Monthly Archives: February 2018

The shear effect of exercise

By Abigail Cook, University of Leeds, @abbycook94

Exercise is good for you. We see this statement daily in one form or another, whether it’s on social media, as advice from medical professionals or making headlines in the news. We know it’s good for our hearts, keeping our weight under control and is even beneficial for our mental health. A question I am often asked is: why is exercise so good for us? My research focuses on the effect of exercise on human arteries and the cells lining these arteries.

Helping blood vessels saves the heart

Cardiovascular disease (CVD) is one of the leading causes of death in the Western world and is responsible for 25% of all deaths in the UK (BHF, 2017). Only 60% of CVD cases, however, can be explained by traditional risk factors such as fat, high blood pressure, and diabetes (Mora et al., 2007). Of the rest, changes to blood vessels appears to play a major part.


Thus, targeting blood vessels appears to be an attractive way to reduce poor functioning of the blood vessels and CVD. As exercise directly impacts blood pressure, heart rate and the quantity of blood leaving the heart per beat, it provides a method of reaching this target without using drugs.

This is especially important given that physical inactivity is the fourth highest risk factor for mortality worldwide. Also physical fitness, when assessed by aerobic capacity (the maximum oxygen consumption in an exercise session), is the strongest predictor of death in populations with and without CVD.

The scene inside our blood vessels

For the appropriate amount of blood to be delivered to our organs and tissues, arteries need to widen appropriately. One of the key molecules that tells the arteries to widen is nitric oxide (NO). NO is produced by the inner lining of the blood vessel. Its release is controlled by the force, which I study in the lab, called shear stress, applied by blood to this lining.


Shear stress can be characterised in different ways, with each form resulting in different responses from the inner lining of the vessels. High levels of unidirectional shear stress occur in the straight sections of blood vessels. This is associated with the production of molecules that fight inflammation, which protect the cell from abnormal growth and proliferation, and even cell death. Low levels of bidirectional shear stress are most often found at curvatures and at branches of blood vessels. This type of shear stress generates molecules that are associated with inflammation.

The areas that are exposed to low levels bidirectional shear stress are at the greatest risk of developing atherosclerosis (a type of CVD), the disease where an artery becomes narrowed due to the build-up of plaques. Prolonged exposure to this type of shear stress can lead to dysfunction of the inner lining of blood vessels, which is an early indicator of CVD.

Exercise lends a helping hand

The ideal shear stress throughout the vasculature to minimise the likelihood of developing CVD such as atherosclerosis would be high levels of unidirectional shear stress. One way of increasing shear stress is by exercising.

Exercise increases heart rate, cardiac output, blood flow, and thus shear stress. Undertaking regular exercise has been shown to be protective against atherosclerosis and slow down the progression of CVD. It is unclear, however, what type of exercise training is most beneficial to the blood vessels. Continuous exercise may provide steady levels of shear stress, whereas interval exercise may allow shear stress to vary throughout exercise from a low to a high level.


My research uses ultrasound and MRI technology to understand the patterns and levels of shear stress applied to arteries during differing exercise protocols. The arteries of interest are both are susceptible to developing atherosclerosis (the aorta and the common femoral artery), and they can be monitored during an exercise protocol.

This is especially important in the common femoral artery as it is directly supplying blood to the working muscle during exercise. Then, I am examining what happens when these patterns and levels are replicated in cells grown in the laboratory, in order to see which type of exercise enhances cell function most effectively.

BHF. (2017). Cardiovascular Disease Statistics 2017. BHF.

Mora S, Cook N, Buring JE, Ridker PM & Lee IM. (2007). Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation 116, 2110-2118.

The female athlete: A balancing act between success and health

By Jessica Piasecki, Manchester Metropolitan University, UK, @JessCoulson90

A longer version of this article originally appeared in Physiology News.

There is a very fine line between training, competition, and recovery for the elite athletes (1). For female athletes, they have an extra balance to take into consideration: the menstrual cycle.

The monthly cycles

The menstrual cycle is a natural process and is essential to maintain bone health and fertility. It can start from the age of 12 and continues until the onset of menopause around the age of 49-52.

The cycle occurs over a period of 28 days. The first 14 days are known as the follicular phase. During this phase, around day 10, the hormones oestrogen, LH (luteinizing hormone) and FSH (follicular stimulating hormone) rise, reaching their peak around day 14.

LH reaches a level double than that of both oestrogen and FSH. After day 14 LH levels rapidly drop off while oestrogen and FSH fall off more slowly, over a 5 day period. The second 14 days are known as the luteal phase and there is a gradual increase in another hormone, progesterone, which reaches a peak around day 22 and returns to base levels at day 28.


Bone stability and structure

Of these three hormones, oestrogen is a key regulator of bone resorption, without oestrogen there would be an excess of bone being broken down over new bone being formed. Bone is in a state of constant turnover, with the help of two types of bone cells (osteoblasts and osteoclasts). Osteoblasts are involved in bone formation, while osteoclasts are involved in bone resorption.

Bone resorption occurs at a much higher rate than formation; bone resorption takes just 30 days whereas the bone remodelling cycle takes 4 months. Therefore, a slight imbalance can lead to a bone fracture very quickly (2).

More is not always better

Elite female athletes, particularly those involved in sports that usually adopt a leaner physique with low body fat, are at a greater risk of disordered eating. The reasons for this disordered eating could be external pressures from teams, coaches and sponsors, or the athletes themselves having the belief that the leaner and lighter they are, the quicker they will be. These pressures may also cause the athlete to push their body to further extremes.


Without the necessary energy intake, the menstrual cycle will most likely become irregular and eventually cease (which is known as amenorrhea). Amenorrhea causes the levels of oestrogen to become reduced, leaving a disproportionate ratio of osteoblasts and osteoclasts, and a higher rate of bone resorption.

This may ultimately lead to bone injuries, (the precursor to osteoporosis), or even osteoporosis at a very young age, making any further career achievements even more difficult.

These three symptoms (disordered eating, amenorrhea and osteoporosis) became more prevalent in the 1990s and were termed ‘The Female Athlete Triad’ in 1997 by the American College of Sports Medicine. It has been estimated that only 50% of trained physicians are knowledgeable about the female athlete triad (3). More recently the triad has been regrouped within a term known as RED-S (Relative energy deficient syndrome); deemed to result from continual disordered eating. Being in a state of energy deficiency for a long duration can disrupt many processes within the body, including the cardiovascular, digestive and hormonal . Redefining the RED-S also allows male athletes who present with similar issues to be included (4).

Current research has looked at the differing effects of the components of the triad on injuries, and bone and muscle health. At Manchester Metropolitan University, we have carried out our own research on some of the UK’s most renowned female endurance runners, investigating the effects of altered menstrual cycle on bone health. Athletes with amenorrhea presented with a greater endocortical circumference (the outer circumference of the inner cortical bone in the tibia (lower leg) and radius (forearm) than controls. Only the athletes with regular menstrual cycles (eumenorrheic) had a greater cortical area, in the tibia and radius, compared to controls. The athletes with amenorrhea had thinner bones (i.e. larger but not denser). We are working to better understand the issues, so accurate diagnosis will become more frequent.

What we really need is education at a young age, as most athletes become familiar with the triad only once they have been diagnosed with a bone injury. If athletes are made aware of the symptoms and issues around the triad before they occur, then nutrition and menstrual cycles can be more closely monitored as they progress through their athletic careers.

Read the full-length version of this article in our magazine, Physiology News.


  1. Barnett, A (2006). Using recovery modalities between training sessions in elite athletes does it help? Sports Med (36), 781-96
  2. Agerbaek, M. O., Eriksen, E. F., Kragstrup, J., Mosekilde, L. and Melsen, F. (1991) A reconstruction of the remodelling cycle in normal human cortical iliac bone. Bone Miner, 12 (2), pp. 101-12.
  3. Curry, E, Logan, C, Ackerman, K, McInnia K, Matzkin, E (2015) Female athlete triad awareness among multispecialty Physicians. Sports Med Open. 1:38.
  4. Tenforde, AS, Parziale, A, Popp, K, Ackerman, K. (2017) Low Bone mineral density in male athletes is associated with bone stress injuries at anatomic sites with greater trabecular composition. Am J Sports Med. DOI: 10.1177/0363546517730584