Understanding mechanoreflex and metaboreflex interactions – a great challenge

The exercise pressor reflex (EPR) plays an essential role in cardiovascular and ventilatory responses to physical activity. Despite immense meaning and increasing validation of the EPR, there is no agreement on the character of interactions between its components and other reflexes in health and disease. The data addressing this issue remain incomplete and incoherent, partially due to various challenges in testing these pathways. The mounting evidence of EPR malfunction contribution to sympathetic over-activation in heart failure and other cardiovascular diseases shows clinical importance of comprehensive understanding of these mechanisms. In this review, we briefly summarize experiments focused on the issue of interactions between mechano-, metabo, chemo-, and baroreflex during exercise. We also address potential reasons of discrepancies in the results, identify gaps in this particular scientific area and propose notional pathways for future research. This article highlights the clinical importance of the EPR deterioration in heart failure pathophysiology and discusses potential therapies focused on restoring the reflex pathways. In addition, consideration is given to the latest sophisticated experiments in this area, underlining the need of changing the paradigm in EPR interactions studying – from teleological to mechanistic approach.