Impact of respiratory physical therapy on heart rate autonomic control in children with leukemia

Abstract

Introduction: Considering that heart rate (HR) autonomic control is impaired in cancer and subsequent respiratory effort may overload the heart, we aimed to evaluate the effect of a respiratory physical therapy session on HR autonomic regulation in children with leukemia so as to confirm its safety. Methods: We selected children with leukemia (n=10) and healthy children (n=11), which were submitted to a session of respiratory physical therapy. We used Spiron Kids (NCS, Brazil), Children's Voldyne (HUDSON RCI, USA) and Shaker (NCS, Brazil) as respiratory devices. The respiratory exercise protocols were founded on three standardized protocols. HR variability (HRV) was analyzed before, in the first minute and 5 to 10 minutes after intervention. Results: We recognized no change between rest and recovery from intervention in HRV (rMSSD-square root mean square of the differences between adjacent normal R-R intervals) -Control: p=0.8111, Leukemia: p=0.1197, among groups: p=0.6574; SD1-standard deviation from instantaneous beat-to-beat variability -Control: p=0.8111, Leukemia: p=0.131, among groups: p=0.6556; 0V-with no variation [3 equal symbols, for example (2,2,2)-Control: p=0.3679, Leukemia: p=0.3553, among groups: p=0.7421; 2UV-with two variations to the contrary [the three symbols form a peak or a valley, for instance (3,5,3)-Control: p=0.3679, Leukemia: p=0.2359, among groups: p=0.4007). HFhigh frequency component, range 0.15 to 0.4Hz -decreased 0 to 1 minute after intervention in the leukemia group (p=0.0303) and no change was observed in the control group between rest versus recovery from intervention (p=0.9761). No significant change was reported in HF between groups (p=0.8700). Two Leukemia subjects treated with Vincristine presented different HRV responses to the intervention group. Conclusion: A respiratory physical therapy session did not significantly change autonomic control of HR in children with leukemia. Yet, clinicians should be mindful of subjects undergoing treatment with Vincristine.