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Erschienen in: Heart and Vessels 4/2019

19.10.2018 | Original Article

Chronotropic incompetence to exercise in anorexia nervosa patients during the body-weight recovery phase as an index of insufficient treatment

verfasst von: Yu Yoshida, Jun Maeda, Hiroyuki Fukushima, Natsuko Tokita, Hiroyuki Yamagishi, Mitsuaki Tokumura

Erschienen in: Heart and Vessels | Ausgabe 4/2019

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Abstract

Resting bradycardia is an important symptom for early diagnosis of anorexia nervosa (AN) during weight loss, and it improves with body-weight recovery. However, chronotropic incompetence (CI) in exercise is observed in some patients with AN despite amelioration of resting bradycardia in the recovery phase. We examined the relationship between CI in exercise and other parameters in patients with AN during the recovery phase. Ninety-two girls with AN (aged 13–20 years, median 15 years) performed cardiopulmonary exercise tolerance tests with a bicycle ergometer in the post-treatment recovery phase. Subjects with a peak-heart rate (HR) of < 160 beats/min (bpm) on subjective maximum loading were assigned to the CI+ group (n = 7), and those with a peak-HR of ≥ 160 bpm were assigned to the CI− group (n = 85). The peak-oxygen uptake (VO2) of both groups was below the normal range. Although there was no difference in peak-VO2 between these groups, both the resting-HR and ΔHR (peak-HR − resting-HR) were significantly lower in the CI+ group than in the CI− group (82 ± 8 vs. 93 ± 16 bpm, respectively; 72 ± 14 vs. 89 ± 13 bpm, respectively), suggesting lower exercise tolerance in patients with CI during the recovery phase of AN. Interestingly, the ΔVO2/ΔHR value was higher in the CI+ group than in the CI− group (0.31 ± 0.13 vs. 0.26 ± 0.06, respectively), suggesting excessive stroke volume for maintaining the cardiac output in patients with CI during their recovery phase. These data suggest that CI could be an index of insufficient recovery of AN and utilized for ideal exercise treatments of patients with AN during the recovery phase.
Literatur
2.
Zurück zum Zitat Franko DL, Keshaviah A, Eddy KT, Krishna M, Davis MC, Keel PK, Herzog DB (2013) Do mortality rates in eating disorders change over time? A longitudinal look at anorexia nervosa and bulimia nervosa. Am J Psychiatry 170:917–925CrossRefPubMedCentralPubMed Franko DL, Keshaviah A, Eddy KT, Krishna M, Davis MC, Keel PK, Herzog DB (2013) Do mortality rates in eating disorders change over time? A longitudinal look at anorexia nervosa and bulimia nervosa. Am J Psychiatry 170:917–925CrossRefPubMedCentralPubMed
3.
Zurück zum Zitat Casiero D, Frishman WM (2006) Cardiovascular complications of eating disorders. Cardiol Rev 14:227–231CrossRefPubMed Casiero D, Frishman WM (2006) Cardiovascular complications of eating disorders. Cardiol Rev 14:227–231CrossRefPubMed
4.
Zurück zum Zitat DiVasta AD, Walls CE, Feldman HA, Quach AE, Woods ER, Gordon CM, Alexander ME (2010) Malnutrition and hemodynamic status in adolescents hospitalized for anorexia nervosa. Arch Pediatr Adolesc Med 164:706–713CrossRefPubMedCentralPubMed DiVasta AD, Walls CE, Feldman HA, Quach AE, Woods ER, Gordon CM, Alexander ME (2010) Malnutrition and hemodynamic status in adolescents hospitalized for anorexia nervosa. Arch Pediatr Adolesc Med 164:706–713CrossRefPubMedCentralPubMed
5.
Zurück zum Zitat Mazurak N, Enck P, Muth E, Teufel M, Zipfel S (2011) Heart rate variability as a measure of cardiac autonomic function in anorexia nervosa: a review of the literature. Eur Eat Disord Rev 19:87–99CrossRefPubMed Mazurak N, Enck P, Muth E, Teufel M, Zipfel S (2011) Heart rate variability as a measure of cardiac autonomic function in anorexia nervosa: a review of the literature. Eur Eat Disord Rev 19:87–99CrossRefPubMed
6.
7.
Zurück zum Zitat Tokumura M, Tanaka T, Nanri S, Watanabe H (2005) Prescribed exercise training for convalescent children and adolescents with anorexia nervosa: reduced heart rate response to exercise is an important parameter for the early recurrence diagnosis of anorexia nervosa. In: Swain PI (ed) Adolescent eating disorders. Nova Science Publishers, New York, pp 69–84 Tokumura M, Tanaka T, Nanri S, Watanabe H (2005) Prescribed exercise training for convalescent children and adolescents with anorexia nervosa: reduced heart rate response to exercise is an important parameter for the early recurrence diagnosis of anorexia nervosa. In: Swain PI (ed) Adolescent eating disorders. Nova Science Publishers, New York, pp 69–84
9.
Zurück zum Zitat Myers J, Tan SY, Abella J, Aleti V, Froelicher VF (2007) Comparison of the chronotropic response to exercise and heart rate recovery in predicting cardiovascular mortality. Eur J Cardiovasc Prev Rehabil 14:215–221CrossRefPubMed Myers J, Tan SY, Abella J, Aleti V, Froelicher VF (2007) Comparison of the chronotropic response to exercise and heart rate recovery in predicting cardiovascular mortality. Eur J Cardiovasc Prev Rehabil 14:215–221CrossRefPubMed
10.
Zurück zum Zitat Liontou C, Chrysohoou C, Skoumas J, Panagiotakos DB, Pitsavos C, Stefanadis C (2016) Chronotropic response during treadmill exercise and subclinical carotid atherosclerosis after adjusting for the calibrated SCORE risk classification: a cross-sectional study. Heart Vessels 31:129–136CrossRefPubMed Liontou C, Chrysohoou C, Skoumas J, Panagiotakos DB, Pitsavos C, Stefanadis C (2016) Chronotropic response during treadmill exercise and subclinical carotid atherosclerosis after adjusting for the calibrated SCORE risk classification: a cross-sectional study. Heart Vessels 31:129–136CrossRefPubMed
11.
Zurück zum Zitat Roche F, Barthélémy JC, Garet M, Costes F, Pichot V, Duverney D, Kadem M, Millot L, Estour B (2004) Chronotropic incompetence to exercise separates low body weight from established anorexia nervosa. Clin Physiol Funct Imaging 24:270–275CrossRefPubMed Roche F, Barthélémy JC, Garet M, Costes F, Pichot V, Duverney D, Kadem M, Millot L, Estour B (2004) Chronotropic incompetence to exercise separates low body weight from established anorexia nervosa. Clin Physiol Funct Imaging 24:270–275CrossRefPubMed
12.
Zurück zum Zitat Wasserman K, Hansen JE, Sue DY, Stringer WW, Sietsema KE, Sun XG, Whipp BJ (2012) Exercise testing and interpretation: including pathophysiology and clinical applications, 5th edn. Lippincott Williams & Wilkins, a Wolters Kluwer business, Philadelphia, pp 154–180 Wasserman K, Hansen JE, Sue DY, Stringer WW, Sietsema KE, Sun XG, Whipp BJ (2012) Exercise testing and interpretation: including pathophysiology and clinical applications, 5th edn. Lippincott Williams & Wilkins, a Wolters Kluwer business, Philadelphia, pp 154–180
13.
Zurück zum Zitat Takahashi Y (2001) Exercise testing. In: Takao A, Monma K, Nakazawa M, Nakanishi T (eds) Clinical developmental cardiology, 3rd edn. Chugai Igakusha, Tokyo, pp 233–243 (in Japanese) Takahashi Y (2001) Exercise testing. In: Takao A, Monma K, Nakazawa M, Nakanishi T (eds) Clinical developmental cardiology, 3rd edn. Chugai Igakusha, Tokyo, pp 233–243 (in Japanese)
14.
16.
Zurück zum Zitat Kuwabara M, Niwa K, Yamada U, Ohta D (2018) Low body mass index correlates with low left ventricular mass index in patients with severe anorexia nervosa. Heart Vessels 33:89–93CrossRefPubMed Kuwabara M, Niwa K, Yamada U, Ohta D (2018) Low body mass index correlates with low left ventricular mass index in patients with severe anorexia nervosa. Heart Vessels 33:89–93CrossRefPubMed
17.
Zurück zum Zitat Gulati M, Shaw LJ, Thisted RA, Black HR, Bairey Merz CN, Arnsdorf MF (2010) Heart rate response to exercise stress testing in asymptomatic women: the St. James Women Take Heart Project. Circulation 122:130–137CrossRefPubMed Gulati M, Shaw LJ, Thisted RA, Black HR, Bairey Merz CN, Arnsdorf MF (2010) Heart rate response to exercise stress testing in asymptomatic women: the St. James Women Take Heart Project. Circulation 122:130–137CrossRefPubMed
Metadaten
Titel
Chronotropic incompetence to exercise in anorexia nervosa patients during the body-weight recovery phase as an index of insufficient treatment
verfasst von
Yu Yoshida
Jun Maeda
Hiroyuki Fukushima
Natsuko Tokita
Hiroyuki Yamagishi
Mitsuaki Tokumura
Publikationsdatum
19.10.2018
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 4/2019
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-018-1282-6

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