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

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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.

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References

  1. Morris J, Twaddle S (2007) Clinical review: anorexia nervosa. BMJ 334:894–898

    Article  PubMed Central  PubMed  Google Scholar 

  2. 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 170:917–925

    Article  PubMed Central  PubMed  Google Scholar 

  3. Casiero D, Frishman WM (2006) Cardiovascular complications of eating disorders. Cardiol Rev 14:227–231

    Article  PubMed  Google Scholar 

  4. 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 164:706–713

    Article  PubMed Central  PubMed  Google Scholar 

  5. 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 19:87–99

    Article  PubMed  Google Scholar 

  6. Yahalom M, Spitz M, Sandler L, Heno N, Roguin N, Turgeman Y (2013) The significance of bradycardia in anorexia nervosa. Int J Angiol 22:83–94

    Article  PubMed Central  PubMed  Google Scholar 

  7. 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

    Google Scholar 

  8. Brubaker PH, Kitzman DW (2011) Chronotropic incompetence: causes, consequences, and management. Circulation 123:1010–1020

    Article  PubMed Central  PubMed  Google Scholar 

  9. 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 14:215–221

    Article  PubMed  Google Scholar 

  10. 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 31:129–136

    Article  PubMed  Google Scholar 

  11. 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 24:270–275

    Article  PubMed  Google Scholar 

  12. 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

    Google Scholar 

  13. 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)

    Google Scholar 

  14. R Core Team (2015) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/. Accessed 23 Jan 2017

  15. Achamrah N, Coëffier M, Rimbert A, Charles J, Folope V, Petit A, Déchelotte P, Grigioni S (2017) Micronutrient status in 153 patients with anorexia nervosa. Nutrients. https://doi.org/10.3390/nu9030225

    Article  PubMed Central  PubMed  Google Scholar 

  16. 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 33:89–93

    Article  PubMed  Google Scholar 

  17. 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 122:130–137

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank to pediatricians specializing in psychiatric disease treatment in our department for their advises, and Mrs. Chie Yoshida for her technical assistance in performing the exercise tests.

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Authors and Affiliations

  1. Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan

    Yu Yoshida, Jun Maeda, Hiroyuki Fukushima, Natsuko Tokita & Hiroyuki Yamagishi

  2. Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan

    Yu Yoshida, Hiroyuki Yamagishi & Mitsuaki Tokumura

  3. Health Center, Keio University, Tokyo, Japan

    Mitsuaki Tokumura

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  1. Yu Yoshida
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  2. Jun Maeda
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  3. Hiroyuki Fukushima
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  4. Natsuko Tokita
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  5. Hiroyuki Yamagishi
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  6. Mitsuaki Tokumura
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Correspondence to Hiroyuki Yamagishi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The clinical evaluations of the patients were approved by the Internal Ethics Committee of Keio University School of Medicine. For this type of study, formal informed consent is not required.

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Yoshida, Y., Maeda, J., Fukushima, H. et al. Chronotropic incompetence to exercise in anorexia nervosa patients during the body-weight recovery phase as an index of insufficient treatment. Heart Vessels 34, 711–715 (2019). https://doi.org/10.1007/s00380-018-1282-6

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  • DOI: https://doi.org/10.1007/s00380-018-1282-6

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