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Lav Madsen P, Sejersen C, Nyberg M, Sørensen MH, Hellsten Y, Gaede P, Bojer AS. The cardiovascular changes underlying a low cardiac output with exercise in patients with type 2 diabetes mellitus. Front Physiol 2024; 15:1294369. [PMID: 38571722 PMCID: PMC10987967 DOI: 10.3389/fphys.2024.1294369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/19/2024] [Indexed: 04/05/2024] Open
Abstract
The significant morbidity and premature mortality of type 2 diabetes mellitus (T2DM) is largely associated with its cardiovascular consequences. Focus has long been on the arterial atheromatosis of DM giving rise to early stroke and myocardial infarctions, whereas less attention has been given to its non-ischemic cardiovascular consequences. Irrespective of ischemic changes, T2DM is associated with heart failure (HF) most commonly with preserved ejection fraction (HFpEF). Largely due to increasing population ages, hypertension, obesity and T2DM, HFpEF is becoming the most prevalent form of heart failure. Unfortunately, randomized controlled trials of HFpEF have largely been futile, and it now seems logical to address the important different phenotypes of HFpEF to understand their underlying pathophysiology. In the early phases, HFpEF is associated with a significantly impaired ability to increase cardiac output with exercise. The lowered cardiac output with exercise results from both cardiac and peripheral causes. T2DM is associated with left ventricular (LV) diastolic dysfunction based on LV hypertrophy with myocardial disperse fibrosis and significantly impaired ability for myocardial blood flow increments with exercise. T2DM is also associated with impaired ability for skeletal muscle vasodilation during exercise, and as is the case in the myocardium, such changes may be related to vascular rarefaction. The present review discusses the underlying phenotypical changes of the heart and peripheral vascular system and their importance for an adequate increase in cardiac output. Since many of the described cardiovascular changes with T2DM must be considered difficult to change if fully developed, it is suggested that patients with T2DM are early evaluated with respect to their cardiovascular compromise.
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Affiliation(s)
- Per Lav Madsen
- Department Cardiology, Herlev-Gentofte Hospital, Copenhagen University, Copenhagen, Denmark
- Department Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- The August Krogh Section for Human Physiology, Department Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Casper Sejersen
- The August Krogh Section for Human Physiology, Department Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
- Department of Anaesthesia, Rigshospitalet, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael Nyberg
- Department Kidney and Vascular Biology, Global Drug Discovery, Novo Nordisk, Copenhagen, Denmark
| | | | - Ylva Hellsten
- The August Krogh Section for Human Physiology, Department Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Peter Gaede
- Department Endocrinology, Slagelse-Næstved Hospital, Copenhagen, Denmark
| | - Annemie Stege Bojer
- Department Cardiology, Herlev-Gentofte Hospital, Copenhagen University, Copenhagen, Denmark
- Department Endocrinology, Slagelse-Næstved Hospital, Copenhagen, Denmark
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2
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Dulaney CS, Heidorn CE, Singer TJ, McDaniel J. Mechanisms that underlie blood flow regulation at rest and during exercise. ADVANCES IN PHYSIOLOGY EDUCATION 2023; 47:26-36. [PMID: 36326475 DOI: 10.1152/advan.00180.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
The cardiovascular system must distribute oxygen and nutrients to the body while maintaining appropriate blood pressure. This is achieved through a combination of central and peripheral mechanisms that influence cardiac output and vasomotor tone throughout the vascular system. Furthermore, the capability to preferentially direct blood to tissues with increased metabolic demand (i.e., active hyperemia) is crucial to exercise tolerance. However, the interaction between these systems is difficult to understand without real-life examples. Fortunately, monitoring blood flow, blood pressure, and heart rate during a series of laboratory protocols will allow students to partition the contributions of these central and peripheral factors. The three protocols include 1) reactive hyperemia in the forearm, 2) small muscle mass handgrip exercise, and 3) large muscle mass cycling exercise. In addition to providing a detailed description of the required equipment, specific protocols, and expected outcomes, this report also reviews some of the common student misconceptions that are associated with the observed physiological responses.NEW & NOTEWORTHY Blood flow regulation during exercise is a complicated process that involves many overlapping mechanisms. This laboratory will help students better understand how the body regulates blood flow to the active muscles using three separate protocols: 1) reactive hyperemia, 2) small muscle mass exercise, and 3) large muscle mass exercise.
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Affiliation(s)
- Cody S Dulaney
- Exercise Physiology, Kent State University, Kent, Ohio
- Department of Exercise and Nutrition Sciences, State University of New York at Plattsburgh, Plattsburgh, New York
| | | | - Tyler J Singer
- Exercise Physiology, Kent State University, Kent, Ohio
- College of Education, Health, and Human Performance, Fairmont State University, Fairmont, West Virginia
| | - John McDaniel
- Exercise Physiology, Kent State University, Kent, Ohio
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3
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Del Seppia C, Federighi G, Lapi D, Gerosolimo F, Scuri R. Effects of a catechins-enriched diet associated with moderate physical exercise in the prevention of hypertension in spontaneously hypertensive rats. Sci Rep 2022; 12:17303. [PMID: 36243879 PMCID: PMC9569358 DOI: 10.1038/s41598-022-21458-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/27/2022] [Indexed: 01/10/2023] Open
Abstract
Hypertension represents the main risk factor for the onset of cardiovascular diseases. Pharmacological treatments to control hypertension have been associated with new treatments involving physical activity and/or the intake of natural components (nutraceuticals). We here report the effects produced by a combination of a natural component (catechins) and a moderate exercise program on the development of hypertension in spontaneous hypertensive rats compared with those of each individual treatment. Arterial blood pressure and heart rate were measured with a non-invasive method in 28 rats randomly assigned to four groups: rats subjected to moderate physical exercise; rats with a catechins-enriched diet; rats subjected to moderate physical exercise combined with a catechins-enriched diet; control, untreated-rats left to age. All treatments were applied for 6 weeks. The statistical analysis revealed that the three treatments significantly reduced the weekly increase in arterial blood pressure observed in control rats (SBP, P < 0.0001; DBP, P = 0.005). However, the reduction of arterial blood pressure induced by combined treatments was not higher than that induced by the single treatment, but more prolonged. All treatments showed strong antioxidative properties. Our data show that physical activity and a diet enriched with catechins individually have an important hypotensive effect, while the association did not produce a higher hypotensive effect than the single treatment, even if it was able to decrease blood pressure for a longer time. These findings have important implications for developing a protocol to apply in novel hypertension prevention procedures.
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Affiliation(s)
- Cristina Del Seppia
- Institute of Clinical Physiology, National Council of Research (CNR), Via Moruzzi, 1, 56124, Pisa, Italy.
| | - Giuseppe Federighi
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Dosminga Lapi
- Department of Biology, University of Pisa, Pisa, Italy
| | - Federico Gerosolimo
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Rossana Scuri
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Hearon CM, Samels M, Dias KA, MacNamara JP, Levine BD, Sarma S. Isolated knee extensor exercise training improves skeletal muscle vasodilation, blood flow, and functional capacity in patients with HFpEF. Physiol Rep 2022; 10:e15419. [PMID: 35924338 PMCID: PMC9350466 DOI: 10.14814/phy2.15419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 05/07/2023] Open
Abstract
Patients with HFpEF experience severe exercise intolerance due in part to peripheral vascular and skeletal muscle impairments. Interventions targeting peripheral adaptations to exercise training may reverse vascular dysfunction, increase peripheral oxidative capacity, and improve functional capacity in HFpEF. Determine if 8 weeks of isolated knee extension exercise (KE) training will reverse vascular dysfunction, peripheral oxygen utilization, and exercise capacity in patients with HFpEF. Nine HFpEF patients (66 ± 5 years, 6 females) performed graded IKE exercise (5, 10, and 15 W) and maximal exercise testing (cycle ergometer) before and after IKE training (3x/week, 30 min/leg). Femoral blood flow (ultrasound) and leg vascular conductance (LVC; index of vasodilation) were measured during graded IKE exercise. Peak pulmonary oxygen uptake (V̇O2 ; Douglas bags) and cardiac output (QC ; acetylene rebreathe) were measured during graded maximal cycle exercise. IKE training improved LVC (pre: 810 ± 417, post: 1234 ± 347 ml/min/100 mmHg; p = 0.01) during 15 W IKE exercise and increased functional capacity by 13% (peak V̇O2 during cycle ergometry; pre:12.4 ± 5.2, post: 14.0 ± 6.0 ml/min/kg; p = 0.01). The improvement in peak V̇O2 was independent of changes in Q̇c (pre:12.7 ± 3.5, post: 13.2 ± 3.9 L/min; p = 0.26) and due primarily to increased a-vO2 difference (pre: 10.3 ± 1.6, post: 11.0 ± 1.7; p = 0.02). IKE training improved vasodilation and functional capacity in patients with HFpEF. Exercise interventions aimed at increasing peripheral oxidative capacity may be effective therapeutic options for HFpEF patients.
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Affiliation(s)
- Christopher M. Hearon
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
- University of Texas Southwestern Medical CenterDepartment of Internal MedicineDallasTexasUSA
| | - Mitchel Samels
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
| | - Katrin A. Dias
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
- University of Texas Southwestern Medical CenterDepartment of Internal MedicineDallasTexasUSA
| | - James P. MacNamara
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
- University of Texas Southwestern Medical CenterDepartment of Internal MedicineDallasTexasUSA
| | - Benjamin D. Levine
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
- University of Texas Southwestern Medical CenterDepartment of Internal MedicineDallasTexasUSA
| | - Satyam Sarma
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
- University of Texas Southwestern Medical CenterDepartment of Internal MedicineDallasTexasUSA
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Gatterer H, Menz V, Burtscher M. Acute Moderate Hypoxia Reduces One-Legged Cycling Performance Despite Compensatory Increase in Peak Cardiac Output: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073732. [PMID: 33918381 PMCID: PMC8038296 DOI: 10.3390/ijerph18073732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 01/23/2023]
Abstract
In severe hypoxia, single-leg peak oxygen uptake (VO2peak) is reduced mainly due to the inability to increase cardiac output (CO). Whether moderate altitude allows CO to increase during single-leg cycling, thereby restoring VO2peak, has not been extensively investigated. Five healthy subjects performed an incremental, maximal, two-legged cycle ergometer test, and on separate days a maximal incremental one-leg cycling test in normoxia and in moderate hypoxia (fraction of inspired oxygen (FiO2) = 15%). Oxygen uptake, heart rate, blood pressure responses, power output, and CO (PhysioFlow) were measured during all tests. Moderate hypoxia lowered single-leg peak power output (154 ± 31 vs. 128 ± 26 watts, p = 0.03) and oxygen uptake (VO2) (36.8 ± 6.6 vs. 33.9 ± 6.9 mL/min/kg, p = 0.04), despite higher peak CO (16.83 ± 3.10 vs. 18.96 ± 3.59 L/min, p = 0.04) and systemic oxygen (O2) delivery (3.37 ± 0.84 vs. 3.47 ± 0.89 L/min, p = 0.04) in hypoxia compared to normoxia. Arterial–venous O2 difference (a–vDO2) was lower in hypoxia (137 ± 21 vs. 112 ± 19 mL/l, p = 0.03). The increases in peak CO from normoxia to hypoxia were negatively correlated with changes in mean arterial pressure (MABP) (p < 0.05). These preliminary data indicate that the rise in CO was not sufficient to prevent single-leg performance loss at moderate altitude and that enhanced baroreceptor activity might limit CO increases in acute hypoxia, likely by reducing sympathetic activation. Since the systemic O2 delivery was enhanced and the calculated a–vDO2 reduced in moderate hypoxia, a potential diffusion limitation cannot be excluded.
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Affiliation(s)
- Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy
- Correspondence:
| | - Verena Menz
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (V.M.); (M.B.)
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (V.M.); (M.B.)
- Austrian Society for High Altitude and Mountain Medicine, 6020 Innsbruck, Austria
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Liang J, Zhang X, Xia W, Tong X, Qiu Y, Qiu Y, He J, Yu B, Huang H, Tao J. Promotion of Aerobic Exercise Induced Angiogenesis Is Associated With Decline in Blood Pressure in Hypertension: Result of EXCAVATION-CHN1. Hypertension 2021; 77:1141-1153. [PMID: 33611934 DOI: 10.1161/hypertensionaha.120.16107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jianwen Liang
- From the Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University (J.L., X.Z., W.X., X.T., Yanxia Qiu, Yumin Qiu, J.H., B.Y., J.T.).,Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University (J.L., H.H.)
| | - Xiaoyu Zhang
- From the Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University (J.L., X.Z., W.X., X.T., Yanxia Qiu, Yumin Qiu, J.H., B.Y., J.T.)
| | - Wenhao Xia
- From the Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University (J.L., X.Z., W.X., X.T., Yanxia Qiu, Yumin Qiu, J.H., B.Y., J.T.)
| | - Xinzhu Tong
- From the Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University (J.L., X.Z., W.X., X.T., Yanxia Qiu, Yumin Qiu, J.H., B.Y., J.T.)
| | - Yanxia Qiu
- From the Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University (J.L., X.Z., W.X., X.T., Yanxia Qiu, Yumin Qiu, J.H., B.Y., J.T.)
| | - Yumin Qiu
- From the Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University (J.L., X.Z., W.X., X.T., Yanxia Qiu, Yumin Qiu, J.H., B.Y., J.T.)
| | - Jiang He
- From the Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University (J.L., X.Z., W.X., X.T., Yanxia Qiu, Yumin Qiu, J.H., B.Y., J.T.)
| | - Bingbo Yu
- From the Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University (J.L., X.Z., W.X., X.T., Yanxia Qiu, Yumin Qiu, J.H., B.Y., J.T.)
| | - Hui Huang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University (J.L., H.H.)
| | - Jun Tao
- From the Department of Hypertension and Vascular Disease, The First Affiliated Hospital of Sun Yat-sen University (J.L., X.Z., W.X., X.T., Yanxia Qiu, Yumin Qiu, J.H., B.Y., J.T.).,Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases (J.T.).,Key Laboratory on Assisted Circulation, Ministry of Health, China (J.T.).,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases (J.T.)
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7
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Ruijsink B, Velasco Forte MN, Duong P, Asner L, Pushparajah K, Frigiola A, Nordsletten D, Razavi R. Synergy in the heart: RV systolic function plays a key role in optimizing LV performance during exercise. Am J Physiol Heart Circ Physiol 2020; 319:H642-H650. [PMID: 32762556 DOI: 10.1152/ajpheart.00256.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The right ventricle (RV) is often overlooked in the evaluation of cardiac performance and treatment of left ventricular (LV) heart diseases. However, recent evidence suggests the RV may play an important role in maintaining systemic cardiac function and delivering stroke volume (SV). We used exercise cardiac magnetic resonance and biomechanical modeling to investigate the role of the RV in LV stroke volume regulation. We studied SV augmentation during exercise by pharmacologically inducing negative chronotropy (sHRi) in healthy volunteers and investigating training-induced SV augmentation in endurance athletes. SV augmentation during exercise after sHRi is achieved differently in the two ventricles. In the RV, the larger SV is driven by increasing contraction down to lower end-systolic volume (ESV; P < 0.001). In the LV, SV augmentation is achieved through an increase in end-diastolic volume (EDV; P < 0.001), avoiding contraction to a lower ESV. The same mechanism underlies the enhanced SV response observed in athletes. Changes in atrial area during SV augmentation suggest that the improved LV EDV response is sustained by the larger RV contractions. Using our biomechanical model, we explain this behavior by showing that the RV systolic function-driven regulation of LV SV optimizes the energetic cost of LV contraction and leads to minimization of the total costs of biventricular contraction. In conclusion, this work provides mechanistic understanding of the pivotal role of the RV in optimizing LV SV during exercise. It demonstrates why optimizing RV function needs to become a key part of therapeutic strategies in patients and training for athletes.NEW & NOTEWORTHY The right ventricle appears to have an important impact on maintaining systemic cardiac function and delivering stroke volume. However, its exact role in supporting left ventricular function has so far been unclear. This study demonstrates a new mechanism of ventricular interaction that provides mechanistic understanding of the key importance of the right ventricle in driving cardiac performance.
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Affiliation(s)
- B Ruijsink
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom.,Departments of Paediatric Cardiology and Adult Congenital Cardiology, Guy's and Saint Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - M N Velasco Forte
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom.,Departments of Paediatric Cardiology and Adult Congenital Cardiology, Guy's and Saint Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - P Duong
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom.,Departments of Paediatric Cardiology and Adult Congenital Cardiology, Guy's and Saint Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - L Asner
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - K Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom.,Departments of Paediatric Cardiology and Adult Congenital Cardiology, Guy's and Saint Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - A Frigiola
- Departments of Paediatric Cardiology and Adult Congenital Cardiology, Guy's and Saint Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - D Nordsletten
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom.,Department of Biomedical Engineering and Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - R Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom.,Departments of Paediatric Cardiology and Adult Congenital Cardiology, Guy's and Saint Thomas' National Health Service Foundation Trust, London, United Kingdom
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CHOU TINGHENG, AKINS JOHND, CRAWFORD CHARLESK, ALLEN JAKOBR, COYLE EDWARDF. Low Stroke Volume during Exercise with Hot Skin Is Due to Elevated Heart Rate. Med Sci Sports Exerc 2019; 51:2025-2032. [DOI: 10.1249/mss.0000000000002029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Han S, Jeong AL, Lee S, Park JS, Buyanravjikh S, Kang W, Choi S, Park C, Han J, Son WC, Yoo KH, Cheong JH, Oh GT, Lee WY, Kim J, Suh SH, Lee SH, Lim JS, Lee MS, Yang Y. C1q/TNF-α–Related Protein 1 (CTRP1) Maintains Blood Pressure Under Dehydration Conditions. Circ Res 2018; 123:e5-e19. [DOI: 10.1161/circresaha.118.312871] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Sora Han
- From the Research Institute of Women’s Health (S.H.)
| | - Ae Lee Jeong
- Sookmyung Women’s University, Seoul, Korea; New Drug Development Center, Osong Medical Innovation Foundation, Korea (A.L.J.)
| | - Sunyi Lee
- Research and Development Center, CJ HealthCare, Icheon, Korea (S.L.)
| | - Jeong Su Park
- Severance Biomedical Science Institute, Yonsei Biomedical Research Institute (J.S.P.)
| | | | - Wonku Kang
- Yonsei University College of Medicine, Seoul, Korea; College of Pharmacy, Chung-Ang University, Seoul, Korea (W.K., S.C., C.P.)
| | - Seungmok Choi
- Yonsei University College of Medicine, Seoul, Korea; College of Pharmacy, Chung-Ang University, Seoul, Korea (W.K., S.C., C.P.)
| | - Changmin Park
- Yonsei University College of Medicine, Seoul, Korea; College of Pharmacy, Chung-Ang University, Seoul, Korea (W.K., S.C., C.P.)
| | - Jin Han
- Department of Physiology, National Research Laboratory for Mitochondrial Signaling, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Korea (J.H.)
| | - Woo-Chan Son
- Pathology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (W.-C.S.)
| | - Kyung Hyun Yoo
- Department of Biological Sciences (K.H.Y., S.B., J.-S.L., M.-S.L., Y.Y.)
| | - Jae Hoon Cheong
- Department of Pharmacy, Sahmyook University, Seoul, Korea (J.H.C.)
| | | | - Won-Young Lee
- Ewha Womans University, Seoul, Korea; Department of Endocrinology (W.-Y.L.)
- Department of Metabolism (W.-Y.L.)
| | - Jongwan Kim
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Laboratory Medicine, Dankook University School of Medicine, Cheonan, Korea (J.K.)
| | - Suk Hyo Suh
- Department of Physiology, Medical School (S.H.S.)
| | - Sang-Hak Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital (S.-H.L.)
| | - Jong-Seok Lim
- Department of Biological Sciences (K.H.Y., S.B., J.-S.L., M.-S.L., Y.Y.)
| | - Myeong-Sok Lee
- Department of Biological Sciences (K.H.Y., S.B., J.-S.L., M.-S.L., Y.Y.)
| | - Young Yang
- Department of Biological Sciences (K.H.Y., S.B., J.-S.L., M.-S.L., Y.Y.)
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Aerobic interval training reduces vascular resistances during submaximal exercise in obese metabolic syndrome individuals. Eur J Appl Physiol 2017; 117:2065-2073. [PMID: 28803380 DOI: 10.1007/s00421-017-3697-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 08/02/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE The aim of this study was to determine the effects of high-intensity aerobic interval training (AIT) on exercise hemodynamics in metabolic syndrome (MetS) volunteers. METHODS Thirty-eight, MetS participants were randomly assigned to a training (TRAIN) or to a non-training control (CONT) group. TRAIN consisted of stationary interval cycling alternating bouts at 70-90% of maximal heart rate during 45 min day-1 for 6 months. RESULTS CONT maintained baseline physical activity and no changes in cardiovascular function or MetS factors were detected. In contrast, TRAIN increased cardiorespiratory fitness (14% in VO2PEAK; 95% CI 9-18%) and improved metabolic syndrome (-42% in Z score; 95% CI 83-1%). After TRAIN, the workload that elicited a VO2 of 1500 ml min-1 increased 15% (95% CI 5-25%; P < 0.001). After TRAIN when subjects pedaled at an identical submaximal rate of oxygen consumption, cardiac output increased by 8% (95% CI 4-11%; P < 0.01) and stroke volume by 10% (95% CI, 6-14%; P < 0.005) being above the CONT group values at that time point. TRAIN reduced submaximal exercise heart rate (109 ± 15-106 ± 13 beats min-1; P < 0.05), diastolic blood pressure (83 ± 8-75 ± 8 mmHg; P < 0.001) and systemic vascular resistances (P < 0.01) below CONT values. Double product was reduced only after TRAIN (18.2 ± 3.2-17.4 ± 2.4 bt min-1 mmHg 10-3; P < 0.05). CONCLUSIONS The data suggest that intense aerobic interval training improves hemodynamics during submaximal exercise in MetS patients. Specifically, it reduces diastolic blood pressure, systemic vascular resistances, and the double product. The reduction in double product, suggests decreased myocardial oxygen demands which could prevent the occurrence of adverse cardiovascular events during exercise in this population. CLINICALTRIALS. GOV IDENTIFIER NCT03019796.
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11
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Nyberg M, Egelund J, Mandrup CM, Andersen CB, Hansen KMBE, Hergel IMF, Valbak-Andersen N, Frikke-Schmidt R, Stallknecht B, Bangsbo J, Hellsten Y. Leg vascular and skeletal muscle mitochondrial adaptations to aerobic high-intensity exercise training are enhanced in the early postmenopausal phase. J Physiol 2017; 595:2969-2983. [PMID: 28231611 DOI: 10.1113/jp273871] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/08/2017] [Indexed: 12/15/2022] Open
Abstract
KEY POINTS Exercise training effectively improves vascular and skeletal muscle function; however, these effects of training may be blunted in postmenopausal women as a result of the loss of oestrogens. Accordingly, the capacity to deliver oxygen to the active muscles may also be impaired in postmenopausal women. In both premenopausal and recent postmenopausal women, exercise training was shown to improve leg vascular and skeletal muscle mitochondrial function. Interestingly, these effects were more pronounced in postmenopausal women. Skeletal muscle oxygen supply and utilization were similar in the two groups of women. These findings suggest that the early postmenopausal phase is associated with an enhanced capacity of the leg vasculature and skeletal muscle mitochondria to adapt to exercise training and that the ability to deliver oxygen to match the demand of the active muscles is preserved in the early phase following the menopausal transition. ABSTRACT Exercise training leads to favourable adaptations within skeletal muscle; however, this effect of exercise training may be blunted in postmenopausal women as a result of the loss of oestrogens. Furthermore, postmenopausal women may have an impaired vascular response to acute exercise. We examined the haemodynamic response to acute exercise in matched pre- and postmenopausal women before and after 12 weeks of aerobic high intensity exercise training. Twenty premenopausal and 16 early postmenopausal (mean ± SEM: 3.1 ± 0.5 years after final menstrual period) women only separated by 4 years of age (mean ± SEM: 50 ± 0 years vs. 54 ± 1 years) were included. Before training, leg blood flow, O2 delivery, O2 uptake and lactate release during knee-extensor exercise were similar in pre- and postmenopausal women. Exercise training reduced (P < 0.05) leg blood flow, O2 delivery, O2 uptake, lactate release, blood pressure and heart rate during the same absolute workloads in postmenopausal women. These effects were not detected in premenopausal women. Quadriceps muscle protein contents of mitochondrial complex II, III and IV; endothelial nitric oxide synthase (eNOS); cyclooxygenase (COX)-1; COX-2; and oestrogen-related receptor α (ERRα) were increased (P < 0.05) with training in postmenopausal women, whereas only the levels of mitochondrial complex V, eNOS and COX-2 were increased (P < 0.05) in premenopausal women. These findings demonstrate that vascular and skeletal muscle mitochondrial adaptations to aerobic high intensity exercise training are more pronounced in recent post- compared to premenopausal women, possibly as an effect of enhanced ERRα signalling. Also, the hyperaemic response to acute exercise appears to be preserved in the early postmenopausal phase.
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Affiliation(s)
- Michael Nyberg
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jon Egelund
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Camilla M Mandrup
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Caroline B Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karen M B E Hansen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Ida-Marie F Hergel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | | | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bangsbo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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12
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Ratziu V, Valla D, Rautou PE. Arterial hypertension as an uninvited player in hepatic stiffness? Am J Physiol Gastrointest Liver Physiol 2016; 311:G942-G944. [PMID: 27765758 DOI: 10.1152/ajpgi.00276.2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Vlad Ratziu
- Service d'hépatogastroentérologie, Institute for Cardiometabolism and Nutrition, Hospital Pitié Salpêtrière, INSERM UMR S_938, Université Pierre et Marie Curie, Paris, France;
| | - Dominique Valla
- INSERM, UMR-970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; and.,Service d'hépatologie, DHU Unity Hôpital Beaujon, APHP, Université Denis Diderot-Paris 7, Sorbonne Paris Cité, Clichy, France
| | - Pierre-Emmanuel Rautou
- INSERM, UMR-970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; and.,Service d'hépatologie, DHU Unity Hôpital Beaujon, APHP, Université Denis Diderot-Paris 7, Sorbonne Paris Cité, Clichy, France
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13
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Li Z, Muller MD, Wang J, Sica CT, Karunanayaka P, Sinoway LI, Yang QX. Dynamic characteristics of T2*-weighted signal in calf muscles of peripheral artery disease during low-intensity exercise. J Magn Reson Imaging 2016; 46:40-48. [PMID: 27783446 DOI: 10.1002/jmri.25532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 10/11/2016] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To evaluate the dynamic characteristics of T2* -weighted signal change in exercising skeletal muscle of healthy subjects and peripheral artery disease (PAD) patients under a low-intensity exercise paradigm. MATERIALS AND METHODS Nine PAD patients and nine age- and sex-matched healthy volunteers underwent a low-intensity exercise paradigm while magnetic resonance imaging (MRI) (3.0T) was obtained. T2*-weighted signal time-courses in lateral gastrocnemius, medial gastrocnemius, soleus, and tibialis anterior were acquired and analyzed. Correlations were performed between dynamic T2*-weighted signal and changes in heart rate, mean arterial pressure, leg pain, and perceived exertion. RESULTS A significant signal decrease was observed during exercise in soleus and tibialis anterior of healthy participants (P = 0.0007-0.04 and 0.001-0.009, respectively). In PAD, negative signals were observed (P = 0.008-0.02 and 0.003-0.01, respectively) in soleus and lateral gastrocnemius during the early exercise stage. Then the signal gradually increased above the baseline in the lateral gastrocnemius during and after exercise in six of the eight patients who completed the study. This signal increase in patients' lateral gastrocnemius was significantly greater than in healthy subjects' during the later exercise stage (two-sample t-tests, P = 0.001-0.03). Heart rate and mean arterial pressure responses to exercise were significantly higher in PAD than healthy subjects (P = 0.036 and 0.008, respectively) and the patients experienced greater leg pain and exertion (P = 0.006 and P = 0.0014, respectively). CONCLUSION During low-intensity exercise, there were different dynamic T2*-weighted signal behavior in the healthy and PAD exercising muscles. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:40-48.
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Affiliation(s)
- Zhijun Li
- Department of Radiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.,Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Matthew D Muller
- Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Jianli Wang
- Department of Radiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Christopher T Sica
- Department of Radiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Prasanna Karunanayaka
- Department of Radiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Lawrence I Sinoway
- Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Qing X Yang
- Department of Radiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.,Department of Neurosurgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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14
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Calbet JAL, González-Alonso J, Helge JW, Søndergaard H, Munch-Andersen T, Saltin B, Boushel R. Central and peripheral hemodynamics in exercising humans: leg vs arm exercise. Scand J Med Sci Sports 2016; 25 Suppl 4:144-57. [PMID: 26589128 DOI: 10.1111/sms.12604] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 12/22/2022]
Abstract
In humans, arm exercise is known to elicit larger increases in arterial blood pressure (BP) than leg exercise. However, the precise regulation of regional vascular conductances (VC) for the distribution of cardiac output with exercise intensity remains unknown. Hemodynamic responses were assessed during incremental upright arm cranking (AC) and leg pedalling (LP) to exhaustion (Wmax) in nine males. Systemic VC, peak cardiac output (Qpeak) (indocyanine green) and stroke volume (SV) were 18%, 23%, and 20% lower during AC than LP. The mean BP, the rate-pressure product and the associated myocardial oxygen demand were 22%, 12%, and 14% higher, respectively, during maximal AC than LP. Trunk VC was reduced to similar values at Wmax. At Wmax, muscle mass-normalized VC and fractional O2 extraction were lower in the arm than the leg muscles. However, this was compensated for during AC by raising perfusion pressure to increase O2 delivery, allowing a similar peak VO2 per kg of muscle mass in both extremities. In summary, despite a lower Qpeak during arm cranking the cardiovascular strain is much higher than during leg pedalling. The adjustments of regional conductances during incremental exercise to exhaustion depend mostly on the relative intensity of exercise and are limb-specific.
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Affiliation(s)
- J A L Calbet
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Canary Islands, Spain.,The Copenhagen Muscle Research Centre, Rigshospitalet, Copenhagen N, Denmark
| | - J González-Alonso
- The Copenhagen Muscle Research Centre, Rigshospitalet, Copenhagen N, Denmark.,Centre for Sports Medicine and Human Performance, Brunel University London, Uxbridge, UK
| | - J W Helge
- The Copenhagen Muscle Research Centre, Rigshospitalet, Copenhagen N, Denmark.,Centre for Healthy Ageing, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H Søndergaard
- The Copenhagen Muscle Research Centre, Rigshospitalet, Copenhagen N, Denmark
| | - T Munch-Andersen
- The Copenhagen Muscle Research Centre, Rigshospitalet, Copenhagen N, Denmark
| | - B Saltin
- The Copenhagen Muscle Research Centre, Rigshospitalet, Copenhagen N, Denmark
| | - R Boushel
- The Copenhagen Muscle Research Centre, Rigshospitalet, Copenhagen N, Denmark.,School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Fadel PJ. Reflex control of the circulation during exercise. Scand J Med Sci Sports 2016; 25 Suppl 4:74-82. [PMID: 26589120 DOI: 10.1111/sms.12600] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 12/01/2022]
Abstract
Appropriate cardiovascular and hemodynamic adjustments are necessary to meet the metabolic demands of working skeletal muscle during exercise. Alterations in the sympathetic and parasympathetic branches of the autonomic nervous system are fundamental in ensuring these adjustments are adequately made. Several neural mechanisms are responsible for the changes in autonomic activity with exercise and through complex interactions, contribute to the cardiovascular and hemodynamic changes in an intensity-dependent manner. This short review is from a presentation made at the Saltin Symposium June 2-4, 2015 in Copenhagen, Denmark. As such, the focus will be on reflex control of the circulation with an emphasis on the work of the late Dr. Bengt Saltin. Moreover, a concerted effort is made to highlight the novel and insightful concepts put forth by Dr. Saltin in his last published review article on the regulation of skeletal muscle blood flow in humans. Thus, the multiple roles played by adenosine triphosphate (ATP) including its ability to induce vasodilatation, override sympathetic vasoconstriction and stimulate skeletal muscle afferents (exercise pressor reflex) are discussed and a conceptual framework is set suggesting a major role of ATP in blood flow regulation during exercise.
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Affiliation(s)
- P J Fadel
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA
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16
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Gouzi F, Maury J, Bughin F, Blaquière M, Ayoub B, Mercier J, Perez-Martin A, Pomiès P, Hayot M. Impaired training-induced adaptation of blood pressure in COPD patients: implication of the muscle capillary bed. Int J Chron Obstruct Pulmon Dis 2016; 11:2349-2357. [PMID: 27703345 PMCID: PMC5038574 DOI: 10.2147/copd.s113657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background and aims Targeting the early mechanisms in exercise-induced arterial hypertension (which precedes resting arterial hypertension in its natural history) may improve cardiovascular morbidity and mortality in COPD patients. Capillary rarefaction, an early event in COPD before vascular remodeling, is a potential mechanism of exercise-induced and resting arterial hypertension. Impaired training-induced capillarization was observed earlier in COPD patients; thus, this study compares the changes in blood pressure (BP) during exercise in COPD patients and matches control subjects (CSs) after a similar exercise training program, in relationship with muscle capillarization. Methods Resting and maximal exercise diastolic pressure (DP) and systolic pressure (SP) were recorded during a standardized cardiopulmonary exercise test, and a quadriceps muscle biopsy was performed before and after training. Results A total of 35 CSs and 49 COPD patients (forced expiratory volume in 1 second =54%±22% predicted) completed a 6-week rehabilitation program and improved their symptom-limited maximal oxygen uptake (VO2SL: 25.8±6.1 mL/kg per minute vs 27.9 mL/kg per minute and 17.0±4.7 mL/kg per minute vs 18.3 mL/kg per minute; both P<0.001). The improvement in muscle capillary-to-fiber (C/F) ratio was significantly greater in CSs vs COPD patients (+11%±9% vs +23%±21%; P<0.05). Although maximal exercise BP was reduced in CSs (DP: 89±10 mmHg vs 85±9 mmHg; P<0.001/SP: 204±25 mmHg vs 196±27 mmHg; P<0.05), it did not change in COPD patients (DP: 94±14 mmHg vs 97±16 mmHg; P=0.46/SP: 202±27 mmHg vs 208±24 mmHg; P=0.13). The change in muscle C/F ratio was negatively correlated with maximal exercise SP in CSs and COPD patients (r=−0.41; P=0.02). Conclusion COPD patients showed impaired training-induced BP adaptation related to a change in muscle capillarization, suggesting the possibility of blunted angiogenesis.
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Affiliation(s)
- Fares Gouzi
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Department of Clinical Physiology, Montpellier University Hospital, Montpellier
| | - Jonathan Maury
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Pulmonary Rehabilitation Center "La Solane", 5 Santé Group, Osséja
| | - François Bughin
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Department of Clinical Physiology, Montpellier University Hospital, Montpellier
| | - Marine Blaquière
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Department of Clinical Physiology, Montpellier University Hospital, Montpellier
| | - Bronia Ayoub
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Department of Clinical Physiology, Montpellier University Hospital, Montpellier
| | - Jacques Mercier
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Department of Clinical Physiology, Montpellier University Hospital, Montpellier
| | - Antonia Perez-Martin
- Dysfunction of Vascular Interfaces Laboratory, EA 2992, University of Montpellier; Department of Vascular Medicine and Investigations, Nîmes University Hospital, Nîmes, France
| | - Pascal Pomiès
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier
| | - Maurice Hayot
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Department of Clinical Physiology, Montpellier University Hospital, Montpellier
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17
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Boushel R. Linking skeletal muscle blood flow and metabolism to the limits of human performance. Appl Physiol Nutr Metab 2016; 42:111-115. [PMID: 28006435 DOI: 10.1139/apnm-2016-0393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Over the last 50 years, Bengt Saltin's contributions to our understanding of physiology of the circulation, the matching of the circulation to muscle metabolism, and the underlying mechanisms that set the limits for exercise performance were enormous. His research addressed the key questions in the field using sophisticated experimental methods including field expeditions. From the Dallas Bedrest Study to the 1-leg knee model to the physiology of lifelong training, his prodigious body of work was foundational in the field of exercise physiology and his leadership propelled integrative human physiology into the mainstream of biological sciences.
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Affiliation(s)
- Robert Boushel
- School of Kinesiology, University of British Columbia, 210-6100 University Boulevard, Vancouver, BC V6T 1Z1, Canada.,School of Kinesiology, University of British Columbia, 210-6100 University Boulevard, Vancouver, BC V6T 1Z1, Canada
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18
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Abstract
Aerobic exercise training leads to cardiovascular changes that markedly increase aerobic power and lead to improved endurance performance. The functionally most important adaptation is the improvement in maximal cardiac output which is the result of an enlargement in cardiac dimension, improved contractility, and an increase in blood volume, allowing for greater filling of the ventricles and a consequent larger stroke volume. In parallel with the greater maximal cardiac output, the perfusion capacity of the muscle is increased, permitting for greater oxygen delivery. To accommodate the higher aerobic demands and perfusion levels, arteries, arterioles, and capillaries adapt in structure and number. The diameters of the larger conduit and resistance arteries are increased minimizing resistance to flow as the cardiac output is distributed in the body and the wall thickness of the conduit and resistance arteries is reduced, a factor contributing to increased arterial compliance. Endurance training may also induce alterations in the vasodilator capacity, although such adaptations are more pronounced in individuals with reduced vascular function. The microvascular net increases in size within the muscle allowing for an improved capacity for oxygen extraction by the muscle through a greater area for diffusion, a shorter diffusion distance, and a longer mean transit time for the erythrocyte to pass through the smallest blood vessels. The present article addresses the effect of endurance training on systemic and peripheral cardiovascular adaptations with a focus on humans, but also covers animal data.
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Affiliation(s)
- Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Michael Nyberg
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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19
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Sarma S, Levine BD. Soothing the sleeping giant: improving skeletal muscle oxygen kinetics and exercise intolerance in HFpEF. J Appl Physiol (1985) 2015; 119:734-8. [PMID: 26048977 DOI: 10.1152/japplphysiol.01127.2014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Patients with heart failure with preserved ejection fraction (HFpEF) have similar degrees of exercise intolerance and dyspnea as patients with heart failure with reduced EF (HFrEF). The underlying pathophysiology leading to impaired exertional ability in the HFpEF syndrome is not completely understood, and a growing body of evidence suggests "peripheral," i.e., noncardiac, factors may play an important role. Changes in skeletal muscle function (decreased muscle mass, capillary density, mitochondrial volume, and phosphorylative capacity) are common findings in HFrEF. While cardiac failure and decreased cardiac reserve account for a large proportion of the decline in oxygen consumption in HFrEF, impaired oxygen diffusion and decreased skeletal muscle oxidative capacity can also hinder aerobic performance, functional capacity and oxygen consumption (V̇o2) kinetics. The impact of skeletal muscle dysfunction and abnormal oxidative capacity may be even more pronounced in HFpEF, a disease predominantly affecting the elderly and women, two demographic groups with a high prevalence of sarcopenia. In this review, we 1) describe the basic concepts of skeletal muscle oxygen kinetics and 2) evaluate evidence suggesting limitations in aerobic performance and functional capacity in HFpEF subjects may, in part, be due to alterations in skeletal muscle oxygen delivery and utilization. Improving oxygen kinetics with specific training regimens may improve exercise efficiency and reduce the tremendous burden imposed by skeletal muscle upon the cardiovascular system.
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Affiliation(s)
- Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Prebysterian Hospital, Dallas, Texas; and Department of Internal Medicine, University of Texas Southwestern Medical Branch, Dallas, Texas
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Prebysterian Hospital, Dallas, Texas; and Department of Internal Medicine, University of Texas Southwestern Medical Branch, Dallas, Texas
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20
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Abstract
In humans, skeletal muscle blood flow is regulated by an interaction between several locally formed vasodilators, including NO and prostaglandins. In plasma, ATP is a potent vasodilator that stimulates the formation of NO and prostaglandins and, very importantly, can offset local sympathetic vasoconstriction. Adenosine triphosphate is released into plasma from erythrocytes and endothelial cells, and the plasma concentration increases in both the feed artery and the vein draining the contracting skeletal muscle. Adenosine also stimulates the formation of NO and prostaglandins, but the plasma adenosine concentration does not increase during exercise. In the skeletal muscle interstitium, there is a marked increase in the concentration of ATP and adenosine, and this increase is tightly coupled to the increase in blood flow. The sources of interstitial ATP and adenosine are thought to be skeletal muscle cells and endothelial cells. In the interstitium, both ATP and adenosine stimulate the formation of NO and prostaglandins, but ATP has also been suggested to induce vasoconstriction and stimulate afferent nerves that signal to increase sympathetic nerve activity. Adenosine has been shown to contribute to exercise hyperaemia, whereas the role of ATP remains uncertain due to lack of specific purinergic receptor blockers for human use. The purpose of this review is to address the interaction between vasodilator systems and to discuss the multiple proposed roles of ATP in human skeletal muscle blood flow regulation.
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Affiliation(s)
- Stefan P Mortensen
- Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Bengt Saltin
- Copenhagen Muscle Research Centre, Rigshospitalet, Copenhagen, Denmark
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21
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Levine BD, Cornwell WK, Drazner MH. Factors Influencing the Rate of Flow Through Continuous-Flow Left Ventricular Assist Devices at Rest and With Exercise ∗. JACC-HEART FAILURE 2014; 2:331-4. [DOI: 10.1016/j.jchf.2014.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 03/28/2014] [Indexed: 12/17/2022]
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22
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Munch GDW, Svendsen JH, Damsgaard R, Secher NH, González-Alonso J, Mortensen SP. Maximal heart rate does not limit cardiovascular capacity in healthy humans: insight from right atrial pacing during maximal exercise. J Physiol 2013; 592:377-90. [PMID: 24190933 DOI: 10.1113/jphysiol.2013.262246] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In humans, maximal aerobic power (VO2 max ) is associated with a plateau in cardiac output (Q), but the mechanisms regulating the interplay between maximal heart rate (HRmax) and stroke volume (SV) are unclear. To evaluate the effect of tachycardia and elevations in HRmax on cardiovascular function and capacity during maximal exercise in healthy humans, 12 young male cyclists performed incremental cycling and one-legged knee-extensor exercise (KEE) to exhaustion with and without right atrial pacing to increase HR. During control cycling, Q and leg blood flow increased up to 85% of maximal workload (WLmax) and remained unchanged until exhaustion. SV initially increased, plateaued and then decreased before exhaustion (P < 0.05) despite an increase in right atrial pressure (RAP) and a tendency (P = 0.056) for a reduction in left ventricular transmural filling pressure (LVFP). Atrial pacing increased HRmax from 184 ± 2 to 206 ± 3 beats min(-1) (P < 0.05), but Q remained similar to the control condition at all intensities because of a lower SV and LVFP (P < 0.05). No differences in arterial pressure, peripheral haemodynamics, catecholamines or VO2 were observed, but pacing increased the rate pressure product and RAP (P < 0.05). Atrial pacing had a similar effect on haemodynamics during KEE, except that pacing decreased RAP. In conclusion, the human heart can be paced to a higher HR than observed during maximal exercise, suggesting that HRmax and myocardial work capacity do not limit VO2 max in healthy individuals. A limited left ventricular filling and possibly altered contractility reduce SV during atrial pacing, whereas a plateau in LVFP appears to restrict Q close to VO2 max .
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Affiliation(s)
- G D W Munch
- Centre of Inflammation and Metabolism, Department of Infectious Diseases, Rigshospitalet, Section 7641, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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23
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Nalbandian A, Nguyen C, Katheria V, Llewellyn KJ, Badadani M, Caiozzo V, Kimonis VE. Exercise training reverses skeletal muscle atrophy in an experimental model of VCP disease. PLoS One 2013; 8:e76187. [PMID: 24130765 PMCID: PMC3794032 DOI: 10.1371/journal.pone.0076187] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 08/21/2013] [Indexed: 12/12/2022] Open
Abstract
Background The therapeutic effects of exercise resistance and endurance training in the alleviation of muscle hypertrophy/atrophy should be considered in the management of patients with advanced neuromuscular diseases. Patients with progressive neuromuscular diseases often experience muscle weakness, which negatively impact independence and quality of life levels. Mutations in the valosin containing protein (VCP) gene lead to Inclusion body myopathy associated with Paget's disease of bone and frontotemporal dementia (IBMPFD) and more recently affect 2% of amyotrophic lateral sclerosis (ALS)-diagnosed cases. Methods/Principle Findings The present investigation was undertaken to examine the effects of uphill and downhill exercise training on muscle histopathology and the autophagy cascade in an experimental VCP mouse model carrying the R155H mutation. Progressive uphill exercise in VCPR155H/+ mice revealed significant improvement in muscle strength and performance by grip strength and Rotarod analyses when compared to the sedentary mice. In contrast, mice exercised to run downhill did not show any significant improvement. Histologically, the uphill exercised VCPR155H/+ mice displayed an improvement in muscle atrophy, and decreased expression levels of ubiquitin, P62/SQSTM1, LC3I/II, and TDP-43 autophagy markers, suggesting an alleviation of disease-induced myopathy phenotypes. There was also an improvement in the Paget-like phenotype. Conclusions Collectively, our data highlights that uphill exercise training in VCPR155H/+ mice did not have any detrimental value to the function of muscle, and may offer effective therapeutic options for patients with VCP-associated diseases.
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Affiliation(s)
- Angèle Nalbandian
- Department of Pediatrics, Division of Genetics and Metabolism, University of California Irvine, Irvine, California, United States of America
| | - Christopher Nguyen
- Department of Pediatrics, Division of Genetics and Metabolism, University of California Irvine, Irvine, California, United States of America
| | - Veeral Katheria
- Department of Pediatrics, Division of Genetics and Metabolism, University of California Irvine, Irvine, California, United States of America
| | - Katrina J. Llewellyn
- Department of Pediatrics, Division of Genetics and Metabolism, University of California Irvine, Irvine, California, United States of America
| | - Mallikarjun Badadani
- Department of Pediatrics, Division of Genetics and Metabolism, University of California Irvine, Irvine, California, United States of America
| | - Vincent Caiozzo
- Department of Physiology and Biophysics, University of California Irvine, Irvine, California, United States of America
- Department of Orthopedics, University of California Irvine, Irvine, California, United States of America
| | - Virginia E. Kimonis
- Department of Pediatrics, Division of Genetics and Metabolism, University of California Irvine, Irvine, California, United States of America
- * E-mail:
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