Sporcularda Görülen Kardiyak Adaptif Mekanizmalar
Özet
Egzersiz, temel olarak kas aktivitelerini arttıran, fiziksel uygunluğun tüm bileşenlerini korumayı ve sürekli olarak geliştirmeyi amaçlayan düzenli faaliyetler bütünüdür. Kardiyovasküler sistem aktivitenin başlaması ve sürdürülmesi aşamasında çeşitli adaptif değişiklikler ile anahtar rol oynamaktadır. Kalbin egzersize verdiği yanıt akut ve kronik değişiklikler ana başlıklarıyla incelenebilir.
Akut değişiklikler; iskelet kaslarında artan işgücü ile birlikte ATP döngüsünün devamının sağlanması amacıyla, ardı sıra fizyolojik değişikliklerin meydana gelmesiyle net etki olarak, ventilasyon ve perfüzyon parametrelerinin artması, kardiyak output’un yükselmesi ve iskelet kaslarında periferik vasküler rezistansın düşmesi şeklinde karşımıza çıkar. Klinik pratikte ise bu düzenlemeler bazı kardiyovasküler parametrelerde değişiklikler olarak karşımıza çıkar. Bu parametreler kalp hızı, kan basıncı değişikliği, atım volümü ve kalp debisidir.
Kronik değişiklikler aktivitenin uzun süreli ve sağlıklı sürdürülebilmesi adına kalbin üzerindeki yükü azaltmaya yönelik uzun dönemde ortaya çıkan adaptif değişikliklerdir. Kronik değişiklikler; kronik adaptif mekanizmalar başlığı altında, uzun süreli dinamik (aerobik) ve statik (direnç) egzersiz tipleri kapsamında ayrı ayrı değerlendirilir. Uzamış egzersize kardiyak adaptasyonun en önemli göstergeleri kalp hızı, kan basıncı ve kalp debisi, kardiyak hipertrofi, kontraktilite artışı, arteryel yeniden şekillenme ve kalpte kapiller damar yapısında artış değişiklikleri olarak belirtilebilir.
Referanslar
Myers JN. Essentials of cardiopulmonary exercise testing. 10th Ed. Human Kinetics Publishing; 1996.p.1-36
Katch FI, Katch VL, McArdle WD. Exercise Physiology; Energy, Nutrition&Human Performance. LWW, Philadelphia 2007 S333-350
Heinonen I, Kalliokoski KK, Hannukainen JC, Duncker DJ, Nuutila P, Knuuti J. Organ-specific physiological responses to acute physical exercise and long-term training in humans. Physiology (2014) 29:421–36. doi: 10.1152/physiol.00067.2013
Günay M., Cicioğlu H. İ. Gazi Kitapevi, Ankara, 2001 Yayın Türü: Kitap / Ders Kitabı; Basım Tarihi: 2001
Thomas GD, Segal SS. Neural control of muscle blood flow during exercise. J Appl Physiol 2004;97:731.
Williamson JW, Nóbrega AC, Winchester PK, et al. Instantaneous heart rate increase with dynamic exercise: central command and muscle-heart reflex contributions. J Appl Physiol 1995;78:1273
Nóbrega ACL, Araújo CGS. Heart rate transient at the onset of active and passive dynamic exercise. Med Sci Sports Exerc 1993;25:37.
Raven PB, Potts JT, Shi X. Baroreflex regulation of blood pressure during dynamic exercise. Exerc Sport Sci Rev 1997;25:365.
Walther C Gielen S, Hambrecht R. The effect of exercise training on endothelial function in cardiovascular disease in humans. Exerc Sport Sci Rev 2004;32:129.
Warburton DE, Gledhill N,et al. Induced hypervolemia, cardiac function, VO2max and performance of elite cyclist. Med Sci Sports Exerc 199;31:800-6.
Goodman JM, Liu PP, Gren HJ. Left ventricular adaptations following short-term endurance training. J Appl Physiol 2005;98:454
O’Connor, PJ, Bryant CX, Veltri JP, Gebhardt SM. State anxiety and ambulatory blood pressure following resistance exercise in females. Med. Sci. Sports Exerc 1993;25:516-521.
McArdle WD, Katch FI and Katch VL. (2000) Essentials of Exercise Physiology: 2nd Edition Philadelphia, PA: Lippincott Williams & Wilkins; 2000.
Plowman SA, Smith DL. Cardiovascular responses to exercise. Chapter 13.In Plowman SA, Smith DL, Exercise Physiology for Health, Fitness and Performance. 2nd Ed. Philadelphia: Walters-Kluver Publlishing; 2013.p.351-382
Toner MM, Glickman EL, Mcardle WD. Cardiovascular adjustment to exercise distributed between the upper and lower body. Med Sci Sports Exerc 1990;22:773.
Miles DS, Cox MH, Bomze JP. Cardiovascular responses to upper body exercise in normals and cardiac patients. Med Sci Sports Exerc 1989;21:S126
Roskamm H, Reindell H, Musshoff K, et al: Relations between heart size and physical efficiency in male and female athletes in comparison with normal male and female subjects. Arch Kreislaufforsch 1961;35:67-102.
Reindell H, Roskamm H, Steim H: The heart and blood circulation in athletes. Med Welt 1960;31:1557-1563.
Bulychev VV, Khmelevskii VA, Rutman IuV: Roentgenological and instrumental examination of the heart in athletes. Klin Med 1965;43: 108-114.
Maron BJ, Pelliccia A. The Heart of Trained Athletes: Cardiac Remodeling and the Risks of Sports, Including Sudden Death. Circulation 2006;114:1633-1644.
Katch FI, Katch VL, McArdle WD. Exercise Physiology; Energy, Nutrition&Human Performance. LWW, Philadelphia 2007 S333-350.
Parker BM, Londeree BR, Cupp GV, Dubiel Jp. The noninvasive cardiac evaluation of long-distance runners. Chest 1978;73:376-381.
Paulsen W, Boughner DR, Ko P, Cunningham DA, Persaud JA. Left ventricular function in marathon runners; echocardiographic assessment. J Appl Physiol 1981;51:881-886.
Rowell LB: Human circulation: regulation during physical stress. New York, NY: Oxford University Press; 1986.
Bassett DR Jr, Howley ET. Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc 2000;32:270
Richardson RS. Oxygen transport: air to muscle cell. Med Sci Sports Exerc 1998;30:53-9.
Nóbrega ACL, Araújo CGS. Heart rate transient at the onset of active and passive dynamic exercise. Med Sci Sports Exerc 1993;25:37
Di Bello V, Santoro G, Talarico L, et al. Left ventricular function during exercise in athletes and in sedentary men. Med Sci Sports Exerc 1996;28:190.
Warburton DE, Gledhill N,et al. Induced hypervolemia, cardiac function, VO2max and performance of elite cyclist. Med Sci Sports Exerc 199;31:800-6.
Abergel E, Chatellier G, Hagege AA, Oblak A, Linhart A, DucardonnetAet al. Serial left ventricular adaptations in world-class professional cyclists: implications for disease screening and follow-up. J Am Coll Cardiol 2004;44:144-9
Wolfe LA, Cunningham DA, Davis GM, Rosenfeld H. Relationship between maximal oxygen uptake and left ventricular function in exercise. J Appl Physiol Respir Environ Exerc Physiol 1978;44:44–9.
Morganroth J, Maron BJ, Henry WL, Epstein SE. Comparative left ventricular dimensions in trained athletes. Ann Intern Med 1975;82:521–4.
Hallen J. K+ balance in humans during exercise. Acta Physiol Scand. (1996) 156:279–86. doi: 10.1046/j.1365-201X.1996.187000.x
Radegran G, Calbet JA. Role of adenosine in exercise-induced human skeletal muscle vasodilatation. Acta Physiol Scand. (2001) 171:177–85. doi: 10.1046/j.1365-201x.2001.00796.x
Sarelius I, Pohl U. Control of muscle blood flow during exercise: local factors and integrative mechanisms. Acta Physiol. (2010) 199:349–65. doi: 10.1111/j.1748-1716.2010.02129.x
Prior BM, Lloyd PG, Yang HT, et al. Exerciseinduced vascular remodeling. Exerc Sports Sci Rev 2003; 31:26–33.
Green DJ, Naylor LH, George K. Cardiac and vascular adaptations to exercise. Curr Opin Clin Nutr Metab Care 2006;9(6):677–684. http://dx.doi.org/10.1097/01.mco.0000247473.49284 .e3
Powell KE, Thompson PD, Caspersen CJ, et al. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health 1987;8:253-287.
Wang CC, Gurevich I, Draznin B. Insulin affects vascular smooth muscle cell phenotype and migration via distinct signaling pathways. Diabetes (2003) 52:2562–9. doi: 10.2337/diabetes.52.10.2562
Longhurst JC, Kelly AR, Gonyea WJ, Mitchell JH. Chronic training with static and dynamic exercise: cardiovascular adaptation and response to exercise. Circ Res 1981;48(6 Pt 2): I171-8.
Referanslar
Myers JN. Essentials of cardiopulmonary exercise testing. 10th Ed. Human Kinetics Publishing; 1996.p.1-36
Katch FI, Katch VL, McArdle WD. Exercise Physiology; Energy, Nutrition&Human Performance. LWW, Philadelphia 2007 S333-350
Heinonen I, Kalliokoski KK, Hannukainen JC, Duncker DJ, Nuutila P, Knuuti J. Organ-specific physiological responses to acute physical exercise and long-term training in humans. Physiology (2014) 29:421–36. doi: 10.1152/physiol.00067.2013
Günay M., Cicioğlu H. İ. Gazi Kitapevi, Ankara, 2001 Yayın Türü: Kitap / Ders Kitabı; Basım Tarihi: 2001
Thomas GD, Segal SS. Neural control of muscle blood flow during exercise. J Appl Physiol 2004;97:731.
Williamson JW, Nóbrega AC, Winchester PK, et al. Instantaneous heart rate increase with dynamic exercise: central command and muscle-heart reflex contributions. J Appl Physiol 1995;78:1273
Nóbrega ACL, Araújo CGS. Heart rate transient at the onset of active and passive dynamic exercise. Med Sci Sports Exerc 1993;25:37.
Raven PB, Potts JT, Shi X. Baroreflex regulation of blood pressure during dynamic exercise. Exerc Sport Sci Rev 1997;25:365.
Walther C Gielen S, Hambrecht R. The effect of exercise training on endothelial function in cardiovascular disease in humans. Exerc Sport Sci Rev 2004;32:129.
Warburton DE, Gledhill N,et al. Induced hypervolemia, cardiac function, VO2max and performance of elite cyclist. Med Sci Sports Exerc 199;31:800-6.
Goodman JM, Liu PP, Gren HJ. Left ventricular adaptations following short-term endurance training. J Appl Physiol 2005;98:454
O’Connor, PJ, Bryant CX, Veltri JP, Gebhardt SM. State anxiety and ambulatory blood pressure following resistance exercise in females. Med. Sci. Sports Exerc 1993;25:516-521.
McArdle WD, Katch FI and Katch VL. (2000) Essentials of Exercise Physiology: 2nd Edition Philadelphia, PA: Lippincott Williams & Wilkins; 2000.
Plowman SA, Smith DL. Cardiovascular responses to exercise. Chapter 13.In Plowman SA, Smith DL, Exercise Physiology for Health, Fitness and Performance. 2nd Ed. Philadelphia: Walters-Kluver Publlishing; 2013.p.351-382
Toner MM, Glickman EL, Mcardle WD. Cardiovascular adjustment to exercise distributed between the upper and lower body. Med Sci Sports Exerc 1990;22:773.
Miles DS, Cox MH, Bomze JP. Cardiovascular responses to upper body exercise in normals and cardiac patients. Med Sci Sports Exerc 1989;21:S126
Roskamm H, Reindell H, Musshoff K, et al: Relations between heart size and physical efficiency in male and female athletes in comparison with normal male and female subjects. Arch Kreislaufforsch 1961;35:67-102.
Reindell H, Roskamm H, Steim H: The heart and blood circulation in athletes. Med Welt 1960;31:1557-1563.
Bulychev VV, Khmelevskii VA, Rutman IuV: Roentgenological and instrumental examination of the heart in athletes. Klin Med 1965;43: 108-114.
Maron BJ, Pelliccia A. The Heart of Trained Athletes: Cardiac Remodeling and the Risks of Sports, Including Sudden Death. Circulation 2006;114:1633-1644.
Katch FI, Katch VL, McArdle WD. Exercise Physiology; Energy, Nutrition&Human Performance. LWW, Philadelphia 2007 S333-350.
Parker BM, Londeree BR, Cupp GV, Dubiel Jp. The noninvasive cardiac evaluation of long-distance runners. Chest 1978;73:376-381.
Paulsen W, Boughner DR, Ko P, Cunningham DA, Persaud JA. Left ventricular function in marathon runners; echocardiographic assessment. J Appl Physiol 1981;51:881-886.
Rowell LB: Human circulation: regulation during physical stress. New York, NY: Oxford University Press; 1986.
Bassett DR Jr, Howley ET. Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc 2000;32:270
Richardson RS. Oxygen transport: air to muscle cell. Med Sci Sports Exerc 1998;30:53-9.
Nóbrega ACL, Araújo CGS. Heart rate transient at the onset of active and passive dynamic exercise. Med Sci Sports Exerc 1993;25:37
Di Bello V, Santoro G, Talarico L, et al. Left ventricular function during exercise in athletes and in sedentary men. Med Sci Sports Exerc 1996;28:190.
Warburton DE, Gledhill N,et al. Induced hypervolemia, cardiac function, VO2max and performance of elite cyclist. Med Sci Sports Exerc 199;31:800-6.
Abergel E, Chatellier G, Hagege AA, Oblak A, Linhart A, DucardonnetAet al. Serial left ventricular adaptations in world-class professional cyclists: implications for disease screening and follow-up. J Am Coll Cardiol 2004;44:144-9
Wolfe LA, Cunningham DA, Davis GM, Rosenfeld H. Relationship between maximal oxygen uptake and left ventricular function in exercise. J Appl Physiol Respir Environ Exerc Physiol 1978;44:44–9.
Morganroth J, Maron BJ, Henry WL, Epstein SE. Comparative left ventricular dimensions in trained athletes. Ann Intern Med 1975;82:521–4.
Hallen J. K+ balance in humans during exercise. Acta Physiol Scand. (1996) 156:279–86. doi: 10.1046/j.1365-201X.1996.187000.x
Radegran G, Calbet JA. Role of adenosine in exercise-induced human skeletal muscle vasodilatation. Acta Physiol Scand. (2001) 171:177–85. doi: 10.1046/j.1365-201x.2001.00796.x
Sarelius I, Pohl U. Control of muscle blood flow during exercise: local factors and integrative mechanisms. Acta Physiol. (2010) 199:349–65. doi: 10.1111/j.1748-1716.2010.02129.x
Prior BM, Lloyd PG, Yang HT, et al. Exerciseinduced vascular remodeling. Exerc Sports Sci Rev 2003; 31:26–33.
Green DJ, Naylor LH, George K. Cardiac and vascular adaptations to exercise. Curr Opin Clin Nutr Metab Care 2006;9(6):677–684. http://dx.doi.org/10.1097/01.mco.0000247473.49284 .e3
Powell KE, Thompson PD, Caspersen CJ, et al. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health 1987;8:253-287.
Wang CC, Gurevich I, Draznin B. Insulin affects vascular smooth muscle cell phenotype and migration via distinct signaling pathways. Diabetes (2003) 52:2562–9. doi: 10.2337/diabetes.52.10.2562
Longhurst JC, Kelly AR, Gonyea WJ, Mitchell JH. Chronic training with static and dynamic exercise: cardiovascular adaptation and response to exercise. Circ Res 1981;48(6 Pt 2): I171-8.
