Expiratory loading modulates the quadriceps muscle pump-induced venous return during rhythmic isometric exercise.

Background: During exercise, the intermittent compression of leg veins by muscle contraction (i.e., the muscle pump) significantly enhances venous return, thereby contributing to an increase in cardiac output. Previous studies have shown that respiratory muscle pressures influence blood flow velocity in the femoral vein both at rest and during leg exercise. Additionally, increased expiratory resistance, such as observed in patients with chronic obstructive pulmonary disease, has been associated with reduced venous return under resting conditions. However, the effect of expiratory resistance on venous return during lower limb exercise remains unclear. Purpose: The aim of this study is to clarify the effect of expiratory resistive breathing on changes in blood flow in the femoral vein (Qfv) during intermittent isometric quadriceps muscle contractions. Methods: Nine healthy young adults (5 males and 4 females; 22±1 yrs, mean±SE) participated in rest and exercise trials. In both trials, participants controlled their breathing for 1-2 minutes with a tidal volume approximately 1.5 times their spontaneous breathing and a breathing frequency of 15 breaths/min (duty cycle 1:1, i.e., 2s inspiration, 2s expiration), with or without an expiratory load of +20 cmH2O. The exercise trials consisted of intermittent isometric knee extension of the right leg at 10% maximum voluntary contraction (2 seconds of contraction and 2 seconds of relaxation). During the exercise trial, the expiratory phase was synchronized with the contraction phase. Femoral venous blood velocity and diameter were continuously measured using Doppler ultrasound. Results: During the resting trial, Qfv during the expiratory phase was lower (P=0.008) with voluntary hyperventilation and expiratory resistance (-22±24 ml/min) than without resistance (139±44 ml/min). In the exercise trials, quadriceps muscle contractions increased Qfv. However, the contraction-induced Qfv was smaller (P=0.007) during voluntary hyperventilation with expiratory resistive breathing (289±115 ml/min) compared to without expiratory resistance (629±93 ml/min). Conclusion: These results suggest that expiratory resistance may modulate venous return during light-intensity intermittent isometric exercise of the quadriceps. This study was supported by JSPS KAKENHI #23K10633, and #23K24736. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Cardiovascular function in humans during exercise: role of the muscle pump

Background: The muscle pump, which refers to the intermittent compression of the leg veins by muscle contractions (i.e., the muscle pump), plays an important role in enhancing venous return. Previous studies have reported that respiratory muscle pressure modulates femoral vein blood flow velocity both at rest and during leg exercise. Furthermore, increased expiratory resistance, as observed in patients with chronic obstructive pulmonary disease, has been shown to affect femoral vein blood flow during calf exercise. However, the skeletal muscles involved in ankle movements are smaller compared to the quadriceps, which are more commonly recruited during dynamic exercises in humans. Purpose: The purpose of this study was to clarify the effect of expiratory resistive breathing on changes in femoral vein blood flow (Qfv) during dynamic, light-intensity leg exercise. Methods: Twelve healthy young participants (age 20±1 yrs, mean±SE) completed both resting and exercise trials. During each trial, participants controlled their breathing for 1-2 minutes with a tidal volume approximately 1.5 times greater than spontaneous breathing and a breathing frequency of 20 breaths/min (duty cycle 1:1, i.e., 1.5 seconds inspiration, 1.5 seconds expiration), with or without an expiratory load of +20 cmH2O. In the exercise trial, participants performed dynamic knee extension and flexion exercise at a light intensity (12-20 watts), with the expiratory phase synchronized to right quadriceps contraction (i.e., knee extension). Femoral venous blood velocity and diameter were continuously measured using Doppler ultrasound. Results: In the resting trial, Qfv during expiratory phase was lower (p<0.001) with voluntary hyperventilation and expiratory resistance (43±14 ml/min) compared to without resistance (114±33 ml/min). In the exercise trial, quadriceps muscle contractions increased Qfv. However, the increase in Qfv during exercise with expiratory resistance (544±61 ml/min) was not different (P=0.137) from that without expiratory resistance (555±39 ml/min). Conclusion: These results suggest that expiratory resistance does not significantly modulate venous return during light-intensity dynamic lower limb exercise involving the quadriceps. This study was supported by JSPS KAKENHI #23K10633, #23K24736. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

We investigated whether fatigue of the expiratory muscle, that is, the abdominal muscle, may account for a change in the respiratory effort sensation in normal subjects during expiratory threshold loading. The respiratory effort sensation was scored using a modified Borg scale. Expiratory muscle fatigue was assessed both from changes in the maximal static expiratory pressure and in the centroid frequency (fc) of the abdominal muscle electromyogram (EMG). Expiratory threshold loading (magnitude of threshold; 40 to 60% of the maximal expiratory pressure at FRC, breathing frequency = 15/min, and duty cycle = 0.5) was continued until exhaustion or for 30 min. Loading was repeated following a 15-min recovery period after the end of the first expiratory loading. The maximal static expiratory pressure during loading (Pmmax) decreased initially and then remained decreased. Decreases were smaller with the 40% load (22 +/- 6%, SEM) than with the 60% load (37 +/- 3%) (p less than 0.05). The decrease during the second run of the 60% load was greater than during the first (p less than 0.01 by ANOVA). The maximal expiratory pressure at TLC before the second run of the 60% load was decreased by 9 +/- 3% compared with the control (p less than 0.02) but that with the 40% load was not. The fc with the 60% load decreased initially by 8 +/- 1% and then remained constant, although no change was observed with the 40% load.(ABSTRACT TRUNCATED AT 250 WORDS)

The Importance of the Muscle and Ventilatory Blood Pumps During Exercise in Patients Without a Subpulmonary Ventricle (Fontan Operation)

The vast majority of quantitative data examining the effects of breathing on venous return have been derived from anaesthetized or reduced animal preparations, making an extrapolation to an upright exercising human problematic due to the lack of a hydrostatic column and an absence of muscular contraction. Thus, this study is the first to quantitatively examine the effects of different breathing mechanics on venous return from the locomotor limbs both at rest and during calf contraction exercise in the semirecumbent human. When subjects inspired using predominantly their ribcage/accessory inspiratory muscles at rest (change in gastric pressure (DeltaP(GA)) = <2 cmH(2)O, change in oesophageal pressure (DeltaP(ES)) = approximately -6 cmH(2)O; inspiratory time/total breath time (T(I)/T(TOT)) = 0.5), a slight facilitation of femoral venous return was observed during inspiration (65% of all flow occurred during inspiration), with a slight reduction in femoral venous return during the ensuing expiratory phase of the breath. However, when subjects inspired using a predominantly diaphragmatic breath at rest (DeltaP(GA) = > 5 cmH(2)O, DeltaP(ES) = approximately -6 cmH(2)O; T(I)/T(TOT) = 0.5), femoral venous return was markedly impeded (net retrograde flow of 11%) and significantly lower than that observed during ribcage breathing conditions (P < 0.01). During the ensuing expiratory phase of a diaphragmatic breath, there was a large resurgence of femoral venous blood flow. The pattern of modulation during ribcage and diaphragmatic breathing persisted during both mild (peak calf force = 7 kg) and moderate (peak calf force = 11 kg) levels of calf contraction. Despite the significant within-breath modulation of femoral venous return by breathing, net blood flow in the steady state was not altered by the breathing pattern followed by the subjects. Though popliteal blood flow appeared to be modulated by respiration at rest, this pattern was absent during mild calf contraction where popliteal outflow was phasic with the concentric phase of calf contraction. We conclude that respiratory muscle pressure production is the predominant factor modulating venous return from the locomotor limb both at rest and during calf contraction even when the veins of the lower limb are distended due to the presence of a physiologic hydrostatic column.

Hybrid and parallel extracorporeal membrane oxygenation circuits

The following is the abstract of the article discussed in the subsequent letter: Tensing of lower body muscles without or with leg crossing (LBMT, LCMT), whole body tensing (WBT), squatting, and sitting with the head bent between the knees (“crash position,” HBK) are believed to abort vasovagal

The purpose of this study was to compare the electromyographic (EMG) amplitudes of the quadriceps femoris (QF) muscles during a maximum voluntary isometric contraction (MVIC) to submaximal and maximal dynamic concentric contractions during active exercises. A secondary purpose was to provide information about the type of contraction that may be most appropriate for normalization of EMG data if one wants to determine if a lower extremity closed chain exercise is of sufficient intensity to produce a strengthening response for the QF muscles. Sixty-eight young healthy volunteers (39 female, 29 male) with no lower extremity pain or injury participated in the study. Surface electrodes recorded EMG amplitudes from the vastus medialis obliquus (VMO), rectus femoris (RF), and vastus lateralis (VL) muscles during 5 different isometric and dynamic concentric exercises. The last 27 subjects performed an additional 4 exercises from which a second data set could be analyzed. Maximum isokinetic knee extension and moderate to maximum closed chain exercises activated the QF significantly more than a MVIC. A 40-cm. lateral step-up exercise produced EMG amplitudes of the QF muscles of similar magnitude as the maximum isokinetic knee extension exercises and would be an exercise that could be considered for strengthening the QF muscles. Most published EMG studies of exercises for the QF have been performed by comparing EMG amplitudes during dynamic exercises to a MVIC. This procedure can lead one to overestimate the value of a dynamic exercise for strengthening the QF muscles. We suggest that when studying the efficacy of a dynamic closed chain exercise for strengthening the QF muscles, the exercise be normalized to a dynamic maximum muscle contraction such as that obtained with knee extension during isokinetic testing.

The aim of this study was to investigate the hemodynamic, oxidative stress (OS), and nitric oxide (NO) responses to a submaximal isometric exercise session (IES) involving large muscle mass. Fourteen hypertensive (HTG: age = 35.9 ± 8.1 yr, height = 1.73 ± 0.10 m, total body mass = 78.0 ± 15.8 kg) and 10 normotensive (NTG: age = 41.1 ± 9.4 yr, height = 1.71 ± 0.12 m, total body mass = 82.3 ± 22.4 kg) participants performed two experimental sessions in the leg press and bench press: (i) control session and (ii) 8 sets × 1 min contraction at 30% maximal voluntary isometric contraction with 2-min rest interval. Blood pressure (BP) was measured at rest and during 60 min postexercise. Blood samples were collected at rest, immediately after the session, and 60 min postexercise. NO was obtained through the Griess reaction method. OS parameters were analyzed using commercial kits. A repeated-measures ANOVA with Bonferroni post hoc test was used to analyze all dependent variables. A significant decrease in systolic BP was observed only for HTG at 45 and 60 min postexercise (baseline vs 45 min: P = 0.03, Δ% = 4.44%; vs 60 min: P = 0.018, Δ% = 5.58%). NO increased immediately postexercise only for HTG (P = 0.008, Δ% = 16.44%). Regarding OS parameters, thiobarbituric acid reactive substances presented a significant reduction 60 min after the IES for NTG and HTG; catalase increased in both groups. The data showed that only 8 min of IES with a large muscle mass elicits an elevated pro-oxidant activity leading to a greater NO bioavailability, increases antioxidant reaction, and consequently reduces BP in hypertensive patients.

1. For the diagnosis of electrolyte disorders, data on skeletal muscle composition are often valuable, but rarely available. We have therefore developed a simple and rapid needle biopsy procedure for the determination of the concentrations of K+, Na+, Mg2+ and Na+, K+-pumps in muscle. 2. Using a Bergström needle, biopsies weighing around 25 mg were taken from the vastus lateralis muscle of 18 normal subjects (aged 44-86 years) and extracted with trichloroacetic acid (TCA). The concentrations of K+, Na+ and Mg2+ were 90.7 +/- 1.8, 31.9 +/- 1.6 and 9.5 +/- 0.2 mumol/g wet wt., respectively (means +/- SE). 3. The TCA extraction gave the same values as digestion with 65% HNO3 or 35% H2O2, could be used over the weight range 10-55 mg and showed a Mg2+ recovery of 101.7%. 4. The concentration of Na+, K+-pumps was quantified as the total capacity for [3H]ouabain binding. In vastus lateralis biopsies obtained from six normal subjects the mean value was 258 +/- 16 pmol/g wet wt. 5. Comparison of the concentrations of K+, Mg2+ and [3H]ouabain-binding sites in samples obtained post mortem showed modest variation among different muscles with varying fibre composition. 6. Measurements of the concentrations of K+, Na+, Mg2+ and Na+, K+-pumps in duplicate biopsies of the vastus lateralis yield values which seen representative for the total pool of skeletal muscle fibres and can be performed within a few hours.(ABSTRACT TRUNCATED AT 250 WORDS)

to the editor: The Perspectives article by Benziane and Chibalin ([1][1]) in this issue comments on part of the literature regarding the possible role of translocation in the regulation of Na+-K+ pumps in skeletal muscle. I have been invited to submit a letter to the editor about this review article

Four men isometrically trained their stronger leg for 19 weeks (attempted knee extension against a restraining strap incrementally increasing to 30 brief maximal contractions X 6 wk-1). Five others similarly trained dynamically (repeated knee extension against a 63 N resistance force, incrementally increasing to 300 extensions X 6 wk-1). Before, at regular intervals during training and after de-training (between 7-11 weeks) measurements were made using trained and control legs of: Maximum Voluntary Isometric Contraction (M.V.C.), Endurance at 60% M.V.C., Knee Extension Performance Test (K.E.P.T.) and One-legged Work Test. Isometric training produced a 30% (p less than 0.01) increase in M.V.C. with a 15% (p less than 0.05) increase in the control leg. These changes persisted with some deterioration after the de-training period. Endurance at 60% M.V.C. remained unchanged, even though M.V.C. was increasing in both trained and control legs. There was some evidence that isometric training improved the cardio-vascular response to one-legged exercise. Dynamic training did not result in changes in M.V.C., Endurance at 60% M.V.C. or the One-legged work Test, but K.E.P.T. (time taken for 50 knee extensions at a comfortable pace against 63 N resistance) improved by 33% (p less than 0.01) and 28% (p less than 0.01) in the trained and control legs respectively. Isometric training resulted in similar improvements in performance of K.E.P.T. (28%, p less than 0.05, trained leg; 18%, p less than 0.05 control leg). For similar time spent in training, isometric work appeared more effective than dynamic work in improving the parameters of muscle function, these improvements appeared to be both centrally (C.N.S.) and locally mediated.

Slowly adapting pulmonary stretch receptors have been hypothesized to be the afferents mediating the vagally dependent, volume-related prolongation of expiratory time (TE) during expiratory loading. It has been further suggested that the vagal component of this prolongation of TE is due to the temporal summation of pulmonary stretch receptor (PSR) activity during expiratory loading. This hypothesis was tested in rabbits exposed to resistive and elastic single-breath expiratory loading while PSR's were simultaneously recorded. Both types of loads resulted in a decreased expired volume (VE) and increased expiratory duration (TE). The TE for resistive loads were significantly greater than for elastic loads for equivalent VE. Thus two different VE-TE relationships were found for resistive and elastic loads. When TE was plotted against the area under the expired volume trajectory, a single linear relationship was observed. PSR activity recorded during expiratory loading increased as VE decreased and TE increased. A single linear relationship resulted when the number of PSR spikes during the expiration was plotted against the associated TE for all types of loads. These findings demonstrate that the volume-related prolongation of TE with single-breath expiratory loads is associated with an increase in PSR discharge. These results support the hypothesis that the vagal component of load-dependent prolongation of TE is a function of both the temporal and spatial summation of PSR activity during the expiratory phase.

Concentration of lactate in fast and slow twitch fibres, respectively, were determined in m. quadriceps femoris after sustained contractions at 25%, 50%, and 75% of maximal voluntary isometric contraction (MVC) until exhaustion as well as after interrupted exercises at 25% and 50% MVC. Maximal lactate concentrations were only found at 50% of MVC performed to exhaustion. Lactate concentration was higher in slow twitch (ST) fibres at 50% MVC compared to in ST fibres at 25% MVC, and higher in fast twitch (FT) fibres at 50% MVC compared to in FT fibres at 75% MVC. After short time isometric exercise (i.e. 75% to exhaustion and 50% and 25% performed for the same period of time as 75% MVC) lactate concentration, expressed as lactate ratio (lactate concentration in FT fibres/lactate concentration in ST fibres) was found to be positively correlated to percent FT fibres (r=0.89). Lactate ratio ranged 0.5-2.0, i.e. at onset of isometric exercise, lactate concentration increase was faster in ST fibres in the muscle rich in ST fibres and faster in FT fibres when the muscle wasrich in FT fibres.