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Heart Fail Rev. 2000 Mar;5(1):87-100. doi: 10.1023/A:1009802308872.

Muscle reflex control of sympathetic nerve activity in heart failure: the role of exercise conditioning.

Heart failure reviews

M H Khan, L I Sinoway

Affiliations

  1. Department of Medicine, Section of Cardiology, Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey 17033, USA.

PMID: 16228918 DOI: 10.1023/A:1009802308872

Abstract

Muscle reflex control of sympathetic nerve activity has been an area of considerable investigation. During exercise, the capacity of the peripheral vasculature to dilate far exceeds the maximal attainable levels of cardiac output. The activation of sympathetic nervous system and engagement of the myogenic reflex serve as the controlling influence between the heart and the muscle vasculature to maintain blood pressure (BP). Two basic theories of neural control have evolved. The first termed "central command", suggests that a volitional signal emanating from central motor areas leads to increased sympathetic activation during exercise. According to the second theory the stimulation of mechanical and chemical afferents in exercising muscle lead to engagement of the "exercise pressor reflex". Some earlier studies suggested that group III muscle afferent fibers are predominantly mechanically sensitive whereas unmyelinated group IV muscle afferents respond to chemical stimuli. In recent years new evidence is emerging which challenges the concept of functional differentiation of muscle afferents as well as the classic description of muscle "mechano" and "metabo" receptors. Studies measuring concentrations of interstitial substances during exercise suggest that K(+) and phosphate, but not H(+) and lactate, may be important muscle afferent stimulants. The role of adenosine as a muscle afferent stimulant remains an area of debate. There is strong evidence that sympathetic vasoconstriction due to muscle reflex engagement plays an important role in restricting blood flow to the exercising muscle. In heart failure (HF), exercise leads to premature fatigue and accumulation of muscle metabolites resulting in a greater degree of muscle reflex engagement and in the process further decreasing the muscle blood flow. Conditioning leads to an increased ability of the muscle to maintain aerobic metabolism, lower interstitial accumulation of metabolites, less muscle reflex engagement and a smaller sympathetic response. Beneficial effects of physical conditioning may be mediated by a direct reduction of muscle metaboreflex activity or via reduction of metabolic signals activating these receptors. In this review, we will discuss concepts of flow and reflex engagement in normal human subjects and then contrast these findings with those seen in heart failure (HF). We will then examine the effects of exercise conditioning on these parameters in normal subjects and those with congestive heart failure (CHF).

References

  1. Am J Physiol. 1969 Jun;216(6):1502-9 - PubMed
  2. J Appl Physiol (1985). 1989 May;66(5):2472-8 - PubMed
  3. Circ Res. 1989 Mar;64(3):592-9 - PubMed
  4. J Clin Invest. 1988 Oct;82(4):1301-5 - PubMed
  5. Clin Sci. 1964 Oct;27:229-44 - PubMed
  6. J Physiol. 1971 Jul;215(3):789-804 - PubMed
  7. Am J Physiol. 1989 Apr;256(4 Pt 2):H962-7 - PubMed
  8. Circ Res. 1997 Jan;80(1):62-8 - PubMed
  9. Eur Heart J. 1995 Apr;16(4):490-5 - PubMed
  10. Acta Physiol Scand Suppl. 1970;342:1-63 - PubMed
  11. J Physiol. 1992;451:643-51 - PubMed
  12. Circulation. 1992 Sep;86(3):903-8 - PubMed
  13. J Am Coll Cardiol. 1993 Apr;21(5):1101-6 - PubMed
  14. Circ Res. 1989 Aug;65(2):468-76 - PubMed
  15. J Appl Physiol (1985). 1997 Oct;83(4):1291-9 - PubMed
  16. Circulation. 1999 Jun 15;99(23):3002-8 - PubMed
  17. Int J Cardiol. 1988 Feb;18(2):187-95 - PubMed
  18. J Appl Physiol (1985). 1989 Jan;66(1):429-36 - PubMed
  19. Circulation. 1974 Jul;50(1):137-43 - PubMed
  20. J Appl Physiol (1985). 1987 Apr;62(4):1724-32 - PubMed
  21. Am J Physiol. 1992 Feb;262(2 Pt 2):H411-9 - PubMed
  22. Respir Physiol. 1985 Mar;59(3):313-37 - PubMed
  23. J Appl Physiol Respir Environ Exerc Physiol. 1983 Jul;55(1 Pt 1):105-12 - PubMed
  24. J Appl Physiol (1985). 1994 Mar;76(3):1077-81 - PubMed
  25. Am J Physiol. 1989 Dec;257(6 Pt 2):H1812-8 - PubMed
  26. J Physiol. 1980 Dec;309:45-54 - PubMed
  27. Heart. 1997 Nov;78(5):437-43 - PubMed
  28. Circulation. 1987 Nov;76(5):1009-19 - PubMed
  29. Circulation. 1989 Nov;80(5):1338-46 - PubMed
  30. J Appl Physiol (1985). 2000 Jan;88(1):126-34 - PubMed
  31. Circulation. 1992 May;85(5):1751-9 - PubMed
  32. Circ Res. 1991 Jul;69(1):228-38 - PubMed
  33. Acta Med Scand Suppl. 1967;472:146-67 - PubMed
  34. J Appl Physiol Respir Environ Exerc Physiol. 1984 May;56(5):1223-8 - PubMed
  35. J Appl Physiol (1985). 1997 Jun;82(6):1811-7 - PubMed
  36. J Clin Invest. 1994 Apr;93(4):1654-60 - PubMed
  37. Circ Res. 1970 Feb;26(2):185-99 - PubMed
  38. J Appl Physiol (1985). 1997 Jun;82(6):1932-8 - PubMed
  39. Am J Physiol. 1984 Jan;246(1 Pt 2):H59-68 - PubMed
  40. J Appl Physiol (1985). 1989 Jan;66(1):88-95 - PubMed
  41. J Pharmacol Exp Ther. 1993 Dec;267(3):1369-74 - PubMed
  42. J Physiol. 1992 Feb;447:549-62 - PubMed
  43. Circ Res. 1985 Sep;57(3):461-9 - PubMed
  44. J Physiol. 1972 Oct;226(1):173-90 - PubMed
  45. Circ Res. 1977 Sep;41(3):332-41 - PubMed
  46. Life Sci. 1986 Dec 8;39(23):2229-36 - PubMed
  47. J Appl Physiol Respir Environ Exerc Physiol. 1984 Sep;57(3):644-50 - PubMed
  48. J Clin Invest. 1993 Nov;92(5):2353-9 - PubMed
  49. J Neurophysiol. 1991 Feb;65(2):360-70 - PubMed
  50. J Physiol. 1985 Sep;366:233-49 - PubMed
  51. Cardiovasc Res. 1997 Feb;33(2):297-306 - PubMed
  52. Circ Res. 1987 Dec;61(6):779-86 - PubMed
  53. Acta Physiol Scand Suppl. 1994;615:1-50 - PubMed
  54. Circulation. 1986 Aug;74(2):245-51 - PubMed
  55. Circ Res. 1990 Jun;66(6):1576-84 - PubMed
  56. Circulation. 1989 Oct;80(4):769-81 - PubMed
  57. Circulation. 1976 Sep;54(3):477-80 - PubMed
  58. Am J Physiol. 1992 Oct;263(4 Pt 2):H1078-83 - PubMed
  59. Physiol Rev. 1981 Jan;61(1):151-247 - PubMed
  60. J Am Coll Cardiol. 1997 Apr;29(5):1067-73 - PubMed
  61. Circulation. 1997 Apr 1;95(7):1764-7 - PubMed
  62. Circulation. 1988 Sep;78(3):506-15 - PubMed
  63. J Appl Physiol (1985). 1988 Jun;64(6):2306-13 - PubMed
  64. Am J Physiol. 1991 Nov;261(5 Pt 2):H1653-8 - PubMed
  65. J Appl Physiol (1985). 1998 Jan;84(1):277-83 - PubMed
  66. J Appl Physiol (1985). 1985 Mar;58(3):936-41 - PubMed
  67. Circulation. 1986 Oct;74(4):775-9 - PubMed
  68. Circulation. 1985 Jan;71(1):57-62 - PubMed
  69. J Auton Nerv Syst. 1981 Sep;4(3):231-47 - PubMed
  70. J Appl Physiol (1985). 1989 Nov;67(5):1801-6 - PubMed
  71. J Appl Physiol (1985). 1997 Nov;83(5):1575-80 - PubMed
  72. J Neurophysiol. 1993 Apr;69(4):1053-9 - PubMed
  73. J Appl Physiol (1985). 1988 Oct;65(4):1539-47 - PubMed
  74. Fed Proc. 1980 Apr;39(5):1506-13 - PubMed
  75. Circ Res. 1995 May;76(5):885-91 - PubMed
  76. Circ Res. 1990 Jun;66(6):1643-57 - PubMed
  77. J Clin Invest. 1968 Apr;47(4):960-70 - PubMed
  78. Circulation. 1991 Oct;84(4):1597-607 - PubMed
  79. J Appl Physiol (1985). 1989 Sep;67(3):980-4 - PubMed
  80. J Appl Physiol (1985). 1993 Jul;75(1):373-81 - PubMed
  81. Prog Cardiovasc Dis. 1976 May-Jun;18(6):459-95 - PubMed
  82. J Appl Physiol (1985). 1993 Aug;75(2):668-74 - PubMed
  83. J Clin Invest. 1992 Jun;89(6):1875-84 - PubMed
  84. Circulation. 1990 Feb;81(2):518-27 - PubMed
  85. J Appl Physiol (1985). 1988 Jul;65(1):434-40 - PubMed
  86. Circulation. 1988 Aug;78(2):320-6 - PubMed
  87. Circ Res. 1995 Jan;76(1):127-31 - PubMed
  88. J Clin Invest. 1990 Sep;86(3):751-8 - PubMed
  89. J Appl Physiol (1985). 1994 Dec;77(6):2612-7 - PubMed
  90. Br J Clin Pharmacol. 1987 Apr;23(4):486-90 - PubMed
  91. J Appl Physiol (1985). 1999 Feb;86(2):767-72 - PubMed
  92. Prog Cardiovasc Dis. 1982 May-Jun;24(6):437-59 - PubMed
  93. Circulation. 1991 Oct;84(4):1589-96 - PubMed
  94. Am J Physiol. 1978 Mar;234(3):H305-11 - PubMed
  95. Am J Physiol. 1991 Jan;260(1 Pt 2):H37-41 - PubMed
  96. Am J Physiol. 1997 Jan;272(1 Pt 2):R386-91 - PubMed
  97. J Physiol. 1937 Jun 3;89(4):372-83 - PubMed
  98. Circ Res. 1994 Feb;74(2):235-43 - PubMed
  99. J Clin Invest. 1996 Jul 15;98(2):584-96 - PubMed
  100. Am J Physiol. 1983 Jul;245(1):H66-71 - PubMed
  101. Circ Res. 1979 May;44(5):660-6 - PubMed
  102. Am J Physiol. 1994 Aug;267(2 Pt 2):H770-8 - PubMed
  103. Circulation. 1986 Apr;73(4):615-21 - PubMed
  104. J Appl Physiol (1985). 1989 Mar;66(3):1046-53 - PubMed
  105. Am J Physiol Regul Integr Comp Physiol. 2000 Mar;278(3):R563-71 - PubMed
  106. J Appl Physiol (1985). 1990 Aug;69(2):407-18 - PubMed
  107. J Physiol. 1972 Jul;224(1):173-86 - PubMed
  108. Circulation. 1996 Mar 1;93(5):940-52 - PubMed
  109. J Appl Physiol (1985). 1998 May;84(5):1551-9 - PubMed
  110. Circ Res. 1970 Oct;27(4):495-503 - PubMed
  111. Circ Res. 1962 Sep;11:370-80 - PubMed
  112. Brain Res. 1976 Jun 11;109(2):402-6 - PubMed
  113. Circulation. 1987 Dec;76(6):1344-52 - PubMed
  114. Circulation. 1991 Nov;84(5):2034-9 - PubMed
  115. J Physiol. 1913 Oct 17;47(1-2):112-36 - PubMed
  116. Circulation. 1990 Aug;82(2):465-72 - PubMed

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