Influence Of Two Exercise Programs On Heart Rate Variability, Body Temperature, Central Nervous System Fatigue, And Cortical Arousal After A Heart Attack Part 2
Oct 09, 2023
3.2. Heart Rate Variability
The stress index was higher in the HAP groups compared to the control groups. Those who did the HIIT protocol had higher Stress Index values from pre-exercise than those who did the MICT protocol, and from exercise to post-exercise, the HAP in HIIT dropped slightly, while the HAP in MICT continued to rise sharply (Table 3). In addition, there was a higher decrease in the number of RR intervals in the HIIT in both groups (HAP: 210.5 ± 112.75 ms2 vs. control: 346 ± 0.00 ms2 ) compared to the MICT groups (HAP: 120.5 ± 74.2 ms2 vs. control: 81.7 ± 0.00 ms2 ). However, no significant interaction or main effects were observed in RMSSD (Table 3).
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3.3. Central Nervous System Fatigue, Blood Pressure, and Cortical Arousal
Analyzing the fatigue of CNS in the different protocols performed, we verified that the continuous training presented greater fatigue of CNS for the HAP than in the control. However, the blood pressure difference was greater in patients with adverse cardiac events than in participants without events, and there were no differences in cortical arousal outcomes between the groups (Table 4).
4. Discussion
This research aimed to analyze the physiological parameters of thermography, HRV, blood pressure, and cortical arousal in cardiac patients who belong to CR programs of HIIT and MICT compared to healthy participants. Analyzing the fatigue perception of the different training conducted, we found that the MICT presented a higher fatigue perception for HAP than in control participants. It seems that the short rest interval allowed the HAP to have a lower fatigue perception, a fact in line with previous studies that also found higher motivation in interval training than in continuous training [40]. It is also important to note that HAP presented more than twice CNS fatigue in MICT than control participants, but HIIT had almost the same fatigue perception in HAP as control patients. We can see how MICT is more demanding for HAP, a fact that may explain the lower adherence to this training; in addition, whilst MICT is a training that is based on a traditional periodization, based on the sequencing of volume for intensity during a certain period, which can make it less challenging, HIIT is identified more with a reverse periodization, based on an opposite paradigm—first, the training intensity and then the volume [41]—and previous studies report that the level of adherence to reverse periodization was significantly greater than traditional training [42]; even so, it seems that the programs where greater adherence to CR programs is being verified are those that introduce virtual reality or video games [5]. This result is important when practitioners have to design training for HAP since HIIT shows higher physiological adaptation [43]; furthermore, MICT in this population produces lower fatigability, a fact that would improve adherence to programs based on HIIT. In addition, independent of the training (HIIT or MICT), a hypotension response was evaluated, in fact, in line with previous studies, although recent research showed higher adaptations after HIIT protocols [44,45]. The same was also verified in patients with cardiac problems [46], which coincides with the results of our study regarding the fatigability of cardiac patients in mental and physical workouts. Still, no suggestions were made on the potential value of this method for the diagnosis or prognosis of cardiac disease.
Patients with hypertension or coronary disease tend to have low values for flicker fusion frequency. However, the patients without evidence of CVD also had values of the fusion frequency, and a positive correlation between flicker fusion frequency and resting systolic blood pressure has been found previously [46]. However, the patients without evidence of CVD also had values of the fusion frequency quite comparable with those for the cardiovascular patients, except for the group with malignant hypertension, but lower than for the normal people of equal age. Many types of pathology may depress flicker fusion frequency [47–50].
In the same regard, the present study showed that HIIT and MICT programs decreased systolic blood pressure in pre- to post-exercise. Mounting evidence demonstrates that participating in physical activity CR programs has been recommended to cardiac patients as an effective non-pharmacological approach to improving blood pressure [11,15,51].
Some studies report the importance of heart rate variability in patients who have suffered heart attacks [52], as it seems that a reduced HRV is related to mortality after a heart attack; thus, HRV can be a useful tool in risk stratification post-HAP [19,53]. Our findings showed that the HIIT protocol had improved the domains of HRV, including the number of RR intervals in HAP compared to MICT. In addition, some studies exposed that, compared with MICT, HIIT has good efficacy in improving cardiovascular fitness [10,43,45,54]. Furthermore, HIIT training appears to be a useful therapeutic intervention to improve the unbalanced autonomic function of HAP, and studies observed an increase in cardiac vagal activity after aerobic exercise programs [9,12,16]. However, our study observed no significant interaction or main effects in RMSSD. Regardless, the stress index of HRV was higher in the HAP groups compared to the control groups. The HIIT protocol had higher values from pre-exercise than those who did the MICT protocol, and from exercise to post-exercise, the HAP in HIIT dropped slightly, while the HAP in MICT continued to rise sharply. High values of the stress index indicate reduced variability and high sympathetic cardiac activation. Similar exercise training programs have been provided. Some similar training programs showed different results, although some do not describe the loads applied in training [55–58]. Other authors report significant improvements in HRV using different training protocols [4,59]. Authors evaluated the cardiac autonomic response through HRV in women who performed a maximum incremental exercise; the results showed an abnormal autonomic modulation at rest, during, and after exercise [60–62], although other authors report that only two weeks of training with intensities above 75% can increase HRV [10].
Analyzing the thermography results, our study demonstrates that the body temperature difference in the chest was greater in patients with adverse cardiac events than in patients without events. In the groups of healthy participants, the temperature remained practically the same. Many authors propose diagnostic imaging as a means of detecting the risk of suffering from CVD [60,63,64]. Controlling inflammation in the carotid arteries may decrease the risk of CVD [63]. Using imaging as a diagnosis can prevent and help determine the cause of CVD [64]. Early signs of heart disease may be associated with increased or decreased peripheral blood flow. Thermography can play a key role in this diagnosis [65].
Limitations of the Study and Future Perspectives
The main limitation of the present study is the low number of participants. Due to the specificity of the disease, namely, in the recovery phases (II on an outpatient basis or in phase III after medical discharge), it is still difficult to find participants to apply high-intensity exercise stimulus; thus, we decided to carry out a case study. Another limitation was the use of indirect measures of cortical arousal; electroencephalography would more deeply explain all cortical responses in this population group. As perspectives for the future, we believe that this methodology is safe and can be beneficial in the recovery of patients who have suffered a heart attack (mainly in phase III of recovery after medical discharge), and can be a method of education or re-education toward healthier lifestyles. Therefore, we propose that this method be used in a larger sample of patients after a heart attack.
5. Conclusions
Finally, we concluded that both training protocols (HIIT and MICT) produced a similar thermographic response in both heart attack patients and control participants, showing in some body segments (such as the chest, abdomen, right and left arm) lower temperatures in the heart attack patients. Regarding the autonomic response, heart attack patients presented higher sympathetic modulation in both pieces of training, showing that HIIT had higher sympathetic modulation than MICT; however, in the post-evaluation, the HRV was equal between HIIT and MICT in heart attack patients. The MICT training produced higher subjective fatigue and a greater decrease in cortical arousal in heart attack patients than HIIT, contrary to that in control participants. No differences in systolic and diastolic blood pressure were found between HIIT and MICT training in heart attack patients; however, they presented higher systolic and lower diastolic blood pressure than control participants during both trainings.
Author Contributions: Conceptualization, C.G., J.A.P., and V.J.C.-S.; methodology, C.G.; software, V.J.C.-S.; validation, C.G., J.P. and A.R.; formal analysis, C.G., and J.A.P. and V.J.C.-S.; investigation, C.G., J.B., A.A., J.A.P., and A.R.; resources, C.G., J.A.P., A.R., J.P., and V.J.C.-S.; data curation, V.J.C.-S.; writing—original draft preparation, C.G.; writing—review and editing, C.G. and J.A.P.; visualization, C.G., J.P., A.R., and V.J.C.-S.; supervision, C.G., J.B., and A.R.; project administration, C.G., and J.A.P.; funding acquisition, C.G., and J.A.P. All authors have read and agreed to the published version of the manuscript.
Funding: This research was funded by Fundação para a Ciência e Tecnologia (Portugal), grant number SFRH/BD/138326/2018, and UÉvora—UniverCIDADE VII program. Portuguese Institute for Sport and Youth—I.P., Support for Sport Activity 2022, Sport Development Program Agreement, CP/217/DDT/2022.
Institutional Review Board Statement: Ethics approval was obtained from the University of Évora Ethics Committee (reference number: 17039).
Informed Consent Statement: All participants were informed about the experimental procedures, indicating the right to withdraw from the study at any time and providing written informed consent.
Data Availability Statement: The data that support the findings of this study are available from the corresponding author, C.G., upon reasonable request.
Acknowledgments: This work was supported by the Fundação para a Ciência e a Tecnologia (Portugal).
Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.
Abbreviations
CR Cardiac rehabilitation
CVD Cardiovascular diseases
CNS Central nervous system
CFFT Critical flicker fusion threshold
HAP Heart attack patients
HRV Heart rate variability
HR Heart rate
HIIT High-Intensity Interval Training
alpha-2 Long-term fluctuation of the detrended fluctuation analysis
ms Milliseconds
MICT Moderate-intensity Continuous Training
NYHA New York Heart Association
Peak Heart Rate
SampEn Sample entropy
alpha-1 Short-term fluctuation of the detrended fluctuation analysis
RMSSD Square root of differences between adjacent RR intervals
VSA Visual analog scale
WHO World Health Organization
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