The ergoreflex: how the skeletal muscle modulates ventilation and cardiovascular function in health and disease

The control of ventilation and cardiovascular function during physical activity is partially regulated by the ergoreflex, a cardiorespiratory reflex activated by physical activity. Two components of the ergoreflex have been identified: the mechanoreflex, which is activated early by muscle contraction and tendon stretch, and the metaboreflex, which responds to the accumulation of metabolites in the exercising muscles. Patients with heart failure (HF) often develop a skeletal myopathy with varying degrees of severity, from a subclinical disease to cardiac cachexia. HF-related myopathy has been associated with increased ergoreflex sensitivity, which is believed to contribute to dyspnoea on effort, fatigue and sympatho-vagal imbalance, which are hallmarks of HF. Ergoreflex sensitivity increases significantly also in patients with neuromuscular disorders. Exercise training is a valuable therapeutic option for both HF and neuromuscular disorders to blunt ergoreflex sensitivity, restore the sympatho-vagal balance, and increase tolerance to physical exercise. A deeper knowledge of the mechanisms mediating ergoreflex sensitivity might enable a drug or device modulation of this reflex when patients cannot exercise because of advanced skeletal myopathy.

Automated summary

The ergoreflex, activated by physical activity, plays a role in regulating ventilation and cardiovascular function. Its two components, the mechanoreflex and metaboreflex, respond to muscle contraction and metabolite accumulation in exercising muscles. Patients with heart failure and neuromuscular disorders often experience increased ergoreflex sensitivity, leading to symptoms like dyspnoea and reduced tolerance to physical exercise. Exercise training can help mitigate ergoreflex sensitivity, restore balance, and improve exercise tolerance in these patients.