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Purpose: To compare the energetic contribution and pacing in 2000- and 1500-m maximal rowing-ergometer performances. Methods: On separate visits (>48 h apart, random order), 18 trained junior (16.7 [0.4] y) male rowers completed 3 trials: a 7 × 4-minute graded exercise test, a 2000-m time trial (TT2000), and a 1500-m TT (TT1500). Respiratory gases were continuously measured throughout each trial. The submaximal power-to-oxygen-consumption relationship from the graded exercise test was used to determine the accumulated oxygen deficit for each TT. Differences in mean power output (MPO), relative anaerobic contribution, percentage of peak oxygen uptake, pacing index, maximum heart rate, rating of perceived exertion, and blood lactate concentration were assessed using linear mixed modeling. Results: Compared to TT2000 (324 [24] W), MPO was 5.2% (3.3%) higher in TT1500 (341 [29 W]; P <.001, η p 2 =.70). There was a 4.9% (3.3%) increase (P <.001, η p 2 =.71) in anaerobic contribution from 17.3% (3.3%) (TT2000) to 22.2% (4.3%) (TT1500). Compared to TT1500, maximum heart rate, rating of perceived exertion, and blood lactate concentration were all greater (P <.05) in TT2000. The pacing index was not different between trials. Percentage increase in MPO from TT2000 to TT1500 was negatively associated with pacing variance in TT1500 (R2 =.269, P =.027). Conclusions: Maximal ergometer performance over 1500 m requires a significantly greater anaerobic contribution compared with 2000 m. Junior male athletes adopt a consistent pacing strategy across both distances. However, those who experienced greater percentage increases in MPO over the shorter test adopted a more even pacing strategy. To prepare for 1500-m performance, greater emphasis should be placed on developing capacity for work in the severe domain and completing race simulations with a more even pacing strategy. [ABSTRACT FROM AUTHOR]

Although trauma is closely linked with hyperarousal and cardiovascular health, little research has examined the effects of posttraumatic stress symptoms (PTSS) on cardiovascular reactivity to trauma reminders among sexual trauma survivors. One type of negative appraisal after trauma, self‐blame, is common after sexual trauma, but its relation to cardiovascular reactivity is unknown. The present study aimed to examine the influence of both PTSS and self‐blame on blood pressure and heart rate (HR) reactivity to a trauma reminder. Cardiovascular reactivity was measured before, during, and after a laboratory‐based sexual trauma reminder among 72 young adult women who have experienced sexual trauma. Higher PTSS predicted lower diastolic blood pressure (DBP) reactivity during the trauma reminder. Higher levels of self‐blame predicted higher HR and systolic blood pressure (SBP) reactivity during and after the trauma reminder. Overall, these findings suggest that survivors of sexual trauma with higher levels of PTSS experience a blunting reaction of DBP when exposed to trauma reminders, as opposed to a more typical cardiovascular stress reaction that may elevate and then extinguish to baseline levels. Meanwhile, individuals with higher levels of self‐blame have heightened cardiovascular SBP and HR responses during trauma reminders that do not return to baseline levels, perhaps due to self‐blame leading individuals to be more 'on guard' to prevent future threats. Longitudinal studies are needed to explore the potential long‐term cardiovascular impacts of heightened self‐blame and PTSS and their associated cardiovascular reactivity patterns. [ABSTRACT FROM AUTHOR]

Background: Exercise fear and low exercise self-efficacy are common in patients attending cardiac rehabilitation (CR). This study tested whether exercise prescription methods influence exercise fear and exercise self-efficacy. We hypothesized that the use of graded exercise testing (GXT) with a target heart rate range exercise prescription, relative to standard exercise prescription using rating of perceived exertion (RPE), would produce greater reductions in exercise fear and increase self-efficacy during CR. Method: Patients in CR (N = 32) were randomized to an exercise prescription using either RPE or a target heart rate range. Exercise fear and self-efficacy were assessed with questionnaires at three time points: baseline; after the GXT in target heart rate range group; and at session 6 for the RPE group and CR completion. Items were scored on a five-point Likert-type scale with higher mean scores reflecting higher fear of exercise and higher self-efficacy. To analyze mean differences, a mixed effects analysis was run. Results: There were no significant changes in exercise self-efficacy between baseline and discharge from CR; these were not statistically significant (mean differences baseline − 0.63; end − 0.27 (p = 0.13)). Similarly, there was no change in fear between groups (baseline 0.30; end 0.51 (p = 0.37)). Conclusion: Patients in the RPE and target heart rate groups had non-significant changes in exercise self-efficacy over the course of CR. Contrary to our hypothesis, the use of GXT and target heart rate range did not reduce fear, and we noted sustained or increases in fear of exercise among patients with elevated baseline fear. A more targeted psychological intervention seems warranted to reduce exercise fear and self-efficacy in CR. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to determine the effect of moderately strenuous aerobic exercise training on heart rate variability (HRV) and heart rate turbulence (HRT) in patients with an implantable cardioverter defibrillator (ICD). Methods: Patients were randomized to a 24-week home-based aerobic exercise (EX) training program (n = 84) or to usual care (UC) (n = 76). All subjects underwent 24-h Holter monitoring at baseline, 8 and 24 weeks. Generalized estimating equations were used to test the effects of exercise on HRV and HRT outcomes. Results: The study group was comprised of n = 160 patients (124 M, 36 F, age 54.9 ± 12.2 years) with an ICD for primary (43%) or secondary prevention (57%). Compared to UC, EX was associated with a significant improvement in parasympathetic HRV for root mean square of successive differences (rMSSD; p =.05) at 8 weeks and global HRV for standard deviation of all normal (N-N) intervals (SDNN; p =.05) and standard deviation of 5-min averages N-N intervals (SDANN; p =.03) at 24 weeks. When stratified by adherence, those who were ≥80% adherent (minutes/week) had significant improvements in parasympathetic HRV (rMSSD, pNN50) and global HRV (SDNN, SDANN) at 8 weeks, and a further significant improvement in global HRV (SDNN, SDANN, SDNN index) at 24 weeks. Neither HRT nor ventricular ectopy changed with exercise training. Conclusion: Moderately strenuous aerobic exercise improved parasympathetic and global HRV indices following an ICD, with greater adherence associated with greater improvements. Clinical trial registration: Clinicaltrials.gov: NCT 00522340. [ABSTRACT FROM AUTHOR]

Interpersonal touch buffers against stress under challenging conditions, but this effect depends on familiarity. People benefit from receiving touch from their romantic partners, but the results are less consistent in the context of receiving touch from an opposite-gender stranger. We propose that there may be important gender differences in how people respond to touch from opposite-gender strangers. Specifically, we propose that touch from an opposite-gender stranger may only have stress-buffering effects for men, not women. Stress was induced as participants took part in an emotion recognition task in which they received false failure feedback while being touched by a romantic partner or stranger. We measured subjective and physiological markers of stress (i.e., reduced heart rate variability) throughout the experiment. Neither stranger's nor partner's touch had any effect on subjective or physiological markers of stress for men. Women, however, subjectively experienced a stress-buffering effect of partner and stranger touch, but showed increased physiological markers of stress when receiving touch from an opposite-gender stranger. These results highlight the importance of considering gender when investigating touch as a stress buffer. [ABSTRACT FROM AUTHOR]

Background: The step test provides valuable information on cardiorespiratory parameters such as maximal oxygen uptake and heart rate. Cardiorespiratory capacity is critical to health-related fitness, with heart rate recovery after exercise serving as a predictor of mortality risk. Main Body: The primary objective of this review was to identify trends, key contributors, and emerging themes in the step test literature through 2023 using the Web of Science Core Collection. Bibliometric data extraction and analysis were performed using a dedicated bibliometric software (VOSviewer). The analysis showed continued interest through 2021. The research categories highlight the multidisciplinary nature of the step test, covering cardiovascular systems, respiratory systems, sports sciences, and medicine. It has gained global attention, with 31 countries involved, with Brazil and the United States leading the way. The diversity of contributing nations is increasing, reflecting a growing global interest. With 111 journals involved, such as Respiratory Care and Medicine and Science in Sports and Exercise, step test research is spread across the academic landscape. With 761 contributing researchers, there is a collaborative and diverse community. The top 10 institutions, including the University of Alabama System and Monash University, illustrate the variety of settings in which step test studies are conducted. Step test studies span multiple disciplines, underscoring their adaptability. The clusters identified in this bibliometric analysis of the step test literature guide future research, suggesting avenues for refining protocols, exploring health implications, optimizing tests for specific conditions such as chronic obstructive pulmonary disease, and adapting step tests in diverse populations. Conclusions: Practical implications highlight the role of the step test in cardiovascular risk assessment, fitness monitoring, and rehabilitation. This broad review underscores the relevance of the step test in diverse settings, reflecting its adaptability and ease of application across occupational and clinical settings. Key Points: Global interest and research in the step test has grown significantly, with contributions from 31 countries and diverse disciplines, highlighting the adaptability and multidisciplinary relevance of the step test. Practical implications of the step test include its critical role in cardiovascular risk assessment, fitness monitoring, and rehabilitation. [ABSTRACT FROM AUTHOR]

Despite having to carry the same occupational load, female soldiers tend to be lighter than male soldiers. The aim of this study was to determine the differences in cardiovascular load between female and male US Marine recruits during progressive load carriage hikes. United States Marine Corps recruits (565 male recruits; 364 female recruits) completed 6 loaded hikes over 6 weeks (1:10 kg, 30 minutes; 2: 10 kg, 45 minutes; 3: 15 kg, 30 minutes, 4: 15 kg, 45 minutes; 5: 20 kg, 30 minutes; 6: 20 kg, 45 minutes) during which cardiovascular response was measured. Average heart rate (HRavg), HR maximum (HRmax), and pace were measured via a wrist-worn physiological monitor. Independent sample t-tests were conducted to compare between sexes, with significance set at 0.008 after adjusting for multiple comparisons. The average female recruit had significantly lower body mass (BM) compared with the average male recruit (p < 0.001) and thus carried a significantly heavier relative load. (10 kg ~17%, 15 kg ~25%, 20 kg ~33%, p < 0.001). There were no significant differences in pace in any hike, and no significant differences were found in HRavg or HRmax when comparing female and male Marines during Hike 1. For female Marines, HRavg was significantly higher compared with male Marines during Hike 2 (+6.5 b⋅min-1, p < 0.001) and Hike 3 (+7.4 b⋅min-1, p < 0.001), and both HRavg and HRmax were significantly higher in Hike 4 (+11.9 b⋅min-1, +8.4 b⋅min-1, p < 0.001), Hike 5 (+7.7 b⋅min-1, +7.9 b⋅min-1, p < 0.001), and Hike 6 (+6.9 b⋅min-1, +7.1 b⋅min-1, p < 0.001), respectively. Female Marines endured greater cardiovascular demand compared with male Marines during load carriage events when carrying loads greater than 15 kg (~25% BM). [ABSTRACT FROM AUTHOR]

Introduction: Ablation of scar‐related reentrant atrial tachycardia (SRRAT) involves identification and ablation of a critical isthmus. A graph convolutional network (GCN) is a machine learning structure that is well‐suited to analyze the irregularly‐structured data obtained in mapping procedures and may be used to identify potential isthmuses. Methods: Electroanatomic maps from 29 SRRATs were collected, and custom electrogram features assessing key tissue and wavefront properties were calculated for each point. Isthmuses were labeled off‐line. Training data was used to determine the optimal GCN parameters and train the final model. Putative isthmus points were predicted in the training and test populations and grouped into proposed isthmus areas based on density and distance thresholds. The primary outcome was the distance between the centroids of the true and closest proposed isthmus areas. Results: A total of 193 821 points were collected. Thirty isthmuses were detected in 29 tachycardias among 25 patients (median age 65.0, 5 women). The median (IQR) distance between true and the closest proposed isthmus area centroids was 8.2 (3.5, 14.4) mm in the training and 7.3 (2.8, 16.1) mm in the test group. The mean overlap in areas, measured by the Dice coefficient, was 11.5 ± 3.2% in the training group and 13.9 ± 4.6% in the test group. Conclusion: A GCN can be trained to identify isthmus areas in SRRATs and may help identify critical ablation targets. [ABSTRACT FROM AUTHOR]

Zavegepant is a novel gepant administered as a nasal spray approved in the United States at a 10 mg dose for the acute treatment of migraine with or without aura in adults. The cardiovascular safety of zavegepant nasal spray was assessed in both single‐ascending dose (SAD) and multiple‐ascending dose (MAD) studies in healthy participants. The SAD study included 72 participants (54 active/18 placebo) who received 0.1–40 mg zavegepant or placebo. The MAD study included 72 participants (56 active/16 placebo) who received 5–40 mg zavegepant or placebo for 1–14 days. Plasma zavegepant pharmacokinetics and electrocardiographic (ECG) parameters (Fridericia‐corrected QT interval [QTcF], heart rate, PR interval, ventricular depolarization [QRS], T‐wave morphology, and U‐wave presence) were analyzed pre‐ and post‐zavegepant administration. Using pooled data from the SAD and MAD studies, the relationship between time‐matched plasma zavegepant concentrations and QTc interval was assessed using a linear mixed‐effects model to evaluate the potential for QTc interval prolongation. Results showed that single and multiple doses of zavegepant had no significant impact on ECG parameters versus placebo, and there was no concentration‐dependent effect on QTcF interval. The estimated slope of the plasma zavegepant concentration‐QTcF model was −0.053 ms per ng/mL with a 90% confidence interval of −0.0955 to −0.0110 (p = 0.0415), which is not considered clinically meaningful. At doses up to four times the recommended daily dose, zavegepant does not prolong the QT interval to any clinically relevant extent. [ABSTRACT FROM AUTHOR]

Background: The incidence of neonatal hyperbilirubinemia in Europe and the United States is estimated to be 3.2 and 4.4 per 10,000 live births, respectively. Abdominal massage for hyperbilirubinemia is considered a safe complementary treatment for infants that may increase number of defecations and decrease bilirubin levels. Purpose: This study was designed as a randomized controlled trial to determine the effect of abdominal massage on bilirubin levels in term infants receiving phototherapy. Methods: The sample consisted of 43 term newborns (intervention group: 23; control group: 20) who received phototherapy in a university hospital between June 2019 and February 2021. Information and observation forms were used for data collection. The intervention group received 6 abdominal massages over 2 days, performed 3 times a day, 6 hours apart, and lasting 5 minutes each. Results: Transcutaneous bilirubin levels and heart rate were significantly lower in the intervention group than in the control group at 48 hours (P = .015 and P = .033, respectively). Number of defecations was higher in the intervention group at 24 hours (P = .007) but there was no significant difference at 48 hours. The decrease in serum bilirubin between 24 and 48 hours was significantly greater in the intervention group (P = .005). Implication for Practice and Research: Abdominal massage was effective in reducing bilirubin levels and may increase the number of defecations. Providing massage training to the parents of infants who are discharged early could be a protective approach to prevent the rise in bilirubin levels. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to examine the acute effects of legal-market cannabis on regular cannabis users' subjective responses to exercise in a controlled laboratory environment. Background: Given the stereotype that cannabis is associated with extreme sedentary behavior, there are concerns that cannabis legalization may exacerbate the US physical inactivity epidemic. However, despite these concerns, recent years have seen considerable public interest in the use of cannabis concurrently with exercise (e.g., running). Methods: The present study compared participants' experiences of exercise without cannabis to their experiences of exercise after acute ad libitum use of one of two commercially available cannabis flower products: a Δ9-tetrahydrocannabinol-dominant or a cannabidiol-dominant product. Participants (N = 42) were regular cannabis users between the ages of 21 and 39 years (mean = 30.81 years, standard deviation = 4.72 years). Results: Although participants reported a more positive affect (p < 0.001), enjoyment (p < 0.001), and runner's high symptoms (p < 0.001) during their cannabis (vs non-cannabis) exercise appointment, they also reported more exertion (p = 0.04). Pain levels were very low and did not differ between appointments (p = 0.45). Effects appeared to depend, in part, on cannabinoid content; there was a larger difference in enjoyment (p = 0.02), and a smaller difference in exertion (p = 0.02), between the cannabis and non-cannabis exercise appointments among participants in the cannabidiol (vs Δ9-tetrahydrocannabinol) condition. Conclusions: To our knowledge, this is the first study to investigate the acute effects of commercially available cannabis on subjective responses to exercise in a laboratory environment. Our findings suggest that, among regular cannabis users who use cannabis in combination with exercise, cannabis use prior to exercise may lead to increases in both positive and negative aspects of the subjective exercise experience. Research using diverse samples, exercise modalities, and methodologies (e.g., placebo-controlled trials) is needed to establish the generalizability of these findings. [ABSTRACT FROM AUTHOR]

Research has demonstrated concussion likely causes autonomic dysfunction leading to exercise intolerance. To measure improvement in exercise intolerance due to suspected dysautonomia associated with protracted concussion recovery, using objective measurements on a Buffalo Concussion Treadmill Test (BCTT) following participation in a prescribed exercise program. This is a retrospective cohort study of 101 patient charts post-concussion. Exercise intolerance was assessed using a BCTT to identify suspected dysautonomia and an exercise prescription was provided using guidelines for treating concussion-associated exercise intolerance. Patients without symptom improvement and/or inability to achieve 80–85% of age-expected maximum heart rate (HR) without symptom exacerbation received a repeat BCTT. Twelve patient charts met inclusion criteria and were included in data analysis. There were significant improvements from pre-intervention to post-intervention testing in: maximum BCTT stage mean scores (p =.02); maximum HR mean scores (p =.01); prescription HR (RxHR) mean scores (p =.01); and HR delta (HR $$\delta $$ δ) mean scores (p =.00). Maximum stage, HR threshold, RxHR, and newly identified HR delta (HR $$\delta $$ δ) are potential objective measurements of progress for dysautonomia treatment post-concussion. Future studies are indicated to create a tailored protocol in the management of protracted concussion-associated dysautonomia. [ABSTRACT FROM AUTHOR]

The authors examined task-based (i.e., executive function), surveyed (i.e., effortful control), and physiological (i.e., resting cardiac respiratory sinus arrhythmia [RSA]) measures of child and maternal regulation as distinct moderators of longitudinal bidirectional links between child externalizing (EXT) behaviors and harsh parenting (HP) from 6 to 9 years. The sample size was 299 (50.9% female; 1% Asian, 4% multiple races; 14% Black; 78% White), and participants were recruited in the United States (a rural college town in Virginia and a midsized city in North Carolina). Higher child EXT at 6 years predicted higher HP at 7–8 years, which predicted higher EXT at 9 years. Also, this path was moderated by 6-year child effortful control, 6-year resting RSA, and 9-year executive function. In contrast, there was no moderating effect of any measure of maternal regulation. Findings suggest it is important to consider child self-regulation when examining bidirectionality in parent and child effects for HP and child EXT. Public Significance Statement: The present study adds impetus for utilizing a variety of measures and indicators of children's and their parents' regulation capacities when addressing child risk for behavioral problems. Distinct effects are found depending on the indicator of regulation. This has implications for prevention and intervention efforts in the family setting, to improve child regulation skills and reduce behavioral problems. [ABSTRACT FROM AUTHOR]

Drawing on linguistic and biocultural anthropological perspectives on embodiment, this paper advances a "biolinguistic" approach to ethnographic research on intimacy, attending simultaneously to the co‐constitutive interactive, psychophysiological, and phenomenological processes that emerge in everyday embodied interaction between long‐term, cohabitating romantic partners. Through concurrent attention to natural interactions captured during video ethnography and moment‐to‐moment shifts in heart‐rate variability, this study complements and complicates existing psychological, communication, and anthropological research on intimacy. Three case‐studies of long‐term couples residing in the Southeastern United States demonstrate how neither pure psychophysiology nor pure linguistic analysis fully encapsulates potential patterns of intimacy among them. Rather, this microanalytical, biolinguistic approach to the complexities of body and language interplay, in treating embodiment and interaction as bidirectional phenomena, emphasizes that meanings and enactments of intimacy might look different for each couple and can change over time in complex ways that index couples' enduring orientations towards various cultural and relational norms. [ABSTRACT FROM AUTHOR]

Purpose: To track cardiac-autonomic functioning, indexed by heart-rate variability, in American college football players throughout a competitive period. Methods: Resting heart rate (RHR) and the natural logarithm root mean square of successive differences (LnRMSSD) were obtained throughout preseason and ∼3 times weekly leading up to the national championship among 8 linemen and 12 nonlinemen. Seated 1-minute recordings were performed via mobile device and standardized for time of day and proximity to training. Results: Relative to preseason, linemen exhibited suppressed LnRMSSD during camp-style preparation for the playoffs (P =.041, effect size [ES] = −1.01), the week of the national semifinal (P <.001, ES = −1.27), and the week of the national championship (P =.005, ES = −1.16). As a combined group, increases in RHR (P <.001) were observed at the same time points (nonlinemen ES = 0.48–0.59, linemen ES = 1.03–1.10). For all linemen, RHR trended upward (positive slopes, R2 =.02–.77) while LnRMSSD trended downward (negative slopes, R2 =.02–.62) throughout the season. Preseason to postseason changes in RHR (r =.50, P =.025) and LnRMSSD (r = −.68, P <.001) were associated with body mass. Conclusions: Heart-rate variability tracking revealed progressive autonomic imbalance in the lineman position group, with individual players showing suppressed values by midseason. Attenuated parasympathetic activation is a hallmark of impaired recovery and may contribute to cardiovascular maladaptations reported to occur in linemen following a competitive season. Thus, a descending pattern may serve as an easily identifiable red flag requiring attention from performance and medical staff. [ABSTRACT FROM AUTHOR]

Background: Heart rate variability (HRV) biofeedback is often performed with structured education, laboratory-based assessments, and practice sessions. It has been shown to improve psychological and physiological function across populations. However, a means to remotely use and monitor this approach would allow for wider use of this technique. Advancements in wearable and digital technology present an opportunity for the widespread application of this approach. Objective: The primary aim of the study was to determine the feasibility of fully remote, self-administered short sessions of HRV-directed biofeedback in a diverse population of health care workers (HCWs). The secondary aim was to determine whether a fully remote, HRV-directed biofeedback intervention significantly alters longitudinal HRV over the intervention period, as monitored by wearable devices. The tertiary aim was to estimate the impact of this intervention on metrics of psychological well-being. Methods: To determine whether remotely implemented short sessions of HRV biofeedback can improve autonomic metrics and psychological well-being, we enrolled HCWs across 7 hospitals in New York City in the United States. They downloaded our study app, watched brief educational videos about HRV biofeedback, and used a well-studied HRV biofeedback program remotely through their smartphone. HRV biofeedback sessions were used for 5 minutes per day for 5 weeks. HCWs were then followed for 12 weeks after the intervention period. Psychological measures were obtained over the study period, and they wore an Apple Watch for at least 7 weeks to monitor the circadian features of HRV. Results: In total, 127 HCWs were enrolled in the study. Overall, only 21 (16.5%) were at least 50% compliant with the HRV biofeedback intervention, representing a small portion of the total sample. This demonstrates that this study design does not feasibly result in adequate rates of compliance with the intervention. Numerical improvement in psychological metrics was observed over the 17-week study period, although it did not reach statistical significance (all P>.05). Using a mixed effect cosinor model, the mean midline-estimating statistic of rhythm (MESOR) of the circadian pattern of the SD of the interbeat interval of normal sinus beats (SDNN), an HRV metric, was observed to increase over the first 4 weeks of the biofeedback intervention in HCWs who were at least 50% compliant. Conclusions: In conclusion, we found that using brief remote HRV biofeedback sessions and monitoring its physiological effect using wearable devices, in the manner that the study was conducted, was not feasible. This is considering the low compliance rates with the study intervention. We found that remote short sessions of HRV biofeedback demonstrate potential promise in improving autonomic nervous function and warrant further study. Wearable devices can monitor the physiological effects of psychological interventions. [ABSTRACT FROM AUTHOR]

Background: Digestive endoscopy (DE) is uncomfortable for most patients. Lorazepam is a potent benzodiazepine with anxiolytic and sedative effects. Objective: This study aims to determine the sedative effect of sublingual lorazepam versus placebo as a premedication in patients who underwent DE. Design: This is a mono-center, double-blind, and randomized controlled trial. Methods: A lorazepam sublingual tablet was made by researchers and physical tests were done on it, then the double-blind placebo-controlled trial was done to investigate the efficacy of 2 mg sublingually administered lorazepam as a premedication for endoscopy. Lorazepam or a placebo tablet was administered sublingually 30 min before the endoscopy. The patients, nurses, and physicians were blinded to the patient group. The depth of sedation was evaluated according to the American Society of Anesthesiology. Results: In all, 116 patients were randomly assigned to take either lorazepam (n = 58) or a placebo (n = 58). The results of physical properties tests were acceptable according to United States Pharmacopeia. There were no statistical differences between groups regarding age and gender. In the lorazepam group, 75.8% of patients showed mild sedation, and 24.2% of patients showed no sedation. All of the patients in the placebo had no sedation (p = 0.001). Time of procedure (p < 0.001), intraoperative O2 saturation (p < 0.001), intraoperative heart rate (p < 0.001), and intraoperative blood pressure (p < 0.001) were significantly lower in the lorazepam group. No significant or dangerous side effects were observed except a bit of giddiness and dizziness. Conclusion: The results of this study showed that prescription of sublingual lorazepam 25–30 min before endoscopy provided mild sedation. Registration: IRCT201611039014N130 (05/11/2016); https://en.irct.ir/trial/9568. [ABSTRACT FROM AUTHOR]

Objective: Despite its widespread use and safety data, the cardiac safety of lamotrigine was brought into question in October 2020 when the U.S. Food and Drug Administration issued a safety warning about its cardiac side effects. Here, we investigated whether there are differences in electrocardiogram (ECG) findings between epilepsy cases receiving lamotrigine monotherapy and those receiving duotherapy. Methods: Patients older than 16 years who were followed up with a diagnosis of epilepsy and receiving lamotrigine were retrospectively identified. Those receiving only lamotrigine and any second anti-seizure medication (ASM) in addition to lamotrigine were included in the study, and those receiving more than two ASMs were excluded. Eligible patients were asked to apply to any health institution and have an ECG performed. Heart rate, PR distance, QRS duration, QT duration, corrected QT value, and Tp-Tend value were calculated manually, and ST-T changes were evaluated. Comparisons were made between patients receiving monotherapy and dootherapy and those receiving low-dose and high-dose lamotrigine. Results: There were 19 patients receiving monotherapy and 11 receiving duotherapy. The ECG parameters of all other patients were within normal values. When ECG parameters were compared between patients receiving monotherapy and those receiving duotherapy, no significant differences were found in heart rate, PR distance, QRS duration, QT duration, QTc duration, Tp-Tend duration, and presence of ST-T changes. When the patients were divided into low-dose and high-dose lamotrigine groups, there were no significant differences in the ECG parameters between these two groups. Conclusion: The relationship between the use of lamotrigine and cardiac conduction problems in patients with epilepsy has attracted the attention of physicians since its introduction into clinical practice. Although our results did not indicate a significant relationship, there is still a need to determine the risk groups and clarify the pathophysiology of lamotrigine-related arrhythmia through genotype- and phenotype-related studies. [ABSTRACT FROM AUTHOR]

Predicting treatment response can inform treatment decisions, expectations, and optimize use of mental health treatment resources. This study examined heart rate (HR), heart rate variability (HRV), and a modified Stroop task (mStroop) to predict post-traumatic stress disorder (PTSD) treatment response. We report on an observational, longitudinal study with 45 U.S. veterans in outpatient PTSD care, who had deployed to Iraq or Afghanistan. HR and HRV were collected before, during, and after virtual reality (VR) combat and civilian scenes. HRV recovery was defined as HRV after a 3-minute VR simulation minus HRV during a VR scene. mStroop threat variables included index scores for combat and general threat. Self-report data were collected at baseline and 6 months later. The outcome variable was the 17-item Clinician Administered PTSD Scale (CAPS). Controlling for baseline CAPS and number of combat experiences, the following baseline HRV recovery variables were significant predictors of 6-month CAPS: standard deviation of normal beat to beat interval (SDNN) after combat scene minus SDNN during combat scene and low-frequency (LF HRV) after civilian scene minus LF during civilian scene. HRV at rest, HR reactivity, HR recovery, and mStroop scores did not predict treatment response. In conclusion, HRV recovery variables in the context of a standardized VR stressor were significant predictors of PTSD treatment response after controlling for baseline CAPS and number of combat experiences. The direction of this relationship indicates that greater baseline HRV recovery predicts lower 6-month PTSD symptom severity. This was an exploratory study in need of replication. [ABSTRACT FROM AUTHOR]

The transition from pregnancy into parturition is physiologically directed by maternal, fetal and placental tissues. We hypothesize that these processes may be reflected in maternal physiological metrics. We enrolled pregnant participants in the third-trimester (n = 118) to study continuously worn smart ring devices monitoring heart rate, heart rate variability, skin temperature, sleep and physical activity from negative temperature coefficient, 3-D accelerometer and infrared photoplethysmography sensors. Weekly surveys assessed labor symptoms, pain, fatigue and mood. We estimated the association between each metric, gestational age, and the likelihood of a participant's labor beginning prior to (versus after) the clinical estimated delivery date (EDD) of 40.0 weeks with mixed effects regression. A boosted random forest was trained on the physiological metrics to predict pregnancies that naturally passed the EDD versus undergoing onset of labor prior to the EDD. Here we report that many raw sleep, activity, pain, fatigue and labor symptom metrics are correlated with gestational age. As gestational age advances, pregnant individuals have lower resting heart rate 0.357 beats/minute/week, 0.84 higher heart rate variability (milliseconds) and shorter durations of physical activity and sleep. Further, random forest predictions determine pregnancies that would pass the EDD with accuracy of 0.71 (area under the receiver operating curve). Self-reported symptoms of labor correlate with increased gestational age and not with the timing of labor (relative to EDD) or onset of spontaneous labor. The use of maternal smart ring-derived physiological data in the third-trimester may improve prediction of the natural duration of pregnancy relative to the EDD. [ABSTRACT FROM AUTHOR]

Two separate bodies of literature point to the link between family bereavement and cardiovascular health and between sleep quality and cardiovascular outcomes. However, less is known about the joint influence of family bereavement and sleep quality on cardiovascular functioning. The aims of this study were to examine the relationships between experiencing the death of a family member and heart rate variability (HRV) and to further explore whether these associations differ by sleep quality. Using data from the Midlife in the United States (MIDUS) Biomarker Project, the sample for this study included respondents who experienced the death of an immediate family member – father, mother, spouse, sibling, or child – within a year before the Biomarker project and those who did not experience any deaths (N = 962). We used two measures of HRV and sleep quality was measured using the Pittsburgh Sleep Quality Index. Results showed that experiencing the death of a family member was associated with worse HRV only among those with poor sleep quality and not for those with good sleep quality. These results suggest that poor sleep quality may indicate psychophysiological vulnerability for those who experienced the death of a family member. Interventions to improve sleep quality could be effective in enhancing cardiovascular health of bereaved individuals. [ABSTRACT FROM AUTHOR]

Prokinetic agents, specifically 5-hydroxytryptamine type 4 (5-HT4) receptor agonists, have been shown to provide relief in chronic idiopathic constipation (CIC). The first-generation 5-HT4 agonists were initially withdrawn from use owing to associations with serious cardiovascular (CV) events. This review summarizes CV safety data for prucalopride, a high-affinity 5-HT4 agonist approved in the United States in 2018 for adults with CIC. No significant effects of prucalopride on CV safety were observed in animal models or early-phase clinical studies, including a thorough QT study at therapeutic (2 mg) or supratherapeutic (10 mg) doses. Among 1,750 patients with CIC who received prucalopride (2-4 mg) in 5 phase 3 studies, no trends in CV adverse events, electrocardiogram parameters, or blood pressure were documented; £1.0%–2.0% of patients had prolonged QT interval corrected for heart rate (HR) using Fridericia formula after placebo or prucalopride treatment, and low HR occurred in £6.1% and £3.3% of these patients, respectively. In two 24-month observational studies among 2,468 patients, changes in electrocardiogram parameters over time were minor, except at occasional time points when significant changes from baseline were reported for HR or QT interval. In a real-world European CV safety study among 35,087 patients (prucalopride, 5,715; polyethylene glycol 3350 [PEG3350], 29,372), results were consistent for no evidence of increased risk of major adverse CV events among patients treated with prucalopride vs PEG3350 (incidence rate ratio 5 0.64; 95% confidence interval 0.36-1.14). Studies to date have not raised concerns regarding the impact of prucalopride treatment on CV parameters. [ABSTRACT FROM AUTHOR]

Deep breathing exercises are the second most used complementary health approach in the United States. Two heart rate variability (HRV) parameters, the root mean square of successive differences (RMSSD) and the respiratory sinus arrhythmia (RSA), are used to assess parasympathetic reactivity to deep breathing, but they are often not in agreement. Our purpose was to determine the cause of the disagreement. We investigated HRV parameters in 38 subjects during baseline, deep breathing, and recovery. Here we show that RMSSD as a measure of parasympathetic reactivity is unreliable; it does not reflect the increase in HRV during deep breathing as determined by RSA. We observed a decrease in RMSSD values despite a marked increase in HRV as determined by RSA and the standard deviation of normal heartbeat interval (SDNN) in healthy subjects and patients with functional bowel disorders. We show that RSA captures all aspects of HRV, whereas successive differences in heart rate intervals are only a small part of HRV, with decreasing variability during deep breathing in most subjects. We present a new measure of calculating RSA during deep breathing that may become an essential tool for researchers and clinicians. We also provide a unique visualization of the increased heart rate variability during deep breathing. Hence, RMSSD cannot be used to assess parasympathetic reactivity during deep breathing; using RSA is recommended. The use of RMSSD in previous influential studies may have led to erroneous conclusions about parasympathetic reactivity during deep breathing. Its continued use may undervalue the effects of the autonomic nervous system in slow deep breathing. [ABSTRACT FROM AUTHOR]

Background: Research on burnout in the medical community has extensively studied the impact of mindfulness-based interventions (MBIs), which can include meditation, outdoor retreats, in-person didactics, and/or online wellness modules. However, in addition to these MBIs lacking objective, physiological measures for wellness, there has been little to no research involving virtual reality (VR) as an MBI modality for healthcare professionals in the United States. Methods: A randomized controlled intervention trial was used to study the impact of VR-based guided-meditations in the form of brief paced-breathing exercises. Heart-rate variability (HRV), a biomarker for relaxation, was measured during each session. Thirty-two participants, consisting of primarily medical students, resident physicians, and registered nurses, were recruited to complete brief guided-meditations via a VR headset or a standalone mobile app in the emergency department (ED) on-call room of a large urban academic medical center. Results: A total of 213 guided-meditation sessions were completed over the course of 4 weeks. Self-reported ratings of anxiety improved in both VR and mobile groups post-study. However, the VR group demonstrated higher intrasession HRV progress, indicating increased state of relaxation that also correlated with the number of sessions completed. Analysis by gender revealed disparity in HRV metrics between male and female VR participants. Conclusion/Application to Practice: VR-based guided meditations prove to be a feasible and accessible MBI that does not require extensive time commitment for healthcare workers. VR may be a more effective meditation platform compared with standalone mobile meditation apps, especially when used on a routine basis. [ABSTRACT FROM AUTHOR]

Introduction: Intimate partner violence is a serious public health problem that costs the United States more than $4.1 billion in direct medical and mental health costs alone. Furthermore, alcohol use contributes to more frequent and more severe intimate partner violence incidents. Compounding this problem is treatments for intimate partner violence have largely been socially informed and demonstrate poor efficacy. We argue that improvements in intimate partner treatment will be gained through systematic scientific study of mechanisms through which alcohol is related to intimate partner violence. We hypothesize that poor emotional and behavioral regulation as indexed by the respiratory sinus arrythymia measure of heart rate variability is a key mechanism between alcohol use and intimate partner violence. Method: The present study is a placebo-controlled alcohol administration study with an emotion-regulation task that investigated heart rate variability in distressed violent and distressed nonviolent partners. Results: We found a main effect for alcohol on heart rate variability. We also found a four-way interaction whereby distressed violent partners exhibited significant reductions in heart rate variability when acutely intoxicated and attempting to not respond to their partners evocative stimuli. Discussion: These findings suggest that distressed violent partners may adopt maladaptive emotion regulation strategies such as rumination and suppression when intoxicated and attempting to not respond to partner conflict. Such strategies of emotion regulation have been shown to have many deleterious emotional, cognitive and social consequences for individuals who adopt them, possibly including intimate partner violence. These findings also highlight an important novel treatment target for intimate partner violence and suggest that novel treatments should focus on teaching effective conflict resolution and emotion-regulation strategies that may be augmented by biobehavioral treatments such as heart rate variability biofeedback. [ABSTRACT FROM AUTHOR]

We conducted a field study using multiple wearable devices on 231 federal office workers to assess the impact of the indoor environment on individual wellbeing. Past research has established that the workplace environment is closely tied to an individual's wellbeing. Since sound is the most-reported environmental factor causing stress and discomfort, we focus on quantifying its association with physiological wellbeing. Physiological wellbeing is represented as a latent variable in an empirical Bayes model with heart rate variability measures—SDNN and normalized-HF as the observed outcomes and with exogenous factors including sound level as inputs. We find that an individual's physiological wellbeing is optimal when sound level in the workplace is at 50 dBA. At lower (<50dBA) and higher (>50dBA) amplitude ranges, a 10 dBA increase in sound level is related to a 5.4% increase and 1.9% decrease in physiological wellbeing respectively. Age, body-mass-index, high blood pressure, anxiety, and computer use intensive work are person-level factors contributing to heterogeneity in the sound-wellbeing association. [ABSTRACT FROM AUTHOR]

Background Cardiovascular disease is a critical public health issue and a growing body of literature on relationships and health point to individuals' interactions and involvement with family members as significant correlates of cardiovascular outcomes. However, less is known about the implications of daily encounters with family members on cardiovascular health outcomes and how the associations vary across adulthood. Purpose The aims of this study were to examine the associations of positive and negative daily experiences with family members with comprehensive measures of cardiovascular health and to further explore how age moderates these associations. Methods This study used data from the Midlife in the United States (MIDUS) II and MIDUS Refresher. The sample was composed of respondents who participated in two subprojects of MIDUS, namely the National Study of Daily Experiences (NSDE) and Biomarker Project (N = 1,312). Indices of cardiovascular health included inflammatory markers, autonomic functioning, and Life's Simple 7 scores. Results Results showed that the associations between daily family experiences and cardiovascular outcomes differed by age. Having more daily negative experiences with family members was associated with better cardiovascular health outcomes among young adults and worse cardiovascular outcomes among older adults. Having more daily positive experiences was also associated with lower heart rate variability for older adults. Conclusions Results revealed that contrary to the general assumption that negative experiences have health-damaging effects, frequent involvement with family members in daily life, even negative ones, may be indicative of active engagement in life that could be health promoting for younger adults. [ABSTRACT FROM AUTHOR]

This study examined the heart rate synchrony between a single couple in emotionally focused therapy (EFT) as a method of measuring coregulatory effects over the course of treatment. A clinician who is an EFT certified therapist, supervisor, and trainer administered all eight sessions in a private practice setting. Surrogate synchrony analysis assessed heart rate synchrony between partners, indicating that significant heart rate synchrony was more likely over time. Significant heart rate synchrony was more likely during sessions that focused on clients' sharing attachment injuries, bonds, and longings with their partner compared to sessions more focused on cognitive processing of the relationship. Additionally, there were delays in heart rate synchrony that occurred between the couple, which may be indicative of the emotional processing speed of the empathic response of each partner. Understanding the physiological synchrony patterns between dyads in treatment could clarify the potential of coregulation in the therapeutic process. [ABSTRACT FROM AUTHOR]

Objectives: To study age at death (AD) and its determinants in cohorts of middle-aged men followed-up until extinction. Material and methods: A total of 9063 middle-aged men enrolled in 10 cohorts of 6 countries (USA, Finland, the Netherlands, Italy, Greece and Japan) within the Seven Countries Study were examined and then followed up for 60 years until extinction. AD was computed and a small number of risk factors were tested through multiple linear regression as possibly related to attained AD. Results: AD ranged across cohorts from 71.8 years in East Finland and 80.5 years in Crete with levels roughly lower in the USA and Northern Europe and higher elsewhere. Across cohorts, the correlation coefficients of systolic blood pressure (R = −0.58) and of CVD prevalence (R = −0.65) versus average AD were the only significant ones. At the individual level in the pool of all cohorts, a multiple linear regression model showed that age, vigorous physical activity, never and ex-smokers were favorably related to AD, while the reverse was true for systolic blood pressure, heart rate, serum cholesterol, CVD prevalence and silent ECG abnormalities. BMI had a parabolic relationship with AD. The predicting power of single risk factors, expressed in years gained or lost, was relatively small, but arbitrary combinations of several of them produced large differences in AD. Conclusions: A small number of CVD risk factors were strongly associated with AD in a life-long follow-up. [ABSTRACT FROM AUTHOR]

This study examined the impact of activity-based multisensory-interventions (MSI) provided in a multisensory environment (MSE) on anxiety, agitation, and pain in adults receiving residential treatment for substance use disorder (SUD). Participants (N = 35) were randomly assigned to two groups and all received four, 30- to 45-minute individualized recreational therapy (RT) sessions over the course of two weeks during their residential stay. The experimental group participated in MSI in a MSE. A comparison group participated in RT sessions using table games (TG). Targeted outcomes were assessed using standardized, self-report measures and physiological data. Pre-and post-session assessments revealed significant reduction in anxiety, agitation, and pain, for individuals in both groups. Between groups comparisons documented a significant main effect for treatment (MSI, TG) on anxiety (p <.001), agitation (p = .03), and pain (p = .05) measures with significantly greater symptom reduction for the MSI group. Individuals receiving MSI also presented with significantly reduced respiration rate following the intervention (p <.01). Heart rate changes were non-significant for both groups. A participant survey at the conclusion of sessions yielded feedback that all individuals who received the MSI (n = 18) reported these sessions were a valuable addition to their SUD treatment. [ABSTRACT FROM AUTHOR]

Rates of alcohol use disorder (AUD) are increasing among civilian and veteran populations of women in the United States, and stress pathophysiology (i.e., abnormal acute and long-term change in physiological responses to stress) is central to themaintenance of alcoholmisuse within this population. Heart rate variability (HRV) is onemeasure of stress regulation thatmay help to explain the association of stress with alcoholmisuse among women. In the current analysis of pilot data, 20 women veterans attended an in-person laboratory session and completed 35 daily assessments of their alcohol use and craving. During the lab session, the effects of a stress induction procedure on self-reported alcohol craving and HRV were assessed. HRV was continuously measured and indexed in the time domain, using the root mean square of successive differences between normal heartbeats (RMSSD). Alcohol craving and use during the longitudinal 35-day study period were measured via self-report questionnaires sent to participants' phones. Results indicated that resting HRV in the lab was positively associated with odds of daily craving. Moreover, HRV during the stressor, as measured in lab, was positively associated with (1) overall alcohol craving in the lab (i.e., with resting and post-stress craving), and (2) number of daily drinks during the 35-day study period. This pilot study suggests the potential role of HRV in response to stressors in predicting alcohol craving and use among female veterans. It provides pilot data for research on stress-reactive HRV as a biomarker for alcohol misuse among women, and discusses directions for future research. [ABSTRACT FROM AUTHOR]

Background: In response to the COVID-19 pandemic, the US states of New York and New Jersey instituted a "lockdown" that closed schools and most businesses except for essential services. The public was urged to remain at home. The 78-day lockdown period extended from 22 March 2020 to 6 June 2020. We sought to evaluate the impact of COVID-19 lockdown on continuously recorded physical activity in our patients with congenital heart disease with implanted cardiac rhythm management (CRM) devices—pacemakers (PPM), defibrillators (ICD) and implantable loop recorders (ILR) enabled with accelerometers that translate motion into a measure of active hours/day. Methods: All patients from our congenital CRM database with accelerometer-enabled devices who had stable cardiac status residing in NY and NJ were included. Forty-one patients met the inclusion criteria; the median age was 29.6 years (range 7–60); 54% female; 23 ICD, 15 PPM and 3 ILR. The patient activity was averaged for the 2 months prior to lockdown, during the lockdown, and the 2 months afterward. Paired t-tests were used to compare activity before and during lockdown, and before and after lockdown. Each patient served as his/her own control. Results: Active hours/day decreased by a mean of 32% (±27%) from baseline (p < 0.001). A total of 32 patients experienced a decline, 6 had no change and 3 had an increase. Active hours rebounded after lockdown and were unchanged compared to pre-lockdown levels. Conclusions: The COVID-19 lockdown in NY/NJ during the Spring of 2020 resulted in a significant drop in active hours/day in children and adults with congenital heart disease. Active hours/day rebounded to baseline after restrictions were lifted. [ABSTRACT FROM AUTHOR]

The present study examined the effects of a 6-week whole-body vibration training (WBVT) regimen on heart rate variability (HRV) and body composition in obese Hispanic postmenopausal women. Participants were randomly assigned to either WBVT (n = 13) or a nonexercising control group (n = 14). HRV and body composition were measured before and after 6 weeks. There was a significant group by time interaction (P < .05) for heart rate, sympathovagal balance, and body fat percentage (BF%) such that all significantly decreased (P < .05); and R-R intervals significantly increased (P < .05) following WBVT compared to no changes after control. The changes in sympathovagal balance were correlated with changes in BF% (r = .63, P < .05). Our findings indicate that WBVT improves HRV and BF% in obese Hispanic postmenopausal women. The improvement in BF% partially explained the decrease in sympathovagal balance. Since obese and older individuals are at increased risk of developing cardiovascular diseases, they could potentially benefit from WBVT. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "American Medical Society For Sports Medicine Position Statement: Mononucleosis and Athletic Participation" which appeared in the previous issue of the periodical.

Posttraumatic Stress Disorder (PTSD) is a psychiatric condition affecting nearly a quarter of the United States war veterans who return from war zones. Treatment for PTSD typically consists of a combination of in-session therapy and medication. However; patients often experience their most severe PTSD symptoms outside of therapy sessions. Mobile health applications may address this gap, but their effectiveness is limited by the current gap in continuous monitoring and detection capabilities enabling timely intervention. The goal of this article is to develop a novel method to detect hyperarousal events using physiological and activity-based machine learning algorithms. Physiological data including heart rate and body acceleration as well as self-reported hyperarousal events were collected using a tool developed for commercial off-the-shelf wearable devices from 99 United States veterans diagnosed with PTSD over several days. The data were used to develop four machine learning algorithms: Random Forest, Support Vector Machine, Logistic Regression and XGBoost. The XGBoost model had the best performance in detecting onset of PTSD symptoms with over 83% accuracy and an AUC of 0.70. Post-hoc SHapley Additive exPlanations (SHAP) additive explanation analysis showed that algorithm predictions were correlated with average heart rate, minimum heart rate and average body acceleration. Findings show promise in detecting onset of PTSD symptoms which could be the basis for developing remote and continuous monitoring systems for PTSD. Such systems may address a vital gap in just-in-time interventions for PTSD self-management outside of scheduled clinical appointments. [ABSTRACT FROM AUTHOR]

The necessity of promoting physical activity in individuals with Autism Spectrum Disorder (ASD) has been emphasized for decades. One of the barriers to participate in physical activity for individuals with ASD is limited interest and motivation. Therefore, understanding the motivation to exercise in this population is important. The objective was to determine the effect of using contingent reinforcement in the form of watching a preferred DVD to increase duration of time pedalling on a stationary bicycle within their predetermined target heart rate zone (THRZ) in children with ASD. Using a crossover design, seven participants (11 2.7 years) who were diagnosed with ASD were randomly assigned to either Group A or B. Time spent pedalling on a bicycle within the THRZ was analysed using a linear mixed-effect model with Bonferroni adjustments. The results showed that the DVD intervention motivated children with ASD to exercise for more than 10 minutes in moderate to vigorous physical activity compared to when they were exercising without watching a DVD. This result is significant as number of studies have revealed that 10 minutes of exercise could bring improvements in activities of daily living such as behaviors and academic performance in school. [ABSTRACT FROM AUTHOR]

Cardiovascular alterations in anorexia nervosa (AN) adolescents include bradycardia and decreased systolic blood pressure and left ventricular mass. However, their determinants remain poorly understood. We assessed the associations between morphological and functional left ventricular (LV) remodeling, autonomic control by heart rate variability (HRV) analysis, thyroid hormones and brain natriuretic peptide (BNP) levels in AN female adolescents without or with weight recovery (WR). Fifty-nine female adolescents including 16 AN patients without WR (mean age 13.9 years (10–16)), 10 AN patients with WR (15.7 years (12–18)) and 33 controls (14.1 years (10–18)) underwent night heart rate (HR) recording to measure HRV (and especially SD1/SD2, the ratio between instantaneous (SD1) and long-term (SD2) standard deviation of R-R intervals, reflecting sympatho-vagal balance), speckle tracking echocardiography to assess LV global longitudinal strain (GLS) and blood test for dosage of tri-iodothyronine (T3) hormone and NT-proBNP. Compared to controls, AN patients without WR presented with lower HR (55 ± 7 vs. 68 ± 6 bpm; p < 0.001), parasympathetic hyperactivity, and higher GLS (−19.2 ± 1.8 vs. −16.9 ± 2.8%; p = 0.009). These alterations were partly abolished in AN patients with WR. In a multivariate regression analysis, T3 was the main factor explaining the variance of SD1/SD2, a sympatho-vagal balance marker. NT-proBNP levels were not correlated with cardiac alterations. AN patients had parasympathetic hyperactivity linked with their rate of T3, and a higher GLS. These alterations were partly restored in AN patients with WR. [ABSTRACT FROM AUTHOR]

Heart failure with reduced left ventricular ejection fraction is a progressive disease that claims > 352,000 lives annually in the United States alone. Despite the development of an extensive array of pharmacologic and device therapies, prognosis remains poor. Disruption in autonomic balance in the form of heightened sympathetic nerve activity and reduced vagal tone have been established as major causes of heart failure progression. Interest in chronic neuromodulation mediated by vagus nerve stimulation (VNS) has intensified in recent years. This review focuses on four main goals: (1) To review the preclinical evidence that supports the concept of a cardioprotective effect of VNS on autonomic function and cardiac electrical stability along with the underlying putative mechanisms. (2) To present the initial clinical experience with chronic VNS in patients with heart failure and highlight the controversial aspects of the findings. (3) To discuss the latest findings of the multifactorial effects of VNS on autonomic tone, baroreceptor sensitivity, and cardiac electrical stability and the state-of-the-art methods employed to monitor these relationships. (4) To discuss the implications of the current findings and the gaps in knowledge that require attention in future investigations. [ABSTRACT FROM AUTHOR]

Nurses experience stress in the workplace. We evaluated the feasibility and effect of Reiki to relieve stress of staff nurses during a work shift. All Reiki treatments were completed without interruption and lasted 30 minutes. Stress scores, respiratory rate, and heart rate were significantly decreased immediately following the Reiki treatment. [ABSTRACT FROM AUTHOR]

Objective: We collected naturalistic heart rate data from veterans diagnosed with post-traumatic stress disorder (PTSD) to investigate the effects of various factors on heart rate. Background: PTSD is prevalent among combat veterans in the United States. While a positive correlation between PTSD and heart rate has been documented, specific heart rate profiles during the onset of PTSD symptoms remain unknown. Method: Veterans were recruited during five cycling events in 2017 and 2018 to record resting and activity-related heart rate data using a wrist-worn device. The device also logged self-reported PTSD hyperarousal events. Regression analyses were performed on demographic and behavioral covariates including gender, exercise, antidepressants, smoking habits, sleep habits, average heart rate during reported hyperarousal events, age, glucocorticoids consumption, and alcohol consumption. Heart rate patterns during self-reported PTSD hyperarousal events were analyzed using Auto Regressive Integrated Moving Average (ARIMA). Heart rate data were also compared to an open-access non-PTSD representative case. Results: Of 99 veterans with PTSD, 91 participants reported at least one hyperarousal event, with a total of 1023 events; demographic information was complete for 38 participants who formed the subset for regression analyses. The results show that factors including smoking, sleeping, gender, and medication significantly affect resting heart rate. Moreover, unique heart rate patterns associated with PTSD symptoms in terms of stationarity, autocorrelation, and fluctuation characteristics were identified. Conclusion: Our findings show distinguishable heart rate patterns and characteristics during PTSD hyperarousal events. Application: These findings show promise for future work to detect the onset of PTSD symptoms. [ABSTRACT FROM AUTHOR]

Cannabis is the most commonly used psychotropic drug in the United States, after alcohol. Despite its apparent sedative and calming effects, cannabis and its main psychoactive constituent, ∆9‐tetrahydrocannabinol (THC) can produce serious adverse effects including tachycardia and anxiety. These effects can be especially pronounced in women, who remain underrepresented in clinical cannabinoid research. The present study is one of the first to characterize the effects of single doses of oral THC on autonomic nervous system function in healthy adult women. Occasional female cannabis users participated in three laboratory sessions in which they received oral THC (7.5 and 15 mg) and placebo. Autonomic measures included heart rate (HR), blood pressure (BP), pre‐ejection period (PEP) a measure of cardiac sympathetic functioning, and high frequency heart rate variability (HF‐HRV) a measure of parasympathetic cardiac control. Autonomic responses were examined in relation to subjective drug effects. THC dose‐dependently increased HR, decreased HF‐HRV, and increased ratings of feeling a drug effect, cannabis‐like intoxication, and anxiety. Although the drug did not significantly affect BP or PEP, HR was negatively related to both PEP and HF‐HRV. HF‐HRV, the measure of parasympathetic activity, was significantly negatively related to subjective measures of cannabis intoxication (but not anxiety) at the 15 mg dose only. PEP was not significantly related to any subjective measure. These results extend our knowledge of the autonomic effects of THC in relation to subjective drug experience. This and future studies will help us to understand risk factors related to cannabis use. Cannabis and its main psychoactive constituent, ∆9‐tetrahydrocannabinol (THC) can produce adverse effects including tachycardia and anxiety. These effects can be especially pronounced in women, who remain underrepresented in clinical cannabinoid research. The present study is one of the first to characterize the effects of single doses of oral THC on autonomic nervous system function in healthy adult women. The results extend our knowledge of the autonomic effects of THC in relation to subjective drug experience. [ABSTRACT FROM AUTHOR]

Palpitations are a common symptom managed by general practitioners and cardiologists; atrial fibrillation (AF) is the most common arrhythmia in adults. The recent commercial availability of smartphone-based devices and wearable technologies with arrhythmia detection capabilities has revolutionized the diagnosis and management of these common medical issues, as it has placed the power of arrhythmia detection into the hands of the patient. Numerous mobile health (mHealth) devices that can detect, record, and automatically interpret irregularities in heart rhythm and abrupt changes in heart rate using photoplethysmography (PPG)- and electrocardiogram-based technologies are now commercially available. As opposed to prescription-based external rhythm monitoring approaches, these devices are more inexpensive and allow for longer-term monitoring, thus increasing sensitivity for arrhythmia detection, particularly for patients with infrequent symptoms possibly due to cardiac arrhythmias. These devices can be used to correlate symptoms with cardiac arrhythmias, assess efficacy and toxicities of arrhythmia therapies, and screen the population for serious rhythm disturbances such as AF. Although several devices have received clearance for AF detection from the United States Food & Drug Administration, limitations include the need for ECG confirmation for arrhythmias detected by PPG alone, false positives, false negatives, charging requirements for the battery, and financial cost. In summary, the growth of commercially available devices for remote, patient-facing rhythm monitoring represents an exciting new opportunity in the care of patients with palpitations and known or suspected dysrhythmias. Physicians should be familiar with the evidence that underlies their added value to patient care and, importantly, their current limitations. [ABSTRACT FROM AUTHOR]

Objective: Chronic stress is associated with increased vulnerability to drug use and may contribute to drugrelated health disparities in the African American community. The underlying physiological mechanisms by which chronic stress confers this increased risk remain unclear. The present study aimed to characterize the impact of chronic and race-related stress exposure on regulatory mechanisms of the autonomic nervous system (ANS) in response to acute stress, to examine John Henryism as potential moderator of this relationship, and to investigate the association between ANS reactivity and subsequent drug use among a sample of African American emerging adults (18-25 years old) in the Southern United States (U.S.). Method: Participants (N = 276) completed self-report measures of chronic and race-related stress and John Henryism and underwent a laboratory-based stressor. ANS reactivity was assessed via heart rate variability (HRV) and skin conductance levels (SCL). At 90-day follow-up, retrospective reports of drug use were provided. Results: Race-related stress was associated with greater SCL reactivity. John Henryism moderated the relationship between chronic stress exposure and HRV reactivity. SCL reactivity was associated with higher rates of alcohol and marijuana use at 90-day follow-up. HRV reactivity was associated with tobacco use at 90-day follow-up. Conclusions: Chronic stress exposure and active coping may interact to affect regulatory mechanisms of the ANS. ANS (dys)regulation may be an important endophenotype for increasing drug use vulnerability among African American emerging adults. [ABSTRACT FROM AUTHOR]

The study explores the sex differences in cardiovascular outcomes among bereaved individuals. In addition, the study differentiates the impact of child maltreatment and recent loss on the physical health of adult men and women. This study conducted a secondary analysis of data drawn from the Biomarker Subproject of the National Survey of Midlife Development in the United States (n = 1,255). Analysis included a series of regression models estimated in Stata version 15.1. A main effect for both sex and loss was observed. Both male and female respondents with loss had higher average heart rates as compared to male respondents without loss. Interestingly, being a female without loss was also associated with a higher average heart rate as compared to males without loss. The findings suggest that sex differences in cardiovascular functioning do occur and that these differences may be exacerbated by experiences of trauma and loss, and this relationship has implications for assessment and intervention. [ABSTRACT FROM AUTHOR]

Training load (TL) is monitored with the aim of making evidence-based decisions on appropriate loading schemes to reduce injuries and enhance team performance. However, little is known in detail about the variables of load and methods of analysis used in high-level football. Therefore, the aim of this study was to provide information on the practices and practitioners' perceptions of monitoring in professional clubs. Eighty-two high-level football clubs from Europe, the United States, and Australia were invited to answer questions relating to how TL is quantified, how players' responses are monitored, and their perceptions of the effectiveness of monitoring. Forty-one responses were received. All teams used GPS and heart-rate monitors during all training sessions, and 28 used rating of perceived exertion. The top-5-ranking TL variables were acceleration (various thresholds), total distance, distance covered above 5.5 m/s, estimated metabolic power, and heart-rate exertion. Players' responses to training are monitored using questionnaires (68% of clubs) and submaximal exercise protocols (41%). Differences in expected vs actual effectiveness of monitoring were 23% and 20% for injury prevention and performance enhancement, respectively (P < .001 d = 1.0-1.4). Of the perceived barriers to effectiveness, limited human resources scored highest, followed by coach buy-in. The discrepancy between expected and actual effectiveness appears to be due to suboptimal integration with coaches, insufficient human resources, and concerns over the reliability of assessment tools. Future approaches should critically evaluate the usefulness of current monitoring tools and explore methods of reducing the identified barriers to effectiveness. [ABSTRACT FROM AUTHOR]

Objective: This study explores relations between occupational and leisure-time physical activity (OPA, LTPA) and sedentary behavior (OSB, LTSB) and several health outcomes. Methods: A total 114 full-time workers had their body composition, waist circumference, height, weight, resting heart rate, and resting blood pressure measured. ActivPal monitor measured physical activity behaviors. Stress, mood, and pain were measured with ecological momentary assessment. General linear models were used to examine the relationship between high and low OPA, LTPA, OSB, and LTSB with each health outcome while controlling for covariates. Results: The high LTPA group had lower body mass index (BMI) (P  = 0.04) and better mood (P  = 0.007) than the low LTPA group. The high LTSB group had higher systolic blood pressure (P  = 0.001), higher diastolic blood pressure (P  = 0.01), higher BMI (P  = 0.027), higher body fat percentage (P  = 0.003), higher waist circumference (P  = 0.01), and worse mood (P  = 0.032) than the low LTSB group. No differences were found between OPA and OSB groups. Conclusions: These findings suggest there may be differential relations between PA and SB accumulated during leisure versus occupational time. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Elmer, DJ, Barron, EN, and Chavez, JL. Acute demands and recovery from common interval training protocols. J Strength Cond Res 35(11): 3041–3049, 2021—The definition of interval training is quite broad, with no accepted procedure for classifying protocols with different workloads and work and recovery interval times. In addition, little is known about the differences in training load and recovery from common interval protocols. The purpose of this study was to evaluate the differences in acute physiological demands and perceived difficulty between 3 common interval training protocols and a moderate, continuous exercise session. Eight subjects completed the training sessions on a cycle ergometer in a randomized order, with at least 1 week between sessions: 30-second/4-minute, 1-minute/1-minute, 4-minute/3-minute, and a 45-minute continuous session. Metabolic variables were measured throughout exercise and 30 minutes of recovery. Training impulse (TRIMP), session-RPE, and RPE-training load were also measured. There were significant differences between protocols, including between interval training protocols, for average V̇ o 2 (p < 0.001) and heart rate (HR) (p = 0.02), total O2 consumption (p < 0.001), peak lactate (p < 0.001), TRIMP (p = 0.02), session-RPE (p = 0.01), and RPE-training load (p < 0.001). There were no significant differences between interval training protocols for peak V̇ o 2 or peak HR attained during exercise. There were also no differences in V̇ o 2 or HR after 5 or 30 minutes of recovery. Blood lactate was only significantly higher after 30 minutes of recovery from the 30-second/4-minute compared with the 4-minute/3-minute protocol (p = 0.001) and the 45-minute session (p < 0.001). These findings show a range of differences in acute physiological demands and perceptions from interval training protocols, which should be accounted for when planning training sessions or research studies or when interpreting past research. [ABSTRACT FROM AUTHOR]

Background: The continued increase in prevalence of methamphetamine use in the United States has resulted in a significant increase in the number of patients entering treatment for methamphetamine use. However, no robustly efficacious pharmacologic treatment for methamphetamine use or withdrawal has been identified to date after stopping methamphetamine use. Aims: Given the association between methamphetamine withdrawal and relapse during early treatment, this study tested a controlled d-amphetamine withdrawal paradigm among methamphetamine-using individuals. Methods: Treatment-seeking adults who used methamphetamine (N = 34; 47% female; 100% white) were enrolled in a 4-week, randomized, double-blind, placebo-controlled trial in a residential setting, in which all participants were maintained on d-amphetamine (30 mg BID) during week 1, then half were switched to placebo during weeks 2–3. All participants received placebo during week 4. Outcomes included vital signs, withdrawal, cravings for methamphetamine, mood, and cognition. Bivariate analyses tested treatment group differences on baseline demographic and outcome variables. Repeated measures models examined main and interaction effects of treatment over time. Results/Outcomes: Participants were successfully randomized and safely stabilized on d-amphetamine. Craving for methamphetamine increased during weeks 2–3 in the placebo group relative to those on d-amphetamine. Interactions with age and heart rate were noted. Conclusions/Interpretation: To our knowledge, this is the first double-blind, placebo-controlled trial measuring pharmacologic effects of abruptly stopping controlled d-amphetamine administration in adults who use methamphetamine. Results support the potential of this withdrawal paradigm to further examine the efficacy of pharmacologic agents in ameliorating methamphetamine withdrawal symptoms. [ABSTRACT FROM AUTHOR]