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Boettcher AE, Penfold HE, Currie KD. Exercise systolic blood pressures are unaffected by time of day in healthy young adults. J Hum Hypertens 2024; 38:568-574. [PMID: 38858588 DOI: 10.1038/s41371-024-00921-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/24/2024] [Accepted: 05/31/2024] [Indexed: 06/12/2024]
Abstract
Blood pressure (BP) assessment during exercise testing has the capacity to identify exaggerated exercise BP (EEBP). BP has a circadian rhythm; therefore, exercise BPs may change throughout the day complicating EEBP identification. The purpose of this study was to determine the effect of time of day on exercise BP in healthy young adults. Thirty-one participants [48% female; 23(4) years] completed a modified Bruce treadmill protocol in the morning (M), afternoon (A), and evening (E). Submaximal (stage 4) and peak (highest value) systolic BP (SBP) were determined and ΔSBP was calculated (peak SBP-pre-exercise SBP). Repeated-measures tests were used to compare SBP data. EEBP was defined as a submaximal SBP ≥ 170 mmHg. Chronotype was assessed using the Morning-Eveningness Questionnaire (MEQ) and Pearson correlations were used to determine the relationship between MEQ score and ΔSBP during all tests. Significance was set at P < 0.05. Submaximal SBP (M:159(25); A:156(16); E:162(24) mmHg; P = 0.295), peak SBP (M:177(32); A:184(25); E:185(26) mmHg; P = 0.087) and ΔSBP (M:62(29); A:67(23); 65(20) mmHg; P = 0.546) were similar across time points. Eight participants had an EEBP on at least two tests. MEQ scores were correlated with ΔSBP during the A test (r = 0.357, P = 0.049) and E test (r = 0.363, P = 0.045). In conclusion, time of day had no effect on SBP responses to exercise, but our correlational analysis suggests changes in SBP may differ between chronotypes depending on the time of day of exercise. Given the clinical value of EEBP, it is notable that 26% of our healthy young sample had EEBP.
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Affiliation(s)
- Amy E Boettcher
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Hannah E Penfold
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Katharine D Currie
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA.
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2
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Reliability of blood pressure responses used to define an exaggerated blood pressure response to exercise in young healthy adults. J Hum Hypertens 2023; 37:56-61. [PMID: 34642432 DOI: 10.1038/s41371-021-00623-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/25/2021] [Accepted: 10/01/2021] [Indexed: 01/31/2023]
Abstract
Exaggerated blood pressure (BP) responses (EBPR) to exercise are prognostic of future cardiovascular risk. The primary objective of this study was to assess the test-retest reliability of BP responses used to categorize EBPR as absent or present. Twenty-seven healthy adults [21(2) years; 12 males] with resting BP < 130/80 mmHg completed a modified Bruce protocol treadmill exercise test on two visits separated by 6 (3) days. BP measurements were obtained during exercise using an automated auscultatory device. Submaximal and maximal systolic and diastolic BP, the change in diastolic BP from rest to maximal diastolic BP, and the change in systolic BP relative to the change in exercise intensity, quantified using the metabolic equivalent of task (SBP/MET-slope) were determined. Test-retest reliability of these BP responses was assessed using intraclass correlation coefficients (ICC) with a value ≥0.61 considered as substantial reliability. Submaximal diastolic BP demonstrated substantial reliability in the total group (ICC = 0.670; P ≤ 0.001). In males, submaximal systolic BP (ICC = 0.655, P < 0.01), submaximal diastolic BP (ICC = 0.699; P < 0.01) and maximal systolic BP (ICC = 0.794; P ≤ 0.001) demonstrated substantial reliability. All other BP responses were not reliable. Despite the prognostic value of EBPR, only three BP responses used to categorize EBPR demonstrated substantial test-retest reliability in healthy young males. In clinical practice, these preliminary findings would support the use of exercise BPs to identify young males with elevated cardiovascular risk, but additional research is needed to improve the clinical utility of exercise BPs and EBPR in females.
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3
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McLaurin NN, Wang T, Chen LS, Tanaka H. A new and specific automated blood pressure device for exercise stress testing. J Hum Hypertens 2023; 37:150-154. [PMID: 36456722 PMCID: PMC9713731 DOI: 10.1038/s41371-022-00784-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
Blood pressure (BP) measurement plays a critical role in cardiac stress testing and is most commonly assessed manually. The emphasis of social distancing during the COVID-19 pandemic has renewed the interest in and the need for an automated BP device for incremental exercise stress testing. We assessed the accuracy of a new automated blood pressure device specifically manufactured for cardiac stress testing. Thirty-five adults aged 35 ± 16 years were studied during an incremental stress test on the cycle ergometer. Three observers measured BP simultaneously, two listening to Korotkoff sounds using a dual-headed stethoscope and one using headphones to listen to sounds generated by an automated BP device. With increasing workload, systolic BP increased progressively without significant differences in BP readings between any observer compared with the automated monitor at any stage during exercise. Systolic BP obtained with the BP machine was strongly correlated with those obtained by the stethoscope observers (r = 0.96) and the observer with headphones (r = 0.95). Diastolic BP obtained with the BP machine was moderately and significantly associated with those obtained by the stethoscope observers (r = 0.75) and the observer with headphones (r = 0.75). The automated BP monitor specifically made for cardiac stress testing accurately measured both systolic and diastolic blood pressure during exercise.
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Affiliation(s)
- Natalie N. McLaurin
- grid.89336.370000 0004 1936 9924Cardiovascular Aging Research Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX 78712 USA
| | - Tianyu Wang
- grid.89336.370000 0004 1936 9924Cardiovascular Aging Research Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX 78712 USA
| | - Lin-Sheng Chen
- grid.89336.370000 0004 1936 9924Cardiovascular Aging Research Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX 78712 USA
| | - Hirofumi Tanaka
- Cardiovascular Aging Research Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, 78712, USA.
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Schultz MG, Currie KD, Hedman K, Climie RE, Maiorana A, Coombes JS, Sharman JE. The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052819. [PMID: 35270514 PMCID: PMC8910717 DOI: 10.3390/ijerph19052819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
Abstract
High blood pressure (BP) is a leading risk factor for cardiovascular disease (CVD). The identification of high BP is conventionally based on in-clinic (resting) BP measures, performed within primary health care settings. However, many cases of high BP go unrecognised or remain inadequately controlled. Thus, there is a need for complementary settings and methods for BP assessment to identify and control high BP more effectively. Exaggerated exercise BP is associated with increased CVD risk and may be a medium to improve identification and control of high BP because it is suggestive of high BP gone undetected on the basis of standard in-clinic BP measures at rest. This paper provides the evidence to support a pathway to aid identification and control of high BP in clinical exercise settings via the measurement of exercise BP. It is recommended that exercise professionals conducting exercise testing should measure BP at a fixed submaximal exercise workload at moderate intensity (e.g., ~70% age-predicted heart rate maximum, stage 1-2 of a standard Bruce treadmill protocol). If exercise systolic BP is raised (≥170 mmHg), uncontrolled high BP should be assumed and should trigger correspondence with a primary care physician to encourage follow-up care to ascertain true BP control (i.e., home, or ambulatory BP) alongside a hypertension-guided exercise and lifestyle intervention to lower CVD risk related to high BP.
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Affiliation(s)
- Martin G. Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia; (R.E.C.); (J.E.S.)
- Correspondence: ; Tel.: +61-(0)-3-6226-4264; Fax: +61-(0)-3-6226-7704
| | - Katharine D. Currie
- Department of Kinesiology, Michigan State University, East Lansing, MI 48824, USA;
| | - Kristofer Hedman
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden;
| | - Rachel E. Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia; (R.E.C.); (J.E.S.)
| | - Andrew Maiorana
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University and Allied Health Department, Fiona Stanley Hospital, Perth, WA 6102, Australia;
| | - Jeff S. Coombes
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD 4072, Australia;
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia; (R.E.C.); (J.E.S.)
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5
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Angius L, Pageaux B, Crisafulli A, Hopker J, Marcora SM. Ischemic preconditioning of the muscle reduces the metaboreflex response of the knee extensors. Eur J Appl Physiol 2021; 122:141-155. [PMID: 34596759 PMCID: PMC8748374 DOI: 10.1007/s00421-021-04815-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/16/2021] [Indexed: 11/25/2022]
Abstract
Purpose This study investigated the effect of ischemic preconditioning (IP) on metaboreflex activation following dynamic leg extension exercise in a group of healthy participants. Method Seventeen healthy participants were recruited. IP and SHAM treatments (3 × 5 min cuff occlusion at 220 mmHg or 20 mmHg, respectively) were administered in a randomized order to the upper part of exercising leg’s thigh only. Muscle pain intensity (MP) and pain pressure threshold (PPT) were monitored while administrating IP and SHAM treatments. After 3 min of leg extension exercise at 70% of the maximal workload, a post-exercise muscle ischemia (PEMI) was performed to monitor the discharge group III/IV muscle afferents via metaboreflex activation. Hemodynamics were continuously recorded. MP was monitored during exercise and PEMI. Results IP significantly reduced mean arterial pressure compared to SHAM during metaboreflex activation (mean ± SD, 109.52 ± 7.25 vs. 102.36 ± 7.89 mmHg) which was probably the consequence of a reduced end diastolic volume (mean ± SD, 113.09 ± 14.25 vs. 102.42 ± 9.38 ml). MP was significantly higher during the IP compared to SHAM treatment, while no significant differences in PPT were found. MP did not change during exercise, but it was significantly lower during the PEMI following IP (5.10 ± 1.29 vs. 4.00 ± 1.54). Conclusion Our study demonstrated that IP reduces hemodynamic response during metaboreflex activation, while no effect on MP and PPT were found. The reduction in hemodynamic response was likely the consequence of a blunted venous return.
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Affiliation(s)
- Luca Angius
- Faculty of Health and Life Sciences, Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK.
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, UK.
| | - Benjamin Pageaux
- École de Kinésiologie et des Sciences de l'Activité Physique (EKSAP), Faculté de Médicine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - Antonio Crisafulli
- The Department of Medical Sciences, Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - James Hopker
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, UK
| | - Samuele Maria Marcora
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, UK
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
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6
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Differences in Blood Pressure and Workload Intensity During Arm and Leg Ergometry at Submaximal Target Heart Rates in College-Aged Individuals. Cardiopulm Phys Ther J 2021. [DOI: 10.1097/cpt.0000000000000181] [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]
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7
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Miyai N, Shiozaki M, Terada K, Takeshita T, Utsumi M, Miyashita K, Arita M. Exaggerated blood pressure response to exercise is associated with subclinical vascular impairment in healthy normotensive individuals. Clin Exp Hypertens 2020; 43:56-62. [PMID: 32799691 DOI: 10.1080/10641963.2020.1806292] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study was designed to evaluate the possible association between an exaggerated blood pressure (BP) response to exercise and subclinical vascular impairment in normotensive individuals. METHODS The study participants consisted of 92 untreated normotensive men (aged 42 ± 9 years) without a history of cardiovascular disease or stroke. A graded exercise test was conducted using a bicycle ergometer, and the mean arterial pressure (MAP) during submaximal exercise was evaluated. The brachial-ankle pulse wave velocity (baPWV) was measured as an index of arterial stiffness. The second peak of radial systolic BP (SBP2) was used as an estimate of central BP. The albumin-to-creatinine ratio (ACR) values were determined as the mean of two nonconsecutive spot urine specimens. RESULTS Compared with individuals with a normal response (MAP z-score < +1.0, n = 60), those with an exaggerated BP response to exercise (MAP z-score ≥ +1.0, n = 32) exhibited significantly higher baPWV (1412 ± 158 vs. 1250 ± 140 cm/s), radial SBP2 (122 ± 11 vs. 106 ± 13 mmHg), and greater log-ACR (0.93 ± 0.30 vs. 0.59 ± 0.23 mg/gCre). Multiple regression analysis revealed that an exaggerated BP response to exercise was significantly associated with baPWV (β = 0.198, P= .043), radial SBP2 (β = 0.156, P = .049), and log-ACR (β = 0.276, P = .006) independent of potential confounding factors. CONCLUSIONS These results suggest that subclinical vascular impairment is associated with an exaggerated increase in BP during exercise even in the absence of clinical hypertension.
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Affiliation(s)
- Nobuyuki Miyai
- School of Health and Nursing Science, Wakayama Medical University , Wakayama, Japan
| | - Maki Shiozaki
- Department of Hygiene, School of Medicine, Wakayama Medical University , Wakayama, Japan
| | - Kazufumi Terada
- Faculty of Budo and Sport Studies, Tenri University , Nara, Japan
| | - Tatsuya Takeshita
- Department of Public Health, School of Medicine, Wakayama Medical University , Wakayama, Japan
| | - Miyoko Utsumi
- School of Health and Nursing Science, Wakayama Medical University , Wakayama, Japan
| | - Kazuhisa Miyashita
- Department of Hygiene, School of Medicine, Wakayama Medical University , Wakayama, Japan
| | - Mikio Arita
- School of Health and Nursing Science, Wakayama Medical University , Wakayama, Japan.,Department of Cardiology, Sumiya Rehabilitation Hospital , Wakayama, Japan
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8
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Severin R, Sabbahi A, Albarrati A, Phillips SA, Arena S. Blood Pressure Screening by Outpatient Physical Therapists: A Call to Action and Clinical Recommendations. Phys Ther 2020; 100:1008-1019. [PMID: 32232372 PMCID: PMC7462048 DOI: 10.1093/ptj/pzaa034] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/27/2019] [Indexed: 01/02/2023]
Abstract
Hypertension (HTN) is among the leading global preventable risk factors for cardiovascular disease and premature mortality. Early detection and effective management of HTN have demonstrated significant reductions in mortality, morbidity rate, and health care costs. Furthermore, screening for HTN by nonphysician health care providers improves detection rates and medical management. As physical therapist practice advances to a more independent care model, physical therapists may serve as the first point of contact into the health care system, thereby necessitating a need for routine blood pressure (BP) monitoring. This is especially relevant in the outpatient physical therapist practice setting, where there is evidence for elevated BP measures among patients, yet omission of routine screening in this setting is well documented. Leading physical therapy professional organizations include statements in their guidelines that suggest that physical therapists have a duty to provide a standard of care that protects the safety and optimizes the overall health of patients under their care. Therefore, it is imperative not only that physical therapists include BP examination into routine practice protocols but that the knowledge and skills to accurately measure and interpret BP at rest and during exercise be integrated into the standard of care. The authors suggest that the profession of physical therapy proactively embrace their potential to address the national and worldwide HTN epidemic through routine assessment of BP, appropriate referral for elevated BP measures, and exploration of HTN management by physical therapists.
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Affiliation(s)
| | - Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago
| | - Ali Albarrati
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Shane A Phillips
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago
| | - Sara Arena
- Physical Therapy Program, School of Health Science, Oakland University, Rochester, Michigan
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9
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Zamani P, Proto EA, Mazurek JA, Prenner SB, Margulies KB, Townsend RR, Kelly DP, Arany Z, Poole DC, Wagner PD, Chirinos JA. Peripheral Determinants of Oxygen Utilization in Heart Failure With Preserved Ejection Fraction: Central Role of Adiposity. ACTA ACUST UNITED AC 2020; 5:211-225. [PMID: 32215346 PMCID: PMC7091498 DOI: 10.1016/j.jacbts.2020.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/27/2019] [Accepted: 01/02/2020] [Indexed: 01/04/2023]
Abstract
ΔAVo2 during exercise is a complex metric that incorporates into its calculation skeletal muscle blood flow and DmO2 across the skeletal muscle capillary membrane. Although ΔAVo2 was reduced in patients with HFpEF during both systemic and local (forearm) exercise, there was no difference in forearm DmO2 among subjects with HFpEF, those with hypertension, and healthy control subjects; therefore, abnormalities in forearm DmO2 cannot explain the reduced forearm ΔAVo2 seen in subjects with HFpEF. Local forearm exercise performance predicted about one-third of the variability in systemic aerobic capacity, demonstrating that peripheral factors are important in determining whole-body exercise tolerance. Degree of adiposity strongly correlated with ΔAVo2 during both local and whole-body exercise, suggesting that adipose tissue may play an active role in limiting exercise capacity in subjects with HFpEF.
The aim of this study was to determine the arteriovenous oxygen content difference (ΔAVo2) in adult subjects with and without heart failure with preserved ejection fraction (HFpEF) during systemic and forearm exercise. Subjects with HFpEF had reduced ΔAVo2. Forearm diffusional conductance for oxygen, a lumped conductance parameter that incorporates all impediments to the movement of oxygen from red blood cells in skeletal muscle capillaries into the mitochondria within myocytes, was estimated. Forearm diffusional conductance for oxygen was not different among adults with HFpEF, those with hypertension, and healthy control subjects; therefore, diffusional conductance cannot explain the reduced forearm ΔAVo2. Instead, adiposity was strongly associated with ΔAVo2, suggesting an active role for adipose tissue in reducing exercise capacity in patients with HFpEF.
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Key Words
- CO, cardiac output
- DEXA, dual-energy x-ray absorptiometry
- DmO2, skeletal muscle diffusional conductance for oxygen
- FIo2, fraction of inspired oxygen
- HFpEF
- HFpEF, heart failure with preserved ejection fraction
- MVC, maximal voluntary contraction force
- NT-proBNP, N-terminal pro–brain natriuretic peptide
- Po2, partial pressure of oxygen
- Vo2, oxygen consumption
- adiposity
- aerobic capacity
- exercise
- oxygen transport
- ΔAVo2, arteriovenous oxygen content difference
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Affiliation(s)
- Payman Zamani
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth A Proto
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy A Mazurek
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stuart B Prenner
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth B Margulies
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raymond R Townsend
- Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel P Kelly
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zoltan Arany
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David C Poole
- Departments of Kinesiology, Anatomy, and Physiology, Kansas State University, Manhattan, Kansas
| | - Peter D Wagner
- Division of Pulmonary Medicine, University of California-San Diego, San Diego, California
| | - Julio A Chirinos
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Moore MN, Picone DS, Callisaya ML, Srikanth V, Sharman JE, Schultz MG. Comparison of manual and automated auscultatory blood pressure during graded exercise among people with type 2 diabetes. J Clin Hypertens (Greenwich) 2019; 21:1872-1878. [PMID: 31638321 DOI: 10.1111/jch.13717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/12/2019] [Accepted: 09/20/2019] [Indexed: 12/01/2022]
Abstract
Manual measurement of blood pressure (BP) during exercise testing is the recommended standard. Automated measurement of BP is an alternative method used during clinical exercise testing, but there is little data comparing manual and automated BP in this setting. The aim of this study was to determine the concordance between manual and automated BP during a standard clinical treadmill exercise test. 416 participants (66 ± 5 years; 54% male) completed a Bruce treadmill exercise test at baseline or follow-up within a clinical trial of participants with type 2 diabetes mellitus. Manual and automated BP were measured simultaneously at each exercise test stage. Manual BP was measured by a technician blinded to automated BP values (Tango+, Suntech). Concordance between manual and automated BP was assessed using mean differences and intraclass correlations (ICC). Concordance between manual and automated BP across all exercise stages was excellent for systolic BP (overall mean difference: 3 ± 11 mm Hg, P = .598; ICC = 0.964 [95% CI 0.942-0.977] and pulse pressure (overall mean difference: 2 ± 14 mm Hg, P = .595; ICC = 0.934 [95% CI 0.899-0.956]). Concordance between manual and automated diastolic BP across all exercise stages was moderate-to-good (overall mean difference: 1 ± 9 mm Hg, P = .905; ICC = 0.784 [95% CI 0.672-0.858]). Automated BP using the Tango + device is concordant with manual BP during early stages of a standard clinical exercise test. Thus, this automated method may be a suitable alternative to manual measurement of BP during clinical exercise testing.
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Affiliation(s)
- Myles N Moore
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Dean S Picone
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Velandai Srikanth
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Vic, Australia.,Department of Medicine, Peninsula Health, Melbourne, Vic, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Martin G Schultz
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tas, Australia
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11
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Cieslik LK, Patel HC, Steele SJ, Beale AL, Tan CN, Mariani JA, Nanayakkara S, Kaye DM. Non-invasive blood pressure monitoring underestimates hypertensive response to exercise in suspected heart failure with preserved ejection fraction. Eur J Prev Cardiol 2019; 27:2180-2182. [PMID: 31480876 DOI: 10.1177/2047487319873452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Hitesh C Patel
- Department of Cardiology, Alfred Hospital, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Australia
| | | | - Anna L Beale
- Department of Cardiology, Alfred Hospital, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Australia.,Department of Medicine, Monash University, Australia
| | | | - Justin A Mariani
- Department of Cardiology, Alfred Hospital, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Australia.,Department of Medicine, Monash University, Australia
| | - Shane Nanayakkara
- Department of Cardiology, Alfred Hospital, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Australia.,Department of Medicine, Monash University, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Australia.,Department of Medicine, Monash University, Australia
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12
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Comparison between cuff-based and radial tonometry exercise-induced central blood pressure. Eur J Appl Physiol 2019; 119:901-911. [DOI: 10.1007/s00421-019-04079-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 01/12/2019] [Indexed: 11/26/2022]
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13
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Angius L, Marcora SM, Hopker JG, Mauger AR. The Effect of Anodal Transcranial Direct Current Stimulation Over Left and Right Temporal Cortex on the Cardiovascular Response: A Comparative Study. Front Physiol 2019; 9:1822. [PMID: 30618831 PMCID: PMC6305457 DOI: 10.3389/fphys.2018.01822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/05/2018] [Indexed: 12/17/2022] Open
Abstract
Background: Stimulation of the right and left anterior insular cortex, increases and decreases the cardiovascular response respectively, thus indicating the brain’s lateralization of the neural control of circulation. Previous experiments have demonstrated that transcranial direct current stimulation (tDCS) modulates the autonomic cardiovascular control when applied over the temporal cortex. Given the importance of neural control for a normal hemodynamic response, and the potential for the use of tDCS in the treatment of cardiovascular diseases, this study investigated whether tDCS was capable of modulating autonomic regulation. Methods: Cardiovascular response was monitored during a post-exercise muscle ischemia (PEMI) test, which is well-documented to increase sympathetic drive. A group of 12 healthy participants performed a PEMI test in a control (Control), sham (Sham) and two different experimental sessions where the anodal electrode was applied over the left temporal cortex and right temporal cortex with the cathodal electrode placed over the contralateral supraorbital area. Stimulation lasted 20 min at 2 mA. The hemodynamic profile was measured during a PEMI test. The cardiovascular parameters were continuously measured with a transthoracic bio-impedance device both during the PEMI test and during tDCS. Results: None of the subjects presented any side effects during or after tDCS stimulation. A consistent cardiovascular response during PEMI test was observed in all conditions. Statistical analysis did not find any significant interaction and any significant main effect of condition on cardiovascular parameters (all ps > 0.316) after tDCS. No statistical differences regarding the hemodynamic responses were found between conditions and time during tDCS stimulation (p > 0.05). Discussion: This is the first study comparing the cardiovascular response after tDCS stimulation of left and right TC both during exercise and at rest. The results of the current study suggest that anodal tDCS of the left and right TC does not affect functional cardiovascular response during exercise PEMI test and during tDCS. In light of the present and previous findings, the effect of tDCS on the cardiovascular response remains inconclusive.
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Affiliation(s)
- Luca Angius
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Kent, United Kingdom
| | - Samuele M Marcora
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Kent, United Kingdom
| | - James G Hopker
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Kent, United Kingdom
| | - Alexis R Mauger
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Kent, United Kingdom
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Currie KD, Floras JS, La Gerche A, Goodman JM. Exercise Blood Pressure Guidelines: Time to Re-evaluate What is Normal and Exaggerated? Sports Med 2018; 48:1763-1771. [PMID: 29574665 DOI: 10.1007/s40279-018-0900-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Blood pressure responses to graded exercise testing can provide important diagnostic and prognostic information. While published guidelines outline what constitutes a "normal" and "abnormal" (i.e., exaggerated) blood pressure response to exercise testing, the widespread use of exaggerated blood pressure responses as a clinical tool is limited due to sparse and inconsistent data. A review of the original sources from these guidelines reveals an overall lack of empirical evidence to support both the normal blood pressure responses and their upper limits. In this current opinion, we critically evaluate the current exercise blood pressure guidelines including (1) the normal blood pressure responses to graded exercise testing; (2) the upper limits of this normal response; (3) the blood pressure criteria for test termination; and (4) the thresholds for exaggerated blood pressure responses. We provide evidence that exercise blood pressure responses vary according to subject characteristics, and subsequently a re-evaluation of what constitutes normal and abnormal responses is necessary to strengthen the clinical utility of this assessment.
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Affiliation(s)
- Katharine D Currie
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - John S Floras
- University Health Network and Mount Sinai Hospital Division of Cardiology, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.,Department of Medicine, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Andre La Gerche
- Sports Cardiology and Cardiac Magnetic Resonance Imaging Lab, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia.,Cardiology Department, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jack M Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada. .,University Health Network and Mount Sinai Hospital Division of Cardiology, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
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15
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White WB, Jalil F, Wakefield DB, Kaplan RF, Bohannon RW, Hall CB, Moscufo N, Fellows D, Guttmann CR, Wolfson L. Relationships among clinic, home, and ambulatory blood pressures with small vessel disease of the brain and functional status in older people with hypertension. Am Heart J 2018; 205:21-30. [PMID: 30145340 DOI: 10.1016/j.ahj.2018.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/08/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Subcortical small vessel disease, represented as white matter hyperintensity (WMH) on magnetic resonance images (MRI) is associated with functional decline in older people with hypertension. We evaluated the relationships of clinic and out-of-office blood pressures (BP) with WMH and functional status in older persons. METHODS Using cross-sectional data from 199 older study participants enrolled in the INFINITY trial, we analyzed the clinic, 24-hour ambulatory, and home BPs and their relationships with WMH burden and mobility and cognitive outcomes. RESULTS Volume of WMH was associated with clinic and 24-hour ambulatory systolic BP but not home systolic BP. The mobility measure, supine-to-sit time, had a significant association with 24-hour systolic BP and pulse pressure but not with diastolic BP or values obtained by home BP. Cognitive measures of processing speed (Trails Making Test Part A and the Stroop Word Test) were significantly associated with 24-hour systolic BP, but not clinic and home BPs. CONCLUSION These data demonstrate that ambulatory BP measurements in older people are more strongly associated with WMH and certain measures of functional status compared to home BP measurements. Hence, home BP may not be a useful substitute for ambulatory BP for assessing subcortical small vessel disease and its consequences. Further longitudinal analyses comparing clinic and various types of out-of-office BP measures with small vessel brain disease are needed. Clinicaltrials.gov identifier: NCT01650402.
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16
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Kaafarani M, Schroer C, Takken T. Reference values for blood pressure response to cycle ergometry in the first two decades of life: comparison with patients with a repaired coarctation of the aorta. Expert Rev Cardiovasc Ther 2017; 15:945-951. [DOI: 10.1080/14779072.2017.1385392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mirna Kaafarani
- Honors College, College of Natural Science, Michigan State University, East Lansing, MI, USA
- Child Development & Exercise, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christian Schroer
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatrics, Maxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | - Tim Takken
- Child Development & Exercise, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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17
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Miller AJ, Luck JC, Kim DJK, Leuenberger UA, Proctor DN, Sinoway LI, Muller MD. Blood pressure and leg deoxygenation are exaggerated during treadmill walking in patients with peripheral artery disease. J Appl Physiol (1985) 2017; 123:1160-1165. [PMID: 28819005 DOI: 10.1152/japplphysiol.00431.2017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 01/03/2023] Open
Abstract
The purpose of this study was to investigate blood pressure (BP) and leg skeletal muscle oxygen saturation (Smo2) during treadmill walking in patients with peripheral artery disease (PAD) and healthy subjects. Eight PAD patients (66 ± 8 yr, 1 woman) and eight healthy subjects (65 ± 7 yr, 1 woman) walked on a treadmill at 2 mph (0.89 m/s). The incline increased by 2% every 2 min, from 0 to 15% or until maximal discomfort. BP was measured every 2 min with an auscultatory cuff. Heart rate (HR) was recorded continuously with an ECG. Smo2 in the gastrocnemius muscle was measured on each leg using near-infrared spectroscopy. The change in systolic BP from seated to peak walking time (PWT) was greater in PAD (healthy: 23 ± 9 vs. PAD: 44 ± 19 mmHg, P = 0.007). HR was greater in PAD patients compared with controls at PWT (P = 0.011). The reduction in Smo2 (PWT - seated) was greater in PAD (healthy: 15 ± 12 vs. PAD: 49 ± 5%, P < 0.001) in the most affected leg and in the least affected leg (healthy: 12 ± 11 vs. PAD: 32 ± 18%, P = 0.003). PAD patients have an exaggerated decline in leg Smo2 during walking compared with healthy subjects, which may elicit the exaggerated rise in BP and HR during walking in PAD.NEW & NOTEWORTHY This is the first study to simultaneously measure skeletal muscle oxygen saturation and blood pressure (BP) during treadmill exercise in patients with peripheral arterial disease. We found that BP and leg deoxygenation responses to slow-paced, graded treadmill walking are greater in patients with peripheral arterial disease compared with healthy subjects. These data may help explain the high cardiovascular risk in patients with peripheral arterial disease.
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Affiliation(s)
- Amanda J Miller
- Heart and Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania; and
| | - J Carter Luck
- Heart and Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania; and
| | - Danielle Jin-Kwang Kim
- Heart and Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania; and
| | - Urs A Leuenberger
- Heart and Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania; and
| | - David N Proctor
- Department of Kinesiology, Noll Laboratory, Penn State University, University Park, Pennsylvania
| | - Lawrence I Sinoway
- Heart and Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania; and
| | - Matthew D Muller
- Heart and Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania; and
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18
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Krnjajic D, Allen DR, Butts CL, Keller DM. Carotid baroreflex control of heart rate is enhanced, while control of mean arterial pressure is preserved during whole body heat stress in young healthy men. Am J Physiol Regul Integr Comp Physiol 2016; 311:R735-R741. [DOI: 10.1152/ajpregu.00152.2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/29/2016] [Indexed: 11/22/2022]
Abstract
Whole body heat stress (WBH) results in numerous cardiovascular alterations that ultimately reduce orthostatic tolerance. While impaired carotid baroreflex (CBR) function during WBH has been reported as a potential reason for this decrement, study design considerations may limit interpretation of previous findings. We sought to test the hypothesis that CBR function is unaltered during WBH. CBR function was assessed in 10 healthy male subjects (age: 26 ± 3; height: 185 ± 7 cm; weight: 82 ± 10 kg; BMI: 24 ± 3 kg/m2; means ± SD) using 5-s trials of neck pressure (+45, +30, and +15 Torr) and neck suction (−20, −40, −60, and −80 Torr) during normothermia (NT) and passive WBH (Δ core temp ∼1°C). Analyses of stimulus response curves (four-parameter logistic model) for CBR control of heart rate (CBR-HR) and mean arterial pressure (CBR-MAP), as well as separate two-way ANOVA of the hypotensive and hypertensive stimuli (factor 1: thermal condition, factor 2: chamber pressure), were performed. For CBR-HR, maximal gain was increased during WBH (−0.73 ± 0.11) compared with NT (−0.39 ± 0.04, mean ± SE, P = 0.03). In addition, the CBR-HR responding range was increased during WBH (33 ± 5) compared with NT (19 ± 2 bpm, P = 0.03). Separate analysis of hypertensive stimulation revealed enhanced HR responses during WBH at −40, −60, and −80 Torr (condition × chamber pressure interaction, P = 0.049) compared with NT. For CBR-MAP, both logistic analysis and separate two-way ANOVA revealed no differences during WBH. Therefore, in response to passive WBH, CBR control of heart rate (enhanced) and arterial pressure (no change) is well preserved.
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Affiliation(s)
- Davor Krnjajic
- Department of Kinesiology, University of Texas, Arlington, Arlington, Texas
| | - Dustin R. Allen
- Department of Kinesiology, University of Texas, Arlington, Arlington, Texas
| | - Cory L. Butts
- Department of Kinesiology, University of Texas, Arlington, Arlington, Texas
| | - David M. Keller
- Department of Kinesiology, University of Texas, Arlington, Arlington, Texas
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Wibmer T, Denner C, Fischer C, Schildge B, Rüdiger S, Kropf-Sanchen C, Rottbauer W, Schumann C. Blood pressure monitoring during exercise: comparison of pulse transit time and volume clamp methods. Blood Press 2015; 24:353-60. [PMID: 26286887 DOI: 10.3109/08037051.2015.1053253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
During physical exercise, pulse transit time (PTT), expressed as the interval between ventricular electrical activity and peripheral pulse wave, may provide a surrogate estimate for blood pressure by the use of specific calibration procedures. The objective of this study was to determine systolic blood pressure (SBP) values derived from the PTT method and from an established method of non-invasive continuous blood pressure measurement based on the volume clamp technique, and to compare their agreement with sphygmomanometry during exercise tests. In 18 subjects, electrocardiogram (ECG) and finger-photoplethysmography were continuously recorded during maximal cycle exercise tests. Intermittent and continuous blood pressure measurements were simultaneously taken using automated sphygmomanometry and a Portapres Model-2 device, respectively. PTT was calculated for each ECG R-wave and the corresponding steepest upstroke slope in the photoplethysmogram, and was transformed to a continuous blood pressure estimate using multipoint nonlinear regression calibration based on the individual subject's sphygmomanometer readings. Bland-Altman limits of agreement between PTT-derived SBP estimates and sphygmomanometer values were -24.7 to 24.1 mmHg, and between Portapres and sphygmomanometer SBP values were -42.0 to 70.1 mmHg. For beat-to-beat SBP estimation during exercise, PTT measurement combined with multipoint nonlinear regression calibration based on intermittent sphygmomanometry may be an alternative to volume clamp devices.
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Affiliation(s)
- Thomas Wibmer
- a Department of Internal Medicine II , University Hospital of Ulm , Ulm , Germany
| | - Coy Denner
- a Department of Internal Medicine II , University Hospital of Ulm , Ulm , Germany
| | - Christoph Fischer
- b Charité - Universitätsmedizin Berlin, Interdisciplinary Center of Sleep Medicine , Berlin , Germany.,c Institute of Assistance Systems and Qualification at the SRH University of Applied Science Heidelberg , Heidelberg , Germany
| | - Benedikt Schildge
- a Department of Internal Medicine II , University Hospital of Ulm , Ulm , Germany
| | - Stefan Rüdiger
- a Department of Internal Medicine II , University Hospital of Ulm , Ulm , Germany
| | | | - Wolfgang Rottbauer
- a Department of Internal Medicine II , University Hospital of Ulm , Ulm , Germany
| | - Christian Schumann
- a Department of Internal Medicine II , University Hospital of Ulm , Ulm , Germany.,d Kempten-Oberallgaeu Hospitals, Department of Pulmonary Diseases , Thoracic Oncology, Sleep and Ventilation , Kempten and Immenstadt , Germany
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20
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Nikolic SB, Adams MJ, Otahal P, Edwards LM, Sharman JE. Association of von Willebrand factor blood levels with exercise hypertension. Eur J Appl Physiol 2014; 115:1057-65. [PMID: 25539599 DOI: 10.1007/s00421-014-3087-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/16/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE A hypertensive response to moderate intensity exercise (HRE) is associated with increased cardiovascular risk. The mechanisms of an HRE are unclear, although previous studies suggest this may be due to haemostatic and/or haemodynamic factors. We investigated the relationships between an HRE with haemostatic and hemodynamic indices. METHODS Sixty-four participants (57 ± 10 years, 71 % male) with indication for exercise stress testing underwent cardiovascular assessment at rest and during moderate intensity exercise, from which 20 participants developed an HRE (defined as moderate exercise systolic BP ≥ 170 mmHg/men and ≥ 160 mmHg/women). Rest, exercise and post-exercise blood samples were analysed for haemostatic markers, including von Willebrand factor (vWf), and haemodynamic measures of brachial and central blood pressure (BP), aortic stiffness and systemic vascular resistance index (SVRi). RESULTS HRE participants had higher rest vWf compared with normotensive response to exercise (NRE) participants (1,927 mU/mL, 95 % CI 1,240-2,615, vs. 1,129 mU/mL, 95 % CI 871-1,386; p = 0.016). vWf levels significantly decreased from rest to post-exercise in HRE participants (p = 0.005), whereas vWf levels significantly increased from rest to exercise in NRE participants (p = 0.030). HRE participants also had increased triglycerides, rest BP, aortic stiffness and exercise SVRi (p < 0.05 for all). Rest vWf predicted exercise brachial systolic BP (β = 0.220, p = 0.043; adjusted R (2) = 0.451, p < 0.001) independent of age, sex, body mass index, triglycerides, rest brachial systolic BP and aortic stiffness. CONCLUSIONS Increased rest blood levels of vWf are independently associated with moderate intensity exercise systolic BP. These findings implicate abnormalities in haemostasis as a possible factor contributing to HRE at moderate intensity.
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Affiliation(s)
- Sonja B Nikolic
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia
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21
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Exercise blood pressure: clinical relevance and correct measurement. J Hum Hypertens 2014; 29:351-8. [DOI: 10.1038/jhh.2014.84] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 11/08/2022]
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22
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Le Meur Y, Louis J, Aubry A, Guéneron J, Pichon A, Schaal K, Corcuff JB, Hatem SN, Isnard R, Hausswirth C. Maximal exercise limitation in functionally overreached triathletes: role of cardiac adrenergic stimulation. J Appl Physiol (1985) 2014; 117:214-22. [DOI: 10.1152/japplphysiol.00191.2014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Functional overreaching (F-OR) induced by heavy load endurance training programs has been associated with reduced heart rate values both at rest and during exercise. Because this phenomenon may reflect an impairment of cardiac response, this research was conducted to test this hypothesis. Thirty-five experienced male triathletes were tested (11 control and 24 overload subjects) before overloading (Pre), immediately after overloading (Mid), and after a 2-wk taper period (Post). Physiological responses were assessed during an incremental cycling protocol to volitional exhaustion, including catecholamines release, oxygen uptake (V̇o2), arteriovenous O2 difference, cardiac output (Q̇), and systolic (SBP) and diastolic blood pressure (DBP). Twelve subjects of the overload group developed signs of F-OR at Mid (decreased performance with concomitant high perceived fatigue), while 12 others did not [acute fatigue group (AF)]. V̇o2max was reduced only in F-OR subjects at Mid. Lower Q̇ and SBP values with greater arteriovenous O2 difference were reported in F-OR subjects at all exercising intensities, while no significant change was observed in the control and AF groups. A concomitant decrease in epinephrine excretion was reported only in the F-OR group. All values returned to baseline at Post. Following an overload endurance training program leading to F-OR, the cardiac response to exhaustive exercise is transiently impaired, possibly due to reduced epinephrine excretion. This finding is likely to explain the complex process of underperformance syndrome experienced by F-OR endurance athletes during heavy load programs.
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Affiliation(s)
- Yann Le Meur
- Laboratory of Sport, Expertise and Performance, Research Department, French National Institute of Sport, Expertise and Performance, (INSEP) Paris, France
| | - Julien Louis
- Laboratory of Sport, Expertise and Performance, Research Department, French National Institute of Sport, Expertise and Performance, (INSEP) Paris, France
| | - Anaël Aubry
- Laboratory of Sport, Expertise and Performance, Research Department, French National Institute of Sport, Expertise and Performance, (INSEP) Paris, France
| | - Jacques Guéneron
- Medical Department, French National Institute of Sport, Expertise and Performance, Paris, France
| | - Aurélien Pichon
- Laboratory of Functional and Cellular Responses to Hypoxia, University Paris 13 North, Sorbonne Paris City, Bobigny, France
| | - Karine Schaal
- Laboratory of Sport, Expertise and Performance, Research Department, French National Institute of Sport, Expertise and Performance, (INSEP) Paris, France
- Sports Performance Laboratory, Sports Medicine Program, University of California, Davis, Sacramento, California
| | - Jean-Benoît Corcuff
- Department of Nuclear Medicine, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Stéphane N. Hatem
- Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, Paris, France; and
- University Paris 6, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Richard Isnard
- Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, Paris, France; and
- University Paris 6, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Christophe Hausswirth
- Laboratory of Sport, Expertise and Performance, Research Department, French National Institute of Sport, Expertise and Performance, (INSEP) Paris, France
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Holwerda SW, Samels MR, Keller DM. Carotid baroreflex responsiveness in normotensive African Americans is attenuated at rest and during dynamic leg exercise. Front Physiol 2013; 4:29. [PMID: 23482843 PMCID: PMC3591748 DOI: 10.3389/fphys.2013.00029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 02/06/2013] [Indexed: 01/11/2023] Open
Abstract
Evidence suggests differences between African Americans (AAs) and Caucasian Americans (CAs) in cardiovascular responsiveness to physiological stressors. This study tested the hypothesis that carotid baroreflex (CBR) control of heart rate (HR) and blood pressure is reduced in AAs compared to CAs during exercise. Mean arterial pressure (MAP) and HR were continuously recorded at rest and during leg cycling in 23 non-hypertensive male subjects (12 AA; 11 CA; age 19–26 years). CBR control of HR and MAP was assessed with 5-s pulses of neck pressure (NP, simulated hypotension) and neck suction (NS, simulated hypertension) ranging from +45 to −80 Torr. Across all NS stimuli (−20, −40, −60, −80 Torr) at rest, the AA group demonstrated attenuated CBR-mediated reductions in HR (AA, −8.9 ± 1.9 vs. CA, −14.1 ± 2.3 bpm; P < 0.001) and MAP (AA, −6.4 ± 1 vs. CA, −7.8 ± 0.8 mmHg; P < 0.05). Despite similar gain and magnitude of resetting observed in the modeled stimulus response curves, an attenuation among AAs persisted in HR (AA, −8.2 ± 1.6 vs. CA, −11.8 ± 3 bpm; P < 0.05) and MAP (AA, −6.8 ± 0.9 vs. CA, −8.2 ± 1.1 mmHg; P < 0.05) responses to NS during exercise. No differences in CBR-mediated HR and MAP responses to NP were detected between groups at rest or during exercise. These data suggest impairment in the ability to defend against a hypertensive challenge among AAs during steady-state exercise compared to their CA counterparts.
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Affiliation(s)
- Seth W Holwerda
- Department of Medical Pharmacology and Physiology, University of Missouri Columbia, SC, USA
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Attinà TM, Drummond ID, Malatino LS, Maxwell SR, Webb DJ. Phosphodiesterase type 5 inhibition improves arterial stiffness after exercise but not exercise capacity in hypertensive men. Am J Hypertens 2013; 26:342-50. [PMID: 23382484 DOI: 10.1093/ajh/hps057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Established hypertension is associated with abnormal exercise hemodynamics and reduced exercise capacity through mechanisms that may include contributions from arterial stiffness and endothelial vasomotor dysfunction. Phosphodiesterase type 5 (PDE5) inhibitors prolong nitric oxide-mediated cyclic guanosine monophosphate (cGMP) signaling in vascular smooth muscle, and have beneficial effects on exercise tolerance in pulmonary hypertension and heart failure. Recent studies suggest they may also be useful antihypertensive agents. We hypothesized they would reduce arterial stiffness and increase exercise capacity in hypertensive men. METHODS In a 3-way, randomized, placebo-controlled study, 15 untreated hypertensive and 15 matched normotensive male subjects received 50mg sildenafil (PDE5 inhibitor), 25mg hydralazine (control, cGMP-independent vasodilator) or placebo, 3 times daily for 1 week, and the effects on exercise blood pressure (during modest and maximal exercise), peak oxygen uptake, and arterial stiffness were investigated. RESULTS Peak oxygen uptake was significantly lower in hypertensive than normotensive subjects (analysis of variance [ANOVA] P < 0.0001), but not affected by sildenafil in either group. However, while pulse wave velocity, as a measure of arterial stiffness, increased after exercise in hypertensive men following placebo, sildenafil reversed these changes, significantly reducing pulse wave velocity compared with both placebo and hydralazine (ANOVA P = 0.0001). CONCLUSIONS PDE5 inhibition with sildenafil did not improve exercise capacity in hypertensive men. Nevertheless, our findings suggest that sildenafil may reduce arterial stiffness in the recovery period after exercise.
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Affiliation(s)
- Teresa M Attinà
- Clinical Pharmacology Unit, Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, UK
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25
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Blunted heart rate recovery is associated with exaggerated blood pressure response during exercise testing. Heart Vessels 2012; 28:750-6. [DOI: 10.1007/s00380-012-0298-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 09/28/2012] [Indexed: 01/20/2023]
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LIU SAM, GOODMAN JACK, NOLAN ROBERT, LACOMBE SHAWN, THOMAS SCOTTG. Blood Pressure Responses to Acute and Chronic Exercise Are Related in Prehypertension. Med Sci Sports Exerc 2012; 44:1644-52. [PMID: 22899388 DOI: 10.1249/mss.0b013e31825408fb] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hartwich D, Aldred S, Fisher JP. Influence of menstrual cycle phase on muscle metaboreflex control of cardiac baroreflex sensitivity, heart rate and blood pressure in humans. Exp Physiol 2012; 98:220-32. [DOI: 10.1113/expphysiol.2012.066498] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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28
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Bond V, Millis RM, Campbell A, Harrell J, Goring KL, Reeves I, Johnson SM, Adams RG. Exaggerated vasopressor response to exercise and cerebral blood flow velocity. Clin Exp Hypertens 2012; 34:370-6. [PMID: 22500813 DOI: 10.3109/10641963.2012.665537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We studied 10 young adults, normotensive at rest, comprising a control group (n = 5) with normal blood pressure responsiveness to exercise and an experimental group exhibiting greater percentage of body fat and body mass index (BMI) than the controls, with exaggerated blood pressure (vasopressor) responsiveness to exercise (EEBPR) (n = 5). Lower absolute and varying oxygen consumption/body weight normalized units of middle cerebral arterial blood flow velocity (MCAV) were found during exercise in the experimental group (P < .01). These findings support the hypothesis that the combination of EEBPR and high BMI is associated with low MCAV that may put such individuals at risk for cerebral hypoperfusion and cognitive deficits.
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Affiliation(s)
- Vernon Bond
- Department of Health, Human Performance & Leisure Studies, The Graduate School of Arts & Sciences, Howard University, Washington, DC, USA
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29
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White WB, Wolfson L, Wakefield DB, Hall CB, Campbell P, Moscufo N, Schmidt J, Kaplan RF, Pearlson G, Guttmann CRG. Average daily blood pressure, not office blood pressure, is associated with progression of cerebrovascular disease and cognitive decline in older people. Circulation 2012; 124:2312-9. [PMID: 22105196 DOI: 10.1161/circulationaha.111.037036] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High blood pressure (BP) is a risk factor for cerebrovascular disease, including stroke. Little is known about the importance of BP on the progression of microvascular disease of the brain, which has been associated with functional decline in mobility and cognition in older people. METHODS AND RESULTS This was a prospective cohort of subjects 75 to 89 years of age to determine relations among vascular risk factors, white matter hyperintensity volume, and functional status. Ninety-nine subjects were enrolled through the use of a balanced 3×3 matrix stratified by age and mobility performance, and 72 subjects completed all sets of baseline and follow-up studies at 2 years. Subjects were excluded if there were medications or systemic or neurological diseases that could compromise mobility. Ambulatory and clinic BP monitoring, magnetic resonance imaging, gait studies, and neuropsychological testing were performed at baseline and after 24 months. Brain classification into normal white matter and T2-hyperintense white matter hyperintensity volume was performed with semiautomated segmentation. Quantitative measures of mobility and cognitive function were obtained longitudinally. Increased ambulatory systolic BP, but not clinic systolic BP, from baseline to 24 month follow-up was associated with increased white matter hyperintensity volume over that same period, as well as measures of executive function/processing speed. Similar associations were observed for 24-hour BP, awake BP, and sleep BP but not for the surge between the sleep and awake time at the 24-month time point. CONCLUSIONS These data demonstrate for the first time the importance of 24-hour systolic BP in the progression of brain white matter hyperintensity volume burden associated with impairment of cognitive function in older people. The 24-hour systolic BP may be a potential target for intervention in the elderly to reduce vascular disease of the brain and impairment of function.
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Affiliation(s)
- William B White
- Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030-3940, USA.
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30
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Hartwich D, Dear WE, Waterfall JL, Fisher JP. Effect of muscle metaboreflex activation on spontaneous cardiac baroreflex sensitivity during exercise in humans. J Physiol 2011; 589:6157-71. [PMID: 21969452 DOI: 10.1113/jphysiol.2011.219964] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We sought to determine whether the activation of metabolically sensitive skeletal muscle afferents (muscle metaboreflex) is a potential mechanism for the decrease in spontaneous cardiac baroreflex sensitivity (cBRS) during exercise in humans. In protocol 1, 15 male subjects (22 ± 1 years) performed steady-state leg cycling at low (26 ± 4 W) and moderate workloads (105 ± 7 W), under free-flow conditions and with partial flow restriction (bilateral thigh cuff inflation at 100 mmHg) to evoke muscle metaboreflex activation during exercise. In protocol 2, rhythmic handgrip exercise at 35% maximum voluntary contraction was performed with progressive upper arm cuff inflation (0, 80, 100 and 120 mmHg) to elicit graded metaboreflex activation. Both protocols were followed by post-exercise ischaemia (PEI) to isolate the muscle metaboreflex. Leg cycling-induced increases in HR and mean BP were augmented by partial flow restriction (P < 0.05 vs. free flow), while HR and mean BP both remained elevated during PEI (P < 0.05 vs. rest). Leg cycling evoked an intensity-dependent decrease in cBRS (16 ± 2, 7 ± 1 and 2 ± 0.2 ms mmHg(-1) at rest, low and moderate workloads, respectively; P < 0.05), which was further reduced with partial flow restriction (by -2.6 ± 0.8 and -0.4 ± 0.1 ms mmHg(-1) at low and moderate workloads). cBRS remained suppressed during PEI following leg cycling with partial flow restriction (4 ± 1 ms mmHg(-1); P < 0.05 vs. rest). cBRS was unchanged during handgrip under free-flow conditions, handgrip with partial flow restriction and PEI following handgrip (P > 0.05 vs. rest). These data indicate that the activation of metabolically sensitive skeletal muscle afferents (muscle metaboreflex) decreases cardiac baroreflex responsiveness during leg cycling exercise in humans.
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Affiliation(s)
- Doreen Hartwich
- School of Sport and Exercise Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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31
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Padilla J, Simmons GH, Vianna LC, Davis MJ, Laughlin MH, Fadel PJ. Brachial artery vasodilatation during prolonged lower limb exercise: role of shear rate. Exp Physiol 2011; 96:1019-27. [PMID: 21784788 DOI: 10.1113/expphysiol.2011.059584] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We recently observed a marked increase in brachial artery (BA) diameter during prolonged leg cycling exercise. The purpose of the present study was to test the hypothesis that this increase in BA diameter during lower limb exercise is shear stress mediated. Accordingly, we determined whether recapitulation of cycling-induced BA shear rate with forearm heating, a known stimulus evoking shear-induced conduit artery dilatation, would elicit comparable profiles and magnitudes of BA vasodilatation to those observed during cycling. In 12 healthy men, BA diameter and blood velocity were measured simultaneously using Doppler ultrasonography at baseline and every 5 min during 60 min of either steady-state semi-recumbent leg cycling (120 W) or forearm heating. At the onset of cycling, the BA diameter was reduced (-3.9 ± 1.2% at 5 min; P < 0.05), but it subsequently increased throughout the remainder of the exercise bout (+15.1 ± 1.6% at 60 min; P < 0.05). The increase in BA diameter during exercise was accompanied by an approximately 2.5-fold rise in BA mean shear rate (P < 0.05). Similar increases in BA mean shear with forearm heating elicited an equivalent magnitude of BA vasodilatation to that observed during cycling (P > 0.05). Herein, we found that in the absence of exercise the extent of the BA vasodilator response was reproduced when the BA was exposed to comparable magnitudes of shear rate via forearm heating. These results are consistent with the hypothesis that shear stress plays a key role in signalling brachial artery vasodilatation during dynamic leg exercise.
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Affiliation(s)
- Jaume Padilla
- Department of Biomedical Sciences, E102 Veterinary Medicine, 1600 East Rollins Road, University of Missouri, Columbia, MO 65211, USA.
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32
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Takken T, Blank AC, Hulzebos EH, van Brussel M, Groen WG, Helders PJ. Cardiopulmonary exercise testing in congenital heart disease: equipment and test protocols. Neth Heart J 2011; 17:339-44. [PMID: 19949476 DOI: 10.1007/bf03086280] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Cardiopulmonary exercise testing (CPET) in paediatric cardiology differs in many aspects from the tests as performed in adult cardiology. Children's cardiovascular responses during exercise testing present different characteristics, particularly oxygen uptake, heart rate and blood pressure response, which are essential in interpreting haemodynamic data. Diseases that are associated with myocardial ischaemia are very rare in children. The main indications for CPET in children are evaluation of exercise capacity and the identification of exercise-induced arrhythmias. In this article we will review exercise equipment and test protocols for CPET in children with congenital heart disease. (Neth Heart J 2009;17:339-44.).
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Affiliation(s)
- T Takken
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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33
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Ogoh S, Fisher JP, Young CN, Fadel PJ. Impact of age on critical closing pressure of the cerebral circulation during dynamic exercise in humans. Exp Physiol 2011; 96:417-25. [DOI: 10.1113/expphysiol.2010.055871] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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34
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Hargens TA, Griffin DC, Kaminsky LA, Whaley MH. The influence of aerobic exercise training on the double product break point in low-to-moderate risk adults. Eur J Appl Physiol 2010; 111:313-8. [PMID: 20878176 DOI: 10.1007/s00421-010-1661-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2010] [Indexed: 10/19/2022]
Abstract
The double product is the product of the heart rate and systolic blood pressure. The double product break point (DPBP) is a physiologic threshold that occurs at similar exercise intensities to that of the ventilatory threshold (VT). The influence of aerobic exercise training on the DPBP has not yet been examined. The purpose of this study was to examine whether aerobic exercise training (ET) increases the exercise intensity at which the DPBP occurs, and whether it increases in a similar fashion to the VT. Seven males and 11 females, all sedentary (mean ± SD: age = 29.9 ± 10.5 years) underwent supervised cardiopulmonary exercise testing using a cycle ergometer ramp protocol at baseline and after 8 weeks of vigorous ET on a cycle ergometer. The VT was determined by gas analysis and the V-slope method. Experienced observers using standardized instructions visually determined the DPBP. Following ET, VO(2 peak), maximal workload, and body composition variables all showed significant positive changes. The VO(2) at which the DPBP and VT occurred increased significantly from baseline to follow-up (P < 0.001). At baseline and at follow-up, the DPBP and VT did not differ. The DPBP and VT were significantly correlated to each other at both time points. Results suggest that the DPBP responds to ET in a similar fashion to that of the VT, and may be an easier and more useful marker of the VT for exercise training purposes.
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Affiliation(s)
- Trent A Hargens
- Clinical Exercise Physiology Program, Human Performance Lab, Ball State University, PL 106, Muncie, IN 47306, USA.
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35
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Fisher JP, Kim A, Young CN, Fadel PJ. Carotid baroreflex control of arterial blood pressure at rest and during dynamic exercise in aging humans. Am J Physiol Regul Integr Comp Physiol 2010; 299:R1241-7. [PMID: 20826707 DOI: 10.1152/ajpregu.00462.2010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The arterial baroreflex is fundamental for evoking and maintaining appropriate cardiovascular adjustments to exercise. We sought to investigate how aging influences carotid baroreflex regulation of blood pressure (BP) during dynamic exercise. BP and heart rate (HR) were continuously recorded at rest and during leg cycling performed at 50% HR reserve in 15 young (22 ± 1 yr) and 11 older (61 ± 2 yr) healthy subjects. Five-second pulses of neck pressure and neck suction from +40 to -80 Torr were applied to determine the full carotid baroreflex stimulus response curve and examine baroreflex resetting during exercise. Although the maximal gain of the modeled stimulus response curve was similar in both groups at rest and during exercise, in older subjects the operating point (OP) was located further away from the centering point (CP) and toward the reflex threshold, both at rest (OP minus CP; -10 ± 3 older vs. 0 ± 2 young mmHg, P < 0.05) and during exercise (OP minus CP; -10 ± 2 older vs. 1 ± 3 young mmHg, P < 0.05). In agreement, older subjects demonstrated a reduced BP response to neck pressure (simulated carotid hypotension) and a greater BP response to neck suction (simulated carotid hypertension). In addition, the magnitude of the upward and rightward resetting of the carotid baroreflex-BP stimulus response curve with exercise was ∼40% greater in older individuals. These data indicate that despite a maintained maximal gain, the ability of the carotid baroreflex to defend against a hypotensive challenge is reduced, whereas responses to hypertensive stimuli are greater with advanced age, both at rest and during exercise.
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Affiliation(s)
- James P Fisher
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, United Kingdom
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36
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Exercise testing is useful to screen for residual coarctation in children. Pediatr Cardiol 2009; 30:763-7. [PMID: 19449057 DOI: 10.1007/s00246-009-9415-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 01/29/2009] [Accepted: 03/11/2009] [Indexed: 10/20/2022]
Abstract
Twenty-seven children (ages 8 to 18 years) who had a history of successful coarctation repair (mean transisthmic Doppler gradient [TI-D] <20 mmHg at rest) and had not received antihypertensive medications underwent echocardiogram at rest and immediately following peak exercise with a standard treadmill test. All were normotensive or had isolated systolic hypertension at rest. Right arm-ankle (RA-A) systolic blood pressure (SBP) difference and TI-D were measured. Eleven children (41%) demonstrated exercise-induced hypertension (peak exercise SBP >98th percentile per body surface area) and 17 (63%) had a mean TI-D > or =40 mmHg. Eight underwent MRI or angiography; a residual coarctation (RCoA) was confirmed in three and excluded in five. RCoA was excluded in three other children who were normotensive at rest and had normal postoperative echocardiographic findings. No individual test (SBP, RA-A SBP, TI-D) at rest or with exercise testing was statistically useful to identify RCoA. However, the requirement for a RA-A SBP difference > or =20 mmHg and a TI-D > or =40 mmHg during exercise testing was a useful screen: RCoA was present in three of five children who fit these criteria but was absent in six of six who did not.
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37
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Myers J, Arena R, Franklin B, Pina I, Kraus WE, McInnis K, Balady GJ. Recommendations for Clinical Exercise Laboratories. Circulation 2009; 119:3144-61. [DOI: 10.1161/circulationaha.109.192520] [Citation(s) in RCA: 221] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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38
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Hawkins MN, Barnes Q, Purkayastha S, Eubank W, Ogoh S, Raven PB. The effects of aerobic fitness and β1-adrenergic receptor blockade on cardiac work during dynamic exercise. J Appl Physiol (1985) 2009; 106:486-93. [DOI: 10.1152/japplphysiol.90795.2008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this investigation was to determine whether cardiovascular adaptations characteristic of long-term endurance exercise compensate more effectively during cardioselective β1-adrenergic receptor blockade-induced reductions in sympathoadrenergic-stimulated contractility. Endurance-trained (ET) athletes ( n = 8) and average-trained (AT; n = 8) subjects performed submaximal cycling exercise at moderate [45% maximum oxygen uptake (V̇o2max)] and heavy (70% V̇o2max) workloads, with and without metoprolol. Cardiac output (Q̇c), heart rate (HR), and systolic blood pressure were recorded at rest and during exercise. Cardiac work was calculated from the triple product of HR, stroke volume, and systolic blood pressure, and myocardial efficiency is represented as cardiac work for a given total body oxygen consumption. Metoprolol reduced Q̇c at 45% V̇o2max ( P = 0.004) and 70% V̇o2max ( P = 0.022) in ET subjects, but did not alter Q̇c in the AT subjects. In ET subjects at 45% V̇o2max, metoprolol-induced reductions in Q̇c were a result of decreases in HR ( P < 0.05) and the absence of a compensatory increase in stroke volume ( P > 0.05). The cardiac work and calculated cardiac efficiency were reduced with metoprolol in ET subjects at both exercise intensities and in the AT subjects during the high-intensity workload ( P < 0.01). The cardiac work and the calculated cardiac efficiency were not affected by metoprolol in the AT subjects during the 45% V̇o2max exercise. Therefore, in AT subjects, β-blockade reduced the amount of pressure generation necessary to produce the same amount of work during moderate-intensity exercise. In patients with heart disease receiving metoprolol, a decrease in the generation of cardiac pressure necessary to perform a given amount of work during mild-to-moderate exercise would prove to be beneficial.
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Fisher JP, Ogoh S, Junor C, Khaja A, Northrup M, Fadel PJ. Spontaneous baroreflex measures are unable to detect age-related impairments in cardiac baroreflex function during dynamic exercise in humans. Exp Physiol 2009; 94:447-58. [PMID: 19139062 DOI: 10.1113/expphysiol.2008.044867] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The dynamic relationship between 'spontaneous' fluctuations in arterial blood pressure (BP) and heart rate (HR) is increasingly being used to provide an estimate of resting cardiac baroreflex sensitivity. Given the ease of use and clinical utility, spontaneous methods are now also being used to examine cardiac baroreflex sensitivity in distinct subject groups during various laboratory stressors and tasks encountered during daily life, such as physical activity. However, the utility of such spontaneous measures to estimate cardiac baroreflex function during exercise remains unclear, particularly when comparing groups. Therefore, we tested the ability of spontaneous indices to detect age-related differences in cardiac baroreflex function during dynamic exercise. Beat-to-beat HR and BP were measured in eighteen healthy young subjects (24 +/- 1 years) and sixteen healthy middle-aged subjects (59 +/- 1 years) at rest and during steady-state leg cycling. Estimates of spontaneous cardiac baroreflex sensitivity using the sequence technique (G(SEQ)) and low-frequency transfer function gain (G(TF)) were compared with the operating point (G(OP)) and maximal gain (G(MAX)) of the full carotid-cardiac baroreflex function curve. At rest G(SEQ), G(TF), G(OP) and G(MAX) were all significantly lower in older subjects. During moderate-intensity steady-state exercise no differences were observed in G(SEQ) and G(TF) (older 0.26 +/- 0.03 beats min(-1) mmHg(-1) versus younger 0.32 +/- 0.04 beats min(-1) mmHg(-1); P > 0.05), whereas G(OP) and G(MAX) (older -0.21 +/- 0.02 beats min(-1) mmHg(-1) versus younger -0.39 +/- 0.03 beats min(-1) mmHg(-1); P < 0.05) remained lower in older subjects. These data indicate that spontaneous measures of cardiac baroreflex sensitivity alone provide limited information when comparing age-groups during exercise, which makes genuine differences in baroreflex function difficult to identify.
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Affiliation(s)
- James P Fisher
- Department of Medical Physiology and Pharmacology, University of Missouri, Colombia, MO 65212, USA
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40
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Arena R, Myers J, Guazzi M. The Clinical Significance of Aerobic Exercise Testing and Prescription: From Apparently Healthy to Confirmed Cardiovascular Disease. Am J Lifestyle Med 2008. [DOI: 10.1177/1559827608323210] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aerobic exercise testing clearly provides valuable clinical information in apparently healthy adults as well as a number of patient populations. Maximal aerobic capacity, either estimated from workload or measured directly, is perhaps the most frequently analyzed variable ascertained from such testing. This practice is warranted given the consistent prognostic significance of maximal aerobic capacity. Other variables obtained from the aerobic exercise test, such as the heart rate response during exercise and into recovery, the systolic and diastolic blood pressure responses during exercise, oxygen consumption at anaerobic threshold, and the ventilatory response to exercise, also provide important insight into an individual's health and prognosis. Furthermore, the aerobic exercise test is highly valuable in developing an individualized and safe exercise prescription. Aerobic exercise training goals, with respect to frequency, duration, frequency, and mode of exercise, are well established for the apparently healthy population as well as individuals at risk for or diagnosed with cardiovascular disease. Adherence to these physical activity recommendations clearly provides numerous health benefits, perhaps most important of which is a significant decrease in the risk for cardiovascular events and mortality. This review addresses concepts of aerobic exercise testing and training and discusses their clinical implications.
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Affiliation(s)
- Ross Arena
- Departments of Internal Medicine, Physiology, and Physical Therapy, Virginia Commonwealth University, Richmond, Virginia,
| | - Jonathan Myers
- VA Palo Alto Health Care System, Cardiology Division, Stanford University, Palo Alto, California
| | - Marco Guazzi
- San Paolo Hospital, Cardiopulmonary Laboratory, Cardiology Division, University of Milano, Milano, Italy
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Fisher JP, Ogoh S, Young CN, Raven PB, Fadel PJ. Regulation of middle cerebral artery blood velocity during dynamic exercise in humans: influence of aging. J Appl Physiol (1985) 2008; 105:266-73. [PMID: 18467548 DOI: 10.1152/japplphysiol.00118.2008] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Although cerebral autoregulation (CA) appears well maintained during mild to moderate intensity dynamic exercise in young subjects, it is presently unclear how aging influences the regulation of cerebral blood flow during physical activity. Therefore, to address this question, middle cerebral artery blood velocity (MCAV), mean arterial pressure (MAP), and the partial pressure of arterial carbon dioxide (Pa(CO(2))) were assessed at rest and during steady-state cycling at 30% and 50% heart rate reserve (HRR) in 9 young (24 +/- 3 yr; mean +/- SD) and 10 older middle-aged (57 +/- 7 yr) subjects. Transfer function analysis between changes in MAP and mean MCAV (MCAV(mean)) in the low-frequency (LF) range were used to assess dynamic CA. No age-group differences were found in Pa(CO(2)) at rest or during cycling. Exercise-induced increases in MAP were greater in older subjects, while changes in MCAV(mean) were similar between groups. The cerebral vascular conductance index (MCAV(mean)/MAP) was not different at rest (young 0.66 +/- 0.04 cm x s(-1) x mmHg(-1) vs. older 0.67 +/- 0.03 cm x s(-1) x mmHg(-1); mean +/- SE) or during 30% HRR cycling between groups but was reduced in older subjects during 50% HRR cycling (young 0.67 +/- 0.03 cm x s(-1) x mmHg(-1) vs. older 0.56 +/- 0.02 cm x s(-1) x mmHg(-1); P < 0.05). LF transfer function gain and phase between MAP and MCAV(mean) was not different between groups at rest (LF gain: young 0.95 +/- 0.05 cm x s(-1) x mmHg(-1) vs. older 0.88 +/- 0.06 cm x s(-1) x mmHg(-1); P > 0.05) or during exercise (LF gain: young 0.80 +/- 0.05 cm x s(-1) x mmHg(-1) vs. older 0.72 +/- 0.07 cm x s(-1) x mmHg(-1) at 50% HRR; P > 0.05). We conclude that despite greater increases in MAP, the regulation of MCAV(mean) is well maintained during dynamic exercise in healthy older middle-aged subjects.
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Affiliation(s)
- James P Fisher
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO 65212, USA
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Fisher JP, Young CN, Fadel PJ. Effect of muscle metaboreflex activation on carotid-cardiac baroreflex function in humans. Am J Physiol Heart Circ Physiol 2008; 294:H2296-304. [PMID: 18326794 DOI: 10.1152/ajpheart.91497.2007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Whether the activation of metabolically sensitive skeletal muscle afferents (i.e., muscle metaboreflex) influences cardiac baroreflex responsiveness remains incompletely understood. A potential explanation for contrasting findings of previous reports may be related to differences in the magnitude of muscle metaboreflex activation utilized. Therefore, the present study was designed to investigate the influence of graded intensities of muscle metaboreflex activation on cardiac baroreflex function. In eight healthy subjects (24 +/- 1 yr), the graded isolation of the muscle metaboreflex was achieved by post-exercise ischemia (PEI) following moderate- (PEI-M) and high- (PEI-H) intensity isometric handgrip performed at 35% and 45% maximum voluntary contraction, respectively. Beat-to-beat heart rate (HR) and blood pressure were measured continuously. Rapid pulse trains of neck pressure and neck suction (+40 to -80 Torr) were applied to derive carotid baroreflex stimulus-response curves. Mean blood pressure increased significantly from rest during PEI-M (+13 +/- 3 mmHg) and was further augmented during PEI-H (+26 +/- 4 mmHg), indicating graded metaboreflex activation. However, the operating point gain and maximal gain (-0.51 +/- 0.09, -0.48 +/- 0.13, and -0.49 +/- 0.12 beats.min(-1).mmHg(-1) for rest; PEI-M and PEI-H) of the carotid-cardiac baroreflex function curve were unchanged from rest during PEI-M and PEI-H (P > 0.05 vs. rest). Furthermore, the carotid-cardiac baroreflex function curve was progressively reset rightward from rest to PEI-M to PEI-H, with no upward resetting. These findings suggest that the muscle metaboreflex contributes to the resetting of the carotid baroreflex control of HR; however, it would appear not to influence carotid-cardiac baroreflex responsiveness in humans, even with high-intensity activation during PEI.
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Affiliation(s)
- James P Fisher
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO 65212, USA
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Fisher JP, Ogoh S, Ahmed A, Aro MR, Gute D, Fadel PJ. Influence of age on cardiac baroreflex function during dynamic exercise in humans. Am J Physiol Heart Circ Physiol 2007; 293:H777-83. [PMID: 17449546 DOI: 10.1152/ajpheart.00199.2007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We investigated the influence of aging on cardiac baroreflex function during dynamic exercise in seven young (22 +/- 1 yr) and eight older middle-aged (59 +/- 2 yr) healthy subjects. Carotid-cardiac baroreflex function was assessed at rest and during moderate-intensity steady-state cycling performed at 50% heart rate reserve (HRR). Five-second pulses of neck pressure and neck suction from +40 to -80 Torr were applied to determine the operating point gain (G(OP)) and maximal gain (G(MAX)) of the full carotid-cardiac baroreflex function curve and examine baroreflex resetting during exercise. At rest, mean arterial pressure (MAP) and heart rate were similar between the younger and older subjects. In contrast, the resting G(OP) and G(MAX) were significantly lower in the older subjects. The increase in MAP from rest to exercise was greater in the older subjects (Delta +20 +/- 2 older vs. Delta +6 +/- 3 younger mmHg; P < 0.001). However, the G(OP) was similar in both groups during exercise because of a reduction in the younger subjects. In contrast, G(MAX) was unchanged from rest and therefore remained lower in older subjects (-0.19 +/- 0.05 older vs. -0.42 +/- 0.05 younger beats.min(-1).mmHg(-1); 50% HRR; P < 0.001). Furthermore, exercise resulted in an upward and rightward resetting of the cardiac baroreflex function curve in both groups. Collectively, these findings suggest that the cardiac baroreflex function curve appropriately resets during exercise in older subjects but operates at a reduced G(MAX) primarily because of age-related reductions in carotid-cardiac control manifest at rest.
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Affiliation(s)
- James P Fisher
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO 65212, USA
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