Exercise Physiology

dr. Patrick W. SpKFR

 Exercise Physiology
– The study of the effects of exercise on the body.
– Body’s responses and adaptations to exercises
– System to subcellular level
– Acute (short term) to chronic (long term) adaptations
– Population served
– Elite performer
– People of all ages and abilities
Physical Fitness

– Ability of the body’s systems to function

efficiently and effectively.
– One is “physically fit” if they have the
ability to:
– “carry out daily tasks with vigor and alertness, without undue
fatigue, and with ample energy to enjoy leisure-time pursuits
and to meet unforeseen emergencies.”
 Physical Fitness
– Health fitness  Performance or skill-
– Body composition related fitness
 Agility
– Cardiorespiratory
endurance  Balance
 Coordination
– Flexibility
 Power
– Muscular endurance
 Reaction Time
– Muscular strength  Speed
Energy Production for Physical Activity

– Use of ATP as energy to perform muscular activity. Two ways to produce ATP:
– Anaerobic system
– Without oxygen
– High energy expenditure, short time (6-60 seconds)
– Aerobic system
– With oxygen
– Lower rate of energy expenditure, longer period of time (more than 3 minutes)
 Types of Exercise
– Anaerobic exercise
(sprinting, weight-lifting)
– short duration, great
intensity (fast-twitch
muscle fibers); creatine
phosphate + glycogen
(glucose) from muscle
o2
– WHITE MUSCLE FIBERS:
- large in diameter
- light in color (low myoglobin)
- surrounded by few
capillaries
- relatively few mitochondria
- high glycogen content (they
have a ready supply of
glucose for glycolysis)
 Types of Exercise
– Aerobic exercise (long-
distance running, swimming)-
prolonged but at lower intensity
(slow-twitch mucle fibers) fuels
stored in muscle, adipose
tissue and liver
- the major fuels used vary with
the intensity and duration of
exercise (glucose – early, FFA –
later)
o2
– RED MUSCLE FIBERS:
- red in colour (high myoglobin
content)
- surrounded by many capillaries
- numerous mitochondria
- low glycogen content (they also
metabolize fatty acids and
proteins, which are broken
down into the acetyl CoA that
enters the Krebs cycle)
 Muscle metabolism
Exercise
intensity
• Low ATP and
creatine phosphate
stimulate glycolysis
creatine and oxidative
ADP, Pi,
phosphate
in skeletal muscle
phosphorylation.
cells
• Exercise can
increase rates of ATP
formation and
Glycolysis Oxidative phosphorylation breakdown more than
tenfold
Creatine phosphate and stored ATP – first few seconds
Glycolysis – after approx. 8-10 seconds
Aerobic respiration – maximum rate after 2-4 min of exercise

Repayment of oxygen debt – lactic

acid converted back to pyruvic acid,
rephosphorylation of creatine (using ATP from oxidative
phosphorylation), glycogen synthesis, O2 re-binds to myoglobin and Hb)
 Energy sources during exercise

– ATP and CP – alactic anaerobic source

– Glucose from stored glycogen in the absence of oxygen – lactic

anaerobic source

– Glucose, lipids, proteins in the presence of oxygen – aerobic source

Integration of Metabolism:
Review of Roles of Systems in
Muscle Contraction

Figure 25-1: Energy metabolism in skeletal muscle

Alactic anaerobic source
(for "explosive" sports: weightlifting, jumping, throwing,
100m running, 50m swimming)

– immediately available
and can't generally be
maintained more than 8-
10 s
– ATP stored in the muscle
is sufficient for about 3 s
of maximal effort
– ATP and CP
regeneration needs the
energy from oxygen
source
Lactic anaerobic source
(for "short" intense sports: gymnastic, 200 to 1000 m
running, 100 to 300 m swimming)

– for less than 2 min of effort

– recovery time after a
maximal effort is 1 to 2 h
– medium effort (active
recovery) better than
passive recovery
– recovery: lactate used for
oxidation (muscle) and
gluconeogenesis in the
liver
 Fast exhaustic exercise (eg. sprint)

– ↑ in anaerobic glycolysis rate (role of Ca2+)

– In the absence of oxygen (anaerobic conditions)
muscle is able to work for about 1-2 minutes
because of H+ accumulation and ↓pH;
– Sprinter can resynthesize ATP at the maximum
speed of the anaerobic pathway for less than
about 60s
- Lactic acid accumulates and one of the rate-
controlling enzymes of the glycolytic pathway is
strongly inhibited by this acidity
Intense exercise 
Glycolysis>aerobic metabolism 
↑ blood lactate (other organs use some)

Blood
lactic
acid
(mM)

Lactate
threshold;
endurance
Relative work rate (% V02 max) estimation
Training reduces blood lactic acid levels at work
rates between approx. 50% and 100% of VO2max
 Sustaining Muscle
contractions: ATP
Sources/Time

Figure 25-2: Speed of ATP production compared with ability to

sustain maximal muscle activity
Hormonal regulation of Energy Source for
ATP Production

Figure 25-3: Use of carbohydrates and fats with increasing exercise

Oxygen Consumption:
Factors Sustaining or Limiting Exercise

Figure 25-4: Changes in oxygen consumption during and after exercise

Respiratory Ventilation:
Exercise Induced hyperventilation

Figure 25-5: Changes in ventilation with submaximal exercise

Respiratory Ventilation:
Exercise Induced hyperventilation

Figure 25-6: Changes in blood

gas, partial pressures, and
arterial pH with exercise
 Muscle fatigue
– Lactic acid

– ↓ATP (accumulation of ADP and Pi, and

reduction of creatine phosphate) 
 ↓ Ca++ pumping and release to and from
SR↓ contraction and relaxation

– Ionic imbalances muscle cell is less

responsive to motor neuron stimulation
 Lactic acid

– ↓ the rate of ATP hydrolysis,

– ↓ efficiency of glycolytic enzymes,
– ↓Ca2+ binding to troponin,
– ↓ interaction between actin and myosin (muscle
fatigue)
– during rest is converted back to pyruvic acid and
oxidized by skeletal muscle, or converted into
glucose (in the liver)
 Aerobic source
(for "long" sports;
after 2-4min of exercise)

– recovery time after a maximal

effort is 24 to 48 hrs
– carbohydrates (early), lipids
(later), and possibly proteins
– the chief fuel utilization
gradually shifts from
carbohydrate to fat
– the key to this adjustment is
hormonal (increase in fat-
mobilizing hormones)
The rate of FFA utilization by muscle
is limited

– Oxidation of fat can only support around 60% of

the maximal aerobic power output
– restricted blood flow through adipose tissue
– insufficient albumin to carry FFA
– glucose oxidation limits muscles’ ability to oxidize
lipids
– perhaps the ability to run at high intensity for long periods was
not important in terms of the evolution of Homo sapiens (maybe the
ability to sprint, to escape from a predator was more important)?
Prolonged intense work ↑ glycogenolysis  ↑
glycolysis glycogen depletion exercise ends
(marathon runners describe this as „hitting the wall”)”)

circulatingglucose cannot be sufficient for high intensity rate of glycolysis

fat can only support around 60% of maximal aerobic power output

Muscle
glycogen
content Exhaustion
(g/kg muscle)

Duration of exercise (hours)

 Principles of Fitness
Training
– Principle of overload
– To improve, one must perform more than one’s normal amount of
exercise.
– Principle of specificity
– Programs should be designed in relation to specific goals in mind.
– Individual’s initial fitness level
– Assess initial level of fitness to design realistic program and a
starting point.
– Progression of program
– Increase program as individual becomes adjusted.
 Principles of Fitness
Training
– Individual differences
– Individual’s work, diet, lifestyle, and management of stress should
be taken into consideration.
– Warm-up, workout, cooldown components
– Helps prevent injury and prepares body for exercise as well as
returns it to a normal state.
– Safety
– Information collected from medical screening, and informing
individual of environmental conditions
– Behavioral factors
– Motivation of individual to adhere to fitness program
 Planning a Fitness Program
– Threshold of training
– Minimal level of exercise needed to achieve desired benefits.
– Target zone
– Defines the upper limits of training and the optimal level of
exercise.
– FITT formula
– Frequency, Intensity, Time, and Type
– Manipulate these factors to produce an individualized exercise
program.
– Needs and goals of individual
– Program should meet the goals of the individual
 FITT formula
– Frequency
– Number of sessions each week
– Intensity
– Degree of effort put forth by the individual during exercise.
– Time
– Duration of activity
– Type
– Mode of exercise being performed
 Cardiorespiratory
Endurance

– Body’s ability to deliver oxygen effectively to the working muscles to

perform physical activity.
– Most important component of health fitness.
– Helps prevent hypokinetic disease.
– Concerned with the aerobic efficiency of the body.
 Cardiorespiratory
Endurance

– Frequency: 3 to 5 times per week

– Intensity: 60% to 90% HRMAX
– Time: 20 - 30 minutes
– Type: Aerobic activities
– Jogging
– Running
– Walking
– Dancing
– Cross Country Skiing
– Biking
– Swimming
Target Zone

– HRMAX=220 bpm - age

– Target zone = 60% to 90% HRMAX
– Lower threshold target HR= HRMAX x 60%
– Upper threshold target HR= HRMAX x 90%
– Calculations for a 20-year-old
– HRMAX =220-20=200 bpm
– Lower threshold = 200 bpm x 60%=120 bpm
– Upper threshold = 200 bpm x 90%=180 bpm
 Body Composition
– Percentage of body weight composed of fat as compared with fat-free or lean
tissue.
– Determined by height and weight tables or BMI
– Obesity is associated with numerous health problems and earlier mortality.
– In 1999, and estimated 61% of adults were either overweight
or obese, and 13% of children were overweight.
– Determination of the cause of obesity is important.
 Body Composition
– Body composition is primarily influenced by nutrition and physical activity.
– Energy balance is important to achieving a favorable body composition.
– Energy expenditure through:
– basal metabolism (maintenance of essential life functions)
– work (including exercise)
– excretion of body wastes
 Body Composition

Classifications for BMI

Classification BMI
Male Female
Underweight <18.5 kg/m2

Average 18% 23% Normal weight 18.5 - 24.9 kg/m2

Overweight 25 - 29.9 kg/m2

Desirable 12% or less 18% or less Obesity (Class 1) 30 - 34.9 kg/m2

Obesity (Class 2) 35 - 39.9 kg/m2

Lower limit 3% 12%
Extreme Obesity (Class 3)  40 kg/m2
 Muscular Strength and
Endurance
– Muscular strength is the ability of a muscle or a muscle group to exert a
single force against a resistance.
– Muscular endurance is the ability of a muscle or muscle group to exert force
repeatedly or over a period of time.
– Maintenance of proper posture; protect joints.
– Production of power to enhance performance.
– Use it of lose it!
 Exercises
– Isometric exercises
– Muscle exerts force against an immovable object.
– Static contraction
– Isotonic exercises
– Force is generated while the muscle is changing in length.
– Concentric and Eccentric contractions
– Isokinetic exercises
– Contractions are performed at a constant velocity.
– Cybex and Orthotron machines
Development of Muscular
Strength and Endurance
– Principle of Overload is critical.
– Repetition is the performance of a movement through the
full range of motion.
– Set is the number of repetitions of performed without rest.
– Strength
– Low number of repetitions with a heavy resistance.
– Endurance
– High number of repetitions with a low resistance.
– FITT
 Flexibility
– Maximum range of motion possible at a joint
– Joint specific: better range of motion in some joints
than in others.
– Can prevent muscle injuries; improve low-back pain
– Decreased flexibility can be caused by:
– Sedentary lifestyle (lack of use of muscles)
– Age
– High amounts of body fat
– Stress
 Flexibility
– Improvement of flexibility
– Ballistic stretching
– Momentum generated from repeated bouncing to stretch.
– Not recommended- may overstretch the muscle.

– Static stretching
– Slowly moving into a stretching position and holding for a certain period of time (10-30
seconds; 5 times).

– Contract-relax technique
– Relaxing of the muscle to be stretched by contracting the opposite muscle
(hamstrings/quadriceps)

– Measurement of flexibility-goniometer
 Effects of Training

Lower oxygen consumption

Lower pulse rate
Larger stroke volume
Lower rise in blood pressure
Slower respiration rate
Lower rate of lactic acid formation
Faster return to “normal”
 Effects of Training
Greater cardiorespiratory efficiency.
Greater endurance.
More “work” can be performed at less cost.
Improvement in fitness components.
Coordination and timing of movements are
better.
Oxygen
consumption
during
exercise
– The peak oxygen consumption is influenced by the age, sex,
and training level
of the person performing
the exercise V peak 02

Oxygen
consumption
(liters/min)

(VO2max)
Work rate
(watts)

– The plateau in peak oxygen consumption, reached during

exercise involving a sufficiently large muscle mass, represents
the maximal oxygen consumption

– Maximal oxygen consumption is limited by the ability to deliver

O2 to skeletal muscles and muscle oxidative capacity (mucle
mass and mitochondirial enzymes activity).
 The ability to deliver O2 to muscles and
muscle’s oxidative capacity limit a
person’s VO2max. Training  ↑ VO2max

70% V02 max (trained) V02 peak

(trained)

V02 peak
Oxygen (untrained)
consumption
(liters/min) 100% V02 max
(untrained)

175
Work rate (watts)
Cardiorespiratory
endurance

– the ability of the heart, lungs and

blood vessels to deliver adequate
amounts of oxygen to the cells to
meet the demands of prolonged
physical activity
 the best indicator of the
– the greater cardiorespiratory cardiorespiratory endurance is VO2max -
endurance  the greater the the maximal amount of oxygen that the
human body is able to utilize per minute
amount of work that can be of strenuous physical activity
performed without undue fatigue
Methods for determination of VO2max

– Direct measuring of volume of

air expired and the oxygen and
carbon dioxide concentrations
of inspired or expired air with
computerized instruments

– Submaximal tests (samples):

- step tests, run tests
- stationary bicycle ergometer (Astrand-Ryhming test)
- Physical Work Capacity (PWC 170/150) test
How does the
respiratory
system
respond
to exercise?
 • during dynamic
Respiration during
exercise of increasing
exercise intensity, ventilation
increases linearly over
the mild to moderate
range, then more
rapidly in intense
exercise
• the workload at which
rapid ventilation
occures is called the
ventilatory breakpoint
(together with lactate
threshold)
Lactate acidifies the blood, driving off CO2 and increasing ventilatory rate
 Major factors which stimulate increased
ventilation during exercise include:
– neural input from the motor areas of the cerebral cortex
– proprioceptors in the muscles and joints
–  body temperature
– circulating NE and E
– pH changes due to lactic acid

Arterial blood
pH

Rest Exercise intensity V02max

It appears that changes in pCO2 and O2 do not play

significant role during exercise
 Before expected exercise begins,
ventilation rises

– 'emotional
hyperventilation‘
– at any rate, impulses
descending from the
cerebral cortex are
responsible
During the exercise, stimuli from the muscles, joints
and perhaps such sensory receptors as pressure
endings in the feet, contribute to the elevation of
ventilation

– so do chemicals, originating in
the active muscles.
– in dynamic exercise, they are
carried in the blood to the
arterial and medullary
chemoreceptors, and probably
have their main effects there
– in isometric efforts the
ventilatory drive originates in
chemically sensitive nerve
endings
 Recovery and ventilation

– Cessation of muscular
effort
– Normal blood K+ and
CO2 oscillations (2-3
min)
– Decreased acidity
(several minutes)
– High temperature
Respiratory Ventilation:
Exercise Induced hyperventilation

Figure 25-5: Changes in ventilation with submaximal exercise

Respiratory Ventilation:
Exercise Induced hyperventilation

Figure 25-6: Changes in blood

gas, partial pressures, and
arterial pH with exercise
How does the
cardiovascular
system
respond
to exercise?
 Cardiovascular Response to
Exercise
•Cardiac output
O 5 to 35 L/min
ORate  2-3 X
•Blood distribution
O muscles to 88% of all blood
O other tissues (except brain)
 Resting cardiac output is typically ~ 5 l/min.

At VO2max it will be ~ 35 l/min in a well-trained

~ 25 l/min in a healthy aerobic athlete, and up
but not especially to 45 l/min in a ultra-
trained young man elite performers
Dynamic exercise 
↑ Muscle pump + ↑ symp. vasocon. 
↑ Venous return  ↑ stroke volume  ↑ cardiac output

HR Cardiac
output
Cardiac
contractility

Maintenance of
Muscle ventricular filling
“pump”

Skin and Venous

splanchnic blood return
volume
 Cardiac output (CO) increase
– Increased CO can be achieved by raising either stroke
volume (SV) or heart rate (HR)
– steady-state HR rises essentially linearly with work rate
over the whole range from rest to VO2max :
- increased sympathetic and decreased parasympathetic
discharge to the cardiac pacemaker + catecholamines
- reflex signals from
the active muscles
- blood-borne metabolites
from these muscles
- temperature rise
 Heart rate
– Maximum HR is predicted to
within 10 b.p.m., in normal
people who are not
endurance trained, by the
rule:
HR (b.p.m.) = 220 - age
– endurance training,
especially if maintained
over many years, lowers
this maximum by up to
15 b.p.m.
– it also, of course, lowers
resting HR
Blood Pressure (BP) also rises in exercise

– systolic pressure (SBP)

goes up to 150-170 mm
Hg during dynamic
exercise; diastolic
scarcely alters

– in isometric (heavy
static) exercise, SBP
may exceed 250 mmHg,
and diastolic (DBP) can
itself reach 180
 Homeostatic Balancing of
Exercise: “Controlled
Disruption”

Figure 25-8: Peripheral resistance and arterial blood pressure during exercise
 Muscle chemoreflex

– Heavy exercise ↑ muscle lactate 

muscle chemorec. and afferent nerves medullary
cardiovascular center ↑ sympathetic neural outflow ↑
HR and cardiac output per minute + vasoconstriction
(viscera, kidneys, skeletal muscles) + vasodilation in
working skeletal muscles
Cardiovascular response
in isometric exercise
– Compression of intramuscular arteries and veins
prevents muscle vasodilation and increased blood flow
– ↓ oxygen delivery causes rapid accumulation of lactic
acid – stimulation of muscle
chemoreceptors – elevation of
baroreceptor set point and
sympathetic drive
(muscle chemoreflex)
– As a result: mean BP is higher
(as compared with dynamic
exercise)
–  systolic and  diastolic BP
Endurance
training

Strength
training
Chronic Effects of Dynamic Exercise
(cardiovascular adaptations to dynamic exercise training)

– Adaptations that increase muscle oxidative capacity

and delay lactate production  ↓ muscle
chemoreflex influence on cardiovascular system
– As a result sympathetic activity is decreased, which
lowers BP and HR (trained people)
Blood flow redistribution is
achieved partly by sympathetic nerve
activity, and partly chemically
 1000ml/min

300ml/min 250ml/min 750ml/min 22 000ml/min

250ml/min
1400ml/min 1100ml/min 750ml/min 500ml/min 1200ml/min
 Coronary artery

Rest
Coronary
blood flow
↑ Cardiac output 
↑ Coronary flow (fivefold)
↑ Endothelial cell
Coronary artery
shear stress 
Nitric oxide Prostacyclin ↑ Endothelial-dependent
vasodilation +
cholinergic fibers
Exercise
stimulation (sympathetic
system)
Nitric oxide
Vasodilator
Prostacyclin capacity
How do
muscle
respond
to exercise?
Response to chronic moderate
exercise
– Increased fatigue resistance is mediated by:
- ↑ muscle capillary density
- ↑ myoglobin content,
- ↑ activity of enzymes (oxidative pathways)
- ↑ oxidative capacity linked to ↑ numbers of mitochondria

– Increased capacity to oxidize FFA shifts the energy

source from glucose to fat (to spare glucose)
Chronic Effects of Dynamic Exercise
Moderate exercise 
↑ oxidative capacity and fat usage 
↑ VO2max and endurance 
↓ lactate
 Response to high intensity muscle
contraction
– ↑ in muscle strength via improvement of motor units
recruitment (1-2 weeks of training)
– muscle hypertrophy (↑ of muscle contractile
elements)
– no change in oxidative capacity
Hormonal
responses
during
aerobic
exercise
Our endocrine system and
hormones are key players in
managing the body’s chemistry
 During exercise

If we concentrate on efforts of significant intensity – e.g. 70%

VO2max - lasting not less than 30 min, there's a simple rule:
all hormones rise over time, except insulin

Norepinephrine rises again ('fight or flight'). Increases glycogen breakdown and

elevates free fatty acids; also cardiovascular effects as in anticipatory phase
Glucagon rises (to keep up blood sugar). Increases glucose release from liver
Cortisol rises (response to the stress). Increases use of fatty acids, reinforces
glucose elevation
Growth hormone begins to rise (damage repair). Stimulates tissue repair, enhances
fat use instead of glucose
Anticipating exercise

Systemic effects include:

– Anticipation principally • bronchodilation
• intra muscular vasodilatation
involves the • visceral and skin vasoconstriction
catecholamine hormones, •increased cardiac output
Metabolic effects include:
particularly epinephrine +
• promotion of glycogenolysis and glycolysis
sympathetic activation in muscle
• release of glucose from liver
• release of free fatty acids from adipose
tissue.
Cortisol's behaviour is particularly complex. In exercise
at low intensity (e.g.30% max - an easy jog) some reports
indicate that its level falls (such gentle aerobic exercise
relieves stress).
When it does rise,
at higher intensities,
it peaks after 30 min,
then falls off again
 Other hormones involved in exercise

– Thyroxine/T3 usually rise somewhat, but less than one might

expect.
– Epinephrine requires more intense effort than norepinephrine to
raise it significantly in this phase. 70% max may be
barely sufficient.
– ADH is released in considerable quantities. It's not just socially
inconvenient to have to urinate during exercise - it's a waste of
fluid which will probably be needed as sweat.
– Testosterone/estrogen increase with exercise - probably, over
many repetitions, promoting increased muscle bulk
– Aldosterone also rises, reducing Na+ loss in sweat (and in
such urine as is still produced).
Insulin concentration falls significantly
after 20-30 min exercise, and goes on
falling (at a lower rate) if the exercise
continues 2-3 hours
 Health Advantages of Regular
Exercise: Quality of Life
•  Cardiovascular disease risks: heart attack,
stroke, high BP
O blood pressure
O LDL & triglycerides
O HDL  risks for diabetes
O obesity
•  stress association
•  immune function
O(to a point)
 Health Advantages of Regular
Exercise: Quality of Life

Figure 25-9b: The effect of exercise on glucose tolerance and insulin secretion
Health Advantages of Regular
Exercise: Quality of Life

Figure 25-10: Immune function and exercise