Is cardiac autonomic modulation during upper limb isometric contraction and Valsalva maneuver impaired in COPD patients?
Received 16 December 2016
Accepted for publication 7 February 2017
Published 13 March 2017 Volume 2017:12 Pages 849—857
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Richard Russell
Cássia da Luz Goulart,1 Ramona Cabiddu,2 Paloma de Borba Schneiders,1 Elisabete Antunes San Martin,1 Renata Trimer,3 Audrey Borghi-Silva,2 Andréa Lúcia Gonçalves da Silva4,5
1Course of Physiotherapy, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil; 2Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos, São Carlos, Brazil; 3Department of Physiotherapy, Federal University of Amazonas, Manaus, AM, Brazil; 4Course of Physiotherapy, Department of Health and Physical Education, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil; 5Pulmonary Rehabilitation Program, Santa Cruz Hospital, Santa Cruz do Sul, Rio Grande do Sul, Brazil
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 (FEV1) vs RMSSD (P=0.04; r=–0.55), FEV1 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). FEV1 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.
Keywords: heart rate, autonomic nervous system, COPD, isometric contraction, Valsalva maneuver
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