Favorable effect of sympathetic nervous activity on rehabilitation outcomes in frail elderly

Koji Shibasaki; Sumito Ogawa; Shizuru Yamada; Katsuya Iijima; Masato Eto; Koichi Kozaki; Kenji Toba; Yasuyoshi Ouchi; Masahiro Akishita

doi:10.1016/j.jamda.2015.06.007

Favorable effect of sympathetic nervous activity on rehabilitation outcomes in frail elderly

J Am Med Dir Assoc. 2015 Sep 1;16(9):799.e7-799.e12. doi: 10.1016/j.jamda.2015.06.007. Epub 2015 Jul 10.

Authors

Koji Shibasaki¹, Sumito Ogawa², Shizuru Yamada³, Katsuya Iijima⁴, Masato Eto⁵, Koichi Kozaki⁶, Kenji Toba⁷, Yasuyoshi Ouchi⁸, Masahiro Akishita¹

Affiliations

¹ Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
² Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan. Electronic address: suogawa-tky@umin.ac.jp.
³ Komagane-kogen Ladies Clinic, Komagane City, Nagano, Japan.
⁴ Institute of Gerontology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
⁵ General Educational Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
⁶ Department of Geriatric Medicine, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan.
⁷ National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan.
⁸ Federation of National Public Service Personnel Mutual Aid Associations, Toranomon Hospital, Minato-ku, Tokyo, Japan.

PMID: 26170032
DOI: 10.1016/j.jamda.2015.06.007

Abstract

Objectives: Previous studies have suggested the relationship between physical function, mortality, and autonomic nervous activity in frail elderly and that maintaining sympathetic nervous activity might lead to improved physical function and mortality in the elderly population. The aim of this study was to investigate the utility of sympathetic nervous activity measured by heart rate variability in frail elderly patients undergoing inpatient rehabilitation, further focusing the nervous activity on the effect of rehabilitation therapy.

Design: Prospective cohort study.

Participants: Sixty-one subjects aged 75 years or older were recruited after treatment of acute phase illness.

Measurements: Before undergoing rehabilitation, data of 24-hour Holter monitoring and a blood venous sample were obtained. From RR intervals in the electrocardiogram, heart rate and SDs of all NN intervals in all 5-minute segments of the entire recording, power spectral density, low frequency (LF), high frequency (HF), and low frequency/high frequency (LF/HF) were calculated. Functional Independence Measure (FIM) and Barthel index were used to measure physical function.

Results: FIM score and Barthel index were 46.8 ± 25.4 and 32.8 ± 31.7, respectively. Serum total protein, albumin, hemoglobin, and total cholesterol were all significantly related to FIM score and Barthel index before rehabilitation. Heart rate variability indices did not show a significant relationship with physical function, whereas the high LH/HF group showed significant improvement in physical function compared with the low LH/HF group. Moreover, LF/HF frequency was a predictive factor for improvement of physical function after 2 months of rehabilitation.

Conclusion: A favorable effect of preserved LF/HF on rehabilitation outcome was observed in elderly undergoing rehabilitation. Preservation of sympathetic nervous activity may lead to improved physical function in the elderly.

Keywords: Frailty; Functional Independence Measure; Holter monitoring; rehabilitation.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Biomarkers / analysis
Cerebrovascular Disorders / physiopathology*
Cerebrovascular Disorders / rehabilitation*
Electrocardiography, Ambulatory
Female
Fractures, Bone / physiopathology*
Fractures, Bone / rehabilitation*
Frail Elderly*
Heart Rate / physiology*
Humans
Japan
Male
Prospective Studies
Sympathetic Nervous System / physiopathology*
Treatment Outcome

Substances

Biomarkers