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Korsak A, Kellett DO, Aziz Q, Anderson C, D’Souza A, Tinker A, Ackland GL, Gourine AV. Immediate and sustained increases in the activity of vagal preganglionic neurons during exercise and after exercise training. Cardiovasc Res 2023; 119:2329-2341. [PMID: 37516977 PMCID: PMC10597628 DOI: 10.1093/cvr/cvad115] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/31/2023] [Accepted: 05/12/2023] [Indexed: 08/01/2023] Open
Abstract
AIMS The brain controls the heart by dynamic recruitment and withdrawal of cardiac parasympathetic (vagal) and sympathetic activity. Autonomic control is essential for the development of cardiovascular responses during exercise, however, the patterns of changes in the activity of the two autonomic limbs, and their functional interactions in orchestrating physiological responses during exercise, are not fully understood. The aim of this study was to characterize changes in vagal parasympathetic drive in response to exercise and exercise training by directly recording the electrical activity of vagal preganglionic neurons in experimental animals (rats). METHODS AND RESULTS Single unit recordings were made using carbon-fibre microelectrodes from the populations of vagal preganglionic neurons of the nucleus ambiguus (NA) and the dorsal vagal motor nucleus of the brainstem. It was found that (i) vagal preganglionic neurons of the NA and the dorsal vagal motor nucleus are strongly activated during bouts of acute exercise, and (ii) exercise training markedly increases the resting activity of both populations of vagal preganglionic neurons and augments the excitatory responses of NA neurons during exercise. CONCLUSIONS These data show that central vagal drive increases during exercise and provide the first direct neurophysiological evidence that exercise training increases vagal tone. The data argue against the notion of exercise-induced central vagal withdrawal during exercise. We propose that robust increases in the activity of vagal preganglionic neurons during bouts of exercise underlie activity-dependent plasticity, leading to higher resting vagal tone that confers multiple health benefits associated with regular exercise.
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Affiliation(s)
- Alla Korsak
- Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London WC1E 6BT, UK
| | - Daniel O Kellett
- Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London WC1E 6BT, UK
| | - Qadeer Aziz
- Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London WC1E 6BT, UK
- Centre for Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Cali Anderson
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Alicia D’Souza
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Andrew Tinker
- Centre for Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Gareth L Ackland
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Alexander V Gourine
- Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London WC1E 6BT, UK
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2
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Kirwan JP, Heintz EC, Rebello CJ, Axelrod CL. Exercise in the Prevention and Treatment of Type 2 Diabetes. Compr Physiol 2023; 13:4559-4585. [PMID: 36815623 DOI: 10.1002/cphy.c220009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Type 2 diabetes is a systemic, multifactorial disease that is a leading cause of morbidity and mortality globally. Despite a rise in the number of available medications and treatments available for management, exercise remains a first-line prevention and intervention strategy due to established safety, efficacy, and tolerability in the general population. Herein we review the predisposing risk factors for, prevention, pathophysiology, and treatment of type 2 diabetes. We emphasize key cellular and molecular adaptive processes that provide insight into our evolving understanding of how, when, and what types of exercise may improve glycemic control. © 2023 American Physiological Society. Compr Physiol 13:1-27, 2023.
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Affiliation(s)
- John P Kirwan
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Elizabeth C Heintz
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Candida J Rebello
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Christopher L Axelrod
- Integrative Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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3
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Benito PJ, Alfaro-Magallanes VM, Rael B, Castro EA, Romero-Parra N, Rojo-Tirado MA, Peinado AB. Effect of Menstrual Cycle Phase on the Recovery Process of High-Intensity Interval Exercise-A Cross-Sectional Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3266. [PMID: 36833959 PMCID: PMC9959793 DOI: 10.3390/ijerph20043266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Although the study of the menstrual cycle influence on endurance exercise has recently increased, there is a lack of literature studying its influence on females' cardiorespiratory recovery. Thus, the aim of the present work was to assess menstrual cycle influence on post-exercise recovery following a high intensity interval exercise in trained females. Thirteen eumenorrheic endurance-trained females performed an interval running protocol in three menstrual cycle phases: early follicular phase (EFP), late follicular phase (LFP), and mid-luteal phase (MLP). The protocol consisted of 8 × 3-min bouts at 85% of their maximal aerobic speed (vVO2peak) with a 90-s rest between bouts and a final 5-min active recovery at 30% vVO2peak. All variables were averaged every 15 s, obtaining 19 moments during recovery (time factor). To analyze the effects of the menstrual cycle on the final active cardiorespiratory recovery, an ANOVA for repeated measures was performed. ANOVA showed an effect on menstrual cycle phase on ventilation (EFP: 1.27 ± 0.35; LFP: 1.19 ± 0.36; MLP: 1.27 ± 0.37), breathing frequency (EFP: 35.14 ± 7.14; LFP: 36.32 ± 7.11; MLP: 37.62 ± 7.23), and carbon dioxide production (EFP: 1120.46 ± 137.62; LFP: 1079.50 ± 129.57; MLP: 1148.78 ± 107.91). Regarding the interaction results (phase x time), ventilation is higher at many of the recovery times during the MLP, with less frequent differences between EFP and LFP (F = 1.586; p = 0.019), while breathing reserve is lower at many of the recovery times during MLP, with less time differences between EFP and LFP (F = 1.643; p = 0.013). It seems that the menstrual cycle affects post-exercise recovery specially during the MLP, rising ventilation and lowering breathing reserve, giving rise to an impaired ventilatory efficiency.
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Affiliation(s)
- Pedro J. Benito
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain
| | - Víctor M. Alfaro-Magallanes
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain
| | - Beatriz Rael
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain
| | - Eliane A. Castro
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain
- Department of Physical Education, São Paulo State University (UNESP), Bauru 17033-360, SP, Brazil
| | - Nuria Romero-Parra
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de CC. de la Salud, Universidad Rey Juan Carlos, 28933 Madrid, Spain
| | - Miguel A. Rojo-Tirado
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain
| | - Ana B. Peinado
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain
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Kim Y, Jeung J, Song Y, Ko H, Park S, Park H, Jeon G, Chung Y. A Wearable System for Heart Rate Recovery Evaluation with Real-Time Classification on Exercise Condition. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7609-7612. [PMID: 34892851 DOI: 10.1109/embc46164.2021.9629673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Heart rate recovery (HRR) is a convenient index to assess a cardiovascular autonomic function response to physical exercise. HRR monitoring during daily exercise can be an effective way to verify cardiorespiratory performance. Because HRR varies depending on exercise intensity and resting condition, an exercise condition needs to be acquired for a reliable HRR analysis. This study presents a wearable system for HRR evaluation with automatic labeling of exercise conditions using real-time activity classification. We developed an activity classification algorithm using two features from accelerometer sensor: an acceleration peak and an angle tilt peak. The classification algorithm was applied to a chest-attached wearable device with an embedded electrocardiogram sensor and accelerometer sensors. We classified daily activities such as running, walking, and postural transitions performed under supervised conditions. The wearable device system accurately detected activities with a sensitivity of 99.2 % and posture transitions with a sensitivity of 92 % and specificity of 93.3 % for seven healthy subjects. The proposed wearable system can help monitor HRR during exercise training by labeling the exercise condition simultaneously.
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5
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Sokas D, Petrėnas A, Daukantas S, Rapalis A, Paliakaitė B, Marozas V. Estimation of Heart Rate Recovery after StairClimbing Using aWrist-Worn Device. SENSORS 2019; 19:s19092113. [PMID: 31067765 PMCID: PMC6539517 DOI: 10.3390/s19092113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 11/20/2022]
Abstract
Heart rate recovery (HRR) after physical exercise is a convenient method to assess cardiovascular autonomic function. Since stair climbing is a common daily activity, usually followed by a slow walking or rest, this type of activity can be considered as an alternative HRR test. The present study explores the feasibility to estimate HRR parameters after stair climbing using a wrist-worn device with embedded photoplethysmography and barometric pressure sensors. A custom-made wrist-worn device, capable of acquiring heart rate and altitude, was used to estimate the time-constant of exponential decay τ, the short-term time constant S, and the decay of heart rate in 1 min D. Fifty-four healthy volunteers were instructed to climb the stairs at three different climbing rates. When compared to the reference electrocardiogram, the absolute and percentage errors were found to be ≤ 21.0 s (≤ 52.7%) for τ, ≤ 0.14 (≤ 19.2%) for S, and ≤ 7.16 bpm (≤ 20.7%) for D in 75% of recovery phases available for analysis. The proposed approach to monitoring HRR parameters in an unobtrusive way may complement information provided by personal health monitoring devices (e.g., weight loss, physical activity), as well as have clinical relevance when evaluating the efficiency of cardiac rehabilitation program outside the clinical setting.
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Affiliation(s)
- Daivaras Sokas
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania.
| | - Andrius Petrėnas
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania.
| | - Saulius Daukantas
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania.
| | - Andrius Rapalis
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania.
| | - Birutė Paliakaitė
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania.
| | - Vaidotas Marozas
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania.
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Gourine AV, Ackland GL. Cardiac Vagus and Exercise. Physiology (Bethesda) 2019; 34:71-80. [PMID: 30540229 PMCID: PMC6383634 DOI: 10.1152/physiol.00041.2018] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 01/09/2023] Open
Abstract
Lower resting heart rate and high autonomic vagal activity are strongly associated with superior exercise capacity, maintenance of which is essential for general well-being and healthy aging. Recent evidence obtained in experimental studies using the latest advances in molecular neuroscience, combined with human exercise physiology, physiological modeling, and genomic data suggest that the strength of cardiac vagal activity causally determines our ability to exercise.
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Affiliation(s)
- Alexander V Gourine
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology and Pharmacology, University College London , London , United Kingdom
| | - Gareth L Ackland
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London , London , United Kingdom
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Gergius YS, El-Sheshtawy NE, El-Arousi NH, Fathalla MM, Abdel Rahman MA, Gharib AM. Functional capacity-based rehabilitation of patients with chronic stable left ventricular heart failure. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2018. [DOI: 10.4103/err.err_5_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Exercise therapy and autonomic function in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 2017; 23:91-108. [DOI: 10.1007/s10741-017-9662-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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9
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Villelabeitia-Jaureguizar K, Vicente-Campos D, Senen AB, Jiménez VH, Garrido-Lestache MEB, Chicharro JL. Effects of high-intensity interval versus continuous exercise training on post-exercise heart rate recovery in coronary heart-disease patients. Int J Cardiol 2017. [PMID: 28648356 DOI: 10.1016/j.ijcard.2017.06.067] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart rate recovery (HRR) has been considered a prognostic and mortality indicator in both healthy and coronary patients. Physical exercise prescription has shown improvements in VO2peak and HRR, but most of the studies have been carried out applying continuous training at a moderate intensity, being very limited the use of protocols of high intensity interval training in coronary patients. We aimed to compare the effects of a moderate continuous training (MCT) versus a high intensity interval training (HIIT) programme on VO2peak and HRR. METHODS Seventy three coronary patients were assigned to either HIIT or MCT groups for 8weeks. Incremental exercise tests in a cycloergometer were performed to obtain VO2peak data and heart rate was monitored during and after the exercise test to obtain heart rate recovery data. RESULTS Both exercise programmes significantly increase VO2peak with a higher increase in the HIIT group (HIIT: 4.5±4.46ml/kg/min vs MCT: 2.46±3.57ml/kg/min; p=0.039). High intensity interval training resulted in a significantly increase in HRR at the first and second minute of the recovery phase (15,44±7,04 vs 21,22±6,62, p<0,0001 and 23,73±9,64 vs 31,52±8,02, p<0,0001, respectively). CONCLUSIONS The results of our research show that the application of HIIT to patients with chronic ischemic heart disease of low risk resulted in an improvement in VO2peak, and also improvements in post-exercise heart-rate recovery, compared with continuous training.
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Noites A, Freitas CP, Pinto J, Melo C, Vieira Á, Albuquerque A, Teixeira M, Ribeiro F, Bastos JM. Effects of a Phase IV Home-Based Cardiac Rehabilitation Program on Cardiorespiratory Fitness and Physical Activity. Heart Lung Circ 2016; 26:455-462. [PMID: 27743855 DOI: 10.1016/j.hlc.2016.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/01/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death globally and sedentary lifestyle is one of the main risk factors. Home-based cardiac rehabilitation (CR) programs appear to be effective to improve exercise tolerance. The aim of the study, therefore, was to evaluate the effects of a phase IV (maintenance) home-based CR program on cardiorespiratory fitness and daily physical activity of patients recovering from an acute myocardial infarction. METHODS This pilot study, with a sub-group randomised controlled trial, included 32 individuals recovering from a myocardial infarction, randomly divided into the experimental group (EG, n=16) and the control group (CG, n=16). The EG performed an exercise program, three times per week, at home during eight weeks. The two groups received health education sessions. Baseline and final assessments included cardiorespiratory fitness, resting and peak heart rate, blood pressure and rate pressure, heart rate recovery and daily physical activity. (ClinicalTrials.gov: NCT01887080). RESULTS At baseline no significant differences were observed between groups. After eight weeks of exercise, the EG significantly increased peak oxygen uptake (p=0.02), test duration (p=0.019), peak rate pressure (p=0.003), peak heart rate (p=0.003) and heart rate recovery (0.025) when compared to the CG. No changes were observed on daily physical activity in both groups. CONCLUSION This specific phase IV home-based exercise program seems to improve cardiorespiratory fitness, haemodynamics at peak exercise and heart rate recovery, an indicator of cardiac autonomic function.
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Affiliation(s)
- Andreia Noites
- Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal.
| | | | - Joana Pinto
- Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal
| | - Cristina Melo
- Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal
| | - Ágata Vieira
- Department of Physiotherapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal
| | - Aníbal Albuquerque
- Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Portugal
| | - Madalena Teixeira
- Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Portugal
| | - Fernando Ribeiro
- School of Health Sciences and Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
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Nascimento PMC, Vieira MC, Sperandei S, Manoel Serra S. Supervised exercise improves autonomic modulation in participants in cardiac rehabilitation programs. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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12
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Nascimentoa PMC, Vieiraa MC, Sperandeib S, Serraa SM. Supervised exercise improves autonomic modulation in participants in cardiac rehabilitation programs. Rev Port Cardiol 2015; 35:19-24. [PMID: 26711536 DOI: 10.1016/j.repc.2015.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 09/21/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES An attenuated heart rate recovery (HRR) response after exercise testing is a robust predictor of mortality. Regular exercise can enhance various physiological parameters. Studies indicate that participation in a cardiac rehabilitation program can improve heart rate recovery. The aim of this study was to analyze changes in functional capacity and autonomic modulation in patients following a cardiac rehabilitation program. METHODS Between 2009 and 2014, 248 individuals were assessed through exercise testing, at baseline and after six months of participation in a cardiac rehabilitation program. The exercise test was performed on a treadmill using a ramp protocol. The first minute of active recovery was standardized at a speed of 1.5 mph and slope of 2.5%. The degree of parasympathetic modulation was assessed by the difference between peak exercise heart rate and heart rate at one minute of recovery. The subjects were divided into two groups according to pre-training HRR (≤ 12 bpm and >12 bpm). RESULTS Exercise training resulted in a similar increase in metabolic equivalent values in both groups, but only the HRR ≤ 12 bpm group showed improvement after training (F=16.13; p<0.001), with a mean increase from 7.4 ± 3.69 bpm to 13.0 ± 9.74 bpm. CONCLUSIONS The cardiac rehabilitation program had a positive impact in a group that had both low functional capacity and reduced parasympathetic activity, producing a favorable effect on these recognized prognostic markers.
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Dimopoulos S. Abnormal heart rate recovery in patients with heart failure: an important target for exercise training treatment. Anatol J Cardiol 2015; 15:735-6. [PMID: 26424622 PMCID: PMC5368482 DOI: 10.5152/anatoljcardiol.2015.16529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Stavros Dimopoulos
- Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, 1st Critical Care Medicine Department, National and Kapodestrian University of Athens; Athens-Greece.
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14
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Koukoui F, Desmoulin F, Lairy G, Bleinc D, Boursiquot L, Galinier M, Smih F, Rouet P. Benefits of cardiac rehabilitation in heart failure patients according to etiology: INCARD French study. Medicine (Baltimore) 2015; 94:e544. [PMID: 25700319 PMCID: PMC4554184 DOI: 10.1097/md.0000000000000544] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We investigated the impact of heart failure (HF) etiology on the outcome of cardiac rehabilitation (CR) assessed by functional and clinical parameters. Treatment of chronic HF requires multidisciplinary approaches with a recognized role for CR. INCARD is a French study aimed at evaluating the benefits of sustainable CR in coronary (C) and noncoronary patients (NC) treated and educated during a 24-month period of follow-up. Prospective, monocentric patients with HF underwent inpatient physical training followed by a home-based program. Evaluations were performed at inclusion, discharge, 3 months after discharge, and subsequently every 6 months over the 24 months of outpatient rehabilitation.A total of 147 HF patients with left ventricular ejection fraction (LVEF) <40 were admitted to the CR center, 63 accepted to join INCARD (29 C and 34 NC). Although the C participants C having both an echocardiographic LVEF and an initially lower peak VO2, inpatient rehabilitation improved all functional parameters. Only NC showed an improved LVEF during the first 3 months of outpatient-follow-up. The main outcome of the outpatient rehabilitation was a trend toward stabilization of clinical and laboratory parameters with no significant difference between C and NC. This study confirms the benefits of initial HF inpatient rehabilitation and encourages prolonged outpatient monitoring. The results on functional parameters suggest exercise training should be conducted regardless of the HF etiology.
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Affiliation(s)
- François Koukoui
- From the INSERM I2MC, UMR 1048, Université UPS, Equipe «Obésité et insuffisance cardiaque: approches moléculaires et cliniques », Toulouse (FK, FD, MG, FS, PR); Service de Réadaptation Cardiaque Centre Hospitalier Sud Francilien, 116 Boulevard Jean Jaurès, Corbeil-Essonnes, (FK, GL, DB, LB); and Cardiology Department, Rangueil Hospital University, Toulouse, France (MG)
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15
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Yaylalı YT, Fındıkoğlu G, Yurtdaş M, Konukçu S, Şenol H. The effects of baseline heart rate recovery normality and exercise training protocol on heart rate recovery in patients with heart failure. Anatol J Cardiol 2014; 15:727-34. [PMID: 25592094 PMCID: PMC5368481 DOI: 10.5152/akd.2014.5710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: It is unclear which exercise training protocol yields superior heart rate recovery (HRR) improvement in heart failure (HF) patients. Whether baseline HRR normality plays a role in the improvement is unknown. We hypothesized that an exercise training protocol and baseline HRR normality would be factors in altering HRR in HF patients. Methods: In this prospective, randomized, controlled and 3 group parallel study, 41 stable HF patients were randomly assigned to 3-times-weekly training sessions for 12 weeks, consisting of i) 30 minutes of interval training (IT) (n=17, 63.7±8.8 years old) versus ii) 30 minutes of continuous training (CT) (n=13, 59.6±6.8 years old) versus iii) no training (CON) (n=11, 60.6±9.9 years old). Each patient had cardiopulmonary exercise testing before and after the training program. Maximum heart rates attained during the test and heart rates at 1 and 2 min (HRR1 and HRR2) during the recovery phase were recorded. Paired samples t-test or Wilcoxon signed-rank test was used for comparisons before and after training. One-way ANOVA or Kruskal-Wallis variance analysis was used for comparisons among groups. Results: HRR1 was unchanged after training. HRR2 improved in the IT group after training, and post-training HRR2 values were significantly faster in the IT group than in controls. Both HRR1 and HRR2 was significantly faster, irrespective of exercise protocol in patients with abnormal baseline values after training. Conclusion: HRR1 did not improve after training. HRR2 improved only in the IT group. Both HRRs in patients with abnormal baseline values improved after both exercise protocols. IT might be superior to CT in improving HRR2. Baseline HRR might play a role in its response to exercise.
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Affiliation(s)
- Yalın Tolga Yaylalı
- Department of Cardiology, Faculty of Medicine, Pamukkale University; Denizli-Turkey.
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Lindemberg S, Chermont S, Quintão M, Derossi M, Guilhon S, Bernardez S, Marchese L, Martins W, Nóbrega ACL, Mesquita ET. Heart rate recovery in the first minute at the six-minute walk test in patients with heart failure. Arq Bras Cardiol 2014; 102:279-87. [PMID: 24714794 PMCID: PMC3987314 DOI: 10.5935/abc.20140036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 10/20/2013] [Accepted: 10/22/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Heart rate recovery at one minute of rest (HRR1) is a predictor of mortality in heart failure (HF), but its prognosis has not been assessed at six-minute walk test (6MWT) in these patients. OBJECTIVE This study aimed to determine the HRR1 at 6MWT in patients with HF and its correlation with six-minute walk distance (6MWD). METHODS Cross-sectional, controlled protocol with 161 individuals, 126 patients with stable systolic HF, allocated into 2 groups (G1 and G2) receiving or not β-blocker and 35 volunteers in control group (G3) had HRR1 recorded at the 6MWT. RESULTS HRR1 and 6MWD were significantly different in the 3 groups. Mean values of HRR1 and 6MWD were: HRR1 = 12 ± 14 beat/min G1; 18 ± 16 beat/min G2 and 21 ± 13 beat/min G3; 6MWD = 423 ± 102 m G1; 396 ± 101 m G2 and 484 ± 96 m G3 (p < 0.05). Results showed a correlation between HRR1 and 6MWD in G1(r = 0.3; p = 0.04) and in G3(r = 0.4; p= 0.03), but not in G2 (r= 0.12; p= 0.48). CONCLUSION HRR1 response was attenuated in patients using βB and showed correlation with 6MWD, reflecting better exercise tolerance. HRR1 after 6MWT seems to represent an alternative when treadmill tests could not be tolerated.
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Affiliation(s)
- Sabrina Lindemberg
- Programa de Pós-graduação em Ciências Cardiovasculares / Universidade
Federal Fluminense, Niterói, RJ - Brazil
- Clínica de Insuficiência Cardíaca (CLIC) / Centro Universitário Serra
dos Órgãos, Teresópolis, RJ - Brazil
| | - Sergio Chermont
- Programa de Pós-graduação em Ciências Cardiovasculares / Universidade
Federal Fluminense, Niterói, RJ - Brazil
- Clínica de Insuficiência Cardíaca (CLIC) / Centro Universitário Serra
dos Órgãos, Teresópolis, RJ - Brazil
| | - Mônica Quintão
- Programa de Pós-graduação em Ciências Cardiovasculares / Universidade
Federal Fluminense, Niterói, RJ - Brazil
- Clínica de Insuficiência Cardíaca (CLIC) / Centro Universitário Serra
dos Órgãos, Teresópolis, RJ - Brazil
| | - Milena Derossi
- Programa de Pós-graduação em Ciências Cardiovasculares / Universidade
Federal Fluminense, Niterói, RJ - Brazil
| | - Sergio Guilhon
- Programa de Pós-graduação em Ciências Cardiovasculares / Universidade
Federal Fluminense, Niterói, RJ - Brazil
- Instituto de Cardiologia Aloisio de Castro, Rio de Janeiro, RJ - Brazil
| | - Sabrina Bernardez
- Programa de Pós-graduação em Ciências Cardiovasculares / Universidade
Federal Fluminense, Niterói, RJ - Brazil
| | - Luana Marchese
- Programa de Pós-graduação em Ciências Cardiovasculares / Universidade
Federal Fluminense, Niterói, RJ - Brazil
- Clínica de Insuficiência Cardíaca (CLIC) / Centro Universitário Serra
dos Órgãos, Teresópolis, RJ - Brazil
| | - Wolney Martins
- Programa de Pós-graduação em Ciências Cardiovasculares / Universidade
Federal Fluminense, Niterói, RJ - Brazil
- Clínica de Insuficiência Cardíaca (CLIC) / Centro Universitário Serra
dos Órgãos, Teresópolis, RJ - Brazil
| | - Antônio Claudio L. Nóbrega
- Programa de Pós-graduação em Ciências Cardiovasculares / Universidade
Federal Fluminense, Niterói, RJ - Brazil
| | - Evandro Tinoco Mesquita
- Programa de Pós-graduação em Ciências Cardiovasculares / Universidade
Federal Fluminense, Niterói, RJ - Brazil
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Giardini A, Fenton M, Derrick G, Burch M. Impairment of heart rate recovery after peak exercise predicts poor outcome after pediatric heart transplantation. Circulation 2013; 128:S199-204. [PMID: 24030407 DOI: 10.1161/circulationaha.112.000369] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A blunted heart rate recovery (HRR) from peak exercise is associated with adverse outcome in adults with ischemic heart disease. We assessed HRR after pediatric heart transplantation (HTx) and its prognostic use. METHODS AND RESULTS Between 2004 and 2010 we performed 360 maximal exercise tests (median, 2 tests/patient; range, 1-7) in 128 children (66 men; age at test, 14 ± 3 years) who received HTx (age, 8.5 ± 5.1 years) because of cardiomyopathy (66%) or congenital heart defects (34%). The change in heart rate from peak exercise to 1 minute of recovery was measured as HRR and was expressed as Z score calculated from reference data obtained in 160 healthy children. HRR was impaired soon after HTx (average in first 2 years Z=-1.9 ± 3.5) but improved afterward (Z=+0.52/y), such that HRR Z score normalized in most patients by 6 years after HTx (average, 0.6 ± 1.8). A subsequent decline in HRR Z score was noted from 6 years after HTx (rate of Z=-0.11/y). After 27 ± 15 months from the most recent exercise test, 19 patients died or were re-heart transplantation. For the follow-up after 6 years, HRR Z score was the only predictor of death/re-heart transplantation (P=0.003). Patients in the lowest quartile of HRR Z score had a much higher 5-year event rate (event-free rate, 29% versus 84%; hazard ratio, 7.0; P=0.0013). CONCLUSIONS HRR is blunted soon after HTx but normalizes at ≈ 6 years, potentially as a result of parasympathetic reinnervation of the graft, but then declines. This late decline in HRR Z score is associated with worse outcome.
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Affiliation(s)
- Alessandro Giardini
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom
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18
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Ribeiro F, Alves AJ, Teixeira M, Miranda F, Azevedo C, Duarte JA, Oliveira J. Exercise training enhances autonomic function after acute myocardial infarction: A randomized controlled study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.repce.2012.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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19
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Ribeiro F, Alves AJ, Teixeira M, Miranda F, Azevedo C, Duarte JA, Oliveira J. Exercise training enhances autonomic function after acute myocardial infarction: a randomized controlled study. Rev Port Cardiol 2012; 31:135-41. [PMID: 22226329 DOI: 10.1016/j.repc.2011.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 09/08/2011] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Heart rate recovery, defined as the fall in heart rate during the first minute after exercise, is an indicator of autonomic function, and has been found to be an independent predictor of mortality after acute myocardial infarction. Exercise training has several well-known benefits in terms of cardiorespiratory fitness, modifiable cardiovascular risk factors and prognosis after acute coronary events. However, there are no randomized controlled studies in the literature evaluating the effects of exercise training per se, controlling for changes in medication and diet, on heart rate recovery. Thus, this study aims to assess the effects of exercise training on autonomic function in coronary artery disease patients recovering from acute myocardial infarction. METHODS Thirty-eight patients following a first acute myocardial infarction participated in this prospective randomized clinical trial. Patients were randomized into two groups: exercise training or control. The exercise group participated in an 8-week aerobic exercise program, while the control received standard medical care and follow-up. Changes in hemodynamics at rest and at peak exercise (heart rate, systolic and diastolic blood pressure, and rate pressure product), dietary intake, cardiorespiratory fitness, and heart rate recovery were assessed. RESULTS Medication and diet remained unchanged in both groups during the study period. The exercise-training group improved resting hemodynamics, particularly resting heart rate (from 68.0 ± 9.2 to 62.6 ± 8.7 bpm, p=0.030) and systolic blood pressure (from 135 ± 7.1 to 125.6 ± 11.3 mm Hg, p=0.012), cardiorespiratory fitness (from 30.8 ± 7.8 to 33.9 ± 8.3 ml/min/kg, p=0.016), and heart rate recovery (from 20 ± 6 to 24 ± 5 bpm, p=0.007). No significant changes were observed in the control group. CONCLUSIONS Exercise training improved autonomic function, assessed by heart rate recovery, resting heart rate and systolic blood pressure, in the absence of changes in diet or medication.
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Affiliation(s)
- Fernando Ribeiro
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.
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20
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Relationship between changes in heart rate recovery after cardiac rehabilitation on cardiovascular mortality in patients with myocardial infarction. Heart Rhythm 2010; 7:929-36. [PMID: 20346416 DOI: 10.1016/j.hrthm.2010.03.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 03/18/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Heart rate recovery (HRR) at predischarge exercise stress test predicts all-cause mortality in patients with myocardial infarction (MI), but the relationship between improvement in HRR with exercise training and clinical outcomes remains unclear. OBJECTIVE The purpose of this study was to evaluate the effect of change in HRR after exercise training on clinical outcomes in MI patients. METHODS The study included 386 consecutive patients with recent MI who were enrolled into our cardiac rehabilitation program. All patients underwent symptom-limited treadmill testing at baseline and after exercise training, and were prospectively followed-up in the outpatient clinic. RESULTS Treadmill testing revealed significant improvement in HRR after 8 weeks of exercise training (17.5 +/- 10.0 bpm to 19.0 +/- 12.3 bpm, P = .011). After follow-up of 79 +/- 41 months, 40 (10.4%) patients died of cardiac events. Multivariate Cox regression analysis revealed that diabetes (hazard ratio [HR] 2.28, 95% confidence interval [CI] 1.01-5.19, P = .049), statin use (HR 0.36, 95% CI 0.16-0.80, P = .012), baseline resting heart rate > or =65 bpm (HR 5.37, 95% CI 1.33-21.61, P = .018), post-training HRR <12 bpm (HR 2.49, 95% CI 1.10-5.63, P = .028), left ventricular ejection fraction < or =30% (HR 4.70, 95% CI 1.34-16.46, P = .016), and exercise capacity < or =4 metabolic equivalents (HR 3.63, 95% CI 1.17-11.28, P = .026) were independent predictors of cardiac death. Patients who failed to improve HRR from <12 bpm to > or =12 bpm after exercise training had significantly higher mortality (HR 6.2, 95% CI 1.3-29.2, P = .022). CONCLUSION Exercise training improved HRR in patients with recent MI, and patients with HRR increased to > or =12 bpm had better cardiac survival.
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21
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Esco MR, Olson MS, Williford HN. Heart Rate Recovery in Patients With Heart Failure and the Effects of Cardiovascular Rehabilitation. Strength Cond J 2009. [DOI: 10.1519/ssc.0b013e31818844e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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PIOTROWICZ EWA, BARANOWSKI RAFAŁ, PIOTROWSKA MAŁGORZATA, ZIELIŃSKI TOMASZ, PIOTROWICZ RYSZARD. Variable Effects of Physical Training of Heart Rate Variability, Heart Rate Recovery, and Heart Rate Turbulence in Chronic Heart Failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 1:S113-5. [DOI: 10.1111/j.1540-8159.2008.02266.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Kubrychtova V, Olson TP, Bailey KR, Thapa P, Allison TG, Johnson BD. Heart rate recovery and prognosis in heart failure patients. Eur J Appl Physiol 2008; 105:37-45. [PMID: 18797918 DOI: 10.1007/s00421-008-0870-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2008] [Indexed: 01/28/2023]
Abstract
The aim of this study is to evaluate the usefulness of heart rate recovery (HRRec) for assessing risk of death in heart failure (HF) patients. Echocardiographic and clinical exercise data were analyzed retrospectively on 712 HF patients (EF < or = 45%). HRRec was calculated as peak exercise heart rate - heart rate at 1 min of active recovery. Patients were followed for all-cause mortality (5.9 +/- 3.3 years follow-up). Groups were identified according to HRRec: group-1 (HRR < or = 4 bpm), group-2 (5 < or = HRR < or = 9 bpm), and group-3 (HRR > or = 10). Kaplan-Meier analysis estimated survival of 91, 64, and 43% (group-1); 94, 76, and 63% (group-2); and 92, 82, and 70% (group-3) at 1, 5, and 10 years, respectively. Ranked HRRec independently predicted mortality after adjusting for age, gender, NYHA class, LVEF and BMI, but was not independent of exercise time, peak V(O)(2) and V(E)/V(CO)(2) at nadir. HRRec is a useful prognostic marker in patients with HF, particularly when gas exchange measures are not available.
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24
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Singh TP, Rhodes J, Gauvreau K. Determinants of heart rate recovery following exercise in children. Med Sci Sports Exerc 2008; 40:601-5. [PMID: 18317389 DOI: 10.1249/mss.0b013e3181621ec4] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Heart rate (HR) recovery during the first minute after cessation of exercise is predominantly modulated by reactivation of vagal tone. Attenuated 1-min HR recovery is a cardiovascular risk factor in adults. The purpose of this study was to determine predictors of 1-min HR recovery after a maximum-effort exercise test in healthy children. METHODS HR recovery after cessation of a maximal treadmill exercise test (Bruce protocol) was assessed in 485 children (197 girls, 288 boys) who underwent an exercise test during their clinical evaluation to exclude cardiac disease and who were discharged as normal. The first-minute cool-down period (1.5 mph, 0% inclination on treadmill) was consistent for all subjects. Age- and gender-specific 25th, 50th, and 75th percentile values of 1-min HR recovery were generated. Multivariable linear regression analyses were performed to determine predictors of 1-min HR recovery. RESULTS One-minute HR recovery was higher in boys and correlated inversely with age and with age-adjusted BMI in both boys and girls. In a multivariable linear regression model, age, gender, BMI, and baseline HR were significant predictors of 1-min HR recovery and explained 39% of variance. Exercise duration and peak HR were also significant predictors when added to the model, but they improved the explained variance by only 2%. CONCLUSION One-minute HR recovery after exercise is attenuated with age in children. Children with higher BMI, particularly those who are overweight, and those with lower exercise endurance, have slower 1-min HR recovery.
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Affiliation(s)
- Tajinder P Singh
- Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA.
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25
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Abstract
To evaluate the effects of a cardiac rehabilitation program on heart rate recovery after percutaneous transluminal coronary angioplasty, a historical cohort study was performed on 436 patients of whom 285 were grouped on completion of 5, 10, or 24 training sessions. All 3 groups showed significant improvements in heart rate recovery, peak heart rate during treadmill testing, and end-training heart rate, from baseline to follow-up. Heart rate recovery on follow-up correlated significantly with the number of completed exercise sessions. The number of sessions, baseline ejection fraction, and age were independent predictors of mean post-training heart rate recovery. The cardiac rehabilitation program had a significant effect on peak heart rate and heart rate recovery, regardless of the underlying characteristics of the patients.
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26
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Effects of cardiac rehabilitation program on exercise capacity and chronotropic variables in patients with orthotopic heart transplant. Clin Res Cardiol 2008; 97:449-56. [PMID: 18317667 DOI: 10.1007/s00392-008-0648-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 01/21/2008] [Indexed: 12/15/2022]
Abstract
AIM To evaluate the effects of home- and hospital-exercise programs on exercise capacity and chronotropic variables in patients with heart transplantation. METHODS Forty patients were randomized into two groups either hospital- or home-based exercise program. The patients were compared, before and after the rehabilitation program, with respect to maximal oxygen uptake (pVO(2)), chronotropic variables [heart rate reserve (HRR(e)), heart rate recovery (HRR(1)), and chronotropic response index (CRI)] and Duke Treadmill Score (DTS). RESULTS Hospital-based exercise group has shown a significant recovery in post-exercise pVO(2) (pre-exercise 16.73 +/- 3.9 ml/kg/min, post-exercise 19.53 +/- 3.89 ml/kg/min, P = 0.002) and DTS (pre-exercise 4.74 +/- 1.17, post-exercise 5.61 +/- 1.11, P = 0.002). A significant recovery in favor of the hospital-based exercise group was found in HRR(e) (pre-exercise 26.9 +/- 14.6, post-exercise 34.6 +/- 14.6, P = 0.01). No significant change was observed in HRR(1) (pre-exercise -1.38 +/- 1.04, post-exercise -1.21 +/- 1.89, P = 0.49) and CRI (pre-exercise 0.44 +/- 0.23, post-exercise 0.48 +/- 0.20, P = 0.15) in hospital-based exercise group. No significant change was observed in any parameters of home-based group (P > 0.05). CONCLUSION A significant recovery was observed both in the functional capacity and the chronotropic response in hospital-based exercise program. Exercise programs that are planned to be performed under supervision in rehabilitation units are useful for the patients with heart transplant in terms of the exercise capacity and chronotropic variables.
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Longitudinal Changes in Heart Rate Recovery After Maximal Exercise in Pediatric Heart Transplant Recipients: Evidence of Autonomic Re-innervation? J Heart Lung Transplant 2007; 26:1306-12. [DOI: 10.1016/j.healun.2007.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 08/29/2007] [Accepted: 08/29/2007] [Indexed: 11/19/2022] Open
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Singh TP, Curran TJ, Rhodes J. Cardiac rehabilitation improves heart rate recovery following peak exercise in children with repaired congenital heart disease. Pediatr Cardiol 2007; 28:276-9. [PMID: 17530324 DOI: 10.1007/s00246-006-0114-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 03/02/2007] [Indexed: 11/28/2022]
Abstract
We assessed heart rate (HR) recovery following peak exercise before and after a 12-week cardiac rehabilitation program in 14 children, 12.1+/-1.8 years of age, with repaired complex congenital heart disease (CHD; 11 with Fontan surgery) and impaired exercise performance. Exercise testing using bicycle ergometry was performed at baseline, after completion of the rehab program and 1.0+/-0.2 years after the baseline test. These data were compared to HR recovery in 15 controls (age, 12.7+/-2.4 years) with CHD (13 with Fontan surgery) with two serial exercise tests at an interval of 1.1+/- 0.3 years. There was no change in peak HR between the two serial tests in either group. Peak VO2 improved in the rehab group (26.3+/-9.6 ml/kg/min at baseline vs 30.9+/-9.6 ml/kg/min after rehab, p=0.01) but remained unchanged in controls on serial testing. One-minute HR recovery (in beats per minute) improved significantly following completion of the rehab program (27+/-15 at baseline vs 40+/-23 after rehab, p=0.01). Partial improvement in 1-minute HR recovery in the rehab group persisted 1 year later (1-minute HR recovery, 35+/-19; p=0.1 compared to baseline). There was no change in 1-minute HR recovery over time in the control group (37+/-16 vs 40+/-13, p = not significant). In conclusion, HR recovery following peak exercise improves in children with CHD after participation in a cardiac rehab program.
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Affiliation(s)
- T P Singh
- Department of Pediatric Cardiology, Children's Hospital, Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
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29
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Myers J, Hadley D, Oswald U, Bruner K, Kottman W, Hsu L, Dubach P. Effects of exercise training on heart rate recovery in patients with chronic heart failure. Am Heart J 2007; 153:1056-63. [PMID: 17540210 DOI: 10.1016/j.ahj.2007.02.038] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 02/02/2007] [Indexed: 12/21/2022]
Abstract
BACKGROUND Heart rate recovery (HRR) is a marker of vagal tone that is associated with survival, but little is known about the effects of exercise training on HRR in patients with heart failure (HF). METHODS Twenty-four patients with HF were randomized to a 2-month residential rehabilitation program or to usual care. Symptom-limited exercise testing was performed at baseline and at discharge from the program. Heart rate recovery was expressed as the decline in heart rate from peak exercise through 6 minutes into recovery. In addition, HRR recovery curves were normalized to a range of 1 at peak heart rate and 0 at 6 minutes and adjusted for differences in heart rate reserve, facilitating the comparison of recovery curve shapes between groups. RESULTS Mean peak oxygen uptake and oxygen uptake at the lactate threshold increased 26% (P < .05) and 39% (P < .001), respectively, in the exercise group, whereas neither of these responses changed significantly among controls. Heart rate recovery was significantly more rapid in the exercise group after training (main effect 12.6 vs 2.6 beat/min in the trained and control groups, respectively, P = .005). The normalized curves showed that the largest improvement in recovery curve shape occurred in the exercise group, but most of the HRR improvement was accounted for by a widening of the difference between peak and resting heart rate. CONCLUSION Exercise training results in a faster HRR in patients with HF. Heart rate recovery, as a simple marker of autonomic function, is an easily acquired response that may be useful for evaluating patient outcomes in cardiac rehabilitation.
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Ness KK, Gurney JG. Adverse Late Effects of Childhood Cancer and Its Treatment on Health and Performance. Annu Rev Public Health 2007; 28:279-302. [PMID: 17367288 DOI: 10.1146/annurev.publhealth.28.021406.144049] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
More than 12,000 newly diagnosed cases of cancer occur each year in the United States among children ages 20 years or younger, and the current 5-year survival rate is near 80%. An estimated 228,000 among adults 47 years or younger and currently living in the United States had a diagnosis of cancer during childhood or adolescence. Here, we review long-term adverse effects of childhood cancer and its treatment with an emphasis on physical performance and health. We also briefly review existing guidelines that may be used to develop appropriate exercise and diet interventions for childhood cancer survivors. We suggest that there is a need for development of evidence-based, risk-based guidelines and interventions for health promotion among long-term childhood cancer survivors, particularly for those whose physical activity limitations interfere with chances for optimizing their bodies' potential in today's society.
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Affiliation(s)
- Kirsten K Ness
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA.
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31
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Reyna VF, Lloyd FJ. Physician decision making and cardiac risk: effects of knowledge, risk perception, risk tolerance, and fuzzy processing. J Exp Psychol Appl 2006; 12:179-95. [PMID: 16953744 DOI: 10.1037/1076-898x.12.3.179] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite training, professionals sometimes make serious errors in risky decision making. The authors investigated judgments and decisions for 9 hypothetical patients at 3 levels of cardiac risk, comparing student and physician groups varying in domain-specific knowledge. Decisions were examined regarding whether they deviated from guidelines, how risk perceptions and risk tolerances determined decisions, and how the latter differed for knowledge groups. More knowledgeable professionals were better at discriminating levels of risk according to external correspondence criteria but committed similar errors in disjunctive probability judgments, violating internal coherence criteria. Also, higher knowledge groups relied on fewer dimensions of information than did lower knowledge groups. Consistent with fuzzy-trace theory, experts achieved better discrimination by processing less information and made sharper all-or-none distinctions among decision categories.
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Affiliation(s)
- Valerie F Reyna
- Department of Human Development, Cornell University, Ithaca, NY, USA.
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