Elsevier

Canadian Journal of Cardiology

Volume 26, Issue 6, June–July 2010, Pages 303-312
Canadian Journal of Cardiology

Improvements in heart rate variability with exercise therapyLes améliorations de la variabilité de la fréquence cardiaque grâce à la rééducation par l’exercice

https://doi.org/10.1016/S0828-282X(10)70395-0Get rights and content

Heart rate variability (HRV) is a noninvasive, practical and reproducible measure of autonomic nervous system function. A heart rate that is variable and responsive to demands is believed to bestow a survival advantage, whereas reduced HRV may be associated with poorer cardiovascular health and outcomes. In recent years, many researchers have investigated the prognostic implications of HRV in a variety of clinical populations. Evidence suggests that reduced HRV has prognostic significance for individuals with myocardial infarction, chronic heart failure, unstable angina and diabetes mellitus. Interventions to increase HRV, such as exercise therapy, have also been examined. The findings of the present review suggest that exercise therapy may improve HRV in myocardial infarction, chronic heart failure and revascularization patients by increasing vagal tone and decreasing sympathetic activity. One hypothesis is that a shift toward greater vagal modulation may positively affect the prognosis of these individuals. While the underlying mechanisms by which exercise training improves vagal modulation are speculative at present, angiotensin II and nitric oxide may be potential mediators.

La variabilité de la fréquence cardiaque (VFR) est une mesure non effractive, pratique et reproductible de la fonction du système nerveux autonome. On pense qu’une fréquence cardiaque variable et réactive aux exigences confère un avantage pour la survie, tandis qu’une VFC réduite pourrait s’associer à une moins bonne santé cardiovasculaire et à des issues plus négatives. Ces dernières années, de nombreux chercheurs ont exploré les conséquences pronostiques de la VFC dans diverses populations cliniques. Selon les données probantes, une VFC réduite a une signification pronostique pour les personnes ayant un infarctus du myocarde, une insuffisance cardiaque chronique, une angine instable et un diabète. Les interventions visant à accroître la VFC, telles que la rééducation par l’exercice, ont également fait l’objet d’un examen. D’après les observations de la présente analyse, la rééducation par l’exercice peut améliorer la VFC en cas d’infarctus du myocarde, d’insuffisance cardiaque chronique et de revascularisation, car elle accroît le tonus vagal et réduit l’activité sympathique. On postule qu’une transition vers une modulation vagale accrue pourrait avoir un effet positif sur le pronostic de ces personnes. Les mécanismes sous-jacents par lesquels l’entraînement à l’exercice améliore la modulation vagale demeurent encore spéculatifs, mais l’angiotensine II et le monoxyde d’azote pourraient constituer des médiateurs potentiels.

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