Evidence of altered autonomic cardiac regulation in breast cancer survivors

Vigo, Chiara; Gatzemeier, Wolfgang; Sala, Roberto; Malacarne, Mara; Santoro, Armando; Pagani, Massimo; Lucini, Daniela

doi:10.1007/s11764-015-0445-z

Cited by 33 publications

(44 citation statements)

References 36 publications

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“…Studies using spectral analysis to explore the patterns of cardiac autonomic modulation have found evidence for autonomic dysregulation at rest in BCS [9,40]. Since a delicate balance exists between sympathetic and parasympathetic activity to govern heart rate and blood pressure responses, reduced R-to-R variance and baroreflex gain may indicate impaired vagal performance among BCS [9]. Though spectral analysis was not performed in the present study, average baseline resting heart rate was 88 beats·min −1 or 8–9 beats·min −1 higher than normative values in adult women [41], in part suggesting reduced parasympathetic activity.…”

Section: Discussionmentioning

confidence: 99%

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Lower rate-pressure product during submaximal walking: a link to fatigue improvement following a physical activity intervention among breast cancer survivors

et al. 2016

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PURPOSE Research showing a link between exercise-induced changes in aerobic fitness and reduced fatigue after a cancer diagnosis has been inconsistent. We evaluated associations of fatigue and rate-pressure product (RPP), a reliable index of myocardial oxygen demand, at rest and during submaximal walking following a physical activity intervention among post-primary treatment breast cancer survivors (BCS). METHODS Secondary analyses of 152 BCS in a randomized controlled trial testing a physical activity intervention (INT) versus usual care (UC) were performed. The INT group completed counseling/group discussions along with supervised exercise sessions tapered to unsupervised exercise. Evaluations were made at baseline and immediately post-intervention (M3) on measures of physical activity (accelerometry), graded-walk test, and average fatigue over the previous 7 days. RPP was calculated by dividing the product of heart rate and systolic blood pressure by 100. RESULTS Resting and submaximal RPPs were significantly improved in both groups at M3, however, the magnitude of change (Δ) was greater in the INT group from stage 1 (ΔRPP1; INT −13±17 vs. UC −7±18; p=0.03) through stage 4 (ΔRPP4; INT −21±26 vs. UC −9±24; p<0.01) of the walk test. The INT group reported significantly reduced fatigue (INT −0.7±2.0 vs. UC +0.1±2.0; p=0.02) which was positively associated with ΔRPP during stages 2–4 of the walk test but not Δaerobic fitness. CONCLUSIONS Lower RPP during submaximal walking was significantly associated with reduced fatigue in BCS. IMPLICATIONS FOR CANCER SURVIVORS Exercise/physical activity training programs that lower the physiological strain during submaximal walking may produce the largest improvements in reported fatigue.

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Section: Discussionmentioning

confidence: 99%

“…Within the setting of breast cancer survivorship, fatigue may be perpetuated by disruption of the autonomic nervous system [9,10]. Generally classified as two divergent branches, the sympathetic and parasympathetic systems are key regulators of energy mobilization and restorative function, respectively.…”

Section: Introductionmentioning

confidence: 99%

Lower rate-pressure product during submaximal walking: a link to fatigue improvement following a physical activity intervention among breast cancer survivors

et al. 2016

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“…Various indexes of autonomic nervous control, including the basis of an interbeat interval (IBI), heart rates (HR), heart rate variability (HRV), standard deviation of the interbeat intervals (SDNN), root mean square of successive differences (RMSSD), mean of the absolute value of the difference between successive interbeat intervals (MSD), mean square successive difference (MSSD), respiratory sinus arrhythmia (RSA), cardiac sympathetic index (CSI), and cardiac vagal index (CVI) were reported (Allen et al, 2007). In many studies of fatigue, parameters of low-frequency (LF) component, high-frequency (HF) component, and LF/HF were used for the indexes of cardiac autonomic nervous modulation (Tanaka et al, 2009, 2011, 2015; Mizuno et al, 2010, 2011, 2014; Park et al, 2011, 2012; Sommerfeldt et al, 2011; Leti and Bricout, 2013; Yu et al, 2013; Schmitt et al, 2015; Vigo et al, 2015). LF and HF components indicate the cardiac autonomic nervous modulations likely influenced by the parasympathetic nervous system (Houle and Billman, 1999; Reyes del Paso et al, 2013).…”

Section: Methodsmentioning

confidence: 99%

Music Improves Subjective Feelings Leading to Cardiac Autonomic Nervous Modulation: A Pilot Study

et al. 2017

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It is widely accepted that listening to music improves subjective feelings and reduces fatigue sensations, and different kinds of music lead to different activations of these feelings. Recently, cardiac autonomic nervous modulation has been proposed as a useful objective indicator of fatigue. However, scientific considerations of the relation between feelings of fatigue and cardiac autonomic nervous modulation while listening to music are still lacking. In this study, we examined which subjective feelings of fatigue are related to participants' cardiac autonomic nervous function while they listen to music. We used an album of comfortable and relaxing environmental music, with blended sounds from a piano and violin as well as natural sound sources. We performed a crossover trial of environmental music and silent sessions for 20 healthy subjects, 12 females, and 8 males, after their daily work shift. We measured changes in eight types of subjective feelings, including healing, fatigue, sleepiness, relaxation, and refreshment, using the KOKORO scale, a subjective mood measurement system for self-reported feelings. Further, we obtained measures of cardiac autonomic nervous function on the basis of heart rate variability before and after the sessions. During the music session, subjective feelings significantly shifted toward healing and a secure/relaxed feeling and these changes were greater than those in the silent session. Heart rates (ΔHR) in the music session significantly decreased compared with those in the silent session. Other cardiac autonomic parameters such as high-frequency (HF) component and the ratio of low-frequency (LF) and HF components (LF/HF) were similar in the two sessions. In the linear regression analysis of the feelings with ΔHR and changes in LF/HF (ΔLF/HF), increases and decreases in ΔHR were correlated to the feeling axes of Fatigue-Healing and Anxiety/Tension–Security/Relaxation, whereas those in ΔLF/HF were related to the feeling axes of Sleepiness–Wakefulness and Gloomy–Refreshed. This indicated that listening to music improved the participants' feelings of fatigue and decreased their heart rates. However, it did not reduce the cardiac LF/HF, suggesting that cardiac LF/HF might show a delayed response to fatigue. Thus, we demonstrated changes in cardiac autonomic nervous functions based on feelings of fatigue.

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“…Prior studies have shown decreased exercise capacity across the BC survivorship continuum. Peak oxygen consumption, a measure of aerobic power, is substantially lower in BC survivors compared to healthy women . In this study, we explored mechanisms underlying this decreased functional capacity in patients with a history of BC who were clinically referred for ETT.…”

Section: Discussionmentioning

confidence: 99%

“…Peak oxygen consumption, a measure of aerobic power, is substantially lower in BC survivors compared to healthy women. 7,25,26 In this study, we explored mechanisms underlying this decreased functional capacity in patients with a history of BC who were clinically referred for ETT. In our study, there was no difference in mean exercise capacity between the BC cohort and controls, even though the BC cohort had fewer cardiovascular risk factors than controls.…”

Section: Discussionmentioning

confidence: 99%

Case‐control study of heart rate abnormalities across the breast cancer survivorship continuum

et al. 2018

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BackgroundMechanisms underlying impaired exercise capacity and increased cardiovascular mortality observed in breast cancer (BC) patients remain unclear. The prevalence, functional, and prognostic significance of elevated resting heart rate (HR) and abnormal heart rate recovery (HRR) in breast cancer (BC) requires evaluation.MethodsIn a single‐center, retrospective, case‐control study of women referred for exercise treadmill testing (ETT), 448 BC patients (62.6 ± 10.0 years) were compared to 448 cancer‐free, age‐matched controls. Elevated resting HR was defined as HR ≥80 bpm at rest. Abnormal HRR at 1‐minute following exercise was defined as ≤12 bpm if active recovery or ≤18 bpm if passive recovery. Association of these parameters with exercise capacity and all‐cause mortality was evaluated.ResultsElevated resting HR (23.7% vs 17.0%, P = 0.013) and abnormal HRR (25.9% vs 20.3%, P = 0.048) were more prevalent in BC cohort than controls. In adjusted analyses, BC patients with elevated resting HR (−0.9 METs (SE 0.3); P = 0.0003) or abnormal HRR (−1.3 METs (SE 0.3); P < 0.0001) had significant reductions in metabolic equivalents (METs) achieved during exercise. Elevated resting HR was not associated with mortality. There was a trend toward increased mortality in BC cohort with abnormal HRR (adjusted hazard ratio 2.06 (95% CI 0.95‐4.44, P = 0.07)).ConclusionsWomen across the BC survivorship continuum, referred for ETT, have an increased prevalence of elevated resting HR and abnormal HRR relative to cancer‐free, age‐matched female controls. These parameters were associated with decreased exercise capacity. Strategies to modulate these abnormalities may help improve functional capacity in this cohort.

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Evidence of altered autonomic cardiac regulation in breast cancer survivors

Abstract: We propose that the concept of clinical phenotype, which may accommodate multiple functional disturbances, might be useful in long-term personalized prevention programs for breast cancer survivors.

Cited by 33 publications

References 36 publications

Lower rate-pressure product during submaximal walking: a link to fatigue improvement following a physical activity intervention among breast cancer survivors

Lower rate-pressure product during submaximal walking: a link to fatigue improvement following a physical activity intervention among breast cancer survivors

Music Improves Subjective Feelings Leading to Cardiac Autonomic Nervous Modulation: A Pilot Study

Case‐control study of heart rate abnormalities across the breast cancer survivorship continuum

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