Cardiovascular Apparatus Research Articles

Cardiodynamic adjustments in skilled civil aircraft pilots while unexpected emergency conditions appeared during a simulated flight within a homemade Airbus A300 cockpit

To highlight which cardiodynamic adjustments take place in civil aircraft pilots when unexpected mechanical accidents occur while they are in flight, in 8 skilled pilots we detected the mean blood arterial pressure (MAP) and heart rate (HR) while a unexpected failing of one engine occurred when they were engaged in a simulated flight with a homemade Airbus A300 cockpit. Comparing these two cardiovascular variables in a simulated flight test, just as when the accident happened, together with the values assessed in a simulated control flight without accidents, by the non-parametric Wilcoxon test for paired data it has been found a significant increase of MAP’s median (+ 20.3%, P = 0.008) without significant increase in HR one. However, in several tested pilots this sudden MAP increase tended to progressively recover baseline values while simulating the flight despite the event triggering this functional response was still present.We concluded that the cardiovascular apparatus of skilled aircraft civil pilots adapts in such a way of sudden respond to unexpected emergency conditions by adjusting mean arterial blood pressure for adequate blood flow to limb muscles, and this happens without a concomitant tachycardia response in order to maintain an optimal mechanical/metabolic efficiency of the heart.

The Intersection of COVID-19 and Metabolic-Associated Fatty Liver Disease: An Overview of the Current Evidence.

The global population is currently experiencing the impact of the SARS-CoV-2 coronavirus, which has caused the Coronavirus Disease 2019 (COVID-19) pandemic. With our profound comprehension of COVID-19, encompassing the involvement sequence of the respiratory tract, gastrointestinal system, and cardiovascular apparatus, the multiorgan symptoms of this infectious disease have been discerned. Metabolic-associated fatty liver disease (MAFLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is a pervasive public health concern intricately linked with metabolic dysregulation and estimated to afflict one-fourth of the global adult population. The burgeoning focus on the association between COVID-19 and MAFLD is justified by the potential role of the latter as a risk factor for both SARS-CoV-2 infection and the subsequent emergence of severe COVID-19 symptoms. Investigations have suggested that changes in both innate and adaptive immune responses among MAFLD patients may play a role in determining the severity of COVID-19. The remarkable similarities observed in the cytokine pathways implicated in both diseases imply the existence of shared mechanisms governing the chronic inflammatory responses characterizing these conditions. The effect of MAFLD on the severity of COVID-19 illness remains uncertain, as indicated by conflicting results in cohort investigations.

The Challenge of Long COVID-19 Management: From Disease Molecular Hallmarks to the Proposal of Exercise as Therapy.

Long coronavirus disease 19 (COVID-19) is the designation given to a novel syndrome that develops within a few months after infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and that is presenting with increasing incidence because of the numerous cases of infection. Long COVID-19 is characterized by a sequela of clinical symptoms that concern different organs and tissues, from nervous, respiratory, gastrointestinal, and renal systems to skeletal muscle and cardiovascular apparatus. The main common molecular cause for all long COVID-19 facets appears to be related to immune dysregulations, the persistence of inflammatory status, epigenetic modifications, and alterations of neurotrophin release. The prevention and management of long COVID-19 are still inappropriate because many aspects need further clarification. Exercise is known to exert a deep action on molecular dysfunctions elicited by long COVID-19 depending on training intensity, duration, and continuity. Evidence suggests that it could improve the quality of life of long COVID-19 patients. This review explores the main clinical features and the known molecular mechanisms underlying long COVID-19 in the perspective of considering exercise as a co-medication in long COVID-19 management.

ATP-sensitive Potassium Channel Subunits in Neuroinflammation: Novel Drug Targets in Neurodegenerative Disorders.

Arachidonic acids and its metabolites modulate plenty of ligand-gated, voltage-dependent ion channels, and metabolically regulated potassium channels including ATP-sensitive potassium channels (KATP). KATP channels are hetero-multimeric complexes of sulfonylureas receptors (SUR1, SUR2A or SUR2B) and the pore-forming subunits (Kir6.1 and Kir6.2) likewise expressed in the pre-post synapsis of neurons and inflammatory cells, thereby affecting their proliferation and activity. KATP channels are involved in amyloid-β (Aβ)-induced pathology, therefore emerging as therapeutic targets against Alzheimer's and related diseases. The modulation of these channels can represent an innovative strategy for the treatment of neurodegenerative disorders; nevertheless, the currently available drugs are not selective for brain KATP channels and show contrasting effects. This phenomenon can be a consequence of the multiple physiological roles of the different varieties of KATP channels. Openings of cardiac and muscular KATP channel subunits, are protective against caspase-dependent atrophy in these tissues and some neurodegenerative disorders, whereas in some neuroinflammatory diseases, benefits can be obtained through the inhibition of neuronal KATP channel subunits. For example, glibenclamide exerts an anti-inflammatory effect in respiratory, digestive, urological, and central nervous system (CNS) diseases, as well as in ischemia-reperfusion injury associated with abnormal SUR1-Trpm4/TNF-α or SUR1-Trpm4/ Nos2/ROS signaling. Despite this strategy being promising, glibenclamide may have limited clinical efficacy due to its unselective blocking action of SUR2A/B subunits also expressed in cardiovascular apparatus with pro-arrhythmic effects and SUR1 expressed in pancreatic beta cells with hypoglycemic risk. Alternatively, neuronal selective dual modulators showing agonist/antagonist actions on KATP channels can be an option.

Sex-Specific Impacts of Exercise on Cardiovascular Remodeling.

Cardiovascular diseases (CVD) remain the leading cause of death in men and women. Biological sex plays a major role in cardiovascular physiology and pathological cardiovascular remodeling. Traditionally, pathological remodeling of cardiovascular system refers to the molecular, cellular, and morphological changes that result from insults, such as myocardial infarction or hypertension. Regular exercise training is known to induce physiological cardiovascular remodeling and beneficial functional adaptation of the cardiovascular apparatus. However, impact of exercise-induced cardiovascular remodeling and functional adaptation varies between males and females. This review aims to compare and contrast sex-specific manifestations of exercise-induced cardiovascular remodeling and functional adaptation. Specifically, we review (1) sex disparities in cardiovascular function, (2) influence of biological sex on exercise-induced cardiovascular remodeling and functional adaptation, and (3) sex-specific impacts of various types, intensities, and durations of exercise training on cardiovascular apparatus. The review highlights both animal and human studies in order to give an all-encompassing view of the exercise-induced sex differences in cardiovascular system and addresses the gaps in knowledge in the field.

The Biophysical Modeling of the Hemodynamic in the Human Organism

The circulatory apparatus has as a main function the constant maintaining of the internal environment in all the regions of the organism. The blood is a liquid tissue, being formed of a fundamental substance – plasma and blood cells. Heart is the central organ of the cardiovascular apparatus. The heart muscles have numerous biophysical properties. The cardiac muscle is never tired unless it suffered a pathological process. During the diastole, blood is aspired in the heart and during the systole it is pushed in the big and small circulation. The blood amount pushed from the heart in the vascular system in a certain time represents the blood flow. The biophysical methods are next: we administer a certain substance amount, then its passing speed will depend on its concentration; to apply the calorimetric principles for the measurement of the gastric blood flow; the diagnostic of a chronic peripheral arteriopathy we use the calorimetric method is based on measuring the heat being introduced in a certain amount of water which has known temperature; one of the most often used methods for the evaluation of the use of radioisotopes in the cardio-vascular system is the compartment method. Any attempt to apply biophysics to the life systems involves three stages. First we observe the phenomena and formulate a biophysical description in the form of equations; after to solve the equations. Finally we return to the real life system and interpret this solution in terms of reality, this interpretation may requiew experimental testing.

Cardiovascular Health and Mitochondrial Function: Testing an Association.

Although mitochondrial dysfunction appears to be a contributing factor in the pathogenesis of cardiovascular and metabolic diseases, empirical data on this association are still lacking. This study evaluated whether mitochondrial oxidative capacity, as assessed by phosphorus magnetic resonance spectroscopy, was associated with cardiovascular risk, as estimated by the Framingham Risk Score (FRS), and with a clinical history of cardiovascular disease (CVD), in community-dwelling adults. A total of 616 subjects from the Baltimore Longitudinal Study of Aging (mean age 66 years) underwent a comprehensive clinical evaluation. Mitochondrial oxidative capacity in skeletal muscle was assessed as post-exercise phosphocreatine recovery time constant by phosphorus magnetic resonance spectroscopy. Multivariate regression models were employed to determine the cross-sectional association of mitochondrial oxidative capacity with FRS and history of CVD. Decreased mitochondrial oxidative capacity was strongly associated with higher FRS independent of age, body composition, and physical activity. Lower oxidative capacity was also associated with a history of positive of CVD and higher number of CVD events. We speculate that the observed association could reflect the effect of an excessive production of oxidative species by dysfunctional mitochondria. Furthermore, decreased energy production could hamper the functionality of heart and vessels. In turn, a malfunctioning cardiovascular apparatus could fail to deliver the oxygen necessary for optimal mitochondrial energy production, therefore creating a vicious cycle. Longitudinal studies are necessary to ascertain the directionality of the association and the eventual presence of common pathogenetic roots. In conclusion, mitochondria could represent an important target for intervention in cardiovascular health.

Deporte, modificaciones fisiológicas y evaluación para la prevención de la muerte súbita. (Parte II). Corazón del deportista

The practice of regular sports has proven to be beneficial for health, and prolong life, both in healthy people and in those with cardiovascular disease, at any age. It is also true that it increases the risk of dying suddenly. Evidence has recently emerged that excess could be harmful and is being investigated. In athletes there are adaptations of the cardiovascular apparatus, which can be confused with abnormalities; on the other hand, there are cardiovascular pathologies that progress faster with exercise, and in people with asymptomatic disorders, exercise can trigger adverse events. Pre-sport assessment has been shown to prevent sudden death. In order not to make erroneous diagnoses that affect the lives of athletes, it is necessary to know the clinical, electrocardiographic and anatomical adaptations that are considered normal and to use precise international guidelines. In this second installment, the aspects related to the athlete’s heart will be evaluated, delving into the differential diagnosis between physiological adaptation and pathology.

Gender Differences in Hemodynamic Regulation and Cardiovascular Adaptations to Dynamic Exercise.

Exercise is a major challenge for cardiovascular apparatus since it recruits chronotropic, inotropic, pre-load, and afterload reserves. Regular physical training induces several physiological adaptations leading to an increase in both cardiac volume and mass. It appears that several gender-related physiological and morphological differences exist in the cardiovascular adjustments and adaptations to dynamic exercise in humans. In this respect, gender may be important in determining these adjustments and adaptations to dynamic exercise due to genetic, endocrine, and body composition differences between sexes. Females seem to have a reduced vasoconstriction and a lower vascular resistance in comparison to males, especially after exercise. Significant differences exist also in the cardiovascular adaptations to physical training, with trained women showing smaller cardiac volume and wall thickness compared with male athletes. In this review, we summarize these differences.

THE IMPORTANCE FOR YOUNG ADULTS TO DO PHYSICAL ACTIVITIES FOR A HEALTHY LIFESTYLE

The relationship between the physical activity and the health condition is very complex since the physical activity brings benefits to health whereas the movement is essential for the human body to work properly. The physical activity, the physical condition and the health condition are influenced by the genetic factors, environmental conditions and lifestyle of each individual. Objectives. The trial aimed at pointing out the cardiorespiratory functional status of students correlated to their lifestyle and physical activity level. Material and method. The cardio-respiratory capacity was tested on the students in the 1st year at the Department of Health and Human Development, precisely 30 students. The inclusion criteria were: their age of 18–40, their consent to take part in the trial, their compliance during the trial, their lack of acute conditions or chronic ones. The Ruffier test was used, a test that assesses the functional capacity of the respiratory and cardiovascular apparatus. Results. The interpretation of the Ruffier test and Ruffier-Dickson test enables an overall view about the ability to adapt the body to effort for the students taken into consideration for the trial. Conclusions. The results of the trial show us that the participants have a good physical condition as they do a series of physical exercises on a daily basis according to the study curriculum. These results are similar to the ones in the specialty literature where the pyramid of physical activities plays an important role

Occupational Fine/Ultrafine Particles and Noise Exposure in Aircraft Personnel Operating in Airport Taxiway

The occupational exposure to airborne fine and ultrafine particles (UFPs) and noise in aircraft personnel employed in airport taxiway was investigated. Stationary samplings and multiple personal sampling sites and job tasks were considered. Size distribution, particle number concentrations, lung dose surface area were measured by personal particle counters and by means of an electric low pressure impactor (ELPI+TM). Morphological and chemical characterization of UFPs were performed by transmission and scanning electron microscopy, the latter together with energy dispersive X-Ray spectroscopy based spatially resolved compositional mapping. A-weighted noise exposure level A-weighted noise exposure level normalized to an 8 h working day and Peak Sound C-weighted Pressure Level was calculated for single worker and for homogeneous exposure groups. Our study provides evidence on the impact of aviation-related emissions on occupational exposure to ultrafine particles and noise exposure of workers operating in an airport taxiway. Main exposure peaks are related to pre-flight operations of engine aircrafts. Although exposure to ultrafine particles and noise appears to not be critical if compared with other occupational scenarios, the coincidence in time of high peaks of exposure to ultrafine particles and noise suggest that further investigations are warranted in order to assess possible subclinical and clinical adverse health effects in exposed workers, especially for cardiovascular apparatus.

PMD96 - Diffusion without Evidence: A Study on High-Risk Medical Devices

To test the hypothesis that, despite the importance of evidence-based decision-making claimed by policymakers, physicians and shcolars, the diffusion process of medical devices often starts and gains momentum in the absence of RCTs. The database was a panel, structured at the product class level with repeated yearly observations on 11 years (2007-2017). In each class we counted the number of devices launched every year. The analysis was restriced to high-risk devices in three therapeutic areas: cardiovascular apparatus, active implantable devices and implantable prostheses. 36 product classes were identified and 1,889 devices were launched in the observed period. We tested for i) differences in the number of launches between classes with and without clinical evidence published before the end of the observed period, studied using a Poisson regression model; ii) differences in the number of launches in a class before and after the publication of clinical evidence, where available, studied using a regression discontinuity design. The analysis showed that simply belonging to a class with available evidence does not impact the launches of new products based on the same technology and, after controlling for competition, RCTs can even slow-down the pattern of new launches. The analysis of possible differences before and after RCTs showed that the year when a RCT is published a higher number of launches is expected. The regression-discontinuity design showed that the effect of RCTs on the number of launches is barely significant and not lasting. RCTs act as a barrier to entry only if the technological class is already crowded. Patients are, then, exposed to the implant of devices whose efficacy is not supported by the presence of RCTs. Such results underline the urge of identifying, producing and accepting prompter forms of evidence (such as real world evidence) to support decision-making in the field of medical devices.

Cáncer y cardiotoxicidad en la mujer

Thanks to the advances in cancer treatment which have increased women's survival rates, the cardiovascular effects of this oncological therapy are seen more and more. These effects are not just related to ventricular dysfunction, but also to the entire cardiovascular apparatus. Cardiovascular complications during treatment include: heart failure, arrhythmias, arterial hypertension, myocardial ischemia and pericarditis, among others. Two types of toxicity have been defined: type I, typical of anthracyclines, which is generally irreversible; and type II, produced by trastuzumab, which is reversible.The main strategy is risk stratification in patients who will receive chemotherapy, prevention of its occurrence, and intervention, in order to gain adequate control of possible complications, and thus aid the oncology group in successfully completing the established treatment. This prevention, follow up and treatment strategy should be carried out before, during and after cancer treatment. A baseline echocardiogram with ejection fraction (EF) evolution and, preferably, evaluation of the global longitudinal strain (GLS), for future comparisons, is imperative. Additionally, biomarkers such as troponins and B-type natriuretic peptide (BNP) improve the sensitivity and specificity of cardiotoxicity detection. Treatment options are enalapril, candesartan, carvedilol, nebivolol and the statins. Team management is recommended, led by a cardio-oncology group.

Hemodynamic Responses during Enduro-Motorcycling Performance.

Much of the information available in the literature on physiological responses during Enduro motorcycling is related to heart rate (HR) and blood lactate (BLa). The aim of this work was to investigate the hemodynamic changes that occur during a 10-min session of Enduro motorcycling. Fifteen skilled riders were enrolled on the study and all participants underwent an Enduro-motorcycling session on a standard track. Hemodynamics were assessed using a miniaturized impedance cardiograph. Results show that HR significantly increased from 96.5 ± 12.8 bpm at rest to 153.1 ± 17.7 bpm during riding, while stroke volume (SV) increased from 53.5 ± 14.1 to 72.2 ± 22.1 ml and cardiac output (CO) from 5.0 ± 1.1 to 10.9 ± 3.0 L·min−1. Moreover, ventricular emptying rate (VER) increased from 192.9 ± 43.0 to 324.1 ± 83.6 ml·s1 and ventricular filling rate (VFR) from 141.1 ± 160.5 to 849 ± 309 ml·s−1. Taken together, these data suggest that Enduro motorcycling induces substantial cardiovascular activation, not only in terms of chronotropism but also in terms of cardiac performance and pre-load, thereby increasing SV and CO. Finally, it is likely that sympathetic-mediated venous constriction occurred. This in turn improved VFR and recruited the Frank-Starling mechanism and inotropic reserve. It was concluded that Enduro motorcycling is a challenging activity for the cardiovascular apparatus.

Cardiotoxicity from anthracycline and cardioprotection in paediatric cancer patients.

Notwithstanding the steady progress in survival rates of children and adolescents suffering from cancer, the benefits associated with chemotherapy do not come without risks involving multiple organs and systems, including the cardiovascular apparatus. Anthracyclines-often administered in combination with radiation therapy and/or surgery-are the most used chemotherapeutic compounds in order to treat tumours and blood malignancies even in paediatric age. Being an important side-effect of anthracyclines, carduitoxicity may limit their efficacy during the treatment and induce long-term sequelae, observed even many years after therapy completion. The purpose of this review was to perform an overview about all the possible strategies to prevent and/or limit the anthracyclines adverse side-effects for the cardiovascular system in childhood cancer survivors.

Gender differences in cardiovascular functions during exercise: a brief review

Exercise is a major challenge for the cardiovascular apparatus, since it has to provide adequate oxygen supply to exercising muscles and to guarantee arterial blood pressure regulation. Several adjustments, such as heart rate increase, contractility enhancement, and venous return modulation are made to accomplish this task. Furthermore, regular physical training induces several physiological adaptations due to an increase in parasympathetic and a decrease in sympathetic tone and to chronic increases in cardiac pre-load and after-load. There are gender-related physiological and morphological differences in the cardiovascular adjustments and adaptations to physical exercise in humans. In this review, we briefly summarize these differences. Moreover, differences in ECG pattern between sexes are discussed.

Nitrergic system and plasmatic methylarginines: Evidence of their role in the perinatal programming of cardiovascular diseases

Atherosclerosis, in turn preceded by endothelial dysfunction, underlies a series of important cardiovascular diseases. Reduced bioavailability of endothelial nitric oxide, by increasing vascular tone and promoting platelet aggregation, leukocyte adhesion, and smooth muscle cell proliferation, plays a key role in the onset of the majority of cardiovascular diseases. In addition, high blood levels of asymmetric dimethylarginine, a potent inhibitor of nitric oxide synthesis, are associated with future development of adverse cardiovascular events and cardiac death. Recent reports have demonstrated that another methylarginine, i.e., symmetric dimethylarginine, is also involved in the onset of endothelial dysfunction and hypertension. Almost a decade ago, prematurity at birth and intrauterine growth retardation were first associated with a potential negative influence on the cardiovascular apparatus, thus constituting risk factors or leading to early onset of cardiovascular diseases. This condition is referred to as cardiovascular perinatal programming. Accordingly, cardiovascular morbidity and mortality are higher among former preterm adults than in those born at term. The aim of this paper was to undertake a comprehensive literature review focusing on cellular and biochemical mechanisms resulting in both reduced nitric oxide bioavailability and increased methylarginine levels in subjects born preterm. Evidence of the involvement of these compounds in the perinatal programming of cardiovascular risk are also discussed.

(172) - Tolerance to Perioperative Cold Ischemia in Donor Myocardium: Gender Differences

There is no doubt that a lot of structural and metabolic functions of cardiovascular apparatus are essentially affected by gender. Experimental studies on animals have shown that female hearts are more resistant to ischemia and other pathologic processes then male hearts. The aim of our study was to find out the differences in the tolerance of human female and male grafts to the perioperative cold ischemia.

Effects of Physical Exercise on Cardiovascular Diseases: Biochemical, Cellular, and Organ Effects.

It is well recognised that regular exercise is cardioprotective. On the other hand, sedentariety is an established risk factor for cardiovascular diseases. Furthermore, several clues suggest that exercise capacity is a strong predictor of risk of death from any cause in both healthy subjects and in those with cardiovascular diseases. However, the exact mechanisms through which regular physical activity confers cardiovascular protection are not yet well understood. Exercise probably acts at multiple levels. One possibility is that regular exercise modifies genes expression, thereby changing the production of bioactive molecules such as proteins and enzymes; another potential site of action is on the mechanisms of cardiovascular regulation during effort, which are improved after periods of training; finally, exercise can affect endothelial and platelet functions, thus reducing the risks of atherosclerosis and consequently the risk of infarction and stroke. This special issue focuses on potential beneficial mechanisms by which exercise operates to confer protection against cardiovascular diseases. The interesting paper by S. Heber and I. Volf reviews the effects of inactivity and training on platelet functions. In their literature review, they conclude that regular physical activity diminishes or prevents platelet activation in response to acute exercise and that habitual physical activity also positively modulates platelet functions. They also conclude that these effects support the well-recognised relation between exercise and the risk for cardiovascular events, as a physically active lifestyle dramatically reduces cardiovascular mortality. In another intriguing review, C.-Y. Hsu et al. focus on the important topic of the effects of exercise training on autonomic function in chronic heart failure (CHF). Exercise intolerance is one of the major and disturbing symptoms in these patients. Increased sympathetic tone and decreased parasympathetic activity have been often reported in CHF and these phenomena are associated with a poor survival. Data from this review indicate that participation in exercise training programs induces beneficial effects on autonomic function in CHF patients. They also point out that further research could examine additional aspects of the effects of exercise training in this population, such as the impact on the responses to exercise training in different levels of CHF severity, the possibility that a threshold intensity may be needed to affect cardiac autonomic function, and the type of exercise that should be recommended to achieve the highest positive effects on sympathovagal balance. In a third review by A. Crisafulli et al., the complex issue of cardiovascular reflexes during exercise is addressed. During exercise, the neural mechanisms controlling the cardiovascular apparatus regulate cardiac output and arteriolar tone in order to counteract the exercise-induced vasodilation due to functional sympatholysis in the working muscle. These cardiovascular adjustments guarantee adequate perfusion to vital organs (the brain and the heart) and to the working muscles as well as adequate washout of exercise-induced by-products. Moreover, these mechanisms prevent excessive increments in blood pressure. In this review, authors summarise neural reflexes operating during dynamic exercise, particularly their interaction. They point out that cardiovascular regulation during exercise is achieved through the contemporary integration and interaction of input arising from motor cortex (central command), skeletal muscle receptors (exercise pressor reflex), and arterial baroreceptors. They also conclude that further research is warranted to better understand how these reflexes interact during effort. The last interesting review by R. B. Batacan Jr. et al. is about the effects of light intensity activity on cardiovascular risk factors. These authors claim that there is little support for the role of light intensity activity to reduce cardiovascular disease risk factors and that further studies are needed to establish the value of light intensity physical activity in reducing cardiovascular risk factors. Finally, the research paper by N. G. Rocha et al. aims at evaluating the acute effects of exercise on endothelial functions in early metabolic syndrome. They find that these subjects, despite being free of symptoms, present with an early impairment of endothelial function. Moreover, they put forward the hypothesis that the analysis of some biomarkers changes could be potentially useful to develop preventive measures before the onset of overt metabolic syndrome. Collectively, these manuscripts confirm that sedentariety is harmful for the cardiovascular system. Moreover, exercise not only exerts positive effect on cardiovascular functions and reduces the risks of cardiovascular diseases (primary prevention), but could also revert cardiovascular disease and play a preventive role in the progression of pathological conditions (secondary/tertiary prevention).

Neural regulation of cardiovascular response to exercise: role of central command and peripheral afferents.

During dynamic exercise, mechanisms controlling the cardiovascular apparatus operate to provide adequate oxygen to fulfill metabolic demand of exercising muscles and to guarantee metabolic end-products washout. Moreover, arterial blood pressure is regulated to maintain adequate perfusion of the vital organs without excessive pressure variations. The autonomic nervous system adjustments are characterized by a parasympathetic withdrawal and a sympathetic activation. In this review, we briefly summarize neural reflexes operating during dynamic exercise. The main focus of the present review will be on the central command, the arterial baroreflex and chemoreflex, and the exercise pressure reflex. The regulation and integration of these reflexes operating during dynamic exercise and their possible role in the pathophysiology of some cardiovascular diseases are also discussed.