ArticleEuropean journal of applied physiology2026
Assessment of the cardiac vagal reflex: validation of the 4-s exercise test during simulated wheelchair propulsion.
Article in European journal of applied physiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe rapid heart rate increase during the first seconds of exercise is primarily mediated by cardiac vagal withdrawal, which can be assessed by the 4-s exercise test (4sET), a pharmacologically validated and highly reliable procedure. However, the need for a cycle ergometer limits its applicability. Thus, we aimed to test the validity of a modified 4sET using wheelchair propulsion simulation (WPS) by comparing it with the traditional cycle ergometer protocol.
methodsSixty healthy adults (30 men, 30 women; 22 ± 2 years) performed, in randomized order, three repetitions each of the traditional (LEG 4sET) and modified (WPS) protocols. RR intervals were recorded via electrocardiography, and the cardiac vagal index (CVI) was calculated as the ratio of the last pre-exercise RR interval (RRB) to the shortest exercise RR interval (RRC).
resultsMean CVI was lower for WPS compared with LEG (1.42 ± 0.03 vs. 1.48 ± 0.03; P = 0.001). Based on identity plots, a correction equation was derived for WPS values < 1.50: y = 0.7706x + 0.3861 (r
conclusionThe WPS shows strong agreement with the traditional cycle ergometer 4sET, supporting its validity as a simpler and more accessible method for assessing dynamic cardiac vagal control.
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