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Bodart A, Invernizzi S, De Leener M, Lefebvre L, Rossignol M. The duration discrimination respiratory task: A new test to measure respiratory interoceptive accuracy. Psychophysiology 2024:e14632. [PMID: 38886914 DOI: 10.1111/psyp.14632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 05/17/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024]
Abstract
Interoception, which refers to the perception of body's internal state, is implicated in emotional processes and psychopathological disorders. Over the last decades, different tools have been developed to measure interoceptive accuracy, or the ability to accurately perceive physiological signals. Most of these tools have focused on cardiac interoception, but respiratory interoception has been less investigated due to the more complex and less portable equipment required. In this study, we suggest a new duration discrimination respiratory (DDR) task that does not require complex equipment. Using an adaptive staircase procedure, this task aims to determine an individual's ability to detect exhalation longer than their resting reference duration. One hundred and twenty-three healthy subjects completed the DDR task, an interoceptive task of heart rate discrimination, and filled out questionnaires on interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness), alexithymia (Toronto Alexithymia Scale [TAS]), affects (Positive and Negative Affect Scale [PANAS]), and anamnestic. Results demonstrated a good internal consistency (Cronbach's alpha = .93) of the DDR task. On average, subjects needed 99.22% (SD = 36.38) of their reference exhalation time in addition to reference exhalation to detect a prolonged exhalation. Higher self-reported fitness levels, not counting during the DDR task and lower difficulty in describing feelings (TAS subscale), predicted higher respiratory discrimination duration. In conclusion, this study demonstrates the utility of the DDR task as a valid measure of interoception.
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Affiliation(s)
- Alice Bodart
- Cognitive Psychology and Neuropsychology Laboratory, Department of Psychology and Educational Sciences, University of Mons, Mons, Belgium
| | - Sandra Invernizzi
- Cognitive Psychology and Neuropsychology Laboratory, Department of Psychology and Educational Sciences, University of Mons, Mons, Belgium
| | - Mélanie De Leener
- Cognitive Psychology and Neuropsychology Laboratory, Department of Psychology and Educational Sciences, University of Mons, Mons, Belgium
| | - Laurent Lefebvre
- Cognitive Psychology and Neuropsychology Laboratory, Department of Psychology and Educational Sciences, University of Mons, Mons, Belgium
| | - Mandy Rossignol
- Cognitive Psychology and Neuropsychology Laboratory, Department of Psychology and Educational Sciences, University of Mons, Mons, Belgium
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2
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Aschbacher K, Mather M, Lehrer P, Gevirtz R, Epel E, Peiper NC. Real-time heart rate variability biofeedback amplitude during a large-scale digital mental health intervention differed by age, gender, and mental and physical health. Psychophysiology 2024; 61:e14533. [PMID: 38454612 DOI: 10.1111/psyp.14533] [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: 04/13/2023] [Revised: 12/06/2023] [Accepted: 01/08/2024] [Indexed: 03/09/2024]
Abstract
Heart rate variability biofeedback (HRVB) is an efficacious treatment for depression and anxiety. However, translation to digital mental health interventions (DMHI) requires computing and providing real-time HRVB metrics in a personalized and user-friendly fashion. To address these gaps, this study validates a real-time HRVB feedback algorithm and characterizes the association of the main algorithmic summary metric-HRVB amplitude-with demographic, psychological, and health factors. We analyzed HRVB data from 5158 participants in a therapist-supported DMHI incorporating slow-paced breathing to treat depression or anxiety symptoms. A real-time feedback metric of HRVB amplitude and a gold-standard research metric of low-frequency (LF) power were computed for each session and then averaged within-participants over 2 weeks. We provide HRVB amplitude values, stratified by age and gender, and we characterize the multivariate associations of HRVB amplitude with demographic, psychological, and health factors. Real-time HRVB amplitude correlated strongly (r = .93, p < .001) with the LF power around the respiratory frequency (~0.1 Hz). Age was associated with a significant decline in HRVB (β = -0.46, p < .001), which was steeper among men than women, adjusting for demographic, psychological, and health factors. Resting high- and low-frequency power, body mass index, hypertension, Asian race, depression symptoms, and trauma history were significantly associated with HRVB amplitude in multivariate analyses (p's < .01). Real-time HRVB amplitude correlates highly with a research gold-standard spectral metric, enabling automated biofeedback delivery as a potential treatment component of DMHIs. Moreover, we identify demographic, psychological, and health factors relevant to building an equitable, accurate, and personalized biofeedback user experience.
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Affiliation(s)
| | - Mara Mather
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Paul Lehrer
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Monmouth Junction, New Jersey, USA
| | - Richard Gevirtz
- Department of Clinical Psychology, California School of Professional Psychology, Alliant International University, San Diego, California, USA
| | - Elissa Epel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Nicholas C Peiper
- Meru Health, San Mateo, California, USA
- Department of Epidemiology and Population Health, University of Louisville, Louisville, Kentucky, USA
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Wang H, Wang W, Gao X, Wu D, Lu Q, Li C, Zheng S, Wang H. Effects of Postural Resonance on Skin Sympathetic Nerve Activity and Blood Pressure: A Pilot Study Evaluating Vascular Tone Baroreflex Stimulation Through Biofeedback. Appl Psychophysiol Biofeedback 2024; 49:205-218. [PMID: 38159163 DOI: 10.1007/s10484-023-09614-1] [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: 12/01/2023] [Indexed: 01/03/2024]
Abstract
Heart rate and vascular tension baroreflex exhibit resonance characteristics at approximately 0.1 and 0.03 Hz. In this study, we aimed to induce postural resonance (PR) through rhythmic postural adjustments. To assess the viability of this technique, we investigated the acute impacts of postural resonance on blood pressure, sympathetic nerve activity, and mood. Fifteen healthy study participants, consisting of 8 males and 7 females, were selected for this self-controlled study. Skin sympathetic nerve activity was continuously monitored during both the intervention and stress test on the experimental day. After PR intervention, the diastolic blood pressure and mean arterial pressure in the PR group exhibited significant reductions compared to the CON group (P = 0.032, CON = 71.67 ± 2.348, PR = 64.08 ± 2.35; P = 0.041, CON = 75.00 ± 2.17, PR = 81.67 ± 2.17). After PR intervention both left brachial ankle pulse wave velocity and right brachial ankle pulse wave velocity exhibited a significant reduction compared to pre-intervention levels (from 1115.86 ± 150.08 to 1048.43 ± 127.40 cm/s, p < 0.001; 1103.86 ± 144.35 to 1060.43 ± 121.35 cm/s, p = 0.018). PR intervention also led to a significant decrease in burst frequency and duration (P = 0.049; CON = 8.96 ± 1.17, PR = 5.51 ± 1.17) and a noteworthy decrease in burst amplitude and burst threshold during the cold-pressor test (P = 0.002; P = 0.002). Additionally, VAS scores exhibited a substantial increase following PR (P = 0.035, CON = 28.4 ± 4.49, PR = 42.17 ± 4.10). PR can induce resonance effects within the cardiovascular system, resulting in the effective reduction of blood pressure, skin sympathetic nerve activity and pulse wave velocity, and decreased burst amplitude and burst threshold of the sympathetic nerve during the cold-pressor test.
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Affiliation(s)
- Hao Wang
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Wendi Wang
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Xiaolin Gao
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China.
| | - Dongzhe Wu
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China.
| | - Qiaopei Lu
- Sports Training Center, Institute of Sport Science, Beijing, China
| | - Chuangtao Li
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Sainan Zheng
- School of Sport Science, Beijing Sport University, Beijing, China
| | - Haoruo Wang
- School of Sport Science, Beijing Sport University, Beijing, China
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Amekran Y, El Hangouche AJ. Effects of Exercise Training on Heart Rate Variability in Healthy Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Cureus 2024; 16:e62465. [PMID: 39015867 PMCID: PMC11250637 DOI: 10.7759/cureus.62465] [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] [Accepted: 06/16/2024] [Indexed: 07/18/2024] Open
Abstract
This meta-analysis was conducted to investigate the effects of exercise training on heart rate variability (HRV) parameters associated with the autonomic nervous system (ANS) activity. Randomized controlled trials (RCTs) involving healthy adults (aged ≥ 18 years) were included. We searched PubMed, Scopus, Web of Science, and EBSCO databases to identify relevant studies. A random-effects meta-analysis was performed using the standardized mean difference (SMD) and 95% confidence interval (CI). Sixteen RCTs with a total of 623 participants were selected for the final analysis. The analysis showed that exercise training improved the standard deviation of normal-to-normal intervals (SDNN) (SMD: 0.58 (0.16, 1.00); p = 0.007), the root mean square of successive differences in heart period series (RMSSD) (SMD: 0.84 (0.36, 1.31); p = 0.0005), and the absolute power of high-frequency band (HF) (SMD: 0.89 (0.27, 1.51); p = 0.005) parameters compared to the control group. Analysis of the moderator variables showed that the effect of exercise on HRV indices may be influenced by sex, age, and type of exercise used, specifically in HF band, absolute power of low-frequency band (LF), and LF/HF ratio parameters. Despite the limited number of existing RCTs related to the subject, the results suggest that exercise training enhances HRV parameters associated with vagal-related activity (RMSSD and HF) and both sympathetic and parasympathetic activities (SDNN). This study overcomes the lack of meta-analyses on the effects of exercise training on autonomic modulation among healthy adults and may bridge the gap in understanding the potential physiological underpinnings of the acknowledged positive health benefits of exercise.
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Affiliation(s)
- Youssra Amekran
- Department of Physiology, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, MAR
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Prakash K, Ranjan N, Malhotra AS. Blood Pressure Variability is Better Associated with Acute Relative Hyperglycemia Than the Heart Rate Variability in Healthy Young Adults. Exp Clin Endocrinol Diabetes 2024. [PMID: 38569511 DOI: 10.1055/a-2298-9005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND Deranged cardiovascular autonomic functions are well-reported complications of diabetes mellitus, where chronic hyperglycemia is an important factor. The role of acute relative hyperglycemia on cardiovascular autonomic functions, particularly on blood pressure variability in healthy subjects, has been rarely explored. Therefore, this study aimed to examine the effect of acute relative hyperglycemia on cardiovascular autonomic functions in healthy young adults. METHODS Beat-to-beat blood pressure and electrocardiogram were recorded to assess the heart rate variability and blood pressure variability in 42 young, healthy subjects during fasting and relative hyperglycemic states. Recorded cardiovascular parameters were analyzed in time and frequency domains. Correlations among analyzed parameters of cardiovascular autonomic variabilities were explored during fasting and relative hyperglycemic state. RESULTS A few of the systolic, mean, and diastolic blood-pressure-variability parameters were significantly altered during acute relative hyperglycemia when compared to the fasting state. However, no significant changes were observed in any of the heart-rate-variability parameters. Also, novel significant correlations were found among many of the parameters of cardiovascular autonomic variabilities during fasting and relative hyperglycemic states. CONCLUSIONS The blood pressure variability is affected significantly during acute relative hyperglycemia in healthy young adults; however, the heart rate variability does not show such changes. Also, many blood pressure variability parameters show significant correlations with heart rate variability and baroreflex sensitivity. It may be hypothesized that although the variabilities in heart rate and blood pressure assess cardiovascular autonomic functions, blood pressure variability is a better indicator of cardiovascular autonomic effects of acute relative hyperglycemia.
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Affiliation(s)
- Kiran Prakash
- Government Medical College and Hospital, Chandigarh, India
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Rietz M, Schmidt-Persson J, Gillies Banke Rasmussen M, Overgaard Sørensen S, Rath Mortensen S, Brage S, Lund Kristensen P, Grøntved A, Brønd JC. Facilitating ambulatory heart rate variability analysis using accelerometry-based classifications of body position and self-reported sleep. Physiol Meas 2024; 45:055016. [PMID: 38684167 DOI: 10.1088/1361-6579/ad450d] [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: 11/05/2023] [Accepted: 04/29/2024] [Indexed: 05/02/2024]
Abstract
Objective.This study aimed to examine differences in heart rate variability (HRV) across accelerometer-derived position, self-reported sleep, and different summary measures (sleep, 24 h HRV) in free-living settings using open-source methodology.Approach.HRV is a biomarker of autonomic activity. As it is strongly affected by factors such as physical behaviour, stress, and sleep, ambulatory HRV analysis is challenging. Beat-to-beat heart rate (HR) and accelerometry data were collected using single-lead electrocardiography and trunk- and thigh-worn accelerometers among 160 adults participating in the SCREENS trial. HR files were processed and analysed in the RHRV R package. Start time and duration spent in physical behaviours were extracted, and time and frequency analysis for each episode was performed. Differences in HRV estimates across activities were compared using linear mixed models adjusted for age and sex with subject ID as random effect. Next, repeated-measures Bland-Altman analysis was used to compare 24 h RMSSD estimates to HRV during self-reported sleep. Sensitivity analyses evaluated the accuracy of the methodology, and the approach of employing accelerometer-determined episodes to examine activity-independent HRV was described.Main results.HRV was estimated for 31 289 episodes in 160 individuals (53.1% female) at a mean age of 41.4 years. Significant differences in HR and most markers of HRV were found across positions [Mean differences RMSSD: Sitting (Reference) - Standing (-2.63 ms) or Lying (4.53 ms)]. Moreover, ambulatory HRV differed significantly across sleep status, and poor agreement between 24 h estimates compared to sleep HRV was detected. Sensitivity analyses confirmed that removing the first and last 30 s of accelerometry-determined HR episodes was an accurate strategy to account for orthostatic effects.Significance.Ambulatory HRV differed significantly across accelerometry-assigned positions and sleep. The proposed approach for free-living HRV analysis may be an effective strategy to remove confounding by physical activity when the aim is to monitor general autonomic stress.
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Affiliation(s)
- Marlene Rietz
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Division of Clinical Physiology, Department for Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Schmidt-Persson
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Applied Research in Child and Adult Health, Department of Midwifery, Physiotherapy, Occupational Therapy, and Psychomotor Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Martin Gillies Banke Rasmussen
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Sarah Overgaard Sørensen
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Sofie Rath Mortensen
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Søren Brage
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Peter Lund Kristensen
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Anders Grøntved
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Jan Christian Brønd
- Center for Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
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Walsh E, Krause AJ, Greytak M, Kaizer AM, Weissbrod PA, Liu K, Taft T, Yadlapati R. Laryngeal Recalibration Therapy Improves Laryngopharyngeal Symptoms in Patients With Suspected Laryngopharyngeal Reflux Disease. Am J Gastroenterol 2024:00000434-990000000-01134. [PMID: 38656937 DOI: 10.14309/ajg.0000000000002839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Laryngopharyngeal symptoms such as cough, throat clearing, voice change, paradoxic vocal fold movement, or laryngospasm are hyper-responsive behaviors resulting from local irritation (e.g., refluxate) and heightened sympathetic tone. Laryngeal recalibration therapy (LRT) guided by a speech-language pathologist (SLP) provides mechanical desensitization and cognitive recalibration to suppress hyper-responsive laryngeal patterns. The aim of this study was to assess symptom response to LRT among patients with chronic laryngopharyngeal symptoms undergoing evaluation of gastroesophageal reflux disease (GERD). METHODS Adults with chronic laryngopharyngeal symptoms referred for evaluation of GERD to a single center were prospectively followed. Inclusion criteria included ≥2 SLP-directed LRT sessions. Data from endoscopy, ambulatory reflux monitoring, and patient-reported outcomes were collected when available. The primary outcome was symptom response. RESULTS Sixty-five participants completed LRT: mean age 55.4 years (SD 17.2), 46 (71%) female, mean body mass index 25.6 kg/m 2 (6.8), and mean of 3.7 (1.9) LRT sessions. Overall, 55 participants (85%) met criteria for symptom response. Specifically, symptom response was similar between those with isolated laryngopharyngeal symptoms (13/15, 87%) and concomitant laryngopharyngeal/esophageal symptoms (42/50, 84%). Among participants who underwent reflux monitoring, symptom response was similar between those with proven, inconclusive for, and no GERD (18/21 [86%], 8/9 [89%], 10/13 [77%]). DISCUSSION Eighty-five percent of patients with chronic laryngopharyngeal symptoms referred for GERD evaluation who underwent LRT-experienced laryngeal symptom response. Rates of symptom response were maintained across patients with or without proven GERD and patients with or without concomitant esophageal reflux symptoms. SLP-directed LRT is an effective approach to incorporate into multidisciplinary management of chronic laryngopharyngeal symptoms/laryngopharyngeal reflux disease.
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Affiliation(s)
- Erin Walsh
- Department of Otolaryngology, University of California San Diego, La Jolla, California, USA
| | - Amanda J Krause
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California, USA
| | - Madeline Greytak
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California, USA
| | - Alexander M Kaizer
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Philip A Weissbrod
- Department of Otolaryngology, University of California San Diego, La Jolla, California, USA
| | - Kelli Liu
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California, USA
| | - Tiffany Taft
- The Rome Foundation Research Institute, Chapel Hill, North Carolina, USA
| | - Rena Yadlapati
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California, USA
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Girishan Prabhu V, Stanley L, Morgan R, Shirley B. Designing and developing a nature-based virtual reality with heart rate variability biofeedback for surgical anxiety and pain management: evidence from total knee arthroplasty patients. Aging Ment Health 2024; 28:738-753. [PMID: 37850735 DOI: 10.1080/13607863.2023.2270442] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES Total knee arthroplasty (TKA) is one of the most common joint surgeries, with over a million procedures performed annually in the US. Over 70% of patients report moderate to high pain and anxiety surrounding TKA surgery, and 96% are discharged with an opioid prescription. This population requires special attention as approximately 90% of TKA patients are older adults and one of the riskiest groups prone to misusing opioids. This study aimed to develop and compare the efficacy of nature-based virtual reality (VR) with heart rate variability biofeedback (HRVBF) to mitigate surgical pain and anxiety. METHODS This randomized control trial recruited 30 patients (mean age = 66.3 ± 8.2 years, 23 F, 7 M) undergoing TKA surgery and randomly assigned to a control, 2D video with HRVBF, or VR with HRVBF group. A visual analog scale (VAS) was used to measure pain levels before and after the intervention. In addition, a second VAS and the State-Trait Anxiety Inventory (STAI) were used to measure anxiety before and after the intervention. Electrocardiogram (ECG) was used to continuously measure HRV and respiration rate in preoperative and postoperative settings. RESULTS VR and 2D-video with HRVBF decreased pain and anxiety post-intervention compared with the control group, p's <.01. On analyzing physiological signals, both treatment groups showed greater parasympathetic activity levels, and VR with HRVBF reduced pain more than the 2D video, p < .01. CONCLUSIONS Nature-based VR and 2D video with HRVBF can mitigate surgical pain and anxiety. However, VR may be more efficacious than 2D video in reducing pain.
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Affiliation(s)
| | - Laura Stanley
- Gianforte School of Computing, Montana State University, Bozeman, MT, USA
| | - Robert Morgan
- Department of Anesthesiology, Prisma Health, Greenville, SC, USA
| | - Brayton Shirley
- Department of Orthopaedics, Prisma Health, Greenville, SC, USA
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Emerson ND, Lavretsky H, Pittman WQ, Viswanathan N, Siddarth P. An open trial of biofeedback for long COVID. J Psychosom Res 2024; 179:111625. [PMID: 38458016 DOI: 10.1016/j.jpsychores.2024.111625] [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: 04/24/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Biofeedback is a therapeutic treatment model that teaches self-regulation of autonomic functions to alleviate stress-related symptoms. "Long COVID" refers to chronic physical and cognitive sequelae post-SARS-CoV-2 infection. This study examined the efficacy of a six-week intervention, consisting of weekly one-hour sessions combining heart rate variability and temperature biofeedback, for alleviating mood symptoms, somatic symptoms and sleep disturbance of patients diagnosed with long COVID. METHODS Data were collected from 20 adult participants aged 22-63 (Mage = 44.1, SDage = 12.2) with varying long COVID symptoms. Within this single arm design, 16 of the 20 participants completed all six sessions of biofeedback; 14 completed an assessment at the three-month post-treatment time point. RESULTS Participants self-reported significant improvements in somatic, anxiety, and depressive symptoms, sleep quality, quality of life, and number of "bad days" immediately after the intervention and three months later (Cohen's d effect size (ES) = 1.09-0.46). Reduced number of medical doctor visits (ES = 0.85) and prescription drug use over the last month (odds ratio = 0.33), as well as improved emotional wellbeing (ES = 0.97) were observed at the three-month time point only. CONCLUSION Results suggest that this short, readily scalable intervention can be potentially efficacious in alleviating symptoms of long COVID. Despite notable improvements, the major limitation of this study is its lack of control group. While a randomized trial merits study, biofeedback appears to be a brief, effective, non-invasive, and low-cost treatment option for patients with chronic somatic symptoms secondary to SARS-CoV-2 infection. CLINICALTRIALS govID: NCT05120648.
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Affiliation(s)
- Natacha D Emerson
- UCLA Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, United States.
| | - Helen Lavretsky
- UCLA Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, United States
| | - William Q Pittman
- UCLA Department of Medicine, David Geffen School of Medicine, United States
| | - Nisha Viswanathan
- UCLA Department of Medicine, David Geffen School of Medicine, United States
| | - Prabha Siddarth
- UCLA Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, United States
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Stallkamp Tidd SJ, Nowacki AS, Singh T, Hayburn A, Wilson R. Comorbid anxiety is associated with more changes in the Management of Postural Orthostatic Tachycardia Syndrome. Gen Hosp Psychiatry 2024; 87:1-6. [PMID: 38224642 DOI: 10.1016/j.genhosppsych.2024.01.003] [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: 07/03/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE Postural Orthostatic Tachycardia Syndrome (POTS) is not an anxiety disorder, but it shares similar symptomatology. The impact of this comorbidity on management is unknown. This information may lead to better strategies to improve the care of this subgroup. METHOD The electronic medical records of 322 patients seen at our institution between 2018 and 2022 with confirmed POTS diagnoses were analyzed. Demographics, anxiety comorbidities, questionnaire responses, and treatment course changes were collected. Negative binomial regression models examined if the presence of an anxiety disorder was associated with the number of POTS treatment course changes offset by observation time. RESULTS When adjusted for sex, age, baseline GAD-7 score, and baseline PROMIS global mental health score, those with a diagnosis of an anxiety disorder had2.6 times the incident rate of treatment changes for POTS management (IRR = 2.66 (95% CI: 1.43-4.95)). CONCLUSION Individuals carrying the diagnosis of an anxiety disorder had an increase in the incident rate of treatment changes for POTS therapy. This finding may be due to the underlying pathophysiology and treatment of anxiety disorders, the effect of bias, and difficulty with symptom differentiation. More work needs to be done to determine how to best care for POTS patients with comorbid anxiety.
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Affiliation(s)
| | - Amy S Nowacki
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Tamanna Singh
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Anna Hayburn
- Department of Neuromuscular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert Wilson
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; Department of Neuromuscular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
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11
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Burch JB, Delage AF, Zhang H, McLain AC, Ray MA, Miller A, Adams SA, Hébert JR. Sleep disorders and cancer incidence: examining duration and severity of diagnosis among veterans. Front Oncol 2024; 14:1336487. [PMID: 38469244 PMCID: PMC10927008 DOI: 10.3389/fonc.2024.1336487] [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: 11/13/2023] [Accepted: 01/29/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Sleep disruption affects biological processes that facilitate carcinogenesis. This retrospective cohort study used de-identified data from the Veterans Administration (VA) electronic medical record system to test the hypothesis that patients with diagnosed sleep disorders had an increased risk of prostate, breast, colorectal, or other cancers (1999-2010, N=663,869). This study builds upon existing evidence by examining whether patients with more severe or longer-duration diagnoses were at a greater risk of these cancers relative to those with a less severe or shorter duration sleep disorder. Methods Incident cancer cases were identified in the VA Tumor Registry and sleep disorders were defined by International Classification of Sleep Disorder codes. Analyses were performed using extended Cox regression with sleep disorder diagnosis as a time-varying covariate. Results Sleep disorders were present among 56,055 eligible patients (8% of the study population); sleep apnea (46%) and insomnia (40%) were the most common diagnoses. There were 18,181 cancer diagnoses (41% prostate, 12% colorectal, 1% female breast, 46% other). The hazard ratio (HR) for a cancer diagnosis was 1.45 (95% confidence interval [CI]: 1.37, 1.54) among those with any sleep disorder, after adjustment for age, sex, state of residence, and marital status. Risks increased with increasing sleep disorder duration (short [<1-2 years] HR: 1.04 [CI: 1.03-1.06], medium [>2-5 years] 1.23 [1.16-1.32]; long [>5-12 years] 1.52 [1.34-1.73]). Risks also increased with increasing sleep disorder severity using cumulative sleep disorder treatments as a surrogate exposure; African Americans with more severe disorders had greater risks relative to those with fewer treatments and other race groups. Results among patients with only sleep apnea, insomnia, or another sleep disorder were similar to those for all sleep disorders combined. Discussion The findings are consistent with other studies indicating that sleep disruption is a cancer risk factor. Optimal sleep and appropriate sleep disorder management are modifiable risk factors that may facilitate cancer prevention.
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Affiliation(s)
- James B. Burch
- Department of Epidemiology, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Alexandria F. Delage
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Palmetto GBA, Columbia, SC, United States
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Alexander C. McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Meredith A. Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Austin Miller
- Alabama College of Osteopathic Medicine, Dothan, AL, United States
| | - Swann A. Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, United States
| | - James R. Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, Columbia, SC, United States
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12
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Pichot V, Corbier C, Chouchou F, Barthélémy JC, Roche F. CVRanalysis: a free software for analyzing cardiac, vascular and respiratory interactions. Front Physiol 2024; 14:1224440. [PMID: 38250656 PMCID: PMC10797906 DOI: 10.3389/fphys.2023.1224440] [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: 05/17/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction: Simultaneous beat-to-beat R-R intervals, blood pressure and respiration signals are routinely analyzed for the evaluation of autonomic cardiovascular and cardiorespiratory regulations for research or clinical purposes. The more recognized analyses are i) heart rate variability and cardiac coherence, which provides an evaluation of autonomic nervous system activity and more particularly parasympathetic and sympathetic autonomic arms; ii) blood pressure variability which is mainly linked to sympathetic modulation and myogenic vascular function; iii) baroreflex sensitivity; iv) time-frequency analyses to identify fast modifications of autonomic activity; and more recently, v) time and frequency domain Granger causality analyses were introduced for assessing bidirectional causal links between each considered signal, thus allowing the scrutiny of many physiological regulatory mechanisms. Methods: These analyses are commonly applied in various populations and conditions, including mortality and morbidity predictions, cardiac and respiratory rehabilitation, training and overtraining, diabetes, autonomic status of newborns, anesthesia, or neurophysiological studies. Results: We developed CVRanalysis, a free software to analyze cardiac, vascular and respiratory interactions, with a friendly graphical interface designed to meet laboratory requirements. The main strength of CVRanalysis resides in its wide scope of applications: recordings can arise from beat-to-beat preprocessed data (R-R, systolic, diastolic and mean blood pressure, respiration) or raw data (ECG, continuous blood pressure and respiratory waveforms). It has several tools for beat detection and correction, as well as setting of specific areas or events. In addition to the wide possibility of analyses cited above, the interface is also designed for easy study of large cohorts, including batch mode signal processing to avoid running repetitive operations. Results are displayed as figures or saved in text files that are easily employable in statistical softwares. Conclusion: CVRanalysis is freely available at this website: anslabtools.univ-st-etienne.fr. It has been developed using MATLAB® and works on Windows 64-bit operating systems. The software is a standalone application avoiding to have programming skills and to install MATLAB. The aims of this paper area are to describe the physiological, research and clinical contexts of CVRanalysis, to introduce the methodological approach of the different techniques used, and to show an overview of the software with the aid of screenshots.
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Affiliation(s)
- Vincent Pichot
- SAINBIOSE U1059, Inserm, Saint-Etienne Jean-Monnet University, Clinical Physiology and Exercise, CHU of Saint-Etienne, Saint-Etienne, France
| | - Christophe Corbier
- LASPI EA3059, Saint-Etienne Jean-Monnet University, Roanne Technology University Institute, Roanne, France
| | - Florian Chouchou
- IRISSE EA4075, UFR SHE, University of La Réunion, Le Tampon, France
| | - Jean-Claude Barthélémy
- SAINBIOSE U1059, Inserm, Saint-Etienne Jean-Monnet University, Clinical Physiology and Exercise, CHU of Saint-Etienne, Saint-Etienne, France
| | - Frédéric Roche
- SAINBIOSE U1059, Inserm, Saint-Etienne Jean-Monnet University, Clinical Physiology and Exercise, CHU of Saint-Etienne, Saint-Etienne, France
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Gilgoff R, Mengelkoch S, Elbers J, Kotz K, Radin A, Pasumarthi I, Murthy R, Sindher S, Harris NB, Slavich GM. The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology. Stress 2024; 27:2327333. [PMID: 38711299 PMCID: PMC11219250 DOI: 10.1080/10253890.2024.2327333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/02/2024] [Indexed: 05/08/2024] Open
Abstract
Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.
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Affiliation(s)
- Rachel Gilgoff
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Summer Mengelkoch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jorina Elbers
- Trauma recovery Program, HeartMath Institute, Boulder Creek, CA, USA
| | | | | | - Isha Pasumarthi
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Reanna Murthy
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | | | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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14
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Corrado J, Iftekhar N, Halpin S, Li M, Tarrant R, Grimaldi J, Simms A, O'Connor RJ, Casson A, Sivan M. HEART Rate Variability Biofeedback for LOng COVID Dysautonomia (HEARTLOC): Results of a Feasibility Study. ADVANCES IN REHABILITATION SCIENCE AND PRACTICE 2024; 13:27536351241227261. [PMID: 38298551 PMCID: PMC10826406 DOI: 10.1177/27536351241227261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024]
Abstract
Introduction Post-COVID-19 syndrome, or Long Covid (LC) refers to symptoms persisting 12 weeks after the COVID-19 infection. LC comprises a wide range of dysautonomia symptoms, including fatigue, breathlessness, palpitations, dizziness, pain and brain fog. This study tested the feasibility and estimated the efficacy, of a Heart Rate Variability Biofeedback (HRV-B) programme via a standardised slow diaphragmatic breathing technique in individuals with LC. Methods LC patients underwent a 4-week HRV-B intervention for 10 minutes twice daily for 4 weeks using the Polar H10 ECG (Electrocardiogram) chest strap and Elite HRV phone application. Outcome measures C19-YRSm (Yorkshire Rehabilitation Scale modified), Composite Autonomic Symptom Score (COMPASS-31), WHO Disability Assessment Schedule (WHODAS), EQ5D-5L (EuroQol 5 Dimensions) and Root Mean Square of Successive Differences between heartbeats (RMSSD) using a Fitbit device were recorded before and after the intervention. The study was pre-registered at clinicaltrials.gov NCT05228665. Results A total of 13 participants (54% female, 46% male) completed the study with high levels of independent use of technology, data completeness and intervention adherence. There was a statistically significant improvement in C19YRS-m (P = .001), COMPASS-31 (P = .007), RMSSD (P = .047), WHODAS (P = .02) and EQ5D Global Health Score (P = .009). Qualitative feedback suggested participants could use it independently, were satisfied with the intervention and reported beneficial effects from the intervention. Conclusion HRV-B using diaphragmatic breathing is a feasible intervention for LC. The small sample size limits generalisability. HRV-B in LC warrants further exploration in a larger randomised controlled study.
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Affiliation(s)
- Joanna Corrado
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Long COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK
- National Demonstration Centre of Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nafi Iftekhar
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Stephen Halpin
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Long COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK
- National Demonstration Centre of Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mengyao Li
- Department of Electrical and Electronic Engineering, University of Manchester, Manchester, UK
| | - Rachel Tarrant
- Long COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Jennifer Grimaldi
- Long COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Alexander Simms
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rory J O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Demonstration Centre of Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alex Casson
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Electrical and Electronic Engineering, University of Manchester, Manchester, UK
| | - Manoj Sivan
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Long COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK
- National Demonstration Centre of Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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15
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Komber A, Chu SH, Zhao X, Komber H, Halbesma N, Mead G. Non-pharmacological interventions for the treatment of post-stroke fatigue: A systematic review. Int J Stroke 2023:17474930231221480. [PMID: 38062564 DOI: 10.1177/17474930231221480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND Post-stroke fatigue (PSF) affects 50% of stroke survivors. Current guidance on management of this condition is limited. AIMS This systematic review and meta-analysis aimed to identify and analyze all randomized clinical trials (RCTs) of non-pharmacological interventions for the treatment of PSF. SUMMARY OF REVIEW Six electronic databases were searched from inception to January 2023 for English-language RCTs investigating the efficacy of non-pharmacological interventions versus passive controls in patients with PSF. The primary outcome was fatigue severity at the end of the intervention. The Cochrane risk-of-bias (ROB)2 tool was used to assess evidence quality. A total of 7990 records were retrieved, 333 studies were scrutinized, and 13 completed RCTs (484 participants) were included. Interventions included psychological therapies, physical therapies, and brain stimulation. Nine studies provided sufficient data for meta-analysis, of which seven also had follow-up data. Fatigue severity was lower in the intervention groups at the end of the intervention compared with control (participants = 310, standardized mean difference (SMD) = -0.57, 95% confidence intervals (CIs) (-0.87 to -0.28)) and at follow-up (participants = 112, SMD = -0.36, 95% CIs (-0.83 to 0.10)). Certainty in the effect estimate was downgraded to low for a serious ROB and imprecision. Subgroup analysis revealed significant benefits with physical therapy and brain stimulation but not psychological therapies, though sample sizes were low. CONCLUSION Non-pharmacological interventions improved fatigue but the quality of evidence was low. Further RCTs are needed for PSF management.
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Affiliation(s)
- Ahmad Komber
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Shuk Han Chu
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Xu Zhao
- Department of Chemistry, Oxford University, Oxford, UK
| | - Hend Komber
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Gillian Mead
- Usher Institute, University of Edinburgh, Edinburgh, UK
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16
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Schoffl J, Arora M, Pozzato I, McBain C, Rodrigues D, Vafa E, Middleton J, Davis GM, Gustin SM, Bourke J, Kifley A, Krassioukov AV, Cameron ID, Craig A. Heart Rate Variability Biofeedback in Adults with a Spinal Cord Injury: A Laboratory Framework and Case Series. J Clin Med 2023; 12:7664. [PMID: 38137732 PMCID: PMC10743967 DOI: 10.3390/jcm12247664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Heart rate variability biofeedback (HRV-F) is a neurocardiac self-regulation therapy that aims to regulate cardiac autonomic nervous system activity and improve cardiac balance. Despite benefits in various clinical populations, no study has reported the effects of HRV-F in adults with a spinal cord injury (SCI). This article provides an overview of a neuropsychophysiological laboratory framework and reports the impact of an HRV-F training program on two adults with chronic SCI (T1 AIS A and T3 AIS C) with different degrees of remaining cardiac autonomic function. The HRV-F intervention involved 10 weeks of face-to-face and telehealth sessions with daily HRV-F home practice. Physiological (HRV, blood pressure variability (BPV), baroreflex sensitivity (BRS)), and self-reported assessments (Fatigue Severity Scale, Generalised Anxiety Disorder Scale, Patient Health Questionnaire, Appraisal of Disability and Participation Scale, EuroQol Visual Analogue Scale) were conducted at baseline and 10 weeks. Participants also completed weekly diaries capturing mood, anxiety, pain, sleep quality, fatigue, and adverse events. Results showed some improvement in HRV, BPV, and BRS. Additionally, participants self-reported some improvements in mood, fatigue, pain, quality of life, and self-perception. A 10-week HRV-F intervention was feasible in two participants with chronic SCI, warranting further investigation into its autonomic and psychosocial effects.
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Affiliation(s)
- Jacob Schoffl
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Mohit Arora
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Ilaria Pozzato
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Candice McBain
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Dianah Rodrigues
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Elham Vafa
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia;
| | - James Middleton
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Glen M. Davis
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia;
| | - Sylvia Maria Gustin
- NeuroRecovery Research Hub, University of New South Wales, Sydney, NSW 2052, Australia;
- The Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2052, Australia
| | - John Bourke
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Annette Kifley
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Andrei V. Krassioukov
- ICORD, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Ian D. Cameron
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Ashley Craig
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
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Won JY, Nam EC, Chun KJ, Kim JW, Lee WH. The 24-Hour Cardiac Autonomic Activity in Patients With Allergic Rhinitis. J Korean Med Sci 2023; 38:e400. [PMID: 38050912 PMCID: PMC10695759 DOI: 10.3346/jkms.2023.38.e400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Definitive knowledge of the 24-hour cardiac autonomic activity in patients with allergic rhinitis (AR) is lacking. Thus, we aimed to evaluate heart rate variability (HRV), which is used to measure cardiac autonomic activity by 24-hour Holter monitoring in patients with AR. METHODS We enrolled 32 patients who visited our clinic and were diagnosed with AR. The control group was selected four-fold (n = 128) by matching (age, sex, hypertension, and diabetes) in the AR group from a Holter registry in the cardiology department. The HRV results, which were measured using 24-hour Holter monitoring, were compared between the AR and control groups. RESULTS All time-domain parameters of HRV revealed no differences between the groups. However, among the frequency domain parameters of HRV, the low-frequency to high-frequency ratio and low-frequency power in normalized units were significantly lower in the AR group. Conversely, high-frequency power in normalized units was significantly higher in the AR group. In the multiple regression analysis, AR was independently associated with sympathetic withdrawal (adjusted odds ratio = 3.393, P = 0.020) after adjusting for age, sex, hypertension, diabetes mellitus, and hyperlipidemia. CONCLUSIONS The present findings suggest differences in cardiac autonomic activity which are related with sympathetic withdrawal in patients with AR compared with that in the normal population over 24 hours.
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Affiliation(s)
- Jun Yeon Won
- Department of Otolaryngology, Kangwon National University Hospital, College of Medicine, Kangwon National University, Chuncheon, Korea
| | - Eui-Cheol Nam
- Department of Otolaryngology, Kangwon National University Hospital, College of Medicine, Kangwon National University, Chuncheon, Korea
| | - Kwang Jin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, College of Medicine, Kangwon National University, Chuncheon, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo Hyun Lee
- Department of Otolaryngology, Kangwon National University Hospital, College of Medicine, Kangwon National University, Chuncheon, Korea.
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Li T, Yang S, Liu X, Li Y, Gu Z, Jiang Z. Dietary neoagarotetraose extends lifespan and impedes brain aging in mice via regulation of microbiota-gut-brain axis. J Adv Res 2023; 52:119-134. [PMID: 37085001 PMCID: PMC10555787 DOI: 10.1016/j.jare.2023.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/31/2023] [Accepted: 04/16/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Dietary oligosaccharides can impact the gut microbiota and confer tremendous health benefits. OBJECTIVES The aim of this study was to determine the impact of a novel functional oligosaccharide, neoagarotetraose (NAT), on aging in mice. METHODS 8-month-old C57BL/6J mice as the natural aging mice model were orally administered with NAT for 12 months. The preventive effect of NAT in Alzheimer's disease (AD) mice was further evaluated. Aging related indicators, neuropathology, gut microbiota and short-chain fatty acids (SCFAs) in cecal contents were analyzed. RESULTS NAT treatment extended the lifespan of these mice by up to 33.3 %. Furthermore, these mice showed the improved aging characteristics and decreased injuries in cerebral neurons. Dietary NAT significantly delayed DNA damage in the brain, and inhibited reduction of tight junction protein in the colon. A significant increase at gut bacterial genus level (such as Lactobacillus, Butyricimonas, and Akkermansia) accompanied by increasing concentrations of SCFAs in cecal contents was observed after NAT treatment. Functional profiling of gut microbiota composition indicated that NAT treatment regulated the glucolipid and bile acid-related metabolic pathways. Interestingly, NAT treatment ameliorated cognitive impairment, attenuated amyloid-β (Aβ) and Tau pathology, and regulated the gut microbiota composition and SCFAs receptor-related pathway of Alzheimer's disease (AD) mice. CONCLUSION NAT mitigated age-associated cerebral injury in mice through gut-brain axis. The findings provide novel evidence for the effect of NAT on anti-aging, and highlight the potential application of NAT as an effective intervention against age-related diseases.
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Affiliation(s)
- Tao Li
- Key Laboratory of Food Bioengineering (China National Light Industry), College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Shaoqing Yang
- Key Laboratory of Food Bioengineering (China National Light Industry), College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Xiaoyan Liu
- Key Laboratory of Food Bioengineering (China National Light Industry), College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Yanxiao Li
- Department of Nutrition and Health, College of Engineering, China Agricultural University, Beijing, China
| | - Zhenglong Gu
- Division of Nutritional Sciences, Cornell University, NY, USA; Greater Bay Area Institute of Precision Medicine (Guangzhou), Nansha District, Guangzhou 511400, China; Institute of Life Sciences, Fudan University, Shanghai 200433, China.
| | - Zhengqiang Jiang
- Key Laboratory of Food Bioengineering (China National Light Industry), College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China.
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Nakagome K, Makinodan M, Uratani M, Kato M, Ozaki N, Miyata S, Iwamoto K, Hashimoto N, Toyomaki A, Mishima K, Ogasawara M, Takeshima M, Minato K, Fukami T, Oba M, Takeda K, Oi H. Feasibility of a wrist-worn wearable device for estimating mental health status in patients with mental illness. Front Psychiatry 2023; 14:1189765. [PMID: 37547203 PMCID: PMC10399687 DOI: 10.3389/fpsyt.2023.1189765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/07/2023] [Indexed: 08/08/2023] Open
Abstract
Object Real-world data from wearable devices has the potential to understand mental health status in everyday life. We aimed to investigate the feasibility of estimating mental health status using a wrist-worn wearable device (Fitbit Sense) that measures movement using a 3D accelerometer and optical pulse photoplethysmography (PPG). Methods Participants were 110 patients with mental illnesses from different diagnostic groups. The study was undertaken between 1 October 2020 and 31 March 2021. Participants wore a Fitbit Sense on their wrist and also completed the State-Trait Anxiety Inventory (STAI), Positive and Negative Affect Schedule (PANAS), and EuroQol 5 dimensions 5-level (EQ-5D-5L) during the study period. To determine heart rate (HR) variability (HRV), we calculated the sdnn (standard deviation of the normal-to-normal interval), coefficient of variation of R-R intervals, and mean HR separately for each sleep stage and the daytime. The association between mental health status and HR and HRV was analyzed. Results The following significant correlations were found in the wake after sleep onset stage within 3 days of mental health status assessment: sdnn, HR and STAI scores, HR and PANAS scores, HR and EQ-5D-5L scores. The association between mental health status and HR and HRV was stronger the closer the temporal distance between mental health status assessment and HR measurement. Conclusion A wrist-worn wearable device that measures PPG signals was feasible for use with patients with mental illness. Resting state HR and HRV could be used as an objective assessment of mental health status within a few days of measurement.
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Affiliation(s)
- Kazuyuki Nakagome
- Department of Psychiatry, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | | | - Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Hirakata, Japan
| | - Norio Ozaki
- Pathophysiology of Mental Disorders, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiko Miyata
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kunihiro Iwamoto
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Atsuhito Toyomaki
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Masaya Ogasawara
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | | | | | - Mari Oba
- Department of Clinical Data Science, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kazuyoshi Takeda
- Department of Clinical Data Science, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Hideki Oi
- Department of Clinical Data Science, National Center of Neurology and Psychiatry, Kodaira, Japan
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20
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Sánchez-Solís AM, Peláez-Hernández V, Santiago-Fuentes LM, Luna-Rodríguez GL, Reyes-Lagos JJ, Orea-Tejeda A. Induced Relaxation Enhances the Cardiorespiratory Dynamics in COVID-19 Survivors. ENTROPY (BASEL, SWITZERLAND) 2023; 25:874. [PMID: 37372218 DOI: 10.3390/e25060874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023]
Abstract
Most COVID-19 survivors report experiencing at least one persistent symptom after recovery, including sympathovagal imbalance. Relaxation techniques based on slow-paced breathing have proven to be beneficial for cardiovascular and respiratory dynamics in healthy subjects and patients with various diseases. Therefore, the present study aimed to explore the cardiorespiratory dynamics by linear and nonlinear analysis of photoplethysmographic and respiratory time series on COVID-19 survivors under a psychophysiological assessment that includes slow-paced breathing. We analyzed photoplethysmographic and respiratory signals of 49 COVID-19 survivors to assess breathing rate variability (BRV), pulse rate variability (PRV), and pulse-respiration quotient (PRQ) during a psychophysiological assessment. Additionally, a comorbidity-based analysis was conducted to evaluate group changes. Our results indicate that all BRV indices significantly differed when performing slow-paced breathing. Nonlinear parameters of PRV were more appropriate for identifying changes in breathing patterns than linear indices. Furthermore, the mean and standard deviation of PRQ exhibited a significant increase while sample and fuzzy entropies decreased during diaphragmatic breathing. Thus, our findings suggest that slow-paced breathing may improve the cardiorespiratory dynamics of COVID-19 survivors in the short term by enhancing cardiorespiratory coupling via increased vagal activity.
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Affiliation(s)
| | - Viridiana Peláez-Hernández
- Cardiology Service, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Mexico City 14080, Mexico
| | - Laura Mercedes Santiago-Fuentes
- School of Medicine, Universidad Autónoma del Estado de México (UAEMéx), Toluca de Lerdo 50180, Mexico
- Health Sciences Department, Universidad Autónoma Metropolitana Unidad Iztapalapa (UAM-I), Mexico City 09340, Mexico
| | | | - José Javier Reyes-Lagos
- School of Medicine, Universidad Autónoma del Estado de México (UAEMéx), Toluca de Lerdo 50180, Mexico
| | - Arturo Orea-Tejeda
- Cardiology Service, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Mexico City 14080, Mexico
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21
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Borlimi R, Buattini M, Riboli G, Nese M, Brighetti G, Giunti D, Vescovelli F. Menstrual cycle symptomatology during the COVID-19 pandemic: The role of interoceptive sensibility and psychological health. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2023; 14:100182. [PMID: 36911251 PMCID: PMC9990892 DOI: 10.1016/j.cpnec.2023.100182] [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: 12/15/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
The literature on the COVID-19 pandemic has shown the importance of investigating its impact on mental health during this sensitive period, also in relation to the female menstrual cycle. To this end, interceptive sensibility has emerged as a fundamental construct for studying the mind-body interaction among psychosomatic and pain symptoms, particularly through the distinction between two attentional styles (namely, a "mindful" and a "non-mindful" sensibility). The aim of the following study is to verify the role of mental health and interoceptive sensibility on menstrual symptoms in women of childbearing age, during the pandemic, as well as to identify the specific contribution of the existing dimensions of interoceptive sensibility in the prediction of symptoms' severity. Data were collected through an online survey, for which 5294 women responded on demographic information, menstrual history, symptoms' disturbance, and completed the Italian versions of the GHQ-12 and the MAIA. The analyses showed that symptoms were strongly correlated to either the GHQ-12 and the MAIA subscales Noticing, Emotional Awareness, Trusting and Not-Worrying. This result was further verified via a hierarchical regression, which revealed that the same interoceptive dimensions and mental health strongly predicted the intensity of menstrual symptoms (R2 = 0.177, ΔR2 = 0.143) compared to other considered dimensions (R2 = 0.180, ΔR2 = 0.002). Results are partially in line with the premises but suggest that mental health has a strong impact on the experience of the menstrual cycle and that only a few interoceptive dimensions may be relevant in explaining the severity of menstrual symptoms. It is here suggested that noticing internal bodily signals and being aware of emotional states might become dysfunctional if not reconciled with a good ability to self-regulate internal states, but may rather contribute to the perpetuation of the 'vicious cycle' of heightened affective and attentional reactions to interoceptive sensations.
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Affiliation(s)
| | | | - Greta Riboli
- Sigmund Freud University, Milan, Italy
- Sigmund Freud PrivatUniversitat, Wien, Austria
- Corresponding author. Sigmund Freud University, Milan, Ripa di Porta Ticinese 79, Italy.
| | | | | | - Daniel Giunti
- Centro Integrato di Sessuologia Clinica “Il Ponte”, Florence, Italy
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22
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Trivedi G, Sharma K, Saboo B, Kathirvel S, Konat A, Zapadia V, Prajapati PJ, Benani U, Patel K, Shah S. Humming (Simple Bhramari Pranayama) as a Stress Buster: A Holter-Based Study to Analyze Heart Rate Variability (HRV) Parameters During Bhramari, Physical Activity, Emotional Stress, and Sleep. Cureus 2023; 15:e37527. [PMID: 37193427 PMCID: PMC10182780 DOI: 10.7759/cureus.37527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
Objective In this study, our goal was to understand the comparative impact of humming, physical activity, emotional stress, and sleep on several heart rate variability (HRV) parameters, including the stress index (SI), and to assess the effectiveness of humming (simple Bhramari) as a stress buster based on the HRV parameters. Methods This pilot study assessed the long-term HRV parameters of 23 participants in terms of four activities: humming (simple Bhramari), physical activity, emotional stress, and sleep. The single-channel Holter device measured the readings, and data was analyzed using Kubios HRV Premium software for time and frequency-domain HRV parameters, including the stress index. Regarding statistical analysis, single-factor ANOVA followed by paired t-test was used to compare the results of HRV parameters "during" the four activities to understand if humming generates the outcome to enhance the autonomic nervous system. Results Our findings revealed that humming generates the lowest stress index compared to all three other activities (physical activity, emotional stress, and sleep). Several additional HRV parameters also supported the positive impact on the autonomic nervous, equivalent to stress reduction. Conclusions Humming (simple Bhramari) can be an effective stress-buster based on the assessment of several HRV parameters during its practice and in comparison with other activities. A regular daily humming routine can help enhance the parasympathetic nervous system and slow down sympathetic activation.
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Affiliation(s)
- Gunjan Trivedi
- Society for Energy & Emotions, Wellness Space, Ahmedabad, IND
| | - Kamal Sharma
- Cardiology, Dr. Kamal Sharma Cardiology Clinic, Ahmedabad, IND
| | - Banshi Saboo
- Department of Endocrinology, Diabetes Care & Hormone Clinic, Ahmedabad, IND
| | - Soundappan Kathirvel
- Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Ashwati Konat
- Department of Zoology, Biomedical Technology and Human Genetics, Gujarat University, Ahmedabad, IND
| | | | | | - Urva Benani
- Smt. NHL Municipal Medical College, Internal Medicine, Ahmedabad, IND
| | - Kahan Patel
- Internal Medicine, B J Medical College, Ahmedabad, IND
| | - Suchi Shah
- Internal Medicine, AMC MET Medical College, Ahmedabad, IND
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23
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Bates ME, Eddie D, Lehrer PM, Nolan RP, Siepmann M. Editorial: Integrated cardiovascular and neural system processes as potential mechanisms of behavior change. Front Psychiatry 2023; 14:1175691. [PMID: 37032946 PMCID: PMC10074486 DOI: 10.3389/fpsyt.2023.1175691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Marsha E. Bates
- Department of Kinesiology and Health, Center of Alcohol and Substance Use Studies, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - David Eddie
- Recovery Research Institute and Psychiatry Department, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Paul M. Lehrer
- Department of Kinesiology and Health, Center of Alcohol and Substance Use Studies, Rutgers University - New Brunswick, New Brunswick, NJ, United States
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Robert P. Nolan
- Behavioural Cardiology Research Unit, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Martin Siepmann
- Clinic for Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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24
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Kremer S, Blue T. Biofeedback as an Adjunct or Alternative Intervention to Cognitive Behavioral Therapy for Insomnia. Sleep Med Clin 2023; 18:85-93. [PMID: 36764789 DOI: 10.1016/j.jsmc.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Insomnia is highly prevalent and comorbid with many disorders. However, insomnia is underdiagnosed and undertreated in many populations. Cognitive behavioral therapy for insomnia (CBT-I) is not appropriate or sufficient for some individuals. Biofeedback has demonstrated efficacy in a range of disorders, including insomnia. The authors discuss the history and rationale for the use of biofeedback in the treatment of insomnia and other comorbid disorders. The article also presents current research on biofeedback for insomnia and comorbid disorders with recommendations for using biofeedback as an adjunct or alternative intervention to CBT-I.
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Affiliation(s)
- Stephanie Kremer
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, UCLA Insomnia Clinic, Cousins Center for Psychoneuroimmunology, 300 Medical Plaza, Suite 3200A, Los Angeles, CA 90095, USA.
| | - Tanecia Blue
- VA Pacific Islands Healthcare System, 459 Patterson Road, Honolulu, HI 96819, USA
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25
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Millet GY, Bertrand MF, Lapole T, Féasson L, Rozand V, Hupin D. Measuring objective fatigability and autonomic dysfunction in clinical populations: How and why? Front Sports Act Living 2023; 5:1140833. [PMID: 37065809 PMCID: PMC10101442 DOI: 10.3389/fspor.2023.1140833] [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: 01/09/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023] Open
Abstract
Fatigue is a major symptom in many diseases, often among the most common and severe ones and may last for an extremely long period. Chronic fatigue impacts quality of life, reduces the capacity to perform activities of daily living, and has socioeconomical consequences such as impairing return to work. Despite the high prevalence and deleterious consequences of fatigue, little is known about its etiology. Numerous causes have been proposed to explain chronic fatigue. They encompass psychosocial and behavioral aspects (e.g., sleep disorders) and biological (e.g., inflammation), hematological (e.g., anemia) as well as physiological origins. Among the potential causes of chronic fatigue is the role of altered acute fatigue resistance, i.e. an increased fatigability for a given exercise, that is related to physical deconditioning. For instance, we and others have recently evidenced that relationships between chronic fatigue and increased objective fatigability, defined as an abnormal deterioration of functional capacity (maximal force or power), provided objective fatigability is appropriately measured. Indeed, in most studies in the field of chronic diseases, objective fatigability is measured during single-joint, isometric exercises. While those studies are valuable from a fundamental science point of view, they do not allow to test the patients in ecological situations when the purpose is to search for a link with chronic fatigue. As a complementary measure to the evaluation of neuromuscular function (i.e., fatigability), studying the dysfunction of the autonomic nervous system (ANS) is also of great interest in the context of fatigue. The challenge of evaluating objective fatigability and ANS dysfunction appropriately (i.e.,. how?) will be discussed in the first part of the present article. New tools recently developed to measure objective fatigability and muscle function will be presented. In the second part of the paper, we will discuss the interest of measuring objective fatigability and ANS (i.e. why?). Despite the beneficial effects of physical activity in attenuating chronic fatigue have been demonstrated, a better evaluation of fatigue etiology will allow to personalize the training intervention. We believe this is key in order to account for the complex, multifactorial nature of chronic fatigue.
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Affiliation(s)
- Guillaume Y. Millet
- Université Jean Monnet Saint-Etienne, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, F-42023, Saint-Etienne, Lyon, France
- Institut Universitaire de France (IUF), Paris, France
- Correspondence: Guillaume Y. Millet
| | - Mathilde F. Bertrand
- Université Jean Monnet Saint-Etienne, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, F-42023, Saint-Etienne, Lyon, France
| | - Thomas Lapole
- Université Jean Monnet Saint-Etienne, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, F-42023, Saint-Etienne, Lyon, France
| | - Léonard Féasson
- Université Jean Monnet Saint-Etienne, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, F-42023, Saint-Etienne, Lyon, France
- Service de physiologie clinique et de l'exercice, CHU de Saint-Étienne, Saint-Étienne, France
- Centre Référent Maladies Neuromusculaires rares - Euro-NmD, CHU de Saint-Étienne, Saint-Étienne, France
| | - Vianney Rozand
- Université Jean Monnet Saint-Etienne, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, F-42023, Saint-Etienne, Lyon, France
| | - David Hupin
- Service de physiologie clinique et de l'exercice, CHU de Saint-Étienne, Saint-Étienne, France
- Jean Monnet University Saint-Etienne, Mines Saint-Etienne, University hospital of Saint-Etienne, INSERM, SAINBIOSE, U1059, DVH team, Saint-Etienne, France
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26
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Corrado J, Halpin S, Preston N, Whiteside D, Tarrant R, Davison J, Simms AD, O'Connor RJ, Casson A, Sivan M. HEART rate variability biofeedback for long COVID symptoms (HEARTLOC): protocol for a feasibility study. BMJ Open 2022; 12:e066044. [PMID: 36410797 PMCID: PMC9680157 DOI: 10.1136/bmjopen-2022-066044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Long COVID (LC), also known as post-COVID-19 syndrome, refers to symptoms persisting 12 weeks after COVID-19 infection. It affects up to one in seven people contracting the illness and causes a wide range of symptoms, including fatigue, breathlessness, palpitations, dizziness, pain and brain fog. Many of these symptoms can be linked to dysautonomia or dysregulation of the autonomic nervous system after SARS-CoV2 infection. This study aims to test the feasibility and estimate the efficacy, of the heart rate variability biofeedback (HRV-B) technique via a standardised slow diaphragmatic breathing programme in individuals with LC. METHODS AND ANALYSIS 30 adult LC patients with symptoms of palpitations or dizziness and an abnormal NASA Lean Test will be selected from a specialist Long COVID rehabilitation service. They will undergo a 4-week HRV-B intervention using a Polar chest strap device linked to the Elite HRV phone application while undertaking the breathing exercise technique for two 10 min periods everyday for at least 5 days a week. Quantitative data will be gathered during the study period using: HRV data from the chest strap and wrist-worn Fitbit, the modified COVID-19 Yorkshire Rehabilitation Scale, Composite Autonomic Symptom Score, WHO Disability Assessment Schedule and EQ-5D-5L health-related quality of life measures. Qualitative feedback on user experience and feasibility of using the technology in a home setting will also be gathered. Standard statistical tests for correlation and significant difference will be used to analyse the quantitate data. ETHICS AND DISSEMINATION The study has received ethical approval from Health Research Authority (HRA) Leicester South Research Ethics Committee (21/EM/0271). Dissemination plans include academic and lay publications. TRIAL REGISTRATION NUMBER NCT05228665.
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Affiliation(s)
- Joanna Corrado
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
- National Demonstration Centre in Rehabilitation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stephen Halpin
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
- Long COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK
- The University of Manchester, Manchester, Manchester, UK
| | - Nick Preston
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
| | - Diana Whiteside
- Long COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Rachel Tarrant
- Long COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Jennifer Davison
- Long COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Alexander D Simms
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rory J O'Connor
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
- National Demonstration Centre in Rehabilitation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alexander Casson
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
- The University of Manchester, Manchester, Manchester, UK
| | - Manoj Sivan
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
- National Demonstration Centre in Rehabilitation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Long COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK
- The University of Manchester, Manchester, Manchester, UK
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27
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Xie L, Zhang C, Zhang J, Zhao M. The efficacy of heart rate variability biofeedback in patients with acute ischemic stroke: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31834. [PMID: 36401495 PMCID: PMC9678518 DOI: 10.1097/md.0000000000031834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Stroke is the most common serious neurological disorder, and in high-income countries, it is the fourth-leading cause of death, long-term disability, and reduced quality of life among adults. Heart rate variability (HRV) can improve autonomic dysfunction, cognitive impairment, and psychological distress in other patient populations, but its effect in patients with acute ischemic stroke is still unclear. We conducted a protocol for systematic review and meta-analysis to evaluate the efficacy of HRV biofeedback in patients with acute ischemic stroke. METHODS A computerized literature search will be performed in the following electronic databases from their inceptions to October 2022: PubMed, EMBASE, MEDLINE, Cochrane Central Register of Controlled Clinical Trials, China Knowledge Resource Integrated Database, Wanfang Data Information, and Weipu Database for Chinese Technical Periodicals. The risk of bias in the included articles is assessed according to the Risk of Bias Assessment Tool in Cochrane Handbook of Systematic Reviews. Data are analyzed with the Review Manager Version 5.3 software. RESULTS This paper will provide high-quality synthesis to assess the efficacy of HRV biofeedback in patients with acute ischemic stroke. CONCLUSION HRV biofeedback may be a promising intervention for improving autonomic function, cognitive impairment, and psychological distress in patients with acute ischemic stroke.
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Affiliation(s)
- Lihua Xie
- Department of Neurology, Linfen People’s Hospital, Linfen, Shanxi Province, China
| | - Chunyan Zhang
- Department of Neurology, Linfen People’s Hospital, Linfen, Shanxi Province, China
| | - Junling Zhang
- Department of Internal Medicine, Taiyuan University of Technology Hospital, Taiyuan, Shanxi Province, China
| | - Min Zhao
- Department of Neurology, Linfen People’s Hospital, Linfen, Shanxi Province, China
- * Correspondence: Min Zhao, Department of Neurology, Linfen People’s Hospital, 319 Gulou West Street, Yaodu District, Linfen, Shanxi Province 041000, China (e-mail: )
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28
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Wang H, Gao X, Shi Y, Wu D, Li C, Wang W. Effects of trunk posture on cardiovascular and autonomic nervous systems: A pilot study. Front Physiol 2022; 13:1009806. [PMID: 36330208 PMCID: PMC9623330 DOI: 10.3389/fphys.2022.1009806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/28/2022] [Indexed: 01/28/2024] Open
Abstract
Objective: Although regular and moderate physical activity has been shown to improve the cardiovascular and autonomic nervous systems, little has been done to study the effects of postural changes in the movement on the heart and autonomic nervous system. To uncover changes in cardiac function and autonomic nerves induced by different underlying posture transitions and explore which trunk postures lead to chronic sympathetic activation. Therefore, this study investigated the effects of trunk posture on the cardiovascular and autonomic nervous systems. Methods: Twelve male subjects (age 24.7 ± 1.3) underwent this study. The non-invasive cardiac output NICOM monitoring equipment and the FIRSTBEAT system are used to dynamically monitor seven trunk postures in the sitting position simultaneously (neutral position, posterior extension, forward flexion, left lateral flexion, right lateral flexion, left rotation, right rotation). Each posture was maintained for 3 min, and the interval between each movement was 3 min to ensure that each index returned to the baseline level. Repeated analysis of variance test was used to compare and analyze the differences in human cardiac function, heart rate variability index, and respiratory rate under different postures. Results: Compared with the related indicators of cardiac output in a neutral trunk position: the cardiac index (CI) was significantly reduced in forwarding flexion and left rotation (3.48 ± 0.34 vs. 3.21 ± 0.50; 3.48 ± 0.34 vs. 3.21 ± 0.46, Δ L/(min/m2)) (p = 0.016, p = 0.013), cardiac output decreased significantly (6.49 ± 0.78 vs. 5.93 ± 0.90; 6.49 ± 0.78 vs. 6.00 ± 0.96, Δ L/min) (p = 0.006, p = 0.014), the stroke volume (stroke volume)decreased significantly (87.90 ± 15.10 vs. 81.04 ± 16.35; 87.90 ± 15.10 vs. 79.24 ± 16.83, Δ ml/beat) (p = 0.017, p = 0.0003); heart rate increased significantly in posterior extension (75.08 ± 10.43 vs. 78.42 ± 10.18, Δ beat/min) (p = 0.001); left rotation stroke volume index (SVI) decreased significantly (47.28 ± 7.97 vs. 46.14 ± 8.06, Δ ml/m2) (p = 0.0003); in the analysis of HRV-related indicators, compared with the neutral trunk position, the LF/HF of the posterior extension was significantly increased (1.90 ± 1.38 vs. 3.00 ± 1.17, p = 0.037), and the LF/HF of the forward flexion was significantly increased (1.90 ± 1.38 vs. 2.85 ± 1.41, p = 0.041), and the frequency-domain index LF/HF of right rotation was significantly increased (1.90 ± 1.38 vs. 4.06 ± 2.19, p = 0.008). There was no significant difference in respiratory rate (p > 0.05). Conclusion: A neutral trunk is the best resting position, and deviations from a neutral trunk position can affect the cardiovascular and autonomic nervous systems, resulting in decreased stroke volume, increased heart rate, and relative activation of sympathetic tone.
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Affiliation(s)
- Hao Wang
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Xiaolin Gao
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Yongjin Shi
- Department of Sports and Arts, China Agricultural University, Beijing, China
| | - Dongzhe Wu
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Chuangtao Li
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Wendi Wang
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
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29
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Neuromodulation Applied to Diseases: The Case of HRV Biofeedback. J Clin Med 2022; 11:jcm11195927. [PMID: 36233794 PMCID: PMC9571900 DOI: 10.3390/jcm11195927] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/02/2022] Open
Abstract
The vagus or “wandering” nerve is the main branch of the parasympathetic nervous system (PNS), innervating most internal organs crucial for health. Activity of the vagus nerve can be non-invasively indexed by heart-rate variability parameters (HRV). Specific HRV parameters predict less all-cause mortality, lower risk of and better prognosis after myocardial infarctions, and better survival in cancer. A non-invasive manner for self-activating the vagus is achieved by performing a slow-paced breathing technique while receiving visual feedback of one’s HRV, called HRV-biofeedback (HRV-B). This article narratively reviews the biological mechanisms underlying the role of vagal activity and vagally mediated HRV in hypertension, diabetes, coronary heart disease (CHD), cancer, pain, and dementia. After searching the literature for HRV-B intervention studies in each condition, we report the effects of HRV-B on clinical outcomes in these health conditions, while evaluating the methodological quality of these studies. Generally, the levels of evidence for the benefits of HRV-B is high in CHD, pain, and hypertension, moderate in cancer, and poor in diabetes and dementia. Limitations and future research directions are discussed.
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Brinza C, Floria M, Covic A, Covic A, Scripcariu DV, Burlacu A. The Usefulness of Assessing Heart Rate Variability in Patients with Acute Myocardial Infarction (HeaRt-V-AMI). SENSORS (BASEL, SWITZERLAND) 2022; 22:3571. [PMID: 35591260 PMCID: PMC9103554 DOI: 10.3390/s22093571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heart rate variability (HRV) could have independent and critical prognostic values in patients admitted for ST segment elevation myocardial infarction (STEMI). There are limited data in the literature regarding HRV assessment in STEMI setting. Thus, we aim to investigate the potential correlations between HRV and adverse outcomes in a contemporary cohort of patients presenting with STEMI undergoing primary percutaneous coronary intervention (PCI). METHODS We will perform a prospective, observational cohort study in a single healthcare center. Adult patients aged ≥18 years presenting with STEMI in sinus rhythm will be enrolled for primary PCI within 12 h from symptoms onset. Time domain, frequency domain, and nonlinear HRV parameters will be measured using a medically approved wrist-wearable device for 5 min segments during myocardial revascularization by primary PCI. Additional HRV measurements will be performed one and six months from the index event. The primary composite outcome will include all-cause mortality and major adverse cardiovascular events (during the hospital stay, one month, and one year following admission). Several secondary outcomes will be analyzed: individual components of the primary composite outcome, target lesion revascularization, hospitalizations for heart failure, ventricular arrhythmias, left ventricular ejection fraction, and left ventricular diastolic function. CONCLUSIONS Our study will enlighten the reliability and usefulness of HRV evaluation as a prognostic marker in contemporary patients with STEMI. The potential validation of HRV as a risk marker for adverse outcomes following STEMI will ensure a background for including HRV parameters in future risk scores and guidelines.
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Affiliation(s)
- Crischentian Brinza
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (M.F.); (A.C.); (A.C.); (A.B.)
- Department of Interventional Cardiology, Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania
| | - Mariana Floria
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (M.F.); (A.C.); (A.C.); (A.B.)
- Internal Medicine Clinic, “Dr. Iacob Czihac” Military Emergency Clinical Hospital, 700483 Iasi, Romania
| | - Adrian Covic
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (M.F.); (A.C.); (A.C.); (A.B.)
- Dialysis and Renal Transplant Center, Nephrology Clinic, “C.I. Parhon” University Hospital, 700503 Iasi, Romania
| | - Andreea Covic
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (M.F.); (A.C.); (A.C.); (A.B.)
- Dialysis and Renal Transplant Center, Nephrology Clinic, “C.I. Parhon” University Hospital, 700503 Iasi, Romania
| | - Dragos-Viorel Scripcariu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (M.F.); (A.C.); (A.C.); (A.B.)
| | - Alexandru Burlacu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (M.F.); (A.C.); (A.C.); (A.B.)
- Department of Interventional Cardiology, Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania
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Guerdoux E, Coutant L, Del Rio M, Gourgou S, Quenet F, Ninot G. Adhésion et implémentation d’un programme de cohérence cardiaque visant à réduire l’anxiété de patients opérés pour une carcinose péritonéale : étude pilote randomisée. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : Évaluer l’implémentation d’une pratique quotidienne de cohérence cardiaque chez des patients opérés pour une carcinose péritonéale.
Matériel et méthode : Étude pilote monocentrique, ouverte, contrôlée, randomisée non comparative, incluant 20 patients en soins courants vs 40 patients formés à la cohérence cardiaque avec biofeedback et guide respiratoire pour une pratique au domicile enregistrée.
Résultats attendus : Adhésion satisfaisante au programme, pouvant caractériser les éléments favorisant son implémentation avant et après chirurgie et évaluation de son impact sur l’anxiété.
Perspectives : Efficacité à déterminer pour transférer ce soin de support.
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Rogers B, Schaffarczyk M, Clauß M, Mourot L, Gronwald T. The Movesense Medical Sensor Chest Belt Device as Single Channel ECG for RR Interval Detection and HRV Analysis during Resting State and Incremental Exercise: A Cross-Sectional Validation Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22052032. [PMID: 35271179 PMCID: PMC8914935 DOI: 10.3390/s22052032] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 05/05/2023]
Abstract
The value of heart rate variability (HRV) in the fields of health, disease, and exercise science has been established through numerous investigations. The typical mobile-based HRV device simply records interbeat intervals, without differentiation between noise or arrythmia as can be done with an electrocardiogram (ECG). The intent of this report is to validate a new single channel ECG device, the Movesense Medical sensor, against a conventional 12 channel ECG. A heterogeneous group of 21 participants performed an incremental cycling ramp to failure with measurements of HRV, before (PRE), during (EX), and after (POST). Results showed excellent correlations between devices for linear indexes with Pearson's r between 0.98 to 1.0 for meanRR, SDNN, RMSSD, and 0.95 to 0.97 for the non-linear index DFA a1 during PRE, EX, and POST. There was no significant difference in device specific meanRR during PRE and POST. Bland-Altman analysis showed high agreement between devices (PRE and POST: meanRR bias of 0.0 and 0.4 ms, LOA of 1.9 to -1.8 ms and 2.3 to -1.5; EX: meanRR bias of 11.2 to 6.0 ms; LOA of 29.8 to -7.4 ms during low intensity exercise and 8.5 to 3.5 ms during high intensity exercise). The Movesense Medical device can be used in lieu of a reference ECG for the calculation of HRV with the potential to differentiate noise from atrial fibrillation and represents a significant advance in both a HR and HRV recording device in a chest belt form factor for lab-based or remote field-application.
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Affiliation(s)
- Bruce Rogers
- Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Correspondence:
| | - Marcelle Schaffarczyk
- Department Sports and Exercise Medicine, Institute of Human Movement Science, University of Hamburg, 20148 Hamburg, Germany;
| | - Martina Clauß
- Institute of Movement and Trainings Science in Sport, Faculty of Sport Science, Leipzig University, 04109 Leipzig, Germany;
| | - Laurent Mourot
- EA3920 Pronostic Factors and Regulatory Factors of Cardiac and Vascular Pathologies, Exercise Performance Health Innovation (EPHI) Plaptform, University of Bourgogne Franche-Comté, 25000 Besançon, France;
- Division for Physical Education, National Research Tomsk Polytechnic University, 634040 Tomsk, Russia
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany;
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Influencing Cardiovascular Outcomes through Heart Rate Variability Modulation: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11122198. [PMID: 34943435 PMCID: PMC8700170 DOI: 10.3390/diagnostics11122198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
Psychological stress is a well-established risk factor for cardiovascular disease (CVD). Heart rate variability (HRV)-biofeedback could significantly reduce stress levels and improve autonomic nervous system function and cardiovascular endpoints. We aimed to systematically review the literature to investigate the impact of HRV modulation through HRV-biofeedback on clinical outcomes in patients with CVD. A literature search was performed in the following databases: MEDLINE (PubMed), Embase, and Cochrane from the inception until 1 October 2021. Patients in the HRV-biofeedback group had significantly lower rates of all-cause readmissions than patients who received psychological education (respectively, p = 0.028 and p = 0.001). Heart failure following HRV-biofeedback displayed an inverse association with stress and depression (respectively, p = 0.022 and p = 0.033). When stratified according to left ventricular ejection fraction (LVEF), patients with LVEF ≥ 31% showed improved values of the 6 min walk test after HRV-biofeedback interventions (p = 0.05). A reduction in systolic and diastolic blood pressure associated with HRV-biofeedback was observed (p < 0.01) in pre-hypertensive patients. HRV-biofeedback had beneficial effects on different cardiovascular diseases documented in clinical trials, such as arterial hypertension, heart failure, and coronary artery disease. A standard breathing protocol should be applied in future studies to obtain equivalent results and outcomes. However, data regarding mortality in patients with coronary artery disease are scarce and need further research.
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Fournié C, Verkindt C, Dalleau G, Bouscaren N, Mohr C, Zunic P, Cabrera Q. Rehabilitation program combining physical exercise and heart rate variability biofeedback in hematologic patients: a feasibility study. Support Care Cancer 2021; 30:2009-2016. [PMID: 34636946 PMCID: PMC8794932 DOI: 10.1007/s00520-021-06601-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
Purpose Hematologic patients have a poorer health-related quality of life due to the disease and its treatments. Non-pharmacological interventions represent an opportunity in tertiary cancer prevention to manage persistent symptoms and support patients in their return to active daily living. This interventional study aimed to evaluate the feasibility of a program combining physical exercise (PE) and heart rate variability biofeedback (HRVB) in hematologic patients. Method Hematologic patients in remission within 6 months participated in a 12-week rehabilitation program including 24 supervised sessions of PE associated with 10 supervised sessions of HRVB and daily home-based practice of paced breathing. We assessed patient adherence, fatigue, physical function, and heart rate variability. Results Twenty patients were included, 17 completed the protocol and 3 dropped out due to disease progression or time constraints; no adverse events or incidents were reported. Participation rates were 85% for PE and 98% for HRVB-supervised sessions. Significant improvements of physical capacity (6-min walk test, p < 0.001; 50-foot walk test, p < 0.001), muscle strength (grip force test, p < 0.01), and flexibility (toe-touch test, p < 0.001; back scratch test, p < 0.05) were measured. Coherence ratio (p < 0.001) and low-frequency spectral density of HRV signal (p < 0.003) increased significantly, suggesting improved autonomic function. Fatigue, static balance, and other time and frequency indicators of HRV were not improved (all p > 0.05). Conclusion A rehabilitation program combining PE and HRVB is feasible in hematologic patients and effective on physical function. Further research with a larger sample size is needed to investigate effectiveness on patients’ autonomic functions and their impacts on symptomatology.
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Affiliation(s)
- Claire Fournié
- Laboratoire IRISSE EA4075, UFR Des Sciences de L'Homme Et de L'Environnement, Université de La Réunion, Le Tampon, La Réunion, France.
| | - Chantal Verkindt
- Laboratoire IRISSE EA4075, UFR Des Sciences de L'Homme Et de L'Environnement, Université de La Réunion, Le Tampon, La Réunion, France
| | - Georges Dalleau
- Laboratoire IRISSE EA4075, UFR Des Sciences de L'Homme Et de L'Environnement, Université de La Réunion, Le Tampon, La Réunion, France
| | - Nicolas Bouscaren
- Centre d'Investigation Clinique, CHU Sud Réunion, Inserm CIC 1410, Saint-Pierre, La Réunion, France
| | - Catherine Mohr
- Service d'Hématologie Clinique, CHU Sud Réunion, Saint Pierre, La Réunion, France
| | - Patricia Zunic
- Service d'Hématologie Clinique, CHU Sud Réunion, Saint Pierre, La Réunion, France
| | - Quentin Cabrera
- Service d'Hématologie Clinique, CHU Sud Réunion, Saint Pierre, La Réunion, France
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