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Effect of Self-Performed Osteopathic Manipulative Treatment (suboccipital release) on Heart Rate Recovery: A Pilot Study

Journal: Journal of Osteopathic Medicine Date: 2021/12, 121(12):Pages: A3-A5. doi: Subito , type of study: pretest posttest design

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2021-2000/html)

Keywords:

heart rate recovery [2]
heart rate variability [43]
pilot study [134]
pretest posttest design [140]
suboccipital release [3]

Abstract:

Context: A rapid heart rate recovery (HRR) correlates with cardiovascular health and a slower HRR with cardiac mortality. It is known that improving HRR via exercise reduces mortality in patients during cardiac rehab after a heart procedure. However, recovering patients often have difficulty performing rigorous physical activity. Thus, identifying interventions such as OMT capable of causing a more rapid HRR is a clinically important area of investigation. Objective: 1. Examine how suboccipital release OMT influences autonomic balance via parallel changes in heart rate variability (HRV). 2. Determine the effectiveness of suboccipital release OMT to facilitate post-exercise heart rate recovery (HRR). Hypothesis: Self-administered OMT performed after a single bout of high-intensity interval training (HIIT) causes a more rapid HRR that correlates with increased parasympathetic tone during the post-exercise period. Methods: Study utilized a prospective intervention study design. Subjects were recruited from a cohort of TUC students. Only volunteers deemed able to safely complete all study protocols based on health questionnaire responses were selected based on Inclusion/Exclusion criteria. 12 subjects were recruited and 9 successfully completed the protocol. Subjects were trained in self-administration of the suboccipital release OMT technique by instructional video based on protocols utilized for training osteopathic students at Touro University California. Subjects also trained in the use of phone apps used to monitor HR variability (HRV) and HR recovery (HRR) (EliteHRV®; Polar Beat®). Proficiency was supervised and facilitated by student researchers trained by principle investigators. Baseline (resting) HRV and HRR parameters for each subject were determined for later comparison to exercise measurements. Using a repeated-measures design, subjects completed two 20-minute sessions of high-intensity interval training (HIIT) bouts followed by a 5 min recovery period: Session 1: OMM Recovery (occipital release performed) and Session 2 Passive Recovery (quite rest) during 5 min recovery period. Sessions were performed 48 hours apart and subjects were randomized in the order of session performance. HRV and HRR data were monitored throughout the exercise and recovery periods via smartphone applications synched to a heart rate chest monitor (Polar H10®). HRV and HRR data were stored on online platforms for later analysis. Group HRV and HRR data from each exercise session were analyzed statistically for differences by T-test with an alpha level of 0.05 Improving HRR via exercise is known to reduce mortality in patients recovering from heart procedures. However, recovering patients have difficulty performing rigorous physical activity. Thus, identifying interventions such as Osteopathic Manipulative Treatment (OMT) capable of causing a more rapid HRR is osteopathically significant. Results: Due to user error/incomplete results from the data collection app EliteHRV®, the sample size for HRV data was 5. Each index for HRV displayed a significantly higher HRV for the OMT recovery group compared to the no OMT recovery group. HRV data was analyzed as HRV Frequency Domain Power (FDP). Units for FDP are displayed as ms2. The major findings from this data included significantly (p<0.05) higher HRV with the OMT Recovery vs. the Passive Recovery for the Low-Frequency (LF) domain and Total Power (TP) domain of HRV indices. The closer the HRV is to the Baseline Readiness value, the larger the HRV. Legend: (OMT recovery; no OMT recovery; Readiness Baseline Value) LF: 1928.83 ms2; 220.95 ms2; 2656.06 ms2 TP: 2801.19 ms2; 362.14 ms2; 3460.77 ms2 Statistically significant differences in each of the indices related to the HRV for OMT recovery were found when compared to the no OMT recovery data. All data were analyzed utilizing a t-test with a significance level of 0.05 (α=0.05). Due to user error/incomplete results from the data collection app Polar Beat®, the sample size for HRR data was 5 for the OMT recovery group data and 7 for the no OMT recovery group data. Results displayed a greater HRR for the no OMT recovery group at both one-minute post-exercise (28.4 HRR for OMT Recovery vs. 40.8 HRR for no OMT Recovery) and five minutes post-exercise (64 HRR for OMT Recovery vs. 63.7 HRR for OMT Recovery). These results are not statistically significant, and no statistical testing was able to be performed due to incomplete HRR results from issues with data collection through the HRR applications used. Conclusion: The HRV group data was consistent with our hypothesis and previous literature, as it showed that the self-administered OMT increases certain HRV variables that correspond to increased parasympathetic tone (LF and TP). The HRR group data showed no benefit from the OMT recovery, as the no OMT recovery group had larger HRRs at one minute and five minutes post-cessation of exercise. These findings are paradoxical in that it is known HRR is predominantly a function of the reactivation of the parasympathetic nervous system, thus vagal activity. The paradox in our findings regarding HRR data could be possibly explained by general study limitations, limited sample size, user error on data collecting applications, and failure to create separate HRV/HRR readings during the recovery phase of the HIIT sessions. Our results suggest that untrained individuals can perform self-administered OMT (suboccipital release) and reap the physiological benefit of an improved HRV (and in theory improved HRR). Further research is required to make a statistically significant claim regarding the extent of the benefit self-administered OMT (suboccipital release) may have on HRR/HRV.


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