Effect of exercise and posture on BP_Corrected by Prof Dr Samia.pptx

The Rawalpindi Medical University

BLOOD MODULE
SKILL LAB /Physiology PRACTICAL
FIRST-YEAR MBBS BATCH 50
Effects of Exercise and Posture on Blood Pressure
Date: 7th September 2023
2
Usman

Table of contents
3
Sr # Content Slide #
1 Motto, Vision 4
2 Professor Umar Model of Integrated Lecture 5
3 Bloom’s Taxonomy (Domains of learning) 6
4 Diagrammatic representation of Blooms taxonomy 7
5 Learning Objectives 8
6 Horizontal Integration 9-11
7 Core Concept 12-22
8 Vertical Integration 23-26
9 Biomedical Ethics (Lesson of the day) 27-29
10 Brainstorming (MCQs relevant with the lecture) 30-36
11 Suggested research article 37-38
12 Promoting IT and Research culture (Digital library) 39
13 References of this lecture 40

Motto Vision; The Dream/Tomorrow
• To impart evidence based
research oriented medical
education
• To provide best possible
patient care
• To inculcate the values of
mutual respect and ethical
practice of medicine

ProfessorUmarModel of Integrated Lecture
60%
CORE SUBJECT
20%
HORIZONTAL
INTEGRATION
Physiology
biochemistry
8%
VERTICAL
INTEGRATION
Pathology
pharmacology
7%
VERTICAL
INTEGRATION
Clinical
integration
5%
VERTICAL
INTEGRATION
Research,
professionalism
Ethics
Digital library

BLOOM'S TAXONOMY : DOMAINS OF LEARNING
Sr. # Domain of
learning
Abbreviation Levels of
the domain
Meaning
1 cognition C C1 Recall / Remembering
2 C2 Understanding
3 C3 Applying / Problem solving
4 Psychomotor P P1 Imitation / copying
5 P2 Manipulation / Follows instructions
6 P3 Precision / Can perform accurately
7 Attitude A A1 Receiving / Learning
8 A2 Respond / Starts responding to the
learned attitude
9 A3 Valuing / starts behaving according to the
learned attitude

BLOOM'S TAXONOMY OF THE
COGNITIVE DOMAIN

LEARNING OBJECTIVES
8
Sr. # Learning Objective Domain of Learning
1 To describe the effects of exercise and posture on blood pressure
and its clinical significance.
C1
2 To identify the anatomical location of baroreceptors. C2
3 To describe the function of baroreceptors. C1
4 To explain the rationale behind postural. C2
5 To apply knowledge of effects of exercise and posture on blood
pressure in a clinical context to assist in making diagnostic
decisions
C3

Horizontal integration
With Anatomy
Horizontal integration

Location of Baroreceptors
Horizontal Integration
with Anatomy

Horizontal Integration
with Anatomy

Core Concept
Core Concept

Effect of Posture on Blood Pressure
• The following changes occur when an
individual moves from a supine position to a
standing position:
• 1. When a person stands, a significant volume
of blood pools in the lower extremities
because of the high compliance of the veins.
(Muscular activity would prevent this pooling.)
Core
Concept

• 2. As a result of venous pooling and increased
local venous pressure, Pc in the legs increases
and fluid is filtered into the interstitium. If net
filtration of fluid exceeds the ability of the
lymphatics to return it to the circulation,
edema will occur.
• 3. Venous return decreases. As a result of the
decrease in venous return, both stroke volume
and cardiac output decrease
Core
Concept

A coordinated response from the vasomotor center
then increases sympathetic outflow to the heart
and blood vessels and decreases parasympathetic
outflow to the heart. As a result, heart rate,
contractility, TPR, and venous return increase, and
blood pressure increases toward normal.
6. Orthostatic hypotension (fainting or light-
headedness on standing) may occur in individuals
whose baroreceptor reflex mechanism is impaired
Core
Concept

Core
Concept

4. Arterial pressure decreases because of the
reduction in cardiac output. If cerebral blood
pressure becomes low enough, fainting may occur.
5. Compensatory mechanisms will attempt to
increase blood pressure to normal. The carotid
sinus baroreceptors respond to the decrease in
arterial pressure by decreasing the firing rate of the
carotid sinus nerves.
Core
Concept

Core
Concept

Effect of Exercise on Blood Pressure
• 1. The central command (anticipation of exercise)
originates in the motor cortex or from reflexes
initiated in muscle proprioceptors when exercise
is anticipated. Initiates the following changes:
a. Sympathetic outflow to the heart and blood
vessels is increased. At the same time,
parasympathetic outflow to the heart is decreased.
As a result, heart rate and contractility (stroke
volume) are increased, and unstressed volume is
decreased.
Core
Concept

b. Cardiac output is increased, primarily as a result
of the increased heart rate and, to a lesser extent,
the increased stroke volume.
c. Venous return is increased as a result of muscular
activity and vasoconstriction. Increased venous
return provides more blood for each stroke volume
d. Arteriolar resistance in the skin, splanchnic
regions, kidneys, and inactive muscles is increased.
Accordingly, blood flow to these organs is
decreased.
Core
Concept

2. Increased metabolic activity of skeletal muscle
Vasodilator metabolites (lactate, K+, and adenosine)
accumulate because of increased metabolism of the
exercising muscle.
These metabolites cause arteriolar dilation in the active
skeletal muscle, thus increasing skeletal muscle blood
flow (active hyperemia). As a result of the increased
blood flow, O2 delivery to the muscle is increased. The
number of perfused capillaries is increased so that the
diffusion distance for O2 is decreased.
Core
Concept

Core
Concept

Vertical integration with Clinical
& Paraclinical Sciences
Vertical integration

Vertical Integration
with Cardiology
Postural Hypotension

with Cardiology
Postural Hypotension
https://doi.org/10.1016/S1474-4422(22)00169-7

with Cardiology

Biomedical Ethics
Understanding
Biomedical Ethics

The four principles of Beauchamp and Childress
• The four principles of Beauchamp and Childress have been extremely influential in the
field of medical ethics, and are fundamental for understanding the current approach to
ethical assessment in health care. 28

Non-maleficence (Lesson of the day)
• The principle of non-maleficence holds that there is an
obligation not to inflict harm on others.
• Example: stopping a medication known to be harmful or
refusing to give a medication to a patient if it has not
been proven to be effective.
29
Understanding
Biomedical Ethics

Brain Storming
Question & Answer
Brain Storming

QUESTIONS
QUESTION 1:-
Define central venous pressure?
31
Brain Storming

32
Brain Storming
Ans: The mean (average) right atrial pressure
that equals right ventricular end-diastolic
pressure (the amount of pressure at the end
of diastole-filling)

QUESTIONS
• Question 2:
During exercise, total peripheral resistance (TPR) decreases because of the
effect of:
(A) the sympathetic nervous system on splanchnic arterioles
(B) the parasympathetic nervous system on skeletal muscle arterioles
(C) local metabolites on skeletal muscle arterioles
(D) local metabolites on cerebral arterioles
(E) histamine on skeletal muscle arterioles
33
Brain Storming

Answer
• The answer is C.
During exercise, local metabolites accumulate in the exercising muscle and
cause local vasodilation and decreased arteriolar resistance of the skeletal
muscle. Because muscle mass is large, it contributes a large fraction of the
total peripheral resistance (TPR). Therefore, the skeletal muscle vasodilation
results in an overall decrease in TPR, even though there is sympathetic
vasoconstriction in other vascular beds
34
Brain Storming

QUESTIONS
Question 3: What is the main determinant of
right ventricular preload?
35
Brain Storming

Answer
The mean right atrial pressure which equals
right ventricular end-diastolic pressure - central
venous pressure
36
Brain Storming

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