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Zhou Y, Wang Q, Larkey L, James D, Cui H. Tai Chi Effects on Heart Rate Variability: A Systematic Review and Meta-Analysis. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:121-132. [PMID: 37695835 DOI: 10.1089/jicm.2022.0682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Background: Tai Chi, originating in China, is a mind-body exercise that integrates mind training, Qi training, and body training. While Tai Chi practice has demonstrated beneficial physical and psychological health benefits, how it achieves effects has been less studied. In recent years, some researchers have begun to explore the potential of heart rate variability (HRV) changes as balancing the autonomic nervous system (ANS) to achieve results, but only a few studies have directly tested how Tai Chi impacts HRV, and results have been mixed. Objective: This study systematically evaluates the effects of Tai Chi on HRV. Methods: Electronic databases including Web of Science, PubMed, Scopus, Cochrane Library, and EBSCOhost direct from inception until December 2020 were searched to obtain eligible studies. The primary outcomes examined were HRV parameters (time domain and frequency domain), and secondary analysis was whether breathing was emphasized during Tai Chi interventions. Results: Based on the 11 randomized controlled trials included comparing Tai Chi with non-active control condition, meta-analyses showed significantly beneficial effects on HRV parameters (low-frequency power [LF], mean difference [MD] = -200.40, 95% confidence interval [CI]: 365.31 to -35.49, p = 0.02; normalized low-frequency power [nLF], MD = -7.39, 95% CI: -12.48 to -2.29, p = 0.004; total power [TP], MD = -649.82, 95% CI: -1180.54 to -119.11, p = 0.02; very low-frequency power [VLF], MD = -200.55, 95% CI: -349.63 to -51.46, p = 0.008; root mean square of the square sum of the difference between adjacent normal heartbeat intervals [RMSSD], MD = 2.59, 95% CI: -7.23 to 12.41, p < 0.0001; standard deviation of the heartbeat interval [SDNN], MD = 8.33, 95% CI: 0.69 to 15.98, p = 0.03). The effect of Tai Chi on certain HRV parameters compared with active control conditions was less favorable (nLF, MD = 6.42, 95% CI: 3.74 to 9.09, p < 0.00001; normalized high-frequency power [nHF], MD: -6.13, 95% CI: -8.76 to -3.50, p < 0.00001; low-frequency/high-frequency power ratio [LF/HF], MD = 1.00, 95% CI: 0.68 to 1.33, p < 0.00001). In addition, studies describing an emphasis on breathing in the Tai Chi intervention showed positive impact on HRV (nLF, MD = -3.22, 95% CI: -5.32 to -1.12, p = 0.003; nHF, MD = 3.80, 95% CI: 0.80 to 6.81, p = 0.01; SDNN, MD = 5.55, 95% CI: 4.85 to 6.25, p < 0.00001). Conclusions: Meta-analysis results showed that Tai Chi compared with non-active control conditions has a positive impact on key HRV parameters associated with the ANS balance. However, active control condition comparisons showed greater HRV improvements than for Tai Chi. Considering the limited number of studies and their heterogeneity, further robust studies are necessary to verify findings and investigate differential effects of Tai Chi on HRV.
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Affiliation(s)
- Yujiao Zhou
- Department of Wushu, Beijing Sport University, Beijing, China
| | - Qiuyu Wang
- Department of Foreign Languages, Beijing Sport University, Beijing, China
| | - Linda Larkey
- Center for Health Promotion and Disease Prevention, Edson College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Dara James
- Center for Health Promotion and Disease Prevention, Edson College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Hua Cui
- Department of Wushu, Beijing Sport University, Beijing, China
- Sport Information Research and Teaching Center, Beijing Sport University, Beijing, China
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Hamasaki H. The Effect of Exercise on Cardiovascular Autonomic Nervous Function in Patients with Diabetes: A Systematic Review. Healthcare (Basel) 2023; 11:2668. [PMID: 37830705 PMCID: PMC10572826 DOI: 10.3390/healthcare11192668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Diabetic neuropathy, including autonomic neuropathy, is a severe complication in patients with poorly controlled diabetes. Specifically, cardiovascular autonomic neuropathy (CAN) plays a significant prognostic role in cardiovascular morbidity and mortality. Exercise, an essential component of diabetes treatment, may have a therapeutic effect on patients with diabetes complicated by CAN. However, it remains unclear whether exercise has a therapeutic or protective effect in diabetes patients with CAN. METHODS The author conducted a systematic search of PubMed/MEDLINE, Embase, and The Cochrane Library, resulting in the identification of eight eligible randomized controlled trials for this review. RESULTS Exercise, including aerobic exercise combined with resistance training (RT), high-intensity interval training, and progressive RT, has shown a beneficial effect on cardiac autonomic function (CAF) in patients with type 2 diabetes, as measured by heart rate variability, heart rate recovery, and baroreflex sensitivity. However, most studies had low quality. Moreover, there were no relevant studies examining the effect of exercise on CAF in older patients, patients with poorly controlled diabetes, and patients with type 1 diabetes. CONCLUSIONS Exercise has the potential to manage patients with CAN by balancing sympathetic and parasympathetic nervous system functions; however, further studies are warranted in the future.
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Silva LRB, Gentil P, Seguro CS, de Oliveira JCM, Silva MS, Marques VA, Beltrame T, Rebelo ACS. High-Intensity Interval Training Improves Cardiac Autonomic Function in Patients with Type 2 Diabetes: A Randomized Controlled Trial. BIOLOGY 2022; 11:biology11010066. [PMID: 35053064 PMCID: PMC8773290 DOI: 10.3390/biology11010066] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 02/04/2023]
Abstract
Different exercise models have been used in patients with type 2 diabetes mellitus (T2D), like moderate intensity continuous training (MICT) and high intensity interval training (HIIT); however, their effects on autonomic modulation are unknown. The present study aimed to compare the effects of different exercise modes on autonomic modulation in patients with T2D. In total, 44 adults with >5 years of T2D diagnosis were recruited and stratified into three groups: HIIT-30:30 (n = 15, age 59.13 ± 5.57 years) that performed 20 repetitions of 30 s at 100% of VO2peak with passive recovery, HIIT-2:2 (n = 14, age 61.20 ± 2.88) that performed 5 repetitions of 2 min at 100% of VO2peak with passive recovery, and MICT (n = 15, age 58.50 ± 5.26) that performed 14 min of continuous exercise at 70% of VO2peak. All participants underwent anamnesis and evaluation of cardiorespiratory fitness and cardiac autonomic modulation. All protocols were equated by total distance and were performed two times per week for 8 weeks. Group × time interactions were observed for resting heart rate (HRrest) [F(2.82) = 3.641; p = 0.031] and SDNN [F(2.82) = 3.462; p = 0.036]. Only the HIIT-30:30 group significantly reduced SDNN (p = 0.002 and 0.025, respectively). HRrest reduced more in the HIIT-30:30 group compared with the MICT group (p = 0.038). Group × time interactions were also observed for offTAU [F(2.82) = 3.146; p = 0.048] and offTMR [F(2.82) = 4.424; p = 0.015]. The MICT group presented increased values of offTAU compared with the HIIT-30:30 and HIIT-2:2 groups (p = 0.001 and 0.013, respectively), representing a slower HR response after eight weeks of intervention. HIIT, specially HIIT-30:30, represents a promising measure for improving autonomic modulation in patients with T2D.
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Affiliation(s)
- Lucas Raphael Bento Silva
- Department of Physical Education, Araguaia University Center, Goiania 74223-060, Brazil;
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiania 74605-050, Brazil; (P.G.); (V.A.M.); (A.C.S.R.)
- Correspondence:
| | - Paulo Gentil
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiania 74605-050, Brazil; (P.G.); (V.A.M.); (A.C.S.R.)
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiania 74690-900, Brazil;
- Hypertension League, Federal University of Goias, Goiania 74605-020, Brazil
| | - Camila Simões Seguro
- Post-Graduate Program in Nutrition and Health, Faculty of Nutrition, Federal University of Goias, Goiania 74605-080, Brazil;
| | - Jordana Campos Martins de Oliveira
- Department of Physical Education, Araguaia University Center, Goiania 74223-060, Brazil;
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiania 74605-050, Brazil; (P.G.); (V.A.M.); (A.C.S.R.)
| | - Maria Sebastiana Silva
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiania 74690-900, Brazil;
| | - Vitor Alves Marques
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiania 74605-050, Brazil; (P.G.); (V.A.M.); (A.C.S.R.)
| | - Thomas Beltrame
- Institute of Computing, University of Campinas, Campinas 13083-852, Brazil;
- Department of Physiotherapy, Federal University of Sao Carlos, Sao Carlos 13565-905, Brazil
| | - Ana Cristina Silva Rebelo
- Post-Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiania 74605-050, Brazil; (P.G.); (V.A.M.); (A.C.S.R.)
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiania 74690-900, Brazil;
- Department of Morphology, Institute of Biological Sciences, Federal University of Goiás, Goiania 74690-900, Brazil
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Bönhof GJ, Herder C, Ziegler D. Diagnostic Tools, Biomarkers, and Treatments in Diabetic polyneuropathy and Cardiovascular Autonomic Neuropathy. Curr Diabetes Rev 2022; 18:e120421192781. [PMID: 33845748 DOI: 10.2174/1573399817666210412123740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022]
Abstract
The various manifestations of diabetic neuropathy, including distal symmetric sensorimotor polyneuropathy (DSPN) and cardiovascular autonomic neuropathy (CAN), are among the most prevalent chronic complications of diabetes. Major clinical complications of diabetic neuropathies, such as neuropathic pain, chronic foot ulcers, and orthostatic hypotension, are associated with considerable morbidity, increased mortality, and diminished quality of life. Despite the substantial individual and socioeconomic burden, the strategies to diagnose and treat diabetic neuropathies remain insufficient. This review provides an overview of the current clinical aspects and recent advances in exploring local and systemic biomarkers of both DSPN and CAN assessed in human studies (such as biomarkers of inflammation and oxidative stress) for better understanding of the underlying pathophysiology and for improving early detection. Current therapeutic options for DSPN are (I) causal treatment, including lifestyle modification, optimal glycemic control, and multifactorial risk intervention, (II) pharmacotherapy derived from pathogenetic concepts, and (III) analgesic treatment against neuropathic pain. Recent advances in each category are discussed, including non-pharmacological approaches, such as electrical stimulation. Finally, the current therapeutic options for cardiovascular autonomic complications are provided. These insights should contribute to a broader understanding of the various manifestations of diabetic neuropathies from both the research and clinical perspectives.
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Affiliation(s)
- Gidon J Bönhof
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
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Callaghan BC, Reynolds EL, Banerjee M, Akinci G, Chant E, Villegas-Umana E, Rothberg AE, Burant CF, Feldman EL. Dietary weight loss in people with severe obesity stabilizes neuropathy and improves symptomatology. Obesity (Silver Spring) 2021; 29:2108-2118. [PMID: 34747574 PMCID: PMC8612943 DOI: 10.1002/oby.23246] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/05/2021] [Accepted: 05/30/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The aim of this study was to determine the effect of dietary weight loss on neuropathy outcomes in people with severe obesity. METHODS A prospective cohort study of participants attending a medical weight-management program was followed. Weight loss was achieved with meal replacement of 800 kcal/d for 12 weeks and then transitioning to 1,200 to 1,500 kcal/d. The coprimary outcomes were changes in intraepidermal nerve fiber density (IENFD) at the distal leg and proximal thigh. Secondary outcomes included nerve conduction studies, Michigan Neuropathy Screening Instrument questionnaire and exam, Quality of Life in Neurological Disorders, and quantitative sensory testing. RESULTS Among 131 baseline participants, 72 (mean [SD] age: 50.1 [10.5] years, 51.4% female) completed 2 years of follow-up. Participants lost 12.4 (11.8) kg. All metabolic syndrome components improved with the exception of blood pressure. IENFD in the distal leg (0.4 [3.3], p = 0.29), and proximal thigh (0.3 [6.3], p = 0.74) did not significantly change. Improvements were observed on the Michigan Neuropathy Screening Instrument questionnaire, two Quality of Life in Neurological Disorders subdomains, and quantitative sensory testing cold threshold. CONCLUSIONS Dietary weight loss was associated with improvements in all metabolic parameters except blood pressure, and both IENFD outcomes remained stable after 2 years. Given that natural history studies reveal decreases in IENFD over time, dietary weight loss may halt this progression, but randomized controlled trials are needed.
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Affiliation(s)
- Brian C Callaghan
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Evan L Reynolds
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mousumi Banerjee
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Gulcin Akinci
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- Division of Pediatric Neurology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Ericka Chant
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Amy E Rothberg
- Division of Metabolism, Endocrinology, and Diabetes, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles F Burant
- Division of Metabolism, Endocrinology, and Diabetes, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
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Picard M, Tauveron I, Magdasy S, Benichou T, Bagheri R, Ugbolue UC, Navel V, Dutheil F. Effect of exercise training on heart rate variability in type 2 diabetes mellitus patients: A systematic review and meta-analysis. PLoS One 2021; 16:e0251863. [PMID: 33999947 PMCID: PMC8128270 DOI: 10.1371/journal.pone.0251863] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background Cardiac autonomic neuropathy is a common complication of type 2 diabetes mellitus (T2DM), that can be measured through heart rate variability (HRV)–known to be decreased in T2DM. Physical exercise can improve HRV in healthy population, however results are under debate in T2DM. We conducted a systemic review and meta-analysis to assess the effects of physical exercise on HRV in T2DM patients. Method PubMed, Cochrane, Embase, and ScienceDirect databases were searched for all studies reporting HRV parameters in T2DM patients before and after exercise training, until September 20th 2020, without limitation to specific years. We conducted random-effects meta-analysis stratified by type of exercise for each of the HRV parameters: RR–intervals (or Normal to Normal intervals–NN), standard deviation of RR intervals (SDNN), percentage of adjacent NN intervals varying by more than 50 milliseconds (pNN50), root mean square of successive RR-intervals differences (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio. Sensitivity analyses were computed on studies with the highest quality. Results We included 21 studies (9 were randomized) for a total of 523 T2DM patients: 472 had an exercise training and 151 were controls (no exercise). Intervention was endurance (14 studies), resistance (2 studies), endurance combined with resistance (4 studies), and high intensity interval training (HIIT) (4 studies). After exercise training, all HRV parameters improved i.e. an increase in SDNN (effect size = 0.59, 95%CI 0.26 to 0.93), RMSSD (0.62, 0.28 to 0.95), pNN50 (0.62, 0.23 to 1.00), HF (0.58, -0.16 to 0.99), and a decrease in LF (-0.37, -0.69 to -0.05) and LF/HF (-0.52, -0.79 to -0.24). There were no changes in controls. Stratification by type of exercise showed an improvement in most HRV parameters (SDNN, RMSSD, pNN50, LF, HF, LF/HF) after endurance training, whereas mostly LF/HF was improved after both resistance training and HIIT. Supervised training improved most HRV parameters. Duration and frequency of training did not influence the benefits on HRV. Conclusion Exercise training improved HRV parameters in T2DM patients which may reflect an improvement in the activity of the autonomic nervous system. The level of proof is the highest for endurance training. Supervised training seemed beneficial.
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Affiliation(s)
- Mathilde Picard
- Endocrinology Diabetology and Metabolic Diseases, CHU Clermont–Ferrand, University Hospital of Clermont–Ferrand, Clermont-Ferrand, France
| | - Igor Tauveron
- Endocrinology Diabetology and Metabolic Diseases, Université Clermont Auvergne, GReD, CNRS, INSERM, CHU Clermont–Ferrand, University Hospital of Clermont–Ferrand, Clermont–Ferrand, France
| | - Salwan Magdasy
- Endocrinology Diabetology and Metabolic Diseases, Université Clermont Auvergne, GReD, CNRS, INSERM, CHU Clermont–Ferrand, University Hospital of Clermont–Ferrand, Clermont–Ferrand, France
| | - Thomas Benichou
- Endocrinology Diabetology and Metabolic Diseases, CHU Clermont–Ferrand, University Hospital of Clermont–Ferrand, Clermont-Ferrand, France
| | - Reza Bagheri
- Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Ukadike C. Ugbolue
- Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Valentin Navel
- Translational Approach to Epithelial Injury and Repair, CHU Clermont-Ferrand, Université Clermont Auvergne, CNRS, INSERM, GReD, University Hospital of Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Occupational and Environmental Medicine, WittyFit, Clermont–Ferrand, France
- * E-mail:
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Grässler B, Thielmann B, Böckelmann I, Hökelmann A. Effects of Different Training Interventions on Heart Rate Variability and Cardiovascular Health and Risk Factors in Young and Middle-Aged Adults: A Systematic Review. Front Physiol 2021; 12:657274. [PMID: 33981251 PMCID: PMC8107721 DOI: 10.3389/fphys.2021.657274] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/30/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: Heart rate variability (HRV), the beat-to-beat variation of adjacent heartbeats, is an indicator of the function of the autonomic nervous system (ANS). Increased HRV reflects well-functioning of autonomic control mechanism and cardiovascular health. The aim of this systematic review is to provide a systematic overview of the effects of different physical training modalities on resting HRV and cardiovascular health and risk factors (i.e., baroreflex sensitivity, body fat, body mass, body mass index, blood pressure, heart rate recovery, VO2 max, and VO2 peak) in young and middle-aged (mean age of the studies samples up to 44 years), healthy adults. Methods: A systematic review in accordance with the PRISMA guidelines was performed. Studies investigating the effects of different physical interventions (endurance, resistance, high-intensity, coordinative, or multimodal training) on HRV were included. Trials were considered eligible if the intervention lasted for at least 4 weeks and participants were regarded as general healthy. Five electronic databases were searched from 2005 to September 8th, 2020. The methodological quality of eligible studies was assessed by two study quality and reporting assessment scales (TESTEX and STARDHRV). PROSPERO registration number: CRD42020206606. Results: Of 3,991 retrieved records, 26 were considered eligible and analyzed. Twelve studies used an endurance training (of which three included high-intensity sessions), six studies resistance training, four studies coordinative training, two studies high-intensity training, and two studies used a multimodal intervention. Overall, the results showed for all types of intervention an improvement in linear and non-linear HRV parameters and cardiovascular health and risk factors. However, quality assessment revealed some methodological and reporting deficits. Conclusion: This systematic review highlights the benefits of different types of physical training interventions on autonomic function and health parameters in young and middle-aged, healthy adults. In conclusion, higher training intensities and frequencies are more likely to improve HRV. For future studies, we recommend adhering to the criteria of methodological standards of exercise interventions and HRV measurements and encourage the use of non-linear HRV parameters.
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Affiliation(s)
- Bernhard Grässler
- Department of Sport Science, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany
| | - Beatrice Thielmann
- Department of Occupational Medicine, Faculty of Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Irina Böckelmann
- Department of Occupational Medicine, Faculty of Medicine, Otto von Guericke University, Magdeburg, Germany
| | - Anita Hökelmann
- Department of Sport Science, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany
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Quiles N, Taylor B, Ortiz A. Effectiveness of an 8-Week Aerobic Exercise Program on Autonomic Function in People Living with HIV Taking Anti-Retroviral Therapy: A Pilot Randomized Controlled Trial. AIDS Res Hum Retroviruses 2020; 36:283-290. [PMID: 31591903 DOI: 10.1089/aid.2019.0194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This study assessed the effectiveness of an 8-week aerobic exercise program on heart rate variability (HRV) in people living with HIV taking antiretroviral therapy. Twenty-six participants were randomly assigned to a control group or an aerobic exercise group. Resting HRV was measured for 5 min in supine position using an electrocardiogram. Estimated maximal oxygen uptake (VO2max) was assessed through a treadmill 6-min walk test. The training program consisted of aerobic exercise thrice per week at 65%-75% of heart rate max for 45 min per session. Repeated measures ANOVA was used to test for differences between groups, and Spearman's rho was used to assess for the correlation between HRV measures and estimated VO2max. There was no significant group by time interactions for any of the HRV indices. However, the standard deviation of normal-to-normal (NN) R-R intervals increased significantly in the aerobic exercise group (pre: 46.97 ± 32.70 ms vs. post: 59.49 ± 37.20 ms, p = .045). There was a strong correlation between the VO2max and the standard deviation of NN intervals (SDNN) (r = 0.617; p = .002). There was a moderate correlation between VO2max and the square root of the mean squared differences of successive normal-to-normal intervals (rMSSD) (r = 0.424; p = .049), the low frequency power (r = 0.506; p = .016), and the standard deviation of differences between successive differences of normal-to-normal intervals (SDSD) (r = 0.424; p = .049). While differences in HRV were not observed between groups, our data suggest that overall autonomic function can improve across time with aerobic exercise, and these changes are associated with greater levels of VO2max. These results advocate the importance of improvements in HRV given their association with lower risk of cardiovascular disease and mortality.
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Affiliation(s)
- Norberto Quiles
- Department of Family, Nutrition and Exercise Sciences, Queens College of the City University of New York, Flushing, New York
| | - Barbara Taylor
- Department of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Alexis Ortiz
- School of Physical Therapy, University of the Incarnate Word, San Antonio, Texas
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Tseng MY, Liang J, Wang JS, Yang CT, Wu CC, Cheng HS, Chen CY, Lin YE, Wang WS, Shyu YIL. Effects of a diabetes-specific care model for hip fractured older patients with diabetes: A randomized controlled trial. Exp Gerontol 2019; 126:110689. [PMID: 31404623 DOI: 10.1016/j.exger.2019.110689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the effects of a diabetes-specific care model for hip fractured elderly with diabetes mellitus (DM). METHODS A randomized controlled trial was implemented in a 3000-bed medical center in northern Taiwan. Older adults (age ≥ 60) with DM who had hip-fracture surgery (N = 176) were recruited and randomly assigned to diabetes-specific care (n = 88) and usual care (n = 88). Usual care entailed one or two in-hospital rehabilitation sessions. Diabetes-specific care comprised an interdisciplinary care (including geriatric consultation, discharge planning, and in-home rehabilitation) and diabetes-specific care (including dietary and diabetes education, blood pressure control, dyslipidemia management, a glycemic treatment regimen, and rehabilitation exercises). Outcomes including heart rate variability; rehabilitation outcomes; activities of daily living and instrumental activities of daily living were assessed before discharge and 1, 3, 6, 12, 18, 24 months afterwards. RESULTS Patients who received diabetes-specific care had significantly higher hip-flexion range of motion (b = 5.24, p < .01), peak-force quadriceps strength of the affected limb (b = 2.13, p < .05), higher total heart rate variability in terms of the time-domain parameter for the mean squared difference between two adjacent normal R-R intervals (b = 11.35, p < .05), and frequency-domain parameters, such as low frequency (b = 42.17, p < .05), and the high frequency-to-low frequency ratio (b = 0.11, p < .01). CONCLUSIONS Our diabetes-specific care model enhanced hip-flexion range of motion, peak quadriceps strength of the affected limb, and overall heart rate variability, indicating dynamic responses to environmental changes during the 24 months following hospital discharge, above and beyond the effects of usual care.
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Affiliation(s)
- Ming-Yueh Tseng
- Department of Nursing, MeiHo University, 23 Pingguang Road, Neipu, Pingtung 91202, Taiwan.
| | - Jersey Liang
- School of Public Health, University of Michigan, 1420 Washington Heights, SPH II M3007, Ann Arbor, MI 48109, USA.
| | - Jong-Shyan Wang
- Graduate Institute of Rehabilitation Science, College of Medicine, and Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan.
| | - Ching-Tzu Yang
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan.
| | - Chi-Chuan Wu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
| | - Huey-Shinn Cheng
- Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
| | - Ching-Yen Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, No. 200, Lane 208, Jijin 1st Road, Anle District, Keelung 20445, Taiwan.
| | - Yueh-E Lin
- Department of Nursing, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
| | - Woan-Shyuan Wang
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan.
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan; Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan; Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, 123 Dapi Road, Niaosng District, Kaohsiung 83301, Taiwan; Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, 261 Wenhwa 1st Road, Guishan District, Taoyuan 33303, Taiwan.
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10
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Park SY, Kwak YS, Pekas EJ. Impacts of aquatic walking on arterial stiffness, exercise tolerance, and physical function in patients with peripheral artery disease: a randomized clinical trial. J Appl Physiol (1985) 2019; 127:940-949. [PMID: 31369328 DOI: 10.1152/japplphysiol.00209.2019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with attenuated vascular function, cardiorespiratory capacity, physical function, and muscular strength. It is essential to combat these negative effects on health by incorporating lifestyle interventions to slow disease progression, such as exercise. We sought to examine the effects of aquatic walking exercise on cardiovascular function, cardiorespiratory capacity [maximal volume of oxygen consumption (V̇o2max)], exercise tolerance [6-min walking distance (6MWD)], physical function, muscular strength, and body composition in patients with PAD. Patients with PAD (n = 72) were recruited and randomly assigned to a 12-wk aquatic walking training group (AQ, n = 35) or a control group (CON, n = 37). The AQ group performed walking and leg exercises in waist-to-chest-deep water. Leg arterial stiffness [femoral-to-ankle pulse wave velocity (legPWV)], heart rate (HR), blood pressure (BP), ankle-to-brachial index (ABI), V̇o2max, 6MWD, physical function, muscular strength, body composition, resting metabolic rate (RMR), and flexibility were measured before and after 12 wk. There were significant group × time interactions (P < 0.05) after 12 wk for legPWV and HR, which significantly decreased (P < 0.05) in AQ, and V̇o2max, 6MWD, physical function, and muscular strength, which significantly increased (P < 0.05) in AQ, compared with no changes in CON. There were no significant differences (P > 0.05) for BP, ABI, RMR, or flexibility after 12 wk. Interestingly, there was relatively high adherence (84%) to the aquatic walking exercise program in this population. These results suggest that aquatic walking exercise is an effective therapy to reduce arterial stiffness and resting HR and improve cardiorespiratory capacity, exercise tolerance, physical function, and muscular strength in patients with PAD.NEW & NOTEWORTHY The results of this study reveal for the first time that aquatic walking exercise can decrease arterial stiffness and improve exercise tolerance, cardiorespiratory capacity, and muscular strength in patients with peripheral artery disease (PAD). Aquatic walking exercise training demonstrates relatively high exercise adherence in this population. Aquatic walking exercise training may be a useful therapeutic intervention for improving physical function in patients with PAD.
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Affiliation(s)
- Song-Young Park
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska.,Department of Physical Education, Dong-Eui University, Busan, South Korea
| | - Yi-Sub Kwak
- Department of Physical Education, Dong-Eui University, Busan, South Korea
| | - Elizabeth J Pekas
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska
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11
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Zilliox LA, Russell JW. Physical activity and dietary interventions in diabetic neuropathy: a systematic review. Clin Auton Res 2019; 29:443-455. [PMID: 31076938 PMCID: PMC6697618 DOI: 10.1007/s10286-019-00607-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/09/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Diabetic neuropathy is a common and disabling disorder, and there are currently no proven effective disease-modifying treatments. Physical activity and dietary interventions in patients with diabetes and diabetic neuropathy have multiple beneficial effects and are generally low risk, which makes lifestyle interventions an attractive treatment option. We reviewed the literature on the effects of physical activity and dietary interventions on length-dependent peripheral neuropathy and cardiac autonomic neuropathy in diabetes. METHODS The electronic database PubMed was systematically searched for original human and mouse model studies examining the effect of either dietary or physical activity interventions in subjects with diabetes, prediabetes, or metabolic syndrome. RESULTS Twenty studies are included in this review. Fourteen studies were human studies and six were in mice. Studies were generally small with few controlled trials, and there are no widely agreed upon outcome measures. CONCLUSIONS Recent research indicates that dietary interventions are effective in modifying diabetic neuropathy in animal models, and there are promising data that they may also ameliorate diabetic neuropathy in humans. It has been known for some time that lifestyle interventions can prevent the development of diabetic neuropathy in type 2 diabetes mellitus subjects. However, there is emerging evidence that lifestyle interventions are effective in individuals with established diabetic neuropathy. In addition to the observed clinical value of lifestyle interventions, there is emerging evidence of effects on biochemical pathways that improve muscle function and affect other organ systems, including the peripheral nerve. However, data from randomized controlled trials are needed.
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Affiliation(s)
- Lindsay A Zilliox
- Department of Neurology, School of Medicine, University of Maryland, 3S-129, 110 South Paca Street, Baltimore, MD, 21201-1595, USA
- Maryland VA Healthcare System, Baltimore, MD, USA
| | - James W Russell
- Department of Neurology, School of Medicine, University of Maryland, 3S-129, 110 South Paca Street, Baltimore, MD, 21201-1595, USA.
- Maryland VA Healthcare System, Baltimore, MD, USA.
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12
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Bellavere F, Cacciatori V, Bacchi E, Gemma ML, Raimondo D, Negri C, Thomaseth K, Muggeo M, Bonora E, Moghetti P. Effects of aerobic or resistance exercise training on cardiovascular autonomic function of subjects with type 2 diabetes: A pilot study. Nutr Metab Cardiovasc Dis 2018; 28:226-233. [PMID: 29402509 DOI: 10.1016/j.numecd.2017.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Both aerobic (AER) and resistance (RES) training improve metabolic control in patients with type 2 diabetes (T2DM). However, information on the effects of these training modalities on cardiovascular autonomic control is limited. Our aim was to compare the effects of AER and RES training on cardiovascular autonomic function in these subjects. METHODS AND RESULTS Cardiovascular autonomic control was assessed by Power Spectral Analysis (PSA) of Heart Rate Variability (HRV) and baroreceptors function indexes in 30 subjects with T2DM, randomly assigned to aerobic or resistance training for 4 months. In particular, PSA of HRV measured the Low Frequency (LF) and High Frequency (HF) bands of RR variations, expression of prevalent sympathetic and parasympathetic drive, respectively. Furthermore, we measured the correlation occurring between systolic blood pressure and heart rate during a standardized Valsalva maneuver using two indexes, b2 and b4, considered an expression of baroreceptor sensitivity and peripheral vasoactive adaptations during predominant sympathetic and parasympathetic drive, respectively. After training, the LF/HF ratio, which summarizes the sympatho-vagal balance in HRV control, was similarly decreased in the AER and RES groups. After AER, b2 and b4 significantly improved. After RES, changes of b2 were of borderline significance, whereas changes of b4 did not reach statistical significance. However, comparison of changes in baroreceptor sensitivity indexes between groups did not show statistically significant differences. CONCLUSION Both aerobic and resistance training improve several indices of the autonomic control of the cardiovascular system in patients with T2DM. Although these improvements seem to occur to a similar extent in both training modalities, some differences cannot be ruled out. CLINICAL TRIAL REGISTRATION NUMBER NCT01182948, clinicaltrials.gov.
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Affiliation(s)
- F Bellavere
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy.
| | - V Cacciatori
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - E Bacchi
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - M L Gemma
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - D Raimondo
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - C Negri
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - K Thomaseth
- Institute of Electronics, Computer and Telecommunication Engineering, National Research Council, Padua, Italy
| | - M Muggeo
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - E Bonora
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy
| | - P Moghetti
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and AOUI of Verona, Verona, Italy.
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13
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Bhati P, Shenoy S, Hussain ME. Exercise training and cardiac autonomic function in type 2 diabetes mellitus: A systematic review. Diabetes Metab Syndr 2018; 12:69-78. [PMID: 28888482 DOI: 10.1016/j.dsx.2017.08.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/20/2017] [Indexed: 02/07/2023]
Abstract
Cardiac autonomic neuropathy (CAN) is a common complication of type 2 diabetes mellitus (T2DM). It has been found to independently predict all cause and cardiovascular disease (CVD) mortality. It remains unclear whether exercise training could improve autonomic control in T2DM patients. The purpose of this study was to systematically review the effects of exercise training on cardiac autonomic function in T2DM patients. Electronic databases (MEDLINE, CENTRAL, PEDro, Scopus and Web of science) were systematically searched to retrieve relevant evidence. Clinical trials administering exercise training for at least 4 weeks and examining either heart rate variability (HRV), baroreflex sensitivity (BRS), heart rate recovery (HRR) as outcome measures were eligible. Eighteen articles were found to be relevant and were then assessed for characteristics and quality. Fifteen studies out of 18 found that exercise training leads to positive improvements in autonomic function of T2DM patients. Exercise participation enhances cardiac autonomic function of type 2 diabetics and therefore should be implemented in their management programs.
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Affiliation(s)
- Pooja Bhati
- DiabetResearch Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India.
| | - Shweta Shenoy
- DiabetResearch Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India.
| | - M Ejaz Hussain
- DiabetResearch Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India.
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14
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Abstract
PURPOSE OF REVIEW This review summarizes the current knowledge on the relationship of physical activity, exercise, and cardiorespiratory fitness (CRF) with cardiovascular autonomic neuropathy (CAN) based on epidemiological, clinical, and interventional studies. RECENT FINDINGS The prevalence of CAN increases with age and duration of diabetes. Further risk factors for CAN comprise poor glycemic control, dyslipidemia, abdominal obesity, hypertension, and the presence of diabetic complications. CAN has been also linked to reduced CRF. We recently showed that CRF parameters (e.g., maximal oxidative capacity or oxidative capacity at the anaerobic threshold) are associated with cardiac autonomic function in patients recently diagnosed with type 1 or type 2 diabetes. Exercise interventions have shown that physical activity can increase cardiovagal activity and reduce sympathetic overactivity. In particular, long-term and regularly, but also supervised, performed endurance and high-intense and high-volume exercise improves cardiac autonomic function in patients with type 2 diabetes. By contrast, the evidence in those with type 1 diabetes and also in individuals with prediabetes or metabolic syndrome is weaker. Overall, the studies reviewed herein addressing the question whether favorably modulating the autonomic nervous system may improve CRF during exercise programs support the therapeutic concept to promote physical activity and to achieve physical fitness. However, high-quality exercise interventions, especially in type 1 diabetes and metabolic syndrome including prediabetes, are further required to better understand the relationship between physical activity, fitness, and cardiac autonomic function.
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Affiliation(s)
- Martin Röhling
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Gidon J Bönhof
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
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15
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Villafaina S, Collado-Mateo D, Fuentes JP, Merellano-Navarro E, Gusi N. Physical Exercise Improves Heart Rate Variability in Patients with Type 2 Diabetes: A Systematic Review. Curr Diab Rep 2017; 17:110. [PMID: 28942507 DOI: 10.1007/s11892-017-0941-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW The aim of the present systematic review is to provide an up-to-date analysis of the research on the effects of exercise programs on heart rate variability (HRV) in individuals with type 2 diabetes mellitus (T2DM). An electronic search of the literature (PubMed, PEDro and Web of Science) was performed. "HRV", "heart rate variability", "exercise", "physical" and "diabetes" were the terms used for article retrieval. Lastly, 15 articles were selected. PRISMA methodology was employed and data were extracted according to the PICOS approach. RECENT FINDINGS Although HRV is not routinely measured in the management of T2DM, it is an important measure due to its relation with mortality and diabetic neuropathy. Physical exercise has become a therapy for T2DM, because it improves physical fitness and functional capacity, enhances metabolic control and insulin sensitivity, reduces inflammatory markers and neuropathy symptoms and can increase the regenerative capacity of cutaneous axons, slowing or preventing neuropathy progression. However, it is not clear to what extent physical exercise can improve HRV in this population. Participation in the 15 selected studies was similar in men and women (48.01% men and 51.99% women). All the intervention programs included aerobic training, and it was complemented by strength training in four studies. Duration of physical exercise sessions ranged between 30 and 75 min, the frequency being between 2 and 7 days/week. Statistically significant improvements in groups with diabetes, relative to baseline, were observed in nine studies. More than 3 days per week of aerobic training, complemented by strength training, during at least 3 months seems to improve HRV in T2DM. Weekly frequency might be the most important factor to improve HRV. These aspects could help to design better programs based in scientific evidence, incorporating HRV as an important variable associated with diabetic neuropathy and mortality.
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Affiliation(s)
- Santos Villafaina
- Faculty of Sport Science, University of Extremadura, Av. De Universidad s/n, 10003, Caceres, Spain.
| | - Daniel Collado-Mateo
- Faculty of Sport Science, University of Extremadura, Av. De Universidad s/n, 10003, Caceres, Spain
| | - Juan Pedro Fuentes
- Faculty of Sport Science, University of Extremadura, Av. De Universidad s/n, 10003, Caceres, Spain
| | | | - Narcis Gusi
- Faculty of Sport Science, University of Extremadura, Av. De Universidad s/n, 10003, Caceres, Spain
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16
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Hsu CC, Liang CS, Tai YM, Cheng SL. Incongruent changes in heart rate variability and body weight after discontinuing aerobic exercise in patients with schizophrenia. Int J Psychophysiol 2016; 109:132-137. [DOI: 10.1016/j.ijpsycho.2016.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/18/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022]
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17
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Kang SJ, Ko KJ, Baek UH. Effects of 12 weeks combined aerobic and resistance exercise on heart rate variability in type 2 diabetes mellitus patients. J Phys Ther Sci 2016; 28:2088-93. [PMID: 27512271 PMCID: PMC4968512 DOI: 10.1589/jpts.28.2088] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/07/2016] [Indexed: 01/05/2023] Open
Abstract
[Purpose] This study evaluated the effects of 12 weeks combined aerobic and resistance
exercise on heart rate variability in patients with Type 2 diabetes mellitus. [Subjects
and Methods] The subjects were 16 female patients with Type 2 diabetes mellitus selected
among the participants of a chronic disease management exercise class at C Region Public
Health Center in South Korea. Subjects were randomly assigned to the exercise group (n=8;
age, 55.97 ± 7.37) or the control group (n=8; age, 57.53 ± 4.63) The exercise group
performed aerobic and resistance exercises for 60 minutes per day, 3 times per week for 12
weeks. Anthropometric measurements, biochemical markers, physical fitness, and heart rate
variability were examined. [Results] After 12 weeks of exercise, weight, body fat
percentage, waist circumference, blood glucose, insulin resistance, glycated hemoglobin
level, systolic blood pressure, and diastolic blood pressure significantly decreased and
cardiorespiratory fitness and muscular strength significantly increased in the exercise
group. Although heart rate variability measures showed favorable changes with the exercise
program, none were significant. [Conclusion] Although the exercise program did not show
notable changes in heart rate variability in patients with Type 2 diabetes within the
timeframe of the study, exercise may contribute to the prevention and control of
cardiovascular autonomic neuropathy.
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Affiliation(s)
- Seol-Jung Kang
- Department of Physical Education, Changwon National University, Republic of Korea
| | - Kwang-Jun Ko
- Department of Sports Medicine, National Fitness Center, Republic of Korea
| | - Un-Hyo Baek
- Department of Sports Science, College of Natural Science, Kyungnam University, Republic of Korea
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18
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Ferreira MJ, Zanesco A. Heart rate variability as important approach for assessment autonomic modulation. MOTRIZ: REVISTA DE EDUCACAO FISICA 2016. [DOI: 10.1590/s1980-65742016000200001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Angelina Zanesco
- Universidade Estadual Paulista "Julio de Mesquita Filho", Brazil
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19
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Grisé KN, Olver TD, McDonald MW, Dey A, Jiang M, Lacefield JC, Shoemaker JK, Noble EG, Melling CWJ. High Intensity Aerobic Exercise Training Improves Deficits of Cardiovascular Autonomic Function in a Rat Model of Type 1 Diabetes Mellitus with Moderate Hyperglycemia. J Diabetes Res 2016; 2016:8164518. [PMID: 26885531 PMCID: PMC4739461 DOI: 10.1155/2016/8164518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/11/2015] [Accepted: 12/15/2015] [Indexed: 02/07/2023] Open
Abstract
Indices of cardiovascular autonomic neuropathy (CAN) in experimental models of Type 1 diabetes mellitus (T1DM) are often contrary to clinical data. Here, we investigated whether a relatable insulin-treated model of T1DM would induce deficits in cardiovascular (CV) autonomic function more reflective of clinical results and if exercise training could prevent those deficits. Sixty-four rats were divided into four groups: sedentary control (C), sedentary T1DM (D), control exercise (CX), or T1DM exercise (DX). Diabetes was induced via multiple low-dose injections of streptozotocin and blood glucose was maintained at moderate hyperglycemia (9-17 mM) through insulin supplementation. Exercise training consisted of daily treadmill running for 10 weeks. Compared to C, D had blunted baroreflex sensitivity, increased vascular sympathetic tone, increased serum neuropeptide Y (NPY), and decreased intrinsic heart rate. In contrast, DX differed from D in all measures of CAN (except NPY), including heart rate variability. These findings demonstrate that this T1DM model elicits deficits and exercise-mediated improvements to CV autonomic function which are reflective of clinical T1DM.
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Affiliation(s)
- Kenneth N. Grisé
- Exercise Biochemistry Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
| | - T. Dylan Olver
- Neurovascular Research Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
| | - Matthew W. McDonald
- Exercise Biochemistry Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
| | - Adwitia Dey
- Exercise Biochemistry Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
| | - Mao Jiang
- Exercise Biochemistry Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
| | - James C. Lacefield
- Department of Electrical and Computer Engineering, Department of Medical Biophysics and Robarts Research Institute, Western University, London, ON, Canada N6A 3K7
| | - J. Kevin Shoemaker
- Neurovascular Research Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
- Department of Physiology and Pharmacology, Western University, London, ON, Canada N6A 3K7
- Lawson Health Research Institute, London, ON, Canada N6C 2R5
| | - Earl G. Noble
- Exercise Biochemistry Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
- Lawson Health Research Institute, London, ON, Canada N6C 2R5
| | - C. W. James Melling
- Exercise Biochemistry Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada N6A 3K7
- *C. W. James Melling:
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20
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Zoppini G, Cacciatori V, Raimondo D, Gemma M, Trombetta M, Dauriz M, Brangani C, Pichiri I, Negri C, Stoico V, Bergamini C, Targher G, Santi L, Thomaseth K, Bellavere F, Bonadonna RC, Bonora E. Prevalence of Cardiovascular Autonomic Neuropathy in a Cohort of Patients With Newly Diagnosed Type 2 Diabetes: The Verona Newly Diagnosed Type 2 Diabetes Study (VNDS). Diabetes Care 2015; 38:1487-93. [PMID: 26068862 DOI: 10.2337/dc15-0081] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/07/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Cardiovascular autonomic diabetic neuropathy (CAN) is a serious complication of diabetes. No reliable data on the prevalence of CAN among patients with newly diagnosed type 2 diabetes are available. Therefore, the aim of this study was to estimate the prevalence of CAN among patients with newly diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS A cohort of 557 patients with newly diagnosed type 2 diabetes with cardiovascular autonomic test results available was selected. Early and confirmed neuropathy were assessed using a standardized methodology and their prevalences determined. A multivariate logistic regression analysis was modeled to study the factors associated with CAN. RESULTS In the entire cohort, the prevalence of confirmed CAN was 1.8%, whereas that of early CAN was 15.3%. Prevalence did not differ between men and women. In the multivariate analyses BMI results were independently and significantly associated with CAN after adjusting for age, sex, hemoglobin A1c, pulse pressure, triglyceride-to-HDL cholesterol ratio, kidney function parameters, and antihypertensive treatment. CONCLUSIONS CAN could be detected very early in type 2 diabetes. This study may suggest the importance of performing standardized cardiovascular autonomic tests after diagnosis of type 2 diabetes.
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Affiliation(s)
- Giacomo Zoppini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Vittorio Cacciatori
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Daniele Raimondo
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Marialuisa Gemma
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Maddalena Trombetta
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Marco Dauriz
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Corinna Brangani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Isabella Pichiri
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Carlo Negri
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Vincenzo Stoico
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Corinna Bergamini
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Lorenza Santi
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Karl Thomaseth
- National Research Council, Institute of Bioengineering, Padua, Italy
| | | | - Riccardo C Bonadonna
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Enzo Bonora
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
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21
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Sacre JW, Jellis CL, Jenkins C, Haluska BA, Baumert M, Coombes JS, Marwick TH. A six-month exercise intervention in subclinical diabetic heart disease: effects on exercise capacity, autonomic and myocardial function. Metabolism 2014; 63:1104-14. [PMID: 24997499 DOI: 10.1016/j.metabol.2014.05.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/03/2014] [Accepted: 05/11/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Autonomic dysfunction may contribute to the etiology and exercise intolerance of subclinical diabetic heart disease. This study sought the efficacy of exercise training for improvement of peak oxygen uptake (VO₂(peak)) and cardiac autonomic function in type 2 diabetic patients with non-ischemic subclinical left-ventricular (LV) dysfunction. MATERIALS/METHODS Forty-nine type 2 diabetic patients with early diastolic tissue Doppler velocity >1 standard deviation below the age-based mean entered an exercise intervention (n=24) or usual care (n=25) for 6-months (controlled, pre-/post- design). Co-primary endpoints were treadmill VO₂(peak) and 5-min heart-rate variability (by the coefficient of variation of normal RR intervals [CVNN]). Autonomic function was additionally assessed by resting heart-rate (for sympathovagal balance estimation), baroreflex sensitivity, cardiac reflexes, and exercise/recovery heart-rate profiles. Echocardiography was performed for LV function (systolic/diastolic tissue velocities, myocardial deformation) and myocardial fibrosis (calibrated integrated backscatter). RESULTS VO₂(peak) increased by 11% during the exercise intervention (p=0.001 vs. -1% in controls), but CVNN did not change (p=0.23). Reduction of resting heart-rate in the intervention group (p<0.05) was associated with an improvement in the secondary endpoint of heart-rate variability total spectral power (p<0.05). However, baroreflex sensitivity, cardiac reflexes, and exercise/recovery heart-rate profiles showed no significant benefit. No effects on LV function were observed despite favorable reduction of calibrated integrated backscatter in the intervention group (p<0.05). CONCLUSIONS The exercise intolerance of subclinical diabetic heart disease was amenable to improvement by exercise training. Despite a reduction in resting heart-rate and potential attenuation of myocardial fibrosis, no other cardiac autonomic or LV functional adaptations were detected.
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Affiliation(s)
- Julian W Sacre
- School of Human Movement Studies, University of Queensland, Brisbane, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
| | | | - Carly Jenkins
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Brian A Haluska
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Mathias Baumert
- School of Electrical & Electronic Engineering, University of Adelaide, Adelaide, Australia
| | - Jeff S Coombes
- School of Human Movement Studies, University of Queensland, Brisbane, Australia
| | - Thomas H Marwick
- School of Medicine, University of Queensland, Brisbane, Australia; Menzies Research Institute Tasmania, Hobart, Australia
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22
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Grieco CR, Colberg SR, Somma CT, Thompson AG, Vinik AI. Acute Effect of Breathing Exercises on Heart Rate Variability in Type 2 Diabetes: A Pilot Study. J Altern Complement Med 2014; 20:642-8. [DOI: 10.1089/acm.2013.0280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
| | - Sheri R. Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, VA
| | - C. Thomas Somma
- Department of Medical Laboratory and Radiation Sciences, Old Dominion University, Norfolk, VA
| | | | - Aaron I. Vinik
- Strelitz Diabetes Institute, Eastern Virginia Medical School, Norfolk, VA
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23
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Zaniqueli D, Morra EA, Dantas EM, Baldo MP, Carletti L, Perez AJ, Rodrigues SL, Mill JG. Heart rate at 4 s after the onset of exercise in endurance-trained men. Can J Physiol Pharmacol 2014; 92:476-80. [PMID: 24886303 DOI: 10.1139/cjpp-2014-0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It has been suggested that the increase in heart rate (HR) at the onset of exercise is caused by vagal withdrawal. In fact, endurance runners show a lower HR in maximum aerobic tests. However, it is still unknown whether endurance runners have a lower HR at 4 s after the onset of exercise (4th-sec-HR). We sought to measure the HR at the onset of the 4 s exercise test (4-sET), clarifying its relationship to heart rate variability (HRV), spectral indices, and cardiac vagal index (CVI) in endurance runners (ER) and healthy untrained controls (CON). HR at 4th-sec-HR, CVI, and percent HR increase during exercise were analyzed in the 4-sET. High frequency spectrum (HF-nu), low frequency spectrum (LF-nu), and low frequency/high frequency band ratio (LF/HF) were analyzed from the HRV. ER showed a significantly higher HF, and both a lower LF and LF/HF ratio compared with the CON. ER presented a significantly lower 4th-sec-HR, although neither CVI nor HR increases during exercise were statistically different from the CON. In conclusion, ER presented a lower 4th-sec-HR secondary to increased vagal influence over the sinus node. CVI seems to be too weak to use for discriminating individuals with respect to the magnitude of HR vagal control.
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Affiliation(s)
- Divanei Zaniqueli
- Department of Physiological Sciences, Federal University of Espírito Santo, Avenida Marechal Campos 1468, Maruipe, Vitoria, Espirito Santo 29042-751, Brazil
| | - Elis Aguiar Morra
- Centre of Physical Education and Sports, Federal University of Espírito Santo, Vitória, Espirito Santo, Brazil
| | - Eduardo Miranda Dantas
- Department of Physiological Sciences, Federal University of Espírito Santo, Avenida Marechal Campos 1468, Maruipe, Vitoria, Espirito Santo 29042-751, Brazil
| | - Marcelo Perim Baldo
- Department of Physiological Sciences, Federal University of Espírito Santo, Avenida Marechal Campos 1468, Maruipe, Vitoria, Espirito Santo 29042-751, Brazil
| | - Luciana Carletti
- Centre of Physical Education and Sports, Federal University of Espírito Santo, Vitória, Espirito Santo, Brazil
| | - Anselmo José Perez
- Centre of Physical Education and Sports, Federal University of Espírito Santo, Vitória, Espirito Santo, Brazil
| | - Sérgio Lamêgo Rodrigues
- Department of Physiological Sciences, Federal University of Espírito Santo, Avenida Marechal Campos 1468, Maruipe, Vitoria, Espirito Santo 29042-751, Brazil
| | - José Geraldo Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Avenida Marechal Campos 1468, Maruipe, Vitoria, Espirito Santo 29042-751, Brazil
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24
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Colberg SR, Grieco CR, Somma CT. Exercise Effects on Postprandial Glycemia, Mood, and Sympathovagal Balance in Type 2 Diabetes. J Am Med Dir Assoc 2014; 15:261-6. [DOI: 10.1016/j.jamda.2013.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
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25
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Carvalho de Lima D, Guimarães JB, Rodovalho GV, Silveira SA, Haibara AS, Coimbra CC. Exercise training starting at weaning age preserves cardiac pacemaker function in adulthood of diet-induced obese rats. Appl Physiol Nutr Metab 2014; 39:888-94. [PMID: 24806307 DOI: 10.1139/apnm-2013-0529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Peripheral sympathetic overdrive in young obese subjects contributes to further aggravation of insulin resistance, diabetes, and hypertension, thus inducing worsening clinical conditions in adulthood. Exercise training has been considered a strategy to repair obesity autonomic dysfunction, thereby reducing the cardiometabolic risk. Therefore, the aim of this study was to assess the effect of early exercise training, starting immediately after weaning, on cardiac autonomic control in diet-induced obese rats. Male Wistar rats (weaning) were divided into four groups: (i) a control group (n = 6); (ii) an exercise-trained control group (n = 6); (iii) a diet-induced obesity group (n = 6); and (iv) an exercise-trained diet-induced obesity group (n = 6). The development of obesity was induced by 9 weeks of palatable diet intake, and the training program was implemented in a motor-driven treadmill (5 times per week) during the same period. After this period, animals were submitted to vein and artery catheter implantation to assess cardiac autonomic balance by methylatropine (3 mg/kg) and propranolol (4 mg/kg) administration. Exercise training increased running performance in both groups (p < 0.05). Exercise training also prevented the increased resting heart rate in obese rats, which seemed to be related to cardiac pacemaker activity preservation (p < 0.05). Additionally, the training program preserved the pressure and bradycardia responses to autonomic blockade in obese rats (p < 0.05). An exercise program beginning at weaning age prevents cardiovascular dysfunction in obese rats, indicating that exercise training may be used as a nonpharmacological therapeutic strategy for the treatment of cardiometabolic diseases.
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Affiliation(s)
- Daniel Carvalho de Lima
- a Department of Physiology and Biophysics, Institute of Biological Sciences; Federal University of Minas Gerais, 31270-901 Belo Horizonte, Brazil
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26
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Fiuza-Luces C, Garatachea N, Berger NA, Lucia A. Exercise is the real polypill. Physiology (Bethesda) 2014; 28:330-58. [PMID: 23997192 DOI: 10.1152/physiol.00019.2013] [Citation(s) in RCA: 328] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The concept of a "polypill" is receiving growing attention to prevent cardiovascular disease. Yet similar if not overall higher benefits are achievable with regular exercise, a drug-free intervention for which our genome has been haped over evolution. Compared with drugs, exercise is available at low cost and relatively free of adverse effects. We summarize epidemiological evidence on the preventive/therapeutic benefits of exercise and on the main biological mediators involved.
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27
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Voulgari C, Pagoni S, Vinik A, Poirier P. Exercise improves cardiac autonomic function in obesity and diabetes. Metabolism 2013; 62:609-21. [PMID: 23084034 DOI: 10.1016/j.metabol.2012.09.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/19/2012] [Accepted: 09/11/2012] [Indexed: 02/07/2023]
Abstract
Physical activity is a key element in the prevention and management of obesity and diabetes. Regular physical activity efficiently supports diet-induced weight loss, improves glycemic control, and can prevent or delay type 2 diabetes diagnosis. Furthermore, physical activity positively affects lipid profile, blood pressure, reduces the rate of cardiovascular events and associated mortality, and restores the quality of life in type 2 diabetes. However, recent studies have documented that a high percentage of the cardiovascular benefits of exercise cannot be attributed solely to enhanced cardiovascular risk factor modulation. Obesity in concert with diabetes is characterized by sympathetic overactivity and the progressive loss of cardiac parasympathetic influx. These are manifested via different pathogenetic mechanisms, including hyperinsulinemia, visceral obesity, subclinical inflammation and increased thrombosis. Cardiac autonomic neuropathy is an underestimated risk factor for the increased cardiovascular morbidity and mortality associated with obesity and diabetes. The same is true for the role of physical exercise in the restoration of the heart cardioprotective autonomic modulation in these individuals. This review addresses the interplay of cardiac autonomic function in obesity and diabetes, and focuses on the importance of exercise in improving cardiac autonomic dysfunction.
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Affiliation(s)
- Christina Voulgari
- 3rd Department of Internal Medicine, Athens Regional General Hospital G.Gennimatas, University Medical School, Athens, Greece.
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28
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Stuckey MI, Kiviniemi AM, Petrella RJ. Diabetes and technology for increased activity study: the effects of exercise and technology on heart rate variability and metabolic syndrome risk factors. Front Endocrinol (Lausanne) 2013; 4:121. [PMID: 24065952 PMCID: PMC3776944 DOI: 10.3389/fendo.2013.00121] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/28/2013] [Indexed: 12/19/2022] Open
Abstract
This study tested the hypothesis that an 8-week exercise intervention supported by mobile health (mHealth) technology would improve metabolic syndrome (MetS) risk factors and heart rate variability (HRV) in a population with MetS risk factors. Participants (n = 12; three male; aged 56.9 ± 7.0 years) reported to the laboratory for assessment of MetS risk factors and fitness (VO2max) at baseline (V 0) and after 8-weeks (V 2) of intervention. Participants received an individualized exercise prescription and a mHealth technology kit for remote monitoring of blood pressure (BP), blood glucose, physical activity, and body weight via smartphone. Participants underwent 24-h ambulatory monitoring of R-R intervals following V 0 and V 2. Low and high frequency powers of HRV were assessed from the recording and the ratio of low-to-high frequency powers and low and high frequency powers in normalized units were calculated. One-way repeated measures analysis of variance showed that waist circumference (V 0: 113.1 ± 11.0 cm, V 2: 108.1 ± 14.7 cm; p = 0.004) and diastolic BP (V 0: 81 ± 6 mmHg, V 2: 76 ± 11 mmHg; p = 0.04) were reduced and VO2max increased (V 0: 31.3 ml/kg/min, V 2: 34.8 ml/kg/min; p = 0.02) with no changes in other MetS risk factors. Low and high frequency powers in normalized units were reduced (V 0: 75.5 ± 12.0, V 2: 72.0 ± 12.1; p = 0.03) and increased (V 0: 24.5 ± 12.0, V 2: 28.0 ± 12.1; p = 0.03), respectively, with no other changes in HRV. Over the intervention period, changes in systolic BP were correlated negatively with the changes in R-R interval (r = -0.600; p = 0.04) and positively with the changes in heart rate (r = 0.611; p = 0.03), with no other associations between MetS risk factors and HRV parameters. Thus, this 8-week mHealth supported exercise intervention improved MetS risk factors and HRV parameters, but only changes in systolic BP were associated with improved autonomic function.
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Affiliation(s)
- Melanie I. Stuckey
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
- Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Antti M. Kiviniemi
- Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland
| | - Robert J. Petrella
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
- Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- *Correspondence: Robert J. Petrella, Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, 801 Commissioners Road East, Suite B3002, London, ON N6C 5J1, Canada e-mail:
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29
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Grant CC, Viljoen M, Janse van Rensburg DC, Wood PS. Heart rate variability assessment of the effect of physical training on autonomic cardiac control. Ann Noninvasive Electrocardiol 2012; 17:219-29. [PMID: 22816541 DOI: 10.1111/j.1542-474x.2012.00511.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The effect of exercise interventions on autonomic nervous system (ANS) control of the heart by heart rate variability (HRV) is often investigated in just one position. It was hypothesized that results of exercise-induced changes on ANS are dependent on body position and that it is possible to distinguish between exercise induced changes in vagal and sympathetic influence by taking measurements in different body positions. METHODS One hundred eighty-three (male = 100, female = 83) healthy volunteers, between 18 and 22 years, participated in a prospective twelve week medium to high intensity exercise intervention study with a self-control design. The influence of the exercise intervention was investigated on supine, rising, and standing as well as on the orthostatic response. Time domain, frequency domain and nonlinear (Poincaré) HRV analysis were performed. RESULTS The exercise intervention lead to a significant increase (P < 0.05) in vagal influence during supine, rising, and standing. Sympathetic control in the supine position was decreased and increased during rising and standing. In the initial orthostatic response to rising from the supine position, the exercise intervention lead to increased (P < 0.05) vagal withdrawal as well as increased sympathetic control. The orthostatic response measured as the difference between standing and supine indicated only an exercise induced increase in sympathetic control. CONCLUSIONS Exercise-induced changes in sympathetic and parasympathetic ANS control differ, depending on posture and period of measurement. Exercise induced changes in parasympathetic and sympathetic outflow, respectively, can be extracted from measurements from supine, through the orthostatic response, to standing, thereby detecting changes in ANS that are otherwise obscured.
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Affiliation(s)
- Catharina C Grant
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
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30
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Janse van Rensburg DC, Ker JA, Grant CC, Fletcher L. Effect of exercise on cardiac autonomic function in females with rheumatoid arthritis. Clin Rheumatol 2012; 31:1155-62. [DOI: 10.1007/s10067-012-1985-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 03/05/2012] [Accepted: 03/30/2012] [Indexed: 12/26/2022]
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31
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Pfeifer K, Huber G, Baldus A, Pöthig D, Schüle K. [Resource management: ICF-oriented exercise programs for patients with diabetes mellitus type 2. Chronic illnesses and biopsychosocial status]. Z Gerontol Geriatr 2012; 45:119-27. [PMID: 22270894 DOI: 10.1007/s00391-011-0276-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Common health problems are increasing due to the combination of decreased physical activity demands in everyday life and demographic changes; thus, the importance of exercise therapy is increasing. The incidence and prevalence of today's predominant chronic diseases are directly related to physical activity. However, daily clinical routine does not stay abreast with these changes. The education of physicians, and thus their scope of action, is dominated by biomedical therapy concepts, predominantly drug therapy concepts. Differential and consolidated findings of modern exercise and sport science are astonishingly rare in the counselling and treatment portfolio of medical care. The present disease management program for persons with diabetes mellitus type 2 is a good example. Referring to this background, the authors address the new approach of "ICF-oriented exercise programs and biopsychosocial status." They present resource-related interventional strategies and health care concepts for chronic health disorders like the metabolic syndrome or diabetes mellitus type 2. The relevance and use of active health promotion and care - due to lifestyle- and age-related health problems of the population - will increase in importance and be more commonly recommended.
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Affiliation(s)
- K Pfeifer
- Institut für Sportwissenschaft und Sport, Lehrstuhl Bewegung und Gesundheit, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Deutschland.
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32
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Bernardi L, Spallone V, Stevens M, Hilsted J, Frontoni S, Pop-Busui R, Ziegler D, Kempler P, Freeman R, Low P, Tesfaye S, Valensi P. Methods of investigation for cardiac autonomic dysfunction in human research studies. Diabetes Metab Res Rev 2011; 27:654-64. [PMID: 21695761 DOI: 10.1002/dmrr.1224] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 06/06/2011] [Indexed: 12/16/2022]
Abstract
This consensus document provides evidence-based guidelines regarding the evaluation of diabetic cardiovascular autonomic neuropathy (CAN) for human research studies; the guidelines are the result of the work of the CAN Subcommittee of the Toronto Diabetic Neuropathy Expert Group. The subcommittee critically reviewed the limitations and strengths of the available diagnostic approaches for CAN and the need for developing new tests for autonomic function. It was concluded that the most sensitive and specific approaches currently available to evaluate CAN in clinical research are: (1) heart rate variability, (2) baroreflex sensitivity, (3) muscle sympathetic nerve activity, (4) plasma catecholamines, and (5) heart sympathetic imaging. It was also recommended that efforts should be undertaken to develop new non-invasive and safe CAN tests to be used in clinical research, with higher sensitivity and specificity, for studying the pathophysiology of CAN and evaluating new therapeutic approaches.
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Affiliation(s)
- Luciano Bernardi
- Department of Internal Medicine, IRCCS S.Matteo and University of Pavia, Pavia, Italy.
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33
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Routledge FS, Campbell TS, McFetridge-Durdle JA, Bacon SL. Improvements in heart rate variability with exercise therapy. Can J Cardiol 2010; 26:303-12. [PMID: 20548976 DOI: 10.1016/s0828-282x(10)70395-0] [Citation(s) in RCA: 213] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Heart rate variability (HRV) is a noninvasive, practical and reproducible measure of autonomic nervous system function. A heart rate that is variable and responsive to demands is believed to bestow a survival advantage, whereas reduced HRV may be associated with poorer cardiovascular health and outcomes. In recent years, many researchers have investigated the prognostic implications of HRV in a variety of clinical populations. Evidence suggests that reduced HRV has prognostic significance for individuals with myocardial infarction, chronic heart failure, unstable angina and diabetes mellitus. Interventions to increase HRV, such as exercise therapy, have also been examined. The findings of the present review suggest that exercise therapy may improve HRV in myocardial infarction, chronic heart failure and revascularization patients by increasing vagal tone and decreasing sympathetic activity. One hypothesis is that a shift toward greater vagal modulation may positively affect the prognosis of these individuals. While the underlying mechanisms by which exercise training improves vagal modulation are speculative at present, angiotensin II and nitric oxide may be potential mediators.
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Affiliation(s)
- Faye S Routledge
- Dalhousie University, School of Nursing, Halifax, Nova Scotia, Canada.
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Goulopoulou S, Baynard T, Franklin RM, Fernhall B, Carhart R, Weinstock R, Kanaley JA. Exercise training improves cardiovascular autonomic modulation in response to glucose ingestion in obese adults with and without type 2 diabetes mellitus. Metabolism 2010; 59:901-10. [PMID: 20015524 PMCID: PMC2875280 DOI: 10.1016/j.metabol.2009.10.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 10/05/2009] [Accepted: 10/14/2009] [Indexed: 10/20/2022]
Abstract
This study examined the effect of aerobic exercise training on vagal and sympathetic influences on the modulations of heart rate and systolic blood pressure in response to an oral glucose load in obese individuals with and without type 2 diabetes mellitus (T2D). Beat-to-beat arterial pressure and continuous electrocardiogram were measured after a 12-hour overnight fast and in response to glucose ingestion (75 g dextrose) in obese subjects with (T2D group, n = 23) and without (OB group, n = 36) T2D before and after 16 weeks of aerobic exercise training at moderate intensity. Autonomic modulation was assessed using spectral analysis of systolic blood pressure variability (BPV), heart rate variability (HRV), and analysis of baroreflex sensitivity (BRS). Glucose ingestion significantly increased low-frequency (LF(SBP)), low-frequency HRV (LF(RRI)), and the ratio of low- to high-frequency components of HRV (LF(RRI)/HF(RRI)), and decreased the high-frequency power (HF(RRI)) (P < .05). Exercise training increased LF(RRI) and LF(RRI)/HF(RRI) responses, and reduced HF(RRI) and LF(SBP) to glucose ingestion in both groups (P < .05), but increased fasted BRS in the OB group only (P < .05); glucose intake had no effect on BRS (P > .05). In conclusion, a 16-week exercise training program improved cardiac autonomic modulation in response to an oral glucose load in obese adults, independently of diabetes status, and in the absence of remarkable changes in body weight, body composition, fitness level, and glycemic control.
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35
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Sverrisdóttir YB, Jansson LM, Hägg U, Gan LM. Muscle sympathetic nerve activity is related to a surrogate marker of endothelial function in healthy individuals. PLoS One 2010; 5:e9257. [PMID: 20174639 PMCID: PMC2822841 DOI: 10.1371/journal.pone.0009257] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 01/29/2010] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Evidence from animal studies indicates the importance of an interaction between the sympathetic nervous system and the endothelium for cardiovascular regulation. However the interaction between these two systems remains largely unexplored in humans. The aim of this study was to investigate whether directly recorded sympathetic vasoconstrictor outflow is related to a surrogate marker of endothelial function in healthy individuals. METHODS AND RESULTS In 10 healthy normotensive subjects (3 f/7 m), (age 37+/-11 yrs), (BMI 24+/-3 kg/m(2)) direct recordings of sympathetic action potentials to the muscle vascular bed (MSNA) were performed and endothelial function estimated with the Reactive Hyperaemia- Peripheral Arterial Tonometry (RH-PAT) technique. Blood samples were taken and time spent on leisure-time physical activities was estimated. In all subjects the rate between resting flow and the maximum flow, the Reactive Hyperemic index (RH-PAT index), was within the normal range (1.9-3.3) and MSNA was as expected for age and gender (13-44 burst/minute). RH-PAT index was inversely related to MSNA (r = -0.8, p = 0.005). RH-PAT index and MSNA were reciprocally related to time (h/week) spent on physical activity (p = 0.005 and p = 0.006 respectively) and platelet concentration (PLT) (p = 0.02 and p = 0.004 respectively). CONCLUSIONS Our results show that sympathetic nerve activity is related to a surrogate marker of endothelial function in healthy normotensive individuals, indicating that sympathetic outflow may be modulated by changes in endothelial function. In this study time spent on physical activity is identified as a predictor of sympathetic nerve activity and endothelial function in a group of healthy individuals. The results are of importance in understanding mechanisms underlying sympathetic activation in conditions associated with endothelial dysfunction and emphasise the importance of a daily exercise routine for maintenance of cardiovascular health.
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Affiliation(s)
- Yrsa Bergmann Sverrisdóttir
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Guiraud T, Gayda M, Curnier D, Juneau M, Talajic M, Fortier A, Nigam A. Long-Term Exercise-Training Improves QT Dispersion in the Metabolic Syndrome. Int Heart J 2010; 51:41-6. [DOI: 10.1536/ihj.51.41] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Thibaut Guiraud
- Cardiovascular Prevention Centre, Montreal Heart Institute
- Clinique de Réadaptation Cardiovasculaire et Pulmonaire de Saint Orens
| | - Mathieu Gayda
- Cardiovascular Prevention Centre, Montreal Heart Institute
| | | | - Martin Juneau
- Cardiovascular Prevention Centre, Montreal Heart Institute
- Department of Medicine, Université de Montréal
- Research Center, Université de Montréal
| | - Mario Talajic
- Department of Medicine, Université de Montréal
- Research Center, Université de Montréal
| | - Annik Fortier
- Montreal Heart Institute Coordinating Center, Université de Montréal
| | - Anil Nigam
- Cardiovascular Prevention Centre, Montreal Heart Institute
- Department of Medicine, Université de Montréal
- Research Center, Université de Montréal
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37
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Kanaley JA, Goulopoulou S, Franklin RM, Baynard T, Holmstrup ME, Carhart R, Weinstock RS, Fernhall B. Plasticity of heart rate signalling and complexity with exercise training in obese individuals with and without type 2 diabetes. Int J Obes (Lond) 2009; 33:1198-206. [PMID: 19652657 PMCID: PMC2761497 DOI: 10.1038/ijo.2009.145] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To examine the responsiveness of cardiac autonomic function and baroreflex sensitivity (BRS) to exercise training in obese individuals without (OB) and with type 2 diabetes (ObT2D). Design Subjects were tested in the supine position and in response to a sympathetic challenge before and after a 16 week aerobic training program. All testing was conducted in the morning following a 12-hour fast. Subjects 34 OB and 22 ObT2D men and women (40-60 yr) Measurements Heart rate variability (HRV) was measured at rest via continuous ECG (spectral analysis with the autoregressive approach) and in response to upright tilt. The dynamics of heart rate complexity were analyzed with sample entropy and Lempel-Ziv entropy, and BRS was determined via the sequence technique. Subjects were aerobically trained 4x/wk for 30-45 min for 16 wks. Results Resting HR decreased and total power (lnTP, msec2) of HRV increased in response to exercise training (P<0.05). High frequency power (lnHF) increased in OB subjects but not in OBT2D, and no changes occurred in ln low frequency/HF power with training. Upright tilt decreased lnTP and lnHF and increased LF/HF (P<0.01) but there were no group differences in the magnitude of these changes nor were they altered with training in either group. Tilt also decreased complexity (sample entropy and Lempel-Ziv; P<0.001), but there was no group or training effect on complexity. BRS decreased with upright tilt (P<0.01) but did not change with training. Compared to OB subjects the ObT2D had less tilt-induced changes in BRS. Conclusion Exercise training improved HRV and parasympathetic modulation (lnHF) in OB subjects but not in ObT2D, indicating plasticity in the autonomic nervous system in response to this weight-neutral exercise program only in the absence of diabetes. HR complexity and BRS were not altered by 16 wk of training in either OB or ObT2D individuals.
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Affiliation(s)
- J A Kanaley
- Department of Exercise Science, Syracuse University, Syracuse, NY 13244, USA.
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Stener-Victorin E, Jedel E, Janson PO, Sverrisdottir YB. Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol 2009; 297:R387-95. [PMID: 19494176 DOI: 10.1152/ajpregu.00197.2009] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We have recently shown that polycystic ovary syndrome (PCOS) is associated with high muscle sympathetic nerve activity (MSNA). Animal studies support the concept that low-frequency electroacupuncture (EA) and physical exercise, via stimulation of ergoreceptors and somatic afferents in the muscles, may modulate the activity of the sympathetic nervous system. The aim of the present study was to investigate the effect of these interventions on sympathetic nerve activity in women with PCOS. In a randomized controlled trial, 20 women with PCOS were randomly allocated to one of three groups: low-frequency EA (n = 9), physical exercise (n = 5), or untreated control (n = 6) during 16 wk. Direct recordings of multiunit efferent postganglionic MSNA in a muscle fascicle of the peroneal nerve before and following 16 wk of treatment. Biometric, hemodynamic, endocrine, and metabolic parameters were measured. Low-frequency EA (P = 0.036) and physical exercise (P = 0.030) decreased MSNA burst frequency compared with the untreated control group. The low-frequency EA group reduced sagittal diameter (P = 0.001), while the physical exercise group reduced body weight (P = 0.004) and body mass index (P = 0.004) compared with the untreated control group. Sagittal diameter was related to MSNA burst frequency (Rs = 0.58, P < 0.005) in the EA group. No correlation was found for body mass index and MSNA in the exercise group. There were no differences between the groups in hemodynamic, endocrine, and metabolic variables. For the first time we demonstrate that low-frequency EA and physical exercise lowers high sympathetic nerve activity in women with PCOS. Thus, treatment with low-frequency EA or physical exercise with the aim to reduce MSNA may be of importance for women with PCOS.
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Affiliation(s)
- Elisabet Stener-Victorin
- Institute of Neuroscience and Physiology, Dept. of Physiology, Sahlgrenska Academy, Univ. of Gothenburg, Box 434, SE-405 30 Göteborg, Sweden.
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Mourot L, Boussuges A, Campo P, Maunier S, Debussche X, Blanc P. Cardiovascular rehabilitation increase arterial compliance in type 2 diabetic patients with coronary artery disease. Diabetes Res Clin Pract 2009; 84:138-44. [PMID: 19264372 DOI: 10.1016/j.diabres.2009.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 02/03/2009] [Accepted: 02/04/2009] [Indexed: 10/21/2022]
Abstract
AIMS The effect of a cardiovascular rehabilitation program on arterial compliance in type 2 diabetes mellitus with coronary disease was studied. METHODS Hemodynamic data and arterial compliance were measured with a tonometer (HDI/Pulse wave CR-2000) in coronary artery disease patients with (n=32) and without (n=24) type 2 diabetes before and after a 6-week multidisciplinary cardiac rehabilitation program. RESULTS A decrease in heart rate and an increase in stroke volume without significant change in resting cardiac output were obtained in diabetic patients. Arterial compliance of both small and large arteries was significantly increased. In 10 diabetic patients, this increase could be related to an increase in the anti-hypertensive treatment and to the decreased blood pressure. In the 22 remainders, the small artery compliance was significantly increased independently of blood pressure change. CONCLUSIONS Exercise training as well as optimization of diabetes and dyslipidemia treatment could explain the improvement of arterial compliance. If these changes are long-lasting and if they improve prognosis remains to be evaluated.
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Affiliation(s)
- L Mourot
- EA 3920 and IFR133, Université de Franche Comté, Physiologie, Faculté de Médecine, Besançon, France.
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BRASSARD PATRICE, LEGAULT SYLVIE, GARNEAU CAROLINE, BOGATY PETER, DUMESNIL JEANGASTON, POIRIER PAUL. Normalization of Diastolic Dysfunction in Type 2 Diabetics after Exercise Training. Med Sci Sports Exerc 2007; 39:1896-901. [DOI: 10.1249/mss.0b013e318145b642] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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