Carolina Pieroni Andrade

Cardiovascular control in women with fibromyalgia syndrome: do causal methods provide nonredundant information compared with more traditional approaches?

The cardiovascular autonomic control and the baroreflex sensitivity (BRS) have been widely studied in fibromyalgia syndrome (FMS) patients through the computation of linear indices of spontaneous heart period (HP) and systolic arterial pressure (SAP) variabilities. However, there are many methodological difficulties regarding the quantification of BRS by the traditional indices especially in relation to the issue of causality. This difficulty has been directly tackled via a model-based approach describing the closed-loop HP-SAP interactions and the exogenous influences of respiration. Therefore, we aimed to assess whether the BRS assessed by the model-based causal closed-loop approach during supine and active standing in patients with FMS could provide complementary information to those obtained by traditional indices based on time and frequency domains. The findings of this study revealed that, at difference with the traditional methods to quantify BRS, the causality analysis applied to the HP, SAP, and respiratory series, through the model-based closed-loop approach, detected lower BRS in supine position, as well as a blunted response to the orthostatic stimulus in patients with FMS compared with healthy control subjects. Also, the strength of the causal relation from SAP to HP (i.e., along the cardiac baroreflex) increased during the active standing only in the control subjects. The model-based closed-loop approach proved to provide important complementary information about the cardiovascular autonomic control in patients with FMS.

Respiratory Sinus Arrhythmia and its Association with Pain in Women with Fibromyalgia Syndrome.

To assess the cardiac autonomic control at rest and during the deep breathing test (DBT) and its association with pain in women with fibromyalgia syndrome (FMS).

Lung Function, Respiratory Muscle Strength, and Thoracoabdominal Mobility in Women With Fibromyalgia Syndrome

BACKGROUND: Fibromyalgia syndrome (FMS) is associated with a variety of symptoms, such as fatigue and dyspnea, which may be related to changes in the respiratory system. The objective of this work was to evaluate pulmonary function, respiratory muscle strength, and thoracoabdominal mobility in women with FMS and its association with clinical manifestations. METHODS: The study included 23 women with FMS and 23 healthy women (control group). Pulmonary function, respiratory muscle strength, and thoracoabdominal mobility were assessed in all participants. Clinical manifestations such as number of active tender points, pain, fatigue, well-being, and general pressure pain threshold and pressure pain threshold in regions involved in respiratory function were also assessed. For data analysis, the Mann-Whitney test and Spearman correlation coefficient were used. RESULTS: The FMS group showed lower values of maximum voluntary ventilation (P = .030), maximal inspiratory pressure (P = .003), and cirtometry at the axillary and xiphoid levels (P < .001 and P < .001, respectively) as well as higher cirtometry at the abdominal level (P = .005) compared with the control group. However, there was no significant difference between groups for maximum expiratory pressure. In predicted percentage, maximal inspiratory pressure showed significant positive correlation with axillary cirtometry (r = 0.41, P = .049) and negative correlation with the number of active tender points (r = −0.44, P = .031) and fatigue (r = −0.41, P = .049). CONCLUSIONS: Subjects with FMS had lower respiratory muscle endurance, inspiratory muscle strength, and thoracic mobility than healthy subjects. In addition, inspiratory muscle strength was associated with the number of active tender points, fatigue, and axillary mobility.

The degree of cardiac baroreflex involvement during active standing is associated with the quality of life in fibromyalgia patients

Fibromyalgia syndrome (FMS) is a rheumatologic disorder characterized by chronic widespread pain, fatigue and other symptoms. Baroreflex dysfunction has been observed in women with FMS. However, it is unknown whether the limited involvement of the baroreflex control during an orthostatic stimulus has some impact on the quality of life of the FMS patient. Therefore, the aim of the study is evaluate the relationship between the quality of life of the FMS patient and indexes of the cardiovascular autonomic control as estimated from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP). We enrolled 35 women with FMS (age: 48.8±8.9 years; body mass index: 29.3±4.3 Kg/m2). The electrocardiogram, non-invasive finger blood pressure and respiratory activity were continuously recorded during 15 minutes at rest in supine position (REST) and in orthostatic position during active standing (STAND). Traditional cardiovascular autonomic control markers were assessed along with a Granger causality index assessing the strength of the causal relation from SAP to HP (CRSAP→HP) and measuring the degree of involvement of the cardiac baroreflex. The impact of FMS on quality of life was quantified by the fibromyalgia impact questionnaire (FIQ) and visual analog score for pain (VAS pain). No significant linear association was found between FIQ scores and the traditional cardiovascular indexes both at REST and during STAND (p>0.05). However, a negative relationship between CRSAP→HP during STAND and FIQ score was found (r = -0.56, p<0.01). Similar results were found with VAS pain. In conclusion, the lower the degree of cardiac baroreflex involvement during STAND in women with FMS, the higher the impact of FMS on the quality of life, thus suggesting that Granger causality analysis might be clinically helpful in assessing the state of the FMS patient.

A escala CR-10 de Borg é viável para quantificar a intensidade do exercício aeróbio em mulheres com síndrome fibromiálgica

Los pacientes con sindrome de fibromialgia (FMS) reportan indices mas altos de esfuerzo percibido (RPE) en comparacion con individuos sanos para la misma intensidad de ejercicio; sin embargo, a nuestro conocimiento, ningun estudio ha evaluado el RPE en el umbral ventilatorio anaerobico (VAT) para estas personas. Este estudio tuvo como objetivo evaluar el RPE utilizando la escala Borg CR-10 durante un test de ejercicio cardiopulmonar (CPET) en mujeres con FMS. Veinticuatro mujeres con FMS y veinte individuos de control sanos (HC) participaron voluntariamente en este estudio. Cerca del final de cada periodo de 1 minuto durante el CPET, se pidio a los individuos que informaran su RPE para la fatiga en los miembros inferiores (RPE-L) y disnea (RPE-D), respectivamente, segun la escala Borg CR-10. Los individuos con FMS mostraron mayores RPE-L y RPE-D comparados con los individuos HC en la rueda libre y en el primer incremento de carga. Sin embargo, no se observo diferencia significativa de potencia de salida entre los grupos. No hubo diferencias significativas entre los grupos en los RPE-L y RPE-D reportados en el VAT y en el maximo CPET. No obstante, los individuos FMS mostraron una menor potencia en comparacion con los individuos HC. Los resultados actuales mostraron que los individuos con FMS presentan RPE mas alto en comparacion con los individuos HC. De todos modos, el RPE reportado en el VAT y en el CPET maximo no fue diferente entre los grupos. Las puntuaciones de la escala Borg CR-10 obtenidas en el VAT se pueden utilizarse como un parametro adicional para prescribir la intensidad del ejercicio en protocolos de entrenamiento aerobico para mujeres con FMS.

FRI0615-HPR Blunted Cardiac Autonomic Response To The Active Standing Is Related To The Impact of fibromyalgia on Quality of Life

Background Several studies have shown that autonomic dysfunction plays an important role in the fibromyalgia syndrome (FMS).1–3 Recent studies have used the active standing test to assess the cardiovascular autonomic control responses to the orthostatic stimulus in several disorders, including FMS.4 However, there are few studies correlating symptoms and clinical factors with cardiovascular autonomic dysfunction. Objectives To assess the relationship between the impact of fibromyalgia on quality of life and cardiac autonomic control response to the active standing test. Methods Ten women (47.9±7.3 years old) with clinical diagnosis of FMS took part in the study. Diagnosis followed the criteria established by the American College of Rheumatology.5 All participants answered the fibromyalgia impact questionnaire (FIQ)6 and underwent the recording of RR intervals (RRi) using a transmitter belt. The RRi were recorded for 15 min in resting supine position and during 15 min in an orthostatic position reached by active standing. The cardiac autonomic control was assessed by indices computed via spectral analysis of RRi in low frequency (LF, 0.04–0.15 Hz) and high frequency bands (HF, 0.15–0.4 Hz). To quantify the magnitude of cardiac autonomic response to the orthostatic stimulus, the delta between values obtained in supine and standing positions was calculated for all variables. Changes induced by the orthostatic stimulus were evaluated by Wilcoxon test. Spearmans coefficient was used to assess the association between the delta of the HRV indices and the FIQ scores. α =5%. Results There were no significant differences between the supine and standing positions in any of the spectral indices. Positive correlation was found between FIQ scores and HF (n.u.) (r =0.67; p=0.03). Negative correlations were observed between the FIQ scores and LF (n.u.) index (r = -0.67; p=0.03, Figure 1B) and LF/HF ratio (r = -0.73; p=0.016, Figure 1C). Conclusions The results showed that the larger the magnitude of the cardiac autonomic adjustments to the gravitational stimulus, the smaller the impact of FMS on quality of life. References Martinez-Lavin M, Hermosillo AG. Autonomic nervous system dysfunction may explain the multisystem features of fibromyalgia. Semin Arthritis Rheum. 2000;29:197–199. Furlan R, Colombo S, Perego F, et al. Abnormalities of cardiovascular neural control and reduced orthostatic tolerance in patients with primary fibromyalgia. J Rheumatol. 2005;32:1787–1793. Zamuner AR, Forti M, Andrade CP, Avila MA, Silva E. Respiratory sinus arrhythmia and its association with pain in women with fibromyalgia syndrome. 2015. doi: 10.1111/papr.12321 Zamunér AR, Porta A, Andrade CP, Marchi A, Forti M, Furlan R, Barbic F, Catai AM, Silva E. Cardiovascular control in women with fibromyalgia syndrome: do causal methods provide nonredundant information compared with more traditional approaches? Am J Physiol Regul Integr Comp Physiol. 2015;309:R79–R84. doi:10.1152/ajpregu.00012.2015 Wolfe F, Smythe HA, Yunus MB, et al. Fibromyalgia. Rheum Dis Clin North Am. 1990;16:681–698. Marques AP, Santos AMB, Assumpção A, Matsutani LA, Lage LV, Pereira CAB. Validation of the Brazilian version of the Fibromyalgia Impact Questionnaire (FIQ). Braz J Rheumatol. 2006;46:24–31. Acknowledgement This study was supported São Paulo Research Foundation (FAPESP), grants #2011/22122–5 and #2015/08445–7. Disclosure of Interest None declared

FRI0616-HPR Cardiac Autonomic Response To Osthostatic Changes in fibromyalgia Sindrome: Table 1.

Background Patients with fibromyalgia syndrome (FMS) have autonomic nervous system (ANS) related disorder1. The orthostatic stimulus is an important method for the assessment of neurocardiac integrity2. However, little is known about the cardiac autonomic response to the active standing test in women with FMS. Objectives To evaluate the cardiac autonomic control response to the active standing test in women with FMS. Methods Ten women with FMS (FMSG n=10) and ten healthy women (HG n=10) took part in the study. The volunteers were submitted to the recording of RR intervals (RRi) during 15 min in supine and 15 min in orthostatic (active standing) positions. RRi were recorded by a heart rate monitor. The parameters of the frequency domain were determined by the heart rate variability (HRV) spectral analysis, obtained in low frequency (LF, 0.04–0.15 Hz) and high frequency bands (HF, 0.15–0.4 Hz) in normalized units (n.u.) and LF/HF ratio3. Results The results are shown in table 1. There were significant group x posture interaction for LF (n.u.) and HF (n.u.). Post hoc analysis revealed that the HG increased LF (n.u.) and decreased the HF (n.u.) during active standing, compared to the supine position. On the other hand, the FMSG presented no significant differences between supine and orthostatic position. Regarding between group comparisons, FMSG presented higher LF (n.u.) and lower HF (n.u.) at supine position.Table 1. Power Spectral Analysis in the HRV of FMSG and HG from supine position to orthostatic (active standing) HG (n=10) FMSG (n=10) P-value Supine Orthostatic Supine Orthostatic Posture Groups Interaction LF (n.u.) 50.11±10.28*† 71.03±8.54 72.13±11.00 71.62±14.58 0.006 0.009 0.004 HF (n.u.) 49.89±10.28*† 28.97±8.54 27.87±11.00 28.37±14.58 0.006 0.009 0.004 LF/HF 1.09±0.46*† 2.82±1.45 3.26±2.13 4.82±2.20 0.03 0.04 0.08 Data are expressed as mean± SD. LF = low frequency component of RR intervals; HF = high frequency component of RR intervals; n.u. = normalized units. Two-way mixed ANOVA with Bonferronis post hoc test. *p<0,05 GS supine posture vs FMSG supine posture. †p<0,05 GS supine posture vs GS orthostatic posture. Conclusions FMSG showed cardiac autonomic dysfunction at supine position, characterized by higher sympathetic and lower parasympathetic cardiac autonomic modulation. In addition, FMSG present a blunted cardiac autonomic control response to the active standing, characterized by a lack of cardiac sympathetic modulation increase and parasympathetic decrease. Therefore, the neurocardiac integrity seems to be compromised in the FMSG. References Zamunér AR, Forti M, Andrade CP, Avila MA, Silva E. Respiratory Sinus Arrhythmia and its Association with Pain in Women with Fibromyalgia Syndrome. 2015 a.[Epub ahead of print]. Furlan R, Colombo S, Perego F, Atzeni F, Diana A, Barbic F, et al. Abnormalities of cardiovascular neural control and reduced orthostatic tolerance in patients with primary fibromyalgia. J Rheumatol. 2005;32:1787–1793. Task Force. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task force of the European society of cardiology and the North American Society of pacing and electrophysiology. Circulation. 1996;93:1043–1065. Acknowledgement This study was supported São Paulo Research Foundation (FAPESP), grants #2011/22122–5, #2013/17504–1 and 2015/23449–9 and by the National Council for Scientific and Technological Development (CNPq), grants no. 483032/2012–3 and 307187/2013–6. Disclosure of Interest None declared

Relationship between heart rate variability and VO 2peak in active women

OBJETIVO: Ava+liar a associacao entre os indices da variabilidade da frequencia cardiaca (VFC) e a aptidao cardiorrespiratoria.METODOS: Sessenta e duas mulheres (idade 22,1 ± 3,3 anos) foram divididas em quatro grupos: treinamento aerobio (AER, n = 15), treinamento de forca (FOR, n = 13), treinamento combinado (aerobio e forca) (AER+FOR, n = 15) e controle (C, n = 19). O teste cardiopulmonar foi realizado para avaliar a aptidao cardiorrespiratoria a partir do consumo de oxigenio pico (VO2pico). A FC foi coletada em repouso na postura supina. A VFC foi analisada a partir de metodos lineares e nao lineares.RESULTADOS: Os grupos AER e AER+FOR apresentaram maiores indices da VFC (lineares e nao lineares) indicadores da modulacao vagal e menores indices da VFC indicadores da modulacao simpatica, em relacao ao grupo C. Os grupos AER e AER+FOR apresentaram maior complexidade e menor regularidade dos intervalos RR e maior VO2pico em relacao aos grupos FOR e C. O VO2picoapresentou correlacao com os indices da VFC.CONCLUSAO: Este estudo mostrou que o treinamento fisico aerobio e combinado contribuiram significativamente para maior modulacao autonoma da FC e aptidao cardiorrespiratoria. A modulacao autonoma da FC, avaliada a partir de metodos lineares e nao lineares, esta associada ao maior consumo de oxigenio.OBJECTIVE: To evaluate the associations between heart rate variability (HRV) with cardiorespiratory fitness.METHODS: Sixty-two women (aged 22.1 ± 3.3) were divided into four groups: aerobic training (AER, n = 15), strength training (STR, n = 13), combined aerobic and strength training (AER+STR, n = 15) and controls (C, n = 19). Cardiopulmonary exercise testing was performed to measure cardiorespiratory fitness by assessing peak oxygen consumption (VO2peak). The HR was recorded at rest in the supine position. The HRV was analyzed by linear and nonlinear methods.RESULTS: The AER and AER+STR groups had higher vagal HRV (linear and nonlinear) indicators of vagal modulation and lower indices of HRV indicators of sympathetic modulation, compared to group C. The AER and AER+STR groups showed greater complexity and lower regularity of R-R intervals and higher peak compared to STR and C groups. The VO2peak was correlated with HRV indices.CONCLUSION: This study showed that aerobic and combined exercise significantly contributed to greater autonomic modulation of HR and cardiorespiratory fitness. The autonomic HR modulation, assessed by linear and nonlinear methods, was associated with a greater oxygen consumption.

Relación entre la variabilidad de la frecuencia cardíaca y VO 2pico en mujeres activas

OBJETIVO: Ava+liar a associacao entre os indices da variabilidade da frequencia cardiaca (VFC) e a aptidao cardiorrespiratoria.METODOS: Sessenta e duas mulheres (idade 22,1 ± 3,3 anos) foram divididas em quatro grupos: treinamento aerobio (AER, n = 15), treinamento de forca (FOR, n = 13), treinamento combinado (aerobio e forca) (AER+FOR, n = 15) e controle (C, n = 19). O teste cardiopulmonar foi realizado para avaliar a aptidao cardiorrespiratoria a partir do consumo de oxigenio pico (VO2pico). A FC foi coletada em repouso na postura supina. A VFC foi analisada a partir de metodos lineares e nao lineares.RESULTADOS: Os grupos AER e AER+FOR apresentaram maiores indices da VFC (lineares e nao lineares) indicadores da modulacao vagal e menores indices da VFC indicadores da modulacao simpatica, em relacao ao grupo C. Os grupos AER e AER+FOR apresentaram maior complexidade e menor regularidade dos intervalos RR e maior VO2pico em relacao aos grupos FOR e C. O VO2picoapresentou correlacao com os indices da VFC.CONCLUSAO: Este estudo mostrou que o treinamento fisico aerobio e combinado contribuiram significativamente para maior modulacao autonoma da FC e aptidao cardiorrespiratoria. A modulacao autonoma da FC, avaliada a partir de metodos lineares e nao lineares, esta associada ao maior consumo de oxigenio.OBJECTIVE: To evaluate the associations between heart rate variability (HRV) with cardiorespiratory fitness.METHODS: Sixty-two women (aged 22.1 ± 3.3) were divided into four groups: aerobic training (AER, n = 15), strength training (STR, n = 13), combined aerobic and strength training (AER+STR, n = 15) and controls (C, n = 19). Cardiopulmonary exercise testing was performed to measure cardiorespiratory fitness by assessing peak oxygen consumption (VO2peak). The HR was recorded at rest in the supine position. The HRV was analyzed by linear and nonlinear methods.RESULTS: The AER and AER+STR groups had higher vagal HRV (linear and nonlinear) indicators of vagal modulation and lower indices of HRV indicators of sympathetic modulation, compared to group C. The AER and AER+STR groups showed greater complexity and lower regularity of R-R intervals and higher peak compared to STR and C groups. The VO2peak was correlated with HRV indices.CONCLUSION: This study showed that aerobic and combined exercise significantly contributed to greater autonomic modulation of HR and cardiorespiratory fitness. The autonomic HR modulation, assessed by linear and nonlinear methods, was associated with a greater oxygen consumption.

Relação entre a variabilidade da frequência cardíaca e VO 2pico em mulheres ativas

OBJETIVO: Ava+liar a associacao entre os indices da variabilidade da frequencia cardiaca (VFC) e a aptidao cardiorrespiratoria.METODOS: Sessenta e duas mulheres (idade 22,1 ± 3,3 anos) foram divididas em quatro grupos: treinamento aerobio (AER, n = 15), treinamento de forca (FOR, n = 13), treinamento combinado (aerobio e forca) (AER+FOR, n = 15) e controle (C, n = 19). O teste cardiopulmonar foi realizado para avaliar a aptidao cardiorrespiratoria a partir do consumo de oxigenio pico (VO2pico). A FC foi coletada em repouso na postura supina. A VFC foi analisada a partir de metodos lineares e nao lineares.RESULTADOS: Os grupos AER e AER+FOR apresentaram maiores indices da VFC (lineares e nao lineares) indicadores da modulacao vagal e menores indices da VFC indicadores da modulacao simpatica, em relacao ao grupo C. Os grupos AER e AER+FOR apresentaram maior complexidade e menor regularidade dos intervalos RR e maior VO2pico em relacao aos grupos FOR e C. O VO2picoapresentou correlacao com os indices da VFC.CONCLUSAO: Este estudo mostrou que o treinamento fisico aerobio e combinado contribuiram significativamente para maior modulacao autonoma da FC e aptidao cardiorrespiratoria. A modulacao autonoma da FC, avaliada a partir de metodos lineares e nao lineares, esta associada ao maior consumo de oxigenio.OBJECTIVE: To evaluate the associations between heart rate variability (HRV) with cardiorespiratory fitness.METHODS: Sixty-two women (aged 22.1 ± 3.3) were divided into four groups: aerobic training (AER, n = 15), strength training (STR, n = 13), combined aerobic and strength training (AER+STR, n = 15) and controls (C, n = 19). Cardiopulmonary exercise testing was performed to measure cardiorespiratory fitness by assessing peak oxygen consumption (VO2peak). The HR was recorded at rest in the supine position. The HRV was analyzed by linear and nonlinear methods.RESULTS: The AER and AER+STR groups had higher vagal HRV (linear and nonlinear) indicators of vagal modulation and lower indices of HRV indicators of sympathetic modulation, compared to group C. The AER and AER+STR groups showed greater complexity and lower regularity of R-R intervals and higher peak compared to STR and C groups. The VO2peak was correlated with HRV indices.CONCLUSION: This study showed that aerobic and combined exercise significantly contributed to greater autonomic modulation of HR and cardiorespiratory fitness. The autonomic HR modulation, assessed by linear and nonlinear methods, was associated with a greater oxygen consumption.