Cardiovascular autonomic adaptation in lunar and martian gravity during parabolic flight.

PURPOSE: Weightlessness has a well-known effect on the autonomic control of the cardiovascular system. With future missions to Mars in mind, it is important to know what the effect of partial gravity is on the human body. We aim to study the autonomic response of the cardiovascular system to partial gravity levels, as present on the Moon and on Mars, during parabolic flight. METHODS: ECG and blood pressure were continuously recorded during parabolic flight. A temporal analysis of blood pressure and heart rate to changing gravity was conducted to study the dynamic response. In addition, cardiovascular autonomic control was quantified by means of heart rate (HR) and blood pressure (BP) variability measures. RESULTS: Zero and lunar gravity presented a biphasic cardiovascular response, while a triphasic response was noted during martian gravity. Heart rate and blood pressure are positively correlated with gravity, while the general variability of HR and BP, as well as vagal indices showed negative correlations with increasing gravity. However, the increase in vagal modulation during weightlessness is not in proportion when compared to the increase during partial gravity. CONCLUSIONS: Correlations were found between the gravity level and modulations in the autonomic nervous system during parabolic flight. Nevertheless, with future Mars missions in mind, more studies are needed to use these findings to develop appropriate countermeasures.

Inhalation/Exhalation ratio modulates the effect of slow breathing on heart rate variability and relaxation.

Slow breathing is widely applied to improve symptoms of hyperarousal, but it is unknown whether its beneficial effects relate to the reduction in respiration rate per se, or, to a lower inhalation/exhalation (i/e) ratio. The present study examined the effects of four ventilatory patterns on heart rate variability and self-reported dimensions of relaxation. Thirty participants were instructed to breathe at 6 or 12 breaths/min, and with an i/e ratio of 0.42 or 2.33. Participants reported increased relaxation, stress reduction, mindfulness and positive energy when breathing with the low compared to the high i/e ratio. A lower compared to a higher respiration rate was associated only with an increased score on positive energy. A low i/e ratio was also associated with more power in the high frequency component of heart rate variability, but only for the slow breathing pattern. Our results show that i/e ratio is an important modulator for the autonomic and subjective effects of instructed ventilatory patterns.

Adaptation of autonomic heart rate regulation in astronauts after spaceflight.

BACKGROUND: Spaceflight causes changes in the cardiovascular control system. The aim of this study was to evaluate postflight recovery of linear and nonlinear neural markers of heart rate modulation, with a special focus on day-night variations. MATERIAL/METHODS: Twenty-four-hour Holter ECG recordings were obtained in 8 astronauts participating in space missions aboard the International Space Station (ISS). Data recording was performed 1 month before launch, and 5 and 30 days after return to Earth from short- and long-term flights. Cardiovascular control was inferred from linear and nonlinear heart rate variability (HRV) parameters, separately during 2-hour day and 2-hour night recordings. RESULTS: No remarkable differences were found in the postflight recovery between astronauts from short- and long-duration spaceflights. Five days after return to Earth, vagal modulation was significantly decreased compared to the preflight condition (day: p=0.001; night: p=0.019), while the sympathovagal balance was strongly increased, but only at night (p=0.017). A few nonlinear parameters were reduced early postflight compared to preflight values, but these were not always statistically significant. No significant differences remained after 30 days of postflight recovery. CONCLUSIONS: Our results show that 5 days after return from both short- and long-duration space missions, neural mechanisms of heart rate regulation are still disturbed. After 1 month, autonomic control of heart rate recovered almost completely.

Circadian rhythm of autonomic cardiovascular control during Mars500 simulated mission to Mars.

INTRODUCTION: The Mars500 project was conceived to gather knowledge about the psychological and physiological effects of living in an enclosed environment during 520 d as would be required for a real mission to Mars. Our objective was to investigate the circadian profile of heart rate variability (HRV) in the context of the Mars500 study. METHODS: Before, during, and after confinement, 24-h EKG records were obtained from the six crewmembers who participated in the mission. Autonomic activity was evaluated through time and frequency domain indexes of HRV analysis. Circadian rhythmicity was assessed both by averaging hourly HRV along wake and sleep scheduled periods and by fitting a 24-h harmonic to the hourly means. RESULTS: During confinement, wake HRV showed (mean +/- SE) a progressive increase in mean RR interval (from 778 +/- 24 ms to 916 +/- 42 ms), and in the amplitude (values are wavelet power coefficients) of very low (from 13.3 +/- 0.3 to 14.1 +/- 0.2) and high (from 7.8 +/- 0.4 to 8.3 +/- 0.3) frequency components. During sleep, the relative amplitude of the high frequency component of HRV decreased (from 11.8 +/- 1.6 to 9.4 +/- 1.8 normalized units). Overall, sleep-wake differences of HRV showed a progressive decrease of the relative amplitude of the high frequency component. Also, circadian HRV rhythms were dampened during confinement. DISCUSSION: Data revealed diminished amplitude of the rest-activity pattern of the autonomic nervous system parasympathetic function. Reduced daylight exposure and mood changes could account for this observation.

Haemodynamic adaptation during sudden gravity transitions.

Haemodynamic responses during parabolic flight were studied. The hypothesis that haemodynamic changes may be counteracted by a transient vagal reflex during acute gravity transitions was tested. ECG, arterial pressure and respiration were recorded continuously in seven male subjects during parabolic flight. Beat-to-beat haemodynamic parameters were estimated. In the supine position no significant differences were shown among the different gravity phases. In the upright position, significant within-group differences were observed across gravity phases for all parameters. Postural differences in haemodynamic data disappeared during the microgravity phase and were enlarged during hypergravity phases. Detailed temporal analysis of cardiac time series in standing subjects confirmed the hypothesized biphasic response of initial parasympathetic modulation: a sharp increase of RRI within 3-5 s followed by a 10% decrease in the remaining period of microgravity (p < 0.001); a sharp increase in SAP within 2-4 s followed by a slow decrease of 25%. Significant within-group differences were observed in the standing position for mean RRI (836 ± 170 ms, p = 0.003), DAP (66 ± 8 mmHg, p < 0.001), MAP (139 ± 12 mmHg, p = 0.001), RRI HF amplitude (17.6 ± 7.5 ms, p < 0.001), SV (146 ± 5%, p < 0.001) and SVR (73 ± 10%, p = 0.020). In standing subjects, the initial baroreflex-mediated vagal heart rate response is limited to a transition period at early microgravity lasting about 3-5 s, followed by a gradual heart rate recovery during the remaining 15-17 s due to a parasympathetic withdrawal. The resultant increase in cardiac output induces a baroreflex-mediated systemic vasodilatation, which may be the driving force for a decreased arterial pressure in weightlessness.

Sleep-wake differences in heart rate variability during a 105-day simulated mission to Mars.

INTRODUCTION: In prolonged spaceflights the effect of long-term confinement on the autonomic regulation of the heart is difficult to separate from the effect of prolonged exposure to microgravity or other space-related stressors. Our objective was to investigate whether the sleep-wake variations in the autonomic control of the heart are specifically altered by long-term confinement during the 105-d pilot study of the Earth-based Mars500 project. METHODS: Before (pre), during (T1: 30, T2: 70, andT3: 100 d), and after (post) confinement, 24-h EKG records were obtained from the six crewmembers that participated in the mission. Sleep and wake periods were determined by fitting a square wave to the data. Autonomic activity was evaluated through time and frequency domain indexes of heart rate variability (HRV) analysis during wake and sleep periods. RESULTS: During confinement, wake HRV showed decreased mean heart rate and increased amplitude at all frequency levels, particularly in the very low (pre: 13.3 +/- 0.2; T1: 13.9 +/- 0.3; T2: 13.9 +/- 0.2; T3: 13.9 +/- 0.2; post: 13.2 +/- 0.2) and high (pre: 7.6 +/- 0.4; T1: 8.3 +/- 0.5; T2: 8.2 +/- 0.4; T3: 8.1 +/- 0.4; post: 7.6 +/- 0.3) frequency components (values expressed as mean +/- SE of wavelet power coefficients). Sleep HRV remained constant, while sleep-wake high frequency HRV differences diminished. DISCUSSION: The observed autonomic changes during confinement reflect an increase in parasympathetic activity during wake periods. Several factors could account for this observation, including reduced daylight exposure related to the confinement situation.

Cardiovascular autonomic adaptation to long-term confinement during a 105-day simulated Mars mission.

INTRODUCTION: Long-term confinement and microgravity may entail alteration in the regulation of the cardiovascular system. A 105-d pilot study of a Mars mission simulation was conducted to test the cardiovascular response to slow-paced breathing and mental stress. METHODS: Finger blood pressure and beat-to-beat heart rate were monitored in six male volunteers taking part in a 105-d Mars mission simulation. Data were collected before, during (Days 35-38, 70-72, and 100), and after confinement. Recordings were performed in the sitting position during 5-min spontaneous breathing, 3-min 12 cycle/min breathing, 3-min 6 cycle/min breathing, and 5-min mental task performance. RESULTS: We found significant U-shaped changes across the confinement period in systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP). In the first month of confinement, mental task performance significantly lowered SAP by 34.23 mmHg and MAP by 19.89 mmHg compared to spontaneous breathing, whereas these changes were reversed during other periods. Furthermore, no differences in arterial pressure and heart rate were found between spontaneous, 12 cycle/min, and 6 cycle/min breathing. CONCLUSIONS: Our findings are in line with and extend previous findings on the alteration of blood pressure regulation due to long-term confinement.

Effects of mental stress on autonomic cardiac modulation during weightlessness.

Sustained weightlessness affects all body functions, among these also cardiac autonomic control mechanisms. How this may influence neural response to central stimulation by a mental arithmetic task remains an open question. The hypothesis was tested that microgravity alters cardiovascular neural response to standardized cognitive load stimuli. Beat-to-beat heart rate, brachial blood pressure, and respiratory frequency were collected in five astronauts, taking part in three different short-duration (10 to 11 days) space missions to the International Space Station. Data recording was performed in supine position 1 mo before launch; at days 5 or 8 in space; and on days 1, 4, and 25 after landing. Heart rate variability (HRV) parameters were obtained in the frequency domain. Measurements were performed in the control condition for 10 min and during a 5-min mental arithmetic stress task, consisting of deducting 17 from a four-digit number, read by a colleague, and orally announcing the result. Our results show that over all sessions (pre-, in-, and postflight), mental stress induced an average increase in mean heart rate (Delta7 +/- 1 beats/min; P = 0.03) and mean arterial pressure (Delta7 +/- 1 mmHg; P = 0.006). A sympathetic excitation during mental stress was shown from HRV parameters: increase of low frequency expressed in normalized units (Delta8.3 +/- 1.4; P = 0.004) and low frequency/high frequency (Delta1.6 +/- 0.3; P = 0.001) and decrease of high frequency expressed in normalized units (Delta8.9 +/- 1.4; P = 0.004). The total power was not influenced by mental stress. No effect of spaceflight was found on baseline heart rate, mean arterial pressure, and HRV parameters. No differences in response to mental stress were found between pre-, in-, and postflight. Our findings confirm that a mental arithmetic task in astronauts elicits sympathovagal shifts toward enhanced sympathetic modulation and reduced vagal modulation. However, these responses are not changed in space during microgravity or after spaceflight.

Cardiac autonomic regulation under hypnosis assessed by heart rate variability: spectral analysis and fractal complexity.

OBJECTIVE: This study examined the effects of hypnosis on autonomic cardiac control. We hypothesized a modification of autonomic modulation of the heart rate with an enhanced vagal tone during hypnosis compared to baseline. METHODS: In 12 healthy subjects (6 men and 6 women, 22.2 +/- 1.0 years of age) ECG was recorded at baseline and during hypnosis. Heart rate variability parameters were obtained in the frequency domain (LFnu: low frequency normalized units, and HFnu: high frequency normalized units) and from nonlinear analysis methods (detrended fluctuation analysis, DFA). RESULTS: Compared to the control condition, hypnosis showed a significantly decreased LFnu, a significantly increased HFnu, and a significantly decreased LF/HF. DFA showed a significantly decreased short-range similarity. Heart rate remained unchanged. CONCLUSION: Autonomic cardiac tone is significantly modified during hypnosis by shifting the balance of the sympathovagal interaction toward an enhanced parasympathetic modulation, accompanied by a reduction of the sympathetic tone and a decreased short-range similarity but without a concomitant change in heart rate. Central and secondary autonomous nervous system changes induced by hypnosis are a possible explanation for our results. Another highly probable explanation is given by a variation in the depth of respiration. Hypnosis appears to prevent the autonomic responses expected during neutral stimulation.

Tilt training increases the vasoconstrictor reserve in patients with neurally mediated syncope evoked by head-up tilt testing.

AIMS: Tilt training is a useful therapeutic option in neurally mediated syncope (NMS). We tested the hypothesis that tilt training will restore orthostatic tolerance by increasing the degree of vasomotor reserve during sustained orthostatic stress. METHODS AND RESULTS In this follow-up study we enrolled 17 patients (age 31 +/- 22 years, 11 females) with a clinical diagnosis of NMS and two consecutive positive tilt tests. The head-up tilt test was repeated day after day: one session per day. All patients were instructed to continue a programme of daily standing training at home. Follow-up tilt testing was performed after a period of 6 weeks in 14 patients. ECG and finger arterial blood pressure (Portapres) were recorded during subsequent tilt testing. Left ventricular stroke volume (SV), cardiac output, and systemic vascular resistance were computed from the pressure pulsations (Modelflow). Spontaneous cardiac baroreflex sensitivity was estimated by cross-spectral analysis of heart rate (HR) and systolic blood pressure. In all patients, orthostatic tolerance was restored after 4.1 +/- 0.9 tilt sessions, median 4. The follow-up tilt test was also negative in all patients. This was accompanied by a significant rise in systemic vascular resistance to compensate for a postural reduction in SV in the sustained head-up tilt position. No evidence could be provided of altered baroreflex control of HR after tilt training. CONCLUSION: Tilt training restores orthostatic tolerance at least in part by increasing the amount of vasoconstriction that can ultimately be made available during sustained orthostatic stress. The increased vasoconstrictor reserve is preserved after 6 weeks of continued standing training at home.

Sleep, napping and alertness during an overwintering mission at Belgrano II Argentine Antarctic station.

During Antarctic isolation personnel are exposed to extreme photoperiods. A frequent observation is a sleep onset phase delay during winter. It is not known if, as a result, daytime sleeping in the form of naps increases. We sought to assess sleep patterns - with focus on daytime sleeping - and alertness in a Latin American crew overwintering in Argentine Antarctic station Belgrano II. Measurements were collected in 13 males during March, May, July, September and November, and included actigraphy and psychomotor vigilance tasks. Sleep duration significantly decreased during winter. A total of eight participants took at least one weekly nap across all measurement points. During winter, the nap onset was delayed, its duration increased and its efficiency improved. We observed a significant effect of seasonality in the association of evening alertness with sleep onset. Our results replicate previous findings regarding sleep during overwintering in Antarctica, adding the description of the role of napping and the report of a possible modulatory effect of seasonality in the relation between sleep and alertness. Napping should be considered as an important factor in the scheduling of activities of multicultural crews that participate in Antarctica.

Impact of age on the vasovagal response provoked by sublingual nitroglycerine in routine tilt testing.

NTG (nitroglycerine) is used in routine tilt testing to elicit a vasovagal response. In the present study we hypothesized that with increasing age NTG triggers a more gradual BP (blood pressure) decline due to a diminished baroreflex-buffering capacity. The purpose of the present study was to examine the effect of NTG on baroreflex control of BP in patients with distinct age-related vasovagal collapse patterns. The study groups consisted of 29 patients (16-71 years old, 17 females) with clinically suspected VVS (vasovagal syncope) and a positive tilt test. Mean FAP (finger arterial pressure) was monitored continuously (Finapres). Left ventricular SV (stroke volume), CO (cardiac output) and SVR (systemic vascular resistance) were computed from the pressure pulsations (Modelflow). BRS (baroreflex sensitivity) was estimated in the time domain. In the first 3 min after NTG administration, BP was well-maintained in all patients. This implied an adequate arterial resistance response to compensate for steeper reductions in SV and CO with increasing age. HR (heart rate) increased and the BRS decreased after NTG administration. The rate of mean FAP fall leading to presyncope was inversely related to age (r=0.51, P=0.005). Accordingly, patients with a mean FAP fall >1.44 mmHg/s (median) were generally younger compared with patients with a slower mean FAP-fall (30+/-10 years compared with 51+/-17 years; P=0.001). The main determinant of the rate of BP fall on approach of presyncope was the rate of fall in HR (r=0.75, P<0.001). It was concluded that, in older patients, sublingual NTG provokes a more gradual BP decline compared with younger patients. This gradual decline cannot be ascribed to failure of the baroreflex-buffering capacity with increasing age. Age-related differences in the laboratory presentation of a vasovagal episode depend on the magnitude of the underlying bradycardic response.

Fractal dimension in health and heart failure.

BACKGROUND: Non-linear analysis of heart rate variability (HRV) can give additional information about autonomic control of the heart rate. This study applied the fractal dimension (FD) in a congestive heart failure (CHF) population. METHODS: FD and HRV were evaluated in a healthy population (n=21) and an end-stage heart failure population (n=21) using 1-h segments during the day and night from Holter recordings. RESULTS: CHF patients presented a loss of circadian variation in both FD and conventional time- and frequency-domain HRV indices. FD was higher in the CHF population both during the day and night. In the CHF population the correlation between FD and high-frequency power of HRV was lost. CONCLUSION: Day-night variations of heart rate fluctuations are lost in heart failure. Changes in FD reflecting physiological and pathophysiological changes were observed.

Cardiovascular function and basics of physiology in microgravity.

Space exploration is a dream of mankind. However, this intriguing environment is not without risks. Life, and the human body, has developed all over evolution in the constant presence of gravity, especially from the moment on when living creatures left the ocean. When this gravitational force is no longer acting on the body, drastic changes occur. Some of these changes occur immediately, others progress only slowly. In the past 40 years of human space flight (first orbital flight by Yuri Gagarin on 12 April, 1961) several hazards for the human body have been identified. Bone mineral density is lost, muscle atrophy and cardiovascular deconditioning occur; pulmonary function, fluid regulating systems of the body, the sensory and the balance system are all disturbed by the lack of gravity. These changes in human physiology have to be reversed again when astronauts return to earth. This can cause adaptation problems, especially after long-duration space flights. Also the reaction of human physiology to radiation in space poses a huge risk at this moment. In this review the accent will be on cardiovascular function in space: how normal function is modified to reach a new equilibrium in space after short- and long-duration exposure to microgravity. In order to make long-duration space flight possible the mechanisms of this physiological adaptation must be understood to full extent. Only with this knowledge, effective countermeasures can be developed.

Orthostatic Intolerance Is Independent of the Degree of Autonomic Cardiovascular Adaptation after 60 Days of Head-Down Bed Rest.

Spaceflight and head-down bed rest (HDBR) can induce the orthostatic intolerance (OI); the mechanisms remain to be clarified. The aim of this study was to determine whether or not OI after HDBR relates to the degree of autonomic cardiovascular adaptation. Fourteen volunteers were enrolled for 60 days of HDBR. A head-up tilt test (HUTT) was performed before and after HDBR. Our data revealed that, in all nonfainters, there was a progressive increase in heart rate over the course of HDBR, which remained higher until 12 days of recovery. The mean arterial pressure gradually increased until day 56 of HDBR and returned to baseline after 12 days of recovery. Respiratory sinus arrhythmia and baroreflex sensitivity decreased during HDBR and remained suppressed until 12 days of recovery. Low-frequency power of systolic arterial pressure increased during HDBR and remained elevated during recovery. Three subjects fainted during the HUTT after HDBR, in which systemic vascular resistance did not increase and remained lower until syncope. None of the circulatory patterns significantly differed between the fainters and the nonfainters at any time point. In conclusion, our data indicate that the impaired orthostatic tolerance after HDBR could not be distinguished by estimation of normal hemodynamic and/or neurocardiac data.

Is autonomic modulation different between European and Chinese astronauts?

PURPOSE: The objective was to investigate autonomic control in groups of European and Chinese astronauts and to identify similarities and differences. METHODS: Beat-to-beat heart rate and finger blood pressure, brachial blood pressure, and respiratory frequency were measured from 10 astronauts (five European taking part in three different space missions and five Chinese astronauts taking part in two different space missions). Data recording was performed in the supine and standing positions at least 10 days before launch, and 1, 3, and 10 days after return. Cross-correlation analysis of heart rate and systolic pressure was used to assess cardiac baroreflex modulation. A fixed breathing protocol was performed to measure respiratory sinus arrhythmia and low-frequency power of systolic blood pressure variability. RESULTS: Although baseline cardiovascular parameters before spaceflight were similar in all astronauts in the supine position, a significant increase in sympathetic activity and a decrease in vagal modulation occurred in the European astronauts when standing; spaceflight resulted in a remarkable vagal decrease in European astronauts only. Similar baseline supine and standing values for heart rate, mean arterial pressure, and respiratory frequency were shown in both groups. Standing autonomic control was based on a balance of higher vagal and sympathetic modulation in European astronauts. CONCLUSION: Post-spaceflight orthostatic tachycardia was observed in all European astronauts, whereas post-spaceflight orthostatic tachycardia was significantly reduced in Chinese astronauts. The basis for orthostatic intolerance is not apparent; however, many possibilities can be considered and need to be further investigated, such as genetic diversities between races, astronaut selection, training, and nutrition, etc.

Different evolutions in heart rate variability after heart transplantation: 10-year follow-up.

BACKGROUND: After heart transplantation, the donor heart is extrinsically denervated. No input of sympathetic or vagal nerves can influence the heart rate, resulting in a flat power spectrum of the beat-to-beat variability. The occurrence and the significance of reinnervation remain controversial. METHODS AND RESULTS: We monitored the evolution of heart rate variability (HRV) after heart transplantation, starting from a few weeks postoperatively up to 10 years after surgery. Twenty-four-hour Holter recordings of 216 heart-transplant patients were analyzed using time and frequency domain analysis of HRV. Analysis of all data revealed an increase in 24-hour and night-time total power starting from 2 years after transplantation. Low-frequency oscillations calculated over the total 24 hours, day- and nighttime increased significantly starting from year 4 and onward (year 4-8: P < 0.005). No evolution was found in high-frequency power. Subgroup analysis revealed a group with a clear spectral component (n = 16), a group with a small component (n = 124), and a group with a flat spectrum (n = 76). Only the first group revealed an evolution in both high- and low-frequency power. CONCLUSION: These results indicate three different types of evolution in HRV, with reinnervating patterns present in only a minority of the patients. The vast majority of the patients show no signs of reinnervation.

Association between restoration of autonomic modulation in the native sinus node and hemodynamic improvement after cardiac transplantation.

BACKGROUND: Little is known about the autonomic control of the native sinus node (NSN) after heart transplantation because its electrical activity is difficult to detect with skin electrodes. METHODS AND RESULTS: The intracardiac electrogram of the NSN and the donor heart electrocardiogram were measured simultaneously. A total of 351 recordings of 107 heart transplant patients (age 53.6+/-12.3 years) were obtained up to 1 year after transplantation. In a subgroup of 41 patients, consecutive recordings were made. Eleven recordings of heart failure patients (age 56.2+/-6.5 years) awaiting cardiac transplantation were used as controls. To examine a relationship between autonomic indices of the NSN and hemodynamics of the donor heart, intracardiac pressures and cardiac output were recorded in the same session. Heart rate variability (HRV) parameters in time and frequency domain of the NSN showed a significant increase starting at 6 months after transplantation, whereas heart rate of the NSN tended to decrease. Heart rate and HRV parameters remained constant over the first year in the donor heart. Higher values of low-frequency and high-frequency powers in the NSN were associated with lower values of right ventricular, pulmonary artery, and mean atrial pressure and cardiac output. Recordings of patients with rejection could not be distinguished from those without rejection based on the spectral content of HRV of either the NSN or the donor heart. CONCLUSIONS: These data suggest a restoration of autonomic modulation of the NSN. This restoration is associated with hemodynamic improvement of the donor heart.

Heart rate variability in athletes.

This review examines the influence on heart rate variability (HRV) indices in athletes from training status, different types of exercise training, sex and ageing, presented from both cross-sectional and longitudinal studies. The predictability of HRV in over-training, athletic condition and athletic performance is also included. Finally, some recommendations concerning the application of HRV methods in athletes are made.The cardiovascular system is mostly controlled by autonomic regulation through the activity of sympathetic and parasympathetic pathways of the autonomic nervous system. Analysis of HRV permits insight in this control mechanism. It can easily be determined from ECG recordings, resulting in time series (RR-intervals) that are usually analysed in time and frequency domains. As a first approach, it can be assumed that power in different frequency bands corresponds to activity of sympathetic (0.04-0.15 Hz) and parasympathetic (0.15-0.4 Hz) nerves. However, other mechanisms (and feedback loops) are also at work, especially in the low frequency band. During dynamic exercise, it is generally assumed that heart rate increases due to both a parasympathetic withdrawal and an augmented sympathetic activity. However, because some authors disagree with the former statement and the fact that during exercise there is also a technical problem related to the non-stationary signals, a critical look at interpretation of results is needed. It is strongly suggested that, when presenting reports on HRV studies related to exercise physiology in general or concerned with athletes, a detailed description should be provided on analysis methods, as well as concerning population, and training schedule, intensity and duration. Most studies concern relatively small numbers of study participants, diminishing the power of statistics. Therefore, multicentre studies would be preferable. In order to further develop this fascinating research field, we advocate prospective, randomised, controlled, long-term studies using validated measurement methods. Finally, there is a strong need for basic research on the nature of the control and regulating mechanism exerted by the autonomic nervous system on cardiovascular function in athletes, preferably with a multidisciplinary approach between cardiologists, exercise physiologists, pulmonary physiologists, coaches and biomedical engineers.

Heart rate variability after heart transplantation: a 10-year longitudinal follow-up study.

BACKGROUND: Cross-sectional studies suggest, by use of heart rate variability (HRV), that partial re-innervation of the sinus node may occur after heart transplantation (HTx). Our aim was to test this hypothesis by examining HRV in long-term longitudinal follow-up study of HTx recipients. METHODS AND RESULTS: 14 HTx recipients (11 men) were studied 1-48 (median 13) months (baseline) and 119-172 (median 141) months after HTx (follow-up). At baseline and follow-up, electrocardiographic RR interval was continuously recorded in the supine position for 20 min. The signals were analyzed in the time domain and in the frequency domain by means of power spectral analysis. RR-interval decreased significantly from baseline to follow-up (p<0.05). This was associated with an increase of total power (p<0.001), absolute low frequency (p<0.001), and high frequency power (p<0.001), but unchanged relative low frequency and high frequency power. CONCLUSIONS: The observed changes in HRV during long-term follow-up after HTx are compatible with partial re-innervation of the cardiac sinus node, as has been suggested by cross-sectional studies.