Cardiovascular changes associated with decreased aerobic capacity and aging in long-distance runners

Fifty-five male runners aged between 30 to 80 years were examined to determine the relative roles of various cardiovascular parameters which may account for the decrease in maximal oxygen uptake (VO2max) with aging. All subjects had similar body fat composition and trained for a similar mileage each week. The parameters tested were VO2max, maximal heart rate (HRmax), cardiac output (Q), and arteriovenous difference in oxygen concentration (Ca-Cv)O2 during graded, maximal treadmill running. Average body fat and training mileage were roughly 12% and 50 km.week-1, respectively. The average 10-km run-time slowed significantly by 6.0%.decade-1 [( 10-km run-time (min) = 0.323 x age (years) + 24.4] (n = 49, r = 0.692, p less than 0.001]. A strong correlation was found between age and VO2max [( VO2max (ml.kg-1.min-1) = -0.439 x age + 76.5] (n = 55, r = -0.768, p less than 0.001]. Thus, VO2max decreased by 6.9%.decade-1 along with reductions of HRmax (3.2%.decade-1, p less than 0.001) and Q (5.8%.decade-1, p less than 0.001), while no significant change with age was observed in estimated (Ca-Cv)O2. It was concluded that the decline of VO2max with aging in runners was mainly explained by the central factors (represented by the decline of HR and Q in this study), rather than by the peripheral factor (represented by (Ca-Cv)O2).     

Heart rate overshoot at the beginning of muscle exercise.

A characteristic notch in the heart rate (fc) on-response at the beginning of square-wave exercise is described in 7 very fit marathon runners and 12 sedentary young men, during cycle tests at 30% and 60% of maximal oxygen consumption (VO2max). The fc notch revealed a fc overshoot with respect to the fc values predicted from exponential beat-by-beat fitted models. While at 30% of VO2max all subjects showed a fc overshoot, at 60% of VO2max it occurred in the marathon runners but not in the sedentary subjects. The mean time of occurrence of the fc overshoot from the onset of the exercise was 16.7 (SD 4.7) s and 12.2 (SD 3.2) s at 30% of VO2max in the runners and the sedentary subjects respectively, and 23.8 (SD 8.8) s at 60% of VO2max in the runners. The amplitude of the overshoot, with respect to rest, was 41 (SD 12) beats.min-1 and 31 (SD 4) beats.min-1 at 30% of VO2max in the runners and the sedentary subjects respectively, and 46 (SD 19) beats.min-1 at 60% of VO2max in the runners. The existence and the amplitude of the fc overshoot may have been related to central command and muscle heart reflex mechanisms and thus may have been indicators of changes in the balance between sympathetic and parasympathetic activity occurring in fit and unfit subjects.     

Physiological differences between black and white runners during a treadmill marathon

To determine why black distance runners currently out-perform white distance runners in South Africa, we measured maximum oxygen consumption (VO2max), maximum workload during a VO2max test (Lmax), ventilation threshold (VThr), running economy, inspiratory ventilation (VI), tidal volume (VT), breathing frequency (f) and respiratory exchange ratio (RER) in sub-elite black and white runners matched for best standard 42.2 km marathon times. During maximal treadmill testing, the black runners achieved a significantly lower (P less than 0.05) Lmax (17 km h-1, 2% grade, vs 17 km h-1, 4% grade) and VI max (6.21 vs 6.82 l kg-2/3 min-1), which was the result of a lower VT (101 vs 119 ml kg-2/3 breath-1) as fmax was the same in both groups. The lower VT in the black runners was probably due to their smaller body size. The VThr occurred at a higher percentage VO2max in black than in white runners (82.7%, SD 7.7% vs 75.6%, SD 6.2% respectively) but there were no differences in the VO2max. However, during a 42.2-km marathon run on a treadmill, the black athletes ran at the higher percentage VO2max (76%, SD 7.9% vs 68%, SD 5.3%), RER (0.96, SD 0.07 vs 0.91, SD 0.04) and f (56 breaths min-1, SD 11 vs 47 breaths min-1, SD 10), and at lower VT (78 ml kg-2/3 breath-1, SD 15 vs 85 ml kg-2/3 breath-1, SD 19). The combination of higher f and lower VT resulted in an identical VI.(ABSTRACT TRUNCATED AT 250 WORDS)     

Angiogenin gene-race interaction for resting and exercise BP phenotypes: the HERITAGE Family Study.

We examined the association between an angiogenin gene polymorphism and blood pressure (BP) at rest and in response to acute exercise before and after a 20-wk endurance-training program. Subjects were 737 normotensive and borderline hypertensive subjects (257 black and 480 white). The polymorphism was detected by PCR and digestion with AvaII, yielding an allele of 253 bp or a rare allele of 194 + 59 bp. Resting and exercise [50 W; 60, 80, and 100% of maximal O2 consumption (VO2 max)] systolic (SBP) and diastolic BP were determined before and after training. Among blacks, adjusted SBP in the sedentary state was significantly lower in carriers of the rare allele at rest and exercise intensities of 60, 80, and 100% of VO2 max. In the trained state, carriers of the rare allele had a significantly (P < 0.05) lower SBP than did noncarriers at rest and at 80 and 100% of VO2 max. The genotypic effect observed among blacks was not evident among whites. Furthermore, change in BP (after--before) was not significantly associated with the genotype. In conclusion, the angiogenin gene AvaII polymorphism is associated with a lower SBP at rest and in response to acute high-intensity exercise in blacks but not in whites.     

Repetitive static muscle contractions in humans —a trigger of metabolic and oxidative stress?

Repetitive static exercise (RSE) is a repetitive condition of partial ischaemia/reperfusion and may therefore be connected to the formation of oxygen-derived free radicals and tissue damage. Seven subjects performed two-legged intermittent knee extension exercise repeating at 10 s on and 10 s off at a target force corresponding to about 30% of the maximal voluntary contraction force. The RSE was continued for 80 min (n = 4) or to fatigue (n = 3). Four of the subjects also performed submaximal dynamic exercise (DE) at an intensity of about 60% maximal oxygen uptake (VO2max) for the same period. Whole body oxygen uptake (VO2) increased gradually with time during RSE (P less than 0.05), indicating a decreased mechanical efficiency. This was further supported by a slow increase in leg blood flow (P less than 0.05) and leg oxygen utilization (n.s.) during RSE. In contrast, prolonged RSE had no effect on VO2 during submaximal cycling. Maximal force (measured in six additional subjects) declined gradually during RSE and was not completely restored after 60 min of recovery. After 20 and 80 min (or at fatigue) RSE phosphocreatine (PC) dropped to 74% and 60% of the initial value, respectively. A similar decrease in PC occurred during DE. Muscle and arterial lactate concentrations remained low during both RSE and DE. The three subjects who were unable to continue RSE for 80 min showed no signs of a more severe energy imbalance than the other subjects. A continuous release of K+ occurred during both RSE and DE.(ABSTRACT TRUNCATED AT 250 WORDS)     

Exercise intensity and glucose tolerance in trained and nontrained subjects

The improved glucose tolerance and increased insulin sensitivity associated with regular exercise appear to be the result, in large part, of the residual effects of the last bout of exercise. To determine the effects of exercise intensity on this response, glucose tolerance and the insulin response to a glucose load were determined in seven well-trained male subjects [maximal O2 uptake (VO2max) = 58 ml.kg-1.min-1] and in seven nontrained male subjects (VO2max = 49 ml.kg-1.min-1) in the morning after an overnight fast 1) 40 h after the last training session (control), 2) 14 h after 40 min of exercise on a cycle ergometer at 40% VO2max, and 3) 14 h after 40 min of exercise at 80% VO2max. Subjects replicated their diets for 3 days before each test and ate a standard meal the evening before the oral glucose tolerance test. No differences in the 3-h insulin or glucose response were observed between the control trial and before exercise at either 40 or 80% VO2max in the trained subjects. In the nontrained subjects the plasma insulin response was decreased by 40% after a single bout of exercise at either 40 or 80% VO2max (7.0 X 10(3) vs. 5.0 X 10(3), P less than 0.05; 3.8 X 10(3) microU.ml-1.180 min-1, P less than 0.01). The insulin response after a single bout of exercise in the nontrained subjects was comparable with the insulin responses found in the trained subjects for the control and exercise trials.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sex and training differences in human growth hormone levels during prolonged exercise

Human growth hormone (hGH) levels were measured during rest, prolonged treadmill exercise at 60% maximum O2 uptake (VO2max), and immediate recovery in four groups of subjects (n = 7/group), ages 21-30 yr, classified as male runners (MR), female runners (FR), male controls (MC), and female controls (FC) to determine whether sex differences in the hGH response are related to resting 17 beta-estradiol (E2) and/or cardiorespiratory endurance (CRE). Glucose (Glc), E2, and hGH levels were determined from serial blood samples taken from an intravenous catheter. Glc did not change significantly during exercise, but different trends for the runners (increases) vs. controls (decreases) resulted in higher (P less than 0.01) postexercise levels in the runners. Resting hGH was higher (P less than 0.05) in the FRs and FCs than the MRs and MCs, respectively, and continued to be higher in the FCs (vs. MCs) during the first 30 min of exercise. The MRs achieved higher peak hGH levels and exhibited higher values than the MCs throughout exercise and recovery. There were no statistically significant training differences in the females. The strongest predictors for peak hGH were absolute work load and group (runners vs. controls), both of which combined accounted for 32-36% of the variability (P less than 0.01) in hGH response. Significant sex-related variables (sex, resting E2) accounted for 11-19% of the variability in peak or percent change in hGH, with E2 having a positive effect at rest but a negative effect during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)     

Utilisation of intramyocellular lipids (IMCLs) during exercise as assessed by proton magnetic resonance spectroscopy (1H-MRS).

Recently, a 1H-MRS method became available to quantify intramyocellular lipids (IMCL) non-invasively. Currently, little is known about the regulation of this lipid pool. During prolonged exercise of moderate intensity, non-plasma-derived fatty acids play an important role as an energy source; lipids located within the skeletal muscle are considered to be a major source for these fatty acids. To see whether IMCL are reduced by exercise, 12 male runners were studied before and after exercising at different workloads and duration. Six subjects participated in a non-competitive run (NCR), three runners in a competitive half marathon (HM, 21 km) and another three in a competitive marathon (M, 42 km). Intra- and extramyocellular lipids were quantified by 1H-MR spectroscopy in the tibialis anterior (TA) and soleus (SOL) muscles prior to and after the exercise bout. Moderate intensity (MI; 60-70% VO2max in NCR) with a mean exercise time (MET) ranging between 105-110 min decreased IMCL by 10 - 36% in both muscles. Prolonged MI exercise (MET 210-240 min; 68-70% VO2max in M) reduced IMCL by 42-57% in TA and 27 - 56% in SOL. In contrast, high intensity exercise (HI; MET 80-120 min; 83-85% VO2max in HM) did not alter IMCL in either muscle. Extramyocellular lipids (EMCL) did not show any significant change in any group. The data show that one bout of moderate-intensity (60-70% VO2max) aerobic exercise markedly reduces the IMCL in TA and SOL muscles in a time-dependent fashion as assessed by 1H-MRS. However, exercise of similar duration but higher workload (> 80% VO2max) does not reduce IMCL. These data suggest that both exercise duration and workload are important factors in determining the reduction of IMCL.     

Effects of specific muscle training on VO2 on-response and early blood lactate

The relationship between half time of the O2 uptake on-response (t1/2 VO2on, seconds) and early blood lactate accumulation (delta Lab, mmol.1(-1) at the onset of submaximal arm and/or leg exercise was the object of a cross-sectional study of sedentary subjects (S,n = 3), and kayakers (K, n = 8), and of a longitudinal study on 11 untrained subjects of specific arm vs. leg training. In supine arm cranking (W = 125 watts) S had an average t1/2 VO2on of 82 s and a delta Aab of 9.2 mmol.1(-1) compared to 47 +/- 7 s and 4 +/- 1.4 mmol.1(-1), respectively, for K. In longitudinal trainees shorter t1/2 VO2on was accompanied by lower Lab for the trained limbs. Specific limb conditioning in swimmers and runners resulted in shorter t1/2 VO2on. A linear relationship was observed between delta Lab and t1/2 VO2on having an intercept on the time axis at congruent to 20 s and a slope proportional to muscle mass. Trained muscles were grouped closest to the intercept indicating local acceleration of the rate of O2 transfer approaching the t1/2 VO2on for isolated perfused muscle at the onset of work. Since t1/2 VO2on, we conclude that factors distal to the capillary are specifically involved in the local training response.     

Vascular volumes and hematology in male and female runners and cyclists

To examine the hypothesis that foot-strike hemolysis alters vascular volumes and selected hematological properties is trained athletes, we have measured total blood volume (TBV), red cell volume (RCV) and plasma volume (PV) in cyclists (n = 21) and runners (n = 17) and compared them to those of untrained controls (n = 20). TBV (ml x kg(-1)) was calculated as the sum of RCV (ml x kg(-1)) and PV (ml x kg(-1)) obtained using 51Cr and 125I-labelled albumin, respectively. Hematological assessment was carried out using a Coulter counter. Peak aerobic power (VO2peak) was measured during progressive exercise to fatigue using both cycle and treadmill ergometry. RCV was 15% higher (P < 0.05) in male cyclists [35.4 (1.0), mean (SE); n = 12] and runners [35.3 (0.98); n = 9] compared to the controls [30.7 (0.92); n = 12]. Similar differences existed between the female cyclists [28.2 (2.1); n = 9] and runners [28.4 (1.0); n = 8] compared to the untrained controls [24.9 (1.4); n = 8]. For the male athletes, PV was between 19% (cyclists) and 28% (runners) higher (P < 0.05) in the trained athletes compared to the untrained controls. The differences in PV between the female groups were not significant. Although the males had a higher (P < 0.05) TBV, RCV and PV than the females, no differences between cyclists and runners were found for either gender. Mean cell volume was not different between the athletic groups. VO2peak (ml x kg(-1) x min(-1)) was higher (P < 0.05) in both male [68.4 (1.5)] and female [54.8 (2.1)] runners when compared to the untrained males [47.1 (1.0)] and females [40.5 (2.1)]. Although differences existed between the genders in VO2peak for both cyclists and runners, no differences were found between the athletic groups within a gender. Since the vascular volumes were not different between cyclists and runners for either the males or females, foot-strike hemolysis would not appear to have an effect on that parameter. The significant correlations (P < 0.05) found between VO2peak and RCV (r = 0.64 and 0.64) and TBV (r = 0.82 and 0.63) for the males and females, respectively, suggests a role for the vascular system in realizing a high aerobic power.     

Angiotensin-converting enzyme ID polymorphism and fitness phenotype in the HERITAGE Family Study.

It has been suggested that genetic variation in the angiotensin-converting enzyme (ACE) gene is associated with physical performance. We studied the association between the ACE insertion (I)/deletion (D) polymorphism and several fitness phenotypes measured before and after 20 wk of a standardized endurance training program in sedentary Caucasian (n = 476) and black (n = 248) subjects. Phenotypes measured were oxygen uptake (VO(2)), work rate, heart rate, minute ventilation, tidal volume, and blood lactate levels during maximal and submaximal [50 W and at 60 and 80% of maximal VO(2) (VO(2 max))] exercise and stroke volume and cardiac output during submaximal exercise (50 W and at 60% VO(2 max)). The ACE ID polymorphism was typed with the three-primer PCR method. Out of 216 association tests performed on 54 phenotypes in 4 groups of participants, only 11 showed significant (P values from 0.042 to 0. 0001) associations with the ACE ID polymorphism. In contrast to previous claims, in Caucasian offspring, the DD homozygotes showed a 14-38% greater increase with training in VO(2 max), VO(2) at 80% of VO(2 max), and all work rate phenotypes and a 36% greater decrease in heart rate at 50 W than did the II homozygotes. No associations were evident in Caucasian parents or black parents or offspring. Thus these data do not support the hypothesis that the ACE ID polymorphism plays a major role in cardiorespiratory endurance.     

Potential for strength and endurance training to amplify endurance performance

The impact of adding heavy-resistance training to increase leg-muscle strength was studied in eight cycling- and running-trained subjects who were already at a steady-state level of performance. Strength training was performed 3 days/wk for 10 wk, whereas endurance training remained constant during this phase. After 10 wk, leg strength was increased by an average of 30%, but thigh girth and biopsied vastus lateralis muscle fiber areas (fast and slow twitch) and citrate synthase activities were unchanged. Maximal O2 uptake (VO2max) was also unchanged by heavy-resistance training during cycling (55 ml.kg-1.min-1) and treadmill running (60 ml.kg-1.min-1); however, short-term endurance (4-8 min) was increased by 11 and 13% (P less than 0.05) during cycling and running, respectively. Long-term cycling to exhaustion at 80% VO2max increased from 71 to 85 min (P less than 0.05) after the addition of strength training, whereas long-term running (10 km times) results were inconclusive. These data do not demonstrate any negative performance effects of adding heavy-resistance training to ongoing endurance-training regimens. They indicate that certain types of endurance performance, particularly those requiring fast-twitch fiber recruitment, can be improved by strength-training supplementation.     

Acute exercise stimulates the renin-angiotensin-aldosterone axis: adaptive changes in runners

The plasma concentrations of aldosterone and its known regulators, plasma renin, potassium and ACTH, were examined during graded intensities of treadmill exercise (50, 70 and 90% of maximal oxygen uptake, VO2max). Sedentary men (n = 7) and two groups of runners of different training status (moderately trained, 15-25 miles/week, n = 7; highly trained, greater than 45 miles/week, n = 7) were studied in an attempt to define whether physical training causes changes in aldosterone homeostasis. Acute exercise was associated with elevations in plasma aldosterone, renin activity, potassium and ACTH in all three groups of subjects at exercise intensities of 70 and 90% VO2max. There were no differences in any of the responses among the three groups except for a blunted response of PRA at 90% VO2max in highly trained athletes. The exercise-induced rise of plasma aldosterone concentration did not correlate with changes in the concentration of its regulatory substances. We conclude that exercise stimulates the renin-angiotensin-aldosterone axis in an intensity-dependent fashion. With increased physical training identical hormonal and metabolic responses result at increased absolute workloads.     

Iron deficiency anemia and steady-state work performance at high altitude

Thirty-seven young adult male highland residents at 3,600-4,100 m in La Paz, Bolivia, performed short-duration cycle ergometry at 60, 80, and 100% of maximal voluntary O2 consumption (VO2max). Three groups of subjects representing the high-altitude population mean hemoglobin (Hb), the 10th percentile Hb, and below the 1st percentile were examined to test the hypothesis that the relationship of exercise performance to Hb concentration is similar to those relationships established at low altitude. Anemic individuals (n = 8) had 23% lower voluntary VO2max and 28% lower maximal work loads compared with controls (n = 17) or marginally anemic subjects (n = 12) although the relationship of VO2 to work load was similar. Anemic individuals maintained significantly higher arterial O2 partial pressures and Hb saturations during heavy exercise (90 +/- 0.5 vs. 85 +/- 0.6%) in conjunction with a greater heart rate up to maximal effort. A significantly decreased erythrocyte 2,3-diphosphoglycerate (2,3-DPG)-to-Hb molar ratio (0.70 +/- 0.04 vs. 1.12 +/- 0.06), suggestive of a left-shifted dissociation curve in anemics, is in contrast to the expected right-shifted curve. Moderate anemics were similar to controls. Anemic individuals did not differ in arterial lactate concentration from controls at absolute work loads; anemics had significantly lower arterial lactate concentrations at maximal effort than controls with no differences in the work load-to-lactate relationship. In conclusion, O2 transport during exercise at high altitude seems unaffected by the Hb concentrations as low as the 10th percentile of the population mean.(ABSTRACT TRUNCATED AT 250 WORDS)     

Muscle and blood ammonia and lactate responses to prolonged exercise with hyperoxia

Investigations using nonsteady-state and fatiguing exercise protocols have demonstrated a strong relationship between ammonia and lactate metabolism and have suggested a cause and effect relationship between these two variables. We investigated the lactate-ammonia response using prolonged exercise and inspiration of hyperoxic gas (60% O2-40% N2). The exercise consisted of either 70-75% maximal O2 uptake (VO2 max) for 40 min (series 1, n = 6) or 75-80% VO2max for 30 min (series 2, n = 6) with the subjects inspiring room air on one occasion and hyperoxia in the other test. In both series blood ammonia rose continuously throughout the exercise regardless of the inspired gas treatment; in contrast blood lactate did not increase after 10 min with room air, and with hyperoxia blood lactate was reduced. Muscle lactate and ammonia (series 2; vastus lateralis) had responses similar to the blood data. The data demonstrated no apparent lactate-ammonia relationship with prolonged exercise or in response to hyperoxia, suggesting that ammonia production can be independent of lactate metabolism. The data also suggest that type I fibers can be a major source of ammonia in humans.     

A hemodynamic comparison of young and older endurance athletes during exercise

This study assessed the hemodynamic responses to exercise of master athletes (56 +/- 5 yr of age) who placed in the top 10% of their age groups in local 10-km competitive events, competitive young runners (26 +/- 3 yr), young runners matched in training and performance to the master athletes (25 +/- 3 yr), and healthy older sedentary subjects (58 +/- 5 yr). The maximal O2 consumption (VO2max) of the master athletes was 9 and 19% lower than that of the matched young and competitive young runners, respectively. When compared at the same relative submaximal work rates, these three groups had similar stroke volumes and arteriovenous O2 (aVO2) differences, though the master athletes had lower VO2, cardiac output, and heart rate, and higher vascular resistance. The older sedentary group had a lower stroke volume, aVO2 difference, and higher vascular resistance than the master athletes. Maximal stroke volume and estimated aVO2 difference were the same in the three groups of athletes; the lower maximal heart rate of the master athletes appears to account for their lower VO2max. The older sedentary subjects' VO2max was 47% lower than that of the master athletes; this difference was almost equally the result of a lower stroke volume and a lower a-VO2 difference. Thus these older athletes did not exhibit the decline in maximum stroke volume and aVO2 difference that occurs with aging in sedentary individuals; they also appear to have retained a greater peripheral vasodilatory response than their sedentary peers.     

Decrease of O(2) deficit is a potential factor in increased time to exhaustion after specific endurance training.

The main purpose of this study was to investigate the effects of an 8-wk severe interval training program on the parameters of oxygen uptake kinetics, such as the oxygen deficit and the slow component, and their potential consequences on the time until exhaustion in a severe run performed at the same absolute velocity before and after training. Six endurance-trained runners performed, on a 400-m synthetic track, an incremental test and an all-out test, at 93% of the velocity at maximal oxygen consumption, to assess the time until exhaustion. These tests were carried out before and after 8 wk of a severe interval training program, which was composed of two sessions of interval training at 93% of the velocity at maximal oxygen consumption and three recovery sessions of continuous training at 60--70% of the velocity at maximal oxygen consumption per week. Neither the oxygen deficit nor the slow component were correlated with the time until exhaustion (r = -0.300, P = 0.24, n = 18 vs. r = -0.420, P = 0.09, n = 18, respectively). After training, the oxygen deficit significantly decreased (P = 0.02), and the slow component did not change (P = 0.44). Only three subjects greatly improved their time until exhaustion (by 10, 24, and 101%). The changes of oxygen deficit were significantly correlated with the changes of time until exhaustion (r = -0.911, P = 0.01, n = 6). It was concluded that the decrease of oxygen deficit was a potential factor for the increase of time until exhaustion in a severe run performed after a specific endurance-training program.     

Short-term plyometric training improves running economy in highly trained middle and long distance runners

Fifteen highly trained distance runners VO(2)max 71.1 +/- 6.0 ml.min(-1).kg(-1), mean +/- SD) were randomly assigned to a plyometric training (PLY; n = 7) or control (CON; n = 8) group. In addition to their normal training, the PLY group undertook 3 x 30 minutes PLY sessions per week for 9 weeks. Running economy (RE) was assessed during 3 x 4 minute treadmill runs (14, 16, and 18 km.h(-1)), followed by an incremental test to measure VO(2)max. Muscle power characteristics were assessed on a portable, unidirectional ground reaction force plate. Compared with CON, PLY improved RE at 18 km.h(-1) (4.1%, p = 0.02), but not at 14 or 16 km.h(-1). This was accompanied by trends for increased average power during a 5-jump plyometric test (15%, p = 0.11), a shorter time to reach maximal dynamic strength during a strength quality assessment test (14%, p = 0.09), and a lower VO(2)-speed slope (14%, p = 0.12) after 9 weeks of PLY. There were no significant differences in cardiorespiratory measures or VO(2)max as a result of PLY. In a group of highly-trained distance runners, 9 weeks of PLY improved RE, with likely mechanisms residing in the muscle, or alternatively by improving running mechanics.     

Impact of heart failure and exercise capacity on sympathetic response to handgrip exercise

Peak oxygen uptake (VO(2 peak)) in patients with heart failure (HF) is inversely related to muscle sympathetic nerve activity (MSNA) at rest. We hypothesized that the MSNA response to handgrip exercise is augmented in HF patients and is greatest in those with low VO(2 peak). We studied 14 HF patients and 10 age-matched normal subjects during isometric [30% of maximal voluntary contraction (MVC)] and isotonic (10%, 30%, and 50% MVC) handgrip exercise that was followed by 2 min of posthandgrip ischemia (PHGI). MSNA was significantly increased during exercise in HF but not normal subjects. Both MSNA and HF levels remained significantly elevated during PHGI after 30% isometric and 50% isotonic handgrip in HF but not normal subjects. HF patients with lower VO(2 peak) (<56% predicted; n = 8) had significantly higher MSNA during rest and exercise than patients with VO(2 peak) > 56% predicted (n = 6) and normal subjects. The muscle metaboreflex contributes to the greater reflex increase in MSNA during ischemic or intense nonischemic exercise in HF. This occurs at a lower threshold than normal and is a function of VO(2 peak).