EXERCISE AND AUTONOMIC FUNCTION IN HEALTH AND CARDIOVASCULAR DISEASE
Section snippets
Parasympathetic Nervous System
Efferent vagal outflow to the heart cannot be measured directly in conscious humans or laboratory animals. However, parasympathetic nerve activity can be inferred from the rise in heart rate observed after the administration of atropine, which inhibits the vagally mediated slowing of heart rate by competing with acetylcholine for available muscarinic receptors. Recently, various techniques have been developed to evaluate parasympathetic activity by quantifying beat-to-beat variations in R-R
AUTONOMIC FUNCTION IN CARDIOVASCULAR DISEASE
Three decades ago, dysfunction of the autonomic nervous system was reported in a number of cardiovascular diseases.36 Since then, a variety of measurements of autonomic function have demonstrated that patients after myocardial infarction (MI)12, 41, 70, 71 and patients with chronic heart failure26, 92, 93, 114 exhibit attenuated parasympathetic and increased sympathetic activity. In addition, the pattern of heart rate recovery after exercise is a new marker of autonomic dysfunction that has
AUTONOMIC FUNCTION DURING EXERCISE AND RECOVERY IN HEALTHY INDIVIDUALS
In order to understand how autonomic function is affected by exercise, it is necessary to distinguish the acute and chronic effects of exercise on autonomic function. In this section, we describe how autonomic function changes during an acute episode of exercise and during immediate recovery from exercise. Following this discussion, we examine how autonomic function changes in response to long-term exercise training.
EFFECT OF ENDURANCE TRAINING ON AUTONOMIC FUNCTION IN HEALTHY INDIVIDUALS
Long-term, or chronic, endurance training has a number of important effects on autonomic function. These effects can be understood by examining changes in the resting heart rate, changes in the heart rate response to exercise, and changes in the pattern of heart rate recovery immediately following exercise.
EXERCISE TRAINING, AUTONOMIC FUNCTION, AND CARDIOVASCULAR DISEASE
Two lines of inquiry led to the hypothesis that exercise training could be used therapeutically to restore autonomic nervous system function toward normal and thus contribute to an improvement in outcome. First, we have already reviewed the data demonstrating that cardiovascular disease is associated with autonomic dysfunction and that more severe autonomic dysfunction is associated with a poor outcome. Second, a number of investigators have shown that endurance training has the potential to
CARDIOPROTECTIVE EFFECTS OF EXERCISE: ACUTE RISKS OF EXERCISE VERSUS CHRONIC BENEFITS OF EXERCISE TRAINING
Sudden death during exercise occurs infrequently and has been associated with some of the sequelae of an acute bout of exercise: myocardial ischemia, hypokalemia, lactic acidosis, increased sympathetic tone, and decreased vagal tone.126 This is consistent with the observation that sudden cardiac death (SCD) often follows periods of increased sympathetic activation and high heart rates. While exercise training has well-known effects on resting autonomic tone, its most important benefit may be
SUMMARY
Autonomic nervous system activity contributes to the regulation of cardiac output during rest, exercise, and cardiovascular disease. Measurement of HRV has been particularly useful in assessing parasympathetic activity, while its utility for assessing sympathetic function and overall sympathovagal balance remains controversial. Studies have revealed that parasympathetic tone dominates the resting state, while exercise is associated with prompt withdrawal of vagal tone and subsequent sympathetic
ACKNOWLEDGMENT
The authors would like to acknowledge the thoughtful comments of Ary Goldberger, MD.
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Address reprint requests to Rochelle L. Goldsmith, EdD, Division of Circulatory Physiology, Columbia University College of Physicians and Surgeons, 630 W 168th Street, New York, NY 10032, e-mail: [email protected]