Is cardiac autonomic modulation during upper limb isometric contraction and Valsalva maneuver impaired in COPD patients?

Abstract

Purpose

To evaluate the heart rate variability (HRV) indices and heart rate (HR) responses during isometric contraction (IC) and Valsalva maneuver (VM) in COPD patients.

Methods

Twenty-two stable moderate to severe COPD patients were evaluated. R-R intervals were recorded (monitor Polar ^® S810i) during dominant upper limb IC (2 minutes). Stable signals were analyzed by Kubios HRV ^® software. Indices of HRV were computed in the time domain (mean HR; square root of the mean squared differences of successive RR intervals [RMSSD] and HRV triangular index [RR tri index]) and in the frequency domain (high frequency [HF]; low frequency [LF] and LF/HF ratio). The HR responses were evaluated at rest, at the peak and at the nadir of the VM (15 seconds). The Valsalva index was also calculated.

Results

During IC: time domain indices (mean HR increased [ P=0.001], RMSSD, and RR tri index decreased [ P=0.005 and P=0.005, respectively]); frequency domain indices (LF increased [ P=0.033] and HF decreased [ P=0.002]); associations were found between forced expiratory volume in 1 second (FEV ₁) vs RMSSD ( P=0.04; r=−0.55), FEV ₁ vs HR ( P=0.04; r=−0.48), forced vital capacity (FVC) vs RMSSD ( P=0.05; r=−0.62), maximum inspiratory pressure (MIP) vs HF ( P=0.02; r=0.68). FEV ₁ and FVC justified 30% of mean HR. During VM: HR increased ( P=0.01); the nadir showed normal bradycardic response; the Valsalva index was =0.7.

Conclusion

COPD patients responded properly to the upper limb IC and to the VM; however, HR recovery during VM was impaired in these patients. The severity of the disease and MIP were associated with increased parasympathetic modulation and higher chronotropic response.

Journal

Journal ID (nlm-ta): Int J Chron Obstruct Pulmon Dis

Journal ID (iso-abbrev): Int J Chron Obstruct Pulmon Dis

Journal ID (publisher-id): International Journal of COPD

Title: International Journal of Chronic Obstructive Pulmonary Disease

Publisher: Dove Medical Press

ISSN (Print): 1176-9106

ISSN (Electronic): 1178-2005

Publication date Collection: 2017

Publication date (Electronic): 13 March 2017

Volume: 12

Pages: 849-857

Affiliations

[1 ]Course of Physiotherapy, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil

[2 ]Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos, São Carlos, Brazil

[3 ]Department of Physiotherapy, Federal University of Amazonas, Manaus, AM, Brazil

[4 ]Course of Physiotherapy, Department of Health and Physical Education, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil

[5 ]Pulmonary Rehabilitation Program, Santa Cruz Hospital, Santa Cruz do Sul, Rio Grande do Sul, Brazil

Author notes

Correspondence: Andréa Lúcia Gonçalves da Silva, Rua Vereador Benno Kist, 1780/15, Bairro Santo Inácio, Santa Cruz do Sul, RS, CEP 96820-688, Brazil, Tel [phone], Email andreag@ 123456unisc.br

Article

Publisher ID: copd-12-849

DOI: 10.2147/COPD.S130428

PMC ID: 5357074

Copyright statement: © 2017 Goulart et al. This work is published and licensed by Dove Medical Press Limited

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Categories

Subject: Original Research