Responses to exercise in the heat related to measures of hypothalamic serotonergic and dopaminergic function

The psychobiology of burnout: are there two different syndromes?

BACKGROUND

Plasma prolactin levels are sensitive to dopamine and serotonin function, and fatigue. Low cortisol, dopamine and/or serotonin may be involved in burnout and detachment.

METHODS

In this double-blind within-subject study, we treated 9 female burnout subjects and 9 controls with 35 mg cortisol and placebo orally. We measured state affect and plasma prolactin, oxytocin, cortisol and adrenocorticotropic hormone levels, and administered an attachment questionnaire.

RESULTS

The burnout subjects displayed an extreme distribution of basal prolactin levels, displaying higher or lower levels compared to the controls. The low prolactin burnouts had profoundly low attachment scores and tended to have low oxytocin levels. The high prolactin burnout subjects tended to show cortisol-induced decreased prolactin and fatigue, and increased vigor.

CONCLUSION

Results are consistent with the hypothesis that burnout subjects are either characterized by low serotonergic function or by low dopaminergic function, and that the latter group benefits from cortisol replacement. These preliminary results suggest that differentiating between two syndromes may resolve inconsistencies in research on burnout, and be necessary for selecting the right treatment strategy.

Central fatigue: the serotonin hypothesis and beyond

The original central fatigue hypothesis suggested that an exercise-induced increase in extracellular serotonin concentrations in several brain regions contributed to the development of fatigue during prolonged exercise. Serotonin has been linked to fatigue because of its well known effects on sleep, lethargy and drowsiness and loss of motivation. Several nutritional and pharmacological studies have attempted to manipulate central serotonergic activity during exercise, but this work has yet to provide robust evidence for a significant role of serotonin in the fatigue process. However, it is important to note that brain function is not determined by a single neurotransmitter system and the interaction between brain serotonin and dopamine during prolonged exercise has also been explored as having a regulative role in the development of fatigue. This revised central fatigue hypothesis suggests that an increase in central ratio of serotonin to dopamine is associated with feelings of tiredness and lethargy, accelerating the onset of fatigue, whereas a low ratio favours improved performance through the maintenance of motivation and arousal. Convincing evidence for a role of dopamine in the development of fatigue comes from work investigating the physiological responses to amphetamine use, but other strategies to manipulate central catecholamines have yet to influence exercise capacity during exercise in temperate conditions. Recent findings have, however, provided support for a significant role of dopamine and noradrenaline (norepinephrine) in performance during exercise in the heat. As serotonergic and catecholaminergic projections innervate areas of the hypothalamus, the thermoregulatory centre, a change in the activity of these neurons may be expected to contribute to the control of body temperature whilst at rest and during exercise. Fatigue during prolonged exercise clearly is influenced by a complex interaction between peripheral and central factors.

Exercise and heat stress: cerebral challenges and consequences

This review deals with new aspects of exercise in the heat as a challenge that not only influences the locomotive and cardiovascular systems, but also affects the brain. Activation of the brain during such exercise is manifested in the lowering of the cerebral glucose to oxygen uptake ratio, the elevated ratings of perceived exertion and increased release of hypothalamic hormones. While the slowing of the electroencephalographic (EEG), the decreased endurance and hampered ability to activate the skeletal muscles maximally during sustained isometric and repeated isokinetic contractions appear to relate to central fatigue arising as the core/brain increases, the central fatigue during exercise with hyperthermia thus can be considered as the ultimate safety break against catastrophic hyperthermia. This would force the subject to stop exercising or decrease the internal heat production. It appears that the dopaminergic system is important, but several other factors may interact and feedback from the skeletal muscles and internal temperature sensors are probably also involved. The complexity of brain fatigue response is discussed based on our own investigations and in the light of recent literature.

The effects of face cooling during hyperthermic exercise in man: evidence for an integrated thermal, neuroendocrine and behavioural response

The present study investigated whether face cooling reduced both the perceived exertion (RPE) and prolactin (PRL) release during hyperthermic exercise. Ten, non-heat-acclimated males (23 +/- 2 years; maximal oxygen consumption, 56 +/- 7 ml kg(-1) min(-1) [mean +/- s.d.]) exercised for 40 min on a cycle ergometer at 65% of their peak aerobic power, at an ambient temperature of 33 degrees C (27% relative humidity) with (FC) and without face cooling as a control (CON). With FC, forehead temperature was maintained approximately 6 degrees C lower than CON, while other skin sites were similar or slightly warmer in the FC condition. Rectal temperature increased by approximately 1.5 degrees C with the same time course in both conditions. A relative bradycardia was observed during FC, with heart rate approximately 5 beats min(-1) lower than CON (P < 0.05). Mean plasma lactate was lower during FC (FC, 5.0 +/- 0.3 mmol l(-1); CON, 5.9 +/- 0.3 mmol l(-1); P < 0.05) but no differences were observed for plasma glucose, which remained constant during exercise. Levels of PRL were maintained at 175 +/- 17 mIU l(-1) during exercise for FC, while values for CON increased to a peak of 373 +/- 22 mIU l(-1) so that towards the end of the exercise, for the same rectal temperature, PRL was significantly lower in the FC condition (P < 0.05). Global and breathing RPE were reduced but only towards the end of the 40 min of exercise during FC, whilst subjective thermal comfort was significantly lower during FC (P < 0.05). We confirm the substantial effect that FC has on the secretion of PRL during hyperthermic exercise but show that it makes a relatively small contribution to the perception of effort when compared to the effect of a cool total skin area as occurs with exercise in a thermoneutral environment.

The effects of face cooling on the prolactin response and subjective comfort during moderate passive heating in humans

The purpose of the present study was twofold: first, to determine the extent to which elevated skin temperature is responsible for the hormonal and perceptual responses to passive heating; and second, to determine to what extent face-cooling can override the effects of raised skin temperature. Sixteen recreationally active, non-heat-acclimated volunteers (12 male, 4 female; age, 29 +/- 9 years, [mean +/- S.D.]) underwent a passive heat exposure for 60 min in a sauna maintained at 58 degrees C (13% relative humidity), conditions under which sweating effectively maintains core temperature. Subjects were allocated to one of two experimental groups which were matched for sex, age, body mass index, body surface area and sweating response; one group received face cooling (FC) every 5 min, whilst the other control group (CON) received none. Mean skin temperatures were elevated by approximately 4 degrees C for the 60 min duration (CON, 36.5 +/- 0.1 degrees C; FC, 35.7 +/- 0.1 degrees C; P < 0.05) but core temperature rose by only approximately 0.25 degrees C with no difference between groups. Circulating prolactin remained stable and showed no increase for the FC group, whereas concentrations increased by 102 +/- 34% (P < 0.05) for the CON group. No differences were observed between groups for heart rate, but the sensation of heat was less (P < 0.05) with FC. We suggest that a significant component of the prolactin response to moderate passive heating is mediated by facial skin temperature, and selective cooling of the face is associated with improved perception of thermal comfort. These results indicate that the temperature of only a small part of the total skin area (approximately 10%) has a disproportionately large effect on the hormonal and perceptual responses to heat stress.

Effect of transdermal nicotine administration on exercise endurance in men

Nicotine is widely reported to increase alertness, improve co-ordination and enhance cognitive performance; however, to our knowledge there have been no attempts to replicate these findings in relation to exercise endurance. The purpose of this study was to determine the effects nicotine might have on cycling endurance, perception of exertion and a range of physiological variables. With local ethics committee approval and having obtained informed consent, 12 healthy, non-smoking men (22 +/- 3 years; maximal O2 uptake, 56 +/- 6 ml kg(-1) min(-1), mean +/- s.d.) cycled to exhaustion at 18 degrees C and 65% of their peak aerobic power, wearing either a 7 mg transdermal nicotine patch (NIC) or a colour-matched placebo (PLA) in a randomized cross-over design; water was available ad libitum. Subjects were exercising at approximately 75% of their maximal O2 uptake with no differences in cadence between trials. Ten out of 12 subjects cycled for longer with NIC administration, and this resulted in a significant 17 +/- 7% improvement in performance (P < 0.05). No differences were observed for perceived exertion, heart rate or ventilation. There were no differences in concentrations of plasma glucose, lactate or circulating fatty acids. In the absence of any effect on peripheral markers, we conclude that nicotine prolongs endurance by a central mechanism. Possible modes of action are suggested.

Central excitability does not limit postfatigue voluntary activation of quadriceps femoris

After fatigue, motor evoked potentials (MEP) elicited by transcranial magnetic stimulation and cervicomedullary evoked potentials elicited by stimulation of the corticospinal tract are depressed. These reductions in corticomotor excitability and corticospinal transmission are accompanied by voluntary activation failure, but this may not reflect a causal relationship. Our purpose was to determine whether a decline in central excitability contributes to central fatigue. We hypothesized that, if central excitability limits voluntary activation, then a caffeine-induced increase in central excitability should offset voluntary activation failure. In this repeated-measures study, eight men each attended two sessions. Baseline measures of knee extension torque, maximal voluntary activation, peripheral transmission, contractile properties, and central excitability were made before administration of caffeine (6 mg/kg) or placebo. The amplitude of vastus lateralis MEPs elicited during minimal muscle activation provided a measure of central excitability. After a 1-h rest, baseline measures were repeated before, during, and after a fatigue protocol that ended when maximal voluntary torque declined by 35% (Tlim). Increased prefatigue MEP amplitude ( P = 0.055) and cortically evoked twitch ( P < 0.05) in the caffeine trial indicate that the drug increased central excitability. In the caffeine trial, increased MEP amplitude was correlated with time to task failure ( r = 0.74, P < 0.05). Caffeine potentiated the MEP early in the fatigue protocol ( P < 0.05) and offset the 40% decline in placebo MEP ( P < 0.05) at Tlim. However, this was not associated with enhanced maximal voluntary activation during fatigue or recovery, demonstrating that voluntary activation is not limited by central excitability.

The influence of pre-warming on the physiological responses to prolonged intermittent exercise

To examine the influence of pre-warming on the physiological responses to prolonged intermittent exercise in ambient temperatures of 21.5 +/- 0.6 degrees C and relative humidities of 35.7 +/- 5.4% (mean +/- s), six healthy men performed intermittent treadmill running (30-s bouts at 90% of maximal oxygen uptake separated by 30-s static recovery periods) to exhaustion after active pre-warming, passive pre-warming and pre-exercise rest (control). Exercise time to exhaustion was significantly different between all conditions (active, 51.8 +/- 7.2 min; passive, 38.5 +/- 11.1 min; control, 72.0 +/- 17.2 min; P < 0.05). These changes in performance time were closely associated with a significant decline in both the rate of heat storage and heat storage capacity (P < 0.05). Rectal temperature, heart rate and ratings of perceived exertion were significantly higher during exercise in the two pre-warming conditions than in the control condition (P < 0.05). Ratings of perceived exertion were also significantly higher during exercise following passive pre-warming compared with active pre-warming (P < 0.05). During exercise there were no significant differences in serum prolactin, plasma norepinephrine and plasma free fatty acid concentrations between conditions. We conclude that both active and passive pre-warming promote a reduction in prolonged intermittent exercise capacity in environmental temperatures of 21 degrees C compared with pre-exercise rest. These performance decrements were dependent upon the mode of pre-warming and closely reflected alterations in body heat content.

Exercise thermoregulation and hyperprolactinaemia

The anterior pituitary hormone prolactin (PRL), measured in the peripheral blood circulation, reflects alterations in central brain 5-hydroxytryptamine (serotonin) and dopaminergic activity and is used as a marker of 'central fatigue' during active heat exposure. Significant correlations have consistently been found between PRL and core temperature (T(CORE)) during prolonged exercise. There has been no investigation into the relationship between PRL and other key thermoregulatory variables during exercise, such as weighted mean skin (T(SK)) and mean body temperature (T(B)), heat storage (HS), thermal gradient (T(GRAD)), heart rate (HR) and skin blood flow (cutaneous vascular conductance, CVC). Therefore, the aim of this study was to ascertain if a significant relationship exists between PRL and these thermoregulatory variables during prolonged exercise. Nine active male subjects conducted three trials of approximately 60% VO(2peak) at 70-80 rpm for 45 min on a semi-recumbent cycle ergometer at three different ambient temperatures [6 degrees C (Cold), 18 degrees C (Neutral) and 30 degrees C (Hot)] to elicit varying levels of thermoregulatory stress during exercise. Significant differences existed in T(SK), T(B), HS, T(GRAD) and CVC across the environmental conditions (p < 0.001). Core temperature (T(CORE)), HR and PRL were significantly elevated only in Hot (p < 0.05). Moderate correlations were found for T(CORE), T(SK), T(B), HS, T(GRAD), HR and CVC with post-exercise PRL (rho = 0.358-0.749). The end-of-exercise <38.0 degrees C T(CORE) responses were not (rho = -0.129, p > 0.05) but the >38.0 degrees C T(CORE) responses were (rho = 0.845, p < 0.001) significantly related to their corresponding PRL responses. The significant relationships between PRL release and T(SK), T(B), HS, T(GRAD), HR and CVC have extended previous research on T(CORE) and PRL release and indicate an association between these thermoregulatory variables, as well as T(CORE), and serotonergic/dopaminergic activity during prolonged exercise.

The prolactin responses to active and passive heating in man

The aim of this study was to compare the prolactin and blood pressure responses at identical core temperatures during active and passive heat stresses, using prolactin as an indirect marker of central fatigue. Twelve male subjects cycled to exhaustion at 60% maximal oxygen uptake (VO2peak) in a room maintained at 33 degrees C (active). In a second trial they were passively heated (passive) in a water bath (41.56 +/- 1.65 degrees C) until core temperature was equal to the core temperature observed at exhaustion during the active trial. Blood samples were taken from an indwelling venous cannula for the determination of serum prolactin during active heating and at corresponding core temperatures during passive heating. Core temperature was not significantly different between the two methods of heating and averaged 38.81 +/- 0.53 and 38.82 +/- 0.70 degrees C (data expressed as means +/- s.d.) at exhaustion during active heating and at the end of passive heating, respectively (P > 0.05). Mean arterial blood pressure was significantly lower throughout passive heating (active, 73 +/- 9 mmHg; passive, 62 +/- 12 mmHg; P < 0.01). Despite the significantly reduced blood pressure responses during passive heating, during both forms of heating the prolactin response was the same (active, 14.9 +/- 12.6 ng ml(-1); passive, 13.3 +/- 9.6 ng ml(-1); n.s.). These results suggest that thermoregulatory, i.e. core temperature, and not cardiovascular afferents provide the key stimulus for the release of prolactin, an indirect marker of central fatigue, during exercise in the heat.

The effect of acute branched-chain amino acid supplementation on prolonged exercise capacity in a warm environment

Eight males were recruited to examine the effect of branched-chain amino acid (BCAA) supplementation on exercise capacity in a glycogen-depleted state in a warm environment. Following a exercise and dietary regimen designed to reduce glycogen availability, subjects returned to the laboratory the following morning and remained seated for 2 h, before cycling to volitional exhaustion at 50% VO2 peak in a warm environment [30.0 (0.2) degrees C; mean (SD)]. Four 250 ml aliquots of a 12 g l(-1) BCAA solution or placebo were ingested at 30 min intervals prior to exercise, with an additional 150 ml consumed every 15 min throughout exercise. BCAA ingestion had no effect on exercise capacity [placebo 103.9 (26.9) min; BCAA 111.0 (29.2) min; P = 0.129). No difference in heart rate (P = 0.345), core temperature (P = 0.628), or weighted mean skin temperature (P = 0.114) was apparent between trials. Ingestion of the BCAA solution produced a marked increase in plasma BCAA immediately prior to exercise [+ 1126 (158) micromol l(-1); P < 0.001) with this difference maintained throughout. Consequently, a significant reduction in the plasma concentration ratio of free tryptophan to BCAA was observed during the BCAA trial when compared to the placebo (P < 0.001). Plasma ammonia concentration was significantly elevated during exercise throughout the BCAA trial (P < 0.001), with no change from rest apparent during the placebo trial (P = 0.608). Blood glucose (P = 0.114) and lactate (P = 0.836) concentrations were not different between trials. Ingestion of a BCAA solution prior to, and during, prolonged exercise in glycogen-depleted subjects did not influence exercise capacity in a warm environment.

Acute dopamine/noradrenaline reuptake inhibition enhances human exercise performance in warm, but not temperate conditions

Nine healthy endurance-trained males were recruited to examine the effect of a dual dopamine/noradrenaline reuptake inhibitor on performance, thermoregulation and the hormonal responses to exercise. Subjects performed four trials, ingesting either a placebo (pla) or 2 x 300 mg bupropion (bup), prior to exercise in temperate (18 degrees C) or warm (30 degrees C) conditions. Trials consisted of 60 min cycle exercise at 55% W(max) immediately followed by a time trial (TT). TT performance in the heat was significantly improved by bupropion (pla: 39.8 +/- 3.9 min, bup: 36.4 +/- 5.7 min; P = 0.046), but no difference between treatments was apparent in temperate conditions (pla: 30.6 +/- 2.2 min, bup: 30.6 +/- 1.9 min; P = 0.954). While TT power output was consistently lower in the heat when compared to temperate conditions, this decrement was attenuated by bupropion. At the end of the TT in the heat, both core temperature (pla 39.7 +/- 0.3 degrees C, bup 40.0 +/- 0.3 degrees C; P = 0.017) and HR (pla 178 +/- 7 beats min(-1), bup 183 +/- 12 beats min(-1); P = 0.039), were higher in the bupropion trial than in the placebo. Circulating pituitary and adrenal hormone concentrations increased throughout exercise in all trials. Circulating serum prolactin was elevated above temperate levels during exercise in a warm environment (P < 0.001). These data indicate that performance in warm conditions is enhanced by acute administration of a dual dopamine/noradrenaline reuptake inhibitor. No such effect was apparent under temperate conditions. It appears that bupropion enabled subjects to maintain a greater TT power output in the heat with the same perception of effort and thermal stress reported during the placebo trial, despite the attainment of a higher core temperature.

Intracerebroventricular tryptophan increases heating and heat storage rate in exercising rats

The role of increased hypothalamic tryptophan (TRP) availability on thermoregulation and rates of core temperature increase and heat storage (HS) during exercise was studied in normal untrained rats running until fatigue. The rats were each anesthetized with 2.5% tribromoethanol (1.0 ml kg(-1) ip) and fitted with a chronic guiding cannula attached to the right lateral cerebral ventricle 1 week prior to the experiments. Immediately before exercise, they were randomly injected through these cannulae with 2.0 microl of 0.15 M NaCl (SAL; n=6) or 20.3 microM L-TRP solution (n=7). Exercise consisted of running on a treadmill at 18 m min(-1) and 5% inclination until fatigue. Body temperature was recorded before and during exercise with a thermistor probe implanted into the peritoneal area. Rates of core temperature increase (HR, degrees C min(-1)) and heat storage (HSR, cal min(-1)) were calculated. TRP-treated rats showed a rapid increase in body temperature which was faster than that observed in the saline-treated group during the exercise period. The TRP group also showed a higher rate of core temperature increase and HS. TRP-treated rats that presented higher HR and HSR also fatigued much earlier than saline-treated animals (16.8+/-1.1 min TRP vs. 40+/-3 min SAL). This suggests that the reduced running performance observed in TRP-treated rats is related to increased HR and HSR induced by intracerebroventricular injection of TRP in these animals.

Cerebral perturbations provoked by prolonged exercise

This review addresses cerebral metabolic and neurohumoral alterations during prolonged exercise in humans with special focus on associations with fatigue. Global energy turnover in the brain is unaltered by the transition from rest to moderately intense exercise, apparently because exercise-induced activation of some brain regions including cortical motor areas is compensated for by reduced activity in other regions of the brain. However, strenuous exercise is associated with cerebral metabolic and neurohumoral alterations that may relate to central fatigue. Fatigue should be acknowledged as a complex phenomenon influenced by both peripheral and central factors. However, failure to drive the motorneurons adequately as a consequence of neurophysiological alterations seems to play a dominant role under some circumstances. During exercise with hyperthermia excessive accumulation of heat in the brain due to impeded heat removal by the cerebral circulation may elevate the brain temperature to >40 degrees C and impair the ability to sustain maximal motor activation. Also, when prolonged exercise results in hypoglycaemia, perceived exertion increases at the same time as the cerebral glucose uptake becomes low, and centrally mediated fatigue appears to arise as the cerebral energy turnover becomes restricted by the availability of substrates for the brain. Changes in serotonergic activity, inhibitory feed-back from the exercising muscles, elevated ammonia levels, and alterations in regional dopaminergic activity may also contribute to the impaired voluntary activation of the motorneurons after prolonged and strenuous exercise. Furthermore, central fatigue may involve depletion of cerebral glycogen stores, as signified by the observation that following exhaustive exercise the cerebral glucose uptake increases out of proportion to that of oxygen. In summary, prolonged exercise may induce homeostatic disturbances within the central nervous system (CNS) that subsequently attenuates motor activation. Therefore, strenuous exercise is a challenge not only to the cardiorespiratory and locomotive systems but also to the brain.