1
|
Chen H, Xu J, Xie H, Huang Y, Shen X, Xu F. Effects of physical activity on heart rate variability in children and adolescents: a systematic review and meta-analysis. CIENCIA & SAUDE COLETIVA 2022; 27:1827-1842. [PMID: 35544812 DOI: 10.1590/1413-81232022275.10402021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/27/2021] [Indexed: 12/24/2022] Open
Abstract
The aim of the study was to investigate the effects of physical activity (PA) on heart rate variability (HRV) in children and adolescents. We conducted a research of Web of Science, PubMed, ScienceDirect, Springer-Link and EBSCO-host. The revised Newcastle-Ottawa Scale was used in an investigative analysis to assess bias risk. A total of 21 studies were included. Overall, medium-sized associations were found between PA and low frequency and high frequency in children and adolescents. High PA level had significantly higher standard deviation of RR intervals and root of the mean of the sum of the squares of differences between adjacent RR intervals in children and adolescents. The effects of PA on HRV were consistent in children and adolescents. Our systematic review and meta-analysis revealed medium-sized between PA and HRV in children and adolescents. Promoting children's and adolescents' participation in moderate-to-vigorous physical activity (MVPA) will increase parasympathetic nerve activity and decreased sympathetic nerve activity. Our findings support motivating children and adolescents to engage in more MVPA in their daily lives to improve autonomic nervous system function and promote cardiovascular safety.
Collapse
Affiliation(s)
- Hao Chen
- School of Physical Education, Hangzhou Normal University. 311121 Hangzhou China.
| | - Jing Xu
- School of Physical Education, Hangzhou Normal University. 311121 Hangzhou China.
| | - Hao Xie
- Department of Physical Education, Zhejiang University of Finance & Economics. Hangzhou China
| | - Yufen Huang
- The Children's Hospital, Zhejiang University School of Medicine. Hangzhou China
| | - Xin Shen
- The Children's Hospital, Zhejiang University School of Medicine. Hangzhou China
| | - Fei Xu
- School of Physical Education, Hangzhou Normal University. 311121 Hangzhou China.
| |
Collapse
|
2
|
Associations of physical activity, sedentary time, and cardiorespiratory fitness with heart rate variability in 6- to 9-year-old children: the PANIC study. Eur J Appl Physiol 2019; 119:2487-2498. [PMID: 31535217 PMCID: PMC6858383 DOI: 10.1007/s00421-019-04231-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/10/2019] [Indexed: 12/16/2022]
Abstract
Purpose To study the associations of physical activity (PA), sedentary time (ST), and cardiorespiratory fitness (CRF) with heart rate variability (HRV) in children. Methods The participants were a population sample of 377 children aged 6–9 years (49% boys). ST, light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and moderate-to-vigorous PA (MVPA), and PA energy expenditure (PAEE) were assessed using a combined heart rate and movement sensor, maximal power output per kilograms of lean body mass as a measure of CRF by maximal cycle ergometer exercise test, and HRV variables (SDNN, RMSSD, LF, and HF) using 5 min resting electrocardiography. Data were analysed by linear regression adjusted for years from peak height velocity. Results In boys, ST was inversely associated (β = − 0.185 to − 0.146, p ≤ 0.049) and MVPA, VPA, PAEE, and CRF were directly associated (β = 0.147 to 0.320, p ≤ 0.048) with HRV variables. CRF was directly associated with all HRV variables and PAEE was directly associated with RMSSD after mutual adjustment for ST, PAEE, and CRF (β = 0.169 to 0.270, p ≤ 0.046). In girls, ST was inversely associated (β = − 0.382 to − 0.294, p < 0.001) and LPA, MPA, VPA, MVPA, and PAEE were directly associated with HRV variables (β = 0.144 to 0.348, p ≤ 0.049). After mutual adjustment for ST, PAEE, and CRF, only the inverse associations of ST with HRV variables remained statistically significant. Conclusions Higher ST and lower PA and CRF were associated with poorer cardiac autonomic nervous system function in children. Lower CRF in boys and higher ST in girls were the strongest correlates of poorer cardiac autonomic function. Electronic supplementary material The online version of this article (10.1007/s00421-019-04231-5) contains supplementary material, which is available to authorized users.
Collapse
|
3
|
Oliveira RS, Barker AR, Wilkinson KM, Abbott RA, Williams CA. Is cardiac autonomic function associated with cardiorespiratory fitness and physical activity in children and adolescents? A systematic review of cross-sectional studies. Int J Cardiol 2017; 236:113-122. [PMID: 28238507 DOI: 10.1016/j.ijcard.2017.02.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/11/2017] [Accepted: 02/03/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Heart rate variability (HRV) is considered to explain improvements in cardiovascular health accrued by physical activity (PA) and cardiorespiratory fitness (CRF) over and above traditional cardiovascular risk factors. OBJECTIVE To systematically address associations between HRV, PA and CRF in children and adolescents. DATA SOURCES Medline, EMBASE, SportDISCUS and CINAHL Plus were searched on 5th September 2015 and updated on 4th August 2016. ELIGIBILITY CRITERIA Observational studies comparing HRV in different groups of PA and CRF, and/or studies investigating associations between PA, CRF and HRV. Sports practices and PA intensities were also included. The square root of the mean of the sum of the squares of differences between adjacent RR intervals (RMSSD), the spectral density in the high (HF) and low (LF) frequency, and the LF/HF ratio were included. Risk of bias was assessed using the adapted Newcastle-Ottawa Scale (NOS). RESULTS Heterogeneity exists in the assessment of the exposures and outcomes, and sample characteristics. Risk of bias (NOS) was observed in most of the studies. Studies with low risk of bias showed positive associations between moderate-to-vigorous PA and RMSSD. The evidence for the associations between PA and frequency indices is weak. Similarly, the evidence for the association between CRF and HRV is weak. CONCLUSIONS Despite the heterogeneity in the studies, moderate-to-vigorous PA is positively associated with RMSSD, but less clear are the associations between CRF and HRV, as well as other PA intensities. Further research is needed to clarify the role of PA and CRF on HRV in children and adolescents.
Collapse
Affiliation(s)
- Ricardo Santos Oliveira
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Alan Robert Barker
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Kelly Michelle Wilkinson
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Rebecca Anne Abbott
- Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Craig Anthony Williams
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
| |
Collapse
|
4
|
Herzig D, Eser P, Radtke T, Wenger A, Rusterholz T, Wilhelm M, Achermann P, Arhab A, Jenni OG, Kakebeeke TH, Leeger-Aschmann CS, Messerli-Bürgy N, Meyer AH, Munsch S, Puder JJ, Schmutz EA, Stülb K, Zysset AE, Kriemler S. Relation of Heart Rate and its Variability during Sleep with Age, Physical Activity, and Body Composition in Young Children. Front Physiol 2017; 8:109. [PMID: 28286485 PMCID: PMC5323426 DOI: 10.3389/fphys.2017.00109] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 02/09/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Recent studies have claimed a positive effect of physical activity and body composition on vagal tone. In pediatric populations, there is a pronounced decrease in heart rate with age. While this decrease is often interpreted as an age-related increase in vagal tone, there is some evidence that it may be related to a decrease in intrinsic heart rate. This factor has not been taken into account in most previous studies. The aim of the present study was to assess the association between physical activity and/or body composition and heart rate variability (HRV) independently of the decline in heart rate in young children. Methods: Anthropometric measurements were taken in 309 children aged 2–6 years. Ambulatory electrocardiograms were collected over 14–18 h comprising a full night and accelerometry over 7 days. HRV was determined of three different night segments: (1) over 5 min during deep sleep identified automatically based on HRV characteristics; (2) during a 20 min segment starting 15 min after sleep onset; (3) over a 4-h segment between midnight and 4 a.m. Linear models were computed for HRV parameters with anthropometric and physical activity variables adjusted for heart rate and other confounding variables (e.g., age for physical activity models). Results: We found a decline in heart rate with increasing physical activity and decreasing skinfold thickness. HRV parameters decreased with increasing age, height, and weight in HR-adjusted regression models. These relationships were only found in segments of deep sleep detected automatically based on HRV or manually 15 min after sleep onset, but not in the 4-h segment with random sleep phases. Conclusions: Contrary to most previous studies, we found no increase of standard HRV parameters with age, however, when adjusted for heart rate, there was a significant decrease of HRV parameters with increasing age. Without knowing intrinsic heart rate correct interpretation of HRV in growing children is impossible.
Collapse
Affiliation(s)
- David Herzig
- Preventive Cardiology and Sports Medicine, University Clinic for Cardiology, Inselspital, Bern University Hospital, University of Bern Bern, Switzerland
| | - Prisca Eser
- Preventive Cardiology and Sports Medicine, University Clinic for Cardiology, Inselspital, Bern University Hospital, University of Bern Bern, Switzerland
| | - Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich Zurich, Switzerland
| | - Alina Wenger
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich Zurich, Switzerland
| | - Thomas Rusterholz
- Institute of Pharmacology and Toxicology, University of ZurichZurich, Switzerland; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBern, Switzerland
| | - Matthias Wilhelm
- Preventive Cardiology and Sports Medicine, University Clinic for Cardiology, Inselspital, Bern University Hospital, University of Bern Bern, Switzerland
| | - Peter Achermann
- Institute of Pharmacology and Toxicology, University of ZurichZurich, Switzerland; Zurich Center for Integrative Human Physiology, University of ZurichZurich, Switzerland
| | - Amar Arhab
- Endocrinology, Diabetes, and Metabolism Service, Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Switzerland
| | - Oskar G Jenni
- Child Development Center, University Children's Hospital ZurichZurich, Switzerland; Children's Research Center, University Children's Hospital ZurichZurich, Switzerland
| | - Tanja H Kakebeeke
- Child Development Center, University Children's Hospital ZurichZurich, Switzerland; Children's Research Center, University Children's Hospital ZurichZurich, Switzerland
| | | | - Nadine Messerli-Bürgy
- Endocrinology, Diabetes, and Metabolism Service, Centre Hospitalier Universitaire Vaudois (CHUV)Lausanne, Switzerland; Department of Clinical Psychology and Psychotherapy, University of FribourgFribourg, Switzerland
| | - Andrea H Meyer
- Department of Psychology, University of Basel Basel, Switzerland
| | - Simone Munsch
- Department of Clinical Psychology and Psychotherapy, University of Fribourg Fribourg, Switzerland
| | - Jardena J Puder
- Endocrinology, Diabetes, and Metabolism Service, Centre Hospitalier Universitaire Vaudois (CHUV)Lausanne, Switzerland; Division of Pediatric Endocrinology, Diabetology and Obesity, Centre Hospitalier Universitaire Vaudois (CHUV)Lausanne, Switzerland
| | - Einat A Schmutz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich Zurich, Switzerland
| | - Kerstin Stülb
- Department of Clinical Psychology and Psychotherapy, University of Fribourg Fribourg, Switzerland
| | - Annina E Zysset
- Child Development Center, University Children's Hospital Zurich Zurich, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich Zurich, Switzerland
| |
Collapse
|
5
|
de Zambotti M, Willoughby AR, Franzen PL, Clark DB, Baker FC, Colrain IM. K-Complexes: Interaction between the Central and Autonomic Nervous Systems during Sleep. Sleep 2016; 39:1129-37. [PMID: 26856907 DOI: 10.5665/sleep.5770] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/23/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To investigate the relationship between K-complexes (KCs) and cardiac functioning. METHODS Forty healthy adolescents aged 16-22 y (19 females) participated in the study. Heart rate (HR) fluctuations associated with spontaneous and evoked KCs were investigated on two nights, one with (event-related potential night) and one without auditory tones presented across the night. RESULTS There was a clear biphasic cardiac response to evoked and spontaneous KCs, with an initial acceleration in HR followed by a deceleration (P < 0.001). HR acceleration occurred immediately to KCs in response to tones presented in the first third of the interbeat interval, but was delayed a beat when the tone occurred later in the cardiac cycle (P < 0.05). Sex differences were also evident. Pretone baseline HR was higher, and the magnitude of the HR response was blunted and delayed, in female compared to male adolescents (P < 0.001). Also, pretone baseline HR was lower when a tone elicited a KC compared to when it did not (P < 0.001), suggesting that KCs are possibly more likely to be elicited by external stimuli in states of reduced cardiac activation. CONCLUSIONS The strict dependency observed between KCs and cardiac control indicates a potential role of KCs in modulating the cardiovascular system during sleep. Sex differences in the KC-cardiac response indicate the sensitivity of this measure in capturing sex differences in cardiac regulatory physiology.
Collapse
Affiliation(s)
| | | | | | - Duncan B Clark
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA.,Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
6
|
Hedger-Archbold K, Sorensen ST, Goodwin JL, Quan SF. Average heart rates of hispanic and caucasian adolescents during sleep: longitudinal analysis from the TuCASA cohort. J Clin Sleep Med 2014; 10:991-5. [PMID: 25142769 PMCID: PMC4153113 DOI: 10.5664/jcsm.4034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The current study describes sleeping heart rate patterns in an adolescent cohort of Hispanic and Caucasian children over approximately a 5-year period to determine how sex, ethnicity, and body mass index (BMI) contribute to sleeping heart rate patterns over time. METHODS Participants were recruited from a large urban school district in the southwest United States as part of the Tucson Children's Assessment of Sleep Apnea Study (TuCASA). Heart rate data was obtained through electrocardiogram (ECG) recordings during in-home polysomnography, approximately 5 years apart. Second-wave cohort data were analyzed to determine how age, sex, ethnicity, physical activity, and BMI contribute to average sleeping heart rates. The same variables were used to investigate how sleeping heart rate patterns change longitudinally from school-age (6-11 years) to adolescence (10-17 years) during sleep. RESULTS Female adolescents had significantly faster average heart rates during sleep. Sleeping heart rate decreased significantly with increasing age in the adolescent cohort. Although the Hispanic group had a statistically significant higher body mass index than Caucasians, there were no significant differences in heart rate observed between ethnicities or in those who were classified as obese (BMI ≥ 95(th) percentile for age). Longitudinal analysis between the school-aged and adolescent cohort revealed a significant overall decrease in heart rate across a 5-year period. CONCLUSIONS Hispanic and Caucasian adolescents experience a similar decrease in sleeping heart rate with age. Female adolescents had significantly faster heart rates than males, and no significant differences were observed between Caucasians and Hispanics, or obese vs. nonobese adolescents.
Collapse
Affiliation(s)
| | - Seth T. Sorensen
- Department of Disability and Psychoeducational Studies, College of Education, University of Arizona, Tucson, AZ
| | - James L. Goodwin
- Arizona Respiratory Center, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ
| | - Stuart F. Quan
- Arizona Respiratory Center, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| |
Collapse
|
7
|
Hwang M, Zebracki K, Betz RR, Mulcahey MJ, Vogel LC. Normative blood pressure and heart rate in pediatric spinal cord injury. Top Spinal Cord Inj Rehabil 2013; 19:87-95. [PMID: 23671378 DOI: 10.1310/sci1902-87] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cardiovascular measures in children with spinal cord injury (SCI) may vary depending on the child's age and physical development in addition to injury-related factors. Developmental changes should be considered when addressing cardiovascular complications in this population. OBJECTIVES To determine baseline blood pressure (BP) and heart rate (HR) measurements in youth with SCI, and to investigate differences in BP and HR in relation to age, gender, body mass index (BMI), and injury-related factors. METHODS Retrospective chart review was conducted for youth under 19 years who had been admitted for rehabilitation at 1 of 2 pediatric SCI programs. Systolic (SBP) and diastolic (DBP) blood pressures and HR were collected in the morning and afternoon on 3 consecutive days. Mean SBP, DBP, and HR were compared among 4 age groups (0-5 years, 6-12 years, 13-15 years, and 16-18 years) and by gender. Diurnal variations were determined according to level and severity of injury. Associations with BMI and injury-related factors were examined. Charts of 315 youths were reviewed: mean age was 12.3 years, 59% were male, 75% were Caucasian, 62% had complete injury, and 66% had paraplegia. RESULTS With increasing age, SBP and DBP increased and HR decreased. SBP and DBP were positively correlated with BMI. SBP was higher in males, those with incomplete injury, and those with paraplegia. HR was higher in females. There was no association between cardiovascular measures and injury duration. CONCLUSION BP and HR are a function of age, BMI, and completeness and level of injury in youth with SCI. Awareness of baseline measures will allow for more effective management of cardiovascular complications, especially in youth presenting with atypical symptoms.
Collapse
Affiliation(s)
- Miriam Hwang
- Shriners Hospitals for Children , Chicago, Illinois ; Marquette University , Milwaukee, Wisconsin
| | | | | | | | | |
Collapse
|
8
|
Determinants and reference values of short-term heart rate variability in children. Eur J Appl Physiol 2012; 113:1477-88. [DOI: 10.1007/s00421-012-2572-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
|
9
|
Daluwatte C, Miles JH, Yao G. Simultaneously measured pupillary light reflex and heart rate variability in healthy children. Physiol Meas 2012; 33:1043-52. [PMID: 22563002 PMCID: PMC3374849 DOI: 10.1088/0967-3334/33/6/1043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We investigated the potential inter-relationship between two measures of autonomic nervous system: pupillary light reflex (PLR) and heart rate variability (HRV), in healthy children of 8-16 years old. PLR was measured at both dark- and light-adapted conditions with various stimulation intensities. Simultaneously measured HRV was obtained in five different PLR testing phases: before PLR test, light-adapted PLR test, dark adaptation, dark-adapted PLR test and after PLR test. The frequency domain HRV parameters measured during the PLR test were significantly different from those measured during rest. Both the regression analysis and factor analysis indicated that PLR and HRV parameters were not correlated, which suggests that they may provide complementary assessment of different aspects of the overall autonomic nervous system.
Collapse
Affiliation(s)
- C Daluwatte
- Department of Biological Engineering, University of Missouri, Columbia, MO 65211
| | - J H Miles
- Child Health and Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO 65211
| | - G Yao
- Department of Biological Engineering, University of Missouri, Columbia, MO 65211
| |
Collapse
|
10
|
Scholle S, Wiater A, Scholle HC. Normative values of polysomnographic parameters in childhood and adolescence: Cardiorespiratory parameters. Sleep Med 2011; 12:988-96. [DOI: 10.1016/j.sleep.2011.05.006] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 04/26/2011] [Accepted: 05/01/2011] [Indexed: 12/01/2022]
|
11
|
Burwell RG, Aujla RK, Grevitt MP, Dangerfield PH, Moulton A, Randell TL, Anderson SI. Pathogenesis of adolescent idiopathic scoliosis in girls - a double neuro-osseous theory involving disharmony between two nervous systems, somatic and autonomic expressed in the spine and trunk: possible dependency on sympathetic nervous system and hormones with implications for medical therapy. SCOLIOSIS 2009; 4:24. [PMID: 19878575 PMCID: PMC2781798 DOI: 10.1186/1748-7161-4-24] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Accepted: 10/31/2009] [Indexed: 12/24/2022]
Abstract
Anthropometric data from three groups of adolescent girls - preoperative adolescent idiopathic scoliosis (AIS), screened for scoliosis and normals were analysed by comparing skeletal data between higher and lower body mass index subsets. Unexpected findings for each of skeletal maturation, asymmetries and overgrowth are not explained by prevailing theories of AIS pathogenesis. A speculative pathogenetic theory for girls is formulated after surveying evidence including: (1) the thoracospinal concept for right thoracic AIS in girls; (2) the new neuroskeletal biology relating the sympathetic nervous system to bone formation/resorption and bone growth; (3) white adipose tissue storing triglycerides and the adiposity hormone leptin which functions as satiety hormone and sentinel of energy balance to the hypothalamus for long-term adiposity; and (4) central leptin resistance in obesity and possibly in healthy females. The new theory states that AIS in girls results from developmental disharmony expressed in spine and trunk between autonomic and somatic nervous systems. The autonomic component of this double neuro-osseous theory for AIS pathogenesis in girls involves selectively increased sensitivity of the hypothalamus to circulating leptin (genetically-determined up-regulation possibly involving inhibitory or sensitizing intracellular molecules, such as SOC3, PTP-1B and SH2B1 respectively), with asymmetry as an adverse response (hormesis); this asymmetry is routed bilaterally via the sympathetic nervous system to the growing axial skeleton where it may initiate the scoliosis deformity (leptin-hypothalamic-sympathetic nervous system concept = LHS concept). In some younger preoperative AIS girls, the hypothalamic up-regulation to circulating leptin also involves the somatotropic (growth hormone/IGF) axis which exaggerates the sympathetically-induced asymmetric skeletal effects and contributes to curve progression, a concept with therapeutic implications. In the somatic nervous system, dysfunction of a postural mechanism involving the CNS body schema fails to control, or may induce, the spinal deformity of AIS in girls (escalator concept). Biomechanical factors affecting ribs and/or vertebrae and spinal cord during growth may localize AIS to the thoracic spine and contribute to sagittal spinal shape alterations. The developmental disharmony in spine and trunk is compounded by any osteopenia, biomechanical spinal growth modulation, disc degeneration and platelet calmodulin dysfunction. Methods for testing the theory are outlined. Implications are discussed for neuroendocrine dysfunctions, osteopontin, sympathoactivation, medical therapy, Rett and Prader-Willi syndromes, infantile idiopathic scoliosis, and human evolution. AIS pathogenesis in girls is predicated on two putative normal mechanisms involved in trunk growth, each acquired in evolution and unique to humans.
Collapse
Affiliation(s)
- R Geoffrey Burwell
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - Ranjit K Aujla
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - Michael P Grevitt
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals Trust, Queen's Medical Centre Campus, Nottingham, UK
| | | | - Alan Moulton
- Department of Orthopaedic Surgery, King's Mill Hospital, Mansfield, UK
| | - Tabitha L Randell
- Department of Child Health, Nottingham University Hospitals Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - Susan I Anderson
- School of Biomedical Sciences, University of Nottingham, Nottingham, UK
| |
Collapse
|