Cardiovascular responses to cold and submaximal exercise in patients with coronary artery disease
Regular year-round exercise is recommended for patients with coronary artery disease (CAD). However, the combined effects of cold and moderate sustained exercise, both known to increase cardiac workload, on cardiovascular responses are not known. We tested the hypothesis that cardiac workload is inc...
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| Veröffentlicht in: | American journal of physiology. Regulatory, integrative and comparative physiology integrative and comparative physiology, 2018-10, Vol.315 (4), p.R768-R776 |
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| creator | Valtonen, Rasmus I P Kiviniemi, Antti Hintsala, Heidi E Ryti, Niilo R I Kenttä, Tuomas Huikuri, Heikki V Perkiömäki, Juha Crandall, Craig van Marken Lichtenbelt, Wouter Alén, Markku Rintamäki, Hannu Mäntysaari, Matti Hautala, Arto Jaakkola, Jouni J K Ikäheimo, Tiina M |
| description | Regular year-round exercise is recommended for patients with coronary artery disease (CAD). However, the combined effects of cold and moderate sustained exercise, both known to increase cardiac workload, on cardiovascular responses are not known. We tested the hypothesis that cardiac workload is increased, and evidence of ischemia would be observed during exercise in the cold in patients with CAD. Sixteen men (59.3 ± 7.0 yr, means ± SD) with stable CAD each underwent 4, 30 min exposures in a randomized order: seated rest and moderate-intensity exercise [walking, 60%-70% of max heart rate (HR)] performed at +22°C and -15°C. Systolic brachial blood pressure (SBP), HR, electrocardiogram (ECG), and skin temperatures were recorded throughout the intervention. Rate pressure product (RPP) and ECG parameters were obtained. The combined effects of cold and submaximal exercise were additive for SBP and RPP and synergistic for HR when compared with rest in a neutral environment. RPP (mmHg·beats/min) was 17% higher during exercise in the cold (18,080 ± 3540) compared with neutral (15,490 ± 2,940) conditions ( P = 0.001). Only a few ST depressions were detected during exercise but without an effect of ambient temperature. The corrected QT interval increased while exercising in the cold compared with neutral temperature ( P = 0.023). Recovery of postexercise blood pressure was similar regardless of temperature. Whole body exposure to cold during submaximal exercise results in higher cardiac workload compared with a neutral environment. Despite the higher RPP, no signs of myocardial ischemia or abnormal ECG responses were observed. The results of this study are useful for planning year-round exercise-based rehabilitation programs for stable CAD patients. |
| doi_str_mv | 10.1152/ajpregu.00069.2018 |
| format | Article |
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However, the combined effects of cold and moderate sustained exercise, both known to increase cardiac workload, on cardiovascular responses are not known. We tested the hypothesis that cardiac workload is increased, and evidence of ischemia would be observed during exercise in the cold in patients with CAD. Sixteen men (59.3 ± 7.0 yr, means ± SD) with stable CAD each underwent 4, 30 min exposures in a randomized order: seated rest and moderate-intensity exercise [walking, 60%-70% of max heart rate (HR)] performed at +22°C and -15°C. Systolic brachial blood pressure (SBP), HR, electrocardiogram (ECG), and skin temperatures were recorded throughout the intervention. Rate pressure product (RPP) and ECG parameters were obtained. The combined effects of cold and submaximal exercise were additive for SBP and RPP and synergistic for HR when compared with rest in a neutral environment. RPP (mmHg·beats/min) was 17% higher during exercise in the cold (18,080 ± 3540) compared with neutral (15,490 ± 2,940) conditions ( P = 0.001). Only a few ST depressions were detected during exercise but without an effect of ambient temperature. The corrected QT interval increased while exercising in the cold compared with neutral temperature ( P = 0.023). Recovery of postexercise blood pressure was similar regardless of temperature. Whole body exposure to cold during submaximal exercise results in higher cardiac workload compared with a neutral environment. Despite the higher RPP, no signs of myocardial ischemia or abnormal ECG responses were observed. The results of this study are useful for planning year-round exercise-based rehabilitation programs for stable CAD patients.</description><identifier>ISSN: 0363-6119</identifier><identifier>EISSN: 1522-1490</identifier><identifier>DOI: 10.1152/ajpregu.00069.2018</identifier><identifier>PMID: 29975565</identifier><language>eng</language><publisher>United States: American Physiological Society</publisher><subject>Aged ; Ambient temperature ; Blood pressure ; Body temperature ; Cardiac Rehabilitation - adverse effects ; Cardiac Rehabilitation - methods ; Cardiovascular disease ; Cardiovascular system ; Cold ; Cold pressing ; Cold Temperature - adverse effects ; Coronary artery ; Coronary artery disease ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - physiopathology ; Coronary Artery Disease - rehabilitation ; Cross-Over Studies ; EKG ; Exercise ; Exercise Test ; Exercise Therapy - adverse effects ; Exercise Therapy - methods ; Exercise Tolerance ; Exposure ; Finland ; Health Status ; Heart diseases ; Heart rate ; Hemodynamics ; Humans ; Ischemia ; Male ; Middle Aged ; Myocardial ischemia ; Patients ; Physical training ; Rehabilitation ; Skin ; Temperature effects ; Time Factors ; Treatment Outcome ; Walking ; Working conditions ; Workload</subject><ispartof>American journal of physiology. Regulatory, integrative and comparative physiology, 2018-10, Vol.315 (4), p.R768-R776</ispartof><rights>Copyright American Physiological Society Oct 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-63ec09afccc6c7cbeaaf6d939eeb243f63cb01e136fd9de8e5d2e2f6cdee44563</citedby><cites>FETCH-LOGICAL-c375t-63ec09afccc6c7cbeaaf6d939eeb243f63cb01e136fd9de8e5d2e2f6cdee44563</cites><orcidid>0000-0002-2763-6004</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3026,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29975565$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Valtonen, Rasmus I P</creatorcontrib><creatorcontrib>Kiviniemi, Antti</creatorcontrib><creatorcontrib>Hintsala, Heidi E</creatorcontrib><creatorcontrib>Ryti, Niilo R I</creatorcontrib><creatorcontrib>Kenttä, Tuomas</creatorcontrib><creatorcontrib>Huikuri, Heikki V</creatorcontrib><creatorcontrib>Perkiömäki, Juha</creatorcontrib><creatorcontrib>Crandall, Craig</creatorcontrib><creatorcontrib>van Marken Lichtenbelt, Wouter</creatorcontrib><creatorcontrib>Alén, Markku</creatorcontrib><creatorcontrib>Rintamäki, Hannu</creatorcontrib><creatorcontrib>Mäntysaari, Matti</creatorcontrib><creatorcontrib>Hautala, Arto</creatorcontrib><creatorcontrib>Jaakkola, Jouni J K</creatorcontrib><creatorcontrib>Ikäheimo, Tiina M</creatorcontrib><title>Cardiovascular responses to cold and submaximal exercise in patients with coronary artery disease</title><title>American journal of physiology. Regulatory, integrative and comparative physiology</title><addtitle>Am J Physiol Regul Integr Comp Physiol</addtitle><description>Regular year-round exercise is recommended for patients with coronary artery disease (CAD). However, the combined effects of cold and moderate sustained exercise, both known to increase cardiac workload, on cardiovascular responses are not known. We tested the hypothesis that cardiac workload is increased, and evidence of ischemia would be observed during exercise in the cold in patients with CAD. Sixteen men (59.3 ± 7.0 yr, means ± SD) with stable CAD each underwent 4, 30 min exposures in a randomized order: seated rest and moderate-intensity exercise [walking, 60%-70% of max heart rate (HR)] performed at +22°C and -15°C. Systolic brachial blood pressure (SBP), HR, electrocardiogram (ECG), and skin temperatures were recorded throughout the intervention. Rate pressure product (RPP) and ECG parameters were obtained. The combined effects of cold and submaximal exercise were additive for SBP and RPP and synergistic for HR when compared with rest in a neutral environment. RPP (mmHg·beats/min) was 17% higher during exercise in the cold (18,080 ± 3540) compared with neutral (15,490 ± 2,940) conditions ( P = 0.001). Only a few ST depressions were detected during exercise but without an effect of ambient temperature. The corrected QT interval increased while exercising in the cold compared with neutral temperature ( P = 0.023). Recovery of postexercise blood pressure was similar regardless of temperature. Whole body exposure to cold during submaximal exercise results in higher cardiac workload compared with a neutral environment. Despite the higher RPP, no signs of myocardial ischemia or abnormal ECG responses were observed. The results of this study are useful for planning year-round exercise-based rehabilitation programs for stable CAD patients.</description><subject>Aged</subject><subject>Ambient temperature</subject><subject>Blood pressure</subject><subject>Body temperature</subject><subject>Cardiac Rehabilitation - adverse effects</subject><subject>Cardiac Rehabilitation - methods</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular system</subject><subject>Cold</subject><subject>Cold pressing</subject><subject>Cold Temperature - adverse effects</subject><subject>Coronary artery</subject><subject>Coronary artery disease</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>Coronary Artery Disease - rehabilitation</subject><subject>Cross-Over Studies</subject><subject>EKG</subject><subject>Exercise</subject><subject>Exercise Test</subject><subject>Exercise Therapy - adverse effects</subject><subject>Exercise Therapy - methods</subject><subject>Exercise Tolerance</subject><subject>Exposure</subject><subject>Finland</subject><subject>Health Status</subject><subject>Heart diseases</subject><subject>Heart rate</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial ischemia</subject><subject>Patients</subject><subject>Physical training</subject><subject>Rehabilitation</subject><subject>Skin</subject><subject>Temperature effects</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Walking</subject><subject>Working conditions</subject><subject>Workload</subject><issn>0363-6119</issn><issn>1522-1490</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUtPwzAQhC0EgvL4AxyQJS5cUvyInfqIKl4SEhc4W1t7A6nSONgJ0H-PC4UDpznsN6PVDCGnnE05V-ISln3El3HKGNNmKhif7ZBJPoiCl4btkgmTWhaac3NADlNaZq6UpdwnB8KYSimtJgTmEH0T3iG5sYVII6Y-dAkTHQJ1ofUUOk_TuFjBZ7OCluInRtckpE1Hexga7IZEP5rhNdMxdBDXFOKAWXymIOEx2auhTXiy1SPyfHP9NL8rHh5v7-dXD4WTlRoKLdExA7VzTrvKLRCg1t5Ig7gQpay1dAvGkUtde-NxhsoLFLV2HrEslZZH5OInt4_hbcQ02FWTHLYtdBjGZAXTuqzkTKqMnv9Dl2GMXf7OCs4rVRmjqkyJH8rFkFLE2vYxVxDXljO7GcBuB7DfA9jNANl0to3OlaH_s_w2Lr8Ac7-GAg</recordid><startdate>20181001</startdate><enddate>20181001</enddate><creator>Valtonen, Rasmus I P</creator><creator>Kiviniemi, Antti</creator><creator>Hintsala, Heidi E</creator><creator>Ryti, Niilo R I</creator><creator>Kenttä, Tuomas</creator><creator>Huikuri, Heikki V</creator><creator>Perkiömäki, Juha</creator><creator>Crandall, Craig</creator><creator>van Marken Lichtenbelt, Wouter</creator><creator>Alén, Markku</creator><creator>Rintamäki, Hannu</creator><creator>Mäntysaari, Matti</creator><creator>Hautala, Arto</creator><creator>Jaakkola, Jouni J K</creator><creator>Ikäheimo, Tiina M</creator><general>American Physiological Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7QR</scope><scope>7TS</scope><scope>7U7</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2763-6004</orcidid></search><sort><creationdate>20181001</creationdate><title>Cardiovascular responses to cold and submaximal exercise in patients with coronary artery disease</title><author>Valtonen, Rasmus I P ; 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Regulatory, integrative and comparative physiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Valtonen, Rasmus I P</au><au>Kiviniemi, Antti</au><au>Hintsala, Heidi E</au><au>Ryti, Niilo R I</au><au>Kenttä, Tuomas</au><au>Huikuri, Heikki V</au><au>Perkiömäki, Juha</au><au>Crandall, Craig</au><au>van Marken Lichtenbelt, Wouter</au><au>Alén, Markku</au><au>Rintamäki, Hannu</au><au>Mäntysaari, Matti</au><au>Hautala, Arto</au><au>Jaakkola, Jouni J K</au><au>Ikäheimo, Tiina M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiovascular responses to cold and submaximal exercise in patients with coronary artery disease</atitle><jtitle>American journal of physiology. Regulatory, integrative and comparative physiology</jtitle><addtitle>Am J Physiol Regul Integr Comp Physiol</addtitle><date>2018-10-01</date><risdate>2018</risdate><volume>315</volume><issue>4</issue><spage>R768</spage><epage>R776</epage><pages>R768-R776</pages><issn>0363-6119</issn><eissn>1522-1490</eissn><abstract>Regular year-round exercise is recommended for patients with coronary artery disease (CAD). However, the combined effects of cold and moderate sustained exercise, both known to increase cardiac workload, on cardiovascular responses are not known. We tested the hypothesis that cardiac workload is increased, and evidence of ischemia would be observed during exercise in the cold in patients with CAD. Sixteen men (59.3 ± 7.0 yr, means ± SD) with stable CAD each underwent 4, 30 min exposures in a randomized order: seated rest and moderate-intensity exercise [walking, 60%-70% of max heart rate (HR)] performed at +22°C and -15°C. Systolic brachial blood pressure (SBP), HR, electrocardiogram (ECG), and skin temperatures were recorded throughout the intervention. Rate pressure product (RPP) and ECG parameters were obtained. The combined effects of cold and submaximal exercise were additive for SBP and RPP and synergistic for HR when compared with rest in a neutral environment. RPP (mmHg·beats/min) was 17% higher during exercise in the cold (18,080 ± 3540) compared with neutral (15,490 ± 2,940) conditions ( P = 0.001). Only a few ST depressions were detected during exercise but without an effect of ambient temperature. The corrected QT interval increased while exercising in the cold compared with neutral temperature ( P = 0.023). Recovery of postexercise blood pressure was similar regardless of temperature. Whole body exposure to cold during submaximal exercise results in higher cardiac workload compared with a neutral environment. Despite the higher RPP, no signs of myocardial ischemia or abnormal ECG responses were observed. The results of this study are useful for planning year-round exercise-based rehabilitation programs for stable CAD patients.</abstract><cop>United States</cop><pub>American Physiological Society</pub><pmid>29975565</pmid><doi>10.1152/ajpregu.00069.2018</doi><orcidid>https://orcid.org/0000-0002-2763-6004</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Ambient temperature Blood pressure Body temperature Cardiac Rehabilitation - adverse effects Cardiac Rehabilitation - methods Cardiovascular disease Cardiovascular system Cold Cold pressing Cold Temperature - adverse effects Coronary artery Coronary artery disease Coronary Artery Disease - diagnosis Coronary Artery Disease - physiopathology Coronary Artery Disease - rehabilitation Cross-Over Studies EKG Exercise Exercise Test Exercise Therapy - adverse effects Exercise Therapy - methods Exercise Tolerance Exposure Finland Health Status Heart diseases Heart rate Hemodynamics Humans Ischemia Male Middle Aged Myocardial ischemia Patients Physical training Rehabilitation Skin Temperature effects Time Factors Treatment Outcome Walking Working conditions Workload |
| title | Cardiovascular responses to cold and submaximal exercise in patients with coronary artery disease |
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