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Qi L, Wang GL, Tian ZH, Guan S, Yang SY, Yang YL, Liu LQ, Lin YZ. Prefrontal cortical hemodynamics and functional network organization during Tai Chi standing meditation: an fNIRS study. Front Hum Neurosci 2023; 17:1294312. [PMID: 37954940 PMCID: PMC10634523 DOI: 10.3389/fnhum.2023.1294312] [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: 09/14/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Tai Chi standing meditation (Zhan Zhuang, also called pile standing) is characterized by meditation, deep breathing, and mental focus based on theories of traditional Chinese medicine. The purpose of the present study was to explore prefrontal cortical hemodynamics and the functional network organization associated with Tai Chi standing meditation by using functional near-infrared spectroscopy (fNIRS). Methods Twenty-four channel fNIRS signals were recorded from 24 male Tai Chi Quan practitioners (54.71 ± 8.04 years) while standing at rest and standing during Tai Chi meditation. The general linear model and the SPM method were used to analyze the fNIRS signals. Pearson correlation was calculated to determine the functional connectivity between the prefrontal cortical sub-regions. The small world properties of the FC networks were then further analyzed based on graph theory. Results During Tai Chi standing meditation, significantly higher concentrations of oxygenated hemoglobin were observed in bilateral dorsolateral prefrontal cortex (DLPFC), ventrolateral prefrontal cortex (VLPFC), frontal eye field (FEF), and pre-motor cortex (PMC) compared with the values measured during standing rest (p < 0.05). Simultaneously, significant decreases in deoxygenated hemoglobin concentration were observed in left VLPFC, right PMC and DLPFC during Tai Chi standing meditation than during standing rest (p < 0.05). Functional connectivity between the left and right PFC was also significantly stronger during the Tai Chi standing meditation (p < 0.05). The functional brain networks exhibited small-world architecture, and more network hubs located in DLPFC and VLPFC were identified during Tai Chi standing meditation than during standing rest. Discussion These findings suggest that Tai Chi standing meditation introduces significant changes in the cortical blood flow and the brain functional network organization.
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Affiliation(s)
- Liping Qi
- Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, China
| | - Guo-Liang Wang
- Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, China
| | - Zhi-Hao Tian
- Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, China
| | - Shuo Guan
- Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, China
| | - Shu-Ye Yang
- School of Physical Education and Health, Dalian University of Technology, Dalian, China
| | - Yu-Long Yang
- School of Physical Education and Health, Dalian University of Technology, Dalian, China
| | - Li-Qing Liu
- School of Physical Education and Health, Dalian University of Technology, Dalian, China
| | - Yong-Zhong Lin
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Rodrigues GD, Lima LS, da Silva NCS, Telles PGL, da Mota Silva Rocha TM, de Aragão Porto VQ, Cardoso VV, da Silva Soares PP. Are home-based exercises effective to reduce blood pressure in hypertensive adults? A systematic review. Clin Hypertens 2022; 28:28. [PMID: 36104807 PMCID: PMC9474275 DOI: 10.1186/s40885-022-00211-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
Sedentarism and chronic non-communicable diseases have been a worldwide health problem that is drastically exacerbated by the COVID-19 pandemic social impacts. Home-based exercises are widely encouraged during social isolation to counterbalance the physical inactive impacts. Although, in the context of hypertension, are home-based exercises effective in blood pressure controlling? Our objective is to conduct a systematic review of high-quality controlled trials comparing the possible effects of different types of home-based exercises in hypertensive patients. The literature search was carried out in three scientific databases: Medline, Europe PMC, and Lilacs. Articles were included following three criteria: analyzing the effect of home-based exercise programs on blood pressure in treated and untreated hypertensive patients; exercises must perform at home and on the frequency, intensity, time, and type (FITT) principle, and the articles were published in English. From the qualitative analysis of 27 original trials screened through 451 identified studies, the main results are the following: 1) both endurance, isometric strength, and respiratory home-based exercise programs were efficient to decrease blood pressure in hypertensive patients; 2) differences in methodological approaches regarding FITT components, distinct blood pressure values at baseline and specific underlying mechanisms must be considered as a potential bias of each home-based interventions. In conclusion, endurance, isometric strength, and breathing home-based programs seems to be effective to reduce blood pressure in hypertensive patients. However, further randomized controlled trials and mechanistic studies must be performing to guide evidence-based recommendations of home-based exercises as antihypertensive therapy.
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Sharpe E, Lacombe A, Sadowski A, Phipps J, Heer R, Rajurkar S, Hanes D, Jindal RD, Bradley R. Investigating components of pranayama for effects on heart rate variability. J Psychosom Res 2021; 148:110569. [PMID: 34271528 PMCID: PMC8568305 DOI: 10.1016/j.jpsychores.2021.110569] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Traditional Indian breath control practices of Pranayama have been shown to increase indices of heart rate variability (HRV) that are generally held to reflect parasympathetic nervous system (PNS) tone. To our knowledge, individual components of pranayama have not been separately evaluated for impact on HRV. The objective of this study was to isolate five components of a pranayama practice and evaluate their impact on HRV. METHODS In a crossover clinical trial, 46 healthy adults were allocated to complete five activities in random order, over five separate visits: 1) sitting quietly; 2) self-paced deep breathing; 3) externally-paced deep breathing; 4) self-paced Sheetali/Sheetkari pranayama; and 5) externally paced Sheetali/Sheetkari pranayama RESULTS: Our final sample included 25 participants. There was a significant increase in a time-domain index of HRV, the root mean square successive differences between RR intervals (RMSSD), during the five interventions. The change in logRMSSD ranged from 0.2 to 0.5 (p < .01 in all conditions by paired t-test). Greater increases were evident during externally-paced breathing than during self-paced breathing (mean pre-during logRMSSD change of 0.50 vs. 0.36, p = .02) or sitting quietly (mean, 0.17 ms; p = .005 and 0.02 when comparing Activities 3 and 5 to Activity 1 by random intercept model with Tukey correction for multiple comparisons). Lastly, pre-during increase in RMSSD was greater for Sheetali/Sheetkari vs. deep breathing, when controlling for respiration rate, though not significantly different (p = .07 in random intercept model) CONCLUSIONS: RMSSD increased with paced breathing, deep breathing, and Sheetali/Sheetkari pranayama, reinforcing evidence of a physiologic mechanism of pranayama. TRIAL REGISTRATION NCT03280589 https://www.clinicaltrials.gov/ct2/show/NCT03280589?term=sheetali&draw=2&rank=1.
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Affiliation(s)
- Erica Sharpe
- National University of Natural Medicine, Portland, OR, United States of America; State University of New York at Canton, Canton, NY, United States of America.
| | - Alison Lacombe
- National University of Natural Medicine, Portland, OR,United States Department of Agriculture, Produce Safety Microbiology Research Unit, Albany, CA
| | - Adam Sadowski
- National University of Natural Medicine, Portland, OR, United States of America.
| | - John Phipps
- National University of Natural Medicine, Portland, OR, United States of America.
| | - Ryan Heer
- National University of Natural Medicine, Portland, OR
| | - Savita Rajurkar
- National University of Natural Medicine, Portland, OR, United States of America.
| | - Douglas Hanes
- National University of Natural Medicine, Portland, OR, United States of America.
| | - Ripu D Jindal
- Birmingham VA Medical Center, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Ryan Bradley
- National University of Natural Medicine, Portland, OR, United States of America; University of California, San Diego, La Jolla, CA, United States of America; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
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Nicolò A, Massaroni C, Schena E, Sacchetti M. The Importance of Respiratory Rate Monitoring: From Healthcare to Sport and Exercise. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6396. [PMID: 33182463 PMCID: PMC7665156 DOI: 10.3390/s20216396] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 12/11/2022]
Abstract
Respiratory rate is a fundamental vital sign that is sensitive to different pathological conditions (e.g., adverse cardiac events, pneumonia, and clinical deterioration) and stressors, including emotional stress, cognitive load, heat, cold, physical effort, and exercise-induced fatigue. The sensitivity of respiratory rate to these conditions is superior compared to that of most of the other vital signs, and the abundance of suitable technological solutions measuring respiratory rate has important implications for healthcare, occupational settings, and sport. However, respiratory rate is still too often not routinely monitored in these fields of use. This review presents a multidisciplinary approach to respiratory monitoring, with the aim to improve the development and efficacy of respiratory monitoring services. We have identified thirteen monitoring goals where the use of the respiratory rate is invaluable, and for each of them we have described suitable sensors and techniques to monitor respiratory rate in specific measurement scenarios. We have also provided a physiological rationale corroborating the importance of respiratory rate monitoring and an original multidisciplinary framework for the development of respiratory monitoring services. This review is expected to advance the field of respiratory monitoring and favor synergies between different disciplines to accomplish this goal.
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Affiliation(s)
- Andrea Nicolò
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy;
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy;
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Nagarathna R, Nagendra HR, Majumdar V. A Perspective on Yoga as a Preventive Strategy for Coronavirus Disease 2019. Int J Yoga 2020; 13:89-98. [PMID: 32669762 PMCID: PMC7336943 DOI: 10.4103/ijoy.ijoy_22_20] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/29/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023] Open
Abstract
The pandemic outbreak of coronavirus disease 2019 (COVID-19) infection caused by severe acute respiratory syndrome-coronavirus 2 has led to profound public health crisis. In particular, individuals with preexisting conditions of heart disease, diabetes, cerebrovascular diseases and the elderly are most vulnerable to succumb to this infection. The current COVID-19 emergency calls for rapid development of potential prevention and management strategies against this virus-mediated disease. There is a plethora of evidence that supports the add-on benefits of yoga in stress management, as well as prevention and management of chronic noncommunicable diseases. There are some studies on the effect of yoga in communicable diseases as well but very few for acute conditions and almost none for the rapidly spreading infections resulting in pandemics. Based on the available scientific evidences on yoga in improving respiratory and immune functions, we have formulated very simple doable integrated yoga modules in the form of videos to be practiced for prevention of the disease by children, adults, and the elderly.
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Affiliation(s)
- R Nagarathna
- Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
| | - H R Nagendra
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
| | - Vijaya Majumdar
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
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Gholamrezaei A, Van Diest I, Aziz Q, Vlaeyen JWS, Van Oudenhove L. Influence of inspiratory threshold load on cardiovascular responses to controlled breathing at 0.1 Hz. Psychophysiology 2019; 56:e13447. [DOI: 10.1111/psyp.13447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/05/2019] [Accepted: 07/06/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Ali Gholamrezaei
- Laboratory for Brain‐Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism and Ageing University of Leuven Leuven Belgium
- Health Psychology Research Group, Faculty of Psychology and Educational Sciences University of Leuven Leuven Belgium
| | - Ilse Van Diest
- Health Psychology Research Group, Faculty of Psychology and Educational Sciences University of Leuven Leuven Belgium
| | - Qasim Aziz
- Centre for Neuroscience and Trauma Blizard Institute, Wingate Institute of Neurogastroeneterology, Queen Mary University of London London UK
| | - Johan W. S. Vlaeyen
- Health Psychology Research Group, Faculty of Psychology and Educational Sciences University of Leuven Leuven Belgium
| | - Lukas Van Oudenhove
- Laboratory for Brain‐Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism and Ageing University of Leuven Leuven Belgium
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Bussotti M, Sommaruga M. Anxiety and depression in patients with pulmonary hypertension: impact and management challenges. Vasc Health Risk Manag 2018; 14:349-360. [PMID: 30510427 PMCID: PMC6231438 DOI: 10.2147/vhrm.s147173] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Anxiety and depression are frequent disorders in patients with pulmonary arterial hypertension (PAH), but despite this only less than one-fourth of them is treated. Our aim was to review the studies regarding the prevalence and the impact of anxiety and depression and to propose management challenges. Methods A literature review regarding 1) anxiety and depression studies in PAH patients and caregivers, 2) psychological interventions, 3) slow breathing approach, and 4) pharmacological approach was performed, based on evidence of effectiveness through a search of the most well-known databases (Cochrane Library, Medline, PsychINFO [2004–2018]). Results The prevalence of mental disorders in PAH patients lies between 7.5% and 53% for depression and 19% and 51% for anxiety and panic disorders. The latest guidelines of the European Society of Cardiology recommend a psychological support with a class of recommendation I and a level of evidence c. The analysis of psychological intervention shows that at present there is no evidence of specific psychological interventions in these patients. However, treatment approaches based on other chronic illnesses are suggested, especially based on relaxation training, slow breathing, and cognitive behavioral therapy. Finally, data concerning the use of antidepressant drugs are conflicting. Conclusion Firstly, our data demonstrate a common underestimation of mental disorders by health professionals and secondly, the need of implementing appropriate methods of screening for mental disorders in PAH patients. However, the paucity of large observational studies in this area requires the attention of researchers. The evidence about optimal approaches for managing anxiety and depression in PAH also remains unclear and largely speculative. The challenge is the introduction of routine psychological intervention, as suggested by the European Society of Cardiology and already applied in other chronic disease.
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Affiliation(s)
- Maurizio Bussotti
- Cardiorespiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy,
| | - Marinella Sommaruga
- Psychology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy
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Slow loaded breathing training improves blood pressure, lung capacity and arm exercise endurance for older people with treated and stable isolated systolic hypertension. Exp Gerontol 2018; 108:48-53. [DOI: 10.1016/j.exger.2018.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/21/2018] [Accepted: 03/26/2018] [Indexed: 11/18/2022]
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9
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Minichiello VJ. Therapeutic Breathing. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Zimlichman R. Response to the Letter from Landman et al. Curr Hypertens Rep 2017; 19:66. [PMID: 28741156 DOI: 10.1007/s11906-017-0761-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Reuven Zimlichman
- Department of Medicine and Hypertension Institute, Brunner Institute for Cardiovascular Research, Sackler Faculty of Medicine, The E. Wolfson Medical Center, Institute for Quality in Medicine, Israeli Medical Association, Tel-Aviv University, P.O.B.5, 58100, Holon, Israel.
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Comments on: Cernes, R. & Zimlichman, R. Role of Paced Breathing for Treatment of Hypertension. Curr Hypertens Rep (2017) 19: 45. Curr Hypertens Rep 2017; 19:65. [PMID: 28735433 DOI: 10.1007/s11906-017-0760-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nivethitha L, Mooventhan A, Manjunath NK. Effects of Various Prāṇāyāma on Cardiovascular and Autonomic Variables. Anc Sci Life 2016; 36:72-77. [PMID: 28446827 PMCID: PMC5382821 DOI: 10.4103/asl.asl_178_16] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular functions are controlled by neural factors, temperature, hormones, etc., Of these, neural factors primarily concern the autonomic nervous system, which plays a major role in maintaining and regulating cardiac functions, e.g., blood pressure and heart rate. Prāṇāyāma is one of the most important yogic practices. There are various review articles on Yoga and its effects but, though Prāṇāyāma is a part of yoga, there is lack of review articles. To the best of our knowledge there is no known review article on effect of various Prāṇāyāma on cardiovascular and autonomic variables. To provide a general overview about the effect of various prāṇāyāma (breathing techniques) on cardiovascular and autonomic variables. A narrative review was performed based on the available scientific literature. An electronic data search was performed in Medline/PubMed database to review relevant articles, using keywords such as "Prāṇāyāma, Yogic breathing techniques, Unilateral nostril breathing, Alternate nostril breathing, Kapalbhati, Bhastrika and Bhramari Pranayama". All the relevant articles published from 1988 to 06-04-2016 were included in this review. Slow type of yogic breathing technique was reported to produce beneficial effect on cardiovascular and autonomic variables while fast breathing techniques do not produce such effects. There is lack of consistency in the results of specific nostril yogic breathing techniques and the mechanisms behind the effects of various prāṇāyāma. This review suggests that different types of Prāṇāyāma techniques produce different effects and the mechanisms behind these effects are not fully understood.
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Affiliation(s)
- L Nivethitha
- From the Department of Research and Development, S-VYASA University, Bengaluru, Karnataka, India
| | - A Mooventhan
- From the Department of Research and Development, S-VYASA University, Bengaluru, Karnataka, India
| | - NK Manjunath
- From the Department of Research and Development, S-VYASA University, Bengaluru, Karnataka, India
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Wehrwein EA, Orer HS, Barman SM. Overview of the Anatomy, Physiology, and Pharmacology of the Autonomic Nervous System. Compr Physiol 2016; 6:1239-78. [PMID: 27347892 DOI: 10.1002/cphy.c150037] [Citation(s) in RCA: 217] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Comprised of the sympathetic nervous system, parasympathetic nervous system, and enteric nervous system, the autonomic nervous system (ANS) provides the neural control of all parts of the body except for skeletal muscles. The ANS has the major responsibility to ensure that the physiological integrity of cells, tissues, and organs throughout the entire body is maintained (homeostasis) in the face of perturbations exerted by both the external and internal environments. Many commonly prescribed drugs, over-the-counter drugs, toxins, and toxicants function by altering transmission within the ANS. Autonomic dysfunction is a signature of many neurological diseases or disorders. Despite the physiological relevance of the ANS, most neuroscience textbooks offer very limited coverage of this portion of the nervous system. This review article provides both historical and current information about the anatomy, physiology, and pharmacology of the sympathetic and parasympathetic divisions of the ANS. The ultimate aim is for this article to be a valuable resource for those interested in learning the basics of these two components of the ANS and to appreciate its importance in both health and disease. Other resources should be consulted for a thorough understanding of the third division of the ANS, the enteric nervous system. © 2016 American Physiological Society. Compr Physiol 6:1239-1278, 2016.
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Affiliation(s)
- Erica A Wehrwein
- Department of Physiology, Michigan State University, East Lansing, Michigan, USA
| | - Hakan S Orer
- Department of Pharmacology, Koc University School of Medicine, Istanbul, Turkey
| | - Susan M Barman
- Department of Pharmacology &Toxicology, Michigan State University, East Lansing, Michigan, USA
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Darviri C, Artemiadis AK, Protogerou A, Soldatos P, Kranioutou C, Vasdekis S, Varvogli L, Nasothimiou E, Vasilopoulou E, Karantzi E, Linardatou A, Michou M, Chrousos GP. A HEALth Promotion and STRESS Management Program (HEAL-STRESS study) for prehypertensive and hypertensive patients: a quasi-experimental study in Greece. J Hum Hypertens 2015; 30:397-403. [DOI: 10.1038/jhh.2015.99] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/14/2015] [Accepted: 08/24/2015] [Indexed: 11/09/2022]
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van Hateren KJJ, Landman GWD, Kleefstra N. Re: "RESPeRATE: the role of paced breathing in hypertension treatment". ACTA ACUST UNITED AC 2015; 9:656-7. [PMID: 26319537 DOI: 10.1016/j.jash.2015.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Gijs W D Landman
- Diabetes Centre, Isala, Zwolle, The Netherlands; Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, The Netherlands; Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Langerhans Medical Research Group, Zwolle, The Netherlands
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