CIRCULATORY

RESPONSES TO EXERCISE
(BRIEF REVISION)

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CIRCULATORY RESPONSES TO EXERCISE
(BRIEF REVISION)
• Organization of the circulatory system
• Heart: myocardium and cardiac cycle
• Cardiac output
• Hemodynamic
• 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 (i.e increased amount of
blood pumped per minute by the heart)
• Redistribution of blood flow from inactive organs
to the active skeletal muscles
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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 less-oxygenated blood to the
lungs via pulmonary arteries
• Returns well-oxygenated blood to
the left side of the heart via
pulmonary veins
• Systemic circuit
• Left side of the heart
• Pumps well-oxygenated blood to the
whole body via arteries
• Returns less-oxygenated blood to
the right side of the heart via veins

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Heart: Myocardium and Cardiac
Cycle

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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
• Exercise training protects against heart
damage during MI
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The Heart Wall

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Exercise Training Protects the Heart
• Many epidemiological studies have provided
evidence that regular exercise can reduce the
incidence of heart attacks and that the
survival rate of heart attack victims is greater
in active people than in sedentary ones

• Exercise training can reduce the magnitude

of cardiac injury during a heart attack by
approximately 60%

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Exercise Training Protects the Heart
• Regular endurance exercise protects the heart against
cell death during a heart attack

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Cardiac Cycle
• The cardiac cycle is the sequence of events
that occur when the heart beats.

• The cycle has two main phases:

• Diastole, when the heart ventricles are
relaxed, and
• Systole, when the ventricles contract

• One cardiac cycle is defined as the

contraction of the two atria followed by
contraction of the two ventricle

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Cardiac Cycle

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Cardiac Cycle
• At rest, diastole longer than systole
• During exercise, both systole and diastole are
shorter
• A healthy twenty one year old female might
have an average resting heart rate of 75 beats
per minute.
• This means that the total cardiac cycle lasts 0.8
second, with 0.5 second spent in diastole and
the remaining 0.3 second dedicated to systole.
• If the heart rate increases from 75 beats per
minute to 180 beats per minute (e.g., heavy
exercise), there is a reduction in the time spent
in both systole and diastole

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Cardiac Cycle

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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 P < atrial P
• Approximately 70% of the blood entering the atria during diastole flows
directly into the ventricles through the AV valves before the atria contract

• Systole
• Pressure in ventricles rises which closes the AV
valves and prevents backflow into the atria
• Semilunar valves open when ventricular P > aortic P & pulmonary artery P
• Blood ejected in pulmonary and systemic
circulation

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Heart sounds
• The two heart sounds that are produced by the
closing of the atrioventricular valves (first heart
sound) and
• The closing of the aortic and pulmonary valves
(second heart sound)

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Arterial Blood Pressure
• Blood pressure is the force exerted by blood against
the arterial walls
• The normal blood pressure of an adult male is
120/80
• Adult females tends to be lower (110/70)
• Systolic pressure
• Pressure generated during ventricular contraction
• Diastolic pressure
• Pressure in the arteries during cardiac relaxation
• Pulse pressure
• Difference between systolic and diastolic B.P

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Measurement of Arterial Blood Pressure

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Hypertension
• Blood pressure in excess of the normal range
for the person's age and sex
• Blood pressure above 140/90 mmHg
• Primary (essential) hypertension
• Cause unknown
• 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 B.P

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Electrical Activity of the Heart
• Many myocardial cells have the unique potential for
spontaneous electrical activity (ie. each has an intrinsic rhythm)
• However, in the normal heart, spontaneous electrical activity is
limited to a special region located in the right atrium.
• This region, called the sinoatrial node (SA node), serves as the
pacemaker for the heart

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Electrical Activity of the Heart
• Spontaneous electrical activity in the SA
node occurs due to a decay of the
resting membrane potential via inward
diffusion of sodium during diastole.

• When the SA node reaches the

depolarization threshold, the wave of
depolarization spreads over the atria,
resulting in atrial contraction

• The conduction of the electrical impulse

throughout the left and right atria is
seen on the ECG as the P wave.

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Electrical Activity of the Heart
• As the electrical activity is spreading
throughout the atria, it travels via
specialized pathways, known
as internodal tracts, from the SA node
to the AV node
• Atrioventricular node (AV node)
• Passes depolarization to ventricles
• Brief delay to allow for ventricular filling

• Bundle Branches
• To left and right ventricle

• Purkinje fibers
• Throughout ventricles

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Electrical Activity of the Heart

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Electrocardiogram (ECG)
• Recording of the electrical changes that occur in
the myocardium during the cardiac cycle is called
an electrocardiogram (ECG)
• To evaluate the heart‘s ability to conduct impulses
and therefore determine if electrical problems exist
• The first deflection on the ECG is called the P wave
and represents the depolarization of the atria.
• The second wave, the QRS complex, represents the
depolarization of the ventricles and occurs
approximately 0.10 second following the P wave.
• The final deflection, the T wave, is the result of
ventricular repolarization

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Electrocardiogram (ECG)

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Electrocardiogram (ECG)

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Cardiac Output

• The amount of blood pumped by the heart each minute

• Product of heart rate and stroke volume
Q = HR x SV
• Heart rate
• Number of beats per minute
• Stroke volume
• Amount of blood ejected in each beat
• Depends on training state and gender

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Typical resting and Maximal Exercise values

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Regulation of Heart Rate

• During exercise, the quantity of blood pumped by the

heart must change in accordance with the elevated
skeletal muscle oxygen demand.

• Because the SA node controls heart rate, changes in

heart rate often involve factors that influence the SA
node.

• The two most prominent factors that influence heart

rate are the parasympathetic and sympathetic nervous
systems
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Regulation of Heart Rate
• Parasympathetic nervous system
• Via vagus nerve
• Arise from neurons in the cardiovascular control
center in the medulla oblongata
• Release acetylcholine, which causes a decrease in
the activity of both the SA and AV nodes
• Acts as a braking system to slow down heart rate
• Even at rest, the vagus nerves carry impulses to
the SA and AV nodes
• This is often referred to as parasympathetic tone

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Regulation of Heart Rate
• Studies have shown that the initial increase in heart
rate during exercise, up to approximately 100 beats
per minute, is due to a withdrawal of
parasympathetic tone
• Sympathetic nervous system
• SNS Increases HR by stimulating SA and AV node via cardiac accelerator
nerves
• Endings of these fibers release norepinephrine upon stimulation, which
act on beta receptors in the heart and cause an increase in both heart
rate and the force of myocardial contraction

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Beta-Blockade and Heart Rate
• Beta-adrenergic blocking drugs (beta-
blockers)
• Compete with epinephrine and
norepinephrine for beta adrenergic receptors
in the heart
• Reduce heart rate and contractility
• Lower the myocardial oxygen demand
• Prescribed for patients with coronary artery
disease and hypertension
• Will lower heart rate during submaximal and
maximal exercise
• Important for exercise prescription

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Regulation of Stroke Volume
• Stroke volume is the amount of blood
ejected in each beat
• Stroke volume is regulated via
• (I) End-diastolic volume,
• (2) Aortic blood pressure, and
• (3) The strength of ventricular contraction.
• End-diastolic volume,
• Volume of blood in the ventricles at the end
of diastole (“preload”)
• Aortic blood pressure
• Pressure the heart must pump against the
aorta to eject blood (“afterload”)

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Regulation of Stroke Volume

• Stroke volume is thus inversely proportional to the

afterload; i.e. an increase in aortic pressure produces a
decrease in stroke volume

• However, it is note worthy that afterload is minimized

during exercise due to arteriole dilation

• This arteriole dilation in the working muscles reduces

afterload and makes it easier for the heart to pump a
large volume of blood

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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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Relationship Between End-Diastolic Volume
and Stroke Volume

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Skeletal Muscle Pump

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Effects of Sympathetic Stimulation on Stroke
Volume

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•Any ?????

•Thanxxxx
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HEMODYNAMICS
Physical Characteristics of Blood
• Blood is composed of two principal components, plasma and cells
• The percentage of the blood that
is composed of cells is called
the hematocrit
• male 42%, female 38%

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Relationships Among Pressure, Resistance, and
Flow:
• blood flow through the vascular system depends in part on the
difference in pressure at the two ends of the system.

• the primary factor regulating blood flow through organs must be the
radius of the blood vessel.
• The greatest vascular resistance in blood flow occurs in arterioles

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CHANGES IN OXYGEN DELIVERY
TO MUSCLE DURING EXERCISE
• During intense exercise, the metabolic need for oxygen in
skeletal muscle increases many times over the resting value
• Oxygen demand by muscles during exercise is 15-25 times
greater than at rest
• increased oxygen delivery to exercising skeletal, muscle is
accomplished via two mechanisms:
(I) an increased cardiac output and
(2) a redistribution of blood flow from inactive organs to the
working skeletal muscle

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Changes in Cardiac Output During Exercise
• Body's total volume of blood, equaling 4 to 6L, passes through heart
every min during rest.
• Cardiac output increases during exercise in direct proportion to the
metabolic rate required to perform the exercise task
• Understanding of CO during activity enables informed exercise
decisions.
• Active muscle require more oxygen then resting muscle
• At the onset of exercise muscle signal heart to pump faster for inc.
blood flow
• In addition, working muscles inc. SV by sending higher amounts of
blood vol. back towards the lungs for oxygen.
• Therefore, increase in cardiac output during exercise is achieved by
an increase in both stroke volume and heart rate.

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Adaptations to Exercise
• CO adapts throughout a training program.
• Adaptations include:
• Inc. ventricular size
• Dec. exercise HR
• Inc. SV
• Therefore, your heart can maintain a high CO with less effort.
Most improvement to CO is contributed to inc. SV
• Positive adaptations occur in as little as three months of
aerobic training
• Enhancing CO allows you to maintain lower HR during physical
activity.
• For example: at start of exercise: HR=150bpm at 6mph pace
After 3 or more months of training: 125bpm at 6mph pace
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(MAX HR)
• A maximum heart rate is the highest number of beats your heart
contracts during one minute measurement. Max HR is a useful tool to
measure training intensities and typically is used to measure or
predict the level of exercise.
Women: age-adjusted Max HR= 226 – your age
Men: age-adjusted Max HR= 220 – your age
• Example: if you are 30 year old female, your age adjusted Max HR is
226 – 30 = 196 bpm.

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TARGET HERAT RATE (THR)

• To find out what your HR should be at a certain intensity (% HRmax),

multiply this result by a percentage( in decimal point form)
• Example: 60 year old male wants to work at intensities b/w 60-90%
what should his target HR be?
• Max HR= 220 – 60 = 160bpm
• THR 60%= 160 × 0.60 = 96bpm
• THR 90%= 160 × 0.90 = 144bpm
• This means if you were to work at intensities b/w 60-90% you should
try to keep your heart rate b/w 96-144bpm.

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Redistribution of Blood Flow
During Exercise

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Regulation of Local Blood Flow
During Exercise
• Muscle as well as other body tissues have the unique ability to
regulate their own blood flow in direct proportion to their metabolic
needs.
• Skeletal muscle vasodilation:
• the arterioles in skeletal muscle have a high vascular resistance at
rest This is due to adrenergic sympathetic stimulation, which
causes arteriole smooth muscle to contract (vasoconstriction)
• This produces a relatively low blood flow to muscle at rest (4-5 ml
per minute per 100 grams of muscle), but because muscles have a
large mass, this accounts for 20% to 25% of total blood flow from
the heart

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Nitric oxide is an Important Vasodilator

• Produced in the endothelium or arterioles

• Promotes smooth muscle relaxation
– Results in vasodilation and increased blood flow
• Important in auto regulation
– With other local factors
• One of several factors involved in blood flow
regulation during exercise
– Increases muscle blood flow

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• Autoregulation refers to intrinsic control of blood flow by change in
local metabolites (e.g., oxygen tension, pH, potassium, adenosine,
and nitric oxide) around arterioles.
• These local changes work together to cause vasodilation of arterioles
feeding the contracting skeletal muscle
• arteriole vasodilation is combined with "recruitment" of the
capillaries in skeletal muscle.
• The level of vasodilation that occurs in arterioles and small arteries
leading to skeletal muscle is regulated by the metabolic need of the
muscle. That is, the intensity of exercise and the number of motor
units recruited determine the overall need for blood flow to the
muscle
• vascular resistance in skeletal muscle decreases during exercise, while
resistance to flow in the visceral organs and other inactivity tissue
increases due to increased sympathetic output to these organs,
which is regulated by the cardiovascular control center. As a result,
vasoconstriction occur.

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CIRCULATORY RESPONSES
TO EXERCISE
• The changes in heart rate and blood pressure that occur during
exercise reflect
• the type and intensity of exercise performed,
• the duration of exercise,
• the environmental conditions under which the work was performed

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Emotional Influence

• Submaximal exercise in an emotionally charged atmosphere results in

higher heart rates and blood pressures when compared to the same
work in a psychologically "neutral" environment

• This emotional elevation in heart rate and blood pressure response to

exercise is mediated by an increase in sympathetic nervous system
activity

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Transition from Rest to Exercise

• At the onset of exercise:

– Rapid increase in HR, SV, cardiac output begin to
increase within the first second after muscular
contraction begins
• During recovery
– Decrease in HR, SV, and cardiac output toward
resting
– Depends on:
 Duration and intensity of exercise
 Training state of subject

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Incremental Exercise

• Heart rate and cardiac output increase in direct proportion

to oxygen uptake.
• The increase in cardiac output during incremental exercise is
achieved via a decrease in vascular resistance to flow
• the increase in heart rate and systolic blood pressure that
occurs during exercise results in an increased workload on
the heart.

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Double Product
• The increased metabolic demand placed on the heart during exercise
can be estimated by examining the double product. The double
product (also known as rate-pressure product) is computed by
multiplying heart rate times systolic blood pressure
Double product = heart rate x systolic blood pressure
• The DP is used to measure as a guideline to prescribe exercise for
patients with coronary artery blockage
• For example: suppose a pt develops chest pain at a certain intensity
of exercise due to myocardial ischemia at a DP of >30,000.
• Because chest pain appears at DP of >30,000, the cardiologist or
exercise physiologist would recommend that this pt perform types of
exercises that result in DP of <30,000.

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Arm Versus Leg Exercise

• At any given level of oxygen consumption both heart rate

and blood pressure are higher during arm work when
compared to leg work
• greater sympathetic outflow to the heart during arm work
when compared to leg exercise
• Additionally, isometric exercise also increases the heart rate
above the expected value based on relative oxygen
consumption

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Intermittent Exercise

• Short burst of intensive exercises (usually less than 1min) alternated

with periods of rest or low intensity workout (eg. Interval training)
• This type of training induces a greater production of enzymes, which
breakdown body fat, improving the ability to lose weight
• Also a larger production of growth hormone, which inc. the rate of
protein synthesis, enhancing muscle tissue growth
• The greater the concentration of fat-burning enzymes and GH, the
more calories your burn throughout the day.
• This type of high intensity workout should be performed one or two
days/week, ensuring there are at least two days gap b/w each session
• Walking bouts permits to jog or sprint at extremely high intensities.

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• The general ratio for this type of intermittent training is b/w 1 to 3
and 1 to 5
• This means that if you jog for one min, you should walk for 3 min
• Or you sprint for 30 sec, you should walk for 90 sec to 150 sec
totaling 25-30 min.
• Recovery of heart rate and blood pressure between bouts depend
on:
• Fitness level
• Temperature and humidity
• Duration and intensity of exercise

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Prolonged Exercise

• Cardiac output is maintained at a constant level throughout

the duration of the exercise.
• Stroke volume declines
• Due to dehydration and reduced plasma volume
• A reduction in plasma vol. acts to reduce venous return to
the heart and therefore reduces stroke vol.
• Gradual increase in heart rate
• the inc. in HR occurs during prolong exercise is called
Cardiovascular drift.

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Summary of Cardiovascular
Response to Exercise

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Central Command Theory

• The term central command refers to a motor signal developed within

the brain
• initial cardiovascular changes at the beginning of dynamic exercise
(e.g., cycle ergometer exercise) are due to centrally generated
cardiovascular motor signals, which set the general pattern of the
cardiovascular response.
• cardiovascular activity can be and is modified by heart
mechanoreceptors, muscle chemoreceptors, muscle
mechanoreceptors, and pressure-sensitive receptors (baroreceptors)
located within the carotid arteries and the aortic arch
• Muscle chemoreceptors are sensitive to increases in muscle
metabolites (e.g., potassium, lactic acid, etc)
• Muscle mechanoreceptors are sensitive to the force and speed of
muscular movement
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• baroreceptors, which are sensitive to changes in arterial blood
pressure

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• THAT’S ALL…

THANKYOU!!!

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