Hemodynamic and autonomic changes induced by Ironman: prediction of competition time by blood pressure variability

Orthostatic testing for heart rate and heart rate variability monitoring in exercise science and practice

Orthostatic testing, involving the transition from different body positions (e.g., from lying or sitting position to an upright or standing position), offers valuable insights into the autonomic nervous system (ANS) functioning and cardiovascular regulation reflected through complex adjustments in, e.g., measures of heart rate (HR) and heart rate variability (HRV). This narrative review explores the intricate physiological mechanisms underlying orthostatic stress responses and evaluates its significance for exercise science and sports practice. Into this matter, active orthostatic testing (e.g., active standing up) challenges the cardiovascular autonomic function in a different way than a passive tilt test. It is well documented that there is a transient reduction in blood pressure while standing up, leading to a reflex increase in HR and peripheral vasoconstriction. After that acute response systolic and diastolic blood pressures are usually slightly increased compared to supine lying body position. The ANS response to standing is initiated by instantaneous cardiac vagal withdrawal, followed by sympathetic activation and vagal reactivation over the first 25-30 heartbeats. Thus, HR increases immediately upon standing, peaking after 15-20 beats, and is less marked during passive tilting due to the lack of muscular activity. Standing also decreases vagally related HRV indices compared to the supine position. In overtrained endurance athletes, both parasympathetic and sympathetic activity are attenuated in supine and standing positions. Their response to standing is lower than in non-overtrained athletes, with a tendency for further decreased HRV as a sign of pronounced vagal withdrawal and, in some cases, decreased sympathetic excitability, indicating a potential overtraining state. However, as a significant main characteristic, it could be noted that additional pathophysiological conditions consist in a reduced responsiveness or counter-regulation of neural drive in ANS according to an excitatory stimulus, such as an orthostatic challenge. Hence, especially active orthostatic testing could provide additional information about HR(V) reactivity and recovery giving valuable insights into athletes' training status, fatigue levels, and adaptability to workload. Measuring while standing might also counteract the issue of parasympathetic saturation as a common phenomenon especially in well-trained endurance athletes. Data interpretation should be made within intra-individual data history in trend analysis accounting for inter-individual variations in acute responses during testing due to life and physical training stressors. Therefore, additional measures (e.g., psychometrical scales) are required to provide context for HR and HRV analysis interpretation. However, incidence of orthostatic intolerance should be evaluated on an individual level and must be taken into account when considering to implement orthostatic testing in specific subpopulations. Recommendations for standardized testing procedures and interpretation guidelines are developed with the overall aim of enhancing training and recovery strategies. Despite promising study findings in the above-mentioned applied fields, further research, thorough method comparison studies, and systematic reviews are needed to assess the overall perspective of orthostatic testing for training monitoring and fine-tuning of different populations in exercise science and training.

Body Oxygen Level Test (BOLT) is not associated with exercise performance in highly-trained individuals

Introduction

The analysis of chemoreflex and baroreflex sensitivity may contribute to optimizing patient care and athletic performance. Breath-holding tests, such as the Body Oxygen Level Test (BOLT), have gained popularity as a feasible way to evaluate the reflex control over the cardiorespiratory system. According to its proponents, the BOLT score reflects the body's sensitivity to carbon dioxide and homeostasis disturbances, providing feedback on exercise tolerance. However, it has not yet been scientifically validated or linked with exercise performance in highly-trained individuals. Therefore, we investigated the association of BOLT scores with the results of standard performance tests in elite athletes.

Methods

A group of 49 speedskaters performed BOLT, Wingate Anaerobic Test (WAnT), and cardiopulmonary exercise test (CPET) on a cycle ergometer. Peak power, total work, and power drop were measured during WAnT. Time to exhaustion and maximum oxygen uptake were measured during CPET. Spearman's rank correlation and multiple linear regression were performed to analyze the association of BOLT scores with parameters obtained during the tests, age, somatic indices, and training experience.

Results

No significant correlations between BOLT scores and parameters obtained during WAnT and CPET were found, r(47) = -0.172-0.013, p = 0.248-0.984. The parameters obtained during the tests, age, somatic indices, and training experience were not significant in multiple linear regression (p = 0.38-0.85). The preliminary regression model showed an R 2 of 0.08 and RMSE of 9.78 sec.

Conclusions

Our findings did not demonstrate a significant relationship between BOLT scores and exercise performance. Age, somatic indices, and training experience were not significant in our analysis. It is recommended to interpret BOLT concerning exercise performance in highly-trained populations with a great degree of caution.

Insult of Ultraendurance Events on Blood Pressure: A Systematic Review and Meta-Analysis

The rise of ultraendurance sports in the past two decades warrants evaluation of the impact on the heart and vessels of a growing number of athletes participating. Blood pressure is a simple, inexpensive method to evaluate one dimension of an athlete's cardiovascular health. No systematic review or meta-analysis to date has chronicled and delineated the effects of ultraendurance races, such as ultramarathons, marathons, half-marathons, and Ironman triathlon events, specifically on heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP) measurements in supine and standing positions before and after the event. This meta-analysis reviews the effects of ultraendurance events on positional and calculated hemodynamic values. Data were extracted from 38 studies and analyzed using a random effects model with a total of 1,645 total blood pressure measurements. Of these, 326 values were obtained from a standing position, and 1,319 blood pressures were taken supine. Pre-race and post-race measurements were evaluated for clinical significance using established standards of hypotension and orthostasis. HR and calculated BP features, such as PP and MAP, were evaluated. Across all included studies, the mean supine post-race HR increased by 21±8 beats per minute (bpm) compared to pre-race values. The mean standing post-race HR increased by 23±14 bpm when compared with pre-race HR. Overall, there was a mean SBP decrease of 19±9 mmHg and a DBP decrease of 9±5 mmHg post-race versus pre-race values. MAP variations reflected SBP and DBP changes. The mean supine and standing pre-race blood pressures across studies were systolic (126±7; 124±14) and diastolic (76±6; 75±12), suggesting that some athletes may enter races with existing hypertension. The post-race increase in the mean HR and decline in mean blood pressure across examined studies suggest that during long-term events, ultramarathon athletes perform with relatively asymptomatic hypotension.

The effects of a 3-day mountain bike cycling race on the autonomic nervous system (ANS) and heart rate variability in amateur cyclists: a prospective quantitative research design

BACKGROUND

The acute and chronic adaptation of endurance athletes' hearts shows that increased volume of endurance exercise might cause an acute reduction in cardiac function, causing a physiological cascade that leads to the release of cardiac biomarkers specific to cardiomyocyte stress. Heart rate variability (HRV) is a valuable tool used as a physiological measurement to evaluate the autonomic nervous system (ANS). It is frequently used to assess cardiac autonomic regulation, determining a patient's risk for unfavorable events. This study set out to determine the changes in the ANS by participating in a 3-day mountain bike cycling race in amateur cyclists using HRV as an outcome measure.

METHODS

Sixteen healthy participants (male and female) participating in a 3-day mountain bike cycling race underwent five-minute resting electrocardiography recordings in a supine position 2 days before the race (baseline testing). In addition, HRV measurements were recorded after each race day and 24 h post-race (recovery).

RESULTS

Time-domain and frequency-domain measures showed significant changes from baseline HRV parameters after each race day (p ≤ 0.05). In addition, our data revealed that the mean heart rate and R-R variability intervals did not return to baseline values after 24 h of recovery. Thus, autonomic nervous system (ANS) alterations may be due to changes in cardiac sympatho-vagal balance.

CONCLUSIONS

The main strength of this study is using HRV as a measuring and screening tool to assess cardiac autonomic activity, whereby the state of the ANS before and after endurance races can be measured. Thus, physicians, athletes, and coaches can determine the stress of endurance races on the ANS and plan recovery strategies. The reasoning is that if the ANS is in a state of sub-optimal function, susceptible amateur athletes might be at risk for a cardiovascular event or maladaptation due to the endurance race.

Central and Peripheral Fatigue in Recreational Trail Runners: A Pilot Study

BACKGROUND

Understanding fatigue mechanisms is crucial for exercise performance. However, scientific evidence on non-invasive methods for assessing fatigue in trail running competitions is scarce, especially when vertical kilometer trail running races (VK) are considered. The main purpose of this study was to assess the autonomic nervous system (ANS) activity (i.e., central fatigue) and the state of muscle activation (i.e., peripheral fatigue) before and after a VK competition.

METHODS

A cross-sectional pilot study was performed. After applying inclusion/exclusion criteria, 8 recreational male trail runners (31.63 ± 7.21 yrs, 1.75 m ± 0.05 m, 70.38 ± 5.41 kg, BMI: 22.88 ± 0.48, running experience: 8.0 ± 3.63 yrs, weekly training volume: 58.75 ± 10.35 km) volunteered to participate and were assessed for both central (i.e., via heart rate variability, HRV) and peripheral (via tensiomyography, TMG) fatigue before and after a VK race.

RESULTS

After the VK, resting heart rate, RMSSD (p = 0.01 for both) and SDNN significantly decreased (p = 0.02), while the stress score and the sympathetic-parasympathetic ratio increased (p = 0.01 and p = 0.02, respectively). The TMG analyses suggest that runners already suffered peripheral fatigue before the VK and that 20-30 min are enough for muscular recovery after the race. In summary, our data suggest that participants experienced a pre-competition fatigue status. Further longitudinal studies are necessary to investigate the mechanisms underlying fatigue during trail running races, while training periodization and tapering strategies could play a key role for minimizing pre-competition fatigue status.

Genetic differentiation in East African ethnicities and its relationship with endurance running success

Since the 1960s, East African athletes, mainly from Kenya and Ethiopia, have dominated long-distance running events in both the male and female categories. Further demographic studies have shown that two ethnic groups are overrepresented among elite endurance runners in each of these countries: the Kalenjin, from Kenya, and the Oromo, from Ethiopia, raising the possibility that this dominance results from genetic or/and cultural factors. However, looking at the life history of these athletes or at loci previously associated with endurance athletic performance, no compelling explanation has emerged. Here, we used a population approach to identify peaks of genetic differentiation for these two ethnicities and compared the list of genes close to these regions with a list, manually curated by us, of genes that have been associated with traits possibly relevant to endurance running in GWAS studies, and found a significant enrichment in both populations (Kalenjin, P = 0.048, and Oromo, P = 1.6x10^-5). Those traits are mainly related to anthropometry, circulatory and respiratory systems, energy metabolism, and calcium homeostasis. Our results reinforce the notion that endurance running is a systemic activity with a complex genetic architecture, and indicate new candidate genes for future studies. Finally, we argue that a deterministic relationship between genetics and sports must be avoided, as it is both scientifically incorrect and prone to reinforcing population (racial) stereotyping.

Transient Reduction of FMD-Response and L-Arginine Accompanied by Increased Levels of E-Selectin, VCAM, and ICAM after Prolonged Strenuous Exercise

We assessed endothelial function by flow-mediated dilatation (FMD), levels of the NO-precursor L-arginine, and markers of endothelial inflammation before, at the finish line, and one week after the Norseman Xtreme triathlon. The race is an Ironman distance triathlon with a total elevation of 5200 m. Nine male participants were included. They completed the race in 14.5 (13.4–15.3) h. FMD was significantly reduced to 3.1 (2.1–5.0)% dilatation compared to 8.7 (8.2–9.3)% dilatation before the race (p < 0.05) and was normalized one week after the race. L-arginine showed significantly reduced levels at the finish line (p < 0.05) but was normalized one week after the race. Markers of endothelial inflammation E-Selectin, VCAM-1, and ICAM-1 all showed a pattern with increased values at the finish line compared to before the race (all p < 0.05), with normalization one week after the race. In conclusion, we found acutely reduced FMD with reduced L-arginine levels and increased E-Selectin, VCAM-1, and ICAM-1 immediately after the Norseman Xtreme triathlon. Our findings indicate a transient reduced endothelial function, measured by the FMD-response, after prolonged strenuous exercise that could be explained by reduced NO-precursor L-arginine levels and increased endothelial inflammation.

Low ventilatory responsiveness to transient hypoxia or breath-holding predicts fast marathon performance in healthy middle-aged and older men

The aim of this study was to test the utility of haemodynamic and autonomic variables (e.g. peripheral chemoreflex sensitivity [PCheS], blood pressure variability [BPV]) for the prediction of individual performance (marathon time and VO_2max) in older men. The post-competition vasodilation and sympathetic vasomotor tone predict the marathon performance in younger men, but their prognostic relevance in older men remains unknown. The peripheral chemoreflex restrains exercise-induced vasodilation via sympathetically-mediated mechanism, what makes it a plausible candidate for the individual performance marker. 23 men aged ≥ 50 year competing in the Wroclaw Marathon underwent an evaluation of: resting haemodynamic parameters, PCheS with two methods: transient hypoxia and breath-holding test (BHT), cardiac barosensitivity, heart rate variability (HRV) and BPV, plasma renin and aldosterone, VO_2max in a cardiopulmonary exercise test (CPET). All tests were conducted twice: before and after the race, except for transient hypoxia and CPET which were performed once, before the race. Fast marathon performance and high VO_2max were correlated with: low ventilatory responsiveness to hypoxia (r =  - 0.53, r = 0.67, respectively) and pre-race BHT (r =  - 0.47, r = 0.51, respectively), (1) greater SD of beat-to-beat SBP (all p < 0.05). Fast performance was related with an enhanced pre-race vascular response to BHT (r =  - 0.59, p = 0.005). The variables found by other studies to predict the marathon performance in younger men: post-competition vasodilation, sympathetic vasomotor tone (LF-BPV) and HRV were not associated with the individual performance in our population. The results suggest that PCheS (ventilatory response) predicts individual performance (marathon time and VO_2max) in men aged ≥ 50 yeat. Although cause-effect relationship including the role of peripheral chemoreceptors in restraining the post-competition vasodilation via the sympathetic vasoconstrictor outflow may be hypothesized to underline these findings, the lack of correlation between individual performance and both, the post-competition vasodilation and the sympathetic vasomotor tone argues against such explanation. Vascular responsiveness to breath-holding appears to be of certain value for predicting individual performance in this population, however.

Exploring the Effects of Osteopathic Manipulative Treatment on Autonomic Function Through the Lens of Heart Rate Variability

The osteopathic community has long hypothesized that the autonomic nervous system (ANS) represents one of the putative substrates through which osteopathic manipulative treatment (OMT) can improve body functions that have been altered by musculoskeletal alterations. Heart rate variability (HRV) is an important physiological measure of cardiac ANS activity. Emerging evidence suggests that OMT is associated with HRV changes that (i) are indicative of a larger cardiac vagal modulation, (ii) are independent from the part of the body needing treatment, (iii) occur even in the absence of musculoskeletal alterations. Yet, many questions remain unanswered, the duration of these effects and the specificity of HRV responses to different OMT techniques being perhaps the most critical. Therefore, this paper discusses prospects for future applications of HRV for the study of the influence of OMT on ANS function. Moreover, based on existing studies and preliminary data on the effects of OMT on HRV in specific pathological (hypertension) and physiological (stress exposure and recovery from sport competition) conditions that are commonly associated with increased sympathetic and/or decreased vagal activity, we propose that HRV analysis could be exploited to evaluate the effectiveness of OMT as a preventive or complementary strategy in clinical and non-clinical conditions characterized by ANS imbalance.

In Amateur Athletes With Type 1 Diabetes, a 9-Day Period of Cycling at Moderate-to-Vigorous Intensity Unexpectedly Increased the Time Spent in Hyperglycemia, Which Was Associated With Impairment in Heart Rate Variability

OBJECTIVE

In type 1 diabetes, autonomic dysfunction may occur early as a decrease in heart rate variability (HRV). In populations without diabetes, the positive effects of exercise training on HRV are well-documented. However, exercise in individuals with type 1 diabetes, particularly if strenuous and prolonged, can lead to sharp glycemic variations, which can negatively impact HRV. This study explores the impact of a 9-day cycling tour on HRV in this population, with a focus on exercise-induced glycemic excursions.

RESEARCH DESIGN AND METHODS

Twenty amateur athletes with uncomplicated type 1 diabetes cycled 1,500 km. HRV and glycemic variability were measured by heart rate and continuous glucose monitoring. Linear mixed models were used to test the effects of exercise on HRV, with concomitant glycemic excursions and subject characteristics considered as covariates.

RESULTS

Nighttime HRV tended to decrease with the daily distance traveled. The more time the subjects spent in hyperglycemia, the lower the parasympathetic tone was. This result is striking given that hyperglycemic excursions progressively increased throughout the 9 days of the tour, and to a greater degree on the days a longer distance was traveled, while time spent in hypoglycemia surprisingly decreased. This phenomenon occurred despite no changes in insulin administration and a decrease in carbohydrate intake from snacks.

CONCLUSIONS

In sports enthusiasts with type 1 diabetes, multiday prolonged exercise at moderate-to-vigorous intensity worsened hyperglycemia, with hyperglycemia negatively associated with parasympathetic cardiac tone. Considering the putative deleterious consequences on cardiac risks, future work should focus on understanding and managing exercise-induced hyperglycemia.

The Advantage of Supine and Standing Heart Rate Variability Analysis to Assess Training Status and Performance in a Walking Ultramarathon

Cardiac autonomic modulation of heart rate, assessed by heart rate variability (HRV), is commonly used to monitor training status. HRV is usually measured in athletes after awakening in the morning in the supine position. Whether recording during standing reveals additional information compared to supine remains unclear. We aimed to evaluate the association between short-duration HRV, assessed both in the supine and standing position, and a low-intensity long-duration performance (walking ultramarathon), as well as training experience. Twenty-five competitors in a 100 km walking ultramarathon underwent pre-race supine (12 min) and standing (6 min) HR recordings, whereas performance and subjective training experience were assessed post-race. There were no significant differences in both supine and standing HRV between finishers (n = 14) and non-finishers (n = 11, mean distance 67 km). In finishers, a slower race velocity was significantly correlated with a higher decrease in parasympathetic drive during position change [larger decrease in High Frequency power normalized units (HF_nu: r = −0.7, p = 0.01) and higher increase in the detrended fluctuation analysis alpha 1 index (DFA1: r = 0.6, p = 0.04)]. Highly trained athletes accounted for higher HF_nu during standing compared to poorly trained competitors (+11.5, p = 0.01). Similarly, greater training volume (total km/week) would predict higher HF_nu during standing (r = 0.5, p = 0.01). HRV assessment in both supine and standing position may provide additional information on the dynamic adaptability of cardiac autonomic modulation to physiologic challenges and therefore be more valuable for performance prediction than a simple assessment of supine HRV. Self-reported training experience may reliably associate with parasympathetic drive, therefore indirectly predicting long-term aerobic performance in ultramarathon walking races.

Effects of a 75-km mountain ultra-marathon on heart rate variability in amateur runners

BACKGROUND

This study examined the effects of a mountain ultra-marathon (MUM) on the activity of the autonomous nervous system through heart rate variability (HRV) monitoring and determined whether this variable related to final performance.

METHODS

Heart rate and HRV were measured in eight male amateur runners (aged 37-60 years). Measurements were recorded before and after the event, in resting conditions, as well as continuously throughout the whole MUM. In addition, percentage (%) of heart rate reserve (HR<inf>res</inf>) and partial and total times during the race were analyzed.

RESULTS

Average heart rate (HR<inf>avg</inf>) measured at rest was increased after the event (+37%). Standard deviation of successive differences (SDSD) and the square root of the mean squared differences of successive NN intervals (RMSSD) were reduced after the MUM (-56% and -59%, respectively). There was a positive relationship between the frequency-domain index normalized low frequency power (PLFn) measured at rest before the event and race time (0.79) while there was a negative relationship between race time and the difference in HR<inf>avg</inf> before and after the event. In the last half of the event, there was a high correlation (Spearman coefficient of correlation >0.9) between race time and the standard deviation of the NN intervals (SDNN) registered during the race.

CONCLUSIONS

Autonomous cardiac regulation can be related to the performance in a mountain ultra-marathon. HRV monitoring could represent a practical tool for the evaluation of the relationship between the autonomous nervous system activity and performance in a mountain ultra-marathon.

Daily Resting Heart Rate Variability in Adolescent Swimmers during 11 Weeks of Training

Adolescent athletes are particularly vulnerable to stress. The current study aimed to monitor one of the most popular and accessible stress markers, heart rate variability (HRV), and its associations with training load and sleep duration in young swimmers during an 11-week training period to evaluate its relevance as a tool for monitoring overtraining. National-level swimmers (n = 22, age 14.3 ± 1.0 years) of sprint and middle distance events followed individually structured training programs prescribed by their swimming coach with the main intention of preparing for the national championships. HRV after awakening, during sleep and training were recorded daily. There was a consistent ~4.5% reduction in HRV after 3–5 consecutive days of high (>6 km/day) swimming volume, and an inverse relationship of HRV with large (>7.0 km/day) shifts in total training load (r = −0.35, p < 0.05). Day-to-day HRV did not significantly correlate with training volume or sleep duration. Taken together, these findings suggest that the value of HRV fluctuations in estimating the balance between the magnitude of a young athlete’s physical load and their tolerance is limited on a day-to-day basis, while under sharply increased or extended training load the lower HRV becomes an important indicator of potential overtraining.

Multimodal approach towards understanding the changes in the autonomic nervous system induced by an ultramarathon

Purpose: Running an ultramarathon can be considered as a multifaceted, intense stressor inducing changes within the autonomic nervous system (ANS). The aim of this study was to examine changes within and across ANS modalities in response to an ultramarathon.Methods: Thirteen runners (44.3 ± 5.9 years) completed a 65 km run. Electrodermal activity (EDA), heart rate (HR), and skin temperature measured at wrist (Temp), were recorded before and after running. Three-minute intervals were analysed. Mean values were compared by t-tests for dependent samples. Joint principal component analysis-canonical correlation analysis (PCA-CCA) and multiset CCA techniques were employed to measure the interactions between either any two or among all modalities.Results: HR (p < 0.01) and EDA (p < 0.01) increased, while Temp decreased (p < 0.01). PCA-CCA revealed one significant component (p < 0.05) for each modality pair in pre and post measures. Component strength increased from pre (mean = 0.73) to post (mean = 0.92) test. Multiset CCA supported the assumption of increasing strength of correlations across modalities.Conclusion: Ultramarathon, an intense physical stressor, increases correlations across modalities pointing towards a reorganization of central ANS control to restore dynamic balance after physical load. This characterization of ANS-states might offer new avenues for training control.

Recovery time and heart rate variability following extreme endurance exercise in healthy women

The relationship between autonomic function and recovery following prolonged arduous exercise in women has not been examined. We undertook an exploratory study that aimed to examine the temporal change in linear and nonlinear measures of heart rate variability (HRV) following prolonged arduous exercise in the form of first all‐female (mean age 32.7 ± 3.1 years) team to attempt an unassisted Antarctic traverse. HRV analysis was performed before and 1, 4, and 15 days postexpedition. The traverse was completed in 61 days. There was a significant paired reduction in heart rate, LnLF, LF:HF, DFAα1 between baseline and 15 days postexercise in the same environment. Conversely, RMSSD, LnHF and HFnu, SD1:SD2, and SampEn significantly increased. DFAα2 levels significantly fell from baseline to Day 1 postexercise. In conclusion, we observed a significant latent increase in relative parasympathetic dominance and RR interval irregularity at 15 days post prolonged arduous exercise, versus pre‐exercise baseline, in a group of very fit and healthy adult women.

The effect of an ultra-endurance running race on heart rate variability

PURPOSE

The aim of this study was to investigate the effect of an ultra-marathon on heart rate variability (HRV) and psychometric indices in endurance runners. In addition, we aimed to determine the magnitude of change and subsequent recovery for 7 days following the race.

METHODS

Recreationally trained runners (n = 13 (8M); age = 36.6 ± 7.6 years; height = 174 ± 9 cm; weight = 70.5 ± 9.3 kg) completed measures of HRV upon waking in the morning for 1 week prior to and 1 week following a 64-km running race. Profile of mood states, wellbeing, and muscular soreness were also measured throughout the study period to further contextualise recovery.

RESULTS

An increase in heart rate accompanied by decreased LnSDNN, LnRMSSD, LnLF, LnHF, and LnLF/HF from baseline were observed 1 day post-race (p < 0.05). Indices of HRV had returned to baseline on day 2 of recovery. Perceptual fatigue and muscle soreness increased post-race (immediately following and on day 1 of recovery) (p < 0.05) and took until day 5 of recovery to return to baseline.

CONCLUSION

The results indicate that cardiac autonomic control is significantly altered in response to a 64 km ultra-marathon. Specifically, parasympathetic activity is suppressed. The change in autonomic control was relatively short-lived, and parasympathetic-related indices had returned to baseline 2 days after the event. Subjective measures of fatigue and wellbeing suggest that athletes were not completely recovered until day 5 post-event, with muscular soreness remaining prominent during this period. A combination of physiological and psychological parameters is important to contextualise recovery in ultra-endurance runners.

Physiological and Pathophysiological Consequences of a 25-Day Ultra-Endurance Exercise Challenge

Background: This case-report characterized the respiratory, cardiovascular, and nutritional/gastrointestinal (GI) responses of a trained individual to a novel ultra-endurance exercise challenge.

Case Presentation: A male athlete (age 45 years; V˙O₂max 54.0 mL⋅kg^-1⋅min^-1) summited 100 mountains on foot in 25 consecutive days (all elevations >600 m).

Measures: Laboratory measures of pulmonary function (spirometry, whole-body plethysmography, and single-breath rebreathe), respiratory muscle function (maximum static mouth-pressures), and cardiovascular structure and function (echocardiography, electrocardiography, large vessel ultrasound, and flow-mediated dilatation) were made at baseline and 48 h post-challenge. Dietary intake (four-day food diary), self-reported GI symptoms and plasma endotoxin concentrations were assessed at baseline, pre/post mid-point, pre/post end-point, and 48 h post-challenge.

Results: The challenge was completed in a total exercise time of 142 h (5.3 ± 2.8 h⋅d^-1), with a distance of 1141 km (42.3 ± 43.9 km⋅d^-1), and energy expenditure of 80460 kcal (2980 ± 1451 kcal⋅d^-1). Relative to baseline, there were post-challenge decreases in pulmonary capacities and expiratory flows (≤34%), maximum expiratory mouth-pressure (19%), and maximum voluntary ventilation (29%). Heart rate variability deteriorated, manifesting as a 48% decrease in the root mean square of successive differences and a 70% increase in the low-frequency/high-frequency ratio. Pre- to post-challenge endotoxin concentrations were elevated by 60%, with a maximum increase of 130% after a given stage, congruent with an increased frequency and severity of GI symptoms.

Conclusion: The challenge resulted in pulmonary and autonomic dysfunction, endotoxaemia, and GI distress. The findings extend our understanding of the limits of physiological function and may inform medical best-practice for personnel supporting ultra-endurance events.

Psychophysiological Stress Response of a Paralympic Athlete During an Ultra-Endurance Event. A Case Study

Psychophysiological response of athletes with spinal cord injurie has not been reported yet in scientific literature. The aim of this study is to examine the psychophysiological stress response of Paralympic athlete during competitive activities. We collected the following psychophysiological measurements: anxiety-trait, anxiety-state, locus of control, perceived psychological stress, stress-copying style, rate of perceived exertion, perceived muscle pain, body temperature, forced vital capacity, blood oxygen saturation, blood glucose and lactate concentrations, isometric hand strength, cortical arousal, heart rate variability, heart rate and velocities of a female Paralympic spinal cord injured athlete in a 11 h and 44 min ultraendurance mountain event. An ultraendurance mountain even produced an increase in the sympathetic autonomous modulation, heart rate, lactate, muscular pain and rated of perceived exertion and a decrease in cortical arousal, hand strength and respiratory muscle in a spinal cord injurie female athlete during. The Paralympic athletes presented a low psychological inflexibility, high life engagement, strong internal locus of control, a low trait and state anxiety and medium perceived psychological stress. These results are consistent with the expected response during a highly stressful situation and consistent with previous findings in athletes without spinal cord injurie.

Physiological responses to a five-day adventure race: Continuous blood glucose, hemodynamics and metabolites the 2012 GODZone field-study

Background/Objective

Adventure racing is an ultra-endurance activity that imposes a unique multifaceted stress on the human body. The purpose of this field study was to examine the physiological responses to a 5-day adventure race.

Methods

Eight competitors, two teams (1 female each) in the 2012 GODZone adventure race volunteered. Competitors trekked, cycled and paddled ∼326 km in ∼116 hours. Continuous glucose was measured the day before and throughout. Body mass, urinary solutes, and blood pressure and heart rate during resting, standing, and repeated squat-stand conditions, were assessed pre and post.

Results

Despite no changes in mean blood glucose levels, there was increased glycemic variability (Standard deviation glucose; Pre: 0.5 ± 0.1 vs Race: 1.0 ± 0.2 mmol/L, p = 0.02) and periods of hypoglycemia (i.e., Min glucose Pre: 4.1 ± 0.3 vs Race: 3.6 ± 0.5 mmol/L, p = 0.05) during the race. After the race, the blood pressure during resting, standing and squat-stand conditions was significantly lower, by 14 ± 14 mmHg, 16 ± 15 mmHg and 18 ± 15 mmHg (all p < 0.05), respectively, with no change in heart rate. During five-days of adventure racing there is increased glycemic variability and more frequent periods of low blood glucose levels. Additionally, following the race pronounced hypotension is observed in competitors.

Conclusion

We observed more frequent glucose fluctuations, lower glucose levels and significant perturbations in blood pressure control. Further research is warranted to examine the long-term impact of adventure racing on metabolic and cardiovascular function.

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Five-days of adventure racing can cause blood pressure pertubations.

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Adventure racing results in fluctuations of blood glucose.

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There are periods of hypoglycemia during an adventure race which maynot be captured by pre-post- measures.

Cardiac Autonomic Modulations and Psychological Correlates in the Yukon Arctic Ultra: The Longest and the Coldest Ultramarathon

Studies on human physical performance in extreme environments have effectively approached the investigation of adaptation mechanisms and their physiological limits. As scientific interest in the interplay between physiological and psychological aspects of performance is growing, we aimed to investigate cardiac autonomic control, by means of heart rate variability, and psychological correlates, in competitors of a subarctic ultramarathon, taking place over a 690 km course (temperatures between +5 and -47°C). At baseline (PRE), after 277 km (D1), 383 km (D2), and post-race (POST, 690 km), heart rate (HR) recordings (supine, 15 min), psychometric measurements (Profile of Mood States/POMS, Borg fatigue, and Karolinska Sleepiness Scale scores both upon arrival and departure) were obtained in 16 competitors (12 men, 4 women, 38.6 ± 9.5 years). As not all participants reached the finish line, comparison of finishers (FIN, n = 10) and non-finishers (NON, n = 6), allowed differential assessment of performance. Resting HR increased overall significantly at D1 (FIN +15.9; NON +14.0 bpm), due to a significant decrease in parasympathetic drive. This decrease was in FIN only partially recovered toward POST. In FIN only, baseline HR was negatively correlated with mean velocity [r -0.63 (P.04)] and parasympathetic drive [pNN50+: r -0.67 (P.03)], a lower HR and a higher vagal tone predicting a better performance. Moreover, in FIN, a persistent increase of the long-term self-similarity coefficient, assessed by detrended fluctuation analysis (DFAα2), was retrieved, possibly due to higher alertness. As for psychometrics, at D1, POMS Vigor decreased (FIN: -7.0; NON: -3.8), while Fatigue augmented (FIN: +6.9; NON: +5.0). Sleepiness increased only in NON, while Borg scales did not exhibit changes. Baseline comparison of mood states with normative data for athletes displayed significantly higher positive mood in our athletes. Results show that: the race conditions induced early decreases in parasympathetic drive; the extent of vagal withdrawal, associated to the timing of its recovery, is crucial for success; pre-competition lower resting HR predicts a better performance; psychological profile is reliably depicted by POMS, but not by Borg fatigue scales. Therefore, assessment of heart rate variability and psychological profile may monitor and partly predict performance in long-duration ultramarathon in extreme cold environment.

Cardio-autonomic functions and sleep indices before and after coronary artery bypass surgery

BACKGROUND:

Earlier studies showed a short-term impairment of cardio-autonomic functions following coronary artery bypass grafting (CABG). There is a lack of consistency in the time of recovery from this impairment. Studies have attributed the post-CABG atrial fibrillation to preexisting obstructive sleep apnea (OSA) without an objective sleep assessment. The aim of this study was to evaluate the effect of CABG on cardio-autonomic and hemodynamic functions and on OSA indices in patients with ischemic heart disease (IHD).

METHODS:

Cardio-autonomic function using heart rate variability indices, hemodynamic parameters, and sleep studies were performed in 26 patients with stable IHD before, on day-6, and day-30 post-CABG surgery.

RESULTS:

The high-frequency powers of normalized R-R intervals significantly (P = 0.002) increased from the preoperative value of 46.09 to 66.52 on day-6 and remained unchanged on day-30 postsurgery. In contrary, the low-frequency powers of normalized R-R interval decreased from 53.91 to 33.48 during the same period (P = 0.002) and remained unchanged on day 30 postsurgery. Baroreceptor sensitivity, obstructive and central apnea indices, desaturation index, and lowest O₂ saturation were not significantly different between preoperative, day-6, and day-30 postsurgery.

CONCLUSION:

Our study revealed that recovery of autonomic functions following CABG occurs as early as 30 days of postsurgery. CABG does not seem to have short-term effects on sleep study indices. However, long-term effects need further evaluation.

Psychophysiological, Body Composition, Biomechanical and Autonomic Modulation Analysis Procedures in an Ultraendurance Mountain Race

The current research aimed to analyze psychophysiological, body composition, biomechanical and autonomic modifications in an ultraendurance mountain race. We analyzed 11 finisher voluntary athletes that participated in a 51.2 km ultraendurance mountain race. We measured before and after the mountain ultraendurance event the following parameters: Rate of perceived exertion, body composition, cortical arousal, blood pressure, body temperature, forced vital capacity, blood oxygen saturation, isometric hand strength and heart rate variability parameters. The results of temperature, rate of perceived exertion, heart rate and the percentage of body water at the end of the race increased significantly. However, the variables of body weight, body fat, muscle, body mass index, abdominal fat, blood oxygen saturation, systolic and diastolic blood pressure, cortical arousal and hands and legs strength significantly decreased after the race. The square root of the average of the sum of the differences squared between normal adjacent R-R intervals, percentage of differences between normal adjacent R-R intervals, high-frequency, sensitivity of the short-term variability, and long-term variability decreased significantly after the race. By contrary low-frequency increased significantly at the end of the race. An ultraendurance mountain event produced a large anticipatory anxiety response, an increase in sympathetic modulation, body fat consumption, percentage of body water, and RPE, not affecting the cortical arousal.

Vincristine-induced neuropathy in pediatric patients with acute lymphoblastic leukemia in Oman: Frequent autonomic and more severe cranial nerve involvement

BACKGROUND

Vincristine (VCR) induced peripheral neuropathy is a common complication in children with acute lymphoblastic leukemia (ALL).

PROCEDURES

A retrospective data analysis over an interval of 10 years (2006-2016) of all children with ALL seen at Sultan Qaboos University Hospital was carried out. Electronic medical records of eligible patients were reviewed. Patients with clinical evidence of neuropathy and abnormal nerve conduction studies (NCSs) were included in the study.

RESULTS

Nineteen (nine females and 10 males) out of 103 pediatric patients developed VCR-related neuropathy, and their age ranged between 2.5 and 14 years. Symptoms started after 2-11 doses of VCR. All 19 patients had documented peripheral neuropathy on NCSs. The autonomic nervous system and cranial nerves affection was relatively common in our patients; two presented with bradycardia, two patients with unexplained tachycardia, and five had abdominal pain and constipation, complicated by typhlitis in two patients. One patient developed unilateral hearing loss. Two patients developed severe life-threatening cranial nerve involvement with bilateral ptosis and recurrent laryngeal nerve involvement presented as vocal cord paralysis, hoarseness of voice, frequent chocking, and aspiration episodes.

CONCLUSIONS

Peripheral neuropathy was the commonest form of VCR-related neuropathy. Autonomic neuropathy was relatively common in our patients. Cranial neuropathy is a serious side effect of VCR that can be severe, involving multiple cranial nerves and needs prompt recognition and management. Concomitant administration of pyridoxine and pyridostigmine does not seem to protect against further neurological damage in some patients.

Acute and chronic changes in baroreflex sensitivity in hypobaric vs. normobaric hypoxia

Normobaric hypoxia (NH) is used as a surrogate for hypobaric hypoxia (HH). Recent studies reported physiological differences between NH and HH. Baroreflex sensitivity (BRS) decreases at altitude or following intense training. However, until now no study compared the acute and chronic changes of BRS in NH vs. HH. First, BRS was assessed in 13 healthy male subjects prior and after 20 h of exposure at 3450 m (study 1), and second in 15 well-trained athletes prior and after 18 days of "live-high train-low" (LHTL) at 2250 m (study 2) in NH vs. HH. BRS decreased (p < 0.05) to the same extent in NH and HH after 20 h of hypoxia and after LHTL. These results confirm that altitude decreases BRS but the decrease is similar between HH and NH. The persistence of this decrease after the cessation of a chronic exposure is new and does not differ between HH and NH. The previously reported physiological differences between NH and HH do not appear strong enough to induce different BRS responses.

Muscle damage, physiological changes, and energy balance in ultra-endurance mountain-event athletes

The biological response to ultra-endurance mountain race events is not yet well understood. The aim of this study was to determine the biochemical and physiological changes after performing an ultra-endurance mountain race in runners. We recruited 11 amateur runners (age: 29.7 ± 10.2 years; height: 179.7 ± 5.4 cm; body mass: 76.7 ± 10.3 kg). Muscle damage, lactate concentration, energy balance, rating of perceived exertion (RPE), heart rate (HR), heart rate variability (HRV), body composition changes, and jump performance were analyzed before, during (only lactate, HR, and HRV), and after the race. Athletes completed 54 km in 6 h, 44 min (±28 min). After the race, myoglobin and creatine kinase concentration increased from 14.9 ± 5.2 to 1419.9 ± 1292.1 μg/L and from 820.0 ± 2087.3 to 2421.1 ± 2336.2 UI/L, respectively (p < 0.01). In addition, lactate dehydrogenase and troponin I significantly increased after the race (p < 0.01). Leukocyte and platelet count increased by 180.6% ± 68.9% and 23.7% ± 11.2%, respectively (p < 0.001). Moreover, after the competition, athletes presented a 3704 kcal negative energy balance; a significant increase in RPE values; a decrease in countermovement and squat jump height; and a decrease in body mass and lower limb girths. During the event, lactate concentration did not change and subjects presented a mean HR of 158.8 ± 17.7 beats/min, a significant decrement in vagal modulation, and a significant increase in sympathetic modulation. Despite the relative “low” intensity achieved, ultra-endurance mountain race is a stressful stimulus that produces a high level of muscle damage in the athletes. These findings may help coaches to design specific training programs that may improve nutritional intake strategies and prevent muscle damage.

Heat stress and dehydration in adapting for performance: Good, bad, both, or neither?

Physiological systems respond acutely to stress to minimize homeostatic disturbance, and typically adapt to chronic stress to enhance tolerance to that or a related stressor. It is legitimate to ask whether dehydration is a valuable stressor in stimulating adaptation per se. While hypoxia has had long-standing interest by athletes and researchers as an ergogenic aid, heat and nutritional stressors have had little interest until the past decade. Heat and dehydration are highly interlinked in their causation and the physiological strain they induce, so their individual roles in adaptation are difficult to delineate. The effectiveness of heat acclimation as an ergogenic aid remains unclear for team sport and endurance athletes despite several recent studies on this topic. Very few studies have examined the potential ergogenic (or ergolytic) adaptations to ecologically-valid dehydration as a stressor in its own right, despite longstanding evidence of relevant fluid-regulatory adaptations from short-term hypohydration. Transient and self-limiting dehydration (e.g., as constrained by thirst), as with most forms of stress, might have a time and a place in physiological or behavioral adaptations independently or by exacerbating other stressors (esp. heat); it cannot be dismissed without the appropriate evidence. The present review did not identify such evidence. Future research should identify how the magnitude and timing of dehydration might augment or interfere with the adaptive processes in behaviorally constrained versus unconstrained humans.

Monitoring Fatigue Status with HRV Measures in Elite Athletes: An Avenue Beyond RMSSD?

Among the tools proposed to assess the athlete's “fatigue,” the analysis of heart rate variability (HRV) provides an indirect evaluation of the settings of autonomic control of heart activity. HRV analysis is performed through assessment of time-domain indices, the square root of the mean of the sum of the squares of differences between adjacent normal R-R intervals (RMSSD) measured during short (5 min) recordings in supine position upon awakening in the morning and particularly the logarithm of RMSSD (LnRMSSD) has been proposed as the most useful resting HRV indicator. However, if RMSSD can help the practitioner to identify a global “fatigue” level, it does not allow discriminating different types of fatigue. Recent results using spectral HRV analysis highlighted firstly that HRV profiles assessed in supine and standing positions are independent and complementary; and secondly that using these postural profiles allows the clustering of distinct sub-categories of “fatigue.” Since, cardiovascular control settings are different in standing and lying posture, using the HRV figures of both postures to cluster fatigue state embeds information on the dynamics of control responses. Such, HRV spectral analysis appears more sensitive and enlightening than time-domain HRV indices. The wealthier information provided by this spectral analysis should improve the monitoring of the adaptive training-recovery process in athletes.

Psychophysiological response and energy balance during a 14-h ultraendurance mountain running event

Many studies have researched the psychophysiological response and energy balance of athletes in numerous ultraendurance probes, but none has investigated an ultraendurance mountain running event. The current study aims to analyze changes in blood lactate concentration, rating of perceived exertion, heart rate, heart rate variability, and energy balance after the performance of an ultraendurance mountain running event. The parameters in the 6 participants who finished the event were analyzed (age, 30.8 ± 3.1 years; height, 176.2 ± 8.6 cm; body mass, 69.2 ± 3.7 kg). The race covered 54 km, with 6441 m of altitude change, 3556 m downhill and 2885 m uphill. The athletes completed together the race in 14 h and 6 min. After the ultraendurance event, the athletes presented a negative energy balance of 4732 kcal, a blood lactate concentration of 2.8 ± 0.3 mmol/L, a heart rate mean/heart rate maximum ratio of 0.64, a heart rate mean of 111.4 ± 5.9 beats/min, a decrease in vagal modulation, and an increase in sympathetic modulation, and recorded 19.5 ± 1.5 points on the 6–20 rating of perceived exertion scale. The event was a stressful stimulus for the athletes despite the low intensity measured by blood lactate concentration and heart rate. The results obtained may be used by coaches as a reference parameter of heart rate, heart rate variability, rating of perceived exertion, and lactate concentration to develop specific training programs. In addition, the energy balance data obtained in this research may improve nutritional intake strategies.

Cardiocirculatory manifestations in Parkinson's disease patients without orthostatic hypotension

The objective of this study was to characterize cardiac sympathetic denervation in Parkinson's disease (PD) patients without neurogenic orthostatic hypotension (NOH), both in terms of hemodynamics and in its relation with vascular denervation. We studied 20 PD patients without NOH. We analyzed the heart rate and blood pressure variability during various physical maneuvers. The following parameters were calculated: expiratory-inspiratory ratio, stroke volume, cardiac output, cardiac index, left ventricular ejection time, left ventricular work index, thoracic fluid content, total peripheral resistance and baroreflex sensitivity (BRS). We also measured direct and spectral derivatives of cardiac (cardiovagal) parasympathetic function. Myocardial I-123 metaiodobenzylguanidine (MIBG) scintigraphy was performed and early and late heart/mediastinum uptake ratios were analyzed. We observed that the late heart/mediastinum uptake ratio was 1.33±0.21. This parameter was correlated with years since diagnosis (correlation coefficient:-0.485; P=0.05), Unified Parkinson's Disease Rating Scale (UPDRS) III score (cc:-0.564; P=0.02) and pressure recovery time in the Valsalva maneuver (cc: 0.61; P<0.001). At rest, it was correlated with BRS (cc:0.75; P=0.003) and low-frequency diastolic blood pressure (LFDBP; cc: 0.58;P=0.017). We found no correlations with any of the cardiography impedance variables. In linear regression models, the variable that best correlated with MIBG results was LFDBP. Our results support that in absence of NOH the degree of denervation of the heart does not produce any effect on its inotropic function. Moreover, BRS and LFDBP can be used as an indirect measure of cardiac sympathetic denervation at rest.

The impact of triathlon training and racing on athletes' general health

Although the sport of triathlon provides an opportunity to research the effect of multi-disciplinary exercise on health across the lifespan, much remains to be done. The literature has failed to consistently or adequately report subject age group, sex, ability level, and/or event-distance specialization. The demands of training and racing are relatively unquantified. Multiple definitions and reporting methods for injury and illness have been implemented. In general, risk factors for maladaptation have not been well-described. The data thus far collected indicate that the sport of triathlon is relatively safe for the well-prepared, well-supplied athlete. Most injuries 'causing cessation or reduction of training or seeking of medical aid' are not serious. However, as the extent to which they recur may be high and is undocumented, injury outcome is unclear. The sudden death rate for competition is 1.5 (0.9-2.5) [mostly swim-related] occurrences for every 100,000 participations. The sudden death rate is unknown for training, although stroke risk may be increased, in the long-term, in genetically susceptible athletes. During heavy training and up to 5 days post-competition, host protection against pathogens may also be compromised. The incidence of illness seems low, but its outcome is unclear. More prospective investigation of the immunological, oxidative stress-related and cardiovascular effects of triathlon training and competition is warranted. Training diaries may prove to be a promising method of monitoring negative adaptation and its potential risk factors. More longitudinal, medical-tent-based studies of the aetiology and treatment demands of race-related injury and illness are needed.

Cardiac parasympathetic reactivation following exercise: implications for training prescription

The objective of exercise training is to initiate desirable physiological adaptations that ultimately enhance physical work capacity. Optimal training prescription requires an individualized approach, with an appropriate balance of training stimulus and recovery and optimal periodization. Recovery from exercise involves integrated physiological responses. The cardiovascular system plays a fundamental role in facilitating many of these responses, including thermoregulation and delivery/removal of nutrients and waste products. As a marker of cardiovascular recovery, cardiac parasympathetic reactivation following a training session is highly individualized. It appears to parallel the acute/intermediate recovery of the thermoregulatory and vascular systems, as described by the supercompensation theory. The physiological mechanisms underlying cardiac parasympathetic reactivation are not completely understood. However, changes in cardiac autonomic activity may provide a proxy measure of the changes in autonomic input into organs and (by default) the blood flow requirements to restore homeostasis. Metaboreflex stimulation (e.g. muscle and blood acidosis) is likely a key determinant of parasympathetic reactivation in the short term (0-90 min post-exercise), whereas baroreflex stimulation (e.g. exercise-induced changes in plasma volume) probably mediates parasympathetic reactivation in the intermediate term (1-48 h post-exercise). Cardiac parasympathetic reactivation does not appear to coincide with the recovery of all physiological systems (e.g. energy stores or the neuromuscular system). However, this may reflect the limited data currently available on parasympathetic reactivation following strength/resistance-based exercise of variable intensity. In this review, we quantitatively analyse post-exercise cardiac parasympathetic reactivation in athletes and healthy individuals following aerobic exercise, with respect to exercise intensity and duration, and fitness/training status. Our results demonstrate that the time required for complete cardiac autonomic recovery after a single aerobic-based training session is up to 24 h following low-intensity exercise, 24-48 h following threshold-intensity exercise and at least 48 h following high-intensity exercise. Based on limited data, exercise duration is unlikely to be the greatest determinant of cardiac parasympathetic reactivation. Cardiac autonomic recovery occurs more rapidly in individuals with greater aerobic fitness. Our data lend support to the concept that in conjunction with daily training logs, data on cardiac parasympathetic activity are useful for individualizing training programmes. In the final sections of this review, we provide recommendations for structuring training microcycles with reference to cardiac parasympathetic recovery kinetics. Ultimately, coaches should structure training programmes tailored to the unique recovery kinetics of each individual.

Deactivation of carotid body chemoreceptors by hyperoxia decreases blood pressure in hypertensive patients

Previous studies have shown that hyperoxia-induced deactivation of carotid body chemoreceptors reduces sympathetic activity in hypertensive patients but it does not affect blood pressure. The maintenance of blood pressure can be explained by the direct, vasoconstrictive effect of hyperoxia, which offsets diminished sympathetic activity. This study compares the effect of acute hyperoxia on hemodynamic parameters between hypertensive and normotensive subjects. Twelve males with hypertension (age 39.4±2.4 years; body mass index 27.4±1.1 kg m(-2)) and 11 normotensive males (age 39.9±2.7 years; body mass index 25.4±0.7 kg m(-2)) received, via non-rebreathing mask ventilation, ambient air, followed by 100% oxygen for 20 min. The stroke volume, heart rate, cardiac output, blood pressure, total peripheral resistance, respiratory rate, baroreceptor control of heart rate and oxygen saturation were recorded continuously. Several 30 s periods were analyzed before, during and after inducing hyperoxia. At baseline, the hypertensive subject's blood pressure was higher and their baroreflex control of heart rate was lower when compared with the normotensive control group. After the first 30 s of hyperoxia, systolic, diastolic and mean blood pressures, as well as the total peripheral resistance, decreased significantly in hypertensives but not in normotensives. After 20 min of 100% oxygen ventilation, systolic and mean blood pressures and total peripheral resistance was increased in hypertensive patients, and the cardiac output and stroke volume had decreased in both groups. The results of this study confirm that deactivation of carotid body chemoreceptors can acutely decrease blood pressure in humans.

Fatigue shifts and scatters heart rate variability in elite endurance athletes

Purpose

This longitudinal study aimed at comparing heart rate variability (HRV) in elite athletes identified either in ‘fatigue’ or in ‘no-fatigue’ state in ‘real life’ conditions.

Methods

57 elite Nordic-skiers were surveyed over 4 years. R-R intervals were recorded supine (SU) and standing (ST). A fatigue state was quoted with a validated questionnaire. A multilevel linear regression model was used to analyze relationships between heart rate (HR) and HRV descriptors [total spectral power (TP), power in low (LF) and high frequency (HF) ranges expressed in ms² and normalized units (nu)] and the status without and with fatigue. The variables not distributed normally were transformed by taking their common logarithm (log₁₀).

Results

172 trials were identified as in a ‘fatigue’ and 891 as in ‘no-fatigue’ state. All supine HR and HRV parameters (Beta±SE) were significantly different (P<0.0001) between ‘fatigue’ and ‘no-fatigue’: HR_SU (+6.27±0.61 bpm), logTP_SU (−0.36±0.04), logLF_SU (−0.27±0.04), logHF_SU (−0.46±0.05), logLF/HF_SU (+0.19±0.03), HF_SU(nu) (−9.55±1.33). Differences were also significant (P<0.0001) in standing: HR_ST (+8.83±0.89), logTP_ST (−0.28±0.03), logLF_ST (−0.29±0.03), logHF_ST (−0.32±0.04). Also, intra-individual variance of HRV parameters was larger (P<0.05) in the ‘fatigue’ state (logTP_SU: 0.26 vs. 0.07, logLF_SU: 0.28 vs. 0.11, logHF_SU: 0.32 vs. 0.08, logTP_ST: 0.13 vs. 0.07, logLF_ST: 0.16 vs. 0.07, logHF_ST: 0.25 vs. 0.14).

Conclusion

HRV was significantly lower in 'fatigue' vs. 'no-fatigue' but accompanied with larger intra-individual variance of HRV parameters in 'fatigue'. The broader intra-individual variance of HRV parameters might encompass different changes from no-fatigue state, possibly reflecting different fatigue-induced alterations of HRV pattern.

Heritability of Hemodynamic Reactivity to Laboratory Stressors in a Homogenous Arab Population: ‘Oman Family Study’

Background:Exaggerated cardiovascular reactivity to stressful stimuli may be a risk factor for the development of hypertension. The genetic influence on blood pressure (BP) reactivity to stress and its control mechanisms has been receiving considerable support. This study aims at examining the heritability of BP and its intermediate hemodynamic phenotypes to acute stress in a homogeneous Arab population.Methods:Parameters were computed from continuous BP, electrocardiography and impedance cardiography measurements, during rest, word conflict (WCT) and cold pressor (CPT) tests. Heritability estimates (h2) were obtained using the variance components-based approach implemented in the SOLAR software package.Results:Reactivity scores for WCT and CPT increased significantly (P< .05) for systolic (SBP), diastolic (DBP), heart rate (HR), cardiac output (CO), and total peripheral resistance (TPR). They decreased significantly (P< .05) for stroke volume (SV), left ventricular ejection time (LVET), end diastolic (EDI) and cardiac contractility (IC) indices. Univariate analysis detected heritability estimates that ranged from 0.19–0.35 for rest, 0.002–0.40 for WCT and 0.08–0.35 for CPT.Conclusion:In this unique cohort, resting as well as challenged cardiovascular phenotypes are significantly influenced by additive genetic effects. Heritability estimates for resting phenotypes are in a relatively narrow range, while h2for their reactivity is somewhat broader with lower estimates. Further analyses of this study may offer important opportunities for gene finding in hypertension.What is Known About the Topic:(1) cardiovascular reactivity to stress predicts cardiovascular disease; (2) genetic susceptibility plays an important role in stress reactivity. Family studies using the cold pressure test reported significant heritability for blood pressure.What this Study Adds:(1) this cohort is from five highly consanguineous isolated Arab pedigrees with genetically verified genealogical records and environmental homogeneity; (2) This is the first study to estimate heritability of detailed intermediate hemodynamic phenotypes that make up normal blood pressure.

Genome-Wide Linkage Analysis of Hemodynamic Parameters Under Mental and Physical Stress in Extended Omani Arab Pedigrees: The Oman Family Study

Background:We performed a genome-wide scan in a homogeneous Arab population to identify genomic regions linked to blood pressure (BP) and its intermediate phenotypes during mental and physical stress tests.Methods:The Oman Family Study subjects (N= 1277) were recruited from five extended families of ~10 generations. Hemodynamic phenotypes were computed from beat-to-beat BP, electrocardiography and impedance cardiography. Multi-point linkage was performed for resting, mental (word conflict test, WCT) and cold pressor (CPT) stress and their reactivity scores (s), using variance components decomposition-based methods implemented in SOLAR.Results:Genome-wide scans for BP phenotypes identified quantitative trait loci (QTLs) with significant evidence of linkage on chromosomes 1 and 12 for WCT-linked cardiac output (LOD = 3.1) and systolic BP (LOD = 3.5). Evidence for suggestive linkage for WCT was found on chromosomes 3, 17 and 1 for heart rate (LOD = 2.3), DBP (LOD = 2.4) and left ventricular ejection time (LVET), respectively. For △WCT, suggestive QTLs were detected for CO on chr11 (LOD = 2.5), LVET on chr3 (LOD = 2.0) and EDI on chr9 (LOD = 2.1). For CPT, suggestive QTLs for HR and LVET shared the same region on chr22 (LOD 2.3 and 2.8, respectively) and on chr9 (LOD = 2.3) for SBP, chr7 (LOD = 2.4) for SV and chr19 (LOD = 2.6) for CO. For △CPT, CO and TPR top signals were detected on chr15 and 10 (LOD; 2.40, 2.08) respectively. Conclusion: Mental stress revealed the largest number of significant and suggestive loci for normal BP reported to date. The study of BP and its intermediate phenotypes under mental and physical stress may help reveal the genes involved in the pathogenesis of essential hypertension.

Effect of maturation on hemodynamic and autonomic control recovery following maximal running exercise in highly trained young soccer players

The purpose of this study was to examine the effect of maturation on post-exercise hemodynamic and autonomic responses. Fifty-five highly trained young male soccer players (12-18 years) classified as pre-, circum-, or post-peak height velocity (PHV) performed a graded running test to exhaustion on a treadmill. Before (Pre) and after (5th-10th min, Post) exercise, heart rate (HR), stroke volume (SV), cardiac output (CO), arterial pressure (AP), and total peripheral resistance (TPR) were monitored. Parasympathetic (high frequency [HF(RR)] of HR variability (HRV) and baroreflex sensitivity [Ln BRS]) and sympathetic activity (low frequency [LF(SAP)] of systolic AP variability) were estimated. Post-exercise blood lactate [La](b), the HR recovery (HRR) time constant, and parasympathetic reactivation (time-varying HRV analysis) were assessed. In all three groups, exercise resulted in increased HR, CO, AP, and LF(SAP) (P < 0.001), decreased SV, HF(RR), and Ln BRS (all P < 0.001), and no change in TPR (P = 0.98). There was no "maturation × time" interaction for any of the hemodynamic or autonomic variables (all P > 0.22). After exercise, pre-PHV players displayed lower SV, CO, and [La](b), faster HRR and greater parasympathetic reactivation compared with circum- and post-PHV players. Multiple regression analysis showed that lean muscle mass, [La](b), and Pre parasympathetic activity were the strongest predictors of HRR (r(2) = 0.62, P < 0.001). While pre-PHV players displayed a faster HRR and greater post-exercise parasympathetic reactivation, maturation had little influence on the hemodynamic and autonomic responses following maximal running exercise. HRR relates to lean muscle mass, blood acidosis, and intrinsic parasympathetic function, with less evident impact of post-exercise autonomic function.

Influence of age on syncope following prolonged exercise: differential responses but similar orthostatic intolerance

Orthostatic tolerance is reduced with increasing age and following prolonged exercise. The aim of this study was to determine the effect of age on cardiovascular and cerebrovascular responses to orthostatic stress following prolonged exercise. Measurements were obtained before, and within 45 min after, 4 h of continuous running at 70-80% of maximal heart rate in nine young (Y; 27 +/- 4 years; V(O(2)max)) 59 +/- 10 ml kg(1) min(1)) and twelve older (O; 65 +/- 5 years; V(O(2)max)) 46 +/- 8 ml kg(1) min(1)) athletes. Middle cerebral artery blood flow velocity (MCAv; transcranial Doppler ultrasound), blood pressure (BP; Finometer) and stroke volume (SV) were measured continuously whilst supine and during 60 deg head-up tilt for 15 min or to pre-syncope. Orthostatic tolerance was reduced post-exercise (tilt completed (min:s, mean +/- s.d.): Pre, 14:39 +/- 0:55; Post, 5:59 +/- 4:53; P < 0.05), but did not differ with age (P > 0.05). Despite a 25% higher supine MCAv in the young, MCAv at syncope was the same in both groups (Y: 34 +/- 10 cm s(1); O: 32 +/- 13; P > 0.05). Although the hypotensive response to syncope did not differ with age, the components of BP did; SV was lowered more in the young (Y: -57 +/- 16%; O: -34 +/- 13%; P < 0.05); and total peripheral resistance was lowered in the older athletes but was unchanged in the young (Y: +8 +/- 10%; O: -21 +/- 12%; (at 10 s pre-syncope) P < 0.05). Despite a lower MCAv in the older athletes, time to syncope was similar between groups; however, the integrative mechanisms responsible for syncope did differ with age. The similar MCAv at pre-syncope indicates there is an age-independent critical cerebral blood flow threshold at which syncope occurs.

Heart rate and stroke volume response patterns to augmented orthostatic stress

AIMS

Combined head up tilt (HUT) and lower body negative pressure (LBNP) can be used to exploit the full spectrum of cardiovascular control mechanisms and to reveal characteristics of individual blood pressure control. We studied whether the response to combined HUT and LBNP was reproducible within subjects and whether characteristic response patterns could be distinguished between different subjects.

MATERIALS AND METHODS

Ten healthy young males were subjected to combined HUT and graded LBNP to achieve a presyncopal end point in four tests, each separated by more than 2 weeks. Heart rate, blood pressure and thoracic impedance were monitored, cardiac output and peripheral vascular resistance were computed.

RESULTS

From supine control to presyncope, heart rate, mean arterial blood pressure, pulse pressure and stroke index changed as expected. The time courses of heart rate and stroke volume as well as orthostatic tolerance times (15 +/- 6 to 18 +/- 7 minutes, n.s) appeared reproducible between trials within subjects but different between different subjects.

CONCLUSION

LBNP-tilt approach was repeatable in time and pattern. Furthermore, differences observed between subjects indicated preferred activation of selected pathways of blood pressure control in different individuals while at the same time, reproducibility measured within the same subject showed that preferential mechanisms were highly conserved within the same individual. These characteristics are a prerequisite to use the combined graded orthostatic paradigm for hemodynamic testing and identification.

Mechanisms of orthostatic intolerance following very prolonged exercise

Nine men completed a 24-h exercise trial, with physiological testing sessions before (T1, ∼0630), during (T2, ∼1640; T3, ∼0045; T4, ∼0630), and 48-h afterwards (T5, ∼0650). Participants cycled and ran/trekked continuously between test sessions. A 24-h sedentary control trial was undertaken in crossover order. Within testing sessions, participants lay supine and then stood for 6 min, while heart rate variability (spectral analysis of ECG), middle cerebral artery perfusion velocity (MCAv), mean arterial pressure (MAP; Finometer), and end-tidal Pco2 (PetCO2) were measured, and venous blood was sampled for cardiac troponin I. During the exercise trial: 1) two, six, and four participants were orthostatically intolerant at T2, T3, and T4, respectively; 2) changes in heart rate variability were only observed at T2; 3) supine MAP (baseline = 81 ± 6 mmHg) was lower ( P < 0.05) by 14% at T3 and 8% at T4, whereas standing MAP (75 ± 7 mmHg) was lower by 16% at T2, 37% at T3, and 15% at T4; 4) PetCO2 was reduced ( P < 0.05) at all times while supine (−3–4 Torr) and standing (−4–5 Torr) during exercise trial; 5) standing MCAv was reduced ( P < 0.05) by 23% at T3 and 30% at T4 during the exercise trial; 6) changes in MCAv with standing always correlated ( P < 0.01) with changes in PetCO2 ( r = 0.78–0.93), but only with changes in MAP at T1, T2, and T3 ( P < 0.05; r = 0.62–0.84); and 7) only two individuals showed minor elevations in cardiac troponin I. Recovery was complete within 48 h. During prolonged exercise, postural-induced hypotension and hypocapnia exacerbate cerebral hypoperfusion and facilitate syncope.