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Al-Othman S, Boyett MR, Morris GM, Malhotra A, Mesirca P, Mangoni ME, D'Souza A. Symptomatic bradyarrhythmias in the athlete-Underlying mechanisms and treatments. Heart Rhythm 2024; 21:1415-1427. [PMID: 38428449 DOI: 10.1016/j.hrthm.2024.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 03/03/2024]
Abstract
Bradyarrhythmias including sinus bradycardia and atrioventricular (AV) block are frequently encountered in endurance athletes especially at night. While these are well tolerated by the young athlete, there is evidence that generally from the fifth decade of life onward, such arrhythmias can degenerate into pathological symptomatic bradycardia requiring pacemaker therapy. For many years, athletic bradycardia and AV block have been attributed to high vagal tone, but work from our group has questioned this widely held assumption and demonstrated a role for intrinsic electrophysiological remodeling of the sinus node and the AV node. In this article, we argue that bradyarrhythmias in the veteran athlete arise from the cumulative effects of exercise training, the circadian rhythm and aging on the electrical activity of the nodes. We consider contemporary strategies for the treatment of symptomatic bradyarrhythmias in athletes and highlight potential therapies resulting from our evolving mechanistic understanding of this phenomenon.
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Affiliation(s)
- Sami Al-Othman
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Mark R Boyett
- Faculty of Life Sciences, University of Bradford, Bradford, United Kingdom.
| | - Gwilym M Morris
- Cardiology Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Aneil Malhotra
- Institute of Sport, Manchester Metropolitan University and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Pietro Mesirca
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France; Laboratory of Excellence "Ion Channel Science and Therapeutics" (ICST), Montpellier, France
| | - Matteo E Mangoni
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France; Laboratory of Excellence "Ion Channel Science and Therapeutics" (ICST), Montpellier, France
| | - Alicia D'Souza
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Marôco JL, Arrais I, Silvestre T, Pinto M, Laranjo S, Magalhães J, Santa-Clara H, Fernhall B, Melo X. Post-acute exercise cardiovagal modulation in older male adults with and without type 2 diabetes. Eur J Appl Physiol 2024; 124:1475-1486. [PMID: 38117338 PMCID: PMC11055715 DOI: 10.1007/s00421-023-05357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 10/28/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE We examined heart rate variability (HRV) and baroreflex sensitivity (BRS) disease- and age-related response at 10-and 60-min after an acute high-intensity interval (HIIE) and moderate continuous exercise (MICE) in older adults with and without type 2 diabetes mellitus (T2DM) and healthy young adults. METHODS Twelve older male adults with (57-84 years) and without T2DM (57-76 years) and 12 healthy young male adults (20-40 years) completed an isocaloric acute bout of HIIE, MICE, and a non-exercise condition in a randomized order. Time and Wavelets-derived frequency domain indices of HRV and BRS were obtained in a supine position and offline over 2-min time-bins using Matlab. RESULTS HIIE but not MICE reduced natural logarithm root mean square of successive differences (Ln-RMSSD) (d = - 0.85; 95% CI - 1.15 to - 0.55 ms, p < 0.001), Ln-high-frequency power (d = - 1.60; 95% CI - 2.24 to - 0.97 ms2; p < 0.001), and BRS (d = - 6.32; 95% CI - 9.35 to - 3.29 ms/mmHg, p < 0.001) in adults without T2DM (averaged over young and older adults without T2DM), returning to baseline 60 min into recovery. These indices remained unchanged in older adults with T2DM after HIIE and MICE. Older adults with T2DM had lower resting Ln-RMSSD and BRS than aged-matched controls (Ln-RMSSD, d = - 0.71, 95% CI - 1.16 to - 0.262 ms, p = 0.001; BRS d = - 3.83 ms/mmHg), 95% CI - 6.90 to - 0.76, p = 0.01). CONCLUSIONS Cardiovagal modulation following acute aerobic exercise is intensity-dependent only in adults without T2DM, and appears age-independent. These findings provide evidence of cardiac autonomic impairments in older adults with T2DM at rest and following aerobic exercise.
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Affiliation(s)
- João Luís Marôco
- Integrative Human Physiology Laboratory, Manning College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, MA, USA
- Ginásio Clube Português, Research & Development Department, GCP Lab, Lisbon, Portugal
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana-Universidade de Lisboa, Oeiras, Portugal
| | - Inês Arrais
- Ginásio Clube Português, Research & Development Department, GCP Lab, Lisbon, Portugal
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana-Universidade de Lisboa, Oeiras, Portugal
| | - Tiago Silvestre
- Ginásio Clube Português, Research & Development Department, GCP Lab, Lisbon, Portugal
- Faculdade de Ciências da Saúde e do Desporto, Universidade Europeia, Lisbon, Portugal
| | - Marco Pinto
- Ginásio Clube Português, Research & Development Department, GCP Lab, Lisbon, Portugal
| | - Sérgio Laranjo
- Department of Physiology, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center. NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - João Magalhães
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana-Universidade de Lisboa, Oeiras, Portugal
| | - Helena Santa-Clara
- Ginásio Clube Português, Research & Development Department, GCP Lab, Lisbon, Portugal
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana-Universidade de Lisboa, Oeiras, Portugal
| | - Bo Fernhall
- Integrative Human Physiology Laboratory, Manning College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Xavier Melo
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana-Universidade de Lisboa, Oeiras, Portugal.
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz School of Health and Science, Caparica, 2829-511, Almada, Portugal.
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Bondarev S, Achkasov E, Zorzi A, Safaryan A, Graziano F, Sizov A. Intrinsic Sinus Node/Atrioventricular Node Dysfunction Requiring Pacemaker Implantation: Role of Former Professional Sport Activity. J Clin Med 2023; 13:203. [PMID: 38202210 PMCID: PMC10779911 DOI: 10.3390/jcm13010203] [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: 11/14/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Sinus bradycardia and first degree or second degree Mobitz type I atrioventricular (AV) block in an athlete are considered adaptive and reversible phenomena; however, some evidence suggests that they may persist after detraining and become pathological. The aim of the study was to investigate the characteristics of a group of former professional athletes who required pacemaker (PM) implantation for intrinsic (idiopathic) sinus node (SN) dysfunction or AV block in comparison to control groups of sedentary individuals. METHODS We included all patients who underwent PM implantation during 2022. Three groups were compared: group 1 including 18 former professional athletes who received a PM for SN dysfunction/AV block in the absence of heart disease; group 2 including the first 20 sedentary individuals without heart disease who underwent PM implantation; and group 3 including all other 323 patients who received PM, the majority with underlying heart diseases. RESULTS Compared to the non-athlete control group 2, the mean age at diagnosis and at the time of PM implantation of former professional athletes did not show statistically significant differences. However, subgroup analysis revealed significant differences depending on the type of sports discipline: the age at diagnosis and at PM implantation was significantly lower in former endurance athletes than former strength/mixed athletes, control non-athletes, and all other patients. Moreover, former endurance professional athletes exhibited a higher prevalence of second or third degree AV block (78%) as the reason for PM implantation compared to power/mixed athletes (44%). The other clinical characteristics, including echocardiographic parameters, did not differ between former athletes and non-athletes. CONCLUSIONS Former professional endurance athletes with idiopathic SN dysfunction/AV block manifested the disease earlier in the life course compared to former power/mixed athletes and non-athletes. This suggests that bradycardia/AV block caused by intense and prolonged endurance sports may not always be benign and adaptive phenomena.
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Affiliation(s)
- Sergei Bondarev
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (S.B.)
| | - Evgeny Achkasov
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (S.B.)
| | - Alexandr Safaryan
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (S.B.)
| | - Alexey Sizov
- Cardiology Department, St. Alexius Hospital, 119071 Moscow, Russia
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Graziano F, Juhasz V, Brunetti G, Cipriani A, Szabo L, Merkely B, Corrado D, D’Ascenzi F, Vago H, Zorzi A. May Strenuous Endurance Sports Activity Damage the Cardiovascular System of Healthy Athletes? A Narrative Review. J Cardiovasc Dev Dis 2022; 9:jcdd9100347. [PMID: 36286299 PMCID: PMC9604467 DOI: 10.3390/jcdd9100347] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 11/18/2022] Open
Abstract
The positive effects of physical activity are countless, not only on the cardiovascular system but on health in general. However, some studies suggest a U-shape relationship between exercise volume and effects on the cardiovascular system. On the basis of this perspective, moderate-dose exercise would be beneficial compared to a sedentary lifestyle, while very high-dose physical activity would paradoxically be detrimental. We reviewed the available evidence on the potential adverse effects of very intense, prolonged exercise on the cardiovascular system, both acute and chronic, in healthy athletes without pre-existing cardiovascular conditions. We found that endurance sports activities may cause reversible electrocardiographic changes, ventricular dysfunction, and troponin elevation with complete recovery within a few days. The theory that repeated bouts of acute stress on the heart may lead to chronic myocardial damage remains to be demonstrated. However, male veteran athletes with a long sports career show an increased prevalence of cardiovascular abnormalities such as electrical conduction delay, atrial fibrillation, myocardial fibrosis, and coronary calcifications compared to non-athletes. It must be underlined that the cause-effect relationship between such abnormalities and the exercise and, most importantly, the prognostic relevance of such findings remains to be established.
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Affiliation(s)
- Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Vencel Juhasz
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
| | - Giulia Brunetti
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Liliana Szabo
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Gaal Jozsef Str. 9-11, 1122 Budapest, Hungary
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Hajnalka Vago
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Gaal Jozsef Str. 9-11, 1122 Budapest, Hungary
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
- Correspondence: ; Tel.: +39-049-8212322
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Topal L, Polyák A, Tóth N, Ágoston G, Bencsik P, Kohajda Z, Prorok J, Déri S, Nagy N, Jost N, Virág L, Farkas AS, Varró A, Baczkó I. Endurance training-induced cardiac remodeling in a guinea pig athlete's heart model. Can J Physiol Pharmacol 2022; 100:993-1004. [PMID: 35834825 DOI: 10.1139/cjpp-2022-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Besides the health benefits of regular exercise, high-level training-above an optimal level-may have adverse effects. In this study, we investigated the effects of long-term vigorous training and its potentially detrimental structural-functional changes in a small animal athlete's heart model. Thirty-eight 4-month-old male guinea pigs were randomized into sedentary and exercised groups. The latter underwent a 15-week-long endurance-training program. To investigate the effects of the intense long-term exercise, in vivo (echocardiography, electrocardiography), ex vivo, and in vitro (histopathology, patch-clamp) measurements were performed. Following the training protocol, the exercised animals exhibited structural left ventricular enlargement and a significantly higher degree of myocardial fibrosis. Furthermore, resting bradycardia accompanied by elevated heart rate variability occurred, representing increased parasympathetic activity in the exercised hearts. The observed prolonged QTc intervals and increased repolarization variability parameters may raise the risk of electrical instability in exercised animals. Complex arrhythmias did not occur in either group, and there were no differences between the groups in ex vivo or cellular electrophysiological experiments. Accordingly, the high parasympathetic activity may promote impaired repolarization in conscious exercised animals. The detected structural-functional changes share similarities with the human athlete's heart; therefore, this model might be useful for investigations on cardiac remodeling.
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Affiliation(s)
- L Topal
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
| | - A Polyák
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- Department of Pediatrics and Pediatric Health Center, University of Szeged, Szeged, 6725, Hungary
| | - N Tóth
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
| | - G Ágoston
- Institute of Family Medicine, University of Szeged, Szeged, 6720, Hungary
| | - P Bencsik
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
| | - Zs Kohajda
- ELKH-SZTE Research Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - J Prorok
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- ELKH-SZTE Research Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - Sz Déri
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
| | - N Nagy
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- ELKH-SZTE Research Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - N Jost
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- ELKH-SZTE Research Group of Cardiovascular Pharmacology, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, 6720, Hungary
| | - L Virág
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, 6720, Hungary
| | - A S Farkas
- Department of Internal Medicine, Cardiology, University of Szeged, Szeged, 6725, Hungary
| | - A Varró
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- ELKH-SZTE Research Group of Cardiovascular Pharmacology, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, 6720, Hungary
| | - I Baczkó
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, 6720, Hungary
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Gajda R, Knechtle B, Gębska-Kuczerowska A, Gajda J, Stec S, Krych M, Kwaśniewska M, Drygas W. Amateur Athlete with Sinus Arrest and Severe Bradycardia Diagnosed through a Heart Rate Monitor: A Six-Year Observation-The Necessity of Shared Decision-Making in Heart Rhythm Therapy Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610367. [PMID: 36012002 PMCID: PMC9408438 DOI: 10.3390/ijerph191610367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 05/14/2023]
Abstract
Heart rate monitors (HRMs) are used by millions of athletes worldwide to monitor exercise intensity and heart rate (HR) during training. This case report presents a 34-year-old male amateur soccer player with severe bradycardia who accidentally identified numerous pauses of over 4 s (maximum length: 7.3 s) during sleep on his own HRM with a heart rate variability (HRV) function. Simultaneous HRM and Holter ECG recordings were performed in an outpatient clinic, finding consistent 6.3 s sinus arrests (SA) with bradycardia of 33 beats/min. During the patient's hospitalization for a transient ischemic attack, the longest pauses on the Holter ECG were recorded, and he was suggested to undergo pacemaker implantation. He then reduced the volume/intensity of exercise for 4 years. Afterward, he spent 2 years without any regular training due to depression. After these 6 years, another Holter ECG test was performed in our center, not confirming the aforementioned disturbances and showing a tendency to tachycardia. The significant SA was resolved after a period of detraining. The case indicates that considering invasive therapy was unreasonable, and patient-centered care and shared decision-making play a key role in cardiac pacing therapy. In addition, some sports HRM with an HRV function can help diagnose bradyarrhythmia, both in professional and amateur athletes.
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Affiliation(s)
- Robert Gajda
- Center for Sports Cardiology, Gajda-Med Medical Center, ul. Piotra Skargi 23/29, 06-100 Pułtusk, Poland
- Department of Kinesiology and Health Prevention, Jan Dlugosz University, 42-200 Czestochowa, Poland
- Correspondence: ; Tel.: +48-604286030
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, 9000 St. Gallen, Switzerland
| | - Anita Gębska-Kuczerowska
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Kazimierza Wóycickiego 1/3, 01-938 Warsaw, Poland
| | - Jacek Gajda
- Center for Sports Cardiology, Gajda-Med Medical Center, ul. Piotra Skargi 23/29, 06-100 Pułtusk, Poland
| | - Sebastian Stec
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for Cardiovascular Intervention, 38-500 Sanok, Poland
| | - Michalina Krych
- Department of Congenital Heart Diseases, The Cardinal Stefan Wyszyński National Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw, Poland
| | - Magdalena Kwaśniewska
- Department of Preventive Medicine, Faculty of Health, Medical University of Lodz, ul. Lucjana Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Wojciech Drygas
- Department of Congenital Heart Diseases, The Cardinal Stefan Wyszyński National Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw, Poland
- Department of Preventive Medicine, Faculty of Health, Medical University of Lodz, ul. Lucjana Żeligowskiego 7/9, 90-752 Łódź, Poland
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Overnight sleeping heart rate variability of Army recruits during a 12-week basic military training course. Eur J Appl Physiol 2022; 122:2135-2144. [PMID: 35833968 PMCID: PMC9381457 DOI: 10.1007/s00421-022-04987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
Purpose This study aimed to quantify sleeping heart rate (HR) and HR variability (HRV) alongside circulating tumor necrosis factor alpha (TNFα) concentrations during 12-week Basic Military Training (BMT). We hypothesised that, despite a high allostatic load, BMT would increase cardiorespiratory fitness and HRV, while lowering both sleeping HR and TNFα in young healthy recruits. Methods Sixty-three recruits (18–43 years) undertook ≥ 2 overnight cardiac frequency recordings in weeks 1, 8 and 12 of BMT with 4 h of beat-to-beat HR collected between 00:00 and 06:00 h on each night. Beat-to-beat data were used to derive HR and HRV metrics which were analysed as weekly averages (totalling 8 h). A fasted morning blood sample was collected in the equivalent weeks for the measurement of circulating TNFα concentrations and predicted VO2max was assessed in weeks 2 and 8. Results Predicted VO2max was significantly increased at week 8 (+ 3.3 ± 2.6 mL kg−1 min−1; p < 0.001). Sleeping HR (wk1, 63 ± 7 b min−1) was progressively reduced throughout BMT (wk8, 58 ± 6; wk12, 55 ± 6 b min−1; p < 0.01). Sleeping HRV reflected by the root mean square of successive differences (RMSSD; wk1, 86 ± 50 ms) was progressively increased (wk8, 98 ± 50; wk12, 106 ± 52 ms; p < 0.01). Fasted circulating TNFα (wk1, 9.1 ± 2.8 pg/mL) remained unchanged at wk8 (8.9 ± 2.5 pg/mL; p = 0.79) but were significantly reduced at wk12 (8.0 ± 2.4 pg/mL; p < 0.01). Conclusion Increased predicted VO2max, HRV and reduced HR during overnight sleep are reflective of typical cardiorespiratory endurance training responses. These results indicate that recruits are achieving cardiovascular health benefits despite the high allostatic load associated with the 12-week BMT.
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Abreu RMD, Porta A, Rehder-Santos P, Cairo B, Sakaguchi CA, da Silva CD, Signini ÉDF, Milan-Mattos JC, Catai AM. Cardiorespiratory coupling strength in athletes and non-athletes. Respir Physiol Neurobiol 2022; 305:103943. [PMID: 35835289 DOI: 10.1016/j.resp.2022.103943] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/21/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite the relevant presence of nonlinear components on heart period (HP) likely due to cardiorespiratory coupling (CRC), the HP is frequently analyzed in absence of concomitant recordings of respiratory movements (RESP). This study aims to assess the cardiovascular dynamics and CRC during postural challenge in athletes and non-athletes via joint symbolic analysis (JSA). METHODS A cross-sectional study was conducted in 50 men, aged between 20 and 40 yrs, divided into athletes (n = 25) and non-athletes (n = 25) groups. The electrocardiogram, blood pressure and RESP signals were recorded during 15 min in both supine position (REST) and after active postural maneuver (STAND). From the beat-to-beat series of HP, systolic arterial pressure (SAP) and RESP, we computed the time and frequency domain indexes and baroreflex sensitivity. The JSA was based on the definition of symbolic HP and RESP patterns and on the evaluation of the rate of their simultaneous occurrence in both HP and RESP series. RESULTS The JSA analysis was able to identify higher CRC strength at REST in athletes. Moreover, the response of CRC to STAND depended on the time scales of the analysis and was much more evident in athletes than in non-athletes, thus indicating a more reactive autonomic control in athletes. CONCLUSION Assessing CRC in athletes via JSA provides additional information compared to standard linear time and frequency domain tools likely due to the more relevant presence of nonlinearities in HP-RESP variability relationship.
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Affiliation(s)
- Raphael Martins de Abreu
- LUNEX University, International University of Health, Exercise & Sports S.A. 50, Department of Physiotherapy, Differdange, Luxembourg; LUNEX ASBL Luxembourg Health & Sport Sciences Research Institute, Differdange, Luxembourg; Federal University of São Carlos, Department of Physical Therapy, São Carlos, São Paulo, Brazil.
| | - Alberto Porta
- University of Milan, Department of Biomedical Sciences for Health, Milan, Italy; IRCCS Policlinico San Donato, Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, San Donato Milanese, Milan, Italy
| | - Patricia Rehder-Santos
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, São Paulo, Brazil
| | - Beatrice Cairo
- University of Milan, Department of Biomedical Sciences for Health, Milan, Italy
| | - Camila Akemi Sakaguchi
- Appalachian State University, Department of Health, Leisure, and Exercise Science, NC, USA
| | | | - Étore De Favari Signini
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, São Paulo, Brazil
| | | | - Aparecida Maria Catai
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, São Paulo, Brazil
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9
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Frequency-Dependent Properties of the Hyperpolarization-Activated Cation Current, I f, in Adult Mouse Heart Primary Pacemaker Myocytes. Int J Mol Sci 2022; 23:ijms23084299. [PMID: 35457119 PMCID: PMC9024942 DOI: 10.3390/ijms23084299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023] Open
Abstract
A number of distinct electrophysiological mechanisms that modulate the myogenic spontaneous pacemaker activity in the sinoatrial node (SAN) of the mammalian heart have been investigated extensively. There is agreement that several (3 or 4) different transmembrane ionic current changes (referred to as the voltage clock) are involved; and that the resulting net current interacts with direct and indirect effects of changes in intracellular Ca2+ (the calcium clock). However, significant uncertainties, and important knowledge gaps, remain concerning the functional roles in SAN spontaneous pacing of many of the individual ion channel- or exchanger-mediated transmembrane current changes. We report results from patch clamp studies and mathematical modeling of the hyperpolarization-activated current, If, in the generation/modulation of the diastolic depolarization, or pacemaker potential, produced by individual myocytes that were enzymatically isolated from the adult mouse sinoatrial node (SAN). Amphotericin-mediated patch microelectrode recordings at 35 °C were made under control conditions and in the presence of 5 or 10 nM isoproterenol (ISO). These sets of results were complemented and integrated with mathematical modeling of the current changes that take place in the range of membrane potentials (−70 to −50 mV), which corresponds to the ‘pacemaker depolarization’ in the adult mouse SAN. Our results reveal a very small, but functionally important, approximately steady-state or time-independent current generated by residual activation of If channels that are expressed in these pacemaker myocytes. Recordings of the pacemaker depolarization and action potential, combined with measurements of changes in If, and the well-known increases in the L-type Ca2+ current, ICaL, demonstrated that ICaL activation, is essential for myogenic pacing. Moreover, after being enhanced (approximately 3-fold) by 5 or 10 nM ISO, ICaL contributes significantly to the positive chronotropic effect. Our mathematical model has been developed in an attempt to better understand the underlying mechanisms for the pacemaker depolarization and action potential in adult mouse SAN myocytes. After being updated with our new experimental data describing If, our simulations reveal a novel functional component of If in adult mouse SAN. Computational work carried out with this model also confirms that in the presence of ISO the residual activation of If and opening of ICaL channels combine to generate a net current change during the slow diastolic depolarization phase that is essential for the observed accelerated pacemaking rate of these SAN myocytes.
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A New Approach for Evaluation of Cardiovascular Fitness and Cardiac Responses to Maximal Exercise Test in Master Runners: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11061648. [PMID: 35329974 PMCID: PMC8955590 DOI: 10.3390/jcm11061648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to analyze the cardiac autonomic function at rest, at maximum exercise, and in recovery after exercise and to determine sex-specific and age-specific values for resting heart rate (RHR), hear rate (HR)-peak, HR recovery (HRR), and HR variability at rest in master runners. Fifty endurance runners (21 women) participated in this study (43.28 ± 5.25 years). The subjects came from different athletic clubs in Andalusia (Spain), and the testing protocol was performed in-season. A 3-km running test was performed and the cardiovascular response was monitored. Regarding sex, no significant differences were found regarding cardiovascular autonomic function at rest, during exercise, and following maximal exercise, only at rest, the standard deviation of all R-R intervals and low frequency values displayed significantly (p < 0.05) lower scores in women. 46% of athletes showed an RHR < 60 bpm. Additionally, HR-peak showed a significant correlation with age (r = −0.369; p = 0.009) and HRR5min (r = 0.476, p = 0.001). Also, endurance performance was inversely associated with obesity traits and cardiometabolic risk factors. In summary, age, sex, fitness, or anthropometrics characteristics did not show a relevant influence on cardiovascular autonomic modulation in master runners. However, the 3-km performance displayed a significant negative association with several factors of cardiometabolic risk.
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Kui P, Polyák A, Morvay N, Tiszlavicz L, Nagy N, Ördög B, Takács H, Leprán I, Farkas A, Papp JG, Jost N, Varró A, Baczkó I, Farkas AS. Long-Term Endurance Exercise Training Alters Repolarization in a New Rabbit Athlete’s Heart Model. Front Physiol 2022; 12:741317. [PMID: 35237176 PMCID: PMC8882986 DOI: 10.3389/fphys.2021.741317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
In the present study, the effect of long-term exercise training was investigated on myocardial morphological and functional remodeling and on proarrhythmic sensitivity in a rabbit athlete’s heart model. New-Zealand white rabbits were trained during a 12-week long treadmill running protocol and compared with their sedentary controls. At the end of the training protocol, echocardiography, in vivo and in vitro ECG recordings, proarrhythmic sensitivity with dofetilide (nM) were performed in isolated hearts, and action potential duration (APD) measurements at different potassium concentrations (4.5 and 2 mM) were made in the isolated papillary muscles. Expression levels of the slow component of delayed rectifier potassium current and fibrosis synthesis and degradation biomarkers were quantified. Echocardiography showed a significantly dilated left ventricle in the running rabbits. ECG PQ and RR intervals were significantly longer in the exercised group (79 ± 2 vs. 69 ± 2 ms and 325 ± 11 vs. 265 ± 6 ms, p < 0.05, respectively). The in vivo heart rate variability (HRV) (SD of root mean square: 5.2 ± 1.4 ms vs. 1.4 ± 0.2 ms, p < 0.05) and Tpeak-Tend variability were higher in the running rabbits. Bradycardia disappeared in the exercised group in vitro. Dofetilide tended to increase the QTc interval in a greater extent, and significantly increased the number of arrhythmic beats in the trained animals in vitro. APD was longer in the exercised group at a low potassium level. Real-time quantitative PCR (RT-qPCR) showed significantly greater messenger RNA expression of fibrotic biomarkers in the exercised group. Increased repolarization variability and higher arrhythmia incidences, lengthened APD at a low potassium level, increased fibrotic biomarker gene expressions may indicate higher sensitivity of the rabbit “athlete’s heart” to life-threatening arrhythmias.
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Affiliation(s)
- Péter Kui
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Alexandra Polyák
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- ELKH-SZTE Working Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - Nikolett Morvay
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - László Tiszlavicz
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Norbert Nagy
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- ELKH-SZTE Working Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - Balázs Ördög
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Hedvig Takács
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - István Leprán
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - András Farkas
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Julius Gy. Papp
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- ELKH-SZTE Working Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - Norbert Jost
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- ELKH-SZTE Working Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - András Varró
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- ELKH-SZTE Working Group of Cardiovascular Pharmacology, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- *Correspondence: András Varró,
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Attila S. Farkas
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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Claiborne A, Alessio H, Slattery E, Hughes M, Barth E, Cox R. Heart Rate Variability Reflects Similar Cardiac Autonomic Function in Explosive and Aerobically Trained Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010669. [PMID: 34682412 PMCID: PMC8535639 DOI: 10.3390/ijerph182010669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022]
Abstract
Autonomic cardiac function can be indirectly detected non-invasively by measuring the variation in microtiming of heart beats by a method known as heart rate variability (HRV). Aerobic training for sport is associated with reduced risk for some factors associated with cardiovascular diseases (CVD), but effects on autonomic function in different athlete types are less known. To compare cardiac autonomic modulation using a standard protocol and established CVD risk factors in highly trained intercollegiate athletes competing in aerobic, explosive, and cross-trained sports. A total of 176 college athletes were categorized in distinct sports as explosive (EA), aerobic (AA), or cross-trained (mixed) athletes. Eight different HRV measures obtained at rest were compared across training type and five health factors: systolic (SBP), diastolic blood pressure (DBP), body weight (BW), sex, and race. All athletic types shared favorable HRV measures that correlated with low CVD risk factors and indicated normal sympathovagal balance. A significant correlation was reported between DBP and pNN50 (% RR intervals > 50 ms) (β = -0.214, p = 0.011) and between BW and low-frequency (LF) power (β = 0.205, p = 0.006). Caucasian and African American athletes differed significantly (p < 0.05) with respect to four HRV variables: pNN50, HF power, LF power, and LF/HF ratios. Explosive, aerobic and mixed athletes had similar cardiovascular and autonomic HRV results in all eight HRV parameters measured. All athletes reported LF and pNN50 values that were significantly correlated with two CVD risk factors: DBP and BW. Compared with Caucasian teammates, African American athletes demonstrated lower LF/HF and higher pNN50, indicating an even more favorable resting sympathovagal activity and healthy CV function.
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Affiliation(s)
- Alex Claiborne
- Department of Kinesiology, Nutrition and Health, Miami University, Oxford, OH 45056, USA; (A.C.); (E.S.); (E.B.); (R.C.)
| | - Helaine Alessio
- Department of Kinesiology, Nutrition and Health, Miami University, Oxford, OH 45056, USA; (A.C.); (E.S.); (E.B.); (R.C.)
- Correspondence: ; Tel.: +1-513-529-2700
| | - Eric Slattery
- Department of Kinesiology, Nutrition and Health, Miami University, Oxford, OH 45056, USA; (A.C.); (E.S.); (E.B.); (R.C.)
| | - Michael Hughes
- Department of Statistics, Miami University, Oxford, OH 45056, USA;
| | - Edwin Barth
- Department of Kinesiology, Nutrition and Health, Miami University, Oxford, OH 45056, USA; (A.C.); (E.S.); (E.B.); (R.C.)
| | - Ronald Cox
- Department of Kinesiology, Nutrition and Health, Miami University, Oxford, OH 45056, USA; (A.C.); (E.S.); (E.B.); (R.C.)
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Buchhorn R, Baumann C, Willaschek C. Pathophysiological mechanisms of bradycardia in patients with anorexia nervosa. Health Sci Rep 2021; 4:e331. [PMID: 34322602 PMCID: PMC8299991 DOI: 10.1002/hsr2.331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/29/2021] [Accepted: 07/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this investigation was to examine heart rate variability (HRV), interbeat interval (IBI), and their interrelationship in healthy controls, bradycardic hyperpolarization-activated cyclic nucleotide-gated channel 4 (HCN4) mutation carriers, and patients with anorexia nervosa (AN). We tested the hypothesis that neural mechanisms cause bradycardia in patients with AN. Therefore, we assumed that saturation of the HRV/IBI relationship as a consequence of sustained parasympathetic control of the sinus node is exclusively detectable in patients with AN. METHODS Patients with AN between the ages of 12 and 16 years admitted to our hospital due to malnutrition were grouped and included in the present investigation (N = 20). A matched-pair group with healthy children and adolescents was created. Groups were matched for age and sex. A 24-hour Holter electrocardiography (ECG) was performed in controls and patients. More specifically, all patients underwent two 24-hour Holter ECG examinations (admission; refeeding treatment). Additionally, the IBI was recorded during the night in HCN4 mutation carriers (N = 4). HRV parameters were analyzed in 5-minute sequences during the night and plotted against mean corresponding IBI length. HRV, IBI, and their interrelationship were examined using Spearman's rank correlation analyses, Mann-Whitney U tests, and Wilcoxon signed-rank tests. RESULTS The relationship between IBI and HRV showed signs of saturation in patients with AN. Furthermore, signs of HRV saturation were present in two HCN4 mutation carriers. In contrast, signs of HRV saturation were not present in controls. CONCLUSIONS The existence of HRV saturation does not support the existence of parasympathetically mediated bradycardia. Nonneural mechanisms, such as HCN4 downregulation, may be responsible for bradycardia and HRV saturation in patients with AN.
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Affiliation(s)
- Reiner Buchhorn
- Department of PediatricsCaritas‐Krankenhaus Bad MergentheimBad MergentheimGermany
| | | | - Christian Willaschek
- Department of PediatricsCaritas‐Krankenhaus Bad MergentheimBad MergentheimGermany
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Regulation of sinus node pacemaking and atrioventricular node conduction by HCN channels in health and disease. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2021; 166:61-85. [PMID: 34197836 DOI: 10.1016/j.pbiomolbio.2021.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 12/19/2022]
Abstract
The funny current, If, was first recorded in the heart 40 or more years ago by Dario DiFrancesco and others. Since then, we have learnt that If plays an important role in pacemaking in the sinus node, the innate pacemaker of the heart, and more recently evidence has accumulated to show that If may play an important role in action potential conduction through the atrioventricular (AV) node. Evidence has also accumulated to show that regulation of the transcription and translation of the underlying Hcn genes plays an important role in the regulation of sinus node pacemaking and AV node conduction under normal physiological conditions - in athletes, during the circadian rhythm, in pregnancy, and during postnatal development - as well as pathological states - ageing, heart failure, pulmonary hypertension, diabetes and atrial fibrillation. There may be yet more pathological conditions involving changes in the expression of the Hcn genes. Here, we review the role of If and the underlying HCN channels in physiological and pathological changes of the sinus and AV nodes and we begin to explore the signalling pathways (microRNAs, transcription factors, GIRK4, the autonomic nervous system and inflammation) involved in this regulation. This review is dedicated to Dario DiFrancesco on his retirement.
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Hu W, Clark RB, Giles WR, Shibata E, Zhang H. Physiological Roles of the Rapidly Activated Delayed Rectifier K + Current in Adult Mouse Heart Primary Pacemaker Activity. Int J Mol Sci 2021; 22:4761. [PMID: 33946248 PMCID: PMC8124469 DOI: 10.3390/ijms22094761] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 01/01/2023] Open
Abstract
Robust, spontaneous pacemaker activity originating in the sinoatrial node (SAN) of the heart is essential for cardiovascular function. Anatomical, electrophysiological, and molecular methods as well as mathematical modeling approaches have quite thoroughly characterized the transmembrane fluxes of Na+, K+ and Ca2+ that produce SAN action potentials (AP) and 'pacemaker depolarizations' in a number of different in vitro adult mammalian heart preparations. Possible ionic mechanisms that are responsible for SAN primary pacemaker activity are described in terms of: (i) a Ca2+-regulated mechanism based on a requirement for phasic release of Ca2+ from intracellular stores and activation of an inward current-mediated by Na+/Ca2+ exchange; (ii) time- and voltage-dependent activation of Na+ or Ca2+ currents, as well as a cyclic nucleotide-activated current, If; and/or (iii) a combination of (i) and (ii). Electrophysiological studies of single spontaneously active SAN myocytes in both adult mouse and rabbit hearts consistently reveal significant expression of a rapidly activating time- and voltage-dependent K+ current, often denoted IKr, that is selectively expressed in the leading or primary pacemaker region of the adult mouse SAN. The main goal of the present study was to examine by combined experimental and simulation approaches the functional or physiological roles of this K+ current in the pacemaker activity. Our patch clamp data of mouse SAN myocytes on the effects of a pharmacological blocker, E4031, revealed that a rapidly activating K+ current is essential for action potential (AP) repolarization, and its deactivation during the pacemaker potential contributes a small but significant component to the pacemaker depolarization. Mathematical simulations using a murine SAN AP model confirm that well known biophysical properties of a delayed rectifier K+ current can contribute to its role in generating spontaneous myogenic activity.
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Affiliation(s)
- Wei Hu
- Biological Physics Group, Department of Physics and Astronomy, The University of Manchester, Manchester M13 9PL, UK;
| | - Robert B. Clark
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada; (R.B.C.); (W.R.G.)
| | - Wayne R. Giles
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada; (R.B.C.); (W.R.G.)
| | - Erwin Shibata
- Department of Physiology, Carver School of Medicine, University of Iowa, Iowa City, IA 52242, USA;
| | - Henggui Zhang
- Biological Physics Group, Department of Physics and Astronomy, The University of Manchester, Manchester M13 9PL, UK;
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, China
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Lasocka Z, Dąbrowska-Kugacka A, Kaleta AM, Lewicka-Potocka Z, Faran A, Szołkiewicz E, Przybyłowski K, Szołkiewicz A, Daniluk P, Raczak G, Lewicka E. Electrocardiographic Changes in Male and Female Amateur Marathon Runners: A Comparison Study. Int J Sports Med 2021; 42:936-944. [PMID: 33621993 DOI: 10.1055/a-1323-3215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Physical training is gaining popularity among amateurs. Males and females exhibit different cardiac adaptation to exercise. The aim of the study was to compare the incidence of electrocardiographic abnormalities before and after the marathon between sexes. 12-lead electrocardiogram was performed in 40 male (39±8 years) and 27 female (40±7 years) amateur runners: 2-3 weeks before (Stage 1) and immediately after (Stage 2) the marathon. Abnormalities in the resting (Stage 1) and exercise (Stage 2) electrocardiograms were compared between sexes. At rest left atrial enlargement was more frequent in females than males (48 vs. 20%; p<0.05). The incidence of right atrial enlargement was significantly more common at Stage 2 than 1, both in men (43 vs. 0%; p<0.001) and in women (48 vs. 4%; p=0.001). Significant increase of P-wave amplitude was found in male runners after the marathon (0.12±0.05 vs. 0.21±0.09 mV; p<0.001 Stage 1 vs. 2), but was absent in females. QTc prolongation was observed in both sexes, however to a higher degree in males (p<0.05 for the interaction stage and sex). Although both male and female amateur marathon runners exhibit abnormalities in resting and exercise electrocardiograms, men present more exercise-induced electrocardiographic changes, which might indicate a higher propensity for post-marathon arrhythmias. Electrocardiographic screening in amateurs should be considered.
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Affiliation(s)
- Zofia Lasocka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Anna Maria Kaleta
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Anna Faran
- University Clinical Centre in Gdańsk, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Szołkiewicz
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Krystian Przybyłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Alicja Szołkiewicz
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Paulina Daniluk
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
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Bidaud I, D'Souza A, Forte G, Torre E, Greuet D, Thirard S, Anderson C, Chung You Chong A, Torrente AG, Roussel J, Wickman K, Boyett MR, Mangoni ME, Mesirca P. Genetic Ablation of G Protein-Gated Inwardly Rectifying K + Channels Prevents Training-Induced Sinus Bradycardia. Front Physiol 2021; 11:519382. [PMID: 33551824 PMCID: PMC7857143 DOI: 10.3389/fphys.2020.519382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Endurance athletes are prone to bradyarrhythmias, which in the long-term may underscore the increased incidence of pacemaker implantation reported in this population. Our previous work in rodent models has shown training-induced sinus bradycardia to be due to microRNA (miR)-mediated transcriptional remodeling of the HCN4 channel, leading to a reduction of the "funny" (I f) current in the sinoatrial node (SAN). Objective: To test if genetic ablation of G-protein-gated inwardly rectifying potassium channel, also known as I KACh channels prevents sinus bradycardia induced by intensive exercise training in mice. Methods: Control wild-type (WT) and mice lacking GIRK4 (Girk4 -/-), an integral subunit of I KACh were assigned to trained or sedentary groups. Mice in the trained group underwent 1-h exercise swimming twice a day for 28 days, 7 days per week. We performed electrocardiogram recordings and echocardiography in both groups at baseline, during and after the training period. At training cessation, mice were euthanized and SAN tissues were isolated for patch clamp recordings in isolated SAN cells and molecular profiling by quantitative PCR (qPCR) and western blotting. Results: At swimming cessation trained WT mice presented with a significantly lower resting HR that was reversible by acute I KACh block whereas Girk4 -/- mice failed to develop a training-induced sinus bradycardia. In line with HR reduction, action potential rate, density of I f, as well as of T- and L-type Ca2+ currents (I CaT and I CaL ) were significantly reduced only in SAN cells obtained from WT-trained mice. I f reduction in WT mice was concomitant with downregulation of HCN4 transcript and protein, attributable to increased expression of corresponding repressor microRNAs (miRs) whereas reduced I CaL in WT mice was associated with reduced Cav1.3 protein levels. Strikingly, I KACh ablation suppressed all training-induced molecular remodeling observed in WT mice. Conclusion: Genetic ablation of cardiac I KACh in mice prevents exercise-induced sinus bradycardia by suppressing training induced remodeling of inward currents I f, I CaT and I CaL due in part to the prevention of miR-mediated transcriptional remodeling of HCN4 and likely post transcriptional remodeling of Cav1.3. Strategies targeting cardiac I KACh may therefore represent an alternative to pacemaker implantation for bradyarrhythmias seen in some veteran athletes.
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Affiliation(s)
- Isabelle Bidaud
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France.,LabEx Ion Channels Science and Therapeutics, Montpellier, France
| | - Alicia D'Souza
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Gabriella Forte
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Eleonora Torre
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France.,LabEx Ion Channels Science and Therapeutics, Montpellier, France
| | - Denis Greuet
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Steeve Thirard
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Cali Anderson
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Antony Chung You Chong
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France.,LabEx Ion Channels Science and Therapeutics, Montpellier, France
| | - Angelo G Torrente
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France.,LabEx Ion Channels Science and Therapeutics, Montpellier, France
| | - Julien Roussel
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Kevin Wickman
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, United States
| | - Mark R Boyett
- Division of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Matteo E Mangoni
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France.,LabEx Ion Channels Science and Therapeutics, Montpellier, France
| | - Pietro Mesirca
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France.,LabEx Ion Channels Science and Therapeutics, Montpellier, France
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Eser P, Jaeger E, Marcin T, Herzig D, Trachsel L, Wilhelm M. Acute and chronic effects of high-intensity interval and moderate-intensity continuous exercise on heart rate and its variability after recent myocardial infarction: A randomized controlled trial. Ann Phys Rehabil Med 2020; 65:101444. [DOI: 10.1016/j.rehab.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/25/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
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Morlin MT, Cruz CJGD, Melo PBS, Lopes GHR, Soares EDMKVK, Porto LGG, Molina GE. BRADYCARDIA IN ATHLETES: DOES THE TYPE OF SPORT MAKE ANY DIFFERENCE? – A SYSTEMATIC REVIEW. REV BRAS MED ESPORTE 2020. [DOI: 10.1590/1517-8692202026052019_0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Bradycardia in athletes can range from moderate to severe, and the factors that contribute to slow heart rate are complex. Studies investigating the mechanisms associated with this condition are controversial, and may be linked to the form of exercise practiced. A systematic literature review was conducted to discuss bradycardia mechanisms in athletes who practice different forms of sport. The databases consulted were Pubmed (MEDLINE), Clinical Trials, Cochrane, Scopus, Web of Science, SciELO, Sport Discus and PEDro. The search included English language articles published up to January 2019, that evaluated athletes who practiced different forms of sport. One hundred and ninety-three articles were found, ten of which met the inclusion criteria, with 1549 male and female athletes who practiced diverse forms of sport. Resting heart rate and cardiac structure were studied in association with the form of sport practiced, through heart rate variability, electrocardiogram, echocardiogram and pharmacological blockade. The studies suggest that a slow resting heart rate cannot be explained by increased vagal modulation alone, but also includes changes in cardiac structure. According to the studies, different sports seem to produce different cardiac responses, and the bradycardia found in athletes can be explained by non-autonomic and autonomic mechanisms, depending on the type of effort or the form of sport practiced. However, the mechanism underlying the slow heart rate in each form of sport is still unclear. Level of evidence II; Prognostic studies - Investigating the effect of a patient characteristic on the outcome of disease.
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20
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Monfredi O, Lakatta EG. Complexities in cardiovascular rhythmicity: perspectives on circadian normality, ageing and disease. Cardiovasc Res 2020; 115:1576-1595. [PMID: 31150049 DOI: 10.1093/cvr/cvz112] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/06/2019] [Accepted: 05/25/2019] [Indexed: 12/13/2022] Open
Abstract
Biological rhythms exist in organisms at all levels of complexity, in most organs and at myriad time scales. Our own biological rhythms are driven by energy emitted by the sun, interacting via our retinas with brain stem centres, which then send out complex messages designed to synchronize the behaviour of peripheral non-light sensing organs, to ensure optimal physiological responsiveness and performance of the organism based on the time of day. Peripheral organs themselves have autonomous rhythmic behaviours that can act independently from central nervous system control but is entrainable. Dysregulation of biological rhythms either through environment or disease has far-reaching consequences on health that we are only now beginning to appreciate. In this review, we focus on cardiovascular rhythms in health, with ageing and under disease conditions.
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Affiliation(s)
- Oliver Monfredi
- Division of Medicine, Department of Cardiology, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, USA.,Laboratory of Cardiovascular Sciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, 251 Bayview Blvd, Baltimore, MD, USA
| | - Edward G Lakatta
- Laboratory of Cardiovascular Sciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, 251 Bayview Blvd, Baltimore, MD, USA
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21
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McNamara DA, Aiad N, Howden E, Hieda M, Link MS, Palmer D, Samels M, Everding B, Ng J, Adams-Huet B, Opondo M, Sarma S, Levine BD. Left Atrial Electromechanical Remodeling Following 2 Years of High-Intensity Exercise Training in Sedentary Middle-Aged Adults. Circulation 2019; 139:1507-1516. [PMID: 30586729 DOI: 10.1161/circulationaha.118.037615] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Moderate intensity exercise is associated with a decreased incidence of atrial fibrillation. However, extensive training in competitive athletes is associated with an increased atrial fibrillation risk. We evaluated the effects of 24 months of high intensity exercise training on left atrial (LA) mechanical and electric remodeling in sedentary, healthy middle-aged adults. METHODS Sixty-one participants (53±5 years) were randomized to 10 months of exercise training followed by 14 months of maintenance exercise or stretching/balance control. Fourteen Masters athletes were added for comparison. Left ventricular (LV) and LA volumes underwent 3D echocardiographic assessment, and signal-averaged electrocardiographs for filtered P-wave duration and atrial late potentials were completed at 0, 10, and 24 months. Extended ambulatory monitoring was performed at 0 and 24 months. Within and between group differences from baseline were compared using mixed-effects model repeated-measures analysis. RESULTS Fifty-three participants completed the study (25 control, 28 exercise) with 88±11% adherence to assigned exercise sessions. In the exercise group, both LA and LV end diastolic volumes increased proportionately (19% and 17%, respectively) after 10 months of training (peak training load). However, only LA volumes continued to increase with an additional 14 months of exercise training (LA volumes 55%; LV end diastolic volumes 15% at 24 months versus baseline; P<0.0001 for all). The LA:LV end diastolic volumes ratio did not change from baseline to 10 months, but increased 31% from baseline in the Ex group ( P<0.0001) at 24 months, without a change in controls. There were no between group differences in the LA ejection fraction, filtered P-wave duration, atrial late potentials, and premature atrial contraction burden at 24 months and no atrial fibrillation was detected. Compared with Masters athletes, the exercise group demonstrated lower absolute LA and LV volumes, but had a similar LA:LV ratio after 24 months of training. CONCLUSIONS Twenty-four months of high intensity exercise training resulted in LA greater than LV mechanical remodeling with no observed electric remodeling. Together, these data suggest different thresholds for electrophysiological and mechanical changes may exist in response to exercise training, and provide evidence supporting a potential mechanism by which high intensity exercise training leads to atrial fibrillation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02039154.
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Affiliation(s)
- David A McNamara
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Norman Aiad
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Erin Howden
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Mark S Link
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Dean Palmer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Mitchel Samels
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Braden Everding
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Jason Ng
- University of Illinois at Chicago School of Medicine (J.N.)
| | - Beverley Adams-Huet
- Division of Biostatistics, Department of Clinical Sciences and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (B.A.-H.)
| | - Mildred Opondo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.).,Stanford University School of Medicine, CA (M.O.)
| | - Satyam Sarma
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Benjamin D Levine
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
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22
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D’Souza A, Trussell T, Morris GM, Dobrzynski H, Boyett MR. Supraventricular Arrhythmias in Athletes: Basic Mechanisms and New Directions. Physiology (Bethesda) 2019; 34:314-326. [DOI: 10.1152/physiol.00009.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Athletes are prone to supraventricular rhythm disturbances including sinus bradycardia, heart block, and atrial fibrillation. Mechanistically, this is attributed to high vagal tone and cardiac electrical and structural remodeling. Here, we consider the supporting evidence for these three pro-arrhythmic mechanisms in athletic human cohorts and animal models, featuring current controversies, emerging data, and future directions of relevance to the translational research agenda.
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Affiliation(s)
- Alicia D’Souza
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Tariq Trussell
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Gwilym M. Morris
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Mark R. Boyett
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
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23
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Abstract
It is established that an intensive training results in a lower average resting heart rate. Management of bradycardia in an athlete can be difficult given the underlying mechanisms are not clearly understood. The authors reviewed the different mechanisms described in the literature, including recent advances in physiology regarding remodeling of ion channels, which may partially explain bradycardia in athletes. Sinus bradycardia amongst athletes, especially endurance focused athletes, is common but difficult to apprehend. The underlying mechanisms are observably of multifactorial origin and likely incompletely elucidated by the current body of knowledge.
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Affiliation(s)
- Benoit Doyen
- Department of Cardiology, CHU UCL Namur , Yvoir , Belgium
| | - David Matelot
- Department of Cardiology, Hopital Pontchaillou , Rennes , France
| | - François Carré
- Department of Cardiology, Hopital Pontchaillou Service de medecine du sport , Rennes , France
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24
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Zadvorev SF, Krysiuk OB, Obrezan AG, Yakovlev AA. Effect of Personal History of Athletic Activity on the Clinical Course of Cardiovascular Diseases in Former Athletes. ADVANCES IN GERONTOLOGY 2019. [DOI: 10.1134/s2079057019010168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Salma RG, Abu-Naim H, Ahmad O, Akelah D, Salem Y, Midoun E. Vital signs changes during different dental procedures: A prospective longitudinal cross-over clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:30-39. [PMID: 30219249 DOI: 10.1016/j.oooo.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/13/2018] [Accepted: 08/03/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the magnitude of vital signs changes during 3 different dental treatments. STUDY DESIGN A prospective longitudinal multiarm cross-over clinical trial was conducted. Three dental procedures were performed on each participant: supragingival scaling, dental restoration under local anesthesia (LA), and exodontia under LA. The following parameters were recorded for in each dental procedure: body temperature (BT), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2). Three repeated measurements of each parameter were recorded at 3 phases of each procedure. RESULTS A total of 150 dental interventions were performed on 50 patients. Scaling caused a statistically significant rise in BT, RR, and SpO2, and a reduction in HR. Restorative treatment caused a statistically significant rise in SpO2 during LA. Exodontia caused a statistically significant rise in BT, RR, SBP (during the procedure), and SpO2 (during LA). CONCLUSIONS Scaling and restorative treatment did not significantly impact heart rate. The respiratory rate may temporarily rise during LA injection and some dental procedures, especially exodontia. Increase in systolic blood pressure and heart rate during exodontia was tolerated by healthy patients.
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Affiliation(s)
- Ra'ed Ghaleb Salma
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Riyadh Elm University, Riyadh, Saudi Arabia.
| | - Horiyah Abu-Naim
- Teaching Assistant, Arab American University, Jenin, State of Palestine
| | - Osama Ahmad
- General practice, New You Medical Center, Riyadh, Saudi Arabia
| | - Doa'a Akelah
- General practice, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Yasmin Salem
- General practice, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Essma Midoun
- General practice, Riyadh Elm University, Riyadh, Saudi Arabia
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26
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Lakin R, Guzman C, Izaddoustdar F, Polidovitch N, Goodman JM, Backx PH. Changes in Heart Rate and Its Regulation by the Autonomic Nervous System Do Not Differ Between Forced and Voluntary Exercise in Mice. Front Physiol 2018; 9:841. [PMID: 30061838 PMCID: PMC6055008 DOI: 10.3389/fphys.2018.00841] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/14/2018] [Indexed: 12/20/2022] Open
Abstract
Most exercise studies in mice have relied on forced training which can introduce psychological stress. Consequently, the utility of mouse models for understanding exercise-mediated effects in humans, particularly autonomic nervous system (ANS) remodeling, have been challenged. We compared the effects of voluntary free-wheel running vs. non-voluntary swimming on heart function in mice with a focus on the regulation of heart rate (HR) by the ANS. Under conditions where the total excess O2 consumption associated with exercise was comparable, the two exercise models led to similar improvements in ventricular function as well as comparable reductions in HR and its control by parasympathetic nervous activity (PNA) and sympathetic nervous activity (SNA), compared to sedentary mice. Both exercise models also increased HR variability (HRV) by similar amounts, independent of HR reductions. In all mice, HRV depended primarily on PNA, with SNA weakly affecting HRV at low frequencies. The differences in both HR and HRV between exercised vs. sedentary mice were eliminated by autonomic blockade, consistent with the similar intrinsic beating rates observed in atria isolated from exercised vs. sedentary mice. In conclusion, both forced and voluntary exercise induce comparable ventricular physiological remodeling as well as HR reductions and HR-independent enhancements of HRV which were both primarily dependent on increased PNA. New and noteworthy -No previous mouse studies have compared the effects of forced and voluntary exercise on the heart function and its modulation by the autonomic nervous system (ANS).-Both voluntary free-wheel running and forced swimming induced similar improvements in ventricular contractile function, reductions in heart rate (HR) and enhancements of HR variability (HRV).-HR regulation in exercised mice was linked to increased parasympathetic nerve activity and reduced sympathetic nerve activity.- HRV was independent of HR and depended primarily on PNA in both exercised and sedentary mice.- Complete cardiac autonomic blockade eliminated differences in both HR and HRV between exercised and sedentary mice.
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Affiliation(s)
- Robert Lakin
- Department of Exercise Sciences, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Mount Sinai Hospital, University Health Network, Toronto, ON, Canada
| | - Camilo Guzman
- Department of Biology, York University, Toronto, ON, Canada
| | - Farzad Izaddoustdar
- Division of Cardiology, Mount Sinai Hospital, University Health Network, Toronto, ON, Canada
| | - Nazari Polidovitch
- Division of Cardiology, Mount Sinai Hospital, University Health Network, Toronto, ON, Canada.,Department of Biology, York University, Toronto, ON, Canada
| | - Jack M Goodman
- Department of Exercise Sciences, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Mount Sinai Hospital, University Health Network, Toronto, ON, Canada
| | - Peter H Backx
- Division of Cardiology, Mount Sinai Hospital, University Health Network, Toronto, ON, Canada.,Department of Biology, York University, Toronto, ON, Canada
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27
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Herzig D, Asatryan B, Brugger N, Eser P, Wilhelm M. The Association Between Endurance Training and Heart Rate Variability: The Confounding Role of Heart Rate. Front Physiol 2018; 9:756. [PMID: 29971016 PMCID: PMC6018465 DOI: 10.3389/fphys.2018.00756] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/29/2018] [Indexed: 12/19/2022] Open
Abstract
Heart rate variability (HRV) is a widely used marker of cardiac autonomic nervous activity (CANA). Changes in HRV with exercise training have often been interpreted as increases in vagal activity. HRV is strongly associated with heart rate, which in turn, is associated with heart size. There is strong evidence from basic studies that lower heart rate in response to exercise training is caused by morphological and electrical remodeling of the heart. In a cross-sectional study in participants of a 10 mile race, we investigated the influence of endurance exercise on HRV parameters independently of heart size and heart rate. One-hundred-and-seventy-two runners (52 females and 120 males) ranging from novice runners with a first participation to an endurance event to highly trained runners, with up to 15 h of training per week, were included in the analysis. R-R intervals were recorded by electrocardiography over 24 h. Left ventricular end diastolic volume indexed to body surface area (LVEDVI) was assessed by transthoracic echocardiography and peak oxygen consumption (VO2peak) by cardiopulmonary exercise testing. Exercise was quantified by VO2peak, training volume, and race performance. HRV was determined during deep sleep. HRV markers of vagal activity were moderately associated with exercise variables (standardized β = 0.28-0.40, all p < 0.01). These associations disappeared when controlling for heart rate and LVEDVI. Due to the intrinsic association between heart rate and HRV, conclusions based on HRV parameters do not necessarily reflect differences in CANA. Based on current evidence, we discourage the use of HRV as a marker of CANA when measuring the effect of chronic exercise.
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Affiliation(s)
- David Herzig
- University Clinic for Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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28
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Affiliation(s)
- Andrew D'Silva
- Clinical Cardiology and Academic Group, St George's University of London,, London, UK
| | - Sanjay Sharma
- Clinical Cardiology and Academic Group, St George's University of London,, London, UK
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29
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Boyett MR, Wang Y, Nakao S, Ariyaratnam J, Hart G, Monfredi O, D'Souza A. Rebuttal from Boyett et al. J Appl Physiol (1985) 2017; 123:689. [PMID: 28684595 DOI: 10.1152/japplphysiol.00606.2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 01/08/2023] Open
Affiliation(s)
- Mark R Boyett
- Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Yanwen Wang
- Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Shu Nakao
- Cardiovascular Sciences, University of Manchester, United Kingdom
| | | | - George Hart
- Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Oliver Monfredi
- Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Alicia D'Souza
- Cardiovascular Sciences, University of Manchester, United Kingdom
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30
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Flannery D, Howden EJ, La Gerche A, Hughson RL, Leicht AS, Boullosa DA, Hautala AJ, Zuo L, He F. Point:Counterpoint. J Appl Physiol (1985) 2017; 123:692-693. [PMID: 28947627 DOI: 10.1152/japplphysiol.00546.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Darragh Flannery
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Erin J Howden
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - André La Gerche
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Richard L Hughson
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Anthony S Leicht
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Daniel A Boullosa
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Arto J Hautala
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Li Zuo
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Feng He
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
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31
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D'Souza A, Pearman CM, Wang Y, Nakao S, Logantha SJRJ, Cox C, Bennett H, Zhang Y, Johnsen AB, Linscheid N, Poulsen PC, Elliott J, Coulson J, McPhee J, Robertson A, da Costa Martins PA, Kitmitto A, Wisløff U, Cartwright EJ, Monfredi O, Lundby A, Dobrzynski H, Oceandy D, Morris GM, Boyett MR. Targeting miR-423-5p Reverses Exercise Training-Induced HCN4 Channel Remodeling and Sinus Bradycardia. Circ Res 2017; 121:1058-1068. [PMID: 28821541 PMCID: PMC5636198 DOI: 10.1161/circresaha.117.311607] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 11/30/2022]
Abstract
Supplemental Digital Content is available in the text. Rationale: Downregulation of the pacemaking ion channel, HCN4 (hyperpolarization-activated cyclic nucleotide gated channel 4), and the corresponding ionic current, If, underlies exercise training–induced sinus bradycardia in rodents. If this occurs in humans, it could explain the increased incidence of bradyarrhythmias in veteran athletes, and it will be important to understand the underlying processes. Objective: To test the role of HCN4 in the training-induced bradycardia in human athletes and investigate the role of microRNAs (miRs) in the repression of HCN4. Methods and Results: As in rodents, the intrinsic heart rate was significantly lower in human athletes than in nonathletes, and in all subjects, the rate-lowering effect of the HCN selective blocker, ivabradine, was significantly correlated with the intrinsic heart rate, consistent with HCN repression in athletes. Next-generation sequencing and quantitative real-time reverse transcription polymerase chain reaction showed remodeling of miRs in the sinus node of swim-trained mice. Computational predictions highlighted a prominent role for miR-423-5p. Interaction between miR-423-5p and HCN4 was confirmed by a dose-dependent reduction in HCN4 3′-untranslated region luciferase reporter activity on cotransfection with precursor miR-423-5p (abolished by mutation of predicted recognition elements). Knockdown of miR-423-5p with anti-miR-423-5p reversed training-induced bradycardia via rescue of HCN4 and If. Further experiments showed that in the sinus node of swim-trained mice, upregulation of miR-423-5p (intronic miR) and its host gene, NSRP1, is driven by an upregulation of the transcription factor Nkx2.5. Conclusions: HCN remodeling likely occurs in human athletes, as well as in rodent models. miR-423-5p contributes to training-induced bradycardia by targeting HCN4. This work presents the first evidence of miR control of HCN4 and heart rate. miR-423-5p could be a therapeutic target for pathological sinus node dysfunction in veteran athletes.
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Affiliation(s)
- Alicia D'Souza
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Charles M Pearman
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Yanwen Wang
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Shu Nakao
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Sunil Jit R J Logantha
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Charlotte Cox
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Hayley Bennett
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Yu Zhang
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Anne Berit Johnsen
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Nora Linscheid
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Pi Camilla Poulsen
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Jonathan Elliott
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Jessica Coulson
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Jamie McPhee
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Abigail Robertson
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Paula A da Costa Martins
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Ashraf Kitmitto
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Ulrik Wisløff
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Elizabeth J Cartwright
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Oliver Monfredi
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Alicia Lundby
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Halina Dobrzynski
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Delvac Oceandy
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Gwilym M Morris
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.)
| | - Mark R Boyett
- From the Division of Cardiovascular Sciences, University of Manchester, United Kingdom (A.D., C.M.P., Y.W., S.N., S.J.R.J.L., C.C., H.B., Y.Z., J.E., A.R., A.K., E.J.C., O.M., H.D., D.O., G.M.M., M.R.B.); K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (A.B.J., U.W.); Faculty of Health Sciences, NNF Center for Protein Research, University of Copenhagen, Denmark (N.L., P.C.P., A.L.); School of Healthcare Science, Manchester Metropolitan University, United Kingdom (J.C., J.M.); Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands (P.A.d.C.M.); and School of Human Movement & Nutrition Sciences, University of Queensland, Australia (U.W.).
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Billman GE. Counterpoint: Exercise training-induced bradycardia: the case for enhanced parasympathetic regulation. J Appl Physiol (1985) 2017; 123:686-688. [PMID: 28684594 DOI: 10.1152/japplphysiol.00605.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
- George E Billman
- Department of Physiology and Cell Biology, The Ohio Univeristy, Columbus, Ohio; and.,Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Columbus, Ohio
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Boyett MR, Wang Y, Nakao S, Ariyaratnam J, Hart G, Monfredi O, D'Souza A. Point: Exercise training-induced bradycardia is caused by changes in intrinsic sinus node function. J Appl Physiol (1985) 2017; 123:684-685. [PMID: 28684593 DOI: 10.1152/japplphysiol.00604.2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 12/15/2022] Open
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Hallman DM, Birk Jørgensen M, Holtermann A. On the health paradox of occupational and leisure-time physical activity using objective measurements: Effects on autonomic imbalance. PLoS One 2017; 12:e0177042. [PMID: 28472190 PMCID: PMC5417644 DOI: 10.1371/journal.pone.0177042] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 04/23/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Leisure-time physical activity (LTPA) has considerable benefits for cardiovascular health and longevity, while occupational physical activity (OPA) is associated with an elevated cardiovascular risk. This "health paradox" may be explained by different effects on the autonomic nervous system from OPA and LTPA. Thus, we aimed to investigate whether objectively measured OPA and LTPA are differentially associated with autonomic regulation among workers. METHODS The study comprised 514 blue-collar workers from the Danish cohort DPHACTO. Physical activity (i.e. walking, climbing stairs, running and cycling) was assessed objectively using accelerometers worn on the thigh, hip and trunk over multiple working days. During this period, a heart rate monitor was used to sample heart period intervals from the ECG signal. Heart rate and heart rate variability (HRV) indices were analyzed during nocturnal sleep as markers of autonomic regulation. Multiple regression analysis was used to determine the main effects of OPA and LTPA and their interaction on heart rate and HRV, adjusting for multiple confounders. RESULTS Statistically significant interaction was found between OPA and LTPA on heart rate (adjusted p<0.0001) and HRV indices in time (rMSSD, adjusted p = 0.004) and frequency-domains (HF, adjusted p = 0.022; LF, adjusted p = 0.033). The beneficial effect of LTPA on nocturnal heart rate and HRV clearly diminished with higher levels of OPA, and high levels of both OPA and LTPA had a detrimental effect. CONCLUSION We found contrasting associations for objectively measured OPA and LTPA with heart rate and HRV during sleep. Differential effects of OPA and LTPA on autonomic regulation may contribute to the physical activity health paradox.
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Affiliation(s)
- David M. Hallman
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
- * E-mail:
| | | | - Andreas Holtermann
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Atrial fibrillation in highly trained endurance athletes — Description of a syndrome. Int J Cardiol 2017; 226:11-20. [DOI: 10.1016/j.ijcard.2016.10.047] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 12/22/2022]
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Ichige MHA, Santos CR, Jordão CP, Ceroni A, Negrão CE, Michelini LC. Exercise training preserves vagal preganglionic neurones and restores parasympathetic tonus in heart failure. J Physiol 2016; 594:6241-6254. [PMID: 27444212 PMCID: PMC5088253 DOI: 10.1113/jp272730] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/08/2016] [Indexed: 01/01/2023] Open
Abstract
KEY POINTS Heart Failure (HF) is accompanied by reduced ventricular function, activation of compensatory neurohormonal mechanisms and marked autonomic dysfunction characterized by exaggerated sympathoexcitation and reduced parasympathetic activity. With 6 weeks of exercise training, HF-related loss of choline acetyltransferase (ChAT)-positive vagal preganglionic neurones is avoided, restoring the parasympathetic tonus to the heart, and the immunoreactivity of dopamine β-hydroxylase-positive premotor neurones that drive sympathetic outflow to the heart is reduced. Training-induced correction of autonomic dysfunction occurs even with the persistence of abnormal ventricular function. Strong positive correlation between improved parasympathetic tonus to the heart and increased ChAT immunoreactivity in vagal preganglionic neurones after training indicates this is a crucial mechanism to restore autonomic function in heart failure. ABSTRACT Exercise training is an efficient tool to attenuate sympathoexcitation, a hallmark of heart failure (HF). Although sympathetic modulation in HF is widely studied, information regarding parasympathetic control is lacking. We examined the combined effects of sympathetic and vagal tonus to the heart in sedentary (Sed) and exercise trained (ET) HF rats and the contribution of respective premotor and preganglionic neurones. Wistar rats submitted to coronary artery ligation or sham surgery were assigned to training or sedentary protocols for 6 weeks. After haemodynamic, autonomic tonus (atropine and atenolol i.v.) and ventricular function determinations, brains were collected for immunoreactivity assays (choline acetyltransferase, ChATir; dopamine β-hydroxylase, DBHir) and neuronal counting in the dorsal motor nucleus of vagus (DMV), nucleus ambiguus (NA) and rostroventrolateral medulla (RVLM). HF-Sed vs. SHAM-Sed exhibited decreased exercise capacity, reduced ejection fraction, increased left ventricle end diastolic pressure, smaller positive and negative dP/dt, decreased intrinsic heart rate (IHR), lower parasympathetic and higher sympathetic tonus, reduced preganglionic vagal neurones and ChATir in the DMV/NA, and increased RVLM DBHir. Training increased treadmill performance, normalized autonomic tonus and IHR, restored the number of DMV and NA neurones and corrected ChATir without affecting ventricular function. There were strong positive correlations between parasympathetic tonus and ChATir in NA and DMV. RVLM DBHir was also normalized by training, but there was no change in neurone number and no correlation with sympathetic tonus. Training-induced preservation of preganglionic vagal neurones is crucial to normalize parasympathetic activity and restore autonomic balance to the heart even in the persistence of cardiac dysfunction.
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Affiliation(s)
- Marcelo H A Ichige
- Department of Physiology and Biophysics, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Carla R Santos
- Department of Physiology and Biophysics, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Camila P Jordão
- Heart Institute, University of Sao Paulo, Medical School, Sao Paulo, SP, Brazil
| | - Alexandre Ceroni
- Department of Physiology and Biophysics, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Carlos E Negrão
- Heart Institute, University of Sao Paulo, Medical School, Sao Paulo, SP, Brazil
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Lisete C Michelini
- Department of Physiology and Biophysics, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil.
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Zheng L, Li QF, Ni L, Wang H, Ruan XC, Wu XS. Lifetime regular exercise affects the incident of different arrhythmias and improves organismal health in aging female Drosophila melanogaster. Biogerontology 2016; 18:97-108. [PMID: 27787741 DOI: 10.1007/s10522-016-9665-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/17/2016] [Indexed: 02/06/2023]
Abstract
We used Drosophila melanogaster as an animal model system to study the impact of exercise training initiated early in life on cardiac function using a well-established model of inherent myogenic properties of the heart and discussed the changes on myosin, a myocardial contractile protein. We also explored the effect of early physical exercise on organismal aging by analyzing the wake-sleep pattern using a Drosophila activity monitor system. We found that a variety of arrhythmias are part of the heart spectrum in old flies after a lifetime of physical exercise as evidenced by reducing the incidence of fibrillations and increasing the occurrence of bradycardias. Maintenance of myocardial myosin levels may be an underlying contributor to these exercise-induced improvements in cardiac function at an advanced age. Moreover, we found that exercise training resulted in improved sleep quality by ameliorating age-related sleep inefficiency, fragmentation and sleep consolidation.
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Affiliation(s)
- Lan Zheng
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, Hunan Province, China.
| | - Qiu Fang Li
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, Hunan Province, China
| | - Liu Ni
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, Hunan Province, China
| | - Hui Wang
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, Hunan Province, China
| | - Xiang Cheng Ruan
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, Hunan Normal University, Changsha, Hunan Province, China
| | - Xiu Shan Wu
- Heart Development Center, Hunan Normal University, Changsha, Hunan Province, China
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Bahrainy S, Levy WC, Busey JM, Caldwell JH, Stratton JR. Exercise training bradycardia is largely explained by reduced intrinsic heart rate. Int J Cardiol 2016; 222:213-216. [PMID: 27497097 DOI: 10.1016/j.ijcard.2016.07.203] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/28/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Resting heart rate (RHR) declines with exercise training. Possible mechanisms include: 1) increased parasympathetic tone, 2) decreased responsiveness to beta-adrenergic stimulation, 3) decreased intrinsic heart rate or 4) combination of these factors. OBJECTIVE To determine whether an increase in resting parasympathetic tone or decrease in response to beta-adrenergic stimulation contributes to the decrease in RHR with training. METHODS 51 screened healthy subjects aged 18-32 (n=20, mean age 26, 11 female) or 65-80 (n=31, mean age 69, 16 female) were tested before and after 6months of supervised exercise training. Heart rate response to parasympathetic withdrawal was assessed using atropine and beta-adrenergic responsiveness during parasympathetic withdrawal using isoproterenol. RESULTS Training increased VO2 max by 17% (28.7±7.7 to 33.6±9.20ml/kg/min, P<0.001). RHR decreased from 62.8±6.6 to 57.6±7.2 beats per minute (P<0.0001). The increase in heart rate in response to parasympathetic withdrawal was unchanged after training (+37.3±12.8 pre vs. +36.4±12.2 beats per min post, P=0.41). There was no change in the heart rate response to isoproterenol after parasympathetic blockade with training (+31.9±10.9 pre vs. +31.0±12.0 post beats per min, P=0.56). The findings were similar in all four subgroups. CONCLUSIONS We did not find evidence that an increase in parasympathetic tone or a decrease in responsiveness to beta-adrenergic activity accounts for the reduction in resting heart rate with exercise training. We suggest that a decline in heart rate with training is most likely due to decrease in the intrinsic heart rate.
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Affiliation(s)
- Samira Bahrainy
- Division of Cardiology, Department of Medicine, VA Medical Center and University of Washington, Seattle, WA, United States.
| | - Wayne C Levy
- Division of Cardiology, Department of Medicine, VA Medical Center and University of Washington, Seattle, WA, United States
| | - Janet M Busey
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - James H Caldwell
- Division of Cardiology, Department of Medicine, VA Medical Center and University of Washington, Seattle, WA, United States; Division of Nuclear Medicine, VA Medical Center and University of Washington, Seattle, WA, United States; Department of Radiology, University of Washington, Seattle, WA, United States
| | - John R Stratton
- Division of Cardiology, Department of Medicine, VA Medical Center and University of Washington, Seattle, WA, United States
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Azevedo LF, Perlingeiro P, Hachul DT, Gomes-Santos IL, Tsutsui JM, Negrao CE, De Matos LDNJ. Predominance of Intrinsic Mechanism of Resting Heart Rate Control and Preserved Baroreflex Sensitivity in Professional Cyclists after Competitive Training. PLoS One 2016; 11:e0148036. [PMID: 26812615 PMCID: PMC4727792 DOI: 10.1371/journal.pone.0148036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/12/2016] [Indexed: 12/02/2022] Open
Abstract
Different season trainings may influence autonomic and non-autonomic cardiac control of heart rate and provokes specific adaptations on heart’s structure in athletes. We investigated the influence of transition training (TT) and competitive training (CT) on resting heart rate, its mechanisms of control, spontaneous baroreflex sensitivity (BRS) and relationships between heart rate mechanisms and cardiac structure in professional cyclists (N = 10). Heart rate (ECG) and arterial blood pressure (Pulse Tonometry) were recorded continuously. Autonomic blockade was performed (atropine—0.04 mg.kg-1; esmolol—500 μg.kg-1 = 0.5 mg). Vagal effect, intrinsic heart rate, parasympathetic (n) and sympathetic (m) modulations, autonomic influence, autonomic balance and BRS were calculated. Plasma norepinephrine (high-pressure liquid chromatography) and cardiac structure (echocardiography) were evaluated. Resting heart rate was similar in TT and CT. However, vagal effect, intrinsic heart rate, autonomic influence and parasympathetic modulation (higher n value) decreased in CT (P≤0.05). Sympathetic modulation was similar in both trainings. The autonomic balance increased in CT but still showed parasympathetic predominance. Cardiac diameter, septum and posterior wall thickness and left ventricular mass also increased in CT (P<0.05) as well as diastolic function. We observed an inverse correlation between left ventricular diastolic diameter, septum and posterior wall thickness and left ventricular mass with intrinsic heart rate. Blood pressure and BRS were similar in both trainings. Intrinsic heart rate mechanism is predominant over vagal effect during CT, despite similar resting heart rate. Preserved blood pressure levels and BRS during CT are probably due to similar sympathetic modulation in both trainings.
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Affiliation(s)
- Luciene Ferreira Azevedo
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
- * E-mail:
| | - Patricia Perlingeiro
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
| | - Denise Tessariol Hachul
- Clinical Arrhythmia Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
| | - Igor Lucas Gomes-Santos
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
| | - Jeane Mike Tsutsui
- Echocardiography Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
| | - Carlos Eduardo Negrao
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
- Biodynamic of the Movement of the Human Body, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Luciana D. N. J. De Matos
- Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, Sao Paulo, Brazil
- Rehabilitation Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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40
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D'Souza A, Sharma S, Boyett MR. CrossTalk opposing view: bradycardia in the trained athlete is attributable to a downregulation of a pacemaker channel in the sinus node. J Physiol 2016; 593:1749-51. [PMID: 25871551 PMCID: PMC4405729 DOI: 10.1113/jphysiol.2014.284356] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Alicia D'Souza
- Institute of Cardiovascular Sciences, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
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Pelà G, Crocamo A, Li Calzi M, Gianfreda M, Gioia MI, Visioli F, Pattoneri P, Corradi D, Goldoni M, Montanari A. Sex-related differences in left ventricular structure in early adolescent non-professional athletes. Eur J Prev Cardiol 2015; 23:777-84. [DOI: 10.1177/2047487315608826] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Giovanna Pelà
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Antonio Crocamo
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Mauro Li Calzi
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Marina Gianfreda
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Margherita I Gioia
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | | | | | - Domenico Corradi
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T.), Unit of Pathology, University Medical School and University Hospital of Parma, Italy
| | - Matteo Goldoni
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Alberto Montanari
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
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Soares-Miranda L, Sattelmair J, Chaves P, Duncan G, Siscovick DS, Stein PK, Mozaffarian D. Response to letter regarding article, "physical activity and heart rate variability in older adults: the cardiovascular health study". Circulation 2015; 131:e349-50. [PMID: 25691709 DOI: 10.1161/circulationaha.114.012825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Luisa Soares-Miranda
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal
| | - Jacob Sattelmair
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Paulo Chaves
- Benjamin Leon Center for Geriatric Research and Education and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Glen Duncan
- Department of Epidemiology, University of Washington, Seattle, WA
| | - David S Siscovick
- Department of Epidemiology, and Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, New York Academy of Medicine, New York, NY
| | - Phyllis K Stein
- Heart Rate Variability Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO
| | - Dariush Mozaffarian
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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43
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Billman GE, Cagnoli KL, Csepe T, Li N, Wright P, Mohler PJ, Fedorov VV. Exercise training-induced bradycardia: evidence for enhanced parasympathetic regulation without changes in intrinsic sinoatrial node function. J Appl Physiol (1985) 2015; 118:1344-55. [PMID: 25749448 PMCID: PMC4451292 DOI: 10.1152/japplphysiol.01111.2014] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/28/2015] [Indexed: 01/17/2023] Open
Abstract
The mechanisms responsible for exercise-induced reductions in baseline heart rate (HR), known as training bradycardia, remain controversial. Therefore, changes in cardiac autonomic regulation and intrinsic sinoatrial nodal (SAN) rate were evaluated using dogs randomly assigned to either a 10- to 12-wk exercise training (Ex, n = 15) or an equivalent sedentary period (Sed, n = 10). Intrinsic HR was revealed by combined autonomic nervous system (ANS) blockade (propranolol + atropine, iv) before and after completion of the study. At the end of the study, SAN function was further evaluated by examining the SAN recovery time (SNRT) following rapid atrial pacing and the response to adenosine in anesthetized animals. As expected, both the response to submaximal exercise and baseline HR significantly (P < 0.01) decreased, and heart rate variability (HRV; e.g., high-frequency R-R interval variability) significantly (P < 0.01) increased in the Ex group but did not change in the Sed group. Atropine also induced significantly (P < 0.01) greater reductions in HRV in the Ex group compared with the Sed group; propranolol elicited similar HR and HRV changes in both groups. In contrast, neither intrinsic HR (Ex before, 141.2 ± 6.7; Ex after, 146.0 ± 8.0 vs. Sed before, 143.3 ± 11.1; Sed after, 141.0 ± 11.3 beats per minute), the response to adenosine, corrected SNRT, nor atrial fibrosis and atrial fibrillation inducibility differed in the Ex group vs. the Sed group. These data suggest that in a large-animal model, training bradycardia results from an enhanced cardiac parasympathetic regulation and not from changes in intrinsic properties of the SAN.
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Affiliation(s)
- George E Billman
- Department of Physiology and Cell Biology, The Ohio State University, Columbus, Ohio; Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio; and
| | - Kristen L Cagnoli
- Department of Physiology and Cell Biology, The Ohio State University, Columbus, Ohio
| | - Thomas Csepe
- Department of Physiology and Cell Biology, The Ohio State University, Columbus, Ohio
| | - Ning Li
- Department of Physiology and Cell Biology, The Ohio State University, Columbus, Ohio
| | - Patrick Wright
- Department of Physiology and Cell Biology, The Ohio State University, Columbus, Ohio; Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio; and
| | - Peter J Mohler
- Department of Physiology and Cell Biology, The Ohio State University, Columbus, Ohio; Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio; and Deaprtment of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, The Ohio State University, Columbus, Ohio; Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio; and
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Choudhury M, Boyett MR, Morris GM. Biology of the Sinus Node and its Disease. Arrhythm Electrophysiol Rev 2015; 4:28-34. [PMID: 26835096 DOI: 10.15420/aer.2015.4.1.28] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/05/2015] [Indexed: 12/21/2022] Open
Abstract
The sinoatrial node (SAN) is the normal pacemaker of the heart and SAN dysfunction (SND) is common, but until recently the pathophysiology was incompletely understood. It was usually attributed to idiopathic age-related fibrosis and cell atrophy or ischaemia. It is now evident that changes in the electrophysiology of the SAN, known as electrical remodelling, is an important process that has been demonstrated in SND associated with heart failure, ageing, diabetes, atrial fibrillation and endurance exercise. Furthermore, familial SND has been identified and mutations have been characterised in key pacemaker genes of the SAN. This review summarises the current evidence regarding SAN function and the pathophysiology of SND.
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Affiliation(s)
- Moinuddin Choudhury
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Mark R Boyett
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Gwilym M Morris
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
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45
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Monfredi O, Zhang H, Boyett MR. Letter by Monfredi et al regarding article, "Physical activity and heart rate variability in older adults: the cardiovascular health study". Circulation 2015; 131:e348. [PMID: 25691708 DOI: 10.1161/circulationaha.114.011515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Oliver Monfredi
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Henggui Zhang
- Biological Physics Group, University of Manchester, Manchester, UK
| | - Mark R Boyett
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
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46
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Quintana DS, Heathers JAJ. Considerations in the assessment of heart rate variability in biobehavioral research. Front Psychol 2014; 5:805. [PMID: 25101047 PMCID: PMC4106423 DOI: 10.3389/fpsyg.2014.00805] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/07/2014] [Indexed: 11/13/2022] Open
Abstract
Heart rate variability (HRV) refers to various methods of assessing the beat-to-beat variation in the heart over time, in order to draw inference on the outflow of the autonomic nervous system. Easy access to measuring HRV has led to a plethora of studies within emotion science and psychology assessing autonomic regulation, but significant caveats exist due to the complicated nature of HRV. Firstly, both breathing and blood pressure regulation have their own relationship to social, emotional, and cognitive experiments – if this is the case are we observing heart rate (HR) changes as a consequence of breathing changes? Secondly, experiments often have poor internal and external controls. In this review we highlight the interrelationships between HR and respiration, as well as presenting recommendations for researchers to use when collecting data for HRV assessment. Namely, we highlight the superior utility of within-subjects designs along with the importance of establishing an appropriate baseline and monitoring respiration.
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Affiliation(s)
- Daniel S Quintana
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo Oslo, Norway ; Division of Mental Health and Addiction, Oslo University Hospital Oslo, Norway
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47
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D'Souza A, Bucchi A, Johnsen AB, Logantha SJRJ, Monfredi O, Yanni J, Prehar S, Hart G, Cartwright E, Wisloff U, Dobryznski H, DiFrancesco D, Morris GM, Boyett MR. Exercise training reduces resting heart rate via downregulation of the funny channel HCN4. Nat Commun 2014; 5:3775. [PMID: 24825544 PMCID: PMC4024745 DOI: 10.1038/ncomms4775] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/01/2014] [Indexed: 12/14/2022] Open
Abstract
Endurance athletes exhibit sinus bradycardia, that is a slow resting heart rate, associated with a higher incidence of sinus node (pacemaker) disease and electronic pacemaker implantation. Here we show that training-induced bradycardia is not a consequence of changes in the activity of the autonomic nervous system but is caused by intrinsic electrophysiological changes in the sinus node. We demonstrate that training-induced bradycardia persists after blockade of the autonomous nervous system in vivo in mice and in vitro in the denervated sinus node. We also show that a widespread remodelling of pacemaker ion channels, notably a downregulation of HCN4 and the corresponding ionic current, If. Block of If abolishes the difference in heart rate between trained and sedentary animals in vivo and in vitro. We further observe training-induced downregulation of Tbx3 and upregulation of NRSF and miR-1 (transcriptional regulators) that explains the downregulation of HCN4. Our findings provide a molecular explanation for the potentially pathological heart rate adaptation to exercise training. Endurance athletes are known to have a low resting heart rate. Here, D'Souza et al. propose that training-induced bradycardia is the result of electrophysiological changes in the sinus node, challenging the classical view that training-induced bradycardia is caused by increased activity of the autonomic nervous system.
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Affiliation(s)
- Alicia D'Souza
- 1] Institute of Cardiovascular Sciences, University of Manchester, Manchester M13 9NT, UK [2]
| | - Annalisa Bucchi
- 1] Department of Biosciences, University of Milano, Milano 20133, Italy [2]
| | - Anne Berit Johnsen
- 1] Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim 7491, Norway [2]
| | - Sunil Jit R J Logantha
- 1] Institute of Cardiovascular Sciences, University of Manchester, Manchester M13 9NT, UK [2]
| | - Oliver Monfredi
- Institute of Cardiovascular Sciences, University of Manchester, Manchester M13 9NT, UK
| | - Joseph Yanni
- Institute of Cardiovascular Sciences, University of Manchester, Manchester M13 9NT, UK
| | - Sukhpal Prehar
- Institute of Cardiovascular Sciences, University of Manchester, Manchester M13 9NT, UK
| | - George Hart
- Institute of Cardiovascular Sciences, University of Manchester, Manchester M13 9NT, UK
| | - Elizabeth Cartwright
- Institute of Cardiovascular Sciences, University of Manchester, Manchester M13 9NT, UK
| | - Ulrik Wisloff
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - Halina Dobryznski
- Institute of Cardiovascular Sciences, University of Manchester, Manchester M13 9NT, UK
| | - Dario DiFrancesco
- Department of Biosciences, University of Milano, Milano 20133, Italy
| | - Gwilym M Morris
- Institute of Cardiovascular Sciences, University of Manchester, Manchester M13 9NT, UK
| | - Mark R Boyett
- Institute of Cardiovascular Sciences, University of Manchester, Manchester M13 9NT, UK
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Boyett MR, D'Souza A, Zhang H, Morris GM, Dobrzynski H, Monfredi O. Reply to Matelot, Schnell, Kervio, Thillaye du Boullay, and Carre. J Appl Physiol (1985) 2013; 114:1757. [DOI: 10.1152/japplphysiol.00391.2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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49
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Matelot D, Schnell F, Kervio G, Thillaye du Boullay N, Carré F. Athlete's bradycardia may be a multifactorial mechanism. J Appl Physiol (1985) 2013; 114:1755-6. [PMID: 23772053 DOI: 10.1152/japplphysiol.00307.2013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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