Physical Training as Non-Pharmacological Treatment of Neurocardiogenic Syncope

Abstract

BackgroundCharacterized as a sudden and temporary loss of consciousness and postural tone, with quick and spontaneous recovery, syncope is caused by an acute reduction of systemic arterial pressure and, therefore, of cerebral blood flow. Unsatisfactory results with the use of drugs allowed the nonpharmacological treatment of neurocardiogenic syncope was contemplated as the first therapeutic option. ObjectivesTo compare, in patients with neurocardiogenic syncope, the impact of a moderate intensity aerobic physical training (AFT) and a control intervention on the positivity of head-up tilting test (HUT) and orthostatic tolerance time. MethodsWere studied 21 patients with a history of recurrent neurocardiogenic syncope and HUT. The patients were randomized into: trained group (TG), n = 11, and control group (CG), n = 10. The TG was submitted to 12 weeks of AFT supervised, in cycle ergometer, and the CG to a control procedure that consisted in 15 minutes of stretching and 15 minutes of light walk. ResultsThe TG had a positive effect to physical training, with a significant increase in peak oxygen consumption. The CG did not show any statistically significant change before and after the intervention. After the intervention period, 72.7% of the TG sample had negative results to the HUT, not having syncope in the revaluation. ConclusionThe program of supervised aerobic physical training for 12 weeks was able to reduce the number of positive HUT, as it was able to increase tolerance time in orthostatic position during the HUT after the intervention period.

Implementation of supervised physical training to reduce vasovagal syncope recurrence: A randomized controlled trial

“…Existing research suggests that exercise is associated with improved orthostatic tolerance 30 . Takahagi et al 16 studied the effects of twice‐weekly supervised moderate‐intensity exercise with a cycling ergometer in 21 patients with VVS and positive head‐up tilt test (HUTT). In this randomized study, the intervention was compared to light exercise in the control group.…”

“…On the other hand, randomized trials of orthostatic training—meant to increase orthostatic tolerance through repeated stress—have shown mixed results among patients with VVS 13,14 . Another approach, aerobic exercise, showed promise in older studies, but its effects need to be further investigated 15,16 . Notably, the efficacy of orthostatic training or exercise is compromised by low adherence over the long term, meaning these strategies can only be helpful among highly motivated individuals 17 …”

“…13,14 Another approach, aerobic exercise, showed promise in older studies, but its effects need to be further investigated. 15,16 Notably, the efficacy of orthostatic training or exercise is compromised by low adherence over the long term, meaning these strategies can only be helpful among highly motivated individuals. 17 The limitations of current treatments and inconsistencies in the available research call for new investigations of modified physical therapeutic strategies.…”

Treating syncope without drugs: Standing still, exercising hard, or simply the “expert's touch”?

“…13,14 Perhaps this is due to true inefficacy, or perhaps it is because it is difficult to persuade people to stand quietly doing nothing else for 30-60 min every day. Physical exercise has been much less well studied, although Takahagi et al 15 reported in a randomized, open-label study that supervised physical exercise reduced syncope outcomes compared to a control group without any supervised exercise.…”

Caracterização da modulação autonômica cardiovascular nas posições supina e vertical, usando-se a manobra postural passiva, em pacientes com história clínica de síncope neurocardiogênica e indivíduos saudáveis

“…Estudos visando o treinamento físico têm sido abordados e indicados como forma de tratamento, com o intuito de diminuir a recorrência das síncopes (COFFIN and RAJ, 2014;TAKAHAGI et al, 2014 JARDINE et al, 2002). Entretanto, recentemente, dois grupos têm relatado a persistência da estimulação simpática muscular na SINC, mostrando que a retirada da estimulação simpática somente ocorre no final do evento fisiológico, onde já há perda de consciência (COOKE and CONVERTINO, 2002;VADDADI et al, 2010).…”