Influence of Insulin Resistance on the Association Between Physical Activity and Heart Rate Variability: The Toon Health Study

in Journal of Physical Activity and Health
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Background: Autonomic activity is possibly influenced by physical activity (PA). However, it remains unclear whether this association is modified by insulin resistance. Methods: This population-based study between 2009 and 2012 included 2016 men and women aged 30–79 years. The PA was assessed using a validated questionnaire based on sleep, occupation, transportation, household characteristics, and leisure-time PA. Heart rate (HR) and heart rate variability (HRV) in the sitting position were determined from 5-minute recordings of pulse waves detected by a fingertip sensor. The HRV was calculated as frequency (standard deviation of normal-to-normal [NN] intervals [SDNN]), root mean square of successive differences (RMSSD), and percentage differences between normal NN intervals >50 milliseconds [pNN50]) and time domains. Insulin resistance was evaluated using the homeostasis model assessment index (HOMA-IR). Results: HR, RMSSD, and pNN50 were related to the total and moderate/vigorous PA tertiles in models that included HOMA-IR. The partial regression coefficient of total PA per 1-SD increase was .05 (P = .019) for log-transformed RMSSD and 1.86 (P = .001) for pNN50. No interactive associations were observed between PA and HOMA-IR. Conclusions: Low total PA was associated with increased HR and low levels of RMSSD and pNN50, reflecting parasympathetic modulation that was not modified by insulin resistance.

Saito is with the Department of Public Health and Epidemiology, Faculty of Medicine, Oita University, Yufu, Oita, Japan. Maruyama is with the Department of Bioscience, Graduate School of Agriculture, Ehime University, Matsuyama, Japan. Kato is with the Center for Education and Educational Research, Faculty of Education, Ehime University, Matsuyama, Japan. Takata, Kawamura, and Osawa are with the Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Japan. Tomooka and Tanigawa are with the Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan. Uesugi and Naito are with the Department of Food Science & Nutrition, School of Human Environmental Science, Mukogawa Women’s University, Hyogo, Japan.

Saito (saitoi@oita-u.ac.jp) is corresponding author.
  • 1.

    Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. JAMA. 2018;320(19):20202028. PubMed ID: 30418471 doi:

  • 2.

    Saint-Maurice PF, Coughlan D, Kelly SP, et al. Association of leisure-time physical activity across the adult life course with all-cause and cause-specific mortality. JAMA Netw Open. 2019;2(3):e190355. PubMed ID: 30848809 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: a meta-analysis. Stroke. 2003;34(10):24752481. PubMed ID: 14500932 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988;37(12):15951607. PubMed ID: 3056758 doi:

  • 5.

    Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C, Zuniga FA. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol. 2018;17(1):122. PubMed ID: 30170598 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Kohl HW, 3rd, Craig CL, Lambert EV, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294305. PubMed ID: 22818941 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Ministry of Health, Labour and Welfare. Review conference on the revision of exercising guidelines and indices guidelines for physical activities for health-building. http://www.mhlw.go.jp/stf/houdou/2r9852000002xple-att/2r9852000002xpqt.pdf. Published 2013. Accessed.

    • Export Citation
  • 8.

    Singh JP, Larson MG, Tsuji H, Evans JC, O’Donnell CJ, Levy D. Reduced heart rate variability and new-onset hypertension: insights into pathogenesis of hypertension: the Framingham Heart Study. Hypertension. 1998;32(2):293297. PubMed ID: 9719057 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Carnethon MR, Golden SH, Folsom AR, Haskell W, Liao D. Prospective investigation of autonomic nervous system function and the development of type 2 diabetes: the atherosclerosis risk in communities study, 1987–1998. Circulation. 2003;107(17):21902195. PubMed ID: 12695289 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Liao D, Carnethon M, Evans GW, Cascio WE, Heiss G. Lower heart rate variability is associated with the development of coronary heart disease in individuals with diabetes: the atherosclerosis risk in communities (ARIC) study. Diabetes. 2002;51(12):35243531. PubMed ID: 12453910 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Wulsin LR, Horn PS, Perry JL, Massaro JM, D’Agostino RB. Autonomic imbalance as a predictor of metabolic risks, cardiovascular disease, diabetes, and mortality. J Clin Endocrinol Metab. 2015;100(6):24432448. PubMed ID: 26047073 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Okada Y, Galbreath MM, Shibata S, et al. Relationship between sympathetic baroreflex sensitivity and arterial stiffness in elderly men and women. Hypertension. 2012;59(1):98104. PubMed ID: 22106403 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Cooper TM, McKinley PS, Seeman TE, Choo TH, Lee S, Sloan RP. Heart rate variability predicts levels of inflammatory markers: evidence for the vagal anti-inflammatory pathway. Brain Behav Immun. 2015;49:94100. PubMed ID: 25541185 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Vinik AI, Maser RE, Ziegler D. Autonomic imbalance: prophet of doom or scope for hope? Diabet Med. 2011;28(6):643651. PubMed ID: 21569084 doi:

  • 15.

    Flaa A, Aksnes TA, Kjeldsen SE, Eide I, Rostrup M. Increased sympathetic reactivity may predict insulin resistance: an 18-year follow-up study. Metabolism. 2008;57(10):14221427. PubMed ID: 18803948 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Chang CJ, Yang YC, Lu FH, et al. Altered cardiac autonomic function may precede insulin resistance in metabolic syndrome. Am J Med. 2010;123(5):432438.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Hemingway H, Shipley M, Brunner E, Britton A, Malik M, Marmot M. Does autonomic function link social position to coronary risk? The Whitehall II study. Circulation. 2005;111(23):30713077. PubMed ID: 15939818 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Fu Q, Levine BD. Exercise and the autonomic nervous system. Handb Clin Neurol. 2013;117:147160. PubMed ID: 24095123 doi:

  • 19.

    Rennie KL, Hemingway H, Kumari M, Brunner E, Malik M, Marmot M. Effects of moderate and vigorous physical activity on heart rate variability in a British study of civil servants. Am J Epidemiol. 2003;158(2):135143. PubMed ID: 12851226 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Soares-Miranda L, Sattelmair J, Chaves P, et al. Physical activity and heart rate variability in older adults: the cardiovascular health study. Circulation. 2014;129(21):21002110. PubMed ID: 24799513 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Greiser KH, Kluttig A, Schumann B, et al. Cardiovascular diseases, risk factors and short-term heart rate variability in an elderly general population: the CARLA study 2002–2006. Eur J Epidemiol. 2009;24(3):123142. PubMed ID: 19199053 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Kluttig A, Schumann B, Swenne CA, et al. Association of health behaviour with heart rate variability: a population-based study. BMC Cardiovasc Disord. 2010;10:58. PubMed ID: 21108803 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Saito I, Hitsumoto S, Maruyama K, et al. Heart rate variability, insulin resistance, and insulin sensitivity in Japanese adults: the toon health study. J Epidemiol. 2015;25(9):583591. PubMed ID: 26277879 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Ishikawa-Takata K, Naito Y, Tanaka S, Ebine N, Tabata I. Use of doubly labeled water to validate a physical activity questionnaire developed for the Japanese population. J Epidemiol. 2011;21(2):114121. PubMed ID: 21258166 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126131. PubMed ID: 3920711

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996;17(3):354381. PubMed ID: 8737210

    • Search Google Scholar
    • Export Citation
  • 27.

    Guemes A, Georgiou P. Review of the role of the nervous system in glucose homoeostasis and future perspectives towards the management of diabetes. Bioelectron Med. 2018;4:9. PubMed ID: 32232085 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Bergholm R, Westerbacka J, Vehkavaara S, Seppala-Lindroos A, Goto T, Yki-Jarvinen H. Insulin sensitivity regulates autonomic control of heart rate variation independent of body weight in normal subjects. J Clin Endocrinol Metab. 2001;86(3):14031409. PubMed ID: 11238539 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Berkelaar M, Eekhoff EM, Simonis-Bik AM, et al. Effects of induced hyperinsulinaemia with and without hyperglycaemia on measures of cardiac vagal control. Diabetologia. 2013;56(6):14361443. PubMed ID: 23404443 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Ribeiro RT, Lautt WW, Legare DJ, Macedo MP. Insulin resistance induced by sucrose feeding in rats is due to an impairment of the hepatic parasympathetic nerves. Diabetologia. 2005;48(5):976983. PubMed ID: 15830187 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Lautt WW. A new paradigm for diabetes and obesity: the hepatic insulin sensitizing substance (HISS) hypothesis. J Pharmacol Sci. 2004;95(1):917. PubMed ID: 15153645 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Saito I, Takata Y, Maruyama K, et al. Association between heart rate variability and home blood pressure: the toon health study. Am J Hypertens. 2018;31(10):11201126. PubMed ID: 29982275 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Sasai H, Nakata Y, Murakami H, et al. Simultaneous validation of seven physical activity questionnaires used in japanese cohorts for estimating energy expenditure: a doubly labeled water study. J Epidemiol. 2018;28(10):437442. PubMed ID: 29709888 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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