Fluid Loss during Exercise-Heat Stress Reduces Cardiac Vagal Autonomic Modulation

Purpose Sweat-induced fluid loss during prolonged exercise-heat stress can compromise cardiovascular and thermoregulatory function, although its effects on cardiac autonomic modulation remain unclear. We therefore examined heart rate variability (HRV) and recovery (HRRec), as surrogates of cardiac autonomic modulation, during and after prolonged exercise in the heat with and without fluid replacement. Methods Eleven young and healthy men performed 90 min of semi-recumbent cycling in dry heat (40 degrees C; 20% relative humidity) at a fixed rate of metabolic heat production (600 W; similar to 46% VO2peak) followed by 40-min resting recovery without fluid replacement (No-FR; similar to 3.4% reduction in body mass). On a separate day, participants completed the same protocol with fluid replacement (FR; 500-700 mL timed boluses) to offset sweat losses. Esophageal temperature and ECG were recorded throughout, with measurements analyzed over 10-min averaged epochs during baseline, each 30-min interval during exercise and 20-min interval during recovery. Results Esophageal temperature and heart rate were elevated in No-FR relative to FR throughout exercise (all P <= 0.02). The HRV indices reflecting vagal influence of heart rate including the cardiac vagal index (CVI = log(10)[16 x SD1 x SD2]) and root-mean-square of successive differences were attenuated throughout exercise relative to baseline in both conditions (all P < 0.05), with the magnitude of the reduction greater in the No-FR condition (all P < 0.05). Further, sample entropy was reduced throughout all time points measured during exercise in the No-FR relative to FR condition (all P <= 0.03). Conclusions Our unique observations indicate that while prolonged exercise heat stress attenuates the vagal influence and complexity of cardiac rhythms, that reduction is further exacerbated by fluid loss, highlighting the importance of fluid replacement in such conditions.