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Brassard P, Roy MA, Labrecque L, Smirl JD. On the challenge of assessing dynamic cerebral autoregulation. Exp Physiol 2024. [PMID: 38712350 DOI: 10.1113/ep091703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Marc-Antoine Roy
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Fletcher EKS, Burma JS, Javra RM, Friesen KB, Emery CA, Dunn JF, Smirl JD. Maximizing the Reliability and Precision of Measures of Prefrontal Cortical Oxygenation Using Frequency-Domain Near-Infrared Spectroscopy. Sensors (Basel) 2024; 24:2630. [PMID: 38676247 PMCID: PMC11054207 DOI: 10.3390/s24082630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
Frequency-domain near-infrared spectroscopy (FD-NIRS) has been used for non-invasive assessment of cortical oxygenation since the late 1990s. However, there is limited research demonstrating clinical validity and general reproducibility. To address this limitation, recording duration for adequate validity and within- and between-day reproducibility of prefrontal cortical oxygenation was evaluated. To assess validity, a reverse analysis of 10-min-long measurements (n = 52) at different recording durations (1-10-min) was quantified via coefficients of variation and Bland-Altman plots. To assess within- and between-day within-subject reproducibility, participants (n = 15) completed 2-min measurements twice a day (morning/afternoon) for five consecutive days. While 1-min recordings demonstrated sufficient validity for the assessment of oxygen saturation (StO2) and total hemoglobin concentration (THb), recordings ≥4 min revealed greater clinical utility for oxy- (HbO) and deoxyhemoglobin (HHb) concentration. Females had lower StO2, THb, HbO, and HHb values than males, but variability was approximately equal between sexes. Intraclass correlation coefficients ranged from 0.50-0.96. The minimal detectable change for StO2 was 1.15% (95% CI: 0.336-1.96%) and 3.12 µM for THb (95% CI: 0.915-5.33 µM) for females and 2.75% (95%CI: 0.807-4.70%) for StO2 and 5.51 µM (95%CI: 1.62-9.42 µM) for THb in males. Overall, FD-NIRS demonstrated good levels of between-day reliability. These findings support the application of FD-NIRS in field-based settings and indicate a recording duration of 1 min allows for valid measures; however, data recordings of ≥4 min are recommended when feasible.
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Affiliation(s)
- Elizabeth K. S. Fletcher
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 4N1, Canada; (R.M.J.); (K.B.F.); (C.A.E.); (J.D.S.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Joel S. Burma
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 4N1, Canada; (R.M.J.); (K.B.F.); (C.A.E.); (J.D.S.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 4N1, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Raelyn M. Javra
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 4N1, Canada; (R.M.J.); (K.B.F.); (C.A.E.); (J.D.S.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Kenzie B. Friesen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 4N1, Canada; (R.M.J.); (K.B.F.); (C.A.E.); (J.D.S.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Carolyn A. Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 4N1, Canada; (R.M.J.); (K.B.F.); (C.A.E.); (J.D.S.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 4N1, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Jeff F. Dunn
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Jonathan D. Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 4N1, Canada; (R.M.J.); (K.B.F.); (C.A.E.); (J.D.S.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 4N1, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 4N1, Canada
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Burma JS, Roy MA, Kennedy CM, Labrecque L, Brassard P, Smirl JD. A systematic review, meta-analysis, and meta-regression amalgamating the driven approaches used to quantify dynamic cerebral autoregulation. J Cereb Blood Flow Metab 2024:271678X241235878. [PMID: 38635887 DOI: 10.1177/0271678x241235878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Numerous driven techniques have been utilized to assess dynamic cerebral autoregulation (dCA) in healthy and clinical populations. The current review aimed to amalgamate this literature and provide recommendations to create greater standardization for future research. The PubMed database was searched with inclusion criteria consisting of original research articles using driven dCA assessments in humans. Risk of bias were completed using Scottish Intercollegiate Guidelines Network and Methodological Index for Non-Randomized Studies. Meta-analyses were conducted for coherence, phase, and gain metrics at 0.05 and 0.10 Hz using deep-breathing, oscillatory lower body negative pressure (OLBNP), sit-to-stand maneuvers, and squat-stand maneuvers. A total of 113 studies were included, with 40 of these incorporating clinical populations. A total of 4126 participants were identified, with younger adults (18-40 years) being the most studied population. The most common techniques were squat-stands (n = 43), deep-breathing (n = 25), OLBNP (n = 20), and sit-to-stands (n = 16). Pooled coherence point estimates were: OLBNP 0.70 (95%CI:0.59-0.82), sit-to-stands 0.87 (95%CI:0.79-0.95), and squat-stands 0.98 (95%CI:0.98-0.99) at 0.05 Hz; and deep-breathing 0.90 (95%CI:0.81-0.99); OLBNP 0.67 (95%CI:0.44-0.90); and squat-stands 0.99 (95%CI:0.99-0.99) at 0.10 Hz. This review summarizes clinical findings, discusses the pros/cons of the 11 unique driven techniques included, and provides recommendations for future investigations into the unique physiological intricacies of dCA.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Marc-Antoine Roy
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Courtney M Kennedy
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
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Brassard P, Smirl JD. Dynamic cerebral autoregulation quantification with spontaneous arterial blood pressure oscillations: Is transfer function analysis our best option? Exp Physiol 2024. [PMID: 38615245 DOI: 10.1113/ep091900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research Center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Labrecque L, Roy MA, Soleimani Dehnavi S, Taghizadeh M, Smirl JD, Brassard P. Directional sensitivity of the cerebral pressure-flow relationship during forced oscillations induced by oscillatory lower body negative pressure. J Cereb Blood Flow Metab 2024:271678X241247633. [PMID: 38613236 DOI: 10.1177/0271678x241247633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
A directional sensitivity of the cerebral pressure-flow relationship has been described using repeated squat-stands. Oscillatory lower body negative pressure (OLBNP) is a reproducible method to characterize dynamic cerebral autoregulation (dCA). It could represent a safer method to examine the directional sensitivity of the cerebral pressure-flow relationship within clinical populations and/or during pharmaceutical administration. Therefore, examining the cerebral pressure-flow directional sensitivity during an OLBNP-induced cyclic physiological stress is crucial. We calculated changes in middle cerebral artery mean blood velocity (MCAv) per alterations to mean arterial pressure (MAP) to compute ratios adjusted for time intervals (ΔMCAvT/ΔMAPT) with respect to the minimum-to-maximum MCAv and MAP, for each OLBNP transition (0 to -90 Torr), during 0.05 Hz and 0.10 Hz OLBNP. We then compared averaged ΔMCAvT/ΔMAPT during OLBNP-induced MAP increases (INC) (ΔMCAvT/Δ MAP T INC ) and decreases (DEC) (ΔMCAvT/Δ MAP T DEC ). Nineteen healthy participants [9 females; 30 ± 6 years] were included. There were no differences in ΔMCAvT/ΔMAPT between INC and DEC at 0.05 Hz. ΔMCAvT/Δ MAP T INC (1.06 ± 0.35 vs. 1.33 ± 0.60 cm⋅s-1/mmHg; p = 0.0076) was lower than ΔMCAvT/Δ MAP T DEC at 0.10 Hz. These results support OLBNP as a model to evaluate the directional sensitivity of the cerebral pressure-flow relationship.
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Affiliation(s)
- Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Marc-Antoine Roy
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Shahrzad Soleimani Dehnavi
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Mahmoudreza Taghizadeh
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
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Neill MG, Burma JS, Miutz LN, Kennedy CM, Penner LC, Newel KT, Smirl JD. Transcranial Doppler Ultrasound and Concussion-Supplemental Symptoms with Physiology: A Systematic Review. J Neurotrauma 2024. [PMID: 38468559 DOI: 10.1089/neu.2023.0421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Sport-related concussion (SRC) can impair the cerebrovasculature both acutely and chronically. Transcranial Doppler (TCD) ultrasound assessment has the potential to illuminate the mechanisms of impairment and provide an objective evaluation of SRC. The current systematic review investigated studies employing TCD ultrasound assessment of intracranial arteries across three broad categories of cerebrovascular regulation: neurovascular coupling (NVC), cerebrovascular reactivity (CVR), and dynamic cerebral autoregulation (dCA). The current review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42021275627). The search strategy was applied to PubMed, as this database indexes all biomedical journals. Original articles on TCD for athletes with medically diagnosed SRC were included. Title/abstract and full-text screening were completed by three authors. Two authors completed data extraction and risk of bias using the Methodological Index for Non-Randomized Studies and Scottish Intercollegiate Guideline Network checklists. Of the 141 articles identified, 14 met the eligibility criteria. One article used an NVC challenge, eight assessed CVR, and six investigated dCA. Methodologies varied widely among studies, and results were heterogeneous. There was evidence of cerebrovascular impairment in all three domains roughly 2 days post-SRC, but the magnitude and recovery of these impairments were not clear. There was evidence that clinical symptom resolution occurred before cerebrovascular function, indicating that physiological deficits may persist despite clinical recovery and return to play. Collectively, this emphasizes an opportunity for the use of TCD to illuminate the cerebrovascular deficits caused by SRC. It also highlights that there is need for consistent methodological rigor when employing TCD in a SRC population.
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Affiliation(s)
- Matthew G Neill
- Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Joel S Burma
- Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Lauren N Miutz
- Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- Department of Health and Sport Science, University of Dayton, Dayton, Ohio, USA
| | - Courtney M Kennedy
- Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Linden C Penner
- Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kailey T Newel
- Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Burma JS, Griffiths JK, Lapointe AP, Oni IK, Soroush A, Carere J, Smirl JD, Dunn JF. Heart Rate Variability and Pulse Rate Variability: Do Anatomical Location and Sampling Rate Matter? Sensors (Basel) 2024; 24:2048. [PMID: 38610260 PMCID: PMC11013825 DOI: 10.3390/s24072048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/16/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024]
Abstract
Wearable technology and neuroimaging equipment using photoplethysmography (PPG) have become increasingly popularized in recent years. Several investigations deriving pulse rate variability (PRV) from PPG have demonstrated that a slight bias exists compared to concurrent heart rate variability (HRV) estimates. PPG devices commonly sample at ~20-100 Hz, where the minimum sampling frequency to derive valid PRV metrics is unknown. Further, due to different autonomic innervation, it is unknown if PRV metrics are harmonious between the cerebral and peripheral vasculature. Cardiac activity via electrocardiography (ECG) and PPG were obtained concurrently in 54 participants (29 females) in an upright orthostatic position. PPG data were collected at three anatomical locations: left third phalanx, middle cerebral artery, and posterior cerebral artery using a Finapres NOVA device and transcranial Doppler ultrasound. Data were sampled for five minutes at 1000 Hz and downsampled to frequencies ranging from 20 to 500 Hz. HRV (via ECG) and PRV (via PPG) were quantified and compared at 1000 Hz using Bland-Altman plots and coefficient of variation (CoV). A sampling frequency of ~100-200 Hz was required to produce PRV metrics with a bias of less than 2%, while a sampling rate of ~40-50 Hz elicited a bias smaller than 20%. At 1000 Hz, time- and frequency-domain PRV measures were slightly elevated compared to those derived from HRV (mean bias: ~1-8%). In conjunction with previous reports, PRV and HRV were not surrogate biomarkers due to the different nature of the collected waveforms. Nevertheless, PRV estimates displayed greater validity at a lower sampling rate compared to HRV estimates.
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Affiliation(s)
- Joel S. Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.G.); (J.C.); (J.D.S.)
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (I.K.O.); (A.S.); (J.F.D.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - James K. Griffiths
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.G.); (J.C.); (J.D.S.)
- Faculty of Biomedical Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
| | | | - Ibukunoluwa K. Oni
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (I.K.O.); (A.S.); (J.F.D.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Ateyeh Soroush
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (I.K.O.); (A.S.); (J.F.D.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Joseph Carere
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.G.); (J.C.); (J.D.S.)
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (I.K.O.); (A.S.); (J.F.D.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jonathan D. Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.G.); (J.C.); (J.D.S.)
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (I.K.O.); (A.S.); (J.F.D.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jeff F. Dunn
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (I.K.O.); (A.S.); (J.F.D.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
- Faculty of Biomedical Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
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Burma JS, Smirl JD. Letter to the editor: Deriving transfer function analysis metrics from driven methods. J Cereb Blood Flow Metab 2024:271678X231224504. [PMID: 38466898 DOI: 10.1177/0271678x231224504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Driven and spontaneous methods have been used to quantify the cerebral pressure-flow relationship via transfer function analysis (TFA). Commonly, TFA derived estimates are assessed using band averages within the very-low (0.02-0.07 Hz) and low (0.07-0.20 Hz) frequency during spontaneous oscillations but are quantified at frequencies of interest where blood pressure oscillations are driven (e.g., 0.05 and/or 0.10 Hz). Driven estimates more closely resemble the autoregulatory challenges individuals experience on a daily basis, while also eliciting higher levels of reliability. While driven estimates with point-estimates are not feasible for all clinical populations, these approaches increase the ability to understand pathophysiological changes.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
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Wallace C, Smirl JD, Adhikari SP, Jones KE, Rieger M, Rothlander K, van Donkelaar P. Neurovascular coupling is altered in women who have a history of brain injury from intimate partner violence: a preliminary study. Front Glob Womens Health 2024; 5:1344880. [PMID: 38495125 PMCID: PMC10940333 DOI: 10.3389/fgwh.2024.1344880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Intimate partner violence (IPV) is a global health crisis with 30% of women over the age of 15 experiencing at least one event in their lifetime. Brain injury (BI) due to head impacts and/or strangulation is a common but understudied part of this experience. Previous research has shown BI from other injury mechanisms can disrupt neurovascular coupling (NVC). To gain further insight into whether similar changes occur in this population, we assessed NVC responses in women with a history of IPV-BI. Methods NVC responses were measured for the middle and posterior cerebral arteries (MCA, PCA) using transcranial Doppler ultrasound while participants performed a complex visual search task. The lifetime history of previous exposure to IPV-BI was captured using the Brain Injury Severity Assessment (BISA) along with measures of post-traumatic stress disorder (PTSD), anxiety, depression, substance use, and demographic information. Initial analyses of NVC metrics were completed comparing participants who scored low vs. high on the BISA or did or did not experience non-fatal strangulation followed by a stepwise multiple regression to examine the impact of PTSD, anxiety, and depression on the relationship between the NVC metrics and IPV-BI. Results Baseline and peak cerebral blood velocity were higher and the percentage increase was lower in the PCA in the low compared to the high BISA group whereas no differences between the groups were apparent in the MCA. In addition, those participants who had been strangled had a lower initial slope and area under the curve in the PCA than those who had not experienced strangulation. Finally, the stepwise multiple regression demonstrated the percentage increase in the PCA was significantly related to the BISA score and both depression and anxiety significantly contributed to different components of the NVC response. Conclusions This preliminary study demonstrated that a lifetime history of IPV-BI leads to subtle but significant disruptions to NVC responses which are modulated by comorbid depression and anxiety. Future studies should examine cerebrovascular function at the acute and subacute stages after IPV episodes to shed additional light on this experience and its outcomes.
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Affiliation(s)
- Colin Wallace
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- Department of Kinesiology, Okanagan College, Penticton, BC, Canada
| | - Jonathan D. Smirl
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Shambhu P. Adhikari
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - K. Elisabeth Jones
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Matt Rieger
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Krystal Rothlander
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
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Burma JS, Griffiths JK, Smirl JD. Validity and reliability of deriving the autoregulatory plateau through projection pursuit regression from driven methods. Physiol Rep 2024; 12:e15919. [PMID: 38262711 PMCID: PMC10805621 DOI: 10.14814/phy2.15919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
To compare the construct validity and between-day reliability of projection pursuit regression (PPR) from oscillatory lower body negative pressure (OLBNP) and squat-stand maneuvers (SSMs). Nineteen participants completed 5 min of OLBNP and SSMs at driven frequencies of 0.05 and 0.10 Hz across two visits. Autoregulatory plateaus were derived at both point-estimates and across the cardiac cycle. Between-day reliability was assessed with intraclass correlation coefficients (ICCs), Bland-Altman plots with 95% limits of agreement (LOA), coefficient of variation (CoV), and smallest real differences. Construct validity between OLBNP-SSMs were quantified with Bland-Altman plots and Cohen's d. The expected autoregulatory curve with positive rising and negative falling slopes were present in only ~23% of the data. The between-day reliability for the ICCs were poor-to-good with the CoV estimates ranging from ~50% to 70%. The 95% LOA were very wide with an average spread of ~450% for OLBNP and ~350% for SSMs. Plateaus were larger from SSMs compared to OLBNPs (moderate-to-large effect sizes). The cerebral pressure-flow relationship is a complex regulatory process, and the "black-box" nature of this system can make it challenging to quantify. The current data reveals PPR analysis does not always elicit a clear-cut central plateau with distinctive rising/falling slopes.
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Affiliation(s)
- Joel S. Burma
- Cerebrovascular Concussion Lab, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Sport Injury Prevention Research Centre, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance Laboratory, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryAlbertaCanada
| | - James K. Griffiths
- Cerebrovascular Concussion Lab, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Faculty of Biomedical EngineeringUniversity of CalgaryCalgaryAlbertaCanada
| | - Jonathan D. Smirl
- Cerebrovascular Concussion Lab, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Sport Injury Prevention Research Centre, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance Laboratory, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryAlbertaCanada
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Burma JS, Lapointe AP, Wilson M, Penner LC, Kennedy CM, Newel KT, Galea OA, Miutz LN, Dunn JF, Smirl JD. Adolescent Sport-Related Concussion and the Associated Neurophysiological Changes: A Systematic Review. Pediatr Neurol 2024; 150:97-106. [PMID: 38006666 DOI: 10.1016/j.pediatrneurol.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/20/2023] [Accepted: 10/28/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Sport-related concussion (SRC) has been shown to induce cerebral neurophysiological deficits, quantifiable with electroencephalography (EEG). As the adolescent brain is undergoing rapid neurodevelopment, it is fundamental to understand both the short- and long-term ramifications SRC may have on neuronal functioning. The current systematic review sought to amalgamate the literature regarding both acute/subacute (≤28 days) and chronic (>28 days) effects of SRC in adolescents via EEG and the diagnostic accuracy of this tool. METHODS The review was registered within the Prospero database (CRD42021275256). Search strategies were created and input into the PubMed database, where three authors completed all screening. Risk of bias assessments were completed using the Scottish Intercollegiate Guideline Network and Methodological Index for Non-Randomized Studies. RESULTS A total of 128 articles were identified; however, only seven satisfied all inclusion criteria. The studies ranged from 2012 to 2021 and included sample sizes of 21 to 81 participants, albeit only ∼14% of the included athletes were females. The studies displayed low-to-high levels of bias due to the small sample sizes and preliminary nature of most investigations. Although heterogeneous methods, tasks, and analytical techniques were used, 86% of the studies found differences compared with control athletes, in both the symptomatic and asymptomatic phases of SRC. One study used raw EEG data as a diagnostic indicator demonstrating promise; however, more research and standardization are a necessity. CONCLUSIONS Collectively, the findings highlight the utility of EEG in assessing adolescent SRC; however, future studies should consider important covariates including biological sex, maturation status, and development.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.
| | - Andrew P Lapointe
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Megan Wilson
- Faculty of Arts and Social Sciences, Carleton University, Ottawa, Ontario, Canada; Faculty of Arts, University of Alberta, Edmonton, Alberta, Canada
| | - Linden C Penner
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Courtney M Kennedy
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Kailey T Newel
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada; Faculty of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada
| | - Olivia A Galea
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Lauren N Miutz
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Jeff F Dunn
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
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12
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Miutz LN, Burma JS, Brassard P, Phillips AA, Emery CA, Smirl JD. Comparison of the Buffalo Concussion Treadmill Test With a Physiologically Informed Cycle Test: Calgary Concussion Cycle Test. Sports Health 2023:19417381231217744. [PMID: 38149331 DOI: 10.1177/19417381231217744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Sport-related concussions are a complex injury requiring multifaceted assessment, including physical exertion. Currently, concussion testing relies primarily on a treadmill-based protocol for assessing exertion-related symptoms in persons after concussion. This study compared a modified cycle protocol (Calgary Concussion Cycle Test [CCCT]) with the clinically adopted standard, the Buffalo Concussion Treadmill Test (BCTT), across multiple physiological parameters. HYPOTHESIS Treadmill and cycle matched workload protocols would produce similar results for cerebral blood velocity, mean arterial pressure (MAP), and end-tidal carbon dioxide partial pressure (PETCO2), but heart rate (HR) and oxygen consumption (VO2) would be higher on the treadmill than the cycle modality. STUDY DESIGN Crossover study design. LEVEL OF EVIDENCE Level 3. METHODS A total of 17 healthy adults (8 men, 9 women; age, 26 ± 3 years; body mass index, 23.8 ± 2.7 kg/m2) completed the BCTT and CCCT protocols, 7 days apart in a randomized order. During both exertional protocols, the physiological parameters measured were middle cerebral artery mean blood velocity (MCAv), MAP, PETCO2, VO2, and HR. Analysis of variance with effect size computations, coefficient of variation, and Bland-Altman plots with 95% limits of agreement were used to compare exercise tests. RESULTS The BCTT and CCCT produced comparable results for both male and female participants with no significant differences for average MCAv, MAP, and PETCO2 (all P > 0.05; all generalized eta squared [η2G] < 0.02 [negligible]; P value range, 0.29-0.99) between stages. When accounting for exercise stage and modality, VO2 (P < 0.01) and HR (P < 0.01) were higher on the treadmill compared with the cycle. Aside from the final few stages, all physiology measures displayed good-to-excellent agreeability/variability. CONCLUSION The CCCT was physiologically similar to the BCTT in terms of MCAv, PETCO2, and MAP; however, HR and VO2 differed between modalities. CLINICAL RELEVANCE Providing a cycle-based modality to exertional testing after injury mayincrease accessibility to determine symptom thresholds in the future.
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Affiliation(s)
- Lauren N Miutz
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Health and Sport Science, University of Dayton, Dayton, Ohio
| | - Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, University Laval, Québec, Canada
- Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Aaron A Phillips
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, Biomedical Engineering, and Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Brassard P, Roy MA, Burma JS, Labrecque L, Smirl JD. Quantification of dynamic cerebral autoregulation: welcome to the jungle! Clin Auton Res 2023; 33:791-810. [PMID: 37758907 DOI: 10.1007/s10286-023-00986-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Patients with dysautonomia often experience symptoms such as dizziness, syncope, blurred vision and brain fog. Dynamic cerebral autoregulation, or the ability of the cerebrovasculature to react to transient changes in arterial blood pressure, could be associated with these symptoms. METHODS In this narrative review, we go beyond the classical view of cerebral autoregulation to discuss dynamic cerebral autoregulation, focusing on recent advances pitfalls and future directions. RESULTS Following some historical background, this narrative review provides a brief overview of the concept of cerebral autoregulation, with a focus on the quantification of dynamic cerebral autoregulation. We then discuss the main protocols and analytical approaches to assess dynamic cerebral autoregulation, including recent advances and important issues which need to be tackled. CONCLUSION The researcher or clinician new to this field needs an adequate comprehension of the toolbox they have to adequately assess, and interpret, the complex relationship between arterial blood pressure and cerebral blood flow in healthy individuals and clinical populations, including patients with autonomic disorders.
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Affiliation(s)
- Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.
- Research center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.
| | - Marc-Antoine Roy
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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Johnson NE, Burma JS, Seok J, Miutz LN, Smirl JD. Influence of sex on the reliability of cerebral blood velocity regulation during lower body negative pressure and supine cycling with considerations of the menstrual cycle. Physiol Meas 2023; 44:114001. [PMID: 37848016 DOI: 10.1088/1361-6579/ad0425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 10/17/2023] [Indexed: 10/19/2023]
Abstract
Objective.To evaluate sex differences in the reliability of absolute and relative cerebral blood velocity (CBv) during concurrent supine cycling with lower body negative pressure (LBNP).Approach. A total of 19 participants (11 females; aged 20-33 years) completed five testing sessions, occurring on 7 d intervals. Visit 1 was a maximal-ramp-cycle test to ascertain peak CBv wattage. During visits 2-5, supine cycling protocol occurred at individualized peak CBv wattages with progressive decreases in LBNP from 0 to -20, -40, -60, -70, and -80 Torr. Menstrual cycle day was self-reported via the Rhinessa Women's Questionnaire. Transcranial Doppler ultrasound insonated bilateral middle cerebral artery velocity (MCAv). Two-way ANOVA assessed potential day- and sex-differences at each LBNP stage. Reliability was determined using intraclass correlation coefficients (ICC) and coefficient of variation (CoV).Main results. For all physiological measures, no main-effects were present for day- or interaction-terms (p> 0.067; negligible-to-small effect sizes), while sex differences were noted for MCAv, blood pressure, and heart rate (p< 0.046). Across visits, males and females displayed excellent and good-to-excellent levels of reliability for MCAv metrics, respectively (ICC range: 0.745-0.999; CoV range: 0.33%-9.90%).Significance. During the current investigation, both relative and absolute CBv demonstrated high reliability in both male and female participants during a supine LBNP cycling protocol. An exploratory analysis revealed increased variance was found in female participants dependent on contraceptive use. Despite this, results indicate future LBNP studies may include females at any menstrual cycle stage.
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Affiliation(s)
- Nathan E Johnson
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - Joel S Burma
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Jina Seok
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - Lauren N Miutz
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Health and Sport Science, University of Dayton, Dayton, OH, United States of America
| | - Jonathan D Smirl
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
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Burma JS, Seok J, Johnston NE, Smirl JD. Cerebral blood velocity during concurrent supine cycling, lower body negative pressure, and head-up tilt challenges: implications for concussion rehabilitation. Physiol Meas 2023; 44:084002. [PMID: 37531960 DOI: 10.1088/1361-6579/acecd4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/02/2023] [Indexed: 08/04/2023]
Abstract
Introduction. The effect of concurrent head-up tilt and lower body negative pressure (LBNP) have been examined on middle cerebral artery velocity (MCAv) at rest; however, it is unknown the superimposed effect these factors have on blunting the elevation in cerebral blood velocity associated with moderate-intensity exercise.Methods. 23 healthy adults (11 females / 12 males, 20-33 years) completed three visits. The first consisted of a maximal ramp supine cycling test to identify the wattage associated with individualized maximal MCAv. Subsequent visits included randomized no LBNP (control) or LBNP at -40 Torr (experimental) with successively increasing head-up tilt stages of 0, 15, 30, and 45 degrees during the pre-described individualized wattage. Transcranial Doppler ultrasound was utilized to quantify MCAv. Two-factorial repeated measures analysis of variance with effect sizes were used to determine differences between days and tilt stages.Results. Between-day baseline values for MCAv, heart rate, and blood pressure displayed low variability with <5% variation. With no LBNP, MCAv was above baseline on average for all participants; however, 15 degrees and 30 degrees tilt with concurrent -40 Torr LBNP was sufficient to return MCAv to 100% of baseline values in females and males, respectively. Body-weight did not impact the association between tilt and pressure (R2range: 0.01-0.12).Conclusion. Combined LBNP and tilt were sufficient to reduce the increase in MCAv associated with moderate-intensity exercise. This exercise modality shows utility to enable individuals with a concussion to obtain the positive physiological adaptions associated with exercise while minimizing symptom exacerbation due to the notion of the Monro-Kellie doctrine.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
| | - Jina Seok
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - Nathan E Johnston
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
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Miutz LN, Burma JS, Van Roessel RK, Johnson NE, Phillips AA, Emery CA, Brassard P, Smirl JD. The effect of supine cycling and progressive lower body negative pressure on cerebral blood velocity responses. J Appl Physiol (1985) 2023; 135:316-325. [PMID: 37348016 DOI: 10.1152/japplphysiol.00758.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
Moderate-intensity aerobic exercise increases cerebral blood velocity (CBv) primarily due to hyperpnea-induced vasodilation; however, the integrative control of cerebral blood flow (CBF) allows other factors to contribute to the vasodilation. Although lower body negative pressure (LBNP) can reduce CBv, the exact LBNP intensity required to blunt the aforementioned exercise-induced CBv response is unknown. This could hold utility for concussion recovery, allowing individuals to exercise at higher intensities without symptom exacerbation. Thirty-two healthy adults (age: 20-33 yr; 19 females/13 males) completed a stepwise maximal exercise test during a first visit to determine each participant's wattage associated with their exercise-induced maximal CBv increase. During the second visit, following supine rest, participants completed moderate-intensity exercise at their determined threshold, while progressive LBNP was applied at 0, -20, -40, -60, -70, -80, and ∼88 Torr. Bilateral middle cerebral artery blood velocities (MCAvs), mean arterial pressure (MAP), heart rate, respiratory rate, and end-tidal carbon dioxide levels were measured continuously. Two-way analysis of variance with effect sizes compared between sexes and stages. Compared with resting supine baseline, averaged MCAv was elevated during 0 and -20 Torr LBNP (q value > 7.73; P < 0.001); however, no differences were noted between baseline and -40 to -70 Torr (q value < |4.24|; P > 0.262). Differences were present between females and males for absolute MCAv measures (q value > 11.2; P < 0.001), but not when normalized to baseline (q value < 0.03; P > 0.951). Supine cycling-elicited increases in MCAv are able to be blunted during the application of LBNP ranging from -40 to -70 Torr. The blunted CBv response demonstrates the potential benefit of allowing individuals to aerobically train (moderate-intensity supine cycling with LBNP) without exacerbating symptoms during the concussion recovery phase.NEW & NOTEWORTHY The current investigation demonstrated that moderate-intensity supine cycling-induced increases in cerebral blood velocities were balanced by the lower body negative pressure-induced decreases in cerebral blood velocity. Although performed in a healthy population, the results may lend themselves to a potential treatment option for individuals recovering from concussion or experience persistent concussion symptoms.
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Affiliation(s)
- Lauren N Miutz
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- Department of Health and Sport Science, University of Dayton, Dayton, Ohio, United States
| | - Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Rowan K Van Roessel
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Nathan E Johnson
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Aaron A Phillips
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
- Biomedical Engineering, and Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, University Laval, Quebec City, Québec, Canada
- Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Québec, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Burma JS, Rattana S, Oni IK, Lapointe AP, Dunn JF, Smirl JD. The temporal neurovascular coupling response remains intact during sinusoidal hypotensive and hypertensive challenges. Physiol Meas 2023; 44:074002. [PMID: 37399810 DOI: 10.1088/1361-6579/ace3a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/03/2023] [Indexed: 07/05/2023]
Abstract
Introduction. Neurovascular coupling (NVC) describes the coupling of neuronal metabolic demand to blood supply, which has shown to be impaired with chronic hypertension, as well as with prolonged hypotension. However, it is unknown the extent the NVC response remains intact during transient hypo- and hyper-tensive challenges.Methods. Fifteen healthy participants (9 females/6 males) completed a visual NVC task ('Where's Waldo?') over two testing sessions, consisting of cyclical 30 s eyes closed and opened portions. The Waldo task was completed at rest (8 min) and concurrently during squat-stand maneuvers (SSMs; 5 min) at 0.05 Hz (10 s squat/stand) and 0.10 Hz (5 s squat-stand). SSMs induce 30-50 mmHg blood pressure oscillations, resulting in cyclical hypo- and hyper-tensive swings within the cerebrovasculature, allowing for the quantification of the NVC response during transient hypo- and hyper-tension. Outcome NVC metrics included baseline, peak, relative increase in cerebral blood velocity (CBv), and area-under-the-curve (AUC30) within the posterior and middle cerebral arteries indexed via transcranial Doppler ultrasound. Within-subject, between-task comparisons were conducted using analysis of variance with effect size calculations.Results. Differences were noted between rest and SSM conditions in both vessels for peak CBv (allp< 0.045) and the relative increase in CBv (allp <0.049) with small-to-large effect sizes. AUC30 metrics were similar between all tasks (allp> 0.090) with negligible-to-small effect sizes.Conclusions. Despite the SSMs eliciting ∼30-50 mmHg blood pressure oscillations, similar levels of activation occurred within the neurovascular unit across all conditions. This demonstrated the signaling of the NVC response remained intact during cyclical blood pressure challenges.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
| | - Selina Rattana
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - Ibukunoluwa K Oni
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew P Lapointe
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeff F Dunn
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
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Yeates KO, Räisänen AM, Premji Z, Debert CT, Frémont P, Hinds S, Smirl JD, Barlow K, Davis GA, Echemendia RJ, Feddermann-Demont N, Fuller C, Gagnon I, Giza CC, Iverson GL, Makdissi M, Schneider KJ. What tests and measures accurately diagnose persisting post-concussive symptoms in children, adolescents and adults following sport-related concussion? A systematic review. Br J Sports Med 2023; 57:780-788. [PMID: 37316186 DOI: 10.1136/bjsports-2022-106657] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To determine what tests and measures accurately diagnose persisting post-concussive symptoms (PPCS) in children, adolescents and adults following sport-related concussion (SRC). DESIGN A systematic literature review. DATA SOURCES MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL and SPORTDiscus through March 2022. ELIGIBILITY CRITERIA Original, empirical, peer-reviewed findings (cohort studies, case-control studies, cross-sectional studies and case series) published in English and focused on SRC. Studies needed to compare individuals with PPCS to a comparison group or their own baseline prior to concussion, on tests or measures potentially affected by concussion or associated with PPCS. RESULTS Of 3298 records screened, 26 articles were included in the qualitative synthesis, including 1016 participants with concussion and 531 in comparison groups; 7 studies involved adults, 8 involved children and adolescents and 11 spanned both age groups. No studies focused on diagnostic accuracy. Studies were heterogeneous in participant characteristics, definitions of concussion and PPCS, timing of assessment and the tests and measures examined. Some studies found differences between individuals with PPCS and comparison groups or their own pre-injury assessments, but definitive conclusions were not possible because most studies had small convenience samples, cross-sectional designs and were rated high risk of bias. CONCLUSION The diagnosis of PPCS continues to rely on symptom report, preferably using standardised symptom rating scales. The existing research does not indicate that any other specific tool or measure has satisfactory accuracy for clinical diagnosis. Future research drawing on prospective, longitudinal cohort studies could help inform clinical practice.
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Affiliation(s)
- Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Anu M Räisänen
- Department of Physical Therapy Education - Oregon, Western University of Health Sciences, College of Health Sciences - Northwest, Lebanon, Oregon, USA
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | - Chantel T Debert
- Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pierre Frémont
- Department of Rehabilitation, Laval University, Quebec, Quebec, Canada
| | - Sidney Hinds
- Uniformed Services University, Bethesda, Maryland, USA
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Karen Barlow
- Child Health Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Ruben J Echemendia
- Department of Psychology, University of Missouri, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, State College, Pennsylvania, USA
| | - Nina Feddermann-Demont
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Sports Neuroscience, University of Zurich, Zurich, Switzerland
| | - Colm Fuller
- College of Medicine and Health, University College Cork, Cork, Ireland
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Trauma Center, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Christopher C Giza
- Department of Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Department of Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - Michael Makdissi
- Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- Australian Football League, Melbourne, Victoria, Australia
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Eliason PH, Galarneau JM, Kolstad AT, Pankow MP, West SW, Bailey S, Miutz L, Black AM, Broglio SP, Davis GA, Hagel BE, Smirl JD, Stokes KA, Takagi M, Tucker R, Webborn N, Zemek R, Hayden A, Schneider KJ, Emery CA. Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis. Br J Sports Med 2023; 57:749-761. [PMID: 37316182 DOI: 10.1136/bjsports-2022-106656] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To evaluate prevention strategies, their unintended consequences and modifiable risk factors for sport-related concussion (SRC) and/or head impact risk. DESIGN This systematic review and meta-analysis was registered on PROSPERO (CRD42019152982) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Eight databases (MEDLINE, CINAHL, APA PsycINFO, Cochrane (Systematic Review and Controlled Trails Registry), SPORTDiscus, EMBASE, ERIC0 were searched in October 2019 and updated in March 2022, and references searched from any identified systematic review. ELIGIBILITY CRITERIA Study inclusion criteria were as follows: (1) original data human research studies, (2) investigated SRC or head impacts, (3) evaluated an SRC prevention intervention, unintended consequence or modifiable risk factor, (4) participants competing in any sport, (5) analytic study design, (6) systematic reviews and meta-analyses were included to identify original data manuscripts in reference search and (7) peer-reviewed. Exclusion criteria were as follows: (1) review articles, pre-experimental, ecological, case series or case studies and (2) not written in English. RESULTS In total, 220 studies were eligible for inclusion and 192 studies were included in the results based on methodological criteria as assessed through the Scottish Intercollegiate Guidelines Network high ('++') or acceptable ('+') quality. Evidence was available examining protective gear (eg, helmets, headgear, mouthguards) (n=39), policy and rule changes (n=38), training strategies (n=34), SRC management strategies (n=12), unintended consequences (n=5) and modifiable risk factors (n=64). Meta-analyses demonstrated a protective effect of mouthguards in collision sports (incidence rate ratio, IRR 0.74; 95% CI 0.64 to 0.89). Policy disallowing bodychecking in child and adolescent ice hockey was associated with a 58% lower concussion rate compared with bodychecking leagues (IRR 0.42; 95% CI 0.33 to 0.53), and evidence supports no unintended injury consequences of policy disallowing bodychecking. In American football, strategies limiting contact in practices were associated with a 64% lower practice-related concussion rate (IRR 0.36; 95% CI 0.16 to 0.80). Some evidence also supports up to 60% lower concussion rates with implementation of a neuromuscular training warm-up programme in rugby. More research examining potentially modifiable risk factors (eg, neck strength, optimal tackle technique) are needed to inform concussion prevention strategies. CONCLUSIONS Policy and rule modifications, personal protective equipment, and neuromuscular training strategies may help to prevent SRC. PROSPERO REGISTRATION NUMBER CRD42019152982.
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Affiliation(s)
- Paul H Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Michel Galarneau
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ash T Kolstad
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - M Patrick Pankow
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Stuart Bailey
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Lauren Miutz
- Health and Sport Science, University of Dayton, Dayton, Ohio, USA
| | - Amanda Marie Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Gavin A Davis
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Brent E Hagel
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Keith A Stokes
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, Bath, UK
| | - Michael Takagi
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Ross Tucker
- School of Management Studies, University of Cape Town, Rondebosch, South Africa
| | - Nick Webborn
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Roger Zemek
- Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Smail OJ, Clarke DJ, Al‐Alem Q, Wallis W, Barker AR, Smirl JD, Bond B. Resistance exercise acutely elevates dynamic cerebral autoregulation gain. Physiol Rep 2023; 11:e15676. [PMID: 37100594 PMCID: PMC10132945 DOI: 10.14814/phy2.15676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
Dynamic cerebral autoregulation (dCA) describes the regulation of cerebral blood flow (CBF) in response to fluctuations in systemic blood pressure (BP). Heavy resistance exercise is known to induce large transient elevations in BP, which are translated into perturbations of CBF, and may alter dCA in the immediate aftermath. This study aimed to better quantify the time course of any acute alterations in dCA after resistance exercise. Following familiarisation to all procedures, 22 (14 male) healthy young adults (22 ± 2 years) completed an experimental trial and resting control trial, in a counterbalanced order. Repeated squat-stand manoeuvres (SSM) at 0.05 and 0.10 Hz were used to quantify dCA before, and 10 and 45 min after four sets of ten repetition back squats at 70% of one repetition maximum, or time matched seated rest (control). Diastolic, mean and systolic dCA were quantified by transfer function analysis of BP (finger plethysmography) and middle cerebral artery blood velocity (transcranial Doppler ultrasound). Mean gain (p = 0.02; d = 0.36) systolic gain (p = 0.01; d = 0.55), mean normalised gain (p = 0.02; d = 0.28) and systolic normalised gain (p = 0.01; d = 0.67) were significantly elevated above baseline during 0.10 Hz SSM 10-min post resistance exercise. This alteration was not present 45 min post-exercise, and dCA indices were never altered during SSM at 0.05 Hz. dCA metrics were acutely altered 10 min post resistance exercise at the 0.10 Hz frequency only, which indicate changes in the sympathetic regulation of CBF. These alterations recovered 45 min post-exercise.
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Affiliation(s)
- Oliver J. Smail
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT), Public Health and Sport SciencesUniversity of ExeterExeterUK
| | - Daniel J. Clarke
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT), Public Health and Sport SciencesUniversity of ExeterExeterUK
| | - Qais Al‐Alem
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT), Public Health and Sport SciencesUniversity of ExeterExeterUK
| | - William Wallis
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT), Public Health and Sport SciencesUniversity of ExeterExeterUK
| | - Alan R. Barker
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT), Public Health and Sport SciencesUniversity of ExeterExeterUK
- Children's Health and Exercise Research CentreUniversity of ExeterExeterUK
| | - Jonathan D. Smirl
- Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Reach InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
- Cerebrovascular Concussion LabUniversity of CalgaryCalgaryAlbertaCanada
| | - Bert Bond
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT), Public Health and Sport SciencesUniversity of ExeterExeterUK
- Children's Health and Exercise Research CentreUniversity of ExeterExeterUK
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21
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Burma JS, Rattana S, Johnson NE, Smirl JD. Do mean values tell the full story? Cardiac cycle and biological sex comparisons in temporally derived neurovascular coupling metrics. J Appl Physiol (1985) 2023; 134:426-443. [PMID: 36603050 DOI: 10.1152/japplphysiol.00170.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Previous reports have noted cerebrovascular regulation differs across the cardiac cycle, with greater regulation occurring within systole. However, this methodological notion has not been meticulously scrutinized during temporally deduced neurovascular coupling (NVC) metrics with additional respect to biological sex. Analyses of 111 healthy individuals (40 females/71 males) were performed where participants engaged in the "Where's Waldo?" paradigm. All NVC parameters were quantified in the posterior and middle cerebral arteries at 310 unique timepoints. Several individuals completed repeat testing which enabled for between-day (3 timepoints) and within-day (7 timepoints) reliability comparisons in 17 and 11 individuals, respectively. One-way analysis of variance compared NVC metrics between diastole, mean, and systole values, as well as differences between biological sexes. Greater absolute cerebral blood velocity (CBv; baseline and peak) and total activation (area under the curve) were noted within systole for both posterior cerebral artery (PCA; P < 0.001) and middle cerebral artery (MCA; P < 0.001) values; however, the relative percent increase in CBv was greater within diastole (P < 0.001). Females had an elevated diastolic and mean CBv and a greater diastolic cerebrovascular conductance (P < 0.050). No sex differences were present for systolic CBv measures and within parameters quantifying the NVC response (area under the curve/relative CBv increase) across the cardiac cycle (P > 0.072). Future investigations seeking to differentiate cerebral regulatory mechanisms between clinical populations may benefit by performing their analyses across the cardiac cycle, as certain pathogenesis may affect one aspect of the cardiac cycle independently. Minimal differences were noted between females and males for metrics characterizing the NVC response across the cardiac cycle.NEW & NOTEWORTHY Neurovascular coupling (NVC) studies commonly assess the mean cerebral hemodynamic response with little consideration for diastole, systole, and biological sex. Greater total activation expressed as the area under the curve was seen within systole compared with mean and diastole. Resting cerebral blood velocity sex differences were more prevalent during diastole when the cerebrovasculature was pressure-passive. Future studies should assess the NVC response across the cardiac cycle as it may help delineate the underlying pathophysiology of various clinical populations.
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Affiliation(s)
- Joel S Burma
- Faculty of Kinesiology, Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, Human Performance Laboratory, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Selina Rattana
- Faculty of Kinesiology, Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada
| | - Nathan E Johnson
- Faculty of Kinesiology, Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Faculty of Kinesiology, Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, Human Performance Laboratory, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
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22
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Panerai RB, Brassard P, Burma JS, Castro P, Claassen JA, van Lieshout JJ, Liu J, Lucas SJ, Minhas JS, Mitsis GD, Nogueira RC, Ogoh S, Payne SJ, Rickards CA, Robertson AD, Rodrigues GD, Smirl JD, Simpson DM. Transfer function analysis of dynamic cerebral autoregulation: A CARNet white paper 2022 update. J Cereb Blood Flow Metab 2023; 43:3-25. [PMID: 35962478 PMCID: PMC9875346 DOI: 10.1177/0271678x221119760] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cerebral autoregulation (CA) refers to the control of cerebral tissue blood flow (CBF) in response to changes in perfusion pressure. Due to the challenges of measuring intracranial pressure, CA is often described as the relationship between mean arterial pressure (MAP) and CBF. Dynamic CA (dCA) can be assessed using multiple techniques, with transfer function analysis (TFA) being the most common. A 2016 white paper by members of an international Cerebrovascular Research Network (CARNet) that is focused on CA strove to improve TFA standardization by way of introducing data acquisition, analysis, and reporting guidelines. Since then, additional evidence has allowed for the improvement and refinement of the original recommendations, as well as for the inclusion of new guidelines to reflect recent advances in the field. This second edition of the white paper contains more robust, evidence-based recommendations, which have been expanded to address current streams of inquiry, including optimizing MAP variability, acquiring CBF estimates from alternative methods, estimating alternative dCA metrics, and incorporating dCA quantification into clinical trials. Implementation of these new and revised recommendations is important to improve the reliability and reproducibility of dCA studies, and to facilitate inter-institutional collaboration and the comparison of results between studies.
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Affiliation(s)
- Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester and NIHR Biomedical Research Centre, Leicester, UK
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, and Research Center of the Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Pedro Castro
- Department of Neurology, Centro Hospitalar Universitário de São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jurgen Ahr Claassen
- Department of Geriatric Medicine and Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Johannes J van Lieshout
- Department of Internal Medicine, Amsterdam, UMC, The Netherlands and Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham Medical School, Queen's Medical Centre, UK
| | - Jia Liu
- Institute of Advanced Computing and Digital Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen University Town, Shenzhen, China
| | - Samuel Je Lucas
- School of Sport, Exercise and Rehabilitation Sciences and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester and NIHR Biomedical Research Centre, Leicester, UK
| | - Georgios D Mitsis
- Department of Bioengineering, McGill University, Montreal, Québec, QC, Canada
| | - Ricardo C Nogueira
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Stephen J Payne
- Institute of Applied Mechanics, National Taiwan University, Taipei
| | - Caroline A Rickards
- Department of Physiology & Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Andrew D Robertson
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Gabriel D Rodrigues
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Jonathan D Smirl
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - David M Simpson
- Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
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23
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Debenham MIB, Grantham TDA, Smirl JD, Foster GE, Dalton BH. The effects of acute normobaric hypoxia on vestibular-evoked balance responses in humans. J Vestib Res 2023; 33:31-49. [PMID: 36530112 DOI: 10.3233/ves-220075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hypoxia influences standing balance and vestibular function. OBJECTIVE The purpose here was to investigate the effect of hypoxia on the vestibular control of balance. METHODS Twenty participants (10 males; 10 females) were tested over two days (normobaric hypoxia and normoxia). Participants stood on a force plate (head rotated leftward) and experienced random, continuous electrical vestibular stimulation (EVS) during trials of eyes open (EO) and closed (EC) at baseline (BL), after 5 (H1), 30 (H2) and 55-min (H3) of hypoxia, and 10-min into normoxic recovery (NR). Vestibular-evoked balance responses were quantified using cumulant density, coherence, and gain functions between EVS and anteroposterior forces. RESULTS Oxyhemoglobin saturation, end-tidal oxygen and carbon dioxide decreased for H1-3 compared to BL; however, end-tidal carbon dioxide remained reduced at NR with EC (p≤0.003). EVS-AP force peak-to-peak amplitude was lower at H3 and NR than at BL (p≤0.01). At multiple frequencies, EVS-AP force coherence and gain estimates were lower at H3 and NR than BL for females; however, this was only observed for coherence for males. CONCLUSIONS Overall, vestibular-evoked balance responses are blunted following normobaric hypoxia >30 min, which persists into NR and may contribute to the reported increases in postural sway.
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Affiliation(s)
- M I B Debenham
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, The University of British Columbia, Kelowna, British Columbia, Canada
| | - T D A Grantham
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, The University of British Columbia, Kelowna, British Columbia, Canada
| | - J D Smirl
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - G E Foster
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, The University of British Columbia, Kelowna, British Columbia, Canada
| | - B H Dalton
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, The University of British Columbia, Kelowna, British Columbia, Canada
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24
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Labrecque L, Smirl JD, Tzeng YC, Brassard P. Point/counterpoint: We should take the direction of blood pressure change into consideration for dynamic cerebral autoregulation quantification. J Cereb Blood Flow Metab 2022; 42:2351-2353. [PMID: 35619230 PMCID: PMC9670010 DOI: 10.1177/0271678x221104868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Accumulating evidence suggests asymmetrical responses of cerebral blood flow during large transient changes in mean arterial pressure. Specifically, the augmentation in cerebral blood flow is attenuated when mean arterial pressure acutely increases, compared with declines in cerebral blood flow when mean arterial pressure acutely decreases. However, common analytical tools to quantify dynamic cerebral autoregulation assume autoregulatory responses to be symmetric, which does not seem to be the case. Herein, we provide the rationale supporting the notion we need to consider the directional sensitivity of large and transient mean arterial pressure changes when characterizing dynamic cerebral autoregulation.
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Affiliation(s)
- Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.,Research Center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada.,Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada
| | - Yu-Chieh Tzeng
- Department of Surgery & Anesthesia, University of Otago, Wellington School of Medicine & Health Sciences, Wellington, New Zealand
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.,Research Center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
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25
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Burma JS, Van Roessel RK, Oni IK, Dunn JF, Smirl JD. Neurovascular coupling on trial: How the number of trials completed impacts the accuracy and precision of temporally derived neurovascular coupling estimates. J Cereb Blood Flow Metab 2022; 42:1478-1492. [PMID: 35209741 PMCID: PMC9274868 DOI: 10.1177/0271678x221084400] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Standard practices for quantifying neurovascular coupling (NVC) with transcranial Doppler ultrasound (TCD) require participants to complete one-to-ten repetitive trials. However, limited empirical evidence exists regarding how the number of trials completed influences the validity and reliability of temporally derived NVC metrics. Secondary analyses was performed on 60 young healthy participants (30 females/30 males) who completed eight cyclical eyes-closed (20-seconds), eyes-open (40-seconds) NVC trials, using the "Where's Waldo?" visual paradigm. TCD data was obtained in posterior and middle cerebral arteries (PCA and MCA, respectively). The within-day (n = 11) and between-day (n = 17) reliability were assessed at seven- and three-time points, respectively. Repeat testing from the reliability aims were also used for the concurrent validity analysis (n = 160). PCA metrics (i.e., baseline, peak, percent increase, and area-under-the-curve) demonstrated five trials produced excellent intraclass correlation coefficient (ICC) 95% confidence intervals for validity and within-day reliability (>0.900), whereas between-day reliability was good-to-excellent (>0.750). Likewise, 95% confidence intervals for coefficient of variation (CoV) measures ranged from acceptable (<20%) to excellent (<5%) with five-or-more trials. Employing fewer than five trials produced poor/unacceptable ICC and CoV metrics. Future NVC, TCD-based research should therefore have participants complete a minimum of five trials when quantifying the NVC response with TCD via a "Where's Waldo?" paradigm.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
| | - Rowan K Van Roessel
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - Ibukunoluwa K Oni
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeff F Dunn
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
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26
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Skow RJ, Brothers RM, Claassen JAHR, Day TA, Rickards CA, Smirl JD, Brassard P. On the use and misuse of cerebral hemodynamics terminology using Transcranial Doppler ultrasound: a call for standardization. Am J Physiol Heart Circ Physiol 2022; 323:H350-H357. [PMID: 35839156 DOI: 10.1152/ajpheart.00107.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cerebral hemodynamics (e.g., cerebral blood flow) can be measured and quantified using many different methods, with Transcranial Doppler ultrasound (TCD) being one of the most commonly utilized approaches. In human physiology, the terminology used to describe metrics of cerebral hemodynamics are inconsistent, and in some instances technically inaccurate; this is especially true when evaluating, reporting, and interpreting measures from TCD. Therefore, this perspectives article presents recommended terminology when reporting cerebral hemodynamic data. We discuss the current use and misuse of the terminology in the context of using TCD to measure and quantify cerebral hemodynamics and present our rationale and consensus on the terminology that we recommend moving forward. For example, one recommendation is to discontinue use of the term "cerebral blood flow velocity" in favor of "cerebral blood velocity" with precise indication of the vessel of interest. We also recommend clarity when differentiating between discrete cerebrovascular regulatory mechanisms, namely cerebral autoregulation, neurovascular coupling, and cerebrovascular reactivity. This will be a useful guide for investigators in the field of cerebral hemodynamics research.
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Affiliation(s)
- Rachel J Skow
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, United States
| | - R Matthew Brothers
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, United States
| | - Jurgen A H R Claassen
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Caroline A Rickards
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.,Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Canada
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27
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Abbariki F, Roy M, Labrecque L, Drapeau A, Imhoff S, Smirl JD, Brassard P. Influence of high-intensity interval training to exhaustion on the directional sensitivity of the cerebral pressure-flow relationship in young endurance-trained men. Physiol Rep 2022; 10:e15384. [PMID: 35822439 PMCID: PMC9277516 DOI: 10.14814/phy2.15384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023] Open
Abstract
We previously reported subtle dynamic cerebral autoregulation (dCA) alterations following 6 weeks of high-intensity interval training (HIIT) to exhaustion using transfer function analysis (TFA) on forced mean arterial pressure (MAP) oscillations in young endurance-trained men. However, accumulating evidence suggests the cerebrovasculature better buffers cerebral blood flow changes when MAP acutely increases compared to when MAP acutely decreases. Whether HIIT affects the directional sensitivity of the cerebral pressure-flow relationship in these athletes is unknown. In 18 endurance-trained men (age: 27 ± 6 years, VO2 max: 55.5 ± 4.7 ml·kg-1 ·min-1 ), we evaluated the impact of 6 weeks of HIIT to exhaustion on dCA directionality using induced MAP oscillations during 5-min 0.05 and 0.10 Hz repeated squat-stands. We calculated time-adjusted changes in middle cerebral artery mean blood velocity (MCAv) per change in MAP (ΔMCAvT /ΔMAPT ) for each squat transition. Then, we compared averaged ΔMCAvT /ΔMAPT during MAP increases and decreases. Before HIIT, ΔMCAvT /ΔMAPT was comparable between MAP increases and decreases during 0.05 Hz repeated squat-stands (p = 0.518). During 0.10 Hz repeated squat-stands, ΔMCAvT /ΔMAPT was lower during MAP increases versus decreases (0.87 ± 0.17 vs. 0.99 ± 0.23 cm·s-1 ·mmHg-1 , p = 0.030). Following HIIT, ΔMCAvT /ΔMAPT was superior during MAP increases over decreases during 0.05 Hz repeated squat-stands (0.97 ± 0.38 vs. 0.77 ± 0.35 cm·s-1 ·mmHg-1 , p = 0.002). During 0.10 Hz repeated squat-stands, dCA directional sensitivity disappeared (p = 0.359). These results suggest the potential for HIIT to influence the directional sensitivity of the cerebral pressure-flow relationship in young endurance-trained men.
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Affiliation(s)
- Faezeh Abbariki
- Department of Kinesiology, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec CityQuébecCanada
| | - Marc‐Antoine Roy
- Department of Kinesiology, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec CityQuébecCanada
| | - Lawrence Labrecque
- Department of Kinesiology, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec CityQuébecCanada
| | - Audrey Drapeau
- Department of Kinesiology, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec CityQuébecCanada
| | - Sarah Imhoff
- Department of Kinesiology, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec CityQuébecCanada
| | - Jonathan D. Smirl
- Cerebrovascular Concussion Laboratory, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Sport Injury Prevention Research Centre, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance Laboratory, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
- Concussion Research Laboratory, Faculty of Health and Exercise ScienceUniversity of British ColumbiaKelownaBritish ColumbiaCanada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec CityQuébecCanada
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28
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Newel KT, Burma JS, Carere J, Kennedy C, Smirl JD. Does oscillation size matter? Impact of added resistance on the cerebral pressure-flow Relationship in females and males. Physiol Rep 2022; 10:e15278. [PMID: 35581899 PMCID: PMC9114660 DOI: 10.14814/phy2.15278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
Sinusoidal squat-stand maneuvers (SSM) without resistance have been shown to produce ~30-50 mmHg swings in mean arterial pressure which are largely buffered in the brain via dynamic cerebral autoregulation (dCA). This study aimed to further elucidate how this regulatory mechanism is affected during SSM with added resistance (~20% bodyweight). Twenty-five participants (sex/gender: 13 females/12 males) completed two bouts of 5-min SSM for both bodyweight and resistance conditions (10% bodyweight in each arm) at frequencies of 0.05 Hz (20-s squat/stand cycles) and 0.10 Hz (10-s squat/stand cycles). Middle and posterior cerebral artery (MCA/PCA) cerebral blood velocities were indexed with transcranial Doppler ultrasound. Beat-to-beat blood pressure (BP) was quantified via finger photoplesmography. Transfer function analysis was employed to quantify dCA in both cerebral arteries across the cardiac cycle (diastole, mean, and systole). Two-by-two Analysis of Variance with generalized eta squared effect sizes were utilized to determine differences between resistance vs. bodyweight squats and between sexes/genders. Absolute mean and diastolic BP were elevated during the resistance squats (p < 0.001); however, only the BP point-estimate power spectrum densities were augmented at 0.10 Hz (p < 0.048). No differences were noted for phase and gain metrics between bodyweight and resistance SSM (p > 0.067); however, females displayed attenuated systolic regulation (p < 0.003). Despite augmented systemic BP during resistance SSM, the brain was effective at buffering the additional stress to mitigate overperfusion/pressure. Females displayed less dCA regulation within the systolic aspect of the cardiac cycle, which may be associated with physiological underpinnings related to various clinical conditions/presentations.
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Affiliation(s)
- Kailey T. Newel
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Faculty of Health and Exercise ScienceUniversity of British ColumbiaKelownaBritish ColumbiaCanada
| | - Joel S. Burma
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
| | - Joseph Carere
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
| | - Courtney M. Kennedy
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
| | - Jonathan D. Smirl
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
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29
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Carere J, Burma JS, Newel KT, Kennedy CM, Smirl JD. Sex differences in autonomic recovery following repeated sinusoidal resistance exercise. Physiol Rep 2022; 10:e15269. [PMID: 35466556 PMCID: PMC9035755 DOI: 10.14814/phy2.15269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023] Open
Abstract
A simple bodyweight squat is sufficient to cause substantial stress on the autonomic nervous system (ANS) via ~30-50 mmHg blood pressure (BP) oscillations. However, it is unknown to the extent of the ANS is impacted during and immediately following bodyweight and resistance squat-stand maneuvers (SSM) while considering chromosomal sex. Thirteen females and twelve males performed four, 5-minute bouts of squat-stand maneuvers (SSM); two at 0.05 Hz (10-second squat/10-second stand) and two at 0.10 Hz (5-s squat/5-s stand). The SSM were performed using bodyweight resistance and additional external resistance (~20% of bodyweight). Five-minutes of quiet-sitting and quiet-standing were completed immediately following both bodyweight and resistance squats. Heart rate variability (HRV) and baroreceptor sensitivity metrics were extracted from beat-to-beat electrocardiography and systemic BP recordings. Repeated measure Analysis of Variance with generalized eta-squared effect sizes assessed differences between SSM task type and chromosomal sex on ANS metrics. Despite added resistance eliciting greater elevations in blood pressure, no differences in ANS function were noted during competition and recovery between SSM tasks (all p > 0.050; negligible/small effect sizes). During recovery, females had an elevated heart rate (p = 0.017; small effect size), greater time-domain HRV measures (p < 0.047; small effect size), greater high-frequency domain HRV measures (p = 0.002; moderate effect size), and reduced low-frequency domain HRV measures (p = 0.002; moderate effect size). A healthy ANS can modulate repetitive cardiovascular stressors via squat-stand maneuvers in a harmonious manner irrespective of added low-level resistance. Females were more parasympathetically driven following low-level resistance exercise/stress, which may be a cardioprotective trait.
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Affiliation(s)
- Joseph Carere
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryABCanada
- Alberta Children’s Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
| | - Joel S. Burma
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryABCanada
- Alberta Children’s Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
| | - Kailey T. Newel
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryABCanada
- Faculty of Health and Exercise ScienceUniversity of British ColumbiaKelownaBritish ColumbiaCanada
| | - Courtney M. Kennedy
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryABCanada
- Alberta Children’s Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
| | - Jonathan D. Smirl
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryABCanada
- Alberta Children’s Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
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Roy MA, Labrecque L, Perry BG, Korad S, Smirl JD, Brassard P. Directional sensitivity of the cerebral pressure-flow relationship in young healthy individuals trained in endurance and resistance exercise. Exp Physiol 2022; 107:299-311. [PMID: 35213765 DOI: 10.1113/ep090159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/08/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Does habitual exercise modality affect the directionality of the cerebral pressure-flow relationship? What is the main finding and its importance? These data suggest the hysteresis-like pattern of dynamic cerebral autoregulation appears present in long-term sedentary and endurance-trained individuals, but absent in resistance-trained individuals. This is the first study to expand knowledge on the directional sensitivity of the cerebral pressure-flow relationship to trained populations. ABSTRACT Evidence suggests the cerebrovasculature may be more efficient at dampening cerebral blood flow (CBF) variations when mean arterial pressure (MAP) transiently increases, compared to when it decreases. Despite divergent MAP and CBF responses to acute endurance and resistance training, the long-term impact of habitual exercise modality on the directionality of dynamic cerebral autoregulation (dCA) is currently unknown. Thirty-six young healthy participants [sedentary (n = 12), endurance-trained (n = 12) and resistance-trained (n = 12)] undertook a 5-min repeated squat-stand protocol at two forced MAP oscillation frequencies (0.05 Hz and 0.10 Hz). Middle cerebral artery mean blood velocity (MCAv) and MAP were continuously monitored. We calculated absolute (ΔMCAvT /ΔMAPT ) and relative (%MCAvT /%MAPT ) changes in MCAv and MAP with respect to the transition time intervals of both variables to compute a time-adjusted ratio in each MAP direction, averaged over the 5-min repeated squat-stand protocols. At 0.10 Hz repeated squat-stands, ΔMCAvT /ΔMAPT and %MCAvT /%MAPT were lower when MAP increased compared with when MAP decreased for sedentary (ΔMCAvT /ΔMAPT : p = 0.032; %MCAvT /%MAPT : p = 0.040) and endurance-trained individuals (ΔMCAvT /ΔMAPT : p = 0.012; %MCAvT /%MAPT : p = 0.007), but not in the resistance-trained (ΔMCAvT /ΔMAPT : p = 0.512; %MCAvT /%MAPT : p = 0.666). At 0.05 Hz repeated squat-stands, time-adjusted ratios were similar for all groups (all p>0.605). These findings suggest exercise training modality does influence the directionality of the cerebral pressure-flow relationship and support the presence of a hysteresis-like pattern during 0.10 Hz repeated squat-stands in sedentary and endurance-trained participants, but not in resistance-trained individuals. In future studies, assessment of elite endurance and resistance training habits may further elucidate modality-dependent discrepancies on directional dCA measurements. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marc-Antoine Roy
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.,Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.,Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Blake G Perry
- School of Health Sciences, Massey University, Wellington, New Zealand.,School of Sport, Exercise and Nutrition, Massey University, Wellington, New Zealand
| | - Stephanie Korad
- School of Health Sciences, Massey University, Wellington, New Zealand.,School of Sport, Exercise and Nutrition, Massey University, Wellington, New Zealand
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada.,Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.,Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
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31
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Burma JS, Kennedy CM, Penner LC, Miutz LN, Galea OA, Ainslie PN, Smirl JD. Long-term heart transplant recipients: heart rate-related effects on augmented transfer function coherence during repeated squat-stand maneuvers in males. Am J Physiol Regul Integr Comp Physiol 2021; 321:R925-R937. [PMID: 34730005 DOI: 10.1152/ajpregu.00177.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous research has highlighted that squat-stand maneuvers (SSMs) augment coherence values within the cerebral pressure-flow relationship to ∼0.99. However, it is not fully elucidated if mean arterial pressure (MAP) leads to this physiological entrainment independently, or if heart rate (HR) and/or the partial pressure of carbon dioxide (Pco2) also have contributing influences. A 2:1 control-to-case model was used in the present investigation [participant number (n) = 40; n = 16 age-matched (AM); n = 16 donor control (DM); n = 8 heart transplant recipients (HTRs)]. The latter group was used to mechanistically isolate the extent to which HR influences the cerebral pressure-flow relationship. Participants completed 5 min of squat-stand maneuvers at 0.05 Hz (10 s) and 0.10 Hz (5 s). Linear transfer function analysis (TFA) examined the relationship between different physiological inputs (i.e., MAP, HR, and Pco2) and output [cerebral blood velocity (CBV)] during SSM; and cardiac baroreceptor sensitivity (BRS). Compared with DM, cardiac BRS was reduced in AM (P < 0.001), which was further reduced in HTR (P < 0.045). In addition, during the SSM, HR was elevated in HTR compared with both control groups (P < 0.001), but all groups had near-maximal coherence metrics ≥0.98 at 0.05 Hz and ≥0.99 at 0.10 Hz (P ≥ 0.399). In contrast, the mean HR-CBV/Pco2-CBV relationships ranged from 0.38 (HTR) to 0.81 (DM). Despite near abolishment of BRS and blunted HR following heart transplantation, long-term HTR exhibited near-maximal coherence within the MAP-CBV relationship, comparable with AM and DM. Therefore, these results show that the augmented coherence with SSM is driven by blood pressure, whereas elevations in TFA coherence as a result of HR contribution are likely correlational in nature.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Courtney M Kennedy
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Linden C Penner
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Lauren N Miutz
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Olivia A Galea
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
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Burma JS, Lapointe AP, Soroush A, Oni IK, Smirl JD, Dunn JF. Insufficient sampling frequencies skew heart rate variability estimates: Implications for extracting heart rate metrics from neuroimaging and physiological data. J Biomed Inform 2021; 123:103934. [PMID: 34666185 DOI: 10.1016/j.jbi.2021.103934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/24/2021] [Accepted: 10/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND While cardiac pulsations are widely present within physiological and neuroimaging data, it is unknown the extent this information can provide valid and reliable heart rate and heart rate variability (HRV) estimates. The objective of this study was to demonstrate how a slight temporal shift due to an insufficient sampling frequency can impact the validity/accuracy of deriving cardiac metrics. METHODS Twenty-two participants were instrumented with valid/reliable industry-standard or open-source electrocardiograms. Five-minute lead II recordings were collected at 1000 Hz in an upright orthostatic position. Following artifact removal, the 1000 Hz recording for each participant was downsampled to frequencies ranging 2-500 Hz. The validity of each participant's downsampled recording was compared against their 1000 Hz recording ("reference-standard") using Bland-Altman plots with 95 % limits of agreement (LOA), coefficient of variation (CoV), intraclass correlation coefficients, and adjusted r-squared values. RESULTS Downsampled frequencies of ≥ 50 and ≥ 90 Hz produced highly robust measures with narrow log-transformed 95 % LOA (<±0.01) and low CoV values (≤3.5 %) for heart rate and HRV metrics, respectively. Below these thresholds, the log-transformed 95 % LOA became wider (LOA range: ±0.1-1.9) and more variable (CoV range: 1.5-111.6 %). CONCLUSION These results provide an important consideration for obtaining cardiac information from physiological data. Compared to the "reference-standard" ECG, a seemingly negligible temporal shift of the systolic contraction (R wave) greater than 11-milliseconds (90 Hz) away from its true value, lessened the validity of the HRV. Further research is warranted to determine the minimum sampling frequency required to obtain valid heart rate/HRV metrics from pulsatile waveforms.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
| | - Andrew P Lapointe
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ateyeh Soroush
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ibukunoluwa K Oni
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
| | - Jeff F Dunn
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Burma JS, Wassmuth RM, Kennedy CM, Miutz LN, Newel KT, Carere J, Smirl JD. Does task complexity impact the neurovascular coupling response similarly between males and females? Physiol Rep 2021; 9:e15020. [PMID: 34514743 PMCID: PMC8436054 DOI: 10.14814/phy2.15020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND While previous studies have demonstrated a complex visual scene search elicits a robust neurovascular coupling (NVC) response, it is unknown how the duration of visual stimuli presentation influences NVC metrics. This study examined how stimuli duration, in addition to biological sex and self-reported engagement impact NVC responses. METHODS Participants (n = 20, female = 10) completed four visual paradigms. Three involved simple visual shapes presented at 0.5-, 2-, and 4-s intervals in randomized orders. The fourth paradigm was a complex visual scene search ("Where's Waldo?"). Participants completed eight cycles of 20-s eyes-closed followed by 40-s eyes-open. Transcranial Doppler ultrasound indexed posterior and middle cerebral artery velocities (PCA and MCA). Participants self-reported their engagement following each task (1 [minimal] to 10 [maximal]). RESULTS The "Where's Waldo?" task evoked greater PCA percent increase (all p < 0.001) and area under the curve during the first 30-s of the task (all p < 0.001) compared to simple shapes. Females displayed greater absolute baseline and peak PCA and MCA velocities across all tasks (all p < 0.002). Subjective engagement displayed moderate correlation levels with PCA percent increase (Spearman ρ = 0.58) and area under the curve (Spearman ρ = 0.60) metrics in males, whereas these were weak for females (Spearman ρ = 0.43 and ρ = 0.38, respectively). CONCLUSIONS The complex visual paradigm "Where's Waldo?" greatly augmented the signal-to-noise ratio within the PCA aspects of the NVC response compared to simple shapes. While both sexes had similar NVC responses, task engagement was more related to NVC metrics in males compared to females. Therefore, future NVC investigations should consider task engagement when designing studies.
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Brassard P, Labrecque L, Smirl JD, Tymko MM, Caldwell HG, Hoiland RL, Lucas SJE, Denault AY, Couture EJ, Ainslie PN. Losing the dogmatic view of cerebral autoregulation. Physiol Rep 2021; 9:e14982. [PMID: 34323023 PMCID: PMC8319534 DOI: 10.14814/phy2.14982] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/04/2021] [Indexed: 02/07/2023] Open
Abstract
In 1959, Niels Lassen illustrated the cerebral autoregulation curve in the classic review article entitled Cerebral Blood Flow and Oxygen Consumption in Man. This concept suggested a relatively broad mean arterial pressure range (~60-150 mmHg) wherein cerebral blood flow remains constant. However, the assumption that this wide cerebral autoregulation plateau could be applied on a within-individual basis is incorrect and greatly variable between individuals. Indeed, each data point on the autoregulatory curve originated from independent samples of participants and patients and represented interindividual relationships between cerebral blood flow and mean arterial pressure. Nonetheless, this influential concept remains commonly cited and illustrated in various high-impact publications and medical textbooks, and is frequently taught in medical and science education without appropriate nuances and caveats. Herein, we provide the rationale and additional experimental data supporting the notion we need to lose this dogmatic view of cerebral autoregulation.
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Affiliation(s)
- Patrice Brassard
- Department of KinesiologyFaculty of MedicineUniversité LavalQuébecQCCanada
- Research center of the Institut universitaire de cardiologie et de pneumologie de QuébecQuébecQCCanada
| | - Lawrence Labrecque
- Department of KinesiologyFaculty of MedicineUniversité LavalQuébecQCCanada
- Research center of the Institut universitaire de cardiologie et de pneumologie de QuébecQuébecQCCanada
| | - Jonathan D. Smirl
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryABCanada
- Cerebrovascular Concussion LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryABCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryABCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryABCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryABCanada
- Alberta Children’s Hospital Research InstituteUniversity of CalgaryCalgaryABCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryABCanada
| | - Michael M. Tymko
- Neurovascular Health LaboratoryUniversity of AlbertaEdmontonABCanada
| | - Hannah G. Caldwell
- Center for Heart, Lung and Vascular HealthSchool of Health and Exercise SciencesUniversity of British Columbia – OkanaganKelownaBCCanada
| | - Ryan L. Hoiland
- Department of Cellular and Physiological SciencesFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
- Department of Anesthesiology, Pharmacology and TherapeuticsUniversity of British ColumbiaVancouverBCCanada
| | - Samuel J. E. Lucas
- School of Sport, Exercise and Rehabilitation SciencesCollege of Life and Environmental SciencesUniversity of BirminghamBirminghamUnited Kingdom
- Centre for Human Brain HealthUniversity of BirminghamBirminghamUnited Kingdom
| | - André Y. Denault
- Department of Anesthesiology and Critical Care DivisionMontreal Heart InstituteMontrealQCCanada
- Division of Critical Care MedicineCentre Hospitalier de l’Université de MontréalMontrealQCCanada
| | - Etienne J. Couture
- Research center of the Institut universitaire de cardiologie et de pneumologie de QuébecQuébecQCCanada
| | - Philip N. Ainslie
- Center for Heart, Lung and Vascular HealthSchool of Health and Exercise SciencesUniversity of British Columbia – OkanaganKelownaBCCanada
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Labrecque L, Smirl JD, Brassard P. Utilization of the repeated squat-stand model for studying the directional sensitivity of the cerebral pressure-flow relationship. J Appl Physiol (1985) 2021; 131:927-936. [PMID: 34264130 DOI: 10.1152/japplphysiol.00269.2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Hysteresis in the cerebral pressure-flow relationship describes the superior ability of the cerebrovasculature to buffer cerebral blood flow changes when mean arterial pressure (MAP) increases compared with when MAP decreases. This phenomenon can be evaluated by comparing the change in middle cerebral artery mean blood velocity (MCAv) per change in MAP during either acute increases or decreases in MAP induced by repeated squat-stands (RSS). However, no real baseline can be used for this particular protocol as there is no true stable reference point. Herein, we characterized a novel metric using the greatest MAP oscillations induced by RSS without using an independent baseline value and adjusted for time intervals (ΔMCAvT/ΔMAPT). We also examined whether this metric during each RSS transition was comparable between each other over a 5-min period. ΔMCAvT/ΔMAPT was calculated using the minimum to maximum MCAv and MAP for each RSS performed at 0.05 Hz and 0.10 Hz. We compared averaged ΔMCAvT/ΔMAPT during MAP increases and decreases in 74 healthy participants [9 women; 26 (20-74) yr]. ΔMCAvT/ΔMAPT was lower for MAP increases than MAP decreases at 0.10 Hz RSS only (0.91 ± 0.34 vs. 1.01 ± 0.44 cm·s-1/mmHg; P = 0.0013). For both frequency and MAP direction, time during RSS had no effect on ΔMCAvT/ΔMAPT. This novel analytical method supports the use of the RSS model to evaluate the directional sensitivity of the pressure-flow relationship. These results contribute to the importance of considering the direction of MAP changes, depending on the oscillations frequency when evaluating dynamic cerebral autoregulation.NEW & NOTEWORTHY Repeated squat-stand maneuvers are able to examine the directional sensitivity of the cerebral pressure-flow relationship. These maneuvers induce stable physiological cyclic changes where brain blood flow changes with blood pressure increases are buffered more than blood pressure decreases. These results highlight the importance of considering directional blood pressure changes within cerebral autoregulation.
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Affiliation(s)
- Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada
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Burma JS, Macaulay A, Copeland P, Khatra O, Bouliane KJ, Smirl JD. Comparison of cerebrovascular reactivity recovery following high-intensity interval training and moderate-intensity continuous training. Physiol Rep 2021; 8:e14467. [PMID: 32506845 PMCID: PMC7276190 DOI: 10.14814/phy2.14467] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 12/27/2022] Open
Abstract
A common inclusion criterion when assessing cerebrovascular (CVR) metrics is for individuals to abstain from exercise for 12–24 hr prior to data collections. While several studies have examined CVR during exercise, the literature describing CVR throughout post‐exercise recovery is sparse. The current investigation examined CVR measurements in nine participants (seven male) before and for 8 hr following three conditions: 45‐min moderate‐continuous exercise (at ~50% heart‐rate reserve), 25‐min high‐intensity intervals (ten, one‐minute intervals at ~85% heart‐rate reserve), and a control day (30‐min quiet rest). The hypercapnic (40–60 mmHg) and hypocapnic (25–40 mmHg) slopes were assessed via a modified rebreathing technique and controlled stepwise hyperventilation, respectively. All testing was initiated at 8:00a.m. with transcranial Doppler ultrasound measurements to index cerebral blood velocity performed prior to the condition (pre) with serial follow‐ups at zero, one, two, four, six, and eight hours within the middle and posterior cerebral artery (MCA, PCA). Absolute and relative MCA and PCA hypercapnic slopes were attenuated following high‐intensity intervals at hours zero and one (all p < .02). No alterations were observed in either hypocapnic or hypercapnic slopes following the control or moderate‐continuous exercise (all p > .13), aside from a reduced relative hypercapnic MCA slope at hours zero and one following moderate‐continuous exercise (all p < .005). The current findings indicate the common inclusion criteria of a 12–24 hr time restriction on exercise can be reduced to two hours when performing CVR measures. Furthermore, the consistent nature of the CVR indices throughout the control day indicate reproducible testing sessions can be made between 8:00a.m. and 7:00p.m.
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Affiliation(s)
- Joel S Burma
- Sport Concussion Research Lab, University of British Columbia, Kelowna, BC, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Human Performance Laboratory, University of Calgary, Calgary, AB, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
| | - Alannah Macaulay
- Sport Concussion Research Lab, University of British Columbia, Kelowna, BC, Canada
| | - Paige Copeland
- Sport Concussion Research Lab, University of British Columbia, Kelowna, BC, Canada
| | - Omeet Khatra
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kevin J Bouliane
- Sport Concussion Research Lab, University of British Columbia, Kelowna, BC, Canada
| | - Jonathan D Smirl
- Sport Concussion Research Lab, University of British Columbia, Kelowna, BC, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Human Performance Laboratory, University of Calgary, Calgary, AB, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
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Burma JS, Lapointe AP, Soroush A, Oni IK, Smirl JD, Dunn JF. The validity and reliability of an open source biosensing board to quantify heart rate variability. Heliyon 2021; 7:e07148. [PMID: 34124405 PMCID: PMC8173091 DOI: 10.1016/j.heliyon.2021.e07148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/17/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Heart rate variability (HRV) is a popular tool to quantify autonomic function. However, this typically requires an expensive 3-12 lead electrocardiogram (ECG) and BioAmp system. This investigation sought to determine the validity and reliability of an OpenBCI cyton biosensing board (open source) for accurately quantifying HRV. New method A cyton board with a 3-lead ECG was employed to acquire heart rate waveform data, which was processed to obtain HRV within both time- and frequency-domains. The concurrent validity was compared to a simultaneous recording from an industry-standard 3-lead ECG (ADInstruments) (n = 15). The reliability of the cyton board was compared between three days within a 7-day timespan (n = 10). Upright quiet-stance short-term HRV metrics were quantified in time- and frequency-domains. Results The two devices displayed excellent limits of agreements (all log mean differences ±0.4) and very high between-device variable associations (all r 2 > 0.98). Between the three time points in the same subjects, no differences were noted within time- (all p > 0.71) or frequency-domains (all p > 0.88) across testing points. Finally, all HRV metrics exhibited excellent levels of reliability through high Cronbach's Alpha (all ≥0.916) and intraclass correlation coefficients (all ≥0.930); and small standard error of the measurement (all ≤0.7) and typical error of the measurement (all ≤0.1) metrics. Comparison with existing methods The cyton board with 3-lead ECG was compared with an industry-standard ADInstruments ECG during HRV assessments. There were no significant differences between devices with respect to time- and frequency-domains. The cyton board displayed high-levels of between-day reliability and provided values harmonious to previous ECG literature highlighting the applicability for longitudinal studies. Conclusion With proper background knowledge regarding ECG principles and a small degree of set-up complexity, an open source cyton board can be created and employed to perform multimodal HRV assessments at a fraction of the cost (~4%) of an industry-standard ECG setup.
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Affiliation(s)
- Joel S. Burma
- Cerebrovascular Concussion Laboratory, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
| | - Andrew P. Lapointe
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ateyeh Soroush
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ibukunoluwa K. Oni
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D. Smirl
- Cerebrovascular Concussion Laboratory, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
| | - Jeff F. Dunn
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Corresponding author.
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Burma JS, Miutz LN, Newel KT, Labrecque L, Drapeau A, Brassard P, Copeland P, Macaulay A, Smirl JD. What recording duration is required to provide physiologically valid and reliable dynamic cerebral autoregulation transfer functional analysis estimates? Physiol Meas 2021; 42. [PMID: 33761474 DOI: 10.1088/1361-6579/abf1af] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/24/2021] [Indexed: 12/31/2022]
Abstract
Objective. Currently, a recording of 300 s is recommended to obtain accurate dynamic cerebral autoregulation estimates using transfer function analysis (TFA). Therefore, this investigation sought to explore the concurrent validity and the within- and between-day reliability of TFA estimates derived from shorter recording durations from squat-stand maneuvers.Approach. Retrospective analyses were performed on 70 young, recreationally active or endurance-trained participants (17 females; age: 26 ± 5 years, [range: 20-39 years]; body mass index: 24 ± 3 kg m-2). Participants performed 300 s of squat-stands at frequencies of 0.05 and 0.10 Hz, where shorter recordings of 60, 120, 180, and 240 s were extracted. Continuous transcranial Doppler ultrasound recordings were taken within the middle and posterior cerebral arteries. Coherence, phase, gain, and normalized gain metrics were derived. Bland-Altman plots with 95% limits of agreement (LOA), repeated measures ANOVA's, two-tailed paired t-tests, coefficient of variation, Cronbach's alpha, intraclass correlation coefficients, and linear regressions were conducted.Main results. When examining the concurrent validity across different recording durations, group differences were noted within coherence (F(4155) > 11.6,p < 0.001) but not phase (F(4155) < 0.27,p > 0.611), gain (F(4155) < 0.61,p > 0.440), or normalized gain (F(4155) < 0.85,p > 0.359) parameters. The Bland-Altman 95% LOA measuring the concurrent validity, trended to narrow as recording duration increased (60 s: < ±0.4, 120 s: < ±0.3, 180 s < ±0.3, 240 s: < ±0.1). The validity of the 180 and 240 s recordings further increased when physiological covariates were included within regression models.Significance. Future studies examining autoregulation should seek to have participants perform 300 s of squat-stand maneuvers. However, valid and reliable TFA estimates can be drawn from 240 s or 180 s recordings if physiological covariates are controlled.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada.,Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | - Lauren N Miutz
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
| | - Kailey T Newel
- Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | - Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Audrey Drapeau
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Paige Copeland
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | - Alannah Macaulay
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada.,Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
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Burma JS, Graver S, Miutz LN, Macaulay A, Copeland PV, Smirl JD. The validity and reliability of ultra-short-term heart rate variability parameters and the influence of physiological covariates. J Appl Physiol (1985) 2021; 130:1848-1867. [PMID: 33856258 DOI: 10.1152/japplphysiol.00955.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Ultra-short-term (UST) heart rate variability (HRV) metrics have increasingly been proposed as surrogates for short-term HRV metrics. However, the concurrent validity, within-day reliability, and between-day reliability of UST HRV have yet to be comprehensively documented. Thirty-six adults (18 males, age: 26 ± 5 yr, BMI: 24 ± 3 kg/m2) were recruited. Measures of HRV were quantified in a quiet-stance upright orthostatic position via three-lead electrocardiogram (ADInstruments, FE232 BioAmp). All short-term data recordings were 300 s in length and five UST time points (i.e., 30 s, 60 s, 120 s, 180 s, and 240 s) were extracted from the original 300-s recording. Bland-Altman plots with 95% limits of agreement, repeated measures ANOVA and two-tailed paired t tests demarcated differences between UST and short-term recordings. Linear regressions, coefficient of variation, intraclass correlation coefficients, and other tests examined the validity and reliability in both time- and frequency domains. No group differences were noted between all short-term and UST measures, for either time- (all P > 0.202) or frequency-domain metrics (all P > 0.086). A longer recording duration was associated with augmented validity and reliability, which was less impacted by confounding influences from physiological variables (e.g., respiration rate, carbon dioxide end-tidals, and blood pressure). Conclusively, heart rate, time-domain, and relative frequency-domain HRV metrics were acceptable with recordings greater or equal to 60 s, 240 s, and 300 s, respectively. Future studies employing UST HRV metrics should thoroughly understand the methodological requirements to obtain accurate results. Moreover, a conservative approach should be utilized regarding the minimum acceptable recording duration, which ensures valid/reliable HRV estimates are obtained.NEW & NOTEWORTHY A one size fits all methodological approach to quantify HRV metrics appears to be inappropriate, where study design considerations need to be conducted upon a variable-by-variable basis. The present results found 60 s (heart rate), 240 s (time-domain parameters), and 300 s (relative frequency-domain parameters) were required to obtain accurate and reproducible metrics. The lower validity/reliability of the ultra-short-term metrics was attributable to measurement error and/or confounding from extraneous physiological influences (i.e., respiratory and hemodynamic variables).
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada
| | - Sarah Graver
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Lauren N Miutz
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
| | - Alannah Macaulay
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada
| | - Paige V Copeland
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada
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Burma JS, Copeland P, Macaulay A, Khatra O, Wright AD, Smirl JD. Dynamic cerebral autoregulation across the cardiac cycle during 8 hr of recovery from acute exercise. Physiol Rep 2021; 8:e14367. [PMID: 32163235 PMCID: PMC7066871 DOI: 10.14814/phy2.14367] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 12/28/2019] [Accepted: 12/30/2019] [Indexed: 01/02/2023] Open
Abstract
Current protocols examining cerebral autoregulation (CA) parameters require participants to refrain from exercise for 12–24 hr, however there is sparse objective evidence examining the recovery trajectory of these measures following exercise across the cardiac cycle (diastole, mean, and systole). Therefore, this study sought to determine the duration acute exercise impacts CA and the within‐day reproducibility of these measures. Nine participants performed squat–stand maneuvers at 0.05 and 0.10 Hz at baseline before three interventions: 45‐min moderate‐continuous exercise (at 50% heart‐rate reserve), 30‐min high‐intensity intervals (ten, 1‐min at 85% heart‐rate reserve), and a control day (30‐min quiet rest). Squat–stands were repeated at hours zero, one, two, four, six, and eight after each condition. Transcranial doppler ultrasound of the middle cerebral artery (MCA) and the posterior cerebral artery (PCA) was used to characterize CA parameters across the cardiac cycle. At baseline, the systolic CA parameters were different than mean and diastolic components (ps < 0.015), however following both exercise protocols in both frequencies this disappeared until hour four within the MCA (ps > 0.079). In the PCA, phase values were affected only following high‐intensity intervals until hour four (ps > 0.055). Normalized gain in all cardiac cycle domains remained different following both exercise protocols (ps < 0.005) and across the control day (p < .050). All systolic differences returned by hour six across all measures (ps < 0.034). Future CA studies may use squat–stand maneuvers to assess the cerebral pressure–flow relationship 6 hr after exercise. Finally, CA measures under this paradigm appear to have negligible within‐day variation, allowing for reproducible interpretations to be drawn.
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Affiliation(s)
- Joel S Burma
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada.,Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Paige Copeland
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | - Alannah Macaulay
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | - Omeet Khatra
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alexander D Wright
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada.,MD/PhD Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Southern Medical Program, University of British Columbia, Kelowna, BC, Canada
| | - Jonathan D Smirl
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada.,Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Southern Medical Program, University of British Columbia, Kelowna, BC, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
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Morrison HR, Miutz LN, Emery CA, Smirl JD. A Standardized Buffalo Concussion Treadmill Test Following Sport-Related Concussion in Youth: Do ActiGraph Algorithms Matter? J Athl Train 2021; 56:451546. [PMID: 33481016 PMCID: PMC8675320 DOI: 10.4085/527-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Current recovery guidelines following sport-related concussion (SRC) include 24-48 hours of rest followed by gradual return-to-activity with heart rate (HR) maintained below symptom threshold. Additionally, the monitoring of physical activity (PA) post-SRC using ActiGraph accelerometers can provide further objective insight on amounts of activity associated with recovery trajectories. Cut-point algorithms for these devices allow minute-by-minute PA to be classified into intensity domains; however, studies have shown different algorithms employed on the same healthy participant dataset can produce varying classifications. OBJECTIVE To identify the most physiologically appropriate cut-point algorithm (Evenson or Romanzini) to analyze ActiGraph data in concussed youth with comparisons to HR response on the Buffalo Concussion Treadmill Test (BCTT). DESIGN Prospective cohort study. SETTING Sport-concussion clinic within a university setting. PATIENTS OR OTHER PARTICIPANTS Eleven high-school students (5 male, 6 female; median [range] age =16 years [15-17], height = 177.8 cm [157.5-198.1], weight = 67 kg [52-98], body mass index = 22 kg/m2 [17-31]) involved in high-risk sport who sustained a physician diagnosed SRC. MAIN OUTCOME MEASURE(S) Evenson and Romanzini algorithm PA intensity domains via ActiGraph data and HR during the BCTT. RESULTS There were differences in moderate (P = .001) and vigorous (P = .002) intensities between algorithms, but no difference in light (P = .548). Evenson classified most of the time as moderate intensity (57.03% [0.00-94.12%]), whereas Romanzini classified virtually all PA as vigorous (88.25% [2.94-97.06%]). PA based on HR (stages 1-7: 20-39% HR reserve (HRR), stages 8-13: 40-59% HRR, stages 14 and above: 60-85% HRR) indicated the BCTT primarily involves light-to-moderate intensity, and therefore is better represented by the Evenson algorithm. CONCLUSIONS The Evenson algorithm better characterizes the HR response during a standardized exercise test in concussed individuals and therefore should be used to analyze ActiGraph PA data in a concussed paediatric population.
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Affiliation(s)
| | | | - Carolyn A. Emery
- Sport Injury Prevention Research Centre, AB, Canada
- Hotchkiss Brain Institute, AB, Canada
- Alberta Children's Hospital Research Institute, AB, Canada
- Department of Psychology and Neurosciences, University of Calgary, AB, Canada
- Department of Paediatrics, University of Calgary, AB, Canada
- Community Health Sciences, University of Calgary, AB, Canada
| | - Jonathan D. Smirl
- Sport Injury Prevention Research Centre, AB, Canada
- Hotchkiss Brain Institute, AB, Canada
- Alberta Children's Hospital Research Institute, AB, Canada
- Libin Cardiovascular Institute, University of Calgary, AB, Canada
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Abstract
Background: Near point of convergence (NPC) assesses the vergence ability of the visuo-oculomotor system; however, little is known regarding: the extent and duration exercise impacts NPC and the between- and within-day reliability of NPC metrics.Methods: An accommodative ruler with a miniature Snellen chart was placed upon the philtrum (upper lip). Participants (n=9) focused upon a 'V' sized 20/20, while the chart was moved at ~1-2 cm/s toward and away from the eyes (twice in each direction). Testing commenced at 8:00am with NPC measures being collected at baseline before three randomized conditions with serial follow-ups occurring at six post-condition timepoints (0-8 hours following). The conditions consisted of 25-minutes high-intensity intervals (10, one-minute intervals at ~85-90% heart-rate reserve), 45-minutes of moderate-intensity exercise (at ~50-60% heart-rate reserve), and a control condition (30-minutes quiet rest).Results: NPC was not impacted across any of the three conditions (all p > .59). Additionally, NPC measures between baseline conditions and across the control condition displayed very high levels of within-day and between-day reliability (coefficient of variation <3.8%).Conclusions: Future NPC measures using an accommodative ruler can be taken immediately following exercise and may be pertinent as a complementary tool in the future sideline screening of concussion.
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Affiliation(s)
- Joel S Burma
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada.,Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Paige V Copeland
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | - Alannah Macaulay
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | - Jonathan D Smirl
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada.,Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Burma JS, Macaulay A, Copeland PV, Khatra O, Bouliane KJ, Smirl JD. Temporal evolution of neurovascular coupling recovery following moderate- and high-intensity exercise. Physiol Rep 2021; 9:e14695. [PMID: 33463899 PMCID: PMC7814491 DOI: 10.14814/phy2.14695] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Studies examining neurovascular coupling (NVC) require participants to refrain from exercise for 12-24 hours. However, there is a paucity of empirical evidence for this restriction. The objectives for this study were to delineate the time-course recovery of NVC metrics following exercise and establish the NVC within- and between-day reliability. METHODS Nine participants completed a complex visual search paradigm to assess NVC via transcranial Doppler ultrasound of the posterior cerebral artery blood velocity (PCA). Measurements were performed prior to and throughout the 8-hour recovery period following three randomized conditions: 45 minutes of moderate-intensity exercise (at 50% heart-rate reserve), 30 minutes high-intensity intervals (10, 1-minute intervals at 85% heart-rate reserve), and control (30 minutes quiet rest). In each condition, baseline measures were collected at 8:00am with serial follow-ups at hours zero, one, two, four, six, and eight. RESULTS Area-under-the-curve and time-to-peak PCA velocity during the visual search were attenuated at hour zero following high-intensity intervals (all p < 0.05); however, these NVC metrics recovered at hour one (all p > 0.13). Conversely, baseline PCA velocity, peak PCA velocity, and the relative percent increase were not different following high-intensity intervals compared to baseline (all p > 0.26). No NVC metrics differed from baseline following both moderate exercise and control conditions (all p > 0.24). The majority of the NVC parameters demonstrated high levels of reliability (intraclass correlation coefficient: >0.90). CONCLUSION Future NVC assessments can take place a minimum of one hour following exercise. Moreover, all metrics did not change across the control condition, therefore future studies using this methodology can reliably quantify NVC between 8:00am and 7:00 pm.
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Affiliation(s)
- Joel S. Burma
- Concussion Research LaboratoryFaculty of Health and Exercise ScienceUniversity of British ColumbiaKelownaBCCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryABCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryABCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryABCanada
- Alberta Children’s Hospital Research InstituteUniversity of CalgaryCalgaryABCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryABCanada
| | - Alannah Macaulay
- Concussion Research LaboratoryFaculty of Health and Exercise ScienceUniversity of British ColumbiaKelownaBCCanada
- School of Health Sciences, Nuclear MedicineBritish Columbia Institute of TechnologyBurnabyBCCanada
| | - Paige V. Copeland
- Concussion Research LaboratoryFaculty of Health and Exercise ScienceUniversity of British ColumbiaKelownaBCCanada
| | - Omeet Khatra
- Faculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Kevin J. Bouliane
- Concussion Research LaboratoryFaculty of Health and Exercise ScienceUniversity of British ColumbiaKelownaBCCanada
| | - Jonathan D. Smirl
- Concussion Research LaboratoryFaculty of Health and Exercise ScienceUniversity of British ColumbiaKelownaBCCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryABCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryABCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryABCanada
- Alberta Children’s Hospital Research InstituteUniversity of CalgaryCalgaryABCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryABCanada
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Burma JS, Copeland PV, Macaulay A, Khatra O, Smirl JD. Effects of high-intensity intervals and moderate-intensity exercise on baroreceptor sensitivity and heart rate variability during recovery. Appl Physiol Nutr Metab 2020; 45:1156-1164. [DOI: 10.1139/apnm-2019-0810] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Numerous studies have examined heart rate variability (HRV) and cardiac baroreceptor sensitivity (BRS) variables during recovery both acutely (under 3 h) and long-term (24, 48, and 72 h) postexercise. However, there is little literature examining HRV and BRS measures between these timepoints. Spontaneous short-term HRV and cardiac BRS measures were collected in 9 participants before and at zero, 1, 2, 4, 6, and 8 h after 3 separate conditions: moderate-intensity continuous exercise (MICE; 45 min at 50% heart rate reserve), high-intensity interval exercise (HIIE; 25 min including ten 1-min intervals at 85% heart rate reserve), and control (30 min quiet rest). HRV measures in the time domain were only affected immediately following HIIE and MICE at hour zero (all p < 0.043), whereas frequency-domain metrics were unaltered (all p > 0.102). These measures were highly consistent across the control day (all p > 0.420). Cardiac BRS was assessed via low-frequency (LF) gain, and revealed reductions following HIIE at hour zero (p < 0.012). Cardiac BRS LF gain remained consistent following MICE and control interventions (all p > 0.280). The common practice of waiting 12 to 24 h is overly conservative as the current findings demonstrate measures return to baseline at ∼60 min after exercise. Moreover, these metrics demonstrated high levels of within- and between-day reliability. Novelty Previously a 12-h minimum restriction from exercise was required before participation in HRV/BRS studies. Recovery from moderate-intensity exercise for HRV and BRS metrics was <60 min; whereas, high-intensity intervals led to alterations for approximately 60 min. Spontaneous HRV and cardiac BRS demonstrated high levels of within-day reproducibility.
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Affiliation(s)
- Joel S. Burma
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC V1V 1V7, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Paige V. Copeland
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC V1V 1V7, Canada
| | - Alannah Macaulay
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC V1V 1V7, Canada
- School of Health Sciences, Nuclear Medicine, British Columbia Institute of Technology, Burnaby, BC V6T 1Z4, Canada
| | - Omeet Khatra
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Jonathan D. Smirl
- Concussion Research Laboratory, Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC V1V 1V7, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
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45
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Smirl JD, Peacock D, Wright AD, Bouliane KJ, Dierijck J, Burma JS, Kennefick M, Wallace C, van Donkelaar P. An Acute Bout of Soccer Heading Subtly Alters Neurovascular Coupling Metrics. Front Neurol 2020; 11:738. [PMID: 32849205 PMCID: PMC7396491 DOI: 10.3389/fneur.2020.00738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/16/2020] [Indexed: 01/22/2023] Open
Abstract
Objective: The current investigation examined how a bout of soccer heading may impact brain function. Design: Semi-randomized crossover cohort. Setting: Controlled soccer heading. Participants: Seven male soccer players (24.1 ± 1.5 years). Intervention: 40 successful soccer headers were performed in 20 min (25 m, launch velocity ~80 km/h). X2 xPatch recorded linear and rotational head accelerations during each impact. A contact control “sham” condition – ball made body contact, but not by the head; and a no activity time “control” condition were also completed. Main Outcome Measures: Posterior and middle cerebral artery (PCA and MCA, respectively), cerebral blood velocity (CBV) was recorded during a visual task (neurovascular coupling: NVC) alongside SCAT3 symptoms scores pre/post a controlled bout of soccer heading. Results: Cumulative linear and rotational accelerations were 1,574 ± 97.9 g and 313,761 ± 23,966 rads/s2, respectively, during heading and changes in SCAT3 symptom number (pre: 2.6 ± 3.0; post: 6.7 ± 6.2, p = 0.13) and severity (pre: 3.7 ± 3.6, post: 9.4 ± 7.6, p = 0.11) were unchanged. In the PCA, no NVC differences were observed, including: relative CBV increase (28.0 ± 7.6%, p = 0.71) and total activation (188.7 ± 68.1 cm, p = 0.93). However, MCA-derived NVC metrics were blunted following heading, demonstrating decreased relative CBV increase (7.8 ± 3.1%, p = 0.03) and decreased total activation (26.7 ± 45.3 cm, p = 0.04). Conclusion: Although an acute bout of soccer heading did not result in an increase of concussion-like symptoms, there were alterations in NVC responses within the MCA during a visual task. This suggests an acute bout of repetitive soccer heading can alter CBV regulation within the region of the brain associated with the header impacts.
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Affiliation(s)
- Jonathan D Smirl
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada.,Human Performance Laboratory, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Dakota Peacock
- Southern Medical Program, University of British Columbia, Kelowna, BC, Canada
| | - Alexander D Wright
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada.,Southern Medical Program, University of British Columbia, Kelowna, BC, Canada.,MD/PhD Program, University of British Columbia, Vancouver, BC, Canada.,Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kevin J Bouliane
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada
| | - Jill Dierijck
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada.,Faculty of Health, School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Joel S Burma
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada.,Human Performance Laboratory, University of Calgary, Calgary, AB, Canada
| | - Michael Kennefick
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada
| | - Colin Wallace
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada
| | - Paul van Donkelaar
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada
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46
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Burma JS, Copeland P, Macaulay A, Khatra O, Smirl JD. Comparison of diurnal variation, anatomical location, and biological sex within spontaneous and driven dynamic cerebral autoregulation measures. Physiol Rep 2020; 8:e14458. [PMID: 32537905 PMCID: PMC7293969 DOI: 10.14814/phy2.14458] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/04/2020] [Accepted: 04/10/2020] [Indexed: 01/31/2023] Open
Abstract
Presently, the literature describing the influence of diurnal variation on dynamic cerebral autoregulation (dCA) metrics is sparse. Additionally, there is little data with respect to dCA comparisons between anterior/posterior circulation beds and biological sexes using squat-stand maneuvers. Eight male and eight female participants (n = 16) performed 5 min of spontaneous upright rest and squat-stand maneuvers at 0.05 and 0.10 Hz across seven time points throughout the day. All testing sessions commenced at 8:00 a.m. each day and dCA parameters were quantified across the cardiac cycle (diastole, mean, and systole) using transcranial Doppler ultrasound to insonate cerebral blood velocity within the middle and posterior cerebral arteries (MCA, PCA). No cardiac cycle alternations were seen spontaneous (all p > .207) while a trend was noted in some driven (all p > .051) dCA metrics. Driven dCA produced much lower coefficient of variances (all <21%) compared with spontaneous (all <58%). Moreover, no sex differences were found within driven metrics (all p > .096). Between vessels, PCA absolute gain was reduced within all spontaneous and driven measures (all p < .014) whereas coherence, phase, and normalized gain were unchanged (all p > .099). There appears to be little influence of diurnal variation on dCA measures across the day (8:00 a.m. to 6:00 p.m.). Absolute gain was blunted in the PCA relative to the MCA and consistent with previous literature, driven methods demonstrated vastly improved reproducibility metrics compared to spontaneous methods. Finally, no dCA differences were found between biological sexes, demonstrating that males and females regulate in a harmonious manner, when females are tested within the early follicular phase of the menstrual cycle.
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Affiliation(s)
- Joel S. Burma
- Concussion Research LaboratoryFaculty of Health and Exercise ScienceUniversity of British ColumbiaKelownaBCCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryABCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryABCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryABCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryABCanada
| | - Paige Copeland
- Concussion Research LaboratoryFaculty of Health and Exercise ScienceUniversity of British ColumbiaKelownaBCCanada
| | - Alannah Macaulay
- Concussion Research LaboratoryFaculty of Health and Exercise ScienceUniversity of British ColumbiaKelownaBCCanada
| | - Omeet Khatra
- Faculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Jonathan D. Smirl
- Concussion Research LaboratoryFaculty of Health and Exercise ScienceUniversity of British ColumbiaKelownaBCCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryABCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryABCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryABCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryABCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryABCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryABCanada
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47
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Wright AD, Smirl JD, Bryk K, Jakovac M, van Donkelaar P. A Prospective Transcranial Doppler Ultrasound-Based Evaluation of the Effects of Repetitive Subconcussive Head Trauma on Neurovascular Coupling Dynamics. Clin J Sport Med 2020; 30 Suppl 1:S53-S60. [PMID: 32132478 DOI: 10.1097/jsm.0000000000000578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effects of repetitive subconcussive head trauma on neurovascular coupling (NVC) responses. DESIGN Prospective cohort study collected between September 2013 and December 2016. SETTING University laboratory. PARTICIPANTS One hundred seventy-nine elite, junior-level (age, 19.6 ± 1.5 years) contact sport (ice hockey, American football) athletes recruited for preseason testing. Fifty-two nonconcussed athletes returned for postseason testing. Fifteen noncontact sport athletes (age, 20.4 ± 2.2 years) also completed preseason and postseason testing. EXPOSURE(S) Subconcussive sport-related head trauma. MAIN OUTCOME MEASURES Dynamics of NVC were estimated during cycles of 20 seconds eyes closed and 40 seconds eyes open to a visual stimulus (reading) by measuring cerebral blood flow (CBF) velocity in the posterior (PCA) and middle (MCA) cerebral arteries via transcranial Doppler ultrasound. RESULTS Both athlete groups demonstrated no significant differences in PCA or MCA NVC dynamics between preseason and postseason, despite exposure to a median of 353.5 (range, 295.0-587.3) head impacts (>2g) over the course of the season for contact sport athletes. CONCLUSIONS Within the context of growing concern over detrimental effects of repetitive subconcussive trauma, the current results encouragingly suggest that the dynamics of NVC responses are not affected by 1 season of participation in junior-level ice hockey or American football. This is an important finding because it indicates an appropriate postseason CBF response to elevated metabolic demand with increases in neural activity.
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Affiliation(s)
- Alexander D Wright
- MD/PhD Program, University of British Columbia, Vancouver, BC, Canada
- Southern Medical Program, Reichwald Health Sciences Centre, University of British Columbia Okanagan, Kelowna, BC, Canada
- Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; and
| | - Jonathan D Smirl
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; and
| | - Kelsey Bryk
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; and
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Michael Jakovac
- Southern Medical Program, Reichwald Health Sciences Centre, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; and
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48
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Smirl JD, Jones KE, Copeland P, Khatra O, Taylor EH, Van Donkelaar P. Characterizing symptoms of traumatic brain injury in survivors of intimate partner violence. Brain Inj 2019; 33:1529-1538. [DOI: 10.1080/02699052.2019.1658129] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jonathan D. Smirl
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - K. Elisabeth Jones
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Paige Copeland
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Omeet Khatra
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward H. Taylor
- School of Social Work, University of British Columbia, Kelowna, British Columbia, Canada
| | - Paul Van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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49
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Labrecque L, Smirl JD, Brassard P. Letter to the Editor: On the need of considering cardiorespiratory fitness when examining the influence of sex on dynamic cerebral autoregulation. Am J Physiol Heart Circ Physiol 2019; 316:H1229. [DOI: 10.1152/ajpheart.00152.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada
| | - Jonathan D. Smirl
- Concussion Research Laboratory, Health and Exercise Sciences, University of British Columbia, Okanagan, British Columbia, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada
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50
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Lewis N, Gelinas JCM, Ainslie PN, Smirl JD, Agar G, Melzer B, Rolf JD, Eves ND. Cerebrovascular function in patients with chronic obstructive pulmonary disease: the impact of exercise training. Am J Physiol Heart Circ Physiol 2019; 316:H380-H391. [DOI: 10.1152/ajpheart.00348.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study examined cerebral blood flow (CBF) and its regulation before and after a short-term periodized aerobic exercise training intervention in patients with chronic obstructive pulmonary disease (COPD). Twenty-eight patients with COPD (forced expiratory volume in 1 s/forced vital capacity < 0.7 and <lower limit of normal) and 24 healthy control subjects participated in the study. Extracranial CBF (duplex ultrasound), middle cerebral artery velocity (MCAv; transcranial Doppler), cerebrovascular reactivity to hypocapnia and hypercapnia, and dynamic cerebral autoregulation (transfer function analysis) were quantified. These tests were repeated in both patients with COPD ( n = 23) and control subjects ( n = 20) after 8 wk of periodized upper and lower body aerobic exercise training (3 sessions/wk). At baseline, global extracranial CBF was comparable between the COPD and control groups (791 ± 290 vs. 658 ± 143 ml/min, P = 0.25); however, MCAv was lower in patients with COPD compared with control subjects (46 ± 9 vs. 53 ± 10 cm/s, P = 0.05). Although there were no group differences in dynamic cerebral autoregulation or the MCAv response to hypercapnia, patients with COPD had a lower MCAv response to hypocapnia compared with control subjects (−1.1 ± 1.5 vs. −1.6 ± 1.3 cm·s−1·mmHg−1, P = 0.02). After aerobic training, absolute peak O2 consumption increased in both groups, with a greater improvement in control subjects (1.7 ± 0.4 vs. 4.1 ± 0.2 ml·kg−1·min−1, respectively, P = 0.001). Despite these improvements in peak O2 consumption, there were no significant alterations in CBF or any measures of cerebrovascular function after exercise training in either group. In conclusion, patients with COPD have a blunted cerebrovascular response to hypocapnia, and 8 wk of aerobic exercise training did not alter cerebrovascular function despite significant improvements in cardiorespiratory fitness. NEW & NOTEWORTHY No study to date has investigated whether exercise training can alter resting cerebral blood flow (CBF) regulation in patients with chronic obstructive pulmonary disease (COPD). This study is the first to assess CBF regulation at rest, before, and after aerobic exercise training in patients with COPD and healthy control subjects. This study demonstrated that while exercise training improved aerobic fitness, it had little effect on CBF regulation in patients with COPD or control subjects.
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Affiliation(s)
- Nia Lewis
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Jinelle C. M. Gelinas
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Philip N. Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Jonathan D. Smirl
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Gloria Agar
- Interior Health, Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - Bernie Melzer
- Interior Health, Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - J. Douglass Rolf
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neil D. Eves
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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