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Yu Y, Chen T, Zheng Z, Jia F, Liao Y, Ren Y, Liu X, Liu Y. The role of the autonomic nervous system in polycystic ovary syndrome. Front Endocrinol (Lausanne) 2024; 14:1295061. [PMID: 38313837 PMCID: PMC10834786 DOI: 10.3389/fendo.2023.1295061] [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] [Received: 09/15/2023] [Accepted: 12/27/2023] [Indexed: 02/06/2024] Open
Abstract
This article reviewed the relationship between the autonomic nervous system and the development of polycystic ovary syndrome (PCOS). PCOS is the most common reproductive endocrine disorder among women of reproductive age. Its primary characteristics include persistent anovulation, hyperandrogenism, and polycystic ovarian morphology, often accompanied by disturbances in glucose and lipid metabolism. The body's functions are regulated by the autonomic nervous system, which consists mainly of the sympathetic and parasympathetic nervous systems. The autonomic nervous system helps maintain homeostasis in the body. Research indicates that ovarian function in mammals is under autonomic neural control. The ovaries receive central nervous system information through the ovarian plexus nerves and the superior ovarian nerves. Neurotransmitters mediate neural function, with acetylcholine and norepinephrine being the predominant autonomic neurotransmitters. They influence the secretion of ovarian steroids and follicular development. In animal experiments, estrogen, androgens, and stress-induced rat models have been used to explore the relationship between PCOS and the autonomic nervous system. Results have shown that the activation of the autonomic nervous system contributes to the development of PCOS in rat. In clinical practice, assessments of autonomic nervous system function in PCOS patients have been gradually employed. These assessments include heart rate variability testing, measurement of muscle sympathetic nerve activity, skin sympathetic response testing, and post-exercise heart rate recovery evaluation. PCOS patients exhibit autonomic nervous system dysfunction, characterized by increased sympathetic nervous system activity and decreased vagal nerve activity. Abnormal metabolic indicators in PCOS women can also impact autonomic nervous system activity. Clinical studies have shown that various effective methods for managing PCOS regulate patients' autonomic nervous system activity during the treatment process. This suggests that improving autonomic nervous system activity may be an effective approach in treating PCOS.
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Affiliation(s)
- Yue Yu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tong Chen
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zheng Zheng
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fan Jia
- Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Yan Liao
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuehan Ren
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinmin Liu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ying Liu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Zhu Z, Xie H, Liu S, Yang R, Yu J, Yan Y, Wang X, Zhang Z, Yan W. Effects of physical exercise on blood pressure during pregnancy. BMC Public Health 2022; 22:1733. [PMID: 36096756 PMCID: PMC9469521 DOI: 10.1186/s12889-022-14074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/22/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Effect of physical exercise on pregnant women currently has become a hot topic in prenatal health care. In this study, A meta-analysis was conducted on account of Randomized Controlled Trial (RCT). It focused on evaluating the effect of physical exercise intervention on blood pressure so that could provide certain evidence for health care during pregnancy. Methods Results of relevant studies were retrieved from PubMed, Embase, Web of Science and the Cochrane Library, and all of these included studies were evaluated according to the Cochrane collaboration’s tool for assessing the risk of bias. Stata 15.1 was used for meta-analysis, and mean difference (MD) was used as statistic for pooled analysis. The effect values were combined by conventional meta-analysis and Bayesian meta-analysis respectively, and the consistency of pooled results was considered as well. Results A total of 18 RCT studies were included in the quantitative analysis. The conventional meta-analysis showed differences in blood pressure between intervention group and control group (P < 0.05). Systolic and diastolic blood pressures of intervention group were 3.19 mmHg (95% CI: -5.13, -1.25) and 2.14 mmHg (95% CI: -4.26, -0.03) lower than that of control group, respectively. Bayesian meta-analysis showed that both systolic and diastolic pressure among intervention group decreased by 3.34 mmHg (95% CrI: -5.15, -1.56) and 2.14 mmHg (95% CrI: -3.79, − 0.50), respectively. Subgroup analysis supported that as long as healthy pregnant women participated in exercises, their blood pressure could be slightly regulated, while hypertension susceptible pregnant women significantly lowered blood pressure. Conclusion Exercise intervention during pregnancy is beneficial to lower or normalize blood pressure, and this research provides clues for follow-up studies.
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Affiliation(s)
- Zhu Zhu
- Jiangsu Vocational Institute of Commerce, Nanjing, 211168, China
| | - Hang Xie
- Office of Clinical Research Center, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Shiping Liu
- Department of Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Ruizhe Yang
- Department of Public Health, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Juan Yu
- Department of Medicine, Gansu University of Chinese Medicine, Dingxi, 743000, China
| | - Yiping Yan
- College of Mathematics and Statistics, Northwest Normal University, Lanzhou, 730070, China
| | - Xu Wang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Zhihua Zhang
- Yunyang People's Hospital of Danyang, Danyang, 212300, China.
| | - Wu Yan
- Department of Children Health Care, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
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Santos WLMD, Eustáquio JMJ, Ferreira ICR, Perez JO, Policarpo RP, Chriguer RS, Barbosa Neto O. DOES GREEN TEA ENHANCE THE EFFECTS OF PHYSICAL TRAINING ON HEART RATE VARIABILITY? REV BRAS MED ESPORTE 2022. [DOI: 10.1590/1517-8692202228042021_0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: Green tea is associated with a series of health benefits, as is physical training. However, in combination they present little known chronotropic and autonomic cardiac effects. Objective: To evaluate the effect of the association of chronic administration of green tea and physical training on basal heart rate (HR) and heart rate variability (HRV) in Wistar rats. Methods: Forty-three Wistar rats (Rattus norvegicus, var. albinus), paired by weight and age, were distributed among four experimental groups, titled sedentary control (CONsed, n = 10), trained control (CONtre, n = 08), sedentary tea (CHÁsed, n = 16) and trained tea (CHÁtre, n = 09). Ingestion of the tea was ad libitum. The physical training protocol lasted for eight weeks and consisted of sessions of swimming with incremental loads. At the end of the training, basal heart rate and heart rate variability (HRV) in both time and frequency domains were determined. The level of significance adopted was 5% (p < 0.05). Results: Both physical training and consumption of green tea caused higher resting bradycardia than that of the CONsed group animals. Regarding HRV, the CONtre, CHÁsed, and CHÁtre groups presented significantly higher values than the CONsed group. Supplementation with green tea caused an increase in the variance, high frequency (HF) component, and sympathovagal balance as compared to the CONsed group. Physical training (PT) did not enhance any of the parameters evaluated. Conclusions: There was no significant optimization of the hemodynamic or autonomic cardiovascular parameters resulting from the association between the administration of green tea and physical training in Wistar rats. Level of Evidence IV; Case Series.
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Philbois SV, Ribeiro VB, Tank J, dos Reis RM, Gerlach DA, Souza HCD. Cardiovascular autonomic modulation differences between moderate-intensity continuous and high-intensity interval aerobic training in women with PCOS: A randomized trial. Front Endocrinol (Lausanne) 2022; 13:1024844. [PMID: 36568110 PMCID: PMC9782449 DOI: 10.3389/fendo.2022.1024844] [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] [Received: 08/22/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Moderate-intensity continuous training (MICT) is strongly recommended for polycystic ovarian syndrome (PCOS) treatment. However, recent studies have suggested that high-intensity interval training (HIIT) would promote great benefits for cardiac autonomic control. Therefore, we investigated whether the benefits of HIIT related to cardiovascular autonomic control were greater than those of MICT in women with PCOS. METHODS Women with PCOS were randomly allocated through a blind draw into three groups: control, MICT, and HIIT. The control group did not undergo exercise, whereas those in the MICT and HIIT groups underwent 16 weeks of aerobic physical training. All groups were evaluated before and after the 16 weeks of intervention in the following aspects: quantification of serum lipids, testosterone, fasting insulin and blood glucose; physical fitness through cardiopulmonary testing; analysis of heart rate variability (HRV) by linear (time domain and frequency domain) and non-linear (symbolic analysis) methods, analysis of blood pressure variability (BPV) and spontaneous baroreflex sensitivity (BRS). RESULTS The final analysis, each group comprised 25 individuals. All groups had similar baseline parameters. After 16 weeks, intragroup comparison showed that the MICT and HIIT groups had a reduction in baseline heart rate (P < 0.001; P < 0.001, respectively) and testosterone levels P < 0.037; P < 0.012, respectively) associated with an increase in VO2peak (MICT, P < 0.001; HIIT, P < 0.001). The MICT (P < 0.36) and HIIT (P < 0.17) groups also showed an increase in cardiac vagal modulation, however only observed in the non-linear analysis. The intergroup comparison showed no differences between the MICT and HIIT groups in any of the hormonal, metabolic and autonomic parameters evaluated, including testosterone, peak oxygen uptake (VO2peak), HRV, BPV and BRS. CONCLUSION HIIT and MICT showed similar results for the different parameters evaluated. This suggests that both training protocols can be recommended for the treatment of PCOS. Brazilian Clinical Trials Registry (RBR-78qtwy).
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Affiliation(s)
- Stella V. Philbois
- Laboratory of Physiology and Cardiovascular Physiotherapy, Department of Science of Health, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Victor B. Ribeiro
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jens Tank
- Department of Cardiovascular Aerospace Medicine, Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Rosana Maria dos Reis
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Darius A. Gerlach
- Department of Cardiovascular Aerospace Medicine, Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Hugo C. D. Souza
- Laboratory of Physiology and Cardiovascular Physiotherapy, Department of Science of Health, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Cardiovascular Aerospace Medicine, Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
- *Correspondence: Hugo C. D. Souza,
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Pinto DMR, do Sacramento MDS, Santos PHS, Silva WS, de Oliveira EC, Gardenghi G, Ladeia AMT, Petto J. Physical exercise in sickle cell anemia: a systematic review. Hematol Transfus Cell Ther 2020; 43:324-331. [PMID: 33032952 PMCID: PMC8446247 DOI: 10.1016/j.htct.2020.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Sickle cell anemia (SCA) is a genetic condition that alters the conformation of deoxygenated red blood cells, which results in their stiffening and the occurrence of vaso-occlusive crises, endothelium damage, organ dysfunction and systemic complications. Additionally, SCA limits the participation of individuals in physical and social activities. As we consider that physical exercise promotes the recovery of functional capacity and cardiorespiratory conditioning, we aim to verify the patterns of prescription, the effects and safety of exercise for individuals with SCA. METHODOLOGY We systematically reviewed the published literature focusing on clinical trials that correlated physical exercise with SCA patients and cross-sectional studies that applied the stress test. The data research was based on the PRISMA recommendations and the following databases were used: Medline by PubMed, Cochrane, PEDro, Scielo. RESULTS Six studies which were based on the evaluation of 212 patients aged between 13 and 40 years, were selected from 122 identified studies. Those studies associated the individual effort tolerance improvement, its inflammatory profile adjustment and the absence of alteration in the autonomic nervous system activity to physical exercise or stress test. CONCLUSION Low-to-moderate intensity physical exercise increased the SCA individual tolerance without causing vaso-occlusive crises, nor changes in the hemorheological and inflammatory profiles.
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Affiliation(s)
| | - Marvyn de Santana do Sacramento
- Actus Cordios Reabilitação Cardiovascular, Respiratória e Metabólica, Salvador, BA, Brazil; Centro Universitário Social da Bahia (UNISBA), Salvador, BA, Brazil.
| | - Pedro Henrique Silva Santos
- Fundação Estatal de Saúde da Família (FESF-SUS), Salvador, BA, Brazil; Fundação Oswaldo Cruz (Fiocruz Bahia - IGM), Salvador, BA, Brazil
| | | | | | - Giulliano Gardenghi
- Hospital Encore, Aparecida de Goiânia, Goiás, GO, Brazil; Faculdade Ceafi, Goiânia, GO, Brazil; Lifecare, Hugol, Unidade de Terapia Intensiva em Queimados, Goiânia, Go, Brazil; Hospital e Maternidade São Cristóvão, São Paulo, SP, Brazil
| | | | - Jefferson Petto
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil; Actus Cordios Reabilitação Cardiovascular, Respiratória e Metabólica, Salvador, BA, Brazil; Centro Universitário Social da Bahia (UNISBA), Salvador, BA, Brazil
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Christoffersen L, Gibson TM, Pui CH, Joshi V, Partin RE, Green DM, Lanctot JQ, Howell CR, Mulrooney DA, Armstrong GT, Robison LL, Hudson MM, Ness KK. Cardiac autonomic dysfunction in survivors of childhood acute lymphoblastic leukemia: The St. Jude Lifetime Cohort Study. Pediatr Blood Cancer 2020; 67:e28388. [PMID: 32383821 PMCID: PMC7302420 DOI: 10.1002/pbc.28388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/15/2020] [Accepted: 04/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiac autonomic dysfunction (CAD) is possible following treatment for childhood cancer. The aims of our analyses were to compare the prevalence of CAD between adult survivors of childhood acute lymphoblastic leukemia and controls, compare exercise response among survivors with and without CAD, and identify treatment-related risk factors for CAD. PROCEDURE Participants were treated for childhood acute lymphoblastic leukemia at St. Jude Children's Research Hospital between 1980 and 2003 (N = 338). A comparison group matched for race/ethnicity, age, and sex was also recruited (N = 325). Resting heart rate (HR) was assessed via electrocardiogram, and heart rate recovery (HRR) and exercise capacity were evaluated with submaximal cardiopulmonary exercise testing. RESULTS CAD was present in 33.7% of survivors and 27.6% of controls (P = 0.09). Although mean resting HR did not differ between survivors and controls (74 ± 12 vs 72 ± 12 beats per minute (bpm), P = 0.07), survivors had lower mean HRR than controls (22 ± 9 vs 25 ± 10 bpm; P < 0.001). Survivors with CAD had lower peak exercise tolerance (25.7 ± 6.5 vs 21.2 ± 4.9 mL/kg/min, P < 0.001) than those without. Survivors treated with cyclophosphamide in combination with vincristine ≥38 mg/m2 and/or glucocorticoids ≥10 000 mg/m2 were 1.56 (95% CI 1.09-2.24) times more likely to have CAD than those without this treatment. Obese survivors were 1.78 (95% CI: 1.31-2.40) times more likely to have CAD than nonobese survivors (P < 0.001). CONCLUSION CAD was present in over one third of survivors and was associated with lower exercise capacity. Obese survivors and those exposed to cyclophosphamide with high doses of vincristine and/or corticosteroids were at greatest risk.
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Affiliation(s)
- Lindsey Christoffersen
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Department of Rehabilitation Services, St. Jude Children’s Research Hospital, Memphis, TN
| | - Todd M. Gibson
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Ching-Hon Pui
- Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Vijaya Joshi
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Robyn E. Partin
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel M. Green
- Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer Q. Lanctot
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carrie R. Howell
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel A. Mulrooney
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Gregory T. Armstrong
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Leslie L. Robison
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M. Hudson
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN,College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Kirsten K. Ness
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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Mravec B, Tibensky M. Increased cancer risk in polycystic ovary syndrome: An (un)sympathetic connection? Med Hypotheses 2019; 134:109437. [PMID: 31655360 DOI: 10.1016/j.mehy.2019.109437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
Women with polycystic ovary syndrome (PCOS) have been shown to have a higher incidence of cancer. It is suggested that several factors, including hyperinsulinemia, dyslipidemia, raised estrogen levels, chronic inflammation, and reduced apoptosis are responsible for this association. However, in this paper we propose the hypothesis that increased sympathetic activity may represent an important factor that interconnects PCOS and cancer. This hypothesis is based on two facts: a) in women with PCOS is found sympathetic hyperactivity and b) recent data showing a stimulatory effect of the sympathetic system on cancer initiation, progression, and development of metastases. If our hypothesis is correct, then new preventive approaches might be used to reduce cancer risk in women with PCOS.
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Affiliation(s)
- Boris Mravec
- Institute of Physiology, Faculty of Medicine, Comenius University in Bratislava, Slovakia; Biomedical Research Center, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia.
| | - Miroslav Tibensky
- Institute of Physiology, Faculty of Medicine, Comenius University in Bratislava, Slovakia; Biomedical Research Center, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia
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Thomas BL, Claassen N, Becker P, Viljoen M. Validity of Commonly Used Heart Rate Variability Markers of Autonomic Nervous System Function. Neuropsychobiology 2019; 78:14-26. [PMID: 30721903 DOI: 10.1159/000495519] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 11/13/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite strong reservations regarding the validity of a number of heart rate variability (HRV) measures, these are still being used in recent studies. AIMS We aimed to compare the reactivity of ostensible sympathetic HRV markers (low and very low frequency [LF and VLF]) to that of electrodermal activity (EDA), an exclusively sympathetic marker, in response to cognitive and orthostatic stress, investigate the possibility of LF as a vagal-mediated marker of baroreflex modulation, and compare the ability of HRV markers of parasympathetic function (root mean square of successive differences [RMSSD] and high frequency [HF]) to quantify vagal reactivity to cognitive and orthostatic stress. RESULTS None of the purported sympathetic HRV markers displayed a reactivity that correlated with electrodermal reactivity. LF (ms2) reactivity correlated with the reactivity of both RMSSD and HF during baroreflex modulation. RMSSD and HF indexed the reactivity of the parasympathetic nervous system under conditions of normal breathing; however, RMSSD performed better as a marker of vagal activity when the task required breathing changes. CONCLUSIONS Neither LF (in ms2 or normalized units [nu]) nor VLF represent cardiac sympathetic modulation of the heart. LF (ms2) may reflect vagally mediated baroreflex cardiac effects. HRV linear analysis therefore appears to be restricted to the determination of vagal influences on heart rate. With regard to HRV parasympathetic markers, this study supports the suggestion that HRV frequency domain analyses, such as HF, should not be used as an index of vagal activity in study tasks where verbal responses are required, as these responses may induce respiratory changes great enough to distort HF power.
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Affiliation(s)
- Bianca Lee Thomas
- Department of Human Anatomy and Physiology, University of Johannesburg, Johannesburg, South Africa, .,Department of Psychiatry, University of Pretoria, Pretoria, South Africa,
| | - Nicolaas Claassen
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Piet Becker
- Research Office, University of Pretoria, Pretoria, South Africa
| | - Margaretha Viljoen
- Department of Psychiatry, University of Pretoria, Pretoria, South Africa
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Mishra A, Sharma R, Mittal P, Kapoor R, Srivastav S. Evaluating exercise challenge to validate cardiac autonomic dysfunction in lean PCOS phenotype. J Basic Clin Physiol Pharmacol 2019; 30:jbcpp-2018-0198. [PMID: 31095510 DOI: 10.1515/jbcpp-2018-0198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/22/2019] [Indexed: 11/15/2022]
Abstract
Background Polycystic ovary syndrome (PCOS) is frequently associated with infertility, obesity, hypertension, and diabetes mellitus. Cardiac autonomic dysfunction is well documented in long-term patients of PCOS, with impairment being proportionate to disease duration. However, there is paucity of literature on cardiac autonomic tone in the "lean" phenotype of PCOS. We used exercise challenge to probe for autonomic dysfunction, as assessed by heart rate variability (HRV), an index of cardiac autonomic tone. Methods Our study population consisted of 27 newly diagnosed PCOS patients and 25 healthy females matched by age and body mass index. Short-term HRV was assessed using time and frequency domain indices. Moderate, isotonic exercise was used as an interventional tool. Indices of both groups were compared in three bins - at baseline, immediate, and late postexercise stages. Results The groups had comparable HRV indices at baseline. However, low-frequency (LF) power was significantly reduced in PCOS patients during immediate and late postexercise phases when compared with controls (p = 0.03 and 0.03, respectively). Time domain indices also exhibited a fall postexercise, although not statistically significant. Conclusions Although "lean" phenotype PCOS patients had comparable HRV parameters as controls at baseline, the administration of exercise challenge led to reduced sympathetic drive, evident by reduced LF power in patient group. This may be due to latent autonomic dysfunction in "lean" PCOS, which is unmasked on exposure to exercise challenge. We propose that the evaluation of HRV response to exercise may serve as a sensitive screening tool to detect early cardiovascular dysfunction in newly diagnosed lean PCOS patients.
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Affiliation(s)
- Abha Mishra
- Department of Physiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Renuka Sharma
- Department of Physiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. Phone: +91-11-26703353
| | - Pratima Mittal
- Department of Obstetrics and Gynaecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Raj Kapoor
- Department of Physiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shival Srivastav
- Department of Physiology, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
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Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2019; 3:CD007506. [PMID: 30921477 PMCID: PMC6438659 DOI: 10.1002/14651858.cd007506.pub4] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) affects 8% to 13% of reproductive-aged women and is associated with reproductive and metabolic dysfunction. Obesity worsens the presentation of PCOS and weight management (weight loss, maintenance or prevention of excess weight gain) is proposed as an initial treatment strategy, best achieved through lifestyle changes incorporating diet, exercise and behavioural interventions. OBJECTIVES To assess the effectiveness of lifestyle treatment in improving reproductive, anthropometric (weight and body composition), metabolic and quality of life factors in PCOS. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL and AMED (date of last search March 2018). We also searched controlled trials registries, conference abstracts, relevant journals, reference lists of relevant papers and reviews, and grey literature databases, with no language restrictions applied. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing lifestyle treatment (diet, exercise, behavioural or combined treatments) to minimal or no treatment in women with PCOS. DATA COLLECTION AND ANALYSIS Two authors independently selected trials, assessed evidence quality and risk of bias, and extracted data. Our primary outcomes were live birth, miscarriage and pregnancy. We used inverse variance and fixed-effect models in the meta-analyses. We reported dichotomous outcomes as an odds ratio and continuous outcomes as a mean difference (MD) or standardised mean difference (SMD). MAIN RESULTS We included 15 studies with 498 participants. Ten studies compared physical activity to minimal dietary and behavioural intervention or no intervention. Five studies compared combined dietary, exercise and behavioural intervention to minimal intervention. One study compared behavioural intervention to minimal intervention. Risk of bias varied: eight studies had adequate sequence generation, seven had adequate clinician or outcome assessor blinding, seven had adequate allocation concealment, six had complete outcome data and six were free of selective reporting. No studies assessed the fertility primary outcomes of live birth or miscarriage. No studies reported the secondary reproductive outcome of menstrual regularity, as defined in this review.Lifestyle intervention may improve a secondary (endocrine) reproductive outcome, the free androgen index (FAI) (MD -1.11, 95% confidence interval (CI) -1.96 to -0.26, 6 RCTs, N = 204, I2 = 71%, low-quality evidence). Lifestyle intervention may reduce weight (kg) (MD -1.68 kg, 95% CI -2.66 to -0.70, 9 RCTs, N = 353, I2 = 47%, low-quality evidence). Lifestyle intervention may reduce body mass index (BMI) (kg/m2) (-0.34 kg/m2, 95% CI -0.68 to -0.01, 12 RCTs, N = 434, I2= 0%, low-quality evidence). We are uncertain of the effect of lifestyle intervention on glucose tolerance (glucose outcomes in oral glucose tolerance test) (mmol/L/minute) (SMD -0.02, 95% CI -0.38 to 0.33, 3 RCTs, N = 121, I2 = 0%, low-quality evidence). AUTHORS' CONCLUSIONS Lifestyle intervention may improve the free androgen index (FAI), weight and BMI in women with PCOS. We are uncertain of the effect of lifestyle intervention on glucose tolerance. There were no studies that looked at the effect of lifestyle intervention on live birth, miscarriage or menstrual regularity. Most studies in this review were of low quality mainly due to high or unclear risk of bias across most domains and high heterogeneity for the FAI outcome.
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Affiliation(s)
- Siew S Lim
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
| | - Samantha K Hutchison
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
- Monash HealthDiabetes Unit and Endocrinology Unit246 Clayton RoadClaytonVictoriaAustralia3168
| | - Emer Van Ryswyk
- College of Medicine and Public Health, Flinders UniversityAdelaide Institute for Sleep Health: A Flinders Centre for Research ExcellenceSturt RoadAdelaideSouth AustraliaAustralia5042
| | - Robert J Norman
- University of AdelaideObstetrics & Gynaecology, Robinson InstituteAdelaideSouth AustraliaAustralia5005
- Fertility SAAdelaideAustralia
| | - Helena J Teede
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
| | - Lisa J Moran
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
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11
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Costa EC, DE Sá JCF, Stepto NK, Costa IBB, Farias-Junior LF, Moreira SDANT, Soares EMM, Lemos TMAM, Browne RAV, Azevedo GD. Aerobic Training Improves Quality of Life in Women with Polycystic Ovary Syndrome. Med Sci Sports Exerc 2019; 50:1357-1366. [PMID: 29443823 DOI: 10.1249/mss.0000000000001579] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the effects of a supervised aerobic exercise training intervention on health-related quality of life (HRQL), cardiorespiratory fitness, cardiometabolic profile, and affective response in overweight/obese women with polycystic ovary syndrome (PCOS). METHODS Twenty-seven overweight/obese inactive women with PCOS (body mass index, ≥ 25 kg·m; age 18 to 34 yr) were allocated into an exercise group (n = 14) and a control group (n = 13). Progressive aerobic exercise training was performed three times per week (~150 min·wk) over 16 wk. Cardiorespiratory fitness, HRQL, and cardiometabolic profile were evaluated before and after the intervention. Affective response (i.e., feeling of pleasure/displeasure) was evaluated during the exercise sessions. RESULTS The exercise group improved 21% ± 12% of cardiorespiratory fitness (P < 0.001) and HRQL in the following domains: physical functioning, general health, and mental health (P < 0.05). Moreover, the exercise group decreased body mass index, waist circumference, systolic and diastolic blood pressure, and total cholesterol level (P < 0.05). The affective response varied from "good" to "fairly good" (i.e., positive affective response) in an exercise intensity-dependent manner during the exercise training sessions. CONCLUSIONS Progressive aerobic exercise training improved HRQL, cardiorespiratory fitness, and cardiometabolic profile of overweight/obese women with PCOS. Moreover, the participants reported the exercise training sessions as pleasant over the intervention. These results reinforce the importance of supervised exercise training as a therapeutic approach for overweight/obese women with PCOS.
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Affiliation(s)
- Eduardo Caldas Costa
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, BRAZIL.,Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, BRAZIL
| | | | - Nigel Keith Stepto
- Institute of Sport Exercise and Active Living, Victoria University, Melbourne Victoria, AUSTRALIA.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton Victoria, AUSTRALIA
| | | | | | | | | | | | | | - George Dantas Azevedo
- Departament of Morphology, Biosciences Center, Federal University of Rio Grande do Norte, Natal, BRAZIL
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12
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Kite C, Lahart IM, Afzal I, Broom DR, Randeva H, Kyrou I, Brown JE. Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis. Syst Rev 2019; 8:51. [PMID: 30755271 PMCID: PMC6371542 DOI: 10.1186/s13643-019-0962-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Typically, management of PCOS focuses on lifestyle changes (exercise and diet), aiming to alleviate symptoms, and lower the associated risk of type 2 diabetes and cardiovascular disease. Our objective was to analyse evidence on the effectiveness of exercise in the management of PCOS, when compared to (i) usual care, (ii) diet alone, and (iii) exercise combined with diet, and also exercise combined with diet, compared to (i) control or usual care and (ii) diet alone. METHODS Relevant databases were searched (June 2017) with no time limit for trial inclusion. Eligible trials employed a randomised or quasi-randomised design to measure the chronic effects of exercise, or exercise and diet in women with PCOS. RESULTS Searches returned 2390 articles; of those, 27 papers from 18 trials were included. Results are presented as mean difference (MD) and 95% confidence intervals (95% CI). Compared with control, exercise had a statistical effect on change from baseline fasting insulin (MD - 2.44 μIU/mL, 95% CIs - 4.24 to - 0.64; very low-quality evidence), HOMA-IR (- 0.57, - 0.99 to - 0.14; very low-quality evidence), total cholesterol (- 5.88 mg/dL, - 9.92 to - 1.83; low-quality evidence), LDL cholesterol (- 7.39 mg/dL, - 9.83 to - 4.95; low-quality evidence), and triglycerides (- 4.78 mg/dL, - 7.52 to - 2.05; low-quality evidence). Exercise also improved VO2 max (3.84 ml/kg/min, 2.87 to 4.81), waist circumference (- 2.62 cm, - 4.13 to - 1.11), and body fat percentage (- 1.39%, - 2.61 to - 0.18) when compared with usual care. No effect was found for change value systolic/diastolic blood pressure, fasting glucose, HDL cholesterol (all low-quality evidence), or waist-to-hip ratio. Many favourable change score findings were supported by post-intervention value analyses: fasting insulin (- 2.11 μIU/mL, - 3.49 to - 0.73), total cholesterol (- 6.66 mg/dL, - 11.14 to - 2.17), LDL cholesterol (- 6.91 mg/dL, - 12.02 to - 1.80), and VO2 max (5.01 ml/kg/min, 3.48 to 6.54). Statistically lower BMI (- 1.02 kg/m2, - 1.81 to - 0.23) and resting heart rate (- 3.26 beats/min - 4.93 to - 1.59) were also revealed in post-intervention analysis. Subgroup analyses revealed the greatest improvements in overweight/obese participants, and more outcomes improved when interventions were supervised, aerobic in nature, or of a shorter duration. Based on limited data, we found no differences for any outcome between the effects of exercise and diet combined, and diet alone. It was not possible to compare exercise vs diet or exercise and diet combined vs diet. CONCLUSION Statistically beneficial effects of exercise were found for a range of metabolic, anthropometric, and cardiorespiratory fitness-related outcomes. However, caution should be adopted when interpreting these findings since many outcomes present modest effects and wide CIs, and statistical effects in many analyses are sensitive to the addition/removal of individual trials. Future work should focus on rigorously designed, well-reported trials that make comparisons involving both exercise and diet. SYSTEMATIC REVIEW REGISTRATION This systematic review was prospectively registered on the Prospero International Prospective Register of Systematic Reviews ( CRD42017062576 ).
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Affiliation(s)
- Chris Kite
- School of Life and Health Sciences, Cell and Tissue Biomedical Research Group, Aston University, Aston Triangle, Birmingham, B4 7ET, UK.,Centre for Active Living, University Centre Shrewsbury, University of Chester, Guildhall, Frankwell Quay, Shrewsbury, SY3 8HQ, UK
| | - Ian M Lahart
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Walsall Campus, Gorway Road, Walsall, WS1 3BD, UK
| | - Islam Afzal
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK
| | - David R Broom
- Academy of Sport and Physical Activity, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Harpal Randeva
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK.,Division of Translational and Experimental Medicine, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK.,Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, CV1 5FB, UK
| | - Ioannis Kyrou
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK.,Division of Translational and Experimental Medicine, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK.,Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, CV1 5FB, UK
| | - James E Brown
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK. .,School of Life and Health Sciences, Cell and Tissue Biomedical Research Group, Aston University, Aston Triangle, Birmingham, B4 7ET, UK.
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13
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Gui J, Wang RH. Cardiovascular autonomic dysfunction in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biomed Online 2017; 35:113-120. [PMID: 28483340 DOI: 10.1016/j.rbmo.2017.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 02/07/2023]
Abstract
Recent studies reveal that polycystic ovary syndrome (PCOS) might be associated with cardiovascular autonomic dysfunction, but with inconsistent results. The aim of this meta-analysis was to study whether women with PCOS have cardiovascular autonomic dysfunction. PubMed, Web of Science, Cochrane Library and SCOPUS were searched for studies comparing cardiovascular function between women with PCOS and controls. A random-effects model was used to evaluate cardiac autonomic modulation and muscle sympathetic nerve activity (MSNA) between women with PCOS and controls. Eight studies were included, including 243 PCOS and 211 controls. Overall, women with PCOS had significantly lower standard deviation of normal-to-normal RR intervals (SDNN) and percentage of the number of interval differences of successive normal-to-normal RR intervals greater than 50 ms among the total number of RR intervals (pNN50), higher MSNA frequency and higher MSNA incidence than controls. Therefore, this meta-analysis provides evidence that women with PCOS might show cardiovascular autonomic dysfunction, with reduced total and parasympathetic cardiac modulation, and increased sympathetic activity.
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Affiliation(s)
- Juan Gui
- Department of Obstetrics, Gynecology, Renmin Hospital of Wuhan University, Wuhan, China; Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China.
| | - Rui-Hao Wang
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
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14
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Shivkumar K, Ajijola OA, Anand I, Armour JA, Chen PS, Esler M, De Ferrari GM, Fishbein MC, Goldberger JJ, Harper RM, Joyner MJ, Khalsa SS, Kumar R, Lane R, Mahajan A, Po S, Schwartz PJ, Somers VK, Valderrabano M, Vaseghi M, Zipes DP. Clinical neurocardiology defining the value of neuroscience-based cardiovascular therapeutics. J Physiol 2016; 594:3911-54. [PMID: 27114333 PMCID: PMC4945719 DOI: 10.1113/jp271870] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 04/08/2016] [Indexed: 12/13/2022] Open
Abstract
The autonomic nervous system regulates all aspects of normal cardiac function, and is recognized to play a critical role in the pathophysiology of many cardiovascular diseases. As such, the value of neuroscience-based cardiovascular therapeutics is increasingly evident. This White Paper reviews the current state of understanding of human cardiac neuroanatomy, neurophysiology, pathophysiology in specific disease conditions, autonomic testing, risk stratification, and neuromodulatory strategies to mitigate the progression of cardiovascular diseases.
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Affiliation(s)
- Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, Los Angeles, CA, USA
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, Los Angeles, CA, USA
| | - Inder Anand
- Department of Cardiology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Andrew Armour
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, Los Angeles, CA, USA
| | - Peng-Sheng Chen
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Murray Esler
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jeffrey J Goldberger
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ronald M Harper
- Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles, CA, USA
| | - Michael J Joyner
- Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | | | - Rajesh Kumar
- Departments of Anesthesiology and Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Richard Lane
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Aman Mahajan
- Department of Anesthesia, UCLA, Los Angeles, CA, USA
| | - Sunny Po
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- University of Tulsa Oxley College of Health Sciences, Tulsa, OK, USA
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Instituto Auxologico Italiano, c/o Centro Diagnostico e di Ricerrca San Carlo, Milan, Italy
| | - Virend K Somers
- Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Miguel Valderrabano
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, Los Angeles, CA, USA
| | - Douglas P Zipes
- Indiana University School of Medicine, Indianapolis, IN, USA
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