Circulatory limitations to exercise capacity in humans: the impact of heat stress and dehydration on brain and muscle blood flow and metabolism

Abstract

Heat stress and dehydration pose a severe challenge to physiological function and the capability to perform physical work. There is, however, limited knowledge on the regional haemodynamic and metabolic responses to strenuous exercise in environmentally stressful conditions. The primary aim of this thesis was to examine whether dehydration and heat stress compromise brain, muscle and systemic blood flow and metabolism, and whether depressed brain and muscle oxygen delivery underpin reduced exercise capacity during graded incremental and prolonged exercise. This thesis makes an original contribution to the knowledge by showing for the first time that dehydration markedly accelerates the decline in cerebral blood flow during maximal incremental (Chapter 4) and prolonged sub-maximal exercise (Chapter 5) in the heat. Cerebral metabolism, however, is preserved by compensatory increases in substrate extraction. Falling carbon dioxide tension underpinned the decline in CBF. However, a distinct regional distribution of blood flow across the head was observed, suggesting that different mechanisms are responsible for the regulation of regional blood flow within the head. A reduced cerebral metabolism is therefore an unlikely factor explaining the compromised exercise capacity in physiologically stressful hot environments. Rather, restrictions in active muscle blood flow and oxygen supply, which are not apparent during sub-maximal exercise, may explain the reduced maximal aerobic power in heat stressed conditions. For the first time we have manipulated skin and core temperature to show that combined internal and skin hyperthermia reduces maximal aerobic power in association with restrictions in limb, brain and systemic blood flow and skeletal muscle metabolism (Chapter 6). Overall, the findings of the present thesis provide novel information on how circulatory limitations across contracting skeletal muscle, brain and systemic tissues and organs might underpin the impairment in exercise capacity in physiologically taxing environments evoking significant dehydration and hyperthermia.