Updates in inspiratory muscle training for older adults: A systematic review.

Systematic reviews support the benefits of inspiratory muscle training (IMT) for exercise performance. Recently, many health benefits from IMT have been reported in older adults. Therefore, this work reviewed the literature focusing on IMT effects beyond physical performance in older adults, such as cardiorespiratory, metabolic, and postural balance outcomes. Searches were conducted with the following terms: ("respiratory muscle training" OR "inspiratory muscle training") OR ("inspiratory muscle strength training") AND ("elderly" OR "older" OR "aging" OR "aging"), and using the databases: MEDLINE (PubMed), SCOPUS and EUROPE PMC. Of the 356 articles found, 13 matched the inclusion criteria after screening. Based on reviewed studies, four to eight weeks of IMT (Mostly from 50 % up to 75 % of MIP, 7 days/week) improve cardiac autonomic control at rest and post-exercise, cerebrovascular response to orthostatic stress, static and dynamic balance, blood pressure control, endothelial function, and oxidative stress in older adults. The benefits of IMT in cardiac autonomic and vascular functions are reversed after training cessation. It thus appears that IMT promotes broad physiological gains for the older population. It is necessary to carry out more randomized clinical trials on the subject to confirm the findings of this research.

The Relationship between Inspiratory Muscle Strength and Cycling Performance: Insights from Hypoxia and Inspiratory Muscle Warm-Up.

Hypoxia increases inspiratory muscle work and consequently contributes to a reduction in exercise performance. We evaluate the effects of inspiratory muscle warm-up (IMW) on a 10 km cycling time trial in normoxia (NOR) and hypoxia (HYP). Eight cyclists performed four time trial sessions, two in HYP (FiO2: 0.145) and two in NOR (FiO2: 0.209), of which one was with IMW (set at 40% of maximal inspiratory pressure-MIP) and the other was with the placebo effect (PLA: set at 15% MIP). Time trials were unchanged by IMW (NORIMW: 893.8 ± 31.5 vs. NORPLA: 925.5 ± 51.0 s; HYPIMW: 976.8 ± 34.2 vs. HYPPLA: 1008.3 ± 56.0 s; p > 0.05), while ventilation was higher in HYPIMW (107.7 ± 18.3) than HYPPLA (100.1 ± 18.9 L.min-1; p ≤ 0.05), and SpO2 was lower (HYPIMW: 73 ± 6 vs. HYPPLA: 76 ± 6%; p ≤ 0.05). A post-exercise-induced reduction in inspiratory strength was correlated with exercise elapsed time during IMW sessions (HYPIMW: r = -0.79; p ≤ 0.05; NORIMW: r = -0.70; p ≤ 0.05). IMW did not improve the 10 km time trial performance under normoxia and hypoxia.

The Time Course of Cardiorespiratory Adaptations to Rowing Indoor Training in Post-Menopausal Women.

BACKGROUND: Post-menopausal women have impaired cardiorespiratory responses to exercise compared to young women. Exercise training may counterbalance impairments, but the time-dependent effects of exercise training remain unclear. The current study aims to investigate the effects of rowing training on maximal aerobic capacity and time-course cardiorespiratory adaptations in older women. METHODS: Female participants (n = 23) were randomly allocated to the experimental group (EXP; n = 23; 66 ± 5 years old) enrolled in rowing exercise training and control group (CON; n = 10; 64 ± 4 years old). The cardiopulmonary exercise test (CET) was performed in a cycle ergometer pre- and post-interventions. Oxygen uptake (VO2), stroke volume (SV), cardiac output (CO), and HR were recorded during CET and analyzed at the peak of the exercise. HR was monitored during exercise recovery, and the index of HRR was calculated by ΔHRR (HRpeak-HR one-minute recovery). Every two weeks, Rowing Stepwise Exercise (RSE) in a rowing machine was performed to track specific adaptations to the exercise modality. HR was continuously recorded during RSE and corrected for the average power of each step (HR/watts). The rowing training protocol consisted of three weekly sessions of 30 min at an intensity corresponding to 60-80% of peak HR for ten weeks. RESULTS: Rowing exercise training increased VO2, SV, and CO at the peak of the CET, and ΔHRR. Increased workload (W) and reduced HR response to a greater achieved workload (HR/W) during RSE were observed after six weeks of training. CONCLUSIONS: Rowing exercise training is a feasible method to improve cardiorespiratory performance, vagal reactivation and heart rate adjustments to exercise in older women.

Respiratory training in older women: Unravelling central and peripheral hemodynamic slow oscillatory patterns.

We hypothesized that inspiratory muscle training (IMT) increases the respiratory-induced low-frequency oscillations of mean blood pressure (MBP) and middle cerebral artery blood velocity (MCAv), upregulating cerebrovascular function in older women. Firstly, participants were recorded with free-breathing (FB) and then breathed at a slow-paced frequency (0.1 Hz; DB test) supported by sonorous metronome feedback. Blood pressure was recorded using finger photoplethysmography method, ECG, and respiration using a thoracic belt. To obtain the MCAv a transcranial ultrasound Doppler device was used. Spectral analysis of MBP, R-R intervals, and mean MCAv time series was obtained by an autoregressive model. The transfer function analysis (TFA) was employed to calculate the coherence, gain, and phase. After that, older women were enrolled in a randomized controlled protocol, the IMT-group (n = 8; 64 ± 3 years-old) performed IMT at 50 % of maximal inspiratory pressure (MIP), and Sham-group, a placebo training at 5 % MIP (Sham-group; n = 6; 66 ± 3 years-old). Participants breathed against an inspiratory resistance twice a day for 4-weeks. DB test is repeated post IMT and Sham interventions. IMT-group, compared to Sham-group, augmented tidal volume responses to DB (Sham-group 1.03 ± 0.41 vs. IMT-group 1.61 ± 0.56 L; p = 0.04), increased respiratory-induced MBP (Sham-group 26.37 ± 4.46 vs. IMT-group 48.21 ± 3.15 mmHg2; p = 0.04) and MCAv (Sham-group 14.16 ± 31.26 vs. IMT-group 79.90 ± 21.76 cm2s-2; p = 0.03) slow oscillations, and reduced TFA gain (Sham-group 2.46 ± 1.32 vs. IMT-group 1.78 ± 1.30 cm·s-1.mmHg-1; p = 0.01). Our findings suggest that IMT increases the respiratory-induced oscillations in MBP and MCAv signals and reduces TFA gain. It seems compatible with an improved dynamic cerebrovascular regulation following IMT in older women.

Cardiovascular autonomic regulation in fighter pilots: Lessons from active standing tests.

Fighter pilots (FP) are exposed to flight accelerations and stressful situations that defy cardiovascular control during and after flight. FP presents a smaller adjustment in sympatho-vagal balance during tilt test after flight compared to baseline, suggesting a huge impact of flight on autonomic modulation to the heart. We undertake to test the hypothesis that FP will have a smaller vagal reentrance and lower sympathetic withdrawal during the recovery at the supine position after a prolonged active standing test that mimics flight hemodynamic demands. Twenty-one military personnel (20-34 years old), composed of 9 FP and 12 non-pilots (NP) matched by age, V̉O2max and body mass index were enroled in the experimental protocol. R-R intervals were continuously recorded in the supine position for 15 min (SUPbaseline ), during the prolonged active standing test (45 min) windowed in six 5 min time frames (from ORT1 to ORT6), and a recovery period in the supine position for 15 min (SUPrecovery ). Heart rate variability was performed by spectral analysis to obtain the normalized low (LFn) and high (HFn) frequency components. The variation (Δ) from baseline (Δ = ORT6 - SUPbaseline ) and from recovery (Δ = SUPrecovery -ORT6) periods were calculated. FP had a smaller ΔLFn (sympathetic mediated) and ΔHFn (vagal meditated) during recovery after active standing as compared to NP. Both groups showed similar changes in ΔLFn and ΔHFn during orthostatic stress compared to baseline, with no differences over time. Therefore, FP show a smaller vagal reentrance and a lower sympathetic reduction during recovery at supine following active standing compared to NP.

Cardiovascular autonomic modulation during passive heating protocols: a systematic review.

Objective.To conduct a systematic review of the possible effects of passive heating protocols on cardiovascular autonomic control in healthy individuals.Approach.The studies were obtained from MEDLINE (PubMed), LILACS (BVS), EUROPE PMC (PMC), and SCOPUS databases, simultaneously. Studies were considered eligible if they employed passive heating protocols and investigated cardiovascular autonomic control by spontaneous methods, such as heart rate variability (HRV), systolic blood pressure variability (SBPV), and baroreflex sensitivity (BRS), in healthy adults. The revised Cochrane risk-of-bias tool (RoB-2) was used to assess the risk of bias in each study.Main results.Twenty-seven studies were included in the qualitative synthesis. Whole-body heating protocols caused a reduction in cardiac vagal modulation in 14 studies, and two studies reported both increased sympathetic modulation and vagal withdrawal. Contrariwise, local-heating protocols and sauna bathing seem to increase cardiac vagal modulation. A reduction of BRS was reported in most of the studies that used whole-body heating protocols. However, heating effects on BRS remain controversial due to methodological differences among baroreflex analysis and heating protocols.Significance.Whole-body heat stress may increase sympathetic and reduce vagal modulation to the heart in healthy adults. On the other hand, local-heating therapy and sauna bathing seem to increase cardiac vagal modulation, opposing sympathetic modulation. Nonetheless, further studies should investigate acute and chronic effects of thermal therapy on cardiovascular autonomic control.

Orthostatic intolerance: a handicap of aging or physical deconditioning?

Despite several studies that have been investigated physical inactivity and age-related effects on orthostatic tolerance, impaired hemodynamics and postural balance responses to orthostatic stress are incorrectly attributed to aging or sedentarism alone. The isolated effects from aging and sedentarism should be investigated through comparative studies between senior athletes and age-matched controls, and physical activity assessments on aging follow-up studies. On the other hand, bed rest and space flight studies mimic accelerated physical inactivity or disuse, which is not the same physiological decline provoked by aging alone. Thus, the elementary question is: could orthostatic intolerance be attributed to aging or physical inactivity? The main purpose of this review is to provide an overview of possible mechanisms underlying orthostatic tolerance contrasting the paradigm of aging and/or physical inactivity. The key points of this review are the following: (1) to counterpoint all relevant literature on physiological aspects of orthostatic tolerance; (2) to explore the mechanistic aspects underneath the cerebrovascular, cardiorespiratory, and postural determinants of orthostatic tolerance; and (3) examine non-pharmacological interventions with the potential to counterbalance the physical inactivity and aging effects. To date, the orthostatic intolerance cannot be attributed exclusively with aging since physical inactivity plays an important role in postural balance, neurovascular and cardiorespiratory responses to orthostatic stress. These physiological determinates should be interpreted within an integrative approach of orthostatic tolerance, that considers the interdependence between physiological systems in a closed-loop model. Based on this multisystem approach, acute and chronic countermeasures may combat aging and sedentarism effects on orthostatic tolerance.

Sex difference in blood pressure response to orthostatic stress: effects of transcutaneous electrical nerve stimulation.

OBJECTIVE: We investigated sex differences in blood pressure (BP) response to transcutaneous electrical nerve stimulation (TENS) during orthostatic stress (ORT). METHODS: Seventeen healthy young adults (males = 9; females = 8) underwent TENS or SHAM stimulus applied in the cervicothoracic region for 30 min in the supine position followed by 10 min in the orthostatic position. Electrocardiogram and BP were continuously recorded at rest and during ORT. Stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) were calculated from the BP signal. RESULTS: Orthostatic challenge decreased BP similarly for both sexes during ORT, a deeper drop in CO and a slight increase in heart rate were found in women compared with men ( P = 0.03 and 0.05, respectively). TENS evoked a pronounced fall in SBP in men compared with the SHAM condition ( P < 0.05). TENS has no effect on SBP in women compared with the SHAM condition. CONCLUSION: This finding suggests a possible modulatory effect by one cervicothoracic TENS session on sympathetic tonus in healthy men.

The interplay between heated environment and active standing test on cardiovascular autonomic control in healthy individuals.

Objective.To investigate the interplay between active standing and heat stress on cardiovascular autonomic modulation in healthy individuals.Approach.Blood pressure (BP) and ECG were continuously recorded during 30 min in supine (SUP) and 6 min in orthostatic position (ORT) under thermal reference (TC; ∼24 °C) or heated environment (HOT; ∼36 °C) conditions, in a randomized order. All data collection was performed during the winter and spring seasons when typical outdoor temperatures are ∼23 °C. Spectral analysis was employed by the autoregressive model of R-R and systolic blood pressure (SBP) time series and defined, within each band, in low (LF, 0.04 to 0.15 Hz) and high (0.15-0.40 Hz) frequencies. The indices of cardiac sympathetic (LF) and cardiac parasympathetic (HF) were normalized (nu) dividing each band power by the total power subtracted the very-low component (<0.04 Hz), obtaining the cardiac autonomic balance (LF/HF) modulation. The gain of the relationship between SBP and R-R variabilities within the LF band was utilized for analysis of spontaneous baroreflex sensitivity (alpha index;αLF). Nonlinear analysis was employed through symbolic dynamics of R-R, which provided the percentage of sequences of three heart periods without changes in R-R interval (0V%; cardiac sympathetic modulation) and two significant variations (2UV% and 2LV%; cardiac vagal modulation).Main results.HOT increased 0V% and HR, and decreasedαLF and 2UV% during SUP compared to TC. During ORT, HOT provokes a greater increment on HR, LF/HF and 0V%, indexes compared to ORT under TC.Significance.At rest, heat stress influences both autonomic branches, increasing sympathetic and decreasing vagal modulation and spontaneous baroreflex sensitivity. The augmented HR during active standing under heat stress seems to be mediated by a greater increment in cardiac sympathetic modulation, showing an interplay between gravitational and thermal stimulus.

Cardiovascular and Autonomic Responses after a Single Bout of Resistance Exercise in Men with Untreated Stage 2 Hypertension.

The aim of this paper is to assess the integrated responses of ambulatory blood pressure (BP), cardiac autonomic modulation, spontaneous baroreflex sensitivity (BRS), and vascular reactivity after a single bout of resistance exercise (RE) in men with stage 2 hypertension who have never been treated before. Ten hypertensive men were subjected to a RE session of three sets of 20 repetitions and an intensity of 40% of the 1-repetition maximum (RM) test in seven different exercises. For the control (CTR) session, the volunteers were positioned on the exercise machines but did not perform any exercise. Forearm blood flow was measured by venous occlusion plethysmography. We also analyzed the heart rate variability (HRV), ambulatory BP, blood pressure variability (BPV), and BRS. All measurements were performed at different timepoints: baseline, 20 min, 80 min, and 24 h after both RE and CTR sessions. There were no differences in ambulatory BP over the 24 h between the RE and CTR sessions. However, the area under the curve of diastolic BP decreased after the RE session. Heart rate (HR) and cardiac output increased for up to 80 and 20 min after RE, respectively. Similarly, forearm blood flow, conductance, and vascular reactivity increased 20 min after RE (p < 0.05). In contrast, HRV and BRS decreased immediately after exercise and remained lower for 20 min after RE. We conclude that a single bout of RE induced an increase in vascular reactivity and reduced the pressure load by attenuating AUC of DBP in hypertensive individuals who had never been treated with antihypertensive medications.

Inspiratory muscles contributions to postural control in healthy older women.

It was hypothesized that induced inspiratory muscles effort, by an acute inspiratory resistance load (IRL) use, increases the postural sway and the neuromuscular activity of postural muscles in older adults. Fifteen older women breathed spontaneously, controlled (15 cycles/minute), and with acute IRL (15 cycles/minute and target load of 30 % of maximal inspiratory pressure) in random order. The breathing tasks were performed in an orthostatic position (eyes closed) during one minute on a baropodometer plate to acquire center-of-pressure (COP) oscillations and with electromyography (EMG) recording. The root mean square (RMS) of EMG was calculated. COP oscillations were higher with IRL use than spontaneous and controlled breathing tasks, but not between spontaneous and controlled conditions. EMG activity of Tibialis anterior and Soleus muscles were higher with IRL use in comparison to spontaneous and controlled breathing conditions. In conclusion, IRL use influenced the postural control through increased postural sway and neuromuscular compensation of the lower limbs in older women.

Inspiratory muscle training improves cerebrovascular and postural control responses during orthostatic stress in older women.

PURPOSE: We aimed to investigate the effect of inspiratory muscle training (IMT) on, hemodynamic, cerebrovascular and postural balance responses during orthostatic stress, in older women. METHODS: Fourteen elderly women were assigned to perform IMT at 50% of maximal inspiratory pressure (MIP) (IMT group, n = 8) or placebo training at 5% MIP (Sham group, n = 6), in a counter-balanced order, using an inspiratory threshold device for 4 weeks. During the protocol, MIP was tested weekly once. In a second visit, blood pressure, heart rate, stroke volume, cardiac output, middle cerebral artery blood flow velocity (MCAv), and ventilation parameters were recorded continuously at rest and during orthostatic stress testing, which was conducted on a force plate to measure center-of-pressure (COP) oscillations (postural balance) and the electromyographic activity of the right medial gastrocnemius and tibialis anterior. RESULTS: IMT increased MIP from second to 4th week. The drops in MCAv, stroke volume, and cardiac output, as well as COP displacements during initial orthostasis decreased post-IMT. CONCLUSION: IMT improves the interplay of the respiratory pump, hemodynamic, cerebrovascular and postural balance responses during orthostatic stress in older women.

Efeitos da Hipóxia na Variabilidade da Frequência Cardíaca em Indivíduos Saudáveis: Uma Revisão Sistemática / Effects of Hypoxia on Heart Rate Variability in Healthy Individuals: A Systematic Review

Fundamento: A hipóxia é uma condição fisiológica que pode influenciar a modulação autonômica cardíaca, qualpode ser avaliada pelas flutuações espontâneas da frequência cardíaca, chamada de variabilidade da frequência cardíaca (VFC). Estudos têm reportado reduções ou manutenção da VFC em situação de hipóxia apresentando efeitos controversos. Há uma lacuna no conhecimento em relação às modificações da VFC durante a hipóxia. Objetivo: Revisar sistematicamente estudos que investigaram os efeitos da hipóxia na VFC em adultos saudáveis e não aclimatados durante o repouso. Métodos: A presente revisão sistemática foi realizada a partir da diretriz PRISMA. Os termos utilizados para a busca nas bases MEDLINE, SCOPUS, LILACS e EUROPE PMC foram: "heart rate variability" OR "cardiac autonomic modulation" OR "cardiac autonomic regulation" AND (hypoxia OR altitude) NOT intermitente NOT sleep. Os registros foram filtrados por espécie, idade e idiomas. Resultados: Ao final da triagem e elegibilidade restaram 13 artigos para a síntese qualitativa. Discussão: Os estudos utilizam protocolos experimentais variados que envolvem diferença na pressão barométrica, no nível de oxigênio, no tempo de exposição à hipóxia e no controle da frequência respiratória. Possivelmente a influência desses fatores e também a variação interindividual à hipóxia podem justificar diferentes respostas na VFC. Conclusão: A partir dos estudos investigados, a hipóxia foi capaz de gerar uma queda na VFC, seja por retirada ou manutenção da modulação vagal, ou por predomínio simpático ou mesmo pela combinação dessas respostas em adultos saudáveis não aclimatados a hipóxia. Este efeito parece ser dependente do nível de altitude e da pressão barométrica

Background: Hypoxia is a physiological condition that may affect the cardiac autonomic modulation, which can be assessed by spontaneous fluctuations in heart rate, know as heart rate variability (HRV). Studies have reported reductions or maintenance of HRV in hypoxic situation presenting controversial effects. There is a knowledge gap in relation to changes in HRV during hypoxia. Objective: The aim of this study was to systematically review the effects of hypoxia on HRV in unacclimatized healthy adults at rest. Methods: This systematic review was performed according to PRISMA guidelines. Search terms used in MEDLINE, SCOPUS, LILACS and EUROPE PMC database were: "heart rate variability" OR "cardiac autonomic modulation" OR "cardiac autonomic regulation" AND NOT intermittent NOT sleep (hypoxia OR altitude). Records were filtered by species, age group and language. Results: At the end of the screening and eligibility, 13 manuscripts remained for qualitative synthesis. Discussion: The studies used different experimental protocols involving difference in barometric pressure, oxygen level, time of exposure to hypoxia and control of respiratory rate. Possibly the influence of these factors and also the interindividual variation to hypoxia may justify different responses in HRV. Conclusion: Based on the investigated studies, hypoxia has been capable of generating a decrease in HRV, either by reduction or maintenance of vagal modulation, or by sympathetic predominance or even the combination of these responses in healthy adults unacclimatized to hypoxia. This effect appears to be dependent on altitude level and barometric pressure

Transcranial direct current stimulation influences the cardiac autonomic nervous control.

To investigate whether the manipulation of brain excitability by transcranial direct current stimulation (tDCS) modulates the heart rate variability (HRV), the effect of tDCS applied at rest on the left temporal lobe in athletes (AG) and non-athletes (NAG) was evaluated. The HRV parameters (natural logarithms of LF, HF, and LF/HF) was assessed in 20 healthy men before, and immediately after tDCS and sham stimulation. After anodal tDCS in AG the parasympathetic activity (HF(log)) increased (P<0.01) and the sympathetic activity (LF(log)) and sympatho-vagal balance (LF/HF(log)) decreased (P<0.01), whereas no significant effects were detected in NAG (P>0.05). No significant changes in HRV indexes were provoked by sham stimulation in both AG and NAG (P>0.05). In conclusion, tDCS applied on the left temporal lobe significantly increased the overall HRV in AG, enhancing the parasympathetic and decreasing the sympathetic modulation of heart rate. Consequently the sympatho-vagal balance decreased at rest in AG but not in NAG. Releasing a weak electric current to stimulate selected brain areas may induce favorable effects on the autonomic control to the heart in highly fit subjects.

História familiar de Diabetes Mellitus tipo 2 e modulação autonômica cardíaca / Family history of type 2 Diabetes Mellitus and cardiac autonomic modulation

Fundamentos: Faltam evidências para identificar se a redução na função autonômica observada em indivíduos com história familiar de primeiro grau de diabetes mellitus tipo 2 (HFDM2) é uma característica primária ou uma consequência de desordens metabólicas comumente observadas nesses indivíduos. Objetivo: Investigar a influência da HFDM2 na modulação autonômica cardíaca em ausência de desordens metabólicas concomitantes. Métodos: Foram recrutados indivíduos saudáveis com HFDM2 (grupo HFDM2; n=61) e sem HFDM2 (grupo-controle; n=53). O protocolo incluiu: dosagem de glicose, insulina, colesterol total e subfrações, triglicerídeos, leptina e proteína C-reativa; e avaliação da variabilidade da frequência cardíaca (VFC) através da análise espectral de um registro de intervalos RR durante 10 minutos na posição supina. Resultados: Os indivíduos com HFDM2 apresentaram maiores valores para variáveis antropométricas e metabólicas e uma menor VFC quando comparados com o grupo-controle (p menor que 0,05)...

Effects of rat sinoaortic denervation on the vagal responsiveness and expression of muscarinic acetylcholine receptors.

We studied heart rate (HR) responses to vagal electrical stimulation (VES) and the expression of muscarinic acetylcholine receptors (mAChRs) in the rat atria 1 day (SADa) and 20 days (SADc) after sinoaortic denervation (SAD). Arterial blood pressure (BP) was recorded in conscious, unrestrained rats and during vagal electrical stimulation of the vagus nerve. In the acute phase, SADa rats had hypertension, tachycardia, and increased blood pressure lability. In the chronic phase, heart rate and blood pressure in SADc rats returned to normal whereas blood pressure lability remained increased. VES produced a frequency-dependent bradycardia that was higher in SADa and SADc groups. Binding experiments with [H] N-methylscopolamine showed that in the chronic phase of SAD mAChRs density (SADc = 412.2 +/- 28.64, SADa = 273.38 +/- 48.37 and CTR = 241.5 +/- 25.35 fmol/mg of protein, P < 0.05) and affinity increased in SADc rats (reduced dissociation constant: SADc = 0.45 +/- 0.05, SADa = 1.01+/-0.26, and CTR = 0.98 +/- 0.12 mM, P < 0.05). Our study provides evidence that vagal hyperresponsiveness coexists with increased sympathetic activity in SADa rats without a concomitant increase in mAChRs density or affinity, suggesting that complex mechanisms might modulate the "accentuated antagonism" observed in the acute SAD phase. However, SADc rats had increased bradycardia to VES, increased affinity, and upregulation of mAChRs in the atria. Our results show that, 20 days after SAD in the rat, functional and cellular adaptations occur in the cardiac parasympathetic efferent pathway that may contribute to other regulatory mechanisms to compensate for cardiovascular changes provoked by baroreceptor arch disruption.