Effects of Upper and Lower Cervical Spinal Manipulative Therapy on Blood Pressure and Heart Rate Variability in Volunteers and Patients With Neck Pain: A Randomized Controlled, Cross-Over, Preliminary Study

Abstract Background Recent experimental research has suggested that spinal manipulative therapy (SMT) may reduce pain through modulation of the ascending pain signals and/or the central pain-regulating mechanisms. People with persistent neck pain (NP) have also been found to have disturbances in autonomic nervous system (ANS) regulation. A common way to study the ANS is to measure heart rate variability (HRV). It is not known whether deviations in HRV are related to changes in pain perception or to the treatment response to SMT. Commonly, an individual in pain will experience pain reduction when exposed to a second pain stimulus, a mechanism known as conditioned pain modulation (CPM). Patients with persistent pain have been found to have a reduced CPM reaction. It is not known whether this is predictive of treatment response to SMT. The aim of the study is to examine the effects of SMT on HRV and pain. Further, a secondary aim is to test whether a CPM test can be used to predict treatment response in a population of patients with recurrent and persistent NP. Method/design A multicentre randomized controlled clinical trial will be carried out in multidisciplinary primary care clinics. This setting is chosen to minimize bias resulting from patient preference for the treatment modality and provider. The subjects are either self-referred or referred from other health care practitioners locally. The treatment modalities are two well-known interventions for NP; SMT and stretching exercises compared to stretching exercises alone. HRV will be measured using a portable heart monitor. The subjective pain experience will be investigated by assessing pain intensity and the affective quality of pain. CPM will be measured with a standardized cold pressor test. Measurements will be performed three times during a 2-week treatment series. Discussion The study will utilize normal clinical procedures, which should aid the transferability and external validity of the results. The study will provide knowledge regarding the underlying mechanisms of the effects of SMT. Furthermore, the study will examine whether a CPM test is predictive of treatment outcome in a population of patients with recurrent and persistent NP. Trial registration ClinicalTrials.gov, NCT03576846. Registered on 3 July 2018.

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The effect of spinal manipulative therapy and home stretching exercises on heart rate variability in patients with persistent or recurrent neck pain: a randomized controlled trial

Chiropractic & Manual Therapies ◽

10.1186/s12998-021-00406-0 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Anders Galaasen Bakken ◽

Andreas Eklund ◽

David M. Hallman ◽

Iben Axén

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Neck Pain ◽

Intervention Group ◽

Spinal Manipulative Therapy ◽

The Other ◽

Control Group ◽

Manipulative Therapy ◽

Randomized Controlled ◽

Stretching Exercises

Abstract Background Persistent or recurrent neck pain is, together with other chronic conditions, suggested to be associated with disturbances of the Autonomic Nervous System. Acute effects on the Autonomic Nervous System, commonly measured using Heart Rate Variability, have been observed with manual therapy. This study aimed to investigate the effect on Heart Rate Variability in (1) a combination of home stretching exercises and spinal manipulative therapy versus (2) home stretching exercises alone over 2 weeks in participants with persistent or recurrent neck pain. Methods A randomized controlled clinical trial was carried out in five multidisciplinary primary care clinics in Stockholm from January 2019 to April 2020. The study sample consisted of 131 participants with a history of persistent or recurrent neck. All participants performed home stretching exercises daily for 2 weeks and were scheduled for four treatments during this period, with the intervention group receiving spinal manipulative therapy in addition to the home exercises. Heart Rate Variability at rest was measured at baseline, after 1 week, and after 2 weeks, with RMSSD (Root mean square of successive RR interval differences) as the primary outcome. Both groups were blinded to the other group intervention. Thus, they were aware of the purpose of the trial but not the details of the “other” intervention. The researchers collecting data were blinded to treatment allocation, as was the statistician performing data analyses. The clinicians provided treatment for participants in both groups and could not be blinded. A linear mixed-effects model with continuous variables and person-specific random intercept was used to investigate the group-time interaction using an intention to treat analysis. Results Sixty-six participants were randomized to the intervention group and sixty-five to the control group. For RMSSD, a B coefficient of 0.4 (p value: 0.9) was found, indicating a non-significant difference in the regression slope for each time point with the control group as reference. No statistically significant differences were found between groups for any of the Heart Rate Variability indices. Conclusion Adding four treatments of spinal manipulation therapy to a 2-week program of daily stretching exercises gave no significant change in Heart Rate Variability. Trial Registration: The trial was registered 03/07/2018 at ClinicalTrials.gov, registration number: NCT03576846. (https://pubmed.ncbi.nlm.nih.gov/31606042/)

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The effect of Spinal Manipulative Therapy on Heart Rate Variability and pain in patients with chronic neck pain: A Randomized Controlled trial

10.21203/rs.2.9454/v1 ◽

2019 ◽

Author(s):

Anders Galaasen Bakken ◽

Iben Axén ◽

Andreas Eklund ◽

Sören O'neill

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Neck Pain ◽

Treatment Response ◽

Spinal Manipulative Therapy ◽

Pain Modulation ◽

Manipulative Therapy ◽

Randomized Controlled ◽

Second Pain ◽

Stretching Exercises

Abstract Background Recent experimental research has suggested that Spinal Manipulative Therapy (SMT) may reduce pain through modulation of the ascending pain signals and/or the central pain regulating mechanisms. People with persistent neck pain (NP) have also been found to have disturbances in Autonomic Nervous System (ANS) regulation. A common way to study ANS is to measure heart rate variability (HRV). It is not known if deviations in HRV are related to changes in pain perception or to the treatment response to SMT. Commonly, an individual in pain will experience pain reduction when exposed to a second pain stimulus, a mechanism known as Conditioning Pain Modulation (CPM). Patients with persistent pain have been found to have a reduced CPM reaction. It is not known if this is predictive of treatment response to SMT. The aim of the study is to examine the effects of SMT on HRV and pain and to test if a CPM test can be used to predict treatment response, in a population of patients with recurrent and persistent NP. Method/Design A multicentre randomized controlled clinical trial will be carried out in multidisciplinary primary care clinics. This setting is chosen to minimize bias resulting from patient preference to treatment modality and provider. The subjects are either self-referred or referred from other health care practitioners locally. The treatment modalities are two well-known interventions for NP; SMT and stretching exercises compared to stretching exercises alone. The subjective pain experience will be investigated by assessing pain intensity and the affective quality of pain. HRV will be measured using a portable heart monitor and CPM will be measured with a standardized cold-pressor-test. Measurements will be performed at baseline, prior to the third treatment and after the fourth treatment. Discussion The study will utilize normal clinical procedures, which should aid transferability and external validity of the results. The study will provide knowledge regarding the underlying mechanisms of the effects of SMT. Furthermore, the study will examine if a CPM test is predictive of treatment outcome in a population of patients with recurrent and persistent NP.

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The effect of Spinal Manipulative Therapy on Heart Rate Variability and pain in patients with chronic neck pain: A Randomized Controlled trial

10.21203/rs.2.9454/v3 ◽

2019 ◽

Author(s):

Anders Galaasen Bakken ◽

Andreas Eklund ◽

Sören O'neill ◽

Iben Axén

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Neck Pain ◽

Treatment Response ◽

Spinal Manipulative Therapy ◽

Pain Modulation ◽

Manipulative Therapy ◽

Randomized Controlled ◽

Second Pain ◽

Stretching Exercises

Abstract Background Recent experimental research has suggested that Spinal Manipulative Therapy (SMT) may reduce pain through modulation of the ascending pain signals and/or the central pain regulating mechanisms. People with persistent neck pain (NP) have also been found to have disturbances in Autonomic Nervous System (ANS) regulation. A common way to study ANS is to measure heart rate variability (HRV). It is not known if deviations in HRV are related to changes in pain perception or to the treatment response to SMT. Commonly, an individual in pain will experience pain reduction when exposed to a second pain stimulus, a mechanism known as Conditioning Pain Modulation (CPM). Patients with persistent pain have been found to have a reduced CPM reaction. It is not known if this is predictive of treatment response to SMT. The aim of the study is to examine the effects of SMT on HRV and pain and to test if a CPM test can be used to predict treatment response, in a population of patients with recurrent and persistent NP. Method/Design A multicentre randomized controlled clinical trial will be carried out in multidisciplinary primary care clinics. This setting is chosen to minimize bias resulting from patient preference to treatment modality and provider. The subjects are either self-referred or referred from other health care practitioners locally. The treatment modalities are two well-known interventions for NP; SMT and stretching exercises compared to stretching exercises alone. The subjective pain experience will be investigated by assessing pain intensity and the affective quality of pain. HRV will be measured using a portable heart monitor and CPM will be measured with a standardized cold-pressor-test. Measurements will be performed at baseline, prior to the third treatment and after the fourth treatment. Discussion The study will utilize normal clinical procedures, which should aid transferability and external validity of the results. The study will provide knowledge regarding the underlying mechanisms of the effects of SMT. Furthermore, the study will examine if a CPM test is predictive of treatment outcome in a population of patients with recurrent and persistent NP.

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The effect of Spinal Manipulative Therapy on Heart Rate Variability and pain in patients with chronic neck pain: A Randomized Controlled trial

10.21203/rs.2.9454/v2 ◽

2019 ◽

Author(s):

Anders Galaasen Bakken ◽

Andreas Eklund ◽

Sören O'neill ◽

Iben Axén

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Neck Pain ◽

Treatment Response ◽

Spinal Manipulative Therapy ◽

Pain Modulation ◽

Manipulative Therapy ◽

Randomized Controlled ◽

Second Pain ◽

Stretching Exercises

Abstract Background Recent experimental research has suggested that Spinal Manipulative Therapy (SMT) may reduce pain through modulation of the ascending pain signals and/or the central pain regulating mechanisms. People with persistent neck pain (NP) have also been found to have disturbances in Autonomic Nervous System (ANS) regulation. A common way to study ANS is to measure heart rate variability (HRV). It is not known if deviations in HRV are related to changes in pain perception or to the treatment response to SMT. Commonly, an individual in pain will experience pain reduction when exposed to a second pain stimulus, a mechanism known as Conditioning Pain Modulation (CPM). Patients with persistent pain have been found to have a reduced CPM reaction. It is not known if this is predictive of treatment response to SMT. The aim of the study is to examine the effects of SMT on HRV and pain and to test if a CPM test can be used to predict treatment response, in a population of patients with recurrent and persistent NP. Method/Design A multicentre randomized controlled clinical trial will be carried out in multidisciplinary primary care clinics. This setting is chosen to minimize bias resulting from patient preference to treatment modality and provider. The subjects are either self-referred or referred from other health care practitioners locally. The treatment modalities are two well-known interventions for NP; SMT and stretching exercises compared to stretching exercises alone. The subjective pain experience will be investigated by assessing pain intensity and the affective quality of pain. HRV will be measured using a portable heart monitor and CPM will be measured with a standardized cold-pressor-test. Measurements will be performed at baseline, prior to the third treatment and after the fourth treatment. Discussion The study will utilize normal clinical procedures, which should aid transferability and external validity of the results. The study will provide knowledge regarding the underlying mechanisms of the effects of SMT. Furthermore, the study will examine if a CPM test is predictive of treatment outcome in a population of patients with recurrent and persistent NP.

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The effect of two weeks of spinal manipulative therapy and home stretching exercises on pain and disability in patients with persistent or recurrent neck pain; a randomized controlled trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04772-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Anders Galaasen Bakken ◽

Andreas Eklund ◽

Anna Warnqvist ◽

Søren O’Neill ◽

Iben Axén

Keyword(s):

Neck Pain ◽

Treatment Effect ◽

Intervention Group ◽

Spinal Manipulative Therapy ◽

Control Group ◽

Manipulative Therapy ◽

Randomized Controlled ◽

Neck Disability ◽

Stretching Exercises

Abstract Background Recurrent or persistent neck pain affects a vast number of people globally, leading to reduced quality of life and high societal costs. Clinically, it is a difficult condition to manage, and treatment effect sizes are often moderate at best. Activity and manual therapy are first-line treatment options in current guidelines. We aimed to investigate the combination of home stretching exercises and spinal manipulative therapy in a multicentre randomized controlled clinical trial, carried out in multidiscipline ary primary care clinics. Methods The treatment modalities utilized were spinal manipulative therapy and home stretching exercises compared to home stretching exercises alone. Both groups received 4 treatments for 2 weeks. The primary outcome was pain, where the subjective pain experience was investigated by assessing pain intensity (NRS − 11) and the quality of pain (McGill Pain Questionnaire). Neck disability and health status were secondary outcomes, measured using the Neck Disability Indexthe EQ-5D, respectively. One hundred thirty-one adult subjects were randomized to one of the two treatment groups. All subjects had experienced persistent or recurrent neck pain the previous 6 months and were blinded to the other group intervention. The clinicians provided treatment for subjects in both group and could not be blinded. The researchers collecting data were blinded to treatment allocation, as was the statistician performing data analyses. An intention-to-treat analysis was used. Results Sixty-six subjects were randomized to the intervention group, and sixty-five to the control group. For NRS − 11, a B-coefficient of − 0,01 was seen, indication a 0,01 improvement for the intervention group in relation to the control group at each time point with a p-value of 0,305. There were no statistically significant differences between groups for any of the outcome measures. Conclusion Based on the current findings, there is no additional treatment effect from adding spinal manipulative therapy to neck stretching exercises over 2 weeks for patients with persistent or recurrent neck pain. Trial registration The trial was registered 03/07/2018 at ClinicalTrials.gov, registration number: NCT03576846.

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Effects of Daily Intake of Almonds on Cardiac Autonomic Functions Measured by Heart Rate Variability in Response to Acute Stress: A Randomized Controlled Trial

Current Developments in Nutrition ◽

10.1093/cdn/nzaa040_020 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 20-20

Author(s):

Vita Dikariyanto ◽

Leanne Smith ◽

May Robertson ◽

Eslem Kusaslan ◽

Molly O'Callaghan-Latham ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Heart Rate Variability ◽

Mental Stress ◽

Autonomic Function ◽

Acute Stress ◽

Physical Stress ◽

Cardiometabolic Health ◽

Cardiac Autonomic Function ◽

Randomized Controlled

Abstract Objectives Stress is inversely associated with heart rate variability (HRV), an indicator of cardiac autonomic function and a predictor of risk of sudden cardiac death. At times of stress, people tend to favor high sugar and fatty foods, often as snacks, with potential adverse effects on cardiometabolic health. Dietary recommendations for cardiovascular disease (CVD) prevention emphasize fruits, vegetables, wholegrains and nuts. There is evidence that consumption of nuts can reduce LDL cholesterol and blood pressure and help with weight management, however the impact of nuts on HRV in response to stress is unknown. The ATTIS dietary intervention study investigated the HRV response to acute stress following 6-week substitution of almonds for typical snacks high in refined starch, free sugars and saturated fats, and low in fibre. The study population comprised adults aged 30–70 y, who were habitual snack consumers, and at moderate risk of developing CVD. It was hypothesized that snacking on almonds would increase HRV during stress tasks, when HRV is expected to be reduced due to increased sympathetic activity. Methods A 6-week randomized controlled parallel trial was conducted. Participants were randomized to 1) control snacks (mini-muffins formulated to follow the average UK snack nutrient profile), or 2) dry-roasted whole almonds, both providing 20% estimated energy requirement. Supine HRV was measured (Mega Electronics Emotion Faros 180°, 2-leads wearable ECG-HRV monitor) during resting (5 min), physical stress (blood pressure monitor cuff inflation 200 mmHg, 5 min) and mental stress (Stroop colour-word test, 5 min) tasks pre- and post-intervention. A total of 105 participants (73 females and 32 males; mean age 56.2 y, SD 10.4) completed the trial. Results Almonds significantly increased the beat-to-beat HRV parameter, high-frequency power, during the mental stress test (mean difference 124 ms2; 95% CI 11, 237; P = 0.031) relative to control, indicating increased parasympathetic regulation. There were no treatment effects during resting and the physical stress task. Conclusions Snacking on whole almonds as a replacement for typical snacks increases HRV during mental stress, indicating an increased resilience in cardiac autonomic function and a novel mechanism whereby nuts may be cardioprotective. Funding Sources Almond Board of California.

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The influence of low-intensity resistance training combined with neuromuscular electrical stimulation on autonomic activity in healthy adults: A randomized controlled cross-over trial

Hong Kong Physiotherapy Journal ◽

10.1142/s1013702521500013 ◽

2020 ◽

pp. 1-9

Author(s):

Toshiki Kutsuna ◽

Hitoshi Sugawara ◽

Hideaki Kurita ◽

Satomi Kusaka ◽

Tetsuya Takahashi

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Heart Rate Variability ◽

Electrical Stimulation ◽

Neuromuscular Electrical Stimulation ◽

Cardiovascular Responses ◽

Healthy Adults ◽

Autonomic Activity ◽

Low Intensity ◽

Randomized Controlled

Background: Low-intensity resistance training (RT) combined with neuromuscular electrical stimulation (NMES) is one method of exercise to improve the deterioration of physical function. However, it is unclear whether low-intensity RT combined with NMES (RT + NMES) can be safely implemented. Objective: This study aimed to examine the influence of low-intensity RT + NMES on autonomic activity and cardiovascular responses in healthy adults. Methods: This study was an open-label, randomized controlled cross-over trial. The exercise intensity of isometric knee extension RT was set to 40% of the maximum voluntary contraction (peak torque). NMES was adjusted to a biphasic asymmetrical waveform with the frequency maintained at 50 Hz and a phase duration of 300 [Formula: see text]s. The difference in the change in autonomic activity and cardiovascular responses was compared by assessing heart rate variability, blood pressure, and heart rate during RT and [Formula: see text]. Results: Twenty healthy male college students (mean age [Formula: see text] years) participated in this study. The ratio of low- and high-frequency components of heart rate variability, systolic blood pressure, and heart rate increased during exercise in the RT and [Formula: see text] sessions ([Formula: see text]). There were no significant differences in autonomic activity and cardiovascular responses throughout the sessions during RT and [Formula: see text]. Conclusion: In conclusion, our results demonstrated that low-intensity [Formula: see text] was safe and did not induce excessive autonomic and cardiovascular responses in healthy adults.

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