Effects of exercise on the cardiovascular system 1

Effects of exercise on the

cardiovascular system
 Exercise is Medicine:
A Global Health Initiative
 Effects of exercise on the cardiovascular system 2

What you will learn about

in this topic:
1. The short-term effects of
exercise on the cardiovascular
system
2. The long-term effects of exercise
on the cardiovascular system
3. Recovery
 Introduction
• Exercise places different demand on the body
when compared to rest
• The changes are dependent on
– intensity,
– duration,
– the muscles being used,
– external and internal environment/situation
• Using the points above use an example to
explain the acute and adaptation changes
EFFECT EXERCISE ON BODY SYSTEM

• RESPONSE
– Short-term, single-bout
• ADAPTATION
– Long-term, regular
– Type of exercise/training
• Endurance
• Resistance
• Flexibility
 Gains in the Beginning of a
Program Steroids

8-12 Weeks
Strength

Steroids
Progress

Hypertrophy

Neural Adaptations

Training Duration
Prescribing an Exercise Program
• FITT formula
– Frequency, Intensity, Time, and Type
• Intensity
– how fast an action is performed (speed), the power or strength
required to achieve an activity (watts, level, incline), or the effort
put forth by the participant during the activity (exertion
– Target zone: Defines the upper limits of training and the optimal level of
exercise.
• Karvonen formula
– 220 - age = maximum heart rate
– Maximum heart rate - resting heart rate = heart rate reserve
– (Heart rate reserve X training%) + resting heart rate
» Beginner or low fitness level :40% - 60%
» Average fitness level: 60% - 70%
» High fitness level :75% - 85%
Maximum Heart Rate Formula

The traditional formulae: 220-age

The new formula (Tanaka formulae):208 − 0.7 ×
age
 Pay attention on

• Blood pressure - 
– Systolic, diastolic, MAP, PP 
• Heart rate - 
– Resting heart rate
• Stroke volume - 
• Cardiac output - 
Short-term effects of exercise on the
cardiovascular
System
Cardiovascular Response to Exercise

Figure 25-7: Distribution of cardiac output at rest and during exercise

Factors Controlling Mean Arterial Pressure :
The Driving Pressure for Blood Flow

Figure 15-10: Factors that influence mean arterial

pressure
 Response to sub-maximal exercise

unconditioned
140 mmHg

conditioned
120 mmHg

Jogging 2-3 hours after exercise

time
Initial minutes recovery
 Steady-State Heart Rate
• Heart rate plateau reached during constant rate of
submaximal work
• Optimal heart rate for meeting circulatory demands at that
rate of work
• The lower the steady-state heart rate, the more efficient the
heart
 Increase in Heart Rate With Increasing Power
Output and Oxygen Uptake

Reprinted, by permission, from P.O. Astrand et al., 2003, Textbook of work physiology, 4th ed. (Champaign,
IL: Human Kinetics), 285.
Changes in Stroke Volume (SV) as a
Subject Exercises on a Treadmill
 Stroke Volume Increases
During Exercise
• Frank Starling mechanism: more blood in the ventricle
causes it to stretch more and contract with more force
• Increased ventricular contractility (without end-diastolic
volume increases)
• Decreased total peripheral resistance due to increased
vasodilation of blood vessels to active muscles
 Cardiac Output
• Resting value is approximately 5.0 L/min.
• Increases directly with increasing exercise intensity to 20 to
40 L/min.
• Value of increase varies with body size and endurance
conditioning.
• When exercise. intensity exceeds 60%, further increases in Q
are more a result of increases in HR than SV.
Changes in Cardiac Output (Q) as a. Subject
Exercises on a Treadmill
Changes in (a) Heart Rate, (b) Stroke Volume, and
(c) Cardiac Output With Changes in Posture

a b c
 Blood Pressure
Cardiovascular Endurance Exercise
• Systolic BP increases in direct proportion to increased
exercise intensity.
• Diastolic BP changes little, if at all, during endurance
exercise, regardless of intensity.
Resistance Exercise
• It exaggerates BP responses to as high as 480/350
mmHg.
• Some BP increases are attributed to the Valsalva
maneuver.
Blood Pressure Responses to Both Leg and Arm
Cycling at the Same Relative Rates of Oxygen
Consumption

Adapted, by permission, from P.-O. Astrand et al., 1965, "Intraarterial blood pressure during exercise with
different muscle groups," Journal of Applied Physiology 20: 253-256.
 Oxygen supply to the heart

1. Normal tissues use 25% of oxygen in the blood

2. Heart muscle uses 70-80% of oxygen in the blood
3. Exercise can increase coronary blood flow 4-6 times
4. Exercise increases myocardial metabolism
 Energy for the heart
 Myocardium (heart muscle) has the greatest number
of mitochondria per cell (compared to all muscles in
the body)

 Myocardium uses glucose, fatty acids, and lactic acid

(from skeletal muscle activity) for energy

 During sub-maximal exercise, the heart muscle may

get up to 50% of its energy from lactic acid
Arterial–Venous Oxygen Difference
• Amount of oxygen extracted from the blood as it travels
through the body.
• Calculated as the difference between the oxygen content of
arterial blood and venous blood.
• Increases with increasing rates of exercise as more oxygen is
taken from blood.
• The Fick equation represents the relationship of the body’s
oxygen consumption (VO2) to the arterial–venous oxygen
difference ((a-v)O2 diff) and cardiac output (Q); VO2 = Q (a-
v)O2 diff.
Changes in the (a-v)O
–2 Difference From Low
Levels to Maximal Levels of Exercise
 Blood Plasma Volume
• Reduced with onset of exercise (goes to interstitial
fluid space).
• More is lost if exercise results in sweating.
• Excessive loss can result in impaired performance.
• Reduction in blood plasma volume results in
hemoconcentration.
 Effect during resistance exercise (lifting)
1. More dramatic changes are seen
2. Strained muscle activity
compresses peripheral arteries
causing significant resistance to
blood flow and an increase in
blood pressure
3. This is dangerous to individuals
with HTN (high blood pressure)
or heart disease
 Response to resistive exercise

190 mmHg

170 mmHg

unconditioned
140 mmHg

conditioned

120 mmHg
Blood pressure changes are more dramatic with
resistance exercise to the upper extremities
(compared to the lower extremities)

• Upper extremity muscles cause greater resistance to

blood flow in the smaller arterioles in the upper
extremities
• Lower extremity muscles cause less resistance to
blood flow in the larger arterioles of the lower
extremities
 Distribution of blood
(arterial)
 Vasodilatation in active muscles will increase blood
flow significantly
• At rest, only 1 of 30-40 capillaries in muscle tissue are open
• Exercise will open these capillaries
– This increases the exchange surface area between blood
and muscle cells
– This is stimulated mostly by sensors in the tissue that
sense an increased demand for oxygen
– Increased circulation is also stimulated by tissue’s
increased temperature, and increased carbon dioxide
levels
 Distribution of blood
(venous)

 Adequate venous return is also important for regulating

distribution of blood
– This is achieved by action of muscles (pushing blood along)

 Also achieved by venous valves (prevention of back flow)

 Oxygen transport in the blood remains
constant
• The blood carries about 200 ml of oxygen per
liter of blood
• The hemoglobin is about 100% saturated and
can not increase what it carries
• The body tissues use about 25% of circulating
oxygen from the blood at rest
• Increased demands of the tissues during
exercise is met by increased cardiac out put,
not more oxygen in the blood
 Oxygen up-take increases with exercise

 At rest - tissues use 25% of oxygen in the

blood (~50 ml per liter of blood)
 During exercise – tissues may use up to 75%
of oxygen in the blood(~150 ml/l of blood)
 After 55 days of training – tissues may use up
to 85% of oxygen in the blood (~175 ml/l of
blood)
How does oxygen uptake increase with exercise?

• This increased oxygen up-take is due primarily

to increased blood flow in the tissues

• also training increases the muscle cell’s ability

to metabolize oxygen (with greater numbers
of mitochondria)
Patients with heart disease can improve oxygen
use (by improving the tissue’s oxygen up-take)
even if heart rate and stroke volume are
unable to improve
 The majority of exercise effects on the vascular endothelium are mediated by intermittent
increases of laminar shear stress associated with increased cardiac output during physical
exertion.

Stephan Gielen et al. Circulation. 2010;122:1221-1238

Copyright © American Heart Association, Inc. All rights reserved.

A model for mobilization of circulating progenitor cells from the bone marrow by increased
shear stress induced by exercise.

Stephan Gielen et al. Circulation. 2010;122:1221-1238

Copyright © American Heart Association, Inc. All rights reserved.

 Effects of exercise on the cardiovascular system 14

Long-term effects of exercise on

the cardiovascular system
• Size and Volume of the heart
increases

• Lower Resting Heart

Rate

• Lower Blood Pressure

• Increased Stroke Volume

• Increased Cardiac Output

• More Capillaries
Why does regular exercise decrease blood
pressure?
Not fully understood

May be an effect on the sympathetic

nervous system

May be the increased elimination of Na

(sodium) which decreases blood volume
which decreases blood pressure
In the microcirculation, several pathways for metabolic vasodilation have been described.

Stephan Gielen et al. Circulation. 2010;122:1221-1238

Copyright © American Heart Association, Inc. All rights reserved.

Resistance training causes a short term
increase in blood pressure during the
exercise, but no long term rise in blood
pressure noted
Athletes have a high heart rate before events
called an anticipatory response
• Sprinters increase the most – up to 148 b/m (74% of the
entire increase in the event)

• Heart rate increase is progressively less with longer

distance events (long distance runners have a higher
anticipatory heart rate than the highest heart rate of
the whole event)
 Recovery
1. After sustained sub-maximal exercise, systolic
blood pressure is reduced below pre-exercise levels
for 2 – 3 hours in all subjects (normal or individuals
with high blood pressure)

2. Blood pressure (diastolic and systolic) appear to be

lower with a regular exercise program
 Cardiovascular fitness
• It is very important to remember that
cardiovascular fitness is not just for top
sportspeople
• It is the most important aspect of fitness for
all of us because it involves the circulatory and
the respiratory systems
• Improved cardiovascular fitness increases the
number of blood vessels in and around the
heart, so reducing the risk of a heart attack
Summary of exercise-mediated effects on different parts of the cardiovascular system.

Stephan Gielen et al. Circulation. 2010;122:1221-1238

Copyright © American Heart Association, Inc. All rights reserved.

Exercise training has the potential to prevent myocardial damage related to I/R injury.

Stephan Gielen et al. Circulation. 2010;122:1221-1238

Copyright © American Heart Association, Inc. All rights reserved.

 In systolic heart failure, endurance exercise can induce reverse remodeling with
improvement of systolic and diastolic LV function and reduction of LV end-diastolic
diameters.

Stephan Gielen et al. Circulation. 2010;122:1221-1238

Copyright © American Heart Association, Inc. All rights reserved.

A model depicting exercise-induced angiogenesis in the peripheral skeletal muscle.

Stephan Gielen et al. Circulation. 2010;122:1221-1238

Copyright © American Heart Association, Inc. All rights reserved.