Cardiovascular Response to Cardiovascular Response to Strength TrainingStrength Training

Chronic Adaptation at RestChronic Adaptation at Rest

Decrease rest Heart rate (HR) and Blood Decrease rest Heart rate (HR) and Blood pressure (BP)pressure (BP)Change in Blood lipidChange in Blood lipidChange in cardiac morphology, Stroke volume Change in cardiac morphology, Stroke volume (SV), Cardiac output (CO)(SV), Cardiac output (CO)

Adaptation at restAdaptation at restHeart rateHeart rateBlood pressureBlood pressure systolicsystolic diastolicdiastolicDouble productDouble productStroke volume (absolute)Stroke volume (absolute)Relative BSARelative BSARelative LBMRelative LBMCardiac systolic functionCardiac systolic functionCardiac diastolic functionCardiac diastolic functionLipid profileLipid profile total cholesteroltotal cholesterol HDL-CHDL-CLDL-CLDL-C

↓↓or no changeor no change

↓↓or no changeor no change↓↓or no changeor no change↓↓or no changeor no change↑↑or no changeor no change No changeNo change No changeNo change↑↑or no changeor no change No changeNo change

↓↓or no changeor no change↑↑or no changeor no change↓↓or no changeor no change

Heart Rate (HR)Heart Rate (HR)

Short-term longitudinal studies report Short-term longitudinal studies report decreases of from 5 to 12%decreases of from 5 to 12%Decrease resting HR is normally attributed to a Decrease resting HR is normally attributed to a combination of increased parasympathetic and combination of increased parasympathetic and diminished tonediminished tone

Nervous System Regulation of Heart Nervous System Regulation of Heart RateRate

The spontaneous activity of The spontaneous activity of autonomic nerves is regulated autonomic nerves is regulated by different types of sensory by different types of sensory receptors in the body that receptors in the body that monitor physiological functionmonitor physiological functionNTS: NTS: nucleus tractus nucleus tractus solitarius (NTS) of the solitarius (NTS) of the medullamedullaReceptor afferents: Sensory Receptor afferents: Sensory receptors that are involved in receptors that are involved in regulating blood pressure are regulating blood pressure are called baroreceptorscalled baroreceptors

Pulse pressurePulse pressure– Difference between systolic and diastolicDifference between systolic and diastolic

Mean arterial pressure (MAP)Mean arterial pressure (MAP)– Average pressure in the arteriesAverage pressure in the arteries

MAP = Diastolic + 1/3(pulse pressure)

Pulse Pressure = Systolic - Diastolic

Blood Pressure (BP)Blood Pressure (BP)

Blood Pressure (BP)Blood Pressure (BP)Highly trained athletes to have Highly trained athletes to have average or lower than average average or lower than average systolic and diastolic blood systolic and diastolic blood pressure (SBP/DBP)pressure (SBP/DBP)

Mean changes in resting Mean changes in resting systolic and diastolic blood systolic and diastolic blood pressures after two months of pressures after two months of combined strength and combined strength and endurance exerciseendurance exercise

MisconceptionsMisconceptionsStrength training causes hypertension?Strength training causes hypertension?Some athletes observed hypertension may be: Some athletes observed hypertension may be: – Essential hypertension Essential hypertension – Chronic overtraining Chronic overtraining – Use of androgens Use of androgens – Large gains of muscle massLarge gains of muscle mass

Possible ExplanationsPossible Explanations

Increase body fatIncrease body fatIncrease body saltIncrease body saltAlternations of the Alternations of the sympathoadrenal drivesympathoadrenal drive

Adrenergic and Adrenergic and Cholinergic Receptors Cholinergic Receptors in Blood Vesselsin Blood Vessels

Double ProductDouble Product

DP=HR × SBPDP=HR × SBPAn estimate of myocardial work and is An estimate of myocardial work and is proportional to myocardial oxygen proportional to myocardial oxygen consumptionconsumptionLongitudinal strength training decrease the rest Longitudinal strength training decrease the rest double productdouble productIndicating a decrease in myocardial oxygen Indicating a decrease in myocardial oxygen consumption at rest as an adaptation to consumption at rest as an adaptation to strength trainingstrength training

Stroke VolumeStroke Volume

Increase absolute stroke Increase absolute stroke volume is due to a greater volume is due to a greater diastolic left ventricular diastolic left ventricular diameter and a normal diameter and a normal ejection fractionejection fractionthe stroke volume is 75 the stroke volume is 75 ml for an untrained man ml for an untrained man at rest, and 105 ml for a at rest, and 105 ml for a trained athlete at resttrained athlete at rest

Lipid ProfileLipid ProfileThe effects of strength training on lipid profile The effects of strength training on lipid profile is controversial in male, female subjects, also is controversial in male, female subjects, also in longitudinal and cross-section designsin longitudinal and cross-section designsThese studies be criticized:These studies be criticized:– Inadequate control of ageInadequate control of age– DietDiet– Training regimesTraining regimes– Androgen useAndrogen use– Single blood sampleSingle blood sample– Change in body compositionChange in body composition– Effect from last training sessionEffect from last training session

Programmes using 8-12 rep. per set of an Programmes using 8-12 rep. per set of an exercise and short rest periods may more exercise and short rest periods may more positively affect lipid profile than heavy positively affect lipid profile than heavy resistance for 1-6 rep. per set and long rest resistance for 1-6 rep. per set and long rest period.period.

Lipid ProfileLipid Profile

Lipoprotein Lipoprotein measurementmeasurement

Low amount, Low amount, moderate moderate intensityintensity

Low amount, Low amount, high intensityhigh intensity

High amount, High amount, high intensityhigh intensity

p*p*

LDL cholesterol LDL cholesterol (mg/dL)(mg/dL)

+5.1+5.1 +2.1+2.1 -3.6-3.6 0.010.01

HDL cholesterol HDL cholesterol (mg/dL)(mg/dL)

+1.1+1.1 +.8+.8 +3.8+3.8 0.0050.005

Triglycerides (mg/dL)Triglycerides (mg/dL) -50.4-50.4 -13.3-13.3 -20-20 0.0020.002

LDL particles (nmol/L)LDL particles (nmol/L) -59-59 -6-6 -96-96 0.0020.002

Small LDL particles Small LDL particles (mg/dL of cholesterol)(mg/dL of cholesterol)

+4.7+4.7 +1.3+1.3 -9.8-9.8 <0.001<0.001

Lipid Profile and Intensity of ExerciseLipid Profile and Intensity of Exercise

Size of LDL particles Size of LDL particles (nm)(nm)

+0.1+0.1 +0.1+0.1 +0.3+0.3 0.050.05

Large VLDL particles Large VLDL particles (mg/dL of (mg/dL of triglycerides)triglycerides)

-42-42 -13.5-13.5 -14.5-14.5 0.030.03

Size of VLDL Size of VLDL particles (nm)particles (nm)

-6.5-6.5 -4.1-4.1 -1.1-1.1 0.040.04

Large HDL particles Large HDL particles (mg/dL of cholesterol)(mg/dL of cholesterol)

+0.9+0.9 +0.9+0.9 +4.9+4.9 0.020.02

Size of HDL particles Size of HDL particles (nm)(nm)

00 00 +0.2+0.2 0.020.02

•p for intention-to-treat analysis, comparing changes in high-amount, high-intensity group with changes in •control patients.To download table as slides, click on slide logo below

Lipoprotein Lipoprotein measurementmeasurement

Low amount, Low amount, moderate moderate intensityintensity

Low amount, Low amount, high high intensityintensity

High High amount, high amount, high intensityintensity

p*p*

Cardiac morphology adaptations at restCardiac morphology adaptations at rest

Relative to:Relative to:AbsoluteAbsolute BSABSA LBMLBM

Wall ThicknessWall Thickness Left ventricleLeft ventricle SeptumSeptum Right ventricleRight ventricleChamber volumeChamber volume Left ventricleLeft ventricle Right ventricleRight ventricleLeft ventricular Left ventricular massmass

↑ ↑ ↑↑ ↑ ↑↑ ↑ ↑↑ ↑ ↑ No changeNo change ↑ ↑↑ ↑or no changeor no change No changeNo change↑↑ ↑↑↑ ↑or no changeor no change

↑↑↑↑or no changeor no change↑↑↑↑or no changeor no change No changeNo change

No changeNo change No changeNo change↑↑↑↑or no changeor no change

↑↑↑↑or no changeor no change↑↑↑↑or no changeor no change No changeNo change

No changeNo change No changeNo change↑↑or no changeor no change

Cardiac Wall ThicknessCardiac Wall Thickness

Diastolic posterior left Diastolic posterior left ventricular (PWTd) and ventricular (PWTd) and intraventricular septum intraventricular septum (IVSd) most common (IVSd) most common use to determine wall use to determine wall thickness using thickness using echocardiographic echocardiographic techniquestechniques

Highly trained male’s absolute PWTd and Highly trained male’s absolute PWTd and IVSd is increased due to strength trainingIVSd is increased due to strength trainingThis increase is reduced if examine relative to This increase is reduced if examine relative to body surface area or lean body massbody surface area or lean body massIncreased wall thickness is caused by Increased wall thickness is caused by intermittent elevated BP during training and intermittent elevated BP during training and related to the caliber of athlete and to the related to the caliber of athlete and to the strength training intensity and volumestrength training intensity and volume

Chamber DimensionsChamber Dimensions

As an indication of volume overload on the heartAs an indication of volume overload on the heartCommonly found in endurance athletesCommonly found in endurance athletes Bodybuilder greater left ventricular internal Bodybuilder greater left ventricular internal dimensions, in absolute or relative to body surface dimensions, in absolute or relative to body surface or lean body mass but not in Weightlifter or lean body mass but not in Weightlifter Strength-training do not increase cardiac chamber Strength-training do not increase cardiac chamber size which may increase after bodybuilding-type size which may increase after bodybuilding-type programmesprogrammes

Left ventricular massLeft ventricular mass

National/international calibre National/international calibre ＞＞ less calibreless calibre

Bodybuilder=weightlifter > controlBodybuilder=weightlifter > control

Bodybuilder ↑chamber size and wall thicknessBodybuilder ↑chamber size and wall thickness

Weightlifter ↑chamber size Weightlifter ↑chamber size

↑↑is related to the intensity and calibre of athletesis related to the intensity and calibre of athletes

Feature Athletic Heart SyndromeCardiomyopathy .

Left ventricular hypertrophy < 13 mm > 15 mm

Left ventricular end-diastolic < 60 mm > 70 mm diameter

Diastolic function Normal (E:A ratio > 1) Abnormal (E:A ratio < 1)

Septal hypertrophy Symmetric Asymmetric (in hypertrophic cardiomyopathy)

Family history None May be present

BP response to exercise Normal Normal or reduced systolic BP response

Deconditioning Left ventricular No left ventricular hypertrophy regression hypertrophy

regression .

Features Distinguishing Athletic Heart Features Distinguishing Athletic Heart Syndrome From Cardiomyopathy Syndrome From Cardiomyopathy

Systolic FunctionSystolic Function

MeasurementMeasurement– % fractional shortening (%FS)% fractional shortening (%FS)– Ejection fraction (Ef) (normal =55-77%)Ejection fraction (Ef) (normal =55-77%)– Velocity of circumferential shortening (VCS)Velocity of circumferential shortening (VCS)Greater %FS in athletes than control (32 vs. Greater %FS in athletes than control (32 vs. 37%)37%)Most data show strength training have no Most data show strength training have no effect on systolic functioneffect on systolic function

Diastolic FunctionDiastolic Function

Abnormalities in diastolic function are Abnormalities in diastolic function are associated with cardiac hypertrophy due to associated with cardiac hypertrophy due to hypertensionhypertensionPower-liftersPower-lifters– Greater absolute and relative to body surface area Greater absolute and relative to body surface area

left ventricular massleft ventricular mass

Factors Increasing Diastolic Factors Increasing Diastolic PressurePressure

Impaired Ventricular Relaxation Increased Ventricular StiffnessImpaired Ventricular Relaxation Increased Ventricular Stiffness

HypertrophyHypertrophy

Myocardial ischemiaMyocardial ischemia

HypertensionHypertension

Collagen deposition and fibrosisCollagen deposition and fibrosis

Regional asynchronyRegional asynchrony

Increased preload, afterloadIncreased preload, afterload

Abnormal calcium fluxAbnormal calcium flux

Tachycardia Tachycardia

HypertrophyHypertrophy

HypertensionHypertension

Collagen deposition and fibrosisCollagen deposition and fibrosis

Cellular disarrayCellular disarray

Myocardial infiltrationMyocardial infiltration

Pericardial constriction or restrictionPericardial constriction or restriction

Acute responseAcute response

HR, SBP, and DBP increase during the HR, SBP, and DBP increase during the performance of dynamic heavy strength performance of dynamic heavy strength exerciseexerciseHighest HR and BP normally occur during the Highest HR and BP normally occur during the last repetitions of a set to volitional fatiguelast repetitions of a set to volitional fatigueHR, BP and CO response increase with HR, BP and CO response increase with increased active muscle massincreased active muscle massThe response is not linear The response is not linear

Acute response of strength exercise Acute response of strength exercise relative to restrelative to rest

Position of repetitionPosition of repetitionConcentricConcentric EccentricEccentric

Heart rateHeart rateBlood pressureBlood pressure SystolicSystolic DiastolicDiastolicIntra-thoracic pressureIntra-thoracic pressureCardiac outputCardiac outputStroke volumeStroke volume

↑ ↑ ↑↑↑↑↑↑No change?No change?No change?No change?

↑↑↑↑↑↑↑↑↑↑??↑↑??

Strength training with Valsalva maneuvers Strength training with Valsalva maneuvers which elevate intra-thoracic pressure would which elevate intra-thoracic pressure would lead to a greater BPlead to a greater BP

Concentric portion of exercise may Concentric portion of exercise may mechanically induce an increase in peripheral mechanically induce an increase in peripheral resistance resistance The increased intra-thoracic pressure may The increased intra-thoracic pressure may have a protective function for the cerebral have a protective function for the cerebral blood vesselsblood vessels

Factors result in an Factors result in an increase in preload (by increase in preload (by causing fluid retention causing fluid retention and venous constriction) and venous constriction) and an increase in heart and an increase in heart rate and contractility, rate and contractility, thereby raising cardiac thereby raising cardiac outputoutput

Chronic adaptation during strength Chronic adaptation during strength exerciseexercise

Lower maximal systolic and diastolic intra-Lower maximal systolic and diastolic intra-arterial BP and HR max during strength arterial BP and HR max during strength training in body builders (absolute and relative training in body builders (absolute and relative workload)workload)Cross-section and longitudinal data have Cross-section and longitudinal data have shown that strength training can result in a shown that strength training can result in a lower pressor response and lower myocardial lower pressor response and lower myocardial oxygen consumption oxygen consumption

Decrease BP during activity resulting in a Decrease BP during activity resulting in a decreased after load on the left ventricledecreased after load on the left ventricleForceful Vasalva manoeuver may elevate Forceful Vasalva manoeuver may elevate intrathoracic and intra abdominal pressure in intrathoracic and intra abdominal pressure in power lifter that lower COpower lifter that lower CO

VOVO22 max increase in some but not all strength max increase in some but not all strength programmesprogrammesFactors affecting VOFactors affecting VO22 max after strength max after strength trainingtraining– Total training volumeTotal training volume– Rest periods between setsRest periods between sets– Large vs small muscle mass exerciseLarge vs small muscle mass exercise

Adaptation during exercise due to Adaptation during exercise due to strength training relative to normalsstrength training relative to normals

Heart rateHeart rateBlood pressureBlood pressure SystolicSystolic DiastolicDiastolicDouble productDouble productCardiac outputCardiac outputStroke VolumeStroke VolumeVOVO2max2max

↓↓

↓ ↓ or no changeor no change↓ ↓ or no changeor no change↓↓↑↑↑↑↑↑

ConculsionConculsion

Strength training does not result in a pressor Strength training does not result in a pressor response that has an impact upon the response that has an impact upon the cardiovascular system cardiovascular system Long-term performance of strength training Long-term performance of strength training can result in positive adaptations of the can result in positive adaptations of the cardiovascular system at rest and during workcardiovascular system at rest and during workThe extent of these adaptations may in large The extent of these adaptations may in large part be dependent upon the volume and part be dependent upon the volume and intensity if strength training performedintensity if strength training performed

DiscussionDiscussionHow do you design a resistance training for a lower How do you design a resistance training for a lower fitness, middle-aged male who could be able to fitness, middle-aged male who could be able to reduce his blood pressure from 138/95 to 120/80.reduce his blood pressure from 138/95 to 120/80.

What do you think why an intense strength training What do you think why an intense strength training could change the preload and afterload of heart (e.g. could change the preload and afterload of heart (e.g. 85% 1RM).85% 1RM).

What would be a possible explanation regarding the What would be a possible explanation regarding the effect of weight training on autonomic nerve system’s effect of weight training on autonomic nerve system’s responses and adaptations. responses and adaptations.