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Chapter 9

Circulatory Responses to Exercise

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Chapter 9

Outline
Organization of the
Circulatory System
Structure of the Heart
Pulmonary and Systemic
Circuits

Heart: Myocardium
and Cardiac Cycle
Myocardium
Cardiac Cycle
Arterial Blood Pressure
Factors That Influence
Arterial Blood Pressure
Electrical Activity of the
Heart

Cardiac Output
Regulation of Heart Rate
Heart Rate Variability
Regulation of Stroke
Volume

Hemodynamics
Physical Characteristics
of Blood
Relationships Among
Pressure, Resistance,
and Flow
Sources of Vascular
Resistance

Changes in Oxygen
Delivery to Muscle
During Exercise
Changes in Cardiac
Output During Exercise
Changes in Arterial-Mixed
Venous O2 Content
During Exercise
Redistribution of Blood
Flow During Exercise
Regulation of Local Blood
Flow During Exercise

Circulatory Responses
to Exercise
Emotional Influence
Transition From Rest to
Exercise
Recovery From Exercise
Incremental Exercise
Arm Versus Leg Exercise
Intermittent Exercise
Prolonged Exercise

Regulation of
Cardiovascular
Adjustments to
Exercise

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Organization of the Circulatory System

Chapter 9

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

Chapter 9

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

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Organization of the Circulatory System

Chapter 9

Structure of the Heart

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Organization of the Circulatory System

Chapter 9

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
Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Organization of the Circulatory System

Chapter 9

Pulmonary and
Systemic Circulations

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Heart: Myocardium and Cardiac Cycle

Chapter 9

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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Heart: Myocardium and Cardiac Cycle

Chapter 9

The Heart Wall


Layer

Coronary vessels

Characteristics

Function

Epicardium
Serous membrane
(visceral
including blood
pericardium) capillaries, lymph
capillaries, and nerve
fibers

Serves as
lubricative
outer covering

Myocardium

Cardiac muscle tissue


separated by
connective tissues
and including blood
capillaries, lymph
capillaries, and nerve
fibers

Provides muscular
contractions that
eject blood from
the heart chambers

Endocardium

Endothelial tissue and


a thick subendothelial
layer of elastic and
collagenous fibers

Serves as
protective inner
lining of the
chambers and
valves

Fibrous pericardium
Serous pericardium

Pericardial cavity
Figure 9.3 The heart wall is composed of three distinct layers: (1) epicardium, (2) myocardium, and (3) endocardium.
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Chapter 9

Cardiac muscle

- Cardiac fibers are typically branched


- Fibers are interconnected via intercalated discs
Heart muscle fibers are highly aerobic and contain large numbers of
mitochondria
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tack can 9be achieved quickly (29).


Chapter

For example, it appears that as few

(18). For more details,


Powers etal.
able. Nonetheless, evidence suggests
Heart: Myocardium
and see
Cardiac
Cycle
that the exercise-training-induced (2008) in the Suggested Readings.

Comparison of Cardiac and Skeletal


Muscle

TABLE 9.1

A Comparison of the Structural and Functional Differences/Similarities


Between Heart Muscle and Skeletal Muscle

Structural Comparison
Contractile proteins: actin
and myosin
Shape of muscle fibers
Nuclei
Z-discs
Striated
Cellular junctions
Connective tissue

Heart Muscle
Present

Present

Shorter than skeletal muscle


fibers and branching
Single
Present
Yes
Yesintercalated discs
Endomysium

Elongatedno branching

Functional Comparison
Energy production
Calcium source (for contraction)
Neural control
Regeneration potential

Skeletal Muscle

Aerobic (primarily)
Sarcoplasmic reticulum and
extracellular calcium
Involuntary
Noneno satellite cells present

Multiple
Present
Yes
No junctional complexes
Epimysium, perimysium, and
endomysium
Aerobic and anaerobic
Sarcoplasmic reticulum
Voluntary
Some possibilities via satellite cells

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Heart: Myocardium and Cardiac Cycle

Chapter 9

The Cardiac Cycle


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

Diastole
Relaxation phase
Filling with blood

At rest, diastole longer than systole


During exercise, both systole and diastole are shorter

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Chapter 9

The Cardiac Cycle


http://highered.mheducation.com/sites/0072495855/
student_view0/chapter22/
animation__the_cardiac_cycle__quiz_2_.html

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Heart: Myocardium and Cardiac Cycle

Chapter 9

The Cardiac Cycle at Rest and


During Exercise
Systole

Diastole

0.3 second

0.5 second

Systole

Diastole

0.2 second

0.13 second

CONFIRMIN

Rest
Heart rate = 75 beats/min

Heavy exercise
Heart rate = 180 beats/min

Illustration of cardiac cycle at rest and during exercise. Notice that increases in heart rate during e
ved primarily through a decrease in the time spent in diastole; however, at high heart rates, the len
nt in systole also decreases.

Time (seconds)
A healthy 21-year-old female might have an
resting heart rate of 75 beats per minute. This
0
0.2
0.4
120
hat the total cardiac cycle lasts 0.8 second,
second spent in diastole and the remaining
100
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nd dedicated toCopyright
systole
(17) (see Fig. 9.5). If

0.6

Heart: Myocardium and Cardiac Cycle

Chapter 9

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

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

Heart sounds
First: closing of AV valves
Second: closing of aortic and pulmonary valves
Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Chapter
.13
second

Heart: Myocardium and Cardiac Cycle

Pressure, Volume, and Heart Sounds


During the Cardiac Cycle

during exercise are achieved primarily through a decrease in the time spent in diastole;
ength of time spent in systole also decreases.

120

0.2

0.4

0.6

0.8

100
Pressure (mm Hg)

e Cardiac Cycle Durssure within the heart


n the atria are relaxed,
e venous circulation. As
ssure inside gradually
of the blood entering
s directly into the vencular valves before the
raction, atrial pressure
remaining 30% of the
.
s low while they are fillct, the ventricular pres-

Time (seconds)

80

Ventricle

60
40
20
0

Volume (ml)

ole and the remaining


e (17) (see figure 9.5). If
75 beats per minute to
avy exercise), there is a
both systole and diasted in figure 9.5. Note
n a greater time reducle is less affected.

Systole

Diastole

120
80
40
1st

2nd

Heart sounds

Copyright 2015 McGraw-Hill


FigureEducation.
9.6 All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Relationship among pressure, volume, and

Heart: Myocardium and Cardiac Cycle

Chapter 9

Electrical Activity of the Heart


Contraction of the heart depends on electrical
stimulation of the myocardium
Conduction system
Sinoatrial node (SA node)
Pacemaker, initiates depolarization

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
Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Chapter 9

Heart: Myocardium and Cardiac Cycle

Conduction System of the Heart

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Heart: Myocardium and Cardiac Cycle

Chapter 9

Electrocardiogram (ECG)
Records the electrical activity of the heart
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
Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

CONFIRMING
PAGES
Heart: Myocardium
and Cardiac
Cycle

Chapter 9

Normal Electrocardiogram
0.8 second

Millivolts

+1
PQ
segment

ST
segment

T wave

P wave
0
Q
PR
S
interval
QT
interval

QRS interval

Atria
contract

Ventricles
contract

Atria
contract

Ventricles
contract

Figure 9.11 Copyright


The normal
electrocardiogram
during
rest.
2015 McGraw-Hill
Education. All rights
reserved.
No reproduction or distribution without the prior written consent of McGraw-Hill Education.

A Closer Look 9.2

Chapter 9

Diagnostic Use of the ECG During


Exercise
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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A Closer Look 9.2

Chapter 9

S-T Segment Depression on the


Electrocardiogram

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Heart: Myocardium and Cardiac Cycle

Chapter 9

Relationship Between Electrical Events


and the ECG
CONFIRMING PAGES

Key
Wave of
depolarization
Wave of
repolarization

4 Ventricular depolarization complete.

1 Atria begin depolarizing.

5 Ventricular repolarization begins at apex and


progresses superiorly.

2 Atrial depolarization complete.

P
Q

3 Ventricular depolarization begins at apex and


progresses superiorly as atria repolarize.

6 Ventricular repolarization complete; heart is


ready for the next cycle.

Copyright
2015 McGraw-Hill
Education. Allbetween
rights reserved.
No reproduction
or distribution
the prior written
consent
McGraw-Hill
Figure 9.12
An illustration
of the relationship
the hearts
electrical
events andwithout
the recording
of the
ECG.ofPanels
12 Education.

ready for the next cycle.

es superiorly as atria repolarize.

Chapter 9

Heart: Myocardium and Cardiac Cycle

Relationship Between Pressure Changes


and the ECG
Pressure in ventricle (mm Hg)

onship between the hearts electrical events and the recording of the ECG. Panels 12
formation of the P wave. Panels 34 illustrate ventricular depolarization and formals 56 illustrate repolarization of the ventricles and formation of the T wave.
Time (seconds)
0.2
0.4

120
100

0.6

0.8

Intraventricular
pressure rises
as ventricles
contract

80
60

Intraventricular
pressure falls
as ventricles
relax

40
20
0

Systole

Diastole

ECG R

changes in the inNotice that the QRS


entricles) occurs at the
entricular pressure.
rization of the ventrie ventricles relax at the

P
Q

AV valves
close

P
Q

S
S1

S2

Semilunar
valves close

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Heart: Myocardium and Cardiac Cycle

Chapter 9

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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Heart: Myocardium and Cardiac Cycle

Chapter 9

Factors that Influence Arterial


Blood Pressure
Determinants of mean arterial pressure (MAP)
Cardiac output
Total vascular resistance
MAP = cardiac output x total vascular resistance

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

Long-term regulation
Kidneys
Via control of blood volume
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Chapter 9

Short-term regulation:
Baroreceptors in aorta and carotid arteries

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Chapter 9

Heart: Myocardium and Cardiac Cycle

Factors That Influence Arterial


Blood Pressure

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Heart: Myocardium and Cardiac Cycle

Chapter 9

In Summary
Blood pressure can be increased by one or all of the following factors:
a. Increase in blood volume
b. Increase in heart rate
c. Increased blood viscosity
d. Increase in stroke volume
e. Increased peripheral resistance
The pacemaker of the heart is the SA node.
A recording of the electrical activity of the heart during the cardiac
cycle is called the electrocardiogram (ECG).

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Cardiac Output

Chapter 9

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 x SV

Depends on training state and gender


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Cardiac Output

Chapter 9

Typical Values for Cardiac Output


TABLE 9.2

Subject

CONFIRMING PAG

Typical Resting and Maximal Exercise Values for Stroke Volume (SV), Heart Rate
) for College-Age Untrained Subjects and Trained
(HR), and Cardiac Output (Q
Endurance Athletes (Body Weights: Male 5 70 kg; Female 5 50 kg)
?
SV
HR
Q
(ml/beat)
(beats/min)
(l/min)

Rest
Untrained male
Untrained female
Trained male
Trained female
Max Exercise
Untrained male
Untrained female
Trained male
Trained female

72
75
50
55

3
3
3
3

70
60
100
80

5
5
5
5

200
200
190
190

3
3
3
3

110
90
180
125

5
5
5
5

5.00
4.50
5.00
4.40
22.0
18.0
34.2
23.8

Note that values are rounded off. Data from references 3, 22, and 68.

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Carotid
baroreceptors

Cardiac Output

Chapter 9

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 ~100 beats/min

Later increase due to increased SNS stimulation


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Chapter 9

Cardiac Output

Nervous System Regulation of Heart


Rate

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Cardiac Output

Chapter 9

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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Cardiac Output

Chapter 9

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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FIRST PAGES
Cardiac Output

Chapter 9

ath
a
an
8).
ales
olm
in

200
Stroke volume (ml)

ed
he

Relationship Between End-Diastolic


Volume and Stroke Volume
Increased
venous
return
100

100

Normal
resting
value
200

300

400

Ventricular end-diastolic volume (ml)


Figure 9.15 An illustration of the relationship between

ventricular end-diastolic volume and stroke volume.


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Cardiac Output

Chapter 9

Skeletal Muscle Pump

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Chapter 9

Cardiac Output

Effects of Sympathetic Stimulation on


Stroke Volume

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Cardiac Output

Chapter 9

Factors that Regulate Cardiac Output CONFIRM

Cardiac
output

Cardiac rate

Stroke volume

Contraction
strength
Parasympathetic
nerves

Sympathetic
nerves

End-diastolic
volume (EDV)

Mean arterial
pressure

Stretch
FrankStarling

18

Factors that regulate cardiac output. Variables that stimulate cardiac output are shown by solid arr
tors that reduce cardiac output are shown by dotted arrows.

MODYNAMICS

Blood sample

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Cardiac Output

Chapter 9

In Summary
Cardiac output is the product of heart rate and stroke volume (Q = HR
x SV). Figure 9.18 summarizes those variables that influence cardiac
output during exercise.
The pacemaker of the heart is the SA node. SA node activity is
modified by the parasympathetic nervous system (slows HR) and the
sympathetic nervous system (increases HR).
Heart rate increases at the beginning of exercise due to a withdrawal
of parasympathetic tone. At higher work rates, the increase in heart
rate is achieved via an increased sympathetic outflow to the SA node.

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Cardiac Output

Chapter 9

In Summary
Stroke volume is regulated by: (1) end-diastolic volume, (2) afterload
(i.e., aortic blood pressure), and (3) the strength of ventricular
contraction.
Venous return increases during exercise due to (1) venoconstriction,
(2) the muscle pump, and (3) the respiratory pump.

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Hemodynamics

Chapter 9

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

Hematocrit
Percentage of blood composed of cells
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Hemodynamics

Chapter 9

Components of Blood

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Hemodynamics

Chapter 9

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 ( Pressure)

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Chapter 9

Hemodynamics

Blood Flow Through the Systemic Circuit

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Hemodynamics

Chapter 9

Hemodynamics
Resistance depends upon:
Length of the vessel
Viscosity of the blood
Radius of the vessel
Length x Viscosity
Resistance =
Radius4

Sources of vascular resistance


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

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Hemodynamics

Chapter 9

Capillaries Venules

Large
veins

Blood pressure
(mm Hg)

Precapillary sphincters

120

Left
Large
ventricle arteries

Arterioles

Pressure Changes Across the Systemic


Circulation
240
200
160
120

80

Stroke volume
(ml beat1)

Pressure (mm Hg)

100
80
60
40

140
120
100
80

0
Resistance vessels

Exchange
vessels

Capacitance
vessels

Figure 9.21 Pressure changes across the systemic circula-

ardiac output
(! min1)

20

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25
20
15
10

Hemodynamics

Chapter 9

In Summary
Blood is composed of two principle components, plasma and cells.
Blood flow through the vascular system is directly proportional to the
pressure at the two ends of the system, and inversely proportional to
resistance.
The most important factor determining resistance to blood flow is the
radius of the blood vessel.
The greatest vascular resistance to blood flow is offered in the
arterioles.

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Chapter 9

Changes in Oxygen Delivery to Muscle During Exercise

Oxygen Delivery During Exercise


Oxygen demand by muscles during exercise is
1525x 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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D Pressure
Blood flow 5 _____________________________
Resistance

The most important factor determining resis-

tance to blood flow is the radius of the blood


vessel. The relationship between vessel radius,
vessel length, blood viscosity, and flow is

200
160

During intense exercise, the metabolic need for oxygen in skeletal muscle increases many times over the
resting value. To meet this rise in oxygen demand,
blood flow to the contracting muscle must increase.
As mentioned earlier, increased oxygen delivery to
exercising skeletal muscle is accomplished via two
mechanisms: (1) an increased cardiac output and (2)
a redistribution of blood flow from inactive organs to
the working skeletal muscle.

Changes in Cardiac Output


DuringExercise

50

75

100

2 max
~40% VO

140
120
100
80
25

50

75

100

25

50

75

100

25

50

75

100

25

50

75

100

25

Cardiac output
(. min1)
Heart rate
(beats min1)

CHANGES IN OXYGEN
DELIVERY TO MUSCLE
DURING EXERCISE

Diastolic

80

20
15
10
5

200
150
100

Arteriovenous
O2 difference
(ml 100ml1)

offered in the arterioles.

Mean

120

Length 3 Viscosity
Resistance 5 ____________________________________________________
Radius4
The greatest vascular resistance to blood flow is

Systolic

240

25

Stroke volume
(ml beat1)

Changes in
Cardiovascular
Variables During
Exercise
IN SUMMARY
Blood is composed of two principal components: plasma and cells.
Blood flow through the vascular system is directly proportional to the pressure at the two
ends of the system and inversely proportional
to resistance:

Blood pressure
(mm Hg)

Changes in Oxygen Delivery to Muscle During Exercise

Chapter 9

50

18
12
6

2 max
Percent VO
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prior written consent of McGraw-Hill Education.

Changes in Oxygen Delivery to Muscle During Exercise

Chapter 9

Changes in Cardiac Output During


Exercise
Cardiac output increases due to:
Increased HR
Linear increase to max

Increased SV
Increase, then plateau at 4060% VO2 max
No plateau in highly trained subjects

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Research Focus 9.1

Chapter 9

Stroke Volume Does Not Plateau in


Endurance Athletes
Stroke volume reaches a plateau at 4060% 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 Oxygen Delivery to Muscle During Exercise

Chapter 9

Changes in Arterial-Mixed Venous O2


Content During Exercise
Higher arteriovenous difference (a-vO2 difference)
Amount of O2 that is taken up from 100 ml blood
Increase due to higher amount of O2 taken up
Used for oxidative ATP production

Fick equation
Relationship between cardiac output (Q), a-vO2 difference, and
VO2
VO2 = Q x avO2 difference

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Changes in Oxygen Delivery to Muscle During Exercise

Chapter 9

Redistribution of Blood Flow During


Exercise
Increased blood flow to working skeletal muscle
At rest, 1520% of cardiac output to muscle
Increases to 8085% 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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Changes in Oxygen Delivery to Muscle During Exercise

Chapter 9

Changes in Muscle and Splanchnic


Blood Flow During Exercise
1,600

Splanchnic blood flow


(% rest)

Muscle blood flow


(% rest)

At the beginning o
muscle vasodilation tha
1,400
metabolic control (41). T
1,200
tion is termed autoreg
1,000
be the most importan
800
flow to muscle during e
bolic rate of skeletal m
600
local changes such as
400
increases in CO2 tension
Rest
adenosine concentratio
(increase in acidity) (se
100
local changes work toge
arterioles feeding the co
80
Vasodilation reduces t
60
therefore increases bloo
changes, blood delivery
40
during heavy exercise m
above that during rest (4
20
tion is combined with r
in skeletal muscle. At res
0
25
50
75
100
illaries in skeletal musc
2 max
Percent VO
however, during intens
FigureEducation.
9.23 All
Changes
splanchnic
capillaries
in contracting
Copyright 2015 McGraw-Hill
rights reserved.in
No muscle
reproduction orand
distribution
without the priorblood
written consent of McGraw-Hill
Education.

Changes in Oxygen Delivery to Muscle During Exercise

Chapter 9

CONFIRMING PAGES

Redistribution of Blood Flow During


Exercise
Cardiac output
= 25 /min.

25 /min.

100%

35%

45%

24%

0.51%

34%

8085%

Heavy exercise
~20 /min.

Heavy
exercise
Rest

~0.75 /min.

Rest

100%

2025%

45%

20%

35%

15%

45%

1520%

Cardiac output
= 5 /min.
5 /min.
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Figure 9.24 Distribution of cardiac output during rest and maximal exercise. At rest, the cardiac output is 5 ,/min.

Chapter 9

Changes in Oxygen Delivery to Muscle During Exercise

Regulation of Local Blood Flow During


Exercise
Skeletal muscle vasodilation
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 203-% of resting values

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Chapter 9

Arteriolar and Venular Networks Paired


in Skeletal Muscle

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Chapter 9

Skeletal muscle vasodilation

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Chapter 9

Rapid onset vasodilation

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Research Focus 9.2

Chapter 9

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 autoregulation
With other local factors

One of several factors involved in blood flow


regulation during exercise
Increases muscle blood flow

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Changes in Oxygen Delivery to Muscle During Exercise

Chapter 9

In Summary
Oxygen delivery to exercising skeletal muscle increases due to (1) an
increased cardiac output and (2) a redistribution of blood flow from
inactive organs to the contracting skeletal muscle.
Cardiac output increases as a linear function of oxygen uptake during
exercise. During exercise in the upright position, stroke volume
reaches a plateau at approximately 4060% of VO2max; therefore, at
work rates above 4060% VO2max, the rise in cardiac output is due
to increases in heart rate alone.

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Changes in Oxygen Delivery to Muscle During Exercise

Chapter 9

In Summary
During exercise, blood flow to contracting muscle is increased, and
blood flow to less-active tissues is reduced.
Regulation of muscle blood flow during exercise is primarily regulated
by local factors (called autoregulation). Autoregulation refers to
intrinsic control of blood flow by changes in local metabolites (e.g.,
oxygen tension, pH, potassium, adenosine, and nitric oxide) around
arterioles.

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Circulatory Responses to Exercise

Chapter 9

Circulatory Responses to Exercise


Changes in heart rate and blood pressure
Depend on:
Type, intensity, and duration of exercise
Arm vs. leg exercise

Environmental condition
Hot/humid vs. cool

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nsion, pH, potasChapter


9
oxide)
around

better recuperative powers than untrained subjects. In


regard to recovery heart rates, the slopesCirculatory
of heart-rateResponses to Exercise
decay following exercise are generally the same for

Stroke volume
(ml beat1)

blood pressure that


e type and intensity of
n of exercise, and the
r which the work was
rate and blood presrk when compared to
ke. Further, exercise in
in higher heart rates
xercise in a cool envitions discuss the carse during a variety of

Exercise

15

Recovery

10
5
120
100
80
140

Heart rate
(beats min1)

PONSES

Cardiac output
( min1)

Transition From Rest to Exercise to


Recovery

120
100
80
60
0

10

20

emotionally charged
Rest
Exercise
Recovery
heart rates and blood
Exercise and recovery time (min)
e same work in a Copyright
psy- 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Circulatory Responses to Exercise

Chapter 9

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
Depends on:
Duration and intensity of exercise
Training state of subject

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Circulatory Responses to Exercise

Chapter 9

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 x systolic BP
Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

As mentioned earlier, the increase in heart rate


Chapter
9

and systolic blood pressure that occurs during exercise results in an increased workload on the heart.
The increased metabolic demand placed on the heart
during exercise can be estimated by examining the
double product. The double product (also known

33) (see Fig. Circulatory


9.26). The explanation
for theto
higher
heart
Responses
Exercise
rate seems to be linked to a greater sympathetic outflow to the heart during arm work when compared to
leg exercise (2). In addition, isometric exercise also increases the heart rate above the expected value based
on relative oxygen consumption (1).

Changes in Double Product During


Exercise

TABLE 9.3

Changes in the Double Product (i.e., Heart Rate 3 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.
Heart Rate
(beats ? min21)

Condition
Rest
Exercise
25% V~ O2 max
50% V~ O2 max
75% V~ O2 max
100% V~ O2 max

www.mhhe.com/powers9e

85-214.indd 209

Systolic Blood
Pressure (mm Hg)

Double Product

75

110

8,250

100
140
170
200

130
160
180
210

13,000
22,400
30,600
42,000

Chapter Nine Circulatory Responses to Exercise

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209

24

Circulatory Responses to Exercise

Chapter 9

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

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Circulatory Responses to Exercise

Chapter 9

180
160

Arm
exercise

140

Leg
exercise

120
100

Heart rate
(beats min1)

Heart Rate
160

Arm
exercise

140
120

Leg
exercise

100
0

Stroke volume
(ml beat1)

Mean Arterial Blood Pressure

|
1.0

|
1.5

Exercise oxygen uptake


( min1)

|
2.0

Heart rate
(beats min1)

Blood pressure
(mm Hg)

200

Cardiac output
( min1)

Heart Rate and Blood Pressure During


Arm and Leg Exercise
15
10
5
120
100
80

180
160
140
120

Copyright 2015 McGraw-Hill


Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Figure
9.27
Figure 9.26

Comparison of mean arterial blood pressure

Changes in

Circulatory Responses to Exercise

Chapter 9

Intermittent Exercise
Recovery of heart rate and blood pressure between
bouts depend on:
Fitness level
Temperature and humidity
Duration and intensity of exercise

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Circulatory Responses to Exercise

Chapter 9

Prolonged Exercise
Cardiac output is maintained
Gradual decrease in stroke volume
Due to dehydration and reduced plasma volume

Gradual increase in heart rate


Cardiovascular drift

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Chapter 9

Circulatory Responses to Exercise

Cardiovascular Changes During


Prolonged Exercise

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Circulatory Responses to Exercise

Chapter 9

In Summary
The changes in heart rate and blood pressure that occur during
exercise are a function of the type and intensity of exercise
performed, the duration of exercise, and the environmental
conditions.
The increased metabolic demand placed on the heart during exercise
can be estimated by examining the double product.
At the same level of oxygen consumption, heart rate and blood
pressure are greater during arm exercise than during leg exercise.
The increase in heart rate that occurs during prolonged exercise is
called cardiovascular drift.
Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

during
Chapter 9

signal developed within the brain (42). The central


Regulation of Cardiovascular Adjustments to Exercise
command theory of cardiovascular control argues that
the initial cardiovascular changes at the beginning of

Summary of Cardiovascular Responses


to Exercise

ring
ar drift.

eginning
after the
here is a
which is
mulation
a vasodiand a re-

CARDIAC
OUTPUT

Cardiac
rate

Sympathoadrenal
system

BLOOD FLOW TO
SKELETAL MUSCLES

Stroke
volume

Improved
venous
return

Metabolic
vasodilation
in muscles

Sympathetic
vasoconstriction
in viscera

Skeletal
muscle
activity

Deeper
breathing
Figure 9.28

A summary of cardiovascular responses to

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Regulation of Cardiovascular Adjustments to Exercise

Chapter 9

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
Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Chapter 9

Central command

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Chapter 9

Mechanisms Mediating Large


Cardiovascular Responses to Exercise

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CONFIRMING
PAGES to Exercise
Regulation of Cardiovascular
Adjustments

Chapter 9

Summary of Cardiovascular Control


During Exercise

r exercise) are
r motor signals,
cardiovascular
cardiovascular
mechanorecepmechanorecep(baroreceptors)
the aortic arch
ensitive to intassium, lactic
r brain centers
ses to exercise
to the cardiogata) has been

Central
command
(higher brain
centers)

CV
control center

Baroreceptors

Heart

Blood vessels

Skeletal muscle

muscle spinChemoreceptors
Mechanoreceptors
ve to the force
ese receptors,
2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
nformation to Copyright Figure
9.29 A summary of cardiovascular control during

Regulation of Cardiovascular Adjustments to Exercise

Chapter 9

In Summary
The central command theory of cardiovascular control during
exercise proposes that the initial signal to drive the cardiovascular
system at the beginning of exercise comes from higher brain centers.
Although central command is the primary drive to increase heart rate
during exercise, the cardiovascular response to exercise is fine-tuned
by feedback from muscle chemoreceptors, muscle
mechanoreceptors, and arterial baroreceptors to the cardiovascular
control center.

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Clinical Applications 9.1

Chapter 9

Exercise Training Protects the Heart


Regular exercise is cardioprotective
Reduce incidence of heart attacks
Improves survival from heart attack

Exercise reduces the amount of myocardial damage


from heart attack
Improvements in hearts antioxidant capacity
Improved function of ATP-sensitive potassium channels

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Clinical Applications 9.1

Chapter 9

CLINICAL
APPLICATIONS
9.1
Endurance Exercise Protects Against
Cardiac
g Protects
the Injury
Heart During Heart Attack
100
Percentage of cardiac injury during
a myocardial infarction

hed that regular


ardioprotective.
iological studies
nce that regular
he incidence of
at the survival
ctims is greater
n in sedentary
ents provide digular endurance
ces the amount
t occurs during
29). The protecis illustrated in
xercise training
itude of cardiac

80

FIGURE 9.4
60
40
20
0

Untrained

Trained

durance exerc
the heart again
during a heart
that during a m
infarction (i.e.,
exercise-traine
als suffer signi
cardiac injury
untrained indi
from reference

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