ABSTRACT
Left-ventricular dysfunction is diagnosed when the heart rate performance curve (HRPC) of patients deflects upwards during incremental exercise. The aim of this study was to investigate the effect of exercise training on the upward deflection of the HRPC in patients with cardiovascular disease.This study comprised 11 patients who had cardiovascular disease and showed an upward deflection of the HRPC. The patients underwent exercise training (aerobic training, AT intensity: 30-40 minutes, 2-3 sessions/week, and 3-month follow-up). The HRPC of the patients was measured before and after exercise training. We used a method described by Pokan for evaluating the HRPC; the performance curve (PC) index ([PC1 - PC2] × [1 + PC1 × PC2]<sup>-1</sup>) was calculated from PC1 and PC2. PC1 and PC2 refer to the heart rate response before and after the O<sub>2</sub> pulse deflection point, respectively. The PC index indicates the following: PC > 0.1, downward deflection; -0.1 ≤ PC ≤ 0.1, linear time course; PC < -0.1, upward deflection.The PC index significantly increased after exercise training (from -0.22 ± 0.09 to -0.14 ± 0.07; p < 0.05). In addition, the HRPC of 4 patients (37%) changed in linear time course.These results suggest that an upward deflection of the HRPC in patients with cardiovascular disease may shift to a linear time course after exercise training.
ABSTRACT
The purpose of the present study was to develop a new method that enables individualized determination of the optimal exercise intensity for health promotion. Our study was based on the following observations : (1) physical activity at ventilatory threshold (VT) has been useful for enhancing physical fitness and even improving medical conditions such as heart failure, hypertension and diabetes, (2) exercise intensity at VT is characterized by suppressed vagal activity, and (3) vagal activity can be evaluated by analyzing heart rate variability (HRV) . In the first study we defined a criteria for determining the exercise intensity corresponding to VT using HRV analysis (heart rate variability threshold, THRV) . In 16 normal subjects, a time series of ECG RR interval were recorded and the means of the sum of the squared differences in successive RR intervals (MSSDs) were calcu-lated during a ramp exercise test with a cycle ergometer. Based on the values of MSSD and the dif-ferences in successive MSSDs (ΔMSSD) at the intensity of VT, we defined the criteria of THRV as follows : MSSD<25 msec<SUP>2</SUP>and ΔMSSD<6 msec<SUP>2</SUP>. Another exercise test with a cycle ergo-meter was performed to evaluate the relationship between THRV and VT in 63 normal subjects. Heart rate (HR) and oxygen uptake (VO<SUB>2</SUB>/wt) at THRV were 111.8±13.2 beats/min and 15.2±4.4 ml/kg/min, and HR and VO<SUB>2</SUB>/wt at VT were 116.2±11.6beats/min and 16.5±3.7ml/kg/min, respectively. There was a significant correlation between THRV and VT (HR : r=0.82, p<0.001, VO<SUB>2</SUB>/wt : r=0.88, p< 0.001) . Thus, THRV and VT provided almost identical exercise intensities. As a result, we propose that, similar to VT, THRV can be used as an indicator of the optimal exercise intensity suitable for health promotion in normal subjects.