Exercise Training Associated with Diet Improves Heart Rate Recovery and Cardiac Autonomic Nervous System Activity in Obese Children

Abstract

The purpose of this study was to test the hypotheses that in obese children: 1) hypocaloric diet (D) improves both heart rate recovery at 1 min (Δ HRR1) cfter an exercise test, and cardiac autonomic nervous system activity (CANSA) in obese children; 2) Diet and exercise training (DET) combined leads to greater improvement in both Δ HRR1 after an exercise test and in CANSA, than D alone. Moreover, we examined the relationships among Δ HRR1, CANSA, cardiorespiratory fitness and anthropometric variables (AV) in obese children submitted to D and to DET. 33 obese children (10±0.2 years; body mass index (BMI) >95^th percentile) were divided into 2 groups: D (n=15; BMI=31±1 kg/m²) and DET (n=18; 29±1 kg/m²). All children performed a maximal cardiopulmonary exercise test on a treadmill. The Δ HRR1 or LF/HF ratio (P>0.05). In contrast, the DET group showed increased peak VO₂ (P=0.01) and improved Δ HRR1 (Δ HRR1=37.3±2.6; P=0.01) and LF/HF ratio (P=0.001). The DET group demonstrated significant relationships among Δ HRR1, peak VO₂ and CANSA (P<0.05). In conclusion, DET, in contrast to D, promoted improved ÄΔ HRR1 and CANSA in obese children, suggesting a positive influence of increased levels of cardiorespiratory fitness by exercise training on cardiac autonomic activity.

Key words

childhood obesity - exercise training - cardiac autonomic activity - heart rate recovery - cardiorespiratory fitness

References

• 1 Arai Y, Saul JP, Albrecht P, Hartley LH, Lilly LS, Cohen RJ, Colucci WS. Modulation of cardiac autonomic activity during and immediately after exercise.  Am J Physiol. 1989;  256 H132-H141
• 2 Arena R, Myers J, Abella J, Peberdy MA, Bensimhon D, Chase P, Guazzi M. The prognostic value of heart rate response during exercise and recovery in patients with heart failure: influence of beta-blockade.  Int J Cardiol. 2010;  138 166-173
• 3 Braga AMF, Nunes N. Cardiopulmonary exercise testing applied cardiology. Exercise Cardiology: Manole, São Paulo; 2005: 128-147
• 4 Brazil MS. Guia Alimentar para a população brasileira. Brasília: Ministério da Saúde; 2006
• 5 Brinkworth GD, Noakes M, Buckley JD, Clifton PM. Weight loss improves heart rate recovery in overweight and obese men with features of the metabolic syndrome.  Am Heart J. 2006;  152 693.e1-693.e6
• 6 Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality.  N Engl J Med. 1999;  341 1351-1357
• 7 Cole TJ, Bellizzi MC, Flegal KM, Deitz WM. Establishing a standard definition for child overweight and obesity worldwide: international survey.  BMJ. 2000;  320 1240-1243
• 8 Cole TJ. The LMS method for constructing normalized growth standards.  Eur J Clin Nutr. 1990;  44 45-60
• 9 Gielen S, Schuler G, Hambrecht R. Exercise in coronary artery disease and coronary vasomotion.  Circulation. 2001;  103 E1-E6
• 10 Gutin B, Owens S, Slavens G, Riggs S, Treiber F. Effect of physical training on heart-period variability in obese children.  J Pediatr. 1997;  130 938-943
• 11 Gutin B, Barbeau P, Litaker MS, Ferguson M, Owens S. Heart rate variability in obese children: relations to total body and visceral adiposity, and changes with physical training and detraining.  Obes Res. 2000;  8 12-19
• 12 Harriss DJ, Atkinson G. International Journal of Sports Medicine – Ethical Standards in Sport and Exercise Science Research.  Int J Sports Med. 2009;  30 701-702
• 13 Houtkooper LB, Going SB, Lohman TG, Roche AF, Van Loan M. Bioelectrical impedance estimation of fat-free body mass in children and youth: a cross-validation study.  J Appl Physiol. 1992;  72 366-373
• 14 Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, Takeda H, Inoue M, Kamada T. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure.  J Am Coll Cardiol. 1994;  24 1529-1535
• 15 Lipinski MJ, Vetrovec GW, Froelicher VF. Importance of the first 2 min of heart rate recovery after exercise treadmill testing in predicting mortality and the presence of coronary artery disease in men.  Am J Cardiol. 2004;  93 445-449
• 16 Maddox TM, Ross C, Ho M, Masoudi FA, Magid D, Daugherty SL, Peterson P, Rumsfeld JS. The prognostic importance of abnormal heart rate recovery and chronotropic response among exercise treadmill tests patients.  Am Heart J. 2008;  156 736-744
• 17 Marcor F, Fagard R, Amery A. Power spectral analysis of RR interval and blood pressure short-term variability at rest and during dynamic exercise: comparison between cyclists and controls.  Int J Sports Med. 1996;  17 175-181
• 18 Martini G, Riva P, Rabbia F, Molini V, Ferrero GB, Cerutti F, Carra R, Veglio F. Heart rate variability in childhood obesity.  Clin Auton Res. 2001;  11 87-91
• 19 McInnis KJ. Exercise and obesity.  Coron Artery Dis. 2000;  11 111-116
• 20 Mertens IL, Van Gaal LF. Overweight, obesity and blood pressure: the effects of modest weight reduction.  Obes Res. 2000;  8 270-278
• 21 Myers J, Hadley D, Oswald U, Bruner K, Kottman W, Hsu L, Dubach P. Effects of exercise training on heart rate recovery in patients with chronic heart failure.  Am Heart J. 2007;  153 1056-1063
• 22 Nagai N, Matsumoto T, Kita H, Moritani T. Autonomic nervous system activity and the state and development of obesity in Japanese school children.  Obes Res. 2003;  11 25-32
• 23 Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart-rate recovery and treadmill exercise score as predictor of mortality in patients referred for exercise ECG.  JAMA. 2000;  284 1392-1398
• 24 Ohuchi H, Suzuki H, Yasuda K, Arakaki Y, Echigo S, Kamiya T. Heart rate recovery after exercise and cardiac autonomic nervous activity in children.  Pediatr Res. 2000;  47 329-335
• 25 O’Leary DS. Autonomic mechanisms of muscle metaboreflex control of heart rate.  J Appl Physiol. 1993;  74 1748-1754
• 26 Pagani M, Lombardi F, Guzzetti S. Power spectral analysis of heart rate and arterial pressure variability as a marker of sympathovagal interaction in man and conscious dog.  Circ Res. 1986;  59 178-193
• 27 Perini R, Orizio C, Comande A, Castellano M, Beschi M, Veicsteinas A. Plasma norepinephrine and heart rate dynamics during recovery from submaximal exercise in man.  Eur J Appl Physiol. 1989;  58 879-883
• 28 Rabbia F, Silke B, Conterno A, Grosso T, De Vito B, Rabbone I, Chiandussi L, Veglio F. Assessment of cardiac autonomic modulation during adolescent obesity.  Obes Res. 2003;  11 541-548
• 29 Rowland TW. Aerobic exercise testing protocols. In: Rowland TW (ed) Pediatric Laboratory Exercise Testing Champaign Human Kinetics; 1993: 19-41
• 30 Savin WM, Davidson DM, Haskell WL. Autonomic contribution to heart rate recovery from exercise in humans.  J Appl Physiol. 1982;  53 1572-1575
• 31 Smith LL, Kukielka M, Billman GE. Heart rate recovery after exercise: a predictor of ventricular fibrillation susceptibility after myocardial infarction.  Am J Physiol. 2005;  288 H1763-H1769
• 32 Soro J, Daniels S. Obesity hypertension in children: a problem of epidemic proportions.  Hypertension. 2002;  40 441-447
• 33 Streuber SD, Amsterdam EA, Stebbins CL. Heart rate recovery in heart failure patients after a 12-week cardiac rehabilitation program.  Am J Cardiol. 2006;  97 694-698
• 34 Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology . Heart rate variability: Standards of measurement, physiological interpretation, and clinical use.  Circulation. 1996;  93 1043-1065
• 35 Thomson RL, Buckley JD, Noakes M, Clifton PM, Norman RJ, Brinkworth GD. Heart rate recovery improves after weight loss in overweight and obese women with polycystic ovary syndrome.  Fertil Steril. 2010;  93 1173-1178
• 36 Trombetta IC, Batalha LT, Rondon MUPR, Laterza MC, Villares SMF, Negrão CE. Weight loss improves neurovascular and muscle metaboreflex control in obesity.  Am J Physiol. 2003;  285 H974-H982
• 37 Wasserman K. The anaerobic threshold measurement to evaluate exercise performance.  Am Rev Respir Dis. 1984;  12 S35-S40
• 38 Weinstock RS, Dai H, Wadden TA. Diet and exercise in the treatment of obesity.  Arch Intern Med. 1998;  158 2477-2483
• 39 US Department of Health and Human Services 2000 CDC growth charts: United States http://www.cdc.gov/growthcharts/

Correspondence