Cardiovascular Stress Responses Research Articles

The Cardiovascular Stress Response as Early Life Marker of Cardiovascular Health: Applications in Population-Based Pediatric Studies\u2014A Narrative Review

Stress inducement by physical exercise requires major cardiovascular adaptations in both adults and children to maintain an adequate perfusion of the body. As physical exercise causes a stress situation for the cardiovascular system, cardiovascular exercise stress tests are widely used in clinical practice to reveal subtle cardiovascular pathology in adult and childhood populations with cardiac and cardiovascular diseases. Recently, evidence from small studies suggests that the cardiovascular stress response can also be used within research settings to provide novel insights on subtle differences in cardiovascular health in non-diseased adults and children, as even among healthy populations an abnormal response to physical exercise is associated with an increased risk of cardiovascular diseases. This narrative review is specifically focused on the possibilities of using the cardiovascular stress response to exercise combined with advanced imaging techniques in pediatric population-based studies focused on the early origins of cardiovascular diseases. We discuss the physiology of the cardiovascular stress response to exercise, the type of physical exercise used to induce the cardiovascular stress response in combination with advanced imaging techniques, the obtained measurements with advanced imaging techniques during the cardiovascular exercise stress test and their associations with cardiovascular health outcomes. Finally, we discuss the potential for cardiovascular exercise stress tests to use in pediatric population-based studies focused on the early origins of cardiovascular diseases.

Heart Rate Reactivity to Acute Psychological Stress Predicts Higher Levels of Posttraumatic Stress Disorder Symptoms During the COVID-19 Pandemic.

Increased autonomic arousal is a proposed risk factor for posttraumatic stress disorder (PTSD). Few studies have prospectively examined the association between physiological responses to acute psychological stress before a traumatic event and later PTSD symptoms. The present prospective study examined whether cardiovascular responses to an acute psychological stress task before the COVID-19 global pandemic predicted PTSD symptoms related to the ongoing pandemic. Participants (n = 120) were a subsample of an ongoing research study. Phase 1 consisted of a 10-minute baseline and 4-minute acute psychological stress task with blood pressure and heart rate recorded throughout. Phase 2 was initiated 2 weeks after the COVID-19 pandemic declaration. Participants completed the Impact of Event Scale-Revised (IES-R) with respect to the ongoing pandemic. Hierarchical linear regression analyses were used to examine whether cardiovascular stress reactivity predicted COVID-19 PTSD symptoms. Heart rate reactivity significantly predicted IES intrusion (β = -0.208, t = -2.28, p = .025, ΔR2 = 0.041, confidence interval = -0.021 to -0.001) and IES hyperarousal (β = -0.224, t = -2.54, p = .012, ΔR2 = 0.047, confidence interval = -0.22 to - 0.003), but not IES avoidance (p = .077). These results remained statistically significant after adjustment for sex, socioeconomic status, baseline cardiovascular activity, neuroticism, race, ethnicity, body mass index, and adverse childhood experiences. There were no statistically significant associations between blood pressure and any of the Impact of Event Scale-Revised subscales (p values > .12). Diminished heart rate responses (i.e., lower physiological arousal) to acute psychological stress before the COVID-19 pandemic significantly predicted reported PTSD symptoms during the crisis.

Diminished cardiovascular stress reactivity is associated with higher levels of behavioral disengagement

Blunted cardiovascular responses to stress have been associated with poor behavioral regulation. The present study examined the relationship between cardiovascular stress reactivity and an established measure behavioral disengagement. Blood pressure and heart rate were measured during rest and stress task in 452 participants. Behavioral disengagement was measured using the Brief Coping Orientation to Problems Experienced Scale (Brief COPE). Regression models adjusting for baseline cardiovascular values, age, gender, race, ethnicity, SES, depressive symptomology, self-report stress task stressfulness, self-report stress task demandingness, and objective stress task performance demonstrated that lower levels of cardiovascular reactivity were associated with behavioral disengagement, β = -.114, t = -2.36, p = .019, ΔR2 = .017. There were no statistically significant associations between blood pressure reactivity and behavioral disengagement (p’s > .077) in fully adjusted models. The results are consistent with the hypothesis that low reactivity may be a marker of motivational dysregulation.

Treatment-Resistant Blunted HPA Activity, but Reversible Cardiovascular Stress Reactivity in Young Women With Eating Disorders

Previous research has provided evidence for a reduced neuroendocrine stress response in women with eating disorders (EDs). In the present study female in-patients with Anorexia and Bulimia nervosa were compared to female healthy controls (HC) before and after completing an in-patient treatment program. Salivary cortisol, alpha-amylase (sAA), heart rate response (HR), high-frequency heart rate variability (HF-HRV) and negative affective state were measured before, during and after exposure to the Trier Social Stress Test (TSST) at pre- and post-treatment. Patients with EDs (n = 13) showed significantly less ED symptoms at post-treatment. Compared to HC (n = 22), patients displayed a blunted cortisol stress response combined with overall attenuated sAA levels at pre-treatment. At post-treatment, the blunted cortisol stress response was still observable, while the differences in sAA responses disappeared. HR was attenuated at pre-treatment in patients, also indicated by a stronger HF-HRV throughout the TSST. These cardiovascular differences disappeared at post-treatment. Patients reported in general (pre- and post-treatment) more negative affect compared to HC. This study provides further evidences of a hypo-reactive hypothalamus–pituitary–adrenal axis (HPA) in patients with EDs which persists even after symptom recovery while initial low cardiovascular stress reactivity apparently can be restored by psychotherapy. Given the small sample size the findings have to be considered preliminary.

Childhood trauma and type D personality: The endocrine and cardiovascular effects on stress reactivity.

Both exaggerated and blunted cardiovascular stress reactions are associated with health problems. Moreover, early life experiences and personality traits affect stress responses. Regarding the childhood traumas and type D personality, this study aimed to compare the endocrine and cardiovascular reactions against acute laboratory stress. Results showed that the simultaneous existence of childhood traumatic experiences and type D personality leads to exaggerated stress reactivity, while each factor results in a blunted cardiovascular response. Although the cardiovascular responses are dampened in type D personality people, their endocrine reactions are exaggerated. The underlying mechanisms of blunted cardiovascular reactivity differ between childhood trauma and type D personality groups.

Lay theory of generalized prejudice moderates cardiovascular stress responses to racism for White women

Research on stigma by prejudice transfer has demonstrated that White women anticipate sexism when interacting with a racist individual due to a belief that prejudices stem from an underlying ideology of group inequality. The present research proposes that individuals’ lay theory of generalized prejudice (LTGP) varies across individuals and examines cardiovascular stress responses (high frequency heart rate variability [HF-HRV] and preejection period [PEP]). White women who held a lay theory of generalized prejudice and were evaluated by a White man with negative attitudes towards Black Americans demonstrated greater cardiovascular reactivity (decreases in parasympathetic activity [Studies 1 and 2] and shortened PEP [Study 2] from baseline to evaluation) than White women being evaluated by a neutral evaluator or who did not hold a lay theory of generalized prejudice. The present studies are the first to demonstrate cardiovascular stress responses to stigma by prejudice transfer and to highlight LTGP as a key individual difference in stigma by prejudice transfer.

The impact of emotion regulation on cardiovascular, neuroendocrine and psychological stress responses

Emotion regulation (ER) is vital for healthy adaptation and influences how individuals respond to and recover from stress. We investigated whether ER improves cardiovascular, neuroendocrine and psychological stress responses, while taking into account the moderating role of habitual ER tendencies. Eighty-six women applied either cognitive reappraisal or expressive suppression (vs. control) while undergoing a stressor. Reappraisal decreased heart rate variability (HRV) during stress, but also initiated a stronger post-stress HRV-recovery relative to suppression. This reappraisal-induced cardiac-vagal-flexibility was particularly observed in habitual reappraisers. Furthermore, the reappraisal group reported enhanced positive affect, whereas the suppression group experienced more unpleasantness and expressed higher cortisol levels than controls. Heightened cortisol reactivity was also found in the reappraisal group, but only for individuals scoring low or mean on trait reappraisal. These results provide preliminary evidence that reappraisal fosters psychophysiological adaptation in response to stress, but also suggest that ER-strategy-efficacy critically depends on its habitual use.

Effects of 8-week endurance and resistance training programmes on cardiovascular stress responses, life stress and coping

ABSTRACT This study tested the effect of 8-week endurance and resistance training programmes on cardiovascular stress responses, life stress, and coping. Fifty-two untrained but healthy female students were randomised to an 8-week endurance training, an 8-week resistance training, or a wait list control group. Before and after the training intervention, we assessed the groups’ cardiorespiratory fitness (VO2max test), self-reported life stress, coping strategies and cardiovascular reactivity to and recovery from a standardised laboratory stressor. Both endurance and resistance training programmes caused physiological adaptation in terms of increased VO2max after the intervention. For stress and coping parameters, participants in the training groups improved cardiovascular recovery from stress and reported having less stress in their everyday life after the intervention than participants in the control group, while the two training groups did not differ from each other. We did not find any significant differences in heart rate reactivity and coping strategies between the study groups. These results partly support that exercise training has stress-reducing benefits regardless of the type of exercise. Both endurance and resistance exercise activities may be effectively used to improve stress regulation competence while having less impact on changing specific coping strategies.

Sexually‐Divergent Effects of Infralimbic Cortex Stimulation on Endocrine and Cardiovascular Stress Reactivity

Stress, defined as a real or perceived threat to homeostasis, promotes adaptive physiological responses. Unfortunately, the burden of prolonged stress contributes to a variety of pathologies including cardiometabolic disorders. While the impact of stress on cardiovascular disease is well‐documented, mechanisms have yet to be defined. Our previous studies found that inhibition of glutamate release from the infralimbic cortex (IL), a subregion of prefrontal cortex, leads to impaired vascular function after chronic stress. This led to the hypothesis that IL activity may be sufficient to restrain cardiovascular and endocrine responses to stress. Furthermore, we hypothesized that IL activity may mitigate chronic variable stress (CVS) effects on cardiac function and structure. In the current study, we utilized optogenetics to stimulate glutamatergic IL neurons in male and female rats exposed to stress. Briefly, male and female rats received intra‐IL injections of adeno‐associated virus containing a construct coding for the light‐sensitive cation channel, channelrhodopsin‐2, or a control construct expressing yellow fluorescent protein. Both constructs were expressed under the calcium/calmodulin‐dependent protein kinase IIa promoter, permitting the activation of IL glutamate neurons via targeted blue light stimulation. After recovery from injection and optic implantation, rats were exposed to restraint and novel environment stressors to examine acute reactivity. During optic stimulation, rats exposed to restraint stress had blood collected to examine stress‐induced corticosterone and glucose responses. Animals were also implanted with radiotelemeters to measure blood pressure and heart rate reactivity, as well as autonomic balance, during exposure to a novel environment. Following acute stress, rats were subject to 14‐day CVS which consisted of twice‐daily and overnight psychological stressors. All animals underwent echocardiographic assessment of cardiac structure and function before and after CVS. In males, activation of IL glutamate outflow reduced corticosterone and glucose responses to restraint. In contrast, females did not have altered corticosterone secretion but exhibited enhanced glucose responses. When placed in a novel environment, IL activation reduced male heart rate and blood pressure reactivity, while increasing female heart rate. Analysis of the autonomic components of heart rate variability during acute stress indicated that IL stimulation reduced net sympathetic drive in males but not females. Likewise, throughout CVS, males but not females showed a decrease in circadian net sympathetic drive. Furthermore, IL activation in males prevented increased left ventricular wall thickness and fractional shortening after CVS. Together, these data suggest IL glutamate neurons are critical for integrating physiological responses to stress. These findings also provide a sex‐specific mechanism linking stress and cardiovascular health outcomes.Support or Funding InformationNIH grant R00 HL122454 to B. Myers

Trait Anxiety and Blood Pressure Reactivity to Mental Stress

Chronic stress is a prevalent issue among the general population, and has been associated with other comorbid pathologies. Despite its widespread impact, the effects of chronic stress on cardiovascular outcomes are not well understood. The purpose of this study was to assess the role trait anxiety might play in blood pressure reactivity at the onset of psychological stress, namely mental arithmetic. We hypothesized that increased trait anxiety levels would be correlated with an augmented blood pressure response at the onset of mental stress, indicating a higher cardiovascular reactivity to stress. Twenty‐four adults (10 men, 14 women; 22±1 years) were assessed during a three‐minute supine baseline followed by five minutes of psychological stress (mental arithmetic). Physiological variables measured included heart rate (HR; electrocardiogram) and blood pressure (sphygmomanometer and finger plethysmography). Trait anxiety was measured prior to the experiment (Spielberger Trait Anxiety Inventory). Average raw and standardized trait anxiety levels were 32±2 and 42±2, respectively. Due to low representation of severe anxiety, a tertile analysis was performed on both raw (n=8 per tertile) and standardized trait (T1: n=8, T2: n=7, T3: n=9) anxiety levels to assess blood pressure reactivity between the different severities represented in our sample population. Mental stress significantly (p<0.001) increased mean arterial pressure (MAP; Δ10±1 mmHg), systolic pressure (SAP; Δ10±2 mmHg), diastolic pressure (DAP; Δ9±1 mmHg), and heart rate (HR; Δ14±1 beats/min), but these increases were not significantly different between tertiles (p>0.05). However, during the first minute following the onset of mental stress, ANOVA analysis revealed a significant difference in the increase of MAP between tertiles (p=0.05). Following post hoc analysis, the first raw trait anxiety tertile exhibited a greater increase (p<0.05) in MAP (Δ8 ±2 mmHg) when compared to tertiles two (Δ2±2 mmHg) and three (Δ2±2 mmHg). Similarly, the first standard trait anxiety tertile showed a significantly greater increase (p<0.05) in MAP (Δ8±2 mmHg) when compared to both tertile two (Δ2±2 mmHg) and three (Δ2±2 mmHg). Contrary to our hypothesis, the results of this study indicate a decreased cardiovascular stress response and potential autonomic dysregulation in individuals with heightened stress levels. These results suggest the use of subjective anxiety questionnaires may be helpful during autonomic function testing to better account for the potential role of anxiety in cardiovascular reactivity.Support or Funding InformationNIH R01 AA‐024892 and NIH R21 HL098676

Worldview Under Stress: Preliminary Findings on Cardiovascular and Cortisol Stress Responses Predicted by Secularity, Religiosity, Spirituality, and Existential Search

This study reports preliminary findings on the hypothesis that worldview can predict cardiovascular and cortisol responses to social stress. Based on theory and previous findings, we assumed that worldview security would provide a basis for stress resilience. Accordingly, religious and atheist individuals were expected to show higher stress resilience than spiritual and agnostic participants. Likewise, dimensional measures of religiosity and atheism were hypothesized to predict decreased, and existential search—indicating worldview insecurity—was hypothesized to predict increased physiological stress responses. Subjects included 50 university students who completed online questionnaires and took part in a standardized social stress test (Trier Social Stress Test). Systolic and diastolic blood pressure (SBP/DBP), heart rate (HR), and salivary cortisol (SC) were assessed at baseline, immediately after stress testing, and during a forty-minute recovery period. Worldview comparisons revealed lower cardiovascular stress responses among religious than among atheist and spiritual participants and particularly high baseline SC among spiritual participants. Across the entire sample, existential search showed substantial positive correlations with SBP, HR, and SC stress parameters. The findings suggest that worldview security might partly explain the health benefits often associated with religion.

Impaired cognitive performance under psychosocial stress in cannabis-dependent men is associated with attenuated precuneus activity

Deficient regulation of stress plays an important role in the escalation of substance use, addiction and relapse. Accumulating evidence suggests dysregulations in cognitive and reward-related processes and the underlying neural circuitry in cannabis dependence. However, despite the important regulatory role of the endocannabinoid system in the stress response, associations between chronic cannabis use and altered stress processing at the neural level have not been systematically examined. Against this background, the present functional MRI study examined psychosocial stress processing in cannabis-dependent men (n = 28) and matched controls (n = 23) using an established stress-induction paradigm (Montreal Imaging Stress Task) that combines computerized (adaptive) mental arithmetic challenges with social evaluative threat. During psychosocial stress exposure, but not the no-stress condition, cannabis users demonstrated impaired performance relative to controls. In contrast, levels of experienced stress and cardiovascular stress responsivity did not differ from controls. Functional MRI data revealed that stress-induced performance deteriorations in cannabis users was accompanied by decreased precuneus activity and increased connectivity of this region with the superior frontal gyrus. Only male cannabis-dependent users were examined; the generalizability in female users remains to be determined. Together, the present findings provide first evidence for exaggerated stress-induced cognitive performance deteriorations in cannabis users. The neural data suggest that deficient stress-related recruitment of the precuneus may be associated with the deterioration of performance at the behavioural level.

Establishing the validity of a novel passive stress task.

Laboratory tasks used to elicit a cardiovascular stress response in the laboratory can involve either active or passive coping. However, in previous work, passive stress tasks often incorporate a distinct physical stress element, such as the handgrip or cold pressor task, meaning observed changes in cardiovascular parameters may be the result of the physical element of the stressor rather than truly reflecting psychological stress. The present study aimed to establish the validity of a psychological passive stressor; one more analogous to active tasks than those previously employed in laboratory studies. Twenty-six young, healthy adults completed a speech task in the laboratory following a resting baseline period. Twelve months later, they were invited back to the laboratory and watched the video recording of their speech. Analyses confirmed that while both tasks elicited significant SBP and DBP change (all ps<.001), only the active task was associated with HR and CO reactivity (both ps<.001), while only the passive task was associated with TPR reactivity (p=.028). Furthermore, the passive stressor was associated with a mixed hemodynamic profile, whereas the active stressor was associated with a clear myocardial profile. This study confirms that watching a video recording of oneself complete a speech task is associated with a more vascular response profile, a response associated with passive coping contexts.

Cardiovascular stress reactions in recent- and long-retired rugby players when watching a game

While hospital admissions for cardiac causes on a population level appear to rise when the national team is playing in a sporting fixture, little research has examined cardiovascular reactions in spectators watching a sporting event. In a sample of 41 male supporters of a rugby team, all of whom had played the sport themselves, cardiovascular levels and psychological ratings of stress and anxiety were measured pre- and post-match. Counterfactual thinking was also assessed. Mixed factorial ANOVA analyses showed that in supporters who had recently retired from playing, psychological ratings of stress and anxiety were significantly lower pre-match compared to those who had long-retired (all ps < 0.001). However, significant phase × player status interactions identified that systolic blood pressure, F(1, 39) = 13.93, p = .001, partial ƞ2 = 0.26, diastolic blood pressure, F(1,39) = 24.62, p < .001, partial η2 = 39, and heart rate, F(1, 39) = 23.02, p < .001, partial η2 = 0.37, increased significantly in recent-retired players compared to long-retired players, indicating that they found watching the match more stressful than the long-retired players. Furthermore, this effect was moderated by counterfactual thinking in recent-retired players only, where greater levels of counterfactual thinking was associated with greater cardiovascular reactivity. These findings confirm that watching a sporting fixture induces cardiovascular reactivity in spectators who recently retired from the sport, with counterfactual thinking a possible underlying pathway.

Comparison of Esmolol and Lidocaine for Attenuating Cardiovascular Stress Response to Direct Laryngoscopy and Endotracheal Intubation

Comparison of Esmolol and Lidocaine for Attenuating Cardiovascular Stress Response to Direct Laryngoscopy and Endotracheal Intubation

P.137 Validation of the alcohol use disorders identification test in patients with anxiety and mood disorders in Lithuania

Knowledge of objective psychophysiological stress parameters and its relationship to health-related quality of life (HRQoL) is limited in patients with coronary artery disease (CAD).The aim was to investigate the association of cardiovascular reaction to psychosocial stress with HRQoL in patients with CAD.One-hundred and thirty-six patients (84.6% men, age 52 ± 8) within 2–3 weeks after acute coronary syndromes (ACS) during cardiac rehabilitation were recruited in this cross-sectional study. Patients were evaluated for HRQoL (SF-36 questionnaire), symptoms of anxiety and depression (Hospital Anxiety and Depression scale) and Type D personality (DS14 scale). Trier Social Stress Test (TSST) was employed to evaluate cardiovascular reactivity (systolic and diastolic blood pressure [BP], and heart rate [HR]) to psychosocial stress. Multiple linear regression analyses were performed to test for the associations between cardiovascular reactivity and HRQoL, while controlling for possible confounders.After controlling for baseline levels of HR, gender, age, NYHA functional class, AH, Type D personality, symptoms of anxiety and depression, use of beta-blockers, and history of smoking, the SF-36 Social functioning scale (β = −0.182; p = .03) and SF-36 Vitality scale (β = −0.203; p = .03) was associated with prolonged HR recovery following stress evoking tasks. No associations were found between HRQoL and BP measures during the TSST.In CAD patients who have experienced ACS, HRQoL was associated with prolonged HR recovery after mental stress, even after controlling for potential confounder. Future studies should investigate the possible role of mediating factors involved in the mechanisms relating cardiovascular stress response and HRQoL.

A randomized trial to evaluate a modified tracheal catheter with upper and lower balloons for anesthetic administration: effect on the cardiovascular, stress response, and comfort in patients undergoing laparoscopic cholecystectomy

BackgroundWe aimed to evaluate a modified endotracheal tube containing upper and lower balloons for anesthetic administration among patients undergoing laparoscopic cholecystectomy.MethodsNinety patients scheduled to undergo laparoscopic cholecystectomy were randomly allocated to 3 equal groups: group A (conventional tracheal intubation without endotracheal anesthesia); B (conventional tracheal intubation with endotracheal anesthesia); and C (tracheal intubation using a modified catheter under study). Blood pressure, heart rate, angiotensin II level, blood glucose level, airway pressure before anesthesia (T1) were measured immediately after intubation (T2), 5 min after intubation (T3), and immediately after extubation (T4). The post-extubation pain experienced was evaluated using the Wong-Baker Face Pain scale. Adverse reactions within 30 min after extubation were recorded.ResultsSystolic blood pressure, diastolic blood pressure, angiotensin II, and blood sugar level in group C at T2, T3 and T4, and heart rate at T2 and T4 were significantly lower than those in group A (P < 0.05); systolic blood pressure and blood sugar at T4, and angiotensin II levels at T2, T3, and T4 were significantly lower than those in group B (P < 0.05). Patients in group C reported the lowest post-extubation pain (P < 0.05 vs. Group A), and the lowest incidence of adverse events such as nausea, vomiting, and sore throat than that in groups A and B (P < 0.05).ConclusionThe modified endotracheal anesthesia tube under study is effective in reducing cardiovascular and tracheal stress response, and increasing patient comfort, without inducing an increase in airway resistance.Trial registrationThe clinical trial was retrospectively registered at the Chinese Clinical Trial Registry with the Registration Number ChiCTR1900020832 at January 20th 2019.

Physiological and emotional responses to evaluative stress in socially inhibited young adults

BackgroundThere are large individual differences in dealing with everyday social stress. Therefore, we investigated the association of social inhibition (and its facets) with the emotional and physiological responses to the Trier Social Stress Test (TSST). MethodsUndergraduate students (N = 312) completed the 15-item Social Inhibition Questionnaire (SIQ15) and participated in the TSST, while emotional and cardiovascular stress responses were recorded. We examined the effect of social inhibition across time with repeated-measures ANCOVAs. FindingsDuring social stress (and recovery), social inhibition was associated with increased negative mood reactivity (especially the behavioral inhibition facet) and heightened sympathetic activation (especially the social withdrawal and interpersonal sensitivity). Physiological stress reactivity seems to be mostly α-adrenergic in women, and also β-adrenergic in men. ConclusionsEmotional and physiological stress responses are associated with individual differences in social inhibition. This warrants more research on mechanisms that underlie the relations between social inhibition, stress and health.

Cardiovascular Reactivity to Acute Mental Stress: THE IMPORTANCE OF TYPE D PERSONALITY, TRAIT ANXIETY, AND DEPRESSION SYMPTOMS IN PATIENTS AFTER ACUTE CORONARY SYNDROMES.

Links between psychophysiological reactions to stress stimuli and perceived mental distress, including type D personality, anxiety, and depression, are still under debate. The aim of this study was to examine associations between cardiovascular reactivity to social stress and mental distress in patients after acute coronary syndrome. Patients (n = 116, 86% males, 52 ± 8 yr) with coronary artery disease 2 wk after acute coronary syndrome were evaluated for sociodemographic, clinical characteristics and coronary artery disease risk factors. The Trier Social Stress Test was employed to measure cardiovascular reactions to social stress (systolic and diastolic blood pressure and heart rate). Mental distress assessment included type D personality (Type D Scale), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), and state and trait anxiety (State-Trait Anxiety Inventory). Multiple linear regression analysis showed associations between type D personality and lower heart rate during Trier Social Stress Test periods of task instruction (β = -.196, P < .04), preparation time (β = -.232, P < .01), and recovery time (β = -.209, P < .029). Higher trait anxiety was linked with lower heart rate during baseline rest (β = -.287, P < .01), task instruction (β = -.286, P < .01), preparation time (β = -.241, P < .01), and recovery period (β = -.209, P < .05). Depressive symptoms were associated with higher systolic blood pressure during baseline rest (β =.187, P < .05), task instruction (β = .306 P < .01), and free speech (β = .264, P < .05). Mental distress was associated with cardiovascular stress reactions independent from possible covariates, suggesting dysregulated psychophysiological reactions to acute stress.

Association between depressive symptoms and perceived exertion during exercise: observational population-based cohort study of European, Indian Asian, and African-Caribbean older adults

BackgroundExercise interventions are increasingly recognised to help reduce depressive symptoms; however, fatigue and perception of increased energy expenditure, which are often associated with depression, may be barriers to adherence. Although depression has been associated with a blunted cardiovascular stress response, little evidence exists describing perceived exertion during exercise and depression. Furthermore, cardiorespiratory fitness and depression vary by ethnicity across a range of ages. We investigated associations between depressive scores and perception of exertion and physiologically measured exertion during exercise in a tri-ethnic population of older adults. MethodsParticipants were older adults enrolled in a tri-ethnic population-based cohort originally recruited in west London (UK), the Southall and Brent REvisited (SABRE) study. 691 participants (57% men, 43% women; mean age 71·3 years, SD 6·5 years; ethnicity European [n=304], Indian Asian [n=222], or African-Caribbean [n=165]) underwent assessment of depression on the ten-item Geriatric Depression Scale (GDS) and undertook a self-paced 6-min step test. Outcomes measured were rate of perceived exertion (assessed using a 0–10 Borg score immediately after exercise) and exertion (steps completed and highest achieved whole-body oxygen consumption in mL/min per kg). Linear relationships were summarised using β-coefficients with 95% CI from regression models adjusted for age, sex, and ethnicity. An interaction term was used to assess the effect of ethnicity on associations. Ethics approval was from the National Research Ethics Service Committee Fulham, London. All participants gave written consent to undertake the tests. FindingsIn all participants, higher rate of perceived exertion was associated with greater GDS (β 0·10, 95% CI 0·01 to 0·19, p=0·03). GDS was inversely associated with objectively measured exertion (β −6·8, 95% CI −9·9 to −3·8 for steps, p<0·001; and −7·0, −10·0 to −4·0 for whole-body oxygen consumption, p<0·001). The effect of GDS on rate of perceived exertion persisted following adjustment for steps achieved during the test (adjusted β 0·12, 95% CI 0·02 to 0·21, p=0·01) or whole-body oxygen consumption (0·14, 0·05 to 0·25, p=0·01). Ethnicity did not modify these associations. InterpretationOlder adults with higher depression scores had an increased perception of exertion independent of objectively measured exertion during exercise. This result is consistent with previous findings and a well-documented blunted cardio-respiratory response to exercise in the presence of depression. Greater perceptions of exertion could hinder compliance in exercise training programmes targeting depressive symptoms in older adults. FundingThe SABRE study was funded by a grant from the British Heart Foundation.