Rehabilitation: Periodic somatosensory stimulation increases arterial baroreflex sensitivity in chronic heart failure patients

Gademan, Maaike G.J.; Sun, Yiping; Han, Liming; Valk, Vanessa J.; Schalij, Martin J.; van Exel, Henk J.; Lucas, Carolien M.H.B.; Maan, Arie C.; Verwey, Harriette F.; van de Vooren, Hedde; Pinna, Gian D.; Maestri, Roberto; La Rovere, Maria Teresa; van der Wall, Ernst E.; Swenne, Cees A.

doi:10.1016/j.ijcard.2010.07.022

« Previous Next »International Journal of Cardiology
Volume 152, Issue 2 , Pages 237-241, 20 October 2011

Rehabilitation: Periodic somatosensory stimulation increases arterial baroreflex sensitivity in chronic heart failure patients☆

Maaike G.J. Gademan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Yiping Sun
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Present address: Department of Pediatrics, Shandong Provincial Hospital, Jinan, Shandong, China.
Liming Han
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Present address: Department of Physical Education, Yantai Teacher's College, Yantai, China.
Vanessa J. Valk
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Martin J. Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Henk J. van Exel
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiopulmonary Rehabilitation, Rijnland Rehabilitation Center, Leiden, The Netherlands
Carolien M.H.B. Lucas
- Department of Cardiology, Rijnland Hospital, Leiderdorp, The Netherlands
Arie C. Maan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Harriette F. Verwey
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Hedde van de Vooren
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Present address: Department of Artificial Intelligence, University of Groningen, Groningen, The Netherlands.
Gian D. Pinna
- Department of Biomedical Engineering, S. Maugeri Foundation, IRCCS, Scientific Institute of Montescano, Montescano, Italy
Roberto Maestri
- Department of Biomedical Engineering, S. Maugeri Foundation, IRCCS, Scientific Institute of Montescano, Montescano, Italy
Maria Teresa La Rovere
- Department of Cardiology, S. Maugeri Foundation, IRCCS, Scientific Institute of Montescano, Montescano, Italy
Ernst E. van der Wall
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Cees A. Swenne
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Corresponding author. Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Tel.: +31 71 526 1972; fax: +31 84 221 8904.

Received 22 March 2010; received in revised form 17 June 2010; accepted 4 July 2010. published online 09 August 2010.

Abstract

Background

One of the beneficial effects of exercise training in chronic heart failure (CHF) is an improvement in baroreflex sensitivity (BRS), a prognostic index in CHF. In our hypothesis-generating study we propose that at least part of this effect is mediated by neural afferent information, and more specifically, by exercise-induced somatosensory nerve traffic.

Objective

To compare the effects of periodic electrical somatosensory stimulation on BRS in patients with CHF with the effects of exercise training and with usual care.

Methods

We compared in stable CHF patients the effect of transcutaneous electrical nerve stimulation (TENS, N=23, LVEF 30±9%) with the effects of bicycle exercise training (EXTR, N=20, LVEF 32±7%). To mimic exercise-associated somatosensory ergoreceptor stimulation, we applied periodic (2/s, marching pace) burst TENS to both feet. TENS and EXTR sessions were held during two successive days.

Results

BRS, measured prior to the first intervention session and one day after the second intervention session, increased by 28% from 3.07±2.06 to 4.24±2.61ms/mmHg in the TENS group, but did not change in the EXTR group (baseline: 3.37±2.53ms/mmHg; effect: 3.26±2.54ms/mmHg) (P(TENS vs EXTR)=0.02). Heart rate and systolic blood pressure did not change in either group.

Conclusions

We demonstrated that periodic somatosensory input alone is sufficient and efficient in increasing BRS in CHF patients. This concept constitutes a basis for studies towards more effective exercise training regimens in the diseased/impaired, in whom training aimed at BRS improvement should possibly focus more on the somatosensory aspect.

Keywords: Chronic heart failure, Transcutaneous electrical nerve stimulation, Rehabilitation, Autonomic nervous system, Baroreflex sensitivity