Autonomic responses to exercise: Deconditioning/inactivity

Vagotomy accelerates the onset of symptoms during early disease progression and worsens joint-level pathogenesis in a male rat model of chronic knee osteoarthritis

Objective

Low vagal tone is common in osteoarthritis (OA) comorbidities and results in greater peripheral inflammation. Characterizing vagal tone's role in OA pathogenesis may offer insights into OA's influences beyond the articular joint. We hypothesized that low vagal tone would accelerate onset of OA-related gait changes and worsen joint damage in a rat knee OA model.

Methods

Knee OA was induced in male Sprague Dawley rats by transecting the medial collateral ligament and medial meniscus. Then, left cervical vagus nerve transection (VGX, n ​= ​9) or sham VGX (non-VGX, n ​= ​6) was performed. Gait and tactile sensitivity were assessed at baseline and across 12 weeks, with histology and systemic inflammation evaluated at endpoint.

Results

At week 4, VGX animals showed limping gait characteristics through shifted stance times from their OA to non-OA limb (p ​= ​0.055; stance time imbalance ​= ​1.6 ​± ​1.6%) and shifted foot strike locations (p ​< ​0.001; spatial symmetry ​= ​48.4 ​± ​0.835%), while non-VGX animals walked with a balanced and symmetric gait. Also at week 4, while VGX animals had a mechanical sensitivity (50% withdrawal threshold) of 13.97 ​± ​7.70 compared to the non-VGX animal sensitivity of 29.74 ​± ​9.43, this difference was not statistically significant. Histologically, VGX animals showed thinner tibial cartilage and greater subchondral bone area than non-VGX animals (p ​= ​0.076; VGX: 0.80 ​± ​0.036 ​mm2; non-VGX: 0.736 ​± ​0.066 ​mm2). No group differences in systemic inflammation were observed at endpoint.

Conclusions

VGX resulted in quicker onset of OA-related symptoms but remained unchanged at later timepoints. VGX also had thinner cartilage and abnormal bone remodeling than non-VGX. Overall, low vagal tone had mild effects on OA symptoms and joint remodeling, and not at the level seen in common OA comorbidities.

Effect of 60 days of head down tilt bed rest on amplitude and phase of rhythms in physiology and sleep in men

Twenty-four-hour rhythms in physiology and behaviour are shaped by circadian clocks, environmental rhythms, and feedback of behavioural rhythms onto physiology. In space, 24 h signals such as those associated with the light-dark cycle and changes in posture, are weaker, potentially reducing the robustness of rhythms. Head down tilt (HDT) bed rest is commonly used to simulate effects of microgravity but how HDT affects rhythms in physiology has not been extensively investigated. Here we report effects of -6° HDT during a 90-day protocol on 24 h rhythmicity in 20 men. During HDT, amplitude of light, motor activity, and wrist-temperature rhythms were reduced, evening melatonin was elevated, while cortisol was not affected during HDT, but was higher in the morning during recovery when compared to last session of HDT. During recovery from HDT, time in Slow-Wave Sleep increased. EEG activity in alpha and beta frequencies increased during NREM and REM sleep. These results highlight the profound effects of head-down-tilt-bed-rest on 24 h rhythmicity.

Prospective association of occupational and leisure-time physical activity with orthostatic blood pressure changes in older adults

Orthostatic hypotension (OH) is common in older people. We examined the influence of self-reported occupational-related physical activity (PA) and leisure-time physical exercise (PE) on orthostatic response in a sample of older people over a 2 year period. Supine and orthostatic systolic blood pressure (sBP), diastolic blood pressure (dBP), and mean blood pressure (mBP) were assessed in response to Active Stand (AS) test in 205 older subjects (> 60 years old) at baseline and 2-year follow-up. OH was found in 24 subjects (11.71%) at baseline and 20 subjects (9.76%) after 2 years, with a significant degree of variability in the occurrence of OH after 2 years. Twenty-two subjects who had OH at baseline were free of it after 2 years, two subjects had persistent OH at baseline and after 2 years. After 2 years, adults with occupational PA showed no significant decrease of blood pressure in response to AS test, while lack of undertaking an occupation-related PA was significantly related with a greater decrease in sBP and mBP in response to AS testing in the 1st min. Occupation-related PA and leisure-time-related PE were related to an increase in the response of BP on AS in change between baseline and after 2 years. High between-subjects variance in OH over 2 years was noted. Occupations that involved continuous physical activity and leisure-time physical exercise in middle age were both protective for BP decline on orthostatic stress test within 2 years.

Impact of daily artificial gravity on autonomic cardiovascular control following 60-day head-down tilt bed rest

Impaired cardiovascular autonomic control following space flight or immobilization may limit the ability to cope with additional hemodynamic stimuli. Head-down tilt bedrest is an established terrestrial analog for space flight and offers the opportunity to test potential countermeasures for autonomic cardiovascular deconditioning. Previous studies revealed a possible benefit of daily artificial gravity on cardiovascular autonomic control following head-down tilt bedrest, but there is a need for efficiency in a long-term study before an artificial gravity facility would be brought to space. We hypothesized that artificial gravity through short-arm centrifugation attenuates functional adaptions of autonomic function during head-down tilt bed rest. 24 healthy persons (8 women, 33.4 ± 9.3 years, 24.3 ± 2.1 kg/m2) participated in the 60-day head-down tilt bed rest (AGBRESA) study. They were assigned to three groups, 30 min/day continuous, or 6(5 min intermittent short-arm centrifugation, or a control group. We assessed autonomic cardiovascular control in the supine position and in 5 minutes 80° head-up tilt position before and immediately after bed rest. We computed heart rate variability (HRV) in the time (rmssd) and frequency domain, blood pressure variability, and baroreflex sensitivity (BRS). RR interval corrected rmssd was reduced supine (p = 0.0358) and during HUT (p = 0.0161). Heart rate variability in the high-frequency band (hf-RRI; p = 0.0004) and BRS (p < 0.0001) decreased, whereas blood pressure variability in the low-frequency band (lf-SBP, p = 0.0008) increased following bedrest in all groups. We did not detect significant interactions between bedrest and interventions. We conclude that up to daily 30 min of artificial gravity on a short-arm centrifuge with 1Gz at the center of mass do not suffice to prevent changes in autonomic cardiovascular control following 60-day of 6° head-down tilt bed rest. Clinical Trial Registration: https://drks.de/search/en/trial/DRKS00015677, identifier, DRKS00015677.

Neuromodulation as a Potential Disease-Modifying Therapy for Osteoarthritis

PURPOSE OF REVIEW

The following review discusses the therapeutic potential of targeting the autonomic nervous system (ANS) for osteoarthritis (OA) treatment and encourages the field to consider the candidacy of bioelectronic medicine as a novel OA treatment strategy.

RECENT FINDINGS

The study of OA pathogenesis has focused on changes occurring at the joint level. As such, treatments for OA have been aimed at the local joint environment, intending to resolve local inflammation and decrease pain. However, OA pathogenesis has shown to be more than joint wear and tear. Specifically, OA-related peripheral and central sensitization can prompt neuroplastic changes in the nervous system beyond the articular joint. These neuroplastic changes may alter physiologic systems, like the neuroimmune axis. In this way, OA and related comorbidities may share roots in the form of altered neuroimmune communication and autonomic dysfunction. ANS modulation may be able to modify OA pathogenesis or reduce the impact of OA comorbidities. Moreover, blocking chronic nociceptive drive from the joint may help to prevent maladaptive nervous system plasticity in OA.

New horizons in the ageing autonomic nervous system: orthostatic hypotension and supine hypertension

Blood pressure regulation is an automatic, moment-by-moment buffering of the blood pressure in response to physiological changes such as orthostasis, exercise and haemorrhage. This finely orchestrated reflex is called the baroreflex. It is a regulated arc of afferent, central and efferent arms. Multiple physiological changes occur with ageing that can disrupt this reflex, making blood pressure regulation less effective. In addition, multiple changes can occur with ageing-related diseases such as neurodegeneration, atherosclerosis, deconditioning and polypharmacy. These changes commonly result in orthostatic hypotension, hypertension or both, and are consistently associated with multiple adverse outcomes. In this article, we discuss the healthy baroreflex, and physiological and pathophysiological reasons for impaired baroreflex function in older people. We discuss why the common clinical manifestations of orthostatic hypotension and concomitant supine hypertension occur, and strategies for balancing these conflicting priorities. Finally, we discuss strategies for treating them, outlining our practice alongside consensus and expert guidance.

A comparative study of heart rate variability and physical fitness in women with moderate and severe fibromyalgia

The aim of this study was to compare the physical fitness and cardiac autonomic activity among women with moderate and severe fibromyalgia (FM) and healthy women. This study included 35 women with FM (age: 46.2±8.9 years) and 17 healthy women (age: 44.3±9.9 years). Participants with FM were divided into moderate FM (n=15) and severe FM (n=20) according to the total score obtained in FM impact questionnaire. The heart rate variability was monitored using a portable cardiac monitor with participants resting in supine position during 10 min. Thereafter, the participants performed the chair sit and reach test, the chair stand test, and the 6-min walk test to measure the lower-body flexibility, lower-body muscle strength, and cardiorespiratory fitness, respectively. The lower-body muscle strength and cardiorespiratory fitness were both reduced in moderate and severe FM compared to healthy women (P<0.01), with greater reduction in severe FM when compared to moderate FM (P<0.05). In addition, the parasympathetic indexes of heart rate variability were all similarly decreased in both moderate and severe FM, when compared to healthy women (P<0.05). The cardiac parasympathetic activity is similarly decreased in women with both moderate and severe FM in comparison to healthy women, despite a greater physical deconditioning in severe FM.

Baroreflex sensitivity in facioscapulohumeral muscular dystrophy

Facioscapulohumeral muscular dystrophy (FSHD), a common form of muscular dystrophy, is caused by a genetic mutation that alters DUX4 gene expression. This mutation contributes to significant skeletal muscle loss. Although it is suggested that cardiac muscle may be spared, people with FSHD have demonstrated autonomic dysregulation. It is unknown if baroreflex function, an important regulator of blood pressure (BP), is impaired in people with FSHD. We examined if baroreflex sensitivity (BRS) is blunted in patients with FSHD. Thirty minutes of resting BP, heart rate, and cardiovagal BRS were measured in 13 patients with FSHD (age: 50 ± 13 years, avg ± SD) and 17 sex- and age-matched controls (age: 47 ± 14 years, p > 0.05). People with FSHD were less active (Activity Metabolic Index, AMI) (FSHD: 24 ± 30; controls: 222 ± 175 kcal/day; p < 0.001) but had a similar body mass index compared with controls (FSHD: 27 ± 4; controls: 27 ± 4 kg/m2 ; p > 0.05). BRSup (hypertensive response), BRSdown (hypotensive response), and total BRS were similar between groups (BRSup: FSHD: 12 ± 8; controls: 12 ± 5 ms/mmHg; BRSdown: FSHD: 10 ± 4; controls: 13 ± 6 ms/mmHg; BRS: FSHD: 14 ± 9; controls: 13 ± 6 ms/mmHg; p > 0.05). Mean arterial pressure was similar between groups (FSHD: 96 ± 7; controls: 91 ± 6mmHg). Individuals with FSHD had an elevated heart rate compared with controls (FSHD: 65 ± 8; controls: 59 ± 8 BPM; p = 0.03), but when co-varied for AMI, this relationship disappeared (p = 0.39). These findings suggest that BRS is not attenuated in people with FSHD, but an elevated heart rate may be due to low physical activity levels, a potential consequence of limited mobility.

Post-Covid-19 Syndrome: Improvements in Health-Related Quality of Life Following Psychology-Led Interdisciplinary Virtual Rehabilitation

Coronavirus disease 2019 (COVID-19) is increasingly recognized as having significant long-term impact on physical and mental health. The Primary Care Wellbeing Service (PCWBS) in Bradford District Care NHS Foundation Trust (BDCFT) is a psychology-led specialist interdisciplinary team of health professionals specializing in persistent physical symptoms (PPS) and Chronic Fatigue Syndrome (CFS)/Myalgic Encephalomyelitis (ME) with an emphasis on holistic integrated care. The PCWBS quickly recognized the risk of the long-term effects of COVID-19, particularly for social, health and care staff, and developed a 7-week virtual rehabilitation course which was piloted in October 2020. The “Recovering from COVID” course takes a whole system, biopsychosocial approach to understanding COVID-19 and post-viral fatigue (PVF) and is delivered by an interdisciplinary team consisting of a clinical psychologist, physiotherapist, occupational therapist, dietitian, speech and language therapist, assistant psychologist, and a personal support navigator with support from a team administrator. The course focuses on understanding PVF, sleep optimization, nutrition, swallowing, activity management, energy conservation, stress management, breathing optimization, managing setbacks, and signposting to appropriate resources and services. Since the pilot, PCWBS has delivered 7 courses to support over 200 people suffering from post-COVID-19 syndrome. One hundred and forty-nine individuals that enrolled on the “Recovering from COVID” course completed the EQ-5D-5L to assess Health-related quality of life (HRQoL) across 5 dimensions, including problems with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Subsequently, 76 individuals completed these measures at the end of the rehabilitation course showing that patient ratings were significantly improved. In response to the NIHR recommendation for rapid evaluation of different service models for supporting people with post-COVID-19 syndrome, this data offers hope that rehabilitation is effective in reversing some of the problems faced by people living with the long-term effects of COVID-19.

Learning From Human Responses to Deconditioning Environments: Improved Understanding of the "Use It or Lose It" Principle

Physical activity, mobility or patterned mobility (i.e., exercise) is intrinsic to the functioning of Homo sapiens, and required for maintenance of health. Thus, systems such as the musculoskeletal and cardiovascular systems appear to require constant reinforcement or conditioning to maintain integrity. Loss of conditioning or development of chronic deconditioning can have multiple consequences. The study of different types of deconditioning and their prevention or reversal can offer a number of clues to the regulation of these systems and point to how deconditioning poses risk for disease development and progression. From the study of deconditioning associated with spaceflight, a condition not predicted by evolution, prolonged bedrest, protracted sedentary behavior, as well as menopause and obesity and their consequences, provide a background to better understand human heterogeneity and how physical fitness may impact the risks for chronic conditions subsequent to the deconditioning. The effectiveness of optimized physical activity and exercise protocols likely depend on the nature of the deconditioning, the sex and genetics of the individual, whether one is addressing prevention of deconditioning-associated disease or disease-associated progression, and whether it is focused on acute or chronic deconditioning associated with different forms of deconditioning. While considerable research effort has gone into preventing deconditioning, the study of the process of deconditioning and its endpoints can provide clues to the regulation of the affected systems and their contributions to human heterogeneity that have been framed by the boundary conditions of Earth during evolution and the "use it or lose it" principle of regulation. Such information regarding heterogeneity that is elaborated by the study of deconditioning environments could enhance the effectiveness of individualized interventions to prevent deconditions or rescue those who have become deconditioned.

A Multi-Systems Approach to Human Movement after ACL Reconstruction: The Cardiopulmonary System

The cardiopulmonary system plays a pivotal role in athletic and rehabilitative activities following anterior cruciate ligament reconstruction, along with serving as an important support for the functioning of other physiologic systems including the integumentary, musculoskeletal, and nervous systems. Many competitive sports impose high demands upon the cardiorespiratory system, which requires careful attention and planning from rehabilitation specialists to ensure athletes are adequately prepared to return to sport. Cardiopulmonary function following anterior cruciate ligament reconstruction (ACLR) can be assessed using a variety of methods, depending on stage of healing, training of the clinician, and equipment availability. Reductions in cardiovascular function may influence the selection and dosage of interventions that are not only aimed to address cardiopulmonary impairments, but also deficits experienced in other systems that ultimately work together to achieve goal-directed movement. The purpose of this clinical commentary is to present cardiopulmonary system considerations within a multi-physiologic systems approach to human movement after ACLR, including a clinically relevant review of the cardiopulmonary system, assessment strategies, and modes of cardiopulmonary training to promote effective, efficient movement.

LEVEL OF EVIDENCE

5.

Investigating the Immediate Influence of Moderate Pedal Exercises during an Assembly Work on Performance and Workload in Healthy Men

Physical inactivity has increased in prevalence among adults in industrialized and developing countries owing to the fact that the majority of job situations require individuals to remain seated for extended periods of time. This research aims to evaluate the influence of cycling on a stationary bike while executing a keyboard assembly task on the task completion time, error percentage, and physiological and subjective measurements. The physiological measures were electroencephalography (EEG) and electrocardiographic (ECG) signal responses, whereas the subjective measures were subjective workload ratings and subjective body discomforts. Two variables were evaluated, namely assembly methods (with versus without pedal exercises at a moderate intensity) and session testing (pre- versus post-test). Thus, the repeated measures design (i.e., assembly method by session testing of participants) was used. According to the completion time, error %, participant self-reports, and ECG and EEG statistical analysis data, the participants' performances in the keyboard assembly task did not decrease while they performed pedaling exercises (p > 0.05). Additionally, when participants completed the assembly task while executing the pedaling exercises, the mean inter-beat (RR) intervals significantly reduced (p < 0.05) while the mean heart rate increased (p < 0.05), which mean that pedaling exercises caused physical workloads on the participants. Participant performance was unaffected by performing a workout while performing the assembly activity. Thus, administrations should encourage their employees to engage in short sessions of moderate-intensity exercise similar to the suggested exercise in the study to improve a person's physical health during work without interfering with the effectiveness of work.

When American Adults Do Move, How Do They Do So? Trends in Physical Activity Intensity, Type, and Modality: 1988-2017

BACKGROUND

Few Americans accumulate enough physical activity (PA) to realize its benefits. Understanding how and why individuals use their discretionary time for different forms of PA could help identify and rectify issues that drive individuals away from certain physical activities, and leverage successful strategies to increase participation in others.

METHODS

The authors analyzed approximately 30 years of changes in PA behavior by intensity, type, and mode, using data from the Behavioral Risk Factor Surveillance System.

RESULTS

Since 1988, the proportions of adults most frequently engaging in exercise, sport, or lifestyle physical activity have changed noticeably. The most apparent changes from 1988 to 2017 were the proportions most frequently engaging in Exercise and Sport. In addition, the proportion of time reportedly spent in vigorous-intensity PA decreased over time, particularly among male respondents. Moreover, the proportion of Americans reporting an "Other" PA mode increased substantially, suggesting a growing need for a greater variety of easily accessible options for adult PA.

CONCLUSIONS

Over time, a smaller proportion of American adults reported participating in sport and exercise modalities and reported engaging more frequently in low-intensity physical activities.

Effect of Moderate- Versus High-Intensity Interval Exercise Training on Heart Rate Variability Parameters in Inactive Latin-American Adults: A Randomized Clinical Trial

Ramírez-Vélez, R, Tordecilla-Sanders, A, Téllez-T, LA, Camelo-Prieto, D, Hernández-Quiñonez, PA, Correa-Bautista, JE, Garcia-Hermoso, A, Ramírez-Campillo, R, and Izquierdo, M. Effect of moderate- versus high-intensity interval exercise training on heart rate variability parameters in inactive Latin-American adults: a randomized clinical trial. J Strength Cond Res 34(12): 3403-3415, 2020-We investigated the effect of moderate versus high-intensity interval exercise training on the heart rate variability (HRV) indices in physically inactive adults. Twenty inactive adults were randomly allocated to receive either moderate-intensity training (MCT group) or high-intensity interval training (HIT group). The MCT group performed aerobic training at an intensity of 55-75%, which consisted of walking on a treadmill at 60-80% of the maximum heart rate (HRmax) until the expenditure of 300 kcal. The HIT group ran on a treadmill for 4 minutes at 85-95% peak HRmax and had a recovery of 4 minutes at 65% peak HRmax until the expenditure of 300 kcal. Supine resting HRV indices (time domain: SDNN = SD of normal-to-normal intervals; rMSSD = root mean square successive difference of R-R intervals and frequency domain: HFLn = high-frequency spectral power; LF = low-frequency spectral power and HF/LF ratio) were measured at baseline and 12 weeks thereafter. The SDNN changes were 3.4 (8.9) milliseconds in the MCT group and 29.1 (7.6) milliseconds in the HIT group {difference between groups 32.6 (95% confidence interval, 24.9 to 40.4 [p = 0.01])}. The LF/HFLn ratio changes were 0.19 (0.03) milliseconds in the MCT group and 0.13 (0.01) milliseconds in the HIT group (p between groups = 0.016). No significant group differences were observed for the rMSSD, HF, and LF parameters. In inactive adults, this study showed that a 12-week HIT training program could increase short-term HRV, mostly in vagally mediated indices such as SDNN and HF/LFLn ratio power. Trial registration. ClinicalTrials.gov NCT02738385 https://clinicaltrials.gov/ct2/show/NCT01796275, registered on March 23, 2016.

Autonomic dysfunction in a group of lower extremities arterial disease outpatients

BACKGROUND

The understanding of the specific role of sympathetic neural control and dysregulation in lower extremities arterial disease (LEAD) is still very limited. Aim of our study was to investigate the autonomic profile in LEAD patients and to evaluate if the eventual autonomic alterations were more severe in patients with advanced disease.

METHODS

We enrolled all consecutive outpatients with LEAD referred to our Departments between July 2012 and September 2014. They were compared to a group of matched outpatients without LEAD. All patients underwent Holter ECG monitoring. Time-domain analysis of heart rate variability (HRV) was evaluated.

RESULTS

Compared to controls, patients with LEAD had a lower SDNN (P=0.007) and SDANN (P=0.003). Patients with clinically advanced LEAD had a lower SDNN (P=0.006) and SDANN (P=0.004) compared to LEAD patients with less severe disease and to those without disease.

CONCLUSIONS

LEAD patients had a reduced SDNN and SDANN than patients without LEAD. Autonomic dysfunction was more significant in clinically advanced stages of disease. This association did not relate to ABI value but to clinical stage of disease.

Physical activity and disability in patients with noncardiac chest pain: a longitudinal cohort study

BACKGROUND

Noncardiac chest pain (NCCP) is one of the leading reasons for emergency department visits and significantly limits patients' daily functioning. The protective effect of physical activity has been established in a number of pain problems, but its role in the course of NCCP is unknown. This study aimed to document the level of physical activity in patients with NCCP and its association with NCCP-related disability in the 6 months following an emergency department visit.

METHODS

In this prospective, longitudinal, cohort study, participants with NCCP were recruited in two emergency departments. They were contacted by telephone for the purpose of conducting a medical and sociodemographic interview, after which a set of questionnaires was sent to them. Participants were contacted again 6 months later for an interview aimed to assess their NCCP-related disability.

RESULTS

The final sample consisted of 279 participants (57.0% females), whose mean age was 54.6 (standard deviation = 15.3) years. Overall, the proportion of participants who were physically active in their leisure time, based on the Actimètre questionnaire criteria, was 22.0%. Being physically active at the first measurement time point was associated with a 38% reduction in the risk of reporting NCCP-related disability in the following 6 months (ρ = .047). This association remained significant after controlling for confounding variables.

CONCLUSIONS

Being physically active seems to have a protective effect on the occurrence of NCCP-related disability in the 6 months following an emergency department visit with NCCP. These results point to the importance of further exploring the benefits of physical activity in this population.

Heart rate as a predictor of cardiovascular risk

Heart rate is a parameter that is very easy to measure and is widely used both in clinic and during daily life activities. Its value gained more relevance with the evidence, in prospective studies and meta-analysis, of association between elevated heart rate values and diseases and outcomes.The increased knowledge of physiological mechanisms of heart rate control and the pathophysiological mechanisms responsible for its dysfunction allows to identify the cut-off value of normalcy providing info for non-pharmacological and pharmacological treatments to reduce the cardiovascular risk both in general population and in pathophysiological conditions. This paper overviews the knowledges of the role of resting heart rate as predictor of cardiovascular risk.

Human papillomavirus vaccination and postural tachycardia syndrome, deconditioning and exercise-induced hyperalgesia: An alternate interpretation of the reported adverse reactions

Human papillomavirus vaccination (HPVV) was included in the national immunization program in 2013 in Japan. However, the Japanese government suspended proactive recommendations 2 months after this decision because various adverse events following the vaccination were reported by the media. More than 6 years have already passed since the suspension of proactive recommendations of all available vaccines in Japan. Although no causal relationship between the adverse effects and HPVV has been confirmed, the Japanese government has not withdrawn the suspension. Thus, it is important to show various possible causes of the adverse events other than HPVV. It is attempted to describe the possible contribution of the misunderstanding regarding the symptoms of postural tachycardia syndrome, deconditioning, and exercise-induced hyperalgesia as the adverse effects of HPVV in this review article.

Effect of Cycling on a Stationary Bike While Performing Assembly Tasks on Human Physiology and Performance Parameters

Objective: This study evaluated participants’ ability to assemble a computer keyboard while at a cycling workstation. Depending on task completion time, error percentage, and workload based on subjective workload ratings, subjective body discomfort, electroencephalography (EEG) and electrocardiographic (ECG) signals, human performances were compared at four different cycling conditions: no cycling, low level cycling (15 km/h), preferred level cycling, and high level cycling (25 km/h). Method: The experiment consisted of 16 participants. Each participant performed the test four times (each cycling condition) on different days. Results: The repeated measure test showed that the alpha and beta EEG signals were high during session times (post) when compared with session times (pre). Moreover, the mean interbeat (R-R) interval decreased after the participants performed the assembly while pedaling, possibly due to the physical effort of cycling. Conclusions: Pedaling had no significant effect on body discomfort ratings, task errors, or completion time.

Optimal Human Functioning Requires Exercise Across the Lifespan: Mobility in a 1g Environment Is Intrinsic to the Integrity of Multiple Biological Systems

It is widely acknowledged that achieving and maintaining a healthier lifestyle can be enhanced through regular participation in sport and physical activity. Coevally, a growing number of health professionals regard exercise as a legitimate intervention strategy for those who have lost their health. Exercise has been shown to be effective for overweight or obese individuals, who are at risk to lose their health due to development of type II diabetes, cardiovascular disease, as well as, infiltration of muscles, bone and other organs with fat, so it can be considered medicine. However, exercise and associated mobility likely also have a strong prevention component that can effectively contribute to the maintenance of the integrity of multiple biological systems for those who do not have overt risk factors or ongoing disease. While prevention is preferred over intervention in the context of disease, it is clear that exercise and associated mobility, generally, can be an effective influence, although overtraining and excessive loading can be deleterious to health. The basis for the generally positive influence of exercise likely lies in the fact that many of our physiological systems are designed to function in the mechanically dynamic and active 1g environment of Earth (e.g., muscles, cartilage, ligaments, tendons, bones, and cardiovascular system, and neuro-cognitive function), and nearly all these systems subscribe to the "use it or lose it" paradigm. This conclusion is supported by the changes observed over the more than 50 years of space flight and exposure to microgravity conditions. Therefore, the premise advanced is: "exercise is preventative for loss of health due to age-related decline in the integrity of several physiological systems via constant reinforcement of those systems, and thus, optimal levels of exercise and physical activity are endemic to, essential for, and intrinsic to optimal health and wellbeing."

Associations of physical activity, sedentary time, and cardiorespiratory fitness with heart rate variability in 6- to 9-year-old children: the PANIC study

Purpose

To study the associations of physical activity (PA), sedentary time (ST), and cardiorespiratory fitness (CRF) with heart rate variability (HRV) in children.

Methods

The participants were a population sample of 377 children aged 6–9 years (49% boys). ST, light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and moderate-to-vigorous PA (MVPA), and PA energy expenditure (PAEE) were assessed using a combined heart rate and movement sensor, maximal power output per kilograms of lean body mass as a measure of CRF by maximal cycle ergometer exercise test, and HRV variables (SDNN, RMSSD, LF, and HF) using 5 min resting electrocardiography. Data were analysed by linear regression adjusted for years from peak height velocity.

Results

In boys, ST was inversely associated (β = − 0.185 to − 0.146, p ≤ 0.049) and MVPA, VPA, PAEE, and CRF were directly associated (β = 0.147 to 0.320, p ≤ 0.048) with HRV variables. CRF was directly associated with all HRV variables and PAEE was directly associated with RMSSD after mutual adjustment for ST, PAEE, and CRF (β = 0.169 to 0.270, p ≤ 0.046). In girls, ST was inversely associated (β = − 0.382 to − 0.294, p < 0.001) and LPA, MPA, VPA, MVPA, and PAEE were directly associated with HRV variables (β = 0.144 to 0.348, p ≤ 0.049). After mutual adjustment for ST, PAEE, and CRF, only the inverse associations of ST with HRV variables remained statistically significant.

Conclusions

Higher ST and lower PA and CRF were associated with poorer cardiac autonomic nervous system function in children. Lower CRF in boys and higher ST in girls were the strongest correlates of poorer cardiac autonomic function.

Electronic supplementary material

The online version of this article (10.1007/s00421-019-04231-5) contains supplementary material, which is available to authorized users.

Acute Effects of Connective Tissue Manipulation on Autonomic Function in Healthy Young Women

Background: Connective tissue manipulation (CTM) has therapeutic effects on diseases with autonomic imbalance, yet its mechanisms of action are not clearly identified. Objective: The aim of this study was to investigate acute autonomic responses to CTM in healthy young women with various physical activity levels. Method: The study was designed as a nonrandomized, controlled single-center study. Healthy women aged between 18 and 25 years were assigned to a connective tissue manipulation group (CTMG) (n = 150) or a control group (CG) (n = 60). CTM was applied to the CTMG while the CG did not receive any intervention. Respiratory rate (RR), heart rate, systolic/diastolic blood pressures (SP/DP), oxygen saturation (OS) and body temperature were measured. The International Physical Activity Questionnaire short form was used to determine physical activity levels. ­Results: Analysis revealed significant reduction in SP and DP and an increment in RR in the CTMG (p < 0.05). RR increased and SP decreased among inactive, SP decreased among moderately active, and SP and OS decreased among highly active participants in the CTMG (p < 0.05). There were no significant alterations in the CG (p > 0.05). Conclusions: CTM has an immediate reducing effect on sympathetic activity in healthy young women independently from the physical activity level. Future studies are needed to clarify long-term effects of CTM on autonomic functions in healthy individuals.

Objectively Measured Sitting and Standing in Workers: Cross-Sectional Relationship with Autonomic Cardiac Modulation

Excessive sitting and standing are proposed risk factors for cardiovascular diseases (CVDs), possibly due to autonomic imbalance. This study examines the association of objectively measured sitting and standing with nocturnal autonomic cardiac modulation. The cross-sectional study examined 490 blue-collar workers in three Danish occupational sectors. Sitting and standing during work and leisure were assessed during 1⁻5 days using accelerometers. Heart rate (HR) and heart rate variability (HRV) were obtained during nocturnal sleep as markers of resting autonomic modulation. The associations of sitting and standing still (h/day) with HR and HRV were assessed with linear regression models, adjusted for age, gender, body mass index, smoking, and physical activity. More sitting time during leisure was associated with elevated HR (p = 0.02), and showed a trend towards reduced HRV. More standing time at work was associated with lower HR (p = 0.02), and with increased parasympathetic indices of HRV (root mean squared successive differences of R-R intervals p = 0.05; high-frequency power p = 0.07). These findings, while cross-sectional and restricted to blue-collar workers, suggest that sitting at leisure is detrimental to autonomic cardiac modulation, but standing at work is beneficial. However, the small effect size is likely insufficient to mitigate the previously shown detrimental effects of prolonged standing on CVD.

A Physiological Approach to Assessment and Rehabilitation of Acute Concussion in Collegiate and Professional Athletes

Sport-related concussion is an important condition that can affect collegiate and professional athletes. Expert consensus guidelines currently suggest that all athletes who sustain acute concussion be managed with a conservative approach consisting of relative rest and gradual resumption of school and sport activities with active intervention reserved for those with persistent post-concussion symptoms lasting >10-14 days for adults. Unfortunately, these recommendations place little emphasis on the rapid physical deconditioning that occurs in athletes within days of exercise cessation or the pathophysiological processes responsible for acute concussion symptoms that can be successfully targeted by evidence-based rehabilitation strategies. Based on our evolving approach to patients with persistent post-concussion symptoms, we now present an updated physiological approach to the initial medical assessment, rehabilitation, and multi-disciplinary management of collegiate and professional athletes with acute concussion. Utilizing the results of a careful clinical history, comprehensive physical examination and graded aerobic exercise testing, we outline how team physicians, and athletic training staff can partner with multi-disciplinary experts in traumatic brain injury to develop individually tailored rehabilitation programs that target the main physiological causes of acute concussion symptoms (autonomic nervous system dysfunction/exercise intolerance, vestibulo-ocular dysfunction, and cervical spine dysfunction) while maintaining the athlete's physical fitness during the recovery period. Considerations for multi-disciplinary medical clearance of collegiate and professional athletes as well as the application of this approach to non-elite athletes are also discussed.

Associations Between Heart Rate Recovery Dynamics With Estradiol Levels in 20 to 60 Year-Old Sedentary Women

It is hypothesized that estradiol levels, as well as aging, influence cardiac autonomic function in women. The main aim of this study was to test the correlations between heart rate recovery (HRR) dynamics, as a proxy of cardiac autonomic function, with estradiol levels and age in women. This cross-sectional study involved 44 healthy women. Heart rate (HR) data were obtained beat-by-beat during the entire experiment. Maximal incremental exercise testing (IET) on a cycle ergometer was performed followed by 6 min of recovery. During the IET recovery period, the overall HRR dynamics were evaluated by exponential data modeling (time constant "τ") where shorter τ indicates faster HRR adjustment. Considering the cardiac autonomic complexity, HRR dynamics were also evaluated by delta (Δ) analysis considering different HR data intervals. The relationship between HRR dynamics, estradiol levels and age was tested by Pearson product-moment correlation. The overall HRR dynamics (i.e., τ) were statistically correlated with age (r = 0.58, p < 0.001) and estradiol levels (r = -0.37, p = 0.01). The Δ analysis showed that the slower overall HRR associated with aging was a consequence of slower dynamics occurring within the 45-210 s interval, indicating slower sympathetic withdrawal. In conclusion, aging effects on HRR in women seems to be correlated with a slower sympathetic withdrawal. In addition, the cardioprotective effect previously associated with estradiol seems not to influence the autonomic modulation during exercise recovery periods in women.

Long-duration bed rest modifies sympathetic neural recruitment strategies in male and female participants

To understand the impact of physical deconditioning with head-down tilt bed rest (HDBR) on the malleability of sympathetic discharge patterns, we studied 1) baseline integrated muscle sympathetic nerve activity (MSNA; microneurography) from 13 female participants in the WISE-2005 60-day HDBR study (retrospective analysis), 2) integrated MSNA and multiunit action potential (AP) analysis in 13 male participants performed on data collected at baseline and during physiological stress imposed by end-inspiratory apnea in a new 60-day HDBR study, and 3) a repeatability study (control; n = 6, retrospective analysis, 4 wk between tests). Neither baseline integrated burst frequency nor incidence were altered with HDBR (both P > 0.35). However, baseline integrated burst latency increased in both HDBR studies (male: 1.35 ± 0.02 to 1.39 ± 0.02 s, P < 0.01; female: 1.23 ± 0.02 to 1.29 ± 0.02 s, P < 0.01), whereas controls exhibited no change across two visits (1.25 ± 0.02 to 1.25 ± 0.02 s, group-by-time interaction, P = 0.02). With the exception of increased AP latency ( P = 0.03), male baseline AP data did not change with HDBR (all P > 0.19). The change in AP frequency on going from baseline to apnea (∆94 ± 25 to ∆317 ± 55 AP/min, P < 0.01) and the number of active sympathetic clusters per burst (∆0 ± 0.2 to ∆1 ± 0.2 clusters/burst, P = 0.02) were greater post- compared with pre-HDBR. The change in total clusters with apnea was ∆0 ± 0.5 clusters pre- and ∆2 ± 0.7 clusters post-HDBR ( P = 0.07). These data indicate that 60-day HDBR modified discharge characteristics in baseline burst latency and sympathetic neural recruitment during apneic stress. NEW & NOTEWORTHY Long-duration bed rest did not modify baseline sympathetic burst frequency in male and female participants, but examination of additional features of the multiunit signal provided novel evidence to suggest augmented synaptic delays or processing times at baseline for all sympathetic action potentials. Furthermore, long-duration bed rest increased reflex-sympathetic arousal to apneic stress in male participants primarily by mechanisms involving an augmented firing rate of action potential clusters active at baseline.

Similar cardiometabolic effects of high- and moderate-intensity training among apparently healthy inactive adults: a randomized clinical trial

BACKGROUND

Metabolic syndrome (MetS) increases the risk of morbidity and mortality from cardiovascular disease, and exercise training is an important factor in the treatment and prevention of the clinical components of MetS.

OBJECTIVE

The aim was to compare the effects of high-intensity interval training and steady-state moderate-intensity training on clinical components of MetS in healthy physically inactive adults.

METHODS

Twenty adults were randomly allocated to receive either moderate-intensity continuous training [MCT group; 60-80% heart rate reserve (HRR)] or high-intensity interval training (HIT group; 4 × 4 min at 85-95% peak HRR interspersed with 4 min of active rest at 65% peak HRR). We used the revised International Diabetes Federation criteria for MetS. A MetS Z-score was calculated for each individual and each component of the MetS.

RESULTS

In intent-to-treat analyses, the changes in MetS Z-score were 1.546 (1.575) in the MCT group and -1.249 (1.629) in the HIT group (between-groups difference, P =  0.001). The average number of cardiometabolic risk factors changed in the MCT group (-0.133, P = 0.040) but not in the HIT group (0.018, P = 0.294), with no difference between groups (P = 0.277).

CONCLUSION

Among apparently healthy physically inactive adults, HIT and MCT offer similar cardiometabolic protection against single MetS risk factors but differ in their effect on average risk factors per subject. Trial registration ClinicalTrials.gov NCT02738385 registered on March 23, 2016.

Toward biotechnology in space: High-throughput instruments for in situ biological research beyond Earth

Space biotechnology is a nascent field aimed at applying tools of modern biology to advance our goals in space exploration. These advances rely on our ability to exploit in situ high throughput techniques for amplification and sequencing DNA, and measuring levels of RNA transcripts, proteins and metabolites in a cell. These techniques, collectively known as "omics" techniques have already revolutionized terrestrial biology. A number of on-going efforts are aimed at developing instruments to carry out "omics" research in space, in particular on board the International Space Station and small satellites. For space applications these instruments require substantial and creative reengineering that includes automation, miniaturization and ensuring that the device is resistant to conditions in space and works independently of the direction of the gravity vector. Different paths taken to meet these requirements for different "omics" instruments are the subjects of this review. The advantages and disadvantages of these instruments and technological solutions and their level of readiness for deployment in space are discussed. Considering that effects of space environments on terrestrial organisms appear to be global, it is argued that high throughput instruments are essential to advance (1) biomedical and physiological studies to control and reduce space-related stressors on living systems, (2) application of biology to life support and in situ resource utilization, (3) planetary protection, and (4) basic research about the limits on life in space. It is also argued that carrying out measurements in situ provides considerable advantages over the traditional space biology paradigm that relies on post-flight data analysis.

Alterations in autonomic cerebrovascular control after spinal cord injury

Among chronic cardiovascular and metabolic sequelae of spinal cord injury (SCI) is an up-to four-fold increase in the risk of ischemic and hemorrhagic stroke, suggesting that individuals with SCI cannot maintain stable cerebral perfusion. In able-bodied individuals, the cerebral vasculature is able to regulate cerebral perfusion in response to swings in arterial pressure (cerebral autoregulation), blood gases (cerebral vasoreactivity), and neural metabolic demand (neurovascular coupling). This ability depends, at least partly, on intact autonomic function, but high thoracic and cervical spinal cord injuries result in disruption of sympathetic and parasympathetic cerebrovascular control. In addition, alterations in autonomic and/or vascular function secondary to paralysis and physical inactivity can impact cerebrovascular function independent of the disruption of autonomic control due to injury. Thus, it is conceivable that SCI results in cerebrovascular dysfunction that may underlie an elevated risk of stroke in this population, and that rehabilitation strategies targeting this dysfunction may alleviate the long-term risk of adverse cerebrovascular events. However, despite this potential direct link between SCI and the risk of stroke, studies exploring this relationship are surprisingly scarce, and the few available studies provide equivocal results. The focus of this review is to provide an integrated overview of the available data on alterations in cerebral vascular function after SCI in humans, and to provide suggestions for future research.

Is prolonged sitting at work associated with the time course of neck-shoulder pain? A prospective study in Danish blue-collar workers

OBJECTIVES

This study aimed to determine the extent to which objectively measured sitting time at work is associated with the course of neck-shoulder pain across 1 year in blue-collar workers.

METHODS

Data were analysed from 625 blue-collar workers in the Danish PHysical ACTivity cohort with Objective measurements (DPHACTO) cohort study (2012-2013). Objective data on sitting time were collected at baseline using accelerometry. Self-reported pain intensity (numeric rating scale 0-10) in the neck-shoulder region was registered for 1 year using repeated text messages (14 in total). Linear mixed models were used to determine the relationship between per cent time in sitting at work and trajectories of neck-shoulder pain, with and without adjustment for demographic, occupational and lifestyle factors, and baseline pain intensity.

RESULTS

More sitting time at work was associated with a faster decline in pain intensity over 12 months, as indicated by a statistically significant effect of sitting on pain trajectories in the crude (p=0.020) and fully adjusted models (p=0.027).

CONCLUSIONS

In blue-collar workers, more sitting time at work was associated with a favourable development of pain intensity over time. The relationship between sitting at work and pain needs further investigation before explicit recommendations and guidelines on sedentary behaviour among blue-collar workers can be developed.

The role of the hippocampus in the pathogenesis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a severe acquired illness characterized by a profound sensation of fatigue, not ameliorated by rest and resulting in a substantial decrease in the amount and quality of occupational, social and recreational activities. Despite intense research, the aetiology and pathogenesis of ME/CFS is still unknown and no conclusive biological markers have been found. As a consequence, an accepted curative treatment is still lacking and rehabilitation programmes are not very effective, as few patients recover. Increased knowledge of the mechanisms leading to the emergence and maintenance of the illness is called for. In this study, I will put forth an alternative hypothesis to explain some of the pathologies associated with ME/CFS, by concentrating on one of the major strategic organs of the brain, the hippocampus. I will show that the ME/CFS triggering factors also impact the hippocampus, leading to neurocognitive deficits and disturbances in the regulation of the stress system and pain perception. These deficits lead to a substantial decrease in activity and to sleep disorders, which, in turn, impact the hippocampus and initiate a vicious circle of increased disability.

Prolonged Sitting is Associated with Attenuated Heart Rate Variability during Sleep in Blue-Collar Workers

Prolonged sitting is associated with increased risk for cardiovascular diseases and mortality. However, research into the physiological determinants underlying this relationship is still in its infancy. The aim of the study was to determine the extent to which occupational and leisure-time sitting are associated with nocturnal heart rate variability (HRV) in blue-collar workers. The study included 138 blue-collar workers (mean age 45.5 (SD 9.4) years). Sitting-time was measured objectively for four days using tri-axial accelerometers (Actigraph GT3X+) worn on the thigh and trunk. During the same period, a heart rate monitor (Actiheart) was used to sample R-R intervals from the electrocardiogram. Time and frequency domain indices of HRV were only derived during nighttime sleep, and used as markers of cardiac autonomic modulation. Regression analyses with multiple adjustments (age, gender, body mass index, smoking, job-seniority, physical work-load, influence at work, and moderate-to-vigorous physical activity) were used to investigate the association between sitting time and nocturnal HRV. We found that occupational sitting-time was negatively associated (p < 0.05) with time and frequency domain HRV indices. Sitting-time explained up to 6% of the variance in HRV, independent of the covariates. Leisure-time sitting was not significantly associated with any HRV indices (p > 0.05). In conclusion, objectively measured occupational sitting-time was associated with reduced nocturnal HRV in blue-collar workers. This indicates an attenuated cardiac autonomic regulation with increasing sitting-time at work regardless of moderate-to-vigorous physical activity. The implications of this association for cardiovascular disease risk warrant further investigation via long-term prospective studies and intervention studies.

Physical activity level is not a determinant of autonomic nervous system activity and clinical severity in children/adolescents with sickle cell anemia: A pilot study

BACKGROUND

Autonomic nervous system (ANS) activity has been suggested to modulate the clinical severity of sickle cell anemia (SCA) by increasing the risk for vaso-occlusive events. Regular physical activity (PA) is known to improve ANS activity and health status in several cardiovascular and metabolic diseases. Whether regular PA improves the health status of SCA patients remains unknown.

PROCEDURE

Twenty-two patients with SCA and 15 healthy (AA) children/adolescents participated to the study. Heart rate variability was measured in supine position and after a tilt-test to quantify the ANS activity. PA energy expenditure (PAEE) was assessed with questionnaire.

RESULTS

1) PAEE was lower in SCA compared to AA (190 ± 152 vs. 432 ± 277 kcal · d(-1), respectively, P < 0.01), 2) overall ANS activity was lower in SCA compared to AA, 3) parasympathetic withdrawal was observed in SCA with aging, 4) ANS reactivity was slightly impaired in SCA compared to AA (reduction in HFnu: -38 ± 27 vs. -58 ± 14%, respectively, P < 0.05), 5) ANS indices, PAEE, and rates of clinical events were not correlated.

CONCLUSION

Both the level of PA and ANS activity are reduced in SCA compared to AA children/adolescents, particularly in those older than 15 years. Neither PAEE, nor ANS activity seem to influence the clinical severity of children/adolescents with SCA.

Cardiac autonomic dysfunction in chronic stroke women is attenuated after submaximal exercise test, as evaluated by linear and nonlinear analysis

Background

We evaluated cardiac autonomic modulation in women with chronic ischemic stroke (at least 4 years post-stroke) at rest and in response to submaximal exercise test.

Methods

Fourteen post-stroke women (S group) and 10 healthy women (C group) participated in this study. Autonomic modulation (using linear and nonlinear analysis), blood pressure and metabolic variables at rest were evaluated immediately after the exercise test and during the recovery period (20 min). All participants underwent submaximal exercise test on cycle ergometer with gas analysis.

Results

At rest, the S group displayed higher lactate concentration, systolic (SBP) and diastolic blood pressure (DBP) values when compared to C group. Furthermore, the S group had lower heart rate variability (HRV) in time domain (SDNN: S = 30 ± 5 vs. 40 ± 8 ms; rMSSD: S = 14 ± 2 vs. C = 34 ± 3 ms), decreased high frequency band of pulse interval (S = 8.4 ± 2 vs. 33.1 ± 9 %) and 2V pattern of symbolic analysis (S = 17.3 ± 1 vs. 30 ± 3 %) (both indicators of cardiac vagal modulation) when compared to C group. Immediately after exercise, S group presented higher values of lactate, SBP, DBP and double product when compared to C group, as well as decreased heart rate recovery (HRR) measured at the first, second and third minutes. At recovery time, all HRV parameters in time and frequency domains improved in the S group; however, HF band remained lower when compared to C group.

Conclusions

After the exercise test, women with chronic stroke presented reduced heart rate variability, reduced cardiac vagal modulation, as well as reduced HRR, while displayed an improvement of heart rate variability and cardiac vagal modulation when compared to their baseline. These results reinforce the importance of a physically active lifestyle for cardiovascular autonomic disorders observed in chronic stroke women.

Aquatic training in MS: neurotherapeutic impact upon quality of life

Three fundamental principals associated with aquatic therapy differentiate it with respect to exercise on land, and in air. These are buoyancy (reduction in weight of the body within the buoyant medium of water), viscosity (a “drag force” is generated when moving within water, when compared with the same movement in air), and the thermodynamic aspect of water exercise, during which the heat capacity of water is about 1000 times greater than that of an equivalent amount of air; equating to a heat transfer from the body into water at a rate 25 times faster than that of air. Aquatic conditioning, can improve neurologic functioning, with dividends favorably impacting activities of daily living, health maintenance, safety, and ultimately quality of life. Here, we review the application of aquatic exercise training in MS patients.