Hemodynamics Monitoring in Sport

Using Hemodynamic Monitor for Sport Training Planning

Anna Shishkina, Natalia Tarbeeva, Oksana Alimpieva, Anastasia Berdnikova,

Alena Tarbeeva and Tatiana Miasnikova

Institute of Physical Education, Sport and Youth Policy, Ural Federal University, Mira Street, Ekaterinburg, Russia

Keywords: Cardiovascular System, Hemodynamic Indicators, Training Process, Athletes’ Hemodynamics, Training and

Testing.

Abstract: The study stresses the meaning of the physiological measures that are obtained with the functional

diagnostics devices and how these values can be used in coaching sportsmen. Methods: Hemodynamic

monitor was used for monitoring hemodynamics and heart function of athletes (n=305) with different fitness

levels. Active orthoclinostatic tests and antiorthostatic tests with passive body position changing were

carried out with hemodynamics measurements recorded. Results: The most informative indicators and

indices of heart function for high performance sport and their values at rest were detected. Along with

common hemodynamics indicators (HR, SV, CO, EDV, blood pressure, etc.) the possibility of using

correlation rhythmogram in coaching was studied. The correlation rhythmogram “cloud” dependence on

athletes’ fitness level was revealed in transient during active orthoclinostatic test.

1 INTRODUCTION

The success in sport training and performance is

determined by the adequate functioning of the

cardiovascular system and by the conformity of

system blood flow to physical work intensity. Too

intensive physical work and mental stress disrupts

the regulatory systems interaction, leads to fatigue

and impaired immunity and causes non-specific

defence mechanisms changing homeostasis and

reducing the effectiveness of professional sport

activity.

Current functional diagnostics provides the

opportunities to study various indicators that are

important in sports activities. Regular measurements

allow estimating how different training load

influences the athlete’s body.

There are several aims of athletes’ functional

diagnostics:

- Assessing current functional state;

- Detecting early signs of physical stress and

overtraining;

- Evaluating the effectiveness of the training

process;

- Determining appropriate ways for further

individual training planning.

Many devices are currently available for measuring

human function (

Critoph, 2013; Magder, 2014;

Rowland, 2003; Newman, 1999; Cooke, 1998, etc

Understanding the utility of these devices requires

an understanding of the determinants.

Functional hemodynamics monitoring is a

rapidly evolving field whose pluripotential is just

now being realized (

Pinsky, 2014). The aim of our

research was twofold. Firstly, it was necessary to

study the possibility of using the hemodynamic

monitor for hemodynamics assessment in sport

research. Secondly, we investigated the use of the

device in sport coaching. Not only is it important to

measure a great number of different indicators, but

also to interpret the data for effective sport training

planning.

2 DEVICE AND TECHNOLOGY

DESCRIPTION

The hemodynamic monitor MARG 10-01

"Microlux" used in emergency and operation rooms

was made in Chelyabinsk (Russia). The device

functioning is based on such noninvasive methods of

hemodynamic monitoring as impedance

103

Shishkina A., Tarbeeva N., Alimpieva O., Berdnikova A., Tarbeeva A. and Miasnikova T..

Hemodynamics Monitoring in Sport - Using Hemodynamic Monitor for Sport Training Planning.

DOI: 10.5220/0005094301030110

In Proceedings of the 2nd International Congress on Sports Sciences Research and Technology Support (icSPORTS-2014), pages 103-110

ISBN: 978-989-758-057-4

 2014 SCITEPRESS (Science and Technology Publications, Lda.)

cardiography and spectrophotometry. Compact

(250x140x90 mm) and light (less than 2 kg) MARG

10-01 measures and displays data of the following

areas: electrocardiogram monitoring (ECG), pulse

oximetry monitoring, reography and central

hemodynamics monitoring, blood pressure and

temperature monitoring.

Figure 1: The hemodynamic monitor MARG 10-01

"Microlux".

ECG monitoring includes a graphic

representation of the current ECG-signal for visual

assessment.

Hemodynamics is described by four general

indicators: volemia, inotropy, vascular tone,

chronotropy. The above-mentioned indicators are

shown as a percentage of normal values. The ranges

of normal values of indicators are counted by the

program taking into account the patient examination

features (gender, age, weight, breast and neck

circumference, distance between electrodes,

hemoglobin, etc.). The deviations of more than 25%

are considered too high/low.

Volemia is the amount of circulating blood

which corresponds to the vessel volume. Inotropy is

myocardial contractility power. Vascular tone may

be normal, dilated or constricted.

A correlation rhythmogram is a set of points

which have coordinates defined by two adjacent

cardiointervals values (RR

and RR

i+1

). Normal

"sinus arrhythmia" forms the image of "cloud"

(fig.2).

Figure 2: Correlation rhythmogram.

The method of heart beat distribution is highly

sensitive to a sudden RR-intervals duration change.

It allows seeing extrasystoles, rhythm disturbances,

signs of different diseases (for instance, acute

respiratory diseases) and other changes in

cardiorhythm.

Central hemodynamic indicators are presented in

four groups: perfusion, preload, afterload,

contractility and left ventricular activity.

Perfusion is the movement of fluid (i.e. blood)

through an organ or tissue in the vessels as a result

of pressure changes. Perfusion is composed of the

following indicators:

• Stroke volume is the volume of blood ejected

by the left ventricle in each systole. In healthy

people it is 60-80 ml at rest;

• Cardiac output is the volume of blood flowing

through the cross section of the aorta and pulmonary

trunk per minute. 3.4 litres is the normal value for

healthy people;

• Stroke index is the ratio of stroke volume to

body surface area;

• Cardiac index is the ratio of cardiac output to

the body surface area in square metres.

Preload is a measure of left ventricular wall

effort at the end of diastole. Preload is represented

by:

• End-diastolic volume is the maximum amount

of blood received in left ventricle at the end of

diastole;

• End-diastolic index is the ratio of end-diastolic

volume to the body surface area in square metres

Afterload is a measure of left ventricular wall

effort during systole. Afterload is represented by the

following indicators:

• The index of total peripheral resistance;

• Stroke index of total peripheral resistance

Contractility and left ventricular activity includes

the following indicators:

• Contractility index (acceleration index) is an

integral component of contractile ability of the heart;

• Ejection fraction is the relative volume of blood

ejected from the left ventricle during contraction, in

healthy individuals it is 58%;

• Index of left ventricle activity is a generalized

measure of the work of the left ventricle;

• Stroke index of left ventricle activity.

Measuring Methods. For the experiment a

patient (athlete) was in supine position on the tilted

table in the silent room with constant air temperature

(22ºC). Before recording all subjects were at rest in

supine position during 10 minutes. 8 pregelled ECG

electrodes Ag/AgCl were attached as shown in

figure 3. All measured indicators of the central

hemodynamics were automatically registered by the

programme by beat-to-beat record.

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Figure 3: Scheme of electrodes attachment.

3 EXPERIMENTS

We assume that regular informative athletes’

functional diagnostics should be the basis for the

planning of the training process.

Experiment 1

Participants and Methods. From May 2010 to

May 2014 a large group (n = 305) of athletes from

different kinds of sport (cross country skiing,

biathlon, track and field, triathlon, swimming,

Greco-Roman wrestling, sport games, etc.) aged

from 10 to 50 was examined. Among the

participants there were athletes of various skill levels

from novice (n=38) and intermediate level (n=239)

to advanced athletes (n=28), including those who

had achieved international level.

By novice we mean those athletes who engaged

in sport not longer than 3 years ago. Intermediate

athletes have 4-7 years of serious training experience

in the chosen kind of sport. Special attention was

given to representatives of endurance kinds of sport

(cross country skiing, track and field and biathlon).

Results And Discussion. To investigate the

functional state of the athletes we chose the most

informative for sports activity hemodynamic

indicators.

Heart rate (HR) is the most accessible and

informative indicator of the development of athletes’

cardiorespiratory system. HR at rest for adult

representatives of endurance cyclical kinds of sport

is less than 55 beats/min. The lowest value recorded

during the experiment was 28 beats/min. – in the

well-trained female who has been practising cross-

country skiing for more than 30 years has such. An

athlete’s HR at rest that is over 55 beats/min

indicates insufficient heart function for elite sport

and/or muscular system domination over the

cardiovascular development preventing success in

endurance sport. The best representatives of

"aerobic" sport with a duration of competitive

activity over 20 min, including sports games, also

have low heart rate. For elite athletes with a

predominance of speed and power parameters in

competitive activities a heart rate within 60±5

beats/min is permissible. High pulse of the latter

may not be the limiting factor in competitive

activity; however, it does not allow an athlete to

cope with a large amount of physical load required

for high performance sport.

The stroke volume (SV) values of untrained

adult men do not exceed 100 ml, well-trained adult

females have 120±15 ml, male athletes – 140±17 ml,

while the best representatives of sports requiring

endurance show SV 180 ±14 ml (Seluyanov, 2002).

These indicator values should be a reference point in

examining athletes.

Cardiac output (CO) is the indicator of cardiac

systolic function and is equal to HR multiplied by

SV. Increasing SV and CO during long term

exercise is one of the main effects of endurance

training. At the same time the growth of CO should

occur due to SV rise, but not due to heart rate rise.

Large end diastolic volume (more than 190 ml)

provides sufficient stroke volume and cardiac output

and is the guarantor of good tolerance to high

intensity work load in training and competitive

activities.

An ejection fraction changes from 60 to 65 and

serves as an indicator of fitness level and the

intensity of the training process. Regular extensive

endurance training does not increase ejection

fraction (Scharhag, 2002). The highest values of

ejection fraction are observed in sport game players.

In cyclical kinds of sport ejection fraction increases

correspondingly to the athlete’s fitness level

enhancement to the competitive activity. It is

explained by analysing the physical load structure

per year: the closer the competition, the more

intensive workouts are used, the higher the ejection

fraction.

Breathing rate. It is considered that special

training of the respiratory system is not required for

well-trained athletes as it develops itself during

physical training. However, 12,13 % of the

examined athletes have higher than normal breathing

rate. The normal number of breaths per minute in

adults is correlated with the heart rate as 1:4.

Breathing and hemodynamics are interdependent

processes (Donina, 2011). In case of high breathing

rate in athletes you should first check blood

hemoglobin, hematocrit and lung capacity, secondly,

exclude post training acidosis and, thirdly,

fermentopathy and heart disease. For enhancing

respiratory function in healthy athletes with high

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breathing rate breathing exercises, altitude training

or partly limited air inhaling during training (for

instance, breathing through nose), intermittent

hypoxic training, etc may be used.

For finding out the correlation between

hemodynamic indicators and sport performance

thirteen well-trained skiers (men) were included in

the next study. The subjects’ age was from 15 to 17.

All of them had 5-6 years of training and

competition experience. Each subject was well

rested before testing during the previous 24 hours.

All athletes in measurement were at rest in the

supine position.

We determined normal values (mean±standard

deviation) for each hemodynamic indicator in the

group of athletes. Then we held correlation analysis

between indicators and sport performance ranking of

skiers in Russia. Statistical analysis showed

significant correlation between athletes’

performances and stroke volume (r = 0.77;

122±22ml), cardiac output (r = 0.61; 6.8±1.6 l), end-

diastolic volume (r = 0.76; 193±34ml), stroke index

(r = 0.82; 69±11ml/m

), heart index (r =

0.65;3.9±0.9l/m

), end-diastolic index (r = 0.81;

110±17ml/m

) and stroke index of left ventricle

work (r = 0.62; 74±14). There was no correlation

between performance and heart rate (57±8

beats/min), ejection fraction (63±2%) and index of

left ventricle activity (4.2±1.0).

Thus such indicators as stroke volume, cardiac

output and end-diastolic volume showed athlete’s

conditions and they might be predictors of fitness

level and competition results. But these indicators do

not take into account athletes’ body size and muscle

mass.

Such indicators as heart rate, ejection fraction

and index of left ventricle work do not correlate with

performance, however they show the heart work

quality and can be good indicators of overexertion.

All the above-mentioned indicators can be used for

monitoring athletes’ function during seasons.

It is known that cardiorespiratory system

functions are considered important factors of success

in endurance sports. In force-velocity sports, martial

arts and sport games coaches sometimes

underestimate the level of cardioendurance.

However, our study showed that important

hemodynamic indicators (SV, EDV) of medal

holders in World and European championships were

always high.

Age-average stroke volume and end diastolic

index of excellent sportsmen in our research are

shown in fig. 4.

Figure 4: Hemodynamics in excellent athletes of different

age. 1 – SV, ml; 2 – EDI, ml/m

It was proved that cardiac output was twice

lower in juvenile rats than in adults (106 +/- 5

ml/min), but cardiac (heart) index was not different

among groups (Delp, 1998). We found that in

human athletes the cardiac output may be equal in

child and adult, the average stroke volume increases

from childhood till the age of 22, then it smoothly

decreases (fig.4). But it stays higher than in

untrained people. End diastolic index (fig. 4) was

used to show the relative hemodynamics changes. In

rats and untrained people it stays constant with age.

Due to intensive sport activity EDI increases

significantly. Thus we can conclude that regular

sport training causes the adaptation changes in

athletes’ central hemodynamics.

It is possible to increase stroke volume and EDV

by special low intensive (HR=120±10) long lasting

training sessions (Seluyanov, 2002) within a month

or two or by high-intensity interval training. But due

to training growth of SV and EDV may be limited

and partly predetermined genetically. Determining

SV and EDV in youth allows predicting athletic

success and prospects for the sport.

Experiment 2

Since stroke volume is not a stable indicator (it

changes during physical load, stays higher

afterwards in recovery period and may be increased

as a result of training process) we organized the

experiment with the purpose to analyse the changes

in central hemodynamics of cross country skiers

during the macrocycle and in the process of long-

term training (3 macrocycles).

Participants and Methods. In the period from

May 2011 to August 2013 a group (n=28) of well-

trained cross country skiers aged from 14 to 20 years

was examined.

The measurements were provided 4 times per

year: 1 – off-season (May), 2 – the 1

part of

preparatory period (June – August), 3 – the 2

part

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of preparatory period (September – November), 4 –

competition period (December – April).

Results and discussion. The dynamics of heart

rate at rest of athletes in supine position during

macrocycle tend to significantly decrease from the

beginning of the off-season till the start of the

competitive period (fig. 5-7). Such dynamics had

place in each subsequent macrocycle in cross

country skiing. At the same time there were positive

dynamics for all indicators. Heart rate at rest for

three-year period has changed in the same period of

training (May) to 68 ± 4,4 to 52,2 ± 3,3 beats/min in

the group of cross country skiers (fig.5).

Figure 5: Heart rate dynamics during three macrocycles.

Figure 6: Stroke volume dynamics during three

macrocycles.

Figure 7: Cardiac output dynamics during three

macrocycles.

In the examined group of skiers SV dynamics for

three macrocycles had a stable growth trend. Within

three macrocycles there is a gradual increase of the

CO from 6,2 to 6,7 l/min on average in the group.

Thus, in the process of long-term training of

cross country skiers the central hemodynamics

indicators such as stroke volume, cardiac output and

cardiac index are rising but heart rate is

appropriately decreasing. This is due to increased

levels of fitness and adaptation to physical work.

The study also revealed SI, CO and CI increases and

decrease in heart rate within the macrocycle for all

periods except off-season time. There was an

increase in HR and a slight decrease in SV, leading

to lowering CO and SI. It proved the ineffectiveness

of the training process for cross country skiers in the

off-seasons.

Experiment 3A.

The aim of the study was to determine the

effects of athletes’ organism adaptation to the

environment and to physical activity.

Participants and Methods. 20 athletes (12

females and 8 males, cross country skiers) aged from

10 to 20 with different fitness levels were

undergoing an active orthoclinostatic test (supine

position1 during 3 min– standing during 3 min ̶

supine position2 during 3 min). All the above

mentioned indicators and indices were registered

automatically with the software of the

Hemodynamic monitor MARG 10-01 (beat-to-beat

record). Special attention was given to correlation

rhythmogram in different patients’ body position

and in transient periods (from supine1 to standing

and from standing to supine2 position).

Results and Discussion. Orthoclinostatic test

allows estimating participation of parasympathetic

and sympathetic system in heart rate regulation and

speed and quality of this regulation.

Quality of transition can be estimated by the

action of physiological systems regulation. The

regulation time and the maximum deviation of the

adjustable value from the initial value are the main

indicators of quality of regulation (Stickland, 2006).

The lower each of the mentioned hemodynamics

indicators is, the higher the quality of regulation in

transient.

Comparison of organism reactions during active

orthoclinostatic tests revealed that athletes with 1 or

2 years of sport experience demonstrate a strong

reaction of heart rate in transient into standing

position (table 1). After returning to supine position2

the heart rate of novices in sport was much higher

than in initial supine position1 at rest. Positive

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changes in adaptation as a rule appeared at the end

of the third year of regular sport training: the heart

rate in supine position2 (HR

) tended to HR

at rest

(table 1). The group of sportsmen with 4-7 years of

sport experience have an adequate adaptation

reaction in orthoclinostatic test similar to the

reaction to physical workload: the HR rise is

moderate.

Advanced athletes have professional sports

reaction in active orthoclinostatic test: HR

is even

lower than HR

. The correlation rhythmogram

proves and specifies HR reaction in the

orthoclinostatic test: the longer the experience in

sport is, the less R-R intervals dispersion at rest

(“cloud” and even “dot”) and in transient

(“bisectrix”) and the shorter the period of HR getting

stabilized.

Thus, according to athletes’ organism

orthoclinostatic test reaction indicators (HR changes

and “cloud” sizes in the correlation rhythmogram)

one can judge the fitness level of young sportsmen

and adjust the physical workload in correspondence

to athletes’ physiological readiness to train hard.

Experiment 3B

Antiorthostatic test is a test method of

diagnostics of the cardiovascular system and its

response to changes from the supine horizontal

position to the head-down tilt. Antiorthostatic test

allows estimating the athlete’s functional state with a

reliable validity because humans do not have

adaptive mechanisms for this position. This method

is mainly used in clinical medicine.

Materials and Methods. Examined group

(n=14) of female athletes (swimming) is aged 17-18.

All of them have intermediate sport level.

Antiorthostatic tests with passive body position

changes and hemodynamics measurements

recording was carried out in the following stages:

1. Supine (horizontal) position at rest during 3 min:

2. Passive (by the tilted table) transition to the

Trendelenburg position (fig.7) with a tilt angle of

30º.

Table 1: Athletes orthoclinostatic test peculiarities in dependence of sport experience.

Athletes’

experience

Supine position 1 Post transition period

1-2

Supine position 2 Heart rate dynamics

Novices with

1-2 years of

sport

experience

= 65 HR

= 86 HR

= 70

Novices of

the third year

of sport

experience

= 63 HR

= 80 HR

= 60

Intermediate

trainees

(4-7 years of

sport

experience)

= 58 HR

= 70 HR

= 55

Advanced

athletes

= 48 HR

= 62 HR

= 45

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3. The Trendelenburg position during 3 min.

4. Passive transition to supine position.

5. Supine (horizontal) position at rest during 3 min.

When carrying out the functional antiorthostatic

test background and transition and post transition

periods of test records were under special attention.

Results and Discussion. All indicators which

have a significant correlation with athlete’s result

were measured.

Heart rate increases from 62

6 beats/min at rest

to 65

7 beats/min during head-down tilt, and then it

decreases to 61

6 beats/min. Heart rate has higher

mean and standard deviation during transients

(71

10 beats/min in head-down tilting, 65 7

beats/min in returning).

Figure 8: Trendelenburg position.

Subjects are more sensitive to the beginning of

head-down tilt than to returning in primary position.

The change in heart rate may be attributed to a

decrease in stroke volume or increase of sympathetic

tone (Lucia, 2000)

Table 2: Dynamics of hemodynamic indicators in the main

position during antiorthostatic test.

Indicator

Mean±SD

1 3 5

HR, beats/min 61±6 67±9 64±8

SV, ml 102±16 101±19 98±18

SI, ml/m

60±5,6 60±6,4 60±6,1

EDV, ml 162±30 161±36 158±31

EDI ml/m

98±11 97±12 97±10

CO, l/min 6,4±1,4 6,8±1,6 6,3±1,4

CI, l/m

3,9±0,7 4±0,7 3,8±0,6

SILVA, 68±6,9 67±11 67±11,2

Stroke volume and end-diastolic volume (EDV)

do not significantly fall from the 1

position to the

head-down tilt and continue decreasing in transient

to supine position. At the same time indices (stroke

index (SI), end-diastolic index (EDI) and stroke

index of left ventricle activity (SILVA)) have

minimal changes or no changes.

Cardiac output (CO) enhances from 6,1±4 l/min at

rest to 6,8±1,7 l/min in antiorthostasis and decreases

to 6,3±1,5 l/min in supine position after head-up tilt.

During head-down tilting cardiac output is 6,6±1,6

l/min, and when returning it increases to 6,9±1,7

l/min. Magnitude of this indicator during test

depends on heart rate change and stroke volume.

Cardiac index is more sensible to position changes

than other indices.

If there is considerable difference between the 1

and the 5

position, the athlete doesn’t have a high

fitness level. Perhaps overtraining or disease come

into play. At the same time individual features

influence is not excluded.

The indicator value in the 3

position shows

cardiovascular and neural response to antiorthostatic

load. If magnitudes exceed the normal value,

inadequate response to workload takes place.

Table 3: Dynamics of hemodynamic indicators in the

transients during antiorthostatic test.

Indicator

Mean±SD

2 4

HR, beats/min

71 9 67 8

SV, ml

97 19,5 100 22

SI, ml/m

7 60 7,6

EDV, ml

158

32 161 34

EDI ml/m

11 97 11

CO, l/min

6,8 1,5 6,7 1,5

CI, l/m

4,1 0,7 4 0,6

SILVA,

65 9,4 69 11

Hemodynamic indicators values have higher

amplitude excursion during transients than in supine

and head-up tilt because of adaptation to new body

position. Too high changes of hemodynamic

indicators point to inadequate response to workload

or overtraining. However, too weak change or its

absence shows adaptation problems which influence

negatively the training process and competition

results.

Thus hemodynamic response to antiorthostatic

tests shows not only the fitness level of athletes, but

the existence of diseases, overtraining and possible

adaptation problems.

4 CONCLUSIONS

The state of the cardiorespiratory system and

hemodynamics is an important criterion in achieving

success in sport performance. That is why sport

scientists should explore informative support

technologies of athletes’ functional diagnostics in

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order to supply sports practice with reliable

information useful for planning the training process.

The use of hemodynamics monitor with

impedance cardiography and spectrophotometry in

base and comparing the obtained athletes’

hemodynamics data with normal values of excellent

athletes enable to detect individual features of

athletes’ physical workability, functional reserves or

limiting factors of physical workability and predict

athletic success and prospects for the sport.

Regular monitoring of athletes’ hemodynamics

allows to estimate the effectiveness of the training

process, progress (or regress) of workability and

suggest proper methods for its correction.

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