The Metaboreflex

Dr Ben Chant
Dr Emma Hart
 Autonomic adjustments to exercise

Metaboreflex

Mechanoreflex
Functional sympatholysis
Fisher (2015)
Blood flow during isometric contractions
• Isometric handgrip exercise for 3
minutes
• 5-30% MVC
• Forearm blood flow reaches
maximum at 30-40% MVC
• >40% forearm blood flow
decreases relative to this maximum
• 70% MVC forearm blood flow can
approach zero.

Huge stimulus for the

metaboreflex

Lind and McNicol (1967)

Post-exercise ischemia (PEI) (typical protocol)

30
1 minute of seconds 1.5 minutes of post-
isometric HG of
exercise exercise ischemia (PEI)
exercise ischemia

At 1 minute of HG exercise
pump an occlusion cuff to
suprasystolic pressure
(normally 240 mmHg)
Pump remains at suprasystolic pressure (240 mmHg) - 30 or 40% MVC
for 1.5 minutes post-exercise = PEI - Beat-to-beat blood
pressure (finapres)
- Heart rate (finapres)
Total time = 3 minutes
What do you expect to happen during post-
exercise ischemia to SBP and HR (compared to
rest)?
Fill in the table on your worksheet…
Time Stage SBP HR
Before exercise Baseline
20 seconds Isometric HG
40 seconds Isometric HG
1 minute Exercise ischemia
1 minute 20 seconds Exercise ischemia
1 minute 40 seconds PEI
2 minutes PEI
2 minutes 20 seconds PEI
2 minutes 40 seconds PEI
3 minutes PEI
Why has SBP gone up during exercise and
during the metaboreflex isolation?
The metaboreflex increases SNA during exercise –
how is blood flow still increased to the active
skeletal muscle?
Do you think patients with spinal cord injury would
still have a similar metaboreflex response?
 Post-exercise ischemia (PEI)
Key results
• During PECO…
• MSNA remained
elevated
• MAP remained
elevated
• HR returned to
normal
Mark et al. (1985)
How can it be that SBP remains elevated
during PEI but HR returns to resting value?
Factors influencing the HR response to
metaboreflex activation
• Consistently, during PEI – the metaboreflex induced ↑ in BP and MSNA
remain elevated.
• HR appears to depend on muscle mass engaged and exercise modality
used.
• HR returns to baseline during PEI with both dynamic and rhythmic HG.
• Accentuated antagonism - the effects of cSNA on heart rate are
significantly lower with high levels of vagal tone than with low levels of
vagal background activity.
• If cSNA is high enough, it can overcome this.

What would you expect to happen to HR during PEI following dynamic

cycling exercise?
 Dynamic leg exercise and the metaboreflex
Protocol Results
Free flow
Key
Flow restriction

Ex90 – exercise at HR: 90 beats/min *P < 0.05 vs. rest of corresponding trial; †P < 0.05 vs. Ex90 of
Ex120 – exercise at HR: 120 beats/min corresponding trial; ‡P < 0.05 vs. Ex120 of corresponding trial;
§P < 0.05 vs. FF trial at corresponding time point.
Hartwich et al. (2011)
 Dynamic leg exercise and the metaboreflex
Results Key take home point
Free flow
Key

• The differing effects on HR during

PEI between different exercise
modalities and intensities is likely
due to the magnitude of
metaboreceptor activation during
exercise which is then sustained
*P < 0.05 vs. rest of corresponding trial; †P < 0.05 vs. Ex90 of
during PEI.
corresponding trial; ‡P < 0.05 vs. Ex120 of corresponding trial;
§P < 0.05 vs. FF trial at corresponding time point.
Hartwich et al. (2011)
 During PEI, following low-to-moderate intensity
exercise or exercise with a small muscle mass
Exercise finishes + PEI Robust ↑ SBP during
PEI (metaboreflex)

Withdrawal of central Withdrawal of muscle Arterial baroreceptor Muscle metaboreflex

command mechanoreflex stimulation stimulation ↑

Activation of cardiac parasympathetic activity ↑ Activation of cSNA ↑

Take home message: HR returns to baseline

• Following low intensity exercise or exercise with a small muscle mass, the activation of SBP remains ↑
cardiac parasympathetic activity can overpower a potential sympathetically mediated MSNA remains ↑
elevation in HR.
 During PEI, following high intensity exercise or
exercise with a large muscle mass
Exercise finishes + PEI Robust ↑↑ SBP during
PEI (metaboreflex)

Withdrawal of central Withdrawal of muscle Arterial baroreceptor Muscle metaboreflex

command mechanoreflex stimulation stimulation ↑↑↑

Activation of cardiac parasympathetic activity ↑ Activation of cSNA ↑↑

Take home message: HR remains ↑

• Following high intensity exercise or exercise with a large muscle mass, where SBP remains ↑
metaboreflex activation is higher, the cardiac sympathetic mediated elevation in HR can MSNA remains ↑
overcome the reactivation of cardiac parasympathetic activity.
 What about activating the metaboreflex during exercise?
Protocol Results
Free flow
Key
Flow restriction

*P < 0.05 vs. rest of corresponding trial; †P < 0.05 vs. Ex90 of
corresponding trial; ‡P < 0.05 vs. Ex120 of corresponding trial;
§P < 0.05 vs. FF trial at corresponding time point.
Hartwich et al. (2011)
What about activating the metaboreflex during exercise?
Hartwich et al. (2011)
Results

*P < 0.05 vs. rest of corresponding trial; †P < 0.05 vs. Ex90 of corresponding trial; ‡P < 0.05 vs. Ex120 of corresponding trial; §P < 0.05 vs. FF trial at corresponding time point.

Metaboreflex activation during exercise is evaluated by occluding (or

partially occluding) perfusion to active muscle – considering the integrated
autonomic response to exercise, why might this be an issue?
What about activating the metaboreflex during exercise?
Hartwich et al. (2011)
Results

*P < 0.05 vs. rest of corresponding trial; †P < 0.05 vs. Ex90 of corresponding trial; ‡P < 0.05 vs. Ex120 of corresponding trial; §P < 0.05 vs. FF trial at corresponding time point.

Metaboreflex activation during exercise is evaluated by occluding (or partially

occluding) perfusion to active muscle. Unlike PEI, this method is carried out during
exercise where central command, the mechanoreflex and other afferents are active
– making it more challenging to isolate the metaboreflex.