Autonomic control of heart rate during exercise studied by heart rate variability spectral analysis

Ischemia-induced reflex sympathoexcitation during the recovery period after maximal treadmill exercise testing

BACKGROUND

Heart rate variability (HRV) analysis is problematic during maximal treadmill exercise testing (ET) due to rapidly changing heart rate.

HYPOTHESIS

The aim of this study was to assess HRV spectral components during treadmill ET in patients with coronary artery disease (CAD) and in healthy controls, and to search for possible differences between the two groups.

METHODS

Thirty patients with CAD and 30 age-matched healthy controls underwent symptom-limited ET and continuous electrocardiographic monitoring. For adequate assessment of HRV during maximal ET, we calculated the HRV measures [normalized units (NU)]--low-frequency (0.040-0.150 Hz) power (LF), high-frequency (0.150-0.400 Hz) power (HF), and the LF/HF ratio--from all the sequential stages of the ET with limited changes (20 beats/min) in heart rate (stress 80-100, 100-120, 120-140, 140-160, 160-180/recovery 180-160, 160-140, 140-120, 120-100, 100-80).

RESULTS

Both LF and HF were found to decrease gradually during ET and to increase during the recovery period in both patients and controls (p < 0.001). LF values were higher during the recovery period than during the respective stages of exercise time in both patients and controls, and LF/HF ratio was higher during recovery in patients only.

CONCLUSIONS

During maximal ET (1) vagal tone withdraws during the exercise time and increases during the recovery period; (2) the sympathetic activity predominates during the recovery period, especially in patients with CAD and exercise-induced myocardial ischemia. This finding raises the possibility of ischemia-induced cardiocardiac sympathetic excitatory reflexes.

Effects of low-intensity exercise conditioning on blood pressure, heart rate, and autonomic modulation of heart rate in men and women with hypertension

Untreated hypertension increases cardiovascular risk 2-fold to 3-fold, leading to serious cardiovascular problems that include left ventricular hypertrophy, stroke, ischemic heart disease, myocardial infarction, vascular disease, renal disease, and death. Exercise conditioning is recommended as one of the initial treatments for hypertension. The purpose of this pretest-posttest study was to quantify the effects of a 12-week home-based low-intensity exercise conditioning (walking) program in hypertensive men and women on systolic and diastolic blood pressure, heart rate, and autonomic modulation of heart rate. A total of 20 mildly hypertensive men and women who were assigned to a structured exercise (walking) program were compared with a control group of 20 nonexercising mildly hypertensive participants. Electrocardiographic heart rate and R-R interval data and beat-by-beat arterial blood pressure data were collected continuously for 10 min with participants in the supine and standing postures and during low-intensity steady-state exercise. The results show that systolic and diastolic blood pressure and R-R interval decreased and spontaneous baroreflex sensitivity increased in the exercise group. The decline in blood pressure was significant statistically and clinically. The increase in spontaneous baroreflex sensitivity indicates that the ability of the cardiovascular system to respond rapidly to changing stimuli improved after the 12-week walking protocol. The low-intensity exercise conditioning program achieved a training effect in this population.

Effect of change in blood volume in skin plus active muscle on heart rate drift during submaximal exercise

The purpose of the present study was to examine the effect of change in blood volume in skin plus active muscle on heart rate drift during moderate exercise and heavy exercise for 30 min. Total hemoglobin concentration (Total Hb) in the vastus lateralis muscle plus its skin was determined by near-infrared spectroscopy. Total Hb significantly increased and remained stable from 20 min in moderate exercise and from 10 min in heavy exercise. Heart rate (HR) rapidly increased until 3 min and showed a steady state in moderate exercise. HR at 30 min was significantly higher than that at 3 min in moderate exercise. HR rapidly increased until 3 min and then gradually but significantly increased in heavy exercise. Increase in total Hb was not significantly related with HR after 3 min of exercise when HR was around 120 beats per min in moderate exercise. Increase in total Hb was significantly related with HR from 3 min to 10 min in the heavy exercise (correlation coefficients ranged from 0.959 to 0.702). It is concluded that an increase in the blood volume in skin plus active muscle is not simply associated with HR drift.

Autonomic control of heart rate during and after exercise : measurements and implications for monitoring training status

Endurance training decreases resting and submaximal heart rate, while maximum heart rate may decrease slightly or remain unchanged after training. The effect of endurance training on various indices of heart rate variability remains inconclusive. This may be due to the use of inconsistent analysis methodologies and different training programmes that make it difficult to compare the results of various studies and thus reach a consensus on the specific training effects on heart rate variability. Heart rate recovery after exercise involves a coordinated interaction of parasympathetic re-activation and sympathetic withdrawal. It has been shown that a delayed heart rate recovery is a strong predictor of mortality. Conversely, endurance-trained athletes have an accelerated heart rate recovery after exercise. Since the autonomic nervous system is interlinked with many other physiological systems, the responsiveness of the autonomic nervous system in maintaining homeostasis may provide useful information about the functional adaptations of the body. This review investigates the potential of using heart rate recovery as a measure of training-induced disturbances in autonomic control, which may provide useful information for training prescription.

Impact of physical activity on heart rate variability in children with type 1 diabetes

OBJECTIVE

Children with type 1 diabetes are usually associated with cardiovascular autonomic neuropathy. The present study explored the influence of physical activity on their autonomic nervous function by measuring the heart rate variability (HRV).

MATERIALS AND METHODS

A total of 93 type 1 diabetic children and 107 healthy control subjects were enrolled. The Physical Activity Questionnaire for Children (PAQ-C) was adopted to determine the physical activity level as low, moderate, or high activity. HRV was determined by frequency analysis and measured in both resting and active states.

RESULTS

Children with type 1 diabetes had significantly lower HRV than that of healthy control subjects in resting state but not in active state. The decreased HRV in diabetic children was observed only in subjects with low physical activity. The HRV in diabetic children with moderate to high physical activity, however, was not different from that of their healthy controls.

CONCLUSIONS

Diabetic children should be encouraged to engage in physical activity with more intensity, which can benefit their autonomic nervous function. Nevertheless, the potential risk of vigorous activity still needs our concern.

Limiar de variabilidade da freqüência cardíaca em adolecentes obesos e não-obesos

A obesidade na adolescência está associada à disfunção simpato-vagal cardíaca em repouso, embora existam poucas informações sobre a resposta autonômica durante o exercício nestes adolescentes. OBJETIVO: Comparar a modulação autonômica durante teste de esforço físico dinâmico incremental em amostras de adolescentes obesos e não-obesos, e analisar a relação entre o limiar de variabilidade da freqüência cardíaca (LiVFC) e o limar ventilatório (LV). MÉTODOS: Dez adolescentes obesos e 19 adolescentes não-obesos do sexo masculino com idades entre 13 e 18 anos foram submetidos à teste de esforço físico progressivo máximo em esteira rolante para estudo da variabilidade da freqüência cardíaca (VFC) e para identificação do LV. A VFC foi estudada mediante análise do desvio-padrão da variabilidade instantânea batimento-a-batimento (SD1) da Plotagem de Poincaré. O LiVFC foi identificado na intensidade de esforço físico em que o SD1 atingiu valor menor que 3 ms. RESULTADOS: O índice SD1 diminuiu progressivamente em ambos os grupos até aproximadamente 50-60% do VO2pico, sendo que os adolescentes obesos apresentaram valores significativamente menores (p<0,001) somente na intensidade relativa a 20% do VO2pico, Os adolescentes obesos apresentaram valores relativos (mL.kg-1.min-1) de VO2pico e LV significativamente menores (p<0,05) que os adolescentes não-obesos. Em ambos os grupos, não foram observadas diferenças significativas entre o ponto de ocorrência do LV e do LiVFC, expressos em valores relativos e absolutos de VO2. Contudo, não foram encontradas correlações significativas entre o ponto de ocorrência do LV e do LiVFC, tanto em valores relativos quanto em valores absolutos de VO2. CONCLUSÕES: A obesidade na adolescência parece não estar associada à alteração da modulação autonômica durante o exercício físico. Torna-se possível determinar o LiVFC mediante análise da Plotagem de Poincaré em adolescentes obesos e não-obesos. Entretanto, a ausência de associação estatística entre o LiVFC e o LV demonstra que parece não haver relação causal entre estes eventos.

Impact of glycemic control, disease duration, and exercise on heart rate variability in children with type 1 diabetes mellitus

BACKGROUND/PURPOSE

Type 1 diabetes is commonly associated with autonomic neuropathy. The present study investigated the influences of glycemic control, disease duration (DD), and exercise on autonomic nervous function in children with type 1 diabetes by analysis of their heart rate variability (HRV).

METHODS

Seventy-nine type 1 diabetic children were recruited and categorized into four groups by HbA1c of 8% and DD of 4.5 years. HRV parameters as determined by separate frequency domain components (low frequency: LnLF, 0.04-0.15 Hz; high frequency: LnHF, 0.15-0.5 Hz; total power: LnTP, 0.04-0.5 Hz) were measured both at rest and during exercise. Pearson's correlation, one-way ANOVA, and multiple regressions with stepwise method were used for statistical analysis.

RESULTS

While at rest, HbA1c and DD were negatively correlated with all HRV parameters. Both HbA1c and DD were significant predictors in LnTP. However, only HbA1c was a significant predictor in LnLF and LnHF. Type 1 diabetes patients with HbA1c > 8% and DD > 4.5 years had a significantly lower HRV than the other patients. During exercise, HRV reduced significantly and no significant correlation between HbA1c and HRV or between DD and HRV was observed. Also, a significant difference in HRV among the four groups was not demonstrated. The smallest decrement in HRV from resting to exercise were in subjects with HbA1c > 8% and DD > 4.5 years.

CONCLUSION

HbA1c was a more dominant predictor for LnTP, LnHF and LnLF than DD in children with type 1 diabetes at rest. HRV reduced significantly from resting to exercise. However, the responses of HRV during exercise differ from the responses of HRV at rest.

Estimation of maximal heart rate using the relationship between heart rate variability and exercise intensity in 40-67 years old men

Large interindividual variation in maximal heart rate (HRmax) may not be accounted for by age alone. In order to evaluate a novel method in the prediction of HRmax, this study examined the profile of HR variability (HRV) during exercise in 40-67 years old men (n = 74). R-R intervals were recorded during supine rest and during a graded exercise test by cycle ergometry until exhaustion. A third-degree polynomial function was fitted to the HRV data recorded during exercise to represent the HRV profile of each subject. The instantaneous beat-to-beat R-R interval variability (SD1), high (HF) and low frequency power decreased between all consecutive exercise intensities (P < 0.033). The relationship between HRmax and a variable illustrating the declining rate of HF (HRHF50%) was stronger (r = 0.50, P < 0.001) than between HRmax and age (r = -0.36, P < 0.01). The regression analysis showed that a more accurate estimation of HR(max) was attained when HRV was used in the equation in addition to age: HRmax = 160.633-0.603(age) + 0.441(HRHF50%) (SEE = 9.8 bpm vs. 11.6 bpm in the equation based on age alone). The decline of HRV during incremental exercise seems to be useful for accurate estimation of maximal heart rate.

Post-exercise heart rate variability of endurance athletes after different high-intensity exercise interventions

Methodological problems have limited the number of studies on heart rate variability (HRV) dynamics immediately after exercise. We used the short-time Fourier transform method to study immediate (5 min) and slow (30 min) recovery of HRV after different high-intensity exercise interventions. Eight male athletes performed two interval interventions at 85% and 93% (IV(85) and IV(93)) and two continuous interventions at 80% and 85% (CO(80) and CO(85)) of the velocity at VO2max (vVO2max). We found no increase in high frequency power (HFP), but low frequency (LFP) and total power (TP) increased (P<0.05) during the first 5 min of the recovery after each intervention. During the 30-min recovery, HFP, LFP and TP (1) increased slowly toward resting values, but HFP remained lower (P<0.01) than at rest, (2) were lower (P<0.05) after IV(93) and CO(85) when compared with IV(85) and CO(80), respectively and (3) were lower (P<0.01) after CO(85) when compared with IV(85). HRV recovery was detected during the immediate recovery after interventions. Increased exercise intensity resulted in lower HRV both in interval and in continuous interventions. In addition, when interval and continuous interventions were performed at a similar workload, HRV was lower after continuous intervention.

Rate of reduction of heart rate variability during exercise as an index of physical work capacity

Breathing rates during physical exercise suggest that, during these conditions, the high-frequency (HF) bandwidth of heart rate variability (HRV) analysis should be extended beyond conventional guidelines. However, there has been little investigation of the most appropriate choice of HF bandwidth during exercise. HRV analysis was performed in 10 males and six females during progressive bicycle exercise. Cardiac cycle (RR) interval and breath-by-breath respiratory data were simultaneously recorded. HRV powers were determined for the band-limited ranges 0.04-0.15 Hz [low-frequency (LF)], 0.15-0.4 Hz (HF 0.4) and 0.15-bf Hz (HF bf, where bf represents maximum breathing frequency). Mono-exponential functions described the relationship between HRV and work rate for each bandwidth (r=0.92-0.95) and were used to calculate the "HRV decay constant" (work rate associated with a 50% reduction in HRV power). The HRV decay constants for each bandwidth were linearly related to maximal work rate (r>0.71; P<0.001) and were substantially greater in males than in females (P<0.001). There was a significant difference between the HRV decay constants for HF 0.4 and HF bf (P<0.005) in both genders. The HRV decay constants for the LF and HF bf bandwidths appear to provide an indication of work capacity from submaximal exercise, without prior assumption regarding heart rate and its relationship with work rate.

Physiological Effects of Shinrin-yoku (Taking in the Atmosphere of the Forest) in an Old-Growth Broadleaf Forest in Yamagata Prefecture, Japan

The physiological effects of "Shinrin-yoku" (taking in the atmosphere of the forest) were examined by investigating blood pressure, pulse rate, heart rate variability (HRV), salivary cortisol concentration, and immunoglobulin A concentration in saliva. Subjective feelings of being "comfortable", "calm", and "refreshed" were also assessed by questionnaire. The subjects were 12 male university students aged from 21 to 23 (mean+/-SD: 22.0+/-1.0). The physiological measurements were conducted six times, i.e., in the morning and evening before meals at the place of accommodation, before and after the subjects walked a predetermined course in the forest and city areas for 15 minutes, and before and after they sat still on a chair watching the scenery in the respective areas for 15 minutes. The findings were as follows. In the forest area compared to the city area, 1) blood pressure and pulse rate were significantly lower, and 2) the power of the HF component of the HRV tended to be higher and LF/(LF+HF) tended to be lower. Also, 3) salivary cortisol concentration was significantly lower in the forest area. These physiological responses suggest that sympathetic nervous activity was suppressed and parasympathetic nervous activity was enhanced in the forest area, and that "Shinrin-yoku" reduced stress levels. In the subjective evaluation, 4) "comfortable", "calm", and "refreshed" feelings were significantly higher in the forest area. The present study has, by conducting physiological investigations with subjective evaluations as supporting evidence, demonstrated the relaxing and stress-relieving effects of "Shinrin-yoku".

Heart rate variability during high-intensity field exercise in female distance runners

The purposes of this study were to demonstrate the transition of heart rate variability (HRV) during trials in the field and to examine the relationship between peak frequency of high-frequency band (HF) and stride frequency. Ten healthy long-distance college female runners (age 19-21 years) performed a 3000 m realistic time trial. The time-series power spectrum analysis by maximum entropy method was used to evaluate cardiac autonomic nervous activity during the race. Cross-correlation coefficients were calculated to estimate the degree of linear co-ordination between the central peak frequency of HF and stride frequency. Just after starting, the decrease in HF (0.15-1.00 Hz) and a transient increase of low-frequency band (LF)/HF were found. After that, the HF remained at a low level and LF/HF decreased sharply. These findings suggested that the parasympathetic activity was suppressed and sympathetic activity increased just after starting, and the sympathetic activity reached the saturated level according to continuation of high-intensity exercise. In spite of the significant decrease of HRV during trials, peak frequency of HF could be differentiated clearly. The cross-correlation coefficient of peak frequency of HF and stride frequency was from 0.703 to 0.868. This finding indicated that exercise rhythm reflected HRV during high-intensity running in the field.

Analysis of the QT interval and its variability in healthy adults during rest and exercise

The aim of the present study was to quantify the variability of electrocardiographic QT and RR intervals during rest and dynamic physical exercise, and to interpret these variabilities in terms of relative autonomic modulation of the atrial and ventricular myocardium. We also sought to characterize the relationships between QT, heart rate-corrected QT (QT(c)) and RR intervals, and to consider their associations with differential autonomic regulation. Nine males and eight females of similar age (22.8 +/- 4.7 years), mass (75.5 +/- 13.0 kg) and aerobic fitness (43.6 +/- 7.7 ml kg(-1) min(-1)) (mean +/- SD) undertook progressive bicycle exercise. A three-lead Holter ECG was recorded continuously during pre-exercise, exercise and recovery, and mean values of RR, QT, QT(c), QT variability index (QTVI) and mean-normalized QT variance (QTVN) were determined. At the onset of exercise QTVI increased rapidly compared with rest and remained significantly elevated throughout exercise and recovery. There were significant differences between QT(a)VI and QT(e)VI (QT measured from Q wave onset to T wave apex (QT(a)) and T wave end (QT(e)), respectively) throughout the experimental protocol. QTVI was significantly reduced in males compared with females prior to exercise but was similar thereafter. We suggest that physical exercise perturbs the resting QT-RR relationship owing to the onset of differential parasympathetic modulation of the atrial and ventricular myocardium. QTVI can be used to quantify the relative autonomic influence on the atrial and ventricular myocardium during rest and exercise, and might be related to HR-dependent and HR-independent influences on the QT interval.

The use of heart rate variability measures to assess autonomic control during exercise

Heart rate variability (HRV) is a non-invasive indicator of cardiac autonomic modulation at rest. During rhythmic exercise, global HRV decreases as a function of exercise intensity. Measures reflecting sympathovagal interactions at rest do not behave as expected during exercise. This makes interpretation of HRV measures difficult, especially at higher exercise intensities. This problem is further confounded by the occurrence of non-neural oscillations in the high-frequency band due to increased respiratory effort. Alternative data treatments, such as coarse graining spectral analysis (CGSA), have demonstrated expected changes in autonomic function during exercise with some success. The separation of harmonic from fractal and/or chaotic components of HRV and study of the latter during exercise have provided further insight into cardioregulatory control. However, more research is needed. Some cross-sectional differences between HRV in athletes and controls during exercise are evident and data suggest longitudinal changes may be possible. Standard spectral HRV analysis should not be applied to exercise conditions. The use of CGSA and non-linear analyses show much promise in this area. Until further validation of these measures is carried out and clarification of the physiological meaning of such measures occurs, HRV data regarding altered autonomic control during exercise should be treated with caution.

Energy expenditure of genuine laughter

OBJECTIVE

To measure energy expenditure (EE) and heart rate (HR) during genuine laughter.

DESIGN

Experimental trial of viewing film clips in four cycles either intended to evoke laughter (humorous -10 min) or unlikely to elicit laughter (not humorous -5 min) under strictly controlled conditions of a whole-room indirect calorimeter equipped with audio recording system.

PARTICIPANTS

Forty five adult friend dyads in either same-sex male (n=7), same-sex female (n=21) and mix-sex male-female (n=17); age 18-34 years; body mass index 24.7+/-4.9 (range 17.9-41.1).

MEASUREMENTS

Energy expenditure in a whole-room indirect calorimeter, HR using Polar HR monitor. Laugh rate, duration and type from digitized audio data using a computerized system and synchronized with HR and EE results.

RESULTS

Laughter EE was 0.79+/-1.30 kJ/min (0.19+/-0.31 kcal/min) higher than resting EE (P<0.001, 95% confidence interval=0.75-0.88 kJ/min), ranging from -2.52 to 9.67 kJ/min (-0.60-2.31 kcal/min). Heart rate during laughter segments increased above resting by 2.1+/-3.8 beats/min, ranging from -7.6 to 26.8 beats/min. Laughter EE was correlated with HR (r (s)=0.250, P<0.01). Both laughter EE and HR were positively correlated with laughter duration (r (s)=0.282 and 0.337, both P<0.001) and rate (r(s)=0.256 and 0.298, both P<0.001).

CONCLUSION

Genuine voiced laughter causes a 10–20% increase in EE and HR above resting values, which means that 10–15 minutes of laughter per day could increase total EE by 10–40 kJ (2–10 kcal) [corrected].

Heart rate variability analysis: a tool to assess cardiac autonomic function

Heart rate monitoring is commonly used to provide an acute indicator of an individual's cardiovascular status and responsiveness. An increasingly popular technique involves quantifying the very small amounts by which the heart rate changes from one cardiac cycle to the next. This "heart rate variability (HRV) analysis" provides a substantial amount of additional information about the cardiovascular system and enables quantification of cardiac regulatory influences on the autonomic nervous system. The autonomic nervous system consists of two main components: the sympathetic system and the parasympathetic system. The relative influence of these two components on the sino-atrial node of the heart determines the heart rate. A number of physiological factors, including blood pressure and respiratory rate, can have a profound effect on this autonomic "balance." HRV analysis therefore provides a noninvasive method for investigating the dynamic influence of changing physiological parameters on cardiac regulation.

Phase-dependent chronotropic response of the heart during running in humans

Heartbeat modulation by muscle contraction during rhythmic exercise involving a small muscle mass is phase-dependent, reflecting the timing of the muscle contraction within the cardiac cycle, but it remains unclear whether such modulation occurs during whole body exercise. To determine whether phase-dependent chronotropic changes in the heart would occur during running, we investigated the relationship between R-R interval (RRI) and the timing of vastus lateralis muscle contractions within the cardiac cycle. Seven healthy subjects were examined during high intensity running where the target heart rate was 160 beats . min(-1). The running pitch was made to wax and wane periodically in the neighborhood of the target heart rate to scan the effect of footfall timing within the cardiac cycle on heart period. We found that when muscle contraction occurred early in the cardiac cycle, RRI was reduced from the mean RRI (P<0.05). Conversely, when muscle contraction occurred in the latter half of the cardiac cycle, RRI tended to increase (P>0.05). Thus, the curve reflecting this phase-dependent relationship between heart period and timing of muscle contraction showed a positive slope within the first one-quarter to three-quarters of the cardiac cycle. Our results suggest the existence of a mechanism that provides beat-by-beat regulation of RRI even when it is very short (approximately 375 ms), i.e., a cardio-locomotor synchronization develops during running, when the frequencies of the two rhythms approach one another.

Effects of Sevoflurane Anesthesia on Carotid-Cardiac Baroreflex Responses in Humans

Sevoflurane depresses cardio-vagal baroreflex gain (ability of vagally mediated R-R interval response to arterial blood pressure change). We examined the effects of sevoflurane anesthesia on maximum buffering capacity of vagally mediated hemodynamic control (baroreflex range) by examining the entire stimulus-response baroreflex relation. Electrocardiogram and invasive arterial blood pressure were monitored in 11 healthy volunteers. Carotid-cardiac baroreflex responses were elicited by increasing neck chamber pressure (external pressure applied over the bilateral carotid sinuses) to 40 mm Hg for 5 heartbeats followed by decreasing chamber pressure by successive 15-mm Hg R-wave triggered decrements to -65 mm Hg during held expiration. R-R intervals were plotted as functions of preceding carotid distending pressure. Range, maximum gain, and operational point (relative position of the resting set point within the entire baroreflex response curve) were determined at conscious baseline, during 2% (end-tidal) sevoflurane anesthesia, without and with phenylephrine infusion to maintain conscious arterial blood pressure, and at 30, 60, 120, and 180 min after emergence from anesthesia. Sevoflurane anesthesia significantly depressed maximum gain (from 3.84 +/- 0.99 to 1.04 +/- 0.40 ms/mm Hg [mean +/- sd]; P < 0.001) and range (from 207 +/- 43 to 52 +/- 19 ms; P < 0.001) of the reflex relation, both of which recovered at 120 and 180 min after emergence. Phenylephrine infusion only partially restored these variables. The operational point was unchanged throughout the study. Our results indicate that maximum cardio-vagal compensatory response to buffer hemodynamic perturbation is depressed during sevoflurane anesthesia. Sevoflurane-induced hypotension, which produced vagal withdrawal, did not play an important role in depressing cardio-vagal reflex function.

Unique Very Low-Frequency Heart Rate Variability During Deep Sleep in Humans

We investigate heart rate variability (HRV) in the very low-frequency (VLF) range (0.003-0.04 Hz) during deep sleep in good sleepers. Spectral analysis of HRV during deep sleep reveals consistent peaks at <0.04 Hz. By using wavelet analysis, we find both stationary and nonstationary periodic patterns in the VLF range, the presence of which has been discussed but has not been fully established to date. Although the mechanism(s) behind the unique VLF oscillations remain to be fully explored, we conjecture that there is an endogenous rhythmic component in human HRV in the VLF range. Further, our results also suggest a need for caution in the interpretation of the VLF spectral power in HRV during deep sleep.

Effects of intermittent hypoxia on heart rate variability during rest and exercise

Changes in heart rate variability induced by an intermittent exposure to hypoxia were evaluated in athletes unacclimatized to altitude. Twenty national elite athletes trained for 13 days at 1200 m and either lived and slept at 1200 m (live low, train low, LLTL) or between 2500 and 3000 m (live high, train low, LHTL). Subjects were investigated at 1200 m prior to and at the end of the 13-day training camp. Exposure to acute hypoxia (11.5% O(2)) during exercise resulted in a significant decrease in spectral components of heart rate variability in comparison with exercise in normoxia: total power (p < 0.001), low-frequency component. LF (p < 0.001), high-frequency component, HF (p < 0.05). Following acclimatization, the LHTL group increased its LF component (p < 0.01) and LF/HF ratio during exercise in hypoxia after the training period. In parallel, exposure to intermittent hypoxia caused an increased ventilatory response to hypoxia. Acclimatization modified the correlation between the ventilatory response to hypoxia at rest and the difference in total power between normoxia and hypoxia (r (2) = 0.65, p < 0.001). The increase in total power, LF component, and LF/HF ratio suggests that intermittent hypoxic training increased the response of the autonomic nervous system mainly through increased sympathetic activity.

Cardiac vagal modulation of heart rate during prolonged submaximal exercise in animals with healed myocardial infarctions: effects of training

The present study investigated the effects of long-duration exercise on heart rate variability [as a marker of cardiac vagal tone (VT)]. Heart rate variability (time series analysis) was measured in mongrel dogs (n = 24) with healed myocardial infarctions during 1 h of submaximal exercise (treadmill running at 6.4 km/h at 10% grade). Long-duration exercise provoked a significant (ANOVA, all P < 0.01, means +/- SD) increase in heart rate (1st min, 165.3 +/- 15.6 vs. last min, 197.5 +/- 21.5 beats/min) and significant reductions in high frequency (0.24 to 1.04 Hz) power (VT: 1st min, 3.7 +/- 1.5 vs. last min, 1.0 +/- 0.9 ln ms(2)), R-R interval range (1st min, 107.9 +/- 38.3 vs. last min, 28.8 +/- 13.2 ms), and R-R interval SD (1st min, 24.3 +/- 7.7 vs. last min 6.3 +/- 1.7 ms). Because endurance exercise training can increase cardiac vagal regulation, the studies were repeated after either a 10-wk exercise training (n = 9) or a 10-wk sedentary period (n = 7). After training was completed, long-duration exercise elicited smaller increases in heart rate (pretraining: 1st min, 156.0 +/- 13.8 vs. last min, 189.6 +/- 21.9 beats/min; and posttraining: 1st min, 149.8 +/- 14.6 vs. last min, 172.7 +/- 8.8 beats/min) and smaller reductions in heart rate variability (e.g., VT, pretraining: 1st min, 4.2 +/- 1.7 vs. last min, 0.9 +/- 1.1 ln ms(2); and posttraining: 1st min, 4.8 +/- 1.1 vs. last min, 2.0 +/- 0.6 ln ms(2)). The response to long-duration exercise did not change in the sedentary animals. Thus the heart rate increase that accompanies long-duration exercise results, at least in part, from reductions in cardiac vagal regulation. Furthermore, exercise training attenuated these exercise-induced reductions in heart rate variability, suggesting maintenance of a higher cardiac vagal activity during exercise in the trained state.

Effect of betaxolol hydrochloride on heart rate variability indices during exercise stress testing in patients with hypertension

Betaxolol hydrochloride is a beta1-selective antagonist that produces vasodilation in patients with hypertension and ischemic heart disease. The goal of the present study was to characterize the effect of betaxolol on heart rate variability indices (HRV), a well-established prognostic marker. Symptom limited-treadmill exercise testing was performed in 17 hypertensive patients (60.9 +/- 14.8 years-old) before and immediately a 3 weeks course of betaxolol hydrochloride (5 mg daily). Frequency domain HRV (high frequency spectra, HF; 0.15-0.40 Hz: low frequency spectra, LF; 0.04-0.15 Hz) was measured during exercise treadmill testing using MemCalc software. Betaxolol hydrochloride significantly decreased the maximal systolic blood pressure and heart rate (184 +/- 29 vs. 156 +/- 26 mmHg, P < 0.01; 132 +/- 21 vs. 113 +/- 15 bpm, P < 0.01) and significantly increased HF and LF during exercise treadmill testing (HF, 32 +/- 36 vs. 56 +/- 55 men/Hz, P < 0.01; LF, 64 +/- 58 vs. 95 +/- 86 men/Hz, P < 0.01). Thus, treatment with betaxolol hydrochloride resulted in a decrease in blood pressure during exercise treadmill testing and in an increase in HRV. This suggests that this agent could have beneficial effects on long-term prognosis in patients with hypertension.

Effects of gender and aerobic fitness on cardiac autonomic responses to head-up tilt in healthy adolescents

Cardiovascular autonomic responses to orthostatic challenges are affected by gender and cardiorespiratory fitness in adults. However, little is know about the effects of these factors in healthy adolescents. We studied 41 adolescents (20 boys and 21 girls) aged 12-17 years, divided into aerobic fitness tertiles based on the results of a maximal treadmill exercise test. Cardiac autonomic modulation was assessed by heart rate variability (HRV) analysis of 5-minute RR interval recordings before and after 70 degrees head-up tilt maneuver. HRV was analyzed by time (TD) and frequency domain (FD) methods. TD was analyzed by standard deviation of the RR intervals and the root mean square of successive differences of RR intervals. The power spectral components were studied at low (LF) and high (HF) frequencies and as the LF/HF ratio. We did not find any differences in TD and FD measures before and after tilt in either gender or fitness groups, except for a higher heart rate response for boys. These results suggests that cardiac autonomic responses to head-up tilt in healthy adolescents are not affected by gender or aerobic fitness.

The concentration-dependent effects of general anesthesia on spontaneous baroreflex indices and their correlations with pharmacological gains

Beat-to-beat assessment of spontaneously occurring fluctuations in heart rate and arterial blood pressure allows noninvasive determination of cardiovagal function, but little is known regarding the effects of general anesthesia on spontaneous baroreflex (SBR) indices. We examined (a) concentration-dependent effects of sevoflurane on SBR indices, heart rate variability (HRV), and blood pressure variability and (b) correlation and agreement between pharmacological baroreflex gains and SBR indices during sevoflurane anesthesia. Continuous electrocardiogram and invasive arterial blood pressure were monitored in nine healthy volunteers before, during, and for 3 h after sevoflurane anesthesia, during which end-tidal sevoflurane was maintained at 0.7%, 1.4%, and 2.0% in random sequences. We derived three SBR indices (sequence method, alpha-index, and low-frequency transfer function) and compared them with pressor and depressor test gains by the pharmacological method. HRV and blood pressure variability were analyzed at a fixed respiratory rate (12 breaths/min) in awake and anesthetized conditions. Except for low-frequency transfer function, SBR indices were depressed by sevoflurane and remained depressed for 30 min after emergence from anesthesia, compared with the conscious baseline value. Spontaneous sequence indices and high- and low-frequency powers of HRV demonstrated concentration-dependent depression. Pharmacological gains and SBR indices during anesthesia generally correlated well, but Bland-Altman analysis revealed that SBR indices had limits of agreement as large as the baroreflex gain itself. These data suggest that spontaneous indices are inadequate estimates of, and are inconsistent with, the pharmacological baroreflex gain during sevoflurane anesthesia.

Differential Effects of MK801 and Lorazepam on Heart Rate Variability in Adolescent Rhesus Monkeys (Macaca Mulatta)

Previous research shows that ketamine significantly alters cardiac signal regulation in rhesus monkeys, however relatively little is known about the mechanism for this effect. In the study reported here the relative contributions of NMDA receptor activation on cardiac signal dynamics were determined by administering a specific NMDA antagonist, MK801, to rhesus monkeys. The general effects of sedation were assessed by measuring cardiac response to lorazepam, a sedative drug without direct NMDA receptor activity. Electrocardiographic signal dynamics were examined before and after I.V. administration of either MK801 (0.16 mg/kg) or lorazepam (0.48 mg/kg). Inter-beat interval time series data were analyzed in the frequency domain after Fourier transform, and a nonlinear measure of autocorrelation, the Hurst exponent (H), was derived. After MK801 administration, log [HF /Total power] increased post-infusion (M = 1.11, SD = 0.45) compared with pre-infusion values [M = -0.19, SD = 0.32, F(1,4) = 19.49, P = 0.01] while H decreased, mean pre versus post 0.52+/-S.D. 0.10 versus 0.01+/- 0.05, P = 0.0002. Lorazepam administration did not significantly alter heart rate variability measures obtained in the frequency or nonlinear domains. To our knowledge, this is the first study that has defined the effects of peripherally administered MK801 on cardiovascular dynamics in primates and establishes that peripheral administration of NMDA antagonists result in large increases the high-frequency components of cardiac rhythm and increased heart rate variability compatible with MK801-associated increases in parasympathetic outflow.

On the genesis of myocardial ischemia

About three quarters of myocardial ischemic events are triggered by the autonomic nervous system. The pathognomonic constellation is a combination of an almost complete withdrawal of tonic vagal activity with increased sympathetic activity. The reduction of tonic vagal activity, which is characteristic for ischemic heart disease, and the acute withdrawal of vagal drive preceding the onset of ischemia are not dependent on coronary artery disease. In this paper, the pathophysiological steps that lead from sympathetic-parasympathetic imbalance to myocardial ischemia shall be discussed. A considerable increase of aerobic glycolysis within the myocardium as a result of the autonomic imbalance is of special importance in this process.

T393C polymorphism of GNAS1 associated with the autonomic nervous system in young, healthy Japanese subjects

1. T393C polymorphism of the gene encoding the Gs-protein alpha-subunit (GNAS1) has been reported recently to be associated with hypertension in which dysfunctions of the autonomic nervous system (ANS) are closely involved. In the present study, the association of this polymorphism with ANS activity was investigated in young, healthy Japanese males. 2. Four hundred and one subjects were genotyped for the T393C polymorphism of GNAS1 by polymerase chain reaction-restriction fragment length polymorphism. Autonomic nervous system activity during supine rest and when standing was assessed in 137 subjects by electrocardiogram R-R interval power spectral analysis. 3. One hundred and fifty-four subjects (38.4%) were homozygous for the T allele (TT), 188 (46.9%) were heterozygous (TC) and 59 (14.7%) were homozygous for the C allele (CC). There were no significant differences as to genotype among the clinical characteristics investigated. In power spectral analysis of heart rate variability, the high-frequency component and parasympathetic nervous system (PNS) index during supine rest were significantly lower in TT and TC carriers than in CC carriers. Furthermore, the increase in heart rate and the responsiveness of sympathetic nervous system index and PNS index to postural change from supine rest to standing were significantly lower in TT and TC carriers than in CC carriers. 4. These observations suggest that the GNAS1 T393C polymorphism is associated with ANS activity in youth, so that it may be useful as a genetic marker for future pathogenesis of hypertension. Follow-up studies are necessary to clarify the prevalence rates of hypertension among 393T allele carriers in the present study.

Cardiopulmonary physiology and responses of ultramarathon athletes to prolonged exercise

The purpose of this study was to determine the changes of pulmonary function and autonomic cardiovascular control after an ultramarathon and their relation to performance. Eight entrants to the Canadian National Championship 100-km running race participated in the study. Pulmonary function and 30-s maximum voluntary ventilation (MVV30s) tests were conducted one day before the race and within 5 minutes of race completion. Heart rate and blood pressure data were collected 30 min before and 5 min after the race as well as during a 10-min stand test one day prior to the race. During the race, beat-by-beat R-R interval data were collected over the first and last 20 km. The results showed that MVV30s and MVV30s tidal volumes were reduced postrace (p < 0.001). Prerace supine total harmonic variation (p < 0.01) and prerace MVV values (10 s to 30 s) (p < 0.05) were correlated with race finish time. The changes in pulmonary function and MVV30s values from pre- and postrace were not significantly correlated to race performance. We conclude that maximal sustainable ventilatory power and dynamic autonomic cardiovascular control are important factors in determining overall performance in an ultramarathon.

Hemodynamic Effects of Perioperative Stressor Events during Rhinoplasty

The hemodynamic effects of perioperative stressors, including preoperative patient anxiety, intraoperative local anesthetic/adrenaline infiltrations, and some painful interventions, have not been fully elucidated in plastic surgery procedures. The present study was designed to determine the hemodynamic effects of perioperative stressor events in American Society of Anesthesiologists class I patients undergoing rhinoplasty procedures under general anesthesia. The study included 50 healthy patients, 18 to 51 years of age (mean age, 27 +/- 7 years), who underwent a rhinoplasty procedure in the authors' department. All patients were connected to a digital ambulatory Holter recorder for 24 hours starting on the day before the operation and continuing throughout the procedure. All of the patients received 10 ml of 2% lidocaine with 1:80,000 adrenaline 15 minutes after intubation. Observations consisted of heart rate, noninvasive blood pressure, and power spectral heart rate variability analyses, the latter of which is indicative of the sympathovagal balance of the patients. The majority of patients developed a persistent, moderate sinus tachycardia before the induction of anesthesia. After the infiltration of lidocaine/adrenaline, a mild to moderate and short-lasting tachycardia was detected. A similar increase in pulse rate was also noticed during lateral osteotomies. No significant blood pressure changes attributable to perioperative stressors (with the exclusion of general anesthesia induction, intubation, and extubation) were observed. Sympathetic activity was found to be responsible from marked tachycardia before the induction, which was attributable to preoperative anxiety. The authors' study has demonstrated that there are three hemodynamically unstable periods causing tachycardia for rhinoplasty patients that directly concern the plastic surgeon: immediate preoperative anxiety, local anesthetic/adrenaline injection, and lateral osteotomies. The authors conclude that these patients would benefit from routine use of premedications and that a lidocaine/adrenaline combination is a safe adjunct to general anesthesia in young rhinoplasty patients. In addition, a deeper anesthesia during local infiltration and osteotomies would be appropriate.

Limiar ventilatório e variabilidade da freqüência cardíaca em adolescentes

As análises da concentração sanguínea de lactato e das trocas gasosas respiratórias são métodos tradicionalmente empregados para identificar a transição de produção de energia pelo metabolismo muscular. No entanto, mais recentemente, vem sendo sugerido método alternativo mediante análise da variabilidade da freqüência cardíaca. Pretendeu-se, com o presente estudo, estabelecer comparações entre o limiar de variabilidade da freqüência cardíaca (LiVFC) e o primeiro limiar ventilatório (LV1), em uma amostra de adolescentes. Para tanto, foram submetidos a teste de esforço físico de carga máxima em esteira ergométrica 41 sujeitos (22 rapazes e 19 moças) com idades entre 15 e 18 anos. O LV1 foi identificado mediante o equivalente ventilatório de oxigênio envolvendo recursos de ergoespirometria. A variabilidade da freqüência cardíaca foi analisada por intermédio dos intervalos R-R, através da plotagem de Poincaré, que oferece informações quanto ao desvio-padrão da variabilidade instantânea batimento-a-batimento (SD1), ao desvio-padrão a longo prazo de intervalos R-R contínuos (SD2) e à razão SD1/SD2. O LiVFC foi identificado pelo SD1 de acordo com três critérios: (1) diferenças entre o SD1 de dois estágios consecutivos menor que 1ms; (2) SD1 menor que 3ms; e (3) ocorrência de ambos os critérios em conjunto. Mediante análise dos resultados verificou-se que os intervalos R-R e SD2 diminuíram progressivamente a cada intervalo de 10% do VO2pico até o final do teste de esforço físico (0,05 < p < 0,01). O SD1 diminuiu significativamente desde 20% até 50% do VO2pico. A partir de 60% até o VO2pico o SD1 não apresentou diferenças significativas. A razão SD1/SD2 aumentou a partir de 60%. O LV1 ocorreu a 54,4 ± 8,8% do VO2pico enquanto o LiVFC, a 52,4 ± 12,5%, 57,0 ± 14,1% e 57,8 ± 13,8% do VO2 pico, para os critérios 1, 2 e 3, respectivamente. Não foram observadas diferenças estatísticas entre o LV1 e os três critérios utilizados para identificação do LiVFC. Observaram-se coeficientes de correlação momento-produto significativos entre o LiVFC identificado mediante os três critérios considerados e o LV1, quando foram utilizados os valores absolutos de VO2. Porém, não foram encontradas correlações estatísticas significativas entre o LiVFC e a identificação do LV1 expresso em proporção do VO2pico. Em assim sendo, concluiu-se que parece ser precipitado tentar empregar o LiVFC como método alternativo na identificação do LV1 de adolescentes.

Short- and long-term effects of a single bout of exercise on heart rate variability: comparison between constant and interval training exercises

Heart rate variability (HRV) was assessed during the short- (within 1 h) and long- (within 48 h) term recovery following a single bout of either constant (CST) or interval training (SWEET) exercise performed at the same total physical work [9.4 (0.3) kJ kg(-1)]. R-R intervals, systolic (SAP) and diastolic (DAP) arterial pressures were recorded in supine and upright positions before and 1, 24 and 48 h after the termination of the exercises in ten male subjects [mean (SEM), age 24.6 (0.6) years, height 177.2 (1.1) cm and body mass 68.5 (0.9) kg]. The parameters were also recorded in the supine position during the first 20 min following the end of the exercise. Spectral analysis parameters of HRV [total (TP), low- (LF), and high- (HF) frequency power, and LF/TP, HF/TP and LF/HF ratios] were determined over 5 min during each phase. Except for higher HF values in both supine and upright positions during the first hour following CST compared with SWEET, cardiovascular and HRV analysis responses were of the same magnitude after their termination. R-R intervals, TP, and HF/TP were significantly decreased while LF/TP and LF/HF were significantly increased during the early recovery, when compared with control values. This could be a response to the significant decrease in SAP and DAP at this time. Twenty-four and 48 h after the end of the exercise, HRV parameters were at the same levels as before exercises in the supine posture, but a persistent tachycardia continued to be observed in the upright posture, together with reduced TP values, showing that cardiovascular functions were still disturbed. The short-term HRV recovery seemed dependent on the type of exercise, contrary to the long-term recovery.

The effect of ventilation on spectral analysis of heart rate and blood pressure variability during exercise

Heart rate variability (HRV) and systolic blood pressure variability (BPV) during incremental exercise at 50, 75, and 100% of previously determined ventilatory threshold (VT) were compared to that of resting controlled breathing (CB) in 12 healthy subjects. CB was matched with exercise-associated respiratory rate, tidal volume, and end-tidal CO(2) for all stages of exercise. Power in the low frequency (LF, 0.04-0.15 Hz) and high frequency (HF, >0.15-0.4 Hz) for HRV and BPV were calculated, using time-frequency domain analysis, from beat-to-beat ECG and non-invasive radial artery blood pressure, respectively. During CB absolute and normalized power in the LF and HF of HRV and BPV were not significantly changed from baseline to maximal breathing. Conversely, during exercise HRV, LF and HF power significantly decreased from baseline to 100% VT while BPV, LF and HF power significantly increased for the same period. These findings suggest that the increases in ventilation associated with incremental exercise do not significantly affect spectral analysis of cardiovascular autonomic modulation in healthy subjects.

Pregnancy-related changes in behavior and cardiac activity in primiparous pigs

Pregnancy in mammals is a time of considerable physical, physiological and behavioral change necessary for the continuance of the gestation. Gestating pigs are often used in behavior and welfare studies; yet, there are little published data describing how pregnancy affects normal behavior and cardiac activity patterns. The objective of this work was to describe the longitudinal dynamics of cardiac activity and behavior during pregnancy in primiparous pigs (gilts). The behavior and cardiac activity of nine gilts were recorded on eight occasions at certain fixed time points during their pregnancy: 1-2 weeks before oestrus and mating (week -1), 14 days postmating (week 2), and days 30 (week 4), 44 (week 6), 65 (week 9), 79 (week 11), 93 (week 13) and 107 (week 15) of pregnancy. Temporal changes in behavior patterns were present in all gilts over the course of gestation. Pretest levels of general activity progressively declined between weeks -1 and 15, as indicated by a decrease in the proportion of observations spent rooting (p<0.001), walking (p<0.001) and standing (p<0.001). There was a corresponding increase in inactivity (p<0.001), and the proportion of time spent sleeping, as opposed to lying alert, increased also (p<0.001). Apart from RR-min and its corresponding HR-max indices, all time-domain parameters were influenced by the stage of gestation. Specifically, mean HR increased (p<0.001), whereas the root-mean-square of successive differences (RMSSD) and standard deviation (S.D.) decreased (p<0.001). Pregnancy further impacted the frequency domain measures of heart rate variability. From week -1 to 15, the absolute magnitude of Total power (p<0.001) decreased, HF power decreased (p<0.001) and LF power increased (p=0.004). In conclusion, pregnancy induced widespread changes in behavior and in sympathovagal regulation of cardiac activity in pigs that were reflected in both the time and frequency domain indices of heart rate variability analysis.

Spectral Analysis of Heart Rate Variability during Exercise in Trained Subjects

PURPOSE

To investigate the effects of strenuous exercise on heart rate variability (HRV).

METHODS

We evaluated the effects of exercise intensity and duration on HRV indices in 14 healthy trained subjects. Each subject exercised for 3, 6, and 9 min at 60 and 70% of the power achieved at maximal oxygen consumption (PVO2(max)) and for 3 and 6 min (or 3 min twice) at 80% of PVO2(max). The electrocardiogram RR intervals were recorded then processed by fast(FFT) and short-time (STFT) Fourier transform for determination of low-frequency (LF, 0.045-0.15 Hz) and high-frequency (HF, 0.15-1.0 Hz) components.

RESULTS

The LF and HF components expressed as absolute power (ms2) decreased significantly at the onset of exercise (P < 0.05). However, with increasing exercise intensity, the HF component expressed as normalized units (n.u.) (reflecting parasympathetic modulation) increased significantly, whereas the LF component (n.u.) and LF/HF ratio (both reflecting sympathetic modulation) decreased significantly (P < 0.05). STFT showed that increasing exercise intensity was associated with a shift in HF peak frequency related to an increase in respiratory rate and a marked decrease in LF power (ms2). Moreover, HFn.u. rose (r = 0.918, P < 0.01) and LFms2 fell as minute ventilation increased (r = 0.906, P < 0.01).

CONCLUSIONS

Parasympathetic respiratory control and nonautonomic mechanisms may influence the HF-peak shift during strenuous exercise. HRV and the usual indexes of sympathetic activity do not accurately reflect changes in autonomic modulation during exhaustive exercise.

Effects of nitrous oxide on baroreflex gain and heart rate variability

BACKGROUND

Spontaneous baroreflex method allows continuous assessment of cardiovagal reflex function within resting blood pressure, but effects of nitrous oxide, per se, on the spontaneous baroreflex response remain unknown. This study was designed to determine the effects of nitrous oxide on spontaneous baroreflex gain and heart rate variability assessed by power spectral analysis in humans.

METHODS

Electrocardiogram and non-invasive blood pressure were monitored in 12 healthy volunteers before and during a 15-min inhalation of 67% nitrous oxide in oxygen, while spontaneous respiration was maintained. Least-square regression analysis relating R-R interval and systolic blood pressure was performed to obtain spontaneous baroreflex gains. Heart rate variability was analyzed using fast Fourier transformation.

RESULTS

Nitrous oxide did not significantly alter spontaneous baroreflex gains, which correlated well with high-frequency power (0.15-0.4 Hz) of heart rate variability before and during nitrous oxide inhalation.

CONCLUSION

Our results indicate that (a) cardiovagal reflex response is not affected by nitrous oxide, per se, and (b) spontaneous baroreflex responses closely reflect beat-to-beat dynamic modulation of the cardiac cycle by the parasympathetic nervous system during inhalation of 67% nitrous oxide.

Heart rate variability at rest and during exercise in persons with Down syndrome

OBJECTIVES

To determine whether autonomic dysfunction explains chronotropic incompetence observed in persons with Down syndrome (DS) and to measure heart rate variability (HRV) at rest and during exercise in persons with mental retardation with and without DS.

DESIGN

Comparative study.

SETTING

University exercise science laboratory.

PARTICIPANTS

Thirty-one subjects with mental retardation (age, 20.2 y) with DS (n=16; 10 men, 6 women) and without DS (n=15; 8 men, 7 women).

INTERVENTIONS

Not applicable. Main outcome measures HRV was determined at rest and at 2 steady-state exercise intensities on the treadmill in both time (standard deviation of the R-R interval, percentage of R-R intervals deviating by more than 50 ms from the previous R-R interval [deviation >50], square root of the mean squared differences of successive differences) and frequency (low-frequency power [LF]), high-frequency power [HF], the LF/HF ratio) domains.

RESULTS

The DS group demonstrated a statistically lower peak heart rate (161 beats/min vs 178 beats/min, P<.05), and peak oxygen consumption (27.4 mL.kg(-1).min(-1) vs 34.3 mL. kg(-1).min(-1), P<.05) than did the group with mental retardation without DS. At rest, all time domain measures of HRV and absolute HF power were significantly higher in the DS group (P<.05). Yet, LF power and LF/HF values did not differ between groups. All HRV variables decreased significantly at both exercise intensities, with no differences between groups during exercise (P<.05).

CONCLUSIONS

People with DS have greater parasympathetic activity at rest, but group differences disappear with the onset of exercise, which suggests that other variables are responsible for chronotropic incompetence in persons with DS.

Plastic Surgeon???s Life: Marvelous for Mind, Exhausting for Body

Surgery is accepted as one of the most demanding professions that create both physical and mental strain on the performers. Therefore, the authors aimed to elucidate the mental burden of surgeons, which is dedicated to operative stress. They also tested the hypotheses that participating in surgery creates mental stress on surgeons that leads to cardiovascular changes, and that this stress is more pronounced for actual operators than for first assistants. The method chosen for this purpose was an analysis of heart rate variability. Twelve surgeons (five plastic surgery staff and seven plastic surgery residents) were monitored by a digital ambulatory Holter recorder on at least two occasions. Half of the recordings were carried out on operating days and the other half on office days. Heart rate variability indices (low frequency, high frequency, high frequency/low frequency ratio, and heart rate) were analyzed from those recordings using computerized research tool software. The heart rate variability indices of the operators showed statistically significant differences between operating days and office hours in favor of an increased sympathetic and decreased parasympathetic activity for the former. For first assistants, three of the parameters, with the exception of heart rate, changed in favor of a sympathetic predominance over parasympathetic activity; these changes were also statistically significant. These results showed a sympathetic hyperactivity for both operators and first assistants during the operations. When the sympathovagal balance of the actual operators was compared with that of assistants, the former group showed a more pronounced sympathetic arousal. This difference is accepted as a proof for the mental stress of the surgery being the main factor responsible for the sympathetic hyperactivity that we detected during the operations. Surgeons continuously face a unique mental strain that other professions rarely bring forth, and these psychological stressors are associated with alterations in cardiac autonomic control that may contribute to the development of cardiac disease. Prolonged sympathetic hyperactivity could anticipate cardiac discomfort in more experienced surgeons with marginal cardiac reserve. Such cardiac diseases would be reconsidered as occupation-related illnesses, which might be reimbursed to the physician. In addition, the legal responsibility of surgeons concerning their unfavorable results might be assessed with more understanding with a realization of their undue working conditions.

Parasympathetic Effects on Heart Rate Recovery after Exercise

Background

Exercise and its recovery period are associated with increased risk of death relative to sedentary periods. They are also accompanied by dynamic changes in autonomic tone. Little information is available regarding parasympathetic effects during high-intensity exercise and recovery.

Methods

Ten normal subjects (five women; age 33 ± 2 years) underwent exercise testing on a bicycle ergometer. On day 1, subjects exercised to maximum tolerated workload using a graded protocol with 5 minutes at maximal workload (peak heart rate achieved 174.7 ± 5.4 bpm). On day 2, subjects performed the identical exercise protocol as on day 1; 1 minute into the maximum exercise stage, atropine (0.04 mg/kg) was administered. Heart rate was recorded every minute during exercise, and an electrocardiogram was recorded every minute in recovery for 10 minutes. The parasympathetic effect on heart rate was defined by the difference in heart rate with and without atropine.

Results

The parasympathetic effect during maximal exercise was 3.4 to 6 bpm ( p < .05). During recovery, a large parasympathetic effect on heart rate was noted by 1 minute (22.8 bpm; p < .0002), increased until 4 minutes, and then remained stable until 10 minutes. Despite faster heart rates with parasympathetic blockade, the P–R interval was shorter ( p < .002), consistent with a significant parasympathetic effect on the atrioventricular node in recovery. Evaluation of the Q–T–R–R relationship on the 2 days demonstrated significant changes in both the slope ( p < .0001) and the intercept ( p < .0001), consistent with a modification of ventricular repolarization by parasympathetic tone in recovery.

Conclusion

These data indicate that in normal subjects, parasympathetic effects persist during high-intensity exercise and are prominent in the early phases of recovery. These parasympathetic effects may play an important role in prevention of sudden cardiac death during these periods of increased risk.

Heart rate variability following coronary artery bypass graft surgery as a function of recovery time, posture, and exercise

This study examined the claim made by Niemela et al. (1992) that the decline in heart rate variability after coronary artery bypass graft surgery is irreversible. We tested six women and 16 men six and 12 weeks postoperative in three postures: in the supine position, in the standing position, and during low-intensity steady-state exercise. Beat-by-beat arterial blood pressure and electrocardiographic R–R interval data were collected continuously for 10 min in each condition. R–R interval data were analyzed with spectral analysis; baroreflex data were analyzed using the sequence method. Our results show that the indices of parasympathetic modulation improved over time, as seen by an | increased spontaneous baroreflex sensitivity and parasympathetic indicator, that both indices were affected by posture, and that spontaneous baroreflex sensitivity was also affected by low-intensity exercise. The effects of posture are consistent with attenuated responses of healthy older subjects to orthostatic stress. Similarly, the effects of low-intensity exercise are consistent with findings in healthy subjects. We found that spontaneous baroreflex sensitivity declined during exercise, whereas, in healthy subjects, this is maintained during low-intensity steady-state exercise. Our results of significant functional recovery between six and 12 weeks postoperative suggest that at least some of the autonomic dysfunction following surgery is temporary. Previously, no such duration of study has lasted longer than four or six weeks following cardiac surgery, which may not have been long enough to show significant functional restoration in heart rate variability.Key words: heart rate variability, spontaneous baroreflex sensitivity, CABG surgery, posture, exercise.

Gender differences in baroreflex response and heart rate variability in anaesthetized humans

BACKGROUND

In conscious humans, men have a greater cardiovagal baroreflex gain than women. We studied gender-related differences in baroreflex function during general anaesthesia.

METHODS

Sixty healthy patients (30 male and 30 female) were anaesthetized with sevoflurane 2% end-tidal in air and oxygen, and their lungs were mechanically ventilated. We recorded the ECG and invasive arterial pressure. Baroreflex gain was measured as the linear relationship of R-R interval with systolic arterial pressure changes caused by doses of phenylephrine i.v., and also the spontaneous changes in R-R interval and arterial pressure. In addition, consecutive R-R intervals were analysed using a fast Fourier transformation.

RESULTS

Baroreflex gains (mean (sd)) assessed by the pharmacological method in men (7.98 (5.12) ms x mm x Hg(-1)) was significantly greater than that in women (4.89 (3.87) ms x mm x Hg(-1)). Similarly, spontaneous baroreflex gains were significantly greater in men than in women, and correlated well with high-frequency power, but not with low-frequency power or low/high ratio, of heart rate variability in both genders.

CONCLUSIONS

Our results extend findings in conscious humans to sevoflurane anaesthesia. Men have greater cardiovagal reflex gains than women, which may reflect differences in parasympathetic action on heart rate.