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Cardiovascular phenotyping for personalized lifestyle treatments of chronic abdominal pain in Irritable Bowel Syndrome: A randomized pilot study.
Davydov, DM, Shahabi, L, Naliboff, B
Neurogastroenterology and motility. 2019;(12):e13710
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Abstract
BACKGROUND Different physical exercise interventions for pain and other related symptoms largely follow non-personalized guidelines and show a high degree of variability in outcome. These interventions are considered to have different pathways toward improvement in autonomic regulation of energy metabolism. The current pilot study was conducted to assess the predictive value of individual cardiovascular (CV) activity markers at rest to predict clinical outcomes for two popular exercise-based interventions (walking and yoga) in patients with Irritable Bowel Syndrome (IBS). METHODS Twenty-seven adult participants with IBS were randomly assigned to a 16-biweekly Iyengar yoga or walking program. They completed pre- and post-treatment assessments on IBS symptom severity, affective and somatic complaints, and various measures of resting autonomic function including blood pressure (BP), heart rate and its variability, baroreceptor sensitivity (BRS) to activations and inhibitions with gains of brady- and tachycardiac baro-responses, and BP start points for these spontaneous baroreflexes. RESULTS Pretreatment BRS was differentially related to clinical response for the treatment groups. Specifically, a significant decrease in pain severity was found in response to yoga for those participants who had lower resting BRS to activations, but decreased pain severity was associated with higher resting BRS for those in the walking group. The effect was not related to affective symptom relief. Other CV measures showed similar associations with clinical outcomes for both groups. CONCLUSIONS The data suggest therefore that CV based phenotypes may be useful in personalizing clinical interventions for IBS. They may also point to autonomic mechanisms that are targets for such interventions.
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High-intensity interval training and cardiac autonomic control in individuals with metabolic syndrome: A randomised trial.
Ramos, JS, Dalleck, LC, Borrani, F, Beetham, KS, Mielke, GI, Dias, KA, Wallen, MP, Keating, SE, Fassett, RG, Coombes, JS
International journal of cardiology. 2017;:245-252
Abstract
BACKGROUND Insulin resistance has been postulated to play a central role in the co-appearance of various cardiovascular disease risk factors constituting the metabolic syndrome (MetS). There is evidence that altered cardiac autonomic function (CAF) may precede the onset of insulin resistance. Exercise training has been shown to improve CAF in different populations, yet little is known regarding the exercise dose response for CAF. The aim of this study was to investigate the impact of different volumes of high-intensity interval training (HIIT) and traditional moderate-intensity continuous training (MICT) on CAF in participants with MetS. METHODS Individuals with MetS (n=56) were randomised into the following 16-week training interventions: i) MICT (n=16, 30min at 60-70%HRpeak, 5×/week); ii) 4HIIT (n=19, 4×4min bouts at 85-95%HRpeak, interspersed with 3min of active recovery at 50-70%HRpeak, 3×/week); or iii) 1HIIT (n=21, 1×4min bout at 85-95%HRpeak, 3×/week). R-R interval recorded for 5min in a supine position at pre- and post-intervention was used to derive linear (SDNN, RMSSD, pNN50, LF, HF, LF/HF) and non-linear (SD1, SD2, Alpha1, Alpha2, SampEn) heart rate variability (HRV) indices as measures of CAF. Group×time interaction effects were examined (ANCOVA) and Eta squared (η2) interaction effect sizes calculated. RESULTS While there were no significant between-group differences in CAF indices, there were small-to-medium group×time interaction effects on SDNN [F(2,52)=0.70, p=0.50, η2=0.02], RMSSD [F(2,52)=1.35, p=0.27, η2=0.03], HF power [F(2,52)=1.27, p=0.29, η2=0.03], SD1 [F(2,52)=0.47, p=0.63, η2=0.01], and SD2 [F(2,52)=0.41, p=0.67, η2=0.01]. The following represent the relative percentage increases across these variables for 4HIIT, MICT, and 1HIIT respectively (SDNN, +30%, +17%, 9%; RMSSD, +30%, +22%, -2%; HF power, +69%, +18%, +7%; SD1, +30%, +22%,-2%; SD2, +22%, +14%, 4%). CONCLUSIONS There were no significant between-group differences for the effects of exercise dose on CAF indices, however; high-volume HIIT demonstrated the greatest magnitude of effect for improving CAF in individuals with MetS.
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[Effectiveness of two aerobic exercise programs in the treatment of metabolic syndrome: a preliminary study].
Salas-Romero, R, Sánchez-Muñoz, V, Franco-Sánchez, JG, Del Villar-Morales, A, Pegueros-Pérez, A
Gaceta medica de Mexico. 2014;(6):490-8
Abstract
The effectiveness of two aerobic exercise programs on the modification of the metabolic syndrome (MS) components and its influence in reducing cardiovascular risk was evaluated in 16 sedentary women (30-66 years old). Patients were randomly divided into two exercise groups: continuous training (CE: 45 minutes at 65-70% of heart rate reserve or HRR) or interval training (IE: 5 x 3 minute intervals at 80-85% HRR with two minutes of active recovery at 65-70% HRR), and each participant gave previous informed consent. The components of MS were assessed according to the criteria for women of the National Cholesterol Education/Third Treatment Adult Panel, and cardiovascular risk factors at baseline and 16 weeks later. Data analyses were performed with the Wilcoxon signed test and the Mann-Whitney U-test (SPSS v. 12.0 Windows: p < 0.05). Both exercise programs were effective in the modification of a number of MS components (triglycerides, systolic/diastolic blood pressure), however IE had a higher percentage of patients without MS diagnosis at the end of the study (62.5%). The CE improved the physical fitness by increasing the VO₂peak and METs and decreasing heart rate recovery, which is reflected on the reduction of cardiovascular risk.
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Reduced heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT.
Gorur, GD, Ciftci, EA, Kozdag, G, Isgoren, S, Oc, MA, Haksal, C, Gur, M, Demir, H
Annals of nuclear medicine. 2012;(8):609-15
Abstract
OBJECTIVE A mild decrease in blood pressure and increase in heart rate (HR) are considered normal hemodynamic responses to dipyridamole. In this study, we tried to investigate HR response to dipyridamole and its predictors in patients undergoing gated myocardial perfusion single photon emission computed tomography (SPECT). METHODS 201 consecutive patients undergoing dipyridamole stress Tc99m-MIBI or Tl-201 gated myocardial perfusion SPECT were prospectively enrolled. Dipyridamole was infused over 4 min and radiopharmaceutical was injected 3 min after the end of infusion. A reduced heart rate response to dipyridamole considered if the HR ratio (peak HR/rest HR) was 1.20 or less. Stress (sLVEF), rest (rLVEF) left ventricular ejection fractions, stress and rest motion (SMS, RMS) and thickening scores (STS, RTS) were derived automatically by QGS. Summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) for myocardial perfusion were calculated. Patients were grouped according to HR response and groups were compared. A logistic regression analysis was used to determine independent predictors of reduced HR response. RESULTS Reduced HR response was found in 78 % of patients. Patients with abnormal HR response were more frequently had a history of diabetes mellitus, chronic renal failure, and had lower high-density lipoprotein (HDL) levels. Peak HR, SSS, SRS, sLVEF and rLVEF were lower; rest HR, RTS, and the number of patients with ≤ 45 % sLVEF and rLVEF were higher in reduced HR response group (all p < 0.05). There was no difference between groups by means of gender, rest and peak systolic or diastolic tension, SDS, SMS, STS, RMS, history of hypertension, peripheral arterial disease, metabolic syndrome, coronary interventions, digoxin, calcium channel blocker or beta blocker usage. Multivariable logistic regression analysis demonstrated that the independent predictors of reduced HR response were HDL, rest HR and SSS. When HDL was removed from the model, chronic renal failure also emerged as an independent predictor. CONCLUSION Reduced HR response to dipyridamole is associated with ventricular dysfunction, cardiac autonomic neuropathy. Low HDL levels also seem to be related with reduced HR response.
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[Clinical efficacy study on calming liver and restraining Yang formula in treating patients with mild or moderate degree of essential hypertension].
Zhong, G, Luo, Y, Xiang, L, Xie, Y, Xie, Q, Li, Y, Zhang, C
Zhongguo Zhong yao za zhi = Zhongguo zhongyao zazhi = China journal of Chinese materia medica. 2010;(6):776-81
Abstract
OBJECTIVE To observe the therapeutic effect of calming the liver and restraining the Yang formula in treating patients with mild or moderate degree of essential hypertension (syndrome of hyperactivity of liver-Yang), and to explore its mechanism in lowering blood pressure. METHOD The 348 patients with EH of stage I , II were randomly divided into two groups, the 174 patients in the treated group were treated with the calming the liver and restraining the Yang formula, and the 174 patients in the control group were treated with amlodipine. The treatment course for them all was 12 weeks. The related clincial symptoms score and quality of life score estimated before and after treatment at 4th week, 8th week and 12th week were observed. Before and after treatment, the ambulatory blood pressure (AMBP), heart rate, blood lipid, serum livels of high-sensitivity C-reactive protein (Hs-CRP), Angiotensin-II (Ang II) and calcitonin gene-related peptide (CGRP) were measured respectively in 40 patients of the treared group and 40 patients of the control group. RESULT After treatment, the treatment in the treated group showed an effect better than that in the control group in terms of nigh-time blood pressure reducing rate (P < 0.05). The reducing blood pressure variability and total effective rate in the treated group were no significant than that in the control group. In respect of reducing symptomatic scores on dizzy, soreness and weakness of the waist and knees, disturbed and dry and bitter of mouth, ameliorating quality of life score, decreasing the levels of heart rate, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol(HDL-C) in the treated group were showing marked improvement as compared with that in the control group (P < 0.05 or P < 0.1). The improvement in the level of Ang II , Hs-CRP and CGRP before treatment in two groups were more significant than that after treatment (P < 0.05). However There were no difference in after treatment between the treated group and the control group. CONCLUSION The calming the liver and restraining the Yang formula shows favorable efficacy in lowering blood pressure on the patients with mild or moderate degree of essential hypertension. It can reduce the clincial symptoms, improve the quality of life, regulate blood lipid metabolism. Its mechanism may be related to the functional relieving inflammatory reaction and inhibition the activity of renin-angiotensin-aldosterone system (RAAS).
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Austrian Moderate Altitude Studies (AMAS): benefits of exposure to moderate altitudes (1,500-2,500 m).
Schobersberger, W, Leichtfried, V, Mueck-Weymann, M, Humpeler, E
Sleep & breathing = Schlaf & Atmung. 2010;(3):201-7
Abstract
OBJECTIVES A considerable part of the millions of Alpine tourists suffer from pre-existing diseases (e.g., metabolic syndrome) and high daily stress levels. The main goal of the Austrian Moderate Altitude Study (AMAS) was to investigate (a) the consequences of an active vacation at moderate altitude on the key parameters of the metabolic syndrome (AMAS I) and (b) the effects of a short active vacation on adult progenitor cells, bio-psychological parameters, and heart rate variability (HRV). METHODS During the AMAS I pilot study (n = 22; 1,700 m a.s.l.) and AMAS I main study (n = 71; 1,700 m a.s.l. and 200 m a.s.l.), the volunteers simulated 3-week coached hiking vacations. For AMAS II, healthy volunteers (n = 13) participated in a 1-week active holiday at 1,700 m. RESULTS There were significant improvements of obesity, hypertension, dyslipidemia, and insulin resistance of AMAS I patients after the vacation. In AMAS II participants, we found an increase in circulating endothelial progenitor cells as well as improvements in bio-psychological and HRV parameters. CONCLUSIONS Active vacations at moderate altitude are associated with a variety of positive health effects in persons with metabolic syndrome and in healthy subjects.
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[Lisinopril: antihypertensive activity, effects on heart rhythm variability and carbohydrate metabolism in patients with metabolic syndrome].
Shevchenko, OP, Praskurnichiĭ, EA, Savel'eva, SA
Terapevticheskii arkhiv. 2008;(10):37-41
Abstract
AIM: To examine antihypertensive activity, heart rate variability (HRV) and carbohydrate metabolism of ACE inhibitor lisinopril in patients with metabolic syndrome (MS). MATERIAL AND METHODS Twenty MS patients (13 females and 7 males) received lisinopril monotherapy for 12 weeks. Before the treatment and after 12 weeks of lisinopril treatment the following tests were made: office measurement of blood pressure (BP), 24-hour BP monitoring, exercise test, investigation of HRV and carbohydrate profile. RESULTS A 12-week treatment with lisinopril had high antihypertensive efficacy, its positive action on HRV and carbohydrate metabolism manifested in reduction of postprandial glycemia and insulinemia.
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[Effects of amlodipine on blood pressure. Results of cardiovascular tests and heart rate variability in patients with metabolic syndrome].
Praskurnichiĭ, EA, Shevchenko, OP, Savel'eva, SA
Terapevticheskii arkhiv. 2008;(11):57-61
Abstract
AIM: To study effects of calcium antagonist amlodipine (normodipine) on blood pressure, heart rate variability (HRV) and carbohydrate metabolism in patients with metabolic syndrome (MS). MATERIAL AND METHODS The trial included 52 patients (37 females, 15 males) with MS. The examination at baseline and after 12 weeks of amlodipine treatment included: office blood pressure (BP) measurement, 24-h BP monitoring, exercise tolerance test, estimation of HRV and carbohydrate profile. Amlodipine was administered as monotherapy for 12 weeks. RESULTS A 12-week treatment with amlodipine demonstrated high antihypertensive effect (BP normalized in 72.7% patients) without negative effects on HRV and carbohydrate profile. CONCLUSION Monotherapy with calcium antagonist amlodipine (normodipine) has high antihypertensive efficacy and is metabolically neutral in MS patients.
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Metabolic syndrome is associated with delayed heart rate recovery after exercise.
Sung, J, Choi, YH, Park, JB
Journal of Korean medical science. 2006;(4):621-6
Abstract
Heart rate (HR) recovery after exercise is a function of vagal reactivation, and its impairment is a predictor of overall mortality and adverse cardiovascular events. While metabolic syndrome is associated with sympathetic overactivity, little is known about the relationship between metabolic syndrome and HR recovery. A symptom-limited exercise stress test in healthy subjects (n=1, 434) was used to evaluate HR recovery. Metabolic syndrome was defined according to the National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP-III) criteria. Seventeen percent of subjects had > or =3 criteria for metabolic syndrome. HR recovery was lower in men than women and in smokers than nonsmokers. The subject with metabolic syndrome (vs. without) showed lower HR recovery (10.3+/-11.6 vs. 13.6+/-9.7 per minute) and higher resting HR (64.3+/-10.3 vs. 61.6+/-9.1 per minute). HR recovery correlated inversely to age (r=-0.25, p<0.0001), but not to resting HR or maximal oxygen uptake. Delayed HR recovery was associated with metabolic syndrome after an adjustment for age, sex, resting HR and smoking (p<0.01). Metabolic syn-drome is associated with impaired vagal reactivation. Adverse cardiovascular out-comes associated with metabolic syndrome may be mediated by the failure of vagal reactivation in addition to sympathetic overactivity.
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New insights into circadian aspects of health and disease.
Singh, RB, Pella, D, Otsuka, K, Halberg, F, Cornelissen, G
The Journal of the Association of Physicians of India. 2002;:1416-25
Abstract
Early awakening and early to bed as well as good conduct, thought, diet, interpersonal dealings and physical activity have been suggested for healthy life in Ayurveda. Circadian rhythms, coordinated in part by the parietal hypothalamic-pituitary and adrenal mechanisms, have been reported in almost all variables examined thus far, including the circulation. It is possible that all metabolic functions undergo circadian rhythms. It remains to be explored whether these rhythms may be optimized by Ayurvedic practices. The onsets of myocardial ischemia, unstable angina, acute myocardial infarction, sudden cardiac death, and strokes have been reported to exhibit a circadian variation, with increased frequency in the second quarter of the day. An increased physical and mental load caused by an attempt to prepare for the day may be important in triggering acute cardiovascular events. Depending on their timing, meditation (Ayurvedic practice), n-3 fatty acids, coenzyme Q10, beta-blockers and estrogens may have beneficial effects, whereas progestins and mental load may have adverse effects on heart rate and blood pressure variability, which may be expressed by different circadian patterns. Around the clock serial recordings of blood pressure and heart rate during usual activities and lifestyles may be recorded and may be analyzed by computer-implemented curve fitting to assess the about 24-hour (circadian) variation, among other rhythmic, chaotic, and trend components of the time structure (chronome) of these variables. The new disease risk syndrome circadian hyper-amplitude-tension (CHAT), a condition characterized by an excessive circadian amplitude of blood pressure, cannot be ascertained on the basis of single casual blood pressure measurements. The International Chronome Ecological Study of Heart Rate (and blood pressure) Variability in various ethnic groups aims at collecting further evidence regarding the role of blood pressure and heart rate variability in the pathogenesis of cardiovascular events, while also examining any role played by ethnicity and lifestyle-associated factors.