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Postigo-Martin P, Cantarero-Villanueva I, Lista-Paz A, Castro-Martín E, Arroyo-Morales M, Seco-Calvo J. A COVID-19 Rehabilitation Prospective Surveillance Model for Use by Physiotherapists. J Clin Med 2021; 10:1691. [PMID: 33920035 PMCID: PMC8071011 DOI: 10.3390/jcm10081691] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
The long-term sequelae of coronavirus disease 2019 (COVID-19) are only now beginning to be defined, but it is already known that the disease can have direct and indirect impacts mainly on the cardiorespiratory and neuromuscular systems and may affect mental health. A role for rehabilitation professionals from all disciplines in addressing COVID-19 sequelae is recognised, but it is essential that patient assessment be systematic if health complications are to be identified and treated and, if possible, prevented. The aim is to present a COVID-19 prospective surveillance model based on sensitive and easily used assessment tools, which is urgently required. Following the Oxford Centre for Evidence-Based Medicine Level of Evidence Tool, an expert team in cardiorespiratory, neuromuscular and mental health worked via telemeetings to establish a model that provides guidelines to rehabilitation professionals working with patients who require rehabilitation after suffering from COVID-19. A COVID-19 prospective surveillance model is proposed for use by rehabilitation professionals and includes both face-to-face and telematic monitoring components. This model should facilitate the early identification and management of long-term COVID-19 sequelae, thus responding to an arising need.
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Affiliation(s)
- Paula Postigo-Martin
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
- Sport and Health Research Center (IMUDs), 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain
| | - Irene Cantarero-Villanueva
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
- Sport and Health Research Center (IMUDs), 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, 18016 Granada, Spain
| | - Ana Lista-Paz
- Faculty of Physiotherapy, University of La Coruña, 15006 La Coruña, Spain;
| | - Eduardo Castro-Martín
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
| | - Manuel Arroyo-Morales
- Health Sciences Faculty, University of Granada, 18016 Granada, Spain; (P.P.-M.); (E.C.-M.); (M.A.-M.)
- Sport and Health Research Center (IMUDs), 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, 18016 Granada, Spain
| | - Jesús Seco-Calvo
- Physiotherapy Department, Institute of Biomedicine (IBIOMED), University of Leon, Campus de Vegazana s/n, 24071 Leon, Spain;
- Department of Physiology, Visiting Professor and Researcher of University of the Basque Country, 48940 Leioa, Spain
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Shull SA, Rich SK, Gillette RL, Manfredi JM. Heart Rate Changes Before, During, and After Treadmill Walking Exercise in Normal Dogs. Front Vet Sci 2021; 8:641871. [PMID: 33912604 PMCID: PMC8071847 DOI: 10.3389/fvets.2021.641871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
In dogs, changes in heart rate (HR) can reflect conditioning, fear, anticipation, and pain; however, these are not routinely assessed in veterinary rehabilitation patients. Knowing the expected HR changes during rehabilitation exercises can guide protocols and can optimize post-operative therapy. The primary objectives of the study were to assess HR in dogs undergoing treadmill exercise (TE) during the walk and to compare the three collection techniques of HR, namely, auscultation, a HR monitor (HR MONITOR), and a Holter monitor (HOLTER). We hypothesized that the HR would increase by 20% during TE, that HR taken after TE would not be the same as the HR during TE, and that all methods of measurement would have good agreement. HR was recorded in all methods simultaneously, in eight adult healthy large breed dogs during rest (REST), immediately before TE (PRE), during TE (WALK), and 15 and 60 s after TE (POST-15, POST-60). Statistical analyses included Spearman and Pearson correlations, Bland-Altman analyses, and a repeated measures ANOVA with Sidak's post-hoc test (significant at value of p < 0.05). Increased HR was reflected in TE during WALK, and elevations in HR during WALK were not reflected in POST timepoints. Auscultation was also not possible during WALK. Significant moderate-to-strong correlations existed among all monitoring options at each of the timepoints (rho range = 0.5-0.9, p < 0.05). There were no correlations between peak HR and age or weight. The main limitation of this study is that only healthy and large breed dogs were used. Both monitors captured the increase in HR during exercise and could guide TE regimens to minimize patient risk of injury and to maximize training effectiveness.
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Affiliation(s)
- Sarah A Shull
- College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Sarah K Rich
- College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Robert L Gillette
- Sportsvet Veterinary Consulting Services, Lancaster, SC, United States
| | - Jane M Manfredi
- College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
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Carneiro HA, Song RJ, Lee J, Schwartz B, Vasan RS, Xanthakis V. Association of Blood Pressure and Heart Rate Responses to Submaximal Exercise With Incident Heart Failure: The Framingham Heart Study. J Am Heart Assoc 2021; 10:e019460. [PMID: 33759543 PMCID: PMC8174367 DOI: 10.1161/jaha.120.019460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Exercise stress tests are conventionally performed to assess risk of coronary artery disease. Using the FHS (Framingham Heart Study) Offspring cohort, we related blood pressure (BP) and heart rate responses during and after submaximal exercise to the incidence of heart failure (HF). Methods and Results We evaluated Framingham Offspring Study participants (n=2066; mean age, 58 years; 53% women) who completed 2 stages of an exercise test (Bruce protocol) at their seventh examination (1998-2002). We measured pulse pressure, systolic BP, diastolic BP, and heart rate responses during stage 2 exercise (2.5 mph at 12% grade). We calculated the changes in systolic BP, diastolic BP, and heart rate from stage 2 to recovery 3 minutes after exercise. We used Cox proportional hazards regression to relate each standardized exercise variable (during stage 2, and at 3 minutes of recovery) individually to HF incidence, adjusting for standard risk factors. On follow-up (median, 16.8 years), 85 participants developed new-onset HF. Higher exercise diastolic BP was associated with higher HF with reduced ejection fraction (ejection fraction <50%) risk (hazard ratio [HR] per SD increment, 1.26; 95% CI, 1.01-1.59). Lower stage 2 pulse pressure and rapid postexercise recovery of heart rate and systolic BP were associated with higher HF with reduced ejection fraction risk (HR per SD increment, 0.73 [95% CI, 0.57-0.94]; 0.52 [95% CI, 0.35-0.76]; and 0.63 [95% CI, 0.47-0.84], respectively). BP and heart rate responses to submaximal exercise were not associated with risk of HF with preserved ejection fraction (ejection fraction ≥50%). Conclusions Accentuated diastolic BP during exercise with slower systolic BP and heart rate recovery after exercise are markers of HF with reduced ejection fraction risk.
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Affiliation(s)
- Herman A Carneiro
- Internal Medicine Residency Program Boston University School of Medicine Boston MA
| | - Rebecca J Song
- Department of Epidemiology Boston University School of Public Health Boston MA
| | - Joowon Lee
- Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA
| | - Brian Schwartz
- Internal Medicine Residency Program Boston University School of Medicine Boston MA
| | - Ramachandran S Vasan
- Department of Epidemiology Boston University School of Public Health Boston MA.,Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA.,Boston UniversityCenter for Computing and Data Sciences Boston MA.,Boston University and National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study) Framingham MA
| | - Vanessa Xanthakis
- Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA.,Boston University and National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study) Framingham MA.,Department of Biostatistics Boston University School of Public Health Boston MA
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54
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Storniolo JL, Cairo B, Porta A, Cavallari P. Symbolic Analysis of the Heart Rate Variability During the Plateau Phase Following Maximal Sprint Exercise. Front Physiol 2021; 12:632883. [PMID: 33833687 PMCID: PMC8021730 DOI: 10.3389/fphys.2021.632883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
Cardiac autonomic control is commonly assessed via the analysis of fluctuations of the temporal distance between two consecutive R-waves (RR). Cardiac regulation assessment following high intensity physical exercise is difficult due to RR non-stationarities. The very short epoch following maximal sprint exercise when RR remains close to its lowest value, i.e., the PLATEAU, provides the opportunity to evaluate cardiac regulation from stationary RR sequences. The aim of the study is to evaluate cardiac autonomic control during PLATEAU phase following 60-m maximal sprint and compare the results to those derived from sequences featuring the same length as the PLATEAU and derived from pre-exercise and post-exercise periods. These sequences were referred to as PRE and POST sequences. RR series were recorded in 21 subjects (age: 24.9 ± 5.1 years, 15 men and six women). We applied a symbolic approach due to its ability to deal with very short RR sequences. The symbolic approach classified patterns formed by three RRs according to the sign and number of RR variations. Symbolic markers were compared to more classical time and frequency domain indexes. Comparison was extended to simulated signals to explicitly evaluate the suitability of methods to deal with short variability series. A surrogate test was applied to check the null hypothesis of random fluctuations. Over simulated data symbolic analysis was able to separate dynamics with different spectral profiles provided that the frame length was longer than 10 cardiac beats. Over real data the surrogate test indicated the presence of determinism in PRE, PLATEAU, and POST sequences. We found that the rate of patterns with two variations with unlike sign increased during PLATEAU and in POST sequences and the frequency of patterns with no variations remained unchanged during PLATEAU and decreased in POST compared to PRE sequences. Results indicated a sustained sympathetic control along with an early vagal reactivation during PLATEAU and a shift of the sympathovagal balance toward vagal predominance in POST compared to PRE sequences. Time and frequency domains markers were less powerful because they were dominated by the dramatic decrease of RR variance during PLATEAU.
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Affiliation(s)
- Jorge L. Storniolo
- Department of Pathophysiology and Transplantation, Human Physiology Section, University of Milan, Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Paolo Cavallari
- Department of Pathophysiology and Transplantation, Human Physiology Section, University of Milan, Milan, Italy
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Manresa-Rocamora A, Flatt AA, Casanova-Lizón A, Ballester-Ferrer JA, Sarabia JM, Vera-Garcia FJ, Moya-Ramón M. Heart rate-based indices to detect parasympathetic hyperactivity in functionally overreached athletes. A meta-analysis. Scand J Med Sci Sports 2021; 31:1164-1182. [PMID: 33533045 DOI: 10.1111/sms.13932] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/24/2020] [Accepted: 01/28/2021] [Indexed: 11/29/2022]
Abstract
Investigations into the sensitivity of heart rate-(HR) derived indices for tracking parasympathetic nervous system (PNS) changes in functionally overreached (F-OR) endurance-trained athletes have produced equivocal findings. Lack of clarity may be a result of methodological inconsistencies. Therefore, the aims of this systematic review and meta-analysis were (a) to determine the sensitivity of resting and post-exercise vagal-related HR variability (HRV) and HR recovery (HRR) indices to detect PNS modulation in F-OR and non-overreached (non-OR) athletes, and (b) to investigate the influence of methodological factors on the sensitivity of HR-based indices to detect PNS hyperactivity in F-OR athletes. We searched CENTRAL, Scopus, PubMed, Embase, and Web of Science up to May 2020 for the following terms: male and female endurance-trained athletes, controlled and uncontrolled studies that carried out an overload training period, and PNS modulation measured in resting and post-exercise, pre- and post-overload training period. A random-effects model of standardized mean difference (SMD) was estimated for each outcome measure based on the training-induced fatigue status (F-OR vs non-OR athletes), and the influence of methodological issues to detect PNS hyperactivity in F-OR was assessed by subgroup analyses. Pooled analysis showed that resting vagal-related HRV indices did not detect PNS hyperactivity in F-OR athletes (SMD+ = -0.01; 95% confidence interval [CI] = -0.51, 0.50), and no statistical difference (P = .600) was found with non-OR athletes (SMD+ = 0.15; 95% CI = -0.14, 0.45). However, subgroup analysis based on HRV parameter showed a moderate statistical increase in weekly averaged HRV in F-OR athletes (SMD+ = 0.81; 95% CI = 0.35, 1.26), while isolated HRV values did not reach statistical significance (SMD+ = -0.45; 95% CI = -0.96, 0.06). We observed a moderate and statistically significant increase in HRR indices among F-OR athletes (SMD+ = 0.65; 95% CI = 0.44, 0.87), no changes for non-OR athletes (SMD+ = 0.10; 95% CI = -0.15, 0.34), and statistically significant differences between F-OR and non-OR athletes (P < .001). Insufficient data prevented meta-analysis for post-exercise vagal-related HRV indices. Our findings show that when methodological factors are considered, HR-based indices are sensitive to increased PNS modulation in F-OR.
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Affiliation(s)
- Agustín Manresa-Rocamora
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - Andrew A Flatt
- Department of Health Sciences and Kinesiology, Georgia Southern University, Georgia, USA
| | - Antonio Casanova-Lizón
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - Juan A Ballester-Ferrer
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - José M Sarabia
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain.,Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Miguel Hernandez University, Alicante, Spain
| | - Francisco J Vera-Garcia
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - Manuel Moya-Ramón
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain.,Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Miguel Hernandez University, Alicante, Spain
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56
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Cardiac autonomic control following resistance exercise with different set configurations in apparently healthy young men: A crossover study. Physiol Behav 2021; 230:113292. [PMID: 33338485 DOI: 10.1016/j.physbeh.2020.113292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 11/21/2022]
Abstract
We compared the heart rate variability (HRV) after a low-intensity resistance exercise (LI-RE) with short (SSC/LI-RE) and long (LSC/LI-RE) set configurations, composed of 10 and 20 repetitions, respectively. Randomly, ten young males performed one session of both RE protocols. Time- and frequency-domain, and nonlinear HRV parameters were assessed at baseline and 20-30 and 50-60 min after protocols. Significant reductions in time-domain, frequency-domain and nonlinear HRV parameters were observed at 20-30 min and 50-60 min after LSC/LI-RE compared to baseline. A low-intensity RE with a long set configuration induces an acute vagal withdrawal and loss of heart rate complexity after exercise.
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57
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Silva ÉP, Soares BA, Reimberg MM, Ritti-Dias R, Nascimento KS, Anjos FS, Wandalsen GF, Solé D, Dal Corso S, Lanza FC. Heart rate recovery in asthmastic children and adolescents after clinical field test. BMC Pulm Med 2021; 21:61. [PMID: 33607978 PMCID: PMC7896361 DOI: 10.1186/s12890-020-01355-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inflammation caused by chronic lung disease in childhood may lead to delayed heart rate recovery (HRR) however, there is lack of evidence on HRR in this population. The aim was to assess HRR after functional capacity testing in asthmatic children and adolescents and to compare with severity and disease control. METHOD This was a study secondary to a randomized control trial. The modified shuttle test (MST) was performed to assess functional capacity and HRR. This is an externally cadenced test in which the distance walked is the outcome. HRR was assessed after MST and was defined as HR at exercise peak minus HR in the second minute after the end of exercise. Asthma control was assessed by the Asthma Control Test (ACT). Data normality was tested by Shapiro Wilk and the comparison between groups was made by Student's t test or Mann Whitney test for numerical variables, and by Chi-square test for categorical variables. Statistical significance was considered when p < 0.05. SPSS version 20 was used in the analyzes. RESULTS The sample included 77 patients diagnosed with asthma (asthma group - AG) who were regularly treated for asthma. Control group (CG) consisted of 44 volunteers considered healthy, matched in age and gender to AG. The median age of CG was 12 (10-14) years and in AG 11 (9-13 years) being classified as mild to moderate asthmatic, and 57% of the sample had controlled asthma by ACT. Distance walked in the CG was 952 ± 286 m and AG 799 ± 313 m, p = 0.001. HRR was more efficient in CG (79 ± 15 bpm) compared to AG (69 ± 12 bpm), p = 0.001. The mild (69 ± 12 beats) and severe (72 ± 15 beats) AG presented worse HRR compared to control group (79 ± 15 bpm), p < 0.05. CONCLUSIONS Asthmatic children and adolescents have delayed HRR after modified Shuttle test compared to their peers, suggesting that asthma leads to autonomic nervous system imbalance. TRIAL REGISTRATION Registered in Clinical Trials under number NCT02383069 and approved by the Universidade Nove de Julho - UNINOVE Research Ethics Committee, protocol number 738192/2014.
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Affiliation(s)
- Élida Pereira Silva
- Post Graduate Programa in Rehabilitation Sciences, Universidade Nove de Julho - UNINOVE, São Paulo, SP, 01525-000, Brazil
| | - Bruno Alvarenga Soares
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, 31270-901, Brazil
| | - Mariana M Reimberg
- Post Graduate Programa in Rehabilitation Sciences, Universidade Nove de Julho - UNINOVE, São Paulo, SP, 01525-000, Brazil
| | - Raphael Ritti-Dias
- Post Graduate Programa in Rehabilitation Sciences, Universidade Nove de Julho - UNINOVE, São Paulo, SP, 01525-000, Brazil
| | - Karina Silva Nascimento
- Post Graduate Programa in Rehabilitation Sciences, Universidade Nove de Julho - UNINOVE, São Paulo, SP, 01525-000, Brazil
| | - Fabiana Silvia Anjos
- Post Graduate Programa in Rehabilitation Sciences, Universidade Nove de Julho - UNINOVE, São Paulo, SP, 01525-000, Brazil
| | - Gustavo Falbo Wandalsen
- Pediatric Department, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, 04025-002, Brazil
| | - Dirceu Solé
- Pediatric Department, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, 04025-002, Brazil
| | - Simone Dal Corso
- Post Graduate Programa in Rehabilitation Sciences, Universidade Nove de Julho - UNINOVE, São Paulo, SP, 01525-000, Brazil
| | - Fernanda Cordoba Lanza
- Post Graduate Programa in Rehabilitation Sciences, Universidade Nove de Julho - UNINOVE, São Paulo, SP, 01525-000, Brazil. .,Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, 31270-901, Brazil.
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58
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Ebersole KT, Cornell DJ, Flees RJ, Shemelya CM, Noel SE. Contribution of the Autonomic Nervous System to Recovery in Firefighters. J Athl Train 2021; 55:1001-1008. [PMID: 32841323 DOI: 10.4085/1062-6050-0426.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Sudden cardiac deaths (SCDs) have accounted for nearly half of the line-of-duty deaths among US firefighters over the past 10 years. In 2018, 33% of all SCDs occurred after the end of a fire service call. Researchers have suggested that an imbalance in autonomic nervous system (ANS) regulation of heart rate postcall may interfere with recovery in firefighters. OBJECTIVE To use heart-rate recovery (HRR) and heart-rate variability (HRV), 2 noninvasive markers of ANS function, to examine the ANS recovery profiles of firefighters. DESIGN Cross-sectional study. SETTING Firehouse and research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-seven male career active-duty firefighters (age = 39 ± 9 years, height = 178.8 ± 5.4 cm, mass = 87.9 ± 11.2 kg). MAIN OUTCOME MEASURE(S) Percentage of maximal HR (%MHR) and HRV (natural log of the square root of the mean sum of the squared differences [lnRMSSD]) were collected after both submaximal and maximal exercise protocols during a 10-minute seated recovery. The HRR profiles were examined by calculating the asymptote, amplitude, and decay parameters of the monoexponential HRR curve for each participant. RESULTS Differences in HRR parameters after 10 minutes of seated recovery were identified after submaximal versus maximal exercise (P < .001). In addition, although ANS was more suppressed after maximal exercise, HRV indicated incomplete recovery, and regardless of the test, recovery %MHR and lnRMSSD values did not return to pretest %MHR and lnRMSSD values. CONCLUSIONS Our results suggest that the ANS contributions to recovery in active-duty firefighters are exercise-intensity specific, and this is likely an important factor when establishing best-practice recovery guidelines.
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Affiliation(s)
- Kyle T Ebersole
- Department of Kinesiology, University of Wisconsin-Milwaukee
| | - David J Cornell
- Department of Physical Therapy and Kinesiology, University of Massachusetts, Lowell
| | - Robert J Flees
- Department of Kinesiology, University of Wisconsin-Milwaukee
| | - Corey M Shemelya
- Department of Electrical and Computer Engineering, University of Massachusetts, Lowell
| | - Sabrina E Noel
- Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell
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Tricot GK, Araújo JA, Novelli FI, Puga GM, Arsa G, Cambri LT. Parasympathetic modulation during sleep time is reduced after maximal exercise, correlated with aerobic fitness in young women. REVISTA BRASILEIRA DE CINEANTROPOMETRIA E DESEMPENHO HUMANO 2021. [DOI: 10.1590/1980-0037.2021v23e83295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
abstract It is known that cardiovascular risk is increased during exercise and recovery. Thus, it is necessary to assess all the risk associated with exercise to minimize the possibility of cardiovascular events. The aim of this study was to verify whether a maximal exercise alters ambulatory cardiac autonomic modulation in untrained women and whether aerobic fitness is correlated to cardiac autonomic modulation. Twelve women (25.35 ± 5.44 years) were outfitted with the Holter monitor on an experimental (after maximum exercise) and a control day to heart rate variability (HRV) evaluation. Maximal exercise increased 24 h heart rate (82 ± 14 vs 77 ± 11 bpm; p = 0.04) and during sleep time (72 ± 14 vs. 65 ± 9 bpm; p = 0.01), reduced parasympathetic modulation (HF – n.u. 49.96 ± 11.56 vs 42.10 ± 14.98; p = 0.04), and increased low-frequency/high-frequency ratio (2.88 ± 3.24 vs 1.31 ± 0.60; p = 0.03) during sleep time compared to the control day. Aerobic fitness was correlated positively with LF, HF, and HF (n.u.) indices (r = 0.61 to 0.73, p < 0.05) and correlated negatively with LF (n.u.) and LF/HF ratio (Rho = - 0.57 to - 0.69; p < 0.05). Maximal exercise alters parasympathetic modulation during sleep time in untrained women. Ambulatory cardiac autonomic modulation after exercise is related to aerobic fitness.
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60
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Omoya R, Miyajima M, Ohta K, Suzuki Y, Aoki A, Fujiwara M, Watanabe T, Yoshida N, Suwa H, Kawara T, Takahashi H, Matsushima E, Takeuchi T. Heart rate response to orthostatic challenge in patients with dementia with Lewy bodies and Alzheimer's disease. Psychogeriatrics 2021; 21:62-70. [PMID: 33089601 DOI: 10.1111/psyg.12625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND To elucidate the differences in autonomic dysfunction between dementia with Lewy bodies (DLB) and Alzheimer's disease using a simple and convenient method, we investigated the heart rate response to orthostatic challenge. METHODS Ninety-seven people participated in this cross-sectional study, and data from 26 DLB patients, 29 Alzheimer's disease patients, and 25 healthy elderly individuals were analysed. Participants underwent postural changes, including 5 min in a supine position, 1 min in a sitting position, and 3 min in an orthostatic position. Their heart rates were continuously recorded. Two heart rate variables were analysed as main outcomes: (i) the difference between heart rate in the sitting position and the peak heart rate within 15 s of orthostasis, defined as the 'early heart rate increase'; and (ii) the difference between the peak heart rate and the negative peak heart rate after this, defined as 'early heart rate recovery.' An early heart rate increase has been considered to reflect parasympathetic and sympathetic functions. Early heart rate recovery is considered to reflect parasympathetic function. We also investigated the frequency domains of resting heart rate variability. RESULTS A significant difference was observed across the three groups in early heart rate increase, and that of the DLB group was lower than that of the healthy control group. Early heart rate recovery also differed significantly across the three groups, and that of the DLB group was less than that of the healthy control group. In addition, the power of the low-frequency component, which represents both sympathetic and parasympathetic activity, was significantly decreased in the DLB group compared to the Alzheimer's disease group. CONCLUSIONS Impaired heart rate response to standing was detected in patients with DLB. Electrocardiogram is a convenient, non-invasive method that might be useful as a subsidiary marker for DLB diagnosis and differentiation from Alzheimer's disease.
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Affiliation(s)
- Rie Omoya
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Wako Hospital, Saitama, Japan
| | - Miho Miyajima
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsuya Ohta
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Onda-Daini Hospital, Chiba, Japan
| | - Yoko Suzuki
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Ibaraki, Japan
| | - Ai Aoki
- Department of Health Policy, National Centre for Child Health and Development, Tokyo, Japan
| | - Mayo Fujiwara
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Tazaki Hospital, Okinawa, Japan
| | | | - Noriko Yoshida
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Narimasu Kosei Hospital, Tokyo, Japan
| | - Hiroshi Suwa
- Department of Psychiatry, Tokyo Kyosai Hospital, Tokyo, Japan
| | - Tokuhiro Kawara
- Graduate School of Health Care Science, Bunkyo Gakuin University, Tokyo, Japan
| | - Hidehiko Takahashi
- Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisuke Matsushima
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Takeuchi
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Cornell DJ, Noel SE, Zhang X, Ebersole KT. Influence of a Training Academy on the Parasympathetic Nervous System Reactivation of Firefighter Recruits-An Observational Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E109. [PMID: 33375223 PMCID: PMC7795559 DOI: 10.3390/ijerph18010109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022]
Abstract
Sudden cardiac death (SCD) is the leading type of line-of-duty death among firefighters. An inability to restore parasympathetic nervous system (PSNS) control after activity is associated with SCD. Post-exercise heart rate recovery (HRR) provides unique insight into reactivation of the PSNS. Thus, the purpose of this study was to examine longitudinal changes in HRR responses of 25 male firefighter recruits. HR data were collected after submaximal exercise at week 1 (W1), week 6 (W6), and week 15 (W15) of their training at an academy. Percent maximal heart rate (%MHR) measures were computed at each HRR time point (%MHR0, %MHR15, %MHR30, %MHR45, %MHR60, %MHR120, %MHR180) and absolute HRR values were calculated at 30 s (ΔHRR30), 60 s (ΔHRR60), 120 s (ΔHRR120), and 180 s (ΔHRR180). After controlling for age and percent body fat, there was no statistically significant interaction between Week × HRR (p = 0.730), and there were no changes in ΔHRR30, ΔHRR60, and ΔHRR120, and ΔHRR180 indices across time. However, %MHR at W6 and W15 was significantly lower than %MHR at W1 at every HRR time point (ps < 0.001). Therefore, although the firefighter recruit training academy elicited positive training adaptations, changes in PSNS reactivation after submaximal activity were not identified.
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Affiliation(s)
- David J. Cornell
- Health Assessment Laboratory, University of Massachusetts Lowell, Lowell, MA 01854, USA;
- Center for Population Health, University of Massachusetts Lowell, Lowell, MA 01854, USA;
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Sabrina E. Noel
- Health Assessment Laboratory, University of Massachusetts Lowell, Lowell, MA 01854, USA;
- Center for Population Health, University of Massachusetts Lowell, Lowell, MA 01854, USA;
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Xiyuan Zhang
- Center for Population Health, University of Massachusetts Lowell, Lowell, MA 01854, USA;
| | - Kyle T. Ebersole
- Human Performance and Sport Physiology Laboratory, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA;
- Department of Occupational Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
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62
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Peçanha T, de Brito LC, Fecchio RY, de Sousa PN, Silva ND, Couto PG, de Abreu AP, da Silva GV, Mion D, Low DA, de Moraes Forjaz CL. Activation of Mechanoreflex, but not Central Command, Delays Heart Rate Recovery after Exercise in Healthy Men. Int J Sports Med 2020; 42:602-609. [DOI: 10.1055/a-1297-4475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AbstractThis study tested the hypotheses that activation of central command and muscle mechanoreflex during post-exercise recovery delays fast-phase heart rate recovery with little influence on the slow phase. Twenty-five healthy men underwent three submaximal cycling bouts, each followed by a different 5-min recovery protocol: active (cycling generated by the own subject), passive (cycling generated by external force) and inactive (no-cycling). Heart rate recovery was assessed by the heart rate decay from peak exercise to 30 s and 60 s of recovery (HRR30s, HRR60s fast phase) and from 60 s-to-300 s of recovery (HRR60−300s slow phase). The effect of central command was examined by comparing active and passive recoveries (with and without central command activation) and the effect of mechanoreflex was assessed by comparing passive and inactive recoveries (with and without mechanoreflex activation). Heart rate recovery was similar between active and passive recoveries, regardless of the phase. Heart rate recovery was slower in the passive than inactive recovery in the fast phase (HRR60s=20±8vs.27 ±10 bpm, p<0.01), but not in the slow phase (HRR60−300s=13±8vs.10±8 bpm, p=0.11). In conclusion, activation of mechanoreflex, but not central command, during recovery delays fast-phase heart rate recovery. These results elucidate important neural mechanisms behind heart rate recovery regulation.
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Affiliation(s)
- Tiago Peçanha
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Leandro Campos de Brito
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
- School of Physical Education and Sport, Sao Paulo, University of Sao Paulo, Brazil
| | - Rafael Yokoyama Fecchio
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Patricia Nascimento de Sousa
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Natan Daniel Silva
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Andrea Pio de Abreu
- Hipertension Unit, General Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Giovanio Vieira da Silva
- Hipertension Unit, General Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Decio Mion
- Hipertension Unit, General Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - David A. Low
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom of Great Britain and Northern Ireland
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Coomans I, De Kinder S, Van Belleghem H, De Groote K, Panzer J, De Wilde H, Muiño Mosquera L, François K, Bové T, Martens T, De Wolf D, Boone J, Vandekerckhove K. Analysis of the recovery phase after maximal exercise in children with repaired tetralogy of Fallot and the relationship with ventricular function. PLoS One 2020; 15:e0244312. [PMID: 33338081 PMCID: PMC7748266 DOI: 10.1371/journal.pone.0244312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background Few studies demonstrate delayed recovery after exercise in children and adults with heart disease. We assess the recovery patterns of gas exchange parameters and heart rate (HR) in children with repaired Tetralogy of Fallot (rToF) compared to healthy peers and investigate the correlation with ventricular function and QRS duration. Methods 45 children after rToF and 45 controls performed a maximal incremental cardiopulmonary exercise test. In the subsequent recovery period, patterns of VO2, VCO2 and HR were analysed. Half-life time (T1/2) of the exponential decay and drop per minute (Recmin) were compared between groups. In the rToF group, correlations were examined between the recovery parameters and QRS-duration and ventricular function, described by fractional shortening (FS) and tricuspid annular plane systolic excursion (TAPSE) measured at baseline prior to exercise. Results Recovery of VO2 and VCO2 was delayed in rToF patients, half-life time values were higher compared to controls (T1/2VO2 52.51 ±11.29 s vs. 44.31 ± 10.47 s; p = 0.001 and T1/2VCO2 68.28 ± 13.84 s vs. 59.41 ± 12.06 s; p = 0.002) and percentage drop from maximal value was slower at each minute of recovery (p<0.05). Correlations were found with FS (T1/2VO2: r = -0.517; p<0.001; Rec1minVO2: r = -0.636, p<0.001; Rec1minVCO2: r = -0.373, p = 0.012) and TAPSE (T1/2VO2: r = -0.505; p<0.001; Rec1minVO2: r = -0.566, p<0.001; T1/2VCO2: r = -0.466; p = 0.001; Rec1minVCO2: r = -0.507, p<0.001), not with QRS-duration. No difference was found in HR recovery between patients and controls. Conclusions Children after rToF show a delayed gas exchange recovery after exercise. This delay correlates to ventricular function, demonstrating its importance in recovery after physical activity.
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Affiliation(s)
- Ilse Coomans
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
- * E-mail:
| | | | | | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Joseph Panzer
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Hans De Wilde
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Katrien François
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Thierry Bové
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Thomas Martens
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Daniël De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Jan Boone
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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Park IK, Lee JY, Suk MH, Yoo S, Seo YG, Oh JK, Kwon JY. Effect of Equine-Assisted Activities on Cardiac Autonomic Function in Children with Cerebral Palsy: A Pilot Randomized-Controlled Trial. J Altern Complement Med 2020; 27:96-102. [PMID: 33252241 DOI: 10.1089/acm.2020.0346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective: Children with cerebral palsy (CP) have an impaired cardiac autonomic function. Attenuated heart rate recovery (HRR), which is a valuable prognostic parameter for autonomic nervous system, is known to be associated with an increased risk of cardiovascular events and all-cause mortality. However, only few studies have observed the effects of exercise on the cardiac autonomic function in children with CP. The purpose of this pilot study was to examine the effects of equine-assisted activity (EAA) program on cardiac autonomic function in children with CP. Design: A single-blinded, parallel, two-arm pilot trial with 1:1 randomization to the EAA or control group. Setting: A tertiary university hospital and a local arena. Subjects: Twenty-six children with CP (Gross Motor Function Classification System Levels I-II). Intervention: Each lesson of the EAA program for the EAA group was conducted for 40 min twice a week, and the whole program duration was 16 weeks (a total of 32 sessions). Outcome measures: A graded exercise test was performed to measure the resting heart rate (RHR), HRR, and peak oxygen uptake (VO2peak) on both groups before and after the 16-week period. Results: The autonomic nervous function measured by the response of HRR improved at 1 min (p < 0.009), 3 min (p < 0.001), and 5 min (p < 0.004) only in the EAA group. RHR significantly improved in the EAA group (p < 0.013), whereas the VO2peak did not significantly differ between the two groups. Conclusion: The HRR and RHR of the children with CP improved after completing the 16-week EAA program. The results demonstrated that the program had a positive effect on the improvement of cardiac autonomic function in these patients. Clinical Trial Registration Number: NCT03870893.
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Affiliation(s)
- In-Kyeong Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Ji Young Lee
- Samsung Equestrian Team, Gunpo, Republic of Korea
| | - Min-Hwa Suk
- Department of Sport Science, College of Sport and Art, Hanyang University, Seoul, Republic of Korea
| | - Soojin Yoo
- Department of Health and Human Performance, University of Texas, Rio Grande Valley, Edinburg, TX, USA
| | - Yong-Gon Seo
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Jea-Keun Oh
- Department of Health Care and Sports Science, Korea National Sport University, Seoul, Republic of Korea
| | - Jeong-Yi Kwon
- Department of Physical & Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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65
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Farrell SW, DeFina LF, Tintle N, Barlow CE, Leonard D, Haskell WL, Berry JD, Willis BL, Pavlovic A, Harris WS. Higher omega-3 index is associated with more rapid heart rate recovery in healthy men and women. Prostaglandins Leukot Essent Fatty Acids 2020; 163:102206. [PMID: 33227647 DOI: 10.1016/j.plefa.2020.102206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/07/2020] [Accepted: 11/07/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Previous studies have suggested that omega-3 polyunsaturated fatty acids (n-3 PUFA) can favorably influence cardiac autonomic tone. However, data regarding n-3 PUFA status and heart rate recovery (HRR) in healthy adults are sparse. PURPOSE To examine the association between n-3 PUFA status and HRR. METHODS Participants included 13,912 patients who underwent a comprehensive examination at the Cooper Clinic, Dallas TX. Fitness was determined from a maximal exercise test. HRR was calculated by subtracting the heart rate at 1, 3, and 5 min of an active recovery period from the maximal heart rate. Participants were categorized as having a low (<4%), normal (4-8%) or optimal (>8%) Omega-3 Index (O3I) (i.e., erythrocyte levels of eicosapentaenoic and docosahexaenoic acids). Multiple linear regression was used to model the association between O3I and HRR adjusting for age, maximal METs, body mass index, and smoking by sex. RESULTS Higher categories of O3I were associated with greater HRR at 1 min (men: 23.7, 23.9, 24.6 beats/min; women: 23.9, 24.6, 25.9 and 3 min (men: 52.4, 52.9, 53.6 beats/min; women: 51.9, 53.4, 54.6), p trend <0.01 for all. Corresponding HRR at 5 min were (men: 60.0, 60.2, 60.7 beats/min, p trend=0.09; women: 59.4, 60.8, 61.6, p trend <0.001). The HRR gradients across O3I categories were steeper in women than men at 1, 3, and 5 min (p<0.03 for all sex x O3I category interactions with HRR). CONCLUSIONS A direct relationship between HRR and O3I values was observed in both men and women, with a steeper gradient in women. These findings suggest a potential cardioprotective mechanism for n-3 PUFA.
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Affiliation(s)
| | | | - Nathan Tintle
- Fatty Acid Research Institute, Sioux Falls, SD; and Department of Mathematics & Statistics; Dordt University; Sioux Center; IA
| | | | | | - William L Haskell
- Department of Medicine, Stanford University, Palo Alto, CA United States
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas TX United States
| | | | | | - William S Harris
- Fatty Acid Research Institute, Sioux Falls, SD; and Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
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66
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Exercise Enhances the Effect of Bariatric Surgery in Markers of Cardiac Autonomic Function. Obes Surg 2020; 31:1381-1386. [PMID: 33111247 DOI: 10.1007/s11695-020-05053-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bariatric surgery improves cardiovascular health, which might be partly ascribed to beneficial alterations in the autonomic nervous system. However, it is currently unknown whether benefits from surgery on cardiac autonomic regulation in post-bariatric patients can be further improved by adjuvant therapies, namely exercise. We investigated the effects of a 6-month exercise training program on cardiac autonomic responses in women undergoing bariatric surgery. METHODS Sixty-two women eligible for bariatric surgery were randomly allocated to either standard of care (control) or an exercise training intervention. At baseline (PRE) and 3 (POST3) and 9 (POST9) months after surgery, we assessed chronotropic response to exercise (CR%; i.e., percentage change in heart rate from rest to peak exercise) and heart rate recovery (HRR30s, HRR60s, and HRR120s; i.e., decay of heart rate at 30, 60, and 120 s post exercise) after a maximal exercise test. RESULTS Between-group absolute changes revealed higher CR% (Δ = 8.56%, CI95% 0.22-19.90, P = 0.04), HRR30s (Δ = 12.98 beat/min, CI95% 4.29-21.67, P = 0.01), HRR60s (Δ = 22.95 beat/min, CI95% 11.72-34.18, P = 0.01), and HRR120s (Δ = 34.54 beat/min, CI95% 19.91-49.17, P < 0.01) in the exercised vs. non-exercised group. CONCLUSIONS Our findings demonstrate that exercise training enhanced the benefits of bariatric surgery on cardiac autonomic regulation. These results highlight the relevance of exercise training as a treatment for post-bariatric patients, ensuring optimal cardiovascular outcomes.
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Abstract
Adaption to changes of external environment or internal health, the body-mind connection, or autonomic nervous system must be flexible and healthy. Population health studies with wearable technology and remote monitoring will lead to paradigm shifts in how to approach the physiology of emotion. Heart rate variability as a whole health biomarker could emerge as a foundation for a process beginning with objective habits and skills of real-time modulation with focused breathing for healthier decision making and autonomic health trajectory change. Physical medicine and rehabilitation is uniquely poised to refine an autonomic rehabilitation process in an integrative manner to help individuals adapt.
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Affiliation(s)
- Raouf S Gharbo
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 109 Elizabeth Meriwether, Williamsburg, VA 23185, USA.
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68
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Nesti L, Pugliese NR, Sciuto P, Natali A. Type 2 diabetes and reduced exercise tolerance: a review of the literature through an integrated physiology approach. Cardiovasc Diabetol 2020; 19:134. [PMID: 32891175 PMCID: PMC7487838 DOI: 10.1186/s12933-020-01109-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022] Open
Abstract
The association between type 2 diabetes mellitus (T2DM) and heart failure (HF) is well established. Early in the course of the diabetic disease, some degree of impaired exercise capacity (a powerful marker of health status with prognostic value) can be frequently highlighted in otherwise asymptomatic T2DM subjects. However, the literature is quite heterogeneous, and the underlying pathophysiologic mechanisms are far from clear. Imaging-cardiopulmonary exercise testing (CPET) is a non-invasive, provocative test providing a multi-variable assessment of pulmonary, cardiovascular, muscular, and cellular oxidative systems during exercise, capable of offering unique integrated pathophysiological information. With this review we aimed at defying the cardiorespiratory alterations revealed through imaging-CPET that appear specific of T2DM subjects without overt cardiovascular or pulmonary disease. In synthesis, there is compelling evidence indicating a reduction of peak workload, peak oxygen assumption, oxygen pulse, as well as ventilatory efficiency. On the contrary, evidence remains inconclusive about reduced peripheral oxygen extraction, impaired heart rate adjustment, and lower anaerobic threshold, compared to non-diabetic subjects. Based on the multiparametric evaluation provided by imaging-CPET, a dissection and a hierarchy of the underlying mechanisms can be obtained. Here we propose four possible integrated pathophysiological mechanisms, namely myocardiogenic, myogenic, vasculogenic and neurogenic. While each hypothesis alone can potentially explain the majority of the CPET alterations observed, seemingly different combinations exist in any given subject. Finally, a discussion on the effects -and on the physiological mechanisms-of physical activity and exercise training on oxygen uptake in T2DM subjects is also offered. The understanding of the early alterations in the cardiopulmonary response that are specific of T2DM would allow the early identification of those at a higher risk of developing HF and possibly help to understand the pathophysiological link between T2DM and HF.
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Affiliation(s)
- Lorenzo Nesti
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy. .,Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy.
| | - Nicola Riccardo Pugliese
- Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Paolo Sciuto
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
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Macartney MJ, Meade RD, Notley SR, Herry CL, Seely AJE, Kenny GP. Fluid Loss during Exercise-Heat Stress Reduces Cardiac Vagal Autonomic Modulation. Med Sci Sports Exerc 2020; 52:362-369. [PMID: 31469711 DOI: 10.1249/mss.0000000000002136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Sweat-induced fluid loss during prolonged exercise-heat stress can compromise cardiovascular and thermoregulatory function, although its effects on cardiac autonomic modulation remain unclear. We therefore examined heart rate variability (HRV) and recovery (HRRec), as surrogates of cardiac autonomic modulation, during and after prolonged exercise in the heat with and without fluid replacement. METHODS Eleven young and healthy men performed 90 min of semi-recumbent cycling in dry heat (40°C; 20% relative humidity) at a fixed rate of metabolic heat production (600 W; ~46% V˙O2peak) followed by 40-min resting recovery without fluid replacement (No-FR; ~3.4% reduction in body mass). On a separate day, participants completed the same protocol with fluid replacement (FR; 500-700 mL timed boluses) to offset sweat losses. Esophageal temperature and ECG were recorded throughout, with measurements analyzed over 10-min averaged epochs during baseline, each 30-min interval during exercise and 20-min interval during recovery. RESULTS Esophageal temperature and heart rate were elevated in No-FR relative to FR throughout exercise (all P ≤ 0.02). The HRV indices reflecting vagal influence of heart rate including the cardiac vagal index (CVI = log10[16 × SD1 × SD2]) and root-mean-square of successive differences were attenuated throughout exercise relative to baseline in both conditions (all P < 0.05), with the magnitude of the reduction greater in the No-FR condition (all P < 0.05). Further, sample entropy was reduced throughout all time points measured during exercise in the No-FR relative to FR condition (all P ≤ 0.03). CONCLUSIONS Our unique observations indicate that while prolonged exercise heat stress attenuates the vagal influence and complexity of cardiac rhythms, that reduction is further exacerbated by fluid loss, highlighting the importance of fluid replacement in such conditions.
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Affiliation(s)
- Michael J Macartney
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, AUSTRALIA
| | - Robert D Meade
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON, CANADA
| | - Sean R Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON, CANADA
| | - Christophe L Herry
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, CANADA
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Monfort A, Banydeen R, Demoniere F, Courty B, Codiat R, Neviere R, Inamo J. Restrictive cardiac phenotype as primary cause of impaired aerobic capacity in Afro-Caribbean patients with val122ile variant transthyretin amyloid cardiomyopathy. Amyloid 2020; 27:145-152. [PMID: 32024385 DOI: 10.1080/13506129.2020.1722098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Impaired aerobic capacity in cardiac amyloidosis patients may be related to limited inotropic myocardial reserve and heart rate (HR) response limiting cardiac output rise. This study sought to investigate whether chronotropic incompetence (CI) and blunted HR recovery would be prevalent in patients with mutant transthyretin (ATTRv) cardiomyopathy.Methods and results: Eighteen ATTRv (Val122Ile) patients (72 ± 8-year) and 15 age-matched controls (73 ± 3-year) were prospectively enrolled. Patients' medical records, pulmonary function and cardiopulmonary exercise testing, including non-invasive cardiac hemodynamics and chronotropic response were studied. Compared with age-matched controls, maximal workload (91 ± 8 vs. 65 ± 20 watts) and peak VO2 (19.5 ± 3.0 vs. 14.4 ± 4.1 mL.kg-1.min-1) were lower in ATTRv patients. Despite reaching similar age-predicted maximal HR, ATTRv patients displayed smaller changes in stroke volume (SV) index relative to change in VO2 (49 ± 26 vs. 67 ± 18%). Adequate chronotropic-metabolic index was prevalent in ATTRv patients. HR recovery, as percent decrease in peak HR at 1 and 3-min, was blunded ATTv patients.Conclusions: In Val122Ile ATTRv patients, chronotropic response was appropriate relative to exercise intensity with only few patients displaying CI. HR response to exercise was further characterised by blunted HR recovery in ATTRv patients suggesting lower parasympathetic activity and greater sympathetic stimulation compared with controls.
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Affiliation(s)
- Astrid Monfort
- Department of Cardiology CHU Martinique, University Hospital of Martinique, Fort de France, France.,Cardiovascular Research Team EA7525, Antilles University, Pointe-à-Pitre, France
| | - Rishika Banydeen
- Cardiovascular Research Team EA7525, Antilles University, Pointe-à-Pitre, France.,Department of Epidemiology and Biostatistics CHU Martinique, University Hospital of Martinique, Fort de France, France
| | - Fabrice Demoniere
- Department of Cardiology CHU Martinique, University Hospital of Martinique, Fort de France, France
| | - Baptiste Courty
- Department of Cardiology CHU Martinique, University Hospital of Martinique, Fort de France, France
| | - Rebecca Codiat
- Department of Cardiology CHU Martinique, University Hospital of Martinique, Fort de France, France
| | - Remi Neviere
- Department of Cardiology CHU Martinique, University Hospital of Martinique, Fort de France, France.,Cardiovascular Research Team EA7525, Antilles University, Pointe-à-Pitre, France
| | - Jocelyn Inamo
- Department of Cardiology CHU Martinique, University Hospital of Martinique, Fort de France, France.,Cardiovascular Research Team EA7525, Antilles University, Pointe-à-Pitre, France
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Lyu S, Zhang J, Nie J, Li C, Gao T, Yuan W, Chen Z, Ma J. Comparative study of physiologic characteristics between the newly compiled Bafa Wubu of tai chi and 24 form simplified tai chi. BMC Sports Sci Med Rehabil 2020; 12:43. [PMID: 32760589 PMCID: PMC7391605 DOI: 10.1186/s13102-020-00192-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 07/21/2020] [Indexed: 11/10/2022]
Abstract
Background The newly compiled Bafa Wubu of Tai Chi (Eight Methods and Five Footworks) is a fitness routine that has been developed in accordance with the appeal of the General Administration of Sport of China and promoted both in China and abroad. This paper aims to compare the differences in energy consumption and related parameters between the two types of Tai Chi. Methods A total of 60 healthy participants were recruited; 37 males (aged 37.4 ± 10.4 years) and 23 females (aged 31.9 ± 12.8 years). The maximal exercise capacity of participants was measured at baseline. Then, they received Tai Chi training for 12-week and their energy metabolism was measured dynamically. Results A set of the Bafa Wubu of Tai Chi requires approximately 3 min, while a set of 24 form simplified Tai Chi approximately 5 min and 40 s. The average oxygen uptake/kg (VO2/kg, 10.8 ± 2.52 ml/kg/min vs. 12.9 ± 2.59 ml/kg/min, P = 0.000), the highest VO2/kg (19.3 ± 6.03 ml/kg/min vs. 24.1 ± 7.50 ml/kg/min, p = 0.000, the average metabolic equivalent (METs,2.3 ± 0.16 METs vs. 3.2 ± 0.14 METs, p = 0.000), the highest oxygen pulse (VO2/HR, 11.1 ± 0.99 ml vs. 13.9 ± 0.93 ml, p = 0.000) and rate of perceived exertion (RPE, 10.7 ± 0.70 vs. 1.3 ± 0.62, p = 0.000) gained immediately after Bafa Wubu of Tai Chi exercise were significantly lower than those in 24 form simplified Tai Chi; heart rate recovery (HRR,1.5 ± 0.41 vs. 1.3 ± 0.45, p = 0.008) at 1 min after the practice was significantly higher than after the 24 form simplified Tai Chi. Meanwhile, the average heart rate (HR, 104.1 ± 11.41 bpm vs. 105.7 ± 9.68 bpm, p = 0.696) and the highest respiratory quotient (RQ, 1.0 ± 0.06 vs. 0.9 ± 0.09, p = 0.643) were not significantly different. The intensity of Tai Chi was described as the highest oxygen uptake of the participants when they performed the Tai Chi divided by their individual maximal oxygen uptake. Tai Chi intensity during Bafa Wubu of Tai Chi (50% ± 11.7% vs. 64% ± 12.5%) was significantly lower than during 24 form simplified Tai Chi. Conclusion The newly compiled Bafa Wubu of Tai Chi is characterized by lower energy consumption than 24 form simplified Tai Chi. Trial registration Ethics Committee of Sports Science Experiment, Beijing Sport University- 2018010H. Registered 19 June 2018.
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Affiliation(s)
- Shaojun Lyu
- College of Physical Education and Sports, Beijing Normal University, Beijing, 100875 China
| | - Jianwei Zhang
- College of Physical Education and Sports, Beijing Normal University, Beijing, 100875 China
| | - Jianquan Nie
- Party Office, The Central Institute of Ethnic Administrators, Beijing, 100094 China
| | - Cuihan Li
- College of Wushu, Beijing Sport University, Beijing, 100084 China
| | - Tianming Gao
- College of Physical Education and Sports, Beijing Normal University, Beijing, 100875 China
| | - Wen Yuan
- College of Wushu, Beijing Sport University, Beijing, 100084 China
| | - Zaihao Chen
- College of Wushu, Beijing Sport University, Beijing, 100084 China
| | - Jing Ma
- Department of Cardiology, First Medical Center of Chinese People's Libration Army General Hospital, Beijing, 100853 China
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Christoffersen L, Gibson TM, Pui CH, Joshi V, Partin RE, Green DM, Lanctot JQ, Howell CR, Mulrooney DA, Armstrong GT, Robison LL, Hudson MM, Ness KK. Cardiac autonomic dysfunction in survivors of childhood acute lymphoblastic leukemia: The St. Jude Lifetime Cohort Study. Pediatr Blood Cancer 2020; 67:e28388. [PMID: 32383821 PMCID: PMC7302420 DOI: 10.1002/pbc.28388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/15/2020] [Accepted: 04/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiac autonomic dysfunction (CAD) is possible following treatment for childhood cancer. The aims of our analyses were to compare the prevalence of CAD between adult survivors of childhood acute lymphoblastic leukemia and controls, compare exercise response among survivors with and without CAD, and identify treatment-related risk factors for CAD. PROCEDURE Participants were treated for childhood acute lymphoblastic leukemia at St. Jude Children's Research Hospital between 1980 and 2003 (N = 338). A comparison group matched for race/ethnicity, age, and sex was also recruited (N = 325). Resting heart rate (HR) was assessed via electrocardiogram, and heart rate recovery (HRR) and exercise capacity were evaluated with submaximal cardiopulmonary exercise testing. RESULTS CAD was present in 33.7% of survivors and 27.6% of controls (P = 0.09). Although mean resting HR did not differ between survivors and controls (74 ± 12 vs 72 ± 12 beats per minute (bpm), P = 0.07), survivors had lower mean HRR than controls (22 ± 9 vs 25 ± 10 bpm; P < 0.001). Survivors with CAD had lower peak exercise tolerance (25.7 ± 6.5 vs 21.2 ± 4.9 mL/kg/min, P < 0.001) than those without. Survivors treated with cyclophosphamide in combination with vincristine ≥38 mg/m2 and/or glucocorticoids ≥10 000 mg/m2 were 1.56 (95% CI 1.09-2.24) times more likely to have CAD than those without this treatment. Obese survivors were 1.78 (95% CI: 1.31-2.40) times more likely to have CAD than nonobese survivors (P < 0.001). CONCLUSION CAD was present in over one third of survivors and was associated with lower exercise capacity. Obese survivors and those exposed to cyclophosphamide with high doses of vincristine and/or corticosteroids were at greatest risk.
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Affiliation(s)
- Lindsey Christoffersen
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Department of Rehabilitation Services, St. Jude Children’s Research Hospital, Memphis, TN
| | - Todd M. Gibson
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Ching-Hon Pui
- Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Vijaya Joshi
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Robyn E. Partin
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel M. Green
- Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer Q. Lanctot
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carrie R. Howell
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel A. Mulrooney
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Gregory T. Armstrong
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Leslie L. Robison
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M. Hudson
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN,College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Kirsten K. Ness
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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Avocado (Persea americana) pulp improves cardiovascular and autonomic recovery following submaximal running: a crossover, randomized, double-blind and placebo-controlled trial. Sci Rep 2020; 10:10703. [PMID: 32612186 PMCID: PMC7329896 DOI: 10.1038/s41598-020-67577-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/19/2020] [Indexed: 11/28/2022] Open
Abstract
Previous studies have demonstrated that regular avocado consumption presents advantageous effects on cardiovascular system. However, little attention has been paid to the use of avocado as a dietary supplement, in particular, for individuals involved in physical exercise training. Therefore, this study aims to evaluate the effect of acute avocado pulp intake on cardiovascular and autonomic recovery subsequent to moderate exercise. Using a crossover, randomized, double-blind and placebo-controlled trial design, 16 healthy female adults underwent two protocols: Avocado pulp (600 mg in capsule) and placebo (600 mg starch in capsule). After the ingestion of Avocado pulp or placebo, the subjects were seated for 60 min at rest, followed by running on a treadmill at a submaximal level and then remained seated for 60 min during recovery from the exercise. Heart rate (HR), heart rate variability (HRV) [rMSSD, SD1, HF (ms2)] and skin conductance were evaluated before and during exercise, as well as during recovery. HR, systolic blood pressure, HRV and skin conductance recovered faster when subjects were given avocado pulp prior to exercise. In conclusion, avocado pulp improved cardiovascular and autonomic recovery after exercise, suggesting a reduced risk of cardiovascular events after exertion. The current results support the beneficial effects of ingestion of avocado prior to submaximal treadmill running.
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Sacubitril/Valsartan Improves Autonomic Function and Cardiopulmonary Parameters in Patients with Heart Failure with Reduced Ejection Fraction. J Clin Med 2020; 9:jcm9061897. [PMID: 32560431 PMCID: PMC7356720 DOI: 10.3390/jcm9061897] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Heart rate recovery (HRR) is a marker of vagal tone, which is a powerful predictor of mortality in patients with cardiovascular disease. Sacubitril/valsartan (S/V) is a treatment for heart failure with reduced ejection fraction (HFrEF), which impressively impacts cardiovascular outcome. This study aims at evaluating the effects of S/V on HRR and its correlation with cardiopulmonary indexes in HFrEF patients. METHODS Patients with HFrEF admitted to outpatients' services were screened out for study inclusion. S/V was administered according to guidelines. Up-titration was performed every 4 weeks when tolerated. All patients underwent laboratory measurements, Doppler-echocardiography, and cardiopulmonary exercise stress testing (CPET) at baseline and at 12-month follow-up. RESULTS Study population consisted of 134 HFrEF patients (87% male, mean age 57.9 ± 9.6 years). At 12-month follow-up, significant improvement in left ventricular ejection fraction (from 28% ± 5.8% to 31.8% ± 7.3%, p < 0.0001), peak exercise oxygen consumption (VO2peak) (from 15.3 ± 3.7 to 17.8 ± 4.2 mL/kg/min, p < 0.0001), the slope of increase in ventilation over carbon dioxide output (VE/VCO2 slope )(from 33.4 ± 6.2 to 30.3 ± 6.5, p < 0.0001), and HRR (from 11.4 ± 9.5 to 17.4 ± 15.1 bpm, p = 0.004) was observed. Changes in HRR were significantly correlated to changes in VE/VCO2slope (r = -0.330; p = 0.003). After adjusting for potential confounding factors, multivariate analysis showed that changes in HRR were significantly associated to changes in VE/VCO2slope (Beta (B) = -0.975, standard error (SE) = 0.364, standardized Beta coefficient (Bstd) = -0.304, p = 0.009). S/V showed significant reduction in exercise oscillatory ventilation (EOV) detection at CPET (28 EOV detected at baseline CPET vs. 9 EOV detected at 12-month follow-up, p < 0.001). HRR at baseline CPET was a significant predictor of EOV at 12-month follow-up (B = -2.065, SE = 0.354, p < 0.001). CONCLUSIONS In HFrEF patients, S/V therapy improves autonomic function, functional capacity, and ventilation. Whether these findings might translate into beneficial effects on prognosis and outcome remains to be elucidated.
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De Cannière H, Smeets CJP, Schoutteten M, Varon C, Van Hoof C, Van Huffel S, Groenendaal W, Vandervoort P. Using Biosensors and Digital Biomarkers to Assess Response to Cardiac Rehabilitation: Observational Study. J Med Internet Res 2020; 22:e17326. [PMID: 32432552 PMCID: PMC7270861 DOI: 10.2196/17326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/06/2020] [Accepted: 04/10/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is known for its beneficial effects on functional capacity and is a key component within current cardiovascular disease management strategies. In addition, a larger increase in functional capacity is accompanied by better clinical outcomes. However, not all patients respond in a similar way to CR. Therefore, a patient-tailored approach to CR could open up the possibility to achieve an optimal increase in functional capacity in every patient. Before treatment can be optimized, the differences in response of patients in terms of cardiac adaptation to exercise should first be understood. In addition, digital biomarkers to steer CR need to be identified. OBJECTIVE The aim of the study was to investigate the difference in cardiac response between patients characterized by a clear improvement in functional capacity and patients showing only a minor improvement following CR therapy. METHODS A total of 129 patients in CR performed a 6-minute walking test (6MWT) at baseline and during four consecutive short-term follow-up tests while being equipped with a wearable electrocardiogram (ECG) device. The 6MWTs were used to evaluate functional capacity. Patients were divided into high- and low-response groups, based on the improvement in functional capacity during the CR program. Commonly used heart rate parameters and cardiac digital biomarkers representative of the heart rate behavior during the 6MWT and their evolution over time were investigated. RESULTS All participating patients improved in functional capacity throughout the CR program (P<.001). The heart rate parameters, which are commonly used in practice, evolved differently for both groups throughout CR. The peak heart rate (HRpeak) from patients in the high-response group increased significantly throughout CR, while no change was observed in the low-response group (F4,92=8.321, P<.001). Similar results were obtained for the recovery heart rate (HRrec) values, which increased significantly over time during every minute of recuperation, for the high-response group (HRrec1: P<.001, HRrec2: P<.001, HRrec3: P<.001, HRrec4: P<.001, and HRrec5: P=.02). The other digital biomarkers showed that the evolution of heart rate behavior during a standardized activity test differed throughout CR between both groups. These digital biomarkers, derived from the continuous measurements, contribute to more in-depth insight into the progression of patients' cardiac responses. CONCLUSIONS This study showed that when using wearable sensor technology, the differences in response of patients to CR can be characterized by means of commonly used heart rate parameters and digital biomarkers that are representative of cardiac response to exercise. These digital biomarkers, derived by innovative analysis techniques, allow for more in-depth insights into the cardiac response of cardiac patients during standardized activity. These results open up the possibility to optimized and more patient-tailored treatment strategies and to potentially improve CR outcome.
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Affiliation(s)
- Hélène De Cannière
- Mobile Health Unit, Limburg Clinical Research Center (LCRC), Faculty of Medicine and Life Sciences, Hasselt University (UHasselt), Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Christophe J P Smeets
- Mobile Health Unit, Limburg Clinical Research Center (LCRC), Faculty of Medicine and Life Sciences, Hasselt University (UHasselt), Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
- Holst Centre, imec the Netherlands, Eindhoven, Netherlands
| | - Melanie Schoutteten
- Mobile Health Unit, Limburg Clinical Research Center (LCRC), Faculty of Medicine and Life Sciences, Hasselt University (UHasselt), Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Carolina Varon
- Center for Dynamical Systems, Signal Processing and Data Analytics (STADIUS), Department of Electrical Engineering (ESAT), KU (Katholieke Universiteit) Leuven, Leuven, Belgium
- Circuits and Systems (CAS), Department of Microelectronics, Delft University of Technology (TU Delft), Delft, Netherlands
| | - Chris Van Hoof
- Center for Dynamical Systems, Signal Processing and Data Analytics (STADIUS), Department of Electrical Engineering (ESAT), KU (Katholieke Universiteit) Leuven, Leuven, Belgium
- imec vzw Belgium, Leuven, Belgium
| | - Sabine Van Huffel
- Center for Dynamical Systems, Signal Processing and Data Analytics (STADIUS), Department of Electrical Engineering (ESAT), KU (Katholieke Universiteit) Leuven, Leuven, Belgium
| | | | - Pieter Vandervoort
- Mobile Health Unit, Limburg Clinical Research Center (LCRC), Faculty of Medicine and Life Sciences, Hasselt University (UHasselt), Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
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Qiu S, Bosnyák E, Zügel M, Steinacker JM, Schumann U. Autonomic function may not modulate irisin release in healthy adults: findings from a randomized cross-over study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:201-204. [PMID: 32555986 PMCID: PMC10522212 DOI: 10.20945/2359-3997000000243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 02/11/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Autonomic nervous system, especially the sympathetic nervous system, may stimulate the expression of peroxisome proliferator-activated receptor γ coactivator-1α, which regulates irisin. This study aimed to explore whether there was any association between autonomic function as assessed by heart rate related indices and irisin release following acute exercise. SUBJECTS AND METHODS Seventeen healthy adults were asked to perform an incremental exhaustive cycling as well as an incremental exhaustive running separately on different days. Heart rate was monitored, and blood samples were collected before, immediately, 10-, and 60-minutes post-exercise. Serum irisin was measured using ELISA kit. RESULTS Markers for autonomic function, such as heart rate at rest, peak, or recovery, heart rate reserve, heart rate recovery, and chronotropic index, were comparable between cycling and running (all P > 0.10). Irisin was increased immediately following both exercise. No significant association was observed between heart rate at rest, peak, or recovery and irisin level at the corresponding time-point, as well as between heart rate reserve, heart rate recovery, or chronotropic index and exercise induced irisin release, with or without controlling for age, body mass index, and glucose (all P > 0.10). CONCLUSIONS Autonomic function might not be associated with irisin release in healthy adults. Arch Endocrinol Metab. 2020;64(3):201-4.
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Affiliation(s)
- Shanhu Qiu
- Shenzhen People’s HospitalClinical Medical CollegeJinan UniversityChinaDepartment of Endocrinology,Shenzhen People’s Hospital; The Second Clinical Medical College of Jinan University; The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
- The First Affiliated HospitalSouthern University of Science and TechnologyShenzhenChina
- Zhongda HospitalSchool of MedicineSoutheast UniversityNanjingChina Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
- Division of Sports and Rehabilitation MedicineUlm University Medical CenterUlmGermanyDivision of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | - Edit Bosnyák
- Division of Sports and Rehabilitation MedicineUlm University Medical CenterUlmGermanyDivision of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
- Department of Health Sciences and Sports MedicineUniversity of Physical EducationBudapestHungaryDepartment of Health Sciences and Sports Medicine, University of Physical Education, Budapest, Hungary
| | - Martina Zügel
- Division of Sports and Rehabilitation MedicineUlm University Medical CenterUlmGermanyDivision of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | - Jürgen Michael Steinacker
- Division of Sports and Rehabilitation MedicineUlm University Medical CenterUlmGermanyDivision of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | - Uwe Schumann
- Division of Sports and Rehabilitation MedicineUlm University Medical CenterUlmGermanyDivision of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
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Exercise-based cardiac rehabilitation and parasympathetic function in patients with coronary artery disease: a systematic review and meta-analysis. Clin Auton Res 2020; 31:187-203. [PMID: 32270406 DOI: 10.1007/s10286-020-00687-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/24/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The effects of exercise-based cardiac rehabilitation (CR) on parasympathetic modulation are controversial. This systematic review and meta-analysis aims to (a) determine the effect of exercise-based CR on heart-rate-derived indices associated with cardiac parasympathetic modulation in resting and post-exercise conditions in coronary artery disease (CAD) patients and (b) identify the possible moderator variables of the effect of exercise-based CR on parasympathetic modulation. METHODS We searched CENTRAL and Web of Science up to November 2018 for the following terms: adult CAD patients, controlled exercise-based CR interventions and parasympathetic modulation measured in resting (vagal-related heart rate variability [HRV] indices of the root mean square of the differences in successive in RR interval [RMSSD] and high frequency [HF]) and post-exercise (heart rate recovery [HRR]) pre- and post-intervention. We estimated a random-effects model of standardised mean difference (SMD) and mean difference (MD) for vagal-related HRV indices and HRR, respectively. We assessed the influence of categorical and continuous variables. RESULTS The overall effect size showed significant differences in RMSSD (SMD+ = 0.30; 95% confidence interval [CI] = 0.12-0.49) and HRR (MD+ = 5.35; 95% CI = 4.08-6.61 bpm) in favour of the exercise-based CR group. The overall effect size showed no differences in HF between groups (SMD+ = 0.14; 95% CI, -0.12-0.40). Heterogeneity analyses reached statistical significance, with high heterogeneity for HF (p < 0.001; I2 = 70%) and HRR (p < 0.001; I2 = 85%). Analysis of the moderator variables showed that the effect on HRR is greater in young patients (p = 0.008) and patients treated with percutaneous intervention (p = 0.020). CONCLUSIONS Exercise-based CR improves the post-exercise parasympathetic function, with greater effects in younger CAD patients and in those who were revascularised with percutaneous intervention. The effects on resting parasympathetic function are more controversial due to methodological inconsistencies in measuring HRV, with the use of RMSSD recommended instead of HF because its results show higher consistency. Future studies involving women, focusing on methodological issues, and performing other training methods are needed to increase our knowledge about this topic.
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Turan Y, Gürel A. The heart rate recovery is impaired in participants with premature ejaculation. Andrologia 2020; 52:e13573. [PMID: 32189391 DOI: 10.1111/and.13573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/09/2020] [Accepted: 03/03/2020] [Indexed: 12/15/2022] Open
Abstract
Premature ejaculation (PE) is one of the most common sexual disorders in men. Excessive activity of the sympathetic nervous system is considered as one of the pathological mechanisms of PE. Heart rate recovery (HRR) is a noninvasive and easily applicable method for evaluating autonomic functions. We aimed to investigate the relationship between PE and HRR. This cross-sectional study included 42 consecutive patients with lifelong PE and 98 healthy volunteers. All participants underwent stress tests according to age-dependent target heart rates outlined in the Bruce protocol. When the maximal heart rate was reached in the stress test, intensive exercise was terminated and electrocardiographic records were obtained for 3 min in the cool-down period. The HRR indices were calculated by subtracting the heart rate at first, second and third minutes from the maximal HR. The two groups were similar in terms of age, body mass index, serum glucose and lipid parameters. HRR indices were significantly lower in the PE group compared with the control group (p < .05 for all). Common factors that affect equilibrium of sympathetic and parasympathetic nervous systems may be involved in the PE and abnormal HRR etiopathogenesis. The cause-and-effect relationship can be more clearly demonstrated with large-scale, prospective studies.
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Affiliation(s)
- Yaşar Turan
- Department of Cardiology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Abdullah Gürel
- Department of Urology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
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Magutah K, Thairu K, Patel N. Effect of short moderate intensity exercise bouts on cardiovascular function and maximal oxygen consumption in sedentary older adults. BMJ Open Sport Exerc Med 2020; 6:e000672. [PMID: 32180993 PMCID: PMC7050352 DOI: 10.1136/bmjsem-2019-000672] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2020] [Indexed: 01/11/2023] Open
Abstract
AIM To investigate effect of <10 min moderate intensity exercise on cardiovascular function and maximal oxygen consumption (V ˙ O2max) among sedentary adults. METHODS We studied 53 sedentary urbanites aged ≥50 years, randomised into: (1) male (MS) and (2) female (FS) undertaking three short-duration exercise (5-10 min) daily, and (3) male (ML) and (4) female (FL) exercising 30-60 min 3-5 days weekly. Resting systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate andV ˙ O2max were measured at baseline and 8 weekly for 24 weeks. RESULTS At baseline, 50% MS, 61.5% ML, 53.8% FS and 53.8% FL had SBP ≥120 mm Hg, and 14.3% MS, 53.8% ML, 23.1% FS and 38.5% FL had DBP ≥80 mm Hg. At 24 weeks, where SBP remained ≥120 mm Hg, values decreased from 147±19.2 to 132.3±9.6 mm Hg (50% of MS), from 144±12.3 to 128±7.0 mm Hg (23.1% of ML), from 143.1±9.6 to 128.0±7.0 mm Hg (53.8% of FS) and from 152.3±23.7 to 129±3.7 mm Hg (30.8% of FL). For DBP ≥80 mm Hg, MS and FS percentages maintained, but values decreased from 101±15.6 to 84.5±0.7 mm Hg (MS) and 99.0±3.6 to 87.7±4.9 mm Hg (FS). In ML and FL, percentage with DBP ≥80 mm Hg dropped to 15.4% (86.1±6.5 to 82.5±3.5 mm Hg) and (91.4±5.3 to 83.5±0.71 mm Hg).V ˙ O2max increased from 26.1±4.4 to 32.0±6.2 for MS, from 25.8±5.1 to 28.8±5.4 for ML (group differences p=0.02), from 20.2±1.8 to 22.7±2.0 for FS and from 21.2±1.9 to 24.2±2.7 for FL (groups differences p=0.38). CONCLUSION Accumulated moderate intensity exercise bouts of <10 min confer similar-to-better cardiovascular andV ˙ O2max improvements compared with current recommendations among sedentary adults.
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Affiliation(s)
- Karani Magutah
- Medical Physiology, Moi University School of Medicine, Eldoret, Kenya
| | - Kihumbu Thairu
- Medical Physiology, University of Nairobi, Nairobi, Kenya
| | - Nilesh Patel
- Medical Physiology, University of Nairobi, Nairobi, Kenya
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Storniolo JL, Esposti R, Cavallari P. Heart Rate Kinetics and Sympatho-Vagal Balance Accompanying a Maximal Sprint Test. Front Psychol 2020; 10:2950. [PMID: 32038363 PMCID: PMC6987453 DOI: 10.3389/fpsyg.2019.02950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/12/2019] [Indexed: 11/13/2022] Open
Abstract
When a maximal sprint starts, heart rate (HR) quickly increases. After the exercise ends, HR keeps high for seconds before recovering with a roughly exponential decay. Such decay and its time constant (τoff) have been widely studied, but less attention was devoted to the time delay (tdelay) between sprint end and HR decay onset. Considering the correlation between sympatho-vagal balance and performance, as well as the occurrence of heart failure in cardiopaths during the post-exercise phase, we evaluated sympatho-vagal balance before and after sprint, trying to correlate it with both tdelay and τoff. R-R intervals, recorded in 24 healthy adults from 5 min before to 5 min after a 60-m sprint-test (from Storniolo et al., 2017, with permission of all authors), were re-processed to extract HR variability power (LF and HF) in the low- and high-frequency ranges, respectively. The sympatho-vagal balance, evaluated in pre-test resting period (LF/HF)REST and at steady-state recovery (LF/HF)RECOV, was correlated with tdelay and τoff. Both (LF/HF)REST and (LF/HF)RECOV had a skewed distribution. Significant rank correlation was found for (LF/HF)REST vs. τoff and for (LF/HF)RECOV vs. both τoff and tdelay. The difference (LF/HF)RECOV-REST had a normal distribution and a strong partial correlation with tdelay but not with τoff. Thus, a long tdelay marks a sympathetic activity that keeps high after exercise, while a high sympathetic activity before sprint leads to a slow recovery (high τoff), seemingly accompanying a poor performance.
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Affiliation(s)
- Jorge L Storniolo
- Human Physiology Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Roberto Esposti
- Human Physiology Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Cavallari
- Human Physiology Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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81
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de Oliveira LS, Fontes AMGG, Vitor ALR, Vanderlei FM, Garner DM, Valenti VE. Lower Systolic Blood Pressure in Normotensive Subjects is Related to Better Autonomic Recovery Following Exercise. Sci Rep 2020; 10:1006. [PMID: 31969683 PMCID: PMC6976706 DOI: 10.1038/s41598-020-58031-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/13/2019] [Indexed: 02/07/2023] Open
Abstract
Blood pressure (BP) is a cardiovascular parameter applied to detect cardiovascular risk. Recently, the pre-hypertension state has received greater consideration for prevention strategies. We evaluated autonomic and cardiorespiratory recovery following aerobic exercise in normotensive individuals with different systolic BP (SBP) values. We investigated 30 healthy men aged 18 to 30 years divided into groups according to systolic BP (SBP): G1 (n = 16), resting SBP <110 mmHg and G2 (n = 14), resting SBP between 120-110 mmHg. The groups endured 15 minutes seated at rest, followed by a submaximal aerobic exercise on a treadmill and then remaining seated for 60 minutes also at rest, during recovery from the exercise. Cardiorespiratory parameters and heart rate (HR) variability (HRV) (rMSSD, SD1, HF [ms2]) were evaluated before and during recovery from exercise. G2 displayed slower return of SBP, rMSSD and SD1 HRV indices during recovery from exercise compared to G1. In conclusion, normotensive subjects with higher resting SBP (110 to 120 mmHg) offered delayed autonomic recovery following moderate exercise. We suggest that this group may be less physiologically optimized leading to cardiac risks.
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Affiliation(s)
- Letícia Santana de Oliveira
- Autonomic Nervous System Center, Post-Graduate Program in Physical Therapy, São Paulo State University, UNESP, Presidente Prudente, SP, Brazil
| | - Anne Michelli G G Fontes
- Autonomic Nervous System Center, Post-Graduate Program in Physical Therapy, São Paulo State University, UNESP, Presidente Prudente, SP, Brazil
| | - Ana Laura Ricci Vitor
- Autonomic Nervous System Center, Post-Graduate Program in Physical Therapy, São Paulo State University, UNESP, Presidente Prudente, SP, Brazil
| | - Franciele M Vanderlei
- Autonomic Nervous System Center, Post-Graduate Program in Physical Therapy, São Paulo State University, UNESP, Presidente Prudente, SP, Brazil
| | - David M Garner
- Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Gipsy Lane, Oxford, OX3 0BP, United Kingdom
| | - Vitor E Valenti
- Autonomic Nervous System Center, Post-Graduate Program in Physical Therapy, São Paulo State University, UNESP, Presidente Prudente, SP, Brazil.
- Autonomic Nervous System Center (CESNA), São Paulo State University, UNESP, Marilia, SP, Brazil.
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82
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Santana MDR, Garner DM, de Moraes YM, Mangueira LB, Alcantara GC, da Silva JRA, Raimundo RD, Oliveira FR, Valenti VE. Association Between Hospital Anxiety Depression Scale and Autonomic Recovery Following Exercise. J Clin Psychol Med Settings 2019; 27:295-304. [PMID: 31776757 DOI: 10.1007/s10880-019-09683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The hospital anxiety depression scale (HADS) is a benchmark used to investigate possible and probable cases of psychosomatic illness. Its affiliation with autonomic recovery after exercise is unclear and, as a technique applied to evaluate cardiovascular risk. We assessed a possible link between HADS and autonomic recovery after exercise. We studied healthy subjects split into two groups: Low HADS (n = 20) and High HADS (n = 21). Subjects consented to moderate aerobic exercise on a treadmill at 60% to 65% of the maximum heart rate (HR) for 30 min. We studied HR variability (HRV) before and during 30 min after exercise. Subjects with higher HADS values presented delayed recovery of HR and root-mean square of differences between adjacent normal RR intervals (RMSSD) after submaximal exercise. RMSSD during recovery from exercise had a significant association with HADS. In summary, subjects with higher HADS presented slower vagal recovery following exercise.
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Affiliation(s)
- Milana D R Santana
- Physiological and Pharmaceutical Sciences Nucleus, School of Juazeiro do Norte, R. São Francisco, 1224 - São Miguel, Juazeiro Do Norte, CE, 63010-475, Brazil
| | - David M Garner
- Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Gipsy Lane, Oxford, OX3 0BP, UK
| | - Yasmim M de Moraes
- Physiological and Pharmaceutical Sciences Nucleus, School of Juazeiro do Norte, R. São Francisco, 1224 - São Miguel, Juazeiro Do Norte, CE, 63010-475, Brazil
| | - Luana B Mangueira
- Physiological and Pharmaceutical Sciences Nucleus, School of Juazeiro do Norte, R. São Francisco, 1224 - São Miguel, Juazeiro Do Norte, CE, 63010-475, Brazil
| | - Guilherme C Alcantara
- Physiological and Pharmaceutical Sciences Nucleus, School of Juazeiro do Norte, R. São Francisco, 1224 - São Miguel, Juazeiro Do Norte, CE, 63010-475, Brazil
| | - José R A da Silva
- Physiological and Pharmaceutical Sciences Nucleus, School of Juazeiro do Norte, R. São Francisco, 1224 - São Miguel, Juazeiro Do Norte, CE, 63010-475, Brazil
| | - Rodrigo D Raimundo
- Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil.
| | - Fernando R Oliveira
- Department of Epidemiology, School of Public Health, University of São Paulo, USP, Av. Dr. Arnaldo, 715 - Cerqueira César, Sao Paulo, SP, Brazil
| | - Vitor E Valenti
- Autonomic Nervous System Center, UNESP, Av. Hygino Muzzi Filho, 737, Bairro: Mirante, Marília, SP, 17.525-900, Brazil
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83
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Peçanha T, Low D, de Brito LC, Fecchio RY, de Sousa PN, da Silva-Júnior ND, de Abreu AP, da Silva GV, Mion-Junior D, Forjaz CLDM. Effects of postexercise cooling on heart rate recovery in normotensive and hypertensive men. Clin Physiol Funct Imaging 2019; 40:114-121. [PMID: 31769592 DOI: 10.1111/cpf.12612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/23/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Postexercise heart rate recovery (HRR) is determined by cardiac autonomic restoration after exercise and is reduced in hypertension. Postexercise cooling accelerates HRR in healthy subjects, but its effects in a population with cardiac autonomic dysfunction, such as hypertensives (HT), may be blunted. This study assessed and compared the effects of postexercise cooling on HRR and cardiac autonomic regulation in HT and normotensive (NT) subjects. METHODS Twenty-three never-treated HT (43 ± 8 years) and 25 NT (45 ± 8 years) men randomly underwent two exercise sessions (30 min of cycling at 70% VO2peak ) followed by 15 min of recovery. In one randomly allocated session, a fan was turned on in front of the subject during the recovery (cooling), while in the other session, no cooling was performed (control). HRR was assessed by heart rate reductions after 60 s (HRR60s) and 300 s (HRR300s) of recovery, short-term time constant of HRR (T30) and the time constant of the HRR after exponential fitting (HRRτ). HRV was assessed using time- and frequency-domain indices. RESULTS HRR and HRV responses in the cooling and control sessions were similar between the HT and NT. Thus, in both groups, postexercise cooling equally accelerated HRR (HRR300s = 39±12 versus 36 ± 10 bpm, P≤0·05) and increased postexercise HRV (lnRMSSD = 1·8 ± 0·7 versus 1·6 ± 0·7 ms, P≤0·05). CONCLUSION Differently from the hypothesis, postexercise cooling produced similar improvements in HRR in HT and NT men, likely by an acceleration of cardiac parasympathetic reactivation and sympathetic withdrawal. These results suggest that postexercise cooling equally accelerates HRR in hypertensive and normotensive subjects.
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Affiliation(s)
- Tiago Peçanha
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - David Low
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Leandro Campos de Brito
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Rafael Yokoyama Fecchio
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Patrícia Nascimento de Sousa
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Natan Daniel da Silva-Júnior
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Andrea Pio de Abreu
- Hypertension Unit, General Hospital, University of São Paulo, São Paulo, Brazil
| | | | - Décio Mion-Junior
- Hypertension Unit, General Hospital, University of São Paulo, São Paulo, Brazil
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84
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Cristina-Oliveira M, Meireles K, Spranger MD, O'Leary DS, Roschel H, Peçanha T. Clinical safety of blood flow-restricted training? A comprehensive review of altered muscle metaboreflex in cardiovascular disease during ischemic exercise. Am J Physiol Heart Circ Physiol 2019; 318:H90-H109. [PMID: 31702969 DOI: 10.1152/ajpheart.00468.2019] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Blood flow restriction training (BFRT) is an increasingly widespread method of exercise that involves imposed restriction of blood flow to the exercising muscle. Blood flow restriction is achieved by inflating a pneumatic pressure cuff (or a tourniquet) positioned proximal to the exercising muscle before, and during, the bout of exercise (i.e., ischemic exercise). Low-intensity BFRT with resistance training promotes comparable increases in muscle mass and strength observed during high-intensity exercise without blood flow restriction. BFRT has expanded into the clinical research setting as a potential therapeutic approach to treat functionally impaired individuals, such as the elderly, and patients with orthopedic and cardiovascular disease/conditions. However, questions regarding the safety of BFRT must be fully examined and addressed before the implementation of this exercise methodology in the clinical setting. In this respect, there is a general concern that BFRT may generate abnormal reflex-mediated cardiovascular responses. Indeed, the muscle metaboreflex is an ischemia-induced, sympathoexcitatory pressor reflex originating in skeletal muscle, and the present review synthesizes evidence that BFRT may elicit abnormal cardiovascular responses resulting from increased metaboreflex activation. Importantly, abnormal cardiovascular responses are more clearly evidenced in populations with increased cardiovascular risk (e.g., elderly and individuals with cardiovascular disease). The evidence provided in the present review draws into question the cardiovascular safety of BFRT, which clearly needs to be further investigated in future studies. This information will be paramount for the consideration of BFRT exercise implementation in clinical populations.
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Affiliation(s)
- Michelle Cristina-Oliveira
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Kamila Meireles
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Marty D Spranger
- Department of Physiology, Michigan State University, East Lansing, Michigan
| | - Donal S O'Leary
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Tiago Peçanha
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
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85
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Fecchio RY, Brito L, Leicht AS, Forjaz CL, Peçanha T. Reproducibility of post-exercise heart rate recovery indices: A systematic review. Auton Neurosci 2019; 221:102582. [DOI: 10.1016/j.autneu.2019.102582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/03/2019] [Accepted: 08/21/2019] [Indexed: 01/14/2023]
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86
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Milan-Mattos JC, de Oliveira Francisco C, Ferroli-Fabrício AM, Minatel V, Marcondes ACA, Porta A, Beltrame T, Parizotto NA, Ferraresi C, Bagnato VS, Catai AM. Acute effect of photobiomodulation using light-emitting diodes (LEDs) on baroreflex sensitivity during and after constant loading exercise in patients with type 2 diabetes mellitus. Lasers Med Sci 2019; 35:329-336. [PMID: 31203569 DOI: 10.1007/s10103-019-02815-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
To evaluate the photobiomodulation (PBM) effect on the cardiovascular autonomic control, analyzed by baroreflex sensitivity (sequence method), during constant load exercise and recovery in diabetic men, we evaluated 11 men with type 2 diabetes (DM2) (40-64 years). The constant workload exercise protocol (TECC) was performed on two different days, 14 days apart from each other, to guarantee PBM washout period. After PBM by light-emitting diode (LED) irradiation (150 J or 300 J or placebo), 10 min of rest (REST) was performed. After this period, the volunteer was positioned on a cycloergometer to start the test (1-min rest, 3-min free-load heating, 6-min constant workload-EXERCISE, 6-min free-load cool-down, 1-min rest) followed by a sitting period of 10 min (RECOVERY). The constant workload corresponded to 80%VO2GET (gas exchange threshold) identified by a previous cardiopulmonary exercise test (CPET). PBM was applied in continuous mode, contact technique, bilaterally, on both femoral quadriceps and gastrocnemius muscle groups. The electrocardiogram R-R intervals (BioAmp FE132) and the peripheral pulse pressure signals (Finometer PRO) were collected continuously throughout the protocol. Stable sequences of 256 points were chosen at REST, EXERCISE, and RECOVERY. The baroreflex sensitivity (BRS) was computed in time domain according to the sequence method (αseq). The comparison between therapies (150 J/300 J/placebo) and condition (REST, EXERCISE, and RECOVERY) was performed using the ANOVA two-way repeated measures test. There was no interaction between therapy and conditions during the TECC. There was only the condition effect (p < 0.001), showing that the behavior of αseq was similar regardless of the therapy. Photobiomodulation with 150 J or 300 J applied previously to a moderate-intensity TECC in DM2 was not able to promote cardiovascular autonomic control changes leading to an improvement in BRS.
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Affiliation(s)
- Juliana Cristina Milan-Mattos
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
| | - Cristina de Oliveira Francisco
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | | | - Ana Carolina Aparecida Marcondes
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Thomas Beltrame
- Computing Institute, Campinas State University, Campinas, Brazil
| | - Nivaldo Antônio Parizotto
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.,Post-Graduation Program in Biotecnology, Araraquara University - UNIARA, Araraquara, Brazil.,Post-Graduation Program in Biomedical Engineering, Universidade Brasil, São Paulo, Brazil
| | - Cleber Ferraresi
- Post-Graduation Program in Biomedical Engineering, Universidade Brasil, São Paulo, Brazil
| | | | - Aparecida Maria Catai
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
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87
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Sokas D, Petrėnas A, Daukantas S, Rapalis A, Paliakaitė B, Marozas V. Estimation of Heart Rate Recovery after StairClimbing Using aWrist-Worn Device. SENSORS 2019; 19:s19092113. [PMID: 31067765 PMCID: PMC6539517 DOI: 10.3390/s19092113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 11/20/2022]
Abstract
Heart rate recovery (HRR) after physical exercise is a convenient method to assess cardiovascular autonomic function. Since stair climbing is a common daily activity, usually followed by a slow walking or rest, this type of activity can be considered as an alternative HRR test. The present study explores the feasibility to estimate HRR parameters after stair climbing using a wrist-worn device with embedded photoplethysmography and barometric pressure sensors. A custom-made wrist-worn device, capable of acquiring heart rate and altitude, was used to estimate the time-constant of exponential decay τ, the short-term time constant S, and the decay of heart rate in 1 min D. Fifty-four healthy volunteers were instructed to climb the stairs at three different climbing rates. When compared to the reference electrocardiogram, the absolute and percentage errors were found to be ≤ 21.0 s (≤ 52.7%) for τ, ≤ 0.14 (≤ 19.2%) for S, and ≤ 7.16 bpm (≤ 20.7%) for D in 75% of recovery phases available for analysis. The proposed approach to monitoring HRR parameters in an unobtrusive way may complement information provided by personal health monitoring devices (e.g., weight loss, physical activity), as well as have clinical relevance when evaluating the efficiency of cardiac rehabilitation program outside the clinical setting.
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Affiliation(s)
- Daivaras Sokas
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania.
| | - Andrius Petrėnas
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania.
| | - Saulius Daukantas
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania.
| | - Andrius Rapalis
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania.
| | - Birutė Paliakaitė
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania.
| | - Vaidotas Marozas
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania.
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88
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Effects of interval training on risk markers for arrhythmic death: a randomized controlled trial. Clin Rehabil 2019; 33:1320-1330. [DOI: 10.1177/0269215519840388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To compare the effects of high-intensity interval training versus moderate-intensity continuous training on risk markers of arrhythmic death in patients who recently suffered from an acute coronary syndrome. Design: Double-blind (patient and evaluator) randomized controlled trial. Setting: Cardiovascular Prevention and Rehabilitation Centre (EPIC Centre) of the Montreal Heart Institute, Montreal, Canada. Subjects: A total of 43 patients were randomized following an acute coronary syndrome. Interventions: Patients were assigned to either high-intensity interval training (n = 18) or isocaloric moderate-intensity continuous training (n = 19), three times a week for a total of 36 sessions. Main measures: Heart rate recovery for 5 minutes, heart rate variability for 24 hours, occurrence of ventricular arrhythmias, and QT dispersion were measured before and after the 36 sessions of training. Results: Among the 43 patients randomized, 6 participants in the high-intensity interval training group stopped training for reasons unrelated to exercise training and were excluded from the analyses. Heart rate recovery improved solely in the high-intensity interval training group, particularly at the end of recovery period ( p < 0.05). There were no differences in heart rate variability, occurrence of ventricular arrhythmias, or QT dispersion parameters between the groups at study end. Conclusion: Despite the lack of power to detect any large difference between the two interventions with respect to risk markers of arrhythmic death, high-intensity interval training appears safe and may be more effective at improving heart rate recovery relative to moderate-intensity continuous training in our patients following acute coronary syndrome.
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89
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Kiviniemi AM, Kenttä TV, Lepojärvi S, Perkiömäki JS, Piira OP, Ukkola O, Huikuri HV, Junttila MJ, Tulppo MP. Recovery of rate-pressure product and cardiac mortality in coronary artery disease patients with type 2 diabetes. Diabetes Res Clin Pract 2019; 150:150-157. [PMID: 30872066 DOI: 10.1016/j.diabres.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 03/05/2019] [Indexed: 01/09/2023]
Abstract
AIMS To investigate prognostic significance of post-exercise recovery of rate-pressure product (RPP) in patients with stable coronary artery disease (CAD) and type 2 diabetes (T2D). METHODS Patients with angiographically documented CAD and T2D (n = 697) underwent symptom-limited bicycle exercise test. Exercise capacity (EC), heart rate, blood pressure and RPP responses to peak exercise and recovery (2' and 5' after cessation of exercise) were analyzed. Cardiac death was the primary and sudden cardiac death (SCD) secondary endpoint. RESULTS During a median follow-up of 76 months, 49 cardiac deaths (7.0%) and 28 SCDs (4.0%) were observed. The recovery of RPP at 5' was the strongest univariate predictor of cardiac death (hazard ratio [HR]: 2.55 per SD decrease, 95%CI: 1.82-3.58, p < 0.001) and SCD (HR: 2.34, 95%CI: 1.51-3.62, p < 0.001). In multivariate analysis, it remained significantly associated to cardiac death and SCD without (HR: 1.66, 95%CI: 1.14-2.41, p < 0.01 and HR: 1.75, 95%CI: 1.08-2.85, p < 0.05, respectively) and with additional adjustment for EC and peak RPP (HR: 1.45, 95%CI: 1.09-1.92, p < 0.05 and HR: 1.52, 95%CI: 1.01-2.27, p < 0.05, respectively). CONCLUSIONS The recovery of RPP after exercise is a potent predictor of cardiac death in patients with CAD and T2D. It provides significant prognostic information beyond EC and peak RPP.
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Affiliation(s)
- Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Samuli Lepojärvi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Olli-Pekka Piira
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Olavi Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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90
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Paula‐Ribeiro M, Ribeiro IC, Aranda LC, Silva TM, Costa CM, Ramos RP, Ota‐Arakaki JS, Cravo SL, Nery LE, Stickland MK, Silva BM. Carotid chemoreflex activity restrains post-exercise cardiac autonomic control in healthy humans and in patients with pulmonary arterial hypertension. J Physiol 2019; 597:1347-1360. [PMID: 30628073 PMCID: PMC6395424 DOI: 10.1113/jp277190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/18/2018] [Indexed: 01/14/2023] Open
Abstract
KEY POINTS Dysfunction of post-exercise cardiac autonomic control is associated with increased mortality risk in healthy adults and in patients with cardiorespiratory diseases. The afferent mechanisms that regulate the post-exercise cardiac autonomic control remain unclear. We found that afferent signals from carotid chemoreceptors restrain the post-exercise cardiac autonomic control in healthy adults and patients with pulmonary arterial hypertension (PAH). Patients with PAH had higher carotid chemoreflex sensitivity, and the magnitude of carotid chemoreceptor restraint of autonomic control was greater in patients with PAH as compared to healthy adults. The results demonstrate that the carotid chemoreceptors contribute to the regulation of post-exercise cardiac autonomic control, and suggest that the carotid chemoreceptors may be a potential target to treat post-exercise cardiac autonomic dysfunction in patients with PAH. ABSTRACT Dysfunction of post-exercise cardiac autonomic control predicts mortality, but its underlying mechanisms remain unclear. We tested whether carotid chemoreflex activity restrains post-exercise cardiac autonomic control in healthy adults (HA), and whether such restraint is greater in patients with pulmonary arterial hypertension (PAH) who may have both altered carotid chemoreflex and altered post-exercise cardiac autonomic control. Twenty non-hypoxaemic patients with PAH and 13 age- and sex-matched HA pedalled until 90% of peak work rate observed in a symptom-limited ramp-incremental exercise test. Recovery consisted of unloaded pedalling for 5 min followed by seated rest for 6 min. During recovery, subjects randomly inhaled either 100% O2 (hyperoxia) to inhibit the carotid chemoreceptor activity, or 21% O2 (normoxia) as control. Post-exercise cardiac autonomic control was examined via heart rate (HR) recovery (HRR; HR change after 30, 60, 120 and 300 s of recovery, using linear and non-linear regressions of HR decay) and HR variability (HRV; time and spectral domain analyses). As expected, the PAH group had higher carotid chemosensitivity and worse post-exercise HRR and HRV than HA. Hyperoxia increased HRR at 30, 60 and 120 s and absolute spectral power HRV in both groups. Additionally, hyperoxia resulted in an accelerated linear HR decay and increased time domain HRV during active recovery only in the PAH group. In conclusion, the carotid chemoreceptors restrained recovery of cardiac autonomic control from exercise in HA and in patients with PAH, with the restraint greater for some autonomic indexes in patients with PAH.
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Affiliation(s)
- Marcelle Paula‐Ribeiro
- Post‐graduate Program in Translational MedicineDepartment of MedicineFederal University of São Paulo (UNIFESP)São PauloSPBrazil
- Pulmonary Vascular Group and Pulmonary Function and Clinical Exercise Physiology UnitDivision of Respiratory DiseasesDepartment of MedicineUNIFESPSão PauloSPBrazil
- Department of PhysiologyUNIFESPSão PauloSPBrazil
| | - Indyanara C. Ribeiro
- Pulmonary Vascular Group and Pulmonary Function and Clinical Exercise Physiology UnitDivision of Respiratory DiseasesDepartment of MedicineUNIFESPSão PauloSPBrazil
- Department of PhysiologyUNIFESPSão PauloSPBrazil
| | - Liliane C. Aranda
- Pulmonary Vascular Group and Pulmonary Function and Clinical Exercise Physiology UnitDivision of Respiratory DiseasesDepartment of MedicineUNIFESPSão PauloSPBrazil
- Department of PhysiologyUNIFESPSão PauloSPBrazil
| | - Talita M. Silva
- Pulmonary Vascular Group and Pulmonary Function and Clinical Exercise Physiology UnitDivision of Respiratory DiseasesDepartment of MedicineUNIFESPSão PauloSPBrazil
- Department of PhysiologyUNIFESPSão PauloSPBrazil
| | - Camila M. Costa
- Pulmonary Vascular Group and Pulmonary Function and Clinical Exercise Physiology UnitDivision of Respiratory DiseasesDepartment of MedicineUNIFESPSão PauloSPBrazil
| | - Roberta P. Ramos
- Pulmonary Vascular Group and Pulmonary Function and Clinical Exercise Physiology UnitDivision of Respiratory DiseasesDepartment of MedicineUNIFESPSão PauloSPBrazil
| | - Jaquelina S. Ota‐Arakaki
- Pulmonary Vascular Group and Pulmonary Function and Clinical Exercise Physiology UnitDivision of Respiratory DiseasesDepartment of MedicineUNIFESPSão PauloSPBrazil
| | | | - Luiz E. Nery
- Pulmonary Vascular Group and Pulmonary Function and Clinical Exercise Physiology UnitDivision of Respiratory DiseasesDepartment of MedicineUNIFESPSão PauloSPBrazil
| | | | - Bruno M. Silva
- Post‐graduate Program in Translational MedicineDepartment of MedicineFederal University of São Paulo (UNIFESP)São PauloSPBrazil
- Pulmonary Vascular Group and Pulmonary Function and Clinical Exercise Physiology UnitDivision of Respiratory DiseasesDepartment of MedicineUNIFESPSão PauloSPBrazil
- Department of PhysiologyUNIFESPSão PauloSPBrazil
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91
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Relation of Exercise Heart Rate Recovery to Predict Cardiometabolic Syndrome in Men. Am J Cardiol 2019; 123:582-587. [PMID: 30527776 DOI: 10.1016/j.amjcard.2018.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 11/22/2022]
Abstract
We examined the hypothesis that delayed heart rate recovery (HRR) after exercise testing, an estimate of decreased autonomic function, predicts the risk of cardiometabolic syndrome (MetS) and is associated with continuous MetS risk scores in healthy men. Participants were 2,740 men who underwent general health examinations and had no evidence of MetS, cardiovascular diseases, diabetes, and hypertension at baseline. Baseline HRR was calculated as the difference between peak heart rate attained during exercise testing and the heart rate at 1 (HRR 1) and 2 minutes (HRR 2) after test termination. Incident MetS was defined as participants having ≥3 MetS components, and continuous MetS risk score was computed as the sum of z-score of 5 risk factors at follow-up. The incidence of MetS was 61/1,000 person-years during an average follow-up of 5 years. The relative risks and 95% confidence interval (CI) of incident MetS in the lowest quartiles of HRR 1 and HRR 2 versus the highest quartile were 1.24 (95% CI 1.02 to 1.51) and 2.02 (95% CI 1.58 to 2.60), respectively, after adjusting for potential confounders, including peak oxygen uptake and resting heart rate. HRR 1 (ß = -0.052, p = 0.005) and HRR 2 (ß = -0.058, p = 0.009) were independently associated with clustered MetS risk scores after adjusting for covariates. In conclusion, the independent association between delayed HRR after exercise testing and incident MetS and continuous MetS risk scores suggests that decreased autonomic function may be considered as a parameter to predict the future likelihood of MetS.
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92
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Volkan Emren S, Gediz RB, Şenöz O, Karagöz U, Şimşek EÇ, Levent F, Özdemir E, Gürsoy MO, Nazlı C. Decreased heart rate recovery may predict a high SYNTAX score in patients with stable coronary artery disease. Bosn J Basic Med Sci 2019; 19:109-115. [PMID: 30599115 DOI: 10.17305/bjbms.2019.3725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/12/2018] [Indexed: 11/16/2022] Open
Abstract
An impaired heart rate recovery (HRR) has been associated with increased risk of cardiovascular events, cardiovascular, and all-cause mortality. However, the diagnostic ability of HRR for the presence and severity of coronary artery disease (CAD) has not been clearly elucidated. Our aim was to investigate the relationship between HRR and the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score in patients with stable CAD (SCAD). A total of 406 patients with an abnormal treadmill exercise test and ≥50% coronary stenosis on coronary angiography were included. The HRR was calculated by subtracting the HR in the first minute of the recovery period from the maximum HR during exercise. The SYNTAX score ≥23 was accepted as high. Correlation of HRR with SYNTAX score and independent predictors of high SYNTAX score were determined. A high SYNTAX score was present in 172 (42%) patients. Mean HRR was lower in patients with a high SYNTAX score (9.8 ± 4.5 vs. 21.3 ± 9, p < 0.001). The SYNTAX score was negatively correlated with HRR (r: -0.580, p < 0.001). In multivariate logistic regression analysis, peripheral arterial disease (OR: 13.3; 95% CI: 3.120-34.520; p < 0.001), decreased HRR (OR: 0.780; 95% CI: 0.674-0.902; p = 0.001), peak systolic blood pressure (OR: 1.054; 95% CI: 1.023-1.087; p = 0.001), and peak HR (OR: 0.950; 95% CI: 0.923-0.977; p < 0.001) were found to be independent predictors of a high SYNTAX score. Our results showed that HRR is significantly correlated with the SYNTAX score, and a decreased HRR is an independent predictor of a high SYNTAX score in patients with SCAD.
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Affiliation(s)
- Sadık Volkan Emren
- Department of Cardiology, Katip Celebi University School of Medicine, Izmir, Turkey.
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93
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von Scheidt F, Meier S, Krämer J, Apitz A, Siaplaouras J, Bride P, Kaestner M, Apitz C. Heart Rate Response During Treadmill Exercise Test in Children and Adolescents With Congenital Heart Disease. Front Pediatr 2019; 7:65. [PMID: 30915321 PMCID: PMC6422868 DOI: 10.3389/fped.2019.00065] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 02/18/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Impaired exercise capacity is a common feature of congenital heart disease (CHD). In adults with CHD, it has been shown that impaired heart rate response during exercise may contribute to exercise limitation. Systematic data in children and adolescents on this topic is limited. We therefore purposed to assess heart rate response during treadmill exercise testing in children and adolescents with CHD compared to healthy controls. Methods: One hundred and sixty three children and adolescents (103 with CHD, median age 15 years and 60 age-matched controls) performed cardiopulmonary exercise testing and were included in this study. Beyond peak oxygen consumption, increase in heart rate from resting level to peak exercise (heart rate reserve) and decrease of heart rate after peak exercise (heart rate recovery) were measured. Chronotropic index was defined as percentage of age predicted maximal heart rate reserve. According to data from adults on bicycle exercise, chronotropic incompetence was assumed for chronotropic index below 0.8. Results: While resting heart rate was similar between both groups, peak heart rate, heart rate reserve as well as chronotropic index were lower in the CHD group than in controls. Chronotropic index was lowest in patients with single ventricle hemodynamics and correlated with peak oxygen consumption. Heart rate recovery was impaired in the CHD group 1 and 2 min after peak exercise compared to controls and correlated with peak oxygen consumption. Chronotropic index below 0.8 was a relatively frequent finding even in the control group suggesting that the threshold of 0.8 appears inadequate for the identification of chronotropic incompetence using treadmill exercise testing in children. After normalizing to the 2.5th chronotropic index percentile of the control group we obtained a chronotropic incompetence threshold of 0.69. Conclusion: As an adjunct to measurement of peak oxygen consumption, heart rate response to exercise appears to be a physiologically important diagnostic parameter in children and adolescents with CHD. However, interpretation of heart rate response needs to consider specific age characteristics and the mode of exercise test. Our data may help future studies on chronotropic incompetence using treadmill ergometer protocols in children and adolescents.
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Affiliation(s)
- Fabian von Scheidt
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, Ulm, Germany
| | - Stephanie Meier
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, Ulm, Germany
| | - Johannes Krämer
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, Ulm, Germany
| | - Anita Apitz
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, Ulm, Germany
| | - Jannos Siaplaouras
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, Ulm, Germany
| | - Peter Bride
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, Ulm, Germany
| | - Michael Kaestner
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, Ulm, Germany
| | - Christian Apitz
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, Ulm, Germany
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94
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Herbsleb M, Schumann A, Lehmann L, Gabriel HHW, Bär KJ. Cardio-Respiratory Fitness and Autonomic Function in Patients with Major Depressive Disorder. Front Psychiatry 2019; 10:980. [PMID: 32116813 PMCID: PMC7011194 DOI: 10.3389/fpsyt.2019.00980] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/10/2019] [Indexed: 11/27/2022] Open
Abstract
Patients with major depressive disorder (MDD) have an augmented risk of cardiovascular morbidity and mortality. Although a link between depression and autonomic dysfunction as well as reduced cardio-respiratory fitness (CRF) is well documented, the underlying cause is a matter of debate. Therefore, we studied the interplay between autonomic function, body composition and severity of the disease to disentangle possible physiological factors influencing the assumed lack of CRF in MDD patients. We investigated seventeen patients suffering from MDD and seventeen control subjects matched with respect to age, sex, body-mass-index, and smoking habits. A resting baseline assessment and a cardiopulmonary exercise test including a prolonged recovery period were performed to study autonomic function (i.e., heart rate responses and heart rate variability) during rest, exercise and recovery as well as CRF. Most investigated autonomic indices were significantly different at rest, during exercise as well as during recovery indicating altered autonomic modulation. Nevertheless, none of our participants was classified as chronotropically incompetent. As expected, a reduced CRF (i.e., peak oxygen uptake and peak power output, p < 0.01) was observed in patients compared to controls. In addition, a correlation of baseline heart rate and of heart rate during recovery with the ventilatory threshold 1 (p < 0.05) was found in patients only, indicating a relation to the lack of CRF. Furthermore, we observed a positive correlation of the severity of the disease with the weekly sitting time (p < 0.01) as well as a negative correlation with the activity time in the intensity domain walking (p < 0.001) and with the total score of the International Physical Activity Questionnaire (p < 0.01) for patients. This study shows that patients with MDD have altered autonomic function not only during resting conditions but also during exercise as well as recovery from exercise. Intervention studies are needed to evaluate how the described autonomic alterations can be influenced by increasing CRF due to appropriate exercise training programs.
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Affiliation(s)
- Marco Herbsleb
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University, Jena, Germany.,Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
| | - Andy Schumann
- Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
| | - Luisa Lehmann
- Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
| | - Holger H W Gabriel
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University, Jena, Germany
| | - Karl-Jürgen Bär
- Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
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95
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Kim MJ. Carotid Arterial Stiffness and Attenuated Heart Rate Recovery in Uncomplicated Hypertensive Patients. J Cardiovasc Imaging 2019; 27:224-226. [PMID: 31359638 PMCID: PMC6669178 DOI: 10.4250/jcvi.2019.27.e39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mi-Jeong Kim
- Department of Cardiovascular Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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96
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Amaro-Vicente G, Laterza MC, Martinez DG, Alves MJNN, Trombetta IC, Braga AMFW, Toschi-Dias E, Rondon MUPB. Exercise Training Improves Heart Rate Recovery after Exercise in Hypertension. MOTRIZ: REVISTA DE EDUCACAO FISICA 2019. [DOI: 10.1590/s1980-6574201900010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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97
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Waist-Stature Ratio And Its Relationship With Autonomic Recovery From Aerobic Exercise In Healthy Men. Sci Rep 2018; 8:16093. [PMID: 30382140 PMCID: PMC6208340 DOI: 10.1038/s41598-018-34246-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/14/2018] [Indexed: 12/28/2022] Open
Abstract
Autonomic modulation and cardiorespiratory variables are influenced by numerous factors, including anthropometric variables. We investigated autonomic recovery following aerobic exercise in healthy men with different waist-stature ratio (WSR) values. The study was conducted with 52 healthy men aged 18 to 30 years, divided into groups according to the WSR: G1 – between 0.40 and 0.449 (N = 19), G2 – between 0.45 and 0.50 (N = 28) and G3 – between 0.5 and 0.56 (N = 5). The subjects endured 15 minutes seated and at rest followed by an aerobic exercise and then remained seated for 60 minutes and at rest during recovery from exercise. Heart rate (HR) variability (HRV) (rMSSD, SD1, HF [ms2]) and cardiorespiratory variables were analyzed before and after exercise. Recovery of respiratory rate, diastolic blood pressure, SD1 and HF indices were delayed in G2. G3 presented delayed recovery after the maximal effort test while no difference with G2 was noted in the moderate intensity. Correlation and linear regression analysis indicated association of WSR, body mass index and waist circumference with HRV indices in the recovery from aerobic exercise (45 to 60 minutes after exercise) in G2. In conclusion, healthy men with higher WSR accomplished delayed autonomic recovery following maximal effort exercise.
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98
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Lopes TR, Sabino-Carvalho JL, Ferreira THN, Succi JE, Silva AC, Silva BM. Effect of Ischemic Preconditioning on the Recovery of Cardiac Autonomic Control From Repeated Sprint Exercise. Front Physiol 2018; 9:1465. [PMID: 30416451 PMCID: PMC6212507 DOI: 10.3389/fphys.2018.01465] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/27/2018] [Indexed: 12/18/2022] Open
Abstract
Repeated sprint exercise (RSE) acutely impairs post-exercise heart rate (HR) recovery (HRR) and time-domain heart rate variability (i. e., RMSSD), likely in part, due to lactic acidosis-induced reduction of cardiac vagal reactivation. In contrast, ischemic preconditioning (IPC) mediates cardiac vagal activation and augments energy metabolism efficiency during prolonged ischemia followed by reperfusion. Therefore, we investigated whether IPC could improve recovery of cardiac autonomic control from RSE partially via improved energy metabolism responses to RSE. Fifteen men team-sport practitioners (mean ± SD: 25 ± 5 years) were randomly exposed to IPC in the legs (3 × 5 min at 220 mmHg) or control (CT; 3 × 5 min at 20 mmHg) 48 h, 24 h, and 35 min before performing 3 sets of 6 shuttle running sprints (15 + 15 m with 180° change of direction and 20 s of active recovery). Sets 1 and 2 were followed by 180 s and set 3 by 360 s of inactive recovery. Short-term HRR was analyzed after all sets via linear regression of HR decay within the first 30 s of recovery (T30) and delta from peak HR to 60 s of recovery (HRR60s). Long-term HRR was analyzed throughout recovery from set 3 via first-order exponential regression of HR decay. Moreover, RMSSD was calculated using 30-s data segments throughout recovery from set 3. Energy metabolism responses were inferred via peak pulmonary oxygen uptake (V˙O2peak), peak carbon dioxide output (V˙O2peak), peak respiratory exchange ratio (RERpeak), first-order exponential regression of V˙O2 decay within 360 s of recovery and blood lactate concentration ([Lac-]). IPC did not change T30, but increased HRR60s after all sets (condition main effect: P = 0.03; partial eta square (η2p) = 0.27, i.e., large effect size). IPC did not change long-term HRR and RMSSD throughout recovery, nor did IPC change any energy metabolism parameter. In conclusion, IPC accelerated to some extent the short-term recovery, but did not change the long-term recovery of cardiac autonomic control from RSE, and such accelerator effect was not accompanied by any IPC effect on surrogates of energy metabolism responses to RSE.
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Affiliation(s)
- Thiago R Lopes
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil.,Laboratory of Exercise Physiology, Olympic Center of Training and Research, São Paulo, Brazil.,São Paulo Association for Medicine Development, São Paulo, Brazil.,Postgraduate Program in Translational Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Jeann L Sabino-Carvalho
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil.,Postgraduate Program in Translational Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Thiago H N Ferreira
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil.,Postgraduate Program in Translational Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - José E Succi
- Department of Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Antônio C Silva
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil.,Laboratory of Exercise Physiology, Olympic Center of Training and Research, São Paulo, Brazil
| | - Bruno M Silva
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil.,Laboratory of Exercise Physiology, Olympic Center of Training and Research, São Paulo, Brazil.,Postgraduate Program in Translational Medicine, Federal University of São Paulo, São Paulo, Brazil
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99
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Effects of 12 weeks of regular aerobic exercises on autonomic nervous system in obstructive sleep apnea syndrome patients. Sleep Breath 2018; 22:1189-1195. [DOI: 10.1007/s11325-018-1736-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/12/2018] [Accepted: 10/03/2018] [Indexed: 12/16/2022]
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100
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Wu F, Zhou J, Zheng H, Liu G. Decreased heart rate recovery in women with a history of pre-eclampsia. Pregnancy Hypertens 2018; 13:25-29. [PMID: 30177061 DOI: 10.1016/j.preghy.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/24/2018] [Accepted: 05/02/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND A growing body of literature has reported that a history of pre-eclampsia (PE) increases a woman's long-term risk of cardiovascular diseases (CVD). Autonomic nervous system dysfunction was found to be significant in this specific population, but most studies observed the role of sympathetic over-activation. The aim of this study was to assess whether parasympathetic impairment was involved in women 1 year after PE, and heart rate recovery (HRR) was used to represent parasympathetic tone. STUDY DESIGN 47 women with previous PE (PE group) and 58 women with a healthy pregnancy (control group) were examined. Blood pressure levels, lipid profiles, homeostasis model assessment of insulin resistance (HOMA-IR), inflammatory biomarkers and HRR were compared between the two groups, and the association between the biochemical parameters and HRR in the PE group was evaluated. RESULTS Compared with the Control group, body mass index, 24-h mean diastolic blood pressure, low-density lipoprotein cholesterol and Ln(HOMA-IR) were higher, and HRR was slower in the PE group. Furthermore, body mass index, total cholesterol, and Ln(HOMA-IR) were independent determinants of HRR in the PE group according to multiple regression analysis. CONCLUSIONS Our findings suggest that parasympathetic impairment is involved in this specific female population, and its close association with body mass index, total cholesterol and insulin resistance might contribute to an increased risk of CVD development in women with PE history.
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Affiliation(s)
- Fan Wu
- Gynecology and Obstetrics Department, Shanghai Tenth People's Hospital affiliated to School of Medicine, Tongji University, Shanghai, China
| | - Jianhong Zhou
- Gynecology and Obstetrics Department, Shanghai Tenth People's Hospital affiliated to School of Medicine, Tongji University, Shanghai, China
| | - Huan Zheng
- Cardiology Department, Shanghai Worldpath Clinic International, Shanghai, China
| | - Guanghui Liu
- Endocrinology Department, Tongji Hospital affiliated to School of Medicine, Tongji University, Shanghai, China.
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