Circulation Research, Vol 58, 281-291, Copyright © 1986 by American Heart Association

ARTICLES

Regulation of stroke volume during submaximal and maximal upright exercise in normal man

MB Higginbotham, KG Morris, RS Williams, PA McHale, RE Coleman and FR Cobb

To characterize the hemodynamic factors that regulate stroke volume during upright exercise in normal man, 24 asymptomatic male volunteers were evaluated by simultaneous right heart catheterization, radionuclide angiography, and expired gas analysis during staged upright bicycle exercise to exhaustion. From rest to peak exercise, oxygen consumption increased from 0.33 to 2.55 liters/min (7.7-fold), cardiac index increased from 3.0 to 9.7 liters/min per m2 (3.2-fold), and arteriovenous oxygen difference increased from 5.8 to 14.1 vol% (2.5-fold). The increase in cardiac index resulted from an increase in heart rate from 73 to 167 beats/min (2.5-fold), and an increase in left ventricular stroke volume index from 41 to 58 ml/m2 (1.4-fold). During low levels of exercise, there was a linear increase in cardiac index due to an increase in both heart rate and stroke volume index; stroke volume index increased as a result of an increase in left ventricular filling pressure and end-diastolic volume index and, to a much smaller extent, a decrease in end-systolic volume index. During high levels of exercise, further increases in cardiac index resulted entirely from an increase in heart rate, since stroke volume index increased no further. Left ventricular end-diastolic volume index decreased despite a linear increase in pulmonary artery wedge pressure; stroke volume index was maintained by a further decrease in end-systolic volume index. The degree to which stroke volume index increased during exercise in individuals correlated with the change in end-diastolic volume index (r = 0.66) but not with the change in end-systolic volume index (r = 0.07). Thus, the mechanism by which left ventricular stroke volume increases during upright exercise in man is dependent upon the changing relationship between heart rate, left ventricular filling, and left ventricular contractility. At low levels of exertion, an increase in left ventricular filling pressure and end-diastolic volume are important determinants of the stroke volume response through the Starling mechanism. At high levels of exertion, the exercise tachycardia is accompanied by a decrease in end-diastolic volume despite a progressive increase in filling pressure, so that stroke volume must be maintained by a decrease in end-systolic volume.

This article has been cited by other articles:

				D. B. Badesch, H. C. Champion, M. A. Gomez Sanchez, M. M. Hoeper, J. E. Loyd, A. Manes, M. McGoon, R. Naeije, H. Olschewski, R. J. Oudiz, et al. Diagnosis and assessment of pulmonary arterial hypertension. J. Am. Coll. Cardiol., June 30, 2009; 54(1 Suppl): S55 - S66. [Abstract] [Full Text] [PDF]

				J. M. Goodman, G.-M. Busato, E. Frey, and Z. Sasson Left ventricular contractile function is preserved during prolonged exercise in middle-aged men J Appl Physiol, February 1, 2009; 106(2): 494 - 499. [Abstract] [Full Text] [PDF]

				J. Gonzalez-Alonso, S. P. Mortensen, T. D. Jeppesen, L. Ali, H. Barker, R. Damsgaard, N. H. Secher, E. A. Dawson, and S. P. Dufour Haemodynamic responses to exercise, ATP infusion and thigh compression in humans: insight into the role of muscle mechanisms on cardiovascular function J. Physiol., May 1, 2008; 586(9): 2405 - 2417. [Abstract] [Full Text] [PDF]

				J. Gonzalez-Alonso Point:Counterpoint: Stroke volume does/does not decline during exercise at maximal effort in healthy individuals J Appl Physiol, January 1, 2008; 104(1): 275 - 276. [Full Text] [PDF]

				A. Crisafulli, E. Salis, F. Tocco, F. Melis, R. Milia, G. Pittau, M. A. Caria, R. Solinas, L. Meloni, P. Pagliaro, et al. Impaired central hemodynamic response and exaggerated vasoconstriction during muscle metaboreflex activation in heart failure patients Am J Physiol Heart Circ Physiol, June 1, 2007; 292(6): H2988 - H2996. [Abstract] [Full Text] [PDF]

				J. M. Goodman, M. R. Freeman, and L. S. Goodman Left ventricular function during arm exercise: influence of leg cycling and lower body positive pressure J Appl Physiol, March 1, 2007; 102(3): 904 - 912. [Abstract] [Full Text] [PDF]

				K. C. Beck, L. N. Randolph, K. R. Bailey, C. M. Wood, E. M. Snyder, and B. D. Johnson Relationship between cardiac output and oxygen consumption during upright cycle exercise in healthy humans J Appl Physiol, November 1, 2006; 101(5): 1474 - 1480. [Abstract] [Full Text] [PDF]

				M. K. Stickland, R. C. Welsh, S. R. Petersen, J. V. Tyberg, W. D. Anderson, R. L. Jones, D. A. Taylor, M. Bouffard, and M. J. Haykowsky Does fitness level modulate the cardiovascular hemodynamic response to exercise? J Appl Physiol, June 1, 2006; 100(6): 1895 - 1901. [Abstract] [Full Text] [PDF]

				M. E Muller, N. van der Velde, J. W M Krulder, and T. J M van der Cammen Syncope and falls due to timolol eye drops BMJ, April 22, 2006; 332(7547): 960 - 961. [Full Text] [PDF]

				D. Vollmann, L. Luthje, P. Schott, G. Hasenfuss, and C. Unterberg-Buchwald Biventricular Pacing Improves the Blunted Force-Frequency Relation Present During Univentricular Pacing in Patients With Heart Failure and Conduction Delay Circulation, February 21, 2006; 113(7): 953 - 959. [Abstract] [Full Text] [PDF]

				H.-F. Tse, C.-W. Siu, K. L.F. Lee, K. Fan, H.-W. Chan, M.-O. Tang, V. Tsang, S. W.L. Lee, and C.-P. Lau The Incremental Benefit of Rate-Adaptive Pacing on Exercise Performance During Cardiac Resynchronization Therapy J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2292 - 2297. [Abstract] [Full Text] [PDF]

				S. P Mortensen, E. A Dawson, C. C Yoshiga, M. K Dalsgaard, R. Damsgaard, N. H Secher, and J. Gonzalez-Alonso Limitations to systemic and locomotor limb muscle oxygen delivery and uptake during maximal exercise in humans J. Physiol., July 1, 2005; 566(1): 273 - 285. [Abstract] [Full Text] [PDF]

				C A Vella and R A Robergs A review of the stroke volume response to upright exercise in healthy subjects Br. J. Sports Med., April 1, 2005; 39(4): 190 - 195. [Abstract] [Full Text] [PDF]

				T. W. Rowland Circulatory Responses to Exercise: Are We Misreading Fick? Chest, March 1, 2005; 127(3): 1023 - 1030. [Abstract] [Full Text] [PDF]

				M. K Stickland, R. C Welsh, M. J Haykowsky, S. R Petersen, W. D Anderson, D. A Taylor, M. Bouffard, and R. L Jones Intra-pulmonary shunt and pulmonary gas exchange during exercise in humans J. Physiol., November 15, 2004; 561(1): 321 - 329. [Abstract] [Full Text] [PDF]

				J. Gonzalez-Alonso, M. K. Dalsgaard, T. Osada, S. Volianitis, E. A. Dawson, C. C. Yoshiga, and N. H. Secher Brain and central haemodynamics and oxygenation during maximal exercise in humans J. Physiol., May 15, 2004; 557(1): 331 - 342. [Abstract] [Full Text] [PDF]

				A. Ferro, C. Duilio, M. Santomauro, and A. Cuocolo Walk test at increased levels of heart rate in patients with dual-chamber pacemaker and with normal or depressed left ventricular function Eur. Heart J., December 1, 2003; 24(23): 2123 - 2132. [Abstract] [Full Text] [PDF]

				R. Lapu-Bula, A. Robert, D. Van Craeynest, A.-M. D'Hondt, B. L. Gerber, A. Pasquet, J. A. Melin, M. De Kock, and J.-L. Vanoverschelde Contribution of Exercise-Induced Mitral Regurgitation to Exercise Stroke Volume and Exercise Capacity in Patients With Left Ventricular Systolic Dysfunction Circulation, September 10, 2002; 106(11): 1342 - 1348. [Abstract] [Full Text] [PDF]

				K. Dickstein In the treatment of heart failure, faster may not always be better Eur. Heart J., August 2, 2002; 23(16): 1239 - 1241. [PDF]

				M. Kindermann, B. Schwaab, N. Finkler, S. Schaller, M. Bohm, and G. Frohlig Defining the optimum upper heart rate limit during exercise. A study in pacemaker patients with heart failure Eur. Heart J., August 2, 2002; 23(16): 1301 - 1308. [Abstract] [PDF]

				D.J.W. van Kraaij, P.E.J. van Pol, A.W. Ruiters, J.B.R.M. de Swart, D.J. Lips, N. Lencer, and P.A.F.M. Doevendans Diagnosing diastolic heart failure Eur J Heart Fail, August 1, 2002; 4(4): 419 - 430. [Abstract] [Full Text] [PDF]

				S. G. De Hert, P. W. ten Broecke, E. Mertens, I. E. Rodrigus, and B. A. Stockman Effects of phosphodiesterase III inhibition on length-dependent regulation of myocardial function in coronary surgery patients Br. J. Anaesth., June 1, 2002; 88(6): 779 - 784. [Abstract] [Full Text] [PDF]

				T. Rowland, E. Mannie, and L. Gawle Dynamics of Left Ventricular Diastolic Filling During Exercise : A Doppler Echocardiographic Study of Boys 10 to 14 Years Old Chest, July 1, 2001; 120(1): 145 - 150. [Abstract] [Full Text] [PDF]

				C.-P. Cheng, T. Ukai, K. Onishi, N. Ohte, M. Suzuki, Z.-S. Zhang, H.-J. Cheng, H. Tachibana, A. Igawa, and W. C. Little The role of ANG II and endothelin-1 in exercise-induced diastolic dysfunction in heart failure Am J Physiol Heart Circ Physiol, April 1, 2001; 280(4): H1853 - H1860. [Abstract] [Full Text] [PDF]

				S. D. McCole, M. D. Brown, G. E. Moore, J. M. Zmuda, J. D. Cwynar, and J. M. Hagberg Cardiovascular hemodynamics with increasing exercise intensities in postmenopausal women J Appl Physiol, December 1, 1999; 87(6): 2334 - 2340. [Abstract] [Full Text] [PDF]

				P. A. Beere, S. D. Russell, M. C. Morey, D. W. Kitzman, and M. B. Higginbotham Aerobic Exercise Training Can Reverse Age-Related Peripheral Circulatory Changes in Healthy Older Men Circulation, September 7, 1999; 100(10): 1085 - 1094. [Abstract] [Full Text] [PDF]

				T. Tanaka, K. Mizushige, H. Masugata, H. Matsuo, and K. Mizushige Prolongation of Left Atrial Augmentation After Handgrip Stress in Coronary Artery Disease: Observation Using Pulsed Doppler Flowmetry Angiology, April 1, 1999; 50(4): 299 - 308. [Abstract] [PDF]

				M. Metra, P. Faggiano, A. D'Aloia, S. Nodari, A. Gualeni, D. Raccagni, and L. Dei Cas Use of cardiopulmonary exercise testing with hemodynamic monitoring in the prognostic assessment of ambulatory patients with chronic heart failure J. Am. Coll. Cardiol., March 15, 1999; 33(4): 943 - 950. [Abstract] [Full Text] [PDF]

				D. K. Rohrer, E. H. Schauble, K. H. Desai, B. K. Kobilka, and D. Bernstein Alterations in dynamic heart rate control in the beta 1-adrenergic receptor knockout mouse Am J Physiol Heart Circ Physiol, April 1, 1998; 274(4): H1184 - H1193. [Abstract] [Full Text] [PDF]

				B. D. Prendergast, B M. Sci, V. F. Sagach, and A. M. Shah Basal Release of Nitric Oxide Augments the Frank-Starling Response in the Isolated Heart Circulation, August 19, 1997; 96(4): 1320 - 1329. [Abstract] [Full Text]

				D. B. Chomsky, C. C. Lang, G. H. Rayos, Y. Shyr, T.-K. Yeoh, R. N. Pierson III, S. F. Davis, and J. R. Wilson Hemodynamic Exercise Testing: A Valuable Tool in the Selection of Cardiac Transplantation Candidates Circulation, December 15, 1996; 94(12): 3176 - 3183. [Abstract] [Full Text]

				J. R. Wilson, J. Groves, and G. Rayos Circulatory Status and Response to Cardiac Rehabilitation in Patients With Heart Failure Circulation, October 1, 1996; 94(7): 1567 - 1572. [Abstract] [Full Text]

				M. Volpe, M. A.E. Rao, A. Cuocolo, R. Russo, A. Nappi, A. F. Mele, I. Enea, B. Trimarco, and M. Condorelli Radionuclide Monitoring of Cardiac Adaptations to Volume Loading in Patients With Dilated Cardiomyopathy and Mild Heart Failure : Effects of Angiotensin-Converting Enzyme Inhibition Circulation, November 1, 1995; 92(9): 2511 - 2518. [Abstract] [Full Text]

				J. R. Wilson, G. Rayos, T. K. Yeoh, P. Gothard, and K. Bak Dissociation Between Exertional Symptoms and Circulatory Function in Patients With Heart Failure Circulation, July 1, 1995; 92(1): 47 - 53. [Abstract] [Full Text]