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Kikuchi T, Kasai T. Relationship between heart rate variability and cancer management. World J Cardiol 2025; 17:107434. [DOI: 10.4330/wjc.v17.i5.107434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2025] [Revised: 04/06/2025] [Accepted: 04/18/2025] [Indexed: 05/23/2025] Open
Abstract
In patients with advanced cancer, the prevalence rate of cardiac autonomic neuropathy (CAN) is high, and the prognosis of patients with CAN is generally poor. Although mechanisms including inflammation, infection, metabolism, neurodegeneration, toxic processes, and cancer treatment have been proposed as etiologies of CAN in cancer patients, these mechanisms have not been completely elucidated, and their relationship has only been described indirectly. A study involving 127 cancer patients revealed that both the disease and its treatments can lead to a decrease in heart rate variability (HRV) indicating the autonomic imbalance. Because managing CAN is essential for improving the survival and quality of life of patients with cancer, patients and specialists can work together to customize cancer treatment and management using HRV as an index.
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Affiliation(s)
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
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Martinez P, Dutschmann M, Epercieux V, Gourjon G, Joulia F. Breath-hold diving as a tool to harness a beneficial increase in cardiac vagal tone. Respir Physiol Neurobiol 2025; 334:104416. [PMID: 40096873 DOI: 10.1016/j.resp.2025.104416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Revised: 03/05/2025] [Accepted: 03/06/2025] [Indexed: 03/19/2025]
Abstract
Here we review central mechanisms that mediate the diving bradycardia and propose that breath-hold diving (BH-D) is a powerful therapeutic tool to improve cardiac vagal tone (CVT). Physiological fluctuations in CVT are known as the respiratory heart rate variability (respirHRV) and involve two respiratory-related brainstem mechanisms. During inspiration pre-Bötzinger complex (pre-BötC) neurons inhibit cardiac vagal motor neurons to increase heart rate and subsequently cardiac vagal disinhibition and a decrease in heart rate is associated with a Kölliker-Fuse (KF) nucleus-mediated partial glottal constriction during early expiration. Both KF and pre-BötC receive direct descending cortical inputs that could mediate volitional glottal closure as critical anatomical framework to volitionally target brainstem circuits that generate CVT during BH-D. Accordingly we show that volitional and reflex glottal closure during BH-D appropriates the respirHRV core network to mediate the diving bradycardia via converging trigeminal afferents inputs from the nose and forehead. Additional sensory inputs linked to prolonged BH-D after regular training further increase CVT during the acute dive and can yield a long-term increase in CVT. Centrally, evidence of Hebbian plasticity within respirHRV/BH-D core circuit further support the notion that regular BH-D exercise can yield a permanent increase in CVT specifically via a sensitization of synapse involved in the generation of the respirHRV. Contrary to other regular physical activity, BH-D reportedly does not cause structural remodeling of the heart and therefore we suggest that regular BH-D exercise could be employed as a save and non-invasive approach to treat sympathetic hyperactivity, particularly in elderly patients with cardio-vascular predispositions.
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Affiliation(s)
- Pierrick Martinez
- Laboratory « Jeunesse - Activité Physique et Sportive, Santé »(J-AP2S), University of Toulon, Toulon, France.
| | - Mathias Dutschmann
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH 44106, USA; Center for Sleep Disorders Research, Louis Stokes Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH 44106, USA
| | - Vincent Epercieux
- Aix Marseille Univ., CNRS, IBDM, Institut de Biologie du Développement de Marseille, Marseille, France
| | - Géraud Gourjon
- Scientific and Osteopathic Research Department, Institut de Formation en Ostéopathie du Grand Avignon, 403 Rue Marcel Demonque, Avignon, France
| | - Fabrice Joulia
- Laboratory « Jeunesse - Activité Physique et Sportive, Santé »(J-AP2S), University of Toulon, Toulon, France; Center for Cardiovascular and Nutrition Research C2VN, INSERM 1263 INRAE 1260 Aix Marseille Université, Marseille, France
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Addleman JS, Lackey NS, Tobin MA, Lara GA, Sinha S, Morse RM, Hajduczok AG, Gharbo RS, Gevirtz RN. Heart Rate Variability Applications in Medical Specialties: A Narrative Review. Appl Psychophysiol Biofeedback 2025:10.1007/s10484-025-09708-y. [PMID: 40293647 DOI: 10.1007/s10484-025-09708-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2025]
Abstract
HRV is clinically considered to be a surrogate measure of the asymmetrical interplay of the sympathetic and parasympathetic nervous system. While HRV has become an increasingly measured variable through commercially-available wearable devices, HRV is not routinely monitored or utilized in healthcare settings at this time. The purpose of this narrative review is to discuss and evaluate the current research and potential future applications of HRV in several medical specialties, including critical care, cardiology, pulmonology, nephrology, gastroenterology, endocrinology, infectious disease, hematology and oncology, neurology and rehabilitation, sports medicine, surgery and anesthesiology, rheumatology and chronic pain, obstetrics and gynecology, pediatrics, and psychiatry/psychology. A narrative literature review was conducted with search terms including HRV and relevant terminology to the medical specialty in question. While HRV has demonstrated promise for some diagnoses as a non-invasive, easy to use, and cost-effective metric for early disease detection, prognosis and mortality prediction, disease monitoring, and biofeedback therapy, several issues plague the current literature. Substantial heterogeneity exists in the current HRV literature which limits its applicability in clinical practice. However, applications of HRV in psychiatry, critical care, and in specific chronic diseases demonstrate sufficient evidence to warrant clinical application regardless of the surmountable research issues. More data is needed to understand the exact impact of standardizing HRV monitoring and treatment protocols on patient outcomes in each of the clinical contexts discussed in this paper.
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Affiliation(s)
| | - Nicholas S Lackey
- Center for Applied Biobehavioral Sciences (CABS), Alliant International University, San Diego, CA, USA.
| | - Molly A Tobin
- Touro University CA College of Osteopathic Medicine, Vallejo, CA, USA
| | - Grace A Lara
- Touro University CA College of Osteopathic Medicine, Vallejo, CA, USA
| | - Sankalp Sinha
- Touro University CA College of Osteopathic Medicine, Vallejo, CA, USA
| | - Rebecca M Morse
- Touro University CA College of Osteopathic Medicine, Vallejo, CA, USA
| | - Alexander G Hajduczok
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Raouf S Gharbo
- Virginia Commonwealth University School of Medicine Department of Physical Medicine and Rehabilitation, Richmond, VA, USA
| | - Richard N Gevirtz
- Center for Applied Biobehavioral Sciences (CABS), Alliant International University, San Diego, CA, USA
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Ge MM, Wang LW, Wang J, Liu J, Chen P, Liu XX, Wang G, Gong GW, Jiang ZW. Prediction of perioperative complications in colorectal cancer via artificial intelligence analysis of heart rate variability. World J Gastrointest Surg 2025; 17:102934. [PMID: 40291886 PMCID: PMC12019052 DOI: 10.4240/wjgs.v17.i4.102934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 01/07/2025] [Accepted: 02/08/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Heart rate variability (HRV) represents efferent vagus nerve activity, which is suggested to be related to fundamental mechanisms of tumorigenesis and to be a predictor of prognosis in various cancers. Therefore, this study hypothesized that HRV monitoring could predict perioperative complication (PC) in colorectal cancer (CRC) patients. AIM To investigate the prognostic value of HRV in hospitalized CRC patients. METHODS The observational studies included 87 patients who underwent CRC surgical procedures under enhanced recovery after surgery programs in a first-class hospital. The HRV parameters were compared between the PC group and the non PC (NPC) group from preoperative day 1 to postoperative day (Pod) 3. In addition, inflammatory biomarkers and nutritional indicators were also analyzed. RESULTS The complication rate was 14.9%. HRV was markedly abnormal after surgery, especially in the PC group. The frequency-domain parameters (including pNN50) and time-domain parameters [including high-frequency (HF)] of HRV were significantly different between the two groups postoperatively. The pNN50 was significantly greater at Pod1 in the PC group than that in the NPC group and returned to baseline at Pod2, suggesting that patients with complications exhibited autonomic nerve dysfunction in the early postoperative period. In the PC group, HFs were also enhanced from Pod1 and were significantly higher than in the NPC group; inflammatory biomarkers were significantly elevated at Pod2 and Pod3; the levels of nutritional indicators were significantly lower at Pod1 and Pod2; and the white blood cell count was slightly elevated at Pod3. CONCLUSION HRV is independently associated with postoperative complications in patients with CRC. Abnormal HRV could predicted an increased risk of postoperative complications in CRC patients. Continuous HRV could be used to monitor complications in patients with CRC during the perioperative period.
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Affiliation(s)
- Miao-Miao Ge
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Li-Wen Wang
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong 000000, Hong Kong, China
| | - Jun Wang
- Department of General Surgery, Xuzhou Traditional Chinese Medicine Hospital, The Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, Jiangsu Province, China
| | - Jiang Liu
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Peng Chen
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Xin-Xin Liu
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Gang Wang
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Guan-Wen Gong
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Zhi-Wei Jiang
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
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Huang WB, Lai HZ, Long J, Ma Q, Fu X, You FM, Xiao C. Vagal nerve activity and cancer prognosis: a systematic review and meta-analysis. BMC Cancer 2025; 25:579. [PMID: 40165090 PMCID: PMC11960028 DOI: 10.1186/s12885-025-13956-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 03/17/2025] [Indexed: 04/02/2025] Open
Abstract
BACKGROUND The prognostic significance of vagal nerve (VN) activity, as measured by heart rate variability (HRV) in cancer patients remains a subject of debate. The aim of this meta-analysis was to evaluate the association between various HRV parameters and cancer prognosis. METHODS We conducted an extensive search of the PubMed, Embase, Cochrane, and Web of Science databases and compared the overall survival (OS) of cancer patients with high and low HRV. The data type was unadjusted hazard ratio (HR). Random or fixed-effects models were used to calculate the pooled HR along with the 95% Confidence Interval (CI). We used funnel plot analysis to evaluate potential publication bias. RESULTS A total of 11 cohort studies were included with 2539 participants. The methodological quality of the included studies is generally high. Compared with low standard deviation of normal-to-normal intervals (SDNN) group, higher SDNN was a protective factor for OS in patients with cancer (I2 = 66%, HR = 0.59, 95% CI: 0.46-0.75, P < 0.0001). Compared with low root mean square of successive differences (RMSSD) group. The prognostic value of RMSSD did not reach statistical significance (I2 = 0%, HR = 0.85, 95% CI: 0.70-1.03, P = 0.11). Among the frequency domain indicators, higher high-frequency power HRV (HF-HRV) and low-frequency power HRV (LF-HRV) were associated with significantly longer overall survival compared to the low HF-HRV and LF-HRV groups (I2 = 6%, HR = 0.59, 95% CI: 0.43-0.80, P = 0.006 and I2 = 74%, HR = 0.45, 95% CI: 0.22-0.93, P = 0.03). In the nonlinear indicators, higher maximal diagonal line length (Lmax), mean diagonal line length (Lmean), percent of recurrence (REC), and determinism (DET) were associated with poorer tumor OS. The funnel plot shows that there is no publication bias in the study. CONCLUSIONS The findings of this study demonstrate that HRV parameters, particularly SDNN, HF-HRV, and nonlinear indices, exhibit predictive value for prognosis in cancer. Furthermore, it can be inferred that elevated VN activity may predict prolonged survival outcomes. However, these findings should be interpreted with caution due to the heterogeneity observed across included studies. Future research should prioritize prospective studies with standardized measurement protocols to validate these associations.
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Affiliation(s)
- Wen-Bo Huang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Heng-Zhou Lai
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Long
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiong Ma
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xi Fu
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Institute of Oncology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Feng-Ming You
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
- Institute of Oncology, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
- Oncology Teaching and Research Office of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Chong Xiao
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
- Institute of Oncology, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
- Oncology Teaching and Research Office of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Deng YZ, Song B. Connection between heart rate variability alterations and cancer in tumor patients. World J Cardiol 2025; 17:102999. [PMID: 40161569 PMCID: PMC11947957 DOI: 10.4330/wjc.v17.i3.102999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 12/18/2024] [Accepted: 03/05/2025] [Indexed: 03/21/2025] Open
Abstract
BACKGROUND A significant proportion of cancer patients experience autonomic dysfunction, and cancer treatments such as chemotherapy and radiation therapy can exacerbate impairments in the cardiac autonomic nervous system. This study sought to investigate the characteristics of heart rate variability (HRV) in individuals with cancer. AIM To evaluate the relationship between HRV and cancer patients, providing insights and references for cancer treatment. METHODS The study included 127 cancer patients with available 24-hour dynamic electrocardiogram data. HRV differences were analyzed using both time domain and frequency domain methods. These findings were then compared to HRV data from reference individuals, sourced from literature that utilized the same HRV computing algorithm. RESULTS Our findings revealed that cancer patients generally exhibited abnormal HRV compared to the reference group. HRV was found to be correlated with age and clinical type (P < 0.05), but no significant correlation was observed with tumor site or gender (P > 0.05). CONCLUSION This study indicates that cancer patients have significantly abnormal HRV compared to reference individuals, suggesting the presence of a certain level of cardiac autonomic dysfunction in this patient population.
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Affiliation(s)
- Yu-Zhu Deng
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
- Department of Electrocardiogram, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230000, Anhui Province, China
| | - Bing Song
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.
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Li Z, Fan J, Gong Z, Tang J, Yang Y, Liu M, Zhang M. Association between cardiac autonomic dysfunction, cognitive impairment, and survival in patients with amyotrophic lateral sclerosis. Clin Auton Res 2025:10.1007/s10286-025-01112-0. [PMID: 40056296 DOI: 10.1007/s10286-025-01112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 01/22/2025] [Indexed: 03/10/2025]
Abstract
PURPOSE The aim of this study was to investigate the relationship between cardiac autonomic dysfunction, cognitive impairment, and survival in patients with amyotrophic lateral sclerosis (ALS). METHODS The heart activity of 65 patients with ALS (28 with normal cognition [ALS-CN]; 37 with impaired cognition [ALS-CI]) and 38 healthy controls (HCs) was measured by 24-h Holter monitoring. Heart rate (HR) measures and heart rate variability (HRV) parameters were compared between the three study groups and, additionally, correlated with five Edinburgh Cognitive and Behavioral ALS Screen (ECAS) domains in the ALS subgroups. Age, gender, and educational level were adjusted. Factors associated with cognitive status were assessed using logistic regression. Survival predictors in patients with ALS were analyzed using the Kaplan-Meier estimator and Cox regression. RESULTS Compared to the HCs, patients with ALS-CI exhibited lower RRI (R-R-interval; P = 0.017), SDNN (standard deviation of all normal RR intervals; P = 0.013), SDNN Index (P = 0.044), and VLF power (very low-frequency power; P = 0.012). Total power was reduced in the ALS-CI group compared to the HCs (P = 0.036) and ALS-CN group (P = 0.048). In patients with ALS-CN, language negatively correlated with mean HR (P = 0.001) and positively with the RRI (P = 0.003), SDNN (P = 0.001), SDANN (standard deviation of the average NN intervals; P = 0.005), total power (P = 0.006), VLF power (P = 0.011), and low-frequency power (P = 0.026). Visuospatial function correlated positively with the SDNN Index (P = 0.041). In patients with ALS-CI, executive function (P = 0.015) and ECAS total score (P = 0.009) negatively correlated with the RMSSD (square root of mean sum-of-squares of differences between adjacent NN intervals), while visuospatial function correlated positively with normalized LF value (LFnu; P = 0.049). No associations were observed between the other cognitive domains and any of the 14 HRV/HR measures in patients with either ALS-CI or ALS-CN. SDNN ≤ 100 ms was linked to cognitive impairment (P = 0.039) and also showed a borderline association (P = 0.066) with poorer survival, while cognitive impairment (P = 0.010) was significantly linked to worse outcomes. CONCLUSIONS Patients with ALS with cognitive impairment demonstrated reduced cardiac autonomic modulations and altered cognitive autonomic associations. Cognitive impairment was linked to reduced survival, with baseline SDNN ≤ 100 ms identified as a potential marker.
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Affiliation(s)
- Zehui Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Jingjing Fan
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Zhenxiang Gong
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Jiahui Tang
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yuan Yang
- Department of Neurology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China
| | - Mao Liu
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Min Zhang
- Department of Neurology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, Shanxi, China.
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Hohneck A, Rodríguez ÁM, Weingärtner S, Merx K, Sarodnick F, von Gagern F, Mavratzas A, Burkholder I, Schumacher G, Hofmann WK, Hofheinz RD. Differential effects of sound interventions tuned to 432 Hz or 443 Hz on cardiovascular parameters in cancer patients: a randomized cross-over trial. BMC Complement Med Ther 2025; 25:18. [PMID: 39844155 PMCID: PMC11755923 DOI: 10.1186/s12906-025-04758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 01/13/2025] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND This study investigated whether a sound intervention tuned to 432 Hz (Hz) yields differential effects on cardiovascular parameters and psychological outcomes compared to 443 Hz, which is the concert pitch in German professional orchestras. METHODS Using a randomized cross-over design, patients with cancer were recruited to receive both a 15-minute sound intervention with a body monochord tuned to 432-443 Hz. Before (pre) and after (post) intervention, cardiovascular parameters were measured using the VascAssist2.0. In addition, visual analogue scales (VAS) for emotional well-being, anxiety, stress, pain and sadness were also assessed pre and post intervention. RESULTS 43 patients (8 male, 35 female) with a median age of 61 years (range 35-86) were included. Both interventions led to a significant reduction in heart rate with a more pronounced effect for 432 Hz (median reduction - 3 bpm (432 Hz) vs. median reduction - 1 bpm (443 Hz), p = 0.04). While heart rate variability was increased exclusively by 432 Hz (median increase + 3 ms, p = 0.01), both vascular resistance (median reduction - 5%, p = 0.008) and stiffness (median reduction %, p = 0.04) were significantly reduced by 432 Hz, which was not observed at 443 Hz. Nevertheless, these effects were not significantly different compared to 443 Hz. On the other hand, 432 Hz led to a reduced pulse wave velocity (median reduction - 0.5 m/s, p < 0.001), which was also significantly different compared to 443 Hz (p < 0.001). Improvement in VAS was observed for both groups, with significant increases in emotional well-being and reduction in fatigue, anxiety and stress for both intervention timepoints, although the majority showed no increased VAS scores even before the intervention (median values 0 for anxiety and stress). CONCLUSION Sound interventions tuned to 432-443 Hz exert both positive effects in cancer patients. While psychological outcomes are improved by both interventions, 432 Hz leads to a more pronounced but not significantly different effect to 443 Hz on objective cardiovascular parameters, which reflect deeper relaxation.
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Affiliation(s)
- Anna Hohneck
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
| | - Ánxelo Maia Rodríguez
- Department of Hematology and Oncology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Simone Weingärtner
- Department of Hematology and Oncology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Cancer Center, Mannheim, Germany
| | - Kirsten Merx
- Department of Hematology and Oncology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Felicitas Sarodnick
- Department of Hematology and Oncology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Athanasios Mavratzas
- Department of Obstetrics and Gynecology, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Iris Burkholder
- Department of Nursing and Health, University of Applied Sciences of the Saarland, Saarbruecken, Germany
| | | | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Cancer Center, Mannheim, Germany
| | - Ralf-Dieter Hofheinz
- Department of Hematology and Oncology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Cancer Center, Mannheim, Germany
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D'Andre SD, Ellsworth LL, Kirsch JL, Montane HN, Kruger MB, Donovan KA, Bronars CA, Markovic SN, Ehlers SL. Cancer and Stress: Understanding the Connections and Interventions. Am J Lifestyle Med 2024:15598276241304373. [PMID: 39651486 PMCID: PMC11624519 DOI: 10.1177/15598276241304373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2024] Open
Abstract
Stress is ubiquitous in our modern society and contributes to many disease states. This narrative review describes the effect of stress/distress on cancer development and progression. Seminal randomized controlled trials, systematic reviews/meta-analyses, and distress management guidelines from the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), and the Society for Integrative LinearOncology (SIO) are highlighted. We describe the physiological effects of distress, distress assessment, and management. Psychological treatments are summarized. Evidence-based lifestyle modifications and integrative therapies are reviewed in detail, including mindfulness-based techniques, yoga, guided imagery, breathing techniques, hypnosis, exercise, music therapy, qigong/Tai Chi, eye movement desensitization and reprocessing, and improving sleep and heart rate variability. Recognition and treatment of distress can improve quality of life. More research is needed to determine the effects of managing distress on cancer outcomes, as well as the best type and duration of intervention, noting that the benefits of interventions may be specific for patients with different cancer types.
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Affiliation(s)
- Stacy D. D'Andre
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA (SDD, HNM, MBK, SNM)
| | - Lisa L. Ellsworth
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN, USA (LLE)
| | - Janae L. Kirsch
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (JLK, KAD, CAB, SLE)
| | - Heather N. Montane
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA (SDD, HNM, MBK, SNM)
| | - Margaret B. Kruger
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA (SDD, HNM, MBK, SNM)
| | - Kristine A. Donovan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (JLK, KAD, CAB, SLE)
| | - Carrie A. Bronars
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (JLK, KAD, CAB, SLE)
| | - Svetomir N. Markovic
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA (SDD, HNM, MBK, SNM)
| | - Shawna L. Ehlers
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (JLK, KAD, CAB, SLE)
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Reshef M, Perek S, Odeh T, Hamati K, Raz-Pasteur A. Prognostic Value of Ultra-Short Heart Rate Variability Measures Obtained from Electrocardiogram Recordings of Hospitalized Patients Diagnosed with Non-ST-Elevation Myocardial Infarction. J Clin Med 2024; 13:7255. [PMID: 39685714 DOI: 10.3390/jcm13237255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 11/22/2024] [Accepted: 11/26/2024] [Indexed: 12/18/2024] Open
Abstract
Background: Myocardial infarction (MI) is a common emergency with high rates of morbidity and mortality. Current risk stratification scores for non-ST-elevation MI (NSTEMI) use subjective or delayed information. Heart rate variability was shown to correlate with prognosis following MI. This study aimed to evaluate ultra-short heart rate variability (usHRV) as a prognostic factor in NSTEMI patients. Methods: A retrospective analysis was performed on 183 NSTEMI patients admitted to Rambam Health Care Campus in 2014. usHRV measures, including the standard deviation of normal-to-normal intervals (SDNN) and root mean square of successive differences (RMSSD), were calculated. Logistic regression assessed whether clinical, laboratory, or usHRV parameters predicted severe in-hospital complications like heart failure (HF), atrial flutter/fibrillation (AFL/AF), ventricular tachycardia/fibrillation (VT/VF), and atrioventricular block (AVB). Both Cox and logistic regression were used for survival analysis. Results: Of 183 patients (71.6% male, mean age 67.1), 35 (19%) died within 2 years. In-hospital complications included 39 cases (21.3%) of HF, 3 cases (1.6%) of VT/VF, and 9 cases (4.9%) of AVB. Lower usHRV was significantly associated with higher mortality at 2 years and showed marginal significance at 90 days and 1 year. Increased usHRV was linked to a higher risk of in-hospital ventricular arrhythmia (VT/VF). Conclusions: Overall, this study is in agreement with previous research, showing a correlation between low usHRV and a higher mortality risk. However, the association between usHRV and the risk of VT/VF demands further investigation. More expansive prospective studies are needed to strengthen the observed associations.
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Affiliation(s)
- Maya Reshef
- Internal Medicine "A" Department, Rambam Medical Health Care Campus, Haifa 3109601, Israel
| | - Shay Perek
- Internal Medicine "A" Department, Rambam Medical Health Care Campus, Haifa 3109601, Israel
- Emergency Medicine Department, Rambam Medical Health Care Campus, Haifa 3109601, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525422, Israel
| | - Tamer Odeh
- Internal Medicine "A" Department, Rambam Medical Health Care Campus, Haifa 3109601, Israel
- Emergency Medicine Department, Rambam Medical Health Care Campus, Haifa 3109601, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525422, Israel
| | - Khalil Hamati
- Internal Medicine "A" Department, Rambam Medical Health Care Campus, Haifa 3109601, Israel
| | - Ayelet Raz-Pasteur
- Internal Medicine "A" Department, Rambam Medical Health Care Campus, Haifa 3109601, Israel
- Emergency Medicine Department, Rambam Medical Health Care Campus, Haifa 3109601, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525422, Israel
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11
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Mikolaskova I, Zvarik M, Szaboova K, Tibenska E, Durmanova V, Suchankova M, Kollarik B, Hesko P, Palacka P, Bucova M, Hunakova L. Association of Sympathovagal Imbalance with Increased Inflammation and Impaired Adaptive Immunity in Bladder Cancer Patients. Int J Mol Sci 2024; 25:12765. [PMID: 39684475 DOI: 10.3390/ijms252312765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Revised: 11/20/2024] [Accepted: 11/26/2024] [Indexed: 12/18/2024] Open
Abstract
Stress responses can impact bladder cancer (BC) outcomes via immune-inflammatory pathway modulation. This study explores heart rate variability (HRV) associations with serum immune-inflammatory biomarkers, blood count inflammatory markers, and psychosocial self-report measures in patients versus healthy controls. The TREM-1 and TREM-2 expressions on peripheral blood monocytes were analysed via flow cytometry; serum inflammatory biomarkers by ELISA; HRV (5-min ECG) pre-tumour resection; blood counts by haematology analyser; and psychosocial factors by validated questionnaires. Patients exhibited altered immune-inflammatory profiles with increased TREM-1/TREM-2, sTREM-1, sTREM-1/sTREM-2 ratio, BDNF, MCP-1, and NLR, and reduced IFN-γ, IL-10, LMR, and PMR. HRV analysis indicated sympathetic dominance (SNS, Stress indices, ACmod) and reduced parasympathetic modulation (PNS index, SDNN, RMSSD, 2UV%, DCmod, SD1). Sympathetic HRV indices correlated positively with sTREM-1, sTREM-1/sTREM-2 ratio, fractalkine, and inflammatory markers (SII, NLR, PLR) and negatively with parasympathetic HRV indices-correlations absent in controls. Only in patients, reduced physical function and social support, and higher anxiety, depression, and fatigue, associated positively with sympathetic HRV indices and inflammatory markers. This study links immune-inflammatory markers, HRV parameters, and psychosocial factors in BC, suggesting that immune and autonomic variations may relate to unfavourable outcomes. Incorporating these assessments could help tailor more personalised treatment strategies for BC patients.
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Affiliation(s)
- Iveta Mikolaskova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, Odborarske namestie 14, 811 08 Bratislava, Slovakia
| | - Milan Zvarik
- Department of Nuclear Physics and Biophysics, Faculty of Mathematics, Physics and Computer Science, Comenius University in Bratislava, Mlynska dolina F1, 842 48 Bratislava, Slovakia
| | - Kinga Szaboova
- Medirex, s.r.o., Galvaniho 17/C, 820 16 Bratislava, Slovakia
| | - Elena Tibenska
- Medirex, s.r.o., Galvaniho 17/C, 820 16 Bratislava, Slovakia
| | - Vladimira Durmanova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, Odborarske namestie 14, 811 08 Bratislava, Slovakia
| | - Magda Suchankova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, Odborarske namestie 14, 811 08 Bratislava, Slovakia
| | - Boris Kollarik
- Department of Urology, Saint Cyril and Methodius Hospital, Antolska 11, 851 07 Bratislava, Slovakia
| | - Patrik Hesko
- Department of Urology, Saint Cyril and Methodius Hospital, Antolska 11, 851 07 Bratislava, Slovakia
| | - Patrik Palacka
- 2nd Department of Oncology, Faculty of Medicine, Comenius University in Bratislava, Kolarska 12, 812 50 Bratislava, Slovakia
| | - Maria Bucova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, Odborarske namestie 14, 811 08 Bratislava, Slovakia
| | - Luba Hunakova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, Odborarske namestie 14, 811 08 Bratislava, Slovakia
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12
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Porto AA, Gonzaga LA, Ribeiro F, de Oliveira CM, Marques Vanderlei LC, Valenti VE. L-Arginine Supplementation Did Not Impact the Rapid Recovery of Cardiovascular and Autonomic Function Following Exercise in Physically Active Healthy Males: A Triple-Blind Randomised Placebo-Controlled Crossover Trial. Nutrients 2024; 16:4067. [PMID: 39683461 PMCID: PMC11643886 DOI: 10.3390/nu16234067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 11/13/2024] [Accepted: 11/25/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND AND AIMS Post-exercise recovery strategies include massage, low-intensity active exercise, thermal contrast, hydration, and nutritional and herbal approaches. These strategies aim to accelerate recovery, enhance performance, and optimise the physical training process. L-arginine (L-ARG) is the physiological precursor of nitric oxide (NO), a crucial mediator of vasodilation and the inhibition of platelet aggregation. A previous study reported that L-ARG supplementation could significantly reduce the systolic blood pressure (SBP) and diastolic blood pressure (DBP). This study aimed to investigate the effects of L-ARG on autonomic and cardiovascular recovery immediately following submaximal exercise. METHODS AND RESULTS Thirty-two healthy individuals were subjected to two experimental protocols. The first protocol included 60 min of rest, a treadmill warm-up, and load increments until reaching 80% of their maximum HR. Before this protocol, the subjects consumed 3 g of starch (placebo protocol). The second protocol was identical, but the subjects consumed 3 g of L-ARG. Heart rate recovery (HRR), heart rate variability (HRV), and blood pressure (BP) responses were assessed. No significant differences in HRR were found (p = 0.944) regarding the root mean square of successive differences in the RR interval (RMSSD30) of HRV (p = 0.562) or in the BP responses (mean arterial pressure (MAP), p = 0.687; pulse pressure (PP), p = 0.929) between the protocols. CONCLUSIONS L-ARG supplementation did not significantly alter immediate post-exercise autonomic recovery in healthy males.
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Affiliation(s)
- Andrey Alves Porto
- Postgraduate Program in Movement Sciences, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, SP, Brazil; (L.A.G.); (F.R.); (L.C.M.V.); (V.E.V.)
- Systematic Reviews Center for Cardiovascular and Metabolic Health, Sao Paulo State University (UNESP), Marilia 17525-900, SP, Brazil;
| | - Luana Almeida Gonzaga
- Postgraduate Program in Movement Sciences, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, SP, Brazil; (L.A.G.); (F.R.); (L.C.M.V.); (V.E.V.)
| | - Felipe Ribeiro
- Postgraduate Program in Movement Sciences, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, SP, Brazil; (L.A.G.); (F.R.); (L.C.M.V.); (V.E.V.)
| | - Camila Marcondes de Oliveira
- Systematic Reviews Center for Cardiovascular and Metabolic Health, Sao Paulo State University (UNESP), Marilia 17525-900, SP, Brazil;
| | - Luiz Carlos Marques Vanderlei
- Postgraduate Program in Movement Sciences, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, SP, Brazil; (L.A.G.); (F.R.); (L.C.M.V.); (V.E.V.)
| | - Vitor Engrácia Valenti
- Postgraduate Program in Movement Sciences, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, SP, Brazil; (L.A.G.); (F.R.); (L.C.M.V.); (V.E.V.)
- Systematic Reviews Center for Cardiovascular and Metabolic Health, Sao Paulo State University (UNESP), Marilia 17525-900, SP, Brazil;
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13
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Durmanova V, Mikolaskova I, Zsemlye E, Ocenasova A, Bandzuchova H, Suchankova M, Kollarik B, Palacka P, Zvarik M, Bucova M, Hunakova L. Association of HLA-G Expression, Its Genetic Variants and Related Neuro-Immunomodulation with Characteristics of Bladder Carcinoma. Cancers (Basel) 2024; 16:3877. [PMID: 39594832 PMCID: PMC11593171 DOI: 10.3390/cancers16223877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 11/15/2024] [Accepted: 11/18/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND Human leukocyte antigen G (HLA-G) is an immune checkpoint molecule with immunosuppressive and anti-inflammatory activities. It belongs to class I non-classical major histocompatibility complex molecules and has been upregulated in various cancer types. In bladder cancer (BC) tumors, the association of HLA-G with cancer progression has to be explained. METHODS A total of 89 BC patients and 74 control subjects were genotyped for the HLA-G 14 bp ins/del polymorphism. In urine cell samples, HLA-G mRNA expression was analyzed using real-time PCR. Soluble HLA-G (sHLA-G) serum levels were measured by ELISA. The associations between the HLA-G 14 bp ins/del polymorphism, HLA-G mRNA expression, and/or sHLA-G levels and selected variables including tumor grade, disease stage, body mass index, and heart rate variability (HRV) parameters were evaluated. RESULTS The protective HLA-G 14 bp ins/ins genotype under the recessive genetic model was associated with lower HLA-G mRNA expression in the BC group (p = 0.049). Significantly higher HLA-G mRNA expression was detected in patients with pT2 + pT3 as compared to those with pTa + pT1 stages (p = 0.0436). Furthermore, higher HLA-G mRNA expression was observed in high-grade muscle-infiltrating BC (MIBC) than in the low-grade non-MIBC group (p = 0.0365). Patients with a level of sHLA-G above 29 U/mL had shorter disease-free survival than patients with lower sHLA-G levels. Furthermore, the opposite HRV correlations with sHLA-G levels in BC patients as compared to controls probably reflect the different roles of HLA-G in health and cancer. CONCLUSIONS Our results suggest the impact of the HLA-G 14 bp ins/del variant, HLA-G expression, and autonomic nervous system imbalance on advanced stages of BC.
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Affiliation(s)
- Vladimira Durmanova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, 811 08 Bratislava, Slovakia; (V.D.); (I.M.); (A.O.); (M.S.); (M.B.)
| | - Iveta Mikolaskova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, 811 08 Bratislava, Slovakia; (V.D.); (I.M.); (A.O.); (M.S.); (M.B.)
| | - Eszter Zsemlye
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, 811 08 Bratislava, Slovakia; (V.D.); (I.M.); (A.O.); (M.S.); (M.B.)
| | - Agata Ocenasova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, 811 08 Bratislava, Slovakia; (V.D.); (I.M.); (A.O.); (M.S.); (M.B.)
| | | | - Magda Suchankova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, 811 08 Bratislava, Slovakia; (V.D.); (I.M.); (A.O.); (M.S.); (M.B.)
| | - Boris Kollarik
- Department of Urology, Saints Cyril and Methodius Hospital, University Hospital Bratislava, 851 07 Bratislava, Slovakia
| | - Patrik Palacka
- 2nd Department of Oncology, Faculty of Medicine and National Cancer Institute, Comenius University, Klenova 1, 833 10 Bratislava, Slovakia;
- Cancer Research Institute, Biomedical Research Center of the Slovak Academy of Sciences, 814 39 Bratislava, Slovakia
| | - Milan Zvarik
- Department of Nuclear Physics and Biophysics, Faculty of Mathematics, Physics and Computer Science, Comenius University in Bratislava, 842 48 Bratislava, Slovakia;
| | - Maria Bucova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, 811 08 Bratislava, Slovakia; (V.D.); (I.M.); (A.O.); (M.S.); (M.B.)
| | - Luba Hunakova
- Institute of Immunology, Faculty of Medicine, Comenius University in Bratislava, 811 08 Bratislava, Slovakia; (V.D.); (I.M.); (A.O.); (M.S.); (M.B.)
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14
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Gitler A, Levine AD, Ayub AEA, Munteanu AG, Lulu OB, Gidron Y. Preoperative vagal activity predicts clinical outcomes after total knee replacement. Exp Ther Med 2024; 28:393. [PMID: 39161609 PMCID: PMC11332153 DOI: 10.3892/etm.2024.12682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/08/2024] [Indexed: 08/21/2024] Open
Abstract
Total knee replacement (TKR) surgery carries with it significant surgical trauma and activates complex inflammatory pathways, which initially assist healing. However, impaired regulation of inflammatory pathways can cause tissue damage and postoperative complications. The vagus nerve regulates inflammation, the activity of which is indexed by heart-rate variability (HRV), which predicts postoperative pain, longer hospitalization and improved recovery during the postoperative period. The present study examined the relationship between presurgical HRV, inflammation and complications after TKR. The present study assessed data from 41 patients undergoing TKR. A retrospective design was used, where preoperative electrocardiograms were scanned to determine HRV. Outcome measures included inflammation [C-reactive protein (CRP) levels] over four postoperative days, length of stay (LOS), and complications. Preoperative HRV predicted the trajectory of postoperative CRP levels. The low HRV group demonstrated higher overall postoperative CRP and a longer time to recover than patients with high HRV. Furthermore, the magnitude of inflammatory decline between postoperative days two and four was associated with LOS. However, HRV did not predict postoperative complications. In conclusion, patients with lower presurgical vagal activity had a worse postoperative inflammatory profile than those with high vagal tone. In the age of personalized medicine, such findings may have implications for identifying and preparing patients before surgery.
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Affiliation(s)
- Asaf Gitler
- Faculty of Social Welfare and Health Sciences, The Cheryl Spencer Department of Nursing, University of Haifa, Haifa 3498838, Israel
- Department of Orthopedic Surgery, Bnai Zion Medical Center, Haifa 31048, Israel
| | - Ariel David Levine
- Department of Orthopedic Surgery, Bnai Zion Medical Center, Haifa 31048, Israel
| | - Abd El Azim Ayub
- Department of Orthopedic Surgery, Bnai Zion Medical Center, Haifa 31048, Israel
| | | | - Oren Ben Lulu
- Department of Orthopedic Surgery, Bnai Zion Medical Center, Haifa 31048, Israel
| | - Yori Gidron
- Faculty of Social Welfare and Health Sciences, The Cheryl Spencer Department of Nursing, University of Haifa, Haifa 3498838, Israel
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15
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O’Grady B, Lambe R, Baldwin M, Acheson T, Doherty C. The Validity of Apple Watch Series 9 and Ultra 2 for Serial Measurements of Heart Rate Variability and Resting Heart Rate. SENSORS (BASEL, SWITZERLAND) 2024; 24:6220. [PMID: 39409260 PMCID: PMC11478500 DOI: 10.3390/s24196220] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 09/13/2024] [Accepted: 09/19/2024] [Indexed: 10/20/2024]
Abstract
The widespread use of wearable devices has enabled continuous monitoring of biometric data, including heart rate variability (HRV) and resting heart rate (RHR). However, the validity of these measurements, particularly from consumer devices like Apple Watch, remains underexplored. This study aimed to validate HRV measurements obtained from Apple Watch Series 9 and Ultra 2 against the Polar H10 chest strap paired with the Kubios HRV software, which together served as the reference standard. A prospective cohort of 39 healthy adults provided 316 HRV measurements over a 14-day period. Generalized Estimating Equations were used to assess the difference in HRV between devices, accounting for repeated measures. Apple Watch tended to underestimate HRV by an average of 8.31 ms compared to the Polar H10 (p = 0.025), with a mean absolute percentage error (MAPE) of 28.88% and a mean absolute error (MAE) of 20.46 ms. The study found no significant impact of RHR discrepancies on HRV differences (p = 0.156), with RHR showing a mean difference of -0.08 bpm, an MAPE of 5.91%, and an MAE of 3.73 bpm. Equivalence testing indicated that the HRV measurements from Apple Watch did not fall within the pre-specified equivalence margin of ±10 ms. Despite accurate RHR measurements, these findings underscore the need for improved HRV algorithms in consumer wearables and caution in interpreting HRV data for clinical or performance monitoring.
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Affiliation(s)
- Ben O’Grady
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04V1W8 Dublin, Ireland; (B.O.); (R.L.); (M.B.); (T.A.)
- Insight SFI Research Centre for Data Analytics, University College Dublin, D04V1W8 Dublin, Ireland
| | - Rory Lambe
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04V1W8 Dublin, Ireland; (B.O.); (R.L.); (M.B.); (T.A.)
- Insight SFI Research Centre for Data Analytics, University College Dublin, D04V1W8 Dublin, Ireland
| | - Maximus Baldwin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04V1W8 Dublin, Ireland; (B.O.); (R.L.); (M.B.); (T.A.)
- Insight SFI Research Centre for Data Analytics, University College Dublin, D04V1W8 Dublin, Ireland
- Institute for Sport and Health, University College Dublin, D04V1W8 Dublin, Ireland
| | - Tara Acheson
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04V1W8 Dublin, Ireland; (B.O.); (R.L.); (M.B.); (T.A.)
- Institute for Sport and Health, University College Dublin, D04V1W8 Dublin, Ireland
| | - Cailbhe Doherty
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04V1W8 Dublin, Ireland; (B.O.); (R.L.); (M.B.); (T.A.)
- Insight SFI Research Centre for Data Analytics, University College Dublin, D04V1W8 Dublin, Ireland
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16
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Bitencourt THB, de Oliveira CM, Porto AA, de Andrade DC, Garner DM, Raimundo RD, Valenti VE. A Systematic Review and Meta-Analysis of Randomized Trials to Evaluate the Impact of Exercise on Heart Rate Variability Post-Bariatric Surgery. J Cardiovasc Dev Dis 2024; 11:248. [PMID: 39195156 DOI: 10.3390/jcdd11080248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 08/29/2024] Open
Abstract
Bariatric surgery is an approach used to treat patients with obesity in a small minority of eligible patients. Non-pharmacological therapies are important to maintain decent health status post-bariatric surgery. We performed a systematic review with meta-analysis to evaluate the effects of exercise on heart rate variability (HRV) in patients submitted to bariatric surgery. The searches were made via MEDLINE/PubMed (via the National Library of Medicine), EMBASE, Web of Science, and Scopus databases. We included non-blind, single-, or double-blind randomized control trials in patients older than 18 years of age submitted to bariatric surgery. The intervention group should be submitted to an exercise training protocol, including aerobic, strength, and other exercise modality after bariatric surgery. We documented 245 studies, and after screening and eligibility phases, only 4 were included. We observed no significant change for the SDNN: subtotal = 19.74 (CI: -4.98, 44.45), p = 0.12, I2 = 85% (very low quality of evidence); pNN50: subtotal = 13.09 (CI: -9.17, 35.35), p = 0.25, I2 = 93% (very low quality of evidence); RMSSD: subtotal = 8.44 (CI: -3.61, 25.50), p = 0.17, I2 = 95% (very low quality of evidence); SD1: subtotal = 9.36 (CI: -4.48, 23.21), p = 0.19, I2 = 96% (very low quality of evidence). We could not detect significant effects of exercise on resting HRV after bariatric surgery. The low certainty of the results via the evidence level analysis suggest further studies might be beneficial.
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Affiliation(s)
- Tulio H B Bitencourt
- Autonomic Nervous System Center, Sao Paulo State University (UNESP), Marilia 17525-900, SP, Brazil
| | | | - Andrey A Porto
- Autonomic Nervous System Center, Sao Paulo State University (UNESP), Marilia 17525-900, SP, Brazil
| | - Davi C de Andrade
- Autonomic Nervous System Center, Sao Paulo State University (UNESP), Marilia 17525-900, SP, Brazil
| | - David M Garner
- Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Gipsy Lane, Oxford OX3 0BP, UK
| | - Rodrigo D Raimundo
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário Faculdade de Medicina do ABC, Santo Andre 09060-870, SP, Brazil
| | - Vitor E Valenti
- Autonomic Nervous System Center, Sao Paulo State University (UNESP), Marilia 17525-900, SP, Brazil
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17
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Speer KE, Naumovski N, McKune AJ. Heart rate variability to track autonomic nervous system health in young children: Effects of physical activity and cardiometabolic risk factors. Physiol Behav 2024; 281:114576. [PMID: 38692385 DOI: 10.1016/j.physbeh.2024.114576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/03/2024]
Abstract
Evidence for a key role of dysregulated autonomic nervous system (ANS) activity in maladaptive stress response/recovery and non-communicable disease development is extensive. Monitoring ANS activity via regular heart rate variability (HRV) measurement is growing in popularity in adult populations given that low HRV has been associated with ANS dysregulation, poor stress response/reactivity, increased cardiometabolic disease risk and early mortality. Although cardiometabolic disease may originate in early life, regular HRV measurement for assessing ANS activity in childhood populations, especially those consisting of children < 6 years of age, remains largely unpractised. A greater understanding of ANS activity modifiers in early life may improve analysis and interpretation of HRV measurements, thereby optimising its usefulness. Taking into consideration that HRV and ANS activity can be improved via daily engagement in physical activity (PA), this review will discuss the ANS and HRV, ANS activity modifiers, cardiometabolic disease risk factors and PA as they relate to childhood/adolescent populations (≤ 18 years old).
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Affiliation(s)
- Kathryn E Speer
- Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Research Institute of Sport and Exercise, University of Canberra, 11 Kirinari Street, Bruce, 2617, Australia.
| | - Nenad Naumovski
- Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Research Institute of Sport and Exercise, University of Canberra, 11 Kirinari Street, Bruce, 2617, Australia; Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, 17671, Greece
| | - Andrew J McKune
- Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Research Institute of Sport and Exercise, University of Canberra, 11 Kirinari Street, Bruce, 2617, Australia; Discipline of Biokinetics, Exercise and Leisure Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, 4000, South Africa
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18
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Sammito S, Thielmann B, Klussmann A, Deußen A, Braumann KM, Böckelmann I. Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science. J Occup Med Toxicol 2024; 19:15. [PMID: 38741189 PMCID: PMC11089808 DOI: 10.1186/s12995-024-00414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
This updated guideline replaces the "Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science" first published in 2014. Based on the older version of the guideline, the authors have reviewed and evaluated the findings on the use of heart rate (HR) and heart rate variability (HRV) that have been published in the meantime and incorporated them into a new version of this guideline.This guideline was developed for application in clinical practice and research purposes in the fields of occupational medicine and occupational science to complement evaluation procedures with respect to exposure and risk assessment at the workplace by the use of objective physiological workload indicators. In addition, HRV is also suitable for assessing the state of health and for monitoring the progress of illnesses and preventive medical measures. It gives an overview of factors influencing the regulation of the HR and HRV at rest and during work. It further illustrates methods for measuring and analyzing these parameters under standardized laboratory and real workload conditions, areas of application as well as the quality control procedures to be followed during the recording and evaluation of HR and HRV.
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Affiliation(s)
- Stefan Sammito
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
- German Air Force Centre of Aerospace Medicine, Experimental Aerospace Medicine Research, Flughafenstraße 1, Cologne, 51147, Germany.
| | - Beatrice Thielmann
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Andre Klussmann
- Competence Centre Health (CCG), Department Health Sciences, University of Applied Sciences (HAW) Hamburg, Hamburg, Germany
| | - Andreas Deußen
- Department of Physiology, Medical Faculty, TU Dresden, Dresden, Germany
| | | | - Irina Böckelmann
- Department of Occupational Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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19
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Haas A, Chung J, Kent C, Mills B, McCoy M. Vertebral Subluxation and Systems Biology: An Integrative Review Exploring the Salutogenic Influence of Chiropractic Care on the Neuroendocrine-Immune System. Cureus 2024; 16:e56223. [PMID: 38618450 PMCID: PMC11016242 DOI: 10.7759/cureus.56223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
In this paper we synthesize an expansive body of literature examining the multifaceted influence of chiropractic care on processes within and modulators of the neuroendocrine-immune (NEI) system, for the purpose of generating an inductive hypothesis regarding the potential impacts of chiropractic care on integrated physiology. Taking a broad, interdisciplinary, and integrative view of two decades of research-documented outcomes of chiropractic care, inclusive of reports ranging from systematic and meta-analysis and randomized and observational trials to case and cohort studies, this review encapsulates a rigorous analysis of research and suggests the appropriateness of a more integrative perspective on the impact of chiropractic care on systemic physiology. A novel perspective on the salutogenic, health-promoting effects of chiropractic adjustment is presented, focused on the improvement of physical indicators of well-being and adaptability such as blood pressure, heart rate variability, and sleep, potential benefits that may be facilitated through multiple neurologically mediated pathways. Our findings support the biological plausibility of complex benefits from chiropractic intervention that is not limited to simple neuromusculoskeletal outcomes and open new avenues for future research, specifically the exploration and mapping of the precise neural pathways and networks influenced by chiropractic adjustment.
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Affiliation(s)
- Amy Haas
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
| | - Jonathan Chung
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
| | - Christopher Kent
- Research, Sherman College, Spartanburg, USA
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
| | - Brooke Mills
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
| | - Matthew McCoy
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
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20
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Martinez P, Grinand M, Cheggour S, Taieb J, Gourjon G. How to properly evaluate cardiac vagal tone in oncology studies: a state-of-the-art review. JOURNAL OF THE NATIONAL CANCER CENTER 2024; 4:36-46. [PMID: 39036385 PMCID: PMC11256691 DOI: 10.1016/j.jncc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 07/23/2024] Open
Abstract
Heart rate variability (HRV) analysis provides an assessment of cardiac vagal tone and consequently global cardiac health as well as systemic condition. In systemic diseases such as cancer and during treatments that affect the whole body, like chemotherapy, the vagus nerve activity is low and deregulated. Some studies focus on using HRV to predict mortality in oncology. However, in cancer patients, systemic alterations substantially increase artifacts during HRV measurement, especially atrial ectopic beats. Moreover, HRV may be altered by various factors (duration and time of measurement, breathing, drugs, and other confounding factors) that alter each metric in different ways. The Standard Deviation of all Normal to Normal intervals (SDNN) is the most commonly used metric to evaluate HRV in oncology, but it does not appear to be specific to the cardiac vagal tone. Thus, cardiac vagal activity diagnosis and vital prognosis of cancer patients can be biased. Our review presents the main HRV metrics that can be currently used in oncology studies and their links with vagus nerve and cancer. We present the influence of external factors and the required duration and time of measurement. Considering all these parameters, this review proposes seven key points for an assessment of HRV and cardiac vagal tone in patients with cancer.
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Affiliation(s)
- Pierrick Martinez
- Scientific and Osteopathic Research Department, Institut de Formation en Ostéopathie du Grand Avignon, 403 Rue Marcel Demonque, Avignon, France
| | - Marilyne Grinand
- Département de recherche clinique, Centre hospitalier d'Avignon, 305A Rue Raoul Follereau, Avignon, France
| | - Saïda Cheggour
- Service de cardiologie, Centre hospitalier d'Avignon, 305A Rue Raoul Follereau, Avignon, France
| | - Jérôme Taieb
- Service de cardiologie, Centre Hospitalier du pays d'Aix-Pertuis, Avenue des Tamaris Aix-en-Provence, France
| | - Géraud Gourjon
- Scientific and Osteopathic Research Department, Institut de Formation en Ostéopathie du Grand Avignon, 403 Rue Marcel Demonque, Avignon, France
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21
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Ben-David K, Wittels HL, Wishon MJ, Lee SJ, McDonald SM, Howard Wittels S. Tracking Cancer: Exploring Heart Rate Variability Patterns by Cancer Location and Progression. Cancers (Basel) 2024; 16:962. [PMID: 38473322 DOI: 10.3390/cancers16050962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Reduced heart rate variability (HRV) is an autonomic nervous system (ANS) response that may indicate dysfunction in the human body. Consistent evidence shows cancer patients elicit lower HRV; however, only select cancer locations were previously evaluated. Thus, the aim of the current study was to explore HRV patterns in patients diagnosed with and in varying stages of the most prevalent cancers. At a single tertiary academic medical center, 798 patients were recruited. HRV was measured via an armband monitor (Warfighter MonitorTM, Tiger Tech Solutions, Inc., Miami, FL, USA) equipped with electrocardiographic capabilities and was recorded for 5 to 7 min with patients seated in an upright position. Three time-domain metrics were calculated: SDNN (standard deviation of the NN interval), rMSSD (the root mean square of successive differences of NN intervals), and the percentage of time in which the change in successive NN intervals exceeds 50ms within a measurement (pNN50). Of the 798 patients, 399 were diagnosed with cancer. Cancer diagnoses were obtained via medical records one week following the measurement. Analysis of variance models were performed comparing the HRV patterns between different cancers, cancer stages (I-IV), and demographic strata. A total of 85% of the cancer patients had breast, gastrointestinal, genitourinary, or respiratory cancer. The cancer patients were compared to a control non-cancer patient population with similar patient size and distributions for sex, age, body mass index, and co-morbidities. For all HRV metrics, non-cancer patients exhibited significantly higher rMSSDs (11.1 to 13.9 ms, p < 0.0001), SDNNs (22.8 to 27.7 ms, p < 0.0001), and pNN50s (6.2 to 8.1%, p < 0.0001) compared to stage I or II cancer patients. This significant trend was consistently observed across each cancer location. Similarly, compared to patients with stage III or IV cancer, non-cancer patients possessed lower HRs (-11.8 to -14.0 bpm, p < 0.0001) and higher rMSSDs (+31.7 to +32.8 ms, p < 0.0001), SDNNs (+45.2 to +45.8 ms), p < 0.0001, and pNN50s (19.2 to 21.6%, p < 0.0001). The HR and HRV patterns observed did not significantly differ between cancer locations (p = 0.96 to 1.00). The depressed HRVs observed uniformly across the most prevalent cancer locations and stages appeared to occur independent of patients' co-morbidities. This finding highlights the potentially effective use of HRV as a non-invasive tool for determining common cancer locations and their respective stages. More studies are needed to delineate the HRV patterns across different ages, between sexes and race/ethnic groups.
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Affiliation(s)
- Kfir Ben-David
- Department of Surgery, Division of Oncology, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Department of Surgery, Wertheim School of Medicine, Florida International University, Miami, FL 33199, USA
| | - Harrison L Wittels
- Tiger Tech Solutions, Inc., Miami, FL 33156, USA
- Science, Technology and Research, Inc., Miami, FL 33156, USA
| | | | - Stephen J Lee
- United States Army Research Laboratory, United States Army Combat Capabilities Development Command, Adelphi, MD 20783, USA
| | - Samantha M McDonald
- Tiger Tech Solutions, Inc., Miami, FL 33156, USA
- School of Kinesiology and Recreation, Illinois State University, Normal, IL 61761, USA
| | - S Howard Wittels
- Tiger Tech Solutions, Inc., Miami, FL 33156, USA
- Science, Technology and Research, Inc., Miami, FL 33156, USA
- Department of Anesthesiology, Mount Sinai Medical Center, Miami, FL 33140, USA
- Department of Anesthesiology, Wertheim School of Medicine, Florida International University, Miami, FL 33199, USA
- Miami Beach Anesthesiology Associates, Miami, FL 33140, USA
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22
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Ritz T. Putting back respiration into respiratory sinus arrhythmia or high-frequency heart rate variability: Implications for interpretation, respiratory rhythmicity, and health. Biol Psychol 2024; 185:108728. [PMID: 38092221 DOI: 10.1016/j.biopsycho.2023.108728] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
Research on respiratory sinus arrhythmia, or high-frequency heart rate variability (its frequency-domain equivalent), has been popular in psychology and the behavioral sciences for some time. It is typically interpreted as an indicator of cardiac vagal activity. However, as research has shown for decades, the respiratory pattern can influence the amplitude of these noninvasive measures substantially, without necessarily reflecting changes in tonic cardiac vagal activity. Although changes in respiration are systematically associated with experiential and behavioral states, this potential confound in the interpretation of RSA, or HF-HRV, is rarely considered. Interpretations of within-individual changes in these parameters are therefore only conclusive if undertaken relative to the breathing pattern. The interpretation of absolute levels of these parameters between individuals is additionally burdened with the problem of residual inspiratory cardiac vagal activity in humans. Furthermore, multiple demographic, anthropometric, life-style, health, and medication variables can act as relevant third variables that might explain associations of RSA or HF-HRV with experiential and behavioral variables. Because vagal activity measured by these parameters only represents the portion of cardiac vagal outflow that is modulated by the respiratory rhythm, alternative interpretations beyond cardiac vagal activity should be considered. Accumulating research shows that activity of multiple populations of neurons in the brain and the periphery, and with that organ activity and function, are modulated rhythmically by respiratory activity. Thus, observable health benefits ascribed to the cardiac vagal system through RSA or HF-HRV may actually reflect beneficial effects of respiratory modulation. Respiratory rhythmicity may ultimately provide the mechanism that integrates central, autonomic, and visceral activities.
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Affiliation(s)
- Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
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23
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Izmailova ES, Wagner JA, Bakker JP, Kilian R, Ellis R, Ohri N. A proposed multi-domain, digital model for capturing functional status and health-related quality of life in oncology. Clin Transl Sci 2024; 17:e13712. [PMID: 38266055 PMCID: PMC10774540 DOI: 10.1111/cts.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/22/2023] [Accepted: 12/07/2023] [Indexed: 01/26/2024] Open
Abstract
Whereas traditional oncology clinical trial endpoints remain key for assessing novel treatments, capturing patients' functional status is increasingly recognized as an important aspect for supporting clinical decisions and assessing outcomes in clinical trials. Existing functional status assessments suffer from various limitations, some of which may be addressed by adopting digital health technologies (DHTs) as a means of collecting both objective and self-reported outcomes. In this mini-review, we propose a device-agnostic multi-domain model for oncology capturing functional status, which includes physical activity data, vital signs, sleep variables, and measures related to health-related quality of life enabled by connected digital tools. By using DHTs for all aspects of data collection, our proposed model allows for high-resolution measurement of objective data as patients navigate their daily lives outside of the hospital setting. This is complemented by electronic questionnaires administered at intervals appropriate for each instrument. Preliminary testing and practical considerations to address before adoption are also discussed. Finally, we highlight multi-institutional pre-competitive collaborations as a means of successfully transitioning the proposed digitally enabled data collection model from feasibility studies to interventional trials and care management.
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Affiliation(s)
| | | | - Jessie P. Bakker
- Departments of Medicine and Neurology, Brigham and Women's HospitalBostonMassachusettsUSA
- Division of Sleep Medicine, Harvard Medical SchoolBostonMassachusettsUSA
| | - Rachel Kilian
- Koneksa HealthNew YorkNew YorkUSA
- SSI StrategyNew YorkNew YorkUSA
| | | | - Nitin Ohri
- Montefiore Medical Center, Albert Einstein College of MedicineBronxNew YorkUSA
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24
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Wu S, Guan W, Zhao H, Li G, Zhou Y, Shi B, Zhang X. Prognostic role of short-term heart rate variability and deceleration/acceleration capacities of heart rate in extensive-stage small cell lung cancer. Front Physiol 2023; 14:1277383. [PMID: 38028778 PMCID: PMC10663334 DOI: 10.3389/fphys.2023.1277383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background: Prior research suggests that autonomic modulation investigated by heart rate variability (HRV) might act as a novel predictive biomarker for cancer prognosis, such as in breast cancer and pancreatic cancer. It is not clear whether there is a correlation between autonomic modulation and prognosis in patients with extensive-stage small cell lung cancer (ES-SCLC). Therefore, the purpose of the study was to examine the association between short-term HRV, deceleration capacity (DC) and acceleration capacity (AC) of heart rate and overall survival in patients with ES-SCLC. Methods: We recruited 40 patients with ES-SCLC, and 39 were included in the final analysis. A 5-min resting electrocardiogram of patients with ES-SCLC was collected using a microelectrocardiogram recorder to analyse short-term HRV, DC and AC. The following HRV parameters were used: standard deviation of the normal-normal intervals (SDNN) and root mean square of successive interval differences (RMSSD). Overall survival of patients with ES-SCLC was defined as time from the date of electrocardiogram measurement to the date of death or the last follow-up. Follow-up was last performed on 07 June 2023. There was a median follow-up time of 42.2 months. Results: Univariate analysis revealed that the HRV parameter SDNN, as well as DC significantly predicted the overall survival of ES-SCLC patients (all p < 0.05). Multivariate analysis showed that the HRV parameters SDNN (hazard ratio = 5.254, 95% CI: 1.817-15.189, p = 0.002), RMSSD (hazard ratio = 3.024, 95% CI: 1.093-8.372, p = 0.033), as well as DC (hazard ratio = 3.909, 95% CI: 1.353-11.293, p = 0.012) were independent prognostic factors in ES-SCLC patients. Conclusion: Decreased HRV parameters (SDNN, RMSSD) and DC are independently associated with shorter overall survival in ES-SCLC patients. Autonomic nervous system function (assessed based on HRV and DC) may be a new biomarker for evaluating the prognosis of patients with ES-SCLC.
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Affiliation(s)
- Shuang Wu
- School of Medicine, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China
| | - Weizheng Guan
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Huan Zhao
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Guangqiao Li
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Yufu Zhou
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China
| | - Bo Shi
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Xiaochun Zhang
- School of Medicine, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Oncology, Yangzhou Hospital of Traditional Chinese Medicine, Yangzhou, Jiangsu, China
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Tegegne BS, Said MA, Ani A, van Roon AM, Shah S, de Geus EJC, van der Harst P, Riese H, Nolte IM, Snieder H. Phenotypic but not genetically predicted heart rate variability associated with all-cause mortality. Commun Biol 2023; 6:1013. [PMID: 37803156 PMCID: PMC10558565 DOI: 10.1038/s42003-023-05376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/19/2023] [Indexed: 10/08/2023] Open
Abstract
Low heart rate variability (HRV) has been widely reported as a predictor for increased mortality. However, the molecular mechanisms are poorly understood. Therefore, this study aimed to identify novel genetic loci associated with HRV and assess the association of phenotypic HRV and genetically predicted HRV with mortality. In a GWAS of 46,075 European ancestry individuals from UK biobank, we identified 17 independent genome-wide significant genetic variants in 16 loci associated with HRV traits. Notably, eight of these loci (RNF220, GNB4, LINCR-002, KLHL3/HNRNPA0, CHRM2, KCNJ5, MED13L, and C160rf72) have not been reported previously. In a prospective phenotypic relationship between HRV and mortality during a median follow-up of seven years, individuals with lower HRV had higher risk of dying from any cause. Genetically predicted HRV, as determined by the genetic risk scores, was not associated with mortality. To the best of our knowledge, the findings provide novel biological insights into the mechanisms underlying HRV. These results also underline the role of the cardiac autonomic nervous system, as indexed by HRV, in predicting mortality.
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Affiliation(s)
- Balewgizie S Tegegne
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Abdullah Said
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alireza Ani
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Bioinformatics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arie M van Roon
- Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sonia Shah
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- Institute of Cardiovascular Science, University College London, London, UK
| | - Eco J C de Geus
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Harriëtte Riese
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Lavín-Pérez AM, Collado-Mateo D, Hinojo González C, Batista M, Mayo X, Ruisánchez Villar C, Jiménez A. An online home-based exercise program improves autonomic dysfunction in breast cancer survivors. Front Physiol 2023; 14:1256644. [PMID: 37841312 PMCID: PMC10570414 DOI: 10.3389/fphys.2023.1256644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction: Exercise interventions for breast cancer survivors have proved their potential to improve clinical, physical, and psychosocial outcomes. However, limited studies have explored exercise effects on autonomic dysfunction and the measurement of exercise tolerance and progression through daily heart rate variability (HRV). Purpose: To analyze the effects of a 16-wk exercise intervention on the autonomic modulation of breast cancer survivors, as well as to examine the evolution of daily measured HRV and its interaction with exercise sessions in this population. Methods: A total of 29 patients who had undergone chemotherapy and radiotherapy were randomly assigned to the exercise group or to the control group. The exercise intervention was delivered remotely through online meetings and consisted of supervised training resistance and cardiovascular exercise 3 times per week. During the intervention all patients measured their HRV daily obtaining the napierian logarithm of the root mean square of successive differences between normal heartbeats (lnrMSSD) and the napierian logarithm of the standard deviation of the interbeat interval of normal sinus beats (lnSDNN) values at four moments: day 0 (the morning of the training sessions), 24, 48, and 72 h after exercise. Results: The results revealed a significant interaction between group and months during the intervention period for lnrMSSD and lnSDNN (p < 0.001). Additionally, there were significant differences in lnSDNN recovery time between months (p < 0.05), while differences in lnrMSSD become apparent only 24 h after exercise (p = 0.019). The control group experienced a significant decrease in both variables monthly (p < 0.05) while exercise group experienced a significant increment (p < 0.05). Conclusion: HRV is daily affected by exercise training sessions in cancer patients. Although results strongly support the role of exercise as a post-chemotherapy and radiotherapy rehabilitation strategy for breast cancer survivors to improve autonomic imbalance, further research is necessary to validate these initial findings.
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Affiliation(s)
- Ana Myriam Lavín-Pérez
- Sport Sciences Research Centre, Rey Juan Carlos University, Madrid, Spain
- GO Fit LAB, GO Fit Life, Science and Technology, S.A., Madrid, Spain
- Program of Epidemiology and Public Health (Interuniversity), Ph.D. International School of Rey Juan Carlos University, Madrid, Spain
| | | | | | - Marco Batista
- Sport, Health, and Exercise Research Unit (SHERU), Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
| | - Xián Mayo
- Sport Sciences Research Centre, Rey Juan Carlos University, Madrid, Spain
| | | | - Alfonso Jiménez
- Sport Sciences Research Centre, Rey Juan Carlos University, Madrid, Spain
- GO Fit LAB, GO Fit Life, Science and Technology, S.A., Madrid, Spain
- Advanced Wellbeing Research Centre, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
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27
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McGovern J, Leadbitter S, Miller G, Hounat A, Kamande I, Dolan RD, Horgan PG, Chang DK, Jamieson NB, McMillan DC. The relationship between heart rate variability and TNM stage, co-morbidity, systemic inflammation and survival in patients with primary operable colorectal cancer. Sci Rep 2023; 13:8157. [PMID: 37208421 PMCID: PMC10198985 DOI: 10.1038/s41598-023-35396-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 05/17/2023] [Indexed: 05/21/2023] Open
Abstract
High vagal nerve activity, reliability measured by HRV, is considered protective in cancer, reducing oxidative stress, inflammation and opposing sympathetic nerve activity. The present monocentric study examines the relationship between HRV, TNM stage, co-morbidity, systemic inflammation and survival in patients who underwent potentially curative resections for colorectal cancer (CRC). Time-domain HRV measures, Standard Deviation of NN-intervals (SDNN) and Root Mean Square of Successive Differences (RMSSD), were examined as categorical (median) and continuous variables. Systemic inflammation was determined using systemic inflammatory grade (SIG) and co-morbidity using ASA. The primary end point was overall survival (OS) and was analysed using Cox regression. There were 439 patients included in the study and the median follow-up was 78 months. Forty-nine percent (n = 217) and 48% (n = 213) of patients were categorised as having low SDNN (< 24 ms) and RMSSD (< 29.8 ms), respectively. On univariate analysis, SDNN was not significantly associated with TNM stage (p = 0.830), ASA (p = 0.598) or SIG (p = 0.898). RMSSD was not significantly associated with TNM stage (p = 0.267), ASA (p = 0.294) or SIG (p = 0.951). Neither SDNN or RMSSD, categorical or continuous, were significantly associated with OS. In conclusion, neither SDNN or RMSSD were associated with TNM stage, ASA, SIG or survival in patients undergoing potentially curative surgery for CRC.
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK.
| | - Stephen Leadbitter
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Gillian Miller
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Adam Hounat
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Irvine Kamande
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - David K Chang
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Nigel B Jamieson
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
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Mortimer G, Nadine H, Nina T, Kirsten S, Anke RS. Effect of transcutaneous auricular vagal nerve stimulation on the fatigue syndrome in patients with gastrointestinal cancers - FATIVA: a randomized, placebo-controlled pilot study protocol. Pilot Feasibility Stud 2023; 9:66. [PMID: 37087481 PMCID: PMC10121416 DOI: 10.1186/s40814-023-01289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/30/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) is defined as a "distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning." CRF is frequently observed in cancer patients even before the initiation of tumor therapy. Its cause is not clear, but in addition to primary effects of therapy, a tumor-induced elevated level of inflammatory cytokines may play a role. Transcutaneous auricular vagal nerve stimulation (taVNS) is a noninvasive way to activate central nervous pathways and modulate pain perception and the immune system. It has positive effects on autoimmune conditions and can also improve fatigue associated with Sjogren's syndrome. It is the main purpose of this feasibility study to investigate the feasibility of daily taVNS against CRF. Therefore, the stimulation protocol of the newly introduced smartphone app of the manufacturer is evaluated. Additionally, the effect taVNS on CRF and quality of life (QoL) shall be evaluated. METHODS Thirty adult patients with gastrointestinal tumors during or after treatment, relevant CRF (Hornheide questionnaire) and life expectancy > 1 year, are enrolled. Patients are randomized to treatment or sham arm and be informed that they will either feel the stimulation or not. Treatment group will receive left-sided tragus above-threshold stimulation with 25 Hz, 250 µs pulse width, and 28-s/32-s on/off paradigm for 4 h throughout the day for 4 weeks. Sham group will receive no stimulation via a nonfunctional electrode. A daily stimulation protocol with time and average intensity is automatically created by a smartphone app connected to the stimulator via Bluetooth®. Multidimensional Fatigue Inventory-20, Short-Form 36 and Beck Depression Inventory questionnaires will be filled out before and after 4 weeks of stimulation. DISCUSSION Primarily, the patients' daily stimulation time and intensity will be evaluated through the electronic protocol after 4 weeks. Secondarily, the effect of taVNS on cancer-related fatigue and QoL will be measured through the questionnaires. As taVNS seems to modulate inflammatory cytokines, this noninvasive method may - if accepted by the patients - be a promising adjunct in the treatment of cancer-related fatigue. TRIAL REGISTRATION The study was approved by local ethics committee (21-7395) and registered at the DRKS database (DRKS00027481).
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Affiliation(s)
- Gierthmuehlen Mortimer
- Department of Neurosurgery, University Medical Center Knappschaftskrankenhaus Bochum, In Der Schornau 23-25, 44892, Bochum, Germany.
| | - Höffken Nadine
- Department of Hematology, Oncology and Palliative Medicine, University Medical Center St. Josef-Hospital Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Timmesfeld Nina
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Universitaetsstrasse 150, 44801, Bochum, Germany
| | - Schmieder Kirsten
- Department of Neurosurgery, University Medical Center Knappschaftskrankenhaus Bochum, In Der Schornau 23-25, 44892, Bochum, Germany
| | - Reinacher-Schick Anke
- Department of Hematology, Oncology and Palliative Medicine, University Medical Center St. Josef-Hospital Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
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Světlák M, Malatincová T, Halámková J, Barešová Z, Lekárová M, Vigašová D, Slezáčková A, Šumec R, Humpolíček P, Šedo J, Chládek J, Roman R, Gottwaldová J, Gescheidtová L, Čermáková Z, Thon V, Hrnčiříková I, Kazda T, Svoboda M. The effectiveness of three mobile-based psychological interventions in reducing psychological distress and preventing stress-related changes in the psycho-neuro-endocrine-immune network in breast cancer survivors: Study protocol for a randomised controlled trial. Internet Interv 2023; 32:100628. [PMID: 37273931 PMCID: PMC10235427 DOI: 10.1016/j.invent.2023.100628] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/16/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Background A growing body of literature shows that psychological distress is not only a major threat to psychological well-being but can also have a significant impact on physical health. In cancer patients, it can negatively affect prognosis and posttreatment recovery processes. Since face-to-face psychological interventions are often inaccessible to cancer patients, researchers have recently been focusing on the effectiveness of eHealth adaptations of well-established approaches. In this context, there has been a call for high-quality randomised controlled trials that would allow for a direct comparison of different approaches, potentially addressing different needs and preferences of patients, and also for more systematic research focusing on how psychological interventions affect not only psychological but also biological markers of stress. Both of these questions are addressed in the present study. Methods A randomised controlled trial will be carried out to test and compare the effectiveness of three eight-week eHealth programmes for the mental health support of cancer patients. All programmes will be delivered through the same application for mobile devices MOU MindCare. N = 440 of breast cancer survivors will be recruited at the end of their adjuvant treatment (chemotherapy, radiotherapy, or both) and randomly assigned to one of the three interventions - Mindfulness-Based Cognitive Therapy for Cancer (MBCT-Ca), Positive Psychology (PP), or Autogenic Training (AT) - or the treatment-as-usual (TAU) control group. Psychological and biological markers of stress and adaptive functioning will be assessed at baseline (T0), post-treatment (T1), three-month follow-up (T2), and nine-month follow-up (T3). Primary outcomes will include heart-rate variability and self-report measures of depression, anxiety, perceived stress, general quality of life, and positive mental health. Secondary outcomes will include the levels of serum cortisol and immunomarkers, sleep quality, fatigue, common health symptoms, and several transdiagnostic psychological variables that are expected to be specifically affected by the MBCT-Ca and PP interventions, including dispositional mindfulness, emotion regulation, self-compassion, perceived hope, and gratitude. The data will be analysed using the mixed model repeated measures (MMRM) approach. Discussion This trial is unique in comparing three different eHealth interventions for cancer patients based on three well-established approaches to mental health support delivered on the same platform. The study will allow us to examine whether different types of interventions affect different indicators of mental health. In addition, it will provide valuable data regarding the effects of stress-reducing psychological interventions on the biomarkers of stress playing an essential role in cancer recovery processes and general health.
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Affiliation(s)
- Miroslav Světlák
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Kamenice 5, 63900 Brno, Czech Republic
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653 Brno, Czech Republic
| | - Tatiana Malatincová
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Kamenice 5, 63900 Brno, Czech Republic
| | - Jana Halámková
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653 Brno, Czech Republic
| | - Zdeňka Barešová
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Kamenice 5, 63900 Brno, Czech Republic
| | - Monika Lekárová
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Kamenice 5, 63900 Brno, Czech Republic
| | - Dana Vigašová
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Kamenice 5, 63900 Brno, Czech Republic
| | - Alena Slezáčková
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Kamenice 5, 63900 Brno, Czech Republic
| | - Rastislav Šumec
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Kamenice 5, 63900 Brno, Czech Republic
- The First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Pekařská 53, 60500 Brno, Czech Republic
| | - Pavel Humpolíček
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Kamenice 5, 63900 Brno, Czech Republic
| | - Jiří Šedo
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653 Brno, Czech Republic
| | - Jan Chládek
- The First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Pekařská 53, 60500 Brno, Czech Republic
- Institute of Scientific Instruments, The Czech Academy of Sciences, Královopolská 147, 61264 Brno, Czech Republic
- Behavioural and Social Neuroscience Research Group, CEITEC–Central European Institute of Technology, Masaryk University, Kamenice 5, 63900 Brno, Czech Republic
| | - Robert Roman
- Department of Medical Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Kamenice 5, 63900 Brno, Czech Republic
- Behavioural and Social Neuroscience Research Group, CEITEC–Central European Institute of Technology, Masaryk University, Kamenice 5, 63900 Brno, Czech Republic
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Jihlavská 20, 62500 Brno, Czech Republic
| | - Jana Gottwaldová
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653 Brno, Czech Republic
| | - Lenka Gescheidtová
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653 Brno, Czech Republic
| | - Zdeňka Čermáková
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653 Brno, Czech Republic
| | - Vojtěch Thon
- Department of Studies Design and Data Management, RECETOX, Faculty of Science, Masaryk University, Kamenice 34, 62500 Brno, Czech Republic
| | - Iva Hrnčiříková
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653 Brno, Czech Republic
| | - Tomáš Kazda
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653 Brno, Czech Republic
| | - Marek Svoboda
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653 Brno, Czech Republic
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Vagal Nerve Activity Predicts Prognosis in Diffused Large B-Cell Lymphoma and Multiple Myeloma. J Clin Med 2023; 12:jcm12030908. [PMID: 36769556 PMCID: PMC9917757 DOI: 10.3390/jcm12030908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
This study examined the prognostic role of vagal nerve activity in patients with relapsed/refractory diffused large B-cell lymphoma (R/R-DLBCL) treated with chimeric antigen receptor cell therapy (CAR-T) and in patients with multiple myeloma (MM) undergoing an autologous hematopoietic cell transplantation (AutoHCT). Participants included 29 patients with R/R-DLBCL and 37 patients with MM. Inclusion criteria were: (1) age over 18; (2) diagnosed with DLBCL or MM; (3) being treated with CAR-T or AutoHCT; and (4) having an ECG prior to cell transfusion. The predictor was vagal nerve activity indexed by heart rate variability (HRV) and obtained retroactively from 10 s ECGs. The main endpoint for R/R-DLBCL was overall survival (OS), and for MM the endpoint was progression-free survival (PFS). Data of 122 patients were obtained, 66 of whom were included in the study. In DLBCL, HRV significantly predicted OS independently of confounders (e.g., performance status, disease status at cell therapy), hazard ratio (HR), and 95% confidence interval (HR = 0.20; 95%CI: 0.06-0.69). The prognostic role of disease severity was moderated by HRV: among severely disease patients, 100% died with low HRV, while only 37.5% died with high HRV. In MM, HRV significantly predicted PFS (HR = 0.19; 95%CI: 0.04-0.90) independently of confounders. Vagal nerve activity independently predicts prognosis in patients with R/R-DLBCL and with MM undergoing cell therapy. High vagal activity overrides the prognostic role of disease severity. Testing the effects of vagal nerve activation on prognosis in blood cancers is recommended.
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Mikolaskova I, Crnogorac-Jurcevic T, Smolkova B, Hunakova L. Nutraceuticals as Supportive Therapeutic Agents in Diabetes and Pancreatic Ductal Adenocarcinoma: A Systematic Review. BIOLOGY 2023; 12:158. [PMID: 36829437 PMCID: PMC9953002 DOI: 10.3390/biology12020158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
The correlation between pancreatic ductal adenocarcinoma (PDAC) and diabetes-related mechanisms support the hypothesis that early therapeutic strategies targeting diabetes can contribute to PDAC risk reduction and treatment improvement. A systematic review was conducted, using PubMed, Embase and Cochrane Library databases, to evaluate the current evidence from clinical studies qualitatively examining the efficacy of four natural products: Curcumin-Curcuma longa L.; Thymoquinone-Nigella sativa L.; Genistein-Glycine max L.; Ginkgo biloba L.; and a low-carbohydrate ketogenic diet in type 2 diabetes (T2D) and PDAC treatment. A total of 28 clinical studies were included, showing strong evidence of inter-study heterogeneity. Used as a monotherapy or in combination with chemo-radiotherapy, the studied substances did not significantly improve the treatment response of PDAC patients. However, pronounced therapeutic efficacy was confirmed in T2D. The natural products and low-carbohydrate ketogenic diet, combined with the standard drugs, have the potential to improve T2D treatment and thus potentially reduce the risk of cancer development and improve multiple biological parameters in PDAC patients.
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Affiliation(s)
- Iveta Mikolaskova
- Institute of Immunology, Faculty of Medicine, Comenius University, Odborarske Namestie 14, 811 08 Bratislava, Slovakia
| | - Tatjana Crnogorac-Jurcevic
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, Charterhouse Square, London EC1M 6BQ, UK
| | - Bozena Smolkova
- Biomedical Research Center, Slovak Academy of Sciences, Cancer Research Institute, Dubravska Cesta 9, 845 05 Bratislava, Slovakia
| | - Luba Hunakova
- Institute of Immunology, Faculty of Medicine, Comenius University, Odborarske Namestie 14, 811 08 Bratislava, Slovakia
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Inbaraj G, Udupa K, Raghavendra RM, Ram A, Patil S, Rajeswaran J, Nandakumar KK, Belur S, Arjun K, Govindaraj R, Bayari SK, Sathyaprabha TN. Effects of an 18-Week Integrated Yoga Program on Cardiac Autonomic Function in Breast Cancer Patients Undergoing Adjuvant Chemotherapy: A Randomized Controlled Trial. Integr Cancer Ther 2023; 22:15347354231168795. [PMID: 37594042 PMCID: PMC10467170 DOI: 10.1177/15347354231168795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Cardiotoxicity is a commonly observed adverse effect seen in breast cancer (BC) patients undergoing chemotherapy with attributes toward cardiac autonomic dysfunction (CAD). Yoga, a mind-body system of medicine that has been shown to improve cardiac autonomic nervous system (ANS) activity in various health conditions, could be an effective adjuvant approach in addressing CAD. OBJECTIVE This study aims to investigate the protective effects of Integrated Yoga Therapy (IYT) on ANS functioning, assessed using Heart rate variability (HRV) in breast cancer patients undergoing chemotherapy. METHODS A total of 68 (stage I-III) BC patients were randomly assigned into 2 groups: Treatment as Usual group (TAU) and TAU with Yoga Therapy group (TAUYT). All patients underwent anthracycline-based adjuvant chemotherapy for a total of 6 cycles with 21 days/cycle. During chemotherapy, the TAUYT group received IYT 5 days a week for 18 weeks, compared with usual care alone in the TAU group. Resting heart rate (RHR) and HRV, measured in both the time and frequency domains, were used to assess the cardiac ANS function of each patient before and after 6 cycles of chemotherapy. RESULTS A total of 30 subjects in the TAU group and 29 subjects in the TAUYT group were included in the analysis. At baseline (before chemotherapy), there were no significant differences between the TAU and TAUYT groups in terms of RHR and HRV indices. However, after chemotherapy, patients in the TAU group had a significantly higher average RHR (P < .02) and lower HRV indices with reduced parasympathetic indices: RMSSD (P < .01), pNN50% (P < .04), high-frequency power (P < .001) and increased sympathetic indices: low-frequency power (P < .001) with sympathovagal imbalance: LF/HF (P < .001) compared with patients in the TAUYT group. CONCLUSION The study showed the protective effects of yoga therapy on CAD in patients receiving anthracycline-based chemotherapy for BC, proposing yoga as a potential adjuvant intervention in improving cardiac health and preventing cardiovascular-related morbidities. TRIAL REGISTRATION This trial is registered with the Clinical Trials Registry-India (CTRI) database (CTRI/2020/10/028446; October 16, 2020).
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Affiliation(s)
- Ganagarajan Inbaraj
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Kaviraja Udupa
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | | | | | - Jamuna Rajeswaran
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | | | | | - Ramajayam Govindaraj
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Wu S, Li G, Chen M, Zhang S, Zhou Y, Shi B, Zhang X. Association of heartbeat complexity with survival in advanced non-small cell lung cancer patients. Front Neurosci 2023; 17:1113225. [PMID: 37123354 PMCID: PMC10130527 DOI: 10.3389/fnins.2023.1113225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
Background Previous studies have shown that the predictive value of traditional linear (time domain and frequency domain) heart rate variability (HRV) for the survival of patients with advanced non-small cell lung cancer (NSCLC) is controversial. Nonlinear methods, based on the concept of complexity, have been used to evaluate HRV, providing a new means to reveal the physiological and pathological changes in HRV. This study aimed to assess the association between heartbeat complexity and overall survival in patients with advanced NSCLC. Methods This study included 78 patients with advanced NSCLC (mean age: 62.0 ± 9.3 years). A 5-min resting electrocardiogram of advanced NSCLC patients was collected to analyze the following HRV parameters: time domain indicators, i.e., standard deviation of the normal-normal intervals (SDNN) and root mean square of successive interval differences (RMSSD); frequency domain indicators, i.e., total power (TP), low frequency power (LF), high frequency power (HF), and the ratio of LF to HF (LF/HF); nonlinear HRV indicators characterizing heartbeat complexity, i.e., approximate entropy (ApEn), sample entropy (SampEn), and recurrence quantification analysis (RQA) indexes: mean diagonal line length (Lmean), maximal diagonal line length (Lmax), recurrence rate (REC), determinism (DET), and shannon entropy (ShanEn). Results Univariate analysis revealed that the linear frequency domain parameter HF and nonlinear RQA parameters Lmax, REC, and DET were significantly correlated with the survival of advanced NSCLC patients (all p < 0.05). After adjusting for confounders in the multivariate analysis, HF, REC, and DET were found to be independent prognostic factors for the survival of patients with advanced NSCLC (all p < 0.05). Conclusion There was an independent association between heartbeat complexity and survival in advanced NSCLC patients. The nonlinear analysis method based on RQA may provide valuable additional information for the prognostic stratification of patients with advanced NSCLC and may supplement the traditional time domain and frequency domain analysis methods.
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Affiliation(s)
- Shuang Wu
- School of Medicine, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China
| | - Guangqiao Li
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Man Chen
- Department of Oncology, Yangzhou Hospital of Traditional Chinese Medicine, Yangzhou, Jiangsu, China
| | - Sai Zhang
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Yufu Zhou
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China
| | - Bo Shi
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
- *Correspondence: Bo Shi,
| | - Xiaochun Zhang
- School of Medicine, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Oncology, Yangzhou Hospital of Traditional Chinese Medicine, Yangzhou, Jiangsu, China
- Xiaochun Zhang,
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Vicente-Campos D, Sanchez-Jorge S, Chicharro JL, Becerro-de Bengoa-Vallejo R, Rodriguez-Sanz D, García AR, Rivoire M, Benet A, Boubekeur S, Calvo-Lobo C. POWERbreathe ® Inspiratory Muscle Training in Amyotrophic Lateral Sclerosis. J Clin Med 2022; 11:6655. [PMID: 36431132 PMCID: PMC9698064 DOI: 10.3390/jcm11226655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/19/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Inspiratory muscle training may benefit respiratory function, cardiocirculatory parameters, quality of life and functionality in neuromuscular diseases. This pilot study aimed to demonstrate the POWERbreathe® inspiratory muscle training effects on maximum inspiratory pressure (PImax), heart rate (HR) and HR variability, as well as the quality of life impairment and functionality in patients with Amyotrophic Lateral Sclerosis (ALS). A pilot single-blinded, non-randomized controlled clinical trial was carried out. A total of 20T ALS patients were enrolled and divided into experimental (n = 10) and control (n = 10) groups. The experimental group received POWERbreathe® inspiratory muscle training in conjunction with usual care, and the control group received only usual care for 8 weeks. PImax (measured by POWERbreathe® KH1), HR and HR variability (evaluated by Polar H7), quality of life impairment [measured by the Amyotrophic Lateral Sclerosis Assessment Questionnaire—40 items (ALSAQ-40)] and functionality [assessed by the ALS Functional Rating Scale Revised (ALSFRS-R)] were collected at baseline and after 8 weeks of intervention. We detected statistically significant differences (p < 0.05) with an effect size ranging from medium to large (Cohen’s d = 0.72−1.37); relative to the control group, the experimental group had an increased PImax (mean difference = 10.80 cm H2O; 95% CI = 3.42−18.17) and ALSFRS-R score (mean difference = 5.30 points; 95% CI = −0.03−10.63) and reduced HR (mean difference = −8.80 beats-per-minute; 95% CI = −20.27−2.67) and R-R interval (mean difference = 78.30 ms; 95% CI = 2.89−153.70). POWERbreathe® inspiratory muscle training, in addition to usual care, may improve inspiratory strength and heart rate in patients with ALS. These results encourage larger and longer trials investigating potential clinically relevant benefits of inspiratory muscle training to these patients over the disease course.
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Affiliation(s)
- Davinia Vicente-Campos
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Sandra Sanchez-Jorge
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - J. L. Chicharro
- Grupo FEBIO, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | | | - David Rodriguez-Sanz
- Faculty of Nursing, Physical Therapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Arianne R. García
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Marie Rivoire
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Astrid Benet
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Sofía Boubekeur
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - César Calvo-Lobo
- Faculty of Nursing, Physical Therapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Neuromodulation Applied to Diseases: The Case of HRV Biofeedback. J Clin Med 2022; 11:jcm11195927. [PMID: 36233794 PMCID: PMC9571900 DOI: 10.3390/jcm11195927] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/02/2022] Open
Abstract
The vagus or “wandering” nerve is the main branch of the parasympathetic nervous system (PNS), innervating most internal organs crucial for health. Activity of the vagus nerve can be non-invasively indexed by heart-rate variability parameters (HRV). Specific HRV parameters predict less all-cause mortality, lower risk of and better prognosis after myocardial infarctions, and better survival in cancer. A non-invasive manner for self-activating the vagus is achieved by performing a slow-paced breathing technique while receiving visual feedback of one’s HRV, called HRV-biofeedback (HRV-B). This article narratively reviews the biological mechanisms underlying the role of vagal activity and vagally mediated HRV in hypertension, diabetes, coronary heart disease (CHD), cancer, pain, and dementia. After searching the literature for HRV-B intervention studies in each condition, we report the effects of HRV-B on clinical outcomes in these health conditions, while evaluating the methodological quality of these studies. Generally, the levels of evidence for the benefits of HRV-B is high in CHD, pain, and hypertension, moderate in cancer, and poor in diabetes and dementia. Limitations and future research directions are discussed.
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Valenti VE. Editorial: New insights into the role of the vagus nerve in health and disease: Basic and clinical studies. Front Neurosci 2022; 16:979695. [PMID: 36248636 PMCID: PMC9555882 DOI: 10.3389/fnins.2022.979695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
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Izmailova ES, Ellis RD. When Work Hits Home: The Cancer-Treatment Journey of a Clinical Scientist Driving Digital Medicine. JCO Clin Cancer Inform 2022; 6:e2200033. [PMID: 36162013 DOI: 10.1200/cci.22.00033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jeon M, Jang H, Lim A, Kim S. Frailty and its associated factors among older adults with cancer undergoing chemotherapy as outpatients: A cross-sectional study. Eur J Oncol Nurs 2022; 60:102192. [PMID: 36029615 DOI: 10.1016/j.ejon.2022.102192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Frailty can affect cancer treatment decisions and outcomes. Depression, fatigue, and cognitive impairment often experienced by patients with cancer are expected to be associated with frailty. We aimed to identify frailty and its related factors in older adults with cancer undergoing chemotherapy. METHODS We conducted a cross-sectional descriptive study in a Korean urban tertiary hospital. A structured self-report questionnaire was used including frailty and its related variables and measured heart rate variability (HRV). Multinomial logistic regression was performed to identify the factors related to frailty. RESULTS Data from 124 out of 136 patients with stomach, colorectal, and lung cancers were analyzed. Approximately 90% of the participants were in the pre-frail and frail groups. There were significant differences among the three groups in terms of depression (p = 0.006) and HRV (p = 0.041). The factor associated with higher frailty levels was depression across groups (pre-frail odds ratio (OR): 1.31, 95% CI: 1.14-1.51; frail OR: 1.29, 95% CI: 1.11-1.49). However, only deficits observed or commented on by others were retained as factors significantly associated with higher frailty in the pre-frail group (OR: 2.40, 95% CI: 1.40-4.13). In contrast, increased HRV (OR: 0.35, 95% CI: 0.13-0.95) was associated with lower frailty levels in the frail group. CONCLUSION It is important to classify older adult patients with cancer into pre-frail and frail groups so that interventions can be provided on time. Understanding the characteristics associated with frailty in older adult patients with cancer can positively affect their health-related quality of life and treatment outcomes.
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Affiliation(s)
- Misun Jeon
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyoeun Jang
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Arum Lim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sanghee Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Liu J, Wang J, Deng Z, Liu S, Li G, Sun Y, Gao L, Li C, Shi B. Differences in the Impact of Heart Rate Variability on the Surgical Approach in Patients With Early Cervical Cancer: Laparoscopic versus Open Surgery. Front Oncol 2022; 12:804242. [PMID: 35720009 PMCID: PMC9205605 DOI: 10.3389/fonc.2022.804242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Evidence suggests that the risk of recurrence and death in patients with early cervical cancer (ECC) undergoing minimally invasive surgery is significantly higher than that in patients undergoing open surgery. However, the mechanisms underlying such a difference remain unclear. Heart rate variability (HRV) represents autonomic nerve activity, which is related to tumorgenesis and can be used as a prognostic indicator for various cancers. The main purpose of this study was to explore the difference in the effects of laparoscopic and open surgery on HRV in ECC patients. Methods A total of 68 ECC (FIGO IA1 with lymphovascular space invasion -IIA2) patients undergoing radical hysterectomy for the first time (84% open group vs. 16% laparoscopic group) were included. A single-lead micro-ECG recorder was used to collect 5 min electrocardiograms 1 day before the operation and 3 days after the operation, and then HRV time domain and frequency domain indices were analyzed, including mean heart rate (MeanHR), maximum heart rate (MaxHR), minimum heart rate (MinHR), the standard deviation of all normal-to-normal intervals (SDNN), the root mean square of successive interval differences (RMSSD), very low-frequency power (VLF), low-frequency power (LF), high-frequency power (HF), total power (TP), and the ratio of LF to HF (LF/HF). Results Heart rate (i.e., MeanHR, MaxHR, and MinHR) were significantly higher, and HRV (i.e., SDNN, RMSSD, LF, HF, and TP) were significantly lower after the operation than before the operation in both the laparoscopic and open groups (P < 0.05). The postoperative reduction in RMSSD and HF was significantly higher in the laparoscopic group than in the open group (P < 0.05). Conclusions These data suggest that radical hysterectomy can lead to increased heart rate and decreased HRV in patients with ECC, which can negatively affect cardiac autonomic regulation. Compared with open surgery, laparoscopic surgery has a greater negative impact on the HRV of ECC patients.
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Affiliation(s)
- Jian Liu
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Jingfeng Wang
- School of Medical Imaging, Bengbu Medical College, Bengbu, China.,Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Zhaoya Deng
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Shiqi Liu
- School of Medical Imaging, Bengbu Medical College, Bengbu, China
| | - Guangqiao Li
- School of Medical Imaging, Bengbu Medical College, Bengbu, China.,Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Yilin Sun
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Longfei Gao
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Chenghui Li
- School of Medical Imaging, Bengbu Medical College, Bengbu, China
| | - Bo Shi
- School of Medical Imaging, Bengbu Medical College, Bengbu, China.,Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
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Foucré C, Schulz S, Stritter W, von Mackensen I, Luchte J, Ivaki P, Voss A, Ghadjar P, Seifert G. Randomized Pilot Trial Using External Yarrow Liver Compress Applications With Metastatic Cancer Patients Suffering From Fatigue: Evaluation of Sympathetic Modulation by Heart Rate Variability Analysis. Integr Cancer Ther 2022; 21:15347354221081253. [PMID: 35430924 PMCID: PMC9019351 DOI: 10.1177/15347354221081253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Liver compresses are commonly applied in complementary medicine during cancer treatment and are believed to have an energizing effect. We conducted a pilot study to investigate the influence of external application of yarrow liver compresses on the autonomous nervous system by analyzing the heart rate variability (HRV) in metastatic cancer patients undergoing radiation therapy and suffering from cancer-related fatigue (CRF). Methods: A randomized pilot trial was undertaken with patients suffering from CRF receiving palliative radiation therapy for bone or brain metastasis over 2 weeks. CRF patients were randomized into an intervention group receiving yarrow liver compresses and a control group receiving no external application. HRV was analyzed at the beginning (T1) and end (T2) period of the study during daytime (d) and nighttime (n) in both groups and quantified using time-, frequency-, and nonlinear dynamics domains. Results: A total of 39 patients were randomized between September 2017 and August 2019 and a total of 20 patients (10 per group) were available for analysis. For both groups, significant differences in HRV analyses were found in the comparison over the timeline between the first and second measurement (T1d→T2d) during daytime. Specifically, the intervention group showed decreased HRV and complexity of heart rate regulation, indicating increased sympathetic activity at time T2d, whereas the control group showed increased HRV and complexity of heart rate regulation, indicating increased vagal activity at time T2d. Furthermore, the observed HRV analyses showed almost no significant differences between the 2 groups in a direct comparison at the beginning and the end of the study (exception: T2d). Conclusions: Yarrow liver compresses led to increased sympathetic activity during daytime in the intervention group, whereas in the control group, which did not receive any external application, increased parasympathetic activity was observed.
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Affiliation(s)
- Clara Foucré
- Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | - Pune Ivaki
- Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Voss
- University of Technology Ilmenau, Ilmenau, Germany
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Use of a Wearable Biosensor to Study Heart Rate Variability in Chronic Obstructive Pulmonary Disease and Its Relationship to Disease Severity. SENSORS 2022; 22:s22062264. [PMID: 35336436 PMCID: PMC8952191 DOI: 10.3390/s22062264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to explore the relationships between heart rate variability (HRV) and various phenotypic measures that relate to health and functional status in chronic obstructive pulmonary disease (COPD), and secondly, to demonstrate the feasibility of ascertaining HRV via a chest-worn wearable biosensor in COPD patients. HRV analysis was performed using SDNN (standard deviation of the mean of all normal R-R intervals), low frequency (LF), high frequency (HF), and LF/HF ratio. We evaluated the associations between HRV and COPD severity, class of bronchodilator therapy prescribed, and patient reported outcomes. Seventy-nine participants with COPD were enrolled. There were no differences in SDNN, HF, and LF/HF ratio according to COPD severity. The SDNN in participants treated with concurrent beta-agonists and muscarinic antagonists was lower than that in other participants after adjusting heart rate (beta coefficient −3.980, p = 0.019). The SDNN was positively correlated with Veterans Specific Activity Questionnaire (VSAQ) score (r = 0.308, p = 0.006) and handgrip strength (r = 0.285, p = 0.011), and negatively correlated with dyspnea by modified Medical Research Council (mMRC) questionnaire (r = −0.234, p = 0.039), health status by Saint George’s Respiratory Questionnaire (SGRQ) (r = −0.298, p = 0.008), symptoms by COPD Assessment Test (CAT) (r = −0.280, p = 0.012), and BODE index (r = −0.269, p = 0.020). When measured by a chest-worn wearable device, reduced HRV was observed in COPD participants receiving inhaled beta-sympathomimetic agonist and muscarinic antagonists. HRV was also correlated with various health status and performance measures.
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Rogers B, Schaffarczyk M, Clauß M, Mourot L, Gronwald T. The Movesense Medical Sensor Chest Belt Device as Single Channel ECG for RR Interval Detection and HRV Analysis during Resting State and Incremental Exercise: A Cross-Sectional Validation Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22052032. [PMID: 35271179 PMCID: PMC8914935 DOI: 10.3390/s22052032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 05/05/2023]
Abstract
The value of heart rate variability (HRV) in the fields of health, disease, and exercise science has been established through numerous investigations. The typical mobile-based HRV device simply records interbeat intervals, without differentiation between noise or arrythmia as can be done with an electrocardiogram (ECG). The intent of this report is to validate a new single channel ECG device, the Movesense Medical sensor, against a conventional 12 channel ECG. A heterogeneous group of 21 participants performed an incremental cycling ramp to failure with measurements of HRV, before (PRE), during (EX), and after (POST). Results showed excellent correlations between devices for linear indexes with Pearson's r between 0.98 to 1.0 for meanRR, SDNN, RMSSD, and 0.95 to 0.97 for the non-linear index DFA a1 during PRE, EX, and POST. There was no significant difference in device specific meanRR during PRE and POST. Bland-Altman analysis showed high agreement between devices (PRE and POST: meanRR bias of 0.0 and 0.4 ms, LOA of 1.9 to -1.8 ms and 2.3 to -1.5; EX: meanRR bias of 11.2 to 6.0 ms; LOA of 29.8 to -7.4 ms during low intensity exercise and 8.5 to 3.5 ms during high intensity exercise). The Movesense Medical device can be used in lieu of a reference ECG for the calculation of HRV with the potential to differentiate noise from atrial fibrillation and represents a significant advance in both a HR and HRV recording device in a chest belt form factor for lab-based or remote field-application.
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Affiliation(s)
- Bruce Rogers
- Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Correspondence:
| | - Marcelle Schaffarczyk
- Department Sports and Exercise Medicine, Institute of Human Movement Science, University of Hamburg, 20148 Hamburg, Germany;
| | - Martina Clauß
- Institute of Movement and Trainings Science in Sport, Faculty of Sport Science, Leipzig University, 04109 Leipzig, Germany;
| | - Laurent Mourot
- EA3920 Pronostic Factors and Regulatory Factors of Cardiac and Vascular Pathologies, Exercise Performance Health Innovation (EPHI) Plaptform, University of Bourgogne Franche-Comté, 25000 Besançon, France;
- Division for Physical Education, National Research Tomsk Polytechnic University, 634040 Tomsk, Russia
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany;
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Liu J, Liu S, Gao L, Li G, Xu J, Sun Y, Wang J, Shi B. Predicting Post-operative Blood Inflammatory Biomarkers Using Pre-operative Heart Rate Variability in Patients With Cervical Cancer. Front Physiol 2021; 12:696208. [PMID: 34803724 PMCID: PMC8599823 DOI: 10.3389/fphys.2021.696208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022] Open
Abstract
Blood inflammatory biomarkers, including the neutrophil-to-lymphocyte ratio (NLR), the lymphocyte-to-monocyte ratio (LMR), and the platelet-to-lymphocyte ratio (PLR), play a significant role in determining the prognosis of patients with cervical cancer (CC). Currently, no methods are available to predict these indexes pre-operatively. Cardiac autonomic function is determined based on the heart rate variability (HRV), which is also associated with a progressive inflammatory response and cancer. Thus, the main aim of this study was to evaluate the feasibility of using pre-operative HRV parameters in CC patients to predict post-operative blood inflammation biomarkers as a means of determining prognosis. Between 2020 and 2021, 56 patients who were diagnosed with CC and then underwent hysterectomy surgery at the Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College were enrolled in this study. Five-minute electrocardiogram data were collected 1 day before the operation for analysis of HRV parameters, including frequency domain parameters (LF, HF, and LF/HF) and Poincaré plot parameters (SD1, SD2, and SD2/SD1). Venous blood was collected 2 days post-operatively and inflammatory biomarkers were evaluated, with the NLR, LMR, and PLR determined. Pre-operative SD2 was significantly associated with post-operative PLR, with each 1-unit increase in SD2 decreasing the PLR value by 2.4 ± 0.9 (P < 0.05). Besides, LF/HF was significantly correlated with NLR, with each 1-unit increase in LF/HF increasing the NLR value by 1.1 ± 0.5 (P < 0.05). This association was independent of patient age and body mass index. These results suggest that the pre-operative autonomic nervous system plays a role in the regulation of post-operative cancer inflammation and that pre-operative HRV parameters can potentially predict post-operative inflammation and facilitate clinical treatment decisions.
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Affiliation(s)
- Jian Liu
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Shiqi Liu
- School of Medical Imaging, Bengbu Medical College, Bengbu, China.,Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Longfei Gao
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Guangqiao Li
- School of Medical Imaging, Bengbu Medical College, Bengbu, China.,Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Jie Xu
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Yilin Sun
- Department of Gynecologic Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Jingfeng Wang
- School of Medical Imaging, Bengbu Medical College, Bengbu, China.,Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Bo Shi
- School of Medical Imaging, Bengbu Medical College, Bengbu, China.,Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
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Vigier M, Vigier B, Andritsch E, Schwerdtfeger AR. Cancer classification using machine learning and HRV analysis: preliminary evidence from a pilot study. Sci Rep 2021; 11:22292. [PMID: 34785733 PMCID: PMC8595703 DOI: 10.1038/s41598-021-01779-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 11/01/2021] [Indexed: 12/16/2022] Open
Abstract
Most cancer patients exhibit autonomic dysfunction with attenuated heart rate variability (HRV) levels compared to healthy controls. This research aimed to create and evaluate a machine learning (ML) model enabling discrimination between cancer patients and healthy controls based on 5-min-ECG recordings. We selected 12 HRV features based on previous research and compared the results between cancer patients and healthy individuals using Wilcoxon sum-rank test. Recursive Feature Elimination (RFE) identified the top five features, averaged over 5 min and employed them as input to three different ML. Next, we created an ensemble model based on a stacking method that aggregated the predictions from all three base classifiers. All HRV features were significantly different between the two groups. SDNN, RMSSD, pNN50%, HRV triangular index, and SD1 were selected by RFE and used as an input to three different ML. All three base-classifiers performed above chance level, RF being the most efficient with a testing accuracy of 83%. The ensemble model showed a classification accuracy of 86% and an AUC of 0.95. The results obtained by ML algorithms suggest HRV parameters could be a reliable input for differentiating between cancer patients and healthy controls. Results should be interpreted in light of some limitations that call for replication studies with larger sample sizes.
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Affiliation(s)
- Marta Vigier
- Division of Oncology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. .,Institute of Psychology, University of Graz, Graz, Austria.
| | | | - Elisabeth Andritsch
- Division of Oncology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
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Taylor MR, Garrison MM, Rosenberg AR. Heart rate variability and psychosocial symptoms in adolescents and young adults with cancer. PLoS One 2021; 16:e0259385. [PMID: 34735505 PMCID: PMC8568181 DOI: 10.1371/journal.pone.0259385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/15/2021] [Indexed: 12/19/2022] Open
Abstract
Background Heart Rate Variability (HRV) is a valid, scalable biomarker of stress. We aimed to examine associations between HRV and psychosocial outcomes in adolescents and young adults (AYAs) with cancer. Methods This was a secondary analysis of baseline data from a randomized trial testing a resilience intervention in AYAs with cancer. Two widely used HRV metrics, the standard deviation of normal to normal beats (SDNN) and root mean square of successive differences (RMSSD), were derived from electrocardiograms. Patient-reported outcome (PRO) survey measures included quality of life, anxiety, depression, distress, and resilience. Linear regression models were used to test associations between HRV and PRO scores. The Wilcoxon rank sum test was used to test differences in median HRV values among participant subgroups. Results Among the n = 76 patients with available electrocardiograms, the mean age was 16 years (SD 3y), 63% were white, and leukemia/lymphoma was the most common diagnosis. Compared to healthy adolescents, AYAs with cancer had lower median HRV (SDNN [Females: 31.9 (12.8–50.7) vs 66.4 (46.0–86.8), p<0.01; Males: 29.9 (11.5–47.9) vs 63.2 (48.4–84.6), p<0.01]; RMSSD [Females: 28.2 (11.1–45.5) vs 69.0 (49.1–99.6), p<0.01; Males: 27.9 (8.6–48.6) vs 58.7 (44.8–88.2), p<0.01]). There was no statistically significant association between PRO measures and SDNN or RMSSD in either an unadjusted or adjusted linear regression models. Conclusion In this secondary analysis, we did not find an association between HRV and psychosocial PROs among AYAs with cancer. HRV measures were lower than for healthy adolescents. Larger prospective studies in AYA biopsychosocial research are needed.
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Affiliation(s)
- Mallory R. Taylor
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, Washington, United States of America
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, United States of America
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Michelle M. Garrison
- Department of Health Services, University of Washington, Seattle, Washington, United States of America
| | - Abby R. Rosenberg
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, Washington, United States of America
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, United States of America
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, United States of America
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Wang YM, Cheng JY, Wang CJ, Hseu SS, Huang EY. Outcomes and Prognosis of Non-Elderly Patients with Brain Metastases-A Prospective Cohort Incorporating Individualized Assessment of Heart Rate Variability. J Pers Med 2021; 11:jpm11111049. [PMID: 34834401 PMCID: PMC8618592 DOI: 10.3390/jpm11111049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 12/19/2022] Open
Abstract
Outcomes and prognostic factors among patients with brain metastases (BM) have been widely studied, but seldom for the non-elderly. Heart rate variability (HRV) is a physiological phenomenon and has been shown as a survival prognostic factor in cancer patients. This study aimed to evaluate the outcomes and prognosis among non-elderly BM patients with the incorporation of HRV analysis. Forty non-elderly BM patients treated using whole brain radiotherapy (WBRT) were studied from January 2010 prospectively with 5-min electrocardiography (ECG) recordings. Individualized HRV was generated by the ECG, and the time domain HRV index SDNN was chosen for survival analysis. The median overall survival (OS) for the entire group was 6.21 months. Univariate analysis revealed that a KPS < 80 (p = 0.019) and an SDNN < 10 ms (p = 0.007) demonstrated statistical significance for OS; multivariate analysis confirmed that a KPS < 80 (p = 0.004; HR = 3.060, CI = 1.437–6.517) and an SDNN < 10 ms (p = 0.010; HR = 2.664, CI = 1.262–5.624) were independent prognostic factors. Prospective studies for risk stratification among non-elderly BM patients based on our results are warranted to validate our findings.
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Affiliation(s)
- Yu-Ming Wang
- Department & Institute of Physiology, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (J.-Y.C.); (C.-J.W.)
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Jen-Yu Cheng
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (J.-Y.C.); (C.-J.W.)
| | - Chong-Jong Wang
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (J.-Y.C.); (C.-J.W.)
| | - Shu-Shya Hseu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Eng-Yen Huang
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (J.-Y.C.); (C.-J.W.)
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: ; Tel.: +886-7-731-7123 (ext. 7000)
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Fournié C, Verkindt C, Dalleau G, Bouscaren N, Mohr C, Zunic P, Cabrera Q. Rehabilitation program combining physical exercise and heart rate variability biofeedback in hematologic patients: a feasibility study. Support Care Cancer 2021; 30:2009-2016. [PMID: 34636946 PMCID: PMC8794932 DOI: 10.1007/s00520-021-06601-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
Purpose Hematologic patients have a poorer health-related quality of life due to the disease and its treatments. Non-pharmacological interventions represent an opportunity in tertiary cancer prevention to manage persistent symptoms and support patients in their return to active daily living. This interventional study aimed to evaluate the feasibility of a program combining physical exercise (PE) and heart rate variability biofeedback (HRVB) in hematologic patients. Method Hematologic patients in remission within 6 months participated in a 12-week rehabilitation program including 24 supervised sessions of PE associated with 10 supervised sessions of HRVB and daily home-based practice of paced breathing. We assessed patient adherence, fatigue, physical function, and heart rate variability. Results Twenty patients were included, 17 completed the protocol and 3 dropped out due to disease progression or time constraints; no adverse events or incidents were reported. Participation rates were 85% for PE and 98% for HRVB-supervised sessions. Significant improvements of physical capacity (6-min walk test, p < 0.001; 50-foot walk test, p < 0.001), muscle strength (grip force test, p < 0.01), and flexibility (toe-touch test, p < 0.001; back scratch test, p < 0.05) were measured. Coherence ratio (p < 0.001) and low-frequency spectral density of HRV signal (p < 0.003) increased significantly, suggesting improved autonomic function. Fatigue, static balance, and other time and frequency indicators of HRV were not improved (all p > 0.05). Conclusion A rehabilitation program combining PE and HRVB is feasible in hematologic patients and effective on physical function. Further research with a larger sample size is needed to investigate effectiveness on patients’ autonomic functions and their impacts on symptomatology.
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Affiliation(s)
- Claire Fournié
- Laboratoire IRISSE EA4075, UFR Des Sciences de L'Homme Et de L'Environnement, Université de La Réunion, Le Tampon, La Réunion, France.
| | - Chantal Verkindt
- Laboratoire IRISSE EA4075, UFR Des Sciences de L'Homme Et de L'Environnement, Université de La Réunion, Le Tampon, La Réunion, France
| | - Georges Dalleau
- Laboratoire IRISSE EA4075, UFR Des Sciences de L'Homme Et de L'Environnement, Université de La Réunion, Le Tampon, La Réunion, France
| | - Nicolas Bouscaren
- Centre d'Investigation Clinique, CHU Sud Réunion, Inserm CIC 1410, Saint-Pierre, La Réunion, France
| | - Catherine Mohr
- Service d'Hématologie Clinique, CHU Sud Réunion, Saint Pierre, La Réunion, France
| | - Patricia Zunic
- Service d'Hématologie Clinique, CHU Sud Réunion, Saint Pierre, La Réunion, France
| | - Quentin Cabrera
- Service d'Hématologie Clinique, CHU Sud Réunion, Saint Pierre, La Réunion, France
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Association between cardiac autonomic modulation and sedentary behavior in breast cancer survivors: a 12-month cohort study. Support Care Cancer 2021; 30:1873-1878. [PMID: 34617160 DOI: 10.1007/s00520-021-06602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to analyze the longitudinal influence of sitting time (ST) on cardiac autonomic modulation (CAM) and resting heart rate (RHR) in a 12-month cohort of 67 breast cancer survivors. METHODS CAM was assessed by heart rate variability with heart monitor which also assessed RHR, and ST was self-reported. The relationship between the variables was analyzed by the Pearson correlation and its magnitude by linear regression. RESULTS At baseline, no associations were found between ST and CAM or RHR. In the delta analyses, a decrease in RMSSD, SD1, and HF(ms2) was associated with sitting time. At 12-month follow-up, there was an increase in the ST and a decrease in RHR. ST was negatively related with CAM (RMSSD, PNN50, and SD1), but no association was observed between ST and RHR. CONCLUSION The increase in ST was associated with worsening of CAM after 12-month follow-up. Promoting reduction in ST will be an important strategy against cardiovascular impairment in breast cancer survivors.
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The biology of stress in cancer: Applying the biobehavioral framework to adolescent and young adult oncology research. Brain Behav Immun Health 2021; 17:100321. [PMID: 34589815 PMCID: PMC8474169 DOI: 10.1016/j.bbih.2021.100321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/28/2021] [Accepted: 08/07/2021] [Indexed: 12/19/2022] Open
Abstract
The stress response influences the development and trajectory of cancer through a host of complex neuroimmune mechanisms. Basic, translational, and clinical research has elucidated these biobehavioral connections and offers a new paradigm for scientific investigation and patient care. Using a biobehavioral approach could offer new diagnostic and therapeutic opportunities in oncology, and this approach will be particularly impactful for adolescent and young adult (AYA) patients with cancer. To date, nearly all biobehavioral oncology research has been done in the adult population. And yet, AYAs have traditionally poorer mental health and cancer-related outcomes, and thus represent a population that could benefit from parallel psychosocial and biomedical intervention. Future biobehavioral work in oncology should focus on the AYA population, integrating new cancer therapies and technology into the next generation of research.
Translational research efforts are clarifying the role of stress in cancer biology and patient outcomes. AYAs have poorer cancer-related and mental health outcomes, but nearly all biobehavioral oncology studies are in adults. Future work in immunotherapy, digital health technology, and interdisciplinary cooperation will advance the field. A translational biobehavioral approach brings the paradigm of precision medicine to psychosocial care in cancer.
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Vargas-Román K, Cortés-Martín J, Sánchez-García JC, Rodríguez-Blanque R, De La Fuente-Solana EI, Díaz-Rodríguez L. Autonomic Imbalance in Lymphoma Survivors. J Clin Med 2021; 10:jcm10194391. [PMID: 34640409 PMCID: PMC8509196 DOI: 10.3390/jcm10194391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/18/2021] [Accepted: 09/22/2021] [Indexed: 12/16/2022] Open
Abstract
Among the types of blood cancers, non-Hodgkin lymphoma is the most common. The usual treatments for this type of cancer can cause heart failure. A descriptive observational study was conducted that included 16 non-Hodgkin lymphoma survivors and 16 healthy controls matched by age and sex. Vagal tone was evaluated in the short term with a three-channel Holter device, and the time and frequency domains were analyzed following a previously accepted methodology to evaluate cardiac autonomic balance. The results of the analysis revealed that the standard deviation of the NN interval (F = 6.25, p = 0.021) and the square root of the mean of the sum of the differences between NN intervals (F = 9.74, p = 0.004) were significantly higher in healthy subjects than in lymphoma survivors. In the heart rate variability (HRV) index, there were no significant differences between the groups (F = 0.03, p = 0.85), nor in the parameters of the frequency domains LF (F = 1.94, p = 0.17), HF (F = 0.35, p = 0.55), and the ratio LF/HF (F = 3.07, p = 0.09). HRV values were lower in non-Hodgkin lymphoma survivors in the first year after treatment, resulting in autonomic imbalance compared to healthy paired subjects.
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Affiliation(s)
- Keyla Vargas-Román
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.); (L.D.-R.)
- Spanish Education Ministry Program FPU16/01437, Methodology of Behavioral Sciences Department, Faculty of Psychology, University of Granada, 18071 Granada, Spain
- Correspondence:
| | - Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.); (L.D.-R.)
| | - Juan Carlos Sánchez-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.); (L.D.-R.)
- Department of Nursing, School of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Raquel Rodríguez-Blanque
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.); (L.D.-R.)
- Health Technology Park, San Cecilio University Hospital, 18016 Granada, Spain
| | | | - Lourdes Díaz-Rodríguez
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.); (L.D.-R.)
- Department of Nursing, School of Health Sciences, University of Granada, 18016 Granada, Spain
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