Cardiovascular control during exercise -: Insights from spinal cord-injured humans

被引:79
作者
Dela, F
Mohr, T
Jensen, CMR
Haahr, HL
Secher, NH
Biering-Sorensen, F
Kjær, M
机构
[1] Univ Copenhagen, Panum Inst, Dept Med Physiol, DK-2200 Copenhagen N, Denmark
[2] Copenhagen Muscle Res Ctr, Copenhagen, Denmark
[3] Herlev Hosp, Dept Clin Physiol Nucl Med, Copenhagen, Denmark
[4] Rigshosp, Dept Anesthesia, DK-2100 Copenhagen, Denmark
[5] Rigshosp, Ctr Spinal Injury, DK-2100 Copenhagen, Denmark
[6] Univ Copenhagen, Bispebjerg Hosp, Sports Med Res Unit, Copenhagen, Denmark
关键词
electrical stimulation; nervous system; autonomic; heart rate; blood pressure;
D O I
10.1161/01.CIR.0000065225.18093.E4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-We studied the role of the central nervous system, neural feedback from contracting skeletal muscles, and sympathetic activity to the heart in the control of heart rate and blood pressure during 2 levels of dynamic exercise. Methods and Results-Spinal cord-injured individuals (SCI) with (paraplegia, n=4) or without (tetraplegia, n=6) sympathetic innervation to the heart performed electrically induced exercise. Responses were compared with those established by able-bodied individuals (control, n=6) performing voluntary exercise at a similar pulmonary oxygen uptake. In all subjects, cardiac output and leg blood flow increased, but in SCI they reached a maximal value. The increase in cardiac output was mainly elicited by an increase in stroke volume in individuals with tetraplegia, whereas in individuals with paraplegia it was by heart rate. The increase in SCI was slow compared with that in controls. During exercise, blood pressure was stable in controls, whereas it decreased over time in SCI and especially in individuals with tetraplegia. Conclusions-The autonomic nervous system provides for acceleration of the heart at the onset of exercise, but a slow increase in heart rate is established even without central command, neural feedback from working muscles, or autonomic influence on the heart. Yet an intact autonomic nervous system is a prerequisite for a large rise in cardiac output and in turn leg blood flow during exercise. Thus, when the sympathetic nervous system is injured at a level where it influences the heart, vasodilatation in working muscles challenges blood pressure.
引用
收藏
页码:2127 / 2133
页数:7
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