Closer to the edge? Contractions, pressures, waterfalls and blood flow to contracting skeletal muscle

The role of the microcirculation and integrative cardiovascular physiology in the pathogenesis of ICU-acquired weakness

Skeletal muscle dysfunction after critical illness, defined as ICU-acquired weakness (ICU-AW), is a complex and multifactorial syndrome that contributes significantly to long-term morbidity and reduced quality of life for ICU survivors and caregivers. Historically, research in this field has focused on pathological changes within the muscle itself, without much consideration for their in vivo physiological environment. Skeletal muscle has the widest range of oxygen metabolism of any organ, and regulation of oxygen supply with tissue demand is a fundamental requirement for locomotion and muscle function. During exercise, this process is exquisitely controlled and coordinated by the cardiovascular, respiratory, and autonomic systems, and also within the skeletal muscle microcirculation and mitochondria as the terminal site of oxygen exchange and utilization. This review highlights the potential contribution of the microcirculation and integrative cardiovascular physiology to the pathogenesis of ICU-AW. An overview of skeletal muscle microvascular structure and function is provided, as well as our understanding of microvascular dysfunction during the acute phase of critical illness; whether microvascular dysfunction persists after ICU discharge is currently not known. Molecular mechanisms that regulate crosstalk between endothelial cells and myocytes are discussed, including the role of the microcirculation in skeletal muscle atrophy, oxidative stress, and satellite cell biology. The concept of integrated control of oxygen delivery and utilization during exercise is introduced, with evidence of physiological dysfunction throughout the oxygen delivery pathway - from mouth to mitochondria - causing reduced exercise capacity in patients with chronic disease (e.g., heart failure, COPD). We suggest that objective and perceived weakness after critical illness represents a physiological failure of oxygen supply-demand matching - both globally throughout the body and locally within skeletal muscle. Lastly, we highlight the value of standardized cardiopulmonary exercise testing protocols for evaluating fitness in ICU survivors, and the application of near-infrared spectroscopy for directly measuring skeletal muscle oxygenation, representing potential advancements in ICU-AW research and rehabilitation.

The impact of leg position on muscle blood flow and oxygenation during low-intensity rhythmic plantarflexion exercise

PURPOSE

Resistance training (RT) is an effective countermeasure to combat physical deconditioning whereby localized hypoxia within the limb increases metabolic stress eliciting muscle adaptation. The current study sought to examine the influence of gravity on muscle oxygenation (SmO₂) alongside vascular hemodynamic responses.

METHODS

In twelve young healthy adults, an ischemic occlusion test and seven minutes of low-intensity rhythmic plantarflexion exercise were used alongside superficial femoral blood flow and calf near-infrared spectroscopy to assess the microvascular vasodilator response, conduit artery flow-mediated dilation, exercise-induced hyperemia, and SmO₂ with the leg positioned above or below the heart in a randomized order.

RESULTS

The microvascular vasodilator response, assessed by peak blood flow (798 ± 231 mL/min vs. 1348 ± 290 mL/min; p < 0.001) and reperfusion slope 10 s of SmO₂ after cuff deflation (0.75 ± 0.45%.s-1 vs.2.40 ± 0.94%.s-1; p < 0.001), was attenuated with the leg above the heart. This caused a blunted dilatation of the superficial femoral artery (3.0 ± 2.4% vs. 5.2 ± 2.1%; p = 0.008). Meanwhile, blood flow area under the curve was comparable (above the heart: 445 ± 147 mL vs. below the heart: 474 ± 118 mL; p = 0.55) in both leg positions. During rhythmic exercise, the increase in femoral blood flow was lower in the leg up position (above the heart: 201 ± 94% vs. below the heart: 292 ± 114%; p = 0.001) and contributed to a lower SmO₂ (above the heart: 41 ± 18% vs. below the heart 67 ± 5%; p < 0.001).

CONCLUSION

Positioning the leg above the heart results in attenuated peak vascular dilator response and exercise-induced hyperemia that coincided with a lower SmO₂ during low-intensity plantarflexion exercise.

Influence of simulated hypogravity on oxygen uptake during treadmill running

Prolonged exposure to microgravity during spaceflights leads to severe deterioration in the physical performance of astronauts. To understand the effectiveness of existing in‐flight daily countermeasures and to plan exercise onboard the International Space Station, we compared supine treadmill running to traditional upright treadmill running on earth. Specifically, we assessed the cardiorespiratory responses to conventional upright running to the responses to supine treadmill running under 0.3 g, 0.6 g, and 1 g of body weight in younger (20–30 years, n = 14, 8 females) and older healthy adults (50–60 years, n = 12, 6 females). Maximal cardiorespiratory capacity was additionally evaluated by performing an incremental running protocol on each treadmill. Maximum speed was greater for 0.3 g and 0.6 g in supine than for upright running (18.5 km/h (1.1) and 15.9 (3.1) vs 13.2 (2.4) p < 0.001). In contrast, maximum oxygen uptake (V˙O2max) and maximum heart rate (HR_max) were greater in upright running than in all supine conditions (Upright treadmill running vs S1.0G vs S0.6G vs S0.3G, 41.7 ml kg⁻¹ min⁻¹ (7.2) vs 30.5 (6.6) vs 32.9 (7.0) vs 30.9 (5.2), p < 0.001 and 171 beats min⁻¹ (14) vs 152 (24) vs 155 (20) vs 152 (18), p < 0.001, respectively). The reduction in V˙O2max was remarkably similar across all three supine conditions, could not be increased by higher running speeds and can be well explained by reduced ground reaction forces (GRF). Thus, although a gravity‐related restriction of pulmonary gas exchange or perfusion of the legs when exercising in the supine position can be suspected, findings are also explicable on grounds of the vertical treadmill mechanics. Reduced loading will constitute a substantial limitation to V˙O2 in space with implications for crew health and the physical deterioration of astronauts.

Cardiopulmonary Responses to Sub-Maximal Ergometer Exercise in a Hypo-Gravity Analog Using Head-Down Tilt and Head-Up Tilt

After more than 50 years of spaceflight, we still do not know what is the appropriate range of gravity levels that are required to maintain normal physiological function in humans. This research effort aimed to investigate musculoskeletal, cardiovascular, and pulmonary responses between 0 and 1 g. A human experiment was conducted to investigate acute physiological outcomes to simulated altered-gravity with and without ergometer exercise using a head-down tilt (HDT)/head-up tilt (HUT) paradigm. A custom tilting platform was built to simulate multiple gravitational loads in the head-to-toe direction (Gz) by tilting the bed to the appropriate angle. Gravity levels included: Microgravity (-6°HDT), Moon (0.17g-Gz at +9.5°HUT), Mars (0.38g-Gz at +22.3°HUT), and Earth (1g-Gz at +90° upright). Fourteen healthy subjects performed an exercise protocol at each simulated gravity level that consisted of three work rates (50W, 75W, 100W) while maintaining a constant cycling rate of 90 rpm. Multiple cardiopulmonary variables were gathered, including volume of oxygen uptake (VO₂), volume of carbon dioxide output (VCO₂), pulmonary ventilation (V_E), tidal volume (V_T), respiratory rate (R_f), blood pressure, and heart rate (HR) using a portable metabolic system and a brachial blood pressure cuff. Foot forces were also measured continuously during the protocol. Exercise data were analyzed with repeated-measures ANOVA with Bonferroni correction for multiple comparisons, and regression models were fitted to the experimental data to generate dose-response curves as a function of simulated AG-levels and exercise intensity. Posture showed a main effect in all variables except for systolic blood pressure. In particular, VO_2, VCO₂, V_E, V_T, R_f, and HR showed average changes across exercise conditions between Microgravity and 1 g (i.e., per unit of simulated AG) of -97.88 mL/min/g, -95.10 mL/min/g, -3.95 L/min/g, 0.165 L/g, -5.33 breaths/min/g, and 5.05 bpm/g, respectively. In the case of VO₂, further pairwise comparisons did not show significant differences between conditions, which was consistent with previous studies using supine and HDT postures. For all variables (except HR), comparisons between Mars and Earth conditions were not statistically different, suggesting that ergometer exercise at a gravitational stress comparable to Mars gravity (∼3/8 g) could provide similar physiological stimuli as cycling under 1 g on Earth.

Vascular conductance and muscle blood flow during exercise are altered by inspired oxygen fraction and arterial perfusion pressure

We tested the hypothesis during the combined challenges of altered inspired O₂ fraction (F_IO₂) and posture changes at lower power output regardless of body position that the vascular conductance (VC) recruitment to the exercising muscle would not limit muscle perfusion and estimated O₂ delivery (DO_2est). However, in head‐down tilt at the higher power output exercise in hypoxia, the recruitment of VC would have a functional limitation which would restrict muscle blood flow (MBF) leading to a limitation in DO_2est with consequent increases in metabolic stress. Ten healthy volunteers repeated plantar flexion contractions at 20% (low power output = LPO) and 30% (higher power output = HPO) of their maximal voluntary contraction in horizontal (HOR), 35° head‐down‐tilt (HDT) and 45° head‐up‐tilt (HUT). Popliteal diameter and muscle blood flow velocity were measured by ultrasound determining MBF. VC was estimated by dividing MBF flow by MPP, and DO_2est was estimated by MBF times saturation. LPO_HUT in hypoxia was associated with no changes in VC and MBF leading to reduced DO_2est. In LPO_HDT under hypoxia, despite no apparent functional limitation in the VC recruitment, rise in MBF to maintain DO_2est was associated with marked increase in muscle electromyographic activity, indicating greater metabolic stress. In HPO_HDT under hypoxia, a functional limitation for the recruitment of VC constrained MBF and DO_2est. Elevated muscle electromyographic signal in HPO_HDT under hypoxia was consistent with challenged aerobic metabolisms which contributed to a greater increase in the relative stress of the exercise challenge and advance the onset of muscle fatigue.

Changes in Muscle and Cerebral Deoxygenation and Perfusion during Repeated Sprints in Hypoxia to Exhaustion

During supramaximal exercise, exacerbated at exhaustion and in hypoxia, the circulatory system is challenged to facilitate oxygen delivery to working tissues through cerebral autoregulation which influences fatigue development and muscle performance. The aim of the study was to evaluate the effects of different levels of normobaric hypoxia on the changes in peripheral and cerebral oxygenation and performance during repeated sprints to exhaustion. Eleven recreationally active participants (six men and five women; 26.7 ± 4.2 years, 68.0 ± 14.0 kg, 172 ± 12 cm, 14.1 ± 4.7% body fat) completed three randomized testing visits in conditions of simulated altitude near sea-level (~380 m, F_IO₂ 20.9%), ~2000 m (F_IO₂ 16.5 ± 0.4%), and ~3800 m (F_IO₂ 13.3 ± 0.4%). Each session began with a 12-min warm-up followed by two 10-s sprints and the repeated cycling sprint (10-s sprint: 20-s recovery) test to exhaustion. Measurements included power output, vastus lateralis, and prefrontal deoxygenation [near-infrared spectroscopy, delta (Δ) corresponds to the difference between maximal and minimal values], oxygen uptake, femoral artery blood flow (Doppler ultrasound), hemodynamic variables (transthoracic impedance), blood lactate concentration, and rating of perceived exertion. Performance (total work, kJ; −27.1 ± 25.8% at 2000 m, p < 0.01 and −49.4 ± 19.3% at 3800 m, p < 0.001) and pulse oxygen saturation (−7.5 ± 6.0%, p < 0.05 and −18.4 ± 5.3%, p < 0.001, respectively) decreased with hypoxia, when compared to 400 m. Muscle Δ hemoglobin difference ([Hbdiff]) and Δ tissue saturation index (TSI) were lower (p < 0.01) at 3800 m than at 2000 and 400 m, and lower Δ deoxyhemoglobin resulted at 3800 m compared with 2000 m. There were reduced changes in peripheral [Δ[Hbdiff], ΔTSI, Δ total hemoglobin ([tHb])] and greater changes in cerebral (Δ[Hbdiff], Δ[tHb]) oxygenation throughout the test to exhaustion (p < 0.05). Changes in cerebral deoxygenation were greater at 3800 m than at 2000 and 400 m (p < 0.01). This study confirms that performance in hypoxia is limited by continually decreasing oxygen saturation, even though exercise can be sustained despite maximal peripheral deoxygenation. There may be a cerebral autoregulation of increased perfusion accounting for the decreased arterial oxygen content and allowing for task continuation, as shown by the continued cerebral deoxygenation.

Post-contractile BOLD contrast in skeletal muscle at 7 T reveals inter-individual heterogeneity in the physiological responses to muscle contraction

Muscle blood oxygenation-level dependent (BOLD) contrast is greater in magnitude and potentially more influenced by extravascular BOLD mechanisms at 7 T than it is at lower field strengths. Muscle BOLD imaging of muscle contractions at 7 T could, therefore, provide greater or different contrast than at 3 T. The purpose of this study was to evaluate the feasibility of using BOLD imaging at 7 T to assess the physiological responses to in vivo muscle contractions. Thirteen subjects (four females) performed a series of isometric contractions of the calf muscles while being scanned in a Philips Achieva 7 T human imager. Following 2 s maximal isometric plantarflexion contractions, BOLD signal transients ranging from 0.3 to 7.0% of the pre-contraction signal intensity were observed in the soleus muscle. We observed considerable inter-subject variability in both the magnitude and time course of the muscle BOLD signal. A subset of subjects (n = 7) repeated the contraction protocol at two different repetition times (TR : 1000 and 2500 ms) to determine the potential of T1 -related inflow effects on the magnitude of the post-contractile BOLD response. Consistent with previous reports, there was no difference in the magnitude of the responses for the two TR values (3.8 ± 0.9 versus 4.0 ± 0.6% for TR  = 1000 and 2500 ms, respectively; mean ± standard error). These results demonstrate that studies of the muscle BOLD responses to contractions are feasible at 7 T. Compared with studies at lower field strengths, post-contractile 7 T muscle BOLD contrast may afford greater insight into microvascular function and dysfunction.

Peripheral circulation

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

Effects of body posture and exercise training on cardiorespiratory responses to exercise

The primary aims of the present study were to evaluate cardiorespiratory responses to incremental head down tilt exercise and to determine if the cardiorespiratory adaptations obtained from endurance training in the head down tilt posture transfer to the upright posture. 22 men (25±3 years) performed V˙O2peak cycle exercise tests in the upright and head down tilt postures. Of these, 11 men were endurance trained on a cycle ergometer in the upright posture for 8 weeks (upright training group; UTG) or in the upright posture for 4 weeks followed by 4 weeks in the head down tilt posture (head down training group; HTG). During acute exercise, V˙O2peak was decreased in the head down tilt posture compared to upright (2.01±0.51 vs. 2.32±0.61l/min respectively, P<0.05). Stroke volume (SV) at 100 W was greater during head down tilt cycling compared to the upright (77±5 vs. 71±4 ml/beat, P<0.05). Following training V˙O2peak increased in both groups during upright exercise. However, V˙O2peak during head down tilt cycling was only increased in the HTG. Sub-maximal and peak SV in the HTG increased in both upright and head down tilt postures. SV in the UTG increased only in the upright posture and was unchanged during head down tilt cycling. In conclusion, acute head down tilt exercise increases sub-maximal SV compared to upright exercise. Furthermore, training in the head down tilt posture induces cardiorespiratory adaptations in both upright and head down tilt postures, while the adaptations to upright exercise training are primarily observed when upright exercise was performed.

Rapid onset vasodilatation is blunted in obese humans

AIM

Conduit artery function in obese humans is frequently assessed at rest, but very little is known about resistance artery function in response to muscle contraction. We tested the hypothesis that obese adults will exhibit reduced contraction-induced rapid onset vasodilatation. Single and brief forearm contractions were used to isolate the local effects of muscle contraction on the forearm vasodilatory response, independent of systemic haemodynamic and sympathetic neural influence.

METHODS

We measured forearm blood flow (Doppler ultrasound), blood pressure (finger photoplethysmography) and heart rate (electrocardiogram) on a beat-by-beat basis in 14 obese (body mass index = 36.2 ± 1.7 kg m(-2)) and 14 lean (body mass index = 21.6 ± 0.7 kg m(-2)) young (18-40 years) adults. Percent changes from baseline in forearm vascular conductance (FVC(%) ) were calculated in response to single, brief forearm contractions performed in random order at 15, 20, 25, 30, 40 and 50% of maximal voluntary contraction (MVC).

RESULTS

In both groups, each single contraction evoked a significant (P < 0.05), immediate (within one cardiac cycle) and graded FVC(%) increase from one up to six cardiac cycles post-contraction. Immediate (20-50% MVC), peak (15-50% MVC) and total (area under the curve, 20-50% MVC) vasodilatory responses were reduced with obesity. The degree of impaired vasodilatation increased with increasing workloads.

CONCLUSIONS

These novel findings demonstrate a blunted contraction-induced rapid onset vasodilatation with obesity that is exercise intensity dependent. Impaired rapid onset vasodilatation may negatively impact haemodynamic responses to everyday intermittent activities performed by obese humans.

Does venous insufficiency impair the exercise-induced rise in arterial leg blood flow?

Objectives

It has been shown that the leg muscle pump increases the immediate rise in arterial leg blood flow during upright exercise in healthy subjects. The present study is the first to investigate the muscle pump effect in exercise hyperaemia in patients with venous insufficiency, who should be lacking an optimally functioning muscle pump.

Methods

Any muscle pump effect is more pronounced in an upright position because of gravitation. The exercise-induced rise in femoral artery flow (FF) (ultrasound Doppler) was thus compared in the supine and 30° head-up tilted position in 10 patients.

Results

Neither the transient nor the steady-state rise in FF showed any difference between positions. This is in contrast to the previous findings in healthy subjects, where the transient rise in FF was larger in the tilted position.

Conclusion

The muscle pump effect in exercise hyperaemia seems to be reduced or lacking in these patients.

Effect of the leg muscle pump on the rise in muscle perfusion during muscle work in humans

The transient and steady-state effects of the calf muscle pump on the rise in muscle perfusion during rhythmic plantarflexions were investigated in 20 volunteers. Because a large hydrostatic column would increase the effect of a muscle pump, exercise in the supine and head-up tilted positions was compared. Within approximately 15 s of the start of muscle work, femoral artery flow (ultrasound Doppler) rose 0.37 L/min above rest in the supine and 0.5 L/min above rest in the tilted position. The latter is a significantly larger rise (P < 0.05). After 80 s of muscle work, femoral flow was stable at 0.38 and 0.39 L/min above rest in the supine and tilted positions, respectively. We conclude that the muscle pump contributes to muscle perfusion during the initial phase of muscle work, but that metabolic vasodilation is a more important determinant of muscle perfusion during steady-state muscle work.

Haemodynamic responses to exercise, ATP infusion and thigh compression in humans: insight into the role of muscle mechanisms on cardiovascular function

The muscle pump and muscle vasodilatory mechanism are thought to play important roles in increasing and maintaining muscle perfusion and cardiac output ((.)Q) during exercise, but their actual contributions remain uncertain. To evaluate the role of the skeletal muscle pump and vasodilatation on cardiovascular function during exercise, we determined leg and systemic haemodynamic responses in healthy men during (1) incremental one-legged knee-extensor exercise, (2) step-wise femoral artery ATP infusion at rest, (3) passive exercise (n=10), (4)femoral vein or artery ATP infusion (n=6), and (5) cyclic thigh compressions at rest and during passive and voluntary exercise (n=7). Incremental exercise resulted in progressive increases in leg blood flow (DeltaLBF 7.4 +/- 0.7 l min(-1)), cardiac output (Delta (.)Q 8.7 +/- 0.7 l min(-1)), mean arterial pressure (DeltaMAP 51 +/- 5 mmHg), and leg and systemic oxygen delivery and (.)VO2 . Arterial ATP infusion resulted in similar increases in (.)Q , LBF, and systemic and leg oxygen delivery, but central venous pressure and muscle metabolism remained unchanged and MAP was reduced. In contrast,femoral vein ATP infusion did not alter LBF, (.)Q or MAP. Passive exercise also increased blood flow (DeltaLBF 0.7 +/- 0.1 l min(-1)), yet the increase in muscle and systemic perfusion, unrelated to elevations in aerobic metabolism, accounted only for approximately 5% of peak exercise hyperaemia.Likewise, thigh compressions alone or in combination with passive exercise increased blood flow (DeltaLBF 0.5-0.7 l min(-1)) without altering (.)Q, MAP or (.)VO2. These findings suggest that the skeletal muscle pump is not obligatory for sustaining venous return, central venous pressure,stroke volume and (.)Q or maintaining muscle blood flow during one-legged exercise in humans.Further, its contribution to muscle and systemic peak exercise hyperaemia appears to be minimal in comparison to the effects of muscle vasodilatation.

Partitioning locomotor energy use among and within muscles Muscle blood flow as a measure of muscle oxygen consumption

Linking the mechanics and energetics of locomotion in vertebrates has been hampered by a lack of information regarding the energy use of individual skeletal muscles in vivo. Here, we present a review of the available data concerning the relationship between the rates of skeletal muscle blood flow and oxygen consumption(V̇O2). In active muscle, during aerobically supported exercise, there is a linear relationship between these variables, irrespective of the muscle fiber type and intensity of exercise through most of the aerobic exercise range. We conclude that the rate of blood flow is the best available indicator of aerobic metabolic rate in multiple individual muscles or regions of muscles during locomotion. The practical considerations of using the injectable microsphere technique to measure muscle blood flow in this context are discussed.

Regional blood flow in respiratory muscles during partial ventilatory assistance in rabbits

We tested the hypothesis that even partial ventilatory assistance would reduce respiratory muscle blood flow to levels similar to those found during control mechanical ventilation (CMV). Three levels of pressure support ventilation (PSV) and 2 CMV settings were compared in 10 rabbits. PSV 0, 6, and 12 cm H2O, under continuous positive airway pressure mode, were applied, and then pressure control ventilation (PCV) values of 6 (36 breaths/min) and 12 cm H2O (18 per breaths/min) were applied to each CMV setting with a muscle relaxant. Using colored microspheres, we measured regional tissue blood flow in respiratory muscles, lower extremities, kidney, and liver. Regional tissue blood flow in the diaphragm during PSV6, PCV6, and PCV12 were less than those during PSV0. During PSV12, blood flow in the crural diaphragm was more than that during PCV12 and similar to that during PSV0. Whereas the transdiaphragmatic pressure of PSV6 was -0.8 +/- 1.6 cm H2O, that of PSV12 was -3.1 +/- 2.4 cm H2O. Inspiratory asynchrony, arising from an ineffective triggering effort, was observed in PSV12. The ventilatory settings did not affect blood flow of the lower extremities, liver, and kidney. In conclusion, ventilatory settings affected blood flow in the diaphragm. At certain PSV settings, blood flow in the diaphragm was minimal.

Effects of ATP-induced leg vasodilation on VO2 peak and leg O2 extraction during maximal exercise in humans

During maximal whole body exercise VO2 peak is limited by O2 delivery. In turn, it is though that blood flow at near-maximal exercise must be restrained by the sympathetic nervous system to maintain mean arterial pressure. To determine whether enhancing vasodilation across the leg results in higher O2 delivery and leg VO2 during near-maximal and maximal exercise in humans, seven men performed two maximal incremental exercise tests on the cycle ergometer. In random order, one test was performed with and one without (control exercise) infusion of ATP (8 mg in 1 ml of isotonic saline solution) into the right femoral artery at a rate of 80 microg.kg body mass-1.min-1. During near-maximal exercise (92% of VO2 peak), the infusion of ATP increased leg vascular conductance (+43%, P<0.05), leg blood flow (+20%, 1.7 l/min, P<0.05), and leg O2 delivery (+20%, 0.3 l/min, P<0.05). No effects were observed on leg or systemic VO2. Leg O2 fractional extraction was decreased from 85+/-3 (control) to 78+/-4% (ATP) in the infused leg (P<0.05), while it remained unchanged in the left leg (84+/-2 and 83+/-2%; control and ATP; n=3). ATP infusion at maximal exercise increased leg vascular conductance by 17% (P<0.05), while leg blood flow tended to be elevated by 0.8 l/min (P=0.08). However, neither systemic nor leg peak VO2 values where enhanced due to a reduction of O2 extraction from 84+/-4 to 76+/-4%, in the control and ATP conditions, respectively (P<0.05). In summary, the VO2 of the skeletal muscles of the lower extremities is not enhanced by limb vasodilation at near-maximal or maximal exercise in humans. The fact that ATP infusion resulted in a reduction of O2 extraction across the exercising leg suggests a vasodilating effect of ATP on less-active muscle fibers and other noncontracting tissues and that under normal conditions these regions are under high vasoconstrictor influence to ensure the most efficient flow distribution of the available cardiac output to the most active muscle fibers of the exercising limb.

Effect of body tilt on calf muscle performance and blood flow in humans

To explore the effect of posture on muscle performance, we tested the effects of body tilt angle on the strength, endurance, and fatigue of, and blood flow into, the plantar flexors. Human subjects were fixed to a tilt table that could tilt them from the horizontal (0 degrees ) to upright (90 degrees ) position and enabled force to be applied to a footplate through isometric action of the right calf muscle. In experiment 1, six subjects performed a strength test and graded test (intermittent contractions) to the point of failure at three tilt angles (0, 47, and 90 degrees ). In Experiment 2, seven subjects performed a strength test and constant-force test [70% maximum force (F(max)); intermittent contractions] to the point of failure in the horizontal and three inclined positions (32, 47, and 67 degrees ). In experiment 3, leg blood flow was assessed during constant-force exercise at two intensities (30 and 70% F(max)) and two tilt angles (0 and 67 degrees ) in six subjects. Strength was not affected (P > 0.05) by tilt angle. Time to failure during the graded test was significantly higher at 47 degrees (25.9 +/- 2.0 min) and 90 degrees (25.1 +/- 3.0 min) than 0 degrees (22.2 +/- 2.6 min). Time to failure during the constant-force test was also significantly higher at 32 degrees (7.1 +/- 3.6 min), 47 degrees (8.0 +/- 5.2 min), and 67 degrees (8.6 +/- 5.6 min) compared with 0 degrees (4.0 +/- 2.6 min). When graded or constant-force exercise was performed with arterial flow to the leg eliminated, there were no differences in exercise time between the horizontal and an inclined position. During nonischemic exercise, leg blood flow was significantly higher during exercise in the inclined position. These results demonstrate that head-up tilt improves endurance of the plantar flexors, that this effect occurs in the absence of an effect on strength, and that it depends on an intact peripheral circulation. Moreover, the postural effect on muscle endurance appears to be due to a greater blood flow into the leg, an effect that is established during the initial contractions.

Impact of combined NO and PG blockade on rapid vasodilation in a forearm mild-to-moderate exercise transition in humans

We tested the hypothesis that nitric oxide (NO) and prostaglandins (PGs) contribute to the rapid vasodilation that accompanies a transition from mild to moderate exercise. Nine healthy volunteers (2 women and 7 men) lay supine with forearm at heart level. Subjects were instrumented for continuous brachial artery infusion of saline (control condition) or combined infusion of NG-nitro-l-arginine methyl ester (l-NAME) and ketorolac (drug condition) to inhibit NO synthase and cyclooxygenase, respectively. A step increase from 5 min of steady-state mild (5.4 kg) rhythmic, dynamic forearm handgrip exercise (1 s of contraction followed by 2 s of relaxation) to moderate (10.9 kg) exercise for 30 s was performed. Steady-state forearm blood flow (FBF; Doppler ultrasound) and forearm vascular conductance (FVC) were attenuated in drug compared with saline (control) treatment: FBF = 196.8 ± 30.8 vs. 281.4 ± 34.3 ml/min and FVC = 179.3 ± 29.4 vs. 277.8 ± 34.8 ml·min−1·100 mmHg−1 (both P < 0.01). FBF and FVC increased from steady state after release of the initial contraction at the higher workload in saline and drug conditions: ΔFBF = 72.4 ± 8.7 and 52.9 ± 7.8 ml/min, respectively, and ΔFVC = 66.3 ± 7.3 and 44.1 ± 7.0 ml·min−1·100 mmHg−1, respectively (all P < 0.05). The percent ΔFBF and ΔFVC were not different during saline infusion or combined inhibition of NO and PGs: ΔFBF = 27.2 ± 3.1 and 28.1 ± 3.8%, respectively ( P = 0.78) and ΔFVC = 25.7 ± 3.2 and 26.0 ± 4.0%, respectively ( P = 0.94). The data suggest that NO and vasodilatory PGs are not obligatory for rapid vasodilation at the onset of a step increase from mild- to moderate-intensity forearm exercise. Additional vasodilatory mechanisms not dependent on NO and PG release contribute to the immediate and early increase in blood flow in an exercise-to-exercise transition.

Muscle contraction-blood flow interactions during upright knee extension exercise in humans

To test for evidence of a muscle pump effect during steady-state upright submaximal knee extension exercise, seven male subjects performed seven discontinuous, incremental exercise stages (3 min/stage) at 40 contractions/min, at work rates ranging to 60-75% peak aerobic work rate. Cardiac cycle-averaged muscle blood flow (MBF) responses and contraction-averaged blood flow responses were calculated from continuous Doppler sonography of the femoral artery. Net contribution of the muscle pump was estimated by the difference between mean exercise blood flow (MBFM) and early recovery blood flow (MBFR). MBFM rose in proportion with increases in power output with no significant difference between the two methods of calculating MBF. For stages 1 and 5, MBFM was greater than MBFR; for all others, MBFM was similar to MBFR. For the lighter work rates (stages 1-4), there was no significant difference between exercise and early recovery mean arterial pressure (MAP). During stages 5-7, MAP was significantly higher during exercise and fell significantly early in recovery. From these results we conclude that 1) at the lightest work rate, the muscle pump had a net positive effect on MBFM, 2) during steady-state moderate exercise (stages 2-4) the net effect of rhythmic muscle contraction was neutral (i.e., the impedance due to muscle contraction was exactly offset by the potential enhancement during relaxation), and 3) at the three higher work rates tested (stages 5-7), any enhancement to flow during relaxation was insufficient to fully compensate for the contraction-induced impedance to muscle perfusion. This necessitated a higher MAP to achieve the MBFM.

Muscle blood flow response to contraction: influence of venous pressure

The skeletal muscle pump is thought to be at least partially responsible for the immediate muscle hyperemia seen with exercise. We hypothesized that increases in venous pressure within the muscle would enhance the effectiveness of the muscle pump and yield greater postcontraction hyperemia. In nine anesthetized beagle dogs, arterial inflow and venous outflow of a single hindlimb were measured with ultrasonic transit-time flow probes in response to 1-s tetanic contractions evoked by electrical stimulation of the sciatic nerve. Venous pressure in the hindlimb was manipulated by tilting the upright dogs to a 30 degrees angle in the head-up or head-down positions. The volume of venous blood expelled during contractions was 2.2 +/- 0.2, 1.6 +/- 0.2, and 1.4 +/- 0.2 ml with the head-up, horizontal, and head-down positions, respectively. Although altering hindlimb venous pressure influenced venous expulsion during contraction, the increase in arterial inflow was similar regardless of position. Moreover, the volume of blood expelled was a small fraction of the cumulative arterial volume after the contraction. These results suggest that the muscle pump is not a major contributor to the hyperemic response to skeletal muscle contraction.

Immediate exercise hyperemia: contributions of the muscle pump vs. rapid vasodilation

A striking characteristic of the blood flow adaptation at exercise onset is the immediate and substantial increase in the first few (0–5 s) seconds of exercise. The purpose of this mini-review is to put into context the present evidence regarding mechanisms responsible for this phase of exercise hyperemia. One potential mechanism that has received much attention is the mechanical effect of muscle contraction (the muscle pump). The rapid vasodilatory mechanism(s) is another possible mechanism that has recently been shown to exist. This review will provide the reader with 1) an understanding of the basic physics of blood flow and the theories of muscle pump function, 2) a critical examination of evidence both for and against the contribution of the muscle pump or rapid vasodilatory mechanisms, and 3) an awareness of the limitations and impact of experimental models and exercise modes on the contribution of each of these mechanisms to the immediate exercise hyperemia. The inability to measure microvenular pressure continues to limit investigators to indirect assessments of the muscle pump vs. vasodilatory mechanism contributions to immediate exercise hyperemia in vivo. Future research directions should include examination of muscle-contraction-induced resistance vessel distortion as a trigger for rapid smooth muscle relaxation and further investigation into the exercise mode dependency of muscle pump vs. rapid vasodilatory contributions to immediate exercise hyperemia.

Ideas about control of skeletal and cardiac muscle blood flow (1876-2003): cycles of revision and new vision

This perspective examines origins of some key ideas central to major issues to be addressed in five subsequent mini-reviews related to Skeletal and Cardiac Muscle Blood Flow. The questions discussed are as follows. 1). What causes vasodilation in skeletal and cardiac muscle and 2). might the mechanisms be the same in both? 3). How important is muscle's mechanical contribution (via muscle pumping) to muscle blood flow, including its effect on cardiac output? 4). Is neural (vasoconstrictor) control of muscle vascular conductance and muscle blood flow significantly blunted in exercise by muscle metabolites and what might be a dominant site of action? 5). What reflexes initiate neural control of muscle vascular conductance so as to maintain arterial pressure at its baroreflex operating point during dynamic exercise, or is muscle blood flow regulated so as to prevent accumulation of metabolites and an ensuing muscle chemoreflex or both?

Evidence for a rapid vasodilatory contribution to immediate hyperemia in rest-to-mild and mild-to-moderate forearm exercise transitions in humans

Controversy exists regarding the contribution of a rapid vasodilatory mechanism(s) to immediate exercise hyperemia. Previous in vivo investigations have exclusively examined rest-to-exercise (R-E) transitions where both the muscle pump and early vasodilator mechanisms may be activated. To isolate vasodilatory onset, the present study investigated the onset of exercise hyperemia in an exercise-to-exercise (E-E) transition, where no further increase in muscle pump contribution would occur. Eleven subjects lay supine and performed a step increase from rest to 3 min of mild (10% maximal voluntary contraction), rhythmic, dynamic forearm handgrip exercise, followed by a further step to moderate exercise (20% maximal voluntary contraction) in each of arm above (condition A) or below (condition B) heart level. Beat-by-beat measures of brachial arterial blood flow (Doppler ultrasound) and blood pressure (arterial tonometry) were performed. We observed an immediate increase in forearm vascular conductance in E-E transitions, and the magnitude of this increase matched that of the R-E transitions within each of the arm positions (condition A: E-E, 52.8 +/- 10.7 vs. R-E, 60.3 +/- 11.7 ml.min(-1).100 mmHg(-1), P = 0.66; condition B: E-E, 43.2 +/- 12.8 vs. R-E, 33.9 +/- 8.2 ml.min(-1).100 mmHg(-1), P = 0.52). Furthermore, changes in forearm vascular conductance were identical between R-E and E-E transitions over the first nine contraction-relaxation cycles in condition A. The immediate and identical increase in forearm vascular conductance in R-E and E-E transitions within arm positions provides strong evidence that rapid vasodilation contributes to immediate exercise hyperemia in humans. Specific vasodilatory mechanisms responsible remain to be determined.

Immediate exercise hyperemia in humans is contraction intensity dependent: evidence for rapid vasodilation

We tested the hypothesis that rapid vasodilation proportional to contraction intensity contributes to the immediate (first cardiac cycle after initial contraction) exercise hyperemia. Ten healthy subjects performed single 1-s isometric forearm contractions at 5, 10, 15, 20, 30, 50, and 70% maximal voluntary contraction intensity (MVC) in arm above heart (AH) and below heart (BH) positions. Forearm blood flow (FBF; brachial artery mean blood velocity, Doppler ultrasound), mean arterial pressure (arterial tonometry), and heart rate (electrocardiogram) were measured beat by beat. Venous emptying (measured with a forearm strain gauge) was already maximized at 5% MVC, indicating that increases in contraction intensity did not further empty the forearm veins. Immediate increases in FBF were linearly proportional to contraction intensity from 5 to 70% MVC in AH (slope = 4.4 ± 0.5%ΔFBF/%MVC). In BH, the immediate increase in FBF demonstrated a curvilinear relationship with increasing contraction intensity and was greater than AH at 15, 20, 30, and 50% MVC ( P < 0.05). Peak changes in FBF were greater in BH vs. AH from 10 to 50% MVC, even when venous refilling was complete ( P < 0.05). These data support the existence of a rapid-acting vasodilatory mechanism(s) at the onset of human forearm exercise.

Muscle pump function during locomotion: mechanical coupling of stride frequency and muscle blood flow

We imposed opposing oscillations in treadmill speed and grade on nine rats to test for direct mechanical coupling between stride frequency and hindlimb blood flow. Resting hindlimb blood flow was 15.5 +/- 1.7 ml/min. For 90 s at 7.5 m/min, rats alternated walking at -10 degrees for 10 s and +10 degrees for 10 s. This elicited oscillations in hindlimb blood flow having an amplitude of 4.1 +/- 0.5 ml/min (18% of mean flow) with a delay presumably due to metabolic vasodilation. Similar oscillations in speed (5.5-9.5 m/min) elicited oscillations in hindlimb blood flow (amplitude 3.4 +/- 0.5 ml/min, 15% of mean flow) with less of a delay, possibly due to changes in vasodilation and muscle pump function. We then simultaneously imposed these speed and grade oscillations out of phase (slow uphill, fast downhill). The rationale was that the oscillations in vasodilation evoked by the opposing oscillations in speed and grade would cancel each other, thereby testing the degree to which stride frequency affects hindlimb blood flow directly (i.e., muscle pumping). Opposing oscillations in speed and grade evoked oscillations in hindlimb blood flow having an amplitude of 3.3 +/- 0.6 ml/min (16% of mean flow) with no delay and directly in phase with the changes in speed and stride frequency. The finding that hindlimb blood flow changes directly with speed (when vasodilation caused by changes in speed and grade oppose each other) indicates that there is a direct coupling of stride frequency and hindlimb blood flow (i.e., muscle pumping).

Delay of muscle vasodilation to changes in work rate (treadmill grade) during locomotion

Previous studies examining the delay to the onset of vasodilation have primarily focused on the onset of exercise, a setting complicated by the fact that the muscle pump and the vasodilator systems are both activated, making it difficult to attribute changes in blood flow to one or both. The goal here was to determine the delay to the onset of vasodilation after changes in work rate imposed by changes in treadmill grade (work intensity) during locomotion at a steady speed. The rationale was that constant speed would help ensure constant muscle pump activity (contraction frequency) such that vasodilator responses could be examined in isolation. Seven Sprague-Dawley rats underwent three trials each in which treadmill incline was suddenly ( approximately 1 s) elevated from -10 degrees to +10 degrees. The delay to the onset of vasodilation averaged 5.0 +/- 1.8 s, and this delay was not altered by inhibition of nitric oxide synthase. Similar or longer delays were seen during sinusoidal exercise. Thus there is a significant delay before the onset of vasodilation after an increase in work intensity (muscle force) during locomotory exercise at constant speed.