IMR Press / RCM / Volume 23 / Issue 2 / DOI: 10.31083/j.rcm2302072
Open Access Review
Autonomic cardiovascular reflex control of hemodynamics during exercise in heart failure with reduced ejection fraction and the effects of exercise training
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1 College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada
2 College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada
*Correspondence: corey.tomczak@usask.ca (Corey R. Tomczak)
Academic Editors: Kazuhiro P. Izawa, Peter H. Brubaker and Giuseppe Santarpino
Rev. Cardiovasc. Med. 2022, 23(2), 72; https://doi.org/10.31083/j.rcm2302072
Submitted: 29 October 2021 | Revised: 20 December 2021 | Accepted: 27 December 2021 | Published: 21 February 2022
(This article belongs to the Special Issue Cardiac rehabilitation)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Heart failure with reduced ejection fraction is associated with increased exercise intolerance, morbidity, and mortality. Importantly, exercise intolerance in heart failure with reduced ejection fraction is a key factor limiting patient quality of life and survival. Exercise intolerance in heart failure with reduced ejection fraction stems from a multi-organ failure to maintain homeostasis at rest and during exercise, including the heart, skeletal muscle, and autonomic nervous system, lending itself to a system constantly trying to “catch-up”. Hemodynamic control during exercise is regulated primarily by the autonomic nervous system, whose operation, in turn, is partly regulated via reflexive information from exercise-stimulated receptors throughout the body (e.g., arterial baroreflex, central and peripheral chemoreceptors, and the muscle metabo- and mechanoreflexes). Persons with heart failure with reduced ejection fraction exhibit malfunctioning autonomic reflexes, which lead to exaggerated sympathoexcitation and attenuated parasympathetic tone. Chronic elevation of sympathetic activity is associated with increased morbidity and mortality. In this review, we provide an overview of how each main exercise-related autonomic reflex is changed in heart failure with reduced ejection fraction, and the role of exercise training in attenuating or reversing the counterproductive changes.

Keywords
sympathoexcitation
sympathetic nerve activity
metaboreflex
mechanoreflex
chemoreflex
arterial baroreflex
cardiac rehabilitation
HFrEF
Figures
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