Physiology of Exercise

PHYSIOLOGY OF
THEME III EXERCISE
CHAPTER OUTLINE
The Cardiovascular System
Physiological Responses and

Adaptations to Weight Training
Motor Control and Proprioception
Safe Prescription for Special

Populations
Hemodinamic Factors
and Cardiovascular Incidents
Key Terms
Heart
Vascular
Metabolism
Injury
Proprioception
Safety
Osteoporosis
Diabetes
Theme III Objectives
After the study of this theme, the reader should be
able:
To Describe
1- The basic function of the Cardiovascular System.

2- The physiological responses and adaptations of the body
to weight training exercises.
3- The functions of the motor control and proprioception sys-
tems during exercise.
4- The classifications of joints with their characteristics.
5- All the important aspects for a safe prescription of weight
training exercises.
6- Osteoporosis and the considerations to weight training.
7- Diabetes and the considerations to weight training.
To Define
1- Stroke Volume, Ejection Fraction and Cardiac Output.

2- The Steady-State Heart Rate during exercise.
3- Co-contractionsl.
4- Total Peripheral Resistance.
European Bodybuilding and Fitness Federation International Federation of Bodybuilding & Fitness
THE CARDIOVASCULAR SYSTEM Blood Flow through the Heart

Introduction Blood that has coursed its way between the
cells of the body, delivering oxygen and nutrients and
The cardiovascular system serves a number picking up waste products, returns through the great
of important functions in the body, most of which sup- veinsthe superior vena cava and inferior vena
port other physiological systems. The major cardio- cavato the right atrium. This chamber receives all
vascular functions fall into five categories: the bodys deoxygenated blood.
From the right atrium, blood passes through
* Delivery the tricuspid valve into the right ventricle. This cham-
* Removal ber pumps the blood through the pulmonary semilu-
* Transport nar valve into the pulmonary artery, which carries the
* Maintenance blood to the right and left lungs. Thus, the right side
* Prevention of the heart is known as the pulmonary side, sending
the blood that has circulated throughout the body into
The cardiovascular system delivers oxy- the lungs for reoxygenation.
gen and nutrient to, and removes carbon dioxide After receiving a fresh supply of oxygen, the
and metabolic waste products from, every cell in the blood exits the lungs through the pulmonary veins,
body. It transports hormones from endocrine glands which carry it back to the heart and into the left atri-
to their target receptors. The system maintains body um. All freshly oxygenated blood is received by this
temperature, and the bloods buffering capabilities chamber.
help control the bodys pH. The cardiovascular sys- From the left atrium, the blood passes through
tem maintains appropriate fluid levels to prevent de- the bicuspid (mitral) valve into the left ventricle. Blood
hydration and helps prevent infection from invading leaves the left ventricle by passing through the aortic
organisms. semilunar valve into the aorta, which ultimately sends
The cardiovascular functions are important it out to all body parts and systems.
for understanding the physiological bases of physical The left side of the heart is known as the sys-
activity. temic side. It receives the oxygenated blood from the
lungs then sends it out to supply all body tissues.
The four heart valves prevent backflow of
blood, ensuring one-way flow through the heart.
Structure and Function of the Cardiovascular These valves maximize the amount of blood pumped
System out of the heart during contraction.

The cardiovascular system is impressive in
its ability to respond immediately to the bodys many The Cardiac Conduction System
and ever-changing needs. All bodily functions and
virtually every cell in the body depend in some way Cardiac muscle has the unique ability to gen-
on this system. erate its own electrical signal, called auto-conduc-
Any system of circulation requires three tion, which allows it to contract rhythmically without
components: neural stimulation. With neither neural nor hormonal
stimulation, the intrinsic heart rate averages 70 to 80
A pump (the heart) beats (contractions) per minute but can drop below
A system of channels (the blood vessels) this rate in endurance-trained people.
A fluid medium (the blood) The four components of the cardiac conduc-
tion system:
The Heart
Sinoatrial (SA) node
The heart has two atria acting as receiving Atrioventricular (AV) node
chambers and two ventricles acting as sending units. AV bundle (bundle of His)
The heart is the primary pump that circulates blood Purkinje fibers
through the entire vascular system.
The impulse for heart contraction is initiated
in the sinoatrial (SA) node, a group of specialized blood pumped per stroke (contraction). To under-
cardiac muscle fibers located in the posterior v/all stand stroke volume, consider the amount of blood in
of the right atrium. Because this tissue generates the ventricle before and after contraction. At the end
the impulse typically at a frequency of about 60 to of diastole, just before contraction, the ventricle has
80 beats/ min, the SA node is known as the hearts completed filling.
pace-maker and the rhythm established is called the The volume of blood it now contains is called
sinus rhythm. the end-diastolic volume, or EDV. At the end of sys-
The electrical impulse generated by the SA tole, just after contraction, the ventricle has complet-
node spreads through both atria and reaches the atri- ed its ejection phase.
oventricular (AV) node, located in the right atria wall The volume of blood remaining in the ventri-
near the center of the heart. As the impulse spreads cle is called the end-systolic volume, or ESV. Stroke
through the atria, they are signalled to contract, which volume is the volume of blood that was ejected and is
they do almost immediately. merely the difference between the amount originally
The AV node conducts the impulse from the there and the amount remaining in the ventricle after
atria into the ventricles. The impulse is delayed by contraction. So stroke volume is simply the differ-
about 0.13 s as it passes through the AV node, and ence between the EDV and the ESV.
then it enters the AV bundle. This delay allows the
atria to fully contract before the ventricles do, maxi-
mizing ventricular filling. Ejection Fraction
The AV bundle travels along the ventricular
septum and then sends right and left bundle branch- The proportion of the blood pumped out of the
es into both ventricles. These branches send the left ventricle each beat is the ejection fraction (EF);
impulse toward the apex of the heart, then outward. this value is determined by dividing the stroke volume
Each bundle branch subdivides into many smaller by the end-diastolic volume. It reveals how much of
ones that spread throughout the entire ventricular the blood entering the ventricle is actually ejected
wall. These terminal branches of the AV bundle are during contraction.
the Purkinje fibers. They transmit the impulse through The ejection fraction, generally expressed as
the ventricles approximately six times faster than a percentage averages 60% at rest. Thus 60% of the
through the rest of the cardiac conduction system. blood in the ventricle at the end of diastole is ejected
This rapid conduction allows all parts of the with the next contraction and 40% remains.
ventricle to contract at about the same time.
Cardiac Output
The Cardiac Cycle
Cardiac output (Q) is the total volume of blood
The cardiac cycle includes all events that pumped by the ventricle per minute, or simply the
occur between two consecutive heartbeats. In me- product of heart rate (HR) and stroke volume (SV).
chanical terms, it consists of all heart chambers un- The stroke volume at rest in the standing position av-
dergoing a relaxation phase (diastole) and a contrac- erages between 60 and 80 ml of blood in most adults.
tion phase (systole). During diastole, the chambers Thus, at a resting heart rate of 80 beats/min, the rest-
fill with blood. During systole, the chambers contract ing cardiac output will vary between 4.8 and 6.4 L/
and expel their contents. T min.
he diastolic phase is longer than the systo- The average adult body contains about 5L of
lic phase. Although the heart seems to always be at blood, so this means that the equivalent of our total
work, it actually spends slightly more time in the rest- blood volume is pumped through our hearts about
ing phase than in the working phase. once every minute.
Stroke Volume The Vascular System
During systole, a certain volume of blood is The vascular system comprises a series of
ejected from the left ventricle. This amount is the vessels that transport blood from the heart to the
stroke volume (SV) of the heart, or the volume of tissues and back:
pressure in the abdominal and thoracic cavities as-
Arteries sist blood return to the heart. As these cavities con-
Arterioles tract, the skeletal muscles in the legs or abdomen
Capillaries also contract.
Venules During breathing and skeletal muscle con-
Veins traction, the veins in those areas where muscles are
contracting and in the abdominal and thoracic cavi-
Arteries are typically the largest, most ties are compressed, and blood is pushed upward to-
muscular, and most elastic vessels, and they al- ward the heart. These actions are aided by a series
ways carry blood away from the heart to the arteri- of valves in the veins that allow blood to flow in only
oles. From the arterioles, blood enters the capillar- one direction, thus preventing backflow and pooling
ies. These are the narrowest vessels, often with walls of the blood in the lower body.
only one cell thick. Virtually all exchange between the
blood and the tissues occurs at the capillaries. Blood
leaves the capillaries to begin the return trip to the Distribution of Blood
heart in the venules, and the venules form larger ves-
sels the veinsthat complete the circuit. Distribution of blood to the various body tis-
In addition to the pulmonary and systemic di- sues varies tremendously depending on the immedi-
visions of the vascular system, the heart, as an active ate needs of a specific tissue and of the whole body.
muscle, requires its own vascular system to supply At rest under normal conditions, the most metaboli-
necessary nutrients and lo clear waste products. The cally active tissues receive the greatest blood sup-
coronary arteries, which originate from the base of ply.
the aorta as it leaves the heart, supply the myocar- The liver and kidneys combined receive al-
dium. These arteries are very susceptible to athero- most half the blood being circulated (27% and 22%,
sclerosis, or narrowing, which can lead to coronary respectively), and resting skeletal muscles receive
artery disease. only about 15%.
During contraction, when blood is forced out During exercise, blood is redirected to the
of the left ventricle under high pressure, the aortic areas where it is needed most. In some exercises
semilunar valve is forced open. When this valve is the muscles can receive up to 80% or more of the
open, its flaps block the entrances to the coronary available blood. This, along with the increases in the
arteries. As the pressure in the aorta decreases, the cardiac output , allows up to 25 times more blood to
semilunar valve closes, and these entrances are ex- flow to active muscles.
posed so that blood can then enter the coronary ar-
teries.
This design ensures that the coronary arteries
are spared the very high blood pressure created by
Blood Pressure
contraction of the left ventricle, thus protecting these
Blood pressure is the pressure exerted by the
vessels from damage.
blood on the vessel walls, and the term usually re-
fers to arterial blood pressure. It is expressed by two
numbers: the systolic pressure and the diastolic pres-
Return of Blood to the Heart sure.
The higher number is the systolic blood
Because of the constant upright position of the
pressure. It represents the highest pressure in the
human body, the cardiovascular system requires as-
artery and corresponds to ventricular systole of the
sistance to overcome the force of gravity when blood
heart. Ventricular contractions pushes the through
returns from the lower parts of the body to the heart.
the arteries with tremendous force, which exerts high
Three basic mechanisms assist in this process:
pressure on the arterial walls.
Breathing The lower number is the diastolic blood pres-
The muscle pump sure and represents the lowest pressure in the artery,
Valves corresponding to ventricular diastole when the heart
is at rest. Blood moving through the arteries during
In each inhalation and exhalation, changes in that phase is not pushed along by a forceful contrac-
tion. the body is overheated. Blood can buffer the acids
produced by anaerobic metabolism, maintaining the
proper pH for efficient activity of metabolic process-
Mean arterial pressure (MAP) represents
es.
the average pressure exerted by the blood as it
travels through the arteries. Mean arterial pressure
can be estimated from the diastolic blood pressure
(DBP) and systolic blood pressure (SBP) as follows: Blood Volume and Composition
The total volume of blood in the body varies

MAP = DBP + [0,333 X (SBP DBP)]
considerably with the individuals size and the state
of training. Larger blood volumes are associated with
larger body size and high levels of endurance train-
The Blood ing. The blood volumes of people of average body
size and normal physical activity (not training aero-
The third component of any system of circula- bically) generally range from 5 to 6 litres in men and
tion is a circulating substance. In the human body, 4 to 5 litres in women.
this is the blood and lymph. These fluids are respon- Blood is composed of plasma (primarily
sible for the actual transportation of various materials water) and formed elements. Plasma normally con-
between the different cells or tissues of the body. stitutes about 55% to 60% of total blood volume but
The relationship between blood and lymph is: can decrease by 10% of its normal amount or more
Some blood plasma filters out of the capillaries into with intense exercise in heat or increase by 10% or
the tissues, becoming interstitial (tissue) fluid. Much more with endurance training or acclimatization to
of the interstitial fluid returns to the capillaries after heat and humidity. Approximately 90% of the plasma
exchange occur, but less is returned than was origi- volume is water, 7% is plasma proteins, and the
nally filtered out. The excess fluid enters the lymph remaining 3% is cellular nutrients, electrolytes, en-
capillaries, and it is then referred to as lymph, which zymes, hormones, antibodies, and wastes.
ultimately returns to the blood. The formed elements, which normally consti-
The lymphatic system plays a crucial role in tute about 40% to 45% of total blood volume, are the
maintaining appropriate fluid levels in the tissues as red blood cells (erythrocytes), white blood cells (leu-
well as maintaining proper blood volume by ensur- kocytes), and platelets (thrombocytes). Red blood
ing that interstitial fluid is returned lo circulation. This cells constitute more than 99%of the formed element
function becomes more important during exercise, volume; white blood cells and platelets together ac-
when increased blood flow to the active muscles count for less than 1%. The percentage of the total
and increased blood pressure lead to the formation blood volume composed of cells or formed elements
of more interstitial fluid. The Lymphatic system mini- is referred as the hematocrit.
mizes swelling in the active areas and keeps the car- White blood cells protect the body from dis-
diovascular system working efficiently. This system ease organism invasions either by directly destroying
is extremely important to coordinate physiological the invading agents through phagocytosis (ingestion)
function and general health. or by forming antibodies to destroy them. Adults have
Blood serves many useful purposes in the about 7,000 white blood cells per cubic millimeter of
regulation of normal body function. The three func- blood.
tions of primary importance lo exercise and sport The remaining formed elements are the blood
are: platelets.
Transportation,
Temperature regulation, and Cardiovascular Response to Exercise
Acid-base (pH) balance.
Now that we have reviewed the basic anato-
In addition, blood is critical in temperature my and physiology of the cardiovascular system, we
regulation during physical activity; it picks up heat can look specifically at how this system responds to
from the body core or from areas of increased meta- the increased demands placed on the body during
bolic activity and dissipates that heat throughout the exercise. During exercise, oxygen demand in the ac-
body during normal conditions and to the skin when tive muscles increases sharply. More nutrients are
used. Metabolic processes speed up, so more waste phrine from your adrenal glands. Vagal tone probably
is created. During prolonged exercise or exercise in also decreases. Because the pre-exercise heart
a hot environment, body temperature increases. In rate is elevated, reliable estimates of actual resting
intense exercise, H+ concentration increases in the heart rate should be made only under conditions of
muscles and blood, lowering their pH. total relaxation, such as early in the morning before
Numerous cardiovascular changes occur rising from a restful nights sleep. Pre-exercise heart
during exercise. All share a common goal; to allow rates should not be used as estimates of resting heart
the system to meet the increased demands placed rate.
on it and to carry out its functions with maximal effi-
ciency. To better understand the changes that occur, Heart Rate during Exercise
we must look more closely at specific cardiovascular
functions. We will examine changes in all compo- When you begin to exercise, your heart rate
nents of the cardiovascular system, looking specifi- increases directly in proportion to the increase in ex-
cally at the following: ercise intensity until you are near the point of exhaus-
tion. As you approach that point, your heart rate begins
Heart rate to level off. This indicates that you are approaching
Stroke volume your maximum value. The maximum heart rate (HR-
Cardiac output max) is the highest heart rate value you achieve in
Blood flow an all-out effort to the point of exhaustion. This is a
Blood pressure highly reliable value that remains constant from day
The blood to day and changes only slightly from year to year.
Maximum heart rate can be estimated based
on your age because maximum heart rate shows a
Heart Rate slight but steady decrease of about one beat per year
beginning at 10 to 15 years of age. Subtracting your
The heart rate (HR) is one of the simplest and age from 220 provides an approximation of your av-
most informative of the cardiovascular parameters. erage maximum heart rate. However, this is only an
Measuring it involves simply taking the subjects estimateindividual values vary considerably from
pulse, usually at the radial or carotid site. Heart rate this average value. To illustrate, for a 40-year-old,
reflects the amount of work the heart must do to meet maximum heart rate would be estimated to be 180
the increased demands of the body when engaged beats/min (HRmax 220 - 40). However, 68% of all
in activity. To understand this, we must compare the 40-year-olds have actual maximum heart rate values
heart rate at rest and during exercise. between 168 and 192 beats/min (mean 1 standard
deviation), and 95% fall between 156 and 204 beats/
min (mean 2 standard deviations). This demon-
strates the potential for error in estimating a persons
Resting Heart Rate maximum heart rate.
Resting heart rate averages 60 to 80 beats/

min. In middle-aged, unconditioned, sedentary indi- To estimate maximum hear rate:
viduals, the resting rate can exceed 100 beats/min.
In highly conditioned, endurance-trained athletes, HRmax = 220 age in years
resting rates in the range of 28 to 40 beats/min have
been reported. Your resting heart rate typically de-
creases with age. It is also affected by environmen- Steady-State Heart Rate
tal factors; for example, it increases with extremes in
temperature and altitude. When the rate of work is held constant at
Before the start of exercise, your pre-exer- submaximal levels of exercise, heart rate increases
cise heart rate usually increases well above normal fairly rapidly until it reaches a plateau. This plateau is
resting values. This is called an anticipatory re- the steady-state heart rate, and it is the optimal heart
sponse. This response is mediated through release rate for meeting the circulatory demands at that spe-
of the neurotransmitter norepinephrine from your cific rate of work. For each subsequent increase in in-
sympathetic nervous system and the hormone epine- tensity, heart rate will reach a new steady-state value
within 1 to 2 min. However, the more intense the ex- Cardiac Output
ercise, the longer it takes to achieve this steady-state
value. Changes in cardiac output, because it is the
The concept of steady-state heart rate forms product of heart rate and stroke volume (Q= HR X
the basis for several tests that have been developed SV), are predictable with increasing work levels. The
to estimate physical fitness. In one such test, indi- resting value for cardiac output is approximately 5.0
viduals are placed on an exercise device, such as a L/min.
cycle ergometer, and exercise at two or three stand- Cardiac output increases directly with increas-
ardized rates of work. ing exercise intensity to between 20 to 40 L/min. The
Those in better physical condition, based on absolute value varies with body size and endurance
their cardiorespiratory endurance capacity, will have conditioning.
lower steady-state heart rates at a given rate of work The linear relationship between cardiac out-
than those who are less fit, Thus, steady-state heart put and work rate should not be surprising, though,
rate is a valid predictor of heart efficiency: A lower because the major purpose of the increase in cardiac
rate reflects a more efficient heart. output is to meet the muscles increased demand for
When exercise is performed at a constant rate oxygen.
over a prolonged period particularly under conditions
of heat stress, the heart rate tends to drift upward
instead of maintaining its steady-state value. This re-
sponse is part of a phenomenon called cardiovascu-
lar drift.
Stroke volume (SV) also changes during ex-
ercise to allow the heart to work more efficiently. It
has become increasingly clear that for near-maximal
and maximal rates of work, stroke volume is a major
determinant of cardiorespiratory endurance capac-
ity.
Stroke volume is determined by four factors:
The volume of venous blood returned to the

heart
Ventricular distensibility (the capacity to en-
large the ventricle)
Ventricular contractility (the capacity of the
ventricle lo con-tract)
Aortic or pulmonary artery pressure (the
pressure against which the ventricles must contract)
The first two factors influence the filling ca-

pacity of the ventricle, determining how much blood
is available for filling the ventricle and the ease with
which the ventricle is filled at the available pressure.
The last two factors influence the ventricles
ability to empty, determining the force with which
blood is ejected and the pressure against which it
must flow in the arteries. These four factors directly
control the alterations in stroke volume in response to
increasing exercise intensity.
Metabolic, Cardiovascular, Pulmonary, from the onset of contraction and is likely involved in
meeting single contraction energy demand. Muscle
and Endocrine Responses and Adap-
lactate has been shown to accumulate without ap-
tation to Weight training exercises pearance in the blood unless the contraction lasts
longer than approximately 5s.
Energy homeostasis in a cell or the whole Post-contraction VO2 is theoretically proportional to
body is based on the relationship that energy sup- the ATP and CrP used during the contraction.
ply equals energy demand. Muscle contraction(s) im-
pose an increased energy demand that requires an
up-regulation of energy metabolism to provide ATP
(adenosine triphosphate) and restore energy home-
Energy Demand
ostasis at the new energy demand. Metabolic up-
With multiple muscle contractions, the meta-
regulation requires an increased delivery of nutrients
bolic strategy remains the same: recovery must fol-
and oxygen to the working muscle cell and removal of
low each contraction. The problem here is providing
carbon dioxide and waste from it. Responses by the
recovery ATP so that the next contraction can be per-
cardiovascular, pulmonary, and endocrine systems
formed. That is, recovery must take place during the
provide the needed substrate and waste removal, al-
contractions. It is this signal that drives the metabolic
lowing the cell to meet the metabolic demand.
rate to increase ATP production during the contrac-
tions. If the supply of ATP is unable to meet demand,
Metabolism the ability to produce force is reduced (fatigue) or ad-
ditional motor units must be recruited to meet the ex-
During a muscle contraction, the energy (ATP) pected force/work. The latter is of diminishing return
demand is based on the energy requirement for the if ATP production cannot be incremented.
various components of the contraction: cross-bridge The typical set of weight training exercise
kinetics, calcium handling and membrane repolariza- would incorporate 2-12 repetitions and would be
tion. ATP demand is directly related to the number completed in less than 2 min. If the contractions (ex-
of cross-bridge interactions, be it force generation ercise) cease before full activation of oxidative me-
(isometric contractions) or work performance (force tabolism, then VO2, will rise during the post exercise
generation with changes in muscle length). Thus, the period. On cessation of the single set, VO2 continues
metabolic response is dictated by the overall ener- to rise to levels that are four to five times rest values
getic demands of force production and work. after the completion of a brief isometric contraction or
an 8-repetition set of exercise. Thus, ATP production
must proceed during the contractions independent of
Metabolic Response to Weight Training oxygen and oxidative phosphorylation, and the ma-
jority of ATP supplied during the contractions must
A muscle contraction is inherently nonoxida- come from CrP and glycolysis (glycogen to lactic
tive (anaerobic); energy for a single contraction is acid).
supplied by cellular ATP stores and creatine phos- Evidence of glycolytic involvement is seen
phate (CrP). Recovery from a single contraction is from small but significant increases in blood lactate
aerobic; oxygen uptake (VO2) increases in propor- concentration (~2 mmol) after a single set and de-
tion to the ATP and CrP used during the contraction. creased glycogen without a change in blood glucose
Single maximum voluntary isometric contractions, 1- concentration. The energy demand for a single set of
RM (one-repetition maximum) contractions, or single weight training exercise is related to the load (inten-
submaximal contractions represent a relatively low sity), number of repetitions and the amount of muscle
energy demand that is dependent on the intensity of mass incorporated in the exercise.
the contraction and the particular exercise being per- The average sustained levels of VO2, range
formed (amount of muscle mass incorporated in the from 35 to 55% of treadmill maximal VO2, with the
exercise). highest levels seen between sets. The magnitude of
The contraction is fueled by ATP present theVO2 response is determined by the load (inten-
at the initiation of contraction and by CrP. There is sity), number of sets and reps, and the amount of rest
some breakdown of glycogen and glucose utilization, between sets.
as ATP production from glycolysis is known to begin The energy supply during each set is still provided pri-
marily by oxygen-independent metabolism as blood
lactate levels continues to rise. Multiple-set work Metabolic Adaptations to Weight Training Ex-
bouts elicit blood lactate concentrations between 5
ercise
and 30 mmol, which, like VO2, are ultimately deter-
mined by amount of work performed (load, number
The metabolic responses to an acute bout of
of sets and repetitions) and the duration of the rest
weight training exercise are increased in resistance-
period. Longer rest periods (2-5 min) are associated
trained individuals, as they are capable of performing
with lower blood lactate levels as more lactate is oxi-
more work and creating greater energetic demands.
dized between sets.
Thus, greater exercise VO2, depletion of CrP, lactate
levels (muscle and blood), and EPOC are observed.
Changes in VO2 max following resistance training
Metabolic Recovery are related to the intensity of the training and the du-
ration of the rest period between sets.
Recovery after a contraction or multiple con- When the rest intervals are short (<30 s), as
tractions is proportional to the energy requirement in circuit weight training protocols, post-training in-
to do the work and how much was provided through creases in VO2 max average about 10%. The mag-
aerobic metabolism during the work. This metabolic nitude of change is small compared to that observed
recovery is typically equivalent to the amount of de- with endurance-type exercise training, but significant
pletion ATP and CrP and utilized oxygen stores (e.g., when considering that the energetic demands of
myoglobin), plus a little extra to support the energy weight training exercise (50% of treadmill VO2 max)
demands of recovery (elevated postexercise heart are bellow the threshold for inducing changes in VO2
rate and, breathing frequency, etc.). max.
When weight training exercise ceases, there Bodybuilders have a higher VO2 max than
is a steep decrease in energy demand; however, VO2 untrained individuals, and typically train with high
decreases exponentially to pre-exercise levels. This volume (high number of sets with 8-12 repetitions
appears to be the case for single-bout weight train- range) and relatively short rest intervals. VO2 max
ing exercise, where VO2 increases in the first minute does not change in response to heavy weight train-
postexercise, but declines to near rest values by 4 ing exercises that promotes large strength gains for
min. example, powerlifting or Olympic-style weightlifting
Multiple-set weight training exercise results in and involves relatively longer rest periods.
a significant elevation in postexercise uptake com- The effects of weight training on aerobic ca-
pared to rest values, which may remain elevated for pacity are reflected in the morphologic and biochemi-
up to 24 h. Further, when performing weight training cal changes in skeletal muscle. In general, various
and endurance type exercises (50% VO2 max for muscle fibers characteristics are altered by weight
1h) with the same total caloric expenditure, the pos- training, but the findings are not consistent. In gen-
texercise oxygen consumption following exercise is eral, heavy weight training exercise reduces the rela-
similarly elevated above rest values for at least 14h. tive oxidative capacity of skeletal muscle.
However, weight training exercise results in a signifi- Mitochondrial density is reduced, and oxida-
cantly higher uptake at 1h postexercise. tive enzyme activity is unaltered or reduced in Pow-
In summary, the energy demand for a single erlifters and Olympic-style weightlifters compared
contraction is dependent on the intensity of the con- to untrained individuals. Additionally, muscle hyper-
traction and the muscle mass involved (e.g., dead lift trophy in Powerlifters or Olympic-style weightlifters
versus bench press). The total energy demand for leads to a reduction in capillary density, despite un-
a single set of weight training exercise is depend- altered capillary per fiber ratios. Despite the extreme
ent on the load (intensity), the number of repetitions muscle enlargement, bodybuilders maintain capillary
performed, and the amount of muscle mass used. density by inducement of new capillary growth.
In multiple-set workouts, the energy demand will be T hese changes appear to support the noted
determined by the single-set characteristics, as well elevation in VO2max compared to untrained individ-
as the number and combinations of sets and the du- uals. Creatine phosphate and glycogen concentra-
ration of the rest interval. The magnitude and dura- tions appear to increase in resting muscle, indicating
tion of the excess postexercise oxygen consumption greater energy storage.
(EPOC) is related to the intensity and duration of the
exercise, similar to that seen with endurance-type ex-
ercise.
The Cardiovascular System intrinsically by the relative vasomotor tone, which is
the summation of vasodilatation and vasoconstriction
The cardiovascular system responds to in- on the entire vascular system. Extrinsically, TPR can
creased metabolic demand during exercise by in- be altered by vascular compression.
creasing blood flow. This function supports metabo- At rest, only about 20% of cardiac output is
lism by delivering oxygen and nutrients to the working directed toward skeletal muscle. During exercise as
muscle cell and removing carbon dioxide and waste. much as 80% of cardiac output may be directed to-
ward active skeletal muscle.
Cardiovascular Response to Resistance Ex- Impedance to blood flow, and therefore ef-
fects on TPR and blood pressure, is achieved when
ercise muscle contracts at intensity as low as 15% of maxi-
The heart rate response to resistance exer- mum voluntary contraction (MVC) while complete oc-
cise is exaggerated compared to endurance-type ex- clusion is possible at 30% of MVC.
ercise. Heart rate per VO2 is significantly greater in Muscular force is greater during the shorten-
weight training exercise. The exaggerated response ing phase, and thus TPR and blood pressure would
is attributed to several mechanisms: be higher during this phase. The longer the contrac-
1- Increments in cardiac output are achieved tion phases relative to the relaxation phases, the
only through increases in heart rate in weight training greater the impact on TPR, blood flow and blood
exercises; pressure. A longer relaxation phase, relative to the
2- The catecholamine response is greater in contraction phase, would minimize the overall effect
weight training exercises; of vascular compression on TPR, total blood flow and
3- The use of Valsalva maneuver impacts blood pressure.
heart rate; This is of special importance when prescrib-
4- Gripping the bar results in sustained iso- ing weight training exercises for the elderly and pa-
metric contractions, which add to the pressor reflex tients with high blood pressure or any other cardio-
drive. vascular disease that may be affected negatively by
high blood pressures during exercise.
The extent of vasodilatation during weight
Stroke volume is influenced by several fac- training exercises is evidenced by a postexercise
tors, including preload, afterload and inotropic state blood pressure that is lower than pre-exercise.
of the myocardium (contractility). Preload is the vol- However, increases in TPR with weight train-
ume placed on the heart as indicated by ventricular ing exercises are entirely related to vascular com-
end diastolic volume (EDV), and is dependent of pression overriding local vasodilatation. Perhaps the
venous return and all the factors that affect venous single greatest determinant of the blood pressure re-
return. Thus, increases in cardiac output associated sponse to weight training exercise is increased TPR
with weight training exercises can be achieved only due to vascular compression.
by drastic increases in the heart rate.
Posture plays an important role in determin- Blood Pressure
ing preload Exercises in supine compared to upright
position leads to dramatic increases in aortic pres- Both systolic and diastolic pressure, and thus
sure. This has the effect of limiting stroke volume by the Mean Arterial Pressure (MAP), increase abruptly
decreasing ventricular emptying time and ejection at initiation of an isometric contraction in an intensity
velocity. Afterload is increased during weight training dependent fashion. With maintenance of the isomet-
exercise as blood pressure rises. The heart attempts ric contraction, blood pressure remains elevated.
to compensate for increased afterload during weight During a single concentric muscle contrac-
training exercise by increasing myocardial contractil- tion, systolic and diastolic pressure rise and peak
ity. rapidly with onset of effort and subsequently decline
trough the range of motion, returning to pre-contrac-
tions levels at or near the end of contraction.
Total Peripheral Resistance (TPR)
In contractions with both resisted concen-
tric and eccentric phases (such as observed during
The vascular system can be viewed as a tube
weight training exercises), arterial systolic and di-
whose diameter is indicative of the peripherys rela-
astolic pressures are modulated in a phase-depend-
tive state of resistance to glow. TPR is determined
European Bodybuilding and Fitness Federation 10 International Federation of Bodybuilding & Fitness
ent manner. Pressure rise with concentric effort and trophy). These changes are attributed to increased
decline trough the range of motion to the lockout po- volume load (preload) on the heart. Although weight
sition. The pressure subsequently rises with onset of training can alter diastolic function through ventricu-
the eccentric phase and continues to rise until transi- lar remodeling and cardiac hypertrophy (concentric
tion from concentric to eccentric movement. In the hypertrophy), diastolic function is enhanced rather
transition from one contraction to another, pressures reduced as in a pathologic case.
again rise abruptly concomitant with the onset of the Typically, weight training exercise duty cycling
next concentric phase. These pressure peaks are as- involves an isometric component that induces severe
sociated with the highest compressive forces in the afterload stress on the heart. Accordingly, increases
muscle. in diastolic posterior wall thickness and diastolic in-
Most of the researches have demonstrated terventricular septal wall thickness occur as a con-
that the relative force production, rather than abso- sequence of weight training. However, ventricular
lute force production, determines the blood pressure wall thickening occurs without significant chances in
response to weight training exercise. Therefore, the diastolic left-ventricular dimension, which are gener-
actual extent of the increase in blood pressure ap- ally associated with the volume overloading effect pf
pears to be dependent on the relative effort (%MVC) endurance training.
involved and, to a lesser extent, the muscle mass in- In conjunction with increasing thickness in
volved. the diastolic posterior wall and interventricular sep-
In summary, during weight training exercise, tal wall, weight training exercise results in absolute
cardiac output is determined by changes in heart rate, increases in left-ventricular mass. However, when
while TPR is determined by vascular compression expressed as a function of lean body mass or body
overriding local vasodilatation. The level of impact surface area, the differences between training modes
of vascular compression is related to the intensity of are reduced.
contractions. The Mean Arterial Pressure (MAP) in-
creases due to increased cardiac output and TPR.
The Pulmonary System
Cardiovascular Adaptation to Weight Train- There has been little direct work on the ventila-
tory response to weight training exercise. Ventilation
ing Exercises increases during exercise to participate in increased
oxygen delivery and carbon dioxide removal.
Increases in muscle mass and body size
associated with weight training exercise result in a
larger demand for cardiac output in order to supply
an increased resting metabolic rate. This increase Ventilatory Response to Weight Training Ex-
in body size is paralleled by proportional increases ercise
in resting stroke volume. This larger stroke volume
enables the heart to meet demand for cardiac output In general, the ventilatory response to exer-
without increasing heart rate. cise occurs in three phases. Ventilation increases
It appears that resistance exercise training rapidly during the initial phase (first 20 s) due to in-
has minimal if any effect on stroke volume other than creased central drive (stimuli originating in the cer-
increases attributable to increases in body size. This ebral cortex) and afferent nerve traffic from the work-
adaptation allows an increase in resting cardiac out- ing muscle. During the second phase, or slow phase,
put to meet increased metabolic demand without in- ventilation raises exponentially. Responsiveness of
creasing heart rate and the rate-pressure product or medullar neurons to stimuli is augmented, allowing
work of the heart. The heart rate response to an acute a greater response to stimuli. Afferent signals from
weight training exercise may be attenuated in trained peripheral chemoreceptors are also integrated to en-
individuals compared to untrained individuals. sure maintenance of pulmonary gas exchange pa-
Changes in left-ventricular morphology are a rameters. The central drive and peripheral afferent
consequence of athletic training and are specific to stimulus components of phase 1 are maintained dur-
training mode. Endurance-type exercise is associat- ing phase II. The final phase of the response is the
ed with increases in left-ventricular internal dimension steady-state response where central and peripheral
with a minimum of wall thickening (eccentric hyper- sensory feedback modulates ventilation to maintain
alveolar gas pressures. The total ventilatory response system activation.
requires about 3-5 min. to reach steady level. Plasma levels of insulin decrease during
To consider the respiratory response to weight train- weight training. However, muscle contraction alone
ing, it is necessary to consider the duration and inten- has been shown to stimulate transport of glucose in-
sity of the exercise bout. The duration of a typical set dependent of insulin.
of weight training exercise (2-12 repetitions) is ap-
proximately 5-120s. Several androgenic hormones are known
A ventilatory response can be seen with a to increase in plasma as a result of weight training. In
contraction intensity as low as 15% of MVC. Weight males, serum levels of both testosterone and free
training performed at 70-80% of 1-RM elicits a mod-
testosterone increase dramatically with weight train-
erate ventilatory response (50-60 L/min). Changes
ing exercise and remain elevated more than 30 min
in resting ventilation, as an adaptation from weight
postexercise. Little or no testosterone response is
training, would likely result from a greater resting
elicited in female.
metabolic rate secondary to increased muscle mass
rather than any change in regulation. Serum growth hormone levels increase in
both males and females performing heavy weight
training exercise, though the magnitude of response
is greater in men. In addition, the growth hormone
The Endocrine System response to weight training in males and females ap-
pears to be dependent on the exercise protocol uti-
Weight training exercises represents two
lized.
unique stresses on the body: an acute metabolic
Hypertrophy-inducing protocols that typically
stress and a developmental stress based on the
have a higher energy demand result in significantly
structural adaptations that accompany weight train-
higher levels of hGH (human growth hormone) than
ing exercise. Thus, integration and regulation of en-
strength protocols. This may reflect the role of hGH
ergy metabolism and development of skeletal muscle
in both tissue development and energy metabolism.
form the basis of the response of the neuroendocrine
The acute effects of hGH include stimulation
system to weight training.
of glucose uptake and inhibition of lipid metabolism,
whereas prolonged elevation of hGH has opposite
effects.
Endocrine Response to Weight training Many of the growth effects of hGH are medi-
ated through insulin-like growth factors (IGF-1), which
In general, the magnitude of the neuroen- have been shown to increase with weight training.
docrine response to weight training exercise will
be based on the amount of work performed as it in-
teracts with load (intensity), muscle mass involved,
Endocrine Adaptation to Weight Training
number of sets and repetitions, and rest period be-
tween sets.
There have been few studies and there are
Adrenal hormones respond to stress. Weight little data regarding adaptations of the endocrine sys-
training results in elevated levels of serum cortisol, tem to weight training exercise.
norepinephrine, epinephrine, and dopamine in both The effects of weight training on resting hor-
males and females. Increases in cortisol during mone levels have been investigated in individuals
weight training appear to reflect the metabolic stress with ability levels ranging from elite-level competitive
of the exercise. lifters to previously untrained recreational lifters.
Cortisol and catecholamines are responsi- At rest, hGH, catecholamines, insulin, insu-
ble for mobilization of free fatty acids and are glyco- lin-like growth factors, and cortisol have been shown
genic, supporting glucose metabolism by stimulating to be unaltered by weight training. Given the nature
gluconeogenesis (amino acids to glucose). Norepine- by which hormone levels are regulated through feed-
phrine and epinephrine play a role in vascular control back mechanisms, by other hormones, release and
and vasomotor tone. transport factors, inhibition/potentiation, diurnal vari-
ation, changing receptor sensitivity, and so on, it is
Epinephrine stimulates glycogen breakdown not surprising that studies show no changes in blood
and glycolytic flux. Catecholamines also play a role hormone profiles, at rest, after weight training.
in muscle function through greater central nervous
However, there is some evidence to sug-
gest that cortisol, when elevated, may be a marker
of overtraining. Chronic elevations in cortisol would
be indicative of pathological stress and reflect a cata-
bolic balance in the body.
Testosterone appears to be the one differ-
ence to the trend described above. However, sev-
eral reports show increases in resting testosterone
levels after weight training. Increased resting levels
of testosterone and decreased levels of cortisol has
been observed in non-elite and previously untrained
lifters in response to weight training exercise. These
changes were coincident with increases in luteniz-
ing hormone (LH) and follicle-stimulating hormone
(FSH), which are higher brain center stimulators of
testosterone production.
Thus, it appears that training experience and
duration of training play a major role in determining
the testosterone response to training In conclusion,
the metabolic, cardiovascular, pulmonary, and endo-
crine responses to an acute bout of weight training
exercise are inherently similar to those observed with
endurance-type exercise.
Differences in the magnitude and the pattern
of responses represent differences in external load-
ing, vascular compression, and contraction duty cy-
cle.
Adaptations to weight training are governed
by the same set of parameters as in endurance-type
exercise: intensity, specificity, and duration/volume of
training. However, the adaptations to weight training
are quite different from those to endurance-type train-
ing given the differences in external loading, vascular
compression, and contraction duty cycle used in the
training.
PROPRIOCEPCION AND NEUROMUS- the larger the pennation angle, the shorter the fiber
length Pennation angle also affects velocity of force
CULAR CONTROL DURING THE EX- production being that muscles that have greater fas-
ERCISE cicle lengths and smaller pennation angles have the
better capacity of velocity production in contrast to
muscles with minor fascicle lengths and greater pen-
The system of motor control is of fundamen- nation angles.
tal importance for all the aspects of the weight train- The impact of muscle architecture on force-
ing. This system controls the production of force and generating capacity is described by the physiologic
power of the muscles and it is also responsible for cross-sectional area (PCSA). The equation for PCSA
maintaining the brain informed of bodys positions is given below:
during the daily movements and during the training.
There are important peripheral receptors in PCSA (cm2) =
the muscles, joints, tendons, ligaments, skin, articu-
Muscle mass (g) x cosine
lar capsule, among other structures that constantly
inform the Central Nervous System (CNS) about the _______________________________
internal and external stimuli that arrives at all times p (g/cm3) x Fiber length (cm)
on the body.
These receptors are also responsible for the Where p = muscle density (commonly taken
conversion of these mechanical stimuli in neurologi- as 1.06 g/cm3) and = muscle pennation angle. Pen-
cal signs that are transmitted to the CNS so that they nate muscles have fibers oriented at angles to force-
can be processed. These receptors are called prop- generating axis; the angle of pennation typically var-
rioceptors and this integration process between the ies between 0 and 40.
proprioceptors and the CNS is called propriocepcion.
Muscle pennation angle plays a role in force
The propriocepcion is a critical source of sensorial
production, because a force generated at an angle to
information for a good and efficient motor control. In
the tendon will always be less than that same force
the highest levels of organization, the somatosenso-
at no angle and thus, pennation angle results in less
rial cortex processes the proprioceptive information
force Transmitted along the axis of force production.
to provide a perception aware of the position and of
A pennation angle-of 30 results in a 15% reduction
the movement of the joints, and the muscular ten-
in force. However, the loss of force can be overcome
sion. Thus, the regulation of the muscular activation
by packing more fibers into a given space. Therefore,
is a direct function of the neuromuscular system or
greater force can actually be generated by pennate
neuromuscular system.
muscles because of more cross bridges.
The purpose of skeletal muscle is to produce
With these characteristics the pennate mus-
force. If the force produced is greater than the load
cles have a large force-generating capacity even
(or resistance) on the muscle, the muscle will shorten,
without a large mass, but this feature compromises
producing work (the product of force and displace-
the elasticity of these muscles in comparison to lon-
ment or F x d).
gitudinal muscles.
The muscle architecture refers to the arrange-
ment of muscle fibers relative to the axis of force gen-
eration. This arrangement is important in determining
a muscles force and shortening velocity capabilities, Neuromuscular Reflexes
as it affects fiber density and cross-bridge number.
Fiber length is rarely identical to whole muscle length Force generation by a skeletal muscle can
and can vary in humans by a 1arge amount (<20 mm be modulated extrinsically by several reflexes and
to >450mm). related phenomenon. Renshaw cells (inhibitory cells
Typically, muscle fascicle (bundles of fibers) transmit inhibitory signals to motor neurons) are lo-
length measured in vivo is equivalent to muscle fiber cated in the spinal cord in close association with mo-
length, although the two are not necessarily synony- tor neurons. These cells function as a regulator of
mous. The more sarcomeres in series, the faster the force production.
shortening and the less shortening each sarcomere When using several muscles around a joint,
has to do for a given length change. the Renshaw cell may prevent all the intended mus-
Fiber length varies with pennation angle: cles from contracting maximally, limiting force pro-
duction. The bodys neuromuscular responses to
weight training
Muscle spindles are connective tissue cap-

sules implanted within the muscle fibers, with afferent
and efferent innervations, and specialized intrafusal The adaptations of the neuromuscular
fibers. These muscle spindles (intrafusal fibers) mon- system follow three overlapping principles: over-
itor muscle fiber length and rate of change of fiber
length. load, novelty, and specificity.
Changes in length result in a concentric con-
traction of the muscle to limit length changes. Spindle Overload: To provide an adaptive response,
reflexes limit force production in a muscle by evoking the neuromuscular system must be exposed to loads
a contraction in the antagonist muscle, which is being beyond those typically encountered in normal activity;
lengthened during movement. this is the basic premise behind the overload princi-
Golgi tendon organs are receptors embed- ple. In weight training exercises these stimuli needed
ded in tendons and respond to tension rather than to provoke an adaptation response can be provided
length. When loaded, these organs exhibit inhibitory in several ways: increased intensity, increased dura-
effects on agonist muscles and facilitatory effects on tion, or some combination of each. Increased intensity
antagonist muscles. This prevents a muscular con- can be provided by increasing the load, changing
traction from generating too much force that could the order of the exercises, decreasing the rest time,
possibly result in injury to the muscles, tendons, or or some combination of these factors. Increased du-
bones involved in the movement. ration can be provided by completing additional sets
Adversely, the extremely high production or repetitions, decreasing the speed of movement, or
of force at the bench press, for example, may acti- some combination of these factors.
vate Golgi tendon organs and the reflex would be
an abruptly interruption in force production from the Novelty: The neuromuscular system will
pectorals muscles, what would result in a possible adapt to new stimuli. At the beginning of a weight
fracture of the ribs due to the impact of the bar with training program, simply adding more weight can be
weight toward the rib cage. This is why its so impor- used as a load progression (although this is not the
tant to have a spotter when lifting heavy weights. better way to increase intensity for the beginners);
In some movements in untrained subjects, it later on, wave sets, pyramid sets, or use of new
is more difficult to achieve full motor unit activation in equipment can represent a novel stimuli independ-
bilateral (both limbs acting together) than in unilateral ent of overload. New exercises or new twists to old
contractions. The force produced in bilateral contrac- exercises (e.g., altered grip) can also provide new
tions is less than the sum of the forces produced by stimuli.
unilateral contractions. This phenomenon is termed Periodization of the training program also plays an
bilateral deficit. important role in novelty, and will affect directly and
positively the risk of injury and overtraining. These
allow an individual to make continued gains through-
Co-Contractions out a training period.
Co-contraction is the simultaneous activation Specificity: Is the physiological adaptation(s)

and contraction of antagonist muscles that occurs that associates precisely with the type of training per-
in response to agonist muscle stimulation. These formed. The specific pattern of neuromuscular ac-
co-contractions appear to have several purposes, tivation required by a particular exercise or training
including joint stabilization, precision of movement, program stimulates other systems (e.g., endocrine)
and as a braking mechanism during rapid, ballistic in such a way as to provoke particular (specific) re-
movements and thus could be considered a positive sponse or adaptation. Thus, weight training programs
protective mechanism during the beginning phase of designed for a particular purpose (e.g., sport) should
a weight training program. employ the types of muscular actions and velocities
Antagonist activation and contraction is encountered in that particular purpose.
known to limit force production in agonists through
reductions in motor unit recruitment. The mechanism The adaptations and their mechanisms by
is especially active in novel tasks or movements. which strength is increased following weight training
can be divided into two distinct, but not exclusive cat-
egories: neural changes and structural changes.
The balance or predominance of neural and
structural adaptations to weight training exercises is
determined by the exercise prescription.
The Neural changes include the increased
motor unit recruitment, increased frequency of stimu-
lation, synchronization, desynchronization, blunted
reflexes, cross education, bilateral deficit, and ago-
nist/antagonist interactions during exercise.
The Structural changes include increased
muscle size (hypertrophy, that can result mainly from
increased fiber cross-sectional area, increases in
fascicle length, increases in connective tissue con-
tent, or a combination of theses factors), changes in
mitochondrial density, glycolytic enzyme concentra-
tion, capillary number, and capillary density.
There are also some structural changes that
occur in the motor neuron and connective tissue that
include changes in neural morphometry and morphol-
ogy (e.g. alteration in metabolic enzyme concentra-
tion), enhanced protein synthesis in the motor neuron
and adaptations of the neuromuscular junction.
These adaptations of the neuromus-
cular junction to weight training help prevent fatigue.
Physiological aspects and safe prescription majority of bone mass is accumulated by 17-18 years
of age; however, bone mass continues to increase
of weight training exercises for special popu- between the ages of 20 and 30 years, during which
lations time peak bone mass is achieved.
During adulthood and middle age, both men
and women begin to lose bone at the rate of ap-
Weight training and Osteoporosis proximately 0.5% per year. The rate of bone loss
accelerates to 1-2% per year or higher in women at
Osteoporosis is a systemic skeletal disease menopause due to decreased estrogenic exposure.
characterized by low bone mass and microarchitec- Both the loss of BMD and muscle mass with age are
tural deterioration of bone tissue, with consequent in- greater in the axial skeleton than in the apendicular
crease in bone fragility and susceptibility to fracture. skeleton.
One important point is that, unfortunately, As exposed on the Themes I and II of this
fracture is often (or almost always) the first indica- course, healthy bone is maintained through a con-
tor of osteoporosis. Osteoporosis can be objectively tinuous remodelling process during which old bone
diagnosed as bone mineral density (BMD) that is 2.5 cells are removed by osteoclasts and replaced by
standard deviations below normal for healthy young newly formed bone cells, osteoblasts. Bone is clas-
adults or approximately 25% bone loss. sified as cortical and trabecular tissue. Cortical bone
The initial bone loss at the beginning of oste- makes up approximately 80% of the skeleton, while
oporosis is called Osteopenia. Several instruments trabecular bone accounts for the remaining 20%.
are used to measure BMD and bone mineral content The minimal essential strain (the threshold
(BMC), diagnose osteoporosis can predict risk of stimulus that initiates new bone formation) is theorized
bone fracture, project rate of bone loss and monitor to be the force per unit area approximately equal to
effects of treatment. one-tenth the level of strain necessary to fracture the
Eighty percent of those affected by osteoporo- bone. A force that is equal or greater than the minimal
sis are women. Certain risk factors for osteoporosis essential strain and occurs repeatedly will signal os-
are nonmodifiable and are evident in individuals of teoblasts to migrate to the region of the bone that is
all ethnic backgrounds. Some risk factors are poten- receiving the stimulus. This first step of bone accre-
tially modifiable with proper treatment. For example, tion occurs within 8-12 weeks of mechanical loading
disordered eating and amenorrhea are treatable at the minimal essential strain level.
conditions; however, a history of disordered eating Mineralization of the collagen fibers must
or amenorrhea during adolescence cannot be elimi- then occur over an additional equal time period to
nated as a present risk factor. ultimately increase BMD and strengthen bone. As a
Lifestyle factors and choice of medical treat- result, the minimum estimated time frame to increase
ment are highly modifiable risk factors. BMD with appropriate loading conditions is four to six
Prevention must take place at each stage of months.
the life cycle. Achieving peak bone mass during child- Weight training can increase bone by provid-
hood, adolescence, and early adulthood, maintaining ing periodic increases greater than the habitual loads
bone mass through middle age, and minimizing loss applied to bone. Thus, minimal essential strain from
during old age are the cornerstones of prevention. weight training will vary by individual based on history
Optimizing BMD and Bone Mineral Content of bone-loading activity and current type and level of
(BMC) in childhood ultimately leads to a reduction in activity.
the risk of osteoporosis. Weight-bearing and strength- The adaptation to mechanical loading occurs
ening exercises that load the skeleton via muscular at a more rapid rate in the axial skeleton than the ap-
contractions (as weight training) are powerful con- pendicular skeleton due to the higher percentage of
tributors to maximizing peak bone mass. trabecular bone in the former.
Hereditary factors determine 70-80% of the The effects of weight training on BMD are
variability of peak bone mass; the remaining vari- depend on the exercise prescription components
ability is determined by dietary intake, hormone ex- mode, frequency, intensity, load and durationand
posure, and environmental and lifestyle factors. The the characteristics of the exercise participantsage,
gender, exercise history, and nutritional status.
The time frame of bone and connective tissue
to adapt to resistance training is longer than mus-
cle adaptation and may be subject to rapid effects Conclusion
of detraining.. This presents an important underlying Weight training is a potent prevention and
assumption in lifelong exercise participation and pre- treatment strategy for osteoporosis and may be most
scription. successful when combined with adequate intake of
calcium and vitamin D, lifestyle modification, and
medication. Also, weight training must be performed
Specific Recommendations for Weight Training at the proper intensity, volume of loading (number of
exercises, sets, repetitions), and be of sufficient du-
The primary consideration for weight train- ration to increase BMD.
ing for osteoporosis is proper medical screening and Varying exercise selection, changing the di-
evaluation, including health history and current health rection of the force applied, including structural ex-
status. ercises, and exercises that allow greater absolute
A bone density test is essential to obtain infor- loads may be of additional benefit to bone.
mation about the specific regions of bone and frac-
ture risk, and to monitor change in bone over time.
Assessment of exercise history, current exercise par- Weight training and Diabetes
ticipation, joint stability, flexibility, and strength is also
appropriate. There are two major types of diabetes melli-
Weight training to maximize bone health tus (DM), commonly labelled type 1 and type2. Type l
should be performed for a minimum of one year at DM results from an insulin-deficiency state, generally
moderate- to high-intensify 75-85% 1-RM or at 8-12 due to autoimmune destruction of the pancreatic -
RM intensity. Three sets of 8-12 repetitions performed cells.
3 times per week for 6-12 total body exercises pro- Type 1 DM usually becomes clinically evident
vide the optimal stimulus to bone before age 30. The insulin-deficient state results in
The exercise selection must be in accordance hyperglycaemia due to both reduced cell glucose up-
to the fact that osteogenesis is mediated by the force take and excess glucose release from the liver. When
of muscle contraction at the site of the tendon attach- blood glucose excretion exceeds the reabsorption
ment to the bone. Thus, the most beneficial exercises threshold for glucose in the kidney, glucose is lost
for bones use muscles that originate or insert at the in the urine (glycosuria), along with increased water
bony landmarks of interest because they provide the (polyuria).
most direct site-specific mechanical load on bone. The increase in the volume of urine may re-
Exercises that involve the six deep external sult in dehydration, stimulating thirst (polydipsia).
rotator muscles of the hip (gemellus inferior and su- Weight loss results from excessive protein and fat
perior; obturator internus and externus, quadratus catabolism to compensate for the inability to use car-
femoris and piriformis) and the adductor muscles bohydrate as fuel, which are direct consequences of
(adductor brevis and longus, pectineus) may contrib- both insulin insufficiency and increased activity of the
ute to significant increase in femoral neck BMD. Leg counter-regulatory hormones.
extension and flexion and hip extension and flexion
exercises, including leg presses and squats stimulate These four symptoms: weight loss, glycosu-
bone at the proximal femur. ria, polyuria, and polydipsia are the cardinal clinical
Back and hip extension exercise, lat pull- manifestations of Diabetes Mellitus. Increased ac-
down, and rows that engage the deep muscle of the tivity of hormone-sensitive lipase in the adipocytes,
spine and the superficial muscles of the back have also associated with insulin deficiency and increased
been shown to be effective in maintaining or increas- counter-regulatory hormonal activity, results in an
ing lumbar spine BMD. Bent-knee dead lifts and excess presentation of fatty acids to the liver which
cleans are advanced structural exercises incorporat- leads to excess ketone body formation and ketoaci-
ing back and hip extension that are also effectives. dosis, which can be a fatal complication in the ab-
The exercises that use brachioradialis and sence of insulin-replacement therapy.
pronator quadratus muscles and joint actions as the Approximately 90-95 % of all cases of DM in
arm curl, arm curl with forearm rotation, wrist prona- most countries are Type 2 DM. It usually begins later
tion, and supination as well as wrist curl and reverse in life than Type 1 diabetes (generally after age 40).
wrist curl result in significant increase in wrist BMD. This type of diabetes primarily results from an insu-
lin-resistant state with a relative insulin deficiency de-
spite normal or elevated blood levels. In contrast to and stroke in diabetic much more than in nondiabetic
type 1 DM, most people with type 2 DM are obese individuals.
and/or have increased subcutaneous and visceral fat Major atherosclerotic-thrombotic cardio-
in the abdominal region.
Although type2 diabetic patients also may vascular complications are the principal causes of
present with glycosuria, polyuria, and polydipsia, morbidity and premature mortality in diabetic individ-
usually the disease onset is accompanied only by uals. Accelerated atherosclerosis in the presence of
non-specific symptoms, such as blurred vision, vagi- DM is due to dyslipidemias and elevated blood pres-
nal infections, or poor wound healing. sure levels. Accompanying coagulation defects also
There is a stronger genetic contribution to the increase the risk of formation of a thrombus, causing
etiology of type 2 DM than type 1 DM. First-degree obstruction of a coronary or cerebral artery and re-
relatives of people with type 2 DM have a fourfold sulting in a myocardial infarct or stroke.
increased risk of type 2 DM than those in the general Diabetic retinopathy is the most common
population. cause of new cases of blindness among persons age
During the first stage, insulin sensitivity is re- 20-74 years. The presence of retinopathy is gener-
duced and hyperinsulinemia is present, but the rate ally considered a relative or absolute contraindication
of liver glucose release is normal, and there is only for strenuous aerobic or weight training exercises be-
a borderline elevation in fasting blood glucose lev- cause of the risks of hemorrhage in the eye and reti-
els and a normal or borderline glucose tolerance test nal detachment.
response. At this stage, the main pathophysiologi- The peripheral neuropathy (as well as pri-
cal feature is postulated to be a genetically related mary muscle damage and reduced vascular supply)
defect in glycogen synthesis in skeletal muscle. If to resulted from diabetes can compromise the force pro-
this genetic defect are added obesity, a sedentary duction ability of the musculoskeletal system. Mus-
lifestyle, and aging, the second stage of the disease cle atrophy in turn adversely affects glucose control,
manifests itself by impaired glucose tolerance and making these individuals more susceptible to further
relative insulin insufficiency. At this stage, hepatic disability from long-term complications. Thus, proper
glucose production and fasting blood glucose still re- weight training programs to help maintain muscle
main normal, but postprandial plasma glucose levels mass and function may permit the diabetic patient to
are increased, which initially can be compensated for perform activities of daily living more efficiently and
by hyperinsulinemia. thereby improve quality of life.
In the third stage, DM is fully expressed with The main goals in the treatment of DM are
excess hepatic glucose release and fasting hyperg- to achieve glycemic control, manage coexisting CVD
lycemia. By then chronic vascular complications may risk factors, and prevent or reduce the progression
already have started or in fact may be initial manifes- of chronic complications. This is accomplished by
tations of the disease. the combination of diet, exercise, smoking cessation,
This emphasizes not only the possibility and and the use of insulin or oral hypoglycemic drugs to
importance of early detection of the disease, but the further improve glucose control, as well as pharmaco-
value of primary prevention strategies, including ex- logical management of coexisting dyslipidemias and
ercise training. hyper-tension. Insulin is essential in the management
of type 1 diabetes to prevent ketoacidosis.
Prior to prescribing an exercise program, it is Weight training exercises might help in the
necessary to screen all individuals with DM for evi- management of DM by increasing skeletal muscle
dence of complications. mass, since muscle is the principal source of glucose
Chronic complications in diabetic individu- disposal.
als are related to two types of vascular processes: Weight reduction is also important in the pre-
microangiopathy (vascular alterations restricted to vention and management of type 2 diabetes. How-
the blood capillaries) and macroangiopathy (prema- ever, weight reduction by dietary restriction alone is
ture atherosclerosis and increased risk of thrombosis accompanied by a concomitant loss of muscle mass,
of medium-sized and large arteries). though this loss can be significantly reduced by add-
The pathophysiological macrovascular ing a regular weight training exercise program.
Postulated mechanisms by which resistance
changes are responsible for the increased risk of exercise training can improve blood glucose control
coronary heart disease, peripheral vascular disease, include increased skeletal muscle mass, glucose up-
take, and glycogen synthesis. It also appears that the ally increased to a maximum of 70% of 1-RM or up to
effects of weight training in improving glucose toler- an Rate of Perceived Exertion (RPE) of 15-16, based
ance can be achieved independent of weight loss or on the response and health of the individual. At this
an increase in VO2max. intensity level, systolic blood pressure generally will
Furthermore, when weight training is combined be maintained within clinically acceptable levels (be-
with aerobic exercise and/or weight loss through diet, low 200 mmHg).
the effects on glycemic control and glucose tolerance When the recommended weights lifted are
would be expected to be significantly better than with again perceived to be light to somewhat hard (RPE
any of the single-treatment modalities alone. 12-13), or if the exerciser is able to perform more
repetitions than initially recommended, the amount of
weight lifted should be increased by about 5% incre-
ments.
The Weight Training Prescription

Before starting a weight training program,
the exercise leader or health professional designing General Guidelines for Weight Training Exer-
and supervising the exercise program should care- cise Program for Type 2 DM individuals
fully demonstrate the proper weightlifting techniques
and allow the individual to practice them, starting with
very light weights or an unloaded bar. 1. Include 8-10 exercises involving all major
The individual should also be instructed not muscle groups of the upper and lower body and the
to excessively squeeze the bar handle, since this can trunk.
cause an exaggerated rise in systolic blood pressure 2. Frequency: 2-3 times per week.
during the concentric phase of the contraction. Both 3. Intensity should start at 40-50% of 1 -RM
concentric and eccentric contractions should be per- and be gradually increased every 2-3 weeks up to
formed slowly for the whole range of motion. While 70% of 1-RM, depending on health status of the indi-
performing the concentric contraction, the exerciser vidual.
should exhale slowly in order to avoid the Valsalva 4. 1-2 sets of 12-15 repetitions, with not more
maneuver that could result in subsequent rise in in- than 60 s between sets.
tra-arterial blood pressure. 5. Follow proper weightlifting techniques and
precautions.
6. First exercise large muscle groups, then
Recommendations in the Event of Hypogly- small muscle groups.
cemia in a DM Individual, Before, During, or
After a Bout of Exercise An exercise prescription should be tailored to
the individuals needs and preferences.
Regular weight training and aerobic exer-
1. If blood glucose is <100 mg/dl before start- cise generally is commended to patients with DM
ing an exercise session, consume 15-20 g of carbo- to improve glucose control, increase cardiovascular
hydrates and wait 15-30 min; recheck blood glucose fitness, lose excess weight, reduce risk factors for
levels and only restart exercise if blood glucose is cardiovascular diseases and improve quality of life.
>100 mg/dl. Weight training exercise also may be prescribed to
2. If symptoms appear during exercise, stop improve athletic performance in young type 1 DM in-
immediately and recheck blood glucose levels. dividuals participating in competitive sports as well as
3. If blood glucose monitoring is not available for diabetic master athletes.
at place of exercise, eat 15-30 g of fast-acting carbo- The goal should be to design an individual-
hydrates prior to prolonged exercise. ized exercise program that properly balances the po-
4. Also consume 15-30 g of carbohydrates as tential benefits and risks of exercise.
soon as possible if blood glucose following exercise Individuals with DM who follow these guide-
is <60 mg/dl. lines should be able to safely improve muscular
strength and endurance, which can not only improve
diabetic control, but also substantially improve ca-
The intensity of the exercise should be gradu- pacity for independent living and enhanced quality of
life in older individuals with diabetes. The Safety of Weight Training: Hemo-
dynamic Factors and Cardiovascular
Incidents
There has been considerable investigation of
the changes in arterial blood pressure and left-ven-
tricular performance during both static (isometric)
and dynamic exercise, but the acute responses to
weightlifting, or weight training, have been character-
ized for little more than the past decade. A number
of factors have been identified as contributing to the
circulatory responses to weight training, and the ef-
fects of weight training have also been documented.
Dynamic, Static, and Weight Training Exercise
Dynamic exercise (e.g., cycling) involves a

brief static muscular contraction followed by con-
centric shortening and almost immediate eccentric
lengthening. This pattern of movement results in
large increases in venous return as result of the mus-
cle pump.
Together with reductions in peripheral vascu-
lar resistance and an increased heart rate and stroke
volume, there are significant increases in cardiac out-
put; that is a volume load on the heart. In contrast,
static contractions above 20% of the maximum volun-
tary contraction strength result in a substantial rise in
mean arterial pressure, and only a modest increase
in cardiac output, primarily due to an increased heart
rate; this pattern of response reflects a pressure
load on the heart.
Depending on the magnitude of the load lift-
ed, weight training exercise produces a circulatory
response that reflects either a volume load or a pres-
sure load.
The lifting and lowering of a weight is achieved
by a combination of static and dynamic contractions.
Before any lifting takes place, there is a static con-
traction until the muscle force exceeds the weight of
the object to be lifted. This is followed by concentric
shortening to raise the weight, a variable period of
muscle unloading when the limb joint(s) reaches
the end of its range of motion (may be extended or
flexed), and then eccentric lengthening to lower the
weight to its starting position.
During lifting of light-to-moderate weights,
both the duration and magnitude of the static con-
traction are very brief, and the circulatory response
should be more of a volume load. In contrast, dur-
ing very heavy lifting and when lifting successively to
failure, there is a longer and more pronounced static
contraction that may evoke a more typical response pressure; but the relation is clearly not linear. For
of a pressure load. example, bilateral leg press may elicit a greater re-
There is now considerable evidence that this sponse than the same exercise done with only one
is in fact the case; the circulatory responses to weight leg, but nowhere near double. When the circulatory
training vary throughout the various lifting stages responses among different individuals are compared,
according to the degree of effort required to do the variations in muscle mass seem to have little effect.
maneuver. This lends further credence to the hypothesis
Both systolic and diastolic pressures show that relative effort is the major influence on the circu-
large fluctuations throughout each lift, becoming latory responses to weight training exercise.
more pronounced over repetitions as the subjects There is also a contributing effect to altera-
began to fatigue. tions in arterial pressures that is related to the joint
angle during the lift. The highest arterial pressures in
a single lift should occur when the muscles are work-
The effects of Load and Repetitions ing in their inner and outer range. At the initiation of
the movement, the knee joint angle, for example, is
When someone lifts weights, the heart rate 90, and the leg extensors are at their weakest point
and arterial pressure response increase in proportion on the strength curve; it is in this very early phase
to the absolute load lifted. But, it is the relative rather that the rise in arterial pressure is the greatest. As the
than the absolute load, which dictates the circulatory movement proceeds, the pressure decreases, reach-
response during weight training exercises, an im- ing almost resting levels at the time of lockout when
portant concept for the people that prescribe weight the knee joint angle is 170, the strongest position for
training programs. the leg extensors (quadriceps femoris).
The arterial pressures in the first repetition of During the eccentric lowering of the weight,
a set of lifts are greater than during the subsequent 2 the arterial pressures rise again, but not to the same
to 3 lifts; thereafter the values rise progressively and level as in the initial concentric phase. Once again,
the slope of the increase is much greater once the this can be explained by the relative effort required
intensity of the lifting exceeds approximately 80% of in the two types of contraction. Muscles can gener-
the 1-RM. During a set of lifts with such heavy loads ate significantly more force during an eccentric con-
(and with the onset of fatigue), there is an obligatory traction than in a concentric contraction, so lowering
use of the Valsalva maneuver to stabilize the trunk a given weight will require a reduced relative effort
and to facilitate the requested force generation. compared with raising it, and this is associated with a
The intrathoracic pressure may rise above reduced circulatory response.
100 mmHg (equal to 60% of the pressure generated Given the evidence that the acute circulatory
during a maximum voluntary Valsalva maneuver), responses to weight training exercises are predomi-
and this contributes to the increase in arterial pres- nantly influenced by the degree of relative effort re-
sure. For this reason, and also because of a potential quired to lift the load, stronger muscles after training
reduction in venous return, individuals doing static should lift a given weight more easily and evoke a
exercises and those engaged in weight training ex- less pronounced increase in heart and blood pres-
ercises are often must be advised not to perform a sure. This is of very special importance when dealing
Valsalva maneuver. with hypertensive individuals who weight train.
It seems that the responses are higher dur- As there is a high degree of specificity associated
ing a training session after the onset of fatigue, when with many of the adaptations to weight training, the
more conscious effort is needed to generate the nec- reductions in the circulatory response is greatest
essary muscular force. It might also be expected that when the trained muscles are engaged in weightlift-
training sessions that utilize brief rest periods being movements.
tween sets would also provoke heightened circula-
tory response.
The Safety of Weight Training and Cardiovas-
cular Incidents
The Effects of Muscle Mass
It appears that resistance training has a re-
It appears that the greater the muscle mass, markable record of safety with respect to cardiovas-
the more pronounced the rise in heart rate and blood cular incidents. Researchers at the Cooper Clinic and
the University of Florida have conducted over 26,000 sponses are influenced in predictable ways by such
assessments of maximum dynamic strength without factors as the number of repetitions, the absolute and
one single cardiovascular event. This is in marked relative load, the engaged muscle mass, the chang-
contrast to the well-established increased risk of car- ing joint angle(s), and the Valsalva maneuver, and
diac problems, and sudden death, associated with should consider these factors when designing the
aerobic exercise. training program.
Nevertheless, despite a higher incidence of
cardiovascular events during aerobic exercise, it is
imprudent to infer an increased relative risk for this
type of exercise in comparison to weight training.
More complications during these activities may simply
reflect the greater relative participation in these types
of exercise. The reason(s) for this difference between
the two types of exercise may also be explained by
the contrasting Hemodynamic stresses that they in-
duce and the timeover which they are sustained.
Aerobic exercise training is usually performed
for sustained periods of 20 min or more, whereas
weight training is done in sets, each of which may be
completed within 1 or 2 min and is then followed by a
variable period of rest. Any increases in blood pres-
sure, heart rate, and cardiac output are thus borne
over a longer period during aerobic exercise training,
and this alone is likely associated with increased car-
diovascular risk.
The best indirect indicator of myocardial ox-
ygen requirements, and hence the demand for in-
creased coronary artery blood flow, is the rate-pres-
sure product. The heart rate, stroke volume, cardiac
output, and rate-pressure product are significantly
higher, and the total peripheral resistance is lower,
during cycling compared with a leg press exercise,
for example.
This suggests a reduced myocardial oxygen
demand during weight training exercise and a left-
ventricular response comparable to aerobic exer-
cise.
With weight training exercise there is a re-
duced heart rate, a similar systolic pressure, and a
higher diastolic pressure (in comparison with aerobic
exercise), combining to produce a thus a more fa-
vourable myocardial oxygen supply to demand bal-
ance. However, there are many reports of reduced
ischemic signs or symptoms during weight training,
and this form of exercise is now widely recommend-
ed as part of cardiac rehabilitation process.
In general, it appears that appropriately pre-
scribed weight training exercises are a safe form of
exercise for the majority of the population and is as-
sociated with minimal risk of cardiovascular events,
even in those with previous myocardial infarction or
chronic congestive heart failure. Nevertheless, any-
one who prescribes weight training programs should
recognize and be aware that the acute circulatory re-
STUDY QUESTIONS
1- How the blood flow is controlled and how it varies wit exercise?
2- What is Cardiac Output?
3- Why would cardiovascular endurance conditioning be important for ath-
letes in nonendurance sports?
4- Describe the primary functions of blood.
5- Describe how heart rate, stroke volume and cardiac outuput respond to
increasing rates of work.
6- Describe the basic metabolic responses of the body to Weight
Training exercises.
7- How the endocrine system adapt to weight training?
8- What are the function of the neuromuscular reflex on the human body
regarding movement and posture?
9- Describe the main factors to be considered when prescribing weight
training exercises to a person with Osteoporosis.
10- Describe the main factors to be considered when prescribing weight
training exercises to a person with Diabetes.

Physiology of Exercise

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PHYSIOLOGY OF

THEME III EXERCISE

The Cardiovascular System

Physiological Responses and

Motor Control and Proprioception

Safe Prescription for Special

1- The basic function of the Cardiovascular System.

1- Stroke Volume, Ejection Fraction and Cardiac Output.

Stroke Volume The Vascular System

The total volume of blood in the body varies

Resting heart rate averages 60 to 80 beats/

Stroke volume is determined by four factors:

The volume of venous blood returned to the

The first two factors influence the filling ca-

Co-contraction is the simultaneous activation Specificity: Is the physiological adaptation(s)

Dynamic, Static, and Weight Training Exercise

Dynamic exercise (e.g., cycling) involves a

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