1
|
Ko DK, Lee H, Kim DI, Park YM, Kang N. Transcranial direct current stimulation improves heart rate variability: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2024; 134:111072. [PMID: 38925337 DOI: 10.1016/j.pnpbp.2024.111072] [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: 10/28/2023] [Revised: 04/09/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Heart rate variability (HRV) is a useful tool for evaluating cardiovascular autonomic nervous system (ANS) functions. This systematic review and meta-analysis examined the potential effects of transcranial direct current stimulation (tDCS) protocols on HRV parameters. METHODS This study acquired 97 comparisons from 24 qualified studies for data synthesis. Using standardized mean difference (SMD), individual and overall effect sizes were estimated to show differences in HRV variables between active tDCS and sham stimulation conditions. More positive effect size values indicated that active tDCS caused greater increases in HRV than sham stimulation. Furthermore, moderator variable analyses were performed to determine whether changes in HRV variables differed depending on (a) task types (physical stress versus psychological stress versus resting condition), (b) targeted brain regions, (c) stimulation polarity, (d) characteristics of participants, and (e) specific HRV variables. Finally, we used meta-regression analyses to determine whether different tDCS parameters (i.e., the number of tDCS sessions, stimulation duration, and density) were associated with changes in HRV patterns. RESULTS The random-effects model meta-analysis showed that tDCS protocols significantly improved HRV variables (SMD = 0.400; P < 0.001). Moreover, for increasing HRV during the physical stress task (SMD = 1.352; P = 0.001), anodal stimulation on the M1 was effective, while combined polarity stimulation on the PFC improved HRV during the psychological stress task (SMD = 0.550; P < 0.001) and resting condition (SMD = 0.192; P = 0.012). Additional moderator variables and meta-regression analyses failed to show that tDCS protocols had positive effects in certain conditions, such as different stimulus polarity, characteristics of participants, specific HRV variables, and tDCS parameters. CONCLUSION These findings tentatively suggest that using tDCS protocols to stimulate optimal targeted brain areas may be effective in improving HRV patterns potentially related to cardiovascular ANS functions.
Collapse
Affiliation(s)
- Do-Kyung Ko
- Department of Human Movement Science, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea.
| | - Hajun Lee
- Department of Human Movement Science, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea.
| | - Dong-Il Kim
- Department of Human Movement Science, Incheon National University, Incheon, South Korea; Division of Health & Kinesiology, Incheon National University, Incheon, South Korea.
| | - Young-Min Park
- Department of Human Movement Science, Incheon National University, Incheon, South Korea; Division of Health & Kinesiology, Incheon National University, Incheon, South Korea.
| | - Nyeonju Kang
- Department of Human Movement Science, Incheon National University, Incheon, South Korea; Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea.
| |
Collapse
|
2
|
Pegado R, Melo M, Oehmen T, Kirsztajn GM, Silva-Filho E, Quintiliano A. Safety and feasibility of transcranial direct current stimulation in end-stage renal disease patients undergoing hemodialysis: an exploratory study. J Bras Nefrol 2024; 46:e20240010. [PMID: 39051759 PMCID: PMC11268524 DOI: 10.1590/2175-8239-jbn-2024-0010en] [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: 01/22/2024] [Accepted: 05/02/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Patients with end-stage renal disease often face a challenging routine of hemodialysis, dietary restrictions, and multiple medications, which can affect their hemodynamic function. Home-based, safe, and nonpharmacological approaches such as transcranial direct current stimulation (tDCS) should be combined with conventional treatment. OBJECTIVE To assess the safety and feasibility of tDCS on blood pressure and heart rate in patients with end-stage renal disease undergoing hemodialysis. METHOD This is a parallel, randomized, sham-controlled trial. Patients undergoing hemodialysis for more than three months were included. The patients received ten non-consecutive 2mA tDCS sessions on the primary motor cortex . Each session lasted 20 minutes. At baseline and after each of the ten sessions, blood pressure and heart rate of the patients were measured hourly for four hours. RESULTS Thirty patients were randomized to the active or sham group. The mean difference between the groups was calculated as the mean value of the sham group minus the mean value of the active group. Despite there were no statistical changes for all outcomes considering all 10 sessions, we found differences between groups for systolic -10.93 (-29.1;7.2), diastolic -3.63 (-12.4; 5.1), and mean blood pressure -6.0 (-16.3; 4.2) and hear rate 2.26 (-2.5; 7.1). No serious adverse events were found. The active group showed higher blood pressure values at all points, while heart rate was lower in the active group. CONCLUSION tDCS is safe and feasible for patients with end-stage renal disease undergoing hemodialysis. Future studies should investigate whether tDCS could potentially induce a hypotensive protective effect during hemodialysis.
Collapse
Affiliation(s)
- Rodrigo Pegado
- Universidade Federal do Rio Grande do Norte,
Programa de Pós-Graduação em Ciências da Reabilitação, Natal, RN,
Brazil.Universidade Federal do Rio Grande do
NortePrograma de Pós-Graduação em Ciências da
ReabilitaçãoNatalRNBrazil
- Universidade Federal do Rio Grande do Norte,
Programa de Pós-Graduação em Ciências da Saúde, Natal, RN, Brazil.Universidade Federal do Rio Grande do
NortePrograma de Pós-Graduação em Ciências da
SaúdeNatalRNBrazil
| | - Monaliza Melo
- Universidade Federal do Rio Grande do Norte,
Programa de Pós-Graduação em Ciências da Reabilitação, Natal, RN,
Brazil.Universidade Federal do Rio Grande do
NortePrograma de Pós-Graduação em Ciências da
ReabilitaçãoNatalRNBrazil
| | - Tayanne Oehmen
- Universidade Federal do Rio Grande do Norte,
Natal, RN, Brazil.Universidade Federal do Rio Grande do
NorteNatalRNBrazil
- Universidade Federal de São Paulo, Programa de
Pós-Graduação em Nefrologia, São Paulo, SP, Brazil.Universidade Federal de São PauloPrograma de Pós-Graduação em
NefrologiaSão PauloSPBrazil
| | - Gianna Mastroianni Kirsztajn
- Universidade Federal de São Paulo, Programa de
Pós-Graduação em Nefrologia, São Paulo, SP, Brazil.Universidade Federal de São PauloPrograma de Pós-Graduação em
NefrologiaSão PauloSPBrazil
| | - Edson Silva-Filho
- Universidade Federal do Rio Grande do Norte,
Programa de Pós-Graduação em Ciências da Saúde, Natal, RN, Brazil.Universidade Federal do Rio Grande do
NortePrograma de Pós-Graduação em Ciências da
SaúdeNatalRNBrazil
| | - Artur Quintiliano
- Universidade Federal do Rio Grande do Norte,
Departamento de Medicina, Natal, RN, BrazilUniversidade Federal do Rio Grande do
NorteDepartamento de MedicinaNatalRNBrazil
| |
Collapse
|
3
|
Brasil IA, Silva JCPL, Pescatello LS, Farinatti P. Central and peripheral mechanisms underlying postexercise hypotension: a scoping review. J Hypertens 2024; 42:751-763. [PMID: 38525904 DOI: 10.1097/hjh.0000000000003702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Blood pressure (BP) reduction occurs after a single bout of exercise, referred to as postexercise hypotension (PEH). The clinical importance of PEH has been advocated owing to its potential contribution to chronic BP lowering, and as a predictor of responders to exercise training as an antihypertensive therapy. However, the mechanisms underlying PEH have not been well defined. This study undertook a scoping review of research on PEH mechanisms, as disclosed in literature reviews. We searched the PubMed, Web of Science, Scopus, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Sport Discus databases until January 2023 to locate 21 reviews - 13 narrative, four systematic with 102 primary trials, and four meta-analyses with 75 primary trials involving 1566 participants. We classified PEH mechanisms according to major physiological systems, as central (autonomic nervous system, baroreflex, cardiac) or peripheral (vascular, hemodynamic, humoral, and renal). In general, PEH has been related to changes in autonomic control leading to reduced cardiac output and/or sustained vasodilation. However, the role of autonomic control in eliciting PEH has been challenged in favor of local vasodilator factors. The contribution of secondary physiological outcomes to changes in cardiac output and/or vascular resistance during PEH remains unclear, especially by exercise modality and population (normal vs. elevated BP, young vs. older adults). Further research adopting integrated approaches to investigate the potential mechanisms of PEH is warranted, particularly when the magnitude and duration of BP reductions are clinically relevant. (PROSPERO CRD42021256569).
Collapse
Affiliation(s)
- Iedda A Brasil
- Graduate Program in Exercise and Sport Sciences, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - José Cristiano P L Silva
- Graduate Program in Exercise and Sport Sciences, University of Rio de Janeiro State, Rio de Janeiro, Brazil
- Faculty of Physical Education, University Center of Volta Redonda, Volta Redonda, Brazil
| | - Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - Paulo Farinatti
- Graduate Program in Exercise and Sport Sciences, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| |
Collapse
|
4
|
Silva-Filho E, Bikson M, Gebodh N, Khadka N, da Cruz Santos A, Pegado R, do Socorro Brasileiro-Santos M. A pilot randomized controlled trial of transcranial direct current stimulation adjunct to moderate-intensity aerobic exercise in hypertensive individuals. FRONTIERS IN NEUROERGONOMICS 2024; 5:1236486. [PMID: 38660589 PMCID: PMC11040684 DOI: 10.3389/fnrgo.2024.1236486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
Background Hypertension is a global issue that is projected to worsen with increasingly obese populations. The central nervous system including the parts of the cortex plays a key role in hemodynamic stability and homeostatic control of blood pressure (BP), making them critical components in understanding and investigating the neural control of BP. This study investigated the effects of anodal transcranial direct current stimulation (tDCS) associated with aerobic physical exercise on BP and heart rate variability in hypertensive patients. Methods Twenty hypertensive patients were randomized into two groups: active tDCS associated with aerobic exercise or sham tDCS associated with aerobic exercise. BP and heart rate variability were analyzed before (baseline) and after twelve non-consecutive sessions. After each tDCS session (2 mA for 20 min), moderate-intensity aerobic exercise was carried out on a treadmill for 40 min. Results A total of 20 patients were enrolled (53.9 ± 10.6 years, 30.1 ± 3.7 Kg/m2). There were no significant interactions between time and groups on diastolic BP during wake, sleep, over 24 and 3 h after the last intervention. Heart rate variability variables showed no significant difference for time, groups and interaction analysis, except for HF (ms2) between groups (p < 0.05). Conclusion Anodal tDCS over the temporal cortex associated with aerobic exercise did not induce improvements in BP and heart rate variability. Clinical trial registration https://ensaiosclinicos.gov.br/rg/RBR-56jg3n/1, identifier: RBR-56jg3n.
Collapse
Affiliation(s)
- Edson Silva-Filho
- Associated Postgraduate Program in Physical Education, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
- Postgraduate Program in Physiotherapy and Postgraduate Program in Health Science, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of The City University of New York, New York, NY, United States
| | - Nigel Gebodh
- Department of Biomedical Engineering, The City College of The City University of New York, New York, NY, United States
| | - Niranjan Khadka
- Department of Biomedical Engineering, The City College of The City University of New York, New York, NY, United States
| | - Amilton da Cruz Santos
- Associated Postgraduate Program in Physical Education, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Rodrigo Pegado
- Postgraduate Program in Physiotherapy and Postgraduate Program in Health Science, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | | |
Collapse
|
5
|
Wu Q, Fang G, Zhao J, Liu J. Effect of Transcranial Pulsed Current Stimulation on Fatigue Delay after Medium-Intensity Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127042. [PMID: 35742289 PMCID: PMC9222574 DOI: 10.3390/ijerph19127042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to investigate the effect of transcranial pulsed current stimulation (tPCS) on fatigue delay after medium-intensity training. Materials and Methods: Ninety healthy college athletes were randomly divided into an experimental group (n = 45) and control group (n = 45). The experimental group received medium-intensity training for a week. After each training, the experimental group received true stimulation of tPCS (continuous 15 min 1.5 mA current intensity stimulation). The control group received sham stimulation. The physiological and biochemical indicators of participants were tested before and after the experiment, and finally 30 participants in each group were included for data analysis. Results: In the experimental group, creatine kinase (CK), cortisol (C), time-domain heart rate variability indices root mean square of the successive differences (RMSSD), standard deviation of normal R-R intervals (SDNN), and frequency domain indicator low frequency (LF) all increased slowly after the intervention. Among these, CK, C, and SDNN values were significantly lower than those in the control group (p < 0.05). Testosterone (T), T/C, and heart rate variability frequency domain indicator high frequency (HF) in the experimental group decreased slowly after the intervention, and the HF value was significantly lower than that in the control group (p < 0.05). The changes in all of the indicators in the experimental group were smaller than those in the control group. Conclusion: The application of tPCS after medium-intensity training enhanced the adaptability to training and had a significant effect on the maintenance of physiological state. The application of tPCS can significantly promote the recovery of autonomic nervous system function, enhance the regulation of parasympathetic nerves, and delay the occurrence of fatigue.
Collapse
Affiliation(s)
- Qingchang Wu
- College of Sports Science, Nantong University, Nantong 226019, China;
| | - Guoliang Fang
- China Institute of Sport Science, Beijing 100061, China; (G.F.); (J.Z.)
| | - Jiexiu Zhao
- China Institute of Sport Science, Beijing 100061, China; (G.F.); (J.Z.)
| | - Jian Liu
- College of Sports Science, Nantong University, Nantong 226019, China;
- Correspondence:
| |
Collapse
|
6
|
Ministro G, Castaño JB, Barboza CA, Moura EG, Ferreira-Melo SE, Mostarda CT, Fattori A, Moreno-Junior H, Rodrigues B. ACUTE TRANSCRANIAL DIRECT CURRENT STIMULATION (tDCS) IMPROVES VENTILATORY VARIABILITY AND AUTONOMIC MODULATION IN RESISTANT HYPERTENSIVE PATIENTS. Respir Physiol Neurobiol 2021; 297:103830. [PMID: 34915178 DOI: 10.1016/j.resp.2021.103830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/29/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
Here, we assessed the impact of one session of transcranial direct current stimulation (tDCS) or SHAM (20 min, each) on ventilatory responses to cardiopulmonary exercise test, central and peripheral blood pressure (BP), and autonomic modulation in resistant hypertensive (RHT) patients. RHT subjects (n = 13) were randomly submitted to SHAM and tDCS crossing sessions (1 week of "washout"). Patients and a technician who set the tDCS/Sham room up were both blind. After brain stimulation, patients were submitted to a cardiopulmonary exercise test to evaluate ventilatory and cardiovascular response to exercise. Hemodynamic (Finometer®, Beatscope), and autonomic variables were measured at baseline (before tDCS/Sham) and after incremental exercise. RESULTS: Our study shows that tDCS condition improved heart rate recovery, VO2 peak, and vagal modulation (after cardiopulmonary exercise test); attenuated the ventilatory variability response, central and peripheral blood pressure well as sympathetic modulation (after cardiopulmonary exercise test) in comparison with SHAM. These data suggest that acute tDCS sessions prevented oscillatory ventilation behavior during the cardiopulmonary exercise test and mitigated the increase of systolic blood pressure in RHT patients. After the exercise test, tDCS promotes better vagal reentry and improved autonomic modulation, possibly reducing central blood pressure and aortic augmentation index compared to SHAM. Brazilian Registry of Clinical Trials (ReBEC): https://ensaiosclinicos.gov.br/rg/RBR-8n7c9p.
Collapse
Affiliation(s)
- Gabriela Ministro
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Javier B Castaño
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Catarina A Barboza
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Eliezer G Moura
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Silvia E Ferreira-Melo
- Laboratory of Cardiovascular Pharmacology & Hypertension, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - André Fattori
- Department of Clinical Medicine, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Heitor Moreno-Junior
- Laboratory of Cardiovascular Pharmacology & Hypertension, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Bruno Rodrigues
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, SP, Brazil; Laboratory of Cardiovascular Pharmacology & Hypertension, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil.
| |
Collapse
|