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Exercise

Types

Endurance (aerobic; isotonic)


high repetition movements
against low resistance

Resistance (static; isometric)


low repetition movements against
high resistance
Blood distribution
Venous Return

- ↑ sympathetic tone (‘stiffening’)


- muscle pumping
- ↑ respiration (↓ thoracic pressure)
BP during exercise
Local effects Systemic effects
↓ PH ↑ catecholamines
↑ CO2
↑Lactate

vasodilation > vasoconstriction

↓TPR ↑C.O.

↓ Diast BP ↑ Syst BP
Blood pressure response to exercise
Isometric contraction and BP
250

200
blood pressure, Torr

150 systolic
mean
100

50
diastolic
0
% MVC

0 25 25 50 75 100
Max. Voluntary
Contraction
Cardiac Output (C.O.)

C.O. = Heart Rate x Stroke Volume


Cardiovascular response to Exercise
Cardiac Output (ml / min)

Untrained Trained

Rest 5000 (70/min x 71ml) 5000 (50/min x 100ml)

Exerc. 22000 (195/min x 113ml) 35000 (195/min x 179ml)


Stroke volumes at rest and during work
Cardiovascular response to
Exercise

= SV/EDV
% of Total Blood
Volume

Absolute Values

Distribution of cardiac output


Endurance training effects
Changes in skeletal muscle

↑ Mitochondria
Aerobic metabolism
↑ Myoglobin
↑ Capillary density
↓ Lactate
↑ Metabolic enzymes ↓
↑Endurance
Endurance training and BP
220
pre training
200
Blood pressure, Torr

systolic Post training


180
160
140
mean
120
100
80
diastolic

Normals
-
VO2, 1-min 1
Rest 1 2 3 4
Myocardial Metabolism
At Rest:
- Energy (almost) only from aerobic reactions
- X3 oxidative capacity > skeletal muscle
- highest mitochondrial concentration of all tissues
- utilizes glucose, lactate, fatty acids

During exercise:
- Heavy – may use lactate as > 50% of its energy
- Prolonged submaximal – may use FFA ~ 70% of
its energy
Myocardial Oxygen Utilization

At Rest:
avO2 difference – 14–16 ml O2/100 ml

During exercise:
Blood flow ↑ X 4-6
- coronary dilatation (ATP, Aden, O2,
sympat.)
- ↑ aortic pressure
Alveolar / Capillary Relation
Respiratory Membrane
Pulmonary volumes at rest and during exercise
Minute ventilation (liter/min) (VE)

Breathing rate Tidal vol. VE


(1/min) (L) (L/min)
Nl 12 0.5 6

Max. Exer. 40 2 80-100

Elite athletes 60-70 3* ~ 200

* ~ 60% of VC
Oxygen Transport
Carried in 2 ways:

1. Dissolved in blood (PO2)


0.3 ml O2 / 100 ml blood (4 sec!)

2. Loose combination with Hb


1.34 ml O2 / 1 gr Hb

(1.34 ml/gr x 15 gr/100 ml = 20 mlO2 /100ml


blood)
Oxygen hemoglobin
dissociation curve
Transport of CO2 in blood
Chemoreceptors (PO2)(Pco2)
Blood gases and exercise
- healthy individuals tend to ‘overbreathe’
during heavy exercise

- pulmonary function does not limit exercise,


except in high endurance athletes
Training and lung function
- minimal effects

-vital capacity : olympic wrestlers = middle


distance runners= untrained healthy
subjects
- exceptions:
- swimming / diving
- ventilatory endurance
a-v O2 difference
Rest
a-vO2d = 5 ml (20 → 15 ml O2)/100ml Blood

Exercise
Sedentary (untrained)
Sedentary (trained)
Endurance
athletes
Oxygen Uptake - VO2

VO2 max = C.O.max x a-vO2 difference max

- VO2 may increase x 20 from :

rest (250 ml) to


exercise (5000 ml) (Trained)
Oxygen Uptake - VO2
- VO2 max - best estimation of fitness

dependent on

Pulmonary Ventilation
Hb Concentration
blood volume & cardiac output
Peripheral blood flow (AVO2 difference)
Aerobic metabolism (mitochondria)
Sedentary (untrained)
Sedentary (trained)
Endurance
athletes
Cardiac Output with O2 transport
Rest
C.O. (trained / untrained) = 5 L / min
O2 content (200 ml/L x 5L) = 1000 ml
O2 consumption = 250 ml

O2 reserve = 750 ml
Cardiac Output with O2 Transport
Exercise (example):
C.O. (200/min x 80 ml) = 16 L/min

O2 content (200 ml/L x 16L) = 3200 ml

VO2 max (Theoret.) = 3200 ml

↑ in C.O. = ↑ in VO2
Max CO with VO2 max
Sedentary (untrained)
Sedentary (trained)
Endurance
athletes

During dynamic exercise –


C.O. is tightly linked to VO2
Summary
• CVS at rest & exercise
• Pulmonary System at rest & exercise
• Both systems are tightly connected
• Exercise – demands integration of CVS,
Pulm. S., Blood transport, ANS,
mitochondria & metablism.
Factors affecting a-vO2 difference:
Exercise

- Diversion of blood to exercising muscles

- ↑ Capillary to fiber ratio (training effect)

- ↑Aerobic production of ATP (training effect)


.a-vO2 difference in I.H.D
Post MI → S.V. and C.O. do not ↑ with training

“cardiac ↑ exercise tolerance



rehabilitation” ↑ aerobic capacity

Due to↑ a-vO2 difference in skeletal muscles


Onset of Blood Lactate
Accumulation (anaerobic
(threshold
- The exercise level (or VO2) at which
blood lactate begins to increase above
rest level
- in healthy, untrained subjects – 55-65%
of VO2max
- can be raised by training (~80% in
trained endurance athletes)
Incremental exercise (up to Vo2,max )
-Anaerobic Threshold
C.O. Measurement
How much blood / min accounts for O2
consumption given observed a-vO2
difference?
O2 consumption
C.O. = ----------------------- X 100
Fick principle a-vO2 difference
Blood Tissue Interaction
(Rest)
PO2 in cells – 40 mm Hg

Dissolved O2 moves from blood to tissue

HbO2 → O2 →
tissue
At PO2 = 40 mm Hg → HbO2 = 70%
(15ml O2 / 100 ml)
a-vO2 difference = 4-5 ml O2 / 100 ml (20-25%)
Blood tissue interaction
(exercise)

- vigorous exercise → tissue PO2 = 15%

- HbO2 (at PO2=15%) = 20% (5 ml O2/100ml)

- avO2 difference = 15 ml O2/ 100ml

(exhaustive exercise → PO2=3% (~0ml O2/100ml

→ x3 O2 delivery w/o ↑flow)


Estimated Maximum H.R.

H.R. max = 220 – age (y)


g lobin
myo

bin
aglo
hem

% saturation of hemaglobin and myoglobin


Ventilatory response to exercise
Respiration—Mechanical
Factors
Alveoli
~ 300 000 000

- interconnected

- at rest (1min) – 250 ml O2


200 ml CO2

- heavy exercise → 6000 ml O2


(trained endurance) 5000 ml CO2
Dead Space

Anatomic – non diffusible conducting parts


(~ 150 ml)

Physiologic – poor ventilation – perfusion ratio


(Nl – very small)
Respiratory regulation
Relation of METs to stages in the various testing protocols

Fletcher, G. F. et al. Circulation 2001;104:1694-1740

Copyright ©2001 American Heart Association