Abnormal cardiovascular and catecholamine responses to supine exercise in human subjects with sympathetic dysfunction.

Smith, George J.; Watson, Laura; Pavitt, D.; Mathias, C. J.

doi:10.1113/jphysiol.1995.sp020663

Cited by 46 publications

(35 citation statements)

References 37 publications

(22 reference statements)

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“…Although absolute DBP was not different between the INC and DEC groups during exercise, the change in DBP was significantly different in the DEC group (e.g., an increase in INC and no change in DEC). This hypothesis is consistent with other autonomic failure disorders that display blunted elevations in splanchnic vascular resistance and blood pressure during exercise [14,15].…”

Section: Discussionsupporting

confidence: 89%

“…The similar heart rate responses to orthostasis and exercise in the INC and DEC groups might suggest that the ability to increase/maintain cardiac output was not the likely mechanism contributing to the impaired blood pressure control in the DEC group, consistent with other autonomic failure disorders that display a preserved cardiac output, yet impaired blood pressure, response to exercise [14,15]. That said, stroke volume (and cardiac output) was not assessed in the present study, cardiac sympathetic denervation is common in Parki so 's disease [1], and an impaired cardiac contractility during exercise has also been reported in PD patients with cardiac sympathetic denervation [11] suggesting that an impaired cardiac output response may have occurred in the DEC group.…”

Section: Discussionmentioning

confidence: 52%

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Exercise hemodynamics in Parkinson's disease and autonomic dysfunction

Low

Vichayanrat

Iodice

2014

Parkinsonism & Related Disorders

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ArticleLJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. ResultsGroup mean systolic blood pressure (SBP) fell during pre-exercise standing (-39±29 mmHg, P<0.001, 17 patients had orthostatic hypotension (OH)), while heart rate (HR) increased (+13±7 beats.min-1, P<0.001). SBP (P<0.001) increased during exercise with a wide variation in responses. SBP increased in 13 patients (INC; +30±14 mmHg) and either did not change or decreased in 10 patients (DEC -12±11 mmHg, P<0.001 vs INC). The increase in HR was not different between sub-groups (30±12 vs 25±10 beats.min-1, INC vs. DEC, P=0.29). The size of the pre-exercise stand SBP reduction was greater in DEC vs INC (-64±23 (10 out of 10 had OH) vs -19±16 mmHg (7 out of 13 had OH), respectively, P<0.001). The HR elevation was not different between sub-groups (13±8 vs 13±4 beats.min-1, DEC vs INC, P=0.94). Post-exercise SBP/DBP were lower for both sub-groups compared to pre-exercise and the standing SBP reduction post-exercise was not greater relative to pre-exercise in either sub-group. ConclusionExercise-induced hypotension can occur in Parkinson's disease patients with autonomic failure with the magnitude of the exercise response being related to the severity of autonomic dysfunction. Exercise does not appear to worsen OH in this sample of Parkinson's patients.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 52%

Exercise hemodynamics in Parkinson's disease and autonomic dysfunction

Low

Vichayanrat

Iodice

2014

Parkinsonism & Related Disorders

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“…18 Or perhaps the heart rate was in¯uenced by exercise-induced hypotension, a condition which has been shown to exist in people with autonomic failure. 19 However, because the present study did not assess blood pressure changes during either combined arm and ES-induced leg cycling or arm cranking alone, we can only speculate on the possible mechanisms explaining the observed heart rate responses in our subjects.…”

Section: Discussionmentioning

confidence: 81%

Oxygen uptake and heart rate responses during arm vs combined arm/electrically stimulated leg exercise in people with paraplegia

et al. 1997

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The purpose of this study was to compare the oxygen uptake and heart rate responses during submaximal arm cranking to combined arm cranking+electrical stimulation (ES)-induced leg cycling in individuals with spinal cord injury (SCI). Seven subjects with paraplegia (T 4 ± T 12 ) performed combined arm and leg cycling exercise for 5 min, followed by arm cranking alone at the same power output for a further 5 min. During both exercise conditions, steady state oxygen consumption (VO 2 ), carbon dioxide output (VCO 2 ), expired ventilation (V E ) and heart rate (HR) were determined. The respiratory exchange ratio (RER) and oxygen pulse were calculated from the measured variables. During combined arm+electrical stimulation-induced leg cycling exercise, the VO 2 was 25% higher (1.58 l min 71 vs 1.26 l min 71), but the HR was 13% lower (132 b min 71 vs 149 b min 71 ), than during arm cranking exercise alone. Oxygen pulse and VCO 2 were also signi®cantly higher (by 42% and 25%, respectively) during combined arm+ES-induced leg exercise, but there were no dierences between the two exercise conditions for V E or RER. These data suggest that the absence of the leg`muscle pump' and a reduced venous return of blood to the heart elevate exercise heart rates during submaximal arm cranking. Conversely, combined arm cranking+ES-induced leg cycling exercise provides the body with a greater metabolic stress than arm cranking alone, while reducing the cardiac stress. The mechanism explaining the heart rate response, however, remains unclear, but may have been in¯uenced by the blood pressure variations across the range of lesions. The ®ndings from this study may have implications for the relative bene®t of combined arm+ES-induced leg cycling training for people with paraplegia.

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“…Notably, NCS can occur during exercise in elderly individuals with sympathetic dysfunction, in whom BP fails to increase during exercise due to an impairment in sympathetic vasoconstriction [8]. Distinguishing syncope during exercise from syncope immediately after exercise is crucial in the diagnostic evaluation of an individual presenting with exercise-related syncope.…”

Section: Discussionmentioning

confidence: 99%

Can Noncardiac Syncope Occur during Exercise?

Christou

Christou²,

Kiortsis³

2017

Cardiology

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We describe the case of a 25-year-old athlete experiencing syncope during a 5-km running race. A thorough diagnostic workup reasonably excluded a cardiac disorder as the cause of syncope. The characterization of this episode of syncope as noncardiac appears to contradict the common belief that syncope during exercise has always a cardiac origin. Following a detailed history taking, it was revealed that the symptoms of the athlete started after a 180° turn of the route. This situation represents a setting relevant to a runner who stops suddenly after reaching the finish line and soon after experiences noncardiac syncope due to the abrupt cessation of muscle pump function of the lower limbs. Although the symptoms of the athlete in this report occurred during running, implying at a first glance the diagnosis of syncope occurring during exercise, a more detailed analysis of the circumstances indicated that these symptoms were in essence presenting after exercise from a pathophysiological view. The distinction between syncope occurring during and after exercise may be challenging enough for athletic activities involving a sudden stop of the running activity, such as for running races with sudden inversion of the route and sports characterized by rapid “starts and stops.”

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Abnormal cardiovascular and catecholamine responses to supine exercise in human subjects with sympathetic dysfunction.

Abstract: With exercise, plasma noradrenaline increased in controls only; plasma adrenaline remained unchanged in all groups. In DBH deficiency, plasma noradrenaline and adrenaline were undetectable, but plasma dopamine was elevated and rose further with exercise.

Cited by 46 publications

References 37 publications

Exercise hemodynamics in Parkinson's disease and autonomic dysfunction

Exercise hemodynamics in Parkinson's disease and autonomic dysfunction

Oxygen uptake and heart rate responses during arm vs combined arm/electrically stimulated leg exercise in people with paraplegia

Can Noncardiac Syncope Occur during Exercise?

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