Heart rate dynamics during cardio-pulmonary exercise testing are associated with glycemic control in individuals with type 1 diabetes

Moser, Othmar; Eckstein, Max L.; McCarthy, Olivia; Deere, Rachel; Bain, Stephen C.; Zijlstra, Eric; Heise, Tim; Bracken, Richard M.

doi:10.1371/journal.pone.0194750

Cited by 18 publications

(27 citation statements)

References 36 publications

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“…The most plausible and actually valid explanation for the different HRPC patterns was found for β1-receptor sensitivity shown by our study group (9). This hypothesis was supported most recently by results from cardio-pulmonary exercise testing in individuals with type 1 diabetes (10) where the degree of HRPC deflection was significantly lower in individuals with type 1 diabetes compared to matched controls. These authors concluded, that constantly elevated HbA 1c levels and concomitantly elevated catecholamine levels and/or inflammation induced chronic stress impairs β1-receptor sensitivity, which alters the degree and direction of the HRPC.…”

Section: Introductionsupporting

confidence: 86%

“…Also aerobic exercise training was shown to reduce circulating catecholamine's (33), which counteracts reduced β-adrenergic density due to overactivation of the sympathetic nervous system and concomitant chronic catecholamine stimulation (34). Thus, sensitization of the β1-receptor through regular exercise might normalize atypical HRPC provoked by chronic stress due to diseases such as type 1 diabetes (10) or cardiovascular disease (11) as shown recently (7).…”

Section: Performance Differencesmentioning

confidence: 88%

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Heart Rate Performance Curve Is Dependent on Age, Sex, and Performance

Birnbaumer

Traninger²,

Borenich

et al. 2020

Front. Public Health

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Introduction: The Heart Rate Performance Curve (HRPC) is neither linear nor uniform and related to ß1-adrenoceptor sensitivity. As aging and exercise influence ß1-adrenoceptors we suggested age, sex and performance effects on the HRPC. Aim of the study was to examine the effects of aging on the deflection of the HRPC in maximal incremental cycle ergometer exercise (CE) in a large cohort of healthy subjects. Methods: Heart rate (HR) data of 2,980 men (51 ± 15 years) and 1,944 women (52 ± 14 years) were classified into age groups (≤20 up to >80 years). We analyzed age and performance (P low 25%-quartile and P high 75%-quartile of age predicted power) effects on HR max and on the degree (k) and the type (regular downward deflection k > 0.1, linear −0.1 ≤ k ≤ 0.1 and atypical upward deflection k < −0.1) of the HRPC. Results: k-values decreased significantly with age in men and women and were significantly higher in women. Atypical HRPC's increased by a linear trend from ≤20 to 70 years (m) respectively 80 years (w) from 10 to 43% (m) and 9 to 30% (w). HR max of all age groups was lower in P low and overall number of atypical HRPC's was 21% (m) and 16% (w) higher compared to P high. Conclusion: Aging increased the number of atypical HRPC's with upward deflection in CE tests, which influences exercise intensity prescription especially when using fixed percentages of HR max. Changes in HRPC's were affected by sex and performance, where women generally and subjects with higher performance presented less atypical HRPC's even at older age.

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Section: Introductionsupporting

confidence: 86%

Section: Performance Differencesmentioning

confidence: 88%

Heart Rate Performance Curve Is Dependent on Age, Sex, and Performance

Birnbaumer

Traninger²,

Borenich

et al. 2020

Front. Public Health

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“…Additionally, the heart rate turn point was defined as the point of intersection of two regression lines in the heart rate to performance curve between LTP 1 and the maximum power output with minimal standard deviation of the two straight lines. The degree and direction of the deflection of the heart rate to performance curve (k HR ) was calculated by a second-degree polynomial function between LTP 1 and the maximum power output ( 12 , 21 ).…”

Section: Methodsmentioning

confidence: 99%

“…As shown previously, different threshold concepts are suitable for healthy ( 6 , 19 ) and T1D individuals ( 20 , 21 ). The first threshold occurring during cardio-pulmonary exercise (CPX) testing [e.g., first lactate turn point (LTP 1 ) or the first ventilatory threshold (VT 1 )] translates to the inability of the muscle to entirely oxidize produced lactate and therefore it is partly shifted into the blood stream and can be metabolized by other organs.…”

Section: Introductionmentioning

confidence: 98%

Different Heart Rate Patterns During Cardio-Pulmonary Exercise (CPX) Testing in Individuals With Type 1 Diabetes

et al. 2018

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To investigate the heart rate during cardio-pulmonary exercise (CPX) testing in individuals with type 1 diabetes (T1D) compared to healthy (CON) individuals. Fourteen people (seven individuals with T1D and seven CON individuals) performed a CPX test until volitional exhaustion to determine the first and second lactate turn points (LTP1 and LTP2), ventilatory thresholds (VT1 and VT2), and the heart rate turn point. For these thresholds cardio-respiratory variables and percentages of maximum heart rate, heart rate reserve, maximum oxygen uptake and oxygen uptake reserve, and maximum power output were compared between groups. Additionally, the degree and direction of the deflection of the heart rate to performance curve (kHR) were compared between groups. Individuals with T1D had similar heart rate at LTP1 (mean difference) −11, [(95% confidence interval) −27 to 4 b.min−1], at VT1 (−12, −8 to 33 b.min−1) and at LTP2 (−7, −13 to 26 b.min−1), at VT2 (−7, −13 to 28 b.min−1), and at the heart rate turn point (−5, −14 to 24 b.min−1) (p = 0.22). Heart rate expressed as percentage of maximum heart rate at LTP1, VT1, LTP2, VT2 and the heart rate turn point as well as expressed as percentages of heart rate reserve at LTP2, VT2 and the heart rate turn point was lower in individuals with T1D (p < 0.05). kHR was lower in T1D compared to CON individuals (0.11 ± 0.25 vs. 0.51 ± 0.32, p = 0.02). Our findings demonstrate that there are clear differences in the heart rate response during CPX testing in individuals with T1D compared to CON individuals. We suggest using submaximal markers to prescribe exercise intensity in people with T1D, as the heart rate at thresholds is influenced by kHR.Clinical Trial Identifier: NCT02075567 (https://clinicaltrials.gov/ct2/show/NCT02075567).

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“…Notably, the HRPC of patients who survived a myocardial infarction is frequently characterized by an upward deflection, and individuals with a more pronounced upward deflection show a more pronounced reduction of LVEF . The pathophysiological value of the HRPC deflection is also supported by more atypical forms in type I diabetic patients with higher HbA1c values …”

Section: Introductionmentioning

confidence: 95%

Exercise‐based cardiac rehabilitation is associated with a normalization of the heart rate performance curve deflection

Heber

Sallaberger-Lehner²,

Hausharter

et al. 2019

Scandinavian Med Sci Sports

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The heart rate (HR) rises with increased power output, whereby in most healthy individuals, the slope of HR levels off with higher intensity. This corresponds to a downward deflection of the heart rate performance curve (HRPC). Conversely, in patients after myocardial infarction, an upward HRPC deflection is frequently observed that is especially pronounced in patients with compromised left ventricular ejection fraction. To investigate whether regular endurance training during cardiac rehabilitation might normalize HRPC, data of 128 male patients were analyzed. All patients performed three exercise tests: at baseline, after 6 weeks, and after 1 year. Ninety‐six patients exercised regularly according to guidelines for 1 year (training group, TG), and 32 stopped after 6 weeks (control group, CG). Similarly, upward‐deflected HRPCs were observed at baseline and after 6 weeks in both groups. After 1 year, TG patients had less upward‐deflected HRPCs compared with CG ones, corresponding to a partial normalization. Greater changes in HRPC deflection were associated with larger improvements in cardiorespiratory fitness. Our results might indicate improved myocardial function due to long‐term rehabilitation. Further, HRPC alterations over time should be considered when prescribing exercise intensities using a target HR, as deflection flattening might render the intensity of corresponding exercise insufficient.

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Heart rate dynamics during cardio-pulmonary exercise testing are associated with glycemic control in individuals with type 1 diabetes

Cited by 18 publications

References 36 publications

Heart Rate Performance Curve Is Dependent on Age, Sex, and Performance

Heart Rate Performance Curve Is Dependent on Age, Sex, and Performance

Different Heart Rate Patterns During Cardio-Pulmonary Exercise (CPX) Testing in Individuals With Type 1 Diabetes

Exercise‐based cardiac rehabilitation is associated with a normalization of the heart rate performance curve deflection

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