Heart rate recovery after exercise and cardiac autonomic nervous activity in children

Post-exercise heart rate variability recovery after 800-m endurance run load among Cameroonian adolescent's males

The 800-m (m) run is part of Physical Education classes in Cameroon, after which arrhythmias may occur during recovery. Hence, this study aimed at determining relationship between 800-m run loads on cardiac autonomic recovery among school adolescents. Forty-two male adolescents (aged [17 ​± ​1] years) performed 800-m. Post-exercise heart rate variability (HRV) was recorded during 5-min (min) (HRV5-min) and 15-min (HRV15-min) in time: Standard deviation of normal to normal (SDNN); Root mean square of successive differences (RMSSD) and frequency domain (LH: Low frequency, HF: High frequency, TP: Total power). Rating of Perceived Exertion (RPE) and blood lactate concentration (BLa) were measured after exercise. In HRV5-min, RPE was associated with SDNN (r ​= ​-0.44, p ​< ​0.01) and RMSSD (r ​= ​-0.38, p ​< ​0.05). BLa was correlated with SDNN (r ​= ​-0.38, p ​< ​0.05) and RMSSD (r ​= ​-0.56, p ​< ​0.001) in the time-domain, LF (r ​= ​-0.64, p ​< ​0.001), HF (r ​= ​-0.58, p ​< ​0.001) and TP (r ​= ​-0.61, p ​< ​0.001) in frequency-domain. Moreover, RPE was correlated with LF (r ​= ​-0.44, p ​< ​0.01), TP (r ​= ​-0.49, p ​< ​0.01) while exercise duration with HF (r ​= ​-0.38, p ​< ​0.05). In HRV15-min, BLa was correlated with RMSSD (r ​= ​-0.53, p ​< ​0.001) and SDNN (r ​= ​-0.68, p ​< ​0.001). RPE was negatively correlated SDNN (r ​= ​-0.53, p ​< ​0.01) and RMSSD (r ​= ​-0.44, p ​< ​0.01). BLa was associated with HF (r ​= ​-0.55, p ​< ​0.001), TP (r ​= ​-0.50, p ​< ​0.01) and RPE with LF (r ​= ​-0.51, p ​< ​0.01), HF (r ​= ​-0.50, p ​< ​0.01), TP (r ​= ​-0.49, p ​< ​0.01). In addition, exercise duration was negatively linked to HF (r ​= ​-0.36, p ​< ​0.05). This study outlined that in untrained adolescents an increase of 800-m loads is associated with a slow vagal indexes of HRV during the recovery.

Examining the Relation Between Exercise and Word Learning in Preschool-Age Children

PURPOSE

There is evidence suggesting that aerobic exercise immediately after vocabulary training can improve word recall in school-age children. This work examined whether the previously identified word-learning benefits associated with exercise can be extended to preschoolers. Additionally, we evaluated whether the effects of physical activity on vocabulary learning may be influenced by existing language skills that the child possesses.

METHOD

Children ages 3-6 years completed the study (N = 42). Data were collected via a virtual testing session in which participants completed a word-learning task that included two experimental conditions (exercise and resting). In the resting measure, children were taught names of novel objects and then sat down and colored for 3 min before being tested on their ability to identify the trained words. The exercise condition was identical, except that participants engaged in 3 min of guided aerobic exercise before testing. Additionally, at the end of the visit, participants completed the Quick Interactive Language Screener (QUILS), which measured general language skills.

RESULTS

Accuracy of word recognition was significantly higher after the exercise condition compared to the resting condition. Furthermore, this pattern of results was not related to children's existing language skills, as measured by the QUILS.

CONCLUSIONS

This study is one of the first to closely examine the relation between physical activity and word-learning abilities in children as young as 3-6 years of age. Results align with previous findings stating that aerobic exercise can boost vocabulary learning and suggest that this is the case regardless of existing language skills.

Exercise Training in Heart Failure With Reduced Ejection Fraction and Permanent Atrial Fibrillation: A Randomized Clinical Trial

BACKGROUND

Heart failure (HF) associated with atrial fibrillation (AF) increases patients' physical inactivity, worsening their clinical condition and mortality. Exercise training is safe and has clear benefits in HF. However, little is known about the effects of exercise training on heart failure patients with reduced ejection fraction and permanent atrial fibrillation (HFAF).

OBJECTIVE

To test the hypothesis that exercise training improves functional capacity, cardiac function, and quality of life in patients with HFAF.

METHODS

This randomized clinical trial was conducted at the Heart Institute. Patients with HFAF, LVEF ≤40% and resting HR ≤80 bpm were included in the study. Cardiopulmonary testing, echocardiography, autonomic, and quality of life assessment were performed before and after the 12-week protocol period.

RESULTS

Twenty-six patients, 58±1 years, were randomized to exercise training (HFAF-trained, n=13) or no training (HFAF-untrained, n=13). At baseline, no differences between groups were found. Exercise improved VO₂ peak, slope VE/VCO₂, and quality of life. HFAF-trained significantly decreased resting HR (from 73±2 to 69±2 bpm, P=.02) and recovery HR (from 148±11 to 128±9 bpm, P=.001). Concomitantly, LVEF increased (from 31±1 to 36±0.9 %, P=.01), LA decreased (from 52±1.2 to 47±1mm, P=.03), and LV-ESV and LV-EDV deceased (from 69±2 to 64±1.8 mL/m², and 99±2.1 to 91±2, P<.05, respectively). No changes were observed in the untrained group.

CONCLUSION

Exercise training can improve exercise capacity, quality of life, and cardiac function in patients with heart failure with reduced ejection fraction and permanent atrial fibrillation.

Performance and Recovery of Well-Trained Younger and Older Athletes during Different HIIT Protocols

Due to physiological and morphological differences, younger and older athletes may recover differently from training loads. High-intensity interval training (HIIT) protocols are useful for studying the progression of recovery. It was the objective of this study to determine age differences in performance and recovery following different HIIT protocols. Methods: 12 younger (24.5 ± 3.7 years) and 12 older (47.3 ± 8.6 years) well-trained cyclists and triathletes took part in this study. Between the age groups there were no significant differences in relative peak power to fat-free mass, maximal heart rate (HR), training volume, and VO_2max-percentiles (%). Participants performed different HIIT protocols consisting of 4 × 30 s Wingate tests with different active rest intervals (1, 3, or 10 min). Peak and average power, lactate, HR, respiratory exchange ratio (RER), subjective rating of perceived exertion (RPE), and recovery (Total Quality Recovery scale, TQR) were assessed. Results: During the different HIIT protocols, metabolic, cardiovascular, and subjective recovery were similar between the two groups. No significant differences were found in average lactate concentration, peak and average power, fatigue (%), %HR_max, RER, RPE, and TQR values between the groups (p > 0.05). Conclusion: The findings of this study indicate that recovery following HIIT does not differ between the two age groups. Furthermore, older and younger participants displayed similar lactate kinetics after the intermittent exercise protocols.

Cardiac Autonomic Modulation of Heart Rate Recovery in Children with Spina Bifida

We aimed to analyse cardiac autonomic control by assessing the post-exercise heart rate recovery (HRR) and physical fitness in children and adolescents with spina bifida (SB), compared to participants with typical development. A total of 124 participants, 42 with spina bifida (SB group) and 82 typical developmental controls (CO group) performed the arm cranking exercise test with a gas analysis system. HRR was determined at the first (HRR_1) and second (HRR_2) minute at recovery phase. Data are shown as [mean difference (95% CI)]. The SB group showed reduced HR reserve [14.5 (7.1-22.0) bmp, P<0.01], slower HRR_1 [12.4 (7.4-17.5) bpm, P<0.01] and HRR_2 [16.3 (10.6-21.9) bpm; P<0.01], lower VO2peak [VO2peak relative: 7.3 (4.2-10.3) mL·min-1·kg-1, P<0.01; VO2peak absolute: 0.42 (0.30-0.54) L·min-1, P<0.01], and lower O2 pulse [2.5 (1.8-3.2) mL·bpm, P<0.01] and ventilatory responses [13.5 (8.8-18.1) L·min-1, P<0.01] than the CO group. VE/VO2 was not different between groups [-2.82 (-5.77- -0.12); P=0.06], but the VE/VCO2 [-2.59 (-4.40-0.78); P<0.01] and the values of the anaerobic threshold corrected by body mass [-3.2 (-5.8- -0.6) mL·min-1·kg-1, P=0.01] were higher in the SB group than in the CO group. We concluded that children and adolescents with SB have reduced physical fitness and a slower HRR response after maximal effort.

Examining the Role of Physical Activity on Word Learning in School-Aged Children

Purpose Previous studies show that there is increased brain activity after exercise, leading to improved word recall in adults. The aim of this study was to examine whether different types of exercise (i.e., aerobic vs. anaerobic) may also lead to improved performance during vocabulary learning in children. Method A total of 48 participants (24 in Experiment 1 and 24 in Experiment 2) between the ages of 6 and 12 years completed a word learning task. Training of words took place in a resting and in an exercise condition using a within-subject design. In the resting measure, children were taught names of novel objects and then colored for 3 min before being tested on their ability to recognize the words. In the exercise condition, the same steps were followed, but instead of coloring, children engaged in 3 min of either aerobic exercise (i.e., swimming in Experiment 1) or anaerobic exercise (i.e., a CrossFit-like workout in Experiment 2). Results In Experiment 1, accuracy of word recognition was significantly higher for words that were trained in the aerobic exercise compared to the resting condition. In Experiment 2, there was no significant difference in performance between the anaerobic exercise and resting conditions. Conclusions These findings suggest that previously identified benefits of exercise on language abilities in adults also extend to school-aged children. However, not all types of physical activity lead to this boost in performance, as only aerobic (but not anaerobic) exercise improved children's ability to acquire new word-object relations. Supplemental Material https://doi.org/10.23641/asha.14462187.

Age- and Sex-Related Differences in Recovery From High-Intensity and Endurance Exercise: A Brief Review

Postexercise recovery is a fundamental component for continuous performance enhancement. Due to physiological and morphological changes in aging and alterations in performance capacity, athletes of different ages may recover at different rates from physical exercise. Differences in body composition, physiological function, and exercise performance between men and women may also have a direct influence on restoration processes.

PURPOSE

This brief review examines current research to indicate possible differences in recovery processes between male and female athletes of different age groups. The paper focuses on postexercise recovery following sprint and endurance tests and tries to identify determinants that modulate possible differences in recovery between male and female subjects of different age groups.

RESULTS

The literature analysis indicates age- and sex-dependent differences in short- and long-term recovery. Short-term recovery differs among children, adults, and masters. Children have shorter lactate half-life and a faster cardiac and respiratory recovery compared to adults. Additionally, children and masters require shorter recovery periods during interval bouts than trained adults. Trained women show a slower cardiac and respiratory recovery compared to trained men. Long-term recovery is strongly determined by the extent of muscle damage. Trained adults tend to have more extensive muscle damage compared to masters and children.

CONCLUSION

The influence of age and sex on the recovery process varies among the different functional systems and depends on the time of the recovery processes. Irrespective of age and sex, the performance capacity of the individual determines the recovery process after high-intensity and endurance exercise.

Heart Rate Responses during Sport-Specific High-Intensity Circuit Exercise in Child Female Gymnasts

This study examined heart rate (HR) responses during a sport-specific high-intensity circuit training session to indirectly assess cardiorespiratory stress in child athletes. Seventeen, female gymnasts, aged 9-11 years performed two 5-min 15 s sets of circuit exercise, interspersed by a 3 min rest interval. Each set included five rounds of five gymnastic exercises (7 s work, 7 s rest) executed with maximal effort. During the first circuit training set, peak heart rate (HR) was 192 ± 7 bpm and average HR was 83 ± 4% of maximum HR (HRmax), which was determined in a separate session. In the second set, peak HR and average HR were increased to 196 ± 8 bpm (p < 0.001, d = 0.55) and to 89 ± 4% HRmax (p < 0.001, d = 2.19), respectively, compared with the first set. HR was above 80% HRmax for 4.1 ± 1.2 min during set 1 and this was increased to 5.1 ± 0.4 min in set 2 (p < 0.001, d = 1.15). Likewise, HR was above 90% of HRmax for 2.0 ± 1.2 min in set 1 and was increased to 3.4 ± 1.7 min in set 2 (p < 0.001, d = 0.98). In summary, two 5-min 15 s sets of high-intensity circuit training using sport-specific exercises, increased HR to levels above 80% and 90% HRmax for extended time periods, and thus may be considered as an appropriate stimulus, in terms of intensity, for improving aerobic fitness in child female gymnasts.

Developing and Validating a Step Test of Aerobic Fitness among Elementary School Children

Purpose: The tests to estimate aerobic fitness among children require substantial space and maximum effort, which is often difficult for children. We developed a simple submaximal step test (Step Test of Endurance for Pediatrics, or STEP) and assessed its reliability, validity, and ability to estimate aerobic fitness among elementary school children. Method: Children aged 5-10 years completed the STEP with a protocol consisting of 0.1-, 0.2-, and 0.3-metre (4, 8, and 12 in.) step heights. Participants underwent treadmill testing with open circuit spirometry to determine actual maximal oxygen consumption (V̇o_2max). Intra-class correlation coefficients (ICCs) assessed test-retest reliability of the STEP and its component tests. Multivariate linear regression assessed the associations between the STEP and V̇o_2max, adjusting for potential covariates such as age, sex, BMI, and comorbidity count. Results: The STEP showed excellent reliability (ICC ≥ 0.92; N = 170), irrespective of effort level during testing. Significant effort issues and collinearity among the independent variables led us to exclude children aged 5-6 years (n = 45) from the regression analysis. The final regression model for children aged 7-10 years with adequate effort (n = 111), as defined by a respiratory exchange ratio of 1.0 or more, showed that the STEP, sex, and BMI were significantly predictive of V̇o_2max (R ² = 0.51). Conclusions: This new, effort-independent step test can estimate the aerobic fitness of children aged 7-10 years. Regression equations to estimate V̇o_2max from the STEP were provided.

Are Prepubertal Children Metabolically Comparable to Well-Trained Adult Endurance Athletes?

It is well acknowledged that prepubertal children have smaller body dimensions and a poorer mechanical (movement) efficiency, and thus a lower work capacity than adults. However, the scientific evidence indicates that prepubertal children have a greater net contribution of energy derived from aerobic metabolism in exercising muscle and reduced susceptibility to muscular fatigue, which makes them metabolically comparable to well-trained adult endurance athletes. For example, the relative energy contribution from oxidative and non-oxidative (i.e. anaerobic) sources during moderate-to-intense exercise, the work output for a given anaerobic energy contribution and the rate of acceleration of aerobic metabolic machinery in response to submaximal exercise are similar between prepubertal children and well-trained adult endurance athletes. Similar conclusions can be drawn on the basis of experimental data derived from intra-muscular measurements such as type I fibre percentage, succinate dehydrogenase enzyme activity, mitochondrial volume density, post-exercise phosphocreatine re-synthesis rate and muscle by-product clearance rates (i.e. H⁺ ions). On a more practical level, prepubertal children also experience similar decrements in peak power output as well-trained adult endurance athletes during repeated maximal exercise bouts. Therefore, prepubertal children have a comparable relative oxidative contribution to well-trained adult endurance athletes, but a decrease in this relative contribution occurs from childhood through to early adulthood. In a clinical context, this understanding may prove central to the development of exercise-based strategies for the prevention and treatment of many metabolic diseases related to mitochondrial oxidative dysfunction (e.g. in obese, insulin-resistant and diabetic patients), which are often accompanied by muscular deconditioning during adolescence and adulthood.

Metabolic and Fatigue Profiles Are Comparable Between Prepubertal Children and Well-Trained Adult Endurance Athletes

The aim of this study was to determine whether prepubertal children are metabolically comparable to well-trained adult endurance athletes and if this translates into similar fatigue rates during high-intensity exercise in both populations. On two different occasions, 12 prepubertal boys (10.5 ± 1.1 y), 12 untrained men (21.2 ± 1.5 y), and 13 endurance male athletes (21.5 ± 2.7 y) completed an incremental test to determine the power output at VO_2max (PVO_2max) and a Wingate test to evaluate the maximal anaerobic power (P_max) and relative decrement in power output (i.e., the fatigue index, FI). Furthermore, oxygen uptake (VO₂), heart rate (HR), and capillary blood lactate concentration ([La]) were measured to determine (i) the net aerobic contribution at 5-s intervals during the Wingate test, and (ii) the post-exercise recovery kinetics of VO₂, HR, and [La]. The P_max-to-PVO_2max ratio was not significantly different between children (1.9 ± 0.5) and endurance athletes (2.1 ± 0.2) but lower than untrained men (3.2 ± 0.3, p < 0.001 for both). The relative energy contribution derived from oxidative metabolism was also similar in children and endurance athletes but greater than untrained men over the second half of the Wingate test (p < 0.001 for both). Furthermore, the post-exercise recovery kinetics of VO₂, HR, and [La] in children and endurance athletes were faster than those of untrained men. Finally, FI was comparable between children and endurance athletes (-35.2 ± 9.6 vs. -41.8 ± 9.4%, respectively) but lower than untrained men (-51.8 ± 4.1%, p < 0.01). To conclude, prepubertal children were observed to be metabolically comparable to well-trained adult endurance athletes, and were thus less fatigable during high-intensity exercise than untrained adults.

Does body fat percentage predict post-exercise heart rate response in non-obese children and adolescents?

BACKGROUND

A correlation between adiposity and post-exercise autonomic regulation has been established in overweight and obese children. However, little information exists about this link in non-obese youth. The main purpose of this cross-sectional study was to describe the relationship between body fat percentage (BFP) and heart rate recovery after exercise [post-exercise heart rate (PEHR)], a marker of autonomic regulation, in normal-weight children and adolescents.

METHODS

We evaluated the body composition of 183 children and adolescents (age 15.0±2.3 years; 132 boys and 51 girls) who performed a maximal graded exercise test on a treadmill, with the heart rate monitored during and immediately after exercise.

RESULTS

A strong positive trend was observed in the association between BFP and PEHR (r=0.14; p=0.06). Hierarchical multiple regression revealed that our model explained 18.3% of the variance in PEHR (p=0.00), yet BFP accounted for only 0.9% of the variability in PEHR (p=0.16). The evaluation of the contribution of each independent variable revealed that only two variables made a unique statistically significant contribution to our model (p<0.01), with age contributing 38.7% to our model (p=0.00) while gender accounted for an additional 25.5% (p=0.01). Neither BFP (14.4%; p=0.16) nor cardiorespiratory endurance (5.0%, p=0.60) made a significant unique contribution to the model.

CONCLUSIONS

Body fatness seems to poorly predict PEHR in our sample of non-obese children and adolescents, while non-modifiable variables (age and gender) were demonstrated as strong predictors of heart rate recovery. The low amount of body fat reported in non-obese young participants was perhaps too small to cause disturbances in autonomic nervous system regulation.

Early determinants of vagal activity at preschool age - With potential dependence on sex

BACKGROUND

In children, autonomic nervous function is related to various highly prevalent health problems and might therefore represent an early indicator of ill health.

AIMS

We aimed to investigate the role of early-life exposures and physical activity (PA) as potential determinants of autonomic function at preschool age.

STUDY DESIGN AND SUBJECTS

We used an existing longitudinal data set of repeated vagal tone measurements (assessed via heart rate recovery (HRR)) and retrospectively assessed early-life exposures in 1052 children (mean age: 59.4months, 47.5% girls) from 52 preschools in Germany recruited from 2008 to 2010.

OUTCOME MEASURES

HRR 1min after submaximal exercise served as primary outcome. Through multilevel linear regression analysis adjusted for demographic and socioeconomic factors, we assessed the association between repeatedly measured HRR and pregnancy smoking status, breastfeeding and objectively measured PA.

RESULTS

Besides significant regression coefficients for previously described correlates of HRR (sex, age), we could show positive associations of HRR with breastfeeding (six versus zero months: +4.2 beats per minute (BPM), p=0.004) and PA (+1.0BPM for 10min increase of moderate-to-vigorous PA/day, p<0.001). Smoking before and during pregnancy showed no significant association with HRR in the total sample. However, we found interactions between sex and smoking before and during pregnancy as well as between sex and breastfeeding, suggesting significant associations with HRR only in girls.

CONCLUSIONS

Besides PA, early pre- and postnatal exposures seem to have long-lasting effects on children's autonomic function, still recordable at preschool age. Our data suggest that these effects might be sex-dependent.

Effectiveness of Moderate Intensity Interval Training as an Index of Autonomic Nervous Activity

The purpose of this study was to examine the effects of moderate intensity interval training from the change of the autonomic nervous activity. Ten male volunteers aged 21-22 years were studied. After 10-minute rest in a seated position, the subjects were asked to perform the strength of moderate cycling exercise in ergometer. Cycling rate was done in 50 times/min. Load resistance of the ergometer was set to 2.0 kgm. Subjects paused the exercise when the heart rate becomes 120 beats/min. Subjects have resumed the exercise when the heart rate returns to the value at rest. This trial was repeated twice. The experiment was ended when the heart rate of the subjects has returned to resting level. When the heart rate during exercise is maintained to less than 120 beats/min, sympathetic nerve activity during exercise did not work actively compared to the baseline. Vagus nerve activity after exercise cessation exceeds the baseline. It is clarified that the exercise as well as activating the vagus nerve activity stimulates the total autonomic nervous activity. It has revealed that at the time of interval training at moderate load the vagus nerve activity can be carried out.

Heritability of heart rate recovery and vagal rebound after exercise

Purpose

The prognostic power of heart rate recovery (HRR) after exercise has been well established but the exact origin of individual differences in HRR remains unclear. This study aims to estimate the heritability of HRR and vagal rebound after maximal exercise in adolescents. Furthermore, the role of voluntary regular exercise behavior (EB) in HRR and vagal rebound is tested.

Methods

491 healthy adolescent twins and their siblings were recruited for maximal exercise testing, followed by a standardized cooldown with measurement of the electrocardiogram and respiratory frequency. Immediate and long-term HRR (HRR60 and HRR180) and vagal rebound (heart rate variability in the respiratory frequency range) were assessed 1 and 3 min after exercise. Multivariate twin modeling was used to estimate heritability of all measured variables and to compute the genetic contribution to their covariance.

Results

Heritability of HRR60, HRR180 and immediate and long-term vagal rebound is 60 % (95 % CI: 48–67), 65 % (95 % CI: 54–73), 23 % (95 % CI: 11–35) and 3 % (95 % CI: 0–11), respectively. We find evidence for two separate genetic factors with one factor influencing overall cardiac vagal control, including resting heart rate and respiratory sinus arrhythmia, and a specific factor for cardiac vagal exercise recovery. EB was only modestly associated with resting heart rate (r = −0.27) and HRR (rHRR60 = 0.10; rHRR180 = 0.19) with very high genetic contribution to these associations (88–91 %).

Conclusions

Individual differences in HRR and immediate vagal rebound can to a large extent be explained by genetic factors. These innate cardiac vagal exercise recovery factors partly reflect the effects of heritable differences in EB.

The Relationship Between β-Receptor Sensitivity and Nocturnal Blood Pressure and Heart Rate Recovery in Normotensive People

This study examined the relationship between nocturnal blood pressure (BP) dipping and chronotropic dose25 (CD25) as an indicator of β-adrenergic receptor functioning in normotensive people. In addition, the authors evaluated the influence of β-receptor functioning on heart rate recovery after exercise. The sample consisted of 41 participants (18 men, 23 women). Ambulatory BP monitoring took place in each patient's home. On a separate occasion, β-adrenergic receptor sensitivity was determined by response to isoproterenol infusion. Heart rate (HR) recovery was defined as the change from peak HR to that measured after 1 and 2 minutes of recovery. Relationships between dipping and CD25 were found such that participants with higher CD25 values had less nocturnal decline in systolic BP, diastolic BP, and mean arterial pressure ( r =–0.445, –0.533, –0.510, respectively; p<0.004, 0.001, 0.001, respectively). Heart rate recovery at 1 and 2 minutes after exercise was 28.8 ±5 and 49.9 ±6 beats/minute, respectively. Participants with higher CD25 values had more heart rate decline during the first 2 minutes of recovery ( r =0.407, p<0.008). In addition, heart rate recovery was inversely related to systolic, diastolic, and mean nocturnal blood pressure dipping ( r =–0.348, –0.432, –0.408, respectively, p<0.028, 0.005, 0.009, respectively). Normotensive people with an abnormal circadian pattern of blood pressure may have desensitized β-adrenergic receptors. This desensitization may contribute to blunted nocturnal blood pressure and increased heart rate recovery as measured at 2 minutes following exercise testing.

Autonomic Recovery Is Delayed in Chinese Compared with Caucasian following Treadmill Exercise

Caucasian populations have a higher prevalence of cardiovascular disease (CVD) when compared with their Chinese counterparts and CVD is associated with autonomic function. It is unknown whether autonomic function during exercise recovery differs between Caucasians and Chinese. The present study investigated autonomic recovery following an acute bout of treadmill exercise in healthy Caucasians and Chinese. Sixty-two participants (30 Caucasian and 32 Chinese, 50% male) performed an acute bout of treadmill exercise at 70% of heart rate reserve. Heart rate variability (HRV) and baroreflex sensitivity (BRS) were obtained during 5-min epochs at pre-exercise, 30-min, and 60-min post-exercise. HRV was assessed using frequency [natural logarithm of high (LnHF) and low frequency (LnLF) powers, normalized high (nHF) and low frequency (nLF) powers, and LF/HF ratio] and time domains [Root mean square of successive differences (RMSSD), natural logarithm of RMSSD (LnRMSSD) and R-R interval (RRI)]. Spontaneous BRS included both up-up and down-down sequences. At pre-exercise, no group differences were observed for any HR, HRV and BRS parameters. During exercise recovery, significant race-by-time interactions were observed for LnHF, nHF, nLF, LF/HF, LnRMSSD, RRI, HR, and BRS (up-up). The declines in LnHF, nHF, RMSSD, RRI and BRS (up-up) and the increases in LF/HF, nLF and HR were blunted in Chinese when compared to Caucasians from pre-exercise to 30-min to 60-min post-exercise. Chinese exhibited delayed autonomic recovery following an acute bout of treadmill exercise. This delayed autonomic recovery may result from greater sympathetic dominance and extended vagal withdrawal in Chinese.

TRIAL REGISTRATION

Chinese Clinical Trial Register ChiCTR-IPR-15006684.

Impact of cancer and chemotherapy on autonomic nervous system function and cardiovascular reactivity in young adults with cancer: a case-controlled feasibility study

Background

Preliminary evidence suggests cancer- and chemotherapy-related autonomic nervous system (ANS) dysfunction may contribute to the increased cardiovascular (CV) morbidity- and mortality-risks in cancer survivors. However, the reliability of these findings may have been jeopardized by inconsistent participant screening and assessment methods. Therefore, good laboratory practices must be established before the presence and nature of cancer-related autonomic dysfunction can be characterized. The purpose of this study was to assess the feasibility of conducting concurrent ANS and cardiovascular evaluations in young adult cancer patients, according to the following criteria: i) identifying methodological pitfalls and proposing good laboratory practice criteria for ANS testing in cancer, and ii) providing initial physiologic evidence of autonomic perturbations in cancer patients using the composite autonomic scoring scale (CASS).

Methods

Thirteen patients (mixed diagnoses) were assessed immediately before and after 4 cycles of chemotherapy. Their results were compared to 12 sex- and age-matched controls. ANS function was assessed using standardized tests of resting CV (tilt-table, respiratory sinus arrhythmia and Valsalva maneuver) and sudomotor (quantitative sudomotor axon reflex test) reactivity. Cardiovascular reactivity during exercise was assessed using a modified Astrand-Ryhming cycle ergometer protocol. Our feasibility criteria addressed: i) recruitment potential, ii) retention rates, iii) pre-chemotherapy assessment potential, iv) test performance/tolerability, and v) identification and minimizing the influence of potentially confounding medication. T-tests and repeated measures ANOVAs were used to assess between- and within-group differences at baseline and follow-up.

Results

The overall success rate in achieving our feasibility criteria was 98.4 %. According to the CASS, there was evidence of ANS impairment at baseline in 30.8 % of patients, which persisted in 18.2 % of patients at follow-up, compared to 0 % of controls at baseline or follow-up.

Conclusions

Results from our feasibility assessment suggest that the investigation of ANS function in young adult cancer patients undergoing chemotherapy is possible. To the best of our knowledge, this is the first study to report CASS-based evidence of ANS impairment and sudomotor dysfunction in any cancer population. Moreover, we provide evidence of cancer- and chemotherapy-related parasympathetic dysfunction – as a possible contributor to the pathogenesis of CV disease in cancer survivors.

Blood pressure changes following aerobic exercise in Caucasian and Chinese descendants

Acute aerobic exercise produces post-exercise hypotension (PEH). Chinese populations have lower prevalence of cardiovascular disease compared to Caucasians. PEH may be associated cardiovascular disease through its influence on hypertension. The purpose of this study was to compare PEH between Caucasian and Chinese subjects following acute aerobic exercise. 62 (30 Caucasian and 32 Chinese, 50% male) subjects underwent measurement of peripheral and central hemodynamics as well as arterial and cardiac evaluations, 30 min and 60 min after 45 min of treadmill exercise. Caucasians exhibited significantly higher baseline BP than the Chinese. While the reduction in brachial artery systolic BP was greater in Caucasian than in the Chinese, there was no difference in changes in carotid systolic BP between the groups. The increase in cardiac output and heart rate was greater in the Chinese than Caucasians, but total peripheral resistance and leg pulse wave velocity decreased by a similar magnitude in the Chinese and Caucasian subjects. We conclude that acute aerobic exercise produces a greater magnitude of PEH in peripheral systolic BP in Caucasian compared to Chinese subjects. The different magnitude in PEH was caused by the greater increase in cardiac output mediated by heart rate, with no change in stroke volume. It is possible that initial BP differences between races influenced the findings.

Protocatechuic acid exerts a cardioprotective effect in type 1 diabetic rats

Oxidative stress has been shown to play an important role in the pathogenesis of diabetes-induced cardiac dysfunction. Protocatechuic acid (PCA) is a phenolic compound, a main metabolite of anthocyanin, which has been reported to display various pharmacological properties. We proposed the hypothesis that PCA exerts cardioprotection in type 1 diabetic (T1DM) rats. T1DM was induced in male Sprague-Dawley rats by a single i.p. injection of 50 mg/kg streptozotocin (STZ) and groups of these animals received the following treatments for 12 weeks: i) oral administration of vehicle, ii) oral administration of PCA at a dose of 50  mg/kg per day, iii) oral administration of PCA at a dose of 100 mg/kg per day, iv) s.c. injection of insulin at a dose of 4 U/kg per day, and v) a combination of PCA, 100 mg/kg per day and insulin, 4 U/kg per day. Metabolic parameters, results from echocardiography, and heart rate variability were monitored every 4 weeks, and the HbA1c, cardiac malondialdehyde (MDA), cardiac mitochondrial function, and cardiac BAX/BCL2 expression were evaluated at the end of treatment. PCA, insulin, and combined drug treatments significantly improved metabolic parameters and cardiac function as shown by increased percentage fractional shortening and percentage left ventricular ejection fraction and decreased low-frequency:high-frequency ratio in T1DM rats. Moreover, all treatments significantly decreased plasma HbA1c and cardiac MDA levels, improved cardiac mitochondrial function, and increased BCL2 expression. Our results demonstrated for the first time, to our knowledge, the efficacy of PCA in improving cardiac function and cardiac autonomic balance, preventing cardiac mitochondrial dysfunction, and increasing anti-apoptotic protein in STZ-induced T1DM rats. Thus, PCA possesses a potential cardioprotective effect and could restore cardiac function when combined with insulin treatment. These findings indicated that supplementation with PCA might be helpful for the prevention and alleviation of cardiovascular complications in T1DM.

Heart rate response and parasympathetic modulation during recovery from exercise in boys and men

The purpose of this study was to examine the influence of postexercise parasympathetic modulation, measured by heart rate variability (HRV), on heart rate recovery (HRR) in boys (n = 13, 10.1 ± 0.8 years) and men (n = 13, 23.9 ± 1.5 years) following maximal and submaximal exercise. Subjects completed 10 min of supine rest, followed by graded exercise on a cycle ergometer to maximal effort. On a separate day, subjects exercised at an intensity equivalent to ventilatory threshold. Immediately following both exercise bouts, 1-min HRR was assessed in the supine position. HRV was analyzed under controlled breathing during the final 5 min of rest and recovery in the time and frequency domains and transformed to natural log (ln) values. Boys had a greater 1-min HRR than men following maximal (58 ± 8 vs. 47 ± 11 beats·min−1) and submaximal (59 ± 8 vs. 47 ± 15 beats·min−1) exercise (p < 0.05). Following maximal exercise, boys had greater ln root mean square successive differences in R-R intervals (2.52 ± 0.95 ms), ln standard deviation of NN intervals (3.34 ± 0.57 ms), ln high-frequency power (4.32 ± 2.00 ms2), and ln low-frequency power (4.98 ± 1.17 ms2) than men (1.33 ± 0.37 ms, 2.52 ± 0.24 ms, 1.32 ± 1.06 ms2 and 2.80 ± 0.74 ms2, respectively) (p < 0.05). There were no differences in any HRV variables between groups following submaximal exercise (p > 0.05). In conclusion, it appears that greater parasympathetic modulation accounts for greater HRR following maximal exercise in boys versus men. Although submaximal HRR was greater in boys, parasympathetic responses were similar between groups.

Resting heart rate variability and heart rate recovery after submaximal exercise

PURPOSE

Aerobic training accelerates Heart Rate Recovery after exercise in healthy subjects and in patients with coronary disease. As shown by pharmacological autonomic blockade, HRR early after exercise is dependent primarily on parasympathetic reactivation. Thus, accelerated HRR early after exercise in endurance-trained athletes may be attributed to augmented parasympathetic reactivation. In the present study, we tested the hypothesis that the HRR early after submaximal exercise is related to the pre-exercise parasympathetic modulation.

METHODS

Thirty endurance-trained athletes (20 males, 50 ± 7 years) and thirty control subjects (20 males, 52 ± 6 years) performed a submaximal exercise on a cyclo-ergometer. Pre-exercise resting short-term heart rate variability (HRV) parameters in time and frequency-domains were correlated with HRR during the first 30 s, 1 and 2 min after cessation of exercise.

RESULTS

We found that HRR was statistically significantly faster in athletes than in controls at all examination time points (p < 0.05). HF, SDNN and RMSSD were statistically significantly higher in athletes than in controls (p < 0.05), but other resting HRV parameters were not statistically different between groups. After 30 s, 1 and 2 min of recovery, HRR correlation with total power, HF, HFnu and RMSSD was positive, while the correlation with LF/HF was negative for small and positive for larger values. The opposite was true for SDNN.

CONCLUSIONS

These findings support the hypothesis that HRR early after submaximal exercise is related to resting parasympathetic modulation in the middle-aged subjects. In addition, they suggested an optimal range of HRV for maximal HRR after exercise.

The correlates of body composition with heart rate recovery after step test: an exploratory study of Malaysian adolescents

BACKGROUND

In adults, heart rate recovery is a predictor of mortality, while in adolescents it is associated with cardio-metabolic risk factors. The aim of this study was to examine the relationship between body composition measures and heart rate recovery (HRR) after step test in Malaysian secondary school students.

METHODS

In the Malaysian Health and Adolescents Longitudinal Research Team (MyHEART) study, 1071 healthy secondary school students, aged 13 years old, participated in the step test. Parameters for body composition measures were body mass index z-score, body fat percentage, waist circumference, and waist height ratio. The step test was conducted by using a modified Harvard step test. Heart rate recovery of 1 minute (HRR1min) and heart rate recovery of 2 minutes (HRR2min) were calculated by the difference between the peak pulse rate during exercise and the resting pulse rate at 1 and 2 minutes, respectively. Analysis was done separately based on gender. Pearson correlation analysis was used to determine the association between the HRR parameters with body composition measures, while multiple regression analysis was used to determine which body composition measures was the strongest predictor for HRR.

RESULTS

For both gender groups, all body composition measures were inversely correlated with HRR1min. In girls, all body composition measures were inversely correlated with HRR2min, while in boys all body composition measures, except BMI z-score, were associated with HRR2min. In multiple regression, only waist circumference was inversely associated with HRR2min (p=0.024) in boys, while in girls it was body fat percentage for HRR2min (p=0.008).

CONCLUSION

There was an inverse association between body composition measurements and HRR among apparently healthy adolescents. Therefore, it is important to identify cardio-metabolic risk factors in adolescent as an early prevention of consequent adulthood morbidity. This reiterates the importance of healthy living which should start from young.

Protective effects of garlic extract on cardiac function, heart rate variability, and cardiac mitochondria in obese insulin-resistant rats

PURPOSE

Garlic has been shown to exhibit antioxidant effects and cardioprotective properties. However, the effects of garlic extract on the heart in insulin resistance induced by long-term high-fat-diet consumption are not well defined. Therefore, we sought to determine the effects of garlic extract in the obese insulin-resistant rats.

METHODS

Male Wistar rats (180-200 g) were divided into two groups: normal-diet or high-fat-diet (n = 24/group) fed for 12 weeks. Rats in each groups were divided into three subgroups (n = 8 each): vehicle or garlic extract (250 or 500 mg/kg/day, respectively) treated for 28 days. At the end of the treatment, the metabolic parameters, heart rate variability (HRV), cardiac function, and cardiac mitochondrial function were determined.

RESULTS

Rats that received a high-fat-diet for 12 weeks had increased body weight, visceral fat, plasma insulin levels, total cholesterol, oxidative stress levels, depressed HRV, and cardiac mitochondrial dysfunction. Garlic extract at both concentrations significantly decreased the plasma insulin, total cholesterol, homeostasis model assessment index, and oxidative stress levels. Furthermore, garlic extract at both doses restored the HRV, cardiac function, and cardiac mitochondrial function.

CONCLUSION

We concluded that garlic extract at both concentrations exerted cardioprotective effects against cardiac dysfunction and mitochondrial dysfunction in obese insulin-resistant rats.

Heart rate recovery is associated with obesity traits and related cardiometabolic risk factors in children and adolescents

BACKGROUND AND AIMS

Increased vagal activity is associated with obesity and metabolic risk in children and adolescents. The aim of the present cross-sectional study was to examine the association of parasympathetic function, as assessed by heart rate recovery (HRR) from a maximal exercise cycle-ergometer test, with obesity traits and related cardiometabolic risk factors in Spanish children and adolescents.

METHODS AND RESULTS

A sample of 437 Spanish 9-year-old-children and 235 15-year-old-adolescents participated in the study. The variables measured were anthropometric characteristics (height, body mass and waist circumference) and physical activity using the Actigraph accelerometer. Additional measured outcomes included fasting insulin, triglycerides, high-density lipoprotein cholesterol (HDLc) and blood pressure. A metabolic risk score was computed as the mean of the standardised outcomes scores. The HRR was calculated as the difference between peak heart rate and heart rate 1, 3 and 5 min after cessation of the maximal ergometer test. Diastolic blood pressure was associated with all the HRR parameters in 9-year-old-girls. In 9-year-old-boys, the 3-min HRR was inversely associated with systolic blood pressure (p < 0.05) and Homeostasis Model Assessment (HOMA) (p < 0.05). Five minute HRR was inversely associated with waist circumference (p < 0.05), sum of five skinfolds (p < 0.01) and HOMA (p = 0.004). There were no significant associations in adolescents. In 9-year-old-girls, the adjusted 5-min HRR showed significant differences between quartile 2 and 4 of metabolic risk (p = 0.011). In all samples, the adjusted HRR (1-, 3- and 5-min HRR) did not show significant differences across quartiles.

CONCLUSION

HRR was inversely associated with obesity traits and related cardiometabolic risk factors mainly in healthy boys.

Pathophysiology of exercise heart rate recovery: a comprehensive analysis

Expanded use of exercise heart rate recovery (HRR) has renewed interest in the pathophysiology of heart rate control. This study uses basic physiologic principles to construct a unique model capable of describing the full time course of sympathetic and parasympathetic activity during HRR. The model is tested in a new study of 22 diverse subjects undergoing both maximal and submaximal treadmill exercise. Based on this analysis, prolongation of HRR involves changes within the sinus node, changes in sympathetic function, in parasympathetic function, and in the central mechanisms regulating autonomic balance. The methods may provide unique insight into alterations in autonomic control in health and disease.

Effects of adiposity and Prader-Willi Syndrome on postexercise heart rate recovery

Heart rate recovery (HRR) is an indicator of all-cause mortality in children and adults. We aimed to determine the effect of adiposity and Prader-Willi Syndrome (PWS), a congenital form of obesity, on HRR. Sixteen children of normal weight (NW = body fat % ≤85th percentile, 9.4 ± 1.1 y), 18 children with obesity (OB = body fat % >95th percentile, 9.3 ± 1.1 y), and 11 PWS youth (regardless of body fat %; 11.4 ± 2.5 y) completed peak and submaximal bike tests on separate visits. HRR was recorded one minute following peak and submaximal exercises. All groups displayed similar HRR from peak exercise, while NW (54 ± 16 beats) and OB (50 ± 12 beats) exhibited a significantly faster HRR from submaximal exercise than PWS (37 ± 14 beats). These data suggest that excess adiposity does not influence HRR in children, but other factors such as low cardiovascular fitness and/or autonomic dysfunction might be more influential.

Determinants of muscle metaboreflex and involvement of baroreflex in boys and young men

This study aimed to assess the arterial pressure (AP) determinants during the muscle metaboreflex in boys and men and to investigate the contribution of baroreflex and sympathovagal function to the metaboreflex-induced responses. Fourteen pre-adolescent boys and 13 men performed a protocol involving: baseline, isometric handgrip exercise, circulatory occlusion, and recovery. The same protocol was repeated without occlusion. During baseline, boys had lower beat-to-beat AP, higher heart rate (HR), and lower low/high frequency HR variability. During exercise, a parasympathetic withdrawal was evident in both groups. In adults, HR was the key contributor to the pressure response, with no changes in stroke volume, whereas in boys, the lower HR increase was counterbalanced by an increase in stroke volume, resulting in similar relative increases in AP in both groups. In recovery, boys exhibited a faster rate of HR-decay, rapid vagal reactivation, and greater decrease in TPR than men. An overshoot in baroreceptor sensitivity was observed in men. The isolated metaboreflex resulted in a similar AP elevation in both age groups (by ~15 mmHg), and attenuated spontaneous baroreceptor sensitivity. However, during the metaboreflex, pre-adolescent males exhibited a lower increase in peripheral resistance and a greater bradycardic response than adults, and a fast restoration of vagal activity to non-occlusion levels. During metaboreflex, boys were capable of eliciting a pressure response similar to the one elicited by men; however, the interplay of the mechanisms underlying the rise in AP differed between the two groups with the vagal contribution being greater in the younger participants.

Enhanced exercise performance and survival associated with evidence of autonomic reinnervation in pediatric heart transplant recipients

Following heart transplantation (HTx), loss of autonomic input to the allograft results in elevated resting heart rate (HR) and decreased chronotropic reserve. As enhanced exercise capacity and HR recovery post exercise are suggestive of reinnervation in pediatric cohorts, we used heart rate variability (HRV) analysis to assess autonomic reinnervation in pediatric HTx recipients. Pediatric patients transplanted between 1996 and 2010 and with serial 24-hour Holter recordings post-HTx were analyzed for HRV using time and frequency domain measures. Of 112 patients, 68 (57%) showed evidence of autonomic reinnervation that was not associated with age at HTx. Evidence of reinnervation was associated with a significant increase in low-frequency power spectrum (p<0.001), suggesting sympathetic reinnervation. Patients with evidence of reinnervation showed higher percent-predicted maxVO(2) on performing an exercise test (+10.2 ± 3.6%, p = 0.006) and improved HR recovery at 3 minutes (-11.4 ± 3.9 bpm, p = 0.004), but no difference in percent-predicted maximal HR. Cox hazards modeling using presumed sinus reinnervation criteria at last Holter recording as a time-dependent covariate was associated with decreased hazard of mortality and/or retransplantation (HR: 0.2, 95% CI 0.04-1.0, p = 0.05). In conclusion, a majority of pediatric HTx recipients demonstrate evidence of reinnervation that is associated with functional outcomes. Studies to assess graft reinnervation as a marker of long-term prognosis are warranted.

Cardioprotective effects of metformin and vildagliptin in adult rats with insulin resistance induced by a high-fat diet

Insulin resistance has been shown to be associated with cardiac sympathovagal imbalance, myocardial dysfunction, and cardiac mitochondrial dysfunction. Whereas metformin is a widely used antidiabetic drug to improve insulin resistance, vildagliptin is a novel oral antidiabetic drug in a group of dipeptidyl peptidase-4 inhibitors in which its cardiac effect is unclear. This study aimed to determine the cardiovascular effects of metformin and vildagliptin in rats with insulin resistance induced by high-fat diet. Male Wistar rats were fed with either a normal diet or high-fat diet (n =24 each) for 12 wk. Rats in each group were divided into three subgroups to receive the vehicle, metformin (30 mg/kg, twice daily), or vildagliptin (3 mg/kg, once daily) for another 21 d. Heart rate variability (HRV), cardiac function, and cardiac mitochondrial function were determined and compared among these treatment groups. Rats exposed to a high-fat diet developed increased body weight, visceral fat, plasma insulin, cholesterol, oxidative stress, depressed HRV, and cardiac mitochondrial dysfunction. Metformin and vildagliptin did not alter body weight and plasma glucose levels but decreased the plasma insulin, total cholesterol, and oxidative stress levels. Although both metformin and vildagliptin attenuated the depressed HRV, cardiac dysfunction, and cardiac mitochondrial dysfunction, vildagliptin was more effective in this prevention. Furthermore, only vildagliptin prevented cardiac mitochondrial membrane depolarization caused by consumption of a high-fat diet. We concluded that vildagliptin is more effective in preventing cardiac sympathovagal imbalance and cardiac dysfunction, as well as cardiac mitochondrial dysfunction, than metformin in rats with insulin resistance induced by high-fat diet.

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

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

Relation of heart rate recovery to heart rate variability in persons with paraplegia

PURPOSE

Heart rate recovery (HRR) after treadmill exercise testing is an index of cardiac autonomic activity in non-disabled persons, but it is unknown if this is also the case in individuals with spinal cord injury (SCI). We investigated the relationship between HRR after maximal arm exercise testing and resting autonomic activity in persons with paraplegia.

METHODS

A total of 17 (male n = 9, female n = 8) active individuals with paraplegia (injury below T6) were included in the study. Frequency domain analyses of resting heart rate variability were obtained and participants completed a maximal arm exercise test. HRR was calculated as the difference between peak heart rate during the test and heart rate 1 min (HRR1) and 2 (HRR2) min after cessation of exercise.

RESULTS

HRR 1 and HRR 2 were statistically significantly correlated with high-frequency (HF) power (r = 0.46, p < 0.05 and r = 0.47, p < 0.05) and the LF/HF ratio (r = -0.49, p < 0.05 and r = -0.50, p < 0.05). After adjusting for age, peak heart rate and peak oxygen uptake, HRR 2 was still significantly associated with HF power (r = 0.50, p < 0.05) and the LF/HF ratio (r = -0.58, p < 0.05).

CONCLUSIONS

These findings indicate that HRR after maximal arm exercise testing is associated with resting cardiac autonomic activity in persons with paraplegia. This would suggest that HRR after maximal arm exercise testing can be used as an index of autonomic function in this population.

Exercise testing and prescription in patients with congenital heart disease

The present paper provides a review of the literature regarding exercise testing, exercise capacity, and the role of exercise training in patients with congenital heart disease (CHD). Different measures of exercise capacity are discussed, including both simple and more advanced exercise parameters. Different groups of patients, including shunt lesions, pulmonary valvar stenosis, patients after completion of Fontan circulation, and patients with pulmonary arterial hypertension are discussed separately in more detail. It has been underscored that an active lifestyle, taking exercise limitations and potential risks of exercise into account is of utmost importance. Increased exercise capacity in these patients is furthermore correlated with an improvement of objective and subjective quality of life.

Postexercise heart rate recovery in children: relationship with power output, blood pH, and lactate

The aim of the present study was to determine whether differences in age-related heart rate recovery (HRR) kinetics were associated with differences in power output, blood lactate concentration ([La]b), and acidosis among children, adolescents, and adults. Ten prepubertal boys (aged 9.6 +/- 0.7 years), 6 pubertal boys (aged 15.2 +/- 0.8 years), and 7 men (aged 20.4 +/- 1.0 years) performed 10 repeated 10-s all-out cycling sprints, interspersed with 5-min passive recovery intervals. Mean power output (MPO) was measured during each sprint, and HRR, [La]b, and acidosis (pHb) were determined immediately after each sprint. Children displayed a shorter time constant of the primary component of HRR than adolescents and adults (17.5 +/- 4.1 vs. 38.0 +/- 5.3 and 36.9 +/- 4.9 s, p < 0.001 for both), but no difference was observed between adolescents and adults (p = 1.00). MPO, [La]b, and pHb were also lower in children compared with the other 2 groups (p < 0.001 for both). When data were pooled, HRR was significantly correlated with MPO (r = 0.48, p < 0.001), [La]b (r = 0.58, p < 0.001), and pHb (r = -0.60, p < 0.001). Covarying for MPO, [La]b, or pHb abolished the between-group differences in HRR (p = 0.42, p = 0.19, and p = 0.16, respectively). Anaerobic glycolytic contribution and power output explained a significant portion of the HRR variance following high-intensity intermittent exercise. The faster HRR kinetic observed in children appears to be related, at least in part, to their lower work rate and inherent lack of anaerobic metabolic capacity.

Determinants of heart rate recovery following exercise in children

PURPOSE

Heart rate (HR) recovery during the first minute after cessation of exercise is predominantly modulated by reactivation of vagal tone. Attenuated 1-min HR recovery is a cardiovascular risk factor in adults. The purpose of this study was to determine predictors of 1-min HR recovery after a maximum-effort exercise test in healthy children.

METHODS

HR recovery after cessation of a maximal treadmill exercise test (Bruce protocol) was assessed in 485 children (197 girls, 288 boys) who underwent an exercise test during their clinical evaluation to exclude cardiac disease and who were discharged as normal. The first-minute cool-down period (1.5 mph, 0% inclination on treadmill) was consistent for all subjects. Age- and gender-specific 25th, 50th, and 75th percentile values of 1-min HR recovery were generated. Multivariable linear regression analyses were performed to determine predictors of 1-min HR recovery.

RESULTS

One-minute HR recovery was higher in boys and correlated inversely with age and with age-adjusted BMI in both boys and girls. In a multivariable linear regression model, age, gender, BMI, and baseline HR were significant predictors of 1-min HR recovery and explained 39% of variance. Exercise duration and peak HR were also significant predictors when added to the model, but they improved the explained variance by only 2%.

CONCLUSION

One-minute HR recovery after exercise is attenuated with age in children. Children with higher BMI, particularly those who are overweight, and those with lower exercise endurance, have slower 1-min HR recovery.

Recovery kinetics of heart rate and oxygen uptake in long-term survivors of acute leukemia in childhood

Analysis of the recovery period following physical exercise has gained importance in evaluating cardiopulmonary capacity, not only in athletes but also in patients with proven or suspected heart failure. The purpose of this study was to apply these methods to long-term survivors of acute lymphoblastic leukemia (ALL) in childhood, who are at risk of developing anthracycline-induced cardiomyopathy. Nine children (mean age 12 years) and 10 adults (mean age 24 years) were included in the study after treatment for childhood ALL. Recovery of oxygen uptake and heart rate following maximal spiroergometric exercise was compared to that in 29 trained and untrained age-matched controls. The change in oxygen uptake (DeltaVO2) and heart rate (DeltaHR) between maximal effort and 60 s of recovery did not differ significantly, either between children after oncological therapy (DeltaVO2: 14.95 ml/kg, DeltaHR: 35 bpm) and healthy children (DeltaVO2: 15.85 ml/kg, DeltaHR: 37 bpm), or between adult former oncological patients (DeltaVO2: 13.1 ml/kg, DeltaHR: 27 bpm) and untrained adults (DeltaVO2: 15.7 ml/kg, DeltaHR: 31 bpm). There was, however, a significant difference in DeltaVO2 between trained adults (DeltaVO2: 24.5 ml/kg) and both untrained adult controls (DeltaVO2: 15.7 ml/kg, p=0.004) and adult patients (DeltaVO2: 13.1 ml/kg, p=0.0002). This difference was not detected for heart rate. In conclusion, the recovery period did not reveal a discernible difference in cardiopulmonary capacity between former ALL patients and untrained age-matched controls. We did confirm that heart rate and oxygen uptake recovery serve as indicators of physical fitness.

Cardiac rehabilitation improves heart rate recovery following peak exercise in children with repaired congenital heart disease

We assessed heart rate (HR) recovery following peak exercise before and after a 12-week cardiac rehabilitation program in 14 children, 12.1+/-1.8 years of age, with repaired complex congenital heart disease (CHD; 11 with Fontan surgery) and impaired exercise performance. Exercise testing using bicycle ergometry was performed at baseline, after completion of the rehab program and 1.0+/-0.2 years after the baseline test. These data were compared to HR recovery in 15 controls (age, 12.7+/-2.4 years) with CHD (13 with Fontan surgery) with two serial exercise tests at an interval of 1.1+/- 0.3 years. There was no change in peak HR between the two serial tests in either group. Peak VO2 improved in the rehab group (26.3+/-9.6 ml/kg/min at baseline vs 30.9+/-9.6 ml/kg/min after rehab, p=0.01) but remained unchanged in controls on serial testing. One-minute HR recovery (in beats per minute) improved significantly following completion of the rehab program (27+/-15 at baseline vs 40+/-23 after rehab, p=0.01). Partial improvement in 1-minute HR recovery in the rehab group persisted 1 year later (1-minute HR recovery, 35+/-19; p=0.1 compared to baseline). There was no change in 1-minute HR recovery over time in the control group (37+/-16 vs 40+/-13, p = not significant). In conclusion, HR recovery following peak exercise improves in children with CHD after participation in a cardiac rehab program.