Central nervous system fatigue, or central fatigue, is a form of

fatigue Fatigue is a state of tiredness (which is not sleepiness), exhaustion or loss of energy. It is a signs and symptoms, symptom of any of various diseases; it is not a disease in itself. Fatigue (in the medical sense) is sometimes associated wit ...

that is associated with changes in the synaptic concentration of

neurotransmitter A neurotransmitter is a signaling molecule secreted by a neuron to affect another cell across a Chemical synapse, synapse. The cell receiving the signal, or target cell, may be another neuron, but could also be a gland or muscle cell. Neurotra ...

s within the

central nervous system The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...

(CNS; including the

brain The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...

and

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the lower brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal c ...

) which affects exercise performance and muscle function and cannot be explained by peripheral factors that affect muscle function. In healthy individuals, central fatigue can occur from prolonged

exercise Exercise or workout is physical activity that enhances or maintains fitness and overall health. It is performed for various reasons, including weight loss or maintenance, to aid growth and improve strength, develop muscles and the cardio ...

and is associated with neurochemical changes in the brain, involving (but not limited to)

serotonin Serotonin (), also known as 5-hydroxytryptamine (5-HT), is a monoamine neurotransmitter with a wide range of functions in both the central nervous system (CNS) and also peripheral tissues. It is involved in mood, cognition, reward, learning, ...

(5-HT),

noradrenaline Norepinephrine (NE), also called noradrenaline (NA) or noradrenalin, is an organic chemical in the catecholamine family that functions in the brain and body as a hormone, neurotransmitter and neuromodulator. The name "noradrenaline" (from ...

, and

dopamine Dopamine (DA, a contraction of 3,4-dihydroxyphenethylamine) is a neuromodulatory molecule that plays several important roles in cells. It is an organic chemical of the catecholamine and phenethylamine families. It is an amine synthesized ...

. The roles of dopamine, noradrenaline, and serotonin in CNS fatigue are unclear, as pharmacological manipulation of these systems has yielded mixed results. Central fatigue plays an important role in endurance sports and also highlights the importance of proper nutrition in endurance athletes.

Neurochemical mechanisms

Existing experimental methods have provided enough evidence to suggest that variations in synaptic

, and

are significant drivers of

fatigue. An increased synaptic dopamine concentration in the CNS is strongly

ergogenic Performance-enhancing substances (PESs), also known as performance-enhancing drugs (PEDs), are substances that are used to improve any form of activity performance in humans. Many substances, such as anabolic steroids, can be used to improve at ...

(promotes exercise performance). Paradoxically, however, direct dopamine agonists such as

bromocriptine Bromocriptine, originally marketed as Parlodel and subsequently under many brand names, is an ergoline derivative and dopamine agonist that is used in the treatment of pituitary tumors, Parkinson's disease, hyperprolactinaemia, neuroleptic malig ...

and pramipexole have caused opposite, pro-fatigue effects in healthy humans.

Noradrenaline

Manipulation of norepinephrine suggests it may actually play a role in creating a feeling of fatigue. Reboxetine, an NRI, decreased time to fatigue and increased subjective feelings of fatigue. This may be explained by a paradoxical decrease in adrenergic activity led by feedback mechanisms.

Serotonin

In the brain, serotonin is a

and regulates

arousal Arousal is the physiology, physiological and psychology, psychological state of being awoken or of Five senses, sense organs stimulated to a point of perception. It involves activation of the ascending reticular activating system (ARAS) in the hu ...

behavior Behavior (American English) or behaviour (British English) is the range of actions of Individual, individuals, organisms, systems or Artificial intelligence, artificial entities in some environment. These systems can include other systems or or ...

sleep Sleep is a state of reduced mental and physical activity in which consciousness is altered and certain Sensory nervous system, sensory activity is inhibited. During sleep, there is a marked decrease in muscle activity and interactions with th ...

, and mood, among other things.Young, S. N. The clinical psychopharmacology of tryptophan. In: Nutrition and the Brain. Vol. 7, R. J. Wurtman and J. J. Wurtman, (Eds.). New York: Raven, 1986, pp. 49–88 During prolonged exercise where central nervous system fatigue is present, serotonin levels in the brain are higher than normal physiological conditions; these higher levels can increase perceptions of effort and peripheral muscle fatigue. The increased synthesis of brain serotonin occurs because of a higher proportion of

tryptophan Tryptophan (symbol Trp or W) is an α-amino acid that is used in the biosynthesis of proteins. Tryptophan contains an α-amino group, an α-carboxylic acid group, and a side chain indole, making it a polar molecule with a non-polar aromat ...

, the serotonin precursor, in the blood and which results in larger amounts of tryptophan crossing the blood–brain barrier. An important factor of serotonin synthesis is the transport mechanism of tryptophan across the

blood–brain barrier The blood–brain barrier (BBB) is a highly selective semipermeable membrane, semipermeable border of endothelium, endothelial cells that regulates the transfer of solutes and chemicals between the circulatory system and the central nervous system ...

. The transport mechanism for tryptophan is shared with the branched chain amino acids (BCAAs),

leucine Leucine (symbol Leu or L) is an essential amino acid that is used in the biosynthesis of proteins. Leucine is an α-amino acid, meaning it contains an α-amino group (which is in the protonated −NH3+ form under biological conditions), an α-Car ...

isoleucine Isoleucine (symbol Ile or I) is an α-amino acid that is used in the biosynthesis of proteins. It contains an α-amino group (which is in the protonated −NH form under biological conditions), an α-carboxylic acid group (which is in the depro ...

, and

valine Valine (symbol Val or V) is an α-amino acid that is used in the biosynthesis of proteins. It contains an α- amino group (which is in the protonated −NH3+ form under biological conditions), an α- carboxylic acid group (which is in the deproton ...

. During extended exercise, BCAAs are consumed for skeletal muscle contraction, allowing for greater transport of tryptophan across the blood–brain barrier. None of the components of the serotonin synthesis reaction are saturated under normal physiological conditions, allowing for the increased production of the neurotransmitter. However the failure of BCAAs to decrease time to fatigue consistently limit this hypothesis. This may be due to a counter-acting mechanism: BCAAs also limit the uptake of

tyrosine -Tyrosine or tyrosine (symbol Tyr or Y) or 4-hydroxyphenylalanine is one of the 20 standard amino acids that are used by cells to synthesize proteins. It is a conditionally essential amino acid with a polar side group. The word "tyrosine" is ...

, another aromatic amino acid, like tryptophan. Tyrosine is a precursor to

catecholamine A catecholamine (; abbreviated CA), most typically a 3,4-dihydroxyphenethylamine, is a monoamine neurotransmitter, an organic compound that has a catechol (benzene with two hydroxyl side groups next to each other) and a side-chain amine. Cate ...

, which enhances performance drive.

Dopamine

Dopamine is a neurotransmitter that regulates arousal,

motivation Motivation is an mental state, internal state that propels individuals to engage in goal-directed behavior. It is often understood as a force that explains why people or animals initiate, continue, or terminate a certain behavior at a particul ...

, muscular coordination, and endurance performance, among other things. Dopamine levels have been found to be lower after prolonged exercise. A decrease in dopamine can decrease athletic performance as well as mental motivation. Dopamine itself cannot cross the blood brain barrier and must be synthesized within the brain. In rats bred for running, increased activity of the

ventral tegmental area The ventral tegmental area (VTA) (tegmentum is Latin for ''covering''), also known as the ventral tegmental area of Tsai, or simply ventral tegmentum, is a group of neurons located close to the midline on the floor of the midbrain. The VTA is th ...

have been observed, and VTA activity correlates with voluntary wheel running. As the VTA is an area dense in dopaminergic neurons that project to many areas of the brain, this suggests that dopaminergic neurotransmission drives physical performance. Further supporting this theory is the fact that dopamine reuptake inhibitors as well as norepinephrine dopamine reuptake inhibitors are able to increase exercise performance, especially in the heat.

Acetylcholine

Acetylcholine Acetylcholine (ACh) is an organic compound that functions in the brain and body of many types of animals (including humans) as a neurotransmitter. Its name is derived from its chemical structure: it is an ester of acetic acid and choline. Par ...

is required for the generation of muscular force. In the central nervous system, acetylcholine modulates arousal and temperature regulation. It also may play a role in central fatigue. During exercise, levels of acetylcholine drop.Conlay, L. A., Sabournjian, L. A., and Wurtman, R. J. Exercise and neuromodulators: choline and acetylcholine in marathon runners.Int. J. Sports Med. 13(Suppl. 1):S141-142, 1992 This is due to a decrease in plasma choline levels. However, there have been conflicting results in studies about the effect of acetylcholine on fatigue. One study found that plasma choline levels had dropped 40% after the subjects ran the Boston Marathon. Another study found that choline supplementation did not improve time to exhaustion. This study also found that plasma choline levels had not changed in either the placebo or the choline supplemented groups. More research is needed to investigate acetylcholine's effects on fatigue.

Cytokines

Cytokines can manipulate neurotransmissions creating sickness behavior, characterized by malaise and fatigue. In animal models, IL-1b stimulates serotonin release and increases activity of GABA.

Lipopolysaccharide Lipopolysaccharide (LPS), now more commonly known as endotoxin, is a collective term for components of the outermost membrane of the cell envelope of gram-negative bacteria, such as '' E. coli'' and ''Salmonella'' with a common structural archit ...

challenges also inhibit activity of histaminergic and dopaminergic neurons.

Ammonia

Increased circulating levels of ammonia may alter brain function and result in fatigue. One hypothesized reason that BCAAs fail to increase exercise performance is due to increased oxidation of BCAAs in supplementation that results in increased fatigue, canceling out the effects on serotonin receptors.

Manipulation

Controlling central nervous system fatigue can help scientists develop a deeper understanding of

as a whole. Numerous approaches have been taken to manipulate neurochemical levels and behavior. In sports, nutrition plays a large role in athletic performance. In addition to fuel, many athletes consume

performance-enhancing drugs Performance-enhancing substances (PESs), also known as performance-enhancing drugs (PEDs), are substances that are used to improve any form of activity performance in humans. Many substances, such as anabolic steroids, can be used to improve at ...

including stimulants in order to boost their abilities.

Dopamine reuptake and release agents

Amphetamine Amphetamine (contracted from Alpha and beta carbon, alpha-methylphenethylamine, methylphenethylamine) is a central nervous system (CNS) stimulant that is used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy, an ...

is a stimulant that has been found to improve both physical and cognitive performance. Amphetamine blocks the reuptake of dopamine and norepinephrine, which delays the onset of fatigue by increasing the amount of dopamine, despite the concurrent increase in norepinephrine, in the central nervous system. Amphetamine is a widely used substance among collegiate athletes for its performance enhancing qualities, as it can improve muscle strength, reaction time, acceleration,

anaerobic exercise Anaerobic exercise is a type of exercise that breaks down glucose in the body without using oxygen; ''anaerobic'' means "without oxygen". This type of exercise leads to a buildup of lactic acid. In practical terms, this means that anaerobic exe ...

performance, power output at fixed levels of perceived exertion, and

endurance Endurance (also related to sufferance, forbearance, resilience, constitution, fortitude, persistence, tenacity, steadfastness, perseverance, stamina, and hardiness) is the ability of an organism to exert itself and remain active for a ...

. Methylphenidate has also been shown to increase exercise performance in time to fatigue and time trial studies.

Caffeine

Caffeine Caffeine is a central nervous system (CNS) stimulant of the methylxanthine chemical classification, class and is the most commonly consumed Psychoactive drug, psychoactive substance globally. It is mainly used for its eugeroic (wakefulness pr ...

is the most widely consumed stimulant in North America. Caffeine causes the release of epinephrine from the adrenal medulla. In small doses, caffeine can improve endurance. It has also been shown to delay the onset of fatigue in exercise. The most probable mechanism for the delay of fatigue is through the obstruction of

adenosine Adenosine (symbol A) is an organic compound that occurs widely in nature in the form of diverse derivatives. The molecule consists of an adenine attached to a ribose via a β-N9- glycosidic bond. Adenosine is one of the four nucleoside build ...

receptors in the central nervous system. Adenosine is a neurotransmitter that decreases arousal and increases sleepiness. By preventing adenosine from acting, caffeine removes a factor that promotes rest, and delays fatigue.

Carbohydrates

Carbohydrates A carbohydrate () is a biomolecule composed of carbon (C), hydrogen (H), and oxygen (O) atoms. The typical hydrogen-to-oxygen atomic ratio is 2:1, analogous to that of water, and is represented by the empirical formula (where ''m'' and ''n'' ma ...

are the main source of energy in organisms for

metabolism Metabolism (, from ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cellular processes; the co ...

. They are an important source of fuel in exercise. A study conducted by the Institute of Food, Nutrition, and Human Health at Massey University investigated the effect of consuming a

carbohydrate A carbohydrate () is a biomolecule composed of carbon (C), hydrogen (H), and oxygen (O) atoms. The typical hydrogen-to-oxygen atomic ratio is 2:1, analogous to that of water, and is represented by the empirical formula (where ''m'' and ''n'' ...

and

electrolyte An electrolyte is a substance that conducts electricity through the movement of ions, but not through the movement of electrons. This includes most soluble Salt (chemistry), salts, acids, and Base (chemistry), bases, dissolved in a polar solven ...

solution on muscle

glycogen Glycogen is a multibranched polysaccharide of glucose that serves as a form of energy storage in animals, fungi, and bacteria. It is the main storage form of glucose in the human body. Glycogen functions as one of three regularly used forms ...

use and running capacity on subjects that were on a high carbohydrate diet. The group that consumed the carbohydrate and electrolyte solution before and during exercise experienced greater endurance capacity. This could not be explained by the varying levels of muscle glycogen; however, higher

plasma glucose The blood sugar level, blood sugar concentration, blood glucose level, or glycemia is the measure of glucose concentrated in the blood. The body tightly regulates blood glucose levels as a part of metabolic homeostasis. For a 70 kg (15 ...

concentration may have led to this result. Dr. Stephen Bailey posits that the central nervous system can sense the influx of carbohydrates and reduces the perceived effort of the exercise, allowing for greater endurance capacity.

Branched-chain amino acids

Several studies have attempted to decrease the synthesis of serotonin by administering

branched-chain amino acid A branched-chain amino acid (BCAA) is an amino acid having an aliphatic substituent, side-chain with a branch (a central carbon atom bound to three or more carbon atoms). Among the proteinogenic amino acids, there are three BCAAs: leucine, isoleu ...

s and inhibiting the transport of tryptophan across the blood brain barrier. The studies performed resulted in little or no change in performance between increased BCAA intake and placebo groups. One study in particular administered a carbohydrate solution and a carbohydrate + BCAA solution. Both of the groups were able to run for longer before fatigue compared to the water placebo group. However, both the carbohydrate and the carbohydrate + BCAA groups had no differences in their performance. Branch-chained amino acid supplementation has proven to have little to no effect on performance. There has been little success utilizing neurotransmitter precursors to control central nervous system fatigue. One review hypothesized that the inconsistency with BCAA administration was the result of ammonia accumulation as a result of increased BCAA oxidation.

Role

Central nervous system fatigue is a key component in preventing peripheral muscle injury. The brain has numerous receptors, such as osmoreceptors, to track

dehydration In physiology, dehydration is a lack of total body water that disrupts metabolic processes. It occurs when free water loss exceeds intake, often resulting from excessive sweating, health conditions, or inadequate consumption of water. Mild deh ...

nutrition Nutrition is the biochemistry, biochemical and physiology, physiological process by which an organism uses food and water to support its life. The intake of these substances provides organisms with nutrients (divided into Macronutrient, macro- ...

, and

body temperature Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when the surrounding temperature is very different. A thermoconforming organism, by contrast, simply adopts the surrounding temperature ...

. With that information as well as peripheral muscle fatigue information, the brain can reduce the quantity of motor commands sent from the central nervous system. This is crucial in order to protect the

homeostasis In biology, homeostasis (British English, British also homoeostasis; ) is the state of steady internal physics, physical and chemistry, chemical conditions maintained by organism, living systems. This is the condition of optimal functioning fo ...

of the body and to keep it in a proper physiological state capable of full recovery. The reduction of motor commands sent from the brain increases the amount of perceived effort an individual experiences. By forcing the body through a higher perceived intensity, the individual becomes more likely to cease exercise by means of exhaustion. Perceived effort is greatly influenced by the intensity of corollary discharge from the

motor cortex The motor cortex is the region of the cerebral cortex involved in the planning, motor control, control, and execution of voluntary movements. The motor cortex is an area of the frontal lobe located in the posterior precentral gyrus immediately ...

that affects the

primary somatosensory cortex In neuroanatomy, the primary somatosensory cortex is located in the postcentral gyrus of the brain's parietal lobe, and is part of the somatosensory system. It was initially defined from surface stimulation studies of Wilder Penfield, and parallel ...

. Endurance athletes learn to listen to their body. Protecting organs from potentially dangerous core temperatures and nutritional lows is an important brain function. Central nervous system fatigue alerts the athlete when physiological conditions are not optimal so either rest or refueling can occur. It is important to avoid

hyperthermia Hyperthermia, also known as overheating, is a condition in which an individual's body temperature is elevated beyond normal due to failed thermoregulation. The person's body produces or absorbs more heat than it dissipates. When extreme te ...

and

, as they are detrimental to athletic performance and can be fatal.Murray R. Dehydration, hyperthermia, and athletes: science and practice. J Athl Train. 1996;31(3):248–252.

References

{{Reflist Central nervous system disorders Exercise physiology