Mandeep Dhindsa

Interrelationships among noninvasive measures of postischemic macro- and microvascular reactivity

The clinical importance of vascular reactivity as an early marker of atherosclerosis has been well established, and a number of established and emerging techniques have been employed to provide measurements of peripheral vascular reactivity. However, relations between these methodologies are unclear as each technique evaluates different physiological aspects related to micro- and macrovascular reactive hyperemia. To address this question, a total of 40 apparently healthy normotensive adults, 19-68 yr old, underwent 5 min of forearm suprasystolic cuff-induced ischemia followed by postischemic measurements. Measurements of vascular reactivity included 1) flow-mediated dilatation (FMD), 2) changes in pulse wave velocity between the brachial and radial artery (DeltaPWV), 3) hyperemic shear stress, 4) reactive hyperemic flow, 5) reactive hyperemia index (RHI) assessed by fingertip arterial tonometry, 6) fingertip temperature rebound (TR), and 7) skin reactive hyperemia. FMD was significantly and positively associated with RHI (r=0.47) and TR (r=0.45) (both P<0.01) but not with reactive hyperemic flow or hyperemic shear stress. There was no correlation between two measures of macrovascular reactivity (FMD and DeltaPWV). Skin reactive hyperemia was significantly associated with RHI (r=0.55) and reactive hyperemic flow (r=0.35) (both P<0.05). There was a significant association between reactive hyperemia and RHI (r=0.30; P<0.05). In more than 75% of cases, vascular reactivity measures were not significantly associated. We concluded that associations among different measures of peripheral micro- and macrovascular reactivity were modest at best. These results suggest that different physiological mechanisms may be involved in changing different measures of vascular reactivity.

Effects of Swimming Training on Blood Pressure and Vascular Function in Adults >50 Years of Age

Swimming is ideal for older adults because it includes minimum weight-bearing stress and decreased heat load. However, there is very little information available concerning the effects of regular swimming exercise on vascular risks. We determined if regular swimming exercise would decrease arterial blood pressure (BP) and improve vascular function. Forty-three otherwise healthy adults >50 years old (60 ± 2) with prehypertension or stage 1 hypertension and not on any medication were randomly assigned to 12 weeks of swimming exercise or attention time controls. Before the intervention period there were no significant differences in any of the variables between groups. Body mass, adiposity, and plasma concentrations of glucose and cholesterol did not change in either group throughout the intervention period. Casual systolic BP decreased significantly from 131 ± 3 to 122 ± 4 mm Hg in the swimming training group. Significant decreases in systolic BP were also observed in ambulatory (daytime) and central (carotid) BP measurements. Swimming exercise produced a 21% increase in carotid artery compliance (p <0.05). Flow-mediated dilation and cardiovagal baroreflex sensitivity improved after the swim training program (p <0.05). There were no significant changes in any measurements in the control group that performed gentle relaxation exercises. In conclusion, swimming exercise elicits hypotensive effects and improvements in vascular function in previously sedentary older adults.

Arterial stiffening following eccentric exercise-induced muscle damage

Acute inflammatory responses are linked to a transient increase in risk of a cardiovascular event, and this risk may be mediated by a concomitant reduction in vascular function. Humans experience an acute inflammatory response as a consequence of infection, injury, or muscle damage. We measured macrovascular function before and after eccentric exercise to determine whether muscle damage from unaccustomed exercise has an unfavorable effect on the large elastic arteries. A total of 27 healthy sedentary or recreationally active men (age 18-38 years) participated in either bilateral leg press eccentric exercise or unilateral elbow flexor eccentric exercise. Postexercise muscle damage was confirmed by significant reductions in isometric strength and increases in muscle soreness (P < 0.05). Carotid-femoral pulse-wave velocity was significantly elevated 48 h after leg exercise (808 ± 31 vs. 785 ± 30 cm/s; P < 0.05) and arm exercise (790 ± 28 vs. 755 ± 24 cm/s; P < 0.05). There were no changes in mean arterial pressure. C-reactive protein was elevated after leg exercise but not after arm exercise. The increase in carotid-femoral pulse wave velocity 48 h after arm exercise was associated with muscle strength (r = -0.47; P < 0.05) and creatine kinase concentrations (r = 0.70; P < 0.01). We concluded that eccentric exercise in both small and large muscle mass translates to transient, unfavorable changes in central macrovascular function and that the increase in central arterial stiffness after small muscle eccentric exercise is associated with indicators of muscle damage.

Endothelial ischemia-reperfusion injury in humans: association with age and habitual exercise

Advancing age is a major risk factor for coronary artery disease. Endothelial dysfunction accompanied by increased oxidative stress and inflammation with aging may predispose older arteries to greater ischemia-reperfusion (I/R) injury. Because coronary artery ischemia cannot be induced safely, the effects of age and habitual endurance exercise on endothelial I/R injury have not been determined in humans. Using the brachial artery as a surrogate model of the coronary arteries, endothelial function, assessed by brachial artery flow-mediated dilation (FMD), was measured before and after 20 min of continuous forearm occlusion in young sedentary (n = 10, 24 ± 2 yr) and middle-aged (n = 9, 48 ± 2 yr) sedentary adults to gain insight into the effects of primary aging on endothelial I/R injury. Young (n = 9, 25 ± 1 yr) and middle-aged endurance-trained (n = 9, 50 ± 2 yr) adults were also studied to determine whether habitual exercise provides protection from I/R injury. Fifteen minutes after ischemic injury, FMD decreased significantly by 37% in young sedentary, 35% in young endurance-trained, 68% in middle-aged sedentary, and 50% in middle-aged endurance-trained subjects. FMD returned to baseline levels within 30 min in young sedentary and endurance-trained subjects but remained depressed in middle-aged sedentary and endurance-trained subjects. Circulating markers of antioxidant capacity and inflammation were not related to FMD. In conclusion, advancing age is associated with a greater magnitude and delayed recovery from endothelial I/R injury in humans. Habitual endurance exercise may provide partial protection to the endothelium against this form of I/R injury with advancing age.

Use of temperature alterations to characterize vascular reactivity.

Monitoring alterations in fingertip temperature during ischaemia and the subsequent hyperaemia provides a novel way of studying microvascular reactivity. The relations between parameters characterizing blood perfusion and the thermal response of fingertips were studied using experimental and theoretical approaches. During the experimental protocol, two brachial artery occlusion tests were conducted in 12 healthy volunteers, and fingertip temperature, heat flux and skin perfusion using laser Doppler flowmetry (LDF) were measured. The temperature curves provide a smooth and robust response that is able to capture occlusion and reperfusion. The temperature fall during occlusion as well as the maximum temperature recorded depended linearly on the initial temperature. The magnitude of the LDF signal was associated with local tissue temperature and followed an exponential response. Heat flux measurements demonstrated rapid changes and followed variations in blood perfusion closely. The time points at which the heat flux reached its maximum corresponded to the time at which the fingertip temperature curves showed an inflection point after cuff release. The time required for the fingertip temperature to arrive at the maximum temperature was greater than the time to peak for the heat flux signal, which was greater than the LDF signal to reach a maximum. The time lag between these signals was a function of the finger size and finger temperature at the moment reperfusion restarted. Our present results indicate that finger temperature, heat flux and perfusion display varying rates of recovery following ischaemic stimuli and that differential responses are associated with the initial finger temperature.

Macro- and microvascular function in habitually exercising systemic lupus erythematosus patients.

Objectives: Vascular dysfunction is commonly observed in systemic lupus erythematosus (SLE) patients and may explain the accelerated cardiovascular disease (CVD) risk. It is unknown whether physical activity influences vascular function in SLE patients. We aimed to determine whether habitually exercising SLE patients also demonstrate a reduction in vascular function. Method: This study involved 41 young and middle-aged adults, including 15 healthy controls, 12 sedentary SLE patients, and 14 physically active SLE patients. Results: Flow-mediated dilation (FMD), a measure of macrovascular function, was lower (3.6 ± 1.3 vs. 8.1 ± 1.2%; p < 0.05) and inflammatory markers [C-reactive protein (CRP), interleukin (IL)-12, and tumour necrosis factor (TNF)-α] were higher in sedentary SLE patients than in age-matched healthy controls (p < 0.05). Importantly, FMD and inflammatory markers were not different between physically active SLE patients and healthy controls. There were no group differences in skin reactive hyperaemia (RH) or minimal vascular resistance, both measures of microvascular function. Physically active SLE patients had lower intercellular adhesion molecule (ICAM)-1 concentrations and SLE disease activity scores than their sedentary peers. FMD was inversely associated with IL-6 and IL-10 (both p < 0.05). Conclusions: Significant SLE-associated macrovascular dysfunction was absent in physically active SLE patients. Additionally, vascular function was associated with inflammatory markers, suggesting that the favourable influence of physical activity may be mediated by its effect on inflammation.

Muscle spasticity associated with reduced whole-leg perfusion in persons with spinal cord injury

Abstract Objective To determine the association between peripheral blood flow and spasticity in individuals with spinal cord injury (SCI). Design A cross-sectional study with measurements of muscle spasticity and whole-limb blood flow in individuals with SCI. Setting University of Texas at Austin and Brain & Spine Recovery Center, Austin, TX, USA. Participants Eighteen individuals (14 males and 4 females) with SCI were classified into high (N = 7), low (N = 6), and no (N = 5) spasticity groups according to the spasticity levels determined by the modified Ashworth scale scores. Interventions Whole-limb blood flow was measured in the femoral and brachial arteries using Doppler ultrasound and was normalized to lean limb mass obtained with dual-energy X-ray absorptiometry. Outcome measures Limb blood flow and muscle spasticity. Results Age, time post-SCI, and the American Spinal Injury Association impairment scale motor and sensory scores were not different among groups with different muscle spasticity. Femoral artery blood flow normalized to lean leg mass was different (P = 0.001) across the three spasticity groups (high 78.9 ± 16.7, low 98.3 ± 39.8, no 142.5 ± 24.3 ml/minute/kg). Total leg muscle spasticity scores were significantly and negatively correlated with femoral artery blood flow (r = −0.59, P < 0.01). There was no significant difference in brachial artery blood flow among the groups. Conclusions Whole-leg blood flow was lower in individuals with greater spasticity scores. These results suggest that a reduction in lower-limb perfusion may play a role, at least in part, in the pathogenesis leading to muscle spasticity after SCI.

Impact of Hot Yoga on Arterial Stiffness and Quality of Life in Normal and Overweight/Obese Adults.

BACKGROUND Obesity is associated with arterial stiffening and diminished quality of life. Bikram yoga may be a feasible alternative to traditional exercise among obese individuals. Accordingly, the purpose of this study was to investigate the impact of Bikram yoga, a heated style of hatha yoga, on arterial stiffness in normal and overweight/obese adults. METHODS Forty-three (23 normal body mass index or BMI; 20 overweight/obese) apparently healthy participants completed an 8-week Bikram yoga intervention. Body composition was estimated via dual energy x-ray absorptiometry, arterial stiffness was measured via brachialankle pulse wave velocity, and health-related quality of life was assessed via RAND 36-Item Short Form survey at baseline and at the end of the 8-week intervention. RESULTS After the intervention, brachial-ankle pulse wave velocity decreased (P < .05) in overweight/obese participants while no such changes were observed in normal BMI participants. In the quality of life measures, emotional well-being improved (P < .05) in both groups, and general health improved (P < .05) only in the normal weight BMI group. CONCLUSION Bikram yoga ameliorates arterial stiffness in overweight/obese adults and can positively impact quality of life regardless of BMI.