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Can Plasma Volume Affect Arterial Stiffness
and Autonomic Modulation Response to
Daniel Rodriguez1*, Danilo Bocallini2 and Aylton Figueira Jr1
1 Department of Cardiology, São Judas Tadeu University, Brazil, Nippon Sports Science University, Tokyo, Japan
2 Espirito Santo Federal University, Espirito Santo, Brazil
Submission: July 01, 2019; Published: July 11, 2019
*Corresponding author: Daniel Rodriguez, Department of Cardiology, São Judas Tadeu University, Nippon Sports Science University, Tokyo, Japan
How to cite this article:Daniel Rodriguez, Danilo Bocallini, Aylton Figueira Jr. Can Plasma Volume Affect Arterial Stiffness and Autonomic Modulation Response
to Resistance Exercise?. J Cardiol & Cardiovasc Ther. 2019; 14(2): 555883. DOI: 10.19080/JOCCT.2019.14.555883
Introduction: Despite the numerous benefits of resistance exercise (RE), stress caused by muscle contractions may cause transient disturbances in the cardiovascular system including arterial stiffness increasing the temporary risk of cardiovascular events. One physiological response which can influence this process but has received little attention from the scientific community is plasma volume (PV).
Discussion: Recent reviews point to a complex interaction between autonomic modulation, central and peripheral adjustments triggered by a RE session. After the end of a moderate to high intensity RE session there may be a reduction in PV caused by its influx into the interstitial tissue and consequent decline in stroke volume and venous return. Moreover, there is an increase in sympathetic modulation, and a decrease in parasympathetic modulation. Arterial stiffness is one of the first signs of pathological changes in the arterial wall leading to an increased risk of cardiovascular events. The stiffening of the main arteries of the body can also be negatively affected by PV reduction. The PV reduction would lead to elevation of sympathetic nerve modulation, cardiac workload and reduction in cardiac perfusion. However, depending of the nature of the PV reduction contradictory results emerges and decrease in arterial stiffness was also reported.
Conclusion: There is no agreement as to why PV reduction may affect arterial stiffness, and several questions regarding hydration status and RE influence remains to be addressed. Future studies should standardize water intake and control hydration status before and during experimental sessions utilizing simple measures of hydration status.
It is well established in the literature that the benefits of resistance exercise (RE) for the general physical health of people of all ages go beyond the increase in muscle mass . RE can improve cardiovascular function, reduce risk factors associated with diabetes mellitus, coronary heart disease , and high blood pressure . Besides, higher levels of muscle strength are associated with lower risks of mortality .
However, despite the numerous benefits of RE, the stress caused by muscle contractions (mainly moderate to high intensity), may cause transient disturbances in the cardiovascular system and arterial stiffness. This response can increase the risk of cardiovascular events such as myocardial infarction and sudden death .
In this sense, many of the cardiovascular responses to RE have not been fully elucidated. One physiological response which can
influence this relationship but has received little attention from the scientific community is a reduction of plasma volume (PV) .
Plasma volume is an important variable, affecting a vast array of physiological functions during exercise, and some studies indicate that changes in its composition may influence cardiovascular system adjustments and autonomic modulation after the exercise.
After the end of a moderate to high intensity RE session, there may be a reduction in plasma volume caused by its influx into the interstitial tissue  with a consequent reduction in stroke volume and venous return. This process would result in a deactivation of cardiopulmonary receptors with subsequent increase in heart rate (HR).
These changes in PV can at least partially explain the behavior
of autonomic modulation. Rezk et al.  for instance, observed
increased HR and stroke volume reduction after high and low
intensity RE sessions. According to the authors, reduction in
PV was responsible for triggering this response accompanied
by an increase in sympathetic modulation, and a decrease in
In this context, recent reviews point to a complex interaction
caused by a RE session between autonomic modulation, central
(heart rate and myocardial contractility) and peripheral (i.e.,
vascular resistance) adjustments .
According to Buchheit et al. , arterial baroreceptors are
dependent on the levels of atrial pressure and stroke volume
witch on the other hand is affected by plasma volume. A decrease
in plasma volume would exert an inhibitory influence on the
receptors of the parasympathetic cardiovascular control centers
in the medulla and cause an excitatory effect on the sympathetic
nervous system (SNS) with consequent elevation of the HR
It is worth mention that during a typical RE session in
thermoneutral conditions (temperature 25o C and humidity
50%), the loss of fluids due to perspiration/sweat and respiration
is considered negligible. The body weight changes caused by
dehydration after most RE studies are far less than those observed
during aerobic exercise studies . Therefore, the mechanisms
for the changes in PV during resistance exercise are not due to loss
of body water to the degree as seen with aerobic exercise.
Rodriguez et al.  hypothesized that during high intensity
RE the influx of plasma to the active muscle seems to occur due
to an imbalance in hydrostatic and osmotic pressure between
the capillary terminal and the interstitial tissue of the active
muscles. That process can result in an elevated capillary filtration
pressure, which facilitates outward filtration of plasma from the
intravascular space into the surrounding tissues  resulting in
reduction of plasma volume in the circulation.
Arterial stiffness typically observed from arterial pulse wave
velocity (PWV) evaluation can also be negatively affected by RE
 and hydration status . PWV is considered an independent
predictor of coronary heart disease, stroke, and mortality ,
reduced arterial stiffness is typically perceived as beneficial
because it indicates a more compliant artery conversely, increased
arterial stiffness is one of the first signs of pathological changes
in the arterial wall leading to an increased risk of cardiovascular
There have been numerous consensus guidelines proposing
protocols to standardize the measurement of arterial stiffness/
PWV and thereby ensure high-quality research, nonetheless, no
one up to date has considered the influence of plasma volume.
Figueroa et al. , pointed out a linear relationship between
exercise intensity x PWV during and shortly after the end of
a RE session. As the intensity of exercise increases, there is a
concomitant increase in blood pressure and PWV. This is important
because arterial stiffness increase is strongly associated with
elevated sympathetic nerve modulation, cardiac workload and
reduction in cardiac perfusion thus increasing the future risk of
left ventricular hypertrophy and myocardial ischemia.
Regarding arterial stiffness and hydration, there are inconsistent
findings. In a recent study from our group, water intake
hindered arterial stiffness caused by high intensity RE . Alternatively,
demonstrated that mild dehydration (reduction of 2% of
body mass) caused by passive heat, provoked a reduction in central
PWV when compared to euhydration.
The contradictory results can be partially explained by the
different nature of plasma volume reduction, as mentioned before,
during a RE session there is an increase in blood pressure that
would lead to PV reduction. On the other hand, during heat stress,
vasodilation occurs in the periphery to increase blood flow to the
skin in attempt to maximize heat loss. Overall, heat stress acts as
an arterial vasodilator, much like nitrates, which reduces stiffness
of the peripheral, but not central, arteries.
There is no agreement as to why PV reduction may affect
arterial stiffness; however, Arnaoutis et al.  verified that in
healthy young adults, dehydration reduced endothelial function,
and reductions in endothelial function are strongly correlated
with increased arterial stiffness. Furthermore, blood pressure
also seems to influence the measurement of arterial stiffness;
hypovolemia can acutely reduce blood pressure  and thereby
reduce arterial stiffness.
Despite those contradictions, reduction of PV seems to play
an important role as one of the mechanisms of arterial stiffness
changes and as well as an intervening variable to cardiovascular
response to RE.
Up to the present date several questions regarding hydration
status and RE influence on arterial stiffness remains to be
addressed. In that sense, Future investigations are necessary to
elucidate the mechanisms and variables influencing this process.
Also, it is desirable to develop strategies to hinder the increased
autonomic modulation and arterial stiffness response to RE
exercise minimizing the risk of cardiovascular events. We strongly
suggest that future studies should standardize water intake and
control hydration status before and during experimental sessions
utilizing simple measures such as urine specific gravity and body
Craig J (2006) What's to drink? Staying hydrated in the heat. Diabetes Self Manag 23(4): 6-8, 11-2, 14.
Rodriguez D, Nakazato K, Naoki K, Alegretti G, Pontes Jr L, Figueira Jr A (2019) Water intake during resistance training affects arterial stiffiness in normotensive healthy adults. Med Sci in Sports Exer S662 51(5) Supplement.