Does training-induced orthostatic hypotension result from reduced carotid baroreflex responsiveness?

As manned space travel has steadily increased in duration and sophistication, the answer to a simple, relevant question remains elusive. Does endurance exercise training - high intensity rhythmic activity, performed regularly for extended periods of time - alter the disposition to, or severity of, postflight orthostatic hypotension? Research results continue to provide different views; however, data are difficult to compare because of the following factors that vary between investigations: the type of orthostatic stress imposed (+Gz, lower body negative pressure (LBNP), head-up tilt); pretest perturbations used (exercise, heat exposure, head-down tilting, bed rest, water immersion, hypohydration, pharmacologically-induced diuresis); the length of the training program used in longitudinal investigations (days versus weeks versus months); the criteria used to define fitness; and the criteria used to define orthostatic tolerance. Generally, research results indicate that individuals engaged in aerobic exercise activities for a period of years have been reported to have reduced orthostatic tolerance compared to untrained control subjects, while the results of shorter term longitudinal studies remain equivocal. Such conclusions suggest that chronic athletic training programs reduce orthostatic tolerance, whereas relatively brief (days to weeks) training programs do not affect orthostatic tolerance to any significant degree (increase or decrease). A primary objective was established to identify the alterations in blood pressure control that contribute to training-induced orthostatic hypotension (TIOH). Although any aspect of blood pressure regulation is suspect, current research has been focused on the baroreceptor system. Reductions in carotid baroreflex responsiveness have been documented in exercise-trained rabbits, reportedly due to an inhibitory influence from cardiac afferent, presumably vagal, nerve fibers that is abolished with intrapericardiac denervation. The purpose of this investigation was to attempt to determine if similar relationships existed in men with varied levels of fitness, using maximal aerobic power, VO2 max, as the marker of fitness

Centrally Acting Perindopril Attenuates the Exercise Induced Increase in Muscle Sympathetic Nerve Activity during Heavy Dynamic Exercise

Central angiotensin II (Ang II) linked free radical (FR) production scavenges nitric oxide (NO) enabling an increased central sympathetic neural outflow (SNA). The pathophysiological increase in Ang II linked FR production is recognized as a major mechanism involved in neurogenic hypertension. During exercise, there is a physiological increase in Ang II and muscle sympathetic nerve activity (MSNA) in direct relation to increasing exercise intensity. We tested the hypothesis that the exercise induced increase in Ang II linked FR production and MSNA activity during exercise is located within the brain. Six healthy subjects performed three randomly ordered trials of 70° upright back-supported dynamic leg cycling after ingestion of two different lipid soluble Angiotensin converting enzyme inhibitors ((ACEi) Perindopril (PER) - highly lipid soluble; Captopril (CAP) non-lipid soluble)) and/or placebo (PL). Repeated measurements of whole venous blood, MSNA, and mean arterial pressures (MAP) were obtained at rest and during steady-state heavy intensity exercise at heart rates (HR) of 120 bpm (e120). Peripheral venous superoxide concentrations as measured by electron paramagnetic resonance (EPR) were not significantly altered at rest (P≥0.4) and during E120 by the ACE inhibitors (P≥0.07). Likewise, baseline MSNA (PL, 25 ± 1.5 bust/min; CAP, 21 ± 0.7 bust/min; PER, 25 ± 0.7 bust/min) and MAP (PL, 86 ± 2.8 mmHg vs. CAP, 84 ± 2.6 mmHg; PER, 84 ± 0.7 mmHg) were unchanged at rest (P≥0.1; P≥0.8 respectively). However, during E120 central acting PER attenuated the increases in MSNA and MAP, increasing only 15±6% for MAP and 24±8% for MSNA when compared to PL (26 ± 6% MAP; 57±16% MSNA; P\u3c0.05) and CAP (26±4%MAP; 69±13%MSNA P\u3c0.05). From these data we conclude that centrally acting PER attenuated the central increase in the exercise induced Ang II linked free radical production resulting in an increased central NO activity induced reduction in MSNA during heavy intensity dynamic exercise

Methods and considerations for the analysis and standardization of assessing muscle sympathetic nerve activity in humans.

The technique of microneurography and the assessment of muscle sympathetic nerve activity (MSNA) are used in laboratories throughout the world. The variables used to describe MSNA, and the criteria by which these variables are quantified from the integrated neurogram, vary among studies and laboratories and, therefore, can become confusing to those starting to learn the technique. Therefore, the purpose of this educational review is to discuss guidelines and standards for the assessment of sympathetic nervous activity through the collection and analysis of MSNA. This review will reiterate common practices in the collection of MSNA, but will also introduce considerations for the evaluation and physiological inference using MSNA

Methods and considerations for the analysis and standardization of assessing muscle sympathetic nerve activity in humans

© 2015 Elsevier B.V.. The technique of microneurography and the assessment of muscle sympathetic nerve activity (MSNA) are used in laboratories throughout the world. The variables used to describe MSNA, and the criteria by which these variables are quantified from the integrated neurogram, vary among studies and laboratories and, therefore, can become confusing to those starting to learn the technique. Therefore, the purpose of this educational review is to discuss guidelines and standards for the assessment of sympathetic nervous activity through the collection and analysis of MSNA. This review will reiterate common practices in the collection of MSNA, but will also introduce considerations for the evaluation and physiological inference using MSNA

Antioxidants Attenuate the Exercise Induced Resetting of the Arterial Baroreflex in Healthy Human Subjects: Implications for Exercise Induced Hypertension

Patients with Exercise-induced-Hypertension (EiHT) exhibit exaggerated increases in arterial pressure at the onset of exercise which may prevent EiHT patients from participating in exercise training programs. EiHT is thought to occur due to dysregulated resetting of the arterial baroreflex (ABR). Prior studies in animal models demonstrate that reactive oxygen species (ROS) generated in the brainstem scavenge the sympathoinhibitory function of central Nitric Oxide (NO) and, thereby enable ABR resetting of the operating point (OP) pressure and hypertension. We tested the hypothesis that a centrally and peripherally active antioxidant cocktail (CT; composed of Vitamin E and C with Co-Q10) will attenuate the exercise induced resetting of the ABR‘s centering point (CP) and OP pressures compared to the same exercise intensity performed with a vehicle placebo (PL). Seven healthy human subjects were recruited and performed 700 back-supported semi-recumbent dynamic leg exercise at moderate (HR at 120 beats per minute: e120) and heavy (HR at 150 beats per minute: e150) intensities. Mean arterial pressure (MAP) was continuously recorded using photoplethysmography at the finger, while HR was recorded via a three lead electrocardiogram (ECG). On experimental day 1, subjects were either given the CT or PL 1 hr. (time of peak plasma concentrations) prior to the start of exercise. On a separate experiment day 2, the subjects repeated the same exercise intensity protocol with the other test article (CT or PL) in a randomized repeated measures design. During exercise with the PL ingestion, the CP of the ABR was reset to higher MAPs from rest to e120 (100 ± 3 mm Hg to 121 ± 3 mm Hg, P\u3c0.02) but not e150 (113 ± 3 mm Hg, P=0.15). The absence of resetting at the higher work intensity was likely due to cardiovascular drift (decreasing MAP). Ingestion of the CT prior to the exercise protocols prevented the increase of the CP to higher MAPs from rest to e120 and e150 (rest: 97 ± 3 mm Hg, e120: 106 ± 3 mm Hg, e150: 106 ± 3 mm Hg, P \u3e0.21). Furthermore, the OP- pressure of the ABR was attenuated with CT ingestion compared to PL at e120 (placebo e120: 116 ± 0.8 mm Hg, CT e120: 111 ± 0.8 mm Hg, P = 0.04). These data: (a) confirm that centrally derived ROS contribute to exercise induced ABR resetting; and (b) indicate that EiHT could be treated by ingestion of an anti-oxidant cocktail prior to the start of exercise

An exploratory study of influences on retail service quality: a focus on Kuwait and Lebanon.

Abstract: The Middle East is a growing and lucrative marketplace. This exploratory study examines retail service in Kuwait and Lebanon, regions with long histories of trade. Retail service, however, has not been well documented in this region. To our knowledge, this is the first study that examines customer and salespeople perceptions of service encounters in these countries, in light of their culture, religion, and nationalities. As retailers expand into new markets worldwide, such information is vital to their success. Future research directions are discussed

The distribution of biodiversity richness in the tropics

We compare the numbers of vascular plant species in the three major tropical areas. The Afrotropical Region (Africa south of the Sahara Desert plus Madagascar), roughly equal in size to the Latin American Region (Mexico southward), has only 56,451 recorded species (about 170 being added annually), as compared with 118,308 recorded species (about 750 being added annually) in Latin America. Southeast Asia, only a quarter the size of the other two tropical areas, has approximately 50,000 recorded species, with an average of 364 being added annually. Thus, Tropical Asia is likely to be proportionately richest in plant diversity, and for biodiversity in general, for its size. In the animal groups we reviewed, the patterns of species diversity were mostly similar except for mammals and butterflies. Judged from these relationships, Latin America may be home to at least a third of global biodiversity

Cerebrovascular Hemodynamics during Concentric and Eccentric Phases of Heavy Resistance Exercise

Rapid and drastic fluctuations in arterial blood pressures, such as those occurring during heavy resistance exercise pose a unique challenge to the maintenance of cerebral perfusion. During high-intensity leg cycling, regulation of cerebral perfusion is reduced by rapid decreases in beat-to-beat fluctuations in blood pressure (diastolic phase) rather than rapid increases (systolic phase). The purpose of this study was to test the hypothesis that rhythmic heavy resistance exercise will similarly impair the regulation of cerebral blood flow during the diastolic phase of beat-to-beat fluctuations in pressure. We studied seven healthy male subjects. Beat-to-beat finger arterial pressures, and middle cerebral artery blood velocity (MCAv) were measured during 10 repetitions (REP) of rhythmic high intensity leg press exercise. Velocities and arterial pressures were evaluated during both the isotonic concentric and eccentric phases of each REP. The Gosling pulsatility index (PI) of MCAv of each REP was calculated as MCAv systolic-MCAv diastolic/MCAv mean. During the concentric phase, systolic arterial pressures progressively increased from REP 1 through REP 10 (P \u3c 0.001), while systolic MCAv was not different across all REPs (P \u3e0.2). Diastolic arterial pressures during the eccentric phase also increased from REP 1 through REP 10 (P = 0.03) however diastolic MCAv decreased during REPs 7-10 compared with REP 2 (P ≤ 0.02). MCAv PI also increased during REP 7-10 compared to REP 2 (P ≤ 0.02). Similar to high-intensity leg cycling, our data suggest that during rhythmic high-intensity leg press exercise, cerebral perfusion is well controlled during periods of rapid increases in blood pressure, but regulation of cerebral perfusion is impaired during the diastolic phase of beat-to-beat fluctuations in pressure

Effects of Antioxidants on Cerebrovascular Hemodynamics During Moderate and High Intensity Exercise

It has been identified that central reactive oxygen species (ROS) scavenge nitric oxide (NO) and increase central sympathetic nerve activity (SNA) outflow. During dynamic exercise increases in ROS have been measured across the brain. We tested the hypothesis that during dynamic leg cycling exercise, antioxidants would increase middle cerebral artery blood velocity (MCAv) and cerebrovascular conductance (CVCi). Five healthy subjects performed back supported semi-recumbent dynamic leg cycling with antioxidant cocktail (AxT) and without AxT (placebo – Pl). Arterial pressures (AP) and MCAv were measured continuously during moderate intensity dynamic leg exercise at heart rates (HR) of 120 bpm (e120) and heavy intensity at HR of 150 bpm (e150). No differences in AP were observed between Pl and Axt at e120 and e150 (P≥0.50). MCAv during AxT at e120 and e150 was increased above Pl (P=0.06). However, the calculated CVCi was significantly greater at e120 and e150 between CT and Pl (P=0.05). From these data we conclude that Axt scavenged exercise induced central ROS resulting in increased central NO induced cerebrovascular vasodilation during exercise