Baroreflex sensitivity following acute upper-body exercise in the cold among stable coronary artery disease patients

Kalle Pikkarainen; Rasmus I P Valtonen; Heidi E Hintsala; Antti Kiviniemi; Craig G Crandall; Juha Perkiömäki; Arto J Hautala; Mikko P Tulppo; Jouni J K Jaakkola; Tiina M Ikäheimo

doi:10.3389/fphys.2023.1184378

Baroreflex sensitivity following acute upper-body exercise in the cold among stable coronary artery disease patients

Front Physiol. 2023 Oct 13:14:1184378. doi: 10.3389/fphys.2023.1184378. eCollection 2023.

Authors

Affiliations

¹ Center for Environmental and Respiratory Health Research, Research Unit of Population Health, University of Oulu, Oulu, Finland.
² Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
³ Centria University of Applied Sciences, Kokkola, Finland.
⁴ Department of Internal Medicine, Texas Health Presbyterian Hospital, Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States.
⁵ Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
⁶ Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland.
⁷ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.

Abstract

Background: A cold environment and exercise separately affect the autonomic nervous system (ANS), baroreflex sensitivity (BRS), and blood pressure variability (BPV) but their combined effects on post-exercise recovery are not known. Our cross-over trial examined these responses following upper-body static and dynamic exercise performed in a cold and neutral environment in patients with coronary artery disease (CAD). Methods: 20 patients with stable coronary artery disease performed both graded static (10%-30% of maximal voluntary contraction) and dynamic (light, moderate and high perceived intensity) upper-body exercise at -15°C and +22°C for 30 min. Electrocardiogram and continuous blood pressure were measured to compute post-exercise (10 and 30 min after exercise) spectral powers of heart rate (HR), blood pressure variability and BRS at low (0.04-0.15 Hz) and high (0.15-0.4 Hz) frequencies. Results: Static upper-body exercise performed in a cold environment increased post-exercise high frequency (HF) spectral power of heart rate (HF RR) (p < 0.001) and reduced heart rate (p = 0.001) and low-to-high frequency (LF/HF) ratio (p = 0.006) more than in a neutral environment. In addition, post-exercise mean BRS (p = 0.015) and high frequency BRS (p = 0.041) increased more following static exercise in the cold than in a neutral environment. Dynamic upper-body exercise performed in a cold environment reduced post-exercise HF BRS (p = 0.019) and systolic blood pressure (p = 0.003). Conclusion: Static upper-body exercise in the cold increased post-exercise BRS and overall vagal activity but without reduced systolic blood pressure. Dynamic upper-body exercise in the cold reduced post-exercise vagal BRS but did not affect the other parameters. The influence of cold exposure on post-exercise autonomic and cardiovascular responses following static upper-body exercise require further studies. This information helps understanding why persons with cardiovascular diseases are vulnerable to low environmental temperature. ClinicalTrials.gov: NCT02855905 (04/08/2016).

Keywords: autonomic nervous system; baroreflex; blood pressure variability; cold; coronary artery disease; exercise; upper-body exercise.

Associated data

ClinicalTrials.gov/NCT02855905