Jacques Regnard

Decrease in heart rate variability with overtraining: assessment by the Poincaré plot analysis

Numerous symptoms have been associated with the overtraining syndrome (OT), including changes in autonomic function. Heart rate variability (HRV) provides non‐invasive data about the autonomic regulation of heart rate in real‐life conditions. The aims of the study were to: (i) characterize the HRV profile of seven athletes (OA) diagnosed as suffering of OT, compared with eight healthy sedentary (C) and eight trained (T) subjects during supine rest and 60° upright, and (ii) compare the traditional time‐ and frequency‐domain analysis assessment of HRV with the non‐linear Poincaré plot analysis. In the latter each R‐R interval is plotted as a function of the previous one, and the standard deviations of the instantaneous (SD1) and long‐term R‐R interval variability are calculated. Total power was higher in T than in C and OA both in supine (1158 ± 1137, 6092 ± 3554 and 2970 ± 2947 ms2 for C, T and OA, respectively) and in upright (640 ± 499, 1814 ± 806 and 1092 ± 712 ms2 for C, T and OA, respectively; P<0·05) positions. In supine position, indicators of parasympathetic activity to the sinus node were higher in T compared with C and OA (high‐frequency power: 419·1 ± 381·2, 1105·3 ± 781·4 and 463·7 ± 715·8 ms2 for C, T and OA, respectively; P<0·05; SD1: 29·5 ± 18·5, 75·2 ± 17·2 and 37·6 ± 27·5 for C, T and OA, respectively; P<0·05). OA had a marked predominance of sympathetic activity regardless of the position (LF/HF were 0·47 ± 0·35, 0·47 ± 0·50 and 3·96 ± 5·71 in supine position for C, T and OA, respectively, and 2·09 ± 2·17, 7·22 ± 6·82 and 12·04 ± 10·36 in upright position for C, T and OA, respectively). The changes in HRV indexes induced by the upright posture were greater in T than in OA. The shape of the Poincaré plots allowed the distinction between the three groups, with wide and narrow shapes in T and OA, respectively, compared with C. As Poincaré plot parameters are easy to compute and associated with the ‘width’ of the scatter gram, they corroborate the traditional time‐ and frequency‐domain analysis. We suggest that they could be used to indicate fatigue and/or prevent OT.

No trend toward a spontaneous improvement of hyperparathyroidism and high bone turnover in normocalcemic long-term renal transplant recipients

Although hyperparathyroidism is a common feature in renal transplant recipients, the long-term course of parathyroid hormone (PTH) secretion in these patients is not well established, and the actual contribution of PTH to posttransplant bone disease remains incompletely understood. Therefore, we studied calcium-regulating hormones and serum osteocalcin, as a marker of bone remodeling, in 82 normocalcemic renal transplant recipients with good renal function who had received a graft 6 to 73 months previously and in 82 healthy subjects matched for age and sex. In all subjects, fasting serum and 24-hour urinary samples were collected. The transplant recipients had excessive PTH secretion (serum PTH, 6.9 +/- 0.5 pmol/L in recipients v 3.0 +/- 0.1 pmol/L in healthy subjects; P < 0.001) and high bone turnover (osteocalcin, 16.6 +/- 0.8 microg/L v 8.0 +/- 0.3 microg/L; P < 0.001). (Values are mean +/- SEM.) In addition, transplant recipients had a slightly higher ionized calcium than the healthy subjects, providing definite evidence of an inappropriate PTH secretion in renal transplant recipients. Furthermore, in subgroups of 25 recipients and 25 healthy controls matched for creatinine clearance, the results superimposed those obtained in the whole groups, suggesting that excessive PTH secretion and high bone turnover in renal transplant recipients did not merely reflect the moderately reduced renal function of some recipients. In the whole group of transplant recipients, PTH correlated positively with osteocalcin (r = 0.40; P < 0.001), suggesting that PTH contributes at least partly to posttransplant bone disease. Conversely, there was no correlation between serum PTH or osteocalcin and the delay from grafting. Therefore, our results provide no evidence for a spontaneous improvement of either persistent hyperparathyroidism or high bone turnover in normocalcemic long-term renal transplant recipients.

Impaired cardiovascular autonomic control in newly and long-term-treated patients with Parkinson's disease: involvement of l-dopa therapy

In idiopathic Parkinsons disease (PD), autonomic dysfunction is frequent, causing orthostatic hypotension. The respective roles of disease progression and dopaminergic treatment remain unclear. In this study, we investigated the autonomic control of cardiovascular functions and its relation to L-dopa therapy in both newly diagnosed (ND) and long-term-treated (LT) patients. Study subjects were: (1) nine ND patients never having undergone treatment with L-dopa; (2) 18 LT patients who had been receiving L-dopa treatment for a long period. ND patients were investigated before L-dopa treatment and after stabilization of their L-dopa dosage. LT patients were investigated once with their regular treatment and once after a 12-h interruption of L-dopa treatment; (3) nine healthy subjects served as controls. At each test session, blood pressure (BP), heart rate (HR), plasma catecholamines, heart rate variability (HRV), and spontaneous baroreflex sensitivity were assessed in the supine and upright positions. Before receiving L-dopa medication, ND patients had reduced E/I ratios (HR response/deep breathing) and lowered HRV when compared to controls; this was evidence of early effects of the disease on autonomic HR control. Introduction of L-dopa treatment reduced BP, HR, and plasma levels of adrenaline and noradrenaline. Similar changes were found in LT patients when contrasting the short-term treatment interruption and the usual L-dopa dosage. The treatment-linked increase in plasma dopamine also correlated with the decrease in noradrenaline. These results showed that mild impairment of autonomic cardiovascular control occurred early in the course of PD. They also provided evidence that the side effects of L-dopa aggravated the impairment of the autonomic control of BP and HR.

Influence of exercise duration on serum insulin-like growth factor and its binding proteins in athletes

Abstract The changes in circulating concentrations of insulin-like growth factors during exercise have to date remained incomplete in their documentation. Therefore, we examined in 25 healthy athletes the effects of three different durations of three types of exercise – incremental ergometer cycling exercise (ICE), long-distance Nordic ski race (NSR) and a treadmill-simulated soccer game (TSG) lasting 20 min, 3 h, and 2 × 45 min separated by a 15-min half-time rest respectively, on plasma concentrations of growth hormone ([GH]), insulin-like growth factor-1 ([IGF-I]) and its binding proteins 1 and 3 ([IGFBP-1], [IGFBP-3]). Compared to baseline, serum [GH] increased by 15.2-fold after ICE (P < 0.001), 2.9-fold after NSR (P < 0.01) and 4.6-fold after TSG. Serum [IGF-I] rose by 11.9% after ICE (P < 0.001), while it decreased by −14.6% after NSR (P < 0.001) and was unchanged after TSG. Serum [IGFBP-1] was slightly increased (1.7-fold) after ICE (P < 0.01), but increased markedly (11.8-fold) after NSR (P < 0.001) and by 6.3-fold after the second session of TSG (P < 0.01) (it remained unchanged at the end of the first period of TSG, i.e. after 45-min exercise). The [IGFBP-3] increased by 14.7% after ICE (P < 0.001) and by 6% after TSG (P < 0.05) while it did not change after NSR. From our results it would appear that [IGFBP-1] increase to bind free IGF and hinder their insulin-like action during long-term exercise (lasting beyond 45 min). It is suggested that IGFBP-1 might thus contribute both to preventing hypoglycaemic action of IGF and to facilitating glucose uptake by muscle cells when muscle glycogen stores become deplete.

Abnormal autonomic cardiovascular control in ankylosing spondylitis

OBJECTIVE This study was aimed at assessing the contribution of the autonomic nervous system to adjustments of cardiovascular function in patients with ankylosing spondylitis (AS). METHODS In 18 AS patients (mean age: 34.9; mean disease duration: 6.4 years) and 13 healthy controls (mean age: 31.7) the changes of heart rate (HR) with deep breathing (E/I ratio) and standing up (30/15 ratio) were recorded. The slope of cardiac baroreflex, the times series of blood pressure and HR values upon lying and standing, and venous plasma concentrations of catecholamines were also analysed. Erythrocyte sedimentation rate (ESR), plasma C reactive protein (CRP) concentration and a clinical index (BASDAI score) were used to assess the degree of disease activity in patients. RESULTS In the standing patients, blood pressure was found to decrease progressively (p< 0.001). Furthermore, the patients with a BASDAI score > 5 had a higher heart rate than patients with a BASDAI score < 5 (p<0.02), and there was a trend for a similar difference when patients were classified according to their ESR and CRP. Plasma catecholamine concentrations and the E/I ratio were not different in patients from controls. The 30/15 ratio and the slope of the spontaneous baroreflex during standing were both lower in AS patients than controls (p< 0.01). CONCLUSIONS This study demonstrated a change in autonomic nervous system function of AS patients, with a decreased parasympathetic activity, as evidenced by higher HR and lower baroreflex slope. As these significant deviances were mainly observed in patients with more active (or more inflammatory) disease, the autonomic nervous system involvement could be related to the inflammatory process. This autonomic strain may be related to the cardiac involvement in AS patients.

Cardiovascular autonomic control during short-term thermoneutral and cool head-out immersion.

BACKGROUND Moderately cold head-out water immersion stimulates both baro- and cold-receptors, and triggers complex and contradictory effects on the cardiovascular system and its autonomic nervous control. OBJECTIVES To assess the effects of water immersion and cold on cardiovascular status and related autonomic nervous activity. METHODS Hemodynamic variables and indexes of autonomic nervous activity (analysis of heart rate and blood pressure variability) were evaluated in 12 healthy subjects during 3 exposures of 20 min each in the upright position, i.e., in air (AIR, 24-25 degrees C), and during head-out water immersion at 35-36 degrees C (WIn) and 26-27 degrees C (WIc). RESULTS Plasma noradrenaline, systolic and diastolic blood pressure, and total peripheral resistances were reduced during WIn compared to AIR (263.9 +/- 39.4 vs. 492.5 +/- 35.7 pg x ml(-1), 116.5 +/- 3.7 and 65.4 +/- 1.7 mmHg vs. 140.8 +/- 4.7 and 89.8 +/- 2.8 mmHg, 14.1 +/- 1.0 vs. 16.3 +/- 0.9 mmHg x L(-1) x min, respectively) while they were increased during WIc (530.8 +/- 84.7 pg ml(-1), 148.0 +/- 7.0 mmHg, 80.8 +/- 3.0 mmHg, and 25.8 +/- 1.9 mmHg x L(-1) x min, respectively). The blood pressure variability was reduced to the same extent during WIc and Win compared to AIR. Heart rate decreased during WIn (67.8 +/- 2.7 vs. 81.2 +/- 2.7 bpm during AIR), in parallel with an increased cardiac parasympathetic activity. This pattern was strengthened during WIc (55.3 +/- 2.2 bpm). CONCLUSIONS Thermoneutral WI lowered sympathetic activity and arterial tone, while moderate whole-body skin cooling triggered vascular sympathetic activation. Conversely, both WI and cold triggered cardiac parasympathetic activation, highlighting a complex autonomic control of the cardiovascular system.

Pulmonary oedema in healthy SCUBA divers: new physiopathological pathways.

Introduction:  The mechanism of immersion pulmonary oedema occurring in healthy divers is a matter of debate. Among consecutive injured divers admitted to our hyperbaric centre, we analysed prospective data about pulmonary oedema.

Lack of evidence that cyclosporine treatment impairs calcium-phosphorus homeostasis and bone remodeling in normocalcemic long-term renal transplant recipients.

Since the effects of cyclosporine on mineral and bone metabolism are controversial, we studied calcium regulating hormones, calcium-phosphorus (Ca-P) metabolism, and bone remodeling, assessed by serum osteocalcin, in long-term renal transplant recipients (RT). Forty-seven normocalcemic patients with good renal function receiving cyclosporine (CT, n = 27) or not (NC, n = 20) were studied at baseline and after an oral Ca load. CT and NC had similar age, daily dose of steroids, GFR level, and duration of transplantation. Baseline evaluation included 24-hr urinary Ca, P, TRP, TmP/GFR, fasting serum intact PTH, 1,25-(OH)2D, 25OHD, osteocalcin, Ca, and P. Subjects of the two groups had excessive secretion of PTH, tubular P wasting, and high serum osteocalcin level, as is usual in RT. However, there was no difference between CT and NC regarding any baseline variable. Ten CT and ten NC, matched for duration of transplantation and serum PTH level, ingested 1g Ca to achieve an acute dynamic study of PTH secretion and Ca-P metabolism. In both CT and NC, this Ca load caused the same decreases in serum PTH (P < 0.001), NcAMP (P < 0.05), and urinary P (P < 0.001) and the same increases in serum and urinary Ca (P < 0.001), and in both TmP/GFR and TRP (P < 0.001). These results strongly suggest that cyclosporine treatment had no significant effect on calcium-regulating hormone secretion, P-Ca metabolism, and bone remodeling level. We therefore consider that cyclosporine is unlikely to have any prominent role in the abnormalities of bone endocrine and mineral metabolism that are common in long-term kidney recipients.

Training-induced increase in nitric oxide metabolites in chronic heart failure and coronary artery disease: an extra benefit of water-based exercises?

Background Rehabilitation programs involving immersed exercises are more and more frequently used, with severe cardiac patients as well. Design This study investigated whether a rehabilitation program including water-based exercises has additional effects on the cardiovascular system compared with a traditional land-based training in heart disease patients. Methods Twenty-four male stable chronic heart failure patients and 24 male coronary artery disease patients with preserved left ventricular function participated in the study. Patients took part in the rehabilitation program performing cycle endurance exercises on land. They also performed gymnastic exercises either on land (first half of the participants) or in water (second half). Resting plasma concentration of nitric oxide metabolites (nitrate and nitrite) and catecholamine were evaluated, and a symptom-limited exercise test on a cycle ergometer was performed before and after the rehabilitation program. Results In the groups performing water-based exercises, the plasma concentration of nitrates was significantly increased (P = 0.035 for chronic heart failure and P = 0.042 for coronary artery disease), whereas it did not significantly change in the groups performing gymnastic exercise on land. No changes in plasma catecholamine concentration occurred. Conclusion In every group, the cardiorespiratory capacity of patients was significantly increased after rehabilitation. The water-based exercises seemed to effectively increase the basal level of plasma nitrates. Such changes may be related to an enhancement of endothelial function and may be of importance for the health of the patients. Eur J Cardiovasc Prev Rehabil 16:215-221

Compression sleeves increase tissue oxygen saturation but not running performance.

The purpose of this study was to determine the effects of calf compression sleeves on running performance and on calf tissue oxygen saturation (StO2) at rest before exercise and during recovery period. 14 moderately trained athletes completed 2 identical sessions of treadmill running with and without calf compression sleeves in randomized order. Each session comprised: 15 min at rest, 30 min at 60% maximal aerobic velocity determined beforehand, 15 min of passive recovery, a running time to exhaustion at 100% maximal aerobic velocity, and 30 min of passive recovery. Calf StO2 was determined by near infra-red spectroscopy and running performance by the time to exhaustion. Compression sleeves increased significantly StO2 at rest before exercise (+ 6.4±1.9%) and during recovery from exercise (+ 7.4±1.7% and + 10.7±1.8% at 20th and 30th min of the last recovery period, respectively). No difference was observed between the times to exhaustion performed with and without compression sleeves (269.4±18.4 s and 263.3±19.8 s, respectively). Within the framework of this study, the compression sleeves do not improve running performance in tlim. However the StO2 results argue for further interest of this garment during effort recovery.