Abstract

Anorexia nervosa (AN) is associated with a wide range of disturbances of the autonomic nervous system. The aim of the present study was to monitor the heart rate (HR) and the heart rate variability (HRV) during light physical activity in a group of adolescent girls with AN and in age-matched controls using a wearable, minimally obtrusive device. For the study, we enrolled a sample of 23 adolescents with AN and 17 controls. After performing a 12-lead electrocardiogram and echocardiography, we used a wearable device to record a one-lead electrocardiogram for 5 min at baseline for 5 min during light physical exercise (Task) and for 5 min during recovery. From the recording, we extracted HR and HRV indices. Among subjects with AN, the HR increased at task and decreased at recovery, whereas among controls it did not change between the test phases. HRV features showed a different trend between the two groups, with an increased low-to-high frequency ratio (LF/HF) in the AN group due to increased LF and decreased HF, differently from controls that, otherwise, slightly increased their standard deviation of NN intervals (SDNN) and the root mean square of successive differences (RMSSD). The response in the AN group during the task as compared to that of healthy adolescents suggests a possible sympathetic activation or parasympathetic withdrawal, differently from controls. This result could be related to the low energy availability associated to the excessive loss of fat and lean mass in subjects with AN, that could drive to autonomic imbalance even during light physical activity.

Highlights

  • Anorexia nervosa (AN) is a psychiatric disorder characterized by a disturbed body image, constant concerns over weight and shape, and an intensive fear of gaining weight, all leading to severe dietary restriction and weight loss [1]

  • The associated z-scores related to the BMI taking into account the age of the subjects were significantly different between the AN group and controls (AN: −2.1 ± 1.2; controls: +0.3 ± 0.6; p < 0.001)

  • At baseline, patients with AN and control subjects had a different autonomic profile, retrieved through the ECG signal, which confirmed our previous results [30] and the findings of other studies performed on adolescents with AN [9,14]

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Summary

Introduction

Anorexia nervosa (AN) is a psychiatric disorder characterized by a disturbed body image, constant concerns over weight and shape, and an intensive fear of gaining weight, all leading to severe dietary restriction and weight loss [1]. AN subjects display a wide range of autonomic disturbances, mostly as a result of the massive imbalance of the parasympathetic-to-sympathetic system activity, with a general predominance of the parasympathetic tone, especially in adolescents [4,5,6,7,8,9,10,11,12,13,14,15,16] Such abnormalities represent good predictors of cardiac mortality risk in AN [6,17,18]; their monitoring might be clinically relevant in this subset of patients. The analysis of the ANS activity in several disorders is helpful for the clinician in order to better characterize the cardiovascular response to exercise and to elucidate the role of physical activity in the relevant disturbance

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