Heart rate variability in relation to the menstrual cycle in trained and untrained women

Inaugural dissertation

to attain the academic degree

Submitted
At the 26th of August 2004
At the Philosophical Faculty IV
Institute of Sports Science of the Humboldt University of Berlin

By
Spielmann, Nadine
Date of Birth: 3rd of May 1975
Native place: Niedererlinsbach, Switzerland

President of the Humboldt University of Berlin
Prof. Dr. Mlynek, Jürgen

Dean:
Dean of the Philosophical Faculty
Prof. Dr. phil. Benner, Dietrich

Gutachter:
1. Prof. Dr. med. Roland Wolff
2. Prof. Dr. med. Niklaus Friederich
3. PD Dr. med. Andreas Patzak

Date of viva voce: 16th of December 2004

Dedication:

……………dedicated to my father.

Table of contents

• 1 Introduction
• 2 Theory
  • 2.1 Physiology
    • 2.1.1 The autonomic nervous system
    • 2.1.2 The cardiovascular system
    • 2.1.3 Electrocardiogram
    • 2.1.4 The vegetative control of the heart
  • 2.2 Physiology of the rhythm derivation
  • 2.3 Measurement of HRV
    • 2.3.1 Time Domain
    • 2.3.2 Frequency Domain
      • 2.3.2.1 Frequency domain parameters in absolute values
      • 2.3.2.2  Frequency domain parameters in normalized units
  • 2.4 Physiological interpretation of HRV
    • 2.4.1 HF power and parasympathetic activity
    • 2.4.2 LF power and sympathetic activity
    • 2.4.3 Orthostatic test
    • 2.4.4  Influence of respiration
  • 2.5 Effect of physical activity on HRV
    • 2.5.1 Physical activity affecting the cardiovascular system
    • 2.5.2 Exercise induced HRV changes
      • 2.5.2.1 HRV in sedentary subjects and athletes
    • 2.5.3 Training interventions and HRV
      • 2.5.3.1  Short time interventions
      • 2.5.3.2 Long time interventions
    • 2.5.4 Summary
  • 2.6 Physiological differences of genders
    • 2.6.1 Menstrual cycle
    • 2.6.2 Basal body temperature
    • 2.6.3 Respiratory response
    • 2.6.4  Hormonal fluctuation in men
  • 2.7  Effect of menstrual cycle on HRV
    • 2.7.1 HRV in relation to the menstrual cycle
  • 2.8  Mood state control
    • 2.8.1 Mood state during the menstrual cycle
    • 2.8.2 Profile of mood state (POMS)
  • 2.9  Derivation of the question
    • 2.9.1 Control parameters
• 3 Methods
  • 3.1 Experimental design
  • 3.2 Subjects
  • 3.3  Study days of men and women
  • 3.4  Procedure
  • 3.5 Analysis
    • 3.5.1 Blood borne parameters and electrolytes
      • 3.5.1.1 Analysis of the electrolytes
    • 3.5.2 Hormonal analysis
      • 3.5.2.1 Analysis of the hormones
      • 3.5.2.2 Intra- and interassay variance
  • 3.6 Recording of electrocardiograms
    • 3.6.1  Electrocardiogram
    • 3.6.2 Breathing frequency
    • 3.6.3 Spiroergometric tests
      • 3.6.3.1 Protocol of bicycle ergometric test
      • 3.6.3.2 Treadmill testing
      • 3.6.3.3 Ventilation recording
  • 3.7 Statistical evaluation
    • 3.7.1 Profile of mood states
    • 3.7.2 Heart rate variability
    • 3.7.3 Reliability
• 4 Results
  • 4.1 Profile of mood state
  • 4.2  Blood borne parameters
    • 4.2.1 Monitoring of the menstrual cycle
    • 4.2.2 Monitoring of hormonal fluctuation in men
    • 4.2.3  Glucose and insulin concentration
    • 4.2.4 Electrolyte concentration and blood count
  • 4.3  Breathing frequency
  • 4.4  Heart rate variability
    • 4.4.1 Heart rate variability at rest
      • 4.4.1.1 Time Domain
      • 4.4.1.2 Frequency Domain
    • 4.4.2 Heart rate variability during the menstrual cycle
      • 4.4.2.1 Time domain
      • 4.4.2.2  Frequency domain
    • 4.4.3  Heart rate variability during the orthostatic test
      • 4.4.3.1 Time Domain
      • 4.4.3.2 Frequency Domain
    • 4.4.4  Orthostatic test during the menstrual cycle
      • 4.4.4.1 Time domain
      • 4.4.4.2 Frequency domain
  • 4.5 Regression and correlation
  • 4.6  Reliability
• 5 Discussion
  • 5.1  Profile of mood state
  • 5.2 Blood borne parameters
    • 5.2.1 Monitoring of the menstrual cycle
    • 5.2.2 Monitoring of hormonal fluctuation in men
    • 5.2.3 Glucose and insulin concentration
    • 5.2.4  Electrolytes and blood count
  • 5.3 Heart rate variability at rest
    • 5.3.1 Heart rate variability affected by the breathing frequency
    • 5.3.2  Heart rate variability and individual training pattern
    • 5.3.3 Summary
  • 5.4 Heart rate variability during the menstrual cycle
  • 5.5  HRV during the orthostatic test
    • 5.5.1 Orthostatic test in athletes and sedentary subjects
    • 5.5.2 Orthostatic test during the menstrual cycle
    • 5.5.3 Summary
  • 5.6 Reliability
  • 5.7  Critics of the method
  • 5.8  Applicable consequences in sports medicine
  • 5.9 Future prospective
• 6 Summary
• Literature
• A Abbreviations
• B Appendix
  • Intragroup correlation coefficient in the time domain
  • Intragroup correlation coefficient in the frequency domain
• SPECIAL THANKS TO

Tables

• Table 2-1: The orthostatic test presented in three different analysis steps based on data of the present study
• Table 3-1: Anthropometrical data of volunteers separated into 4 subgroups
• Table 3-2: Anamnesis of training data including training age in years (TAge), training sessions per week (TSpweek) and training units per week in hours (TUpweek)
• Table 4-1: Breathing frequency (BF) of men and women
• Table 4-2: Breathing frequency in course of the menstrual cycle in trained and untrained women
• Table 4-3: Time domain parameters of trained and untrained men with its significance level (p-value)
• Table 4-4: Time domain parameters of trained and untrained women with its significance level (p-value)
• Table 4-5: Frequency domain parameters of trained and untrained men with its significance level (p-value)
• Table 4-6: Frequency domain parameters of trained and untrained women with its significance level (p-value)
• Table 4-7: LFnu, HFnu and LF/HF ratio in trained and untrained men and its significance level (p-value)
• Table 4-8: LFnu, HFnu and LF/HF ratio in trained and untrained women
• Table 4-9: Intergroup correlations coefficient (ICC) of trained and untrained men as well as of all men
• Table 4-10: Coefficient of variation (CV) of trained and untrained as well as of all men

Images

• Figure 2-1: Illustration of the pulmonary and the systemic circulation (data modified from [77])
• Figure 2-2: Conduction system of the heart (frontal tomogram modified from [77])
• Figure 2-3: Part of an ECG recording of our study which presents the single segments classified by letters
• Figure 2-4: Steps in the analysis of the HRV
• Figure 2- 5 : Feedback control system of the hypothalamus, the hypophysis and the ovary (modified from [77])
• Figure 4-1: Similar profiles of mood state (POMS) separated into depression, fatigue, vigor and anger (subscales of the POMS) in the pre and the test month of women; no significance was noted
• Figure 4-2: Overall score of POMS in pretest and test month of women compared with men; overall scores were not significantly different in men and women
• Figure 4-3: LH and FSH concentration all women; LH and FSH peaks are noted around the ovulation day (O)
• Figure 4-4: P and E2 concentration of all women during five phases of the menstrual cycle; E2 peak around ovulation (O) combined with a constant increase of P
• Figure 4-5: INS concentrations of trained and untrained men and women during the study; lower INS levels in trained and higher ones in untrained subjects were noted
• Figure 4-6: BG of athletes and sedentary men and women during the study; similar levels were noted in athletes and sedentary subjects
• Figure 4-7: The stable course of the Hc of men and women in % during one month i.e. one menstrual cycle; women have higher Hc (lower %) than men
• Figure 4-8: Similar Ca+ levels in men and women during one month; no menstrual cycle related fluctuations were noted
• Figure 4-9: Cl-levels of men and women in course of one menstrual cycle; no differences were noted
• Figure 4-10: Similar K+ concentrations of male and female subjects during five study days
• Figure 4-11: No significant difference was noted in Na+ levels between men and women and during the study
• Figure 4-12: Mg²+concentration in men and women without any significant differences between genders and in course of the study month
• Figure 4-13: Breathing frequency was significantly lower in trained than in untrained men (p<0.001) without any significance in course of the study
• Figure 4-14: The median of the breathing frequency of untrained women was significantly lower compared with trained women (p<0.01); still the athletes showed significantly enhanced BF in MidL (p<0.05) a in PreM (p<0.05) compared to M whereas the untrained women did not show any significance in course of the menstrual cycle
• Figure 4-15: The course of the meanNN during the menstrual cycle was similar in both groups; no significance was noted
• Figure 4-16: The course of the SDNN was not significantly different between athletic and sedentary females during the five menstruation phases
• Figure 4-17: The course of the RMSSD was similar in both groups; no significance was noted
• Figure 4-18: The course of pNN50 was not significantly different in trained and untrained women during the menstrual cycle
• Figure 4-19: The course of the TP was not significantly different in trained and untrained women during the menstrual cycle
• Figure 4-20: The course of the VLF was similar in both groups during the five menstruation phases
• Figure 4-21: The course of the LF power was the same in both groups; no significance was noted during one menstrual cycle
• Figure 4-22: The course of the HF power was not significantly different in athletic and sedentary women throughout the five menstruation phases
• Figure 4-23: The course of the LFnu was similar in both female groups; no significance was noted during one menstrual cycle
• Figure 4-24: The course of the HFnu was not significantly different in trained and untrained women during the menstrual cycle
• Figure 4-25: The course of the LF/HF ratio was similar in athletic and sedentary females; no significance was noted during the five menstruation phases
• Figure 4-26: MeanNN during the orthostatic tests in trained and untrained men and women; no significance was noted between the groups
• Figure 4-27: SDNN during the orthostatic tests was not significantly different in athletic and sedentary men and women
• Figure 4-28: RMSSD during the orthostatic tests was similar in all groups; no significance was noted
• Figure 4-29: pNN50 during the orthostatic tests in trained and untrained men and women without any significant difference between the groups
• Figure 4-30: The TP during the orthostatic tests decreased while standing and increased in supine position in all groups whereas the TP of trained and untrained women decreased and increased more significantly compared with men (for athletes p<0.05, for sedentary subjects p<0.01)
• Figure 4-31: The VLF was not significantly different between male and female athletes whereas the VLF reacted opposite in the sedentary group; while standing the VLF increased in untrained men and decreased in womenwhich resulted in a significantly different course of VLF (p<0.05)
• Figure 4-32: The LF power was increased while standing and remained enhanced in supine position in athletic and sedentary men whereas the LF power of women decreased while standing and increased in supine position; thus the LF power was significantly different in athletes (p<0.001) and in sedentary subjects (p<0.001).
• Figure 4-33:The HF power was similar in all groups with a decrease while standing and an increase in supine position; no significant difference was noted
• Figure 4-34: The LFnu was not significantly different in athletes and sedentary men and women; while standing the LFnu increased and decreased in supine position
• Figure 4-35: The HFnu reacted in the opposite way and was increased in supine position and decreased while standing in all groups; no significant difference was noted
• Figure 4-36: The LF/HF ratio decreased while standing and increased in supine position whereas the male athletes had a significantly higher increase and decrease compared with the female athletes (p<0.05); the sedentary groups were not significantly different
• Figure 4-37: The meanNN during the orthostatic test was similar five times; no significant difference was noted during the menstrual cycle in women
• Figure 4-38: The SDNN during the orthostatic test was not significantly different in course of the menstrual cycle in women
• Figure 4-39: The RMSSD during the orthostatic test reacted similarly during the five menstrual cycle phases in women; no significant difference was noted
• Figure 4-40: The pNN50 was not significantly different throughout the five menstrual cycle phases in women
• Figure 4-41: The TP during the orthostatic test was similar five times in women; no significant difference was noted
• Figure 4-42: The VLF during the orthostatic test was not significantly different throughout one menstrual cycle in women
• Figure 4-43: The LF power during the orthostatic test was similar in all menstrual cycle phases; the results were not significantly different between the five days
• Figure 4-44: The HF power during the orthostatic test was not significantly different in five menstruation phases in women
• Figure 4-45: The LFnu during the orthostatic test was similar in course of the menstrual cycle; no significant difference was noted between the five study days in women
• Figure 4-46: The HFnu during the orthostatic test was not significantly different throughout one menstrual cycle in women
• Figure 4-47: The LF/HF ratio during the orthostatic test was not significantly different in five study days in course of the menstrual cycle in women
• Figure 4-48: Bland-Altman plot of pNN50 with an acceptable dispersion (96% of cases) within mean ± 2 standard deviations and acceptable limits of agreements (mean ± 2 standard deviations)
• Figure 4-49: Bland-Altman plot of LF power illustrates an unacceptable dispersion (92% of cases) because the limits of agreement (mean ± 2 standard deviations) are not related to the original scale of measurement; the mean is 616 ms² and the range of limits 7571 ms².
• Spectrum 5-1:Power spectrum with a BF of 11.2 breaths/min and its main frequency around 0.19 Hz; the HF power peak can be noted between 0.15-0.25 Hz inside the HF band
• Spectrum 5-2: Power spectrum with a BF of 5.2 breaths/min and its main frequency around 0.09 Hz; the HF power peak shifted inside the LF band between 0.15-0.04 Hz where several peaks can be noted
• Spectrum 5-3: Five power spectra of an untrained man with HF peaks around 0.2 Hz; unaffected HF power due to the BF
• Spectrum 5-4: Power spectra of a woman with HF peaks shifting between 0.15-0.3 Hz in course of the menstrual cycle; still the HF power peaks remained in the HF area
• Spectrum 5-5: The orthostatic test presented in three different parts (i.e. supine, standing and supine) of a trained woman
• Spectrum 5-6: The orthostatic test presented in three different parts (i.e. supine, standing and supine) of a trained man