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Balestra E, Bobbo M, Cittar M, Chicco D, D’Agata Mottolese B, Barbi E, Caiffa T. Congenital Long QT Syndrome in Children and Adolescents: A General Overview. CHILDREN (BASEL, SWITZERLAND) 2024; 11:582. [PMID: 38790576 PMCID: PMC11119491 DOI: 10.3390/children11050582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
Congenital long QT syndrome (LQTS) represents a disorder of myocardial repolarization characterized by a prolongation of QTc interval on ECG, which can degenerate into fast polymorphic ventricular arrhythmias. The typical symptoms of LQTS are syncope and palpitations, mainly triggered by adrenergic stimuli, but it can also manifest with cardiac arrest. At least 17 genotypes have been associated with LQTS, with a specific genotype-phenotype relationship described for the three most common subtypes (LQTS1, -2, and -3). β-Blockers are the first-line therapy for LQTS, even if the choice of the appropriate patients needing to be treated may be challenging. In specific cases, interventional measures, such as an implantable cardioverter-defibrillator (ICD) or left cardiac sympathetic denervation (LCSD), are useful. The aim of this review is to highlight the current state-of-the-art knowledge on LQTS, providing an updated picture of possible diagnostic algorithms and therapeutic management.
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Affiliation(s)
- Elia Balestra
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Marco Bobbo
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34127 Trieste, Italy; (M.B.); (D.C.); (B.D.M.); (T.C.)
| | - Marco Cittar
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, 34127 Trieste, Italy;
| | - Daniela Chicco
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34127 Trieste, Italy; (M.B.); (D.C.); (B.D.M.); (T.C.)
| | - Biancamaria D’Agata Mottolese
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34127 Trieste, Italy; (M.B.); (D.C.); (B.D.M.); (T.C.)
| | - Egidio Barbi
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy;
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34127 Trieste, Italy; (M.B.); (D.C.); (B.D.M.); (T.C.)
| | - Thomas Caiffa
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34127 Trieste, Italy; (M.B.); (D.C.); (B.D.M.); (T.C.)
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Laborde S, Wanders J, Mosley E, Javelle F. Influence of physical post-exercise recovery techniques on vagally-mediated heart rate variability: A systematic review and meta-analysis. Clin Physiol Funct Imaging 2024; 44:14-35. [PMID: 37754676 DOI: 10.1111/cpf.12855] [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: 09/21/2022] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023]
Abstract
In sports, physical recovery following exercise-induced fatigue is mediated via the reactivation of the parasympathetic nervous system (PNS). A noninvasive way to quantify the reactivation of the PNS is to assess vagally-mediated heart rate variability (vmHRV), which can then be used as an index of physical recovery. This systematic review and meta-analysis investigated the effects of physical recovery techniques following exercise-induced fatigue on vmHRV, specifically via the root mean square of successive differences (RMSSD). Randomized controlled trials from the databases PubMed, WebOfScience, and SportDiscus were included. Twenty-four studies were part of the systematic review and 17 were included in the meta-analysis. Using physical post-exercise recovery techniques displayed a small to moderate positive effect on RMSSD (k = 22, Hedges' g = 0.40, 95% confidence interval [CI] = 0.20-0.61, p = 0.04) with moderate heterogeneity. In the subgroup analyses, cold water immersion displayed a moderate to large positive effect (g = 0.75, 95% CI: 0.42-1.07) compared with none for other techniques. For exercise type, physical recovery techniques performed after resistance exercise (g = 0.69, 95% CI: 0.48-0.89) demonstrated a larger positive effect than after cardiovascular intermittent (g = 0.52, 95% CI: 0.06-0.97), while physical recovery techniques performed after cardiovascular continuous exercise had no effect. No significant subgroup differences for training status and exercise intensity were observed. Overall, physical post-exercise recovery techniques can accelerate PNS reactivation as indexed by vmHRV, but the effectiveness varies with the technique and exercise type.
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Affiliation(s)
- Sylvain Laborde
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
- UFR STAPS, Normandie Université, Caen, France
| | - Jannik Wanders
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Emma Mosley
- Solent University Southampton, Southampton, UK
| | - Florian Javelle
- NeuroPsychoImmunology Research Unit, Department of Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
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Lundström A, Wiklund U, Winbo A, Eliasson H, Karlsson M, Rydberg A. Cardiac response to water activities in children with Long QT syndrome type 1. PLoS One 2023; 18:e0295431. [PMID: 38060596 PMCID: PMC10703314 DOI: 10.1371/journal.pone.0295431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Swimming is a genotype-specific trigger in long QT syndrome type 1 (LQT1). OBJECTIVE To examine the autonomic response to water activities in children and adolescents with LQT1. METHODS In this cross-sectional study, LQT1 patients were age and sex matched to one healthy control subject. Electrocardiograms (ECGs) were recorded during face immersion (FI), swimming, diving, and whole-body submersion (WBS). Heart rate (HR) and heart rate variability (HRV) was measured. The high frequency (HF) component of HRV was interpreted to reflect parasympathetic activity, while the low frequency (LF) component was interpreted as reflecting the combined influence of sympathetic and parasympathetic activity on autonomic nervous modulation of the heart. RESULTS Fifteen LQT1 patients (aged 7-19 years, all on beta-blocker therapy) and fifteen age and sex matched non-medicated controls were included. No significant ventricular arrhythmias were observed in the LQT1 population during the water activities. Out of these 15 matched pairs, 12 pairs managed to complete FI and WBS for more than 10 seconds and were subsequently included in HR and HRV analyses. In response to FI, the LQT1 group experienced a drop in HR of 48 bpm, compared to 67 bpm in the control group (p = 0.006). In response to WBS, HR decreased by 48 bpm in the LQT1 group and 70 bpm in the control group (p = 0.007). A significantly lower PTOT (p < 0.001) and HF (p = 0.011) component was observed before, during and after FI in LQT1 patients compared with the controls. Before, during and after WBS, a significantly lower total power (p < 0.001), LF (p = 0.002) and HF (p = 0.006) component was observed in the LQT1 patients. CONCLUSION A significantly lower HR decrease in response to water activities was observed in LQT1 subjects on beta-blocker therapy, compared to matched non-medicated controls. The data suggests an impaired parasympathetic response in LQT1 children and adolescents. An aberrant autonomic nervous system (ANS) response may cause an autonomic imbalance in this patient group.
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Affiliation(s)
- Anna Lundström
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Urban Wiklund
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Annika Winbo
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Håkan Eliasson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Karlsson
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Ackermann SP, Raab M, Backschat S, Smith DJC, Javelle F, Laborde S. The diving response and cardiac vagal activity: A systematic review and meta-analysis. Psychophysiology 2023; 60:e14183. [PMID: 36219506 DOI: 10.1111/psyp.14183] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 01/25/2023]
Abstract
This article aimed to synthesize the various triggers of the diving response and to perform a meta-analysis assessing their effects on cardiac vagal activity. The protocol was preregistered on PROSPERO (CRD42021231419; 01.07.2021). A systematic and meta-analytic review of cardiac vagal activity was conducted, indexed with the root mean square of successive differences (RMSSD) in the context of the diving response. The search on MEDLINE (via PubMed), Web of Science, ProQuest and PsycNet was finalized on November 6th, 2021. Studies with human participants were considered, measuring RMSSD pre- and during and/or post-exposure to at least one trigger of the diving response. Seventeen papers (n = 311) met inclusion criteria. Triggers examined include face immersion or cooling, SCUBA diving, and total body immersion into water. Compared to resting conditions, a significant moderate to large positive effect was found for RMSSD during exposure (Hedges' g = 0.59, 95% CI 0.36 to 0.82, p < .001), but not post-exposure (g = 0.11, 95% CI -0.14 to 0.36, p = .34). Among the considered moderators, total body immersion had a significantly larger effect than forehead cooling (QM = 23.46, df = 1, p < .001). No further differences were detected. Limitations were the small number of studies included, heterogenous triggers, few participants and low quality of evidence. Further research is needed to investigate the role of cardiac sympathetic activity and of the moderators.
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Affiliation(s)
- Stefan Peter Ackermann
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Markus Raab
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany.,School of Applied Sciences, London South Bank University, London, UK
| | - Serena Backschat
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - David John Charles Smith
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Florian Javelle
- Department of Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Sylvain Laborde
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany.,UFR STAPS, EA 4260, Cesams, Normandie Université, Caen, France
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A single session of whole-body cryotherapy boosts maximal cycling performance and enhances vagal drive at rest. Exp Brain Res 2023; 241:383-393. [PMID: 36544016 PMCID: PMC9895013 DOI: 10.1007/s00221-022-06528-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Whole-body cryotherapy (WBC) has been reported to maximize physical recovery after exercise and reduce the ensuing muscle damage. In addition, WBC triggers cardiovascular responses leading to an increased vagal drive. Here we tested whether WBC may boost exercise performance as well as post-exercise recovery. Moreover, we compared the effects of WBC and exercise on sympathovagal balance and tested whether these two factors may interact. ECG was recorded in 28 healthy adults who underwent rest, all-out effort on a cycloergometer, 5 min recovery and again rest. After 3-5 days, WBC (3 min exposure to - 150 °C air) was applied and the whole procedure repeated. Total exercise duration was split into the time needed to reach peak power output (tPEAK) and the time to exhaustion (tEXH). The post-exercise exponential decay of HR was characterized by its delay from exercise cessation (tDELAY) and by its time constant (τOFF). Sympathovagal balance was evaluated by measuring HR variability power in the low (LF) and high (HF) frequency bands, both before exercise and after recovery from it. Sympathetic vs. vagal predominance was assessed by the sympathovagal index LFnu. Paired t-tests indicated that WBC increased tEXH and reduced tDELAY, speeding up the HR recovery. These results suggest that WBC may be exploited to boost exercise performance by about 12-14%. ANOVA on HR variability confirmed that exercise shifted the sympathovagal balance towards sympathetic predominance, but it also highlighted that WBC enhanced vagal drive at rest, both before exercise and after full recovery, covering ~ 70% of the exercise effect.
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Debnath S, Levy TJ, Bellehsen M, Schwartz RM, Barnaby DP, Zanos S, Volpe BT, Zanos TP. A method to quantify autonomic nervous system function in healthy, able-bodied individuals. Bioelectron Med 2021; 7:13. [PMID: 34446089 PMCID: PMC8394599 DOI: 10.1186/s42234-021-00075-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/20/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The autonomic nervous system (ANS) maintains physiological homeostasis in various organ systems via parasympathetic and sympathetic branches. ANS function is altered in common diffuse and focal conditions and heralds the beginning of environmental and disease stresses. Reliable, sensitive, and quantitative biomarkers, first defined in healthy participants, could discriminate among clinically useful changes in ANS function. This framework combines controlled autonomic testing with feature extraction during physiological responses. METHODS Twenty-one individuals were assessed in two morning and two afternoon sessions over two weeks. Each session included five standard clinical tests probing autonomic function: squat test, cold pressor test, diving reflex test, deep breathing, and Valsalva maneuver. Noninvasive sensors captured continuous electrocardiography, blood pressure, breathing, electrodermal activity, and pupil diameter. Heart rate, heart rate variability, mean arterial pressure, electrodermal activity, and pupil diameter responses to the perturbations were extracted, and averages across participants were computed. A template matching algorithm calculated scaling and stretching features that optimally fit the average to an individual response. These features were grouped based on test and modality to derive sympathetic and parasympathetic indices for this healthy population. RESULTS A significant positive correlation (p = 0.000377) was found between sympathetic amplitude response and body mass index. Additionally, longer duration and larger amplitude sympathetic and longer duration parasympathetic responses occurred in afternoon testing sessions; larger amplitude parasympathetic responses occurred in morning sessions. CONCLUSIONS These results demonstrate the robustness and sensitivity of an algorithmic approach to extract multimodal responses from standard tests. This novel method of quantifying ANS function can be used for early diagnosis, measurement of disease progression, or treatment evaluation. TRIAL REGISTRATION This study registered with Clinicaltrials.gov , identifier NCT04100486 . Registered September 24, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04100486 .
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Affiliation(s)
- Shubham Debnath
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Todd J Levy
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Mayer Bellehsen
- Department of Psychiatry, Unified Behavioral Health Center and World Trade Center Health Program, Northwell Health, Bay Shore, NY, USA
| | - Rebecca M Schwartz
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Center for Disaster Health, Trauma, and Resilience, New York, NY, USA
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Douglas P Barnaby
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Northwell Health, Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Bruce T Volpe
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Northwell Health, Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Theodoros P Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA.
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Sautillet B, Leprêtre PM, Schmitt L, Ahmaidi S, Costalat G. Post-exercise Heart Rate Variability: Whole-body Cryotherapy vs. Contrast Water Therapy. Int J Sports Med 2021; 42:979-984. [PMID: 33735918 DOI: 10.1055/a-1312-6914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
High-intensity training sessions are known to alter cardiac autonomic modulation. The purpose of this study was to compare the effects of whole-body cryotherapy, contrast water therapy and passive recovery on the time course of cardiac autonomic markers following a standardized HIT session. Eleven runners completed a high intensity session followed by one of the following recovery interventions: whole-body cryotherapy, contrast water therapy or passive recovery. Changes in cardiac autonomic modulation were assessed in supine and standing positions during an active tilt test at pre-, post-14 h and post-38 h. In supine, high-frequency power increased from pre- to post-14 h following whole-body cryotherapy (1661.1±914.5 vs. 2799.0±948.4 ms2, respectively; p=0.023) and contrast water therapy (1906.1±1327.9 vs. 4174.3±2762.9 ms2, respectively; p=0.004) whereas high frequency power decreased in response to passive recovery (p=0.009). In standing, low-frequency power increased from pre-to post-38 h (1784.3 ± 953.7 vs. 3339.8±1862.7 ms2, respectively; p=0.017) leading to an increase in total power from pre- to post-38 h (1990.8 ± 1089.4 vs. 3606.1±1992.0 ms2, respectively; p=0.017). Spectral analysis revealed that contrast water therapy appears to be a more efficient recovery strategy than whole-body cryotherapy in restoring cardiac autonomic homeostasis.
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Affiliation(s)
- Benoît Sautillet
- Université de Picardie Jules Verne, Faculty of Sport Sciences, Amiens, France
| | - Pierre Marie Leprêtre
- Université de Picardie Jules Verne, Faculty of Sport Sciences/APERE laboratory, Amiens, France
| | - Laurent Schmitt
- National Centre of Nordic-Ski, Research and Performance, Premanon, France
| | - Said Ahmaidi
- Université de Picardie Jules Verne, Faculty of Sport Sciences/APERE laboratory, Amiens, France
| | - Guillaume Costalat
- Université de Picardie Jules Verne, Faculty of Sport Sciences/APERE laboratory, Amiens, France
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Takahashi K, Shimizu W, Makita N, Nakayashiro M. Dynamic QT response to cold-water face immersion in long-QT syndrome type 3. Pediatr Int 2020; 62:899-906. [PMID: 32449227 PMCID: PMC7496693 DOI: 10.1111/ped.14319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 05/03/2020] [Accepted: 05/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Abnormal dynamics of QT intervals in response to sympathetic nervous system stimulation are used to diagnose long-QT syndrome (LQTS). We hypothesized that parasympathetic stimulation with cold-water face immersion following exercise would influence QT dynamics in patients with LQTS type 3 (LQT3). METHODS Study participants (n = 42; mean age = 11.2 years) comprised 20 genotyped LQTS children and 22 healthy children. The LQTS group was divided into LQT3 (n = 12) and non-LQT3 (n = 8) subgroups. Provocative testing for assessing QT dynamics comprised a treadmill exercise followed by cold-water face immersion. The QT intervals were automatically measured at rest and during exercise, recovery, and cold-water face immersion. The QT/heart rate (HR) relationship was visualized by plotting beat-to-beat confluence of the data. RESULTS The QT/HR slopes, determined by linear regression analysis, were steeper in the LQTS group than in the control group during exercise and immersion tests: -2.16 ± 0.63 versus -1.21 ± 0.28, P < 0.0001, and -2.02 ± 0.76 vs -0.75 ± 0.24, P < 0.0001, respectively. The LQT3 patients had steeper slopes in the immersion test than did non-LQT3 and control individuals: -2.42 ± 0.52 vs -1.40 ± 0.65, P < 0.0001, and vs -0.75 ± 0.24, P < 0.0001. CONCLUSIONS The QT dynamics of LQT3 patients differ from those of other LQTS subtypes during the post-exercise cold-water face immersion test in this study. Abnormal QT dynamics during the parasympathetic provocative test are concordant with the fact that cardiac events occur when HRs are lower or during sleep in LQT3 patients.
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Affiliation(s)
- Kazuhiro Takahashi
- Department of Pediatric CardiologyOkinawa Nanbu and Children’s Medical CenterOkinawaJapan
| | | | - Naomasa Makita
- National Cerebral and Cardiovascular CenterResearch InstituteOsakaJapan
| | - Mami Nakayashiro
- Department of Pediatric CardiologyOkinawa Nanbu and Children’s Medical CenterOkinawaJapan
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Benhamou K, Piedra A. CBT-Informed Interventions for Essential Workers During the COVID-19 Pandemic. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020; 50:275-283. [PMID: 32836379 PMCID: PMC7367784 DOI: 10.1007/s10879-020-09467-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Essential workers during the COVID-19 pandemic face heightened levels of anxiety and depression due to increased work demands, lack of adequate personal protective equipment, fear of contracting the virus, and fear of spreading it to loved ones. This is a time of urgent need for mental health support for workers affected by the pandemic crisis. Clinicians may employ empirically supported interventions derived from cognitive behavioral therapy (CBT) and related therapies. Psychological First Aid, an evidence-based crisis intervention, may be utilized to emphasize basic needs and support, but is intended as an acute disaster intervention. Given that a pandemic is an ongoing and prolonged stressor, additional CBT-informed interventions are likely needed to fully support essential workers during these times. It is recommended that clinicians help essential worker clients meet their basic needs by modifying health and sleep habits where possible and helping them advocate for their needs using interpersonal effectiveness skills. Empathic listening, validation of the crisis at hand, and values clarification can aid the therapeutic relationship, help them feel a renewed sense of purpose and meaning in their careers and with their families, and facilitate behavior change consistent with chosen values. Self-monitoring through a daily diary can help clients focus their thoughts and recognize maladaptive patterns in their thoughts and behaviors. In tandem with these techniques, behavioral activation and coping strategies including relaxation, distress tolerance, and acceptance promote engaging in positive and adaptive activities. Finally, therapists can help clients reduce anxiety related to the pandemic by helping them limit information intake.
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Affiliation(s)
- Kathy Benhamou
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
| | - Alexandra Piedra
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
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The Occurrence of Arrhythmias and Heart Rate Variability During Diving in Recreational Divers Using Continuous Electrocardiographic Holter Monitoring. POLISH HYPERBARIC RESEARCH 2020. [DOI: 10.2478/phr-2019-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of the research was to evaluate the occurrence of arrhythmias and heart rate variability during diving in recreational divers. Continuous electrocardiographic (ECG) Holter monitoring was conducted in a group of 50 divers (age 36,8 ± 8,7). The recorded data included the duration of the dive, including a period of 60 minutes before the dive and 60 minutes after the dive. Moreover, divers filled in a questionnaire that had been prepared for the purpose of the study and the psychological tests State-Trait Anxiety Inventory (STAI). The ECG recordings were synchronised with dive computers to correlate the ECG changes with diving events and analysed for the heart rate, arrhythmias and conduction disorders. The average heart rate was the highest (M=107.34 beats/minute) before diving, and the lowest after diving (M = 102.00 beats/minute). Supraventricular arrhythmias were recorded in nineteen (38%) of the participants of the study. The number of arrhythmias during diving (M = 14,45) is significantly higher than before (M = 9,93, p < 0,01) and after dive (M = 6,02, p < 0,05). All results were obtained from the continuous ECG Holter monitoring. It seems that using continuous ECG monitoring in conditions similar to diving (physical and psychological stress), brings more benefits than traditional, resting electrocardiogram.
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Laborde S, Mosley E, Mertgen A. A unifying conceptual framework of factors associated to cardiac vagal control. Heliyon 2018; 4:e01002. [PMID: 30623126 PMCID: PMC6313821 DOI: 10.1016/j.heliyon.2018.e01002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/20/2018] [Accepted: 11/29/2018] [Indexed: 11/30/2022] Open
Abstract
Cardiac vagal control (CVC) reflects the activity of the vagus nerve regulating cardiac functioning. CVC can be inferred via heart rate variability measurement, and it has been positively associated to a broad range of cognitive, emotional, social, and health outcomes. It could then be considered as an indicator for effective self-regulation, and given this role, one should understand the factors increasing and decreasing CVC. The aim of this paper is to review the broad range of factors influencing CVC, and to provide a unifying conceptual framework to integrate comprehensively those factors. The structure of the unifying conceptual framework is based on the theory of ecological rationality, while its functional aspects are based on the neurovisceral integration model. The structure of this framework distinguishes two broad areas of associations: person and environment, as this reflects adequately the role played by CVC regarding adaptation. The added value of this framework lies at different levels: theoretically, it allows integrating findings from a variety of scientific disciplines and refining the predictions of the neurovisceral integration model; methodologically, it helps identifying factors that increase and decrease CVC; and lastly at the applied level, it can play an important role for society regarding health policies and for the individual to empower one's flourishing.
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Affiliation(s)
- Sylvain Laborde
- German Sport University Cologne, Institute of Psychology, Department of Performance Psychology, Germany.,Normandie Université Caen, UFR STAPS, EA 4260, Germany
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Jungmann M, Vencatachellum S, Van Ryckeghem D, Vögele C. Effects of Cold Stimulation on Cardiac-Vagal Activation in Healthy Participants: Randomized Controlled Trial. JMIR Form Res 2018; 2:e10257. [PMID: 30684416 PMCID: PMC6334714 DOI: 10.2196/10257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/14/2018] [Accepted: 07/28/2018] [Indexed: 11/20/2022] Open
Abstract
Background The experience of psychological stress has not yet been adequately tackled with digital technology by catering to healthy individuals who wish to reduce their acute stress levels. For the design of digitally mediated solutions, physiological mechanisms need to be investigated that have the potential to induce relaxation with the help of technology. Research has shown that physiological mechanisms embodied in the face and neck regions are effective for diminishing stress-related symptoms. Our study expands on these areas with the design for a wearable in mind. As this study charts new territory in research, it also is a first evaluation of the viability for a wearables concept to reduce stress. Objective The objectives of this study were to assess whether (1) heart rate variability would increase and (2) heart rate would decrease during cold stimulation using a thermode device compared with a (nonstimulated) control condition. We expected effects in particular in the neck and cheek regions and less in the forearm area. Methods The study was a fully randomized, within-participant design. Volunteer participants were seated in a laboratory chair and tested with cold stimulation on the right side of the body. A thermode was placed on the neck, cheek, and forearm. We recorded and subsequently analyzed participants’ electrocardiogram. The cold stimulation was applied in 16-second intervals over 4 trials per testing location. The control condition proceeded exactly like the cold condition, except we manipulated the temperature variable to remain at the baseline temperature. We measured heart rate as interbeat intervals in milliseconds and analyzed root mean square of successive differences to index heart rate variability. We analyzed data using a repeated-measures ANOVA (analysis of variance) approach with 2 repeated-measures factors: body location (neck, cheek, forearm) and condition (cold, control). Results Data analysis of 61 participants (after exclusion of outliers) showed a main effect and an interaction effect for body location and for condition, for both heart rate and heart rate variability. The results demonstrate a pattern of cardiovascular reactivity to cold stimulation, suggesting an increase in cardiac-vagal activation. The effect was significant for cold stimulation in the lateral neck area. Conclusions The results confirmed our main hypothesis that cold stimulation at the lateral neck region would result in higher heart rate variability and lower heart rate than in the control condition. This sets the stage for further investigations of stress reduction potential in the neck region by developing a wearable prototype that can be used for cold application. Future studies should include a stress condition, test for a range of temperatures and durations, and collect self-report data on perceived stress levels to advance findings.
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Affiliation(s)
- Manuela Jungmann
- Institute for Health and Behaviour, Faculty of Language and Literature, Humanities, Arts and Education, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Shervin Vencatachellum
- Institute for Health and Behaviour, Faculty of Language and Literature, Humanities, Arts and Education, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Dimitri Van Ryckeghem
- Institute for Health and Behaviour, Faculty of Language and Literature, Humanities, Arts and Education, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Claus Vögele
- Institute for Health and Behaviour, Faculty of Language and Literature, Humanities, Arts and Education, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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Enhancing cardiac vagal activity: Factors of interest for sport psychology. PROGRESS IN BRAIN RESEARCH 2018; 240:71-92. [PMID: 30390842 DOI: 10.1016/bs.pbr.2018.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Self-regulation plays a critical role in sport performance. An objective, psychophysiological marker of self-regulation is cardiac vagal activity, the activity of the vagus nerve regulating cardiac functioning. The aim of this paper is to provide an overview of factors influencing cardiac vagal activity, which can be useful for athletes. Specifically, we organize this overview in two main domains: personal factors and environmental factors. Among the personal factors, we discuss the behavioral strategies that can be used by athletes: nutrition, non-ingestive oral habits, water immersion, body temperature reduction, sleeping habits, relaxation methods, cognitive techniques, praying, music, and exercise. Among environmental factors, we discuss those linked to the social (i.e., contact with humans and animals) and physical (i.e., aromas, lights, sounds, temperature, outdoor, altitude) environment. Future research directions are given, as well as practical implications for athletes and coaches.
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14
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Wearable Current-Based ECG Monitoring System with Non-Insulated Electrodes for Underwater Application. APPLIED SCIENCES-BASEL 2017. [DOI: 10.3390/app7121277] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Diurnal variation in the diving bradycardia response in young men. Clin Auton Res 2016; 26:135-40. [PMID: 26795189 DOI: 10.1007/s10286-016-0342-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The present study aimed to examine diurnal variation of the diving bradycardia responses on the same day. METHODS Eighteen young men (age 26 ± 2 years; height 174.2 ± 6.0 cm; body mass 70.2 ± 8.1 kg; body fat 18.0 ± 3.8 %; mean ± standard deviation) participated in this study. Oral temperature, heart rate variability (HRV) from 5-min of electrocardiogram data, and diving bradycardia responses were measured at 0900, 1300, and 1700 hours daily. All participants performed diving reflex tests twice in the sitting position with the face immersed in cold water (1.9-3.1 °C) and apnea at midinspiration for a minimum of 30 s and as long as possible, in consecutive order. RESULTS Oral temperature was found to be less in the morning (0900) than in the afternoon (1300) and evening (1700). In the frequency domain parameters of heart rate variability, the natural logarithms of high-frequency power were higher in the morning than in the evening. All participants showed bradycardia response to the two diving reflex tests. The peak values of R-R interval during the diving reflex test both for as long as possible and 30 s were longer in the morning than in the afternoon and evening. CONCLUSION Our results indicated that the maximal bradycardia during the diving reflex test exhibits a diurnal variation, with peak levels at morning and gradual decrease towards the evening. The HRV indexes show the same variation.
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Sharif H, Millar PJ, Incognito AV, Ditor DS. Non-invasive electrocardiographic assessments of cardiac autonomic modulation in individuals with spinal cord injury. Spinal Cord 2015; 54:166-71. [DOI: 10.1038/sc.2015.207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/09/2015] [Accepted: 10/16/2015] [Indexed: 12/11/2022]
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17
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Head Exposure to Cold during Whole-Body Cryostimulation: Influence on Thermal Response and Autonomic Modulation. PLoS One 2015; 10:e0124776. [PMID: 25915642 PMCID: PMC4411165 DOI: 10.1371/journal.pone.0124776] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/08/2015] [Indexed: 12/13/2022] Open
Abstract
Recent research on whole-body cryotherapy has hypothesized a major responsibility of head cooling in the physiological changes classically reported after a cryostimulation session. The aim of this experiment was to verify this hypothesis by studying the influence of exposing the head to cold during whole-body cryostimulation sessions, on the thermal response and the autonomic nervous system (ANS). Over five consecutive days, two groups of 10 participants performed one whole-body cryostimulation session daily, in one of two different systems; one exposing the whole-body to cold (whole-body cryostimulation, WBC), and the other exposing the whole-body except the head (partial-body cryostimulation, PBC).10 participants constituted a control group (CON) not receiving any cryostimulation. In order to isolate the head-cooling effect on recorded variables, it was ensured that the WBC and PBC systems induced the same decrease in skin temperature for all body regions (mean decrease over the 5 exposures: -8.6°C±1.3°C and -8.3±0.7°C for WBC and PBC, respectively), which persisted up to 20-min after the sessions (P20). The WBC sessions caused an almost certain decrease in tympanic temperature from Pre to P20 (-0.28 ±0.11°C), while it only decreased at P20 (-0.14±0.05°C) after PBC sessions. Heart rate almost certainly decreased after PBC (-8.6%) and WBC (-12.3%) sessions. Resting vagal-related heart rate variability indices (the root-mean square difference of successive normal R-R intervals, RMSSD, and high frequency band, HF) were very likely to almost certainly increased after PBC (RMSSD:+49.1%, HF: +123.3%) and WBC (RMSSD: +38.8%, HF:+70.3%). Plasma norepinephrine concentration was likely increased in similar proportions after PBC and WBC, but only after the first session. Both cryostimulation techniques stimulated the ANS with a predominance of parasympathetic tone activation from the first to the fifth session and in slightly greater proportion with WBC than PBC. The main result of this study indicates that the head exposure to cold during whole-body cryostimulation may not be the main factor responsible for the effects of cryostimulation on the ANS.
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Schipke JD, Cleveland S, Caspers C. Computer-assisted paranasal sinus operation induces diving bradycardia. Am J Otolaryngol 2013; 34:617. [PMID: 23886806 DOI: 10.1016/j.amjoto.2013.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 06/21/2013] [Indexed: 11/24/2022]
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Miyazawa T, Horiuchi M, Ichikawa D, Subudhi AW, Sugawara J, Ogoh S. Face cooling with mist water increases cerebral blood flow during exercise: effect of changes in facial skin blood flow. Front Physiol 2012; 3:308. [PMID: 22934059 PMCID: PMC3429079 DOI: 10.3389/fphys.2012.00308] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/13/2012] [Indexed: 11/21/2022] Open
Abstract
Facial cooling (FC) increases cerebral blood flow (CBF) at rest and during exercise; however, the mechanism of this response remains unclear. The purpose of the present study was to test our hypothesis that FC causes facial vasoconstriction that diverts skin blood flow (SkBFface) toward the middle cerebral artery (MCA Vmean) at rest and to a greater extent during exercise. Nine healthy young subjects (20 ± 2 years) underwent 3 min of FC by fanning and spraying the face with a mist of cold water (~4°C) at rest and during steady-state exercise [heart rate (HR) of 120 bpm]. We focused on the difference between the averaged data acquired from 1 min immediately before FC and last 1 min of FC. SkBFface, MCA Vmean, and mean arterial blood pressure (MAP) were higher during exercise than at rest. As hypothesized, FC decreased SkBFface at rest (−32 ± 4%) and to a greater extent during exercise (−64 ± 10%, P = 0.012). Although MCA Vmean was increased by FC (Rest, +1.4 ± 0.5 cm/s; Exercise, +1.4 ± 0.6 cm/s), the amount of the FC-evoked changes in MCA Vmean at rest and during exercise differed among subjects. In addition, changes in MCA Vmean with FC did not correlate with concomitant changes in SkBFface (r = 0.095, P = 0.709). MAP was also increased by FC (Rest, +6.2 ± 1.4 mmHg; Exercise, +4.2 ± 1.2 mmHg). These findings suggest that the FC-induced increase in CBF during exercise could not be explained only by change in SkBFface.
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Affiliation(s)
- Taiki Miyazawa
- Center for Biomedical Engineering Research, Toyo University Kawagoe, Japan
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Alentejano TC, Marshall D, Bell GJ. Breath holding with water immersion in synchronized swimmers and untrained women. Res Sports Med 2010; 18:97-114. [PMID: 20397113 DOI: 10.1080/15438620903323678] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Breath holding (BH) and water immersion induce several physiological responses. Individuals, who are BH trained tend to have an advantage versus untrained subjects. This study compared physiological responses to BH at rest between synchronized swimmers (SS) and controls (C). Each participant performed five resting BH periods in water. Breath holding periods were significantly longer for SS (109.8 +/- 39.3 vs. 78.3 +/- 25.0s), despite a similar end tidal partial pressure of carbon dioxide and oxygen following BH. Recovery times after BH were similar for oxygen consumption, ventilation, and blood oxygen saturation. Synchronized swimmers (SS) experienced bradycardia at 45s of max BH, whereas C did not (60 +/- 9 vs. 65 +/- 14 b x min(-1)). A significant oxygen conservation effect occurred for SS in only one BH trial. These results suggest that SS exhibited an enhanced ability to breath hold with similar respiratory responses but a lower heart rate (HR) during recovery, suggesting a better adaptation to BH.
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Affiliation(s)
- Teresa C Alentejano
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.
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21
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Influence of cold water face immersion on post-exercise parasympathetic reactivation. Eur J Appl Physiol 2009; 108:599-606. [DOI: 10.1007/s00421-009-1253-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2009] [Indexed: 10/20/2022]
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22
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Cold face test in persons with spinal cord injury: age versus inactivity. Clin Auton Res 2009; 19:221-9. [DOI: 10.1007/s10286-009-0009-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 03/13/2009] [Indexed: 12/21/2022]
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Dominance in cardiac parasympathetic activity during real recreational SCUBA diving. Eur J Appl Physiol 2009; 106:345-52. [PMID: 19277697 DOI: 10.1007/s00421-009-1010-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2009] [Indexed: 01/02/2023]
Abstract
It was already established that exposure to hyperbaric conditions induces vagal-depended bradycardia but field study on autonomic nervous system (ANS) activity during self-contained underwater breathing apparatus (SCUBA) diving is lacking. The aim of the present study was to evaluate ANS modifications during real recreational SCUBA diving using heart rate variability analysis (timedomain, frequency-domain and Poincaré plot) in 10 experienced and volunteers recreational divers. Mean RR, root mean square of successive differences of interval (rMSSD), high frequency of spectral analysis and standard deviation 1 of Poincaré Plot increased (P < 0.05) during dive. Low frequency/high frequency ratio decreased during dive (P < 0.05) but increased after (P < 0.05). Recreational SCUBA diving induced a rise in vagal activity and a decrease in cardiac sympathetic activity. Conversely, sympathetic activity increases (P < 0.05) during the recovery.
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