BY
Kaitlin E Moyer
Hope College, Holland Michigan
In partial fulfillment of the requirements of Kinesiology 222
December 6, 2010
In today’s world, the amount of stress United States citizens experience can be classified as a health risk. The range in which hypertension can affect the bodies normal state is large; commonly ranging from high blood pressure to virus’, strokes, heart attacks and obesity. The chaos of American society has blinded the need for balance in life. Doctors have taken it upon themselves to promote prevention by encouraging the average patient to eat right and exercise regularly (2).
The types of stress management that are promoted include meditation, seeking therapy form a clinical psychologist, consuming a healthy diet and increased involvement of physical activity. Among the four, exercise is most recommended for people in need of treatment for hypertension. Research has shown that benefits of exercise not only stimulate the systems of the body, but it improves emotional state and cognitive function (7). Research has also shown that patients who have undergone long periods of both psychological and physical stress rely on exercise as a non-pharmaceutical treatment mechanism (5).
The long term damage done to the body in result of the combination of psychological and physical stressors can result in autonomic dysfunction. Documented cases involved patients two have fallen victim to an unknown virus (symptoms vary in all cases) and never fully recover. This amount of stress causes the body to lose sensitivity to stimuli, causing the body to forget how to function properly (1). Victims of autonomic dysfunction, or more commonly known as as Postural Orthostatic Tachycardia Syndrome (POTS), experience great energy taxes on the body, mind and spirit daily.
Top researchers in partnership with doctors at Mayo Clinic have found victims of POTS to benefit from a strict balanced treatment plan. The use of retraining the body through the use of exercise, ironically aids in the recovery of autonomic dysfunction. Strenuous aerobic exercise six days a week paired with the appropriate diet has been found to increased the body’s sensitivity to hemodynamic shifts. This increase in awareness causes the body to improve the regulation of blood pressure, therefor decreasing symptoms of fatigue and dizziness.
The purpose of this article is to address the positive effects exercise brings upon a body with autonomic dysfunction. Specifically, the benefits of the recommended exercise frequency and intensity as part of the individualized prescribed treatment plans. Research has shown that through balance and time involuntary actions of the body will function properly, allowing one to experience life in a body with normal function.
Quality of Exercise Determines Quality of Recovery
Studies have shown the human genome has evolved in an environment of high physical activity (4). Americans most commonly lead less active lifestyles. Inactivity results in major health problems due to the decrease use of personal body mechanics which leads to the fall to illness and development of symptoms in relation to stress. These symptoms run the risk of developing hypertension, even autonomic nervous system dysfunction. Chronic conditions such as these, are the leading health issues in a America. Not only have they increases our awareness of the importance of exercise as part of our daily routines, but the risks involved for those who live sedentary lifestyles.
Studies have also shown that negative moods have a correlation with induced stress to the body resulting in an increase of heart rate (10). These symptoms alone or combined put ones ability for optimal function at risk. In cases for which stress symptoms are not treated correctly or are diagnosed too late, chronic illness occurs. Autonomic dysfunction also known as as Postural Orthostatic Tachycardia Syndrome (POTS) is developed through high levels of mental and physical stress in combination with an unknown virus. The shock of illness causes the body to lose proper involuntary function. In a sense the body forgets how to function; the autonomic nervous system fails to maintain a homeostatic state. Interestingly, exercise is shown to help retrain a body with autonomic nervous system dysfunction.
Although exercise is commonly thought of as a competition or sport, exercise provides multiple benefits to high risk individuals (4). A study done at the University of Ferrara showed an increase in health benefits among various populations in response to exercise training. The recommended thirty minutes of exercise fifty percent VO2max improved physical functions that were originally hindered by stress (4). These symptoms anger, fatigue, confusion, depression, distress and tension decreased. Doctors as Mayo Clinic have found exercise to be the main factor in speeding recovery for patients with autonomic dysfunction, beyond the improvement of the hypertensive symptoms (7).
In conclusion, the onset of POTS most specifically affects the patient in hemodynamic shifts. Victims are said to specifically experience light headiness, fatigues, low blood pressure, nauseas, fast heart rate and poor circulation (1). As stated, research has shown that exercise helps decrease hypertensive symptoms. Full recovery from autonomic dysfunction shows a strong positive correlation with a proper exercise plan. The training methods involving overloading and specificity become important when prescribing individualized exercise plans. Doctors at Mayo Clinic in Rochester Minnesota have led research studies that have developed the proper prescribed exercise, involving a combination of aerobic and anaerobic workouts that have been seen to alleviate symptoms of stress and autonomic dysfunction (2).
Although exercise is key to developing a healthy functioning autonomic nervous system, it is especially important for POTS patients to live by a strict schedule including proper rest and diet. Research at Mayo Clinic has shown that proper balance decreases symptoms resulting from stress. POTS patients are advised to “Focus on their treatment goals. Consume enough salt and fluids, don’t skip meals; stick to their exercise plan keep a regular sleep schedule and don’t nap during the day; don’t over do it; maintain a regular schedule while working through their symptoms” (2).
According to Mayo Clinic much of POTS treatment is anecdotal in nature; the backbone of the majority of treatment consists of adequate hydration especially due to the volume of exercise required. Recommended daily water consumption for POTS patients exceeds the average 1.5L. This increase of water makes up for water loss due to high sodium intake. Studies have shown that more than 5g of table salt a day helps increase intravascular volume. Therefore patients should be well hydrated before, during and after exercise (1). Patients are advised to resist caffeinated food sources. Although caffeine helps increase blood pressure and neurotransmitter release, this stimulation will allow for the development of a “wash out” period which can lead to additional unwanted fatigue.
The recommended exercise prescription for a POTS patient requires a minimum of 40% of maximal capacity, at least twenty-fifty minutes of moderate aerobic exercise six days a week. The intensity and duration recommendations show a slight difference then compared to the thirty minutes of aerobic exercise at 50% VO2max, which is recommended for the average population. The idea that rest is the cure for dysfunctional bodies is irrelevant when it comes to autonomic dysfunction. The prescribed individualized programs developed slowly, will gradually increase in duration and intensity over time; ensuring recovery. The common symptoms of light headedness, slow venous return and fatigue are all helped with specific prescribed exercise and diet.
Studies conducted using a POTS group and non-POTS group have shown that POTS patients have a significantly higher resting heart rate compared to non POTS group. Differences varied among 5bmp. The study showed the POTS group having higher heart rates and lower stroke volumes during exercise. It also showed aerobic training in combination with light lower extremity resistance training will help increase venous return. Which in return will also lessen the work load of the already over worked heart (tachycardia), and improving stroke volume and heart rate measurements (5).
Although POTS patients’ heart rate and fatigue index are more exaggerated than those with functional autonomic nervous systems, they are not considered to be “De-conditioned”. They are classified to have a complex orthostatic intolerance (5). Increase of exercise in POTS patients results in high increase of heart rate and lower stroke volume throughout the duration of exercise. This change stimulates the autonomic nervous systems and increases proper function. In result, orthostatic intolerance decreases. A study showing orthostatic stress response across a twenty-four hour exercise trail explored the related changes in autonomic function. This study showed the importance of maintenance of blood pressure during exercise due to the volume of exercise and cardio-vascular stress interference. For that reason, doctors calculate individual target heart rates and recommend the use of a heart strap while exercising to increase maximum benefits in recovery rate.
An example of autonomic nervous system challenge is shown in a study done in the Andean mountains. Participants involved showed a greater adaptation capacity to high altitude environment. This study showed the body’s ability to train to harsh conditions which improved their recovery process (3). There autonomic capacity was higher than those who trained in less harsh conditions. As discussed earlier, POTS patients are not “de-conditioned”. Therefore the challenging high intensity aerobic training principle applies and is key to faster recovery. However, post exercise studies have shown a delay in heart rate recovery in POTS patients, compared to the average population with a difference of five minutes and blood pressure of 125+/-16 versus 117+/-17bpm (5). There are days where workouts will be overcome with orthostatic symptoms in victims of POTS. However, the patient is encouraged to complete the workout at a moderate rate for the purpose of ensured recovery and decrease changes of backtracking.
Research has shown that all together the long term damage done to the body in result of the combination of psychological and physical stressors, results in the energy taxing autonomic dysfunction. The loss of sensitivity to stimuli decreases autonomic nervous systems ability to regulate blood pressure and heart rate. As a result the increase of abnormal heart rate in response to exercise creates a viscous cycle of exercise intolerance. Compared to the average population POTS patients not only have to train their body for health, but have to “re-train” what should already be a natural involuntary system.
Although the average Americans exercise recommendations for health and wellness differ from that of POTS patients, the same training principles of duration, intensity and overloading still apply. Dr. Manfridini famously stated that “There may never be one pill to replace all the health benefits of exercise”. Exercise can be considered as a cornerstone therapy for the prevention, treatment and control of stress related conditions; requiring motivation by both the patient and physician (4). Albert Einstein’s idea of letting a man “but burn with enough intensity, and he will set fire tot he world” could be encompassed, POTS patients could once again remember what it feels like to live life in a body with a proper functioning involuntary autonomic nervous system.
Conclusion
It can be seen that exercise does improve wellness. Among the numerous studies that have been done, the testing used on participants with mood disorders, on athletes training in higher altitudes or even with those who have autonomic dysfunction have shown that the physical challenge of exercise increases good health (3,7). Doctors have rated exercise among the top non-pharmaceutical treatments for illness recovery (4). Showing there to be no detrimental harm in regards to intensity through these studies, but positive health related benefits. Duet to the positive linear relationship among health benefits and exercise, doctors have made anaerobic and aerobic activity a key part of their treatment plans for their patients suffering from Postural Orthostatic Tachycardia Syndrome or in other terms, autonomic dysfunction. In combination with low stress environments, the proper diet, adequate amounts of sleep and routine workouts involving target heart rates together have been shown to speed up recovery (2,6).
To a patient with autonomic dysfunction, the symptoms of light headedness, high resting heart rate and orthostatic intolerance is adjusted to average healthy measures through the prescribed treatment plans (1,8). Whether de-conditioned or conditioned the physical stress resulting form exercise tricks the patient’s body in functioning properly (5). Over time, by maintaining the prescribed target heart rate during routine aerobic activity, there is a decrease in rate pressure product resulting in less fatigue and an increase in orthostatic tolerance. All supporting the suggestion that the quality and/or intensity of exercise really does determine the quality of recovery.
References
- Postural Orthostatic Tachycardia Syndrome: A Clinical Review
- Teens & Autonomic Dysfunction
- Autonomic Adaption’s in Andean Trained Participants to A 4220-m Altitude Marathon
- Sport Therapy for Hypertension: Why, How and How Much?
- Exercise Performance in Adolescents with Autonomic Dysfunction
- The Influence of Caffeine on Voluntary Muscle Activation
- Effects of Acute Exercise on Mood and Well-Being in Patients with Major Depressive Disorder
- Mechanisms of Orthostatic Intolerance Following Very Prolonged Exercise
- Mood and Transient Cardiac Dysfunction in Everyday Life
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