Objective: To examine the autonomic function using HRV measures in apparently healthy individuals undergoing exercise stress test (EST) and demonstrating slow HRR response. Methods: HRV was measured with 12 lead ECGs during graded EST and analyzed via a post-processing method. Autonomic function was determined by Power Spectral Analysis of the very low frequency (VLF), low frequency (LF), high frequency (HF), and the ratio of LF/HF. We correlated HRV indices with resting, exercise, and recovery data. Results: No differences were found in anthropometric measurements, peak EST HR, and METS between individuals with slow HRR (below 18 b/min) compared with controls (HRR > 18 b/min). Only the VLF component of the HRV indices was statistically different (p = 0.03) at one-minute post-exercise compared with controls. Additionally, a significant correlation between HRR and resting LF and HF indices was found in the individuals with slow HRR but not in the controls. Conclusion: In apparently healthy individuals with slow HRR post-EST, autonomic function did not demonstrate any differences at any phase of the EST, including at one minute of recovery. However, a significant correlation was found between resting LF and HF powers and HRR in individuals with slow vagal reactivation post-exercise. The clinical and prognostic implications of such observation deserve further investigation.
References
[1]
Cole, C.R., Blackstone, E.H., Pashkow, F.J., Snader, C.E. and Lauer, M.S. (1999) Heart-Rate Recovery Immediately after Exercise as a Predictor of Mortality. New England Journal of Medicine, 341, 1351-1357.
https://doi.org/10.1056/NEJM199910283411804
[2]
Jouven, X., Empana, J.P., Schwartz, P.J., Desnos, M., Courbon, D. and Ducimetière, P. (2005) Heart-Rate Profile during Exercise as a Predictor of Sudden Death. New England Journal of Medicine, 352, 1951-1958.
https://doi.org/10.1056/NEJMoa043012
[3]
Buchheit, M. and Gindre, C. (2006) Cardiac Parasympathetic Regulation: Respective Associations with Cardiorespiratory Fitness and Training Load. American Journal of Physiology-Heart and Circulatory Physiology, 291, H451-H458.
https://doi.org/10.1152/ajpheart.00008.2006
[4]
Pecanha, T., Silva-Júnior, N.D. and Forjaz, C.L. (2014) Heart Rate Recovery: Autonomic Determinants, Methods of Assessment and Association with Mortality and Cardiovascular Diseases. Clinical Physiology and Functional Imaging, 34, 327-339.
https://doi.org/10.1111/cpf.12102
[5]
Okutucu, S., Karakulak, U.N., Aytemir, K. and Oto, A. (2011) Heart Rate Recovery: A Practical Clinical Indicator of Abnormal Cardiac Autonomic Function. Expert Review of Cardiovascular Therapy, 9, 1417-1430. https://doi.org/10.1586/erc.11.149
[6]
Qiu, S., Cai, X., Sun, Z., Li, L., Zuegel, M., Steinacker, J.M. and Schumann, U. (2017) Heart Rate Recovery and Risk of Cardiovascular Events and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies. Journal of the American Heart Association, 6, e005505. https://doi.org/10.1161/JAHA.117.005505
[7]
Goldberger, J.J., Le, F.K., Lahiri, M., Kannankeril, P.J., Ng, J. and Kadish, A.H. (2006) Assessment of Parasympathetic Reactivation after Exercise. American Journal of Physiology-Heart and Circulatory Physiology, 290, H2446-H2452.
https://doi.org/10.1152/ajpheart.01118.2005
[8]
Akselrod, S., Gordon, D., Ubel, F.A., Shannon, D.C., Berger, A.C. and Cohen, R.J. (1981) Power Spectrum Analysis of Heart Rate Fluctuation: A Quantitative Probe of Beat-to-Beat Cardiovascular Control. Science, 213, 220-222.
https://doi.org/10.1126/science.6166045
[9]
Ng, J., Sundaram, S., Kadish, A.H. and Goldberger, J.J. (2009) Autonomic Effects on the Spectral Analysis of Heart Rate Variability after Exercise. American Journal of Physiology-Heart and Circulatory Physiology, 297, H1421-H1428.
https://doi.org/10.1152/ajpheart.00217.2009
[10]
Taylor, J.A., Carr, D.L., Myers, C. and Eckberg, D.L. (1998) Mechanisms Underlying Very-Low-Frequency RR-Interval Oscillations in Humans. Circulation, 98, 547-555.
https://doi.org/10.1161/01.CIR.98.6.547
[11]
Javorka, M., Zila, I., Balharek, T. and Javorka, K. (2002) Heart Rate Recovery after Exercise: Relations to Heart Rate Variability and Complexity. Brazilian Journal of Medical and Biological Research, 35, 991-1000.
https://doi.org/10.1590/S0100-879X2002000800018
[12]
Carnethon, M.R., Jacobs Jr., D.R., Sidney, S., Sternfeld, B., Gidding, S.S., Shoushtari, C. and Liu, K. (2005) A Longitudinal Study of Physical Activity and Heart Rate Recovery: CARDIA, 1987-1993. Medicine and Science in Sports and Exercise, 37, 606-612.
https://doi.org/10.1249/01.MSS.0000158190.56061.32
[13]
Bechke, E., Kliszczewicz, B., McLester, C., Tillman, M., Esco, M. and Lopez, R. (2020) An Examination of Single Day vs. Multi-Day Heart Rate Variability and Its Relationship to Heart Rate Recovery Following Maximal Aerobic Exercise in Females. Scientific Reports, 10, Article No. 14760.
https://doi.org/10.1038/s41598-020-71747-8
[14]
Dupuy, O., Mekary, S., Berryman, N., Bherer, L., Audiffren, M. and Bosquet, L. (2012) Reliability of Heart Rate Measures Used to Assess Post-Exercise Parasympathetic Reactivation. Clinical Physiology and Functional Imaging, 32, 296-304.
https://doi.org/10.1111/j.1475-097X.2012.01125.x
[15]
Lee, C.M. and Mendoza, A. (2012) Dissociation of Heart Rate Variability and Heart Rate Recovery in Well-Trained Athletes. European Journal of Applied Physiology, 112, 2757-2766. https://doi.org/10.1007/s00421-011-2258-8
[16]
Nunan, D., Jakovljevic, D.G., Donovan, G., Singleton, L.D., Sandercock, G.R. and Brodie, D.A. (2010) Resting Autonomic Modulations and the Heart Rate Response to Exercise. Clinical Autonomic Research, 20, 213-221.
https://doi.org/10.1007/s10286-010-0073-7
[17]
Chen, J.Y., Lee, Y.L., Tsai, W.C., Lee, C.H., Chen, P.S., Li, Y.H., Tsai, L.M., Chen, J.H. and Lin, L.J. (2011) Cardiac Autonomic Functions Derived from Short-Term Heart Rate Variability Recordings Associated with Heart Rate Recovery after Treadmill Exercise Test in Young Individuals. Heart and Vessels, 26, 282-288.
https://doi.org/10.1007/s00380-010-0048-6
[18]
Usui, H. and Nishida, Y. (2017) The Very Low-Frequency Band of Heart Rate Variability Represents the Slow Recovery Component after a Mental Stress Task. PLoS ONE, 12, e0182611. https://doi.org/10.1371/journal.pone.0182611
[19]
Sydó, N., Sydó, T., Gonzalez Carta, K.A., Hussain, N., Farooq, S., Murphy, J.G., Merkely, B., Lopez-Jimenez, F. and Allison, T.G. (2018) Prognostic Performance of Heart Rate Recovery on an Exercise Test in a Primary Prevention Population. Journal of the American Heart Association, 7, e008143.
https://doi.org/10.1161/JAHA.117.008143
[20]
Davrath, L.R., Akselrod, S., Pinhas, I., Toledo, E., Beck, A., Elian, D. and Scheinowitz, M. (2006) Evaluation of Autonomic Function Underlying Slow Post Exercise Heart Rate Recovery. Medicine and Science in Sports and Exercise, 38, 2095-2101.
https://doi.org/10.1249/01.mss.0000235360.24308.c7
[21]
D’agostino, R.B., Belanger, A. and D’Agostino Jr., R.B. (1990) A Suggestion for Using Powerful and Informative Tests of Normality. The American Statistician, 44, 316-321. https://doi.org/10.1080/00031305.1990.10475751
[22]
Shaffer, F., McCraty, R. and Zerr, C.L. (2014) A Healthy Heart Is Not a Metronome: An Integrative Review of the Heart’s Anatomy and Heart Rate Variability. Frontiers in Psychology, 5, Article No. 1040. https://doi.org/10.3389/fpsyg.2014.01040
[23]
Lu, D.Y., Yang, A.C., Cheng, H.M., Lu, T.M., Yu, W.C., Chen, C.H. and Sung, S.H. (2016) Heart Rate Variability Is Associated with Exercise Capacity in Patients with Cardiac Syndrome X. PLoS ONE, 11, e0144935.
https://doi.org/10.1371/journal.pone.0144935
[24]
Bigger Jr., J.T., Fleiss, J.L., Steinman, R.C., Rolnitzky, L.M., Kleiger, R.E. and Rottman, J.N. (1992) Frequency Domain Measures of Heart Period Variability and Mortality after Myocardial Infarction. Circulation, 85, 164-171.
https://doi.org/10.1161/01.CIR.85.1.164
[25]
Berntson, G.G., Thomas Bigger Jr., J., Eckberg, D.L., Grossman, P., Kaufmann, P.G., Malik, M., Nagaraja, H.N., Porges, S.W., Saul, J.P., Stone, P.H. and Van der Molen, M.W. (1997) Heart Rate Variability: Origins, Methods, and Interpretive Caveats. Psychophysiology, 34, 623-648. https://doi.org/10.1111/j.1469-8986.1997.tb02140.x
[26]
Albert, C.M., Mittleman, M.A., Chae, C.U., Lee, I.M., Hennekens, C.H. and Manson, J.E. (2000) Triggering of Sudden Death from Cardiac Causes by Vigorous Exertion. New England Journal of Medicine, 343, 1355-1361.
https://doi.org/10.1056/NEJM200011093431902
[27]
Bosquet, L., Gamelin, F.X. and Berthoin, S. (2007) Is Aerobic Endurance a Determinant of Cardiac Autonomic Regulation? European Journal of Applied Physiology, 100, 363-369. https://doi.org/10.1007/s00421-007-0438-3
[28]
Bosquet, L., Gamelin, F.X. and Berthoin, S. (2008) Reliability of Postexercise Heart Rate Recovery. International Journal of Sports Medicine, 29, 238-243.
https://doi.org/10.1055/s-2007-965162
[29]
Esco, M.R., Olson, M.S., Williford, H.N., Blessing, D.L., Shannon, D. and Grandjean, P. (2010) The Relationship between Resting Heart Rate Variability and Heart Rate Recovery. Clinical Autonomic Research, 20, 33-38.
https://doi.org/10.1007/s10286-009-0033-2
[30]
Javorka, M., Zila, I., Balhárek, T. and Javorka, K. (2003) On- and Off-Responses of Heart Rate to Exercise-Relations to Heart Rate Variability. Clinical Physiology and Functional Imaging, 23, 1-8. https://doi.org/10.1046/j.1475-097X.2003.00460.x
[31]
Cunha, F.A., Midgley, A.W., Goncalves, T., Soares, P.P. and Farinatti, P. (2015) Parasympathetic Reactivation after Maximal CPET Depends on Exercise Modality and Resting Vagal Activity in Healthy Men. SpringerPlus, 4, Article No. 100.
https://doi.org/10.1186/s40064-015-0882-1