Impact of Stimulant Medication Use on Heart Rate and Systolic Blood Pressure During Submaximal Exercise Treadmill Testing in Adolescents.
Inappropriately decreased heart rate (HR) during peak exercise and delayed heart rate recovery (HRR) has been observed in adult users of stimulant medications who underwent exercise testing, suggesting autonomic adaptation to chronic stimulant exposure. In the general population, this pattern of hemodynamic changes is associated with increased mortality risk. Whether the same pattern of hemodynamic changes might be observed in adolescent stimulant medication users undergoing exercise testing is unknown.



Among adolescents (aged 12 to 20 years) that underwent submaximal exercise treadmill testing from 1999 to 2004 in the National Health and Nutrition Examination Survey, propensity score matching of stimulant medication users (n = 89) to matched nonusers (n = 267) was conducted. Testing consisted of a 3-minute warm-up period, two 3-minute exercise stages, and three 1-minute recovery periods, with the goal of reaching 75% of the predicted HR maximum. A linear mixed model analysis was used to evaluate the effect of stimulant exposure on each of the exercise outcomes.



Stimulant medication users compared to matched nonusers had a lower peak HR in Stage 2 (154.9 vs. 158.3 beats/minute [bpm], p = 0.055) and lower HR at 1-minute recovery (142.2 vs. 146.4 bpm, p = 0.030). However, submaximal HRR at 1 minute did not differ between stimulant users and matched nonusers (13.0 vs. 12.1 bpm, p = 0.38). Duration of stimulant use was not related to these outcomes.



Adolescent stimulant medication users compared to matched nonusers demonstrated a trend toward decreased HR during submaximal exercise, which is potential evidence of chronic adaptation with stimulant exposure. There was no evidence for delayed HRR in this study, and thus, no evidence for decreased parasympathetic activity during initial exercise recovery. Exercise testing outcomes may have utility in future research as a method to assess stimulant-associated autonomic nervous system adaptations.
1 Department of Psychiatry, UT Southwestern Medical Center , Dallas, Texas.|2 Department of Clinical Sciences, UT Southwestern Medical Center , Dallas, Texas.
Arthur N
AN
Westover
1 Department of Psychiatry, UT Southwestern Medical Center , Dallas, Texas.|2 Department of Clinical Sciences, UT Southwestern Medical Center , Dallas, Texas.
Paul A
PA
Nakonezny
1 Department of Psychiatry, UT Southwestern Medical Center , Dallas, Texas.|3 Dallas VA Medical Center , VA North Texas Health Care System, Dallas, Texas.
Bryon
B
Adinoff
1 Department of Psychiatry, UT Southwestern Medical Center , Dallas, Texas.
Edson Sherwood
ES
Brown
2 Department of Clinical Sciences, UT Southwestern Medical Center , Dallas, Texas.|4 Division of General Internal Medicine, Department of Internal Medicine, UT Southwestern Medical Center , Dallas, Texas.
Ethan A
EA
Halm
D000293:Adolescent; D001341:Autonomic Nervous System / Q000187:drug effects* / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects*; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000494:pharmacology; D002648:Child; D003430:Cross-Sectional Studies; D015444:Exercise / Q000502:physiology; D005080:Exercise Test / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D016014:Linear Models; D008297:Male; D009749:Nutrition Surveys; D057216:Propensity Score; D055815:Young Adult
D000697:Central Nervous System Stimulants
ADHD; amphetamine; cardiovascular; exercise; methylphenidate; stimulants