Transcript psychomotor performance

Neglected mechanisms of cardiopulmonary capacity in health
and heart failure - Why brain and heat stress really matter ?
ROBERT SKALIK, MD, PhD, CONSULTANT IN CARDIOLOGY
MEDICAL UNIVERSITY OF WROCŁAW, POLAND
DEPARTMENT OF PHYSIOLOGY
,
DETERMINANTS OF CARDIOPULMONARY CAPACITY IN HEALTH
AND HEART FAILURE – STATE OF THE ART
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CARDIAC MUSCLE AND VALVES FUNCTION
LUNG FUNCTION (PERFUSION-VENTILATION COUPLING)
BLOOD ( ANAEMIA )
PERIPHERAL VESSELS FUNCTION ( OXYGEN TRANSPORTATION CONDUIT)
SKELETAL MUSCLE STRUCTURE (TYPES OF MUSCLE FIBRES, MITOCHONDRIAL
CAPACITY)
• CENTRAL AND PERIPHERAL RECEPTORS:
METABORECEPTORS, CHEMORECEPTORS, BARORECEPTORS, ERGORECEPTORS
• IMMUNOLOGICAL SYSTEM (PROINFLAMMATORY CYTOKINES,LPS)
• AUTONOMIC NERVOUS SYSTEM
PATEL et al. Am J Cardiol 2014
Characteristics and outcomes of patients with heart failure and
discordant findings by right- sided heart catheterization and
cardiopulmonary exercise testing
• Relevant discrepancy between cardiac hemodynamic
parameters as measured by cardiac catheterization and
functional capacity during cardiopulmonary exercise
testing (CPX) in patients with advanced heart failure
(47% of pts)
• Importance of extracardiopulmonary factors for exercise
tolerance !!!
DETERMINANTS OF EXERCISE CAPACITY IN HEALTH AND HEART FAILURE
DO WE REALLY KNOW AND UNDERSTAND ALL OF THEM ?
• HEAT STRESS AND THERMOREGULATION:
CORE BODY TEMPERATURE, THERMORECEPTORS, HYPOTHALAMUS
• BRAIN PROCESSING (PSYCHOMOTOR PERFORMANCE):
CORTICAL CENTRES (MOTOR CORTEX) AND SUBCORTICAL STRUCTURES
HYPOTHALAMUS AND BRAIN CORTEX – STRONG DETERMINANT
OF EXERCISE PERFORMANCE
• HORMONES AND CORE BODY TEMPERATURE
(HYDRATION STATUS AND BLOOD PRESSURE, TISSUE METABOLISM)
• PSYCHOMOTOR PERFORMNACE
CORTEX ACTIVATION- PYRAMIDAL TRACTS CONDUCTION - PERIPHERAL NERVES
TRANSMISSION – SKELETAL MUSCLE CONTRACTION
Cheung SS. Neuromuscular response to exercise heat stress. Med Sport Sci 2008
The significant increase in core body temperature can impair exercise capacity,
and the primary pathway of the impairment may be the neuromuscular system
WHY THERMOREGULATION REALLY MATTERS IN HEALTH
AND HEART FAILURE ?
• HYPOTHALAMUS
1. CORE BODY TEMPERATURE REGULATION:
- SKELETAL MUSCLE CONTRACTILITY DURING EXERCISE,
- INTESNITY OF OXIDATIVE PROCESSES IN SKELETAL MUSCLES DURING EXERCISE (MPK)
- SPEED OF NEUROMUSCULAR TRANSMISSION
(BRAIN – PERIPHERAL NERVES - SKELETAL MUSCLE)
2. HORMONAL REGULATION ( SUPERIOR HORMONE REGULATORY CENTRE )
3. REGULATION OF LOCOMOTION AND VENTILATION
HYPOTHALAMUS
KEY PLAYER IN EXERCISE
INITIATION OF
HYPERVENTILATION
DURING EXERCISE
*(LOCOMOTOR REGION HTLR)
+
PSYCHOMOTOR
PERFORMANCE
(brain motor cortex activity)
HORMONAL ACTIVITY
VASOPRESSIN
TRH-TSH-FT3,FT4 AXIS
CRH-ACTH-ACE SYSTEM
THERMOREGULATION
DURING EXERCISE
INTERACTION WITH
BAROREFLEX, AUTONOMIC
NERVOUS SYSTEM
(paraventricular nucleus)
AND SKIN VESSELS
Koji I and Miyamura M. J Phys Fitness Sports Med. 2012*
Neural regulation of respiration during exercise. Beyond the conventional central command and afferent feedback
mechanisms.
HYPOTHALAMUS AND BRAIN CORTEX – STRONG DETERMINANT
OF EXERCISE PERFORMANCE
• MINUTE VENTILATION AND MOVEMENT (CORTEX, THERMORECEPTORS, LOCOMOTION
REGION HTLR)
• RESPONSIVENESS TO CO2 ( CORTICAL CHEMORECEPTION ) = CO2 OUTPUT ↑↓
Skalik et al. (2010,Berlin, HFA Congress)
• HEAT EXPULSION THROUGH THE LUNGS AND SKIN DURING EXERCISE (THERMORECEPTORS,
CORE BODY TEMPERATURE)
White MD. Components and mechanisms of thermal hyperpnea. J Appl Physiol 2006
CORE BODY TEMPERATURE ↑ = ACTIVATION OF BAROREFLEX = ANS ↑ = HEAT
EXPULSION (SKIN)↑
THERMORECEPTORS ACTIVATION ↑ = MINUTE VENTILATION ↑ = HEAT
EXPULSION ↑
HYPOTHALAMUS AND BRAIN CORTEX – REVIEW OF LITERATURE
• Heart failure patients had a distinct pattern of regional cortical activity with
exercise-induced breathlessness. These central neural differences in activity may
contribute to some features of heart failure, such as variability in symptoms and
autonomic dysregulation.
Rosen et al. Eur Heart J 2004, Pindus et al. Psychol Res 2015
• brain structural injuries in CHF patients emerge in areas involved in the
physiologic control of core body temperature (hypothalamus) and
breathlessness sensations (insular cortex) in healthy humans
Woo et al. J Card Fail 2009
improvement of exercise performance following regular training sessions in
athletes is related to the metabolic changes and amelioration of psychomotor
functions
Chmura et al. Int J Psychophysiol 2010
THERMOREGULATION AND HEART FAILURE – REVIEW OF LITERATURE
• Cui J et al. Effects of heat stress on thermoregulatory responses in
congestive heart failure patients Circulation 2005
• Cui J et al. Chronic heart failure does not attenuate the total activity of
sympathetic outflow to skin during whole-body heating Circ Heart Fail
2013
• Cui J et al. Cardiovascular responses to heat stress in chronic heart failure
Curr Heart Fail Rep 2014
THE AIM OF THE STUDY
to investigate the impact of core body temperature and
psychomotor performance on cardiopulmonary capacity and
test the value of thermometabolic (TMI) and
neurothermometabolic index (NTMI) as new markers of exercise
capacity in healthy volunteers
BACKGOUND OF THE INVESTIGATION
• there are no detailed studies that analyze interdependence between
thermal response to exercise, psychomotor performance and
ventilatory parameters as measured by CPX in the neutral ambient
climatic conditions !!!
• the interaction between the magnitude of increase in core body
temperature during exercise and psychomotor performance has a
strong impact on the exercise performance ?
• the core body temperature during exercise may correspond with the
intensity of aerobic metabolism at the anaerobic threshold (VO2AT),
i.e. a strong determinant of skeletal muscles (limb and respiratory
muscles) work efficiency during exercise ?
METHODS
• CARDIOPULMONARY EXERCISE TEST (CPX)
• CORE BODY TEMPERATURE MONITORING DURING EXERCISE
• PSYCHOMOTOR PERFORMANCE TESTS BEFORE AND IMMEDIATELY
AFTER CPX (ART – average reaction time, NCRLS- number of
correctly received light stimuli)
• NEUTRAL AMBIENT CLIMATIC CONDITIONS IN EXERCISE
LABORATORY
METHODS
PSYCHOMOTOR PERFORMANCE
METHODS
THERMOMETABOLIC INDEX (TMI)
VO2AT / CORE BODY TEMPERATURE AT MAXIMAL EXERCISE (Tc)
NEUROTHERMOMETABOLIC INDEX (NTMI)
VO2AT / (Tc + ART after CPX)
RESULTS
PSYCHOMOTOR PERFORMANCE AND VENTILATORY PARAMETERS
Relationship between psychomotor performance
and CO2 output at the maximal exercise
RESULTS
PSYCHOMOTOR PERFORMANCE AND VENTILATORY PARAMETERS
Relationship between psychomotor performance (NCRLS1) and VECO2AT
RESULTS
Relationship between heat stress at the maximal exercise (Tc) and
psychomotor performance
RESULTS
THERMOMETABOLIC INDEX AND VENTILATORY PARAMETERS
RESULTS
NEUROTHERMOMETABOLIC INDEX AND VENTILATORY PARAMETERS
RESULTS
NEUROTHERMOMETABOLIC INDEX AND VENTILATORY PARAMETERS
CONCLUSIONS
• The study confirmed the relevant psychomotor performance - mediated effect of
heat stress on cardiopulmonary capacity during exercise in the neutral ambient
climatic conditions in healthy volunteers
• Core body temperature demonstrated a strong association with the postexercise psychomotor performance
• Psychomotor performance demonstrated a strong relationship with VECO2AT
and VCO2 (cortex – central chemoreception)
• Thermometabolic index and neurothermometabolic index demonstrated strong
correlations with the selected ventilatory parameters
CONCLUSIONS
HEAT STRESS , PSYCHOMOTOR PERFORMNACE AND
INTENSITY OF OXIDATIVE PROCESSES AT ANAEROBIC
THRESHOLD (SKELETAL MUSCLES – LIMBS AND
VENTILATORY MUSCLES) BUILD ONE FUNCTIONAL
MODULE THAT DETERMINES EXERCISE PERFORMNACE
IN HUMANS
DETERMINANTS OF EXERCISE FITNESS
BRAIN - CORTEX
AND HYPOTHALAMUS
MITOCHONDRIA
LUNGS
DNA
BLOOD
HEART
SKIN- HEAT EXPULSION
SKELETAL MUSCLES
MUSCLE PURYVATE KINASE
CLINICAL ASPECTS OF THE INVESTIGATION
Zhang et al.
Centrally administered lipopolysaccharide elicits sympathetic excitation via NAD(P)H oxidasedependent mitogen-activated protein kinase signaling J Hypertens 2010
• intracerebroventricular injection of LPS increased neuronal excitation in the paraventricular
nucleus of hypothalamus, hypothalamic mRNA for tumor necrosis factor-alpha, renal
sympathetic nerve activity, blood pressure and heart rate
Pyner
The paraventricular nucleus and heart failure Exp Physiol 2014
• The paraventricular nucleus of the hypothalamus (PVN) is one of the most important
central sites involved in regulating sympathetic tone and is, in part, responsible for the
dysregulation of the sympathetic nervous system evident in heart failure
CLINICAL ASPECTS OF THE INVESTIGATION
• Miyamoto et al. demonstrated the relevant positive effect of the controlled
heat exposure (sauna, steam bathing) in CHF patients
J Card Fail 2005
• Preliminary reports confirming the positive impact of body heat extraction by
means of the innovative techniques on exercise performance, muscle fatigue in
athletes and patients with neurological disabilities
Grahn et al. Cooling via one hand improves physical performance in heatsensitive individuals with multiple sclerosis: a preliminary study.
BMC Neurol 2008
CLINICAL ASPECTS OF THE INVESTIGATION
The cyclically repeated heat exposure during training period
in healthy volunteers or CHF patients may cause habituation of
cerebral cortex to the enhanced thermal load during exercise,
resetting of the hypothalamic responsiveness to heat stress,
amelioration of cardiopulmonary capacity and exercise
performance
McLellan (2001)
Comp Biochem Physiol A Mol Integr Physiol
CLINICAL ASPECTS OF THE INVESTIGATION
Robertson CV et al. (2015) Prefrontal and motor cortex EEG responses and their
relationship to ventilatory thresholds during exhaustive incremental exercise
Eur J Appl Physiol
• All EEG activity increased from 50 % Vo2peak to RESPIRATORY COMPENSATION POINT
• There is a decline in the EEG response to exercise in the PREFRONTAL CORTEX
following the RESPIRATORY COMPENSATION POINT
• EEG alpha activity in the MOTOR CORTEX is preferentially maintained
• Changes within the PREFRONTAL CORTEX appear to play a role in exercise
termination in athletes (cyclists)
CLINICAL ASPECTS OF THE INVESTIGATION
COOLING GLOVE – STANFORD UNIVERSITY, USA
CLINICAL ASPECTS OF THE INVESTIGATION
COOLING GLOVE
CLINICAL ASPECTS OF THE INVESTIGATION
COOLING GLOVE
Six weeks of conditioning with and without cooling
The effect of cooling on pull-up capacity over
a six week training session.
700
616 pull-ups
600
1 cooling/workout
6 coolings/workout
pull-ups/workout
500
*
* Control days (no cooling)
400
*
300
*
*
*
200
*
100
180 pull-ups
0
0
10
20
time (days)
30
40
CLINICAL ASPECTS OF THE INVESTIGATION
Skalik et al. The efficiency of carbon dioxide output and ventilatory response while
cardiopulmonary exercise test is related to cognitive performance irrespective of left ventricular
contractile function
Skalik et al. Thermometabolic index is a new reliable determinant of cardiopulmonary capacity in
health and chronic heart failure
Eur J Heart Fail Suppl 2010 , Heart Failure Congress 2010 Berlin (Germany)
Skalik et al. Thermometabolic index - a brand-new determinant of cardiopulmonary capacity in
athletes
Eur Heart J 2011 abstract suppl
European Society of Cardiology Congress 2011. Paris (France)
MEDICAL UNIVERISTY OF WROCLAW (BRESLAU)
Great minds who investigated brain and heart
Alois Alzheimer
Alzheimer disease
Wilhelm Ebstein
Ebstein Anomaly
Jan Purkinje
Cardiac Purkinje fibers