analysis showed that 1) most postexercise hypotension cases are due to a reduction in systemic vascular resistance; 2) age, body mass index, and blood pressure status influence postexercise hemodynamics, favoring cardiac output decrease in elderly, overweight, and hypertensive subjects; 3) gender and training status do not have an isolated influence; 4) exercise duration, intensity, and mode also do not affect postexercise hemodynamics; 5) time of day might have an influence, but more data are needed; and 6) recovery in the supine position facilitates systemic vascular resistance decrease. In conclusion, many factors may influence postexercise hypotension hemodynamics, and future studies should directly address these specific influences because different combinations may explain the observed variability in postexercise hemodynamic studies.

Daily exercise prescription on the basis of HR variability among men and women

PURPOSE

To test the utility of HR variability (HRV) in daily exercise prescription in moderately active (approximately two exercises per week) men and women.

METHODS

A total of 21 men and 32 women were divided into standard training (ST: males = 7 and females = 7), HRV-guided training (HRV-I: males = 7 and females = 7; HRV-II: females = 10), and control (males = 7 and females = 8) groups. The 8-wk aerobic training period included 40-min exercises at moderate and vigorous intensities (70% and 85% of maximal HR). The ST group was instructed to perform two or more sessions at moderate and three or more sessions at vigorous intensity weekly. HRV-I and HRV-II groups trained on the basis of changes in HRV, measured every morning. In the HRV-I group, an increase or no change in HRV resulted in vigorous-intensity training on that day. Moderate-intensity exercise or rest was prescribed if HRV had decreased. The HRV-II group performed a vigorous-intensity exercise only when HRV had increased. Peak oxygen consumption (VO2peak) and maximal workload (Loadmax) were measured by a maximal bicycle ergometer test before and after the intervention.

RESULTS

The changes in VO2peak did not differ between the training groups either in men or in women. In men, the change in Loadmax was higher in the HRV-I group than in the ST group (30 +/- 8 vs 18 +/- 10 W, P = 0.033). In women, no differences were found in the changes in Loadmax between the training groups (18 +/- 10, 15 +/- 11, and 18 +/- 5 W for ST, HRV-I, and HRV-II, respectively). The HRV-II group performed fewer vigorous-intensity exercises than the ST and HRV-I groups (1.8 +/- 0.3 vs 2.8 +/- 0.6 and 3.3 +/- 0.2 times per week, respectively, P < 0.01 for both).

CONCLUSIONS

HRV measurements are beneficial in exercise training prescription in moderately active men and women. Women benefit from HRV guidance by achieving significant improvement in fitness with a lower training load.

Menstrual cycle and oral contraceptive use do not modify postexercise heat loss responses

It is unknown whether menstrual cycle or oral contraceptive (OC) use influences nonthermal control of postexercise heat loss responses. We evaluated the effect of menstrual cycle and OC use on the activation of heat loss responses during a passive heating protocol performed pre- and postexercise. Women without OC (n = 8) underwent pre- and postexercise passive heating during the early follicular phase (FP) and midluteal phase (LP). Women with OC (n = 8) underwent testing during the active pill consumption (high exogenous hormone phase, HH) and placebo (low exogenous hormone phase, LH) weeks. After a 60-min habituation at 26 degrees C, subjects donned a liquid conditioned suit. Mean skin temperature was clamped at approximately 32.5 degrees C for approximately 15 min and then gradually increased, and the absolute esophageal temperature at which the onset of forearm vasodilation (Th(vd)) and upper back sweating (Th(sw)) were noted. Subjects then cycled for 30 min at 75% Vo(2 peak) followed by a 15-min seated recovery. A second passive heating was then performed to establish postexercise values for Th(vd) and Th(sw). Between 2 and 15 min postexercise, mean arterial pressure (MAP) remained significantly below baseline (P < 0.05) by 10 +/- 1 and 11 +/- 1 mmHg for the FP/LH and LP/HH, respectively. MAP was not different between cycle phases. During LP/HH, Th(vd) was 0.16 +/- 0.24 degrees C greater than FP/LH preexercise (P = 0.020) and 0.15 +/- 0.23 degrees C greater than FP/LH postexercise (P = 0.017). During LP/HH, Th(sw) was 0.17 +/- 0.23 degrees C greater than FP/LH preexercise (P = 0.016) and 0.18 +/- 0.16 degrees C greater than FP/LH postexercise (P = 0.001). Postexercise thresholds were significantly greater (P < or = 0.001) than preexercise during both FP/LH (Th(vd), 0.22 +/- 0.03 degrees C; Th(sw), 0.13 +/- 0.03 degrees C) and LP/HH (Th(vd), 0.21 +/- 0.03 degrees C; Th(sw), 0.14 +/- 0.03 degrees C); however, the effect of exercise was similar between LP/HH and FP/LH. No effect of OC use was observed. We conclude that neither menstrual cycle nor OC use modifies the magnitude of the postexercise elevation in Th(vd) and Th(sw).

Hyperthermia modifies the nonthermal contribution to postexercise heat loss responses

PURPOSE

This study investigated the nonthermoregulatory control of cutaneous vascular conductance (CVC) and sweating during recovery from exercise-induced hyperthermia as well as possible sex-related differences in these responses. Two hypotheses were tested in this study: 1) active and passive recovery would be more effective in attenuating the fall in mean arterial pressure (MAP) than inactive recovery, but CVC and sweat rate responses would be similar between all recovery modes; and 2) the magnitude of the change in postexercise heat loss and hemodynamic responses between recovery modes would be similar between sexes.

METHODS

Nine males and nine females were rendered hyperthermic (esophageal temperature = 39.5 degrees C) by exercise, followed by 60 min of 1) active, 2) inactive, and 3) passive recovery. CVC, sweat rate, and MAP were recorded at baseline, after 2, 5, 12, and 20 min, and at every 10 min until the end of recovery.

RESULTS

MAP was elevated above inactive recovery by 6 +/- 2 and 4 +/- 1 mm Hg for active and passive recovery, respectively (P < 0.001). No differences were observed between modes during the initial 10 min of recovery for CVC and 50 min of recovery for sweat rate. However, relative to inactive recovery CVC and sweat rate were subsequently greater by 16.2 +/- 5.8% of CVCpeak and 0.28 +/- 0.04 mg.min.cm, respectively, during active recovery, and by 11.6 +/- 2.9% of CVCpeak and 0.23 +/- 0.03 mg.min.cm, respectively, during passive recovery.

CONCLUSION

We conclude that in the presence of a greater thermal drive associated with hyperthermia, the influence of nonthermal input on postexercise heat loss responses is still observed. However, thermal control predominates over nonthermal factors in the first 10 min of recovery for CVC and for up to 50 min postexercise for sweating. Sex did not influence the effect of recovery mode on any variable.

Human heat balance during postexercise recovery: separating metabolic and nonthermal effects

Previous studies report greater postexercise heat loss responses during active recovery relative to inactive recovery despite similar core temperatures between conditions. Differences have been ascribed to nonthermal factors influencing heat loss response control since elevations in metabolism during active recovery are assumed to be insufficient to change core temperature and modify heat loss responses. However, from a heat balance perspective, different rates of total heat loss with corresponding rates of metabolism are possible at any core temperature. Seven male volunteers cycled at 75% of V̇o2peak in the Snellen whole body air calorimeter regulated at 25.0°C, 30% relative humidity (RH), for 15 min followed by 30 min of active (AR) or inactive (IR) recovery. Relative to IR, a greater rate of metabolic heat production (Ṁ − Ẇ) during AR was paralleled by a greater rate of total heat loss (ḢL) and a greater local sweat rate, despite similar esophageal temperatures between conditions. At end-recovery, rate of body heat storage, that is, [(Ṁ − Ẇ) − ḢL] approached zero similarly in both conditions, with Ṁ − Ẇ and ḢL elevated during AR by 91 ± 26 W and 93 ± 25 W, respectively. Despite a higher Ṁ − Ẇ during AR, change in body heat content from calorimetry was similar between conditions due to a slower relative decrease in ḢL during AR, suggesting an influence of nonthermal factors. In conclusion, different levels of heat loss are possible at similar core temperatures during recovery modes of different metabolic rates. Evidence for nonthermal influences upon heat loss responses must therefore be sought after accounting for differences in heat production.

Lower body negative pressure exercise plus brief postexercise lower body negative pressure improve post-bed rest orthostatic tolerance

Orthostatic intolerance follows actual weightlessness and weightlessness simulated by bed rest. Orthostasis immediately after acute exercise imposes greater cardiovascular stress than orthostasis without prior exercise. We hypothesized that 5 min/day of simulated orthostasis [supine lower body negative pressure (LBNP)] immediately following LBNP exercise maintains orthostatic tolerance during bed rest. Identical twins (14 women, 16 men) underwent 30 days of 6° head-down tilt bed rest. One of each pair was randomly selected as a control, and their sibling performed 40 min/day of treadmill exercise while supine in 53 mmHg (SD 4) [7.05 kPa (SD 0.50)] LBNP. LBNP continued for 5 min after exercise stopped. Head-up tilt at 60° plus graded LBNP assessed orthostatic tolerance before and after bed rest. Hemodynamic measurements accompanied these tests. Bed rest decreased orthostatic tolerance time to a greater extent in control [34% (SD 10)] than in countermeasure subjects [13% (SD 20); P < 0.004]. Controls exhibited cardiac stroke volume reduction and relative cardioacceleration typically seen after bed rest, yet no such changes occurred in the countermeasure group. These findings demonstrate that 40 min/day of supine LBNP treadmill exercise followed immediately by 5 min of resting LBNP attenuates, but does not fully prevent, the orthostatic intolerance associated with 30 days of bed rest. We speculate that longer postexercise LBNP may improve results. Together with our earlier related studies, these ground-based results support spaceflight evaluation of postexercise orthostatic stress as a time-efficient countermeasure against postflight orthostatic intolerance.

Postexercise heat loss and hemodynamic responses during head-down tilt are similar between genders

PURPOSE

We evaluated the hypothesis that during recovery from dynamic exercise in the 15 degrees head-down tilt (HDT) position, the attenuation of the fall in mean arterial pressure (MAP), cutaneous vascular conductance (CVC), and sweat rate, and the augmentation of the rate of esophageal temperature (T(es)) decay relative to the upright seated (URS) posture, would be different between males and females.

METHODS

Fourteen subjects (seven males, seven females) performed two experimental protocols: 1) 15 min of cycle ergometry at 75% VO2peak and then 60 min of recovery in the URS posture; or 2) 15 min of cycle ergometry at 75% VO2peak and then 60 min of recovery in the 15 degrees HDT position. Mean skin temperature, Tes, CVC, sweat rate, cardiac output (CO), stroke volume (SV), heart rate (HR), total peripheral resistance (TPR), and MAP were recorded at baseline; end of exercise; 2 min, 5 min, 8 min, 12 min, 15 min, and 20 min after exercise; and every 5 min until the end of recovery (60 min).

RESULTS

During recovery from exercise, we observed significantly greater values for MAP, CVC, and sweat rate with HDT in comparison with the URS recovery posture (P <or= 0.05). The magnitude of these responses to HDT did not differ between genders, and a significantly lower T(es) was subsequently observed with HDT for the duration of recovery (P <or= 0.05) for both males and females. In the URS posture, females showed a greater decrease of postexercise MAP than did males (P <or= 0.05). At the end of 60 min of recovery, T(es) remained significantly elevated above baseline with the URS recovery posture (P <or= 0.05). With HDT, T(es) returned to baseline after 20 min.

CONCLUSION

HDT attenuates the reductions in MAP, CVC, and sweat rate observed after exercise in a gender-independent manner, and this likely is attributable to a nonthermal baroreceptor influence.

Evidence of a greater onset threshold for sweating in females following intense exercise

We evaluated the hypothesis that females would show a greater postexercise hypotension and concurrently a greater increase in the onset threshold for sweating. Fourteen subjects (7 males and 7 females) of similar age, body composition, and fitness status participated in the study. Esophageal temperature was monitored as an index of core temperature while sweat rate was measured by using a ventilated capsule placed on the upper back. Subjects cycled at either 60% (moderate) or 80% (intense) of peak oxygen consumption (VO2speak) followed by 20-min recovery. Subjects then donned a liquid-conditioned suit used to regulate mean skin temperature. The skin was then heated (approximately 4.3 degrees C.h(-1)) until sweating occurred. Esophageal temperatures were similar to baseline before the start of whole body warming for all conditions. The postexercise threshold values for sweating following moderate and intense exercise were an esophageal temperature increase of 0.10+/-0.02 and 0.22+/-0.04 degrees C, respectively for males, and 0.15+/-0.03 and 0.34+/-0.01 degrees C, respectively for females. All were elevated above baseline resting (P<0.05) and a significant sex-related difference was observed for sweating threshold values following intense exercise (P<0.05). This was paralleled by a greater decrease in mean arterial pressure in females at the end of the 20-min recovery (P<0.05). In conclusion, females demonstrate a greater postexercise onset threshold for sweating, which is paralleled by a greater postexercise hypotensive response following intense exercise.

Disturbance of thermal homeostasis following dynamic exercise

Recovery from dynamic exercise results in significant perturbations of thermoregulatory control. These perturbations evoke a prolonged elevation in core body temperature and a concomitant decrease in sweating, skin blood flow, and skin temperature to pre-exercise baseline values within the early stages of recovery. Cutaneous vasodilation and sweating are critical responses necessary for effective thermoregulation during heat stress in humans. The ability to modulate the rate of heat loss through adjustments in vasomotor and sudomotor activity is a fundamental mechanism of thermoregulatory homeostasis. There is a growing body of evidence in support of a possible relationship between hemodynamic changes postexercise and heat loss responses. Specifically, nonthermoregulatory factors, such as baroreceptors, associated with hemodynamic changes, influence the regulation of core body temperature during exercise recovery. The following review will examine the etiology of the post-exercise disturbance in thermal homeostasis and evaluate possible thermal and nonthermal factors associated with a prolonged hyperthermic state following exercise.

Sex differences in postexercise esophageal and muscle tissue temperature response

Factors associated with blood pressure regulation during recovery from exercise dramatically influence core temperature regulation. However, it is unknown whether sex-related differences in postexercise hemodynamics affect core and muscle temperature response. Sixteen participants (8 males, 8 females) completed an incremental isotonic test on a Kin-Com isokinetic apparatus to determine their activity-specific peak oxygen consumption during bilateral knee extensions (V̇o2sp). On a separate day, participants performed 15 min of isolated bilateral knee extensions at a moderate (60% V̇o2sp) exercise intensity followed by a 90-min recovery. Esophageal temperature (Tes), mean arterial pressure (MAP), muscle temperature at four depths in the active vastus medialis (TVM) and three depths in the inactive triceps brachii (TTB) were measured concurrently with sweat rate and cutaneous vascular conductance (CVC). Relative to the preexercise resting Tes of 36.7°C (SD 0.1), between 10 and 50-min of recovery Tes was 0.19°C (SD 0.02) higher for females than males ( P = 0.037). All measurements of TVM (0.036 > P > 0.014) and TTB (0.048 > P > 0.008) were higher for females during the initial 30 min of recovery by between 0.46°C and 0.64°C for TVM and by between 0.53°C and 0.70°C for TTB. In parallel, females showed a 5 to 7 mmHg greater reduction in MAP during recovery relative to males ( P = 0.002) and a significantly lower CVC ( P = 0.020) and sweat rate ( P = 0.034). Therefore, it is concluded that females demonstrate a greater and more prolonged elevation in postexercise esophageal temperature and active and inactive muscle temperatures, which is paralleled by a greater postexercise hypotensive response.

Effects of the menstrual cycle and sex on postexercise hemodynamics

Factors associated with the menstrual cycle, such as the endogenous hormones estrogen and progesterone, have dramatic effects on cardiovascular regulation. It is unknown how this affects postexercise hemodynamics. Therefore, we examined the effects of the menstrual cycle and sex on postexercise hemodynamics. We studied 14 normally menstruating women [24.0 (4.2) yr; SD] and 14 men [22.5 (3.5) yr] before and through 90 min after cycling at 60% .VO2(peak) for 60 min. Women were studied during their early follicular, ovulatory, and mid-luteal phases; men were studied once. In men and women during all phases studied, mean arterial pressure was decreased after exercise throughout 60 min (P < 0.001) postexercise and returned to preexercise values at 90 min (P = 0.089) postexercise. Systemic vascular conductance was increased following exercise in both sexes throughout 60 min (P = 0.005) postexercise and tended to be elevated at 90 min postexercise (P = 0.052), and femoral vascular conductance was increased following exercise throughout 90 min (P < 0.001) postexercise. Menstrual phase and sex had no effect on the percent reduction in arterial pressure (P = 0.360), the percent rise in systemic vascular conductance (P = 0.573), and the percent rise in femoral vascular conductance (P = 0.828) from before to after exercise, nor did the pattern of these responses differ across recovery with phase or sex. This suggests that postexercise hemodynamics are largely unaffected by sex or factors associated with the menstrual cycle.

The influence of menstrual cycle phase upon postexercise hypotension

PURPOSE

Postexercise hypotension (PEH) has been observed in males and females; however, the impact of menstrual cycle phase upon PEH has not been evaluated. We examined the pattern of PEH in the early follicular (EF), late follicular (LF), and midluteal (ML) phases of the menstrual cycle in eight eumenorrheic women following 30 min of exercise at 80% lactate threshold.

METHODS

Supine hemodynamic measurements were assessed at rest and then for 45 min following exercise. Blood pressure was measured with manual sphygmomanometry, calf vascular resistance (CVR) via venous occlusion plethysmography, and central hemodynamics with echocardiography.

RESULTS

Cardiovascular parameters did not differ between menstrual phases at rest (P > 0.05). The pattern of PEH was unaffected by menstrual phase, but mean arterial and diastolic (DBP) pressures dropped to significantly lower levels across the recovery period in the EF phase than in the LF and ML phases (mean DBP EF: 69 +/- 4; LF 74 +/- 3; ML 72 +/- 5; P < 0.05). Postexercise cardiac output, stroke volume, ejection fraction, left ventricular dimensions, and heart rate did not differ across menstrual phases (P > 0.05). These parameters, except for left ventricular dimensions in systole and heart rate, varied with recovery time, increasing to a peak between 5 and 10 min postexercise (P < 0.05). CVR displayed a significant interaction between cycle phase and recovery time as resistance increased to greater values in the ML phase compared with the EF and LF phases following 30 min of postexercise recovery (P < 0.05).

CONCLUSION

Buffering of PEH appears to be enhanced in the LF and ML phases of the cycle where estrogen concentrations are known to be elevated.

Effects of Gender on Physiological Responses during Submaximal Exercise and Recovery

PURPOSE

This investigation was conducted to compare the physiological responses of men and women, both during and following an exercise bout at the same relative submaximal intensity.

METHODS

Ten untrained men (20.7+/-0.5 yr, 178.4+/-2.3 cm, 79.6+/-4.8 kg; mean+/-SE) and 10 untrained women (20.3+/-0.3 yr, 163.8+/-2.2 cm, 59.5+/-2.1 kg) cycled for 30 min at 60-65% of their predetermined peak oxygen uptake. Physiological variables were measured before exercise, at 15 and 30 min of exercise, and at 5 and 15 min postexercise. For each variable of interest, a two-way repeated-measures of analysis was used to assess the main effects of gender and time, along with potential interactive effects.

RESULTS

Our data revealed that for many variables including HR, relative HR (% peak value), mean arterial pressure, and rectal temperature, men and women responded similarly both during exercise and throughout the recovery period. In contrast, significant (P<or=0.05) gender-related differences were noted for RER, plasma lactate, systolic blood pressure, and plasma volume shifts. In each of those variables, values displayed by men during exercise were significantly greater than those observed among women. However, with the exception of plasma lactate, those gender-related differences did not persist into recovery.

CONCLUSION

During exercise of the same relative submaximal intensity, some physiological parameters responded likewise in young men and young women, whereas others did not. Among those variables that demonstrated significant gender-related differences, all but one (plasma lactate) were obscured within 5 min of postexercise recovery.

Differences in the postexercise threshold for cutaneous active vasodilation between men and women

The purpose of this study was to evaluate the possible differences in the postexercise cutaneous vasodilatory response between men and women. Fourteen subjects (7 men and 7 women) of similar age, body composition, and fitness status remained seated resting for 15 min or cycled for 15 min at 70% of peak oxygen consumption followed by 15 min of seated recovery. Subjects then donned a liquid-conditioned suit. Mean skin temperature was clamped at ∼34°C for 15 min. Mean skin temperature was then increased at a rate of 4.3 ± 0.8°C/h while local skin temperature was clamped at 34°C. Skin blood flow was measured continuously at two forearm skin sites, one with (UT) and without (BT) (treated with bretylium tosylate) intact α-adrenergic vasoconstrictor activity. The exercise threshold for cutaneous vasodilation in women (37.51 ± 0.08°C and 37.58 ± 0.04°C for UT and BT, respectively) was greater than that measured in men (37.33 ± 0.06°C and 37.35 ± 0.06°C for UT and BT, respectively) ( P < 0.05). Core temperatures were similar to baseline before the start of whole body warming for all conditions. Postexercise heart rate (HR) for the men (77 ± 4 beats/min) and women (87 ± 6 beats/min) were elevated above baseline (61 ± 3 and 68 ± 4 beats/min for men and women, respectively), whereas mean arterial pressure (MAP) for the men (84 ± 3 mmHg) and women (79 ± 3 mmHg) was reduced from baseline (93 ± 3 and 93 ± 4 mmHg for men and women, respectively) ( P < 0.05). A greater increase in HR and a greater decrease in the MAP postexercise were noted in women ( P < 0.05). No differences in core temperature, HR, and MAP were measured in the no-exercise trial. The postexercise threshold for cutaneous vasodilation measured at the UT and BT sites for men (37.15 ± 0.03°C and 37.16 ± 0.04°C, respectively) and women (37.36 ± 0.05°C and 37.42 ± 0.03°C, respectively) were elevated above no exercise (36.94 ± 0.07°C and 36.97 ± 0.05°C for men and 36.99 ± 0.09°C and 37.03 ± 0.11°C for women for the UT and BT sites, respectively) ( P < 0.05). A difference in the magnitude of the thresholds was measured between women and men ( P < 0.05). We conclude that women have a greater postexercise onset threshold for cutaneous vasodilation than do men and that the primary mechanism influencing the difference between men and women in postexercise skin blood flow is likely the result of an altered active vasodilatory response and not an increase in adrenergic vasoconstrictor tone.

Nonthermoregulatory control of cutaneous vascular conductance and sweating during recovery from dynamic exercise in women

The purpose of the study was to examine the effect of 1) active (loadless pedaling), 2) passive (assisted pedaling), and 3) inactive (motionless) recovery modes on mean arterial pressure (MAP), cutaneous vascular conductance (CVC), and sweat rate during recovery after 15 min of dynamic exercise in women. It was hypothesized that an active recovery mode would be most effective in attenuating the fall in MAP, CVC, and sweating during exercise recovery. Ten female subjects performed 15 min of cycle ergometer exercise at 70% of their predetermined peak oxygen consumption followed by 20 min of 1) active, 2) passive, or 3) inactive recovery. Mean skin temperature (Tsk), esophageal temperature (Tes), skin blood flow, sweating, cardiac output (CO), stroke volume (SV), heart rate (HR), total peripheral resistance (TPR), and MAP were recorded at baseline, end exercise, and 2, 5, 8, 12, 15, and 20 min postexercise. Cutaneous vascular conductance (CVC) was calculated as the ratio of laser-Doppler blood flow to MAP. In the active recovery mode, CVC, sweat rate, MAP, CO, and SV remained elevated over inactive values (P < 0.05). The passive mode was equally as effective as the active mode in maintaining MAP. Sweat rate was different among all modes after 12 min of recovery (P < 0.05). TPR during active recovery remained significantly lower than during recovery in the inactive mode (P < 0.05). No differences in either Tes or Tsk were observed among conditions. The results indicate that CVC can be modulated by central command and possibly cardiopulmonary baroreceptors in women. However, differences in sweat rate may be influenced by factors such as central command, mechanoreceptor stimulation, or cardiopulmonary baroreceptors.

Women have lower tonic autonomic support of arterial blood pressure and less effective baroreflex buffering than men

BACKGROUND

Short-term and tonic regulation of arterial blood pressure (BP) differ in premenopausal women and men of similar age. The autonomic nervous system (ANS) plays a critical role in BP regulation.

METHODS AND RESULTS

To test the hypothesis that women have lower tonic ANS support of BP (reduction in intra-arterial BP during acute ganglionic blockade [GB] with intravenous trimethaphan) and less effective baroreflex buffering (BRB) of BP (potentiation of the systolic BP [SBP] response to bolus phenylephrine during versus before GB) than men, 51 healthy adults, 22 premenopausal women (aged 28+/-1 years, mean+/-SE) and 29 men (aged 27+/-1 years), were studied. Women had lower baseline SBP and plasma catecholamine concentrations than men (P<0.05). Tonic ANS support of BP was approximately 50% to 65% lower in the women (P<0.001). The reductions in BP during GB were related to baseline plasma catecholamine concentrations (r=-0.31 to -0.41, P<0.05). Acute BRB of BP was 47% smaller in the women (3.3+/-0.5 versus 6.3+/-0.9, P=0.006) and was related to the SBP responses to phenylephrine before GB (R2=0.71, P<0.0001). Systemic alpha1-adrenergic vascular responsiveness (SBP response to bolus phenylephrine during GB) was not different (women 21.5+/-2 mm Hg versus men 18.6+/-2 mm Hg, P=0.3).

CONCLUSIONS

Premenopausal women have lower tonic sympathoadrenal activity-related ANS support of BP and less effective BRB of BP than men of similar age. The lower tonic ANS support of BP could contribute to the lower chronic BP levels of premenopausal women, whereas attenuated BRB of BP may help explain less effective BP regulation in women in response to vasoactive drugs and acute stress.

Effects of the muscle pump and body posture on cardiovascular responses during recovery from cycle exercise

The purpose of the study was to characterize the effects of muscular contractions (the muscle pump) and body posture on cardiovascular responses during recovery from moderate exercise in the upright-sitting or supine positions. Heart rate (HR), stroke volume (SV), and cardiac output (CO) were measured in seven young male subjects at rest and during 10-min of cycle exercise at 60% of peak oxygen uptake (VO2peak). This was followed by either complete rest for 5 min (inactive recovery) or cycling at VO2peak for 5 min (active recovery) in the upright or supine positions. In the upright position, an initial rapid decrease in HR was followed by a gradual decrease in HR, and this response was similar when comparing inactive and active recoveries. Upright SV during inactive recovery decreased gradually to the pre-exercise resting level, whereas upright SV during active recovery remained significantly elevated. In contrast, in the supine position, the HR during active recovery decreased, but remained significantly higher than that during inactive recovery. Changes in supine SV were similar when comparing inactive and active recovery. Thus, maintenance of SV and HR resulted in significantly greater CO during active recovery than during inactive recovery, regardless of body position. HR was greater during supine active-recovery than during supine inactive-recovery, and there was no difference in SV. These data suggest that the muscle pump is less important in facilitating venous return and vagal resumption in the supine position as compared to the upright position.

Subclavian artery stenting: factors influencing long-term outcome

This study provides extended follow-up of a nonrandomized series of symptomatic patients who underwent subclavian stent-supported angioplasty (SSA) with emphasis on preprocedure factors that may have influenced outcome. The endpoints of mortality and restenosis were analyzed using backward stepwise logistic regression with the following clinical variables: coronary artery disease, hypertension, hyperlipidemia, smoking, diabetes mellitus, chronic obstructive pulmonary disease, chronic renal insufficiency/failure, and hypothyroidism. Restenosis is reported based on prospective serial noninvasive studies and/or angiography. Mortality was evaluated by retrospective database review and inquiry to the State Department of Health and Human Services' statistical registry in patients who were lost to follow-up. Over a 9-year period (mean follow-up, 36.1 +/- 30.4 months; maximum observation, 109.5 months), 101 stents were placed in 91 consecutive patients (37 male, 54 female). The mean age at intervention was 62.03 +/- 9.3. The procedure was technically successful in 89 patients 97% (mean pre- and postoperative stenosis and pressure gradients were 90.2% +/- 9.4% vs. 3.7% +/- 6.6%, P < 0.001, and 59.9 +/- 35.2 vs. 0 mm Hg, P < 0.001, respectively), with 13 minor complications and no immediate major complications. One patient died of unrelated causes within 30 days. Per Kaplan-Meier method, for years 1 through 5, the rates of overall patency were 96%, 91%, 86%, 77%, and 72%; likewise, overall patient survival was 93%, 88%, 8%4, 81%, and 76%. No clear predictors for restenosis were discovered, although a trend toward higher recurrence was noted in women (18.5% in female vs. and 8.6% in male; P > 0.05), but the same were less likely to die during follow-up (P > 0.001). Also, the presence of hypothyroidism (P = 0.004) and increasing age (P = 0.068) were positively correlated with all-cause mortality. This study suggests that SSA is predictable, safe, and durable. The diagnosis of symptomatic subclavian disease is of prognostic importance, with age and male gender representing important predictors of all-cause long-term mortality. The strong association of increased mortality with hypothyroidism is difficult to discard and raises the question of a yet to be described thyroid steal phenomena.

Effects of mode of exercise recovery on thermoregulatory and cardiovascular responses

To identify the effects of exercise recovery mode on cutaneous vascular conductance (CVC) and sweat rate, eight healthy adults performed two 15-min bouts of upright cycle ergometry at 60% of maximal heart rate followed by either inactive or active (loadless pedaling) recovery. An index of CVC was calculated from the ratio of laser-Doppler flux to mean arterial pressure. CVC was then expressed as a percentage of maximum (%max) as determined from local heating. At 3 min postexercise, CVC was greater during active recovery (chest: 40 +/- 3, forearm: 48 +/- 3%max) compared with during inactive recovery (chest: 21 +/- 2, forearm: 25 +/- 4%max); all P < 0.05. Moreover, at the same time point sweat rate was greater during active recovery (chest: 0.47 +/- 0.10, forearm: 0.46 +/- 0.10 mg x cm(-2) x min(-1)) compared with during inactive recovery (chest: 0.28 +/- 0.10, forearm: 0.14 +/- 0.20 mg x cm(-2) x min(-1)); all P < 0.05. Mean arterial blood pressure, esophageal temperature, and skin temperature were not different between recovery modes. These data suggest that skin blood flow and sweat rate during recovery from exercise may be modulated by nonthermoregulatory mechanisms and that sustained elevations in skin blood flow and sweat rate during mild active recovery may be important for postexertional heat dissipation.