fisiologi exercises Cordio Respirasi

Oleh: Drs. Slamet sumarno Di sampaikan untuk Mahasiswa Eksekutif Universitas Indonusa Esa Unggul Klas Jauh Bandung Pada tanggal: 9 Desember 2007

PENDAHULUAN. The Normal Heart - Coronary Artery Anatomy Anatomi arteria coronarria dan jantung normal Left Main CA Layers of the Arterial Wall Circumflex Right CA Marginal Branch Left Anterior Descending Coronaria Arteri

Pengertian volume ventrikel kiri End Diastolic Volume (EDV) Volume akir diastol (volume akir pengisian ventrikel) EDV End Systolic Volume (ESV) Volume akir sistol (akir kontraksi ventrikel) Stroke Volume (SV) = EDV - ESV Ejection Fraction (EF) = SV EDV ESV Hambatan pompa jantung adalah indikator terbaik dari kemampuan kerja jantung dan prognosa kondisi jantung. Normal darah yg dipompo ventrikel kiri: 62%

Pengertian Q=Cardiac Output (COP) = Heart Rate X Strooke Volumes Cardiac Index = COP body surface area Preload: Volume darah yang masuk ventrikel saat diastole (End Diastole Volume= reflects stretch of the cardiac muscle cells) Afterload: Tahanan ventricular selama systole (Kemampuan otot ventrikel untuk mendorong darah ke aorta) Frank Starling Law of the Heart - Kemampuan kontraksi otot ventrikel terbesar mulai pre load secara bertahap. Myocardial Contractility – Kekuatan kontraksi otot jantung dan perkembangannya sampai preload. Regulated by: sympathetic nerve activity (most influential) catecholamines (epinephrine norepinephrine) amount of contractile mass drugs

Starlings Law of the Heart and Contractility SV left ventricular performance u contractility > 100 normal contractility 70-80 cc < 60 d contractility (heart failure) preload (venous return)

Normal Heart Failure (lemah jantung) Curves saat tekanan ventrikel indikasi kemampuan kontraksi Dan fungsi jantung. Perubahan tekanan per tahap dP/dt = change in pressure per unit of time dP/dt dP/dt Normal Heart Failure (lemah jantung) 120 Gambaran peningkatan saat dan akhir tekanan diastol Pada jantung normal SV= 60-80 CC Jantung terlatih SV= 90-250 CC Jantung sakit SV = 40-50 CC

Kemampuan kontraksi dipengaruhi oleh Kekuatan otot jantung. Fleksibilitas otot jantung. Tahanan perifer (aorta, jaringan, vena Peningkatan maks selisih preload dan afterload (dP/dt from LV pressure curve) Pengaruh Positive/negative iontropic. Ejection fraction (EF = SV/EDV) used in clinical practice Hormonal (epineprin atau norepineprin) increase contractility assumed with increase EF  with Ca, NE, digitalis, exercise with [K]o, [Na]o

Contractility related to : 1. sympathetic adrenergic nerves a. catecholamines: epinephrine norepinephrine b. Obat: digitalis sympathomimetics anesthetics, barbiturates 2. Hilangnya kemampuan kontraksi otot misalnya MCI, cardiomyopathy.

Definisi Perbedaan tekanan oksigen antara darah arteri dan vena. Arteriovenous Oxygen Difference (AVO2D) PENGUKURAN DALAM ml % - ml O2 / 100 ml blood Oxygen Consumption (VO2) – Jumlah oksigen yang dibutuhkan darah untuk metabilism dalam menghasilkan energi/ “absolute” measures: L / min , ml / min “relative measures: ml / kg body wt. / min Fick equation: VO2 = COP X Selisih O2 arteri dan vena Maximum Oxygen Consumption (VO2max) Jumlah oksigen yang mampu disediakan secara maksimal per menit untuk metabolism dalam menghasikan energi Tak langsung 220-usia = 60-80 % VO2 maks. Spirometri .

Myocardial Oxygen Consumption VO2 of the heart muscle (myocardium) Definisi Myocardial Oxygen Consumption VO2 of the heart muscle (myocardium) "estimated" by RPP: HR X Sistole BP. 5. Functional Aerobic Impairment: mild 27% - 40% moderate 41% - 54% marked 55% - 68% severe > 69% predicted VO2max - attained VO2max predicted VO2max

Definitions Systolic Blood Pressure (SBP) pressure measured in brachial artery during systole (ventricular emptying and ventricular contraction period) Diastolic Blood Pressure (DBP) pressure measured in brachial artery during diastole (ventricular filling and ventricular relaxation) Mean Arterial Pressure (MAP) "average" pressure throughout the cardiac cycle against the walls of the proximal systemic arteries (aorta) estimated as: .33(SBP - DBP) + DBP Total Peripheral Resistance (TPR) - the sum of all forces that oppose blood flow length of vasculature (L) blood viscosity (V) hydrostatic pressure (P) vessel radius (r) TPR = ( 8 ) ( V ) ( L ) ( p ) ( r 4 )

Cardiovascular Hemodynamic Basics Pressure (MAP) P aorta – P vena cava = Resistance (TPR) (8) (V) (L) () (r 4) Flow (COP) = = () (Pa – Pv) (r 4) (8) (V) (L) Flow (COP) Normally Resting Q is about 5 - 6 liters / minute V = viscosity of fluid (blood) flowing through the pipe L = length of pipe (blood vessel) r = radius of the pipe (blood vessel) Pa = aortic pressure TPR=Total peripheral Resistance Pv = venous pressure MAP= Means arterial Presure

The Systemic Circulation Brain The Systemic Circulation Lungs Arteries (Stiff Inflexible “Pipes”) Veins (Flexible Compliant “Pipes”) Precapillary Sphincters Liver Stomach Pancreas Intestines Kidneys Arterioles Skin Muscle

Kontrol fungsi jantung paru.

REST KERJA Cardiorespiratory Control Exercise Systemic Blood Flow: Autonomic influences Sympathetic outflow & circulating catecholamines a activation r vasoconstriction in non - exercising tissue Approximate redistribution of blood flow during maximal exercise NC in brain blood flow 500 ml/min u to heart 11,300 ml/min u to muscle 400 ml/min u to skin 500 ml/min d to kidneys 800 ml/min d to viscera 200 ml/min d to various other parts of the body REST KERJA

Acute Cardio respiratory Responses to Endurance Exercise

Pengaruh langsung dari latihan aerobik 1. Heart Rate Meningkat 3 kali lipat dari HR saa rest t 2. Oxygen Consumption (VO2) Satuan ukur relative dan absolute : Relative: ml O2/kg/min Absolute: ml/min or L/min Rata-rata VO2max usia 40 th- 37th (laki) ml/kg/min Resting metabolic equivalent = 1 MET = 3.5 ml/kg/min Oxygen consumption linked to caloric expenditure (1 liter of O2 consumed = 5 kcal) 180 160 140 100 Heart Rate HR – VO2 relationship is linear until about 90% VO2max 1.0 2.0 3.0 Oxygen Uptake (L / min) 50 150 250 Workloads (Watts)

Naik 4 x rest saat latihan 3 Cardiac Output (COP) Naik 4 x rest saat latihan COP meningkat akan meningkatkan sirkulasi vena Venous return dipengaruhi: sympathetic venoconstriction muscle pump Peningkatan inspirasi (thoracic pressure) Aliran darah ke jaringa meningkat Peningkatan inspirasi karena tekanan abdominal Kontraksi otot abdominal Pemerasan (squeezing) vena abdominal 120 110 70 Stroke Volume (ml/beat 25% 50% 75% Percentage of VO2 max

Meningkat sampai 1.5 kali istirahat bila exercise 4. Stroke Volume Meningkat sampai 1.5 kali istirahat bila exercise Tahap peningkatan 40% - 50% VO2 max Venous return naik End Diastole Volume (Starling mechanism) End Systole Volume naik sesuai kemampuan kontraksi myocard. Tahanan perifer 58% rest, max exercise: 83% 120 110 70 Stroke Volume (ml/beat 25% 50% 75% Percentage of VO2 max

Acute Responses to Aerobic Exercise 5. Perbedaan oksigen arteri dan vena Tergambar pada oxyhemoglobin desaturation curve up approximately 3 fold from rest to max exercise Saat rest antara 25% O2 arteri Saat exercise 85% O2 arterial Tekanan darah (B P) dan TPR SBP: up - failure to up signifies heart failure DBP: slight up or slight d or NC MAP: slight up TPR: down - mainly due to vasodilation in exercising muscle Acute Responses to Aerobic Exercise SBP= Sistole blood presure DBP=Dyastole blood presure MAP=Mean arterial presure TPR=Total peripher resistance.

Acute Responses to Aerobic Exercise 7. Coronary (Myocardial) Blood Flow 4.5% COP untuk myocardium saat rest dan meningkat saat exercise Peningkatan ini karena meningkatnya Mean Arteria Presure dan CA vasodilasi 8. Aliran darah ke kulit. Naik saat durasi rendah Turun saat latihan tinggi(krn peningkatan ke otot). Naik selama exercise recovery percepatan penurunan suhu dan dan bufer. Acute Responses to Aerobic Exercise

Acute Responses to Aerobic Exercise Ventilasi semenit Saat rest : 6 Liters/min Saat exercise : 175 Liters/min RR rest : 12-18/ min Saat exercise : 45-60/ min TV rest : 500 cc Exercise: : 2250 cc

Sirkulasi saat rest /exc Daerah Rest A-v O2/100ml light Moderat max Pencernaan Ren Cerebral Coronaria Otot kasar Kulit Lain-lain 4,1 1,3 6,3 14,0 8,4 1,0 - 1100 12% 900 10% 750 8% 350 4% 4500 47% 1500 15% 400 4 % 600 750 12500 1900 500 300 1% 250 1% 3 % 1000 4 % 22.000 88% 600 2% 100 1 % Rest EXC Tak terlatih COP 5000 ml/min 22000 ml/min HR 70/min 195/min SV 75 ml 113 ml Terlatih 35000 ml/min 50/min 100ml 179 ml

Plasma darah meningkat pada otot berkerja. Cairan tubuh turun 5% Acute Responses to Aerobic Exercise Volume Plasma Plasma darah meningkat pada otot berkerja. Cairan tubuh turun 5% blood viscosity increases

VO2 Oxygen Debt and Deficit Oxygen Deficit Oxygen DEBT & Oxygen DEFICIT Oxygen Debt(EPEOC) “Steady State” VO2 VO2 Untrained or people with certain cardiorespiratory diseases will have larger DEBTS and DEFICITS Rest EXERCISE TIME Onset Termination Oxygen Deficit due to: delay in time for aerobic ATP production to supply energy Oxygen Debt due to: resynthesis of high energy pohosphates (CP, ATP) replace oxygen stores lactate conversion to glucose (gluconeogenesis) u HR, respiration, catecholamines, body temperature

Training Adaptations to Chronic Endurance Exercise

Hubungan Pengaruh dari latihan terhadap Komponen menurut Fick Saat tidak aktivitas. NC NC VO2 = HR x SV x AVO2diff Seharusnya: Seharusnya: u time in diastole u preload d afterload u ventricle size u blood volume Submax Workload (measured at same pre-training workload) NC NC VO2 = HR x SV x AVO2diff note: a d in afterload (mentioned above) accompanied by a d in HR response translates into a d myocardial VO2 at rest or at any workload Max Workload (measured at peak exercise) NC some studies show a slight decrease Hubungan Pengaruh dari latihan terhadap Komponen menurut Fick

Training Adaptations 1.Tekanan Arteria sedang NC Saat rest atau selama exercise 2.Systolic and Diastolic Blood Pressure usually NC at rest or during exercise Turun saat submaximal workload Mungkin turun terbatas saat rest 3. hypertensives Banyak studies mencatat rata-rata turun 9 mmHg 4.Total Peripheral Resistance and Afterload capillarization naik (more parallel circuits) r d TPR TPR turun r d Afterload (slight – not of major significance)

Submax exercise: Turun Max exercise: sedikit naik Tidal Volume Training Adaptations Respiratory Rate Rest: NC Submax exercise: Turun Max exercise: sedikit naik Tidal Volume Submax exercise: NC or slight u Max exercise: slight u Anaerobic Threshold (lebih tinggi) tidak peka Occurs at a higher percentage of VO2 max Pre-training: 50% VO2max Post-training: 80% VO2max

Jumalah naik, ukuran dan luas permukaan membrane Training Adaptations Mitochondria Jumalah naik, ukuran dan luas permukaan membrane Aerobic Enzymes in Exercising Muscle u Krebs cycle enzymes (succinate dehydrogenase) u b oxidation enzymes (carnitine acyltransferase) u electron transport enzymes (cytochrome oxydase) Fatty Acid & Glycogen Utilization u utilization of b oxidative pathways to produce ATP Called the “glycogen sparring” effect d RER for any given submaximal workload u muscle glycogen stores (with high carbohydrate diet)

d Platelet Aggregation u Fibrinolytic Activity Training Adaptations d Platelet Aggregation u Fibrinolytic Activity d Circulating Catecholamines u vagal tone r d risk of arrhythmia No Appreciable Change in Resting Metabolic Rate Exception: training induced u in lean muscle mass Resistance to Pathological Events smaller infarct size and quicker recovery Less of a d in ventricular function during ischemia

"Average" Values for Sedentary and Trained Individuals Heart Rate ( beats / minute )

"Average" Values for Sedentary and Trained Individuals Stroke Volume ( ml / beat )

"Average" Values for Sedentary and Trained Individuals Cardiac Output ( liters / minute) l/min

"Average" Values for Sedentary and Trained Individuals A-V O2 Difference ( ml%) ml%

"Average" Values for Sedentary and Trained Individuals Systolic Blood Pressure ( mm Hg) mmHg

"Average" Values for Sedentary and Trained Individuals Diastolic Blood Pressure ( mm Hg) mmHg

"Average" Values for Sedentary and Trained Individuals Oxygen Consumption ( ml / kg / minute) Ml/kg/min

"Average" Values for Sedentary and Trained Individuals Minute Ventilation ( liters / minute) l/min

Tak berubah Turun//tak berubah Meningkatan Meningkatan Meningkatan Meningkatan Tak berubah Turun Turun Kecil / tak Ada perubahan Kecil / tak Ada perubahan Kecil / tak Ada perubahan Meningkatan Tak berubah Tak berubah Turun Turun Turun Tak berubah

Kesimpulan. Cardiovascular/male/sesaat Vareable Pre training Post training Endurance runner HR Rest HR Max SV Rest SV Max Q rest Q Max Heart Volume Blood Volume Sys BPRest Sys BP max Dias BP rest Dias BP Max 71 beats/min 185 beats/min 65 ml/beat 120 ml/beat 4,6 l/min 22,2 l/min 750 ml 4,7 L 135 mmHg 210 mmHg 78 mmHg 82 mmHg 59 183 80 140 4,7 25,6 820 5,1 130 205 76 36 174 125 200 4,5 34,8 1,200 6,0 120 210 65

Respirasi METABOLIC Vareable Pre Post Endurance Runner VE rest VE max TV rest TV max VC RV 7 l/min 110 L 0,5 L 2,75 L 5,8 L 1,4 l 6 135 0,5 3,0 6,0 1,2 195 3,9 6,2 METABOLIC Vareable Pre Post Endurance Runner A-vO2 diff Rest A-VO2 diff Max VO2 Rest VO2 Max Blood lactate Rest Blood lactate maX 6,0 ml/100ml 14,5 ml/100ml 3,5 ml/kg/min 40,5 ml/kg/min 1,0 mmol/L 7,5 mmol/L 6,0 15,0 3,5 49,8 1,0 8,5 16,0 76,7 9,0

Body composisi Vareable Pre Post Enduran Runner Weight Kg Fat weight Kg Fat-free weight Kg Fat % 79 12,6 66,4 16,0 77 9,6 67,4 12,5 68 5,1 62,9 7,5 Latihan Dilakukan pada atlit wanita dibandingkan dengan tidak latihan

Thank you Trimakasih

Perpustakaan. Brian J Sharkey; Physiology of fitness; Human Kenetics Publichers 1994 Per-olof Astrand, Kaare rodahl; Textbook of Work Physiology physiological Bases of Exercise; Mc Graw-hill Book Company,1998

3. Mc Ardle- Katch-Katch ; Exercise Physiology, Lea&Febiger 1994. 4. Ann B Mc Naught, Robin Callander ,Illustrated physiology, E&S Livingstone ltd Edinburgh and London 1965. 5. Jack H Willmore/ David L costill, Physiology of Sport and exercise, human kenetic,1999 5. Stewart, j.v. basmajian: exercise in water, edisi 3, williams&wilkins 1978. 6. W.F. Ganong, Review of Medical Physiology, LMP, Los Altos, California, 1981.