Kenneth S. Graham

Cardiac Autonomic Responses during Exercise and Post-exercise Recovery Using Heart Rate Variability and Systolic Time Intervals—A Review

Cardiac parasympathetic activity may be non-invasively investigated using heart rate variability (HRV), although HRV is not widely accepted to reflect sympathetic activity. Instead, cardiac sympathetic activity may be investigated using systolic time intervals (STI), such as the pre-ejection period. Although these autonomic indices are typically measured during rest, the “reactivity hypothesis” suggests that investigating responses to a stressor (e.g., exercise) may be a valuable monitoring approach in clinical and high-performance settings. However, when interpreting these indices it is important to consider how the exercise dose itself (i.e., intensity, duration, and modality) may influence the response. Therefore, the purpose of this investigation was to review the literature regarding how the exercise dosage influences these autonomic indices during exercise and acute post-exercise recovery. There are substantial methodological variations throughout the literature regarding HRV responses to exercise, in terms of exercise protocols and HRV analysis techniques. Exercise intensity is the primary factor influencing HRV, with a greater intensity eliciting a lower HRV during exercise up to moderate-high intensity, with minimal change observed as intensity is increased further. Post-exercise, a greater preceding intensity is associated with a slower HRV recovery, although the dose-response remains unclear. A longer exercise duration has been reported to elicit a lower HRV only during low-moderate intensity and when accompanied by cardiovascular drift, while a small number of studies have reported conflicting results regarding whether a longer duration delays HRV recovery. “Modality” has been defined multiple ways, with limited evidence suggesting exercise of a greater muscle mass and/or energy expenditure may delay HRV recovery. STI responses during exercise and recovery have seldom been reported, although limited data suggests that intensity is a key determining factor. Concurrent monitoring of HRV and STI may be a valuable non-invasive approach to investigate autonomic stress reactivity; however, this integrative approach has not yet been applied with regards to exercise stressors.

Differential effect of metabolic alkalosis and hypoxia on high-intensity cycling performance.

Abstract Flinn, S, Herbert, K, Graham, K, and Siegler, JC. Differential effect of metabolic alkalosis and hypoxia on high-intensity cycling performance. J Strength Cond Res 28(10): 2852–2858, 2014—The purpose of this study was to investigate the effects of sodium bicarbonate (NaHCO3) ingestion and acute hypoxic exposure on repeated bouts of high-intensity cycling to task failure. Twelve subjects completed 4 separate intermittent cycling bouts cycling bouts to task failure (120% peak power output for 30-second interspersed with 30-second active recovery) under the following conditions: normoxia (FIO2% at 20.93%) alkalosis (NA), normoxia placebo (NP), hypoxia (FIO2% at 14.7%) alkalosis (HA), and hypoxia placebo (HP). For the NA and HA trials, the buffer solution (0.3 g·kg−1 of NaHCO3) was dispensed into gelatin capsules and consumed over 90 minutes with 1 L of water. Whole-blood acid-base findings demonstrated metabolic alkalosis in both NA and HA before exercise (HCO3−: 32.8 ± 1.8 mmol·L−1). Time to task failure was significantly impaired in the hypoxic conditions (NA: 199.1 ± 62.3 seconds, NP: 183.8 ± 45.0 seconds, HA: 127.8 ± 27.9 seconds, HP: 133.3 ± 28.7 seconds; p < 0.001; &eegr;2 = 0.7). There was no difference between the HA and HP conditions (p = 0.41); however the 2 normoxic conditions approached significance with the NA condition on average resulting in approximately 15-second improvement in time to task failure (p = 0.09). These findings suggest that an acute decline in FIO2% consistent with hypoxic exposure is more inhibiting than metabolic acidosis during intermittent high-intensity cycling to task failure. In application, the use of hypoxia and NaHCO3 concurrently to improve performance under these conditions does not seem warranted.

Low-intensity pulsed ultrasound in lower limb bone stress injuries: a randomized controlled trial.

Objective:To evaluate the effectiveness of low-intensity pulsed ultrasound (LIPUS) for the improvement of lower limb bone stress injuries in a civilian population. Design:A prospective, randomized, double-blinded, placebo-controlled trial to compare LIPUS with placebo. Setting:Civilian private practice population in Sydney, Australia. Participants:Subjects were recruited if a grade II-IV bone stress injury was diagnosed on magnetic resonance imaging (MRI) of either the postero-medial tibia, fibula or second, third, or fourth metatarsal. Subjects of all levels of sporting activity were included. Thirty subjects were initially recruited, and 23 subjects were included in the final analysis. Interventions:Subjects were randomized into either the treatment or placebo arm and matched to the site of injury (tibia, fibula, or metatarsal). Subjects in both arms used either treatment or placebo devices for 20 minutes daily for 4 weeks. Main Outcome Measures:Six clinical parameters (night pain, pain at rest, pain on walking, pain with running, tenderness, and pain with single leg hop) were compared before and after intervention. The changes in MRI grade and bone marrow edema size were also compared. Results:There were no significant differences between the treatment and placebo conditions for changes in MRI grading (2.2 vs 2.4, P = 0.776) or bone marrow edema size (3 vs 4.1, P = 0.271). There were no significant differences between the treatment and placebo conditions for the 6 clinical parameters. Conclusions:Low-intensity pulsed ultrasound was found not to be an effective treatment for the healing of lower limb bone stress injuries in this study. However, this was measured over a relatively short duration of 4 weeks in a small, mostly female population. Clinical Relevance:This double-blinded, randomized, placebo-controlled trial has shown that LIPUS is not an effective treatment for lower limb bone stress injuries.

The validation and application of Inertial Measurement Units to springboard diving

Abstract Inertial Measurement Units (IMUs) may offer an ecologically valid, reliable, and practical method for biomechanical performance analysis. With such potential in mind, Part 1 of this study examined the accuracy of IMUs gyroscopes with an optical system (Cortex 3.3). A calibration formula standardised the IMUs angular velocity output with the optical system. The percentage differences between the two measures = 0.5% (p < 0.05), suggest IMU’s efficacy for application. In Part 2, the aim was to examine and understand how dive flight angular velocity time series plots change and increase according to dive degree of difficulty. With IMUs attached to three competitive divers performing forward somersault dives, dive flight kinematics were assessed. Biomechanically, a 4½ tuck somersault dive differed to lower degree of difficulty dives in terms of: (1) a rotational delay immediately after takeoff (to gain greater vertical translation); (2) increased total time of flight; (3) greater muscle effort to resist increased centrifugal forces produced by the increased angular velocity (1,090 °/s); and (4) greater eccentric control during deceleration allow a safe and vertical entry into the water. IMUs can be effectively utilised and integrated into contexts such as springboard diving for performance analysis and optimisation purposes.

What is the Effect of Compression Garments on a Novel Kick Accuracy Task

The purpose of this study was to investigate the effect of wearing long leg compression garments (CGs) on the accuracy of elite football players performing a novel kicking task. A double-blinded, crossover, randomised and controlled laboratory trial was used to examine the contribution of the long leg CGs to kicking accuracy of a drop-punt-kick. The drop-punt-kick is a backward spinning kick often used in Australian Rules. Participants performed 10 drop-punt-kicks towards a target for each garment condition (fitted, over-sized and training shorts) with both their dominant and non-dominant leg. Kicking accuracy data was collected using a high-speed camera. Kicking accuracy between garment conditions was only significantly different when kicking with the dominant leg (p = 0.002). Kicking accuracy was reduced in the fitted CG condition compared to the oversized CG (mean difference = 20 cm, p = 0.018) and for fitted CGs compared to training shorts (mean difference = 21 cm, p = 0.003) indicating that the fitted CGs had a negative effect on kicking accuracy. As these compression garments are worn regularly during training, further research is required to determine the long-term effect on skill development.

Whole-body Cryotherapy as a Recovery Technique after Exercise: A Review of the Literature

This review aims to evaluate the current body of literature investigating the effect of whole body cryotherapy on recovery after exercise. A systematic search was conducted to investigate the effect of whole body cryotherapy (WBC, exposure to temperatures between -110 to -190°C) on markers of recovery after damaging exercise in healthy, physically active subjects. Of the 16 eligible articles extracted, ten induced muscle damage using controlled exercise in a laboratory setting, while six induced damage during sport-specific training. Results indicated that muscle pain was reduced in 80% of studies following WBC. Two applied studies found recovery of athletic capacity and performance with WBC improved, variables of this nature were also improved in 71% of studies using controlled exercise. Further benefits of WBC treatment included reduction of systemic inflammation and lower concentrations of markers for muscle cell damage. These results suggest that WBC may improve recovery from muscle damage, with multiple exposures more consistently exhibiting improvements in recovery from pain, loss of muscle function, and markers of inflammation and damage. The diversity in muscle damage protocols, exposure timing with regards to exercise, as well as temperatures, duration and frequencies of exposure, make specific recommendations preliminary at present.

Higher exercise intensity delays postexercise recovery of impedance-derived cardiac sympathetic activity

Systolic time intervals (STIs) provide noninvasive insights into cardiac sympathetic neural activity (cSNA). As the effect of exercise intensity on postexercise STI recovery is unclear, this study investigated the STI recovery profile after different exercise intensities. Eleven healthy males cycled for 8 min at 3 separate intensities: LOW (40%-45%), MOD (75%-80%), and HIGH (90%-95%) of heart-rate (HR) reserve. Bio-impedance cardiography was used to assess STIs - primarily pre-ejection period (PEP; inversely correlated with cSNA), as well as left ventricular ejection time (LVET) and PEP:LVET - during 10 min seated recovery immediately postexercise. Heart-rate variability (HRV), i.e., natural-logarithm of root mean square of successive differences (Ln-RMSSD), was calculated as an index of cardiac parasympathetic neural activity (cPNA). Higher preceding exercise intensity elicited a slower recovery of HR and Ln-RMSSD (p < 0.001), and these measures did not return to baseline by 10 min following any intensity (p ≤ 0.009). Recovery of STIs was also slower following higher intensity exercise (p ≤ 0.002). By 30 s postexercise, higher preceding intensity resulted in a lower PEP (98 ± 14 ms, 75 ± 6 ms, 66 ± 5 ms for LOW, MOD, and HIGH, respectively, p < 0.001). PEP recovered to baseline (143 ± 11 ms) by 5 min following LOW (139 ± 13 ms, p = 0.590) and by 10 min following MOD (145 ± 17 ms, p = 0.602), but was still suppressed at 10 min following HIGH (123 ± 21 ms, p = 0.012). Higher preceding exercise intensity attenuated the recovery of indices for cSNA (from STIs) and cPNA (from HRV) in a graded dose-response fashion. While exercise intensity must be considered, acute recovery may be a valuable period during which to concurrently monitor these noninvasive indices, to identify potentially abnormal cardiac autonomic responses.

Influence of exercise modality on cardiac parasympathetic and sympathetic indices during post-exercise recovery

OBJECTIVES This study investigated indirect measures of post-exercise parasympathetic reactivation (using heart-rate-variability, HRV) and sympathetic withdrawal (using systolic-time-intervals, STI) following upper- and lower-body exercise. DESIGN Randomized, counter-balanced, crossover. METHODS 13 males (age 26.4±4.7years) performed maximal arm-cranking (MAX-ARM) and leg-cycling (MAX-LEG). Subsequently, participants undertook separate 8-min bouts of submaximal HR-matched exercise of each mode (ARM and LEG). HRV (including natural-logarithm of root-mean-square-of-successive-differences, Ln-RMSSD) and STI (including pre-ejection-period, PEP) were assessed throughout 10-min seated recovery. RESULTS Peak-HR was higher (p=0.001) during MAX-LEG (182±7beatsmin-1) compared with MAX-ARM (171±12beatsmin-1), while HR (p<0.001) and Ln-RMSSD (p=0.010) recovered more rapidly following MAX-ARM. PEP recovery was similar between maximal bouts (p=0.106). HR during submaximal exercise was 146±7 (LEG) and 144±8beatsmin-1 (LEG) (p=0.139). Recovery of HR and Ln-RMSSD was also similar between submaximal modalities, remaining below baseline throughout recovery (p<0.001). PEP was similar during submaximal exercise (LEG 70±6ms; ARM 72±9ms; p=0.471) although recovery was slower following ARM (p=0.021), with differences apparent from 1- to 10-min recovery (p≤0.036). By 10-min post-exercise, PEP recovered to baseline (132±21ms) following LEG (130±21ms; p=0.143), but not ARM (121±17ms; p=0.001). CONCLUSIONS Compared with submaximal lower-body exercise, HR-matched upper-body exercise elicited a similar recovery of HR and HRV indices of parasympathetic reactivation, but delayed recovery of PEP (reflecting sympathetic withdrawal). Exercise modality appears to influence post-exercise parasympathetic reactivation and sympathetic withdrawal in an intensity-dependent manner. These results highlight the need for test standardization and may be relevant to multi-discipline athletes and in clinical applications with varying modes of exercise testing.

Depression, Anxiety, and Alcohol Use in Elite Rugby League Players Over a Competitive Season.

Objective: To assess the prevalence of symptoms of depression, anxiety, and rates of alcohol misuse in elite rugby league players in Australasia. Design: A cross-sectional, epidemiological study with repeated measures. Setting: Surveys were conducted during the 2015 preseason and in-season. Participants: Four hundred four elite rugby league players participated preseason and 278 players in-season. Main Outcome Measures: Symptoms of depression were measured using the Patient Health Questionnaire-9 scale, symptoms of generalized anxiety disorder (GAD) with the GAD-7 scale, and the Alcohol Use Disorders Identification Test Consumption scale was used to assess hazardous alcohol use. Results: The overall prevalence of depression was 12.6% preseason and 10.1% in-season. Generalized anxiety disorder had a prevalence of 14.6% and 10.1% for these 2 periods. Overall, 68.6% of players had hazardous levels of alcohol use preseason, and 62.8% in-season. There was no significant difference for any of the main outcomes between the periods. Players with a history of mental illnesses had 5.62 greater odds (95% confidence interval [CI], 2.62-12.04) of depression than those without during preseason, and 22.08 greater odds (95% CI, 7.77-62.71) in-season. Players reporting ≥3 previous concussions had 2.02 greater odds (95% CI, 1.07-3.82) of depression than those reporting ⩽2 in the preseason sample. Conclusions: Rugby league players have a lower prevalence of depression compared with studies of the general population and other athletes, but a higher prevalence of GAD, and high rates of alcohol misuse. Clubs may consider implementing regular screening for these conditions. Further prospective research to determine causality of independent factors is required.