Transcript Effect of HRV

三個月太極拳訓練對中年人和老年人心率
變異度、血脂肪以及細胞激素之效應
Effect of 3-Month Tai Chi Chuan on Heart Rate
Variability, Blood Lipid and Cytokine Profiles
in Middle-Aged and Elderly Individuals
呂萬安
佛光大學文化資產與創意學系
台北榮民總醫院教研部生物物理研究室
Outline
Introduction
Aim of study
Materials and Methods
Results
Discussion
Conclusion
Introduction
Heart rate variability (HRV)
• HRV has been systematically examined since
18th century.
• Hales (1733)
– first reported beat-to-beat variability of heart rate in
conjunction with arterial blood pressure.
– found correlation between respiratory cycle, blood
pressure and the interval between heart beats (RR
intervals).
Heart rate variability
• Hon & Lee (1965 ) first used it in fetal
monitoring:
– Diminished beat-to beat variation in fetal heart rate
signifies fetal distress.
– Recognition of spontaneous fluctuation in sinus
rate as an index of autonomic function.
Heart rate variability
• Akselrod et al., 1981
– Power spectrum analysis:
sympathetic
vagal (parasympathetic)
renin-angiotensin activity
Autonomic Nervous Modulation (1)
• Decreased vagal modulation :
– Aging
– Total spectral power in the 0.01-0.40-Hz
frequency range and low-frequency and highfrequency components of the HR power
spectrum were significantly lower in old than
in young subjects in supine and upright
positions.(Lipsitz L A et al. Circulation 1990;81:1803-10)
Autonomic Nervous Modulation (2)
•
Diabetes mellitus
–
A marked reduction in the power of heart rate (HR)
fluctuations, at all frequencies, was found in the
diabetic patients as compared to controls.(Lishner M et al.
J Auto Nerv Sys 1987;19: 119-25)
•
Chronic renal failure
–
Spectral analysis of fluctuations in heart rate: an
objective evaluation of autonomic nervous control
in chronic renal failure.(Akselrod S et al. Nephron 1987;45: 202-6)
Autonomic Nervous Modulation (3)
•
Congestive heart failure
–
Heart rate fluctuations at very low frequencies
(0.01 to 0.04 Hz) less effectively differentiated
CHF patients from control subjects. (Saul J P et al. Am J
Cardiol1988; 61:1292-9)
•
Acute myocardial infarction
–
the sympathetic predominance that is detectable 2
weeks after AMI is followed by recovery of vagal
tone and a normalization of sympathovagal
interaction, not only during resting conditions, but
also in response to a sympathetic stimulus. (Lombardi
F et al. Am J Cardiol 1987;60: 1239-45)
Physiological means 1 ( safety,
feasibility, lack of complications )
•
Position
–
Right lateral positions was better for
patients of myocardial infarction. (Kuo C D et
al. Crit Care Med 2000;28:1283-9)
Physiological means 2 ( safety,
feasibility, lack of complications )
• Exercise
vagal modulation of HR variability is more prominent
in normal coronary artery subjects than in CAD
subjects during handgrip exercise . (Kurita A et al. Clin Cardiol
1999;22:207-12)
Impact of a 12-month exercise produce a significantly
increase in the functional fitness of osteopenic women.
(Bravo G et al. J Am Geriatr Soc 1996;44:756-62)
Tumor necrosis factor (TNF)
• Cytokine
It is produced chiefly by activated macrophages.
它可以藉由趨化作用(chemotaxis, 5～20μm/min)引
導嗜中性白血球(leucocyte neutrophil)移向感染處，
它還可以造成發燒、嗜睡和血漿鐵濃度降低，具有
毒殺癌細胞的特性。
Interferon-γ (IFN-γ)
• Cytokine
Interferon gamma (IFNγ) is produced predominantly
by natural killer and natural killer T cells.
1957年由英國Alick Isaacs和Jean Lindenmann所發現，
當細胞受到病毒感染時，會立即製造出干擾素以抵
抗病毒，並同時警告鄰近正常的細胞，提高警覺，
以防病毒入侵。具有強力吞噬細胞活化(phagocyteactivating)的作用。(Interferon gamma was also
called macrophage-activating factor)
Tai Chi Chuan ( TCC )
• Shadow boxing ( Tai Chi Chuan ) is a
traditional Chinese martial art.
• It consists of many fundamental postures having
graceful movements.
• During the performance of TCC, deep breathing
and mental concentration are required to
achieve harmony between body and mind.
Studies of TCC (1)
1. Changes in heart rate, noradrenaline, cortisol
and mood during Tai Chi. (Jin PT et al. J Psychosom
Res 1989;33:197-206)
2. Efficacy of Tai Chi, brisk walking, mediation,
and reading in reducing mental and emotional
stress. (Jin PT et al. J Psychosom Res 1992;36:361-70)
TCC can reduce tension, anxiety and
mood disturbance.
Studies of TCC (2)
1. Two-year trends in cardiorespiratory function
among older Tai Chi Chuan practitioners and
sedentary subjects. (Lai JS et al.J Am Geriatr Soc 1995;43: 12227).
2. The cardiorespiratory function, flexibility, and
body composition among geriatric Tai Chi Chuan
practitioners. (Lan C et al. Arch Phys Med Rehabil 1996; 77: 612-6).
Studies of TCC (3)
3. A 12-month Tai Chi training in the elderly: its effect
on health fitness. (Lan C et al. Med Sci Sports Exerc 1998 ;30: 34551).
4. Tai Chi and potural control in the well elderly.(Tse S K
et al. Am J Occup Ther 1992; 46: 295-300).
5. Reducing frailty and falls in older persons: an
investigation of Tai Chi and computerized balance
training.(Wolf SL et al. J Am Geriatr Soc 1996; 44: 489-97).
TCC’s training is beneficial to the cardiorespiratory
function, balance, strength and delay the decline
of aerobic power.
Aim of this study
• To investigate the effect of 3 months of
Tai Chi Chuan training on heart rate
variability, blood lipids and cytokine
production in elderly people
Materials and Methods
Study Subjects
• Participants were recruited from the community and
divided randomly into two groups.
• The TCC trainees exercised the classical Yang's TCC
for 40 minutes/session, seven times/week over a course
of 3 months.
• Bright and quiet room with a constant temperature of
24 to 25 °C.
Study Design (1)
• This was a longitudinal study with 3 months of followup.
• Standard 12-lead electrocardiogram, spirometry,
biochemistry and cytokine analysis.
• Before TCC, the subjects was instructed to lie down
and take a rest in supine position.After 5 minutes´ rest,
A trend of conventional leadⅡelectrocardiographic
signal was picked up and transferred to storage and
further analysis.
Study Design (2)
• After baseline recording, the subject was advised to
practice classical Yang´s TCC for 40 minutes.
• Each set of Yang´s TCC included 64 postures that
included 10 minutes´ warm-up exercise, 20 minutes´
TCC practicing, and 10 minutes´ cool-down exercise.
• The subjects kept the same speed in exercising and
each posture was performed according to a prerecorded
tape.
Study Design (3)
• Before and after 3 months of TCC training, HRV,
spirometry, hemodynamic data, blood biochemistry,
lipid profile and serum cytokine levels of the TCC
trainees were measured using the same methodology.
•
TCC for 40 minutes/session, seven times/week
————————————————————
•
• Before TCC training
after 3 months of TCC training
Measurement (1)
• The sampling frequency: 200 Hz
• The peak of the R wave was identified .
• The R-wave detecting software: the consecutive
RR intervals.
• Sinus pause, arterial or ventricular arrhythmia
• The last 512 stationary RR intervals: heart rate
variability analysis.
• >5%, screen out
Measurement (2)
• The power spectra of RR intervals:
fast Fourier transformation
• The spectral peaks (0.15-0.40 Hz):
high frequency power
• The spectral peaks (0.04-0.15 Hz):
low frequency power
• The spectral peaks (0.01-0.40 Hz):
total power
Measurement (3)
• The normalized high-frequency power ( highfrequency power / total power ) :
vagal activity
• The normalized low-frequency power ( lowfrequency power / total power ) :
sympathetic activity
• The low /high-frequency power ratio :
sympathovagal balance
Measurement (4)
• Biochemistry assays:
total cholesterol (TC), HDL-cholesterol (HDL-C),
low- density lipoprotein-cholesterol (LDL-C),
triglyceride (TG), fasting blood sugar (FBS), uric
acid (UA)
• Immunoenzymometric assays:
tumor necrosis factor-α (TNF-α), Interferon-γ
(INF-γ）
Statistics (1)
•
•
•
•
Descriptive statistics: median (25% —75%).
The Mann-Whitney rank sum test .
The Wilcoxon signed rank test.
p<0.05 was considered statistically significant.
Statistics (2)
• The percentage change were calculated by using
the following formula:
•  =[(after before )(before )]100
Results
• Table 1. General characteristics, spirometry and hemodynamics of controls
and TCC trainees before and after TCC training
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Characteristics
Age (years)
Gender (M/F)
Body weight (Kg)
Body height (cm)
BMI (kg/m2)
FVC (l)
%FVC (%)
FEV1 (l)
%FEV (%)
FEV1/ FVC (%)
SBP (mmHg)
DBP (mmHg)
MABP (mmHg)
PP (mmHg)
Controls
Controls
TCC Trainees
(Before 3 months) (After 3 months) (Before training)
TCC Trainees
(After training)
(n = 25)
53 (47~59)
12/13
61 (53~62)
162 (158~163)
22.9 (20.9~24.9)
2.7 (2.3~3.2)
85.0 (77.0~89.3)
2.3 (1.7~2.5)
82.0 (72.8~89.3)
80.0 (74.3~84.5)
119 (107~128)
67 (61~74)
83 (77~92)
48 (42~56)
(n = 25)
57 (50~67)
8/17
56 (52~63)
156 (153~164)
22.6 (21.6~24.5)
2.5 (2.2~2.9)
86.0 (80.3~90.3)
2.1 (1.8~2.4)
86.0 (80.3~91.5)
81.0 (77.0~85.0)*
120 (109~133)
67 (60~72)
82 (78~92)
51 (44~64)
(n = 25)
53 (47~59)
12/13
61 (55~63)
162 (158~163)
22.9 (21.4~24.9)
2.6 (2.3~3.2)
85.0 (82.3~87.5)
2.3 (1.7~2.5)
83.0 (72.8~90.3)
80.4 (75.4~86.4)
120 (113~137)
67 (63~72)
85 (80~92)
53 (43~65)
(n = 25)
57 (50~67)
8/17
56 (52~63)
156 (153~164)
22.7 (21.6~24.6)
2.6 (2.2~2.9)
87.0 (79.3~95.0)
2.1 (1.7~2.3)
84.0 (77.5~92.3)
79.0 (75.0~82.8)
126 (112~131)
67 (64~69)
85 (82~92)
55 (49~65)
Data are presented as medians (25 percentile~75 percentile)
* p < 0.05 vs. before TCC training in TCC trainees.
BMI = body mass index; FVC = forced vital capacity; FEV1 = forced expiratory volume in the first
second; l = liter; SBP = systolic blood pressure; DBP = diastolic blood pressure; MABP = mean arterial
blood pressure; PP = pulse pressure.
• Table 2. HRV measures of the controls and TCC trainees before and after
TCC training
•
•
•
Measures
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Time domain HRV measures
Mean RRI (ms)
884 (781~938)
Heart rate (bpm)
67 (63~75)
SDRR (ms)
48 (37~52)
CVRR (%)
5.3 (3.6~6.1)
Frequency domain HRV measures
TP (ms2)
993 (634~1176)
VLFP (ms2)
163 (115~363)
LFP (ms2)
268 (167~318)
HFP (ms2)
395 (249~458)319
nHFP (nu)
39.9 (32.9~53.8)
nLFP (nu)
29.2 (25.7~33.2)
nVLFP (nu)
22.9 (16.5~34.2)
LFP/HFP
0.80 (0.52~1.13)
•
•
•
Data are presented as medians (25 percentile~75 percentile)
*p<0.05 vs. before TCC training
RRI = RR intervals; SDRR = standard deviation of RR; CVRR = coefficient of variation of RR; ms =
millisecond; bpm = beats per minute; nu = normalized unit; TP = total power; VLFP = very lowfrequency power; LFP = low-frequency power; HFP = high-frequency power; nHFP = normalized highfrequency power; nLFP = normalized low-frequency power; nVLFP = normalized very low-frequency
power; LFP/HFP = low-/high-frequency power ratio.
Controls
Controls
TCC Trainees
(Before 3 Months) (After 3 Months) (Before Training)
(n = 25)
(n = 25)
(n = 25)
TCC Trainees
(After Training)
(n = 25)
892 (791~956)
68 (65~76)
43 (36~50)
5.1 (3.9~6.2)
921 (826~1027)
65 (58~73)
41 (28~55)
4.4 (3.1~5.3)
891 (801~957)
67 (63~75)
34 (24~50)
3.7 (2.8~5.3)
823 (583~1202)
195 (97~359)
258 (148~371)
(232~491)
44.3 (38.5~51.6)
30.5 (26.9~39.8)
25.5 (18.5~30.9)
0.68 (0.51~0.93)
681 (371~1312)
215 (140~300)
157 (89~322)
259 (117~628)
40.1 (23.9~61.6)
23.7 (18.6~29.2)
31.3 (18.6~46.0)
0.54 (0.33~1.49)
508 (215~1455)
148 (77~355)
92 (53~421)
305 (57~436)*
39.7 (21.4~56.3)
27.4 (20.7~33.5)
29.0 (23.2~46.6)
0.76 (0.44~1.17)
• Table 3. Changes in blood biochemistry, lipid profile and cytokine levels
before and after 3 months of TCC training
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Blood Tests
Controls
(Before 3 months)
(n = 25)
Controls
(After 3 months)
(n = 25)
TCC Trainees
(Before training)
(n = 25)
TCC Trainees
(After training)
(n = 25)
FBS (mg/dl)
TG (mg/dl)
TC (mg/dl)
LDL-C (mg/dl)
HDL-C (mg/dl)
TC/HDL-C
LDL-C/HDL-C
UA (mg/dl)
TNF-α (μg/ml)
IFN-γ (μg/ml)
93 (83~102)
125 (89~167)
201 (185~210)
125 (109~152)
51 (48~60)
3.98 (3.17~4.46)
2.36 (1.97~2.88)
5.9 (4.8~6.5)
13.9 (12.7~17.6)
0.47 (0.42~0.60)
97 (85~105)
117 (102~136)
198 (179~211)
126 (109~153)
52 (47~63)
3.94 (3.08~4.26)
2.49 (1.99~2.96)
5.9 (5.0~6.5)
14.4 (13.2~17.5)
0.51 (0.45~0.61)
89 (81~94)
123 (87~162)
206 (180~235)
127 (106~158)
54 (43~64)
4.15 (3.46~5.00)
2.66 (2.28~3.19)
5.1 (4.5~7.0)
7.9 (6.5~12.9)
0.38 (0.32~0.43)*
96 (93~104)†
95 (69~161)
191 (165~205)†
144 (114~158)
55 (45~63)#
3.53 (3.00~4.23)†
2.67 (2.34~3.18)
5.6 (4.5~6.6)
16.2 (13.4~19.3)†
0.96 (0.73~1.30)†
Data are presented as medians (25 percentile~75 percentile)
*p<0.01 vs. controls; p<0.001 vs. controls; #p<0.05 vs. before TCC training; † p<0.001 vs. before TCC
training.
FBS = fasting blood sugar; TG = triglycerides; TC = total cholesterol; LDL-C = low-density lipoproteincholesterol; HDL-C = high-density lipoprotein-cholesterol; HDL-C / TC = the ratio of HDL-C over TC;
UA = uric acid; TNF-α= Tumor Necrosis Factor-alpha; IFN-γ = Interferon-gamma.
• Table 4. Percentage changes in general characteristics, spirometry and
hemodynamics of the controls and TCC trainees
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
_____________________________________________________________________
Characteristics
Controls
TCC Trainees
_____________________________________________________________________
Body weight; %
0.00 (0.00~0.79)
0.00 (0.00~0.00)*
BMI; %
0.00 (0.00~0.79)
0.00 (0.00~0.00)*
FVC; %
0.00 (-4.56~0.00)
-0.04 (-6.68~4.01)
%FVC; %
0.00 (-1.12~1.18)
1.14 (-6.05~4.13)
FEV1; %
0.00 (0.00~0.00)
3.49 (-1.83~7.13)*
%FEV; %
0.00 (0.00~0.51)
3.41 (-1.29~7.87)
FEV1/ FVC; %
0.52 (-0.46~4.65)
3.75 (-1.22~9.57)
SBP; %
0.68 (0.00~6.56)
-0.82 (-10.53~4.94)
DBP; %
0.00 (-3.16~6.52)
-4.29 (-8.19~9.08)
MABP; %
2.60 (-0.20~5.41)
-0.85 (-9.55~5.55)
PP; %
1.72 (-6.81~20.68) -6.25 (-15.71~7.04)
_________________________________________________________________________
•
•
Data are presented as median (25 percentile~75 percentile)
*p<0.05 vs. Controls.
• Table 5-1. Percentage changes in HRV measures, blood biochemistry, lipid
profile and cytokine levels of the controls and TCC trainees
•
_____________________________________________________________________
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Measures
Controls
TCC Trainees
_____________________________________________________________________
Time domain HRV
Mean RRI; %
0.0 (-4.9~6.7)
-5.0 (-14.5~5.4)
Heart rate; %
-0.9 (-5.3~0.3)
5.2 (-5.1~17.0)
SDRR; %
-0.6 (-14.6~8.9)
-7.9 (-32.3~30.3)
CVRR; %
0.0 (-11.4~8.0)
-3.1 (-24.2~32.3)
Frequency domain HRV
TP; %
0.0 (-25.8~31.4)
-21.5 (-48.2~69.6)
VLFP; %
0.0 (-52.5~53.9)
-9.1 (-44.1~48.8)
LFP; %
4.2 (-7.0~27.9)
-31.6 (-50.1~87.7)
HFP; %
0.0 (-19.4~13.0)
-31.9 (-65.0~94.3)
nHFP; %
7.3 (-17.8~66.9)
-7.5 (-43.3~49.9)
nLFP; %
5.9 (-11.9~41.1)
12.8 (-32.3~46.0)
nVLFP; %
3.5 (-31.9~31.6)
1.2 (-29.9~66.6)
LFP/HFP; %
-13.4 (-37.3~9.4)
10.5 (-46.0~122.2)
•
•
_________________________________________________________________________
•
•
Data are presented as medians (25 percentile~75 percentile)
*p<0.05 vs. Controls; † p<0.001 vs. Controls.
• Table 5-2. Percentage changes in HRV measures, blood biochemistry, lipid
profile and cytokine levels of the controls and TCC trainees
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
_____________________________________________________________________
Measures
Controls TCC Trainees
_____________________________________________________________________
Blood tests
FBS; %
3.1 (-5.0~11.1)
10.4 (7.6~15.0)*
TG; %
5.3 (-22.9~21.4)
8.0 (-27.0~26.8)
TC; %
0.6 (-2.3~2.8)
-10.6 (-13.7~-4.8)†
LDL-C; %
0.5 (0.0~4.9)
3.6 (-1.6~12.5)
HDL-C; %
0.0 (-0.4~4.3)
2.9 (-2.4~9.5)
TC/HDL-C; % -1.0 (-4.2~1.4)
-11.9 (-18.4~-6.8)†
LDL-C/HDL-C; %
0.0 (-3.4~4.9)
3.9 (-4.3~-11.2)
UA; %
0.0 (0.0~0.0)
7.2 (-8.7~-15.3)
TNF-α; %
0.0 (0.0~4.6)
96.8 (5.6~162.6)†
IFN-γ; %
0.0 (0.0~16.9)
137.8 (109.3~185.9)†
_________________________________________________________________________
Data are presented as medians (25 percentile~75 percentile)
*p<0.05 vs. Controls; † p<0.001 vs. Controls.
Discussion
TCC have beneficial effects on the
cardiorespiratory function
1. two-year practicing TCC regularly may delay the
decline of cardiorespiratory function in older
individuals. (Lai et al. J Am Geriatr Soc 1995;43:1222-7)
2. 12-month TCC program was effective in improving
cardiorespiratory function, muscle strength, and
flexibility in the elderly. (Lan et al. Med Sci Sport Exerc 1998;30:34551)
• The FEV1/FVC of the TCC trainees was increased
significantly after 3 months of TCC training.
TCC have beneficial effects on the
cardiorespiratory function
3. 12 weeks of exercise in mild hypertensive patients
reduced blood pressure and favorable changes of
lipid profile. (Tsai et al. Clin Exp Hyper 2002;24:315-24)
4. TC/HDL-C, LDL/HDL ratios were associated with
coronary heart disease risk. (Arsenault et al. Eur J Clin Invest
2010;40:1081-93)
• The HDL-C increased significantly, the TC was
decreased significantly, TC/HDL-C decreased
significantly after 3 months of TCC training.
TCC exercise might benefit
immunoregulatory function of the subjects
1. Endurance athletes activate anti-leukemic immunity
and that TNF-α and IFN-γ were much higher
compared to the controls. (Chiang et al. Int J Sports Med 2000;21:602-7)
2. TCC for two months significantly increase the level of
IgG. (Zhang et al. J Beijing Inst Phys Edu 1990;4:12-4)
3. The number and activity of natural killer cells
significantly increased after the practice of Wu’s
TCC . (Li and Shen. Chin J Sports Med 1995;14:53-6)
TCC exercise might benefit
immunoregulatory function of the subjects
4.
Circulating T cells, active T lymphocytes all
significantly higher in the TCC practitioners. (Sun et al. J
Sports Med 1989;10:217-9)
5. TCC exercise increase CD4CD25 regulatory Tlymphocytes in type 2 diabetic patients. (Yeh et al. Diab Care
2007;30:716-8)
6. TNF-α possessed antitumor and immunomodulation,
IFN-γ plays an important role in the growth and
differentiation of cytotoxic T cells, activates NK cells
and B cell maturation factor. (Lans et al. Anticancer Res
2004;24:2243-8; Ohno et al. Int J Hematol 2003;77:286-94)
Conclusion
• Three months of TCC training can improve
the pulmonary function, glucose availability
and blood lipid profile, as well as increase the
cytokine production in middle-aged and
elderly subjects.
• TCC may be beneficial to the middle-aged
and elderly people as a health-promoting
calisthenics.
• 研究成果
• Wan-An Lu, Cheng-Deng Kuo. Effect of 3Month Tai Chi Chuan on Heart Rate
Variability, Blood Lipid and Cytokine
Profiles in Middle-Aged and Elderly
Individuals. Int J Gerontol. 2012 March;
6(4):267-272.
Thanks for your attention