Cardiovascular responses to dynamic and static upper-body exercise in a cold environment in coronary artery disease patients

Rasmus I. P. Valtonen,Wouter van Marken Lichtenbelt,Heidi H. E. Hintsala,Jouni J. K. Jaakkola,Antti Kiviniemi,Arto Hautala,Tiina M. Ikäheimo,Craig Crandall,Juha Perkiömäki,Tuomas Kenttä

doi:10.1007/s00421-021-04826-x

Abstract

PurposeUpper-body exercise performed in a cold environment may increase cardiovascular strain, which could be detrimental to patients with coronary artery disease (CAD). This study compared cardiovascular responses of CAD patients during graded upper-body dynamic and static exercise in cold and neutral environments.Methods20 patients with stable CAD performed 30 min of progressive dynamic (light, moderate, and heavy rating of perceived exertion) and static (10, 15, 20, 25 and 30% of maximal voluntary contraction) upper body exercise in cold (− 15 °C) and neutral (+ 22 °C) environments. Heart rate (HR), blood pressure (BP) and electrocardiographic (ECG) responses were recorded and rate pressure product (RPP) calculated.ResultsDynamic-graded upper-body exercise in the cold increased HR by 2.3–4.8% (p = 0.002–0.040), MAP by 3.9–5.9% (p = 0.038–0.454) and RPP by 18.1–24.4% (p = 0.002–0.020) when compared to the neutral environment. Static graded upper-body exercise in the cold resulted in higher MAP (6.3–9.1%; p = 0.000–0.014), lower HR (4.1–7.2%; p = 0.009–0.033), but unaltered RPP compared to a neutral environment. Heavy dynamic exercise resulted in ST depression that was not related to temperature. Otherwise, ECG was largely unaltered during exercise in either thermal condition.ConclusionsDynamic- and static-graded upper-body exercise in the cold involves higher cardiovascular strain compared with a neutral environment among patients with stable CAD. However, no marked changes in electric cardiac function were observed. The results support the use of upper-body exercise in the cold in patients with stable CAD.Trial registrationClinical trial registration NCT02855905 August 2016.

Highlights

It is well established that the cold season is associated with increased morbidity and mortality, which is often cardiovascular related (Sun et al 2018; Liu et al 2015; Fares 2013)
The reason for these events could be related to the high myocardial oxygen demand caused by the combined effects of cold exposure and exercise that cannot be met by a myocardial blood flow-limiting disease, such as coronary artery disease (CAD) (Ikäheimo 2018; Manou-Staphopoulou et al 2015)
T sk remained at a lowered level throughout the follow-up period after exercise in the cold compared with a neutral environment (Fig. 1)

Summary

Introduction

It is well established that the cold season is associated with increased morbidity and mortality, which is often cardiovascular related (Sun et al 2018; Liu et al 2015; Fares 2013). Adding exercise to cold exposure may increase cardiovascular strain further (Ikäheimo 2018; Manou-Staphopoulou et al 2015), given an increased incidence of myocardial infarctions related to winter sports (Klug et al 2011) or heavy exercise, such as snow shoveling (Nichols et al 2012; Janardhanan et al 2010). These cardiovascular events are more common among populations with ischemic heart disease (Toukola et al 2015). The mismatch between myocardial demand and blood flow during exercise in the cold may result in earlier appearance of myocardial ischemia (Meyer et al 2010)

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