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Han J, Park J, Kang H, Lee H, Kim N. The Effect of a Biofeedback-Based Integrated Program on Improving Orthostatic Hypotension in Community-Dwelling Older Adults: A Pilot Study. J Cardiovasc Nurs 2023:00005082-990000000-00120. [PMID: 37615610 DOI: 10.1097/jcn.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Orthostatic hypotension (OH) is prevalent among community-dwelling older adults and is associated with multiple negative health outcomes. Older adults are susceptible to developing OH because aging alters autonomic nervous system function. Biofeedback is a noninvasive, nonpharmacological intervention that can modulate autonomic nervous system dysfunction in older adults. OBJECTIVES Our aim in this study was to examine the effect of a biofeedback-based integrated program on community-dwelling older adults with OH. METHODS We conducted a controlled pilot study. Community-dwelling older adults 65 years or older who had nonneurogenic OH were eligible. Data from 51 participants, comprising 27 in the intervention group and 24 in the control group, were analyzed. Weekly biofeedback-based integrated program consisting of biofeedback training along with group education about behavioral modification, physical activities, and telephone counseling was provided for 12 weeks. Orthostatic hypotension was evaluated by measuring the drop in systolic and diastolic blood pressure after postural changes. Autonomic nervous system function was measured using heart rate variability. RESULTS Among the indicators of heart rate variability, total power (P = .037) and low frequency (P = .017) increased significantly, suggesting that autonomic function improved. Severity of orthostatic symptoms (P < .001) and drops in systolic (P = .003) and diastolic (P = .012) blood pressure after postural changes decreased significantly in the intervention group. CONCLUSION Biofeedback-based integrated program was effective in improving autonomic nervous system function and alleviated OH. Therefore, biofeedback-based integrated program should be tested in a larger randomized controlled study with long-term follow-up.
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Orthostatic hypotension and health-related quality of life among community-living older people in Korea. Qual Life Res 2019; 29:303-312. [PMID: 31515746 DOI: 10.1007/s11136-019-02295-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the association of orthostatic hypotension (OH) with health-related quality of life (HRQoL) in older people living in the community. METHODS A cross-sectional design was used. A total of 217 participants aged 65 and older were classified as having OH if their systolic or diastolic blood pressure showed a drop of ≥ 20 mmHg systolic blood pressure or ≥ 10 mmHg diastolic blood pressure, respectively, within 3 min of standing. Participants provided demographic and medical information and responded to questionnaires about their HRQoL (EuroQoL-5D-3L), as well as depression, anxiety, cognitive function, and recent physical activities. RESULTS The number of participants with OH was 117, and those without OH numbered 100. The mean HRQoL levels were 0.56 (SD 0.29) in the OH group and 0.74 (SD 0.25) in the non-OH group (p < .001). Participants with OH were more likely to be older, women, and smokers. These participants had fewer years of education, a greater history of stroke and hypertension, and a greater number of comorbidities. The absence of OH, a higher physical activity level, a lower degree of depression, an absence of stroke history, and younger age were all significant determinants of greater HRQoL. CONCLUSIONS The level of HRQoL of older people with OH was significantly lower than that of older people without. The presence of OH was an independent determinant of HRQoL in older adults after adjusting for covariates. This finding suggests that strategies for relieving OH could improve HRQoL in affected older adults.
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Soye A, O'Súilleabháin PS. Facets of openness to experience are associated with cardiovascular reactivity and adaptation across both active and passive stress exposures. Int J Psychophysiol 2019; 140:26-32. [PMID: 30946867 DOI: 10.1016/j.ijpsycho.2019.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/18/2019] [Accepted: 03/31/2019] [Indexed: 11/16/2022]
Abstract
Research suggests the personality trait of Openness to Experience is associated with cardiovascular stress processes. It is unknown if the underlying facets of Openness are associated with cardiovascular responsivity, and whether adaptation is evident across active and passive stress. The objective of this study was to determine if the facets of Openness are related to cardiovascular reactivity and adaptation across active and passive stress exposures. Personality measures and continuous cardiovascular data from sixty-six female adults across a protocol of active and passive stress tasks were collated. Multiple regression analysis revealed that the facet of Feelings was associated with systolic blood pressure (SBP) reactivity to active stress. Examination of cardiovascular adaption revealed that the facet of Feelings was positively associated with SBP and diastolic blood pressure (DBP) adaptation, whereas the facet of Actions demonstrated a negative association. Supplementary analyses revealed the significant effects for Feelings were not reliant on the remaining Openness facets, whereas the significant effects for Actions were. No significant effects emerged for the higher-order trait of Openness. These findings suggest that the underlying facet of Feelings is associated with active stress reactivity, with the facets of Feelings and Actions appearing to be of importance to cardiovascular adaptation. This study is the first to demonstrate personality effects on cardiovascular adaptation across active and passive stress. Attending to the facets of personality traits may provide a more precise understanding of the personality effects on cardiovascular stress psychophysiology.
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Affiliation(s)
- Anna Soye
- School of Psychology, National University of Ireland, Galway, University Road, Galway, Ireland
| | - Páraic S O'Súilleabháin
- School of Psychology, National University of Ireland, Galway, University Road, Galway, Ireland.
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Lee H, Kim HA. Orthostatic tachycardia with different onset time in patients with orthostatic intolerance. J Neurol Sci 2018; 390:166-171. [PMID: 29801880 DOI: 10.1016/j.jns.2018.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate whether there is a difference in the neuro-autonomic and hemodynamic parameters in patients with postural tachycardia syndrome (POTS) according to onset time of orthostatic tachycardia during the Head-up tilt (HUT) test. METHODS We retrospectively reviewed neuro-autonomic and hemodynamic data from patients with orthostatic intolerance. A standardized battery of neuro-autonomic tests, including the HUT, Valsalva maneuver, heart rate deep breathing and quantitative sudomotor axon reflex test, was performed. The beat-to-beat derived hemodynamic parameters, including systolic blood pressure (BP) (SBP), mean BP (MBP), diastolic BP, heart rate (HR), total peripheral resistance, stroke volume, and cardiac output, were also extracted from HUT test. According to onset time of orthostatic tachycardia (OT), we divided patients into two groups; HR increase "within 10 minutes" (i.e., early OT) and HR increase "after 10 minutes" (i.e., late OT). RESULTS We identified 210 patients with OT during HUT test. Forty-three percent of patients were included in early OT group and 57% were late OT group. Patients in late OT group were older than early OT group. Late OT group tended to have baseline hypertension more frequently compared to early OT group. After adjusting for age, late OT group showed higher baseline SBP and MBP, and lower increase of HR during HUT test than early OT group. However, other neuro-autonomic and hemodynamic parameters did not show significant differences between two groups. CONCLUSION Orthostatic tachycardia might be developed in the late period during the HUT test. There were no remarkable differences in neuro-autonomic and hemodynamic parameters between early and late OT groups. It seems reasonable to extend the duration of HUT test to at least 20 min, to increase the diagnostic yield in patients with a history of orthostatic intolerance suspected as having POTS.
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Affiliation(s)
- Hyung Lee
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Hyun Ah Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea.
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Sardeli AV, Ferreira MLV, Santos LDC, Rodrigues MDS, Damasceno A, Cavaglieri CR, Chacon-Mikahil MPT. LOW-LOAD RESISTANCE EXERCISE IMPROVES COGNITIVE FUNCTION IN OLDER ADULTS. REV BRAS MED ESPORTE 2018. [DOI: 10.1590/1517-869220182402179200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: Resistance exercise (RE) training is widely recommended for increasing muscle strength and mass in older adults. RE is also a potential stimulus to improve cognitive functions (CF), but the best protocol for this purpose is unknown. Objective: To compare the effects of different RE protocols on CF in the same group of individuals. Methods: Twenty-four older adults were randomized (cross over) to control (CON) and lower limb RE protocols with high load (HL - 80% of 1RM), low load (LL - 30% of 1RM) and LL with blood flow restriction (LL-BFR - 30% of 1RM and 50% BFR). For CF assessment, participants underwent the Stroop test before and after each RE protocol. Results: Reduction in response time for Stroop neutral stimuli was greater after LL (effect size (ES) = -0.92) compared to CON (ES = -0.18) and HL (ES = -0.03), but was not different from LL-BFR (ES = -0.24). The reduced response time was associated with reduced parasympathetic modulation and increased cardiac output across protocols. Conclusion: LL was the most effective RE protocol to improve CF of older adults and a potential beneficial effect of LL-BFR on CF (non-significant) was identified. Therefore, LL resistance exercise appears to stimulate acute cognitive improvements in healthy older adults, probably through exercise-induced optimal autonomic modulation changes. Level of Evidence I; Therapeutic studies-Investigating the results of treatment.
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O'Hare C, McCrory C, O'Connell MD, Kenny RA. Sub-clinical orthostatic hypotension is associated with greater subjective memory impairment in older adults. Int J Geriatr Psychiatry 2017; 32:429-438. [PMID: 27245850 DOI: 10.1002/gps.4485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 03/04/2016] [Accepted: 03/15/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Orthostatic blood pressure (BP) is a measure of cardiovascular autonomic function. Orthostatic BP dysregulation may lie on the causal pathway to dementia. Subjective memory impairment (SMI) is commonly reported by older people some of whom may progress to dementia. We hypothesised that sub-clinical orthostatic hypotension would be associated with SMI and explored these associations according to sex. METHODS Cross-sectional analysis of data from 4340 participants aged 50 and over collected during the first wave (2009-2011) of the cohort study, The Irish Longitudinal Study on Ageing. Subjective memory was rated according to a 5-point scale ranging from 'poor' to 'excellent'. BP was measured during orthostatic stress using continuous non-invasive beat-to-beat recording over 2 min. RESULTS 2% reported 'poor' subjective memory, 12.3% 'fair' , 38% 'good', 33% 'very good' and 14.6% 'excellent'. After controlling for several potential confounding factors including cardiovascular risk, objective cognition, and depressive symptoms mean systolic orthostatic BP was lowest in those with poor subjective memory: 92.2 mmHg (CI95% = 87.1, 97.3) versus excellent 99.3 mmHg (CI95% = 97.4, 101.2); p = 0.011. Further adjustment for supine systolic BP suggested that men with poor subjective memory reached the lowest average systolic orthostatic BP and had the greatest impairment in systolic orthostatic BP stabilisation to baseline levels at 10 s post-stand (-6.64 mmHg; CI95% = -11.49, -1.79; p = 0.007). CONCLUSIONS Sub-clinical orthostatic hypotension is associated with SMI, and there are sex-specific relationships evident in this population-based cohort. Subtle cardiovascular autonomic dysfunction may represent a modifiable risk marker at an early stage of cognitive decline in older adults. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Celia O'Hare
- Department of Psychiatry, Trinity College Dublin
| | - Cathal McCrory
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Matthew Dl O'Connell
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
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Minatel V, Takahashi ACM, Perseguini NM, Milan JC, Castello-Simões V, Gomes EC, Borghi-Silva A, Catai AM. Maximal expiratory pressure and Valsalva manoeuvre do not produce similar cardiovascular responses in healthy men. Exp Physiol 2016; 101:599-611. [PMID: 26935142 DOI: 10.1113/ep085203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/01/2016] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? This is the first study to evaluate and describe the cardiovascular responses during maximal expiratory pressure compared with the Valsalva manoeuvre, and whether those responses are similar. What is the main finding and its importance? This study showed that the duration of the manoeuvres appears to be responsible for the different physiological mechanisms involved in the cardiovascular responses to each manoeuvre and that the intensity of expiratory effort was related to the response in maximal expiratory pressure. These results are important to identify the risks to which subjects are exposed when performing these manoeuvres. The main purpose of this study was to compare the cardiovascular responses between the Valsalva manoeuvre (VM) and maximal expiratory pressure (MEP) and to evaluate the effect of age on these responses. Twenty-eight healthy men were evaluated and divided into two groups, younger (n = 15, 25 ± 5 years) and middle aged (n = 13, 50 ± 5 years), and they performed the VM and MEP measurement. The VM consisted of an expiratory effort (40 mmHg) against a manometer for 15 s, and the MEP was performed according to American Thoracic Society guidelines. The cardiovascular responses were analysed at rest, isotime (3 s), peak, nadir and recovery, and the cardiovascular variations (Δ) were calculated as peak or isotime minus resting values. For the statistical analysis, we used two-way ANOVA (P < 0.05). We observed that MEP and the VM generate similar changes in cardiac output (P > 0.05), but MEP presents higher values for mean arterial pressure (MAPPeak , MAPIsotime , ΔMAP and ΔMAPIsotime ) than those observed in the VM (P < 0.05). The execution time of the manoeuvres (VM ∼15 s and MEP ∼5 s) appears to be largely responsible for the activation of different physiological mechanisms involved in the cardiovascular control for each manoeuvre, and the intensity of expiratory effort is related to the higher response of MAP and peripheral vascular resistance (PVRIsotime and ΔPVRIsotime ) during MEP (P < 0.05). Moreover, it appears that age affects only the heart rate and PVR responses (P < 0.05), which were higher in the young and middle-aged group, respectively. Based on these findings, we can conclude that MEP and the VM do not generate similar cardiovascular responses, except for cardiac output.
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Affiliation(s)
- Vinicius Minatel
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Anielle C M Takahashi
- Research Laboratory in Health Elderly, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Natália Maria Perseguini
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Juliana Cristina Milan
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Viviane Castello-Simões
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Ellen C Gomes
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Audrey Borghi-Silva
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Aparecida Maria Catai
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
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Orthostatic hypertension: An underestimated cause of orthostatic intolerance. Clin Neurophysiol 2016; 127:2102-7. [PMID: 26806722 DOI: 10.1016/j.clinph.2015.12.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/26/2015] [Accepted: 12/20/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the frequency and mechanism of orthostatic hypertension (OHT) in patients with orthostatic intolerance. METHODS We retrospectively reviewed 1033 consecutive case series of orthostatic intolerance that underwent autonomic function tests including a head-up tilt test. OHT was defined as a paradoxical orthostatic increase in systolic blood pressure (BP) of at least 20 mmHg during the tilt. We collected autonomic parameters during the standardized autonomic function tests, which included the beat-to-beat derived hemodynamic parameters during the tilt table test and compared them with age and sex-matched normal controls and the orthostatic hypotension (OH) group with orthostatic symptoms. RESULTS We identified 38 (3.7%) patients who showed OHT during the tilt. The increase in mean systolic BP during the tilt was 26.5 mmHg. Approximately 87% (33/38) of the OHT patients showed an increase in total peripheral resistance during the tilt. The mean increase in total peripheral resistance from a supine baseline was significantly higher in OHT patients compared to normal controls, but the OH group showed a decrease in mean total peripheral resistance during the tilt. CONCLUSION A select few patients with orthostatic dizziness can show OHT during the tilt and they have signs of increased peripheral resistance. SIGNIFICANCE OHT may be considered in the differential diagnosis of orthostatic intolerance.
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Mellingsæter MR, Wyller VB, Wyller TB, Ranhoff AH. Gender differences in orthostatic tolerance in the elderly. Aging Clin Exp Res 2013; 25:659-65. [DOI: 10.1007/s40520-013-0092-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/11/2013] [Indexed: 01/22/2023]
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