Time-of-day effect on cardiac responses to progressive exercise

Sensor-Based Assessment of Time-of-Day-Dependent Physiological Responses and Physical Performances during a Walking Football Match in Higher-Weight Men

Monitoring key physiological metrics, including heart rate and heart rate variability, has been shown to be of value in exercise science, disease management, and overall health. The purpose of this study was to investigate the diurnal variation of physiological responses and physical performances using digital biomarkers as a precise measurement tool during a walking football match (WFM) in higher-weight men. Nineteen males (mean age: 42.53 ± 12.18 years; BMI: 33.31 ± 4.31 kg·m-2) were engaged in a WFM at two different times of the day. Comprehensive evaluations of physiological parameters (e.g., cardiac autonomic function, lactate, glycemia, and oxygen saturation), along with physical performance, were assessed before, during, and after the match. Overall, there was a significant interaction (time of day x WFM) for mean blood pressure (MBP) (p = 0.007) and glycemia (p = 0.039). Glycemia decreased exclusively in the evening after WFM (p = 0.001), while mean blood pressure did not significantly change. Rating of perceived exertion was significantly higher in the evening than in the morning (p = 0.04), while the heart rate recovery after 1 min (HRR60s) of the match was lower in the evening than in the morning (p = 0.048). Overall, walking football practice seems to be safe, whatever the time of day. Furthermore, HRR60, glycemia, and (MBP) values were lower in the evening compared to the morning, suggesting that evening exercise practice could be safer for individuals with higher weight. The utilization of digital biomarkers for monitoring health status during WFM has been shown to be efficient.

Time-of-Day Effects of Exercise on Cardiorespiratory Responses and Endurance Performance-A Systematic Review and Meta-Analysis

ABSTRACT

Kang, J, Ratamess, NA, Faigenbaum, AD, Bush, JA, Finnerty, C, DiFiore, M, Garcia, A, and Beller, N. Time-of-day effects of exercise on cardiorespiratory responses and endurance performance-A systematic review and meta-analysis. J Strength Cond Res 37(10): 2080-2090, 2023-The time-of-day effect of exercise on human function remains largely equivocal. Hence, this study aimed to further analyze the existing evidence concerning diurnal variations in cardiorespiratory responses and endurance performance using a meta-analytic approach. Literature search was conducted through databases, including PubMed, CINAHL, and Google Scholar. Article selection was made based on inclusion criteria concerning subjects' characteristics, exercise protocols, times of testing, and targeted dependent variables. Results on oxygen uptake (V̇ o2 ), heart rate (HR), respiratory exchange ratio, and endurance performance in the morning (AM) and late afternoon or evening (PM) were extracted from the chosen studies. Meta-analysis was conducted with the random-effects model. Thirty-one original research studies that met the inclusion criteria were selected. Meta-analysis revealed higher resting V̇ o2 (Hedges' g = -0.574; p = 0.040) and resting HR (Hedges' g = -1.058; p = 0.002) in PM than in AM. During exercise, although V̇ o2 remained indifferent between AM and PM, HR was higher in PM at submaximal (Hedges' g = -0.199; p = 0.046) and maximal (Hedges' g = -0.298; p = 0.001) levels. Endurance performance as measured by time-to-exhaustion or the total work accomplished was higher in PM than in AM (Hedges' g = -0.654; p = 0.001). Diurnal variations in V̇ o2 appear less detectable during aerobic exercise. The finding that exercising HR and endurance performance were greater in PM than in AM emphasizes the need to consider the effect of circadian rhythm when evaluating athletic performance or using HR as a criterion to assess fitness or monitor training.

Higher evening metabolic responses contribute to diurnal variation of self-paced cycling performance

This study examined the effect of time of day (TOD) on physical performance, and physiological and perceptual responses to a 10-km cycling time trial (TT_10km). Twelve physically trained subjects (20.3 ± 1.2 years, 74.3 ± 7.4 kg, 179.7 ± 5.5 cm) completed, in a randomized order, a TT_10km in the morning and in the evening. Intra-aural temperature (IAT) was measured at rest and following the TT_10km. Completion time, power output (PO), rating of perceived exertion (RPE), heart rate (HR), minute ventilation (V̇E), oxygen uptake (V̇O₂), carbon dioxide production (V̇CO₂) and respiratory exchange ratio (RER) were assessed every km during the TT_10km. Blood lactate concentration [La] and blood glucose concentration [Glu] were assessed before, during and immediately after the TT_10km. Faster completion time (Δ = 15.0s, p = 0.03) and higher IAT (Δ = 0.33°C, p = 0.02 for pre-TT_10km) were obtained in the evening compared to the morning with a significant correlation between Δ completion time and Δ IAT at post-TT_{10 km} (r = -0.83, p = 0.04). V̇O₂, [La] and [Glu] increased significantly during both test sessions (p < 0.001) with higher values in the evening compared to the morning (p = 0.015, p = 0.04, p = 0.01, respectively). However, the remaining parameters were found to be only affected by the TT_10km (p < 0.001). The TT_10km generates a higher V̇O₂ and higher [La] and [Glu] responses, contributing to a better cycling performance in the evening compared to the morning. The similar magnitude of the TOD effect on completion time and IAT at post-TT_10km confirms that core temperature is one of the underlying factors contributing to the diurnal variation in physical performance.

Morning and evening exercise

A growing body of evidence suggests that exercise may contribute to preventing pathological changes, treating multiple chronic diseases, and reducing mortality and morbidity ratios. Scientific evidence moreover shows that exercise plays a key role in improving health-related physical fitness components and hormone function. Regular exercise training is one of the few strategies that has been strictly adapted in healthy individuals and in athletes. However, time-dependent exercise has different outcomes, based on the exercise type, duration, and hormone adaptation. In the present review, we therefore briefly describe the type, duration, and adaptation of exercise performed in the morning and evening. In addition, we discuss the clinical considerations and indications for exercise training.

Effect of comprehensive cardiac rehabilitation after heart valve surgery (CopenHeartVR): study protocol for a randomised clinical trial

Background

Heart valve diseases are common with an estimated prevalence of 2.5% in the Western world. The number is rising due to an ageing population. Once symptomatic, heart valve diseases are potentially lethal, and heavily influence daily living and quality of life. Surgical treatment, either valve replacement or repair, remains the treatment of choice. However, post surgery, the transition to daily living may become a physical, mental and social challenge. We hypothesise that a comprehensive cardiac rehabilitation programme can improve physical capacity and self-assessed mental health and reduce hospitalisation and healthcare costs after heart valve surgery.

Methods

A randomised clinical trial, CopenHeart_VR, aims to investigate whether cardiac rehabilitation in addition to usual care is superior to treatment as usual after heart valve surgery. The trial will randomly allocate 210 patients, 1:1 intervention to control group, using central randomisation, and blinded outcome assessment and statistical analyses. The intervention consists of 12 weeks of physical exercise, and a psycho-educational intervention comprising five consultations. Primary outcome is peak oxygen uptake (VO₂ peak) measured by cardiopulmonary exercise testing with ventilatory gas analysis. Secondary outcome is self-assessed mental health measured by the standardised questionnaire Short Form 36. Also, long-term healthcare utilisation and mortality as well as biochemistry, echocardiography and cost-benefit will be assessed. A mixed-method design is used to evaluate qualitative and quantitative findings encompassing a survey-based study before the trial and a qualitative pre- and post-intervention study.

Discussion

The study is approved by the local regional Research Ethics Committee (H-1-2011-157), and the Danish Data Protection Agency (j.nr. 2007-58-0015).

Trial registration

ClinicalTrials.gov (http://NCT01558765).

The effect of integrated cardiac rehabilitation versus treatment as usual for atrial fibrillation patients treated with ablation: the randomised CopenHeartRFA trial protocol

INTRODUCTION

Atrial fibrillation affects almost 2% of the population in the Western world. To preserve sinus rhythm, ablation is undertaken in symptomatic patients. Observational studies show that patients with atrial fibrillation often report a low quality of life and are less prone to be physically active due to fear of triggering fibrillation. Small trials indicate that exercise training has a positive effect on exercise capacity and mental health, and both patients with recurrent atrial fibrillation and in sinus rhythm may benefit from rehabilitation in managing life after ablation. No randomised trials have been published on cardiac rehabilitation for atrial fibrillation patients treated with ablation that includes exercise and psychoeducational components.

AIM

To test the effects of an integrated cardiac rehabilitation programme versus treatment as usual for patients with atrial fibrillation treated with ablation. METHODS AND ANALYSIS DESIGN: The trial is a multicentre parallel arm design with 1:1 randomisation to the intervention and control group with blinded outcome assessment. 210 patients treated for atrial fibrillation with radiofrequency ablation will be included. The intervention consists of a rehabilitation programme including four psychoeducative consultations with a specially trained nurse and 12 weeks of individualised exercise training, plus the standard medical follow-up. Patients in the control group will receive the standard medical follow-up. The primary outcome measure is exercise capacity measured by the VO(2) peak. The secondary outcome measure is self-rated mental health measured by the Short Form 36 questionnaire. Postintervention, qualitative interviews will be conducted in 10% of the intervention group.

ETHICS AND DISSEMINATION

The protocol is approved by the regional research ethics committee (number H-1-2011-135), the Danish Data Protection Agency (reg. nr. 2007-58-0015) and follows the latest version of the Declaration of Helsinki. The results will be published in peer-reviewed journals and may possibly impact on rehabilitation guidelines.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT01523145.

Conducting an acute intense interval exercise session during the Ramadan fasting month: what is the optimal time of the day?

This study examines the effects of Ramadan fasting on performance during an intense exercise session performed at three different times of the day, i.e., 08:00, 18:00, and 21:00 h. The purpose was to determine the optimal time of the day to perform an acute high-intensity interval exercise during the Ramadan fasting month. After familiarization, nine trained athletes performed six 30-s Wingate anaerobic test (WAnT) cycle bouts followed by a time-to-exhaustion (T(exh)) cycle on six separate randomized and counterbalanced occasions. The three time-of-day nonfasting (control, CON) exercise sessions were performed before the Ramadan month, and the three corresponding time-of-day Ramadan fasting (RAM) exercise sessions were performed during the Ramadan month. Note that the 21:00 h session during Ramadan month was conducted in the nonfasted state after the breaking of the day's fast. Total work (TW) completed during the six WAnT bouts was significantly lower during RAM compared to CON for the 08:00 and 18:00 h (p < .017; effect size [d] = .55 [small] and .39 [small], respectively) sessions, but not for the 21:00 h (p = .03, d = .18 [trivial]) session. The T(exh) cycle duration was significantly shorter during RAM than CON in the 18:00 (p < .017, d = .93 [moderate]) session, but not in the 08:00 (p = .03, d = .57 [small]) and 21:00 h (p = .96, d = .02 [trivial]) sessions. In conclusion, Ramadan fasting had a small to moderate, negative impact on quality of performance during an acute high-intensity exercise session, particularly during the period of the daytime fast. The optimal time to conduct an acute high-intensity exercise session during the Ramadan fasting month is in the evening, after the breaking of the day's fast.

Orthostatic effects on echocardiographic measures of ventricular function

Orthostatic-induced alterations in Doppler echocardiographic measures of ventricular function have not been well-defined. Identifying such changes may provide useful insights regarding the responses of these measures to variations in ventricular loading conditions. Standard assessment of mitral inflow velocity and tissue Doppler imaging (TDI) of left ventricular longitudinal myocardial velocities was performed on 14 young males (mean age 17.9 ± 0.7 years) in the supine position and then 5 minutes after assuming a sitting position with legs dependent. Upon sitting, average values of stroke volume and cardiac output fell by 28% and 18%, respectively, while heart rate increased from 64 ± 10 to 73 ± 12 beats/min (+14%) and calculated systemic vascular resistance rose from 12.9 ± 2.2 to 16.4 ± 3.1 units (+27%). Mitral E peak velocity declined from 87 ± 16 to 64 ± 16 cm/sec, and average TDI-E' and TDI-S both decreased (by -44% and -20%, respectively). When adjusted for orthostatic decreases in left ventricular end-diastolic volume, the mean decrease in TDI-E' was reduced to -29 (P < 0.01), but no significant decline was observed in adjusted TDI-S. Average E/E' rose with sitting by 40% (P = 0.02). These findings suggest that (a) decreases in TDI measures when assuming the upright position reflect the reduction of left ventricular size; (b) orthostatic fall in TDI-E' is also related to smaller ventricular size but, in addition, to a nonspecified reduction in ventricular relaxation; and (c) values of E/E' do not reflect alterations in ventricular preload, which occur during an orthostatic challenge.