Cardiac and vascular adaptations to exercise

Current Opinion in Clinical Nutrition and Metabolic Care

Volumn 9, Issue 6, 2006, Pages 677-684

  Green, Daniel J ^a   Naylor, Louise H ^b   George, Keith ^a  

^a LIVERPOOL JOHN MOORES UNIVERSITY   (United Kingdom)

^b ROYAL PERTH HOSPITAL   (Australia)

Author keywords

Athletes; Cardiac fatigue; Diastolic function; Echocardiography; Exercise; Exercise training; Troponin; Vascular function

Indexed keywords

BRAIN NATRIURETIC PEPTIDE; TROPONIN;

ATHLETE; CARDIOVASCULAR SYSTEM; EXERCISE; FATIGUE; HEART DISEASE; HEART MUSCLE CELL; HUMAN; PHYSICAL STRESS; REVIEW; TRAINING;

ADAPTATION, PHYSIOLOGICAL; CARDIOVASCULAR PHYSIOLOGY; EXERCISE; HEART; HUMANS; MYOCARDIUM; PHYSICAL ENDURANCE;

EID: 33750287102     PISSN: 13631950     EISSN: 15353885     Source Type: Journal    
DOI: 10.1097/01.mco.0000247473.49284.e3     Document Type: Review

References (56)

1. Maron BJ. Sudden death in young athletes. N Engl J Med 2003; 349:1064-1075.
2. Pelliccia A, Maron BJ, De Luca R, et al. Remodeling of left ventricular hypertrophy in elite athletes after long-term conditioning. Circulation 2002; 105:944-949.
3. Maron BJ, Gohman TE, Aeppli D. Prevalence of sudden death during competitive sports activities in Minnesota high school athletes. J Am Coll Cardiol 1998; 32:1881-1884.
4. Thompson PDB. Dill Historical Lecture: Historical concepts of the athlete's heart. Med Sci Sports Ex 2004; 36:363-370.
5. Albert CM, Mittleman MPH, Chae PH, et al. Triggering of sudden cardiac death from cardiac causes by vigorous exertion. N Engl J Med 2000; 343:1355-1361.
6. Tanasescu M, Leitzmann MF, Rimm EB, et al. Exercise type and intensity in relation to coronary heart disease in men. JAMA 2002; 288:1994-2000.
7. Myers J, Prakash M, Froelicher V, et al. Exercise capacity and mortality amongst men referred for exercise testing. N Engl J Med 2002; 346:793-801.
8. Leitch SP, Paterson DJ. Interactive effects of K +, acidosis, and catecholamines on isolated rabbit heart: implications for exercise. J Appl Physiol 1994; 177:1164-1171.
9. Green DJ, Maiorana AJ, O'Driscoll JG, et al. The effects of exercise training on vascular endothelial nitric oxide function. J Physiol (Lond) 2004; 561:1-25.
10. Hambrecht R, Walther C, Möbius-Winkler S, et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation 2004; 109:1371-1378.
11. Damm S, Andersson LG, Henriksen E, et al. Wall motion abnormalities in male elite orienteers are aggravated by exercise. Clin Physiol 1999; 19:121-126.
12. Rowe WJ. Extraordinary unremitting endurance exercise and permanent injury to normal heart. Lancet 1992; 340:712-714.
13. McGavock JM, Warburton DER, Taylor D, et al. The effects of prolonged strenuous exercise on left ventricular function: a brief review. Heart Lung 2002; 31:279-292.
14. Dawson E, George K, Shave R, et al. Does the human heart fatigue subsequent to prolonged exercise? Sports Med 2003; 33:365-380.
15. Saltin B, Stenberg J. Circulatory response to prolonged severe exercise. J Appl Physiol 1964; 19:833-838.
16. Mortensen SP, Dawson EA, Yoshiga CC, et al. Limitations to systemic and locomotor limb muscle oxygen delivery and uptake during maximal exercise in humans. J Physiol (Lond) 2005; 566:273-285. A study which suggests that maximal oxygen uptake is limited by oxygen delivery, due in turn to decreased stroke volume at maximal exertion. An important contribution to the debate encapsulated in a recent Journal of Applied Physiology point-counterpoint regarding the limits to oxygen uptake in healthy humans at sea level.
17. Middleton N, Shave R, George K, et al. Left ventricular function immediately following prolonged exercise: a meta-analysis. Med Sci Sports Exerc 2006; 38:681-687. A meta-analysis which pools studies to establish that systolic and diastolic function are impaired following intense prolonged exercise in humans.
18. Dawson EA, Shave R,George K, et al. Cardiac drift during prolonged exercise with echocardiographic evidence of reduced diastolic function. Eur J Appl Physiol 2005; 94:305-309. A study which raises the possibility that impaired diastolic function may precede impairment in systolic function following prolonged intense exercise.
19. George K, Oxborough D, Forster J, et al. Mitral annular myocardial velocity assessment of segmental left ventricular diastolic function after prolonged exercise in humans. J Physiol (Lond) 2005; 569:305-313. The first study to use tissue Doppler indices at the end of prolonged intense exercise. Suggests that diastolic function is impaired and that this is not related to cardiac loading conditions.
20. Neilan TG, Yoerger DM, Douglas PS, et al. Persistent and reversible cardiac dysfunction among amateur marathon runners. Eur Heart J 2006; 27:1079-1084. An important recent study using state-of-the-art imaging approaches which indicates that measures of systolic function are impaired after a marathon, whilst diastolic function measures may remain impaired for a month post event.
21. George K, Whyte G, Stephenson C, et al. Postexercise left ventricular function and cTnT in recreational marathon runners. Med Sci Sports Exerc 2004; 36:1709-1715.
22. Scharhag J, Herrmann M, Urhausen A, et al. Independent elevations of N-terminal pro-brain natriuretic peptide and cardiac troponins in endurance athletes after prolonged strenuous exercise. Am Heart J 2005; 150:1128-1134. A study which compared troponin and BNP elevations in athletes completing multiple prolonged strenuous events. Concluded that increases in these circulating markers were not entirely consistent between different events in the same individuals.
23. •]).
24. Welsh RC, Warburton DER, Humen DP, et al. Prolonged strenuous exercise alters the cardiovascular response to dobutamine stimulation in male athletes. J Physiol (Lond) 2005; 569:325-330. An important addition to the field which sheds light on at least one of the mechanisms responsible for cardiac fatigue.
25. Libonati JR. Myocardial diastolic function and exercise. Med Sci Sports Ex 1999; 31:1741-1747.
26. Pluim BM, Zwinderman AH, van der Laarse A, et al. The athlete's heart: a metaanalysis of cardiac structure and function. Circulation 1999; 100:336-344.
27. Pela G, Bruschi G, Montagna L, et al. Left and right ventricular adaptation assessed by Doppler tissue echocardiography in athletes. J Am Soc Echocard 2004; 17:205-211.
28. Caso P, D'Andres A, Galderisi M, et al. Pulsed Doppler tissue imaging in endurance athletes: relation between left ventricular preload and myocardial regional diastolic function. Am J Cardiol 2000; 85:1131-1136.
29. Schmidt-Trucksass A, Schmid A, Haussler C, et al. Left ventricular wall motion during diastolic filling in endurance-trained athletes. Med Sci Sports Ex 2000; 33:189-195.
30. Pluim BM, Lamb HJ, Kayser HWM, et al. Functional and metabolic evaluation of the athlete's heart by magnetic resonance imaging and dobutamine stress magnetic resonance spectroscopy. Circulation 1998; 97:666-672.
31. Sadaniantz A, Yurgalevitch S, Zmuda JM, et al. One year of exercise does not alter resting left ventricular systolic or diastolic function. Med Sci Sports Ex 1996; 28:1345-1350.
32. Rodrigues ACT, Costa JM, Alves GB, et al. Left ventricular function after exercise training in young men. Am J Cardiol 2006; 97:1089-1092. A rare longitudinal assessment of the effects of moderate intensity exercise training on diastolic function, including tissue Doppler assessment, in healthy individuals.
33. Naylor L, Arnolda L, Deague J, et al. Reduced ventricular flow propagation velocity in elite athletes is augmented with the resumption of exercise training. J Physiol (Lond) 2005; 563:957-963. A study which followed high-level elite athletes across an intensive training cycle. Raises the hypothesis, which will require further investigation, that cardiac remodelling in athletes who desist from exercise may be associated with reduced diastolic function.
34. Rowell LB. Ideas about control of muscle blood flow during exercise. J Appl Physiol 2004; 97:384-389.
35. Joyner MJ. Skeletal and cardiac muscle blood flow. Exerc Sport Sci Rev 2005; 33:1-2.
36. Jasperse JL, Laughlin MH. Endothelial function and exercise training: evidence from studies using animal models. Med Sci Sports Exerc 2006; 38:445-454. Many of the key studies of the effects of exercise training on the vasculature have come from Professor Laughlin's laboratory and this recent review provides an excellent overview of these and other important animal studies.
37. Schrage WG, Dietz NM, Joyner MJ. Effects of combined inhibition of ATP-sensitive potassium channels, nitric oxide, and prostaglandins on hyperemia during moderate exercise. J Appl Physiol 2006; 100:1506-1512. One of the few studies in the literature which has attempted multiple blockade to determine the nature and importance of redundancy in the control of exercise blood flow in humans.
38. Martin EA, Nicholson WT, Eisenach JH, et al. Bimodal distribution of vasodilator responsiveness to adenosine due to difference in nitric oxide component: implications for exercise hyperemia. J Appl Physiol 2006; 101:492-499. A paper, also from the Joyner lab, which investigates the role of adenosine in forearm vasodilation. As is becoming clear from this and other similar studies, great individual variation exists in the mechanism responsible for hyperaemia and blood flow control in humans.
39. Van Teeffelen JW, Segal SS. Interaction between sympathetic nerve activation and muscle fibre contraction in resistance vessels of hamster retractor muscle. J Physiol (Lond) 2003; 550:563-574.
40. Dinenno FA, Masuki S, Joyner MJ. Impaired modulation of sympathetic alpha-adrenergic vasoconstriction in contracting forearm muscle of ageing men. J Physiol (Lond) 2005; 567:311-321. A typically thorough study from this group which investigated the impact of aging on the vasculature using an array of pharmacological stimuli. Concluded that functional 'sympatholysis' is impaired with aging.
41. Sheriff D. The muscle pump raises muscle blood flow during locomotion. J Appl Physiol 2005; 99:371-375. Another in the Journal of Applied Physiology series of point-counterpoint debates which teases out the arguments for and against the muscle pump as a mechanism for augmenting skeletal muscle blood flow, particularly at the beginning of exercise.
42. Clifford PS, Hamann JJ, Valic Z, et al. The muscle pump is not an important determinant of muscle blood flow during exercise. J Appl Physiol 2005; 99:371-375. Another in the Journal of Applied Physiology series of point-counterpoint debates which teases out the arguments for and against the muscle pump as a mechanism for augmenting skeletal muscle blood flow, particularly at the beginning of exercise.
43. Rogers A, Saunders N, Pyke KE, et al. Rapid vasoregulatory mechanisms in exercising human skeletal muscle: dynamic response to repeated changes in contraction intensity. Am J Physiol Heart Circ Physiol 2006; 291:H1065-H1073. A recent contribution to the debate above relating to the importance of the muscle pump versus metabolic factors during exercise in which the authors cleverly manipulated work/rest cycles.
44. Gonzalez-Alonso J, Mortensen SP, Dawson EA, et al. Erythrocytes and the regulation of human skeletal muscle blood flow and oxygen delivery: role of erythrocyte count and oxygenation state of haemoglobin. J Physiol (Lond) 2006; 572:295-305. Along with Refs [45,46], suggests that active muscle vasodilation during exercise may be tightly regulated by the delivery of oxygen itself via the impact of haemoglobin dissociation on vasodilator messengers. An elegant hypothesis that explains the observation of tight coupling between oxygen demand and delivery in humans.
45. Stamler JS, Jia L, Eu JP, et al. Blood flow regulation by S-nitrosohemoglobin in the physiological oxygen gradient. Science 1997; 276:2034-2037.
46. Ellsworth ML. Red blood cell-derived ATP as a regulator of skeletal muscle perfusion. Med Sci Sports Exerc 2004; 36:35-41.
47. Brown MD. Exercise and coronary vascular remodelling in the healthy heart. Exp Biol Med 2003; 88:645-658.
48. Naylor L, O'Driscoll G, Fitzsimons M, et al. Effects of training resumption on conduit arterial diameter in elite rowers. Med Sci Sports Ex 2006; 38:86-92. A study which confirms the well established increase in conduit artery diameter in elite athletes and adds results which indicate that resumption of intensive training is associated with further arteriogenesis.
49. Langille BL, O'Donnell F. Reductions in arterial diameter produced by chronic decreases in blood flow are endothelium-dependent. Nature 1986; 231:405-407.
50. Tronc F, Wassef M, Esposito B, et al. Role of NO in flow-induced remodeling of rabbit common carotid artery. Arterioscler Thromb Vasc Biol 1996; 16:1256-1262.
51. Prior BM, Lloyd PG, Yang HT, et al. Exercise-induced vascular remodeling. Exerc Sports Sci Rev 2003; 31:26-33.
52. Green D, Bilsborough W, Naylor L, et al. Comparison of forearm blood flow responses to incremental handgrip and cycle ergometer exercise: relative contribution of nitric oxide. J Physiol (Lond) 2005; 562 (Pt 2):617-628. This study compared the bioactivity of endothelium-derived nitric oxide in the upper limbs during handgrip versus cycle ergometer exercise. During leg exercise blood flow through the upper limbs exhibited an antegrade/retrograde pattern which was not evident during handgrip exercise. Nitric oxide bioactivity was greater during cycling than handgrip exercise.
53. Hambrecht R, Adams V, Erbs S, et al. Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase. Circulation 2003; 107:3152-3158.
54. Green DJ, Walsh JH, Maiorana A, et al. Exercise-induced improvement in endothelial dysfunction is not mediated by changes in CV risk factors: pooled analysis of diverse patient populations. Am J Physiol Heart Circ Physiol 2003; 285:H2679-H2687.
55. Goto C, Higashi Y, Kimura M, et al. Effect of different intensities of exercise on endothelium-dependent vasodilation in humans: role of endothelium-dependent nitric oxide and oxidative stress. Circulation 2003; 108:530-535.
56. Booth FW, Chakravarthy MV, Spangenburg EE. Exercise and gene expression: physiological regulation of the human genome through physical activity. J Physiol (Lond) 2002; 543:399-411.