Cardiovascular Responses to Apnea during Dynamic Exercise

Abstract

Breath holding maneuvers induce hypoxia, hypercapnia, and various cardiovascular responses typically including increases in total peripheral resistance, mean arterial pressure (MAP) and decreases in heart rate (HR). During dynamic exercise these responses may have a generally negative impact on performance. Moreover, they deserve particular attention in cardiovascular risk subjects. In 26 healthy sport students we studied the HR and MAP effects induced by the combination of dynamic exercise (cycle ergometry, 30 W and 250 W) with 20 s of either respiratory arrest (mouth piece pressure held constant at 20 mm Hg), free breathing, or rebreathing, i. e. periods of unimpeded breathing leading to similar levels of hypercapnia and hypoxia as the respiratory arrest. The measurements yielded no major differences between the conditions of rebreathing and free breathing. In contrast, 20 s of apnea led to a marked increase in MAP and a HR depression at both levels of exercise intensity. Additionally, there was a delayed MAP recovery after this stimulus. The present findings show that breath holding has marked effects on MAP and HR during dynamic exercise, which are essentially independent of the resulting hypoxia and of increases in intrathoracic pressure. The key factor seems to be an increase in total peripheral resistance, probably including a vasoconstriction in the exercising muscles.

Breath holding - human diving response - rebreathing - strenuous exercise - blood pressure - heart rate

References

• 1 Ahn B, Nishibayashi Y, Okita S, Masuda A, Takaishi S, Paulev E, Honda Y. Heart rate response to breath-holding during supramaximal exercise.  Eur J Appl Physiol. 1989;  59 146-151
• 2 Baum K, Essfeld D, Leyk D, Stegemann J. Blood pressure and heart rate during rest-exercise and exercise-rest transitions.  Eur J Appl Physiol. 1992;  64 134-138
• 3 Baum K, Ruether T, Essfeld D. Reduction of blood pressure response during strength training through intermittent muscle relaxations.  Int J Sports Med. 2003;  24 441-445
• 4 Ciccone M, Federici A, di Noia D, Cipressa A, Epifani M, Losano G, Rizzon P. Tachycardia and coronary blood flow: non-invasive estimation during Valsalva manoeuvre and exercise.  Clin Physiol. 1993;  13 525-533
• 5 Craig A B, Medd W L. Man's responses to breath-hold exercise in air and in water.  J Appl Physiol. 1968;  24 773-777
• 6 Elisberg E, Singian E, Miller M, Katz L. The effects of the Valsalva maneuver on the circulation.  Circulation. 1953;  7 880
• 7 Ferretti G. Extreme human breath-hold diving.  Eur J Appl Physiol. 2001;  84 254-271
• 8 Ferrigno M, Lundgren C E. Breath-hold diving. Bennett P, Elliott D, Brubakk AO Bennett and Elliott's Physiology and Medicine of Diving. 5th ed. Edinburgh; Saunders 2003: 153-180
• 9 Hamilton W F, Woodbury R A, Harper H T. Physiological relationships between intrathoracic and arterial pressures.  JAMA. 1936;  107 853
• 10 Hong S K. Breath-hold diving. Bove AA, Davis JC Diving Medicine. 2nd ed. Philadelphia; WB Saunders 1990: 59-68
• 11 Korner P I, Tonkin A M, Uther J B. Reflex and mechanical circulatory effects of graded Valsalva maneuvers in normal man.  J Appl Physiol. 1976;  40 434-440
• 12 Leyk D, Baum K, Wamser P, Wackerhage H, Essfeld D. Cardiac output, leg blood flow and oxygen uptake during foot plantar flexions.  Int J Sports Med. 1999;  20 510-515
• 13 Lin Y C, Shida K K, Hong S K. Effects of hypercapnia, hypoxia, and rebreathing on heart rate response during apnea.  J Appl Physiol. 1983;  54 166-171
• 14 Lin Y C, Shida K K, Hong S K. Effects of hypercapnia, hypoxia, and rebreathing on circulatory response to apnea.  J Appl Physiol. 1983;  54 172-177
• 15 Lindholm P, Sundblatt P, Linnarsson D. Oxygen conserving effects of apnea in exercising men.  J Appl Physiol. 1999;  87 2122-2127
• 16 Maentysaari M, Antila K, Peltonen T. Relationship between the changes in heart rate and cardiac output during the Valsalva maneuver.  Acta Physiol Scand. 1984;  122 (Suppl 537) 45-49
• 17 Nobrega A CL, Williamson J W, Araujo C GS, Friedman D B. Heart rate and blood pressure responses at the onset of dynamic exercise: effect of Valsalva manoeuvre.  Eur J Appl Physiol. 1994;  68 336-340
• 18 Olschewski H, Brück K. Cardiac responses to the Valsalva manoeuvre in different body positions.  Eur J Appl Physiol. 1990;  61 20-25
• 19 Paulev P E, Honda Y, Sakakibara Y, Morikawa T, Tanaka Y, Nakamura W. Brady- and tachycardia in light of the Valsalva and the Mueller maneuver (apnea).  Jpn J Physiol. 1988;  38 507-517
• 20 Porth C J, Bamrah V S, Tristani F E, Smith J J. The Valsalva maneuver: mechanisms and clinical implications.  Heart Lung. 1984;  13 507-518
• 21 Sánchez J, Sébert Ph. Sex differences in cardiac responses to breath holding during dynamic and isometric exercises.  Eur J Appl Physiol. 1983;  50 429-444
• 22 Sébert Ph, Sánchez J. Sexual and postural differences in cardioventilatory responses during and after breath holding at rest.  Eur J Appl Physiol. 1981;  47 209-222
• 23 Song S H, Lee W K, Chung Y A, Hong S K. Mechanism of apneic bradycardia in man.  J Appl Physiol. 1969;  27 323-327
• 24 Strømme S B, Kerem D, Elsner R. Diving bradycardia during rest and exercise and its relation to physical fitness.  J Appl Physiol. 1970;  28 614-621