Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure

First Department of Medicine, Osaka University School of Medicine, Japan.

OBJECTIVES. Vagally mediated heart rate recovery after exercise was assessed in patients with chronic heart failure and in well trained athletes by analyzing the postexercise heart rate decay. BACKGROUND. Vagal reactivation is an important cardiac deceleration mechanism after exercise. However, alterations of this mechanism under pathologic conditions have not been characterized because of the lack of a specific index. METHODS. To find a vagally mediated component of heart rate recovery, the time constants of the beat-by-beat heart rate decay for the first 30 s (T30) and the first 120 s (T120) after exercise were obtained at six levels of exercise in eight normal volunteers: 1) at maximal exercise, 2) at anaerobic threshold, 3) at anaerobic threshold with propranolol administration, 4) at anaerobic threshold with atropine administration, 5) at anaerobic threshold with concomitant administration of both drugs, and 6) at 50% of anaerobic threshold. To investigate the effects of heart failure and endurance training on vagally mediated heart rate recovery, T30 and T120 at anaerobic threshold were obtained in 20 patients with chronic heart failure and in 9 cross-country skiers. RESULTS. In normal volunteers, T30 and T120 were markedly prolonged by atropine administration, indicating that both time constants are mediated by vagal reactivation. Moreover, T30 was almost independent of the exercise intensity and sympathetic blockade, whereas T120 was affected by sympathetic nerve activity and exercise work load. These results indicate that T30 is mediated primarily by vagal reactivation, independent of sympathetic withdrawal, and is significantly smaller in athletes (p < 0.01) and significantly larger in patients with chronic heart failure (p < 0.01) than that in respective age-matched normal control subjects. CONCLUSIONS. The T30 value could be a specific index for vagally mediated heart rate recovery. Vagally mediated heart rate recovery after exercise is accelerated in well trained athletes but blunted in patients with chronic heart failure.

This article has been cited by other articles:

				E. G. Ciolac, E. A. Bocchi, J. M. Greve, and G. V. Guimaraes Heart rate response to exercise and cardiorespiratory fitness of young women at high familial risk for hypertension: effects of interval vs continuous training European Journal of Cardiovascular Prevention & Rehabilitation, December 1, 2011; 18(6): 824 - 830. [Abstract] [Full Text] [PDF]

				M. A. Jolly, D. M. Brennan, and L. Cho Impact of Exercise on Heart Rate Recovery Circulation, October 4, 2011; 124(14): 1520 - 1526. [Abstract] [Full Text] [PDF]

				N. C. Wang, A. Chicos, S. Banthia, D. W. Bergner, M. K. Lahiri, J. Ng, H. Subacius, A. H. Kadish, and J. J. Goldberger Persistent sympathoexcitation long after submaximal exercise in subjects with and without coronary artery disease Am J Physiol Heart Circ Physiol, September 1, 2011; 301(3): H912 - H920. [Abstract] [Full Text] [PDF]

				S. Okutucu, K. Aytemir, B. Evranos, H. Aksoy, C. Sabanov, U. Nadir Karakulak, E. Baris Kaya, G. Kabakci, L. Tokgozoglu, H. Ozkutlu, et al. Cardiac resynchronization therapy improves exercise heart rate recovery in patients with heart failure Europace, April 1, 2011; 13(4): 526 - 532. [Abstract] [Full Text] [PDF]

				A. Kadowaki, K. Matsukawa, R. Wakasugi, T. Nakamoto, and N. Liang Central command does not decrease cardiac parasympathetic efferent nerve activity during spontaneous fictive motor activity in decerebrate cats Am J Physiol Heart Circ Physiol, April 1, 2011; 300(4): H1373 - H1385. [Abstract] [Full Text] [PDF]

				P. H. Brubaker and D. W. Kitzman Chronotropic Incompetence: Causes, Consequences, and Management Circulation, March 8, 2011; 123(9): 1010 - 1020. [Full Text] [PDF]

				T. Yamada, T. Yoshitama, K. Makino, T. Lee, and F. Saeki Heart Rate Recovery After Exercise Is a Predictor of Silent Myocardial Ischemia in Patients With Type 2 Diabetes Diabetes Care, March 1, 2011; 34(3): 724 - 726. [Abstract] [Full Text] [PDF]

				I. Ardic, M. G. Kaya, M. Yarlioglues, O. Dogdu, H. Buyukoglan, N. Kalay, A. Kanbay, C. Zencir, and A. Ergin Impaired Heart Rate Recovery Index in Patients With Sarcoidosis Chest, January 1, 2011; 139(1): 60 - 68. [Abstract] [Full Text] [PDF]

				S. Yanagisawa, K. Miki, N. Yasuda, T. Hirai, N. Suzuki, and T. Tanaka The prognostic value of treadmill exercise testing in very elderly patients: heart rate recovery as a predictor of mortality in octogenarians Europace, January 1, 2011; 13(1): 114 - 120. [Abstract] [Full Text] [PDF]

				Writing Committee Members, P. Greenland, J. S. Alpert, G. A. Beller, E. J. Benjamin, M. J. Budoff, Z. A. Fayad, E. Foster, M. A. Hlatky, J. M. Hodgson, et al. 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 21, 2010; 122(25): e584 - e636. [Full Text] [PDF]

				P. Greenland, J. S. Alpert, G. A. Beller, E. J. Benjamin, M. J. Budoff, Z. A. Fayad, E. Foster, M. A. Hlatky, J. M. Hodgson, F. G. Kushner, et al. 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance J. Am. Coll. Cardiol., December 14, 2010; 56(25): e50 - e103. [Full Text] [PDF]

				O. DOGDU, M. YARLIOGLUES, M. G. KAYA, I. ARDIC, N. OGUZHAN, M. AKPEK, O. SAHIN, L. AKYOL, S. KELESOGLU, F. KOC, et al. Deterioration of Heart Rate Recovery Index in Patients with Systemic Lupus Erythematosus J Rheumatol, December 1, 2010; 37(12): 2511 - 2515. [Abstract] [Full Text] [PDF]

				H. Makimoto, E. Nakagawa, H. Takaki, Y. Yamada, H. Okamura, T. Noda, K. Satomi, K. Suyama, N. Aihara, T. Kurita, et al. Augmented ST-Segment Elevation During Recovery From Exercise Predicts Cardiac Events in Patients With Brugada Syndrome J. Am. Coll. Cardiol., November 2, 2010; 56(19): 1576 - 1584. [Abstract] [Full Text] [PDF]

				D. E. Thomas, S. A. Exton, and Z. R. Yousef Heart rate deceleration after exercise predicts patients most likely to respond to cardiac resynchronisation therapy Heart, September 1, 2010; 96(17): 1385 - 1389. [Abstract] [Full Text] [PDF]

				J. P. Fisher, T. Seifert, D. Hartwich, C. N. Young, N. H. Secher, and P. J. Fadel Reply from James P. Fisher, Thomas Seifert, Doreen Hartwich, Colin N. Young, Niels H. Secher and Paul J. Fadel J. Physiol., July 15, 2010; 588(14): 2681 - 2681. [Full Text] [PDF]

				M. T. Maeder, C. Duerring, R. P. Engel, C. Boescha, M. E. Pfisterer, J. Myers, J. Muller-Brand, and M. J. Zellweger Predictors of impaired heart rate recovery: a myocardial perfusion SPECT study European Journal of Cardiovascular Prevention & Rehabilitation, June 1, 2010; 17(3): 303 - 308. [Abstract] [Full Text] [PDF]

				T. P. Singh and S. Evans Socioeconomic Position and Heart Rate Recovery After Maximal Exercise in Children Arch Pediatr Adolesc Med, May 1, 2010; 164(5): 479 - 484. [Abstract] [Full Text] [PDF]

				J. P. Fisher, T. Seifert, D. Hartwich, C. N. Young, N. H. Secher, and P. J. Fadel Autonomic control of heart rate by metabolically sensitive skeletal muscle afferents in humans J. Physiol., April 1, 2010; 588(7): 1117 - 1127. [Abstract] [Full Text] [PDF]

				J. H. Coote Recovery of heart rate following intense dynamic exercise Exp Physiol, March 1, 2010; 95(3): 431 - 440. [Abstract] [Full Text] [PDF]

				I. Kesoi, B. Sagi, T. Vas, T. Kovacs, I. Wittmann, and J. Nagy Heart rate recovery after exercise is associated with renal function in patients with a homogenous chronic renal disease Nephrol. Dial. Transplant., February 1, 2010; 25(2): 509 - 513. [Abstract] [Full Text] [PDF]

				M. T. Maeder, P. Ammann, O. D. Schoch, H. Rickli, W. Korte, C. Hurny, J. Myers, and T. Munzer Determinants of Postexercise Heart Rate Recovery in Patients With the Obstructive Sleep Apnea Syndrome Chest, February 1, 2010; 137(2): 310 - 317. [Abstract] [Full Text] [PDF]

				R. v. Kanel, H. Saner, S. Kohls, J. Barth, H. Znoj, G. Saner, and J.-P. Schmid Relation of heart rate recovery to psychological distress and quality of life in patients with chronic heart failure European Journal of Cardiovascular Prevention & Rehabilitation, December 1, 2009; 16(6): 645 - 650. [Abstract] [Full Text] [PDF]

				J. Ng, S. Sundaram, A. H. Kadish, and J. J. Goldberger Autonomic effects on the spectral analysis of heart rate variability after exercise Am J Physiol Heart Circ Physiol, October 1, 2009; 297(4): H1421 - H1428. [Abstract] [Full Text] [PDF]

				J. J. Swigris, J. Swick, F. S. Wamboldt, D. Sprunger, R. du Bois, A. Fischer, G. P. Cosgrove, S. K. Frankel, E. R. Fernandez-Perez, D. Kervitsky, et al. Heart Rate Recovery After 6-Min Walk Test Predicts Survival in Patients With Idiopathic Pulmonary Fibrosis Chest, September 1, 2009; 136(3): 841 - 848. [Abstract] [Full Text] [PDF]

				X. Jouven, P. J. Schwartz, S. Escolano, C. Straczek, M. Tafflet, M. Desnos, J. P. Empana, and P. Ducimetiere Excessive heart rate increase during mild mental stress in preparation for exercise predicts sudden death in the general population Eur. Heart J., July 2, 2009; 30(14): 1703 - 1710. [Abstract] [Full Text] [PDF]

				S. Boettger, F. Wetzig, C. Puta, L. Donath, H.-J. Muller, H. H. W. Gabriel, and K.-J. Bar Physical Fitness and Heart Rate Recovery Are Decreased in Major Depressive Disorder Psychosom Med, June 1, 2009; 71(5): 519 - 523. [Abstract] [Full Text] [PDF]

				M. S. LAUER Autonomic function and prognosis Cleveland Clinic Journal of Medicine, April 1, 2009; 76(Suppl_2): S18 - S22. [Abstract] [Full Text] [PDF]

				J.-Y. Tabet, P. Meurin, F. Beauvais, H. Weber, N. Renaud, G. Thabut, A. Cohen-Solal, D. Logeart, and A. B. Driss Absence of Exercise Capacity Improvement After Exercise Training Program: A Strong Prognostic Factor in Patients With Chronic Heart Failure Circ Heart Fail, November 1, 2008; 1(4): 220 - 226. [Abstract] [Full Text] [PDF]

				J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention J. Am. Coll. Cardiol., September 30, 2008; 52(14): 1179 - 1199. [Full Text] [PDF]

				J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention Circulation, September 30, 2008; 118(14): 1497 - 1518. [Full Text] [PDF]

				P. Palatini Exercise testing in asymptomatic subjects: from diagnostic test to prognostic tool? Eur. Heart J., August 1, 2008; 29(15): 1803 - 1806. [Full Text] [PDF]

				M. K. Lahiri, P. J. Kannankeril, and J. J. Goldberger Assessment of Autonomic Function in Cardiovascular Disease: Physiological Basis and Prognostic Implications J. Am. Coll. Cardiol., May 6, 2008; 51(18): 1725 - 1733. [Abstract] [Full Text] [PDF]

				L.-Y. Lin, H.-K. Kuo, L.-P. Lai, J.-L. Lin, C.-D. Tseng, and J.-J. Hwang Inverse Correlation Between Heart Rate Recovery and Metabolic Risks in Healthy Children and Adolescents: Insight from the National Health and Nutrition Examination Survey 1999-2002 Diabetes Care, May 1, 2008; 31(5): 1015 - 1020. [Abstract] [Full Text] [PDF]

				F. E. Dewey, J. R. Kapoor, R. S. Williams, M. J. Lipinski, E. A. Ashley, D. Hadley, J. Myers, and V. F. Froelicher Ventricular Arrhythmias During Clinical Treadmill Testing and Prognosis Arch Intern Med, January 28, 2008; 168(2): 225 - 234. [Abstract] [Full Text] [PDF]

				S. Sundaram, M. Carnethon, K. Polito, A. H. Kadish, and J. J. Goldberger Autonomic effects on QT-RR interval dynamics after exercise Am J Physiol Heart Circ Physiol, January 1, 2008; 294(1): H490 - H497. [Abstract] [Full Text] [PDF]

				M. Takahashi, K. Matsukawa, T. Nakamoto, H. Tsuchimochi, A. Sakaguchi, K. Kawaguchi, and K. Onari Control of heart rate variability by cardiac parasympathetic nerve activity during voluntary static exercise in humans with tetraplegia J Appl Physiol, November 1, 2007; 103(5): 1669 - 1677. [Abstract] [Full Text] [PDF]

				M. Buchheit, Y. Papelier, P. B. Laursen, and S. Ahmaidi Noninvasive assessment of cardiac parasympathetic function: postexercise heart rate recovery or heart rate variability? Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H8 - H10. [Full Text] [PDF]

				T. A. Dewland, A. S. Androne, F. A. Lee, R. J. Lampert, and S. D. Katz Effect of acetylcholinesterase inhibition with pyridostigmine on cardiac parasympathetic function in sedentary adults and trained athletes Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H86 - H92. [Abstract] [Full Text] [PDF]

				M. Buchheit, P. B. Laursen, and S. Ahmaidi Parasympathetic reactivation after repeated sprint exercise Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H133 - H141. [Abstract] [Full Text] [PDF]

				J. Myers, S. Y. Tan, J. Abella, V. Aleti, and V. F. Froelicher Comparison of the chronotropic response to exercise and heart rate recovery in predicting cardiovascular mortality European Journal of Cardiovascular Prevention & Rehabilitation, April 1, 2007; 14(2): 215 - 221. [Abstract] [Full Text] [PDF]

				J. M. Scott, B. T. A. Esch, M. J. Haykowsky, S. Isserow, M. S. Koehle, B. G. Hughes, D. Zbogar, S. S. D. Bredin, D. C. McKenzie, and D. E. R. Warburton Sex differences in left ventricular function and beta-receptor responsiveness following prolonged strenuous exercise J Appl Physiol, February 1, 2007; 102(2): 681 - 687. [Abstract] [Full Text] [PDF]

				J. M. Legramante, F. Iellamo, M. Massaro, S. Sacco, and A. Galante Effects of residential exercise training on heart rate recovery in coronary artery patients Am J Physiol Heart Circ Physiol, January 1, 2007; 292(1): H510 - H515. [Abstract] [Full Text] [PDF]

				P. Kligfield and M. S. Lauer Exercise Electrocardiogram Testing: Beyond the ST Segment Circulation, November 7, 2006; 114(19): 2070 - 2082. [Full Text] [PDF]

				H. Akgoz, U. Gurkan, S. U. Dayi, S. Terzi, T. Akbulut, A. Torun, and G. Tayyareci The Relationship Between {beta}-Receptor Sensitivity and Nocturnal Blood Pressure and Heart Rate Recovery in Normotensive People Angiology, August 1, 2006; 57(4): 495 - 500. [Abstract] [PDF]

				F. Giallauria, A. D. Lorenzo, F. Pilerci, A. Manakos, R. Lucci, M. Psaroudaki, M. D'Agostino, D. D. Forno, and C. Vigorito Long-term effects of cardiac rehabilitation on end-exercise heart rate recovery after myocardial infarction European Journal of Cardiovascular Prevention & Rehabilitation, August 1, 2006; 13(4): 544 - 550. [Abstract] [Full Text] [PDF]

				M. A. Kizilbash, M. R. Carnethon, C. Chan, D. R. Jacobs, S. Sidney, and K. Liu The temporal relationship between heart rate recovery immediately after exercise and the metabolic syndrome: the CARDIA study Eur. Heart J., July 1, 2006; 27(13): 1592 - 1596. [Abstract] [Full Text] [PDF]

				A. J. Hautala, T. Rankinen, A. M. Kiviniemi, T. H. Makikallio, H. V. Huikuri, C. Bouchard, and M. P. Tulppo Heart rate recovery after maximal exercise is associated with acetylcholine receptor M2 (CHRM2) gene polymorphism Am J Physiol Heart Circ Physiol, July 1, 2006; 291(1): H459 - H466. [Abstract] [Full Text] [PDF]

				J. J. Goldberger, F. K. Le, M. Lahiri, P. J. Kannankeril, J. Ng, and A. H. Kadish Assessment of parasympathetic reactivation after exercise Am J Physiol Heart Circ Physiol, June 1, 2006; 290(6): H2446 - H2452. [Abstract] [Full Text] [PDF]

				A. B. Newman, E. M. Simonsick, B. L. Naydeck, R. M. Boudreau, S. B. Kritchevsky, M. C. Nevitt, M. Pahor, S. Satterfield, J. S. Brach, S. A. Studenski, et al. Association of Long-Distance Corridor Walk Performance With Mortality, Cardiovascular Disease, Mobility Limitation, and Disability JAMA, May 3, 2006; 295(17): 2018 - 2026. [Abstract] [Full Text] [PDF]

				T Kawasaki, A Azuma, T Kuribayashi, T Taniguchi, S Asada, T Kamitani, S Kawasaki, H Matsubara, and H Sugihara Enhanced vagal modulation and exercise induced ischaemia of the inferoposterior myocardium Heart, March 1, 2006; 92(3): 325 - 330. [Abstract] [Full Text] [PDF]

				M. H. Shishehbor, D. Litaker, C. E. Pothier, and M. S. Lauer Association of Socioeconomic Status With Functional Capacity, Heart Rate Recovery, and All-Cause Mortality JAMA, February 15, 2006; 295(7): 784 - 792. [Abstract] [Full Text] [PDF]

				K. Rahimi, A. Thomas, M. Adam, B.-F. Hayerizadeh, G. Schuler, and M.-A. Secknus Implications of exercise test modality on modern prognostic markers in patients with known or suspected coronary artery disease: Treadmill versus bicycle European Journal of Cardiovascular Prevention & Rehabilitation, February 1, 2006; 13(1): 45 - 50. [Abstract] [Full Text] [PDF]

				E.J.F. Danson, Y.H. Zhang, C.E. Sears, A.R. Edwards, B. Casadei, and D.J. Paterson Disruption of inhibitory G-proteins mediates a reduction in atrial {beta}-adrenergic signaling by enhancing eNOS expression Cardiovasc Res, September 1, 2005; 67(4): 613 - 623. [Abstract] [Full Text] [PDF]

				M. Lauer, E. S. Froelicher, M. Williams, and P. Kligfield Exercise Testing in Asymptomatic Adults: A Statement for Professionals From the American Heart Association Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention Circulation, August 2, 2005; 112(5): 771 - 776. [Abstract] [Full Text] [PDF]

				D. J. Brotman, J. P. Girod, M. J. Garcia, J. V. Patel, M. Gupta, A. Posch, S. Saunders, G. Y. H. Lip, S. Worley, and S. Reddy Effects of Short-Term Glucocorticoids on Cardiovascular Biomarkers J. Clin. Endocrinol. Metab., June 1, 2005; 90(6): 3202 - 3208. [Abstract] [Full Text] [PDF]

				L. L. Smith, M. Kukielka, and G. E. Billman Heart rate recovery after exercise: a predictor of ventricular fibrillation susceptibility after myocardial infarction Am J Physiol Heart Circ Physiol, April 1, 2005; 288(4): H1763 - H1769. [Abstract] [Full Text] [PDF]

				N. Tahara, H. Takaki, A. Taguchi, K. Suyama, T. Kurita, W. Shimizu, S. Miyazaki, T. Kawada, and K. Sunagawa Pronounced HR variability after exercise in inferior ischemia: evidence that the cardioinhibitory vagal reflex is invoked by exercise-induced inferior ischemia Am J Physiol Heart Circ Physiol, March 1, 2005; 288(3): H1179 - H1185. [Abstract] [Full Text] [PDF]

				M. P. Tulppo, H. V. Huikuri, E. Tutungi, D. S. Kimmerly, A. W. Gelb, R. L. Hughson, T. H. Makikallio, and J. Kevin Shoemaker Feedback effects of circulating norepinephrine on sympathetic outflow in healthy subjects Am J Physiol Heart Circ Physiol, February 1, 2005; 288(2): H710 - H715. [Abstract] [Full Text] [PDF]

				D. R. Ricardo, M. B. de Almeida, B. A. Franklin, and C. G. S. Araujo Initial and Final Exercise Heart Rate Transients: Influence of Gender, Aerobic Fitness, and Clinical Status Chest, January 1, 2005; 127(1): 318 - 327. [Abstract] [Full Text] [PDF]

				J. E. Madias Blunted Decline in Systolic Blood Pressure After Exercise Predicts Future Acute Myocardial Infarction Hypertension, December 1, 2004; 44(6): 807 - 808. [Full Text] [PDF]

				A. P. Morise Heart Rate Recovery: Predictor of Risk Today and Target of Therapy Tomorrow? Circulation, November 2, 2004; 110(18): 2778 - 2780. [Full Text] [PDF]

				M P Frenneaux Autonomic changes in patients with heart failure and in post-myocardial infarction patients Heart, November 1, 2004; 90(11): 1248 - 1255. [Abstract] [Full Text] [PDF]

				L. W. Raymond Vagal Pas de Deux: Heart-Lung Interplay in Postexercise Heart Rate Recovery Chest, April 1, 2004; 125(4): 1186 - 1190. [Full Text] [PDF]

				N. Seshadri, T. R. Gildea, K. McCarthy, C. Pothier, M. S. Kavuru, and M. S. Lauer Association of an Abnormal Exercise Heart Rate Recovery With Pulmonary Function Abnormalities Chest, April 1, 2004; 125(4): 1286 - 1291. [Abstract] [Full Text] [PDF]

				M. H. Shishehbor, B. J. Hoogwerf, and M. S. Lauer Association of Triglyceride-to-HDL Cholesterol Ratio With Heart Rate Recovery Diabetes Care, April 1, 2004; 27(4): 936 - 941. [Abstract] [Full Text] [PDF]

				M. R. Carnethon, D. R. Jacobs Jr., S. Sidney, and K. Liu Influence of Autonomic Nervous System Dysfunction on the Development of Type 2 Diabetes: The CARDIA study Diabetes Care, November 1, 2003; 26(11): 3035 - 3041. [Abstract] [Full Text] [PDF]

				S. Mora, R. F. Redberg, Y. Cui, M. K. Whiteman, J. A. Flaws, A. R. Sharrett, and R. S. Blumenthal Ability of Exercise Testing to Predict Cardiovascular and All-Cause Death in Asymptomatic Women: A 20-Year Follow-up of the Lipid Research Clinics Prevalence Study JAMA, September 24, 2003; 290(12): 1600 - 1607. [Abstract] [Full Text] [PDF]

				D. P. Vivekananthan, E. H. Blackstone, C. E. Pothier, and M. S. Lauer Heart rate recovery after exercise is apredictor of mortality, independent of the angiographic severity of coronary disease J. Am. Coll. Cardiol., September 3, 2003; 42(5): 831 - 838. [Abstract] [Full Text] [PDF]

				A S Androne, K Hryniewicz, R Goldsmith, A Arwady, and S D Katz Acetylcholinesterase inhibition with pyridostigmine improves heart rate recovery after maximal exercise in patients with chronic heart failure Heart, August 1, 2003; 89(8): 854 - 858. [Abstract] [Full Text] [PDF]

				E J F Danson and D J Paterson Enhanced neuronal nitric oxide synthase expression is central to cardiac vagal phenotype in exercise-trained mice J. Physiol., January 1, 2003; 546(1): 225 - 232. [Abstract] [Full Text] [PDF]

				A. A. W. Roest, A. de Roos, H. J. Lamb, W. A. Helbing, J. G. van den Aardweg, J. Doornbos, E. E. van der Wall, and P. Kunz Tetralogy of Fallot: Postoperative Delayed Recovery of Left Ventricular Stroke Volume after Physical Exercise--Assessment with Fast MR Imaging Radiology, January 1, 2003; 226(1): 278 - 284. [Abstract] [Full Text] [PDF]

				H. Ohuchi, H. Ohashi, J. Park, J. Hayashi, A. Miyazaki, and S. Echigo Abnormal Postexercise Cardiovascular Recovery and Its Determinants in Patients After Right Ventricular Outflow Tract Reconstruction Circulation, November 26, 2002; 106(22): 2819 - 2826. [Abstract] [Full Text] [PDF]

				P. J. Kannankeril and J. J. Goldberger Parasympathetic effects on cardiac electrophysiology during exercise and recovery Am J Physiol Heart Circ Physiol, June 1, 2002; 282(6): H2091 - H2098. [Abstract] [Full Text] [PDF]

				M. S. Lauer The "exercise" part of exercise echocardiography J. Am. Coll. Cardiol., April 17, 2002; 39(8): 1353 - 1355. [Full Text] [PDF]

				C. Panzer, M. S. Lauer, A. Brieke, E. Blackstone, and B. Hoogwerf Association of Fasting Plasma Glucose With Heart Rate Recovery in Healthy Adults: A Population-Based Study Diabetes, March 1, 2002; 51(3): 803 - 807. [Abstract] [Full Text] [PDF]

				K. Shetler, R. Marcus, V. F. Froelicher, S. Vora, D. Kalisetti, M. Prakash, D. Do, and J. Myers Heart rate recovery: validation and methodologic issues J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1980 - 1987. [Abstract] [Full Text] [PDF]

				J. Watanabe, M. Thamilarasan, E. H. Blackstone, J. D. Thomas, and M. S. Lauer Heart Rate Recovery Immediately After Treadmill Exercise and Left Ventricular Systolic Dysfunction as Predictors of Mortality: The Case of Stress Echocardiography Circulation, October 16, 2001; 104(16): 1911 - 1916. [Abstract] [Full Text] [PDF]

				E. S. Mezzacappa, R. M. Kelsey, E. S. Katkin, and R. P. Sloan Vagal Rebound and Recovery From Psychological Stress Psychosom Med, July 1, 2001; 63(4): 650 - 657. [Abstract] [Full Text] [PDF]

				C. E. Negrao, M. U. P. B. Rondon, T. Tinucci, M. J. N. Alves, F. Roveda, A. M. W. Braga, S. F. Reis, L. Nastari, A. C. P. Barretto, E. M. Krieger, et al. Abnormal neurovascular control during exercise is linked to heart failure severity Am J Physiol Heart Circ Physiol, March 1, 2001; 280(3): H1286 - H1292. [Abstract] [Full Text] [PDF]

				E. O. Nishime, C. R. Cole, E. H. Blackstone, F. J. Pashkow, and M. S. Lauer Heart Rate Recovery and Treadmill Exercise Score as Predictors of Mortality in Patients Referred for Exercise ECG JAMA, September 20, 2000; 284(11): 1392 - 1398. [Abstract] [Full Text] [PDF]

				C. R. Cole, J. M. Foody, E. H. Blackstone, and M. S. Lauer Heart Rate Recovery after Submaximal Exercise Testing as a Predictor of Mortality in a Cardiovascularly Healthy Cohort Ann Intern Med, April 4, 2000; 132(7): 552 - 555. [Abstract] [Full Text] [PDF]

				H. R. Middlekauff, A. H. Nguyen, C. E. Negrao, E. U. Nitzsche, C. K. Hoh, B. A. Natterson, M. A. Hamilton, G. C. Fonarow, A. Hage, and J. D. Moriguchi Impact of Acute Mental Stress on Sympathetic Nerve Activity and Regional Blood Flow in Advanced Heart Failure : Implications for `Triggering' Adverse Cardiac Events Circulation, September 16, 1997; 96(6): 1835 - 1842. [Abstract] [Full Text]

				P. J. Kannankeril and J. J. Goldberger Parasympathetic effects on cardiac electrophysiology during exercise and recovery Am J Physiol Heart Circ Physiol, June 1, 2002; 282(6): H2091 - H2098. [Abstract] [Full Text] [PDF]