Body Periodic Acceleration Research Articles

Preconditioning with periodic acceleration (pGz) provides second window of cardioprotection

AimsWhole body periodic acceleration (pGz) is achieved with a motorized platform that moves the supine body with repetitive, sinusoidal head to foot motion. This increases pulsatile shear stress to the endothelium thereby activating endothelial nitric oxide synthase (eNOS) to produce increased release of nitric oxide (eNO). The current investigation was undertaken to determine whether or not pGz preconditioning can induce second window of protection (SWOP) cardioprotective affects in an in-vivo rat model of myocardial infarction. Main methodsRats received 1, 3 or 7 daily pGz treatments of 60minutes, or no pGz (CONT). Twenty-four hours after the last pGz treatment, ischemia reperfusion injury was produced by ligation of the left coronary artery (LCA) for 30minutes followed by 90minutes of reperfusion. Key findingsAll pGz preconditioned animals survived 90minutes. Three and 7days of pGz preconditioning reduced myocardial infarct size by 41 and 38% respectively, with better left ventricular function. Additionally, pGz preconditioning increased eNOS, p-eNOS, Akt and p-Akt, HSP70 and nNOS proteins. L-NAME (NOS inhibitor) or Wortmannin (PI3/Akt inhibitor) 15minutes prior to LCA ligation abolished pGz's cardioprotective effects. SignificancepGz preconditioning provides SWOP, with increased survival, infarct size reduction, and improved contractility, in part due to up regulation of HSP70 and the PI3/Akt/eNOS , which last at least 72hours.

Preliminary observations of passive exercise using whole body periodic acceleration on coronary microcirculation and glucose tolerance in patients with type 2 diabetes

BackgroundThe whole body periodic acceleration (WBPA) system was recently developed as a passive exercise device by providing increased pulsatile shear stress for improvement of endothelial function. This study aimed to investigate the acute effects of WBPA on coronary microcirculation and glucose tolerance in patients with type 2 diabetes (T2D). MethodsThe study subjects were 8 patients with T2D who underwent transthoracic Doppler echocardiography for the assessment of coronary flow reserve (CFR) before and immediately after a 45-min session of WBPA. The flow velocity in the distal portion of the left anterior descending coronary artery was measured at baseline and during adenosine infusion. The CFR represented the ratio of hyperemic to basal mean diastolic flow velocity. ResultsWBPA increased CFR from 2.3±0.3 to 2.6±0.4 (p=0.02). WBPA decreased serum insulin level from 26±19μIU/ml to 19±15μIU/ml (p=0.01) and increased total adiponectin from 11.6±7.3μg/ml to 12.5±8.0μg/ml (p=0.02) and high molecular weight adiponectin from 4.9±3.6μg/ml to 5.3±3.9μg/ml (p=0.03), whereas the serum glucose level was stable from 207±66mg/dl to 203±56mg/dl (p=0.8). ConclusionsThis study demonstrates that a single session of WBPA treatment simultaneously improved coronary microcirculation and glucose tolerance in patients with T2D.

Whole Body Periodic Acceleration: "Passive Exercise" for Parkinson’s disease

Whole Body Periodic Acceleration: "Passive Exercise" for Parkinson’s disease Marvin A. SacknerVoluntary Professor of Medicine at Mt Sinai, Miller School of Medicine, University of Miami and Emeritus Director of Medical Services, Mt Sinai Medical Center of Greater Miami The important benefits of exercise in the prevention and treatment of chronic diseases have long been recognized. However, exercise particip-ation such as brisk walking at least 30 minutes a day for five days a week as recommended by the American Heart Association is accomplished in less than 10% of the adult American population.1 For patients with chronic conditions such as Parkinson’s disease (PD), compliance is even lower. Patients with PD are usually elderly, often sedentary, and frail, with the afflictions of cardio-vascular and rheumatologic diseases and therefore incapable of exercising. Further, the fear of falling, freezing of gait, and impaired economy of gait (small stepping distance) associated with PD interfere with walking.2 3 4 Therefore, there is a place for technology that would provide similar benefits to exercise without requiring voluntary movements.

Whole Body Periodic Acceleration: “Passive Exercise” for Parkinson’s disease

Whole Body Periodic Acceleration: “Passive Exercise” for Parkinson’s disease

Abstract 9481: Whole Body Periodic Acceleration, Novel Passive Exercise Devices, Enhances Blood Supply to Ischemic Hindlimb in Mice and Human

Introduction: Whole body periodic acceleration (WBPA) is a non-invasive, passive exercise device that has been shown to improve endothelial function by increasing shear stress by head-to-foot direction movements of the body. However, the impact of WBPA on blood flow to ischemic legs has not been investigated. Hypothesis: WBPA enhances blood supply in a mouse model of hindlimb ischemia and in patients with peripheral arterial disease (PAD). Methods and Results: After unilateral femoral artery excision, wild type mice were assigned to either the WBPA (n=15) or control (n=13) group. WBPA was applied at 150 cpm for 45 min under anesthesia once a day. WBPA significantly increased blood flow recovery at 7 and 14 days after surgery as determined by laser doppler perfusion imaging. Sections of ischemic adductor muscle stained with anti-CD31 antibody showed a significant increase in capillary density in WBPA-treated mice compared with control mice, suggesting that WBPA promotes angiogenesis at a microcirculatory level. WBPA increased the phosphorylation of endothelial nitric oxide synthase (eNOS) in adductor muscle. The pro-angiogenic effect of WBPA on ischemic limb was blunted in eNOS-deficient mice, suggesting that the stimulatory effects of WBPA on revascularization are eNOS-dependent. Quantitative real-time PCR analysis showed significant increases in molecules involved in angiogenesis, such as VEGF, FGF2, SDF-1, PDGF-B in ischemic hindlimb by WBPA. Protein array analysis showed that WBPA induced changes in the expression profile of serum angiogenesis-related proteins. Facilitated blood flow recovery was observed in a mouse model of diabetes despite no changes in glycemic control. Clinically, 10 patients (age, 69±7 years, 9 men) with PAD underwent single session of WBPA treatment at 140 cpm for 45 min. WBPA significantly improved the ischemic/non-ischemic ratio of blood flow in the lower extremity from 0.74±0.21 to 0.87±0.21 (p<0.05). Conclusions: WBPA increased blood supply to ischemic lower extremities through activation of eNOS signaling and upregulation of pro-angiogenic growth factor in ischemic skeletal muscle. WBPA is a potentially suitable non-invasive intervention to facilitate therapeutic angiogenesis.

Whole Body Periodic Acceleration is a Potential Substitute of Exercise Training of Patients with Risk Factors and Cardiovascular Diseases

Exercise training is beneficial in the primary and secondary prevention and treatment of coronary artrery disease. However, moderate aerobic exercise for at least 30 minutes a day for at least five days is not attainable in patients who are incapable or unwilling to meet these requirements such as those with neurological and rheumatological diseases, and mobility problems. Whole body periodic acceleration (WBPA) with a horizontal motion platform in the direction of the spinal axis through repetitive movements augments intravascular pulsatile shear stress with a release of nitric oxide and improves vascular endothelial function. This device might offer an alternative to active exercise for patients whose medical conditions limit physical activity. In addition, forty-five minutes' WBPA improves the flow reserve of the left anterior descending coronary artery evaluated by transthoracic Doppler echocardiography and insulin resistance in type 2 diabetic patients.Treatment with WBPA for angina patients ameliorates exercise capacity, myocardial ischemia and left ventricular remodeling through central and peripheral effects. In conclusion, WBPA may be a promising treatment tool of patients with endothelial dysfunction, type 2 diabetic patients, and angina patients with old myocardial infarction. The development of such a therapeutic modality will become a substitute of exercise training of patients with risk factors and cardiovascular diseases in the field of cardiac rehabilitation.

Microcirculatory and therapeutic effects of whole body periodic acceleration (pGz) applied after cardiac arrest in pigs

Aims Cardiac arrest (CA) and resuscitation are models of whole body ischemia reperfusion injury. Interventions performed prior to (pre-treatment) or after (post-treatment) can result in cardioprotection. Myocardial stunning, characterized by microcirculatory and contractile dysfunction after CA, is an important component of the post-cardiac arrest syndrome. Periodic acceleration (pGz), produced by the cyclical motion of the supine body headward to footward, increases microcirculatory blood flow to vital organs and elicits production of endothelial derived cytoprotective factors in normal animals. We tested the hypothesis that application of pGz 30 min after return of circulation from CA, as a delayed post-treatment strategy, would improve regional microcirculatory blood flow to vital organs and functional indices of myocardial stunning in pigs. Methods 8 min of unsupported VF followed by cardiopulmonary resuscitation and defibrillation was carried out in twenty anesthetized and paralyzed male swine who were randomized to delayed post-treatment with pGz (dPost) or none (CONT). pGz was begun 30 min after return of circulation along with conventional mechanical ventilation. Hemodynamics, echocardiogram, and regional blood flows were measured as well as biochemical index of cardiac tissue injury. Results All animals had spontaneous return of circulation after cardiopulmonary resuscitation (CPR) and defibrillation. dPost animals had less myocardial stunning and greater regional blood flows to the heart, brain, kidneys, ileum and stomach than CONT. Post-treatment with pGz blunted the increase in Troponin I produced by CA and resuscitation, and, induced a greater rise in endothelial derived nitric oxide synthase (eNOS) and its phosphorylation (p-eNOS). Conclusions Delayed post-treatment with pGz as a therapeutic strategy, protects against early myocardial stunning in VF cardiac arrest by improving microcirculatory blood flow to the heart and also protects other vital organs by this mechanism.

Whole Body Periodic Acceleration Reduces Levels of Delayed Onset Muscle Soreness after Eccentric Exercise

Whole Body Periodic Acceleration Reduces Levels of Delayed Onset Muscle Soreness after Eccentric Exercise

Whole Body Periodic Acceleration (pGz) Improves Survival and Allows for Resuscitation in a Model of Severe Hemorrhagic Shock in Pigs

Whole body periodic acceleration (pGz), the repetitive, head-foot sinusoidal motion of the body, increases pulsatile shear stress on the vascular endothelium producing increased release of endothelial derived nitric oxide (eNO) into circulation. Based upon prior CPR investigations, we hypothesized that pGz instituted prior to and during hemorrhagic shock (HS) should improve survival. Sixteen anesthetized male pigs, 23 ± 5 kg, were randomized to receive 1 h pGz or no pGz (CONT) prior to and during severe controlled graded HS up to 2-1/2 h. HS was induced by removing blood at 10 mL/kg increments from the circulation at 30-min intervals up to a maximum blood loss of 50 mL/kg. Thirty minutes after maximum blood loss, shed blood and lactated Ringers solution was infused intravenously. All animals survived up to 30 mL/kg blood loss. Survival and return to normal blood pressure to 120 min was achieved in 50% of animals receiving pGz compared with none in CONT. Cardiac output, blood pressure, and oxygen delivery decreased equally in both groups but oxygen consumption was significantly lower with pGz than CONT during all hemorrhage time points. Regional blood flow (RBF) was preserved in brain, heart, kidneys, ileum, and stomach in both groups up to 40 mL/kg of blood loss. After 40 mL/kg blood loss, RBF was much better preserved in pGz than CONT. pGz applied 1 h prior to and during severe graded hemorrhagic shock delays onset of irreversible shock, enabling potential restoration of blood loss and survival.

Nitric Oxide and the Ryanodine Receptor Ca-Release Channel

To the Editor: I have read with interest the recent review on the role of S -nitrosylation in cardiovascular signaling, in which Lima et al1 provide a very useful digest on the current status of research in this important but burgeoning field of cardiovascular physiology. On the other hand, I believe that one of the many functions of a scientific review, especially when summarizing the status of a field with a certain degree of ambiguity, is to promote further progress. This is, perhaps, best achieved if all the available data relevant to the field are summarized and discussed, even those that seem to be contradictory to the intended conclusion of the review. Although the review in question cites almost 200 works, it …

“Passive exercise” using whole body periodic acceleration: Effects on coronary microcirculation

The whole body periodic acceleration (WBPA) system has recently been developed as a "passive exercise" device by providing increased pulsatile shear stress for improvement of endothelial function. This study aimed to investigate the short-term effect of WBPA on coronary flow reserve (CFR) through transthoracic Doppler echocardiography (TTDE) in healthy subjects and patients with coronary artery disease (CAD). This study consisted of 15 healthy subjects and 20 patients with CAD who underwent CFR examination before and immediately after WBPA. The flow velocity in the distal portion of the left anterior descending coronary artery (LAD) was measured with TTDE at baseline and during adenosine infusion. Coronary flow reserve was calculated as the ratio of hyperemic to basal mean diastolic flow velocity. The WBPA treatment was completed in all 35 subjects without complications. There were no significant differences in heart rate and systolic blood pressure before and after WBPA. Whole body periodic acceleration increased CFR from 3.3 +/- 1.0 to 3.7 +/- 1.1 in the 35 subjects (P < .001). Coronary angiography showed significant LAD narrowing in 8 of the 20 CAD patients, but WBPA increased CFR from 2.4 +/- 0.4 to 2.7 +/- 0.5 in them as well (P < .01). This study demonstrates that WBPA improves CFR in healthy subjects and patients with CAD.

Abstract P48: Preconditioning with Periodic Acceleration Significantly Decreases Infarct Size and Arrhythmias after Left Ventricular Ischemia Reperfusion Injury in Rats

BACKGROUND: Whole body periodic acceleration (pGz) is the sinusoidal head-foot motion in the spinal axis. pGz increases pulsatile vascular shear stress to the endothelium, activates endothelial nitric oxide synthase (eNOS) thus promoting increased release of nitric oxide (NO) in pigs, sheep, rats, isolated aorta, and humans. pGz is cardioprotective via NO release 1 hr prior to CPR or during CPR in pigs with induced ventricular fibrillation. The purpose of this study was to ascertain whether acute and chronic pGz preconditioning is cardioprotective in myocardial ischemia reperfusion (I/R) injury in rats as measured by infarction size, and arrhythmias. METHODS: Unsedated, restrained, male rats (310±9 g, n=16) were preconditioned with pGz ( f =6 cps, a =3.4 m/s 2 ). Rats were randomized to: a) pGz 2 hr for 1 day prior to I/R (PRE-pGz 1D) n=4, b) pGz 2 hrs per day for 3 days prior to I/R (PRE-pGz 3D) n=6 and c) Control (C) n=6. Then, they were anesthetized and underwent focal I/R injury by left coronary artery ligation for 30 minutes followed by 120 min of reperfusion. ECG, and aortic pressure were monitored and infarct size calculated as % area at risk. RESULTS: PRE-pGz 3D had an infarct sparring effect of 77% of C. Both 1 and 3 days PRE-pGz significantly attenuated ventricular arrhythmias during reperfusion. Figure below shows % infarct for all groups, † P &lt;0.001 PRE-pGz 3D vs. C, * P &lt;0.001 PRE-pGz 1D vs. C, and representative areas of infarct (INF) and at risk (AAR) in PRE-pGz 3D and C. CONCLUSIONS: pGz preconditioning in rats significantly reduces infarct size and attenuates ventricular arrhythmias. This simple and non-invasive method of cardioprotection for I/R injury warrants human investigations.

Non-selective cyclooxygenase inhibition before periodic acceleration (pGz) cardiopulmonary resuscitation (CPR) in a porcine model of ventricular fibrillation

Whole body periodic acceleration (pGz) along the spinal axis is a novel method of cardiopulmonary resuscitation (CPR). Oscillatory motion of the supine body in a horizontal fashion provides ventilation and blood flow to vital organs during cardiac arrest and pulsatile shear stress to the vascular endothelium. We previously showed in pigs that pGz-CPR affords better overall survival, post resuscitation myocardial function, and neurological outcomes compared to conventional chest compression CPR. pGz through pulsatile shear stress on the vascular endothelium elicits acute production of prostaglandins and endothelial-derived nitric oxide (eNO) in whole animal models and in vitro preparations. The salutary effects associated with pGz-CPR compared to chest compression CPR are in part related to endothelial-derived nitric oxide. Both eNO and prostaglandins are cardioprotective in ischemia reperfusion models. To differentiate between the roles of these mediators, indomethacin a non-selective cyclooxygenase inhibitor (COX) was used as a tool to investigate prostaglandin effects during pGz-CPR by acute outcomes of survival, cardioprotection and regional blood flows (RBF). Two groups of anesthetized, intubated pigs weighing 25-36kg were studied. Prior to electrical induction of ventricular fibrillation (VF) animals received equal volumes of either saline placebo Control (CONT) (n=9) or indomethacin (INDO), (n=8), (2mg/kg). After 3min of unsupported VF, both groups received 15min of pGz-CPR followed by pharmacologic and electrical attempts for resuscitation. Return of circulation (ROSC) to 3h occurred in (78%) in CONT and (63%) in INDO pretreated animals. There was no statistically significant difference in hemodynamics between groups at baseline or during the protocol. At baseline, INDO caused a decrease in brain RBF. Two hours after ROSC, INDO blunted the hyperemia response to brain and heart. Echocardiographic evidence of myocardial dysfunction was most notable for the INDO group in the wall motion score index (WMSI). After 3h of ROSC there was a 4-fold difference in both creatine phosphokinase (CPK) and Troponin I concentration between INDO and CONT. Therefore, non-specific acute inhibition of COX in part blunts the salutary effects of pGz-CPR. These data suggest that prostaglandins in part are involved in the cardio protection induced by pGz during CPR.

Echocardiographic comparison of cardiopulmonary resuscitation (CPR) using periodic acceleration (pGz) versus chest compression

Objective: This investigation compared the effects of conventional cardiopulmonary resuscitation (CPR) using an automated Thumper™ chest compression device to periodic acceleration CPR (pGz-CPR) on early post-resuscitation ventricular function assessed by echocardiography, in an adult pig model of CPR. Background: Whole body periodic acceleration along the spinal axis (pGz) is a new method of cardiopulmonary resuscitation (CPR). Biomechanical forces and biochemical release produced by pGz impart ventilation and increase blood flow. Our laboratory has reported normal neurological and cardiovascular function 48 h after return of spontaneous circulation in animals that have undergone 22 min of pGz-CPR. Methods: Ventricular fibrillation (VF) was induced in 16 animals (25–35 kg). After 3 min of non-interventional period, the animals were randomized to receive either pGz-CPR or Thumper-CPR for 15 min. After 18 min of VF, a single dose of vasopressin and bicarbonate were administered and defibrillation attempted. An echocardiogram was performed at baseline and serially for 6 h. Ejection fraction (EF), fractional shortening (FS) and wall motion were assessed by 2D and M-mode echocardiography. Results: Return of spontaneous circulation to 360 min occurred in 5/8 (62%) of the animals receiving Thumper-CPR and in 7/8 (88%) receiving pGz-CPR. FS and EF were impaired after CPR, but pGz-CPR animals had less impairment than Thumper-CPR animals. Further, wall motion score index (WMSI) was more impaired after Thumper-CPR and remained as such even 6 h post-CPR. Conclusion: pGz holds promise as a new method for CPR with better left ventricular (LV) function post-CPR than the more traditional chest compression method.

Say NO to fibromyalgia and chronic fatigue syndrome: an alternative and complementary therapy to aerobic exercise

Increased shear stress to the endothelium increases activity of endothelial nitric oxide synthase (eNOS) with subsequent release of small quantities (nMol) of nitric oxide (NO) into the circulation. It occurs during moderate aerobic exercise mostly as a result of laminar shear stress and with whole body, periodic acceleration as a result of pulsatile shear stress. The latter is administered by means of a new, non-invasive, passive exercise device. Moderate exercise has long been known to alleviate the symptoms of fibromyalgia and chronic fatigue syndrome and in the current study, whole body, periodic acceleration did as well. Since NO through action of eNOS has potent anti-inflammatory properties mainly by suppressing nuclear factor κβ activity, it is hypothesized that both diseases have chronic inflammation as their basis. Whole body periodic acceleration can be applied separately or supplementary to aerobic exercise in the treatment of fibromyalgia and chronic fatigue syndrome.

Survival and normal neurological outcome after CPR with periodic Gz acceleration and vasopressin

Background: We showed previously that whole body periodic acceleration along the spinal axis (pGz) is a novel method of cardiopulmonary resuscitation (CPR). The ultimate assessment of the value of any CPR technique is the neurological outcome after using such a technique. In this study, we determined the neurological outcome in pigs after prolonged pGz–CPR, with administration of vasopressin immediately prior to defibrillation. Neurological outcome after pGz–CPR was compared to a control group where no intervention occurred for the same time period (C-NoInterv). Methods and Results: Ventricular Fibrillation (VFIB) was induced in 12 animals. After a 3 min non-interventional interval, the animals received either pGz–CPR ( n=7), or C-NoInterv ( n=5) for 15 min. After 18 min of VFIB, a single dose of vasopressin (0.8 U/kg) was administered along with sodium bicarbonate and bretylium, and defibrillation was attempted. All animals in the pGz–CPR group had return of spontaneous circulation (ROSC) and normal neurological assessment at 24 h. Neurologic outcome remained normal at 48 h. In contrast, none of the animals in the C-NoInterv had ROSC. Conclusion: Prolonged pGz–CPR, with administration of vasopressin immediately prior to defibrillation results in normal neurological outcomes at 24 h.