Recent advances in exercise pressor reflex function in health and disease

Grotle, Ann-Katrin; Macefield, Vaughan G.; Farquhar, William B.; O’Leary, Donal S.; Stone, Audrey J.

doi:10.1016/j.autneu.2020.102698

Cited by 57 publications

(41 citation statements)

References 250 publications

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“…Accumulating evidence in non-pregnant individuals suggests that the blood pressure response to exercise is often exaggerated in obesity or insulin resistance (T2DM), in part, due to an exaggerated exercise pressor reflex [87][88][89][90][91]. An increased sympathetic stimulation can increase peripheral resistance and attenuate blood flow to the active muscles during exercise.…”

Section: Metabolic Neural and Vascular Alterations That Can Affect The Responses To Exercise In Gestational Diabetesmentioning

confidence: 99%

Exercise as a Therapeutic Intervention in Gestational Diabetes Mellitus

et al. 2021

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Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Regular exercise is important for a healthy pregnancy and can lower the risk of developing GDM. For women with GDM, exercise is safe and can affect the pregnancy outcomes beneficially. A single exercise bout increases skeletal muscle glucose uptake, minimizing hyperglycemia. Regular exercise training promotes mitochondrial biogenesis, improves oxidative capacity, enhances insulin sensitivity and vascular function, and reduces systemic inflammation. Exercise may also aid in lowering the insulin dose in insulin-treated pregnant women. Despite these benefits, women with GDM are usually inactive or have poor participation in exercise training. Attractive individualized exercise programs that will increase adherence and result in optimal maternal and offspring benefits are needed. However, as women with GDM have a unique physiology, more attention is required during exercise prescription. This review (i) summarizes the cardiovascular and metabolic adaptations due to pregnancy and outlines the mechanisms through which exercise can improve glycemic control and overall health in insulin resistance states, (ii) presents the pathophysiological alterations induced by GDM that affect exercise responses, and (iii) highlights cardinal points of an exercise program for women with GDM.

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Section: Metabolic Neural and Vascular Alterations That Can Affect The Responses To Exercise In Gestational Diabetesmentioning

confidence: 99%

Exercise as a Therapeutic Intervention in Gestational Diabetes Mellitus

et al. 2021

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“…It is believed that the purpose of the nervous response to isometric exercise is to ensure adequate blood flow and oxygen delivery to working muscle, and increasing MAP intuitively seems reasonable to perfuse an isometrically contracting muscle. Increased muscle sympathetic nerve activity (MSNA) is believed to mediate vasoconstriction and reduced conductance in skeletal muscle, and although the mechanisms may differ from that of working muscle, it is also believed to increase in non-contracting muscle [ 64 ]. Our results indicate that the muscles and skin in the resting arm do not play an important role in increasing TPR during isometric handgrip in supine position, but do make a contribution during reduced preload caused by application of LBNP.…”

Section: Discussionmentioning

confidence: 99%

Factors mediating the pressor response to isometric muscle contraction: An experimental study in healthy volunteers during lower body negative pressure

et al. 2020

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Whilst both cardiac output (CO) and total peripheral resistance (TPR) determine mean arterial blood pressure (MAP), their relative importance in the pressor response to isometric exercise remains unclear. This study aimed to elucidate the relative importance of these two different factors by examining pressor responses during cardiopulmonary unloading leading to step-wise reductions in CO. Hemodynamics were investigated in 11 healthy individuals before, during and after two-minute isometric exercise during lower body negative pressure (LBNP; -20mmHg and -40mmHg). The blood pressure response to isometric exercise was similar during normal and reduced preload, despite a step-wise reduction in CO during LBNP (-20mmHg and -40mmHg). During -20mmHg LBNP, the decreased stroke volume, and consequently CO, was counteracted by an increased TPR, while heart rate (HR) was unaffected. HR was increased during -40 mmHg LBNP, although insufficient to maintain CO; the drop in CO was perfectly compensated by an increased TPR to maintain MAP. Likewise, transient application of LBNP (-20mmHg and -40mmHg) resulted in a short transient drop in MAP, caused by a decrease in CO, which was compensated by an increase in TPR. This study suggests that, in case of reductions of CO, changes in TPR are primarily responsible for maintaining the pressor response during isometric exercise. This highlights the relative importance of TPR compared to CO in mediating the pressor response during isometric exercise.

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“…It is worth noting that skeletal muscle afferents also increase SNA via direct projections to the rostral ventral lateral medulla (Potts, 2006). For more in-depth discussions on neurovascular control, we refer the reader to several comprehensive reviews (Fadel and Raven, 2012;Fisher et al, 2015;Holwerda et al, 2015;Michelini et al, 2015;Nyberg et al, 2015;Grotle et al, 2020).…”

Section: Neurovascular Regulation During Exercise In Healthmentioning

confidence: 99%

Neurovascular Dysregulation During Exercise in Type 2 Diabetes

et al. 2021

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Emerging evidence suggests that type 2 diabetes (T2D) may impair the ability to properly adjust the circulation during exercise with augmented blood pressure (BP) and an attenuated contracting skeletal muscle blood flow (BF) response being reported. This review provides a brief overview of the current understanding of these altered exercise responses in T2D and the potential underlying mechanisms, with an emphasis on the sympathetic nervous system and its regulation during exercise. The research presented support augmented sympathetic activation, heightened BP, reduced skeletal muscle BF, and impairment in the ability to attenuate sympathetically mediated vasoconstriction (i.e., functional sympatholysis) as potential drivers of neurovascular dysregulation during exercise in T2D. Furthermore, emerging evidence supporting a contribution of the exercise pressor reflex and central command is discussed along with proposed future directions for studies in this important area of research.

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Recent advances in exercise pressor reflex function in health and disease

Cited by 57 publications

References 250 publications

Exercise as a Therapeutic Intervention in Gestational Diabetes Mellitus

Exercise as a Therapeutic Intervention in Gestational Diabetes Mellitus

Factors mediating the pressor response to isometric muscle contraction: An experimental study in healthy volunteers during lower body negative pressure

Neurovascular Dysregulation During Exercise in Type 2 Diabetes

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