Impaired Cardiac Autonomic Control in Women With Fibromyalgia Is Independent of Their Physical Fitness.

BACKGROUND/OBJECTIVE: Evidence has suggested abnormal cardiac autonomic responses to exercise in patients with fibromyalgia (FM). However, it is not clear whether the dysautonomia represents a reduced physical fitness rather directly related to FM pathogenesis. Thus, we aimed to verify the cardiac autonomic responses before, during, and after a maximal incremental exercise in women with FM and whether these hypothesized alterations would be dependent with their physical fitness. METHODS: This is a cross-sectional study with 23 FM women and 17 healthy women. The participants performed a maximal incremental cycling test to determine their maximal workload (Wmax) and were further matched by their Wmax (14 FM patients, Wmax: 128.6 ± 16.2 W; and 14 healthy women, Wmax: 131.9 ± 15.9 W). Beat-to-beat heart rate (HR) was continuously monitored to calculate HR variability indexes at rest, chronotropic reserve during exercise, and HR recovery. RESULTS: Heart rate variability indexes related to vagal modulation were significantly lower in FM patients than in healthy women (p < 0.05). The chronotropic reserve and the HR recovery at 30, 120, 180, 300, and 600 seconds after exercise were all lower in FM patients compared with those of healthy women (p < 0.05). Similar findings were found when analysis was performed using the matched physical fitness subgroup. CONCLUSIONS: The documented cardiac autonomic abnormalities at rest, during, and after exercise in FM patients persist even when physical fitness status is taken in account. Thus, strategies to attenuate the dysautonomia in FM patients must be considered.

Effects of Walking Training with Restricted Blood Flow on HR and HRV Kinetics and HRV Recovery.

The aim of this study was to investigate the effects of walking training with and without blood flow restriction (BFR) on heart rate (HR) and heart rate variability (HRV) kinetics and HRV recovery. Twenty-one men (53.5±3.2 years; 82.4±13.5 kg; 168.5±7.2 cm) were randomly assigned to two training groups: walk training group with (BFR-W; n=11) and without (NOR-W; n=10) BFR. Before and after training, all subjects underwent body composition evaluation, incremental test, and one constant load test. Walking training was performed 3 times/week, during 6 weeks. Each session was composed by 5 sets of 3-min walking and 1-min rest between the sets. All parameters of HR on- and off-kinetics and RMSSD15 0 parameter of HRV on-kinetics were improved for BFR-W group after training (p<0.05), with an interaction effect for HR on-kinetics parameters and RMSSD15 0 parameter (p<0.05). Also, parameters of time and frequency domain of HRV recovery were also improved in BFR-W after training (p<0.05), with no interaction effect (p>0.05). Additionally, in BFR-W group, RMSSD60s values were improved in some moments after training (p<0.05). Therefore, this study demonstrates that a 6-week walking training with BFR improved cardiac autonomic responses on the onset and recovery of exercise.

Cardiac autonomic responses and number of repetitions maximum after LED irradiation in the ipsilateral and contralateral lower limb.

The aim of this study was to verify the maximum number of repetitions, fatigue index, blood lactate concentration ([Lac]), and cardiac autonomic responses after LED irradiation (LEDI) in the ipsilateral and contralateral limb. Twelve male subjects (22.0 ± 3.86 years; weight 82.94 ± 12.58 kg; height 1.77 ± 0.05 m), physically active, took part in this study. The subjects underwent a one repetition maximum (1RM) test and performed four randomly experimental sessions in the horizontal leg press exercise, which consisted in four sets of maximum repetitions at 80% of 1RM. The subjects performed two experimental sessions applying LED active or placebo on ipsilateral limb and two experimental sessions applying LED active or placebo on contralateral limb prior exercise and in the interval of sets on quadriceps and hamstrings muscles. A number of repetitions and fatigue index were verified. [Lac] and heart rate variability (HRV) were collected during post-exercise recovery and analyzed. It was observed that active LEDI promoted an increase in maximal number of repetitions (LEDI = 44.4 ± 9.0 vs placebo = 39.9 ± 11.4; p < 0.05) and decreases the fatigue index (LEDI = 34.3 ± 21.8% vs placebo = 50.0 ± 26.6%; p < 0.05) comparing to placebo situation, only in the ipsilateral application. There were no differences on [Lac] and in HRV parameters comparing LEDI vs placebo on post-exercise recovery in both applications (p > 0.05). The LEDI improves performance only in the ipsilateral application, but there were no differences on [Lac] and cardiac autonomic responses after exercise for both the applications.

Cardiac autonomic regulation during submaximal exercise in women with fibromyalgia.

Fibromyalgia (FM) patients present impaired cardiac autonomic regulation during maximal exercise; however, it is unknown whether these alterations also manifest during submaximal exercise. The aim of this study was to compare the on-transient heart rate (HR) response and HR variability during a constant-load submaximal cycling exercise between FM and control (CON) women. Ten women with FM (age: 45.2±9.3 years) and 10 age-matched CON women (age: 48.4±6.1 years) performed a 15-min cycling exercise, with the work rate fixed at 50% of the individual peak power output attained in a maximal graded exercise test. The time intervals between consecutive heartbeats were recorded regularly during the exercise for subsequent analysis of on-transient HR response and HR variability indices. The on-transient HR time constant was similar (P=0.83) between the FM (41.0±14.1 sec) and CON (42.2±10.4 sec). During the 5-10 and 10-15 min of exercise, HR variability indices indicating sympathetic and parasympathetic activities were similar (P>0.05) between FM and CON groups. In conclusion, women with FM presented a normal cardiac autonomic response to submaximal cycling exercise. These findings have clinical relevance, as submaximal exercises are commonly prescribed for FM patients.

Caffeine Attenuates Exacerbated Central Fatigue during Moderate-Intensity Cycling Exercise in Women with Fibromyalgia.

PURPOSE: To compare the development of fatigability during a moderate-intensity cycling exercise between women with fibromyalgia (FM) and control women (CON) after acute ingestion of caffeine and placebo. METHODS: Ten FM and 10 CON women performed a 30-min moderate-intensity cycling exercise 1 h after the ingestion of a capsule containing either caffeine or a placebo. Fatigability and its central and peripheral determinants were determined via changes from pre- to post-15 and post-30 min of exercise in maximal voluntary isometric contractions, voluntary activation (VA), and quadriceps potentiated twitch torque ( Qtw-pot ), respectively. Heart rate, muscle oxygen saturation, perceptive responses, mood state, localized and widespread pain, and sleepiness were also monitored during and after exercise. RESULTS: There was a time versus group interaction for maximal voluntary isometric contraction and VA ( P < 0.001) but not for Qtw-pot ( P = 0.363), indicating a greater rate of fatigability development, mainly caused by central mechanisms, in the FM than in the CON group. There was also a main effect of condition for VA ( P = 0.011), indicating that caffeine attenuates central mechanisms of fatigability in both groups. Caffeine ingestion also increased muscle oxygenation, perceived vigor, and energy, and decreased leg muscle pain, sleepiness, and perceived fatigue in both groups. However, caffeine improved perceived pleasure/displeasure and exercise adherence likelihood only in the FM group. CONCLUSIONS: Compared with CON, women with FM present a greater rate of fatigability during exercise, mainly of central origin. Caffeine seems to be a promising bioactive to counteract the central mechanisms of fatigability and improve the exercise experience among FM women.

Acute Caffeine Intake Reduces Perceived Exertion But Not Muscle Pain during Moderate Intensity Cycling Exercise in Women with Fibromyalgia.

OBJECTIVE: Exacerbated perceived exertion and muscle pain responses during exercise might limit physical activity practice in fibromyalgia patients. Thus, nutritional strategies that can reduce perceived exertion and muscle pain during exercise in fibromyalgia patients would be useful. The purpose of this study was to investigate the effects of acute caffeine intake on the perceptions of exertion and muscle pain during a moderate intensity exercise in women with fibromyalgia. METHOD: Using a randomized, double-blinded, placebo-controlled and crossover experimental design, eleven sedentary women diagnosed with fibromyalgia (age: 44.6 ± 10.5 years; body mass index: 28.5 ± 4.5 kg.m-2) ingested a capsule containing either caffeine (5 mg per kg of body mass) or cellulose (placebo), 60 minutes before performing a 30-minute constant-load cycling exercise, with work rate fixed at 50% of their individual peak workload attained in an incremental exercise test. Ratings of perceived leg muscle pain and perceived exertion were assessed every 5 minutes of exercise. RESULTS: The perceived leg muscle pain was similar (F(1,10) = 1.18, p = 0.30, ŋ2 = 0.11) between caffeine (2.1 ± 1.2 arbitrary units) and placebo conditions (2.2 ± 0.9 arbitrary units). The perceived exertion, however, was on average 8 ± 6% lower (F(1,10) = 12.13; p = 0.006; ŋ2 = 0.55) during exercise in the caffeine condition (12.4 ± 1.3 arbitrary units) than in the placebo condition (13.1 ± 1.1 arbitrary units). CONCLUSIONS: These findings indicate that acute caffeine intake could be an attractive strategy to attenuate the exacerbated perceived exertion of fibromyalgia patients during moderate intensity exercise.

A comparative study of heart rate variability and physical fitness in women with moderate and severe fibromyalgia.

The aim of this study was to compare the physical fitness and cardiac autonomic activity among women with moderate and severe fibromyalgia (FM) and healthy women. This study included 35 women with FM (age: 46.2±8.9 years) and 17 healthy women (age: 44.3±9.9 years). Participants with FM were divided into moderate FM (n=15) and severe FM (n=20) according to the total score obtained in FM impact questionnaire. The heart rate variability was monitored using a portable cardiac monitor with participants resting in supine position during 10 min. Thereafter, the participants performed the chair sit and reach test, the chair stand test, and the 6-min walk test to measure the lower-body flexibility, lower-body muscle strength, and cardiorespiratory fitness, respectively. The lower-body muscle strength and cardiorespiratory fitness were both reduced in moderate and severe FM compared to healthy women (P<0.01), with greater reduction in severe FM when compared to moderate FM (P<0.05). In addition, the parasympathetic indexes of heart rate variability were all similarly decreased in both moderate and severe FM, when compared to healthy women (P<0.05). The cardiac parasympathetic activity is similarly decreased in women with both moderate and severe FM in comparison to healthy women, despite a greater physical deconditioning in severe FM.

Effect of walk training combined with blood flow restriction on resting heart rate variability and resting blood pressure in middle-aged men

Aim: To investigate the effects of low-intensity walk training with and without blood flow restriction (BRF) on resting heart rate variability (HRV) and blood pressure (BP) in middle-aged men. Methods: Twenty-one men were randomly assigned into the walk training group with (BRF-W; n = 11) and without (NOR-W; n = 10) BFR. The resting HRV and blood pressure were assessed pre- and post-6 weeks of the intervention [3 times/week, 5 sets of 3-min walking (6 km.h-1) with 1-min of rest, totalizing 18 sessions of training]. The BFR-W group received the occlusive stimulus before of training sessions though of a standard sphygmomanometer and performed the training sessions with the vascular occlusion (80-100 mmHg) in both the legs. Results: Only BRF-W group improved HRV on time domain indices (SDNN and RMSSD; p < 0.05) after training but it was not found differences on frequency domain indices. In addition, systolic blood pressure (SBP) improved after training (PRE: 128.5 ± 5.9 vs POST: 119.1 ± 8.6 mmHg; Cohen's d = -1.30; p < 0.01) only in BFR-W group. There was not a significant difference on diastolic blood pressure (DBP) after training, however, effect size was moderate for BFR-W (Cohen's d = -0.56; p > 0.05). Conclusion: Our results showed that walking training with blood flow restriction can improve health cardiovascular parameters in middle-aged men.(AU)

Cardiac autonomic responses during and after a single session of aerobic exercise with and without blood flow restriction

Aim: To verify the on and off heart rate (HR) and HR variability (HRV) kinetics during a high-load aerobic exercise and a low-load aerobic exercise, with and without blood flow restriction (BFR). Methods: Fourteen healthy male subjects performed three randomly assigned experimental sessions: 1) 10 minutes walking at 40% of maximal aerobic speed (MAS) (40LL); 2) 10 minutes walking at 40% of MAS with BFR (40LL+BFR); and 3) 10 minutes running at 70% of MAS (70HL). The HR and HRV measurements were taken at rest, during exercise and the recovery period after constant load sessions. Results: The HR on- and off- kinetics, and HRV on-kinetics were faster in 40LL than in 40LL +BFR and 70HL (p < 0.05). The time constant (τon) of HR on-kinetics was faster in 40LL+BFR than in 70HL (23.4 ± 9.5 s vs 42 ± 9.5 s, respectively, p < 0.01), and was accompanied by faster HRV on-kinetics (12.4 ± 9.6 s vs 20.3 ± 13.7 s, respectively, p < 0.01). Although HR off-kinetics was not different between 40LL+BFR and 70HL, the recovery of time and frequency HRV indices were delayed in 70HL when compared to 40LL and 40LL+BFR (p < 0.05). Conclusions: These findings indicate that 40LL promoted faster cardiac adjustments compared to 40LL+BFR and 70HL sessions. Additionally, 40LL+BFR promoted faster cardiac adjustment and better HRV recovery compared to the 70HL session. (AU)