Table of Contents

Basic Anatomy and Physiology

Anatomical Position and Planes of Movement
Skeletal System
Muscular System
Energy System
Nervous System
Cardiovascular System
Respiratory System
Body System Responses to Physical Activity
Conclusion
Heart Rate, Stroke Volume and Blood Pressure Responses to
Aerobic Activity
References
Canadian Society For Exercise Physiology
Physical Activity Training For Health (CSEP-PATH®)
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BASIC ANATOMY AND
PHYSIOLOGY
A solid understanding of anatomy and the
effects of physical activity on the body’s various
systems is essential to prescribing safe and
effective physical activity programs. This section
provides an overview of key principles of
anatomy and physiology that are relevant to
qualified exercise professionals. It is not
intended to be comprehensive, but to provide a
general refresher of subject matter that qualified
exercise professionals are expected to have
studied extensively through other post-
secondary coursework. As much as possible, it
is written in practical terms to provide a usable
script to draw upon when explaining the
rationale and processes involved in program
recommendations for clients.
KEY CONCEPTS
Anatomical position and planes of

movement

Skeletal system

Muscular system

Energy systems

Nervous system

Cardiovascular system

Respiratory system

Body system responses to physical activity

Anatomical Position and Planes of

Movement
The anatomical position is the standard reference position used
to describe the anatomy of the human body. In it, the body is
assumed to be standing upright, with feet together, arms to the
side, with the head, eyes and palms of the hands facing forward.
Human movement is typically described using the planes of
movement, which divide the body into dimensions that pass
through the body (Figure 1.1).

The sagittal plane (or medial plane) divides the body along
the midline of the body into the left and right sides. The
term medial refers to the inner side (toward or at the
midline), while lateral refers to the outer side (away from
the midline).
The frontal plane (or coronal plane) separates the body into
the anterior (front of the body) and posterior (back of the
body) portions.
The transverse plane (or horizontal plane) separates the
body into the superior (toward the head or upper body)
and inferior (away from the head or lower body).

When describing relative positions of the body parts, the terms

proximal or closer to the origin of reference (e.g., the elbow is
proximal to the wrist) and distal or further away from the origin of
reference (e.g., the foot is distal to the knee) are also commonly
used terms (Figure 1.1).

FIGURE 1.1 Anatomical Position

Figure 1.2 provides images to assist with visualizing some of the
following anatomical planes.

FIGURE 1.2 Anatomical Planes

Abduction Adduction External Internal
rotation i

Dorsi Plantar Eversion Inversion

flexion fl i

Arm flexion

Circumd Flexi
Arm
i

Exten

Supination Pronation

Flexion and extension: Decreasing and increasing angle with

the frontal plane.
Abduction and adduction: Moving away from or toward the
sagittal plane.
 Protraction and retraction: Moving forward or backward
along a surface.
Elevation and depression: Raising and lowering something.
Medial and lateral rotation: Movement inwards and
outwards around the midline of the body.
Supination or pronation: Lying face up or face down.

It is common to see movement described as happening in a

particular dominant plane (e.g., walking might be described as
happening in the sagittal plane) (Table 1.1). This is only a gross
approximation, however, as movement at the individual joint
level is most often happening in several planes simultaneously.
During walking or running, for example, the hip will be flexing
and extending in the sagittal plane, abducting and adducting in
the frontal plane, and rotating medially and laterally in the
transverse plane.

TABLE 1.1 Planes and Axis of Movement

PLANE MOTION AXIS EXAMPLES

Sagittal Flexion/extension Frontal Walking,

squatting,
overhead
press

Frontal Abduction/adduction Side Sagittal Jumping

flexion jack Lateral
arm raise

Transverse Internal/external rotation Vertical Throwing

Horizontal Baseball
flexion/extension swing Golf
Supination/pronation swing
Skeletal System
Part of the musculoskeletal system which provides for form,
structure and movement of the body, the skeletal system (Figure
1.3) includes all of the bones and joints in the body that serve as
a framework for tissues and organs, and acts as a protective
structure for vital organs (e.g., the brain is protected by the skull
and the lungs are protected by the rib cage). It also provides
attachment points for muscles to allow movements at the joints.
New blood cells are produced by the red bone marrow inside of
our bones. Bones are complex living organs that act as the body’s
warehouse for calcium, iron, and energy in the form of fat.

FIGURE 1.3Skeletal Structure – Anterior &

Posterior Views (Copyright © 2019, Wolters
Kluwer Health. All rights reserved.) Note: A
full-sized version of this image is included in
the online CSEP-PATH® Toolkit.
Skeletal System Arrangement
The skeletal system in an adult body is made up of 206 individual
bones that are arranged into two major divisions called the axial
and appendicular skeleton. The axial skeleton runs along the
body’s midline axis and is made up of 80 bones in the skull,
hyoid, auditory ossicles, ribs and sternum, vertebral column. The
appendicular skeleton is made up of 126 bones in the upper limbs,
lower limbs, pelvic girdle and shoulder girdle.
Every bone in the body is classified as one of five types (long,
short, flat, irregular, and sesamoid). Long bones are longer than
they are wide and are the major bones of the limbs. They grow
more than the other classes of bone throughout childhood and
so are responsible for the bulk of our height as adults. A hollow
medullary cavity is found in the center of long bones and serves
as a storage area for bone marrow. Examples of long bones
include the femur, tibia, fibula, metatarsals, and phalanges. Short
bones are about as long as they are wide and are often cubed or
round in shape. The carpal bones of the wrist and the tarsal
bones of the foot are examples of short bones. Flat bones vary
greatly in size and shape, but have the common feature of being
very thin in one direction. Because they are thin, flat bones do
not have a medullary cavity like the long bones. The frontal,
parietal, and occipital bones of the cranium, as well as the rib and
hip bones, are all examples of flat bones. Irregular bones have a
shape that does not fit the pattern of the long, short, or flat
bones. The vertebrae, sacrum, and coccyx of the spine are all
irregular bones. The sesamoid bones are formed after birth inside
of tendons that run across joints and grow to protect tendons
from stresses and strains at the joint and can help to give a
mechanical advantage to muscles pulling on the tendon. The
patella and the pisiform bones of the carpals are examples.
Joints
A joint (or articulation) is a point of contact between bones,
between a bone and cartilage, or between a bone and a tooth.
Synovial joints are the most common type of articulation and
feature a small gap between the bones. This gap allows a free
range of motion and space for synovial fluid to lubricate the joint.
Fibrous joints exist where bones are very tightly joined and offer
little to no movement between the bones. Fibrous joints also hold
teeth in their bony sockets. Finally, cartilaginous joints are formed
where bone meets cartilage or where there is a layer of cartilage
between two bones. These joints provide a small amount of
flexibility in the joint due to the gel-like consistency of cartilage.

Muscular System
The muscular system (Figure 1.4) is largely responsible for the
movement of the human body. There are about 700 named
muscles that make up roughly half of a person’s body weight.
Each of these muscles is a discrete organ constructed of muscle
tissue, blood vessels, tendons, and nerves. Muscle tissue is also
found inside the heart, digestive organs, and blood vessels.
The body has three major types of muscles – cardiac, smooth and
skeletal. Cardiac muscles are responsible for contraction of the
heart. Smooth muscles are responsible for many involuntary
bodily functions, including the movement of food through the
digestive system and the enlargement and contraction of blood
vessels. Both cardiac and smooth muscles are involuntary
muscles because they are controlled by the body’s central
nervous system. The skeletal muscles are the muscles that attach
to bones (by tough connective tissue called tendons) and are
voluntarily activated to produce movement.
Skeletal Muscle Classification
Skeletal muscles are named based on many different factors,
including their location, origin and insertion, shape, size,
direction, and function. Some muscles derive their names from
their anatomical location, such as the rectus abdominis and
transverse abdominis as each are located in the abdominal region.
Others are named after the part of the bone to which they are
attached (e.g., the tibialis anterior is attached to the anterior
portion of the tibia). Still others are a hybrid of these two (e.g.,
the brachioradialis is named after its location in the brachial
region and its attachment to the radius bone). Some muscles are
named based on their connection to a stationary bone (origin)
and a moving bone (insertion). Examples include the
sternocleidomastoid (connecting the sternum and clavicle to the
mastoid process of the skull) and the occipitofrontalis (connecting
the occipital bone to the frontal bone). Where muscles connect to
more than one bone or to more than one place on a bone it is
often reflected in the name (e.g., the biceps have two origins,
triceps have three, and quadriceps have four). Muscles can also be
classified by shape. For example, the deltoids have a delta or
triangular shape. The serratus muscles feature a serrated or saw-
like shape. The rhomboid major is a rhombus or diamond shape.
The size of the muscle can be used to distinguish between two
muscles found in the same region. The gluteal region contains
three muscles differentiated by size – the gluteus maximus (large),
gluteus medius (medium) and gluteus minimus (smallest). The
direction in which the muscle fibres run can also be used to
identify a muscle. In the abdominal region, there are several sets
of wide, flat muscles. The muscles whose fibres run straight up
and down are the rectus abdominis, those running transversely
(left to right) are the transverse abdominis, and the ones running
at an angle are the obliques. Finally, muscles can also be classified
by the type of function that they perform. Most of the muscles of
the forearm are named based on their function because they are
located in the same region and have similar shapes and sizes. For
example, the flexor group of the forearm flexes the wrist and the
fingers. The supinator is a muscle that supinates the wrist by
rolling it over to face palm up. The adductors in the legs adduct or
pull the legs together.

Muscular System – Superficial

FIGURE 1.4
Muscles (Copyright © 2019, Wolters Kluwer
Health. All rights reserved.) Note: A full-sized
version of this image is included in the online
CSEP-PATH® Toolkit.
Skeletal Muscle Cellular Composition and Action
Skeletal muscle fibres differ dramatically from other tissues of the
body due to their highly specialized functions. The sarcolemma is
the cell membrane of muscle fibres and acts as a conductor for
the electrochemical signals that stimulate muscle cells.
Connected to the sarcolemma are transverse tubules that help
carry these electrochemical signals into the middle of the muscle
fibre. The sarcoplasmic reticulum serves as a storage facility for
calcium ions (Ca2+) that are vital to muscle contraction.
Mitochondria are considered the ‘power houses’ of the cell as they
produce ATP to fuel muscle contraction. Most of the muscle
fibre’s structure is made up of myofibrils, which are the contractile
structures of the cell, and are made up of many protein fibres
arranged into repeating subunits called sarcomeres (the
functional unit of muscle fibres). Sarcomeres are made of two
types of protein fibres. Thick filaments are made of bonded units
of the protein myosin. Thin filaments are made of three proteins:
actin (which contains myosin-binding sites that allow myosin to
connect to and move actin during muscle contraction);
tropomyosin (which wrap around actin, covering the myosin
binding sites); and troponin (which move tropomyosin away from
myosin binding sites during muscle contraction).
Skeletal muscles contract through a process outlined in the sliding
filament model, where actin filaments interact with myosin
filaments, appearing to ‘slide over’ each other, resulting in a
shortening of the length of the sarcomeres and hence contracting
or shortening of the muscle fibre. As a number of muscle fibres
shorten at the same time, the whole muscle contracts and causes
the tendon to pull on the bone causing movement. For the
muscle to return to normal length, cessation of the
electrochemical signal needs to occur, stopping the activation
and contraction process and allowing the muscle to resume its
natural resting length, or another force must be applied (e.g.,
contraction of the opposing muscle group).
The stimulus to contract is initiated in response to nerve impulses
(e.g., action potentials) transmitted from the brain and spinal
cord of the Central Nervous System along the nerve cells and
fibres that make up the Peripheral Nervous System. Essentially,
an action potential travels along a nervous pathway to a
neuromuscular junction where it triggers the release of a
neurotransmitter that signals the muscle fibres to contract. The
muscle fibres are activated by motor neurons (a motor unit is
made up of a single motor neuron, as well as all of the skeletal
muscle fibres that it activates). A single motor neuron can control
several hundred muscle fibres at a time, depending on the size
and function of the muscle. For example, motor neurons for eye
muscles may control 10–100 fibres, while motor neurons for large
leg muscles may control thousands of muscle fibres.
Groups of motor units often work together to coordinate the
contractions of a single muscle. The number of muscle fibres
recruited regulates the force generated, according to the size
principle of recruitment. For example, when one lifts a lightweight
object, fewer muscle fibres will be recruited. Lifting a heavier
weight will require recruitment of many more muscle fibres.
Skeletal muscles are made of bundles of muscle fibres that are
within a continuum from slow- to fast-twitch and a continuum
from oxidative to glycolytic energy supply. Based on their
contractile (i.e., twitch) and metabolic (i.e., energy supply)
properties and patterns of use, muscle fibres are also
characterized along a continuum of fatigue characteristics. Slow-
twitch oxidative fibres contract more slowly because they express
contractile proteins (i.e., myosin ATPase) with slower kinetics. The
contraction process in these fibres is more efficient and they have
a high level of mitochondria, oxidative enzymes and myoglobin to
supply vast amounts of ATP through aerobic metabolism, and are
therefore resistant to fatigue. This makes them better-suited to
continuous work over time, such as distance running or
maintaining posture. Fast-twitch glycolytic fibres have contractile
proteins that develop more force more quickly. This makes them
better suited to provide substantial contributions to powerful
activities like sprinting and jumping. They have little aerobic
energy supply, make greater use of anaerobic metabolism, and
fatigue more quickly. Intermediate fast twitch oxidative fibres have
fast contraction characteristics, but also a high level of aerobic
and anaerobic energy supply. Hence, they have a greater balance
in their contractile and energy supply characteristics than pure
fast-twitch fibres and therefore have an intermediate fatigue
profile.
Skeletal muscles contain a genetically determined mixture of
both slow and fast fibre types and the ratio may influence the
kind of activities an individual will excel at. For example, an
individual with a high percentage of fast twitch fibres may excel at
sprinting whereas those with predominantly more slow twitch
fibres may prefer endurance activities. The pattern of training can
further influence the metabolic characteristics of these fibres.
Skeletal Muscle Biomechanics
Skeletal muscles work as a biomechanical system in which the
bones and joints form levers and the muscle acts as the effort
force. The joint acts as the fulcrum and the bone that the muscle
moves acts as the lever. The object being moved acts as the load.
There are three classes of levers, but the vast majority of the
levers in the body are third class levers in which the fulcrum is at
the end of the lever and the effort is between the fulcrum and
the load at the other end of the lever. Skeletal muscles are
arranged in antagonistic pairs (or opposing muscle groups)
around joints (where two or more bones meet and are held
together by ligaments). To move the bone, the agonist muscles –
which include prime movers and synergists (or helpers) – will
contract and generate the force required for the movement. As
the prime and synergist muscles generate the movement, the
antagonist muscles relax or lengthen. Joint stabilizers are muscles
that prevent unwanted movement at the joints (e.g., rotator cuff
at the shoulder or piriformis muscle at the hip). There are also
global stabilizers that stabilize the trunk (or ‘core’) to create a
more solid foundation for movement.
Energy System
Energy is required to fuel the working muscles during physical
activity. To release energy, a cellular respiration process
metabolizes nutrients (i.e., protein, carbohydrate and fat from
food intake) to yield high-energy molecules called adenosine
triphosphate (ATP), which are then available in muscle cells to
provide an immediate source of energy for muscle action. The
storage capacity is limited to a few seconds of energy supply
however. As ATP is a very reactive molecule, it is maintained in
very low concentration in tissues, and requires a very responsive
system of energy support to re-supply once it is used. During
activity, the body manufactures ATP through three primary
pathways depending on the rate of energy supply needed and
how much oxygen is available to the muscles. Although one of
the three energy systems will be the dominant source of energy
during particular types of physical activity, all of the exercise
energy systems are active at all times. It is simply the relative
amount of energy that each system is providing that will change
with activities of varying intensity levels and duration.
The Anaerobic Alactic Energy System (high energy phosphate
system) is the dominant source of energy for the high rate of
energy supply that is typically required at the onset of any
movement. It can provide energy immediately, it does not require
any oxygen (i.e., is ‘anaerobic’), and it does not directly produce
lactic acid (i.e., is ‘alactic’). This system provides ATP energy
through a combination of ATP already stored in the muscles and
by converting phosphocreatine (PCr) into usable ATP. The PCr
substrate is also used as an energy capacitor or shuttle for
energy from other sources (e.g., aerobic respiration) when oxygen
becomes available from the mitochondria in the muscle (Table
1.2).
 TABLE 1.2 Energy System Characteristics
TIME
ENERGY FRAME BY- ACTIVITY
SYSTEM FUELS (Seconds) PRODUCTS EXAMPLES

Anaerobic ATP 0–15 ADP 100m sprint

(Alactic) CP Cr + Pi Jumping,
agility,
(creatine +
weight
inorganic
lifting
phosphate)

Anaerobic CHO 15–120 Lactic Acid 200m

(Lactic) incomplete 2 ATP / mol (power)
breakdown CHO 800m
(endurance)
Resistance
training

Aerobic CHO 120 – CO2 Distance

FATS several Water running
hours 1500m
(PROTEIN Heat
(power)
<5%) 36 ATP / Marathon
complete mol CHO (endurance
breakdown (net) or capacity)

The Anaerobic Lactic Energy System is the dominant source of

muscle energy for high intensity physical activity that lasts longer
than about 10 seconds. Essentially, this system is dominant when
the alactic anaerobic energy system is not sufficient to provide all
of the energy required when the body continues to work at an
intensity that is too demanding for the aerobic energy system to
handle. This system uses glycolysis, which primarily converts
glucose (from carbohydrates) into usable ATP. Lactic acid is
produced as a side reaction to keep energy supply going when
the mitochondria cannot keep pace with the high rate of energy
supply needed. Lactate accumulates (along with other fatigue by-
products hydrogen (H+), adenosine diphosphate (ADP), and
inorganic phosphate (Pi), carbon dioxide and water) when the
intensity of effort is above the lactate threshold (i.e., greater than
about 70% mVO2), and increases exponentially with more intense
efforts. The accumulations of many metabolic by-products
combine to inhibit muscle performance. Because of its ability to
supply ATP at a high rate, anaerobic metabolism is used in
powerful bursts of energy such as sprinting and weight training,
but the consequence is fatigue. The anaerobic system is used
extensively in sports and is quite adaptive to an appropriate
training stimulus (Table 1.2).
The Aerobic Energy System is active during all physical activity, but
provides proportionally the most energy during lower intensity
physical activity of longer duration (i.e., over two minutes); when
inertia in the oxygen supply chain can be overcome to meet the
demand in the working muscle. In this case, a continuous supply
of oxygen allows the body to directly recruit the active cellular
respiration process to convert food energy (e.g., carbohydrates,
fats, protein) into usable ATP. If the delivery of oxygen to the
working muscles is adequate, no lactic acid is produced. The only
by-products are carbon dioxide and water, which the body
disposes of through breathing and sweating (Table 1.2).
At the initial onset of prolonged aerobic activity, oxygen
consumption may not yet be sufficient to fully support the
activity. This lag is referred to as oxygen deficit and it continues
until the body reaches a steady state. Oxygen uptake also
remains elevated for several minutes during recovery from
activity. Traditionally termed oxygen debt, this has more recently
been referred to as elevated post-exercise oxygen consumption
(EPOC). Post-exercise metabolism is higher after high-intensity
activity than moderate- or light-intensity effort, and remains
elevated longer after prolonged versus short-term exertion. This
is because of the greater energy needed to restore ionic balance
in the muscles, redistribute blood flow, restore substrate and
nutrients, and begin the recovery process that may be more
pronounced after higher-intensity activity.
Carbohydrates and fats are the primary fuels for aerobic activity.
Carbohydrates are the primary source at the onset of exercise
and during high intensity work. During prolonged exercise there
is a shift in reliance on distal (to the muscle) fuel sources so that
plasma-derived free fatty acids (FFAs) and glucose are
preferentially used over muscle glycogen and intramuscular
triglycerides to sustain the exercise. As aerobic activity is more
prolonged (i.e., > 30 minutes), there is continuous and a gradual
reliance on fat as a fuel source. In only the more severe states of
energy reliance (i.e., severe calorie restriction or at the end of a
prolonged endurance event like a marathon), protein is oxidized
to supply energy for the working muscle.

Nervous System
The nervous system (Figure 1.5) consists of the brain, spinal cord,
sensory organs, and all of the nerves that connect these organs
with the rest of the body. Together, these organs are responsible
for the control of the body and communication among its parts.

Anatomy of the Nervous System

FIGURE 1.5
(Copyright © 2019, Wolters Kluwer Health. All
rights reserved.) Note: A full-sized version of
this image is included in the online CSEP-
PATH® Toolkit.
Central Nervous System
The brain and spinal cord together form the central nervous
system (CNS), where information is processed and responses
originate.
The brain is located inside the cranial cavity, where the bones of
the skull surround and protect it. The approximately 100 billion
neurons of the brain form the main control center of the body.
The brain is the seat of higher mental functions such as
consciousness, memory, planning, and voluntary actions. It also
controls lower body functions such as the maintenance of
respiration, heart rate, blood pressure, and digestion.
The spinal cord is a long, thin mass of bundled neurons that
carries information through the vertebral cavity of the spine
beginning at the medulla oblongata of the brain on its superior
end and continuing downwards to the lumbar region of the
spine. In the lumbar region, the spinal cord separates into a
bundle of individual nerves called the cauda equina (due to its
resemblance to a horse’s tail) that continues downward to the
sacrum and coccyx. The white matter of the brain and spinal cord
functions as the main conduit of nerve signals to the body from
the brain. The grey matter of the brain and spinal cord integrates
responses to stimuli.
Peripheral Nervous System
The peripheral nervous system (PNS) consists of the nerves and
collection of nerve bodies (i.e., ganglia) outside of the brain and
spinal cord. Its main function is to connect the CNS to the limbs
and organs. Unlike the CNS, the PNS is not protected by the
bones of the skull and spine. The PNS is divided into the somatic
nervous system (SNS) and the autonomic nervous system (ANS).
The SNS is the only consciously controlled part of the PNS and is
responsible for stimulating skeletal muscles in the body. The ANS
controls subconscious effectors such as visceral muscle tissue,
cardiac muscle tissue, and glandular tissue. The sympathetic
division of the ANS forms the body’s “fight or flight” response to
stress, danger, excitement, exercise, emotions, and
embarrassment. It increases respiration and heart rate, releases
adrenaline and other stress hormones, and decreases digestion
to cope with these situations. The parasympathetic division of the
ANS forms the body’s “rest and digest” response when the body
is relaxed, resting, or feeding. It works to undo the work of the
sympathetic division after a stressful situation. Among other
functions, the parasympathetic division works to decrease
respiration and heart rate, increase digestion, and permit the
elimination of wastes. The enteric nervous system (ENS) is the
division of the ANS that is responsible for regulating digestion
and the function of the digestive organs.
Nerves are bundles of axons in the PNS that act as information
highways to carry signals between the brain and spinal cord and
the rest of the body. Neurons that carry information one-way
from sensory receptors to the central nervous system are called
afferent neurons. Efferent neurons carry signals one-way from the
central nervous system to effectors such as muscles and glands.
Mixed nerves (which contain both afferent and efferent axons)
function like 2-way streets. Extending from the inferior side of the
brain are 12 pairs of cranial nerves, each of which is identified by a
Roman Numeral (I to XII) based upon its location along the
anterior-posterior axis of the brain. Each nerve also has a
descriptive name (e.g., olfactory, optic) that identifies its function
or location. The cranial nerves provide a direct connection to the
brain for the special sense organs, muscles of the head, neck, and
shoulders, the heart and the gastrointestinal tract. Extending
from the left and right sides of the spinal cord are 31 pairs of
spinal nerves, which carry both sensory and motor signals
between the spinal cord and specific regions of the body. The 31
spinal nerves are split into groups named for the five regions of
the vertebral column: eight pairs of cervical nerves, 12 pairs of
thoracic nerves, five pairs of lumbar nerves, five pairs of sacral
nerves and one pair of coccygeal nerves. Each spinal nerve exits
from the spinal cord through the intervertebral foramen between
a pair of vertebrae or between the C1 vertebra and the occipital
bone of the skull.
All of the body’s sense organs are components of the nervous
system. Vision, taste, smell, hearing, and balance are all detected
by specialized organs such as the eyes, taste buds, and olfactory
epithelium. Sensory receptors for the general senses like touch,
temperature, and pain are found throughout most of the body.
All of the sensory receptors of the body are connected to afferent
neurons that carry their sensory information to the CNS to be
processed and integrated.

Cardiovascular System
The cardiovascular system includes the heart and the circulatory
network of blood vessels that includes arteries, veins and
capillaries. Its function is to deliver oxygen and nutrients to the
organs of the body. Given muscle is the primary organ
responsible for moving the body, the cardiovascular system has
an important role to play in supplying oxygen and nutrients to
the muscle during physical activity and exercise.
The heart (Figure 1.6) is a four-chambered muscular pump and is
responsible for pumping blood around the body. It consists of
two collecting chambers (the right and left atria) and two
pumping chambers (the right and left ventricles). The heart also
includes four valves that keep the blood moving in the right
direction (i.e., preventing backflow). The atrioventricular (AV)
valves separate the atria from the ventricles and the semilunar
valves separate the ventricles from the aorta and pulmonary
artery.
The right side of the heart receives de-oxygenated blood from the
periphery (right atria) and pumps it to the lungs (right ventricle).
This is called the pulmonary circuit. The blood is oxygenated in the
lungs and carried back to the left atrium via the pulmonary vein.
The blood then moves into the left ventricle where it is pumped
into the aorta and carried throughout the body. This is called the
systemic circuit.
When the blood flows from the heart it enters the vascular system,
a vast system of blood vessels that carry oxygen and nutrients to
the tissues of the body (e.g., digestive system, liver, kidneys,
muscles, skin). Starting with the aorta, the blood vessels that
carry blood away from the heart are arteries. Arteries continue to
subdivide until they reach their smallest size (called arterioles)
and then lead into the tiniest blood vessels (called capillaries).
Capillaries have very thin walls across which oxygen and carbon
dioxide, nutrients, minerals, vitamins and hormones easily
diffuse to and from the tissues.
The blood vessels that bring blood back to the heart are veins.
The smallest veins (called venules) collect deoxygenated blood
from the capillaries and transport it along the veins leading back
to the heart.

Anatomy of the Heart (Copyright ©

FIGURE 1.6
2019, Wolters Kluwer Health. All rights
reserved.)
Respiratory System
The respiratory system consists of the nose, nasal cavity, pharynx,
larynx, trachea, bronchial tree, and the lungs. Its primary function
is to filter air that enters the body and allow for oxygen-carbon
dioxide gas exchange in the alveolar sacs in the lungs.
Air is sucked into the lungs (Figure 1.7) through the process of
inhalation in which the diaphragm and intercostal muscles
contract, pushing the rib cage out and up to draw air into the
lungs. In exhalation, the diaphragm and intercostal muscles relax
to pull the rib cage in and down and forcing air out of the lungs.
Upon inhalation, air enters the lungs through the bronchi, which
divide into the secondary bronchi (two in the left and three in the
right), and continue to sub-divide into the tertiary bronchi,
bronchioles, terminal bronchioles and finally into small air filled
sacs called alveoli. Each alveoli is covered by capillaries through
which oxygen passes from the alveoli into the bloodstream to be
returned to the heart and pumped throughout the body. It is here
also that carbon dioxide passes from the bloodstream into the
alveoli where it is eliminated by the lungs through exhalation.

Anatomy of the Lungs (Copyright ©

FIGURE 1.7
2019, Wolters Kluwer Health. All rights
reserved.)
Body System Responses to Physical Activity
The nervous, cardiovascular, respiratory, energy, and
musculoskeletal systems all work closely together to get the body
moving, to provide the oxygen and nutrients required for such
movement and to remove metabolic waste (i.e., carbon dioxide,
heat and waste products such as lactic acid) that are produced as
a result of the movement.
Aerobic Responses
When an individual engages in aerobic activity, a number of
short-term physiological adaptations occur. The heart gets
messages from the body that tell it when to pump more or less
blood to meet the body’s needs. When the body is at rest (e.g.,
sitting), breathing slows and the heart pumps more slowly to
provide for the lower amounts of oxygen needed. During physical
activity, the body’s oxygen demand and production of waste
products increases and the heart responds by increasing its
cardiac output (the volume of blood ejected from the heart per
minute). Cardiac output will typically increase from 5.0 L · min–1 at
rest to about 20–30 L · min–1 during more intense physical activity.
Blood flow to the working muscles increases and a larger fraction
of the available oxygen is extracted from the circulating blood. If
the increase in flow and enhanced oxygen extraction match the
demands of the effort, the activity remains aerobic. The activity is
anaerobic when oxygen delivery is inadequate and lactic acid
accumulates in the blood and working muscles.
Over a period of time, an individual’s engagement in regular
physical activity will produce a number of important longer-term
physiological adaptations (Table 1.3). With regular aerobic
physical activity, for example, the cardiovascular and respiratory
systems will become more efficient at delivering oxygen to
working muscles. More red blood cells will be produced to carry
more oxygen in the blood. Arteries will widen and become more
elastic, reducing blood pressure. The heart will grow stronger so
it can pump more blood with each beat. The resting heart rate
may decrease. Post-activity heart rate recovery times will drop.
More capillaries will grow within the muscles so they can more
efficiently extract oxygen. More capillaries also grow around the
alveoli in the lungs, increasing the efficiency of the exchange of
oxygen and carbon dioxide. The diaphragm and intercostal
muscles may become stronger and better able to move the chest
cavity for breathing. Regular engagement in weight bearing
aerobic activities (e.g., walking or jogging) can help make the
muscles, tendons, ligaments and bones stronger and more
resistant to injury and age-related decline.

Physiological Adaptations to
TABLE 1.3
Physical Activity Training
PHYSIOLOGICAL ADAPTATION
RAISES LOWERS

Aerobic
Training cardiac output peripheral
blood volume resistance
hematocrit
heart volume
blood flow to lungs
size/number of
mitochondria
mitochondral
enzymatic activity
capillarization ADAPTATION
PHYSIOLOGICAL
f d
 in fat oxidation
enzyme activity
blood
supply/vascularization
to heart muscle
stroke volume
left ventricular
volume
ventricular wall
thickness

Resistance
Training muscle strength % body fat
muscle power low back pain
balance and sarcopenia and
coordination osteoporosis
basal metabolic rate insulin
lean tissue mass concentration/
response to
muscle endurance
glucose challenge
motor performance
insulin sensitivity

Source: Adapted from the ACSM Resource Manual for Guidelines for Exercise Testing
and Prescription, 6th.

Resistance Training Responses

Resistance training improves musculoskeletal fitness by
increasing strength and muscular endurance. Along with
adaptations to skeletal muscles and bone, neural adaptations
also contribute significantly to strength gains (particularly at the
outset) by increasing the recruitment and activation of motor
units, and by decreasing co-contraction of antagonistic muscle
groups (Sale, 1988).
Changes in force production can occur rapidly during the initial 2–
6 weeks of resistance training, with no changes in muscle size. If
untrained, the brain may activate required motor units at slightly
different times, causing inefficient movement. Resistance training
aids coordination of motor unit recruitment (i.e., the ability to
activate needed motor units at the exact time) for maximal
strength production and movement efficiency. Coordinated
motor unit activation works much like rowers rowing a boat in
sync versus the rowers rowing at different times.
Over time, resistance training can also lengthen the time a motor
unit can stay activated, delivering improvements in muscular
endurance (e.g., the ability to perform a greater number of push-
ups or pull-ups in succession) (Table 1.3). After 4–6 weeks of
resistance training, increases in muscle size (called muscle
hypertrophy) contribute more to strength gains than neural
adaptation. Hypertrophy results from an increase in total amount
of contractile protein, number and size of myofibrils per fibre,
and the amount of connective tissue surrounding the muscle
fibres (Goldberg et al., 1975). Since long-term resistance training
can yield continued strength increases without hypertrophy, a
secondary phase of neural adaptation is likely responsible for
strength gains occurring during 6–12 months of training
(Deschenes and Kraemer 2002). Evidence also suggests that
resistance training induced hypertrophy is an important
mechanism underlying strength gains in older women and men.
This implies that older adults can effectively counter age-related
loss of muscle mass (or sarcopenia) with resistance training.
Resistance training also has beneficial effects on bone health that
may decrease risk of osteoporosis and bone fractures,
particularly in women. Improvements in bone mineral density
appear to be site-specific (i.e., greater changes occur in bones to
which the exercising muscles attach). Resistance training also
improves the size and strength of ligaments and tendons
(Edgerton, 1973; Fleck et al., 1986; Tipton et al., 1975), which may
increase joint stability, thereby reducing risk of sprains and
dislocations. As muscles grow stronger, the ratio of lean body
mass to fat can also improve, further reducing strain on muscles,
bones and joints. Furthermore, regular flexibility training (i.e.,
stretching) can increase flexibility and limit the tendency of the
ligaments and tendons to shorten and restrict movement as a
person ages. It can also help in preventing injuries, improving
posture, reducing lower back pain, and improve balance during
movement.

Heart Rate, Stroke Volume and Blood

Pressure Responses to Aerobic Activity
Heart Rate (HR) is the number of heart beats per minute (bpm).
An average normal resting HR is about 60–80 bpm, although it
varies by gender (higher for women), age (lower with age) and
aerobic fitness level (lower for more fit individuals). When the
HR increases in response to physical activity, the magnitude of
the response will also vary by the person’s age, health status,
fitness level, type of activity, intensity of activity and external
conditions such as temperature.
Stroke volume (SV) refers to the volume of blood that is
pumped by the heart with each contraction. During physical
activity, the muscles require more oxygen and the stroke
volume increases until the intensity reaches about 50% of
maximal oxygen uptake (VO2max). After that, the heart rate will
increase to produce the cardiac output required to meet the
required oxygen demand. After a period of regular physical
activity training, an individual’s stroke volume is likely to be
higher and resting heart rate lower.
Blood Pressure (BP) refers to the pressure that the blood exerts
on the walls of the blood vessels and reflects the efficiency of
blood flow through the cardiovascular system. The lowest
pressure (just before the heart contracts) is the diastolic
 pressure (just before the heart contracts) is the diastolic
pressure and the highest pressure (just after the heart
contracts) is the systolic pressure. An average healthy adult
would have a resting BP of 120 mm Hg (systolic) over 80 mm Hg
(diastolic), i.e., the typical blood pressure one would see in an
inactive, but otherwise healthy adult. Normal blood pressure
readings for an active, healthy adult would typically read
110/70. During physical activity, the systolic blood pressure
increases from its normal resting value as the body attempts to
force blood through the vigorously contracting muscles. In
contrast, the diastolic pressure shows little change during
aerobic physical activity but may elevate in resistance activity.
Increases in blood pressure during any type of activity are
greater if resting values are already high, and in such
circumstances, may reach dangerous levels.

Conclusion
Our bodies were built to move, meaning that these positive
physiological processes are a means for humans to be active
(historically to seek food) and stay healthy. Because maintaining
physiological adaptations is a metabolically expensive situation
for most tissues and especially muscle, an absence of physical
activity or prolonged periods of sedentary behaviour reverse the
positive processes and typically result in decline or decrease in
adaptations or system function (i.e., a simple matching of supply
and demand). In this context, sedentary behaviours reduce
health and fitness, light and moderate activities maintain regular
physiological function, and moderate- to vigorous-physical
activities typically build fitness and health. This is why a range of
physical activities is most beneficial for optimal health.
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Wolters Kluwer. (2019). Anatomy Reference Charts. Permission
obtained - All rights reserved.