Plasma pH does not influence the cerebral metabolic ratio during maximal whole body exercise.

Exercise lowers the cerebral metabolic ratio of O2 to carbohydrate (glucose+1/2 lactate) and metabolic acidosis appears to promote cerebral lactate uptake. However, the influence of pH on cerebral lactate uptake and, in turn, on the cerebral metabolic ratio during exercise is not known. Sodium bicarbonate (Bicarb, 1 M; 350-500 ml) or an equal volume of normal saline (Sal) was infused intravenously at a constant rate during a '2000 m' maximal ergometer row in six male oarsmen (23±2 years; mean±S.D.). During the Sal trial, pH decreased from 7.41±0.01 at rest to 7.02±0.02 but only to 7.36±0.02 (P <0.05) during the Bicarb trial. Arterial lactate increased to 21.4±0.8 and 32.7±2.3 mM during the Sal and Bicarb trials, respectively (P <0.05). Also, the arterial-jugular venous lactate difference increased from-0.03±0.01 mM at rest to 3.2±0.9 mM (P <0.05) and 3.4±1.4 mM (P <0.05) following the Sal and Bicarb trials, respectively. Accordingly, the cerebral metabolic ratio decreased equally during the Sal and Bicarb trials: from 5.8±0.6 at rest to 1.7±0.1 and 1.8±0.2, respectively. The enlarged blood-buffering capacity after infusion of Bicarb eliminated metabolic acidosis during maximal exercise but that did not affect the cerebral lactate uptake and, therefore, the decrease in the cerebral metabolic ratio.

The carotid baroreflex is reset following prolonged exercise in humans.

AIM: Alterations in the carotid baroreflex (CBR) control of arterial pressure may explain the reduction in arterial pressure and left ventricular (LV) function after prolonged exercise. We examined the CBR control of heart rate (HR) and mean arterial pressure (MAP), in addition to changes in LV function, pre- to post-exercise. METHODS: Seven males (age, mean ± SEM; 29 ± 4 years) completed 4 h of ergometer rowing at a workload of 10-15% below the lactate threshold. The CBR control of HR and MAP was assessed via the rapid neck-suction/pressure protocol. LV systolic function was measured by echocardiography, where ejection fraction (EF), the ratio of systolic blood pressure to end systolic volume (SBP/ESV) and stroke volume (SV) were estimated. RESULTS: Following exercise MAP was reduced (12 ± 3%) and HR was elevated (35 ± 5%; P < 0.05). Furthermore, CBR control of MAP was relocated to the left on the stimulus-response curve (P < 0.05) demonstrating that the CBR operated around a lower arterial pressure. Concomitantly, LV systolic function was reduced, indicated by a decrease in EF (22 ± 2%), SBP/ESV (32 ± 14%) and SV (25 ± 5%, P < 0.05). The reduced EF and SBP/ESV were associated with the decreased MAP operating point (r² = 0.71 and r² = 0.47, respectively, P < 0.05). CONCLUSION: The CBR is reset after prolonged exercise to a lower prevailing arterial pressure. This resetting of the CBR may contribute to the reduction arterial pressure and LV function after exercise.

Cerebral oxygenation is reduced during hyperthermic exercise in humans.

AIM: Cerebral mitochondrial oxygen tension (P(mito)O(2)) is elevated during moderate exercise, while it is reduced when exercise becomes strenuous, reflecting an elevated cerebral metabolic rate for oxygen (CMRO(2)) combined with hyperventilation-induced attenuation of cerebral blood flow (CBF). Heat stress challenges exercise capacity as expressed by increased rating of perceived exertion (RPE). METHODS: This study evaluated the effect of heat stress during exercise on P(mito)O(2) calculated based on a Kety-Schmidt-determined CBF and the arterial-to-jugular venous oxygen differences in eight males [27 +/- 6 years (mean +/- SD) and maximal oxygen uptake (VO(2max)) 63 +/- 6 mL kg(-1) min(-1)]. RESULTS: The CBF, CMRO(2) and P(mito)O(2) remained stable during 1 h of moderate cycling (170 +/- 11 W, approximately 50% of VO(2max), RPE 9-12) in normothermia (core temperature of 37.8 +/- 0.4 degrees C). In contrast, when hyperthermia was provoked by dressing the subjects in watertight clothing during exercise (core temperature 39.5 +/- 0.2 degrees C), P(mito)O(2) declined by 4.8 +/- 3.8 mmHg (P < 0.05 compared to normothermia) because CMRO(2) increased by 8 +/- 7% at the same time as CBF was reduced by 15 +/- 13% (P < 0.05). During exercise with heat stress, RPE increased to 19 (19-20; P < 0.05); the RPE correlated inversely with P(mito)O(2) (r(2) = 0.42, P < 0.05). CONCLUSION: These data indicate that strenuous exercise in the heat lowers cerebral P(mito)O(2), and that exercise capacity in this condition may be dependent on maintained cerebral oxygenation.

Interaction of cardiac and muscle mechanical afferents on baroreflex control of the sinus node during dynamic exercise.

The effects of cardiopulmonary baroreceptors and muscle mechanoreceptors stimulation on cardiac baroreflex sensitivity (BRS), and heart rate variability (HRV) were evaluated by measuring continuously and non-invasively systolic blood pressure (SBP) and pulse interval (PI) during upright and supine passive cycling. BRS and HRV were evaluated with the cross-correlation method (xBRS) and in the frequency domain, respectively. At rest, the shift from upright to supine posture enhanced xBRS from 16.4+/-12.1 to 23.4+/-12.9 ms/mmHg, and the high frequency (HF, 0.15-0.4 Hz) power of HRV from 48.9+/-18.6 to 55.1+/-14.7 normalized units (NU), while it attenuated the low-frequency (LF, 0.04-0.15 Hz) power from 51.1+/-18.6 to 44.9+/-14.7 NU (P<0.05), respectively. During both upright and supine passive exercise, xBRS and the HF power were attenuated (10.0+/-8.0 and 12.5+/-9.0 ms/mmHg; 41.1+/-21.2 and 41.5+/-12.7 NU, respectively; P<0.05) and the LF power increased (58.8+/-21.2 and 58.5+/-12.7 NU, P<0.05), compared with rest. The effect of mechanoreflex activation overrides that of the cardiopulmonary baroreceptors loading resulting in decreased cardiac vagal outflow and reduced BRS during supine passive exercise.

The cerebral metabolic ratio is not affected by oxygen availability during maximal exercise in humans.

Intense exercise decreases the cerebral metabolic ratio of O(2) to carbohydrates (glucose + (1/2) lactate) and the cerebral lactate uptake depends on its arterial concentration, but whether these variables are influenced by O(2) availability is not known. In six males, maximal ergometer rowing increased the arterial lactate to 21.4 +/- 0.8 mm (mean +/- s.e.m.) and arterial-jugular venous (a-v) difference from -0.03 +/- 0.01 mm at rest to 2.52 +/- 0.03 mm (P < 0.05). Arterial glucose was raised to 8.5 +/- 0.5 mm and its a-v difference increased from 1.03 +/- 0.01 to 1.86 +/- 0.02 mm (P < 0.05) in the immediate recovery. During exercise, the cerebral metabolic ratio decreased from 5.67 +/- 0.52 at rest to 1.70 +/- 0.23 (P < 0.05) and remained low in the early recovery. Arterial haemoglobin O(2) saturation was 92.5 +/- 0.2% during exercise with room air, and it reached 87.6 +/- 1.0% and 98.9 +/- 0.2% during exercise with an inspired O(2) fraction of 0.17 and 0.30, respectively. Whilst the increase in a-v lactate difference was attenuated by manipulation of cerebral O(2) availability, the cerebral metabolic ratio was not affected significantly. During maximal rowing, the cerebral metabolic ratio reaches the lowest value with no effect by a moderate change in the arterial O(2) content. These findings suggest that intense whole body exercise is associated with marked imbalance in the cerebral metabolic substrate preferences independent of oxygen availability.

Baroreflex control of sinus node during dynamic exercise in humans: effect of muscle mechanoreflex.

AIM: This study evaluated the influence of muscle mechanical afferent stimulation on the integrated arterial baroreflex control of the sinus node during dynamic exercise. METHODS: Systolic blood pressure (SBP) and pulse interval (PI) were measured continuously and non-invasively in 15 subjects at rest and during passive cycling. The arterial baroreflex was evaluated with the cross-correlation method (xBRS) for the computation of time-domain baroreflex sensitivity on spontaneous blood pressure and PI variability. xBRS computes the greatest positive correlation between beat-to-beat SBP and PI, and when significant at P = 0.01, slope and delay are recorded as one xBRS value. Heart rate variability (HRV) was evaluated in the frequency domain. RESULTS: Compared with rest, passive exercise resulted in a parallel increase in heart rate (67 +/- 3.2 vs. 70 +/- 3.6 beats min(-1); P < 0.05) and mean arterial pressure (87 +/- 2 vs. 95 +/- 2 mmHg; P < 0.05), and a significant decrease in xBRS (13.1 +/- 1.8 vs. 10.5 +/- 1.7 ms mmHg(-1); P < 0.01) with an apparent rightward shift in the regression line relating SBP to PI. Also low frequency power of HRV increased while high frequency power decreased (56.7 +/- 3.5 vs. 62.7 +/- 4.8 and 43.2 +/- 3.4 vs. 36.9 +/- 4.9 normalized units respectively; P < 0.05). CONCLUSION: These data suggest that the stimulation of mechanosensitive stretch receptors is capable of modifying the integrated baroreflex control of sinus node function by decreasing the cardiac vagal outflow during exercise.

The plasma atrial natriuretic peptide response to arm and leg exercise in humans: effect of posture.

During arm exercise (A), mean arterial pressure (MAP) is higher than during leg exercise (L). We evaluated the effect of central blood volume on the MAP response to exercise by determining plasma atrial natriuretic peptide (ANP) during moderate upright and supine A, L and combined arm and leg exercise (A + L) in 11 male subjects. In the upright position, MAP was higher during A than at rest (102 +/- 6 versus 89 +/- 6 mmHg; mean +/- s.d.) and during L (95 +/- 7 mmHg; P < 0.05), but similar to that during A + L (100 +/- 6 mmHg). There was no significant change in plasma ANP during A, while plasma ANP was higher during L and A + L (42.7 +/- 12.2 and 43.3 +/- 17.1 pg ml(-1), respectively) than at rest (34.6 +/- 14.3 pg ml(-1), P < 0.001). In the supine position, MAP was also higher during A than at rest (100 +/- 7 versus 86 +/- 5 mmHg) and during L (92 +/- 5 mmHg; P < 0.01) but similar to that during A + L (102 +/- 6 mmHg). During supine A, plasma ANP was higher than at rest and during L but lower than during A + L (73.1 +/- 22.5 versus 47.2 +/- 15.9, 67.4 +/- 18.3 and 78.1 +/- 25.0 pg ml(-1), respectively; P < 0.05). Thus, upright A was the exercise mode that did not enhance plasma ANP, suggesting that central blood volume did not increase. The results suggest that the similar blood pressure response to A and to A + L may relate to the enhanced central blood volume following the addition of leg to arm exercise.

Arterial blood pressure and carotid baroreflex function during arm and combined arm and leg exercise in humans.

AIM: During arm cranking (A) blood pressure is higher than during combined arm and leg exercise (A + L), while the carotid baroreflex (CBR) is suggested to reset to control a higher blood pressure in direct relation to work intensity and the engaged muscle mass. METHOD: This study evaluated the function of the CBR by using neck pressure and neck suction during upright A, L and A + L in 12 subjects and, in order to evaluate a potential influence of the central blood volume on the CBR, also during supine A in five subjects. Exercise intensities for A and L were planned to elicit a heart rate response of c. 100 and 120 beats min(-1), respectively, in the upright position and both workloads were maintained during A + L and supine A. RESULTS: The CBR operating point, corresponding to the pre-stimulus blood pressure, was 88 +/- 6 mmHg (mean +/- SE) at rest. During upright A, L and A + L and supine A it increased to 109 +/- 9, 95 +/- 7, 103 +/- 7 and 104 +/- 4 mmHg, respectively, and it was thus higher during upright A than during A + L and supine A (P < 0.05). In addition, the CBR threshold and saturation pressures, corresponding to the minimum and maximum carotid sinus pressure, respectively, were higher during upright A than during supine A, A + L, L and at rest (P < 0.05) with no significant change in the maximal reflex gain. CONCLUSION: These findings demonstrate that during combined arm and leg and exercise in the upright position the CBR resets to a lower blood pressure than during arm cranking likely because the central blood volume is enhanced by the muscle pump of the legs.

Effect of fitness on arm vascular and metabolic responses to upper body exercise.

We investigated arm perfusion and metabolism during upper body exercise. Eight average, fit subjects and seven rowers, mean +/- SE maximal oxygen uptake (VO2 max) 157 +/- 7 and 223 +/- 14 ml O2. kg(-0.73).min(-1), respectively, performed incremental arm cranking to exhaustion. Arm blood flow (ABF) was measured with thermodilution and arm muscle mass was estimated by dual-energy X-ray absorptiometry. During maximal arm cranking, pulmonary VO2 was approximately 45% higher in the rowers compared with the untrained subjects and peak ABF was 6.44 +/- 0.40 and 4.55 +/- 0.26 l/min, respectively (P < 0.05). The arm muscle mass for the rowers and the untrained subjects was 3.5 +/- 0.4 and 3.3 +/- 0.1 kg, i.e., arm perfusion was 1.9 +/- 0.2 and 1.4 +/- 0.1 l blood.kg(-1).min(-1), respectively (P < 0.05). The arteriovenous O2 difference was 156 +/- 7 and 120 +/- 8 ml/l, respectively, and arm VO2 was 0.98 +/- 0.08 and 0.60 +/- 0.04 l/min corresponding with 281 +/- 22 and 181 +/- 12 ml/kg, while arm O(2) diffusional conductance was 49.9 +/- 4.3 and 18.6 +/- 3.2 ml.min(-1).mmHg(-1), respectively (P < 0.05). Also, lactate release in the rowers was almost three times higher than in the untrained subjects (26.4 +/- 1.1 vs. 9.5 +/- 0.4 mmol/min, P < 0.05). The energy requirement of an approximately 50% larger arm work capacity after long-term arm endurance training is covered by an approximately 60% increase in aerobic metabolism and an almost tripling of the anaerobic capacity.

Arm blood flow and oxygenation on the transition from arm to combined arm and leg exercise in humans.

The cardiovascular response to exercise with several groups of skeletal muscle implies that work with the legs may reduce arm blood flow. This study followed arm blood flow (Yarm) and oxygenation on the transition from arm cranking (A) to combined arm and leg exercise (A+L). Seven healthy male subjects performed A at approximately 80 % of maximum work rate (Wmax) and A at ~80 % Wmax combined with L at approximately 60 % Wmax. A transition trial to volitional exhaustion was performed where L was added after 2 min of A. The Yarm was determined by constant infusion thermodilution in the axillary vein and changes in biceps muscle oxygenation were measured with near-infrared spectroscopy. During A+L Yarm was lowered by 0.38 +/- 0.06 l min-1 (10.4 +/- 3.3 %, P < 0.05) from 2.96 +/- 1.54 l min-1 during A. Total (HbT) and oxygenated haemoglobin (HbO2) concentrations were also lower. During the transition from A to A+L Yarm decreased by 0.22 +/- 0.03 l min-1 (7.9 +/- 1.8 %, P < 0.05) within 9.6 +/- 0.2 s, while HbT and HbO2 decreased similarly within 30 +/- 2 s. At the same time mean arterial pressure and arm vascular conductance also decreased. The data demonstrate reduction in blood flow to active skeletal muscle during maximal whole body exercise to a degree that arm oxygen uptake and muscle tissue oxygenation are compromised.

Arm blood flow and metabolism during arm and combined arm and leg exercise in humans.

The cardiovascular response to exercise with several groups of skeletal muscle suggests that work with the arms may decrease leg blood flow. This study evaluated whether intense exercise with the legs would have a similar effect on arm blood flow (Y(arm)) and O(2) consumption (V(O(2))(,arm)). Ten healthy male subjects (age 21 +/- 1 year; mean +/- S.D.) performed arm cranking at 80 % of maximum arm work capacity (A trial) and combined arm cranking with cycling at 60 % of maximum leg work capacity (A + L trial). The combined trial was a maximum effort for 5-6 min. Y(arm) measurement by thermodilution in the axilliary vein and arterial and venous blood samples permitted calculation of V(O(2))(,arm). During the combined trial, Y(arm) was reduced by 0.58 +/- 0.25 l min(-1) (19.1 +/- 3.0 %, P < 0.05) from the value during arm cranking (3.00 +/- 0.46 l min(-1)). The arterio-venous O(2) difference increased from 122 +/- 15 ml l(-1) during the arm trial to 150 +/- 21 ml l(-1) (P < 0.05) during the combined trial. Thus, V(O(2))(,arm) (0.45 +/- 0.06 l min(-1)) was reduced by 9.6 +/- 6.3 % (P < 0.05) and arm vascular conductance from 27 +/- 4 to 23 +/- 3 ml min(-1) (mmHg)(-1) (P < 0.05) as noradrenaline spillover from the arm increased from 7.5 +/- 3.5 to 13.8 +/- 4.2 nmol min(-1) (P < 0.05). The data suggest that during maximal whole body exercise in humans, arm vasoconstriction is established to an extent that affects oxygen delivery to and utilisation by working skeletal muscles.

Re: Evaluation of an inspiratory muscle trainer in healthy humans (Respir Med 2001; 95: 526-531).

The main outcome of this study is that twitch Pdi is unsuitable for assessing outcmes in small studies of IMT.

Specific respiratory warm-up improves rowing performance and exertional dyspnea.

PURPOSE: The purpose of this study was a) to compare the effect of three different warm-up protocols upon rowing performance and perception of dyspnea, and b) to identify the functional significance of a respiratory warm-up. METHODS: A group of well-trained club rowers (N = 14) performed a 6-min all-out rowing simulation (Concept II). We examined differences in mean power output and dyspnea measures (modified CR-Borg scale) under three different conditions: after a submaximal rowing warm-up (SWU), a specific rowing warm-up (RWU), and a specific rowing warm-up with the addition of a respiratory warm-up (RWUplus) protocol. RESULTS: Mean power output during the 6-min all-out rowing effort increased by 1.2% after the RWUplus compared with that obtained after the RWU (P < 0.05) which, in turn, was by 3.2% higher than the performance after the SWU (P < 0.01). Similarly, after the RWUplus, dyspnea was 0.6 +/- 0.1 (P < 0.05) units of the Borg scale lower compared with the dyspnea after the RWU and 0.8 +/- 0.2 (P < 0.05) units lower than the dyspnea after the SWU. CONCLUSION: These data suggest that a combination of a respiratory warm-up protocol together with a specific rowing warm-up is more effective than a specific rowing warm-up or a submaximal warm-up alone as a preparation for rowing performance.

Inspiratory muscle training improves rowing performance.

PURPOSE: To investigate the effects of a period of resistive inspiratory muscle training (IMT) upon rowing performance. METHODS: Performance was appraised in 14 female competitive rowers at the commencement and after 11 wk of inspiratory muscle training on a rowing ergometer by using a 6-min all-out effort and a 5000-m trial. IMT consisted of 30 inspiratory efforts twice daily. Each effort required the subject to inspire against a resistance equivalent to 50% peak inspiratory mouth pressure (PImax) by using an inspiratory muscle training device. Seven of the rowers, who formed the placebo group, used the same device but performed 60 breaths once daily with an inspiratory resistance equivalent to 15% PImax. RESULTS: The inspiratory muscle strength of the training group increased by 44 +/- 25 cm H2O (45.3 +/- 29.7%) compared with only 6 +/- 11 cm H2O (5.3 +/- 9.8%) of the placebo group (P < 0.05 within and between groups). The distance covered in the 6-min all-out effort increased by 3.5 +/- 1.2% in the training group compared with 1.6 +/- 1.0% in the placebo group (P < 0.05). The time in the 5000-m trial decreased by 36 +/- 9 s (3.1 +/- 0.8%) in the training group compared with only 11 +/- 8 s (0.9 +/- 0.6%) in the placebo group (P < 0.05). Furthermore, the resistance of the training group to inspiratory muscle fatigue after the 6-min all-out effort was improved from an 11.2 +/- 4.3% deficit in PImax to only 3.0 +/- 1.6% (P < 0.05) pre- and post-intervention, respectively. CONCLUSIONS: IMT improves rowing performance on the 6-min all-out effort and the 5000-m trial.

Assessment of maximum inspiratory pressure. Prior submaximal respiratory muscle activity ('warm-up') enhances maximum inspiratory activity and attenuates the learning effect of repeated measurement.

BACKGROUND: The variability of maximal inspiratory pressure (PImax) in response to repeated measurement affects its reliability; published studies have used between three and twenty PImax measurements on a single occasion. OBJECTIVE: This study investigated the influence of a specific respiratory 'warm-up' upon the repeated measurement of inspiratory muscle strength and attempts to establish a procedure by which PImax can be assessed with maximum reliability using the smallest number of manoeuvres. METHODS: Fourteen healthy subjects, familiar with the Mueller manoeuvre, were studied. The influence of repeated testing on a single occasion was assessed using an 18-measurement protocol. Using a randomised cross-over design, subjects performed the protocol, preceded by a specific respiratory warm-up (RWU) and on another occasion, without any preliminary activity (control). Comparisons were made amongst 'baseline' (best of the first 3 measurements), 'short' series (best of 7th to 9th measurement) and 'long' series (best of the last 3 measurements). RESULTS: Under control conditions, the mean increase ('baseline' vs. 'long' series) was 11.4 (5.8)%; following the RWU, the increase (post RWU 'baseline' vs. 'long' series) was 3.2 (10.0)%. There were statistically significant differences between measurements made at all 3 protocol stages ('baseline', 'short' and 'long' series) under control conditions, but none following the RWU. CONCLUSIONS: The present data suggest that a specific RWU may attenuate the 'learning effect' during repeated PImax measurements, which is one of the main contributors of the test variability. The use of a RWU may provide a means of obtaining reliable values of PImax following just 3 measurements.

The influence of prior activity upon inspiratory muscle strength in rowers and non-rowers.

The aim of this study was to investigate whether a 'warm-up' phenomenon in the strength of the inspiratory muscles exists, and, under this assumption, whether whole body warm-up protocols or a specific respiratory warm-up is more effective in this respect. Eleven club level rowers performed a rowing warm-up, and twelve university students performed a general cycling warm-up. Both groups also performed a specific respiratory warm-up. Inspiratory muscle strength (Mueller manoeuvre) and lung function (flow-volume loops) were measured before and after the three conditions. Isokinetic strength during knee extension was measured before and after the rowing warm-up. The two whole body warm-up protocols had no effect on inspiratory muscle strength or any lung function parameter despite the significant (3.8+/-SD 1.4%; p<0.05) increase in peak torque that the rowing warm-up elicited. The respiratory warm-up induced a significant increase in inspiratory mouth pressure (8.5+/-1.8%; p<0.0001) but not in any other lung function parameter. Following the rowing incremental test to exhaustion, maximum inspiratory pressure decreased by 7.0+/-2.0%, which is an indication of respiratory muscle fatigue. These data suggest that the inspiratory muscle strength can be enhanced with preliminary activity, a phenomenon similar to the one known to exist for other skeletal muscles. In addition, a specific respiratory warm-up is more effective in this respect than whole body protocols.