The autonomic adjustments to exercise are mediated by central signals from the higher brain (central command) and by a peripheral reflex arising from working skeletal muscle (exercise pressor reflex), with further modulation provided by the arterial baroreflex. Although it is clear that central command, the exercise pressor reflex and the arterial baroreflex are all requisite for eliciting appropriate cardiovascular adjustments to exercise, this review will be limited primarily to discussion of central command. Central modulation of the cardiovascular system via descending signals from higher brain centres has been well recognized for over a century, yet the specific regions of the human brain involved in this exercise-related response have remained speculative. Brain mapping studies during exercise as well as non-exercise conditions have provided information towards establishing the cerebral cortical structures in the human brain specifically involved in cardiovascular control. The purpose of this review is to provide an update of current concepts on central command in humans, with a particular emphasis on the regions of the brain identified to alter autonomic outflow and result in cardiovascular adjustments.

The purpose was to compare patterns of brain activation during imagined handgrip exercise and identify cerebral cortical structures participating in "central" cardiovascular regulation. Subjects screened for hypnotizability, five with higher (HH) and four with lower hypnotizability (LH) scores, were tested under two conditions involving 3 min of 1) static handgrip exercise (HG) at 30% of maximal voluntary contraction (MVC) and 2) imagined HG (I-HG) at 30% MVC. Force (kg), forearm integrated electromyography, rating of perceived exertion, heart rate (HR), mean blood pressure (MBP), and differences in regional cerebral blood flow distributions were compared using an ANOVA. During HG, both groups showed similar increases in HR (+13 +/- 5 beats/min) and MBP (+17 +/- 3 mmHg) after 3 min. However, during I-HG, only the HH group showed increases in HR (+10 +/- 2 beats/min; P < 0.05) and MBP (+12 +/- 2 mmHg; P < 0.05). There were no significant increases or differences in force or integrated electromyographic activity between groups during I-HG. The rating of perceived exertion was significantly increased for the HH group during I-HG, but not for the LH group. In comparison of regional cerebral blood flow, the LH showed significantly lower activity in the anterior cingulate (-6 +/- 2%) and insular cortexes (-9 +/- 4%) during I-HG. These findings suggest that cardiovascular responses elicited during imagined exercise involve central activation of insular and anterior cingulate cortexes, independent of muscle afferent feedback; these structures appear to have key roles in the central modulation of cardiovascular responses.

Intensive task-specific rehabilitative training, such as robotic BWSTT, can promote supraspinal plasticity in the motor centers known to be involved in locomotion. Furthermore, improvement in over-ground locomotion is accompanied by an increased activation of the cerebellum.

. Activation of the insular cortex is affected by the intensity of exercise. J. Appl. Physiol. 87(3): 1213-1219, 1999.-The purpose of this investigation was to determine whether there were differences in the magnitude of insular cortex activation across varying intensities of static and dynamic exercise. Eighteen healthy volunteers were studied: eight during two intensities of leg cycling and ten at different time periods during sustained static handgrip at 25% maximal voluntary contraction or postexercise cuff occlusion. Heart rate, blood pressure (BP), perceived exertion, and regional cerebral blood flow (rCBF) distribution data were collected. There were significantly greater increases in insular rCBF during lower (6.3 Ϯ 1.7%; P Ͻ 0.05) and higher (13.3 Ϯ 3.8%; P Ͻ 0.05) intensity cycling and across time during static handgrip (change from rest for right insula at 2-3 min, 3.8 Ϯ 1.1%, P Ͻ 0.05; and at 4-5 min, 8.6 Ϯ 2.8%, P Ͻ 0.05). Insular rCBF was decreased during postexercise cuff occlusion (Ϫ5.5 Ϯ 1.2%; P Ͻ 0.05) with BP sustained at exercise levels. Right insular rCBF data, but not left, were significantly related, with individual BP changes (r 2 ϭ 0.80; P Ͻ 0.001) and with ratings of perceived exertion (r 2 ϭ 0.79; P Ͻ 0.01) during exercise. These results suggest that the magnitude of insular activation varies with the intensity of exercise, which may be further related to the level of perceived effort or central command.human; brain; single-photon emission-computed tomography; magnetic resonance imaging; autonomic nervous system THE CEREBRAL CORTEX HAS long been recognized as having an important role in the regulation of autonomic function; this realization occurred even before the identification of any specific cortical region (10, 12). Studies implicating various cerebral cortical regions as possible sites for autonomic regulation were reviewed by Cechetto and Saper (3). Using specific criteria, they concluded that the insular cortex played a significant role. The insular cortex is a forebrain autonomic nucleus involved in the integration of sensory and visceral information (26). Of particular interest is the role played by the insular cortex in cardiovascular regulation (6,11,17,18,23,24). The right and left insular cortices possess reciprocal connectivity with numerous subcortical sites, including the lateral hypothalamus (31), ventrolateral medulla (31), and the nucleus tractus solitarii (NTS) (20, 31). These specific subcortical sites are known to be prominently involved in cardiovascular regulation at rest, as well as during physical activity (27). During exercise, when blood pressure (BP) must be regulated to sustain flow to both the brain and working musculature, signals from higher cortical centers (central command) and muscle afferent input (exercise pressor reflex) from the working limbs appear to converge at these sites to dictate an integrated cardiovascular response (16,27).Activation of the insular cortex has been shown to occur during volitional exercise (29). However, there was no si...

The purpose of this investigation was to hypnotically manipulate effort sense during dynamic exercise and determine whether cerebral cortical structures previously implicated in the central modulation of cardiovascular responses were activated. Six healthy volunteers (4 women, 2 men) screened for high hypnotizability were studied on 3 separate days during constant-load exercise under three hypnotic conditions involving cycling on a 1) perceived level grade, 2) perceived downhill grade, and 3) perceived uphill grade. Ratings of perceived exertion (RPE), heart rate (HR), blood pressure (BP), and regional cerebral blood flow (rCBF) distributions for several sites were compared across conditions using an analysis of variance. The suggestion of downhill cycling decreased both the RPE [from 13 +/- 2 to 11 +/- 2 (SD) units; P < 0.05] and rCBF in the left insular cortex and anterior cingulate cortex, but it did not alter exercise HR or BP responses. Perceived uphill cycling elicited significant increases in RPE (from 13 +/- 2 to 14 +/- 1 units), HR (+16 beats/min), mean BP (+7 mmHg), right insular activation (+7.7 +/- 4%), and right thalamus activation (+9.2 +/- 5%). There were no differences in rCBF for leg sensorimotor regions across conditions. These findings show that an increase in effort sense during constant-load exercise can activate both insular and thalamic regions and elevate cardiovascular responses but that decreases in effort sense do not reduce cardiovascular responses below the level required to sustain metabolic needs.