Monitoring of post-exercise dynamics of cardiovascular parameters in children: for coaches and physicians Nataliya Pankova, Eugeniya Bogdanova, Mikhail Karganov Moscow Institute of Open Education, Institute of General Pathology and Pathophysiology under the Russian Academy of Medical Sciences, Russia

Equipment Respiration (ml) ECG Blood Pressure (mmHg) Time (sec) Spiro Arterio Cardio Rhythmograph Spectrum of Heart Rate Variability Spectrum of Blood Pressure Variability (systolic and diastolic) Spectrum of Respiration (air velocity) Parameters: Total Power, absolute and relative power of VLF, LF and HF ranges (ms2, mmHg2, l/m2)

BaroReflex Sensitivity (direct measurement) Spontaneous baroreflex up mean down Calculated BRS BPs (mmHg) RR (msec)

Stroke Volume (indirect assessment) The classical methods of SV measurement are based on Fick's principle (1870), according to which cardiac output is proportional to the arterio-venous oxygen content difference [Ehlers K.C. et al., Cardiac output measurements. A review of current techniques and research, Annals of Biomedical Engineering, 1986, vol. 14, p. 219.] Noninvasive methods of SV measurements are more preferable for children, e.g. the method based on Kubicek's formula for impedance cardiography allowing evaluation of SV from the pulse wave parameters [Kubicek W.G. et al. Impedance cardiography as a noninvasive means to monitor cardiac function, J. Assoc. Adv. Med. Instrum., 1970, vol. 4, no., p. 79.] Another approach is SV calculation by two-dimensional reconstruction from the parameters of averaged ECG [Kim T.H. et al. Two-phase reconstruction for the assessment of left ventricular volume and function using retrospective ECG-gated MDCT: comparison with echocardiography, Am. J. Roentgenol., 2005, vol. 185, no. 2, p. 319. ].

Evaluated parameters Tidal volume at rest, vital capacity and index Tiffno (optional testing after regular records). Mean, maximum, and minimum values of systolic and diastolic Blood Pressure (BP), standard parameters of BPs and BPd variability spectra (TP, VLF, LF, HF). Amplitude-time parameters of cardiac complex (average data of all complexes occurring in the current ECG record) with following calculation of end-systolic, end-diastolic, and stroke volumes (SV), and cardiac output (CO). Mean, maximum, and minimum values of Heart Rate (HR) (R-R interval duration), standard parameters of HR variability (TP, VLF, LF, HF), with following calculation of indices of autonomic balance AB = LF/HF, and stress index. Baroreflex sensitivity (BRS). In our study, functional capacities of the cardiovascular system were evaluated by the degree of changes (reactivity) in various parameters after physical load in comparison with testing before it.

Exercise tests Warm-up running at the physical education class at school (nonathletic schoolchildren): 14-15 min with final HR 160 strokes in minute, =moderate physical load Martinet test (young figure skaters): 20 sit-ups in 30 seconds with final HR 125 strokes in minute, =moderate physical load Short program (young figure skaters): 2 min 30 sec ± 10 sec with the same set of required elements with final HR 195-210 strokes in minute, =submaximal physical load For evaluation of reactivity of the parameters during exercise test, they were measured for 2-min in the sitting position before and immediately after the exercise.

Design of Experiment Nonathletic schoolchildren Young figure skaters HR 160/min Background record Testing record SACR adjustment (30 sec) SACR adjustment (30 sec) SACR record (120 sec) moderate physical exercise (warm-up running at school lesson) approaching (20-30 sec) SACR record (75 sec) HR 125/min Young figure skaters moderate physical exercise (Martinet test) SACR record (120 sec) HR 195-210/min submaximal physical exercise (performance of a short program) SACR record (120 sec)

Subjects characteristics Physical load: 14 pupils of Moscow general education school (9 boys and 5 girls at the age of 9-10 years), control group of nonathletic schoolchildren 14 young figure skaters (7 girls and 7 boys at the age of 8-14 years), "Candidate Master" or "Master of Sports" qualification degree Monitoring (2010-2013, 7 points): 35 young figure skaters (22 girls and 13 boys at the age of 8-14 years) In accordance with The Universal Declaration on Bioethics and Human Rights Articles 5, 6 and 7, all tests were carried out only with the consent of the children and their parents (or legal representatives).

Heart Rate delta, %

Stroke Volume delta, %

Baroreflex Sensitivity delta, %

Dynamics of the cardiovascular system parameters of young figure skaters for 36 months (2010-2013) Testing at rest in sitting position: HR (and CO) decrease Increase in TP of HRV spectrum and in absolute power of all ranges of the spectrum without changing their relative magnitudes BPs increase Stress-index decrease =physiological laws of development

Dynamics in degree of changes (reactivity) of cardiovascular system parameters after physical load Stroke volume BPd range 1 – spring, 2 - autumn

(continuation) Stress-index R-R range 1 – spring, 2 - autumn

Parameters of the cardiovascular system in 2 examinees of the same gender and age with different exercise intensification prognosis: before and after short program performance and changes in the parameters in %. Gender, age f, 10 years prognosis positive negative   before after  (%) Heart rate, stroke/min 84.39 92.45 9.55 91.05 133.60 46.74 Stroke volume, ml 58.9 56.7 –3.74 52.0 48.2 –7.31 Minute volume, l/min 5.0 5.2 4.00 4.7 6.0 27.66 RR range, ms 383 463 20.89 410 67 –83.66 Total spectral power TPHR, ms2 8074 9745 20.69 6585 219 –96.67 VLFHR range power, ms2 795 1268 59.43 938 144 –84.67 Relative VLFHR range power, % 9.85 13.01 32.10 14.25 65.68 360.91 LFHR range power, ms2 1960 1500 –23.48 1289 60 –95.38 Relative LFHR range power, % 24.28 15.39 –36.60 19.58 27.20 38.95 HFHR range power, ms2 5319 6978 31.18 4358 16 –99.64 Relative HFHR range power, % 65.88 71.60 8.69 66.17 7.12 –89.24 Autonomic balance, LFHR/HFHR 0.37 0.21 –41.67 0.30 3.82 1191.46 Stress index 52.3 39.61 –24.26 46.83 1121.33 2294.47 BPS, mmHg 99.74 108.34 8.62 122.45 116.00 –5.27 BPS range, mmHg 40 46 15.00 21 29 38.10 BPD, mmHg 66.31 78.19 17.92 64.87 75.00 15.62 BPD range, mmHg 18 25 38.89 –11.11 Baroreflex sensitivity, ms/mmHg 20.1 31.5 56.72 28.7 5.1 –82.23

Nataliya Pankova Moscow Institute of Open Education, Institute of General Pathology and Pathophysiology under the Russian Academy of Medical Sciences, Russia nbpankova@gmail.com Free full text Pankova N.B., Bogdanova E.V., Lubina B.G., Eygel M.Ya., Karganov M.Yu. Evaluation of Cardiovascular System’s Functional Reserves in Young Figure Skaters // Polysystemic approach to school, sport and environment medicine / Ed. M.Karganov. – USA, Henderson: OMICS Group, 2013. – URL: http://www.esciencecentral.org/ebooks/polysystemic-approach/evaluation-cardiovascular.php