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Mastrandrea CJ, Hedge ET, Hughson RL. The Detrimental Effects of Bedrest: Premature Cardiovascular Aging and Dysfunction. Can J Cardiol 2024; 40:1468-1482. [PMID: 38759726 DOI: 10.1016/j.cjca.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
Bedrest as an experimental paradigm or as an in-patient stay for medical reasons has negative consequences for cardiovascular health. The effects of severe inactivity parallel many of the changes experienced with natural aging but over a much shorter duration. Cardiac function is reduced, arteries stiffen, neural reflex responses are impaired, and metabolic and oxidative stress responses impose burden on the heart and vascular systems. The effect of these changes is revealed in studies of integrative function. Aerobic fitness progressively deteriorates with bedrest and tolerance of upright posture is rapidly impaired. In this review we consider the similarities of aging and bedrest-induced cardiovascular deconditioning. We concur with many recent clinical recommendations that early and regular mobility with upright posture will reduce likelihood of hospital-associated disability related to bedrest.
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Affiliation(s)
- Carmelo J Mastrandrea
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada; Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Eric T Hedge
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada; Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Richard L Hughson
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada.
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Grandperrin A, Ollive P, Kretel Y, Maufrais C, Nottin S. Impact of a 16-week strength training program on physical performance, body composition and cardiac remodeling in previously untrained women and men. Eur J Sport Sci 2024; 24:474-486. [PMID: 38895874 PMCID: PMC11170668 DOI: 10.1002/ejsc.12033] [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: 02/07/2023] [Revised: 07/09/2023] [Accepted: 08/22/2023] [Indexed: 06/21/2024]
Abstract
Even if more and more women are involved in strength-training (ST) programs in fitness centers, studies on strength gain, body composition, and cardiac remodeling were mainly conducted in men and whether they are similar in women remains to be explored. In this context, the aim of our study was to assess the effect of a supervised ST program on strength gains, body composition, and cardiac remodeling in previously untrained women and men. 17 healthy and previously untrained young women and 17 young men participated in a supervised 16-week ST program built according to the recommendation of the American College of Sports Medicine in terms of intensity, and strictly using similar volume and intensity in both groups. Strength performance, body composition, and cardiac remodeling were evaluated every 4 weeks. Cardiac adaptations were assessed using resting echocardiography, including regional 2D-Strain analysis of the left atrium and ventricle (LA and LV, respectively). Despite lower values at baseline, women exhibited similar or even higher strength gains compared to men. ST induced a decrease of body and abdominal fat mass and an increase of lean body mass in both groups. Similar cardiac remodeling was observed in women, and women, including an early and progressive LV and LA enlargement throughout the ST program, without any alteration of LV diastolic and systolic functions. These findings underlie that ST programs are highly suitable for women to enhance their strength performance and their cardiovascular health.
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Buchanan C, Buchanan C, Riordan M, Byrd J, Schulte M, Kohrt WM, Ambardekar AV, Allen LA, Wolfel G, Lawley J, Levine BD, Cornwell WK. Cardiopulmonary Performance Among Heart Failure Patients Before and After Left Ventricular Assist Device Implantation. JACC. HEART FAILURE 2024; 12:117-129. [PMID: 37632493 DOI: 10.1016/j.jchf.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Patients with heart failure with reduced ejection fraction (HFrEF) have persistent impairments in functional capacity after continuous-flow left ventricular assist device (CF-LVAD) implantation. OBJECTIVES This study aims to characterize longitudinal changes in exercise hemodynamics and functional capacity among patients with HFrEF before and after CF-LVAD implantation. METHODS Ten patients underwent 3 invasive cardiopulmonary exercise tests on upright cycle ergometry with pulmonary artery catheterization: 1) Visit 1 before CF-LVAD implantation; 2) Visit 2 after device implantation with CF-LVAD pump speed held constant at baseline speed; and 3) Visit 3 with increases in pump speed during exercise (median: 1,050 rpm [IQR: 750-1,150 rpm] and 220 rpm [IQR: 120-220 rpm] for HeartMate 3 and HeartWare VAD, respectively). Hemodynamics and direct Fick cardiac output were monitored using pulmonary artery catheterization. Gas exchange metrics were determined using indirect calorimetry. RESULTS Maximal oxygen uptake (Visits 1, 2, and 3: 10.8 ± 2.5 mL/kg/min, 10.7 ± 2.2 mL/kg/min, and 11.5 ± 1.7 mL/kg/min; P = 0.92) did not improve after device implantation. Mean pulmonary arterial and pulmonary capillary wedge pressures increased significantly during submaximal and peak exercise on preimplantation testing (P < 0.01 for rest vs peak exercise) and remained elevated, with minimal change on Visits 2 and 3 regardless of whether pump speed was fixed or increased. CONCLUSIONS Among patients with HFrEF, cardiovascular hemodynamics and exercise capacity were similar after CF-LVAD implantation, regardless of whether patients exercised at fixed or adjusted pump speeds during exercise. Further research is needed to determine methods by which LVADs may alleviate the HFrEF syndrome after device implantation. (Effect of mechanIcal circulatoRy support ON exercise capacity aMong pAtieNts with heart failure [IRONMAN]; NCT03078972).
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Affiliation(s)
- Cole Buchanan
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Collen Buchanan
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maeveen Riordan
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jessica Byrd
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Margaret Schulte
- Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wendy M Kohrt
- Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Medicine-Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amrut V Ambardekar
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Larry A Allen
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gene Wolfel
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Justin Lawley
- Department of Sport Science, Division of Physiology, University of Innsbruck, Innsbruck, Austria
| | - Benjamin D Levine
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, and the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, USA
| | - William K Cornwell
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
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Shibata S, Wakeham DJ, Thomas JD, Abdullah SM, Platts S, Bungo MW, Levine BD. Cardiac Effects of Long-Duration Space Flight. J Am Coll Cardiol 2023; 82:674-684. [PMID: 37587578 DOI: 10.1016/j.jacc.2023.05.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Ventricular mass responds to changes in physical activity and loading, with cardiac hypertrophy after exercise training, and cardiac atrophy after sustained inactivity. Ventricular wall stress (ie, loading) decreases during microgravity. Cardiac atrophy does not plateau during 12 weeks of simulated microgravity but is mitigated by concurrent exercise training. OBJECTIVES The goal of this study was to determine whether the current exercise countermeasures on the International Space Station (ISS) offset cardiac atrophy during prolonged space flight. METHODS We measured left ventricular (LV) and right ventricular (RV) mass and volumes (via magnetic resonance imaging) in 13 astronauts (4 females; age 49 ± 4 years), between 75 and 60 days before and 3 days after 155 ± 31 days aboard the ISS. Furthermore, we assessed total cardiac work between 21 and 7 days before space flight and 15 days before the end of the mission. Data were compared via paired-samples t-tests. RESULTS Total cardiac work was lower during space flight (P = 0.008); however, we observed no meaningful difference in LV mass postflight (pre: 115 ± 30 g vs post: 118 ± 29 g; P = 0.053), with marginally higher LV stroke volume (P = 0.074) and ejection fraction postflight (P = 0.075). RV mass (P = 0.999), RV ejection fraction (P = 0.147), and ventricular end-diastolic (P = 0.934) and end-systolic volumes (P = 0.145) were not different postflight. There were strong positive correlations between the relative change in LV mass with the relative changes in total cardiac output (r = 0.73; P = 0.015) and total cardiac work (r = 0.53; P = 0.112). CONCLUSIONS The current exercise countermeasures used on the ISS appear effective in offsetting reductions in cardiac mass and volume, despite overall reductions in total cardiac work, during prolonged space flight.
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Affiliation(s)
- Shigeki Shibata
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Denis J Wakeham
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Michael W Bungo
- University of Texas Health Science Center, Houston, Texas, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Mastrandrea CJ, Hedge ET, Robertson AD, Heckman GA, Ho J, Granados Unger F, Hughson RL. High-intensity exercise does not protect against orthostatic intolerance following bedrest in 55- to 65-yr-old men and women. Am J Physiol Regul Integr Comp Physiol 2023; 325:R107-R119. [PMID: 37184226 DOI: 10.1152/ajpregu.00315.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/20/2023] [Accepted: 05/09/2023] [Indexed: 05/16/2023]
Abstract
Prolonged bedrest provokes orthostatic hypotension and intolerance of upright posture. Limited data are available on the cardiovascular responses of older adults to head-up tilt following bedrest, with no studies examining the potential benefits of exercise to mitigate intolerance in this age group. This randomized controlled trial of head-down bedrest (HDBR) in 55- to 65-yr-old men and women investigated if exercise could avert post-HDBR orthostatic intolerance. Twenty-two healthy older adults (11 female) underwent a strict 14-day HDBR and were assigned to either an exercise (EX) or control (CON) group. The exercise intervention included high-intensity, aerobic, and resistance exercises. Head-up tilt-testing to a maximum of 15 minutes was performed at baseline (Pre-Bedrest) and immediately after HDBR (R1), as well as 6 days (R6) and 4 weeks (R4wk) later. At Pre-Bedrest, three participants did not complete the full 15 minutes of tilt. At R1, 18 did not finish, with no difference in tilt end time between CON (422 ± 287 s) and EX (409 ± 346 s). No differences between CON and EX were observed at R6 or R4wk. At R1, just 1 participant self-terminated the test with symptoms, while 12 others reported symptoms only after physiological test termination criteria were reached. Finishers on R1 protected arterial pressure with higher total peripheral resistance relative to Pre-Bedrest. Cerebral blood velocity decreased linearly with reductions in arterial pressure, end-tidal CO2, and cardiac output. High-intensity interval exercise did not benefit post-HDBR orthostatic tolerance in older adults. Multiple factors were associated with the reduction in cerebral blood velocity leading to intolerance.
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Affiliation(s)
| | - Eric T Hedge
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- Department of Kinesiology and Health Studies, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrew D Robertson
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- Department of Kinesiology and Health Studies, University of Waterloo, Waterloo, Ontario, Canada
| | - George A Heckman
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Joanne Ho
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Federico Granados Unger
- Department of Kinesiology and Health Studies, University of Waterloo, Waterloo, Ontario, Canada
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Hoenemann JN, Moestl S, van Herwaarden AE, Diedrich A, Mulder E, Frett T, Petrat G, Pustowalow W, Arz M, Heusser K, Lee S, Jordan J, Tank J, Hoffmann F. Effects of daily artificial gravity training on orthostatic tolerance following 60-day strict head-down tilt bedrest. Clin Auton Res 2023; 33:401-410. [PMID: 37347452 PMCID: PMC10439060 DOI: 10.1007/s10286-023-00959-5] [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: 03/01/2023] [Accepted: 05/26/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Orthostatic intolerance commonly occurs following immobilization or space flight. We hypothesized that daily artificial gravity training through short-arm centrifugation could help to maintain orthostatic tolerance following head-down tilt bedrest, which is an established terrestrial model for weightlessness. METHODS We studied 24 healthy persons (eight women; age 33.3 ± 9.0 years; BMI 24.3 ± 2.1 kg/m2) who participated in the 60-days head-down tilt bedrest (AGBRESA) study. They were assigned to 30 min/day continuous or 6 × 5 min intermittent short-arm centrifugation with 1Gz at the center of mass or a control group. We performed head-up tilt testing with incremental lower-body negative pressure until presyncope before and after bedrest. We recorded an electrocardiogram, beat-to-beat finger blood pressure, and brachial blood pressure and obtained blood samples from an antecubital venous catheter. Orthostatic tolerance was defined as time to presyncope. We related changes in orthostatic tolerance to changes in plasma volume determined by carbon dioxide rebreathing. RESULTS Compared with baseline measurements, supine and upright heart rate increased in all three groups following head-down tilt bedrest. Compared with baseline measurements, time to presyncope decreased by 323 ± 235 s with continuous centrifugation, by 296 ± 508 s with intermittent centrifugation, and by 801 ± 354 s in the control group (p = 0.0249 between interventions). The change in orthostatic tolerance was not correlated with changes in plasma volume. CONCLUSIONS Daily artificial gravity training on a short-arm centrifuge attenuated the reduction in orthostatic tolerance after 60 days of head-down tilt bedrest.
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Affiliation(s)
- J-N Hoenemann
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology, and Intensive Care, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Moestl
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - A E van Herwaarden
- Laboratory Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands
| | - A Diedrich
- Department of Medicine, Division of Clinical Pharmacology, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN, USA
| | - E Mulder
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - T Frett
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - G Petrat
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - W Pustowalow
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - M Arz
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - K Heusser
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - S Lee
- NASA JSC KBR Wyle, Houston, TX, USA
| | - J Jordan
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
- Head of Aerospace Medicine, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany
| | - J Tank
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany.
| | - F Hoffmann
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology, and Intensive Care, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Ely MR, Schleifer GD, Singh TK, Baggish AL, Taylor JA. Exercise Training Does Not Attenuate Cardiac Atrophy or Loss of Function in Individuals With Acute Spinal Cord Injury: A Pilot Study. Arch Phys Med Rehabil 2023; 104:909-917. [PMID: 36572202 PMCID: PMC10247388 DOI: 10.1016/j.apmr.2022.12.001] [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: 05/16/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the effects of 2 modes of exercise training, upper-body alone, and the addition of electrical stimulation of the lower body, to attenuate cardiac atrophy and loss of function in individuals with acute spinal cord injury (SCI). DESIGN Randomized controlled trial. SETTING Rehabilitation Hospital. PARTICIPANTS Volunteers (N=27; 5 women, 22 men) who were <24 months post SCI. INTERVENTIONS Volunteers completed either 6 months of no structured exercise (Control), arm rowing (AO), or a combination of arm rowing with electrical stimulation of lower body paralyzed muscle (functional electrical stimulation [FES] rowing). MAIN OUTCOME MEASURES Transthoracic echocardiography was performed on each subject prior to and 6 months after the intervention. The relations between time since injury and exercise type to cardiac structure and function were assessed via 2-way repeated-measures analysis of variance and with multilevel linear regression. RESULTS Time since injury was significantly associated with a continuous decline in cardiac structure and systolic function, specifically, a reduction in left ventricular mass (0.197 g/month; P=.049), internal diameter during systole (0.255 mm/month; P<.001), and diastole (0.217 mm/month; P=.019), as well as cardiac output (0.048 L/month, P=.019), and left ventricular percent shortening (0.256 %/month; P=.027). These associations were not differentially affected by exercise (Control vs AO vs FES, P>.05). CONCLUSIONS These results indicate that within the subacute phase of recovery from SCI there is a linear loss of left ventricular cardiac structure and systolic function that is not attenuated by current rehabilitative aerobic exercise practices. Reductions in cardiac structure and function may increase the risk of cardiovascular disease in individuals with SCI and warrants further interventions to prevent cardiac decline.
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Affiliation(s)
- Matthew R Ely
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Cambridge, MA.
| | - Grant D Schleifer
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Cambridge, MA
| | - Tamanna K Singh
- Cardiovascular Performance Program, Harvard Medical School, Cambridge, MA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Harvard Medical School, Cambridge, MA
| | - J Andrew Taylor
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Cambridge, MA
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Murgoci N. Comparative study on the efficiency of motor rehabilitation of the lower limbs using a stationary horizontal bicycle versus a standard therapeutic program. BALNEO AND PRM RESEARCH JOURNAL 2022. [DOI: 10.12680/balneo.2022.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract: The purpose of the present study is to compare the efficiency of two physiother-apeutic programs for rehabilitation of the lower limbs, one using a stationary bicycle and the other one being a standard program, targeting muscle imbalance deficit. Subjects are outpatients - the control group (C n=5), 58.67 ± 11.67 years, received a standard rehabilita-tion program, and the experimental group (E n=5), 56.67 ± 12.14 years, received a pro-posed rehabilitation program implying a stationary bicycle. Equipment used is for muscle imbalances – sensor attached to bicycle pedals, for joint testing – goniometer, for heart rate smart watch, pain assessment – VAS numeric scale, and for perceived effort Borg scale. The rehabilitation program including the stationary horizontal bicycle obtained better re-sults in terms of pain control (T-Test p C/E=.004/.001 and Wilcoxon p C/E=.039/.041) and the correction of muscular imbalances (T-Test p C/E=.003/.000, r= .990/.997) related to the lower limbs, with the mention that both programs recorded statistically significant results regarding functionality. HR values for the control group and experimental group < THR values, aerobic conditioning with the submaximal effort being essential for rehabilitation. Both programs maintained the same perceived level of effort with an average of 3.6 Borg- moderate effort, respectively mild-moderate dyspnea.
Keywords: rehabilitation; lower limbs; stationary bicycle; muscle imbalance; pedal sensor; ana-log value; heart rate (HR); target heart rate (THR).
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Affiliation(s)
- Nicolae Murgoci
- “Dunărea de Jos” University, Faculty of Physical Education and Sports, Department of Indi-vidual Sports and Kinetotherapy, 63-65 Gării Street, Galați, Romania
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Robin A, Wang L, Custaud MA, Liu J, Yuan M, Li Z, Lloret JC, Liu S, Dai X, Zhang J, Lv K, Li W, Gauquelin-Koch G, Wang H, Li K, Li X, Qu L, Navasiolava N, Li Y. Running vs. resistance exercise to counteract deconditioning induced by 90-day head-down bedrest. Front Physiol 2022; 13:902983. [PMID: 36117704 PMCID: PMC9473647 DOI: 10.3389/fphys.2022.902983] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Spaceflight is associated with enhanced inactivity, resulting in muscular and cardiovascular deconditioning. Although physical exercise is commonly used as a countermeasure, separate applications of running and resistive exercise modalities have never been directly compared during long-term bedrest. This study aimed to compare the effectiveness of two exercise countermeasure programs, running and resistance training, applied separately, for counteracting cardiovascular deconditioning induced by 90-day head-down bedrest (HDBR). Maximal oxygen uptake (V˙O2max), orthostatic tolerance, continuous ECG and blood pressure (BP), body composition, and leg circumferences were measured in the control group (CON: n = 8), running exercise group (RUN: n = 7), and resistive exercise group (RES: n = 7). After HDBR, the decrease in V˙O2max was prevented by RUN countermeasure and limited by RES countermeasure (−26% in CON p < 0.05, −15% in RES p < 0.05, and −4% in RUN ns). Subjects demonstrated surprisingly modest orthostatic tolerance decrease for different groups, including controls. Lean mass loss was limited by RES and RUN protocols (−10% in CON vs. −5% to 6% in RES and RUN). Both countermeasures prevented the loss in thigh circumference (−7% in CON p < 0.05, −2% in RES ns, and −0.6% in RUN ns) and limited loss in calf circumference (−10% in CON vs. −7% in RES vs. −5% in RUN). Day–night variations in systolic BP were preserved during HDBR. Decrease in V˙O2max positively correlated with decrease in thigh (r = 0.54 and p = 0.009) and calf (r = 0.52 and p = 0.012) circumferences. During this 90-day strict HDBR, running exercise successfully preserved V˙O2max, and resistance exercise limited its decline. Both countermeasures limited loss in global lean mass and leg circumferences. The V˙O2max reduction seems to be conditioned more by muscular than by cardiovascular parameters.
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Affiliation(s)
- Adrien Robin
- Univ Angers, CHU Angers, CRC, INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, Angers, France
| | - Linjie Wang
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Marc-Antoine Custaud
- Univ Angers, CHU Angers, CRC, INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, Angers, France
| | - Jiexin Liu
- Beijing Tiantan Hospital, Medical Capital University, Beijing, China
| | - Min Yuan
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Zhili Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | | | - Shujuan Liu
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Xiaoqian Dai
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Jianfeng Zhang
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Ke Lv
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Wenjiong Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | | | - Huijuan Wang
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Kai Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Xiaotao Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Lina Qu
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Nastassia Navasiolava
- Univ Angers, CHU Angers, CRC, INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, Angers, France
- *Correspondence: Nastassia Navasiolava, ; Yinghui Li,
| | - Yinghui Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
- *Correspondence: Nastassia Navasiolava, ; Yinghui Li,
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Hedge ET, Patterson CA, Mastrandrea CJ, Sonjak V, Hajj-Boutros G, Faust A, Morais JA, Hughson RL. Implementation of exercise countermeasures during spaceflight and microgravity analogue studies: Developing countermeasure protocols for bedrest in older adults (BROA). Front Physiol 2022; 13:928313. [PMID: 36017336 PMCID: PMC9395735 DOI: 10.3389/fphys.2022.928313] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/27/2022] [Indexed: 12/18/2022] Open
Abstract
Significant progress has been made in the development of countermeasures to attenuate the negative consequences of prolonged exposure to microgravity on astronauts’ bodies. Deconditioning of several organ systems during flight includes losses to cardiorespiratory fitness, muscle mass, bone density and strength. Similar deconditioning also occurs during prolonged bedrest; any protracted time immobile or inactive, especially for unwell older adults (e.g., confined to hospital beds), can lead to similar detrimental health consequences. Due to limitations in physiological research in space, the six-degree head-down tilt bedrest protocol was developed as ground-based analogue to spaceflight. A variety of exercise countermeasures have been tested as interventions to limit detrimental changes and physiological deconditioning of the musculoskeletal and cardiovascular systems. The Canadian Institutes of Health Research and the Canadian Space Agency recently provided funding for research focused on Understanding the Health Impact of Inactivity to study the efficacy of exercise countermeasures in a 14-day randomized clinical trial of six-degree head-down tilt bedrest study in older adults aged 55–65 years old (BROA). Here we will describe the development of a multi-modality countermeasure protocol for the BROA campaign that includes upper- and lower-body resistance exercise and head-down tilt cycle ergometry (high-intensity interval and continuous aerobic exercise training). We provide reasoning for the choice of these modalities following review of the latest available information on exercise as a countermeasure for inactivity and spaceflight-related deconditioning. In summary, this paper sets out to review up-to-date exercise countermeasure research from spaceflight and head-down bedrest studies, whilst providing support for the proposed research countermeasure protocols developed for the bedrest study in older adults.
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Affiliation(s)
- Eric T. Hedge
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Vita Sonjak
- Research Institute of McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Guy Hajj-Boutros
- Research Institute of McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Andréa Faust
- Research Institute of McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - José A. Morais
- Research Institute of McGill University Health Centre, McGill University, Montréal, QC, Canada
- Division of Geriatric Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Richard L. Hughson
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada
- *Correspondence: Richard L. Hughson,
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11
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Petek BJ, Groezinger EY, Pedlar CR, Baggish AL. Cardiac effects of detraining in athletes: A narrative review. Ann Phys Rehabil Med 2021; 65:101581. [PMID: 34624549 DOI: 10.1016/j.rehab.2021.101581] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/12/2021] [Accepted: 08/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Routine physical activity stimulates numerous morphologic and functional adaptations of the cardiac system, which are commonly referred to as exercise-induced cardiac remodeling (EICR). EICR has been well documented in elite and recreational athletes, but comparatively little is known about the "reverse" cardiac adaptations during detraining in an athletic population. OBJECTIVE To assess the morphologic and functional cardiac effects of detraining in athletes. METHODS Eligible studies were identified in PubMed from inception to May 2020. Studies were included if they assessed the cardiac effects of detraining periods in athletes. RESULTS A total of 16 studies from the literature search were identified and included in this review. These studies included athletes from multiple different sporting disciplines and detraining periods ranged from 3 weeks to 13 years. Detraining periods led to significantly decreased right ventricular and left (LV) ventricular dimensions, LV mass, and LV wall thickness, but only limited changes in systolic and diastolic functional parameters were observed. CONCLUSIONS From the limited data available in this population, cardiac atrophy has been observed with short periods of detraining (1-8 weeks) but often spares systolic and diastolic heart function. Supplemental exercise training during times of rehabilitation to combat cardiac regression has not been vigorously studied in athletes, so the ideal frequency, intensity, and modality of exercise needed to maintain EICR remains unclear.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
| | - Erich Y Groezinger
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, United States
| | - Charles R Pedlar
- Faculty of Sport, Health and Applied Science, St. Mary's University, Twickenham, United Kingdom
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, United States.
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12
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Shibata S, Hirabuki K, Hata N, Suzuki R, Suda T, Uechi T, Hirasawa A. Pivotal Role of Heart for Orthostasis: Left Ventricular Untwisting Mechanics and Physical Fitness. Exerc Sport Sci Rev 2021; 49:88-98. [PMID: 33720910 DOI: 10.1249/jes.0000000000000247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Augmentation of left ventricular (LV) untwisting due to central hypovolemia is likely to be a compensatory mechanism for maintaining stroke volume, which is reduced by a decrease in cardiac filling during orthostatic stress. Orthostatic intolerance observed in both high and low fitness levels may be explained by the impaired response of LV untwisting due to central hypovolemia.
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Affiliation(s)
| | | | | | - Rina Suzuki
- Emergency Department, Kyorin University Hospital
| | - Tomoya Suda
- Emergency Department, Kyorin University Hospital
| | | | - Ai Hirasawa
- Department of Health and Welfare, Faculty of Health Sciences, Kyorin University, Tokyo, Japan
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13
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Ganse B, Bosutti A, Drey M, Degens H. Sixty days of head-down tilt bed rest with or without artificial gravity do not affect the neuromuscular secretome. Exp Cell Res 2020; 399:112463. [PMID: 33385417 DOI: 10.1016/j.yexcr.2020.112463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 01/13/2023]
Abstract
Artificial gravity is a potential countermeasure to attenuate effects of weightlessness during long-term spaceflight, including losses of muscle mass and function, possibly to some extent attributable to disturbed neuromuscular interaction. The 60-day AGBRESA bed-rest study was conducted with 24 participants (16 men, 8 women; 33 ± 9 years; 175 ± 9 cm; 74 ± 10 kg; 8 control group, 8 continuous (cAG) and 8 intermittent (iAG) centrifugation) to assess the impact of bed rest with or without daily 30-min continuous/intermittent centrifugation with 1G at the centre of mass. Fasting blood samples were collected before and on day 6, 20, 40 and 57 during 6° head-down tilt bed rest. Concentrations of circulating markers of muscle wasting (GDF-8/myostatin; slow skeletal muscle troponin T; prostaglandin E2), neurotrophic factors (BDNF; GDNF) and C-terminal Agrin Fragment (CAF) were determined by ELISAs. Creatine kinase activity was assessed by colorimetric enzyme assay. Repeated-measures ANOVAs were conducted with TIME as within-subject, and INTERVENTION and SEX as between-subject factors. The analyses revealed no significant effect of bed rest or sex on any of the parameters. Continuous or intermittent artificial gravity is a safe intervention that does not have a negative impact of the neuromuscular secretome.
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Affiliation(s)
- Bergita Ganse
- Manchester Metropolitan University, Research Centre for Musculoskeletal Science & Sports Medicine, Faculty of Science and Engineering, John Dalton Building, Manchester, United Kingdom.
| | | | - Michael Drey
- Department of Medicine IV, Geriatrics, University Hospital of LMU Munich, Munich, Germany
| | - Hans Degens
- Manchester Metropolitan University, Research Centre for Musculoskeletal Science & Sports Medicine, Faculty of Science and Engineering, John Dalton Building, Manchester, United Kingdom; Lithuanian Sports University, Institute of Sport Science and Innovations, Kaunas, Lithuania
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14
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Rabineau J, Hossein A, Landreani F, Haut B, Mulder E, Luchitskaya E, Tank J, Caiani EG, van de Borne P, Migeotte PF. Cardiovascular adaptation to simulated microgravity and countermeasure efficacy assessed by ballistocardiography and seismocardiography. Sci Rep 2020; 10:17694. [PMID: 33077727 PMCID: PMC7573608 DOI: 10.1038/s41598-020-74150-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Head-down bed rest (HDBR) reproduces the cardiovascular effects of microgravity. We tested the hypothesis that regular high-intensity physical exercise (JUMP) could prevent this cardiovascular deconditioning, which could be detected using seismocardiography (SCG) and ballistocardiography (BCG). 23 healthy males were exposed to 60-day HDBR: 12 in a physical exercise group (JUMP), the others in a control group (CTRL). SCG and BCG were measured during supine controlled breathing protocols. From the linear and rotational SCG/BCG signals, the integral of kinetic energy ([Formula: see text]) was computed on each dimension over the cardiac cycle. At the end of HDBR, BCG rotational [Formula: see text] and SCG transversal [Formula: see text] decreased similarly for all participants (- 40% and - 44%, respectively, p < 0.05), and so did orthostatic tolerance (- 58%, p < 0.01). Resting heart rate decreased in JUMP (- 10%, p < 0.01), but not in CTRL. BCG linear [Formula: see text] decreased in CTRL (- 50%, p < 0.05), but not in JUMP. The changes in the systolic component of BCG linear iK were correlated to those in stroke volume and VO2 max (R = 0.44 and 0.47, respectively, p < 0.05). JUMP was less affected by cardiovascular deconditioning, which could be detected by BCG in agreement with standard markers of the cardiovascular condition. This shows the potential of BCG to easily monitor cardiac deconditioning.
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Affiliation(s)
- Jeremy Rabineau
- LPHYS, Université Libre de Bruxelles, Brussels, Belgium. .,TIPs, Université Libre de Bruxelles, Brussels, Belgium.
| | - Amin Hossein
- LPHYS, Université Libre de Bruxelles, Brussels, Belgium
| | - Federica Landreani
- Electronic, Information and Biomedical Engineering Department, Politecnico Di Milano, Milan, Italy
| | - Benoit Haut
- TIPs, Université Libre de Bruxelles, Brussels, Belgium
| | - Edwin Mulder
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Elena Luchitskaya
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Enrico G Caiani
- Electronic, Information and Biomedical Engineering Department, Politecnico Di Milano, Milan, Italy
| | - Philippe van de Borne
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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15
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Guinet P, MacNamara JP, Berry M, Larcher F, Bareille MP, Custaud MA, Pavy-Le Traon A, Levine BD, Navasiolava N. MNX (Medium Duration Nutrition and Resistance-Vibration Exercise) Bed-Rest: Effect of Resistance Vibration Exercise Alone or Combined With Whey Protein Supplementation on Cardiovascular System in 21-Day Head-Down Bed Rest. Front Physiol 2020; 11:812. [PMID: 32765296 PMCID: PMC7378749 DOI: 10.3389/fphys.2020.00812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022] Open
Abstract
Current inflight countermeasures do not completely prevent bone and cardiovascular changes induced by microgravity. High load Resistance Exercise combined with whole body Vibration (RVE) demonstrated benefits on bone and cardiovascular system during previous Head-Down Bed Rest (HDBR) studies. We examined the effectiveness of RVE alone or combined with a nutritional supplementation of Whey protein (NeX) on cardiovascular deconditioning. Eight male subjects (age 34 ± 8 years) in a crossover design completed three 21-day HDBR campaigns (Control-CON, RVE, and NeX). Pre and post HDBR Orthostatic Tolerance (OT) was evaluated by a 15-min head-up tilt test followed by increasing levels of Lower Body Negative Pressure (LBNP). Heart rate (HR), blood pressure (BP), and Sympathetic Index (ΣI) through spectral analysis were measured during OT test. Plasma Volume (PV), and Maximal Oxygen Uptake (VO2max) were measured before and after each campaign. Left ventricular mass, left ventricular end diastolic (LVEDV), end systolic (LVESV), stroke (SV) volumes, and circumferential deformation at rest and during an orthostatic stress simulated by a 30 mmHg LBNP were measured by cardiac MRI. RVE failed to prevent any change in these variables and NeX did not have any additional effect over exercise alone. In the 3 groups, (1) OT time dropped similarly (bed rest p < 0.001), (2) HR and ΣI were increased at rest at the end of HDBR and HR increased markedly during LBNP-tilt test, with inability to increase further the ΣI, (3) PV dropped (bed rest p < 0.001), along with LVEDV, LVESV and SV (p = 0.08, p < 0.001, and p = 0.045, respectively), (4) Left ventricle mass did not change significantly, (5) Deformation of the heart assessed by global circumferential strain was preserved and early diastolic circumferential strain rate was increased during orthostatic stress at the end of HDBR, illustrating preserved systolic and diastolic function respectively, without any difference between groups. Despite the drop in PV and LV volumes, RVE and NeX tended to alleviate the decrease in VO2max. In conclusion, RVE and NeX failed to prevent the cardiovascular deconditioning induced by a 21 day-HDBR.
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Affiliation(s)
- Patrick Guinet
- Département d’Anesthésie Réanimation, Centre Hospitalier Universitaire de Rennes, Rennes, France
- Centre Hospitalier de Fougères, Fougères, France
| | - James Patrick MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | | | - Françoise Larcher
- Laboratoire de Biochimie, Centre Hospitalier Universitaire d’Angers, Angers, France
| | | | - Marc-Antoine Custaud
- Centre de Recherche Clinique, Centre Hospitalier Universitaire d’Angers, Angers, France
- Mitovasc UMR INSERM 1083-CNRS 6015, Université d’Angers, Angers, France
| | - Anne Pavy-Le Traon
- Department of Neurology, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France
- Institute of Cardiovascular and Metabolic Diseases INSERM U 1048, Toulouse, France
| | - Benjamin D. Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Nastassia Navasiolava
- Centre de Recherche Clinique, Centre Hospitalier Universitaire d’Angers, Angers, France
- Mitovasc UMR INSERM 1083-CNRS 6015, Université d’Angers, Angers, France
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16
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Sarafis ZK, Monga AK, Phillips AA, Krassioukov AV. Is Technology for Orthostatic Hypotension Ready for Primetime? PM R 2019; 10:S249-S263. [PMID: 30269810 DOI: 10.1016/j.pmrj.2018.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 01/29/2023]
Abstract
Spinal cord injury (SCI) often results in the devastating loss of motor, sensory, and autonomic function. After SCI, the interruption of descending sympathoexcitatory pathways disrupts supraspinal control of blood pressure (BP). A common clinical consequence of cardiovascular dysfunction after SCI is orthostatic hypotension (OH), a debilitating condition characterized by rapid profound decreases in BP when assuming an upright posture. OH can result in a diverse array of insidious and pernicious health consequences. Acute effects of OH include decreased cardiac filling, cerebral hypoperfusion, and associated presyncopal symptoms such as lightheadedness and dizziness. Over the long term, repetitive exposure to OH is associated with a drastically increased prevalence of heart attack and stroke, which are leading causes of death in those with SCI. Current recommendations for managing BP after SCI primarily include pharmacologic interventions with prolonged time to effect. Because most episodes of OH occur in less than 3 minutes, this delay in action often renders most pharmacologic interventions ineffective. New innovative technologies such as epidural and transcutaneous spinal cord stimulation are being explored to solve this problem. It might be possible to electrically stimulate sympathetic circuitry caudal to the injury and elicit rapid modulation of BP to manage OH. This review describes autonomic control of the cardiovascular system before injury, resulting cardiovascular consequences after SCI such as OH, and the clinical assessment tools for evaluating autonomic dysfunction after SCI. In addition, current approaches for clinically managing OH are outlined, and new promising interventions are described for managing this condition.
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Affiliation(s)
- Zoe K Sarafis
- ICORD-BSCC, University of British Columbia, Vancouver, BC, Canada(∗)
| | - Aaron K Monga
- ICORD-BSCC, University of British Columbia, Vancouver, BC, Canada(†)
| | - Aaron A Phillips
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada(‡)
| | - Andrei V Krassioukov
- ICORD-BSCC; Experimental Medicine Program; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia; GF Strong Rehabilitation Center, Vancouver Coastal Health; 818 West 10th Avenue, Vancouver, BC, Canada, V5Z1M9(§).
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17
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Fu Q, Shibata S, Hastings JL, Platts SH, Hamilton DM, Bungo MW, Stenger MB, Ribeiro C, Adams-Huet B, Levine BD. Impact of Prolonged Spaceflight on Orthostatic Tolerance During Ambulation and Blood Pressure Profiles in Astronauts. Circulation 2019; 140:729-738. [DOI: 10.1161/circulationaha.119.041050] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background:
Astronauts returning to earth usually demonstrate reduced orthostatic tolerance when assessed on a tilt table or quiet standing, but no studies have evaluated postflight orthostatic tolerance during activities of daily living, when it is most clinically relevant. Ambulatory blood pressure (BP) variability also is associated with orthostatic intolerance in certain patient populations and can capture clinically significant orthostatic hypotension during activities of daily living, especially when measured on a beat-to-beat basis. We evaluated the impact of prolonged spaceflight on orthostatic tolerance and BP profiles in astronauts.
Methods:
Ambulatory beat-to-beat BP was recorded using a portable device for multiple 24-hour time periods before, during, and after 6 months of spaceflight in 12 astronauts (4 women; age 48±5 [mean±SD] years). BP variability in the time domain was calculated as the SD. Systolic BP distribution during activities of daily living was characterized by skewness and kurtosis.
Results:
In contrast with results from previous studies that used tilt tables or stand tests, no astronaut experienced orthostatic intolerance/hypotension during activities of daily living before or after spaceflight. Also, 24-hour systolic BP decreased in space (120±10 mm Hg before spaceflight versus 106±9 mm Hg during spaceflight;
P
<0.01), but it returned to normal upon landing (122±13 mm Hg). Diastolic BP was unchanged during and after spaceflight. Systolic and diastolic BP variability remained the same before, during, and after spaceflight (both
P
>0.05). The skewness of systolic BP increased in space (0.74±0.51 versus 1.43±1.00;
P
=0.001), indicating that signal fluctuations became asymmetrical; however, it returned to preflight levels after landing (0.51±0.42). The kurtosis increased in space (5.01±7.67 versus 11.10±11.79;
P
=0.010), suggesting that fluctuations concentrated around the mean with a narrow distribution; however, it also returned to preflight levels (2.21±2.56) after return to earth.
Conclusions:
Given current countermeasures including in-flight exercise training and volume resuscitation on return, no astronauts experienced orthostatic hypotension or intolerance during routine (for landing day) activities in the initial 24 hours after landing following 6 months in space. Prolonged exposure to spaceflight had little impact on systolic BP variability and its distribution, although the latter showed a transient change in space (accompanied by mild relative hypotension), all of which returned to preflight values after return to earth.
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Affiliation(s)
- Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (Q.F., S.S., B.D.L.)
- The University of Texas Southwestern Medical Center, Dallas (Q.F., S.S., J.L.H., B.A.-H., B.D.L.)
| | - Shigeki Shibata
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (Q.F., S.S., B.D.L.)
- The University of Texas Southwestern Medical Center, Dallas (Q.F., S.S., J.L.H., B.A.-H., B.D.L.)
| | - Jeffrey L. Hastings
- The University of Texas Southwestern Medical Center, Dallas (Q.F., S.S., J.L.H., B.A.-H., B.D.L.)
| | - Steven H. Platts
- NASA Johnson Space Center, Houston, TX (S.H.P., D.M.H., M.B.S., C.R.)
| | - Douglas M. Hamilton
- NASA Johnson Space Center, Houston, TX (S.H.P., D.M.H., M.B.S., C.R.)
- The University of Calgary, Alberta, Canada (D.M.H.)
| | - Michael W. Bungo
- The University of Texas McGovern Medical School, Houston (M.W.B.)
| | | | - Christine Ribeiro
- NASA Johnson Space Center, Houston, TX (S.H.P., D.M.H., M.B.S., C.R.)
| | - Beverley Adams-Huet
- The University of Texas Southwestern Medical Center, Dallas (Q.F., S.S., J.L.H., B.A.-H., B.D.L.)
| | - Benjamin D. Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (Q.F., S.S., B.D.L.)
- The University of Texas Southwestern Medical Center, Dallas (Q.F., S.S., J.L.H., B.A.-H., B.D.L.)
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18
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Scott JM, Martin D, Ploutz-Snyder R, Downs M, Dillon EL, Sheffield-Moore M, Urban RJ, Ploutz-Snyder LL. Efficacy of Exercise and Testosterone to Mitigate Atrophic Cardiovascular Remodeling. Med Sci Sports Exerc 2019; 50:1940-1949. [PMID: 29570536 DOI: 10.1249/mss.0000000000001619] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Early and consistent evaluation of cardiac morphology and function throughout an atrophic stimulus is critically important for the design and optimization of interventions. This randomized controlled trial was designed 1) to characterize the time course of unloading-induced morphofunctional remodeling and 2) to examine the effects of exercise with and without low-dose testosterone supplementation on cardiac biomarker, structural, and functional parameters during unloading. METHODS Twenty-six subjects completed 70 d of head-down tilt bed rest (BR): 9 were randomized to exercise training (Ex), 8 to EX and low-dose testosterone (ExT), and 9 remained sedentary (CONT). Exercise consisted of high-intensity, continuous, and resistance exercise. Cardiac morphology (left ventricular mass [LVM]) and mechanics (longitudinal, radial, and circumferential strain and twist), cardiovascular biomarkers, and cardiorespiratory fitness (V˙O2peak) were assessed before, during, and after BR. RESULTS Sedentary BR resulted in a progressive decline in LVM, longitudinal, radial, and circumferential strain in CONT, whereas Ex and ExT mitigated decreases in LVM and function. Twist was increased throughout BR in sedentary BR, whereas after an initial increase at BR7, there were no further changes in twist in Ex and ExT. HDL cholesterol was significantly decreased in all groups compared with pre-BR (P < 0.007). There were no significant changes in other cardiovascular biomarkers. Change in twist was significantly related to change in V˙O2max (R = 0.68, P < 0.01). CONCLUSION An integrated approach with evaluation of cardiac morphology, mechanics, V˙O2peak, and biomarkers provides extensive phenotyping of cardiovascular atrophic remodeling. Exercise training and exercise training with low-dose testosterone supplementation abrogates atrophic remodeling.
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19
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Maggioni MA, Castiglioni P, Merati G, Brauns K, Gunga HC, Mendt S, Opatz OS, Rundfeldt LC, Steinach M, Werner A, Stahn AC. High-Intensity Exercise Mitigates Cardiovascular Deconditioning During Long-Duration Bed Rest. Front Physiol 2018; 9:1553. [PMID: 30510516 PMCID: PMC6252355 DOI: 10.3389/fphys.2018.01553] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 10/16/2018] [Indexed: 02/02/2023] Open
Abstract
Head-down-tilt bed rest (HDT) mimics the changes in hemodynamics and autonomic cardiovascular control induced by weightlessness. However, the time course and reciprocal interplay of these adaptations, and the effective exercise protocol as a countermeasure need further clarification. The overarching aim of this work (as part of a European Space Agency sponsored long-term bed rest study) was therefore to evaluate the time course of cardiovascular hemodynamics and autonomic control during prolonged HDT and to assess whether high-intensity, short-duration exercise could mitigate these effects. A total of n = 23 healthy, young, male participants were randomly allocated to two groups: training (TRAIN, n = 12) and non-training (CTRL, n = 11) before undergoing a 60-day HDT. The TRAIN group underwent a resistance training protocol using reactive jumps (5–6 times per week), whereas the CTRL group did not perform countermeasures. Finger blood pressure (BP), heart rate (HR), and stroke volume were collected beat-by-beat for 10 min in both sitting and supine positions 7 days before HDT (BDC−7) and 10 days after HDT (R+10), as well as on the 2nd (HDT2), 28th (HDT28), and 56th (HDT56) day of HDT. We investigated (1) the isolated effects of long-term HDT by comparing all the supine positions (including BDC−7 and R+10 at 0 degrees), and (2) the reactivity of the autonomic response before and after long-term HDT using a specific postural stimulus (i.e., supine vs. sitting). Two-factorial linear mixed models were used to assess the time course of HDT and the effect of the countermeasure. Starting from HDT28 onwards, HR increased (p < 0.02) and parasympathetic tone decreased exclusively in the CTRL group (p < 0.0001). Moreover, after 60-day HDT, CTRL participants showed significant impairments in increasing cardiac sympathovagal balance and controlling BP levels during postural shift (supine to sitting), whereas TRAIN participants did not. Results show that a 10-day recovery did not compensate for the cardiovascular and autonomic deconditioning following 60-day HDT. This has to be considered when designing rehabilitation programs—not only for astronauts but also in general public healthcare. High-intensity, short-duration exercise training effectively minimized these impairments and should therefore deserve consideration as a cardiovascular deconditioning countermeasure for spaceflight.
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Affiliation(s)
- Martina A Maggioni
- Charité-Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | | | - Giampiero Merati
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Katharina Brauns
- Charité-Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Hanns-Christian Gunga
- Charité-Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Stefan Mendt
- Charité-Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Oliver S Opatz
- Charité-Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Lea C Rundfeldt
- Charité-Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Mathias Steinach
- Charité-Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Anika Werner
- Charité-Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany.,Université de Normandie, INSERM U 1075 COMETE, Caen, France
| | - Alexander C Stahn
- Charité-Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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20
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Fu Q, Levine BD. Exercise and non-pharmacological treatment of POTS. Auton Neurosci 2018; 215:20-27. [PMID: 30001836 DOI: 10.1016/j.autneu.2018.07.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/29/2018] [Accepted: 07/01/2018] [Indexed: 12/11/2022]
Abstract
Recent research has demonstrated that cardiovascular deconditioning (i.e., cardiac atrophy and hypovolemia) contributes significantly to the Postural Orthostatic Tachycardia Syndrome (POTS) and its functional disability. Therefore, physical reconditioning with exercise training and volume expansion via increased salt and fluid intake should be initiated early in the course of treatment for patients with POTS if possible. The use of horizontal exercise (e.g., rowing, swimming, recumbent bike, etc.) at the beginning is a critical strategy, allowing patients to exercise while avoiding the upright posture that elicits their POTS symptoms. As patients become increasingly fit, the duration and intensity of exercise should be progressively increased, and upright exercise can be gradually added as tolerated. Supervised training is preferable to maximize functional capacity. Other non-pharmacological interventions, which include: 1) chronic volume expansion via sleeping in the head-up position; 2) reduction in venous pooling during orthostasis by lower body compression garments extending at least to the xiphoid or with an abdominal binder; and 3) physical countermeasure maneuvers, such as squeezing a rubber ball, leg crossing, muscle pumping, squatting, negative-pressure breathing, etc., may also be effective in preventing orthostatic intolerance and managing acute clinical symptoms in POTS patients. However, randomized clinical trials are needed to evaluate the efficacies of these non-pharmacological treatments of POTS.
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Affiliation(s)
- Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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21
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Ried-Larsen M, Aarts HM, Joyner MJ. Effects of strict prolonged bed rest on cardiorespiratory fitness: systematic review and meta-analysis. J Appl Physiol (1985) 2017; 123:790-799. [DOI: 10.1152/japplphysiol.00415.2017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/29/2017] [Accepted: 07/07/2017] [Indexed: 12/29/2022] Open
Abstract
The aim of this systematic review and meta-analysis [International Prospective Register of Systematic Reviews (PROSPERO) CRD42017055619] was to assess the effects of strict prolonged bed rest (without countermeasures) on maximal oxygen uptake (V̇o2max) and to explore sources of variation therein. Since 1949, 80 studies with a total of 949 participants (>90% men) have been published with data on strict bed rest and V̇o2max. The studies were conducted mainly in young participants [median age (interquartile range) 24.5 (22.4–34.0) yr]. The duration of bed rest ranged from 1 to 90 days. V̇o2max declined linearly across bed rest duration. No statistical difference in the decline among studies reporting V̇o2max as l/min (−0.3% per day) compared with studies reporting V̇o2max normalized to body weight (ml·kg−1·min−1; −0.43% per day) was observed. Although both total body weight and lean body mass declined in response to bed rest, we did not see any associations with the decline in V̇o2max. However, 15–26% of the variation in the decline in V̇o2max was explained by the pre-bed-rest V̇o2max levels, independent of the duration of bed rest (i.e., higher pre-bed-rest V̇o2max levels were associated with larger declines in V̇o2max). Furthermore, the systematic review revealed a gap in the knowledge about the cardiovascular response to extreme physical inactivity, particularly in older subjects and women of any age group. In addition to its relevance to spaceflight, this lack of data has significant translational implications because younger women sometimes undergo prolonged periods of bed rest associated with the complications of pregnancy and the incidence of hospitalization including prolonged periods of bed rest increases with age. NEW & NOTEWORTHY Large interindividual responses of maximal oxygen uptake (V̇o2max) to aerobic exercise training exist. However, less is known about the variability in the response of V̇o2max to prolonged bed rest. This systematic review and meta-analysis showed that pre-bed-rest V̇o2max values were inversely associated with the change in V̇o2max independent of the duration of bed rest. Moreover, we identified a large knowledge gap about the causes of decline in V̇o2max, particularly in postmenopausal women, which may have clinical implications.
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Affiliation(s)
- Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark; and
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hugo M. Aarts
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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22
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Ade CJ, Broxterman RM, Moore AD, Barstow TJ. Decreases in maximal oxygen uptake following long-duration spaceflight: Role of convective and diffusive O 2 transport mechanisms. J Appl Physiol (1985) 2017; 122:968-975. [PMID: 28153941 DOI: 10.1152/japplphysiol.00280.2016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 12/19/2016] [Accepted: 01/19/2017] [Indexed: 01/22/2023] Open
Abstract
We have previously predicted that the decrease in maximal oxygen uptake (V̇o2max) that accompanies time in microgravity reflects decrements in both convective and diffusive O2 transport to the mitochondria of the contracting myocytes. The aim of this investigation was therefore to quantify the relative changes in convective O2 transport (Q̇o2) and O2 diffusing capacity (Do2) following long-duration spaceflight. In nine astronauts, resting hemoglobin concentration ([Hb]), V̇o2max, maximal cardiac output (Q̇Tmax), and differences in arterial and venous O2 contents ([Formula: see text]-[Formula: see text]) were obtained retrospectively for International Space Station Increments 19-33 (April 2009-November 2012). Q̇o2 and Do2 were calculated from these variables via integration of Fick's Principle of Mass Conservation and Fick's Law of Diffusion. V̇o2max significantly decreased from pre- to postflight (-53.9 ± 45.5%, P = 0.008). The significant decrease in Q̇Tmax (-7.8 ± 9.1%, P = 0.05), despite an unchanged [Hb], resulted in a significantly decreased Q̇o2 (-11.4 ± 10.5%, P = 0.02). Do2 significantly decreased from pre- to postflight by -27.5 ± 24.5% (P = 0.04), as did the peak [Formula: see text]-[Formula: see text] (-9.2 ± 7.5%, P = 0.007). With the use of linear regression analysis, changes in V̇o2max were significantly correlated with changes in Do2 (R2 = 0.47; P = 0.04). These data suggest that spaceflight decreases both convective and diffusive O2 transport. These results have practical implications for future long-duration space missions and highlight the need to resolve the specific mechanisms underlying these spaceflight-induced changes along the O2 transport pathway.NEW & NOTEWORTHY Long-duration spaceflight elicited a significant decrease in maximal oxygen uptake. Given the adverse physiological adaptations to microgravity along the O2 transport pathway that have been reported, an integrative approach to the determinants of postflight maximal oxygen uptake is needed. We demonstrate that both convective and diffusive oxygen transport are decreased following ~6 mo International Space Station missions.
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Affiliation(s)
- C J Ade
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma; .,Department of Kinesiology, Kansas State University, Manhattan, Kansas
| | - R M Broxterman
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - A D Moore
- Department of Health and Kinesiology, Lamar University, Beaumont, Texas; and
| | - T J Barstow
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
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23
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Currie KD, West CR, Stöhr EJ, Krassioukov AV. Left Ventricular Mechanics in Untrained and Trained Males with Tetraplegia. J Neurotrauma 2017; 34:591-598. [DOI: 10.1089/neu.2016.4510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katharine D. Currie
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher R. West
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric J. Stöhr
- Discipline of Physiology & Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- G.F. Strong Rehabilitation Center, Vancouver, British Columbia, Canada
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24
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Davidson R, Phillips A. Cardiovascular Physiology and Responses to Sexual Activity in Individuals Living with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2017; 23:11-19. [PMID: 29339873 PMCID: PMC5340505 DOI: 10.1310/sci2301-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Spinal cord injury (SCI) may profoundly impact autonomic function producing a variable degree of dysfunction in cardiovascular, bronchopulmonary, sweating, bladder, bowel, and sexual function. The cardiovascular system is crucially important for sexual function, as it is responsible for blood flow shifts to cavernous and musculoskeletal tissue during sexual activity. This system is prone to 3 main abnormalities after SCI including low resting blood pressure (LRBP), orthostatic hypotension (OH), and autonomic dysreflexia (AD), all of which have important effects on sexual function. Methods: We review the current etiological mechanisms and manifestations of cardiovascular dysfunction after SCI and discuss how this is documented to impact sexual function in individuals living with SCI. Conclusions: All individuals with SCI at or above the T6 neurologic level have an increased risk of AD during sexual stimulation, with increasing risk associated with higher levels of injury and greater completeness of injury. AD can be silent, and individuals living with SCI should be aware of blood pressure values at baseline and during sexual activity. Clinicians performing vibrostimulation fertility procedures need to be aware of the risk of AD and consider pretreatment if needed. Researchers studying the cardiovascular response to sexual stimulation should consider continuous monitoring of blood pressure, as intermittent monitoring may underestimate true blood pressure values.
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Affiliation(s)
- Ross Davidson
- International Collaboration On Repair Discoveries, Vancouver, BC, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, British Columbia, Canada
| | - Aaron Phillips
- International Collaboration On Repair Discoveries, Vancouver, BC, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, British Columbia, Canada
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25
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Analysis of cardio-pulmonary and respiratory kinetics in different body positions: impact of venous return on pulmonary measurements. Eur J Appl Physiol 2016; 116:1343-53. [DOI: 10.1007/s00421-016-3386-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 04/30/2016] [Indexed: 11/27/2022]
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26
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Westby CM, Martin DS, Lee SMC, Stenger MB, Platts SH. Left ventricular remodeling during and after 60 days of sedentary head-down bed rest. J Appl Physiol (1985) 2016; 120:956-64. [PMID: 26494448 PMCID: PMC4835908 DOI: 10.1152/japplphysiol.00676.2015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/20/2015] [Indexed: 11/22/2022] Open
Abstract
Short periods of weightlessness are associated with reduced stroke volume and left ventricular (LV) mass that appear rapidly and are thought to be largely dependent on plasma volume. The magnitude of these cardiac adaptations are even greater after prolonged periods of simulated weightlessness, but the time course during and the recovery from bed rest has not been previously described. We collected serial measures of plasma volume (PV, carbon monoxide rebreathing) and LV structure and function [tissue Doppler imaging, three-dimensional (3-D) and 2-D echocardiography] before, during, and up to 2 wk after 60 days of 6° head down tilt bed rest (HDTBR) in seven healthy subjects (four men, three women). By 60 days of HDTBR, PV was markedly reduced (2.7 ± 0.3 vs. 2.3 ± 0.3 liters,P< 0.001). Resting measures of LV volume and mass were ∼15% (P< 0.001) and ∼14% lower (P< 0.001), respectively, compared with pre-HDTBR values. After 3 days of reambulation, both PV and LV volumes were not different than pre-HDTBR values. However, LV mass did not recover with normalization of PV and remained 12 ± 4% lower than pre-bed rest values (P< 0.001). As previously reported, decreased PV and LV volume precede and likely contribute to cardiac atrophy during prolonged LV unloading. Although PV and LV volume recover rapidly after HDTBR, there is no concomitant normalization of LV mass. These results demonstrate that reduced LV mass in response to prolonged simulated weightlessness is not a simple effect of tissue dehydration, but rather true LV muscle atrophy that persists well into recovery.
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Affiliation(s)
- Christian M Westby
- Universities Space Research Association, Division of Space Life Sciences, Houston, Texas
| | - David S Martin
- Wyle Science, Technology & Engineering Group, Houston, Texas; and
| | - Stuart M C Lee
- Wyle Science, Technology & Engineering Group, Houston, Texas; and
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27
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Ade CJ, Broxterman RM, Barstow TJ. VO(2max) and Microgravity Exposure: Convective versus Diffusive O(2) Transport. Med Sci Sports Exerc 2016; 47:1351-61. [PMID: 25380479 DOI: 10.1249/mss.0000000000000557] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Exposure to a microgravity environment decreases the maximal rate of O2 uptake (VO(2max)) in healthy individuals returning to a gravitational environment. The magnitude of this decrease in VO(2max) is, in part, dependent on the duration of microgravity exposure, such that long exposure may result in up to a 38% decrease in VO(2max). This review identifies the components within the O(2) transport pathway that determine the decrease in postmicrogravity VO(2max) and highlights the potential contributing physiological mechanisms. A retrospective analysis revealed that the decline in VO(2max) is initially mediated by a decrease in convective and diffusive O(2) transport that occurs as the duration of microgravity exposure is extended. Mechanistically, the attenuation of O(2) transport is the combined result of a deconditioning across multiple organ systems including decreases in total blood volume, red blood cell mass, cardiac function and mass, vascular function, skeletal muscle mass, and, potentially, capillary hemodynamics, which become evident during exercise upon re-exposure to the head-to-foot gravitational forces of upright posture on Earth. In summary, VO(2max) is determined by the integration of central and peripheral O(2) transport mechanisms, which, if not maintained during microgravity, will have a substantial long-term detrimental impact on space mission performance and astronaut health.
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Affiliation(s)
- Carl J Ade
- 1Department of Health and Exercise Science, University of Oklahoma, Norman, OK; 2Department of Kinesiology, Kansas State University, Manhattan, KS; and 3Department of Anatomy and Physiology, Kansas State University, Manhattan, KS
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28
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Thyfault JP, Du M, Kraus WE, Levine JA, Booth FW. Physiology of sedentary behavior and its relationship to health outcomes. Med Sci Sports Exerc 2016; 47:1301-5. [PMID: 25222820 DOI: 10.1249/mss.0000000000000518] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE This article reports on the findings and recommendations of the "Physiology of Sedentary Behavior and Its Relationship to Health Outcomes" group, a part of a larger workshop entitled Sedentary Behavior: Identifying Research Priorities sponsored by the National Heart, Lung, and Blood Institute and by the National Institute on Aging, which aimed to establish sedentary behavior research priorities. METHODS The discussion within our workshop led to the formation of critical physiological research objectives related to sedentary behaviors, that is, if appropriately researched, would greatly affect our overall understanding of human health and longevity. RESULTS AND CONCLUSIONS Primary questions are related to physiological "health outcomes" including the influence of physical activity versus sedentary behavior on the function of a number of critical physiological systems (aerobic capacity, skeletal muscle metabolism and function, telomeres/genetic stability, and cognitive function). The group also derived important recommendations related to the "central and peripheral mechanisms" that govern sedentary behavior and how energy balance has a role in mediating these processes. General recommendations for future sedentary physiology research efforts indicate that studies of sedentary behavior, including that of sitting time only, should focus on the physiological effect of a "lack of human movement" in contradistinction to the effects of physical movement and that new models or strategies for studying sedentary behavior-induced adaptations and links to disease development are needed to elucidate underlying mechanism(s).
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Affiliation(s)
- John P Thyfault
- 1Departments of Nutrition and Exercise Physiology and Medicine, University of Missouri, Columbia, MO; 2Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA; 3Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC; 4Mayo Clinic, Obesity Solutions, Scottsdale, AZ; and 5Departments of Biomedical Sciences, Medical Pharmacology-Physiology, and Nutrition and Exercise Physiology, University of Missouri, Columbia, MO
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29
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Scott JM, Armenian S, Giralt S, Moslehi J, Wang T, Jones LW. Cardiovascular disease following hematopoietic stem cell transplantation: Pathogenesis, detection, and the cardioprotective role of aerobic training. Crit Rev Oncol Hematol 2016; 98:222-34. [PMID: 26643524 PMCID: PMC5003053 DOI: 10.1016/j.critrevonc.2015.11.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 01/02/2023] Open
Abstract
Advances in hematopoietic cell transplantation (HCT) techniques and supportive care strategies have led to dramatic improvements in relapse mortality in patients with high-risk hematological malignancies. These improvements, however, conversely increase the risk of late-occurring non-cancer competing causes, mostly cardiovascular disease (CVD). HCT recipients have a significantly increased risk of CVD-specific mortality, including elevated incidence of coronary artery disease (CAD), cerebrovascular disease, and heart failure (HF) compared to age-matched counterparts. Accordingly, there is an urgent need to identify techniques for the detection of early CVD in HCT patients to inform early prevention strategies. Aerobic training (AT) is established as the cornerstone of primary and secondary disease prevention in multiple clinical settings, and may confer similar benefits in HCT patients at high-risk of CVD. The potential benefits of AT either before, immediately after, or in the months/years following HCT have received limited attention. Here, we discuss the risk and extent of CVD in adult HCT patients, highlight novel tools for early detection of CVD, and review existing evidence in oncology and non-oncology populations supporting the efficacy of AT to attenuate HCT-induced CVD. This knowledge can be utilized to optimize treatment, while minimizing CVD risk in individuals with hematological malignancies undergoing HCT.
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Affiliation(s)
- Jessica M Scott
- Universities Space Research Association NASA Johnson Space Center, Houston, TX, USA
| | - Saro Armenian
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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30
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Phillips AA, Krassioukov AV. Contemporary Cardiovascular Concerns after Spinal Cord Injury: Mechanisms, Maladaptations, and Management. J Neurotrauma 2015; 32:1927-42. [PMID: 25962761 DOI: 10.1089/neu.2015.3903] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cardiovascular (CV) issues after spinal cord injury (SCI) are of paramount importance considering they are the leading cause of death in this population. Disruption of autonomic pathways leads to a highly unstable CV system, with impaired blood pressure (BP) and heart rate regulation. In addition to low resting BP, on a daily basis the majority of those with SCI suffer from transient episodes of aberrantly low and high BP (termed orthostatic hypotension and autonomic dysreflexia, respectively). In fact, autonomic issues, including resolution of autonomic dysreflexia, are frequently ranked by individuals with high-level SCI to be of greater priority than walking again. Owing to a combination of these autonomic disturbances and a myriad of lifestyle factors, the pernicious process of CV disease is accelerated post-SCI. Unfortunately, these secondary consequences of SCI are only beginning to receive appropriate clinical attention. Immediately after high-level SCI, major CV abnormalities present in the form of neurogenic shock. After subsiding, new issues related to BP instability arise, including orthostatic hypotension and autonomic dysreflexia. This review describes autonomic control over the CV system before injury and the mechanisms underlying CV abnormalities post-SCI, while also detailing the end-organ consequences, including those of the heart, as well as the systemic and cerebral vasculature. The tertiary impact of CV dysfunction will also be discussed, such as the potential impediment of rehabilitation, and impaired cognitive function. In the recent past, our understanding of autonomic dysfunctions post-SCI has been greatly enhanced; however, it is vital to further develop our understanding of the long-term consequences of these conditions, which will equip us to better manage CV disease morbidity and mortality in this population.
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Affiliation(s)
- Aaron A Phillips
- 1 Center for Heart, Lung, and Vascular Health, Faculty of Health and Social Development, University of British Columbia , Kelowna, British Columbia, Canada .,2 Experimental Medicine Program, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,3 International Collaboration on Repair Discoveries (ICORD), University of British Columbia , Vancouver, British Columbia, Canada
| | - Andrei V Krassioukov
- 2 Experimental Medicine Program, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,3 International Collaboration on Repair Discoveries (ICORD), University of British Columbia , Vancouver, British Columbia, Canada .,4 Department of Physical Medicine and Rehabilitation, University of British Columbia , Vancouver, British Columbia, Canada
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31
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Clément GR, Bukley AP, Paloski WH. Artificial gravity as a countermeasure for mitigating physiological deconditioning during long-duration space missions. Front Syst Neurosci 2015; 9:92. [PMID: 26136665 PMCID: PMC4470275 DOI: 10.3389/fnsys.2015.00092] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 05/30/2015] [Indexed: 11/21/2022] Open
Abstract
In spite of the experience gained in human space flight since Yuri Gagarin’s historical flight in 1961, there has yet to be identified a completely effective countermeasure for mitigating the effects of weightlessness on humans. Were astronauts to embark upon a journey to Mars today, the 6-month exposure to weightlessness en route would leave them considerably debilitated, even with the implementation of the suite of piece-meal countermeasures currently employed. Continuous or intermittent exposure to simulated gravitational states on board the spacecraft while traveling to and from Mars, also known as artificial gravity, has the potential for enhancing adaptation to Mars gravity and re-adaptation to Earth gravity. Many physiological functions are adversely affected by the weightless environment of spaceflight because they are calibrated for normal, Earth’s gravity. Hence, the concept of artificial gravity is to provide a broad-spectrum replacement for the gravitational forces that naturally occur on the Earth’s surface, thereby avoiding the physiological deconditioning that takes place in weightlessness. Because researchers have long been concerned by the adverse sensorimotor effects that occur in weightlessness as well as in rotating environments, additional study of the complex interactions among sensorimotor and other physiological systems in rotating environments must be undertaken both on Earth and in space before artificial gravity can be implemented.
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32
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Short-arm centrifugation as a partially effective musculoskeletal countermeasure during 5-day head-down tilt bed rest—results from the BRAG1 study. Eur J Appl Physiol 2015; 115:1233-44. [DOI: 10.1007/s00421-015-3120-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/30/2015] [Indexed: 11/25/2022]
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33
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Fu Q, Levine BD. Exercise in the postural orthostatic tachycardia syndrome. Auton Neurosci 2014; 188:86-9. [PMID: 25487551 DOI: 10.1016/j.autneu.2014.11.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 10/06/2014] [Accepted: 11/15/2014] [Indexed: 01/05/2023]
Abstract
Patients with the Postural Orthostatic Tachycardia Syndrome (POTS) have orthostatic intolerance, as well as exercise intolerance. Peak oxygen uptake (VO2peak) is generally lower in these patients compared with healthy sedentary individuals, suggesting a lower physical fitness level. During acute exercise, POTS patients have an excessive increase in heart rate and reduced stroke volume for each level of absolute workload; however, when expressed at relative workload (%VO2peak), there is no difference in the heart rate response between patients and healthy individuals. The relationship between cardiac output and VO2 is similar between POTS patients and healthy individuals. Short-term (i.e., 3 months) exercise training increases cardiac size and mass, blood volume, and VO2peak in POTS patients. Exercise performance is improved after training. Specifically, stroke volume is greater and heart rate is lower at any given VO2 during exercise after training versus before training. Peak heart rate is the same but peak stroke volume and cardiac output are greater after training. Heart rate recovery from peak exercise is significantly faster after training, indicating an improvement in autonomic circulatory control. These results suggest that patients with POTS have no intrinsic abnormality of heart rate regulation during exercise. The tachycardia in POTS is due to a reduced stroke volume. Cardiac remodeling and blood volume expansion associated with exercise training increase physical fitness and improve exercise performance in these patients.
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Affiliation(s)
- Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Arbab-Zadeh A, Perhonen M, Howden E, Peshock RM, Zhang R, Adams-Huet B, Haykowsky MJ, Levine BD. Cardiac remodeling in response to 1 year of intensive endurance training. Circulation 2014; 130:2152-61. [PMID: 25281664 DOI: 10.1161/circulationaha.114.010775] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unclear whether, and to what extent, the striking cardiac morphological manifestations of endurance athletes are a result of exercise training or a genetically determined characteristic of talented athletes. We hypothesized that prolonged and intensive endurance training in previously sedentary healthy young individuals could induce cardiac remodeling similar to that observed cross-sectionally in elite endurance athletes. METHODS AND RESULTS Twelve previously sedentary subjects (aged 29±6 years; 7 men and 5 women) trained progressively and intensively for 12 months such that they could compete in a marathon. Magnetic resonance images for assessment of right and left ventricular mass and volumes were obtained at baseline and after 3, 6, 9, and 12 months of training. Maximum oxygen uptake ( max) and cardiac output at rest and during exercise (C2H2 rebreathing) were measured at the same time periods. Pulmonary artery catheterization was performed before and after 1 year of training, and pressure-volume and Starling curves were constructed during decreases (lower body negative pressure) and increases (saline infusion) in cardiac volume. Mean max rose from 40.3±1.6 to 48.7±2.5 mL/kg per minute after 1 year (P<0.00001), associated with an increase in both maximal cardiac output and stroke volume. Left and right ventricular mass increased progressively with training duration and intensity and reached levels similar to those observed in elite endurance athletes. In contrast, left ventricular volume did not change significantly until 6 months of training, although right ventricular volume increased progressively from the outset; Starling and pressure-volume curves approached but did not match those of elite athletes. CONCLUSIONS One year of prolonged and intensive endurance training leads to cardiac morphological adaptations in previously sedentary young subjects similar to those observed in elite endurance athletes; however, it is not sufficient to achieve similar levels of cardiac compliance and performance. Contrary to conventional thinking, the left ventricle responds to exercise with initial concentric but not eccentric remodeling during the first 6 to 9 months after commencement of endurance training depending on the duration and intensity of exercise. Thereafter, the left ventricle dilates and restores the baseline mass-to-volume ratio. In contrast, the right ventricle responds to endurance training with eccentric remodeling at all levels of training.
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Affiliation(s)
- Armin Arbab-Zadeh
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Merja Perhonen
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Erin Howden
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Ronald M Peshock
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Rong Zhang
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Beverly Adams-Huet
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Mark J Haykowsky
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Benjamin D Levine
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.).
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35
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Secher NH. Inhale your blood volume! Exp Physiol 2014; 99:1285. [DOI: 10.1113/expphysiol.2014.081844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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36
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Caiani EG, Massabuau P, Weinert L, Vaïda P, Lang RM. Effects of 5 days of head-down bed rest, with and without short-arm centrifugation as countermeasure, on cardiac function in males (BR-AG1 study). J Appl Physiol (1985) 2014; 117:624-32. [DOI: 10.1152/japplphysiol.00122.2014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study examined cardiac remodeling and functional changes induced by 5 days of head-down (−6°) bed rest (HDBR) and the effectiveness of short-arm centrifugation (SAC) in preventing them in males. Twelve healthy men (mean age: 33 ± 7) were enrolled in a crossover design study (BR-AG1, European Space Agency), including one sedentary (CTRL) and two daily SAC countermeasures (SAC1, 30 min continuously; SAC2, 30 min intermittently) groups. Measurements included plasma and blood volume and left ventricular (LV) and atrial (LA) dimensions by transthoracic echocardiography (2- and 3-dimensional) and Doppler inflows. Results showed that 5 days of HDBR had a major impact on both the geometry and cardiac function in males. LV mass and volume decreased by 16 and 14%, respectively; LA volume was reduced by 36%; Doppler flow and tissue Doppler velocities were reduced during early filling by 18 and 12%, respectively; and aortic flow velocity time integral was decreased by 18% with a 3% shortening of LV ejection time. These modifications were presumably due to decreased physiological loading and dehydration, resulting in reduced plasma and blood volume. All these changes were fully reversed 3 days after termination of HDBR. Moreover, SAC was not able to counteract these changes, either when applied continuously or intermittently.
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Affiliation(s)
- E. G. Caiani
- Politecnico di Milano, Electronics, Information and Biomedical Engineering Department, Milano, Italy
| | - P. Massabuau
- University Hospital of Rangueil, Department of Cardiology, Toulouse, France
| | - L. Weinert
- University of Chicago, Noninvasive Cardiac Imaging Laboratory, Chicago, Illinois; and
| | - P. Vaïda
- Université de Bordeaux, Bordeaux, France
| | - R. M. Lang
- University of Chicago, Noninvasive Cardiac Imaging Laboratory, Chicago, Illinois; and
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Moore AD, Downs ME, Lee SMC, Feiveson AH, Knudsen P, Ploutz-Snyder L. Peak exercise oxygen uptake during and following long-duration spaceflight. J Appl Physiol (1985) 2014; 117:231-8. [DOI: 10.1152/japplphysiol.01251.2013] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This investigation was designed to measure aerobic capacity (V̇o2peak) during and after long-duration International Space Station (ISS) missions. Astronauts (9 males, 5 females: 49 ± 5 yr, 77.2 ± 15.1 kg, 40.6 ± 6.4 ml·kg−1·min−1 [mean ± SD]) performed peak cycle tests ∼90 days before flight, 15 days after launch, every ∼30 days in-flight, and on recovery days 1 (R + 1), R + 10, and R + 30. Expired metabolic gas fractions, ventilation, and heart rate (HR) were measured. Data were analyzed using mixed-model linear regression. The main findings of this study were that V̇o2peak decreased early in-flight (∼17%) then gradually increased during flight but never returned to preflight levels. V̇o2peak was lower on R + 1 and R + 10 than preflight but recovered by R + 30. Peak HR was not different from preflight at any time during or following flight. A sustained decrease in V̇o2peak during and/or early postflight was not a universal finding in this study, since seven astronauts were able to attain their preflight V̇o2peak levels either at some time during flight or on R + 1. Four of these astronauts performed in-flight exercise at higher intensities compared with those who experienced a decline in V̇o2peak, and three had low aerobic capacities before flight. These data indicate that, while V̇o2peak may be difficult to maintain during long-duration ISS missions, aerobic deconditioning is not an inevitable consequence of long-duration spaceflight.
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Affiliation(s)
- Alan D. Moore
- Wyle Science, Technology & Engineering Group, Houston, Texas
| | | | | | - Alan H. Feiveson
- National Aeronautics and Space Administration Johnson Space Center, Houston, Texas
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Krainski F, Hastings JL, Heinicke K, Romain N, Pacini EL, Snell PG, Wyrick P, Palmer MD, Haller RG, Levine BD. The effect of rowing ergometry and resistive exercise on skeletal muscle structure and function during bed rest. J Appl Physiol (1985) 2014; 116:1569-81. [PMID: 24790012 DOI: 10.1152/japplphysiol.00803.2013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exposure to microgravity causes functional and structural impairment of skeletal muscle. Current exercise regimens are time-consuming and insufficiently effective; an integrated countermeasure is needed that addresses musculoskeletal along with cardiovascular health. High-intensity, short-duration rowing ergometry and supplemental resistive strength exercise may achieve these goals. Twenty-seven healthy volunteers completed 5 wk of head-down-tilt bed rest (HDBR): 18 were randomized to exercise, 9 remained sedentary. Exercise consisted of rowing ergometry 6 days/wk, including interval training, and supplemental strength training 2 days/wk. Measurements before and after HDBR and following reambulation included assessment of strength, skeletal muscle volume (MRI), and muscle metabolism (magnetic resonance spectroscopy); quadriceps muscle biopsies were obtained to assess muscle fiber types, capillarization, and oxidative capacity. Sedentary bed rest (BR) led to decreased muscle volume (quadriceps: -9 ± 4%, P < 0.001; plantar flexors: -19 ± 6%, P < 0.001). Exercise (ExBR) reduced atrophy in the quadriceps (-5 ± 4%, interaction P = 0.018) and calf muscle, although to a lesser degree (-14 ± 6%, interaction P = 0.076). Knee extensor and plantar flexor strength was impaired by BR (-14 ± 15%, P = 0.014 and -22 ± 7%, P = 0.001) but preserved by ExBR (-4 ± 13%, P = 0.238 and +13 ± 28%, P = 0.011). Metabolic capacity, as assessed by maximal O2 consumption, (31)P-MRS, and oxidative chain enzyme activity, was impaired in BR but stable or improved in ExBR. Reambulation reversed the negative impact of BR. High-intensity, short-duration rowing and supplemental strength training effectively preserved skeletal muscle function and structure while partially preventing atrophy in key antigravity muscles. Due to its integrated cardiovascular benefits, rowing ergometry could be a primary component of exercise prescriptions for astronauts or patients suffering from severe deconditioning.
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Affiliation(s)
- Felix Krainski
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas; University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; and
| | - Jeffrey L Hastings
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas; University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; and North Texas VA Medical Center, Dallas, Texas
| | - Katja Heinicke
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Nadine Romain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Eric L Pacini
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Peter G Snell
- University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; and
| | - Phil Wyrick
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - M Dean Palmer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Ronald G Haller
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas; University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; and North Texas VA Medical Center, Dallas, Texas
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas; University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; and
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Jeong SM, Hwang GS, Kim SO, Levine BD, Zhang R. Dynamic cerebral autoregulation after bed rest: effects of volume loading and exercise countermeasures. J Appl Physiol (1985) 2014; 116:24-31. [DOI: 10.1152/japplphysiol.00710.2013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study assessed effects of head-down-tilt (HDT) bed rest on dynamic cerebral autoregulation (CA) in 21 healthy young adults with volume loading and exercise countermeasures. Of these, seven underwent an 18-day bed rest without exercise countermeasures ( sedentary group). Volume loading with dextran infusion was performed after bed rest to restore reduced plasma volume to levels before bed rest. In the other 14 subjects, supine cycling during bed rest was performed to preserve cardiac work from before bed rest ( exercise group). Volume loading was also performed in a subgroup of these subjects ( Ex+Dex, n = 7). Dynamic CA was estimated by transfer function analysis of changes in arterial pressure and cerebral blood flow (CBF) velocity in the very low (VLF, 0.02–0.07 Hz), low (LF, 0.07–0.20 Hz), and high frequency ranges (HF, 0.20–0.35 Hz). After bed rest, transfer function gain was reduced in the sedentary group (VLF, 0.93 ± 0.23 to 0.61 ± 0.23 cm−1·s−1·mmHg; P = 0.007) and in the exercise group (LF, 1.22 ± 0.43 to 0.94 ± 0.26 cm−1·s−1·mmHg; P = 0.005, HF, 1.32 ± 0.55 to 1.00 ± 0.32 cm−1·s−1·mmHg; P = 0.010). After volume loading, transfer function gain increased in the sedentary group but not in the Ex+Dex group. Taken together, these findings suggest that dynamic CA was preserved or improved after HDT bed rest in both sedentary and exercise subjects. Furthermore, increases of transfer function gain with volume loading suggest that changes in plasma volume may play an important role in CBF regulation.
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Affiliation(s)
- Sung-Moon Jeong
- Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
- Department of Anesthesiology and Pain Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea; and
| | - Gyu-Sam Hwang
- Department of Anesthesiology and Pain Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea; and
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Benjamin D. Levine
- Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
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Morris CJ, Hastings JA, Boyd K, Krainski F, Perhonen MA, Scheer FAJL, Levine BD. Day/night variability in blood pressure: influence of posture and physical activity. Am J Hypertens 2013; 26:822-8. [PMID: 23535155 DOI: 10.1093/ajh/hpt026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Blood pressure (BP) is highest during the day and lowest at night. Absence of this rhythm is a predictor of cardiovascular morbidity and mortality. Contributions of changes in posture and physical activity to the 24-hour day/night rhythm in BP are not well understood. We hypothesized that postural changes and physical activity contribute substantially to the day/night rhythm in BP. METHODS Fourteen healthy, sedentary, nonobese, normotensive men (aged 19-50 years) each completed an ambulatory and a bed rest condition during which BP was measured every 30-60 minutes for 24 hours. When ambulatory, subjects followed their usual routines without restrictions to capture the "normal" condition. During bed rest, subjects were constantly confined to bed in a 6-degree head-down position; therefore posture was constant, and physical activity was minimized. Two subjects were excluded from analysis because of irregular sleep timing. RESULTS The systolic and diastolic BP reduction during the sleep period was similar in ambulatory (-11±2mmHg/-8±1mmHg) and bed rest conditions (-8±3mmHg/-4±2mmHg; P = 0.38/P = 0.12). The morning surge in diastolic BP was attenuated during bed rest (P = 0.001), and there was a statistical trend for the same effect in systolic BP (P = 0.06). CONCLUSIONS A substantial proportion of the 24-hour BP rhythm remained during bed rest, indicating that typical daily changes in posture and/or physical activity do not entirely explain 24-hour BP variation under normal ambulatory conditions. However, the morning BP increase was attenuated during bed rest, suggesting that the adoption of an upright posture and/or physical activity in the morning contributes to the morning BP surge.
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Affiliation(s)
- Christopher J Morris
- Medical Chronobiology Program, Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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41
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Adami A, Pizzinelli P, Bringard A, Capelli C, Malacarne M, Lucini D, Simunič B, Pišot R, Ferretti G. Cardiovascular re-adjustments and baroreflex response during clinical reambulation procedure at the end of 35-day bed rest in humans. Appl Physiol Nutr Metab 2013; 38:673-80. [DOI: 10.1139/apnm-2012-0396] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
During the reambulation procedure after 35-day head-down tilt bed rest (HDTBR) for 9 men, we recorded for the first time heart rate (HR; with electrocardiogram) and arterial pressure profiles (fingertip plethysmography) for 5 min in HDTBR and horizontal (SUP) positions, followed by 12 min in standing position, during which 4 subjects fainted (intolerant, INT) and were laid horizontal again (Recovery). We computed: mean arterial pressure (P¯; pressure profiles integral mean), stroke volume (SV; obtained with Modelflow method), and cardiac output (Q̇; SV × HR). All cardiovascular data remained stable in HDTBR and SUP for both groups (EXP). Taking the upright posture, EXP showed a decrease in SV and an increase in HR, becoming significantly different from SUP within 1 min. Further evolution of these parameters kept Q̇ stable in both groups until the second minute of standing. Afterward, in INT, P̄ precipitated without further HR increases: SV stopped being corrected and Q̇ reached 2.9 ± 0.4 L·min−1 at the last 15 s of standing. Sudden drop in P̄ allowed identification of a low-pressure threshold in INT (70.7 ± 12.9 mm Hg), after which syncope occurred within 80 s. During Recovery, baroreflex curves showed a flat phase (P̄ increase, HR stable), followed by a steep phase (P̄ increased, HR decreased, starting when P̄ was 84.5 ± 12.5 mm Hg and Q̇ was 9.6 ± 1.5 L·min−1). INT, in contrast with tolerant subjects, did not sustain standing because HR was unable to correct for the P̄ drop. These results indicate a major role for impaired arterial baroreflexes in the onset of orthostatic intolerance.
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Affiliation(s)
- Alessandra Adami
- Département de Neuroscience Fondamentales, Centre Médical Universitaire, Université de Genève, 1 Rue Michel Servet, CH-1211 Genève 4, Switzerland
| | - Paolo Pizzinelli
- Dipartimento di Scienze Cliniche, Ospedale L. Sacco, Università di Milano, via GB. Grassi 74, Milano, Italia
| | - Aurélien Bringard
- Département de Neuroscience Fondamentales, Centre Médical Universitaire, Université de Genève, 1 Rue Michel Servet, CH-1211 Genève 4, Switzerland
| | - Carlo Capelli
- Dipartimento di Scienze Neurologiche, Neuropsicologiche, Morfologiche e Motorie, Facoltà di Scienze Motorie, Università di Verona, via F. Casorati, 54, 37100 Verona, Italia
| | - Mara Malacarne
- Dipartimento di Scienze Cliniche, Ospedale L. Sacco, Università di Milano, via GB. Grassi 74, Milano, Italia
| | - Daniela Lucini
- Dipartimento di Scienze Cliniche, Ospedale L. Sacco, Università di Milano, via GB. Grassi 74, Milano, Italia
| | - Boštjan Simunič
- Institute of Kinesiology Research, Science and Research Center, University of Primorska, Koper, Garibaldijeva street 1, 6000 Koper, Slovenia
| | - Rado Pišot
- Institute of Kinesiology Research, Science and Research Center, University of Primorska, Koper, Garibaldijeva street 1, 6000 Koper, Slovenia
| | - Guido Ferretti
- Département de Neuroscience Fondamentales, Centre Médical Universitaire, Université de Genève, 1 Rue Michel Servet, CH-1211 Genève 4, Switzerland
- Dipartimento di Scienze Biomediche e Biotecnologie, Facoltà di Medicina, Università di Brescia, Viale Europa 11, 25123 Brescia, Italia
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Prise en charge de la mobilisation précoce en réanimation, chez l’adulte et l’enfant (électrostimulation incluse). ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13546-013-0658-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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43
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Fu Q, Levine BD. Exercise and the autonomic nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2013; 117:147-60. [DOI: 10.1016/b978-0-444-53491-0.00013-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Hackney KJ, Everett M, Scott JM, Ploutz-Snyder L. Blood flow-restricted exercise in space. EXTREME PHYSIOLOGY & MEDICINE 2012; 1:12. [PMID: 23849078 PMCID: PMC3710201 DOI: 10.1186/2046-7648-1-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 09/05/2012] [Indexed: 12/21/2022]
Abstract
Prolonged exposure to microgravity results in chronic physiological adaptations including skeletal muscle atrophy, cardiovascular deconditioning, and bone demineralization. To attenuate the negative consequences of weightlessness during spaceflight missions, crewmembers perform moderate- to high-load resistance exercise in conjunction with aerobic (cycle and treadmill) exercise. Recent evidence from ground-based studies suggests that low-load blood flow-restricted (BFR) resistance exercise training can increase skeletal muscle size, strength, and endurance when performed in a variety of ambulatory populations. This training methodology couples a remarkably low exercise training load (approximately 20%-50% one repetition maximum (1RM)) with an inflated external cuff (width, ranging between approximately 30-90 mm; pressure, ranging between approximately 100-250 mmHg) that is placed around the exercising limb. BFR aerobic (walking and cycling) exercise training methods have also recently emerged in an attempt to enhance cardiovascular endurance and functional task performance while incorporating minimal exercise intensity. Although both forms of BFR exercise training have direct implications for individuals with sarcopenia and dynapenia, the application of BFR exercise training during exposure to microgravity to prevent deconditioning remains controversial. The aim of this review is to present an overview of BFR exercise training and discuss the potential usefulness of this method as an adjunct exercise countermeasure during prolonged spaceflight. The work will specifically emphasize ambulatory BFR exercise training adaptations, mechanisms, and safety and will provide directions for future research.
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Affiliation(s)
- Kyle J Hackney
- Wyle Science, Technology and Engineering Group, Houston, TX 77002, USA
| | | | - Jessica M Scott
- Universities Space Research Association, Houston, TX, 77002, USA
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Carrick-Ranson G, Hastings JL, Bhella PS, Shibata S, Levine BD. The effect of exercise training on left ventricular relaxation and diastolic suction at rest and during orthostatic stress after bed rest. Exp Physiol 2012; 98:501-13. [DOI: 10.1113/expphysiol.2012.067488] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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46
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Tsvirkun D, Bourreau J, Mieuset A, Garo F, Vinogradova O, Larina I, Navasiolava N, Gauquelin-Koch G, Gharib C, Custaud MA. Contribution of social isolation, restraint, and hindlimb unloading to changes in hemodynamic parameters and motion activity in rats. PLoS One 2012; 7:e39923. [PMID: 22768322 PMCID: PMC3388052 DOI: 10.1371/journal.pone.0039923] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 05/29/2012] [Indexed: 11/19/2022] Open
Abstract
The most accepted animal model for simulation of the physiological and morphological consequences of microgravity on the cardiovascular system is one of head-down hindlimb unloading. Experimental conditions surrounding this model include not only head-down tilting of rats, but also social and restraint stresses that have their own influences on cardiovascular system function. Here, we studied levels of spontaneous locomotor activity, blood pressure, and heart rate during 14 days under the following experimental conditions: cage control, social isolation in standard rat housing, social isolation in special cages for hindlimb unloading, horizontal attachment (restraint), and head-down hindlimb unloading. General activity and hemodynamic parameters were continuously monitored in conscious rats by telemetry. Heart rate and blood pressure were both evaluated during treadmill running to reveal cardiovascular deconditioning development as a result of unloading. The main findings of our work are that: social isolation and restraint induced persistent physical inactivity, while unloading in rats resulted in initial inactivity followed by normalization and increased locomotion after one week. Moreover, 14 days of hindlimb unloading showed significant elevation of blood pressure and slight elevation of heart rate. Hemodynamic changes in isolated and restrained rats largely reproduced the trends observed during unloading. Finally, we detected no augmentation of tachycardia during moderate exercise in rats after 14 days of unloading. Thus, we concluded that both social isolation and restraint, as an integral part of the model conditions, contribute essentially to cardiovascular reactions during head-down hindlimb unloading, compared to the little changes in the hydrostatic gradient.
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Affiliation(s)
- Darya Tsvirkun
- UMR CNRS 6214 – INSERM 1083, Faculté de Médecine d’Angers, Université d’Angers, Angers, France
- Department of Human and Animal Physiology, M.V. Lomonosov Moscow State University, Moscow, Russia
| | - Jennifer Bourreau
- UMR CNRS 6214 – INSERM 1083, Faculté de Médecine d’Angers, Université d’Angers, Angers, France
| | - Aurélie Mieuset
- UMR CNRS 6214 – INSERM 1083, Faculté de Médecine d’Angers, Université d’Angers, Angers, France
| | - Florian Garo
- UMR CNRS 6214 – INSERM 1083, Faculté de Médecine d’Angers, Université d’Angers, Angers, France
| | - Olga Vinogradova
- Institute for Biomedical Problems Russian Academy of Sciences SSC, Moscow, Russia
| | - Irina Larina
- Associated French-Russia laboratory CaDyWEC (Cardiovascular Dysfunction induced by Weightlessness and Environmental Conditions), Angers, France
- Institute for Biomedical Problems Russian Academy of Sciences SSC, Moscow, Russia
| | - Nastassia Navasiolava
- Associated French-Russia laboratory CaDyWEC (Cardiovascular Dysfunction induced by Weightlessness and Environmental Conditions), Angers, France
- Institute for Biomedical Problems Russian Academy of Sciences SSC, Moscow, Russia
| | | | - Claude Gharib
- ISOSTEO-LYON (Institut Supérieur d’Ostéopathie), Limonest, France
- Faculté de Médecine Lyon-Est, Physiologie, Lyon, France
| | - Marc-Antoine Custaud
- UMR CNRS 6214 – INSERM 1083, Faculté de Médecine d’Angers, Université d’Angers, Angers, France
- Associated French-Russia laboratory CaDyWEC (Cardiovascular Dysfunction induced by Weightlessness and Environmental Conditions), Angers, France
- Explorations Fonctionnelles Vasculaires, CHU d’Angers, Angers, France
- * E-mail:
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Shibata S, Fu Q, Bivens TB, Hastings JL, Wang W, Levine BD. Short-term exercise training improves the cardiovascular response to exercise in the postural orthostatic tachycardia syndrome. J Physiol 2012; 590:3495-505. [PMID: 22641777 DOI: 10.1113/jphysiol.2012.233858] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Recent studies have suggested the presence of cardiac atrophy as a key component of the pathogenesis of the postural orthostatic tachycardia syndrome (POTS), similar to physical deconditioning. It has also been shown that exercise intolerance is associated with a reduced stroke volume (SV) in POTS, and that the high heart rate (HR) observed at rest and during exercise in these patients is due to this low SV. We tested the hypotheses that (a) circulatory control during exercise is normal in POTS; and (b) that physical ‘reconditioning' with exercise training improves exercise performance in patients with POTS. Nineteen (18 women) POTS patients completed a 3 month training programme. Cardiovascular responses during maximal exercise testing were assessed in the upright position before and after training. Resting left ventricular diastolic function was evaluated by Doppler echocardiography. Results were compared with those of 10 well-matched healthy sedentary controls. A lower SV resulted in a higher HR in POTS at any given oxygen uptake (V(O(2))) during exercise while the cardiac output (Q(c))-V(O(2)) relationship was normal. V(O(2peak)) was lower in POTS than controls (26.1 ± 1.0 (SEM) vs. 36.3 ± 0.9 ml kg-1 min-1; P < 0.001) due to a lower peak SV (65 ± 3 vs. 80 ± 5 ml; P = 0.009). After training in POTS, HR became lower at any given due to increased SV without changes in the – relationship. V(O(2peak)) increased by 11% (P < 0.001) due to increased peak SV (P = 0.021) and was proportional to total blood volume. Peak HR was similar, but HR recovery from exercise was faster after training than before training (P = 0.036 for training and 0.009 for interaction). Resting diastolic function was mostly normal in POTS before training, though diastolic suction was impaired (P = 0.023). There were no changes in any Doppler index after training. These results suggest that short-term exercise training improves physical fitness and cardiovascular responses during exercise in patients with POTS.
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Affiliation(s)
- Shigeki Shibata
- Institute for Exercise and Environmental Medicine, 7232 Greenville Avenue, Suite 435, Dallas, TX 75231, USA
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Hastings JL, Krainski F, Snell PG, Pacini EL, Jain M, Bhella PS, Shibata S, Fu Q, Palmer MD, Levine BD. Effect of rowing ergometry and oral volume loading on cardiovascular structure and function during bed rest. J Appl Physiol (1985) 2012; 112:1735-43. [PMID: 22345434 DOI: 10.1152/japplphysiol.00019.2012] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study examined the effectiveness of a short-duration but high-intensity exercise countermeasure in combination with a novel oral volume load in preventing bed rest deconditioning and orthostatic intolerance. Bed rest reduces work capacity and orthostatic tolerance due in part to cardiac atrophy and decreased stroke volume. Twenty seven healthy subjects completed 5 wk of -6 degree head down bed rest. Eighteen were randomized to daily rowing ergometry and biweekly strength training while nine remained sedentary. Measurements included cardiac mass, invasive pressure-volume relations, maximal upright exercise capacity, and orthostatic tolerance. Before post-bed rest orthostatic tolerance and exercise testing, nine exercise subjects were given 2 days of fludrocortisone and increased salt. Sedentary bed rest led to cardiac atrophy (125 ± 23 vs. 115 ± 20 g; P < 0.001); however, exercise preserved cardiac mass (128 ± 38 vs. 137 ± 34 g; P = 0.002). Exercise training preserved left ventricular chamber compliance, whereas sedentary bed rest increased stiffness (180 ± 170%, P = 0.032). Orthostatic tolerance was preserved only when exercise was combined with volume loading (-10 ± 22%, P = 0.169) but not with exercise (-14 ± 43%, P = 0.047) or sedentary bed rest (-24 ± 26%, P = 0.035) alone. Rowing and supplemental strength training prevent cardiovascular deconditioning during prolonged bed rest. When combined with an oral volume load, orthostatic tolerance is also preserved. This combined countermeasure may be an ideal strategy for prolonged spaceflight, or patients with orthostatic intolerance.
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Affiliation(s)
- Jeffrey L Hastings
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX 75231, USA
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Diurnal variability in orthostatic tachycardia: implications for the postural tachycardia syndrome. Clin Sci (Lond) 2011; 122:25-31. [PMID: 21751966 DOI: 10.1042/cs20110077] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with POTS (postural tachycardia syndrome) have excessive orthostatic tachycardia (>30 beats/min) when standing from a supine position. HR (heart rate) and BP (blood pressure) are known to exhibit diurnal variability, but the role of diurnal variability in orthostatic changes of HR and BP is not known. In the present study, we tested the hypothesis that there is diurnal variation of orthostatic HR and BP in patients with POTS and healthy controls. Patients with POTS (n=54) and healthy volunteers (n=26) were admitted to the Clinical Research Center. Supine and standing (5 min) HR and BP were obtained in the evening on the day of admission and in the following morning. Overall, standing HR was significantly higher in the morning (102±3 beats/min) than in the evening (93±2 beats/min; P<0.001). Standing HR was higher in the morning in both POTS patients (108±4 beats/min in the morning compared with 100±3 beats/min in the evening; P=0.012) and controls (89±3 beats/min in the morning compared with 80±2 beats/min in the evening; P=0.005) when analysed separately. There was no diurnal variability in orthostatic BP in POTS. A greater number of subjects met the POTS HR criterion in the morning compared with the evening (P=0.008). There was significant diurnal variability in orthostatic tachycardia, with a great orthostatic tachycardia in the morning compared with the evening in both patients with POTS and healthy subjects. Given the importance of orthostatic tachycardia in diagnosing POTS, this diurnal variability should be considered in the clinic as it may affect the diagnosis of POTS.
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Jeong SM, Shibata S, Levine BD, Zhang R. Exercise plus volume loading prevents orthostatic intolerance but not reduction in cerebral blood flow velocity after bed rest. Am J Physiol Heart Circ Physiol 2011; 302:H489-97. [PMID: 22081705 DOI: 10.1152/ajpheart.00427.2011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study tested the hypothesis that reduction in cerebral blood flow (CBF) during orthostatic stress after bed rest can be ameliorated with volume loading, exercise, or both. Transcranial Doppler was used to measure changes in CBF velocity during lower body negative pressure (LBNP) before and after an 18-day bed rest in 33 healthy subjects. Subjects were assigned into four groups with similar age and sex: 1) supine cycling during bed rest (Exercise group; n = 7), 2) volume loading with Dextran infusion after bed rest to restore reduced left ventricular filling pressure (Dextran group; n = 7), 3) exercise combined with volume loading to prevent orthostatic intolerance (Ex-Dex group; n = 7), and 4) a control group (n = 12). LBNP tolerance was measured using a cumulative stress index (CSI). After bed rest, CBF velocity was reduced at a lower level of LBNP in the Control group, and the magnitude of reduction was greater in the Ex-Dex group. However, reduction in orthostatic tolerance was prevented in the Ex-Dex group. Notably, volume loading alone prevented greater reductions in CBF velocity after bed rest, but CSI was reduced still by 25%. Finally, decreases in CBF velocity during LBNP were correlated with reduction in cardiac output under all conditions (r(2) = 0.86; P = < 0.001). Taken together, these findings demonstrate that volume loading alone can ameliorate reductions in CBF during LBNP. However, the lack of associations between changes in CBF velocity and orthostatic tolerance suggests that reductions in CBF during LBNP under steady-state conditions by itself are unlikely to be a primary factor leading to orthostatic intolerance.
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Affiliation(s)
- Sung-Moon Jeong
- Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, and University of Texas Southwestern Medical Center at Dallas, TX 75231, USA
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