Supine Rest Research Articles

Aortic blood pressure and pulse wave indices responses to exercise in peripheral artery disease.

Peripheral artery disease (PAD) refers to obstructed blood flow in peripheral arteries typically due to atherosclerotic plaques. How PAD alters aortic blood pressure and pressure wave propagation during exercise is unclear. Thus, this study examined central blood pressure responses to plantar flexion exercise by investigating aortic pulse wave properties in PAD. Thirteen subjects with PAD and 13 healthy [age-, sex-, body mass index (BMI) matched] subjects performed rhythmic plantar flexion for 14 min or until fatigue (20 contractions/min; started at 2 kg with 1 kg/min increment up to 12 kg). Brachial (oscillometric cuff) and radial (SphygmoCor) blood pressure and derived-aortic waveforms were analyzed during supine rest and plantar flexion exercise. At rest, baseline augmentation index (P = 0.0263) and cardiac wasted energy (P = 0.0321) were greater in PAD due to earlier arrival of the reflected wave (P = 0.0289). During exercise, aortic blood pressure (aMAP) and aortic pulse pressure showed significant interaction effects (P = 0.0041 and P = 0.0109, respectively). In particular, PAD had a greater aMAP increase at peak exercise (P = 0.0147). Moreover, the tension time index was greater during exercise in PAD (P = 0.0173), especially at peak exercise (P = 0.0173), whereas the diastolic time index (P = 0.0685) was not different between the two groups. Hence, during exercise, the subendocardial viability ratio was lower in PAD (P = 0.0164), especially at peak exercise (P = 0.0164). The results suggest that in PAD, the aortic blood pressure responses and myocardial oxygen demand during exercise are increased compared with healthy controls.

Effects of Posture and Walking on Tibial Vascular Hemodynamics Before and After 14 Days of Head-Down Bed Rest.

Human skeletal hemodynamics remain understudied. Neither assessments in weight-bearing bones during walking nor following periods of immobility exist, despite knowledge of altered nutrient-artery characteristics after short-duration unloading in rodents. We studied 12 older adults (8 females, aged 59 ± 3 years) who participated in ambulatory near-infrared spectroscopy (NIRS) assessments of tibial hemodynamics before (PRE) and after (POST) 14 days of head-down bed rest (HDBR), with most performing daily resistance and aerobic exercise countermeasures during HDBR. Continual simultaneous NIRS recordings were acquired over the proximal anteromedial tibial prominence of the right lower leg and ipsilateral lateral head of the gastrocnemius muscle during supine rest, walking, and standing. During 10 minutes of walking, desaturation kinetics in the tibia were slower (time to 95% nadir values 125.4 ± 56.8 s versus 55.0 ± 30.1 s, p = 0.0014). Tibial tissue saturation index (TSI) immediately fell (-9.9 ± 4.55) and did not completely recover by the end of 10 minutes of walking (-7.4 ± 6.7%, p = 0.027). Upon standing, total hemoglobin (tHb) kinetics were faster in the tibia (p < 0.0001), whereas HDBR resulted in faster oxygenated hemoglogin (O2Hb) kinetics in both tissues (p = 0.039). After the walk-to-stand transition, changes in O2Hb (p = 0.0022) and tHb (p = 0.0047) were attenuated in the tibia alone after bed rest. Comparisons of NIRS-derived variables during ambulation and changes in posture revealed potentially deleterious adaptations of feed vessels after HDBR. We identify important and novel tibial hemodynamics in humans during ambulation before and after bed rest, necessitating further investigation. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Sex-specific differences in the circulatory response to postural stress among young adults with adverse childhood experiences (ACEs)

Adverse childhood experiences (ACEs)—a highly prevalent assortment of traumatic childhood events (e.g., abuse)—are strongly linked to adult cardiovascular disease (CVD), though differently among males and females. Biological sex differences in the circulatory response to physiological stress (e.g., postural stress) have been well-characterized; however, whether ACEs affect this response differently among males and females remains unclear. This study tested the hypothesis that ACEs affect the circulatory response to head-up tilt (HUT; postural stress) differently among males and females. Three hundred ( n = 156 female; 22.4 ± 1.8 years) young adults recruited through the Niagara Longitudinal Heart Study (NLHS) were included in the current analyses. ACEs were assessed (Childhood Trust Events Survey 2.0) and participants were dichotomized into high (≥4 ACEs) and low (&lt;4 ACEs) exposure groups. Beat-by-beat mean arterial pressure (MAP; finger photoplethysmography) and heart rate (HR; electrocardiogram) were recorded during 10-minutes of supine rest and 5-minutes of 60° HUT. Sex-stratified, mixed-model regression analyses assessed the effect of ACEs on changes (Δ) in MAP and HR from supine rest to HUT, adjusting for age, body mass index, physical activity, and smoking status. During HUT, MAP increased to a similar extent in males with high and low ACEs exposure (ΔMAP: 11.5 ± 10.8 mmHg vs. 10.1 ± 10.9 mmHg, respectively; p &gt; 0.05). In contrast, MAP increased to a greater extent in females with high ACEs exposure compared to females with low ACEs exposure (ΔMAP: 11.3 ± 10.4 mmHg vs. 5.9 ± 9.8 mmHg, respectively; p = 0.003). HR increased during HUT in males with both high and low ACEs exposure; however, it increased to a lesser extent in males with high ACEs exposure compared to males with low ACEs exposure (ΔHR: 14.7 ± 7.5 bpm vs. 18.7 ± 8.1 bpm, respectively; p = 0.015). In females, HR increased to a similar extent during HUT in those with high and low ACEs exposure (ΔHR: 16.5 ± 8.1 bpm vs. 17.6 ± 8.9 bpm, respectively; p &gt; 0.05). These data suggest that ACEs affect the circulatory response to postural stress differently in males and females. Further, these data imply that sex-specific differences in circulatory regulation can be observed as early as young adulthood in those reporting high ACEs exposure. This work was supported by the Canadian Institute of Health Research (CIHR) and Brock University This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Blunted sympathetic transduction to blood pressure in females with relapsing-remitting multiple sclerosis

Approximately 1 million people in the United States are living with multiple sclerosis (MS) with nearly 75% of those being female. MS is a progressive demyelinating neurological disease of the central nervous system associated with a high prevalence of orthostatic hypotension. Our laboratory has previously shown that individuals with MS have a reduced ability to increase mean arterial pressure during simulated hypotension which was attributed to a blunted vascular response. The purpose of this project was to investigate how spontaneous bursts of muscle sympathetic nerve activity (MSNA) induce end-organ response(s) and ultimately evoke a change in blood pressure (BP) on a heartbeat-to-heartbeat basis in females with MS, a process known as sympathetic transduction to BP. We tested the hypothesis that females with MS have reduced resting sympathetic transduction to BP compared to sex-, height-, weight-, age- and race-matched healthy controls. Beat-to-beat BP (Finometer) and MSNA (peroneal microneurography) were continuously recorded during 10 minutes of quiet supine rest in 9 females with relapsing-remitting MS (age: 39.6 ± 3.3 years; Expanded Disability Status Scale &lt; 6.0) and 10 healthy female controls (age: 35.4 ± 2.1 years). Total vascular conductance (TVC) was estimated using modelflow. Sympathetic transduction was determined by identifying the peak change in diastolic BP and the nadir reduction of TVC over 10 cardiac cycles following spontaneous MSNA bursts using signal averaging. No differences were detected in resting mean arterial pressure (MS: 88 ± 3 mmHg; controls: 85 ± 2; P = 0.42) or MSNA burst frequency (MS: 26 ± 3 bursts/min; controls: 19 ± 3 bursts/min; P = 0.11) between groups. Peak increases in diastolic BP following MSNA bursts were lower in females with MS (1.2 ± 0.2 mmHg) compared to controls (2.5 ± 0.6 mmHg; P = 0.039). Whereas no differences were observed in nadir reductions in TVC (MS: -1.7 ± 0.5 ml/min/mmHg; controls: -3.0 ± 0.8 ml/min/mmHg; P = 0.11). These preliminary data suggest that sympathetic transduction to BP is blunted in females with MS. Reduced sympathetic transduction to BP may contribute to the high occurrence of orthostatic hypotension in this clinical population. Further investigation is warranted to help better understand the potential mechanism(s) underlying lower sympathetic transduction in females with MS. This work was supported by American Heart Association Predoctoral Fellowship (Award #915655, Trotter) and American College of Sports Medicine Doctoral Research Grant (Award # 19-01141, Trotter) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Trait anxiety is associated with blood pressure and muscle sympathetic nerve activity

Heightened anxiety is associated with an increased risk for cardiovascular diseases such as coronary heart disease and hypertension. While hyperactivity of the sympathetic nervous system has been suggested to mediate this relationship, direct measures of muscle sympathetic nerve activity (MSNA) in people with elevated anxiety have indicated little, if any, alterations in baseline sympathetic function. However, studies examining anxiety and MSNA have been limited by small sample sizes and lack of detail on anxiety severity, limiting the ability to investigate subtle interactions. The present study assessed associations between trait anxiety, mean arterial pressure (MAP), and MSNA using a large, representative sample of healthy young men and women, with an exploratory assessment of sex-specific interactions. We hypothesized that heightened trait anxiety would be associated with elevated resting MAP and MSNA. Trait anxiety was assessed using the Spielberger Trait Anxiety Inventory (STAI) in 97 healthy adults (52 male, 45 female; 25±1 years; 26±1 kg/m 2 ). In each participant, the average of three seated brachial blood pressures was recorded and used in subsequent analysis. All participants underwent an autonomic function test that simultaneously assessed heart rate (HR), beat-to-beat blood pressure, MSNA burst frequency (BF) and incidence (BI) during 5-10 minutes of supine rest. MSNA recordings were captured in 91 participants. Multiple regression was used to test the relationship between STAI, MAP, MSNA, and HR while accounting for age and sex. Sex-specific interactions were explored with correlations controlling for age. The regression model significantly predicted MAP (R 2 =.196, P&lt;0.001), BF (R 2 =.136, P=0.005), and BI (R 2 =.150, P=0.003), but not HR (R 2 =.055, P=0.155). STAI scores were independently associated with MAP (β=.207, P=0.029), BF (β=.245, P=0.016), and BI (β=.224, P=0.027). In males, STAI was correlated with MAP (R=.277, P=0.049), BF (R=.363, P=0.009), and BI (R=.346, P=0.013), but not HR (R=.140, P=0.326). In contrast, STAI was not associated with MAP (R=.174, P=0.260), BF (R=.094, P=0.574), BI (R=.069, P=0.681), or HR (R=.226, P=0.141) in females. In a large sample of healthy adults, our results highlight the relationship between the severity of trait anxiety, resting blood pressure, and sympathetic outflow, with a more pronounced relationship in males. Support: NIH (AA-024892, 1R15HL140596-01, AG064038-01A1, U54GM115371; P20GM103474, 2TL1 TR002318). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Inspiratory resistance training transiently improves endothelium-dependent dilation in young adults

Introduction: Inspiratory resistance training (IRT) is a resisted breathing exercise originally devised to improve diaphragmatic strength. We have shown IRT to be a potent non-pharmacological therapy that yields significant reductions in resting blood pressure. When performed daily for 6 weeks, systolic blood pressure is reduced by ~9 mmHg, secondary to reductions in systemic vascular resistance. Whereas the effects of IRT on the vasculature have been described over the intermediate term, the acute responses that mediate these longer-term adaptations have not been fully characterized. Purpose: Our primary aim was to quantify the acute effects of a single bout of IRT on (endothelium-dependent dilation) EDD in healthy men and women. Secondarily, our goal was to determine the acute effects of IRT on arterial stiffness. Methods: Nitric oxide-mediated EDD and ischemia-induced maximal shear rate were assessed with brachial artery flow-mediated dilation (FMD), and arterial stiffness was assessed via carotid-femoral pulse wave velocity (PWV). Twenty healthy young adults (22.9 ± 3.4 years; 10 males, 10 females) were randomized to the experimental (IRT; 5 sets of 6 breaths at 50% of maximal inspiratory pressure with 1-minute rest intervals) and control (time-matched supine rest) conditions in a crossover design, with at least 48 hours between visits. FMD and PWV were performed before, 10 minutes after, and 40 minutes after the assigned intervention. Statistical analysis included repeated measures ANOVA with Sidak post hoc analyses. Results: All values are mean difference ± SD. There were no between-day differences in EDD at baseline (mean difference: 0.08 ± 3.03%; p=0.908). EDD was significantly increased from baseline at 10 minutes post-IRT (+1.86 ± 2.75%; p=0.025), but returned to baseline levels at 40 minutes post-IRT (-0.10 ± 3.00%; p=0.998). During the control condition, EDD was unchanged from baseline at 10 minutes post-rest and 40 minutes post-rest ( p=0.136). Lastly, maximal shear rate following 5 minutes of forearm blood flow occlusion was not different from baseline at any time point following IRT ( p=0.749) and thus, the change in EDD is not a result of a modified hyperemic response. However, in the control condition maximal shear rate was significantly lower at 40 minutes post-rest, relative to baseline (mean difference -9.94 ± 2.64 per second; p=0.005), although the reduced shear rate did not impact EDD at 40 minutes post-rest. Arterial stiffness was unchanged from baseline in response to IRT ( p=0.217) or the rest intervention ( p=0.150). Conclusions: In healthy young adult men and women, a single bout of IRT elicits a transient enhancement in EDD. The effect endures for at least 10 minutes but is extinguished at 40 minutes post IRT. Repeated acute enhancements in EDD may contribute to sustained IRT-related reductions in vascular resistance after 6 weeks of traini This work was supported by NIA/NIH Grant Number: 1R01AG065346-01A1 (EFB), NIH Training Grant Number: 5T32HL007249-44 (DT), and NIH/NHLBI Grant Number: 1K01HL153326-01 (DHC) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Do cytochrome P450 2C9 pathways contribute to the cerebrovascular response to small muscle exercise?

Cytochrome P450 2C9 (CYP450) contributes to regulation of cerebral blood flow in animal models, however, the involvement of CYP450 in human cerebrovascular control is under researched. To this effect, small muscle exercise has been utilized as a model to evaluate cerebral flow in humans, but whether CYP450 contributes to that response is unknown. PURPOSE: To determine if CYP450 contributes to cerebrovascular response during small muscle exercise. METHODS: 16 healthy young adults (10 females tested only in the first 5 days of their menstrual cycle) participated in a familiarization visit followed by 2 experimental visits separated by ≥72hrs. Participants received either a microcrystalline cellulose placebo (PLA 250mg) or the CYP450 inhibitor fluconazole (FLZ 150mg) in a single-blind, randomized, crossover design. After ingestion, participants rested for 120 minutes prior to the experiment. After which, mean arterial pressure (MAP, mmHg, finger photoplethysmography) and middle cerebral artery velocity (MCAv, cm/s, Transcranial Doppler) were measured continuously for 5 minutes of supine rest followed by 5 minutes of dynamic hand grip exercise (contraction/relaxation cycle 1:2 seconds) at heart level at resistance 20% of their maximal voluntary contraction. Cerebrovascular conductance index was calculated as CVCi = MCAv/MAP (cm/s/mmHg). RESULTS: Data was averaged as 3 second intervals to match the contraction rate and presented as change (Δ) from rest to exercise, reported as mean ± SD. All values were not different between treatments at steady state exercise (MAP PLA Δ 10.9±5.5 vs. FLZ Δ 10.4±3.3 mmHg, p = 0.88, MCAv PLA Δ 0.9±7.7 vs. FLZ Δ 1.2±4.7 cm/s, p = 0.88, CVCi PLA Δ -0.07±0.06 vs. FLZ Δ -0.06±0.06, p = 0.34). Interestingly, at exercise onset (~ 18s or first 6 contraction cycles) MCAv response was blunted with FLZ (PLA Δ 5.2±4.8, FLZ Δ 2.9±3.9 cm/s, p = 0.03, d = 0.51). This attenuation was not due to a change in MAP (PLA Δ 1.2±3.0, FLZ Δ 2.2±4.8 mmHg, p = 0.2, d = -0.25). Thus, attenuation of the MCAv in FLZ was due to a reduction in CVCi response (PLA Δ 0.04±0.04, FLZ Δ 0.009±0.04 cm/s/mmHg, p = 0.003, d = 0.8). CONCLUSION: Our results indicate that CYP450 does not affect MCAv, CVCi, or MAP once steady state is achieved during small muscle exercise. However, CYP450 inhibition attenuates vascular response at exercise onset. Therefore, CYP450 contributes to the cerebrovascular response to small muscle mass exercise, however, compensatory vascular mechanisms can overcome CYP450 inhibition indicating CYP450 has a significant yet non-obligatory role in cerebrovascular regulation during exercise in humans. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

On the Different Abilities of Cross-Sample Entropy and K-Nearest-Neighbor Cross-Unpredictability in Assessing Dynamic Cardiorespiratory and Cerebrovascular Interactions.

Nonlinear markers of coupling strength are often utilized to typify cardiorespiratory and cerebrovascular regulations. The computation of these indices requires techniques describing nonlinear interactions between respiration (R) and heart period (HP) and between mean arterial pressure (MAP) and mean cerebral blood velocity (MCBv). We compared two model-free methods for the assessment of dynamic HP-R and MCBv-MAP interactions, namely the cross-sample entropy (CSampEn) and k-nearest-neighbor cross-unpredictability (KNNCUP). Comparison was carried out first over simulations generated by linear and nonlinear unidirectional causal, bidirectional linear causal, and lag-zero linear noncausal models, and then over experimental data acquired from 19 subjects at supine rest during spontaneous breathing and controlled respiration at 10, 15, and 20 breaths·minute-1 as well as from 13 subjects at supine rest and during 60° head-up tilt. Linear markers were computed for comparison. We found that: (i) over simulations, CSampEn and KNNCUP exhibit different abilities in evaluating coupling strength; (ii) KNNCUP is more reliable than CSampEn when interactions occur according to a causal structure, while performances are similar in noncausal models; (iii) in healthy subjects, KNNCUP is more powerful in characterizing cardiorespiratory and cerebrovascular variability interactions than CSampEn and linear markers. We recommend KNNCUP for quantifying cardiorespiratory and cerebrovascular coupling.

Effects of posture changes on dynamic cerebral autoregulation during early pregnancy in women with obesity and/or sleep apnea.

The incidence of syncope during orthostasis increases in early human pregnancy, which may be associated with cerebral blood flow (CBF) dysregulation in the upright posture. In addition, obesity and/or sleep apnea per se may influence CBF regulation due to their detrimental impacts on cerebrovascular function. However, it is unknown whether early pregnant women with obesity and/or sleep apnea could have impaired CBF regulation in the supine position and whether this impairment would be further exacerbated in the upright posture. Dynamic cerebral autoregulation (CA) was evaluated using transfer function analysis in 33 women during early pregnancy (13 with obesity, 8 with sleep apnea, 12 with normal weight) and 15 age-matched nonpregnant women during supine rest. Pregnant women also underwent a graded head-up tilt (30° and 60° for 6min each). We found that pregnant women with obesity or sleep apnea had a higher transfer function low-frequency gain compared with nonpregnant women in the supine position (P = 0.026 and 0.009, respectively) but not normal-weight pregnant women (P = 0.945). Conversely, the transfer function low-frequency phase in all pregnancy groups decreased during head-up tilt (P = 0.001), but the phase was not different among pregnant groups (P = 0.180). These results suggest that both obesity and sleep apnea may have a detrimental effect on dynamic CA in the supine position during early pregnancy. CBF may be more vulnerable to spontaneous blood pressure fluctuations in early pregnant women during orthostatic stress compared with supine rest due to less efficient dynamic CA, regardless of obesity and/or sleep apnea.

Decompression strain in parachute jumpmasters during simulated high-altitude missions: a special reference to preoxygenation strategies

PurposeMilitary parachute operations are often executed at high altitude, from an unpressurized aircraft compartment. Parachute jumpmasters (JM) are thus regularly exposed to 29,500 ft for 60 min. The aim was to investigate the decompression strain during a simulated JM mission at high altitude and to compare two strategies of preoxygenation, conducted either at sea-level or below 10,000 ft, during ascent to mission altitude.MethodsTen JM completed, on separate occasions, a 45-min preoxygenation either at sea-level (normobaric: N) or 8200ft (hypobaric: H), followed by exposure to 28,000 ft for 60 min, whilst laying supine and breathing 100% oxygen. At min 45 of the exposure to 28,000 ft, the JM performed 10 weighted squats. Decompression strain was determined from ultrasound assessment of venous gas emboli (VGE) during supine rest (5-min intervals), after three unloaded knee-bends (15-min intervals) and immediately following the weighted squats. The VGE were scored using a six-graded scale (0–5).ResultsIn condition H, two JM experienced decompression sickness (DCS), whereas no DCS incidents were reported in condition N. The prevalence of VGE was higher in the H than the N condition, at rest [median(range), 3(0–4) vs 0(0–3); p = 0.017], after unloaded knee-bends [3(0–4) vs 0(0–3); p = 0.014] and after the 10 weighted squats [3(0–4) vs 0(0–3); p = 0.014]. VGE were detected earlier in the H (28 ± 20 min, p = 0.018) than the N condition (50 ± 19 min).ConclusionsA preoxygenation/altitude procedure commonly used by JM, with a 60-min exposure to 28,000 ft after pre-oxygenation for 45 min at 8200 ft is associated with high risk of DCS. The decompression strain can be reduced by preoxygenating at sea level.

Exaggerated postural sway improves orthostatic cardiovascular and cerebrovascular control.

Healthy individuals with poor cardiovascular control, but who do not experience syncope (fainting), adopt an innate strategy of increased leg movement in the form of postural sway that is thought to counter orthostatic (gravitational) stress on the cardiovascular system. However, the direct effect of sway on cardiovascular hemodynamics and cerebral perfusion is unknown. If sway produces meaningful cardiovascular responses, it could be exploited clinically to prevent an imminent faint. Twenty healthy adults were instrumented with cardiovascular (finger plethysmography, echocardiography, electrocardiogram) and cerebrovascular (transcranial Doppler) monitoring. Following supine rest, participants performed a baseline stand (BL) on a force platform, followed by three trials of exaggerated sway (anterior-posterior, AP; mediolateral, ML; square, SQ) in a randomized order. All exaggerated postural sway conditions improved systolic arterial pressure (SAP, p = 0.001) responses, while blunting orthostatic reductions in stroke volume (SV, p < 0.01) and cerebral blood flow (CBFv, p < 0.05) compared to BL. Markers of sympathetic activation (power of low-frequency oscillations in SAP, p < 0.001) and maximum transvalvular flow velocity (p < 0.001) were reduced during exaggerated sway conditions. Responses were dose-dependent, with improvements in SAP (p < 0.001), SV (p < 0.001) and CBFv (p = 0.009) all positively correlated with total sway path length. Coherence between postural movements and SAP (p < 0.001), SV (p < 0.001) and CBFv (p = 0.003) also improved during exaggerated sway. Exaggerated sway improves cardiovascular and cerebrovascular control and may supplement cardiovascular reflex responses to orthostatic stress. This movement provides a simple means to boost orthostatic cardiovascular control for individuals with syncope, or those with occupations that require prolonged motionless standing.

Daily rhythm of dynamic cerebral autoregulation in patients after stroke

Dynamic cerebral autoregulation (dCA) in healthy young adults displays a daily variation. Whether the rhythm exists in patients with stroke is unknown. We studied 28 stroke patients (age: 26–83 years, 7 females) within 48 hours after thrombolysis. dCA was assessed 54 times in these patients during supine rest (twice in 26 and once in 2 patients): 9 assessments between 0–9AM, 12 between 9AM–2PM, 20 between 2–7PM, and 13 between 7PM–12AM. To estimate dCA, phase shifts between spontaneous oscillations of cerebral blood flow velocity (CBFV) in the middle cerebral artery and arterial blood pressure (BP) were obtained in four frequency bands: <0.05 Hz, 0.05–0.1 Hz, 0.1–0.2 Hz, and >0.2 Hz. CBFV-BP phase shifts at <0.05 Hz were significantly larger between 2–7PM, suggesting better dCA, than those at other times (p < 0.0001), and the daily rhythm was consistent for stroke and non-stroke sides. No significant rhythms were observed at higher frequencies (all p > 0.2). All results were independent of age, sex, stroke type and severity, and other cardiovascular conditions. dCA after stroke showed a daily rhythm, leading to a better regulation of CBFV at <0.05 Hz during the afternoon. The finding may have implications for daily activity management of stroke patients.

Effect of Orthostatic Hypotension on Kidney Function

Background: The association between orthostatic hypotension (OH) and long-term changes in kidney function in the general population is not yet well known. Methods: We performed a population-based cohort study based on data from the Korean Genome and Epidemiology Study (KoGES). The primary exposure was the presence of classic OH, defined as a postural drop in blood pressure (systolic blood pressure ≥20 mm Hg and/or diastolic blood pressure ≥10 mm Hg) at 2 min of standing after 5 min of supine rest. The primary outcome was a 12-year change in kidney function, assessed by subtracting the baseline estimated glomerular filtration rate (eGFR) from the eGFR at 12 years of follow-up. Results: Our study included 5,905 participants (median [interquartile range] age, 49 [44–58] years; 46% males) who met inclusion and exclusion criteria. Classic OH was detected in 268 (4.5%) of the total participants. In the regression analyses, participants with classic OH had a greater decline in eGFR over 12 years compared with those without classic OH; the fully adjusted beta coefficient and 95% confidence intervals (95% CIs) were −1.74 (−3.07, −0.40). Furthermore, classic OH was associated with 27% greater risk of a 30% decline in kidney function compared with those without classic OH; fully adjusted hazard ratio and 95% CIs were 1.27 (1.07, 1.49). Conclusions: Classic OH can negatively affect long-term kidney function in the general population.

Designing an App to Promote Physical Exercise in Sedentary People Using a Day-to-Day Algorithm to Ensure a Healthy Self-Programmed Exercise Training.

Heart rate variability (HRV) has allowed the implementation of a methodology for daily decision making called day-to-day training, which allows data to be recorded by anyone with a smartphone. The purpose of the present work was to evaluate the validity and reliability of HRV measurements with a new mobile app (Selftraining UMH) in two resting conditions. Twenty healthy people (10 male and 10 female) were measured at rest in supine and seated positions with an electrocardiogram and an application for smartphones at the same time (Selftraining UMH) using recordings obtained through an already validated chest-worn heart rate monitor (Polar H10). The Selftraining UMH app showed no significant differences compared to an electrocardiogram, neither in supine nor in sitting position (p > 0.05) and they presented almost perfect correlation levels (r ≥ 0.99). Furthermore, no significant differences were found between ultra-short (1-min) and short (5-min) length measurements. The intraclass correlation coefficient showed excellent reliability (>0.90) and the standard error of measurement remained below 5%. The Selftraining UMH smartphone app connected via Bluetooth to the Polar H10 chest strap can be used to register daily HRV recordings in healthy sedentary people.

Could Orthostatic Stress Responses Predict Acute Mountain Sickness Susceptibility Prior to High Altitude Travel? A Pilot Study.

Bellovary, Bryanne N., Andrew D. Wells, Zachary J. Fennel, Jeremy B. Ducharme, Jonathan M. Houck, Trevor J. Mayschak, Ann L. Gibson, Scott N. Drum, and Christine M. Mermier. Could orthostatic stress responses predict acute mountain sickness susceptibility before high altitude travel? A pilot study. High Alt Med Biol. 24:19-26, 2023. Purpose: This study assessed head-up tilt (HUT) responses in relation to acute mountain sickness (AMS)-susceptibility during hypoxic exposure. Materials and Methods: Fifteen participants completed three lab visits: (1) protocol familiarization and cycle maximal oxygen consumption (VO2max) test; (2) HUT test consisting of supine rest for 20 minutes followed by 70° tilting for ≤40 minutes; and (3) 6 hours of hypobaric hypoxic exposure (4,572 m) where participants performed two 30-minute cycling bouts separated by 1 hour at a 50% VO2max workload within the first 3 hours and rested when not exercising. During HUT, systolic blood pressure (SBP), diastolic blood pressure, heart rate (HR), and variability (blood pressure variability [BPV] and HR variability [HRV]) were measured continuously. The AMS scores were determined after 6 hours of exposure. Correlations determined relationships between HUT cardiovascular responses and AMS scores. Repeated-measures analysis of variance (ANOVA) assessed differences between those with and without AMS symptoms during HUT. Results: Higher AMS scores correlated with greater change in SBP variability (r = 0.52, p = 0.048) and blunted changes in HRV (root mean square of successive differences between normal heartbeats r = 0.81, p = 0.001, percentage of adjacent normal sinus intervals that differ by more than 50 milliseconds [pNN50] r = 0.87, p < 0.001) during HUT. A pNN50 interaction (p = 0.02) suggested elevated cardiac sympathetic activity at baseline and a blunted increase in cardiac sympathetic influence throughout HUT in those with AMS (pNN50 baseline: AMS = 26.2% ± 15.3%, no AMS = 51.0% ± 13.5%; first 3 minutes into HUT: AMS = 17.2% ± 19.1%, no AMS = 17.1% ± 10.9%; end of HUT: AMS = 6.2% ± 9.1%, no AMS 11.0% ± 10.0%). Conclusions: The results suggest autonomic responses via HUT differ in AMS-susceptible individuals. Changes in HRV and BPV during HUT may be a promising predictive measurement for AMS-susceptibility, but further research is needed for confirmation.

Validity and reliability of capillary vs. Venous blood for the assessment of haemoglobin mass and intravascular volumes.

Objectives: Haemoglobin mass (Hbmass) assessment with the carbon monoxide rebreathing method is a more accurate estimate than other measures of oxygen-carrying capacity. Blood may be collected by several means and differences in the measured variables may exist as a result. The present study assessed the validity and reliability of calculated Hbmass and intravascular volumes obtained from capillary blood (CAP) when compared to venous blood (VEN) draws. Methods: Twenty-two adults performed a carbon monoxide rebreathing procedure with paired VEN and CAP draws at baseline, pre-rebreathing and post-rebreathing (POST). Thirteen of these participants performed this protocol on two occasions to assess the data reliability from both blood sampling sites. In a second experiment, 14 adults performed a 20-min seated and a 20-min supine rest to assess for the effect of posture on haematological parameters. Results: Haemoglobin mass (CAP = 948.8 ± 156.8g; VEN = 943.4 ± 157.3 g, p = 0.108) and intravascular volume (CAP = 6.5 ± 1L; VEN = 6.5 ± 0.9 L, p = 0.752) were statistically indifferent, had low bias (Hbmass bias = 14.45 ± 40.42g, LoA -64.78g-93.67g) and were highly correlated between sampling techniques. Reliability analysis demonstrated no difference in the mean change in variables calculated from both sampling sites and good to excellent intraclass correlation coefficients (>0.700), however, typical measurement error was larger in variables measured using CAP (VEN Hbmass TE% = 2.1%, CAP Hbmass TE% = 5.5%). The results indicate that a supine rest prior to the rebreathing protocol would have a significant effect on haemoglobin concentration and haematocrit values compared to a seated rest, with no effect on carboxyhaemoglobin %. Conclusion: The present study demonstrates that CAP and VEN were comparable for the calculation of Hbmass and intravascular volumes in terms of accuracy. However, reduced reliability and increased error in the CAP variables indicates that there are methodological considerations to address when deciding which blood drawing technique to utilise. To reduce this CAP error, increased replicate analyses are required.

Cerebrovascular regulation in patients with vasovagal syncope and autonomic failure due to familial amyloidotic polyneuropathy.

While there is strong evidence for autonomic involvement in cerebrovascular function acutely, long-term role of autonomic nervous system in cerebrovascular function has been controversial. We assessed autoregulation in 10 healthy individuals, nine patients with vasovagal syncope (VVS), and nine with Familial Amyloidotic Polyneuropathy (FAP), in response to head-up tilt test (HUTT). Arterial blood pressure heart rate, cardiac output, and bilateral cerebral blood flow velocity (CBFV) at the M1 segment of middle cerebral artery (transcranial Doppler ultrasound) were recorded during supine rest and 70° HUTT. Autoregulation was quantified using a validated nonlinear and nonparametric approach based on projection pursuit regression. Plasma adrenaline and noradrenaline were also measured at rest and during HUTT. During supine rest and HUTT, plasma noradrenaline content was lower in FAP patients. During HUTT, VVS patients had a hyperadrenergic status; CBFV decreased in all groups, which was greater in FAP patients (p<0.01). Healthy controls responded to HUTT with a reduction in CBFV responses to increases (p=0.01) and decreases (p<0.01) in arterial pressure without any change in the range or effectiveness of autoregulation. VVS patients responded to HUTT with a reduction in falling (p=0.02), but not rising slope (p=0.40). Autoregulatory range (p<0.01) and effectiveness increased (p=0.09), consistent with the rapid increase in levels of catecholamines. In FAP patients, the level of increase in range of autoregulation was significantly related to the magnitude of increase in plasma noradrenaline in response to HUTT (R2=0.26, p=0.05). Autonomic dysfunction affects the cerebral autoregulatory response orthostatic to challenge.

Effects of acupuncture and Nordic walking practice, and their interaction, on bodily fluids distribution of breast cancer survivors

Purpose.Integrative treatments are growing among breast cancer survivors (BCS), and both acupuncture and Nordic walking (NW) are found particularly useful for them. Their positive effect on BCS health is partially due to their impact on bodily fluid balance. The study of bodily resistance and reactance is a practical method to monitor bodily fluid balance. The aims of our study were to investigate (a) the acute effects of acupuncture treatment on resistance and reactance in BCS who never had received acupuncture treatment before; (b) if BCS practising NW had better resistance and reactance than non-exercising BCS; and (c) if BCS practising NW presented a better response after acupuncture treatment than other conditions.Methods.A total of 80 BCS (53.24 ± 5.50 years), including 38 women not practising physical exercise and 42 Nordic walkers, were recruited and investigated for bodily resistance and reactance immediately before and after (a) acupuncture treatment; (b) supine rest without acupuncture.Results.Acupuncture seems to positively influence bodily resistance and reactance variation compared with supine rest. NW practice seems able to assure the best resistance and reactance basal values, and their best positive variation after supine rest and acupuncture alone. The observed results are amplified when NW and acupuncture are coupled.Conclusions.Both acupuncture and NW could be used to positively influence bodily fluids distribution, also considering that, when coupled, their positive effects are amplified. Therefore, NW should be prescribed to maintain the positive effect of acupuncture or to prepare the body for it.

Arterial compliance and its dynamics in obese adolescents.

Arterial compliance (AC) decrease with aging is accelerated by factors associated with the progression of atherosclerotic process, including obesity. Prevalence of obesity increases not only in adult population but also in children and adolescents. The results of studies characterizing the effect of obesity on AC (often indirectly estimated by pulse wave velocity (PWV)) are contradictory. Considering the limitations of previously applied methods and the need to interpret AC values in the context of potential confounders or during various physiological states, the aim of this study was to compare AC of control and obese adolescents during four different physiological states: supine rest, head-up tilt (HUT), supine recovery and mental arithmetic (MA). AC was assessed by the method based on two-element Windkessel model as the ratio of a time constant t characterizing diastolic blood pressure decay and total peripheral resistance (TPR). In total, fifty healthy and normotensive subjects (40 females, 10 males, age 17.5 years (SD=1.1 years)) were examined - 25 obese and 25 age- and sex-matched control subjects. We observed significantly increased AC values during all phases in obese group. An increase in AC was also preserved after controlling for blood pressure influence. These results were confirmed using PWV based AC estimation. Interestingly, AC decreased similarly during stress phases (HUT, MA) in both groups. Lastly, TPR was decreased throughout the study protocol in obese subjects. In conclusion, AC is increased in young obese subjects consistently during various physiological states. Furthermore, changes of physiological states evoke similar response of AC in both groups indicating preserved autonomic control of elastic arteries. A decreased TPR in obese subjects points towards the influence of different maturation state of the arterial tree and/or changes in vasomotion possibly counterbalancing acceleration of atherosclerosis process.

Sympathetic Action Potential Firing and Recruitment Patterns Are Abnormal in Gestational Hypertension.

We tested the hypothesis that women who develop gestational hypertension (GH) display abnormal sympathetic action potential (AP) discharge patterns during late pregnancy (32-36 weeks), both at supine rest and during postural stress. Thirteen nonpregnant, female controls (nonpregnant controls [CTRL]) and 32 pregnant women participated; 14 had low-risk (no personal history of GH) normal pregnancies (LR-NP), 10 had high-risk (personal history of GH) normal pregnancies (HR-NP), and 8 developed GH. We measured heart rate, blood pressure, and muscle sympathetic nerve activity (microneurography) at supine rest and 60° head-up tilt. Sympathetic AP patterns were studied using wavelet-based methodology. At rest, muscle sympathetic nerve activity burst frequency was elevated in LR-NP, HR-NP, and GH versus CTRL (all P≤0.01); however, the AP content per integrated burst was augmented only in GH (20±5 spikes/burst), compared with CTRL (8±3 spikes/burst), LR-NP (9±2 spikes/burst) and HR-NP (11±4 spikes/burst; all P<0.0001). Thus, total AP firing frequency was greater in GH versus each of CTRL, LR-NP, and HR-NP (all P<0.0001). In pregnancy, AP frequency is related directly to systolic (R2=46%) and diastolic (R2=20%) blood pressure (both P≤0.01). Unlike CTRL (both P<0.01), women who developed GH were unable to increase within-burst AP firing (P=0.71) or recruit latent subpopulations of larger-sized APs (P=0.72) in response to head-up tilt, perhaps related to a ceiling-effect; however, total AP firing frequency in the upright posture was elevated in the GH cohort versus CTRL, LR-NP, and HR-NP (all P<0.05). Women who develop GH display aberrant sympathetic AP firing patterns in both the supine and upright postures.