Abstract
Autonomic alterations at the onset of exercise are critical to redistribute cardiac
output towards the contracting muscles while preventing a fall in arterial pressure
due to excessive vasodilation within the contracting muscles. Neural mechanisms responsible
for these adjustments include central command, the exercise pressor reflex, and arterial
and cardiopulmonary baroreflexes. The exercise pressor reflex evokes reflex increases
in sympathetic activity to the heart and systemic vessels and decreases in parasympathetic
activity to the heart, which increases blood pressure (BP), heart rate, and total
peripheral resistance through vasoconstriction of systemic vessels. In this review,
we discuss recent advancements in our understanding of exercise pressor reflex function
in health and disease. Specifically, we discuss emerging evidence suggesting that
sympathetic vasoconstrictor drive to the contracting and non-contracting skeletal
muscle is differentially controlled by central command and the metaboreflex in healthy
conditions. Further, we discuss evidence from animal and human studies showing that
cardiovascular diseases, including hypertension, diabetes, and heart failure, lead
to an altered exercise pressor reflex function. We also provide an update on the mechanisms
thought to underlie this altered exercise pressor reflex function in each of these
diseases. Although these mechanisms are complex, multifactorial, and dependent on
the etiology of the disease, there is a clear consensus that several mechanisms are
involved. Ultimately, approaches targeting these mechanisms are clinically significant
as they provide alternative therapeutic strategies to prevent adverse cardiovascular
events while also reducing symptoms of exercise intolerance.
Keywords
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Article info
Publication history
Published online: July 27, 2020
Accepted:
July 2,
2020
Received in revised form:
July 1,
2020
Received:
June 1,
2020
Identification
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© 2020 Elsevier B.V. All rights reserved.
