Assessment of parasympathetic reactivation after exercise

Predicting clinical physiology: a Markov chain model of heart rate recovery after spontaneous breathing trials in mechanically ventilated patients

Analysis of heart rate (HR) dynamics before, during, and after a physiologic stress has clinical importance. For example, the celerity of heart rate recovery (HRR) after a cardiac stress test (eg, treadmill exercise test) has been shown to be an independent predictor of all-cause mortality. Heart rate dynamics are modulated, in part, by the autonomic nervous system. These dynamics are commonly abstracted using metrics of heart rate variability (HRV), which are known to be sensitive to the influence of the autonomic nervous system on HR. The patient-specific modulators of HR should be reflected both in the response to stress as well as in the recovery from stress. We therefore hypothesized that the patient-specific HR response to stress could be used to predict the HRR after the stress. We devised a Markov chain model to predict the poststress HRR dynamics using the parameters (transition matrix) calculated from HR data during the stress. The model correctly predicts the exponential shape of poststress HRR. This model features a simple analytical relationship linking poststress HRR time constant (T(off)) with a standard measure of HRV, namely the correlation coefficient of the Poincaré plot (first return map) of the HR recorded during the stress. A corresponding relationship exists between the time constant (T(on)) of R-R interval decrease at the onset of stress and the correlation coefficient of the Poincaré plot of prestress R-R intervals. Consequently, the model can be used for the prediction of poststress HRR using the HRV measured during the stress. This direct relationship between the event-to-event microscopic fluctuations (HRV) during the stress and the macroscopic response (HRR) after the stress terminates can be interpreted as an instance of a fluctuation-dissipation relationship. We have thus applied the fluctuation-dissipation theorem to the analysis of heart rate dynamics. The approach is specific neither to cardiac physiology nor to transitions between mechanical and free ventilation as a specific stress. It may therefore have wider applicability to physiologic systems subject to modest stresses.

Autonomic effects on the spectral analysis of heart rate variability after exercise

Although frequency-domain analysis of heart rate variability (HRV) has been performed in the setting of exercise and recovery from exercise, the relationship of specific frequency components to sympathetic and parasympathetic inputs has not been validated in this setting. The aim of this study is to evaluate the relationship of frequency components of HRV to sympathetic and parasympathetic modulation in the setting of recovery after exercise using selective autonomic blockade. Normal subjects (n = 27, 17 men, 53 +/- 7 yr old) underwent bicycle stress testing on four separate days. On day 1, a baseline study without autonomic blockade was performed. On days 2 through 4, either beta-adrenergic, parasympathetic, or double blockade was administered during exercise and completed 3 min before recovery. Continuous ECG was recorded for 5 min starting from the end of exercise. Time- and frequency-domain measures of HRV were computed for each of the five 1-min segments of RR intervals. Parasympathetic blockade significantly decreased all the HRV measures compared with baseline (P < 0.02 for all). Root mean square of successive differences of RR intervals (rMSSD) was increased by beta-adrenergic blockade (P < 0.0002). All the HRV measures except rMSSD showed increases with time after the first minute of recovery. The low frequency-to-high frequency ratio did not respond to autonomic blockade or to recovery time, consistent with the expected changes in sympathovagal influence. Root mean square (detrended SD) and rMSSD were highly correlated with the square root of the total power (r = 0.96) and high-frequency power (r = 0.95), respectively. Although there are marked reductions in the frequency-domain measures in recovery versus rest, the fluctuations in the low- and high-frequency bands respond to autonomic blockade in the expected fashion. Time-domain measures of HRV were highly correlated with frequency-domain measures and therefore provide a computationally more efficient assessment of autonomic influences during recovery from exercise that is less susceptible to anomalies of frequency-domain analysis.

Patterns of Cerebral Blood Flow and Systemic Hemodynamics During Arithmetic Processing

The present study explored modulations in cerebral blood flow and systemic hemodynamics during the execution of a mental calculation task in 41 healthy subjects. Time course and lateralization of blood flow velocities in the medial cerebral arteries of both hemispheres were assessed using functional transcranial Doppler sonography. Indices of systemic hemodynamics were obtained using continuous blood pressure recordings. Doppler sonography revealed a biphasic left dominant rise in cerebral blood flow velocities during task execution. Systemic blood pressure increased, whereas heart period, heart period variability, and baroreflex sensitivity declined. Blood pressure and heart period proved predictive of the magnitude of the cerebral blood flow response, particularly of its initial component. Various physiological mechanisms may be assumed to be involved in cardiovascular adjustment to cognitive demands. While specific contributions of the sympathetic and parasympathetic systems may account for the observed pattern of systemic hemodynamics, flow metabolism coupling, fast neurogenic vasodilation, and cerebral autoregulation may be involved in mediating cerebral blood flow modulations. Furthermore, during conditions of high cardiovascular reactivity, systemic hemodynamic changes exert a marked influence on cerebral blood perfusion.

Treating patients with overactive bladder syndrome with antimuscarinics: heart rate considerations

In this excellent mini-review, the authors present an extensive and relevant paper on the effect of antimuscarinic agents on the heart. This is without doubt the most detailed and the most reader-friendly paper on this subject, and I am sure that it will help urologists to assist in further educating their patients when prescribing these compounds.

Control of heart rate variability by cardiac parasympathetic nerve activity during voluntary static exercise in humans with tetraplegia

Heart rate (HR) is controlled solely by via cardiac parasympathetic outflow in tetraplegic individuals, who lack supraspinal control of sympathetic outflows and circulating catecholamines but have intact vagal pathways. A high-frequency component (HF; at 0.15–0.40 Hz) of the power spectrum of HR variability and its relative value against total power (HF/Total) were assessed using a wavelet transform to identify cardiac parasympathetic outflow. The relative contribution of cardiac parasympathetic and sympathetic outflows to controlling HR was estimated by comparing the HF/Total-HR relationship between age-matched tetraplegic and normal men. Six tetraplegic men with complete cervical spinal cord injury performed static arm exercise at 35% of the maximal voluntary contraction until exhaustion. Although resting cardiac output and arterial blood pressure were lower in tetraplegic than normal subjects, HR, HF, and HF/Total were not statistically different between the two groups. When tetraplegic subjects developed the same force during exercise as normal subjects, HF and HF/Total decreased to 67–90% of the preexercise control and gradually recovered 1.5 min after exercise. The amount and time course of the changes in HF/Total during and after exercise coincided well between both groups. In contrast, the increase in HR at the start of exercise was blunted in tetraplegic compared with normal subjects, and the HR recovery following exercise was also delayed. It is likely that, although the withdrawal response of cardiac parasympathetic outflow is preserved in tetraplegic subjects, sympathetic decentralization impairs the rapid acceleration of HR at the onset of exercise and the rapid deceleration following exercise.

Water intake accelerates post-exercise cardiac vagal reactivation in humans

Post-exercise cardiac vagal reactivation is well-investigated; however, the effect of water intake during this period has not been well studied. Therefore, our aim was to assess the influence of water intake on the cardiac vagal reactivation after 30 min of a submaximal cycling exercise. Ten healthy subjects (eight men) aged 23-35 years were evaluated. A 3-day testing cycle duration, subjects were randomly chosen to drink either 500 ml (experimental visit) or 50 ml (control visit) of water immediately after the 30-min cycling exercise at a workload representing 80% of a previously measured anaerobic threshold. A cardiac vagal index (CVI) was obtained using the 4-s exercise test measured before and after (10 and 30 min) exercise at each testing day. Data analysis (2 x 3 ANOVA for repeated measures) showed higher cardiac vagal activity at the 30-min post-exercise period when 500 ml of water was ingested. CVI values for the 500 and 50 ml trials were 1.55 +/- 0.04 vs. 1.49 +/- 0.04, P = 0.003 (mean +/- SEM), respectively. Heart rate and blood pressure values were relatively the same. In conclusion, water intake of about 500 ml immediately after 30 min of cycling exercise accelerates post-exercise cardiac vagal reactivation. These results suggest that post-exercise hydration might be beneficial not only for thermoregulation, but also for vagal reactivation.

Heart rate variability dynamics during early recovery after different endurance exercises

Since heart rate variability (HRV) during the first minutes of the recovery after exercise has barely been studied, we wanted to find out HRV dynamics immediately after five different constant-speed exercises. Thirteen sedentary women performed two low-intensity (3,500 m [3,500(LI)] and 7,000 m [7,000(LI)] at 50% of the velocity of VO(2max) [vVO(2max)]), two moderate-intensity (3,500 m [3,500(MI)] and 7,000 m [7,000(MI)] at approximately 63% vVO(2max)) and one high-intensity (3,500 m at approximately 74% vVO(2max) [3,500(HI)]) exercises on a treadmill. HRV was analyzed with short-time Fourier transform method during the 30-min recovery. High frequency power (HFP) was for the first time higher than at the end of the exercise after the first minute of the recovery (3,500(LI) and 7,000(LI), P < 0.001), after the fourth (3,500(MI), P < 0.05) and the fifth (7,000(MI), P < 0.05) minute of the recovery and at the end of the 30-min recovery (3,500(HI), P < 0.01). There were no differences in HRV between 3,500(LI) and 7,000(LI) or between 3,500(MI) and 7,000(MI) during the recovery. The levels of HFP and TP were higher during the whole recovery after 3,500(LI) compared to 3,500(MI) and 3,500(HI). We found increased HFP, presumably caused by vagal reactivation, during the first 5 min of the recovery after each exercise, except for 3,500(HI). The increased intensity of the exercise resulted in slower recovery of HFP as well as lower levels of HFP and TP when compared to low-intensity exercise. Instead, the doubled running distance had no influence on HRV recovery.

Independent Relationship Between Heart Rate Recovery and C-Reactive Protein in Older Adults

OBJECTIVES

To examine the independent effect of parasympathetic tone (PST), assessed here according to heart rate recovery (HRR) after exercise, on circulating levels of C-reactive protein (CRP) in 132 elderly participants.

DESIGN

Cross-sectional analysis using baseline data from an ongoing trial assessing the effects of exercise on immune function.

SETTING

Champaign/Urbana, Illinois, vicinity.

PARTICIPANTS

Community-living older adults who had been sedentary for 6 months or longer. Major exclusion criteria were current use of medications that could interfere with immunity, severe arthritis, history of cancer or inflammatory disease, recent illness or vaccination, and smoking.

MEASUREMENTS

Participants were assessed for serum CRP (using enzyme-linked immunosorbent assay), cardiorespiratory fitness (peak oxygen intake (VO(2))), HRR, percentage body fat (using dual-energy x-ray absorptiometry), physical activity level (according to the Physical Activity Scale for the Elderly (PASE)), fasting plasma glucose, kidney function (creatinine level), and perceived stress.

RESULTS

Mean CRP level+/-standard deviation was 3.81+/-2.7 mg/L, placing this group in a high-risk category. After adjusting for the effects of body fat (34.6%+/-7.4%), aspirin use, VO(2) peak (19.5+/-3.9 mL oxygen/kg per minute), PASE, sex (64% women), and perceived stress, HRR was the only independent predictor of CRP (beta=-0.257, P=.003, change in coefficient of determination=0.060).

CONCLUSION

HRR after exercise appears to be independently associated with lower CRP in older sedentary individuals, suggesting that the parasympathetic nervous system is involved in regulating chronic inflammation in older adults. Improvements in PST, as a result of regular physical exercise, may contribute to the antiinflammatory effects of exercise, independent of physical fitness or fatness.

Parasympathetic reactivation after repeated sprint exercise

The purpose of this study was to examine the effects of muscular power engagement, anaerobic participation, aerobic power level, and energy expenditure on postexercise parasympathetic reactivation. We compared the response of heart rate (HR) after repeated sprinting with that of exercise sessions of comparable net energy expenditure and anaerobic energy contribution. Fifteen moderately trained athletes performed 1) 18 maximal all-out 15-m sprints interspersed with 17 s of passive recovery (RS), 2) a moderate isocaloric continuous exercise session (MC) at a level of mean oxygen uptake similar to that of the RS trial, and 3) a high-intensity intermittent exercise session (HI) conducted at a level of anaerobic energy expenditure similar to that of the RS trial. Subjects were immediately seated after the exercise trials, and beat-to-beat HR was recorded for 10 min. Parasympathetic reactivation was evaluated through 1) immediate postexercise HR recovery, 2) the time course of the root mean square for the successive R-R interval difference between successive 30-s segments (RMSSD(30s)) and 3) HR variability vagal-related indexes calculated for the last 5-min stationary period of recovery. RMSSD(30s) increased during the 10-min period after the MC trial, whereas RMSSD(30s) remained depressed after both the RS and HI trials. Parasympathetic reactivation indexes were similar for the RS and HI trials but lower than for the MC trial (P < 0.001). When data of the three exercise trials were considered together, only anaerobic contribution was related to HR trial-derived indexes. Parasympathetic reactivation is highly impaired after RS exercise and appears to be mainly related to anaerobic process participation.

Novel predictor of prognosis from exercise stress testing: heart rate variability response to the exercise treadmill test

BACKGROUND

Although the prognostic power of heart rate variability (HRV) at rest has been demonstrated, the prognostic potential of exercise-induced HRV has not been investigated. We aimed to evaluate the prognostic power of exercise-induced HRV during and after standard exercise testing.

METHODS

Time- and frequency-domain HRV analysis was performed on R-R interval data taken from 1335 subjects (95% male, mean age 58 years) during the first and last 2 minutes of exercise treadmill testing and the first 2 minutes of recovery. Cox survival analysis was performed for the 53 cardiovascular and 133 all-cause mortality end points that accrued during the 5.0-year mean follow-up.

RESULTS

After adjusting for potential confounders, greater root mean square successive difference in R-R interval during peak exercise and recovery, greater high-frequency (HF) power and percentage of HF power, lower percentage of low-frequency power, and lower ratio of low frequency to HF during recovery were significantly associated with increased risks for all-cause and cardiovascular death. Of all time-domain variables considered, the log of the root mean square successive difference during recovery was the strongest predictor of cardiovascular mortality (adjusted hazard ratio 5.0, 95% CI 1.5-17.0 for the top quintile compared with the lowest quintile). Log HF power during recovery was the strongest predictor of cardiovascular mortality in the frequency domain (adjusted hazard ratio 5.9, 95% CI 1.3-25.8 for the top quintile compared with the lowest quintile).

CONCLUSIONS

Exercise-induced HRV variables during and after clinical exercise testing strongly predict both cardiovascular and all-cause mortality independent of clinical factors and exercise responses in our study population.

Quantification of Cardiac Baroreflex Function at Rest and during Autonomic Stimulation

The cardiac baroreflex constitutes an important mechanism mediating autonomic control of heart activity. Its function can be quantified by applying sequence analysis based on continuous recordings of blood pressure and heart rate. In this study, several indices derived from this method were compared regarding their suitability to estimate baroreflex function at rest and during autonomic stimulation. A cold pressor test was used to induce vagal withdrawal. Changes in the following indices evoked by this procedure were examined: baroreflex sensitivity (the extent of changes in heart period following blood pressure fluctuations), baroreflex effectiveness (the relative frequency in which the reflex responds to blood pressure fluctuations), and baroreflex power (the reflex operations in a defined period). The values of all indices decreased during autonomic stimulation. The strongest and most consistent effect, however, was observed for baroreflex sensitivity, suggesting that this parameter is the most sensitive to changes in parasympathetic tone among the three parameters. Baroreflex sensitivity also proved to differentiate between individuals with higher and lower resting blood pressure. Therefore, this index may best reflect the well-known involvement of the baroreflex in the long-term setting of blood pressure. Midrange correlations between the indices of baroreflex function suggest that they quantify similar, though not identical, aspects of baroreflex function. This study supports the use of sequence analysis as a reliable tool for the quantification of parasympathetic cardiac control. The sensitivity index must be considered the most relevant to quantify baroreflex function among the three parameters.

Sex differences in left ventricular function and beta-receptor responsiveness following prolonged strenuous exercise

Sex differences in neuroendocrine and metabolic responses to prolonged strenuous exercise (PSE) have been well documented. The aim of this investigation was to examine sex differences in left ventricular function and cardiac beta-receptor responsiveness following a single bout of PSE. Nine male and eight female triathletes were examined during three separate sessions: before, immediately after, and 24 h following a half-ironman triathlon using dobutamine stress echocardiography. Steady-state graded infusions of dobutamine were used to assess beta-receptor responsiveness. Slopes calculated from linear regressions between dobutamine doses and changes in heart rate and contractility for each participant were used as an index of beta-receptor responsiveness. Despite no change in preload, fractional area change decreased from baseline after the race in both men and women, with a greater decrease in men [men: 54.1% (SD 2.1) to 50.7% (SD 3.4) vs. women: 55.4% (SD 2.7) to 53.3% (SD 2.5); P < 0.05]. The amount of dobutamine necessary to increase heart rate by 25 beats/min [men: 29.6 microg x kg(-1) x min(-1) (SD 6.6) to 42.7 microg x kg(-1) x min(-1) (SD 12.9) vs. women: 23.5 microg x kg(-1) x min(-1) (SD 4.0) to 30.0 microg x kg(-1) x min(-1) (SD 7.8); P < 0.05] and contractility by 10 mmHg/cm2 [men: 20.9 microg x kg(-1) x min(-1) (SD 5.1) to 37.0 microg x kg(-1) x min(-1) (SD 11.5) vs. women: 22.6 microg x kg(-1) x min(-1) (SD 6.4) to 30.7 microg x kg(-1) x min(-1) (SD 7.2); P < 0.05] was greater in both men and women postrace. However, the amount of dobutamine required to induce these changes was greater in men, reflecting larger beta-receptor alterations in male triathletes following PSE relative to women. These data suggest that following an acute bout of PSE, male triathletes demonstrate an attenuated chronotropic and inotropic response to beta-adrenergic stimulation compared with female triathletes.