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Duman D, Karpuz D, Taşdelen B, Kuyucu N. Assessing autonomic activity and prognostic risk factors comparing multisystem inflammatory syndrome and isolated viral myocarditis/myopericarditis. Cardiol Young 2024; 34:421-427. [PMID: 38303630 DOI: 10.1017/s1047951123004377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
INTRODUCTION AND AIM In pediatric multisystem inflammatory syndrome and isolated viral myocarditis/myopericarditis, autonomic nervous system function can be evaluated by a non-invasive method called heart rate variability. This study aims to evaluate heart rate variability in these two groups by comparing them with each other. This is the first study assessing these values in these two groups of patients. METHOD Patients who are diagnosed with multisystem inflammatory syndrome in children and isolated viral myocarditis/myopericarditis at a university hospital from September 2021 to February 2023 are screened by electrocardiography, echocardiography, and 24-hour Holter monitoring. A healthy control group, compatible in age and gender with the patient groups, was selected from healthy subjects that applied to the hospital for palpitation, murmur, and/or chest pain. Heart rate variability parameters and related laboratory markers were analyzed and compared among the three groups. RESULTS There were 30 patients with multisystem inflammatory syndrome in children, 43 patients with isolated viral myocarditis/myopericarditis, and 109 participants in the healthy control group. Statistically significant differences were found in most of the heart rate variability parameters: standard deviation of normal to normal intervals (SDNN), the mean of the 5- minute RR interval standard deviations (SDNNİ), the standard deviation of 5-minute R wave to R wave(RR) interval means (SDANN), the root mean square of successive RR interval differences (RMSSD), and the percentage of the beats with a consecutive RR interval difference of more than 50 ms (pNN50%), very low frequency, high frequency, low frequency, triangular index, and low frequency/high-frequency ratio. Multisystem inflammatory syndrome in children patients had impaired and declined heart rate variability values compared to the other two groups. In patients with myocarditis/myopericarditis, we couldn't find a significant difference in these parameters with the control group. CONCLUSION Heart rate variability can be used as an important non-invasive autonomic function parameter in determining prognosis and treatment plans, especially in patients diagnosed with multisystem inflammatory syndrome in children. This impairment of autonomic activity could be more prominent in patients with decreased left ventricular systolic functions.
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Affiliation(s)
- Derya Duman
- Department of Pediatric Cardiology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Derya Karpuz
- Department of Pediatric Cardiology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Bahar Taşdelen
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Necdet Kuyucu
- Department of Pediatric Infectious Disease, Faculty of Medicine, Mersin University, Mersin, Turkey
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Dantas FMNA, Magalhães PAF, Hora ECN, Andrade LB, Sarinho ESC. Heart rate variability in school-age children born moderate-to-late preterm. Early Hum Dev 2024; 189:105922. [PMID: 38163385 DOI: 10.1016/j.earlhumdev.2023.105922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Prematurity is associated with reduced cardiac autonomic function. This study aimed to investigate the heart rate variability (HRV) in school-age children born moderately to late preterm (MLPT). METHODS This cross-sectional study investigated school-age children, aged 5 to 10 years, born moderate-to-late preterm. Electrocardiograms recordings were performed during fifteen-minutes. Time and frequency domain parameters were calculated, corrected for heart rate and compared between the groups. RESULTS A total of 123 children were evaluated and 119 were included in this study. HRV measures, studied in the time and frequency domains, were similar in both groups. Corrected values of root mean square of successive differences between normal cycles (RMSSD), percentage of successive cycles with a duration difference >50 ms (pNN50%), and high frequency (HF), indices that predominantly represent the parasympathetic activity of the autonomic nervous system, were 1.6E-7 and 1.8E-7 (p=0.226); 1.6E-13 and 1.6E-13 (p=0.506); 6.9E-12 and 7.4E-12 (p=0.968) in the preterm and control groups, respectively. CONCLUSION This study did not find differences in heart rate variability between school-age children born MLPT and those born at term, suggesting that plasticity of cardiac autonomic modulation continues to occur in children up to school age or there is less impairment of the autonomic system in MLPT.
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Affiliation(s)
- Fabianne M N A Dantas
- Research Group of Neonatal and Pediatric Physical Therapy, Baby GrUPE, Universidade de Pernambuco, Petrolina, Pernambuco, Brazil; Department of Physical Therapy, Universidade de Pernambuco, Pernambuco, Brazil.
| | - Paulo A F Magalhães
- Research Group of Neonatal and Pediatric Physical Therapy, Baby GrUPE, Universidade de Pernambuco, Petrolina, Pernambuco, Brazil; Department of Physical Therapy, Universidade de Pernambuco, Pernambuco, Brazil; Graduate Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, Petrolina, Pernambuco, Brazil
| | - Emilly C N Hora
- Universidade Federal de Sergipe, Aracaju, Pernambuco, Brazil
| | - Lívia B Andrade
- Professor Fernando Figueira Integral Medicine Institute, Recife, Pernambuco, Brazil
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Sahn B, Pascuma K, Kohn N, Tracey KJ, Markowitz JF. Transcutaneous auricular vagus nerve stimulation attenuates inflammatory bowel disease in children: a proof-of-concept clinical trial. Bioelectron Med 2023; 9:23. [PMID: 37849000 PMCID: PMC10583463 DOI: 10.1186/s42234-023-00124-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Vagus nerve stimulation is an investigational anti-inflammatory therapy targeting the nervous system to modulate immune activity. This study evaluated the efficacy and safety of transcutaneous auricular VNS (ta-VNS) in patients with pediatric-onset Crohn's disease (CD) or ulcerative colitis (UC). METHODS Participants were 10-21 years of age with mild/moderate CD or UC and fecal calprotectin (FC) > 200 ug/g within 4 weeks of study entry. Subjects were randomized to receive either ta-VNS targeting the cymba conchae of the external left ear, or sham stimulation, of 5 min duration once daily for a 2-week period, followed by a cross over to the alternative stimulation for an additional 2 weeks. At week 4, all subjects received ta-VNS of 5 min duration twice daily until week 16. Primary study endpoints were clinical remission, and a ≥ 50% reduction in FC level from baseline to week 16. Heart rate variability measurements and patient-reported outcome questionnaires were completed during interval and week 16 assessments. RESULTS Twenty-two subjects were enrolled and analyzed (10 CD, 12 UC). Six of 10 with CD had a wPCDAI > 12.5 and 6/12 with UC had a PUCAI > 10 at baseline, correlating to mild to moderate symptom activity. Among the 12 subjects with active symptomatic disease indices at baseline, clinical remission was achieved in 3/6 (50%) with CD and 2/6 (33%) with UC at week 16. Despite all subjects having FC levels ≥ 200 within 4 weeks of enrollment, five subjects (4 UC, 1 CD) had FC levels < 200 at the baseline visit and were excluded from the FC analysis. Of the remaining 17, median baseline FC was 907 µg/g (IQR 411-2,120). At week 16, 11/17 (64.7%) of those with baseline FC ≥ 200 had a ≥ 50% reduction in FC (95% CI 38.3-85.8). In the UC subjects, there was an 81% median reduction in FC vs baseline (833 µg/g; p = 0.03) while in the CD subjects, median reduction in FC at 16 weeks was 51% (357 µg/g; p = 0.09). There were no safety concerns. CONCLUSION Noninvasive ta-VNS attenuated signs and symptoms in a pediatric cohort with mild to moderate inflammatory bowel disease. TRIAL REGISTRATION NCT03863704-Date of registration 3/4/2019.
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Affiliation(s)
- Benjamin Sahn
- Division of Pediatric Gastroenterology, Liver Diseases, & Nutrition, Steven & Alexandra Cohen Children's Medical Center, Northwell Health, 1991 Marcus Ave, Suite M100, New Hyde Park, NY, 11042, USA.
- Feinstein Institutes for Medical Research, Manhasset, NY, USA.
| | - Kristine Pascuma
- Division of Pediatric Gastroenterology, Liver Diseases, & Nutrition, Steven & Alexandra Cohen Children's Medical Center, Northwell Health, 1991 Marcus Ave, Suite M100, New Hyde Park, NY, 11042, USA
| | - Nina Kohn
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Biostatistics Unit, Office of Academic Affairs, New Hyde Park, NY, USA
| | - Kevin J Tracey
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - James F Markowitz
- Division of Pediatric Gastroenterology, Liver Diseases, & Nutrition, Steven & Alexandra Cohen Children's Medical Center, Northwell Health, 1991 Marcus Ave, Suite M100, New Hyde Park, NY, 11042, USA
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Oliveira PML, da Silva RMFL, Tonelli HDAF, Meira ZMA, Mota CDCC. Clinical and Autonomic Profile, and Modified Calgary Score for Children and Adolescents with Presumed Vasovagal Syncope Submitted to the Tilt Test. Arq Bras Cardiol 2023; 120:e20220543. [PMID: 37556654 PMCID: PMC10382152 DOI: 10.36660/abc.20220543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/01/2023] [Accepted: 04/05/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND In the pediatric population, syncope is mainly from vasovagal (VVS) origin. Its evaluation must be done by clinical methods, and the tilt test (TT) can contribute to the diagnosis. OBJECTIVES To analyze the clinical profile, Calgary and modified Calgary scores, response to TT and heart rate variability (HRV) of patients aged ≤ 18 years with presumed VVS. To compare the variables between patients with positive and negative responses to TT. METHOD Observational and prospective study, with 73 patients aged between 6 and 18 years, submitted to clinical evaluation and calculation of scores without previous knowledge of the TT. It was done at 70º under monitoring for HRV analysis. P-value < 0.05 was the statistical significance criterion. RESULTS Median age was 14.0 years; 52% of participants were female, 72 had Calgary ≥ -2 (mean 1.80), and 69 had modified Calgary ≥ -3 (mean 1.38). Prodromes were observed in 59 patients, recurrence in 50 and trauma in 19. The response to TT was positive in 54 participants (49 vasovagal, with 39 vasodepressor responses), with an increase in the low frequency (LF) component and a decrease in the high frequency (HF) component (p < 0,0001). In the supine position, LF was 33.6 in females and 47.4 in normalized units for males (p = 0.02). When applying the operating characteristic curve for positive TT, there was no statistical significance for HRV and scores. CONCLUSION Most children and adolescents with a presumed diagnosis of VVS presented a typical clinical scenario, with a Calgary score ≥ -2, and a predominant vasodepressor response to TT. Greater sympathetic activation was observed in the supine position in males. Calgary scores and sympathetic activation did not predict the response to TT.
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Affiliation(s)
- Pamela Michelle Leite Oliveira
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Rose Mary Ferreira Lisboa da Silva
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Henrique de Assis Fonseca Tonelli
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Zilda Maria Alves Meira
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Cleonice de Carvalho Coelho Mota
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
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Ziadia H, Sassi I, Trudeau F, Fait P. Normative values of resting heart rate variability in young male contact sport athletes: Reference values for the assessment and treatment of concussion. Front Sports Act Living 2023; 4:730401. [PMID: 36699983 PMCID: PMC9869270 DOI: 10.3389/fspor.2022.730401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/07/2022] [Indexed: 01/12/2023] Open
Abstract
Objective The objective of this study was to identify the main determinants of heart rate variability (HRV) in male athletes aged 14 to 21 years who practice competitive contact sports and to integrate these determinants with the aim of defining normative values of short-term HRV in the time and frequency domains. Methods Participants (n = 369) were aged 14 to 21 years and included 221 football players and 148 ice hockey players. HRV was measured for 5 min at rest, and standard HRV parameters in the time and frequency domains were calculated. Heart rate (HR), age, body mass index (BMI), number of sports weekly practices (WSP) and concussion history (mTBI) were considered determinants potentially able to influence HRV. Results Multiple regression analysis revealed that HR was the primary determinant of standard HRV parameters. The models accounted for 13% to 55% of the total variance of HRV and the contribution of HR to this model was the strongest (β ranged from -0.34 to -0.75). HR was the only determinant that significantly contributes to all HRV parameters. To counteract this dependence, we calculated HRV corrected by the mean RR interval (RRm). Such corrections do not remove any physiological differences in HRV; they simply remove the mathematical bias. HRV parameters were therefore normalized, and their normative limits were developed relative to the mean heart rate. After correction, the correlation coefficients between HR and all corrected HRV parameters were not statistically significant and ranged from -0.001 to 0.045 (p > 0.40 for all). The automatically corrected HRV calculator, which recalculates standard HRV parameters and converts them into corrected parameters in addition to determining whether a given value is within normal limits, facilitates clinical interpretation. Conclusion This study provides for the first time corrected normative values of short-term and resting state HRV parameters in competitive contact sport athletes aged 14 to 21 years. These values were developed independently of the major determinants of HRV. The baseline values for HRV parameters given here could be used in clinical practice when assessing and monitoring cerebral concussions. They may assist in decision making for a safe return to play.
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Affiliation(s)
- Hatem Ziadia
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Exercise Physiology Laboratory, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Correspondence: Hatem Ziadia
| | - Idriss Sassi
- Exercise Physiology Laboratory, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - François Trudeau
- Exercise Physiology Laboratory, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Philippe Fait
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Research Group on Neuromusculoskeletal Conditions (GRAN), Trois-rivieres, QC, Canada,Centre for Research in Neuropsychology and Cognition (CERNEC), Montreal, QC, Canada,Cortex Concussion Clinic, Quebec City, QC, Canada
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Lundstrom CJ, Foreman NA, Biltz G. Practices and Applications of Heart Rate Variability Monitoring in Endurance Athletes. Int J Sports Med 2023; 44:9-19. [PMID: 35853460 DOI: 10.1055/a-1864-9726] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Heart rate variability reflects fluctuations in the changes in consecutive heartbeats, providing insight into cardiac autonomic function and overall physiological state. Endurance athletes typically demonstrate better cardiac autonomic function than non-athletes, with lower resting heart rates and greater variability. The availability and use of heart rate variability metrics has increased in the broader population and may be particularly useful to endurance athletes. The purpose of this review is to characterize current practices and applications of heart rate variability analysis in endurance athletes. Important considerations for heart rate variability analysis will be discussed, including analysis techniques, monitoring tools, the importance of stationarity of data, body position, timing and duration of the recording window, average heart rate, and sex and age differences. Key factors affecting resting heart rate variability will be discussed, including exercise intensity, duration, modality, overall training load, and lifestyle factors. Training applications will be explored, including heart rate variability-guided training and the identification and monitoring of maladaptive states such as overtraining. Lastly, we will examine some alternative uses of heart rate variability, including during exercise, post-exercise, and for physiological forecasting and predicting performance.
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Affiliation(s)
| | - Nicholas A Foreman
- School of Kinesiology, University of Minnesota Twin Cities, Minneapolis, United States
| | - George Biltz
- School of Kinesiology, University of Minnesota Twin Cities, Minneapolis, United States
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Kovalchuk T, Boyarchuk O, Boyarchuk O. Serum Vitamin D Levels in Children and Adolescents with Vasovagal Syncope, Syncope Due to Orthostatic Hypotension, and Cardiac Syncope. Turk Arch Pediatr 2023; 58:42-48. [PMID: 36598210 PMCID: PMC9885808 DOI: 10.5152/turkarchpediatr.2022.22141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The study aimed to compare vitamin D levels between children and adolescents with vasovagal syncope, syncope due to orthostatic hypotension, cardiac syncope, and healthy individuals and to investigate the correlations of 25(OH)D with main clinical parameters of syncope. MATERIALS AND METHODS This study involved 83 children aged 8-17 years with syncope: 40 with vasovagal syncope, 24 with syncope due to orthostatic hypotension, and 19 with cardiac syncope. There were 24 healthy volunteers in the control group. Data concerning active standing test, electrocardiography, echocardiography, electroencephalography, and 24-hour Holter monitoring findings were collected. Serum vitamin D was evaluated by an enzyme-linked immunoassay technique test. RESULTS The mean levels of serum 25(OH)D were decreased in children with vasovagal syncope (18.8 ± 5.9 ng/mL), syncope due to orthostatic hypotension (19.9 ± 6.7 ng/mL), and cardiac syncope (20.6 ± 7.3 ng/mL) in comparing with the control group (30.9 ± 5.9 ng/mL; P < .001). In patients with syncope due to orthostatic hypotension, vitamin D deficiency was associated with a reduction in systolic blood pressure (r = 0.43) and diastolic blood pressure (r = 0.38) within the first minute, lower systolic blood pressure (r = 0.44) within the third minute of active orthostasis (P < .05). There were significant correlations of vitamin D deficiency with parameters of cardiac autonomic activity pNN50 (r = 0.49), total power (r = 0.39), and low frequency index (r = 0.35) in children with cardiac syncope (P < .05), while heart rate variability was not affected in patients with vasovagal syncope and syncope due to orthostatic hypotension (P > .05). CONCLUSION Children and adolescents with vasovagal syncope, syncope due to orthostatic hypotension, as well as cardiac syncope had higher frequency of vitamin D deficiency than healthy pediatric controls. This provides a new approach to syncope management in pediatric population, requiring further studies.
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Affiliation(s)
- Tetiana Kovalchuk
- Department of Pediatrics, Horbachevsky Ternopil National Medical University, Ternopil, Ukraine,Corresponding author:Tetiana Kovalchuk ✉
| | - Oksana Boyarchuk
- Department of Pediatrics and Pediatric Surgery, Horbachevsky Ternopil National Medical University Ternopil, Ukraine
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Lee LA, Chuang HH, Hsieh HS, Wang CY, Chuang LP, Li HY, Fang TJ, Huang YS, Lee GS, Yang AC, Kuo TBJ, Yang CCH. Using sleep heart rate variability to investigate the sleep quality in children with obstructive sleep apnea. Front Public Health 2023; 11:1103085. [PMID: 36923030 PMCID: PMC10008856 DOI: 10.3389/fpubh.2023.1103085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/10/2023] [Indexed: 03/03/2023] Open
Abstract
Background Obstructive sleep apnea (OSA) is associated with impaired sleep quality and autonomic dysfunction. Adenotonsillectomy significantly improves subjective and objective sleep quality in children with OSA. However, the postoperative changes in heart rate variability (HRV) indices (indicators of cardiac autonomic function) and their importance remain inconclusive in childhood OSA. This retrospective case series aimed to investigate the association of sleep HRV indices, total OSA-18 questionnaire score (a subjective indicator of sleep quality) and polysomnographic parameters (objective indicators of sleep quality), and effects of adenotonsillectomy on HRV indices, total OSA-18 questionnaire score and polysomnographic parameters in children with OSA. Methods Seventy-six children with OSA were included in baseline analysis, of whom 64 (84%) completed at least 3 months follow-up examinations after adenotonsillectomy and were included in outcome analysis. Associations between baseline variables, and relationships with treatment-related changes were examined. Results Multivariable linear regression models in the baseline analysis revealed independent relationships between tonsil size and obstructive apnea-hypopnea index (OAHI), adenoidal-nasopharyngeal ratio and very low frequency (VLF) power of HRV (an indicator of sympathetic activity), and normalized low frequency power (an indicator of sympathetic activity) and OAHI. The outcome analysis showed that adenotonsillectomy significantly improved standard deviation of all normal-to-normal intervals, and high frequency power, QoL (in terms of reduced total OSA-18 questionnaire score), OAHI and hypoxemia. Using a conceptual serial multiple mediation model, % change in OSA-18 questionnaire score and % change in VLF power serially mediated the relationships between change in tonsil size and % change in OAHI. Conclusions The improvement in OAHI after adenotonsillectomy was serially mediated by reductions in total OSA-18 questionnaire score and VLF power. These preliminary findings are novel and provide a direction for future research to investigate the effects of VLF power-guided interventions on childhood OSA.
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Affiliation(s)
- Li-Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Sleep Center, Metabolism and Obesity Institute, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei CIty, Taiwan
| | - Hai-Hua Chuang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Sleep Center, Metabolism and Obesity Institute, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.,Department of Family Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hui-Shan Hsieh
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Chao-Yung Wang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Sleep Center, Metabolism and Obesity Institute, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Cardiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Pang Chuang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Sleep Center, Metabolism and Obesity Institute, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Sleep Center, Metabolism and Obesity Institute, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shu Huang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Sleep Center, Metabolism and Obesity Institute, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Child Psychiatry, Linkou Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Guo-She Lee
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology, Taipei City Hospital, Taipei City, Taiwan
| | - Albert C Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei CIty, Taiwan.,Department of Psychiatry, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei CIty, Taiwan.,Center for Mind and Brain Medicine, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou City, Taiwan.,Sleep Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei CIty, Taiwan.,Sleep Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
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Campos JO, Barros MAV, Oliveira TLPSA, Nobre IG, de Morais AS, Santos MAM, Leandro CG, Costa-Silva JH. Cardiac autonomic dysfunction in school age children with overweight and obesity. Nutr Metab Cardiovasc Dis 2022; 32:2410-2417. [PMID: 35872100 DOI: 10.1016/j.numecd.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS We investigated cardiac autonomic function in overweight and obese school-age children. METHODS AND RESULTS Quantitative cross-sectional study conducted with children (n = 110) of both genders. Children were divided by normal weight (NW; n = 54), overweight (OW; n = 24) and obese (OB; n = 32). Systolic (SBP) and diastolic (DBP) blood pressure and electrocardiograms were recorded and analyzed for heart rate and the heart rate variability (HRV) in time (SDRR, RMSSD, PRR50, SD1 and SD2) and frequency domains (HF, LF and LF/HF). The OB group presented higher SBP (p ≤ 0.01) and DBP (p ≤ 0.01). For HRV, the OB group had a lower PRR50 (p ≤ 0.01) and HF (p ≤ 0.01), associated with higher LF (p ≤ 0.01). Moderate negative correlations were found between the HF, BMI (r = -0.37; p ≤ 0.01) and WC (r = -0.38; p ≤ 0.01). Positive moderate correlation were found between LF, LF/HF and BMI (LF: r = 0.32; p ≤ 0.01; LF/HF: r = 0.31; p ≤ 0.01) and WC (LF: r = 0.34; p ≤ 0.01; LF/HF: = 0.34; p ≤ 0.01). Multiple linear regression showed a positive association between body fat and the SDRR (β: 0.48; CI: 0.2-4.2; p = 0.02). No differences were observed in cardiac electrical activity. CONCLUSION Children with obesity but not overweight presented higher blood pressure and cardiac autonomic dysfunction, with sympathetic predominance on the heart rate. This fact was positively correlated with BMI and may be considered an important marker for cardiovascular risk in children.
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Affiliation(s)
- Jéssica O Campos
- Laboratory of Nutrition, Physical Activity and Phenotypic Plasticity, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil; Laboratory of Physical Evaluation and Signal Processing, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil
| | - Monique A V Barros
- Laboratory of Nutrition, Physical Activity and Phenotypic Plasticity, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil; Laboratory of Physical Evaluation and Signal Processing, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil
| | - Tafnes L P S A Oliveira
- Laboratory of Physical Evaluation and Signal Processing, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil
| | - Isabele G Nobre
- Laboratory of Physical Evaluation and Signal Processing, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil
| | - André S de Morais
- Academic Center of Agreste, Universidade Federal de Pernambuco, UFPE, Caruaru PE, Brazil
| | - Marcos A M Santos
- Superior School of Physical Education, Universidade de Pernambuco, Recife, PE, Brazil
| | - Carol G Leandro
- Laboratory of Nutrition, Physical Activity and Phenotypic Plasticity, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil; Laboratory of Physical Evaluation and Signal Processing, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil
| | - João H Costa-Silva
- Laboratory of Nutrition, Physical Activity and Phenotypic Plasticity, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil; Laboratory of Physical Evaluation and Signal Processing, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil. /
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10
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Gorban VV, Svistun OV, Gorban EV. Сardiorespiratory relationships in people of young age depending on the composite composition of the body. OBESITY AND METABOLISM 2022. [DOI: 10.14341/omet12829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND: The decisive importance of the sympathetic and parasympathetic nervous system in maintaining vegetative homeostasis requires the determination of sensitive non-invasive parameters of multidimensional outpatient monitoring of cardiorespiratory adaptation under various physiological and clinical conditions, taking into account the function of external respiration (FER), compound body composition and heart rate variability (HRV).AIM: To identify concomitant changes in HRV, HR and compound body composition in young people as markers of cardiorespiratory adaptation and rehabilitation.MATERIALS AND METHODS: On the basis of the Kuban State Medical University, a single-centre, interventional, cross-sectional, single-sample, comparative, uncontrolled study of a general group of young people in which respiratory parameters and parameters of the compound body composition were determined. Some individuals in this group additionally underwent Holter monitoring of the electrocardiogram (ECG) at short intervals.RESULTS: In young people, a change in the compound body composition with an increase in total fat mass, visceral and body fat is associated with a decrease in respiratory function (a decrease in the Tiffno index, a decrease in the maximum middle-expiratory flow — MMEF), manifested by a decrease in HRV (according to the TI indicator), the absence of an increase in the autonomic regulation circuit (according to SDNN indicator), a decrease in parasympathetic activity (in terms of rMSSD) and the absence of sympathetic activation (in terms of SDANN). Positive shifts in the form of an increase in trunk muscles, the total amount of water and a decrease in the total fat mass are accompanied by an increase in lung capacity, forced expiratory volume in the first second and a change in HRV with sympathetic (in terms of LF / HF, SDANN) and parasympathetic activation (in terms of rMSSD), an increase in HRV (in terms of TI) and an increase in the autonomic regulation circuit of the vegetative nervous system (in terms of SDNN).CONCLUSION: Accurate and rapid diagnostics of vegetative homeostasis requires a comprehensive correlative analysis of the parameters characterizing HRV in short recordings, the compound composition of the human body and respiratory function.
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11
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Latorre-Román PA, Floody PD, Martínez-Redondo M, Salas-Sánchez J, Consuegra-González PJ, Aragón-Vela J, Robles-Fuentes A, Sarabia-Cachadiña E, Párraga-Montilla JA. Comprehensive cardiac evaluation to maximal exercise in a contemporary population of prepubertal children. Pediatr Res 2022; 92:526-535. [PMID: 34718350 DOI: 10.1038/s41390-021-01809-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/02/2021] [Accepted: 09/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Heart rate (HR) is a biomarker used to measure physiological function, health status and cardiovascular autonomic function. The purpose of this study was to determine sex- and age-specific reference values for cardiac autonomic function at rest, during maximal exercise and the recovery phase in prepubertal children. METHODS Five hundred and twelve healthy children 7-11 years of age performed a Léger test. A heart RR-interval monitor recorded the heart data and a specific software analysed the cardiac autonomic response through HR and HR variability (HRV). It analysed HR before the test (resting HR, RHR), during the test (HRpeak) and HR recovery (HRR) in the first minute (HRR1) and the fifth minute (HRR5). The values are mean ± SD. RESULTS Collectively, 91.2% of girls and 92.3% of boys were within the recommended ranges regarding RHR. The average HRpeak was 199 ± 10.83 b.p.m. and 96.8% of girls and 95.3% of boys were within the minimum threshold value recommended (180 b.p.m.). Boys showed lower values of RHR than girls (p < 0.001) and larger values of HRR 1 and HRR5 (p < 0.001). CONCLUSIONS This study comprehensively provides a reference set of data for the most important HR variables that can be obtained during exercise testing in prepubertal children regarding age and sex and in a field setting. IMPACT This is the first study to provide reference values of autonomic cardiac function at rest, during maximal exercise and during the recovery period in prepubertal children aged 7-11 years. Despite the early age of participants, cardiorespiratory fitness, RHR and HRR are different according to sex. Aerobic performance and HRpeak have a negative correlation with body mass index and cardiometabolic risk.
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Affiliation(s)
| | - Pedro Delgado Floody
- Department of Physical Education, Sports, and Recreation, Universidad de La Frontera, Temuco, Chile
| | | | | | | | - Jerónimo Aragón-Vela
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark.
| | | | - Elena Sarabia-Cachadiña
- Department of Physical Activity and Sport, Cardenal Spínola-CEU University Studies Center (Seville), Seville, Spain
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12
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Cardiac Evaluation of Exercise Testing in a Contemporary Population of Preschool Children: A New Approach Providing Reference Values. CHILDREN 2022; 9:children9050654. [PMID: 35626831 PMCID: PMC9139640 DOI: 10.3390/children9050654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/26/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022]
Abstract
The objective of this study was to evaluate cardiac autonomic function at rest, during maximal exercise, and in post-exercise recovery, to determine sex-specific and age-specific differences in resting heart rate (RHR), linear and spectral parameters of Heart Rate Variability (HRV), HRpeak, and heart rate recovery (HRR) after one and five minutes, in preschool children. This study involved a cohort of 167 healthy children (79 girls) aged 3 to 6 years that were selected from several schools in southern Spain. A 10 × 20 m test was conducted, and the cardiovascular response was recorded. No significant differences were found in all variables between the sexes. However, a significant reduction in RHR and an increase in HRR were found from age 4 to age 6. HRV parameters at rest were higher in older children. No associations between 10 × 20 m performance, weight status, and cardiac parameters were found. Simple linear regression analysis revealed that heart rate reserve (HRr), HRR5min, RMSSD, and HF were the variables that showed association with all HR parameters. There was also a significant correlation between HRr and HRR5min. In conclusion, cardiovascular autonomic function during rest, exercise, and recovery in Spanish preschool children was not influenced by sex, although older children showed greater cardiovascular modulation. Cardiorespiratory fitness status was not associated with HR response.
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13
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Caillet AR, Russell AC, Wild MG, Acra S, Bradshaw LA, Bruehl S, Walker LS, Stone AL. Sex Moderates the Relationship Between Nausea Severity and Heart Rate Variability in Adolescents and Young Adults. Dig Dis Sci 2022; 67:606-612. [PMID: 33608817 PMCID: PMC8373993 DOI: 10.1007/s10620-021-06892-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Nausea is a common complaint among children and is particularly prevalent in children with functional abdominal pain (FAP), with nearly half of children with FAP also endorsing nausea. Dysfunction of the autonomic nervous system, which can be indexed by heart rate variability (HRV), leads to abnormalities in gastric electrical activity that are associated with GI symptoms. AIMS To evaluate that relationship between nausea severity and HRV in adolescents and young adults with a history of FAP and to assess for sex differences. METHODS Participants were pediatric patients with a diagnosis of FAP who were recruited from a pediatric GI clinic between 1993 and 2007 for a prospective study of the course of FAP. Study analyses focused on the cross-sectional relationship between HRV, indexed by standard deviation of the R-R interval (SDRRI) and high-frequency (HF) power, and nausea severity collected during a follow-up visit in late adolescence and young adulthood. RESULTS Controlling for age and BMI, a significant nausea by sex interaction emerged for both SDRRI and HF power. Tests of conditional effects of nausea by sex showed that the inverse relation between nausea severity and both SDRRI and HF was significant for females but not for males. CONCLUSIONS This is the first study to evaluate the relationship between nausea severity and HRV. Greater nausea severity was associated with lower HRV in females but not in males. Further validation of these results may provide insight into novel treatment approaches for females with nausea that target vagal tone.
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Affiliation(s)
- Aimée R. Caillet
- Division of Pediatric Gastroenterology, Nutrition, and Hepatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Alexandra C. Russell
- Division of Pediatric Gastroenterology, Nutrition, and Hepatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Marcus G. Wild
- Department of Psychological Sciences, Vanderbilt University, Nashville, TN
| | - Sari Acra
- Division of Pediatric Gastroenterology, Nutrition, and Hepatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Lynn S. Walker
- Division of Adolescent Medicine and Young Adult Health, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Amanda L. Stone
- Division of Adolescent Medicine and Young Adult Health, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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14
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Perulli M, Battista A, Sivo S, Turrini I, Musto E, Quintiliani M, Gambardella ML, Contaldo I, Veredice C, Mercuri EM, Lanza GA, Dravet C, Delogu AB, Battaglia DI. Heart rate variability alterations in Dravet Syndrome: The role of status epilepticus and a possible association with mortality risk. Seizure 2021; 94:129-135. [PMID: 34896816 DOI: 10.1016/j.seizure.2021.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/02/2021] [Accepted: 11/26/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Preliminary data suggest that patients with Dravet Syndrome (DS) have a reduced heart rate variability (HRV). This seems particularly evident in patients who experienced sudden unexpected death in epilepsy (SUDEP). This study aims at confirming these findings in a larger cohort and at defining clinical, genetic or electroencephalographic predictors of HRV impairment in DS patients. METHODS DS patients followed at our Institution performed a 24h-ECG Holter to derive HRV parameters. We used as control population patients with epilepsy (PWEs) and healthy controls (HCs). In DS patients, we assessed the impact of different clinical, neurophysiological and genetic features on HRV alterations through multiple linear regression. After a mean follow-up of 7.4 ± 3.2 years since the HRV assessment, all DS patients were contacted to record death or life-threatening events. RESULTS 56 DS patients had a significantly reduced HRV compared to both HCs and PWEs. A recent history of status epilepticus (SE) was the only significant predictor of lower HRV in the multivariate analysis. At follow-up, only one patient died; her HRV was lower than that of all the controls and was in the low range for DS patients. CONCLUSION We describe for the first time an association between SE and HRV alterations in DS. Further studies on other SCN1A-related phenotypes and other epilepsies with frequent SE will help clarify this finding. Compared to the literature, our cohort showed better HRV and lower mortality. Although limited, this observation reinforces the role of HRV as a biomarker for mortality risk in DS.
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Affiliation(s)
- Marco Perulli
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Battista
- Pediatrics, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serena Sivo
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ida Turrini
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Musto
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michela Quintiliani
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Luigia Gambardella
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilaria Contaldo
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Veredice
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eugenio Maria Mercuri
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Antonio Lanza
- Cardiology, Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze cardiovascolari e pneumologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Charlotte Dravet
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angelica Bibiana Delogu
- Pediatrics, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenica Immacolata Battaglia
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
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15
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Lugao RDS, Barbosa RRB, Coelho PDF, Liberato FMG, Vidal PR, Carvalho RBCOD, Melotti RDCNC, Donadio MVF. Association of sleep disorders with heart rate variability in children and adolescents with cystic fibrosis. ACTA ACUST UNITED AC 2021; 40:e2020295. [PMID: 34495277 PMCID: PMC8432146 DOI: 10.1590/1984-0462/2022/40/2020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/17/2021] [Indexed: 11/25/2022]
Abstract
Objective: To assess the association of sleep disorders with the findings of heart rate variability (HRV) in children and adolescents with cystic fibrosis (CF). Methods: Cross-sectional study including children and adolescents aged six to 18 years with a clinical diagnosis of CF. Sociodemographic and clinical data were collected. Sleep disorders were evaluated using baseline nocturnal polysomnography. The autonomic nervous system (ANS) was evaluated through resting HRV. Results: A total of 30 individuals (11.2 years) with a mean forced expiratory volume in the first second (FEV1) of 62.7% were included. The respiratory disturbance index presented a median of 2.6 and obstructive sleep apnea syndrome (OSAS) was identified in 30%. In the HRV analysis, a mean standard deviation of all inter-beat (RR) intervals (SDNN) of 60.8±45.9ms was found. There was a significant correlation between the HRV low-frequency/high-frequency (LF/HF) global modulation index and the minimum SpO2 during sleep in patients with FEV1<60% (r=0.71; p=0.02). The prevalence of sleep disorders and HRV abnormalities was higher in individuals with lesser pulmonary function (FEV1<60%). Conclusions: The results indicate a weak correlation of sleep disorders (minimum SpO2) with HRV parameters (LH/HF) in children and adolescents with CF. When pulmonary function was reduced, a stronger correlation was found, highlighting the influence of disease severity. A high prevalence of ANS disorders, nocturnal hypoxemia, and presence of OSAS was also found.
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Affiliation(s)
| | | | | | | | - Pâmela Reis Vidal
- School of Sciences, Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil
| | | | | | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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16
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Buchhorn R, Baumann C, Willaschek C. Pathophysiological mechanisms of bradycardia in patients with anorexia nervosa. Health Sci Rep 2021; 4:e331. [PMID: 34322602 PMCID: PMC8299991 DOI: 10.1002/hsr2.331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/29/2021] [Accepted: 07/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this investigation was to examine heart rate variability (HRV), interbeat interval (IBI), and their interrelationship in healthy controls, bradycardic hyperpolarization-activated cyclic nucleotide-gated channel 4 (HCN4) mutation carriers, and patients with anorexia nervosa (AN). We tested the hypothesis that neural mechanisms cause bradycardia in patients with AN. Therefore, we assumed that saturation of the HRV/IBI relationship as a consequence of sustained parasympathetic control of the sinus node is exclusively detectable in patients with AN. METHODS Patients with AN between the ages of 12 and 16 years admitted to our hospital due to malnutrition were grouped and included in the present investigation (N = 20). A matched-pair group with healthy children and adolescents was created. Groups were matched for age and sex. A 24-hour Holter electrocardiography (ECG) was performed in controls and patients. More specifically, all patients underwent two 24-hour Holter ECG examinations (admission; refeeding treatment). Additionally, the IBI was recorded during the night in HCN4 mutation carriers (N = 4). HRV parameters were analyzed in 5-minute sequences during the night and plotted against mean corresponding IBI length. HRV, IBI, and their interrelationship were examined using Spearman's rank correlation analyses, Mann-Whitney U tests, and Wilcoxon signed-rank tests. RESULTS The relationship between IBI and HRV showed signs of saturation in patients with AN. Furthermore, signs of HRV saturation were present in two HCN4 mutation carriers. In contrast, signs of HRV saturation were not present in controls. CONCLUSIONS The existence of HRV saturation does not support the existence of parasympathetically mediated bradycardia. Nonneural mechanisms, such as HCN4 downregulation, may be responsible for bradycardia and HRV saturation in patients with AN.
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Affiliation(s)
- Reiner Buchhorn
- Department of PediatricsCaritas‐Krankenhaus Bad MergentheimBad MergentheimGermany
| | | | - Christian Willaschek
- Department of PediatricsCaritas‐Krankenhaus Bad MergentheimBad MergentheimGermany
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17
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de Freitas Coelho P, Barbosa RRB, dos Santos Lugao R, Liberato FMG, Vidal PR, de Cássia Nunes Cruz Melotti R, Donadio MVF. Heart rate variability, exercise capacity and levels of daily physical activity in children and adolescents with mild-to-moderate cystic fibrosis. Hong Kong Physiother J 2021; 42:5-14. [PMID: 35782696 PMCID: PMC9244599 DOI: 10.1142/s1013702522500019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Autonomic nervous system balance is altered in cystic fibrosis (CF), although its influence on physical fitness has been poorly explored. Objective: This study aimed to evaluate the association of heart rate variability (HRV) with exercise capacity and levels of daily physical activity in children and adolescents with mild-to-moderate CF. Methods: A cross-sectional study including individuals with CF aged 6–18 years, not under CFTR modulator therapy, was performed. Sociodemographic (age, sex) and clinical information (airway colonization, pancreatic insufficiency, and genotyping) were collected. In addition, exercise capacity (modified shuttle test — MST), lung function (spirometry), body composition (bioimpedance), levels of daily physical activity (5-day accelerometer), and HRV (both at rest and during the MST) were evaluated. Results: 30 individuals (20 females) aged [Formula: see text] years, mean FEV[Formula: see text]%, were included. A sympathovagal balance (LF/HF) increase ([Formula: see text]) during the MST was shown, indicating a predominance of sympathetic modulation. The standard deviation of all RR intervals (SDNN) and the high frequency (HF) index during exercise correlated significantly with FEV1 ([Formula: see text], [Formula: see text] and [Formula: see text], [Formula: see text]; respectively). MST distance also correlated positively and significantly with SDNN ([Formula: see text], [Formula: see text]), square root of the mean of the sums of squares of frequencies between RR intervals greater than 50[Formula: see text]ms — RMSSD ([Formula: see text], [Formula: see text]), low frequency — LF ([Formula: see text], [Formula: see text]), HF ([Formula: see text], [Formula: see text]), dispersion of points perpendicular to the short-term identity line — SD1 ([Formula: see text], [Formula: see text]) and negatively with LF/HF ([Formula: see text], [Formula: see text]). Regarding daily physical activity, SDNN at rest ([Formula: see text], [Formula: see text]) and exercise ([Formula: see text], [Formula: see text]) showed positive correlations with time in moderate-to-vigorous activities. When normalizing the SDNN and classifying individuals as normal or altered, those presenting altered SDNN showed poorest FEV1 ([Formula: see text]) and lower exercise capacity ([Formula: see text]). Conclusion: HRV correlates with lung function, exercise capacity and levels of daily physical activity in children and adolescents with CF. The study highlights the influence of CF on autonomic function and suggests HRV measurement as an easy tool to be used in clinical settings as an alternative marker to monitor CF individuals.
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Affiliation(s)
- Pitiguara de Freitas Coelho
- Escola Superior de Ciˆencias da Santa Casa de Misericórdia de, Vitória – EMESCAM, Vitória, Espírito Santo, Brazil
| | | | - Rodrigo dos Santos Lugao
- Escola Superior de Ciˆencias da Santa Casa de Misericórdia de, Vitória – EMESCAM, Vitória, Espírito Santo, Brazil
| | | | - Pâmela Reis Vidal
- Escola Superior de Ciˆencias da Santa Casa de Misericórdia de, Vitória – EMESCAM, Vitória, Espírito Santo, Brazil
| | | | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica, do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
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18
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Pham T, Lau ZJ, Chen SHA, Makowski D. Heart Rate Variability in Psychology: A Review of HRV Indices and an Analysis Tutorial. SENSORS (BASEL, SWITZERLAND) 2021; 21:3998. [PMID: 34207927 PMCID: PMC8230044 DOI: 10.3390/s21123998] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 12/16/2022]
Abstract
The use of heart rate variability (HRV) in research has been greatly popularized over the past decades due to the ease and affordability of HRV collection, coupled with its clinical relevance and significant relationships with psychophysiological constructs and psychopathological disorders. Despite the wide use of electrocardiograms (ECG) in research and advancements in sensor technology, the analytical approach and steps applied to obtain HRV measures can be seen as complex. Thus, this poses a challenge to users who may not have the adequate background knowledge to obtain the HRV indices reliably. To maximize the impact of HRV-related research and its reproducibility, parallel advances in users' understanding of the indices and the standardization of analysis pipelines in its utility will be crucial. This paper addresses this gap and aims to provide an overview of the most up-to-date and commonly used HRV indices, as well as common research areas in which these indices have proven to be very useful, particularly in psychology. In addition, we also provide a step-by-step guide on how to perform HRV analysis using an integrative neurophysiological toolkit, NeuroKit2.
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Affiliation(s)
- Tam Pham
- School of Social Sciences, Nanyang Technological University, Singapore 639818, Singapore; (T.P.); (Z.J.L.); (D.M.)
| | - Zen Juen Lau
- School of Social Sciences, Nanyang Technological University, Singapore 639818, Singapore; (T.P.); (Z.J.L.); (D.M.)
| | - S. H. Annabel Chen
- School of Social Sciences, Nanyang Technological University, Singapore 639818, Singapore; (T.P.); (Z.J.L.); (D.M.)
- Centre for Research and Development in Learning, Nanyang Technological University, Singapore 637460, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
- National Institute of Education, Nanyang Technological University, Singapore 637616, Singapore
| | - Dominique Makowski
- School of Social Sciences, Nanyang Technological University, Singapore 639818, Singapore; (T.P.); (Z.J.L.); (D.M.)
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Goroso DG, Watanabe WT, Napoleone F, da Silva DP, Salinet JL, da Silva RR, Puglisi JL. Remote monitoring of heart rate variability for obese children. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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20
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Estévez-González AJ, Donadio MVF, Cobo-Vicente F, Fernández-Luna Á, Sanz-Santiago V, Villa Asensi JR, Iturriaga Ramirez T, Fernández-Del-Valle M, Diez-Vega I, Larumbe-Zabala E, Pérez-Ruiz M. Effects of a Short-Term Resistance-Training Program on Heart Rate Variability in Children With Cystic Fibrosis-A Randomized Controlled Trial. Front Physiol 2021; 12:652029. [PMID: 33859572 PMCID: PMC8042150 DOI: 10.3389/fphys.2021.652029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/10/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Cystic fibrosis (CF) affects the autonomic nervous system (ANS) and exercise in healthy children modulates the interaction between sympathetic and parasympathetic activity. This study aimed to evaluate the effects of a short-term resistance exercise program on heart rate variability (HRV) in children and adolescents with CF. Methods: A randomized controlled trial was carried out in children diagnosed with CF aged 6–18 years. Individuals were divided into two groups: control (CON) and resistance-training (EX). Individuals in the EX group completed an individualized guided resistance program (5-RM—60–80%) for 8 weeks (3 sessions of 60 min/week). Upper and lower limbs exercises (seated bench press, seated lateral row, and leg press) were used. HRV was measured using a Suunto watch with subjects in lying position. Results: Nineteen subjects (13 boys) were included (CON = 11; and EX = 8). Mean age was 12.2 ± 3.3, FEV1 (forced expiratory volume in the first second) z-score was 1.72 ± 1.54 and peak oxygen consumption (VO2peak) 42.7 ± 7.4 mL.Kg–1.min–1. Exercise induced significant changes in the frequency-domain variables, including a decrease in LF power (p = 0.001, d = 0.98) and LF/HF ratio (p = 0.020, d = 0.92), and an increase in HF power (p = 0.001, d = −0.97), compared to the CON group. No significant changes were found for time-domain variables, although increases with a moderate effect size were seen for SDNN (p = 0.152, d = −0.41) and RMSSD (p = 0.059, d = −0.49) compared to the CON group. Conclusion: A short-term resistance exercise-training program was able to modulate HRV in children and adolescents with CF presenting mild to moderate lung function impairment and good physical condition. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT04293926.
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Affiliation(s)
| | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | | | | | | | - Tamara Iturriaga Ramirez
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Ignacio Diez-Vega
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
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21
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Akinci G, Savelieff MG, Gallagher G, Callaghan BC, Feldman EL. Diabetic neuropathy in children and youth: New and emerging risk factors. Pediatr Diabetes 2021; 22:132-147. [PMID: 33205601 DOI: 10.1111/pedi.13153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 12/23/2022] Open
Abstract
Pediatric neuropathy attributed to metabolic dysfunction is a well-known complication in children and youth with type 1 diabetes. Moreover, the rise of obesity and in particular of type 2 diabetes may cause an uptick in pediatric neuropathy incidence. However, despite the anticipated increase in neuropathy incidence, pathogenic insights and strategies to prevent or manage neuropathy in the setting of diabetes and obesity in children and youth remain unknown. Data from adult studies and available youth cohort studies are providing an initial understanding of potential diagnostic, management, and preventative measures in early life. This review discusses the current state of knowledge emanating from these efforts, with particular emphasis on the prevalence, clinical presentation, diagnostic approaches and considerations, and risk factors of neuropathy in type 1 and type 2 diabetes in children and youth. Also highlighted are current management strategies and recommendations for neuropathy in children and youth with diabetes. This knowledge, along with continued and sustained emphasis on identifying and eliminating modifiable risk factors, completing randomized controlled trials to assess effectiveness of strategies like weight loss and exercise, and enhancing awareness to support early detection and prevention, are pertinent to addressing the rising incidence of neuropathy associated with diabetes and obesity in children and youth.
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Affiliation(s)
- Gulcin Akinci
- Department of Neurology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Masha G Savelieff
- Department of Neurology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Gary Gallagher
- Department of Neurology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Brian C Callaghan
- Department of Neurology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Eva L Feldman
- Department of Neurology, University of Michigan Medicine, Ann Arbor, Michigan, USA
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Parma V, Cellini N, Guy L, McVey AJ, Rump K, Worley J, Maddox BB, Bush J, Bennett A, Franklin M, Miller JS, Herrington J. Profiles of Autonomic Activity in Autism Spectrum Disorder with and without Anxiety. J Autism Dev Disord 2021; 51:4459-4470. [PMID: 33565037 DOI: 10.1007/s10803-020-04862-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 12/28/2022]
Abstract
Both anxiety and autism spectrum disorder (ASD) are associated with atypical physiological activity. Few studies have systematically assessed the resting physiological activity in ASD with co-occurring anxiety disorders. We tested 75 participants divided in four groups: youth with ASD, with (ASD + Anxiety = 22, 6F, 12.29 ± 2.83 years old) and without co-occurring anxiety (ASD Alone = 15, 6F, 11.59 ± 2.85 years old) and compared their physiological profile with that of matched typically developing controls (TDC) with (Anxiety Alone = 16, 6F, 11.24 ± 3.36 years old) and without co-occurring anxiety disorders (TDC = 22, 8F, 11.88 ± 2.88 years old). Results indicated reduced sympathetic and parasympathetic activity at rest in ASD as compared to TDC youth. ASD + Anxiety and Anxiety Alone groups showed different sympathetic, but similar parasympathetic activity. These findings suggest that autonomic profile-based approaches may advance research, diagnosis, and treatment of ASD and anxiety.
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Affiliation(s)
- Valentina Parma
- Department of Psychology, Temple University, 1701 N 13th St, Philadelphia, PA, 19122, USA. .,Center for Autism Research, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA.
| | - Nicola Cellini
- Department of General Psychology, University of Padova, Via Venezia, 8, 35131, Padova, Italy
| | - Lisa Guy
- TEACCH Autism Program, University of North Carolina at Chapel Hill, Greensboro, NC, USA
| | - Alana J McVey
- Marquette University, 604 N. 16th Street, Milwaukee, WI, 53233, USA
| | - Keiran Rump
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | | | - Brenna B Maddox
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | | | - Amanda Bennett
- Center for Autism Research, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA
| | - Martin Franklin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Judith S Miller
- Center for Autism Research, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - John Herrington
- Center for Autism Research, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Kunikullaya U K, Kunnavil R, Vijayadas, Goturu J, Prakash VS, Murthy NS. Normative data and gender differences in heart rate variability in the healthy young individuals aged 18-30 years, a South Indian cross-sectional study. Indian Pacing Electrophysiol J 2021; 21:112-119. [PMID: 33482336 PMCID: PMC7952895 DOI: 10.1016/j.ipej.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/12/2020] [Accepted: 01/09/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- Kirthana Kunikullaya U
- Department of Physiology, M S Ramaiah Medical College, MSR Nagar, MSRIT Post, Bangalore, Karnataka, 560054, India.
| | - Radhika Kunnavil
- Department of Community Medicine, ESI Post Graduate Institute of Medical Science and Research, 41st Cross Rd, Rajajinagar, Bangalore, Karnataka, 560010, India.
| | - Vijayadas
- Department of Physiology, M S Ramaiah Medical College, MSR Nagar, MSRIT Post, Bangalore, Karnataka, 560054, India.
| | - Jaisri Goturu
- Department of Physiology, International Medical School, MSR Nagar, MSRIT Post, Bangalore, Karnataka, 560054, India.
| | - Vadagenahalli S Prakash
- Department of Cardiology, M S Ramaiah Memorial Hospitals, MSR Nagar, MSRIT Post, Bangalore, Karnataka, 560054, India.
| | - Nandagudi Srinivasa Murthy
- Department of Research and Patents, Gokula Education Foundation, MSR Nagar, MSRIT Post, Bangalore, Karnataka, 560054, India.
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How to Use Heart Rate Variability: Quantification of Vagal Activity in Toddlers and Adults in Long-Term ECG. SENSORS 2020; 20:s20205959. [PMID: 33096844 PMCID: PMC7589813 DOI: 10.3390/s20205959] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/04/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022]
Abstract
Recent developments in noninvasive electrocardiogram (ECG) monitoring with small, wearable sensors open the opportunity to record high-quality ECG over many hours in an easy and non-burdening way. However, while their recording has been tremendously simplified, the interpretation of heart rate variability (HRV) data is a more delicate matter. The aim of this paper is to supply detailed methodological discussion and new data material in order to provide a helpful notice of HRV monitoring issues depending on recording conditions and study populations. Special consideration is given to the monitoring over long periods, across periods with different levels of activity, and in adults versus children. Specifically, the paper aims at making users aware of neglected methodological limitations and at providing substantiated recommendations for the selection of appropriate HRV variables and their interpretation. To this end, 30-h HRV data of 48 healthy adults (18–40 years) and 47 healthy toddlers (16–37 months) were analyzed in detail. Time-domain, frequency-domain, and nonlinear HRV variables were calculated after strict signal preprocessing, using six different high-frequency band definitions including frequency bands dynamically adjusted for the individual respiration rate. The major conclusion of the in-depth analyses is that for most applications that implicate long-term monitoring across varying circumstances and activity levels in healthy individuals, the time-domain variables are adequate to gain an impression of an individual’s HRV and, thus, the dynamic adaptation of an organism’s behavior in response to the ever-changing demands of daily life. The sound selection and interpretation of frequency-domain variables requires considerably more consideration of physiological and mathematical principles. For those who prefer using frequency-domain variables, the paper provides detailed guidance and recommendations for the definition of appropriate frequency bands in compliance with their specific recording conditions and study populations.
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González-Velázquez VE, Pedraza-Rodríguez EM, Carrazana-Escalona R, Moreno-Padilla M, Muñoz-Bustos GA, Sánchez-Hechavarría ME. Cardiac vagal imbalance to the isometric sustained weight test in adolescents with emotional eating behavior. Physiol Behav 2020; 223:112994. [PMID: 32502529 DOI: 10.1016/j.physbeh.2020.112994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/24/2020] [Accepted: 05/29/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the relationship between emotional eating behavior and heart rate variability in Spanish adolescents during an isometric exercise test. METHODS Participants included 52 adolescents aged between 13 and 18 years old. Heart rate was continuously recorded at rest (2 minutes) and during the sustained weight test (2 minutes). Linear and nonlinear methods of heart rate variability were assessed and related to the emotional eating behavior divided in two clusters. RESULTS Statistically significant differences were observed in linear and non-linear parameters of heart rate variability comparing rest and sustained weight test. An increase in the value of emotional eating in overweight adolescents was founded. During the sustained weight test, there were differences between the two emotional eating clusters regarding the variables peak high frequency power, normalized low frequency power, normalized high frequency power, low frequency/high frequency ratio, and sample entropy. A positive correlation between the emotional eating behavior and the peak high frequency power was observed, though the prediction capacity of the high frequency waves is low it is observed that there is a good fit to the regression line. CONCLUSION Results of this study shows that there was a relationship between vagal tone and emotional eating behavior in adolescents during an isometric exercise, with excessive parasympathetic predominance and sympathetic withdrawal during a physical effort.
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Affiliation(s)
- Victor Ernesto González-Velázquez
- Departamento de Ciencias Básicas Biomédicas. Facultad de Medicina. Universidad de Ciencias Médicas de Villa Clara. Villa Clara, Cuba
| | - Elys María Pedraza-Rodríguez
- Departamento de Ciencias Básicas Biomédicas. Facultad de Medicina. Universidad de Ciencias Médicas de Villa Clara. Villa Clara, Cuba
| | - Ramón Carrazana-Escalona
- Departamento de Ciencias Básicas Biomédicas. Facultad de Medicina 1. Universidad de Ciencias Médicas de Santiago de Cuba. Santiago de Cuba, Cuba
| | | | | | - Miguel Enrique Sánchez-Hechavarría
- Departamento de Ciencias Basicas y Morfologicas. Facultad de Medicina. Universidad Católica de la Santísima Concepción. Concepción, Chile..
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Affiliation(s)
- Breno Quintella Farah
- Departamento de Educação FísicaUniversidade Federal Rural de PernambucoRecifePEBrasil Departamento de Educação Física da Universidade Federal Rural de Pernambuco (UFRPE), Recife , PE - Brasil
- Programa de Pós-Graduação em Educação FísicaUFPERecifePEBrasil Programa de Pós-Graduação em Educação Física da UFPE Recife , PE - Brasil
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27
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Gąsior JS, Zamunér AR, Silva LEV, Williams CA, Baranowski R, Sacha J, Machura P, Kochman W, Werner B. Heart Rate Variability in Children and Adolescents with Cerebral Palsy-A Systematic Literature Review. J Clin Med 2020; 9:jcm9041141. [PMID: 32316278 PMCID: PMC7230809 DOI: 10.3390/jcm9041141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/04/2020] [Accepted: 04/13/2020] [Indexed: 12/14/2022] Open
Abstract
Cardiac autonomic dysfunction has been reported in patients with cerebral palsy (CP). The aim of this study was to assess the existing literature on heart rate variability (HRV) in pediatric patients with CP and a special attention was paid to the compliance of the studies with the current HRV assessment and interpretation guidelines. A systematic review was performed in PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases searched for English language publications from 1996 to 2019 using Medical Subject Headings (MeSH) terms “heart rate variability” and “cerebral palsy” in conjunction with additional inclusion criteria: studies limited to humans in the age range of 0–18 years and empirical investigations. Out of 47 studies, 12 were included in the review. Pediatric patients with CP presented a significantly higher resting heart rate and reduced HRV, different autonomic responses to movement stimuli compared to children with normal development, but also reduced HRV parameters in the children dependent on adult assistance for mobility compared to those generally independent. None of the included studies contained the necessary details concerning RR intervals acquisition and HRV measurements as recommended by the guidelines. Authors of HRV studies should follow the methodological guidelines and recommendations on HRV measurement, because such an approach may allow a direct comparison of their results.
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Affiliation(s)
- Jakub S. Gąsior
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities, 26-600 Radom, Poland
- Correspondence: ; Tel.: +48-793-199-222
| | | | - Luiz Eduardo Virgilio Silva
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo 14049-900, Brazil;
| | - Craig A. Williams
- Children’s Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St Luke’s Campus, Exeter EX1 2LU, UK;
| | - Rafał Baranowski
- Department of Heart Rhythm Disorders, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland;
- Department of Cardiology, University Hospital in Opole, University of Opole, 45-401 Opole, Poland
| | - Paulina Machura
- Department of Gynaecological Endocrinology, Medical University of Warsaw, 00-950 Warsaw, Poland;
| | - Wacław Kochman
- Clinical Department of Cardiology at Bielanski Hospital, National Institute of Cardiology, 01-809 Warsaw, Poland;
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland;
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Isaiah A, Bertoni D, Pereira KD, Diaz-Abad M, Mitchell RB, Das G. Treatment-Related Changes in Heart Rate Variability in Children with Sleep Apnea. Otolaryngol Head Neck Surg 2020; 162:737-745. [PMID: 32122243 DOI: 10.1177/0194599820907882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Heart rate variability (HRV), a noninvasive indicator of autonomic regulation of cardiac rhythm, may represent the physiologic burden of obstructive sleep apnea (OSA). We hypothesized that the treatment-related effects of OSA on HRV in children are causally attributable to the improvement in OSA severity. STUDY DESIGN Secondary analysis of outcomes from the Childhood Adenotonsillectomy Trial (CHAT). SETTING Analysis of database. SUBJECTS AND METHODS Time- and frequency-domain HRV parameters along with polysomnographic (PSG) and demographic variables were obtained from the CHAT study, which compared early adenotonsillectomy (eAT) to watchful waiting (WW) in children with OSA. The relative contributions of PSG variables and covariates to each HRV parameter were quantified. The proportion of changes in HRV parameters causally attributable to changes in OSA severity, measured by the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI), was estimated. RESULTS In total, 404 children aged 5 to 10 years were included. The median (interquartile range) age was 6 (3-9) years. The median body mass index percentile was 82 (53), 195 (48%) children were male, and 147 (36%) were African American. The average heart rate during PSG was the strongest independent predictor of each HRV parameter (P < .001). Although eAT resulted in statistically significant changes in the majority of HRV parameters, these effects were not causally attributable to treatment-related changes in AHI or ODI. CONCLUSIONS The average heart rate strongly modulates HRV in children with OSA. Although eAT results in discernible changes in HRV, it appears to not be causally attributable to specific treatment-related changes in AHI or ODI.
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Affiliation(s)
- Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dylan Bertoni
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kevin D Pereira
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Montserrat Diaz-Abad
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ron B Mitchell
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern and Children's Health, Dallas, Texas, USA
| | - Gautam Das
- Department of Computer Science and Engineering, University of Texas at Arlington, Arlington, Texas, USA
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Mubayed L, Romme A, Nguyen HH. QT Prolongation After Minor Head Trauma in a Pediatric Patient. Pediatr Cardiol 2020; 41:414-417. [PMID: 31599347 DOI: 10.1007/s00246-019-02213-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/10/2019] [Indexed: 11/26/2022]
Abstract
We report a case of QTc prolongation associated with mild concussion in a pediatric patient. An 11-year-old male presented to the emergency department after sustaining a head injury during football practice. He complained of headache and blurry vision. Physical examination was within normal apart from an irregular heart rhythm. Electrocardiogram (ECG) showed normal sinus rhythm with QTc (Bazett formula) 460 ms. The patient was diagnosed with concussion and referred for cardiology follow-up of the QTc. ECG the next day showed QTc 462 ms (heart rate 105 bpm) supine and 494 ms after suddenly standing up (heart rate 120 bpm). Family history was negative for sudden cardiac events. Exercise stress testing 1 week later showed a baseline QTc 462 ms and 488 ms at 4 min into recovery. Holter monitoring showed evidence of increased parasympathetic activity manifested by marked sinus arrhythmia. Repeated ECG, exercise stress testing, and Holter monitoring 3 months later showed normalized QTc values. His concussion symptoms were resolved at the time of repeat testing. Mild head trauma/concussion could be associated with prolonged QTc and abnormal cardiac repolarization. While these changes seem to be self-limiting, they remain a possible substrate for malignant arrhythmias. Recognition of these changes would lead to appropriate reassurance and/or precautions in the acute setting, especially in at-risk populations such as long QT syndrome patients.
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Affiliation(s)
- Lamya Mubayed
- Department of Pediatrics/Division of Cardiology, Rush University Medical College, Chicago, IL, USA.
| | - Angela Romme
- Department of Pediatrics/Division of Cardiology, Rush University Medical College, Chicago, IL, USA
| | - Hoang H Nguyen
- Department of Pediatrics/Division of Cardiology, Rush University Medical College, Chicago, IL, USA
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Associations of physical activity, sedentary time, and cardiorespiratory fitness with heart rate variability in 6- to 9-year-old children: the PANIC study. Eur J Appl Physiol 2019; 119:2487-2498. [PMID: 31535217 PMCID: PMC6858383 DOI: 10.1007/s00421-019-04231-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/10/2019] [Indexed: 12/16/2022]
Abstract
Purpose To study the associations of physical activity (PA), sedentary time (ST), and cardiorespiratory fitness (CRF) with heart rate variability (HRV) in children. Methods The participants were a population sample of 377 children aged 6–9 years (49% boys). ST, light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and moderate-to-vigorous PA (MVPA), and PA energy expenditure (PAEE) were assessed using a combined heart rate and movement sensor, maximal power output per kilograms of lean body mass as a measure of CRF by maximal cycle ergometer exercise test, and HRV variables (SDNN, RMSSD, LF, and HF) using 5 min resting electrocardiography. Data were analysed by linear regression adjusted for years from peak height velocity. Results In boys, ST was inversely associated (β = − 0.185 to − 0.146, p ≤ 0.049) and MVPA, VPA, PAEE, and CRF were directly associated (β = 0.147 to 0.320, p ≤ 0.048) with HRV variables. CRF was directly associated with all HRV variables and PAEE was directly associated with RMSSD after mutual adjustment for ST, PAEE, and CRF (β = 0.169 to 0.270, p ≤ 0.046). In girls, ST was inversely associated (β = − 0.382 to − 0.294, p < 0.001) and LPA, MPA, VPA, MVPA, and PAEE were directly associated with HRV variables (β = 0.144 to 0.348, p ≤ 0.049). After mutual adjustment for ST, PAEE, and CRF, only the inverse associations of ST with HRV variables remained statistically significant. Conclusions Higher ST and lower PA and CRF were associated with poorer cardiac autonomic nervous system function in children. Lower CRF in boys and higher ST in girls were the strongest correlates of poorer cardiac autonomic function. Electronic supplementary material The online version of this article (10.1007/s00421-019-04231-5) contains supplementary material, which is available to authorized users.
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Constantinescu V, Matei D, Constantinescu I, Cuciureanu DI. Heart Rate Variability and Vagus Nerve Stimulation in Epilepsy Patients. Transl Neurosci 2019; 10:223-232. [PMID: 31497318 PMCID: PMC6708288 DOI: 10.1515/tnsci-2019-0036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/23/2019] [Indexed: 01/01/2023] Open
Abstract
Background Vagus nerve stimulation (VNS) exerts a cortical modulating effect through its diffuse projections, especially involving cerebral structures related to autonomic regulation. The influence of VNS on cardiovascular autonomic function in drug-resistant epilepsy patients is still debated. We aimed to evaluate the impact of VNS on cardiovascular autonomic function in drug-resistant epilepsy patients, after three months of neurostimulation, using the heart rate variability (HRV) analysis. Methodology Multiple Trigonometric Regressive Spectral analysis enables a precise assessment of the autonomic control on the heart rate. We evaluated time and frequency-domain HRV parameters in resting condition and during sympathetic and parasympathetic activation tests in five epilepsy patients who underwent VNS procedure. Results We found appropriate cardiac autonomic responses to sympathetic and parasympathetic activation tests, described by RMSSD, pNN50, HF and LF/HF dynamics after three months of VNS. ON period of the neurostimulation may generate a transient vagal activation reflected on heart rate and RMSSD values, as observed in one of our cases. Conclusion VNS therapy in epilepsy patients seems not to disrupt the cardiac autonomic function. HRV represents a useful tool in evaluating autonomic activity. More extensive studies are needed to further explore cardiac autonomic response after neurostimulation.
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Affiliation(s)
- Victor Constantinescu
- Neurology Department, Faculty of Medicine, University of Medicine and Pharmacy Iasi, Iasi Romania
| | - Daniela Matei
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy Iasi, Iasi Romania
| | | | - Dan Iulian Cuciureanu
- Neurology Department, Faculty of Medicine, University of Medicine and Pharmacy Iasi, Iasi Romania
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Bayo-Tallón V, Esquirol-Caussa J, Pàmias-Massana M, Planells-Keller K, Palao-Vidal DJ. Effects of manual cranial therapy on heart rate variability in children without associated disorders: Translation to clinical practice. Complement Ther Clin Pract 2019; 36:125-141. [PMID: 31383430 DOI: 10.1016/j.ctcp.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 06/11/2019] [Accepted: 06/30/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND and purpose: Heart rate variability (HRV) represents a marker of autonomic activity, self-regulation and psychiatric illness. Few studies of manual therapy have investigated the neurophysiological effects of manual cranial therapy (MC-t). This study assessed the neurophysiological short/medium-term effects of two manual therapy interventions: massage therapy (Mss-t) and MC-t. MATERIALS AND METHODS A double-blind clinical trial was conducted with 50 healthy children, randomized into two groups who received a Mss-t intervention or MC-t. The variables analysed included vital signs (temperature, respiratory rate, heart rate, blood pressure) and HRV components, including the root mean square of successive differences (RMSSD), high frequency (HF), low frequency (LF) and LF/HF ratio. RESULTS Both interventions produced short-term parasympathetic effects, although the effects of MC-t were more persistent. CONCLUSION The persistence of the MC-t intervention suggested a prominent vagal control and better self-regulation. Autonomic imbalances in mental pathologies may benefit from the neurophysiological effects of MC-t.
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Affiliation(s)
- Vanessa Bayo-Tallón
- Universitary Research Service of Physical Therapy, Servei Universitari de Recerca en Fisioteràpia -S.U.R.F, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain.
| | - Jordi Esquirol-Caussa
- Universitary Research Service of Physical Therapy, Servei Universitari de Recerca en Fisioteràpia -S.U.R.F, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain.
| | - Montserrat Pàmias-Massana
- Executive Direction of Adult, Child and Juvenile Mental Health Area at Corporación Sanitaria y Universitaria Parc Taulí (Neurosciences) (Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Kalia Planells-Keller
- Executive Direction of Adult, Child and Juvenile Mental Health Area at Corporación Sanitaria y Universitaria Parc Taulí (Neurosciences) (Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Diego J Palao-Vidal
- Executive Direction of Adult, Child and Juvenile Mental Health Area at Corporación Sanitaria y Universitaria Parc Taulí (Neurosciences) (Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
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Plaza-Florido A, Migueles JH, Mora-Gonzalez J, Molina-Garcia P, Rodriguez-Ayllon M, Cadenas-Sanchez C, Esteban-Cornejo I, Navarrete S, Maria Lozano R, Michels N, Sacha J, Ortega FB. The Role of Heart Rate on the Associations Between Body Composition and Heart Rate Variability in Children With Overweight/Obesity: The ActiveBrains Project. Front Physiol 2019; 10:895. [PMID: 31379602 PMCID: PMC6646801 DOI: 10.3389/fphys.2019.00895] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/27/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Heart rate variability (HRV) is negatively associated with body mass index and adiposity in several populations. However, less information is available about this association in children with overweight and obesity, especially severe/morbid obesity, taking into consideration the dependence of HRV on heart rate (HR). OBJECTIVES (1) to examine associations between body composition measures and HRV, (2) to study differences in HRV between children with overweight and severe/morbid obesity; and (3) to test whether relationships and differences tested in objectives 1 and 2, respectively are explained by the dependency of HRV on HR. METHODS A total of 107 children with overweight/obesity (58% boys, 10.03 ± 1.13 years) participated in this study. Body composition measures were evaluated by Dual-energy X-ray absorptiometry (DXA). HRV parameters were measured with Polar RS800CX®. RESULTS Body composition measures were negatively associated with HRV indicators of parasympathetic activity (β values ranging from -0.207 to -0.307, all p < 0.05). Children with severe/morbid obesity presented lower HRV values with respect to children with overweight/mild obesity in HRV parameters indicators of parasympathetic activity (p = 0.035). All associations disappeared after further adjustment for HR (all p > 0.05). CONCLUSION All associations between adiposity/obesity and HRV could be explained by HR, suggesting a key confounding role of HR in HRV studies in children with weight disturbances.
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Affiliation(s)
- Abel Plaza-Florido
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Jairo H. Migueles
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Jose Mora-Gonzalez
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Pablo Molina-Garcia
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Maria Rodriguez-Ayllon
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Cristina Cadenas-Sanchez
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Irene Esteban-Cornejo
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Center for Cognitive and Brain Health, Department of Psychology, Northeastern University, Boston, MA, United States
| | - Socorro Navarrete
- Andalusian Centre of Sport Medicine (CAMD), Junta de Andalucía, Granada, Spain
| | - Rosa Maria Lozano
- Andalusian Centre of Sport Medicine (CAMD), Junta de Andalucía, Granada, Spain
| | - Nathalie Michels
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
- Department of Cardiology, University Hospital, University of Opole, Opole, Poland
| | - Francisco B. Ortega
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
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