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de Aquino TN, Prado JP, Crisafulli E, Clini EM, Galdino G. Efficacy of Respiratory Muscle Training in the Immediate Postoperative Period of Cardiac Surgery: A Systematic Review and Meta-Analysis. Braz J Cardiovasc Surg 2024; 39:e20220165. [PMID: 38315040 PMCID: PMC10836657 DOI: 10.21470/1678-9741-2022-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/19/2023] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION This study aimed to evaluate the efficacy of respiratory muscle training during the immediate postoperative period of cardiac surgery on respiratory muscle strength, pulmonary function, functional capacity, and length of hospital stay. METHODS This is a systematic review and meta-analysis. A comprehensive search on PubMed®, Excerpta Medica Database (or Embase), Cumulative Index of Nursing and Allied Health Literature (or CINAHL), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Physiotherapy Evidence Database (or PEDro), and Cochrane Central Register of Controlled Trials databases was performed. A combination of free-text words and indexed terms referring to cardiac surgery, coronary artery bypass grafting, respiratory muscle training, and clinical trials was used. A total of 792 studies were identified; after careful selection, six studies were evaluated. RESULTS The studies found significant improvement after inspiratory muscle training (IMT) (n = 165, 95% confidence interval [CI] 9.68, 21.99) and expiratory muscle training (EMT) (n = 135, 95% CI 8.59, 27.07) of maximal inspiratory pressure and maximal expiratory pressure, respectively. Also, IMT increased significantly (95% CI 19.59, 349.82, n = 85) the tidal volume. However, no differences were found in the peak expiratory flow, functional capacity, and length of hospital stay after EMT and IMT. CONCLUSION IMT and EMT demonstrated efficacy in improving respiratory muscle strength during the immediate postoperative period of cardiac surgery. There was no evidence indicating the efficacy of IMT for pulmonary function and length of hospital stay and the efficacy of EMT for functional capacity.
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Affiliation(s)
- Tarcísio Nema de Aquino
- Instituto de Ciências da Motricidade, Universidade Federal
de Alfenas, Alfenas, Minas Gerais, Brazil
- Department of Rehabilitation and Cardiology, Hospital Santa
Lúcia, Poços de Caldas, Minas Gerais, Brazil
| | - João Paulo Prado
- Instituto de Ciências da Motricidade, Universidade Federal
de Alfenas, Alfenas, Minas Gerais, Brazil
| | - Ernesto Crisafulli
- Department of Medicine and Surgery, Respiratory Disease and Lung
Function Unit, University of Parma, Parma, Italy
| | - Enrico Maria Clini
- Department of Medical and Surgical Sciences, University of Modena
and Reggio Emilia and University Hospital of Modena Policlinico, Modena, Italy
| | - Giovane Galdino
- Instituto de Ciências da Motricidade, Universidade Federal
de Alfenas, Alfenas, Minas Gerais, Brazil
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Effects of Endurance Exercise Intensities on Autonomic and Metabolic Controls in Children with Obesity: A Feasibility Study Employing Online Exercise Training. Nutrients 2023; 15:nu15041054. [PMID: 36839416 PMCID: PMC9963256 DOI: 10.3390/nu15041054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023] Open
Abstract
Exercise is one of the major determinants of a healthy lifestyle, which is particularly important in childhood and serves as a powerful preventive tool. On the other hand, obesity and arterial hypertension rates are increasing in children, representing a huge risk for developing major cardiovascular and metabolic diseases in adult life. Of fundamental importance is the modality and volume of exercise required to obtain benefits. In this feasibility study, we considered a group of obese children, studied before and after a 12-week online exercise training program, and subdivided the participants into two groups considering the volume of exercise performed (above or below 1200 MET·min/week). This threshold level was applied in two different ways: subdivision A considered the total weekly physical activity volume (considering both time spent walking for at least 10 min consecutively and time spent performing structured exercise) and subdivision B considered only the weekly volume of structured exercise. We assessed autonomic and metabolic control and auxological and lifestyle parameters. We observed that the improved volume of structured exercise was associated with reduced arterial pressure percentile only in subdivision B and an improvement in markers of vagal and metabolic control was evident. Moreover, the 12-week online exercise training program, defined considering individual fitness level and progressively adapted as the goal was reached, proved to be sustainable from an economical and organizational point of view.
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Kushwaha P, Moiz JA, Mujaddadi A. Exercise training and cardiac autonomic function following coronary artery bypass grafting: a systematic review and meta-analysis. Egypt Heart J 2022; 74:67. [PMID: 36138168 PMCID: PMC9500144 DOI: 10.1186/s43044-022-00306-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 09/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise training improves cardiac autonomic function is still debatable in patients with coronary artery bypass grafting (CABG). The aim of the present review is to assess the effect of exercise on CABG patient's heart rate variability (HRV) and heart rate recovery (HRR) parameters. MAIN BODY Databases (PubMed, Web of Science and PEDro) were accessed for systematic search from inception till May 2022. Eleven potential studies were qualitatively analyzed by using PEDro and eight studies were included in the quantitative synthesis. Meta-analysis was conducted by using a random-effect model, inverse-variance approach through which standardized mean differences (SMDs) were estimated. The analysis of pooled data showed that exercise training improved HRV indices of standard deviation of the R-R intervals (SDNN) [SMD 0.44, 95% CI 0.17, 0.71, p = 0.002], square root of the mean squared differences between adjacent R-R intervals (RMSSD) [SMD 0.68, 95% CI 0.28, 1.08, p = 0.0008], high frequency (HF) [SMD 0.58, 95% CI 0.18, 0.98, p = 0.005] and low frequency-to-high frequency (LF/HF) ratio [SMD - 0.34, 95% CI - 0.65, - 0.02, p = 0.03]. CONCLUSIONS Exercise training enhances cardiac autonomic function in CABG patients. Owing to the methodological inconsistencies in assessing HRV, the precise effect on autonomic function still remains conflicted. Future high-quality trials are needed focusing on precise methodological approach and incorporation of various types of exercise training interventions will give clarity regarding autonomic adaptations post-exercise training in CABG. Trial registration CRD42021230270 , February 19, 2021.
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Affiliation(s)
- Purnima Kushwaha
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025, India
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025, India
| | - Aqsa Mujaddadi
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025, India.
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Giovanelli L, Palombo C, Pina M, Facchetti S, Malacarne M, Pagani M, Nannipieri M, Berta R, Lucini D. Progressive Additive Benefits of Prehabilitation and Subsequent Bariatric Surgery on Cardiac Autonomic Regulation as Assessed by Means of a Simple Unitary Composite Index: Preliminary Data from an Observational Study. J Pers Med 2022; 12:jpm12081317. [PMID: 36013266 PMCID: PMC9409827 DOI: 10.3390/jpm12081317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Obesity is associated with an increased risk of several chronic comorbidities, which may also be determined by dysfunctional autonomic nervous system (ANS). The influence of bariatric surgery (BS) on ANS balance was explored in previous studies, but with high heterogeneity in both the assessment timing and methods employed. In the present observational study, we applied a clinical protocol which considers two subsequent phases. Twenty-nine non-diabetic obese subjects were studied at baseline (T0), after one month of lifestyle modification (prehabilitation) (phase 1-T1), and after eight months following BS (phase 2-T2). ANS regulation was assessed across the three study epochs by means of ANSI, a single composite percent-ranked proxy of autonomic balance, being free of gender and age bias, economical and simple to apply in a clinical setting. The aim of the present study was to investigate the effects of the clinical protocol based on prehabilitation and subsequent BS on the ANS regulation by means of ANSI. Potential intertwined correlations with metabolic parameters were also investigated. Notably, we observed a progressive improvement in ANS control, even by employing ANSI. Moreover, the reduction in the markers of sympathetic overactivity was found to significantly correlate with the amelioration in some metabolic parameters (fasting glucose, insulin levels, and waist circumference), as well as in stress and tiredness perception. In conclusion, this study provides convincing evidence that a unitary proxy of cardiac autonomic regulation (CAR) may reflect the progressive improvement in autonomic regulation following behavioral and surgical interventions in obese patients. Intriguingly, this might contribute to reducing cardiovascular and metabolic risk.
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Affiliation(s)
- Luca Giovanelli
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
- Department of Endocrine and Metabolic Medicine, Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy
| | - Carlo Palombo
- Department of Surgical, Medical, Molecular Pathology and Critical Area Medicine, University of Pisa, 56126 Pisa, Italy
| | - Matteo Pina
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Simone Facchetti
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Mara Malacarne
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Massimo Pagani
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, 56216 Pisa, Italy
| | - Rossana Berta
- Obesity Surgery Division, Pisa University Hospital, 56216 Pisa, Italy
| | - Daniela Lucini
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
- Correspondence: ; Tel.: +3902-619-1128-08
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Evidence of Better Autonomic, Metabolic and Psychological Profile in Breast Cancer Survivors Meeting Current Physical Activity Recommendations: An Observational Study. J Pers Med 2022; 12:jpm12020273. [PMID: 35207761 PMCID: PMC8876012 DOI: 10.3390/jpm12020273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 12/20/2022] Open
Abstract
The increased cardiometabolic risk observed in breast cancer survivors (BCS) is due to multiple mechanisms: Hormonal and immunological dysfunction are well-identified ones, while cardiac autonomic regulation (CAR) is less recognized but may play a new complementary role particularly relevant when considering conditions and behaviors associated with a better prognosis in BCS, such as physical training. This observational study investigated a group of consecutive (172) BCS subdivided in two groups: those who reached the physical activity goals above 600 (MET·min/week) and those who did not. We assessed CAR by autoregressive spectral analysis of cardiovascular variabilities (considering in particular the unitary autonomic nervous system index—ANSI), body mass composition, stress perception and lifestyle in order to verify possible differences due to execution of physical activity. Subjects who spontaneously met physical activity recommendations presented a better autonomic, metabolic and psychological profile compared to those who did not. Lower physical activity volume, poor metabolic parameters, increased stress and fatigue perception may cluster together, leading to worsened CAR. This control mechanism may play a complementary role in determining the increased cardiometabolic risk observed in BCS. Furthermore, it may also explain, albeit in part, the better prognosis observed in patients following interventions aiming to improve the sympathetic–parasympathetic balance, such as physical training, using a personalized medicine approach.
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Szmigielska K, Jegier A. The influence of cardiac rehabilitation on heart rate variability indices in men with type 2 diabetes and coronary artery disease. Diab Vasc Dis Res 2021; 18:14791641211020184. [PMID: 34169771 PMCID: PMC8481742 DOI: 10.1177/14791641211020184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
METHOD The study population included 141 male CAD patients prospectively and consecutively admitted to an outpatient comprehensive CR program. Twenty-seven patients with type-2 diabetes were compared with 114 males without diabetes. The participants performed a 45-min cycle ergometer interval training alternating 4-min workload and a 2-min active restitution three times a week for 8 weeks. The training intensity was adjusted so that the patient's heart rate achieved the training heart rate calculated according to the Karvonen formula. At the baseline and after 8 weeks, all the patients underwent the HRV assessment. RESULTS HRV indices in the patients with diabetes were significantly lower as compared to the patients without diabetes in SDNN, TP, LF parameters, both at the baseline and after 8 weeks of CR. After 8 weeks of CR, a significant improvement of TP, SDNN, pNN50% and HF occurred in the patients without diabetes, whereas in the patients with diabetes only HF component improved significantly. CONCLUSIONS As regards HRV indices, CR seems to be less effective in patients with CAD and type-2 diabetes.
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Affiliation(s)
- Katarzyna Szmigielska
- Katarzyna Szmigielska, Department of Sports Medicine, Medical University of Lodz, ul. Pomorska 251, Łódź 92-213, Poland.
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Solaro N, Pagani M, Lucini D. Altered Cardiac Autonomic Regulation in Overweight and Obese Subjects: The Role of Age-and-Gender-Adjusted Statistical Indicators of Heart Rate Variability and Cardiac Baroreflex. Front Physiol 2021; 11:567312. [PMID: 33584323 PMCID: PMC7876296 DOI: 10.3389/fphys.2020.567312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022] Open
Abstract
In the context of functional determinants of cardiovascular risk, a simple excess in body weight, as indexed by a rise in body mass index (BMI), plays a significant, well-recognized causal role. Conversely, BMI reductions toward normal result in an improvement of risk. Obesity is associated with impaired cardiac autonomic regulation (CAR), through either vagal or sympathetic mechanisms, which could favor the tendency to foster hypertension. Here we study the changing properties of the relationship between increasing grades of BMI and CAR in a population of 756 healthy subjects (age 35.9 ± 12.41 years, 37.4% males, 21.6% overweight, and 16% obese). Evaluation of CAR is based on autoregressive spectral analysis of short-term RR interval and systolic arterial pressure variability, from which a multitude of indices, treated overall as autonomic nervous system (ANS) proxies, is derived. Inspection of the study hypothesis that elevated BMI conditions associate significantly with alterations of CAR, independently of age and gender, is carried out using a mix of statistical transformations, exploratory factor analysis, non-parametric testing procedures, and graphical tools particularly well suited to address alterations of CAR as a disturbed process. In particular, to remove the effects of the inter-individual variability, deriving from components like age, gender or ethnicity, and to reduce the number of ANS proxies, we set up six age-and-gender-adjusted CAR indicators, corresponding to four ANS latent domains (oscillatory, amplitude, pressure, and pulse), cardiac baroreflex regulation, and autonomic nervous system index (ANSI). An impairment of the CAR indicators is overall evident in the overweight group and more marked in the obesity group. Empirical evidence is strong (9/9 concordant non-parametric test results) for pressure domain, almost strong (8/9) for ANSI, medium-strong for baroreflex (6/9) and pulse (7/9), weak for oscillatory (2/9) and amplitude (1/9) domains. In addition, the distribution of the CAR indicators corresponding to pressure, pulse, baroreflex, and ANSI is skewed toward the unfavorable abscissa extremity, particularly in the obese group. The significant association of increased BMI with progressive impairments of CAR regarding specifically the pressure domain and the overall ANS performance might underscore the strong hypertensive tendency observed in obesity.
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Affiliation(s)
- Nadia Solaro
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Massimo Pagani
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Daniela Lucini
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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Two early rehabilitation training models in male patients after coronary artery bypass surgery: application of continuous walking training as an alternative to interval cycle ergometer training. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:87-93. [PMID: 32728371 PMCID: PMC7379224 DOI: 10.5114/kitp.2020.97265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/17/2020] [Indexed: 11/17/2022]
Abstract
Introduction Walking training is a good alternative to the commonly used cycle ergometer training. It is still necessary to develop rehabilitation programs based on walking characterized by a high degree of safety and effectiveness. Aim Application of continuous walking training as an alternative to interval cycle ergometer training in men after coronary artery bypass graft (CABG) surgery, using the 6-minute walk test (6-MWT) to determine the initial training load. Material and methods Forty-four men aged 45 to 76 years, up to 3 months after CABG surgery, were randomly assigned to continuous training on a treadmill (study group) or interval training on a cycle ergometer (control group), performed 6 times per week (12-15 sessions). Participants underwent the treadmill exercise stress test (TEST) and 6-MWT at the begining and after completion of the rehabilitation program. Before and 3 minutes after the 6th and 12th training session blood lactate concentration was determined. Results Energy expenditure in TEST increased from 4.4 to 6.3 MET in the study group and from 5.0 to 6.5 MET in the control group. Distance walked in 6-MWT increased from 420 to 519 m and from 438 to 510 m, respectively. Resting heart rate (HR) and double product (DP) decreased only in the study group as well as systolic blood pressure (SBP), HR and DP at peak exercise load in baseline TEST. Mean energy expenditure during training sessions was 2.6 MET in the study group and 2.8 MET in the control group (NS). Exercise blood lactate concentration did not exceed 2.0 mmol/l in both groups. Conclusions Both rehabilitation programs were of similar effectiveness and their intensity did not exceed the anaerobic threshold.
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ButtÀ C, Tuttolomondo A, Casuccio A, DI Raimondo D, Miceli G, Cuttitta F, Zappulla V, Corpora F, Pinto A. Autonomic dysfunction in a group of lower extremities arterial disease outpatients. Minerva Cardiol Angiol 2020; 69:28-35. [PMID: 32643892 DOI: 10.23736/s2724-5683.20.05094-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The understanding of the specific role of sympathetic neural control and dysregulation in lower extremities arterial disease (LEAD) is still very limited. Aim of our study was to investigate the autonomic profile in LEAD patients and to evaluate if the eventual autonomic alterations were more severe in patients with advanced disease. METHODS We enrolled all consecutive outpatients with LEAD referred to our Departments between July 2012 and September 2014. They were compared to a group of matched outpatients without LEAD. All patients underwent Holter ECG monitoring. Time-domain analysis of heart rate variability (HRV) was evaluated. RESULTS Compared to controls, patients with LEAD had a lower SDNN (P=0.007) and SDANN (P=0.003). Patients with clinically advanced LEAD had a lower SDNN (P=0.006) and SDANN (P=0.004) compared to LEAD patients with less severe disease and to those without disease. CONCLUSIONS LEAD patients had a reduced SDNN and SDANN than patients without LEAD. Autonomic dysfunction was more significant in clinically advanced stages of disease. This association did not relate to ABI value but to clinical stage of disease.
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Affiliation(s)
- Carmelo ButtÀ
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy -
| | - Antonino Tuttolomondo
- Unit of Internal Medicine and Stroke, Department of Health Promotion, Maternal and Child, Internal and Specialized Medicine, University of Palermo, Palermo, Italy
| | - Alessandra Casuccio
- Department of Health Promotion, Maternal and Child, Internal and Specialized Medicine, University of Palermo, Palermo, Italy
| | - Domenico DI Raimondo
- Unit of Internal Medicine and Stroke, Department of Health Promotion, Maternal and Child, Internal and Specialized Medicine, University of Palermo, Palermo, Italy
| | - Giuseppe Miceli
- Unit of Internal Medicine and Stroke, Department of Health Promotion, Maternal and Child, Internal and Specialized Medicine, University of Palermo, Palermo, Italy
| | - Francesco Cuttitta
- Unit of Internal Medicine and Stroke, Department of Health Promotion, Maternal and Child, Internal and Specialized Medicine, University of Palermo, Palermo, Italy
| | - Valentina Zappulla
- Unit of Internal Medicine and Stroke, Department of Health Promotion, Maternal and Child, Internal and Specialized Medicine, University of Palermo, Palermo, Italy
| | - Francesca Corpora
- Unit of Internal Medicine and Stroke, Department of Health Promotion, Maternal and Child, Internal and Specialized Medicine, University of Palermo, Palermo, Italy
| | - Antonio Pinto
- Unit of Internal Medicine and Stroke, Department of Health Promotion, Maternal and Child, Internal and Specialized Medicine, University of Palermo, Palermo, Italy
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Armstrong K, Gokal R, Todorsky W. Neuromodulating Influence of Two Electroacupuncture Treatments on Heart Rate Variability, Stress, and Vagal Activity. J Altern Complement Med 2020; 26:928-936. [PMID: 32654498 DOI: 10.1089/acm.2019.0267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction: Although the clinical use of electro-acupuncture is widespread, the neuromodulating influence of various applied frequencies is not well established. Objectives: Heart rate variability (HRV), stress and parasympathetic recovery are closely related to health, longevity and vitality in humans. This study was undertaken to determine the influence of different electro-therapy frequencies on various autonomic nervous system markers when applied to a Battlefield Acupuncture Protocol (BFA). Design: A detailed comparison of autonomic nervous system (ANS) response to low frequency (LF) 2.5 Hz electro-acupuncture and mid-frequency (MF) 15 Hz electro-acupuncture applied by point stimulation to acupuncture points was undertaken on 2 groups of 12 patients. Interventions: Both LFEA and MFEA were applied to Battlefield Acupuncture protocol, consisting of five (5) key acupuncture ear (auricular) points that isolate the autonomic nervous system (ANS) and central nervous system's role in the chronic/acute pain cycle. Evaluations entailed an advanced status of autonomic nervous system (ANS) function through Electro-Cardiogram (ECG) baseline markers reflecting: sympathetic stress (SI); parasympathetic vagal tone (high frequency [HF]) and heart rate variability (HRV = total power). All were repeated subsequent to electro-therapy using 2 separate electro-modalities of low-frequency (2.5 Hz) electro-acupuncture (LFEA) and Mid-Frequency (15 Hz) electro-acupuncture (MFEA). All 24 patients received one (1) elector-acupuncture session. Results: The autonomic nervous system response to LFEA (2.5 Hz) reflected a statistically significant pre-post improvement in three of the markers collected: heart rate variability (HRV) improved by 61% [p = 0.002]; sympathetic stress (SI) reduced 42% [p = 0.002]; and parasympathetic vagal tone (HF) increased 56% [p = 0.017]. In contrast, MFEA (15 Hz) showed positive but non-significant changes in outcomes in all nervous system markers. Conclusions: The autonomic nervous system response with LFEA showed a measurable reduction in sympathetic stress with subsequent improvement in vagal tone, and HRV. This positive sympathetic nervous system deactivation from LFEA application shown in this study could have a major impact on other pathologies related to human health and longevity. Further cohort studies are warranted to determine the validity of these outcomes.
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Affiliation(s)
- Kelly Armstrong
- Center for Pain & Stress Research Ltd., St. Augustine, FL, USA
| | - Raman Gokal
- University of Manchester, Royal Infirmary, Manchester, United Kingdom.,Center for Pain & Stress Research Ltd., Toronto, Canada
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Exercise-based cardiac rehabilitation and parasympathetic function in patients with coronary artery disease: a systematic review and meta-analysis. Clin Auton Res 2020; 31:187-203. [PMID: 32270406 DOI: 10.1007/s10286-020-00687-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/24/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The effects of exercise-based cardiac rehabilitation (CR) on parasympathetic modulation are controversial. This systematic review and meta-analysis aims to (a) determine the effect of exercise-based CR on heart-rate-derived indices associated with cardiac parasympathetic modulation in resting and post-exercise conditions in coronary artery disease (CAD) patients and (b) identify the possible moderator variables of the effect of exercise-based CR on parasympathetic modulation. METHODS We searched CENTRAL and Web of Science up to November 2018 for the following terms: adult CAD patients, controlled exercise-based CR interventions and parasympathetic modulation measured in resting (vagal-related heart rate variability [HRV] indices of the root mean square of the differences in successive in RR interval [RMSSD] and high frequency [HF]) and post-exercise (heart rate recovery [HRR]) pre- and post-intervention. We estimated a random-effects model of standardised mean difference (SMD) and mean difference (MD) for vagal-related HRV indices and HRR, respectively. We assessed the influence of categorical and continuous variables. RESULTS The overall effect size showed significant differences in RMSSD (SMD+ = 0.30; 95% confidence interval [CI] = 0.12-0.49) and HRR (MD+ = 5.35; 95% CI = 4.08-6.61 bpm) in favour of the exercise-based CR group. The overall effect size showed no differences in HF between groups (SMD+ = 0.14; 95% CI, -0.12-0.40). Heterogeneity analyses reached statistical significance, with high heterogeneity for HF (p < 0.001; I2 = 70%) and HRR (p < 0.001; I2 = 85%). Analysis of the moderator variables showed that the effect on HRR is greater in young patients (p = 0.008) and patients treated with percutaneous intervention (p = 0.020). CONCLUSIONS Exercise-based CR improves the post-exercise parasympathetic function, with greater effects in younger CAD patients and in those who were revascularised with percutaneous intervention. The effects on resting parasympathetic function are more controversial due to methodological inconsistencies in measuring HRV, with the use of RMSSD recommended instead of HF because its results show higher consistency. Future studies involving women, focusing on methodological issues, and performing other training methods are needed to increase our knowledge about this topic.
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Abstract
Coronary artery disease (CAD) can be obstructive or nonobstructive. Patients with nonobstructive and stable angina pectoris are usually women. Nonobstructive CAD is caused by endothelial dysfunction at the microvascular level, such as cardiac syndrome X and coronary slow flow syndrome. Even if coronary anatomy is nonobstructive, the presence of myocardial ischemia is a major determinant for the exercise program. CAD is a chronic inflammatory disease, and the progression of the disease can lead to a rapid change in the functional capacity of CAD patients. Exercise training is a major component of cardiac rehabilitation and reduces cardiovascular mortality, morbidity, and rehospitalization as well as improves psychological stress and controls risk factors of CAD, such as diabetes mellitus, hypertension, and obesity. It is possible that the quality of life of patients with CAD can be improved by using appropriate exercise therapy. However, the exercise programs among CAD patients are highly underutilized. This chapter will summarize the research progress of exercise in the prevention and treatment of CAD as well as how to create safe exercise programs and the importance of exercise for patients with CAD. In addition, exercise training has fundamental beneficial effects on ischemic and nonischemic heart failure.
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Affiliation(s)
- Aydin Akyuz
- Faculty of Medicine, Department of Cardiology, University Hospital, Namık Kemal University, Tekirdag, Turkey.
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O'Keefe EL, O'Keefe JH, Lavie CJ. Exercise Counteracts the Cardiotoxicity of Psychosocial Stress. Mayo Clin Proc 2019; 94:1852-1864. [PMID: 31451292 DOI: 10.1016/j.mayocp.2019.02.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/15/2019] [Accepted: 02/19/2019] [Indexed: 12/12/2022]
Abstract
Physical inactivity and psychosocial stress are prevalent in residents of the United States. The purpose of this article is to review the interaction between these 2 conditions and examine the effects of exercise on stress and cardiovascular (CV) health. A query of scientific references between 1974 to 2018 was performed using the PubMed search engine accessing the MEDLINE database using the search terms psychosocial stress, CV disease (CVD), physical activity, exercise, cardiac rehabilitation, and team sports. Psychosocial stress is a strong independent risk factor for adverse CV events. Conversely, people who experience CV events subsequently have drastically elevated rates of new-onset mental health disorders, including depression and anxiety. Psychosocial stress and CVD often trigger self-reinforcing feedback loops that can worsen mental health and cardiac prognosis. Exercise predictably improves CV health and prognosis and also is effective at lowering levels of psychosocial stress. Group exercise in particular seems to provide social support while at the same time boosting fitness levels and, thus, may be the single most important intervention for patients with concomitant CVD and emotional stress. Collaborative physical activity, such as group exercise, team sports, interactive physical play, and cardiac rehabilitation programs, have the potential to improve mental health and CV prognosis.
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Affiliation(s)
- Evan L O'Keefe
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - James H O'Keefe
- University of Missouri-Kansas City and Saint Luke's Mid America Heart Institute, New Orleans, LA
| | - Carl J Lavie
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, New Orleans, LA.
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14
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Ritti-Dias RM, Correia MDA, Andrade-Lima A, Cucato GG. Exercise as a therapeutic approach to improve blood pressure in patients with peripheral arterial disease: current literature and future directions. Expert Rev Cardiovasc Ther 2018; 17:65-73. [DOI: 10.1080/14779072.2019.1553676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Aluísio Andrade-Lima
- Department of Physical Education, Federal University of Sergipe, Aracaju, Brazil
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15
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Maddison R, Rawstorn JC, Stewart RAH, Benatar J, Whittaker R, Rolleston A, Jiang Y, Gao L, Moodie M, Warren I, Meads A, Gant N. Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial. Heart 2018; 105:122-129. [PMID: 30150328 PMCID: PMC6352408 DOI: 10.1136/heartjnl-2018-313189] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 12/17/2022] Open
Abstract
Objective Compare the effects and costs of remotely monitored exercise-based cardiac telerehabilitation (REMOTE-CR) with centre-based programmes (CBexCR) in adults with coronary heart disease (CHD). Methods Participants were randomised to receive 12 weeks of telerehabilitation or centre-based rehabilitation. REMOTE-CR provided individualised exercise prescription, real-time exercise monitoring/coaching and theory-based behavioural strategies via a bespoke telerehabilitation platform; CBexCR provided individualised exercise prescription and coaching via established rehabilitation clinics. Outcomes assessed at baseline, 12 and/or 24 weeks included maximal oxygen uptake (V̇O2max, primary) modifiable cardiovascular risk factors, exercise adherence, motivation, health-related quality of life and programme delivery, hospital service utilisation and medication costs. The primary hypothesis was a non-inferior between-group difference in V̇O2max at 12 weeks (inferiority margin=−1.25 mL/kg/min); inferiority margins were not set for secondary outcomes. Results 162 participants (mean 61±12.7 years, 86% men) were randomised. V̇O2 max was comparable in both groups at 12 weeks and REMOTE-CR was non-inferior to CBexCR (REMOTE-CR-CBexCR adjusted mean difference (AMD)=0.51 (95% CI −0.97 to 1.98) mL/kg/min, p=0.48). REMOTE-CR participants were less sedentary at 24 weeks (AMD=−61.5 (95% CI −117.8 to −5.3) min/day, p=0.03), while CBexCR participants had smaller waist (AMD=1.71 (95% CI 0.09 to 3.34) cm, p=0.04) and hip circumferences (AMD=1.16 (95% CI 0.06 to 2.27) cm, p=0.04) at 12 weeks. No other between-group differences were detected. Per capita programme delivery (NZD1130/GBP573 vs NZD3466/GBP1758) and medication costs (NZD331/GBP168 vs NZD605/GBP307, p=0.02) were lower for REMOTE-CR. Hospital service utilisation costs were not statistically significantly different (NZD3459/GBP1754 vs NZD5464/GBP2771, p=0.20). Conclusion REMOTE-CR is an effective, cost-efficient alternative delivery model that could—as a complement to existing services—improve overall utilisation rates by increasing reach and satisfying unique participant preferences.
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Affiliation(s)
- Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Jonathan Charles Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Ralph A H Stewart
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
| | - Jocelyne Benatar
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Lan Gao
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Ian Warren
- Department of Computer Science, University of Auckland, Auckland, New Zealand
| | - Andrew Meads
- Department of Computer Science, University of Auckland, Auckland, New Zealand
| | - Nicholas Gant
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
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16
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Heart rate variability alterations in late life depression: A meta-analysis. J Affect Disord 2018; 235:456-466. [PMID: 29679898 DOI: 10.1016/j.jad.2018.04.071] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 03/20/2018] [Accepted: 04/07/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE There is strong evidence for a bi-directional relationship between heart-health and depression in later life, but the physiological mechanisms underlying this relationship remain unclear. Heart rate variability is one promising factor that might help explain this relationship. We present results of a meta-analysis that considers heart rate variability alterations in older adults with depression. METHODS Literature search of Embase, PsychInfo and Medline revealed five clinical studies and six observational studies that examined the relationship between heart rate variability and depression in adults with a mean age over 60. These studies were included in this meta-analysis. RESULTS Heart rate variability was reduced among older adults with clinical depression (N = 550), relative to healthy controls (Hedges' g = -0.334, 95%CI [-0.579, -0.090], p = .007). When high-frequency and low-frequency heart rate variability were investigated separately, only low-frequency heart rate variability was significantly reduced in depressed patients (Hedges' g = -0.626, 95%CI [-1.083, -0.169], p = .007). A similar but weaker pattern of results was found in the observational studies. Most findings remained significant among unmedicated depressed older adults. LIMITATIONS Evidence of effect-size heterogeneity was found in the clinical studies, indicating the need for more well-designed research in the area. CONCLUSION Heart rate variability is reduced among older adults with depression, and this effect is not fully attributable to antidepressant medication use. Specifically, low-frequency heart rate variability may be reduced in depressed older adults. Heart rate variability warrants further attention, as it could help inform research into the prevention and treatment of depression in later life.
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17
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The prognostic value of heart rate recovery in patients with coronary artery disease: A systematic review and meta-analysis. Am Heart J 2018; 199:163-169. [PMID: 29754656 DOI: 10.1016/j.ahj.2018.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 02/07/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Routine outpatient care of patients with coronary artery disease (CAD) lacks a simple measure of physical fitness and risk of mortality. Heart rate recovery (HRR) is noninvasive and easily obtainable in outpatient settings. Prior studies have suggested that delayed postexercise HRR in the first minutes is associated with mortality in several types of populations. However, a comprehensive overview of the prognostic value of delayed HRR for time to mortality specifically in CAD patients is not available. The purpose of the current meta-analysis is to evaluate the prognostic value of delayed HRR in CAD patients. METHODS We conducted a systematic search in OVID MEDLINE and OVID EMBASE to identify studies reporting on HRR and risk of incident cardiovascular events or mortality in CAD patients. Hazard ratios for delayed versus nondelayed HRR were pooled using random-effects meta-analysis. RESULTS Four studies were included, comprising 2,428 CAD patients. The study quality of the included studies was rated moderate (n = 2) to high (n = 2). Delayed HRR was defined by ≤12 to ≤21 beat/min in the recovery period. During follow-up (range 2.0-9.8 years), 151 patients died (6.2% [range 2.5%-19.5%]). Only data on mortality could be pooled. Heterogeneity was limited (I2 = 32%; P = .23); pooled unadjusted hazard ratio for mortality, based on 3 studies, was 5.8 (95% CI 3.2-10.4). CONCLUSIONS In CAD patients, delayed HRR is significantly associated with all-cause mortality. As exercise testing is performed routinely in CAD patients, HRR can be considered in monitoring exercise; still, further research must investigate the addition of HRR in current risk scores.
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Fiogbé E, Ferreira R, Sindorf MAG, Tavares SA, de Souza KP, de Castro Cesar M, Lopes CR, Moreno MA. Water exercise in coronary artery disease patients, effects on heart rate variability, and body composition: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018. [PMID: 29542251 DOI: 10.1002/pri.1713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE It is important to assess the effectiveness and efficiency of water-based training programs in order to prescribe it as an alternative in cardiac rehabilitation for patients who have coronary artery disease (CAD). In these patients, autonomic dysfunction is an important physiological change strongly associated with adverse outcomes, morbidity, and mortality. Given that the beneficial effects of physical training in CAD patients have been traditionally evidenced with programs involving land-based aerobic exercises, this study aims to evaluate the effects of water aerobic exercise training (WAET) on the autonomic modulation of heart rate (HR) and body composition, in the rehabilitation of CAD patients. METHODS Twenty-six male subjects with CAD were randomly divided into a training group (n = 14), submitted to the WAET, and a control group (n = 12). The WAET consisted of 3 weekly sessions on alternate days, totalling 48 sessions. The analysis of HR variability was used to evaluate the autonomic modulation of HR, from the recording of R-R intervals for 15 min, at rest in the supine position, and the body composition was evaluated through the bioelectrical impedance analysis. RESULTS Only the training group participants had improvement in the HR variability indices; patterns without variation decreased (0V, p = .005) and an increase of patterns of two different variations (p < .001), Shannon entropy (p = .02), and normalized conditional entropy (p = .03), whereas the control group had an increase of 0V (p = .04) and a decrease of normalized conditional entropy (p = .01). All body composition variables remained unchanged. CONCLUSIONS The WAET protocol improved the cardiac autonomic modulation of patients with CAD and can be considered as exercise training strategy in cardiac rehabilitation programs.
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Affiliation(s)
- Elie Fiogbé
- Post-Graduation Program in Physical Therapy, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil.,Post-Graduation Program in Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Rafaela Ferreira
- Post-Graduation Program in Physical Therapy, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Márcio Antônio Gonçalves Sindorf
- Post-Graduation Program in Physical Education, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Silvia Aparecida Tavares
- Graduation Program in Physical Therapy, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Keiti Passoni de Souza
- Graduation Program in Physical Therapy, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Marcelo de Castro Cesar
- Post-Graduation Program in Physical Education, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Charles Ricardo Lopes
- Post-Graduation Program in Physical Education, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil.,Faculty Adventist of Hortolândia (UNASP), Hortolândia, SP, Brazil
| | - Marlene Aparecida Moreno
- Post-Graduation Program in Physical Therapy, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil
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Lucini D, Sala R, Spataro A, Malacarne M, Benzi M, Tamorri S, Pagani M. Can the use of a single integrated unitary autonomic index provide early clues for eventual eligibility for olympic games? Eur J Appl Physiol 2018; 118:919-926. [PMID: 29450627 DOI: 10.1007/s00421-018-3822-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/06/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Optimal autonomic regulation and stress resilience might be considered critical elements of athletic performance. We hypothesize that a novel unitary autonomic index for sports (ANSIs), together with a somatic stress related symptom score (4SQ) might help characterize athletes who were eventually selected for the Rio 2016 Olympic Games Italian team (Rio +). METHODS In this retrospective study we examined 778 athletes (age 24.4 ± 6.7 yrs) who underwent a planned yearly pre-participation screening. All athletes underwent clinical, autonomic and exercise ECG evaluation. The combination of vagal and sympathetic indices from RR variability into ANSIs was performed by radar plot and percent ranking of index variables. We assessed (Rio +) versus (Rio -) athletes also after subdivision into three sport intensity groups (low, mid and high intensity). RESULTS Overall there were no significant differences between (Rio +) and (Rio -) athletes when considering individual spectral derived variables. Conversely, the unitary Index ANSIs was significantly higher in (Rio +) compared to (Rio -) athletes (respectively 54.5 ± 29.5 and 47.9 ± 28.4 p = 0.014). This difference was particularly evident (p = 0.017) in the group of athletes characterized by both high static and dynamic components. 4SQ was smaller in the (Rio +) group, particularly in the groups of athletes characterized by both low-medium static and dynamic components. CONCLUSIONS ANSIs, a proxy of integrated cardiac autonomic regulation and simple assessment of resilience to stress, may differentiate Italian athletes who were eventually selected for participation in the 2016 Rio Olympic Games from those who were not, suggesting the possibility of a "winning functional phenotype".
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Affiliation(s)
- Daniela Lucini
- BIOMETRA University of Milano, Via Alessandro Manzoni, 56, 20089, Rozzano (Milano), Italy. .,Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano (Milano), Italy.
| | - Roberto Sala
- BIOMETRA University of Milano, Via Alessandro Manzoni, 56, 20089, Rozzano (Milano), Italy
| | | | - Mara Malacarne
- BIOMETRA University of Milano, Via Alessandro Manzoni, 56, 20089, Rozzano (Milano), Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano (Milano), Italy
| | | | | | - Massimo Pagani
- BIOMETRA University of Milano, Via Alessandro Manzoni, 56, 20089, Rozzano (Milano), Italy
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20
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Choe Y, Han JY, Choi IS, Park HK. Changes in Oxygen Consumption and Heart Rate After Acute Myocardial Infarction During 6-Month Follow-up. PM R 2017; 10:587-593. [PMID: 29222074 DOI: 10.1016/j.pmrj.2017.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/09/2017] [Accepted: 11/20/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Exercise intensity is a particularly important determinant of physiological responses to exercise training in patients with acute myocardial infarction. Heart rate (HR) is commonly used as a practical way of prescribing and monitoring exercise as specific intensities based on a linear relationship between the percentage of maximum HR (%HRmax) and the percentage of maximum oxygen consumption (%VO2max) regardless of age, gender, or exercise mode. OBJECTIVE To examine the change in variability in the correlation between %HRmax and %VO2max after acute myocardial infarction. DESIGN Retrospective study. SETTING Regional cardio-cerebrovascular center at a tertiary hospital. PATIENTS A total of 66 patients were enrolled who were referred for cardiac rehabilitation (CR) after percutaneous intervention, and who had reached stage 3 of the modified Bruce Protocol (mBP) on an exercise tolerance test (ETT). METHODS There were 54 men and 12 women with an average age of 56.7 ± 9.48 years, ejection fraction (EF) of 56.4% ± 8.89%, and body mass index (BMI) of 24.73 ± 2.86 kg/m2. All patients participated in a 4-week outpatient CR program and underwent ETT with a gas analyzer to determine maximal heart rate and maximal oxygen consumption before CR and 1 month, 3 months, and 6 months after CR. MAIN OUTCOME MEASUREMENTS VO2max and HRmax were defined as the highest values attained during the ETT. The HR and VO2 values at each stage of the mBP were expressed as percentages of their maximum. %HRmax and %VO2max were calculated at each stage of the mBP. RESULTS The maximum METs and VO2max significantly improved at 1 month after CR, but not significantly at 3 and 6 months after CR. The correlation between VO2max and HRmax progressively changed in a favorable manner during CR. The relationship between %HRmax and %VO2max indicated a coefficient of variation before and 1, 3, and 6 months after of 0.800, 0.826, 0.832, and 0.880, respectively. CONCLUSIONS This study showed that the %HRmax correlates better with the %VO2max in the late-stage post-AMI than in the initial stage. We should therefore set and monitor the exercise intensity using maximal oxygen consumption in the early stage of exercise training after onset of acute myocardial infarction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yuri Choe
- Department of Physical & Rehabilitation Medicine, Gwangju Veterans Hospital, Gwangju City, Republic of Korea.,Department of Physical & Rehabilitation Medicine, Regional Cardiocerebrovascular Center, Center for Aging and Geriatrics, Chonnam National University Medical School & Hospital, 42 Jebong-Ro, Dong-Gu, Gwangju, 501-757, Republic of Korea.,Department of Physical & Rehabilitation Medicine, Regional Cardiocerebrovascular Center, Center for Aging and Geriatrics, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Jae-Young Han
- Department of Physical & Rehabilitation Medicine, Gwangju Veterans Hospital, Gwangju City, Republic of Korea.,Department of Physical & Rehabilitation Medicine, Regional Cardiocerebrovascular Center, Center for Aging and Geriatrics, Chonnam National University Medical School & Hospital, 42 Jebong-Ro, Dong-Gu, Gwangju, 501-757, Republic of Korea.,Department of Physical & Rehabilitation Medicine, Regional Cardiocerebrovascular Center, Center for Aging and Geriatrics, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - In-Sung Choi
- Department of Physical & Rehabilitation Medicine, Gwangju Veterans Hospital, Gwangju City, Republic of Korea.,Department of Physical & Rehabilitation Medicine, Regional Cardiocerebrovascular Center, Center for Aging and Geriatrics, Chonnam National University Medical School & Hospital, 42 Jebong-Ro, Dong-Gu, Gwangju, 501-757, Republic of Korea.,Department of Physical & Rehabilitation Medicine, Regional Cardiocerebrovascular Center, Center for Aging and Geriatrics, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Hyeng-Kyu Park
- Department of Physical & Rehabilitation Medicine, Gwangju Veterans Hospital, Gwangju City, Republic of Korea.,Department of Physical & Rehabilitation Medicine, Regional Cardiocerebrovascular Center, Center for Aging and Geriatrics, Chonnam National University Medical School & Hospital, 42 Jebong-Ro, Dong-Gu, Gwangju, 501-757, Republic of Korea.,Department of Physical & Rehabilitation Medicine, Regional Cardiocerebrovascular Center, Center for Aging and Geriatrics, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
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The Influence of Comprehensive Cardiac Rehabilitation on Heart Rate Variability Indices after CABG is More Effective than after PCI. J Cardiovasc Transl Res 2017; 11:50-57. [PMID: 29204786 DOI: 10.1007/s12265-017-9773-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study was to evaluate the influence of cardiac rehabilitation (CR) on heart rate variability (HRV) indices in men with coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). The study population consisted of 131 male patients with CAD prospectively and consecutively admitted to CR after PCI n = 72, or CABG n = 59. Participants performed cycle ergometer interval training for 45 min three times a week for 8 weeks. At baseline and after 8 weeks, all patients underwent the HRV assessment. HRV indices in CAGB survivals were significantly lower in comparison to PCI patients at baseline. Significant increases were seen for SDNN, rMSSD, and HF in the CABG group and only in HF component in PCI group after 8 weeks of CR. Eight weeks of CR seems to be more effective in CABG patients than patients after PCI.
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22
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Elliott AD, Maatman B, Emery MS, Sanders P. The role of exercise in atrial fibrillation prevention and promotion: Finding optimal ranges for health. Heart Rhythm 2017; 14:1713-1720. [DOI: 10.1016/j.hrthm.2017.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Indexed: 11/29/2022]
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Lucini D, Marchetti I, Spataro A, Malacarne M, Benzi M, Tamorri S, Sala R, Pagani M. Heart rate variability to monitor performance in elite athletes: Criticalities and avoidable pitfalls. Int J Cardiol 2017; 240:307-312. [PMID: 28495249 DOI: 10.1016/j.ijcard.2017.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Spectral analysis of Heart Rate Variability (HRV) is a simple, non-invasive technique that is widely used in sport to assess sympatho-vagal regulation of the heart. Its employment is increasing partly due to the rising usage of wearable devices. However data acquisition using these devices may be suboptimal because they cannot discriminate between sinus and non-sinus beats and do not record any data regarding respiratory frequency. This information is mandatory for a correct clinical interpretation. METHODS This study involved 974 elite athletes, all of them underwent a complete autonomic assessment, by way of Autoregressive HRV analysis. RESULTS In 91 subjects (9% of the total population) we observed criticalities of either cardiac rhythm or respiration. Through perusal of one-lead ECG analysis we observed that 77 subjects had atrial or ventricular ectopy, i.e. conditions which impair stationarity and sinus rhythm. Running anyway autonomic nervous system analysis in this population, we observed that RR variance and raw values of LF and HF regions are significantly higher in arrhythmic subjects. In addition 14 subjects had slow (about 6 breath/min, 0.1Hz) respiration. This condition clouds the separation between LF from HF spectral regions of RR interval variability, respectively markers of the prevalent sympathetic and vagal modulation of SA node and of their synergistic interaction. CONCLUSIONS Caution must be payed when assessing HRV with non-ECG wearable devices. Recording ECG signal and ensuring that respiratory rate is higher than 10 breath/min are both prerequisites for a more reliable analysis of HRV particularly in athletes.
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Affiliation(s)
- Daniela Lucini
- University of Milano, BIOMETRA, via Vanvitelli 32, Milano 20129, Italy; Sezione Medicina dell'Esercizio e Patologie Funzionali, Humanitas Clinical and Research Center, via Manzoni 56, Rozzano 20089, Italy.
| | - Ilaria Marchetti
- University of Milano, BIOMETRA, via Vanvitelli 32, Milano 20129, Italy
| | - Antonio Spataro
- Sports Medicine Institute CONI, largo G Onesti 1, Rome 00197, Italy
| | - Mara Malacarne
- University of Milano, BIOMETRA, via Vanvitelli 32, Milano 20129, Italy; Sezione Medicina dell'Esercizio e Patologie Funzionali, Humanitas Clinical and Research Center, via Manzoni 56, Rozzano 20089, Italy
| | - Manuela Benzi
- Sports Medicine Institute CONI, largo G Onesti 1, Rome 00197, Italy
| | - Stefano Tamorri
- Sports Medicine Institute CONI, largo G Onesti 1, Rome 00197, Italy
| | - Roberto Sala
- University of Milano, BIOMETRA, via Vanvitelli 32, Milano 20129, Italy
| | - Massimo Pagani
- University of Milano, BIOMETRA, via Vanvitelli 32, Milano 20129, Italy
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24
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Medeiros WM, de Luca FA, de Figueredo Júnior AR, Mendes FAR, Gun C. Heart rate recovery improvement in patients following acute myocardial infarction: exercise training, β-blocker therapy or both. Clin Physiol Funct Imaging 2017; 38:351-359. [DOI: 10.1111/cpf.12420] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Wladimir M. Medeiros
- Laboratory of Exercise Physiology and Cardiac Rehabilitation (GERFE); Department of Medicine and Physiotherapy; Santo Amaro University (UNISA); São Paulo Brazil
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE); Respiratory Division; Department of Medicine; Federal University of São Paulo (UNIFESP); São Paulo Brazil
- Department of Rehabilitation and Functional Capacity; School of Physiotherapy; Ibirapuera University (UNIB); São Paulo Brazil
| | - Fabio A. de Luca
- Laboratory of Exercise Physiology and Cardiac Rehabilitation (GERFE); Department of Medicine and Physiotherapy; Santo Amaro University (UNISA); São Paulo Brazil
| | - Alcides R. de Figueredo Júnior
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE); Respiratory Division; Department of Medicine; Federal University of São Paulo (UNIFESP); São Paulo Brazil
| | - Felipe A. R. Mendes
- Department of Rehabilitation and Functional Capacity; School of Physiotherapy; Ibirapuera University (UNIB); São Paulo Brazil
| | - Carlos Gun
- Laboratory of Exercise Physiology and Cardiac Rehabilitation (GERFE); Department of Medicine and Physiotherapy; Santo Amaro University (UNISA); São Paulo Brazil
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Sala R, Malacarne M, Solaro N, Pagani M, Lucini D. A composite autonomic index as unitary metric for heart rate variability: a proof of concept. Eur J Clin Invest 2017; 47:241-249. [PMID: 28102898 DOI: 10.1111/eci.12730] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/16/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study addresses whether a unitary cardiac autonomic nervous system index (ANSI), obtained combining multiple metrics from heart rate variability (HRV) into a radar plot could provide an easy appreciation of autonomic performance in a clinical setting. MATERIALS AND METHODS Data are standardized using percentile ranking of autonomic proxies from a relatively large reference population (n = 1593, age 39 ± 13 years). Autonomic indices are obtained from autoregressive spectral analysis of (ECG derived) HRV at rest and during standing up. A reduced ANSI (using RR, RR variance and rest-stand difference of LFnu) is then constructed as a radar plot, quantified according to its combined area and tested against different risk subgroups. RESULTS With growing risk profile, there is a marked reduction of the rank value of ANSI, quantified individually by the radar plot area. The practical usefulness of the approach was tested in small groups of additional subjects putatively characterized by elevated or poor autonomic performance. Data show that elite endurance athletes are characterized by elevated values of ANSI (80·6 ± 14·9, P < 0·001) while subjects with either Type 1 or Type 2 diabetes show lower values (DM1 = 37·0 ± 18·9 and DM2 = 26·8 ± 23·3, P = 0·002), and patients with coronary artery disease (CAD) represent a nadir (17 ± 20, P < 0·001). CONCLUSIONS This observational study shows the feasibility of testing simpler metrics of cardiac autonomic regulation based on a multivariate unitary index in a preventive setting. This simple approach might foster a wider application of HRV in the clinical arena, and permit an easier appreciation of autonomic performance.
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Affiliation(s)
- Roberto Sala
- BIOMETRA Department, University of Milano, Milano, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Mara Malacarne
- BIOMETRA Department, University of Milano, Milano, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Nadia Solaro
- Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milano, Italy
| | - Massimo Pagani
- BIOMETRA Department, University of Milano, Milano, Italy
| | - Daniela Lucini
- BIOMETRA Department, University of Milano, Milano, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Hospital, Rozzano, Italy
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Kachur S, Menezes AR, De Schutter A, Milani RV, Lavie CJ. Significance of Comorbid Psychological Stress and Depression on Outcomes After Cardiac Rehabilitation. Am J Med 2016; 129:1316-1321. [PMID: 27480388 DOI: 10.1016/j.amjmed.2016.07.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression is associated with increased mortality in stable coronary heart disease. Cardiac rehabilitation and exercise training has been shown to decrease depression, psychological stress, and mortality after a coronary heart disease event. The presence of depression at completion of cardiac rehabilitation and exercise training is associated with increased mortality. However, it is unknown if depression with comorbid psychological risk factors such as anxiety or hostility confers an additional mortality disadvantage. We evaluated the mortality effect of anxiety and hostility on depression after cardiac rehabilitation and exercise training. PATIENTS AND METHODS We studied 1150 patients with coronary heart disease following major coronary heart disease events who had completed formal cardiac rehabilitation and exercise training. Using Kellner questionnaires, stress levels were measured in 1 of 3 domains: anxiety, hostility, and depression (with an aggregated overall psychological stress score) and divided into 3 groups: nondepressed (n = 1072), depression alone (n = 18), and depression with anxiety or hostility (n = 60). Subjects were analyzed for all-cause mortality over 161 months of follow-up (mean 6.4 years) by National Death Index. RESULTS Depression after cardiac rehabilitation was not common (6.8%; mortality 20.8%) but when present, frequently associated with either anxiety or hostility (77% of depressed patients; mortality 22.0%). After adjustment for age, sex, ejection fraction, and baseline peak oxygen consumption, depression alone (hazard ratio [HR] 1.73, P = .04), as well as depression with comorbid psychological stress, was associated with higher mortality (HR 1.98, P = .03). Furthermore, our data showed an increased mortality when both anxiety and hostility were present in addition to depression after cardiac rehabilitation (HR 2.41, P = .04). CONCLUSIONS After cardiac rehabilitation, depression, when present, is usually associated with other forms of psychological stress, which confers additional mortality. More measures are needed to address psychological stress after cardiac rehabilitation.
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Affiliation(s)
- Sergey Kachur
- Graduate Medical Education Department, Ocala Regional Medical Center, Fla
| | - Arthur R Menezes
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, La
| | - Alban De Schutter
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, La
| | - Richard V Milani
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, La
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, La.
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Lavie CJ, Menezes AR, De Schutter A, Milani RV, Blumenthal JA. Impact of Cardiac Rehabilitation and Exercise Training on Psychological Risk Factors and Subsequent Prognosis in Patients With Cardiovascular Disease. Can J Cardiol 2016; 32:S365-S373. [DOI: 10.1016/j.cjca.2016.07.508] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/08/2016] [Accepted: 07/08/2016] [Indexed: 11/16/2022] Open
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Giallauria F, De Lorenzo A, Pilerci F, Manakos A, Lucci R, Psaroudaki M, D'Agostino M, Del Forno D, Vigorito C. Long-term effects of cardiac rehabilitation on end-exercise heart rate recovery after myocardial infarction. ACTA ACUST UNITED AC 2016; 13:544-50. [PMID: 16874143 DOI: 10.1097/01.hjr.0000216547.07432.fb] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heart rate recovery (HRR) is a marker of vagal tone that is a powerful predictor of mortality in patients with coronary artery disease. DESIGN This study aims at evaluating the effects of long-term exercise training on HRR after acute myocardial infarction (AMI), in order to clarify whether prolonged exercise training could maintain a long-term improvement of HRR. METHODS Forty-four patients after AMI were enrolled in a 3-month hospital-based exercise training programme. At the end, patients were subdivided into two groups: group A (n=22), patients discharged with a specific home-based exercise training programme and instructions for improving leisure-time physical activity; group B (n=22), patients discharged with generic instructions to maintain physical activity. All patients underwent a cardiopulmonary exercise test before, at the end of 3 months exercise training and at 6 months follow-up. RESULTS At the end of the hospital-based exercise training programme we observed an increase in peak oxygen consumption [VO2peak; from 13.9+/-3.6 to 18+/-2.7 ml/kg per min (A) and from 14.1+/-3.9 to 17.9+/-2.1 ml/kg per min (B), P<0.001] and in HRR [from 17.1+/-1.8 to 23.4+/-1.4 beats/min (A), and from 18.8+/-2.1 to 24.3+/-1.9 beats/min (B), P<0.001]. At 6 months' follow-up we observed a further improvement in VO2peak (from 18.0+/-2.7 to 20.3+/-2.7 ml/kg per min, P<0.001) and in HRR (from 23.4+/-1.4 to 27.8+/-2.1 beats/min, P<0.001) in group A, but a significant decrease in VO2peak and in HRR in group B (P<0.001). CONCLUSION Long-term exercise training is useful for maintaining or improving the beneficial results of the standard 3-month exercise training programme on cardiovascular capacity and HRR. This observation may bear beneficial prognostic effects on patients after AMI.
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Affiliation(s)
- Francesco Giallauria
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University of Naples Federico II, Naples, Italy.
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Tsai SW, Lin YW, Wu SK. The effect of cardiac rehabilitation on recovery of heart rate over one minute after exercise in patients with coronary artery bypass graft surgery. Clin Rehabil 2016; 19:843-9. [PMID: 16323383 DOI: 10.1191/0269215505cr915oa] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the effects of cardiac rehabilitation on the recovery of heart rate over 1 min after peak exercise of patients who received coronary artery bypass graft (CABG) surgery. Design: Thirty subjects who received CABG surgery were randomly assigned to enter or not enter a cardiac rehabilitation exercise programme (cardiac rehabilitation n=15; control group n=15). Setting: Outpatient cardiac rehabilitation centre in a national medical hospital. Interventions: Patients assigned to the cardiac rehabilitation group received 36 sessions of the exercise programme, three times a week, with the intensity designed to achieve an individual 60-85% peak heart rate in cardiopulmonary exercise test. Patients assigned to the control group did not get further advice about a specific exercise programme. Main outcome measures: Resting heart rate and recovery of heart rate over 1 min after a peak exercise test at discharge and three months later were collected. The heart rates were analysed with computer-recorded electrocardiogram. Results: At follow-up, the 15 patients in the cardiac rehabilitation group had a significantly lower resting heart rate (77.469± 9.49 versus 92.319± 10.18 bpm; p B± 0.001) and a significantly higher recovery of heart rate over 1 min (16.389± 6.32 versus 11.389± 4.81 bpm; p ± 0.03) compared with the control group. There were also significant reductions in resting heart rates (cardiac rehabilitation p ± 0.001; control p=0.05) and improvements in recovery on heart rate over 1 min (cardiac rehabilitation p ± 0.001; control p= 0.001) compared with baseline measurements in both the cardiac rehabilitation and control groups. Conclusion: Cardiac rehabilitation had a positive effect on the improvement of recovery on heart rate over 1 min in patients with coronary artery disease who received CABG surgery.
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Affiliation(s)
- Sen-Wei Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung and Department of Physical Therapy, HungKuang University, Taichung County, Taiwan
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Cardiac Rehabilitation Prevents Recurrent Revascularization in Patients With Coronary Heart Disease: A POPULATION-BASED COHORT STUDY IN TAIWAN. J Cardiopulm Rehabil Prev 2016; 36:250-7. [PMID: 26959494 DOI: 10.1097/hcr.0000000000000168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effects of cardiac rehabilitation (CR) provided within the first 3 months of revascularization on reducing recurrent revascularization in patients with coronary heart disease in Taiwan. METHODS In this population-based cohort study, we used the claims data of 1 million beneficiaries who were randomly selected from all beneficiaries enrolled in Taiwan's National Health Insurance program from 1996 to 2000. Between 2000 and 2007, 2838 patients underwent a first-event revascularization. Of these patients, 442 (15.6%) underwent CR within the first 3 months of admission for revascularization. The remaining 84.4% (n = 2396) served as the non-CR group. All the study patients were followed-up until the end of 2008 for any recurrent revascularization. A propensity score-adjusted Cox proportional hazard model was used to estimate the relative risk of recurrent revascularization associated with CR. RESULTS During the 1- to 9-year follow-up, 69 patients (15.6%) in the CR group and 840 (35.1%) patients in the non-CR group experienced recurrent revascularization. The results of the propensity score-adjusted Cox proportional hazard regression analysis showed that CR was significantly associated with a reduced risk of recurrent revascularization with a hazard ratio of 0.48 (95% CI, 0.37 to -0.62). CONCLUSIONS Cardiac rehabilitation within the first 3 months of revascularization is significantly associated with a reduced risk of recurrent revascularization. This preventive effect was more pronounced in men compared with other subgroups of patients.
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Jorat M, Raafat S, Ansari Z, Mahdavi-Anari L, Ghanbari-Firoozabadi M. The Impact of Hospital-Based Cardiac Rehabilitation on Signal Average ECG Parameters of the Heart After Myocardial Infarction. Res Cardiovasc Med 2015; 4:e26353. [PMID: 26448915 PMCID: PMC4592540 DOI: 10.5812/cardiovascmed.26353v2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/11/2015] [Accepted: 04/19/2015] [Indexed: 11/17/2022] Open
Abstract
Background: Cardiac rehabilitation is a combination of integrated programs aimed at improving outcomes in patients recovering from heart events. Objectives: The present study aimed to evaluate the early benefits of supervised exercise training on electrophysiological function of post-ischemic myocardium. In this regard, signal-averaged electrocardiogram (SAECG) was used. Patients and Methods: Between May and September 2012, all patients (n = 100) admitted to our center, with the diagnosis of acute Myocardial Infarction (MI), were enrolled in this study. Every other patient was assigned to two groups receiving either inpatient cardiac rehabilitation plus standard post-MI care (cases) or only standard post-MI care (controls). Electrophysiological function was assessed by SAECG in all the patients at baseline and on the day 5. The patients were considered as having late potential if they had abnormalities in at least two SAECG indices. Results: Cardiac rehabilitation led to significant improvements in QRS duration (P < 0.001), square root of amplitude in the last 40 ms (P < 0.001) and duration of terminal signal with low amplitude (P < 0.001). Cardiac rehabilitation also resulted in amelioration of SAECG parameters; frequency of patients with late potential significantly decreased from 64% to 20% after five days (P < 0.001). Conclusions: Supervised in-hospital exercise training was associated with improvements in SAECG-measured electrical activity post-MI.
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Affiliation(s)
- Mohammadvahid Jorat
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Sina Raafat
- Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
| | - Zahra Ansari
- Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
- Corresponding author: Zahra Ansari, Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran. Fax: +98-3535253335, E-mail:
| | - Leila Mahdavi-Anari
- Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
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Sala R, Malacarne M, Pagani M, Lucini D. Evidence of increased cardiac parasympathetic drive in subjects meeting current physical activity recommendations. Clin Auton Res 2015; 25:285-91. [PMID: 26359269 DOI: 10.1007/s10286-015-0300-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Aerobic fitness seems to provide extra protection to the cardiovascular system beyond changing the traditional risk factors, a phenomenon referred to as the risk factor gap model. Aerobic fitness may possibly lead to improved autonomic regulation. The Task Force of the American Heart Association supports a national campaign to reach specific cardiovascular health goals considering various metrics, including recommended physical activity (PA) volumes. It may be clinically relevant to assess whether autonomic remodeling occurs in those who adhere to the PA recommendations. METHODS We studied 39 healthy subjects (22 males and 17 females), subdivided into two groups, according to whether they were meeting or not meeting PA recommendations (150 min/week of moderate aerobic activity, or 75 min/week of vigorous aerobic activity, or a combination of both). For each group, we evaluated aerobic capacity (VO2 Peak), body composition (Fat Mass) and autonomic nervous system profile, by way of mono and bivariate spectral analysis of cardiovascular beat by beat variability. RESULTS Subjects following PA recommendations show higher RR period, higher RR variance, greater absolute power of the respiratory component of RR variability (HFRR) and higher index alpha (a measure of spontaneous baroreflex). Moreover, as expected, the group that was meeting or exceeding current PA recommendations had higher VO2 peak, less fat mass and greater weekly energy expenditure. CONCLUSION Data show that subjects meeting current PA recommendations present a phenotype suggestive of enhanced parasympathetic drive to the SA node. This finding is compatible with the hypothesis that a more favorable autonomic profile is part of the mechanisms of the risk factor gap.
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Affiliation(s)
- Roberto Sala
- University of Milan, Milan, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Mara Malacarne
- Exercise Medicine Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.,Biometra Department, University of Milan, Milan, Italy
| | | | - Daniela Lucini
- Exercise Medicine Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy. .,Biometra Department, University of Milan, Milan, Italy.
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The Effect of Park and Urban Environments on Coronary Artery Disease Patients: A Randomized Trial. BIOMED RESEARCH INTERNATIONAL 2015; 2015:403012. [PMID: 26161399 PMCID: PMC4486308 DOI: 10.1155/2015/403012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/18/2014] [Indexed: 12/02/2022]
Abstract
Aim. To test the hypothesis that walking in a park has a greater positive effect on coronary artery disease (CAD) patients' hemodynamic parameters than walking in an urban environment. Methods. Twenty stable CAD patients were randomized into two groups: 30-minute walk on 7 consecutive days in either a city park or busy urban street. Wilcoxon signed-rank test was employed to study short-term (30 min) and cumulative changes (following 7 consecutive days of exposure) in resting hemodynamic parameters in different environments. Results. There were no statistically significant differences in the baseline and peak exercise systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), exercise duration, or HR recovery in urban versus park exposure groups. Seven days of walking slightly improved all hemodynamic parameters in both groups. Compared to baseline, the city park group exhibited statistically significantly greater reductions in HR and DBP and increases in exercise duration and HR recovery. The SBP and DBP changes in the urban exposed group were lower than in the park exposed group. Conclusions. Walking in a park had a greater positive effect on CAD patients' cardiac function than walking in an urban environment, suggesting that rehabilitation through walking in green environments after coronary events should be encouraged.
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Pagani M, Lucini D. Cost-effectiveness of preparticipation screening of athletes with ECG in Europe and Algeria. Intern Emerg Med 2015; 10:125-7. [PMID: 25605676 DOI: 10.1007/s11739-014-1180-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Massimo Pagani
- University of Milano, Corso Magenta 83/2, 20123, Milan, Italy,
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Fiuza-Luces C, Garatachea N, Berger NA, Lucia A. Exercise is the real polypill. Physiology (Bethesda) 2014; 28:330-58. [PMID: 23997192 DOI: 10.1152/physiol.00019.2013] [Citation(s) in RCA: 312] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The concept of a "polypill" is receiving growing attention to prevent cardiovascular disease. Yet similar if not overall higher benefits are achievable with regular exercise, a drug-free intervention for which our genome has been haped over evolution. Compared with drugs, exercise is available at low cost and relatively free of adverse effects. We summarize epidemiological evidence on the preventive/therapeutic benefits of exercise and on the main biological mediators involved.
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Jelinek HF, Huang ZQ, Khandoker AH, Chang D, Kiat H. Cardiac rehabilitation outcomes following a 6-week program of PCI and CABG Patients. Front Physiol 2013; 4:302. [PMID: 24198786 PMCID: PMC3812547 DOI: 10.3389/fphys.2013.00302] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/02/2013] [Indexed: 12/03/2022] Open
Abstract
Coronary artery events requiring intervention are associated with depressed cardiac autonomic function. Whether a 6-week cardiac rehabilitation (CR) differs in effectiveness in improving exercise capacity (6MWT), cardiorespiratory function (peakVO2), and autonomic function (HRV) following either cardiac bypass surgery (CABG) or percutaneous coronary revascularization (PCI) is unknown. The current study therefore compared the change in 6MWT and peak VO2 to HRV variables following a 6-week CR program and with patients having either PCI or CABG. Thirty-eight patients, (PCI, n = 22 and CABG, n = 16) participated in the CR program and results for pre and post 6 min walk test (6MWT), peakVO2, and heart rate variability (HRV) were obtained. Our study has shown that a 6 weeks program following either PCI or CABG improves function. However, the effect on post-CABG differs to that of post-PCI patients. The change in distance walked (6MWT, metres) was higher in the CABG (Δ6MWT: 61, p < 0.001) compared to the PCI group (Δ6MWT: 41, p < 0.001). Maximum exercise capacity (peak VO2, ml/kg.min) also changed significantly with a greater change in the CABG group (ΔPCI: 0.7, p < 0.001; ΔCABG: 1.0, p < 0.001) but did not reach normal population values. Although an improvement in HRV parameters was noted for the PCI group, a statistically significant improvement in HRV was observed only in the CABG group for the following; SDNN (ms) (baseline vs. post-rehabilitation (median ± IQR): 31.2 ± 25.6 vs. 51.8 ± 23.1, p < 0.01), RMSSD (19.32 ± 19.9 vs. 42.1 ± 34.2, p < 0.01); LF (ms(2)) (191 ± 216 vs. 631 ± 693, p < 0.01) and HF (107 ± 201 vs. 449 ± 795.0, p < 0.05). A significant interaction in the PCI group but not in the CABG group was observed using correlation analysis between the 6MWT and peak VO2 with HRV parameters indicating that being healthier that is, a better 6MWT and peak VO2 led to better HRV results but no significant effect of CR in the PCI group. When the results were investigated for baseline 6MWT and peak VO2 effect using a covariate analysis, a significant influence of CR on HRV parameters was retained in the CABG group (p = 0.0072). Our study indicates that a 6-weeks CR program benefits both patient groups in terms of exercise capacity, cardiorespiratory function and autonomic nervous system modulation of heart rate, with CABG patients showing the most improvement. HRV can be a useful additional variable to gauge cardiac function following CR.
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Affiliation(s)
- Herbert F. Jelinek
- Australian School of Advanced Medicine, Macquarie UniversitySydney, NSW, Australia
- Department of Biomedical Engineering, Khalifa University of Science, Technology and ResearchAbu Dhabi, United Arab Emirates
- School of Community Health, Charles Sturt UniversityAlbury, NSW, Australia
| | - Zhaoqi Q. Huang
- Department of Cardiology, The Third Affiliated Hospital of Guangzhou Medical CollegeGuangzhou, China
- Department of Cardiac Rehabilitation, Sydney Adventist HospitalSydney, NSW, Australia
| | - Ahsan H. Khandoker
- Department of Biomedical Engineering, Khalifa University of Science, Technology and ResearchAbu Dhabi, United Arab Emirates
| | - Dennis Chang
- Centre for Complementary Medicine Research, University of Western SydneySydney, NSW, Australia
| | - Hosen Kiat
- Australian School of Advanced Medicine, Macquarie UniversitySydney, NSW, Australia
- Department of Cardiac Rehabilitation, Sydney Adventist HospitalSydney, NSW, Australia
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The physical effects of aromatherapy in alleviating work-related stress on elementary school teachers in taiwan. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:853809. [PMID: 24228065 PMCID: PMC3818840 DOI: 10.1155/2013/853809] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/28/2013] [Accepted: 09/04/2013] [Indexed: 11/17/2022]
Abstract
People use aromatherapy to relieve the symptoms of physical and psychological stress. However, previous studies have not precisely clarified a scientific basis for the beneficial effects of aromatherapy. Therefore, the overall purpose of this study was to elucidate the beneficial effect of aromatherapy in relieving work-related stress. Twenty-nine elementary school teachers from Taiwan participated in this study. The experimental procedures comprised 2 phases. First, we verified the effect of aromatherapy by conducting 2 blind tests. We used natural bergamot essential oil extracted from plants and synthesized a chemical essential oil as the placebo to do the aromatherapy. Second, we analyzed the performance of the aromatherapy treatment on the teachers who had various workloads. We measured the teachers' heart rate variability to evaluate their autonomic nervous system activity. The results show that only the natural bergamot essential oil had an effect and that the aromatherapy treatment relieved work-related stress of teachers with various workloads. However, the aromatherapy treatment had a weak effect on young teachers who had a heavy workload. Moreover, the aromatherapy treatment exhibited no effect on teachers who belong to the abnormal body mass index subgroup having a heavy workload.
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Oliveira NL, Ribeiro F, Alves AJ, Teixeira M, Miranda F, Oliveira J. Heart rate variability in myocardial infarction patients: Effects of exercise training. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Oliveira NL, Ribeiro F, Alves AJ, Teixeira M, Miranda F, Oliveira J. Heart rate variability in myocardial infarction patients: effects of exercise training. Rev Port Cardiol 2013; 32:687-700. [PMID: 23993292 DOI: 10.1016/j.repc.2013.02.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 02/04/2013] [Indexed: 12/18/2022] Open
Abstract
Heart rate variability (HRV) is a simple and noninvasive measure that estimates cardiac autonomic modulation, mainly the parasympathetic contribution. Increased sympathetic and/or decreased parasympathetic nervous activity is seen in post-myocardial infarction (MI) patients. Consequently, these patients present reduced HRV, which has been associated with increased risk of adverse events and mortality. Exercise training, recommended as a complementary therapy for patients with cardiovascular disease, has shown numerous beneficial effects. The main aim of the present manuscript was to provide a critical review of studies investigating the effects of exercise training on cardiac autonomic modulation, through HRV, in MI patients and the possible mechanisms involved. Despite conflicting evidence, exercise training appears to be a useful therapeutic intervention to improve the unbalanced autonomic function of MI patients. Finally, the mechanisms involved are not yet well understood, but nitric oxide bioavailability and angiotensin II levels seem to play an important role.
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Affiliation(s)
- Nórton Luís Oliveira
- Research Center in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.
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Ramos RP, Alencar MCN, Treptow E, Arbex F, Ferreira EMV, Neder JA. Clinical usefulness of response profiles to rapidly incremental cardiopulmonary exercise testing. Pulm Med 2013; 2013:359021. [PMID: 23766901 PMCID: PMC3666297 DOI: 10.1155/2013/359021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 12/17/2012] [Accepted: 01/15/2013] [Indexed: 02/06/2023] Open
Abstract
The advent of microprocessed "metabolic carts" and rapidly incremental protocols greatly expanded the clinical applications of cardiopulmonary exercise testing (CPET). The response normalcy to CPET is more commonly appreciated at discrete time points, for example, at the estimated lactate threshold and at peak exercise. Analysis of the response profiles of cardiopulmonary responses at submaximal exercise and recovery, however, might show abnormal physiologic functioning which would not be otherwise unraveled. Although this approach has long been advocated as a key element of the investigational strategy, it remains largely neglected in practice. The purpose of this paper, therefore, is to highlight the usefulness of selected submaximal metabolic, ventilatory, and cardiovascular variables in different clinical scenarios and patient populations. Special care is taken to physiologically justify their use to answer pertinent clinical questions and to the technical aspects that should be observed to improve responses' reproducibility and reliability. The most recent evidence in favor of (and against) these variables for diagnosis, impairment evaluation, and prognosis in systemic diseases is also critically discussed.
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Affiliation(s)
- Roberta P. Ramos
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Maria Clara N. Alencar
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Erika Treptow
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Flávio Arbex
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Eloara M. V. Ferreira
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - J. Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University and Kingston General Hospital, Richardson House, 102 Stuart Street, Kingston, ON, Canada K7L 2V6
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Correlation and Discrepancies Between Obesity by Body Mass Index and Body Fat in Patients With Coronary Heart Disease. J Cardiopulm Rehabil Prev 2013; 33:77-83. [DOI: 10.1097/hcr.0b013e31828254fc] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Baum P, Petroff D, Classen J, Kiess W, Blüher S. Dysfunction of autonomic nervous system in childhood obesity: a cross-sectional study. PLoS One 2013; 8:e54546. [PMID: 23358101 PMCID: PMC3554723 DOI: 10.1371/journal.pone.0054546] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 12/14/2012] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To assess the distribution of autonomic nervous system (ANS) dysfunction in overweight and obese children. METHODS Parasympathetic and sympathetic ANS function was assessed in children and adolescents with no evidence of impaired glucose metabolism by analysis of heart rate variability (low frequency power ln(LF), high frequency power, ln(HF); ln(LF/HF) ratio, ratio of longest RR interval during expiration to shortest interval during inspiration (E/I ratio), root mean square of successive differences (RMSSD); sympathetic skin response (SSR); and quantitative pupillography (pupil diameter in darkness, light reflex amplitude, latency, constriction velocity, re-dilation velocity). The relationship of each ANS variable to the standard deviation score of body mass index (BMI-SDS) was assessed in a linear model considering age, gender and pubertal stage as co-variates and employing an F-statistic to compare the fit of nested models. Group comparisons between normal weight and obese children as well as an analysis of dependence on insulin resistance (as indexed by the Homeostasis Model Assessment of Insulin Resistance, HOMA-IR) were performed for parameters shown to correlate with BMI-SDS. Statistical significance was set at 5%. RESULTS Measurements were performed in 149 individuals (mean age 12.0 y; 90 obese 45 boys; 59 normal weight, 34 boys). E/I ratio (p = 0.003), ln(HF) (p = 0.03), pupil diameter in darkness (p = 0.01) were negatively correlated with BMI-SDS, whereas ln(LF/HF) was positively correlated (p = 0.05). Early re-dilation velocity was in trend negatively correlated to BMI-SDS (p = 0.08). None of the parameters that depended significantly on BMI-SDS was found to be significantly correlated with HOMA-IR. CONCLUSION These findings demonstrate extended ANS dysfunction in obese children and adolescents, affecting several organ systems. Both parasympathetic activity and sympathetic activity are reduced. The conspicuous pattern of ANS dysfunction raises the possibility that obesity may give rise to dysfunction of the peripheral autonomic nerves resembling that observed in normal-weight diabetic children and adolescents.
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Affiliation(s)
- Petra Baum
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Joseph Classen
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
- Department of Women and Child Health, University Hospital for Children and Adolescents, Leipzig, Germany
| | - Susann Blüher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
- Department of Women and Child Health, University Hospital for Children and Adolescents, Leipzig, Germany
- * E-mail:
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Swift DL, Lavie CJ, Johannsen NM, Arena R, Earnest CP, O'Keefe JH, Milani RV, Blair SN, Church TS. Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J 2013; 77:281-92. [PMID: 23328449 DOI: 10.1253/circj.cj-13-0007] [Citation(s) in RCA: 219] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Substantial data have established that higher levels of physical activity (PA), participating in exercise training (ET), and higher overall cardiorespiratory fitness (CRF) provide considerable protection in the primary and secondary prevention of coronary heart disease (CHD). This review surveys data from epidemiological and prospective ET studies supporting the favorable impact of PA, ET, and CRF in primary CHD prevention. Clearly, cardiac rehabilitation and ET (CRET) programs have been underutilized for patients with CHD, particularly considering the effect of CRET on CHD risk factors, including CRF, obesity indices, fat distribution, plasma lipids, inflammation, and psychological distress, as well as overall morbidity and mortality. These data strongly support the routine referral of patients with CHD to CRET programs and that patients should be vigorously encouraged to attend CRET following major CHD events.
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Affiliation(s)
- Damon L Swift
- Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
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Currie KD, Rosen LM, Millar PJ, McKelvie RS, MacDonald MJ. Heart rate recovery and heart rate variability are unchanged in patients with coronary artery disease following 12 weeks of high-intensity interval and moderate-intensity endurance exercise training. Appl Physiol Nutr Metab 2013; 38:644-50. [PMID: 23724882 DOI: 10.1139/apnm-2012-0354] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Decreased heart rate variability and attenuated heart rate recovery following exercise are associated with an increased risk of mortality in cardiac patients. This study investigated the effects of 12 weeks of moderate-intensity endurance exercise (END) and a novel low-volume high-intensity interval exercise protocol (HIT) on measures of heart rate recovery and heart rate variability in patients with coronary artery disease (CAD). Fourteen males with CAD participated in 12 weeks of END or HIT training, each consisting of 2 supervised exercise sessions per week. END consisted of 30-50 min of continuous cycling at 60% peak power output (PPO). HIT involved ten 1-min intervals at 88% PPO separated by 1-min intervals at 10% PPO. Heart rate recovery at 1 min and 2 min was measured before and after training (pre- and post-training, respectively) using a submaximal exercise bout. Resting time and spectral and nonlinear domain measures of heart rate variability were calculated. Following 12 weeks of END and HIT, there was no change in heart rate recovery at 1 min (END, 40 ± 12 beats·min(-1) vs. 37 ± 19 beats·min(-1); HIT, 31 ± 8 beats·min(-1) vs. 35 ± 8 beats·min(-1); p ≥ 0.05 for pre- vs. post-training) or 2 min (END, 44 ± 18 beats·min(-1) vs. 43 ± 19 beats·min(-1); HIT, 42 ± 10 beats·min(-1) vs. 50 ± 6 beats·min(-1); p ≥ 0.05 for pre- vs. post-training). All heart rate variability indices were unchanged following END and HIT training. In conclusion, neither END nor HIT exercise programs elicited training-induced improvements in cardiac autonomic function in patients with CAD. The absence of improvements with training may be attributed to the optimal medical management and normative pretraining state of our sample.
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Affiliation(s)
- Katharine D Currie
- Department of Kinesiology, McMaster University, Ivor Wynne Centre, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
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Nauman J, Aspenes ST, Nilsen TIL, Vatten LJ, Wisløff U. A prospective population study of resting heart rate and peak oxygen uptake (the HUNT Study, Norway). PLoS One 2012; 7:e45021. [PMID: 23028740 PMCID: PMC3445602 DOI: 10.1371/journal.pone.0045021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 08/14/2012] [Indexed: 02/02/2023] Open
Abstract
Objectives We assessed the prospective association of resting heart rate (RHR) at baseline with peak oxygen uptake (VO2peak) 23 years later, and evaluated whether physical activity (PA) could modify this association. Background Both RHR and VO2peak are strong and independent predictors of cardiovascular morbidity and mortality. However, the association of RHR with VO2peak and modifying effect of PA have not been prospectively assessed in population studies. Methods In 807 men and 810 women free from cardiovascular disease both at baseline (1984–86) and follow-up 23 years later, RHR was recorded at both occasions, and VO2peak was measured by ergospirometry at follow-up. We used Generalized Linear Models to assess the association of baseline RHR with VO2peak, and to study combined effects of RHR and self-reported PA on later VO2peak. Results There was an inverse association of RHR at baseline with VO2peak (p<0.01). Men and women with baseline RHR greater than 80 bpm had 4.6 mL·kg−1·min−1 (95% confidence interval [CI], 2.8 to 6.3) and 1.4 mL·kg−1·min−1 (95% CI, −0.4 to 3.1) lower VO2peak at follow-up compared with men and women with RHR below 60 bpm at baseline. We found a linear association of change in RHR with VO2peak (p = 0.03), suggesting that a decrease in RHR over time is likely to be beneficial for cardiovascular fitness. Participants with low RHR and high PA at baseline had higher VO2peak than inactive people with relatively high RHR. However, among participants with relatively high RHR and high PA at baseline, VO2peak was similar to inactive people with relatively low RHR. Conclusion RHR is an important predictor of VO2peak, and serial assessments of RHR may provide useful and inexpensive information on cardiovascular fitness. The results suggest that high levels of PA may compensate for the lower VO2peak associated with a high RHR.
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Affiliation(s)
- Javaid Nauman
- K.G. Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Janse van Rensburg DC, Ker JA, Grant CC, Fletcher L. Effect of exercise on cardiac autonomic function in females with rheumatoid arthritis. Clin Rheumatol 2012; 31:1155-62. [DOI: 10.1007/s10067-012-1985-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 03/05/2012] [Accepted: 03/30/2012] [Indexed: 12/26/2022]
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Ribeiro F, Alves AJ, Teixeira M, Miranda F, Azevedo C, Duarte JA, Oliveira J. Exercise training enhances autonomic function after acute myocardial infarction: A randomized controlled study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.repce.2012.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ribeiro F, Alves AJ, Teixeira M, Miranda F, Azevedo C, Duarte JA, Oliveira J. Exercise training enhances autonomic function after acute myocardial infarction: a randomized controlled study. Rev Port Cardiol 2012; 31:135-41. [PMID: 22226329 DOI: 10.1016/j.repc.2011.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 09/08/2011] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Heart rate recovery, defined as the fall in heart rate during the first minute after exercise, is an indicator of autonomic function, and has been found to be an independent predictor of mortality after acute myocardial infarction. Exercise training has several well-known benefits in terms of cardiorespiratory fitness, modifiable cardiovascular risk factors and prognosis after acute coronary events. However, there are no randomized controlled studies in the literature evaluating the effects of exercise training per se, controlling for changes in medication and diet, on heart rate recovery. Thus, this study aims to assess the effects of exercise training on autonomic function in coronary artery disease patients recovering from acute myocardial infarction. METHODS Thirty-eight patients following a first acute myocardial infarction participated in this prospective randomized clinical trial. Patients were randomized into two groups: exercise training or control. The exercise group participated in an 8-week aerobic exercise program, while the control received standard medical care and follow-up. Changes in hemodynamics at rest and at peak exercise (heart rate, systolic and diastolic blood pressure, and rate pressure product), dietary intake, cardiorespiratory fitness, and heart rate recovery were assessed. RESULTS Medication and diet remained unchanged in both groups during the study period. The exercise-training group improved resting hemodynamics, particularly resting heart rate (from 68.0 ± 9.2 to 62.6 ± 8.7 bpm, p=0.030) and systolic blood pressure (from 135 ± 7.1 to 125.6 ± 11.3 mm Hg, p=0.012), cardiorespiratory fitness (from 30.8 ± 7.8 to 33.9 ± 8.3 ml/min/kg, p=0.016), and heart rate recovery (from 20 ± 6 to 24 ± 5 bpm, p=0.007). No significant changes were observed in the control group. CONCLUSIONS Exercise training improved autonomic function, assessed by heart rate recovery, resting heart rate and systolic blood pressure, in the absence of changes in diet or medication.
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Affiliation(s)
- Fernando Ribeiro
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.
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Do antioxidant vitamins ameliorate the beneficial effects of exercise training on insulin sensitivity? J Cardiopulm Rehabil Prev 2011; 31:211-6. [PMID: 21427602 DOI: 10.1097/hcr.0b013e318211e3d8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Exercise training has numerous health benefits, and in patients with type 2 diabetes mellitus and metabolic syndrome, it can improve insulin sensitivity and glucose control. A recent publication suggests that antioxidant vitamins (C and E) block these effects on blood glucose. This investigation was undertaken to determine whether antioxidant vitamins ameliorate the beneficial effects of cardiac rehabilitation and exercise training (CRET) on insulin sensitivity and glucose metabolism in patients with coronary heart disease (CHD). METHODS We assessed CHD risk factors, including clinical indices of glucose metabolism, and evaluated the effects of exercise training in 315 patients with CHD with diabetes mellitus and/or metabolic syndrome before and after a 3-month program of CRET. Patients were divided into 2 groups based on self-reported antioxidant vitamin (vitamins C and E) consumption. RESULTS Both groups, 113 patients (36%) consuming vitamins (Vits group) and 202 patients (64%) who reported no vitamin use (no-Vits group) were statistically similar at baseline. Following CRET, patients improved exercise capacity (10%, P < .0001), fasting blood glucose (-7%, P < .0001), percent body fat (-3%, P = .0001), high-sensitive Creactive protein (-31%, P = .003), and various lipids and behavioral parameters, but there was no significant improvement in glycosylated hemoglobin following formal CRET. Both Vits group and no-Vits group achieved statistically similar improvements in fasting blood glucose, body fat, and other CHD risk factors. CONCLUSIONS Commercially available antioxidant supplements (mean dose of 400 IU of vitamin E and 500 mg of vitamin C) do not ameliorate the health benefits of exercise training, including fasting blood glucose, in CHD patients
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