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Influence of Sex, Menstrual Cycle, and Menopause Status on the Exercise Pressor Reflex

SMITH, JOSHUA R.; KOEPP, KATLYN E.; BERG, JESSICA D.; AKINSANYA, JOSHUA G.; OLSON, THOMAS P.

Medicine & Science in Sports & Exercise: May 2019 - Volume 51 - Issue 5 - p 874–881
doi: 10.1249/MSS.0000000000001877
BASIC SCIENCES
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ABSTRACT In this review, we highlight the underlying mechanisms responsible for the sex differences in the exercise pressor reflex (EPR), and, importantly, the impact of sex hormones and menopausal status. The EPR is attenuated in premenopausal women compared with age-matched men. Specifically, activation of the metaboreflex (a component of the EPR) results in attenuated increases in blood pressure and sympathetic vasomotor outflow compared with age-matched men. In addition, premenopausal women exhibit less transduction of sympathetic outflow to the peripheral vasculature than men. In stark contrast, postmenopausal women exhibit an augmented EPR arising from exaggerated metaboreflex-induced autonomic and cardiovascular reflexes. We propose that metaboreflex-induced autonomic and cardiovascular changes associated with menopause majorly contribute to the elevated blood pressure response during dynamic exercise in postmenopausal women. In addition, we discuss the potential mechanisms by which sex hormones in premenopausal women may impact the EPR as well as metaboreflex.

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN

Address for correspondence: Thomas P. Olson, Ph.D., Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester MN 55901; E-mail: olson.thomas2@mayo.edu.

Submitted for publication September 2018.

Accepted for publication December 2018.

© 2019 American College of Sports Medicine