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      Utilização da variabilidade da frequência cardíaca para a identificação do limiar anaeróbio: uma revisão sistemática Translated title: Use of heart rate variability to identify the anaerobic threshold: a systematic review

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          Abstract

          O objetivo desta revisão sistemática foi investigar os níveis de correlação e/ou concordância entre o Limiar de variabilidade da frequência cardíaca (LVFC), identificado por meio dos índices RMSSD e SD1, e o limiar anaeróbio (LA) em amostras com diferentes condições clínicas e funcionais. A busca foi realizada por dois autores de forma independente nas bases de dados Scielo, LILACS e PUBMED. Para tal, foram utilizados os termos "anaerobic threshold", "autonomic nervous system" e "heart rate variability", aplicando seus correspondentes em língua portuguesa quando apropriado. Um total de seis artigos cumpriu os critérios de inclusão. Foram encontradas correlações (r) de 0,42 a 0,99 entre as variáveis investigadas, dependendo da amostra analisada. Observaram-se correlações significativas em cinco dos seis artigos selecionados, nos quais, apenas dois apresentaram de forma efetiva a análise de viés e erro pela técnica de Bland-Altman, demonstrando concordância entre os métodos propostos. Desta forma, verificou-se que dentro das condições adotadas nos estudos analisados, a estimativa do limiar anaeróbio por meio dos índices propostos fica limitada a homens adultos aparentemente saudáveis e diabéticos do tipo II, bem como para homens e mulheres com insuficiência cardíaca. Por outro lado, conclui-se que o número de estudos analisados não é suficientemente robusto para assegurar a estimativa do LA por meio do LVFC nas condições analisadas. Por fim, verifica-se a necessidade de novas investigações sobre a aplicação desta técnica em diferentes tipos de protocolos e populações.

          Translated abstract

          The aim of this systematic review was investigate the correlation and/or agreement between the heart rate variability threshold (HRVT), identified by heart rate variability index (RMSSD and SD1), and anaerobic threshold (AT) in samples with different clinical and functional conditions. The search was performed by two authors independently using the SciELO , LILACS, and PubMed databases . The terms "anaerobic threshold", " autonomic nervous system" and "heart rate variability " were used , and when it was necessary the same words in portuguese. A total of six articles met the inclusion criteria. Correlations (r) from 0.42 to 0.99 were found between the variables investigated, depending on the sample analyzed. There were significant correlations in five of the six selected articles, in which only two were analyzed using the Bland - Altman plot showing agreement between the proposed methods. Thus, it was found that under the conditions adopted in the studies analyzed, the estimated anaerobic threshold by means of the proposed index is limited to apparently healthy adult males and type II diabetics as well as for men and women with heart failure. Moreover, it is concluded that the number of trials analyzed is not sufficiently robust to ensure the AT estimated by HRVT under the conditions studied. Finally, further research IS NEEDED on the application of this technique in different types of protocols and populations.

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          Most cited references31

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          Vagal modulation of heart rate during exercise: effects of age and physical fitness.

          This study was designed to assess the effects of age and physical fitness on vagal modulation of heart rate (HR) during exercise by analyzing the instantaneous R-R interval variability from Poincaré plots (SD1) at rest and at different phases of a bicycle exercise test in a population of healthy males. SD1 normalized for the average R-R interval (SD1n), a measure of vagal activity, was compared at rest and during exercise among subjects of ages 24-34 (young, n = 25), 35-46 (middle-aged, n = 30), and 47-64 yr (old, n = 25) matched for peak O2 consumption (VO2 peak) and among subjects with VO2 peak of 28-37 (poor, n = 25), 38-45 (average, n = 36), and 46-60 ml.kg-1.min-1 (good, n = 25) matched for age. SD1n was higher at rest in the young subjects than in the middle-aged or old subjects (39 +/- 14, 27 +/- 16, and 21 +/- 8, respectively; P < 0.001), but the age-related differences in SD1n were smaller during exercise [e.g., 11 +/- 5, 9 +/- 5, and 8 +/- 4 at the level of 100 W; P = not significant (NS)]. The age-matched subjects with good, average, and poor VO2 peak showed no difference in SD1n at rest (32 +/- 17, 28 +/- 13, and 26 +/- 11, respectively; P = NS), but SD1n differed significantly among the groups from a low to a moderate exercise intensity level (e.g., 13 +/- 6, 10 +/- 5, and 6 +/- 3 for good, average, and poor fitness groups, respectively; P < 0.001, 100 W). These data show that poor physical fitness is associated with an impairment of cardiac vagal function during exercise, whereas aging itself results in more evident impairment of vagal function at rest.
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            Assessment of parasympathetic reactivation after exercise.

            The objective of this study was to evaluate whether heart rate variability (HRV) can be used as an index of parasympathetic reactivation after exercise. Heart rate recovery after exercise has recently been shown to have prognostic significance and has been postulated to be related to abnormal recovery of parasympathetic tone. Ten normal subjects [5 men and 5 women; age 33 +/- 5 yr (mean +/- SE)] exercised to their maximum capacity, and 12 subjects (10 men and 2 women; age 61 +/- 10 yr) with coronary artery disease exercised for 16 min on two separate occasions, once in the absence of atropine and once with atropine (0.04 mg/kg) administered during exercise. The root mean square residual (RMS), which measures the deviation of the R-R intervals from a straight line, as well as the standard deviation (SD) and the root mean square successive difference of the R-R intervals (MSSD), were measured on successive 15-, 30-, and 60-s segments of a 5-min ECG obtained immediately after exercise. In recovery, the R-R interval was shorter with atropine (P < 0.0001). Without atropine, HRV, as measured by the MSSD and RMS, increased early in recovery from 4.1 +/- 0.4 and 3.7 +/- 0.4 ms in the first 15 s to 7.2 +/- 1.0 and 7.4 +/- 0.9 ms after 1 min, respectively (P < 0.0001). RMS (range 1.7-2.1 ms) and MSSD were less with atropine (P < 0.0001). RMS remained flat throughout recovery, whereas MSSD showed some decline over time from 3.0 to 2.2 ms (P < 0.002). RMS and MSSD were both directly related (r(2) = 0.47 and 0.56, respectively; P < 0.0001) to parasympathetic effect, defined as the difference in R-R interval without and with atropine. In conclusion, RMS and MSSD are parameters of HRV that can be used in the postexercise recovery period as indexes of parasympathetic reactivation after exercise. These tools may improve our understanding of parasympathetic reactivation after exercise and the prognostic significance of heart rate recovery.
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              Cardiac autonomic neural remodeling and susceptibility to sudden cardiac death: effect of endurance exercise training.

              Sudden cardiac death resulting from ventricular tachyarrhythmias remains the leading cause of death in industrially developed countries, accounting for between 300,000 and 500,000 deaths each year in the United States. Yet, despite the enormity of this problem, both the identification of factors contributing to ventricular fibrillation as well as the development of safe and effective antiarrhythmic agents remain elusive. Subnormal cardiac parasympathetic regulation coupled with an elevated cardiac sympathetic activation may allow for the formation of malignant ventricular arrhythmias. In particular, myocardial infarction can reduce cardiac parasympathetic regulation and alter beta-adrenoceptor subtype expression enhancing beta(2)-adrenoceptor sensitivity that can lead to intracellular calcium dysregulation and arrhythmias. As such, myocardial infarction can induce a remodeling of cardiac autonomic regulation that may be required to maintain cardiac pump function. If alterations in cardiac autonomic regulation play an important role in the genesis of life-threatening arrhythmias, then one would predict that interventions designed to either augment parasympathetic activity and/or reduce cardiac adrenergic activity would also protect against ventricular fibrillation. Recently, studies using a canine model of sudden death demonstrate that endurance exercise training (treadmill running) enhanced cardiac parasympathetic regulation (increased heart rate variability), restored a more normal beta-adrenoceptor balance (i.e., reduced beta(2)-adrenoceptor sensitivity and expression), and protected against ventricular fibrillation induced by acute myocardial ischemia. Thus exercise training may reverse the autonomic neural remodeling induced by myocardial infarction and thereby enhance the electrical stability of the heart in individuals shown to be at an increased risk for sudden cardiac death.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                refuem
                Revista da Educação Física / UEM
                Rev. educ. fis. UEM
                Universidade Estadual de Maringá (Maringá )
                1983-3083
                December 2014
                : 25
                : 4
                : 675-683
                Affiliations
                [1 ] Centro Universitário Euro Americano Brasil
                [2 ] Universidade de Brasília Brazil
                Article
                S1983-30832014000400675
                10.4025/reveducfis.v25i4.22495
                121e6fe1-f133-401d-bb3b-65c2924e0a54

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1983-3083&lng=en
                Categories
                SPORT SCIENCES

                Sports medicine
                Anaerobic threshold,Nervous system,Heart rate,Limiar anaeróbio,Sistema nervoso,Frequência cardíaca

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