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Cardiovascular Control During Exercise

CARDIOVASCULAR CONTROL DURING EXERCISE A. Structure & Function the Cardiovascular System (CVS)
Major functions:

1. 2. 3. 4. 5.

Delivery Removal Transport

– CV S delivers O2 & nutrients to cells. – CV S removes CO2 & metabolic waste products from every cell. - CVS transports hormones from endocrine glands to their target receptors. Maintenance - CVS maintains body temperature & the blood’s buffering capabilities help control the body’s pH. Prevention – CV S maintains appropriate fluid levels to prevent dehydration & helps to prevent infection by invading organisms.

1. The Heart (A Pump)    2 atria acting as receiving chambers. 2 ventricles acting as sending units (discharging chambers). As a pump that circulates blood through the entire vascular system.

Blood Flow Through the Heart


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Blood delivering O2 & nutrients & picking up waste products, returns through the great veins – superior vena cava & inferior vena cava to the right atrium (RA). The (RA) chamber receives all the body’s deoxygenated blood. From the (RA), blood passes through the tricuspid valve into the right ventricle (RV). The (RV) chamber pumps the blood through the pulmonary semilunar valve into pulmonary artery, which carries the blood to the lungs. Thus, the right side of the heart is known as the pulmonary side, sending the blood that has circulated throughout the body into the lungs for reoxygenation. After receiving a fresh supply of O2, the blood exits the lungs through the pulmonary veins, which carry it back to the heart & into the left atrium (LA). The (LA) chamber receives all the freshly oxygenated blood. From (LA), blood passes through the bicuspid (mitral) valve into the left ventricle (LV). Blood leaves the left ventricle by passing through the aortic semilunar valve into the aorta, which sends it out to all body parts & systems. The left side of the heart is known as the systemic side – receives the oxygenated blood from the lungs then sends it out to supply all body tissues.
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11. Cardiovascular Control During Exercise

The Myocardium (Cardiac muscle)

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Cardiac muscle is collectively called the myocardium. Left ventricle (LV) is the most powerful of the 4 chambers – pump oxygenated blood out through the entire systemic route. When the body is standing or sitting, the (LV) must contract with enough force to overcome the effect of gravity, which tends to pool blood in the lower extremities. (LV) has the greater size (hypertrophy) of its muscular wall – this hypertrophy is the result of demands placed on it. With more vigorous exercise – intense aerobic activity, which working muscles’ need for blood, increases the demands on the (LV) are high. Over time it responds by increasing it size (hypertrophy). * The atria receive blood into the heart; the ventricles eject blood from the heart. Left ventricle must produce more power than other chambers because has to pump blood to all parts of the body; therefore its myocardium is thicker, due to hypertrophy.

The Cardiac Conduction System (Intrinsic Control of The Heart)


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Cardiac muscle has the unique ability to generate its own electrical signal, called autoconduction, which allows it contract rhythmically without neural stimulation. The intrinsic heart rate (HR) averages 70 -80- beats per minute (contractions). HR can drop below this rate in endurance-trained people.

Four (4) components of the cardiac conduction system: 1. Sinoatral (SA) node 2. Atrioventricular (AV) node 3. Atrioventricular (AV) bundle (Bundle of His) 4. Purkinje fibers

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The impulse for heart contraction is initiated in the sinoatrial (SA) node, a group of specialized cardiac muscle fibers located in the posterior wall of the right atrium. This tissue (SA node) generates the impulse at about 60 -80 beats per minutes. SA node is known as the heart’s pacemaker, & the beating rate is establishes is called the sinus rhythm. The electrical impulse generated by the SA node spreads through both atria & reaches the atrioventricular (AV) node, located in the right atrial wall near the center of the heart. As the impulse spreads through the atria, both atria are signaled to contract immediately & simultaneously. AV node conducts the impulse from the atria into the ventricles.
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The impulse is delayed by about 0.13s as it passes through the AV node, then it enters the AV bundle. The delay allows the atria to fully contract before the ventricle, maximizing ventricular filling. AV bundle travels along the ventricular septum & then sends right & left bundle branches into 2 ventricles. These branches send the impulse toward the apex of the heart, then outward. These terminal branches of the AV bundles are the Purkinje fibers (Pf). Pf transmit the impulse through the ventricles 6 times faster than the rest of the cardiac conduction system. * Cardiac tissue is capable of autoconduction. Cardiac conduction system has own conduction system initiates own pulse without neural control. * SA node is the heart’s pacemaker, establishing the pulse and coordinate activity throughout the heart.

Extrinsic Control of Heart Activity The heart initiates its own electrical impulse (intrinsic control), their timing & effects can be altered through 3 extrinsic system:

1. The parasympathethic nervous system
(Autonomic nervous system)

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Acts on the heart through the vagus nerve (cranial nerve X). Parasympathetic stimulation = vagal tone Vagus nerves has a depressant effect, it slows impulse conduction & thus decrease the HR. Maximal vagal stimulation can lower the HR to 20 -30 beats per minute. Vagus nerve also decreases the force of cardiac contraction.

The sympathetic nervous system (Autonomic nervous system)



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Sympathetic stimulation increases the impulse conduction speed thus increase the HR Maximal sympathetic stimulation will allows the HR to soar up to 250 beats per minute. Sympathetic input also increases the contraction force. Predominates during times of physical or emotional stress. After the stress subsides the parasympathetic system again predominates.
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3.

The endocrine system (hormones)

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Hormones released by the adrenal medulla: norepinephrine & epinephrine (catecholamines). Stimulates the heart & increase its HR. Released of these hormone triggered the sympathetic stimulation during stress & their actions prolong the sympathetic response.

 Normal resting HR = 60 – 85 beats per minute (bpm).  With extended periods of endurance training (months to years), the resting HR can decrease to 35 beats per minute or less.  A world-class long-distance runner = 28 beats per minute.  Lower RHR are postulated to result from increased parasympathetic stimulation (vagal tone), with a reduced sympathetic activity probably playing a lesser role. * Heart rate and contraction strength of the heart can be altered by the autonomic nervous system or the endocrine system.

Cardiac Arrhythmias

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Disturbances in the normal sequence of cardiac events can lead to an irregular heart rhythm, called an arrhythmia. Can affect blood circulation. Bradycardia (slow heart) = resting HR lower than 60 beats per minute. Tachycardia (fast heart) = resting HR higher than 100 beats per minute. Symptoms of both arrhythmias include fatigue, dizziness, lightheadedness, & fainting. Other arrhythmias: Premature Ventricular Contractions (PVC), which result in the feeling of skipped or extra beats, result from impulses originating outside the SA node. Atrial Flutter, in which atria contract at rates of 200-400 bpm. Atrial Fibrillation – atria contract in a rapid & uncoordinated manner – is more serious arrhythmias, which cause the atria to pump little blood or no blood. Ventricular fibrillation – uncoordinated ventricular contraction – cause heart cannot pump blood & leads to fatal. Use of a defibrillator to shock the heart to get back normal sinus rhythm. * Endurance training cause low resting HR (bradycardia)
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The Electrocardiogram (ECG)  Electrical activity of heart can be recorded to diagnose potential cardiac problems or to monitor cardiac changes. The principle involved is simple –  Body fluids are good electrical conductors.  Electrical impulses generated in the heart are conducted through body fluids to the skin, where they can be detected & printed out by a sensitive machine called an electrocardiograph.  This printout is called an electrocardiogram (ECG). Three components of ECG represent aspects of cardiac function: 1. The P wave 2. The QRS complex 3. The T wave The P wave represents atrial depolarization & occurs when the electrical impulse travels from the SA node through the atria to the AV node. * “Depolarization” = a decrease in the electrical potential across a membrane, such as when the inside of a neuron becomes less negative relative to the outside.

The QRS complex represents ventricular depolarization & occurs as the impulse spreads from the AV bundle to the Purkinje fibers & through the ventricles. The T wave represents ventricular repolarization. Atrial repolarization cannot be seen as it occurs during ventricular depolarization (QRS complex). Often ECGs are obtained during exercise. ECGs are valuable diagnostic tests. As exercise intensity increases, the heart must beat faster and work harder to deliver more blood to active muscle. If the heart is diseased, an indication may show up on the ECG as the heart increases its rate of work. Exercise ECGs have also been invaluable tools for research in exercise physiology because they provide a convenient method for tracking cardiac changes during acute & chronic exercise. * ECG is a recording of the heart’s electrical functioning. An exercise ECG may reveals underlying cardiac disorders.

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Terminology of Cardiac Function Cardiac Cycle

Includes all events occurring between 2 consecutive heartbeats: a relaxation phase (Diastole) & a contraction phase (Systole). • During diastole, the chambers fill with blood. • During systole, the chambers contract & expel blood. • Diastolic phase is longer than systolic phase. • Eg: An individual with HR = 74 bpm, the entire cardiac cycle takes 0.81s to complete (60s/74 bpm); diastole accounts for 0.50s (62%) of the cycle & systole accounts for 0.31s (38%). • As HR increases, these absolute time intervals shorten proportionately. * (Refer to Normal ECG) • One cardiac cycle spans the time between one systole & the next. • Ventricular contraction (systole) begins during the QRS complex & the ends in the T wave. • Ventricular relaxation (diastole) occurs during the T wave & continues until the next contraction.

Stoke Volume (SV) • The volume of blood pumped per stroke (contraction). • A certain amount of blood is ejected from the left ventricle during systole. • At the end of diastole, just before systole, the ventricle has completed filling with blood. This volume of blood is called ‘end-diastole volume’ (EDV). • At the end of systole, just after contraction, the ventricle has completed its ejection phase. This volume of blood left in the ventricle is called ‘end-systole volume’ (ESV). • SV is the volume of blood that was ejected, & is the difference between the amounts originally there & the amount remaining in the ventricle after contraction. • SV = EDV - SDV

EDV = 100 ml
End of ventricle filling

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ESV = 40 ml
End of ventricle contraction

=

SV = 60 ml
Blood vessels
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11. Cardiovascular Control During Exercise

Ejection Fraction (EF) • The proportion of blood pumped out of the left ventricle at each beat. EF = EDV SV x 100 = 100 60 x 100 = 60%

• Expressed as a percentage, average 60% at rest. Thus 60% of the blood in the ventricle is ejected & 40% remains.

Cardiac Output (Q) • • The total volume of blood pumped by ventricle per minute. Q = HR x SV (The product of HR & SV)

• SV at rest in the standing position averages between 60-80 ml of blood foe most adults. • Thus RHR = 80 bpm, the resting Q = 4.8 –6.4 L/min. • Average adult body contains 5 L of blood, so this means all our blood is pumped through our heart about once every minute.

2. The Vascular System (The Blood Vessel/ A system of channels)  Composed of a series of vessels that transport blood from the heart to the tissue and back. Arteries are typically the largest, most muscular, & most elastic vessels, & carry blood away from the heart to the arterioles. From the arterioles, blood enters the capillaries, the narrowest vessels. All exchange between the blood and the tissues occurs at the capillaries. Blood leaves the capillaries to begin the return trip to the heart in the venules, & the venules form larger vessels – the veins - that complete the circuit. *Heart has also own vascular system – coronary arteries & veins

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Return of Blood to the Heart • • CV system requires assistance to overcome the force of gravity (upright position) when returning blood from the lower extremities back to the heart. Three basic mechanisms assist in this process: a. Breathing – pressure changes in the abdominal & thoracic cavities. b. Muscle pump – During skeletal muscle contraction, veins are compressed & blood is pushed upwards toward the heart c. Valves within veins - allow blood flow in one direction only. Blood returns to the heart through the veins, assisted by breathing, the muscle pump, and valves within the vessels.

Distribution of Blood • Varies depending on the needs of specific tissue & of the whole body. At rest – Most metabolically active tissue receive the greatest blood supply: 27% to liver; 22% to kidneys & only 15% to skeletal muscles. During exercise – blood is redirected to the needed areas. Heavy endurance exercise, skeletal muscles receive up to 80% or more of the available blood. After meal – digestive system receives more blood. During heat stress – the skin’s blood supply increases as the body attempts to maintain normal temperature. *Blood is redistributed throughout the body based on the tissues’ needs. The most active tissues receive the most blood. (The more active the muscle is, the more blood goes to it.)


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Distribution of blood to various areas is controlled primarily by the arterioles. These vessels have strong muscular wall & respond to the mechanisms that control blood flow: autoregulation & extrinsic neural control. Autoregulation (intrinsic control). Causes vasodilation in response to local chemical changes, thus increases blood flow or supply to the areas where more O2 demand. Chemical changes also increases in clearing the by-products (CO2, K+, H+ & lactic acid) Extrinsic Neural Control of distribution is accomplished by the SNS stimulation causing constriction of blood vessels (decrease blood flow into that area). But SNS can also cause vasodilation e.g. during fight – or – flight response or exercising (increase blood flow to the skeletal muscle & in the heart).
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Redistribution of Venous Blood – At rest 64% blood in the veins, but during exercise SNS causes vasoconstriction of these veins, therefore more blood flow to areas in need.

Blood Pressure

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The pressure exerted by the blood on the vessel walls, & the term usually refers to the arterial blood pressure. Expressed by 2 numbers: the systolic pressure & the diastolic pressure. BP = Systolic BP Diastolic BP

The higher number is the systolic blood pressure.  Represent the highest pressure in the artery & corresponds to ventricular systole of the heart.  Ventricular contraction pushes the blood through the arteries with tremendous force, which exerts high pressure on the arterial wall.

The lower number is the diastolic blood pressure.  Represent the lowest pressure in the artery & corresponds to ventricular diastole when the heart is at rest.  Blood moving through the arteries during that phase is not pushed along by a forceful contraction. *Systolic blood pressure is the highest pressure within the vascular system. Diastolic blood pressure is the lowest pressure. Mean arterial pressure is the average pressure on the vessel walls

Hypertension    Constriction of blood vessels increases blood pressure. Condition in which blood pressure is chronically elevated above normal, healthy values. The cause is generally unknown in approximately 90% of cases, but it can usually be controlled effectively by weight loss, proper diet, & exercise, although appropriate medication may also be required.

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3. The Blood Basic 1. 2. 3. • • Functions primary importance to exercise: Transportation Temperature regulation Acid-base (pH) balance

Blood & lymph are substances that transport materials to & from body tissues. Fluid from plasma enters the tissues, becoming interstitial fluid. Most interstitial fluid returns to the capillaries, but some enters the lymphatic system as lymph, eventually returning to the blood. Blood volume = 5-6 L in males & 4-5 L in females.

Blood Composition • Plasma – 55% (90% water, 7% plasma proteins & 3% others) • Formed elements - 45% (> 99% RBC & < 1% WBC & platelets) RBC (Erythrocytes) • % RBC volume in the blood is hematocrit (normal = 40-45%) • O2 is primarily transported bound to the hemoglobin in RBC. • RBC contains hemoglobin: Protein (globin) & Pigment (heme) that contains iron that binds O2. • Each RBC contains approximately 250 million hemoglobin molecules, each able to binds 4 O2 molecules, so each RBC can bind up to a billion molecules of O2. • Average 15 g Hb per 100 ml of whole blood. Blood Viscosity • Viscosity refers to the thickness or stickiness of the blood. • The more viscous, the more resistant it is to flow. • Viscosity of blood is about twice than water. • Increase viscosity of blood = Increase resistance of blood flow • Increase hematocrit = Increase resistance of blood flow • CV system’s normal adaptations to training – Increase hematocrit & normal or slightly increase RBC.

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11. Cardiovascular Control During Exercise

SUMMARY
1. 2. The atria receive blood into the heart; the ventricles eject blood from the heart. Left ventricle must produce more power than other chambers because has to pump blood to all parts of the body; therefore its myocardium is thicker, due to hypertrophy.

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conduction system initiates own pulse without neural control. 4.

Cardiac tissue is capable of autoconduction. Cardiac conduction system has own

SA node is the heart’s pacemaker, establishing the pulse and coordinate activity throughout the heart.

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nervous system or the endocrine system. 6.

Heart rate and contraction strength of the heart can be altered by the autonomic

Endurance training cause low resting HR (bradycardia). ECG is a recording of the heart’s electrical functioning. An exercise ECG may reveals underlying cardiac disorders. Blood returns to the heart through the veins, assisted by breathing, the muscle pump, and valves within the vessels. Blood is redistributed throughout the body based on the tissues’ needs. The most active tissues receive the most blood. Redistribution of blood is controlled by autoregulation. Autoregulation causes vasodilation in response to local chemical changes, thus increasing blood flow or supply to the areas. Extrinsic neural control of distribution is accomplished by the SNS, primarily through vasoconstriction. Blood & lymph are substances that transport materials to and from body tissues. Blood is about 55% plasma and 45% formed elements, Oxygen is transported by binding to the hemoglobin in RBCs. As blood viscosity increases, so does resistance to flow.
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B. Cardiovascular Response to Exercise
1. Heart Rate (HR) • HR is one of the simplest & most informative of the CV parameters. Measure pulse: Carotid pulse or radial pulse. HR reflects the amount of work the heart must do to meet the increased demands of the body when engaged in activity. HR increases with the increase rates of work.


Resting HR • Averages 60-80 bpm. • In middle-aged, unconditioned, sedentary individuals, RHR can exceed 100 bpm. • High conditioned, endurance-trained athletes, RHR in the range of 28-40 bpm. • RHR affected by environmental factors: RHR increases with extreme temperature and altitude. HR During Exercise • As exercise intensity increases, HR increases. The heart ejects blood more often, thus speeding up circulation. • HR increases directly as increase in exercise intensity, until a point of exhaustion. As this point is approached, HR begins to level off. This indicates the maximum value is reached. Maximum HR (HR max) • HR max is the highest HR value achieve in an all-out effort to the point of exhaustion. • Estimate of maximum HR can be made based on the age because maximum HR shows a slight but steady decrease of about 1 beat per year beginning at 10 to 15 years of age. • Subtracting your age from 220 provides an approximation of your maximum HR. To estimate maximum HR: Eg: 40 years old individual: HR HR
max

= 220 – age in years = 220 – 40 = 180 bpm

max

Steady State HR • HR increase during submaximal exercise until reaches a plateau. This plateau is the steady state HR, & it is the optimal HR for meeting the circulatory demands at that specific rate of work. • Lower rate of steady state HR shows a more efficient heart.

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2. Stroke Volume

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SV increases with the increase rates of work, so the amount of blood ejected with each contraction increases. SV is determined by: 1. Volume of venous blood returned to the heart 2. Ventricular distensibility,(the capacity to enlarge the ventricle) 3. Ventricular contractility 4. Aortic or pulmonary artery pressure (the pressure against which the ventricles must contract)

3. Cardiac Output (Q)

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Q increases with the increase rates of work. Increases in HR & SV increase Q. Thus more blood is forced out of the heart during exercise than when at rest, & circulation speed up. This ensures that adequate supplies of the needed materials (O2 & nutrients) reach the tissues & the waste products, which build up much more rapidly during exercise, ere quickly cleared away. Exercise increases Q to match the need for O2 supply to the working muscles.

4. Blood flow Redistribution of Blood During Exercise • During rest, only 15-20% of the resting Q goes to muscle. • During exercise, the muscles receive up to 80%- 85% of the Q. • During exercise in heat, there is increase blood flow to the skin. More blood is redirected to the skin to conduct heat away from the core body to its periphery, promote heat loss to the environment.

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The metabolic rate of the muscle tissues rises during exercise. As a result, metabolic waste products begin to accumulate. Increased metabolism causes an increase in acidity, CO2 & temperature in the muscle tissue. These changes trigger vasodilation through autoregulation (effect of SNS), increasing blood flow through the local capillaries.

Cardiovascular Drift (CV drift) • CV drift is an increase in HR during prolong exercise to compensate for a decrease in SV. This compensation helps to maintain a constant Q. • Prolonged exercise in the heat causes decrease in blood volume due to water loss through sweating & a shifting of fluid out of the blood into the tissue, which results
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11. Cardiovascular Control During Exercise

in decrease in SV. HR increases to compensate for the decreased SV, in an effort to maintain Q. CV drift allows the body to continue exercising at low to moderate intensities. At high intensities, the increase in HR cannot compensate the decreased in SV because the HR attains its maximal value (HR max) at much lower exercise intensity, HR begins to level off as this point is reached, thus limiting the maximal performances.

5. Blood Pressure (BP)

BP is pressure exerted by blood against the blood vessels. Systolic Pressure = highest Pressure in the artery Diastolic Pressure = lowest Pressure in the artery With endurance exercise, systolic blood pressure increase in direct proportion to increased exercise intensity. Increase systolic BP results from the increased Q that accompanies increasing rates of work. Diastolic BP changes little if any during endurance exercise, regardless of the intensity. Remember that diastolic pressure reflects the pressure in the arteries when the heart is at rest.

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6. Blood

The changes that occur in the blood during exercise demonstrate that the blood is carrying out its necessary tasks. The major changes are: 1. The arterial-venous oxygen difference (a-vO2 diff) increases. This happens because the venous O2 concentration decreases during exercise, reflecting increased extraction of O2 from the blood for use by the active tissues. 2. Plasma volume decreases during exercise. The fluid (water) is pushed out of the capillaries by increases in hydrostatic pressure as BP increase & is drawn into the muscle by the increased osmotic pressure that results from waste accumulation. However, with prolonged exercise or exercise in hot environment, increasingly more plasma fluid is lost through sweating in an attempt to maintain body temperature, placing the person at risk of dehydration. 3. Hemoconcentration occurs as plasma fluid is lost. Although the actual number of RBC might not increase, the net effect of this process is to increase the number of RBC per unit of blood, which increases oxygen –carrying capacity. 4. Blood pH can change significantly during exercise, becoming more acidic as it move from the slightly alkaline resting value of 7.4 down to 7.0 or lower. The muscle pH decreases even further. The decrease in pH primarily results from increased blood lactate accumulation during increased exercise intensity.
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11. Cardiovascular Control During Exercise

SUMMARY
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As exercise intensity increases, Heart rate increases. The heart ejects blood more often, thus speeding up circulation. Stroke volume also increases with the increase rates of work, so the amount of blood ejected with each contraction increases. Increases in HR & SV increase cardiac output (Q). Thus more blood is forced out of the heart during exercise than when at rest, and circulation speed up. During exercise, cardiac output increases primarily to match the need for increased O2 supply to the working muscles. During exercise, the muscles receive up to 80%- 85% of the cardiac output. Cardiovascular drift is increases in HR during prolong exercise to compensate for a decrease in SV. This compensation helps to maintain a constant Q. With endurance exercise, systolic blood pressure increase in direct proportion to increased exercise intensity. With increasing rates of exercise, the arterial-venous oxygen difference (a-vO2 diff) increases progressively. Plasma volume decreases during exercise. When plasma volume reduces, hemoconcentration occurs as plasma fluid is reduced and increasing the concentration of the substances that remain in the blood. Blood pH can change significantly during exercise, becoming more acidic due to increases in blood lactate.

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