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Chen Y, Ge H, Su X, Ma X. Classification of exercise fatigue levels by multi-class SVM from ECG and HRV. Med Biol Eng Comput 2024; 62:2853-2865. [PMID: 38705958 DOI: 10.1007/s11517-024-03116-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
Among the various physiological signals, electrocardiogram (ECG) is a valid criterion for the classification of various exercise fatigue. In this study, we combine features extracted by deep neural networks with linear features from ECG and heart rate variability (HRV) for exercise fatigue classification. First, the ECG signals are converted into 2-D images by using the short-term Fourier transform (STFT), and image features are extracted by the visual geometry group (VGG) . The extracted image and linear features of ECG and HRV are sent to the different types of classifiers to distinguish distinct exercise fatigue level. To validate performance, the proposed methods are tested on (i) an open-source EPHNOGRAM dataset and (ii) a self-collected dataset (n = 51). The results reveal that the classification based on the concatenated features has the highest accuracy, and the calculation time of the system is also significantly reduced. This demonstrates that the proposed novel hybrid approach can be used to assist in improving the accuracy and timeliness of exercise fatigue classification in a real-time exercise environment. The experimental results show that the proposed method outperforms other recent state-of-the-art methods in terms of accuracy 96.90%, sensitivity 96.90%, F1-score of 0.9687 in EPHNOGRAM and accuracy 92.17%, sensitivity 92.63%, F1-score of 0.9213 in self-collected dataset.
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Affiliation(s)
- Yuru Chen
- School of Sports Engineering, Beijing Sport University, Beijing, China
| | - Huanmin Ge
- School of Sports Engineering, Beijing Sport University, Beijing, China.
| | - Xinhua Su
- School of Sports Engineering, Beijing Sport University, Beijing, China
| | - Xinxin Ma
- School of Sports Engineering, Beijing Sport University, Beijing, China
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Castillo-Escamilla J, Ruffo I, Carrasco-Poyatos M, Granero-Gallegos A, Cimadevilla JM. Heart rate variability modulates memory function in a virtual task. Physiol Behav 2024; 283:114620. [PMID: 38925434 DOI: 10.1016/j.physbeh.2024.114620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 06/28/2024]
Abstract
Heart rate variability (HRV) is considered one of the most relevant indicators of physical well-being and relevant biomarker for preventing cardiovascular risks. More recently, a growing amount of research has tracked an association between HRV and cognitive functions (i.e., attention). Research is still scarce on spatial orientation, a basic capability in our daily lives. It is also an important indicator of memory performance, and its malfunctioning working as an early sign of dementia. In this study, a total of 43 female students (M Age = 18.76; SD = 2.02) were measured in their lnRMSSD using the photoplethysmography technique with the Welltory smartphone app. They were also tested in their spatial memory with The Boxes Room, a virtual navigation test. Measures of physical activity were obtained with the International Physical Activity Questionnaire (IPAQ). Correlation analyses and repeated measures ANOVA were performed, comparing participants with high / low lnRMSSD in their spatial performance. Results showed that, at an equal level of physical activity, participants with a higher lnRMSSD were more effective in the early trials of The Boxes Room, being more precise in estimating the correct position of the stimuli. Moreover, a subsequent simple linear regression showed that a higher lnRMSSD was related to a smaller number of errors at the beginning of the spatial task. Overly, these results outline the relationship between HRV and navigation performance in early stages of processing, where the environment is still unknown and the situation is more demanding.
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Affiliation(s)
- Joaquín Castillo-Escamilla
- Department of Psychology, University of Almeria, Carretera de Sacramento s/n, 04120. Almeria, Andalucia, Spain; Centro de Investigación en Salud (Health Research Center), CEINSA-UAL, University of Almeria, Carretera de Sacramento s/n, 04120, Almeria, Andalucia, Spain
| | - Irene Ruffo
- Department of Psychology, Sapienza University of Rome, Via dei Marsi, 78, 00185 Rome, Italy
| | - María Carrasco-Poyatos
- Department of Education, University of Almeria, Carretera de Sacramento s/n, 04120, Almeria, Andalucia, Spain; Centro de Investigación en Salud (Health Research Center), CEINSA-UAL, University of Almeria, Carretera de Sacramento s/n, 04120, Almeria, Andalucia, Spain
| | - Antonio Granero-Gallegos
- Department of Education, University of Almeria, Carretera de Sacramento s/n, 04120, Almeria, Andalucia, Spain; Centro de Investigación en Salud (Health Research Center), CEINSA-UAL, University of Almeria, Carretera de Sacramento s/n, 04120, Almeria, Andalucia, Spain
| | - José Manuel Cimadevilla
- Department of Psychology, University of Almeria, Carretera de Sacramento s/n, 04120. Almeria, Andalucia, Spain; Centro de Investigación en Salud (Health Research Center), CEINSA-UAL, University of Almeria, Carretera de Sacramento s/n, 04120, Almeria, Andalucia, Spain.
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Pernigoni M, Perazzetti A, Digno M, Tessitore A, Kamandulis S, Conte D. Chill Without Thrill: A Crossover Study on Whole-Body Cryotherapy and Postmatch Recovery in High-Level Youth Basketball Players. Int J Sports Physiol Perform 2024:1-9. [PMID: 39179229 DOI: 10.1123/ijspp.2024-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/28/2024] [Accepted: 06/19/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE To assess the effect of whole-body cryotherapy (WBC) on postmatch recovery in basketball. METHODS Using a crossover design, 17 youth male players (age 16.2 [1.2] y, stature 190.5 [9.4] cm, body mass 79.2 [9.6] kg, experience 9.9 [3.9] y) completed 2 simulated matches, followed by WBC (4 min, -75 to - 85 °C) or a placebo intervention (CON). Countermovement-jump height, change-of-direction performance, 10- and 20-m sprint times, heart-rate variability (log-transformed squared root of the mean sum of the squared differences between R-R intervals [Ln-rMSSD]), muscle soreness, and perceived recovery (Perceived Recovery Status Scale [PRS]) were recorded at prematch, postmatch, postrecovery, and 24 hours postmatch. Additionally, Ln-rMSSD was recorded upon awakening on match day and the following morning. RESULTS Compared with CON, higher PRS values were reported in WBC at prematch and postrecovery (P ≤ .026), while no significant between-interventions differences were found for any other measure (P > .05). Regarding the effect of time, our findings revealed that 20-m sprint times, Ln-rMSSD, and PRS deteriorated in both interventions from prematch to postmatch (ie, acute changes, P ≤ .045), while muscle soreness worsened in WBC only (P ≤ .003). Conversely, countermovement-jump height, change-of-direction, and 10-m sprint performance were unaffected by match play in the acute phase (P > .05), while none of the investigated measures showed impairments at 24 hours postmatch, compared with prematch (P > .05). CONCLUSIONS Overall, these findings suggest that WBC was mostly ineffective for improving postexercise recovery in the investigated sample, with benefits observed for perceived recovery being potentially influenced by the participants' status at baseline (ie, higher prematch PRS scores in WBC compared with CON).
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Affiliation(s)
- Marco Pernigoni
- Department of Coaching Science, Lithuanian Sports University, Kaunas, Lithuania
| | - Andrea Perazzetti
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico,"Rome, Italy
| | | | - Antonio Tessitore
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico,"Rome, Italy
| | - Sigitas Kamandulis
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Daniele Conte
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico,"Rome, Italy
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Dias RKN, Penna EM, Noronha ÁSN, Neto OB, Monteiro EP, Coswig VS. Minimal dose resistance training enhances strength without affecting cardiac autonomic modulation in menopausal women: a randomized clinical trial. Sci Rep 2024; 14:19355. [PMID: 39169050 PMCID: PMC11339369 DOI: 10.1038/s41598-024-69073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 07/31/2024] [Indexed: 08/23/2024] Open
Abstract
The proposition of a minimal dose of resistance training (RT) to elicit health benefits, encompassing physiological and psychological aspects, has garnered attention. While empirical investigations have demonstrated the efficacy of low-volume RT protocols in inducing adaptations such as enhanced strength and functional capacity, further exploration of the effects of this paradigm across a broader spectrum of variables is warranted. Thus, this study aimed to investigate the effects of minimal dose RT on strength and functional capacity, cardiac autonomic modulation, and hemodynamic parameters in menopausal women. Twenty-six women were randomly assigned to the training (TG: 63.2 ± 9.3 years) or control group (CG: 59.3 ± 7.6 years). Anthropometric measurements, strength and functional performance tests, cardiac autonomic assessment, and hemodynamic parameters were performed before and after four weeks of intervention. The TG performed the minimum dose RT twice weekly for four weeks (2 sets of 8-12 repetitions in three dynamic exercises, plus three 1-min isometric planks), and the CG had a weekly meeting with lectures and stretching. Two-way ANOVA with repeated measures was applied to each variable. Regarding time comparisons, there was a significant increase for LniRR (F = 4.78; ω2 = 0.046; p = 0.04), one repetition maximum (1RM) bench press (F = 8.06; ω2 = 0,013; p = 0.01), and 1RM leg press (F = 17.3; ω2 = 0,098; p < 0.01). There was a group*time interaction only for the index LnRMSSD (F = 5.11; ω2 = 0.042; p = 0.03), and 1RM bench press (F = 9.52; ω2 = 0,016; p = 0.01). No between-group main effect for any variable was found. The minimal dose RT protocol improved muscle strength, while cardiac autonomic and hemodynamic variables, as well as functional capacity, remained stable over 4 weeks in menopausal women.
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Affiliation(s)
| | - Eduardo Macedo Penna
- Graduate Program in Human Movement Sciences, Federal University of Pará, Belém, Pará, Brazil.
| | | | - Octávio Barbosa Neto
- Physical Education and Sports Institute, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Elren Passos Monteiro
- Graduate Program in Human Movement Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Victor Silveira Coswig
- Graduate Program in Human Movement Sciences, Federal University of Pará, Belém, Pará, Brazil
- Physical Education and Sports Institute, Federal University of Ceará, Fortaleza, CE, Brazil
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Tendero-Ortiz E, Johnson MJ, Horsfall CM, Vondrasek JD, Grosicki GJ, Riemann BL, Flatt AA. Tournament Recovery Profiles and Physical Demands in a Collegiate Women's Tennis Team. J Strength Cond Res 2024:00124278-990000000-00505. [PMID: 39074238 DOI: 10.1519/jsc.0000000000004876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
ABSTRACT Tendero-Ortiz, E, Johnson, MJ, Horsfall, CM, Vondrasek, JD, Grosicki, GJ, Riemann, BL, and Flatt, AA. Tournament recovery profiles and physical demands in a collegiate women's tennis team. J Strength Cond Res XX(X): 000-000, 2024-We aimed to characterize recovery profiles and tournament physical demands in women's collegiate tennis players. A Division 1 team (n = 9) participated in the study. Markers of cardiac autonomic (resting heart rate [HR], HR variability), neuromuscular (isometric handgrip strength, seated single-arm shot-put test [SSAPT], hexagon agility, countermovement jump characteristics), and perceptual recovery were obtained before the tournament (baseline) and again 1 and 2 days posttournament. Cardiorespiratory (HR) and movement characteristics from matches were quantified with wearable devices. p values < 0.05 were statistically significant. No recovery markers differed from baseline (ps > 0.05), although small effect size reductions 1 day posttournament were noted for SSAPT, hexagon agility, and select countermovement jump characteristics. In addition, hexagon agility times and SSAPT were slower (p < 0.01) and shorter (p < 0.05), respectively, at 1 versus 2 days posttournament. Similarly, relative to 1 day posttournament, perceptual makers were improved 2 days posttournament (ps < 0.05). Mean and peak HR were higher for singles versus doubles matches (ps < 0.05). Except for average speed, movement parameters were greater during singles versus doubles matches (ps < 0.05). Markers of recovery were minimally affected 1 day posttournament relative to baseline, but perceptual and select neuromuscular markers were most improved 2 days posttournament. Thus, passive rest or limited intensity training 1 day posttournament seems advisable. Competition HR and movement profiles inform practitioners of the cardiorespiratory and locomotor demands of women's collegiate tennis, which may be useful in designing preparatory conditioning programs to ensure that players attain match-specific physical capacities in training before competition.
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Affiliation(s)
- Elena Tendero-Ortiz
- Department of Health Sciences and Kinesiology, Biodynamics and Human Performance Center, Georgia Southern University-Armstrong Campus, Savannah, Georgia
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Kubica C, Ketelhut S, Nigg CR. Polarized running training adapted to versus contrary to the menstrual cycle phases has similar effects on endurance performance and cardiovascular parameters. Eur J Appl Physiol 2024:10.1007/s00421-024-05545-9. [PMID: 38977510 DOI: 10.1007/s00421-024-05545-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 06/16/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE This study compared the effects of polarized running training adapted to the menstrual cycle (MC) phases versus polarized training adapted contrary to the MC on endurance performance and cardiovascular parameters. METHODS Thirty-three naturally menstruating, moderately trained females (age: 26 ± 4 years; BMI: 22.3 ± 3.2 kg/m2; V ˙ O2max/rel: 40.35 ± 4.61 ml/min/kg) were randomly assigned to a control (CON) and intervention (INT) group. Both groups participated in a load-matched eight-week running training intervention. In the INT, high-intensity sessions were aligned with the mid and late follicular phase, low-intensity sessions with the early and mid-luteal phase, and recovery with the late luteal and early follicular phase. In the CON, high-intensity sessions were matched to the late luteal and early follicular phase, and recovery to the mid and late follicular phase. Endurance performance and cardiovascular parameters were assessed at baseline and after the intervention. RESULTS Twenty-six females completed the intervention. A repeated measures ANOVA determined no time × group interaction effect for any parameter. A significant time effect was found for maximal oxygen uptake (F(1,12) = 18.753, p = 0.005, ηp2 = 0.630), the velocity at the ventilatory threshold one (F(1,12) = 10.704, p = 0.007, ηp2 = 0.493) and two (F(1,12) = 7.746, p = .018, ηp2 = .413). CONCLUSION The training intervention improved endurance performance in both groups, with no further benefit observed from the MC-adapted polarized training in a group-based analysis. Replications with an extended intervention period, a larger sample size, and a more reliable MC determination are warranted.
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Affiliation(s)
- Claudia Kubica
- Health Science Department, University of Bern, Bern, Switzerland.
| | - Sascha Ketelhut
- Health Science Department, University of Bern, Bern, Switzerland
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Lee S, Kim T, Woo M. Eight-week stress management exercise program improves mental health and autonomic nervous system of adults exposed to chronic stress. J Sports Med Phys Fitness 2024; 64:707-717. [PMID: 38916094 DOI: 10.23736/s0022-4707.24.15407-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND This study investigated a stress management exercise program's effect on mental health, muscle pain, and autonomic nervous system activity in adults exposed to chronic stress. METHODS Thirty mothers between 40 to 59 years old raising children with disabilities were equally allocated into the yoga (YG) or control group (CG). The YG participated in 16 prop-assisted yoga sessions twice weekly for eight weeks, focusing on relaxing and strengthening neck, shoulder, back, and waist stress-related muscles. The Beck Depression Inventory, State-Trait Anxiety Inventory, Parenting Stress Scale, Stress Response Inventory, and Brief Resilience Scale assessed mental health variable changes. Visual Analog Scales (VAS) were used to self-report neck, shoulders, back, and waist pain and assess stress, anxiety, relaxation, and confidence. We also measured pain, psychological VAS, and Heart Rate Variability (HRV) immediately before and after each yoga session. RESULTS The YG exhibited significant reductions in muscle pain, depression, stress response, fatigue, and frustration, whereas the CG expressed no change. Prop-assisted yoga immediately improved pain and psychological VAS. HRV analyses revealed instantly reduced heart rates and an R-R interval and standard deviation normal to normal (SDNN) increase. CONCLUSIONS Prop-assisted yoga may serve as a viable, safe, and efficient alternative therapeutic modality for managing chronic stress-related conditions.
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Affiliation(s)
- Sujin Lee
- School of Exercise and Sport Science, University of Ulsan, Ulsan, South Korea
| | - Teri Kim
- Division of Health and Sport Science, Dongguk University-WISE, Gyeongju, South Korea
| | - Minjung Woo
- School of Exercise and Sport Science, University of Ulsan, Ulsan, South Korea -
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Srivastav S, Gadhvi MA, Shukla RG, Bhagat OL. Exploring Ultra-short Heart Rate Variability Metrics in Patients with Diabetes Mellitus: A Reliability Analysis. Int J Appl Basic Med Res 2024; 14:169-173. [PMID: 39310075 PMCID: PMC11412562 DOI: 10.4103/ijabmr.ijabmr_238_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 07/21/2024] [Accepted: 07/25/2024] [Indexed: 09/25/2024] Open
Abstract
Objectives Ultra-short heart rate variability (HRV) metrics represent autonomic tone parameters derived using small epochs of interbeat interval data. These measures have risen in popularity with the advent of wearable devices that can capture interbeat interval data using electrocardiography (ECG) or photoplethysmography. Autonomic neuropathy in diabetes mellitus (DM) is well established, wherein 5-min HRV is conventionally used. Ultra-short measures have the potential to serve as markers of reduced autonomic tone in this patient population. Methods Data of patients with Type I and Type II DM who had presented to our laboratory for autonomic neuropathy assessment were chosen for analysis. One-minute and 2-min epochs were chosen from 5 min of ECG data using standard software. Time domain, frequency domain, and nonlinear measures were computed from 1 to 2 min epochs, and reliability was compared with measures derived from 5-min HRV using intraclass correlation coefficients (ICCs). Results Data of 131 subjects (79 males, 52 females; mean age = 53.3 ± 12.16 years) were analyzed. All ultra-short HRV measures derived from 1 min to 2 min data showed good to excellent reliability (median ICC values ranging from 0.83 to 0.94) when compared with 5-min metrics. The notable exception was very low frequency (VLF) power, which showed poor reliability (median ICC = 0.43). Conclusions Ultra-short HRV metrics derived from 1 to 2 min epochs of ECG data can be reliably used as predictors of autonomic tone in patients with DM. VLF power is poorly reproducible in these small epochs, probably due to variability in respiratory rates. Our findings have implications for ultra-short HRV estimation using short epochs of ECG data.
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Affiliation(s)
- Shival Srivastav
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahesh Arjundan Gadhvi
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravindra Gayaprasad Shukla
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Om Lata Bhagat
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Farrell G, Chapple C, Kennedy E, Reily-Bell M, Sampath K, Gisselman AS, Cook C, Katare R, Tumilty S. Autonomic nervous system and endocrine system response to upper or lower cervical spine mobilization in males with persistent post-concussion symptoms: a proof-of-concept trial. J Man Manip Ther 2024:1-17. [PMID: 38904298 DOI: 10.1080/10669817.2024.2363018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/29/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION The peripheral stress response, consisting of the autonomic nervous system (ANS) and hypothalamic pituitary adrenal-axis (HPA-axis), functions to maintain homeostasis in response to stressors. Cervical spine manual therapy has been shown to differentially modulate the stress response in healthy populations. No study has investigated whether cervical spine mobilizations can differentially modulate the stress response in individuals with persistent post-concussion symptoms (PPCS), a population characterized by a dysfunctional stress response. METHODS A randomized, controlled, parallel design trial was performed to investigate whether upper or lower cervical spine mobilization can differentially modulate components of the stress response in individuals with PPCS. The outcomes were salivary cortisol (sCOR) concentration (primary) and the HRV metric, rMSSD, measured with a smartphone application (secondary). Nineteen males diagnosed with PPCS, aged 19-35, were included. Participants were randomly assigned into either intervention group, upper (n = 10) or lower (n = 9) cervical spine mobilization. Each outcome was collected at different time points, pre- and post-intervention. Statistical analyses were performed using the Friedman's Two-Way ANOVA, Mann-Whitney U test, and Wilcoxon Signed Rank Test. RESULTS There was a statistically significant within-group reduction in sCOR concentration 30 minutes following lower cervical spine mobilizations and statistically significant within-group increase in rMSSD 30 minutes following upper cervical spine mobilizations. CONCLUSION The results of this trial provide preliminary evidence for cervical spine mobilizations to differentially modulate components of the stress response at specific time points. Understanding the mechanisms of the effect of cervical spine mobilizations on the stress response provides a novel rationale for selecting cervical spine mobilizations to rehabilitate individuals with PPCS.
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Affiliation(s)
- Gerard Farrell
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, Dunedin, New Zealand
| | - Cathy Chapple
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, Dunedin, New Zealand
| | - Ewan Kennedy
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, Dunedin, New Zealand
| | - Matthew Reily-Bell
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Kesava Sampath
- Centre for Health and Social Practice, Waikato Institute of Technology-Rotokauri Campus, Hamilton, Waikato, New Zealand
| | | | - Chad Cook
- Doctor of Physical Therapy Program, Duke University, Durham, NC, USA
| | - Rajesh Katare
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, Dunedin, New Zealand
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Lee S, Kim H, Kim JH, So M, Kim JB, Kim DJ. Heart rate variability as a preictal marker for determining the laterality of seizure onset zone in frontal lobe epilepsy. Front Neurosci 2024; 18:1373837. [PMID: 38784087 PMCID: PMC11114103 DOI: 10.3389/fnins.2024.1373837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
Determining the laterality of the seizure onset zone is challenging in frontal lobe epilepsy (FLE) due to the rapid propagation of epileptic discharges to the contralateral hemisphere. There is hemispheric lateralization of autonomic control, and heart rate is modulated by interactions between the sympathetic and parasympathetic nervous systems. Based on this notion, the laterality of seizure foci in FLE might be determined using heart rate variability (HRV) parameters. We explored preictal markers for differentiating the laterality of seizure foci in FLE using HRV parameters. Twelve patients with FLE (6 right FLE and 6 left FLE) were included in the analyzes. A total of 551 (460 left FLE and 91 right FLE) 1-min epoch electrocardiography data were used for HRV analysis. We found that most HRV parameters differed between the left and right FLE groups. Among the machine learning algorithms applied in this study, the light gradient boosting machine was the most accurate, with an AUC value of 0.983 and a classification accuracy of 0.961. Our findings suggest that HRV parameter-based laterality determination models can be convenient and effective tools in clinical settings. Considering that heart rate can be easily measured in real time with a wearable device, our proposed method can be applied to a closed-loop device as a real-time monitoring tool for determining the side of stimulation.
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Affiliation(s)
- Seho Lee
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
- Department of Artificial Intelligence, Korea University, Seoul, Republic of Korea
| | - Hayom Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Hyung Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Mingyeong So
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung Bin Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong-Joo Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- NeuroTx, Co., Ltd., Seoul, Republic of Korea
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Maset-Roig R, Caplliure-Llopis J, de Bernardo N, Privado J, Alarcón-Jiménez J, Martín-Ruiz J, Botella-Navas M, Villarón-Casales C, Sancho-Cantus D, de la Rubia Ortí JE. Analysis of Heart Rate Variability in Individuals Affected by Amyotrophic Lateral Sclerosis. SENSORS (BASEL, SWITZERLAND) 2024; 24:2355. [PMID: 38610566 PMCID: PMC11014346 DOI: 10.3390/s24072355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/25/2024] [Accepted: 04/06/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) produces alterations in the autonomic nervous system (ANS), which explains the cardiac manifestations observed in patients. The assessment of heart rate variability (HRV) is what best reflects the activity of the ANS on heart rate. The Polar H7 Bluetooth® device proves to be a non-invasive and much faster technology than existing alternatives for this purpose. OBJECTIVE The goal of this study is to determine HRV using Polar H7 Bluetooth technology in ALS patients, comparing the obtained measurements with values from healthy individuals. METHOD The sample consisted of 124 participants: 68 diagnosed with ALS and 56 healthy individuals. Using Polar H7 Bluetooth technology and the ELITE HRV application, various HRV measurements were determined for all participants, specifically the HRV index, RMSSD, RMSSD LN, SDNN index, PNN50, LF, HF, LF/HF ratio, HR average, and HF peak frequency. RESULTS Statistically significant differences were observed between ALS patients and healthy individuals in the HRV index, RMSSD, RMSSD LN, SDNN index, PNN50, HF, and LF, where healthy individuals exhibited higher scores. For the HR average, the ALS group showed a higher value. Values were similar when comparing men and women with ALS, with only a higher HF peak frequency observed in women. CONCLUSION The Polar H7 Bluetooth® device is effective in determining heart rate variability alterations in ALS, being a promising prognostic tool for the disease.
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Affiliation(s)
- Rosa Maset-Roig
- Doctoral Degree School, Catholic University San Vicente Mártir, 46001 Valencia, Spain;
| | - Jordi Caplliure-Llopis
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (J.C.-L.); (M.B.-N.); (J.E.d.l.R.O.)
| | - Nieves de Bernardo
- Department of Physiotherapy, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (N.d.B.); (J.A.-J.)
| | - Jesús Privado
- Department of Methodology of Behavioral Sciences, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - Jorge Alarcón-Jiménez
- Department of Physiotherapy, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (N.d.B.); (J.A.-J.)
| | - Julio Martín-Ruiz
- Department of Health and Functional Evaluation, Faculty of Physical Activity and Sports Sciences, Catholic University San Vicente Mártir, 46001 Valencia, Spain;
| | - Marta Botella-Navas
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (J.C.-L.); (M.B.-N.); (J.E.d.l.R.O.)
| | - Carlos Villarón-Casales
- Biomechanics & Physiotherapy in Sports (BIOCAPS), Faculty of Health Sciences, Spain, European University of Valencia, 46001 Valencia, Spain
| | - David Sancho-Cantus
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (J.C.-L.); (M.B.-N.); (J.E.d.l.R.O.)
| | - José Enrique de la Rubia Ortí
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (J.C.-L.); (M.B.-N.); (J.E.d.l.R.O.)
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12
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Ketelhut S, Nigg CR. Heartbeats and high scores: esports triggers cardiovascular and autonomic stress response. Front Sports Act Living 2024; 6:1380903. [PMID: 38638448 PMCID: PMC11024241 DOI: 10.3389/fspor.2024.1380903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Gaming is often labeled as sedentary behavior. However, competitive gaming, also known as esports, involves significant cognitive demands and may induce stress. This study aims to investigate whether the psychophysical demands during esports elicit a physiological stress response. Methods Fourteen FIFA 21 and thirteen League of Legends players (23.3 ± 2.8 years) were recruited for the study. Heart rate (HR), root mean square of successive differences between normal heartbeats (RMSSD), peripheral and central blood pressure (BP), pulse wave velocity (PWV), and energy expenditure (EE) were assessed during supine rest, seated rest, and competitive FIFA or League of Legends matches. Results No significant group × condition interactions were observed for any of the outcomes. However, there were significant increases in mean HR (p < 0.001, η p 2 = 0.383), RMSSD (p = 0.019, η p 2 = 0.226), peripheral systolic BP (p < 0.001, η p 2 = 0.588), peripheral diastolic BP (p = 0.005, η p 2 = 0.272), central systolic BP (p = 0.005; η p 2 = 0.369), central diastolic BP (p = 0.016, η p 2 = 0.313), PWV (p = 0.004, η p 2 = 0.333), and EE (p < 0.001, η p 2 = 0.721) during both games compared to the seated rest condition. Conclusion Despite the sedentary nature of esports, the psychophysical demands appear to elicit physiological responses. Interestingly, no significant differences were found between the different game genres.
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Affiliation(s)
- Sascha Ketelhut
- Department of Health Science, Institute of Sport Science, University of Bern, Bern, Switzerland
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13
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Breunissen EHW, Groenveld TD, Garms L, Bonnes JL, van Goor H, Damman P. Virtual reality to reduce periprocedural anxiety during invasive coronary angiography: rationale and design of the VR InCard trial. Open Heart 2024; 11:e002628. [PMID: 38569670 PMCID: PMC10989163 DOI: 10.1136/openhrt-2024-002628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/24/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Patients undergoing invasive coronary angiography (ICA) experience anxiety due to various reasons. Procedural anxiety can lead to physiological and psychological complications, compromising patient comfort and overall procedural outcomes. Benzodiazepines are commonly used to reduce periprocedural anxiety, although the effect is modest. Virtual reality (VR) is a promising non-pharmacological intervention to reduce anxiety in patients undergoing ICA. METHODS AND ANALYSIS A single-centre open-label randomised controlled trial is conducted assessing the effectiveness of add-on VR therapy on anxiety in 100 patients undergoing ICA and experiencing anxiety in a periprocedural setting. The primary outcome is the Numeric Rating Scale (NRS) anxiety score measured just before obtaining arterial access. Secondary outcomes include postarterial puncture and postprocedural anxiety, patient-reported outcome measures (PROMs) of anxiety and physiological measurements associated with anxiety. The NRS anxiety level and physiological measurements are assessed five times during the procedure. The PROM State-Trait Anxiety Inventory and Perceived Stress Scale are completed preprocedure, and the PROM STAI and the Igroup Presence Questionnaire are performed postprocedure. ETHICS AND DISSEMINATION The protocol of this study has been approved by the Research Ethics Committee of the Radboud University Medical Centre, the Netherlands (CMO Arnhem-Nijmegen, 2023-16586). Informed consent is obtained from all patients. The trial is conducted according to the principles of the Helsinki Declaration and in accordance with Dutch guidelines, regulations, and acts (Medical Research involving Human Subjects Act, WMO). REGISTRATION DETAILS Trial registration number: NCT06215456.
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Affiliation(s)
| | | | - Linda Garms
- Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Judith L Bonnes
- Cardiology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Harry van Goor
- Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Peter Damman
- Cardiology, Radboudumc, Nijmegen, Gelderland, The Netherlands
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14
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Yang J, Ben-Menachem E. Accuracy and clinical utility of heart rate variability derived from a wearable heart rate monitor in patients undergoing major abdominal surgery. J Clin Monit Comput 2024; 38:433-443. [PMID: 37831376 DOI: 10.1007/s10877-023-01080-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/16/2023] [Indexed: 10/14/2023]
Abstract
Low heart rate variability (HRV) can potentially identify patients at risk of intraoperative hypotension. However, it is unclear whether cheaper, readily accessible consumer heart rate (HR) monitors can provide similar utility to clinical Holter electrocardiograph (ECG) monitors. The objectives of this study were (1) to assess the validity of using the Polar H10 HR monitor as an alternative to a clinical Holter ECG and (2) to test total power (TP) as a predictor of intraoperative hypotension. The primary outcome was the level of agreement between Polar H10 and Holter ECG. Twenty-three patients undergoing major abdominal surgery with general anesthesia had 5-minute HR recordings taken concurrently with both devices during a pre-anesthetic consultation. Agreement between Polar H10 and Holter ECG was compared via Bland-Altman analysis and Lin's Concordance Correlation Coefficient. Patients were divided into groups based on TP < 500 m s 2 and TP > 500 m s 2 . Intraoperative hypotension was defined as MAP < 60 mmHg, systolic blood pressure < 80 mmHg, or 35% decrease in MAP from baseline. There was substantial agreement between Polar H10 and Holter ECG for average R-R interval, TP and other HRV indices. Reduced TP (< 500 ms 2 ) had a high sensitivity (80%) and specificity (100%) in predicting intraoperative hypotension. Patients with reduced TP were significantly more likely to require vasoactive drugs to maintain blood pressure.The substantial agreement between Polar H10 and Holter ECG may justify its use clinically. The use of preoperative recordings of HRV has the potential to become part of routine preoperative assessment as a useful screening tool to predict hemodynamic instability in patients undergoing general anesthesia.
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Affiliation(s)
- James Yang
- School of Clinical Medicine, Faculty of Medicine and Health, St Vincent's Healthcare Clinical Campus, UNSW Sydney, Sydney, Australia
| | - Erez Ben-Menachem
- Department of Anesthesia, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.
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15
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Mihailovic T, Groslambert A, Bouzigon R, Feaud S, Millet GP, Gimenez P. Acute Responses to Repeated-Sprint Training in Hypoxia Combined With Whole-Body Cryotherapy: A Preliminary Study. Int J Sports Physiol Perform 2024; 19:280-289. [PMID: 38171353 DOI: 10.1123/ijspp.2023-0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/03/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE This study aimed to investigate acute psychophysiological responses to repeated-sprint training in hypoxia (RSH) combined with whole-body cryotherapy (WBC). METHOD Sixteen trained cyclists performed 3 sessions in randomized order: RSH, WBC-RSH (WBC pre-RSH), and RSH-WBC (WBC post-RSH). RSH consisted of 3 sets of 5 × 10-second sprints with 20-second recovery at a simulated altitude of 3000 m. Power output, muscle oxygenation (tissue saturation index), heart-rate variability, and recovery perception were analyzed. Sleep quality was assessed on the nights following test sessions and compared with a control night using nocturnal ActiGraphy and heart-rate variability. RESULTS Power output did not differ between the conditions (P = .27), while the decrease in tissue saturation index was reduced for WBC-RSH compared to RSH-WBC in the last set. In both conditions with WBC, the recovery perception was higher compared to RSH (WBC-RSH: +15.4%, and RSH-WBC: +21.9%, P < .05). The number of movements during the RSH-WBC night was significantly lower than for the control night (-18.7%, P < .01) and WBC-RSH (-14.9%, P < .05). RSH led to a higher root mean square of the successive differences of R-R intervals and high-frequency band during the first hour of sleep compared to the control night (P < .05) and RSH-WBC (P < .01). CONCLUSIONS Inclusion of WBC in an RSH session did not modify the power output but could improve prolonged performance in hypoxia by maintaining muscle oxygenation. A single RSH session did not deteriorate sleep quality. WBC, particularly when performed after RSH, positively influenced recovery perception and sleep.
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Affiliation(s)
- Thibaud Mihailovic
- Laboratory of Culture, Sport, Health, Society (C3S-UR 4660), Sport and Performance Department, University of Franche-Comte, Besançon, France
- Inside the Athletes 3.0 (ITA 3.0), Besançon, France
- Besancon Fitness, Besancon, France
| | - Alain Groslambert
- Laboratory of Culture, Sport, Health, Society (C3S-UR 4660), Sport and Performance Department, University of Franche-Comte, Besançon, France
- Locomotion Athlete Material Environment Platform (Laboratory C3S-Groupama FDJ cycling team), Besançon, France
| | - Romain Bouzigon
- Laboratory of Culture, Sport, Health, Society (C3S-UR 4660), Sport and Performance Department, University of Franche-Comte, Besançon, France
- Inside the Athletes 3.0 (ITA 3.0), Besançon, France
- Besancon Fitness, Besancon, France
| | - Simon Feaud
- Laboratory of Culture, Sport, Health, Society (C3S-UR 4660), Sport and Performance Department, University of Franche-Comte, Besançon, France
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Philippe Gimenez
- Laboratory of Culture, Sport, Health, Society (C3S-UR 4660), Sport and Performance Department, University of Franche-Comte, Besançon, France
- Locomotion Athlete Material Environment Platform (Laboratory C3S-Groupama FDJ cycling team), Besançon, France
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Pernigoni M, Calleja-González J, Lukonaitienė I, Tessitore A, Stanislovaitienė J, Kamarauskas P, Conte D. Comparative Effectiveness of Active Recovery and Static Stretching During Post-Exercise Recovery in Elite Youth Basketball. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024; 95:272-280. [PMID: 37039750 DOI: 10.1080/02701367.2023.2195457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 03/19/2023] [Indexed: 06/19/2023]
Abstract
Purpose: To compare the effectiveness of active recovery (AR) versus static stretching (SS) during post-exercise recovery in basketball. Methods: Using a counterbalanced crossover design, 17 elite youth male players completed two 90-min training sessions, followed by either AR or SS. Differences in jump height (CMJ), heart rate variability (Ln-rMSSD), muscle soreness (VAS), perceived recovery (TQR) and hormonal biomarkers (cortisol, testosterone, testosterone:cortisol ratio) between interventions were assessed at pre-session, post-session (except hormonal biomarkers), post-recovery and 24 h post-session. Differences in Ln-rMSSD were additionally assessed upon awakening on training day, and the following morning. Results: No significant differences were found between interventions at corresponding time points (p > .05). However, the within-intervention time course of recovery differed, as CMJ values were lower at post-recovery, compared with all other time points, in SS only (p < .05, effect size [ES] moderate-to-very large). Additionally, Ln-rMSSD values failed to return to baseline at post-recovery in AR only (p < .05, ES large-to-very large). Similarly, TQR scores were impaired at post-session and post-recovery in AR only (p < .05, ES moderate-to-large). No differences were reported for the remaining variables (p > .05). Conclusion: Differences between AR and SS were probably due to short-term phenomena, indicating that neither strategy was likely superior for improving recovery in the longer term. Overall, neither strategy seemed to significantly improve post-exercise recovery.
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17
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Kania A, Roufail J, Prokop J, Stauss HM. A framework for the interpretation of heart rate variability applied to transcutaneous auricular vagus nerve stimulation and osteopathic manipulation. Physiol Rep 2024; 12:e15981. [PMID: 38508860 PMCID: PMC10954510 DOI: 10.14814/phy2.15981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
Reports on autonomic responses to transcutaneous auricular vagus nerve stimulation (taVNS) and osteopathic manipulative techniques have been equivocal, partly due to inconsistent interpretation of heart rate variability (HRV). We developed a mechanistic framework for the interpretation of HRV based on a model of sinus node automaticity that considers autonomic effects on Phase 3 repolarization and Phase 4 depolarization of the sinoatrial action potential. The model was applied to HRV parameters calculated from ECG recordings (healthy adult humans, both genders) before (30 min), during (15 min), and after (30 min) a time control intervention (rest, n = 23), taVNS (10 Hz, 300 μs, 1-2 mA, cymba concha, left ear, n = 12), or occipitoatlantal decompression (OA-D, n = 14). The experimental protocol was repeated on 3 consecutive days. The model simulation revealed that low frequency (LF) HRV best predicts sympathetic tone when calculated from heart rate time series, while high frequency (HF) HRV best predicts parasympathetic tone when calculated from heart period time series. Applying our model to the HRV responses to taVNS and OA-D, revealed that taVNS increases cardiac parasympathetic tone, while OA-D elicits a mild decrease in cardiac sympathetic tone.
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Affiliation(s)
- Adrienne Kania
- Department of Clinical MedicineBurrell College of Osteopathic MedicineLas CrucesNew MexicoUSA
| | - Jumana Roufail
- Department of Clinical MedicineBurrell College of Osteopathic MedicineLas CrucesNew MexicoUSA
- Department of Biomedical SciencesBurrell College of Osteopathic MedicineLas CrucesNew MexicoUSA
| | - Joseph Prokop
- Department of Clinical MedicineBurrell College of Osteopathic MedicineLas CrucesNew MexicoUSA
- Department of Biomedical SciencesBurrell College of Osteopathic MedicineLas CrucesNew MexicoUSA
| | - Harald M. Stauss
- Department of Biomedical SciencesBurrell College of Osteopathic MedicineLas CrucesNew MexicoUSA
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18
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Ortega E, Bryan CYX, Christine NSC. The Pulse of Singapore: Short-Term HRV Norms. Appl Psychophysiol Biofeedback 2024; 49:55-61. [PMID: 37755550 DOI: 10.1007/s10484-023-09603-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/28/2023]
Abstract
Short-term heart rate variability (HRV) is increasingly used to assess autonomic nervous system activity and found to be useful for monitoring and providing care due to its quick measurement. With evidence of low HRV associated with chronic diseases, mental disorders, and an increased risk of cardiovascular disease, having normative data of HRV across the age spectrum would be useful for monitoring health and well-being of a population. This study examines HRV of healthy Singapore sample, with ages ranging from 10 to 89 years. Short-term HRV of five minutes was measured from 2,143 participants. 974 males and 1,169 females, and overall HRV was found to be 42.4ms (RMSSD) and 52.0 ms (SDNN) with a further breakdown of HRV by age and gender. Overall HRV declined with age and gender, although gender differences dissipated in the 60s age range onwards, with the 50s age range having the sharpest decline in HRV. Short-term HRV norms were similar to Nunan et al.'s (2010) systematic review in various populations and less similar to Choi et al.'s (2020) study on Koreans.
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Affiliation(s)
- Emily Ortega
- School of Humanities and Behavioural Sciences, Singapore University of Social Sciences, Singapore, Singapore.
| | - Chan Yu Xiu Bryan
- School of Humanities and Behavioural Sciences, Singapore University of Social Sciences, Singapore, Singapore
| | - Ng Su Chin Christine
- School of Humanities and Behavioural Sciences, Singapore University of Social Sciences, Singapore, Singapore
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Birk JL, Cumella R, Lopez-Veneros D, Agarwal S, Kronish IM. Feasibility of a remote heart rate variability biofeedback intervention for reducing anxiety in cardiac arrest survivors: A pilot trial. Contemp Clin Trials Commun 2024; 37:101251. [PMID: 38312473 PMCID: PMC10837694 DOI: 10.1016/j.conctc.2023.101251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 04/12/2023] [Accepted: 12/22/2023] [Indexed: 02/06/2024] Open
Abstract
Background Heart rate variability biofeedback (HRVB) is a promising non-pharmacologic approach for reducing anxiety. This intervention's feasibility needs testing in psychologically distressed cardiac patients for whom heart-related anxiety is a core concern. To enhance scalability and convenience, remote delivery of HRVB also needs to be assessed. Accordingly, we evaluated the feasibility of remote HRVB in survivors of cardiac arrest (CA) with elevated CA-related psychological distress. Methods The intervention was comprised of daily sessions of diaphragmatic paced breathing and real-time monitoring of cardiac activity guided by a smartphone app and heart rate monitor. This single-arm feasibility trial assessed the percentage of eligible contacted patients who consented and engaged in the study and the self-reported acceptability, feasibility, appropriateness, and usability of the intervention. Exploratory analyses assessed pre-to-post changes in trait anxiety, negative affect, cardiac-related interoceptive fear, and resting-state HRV. Results Of 12 eligible CA survivors contacted, 10 enrolled. All 10 patients completed the virtual study visits and the majority (>50 %) of prescribed training sessions. Ninety percent reported good scores for intervention acceptability and feasibility, and 80 % reported good scores for its appropriateness and usability for reducing fear. Trait anxiety decreased significantly pre-to-post intervention. There were no changes in negative affect, interoceptive fear, or resting state HRV. Conclusion A remotely delivered HRVB intervention was acceptable, feasible, and useable for cardiac patients with CA-related psychological distress. A phase 2 randomized controlled trial evaluating the efficacy of HRVB on cardiac patients' psychological distress, health behaviors, and autonomic dysfunction may be warranted.
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Affiliation(s)
- Jeffrey L. Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, 10032, United States
| | - Robin Cumella
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, 10032, United States
| | - David Lopez-Veneros
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, 10032, United States
| | - Sachin Agarwal
- Department of Neurology, Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center, 177 Fort Washington Avenue, Milstein Hospital, 8GS-300, New York, 10032, United States
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, 10032, United States
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20
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Wesolowski E, Ahmed Z, Di Pietro V. History of concussion and lowered heart rate variability at rest beyond symptom recovery: a systematic review and meta-analysis. Front Neurol 2024; 14:1285937. [PMID: 38318235 PMCID: PMC10838961 DOI: 10.3389/fneur.2023.1285937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Concussion is a growing concern in worldwide sporting culture. Heart rate variability (HRV) is closely tied with autonomic nervous system (ANS) deficits that arise from a concussion. The objective of this review was to determine if a history of concussion (HOC) can impact HRV values in the time-domain in individuals at rest. This review works to add to the literature surrounding HRV testing and if it can be used to check for brain vulnerabilities beyond the recovery of concussion symptoms. Materials and methods The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) method. A computer based systematic review scanned articles dating from 1996 to June 2023 through PubMed, Cochrane Library, Google Scholar, and EMBASE databases. A risk of bias assessment was conducted using the ROBINS-E tool. The average difference in time between heartbeats (MeanNN), the standard deviation of the differences (SDNN), and the root mean squared of the successive intervals (RMSSD) were measured. Results Six total studies were found that fit the inclusion criteria including a total of 242 participants (133 without HOC, 109 with HOC). The average age of the control group was 23.3 ± 8.2, while the average age of the history of TBI group was 25.4 ± 9.7, with no significant difference between the groups (p = 0.202). Four of the studies reported no significant difference in any of the three measures, while two of the studies reported significant difference for all three measures. The meta-analysis was conducted and found that MeanNN (p = 0.03) and RMSSD (p = 0.04) reached statistical significance, while SDNN did not (p = 0.11). Conclusion The results of this meta-analysis showed significant difference in two of the three HRV time-domain parameters evaluated. It demonstrates that there can be lowered HRV values that expand beyond the recovery of symptoms, reflecting an extensive period of ANS susceptibility after a concussion. This may be an important variable in determining an athlete's return to play (RTP). Lack of homogenous study populations and testing methods introduces potential for bias and confounding factors, such as gender or age. Future studies should focus on baseline tests to compare individuals to themselves rather than matched controls.
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Affiliation(s)
- Eric Wesolowski
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Zubair Ahmed
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Centre for Trauma Sciences Research, University of Birmingham, Birmingham, United Kingdom
| | - Valentina Di Pietro
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Centre for Trauma Sciences Research, University of Birmingham, Birmingham, United Kingdom
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Kubica C, Ketelhut S, Querciagrossa D, Burger M, Widmer M, Bernhard J, Schneider M, Ries T, Nigg CR. Effects of a training intervention tailored to the menstrual cycle on endurance performance and hemodynamics. J Sports Med Phys Fitness 2024; 64:45-54. [PMID: 37800402 DOI: 10.23736/s0022-4707.23.15277-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND This study aimed to compare the effects of block periodized training and training adapted to the menstrual cycle (MC) phases on endurance performance, cardiovascular parameters, recovery, and MC-related symptoms in active females. METHODS Fourteen naturally menstruating, moderately trained females (age: 24±3 years; BMI: 22.3±2.7) were randomized into an intervention (INT) and a control (CON) group. Throughout an 8-week intervention period, both groups participated in a polarized training program. In the INT, the training sessions were adapted to the MC with higher training loads within the mid and late follicular phase. Before and after the intervention maximal oxygen consumption (VO2max), velocity and heart rate at ventilatory thresholds one and two (vVT1, vVT2, hrVT1, hrVT2), systolic and diastolic blood pressure (sBP, dBP), root mean square of successive RR interval differences (RMSSD), standard deviation of NN intervals (SDNN), pulse wave velocity (PWV), and the premenstrual assessment form (PAF) were assessed. RESULTS There were no significant time × group interaction effects in all physiological parameters (VO2max: P=0.890; vVT1: P=1.000; hrVT1: P=0.464; vVT2: P=0.356; hrVT2: P=0.762 sBP: P=0.948; dBP: P=0.203; RMSSD: P=0.257; SDNN: P=0.241; PWV: P=0.818), or psychological parameters (PAF: P=0.745). CONCLUSIONS Tailoring a polarized training program to the MC did not augment training responses compared to a regular training program in active females. However, a substantial portion of the training intervention in the CON was coincidentally matched to the MC.
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Affiliation(s)
- Claudia Kubica
- Department of Health Science, University of Bern, Bern, Switzerland -
| | - Sascha Ketelhut
- Department of Health Science, University of Bern, Bern, Switzerland
| | | | - Manuel Burger
- Department of Health Science, University of Bern, Bern, Switzerland
| | - Mara Widmer
- Department of Health Science, University of Bern, Bern, Switzerland
| | - Julia Bernhard
- Department of Health Science, University of Bern, Bern, Switzerland
| | | | - Thomas Ries
- Department of Health Science, University of Bern, Bern, Switzerland
| | - Claudio R Nigg
- Department of Health Science, University of Bern, Bern, Switzerland
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Coates AM, Thompson KMA, Grigore MM, Baker RE, Pignanelli C, Robertson AA, Frangos SM, Cheung CP, Burr JF. Altered carbohydrate oxidation during exercise in overreached endurance athletes is applicable to training monitoring with continuous glucose monitors. Scand J Med Sci Sports 2024; 34:e14551. [PMID: 38093477 DOI: 10.1111/sms.14551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE The purpose of the study was to investigate whether carbohydrate utilization is altered during exercise in overreached endurance athletes and examine the utility of continuous glucose monitors (CGM) to detect overreaching status. METHODS Eleven endurance athletes (M:8, F:3) completed a 5-week training block consisting of 1 week of reduced training (PRE), 3 weeks of high-intensity overload training (POST), and 1 week of recovery training (REC). Participants completed a Lamberts and Lambert Submaximal Cycling Test (LSCT) and 5 km time-trial at PRE, POST, and REC time points, 15 min following the ingestion of a 50 g glucose beverage with glucose recorded each minute via CGM. RESULTS Performance in the 5 km time-trial was reduced at POST (∆-7 ± 10 W, p = 0.04,η p 2 = 0.35) and improved at REC (∆12 ± 9 W from PRE, p = 0.01,η p 2 = 0.66), with reductions in peak lactate (∆-3.0 ± 2.0 mmol/L, p = 0.001,η p 2 = 0.71), peak HR (∆-6 ± 3 bpm, p < 0.001,η p 2 = 0.86), and Hooper-Mackinnon well-being scores (∆10 ± 5 a.u., p < 0.001,η p 2 = 0.79), indicating athletes were functionally overreached. The respiratory exchange ratio was suppressed at POST relative to REC during the 60% (POST: 0.80 ± 0.05, REC: 0.87 ± 0.05, p < 0.001,η p 2 = 0.74), and 80% (POST: 0.93 ± 0.05, REC: 1.00 ± 0.05, p = 0.003,η p 2 = 0.68) of HR-matched submaximal stages of the LSCT. CGM glucose was reduced during HR-matched submaximal exercise in the LSCT at POST (p = 0.047,η p 2 = 0.36), but not the 5 km time-trial (p = 0.07,η p 2 = 0.28) in overreached athletes. CONCLUSION This preliminary investigation demonstrates a reduction in CGM-derived glucose and carbohydrate oxidation during submaximal exercise in overreached athletes. The use of CGM during submaximal exercise following standardized nutrition could be employed as a monitoring tool to detect overreaching in endurance athletes.
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Affiliation(s)
- Alexandra M Coates
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Kyle M A Thompson
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Monica M Grigore
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Ryleigh E Baker
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Christopher Pignanelli
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Alexa A Robertson
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Sara M Frangos
- Mitochondrial Metabolism Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Christian P Cheung
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jamie F Burr
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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23
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Li K, Cardoso C, Moctezuma-Ramirez A, Elgalad A, Perin E. Heart Rate Variability Measurement through a Smart Wearable Device: Another Breakthrough for Personal Health Monitoring? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7146. [PMID: 38131698 PMCID: PMC10742885 DOI: 10.3390/ijerph20247146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/06/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
Heart rate variability (HRV) is a measurement of the fluctuation of time between each heartbeat and reflects the function of the autonomic nervous system. HRV is an important indicator for both physical and mental status and for broad-scope diseases. In this review, we discuss how wearable devices can be used to monitor HRV, and we compare the HRV monitoring function among different devices. In addition, we have reviewed the recent progress in HRV tracking with wearable devices and its value in health monitoring and disease diagnosis. Although many challenges remain, we believe HRV tracking with wearable devices is a promising tool that can be used to improve personal health.
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Affiliation(s)
- Ke Li
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX 77030, USA
| | - Cristiano Cardoso
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX 77030, USA
| | - Angel Moctezuma-Ramirez
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX 77030, USA
| | - Abdelmotagaly Elgalad
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX 77030, USA
| | - Emerson Perin
- Center for Clinical Research, The Texas Heart Institute, Houston, TX 77030, USA
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24
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Boullosa D, Claudino JG, Fernandez-Fernandez J, Bok D, Loturco I, Stults-Kolehmainen M, García-López J, Foster C. The Fine-Tuning Approach for Training Monitoring. Int J Sports Physiol Perform 2023; 18:1374-1379. [PMID: 37689401 DOI: 10.1123/ijspp.2023-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/24/2023] [Accepted: 07/31/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE Monitoring is a fundamental part of the training process to guarantee that the programmed training loads are executed by athletes and result in the intended adaptations and enhanced performance. A number of monitoring tools have emerged during the last century in sport. These tools capture different facets (eg, psychophysiological, physical, biomechanical) of acute training bouts and chronic adaptations while presenting specific advantages and limitations. Therefore, there is a need to identify what tools are more efficient in each sport context for better monitoring of training process. METHODS AND RESULTS We present and discuss the fine-tuning approach for training monitoring, which consists of identifying and combining the best monitoring tools with experts' knowledge in different sport settings, designed to improve (1) the control of actual training loads and (2) understanding of athletes' training adaptations. Instead of using single-tool approaches or merely subjective decision making, the identification of the best combination of monitoring tools to assist experts' decisions in each specific context (ie, triangulation) is necessary to better understand the link between acute and chronic adaptations and their impact on health and performance. Future studies should elaborate on the identification of the best combination of monitoring tools for each specific sport setting. CONCLUSION The fine-tuning monitoring approach requires the simultaneous use of several valid and practical tools, instead of a single tool, to improve the effectiveness of monitoring practices when added to experts' knowledge.
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Affiliation(s)
- Daniel Boullosa
- Faculty of Physical Activity and Sports Sciences, Universidad de León, León, Spain
| | - João Gustavo Claudino
- Group of Research, Innovation and Technology Applied to Sport (GSporTech), Department of Physical Education, Center for Health Sciences, Federal University of Piauí, Teresina, PI, Brazil
| | | | - Daniel Bok
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Irineu Loturco
- Nucleus of High Performance in Sport, São Paulo, SP, Brazil
| | | | - Juan García-López
- Faculty of Physical Activity and Sports Sciences, Universidad de León, León, Spain
| | - Carl Foster
- Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI, USA
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25
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Vondrasek JD, Riemann BL, Grosicki GJ, Flatt AA. Validity and Efficacy of the Elite HRV Smartphone Application during Slow-Paced Breathing. SENSORS (BASEL, SWITZERLAND) 2023; 23:9496. [PMID: 38067869 PMCID: PMC10708620 DOI: 10.3390/s23239496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/25/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023]
Abstract
Slow-paced breathing is a clinical intervention used to increase heart rate variability (HRV). The practice is made more accessible via cost-free smartphone applications like Elite HRV. We investigated whether Elite HRV can accurately measure and augment HRV via its slow-paced breathing feature. Twenty young adults completed one counterbalanced cross-over protocol involving 10 min each of supine spontaneous (SPONT) and paced (PACED; 6 breaths·min-1) breathing while RR intervals were simultaneously recorded via a Polar H10 paired with Elite HRV and reference electrocardiography (ECG). Individual differences in HRV between devices were predominately skewed, reflecting a tendency for Elite HRV to underestimate ECG-derived values. Skewness was typically driven by a limited number of outliers as median bias values were ≤1.3 ms and relative agreement was ≥very large for time-domain parameters. Despite no significant bias and ≥large relative agreement for frequency-domain parameters, limits of agreement (LOAs) were excessively wide and tended to be wider during PACED for all HRV parameters. PACED significantly increased low-frequency power (LF) for Elite HRV and ECG, and between-condition differences showed very large relative agreement. Elite HRV-guided slow-paced breathing effectively increased LF values, but it demonstrated greater precision during SPONT and in computing time-domain HRV.
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Affiliation(s)
- Joseph D. Vondrasek
- Biodynamics and Human Performance Center, Department of Health Sciences and Kinesiology, Georgia Southern University (Armstrong), 11935 Abercorn St., Savannah, GA 31419, USA; (B.L.R.); (G.J.G.); (A.A.F.)
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26
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Ketelhut S, Querciagrossa D, Bisang X, Metry X, Borter E, Nigg CR. The effectiveness of the Wim Hof method on cardiac autonomic function, blood pressure, arterial compliance, and different psychological parameters. Sci Rep 2023; 13:17517. [PMID: 37845341 PMCID: PMC10579249 DOI: 10.1038/s41598-023-44902-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023] Open
Abstract
The Wim Hof method (WHM) is a multi-disciplinary approach to physical and mental well-being combining cold exposure, breathing exercises, and meditation. This study evaluated the effects of a 15 days WHM intervention on cardiovascular parameters at rest and during a cold pressor test (CPT), as well as on various psychological parameters. Forty two participants were randomized into an intervention (IG) and a control group. Throughout the 15 days intervention, the IG performed the WHM daily. Before and after the intervention, systolic (SBP) and diastolic blood pressure (DBP), pulse wave velocity (PWV), heart rate (HR), root mean sum of squared distance (RMSSD), and standard deviation of RR-intervals (SDNN) were assessed at rest and during a CPT. Furthermore, perceived stress (PSS), positive affect (PANAS+), negative affect (PANAS-), and subjective vitality (trait (SVSt) and state (SVSs)) was determined. No significant time × group interactions could be detected in HR (p = 0.709); RMSSD (p = 0.820), SDNN (p = 0.186), SBP (p = 0.839), DBP (p = 0.318), PWV (p = 0.983), PANAS+ (p = 0.427), PANAS- (p = 0.614), SVSt (p = 0.760), SVSs (p = 0.366), and PSS (p = 0.364). No significant time × group effects could be detected during the CPT (ΔHR: p = 0.596; ΔSBP: p = 0.366; ΔDBP: p = 0.999; ΔPWV: p = 0.635; perceived pain: p = 0.231). Performing the WHM daily did not exert positive effects on cardiovascular and psychological parameters.
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Affiliation(s)
- Sascha Ketelhut
- Institute of Sport Science, University of Bern, Bremgartenstrasse 145, 3012, Bern, Switzerland.
| | - Dario Querciagrossa
- Institute of Sport Science, University of Bern, Bremgartenstrasse 145, 3012, Bern, Switzerland
| | - Xavier Bisang
- Institute of Sport Science, University of Bern, Bremgartenstrasse 145, 3012, Bern, Switzerland
| | - Xavier Metry
- Institute of Sport Science, University of Bern, Bremgartenstrasse 145, 3012, Bern, Switzerland
| | - Eric Borter
- Institute of Sport Science, University of Bern, Bremgartenstrasse 145, 3012, Bern, Switzerland
| | - Claudio R Nigg
- Institute of Sport Science, University of Bern, Bremgartenstrasse 145, 3012, Bern, Switzerland
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27
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Lavín-Pérez AM, Collado-Mateo D, Hinojo González C, Batista M, Mayo X, Ruisánchez Villar C, Jiménez A. An online home-based exercise program improves autonomic dysfunction in breast cancer survivors. Front Physiol 2023; 14:1256644. [PMID: 37841312 PMCID: PMC10570414 DOI: 10.3389/fphys.2023.1256644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction: Exercise interventions for breast cancer survivors have proved their potential to improve clinical, physical, and psychosocial outcomes. However, limited studies have explored exercise effects on autonomic dysfunction and the measurement of exercise tolerance and progression through daily heart rate variability (HRV). Purpose: To analyze the effects of a 16-wk exercise intervention on the autonomic modulation of breast cancer survivors, as well as to examine the evolution of daily measured HRV and its interaction with exercise sessions in this population. Methods: A total of 29 patients who had undergone chemotherapy and radiotherapy were randomly assigned to the exercise group or to the control group. The exercise intervention was delivered remotely through online meetings and consisted of supervised training resistance and cardiovascular exercise 3 times per week. During the intervention all patients measured their HRV daily obtaining the napierian logarithm of the root mean square of successive differences between normal heartbeats (lnrMSSD) and the napierian logarithm of the standard deviation of the interbeat interval of normal sinus beats (lnSDNN) values at four moments: day 0 (the morning of the training sessions), 24, 48, and 72 h after exercise. Results: The results revealed a significant interaction between group and months during the intervention period for lnrMSSD and lnSDNN (p < 0.001). Additionally, there were significant differences in lnSDNN recovery time between months (p < 0.05), while differences in lnrMSSD become apparent only 24 h after exercise (p = 0.019). The control group experienced a significant decrease in both variables monthly (p < 0.05) while exercise group experienced a significant increment (p < 0.05). Conclusion: HRV is daily affected by exercise training sessions in cancer patients. Although results strongly support the role of exercise as a post-chemotherapy and radiotherapy rehabilitation strategy for breast cancer survivors to improve autonomic imbalance, further research is necessary to validate these initial findings.
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Affiliation(s)
- Ana Myriam Lavín-Pérez
- Sport Sciences Research Centre, Rey Juan Carlos University, Madrid, Spain
- GO Fit LAB, GO Fit Life, Science and Technology, S.A., Madrid, Spain
- Program of Epidemiology and Public Health (Interuniversity), Ph.D. International School of Rey Juan Carlos University, Madrid, Spain
| | | | | | - Marco Batista
- Sport, Health, and Exercise Research Unit (SHERU), Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
| | - Xián Mayo
- Sport Sciences Research Centre, Rey Juan Carlos University, Madrid, Spain
| | | | - Alfonso Jiménez
- Sport Sciences Research Centre, Rey Juan Carlos University, Madrid, Spain
- GO Fit LAB, GO Fit Life, Science and Technology, S.A., Madrid, Spain
- Advanced Wellbeing Research Centre, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
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Teixeira IG, Verzola MR, Filipini RE, Speretta GF. The effects of a firefighting simulation on the vascular and autonomic functions and cognitive performance: a randomized crossover study. Front Physiol 2023; 14:1215006. [PMID: 37811491 PMCID: PMC10551144 DOI: 10.3389/fphys.2023.1215006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction: During firefighting, physical and cognitive demands increase. However, the stress inherent to these events can decrease cognitive performance and increase the risk of cardiovascular events in firefighters. Thus, this crossover study aimed to evaluate the effects of a firefighting Simulation on cognitive performance and vascular and autonomic functions in military firefighters. Methods: Sixteen firefighters (37.8 ± 5.6 years) underwent anthropometry, mental health status, and sleep quality assessments. They randomly performed two interventions, Simulation (Firefighting tasks; 10.0 ± 1.1 min) and Control (rest for 10 min), on different days. After both interventions, cognitive performance was assessed using the Stroop Test, Paced Auditory Serial Addition Test, and Trail Making Test. Then, the vascular function was assessed using ultrasonography through the carotid artery reactivity to the cold pressor test. The arterial pressure, heart rate, and cardiac intervals were recorded before interventions. The cardiac intervals were also measured during the cold pressor test. Student's t-test and Wilcoxon were used for comparisons between Control and Simulation and the analysis of variance for repeated measures was used for comparison over time during the cold pressor test. A significance level of p < 0.05 was adopted. Results: Although the mean and maximum heart rate were higher before the Simulation (p < 0.0001), all the heart rate variability parameters (p > 0.05) and mean arterial pressure (p > 0.3795) were similar before the interventions. After Simulation, the cognitive performance was similar to Control (p > 0.05), except for the improvement in Stroop Test part B (p < 0.0001). After Simulation, carotid artery reactivity was attenuated (p < 0.0010). During the cold pressor test, the high-frequency band of the heart rate variability was lower after the Simulation (p < 0.0104). Discussion: Although firefighting Simulation did not substantially change cognitive performance, the lower carotid artery reactivity and parasympathetic modulation to the heart during the cold pressor test may contribute to greater vulnerability to cardiovascular events in firefighters on duty.
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Affiliation(s)
- Iara G. Teixeira
- Post-Graduate Program in Neurosciences, Federal University of Santa Catarina, Florianópolis, Brazil
- Department of Physiological Sciences, Biological Sciences Centre, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Marcio R. Verzola
- Military Firefighters Corps of Santa Catarina, Florianópolis, Brazil
| | - Richard E. Filipini
- Department of Physiological Sciences, Biological Sciences Centre, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Guilherme F. Speretta
- Post-Graduate Program in Neurosciences, Federal University of Santa Catarina, Florianópolis, Brazil
- Department of Physiological Sciences, Biological Sciences Centre, Federal University of Santa Catarina, Florianópolis, Brazil
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29
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Pernigoni M, Kreivytė R, Lukonaitienė I, Toper CR, Kamandulis S, Conte D. Is foam rolling as effective as its popularity suggests? A randomised crossover study exploring post-match recovery in female basketball. J Sports Sci 2023; 41:1718-1725. [PMID: 38114332 DOI: 10.1080/02640414.2023.2296718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023]
Abstract
This study aimed to assess the effectiveness of foam rolling as a post-match recovery tool in basketball. Using a crossover design, 13 female players completed two simulated matches, followed by foam rolling (FR) or placebo (CON). Countermovement jump height (CMJ), heart rate variability (Ln-rMSSD), muscle soreness (VAS), perceived recovery (TQR) and fatigue (Rating-of-Fatigue) were recorded at pre-match, post-match, post-recovery and 24 h post-match. No significant effect of time*intervention and intervention were found for any variable (p > 0.05), while a significant effect of time (p < 0.01) was reported for all variables. Post-hoc analyses revealed lower CMJ and Ln-rMSSD at post-match compared with all other time points (p < 0.001), increases in pre-match VAS scores at all subsequent time points (p < 0.01), and worse TQR and Rating-of-Fatigue scores from pre-to-post-match and pre-match-to-post-recovery (p < 0.01), except for unchanged TQR values from pre-match-to-post-recovery in FR (p > 0.05). Overall, the present data suggest that foam rolling was generally ineffective for improving post-exercise recovery in female basketball players after a single match. Future research investigating the effectiveness of foam rolling in players of different sex, age and/or competitive level is warranted to provide further insight on the topic.
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Affiliation(s)
- Marco Pernigoni
- Department of Coaching Science, Lithuanian Sports University, Kaunas, Lithuania
| | - Rasa Kreivytė
- Department of Coaching Science, Lithuanian Sports University, Kaunas, Lithuania
| | - Inga Lukonaitienė
- Department of Coaching Science, Lithuanian Sports University, Kaunas, Lithuania
| | - Cem Rifat Toper
- Department of Coaching Science, Lithuanian Sports University, Kaunas, Lithuania
| | - Sigitas Kamandulis
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Daniele Conte
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
- Department of Coaching Science, Lithuanian Sports University, Kaunas, Lithuania
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30
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Casanova-Lizón A, Sarabia JM, Pastor D, Javaloyes A, Peña-González I, Moya-Ramón M. Designing an App to Promote Physical Exercise in Sedentary People Using a Day-to-Day Algorithm to Ensure a Healthy Self-Programmed Exercise Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1528. [PMID: 36674281 PMCID: PMC9861270 DOI: 10.3390/ijerph20021528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Heart rate variability (HRV) has allowed the implementation of a methodology for daily decision making called day-to-day training, which allows data to be recorded by anyone with a smartphone. The purpose of the present work was to evaluate the validity and reliability of HRV measurements with a new mobile app (Selftraining UMH) in two resting conditions. Twenty healthy people (10 male and 10 female) were measured at rest in supine and seated positions with an electrocardiogram and an application for smartphones at the same time (Selftraining UMH) using recordings obtained through an already validated chest-worn heart rate monitor (Polar H10). The Selftraining UMH app showed no significant differences compared to an electrocardiogram, neither in supine nor in sitting position (p > 0.05) and they presented almost perfect correlation levels (r ≥ 0.99). Furthermore, no significant differences were found between ultra-short (1-min) and short (5-min) length measurements. The intraclass correlation coefficient showed excellent reliability (>0.90) and the standard error of measurement remained below 5%. The Selftraining UMH smartphone app connected via Bluetooth to the Polar H10 chest strap can be used to register daily HRV recordings in healthy sedentary people.
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Affiliation(s)
- Antonio Casanova-Lizón
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - José M. Sarabia
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain
- Department of Sport Sciences, Miguel Hernandez University, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Diego Pastor
- Department of Sport Sciences, Miguel Hernandez University, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Alejandro Javaloyes
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Iván Peña-González
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Manuel Moya-Ramón
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain
- Department of Sport Sciences, Miguel Hernandez University, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
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31
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Lundstrom CJ, Foreman NA, Biltz G. Practices and Applications of Heart Rate Variability Monitoring in Endurance Athletes. Int J Sports Med 2023; 44:9-19. [PMID: 35853460 DOI: 10.1055/a-1864-9726] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Heart rate variability reflects fluctuations in the changes in consecutive heartbeats, providing insight into cardiac autonomic function and overall physiological state. Endurance athletes typically demonstrate better cardiac autonomic function than non-athletes, with lower resting heart rates and greater variability. The availability and use of heart rate variability metrics has increased in the broader population and may be particularly useful to endurance athletes. The purpose of this review is to characterize current practices and applications of heart rate variability analysis in endurance athletes. Important considerations for heart rate variability analysis will be discussed, including analysis techniques, monitoring tools, the importance of stationarity of data, body position, timing and duration of the recording window, average heart rate, and sex and age differences. Key factors affecting resting heart rate variability will be discussed, including exercise intensity, duration, modality, overall training load, and lifestyle factors. Training applications will be explored, including heart rate variability-guided training and the identification and monitoring of maladaptive states such as overtraining. Lastly, we will examine some alternative uses of heart rate variability, including during exercise, post-exercise, and for physiological forecasting and predicting performance.
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Affiliation(s)
| | - Nicholas A Foreman
- School of Kinesiology, University of Minnesota Twin Cities, Minneapolis, United States
| | - George Biltz
- School of Kinesiology, University of Minnesota Twin Cities, Minneapolis, United States
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32
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Himariotis AT, Coffey KF, Noel SE, Cornell DJ. Validity of a Smartphone Application in Calculating Measures of Heart Rate Variability. SENSORS (BASEL, SWITZERLAND) 2022; 22:9883. [PMID: 36560256 PMCID: PMC9787958 DOI: 10.3390/s22249883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
The purpose of the current study was to determine the concurrent validity of the Elite HRV smartphone application when calculating heart rate variability (HRV) metrics in reference to an independent software criterion. A total of 5 minutes of R−R interval and natural log of root mean square of the successive differences (lnRMSSD) resting HRV data were simultaneously collected using two Polar H10 heart rate monitors (HRMs) in both the seated and supine positions from 22 participants (14 males, 8 females). One H10 HRM was paired with a Polar V800 watch and one with the Elite HRV application. When no artifact correction was applied, significant, but small, differences in the lnRMSSD data were observed between the software in the seated position (p = 0.022), and trivial and nonstatistically significant differences were observed in the supine position (p = 0.087). However, significant differences (p > 0.05) in the lnRMSSD data were no longer identifiable in either the seated or the supine positions when applying Very Low, Low, or Automatic artifact-correction filters. Additionally, excellent agreements (ICC3,1 = 0.938 − 0.998) and very strong to near-perfect (r = 0.889 − 0.997) relationships were observed throughout all correction levels. The Elite HRV smartphone application is a valid tool for calculating resting lnRMSSD HRV metrics.
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Affiliation(s)
- Andreas T. Himariotis
- Health Assessment Laboratory, University of Massachusetts Lowell, Lowell, MA 01854, USA
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Kyle F. Coffey
- Health Assessment Laboratory, University of Massachusetts Lowell, Lowell, MA 01854, USA
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Sabrina E. Noel
- Health Assessment Laboratory, University of Massachusetts Lowell, Lowell, MA 01854, USA
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - David J. Cornell
- Health Assessment Laboratory, University of Massachusetts Lowell, Lowell, MA 01854, USA
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA 01854, USA
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Martínez-González-Moro I, Albertus Cámara I, Paredes Ruiz MJ. Influences of Intense Physical Effort on the Activity of the Autonomous Nervous System and Stress, as Measured with Photoplethysmography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16066. [PMID: 36498140 PMCID: PMC9735638 DOI: 10.3390/ijerph192316066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Background: The autonomic nervous system, which is composed of the sympathetic and parasympathetic nervous system, is closely related to the cardiovascular system. The temporal variation between each of the intervals between the consecutive “R” waves of an electrocardiogram is known as heart rate variability. Depending on the type of activity, both systems can be activated, and also influence the interval between “R” waves. Currently, with advancements in technology and electronic devices, photoplethysmography is used. Photoplethysmography detects changes in the intensity of reflected light that allow differentiation between systole and diastole and, therefore, determines the heart rate, its frequency and its variations. In this way, changes in the autonomic nervous system can be detected by devices such as the Max Pulse®. Objective: To determine whether the information provided by Max Pulse® on autonomic balance and stress is modified after intense physical exercise, thereby determining whether there is a relationship with body composition, and also whether there are differences with respect to gender. Materials and Methods: Fifty-three runners (38.9% female) with a mean age of 31.3 ± 8.1 years participated in the study. Two measurements (before and after intense physical effort) were performed with the Max Pulse® device. The flotoplethysmography measurement lasted 3 min, and was performed in the supine position. The exercise test was performed on a treadmill. It was initiated at a speed of 6 and 7 km/h for women and men, respectively. Subjects indicated the end of the test by making a hand gesture when unable to continue the test. Results: Autonomic nervous system activity and mental stress values decreased significantly (p < 0.05) in men and women, while autonomic nervous system balance decreased only in women. Physical stress increased (p < 0.05) in both sexes. Conclusions: Intense exercise causes changes in variables that assess autonomic nervous system balance and stress, as measured by a device based on photoplethysmography. The changes are evident in both sexes, and are not related to body composition.
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Taoum A, Bisiaux A, Tilquin F, Le Guillou Y, Carrault G. Validity of Ultra-Short-Term HRV Analysis Using PPG-A Preliminary Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22207995. [PMID: 36298346 PMCID: PMC9611389 DOI: 10.3390/s22207995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 05/26/2023]
Abstract
Continuous measurement of heart rate variability (HRV) in the short and ultra-short-term using wearable devices allows monitoring of physiological status and prevention of diseases. This study aims to evaluate the agreement of HRV features between a commercial device (Bora Band, Biosency) measuring photoplethysmography (PPG) and reference electrocardiography (ECG) and to assess the validity of ultra-short-term HRV as a surrogate for short-term HRV features. PPG and ECG recordings were acquired from 5 healthy subjects over 18 nights in total. HRV features include time-domain, frequency-domain, nonlinear, and visibility graph features and are extracted from 5 min 30 s and 1 min 30 s duration PPG recordings. The extracted features are compared with reference features of 5 min 30 s duration ECG recordings using repeated-measures correlation, Bland-Altman plots with 95% limits of agreements, Cliff's delta, and an equivalence test. Results showed agreement between PPG recordings and ECG reference recordings for 37 out of 48 HRV features in short-term durations. Sixteen of the forty-eight HRV features were valid and retained very strong correlations, negligible to small bias, with statistical equivalence in the ultra-short recordings (1 min 30 s). The current study concludes that the Bora Band provides valid and reliable measurement of HRV features in short and ultra-short duration recordings.
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Affiliation(s)
- Aline Taoum
- Laboratoire Traitement du Signal et de l’Image (LTSI-Inserm UMR 1099), Université de Rennes 1, 35042 Rennes, France
| | | | | | | | - Guy Carrault
- Laboratoire Traitement du Signal et de l’Image (LTSI-Inserm UMR 1099), Université de Rennes 1, 35042 Rennes, France
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Ha SS, Kim DK. Diagnostic Efficacy of Ultra-Short Term HRV Analysis in Obstructive Sleep Apnea. J Pers Med 2022; 12:jpm12091494. [PMID: 36143279 PMCID: PMC9505782 DOI: 10.3390/jpm12091494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Heart rate variability (HRV) is the standard method for assessing autonomic nervous system (ANS) activity and is considered a surrogate marker for sympathetic overactivity in obstructive sleep apnea (OSA). Although HRV features are usually obtained from the short-term segment method, it is impossible to evaluate rapid dynamic changes in ANS activity. Herein, we propose the ultra-short-term analysis to detect the balance of ANS activity in patients with OSA. In 1021 OSA patients, 10 min HRV target datasets were extracted from polysomnographic data and analyzed by shifting the 2 min (ultra-short-term) and 5 min (short-term) segments. We detected frequency-domain parameters, including total power (Ln TP), very low frequency (Ln VLF), low frequency (Ln LF), and high frequency (Ln HF). We found that overall HRV feature alterations indicated sympathetic overactivity dependent on OSA severity, and that this was more pronounced in the ultra-short-term methodology. The apnea-hypopnea index, oxygen desaturation index, and Epworth sleepiness scale correlated with increased sympathetic activity and decreased parasympathetic activity, regardless of the methodology. The Bland-Altman plot analyses also showed a higher agreement of HRV features between the two methodologies. This study suggests that ultra-short-term HRV analysis may be a useful method for detecting alterations in ANS function in OSA patients.
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Affiliation(s)
- Seung-Su Ha
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
- Correspondence: ; Tel.: +82-33-240-5180
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Schaffarczyk M, Rogers B, Reer R, Gronwald T. Validity of the Polar H10 Sensor for Heart Rate Variability Analysis during Resting State and Incremental Exercise in Recreational Men and Women. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22176536. [PMID: 36081005 PMCID: PMC9459793 DOI: 10.3390/s22176536] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 05/09/2023]
Abstract
Heart rate variability (HRV) is frequently applied in sport-specific settings. The rising use of freely accessible applications for its recording requires validation processes to ensure accurate data. It is the aim of this study to compare the HRV data obtained by the Polar H10 sensor chest strap device and an electrocardiogram (ECG) with the focus on RR intervals and short-term scaling exponent alpha 1 of Detrended Fluctuation Analysis (DFA a1) as non-linear metric of HRV analysis. A group of 25 participants performed an exhaustive cycling ramp with measurements of HRV with both recording systems. Average time between heartbeats (RR), heart rate (HR) and DFA a1 were recorded before (PRE), during, and after (POST) the exercise test. High correlations were found for the resting conditions (PRE: r = 0.95, rc = 0.95, ICC3,1 = 0.95, POST: r = 0.86, rc = 0.84, ICC3,1 = 0.85) and for the incremental exercise (r > 0.93, rc > 0.93, ICC3,1 > 0.93). While PRE and POST comparisons revealed no differences, significant bias could be found during the exercise test for all variables (p < 0.001). For RR and HR, bias and limits of agreement (LoA) in the Bland−Altman analysis were minimal (RR: bias of 0.7 to 0.4 ms with LoA of 4.3 to −2.8 ms during low intensity and 1.3 to −0.5 ms during high intensity, HR: bias of −0.1 to −0.2 ms with LoA of 0.3 to −0.5 ms during low intensity and 0.4 to −0.7 ms during high intensity). DFA a1 showed wider bias and LoAs (bias of 0.9 to 8.6% with LoA of 11.6 to −9.9% during low intensity and 58.1 to −40.9% during high intensity). Linear HRV measurements derived from the Polar H10 chest strap device show strong agreement and small bias compared with ECG recordings and can be recommended for practitioners. However, with respect to DFA a1, values in the uncorrelated range and during higher exercise intensities tend to elicit higher bias and wider LoA.
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Affiliation(s)
- Marcelle Schaffarczyk
- Department Sports and Exercise Medicine, Institute of Human Movement Science, University of Hamburg, 20148 Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
- Correspondence:
| | - Bruce Rogers
- Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
| | - Rüdiger Reer
- Department Sports and Exercise Medicine, Institute of Human Movement Science, University of Hamburg, 20148 Hamburg, Germany
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
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