Interaction of local and reflex thermal effects in control of forearm blood flow

We measured forearm blood flow (ABF) bilaterally on six subjects during 15-min periods of leg exercise and the first 10 min of recovery. One forearm (control) was kept at about 33 degrees C skin temperature in all experiments. In experiments at ambient temperature (Ta) of 15 degrees C, the other arm (experimental) was kept at about 26, 33, and 40 degrees C, respectively, during three successive cycles of exercise and recovery. ABF in the 26 degrees C forearm was linearly related to and averaged 42% of control. The relation of ABF in the 40 degrees C forearm to control ABF showed a bend at control ABF of 4-5 ml X 100 ml-1 X min-1. Below the bend, experimental ABF average 213% of control. Above the bend, experimental ABF averaged 5.09 ml X 100 ml-1 X min-1 above control. In four subjects, after heating the experimental forearm to 40 degrees C, we measured ABF for 25-30 min at rest in Ta of both 15 and 25 degrees C. At 25 degrees C Ta, ABF in the heated forearms rose gradually, but control ABF showed little change. At 15 degrees C Ta, the effect on ABF of local heating to 40 degrees C was much reduced, apparently due to reflex vasoconstrictor signals.     

The effect of local heating on blood flow in the finger and the forearm skin

Blood flow of the finger and the forearm were measured in five male subjects by venous occlusion plethysmography using mercury-in-Silastic strain gauges in either a cool-dry (COOL: 25 degrees C, 40% relative humidity), a hot-dry (WARM: 35 degrees C, 40% relative humidity), or a hot-wet (HOT: 35 degrees C, 80% relative humidity) environment. One hand or forearm was immersed in a water bath, the temperature (Tw) of which was raised every 10 min by steps of 2 degrees C until it reached 41 degrees or 43 degrees C. While the other hand or forearm was kept immersed in a water bath (Tw, 35 degrees C), blood flow in the heated side (BFw) was compared with the corresponding blood flow in the control side (BFc). Under WARM or HOT conditions, finger BFw was significantly lower than finger BFc at a Tw of 39-41 degrees C in the majority of subjects. When Tw was raised to 43 degrees C, however, finger BFw became higher than BFc in nearly half of the subjects. In the COOL state, finger BFw did not decrease but increased steadily when Tw increased from 37 degrees to 43 degrees C. In the forearm, BFw increased steadily with increasing Tw even in WARM-HOT environments. No such heat-induced vasoconstriction was observed in the forearm. From these results we conclude that in hyperthermic subjects, the rise in local temperature to above core temperature produces vasoconstriction in the fingers, an area where no thermal sweating takes place.     

Dynamic response characteristics of local muscle blood flow regulatory mechanisms in human forearm exercise.

We sought to understand the nature of control mechanisms involved in the adaptation of exercising muscle hyperemia. Seven subjects performed rhythmic dynamic forearm exercise under two exercise conditions: small step 1 [step increase from rest to 40% peak forearm vascular conductance (FVC), in ml.min(-1).100 mmHg-1] for 5 min followed by small step 2 (further increase to 80% peak FVC for 5 min), and large step (step increase from rest to 80% peak FVC for 5 min). FVC data were fit with a two- (small step 1) and three-component (small step 2, large step) exponential as appropriate. For the rapid phase I response, FVC dynamic response characteristics (time delay, time constant) were not affected by the magnitude of the work intensity increase when the transition began from rest, but were slower in the 40-80% transition. Rest-80% gain was greater than either rest-40% or 40-80% transitions but represented the same proportion of the phase I + phase II gain across all transitions (57 vs. 56 vs. 57%, respectively, P = 0.975). For the slower phase II response, dynamic response characteristics were not affected by the magnitude of the work intensity increase when initiated from rest. The time constant was not altered when the transition began from exercise vs. rest. We conclude that 1) dynamic response characteristics of exercise hyperemia control mechanisms are not affected by the magnitude of work rate increase when forearm exercise is initiated from rest, 2) phase I but not phase II dynamic response characteristics are sensitive to baseline exercise intensity, and 3) the mechanisms contributing to phase I result in the same relative response magnitude, regardless of the size of the step increase in exercise intensity or the baseline from which it is initiated.     

Blood flow fluctuation underneath human forearm skin caused by local thermal stimuli of different fabrics

The aim of this study was to investigate physiological interactions between fabric and the human body via skin and the resultant disturbance to blood flow, which in turn influences the skin temperature and the sensation of warmth and chilliness, thus the feeling of comfort. We focussed on the effects on the forearm skin blood flow by different local physical stimuli from fabrics. The blood flows were examined under three protocols: (1) using fabrics of different fiber types and fiber blending, (2) different surface characteristics of the same fabric and fiber type, and (3) different moisture levels of the same fabric type. A total of five different fabrics were wrapped over the forearm of a female subject at a good health state for test. The fabric samples were preconditioned for 24 h, and the subject sat for 30 min, in both cold and dry ambient conditions (20.5±0.5 °C, 45±5 p.100 RH) to reach equilibrium before testing. The forearm skin blood flow and temperature were recorded by a laser-Doppler flowmeter (DP1T/7-V2) with two probes mounted on both forearms to eliminate any systematic common mode fluctuations. Several conclusions were drawn from our test data. First, the fabric impact on both skin temperature and blood flow can be significant. Also fabric surface characteristics play important role, especially during the transient heat exchange at the beginning of contact. Finally, moisture level in the samples exhibits considerable influences on skin temperature and blood flow, and the higher the moisture level, the longer the duration of the impact.     

Effect of nerve block on response of forearm blood flow to local temperature

To determine the role of neurotransmitter in the response of forearm blood flow (ABF) to local (forearm) skin temperature (Tsk) we measured ABF of six subjects at Tsk from 25 to 40 degrees C before (control) and after brachial plexus block (BPB). Control experiments were conducted in an ambient temperature of 27-29 degrees C, adjusted to minimize the subject's overall thermal sensation. Tsk was regulated by blowing a controlled-temperature airstream through a plastic bag enclosing the arm. We first lowered Tsk to 25 degrees C and after 20 min began to measure ABF with Whitney strain gauges. We then raised Tsk by 2.5 degrees C steps to 40 degrees C and measured ABF every 30 s for at least 10 min at each level of Tsk. Mean ABF rose from 1.1 ml X 100 ml-1 X min-1 at Tsk of 25 degrees C to 2.1 ml X 100 ml-1 X min-1 at 32.5 degrees C to 13.7 ml X 100 ml-1 X min-1 at 40 degrees C in control experiments and from 2.8 to 4.4 to 14.8 ml X 100 ml-1 X min-1 after BPB. The effect of Tsk on ABF was highly significant (P less than 0.0001) but the effect of BPB was not (P approximately equal to 0.2). At thermoneutrality, the effect of Tsk on ABF is largely independent of neural activity, since this effect is unaffected by nerve block.     

Influence of female reproductive hormones on local thermal control of skin blood flow.

Progesterone and estrogen modify thermoregulatory control such that, when both steroids are elevated, body temperature increases and the reflex thermoregulatory control of cutaneous vasodilation is shifted to higher internal temperatures. We hypothesized that the influence of these hormones would also include effects on local thermal control of skin blood flow. Experiments were conducted in women in high-hormone (HH) and low-hormone (LH) phases of oral contraceptive use. Skin blood flow was measured by laser-Doppler flowmetry, and local temperature (T(loc)) was controlled over 12 cm(2) around the sites of blood flow measurement. T(loc) was held at 32 degrees C for 10-15 min and was then decreased at one site from 32 to 20 degrees C in a ramp over 20 min. Next, T(loc) was increased from 32 to 42 degrees C in a ramp over 15 min at a separate site. Finally, T(loc) at both sites was held at 42 degrees C for 30 min to elicit maximum vasodilation; data for cutaneous vascular conductance (CVC) are expressed relative to that maximum. Whole body skin temperature (T(sk)) was held at 34 degrees C throughout each study to minimize reflex effects from differences in T(sk) between experiments. Baseline CVC did not differ between phases [8.18 +/- 1.38 (LH) vs. 8. 41 +/- 1.31% of maximum (HH); P > 0.05]. The vasodilator response to local warming was augmented in HH (P < 0.05, ANOVA). For example, at T(loc) of 40-42 degrees C, CVC averaged 76.41 +/- 3.08% of maximum in HH and 67.71 +/- 4.43% of maximum in LH (P < 0.01 LH vs. HH). The vasoconstrictor response to local cooling was unaffected by phase (P > 0.05). These findings indicate that modifications in cutaneous vascular control by female steroid hormones include enhancement of the vasodilator response to local warming and are consistent with reports of the influence of estrogen to enhance nitric oxide-dependent vasodilator responses.     

Six-minute walk test improved forearm skin blood flow in Tunisian obese women

The purpose of this study was to investigate whether 6-min walk test (6MWT) would improve the forearm skin blood flow (FSBF) response to acetylcholine (ACh), an endothelium-dependent vasodilator, in Tunisian women over a wide range of BMI. The FSBF was measured noninvasively using a laser Doppler flowmeter in response to local infusion of a cumulative dose of ACh, before and after the 6MWT for 102 healthy women; the results were expressed as percentage of baseline. The 6MWT was monitored and recorded. The mean response of FSBF to ACh was significantly greater before as well as after the 6MWT in lean (1,235 ± 123% vs. 1,644 ± 140%) than in overweight (630 ± 62% vs. 1,080 ± 66%) and obese subjects (402 ± 38% vs. 795 ± 40%) (P < 0.0001). Our regression analysis also revealed that the maximal FSBF response to ACh (i.e., its efficacy) was inversely correlated with BMI both before as well as after the 6MWT (r = -0.828, P < 0.0001; r = -0.859, P < 0.0001, respectively), and the efficacies of ACh in the three groups were all significantly elevated following the 6MWT (P < 0.0001). As indicated by ANOVA test, the 6MWT improved the FSBF responses of the lean, overweight, and obese subjects, by 33, 71, and 98%, respectively. We confirm that obesity induced a reduction of skin vasodilatory reserve and altered both endothelial-dependent relaxation and wall compliance. However, our new data clearly demonstrated that the 6MWT not only improved significantly the FSBF responses in the three groups of women, but the obese patients appeared to benefit more from the 6MWT than the overweight and the lean subjects.     

Nonthermoregulatory control of human skin blood flow

Although it is well accepted that skin blood flow (SkBF) in humans is controlled by thermoregulatory reflexes, the conclusion that the cutaneous circulation is also controlled by reflexes of nonthermoregulatory origin is not universally held. This review considers the extent to which the cutaneous circulation participates in baroreceptor-mediated reflexes and in the reflexes associated with exercise. Exercise is explored in some detail, because it elicits both thermoregulatory and nonthermoregulatory reflexes. The overall conclusion reached is that thermoregulatory control of SkBF is subject to modification by or competition from several other sources. The fundamental pattern for control of SkBF is described by the threshold and slope of the SkBF-internal temperature relationship. Reflex effects of skin temperature act to shift the threshold of this relationship such that lower levels of skin temperature are associated with higher threshold internal temperatures at which cutaneous vasodilation begins. Similarly, baroreceptor reflexes, reflexes associated with exercise, and effects of some cardiovascular disease also operate against this background. Although modification of the SkBF-internal temperature slope is occasionally seen, the most consistent effect of these nonthermoregulatory factors is to elevate the threshold internal temperature for cutaneous vasodilation. The consequence of this modification of thermoregulatory control of SkBF is that temperature regulation will often suffer when increases in SkBF are delayed or limited. Blood flow to other regions, possibly including active skeletal muscle, may also be compromised when thermoregulatory demands for SkBF are high.     

Nitric oxide and neurally mediated regulation of skin blood flow during local heating.

The mechanisms underlying the skin blood flow (SkBF) response to local heating are complex and poorly understood. Our goal was to examine the role of axon reflexes and nitric oxide (NO) in the SkBF response to a local heating protocol. We performed 40 experiments following a standardized heating protocol with different interventions, including blockade of the axon reflex (EMLA cream), antebrachial nerve blockade (0.5% bupivacaine injection), and NO synthase (NOS) inhibition (> or =10 mM N(G)-nitro-L-arginine methyl ester; microdialysis). Appropriate controls were performed to verify the efficacy of the various blocks. Values are expressed as a percentage of maximal SkBF (SkBF(max); 50 mM sodium nitroprusside). At the initiation of local heating, SkBF rose to an initial peak, followed by a brief nadir, and a secondary, progressive rise to a plateau. Axon reflex block decreased the initial peak from 75+3 to 32 +/- 2% SkBF(max) (P < 0.01 vs. control) but did not affect the plateau. NOS inhibition before and throughout local heating reduced the initial peak from 75 +/- 3 to 56 +/- 3% SkBF(max) (P < 0.01) and the plateau from 87 +/- 4 to 40 +/- 5%. NOS inhibition during axon reflex block did not further reduce the initial SkBF peak compared with axon reflex block alone. Antebrachial nerve block did not affect the local heating SkBF response. The primary finding of these studies is that there are at least two independent mechanisms contributing to the rise in SkBF during nonpainful local heating: a fast-responding vasodilator system mediated by the axon reflexes and a more slowly responding vasodilator system that relies on local production of NO.     

Leg exercise conditioning increases peak forearm blood flow.

To examine whether forearm vascular adaptations could occur after upright-leg exercise training, the reactive hyperemic blood flow after 10 min of forearm circulatory arrest (RHBF10) was studied. RHBF10 was examined in seven subjects before, at 2 wk, and after the completion of 4 wk of bicycle ergometer training. Maximal O2 consumption (VO2max) for leg ergometer work increased 13% (P less than 0.05) over 4 wk. Over that period of time RHBF10 in the forearm increased 50% (P less than 0.05), with a reciprocal drop in minimum vascular resistance. Resting heart rate decreased 15% (P less than 0.05) during the same period. Changes in RHBF10 and VO2max were noted after 2 wk of training. Mean arterial pressure did not change. We conclude that vascular adaptations can occur in the forearm muscle beds, even though the training regimen is designed to condition the lower extremities.     

Effect of different prostaglandin synthesis inhibitors on post-occlusive blood flow in human forearm

The vascular relaxation response in the human forearm that follows a short period of arterial occlusion (reactive hyperemia) was investigated with respect to its dependance on an intact PG synthesis. In 10 healthy subjects, five men and five women, forearm blood flow was measured, using venous occlusion plethysmography, in the basal state and during the recovery phase following 5 min of obstructed arterial flow. The subjects were studied at nine different occasions. At six of these they were pre-treated with the highest recommended doses of either of the PG synthesis inhibitors acetyl-salicylic acid, diclofenac, ibuprofen, indomethacin, naproxen or piroxicam; the remaining occasions were controls, performed in the absence of drugs in the beginning, middle, and end of the series.All the drugs significantly decreased the total reactive hyperemia following 5 min of arterial occlusion. Ibuprofen was the most efficient agent, inhibiting the total reactive hyperemia by more than 70%, and naproxen was least active, producing about 35% inhibition. The rest of the drugs diminished the total reactive hyperemia by 55–65%. Basal forearm blood flow was not affected by either of the agents.From these data we conclude that drugs which inhibit PG synthesis in man have in common the capacity to decrease post-occlusive reactive hyperemia. This indicates that an activation of the local release of arachidonic acid, leading to formation of vasodilator PG, is one of the main factors behind the vascular smooth muscle relaxation response to arterial occlusion.