Because learning changes everything.

Chapter 09

Circulatory responses
to exercise
EXERCISE PHYSIOLOGY
Theory and Application to
Fitness and Performance
Twelfth Edition
Scott K. Powers, Edward T. Howley, John
C. Quindry

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Lecture Outline

• Organization of the Circulatory System

• Heart: Myocardium and Cardiac Cycle
• Cardiac Output
• Haemodynamics
• Changes in Oxygen Delivery to Muscle During Exercise
• Circulatory Responses to Exercise
• Regulation of Cardiovascular Adjustments to Exercise

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Organization of the circulatory system

Works with the pulmonary system

• Cardiopulmonary or cardiorespiratory system

Purposes of the cardiorespiratory system

• Transport O2 and nutrients to tissues
• Removal of CO2 wastes from tissues
• Regulation of body temperature

Two major adjustments of blood flow during exercise

• Increased cardiac output
• Redistribution of blood flow from inactive organs to active muscle

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Organization of the circulatory system

Heart
• Creates pressure to pump blood

Arteries and arterioles

• Carry blood away from the heart

Capillaries
• Exchange of O2, CO2, and nutrients with tissues

Veins and venules

• Carry blood toward the heart

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Structure of the heart

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Pulmonary and systemic circuits

Pulmonary circuit
• Right side of the heart
• Pumps deoxygenated blood to the lungs via pulmonary arteries
• Returns oxygenated blood to the left side of the heart via pulmonary
veins

Systemic circuit
• Left side of the heart
• Pumps oxygenated blood to the whole body via arteries
• Returns deoxygenated blood to the right side of the heart via veins

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Pulmonary and systemic circulations

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Myocardium

The heart wall

• Epicardium
• Myocardium
• Endocardium

Receives blood supply via coronary arteries

• High demand for oxygen and nutrients

Myocardial infarction (MI)

• Blockage in coronary blood flow results in cell damage/death
• Exercise training protects against heart damage during an MI

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The heart wall

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Exercise training protects the heart

Clinical Applications 9.1

Regular exercise is cardioprotective

• Reduces incidence of heart attacks
• Improves survival from a heart attack

Exercise reduces the amount of myocardial damage from heart attack

• Improvements in heart’s antioxidant capacity
• Improved function of ATP-sensitive potassium channels

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Endurance exercise protects against cardiac injury
during heart attack
Clinical Applications 9.1

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The cardiac cycle

Systole
• Contraction phase
• Ejection of blood
• Approximately 2/3 blood is ejected from ventricles per beat

Diastole
• Relaxation phase
• Filling with blood

At rest
• Diastolic time is longer than systolic time

During exercise
• The duration of both systole and diastole are shorter
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The cardiac cycle at rest and during exercise

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Pressure changes during the cardiac cycle

Diastole
• Pressure in ventricles is low
• Filling with blood from atria
• AV valves open when ventricular Pressure < atrial Pressure

Systole
• Pressure in ventricles rises
• Blood ejected in pulmonary and systemic circulation
• Semilunar valves open when ventricular Pressure > aortic Pressure

Heart sounds
• First: closing of AV valves
• Second: closing of aortic and pulmonary valves

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Pressure, volume, and heart sounds during the cardiac
cycle

Heart sounds
First: closing of AV valves
Second: closing of aortic and
pulmonary valves

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Arterial blood pressure

Expressed as systolic/diastolic
• Normal is 120/80 mmHg
Systolic pressure
• Pressure generated during ventricular contraction
Diastolic pressure
• Pressure in the arteries during cardiac relaxation

Pulse pressure
• Difference between systolic and diastolic

Mean arterial pressure (MAP)

• Average pressure in the arteries
MAP = DBP + 0.33(SBP – DBP)

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Hypertension

Hypertension = Blood pressure above 130/80 mmHg

Primary (essential) hypertension
• Cause unknown (multifactorial)
• 90% cases of hypertension

Secondary hypertension
• Result of some other disease process

Risk factor for…

• Left ventricular hypertrophy
• Atherosclerosis and heart attack
• Kidney damage
• Stroke

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Factors that influence arterial blood pressure

Determinants of mean arterial pressure (MAP)

• Cardiac output
• Total vascular resistance
• MAP = cardiac output × total vascular resistance

Short-term regulation
• Sympathetic nervous system
• Baroreceptors in aorta and carotid arteries
• Increase in BP = decreased sympathetic nervous system (SNS) activity
• Decrease in BP = increased SNS activity

Long-term regulation
• Kidneys
• Via control of blood volume

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Factors that influence arterial blood pressure

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Measurement of arterial blood pressure

A Closer Look 9.1

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Electrical activity of the heart

Contraction of the heart depends on electrical stimulation of the

myocardium
Conduction system anatomy overview
• Sinoatrial node (SA node)
• Pacemaker, initiates depolarization
• Atrioventricular node (AV node)
• Passes depolarization to ventricles
• Brief delay to allow for ventricular filling
• Bundle Branches
• Connect atria to left and right ventricle
• Purkinje fibers
• Spread wave of depolarization throughout ventricles

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Conduction system of the heart

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Electrocardiogram (ECG)

Records the heart’s electrical activity

P wave
• Atrial depolarization
QRS complex
• Ventricular depolarization and atrial repolarization
T wave
• Ventricular repolarization

ECG abnormalities may indicate coronary heart disease

• ST-segment depression can indicate myocardial ischemia

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Normal electrocardiogram

P wave
Atrial depolarization
QRS complex
Ventricular depolarization
and atrial repolarization
T wave
Ventricular repolarization

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Relationship between electrical events and the ECG

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Relationship between electrical events and the ECG

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Relationship between electrical events and the ECG

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Relationship between electrical events and the ECG

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Relationship between electrical events and the ECG

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Relationship between electrical events and the ECG

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Relationship between electrical events and the ECG

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Diagnostic use of the ECG during exercise

A Closer Look 9.2

Graded exercise test to evaluate cardiac function

• Observe ECG during exercise
• Also observe changes in blood pressure

Atherosclerosis
• Fatty plaque that narrows coronary arteries
• Reduces blood flow to myocardium
• Myocardial ischemia

S-T segment depression

• Suggests myocardial ischemia

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S-T segment depression on the electrocardiogram

A Closer Look 9.2

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Cardiac output

The amount of blood pumped by the heart each minute

Product of heart rate and stroke volume
• Heart rate
• Number of beats per minute
• Stroke volume
• Amount of blood ejected in each beat

Q = HR × SV

Depends on training state and sex

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Typical values for cardiac output

Subject HR SV Q
(beats/min) (ml/beat) (L/min)
Rest
Untrained male 72 × 70 = 5.00

Untrained female 75 × 60 = 4.50

Trained male 50 × 100 = 5.00

Trained female 55 × 80 = 4.40

Max Exercise ×

Untrained male 200 × 110 = 22.0

Untrained female 200 × 90 = 18.0

Trained male 190 × 180 = 34.2

Trained female 190 × 125 = 23.8

Typical Resting and Maximal Exercise Values for Stroke Volume (SV), Heart Rate (HR), and
Cardiac Output for College-Age Untrained Subjects and Trained Endurance Athletes (Body
Weights: Male = 70 kg; Female = 50 kg)

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 From here…

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Regulation of heart rate

Parasympathetic nervous system

• Via vagus nerve
• Slows HR by inhibiting SA and AV node
Sympathetic nervous system
• Via cardiac accelerator nerves
• Increases HR by stimulating SA and AV node

Low resting HR due to parasympathetic tone

Increase in HR at onset of exercise
• Initial increase due to parasympathetic withdrawal
• Up to approximately 100 beats/min
• Later increase due to increased SNS outflow

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Autonomic nervous system control of exercise
heart rate

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Heart rate variability

The time between heart beats

• Standard deviation of the R–R interval

Balance between SNS and PNS

• Sympathovagal balance

Wide variation in HRV is considered “healthy”

Low HRV is a predictor of cardiovascular morbidity and mortality
• In patients with existing cardiovascular disease

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Regulation of stroke volume

End-diastolic volume (EDV)

• Volume of blood in the ventricles at the end of diastole (“preload”)

Average aortic blood pressure

• Pressure the heart must pump against to eject blood (“afterload”)
• Mean arterial pressure

Strength of the ventricular contraction (contractility)

• Enhanced by:
• Circulating epinephrine and norepinephrine
• Direct sympathetic stimulation of heart

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End-diastolic volume

Frank-Starling mechanism
• Greater EDV results in a more forceful contraction
• Due to stretch of ventricles

Dependent on venous return

Venous return increased by:
• Venoconstriction
• Via SNS
• Skeletal muscle pump
• Rhythmic skeletal muscle contractions force blood in the extremities toward
the heart
• One-way valves in veins prevent backflow of blood
• Respiratory pump
• Changes in thoracic pressure pull blood toward heart

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Skeletal muscle pump

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Factors that regulate cardiac output

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Physical characteristics of blood

Plasma
• Liquid portion of blood
• Contains ions, proteins, hormones
Cells
• Red blood cells
• Contain hemoglobin to carry oxygen
• White blood cells
• Important in preventing infection
• Platelets
• Important in blood clotting
Haematocrit
• Percentage of blood composed of cells

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 Relationships among pressure, resistance,
and flow

Blood flow
• Directly proportional to the pressure difference between the two ends of
the system
• Inversely proportional to resistance

 Pressure
Blood flow 
Resistance

Pressure
• Proportional to the difference between MAP and right atrial pressure
(Δ Pressure)

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 Blood flow through the systemic circuit

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 Hemodynamics

Resistance depends upon

• Length of the vessel
• Viscosity of the blood
• Radius of the vessel (greatest influence on resistance)

Length  Viscosity
Resistance 
Radius 4

Sources of vascular resistance

• MAP decreases throughout the systemic circulation
• Largest BP drop occurs across the arterioles
• Arterioles are called “resistance vessels”

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 Pressure changes across the systemic circulation

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 Oxygen delivery during exercise

Oxygen demand by muscles increases during exercise

• 15x to 25x greater than at rest

Increased O2 delivery accomplished by

• Increased cardiac output
• Redistribution of blood flow
• From inactive organs to working skeletal muscle

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 Changes in cardiac output during exercise

Cardiac output increases due to

• Increased HR
• Linear increase to max
• For adults: Max HR = 220 − age (years)
• For children: Max HR = 208 − 0.7 × age (years)

• Increased SV
• Increase, then plateau at 40 to 60% VO2 max
• No plateau in highly trained subjects

Q = SV x HR

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 Stroke volume does not plateau in endurance athletes
Research Focus 9.1

Stroke volume reaches a plateau at 40 to 60% VO2 max in untrained

subjects
• At high HR, filling time is decreased
• Decrease in EDV and SV

Stroke volume does not plateau in trained subjects

• Improved ventricular filling
• Increase in EDV and SV at high HR

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 Changes in arterial-mixed venous O2 content during
exercise

Arteriovenous difference (a-vO2 difference)

• Amount of O2 that is taken up from 100 ml blood
• Increases during exercise due to higher O2 uptake in tissues
• Used for oxidative ATP production

Fick equation
• Relationship between cardiac output (Q), a-vO2 difference, and VO2

VO2 = Q x a – vO2 difference

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 Changes in cardiovascular variables during exercise

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 Impact of body position on stroke volume during
exercise
A Closer Look 9.3

Body position has a major influence on SV

• True at rest and during exercise
• Related to the effect of gravity on venous return
• Gravity promotes blood pooling in legs, lowering venous return, lower EDV –
Starling effect

Upright exercise results in increased SV

• Due to larger EDV, increased venous return
• Increase in EDV and SV at high HR

Supine exercise (for example, swim) results in small increases in SV

• Due to resting SV being relatively high while supine

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 Redistribution of blood flow during exercise 1

Increased blood flow to working skeletal muscle

• At rest, 15 to 20% of cardiac output to muscle
• Increases to 80 to 85% during maximal exercise

Decreased blood flow to less active organs

• Liver, kidneys, GI tract

Redistribution depends on metabolic rate

• Exercise intensity

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 Redistribution of blood flow during exercise 2

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 Regulation of local blood flow during exercise

Skeletal muscle vasodilation

• Autoregulation
• Blood flow increased to meet metabolic demands of tissue
• Due to changes in O2 tension, CO2 tension, nitric oxide, potassium,
adenosine, and pH

Vasoconstriction to visceral organs and inactive tissues

• SNS vasoconstriction
• Blood flow reduced to 20 to 30% of resting values

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 Changes in muscle and splanchnic blood flow
during exercise

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 Circulatory responses to exercise

Changes in heart rate and blood pressure

Depend on:
• Type, intensity, and duration of exercise
• Arm versus leg exercise
• Environmental condition
• Hot/humid versus cool

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 Pressure and volume responses to exercise 2

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Emotional influence

Elevated HR and BP in emotionally charged environment

• Due to increases in SNS activity

Can increase pre-exercise HR and BP

Does not increase peak HR or BP during exercise

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Transition from rest to exercise and exercise
to recovery

At the onset of exercise

• Rapid increase in HR, SV, cardiac output
• Plateau in submaximal (below lactate threshold) exercise

During recovery
• Decrease in HR, SV, and cardiac output toward resting levels
• Depends on:
• Duration and intensity of exercise
• Training state of subject

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Transition from rest to exercise and exercise
to recovery

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Incremental exercise

Heart rate and cardiac output

• Increases linearly with increasing work rate
• Reaches plateau at 100% VO2 max

Blood pressure
• Mean arterial pressure increases linearly
• Systolic BP increases
• Diastolic BP remains fairly constant

Double product (Rate-pressure product)

• Increases linearly with exercise intensity
• Indicates the work of the heart

Double product = HR × systolic BP

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 Changes in double product during exercise

TABLE 9.3 Changes in the Double Product (for example, Heart Rate × Systolic Blood
Pressure) during an Incremental Exercise Test in a Healthy 21-Year-Old Female Subject
Note that the double product is a dimensionless term that reflects the relative changes in
the workload placed on the heart during exercise and other forms of stress.
Condition Systolic Blood Double Product
Heart Rate (beats min-1 )
Pressure (mm Hg)
Rest 75 110 8,250

Exercise
.
25% V O2 max 100 130 13,000
.
50% V O2 max 140 160 22,400
.
75% V O2 max 170 180 30,600
.
100% V O2 max 200 210 42,000

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Arm versus leg exercise

At the same oxygen uptake, arm work results in higher

• Heart rate
• Due to higher sympathetic stimulation
• Blood pressure
• Due to vasoconstriction of large inactive muscle mass (legs)

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Heart rate and blood pressure during arm and leg
exercise

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Intermittent exercise

Recovery of heart rate and blood pressure between bouts depend on

• Fitness level
• Temperature and humidity
• Duration and intensity of exercise

Heavy-intensity intermittent exercise

• Near maximal HR values are possible

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Cardiovascular changes during prolonged exercise

Cardiac output is maintained

Gradual decrease in stroke volume

• Due to dehydration and reduced plasma volume

Gradual increase in heart rate during prolonged exercise

(particularly in heat)
• Cardiovascular drift

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Cardiovascular changes during prolonged exercise

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Summary of cardiovascular responses to exercise

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Sudden cardiac death during exercise

Clinical Applications 9.3

Sudden cardiac death during exercise is uncommon

• 1/200,000 youth athletes

Caused by abnormal, lethal heart rhythms

• In children and adolescents, due to:
• Genetic anomalies of coronary arteries
• Cardiomyopathy
• Myocarditis
• In adults, due to:
• Coronary artery disease
• Cardiomyopathy

A medical exam can identify those at risk

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Central command theory

Initial signal to “drive” cardiovascular system comes from higher

brain centers
• Due to centrally generated motor signals

Fine-tuned by feedback from:

• Heart mechanoreceptors
• Muscle chemoreceptors
• Sensitive to muscle metabolites (K+, lactic acid)
• Exercise pressor reflex
• Muscle mechanoreceptors
• Sensitive to force and speed of muscular movement
• Baroreceptors
• Sensitive to changes in arterial blood pressure

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 Summary of cardiovascular control during exercise

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 Lecture Summary

• Organization of the Circulatory System

• Heart: Myocardium and Cardiac Cycle
• Cardiac Output
• Hemodynamics
• Changes in Oxygen Delivery to Muscle During Exercise
• Circulatory Responses to Exercise
• Regulation of Cardiovascular Adjustments to Exercise

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