Association of Metabolic Syndrome with Exercise Capacity and Heart Rate Recovery after Treadmill Exercise Test

  • Shin, Kyung-A (Department of Laboratory Medicine Bundang Jesaeng Hospital)
  • 신경아 (분당제생병원 진단검사의학과)
  • Received : 2011.08.22
  • Accepted : 2011.12.27
  • Published : 2011.12.31

Abstract

Heart rate recovery (HRR) immediately after a treadmill exercise test is a function of vagal reactivation. A delayed heart rate recovery is associated with an increased risk for overall cardiovascular mortality. The purpose of this study is to find out if metabolic syndrome is associated with autonomic nerve function and exercise capacity in healthy adults. We measured the treadmill exercise capacity (METs) and heart rate recovery in 119 subjects through a medical checkup at $J$ General Hospital. The metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. The value for the HRR was defined as the difference between the heart rate obtained during the peak exercise and the heart rate obtained at first minute during the recovery period. The subjects with the metabolic syndrome had significantly lower exercise duration ($9.6{\pm}1.5$ vs $8.7{\pm}1.4$), METs ($11.6{\pm}1.7$ vs $10.4{\pm}2.5$), and HRR ($37.5{\pm}14.3$ vs $27.1{\pm}8.9$). The waist circumference in subjects with the metabolic syndrome was more strongly correlated with HRR ($r$=-.517, $P$ <.001) than in normal subjects. Furthermore, delayed HRR was associated with high resting heart rate and increased waist circumference ($P$=.032, $P$ <.001, respectively). In conclusion, delayed HRR during the first minute after a treadmill exercise test was associated with the metabolic syndrome risk factors. Delayed HRR was also associated with high resting heart rate and increased waist circumference.

Keywords

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(1 Pt 2): H132-141.
  2. Cheng YJ, Lauer MS, Earnest CP, Church TS, Kampert JB, Gibbons LW, Blair SN. Heart rate recovery following maximal exercise testing as a predictor of cardiovascular disease and all-cause mortality in men with diabetes. Diabetes Care 2003. 26: 2052-2057. https://doi.org/10.2337/diacare.26.7.2052
  3. 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. https://doi.org/10.1056/NEJM199910283411804
  4. Deniz F, Katircibasi MT, Pamukcu B, Binici S, Sanisoglu SY. Association of metabolic syndrome with impaired heart rate recovery and low exercise capacity in young male adults. Clin Endocrinol (Oxf). 2007. 66: 218-223. https://doi.org/10.1111/j.1365-2265.2006.02711.x
  5. Dimkpa U, Oji JO. Association of heart rate recovery after exercise with indices of obesity in healthy, non-obese adults. Eur J Appl Physiol. 2009. 108: 695-699.
  6. Expert panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001. 285: 2486-2497. https://doi.org/10.1001/jama.285.19.2486
  7. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Pina IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 2001. 104: 1694-1740. https://doi.org/10.1161/hc3901.095960
  8. Huang PH, Leu HB, Chen JW, Cheng CM, Huang CY, Tuan TC, Ding PY, Lin SJ. Usefulness of attenuated heart rate recovery immediately after exercise to predict endothelial dysfunction in patients with suspected coronary artery disease. Am J Cardiol. 2004. 93: 10-13. https://doi.org/10.1016/j.amjcard.2003.09.004
  9. Imai K, Sato N, Hori M, Kusuoka H, Ozaki H, Yokoyama H. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patient with chronic heart failure. J Am Coll Cardiol. 1994. 24: 1529-1535. https://doi.org/10.1016/0735-1097(94)90150-3
  10. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen MR, Groop L. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001. 24: 683-689. https://doi.org/10.2337/diacare.24.4.683
  11. Jae SY, Ahn ES, Heffernan KS, Woods JA, Lee MK, Park WH, Fernhall B. Relation of heart rate recovery after exercise to C-reactive protein and white blood cell count. Am J Cardiol. 2007. 99: 707-710. https://doi.org/10.1016/j.amjcard.2006.09.121
  12. Jae SY, Carnethon MR, Heffernan KS, Choi YH, Lee MK, Park WH, Fernhall B. Slow heart rate recovery after exercise is associated with carotid atherosclerosis. Atherosclerosis 2008. 196: 256-261. https://doi.org/10.1016/j.atherosclerosis.2006.10.023
  13. Jorgensen CR, Gobel FL, Taylor HL, Wang Y. Myocardial blood flow and oxygen consumption during exercise. Ann N Y Acad Sci. 1977. 301: 213-223. https://doi.org/10.1111/j.1749-6632.1977.tb38200.x
  14. Katircibasi MT, Canatar T, Kocum HT, Erol T, Tekin G, Demircan S, Tekin A, Sezgin AT, Baltali M, Muderrisoglu H. Decreased heart rate recovery in patients with heart failure: effect of fluvastatin therapy. Int Heart J. 2005. 46: 845-854. https://doi.org/10.1536/ihj.46.845
  15. Kim YJ, Shin YO. Effects of aerobic exercise on cardiopulmonary-related factors in exercise-induced hypertension patients. Korean Society of Exercise Physiology 2007. 16: 131-140.
  16. Lind L, Andren B. Heart rate recovery after exercise is related to the insulin resistance syndrome and heart rate variability in elderly men. Am Heart J. 2002. 144: 666-672.
  17. Nilsson G, Hedberg P, Jonason T, Lonnberg I, Ohrvik J. Heart rate recovery is more strongly associated with the metabolic syndrome, waist circumference, and insulin sensitivity in women than in men among the elderly in the general population. Am Heart J. 2007. 154: 460-467.
  18. Savonen KP, Lakka TA, Laukkanen JA, Halonen PM, Rauramaa TH, Salonen JT, Rauramaa R. Heart rate response during exercise test and cardiovascular mortality in middle-aged men. Eur Heart J. 2006. 27: 582-288. https://doi.org/10.1093/eurheartj/ehi708
  19. Savonen KP, Kiviniemi V, Laaksonen DE, Lakka TA, Laukkanen JA, Tuomainen TP, Rauramaa R. Two-minute heart rate recovery after cycle ergometer exercise and all-cause mortality in middle-aged men. J Intern Med. 2011. (in press)
  20. Schwartz PJ, La Rovere MT, Vanoli E. Autonomic nervous system and sudden cardiac death. Experimental basis and clinical observations for post-myocardial infarction risk stratification. Circulation 1992. 85(1 suppl): 77-91.
  21. Spies C, Otte C, Kanaya A, Pipkin SS, Schiller NB, Whooley MA. Association of metabolic syndrome with exercise capacity and heart rate recovery in patients with coronary heart disease in the heart and soul study. Am J Cardiol. 2005. 95: 1175-1179. https://doi.org/10.1016/j.amjcard.2005.01.045
  22. Sung J, Choi YH, Park JB. Metabolic syndrome is associated with delayed heart rate recovery after exercise. J Korean Med Sci. 2006. 21: 621-626. https://doi.org/10.3346/jkms.2006.21.4.621
  23. Vivekananthan DP, Blackstone EH, Pothier CE, Lauer MS. Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of coronary disease. J Am Coll Cardiol. 2003. 42: 831-838. https://doi.org/10.1016/S0735-1097(03)00833-7
  24. World Health Organization. West Pacific Region. The Asia-pacific Perspective: redefining obesity and its treatment. International Obesity Task Force. 2000. 2: 15-21.