What does this research mean for the field?

Exercise shortens pulse arrival times (PATs) across peripheral vascular beds, and postural changes differentially alter PATs to the upper and lower body, demonstrating that PAT and PAT ratios effectively represent arterial vascular tree properties. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 6, 2017Frontiers in PhysiologyOpen Access

Noninvasive Assessment of the Effect of Position and Exercise on Pulse Arrival to Peripheral Vascular Beds in Healthy Volunteers

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Why the study?

Does exercise and positional change alter pulse arrival time in healthy volunteers?

Structured PICO

Does exercise and positional change alter pulse arrival time in healthy volunteers?

Population

13 healthy volunteers with no history of vascular or cardiac disease, age 23–41 years old (mean age 30, 45% female).

Intervention

Positional changes (standing, sitting, supine) and exercise (30 squats).

Comparator

Resting state and comparison between different positions.

Outcome

Pulse arrival time (PAT) to the ear lobe, index finger, and big toe, and PAT ratios compared to pulse path distance ratios.surrogate

The arterial vascular tree actively minimizes the time difference in pulse wave arrival to peripheral tissue beds irrespective of distance from the heart, and these properties are modulated by exercise and position.

Limitations

Limited to young and healthy population
Sampling bias due to recruitment method
Inability to distinguish between pressure generated by capillary filling and extremity movements
Inability to simultaneously record signals from both sides of the body
Lack of normalization for blood pressure or heart rate
Use of the peak of the R-wave on the ECG as the starting point instead of S1 heart sound

Implication

PAT varies with posture/exercise; leaves open its validation as arterial property marker in prospective studies.

Abstract

Background: The effects of position and exercise on pulse wave distribution across a healthy, compliant arterial tree are not fully understood. We studied the effects of exercise and position on the pattern of pulse arrival times (PATs) in healthy volunteers. Moreover we compared the pulse arrival time ratios to the respective distance ratios between different locations. Methods: Thirteen young healthy volunteers were studied, using an electrocardiogram and plethysmograph to simultaneously record pulse wave arrival at the ear lobe, index finger and big toe. We compared the differences in PAT between each location at rest and post-exercise in the supine, sitting, and standing position. We also compared the PAT ratio (toe/ear, toe/finger and finger/ear) to the corresponding pulse path distance ratios. Results: PAT was shortest at the ear then finger and longest at the toe regardless of position or exercise status. PATs were shorter post exercise compared to rest. When transitioning from a standing to sitting or supine position, PAT to the ear decreased, while the PAT to the toe increased, and PAT to the finger didn’t significantly change. PAT ratios were significantly smaller than predicted by the path distance ratios regardless of position or exercise status. Conclusions: Exercise makes PATs shorter. Standing position decrease PAT to the toe and increase to the ear. We conclude that PAT and PAT ratio represent the arterial vascular tree properties as surely as pulse transit time and pulse wave velocity.