CARDIOVASCULAR ADAPTATION TO MUSCULAR EXERCISE

Cardiovascular changes during muscular exercise

CARDIOVASCULAR ADAPTATION TO MUSCULAR EXERCISE

The blood flow of resting skeletal muscles is low (900 ml/min).
During exercise, the flow is greatly increased to as much as 20-fold.

Exercise produces increased H+ ion, excess metabolites, excitement, adrenaline-secretion, rise of temperature and so on
these factors alter the activity of the different systems by their central and peripheral actions and regulate their functional level according to the needs of the body.

CARDIOVASCULAR ADAPTATION TO MUSCULAR EXERCISE

The cardiovascular changes produced are either:
general or local

A) General effects
I. Heart rate:
Heart rate is increased and may reach 140 to 180 beats per minute or more. The increase in heart rate is presumably due to:
irradiation of impulses from the higher centers (cerebral cortex, respiratory center etc....) to the cardiovascular centers (CVCs). The rise of temperature and increased acidity stimulate the cardiovascular centers further. The increased venous return sets up the Atrial stretch reflex. Also the muscular system (through the muscle spindles and the other proprioceptors) sends impulses to the higher centers via the sensory nerves.

A) General effects
I. Heart rate:(cont.)
The net result of all the discharge to the CVCs is to produce marked depression of vagal tone and increase of the sympathetic tone. There is only one factor which tends to slow the heart during exercise, namely the rise in the ABP, according to Mareys law.
But the vagal neurons of the CVCs become so inhibited by the various mentioned factors
this may be explained by assuming that during exercise the baroreceptors become out of function

A) General effects
II. Venous return
This is increased by about 5 or 6 folds due to:
the arteriolar dilatation in skeletal muscles the increase in sympathetic venomotor tone the activated muscle pump the thoracic pump action

A) General effects
III. Cardiac output
The cardiac output is increased up to 25 L/min. and in very well trained athletes to 35 L/min. The mechanisms responsible for this increase are :
increased heart rate increased venous return and stroke volume

The heart muscle contracts more forcibly to achieve a smaller end-systolic volume, i.e.
EDV is increased while the ESV is decreased.

The chronotropic and inotropic effects on the heart are due to increased activity in the noradrenergic sympathetic nerves to the heart and the decreased vagal tone.

Cardiac output (L/min)

Heart rate (beat/min)

Stroke (volume ml)

EDV(ml)

ESV (ml)

Non-athlete
Rest 5 70 70 130 60

Maximum exercise

22 Diff. (*3.4)

180 (*2.5)

120 (*1.7)

140 (+10)

20 (- 40)

Trained athlete
Rest
Maximum exercise

5
36 Diff. (*6.2)

40
180 (*4.5)

120
200 (*1.6)

200
220 (+20)

80
20 ( -60)

Cardiac variables at rest & at maximum exercise for non-athlete & trained athlete

A) General effects
IV. Blood pressure:
In spite of the marked increase in the cardiac output, there is a fall in the total peripheral resistance due to vasodilatation of the exercising muscles
Consequently, systolic blood pressure rises only moderately, whereas the diastolic pressure may remain unchanged or even falls Evidence of such vasodilatation is that: CO increases five times but the ABP is increased only at the most to two-folds. ABP = CO X Peripheral resistance

B) Local effects
I. Local blood vessels
Vasodilatation takes place in arterioles, capillaries and venules in the muscles. Many capillaries which were collapsed at rest become patent.
These actions are caused by :
O2 lack increased CO2 and increased H+ ion concentration in skeletal muscles. Potassium is another substance that accumulates locally and has a dilator action. A rise in temperature exerts a direct vasodilator effect. Adrenaline dilates muscular vessels it is secreted from the adrenal medulla exclusively. Noradrenaline is secreted mainly from the noradrenergic postganglionic sympathetic fibers and a little from the adrenal medulla.

The net effect of all these local changes is to increase the O2 utilization

B) Local effects
II. Tissue fluid and lymph:
Tissue fluid formation is increased because the capillary blood pressure rises, and the filtering force is increased. The dilatation of the capillaries increases their permeability and so more lymph is drained by the lymphatics.

1. Blood flow in skeletal muscles of the legs should increase tremendously during vigorous running. Which of the following mechanisms contributes to increased skeletal muscle blood flow?

A) Local metabolites dilate skeletal muscle blood vessels B) Resistance of the veins and venules decreases C) Total peripheral resistance increases D) Circulating epinephrine constricts skeletal

2-The increase in blood flowing through coronary vessels during exercise is largely due to a regulation involving:

a) Adrenergic relaxation of the tension exerted by myocardial fibers.

b) Increase in coronary pressure due to a concomitant higher aortic pressure. c) Oxygen dependent mechanism.
d) All of the above.

3-In muscular exercise, cardiac output depends primarily on:

a) Heart acceleration.
b) Smaller end diastolic volume. c) Greater end systolic volume.

d) Marked increase in stroke volume

4-During exercise, total peripheral resistance decrease because of the effect of:
a) the sympathetic nervous system on splanchnic arterioles.
b) the parasympathetic nervous system on skeletal muscle arterioles. c) local metabolites on skeletal muscle arterioles. d) local metabolites on cerebral arterioles.

a- increase arterial blood pressure

5-During muscular exercise tachycardia is due to all the following EXCEPT

b- impulses from skeletal muscles.

c- increase body temperature.

d- increase venous return.

6-In a healthy subject, running is usually associated with a decrease in the end-systolic volume of the right and left ventricles and with an increase in their stroke volume. The mechanism for this response is probably the following:

A) Starlings law of the heart B) Decrease in sympathetic tone to ventricles C) A Decrease in venous return to the heart D) An increase in pulmonary and systemic resistance

7-Local metabolic activity is the main factor determining the rate of blood flow to all of the following except:
A) Heart

B) Skin
C) Skeletal muscle

D) Brain

8-Each of the following tends to increase lymph flow, EXCEPT: a) Increased plasma colloid osmotic pressure b) Increased capillary pressure
c) Increased muscular activity d) Increased permeability of the capillaries

9-All of the following factors can cause an increase in cardiac output EXCEPT:

a) exercise

b) deep inspiration
c) Ischemia of the cardiac muscles d) Arteriolar dilatation.

10-The increase in stroke volume which results from greater diastolic volume depends primarily on:
a)the initial length of myocardial fibres b) increased coronary blood flow

c) decreased aortic resistance

d) parasympathetic nervous system

11-Which of the following are incorrectly paired?

a) loss of blood: hypotension. b) increased cardiac output :exercise.
c) increased total peripheral resistance : fainting

d) adenosine: coronary vasodilatation.

12- Venous return to the heart is facilitated by:

a) The amount of blood filling the circulatory system
b) The tone of sympathetic system on the veins c) The activity of skeletal muscles d) All of the above

a) Impulses from cardiovascular centers

13-The most important variable which increases cardiac output during exercise is the:

b) Compression of abdominal muscles which reduces the vascular bed by a purely mechanical effect and raises the mean systemic filling pressure

c) Increased myocardial contractility due to increased circulating epinephrine

d) Increased metabolism of muscle that

parameters is decreased during moderate exercise:-

a- Heart rate.

b- Cardiac output.
c- Pulse pressure.

d- Total peripheral resistance.

15-During exercise, all of the following increase EXCEPT: a- The total peripheral resistance.
b- The systolic BP. c- The stroke volume.

d- The heart rate.

16-The increase in blood flowing through coronary vessels during exercise is due to:
a) Parasympathetic mediated vasodilatation b) Direct sympathetic stimulation of adrenergic receptors c) Increase in coronary pressure d) Local accumulation of vasodilator

D .

17-Venous return to the heart is facilitated by:

a) The tone of sympathetic system on veins

b)The negativity of the thoracic pressure

c) The activity of skeletal muscles d) All of the above

18-The general effect of exercise on arterial blood pressure is to:

A. Raise systolic and lower diastolic pressures due to an increase in peripheral resistance B. Lower systolic and raise diastolic pressures

C. Raise systolic and lower diastolic pressures accompanied by, and partly due to, a decreased peripheral resistance
D. Raise both systolic and diastolic pressures accompanied by, and partly due to, a decreased peripheral resistance

1. Blood flow in skeletal muscles of the legs should increase tremendously during vigorous running. Which of the following mechanisms contributes to increased skeletal muscle blood flow?

A) Local metabolites dilate skeletal muscle blood vessels B) Resistance of the veins and venules decreases C) Total peripheral resistance increases D) Circulating epinephrine constricts skeletal

2-The increase in blood flowing through coronary vessels during exercise is largely due to a regulation involving:

a) Adrenergic relaxation of the tension exerted by myocardial fibers.

b) Increase in coronary pressure due to a concomitant higher aortic pressure. c) Oxygen dependent mechanism.
d) All of the above.

3-In muscular exercise, cardiac output depends primarily on:

a) Heart acceleration.
b) Smaller end diastolic volume. c) Greater end systolic volume.

d) Marked increase in stroke volume

4-During exercise, total peripheral resistance decrease because of the effect of:
a) the sympathetic nervous system on splanchnic arterioles.
b) the parasympathetic nervous system on skeletal muscle arterioles. c) local metabolites on skeletal muscle arterioles. d) local metabolites on cerebral arterioles.

a- increase arterial blood pressure

5-During muscular exercise tachycardia is due to all the following EXCEPT

b- impulses from skeletal muscles.

c- increase body temperature.

d- increase venous return.

6-In a healthy subject, running is usually associated with a decrease in the end-systolic volume of the right and left ventricles and with an increase in their stroke volume. The mechanism for this response is probably the following:

A) Starlings law of the heart B) Decrease in sympathetic tone to ventricles C) A Decrease in venous return to the heart D) An increase in pulmonary and systemic resistance

7-Local metabolic activity is the main factor determining the rate of blood flow to all of the following except:
A) Heart

B) Skin
C) Skeletal muscle

D) Brain

8-Each of the following tends to increase lymph flow, EXCEPT: a) Increased plasma colloid osmotic pressure b) Increased capillary pressure
c) Increased muscular activity d) Increased permeability of the capillaries

9-All of the following factors can cause an increase in cardiac output EXCEPT:

a) exercise

b) deep inspiration
c) Ischemia of the cardiac muscles d) Arteriolar dilatation.

10-The increase in stroke volume which results from greater diastolic volume depends primarily on:
a)the initial length of myocardial fibres b) increased coronary blood flow

c) decreased aortic resistance

d) parasympathetic nervous system

11-Which of the following are incorrectly paired?

a) loss of blood: hypotension. b) increased cardiac output :exercise.
c) increased total peripheral resistance : fainting

d) adenosine: coronary vasodilatation.

12- Venous return to the heart is facilitated by:

a) The amount of blood filling the circulatory system
b) The tone of sympathetic system on the veins c) The activity of skeletal muscles d) All of the above

a) Impulses from cardiovascular centers

13-The most important variable which increases cardiac output during exercise is the:

b) Compression of abdominal muscles which reduces the vascular bed by a purely mechanical effect and raises the mean systemic filling pressure

c) Increased myocardial contractility due to increased circulating epinephrine

d) Increased metabolism of muscle that

parameters is decreased during moderate exercise:-

a- Heart rate.

b- Cardiac output.
c- Pulse pressure.

d- Total peripheral resistance.

15-During exercise, all of the following increase EXCEPT: a- The total peripheral resistance.
b- The systolic BP. c- The stroke volume.

d- The heart rate.

16-The increase in blood flowing through coronary vessels during exercise is due to:
a) Parasympathetic mediated vasodilatation b) Direct sympathetic stimulation of adrenergic receptors c) Increase in coronary pressure d) Local accumulation of vasodilator

D .

17-Venous return to the heart is facilitated by:

a) The tone of sympathetic system on veins

b)The negativity of the thoracic pressure

c) The activity of skeletal muscles d) All of the above

18-The general effect of exercise on arterial blood pressure is to:

A. Raise systolic and lower diastolic pressures due to an increase in peripheral resistance B. Lower systolic and raise diastolic pressures

C. Raise systolic and lower diastolic pressures accompanied by, and partly due to, a decreased peripheral resistance
D. Raise both systolic and diastolic pressures accompanied by, and partly due to, a decreased peripheral resistance