Practical exercise physiology

Prof.dr.heba.shawky
Physiological response to
exercise
 Section 1
Metabolic response
Prof. dr.heba shawky
Metabolism?
The chemical reactions that take place in the body cells
❖Catabolic Reactions
Energy released in 2 forms:
• ATP
• Heat Energy
❖Anabolic Reactions
• Metabolic Rate?
The amount of heat released in chemical
reactions per hour, measured by calorie.
 calorie?
Kilocalorie?
Calorie?
• calorie: the amount of heat required to raise the
temperature of one gram of water 1οC.

• Kilocalorie=Calorie= 1000 calories= the amount of heat

required to raise the temperature of one kilogram of
water 1οC.
Caloric (Heat) Value of Food
Physical value: heat liberated from one gram outside the
body
Physiological value: heat liberated from 1 gram inside the
body.
Energy Equivalent of Oxygen
• The amount of energy liberated when one liter of oxygen is used by
the body for oxidation of mixed food substance. It is equivalent to 4.8
Calories.

• 5Cal. for CHO, 4.7 for fats and 4.6 for proteins
Measurement of Metabolic Rate
Direct Calorimetry:
MR ₌
volume of water × temperature difference before and after one hour.
• Difficult
• Only in research
Indirect Calorimetry:
MR ₌
volume of O2 utilization per hour × 4.8 divided by 1000
• Accurate
Energy Balance
Energy Balance?
Energy intake= Energy output
The energy output can be :
Essential metabolic functions
Various physical activities
Digestion and absorption of food
Body temperature
Specific dynamic action of food (SDA).
Thermogenic Effect of Food
• A temporary increase in the metabolic rate after food intake.
• It is due to different metabolic reactions in the liver associated with
storage of food, following digestion and absorption.
• Starts one hour after food intake.
• Lasts for 4 –12 hours.
Rise of MR following meals due to SDA
Factors affecting the SDA
1. Type of food
A meal containing carbohydrates or fats produces 4% - 6%
increase in MR.
A high- protein meal produces 30 % increase in MR.
2. Amount of food
SDA is directly proportional to amount of food intake.
Respiratory Quotient (RQ):
• Def. It is the ratio of the volume of carbon dioxide produced to the
volume of oxygen used per unit time.
• RQ = CO2 produced / O2 consumed in the same metabolic process
1. Determination of the oxidized type of food substance
The RQ ranges from 0.7 to 1.0 according to the type of food substance used:
• RQ for CHO is 1.0 since one molecule of carbon dioxide is formed for each
molecule of oxygen used when metabolized with CHO.

• RQ for fats is 0.7 since a large amount of oxygen combines with hydrogen atoms
from fats to form water instead of carbon dioxide
• RQ for proteins is 0.82 and for a mixed diet 0.85

.
 2-Can be measured for specific tissues or organs as well as for the whole body:
If the O2 consumption and CO2 produced by a specific organ can be calculated
(Blood Flow of the organ per unit time × arterio-venous difference of O2 and CO2
across the organ), then the RQ can be calculated.
• 3-Determination of the source of energy used by an organ:

• E.g. In the brain, the RQ is 0.97 – 0.99, since glucose is its principal source of
energy.
• 4-Determination of pathological disorders:
• In diabetes mellitus, RQ decreases to 0.7 since fats are the main source of energy.
When insulin is given, the RQ is increased to 1.0 due to the oxidation of glucose.
• 5-Determination of the energy equivalent of oxygen:
• When RQ is 1.0, the energy equivalent of oxygen is 5 Calories for CHO.
• When RQ is 0.7, the energy equivalent of oxygen is 4.7 Calories for fats.
• When RQ is 0.82, the energy equivalent of oxygen is 4.8 Calories for proteins.
Differences between the respiratory quotient and respiratory exchange ratio:
• The RQ should be differentiated from the respiratory exchange ratio (R).
• Respiratory exchange ratio (R) This is the ratio of the carbon dioxide output to
the oxygen uptake by the lungs at any given time whether or not equilibrium has
been reached
• Since 5 ml of oxygen is transported by each 100 ml blood from the lungs to the
tissues and only 4 ml of carbon dioxide is transported from the tissues to the lungs,
therefore R under normal resting conditions is less than one.
1. The RQ is affected by metabolism, but R is affected by factors other than
metabolism.
1. The RQ ranges between 0.7 and 1.
2. In contrast, R can reach values as low as 0.5 as in high O2 consumption
(After Exercise) and higher than 1.0 in the following conditions:
• Hyperventilation due to increased volume of expired carbon dioxide.
• During strenuous exercise, R may reach 2.0 due to an increase in the CO2 expired
and also that produced from the buffering of lactic acid to Co2 and water during
anaerobic glycolysis.
• In metabolic acidosis, as respiratory compensation causes the amount of expired
CO2 to rise.
BASAL METABOLIC RATE

Total daily energy expenditure

BASAL METABOLIC RATE (BMR)
• The metabolic rate measured under basal
conditions:
Complete physical and mental rest
Post- absorptive state
Comfortable air temperature
 Calculation?
• The amount of heat production ∕hour ∕meter² surface
area.
• Most of the heat produced is lost by the skin.
• In an average size man it is about
40 C/hour/m2 surface area + 15%.
• The body surface area of the subject can be known from the Du Bois
curve by measuring the weight and height of the subject.

• Because the level of physical activity is variable among different

individuals, the BMR can provide a useful way of comparing metabolic
rate of a person to that of another.
Du Bois chart
Factors affecting the BMR
Physiological Factors:
❖Age: declines with age
❖Sex: the males have a higher metabolic rate than females
❖Physical activity: physical exercise increases BMR
❖Sleep decreases BMR
❖Pregnancy and lactation increase BMR.
❖Cell growth and division increases the metabolic
reactions.
❖Environmental Temperature: low temperature increases
the BMR.
❖Recent food intake increases BMR
❖Fasting decreases BMR
❖Hormones:
Growth hormone increases the BMR by 15-20 %
Thyroid hormones increase BMR.
Adrenaline and noradrenaline increase BMR.
Pathological Factors:
❖Fever accelerates the chemical reactions and increases
BMR by 40%
❖Hyperthyroidism increases BMR by 60 - 100%,
❖Myxoedema decreases BMR by 40%.
❖Malignancy and polycythemia increase BMR.
 Section 2
Metabolic response
Prof. dr.heba shawky
Exercise-Energy Sources

• ATP is the only immediate E source for ms contraction

• ATP inside ms is enough for about 5-6 sec.
• So, ATP is continuously formed by 3 different ways:
• Phosphagen (Phosphocreatine) System (10-15 sec)
• Glycogen-Lactic acid System (30-40 sec)
• Aerobic System (unlimited)
ATP continuous formation
• Phosphocreatine
• The Glycogen lactic Acid system
• The Aerobic System( oxidative phosphorylation)
Phosphocreatine
• Muscle cells have two to three times as much phosphocretine as ATP.
CP:ATP [2-3 :1]
• The cell phosphocreatine plus its ATP are called the phosphogen
energy system[Creatine ~ po3].
• ADP + creatine phosphate ATP +creatine
• Provide maximal muscle power for a period of 10 to 15 seconds. [100-
m run].
• Creatine phosphate is restored by the reverse reaction during muscle
relaxation.
Glycogen lactic Acid system
• In the absence of oxygen ,glycogen is converted to glucose then to
pyruvate ( anaerobic metabolism ).
• Pyruvic acid is converted to lactic acid which diffuses out of the
muscle to interstitial fluid and blood.
• Accumulation of acid metabolites within the muscle inhibits further
breakdown of glycogen and may interfere with the muscle contractile
process.
Glycogen lactic Acid system
• Glycogen lactic acid system (occur in cytoplasm) can provide 30 to 40
second of excess muscle activity in additions to the 10 to 15 second
provided by the phoshogen system. [200 -m runs]
• Lactic acid causes extreme fatigue which serves as a self limitation to
further use of this system for energy.
• Removal of the lactic acid by three ways:
1. Converted to pyruvic acid that metabolized oxidatively by all the body
tissues.
2. Converted to glucose by the liver that is used mainly to replenich the
glycogen stores of the muscles.
3. Used as a fuel in the heart
Fate of Lactic Acid

Pyruvate
The Aerobic System (oxidative-
phosphorylation)
• In the presence of oxygen, fats and glucose can be oxidized completely to
CO2 and H2O (inside mitochondria).
• Glucose is converted to pyruvic acid that enters the mitochondria to react
in the presence of oxygen and give 38ATP/mol of glucose .
• •Aerobic system is required for prolonged athletic activity due to unlimited
source of energy.

• The CO2 is removed by the lung and no lactic acid formation

• Free fatty acids + O2 CO2+H2O+ATP

Fuel of exercise
• Carbohydrate (glycogen & blood glucose):
• Carbohydrates are best suited for brief bouts of intense work since it
can be used anaerobically.
• The total glycogen store in muscles and liver can be exhausted in as
little as 100 minutes of vigorous activity
• The blood glucose reserve is limited.
• That is why athletes ingest glucose solutions while exercising to
counter hypoglycemia and to delay muscle glycogen depletion.
• The fat found in adipose tissue is the main energy reserve of the
body.
Fuel of exercise
• Factors determining the use of carbohydrates or fats as a fuel during
exercise depends on many factors:
• The intensity &duration of exercise.
1. In maximal & submaximal activity with short term duration
carbohydrate.
2. Prolonged steady activity of moderate intensity favors fat usage.
• Blood levels of fatty acids.
• The state of training of the individual ,with training more fat is used.
• N.B. Proteins usually are not considered as a source of energy during
exercise
Oxygen dept
• The oxygen consumed post exercise above resting or basal oxygen
consumption
• (i.e excess post- exercise oxygen consumption )
Oxygen dept
• After a period of exertion is over, the rate of ventilation remains high
for some time, extra O2 is consumed to:
➢Replenishment of glycogen
➢Replenishment of myoglobin with oxygen
➢Removal of lactic acid
➢Replenishment of ATP
Factors keeping high post-exercise O2 consumption

• Increased body temp

• ↑ catecholamines & thyroid hormones
• Restoration of electrolyte disturbance

• N.B. The amount of time to re-establish pre-exercise oxygen uptake

will depend on exercise intensity and duration (several minutes-
several hours)
• O2 dept calculation:
• The difference between the amount of O2 required after exercise & the
amount required in a resting state.
 section 3
Respiratory response
Prof.Dr.Heba Shawky
Lung volumes & capacities using spirometer
Lung volumes
1-Pulmonary ventilation = minute respiratory volume
- It the total volume of air that flows into and out of the respiratory system in one minute.
- Minute ventilation = TV × respiratory rate
= 500 ml/breath × 12 breath/min
= 6000 ml/min.

2. Tidal volume (TV):

It is the volume of air inspired or expired in one respiratory cycle at rest . Equals 500 ml of air.

3. Inspiratory reserve volume (IRV):

It is the maximum volume of air that can be inspired by forced inspiration after normal inspiration.
It equal 3000 ml.

4. Expiratory reserve volume (ERV):

It is the maximum volume of air that can be expired by forced expiration at the end of normal expiration.
It equals 1100 ml
It decreases in lung diseases.
Lung volumes
5. Residual volume (RV):
• it is the volume of air that remain in the lung after a maximal forced expiration.
• It equals: 1200 ml.
• Importance:
• It aerates blood between breaths and hence prevents marked changes in blood
PO2, PCO2.
• It prevents lung collapse.
• It only can be expelled by opening the chest wall
• It increases when the resistance of air passages is increased (bronchial asthma).
• It also increases when lung elasticity decreases (emphysema).
• It cant be measured by spirometry.
Minimal air
• It is a very small volume of air (few ccs) that remains in the lungs even
after opening of the chest wall and complete collapse of the lung.

• It has a medicolegal importance as it indicates that an infant was born

alive and has taken his first breath.

• If a piece of lung tissue is placed in water, it floats while in case of an

infant born dead (still birth) the lung tissue sinks in water.
Lung capacities
• Lung capacities are sums of more than one lung volume.

• Inspiratory capacity (IC):

• It is the maximum volume of air that can be inspired at the end of a normal
expiration.
• IC = TV + IRV = 500+ 3000= 3500 ml.

• Functional residual capacity (FRC):

• It is the volume of air remaining in the lung after normal expiration.
• FRC = ERV + RV =1200+ 1100 = 2300 ml.
• FRC is the volume of air in the lungs between breaths when the respiratory muscles
are relaxed.
• It cant be measured by spirometry.
Lung capacities
• Vital capacity (VC):
• It is the maximum volume of air that can be expired following a maximum
inspiration.
• VC = TV+ IRV+ ERV = 500+ 3000+ 1100= 4600ml.

• Total lung capacity (TLC):

• It is the volume of air in the lung at the end of maximum inspiration.
• TLC = TV+ IRV+ ERV+ RV = 5800 ml.
• It cant be measured by spirometry.
Volumes and capacities that can’t be
measured by spirometry:
1. Residual volume or capacity.
2. Functional residual capacity.
3. Total lung capacity.

• They are measured by Helium dilution method.

Clinical significance of the vital capacity:
• VC is measured clinically as an index of pulmonary function.
• It gives useful information about the health of lungs and the strength
of respiratory muscles.
• It is larger in:
1. Males (more than females).
2. Athletes ( more than sedentary people).
3. Standing position, where gravity pulls the viscera down, allowing more free
descent of the diaphragm.
Clinical significance of the vital capacity:
• It is smaller in:
1. Females.
2. Recumbent position, pregnancy, abdominal tumors, where the abdominal
viscera prevent free descent of the diaphragm.
3. Paralysis and weakness of respiratory muscles.
4. Bone deformities of chest wall, e.g. kyphosis, lordosis, or scoliosis.
5. Loss of lung elasticity, e.g. emphysema.
6. Obstructive lung disease, e.g., bronchial asthma.
7. Restrictive lung disease, e.g., lung fibrosis.
Timed vital capacity
• It is a very simple test of pulmonary function.

• It is obtained by spirometry when a subject inspires maximally and then expires

as hard and as completely as he can.

• The volume exhaled in the first second is called forced expiratory volume 1
(FEV1).

• The total volume exhaled is the forced vital capacity or FVC ( This is often slightly
less than the vital capacity measured on a slow exhalation).

• Normally, FEV1 is about 80% of the FVC.

Obstructive And Restrictive Lung Diseases
OBSTRUCTIVE LUNG DISEASE RESTRICTIVE LUNG DISEASE

Bronchial asthma , emphysema Lung fibrosis, lung collapse

FEV 1 IS REDUSED more than FVC Both FEV1 & FVC are reduced

Ratio FEV1/ FVC % is low Ratio FEV1/FVC % is normal or increased

Residual volume is increased. Residual volume is decreased.

 Section 4
Respiratory &Cardiovascular
response to Exercise
Prof.dr.heba shawky
 The ventilatory response to acute exercise

• The causes of increased minute ventilation during

exercise :
a) Changes in the tidal volume are the major contributor to
increase in pulmonary minute ventilation in light –
moderate intensity exercise while at higher exercise
intensity , tidal volume tends to reach plateau .
b) At the point of tidal volume plateau ,further increase in
pulmonary minute ventilation is attributed to continued
increases in the respiratory rate
Extra amounts of oxygen are provided to the
blood during exercise through:
1- Ventilation increases linearly with respect to oxygen
uptake (VO2)..
2- The increase in ventilation is caused initially by an
increase in both tidal volume and respiratory rate. However
as exercise increases tidal volume reaches a plateau and the
increase is then only due to increasing respiratory rate.
3- A three-fold increase in O2 diffusing capacity resulting
mainly from perfusion of all pulmonary capillaries, thus
providing a greater surface area for oxygen diffusion
 • The oxyhemoglobin dissociation curve:
-Is shifted to the right during exercise
-Hb is about 20% saturated with O2. So,tissues take about 50% of O2 of arterial blood
-Factors that shift the oxyhemoglobin dissociation curve to the right ( during exercise)
1-increase of PCO2
2-increase of temperature
3-decrease of pH and increase H+ concentration
4- increase 2,3-diphosphoglycerate (2,3-DPG), it is an end product of the RBCs metabolism,it
binds to hemoglobin ,changing its conformation and facilitating the off-loading of O2 and
shifting the oxyhemoglobin dissociation curve to the right.

A right ward shift of the curve means that at a given PO2 there is less O2
bound to hemoglobin and more O2 is available to the active muscle
The oxyhemoglobin dissociation curve
Arterial Pulsation
• With each systolic ejection of blood from the left
ventricle, the aorta expands and then recoils, thus
setting up a pressure wave or pulse wave.
• This rhythmic pulsatile phenomenon which is
transmitted from segment to segment of the systemic
arteries, and which can be felt is the arterial pulse.
Comments on radial pulsation:
• Rate, the number of
pulsations per min
• Rhythm, normal regular
heart rhythm is called Sinus
Rhythm
• Equality on both sides,
comparing both sides to
detect any obstruction of
flow.
 Procedure :
Palpate the pulse while recording the time using stopwatch
(count/min)
A) At rest
B) Observe the change in HR
Then ask the person do acute exercise either by walking /running on
the treadmill or cycling .
Calculate HR
• Then, Calculate the expected maximum HR of the person during
exercise .
Maximum heart rate= 220- Age in years
Observe if the person able to achieve the maximum heart rate or not.
The effect of exercise on HR & CO:

• During acute endurance exercise (e.g., walking or cycling), cardiac

output rises in response to the metabolic needs of the exercising
• This type of exercise will lead to an increase in HR&CO due to
a) Deceased vagal tone
b) Rise in sympathetic tone
c) Stroke volume also rises because of increases in venous return lead to
an increased LV contractility and increased stroke volume.
Cardiac function curve
• Remember ,This will shift the cardiac function curve up and to the
left through the following effects:
1-Increasing heart rate.
2-Increasing contractility.
3-Decreasing afterload by decreaseing total peripheral resistance.
Cardiac function curve (Shift up and to the left)
Venous return curve

• The venous return curve also shift up and to the right

through the following effects:
1-Increased MSFP:
2-Increased muscle pumping action and thoracic and cardiac
suction mechanisms to venous return against gravity
3-Arteriolar dilation in contracting muscles
4-Decreased RVR:
This is due to vasodilation of skeletal muscle vessels caused
by vasodilator metabolites .
The heart rate is much lower in trained athelets at rest due to
greater vagal tone and reduced sympathetic drive
Example :
Trained : Resting HR = 50 b/min while SV= 100 ml
Untrained: Resting HR = 70 b/min while SV= 70 ml
Arterial Blood Pressure (ABP)
Arterial Blood Pressure (ABP)
expressed as

Systolic pressure
Diastolic pressure
 Definitions
Definition of ABP:
It is the lateral pressure of the blood on the arterial wall.

Systolic Blood Pressure:

It is the maximum pressure reached in the arteries during ventricular ejection. It equals 120 mmHg.

Diastolic Blood Pressure:

It is the minimum pressure reached in the arteries just before ventricular ejection begins. It equals 80 mmHg

Pulse pressure:
It is the difference between systolic pressure and diastolic pressure.
It equals 40 mmHg.

Mean arterial blood pressure:

It is the average pressure throughout the cardiac cycle.
It equals diastolic pressure + 1/3 pulse pressure.

It is 90 mmHg in average and it provides the driving force for the blood into the tissues.

ABP = Cardiac output × total peripheral resistance

= (HR × SV) × TPR
Measurement of blood pressure provides us with information about the
heart's pumping ability and the condition of the systemic blood
vessels.

-In general, systolic blood pressure indicates the force contraction of the
heart, whereas the diastolic blood pressure indicates the state of the
peripheral resistance.
Principle:
- Normally the flow of blood
in the vessels is streamline or
laminar. If a stethoscope is put on a
vessel with laminar flow, no
sound is heard.
- When the flow of blood in
vessel is turbulent, sounds can be
heard with stethoscope. The
sounds heard during the
auscultatory method of
measurement of ABP are known as
korotkoff sounds.
Apparatus:
Blood pressure is measured indirectly by the use of sphygmomanometer.
The sphygmomanometer consists of:
•A rubber bag (23 × 13 cm)
2- Hand (air) pump
3- Mercury manometer
4- Mercury reservoir
Principle:
Human blood pressure is most commonly measured in the brachial
artery of the upper arm. In addition to being a convenient place for
measurement it has the added advantage of being at approximately
the same level of the heart, so that the pressure which is obtained
closely approximates the pressure in the aorta leaving the heart. This
allows us to correlate blood pressure with heart activity.
General instructions:
1- Ask patient if he/she has ingested caffeine or used nicotine within the
past 60 minutes or exercised within the past 30 minutes. Also note if the
patient is in pain or very emotionally upset.
2- Patient should sit quietly for at least 5 minutes prior to measurement.
3- Measurement done on bare arm ‐ remove a sleeve that cannot be rolled
up without causing restriction.
4- Patient is seated in chair with back supported.
5- Feet flat on the floor, legs uncrossed.
6- Patient must evacuate his bladder from urine before measurement.
7- Patient is seated comfortably and the arm extended on the table.
8- The cuff is completely deflated by rolling it into a tight cylinder with
the valve open.
9- The cuff is then opened and wrapped around the bare upper arm,
making certain that the inflatable bag within the cuff is placed over the medial
aspect of the upper arm, i.e. over the brachial artery. The cuff should not be
too tight or too loose. The lower edge of the cuff should be one or two inches
above the antecubital fossa. If the inflation causes the bag to bulge unevenly,
the whole bag should be re-applied more evenly.

10. Place the manometer on a table at the level of the heart

 Section 5
Cardiovascular response to
Exercise
Prof.dr.heba shawky
Methods:
Two methods are used for determining blood pressure:
Palpatory method
Auscultatory method.

Both methods are essential because occasionally the auscultatory

method; though generally more accurate, may give inaccurate results.
 The palpatory method measures only the
systolic pressure and is inaccurate
Results:
Reading A: ……………………
Reading B: …………………...
Systolic P: …………………….
Auscultatory Method:
you will be able to hear four phases of sounds changes, called Korotkoff
sounds.
- Phase 1: Sharp and clear sound. The pressure where the sound first
appears is the systolic pressure.
- Phase 2: The sounds become softer murmur
- Phase 3: The sounds become louder and clear again
- Phase 4: The sounds suddenly become muffled and reduced in
intensity. After which all sounds disappear.

Diastolic pressure is the pressure at which the sounds disappear.

Auscultatory method principle
Pressure in cuff Artery state Flow Sound

Above Systolic closed No No

pressure

Between systolic Partially Turbulent Yes

and diastolic obstructed

Below diastolic open Laminar No

pressure
So, auscultatory method is more accurate than palpatory method and it
measures both systolic and diastolic blood pressure.

Why palpatory before auscultatory?

To avoid auscultatory gap
Why palpatory before auscultatory?
Palpatory method Auscultatory method
Record systolic only Record both systolic and diastolic
Not accurate accurate

To avoid auscultatory gap

 Physiologic variations in ABP
1-Age Infants : 80/40 mm Hg
Children: 100/65 mm Hg
Adults: 120/80 mm Hg

2-Sex Women < men before menopause

peak value early in the morning due to

3-Circadian rhythm sympathetic activity and lower at midnight
lowest level at midnight
4-Race: People belonging to some races may have higher ABP and higher
incidence of hypertension than people belonging to other races.

5-Emotions: strong emotional stress elevates ABP.

6-Effect of gravity on ABP:

- The MAP in all major arteries is about 100 mmHg in average when
they are at the level of the left ventricle as when the subject is lying down.
- However, in standing position, pressure in arteries above the level of
left ventricle decreases by 0.77 mmHg for each 1 cm above the level of the
ventricle.
- Pressure in arteries below the level of left ventricle increases by 0.77
mmHg for each 1 cm below the level of the ventricle.
Physiologic variations in ABP
Effect of gravity on ABP
In standing position - 0.77 mmHg/cm

100 mmHg

+ 0.77 mmHg/cm
 Physiologic variations in ABP
7-Effect of exercise on systolic and diastolic BP

It depends on type of exercise

Dynamic Static
• Systolic Pr. increases • Systolic → Increases
due to increase SV • Diastolic → Increases
• Diastolic Pr. No • Due to compression of
change or fall due to Bl.V. and increased
VD metabolites lowest level at midnight
resistance
Procedure:
Record your basal ABP.
Exercise on treadmill for about 3-4 min and record ABP
Comment on ABP changes and interpret the findings.
8-Effect of Respiration on ABP:
• ABP fluctuates with respiratory cycles (about 12 cycles per minute).
• These fluctuations are known as “Traube-Hering waves”.
• Mean arterial pressure decreases during inspiration and increases
during expiration.
• These waves are caused by expansion and increased capacity of
pulmonary vascular bed during inspiration due to negative intrapleural
pressure ( suction pressure to the wall of pulmonary vessels ). This
decreases venous return to left ventricle with consequent decrease in
stroke volume, cardiac output and arterial blood pressure.
• The reverse occurs during expiration leading to elevation of arterial
blood pressure.
 Section 6
Cardiovascular response to
Exercise
prof.dr.heba shawky
Electrocardiogram ECG
- Depolarization & repolarization of cardiac myocytes results in
electrical currents.
- These currents can be recorded by electrodes on the body
surface(good conductor).
- Each wave of ECG has characteristic shape, direction,
duration and amplitude.
Apparatus:
Electrocardiograph: It consists of:
1- A sensitive galvanometer and amplifier to amplify the picked electrical current from
the body surface.
2- Writing machine which has electrically heated stylus which inscribes on chemically
treated graph paper.
3- The recording paper moves out of the apparatus at a constant speed of 25 mm/sec.
The paper is divided into small squares 1 × 1 mm. Each 5 small squares are bounded by
a heavier line.
Each small square = 0.04 second. The horizontal calibration gives the amplitude of the
waves in mV. 1 mV = 10 mm.
4- Connector cable: connects the electrode leads to the body surface.
ECG machine
 Description of the Normal ECG:
1-The P wave: represents atrial depolarization.
2-The QRS Complex: represents ventricular depolarization.
It is formed of:
a-Q wave which represents the depolarization of the interventricular septum.
b-R wave which represents the depolarization of the 2 ventricles simultaneously.
c-S wave which represents the depolarization of the thick posterobasal part of the
left ventricle.
3-The T wave: represents ventricular repolarization.
4-U wave (which is usually absent) represents repolarization of the papillary muscles

N.B.: Atrial repolarization is masked by ventricular depolarization.

Important of PR interval:
It is the interval from beginning of P wave to beginning of QRS complex.
It represents the atrial depolarization and the duration of the
atrioventricular conduction.

Important of ST Segment:
From the end of the S wave to the beginning of the T wave. During this
time the heart is completely depolarized, and therefore the record is
isoelectric.
ECG Recording Analysis
1- Determination of the heart rate:

• HR = 1500/ Number of small squares between 2

successive R

- Or HR = 300 / number of large squares in

between each consecutive R wave.
**60–100 beats/min (Normal)
**>100 beats/min (Tachycardia)
**<60 beats/min (Bradycardia)
2-Rhythmcity:
Measure successive R-R intervals: If the intervals are equal in
duration this means regular heart rate. If not, this means irregular
heart rate.
3-P-R interval:
• Measured from beginning of P-wave to beginning of R wave
• It represents: …………………………………………….
4-QRS Complex:
• It represent ……………………………………………...
5-S-T segment:
• Measured from the end of the S wave to beginning of T wave
• S-T segment = ………………………………….……….
• If it is not isoelectrical what is the significance?…myocardial
infarction……..
How to calculate heart rate from ECG
Heart rate = 1500 / R-R in small squares
=300/ R-R in large squares

Calculate the heart rate in this ECG

R-R interval = 20 small square

HR= 1500 / 20 = 75 / minute

 Section 7
Cardiovascular & Autonomic
response to Exercise&
 Some Abnormal ECG Recordings
1. Sinus Tachycardia

• Elevated heart rate of impulses greater than 100 beats/min in an average adult.
• Causes:
Physiological: exercise and stress.
Pathological: fever and hyperthyroidism.
• Symptoms:
Sinus tachycardia is often asymptomatic unless very rapid it may cause Heart
palpitations , a racing, uncomfortable heartbeat or a sensation of "flopping" in
the chest.
• Treatment:*Treatment of the cause.
* Beta blockers are useful if the cause is sympathetic over activity.
• 2. Sinus Bradycardia

Bradycardia can be a serious problem if the heart doesn't

pump enough oxygen-rich blood to the body, brain and
other organs might not get enough oxygen, possibly
causing these
• Symptoms:
*Near-fainting or fainting (syncope)
*Fatigue
*Chest pains
*Easily tiring during physical activity
• Causes of sinus bradycardia:
1-Vagal stimulation
2-Acetylcholine
3-Digitalis
4-Beta blocker
• When a slow heart rate is physiologically normal?
5-Well- trained athletes.
 Effect of exercise on ECG:
• Cause: altered action potential duration, conduction velocity,
and contractile velocity associated with the increase in heart
rate during exercise .
A -Heart rate increases linearly with exercise intensity up to
maximum heart rate
• Failure of heart rate to rise or an abnormally slow increase
during exercise (chronotropic incompetence) may indicate;
• -Electrical conduction pathway disease.
• -It may be drug induced by beta-blockers or calcium channel
antagonists.
B- RR interval: decreases
C-QRS complex: minimal shortening
D- QT interval experiences a rate-related shortening.

• N.B.Sometimes ECG abnormalities seen only during exercise . It is called a

“stress test" or a “treadmill test"
The autonomic nervous system regulates important functions of the body as blood
pressure (BP), heart rate, thermoregulation and respiration.
Autonomic function tests during exercise:
These tests measure how the various systems in the body controlled by
the autonomic nervous system respond to stimulation .
They include:
i- Heart rate variation during respiration
ii- Heart rate variation during postural change
iii- Heart rate response to valsalva manouver
• i- Heart rate variation during respiration
• HR increases during inspiration and decreases during expiration
• Theses changes is called respiratory sinus arrhythmia.
•
• Respiratory sinus arrhythmia: cyclic variation in heart rate with
respitation.
• - Heart rate increases during inspiration and decreases during expiration
• - It is a physiological phenomenon known as cardio-respiratory
coupling results in modulation of sinus rhythm by breathing.
• - It occurs during rest and persist during exercise due to increase in
ventilation.
• - Value :At rest it improves the efficiency of pulmonary gas exchange via
efficient ventilation/perfusion matching. During exercise it increased due to
increase ventilation.
**Is detected by recording HR by using ECG while the subject is breathing deeply
**The R-R interval on an ECG is shortened during inspiration and prolonged during
expiration.
Explanation of Sinus arrhythmia
**HR increases during inspiration due to decreased
cardiac vagal activity
**HR decreases during expiration due to increased vagal
activity
**So, It is considered an index of cardiac vagal function.
Procedure:
1- Connect ECG electrodes for recoding lead II
2- Ask the subject to breath deeply at a rate six breaths per minute
for 3 cycles (allowing 5 seconds each for inspiration and expiration)
3- Record maximum and minimum heart rate with each respiratory
cycle
4- Average the 3 differences:
- Normal: > or equal 15 beats /min
- Borderline: = 11-14 beats/min
- Abnormal: < or equal 10 beats /min
 Section 8
Autonomic response
during exercise
Prof.dr.heba shawky
ii- Heart rate variation during
postural change
ii- Heart rate variation during postural change
(procedure):
• 1-Continuous monitoring of HR for 30 seconds prior to and 60
seconds after standing.
• 2-In normal individuals, reflex acceleration of heart rate is maximal
approximately 15 seconds after standing and then gradually slows
back to near-supine rate.
Failure of heart rate to increase with the development of
symptomatic orthostatic hypotension is indicative of
autonomic dysfunction.
Causes of autonomic dysfunction:
• I- Diabetes Mellitus
• II- Nutritional causes such as vit. B12 deficiency
• III- Toxic /metabolic causes such as porphyria
• IV- Central causes such as cerebral vascular accidents, central
hemorrhages, and syringomyelia.
• V- Primary (idiopathic) degeneration of autonomic postganglionic
fibers
iii- Heart rate response to valsalva maneuver:
- The Valsalva is forced expiration against resistance
- The manoeuvre can result in complex transient cardiovascular
effect associated with the increased intrathoracic and intra-abdominal
pressure with corresponding changes in blood pressure (BP).
- It is relatively simple, inexpensive, non-invasive and reproducible
method .
- The test requires the maintenance of forced expiration against
resistance for 15 seconds, with intrathoraic pressure of about 40 mmHg
(measured by aneroid manometer).
Phases of Valsalva:
Phase I (onset of strain):
Blood pressure increases slightly due to increased intrathoracic pressure
(transmitting the intra thoracic pressure to the rest of the circulation)

Phase II (continued strain):

Arterial pressure decreases, so heart rate begins to increase.
(Continuous elevation of intrathoracic and intra-abdominal pressure
impedes venous return to the heart with decrease in cardiac output and
arterial pressure .The reduced arterial pressure will be sensed by arterial
baroreceptors, causing increased sympathetic activity to the heart lead to
corresponding tachycardia)
Phase III (release):
Further drop in blood pressure due to a sudden drop in intrathoracic
pressure, and the heart rate increase is sustained

Phase IV (Recovery):
- Is associated with increased cardiac output, "overshoot"
hypertension, and finally a reflex bradycardia.
- The restoration of venous return causes a continuous rise in
diastolic heart filling, thus improving the cardiac function leading to;
* An increased stroke volume and cardiac output
Pressure overshoot
• The arterial BP rises in this phase typically 20–40 mmHg above the
baseline pressure, although in some individuals, it can increase even to
80 mmHg above control values.
• (This is due to the fact that the previously released noradrenaline is still
circulating in the system, thus preventing the vessels to dilate, and to
the inertia of the constricted vessels and the high blood volume ejected
from the left ventricle to the constricted arterial tree leads therefore to
a significant increase in the arterial pressure (so-called pressure
overshoot)
 Reflex bradycardia
The activity of arterial baroreceptors which responding to the increased
level of pressure initiates reflex slowing down of the heart rate .
N.B.:
- However valsalva maneuver is commonly accepted as a safe method of
testing cardiac function or the integrity of the autonomic nervous system, the
manoeuvre is not free of potential side effects
- The manoeuver results in an increased intra-ocular pressure which can
lead to retinal or macular haemorrhage
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