Autonomic nervous system responses to exercise in relation to ventilatory threshold

Exercise intensity measurement using fractal analysis of heart rate variability: Reliability, agreement and influence of sex and cardiorespiratory fitness

The study aimed to establish the test-retest reliability of detrended fluctuation analysis of heart rate variability (DFA-α1) based exercise intensity thresholds, assess its agreement with ventilatory- and lactate-derived thresholds and the moderating effect of sex and cardiorespiratory fitness (CRF) on the agreement. Intensity thresholds for thirty-seven participants (17 females) based on blood lactate (LT1/LT2), gas-exchange (VT1/VT2) and DFA-α1 (αTh1/αTh2) were assessed. Heart rate (HR) at αTh1 and αTh2 showed good test-retest reliability (coefficient of variation [CV] < 6%), and moderate to high agreement with LTs (r = 0.40 - 0.57) and VTs (r = 0.61 - 0.66) respectively. Mixed effects models indicated bias magnitude depended on CRF, with DFA-α1 overestimating thresholds versus VTs for lower fitness levels (speed at VT1 <8.5 km⋅hr-1), while underestimating for higher fitness levels (speed at VT2 >15 km⋅hr-1; VO2max >55 mL·kg-1·min-1). Controlling for CRF, sex significantly affected bias magnitude only at first threshold, with males having higher mean bias (+2.41 bpm) than females (-1.26 bpm). DFA-α1 thresholds are practical and reliable intensity measures, however it is unclear if they accurately represent LTs/VTs from the observed limits of agreement and unexplained variance. To optimise DFA-α1 threshold estimation across different populations, bias should be corrected based on sex and CRF.

Agreement Between Heart Rate Variability - Derived vs. Ventilatory and Lactate Thresholds: A Systematic Review with Meta-Analyses

BACKGROUND

Determining thresholds by measuring blood lactate levels (lactate thresholds) or gas exchange (ventilatory thresholds) that delineate the different exercise intensity domains is crucial for training prescription. This systematic review with meta-analyses aims to assess the overall validity of the first and second heart rate variability - derived threshold (HRVT1 and HRVT2, respectively) by computing global effect sizes for agreement and correlation between HRVTs and reference - lactate and ventilatory (LT-VTs) - thresholds. Furthermore, this review aims to assess the impact of subjects' characteristics, HRV methods, and study protocols on the agreement and correlation between LT-VTs and HRVTs.

METHODS

Systematic computerised searches for studies determining HRVTs during incremental exercise in humans were conducted. The agreements and correlations meta-analyses were conducted using a random-effect model. Causes of heterogeneity were explored by subgroup analysis and meta-regression with subjects' characteristics, incremental exercise protocols, and HRV methods variables. The methodological quality was assessed using QUADAS-2 and STARDHRV tools. The risk of bias was assessed by funnel plots, fail-safe N test, Egger's test of the intercept, and the Begg and Mazumdar rank correlation test.

RESULTS

Fifty included studies (1160 subjects) assessed 314 agreements (95 for HRVT1, 219 for HRVT2) and 246 correlations (82 for HRVT1, 164 for HRVT2) between LT-VTs and HRVTs. The standardized mean differences were trivial between HRVT1 and LT1-VT1 (SMD = 0.08, 95% CI -0.04-0.19, n = 22) and between HRVT2 and LT2-VT2 (SMD = -0.06, 95% CI -0.15-0.03, n = 42). The correlations were very strong between HRVT1 and LT1-VT1 (r = 0.85, 95% CI 0.75-0.91, n = 22), and between HRVT2 and LT2-VT2 (r = 0.85, 95% CI 0.80-0.89, n = 41). Moreover, subjects' characteristics, type of ergometer, or initial and incremental workload had no impact on HRVTs determination.

CONCLUSION

HRVTs showed trivial differences and very strong correlations with LT-VTs and might thus serve as surrogates. These results emphasize the usefulness of HRVTs as promising, accessible, and cost-effective means for exercise and clinical prescription purposes.

Normalized economical speed is influenced by aging and not by exercise habituation

OBJECTIVE

A U-shaped relationship between energy cost of walking (Cw) and walking speed indicates that there is a specific speed minimizing the Cw, called economical speed (ES). It is mostly slower in older adults than young adults; however, effects of leg length on the ES have been ignored. We investigated effects of aging and exercise habituation on the normalized ES by leg length (ESnormalized). We quantified time delay of stride length and step frequency in sedentary young (SY), active young (AY), and active elderly (AE) adults in response to sinusoidal gait speed change at 30-s and 180-s periods with an amplitude of ± 0.56 m･s- 1.

RESULTS

The ES was significantly slower in the following sequence: AE, SY, and AY, whereas ESnormalized was slower in the AE than in other young groups, with no difference between AY and SY. AE and SY showed greater step variabilities at the 180-s period, whereas AY showed relatively smaller step variabilities at both periods. Collectively, the ESnormalized slowed due to aging, not due to exercise habituation. When optimizing the appropriate SL-SF combination for sinusoidal speed changes, young and elderly adults may adopt different strategies. Exercise habituation may reduce step variabilities in young adults.

Heart Rate Variability-Derived Thresholds for Exercise Intensity Prescription in Endurance Sports: A Systematic Review of Interrelations and Agreement with Different Ventilatory and Blood Lactate Thresholds

BACKGROUND

Exercise intensities are prescribed using specific intensity zones (moderate, heavy, and severe) determined by a 'lower' and a 'higher' threshold. Typically, ventilatory (VT) or blood lactate thresholds (LT), and critical power/speed concepts (CP/CS) are used. Various heart rate variability-derived thresholds (HRVTs) using different HRV indices may constitute applicable alternatives, but a systematic review of the proximity of HRVTs to established threshold concepts is lacking.

OBJECTIVE

This systematic review aims to provide an overview of studies that determined HRVTs during endurance exercise in healthy adults in comparison with a reference VT and/or LT concept.

METHODS

A systematic literature search for studies determining HRVTs in healthy individuals during endurance exercise and comparing them with VTs or LTs was conducted in Scopus, PubMed and Web of Science (until January 2022). Studies claiming to describe similar physiological boundaries to delineate moderate from heavy (HRVTlow vs. VTlow and/or LTlow), and heavy from severe intensity zone (HRVThigh vs. VThigh and/or LThigh) were grouped and their results synthesized.

RESULTS

Twenty-seven included studies (461 participants) showed a mean difference in relative HR between HRVTlow and VTlow of - 0.6%bpm in weighted means and 0.02%bpm between HRVTlow and LTlow. Bias between HR at HRVTlow and VTlow was 1 bpm (limits of agreement (LoA): - 10.9 to 12.8 bpm) and 2.7 bpm (LoA: - 20.4 to 25.8 bpm) between HRVTlow and LTlow. Mean difference in HR between HRVThigh and VThigh was 0.3%bpm in weighted means and 2.9%bpm between HRVThigh and LThigh while bias between HR at HRVThigh and VThigh was - 4 bpm (LoA: - 17.9 to 9.9 bpm) and 2.5 bpm (LoA: - 12.1 to 17.1 bpm) between HRVThigh and LThigh.

CONCLUSION

HRVTlow seems to be a promising approach for the determination of a 'lower' threshold comparable to VTlow and potentially for HRVThigh compared to VThigh, although the latter needs further empirical evaluation. LoA for both intensity zone boundaries indicates bias of HRVTs on an individual level. Taken together, HRVTs can be a promising alternative for prescribing exercise intensity in healthy, male athletes undertaking endurance activities but due to the heterogeneity of study design, threshold concepts, standardization, and lack of female participants, further research is necessary to draw more robust and nuanced conclusions.

Effects of exercise habituation and aging on the intersegmental coordination of lower limbs during walking with sinusoidal speed change

Background

The time courses of the joint elevation angles of the thigh, shank, and foot in one stride during walking can be well approximated by a “plane” in a triaxial space. This intersegmental coordination (IC) of the lower limb elevation angles is referred to as the planar covariation law. We examined the effects of exercise habituation and aging on the thickness of the IC plane of the lower limbs under sinusoidal speed changing conditions.

Methods

Seventeen sedentary young (SY), 16 active young (AY), and 16 active elderly (AE) adults walked on a treadmill in accordance with a sinusoidal speed changing protocol at 120, 60, and 30 s periods with an amplitude of ± 0.56 m·s⁻¹. Motion of the lower limbs from the sagittal direction was recorded to calculate the elevation angles of the lower limbs. When the best-fit IC plane was determined, the smallest standard deviation of the IC plane was considered as the anteroposterior gait variability of the lower limbs. The coefficient of variance of the step width was also quantified to evaluate the lateral step variability (CV_SW).

Results

The standard deviation of the IC plane was significantly greater in the order of SY, AY, and AE, regardless of the sinusoidal wave periods of the changing speed. The CV_SW was not significantly different among the three groups.

Conclusions

Exercise habituation influences anteroposterior gait variability of the lower limbs, but not lateral step variability, even in young adults. Given these, gait adaptability for sinusoidal speed changes does not always decline with aging.

Trial registration

UMIN000031456 (R000035911; registered February 23, 2018).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40101-022-00298-w.

Acute effects of exercise on cardiac autonomic function and arterial stiffness in patients with stable coronary artery disease

Objectives. To examine the acute effect of a maximal aerobic exercise effort on aortic, peripheral arterial stiffness and cardiovagal modulation of trained and untrained patients with coronary artery disease (CAD). Design. Cross-sectional study. Methods. Eighteen untrained patients with CAD, 18 trained patients with CAD, and 18 apparently healthy trained subjects were sampled and matched for age and body mass index. Aortic and peripheral stiffness were measured by applanation tonometry estimates of carotid-femoral (cfPWV), carotid-radial (crPWV), and carotid-dorsalis pedis pulse wave velocity (cdPWV), respectively. Cardiovagal modulation was assessed by heart-rate variability (HRV) indices including the standard deviation of normal-to-normal RR intervals (SDNN), root-mean-square of successive differences (RMSSD), and the high-frequency power band (HF). cfPWV, crPWV, cdPWV, and HRV indices were measured at rest, 10 and 30 min following a maximal cardiopulmonary exercise test on a cycle ergometer. Results. No differences were observed between groups at rest nor over time in indices of HRV, cfPWV and cdPWV. Still, main effects of time were observed in cfPWV (p < .001; ɳ² = 0.313) and cdPWV (p = .003, ɳ² = 0.111), RMSSD (p < .001, ɳ² = 0.352), HF (p < .001, ɳ² = 0.265) and LF/HF (p = .001, ɳ² = 0.239), as cdPWV, RMSSD, and HF were reduced 10 min following exercise, whereas cfPWV and LF/HF were increased. Changes in cPP were associated with changes in HRV from rest to min 10 (HF, r = 0.302), and to min 30 (HF, r = 0.377; SDNN, r = 0.357; RMSSD, r = 0.429). Conclusion. Training level and CAD do not seem to influence arterial stiffness and cardiac autonomic responses to maximal exercise.

The acute exercise-cognition interaction: From the catecholamines hypothesis to an interoception model

An interoception model for the acute exercise-cognition interaction is presented. During exercise following the norepinephrine threshold, interoceptive feedback induces increased tonic release of extracellular catecholamines, facilitating phasic release hence better cognitive performance of executive functions. When exercise intensity increases to maximum, the nature of task-induced norepinephrine release from the locus coeruleus is dependent on interaction between motivation, perceived effort costs and perceived availability of resources. This is controlled by interaction between the rostral and dorsolateral prefrontal cortices, orbitofrontal cortex, anterior cingulate cortex and anterior insula cortex. If perceived available resources are sufficient to meet predicted effort costs and reward value is high, tonic release from the locus coeruleus is attenuated thus facilitating phasic release, therefore cognition is not inhibited. However, if perceived available resources are insufficient to meet predicted effort costs or reward value is low, tonic release from the locus coeruleus is induced, attenuating phasic release. As a result, cognition is inhibited, although long-term memory and tasks that require switching to new stimuli-response couplings are probably facilitated.

Vigorous-Intensity Physical Activities Are Associated with High Brown Adipose Tissue Density in Humans

Brown adipose tissue (BAT) plays a role in adaptive thermogenesis in response to cold environments and dietary intake via sympathetic nervous system (SNS) activation. It is unclear whether physical activity increases BAT density (BAT-d). Two-hundred ninety-eight participants (age: 41.2 ± 12.1 (mean ± standard deviation), height: 163.6 ± 8.3 cm, weight: 60.2 ± 11.0 kg, body mass index (BMI): 22.4 ± 3.0 kg/m2, body fat percentage: 25.4 ± 7.5%) without smoking habits were categorized based on their physical activity levels (a group performing physical activities including walking and moderate physical activity (WM) and a group performing WM + vigorous-intensity physical activities (VWM)). We measured the total hemoglobin concentration ([Total-Hb]) in the supraclavicular region, an index of BAT-d, and anthropometric parameters. [Total-Hb] was significantly higher in VWM than WM for all participant groups presumably owing to SNS activation during vigorous-intensity physical activities, and unrelated to the amount of total physical activity levels. Furthermore, multiple regression analysis revealed that BAT-d was related to visceral fat area and VWM in men and related to body fat percentage in women. We conclude that vigorous-intensity physical activities are associated with high BAT-d in humans, especially in men.

Non-linear dynamics of heart rate variability during incremental cycling exercise

Within the last years complex models of cardiovascular regulation and exercise fatigue have implemented heart rate variability (HRV) as a measure of autonomic nervous system. Using detrended fluctuation analysis (DFA) to assess heart rate correlation properties, the present study examines the influence of exercise intensity on total variability and complexity in non-linear dynamics of HRV. Sixteen cyclists performed a graded exercise test on a bicycle ergometer. HRV time domain measures and fractal correlation properties were analyzed using short-term scaling exponent alpha1 of DFA. Amplitude and complexity of HRV parameters decreased significantly. DFA-alpha1 increased from rest to low exercise intensity and showed an almost linear decrease from higher intensities until exhaustion. These findings support a qualitative change in self-organized heart rate regulation from a complex autonomic control at rest and low intensities towards a breakdown of the interaction in control mechanisms with non-autonomic heart rate control dominating at high intensities.

Non-linear dynamics of cardiac autonomic activity during cycling exercise with varied cadence

In recent years, complex models of cardiac regulation have integrated heart rate variability (HRV) as a measure of the cardiac autonomic activity during exercise. Using detrended fluctuation analysis (DFA) technique, the present study examines the influence of cycling cadence and exercise duration on non-linear dynamics of HRV. Sixteen trained cyclists performed a 60-minute exercise bout at 90% of the individual anaerobic threshold on a bicycle ergometer. Cadence was changed every 10 min (90-120-60-120-60-90 rpm). Heart rate (HR) and RR-intervals were recorded continuously during exercise. HRV time domain measures (meanRR, SDNN) and correlation properties were analyzed using short-term scaling exponent alpha1 of DFA. Moreover, blood lactate (La) and rating of perceived exertion (RPE) were recorded at regular intervals at the end of condition. HR, La and RPE increased significantly at 120 rpm compared to 60 rpm. In contrast, all analyzed HRV parameters (meanRR, SDNN, DFA-alpha1) showed a significant decrease during cycling at 120 rpm compared to 60 rpm. The comparison of the first and last 10 min with the same cadence indicates a significant increase in HR and RPE, but also a significant decrease in all analyzed HRV measures. The decrease of HRV values over time and in relation to the increase in cadence indicates a decrease in the overall variability as well as a reduction in complexity of the RR-interval-fluctuations due to the increased organismic demands. Therefore, the decrease of DFA-alpha1 might be associated with a withdrawal of the organismic system aiming at the maintenance of the homeostasis under the control of the central nervous system. In this context, non-linear HRV analyses provide a more systemic view of cardiac regulation during exercise.

Cardiac Autonomic Responses during Exercise and Post-exercise Recovery Using Heart Rate Variability and Systolic Time Intervals-A Review

Cardiac parasympathetic activity may be non-invasively investigated using heart rate variability (HRV), although HRV is not widely accepted to reflect sympathetic activity. Instead, cardiac sympathetic activity may be investigated using systolic time intervals (STI), such as the pre-ejection period. Although these autonomic indices are typically measured during rest, the “reactivity hypothesis” suggests that investigating responses to a stressor (e.g., exercise) may be a valuable monitoring approach in clinical and high-performance settings. However, when interpreting these indices it is important to consider how the exercise dose itself (i.e., intensity, duration, and modality) may influence the response. Therefore, the purpose of this investigation was to review the literature regarding how the exercise dosage influences these autonomic indices during exercise and acute post-exercise recovery. There are substantial methodological variations throughout the literature regarding HRV responses to exercise, in terms of exercise protocols and HRV analysis techniques. Exercise intensity is the primary factor influencing HRV, with a greater intensity eliciting a lower HRV during exercise up to moderate-high intensity, with minimal change observed as intensity is increased further. Post-exercise, a greater preceding intensity is associated with a slower HRV recovery, although the dose-response remains unclear. A longer exercise duration has been reported to elicit a lower HRV only during low-moderate intensity and when accompanied by cardiovascular drift, while a small number of studies have reported conflicting results regarding whether a longer duration delays HRV recovery. “Modality” has been defined multiple ways, with limited evidence suggesting exercise of a greater muscle mass and/or energy expenditure may delay HRV recovery. STI responses during exercise and recovery have seldom been reported, although limited data suggests that intensity is a key determining factor. Concurrent monitoring of HRV and STI may be a valuable non-invasive approach to investigate autonomic stress reactivity; however, this integrative approach has not yet been applied with regards to exercise stressors.

Submaximal exercise intensity modulates acute post-exercise heart rate variability

PURPOSE

This study investigated whether short-term heart rate variability (HRV) can be used to differentiate between the immediate recovery periods following three different intensities of preceding exercise.

METHODS

12 males cycled for 8 min at three intensities: LOW (40-45 %), MOD (75-80 %) and HIGH (90-95 %) of heart rate (HR) reserve. HRV was assessed during exercise and throughout 10-min seated recovery.

RESULTS

1-min HR recovery was reduced following greater exercise intensities when expressed as R-R interval (RRI, ms) (p < 0.001), but not b min(-1) (p = 0.217). During exercise, the natural logarithm of root mean square of successive differences (Ln-RMSSD) was higher during LOW (1.66 ± 0.47 ms) relative to MOD (1.14 ± 0.32 ms) and HIGH (1.30 ± 0.25 ms) (p ≤ 0.037). Similar results were observed for high-frequency spectra (Ln-HF-LOW: 2.9 ± 1.0; MOD: 1.6 ± 0.6; HIGH: 1.6 ± 0.3 ms(2), p < 0.001). By 1-min recovery, higher preceding exercise intensities resulted in lower HRV amongst all three intensities for Ln-RMSSD (LOW: 3.45 ± 0.58; MOD: 2.34 ± 0.81; HIGH: 1.66 ± 0.78 ms, p < 0.001) and Ln-HF (LOW: 6.0 ± 1.0; MOD: 4.3 ± 1.4; HIGH: 2.8 ± 1.4 ms(2), p < 0.001). Similarly, by 1-min recovery 'HR-corrected' HRV (Ln-RMSSD: RRI × 10(3)) was different amongst all three intensities (LOW: 3.64 ± 0.49; MOD: 2.90 ± 0.65; HIGH: 2.40 ± 0.67, p < 0.001). These differences were maintained throughout 10-min recovery (p ≤ 0.027).

CONCLUSION

Preceding exercise intensity has a graded effect on recovery HRV measures reflecting cardiac vagal activity, even after correcting for the underlying HR. The immediate recovery following exercise is a potentially useful period to investigate autonomic activity, as multiple levels of autonomic activity can be clearly differentiated between using HRV. When investigating post-exercise HRV it is critical to account for the relative exercise intensity.

Relationships between Psychophysiological Responses to Cycling Exercise and Post-Exercise Self-Efficacy

Although self-efficacy (SE) is an important determinant of regular exercise, it is unclear how subjective and physiological states before, during, and after the exercise session affects post-exercise SE. The aim of this study was to clarify subjective and physiological factors affecting post-exercise SE assessed after a single exercise session at a physiologically equivalent level. Forty-three healthy volunteers (28 women, 15 men) completed an 82-min experimental session, comprising a 22-min pre-exercise rest, a 30-min steady-state cycling exercise at moderate intensity [40% of heart rate (HR) reserve], and a 30-min post-exercise rest. We measured physiological (HR) and subjective [Rating of Perceived Exertion (RPE), Feeling Scale (FS)] states during the experimental session. Autonomic states were assessed by power spectral analysis of heart rate variability (HRV) during pre- and post-exercise rest. Post-exercise SE, which was the participants' confidence in their ability to perform the 30-min exercise that they had just performed, was assessed at 30-min post-exercise. A stepwise multiple regression analysis, with post-exercise SE as the dependent variable and physiological and subjective measures of the exercise as candidate explanatory variables, showed that post-exercise SE was negatively correlated with RPE and positively correlated with FS at the end of the 30-min exercise. In addition, post-exercise SE was negatively correlated with high-frequency power of the post-exercise HRV, an index of parasympathetic function. These results indicate that post-exercise SE is related not only to subjective responses to the exercise but also to autonomic response after the exercise.

Heart rate variability to assess ventilatory threshold in ski-mountaineering

The capacity to predict the heart rate (HR) and speed at the first (VT1) and second (VT2) ventilatory thresholds was evaluated during an incremental ski-mountaineering test using heart rate variability (HRV). Nine skiers performed a field test to exhaustion on an alpine skiing track. VT1 and VT2 were individually determined by visual analysis from gas exchanges (VT1V and VT2V) and time-varying spectral HRV analysis (VT1fH, VT2fH and VT2H). VT1 could not be determined with the HRV methods used. On the contrary, the VT2 was determined in all skiers. No significant difference between HR and speed at VT2H and VT2V was observed (174.3 ± 5.6 vs. 174.3 ± 5.3 bpm, and 6.3 ± 0.9 and 6.3 ± 0.9 km h(-1), respectively). Strong correlations were obtained for HR (r = 0.91) and speed (r = 0.92) at VT2H and VT2V with small limits of agreement (±3.6 bpm for HR). Our results indicated that HRV enables determination of HR and speed at VT2 during a specific ski-mountaineering incremental test. These findings provide practical applications for skiers in order to evaluate and control specific training loads, at least when referring to VT2.

Influence of exercise modality on agreement between gas exchange and heart rate variability thresholds

The main purpose of this study was to investigate the level of agreement between the gas exchange threshold (GET) and heart rate variability threshold (HRVT) during maximal cardiopulmonary exercise testing (CPET) using three different exercise modalities. A further aim was to establish whether there was a 1:1 relationship between the percentage heart rate reserve (%HRR) and percentage oxygen uptake reserve (%VO2 R) at intensities corresponding to GET and HRVT. Sixteen apparently healthy men 17 to 28 years of age performed three maximal CPETs (cycling, walking, and running). Mean heart rate and VO2 at GET and HRVT were 16 bpm (P<0.001) and 5.2 mL · kg(-1) · min(-1) (P=0.001) higher in running than cycling, but no significant differences were observed between running and walking, or cycling and walking (P>0.05). There was a strong relationship between GET and HRVT, with R2 ranging from 0.69 to 0.90. A 1:1 relationship between %HRR and % VO2 R was not observed at GET and HRVT. The %HRR was higher during cycling (GET mean difference=7%; HRVT mean difference=11%; both P<0.001), walking (GET mean difference=13%; HRVT mean difference=13%; both P<0.001), or running (GET mean difference=11%; HRVT mean difference=10%; both P<0.001). Therefore, using HRVT to prescribe aerobic exercise intensity appears to be valid. However, to assume a 1:1 relationship between %HRR and % VO2 R at HRVT would probably result in overestimation of the energy expenditure during the bout of exercise.

Effects of gas exchange on acid-base balance

This paper describes the interactions between ventilation and acid-base balance under a variety of conditions including rest, exercise, altitude, pregnancy, and various muscle, respiratory, cardiac, and renal pathologies. We introduce the physicochemical approach to assessing acid-base status and demonstrate how this approach can be used to quantify the origins of acid-base disorders using examples from the literature. The relationships between chemoreceptor and metaboreceptor control of ventilation and acid-base balance summarized here for adults, youth, and in various pathological conditions. There is a dynamic interplay between disturbances in acid-base balance, that is, exercise, that affect ventilation as well as imposed or pathological disturbances of ventilation that affect acid-base balance. Interactions between ventilation and acid-base balance are highlighted for moderate- to high-intensity exercise, altitude, induced acidosis and alkalosis, pregnancy, obesity, and some pathological conditions. In many situations, complete acid-base data are lacking, indicating a need for further research aimed at elucidating mechanistic bases for relationships between alterations in acid-base state and the ventilatory responses.

Chronotropic and pressor effects of water ingestion at rest and in response to incremental dynamic exercise

Ingestion of water attenuates the chronotropic response to submaximal exercise. However, it is not known whether this effect is equally manifested during dynamic exercise below and above the ventilatory threshold (VT). We explored the effects of water ingestion on the heart rate response to an incremental cycle-ergometer protocol. In a randomized fashion, 19 healthy adults (10 men and nine women, age 20.9 ± 1.8 years) ingested 50 and 500 ml of water before completing a cycle-ergometer protocol on two separate days. The heart rate and oxygen uptake ( ) responses to water ingestion were analysed both at rest and during exercise performed below and above the VT. The effects of water intake on brachial blood pressure were measured only at rest. Resting mean arterial pressure increased and resting heart rate decreased, but only after 500 ml of water (P < 0.05). Compared with that seen after 50 ml of water, the 500 ml volume elicited an overall decrease in submaximal heart rate (P < 0.05). In contrast, drinking 500 ml of water did not affect submaximal . The participants' maximal heart rate, maximal and VT were similar between conditions. Our results therefore indicate that, owing to its effects on submaximal heart rate over a broad spectrum of intensities, the drinking of water should be recognized as a potential confounder in cardiovascular exercise studies. However, by showing no differences between conditions for submaximal , they also suggest that the magnitude of heart rate reduction after drinking 500 ml of water may be of minimal physiological significance for exercise cardiorespiratory capacity.

Limiar de variabilidade da freqüência cardíaca em adolecentes obesos e não-obesos

A obesidade na adolescência está associada à disfunção simpato-vagal cardíaca em repouso, embora existam poucas informações sobre a resposta autonômica durante o exercício nestes adolescentes. OBJETIVO: Comparar a modulação autonômica durante teste de esforço físico dinâmico incremental em amostras de adolescentes obesos e não-obesos, e analisar a relação entre o limiar de variabilidade da freqüência cardíaca (LiVFC) e o limar ventilatório (LV). MÉTODOS: Dez adolescentes obesos e 19 adolescentes não-obesos do sexo masculino com idades entre 13 e 18 anos foram submetidos à teste de esforço físico progressivo máximo em esteira rolante para estudo da variabilidade da freqüência cardíaca (VFC) e para identificação do LV. A VFC foi estudada mediante análise do desvio-padrão da variabilidade instantânea batimento-a-batimento (SD1) da Plotagem de Poincaré. O LiVFC foi identificado na intensidade de esforço físico em que o SD1 atingiu valor menor que 3 ms. RESULTADOS: O índice SD1 diminuiu progressivamente em ambos os grupos até aproximadamente 50-60% do VO2pico, sendo que os adolescentes obesos apresentaram valores significativamente menores (p<0,001) somente na intensidade relativa a 20% do VO2pico, Os adolescentes obesos apresentaram valores relativos (mL.kg-1.min-1) de VO2pico e LV significativamente menores (p<0,05) que os adolescentes não-obesos. Em ambos os grupos, não foram observadas diferenças significativas entre o ponto de ocorrência do LV e do LiVFC, expressos em valores relativos e absolutos de VO2. Contudo, não foram encontradas correlações significativas entre o ponto de ocorrência do LV e do LiVFC, tanto em valores relativos quanto em valores absolutos de VO2. CONCLUSÕES: A obesidade na adolescência parece não estar associada à alteração da modulação autonômica durante o exercício físico. Torna-se possível determinar o LiVFC mediante análise da Plotagem de Poincaré em adolescentes obesos e não-obesos. Entretanto, a ausência de associação estatística entre o LiVFC e o LV demonstra que parece não haver relação causal entre estes eventos.

Introduction: Cardiovascular physics

The number of patients suffering from cardiovascular diseases increases unproportionally high with the increase of the human population and aging, leading to very high expenses in the public health system. Therefore, the challenge of cardiovascular physics is to develop high-sophisticated methods which are able to, on the one hand, supplement and replace expensive medical devices and, on the other hand, improve the medical diagnostics with decreasing the patient's risk. Cardiovascular physics-which interconnects medicine, physics, biology, engineering, and mathematics-is based on interdisciplinary collaboration of specialists from the above scientific fields and attempts to gain deeper insights into pathophysiology and treatment options. This paper summarizes advances in cardiovascular physics with emphasis on a workshop held in Bad Honnef, Germany, in May 2005. The meeting attracted an interdisciplinary audience and led to a number of papers covering the main research fields of cardiovascular physics, including data analysis, modeling, and medical application. The variety of problems addressed by this issue underlines the complexity of the cardiovascular system. It could be demonstrated in this Focus Issue, that data analyses and modeling methods from cardiovascular physics have the ability to lead to significant improvements in different medical fields. Consequently, this Focus Issue of Chaos is a status report that may invite all interested readers to join the community and find competent discussion and cooperation partners.

The use of heart rate variability measures to assess autonomic control during exercise

Heart rate variability (HRV) is a non-invasive indicator of cardiac autonomic modulation at rest. During rhythmic exercise, global HRV decreases as a function of exercise intensity. Measures reflecting sympathovagal interactions at rest do not behave as expected during exercise. This makes interpretation of HRV measures difficult, especially at higher exercise intensities. This problem is further confounded by the occurrence of non-neural oscillations in the high-frequency band due to increased respiratory effort. Alternative data treatments, such as coarse graining spectral analysis (CGSA), have demonstrated expected changes in autonomic function during exercise with some success. The separation of harmonic from fractal and/or chaotic components of HRV and study of the latter during exercise have provided further insight into cardioregulatory control. However, more research is needed. Some cross-sectional differences between HRV in athletes and controls during exercise are evident and data suggest longitudinal changes may be possible. Standard spectral HRV analysis should not be applied to exercise conditions. The use of CGSA and non-linear analyses show much promise in this area. Until further validation of these measures is carried out and clarification of the physiological meaning of such measures occurs, HRV data regarding altered autonomic control during exercise should be treated with caution.

Influence of Autonomic Nervous Dysfunction Characterizing Effect of Diabetes Mellitus on Heart Rate Response and Exercise Capacity in Patients Undergoing Cardiac Rehabilitation for Acute Myocardial Infarction

BACKGROUND

The aim of this study was to clarify the influence of sympathetic and parasympathetic nerve (SN and PN) dysfunction on the heart rate (HR) response to exercise and the exercise capacity of patients with acute myocardial infarction (AMI) and diabetes mellitus (DM).

METHODS AND RESULTS

Fifty-two male patients who underwent cardiopulmonary exercise testing (CPX) 1 month after onset of AMI were divided into 2 groups: (DM (+) group, n=20; DM (-) group, n=32). HR, peak oxygen uptake (VO2peak), and plasma norepinephrine (NE) levels were measured during CPX. The high-frequency power (HF) was analyzed by HR variability. The DeltaHR/logDeltaNE obtained from changes of HR and NE from rest to peak exercise and HR change from baseline to the minimum HF (DeltaHRHF) were calculated as parameters of HR response derived from SN and PN activities, respectively. DeltaHR, VO2peak, DeltaHR/logDeltaNE, and DeltaHRHF were significantly lower in the DM (+) group than in the DM (-) group, and both of them showed positive correlations with VO2peak.

CONCLUSION

An inadequate HR response to exercise is a major factor causing a decline of exercise capacity, which is derived from both of SN and PN dysfunction, in AMI patients with DM.

Increase in reaction time for the peripheral visual field during exercise above the ventilatory threshold

The purpose of the present study was to determine whether reaction time (RT) for the peripheral visual field increases at exercise intensity above the ventilatory threshold (VT) during incremental exercise and to examine the relationship between aerobic capacity and the extent of increase in the RT. Nine healthy subjects performed a simple manual RT task for the peripheral visual field at rest, during exercise on a cycle ergometer, and immediately after exercise. After warm-up exercise, the subjects cycled at 40 W for 3 min, increasing by 40 W every 3 min until 240 W in a step-wise manner. During incremental exercise, RT measurements were performed 1 min and 30 s after the start of every increase in workload. The RT for the peripheral visual field significantly increased at exercise intensity above VT, as compared with at rest. The increase in the RT, which was calculated by subtracting the RT at rest from the RT at 240 W, negatively correlated with maximal oxygen uptake VO(2max) for each subject (r = -0.73, P < 0.05). It is likely that high aerobic capacity attenuates the increase in the RT for the peripheral visual field during exhaustive exercise.

Comparison of heart rate variability and stroke volume variability

In order to compare the heart rate variability (HRV) and stroke volume variability (SVV), supine electrocardiographic (ECG) and the time series data of left ventricular (LV) volume recordings were taken in 12 healthy adult male volunteers. The low frequency (LF) and high frequency (HF) peaks of HRV and SVV were evaluated quantitatively by power spectral analysis. The fractal dimension (FD) of the time series data was analyzed by the box-counting method. A LF peak around 0.1 Hz and a HF peak around 0.3 Hz were as clearly observed in the SVV spectrum as in the HRV spectrum. The LF/HF ratio in SVV was significantly lower than that in HRV, while the FD was significantly higher in SVV than in HRV. No significant correlation of HF, LF or FD was observed between HRV and SVV. Our results indicate that SVV provides different information about the activity of the autonomic nervous system than HRV.

Limiar ventilatório e variabilidade da freqüência cardíaca em adolescentes

As análises da concentração sanguínea de lactato e das trocas gasosas respiratórias são métodos tradicionalmente empregados para identificar a transição de produção de energia pelo metabolismo muscular. No entanto, mais recentemente, vem sendo sugerido método alternativo mediante análise da variabilidade da freqüência cardíaca. Pretendeu-se, com o presente estudo, estabelecer comparações entre o limiar de variabilidade da freqüência cardíaca (LiVFC) e o primeiro limiar ventilatório (LV1), em uma amostra de adolescentes. Para tanto, foram submetidos a teste de esforço físico de carga máxima em esteira ergométrica 41 sujeitos (22 rapazes e 19 moças) com idades entre 15 e 18 anos. O LV1 foi identificado mediante o equivalente ventilatório de oxigênio envolvendo recursos de ergoespirometria. A variabilidade da freqüência cardíaca foi analisada por intermédio dos intervalos R-R, através da plotagem de Poincaré, que oferece informações quanto ao desvio-padrão da variabilidade instantânea batimento-a-batimento (SD1), ao desvio-padrão a longo prazo de intervalos R-R contínuos (SD2) e à razão SD1/SD2. O LiVFC foi identificado pelo SD1 de acordo com três critérios: (1) diferenças entre o SD1 de dois estágios consecutivos menor que 1ms; (2) SD1 menor que 3ms; e (3) ocorrência de ambos os critérios em conjunto. Mediante análise dos resultados verificou-se que os intervalos R-R e SD2 diminuíram progressivamente a cada intervalo de 10% do VO2pico até o final do teste de esforço físico (0,05 < p < 0,01). O SD1 diminuiu significativamente desde 20% até 50% do VO2pico. A partir de 60% até o VO2pico o SD1 não apresentou diferenças significativas. A razão SD1/SD2 aumentou a partir de 60%. O LV1 ocorreu a 54,4 ± 8,8% do VO2pico enquanto o LiVFC, a 52,4 ± 12,5%, 57,0 ± 14,1% e 57,8 ± 13,8% do VO2 pico, para os critérios 1, 2 e 3, respectivamente. Não foram observadas diferenças estatísticas entre o LV1 e os três critérios utilizados para identificação do LiVFC. Observaram-se coeficientes de correlação momento-produto significativos entre o LiVFC identificado mediante os três critérios considerados e o LV1, quando foram utilizados os valores absolutos de VO2. Porém, não foram encontradas correlações estatísticas significativas entre o LiVFC e a identificação do LV1 expresso em proporção do VO2pico. Em assim sendo, concluiu-se que parece ser precipitado tentar empregar o LiVFC como método alternativo na identificação do LV1 de adolescentes.

The effect of ventilation on spectral analysis of heart rate and blood pressure variability during exercise

Heart rate variability (HRV) and systolic blood pressure variability (BPV) during incremental exercise at 50, 75, and 100% of previously determined ventilatory threshold (VT) were compared to that of resting controlled breathing (CB) in 12 healthy subjects. CB was matched with exercise-associated respiratory rate, tidal volume, and end-tidal CO(2) for all stages of exercise. Power in the low frequency (LF, 0.04-0.15 Hz) and high frequency (HF, >0.15-0.4 Hz) for HRV and BPV were calculated, using time-frequency domain analysis, from beat-to-beat ECG and non-invasive radial artery blood pressure, respectively. During CB absolute and normalized power in the LF and HF of HRV and BPV were not significantly changed from baseline to maximal breathing. Conversely, during exercise HRV, LF and HF power significantly decreased from baseline to 100% VT while BPV, LF and HF power significantly increased for the same period. These findings suggest that the increases in ventilation associated with incremental exercise do not significantly affect spectral analysis of cardiovascular autonomic modulation in healthy subjects.

Spectral Analysis of Heart Rate Variability during Exercise in Trained Subjects

PURPOSE

To investigate the effects of strenuous exercise on heart rate variability (HRV).

METHODS

We evaluated the effects of exercise intensity and duration on HRV indices in 14 healthy trained subjects. Each subject exercised for 3, 6, and 9 min at 60 and 70% of the power achieved at maximal oxygen consumption (PVO2(max)) and for 3 and 6 min (or 3 min twice) at 80% of PVO2(max). The electrocardiogram RR intervals were recorded then processed by fast(FFT) and short-time (STFT) Fourier transform for determination of low-frequency (LF, 0.045-0.15 Hz) and high-frequency (HF, 0.15-1.0 Hz) components.

RESULTS

The LF and HF components expressed as absolute power (ms2) decreased significantly at the onset of exercise (P < 0.05). However, with increasing exercise intensity, the HF component expressed as normalized units (n.u.) (reflecting parasympathetic modulation) increased significantly, whereas the LF component (n.u.) and LF/HF ratio (both reflecting sympathetic modulation) decreased significantly (P < 0.05). STFT showed that increasing exercise intensity was associated with a shift in HF peak frequency related to an increase in respiratory rate and a marked decrease in LF power (ms2). Moreover, HFn.u. rose (r = 0.918, P < 0.01) and LFms2 fell as minute ventilation increased (r = 0.906, P < 0.01).

CONCLUSIONS

Parasympathetic respiratory control and nonautonomic mechanisms may influence the HF-peak shift during strenuous exercise. HRV and the usual indexes of sympathetic activity do not accurately reflect changes in autonomic modulation during exhaustive exercise.

Heart rate variability in athletes

This review examines the influence on heart rate variability (HRV) indices in athletes from training status, different types of exercise training, sex and ageing, presented from both cross-sectional and longitudinal studies. The predictability of HRV in over-training, athletic condition and athletic performance is also included. Finally, some recommendations concerning the application of HRV methods in athletes are made.The cardiovascular system is mostly controlled by autonomic regulation through the activity of sympathetic and parasympathetic pathways of the autonomic nervous system. Analysis of HRV permits insight in this control mechanism. It can easily be determined from ECG recordings, resulting in time series (RR-intervals) that are usually analysed in time and frequency domains. As a first approach, it can be assumed that power in different frequency bands corresponds to activity of sympathetic (0.04-0.15 Hz) and parasympathetic (0.15-0.4 Hz) nerves. However, other mechanisms (and feedback loops) are also at work, especially in the low frequency band. During dynamic exercise, it is generally assumed that heart rate increases due to both a parasympathetic withdrawal and an augmented sympathetic activity. However, because some authors disagree with the former statement and the fact that during exercise there is also a technical problem related to the non-stationary signals, a critical look at interpretation of results is needed. It is strongly suggested that, when presenting reports on HRV studies related to exercise physiology in general or concerned with athletes, a detailed description should be provided on analysis methods, as well as concerning population, and training schedule, intensity and duration. Most studies concern relatively small numbers of study participants, diminishing the power of statistics. Therefore, multicentre studies would be preferable. In order to further develop this fascinating research field, we advocate prospective, randomised, controlled, long-term studies using validated measurement methods. Finally, there is a strong need for basic research on the nature of the control and regulating mechanism exerted by the autonomic nervous system on cardiovascular function in athletes, preferably with a multidisciplinary approach between cardiologists, exercise physiologists, pulmonary physiologists, coaches and biomedical engineers.

Blunted cardiac autonomic responsiveness to hypoxemic stress in healthy older adults

Supine resting cardiac dynamics and responses to steady-state hypoxemia were investigated in six healthy older (59-72 yrs) adults using coarse-graining spectral analysis of heart rate variability (HRV) and were compared to six young (22-29 yrs) adults studied previously (Lucy et al., 2000). End-tidal carbon dioxide pressure (PETCO2) was clamped at 1-2 mmHg above the usual resting value for 11 min of euoxia (PETO2 100 mmHg), followed by 22 min of hypoxia (PETO2 55 mmHg). During euoxia, vagally mediated harmonic and fractal power of HRV of older adults was minimal. Hypoxia induced an increase in ventilation, p < 0.01, and heart rate, p < 0.05. The heart rate increase (mean +/- SE) of 0.23 +/- 0.08 beats.min-1 per 1% decrease in arterial O2 saturation was 25% of that demonstrated previously by young subjects, p < 0.001. In older adults, HRV spectral power remained unchanged during hypoxia, providing further evidence of an age-related blunting of cardiac autonomic function.

Effect of endurance exercise on autonomic control of heart rate

Long-term endurance training significantly influences how the autonomic nervous system controls heart function. Endurance training increases parasympathetic activity and decreases sympathetic activity in the human heart at rest. These two training-induced autonomic effects, coupled with a possible reduction in intrinsic heart rate, decrease resting heart rate. Long-term endurance training also decreases submaximal exercise heart rate by reducing sympathetic activity to the heart. Physiological ageing is associated with a reduction in parasympathetic control of the heart; this decline in parasympathetic activity can be reduced by regular endurance exercise. Some research has indicated that females have increased parasympathetic and decreased sympathetic control of heart rate. These gender-specific autonomic differences probably contribute to a decreased cardiovascular risk and increased longevity observed in females.

Fractal characterization of complexity in temporal physiological signals

This review first gives an overview on the concept of fractal geometry with definitions and explanations of the most fundamental properties of fractal structures and processes like self-similarity, power law scaling relationship, scale invariance, scaling range and fractal dimensions. Having laid down the grounds of the basics in terminology and mathematical formalism, the authors systematically introduce the concept and methods of monofractal time series analysis. They argue that fractal time series analysis cannot be done in a conscious, reliable manner without having a model capable of capturing the essential features of physiological signals with regard to their fractal analysis. They advocate the use of a simple, yet adequate, dichotomous model of fractional Gaussian noise (fGn) and fractional Brownian motion (fBm). They demonstrate the importance of incorporating a step of signal classification according to the fGn/fBm model prior to fractal analysis by showing that missing out on signal class can result in completely meaningless fractal estimates. Limitation and precision of various fractal tools are thoroughly described and discussed using results of numerical experiments on ideal monofractal signals. Steps of a reliable fractal analysis are explained. Finally, the main applications of fractal time series analysis in biomedical research are reviewed and critically evaluated.

Effects of physical training on the recovery of the autonomic nervous activity during exercise after coronary artery bypass grafting: effects of physical training after CABG

Analysis of heart rate variability (HRV) can identify patients at risk of sudden cardiac death after myocardial infarction. The present study examined the effect of 2 weeks of supervised aerobic exercise training on the recovery of the autonomic nervous activity, exercise capacity, and cardiac output (CO) after coronary artery bypass grafting (CABG). Twenty-eight patients were randomly divided into the training group or the control group and performed exercise tests at 1 week, 3 weeks, 3 months, 6 months and 1 year after CABG. The HRV was measured, and the high-frequency component of HRV was used as an index of parasympathetic nerve activity (PNA); the plasma norepinephrine concentration (NE) was used as an index of sympathetic nervous activity. Cardiac output was also measured. In the training group, peak VO2, peak CO and PNA during exercise had improved at 3 weeks, but there was no improvement in these indices in the control group. NE decreased 1 week after CABG in both groups. These results indicate that physical training soon after CABG improves not only the exercise capacity, but also PNA.

Contribution of peripheral chemoreceptor drive in exercise hyperpnea in humans

The peripheral chemoreceptors play a dominant role in the respiratory compensation of lactic acidosis during heavy exercise of humans. Our object was to determine the contribution of peripheral chemoreceptors to exercise hyperpnea during mild to moderate and heavy exercise above the anaerobic threshold. We used a hyperoxic suppression test in six normal male subjects. Inspired gas was abruptly changed without the subject's knowledge from air to pure oxygen for 5 to 6 breaths. The maximal ventilatory depression after O2 breathing was 5.5 +/- 1.7 L/min (BTPS) at mild exercise, and the depression increased with increasing exercise intensity up to 12.8 +/- 4.1 L/min (BTPS). The relative contribution of the peripheral chemoreceptors to ventilation in terms of percentage of the maximal ventilatory depression was maintained, being 20% throughout the entire work ranges studied. The contribution of the peripheral chemoreceptors to total ventilation is hardly altered by lactic acidosis caused by heavy exercise above the anaerobic threshold according to our data. These results suggested that the peripheral chemoreceptors may not be solely responsible for excessive hyperventilation, or residual activities of peripheral chemoreceptors still exist after O2 breathing especially during heavy exercise above the anaerobic threshold.

Heart rate variability at rest and exercise: influence of age, gender, and physical training

The adaptive responses of the cardiovascular system to regular physical activity appear to include a reduction in sympathetic (SNS) activity and an increase in parasympathetic (PNS) activity during rest and at different absolute intensities of exercise. In a cross-sectional design, trained individuals who exercised at least 5 days/week for 45 min/day or more were compared with age- and gender-matched untrained controls. There was a relative bradycardia in the trained groups at rest and at the same absolute intensity of exercise in both young and middle-aged subjects. There were no differences in indicators of PNS and SNS activity at rest in young subjects. There was a reduced SNS activity and increased PNS activity in middle-aged trained subjects versus their age-matched controls. Spectral analysis was capable of showing changes in autonomic control of heart rate at rest and across intensities of exercise. These data showed significant shifts to increased PNS and reduced SNS indicators at rest in trained versus untrained middle-aged subjects and in females in both age groups versus males.

The effects of sympathetic activation on physiological and subjective sexual arousal in women

This investigation was designed to examine the effects of acute exercise on physiological and subjective sexual arousal in women. In Experiment 1, Ss participated in two experimental sessions in which they viewed a neutral film followed by an erotic film. In one of these sessions, Ss were exposed to 20 min of intense exercise prior to viewing the films. Subjective sexual arousal was measured with a self-report rating scale and physiological sexual arousal was measured with a vaginal photoplethysmograph. Acute exercise significantly decreased vaginal pulse amplitude responses to a neutral stimulus and significantly increased vaginal pulse amplitude responses to an erotic stimulus. Exercise marginally increased vaginal blood volume responses to an erotic film but had no significant effect on subjective perceptions of sexual arousal. In Experiment 2, Ss viewed two consecutive neutral stimuli preceded by 20 min of intense exercise. There were no significant differences in either vaginal blood volume or vaginal pulse amplitude between the two neutral films. Together, the data from Experiments 1 and 2 provide indirect support for a facilitatory role of sympathetic activation in female sexual arousal.

A review of the control of breathing during exercise

During the past 100 years many experimental investigations have been carried out in an attempt to determine the control mechanisms responsible for generating the respiratory responses observed during incremental and constant-load exercise tests. As a result of these investigations a number of different and contradictory control mechanisms have been proposed to be the sole mediators of exercise hyperpnea. However, it is now becoming evident that none of the proposed mechanisms are solely responsible for eliciting the exercise respiratory response. The present-day challenge appears to be one of synthesizing the proposed mechanisms, in order to determine the role that each mechanism has in controlling ventilation during exercise. This review, which has been divided into three primary sections, has been designed to meet this challenge. The aim of the first section is to describe the changes in respiration that occur during constant-load and incremental exercise. The second section briefly introduces the reader to traditional and contemporary control mechanisms that might be responsible for eliciting at least a portion of the exercise ventilatory response during these types of exercise. The third section describes how the traditional and contemporary control mechanisms may interact in a complex fashion to produce the changes in breathing associated with constant-load exercise, and incorporates recent experimental evidence from our laboratory.

Heart rate variability to monitor autonomic nervous system activity during orthostatic stress

Exposure to microgravity with space flight, or to earth-based analogs such as head-down tilt (HDT) bedrest, results in cardiovascular deconditioning. With reapplication of gravity, deconditioning is most often observed as an elevated heart rate, a narrowed pulse pressure, and possibly even a failure to maintain blood pressure with symptoms of presyncope or syncope. Noninvasive measurements of heart rate variability (HRV) have been used to study cardiovascular control mechanisms during orthostatic stress (head-up tilt and lower body negative pressure [LBNP]). Recently, the authors developed a new approach to study heart rate and blood pressure control mechanisms. Coarse graining spectral analysis (CGSA) allows simultaneous extraction of not only parasympathetic (PNS) and sympathetic (SNS) indicators from the HRV signal, but also determines the fractal dimension (DF), calculated from the slope (beta) of the log spectral power-log frequency relationship. The fractal dimension is an index of the complexity of the cardiovascular control system. Our investigations have indicated patterns of HRV consistent with reduced PNS and increased SNS activity and reduced DF with the HRV signal during orthostatic stress. These findings also indicate that the cardiovascular system may be less stable when operating at a reduced level of complexity.