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  <head>
    <title>104-01 Exercise energetics and integrated physiological response</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Exercise energetics and integrated response">
      <outline text="Energy systems">
        <outline text="ATP stores sustain maximal contraction for seconds"/>
        <outline text="Phosphocreatine buffers abrupt demand">
          <outline text="Creatine kinase donates phosphate to ADP"/>
        </outline>
        <outline text="Anaerobic glycolysis makes ATP rapidly">
          <outline text="Pyruvate to lactate regenerates oxidised cofactor"/>
        </outline>
        <outline text="Oxidative phosphorylation: slower, far greater capacity">
          <outline text="Carbohydrate, fat, some amino acids"/>
        </outline>
        <outline text="Systems work simultaneously, not in sequence">
          <outline text="Sprint: high phosphagen and glycolytic flux"/>
          <outline text="Prolonged moderate: mitochondria, glycolysis continues"/>
        </outline>
        <outline text="Lactate does not mean absent oxygen">
          <outline text="Reflects glycolytic flux and redox balance"/>
          <outline text="Oxidised by muscle and heart, or hepatic glucose"/>
        </outline>
      </outline>
      <outline text="Cardiac output and blood flow">
        <outline text="Oxygen uptake: cardiac output x a-v O2 difference"/>
        <outline text="Sympathetic activation, vagal withdrawal raise heart rate"/>
        <outline text="Pumps, venoconstriction, redistribution raise return"/>
        <outline text="Stroke volume rises, then often plateaus">
          <outline text="Endurance-trained may keep increasing"/>
        </outline>
        <outline text="Metabolic vasodilation in active muscle">
          <outline text="Functional sympatholysis opposes constriction"/>
        </outline>
        <outline text="Sympathetic constriction in less active beds"/>
        <outline text="Skin flow later rises for heat loss"/>
        <outline text="Mean arterial pressure rises moderately">
          <outline text="Cardiac output rises more than resistance falls"/>
        </outline>
      </outline>
      <outline text="Resistance exercise haemodynamics">
        <outline text="Contracting muscle compresses vessels"/>
        <outline text="Very high transient pressure with breath holding">
          <outline text="Valsalva alters return, pressure, baroreflex"/>
        </outline>
        <outline text="Breathing, technique, load modify risk"/>
        <outline text="Acute pressor response is not chronic hypertension"/>
      </outline>
      <outline text="Ventilation and gas exchange">
        <outline text="Immediate rise: central command, sensory feedback"/>
        <outline text="Then follows carbon dioxide and acid-base demand"/>
        <outline text="Arterial gases near normal at moderate exercise"/>
        <outline text="Tidal volume first, frequency at high intensity"/>
        <outline text="Beyond ventilatory threshold: disproportionate rise">
          <outline text="Bicarbonate buffering adds carbon dioxide"/>
        </outline>
        <outline text="Capillary recruitment raises diffusion, perfusion"/>
        <outline text="Arterial desaturation when reserve is exceeded">
          <outline text="Short transit, mismatch, diffusion limitation"/>
        </outline>
      </outline>
      <outline text="Oxygen transport and extraction">
        <outline text="Content set by haemoglobin and saturation">
          <outline text="Anaemia demands higher cardiac output"/>
          <outline text="Carbon monoxide reduces carriage, distorts readings"/>
        </outline>
        <outline text="Heat, carbon dioxide, acidity aid unloading"/>
        <outline text="Extraction: perfusion, gradients, myoglobin, mitochondria"/>
        <outline text="Delivery and utilisation are interdependent">
          <outline text="Mitochondria cannot offset severe flow limits"/>
          <outline text="Flow cannot help without functional mitochondria"/>
        </outline>
        <outline text="Maximal uptake reflects a specific test mode"/>
      </outline>
      <outline text="Recruitment and substrates">
        <outline text="Low-threshold fatigue-resistant units first"/>
        <outline text="Larger faster units added as force rises"/>
        <outline text="Fibre phenotypes lie on adaptable continua"/>
        <outline text="Order altered by ballistic tasks, stimulation, injury"/>
        <outline text="Carbohydrate: faster ATP, more per oxygen">
          <outline text="Muscle glycogen local, liver sustains blood glucose"/>
        </outline>
        <outline text="Fat dominates at low intensity, long duration"/>
        <outline text="Carbohydrate use rises with intensity">
          <outline text="Crossover shifted by training, diet, hormones"/>
        </outline>
      </outline>
      <outline text="Hormones and fluid">
        <outline text="Catecholamines: heart, glycogenolysis, lipolysis"/>
        <outline text="Insulin falls, contraction drives glucose uptake"/>
        <outline text="Glucagon, catecholamines support hepatic output"/>
        <outline text="Cortisol, growth hormone in long exercise"/>
        <outline text="Graded by relative intensity">
          <outline text="Smaller stress response after training"/>
        </outline>
        <outline text="Plasma volume loss causes cardiovascular drift">
          <outline text="Stroke volume falls, heart rate rises"/>
        </outline>
        <outline text="Dehydration and hypotonic overdrinking both dangerous"/>
      </outline>
      <outline text="Efficiency, perception, and fatigue">
        <outline text="Efficiency: external work over energy expended">
          <outline text="Most energy becomes heat"/>
        </outline>
        <outline text="Economy improves via technique, elastic energy"/>
        <outline text="Perceived exertion integrates many signals">
          <outline text="Not a disguised heart rate or lactate"/>
        </outline>
        <outline text="Deception about distance alters output"/>
        <outline text="Peripheral fatigue: metabolites, coupling, ions"/>
        <outline text="Central fatigue: reduced effective neural drive"/>
      </outline>
      <outline text="Testing and integration">
        <outline text="Protocols link workload to responses"/>
        <outline text="Interpret mode, effort, medication, stop reason"/>
        <outline text="Peak may be limited before physiological maximum"/>
        <outline text="Submaximal thresholds locate the constraint"/>
        <outline text="Match ATP demand to oxygen, substrate, heat removal"/>
        <outline text="Disease shifts the bottleneck"/>
        <outline text="Exercise as a stress test of reserve"/>
      </outline>
    </outline>
  </body>
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