34,0 vs 16 1 T
sk 30,5 unit Borg; P 0,05 untuk semua
perbandingan).
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www.jappl.org
•
34,0 ° C Berarti T
sk
PEMBAHASAN
Novel Temuan prinsip dari penelitian ini adalah bahwa respon msna untuk akut seluruh tubuh stres
dingin ditambah pada orang dewasa yang lebih tua yang sehat. Namun, bertentangan dengan pothesis
awal hy- kami, baik msna maupun tanggapan BP statis HG selama stres dingin yang berlebihan pada
orang dewasa yang lebih tua, menunjukkan bahwa respon simpatik selama latihan isometrik yang
diawetkan dalam penuaan sehat. Secara kolektif, data ini menunjukkan bahwa kenaikan ditandai dalam
aliran simpatis kemungkinan berkontribusi pada peningkatan besar dalam arteri BP saat terpapar dingin
pada populasi yang lebih tua. Perubahan dalam respon simpatik dan pressor akut dingin dapat
menyebabkan hubungan klinis antara suhu dingin dan peningkatan tality mor- kardiovaskular dalam
penuaan primer.
Laporan terbatas pada orang dewasa muda telah menunjukkan baik tidak ada perubahan (3) atau
meningkat (12) di msna saat terpapar dingin menimbulkan melalui seluruh tubuh air-perfusi jas dan
pendinginan wajah selama paparan suhu ambient rendah, masing-masing. Meskipun alasan untuk
temuan yang berbeda tetap un- jelas, perbedaan mungkin terkait dengan metodologi bervariasi dari
gangguan pendinginan, karena intensitas dan populasi reseptor termal dan / atau nyeri dirangsang oleh
pendinginan para-
30,5 ° C
652
msna Responses to Cooling dan Latihan di Aging
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Greaney JL et al.
Ara. 2. Data ringkasan Group untuk aktivitas otot mutlak saraf simpatis (msna; frekuensi meledak; ANOVA: Kondisi P
0,01, kelompok P 0,01, dan interaksi P 0,01) dan tekanan arteri rerata (MAP; ANOVA: Kondisi P 0,01, kelompok P
0,05, dan interaksi P 0,835) pada masing-masing 0,5 ° C penurunan rata-rata T
sk
ditampilkan di A dan B. meningkat (nilai delta) di msna dan MAP dari baseline (yaitu, berarti T
sk
34 ° C) berarti T
sk
30,5 ° C ditunjukkan pada C dan D.
, Orang dewasa muda;
Œ,
orang dewasa yang lebih tua. * P 0,05 vs muda; † P 0,05 vs berarti T
sk
34 ° C.
digm diketahui mempengaruhi aliran simpatis. Untuk tujuan ini, penyelidikan ini diperiksa saraf simpatik
aktivasi tem sistematis pada orang dewasa muda dan tua yang sehat menggunakan seluruh permukaan
kulit tubuh protokol pendingin standar melalui setelan air-perfusi (3, 30, 51, 55). Konsisten dengan tubuh
macam literatur meneliti msna saat istirahat pada orang dewasa yang lebih tua di ther- moneutrality (27,
39, 53), orang dewasa yang lebih tua dalam penelitian ini dipamerkan peningkatan otot basal aliran
simpatis. Fur- thermore, seluruh tubuh stres dingin menimbulkan kenaikan diucapkan di msna meledak
frekuensi dan kekuatan dalam yang lebih tua, tetapi tidak muda, dewasa. Satu studi sebelumnya
diperiksa meningkat dingin-diinduksi pada
Tabel 2. Kardiovaskular dan tanggapan bersimpati kepada seluruh tubuh pendinginan
Berarti T
sk
34,0 ° C Berarti T
sk
30,5 ° C
sistolik BP, mmHg
Muda 120 3 125 3 † 5 2 Lebih tua 122 3 136 4 * † 14 2 * diastolik BP, mmHg
muda 72 2 79 2 † 7 1 Lama 76 2 81 3 † 6 1 Denyut jantung, mengalahkan / min
muda 59 2 59 3 0 2 Lebih tua 59 2 59 2 0 1 Burst kejadian,
semburan / 100 mengalahkan muda 21 5 22 5 1 2 Lama 46 4 * 58 4 * † 12 2 * Jumlah msna, AU / mengalahkan
muda 15,1 2,5 15,0 2,4 0,1 0,8 Lama 28,6 2,3 * 39,9 3,3 * † 11,4 2,7 * aktivitas total, AU / min
muda 840 124 828 118 12 51 Lama 1623 115 * 2459 186 * † 836 161 *
Nilai yang berarti SE. T
sk,
suhu kulit; AU, unit sewenang-wenang. * P 0,05 vs muda; † P 0,05 vs berarti T
sk
34,0 ° C.
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norepinefrin plasma pada orang dewasa muda dan tua, melaporkan kenaikan tumpul di norepinefrin
plasma pada orang dewasa yang lebih tua selama penurunan suhu inti tubuh menimbulkan via dingin
infus saline intravena (15). Yang penting, penelitian ini digunakan ukuran langsung dari aliran simpatis
sentral (msna), sedangkan langkah-langkah norepinefrin plasma indikator rect puncak-aktivitas simpatik
dan tergantung pada tingkat pemindahan norepinefrin selain aliran simpatis dan rilis norepinefrin. Selain
itu, karena kami antar ested dalam efek yang tepat penuaan utama pada respon latory neurocircu-
paparan dingin, kami menggunakan lebih ringan dingin stres (yaitu, tidak ada perubahan suhu inti dan
dirancang tidak untuk mendorong menggigil) untuk mengisolasi vasokonstriktor tanggapan. Paparan
sebesar ini pendinginan kemungkinan lebih menunjukkan stres dingin khas dialami oleh orang dewasa
yang lebih tua (23) dan karena itu mungkin memiliki relevansi klinis yang lebih besar.
Studi di kedua model hewan dan manusia mengindikasikan adanya penurunan yang berkaitan dengan
usia norepinefrin-dimediasi vasokonstriksi di beberapa tempat tidur pembuluh darah, termasuk otot dan
cuta- sirkulasi termoregulasi neous (8, 24, 41, 54, 58). Msna dan norepinefrin plasma konsentrasi yang
meningkat dengan usia lanjut (15, 24, 27, 39, 53); Oleh karena itu, gangguan vasokonstriksi
norepinefrin-dimediasi umumnya telah dikaitkan dengan ditopang desensitisasi agonis-dimediasi respon
reseptor adrenergik (24). Sebaliknya, peningkatan terkait usia di msna selama pendinginan mungkin
respon pensatory com- sebagai akibat dari pengurangan terkait usia dalam respon reseptor adrenergik.
Menariknya, penelitian juga menunjukkan adanya penurunan berhubungan dengan usia pada oksida
nitrat tonik “buff- kenai” dari
2
responsif adrenergik reseptor (31) atau HAPS per- tive berkurang
dari yang lebih umum 2
pengurangan adrenergik reseptor di respon nitrat oksida bioavail--refleksi kemampuan dengan penuaan
(8). Lebih jauh lagi, sementara cotransmitters simpatik NPY dan ATP berkontribusi reflekskulit
vasokonstriksipada orang dewasa muda, mekanisme ini func- tionally absen dalam penuaan yang sehat;
Oleh karena itu, orang dewasa bukan mengandalkan sepenuhnya pada gangguan vasokonstriksi
adrenergik-dimediasi selama stres dingin (55). Jelas, interaksi antara outflow menyedihkan sym- dan
fungsi reseptor adrenergik selama seluruh tubuh pendinginan dalam konteks penuaan yang sehat
membutuhkan penyelidikan lebih lanjut.
Tubuh dingin stres seluruh memunculkan respon pressor sistemik yang kuat (3, 4, 9, 23, 62) yang
berlebihan pada orang dewasa berusia,
653 msna Responses to
Cooling dan Latihan di Aging
•
Greaney JL et al.
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•
Gambar. 3. Data Kelompok ringkasan untuk mutlak msna (frekuensi meledak; ANOVA: Kondisi P 0,01, kelompok P
0,01, dan interaksi P 0,194) dan MAP (ANOVA: Kondisi P 0,01, kelompok P 0,552, dan interaksi P 0,679) selama
dasar (base) dan selama menit terakhir intensitas erate mod- handgrip statis (HG) di rata-rata T
sk
34 ° C dan T
sk
30,5 ° C pada orang dewasa muda dan tua ditampilkan di A dan B. meningkat (nilai delta) di
msna (ANOVA: kondisi P 0,10, kelompok P 0,179, dan interaksi P 0,178) dan MAP (ANOVA: kondisi P 0.470,
kelompok P 0,705, dan interaksi P 0,329) dari baseline ke menit terakhir statis HG disajikan di C dan D. * P 0,05 vs
muda; † P 0,05 vs berarti T
sk 34 ° C; ‡ P 0,05 basis vs.
Tabel 3. Kardiovaskular dan tanggapan bersimpatipegangan statis
P Nilai
Berarti T
sk
dibuktikan oleh ini dan lainnya (23, 60) studi. The augmented pressor response to skin surface cooling in
older adults is likely not mediated by an increase in cardiac output, as cardiac output derived via
transthoracic echocardiography remains unchanged throughout cooling in older adults (60). The results of
the present study indicate that pronounced increases in MSNA during cold stress in older adults may
contribute to the greater pressor response. Indeed, the exaggerated increases in sympa- thetic outflow
noted in the present study were accompanied by
34.0°C Mean T
sk
30.5°C Group Condition Interaction
Systolic BP, mmHg
Young 29 4 22 4 0.599 0.249 0.436 Older 24 5 23 3 Diastolic BP, mmHg
Young 17 2 17 3 0.187 0.835 0.328 Older 15 3 13 2 Heart rate, beats/min
Young 11 3 11 2 0.143 0.882 0.995 Older 7 1 7 2 Burst incidence, bursts/100 beats
Young 16 2 13 3 0.077 0.158 0.293 Older 11 2 7 3 Total MSNA, AU/beat
Young 12.7 2.8 18.1 4.8 0.328 0.618 0.040 Older 14.2 3.9 10.4 1.9* Total activity, AU/min
Young 1,136 252 1,458 457 0.426 0.843 0.067 Older 1,216 273 904 121
Values are means SE. *P 0.05 vs. young.
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MSNA Responses to Cooling and Exercise in Aging
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greater increases in BP throughout cold exposure, presumably
adults. Interestingly, there also were no
age-related differences by increases in systemic vascular resistance. Importantly,
in the pressor or sympathetic burst frequency
responses to HG whole body cooling elicits significant visceral (celiac, superior
in the cold. Although the increase in indexes
of MSNA burst mesenteric, and renal vascular conductance indexes) and pe-
area during HG in the cold condition were
less in the older ripheral (brachial artery, total forearm, and CVC) vasoconstric-
adults, perhaps suggesting blunted
sympathetic activation dur- tion that contributes to sustained increases in BP throughout
ing combined isometric exercise and cold
stress, when consid- cooling in young adults (62). Reflex peripheral cutaneous
ered collectively with burst frequency, the
sympathetic re- vasoconstriction is significantly impaired in aged adults (30,
sponses are clearly not augmented in older
adults. Neverthe- 51, 55). While the visceral vasoconstrictor responses to cold
less, our finding of no difference in the
sympathetic and pressor stress have not been examined in older adults, it is interesting
responses to HG between temperature
conditions in the older to note that the splanchnic vasoconstrictor responses to upright
subjects, which was contrary to our initial
hypothesis, instead tilt are greater in older compared with young subjects (36).
suggests preserved sympathetic
responsiveness during exercise Conceivably, greater visceral vasoconstriction during cold ex-
in the cold in healthy aging. These results
were somewhat posure, concomitant with greater increases in sympathetic
surprising given the clear increases in
sympathetic outflow outflow, may further contribute to augmented pressor re-
during cooling. However, it is plausible that
higher absolute sponses in older adults and warrants further investigation.
MSNA may impose a ceiling effect for further
increasing The age-related alterations in the acute responses to cold
MSNA during exercise, especially as some
older adults ap- stress observed in the present study may underlie increased
proached maximal burst frequency during
exercise in the cold. cardiovascular risk in older adults exposed to cold environ-
Previous studies (7) of normotensive older
adults with basal ments (5, 38, 44, 50, 63). Because isometric exercise is ac-
MSNA similar to that reported in the older
adults during companied by robust increases in MSNA and BP (34, 37), and
cooling in this study (ie, 31 bursts/min) have
demonstrated coupled with the noted impairments in the sympathetic and
increases in MSNA during
sympathoexcitatory maneuvers pressor responses to cooling, we reasoned that physical exer-
above those which were noted during
combined exercise and tion in the cold may impart greater challenges to sympathetic
cold stress in this investigation. In addition to
the aforemen- control of the cardiovascular system compared with cold ex-
tioned ceiling effect, similar sympathetic and
pressor responses posure alone. Importantly, many physical activities of daily
to HG in the cold in older adults may also
reflect preserved living for healthy older adults that may occur in the cold have
buffering capacity of the arterial baroreflex
during exercise. brief and submaximal components in the forearm muscula-
However, it is important to note that this study
was not ture (eg, gripping snow shovels, scraping ice, etc.). While
designed to investigate specific reflex
mechanisms governing these brief bouts of isometric contractions are likely occurring
BP regulation during exercise (eg, exercise
pressor reflex, in the context of dynamic whole body exercise, they presum-
baroreflex, etc.). Future studies more directly
assessing the ably result in transient increases in MSNA and BP, and these
contribution of alterations in these individual
reflex mecha- repeated responses may increase both short- and long-term
nisms are necessary. cardiovascular risk (45).
Therefore, understanding the acute
The baroreceptors operate as a negative
feedback control physiological responses to isometric forearm muscle contrac-
system that responds to beat-to-beat changes
in BP by reflex- tions in the cold is clinically relevant. Studies of adults exer-
ively adjusting autonomic outflow to modulate
cardiac output cising in cold environments are few and generally limited to
and systemic vascular resistance. Therefore,
the baroreflex is those using varied methodology exploring either the control of
critically important in rapid reflex adjustments
that accompany cutaneous blood flow during exercise (46) or the performance-
acute cardiovascular stressors (10), such as
whole body cooling related effects of cold acclimation (17, 57, 61). At thermoneu-
and isometric exercise. Interestingly, in young
adults, the tral temperatures, older adults exhibit either similar (21, 40, 49)
sensitivity of arterial baroreflex control of
MSNA (ie, the or blunted (26, 33, 48) increases in MSNA and BP during static
slope of the relation between MSNA and
diastolic BP) assessed HG compared with the increases demonstrated in young adults.
during pharamacological manipulations in BP
was not altered Consistent with these previous studies, we report no age-
during whole body cooling (3). However, the
operating point related differences in the sympathetic and pressor responses to
of the baroreflex curve, defined as the mean MSNA and BP for static HG both thermoneutral and cold
conditions, was shifted rightward To our to operate around the cooling-induced increase in BP (3).
Presumably, this shift allows adequate baroreflex-mediated buffering if BP was further increased during
cold stress. The current study was not intended to examine age-related differ- ences in baroreflex
function, at rest or during exercise, during cold stress. However, it is plausible that potential age-related
impairments in baroreflex function could result in a reduced ability to appropriately buffer increases in
MSNA and BP during cooling, resulting in the exaggerated neurocirculatory responses to cold stress
noted in the present study. To begin to address this possibility, we quantified sympathetic baroreflex
sensitivity around the operating point of the arterial baroreflex by analyzing the relation between
spontaneously occurring variations in diastolic BP and MSNA. Similar to the previous report in young
adults (3), there was no change in the gain of
J Appl Physiol
• at baseline (ie, knowledge, only mean one previous T
sk
34.0°C).
study has examined cardiovascular function during combined
isometric exercise and whole body cold exposure in young adults (32). These authors reported that the
increases in BP and heart rate during isometric HG were not different in warm (25°C) and cold (10°C)
ambient environmental conditions (32). The results of the present investigation are similar, as the
increases in BP during HG were not different during combined cold stress in young adults. Furthermore,
we extend the findings of this previous report by demonstrating that increases in MSNA during isometric
HG in the cold are not different from the responses at thermoneutral temperatures in young healthy
adults. Moreover, our novel findings also demonstrate that there are no temperate-related differences in
the sympathetic and pressor responses to isometric exercise in healthy older
doi:10.1152/japplphysiol.00516.2014
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655 MSNA Responses to Cooling and Exercise in Aging
•
Greaney JL et al.
arterial baroreflex control of MSNA during whole body cool-
indicates that older adults do not exhibit
exaggerated sympa- ing, for either burst incidence or total MSNA, in older adults,
thetic responsiveness to cardiovascular
challenges in cold en- which is indicative of preserved sympathetic baroreflex func-
vironments. Taken together, these findings
have significant tion during cold exposure in healthy aging. However, future
clinical implications and provide further insight
into the mech- studies including a more robust investigation of baroreflex
anisms underlying the association between
cold temperature function are warranted, both during cold exposure alone and
and increased cardiovascular mortality in
healthy aging. also in combination with exercise, to more appropriately ex- amine potential age- or
temperature-related alterations in the
ACKNOWLEDGMENTS role of the arterial
baroreflex in contributing to neurocircula-
The time and effort expended by all the
volunteer subjects are greatly appre- tory modulation.
Limitations. By study design, only apparently healthy older
J Appl Physiol
•
ciated. We thank Dr. Paul J. Fadel for the use of the analysis program. We are grateful for the assistance
of Jessica L. Kutz, Susan Slimak, and Jane Pierzga. adults were included in this study, and all older
subjects were normotensive, nondiabetic, and nonobese. Despite the strict study inclusion criteria, older
adults still exhibited robust increases in MSNA and BP during whole body cold stress. Importantly, these
exaggerated responses to cold exposure
GRANTS
This research was supported by National Institutes of Health Grants HL-120471-01 (to JL Greaney),
AG-007004-23 (to WL Kenney), and HL-093-238-04 (to LM Alexander).
occur even in the absence of overt cardiovascular disease. In
DISCLOSURES addition, no direct
quantification of muscle mass was obtained
No conflicts of interest, financial or
otherwise, are declared by the author(s). in subjects participating in this study. Potential age-related
differences in body composition may influence the vasocon-
AUTHOR CONTRIBUTIONS strictor
responses to cold exposure. Importantly, the mean age
Author contributions: JLG, WLK, and LMA
conception and design of of the older subjects was 60 yr; therefore, because sarcopenia would likely be a
much larger potential confounding factor to consider in an elderly population (35), decrements in muscle
mass likely minimally affected muscle vascular resistance in
research; JLG and AES performed experiments; JLG analyzed data; JLG, AES, WLK, and LMA interpreted results of
experiments; JLG prepared figures; JLG drafted manuscript; JLG, AES, WLK, and LMA edited and revised
manuscript; JLG, AES, WLK, and LMA approved final version of manuscript. this group of healthy older adults.
However, the acute sympa- thetic and pressor responses to whole body cooling remain to
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