Water drinking during aerobic exercise improves the recovery of non-linear heart rate dynamics in coronary artery disease: crossover clinical trial

Maria Júlia Lopez Laurino; Anne Kastelianne França da Silva; Lorena Altafin Santos; Luiz Carlos Marques Vanderlei

doi:10.3389/fnins.2023.1147299

Water drinking during aerobic exercise improves the recovery of non-linear heart rate dynamics in coronary artery disease: crossover clinical trial

Front Neurosci. 2023 Jun 22:17:1147299. doi: 10.3389/fnins.2023.1147299. eCollection 2023.

Authors

Maria Júlia Lopez Laurino¹, Anne Kastelianne França da Silva¹, Lorena Altafin Santos¹, Luiz Carlos Marques Vanderlei¹

Affiliation

¹ Laboratory of Stress Physiology, Department of Physiotherapy, São Paulo State University (UNESP), Faculty of Science and Technology, Presidente Prudente, Brazil.

Abstract

Introduction: The post-exercise recovery is a period of vulnerability of the cardiovascular system in which autonomic nervous system plays a key role in cardiovascular deceleration. It is already known that individuals with coronary artery disease (CAD) are at greater risk due to delayed vagal reactivation in this period. Water ingestion has been studied as a strategy to improve autonomic recovery and mitigate the risks during recovery. However, the results are preliminary and need further confirmation. Therefore, our aim was to investigate the influence of individualized water drinking on the non-linear dynamics of heart rate during and after aerobic exercise in CAD subjects.

Methods: 30 males with CAD were submitted to a control protocol composed of initial rest, warming up, treadmill exercise, and passive recovery (60 min). After 48 hours they performed the hydration protocol, composed of the same activities, however, with individualized water drinking proportional to the body mass lost in the control protocol. The non-linear dynamics of heart rate were assessed by indices of heart rate variability extracted from the recurrence plot, detrended fluctuation analysis, and symbolic analysis.

Results and discussion: During exercise, the responses were physiological and similar in both protocols, indicating high sympathetic activity and reduced complexity. During recovery, the responses were also physiological, indicating the rise of parasympathetic activity and the return to a more complex state. However, during hydration protocol, the return to a more complex physiologic state occurred sooner and non-linear HRV indices returned to resting values between the 5th and 20th minutes of recovery. In contrast, during the control protocol, only a few indices returned to resting values within 60 minutes. Despite that, differences between protocols were not found. We conclude that the water drinking strategy accelerated the recovery of non-linear dynamics of heart rate in CAD subjects but did not influence responses during exercise. This is the first study to characterize the non-linear responses during and after exercise in CAD subjects.

Keywords: autonomic nervous system; cardiac rehabilitation; complexity; coronary artery disease; fluid replacement; post-exercise recovery.

Grants and funding

This work was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) [Grant Number 401258/2016-5] and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES) [finance code 001].