Influence of Sex, Menstrual Cycle, and Menopause Status on the Exercise Pressor Reflex

In this review, we highlight the underlying mechanisms responsible for the sex differences in the exercise pressor reflex, and, importantly, the impact of sex hormones and menopausal status. The exercise pressor reflex is attenuated in pre-menopausal women compared to age-matched men. Specifically, activation of the metaboreflex (a component of the exercise pressor reflex) results in attenuated increases in blood pressure and sympathetic vasomotor outflow compared to age-matched men. In addition, pre-menopausal women exhibit less transduction of sympathetic outflow to the peripheral vasculature than men. In stark contrast, post-menopausal women exhibit an augmented exercise pressor reflex arising from exaggerated metaboreflex-induced autonomic and cardiovascular reflexes. We propose that metaboreflex-induced autonomic and cardiovascular changes associated with menopause majorly contribute to the elevated blood pressure response during dynamic exercise in post-menopausal women. In addition, we discuss the potential mechanisms by which sex hormones in pre-menopausal women may impact the exercise pressor reflex as well as metaboreflex. Corresponding author: Thomas P. Olson, PhD, Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester MN 55901. Email: olson.thomas2@mayo.edu Acknowledgements: This work was supported by the National Institutes of Health [HL126638 to TPO] and American Heart Association [18POST3990251 to JRS]. Conflict of interest: The authors have no conflicts of interest to report for this manuscript. The findings of the present study do not constitute endorsement by the American College of Sports Medicine. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for publication: 17 December 2018. © 2018 American College of Sports Medicine

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