Chronotropic incompetence of the heart is associated with exercise intolerance in patients with schizophrenia

Herbsleb, Marco; Schumann, Andy; Malchow, Berend; Puta, Christian; Schulze, P. Christian; Gabriel, H. H. W.; Bär, Karl‐Jürgen

doi:10.1016/j.schres.2018.02.020

Cited by 14 publications

(9 citation statements)

References 54 publications

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“…In the present study, we identified impaired chronotropic responses with a step-wise incremental exercise test in contrast to the ramp-wise protocol used in the previous study by Herbsleb et al ( 34 ). However, in this independent sample only 23% of the multi-episode patients with schizophrenia showed CI.…”

Section: Discussioncontrasting

confidence: 47%

“…More recently, we investigated the putative link between autonomic dysfunction and physical incapacity in these patients. And indeed, Herbsleb et al ( 34 ) were able to present evidence that about half of the tested population of patients with schizophrenia showed a strikingly absent heart rate acceleration during physical exercise. This phenomenon is called chronotropic incompetence of the heart (CI) and was again described in various cardiac conditions ( 35 – 38 ).…”

Section: Introductionmentioning

confidence: 96%

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The Influence of Continuous Exercising on Chronotropic Incompetence in Multi-Episode Schizophrenia

et al. 2019

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People with schizophrenia die on average 15–20 years earlier than age and gender matched controls in the general population. An essential part of this excess mortality in people with schizophrenia is caused by physical illnesses. Among the physical illnesses, cardiovascular disease (CVD) has been identified as the most common natural cause of death in up to 40–45% of the cases. Chronotropic incompetence (CI) is defined as the inability of the heart to increase its beating frequency in proportion to increased physical activity or higher metabolic demand. It is an established independent cardiovascular risk factor for major cardiac events and overall mortality and might explain adaptation intolerance of the cardiovascular system to even minor exercise courses. CI needs objective exercise testing for definitive diagnosis and therefore represents a biological marker indicating the integrity of the cardiovascular system. It was recently described in patients with schizophrenia and might help explain the reduced physical fitness in these patients and the inability of a subgroup of patients to benefit from exercise interventions. In this study, we tried to replicate the occurrence of CI in an independent sample of patients with schizophrenia and evaluated whether CI can be influenced by a continuous endurance training of 12 weeks. Therefore, we re-analyzed the fitness testing data of 43 patients with schizophrenia and 22 aged and gender matched healthy controls. Parameters of aerobic fitness and chronotropic response to exercise were calculated. Patients with schizophrenia were less physically fit than the healthy controls and displayed a significantly higher heart rate at rest. 10 of 43 patients with schizophrenia and no healthy control subject were classified as chronotropically incompetent. Chronotropic response to exercise did not change significantly after 12 weeks of continuous aerobic exercise training. No differences were observed for baseline heart rate and peak heart rate in both subgroups of schizophrenia patients. Aerobic fitness did not improve significantly in the patients with schizophrenia classified as chronotropically incompetent. Our results confirm the occurrence of CI in patients with multi-episode schizophrenia. This should be taken into account when planning an exercise or lifestyle intervention studies in this population. Schizophrenia patients with CI do not seem to benefit as well as schizophrenia patients without CI from aerobic exercise training interventions. Larger, prospective randomized controlled clinical trials with different training interventions are urgently needed to address the topic of schizophrenia patients not responding to exercise and the relationship to the illness itself.

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Section: Discussioncontrasting

confidence: 47%

Section: Introductionmentioning

confidence: 96%

The Influence of Continuous Exercising on Chronotropic Incompetence in Multi-Episode Schizophrenia

et al. 2019

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“…The fact that the prevalence of metabolic syndrome is increased in people with schizophrenia—who have a notoriously high risk profile for obesity, poor diet, sedentary lifestyle and smoking and other substance abuse, as well as type 2 diabetes—goes a considerable distance towards explaining the increase in risk for CVD 7. However, studies suggest that severe mental illnesses and the metabolic syndrome might share a number of pathophysiological features, including hypothalamic–pituitary–adrenal and mitochondrial dysfunction, neuro-inflammation, common genetic links and epigenetic interactions 8…”

Section: Metabolic Syndromementioning

confidence: 99%

“…The mechanisms by which the vagal activity is suppressed in schizophrenia are obscure, but disturbances in cortico-subcortical circuits modulating autonomic nervous activity have been suggested. The effects of medication make the situation less clear, although some workers have clearly found a decrease in the high-frequency spectral component of HRV, independent of medication 8. The altered sympatho-vagal balance may also reflect underlying neurophysiological differences; a number of studies have suggested that the right hemisphere predominantly modulates sympathetic activity, whereas the left hemisphere predominantly modulates parasympathetic activity 11…”

Section: Autonomic Dysfunctionmentioning

confidence: 99%

Cardiovascular effects of psychotic illnesses and antipsychotic therapy

Howell

Yarovova

Khwanda

et al. 2019

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Mortality from cardiovascular disease is increased in people with mental health disorders in general and schizophrenia in particular. The causes are multifactorial, but it is known that antipsychotic medication can cause cardiac side-effects beyond the traditional coronary risk factors. Schizophrenia itself is a contributor to an increased risk of cardiovascular mortality via cardiac autonomic dysfunction and a higher prevalence of metabolic syndrome, both contributing to a reduced life expectancy. The pro-arrhythmic impact of traditional antipsychotics, especially via the hERG-potassium channel, has been known for several years. Newer antipsychotics have a reduced pro-arrhythmic profile but might contribute to higher cardiac death rates by worsening the metabolic profile. Clozapine-induced cardiomyopathy, which is dose independent, is a further concern and continuous monitoring of these patients is required. Prophylaxis with angiotensin-converting enzyme inhibitors is currently under review. Overall, management of cardiovascular risk within this population group must be multifaceted and nuanced to allow the most effective treatment of serious mental illness to be conducted within acceptable parameters of cardiovascular risk; some practical measures are presented for the clinical cardiologist.

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“…It has been proposed that, in addition to adverse metabolic effects, antipsychotic drugs also have adverse effects on the cardiovascular system (i.e., antagonistic activity at alpha-adrenergic receptors) [ 26 – 28 ]. It is also proposed that a high prevalence of chronotropic incompetence (attenuated heart rate response to exercise) [ 26 , 29 ], reduced activity of the efferent vagal system [ 30 ] and mitochondrial dysfunction [ 31 , 32 ] may be condition-specific factors related to their CRF level.…”

Section: Introductionmentioning

confidence: 99%

Effect of high-intensity interval training on cardiorespiratory fitness, physical activity and body composition in people with schizophrenia: a randomized controlled trial

et al. 2020

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Background: Exercise may improve cardiorespiratory fitness in people with schizophrenia, however, possible conditionspecific cardiorespiratory disadvantages, a scarcity of methodologically sound studies, and conflicting results raise questions about the effect of exercise on maximal oxygen uptake (VO 2max) in this group. The primary aim of this study, therefore, was to investigate the effect of high-intensity interval training on VO 2max in people with schizophrenia. Second, we sought to determine whether the intervention would have an effect on general physical activity (PA) level and body composition. Methods: Eighty-two patients with schizophrenia were randomly assigned to supervised high-intensity interval training or computer gaming skills training, performed twice a week for 12 weeks. Oxygen uptake was measured directly, during a maximum exercise session on a treadmill. PA level were assessed using ActiGraph accelerometer, and body composition was assessed by bioelectrical impedance. Differences between groups were assessed by analysis of variance using a univariate general linear model. Results: There were no significant differences between the groups on any of the cardiorespiratory variables neither at baseline nor after the program. There were also no significant within-group differences in any of the cardiorespiratory fitness variables between the baseline and post-program time points, despite that 61% of the participants performing highintensity interval training showed a significant increase in workload on the treadmill. However, 47% of the participants in the high-intensity interval training group had a ≥ 5% increase in VO 2max. Participants supervised by mental health care providers with PA competence (e.g. rehabilitation center staff, sport scientist, physical trainer) had a much larger increase in VO 2max compared to participants supervised by mental health workers without such competence, and when adding PA competence to the model, the intervention group increased VO 2max significantly compared to the comparison group. The intervention had no significant effect on PA level or body composition.

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Chronotropic incompetence of the heart is associated with exercise intolerance in patients with schizophrenia

Cited by 14 publications

References 54 publications

The Influence of Continuous Exercising on Chronotropic Incompetence in Multi-Episode Schizophrenia

The Influence of Continuous Exercising on Chronotropic Incompetence in Multi-Episode Schizophrenia

Cardiovascular effects of psychotic illnesses and antipsychotic therapy

Effect of high-intensity interval training on cardiorespiratory fitness, physical activity and body composition in people with schizophrenia: a randomized controlled trial

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