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      Blunted Cardiac Parasympathetic Activation in Student Athletes With a Remote History of Concussion: A Pilot Study


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          Introduction: Blunted cardiac autonomic nervous system (ANS) responses, quantified using heart rate variability (HRV), have been reported after sport-related concussion (SRC). Research suggests this persists beyond clinical recovery. This study compared cardiac parasympathetic responses in student athletes with a remote history of SRC (> 1-year ago, Concussion History: CH) with those who reported no lifetime history of SRC (Concussion Naïve: CN).

          Design: Retrospective nested case-control.

          Setting: University laboratory.

          Patients or Other Participants: CH ( n = 9, 18.3 ± 2 years, 44% male, median 2 years since injury) were student athletes with a remote history of concussion(s) from more than 1 year ago. CN ( n = 21, 16.7 ± 3 years, 67% male) were student athletes with no lifetime history of concussion. Exclusion criteria included taking medications that could affect ANS function, history of concussion within the past year, persistent concussion symptoms, lifetime history of moderate to severe brain injury, and lifetime history of more than 3 concussions.

          Material and Methods: Participants performed the Face Cooling (FC) test for 3-min after 10-min of supine rest while wearing a 3-lead electrocardiogram in a controlled environment.

          Outcome Measures: Heart rate (HR), R-R interval (RRI), root mean square of the successive differences (RMSSD) of RRI, high frequency (HF) and low frequency to HF (LF:HF) ratios.

          Results: At baseline, CH had a lower resting HR than CN (62.3 ± 11 bpm vs. 72.9 ± 12, p = 0.034). CH had a different HR response to FC than CN (+8.9% change from baseline in CH vs. −7.5% in CN, p = 0.010). CH also had a smaller RMSSD increase to FC than CN (+31.8% change from baseline in CH vs. +121.8% in CN, p = 0.048). There were no significant group differences over time in RRI ( p = 0.106), HF ( p = 0.550) or LF:HF ratio ( p = 0.053).

          Conclusion: Asymptomatic student athletes with a remote history of concussion had a blunted cardiac parasympathetic response to FC when compared with athletes with no lifetime history of concussion. These data suggest that an impaired autonomic response to a physiological stressor persists after clinical recovery from SRC for longer than previously reported.

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          Most cited references 33

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          An Overview of Heart Rate Variability Metrics and Norms

          Healthy biological systems exhibit complex patterns of variability that can be described by mathematical chaos. Heart rate variability (HRV) consists of changes in the time intervals between consecutive heartbeats called interbeat intervals (IBIs). A healthy heart is not a metronome. The oscillations of a healthy heart are complex and constantly changing, which allow the cardiovascular system to rapidly adjust to sudden physical and psychological challenges to homeostasis. This article briefly reviews current perspectives on the mechanisms that generate 24 h, short-term (~5 min), and ultra-short-term (<5 min) HRV, the importance of HRV, and its implications for health and performance. The authors provide an overview of widely-used HRV time-domain, frequency-domain, and non-linear metrics. Time-domain indices quantify the amount of HRV observed during monitoring periods that may range from ~2 min to 24 h. Frequency-domain values calculate the absolute or relative amount of signal energy within component bands. Non-linear measurements quantify the unpredictability and complexity of a series of IBIs. The authors survey published normative values for clinical, healthy, and optimal performance populations. They stress the importance of measurement context, including recording period length, subject age, and sex, on baseline HRV values. They caution that 24 h, short-term, and ultra-short-term normative values are not interchangeable. They encourage professionals to supplement published norms with findings from their own specialized populations. Finally, the authors provide an overview of HRV assessment strategies for clinical and optimal performance interventions.
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            Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016.

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              Heart rate variability: a noninvasive electrocardiographic method to measure the autonomic nervous system.

               Juan Sztajzel (2004)
              The autonomic nervous system (ANS) plays an important role not only in physiological situations, but also in various pathological settings such as diabetic neuropathy, myocardial infarction (MI) and congestive heart failure (CHF). Autonomic imbalance associating increased sympathetic activity and reduced vagal tone has been been strongly implicated in the pathophysiology of arrhythmogenesis and sudden cardiac death. Among the different available noninvasive techniques for assessing the autonomic status heart rate variability (HRV) has emerged as a simple, noninvasive method to evaluate the sympathovagal balance at the sinoatrial level. It has been used in a variety of clinical situations including diabetic neuropathy, MI, sudden death and CHF. The standard measurements intervening in the analysis of HRV comprise time domain indices, geometric methods and components of the frequency domain. Measurements of HRV are generally performed on the basis of 24 hour Holter recordings (long-term recordings) or on shorter periods ranging from 0.5 to 5 minutes (short-term recordings). The use of long or short-term recordings depends on the type of study that has to be realised. Established clinical data based on numerous studies published during the last decade consider decreased global HRV as a strong predictor of increased all-cause cardiac and/or arrhythmic mortality, particularly in patients at risk after MI or with CHF. This article reviews the mechanism, the parameters and the use of HRV as a marker reflecting the activity of the sympathetic and vagal components of the ANS on the sinus node, and as a clinical tool for screening and identifying patients particularly at risk for cardiac mortality.

                Author and article information

                Front Neurol
                Front Neurol
                Front. Neurol.
                Frontiers in Neurology
                Frontiers Media S.A.
                30 September 2020
                : 11
                1UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo , Buffalo, NY, United States
                2Department of Neuroscience, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo , Buffalo, NY, United States
                3Department of Biostatistics, School of Public Health and Health Professions, State University of New York at Buffalo , Buffalo, NY, United States
                4Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, State University of New York at Buffalo , Buffalo, NY, United States
                5Jundiaí Medical School, Faculdade de Medicina de Jundiaí (FMJ) , Jundiai, Brazil
                6Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo , Buffalo, NY, United States
                Author notes

                Edited by: Jean-charles Sanchez, Université de Genève, Switzerland

                Reviewed by: Nathan Churchill, St. Michael's Hospital, Canada; Kelsey Bryk, University of Delaware, United States

                *Correspondence: Blair D. Johnson bj33@ 123456indiana.edu

                This article was submitted to Neurotrauma, a section of the journal Frontiers in Neurology

                Copyright © 2020 Haider, Johnson, Horn, Leddy, Wilber, Reed, O'Leary, Bloomfield, Decezaro and Willer.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 5, Tables: 2, Equations: 0, References: 35, Pages: 7, Words: 5170
                Funded by: National Institute of Neurological Disorders and Stroke 10.13039/100000065
                Funded by: National Center for Advancing Translational Sciences 10.13039/100006108
                Original Research


                concussion, autonomic nervous system, sport, heart rate vaiability, face cooling


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