Diaphragmatic Breathing and Heart Rate Variability Training for Improving Hypertension in Fragile X Associated Tremor/Ataxia

NCT ID: NCT03816540

Last Updated: 2019-10-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-05-01

Study Completion Date

2019-03-13

Brief Summary

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To study whether heart rate variability training and respiratory coherence can improve hypertension in individuals with FXTAS.

All patients will receive HRV biofeedback training for 20 sessions. Our hypothesis is that individuals with FXTAS who undergo 20 sessions of biofeedback training will improve self-regulatory skills for reducing hypertension, as measured by blood pressure measurement to below 140/90. The investigators hypothesize that individuals who successfully develop increased heart rate variability and better synchrony between heart rhythm and respiration will show the greatest improvements in self-regulatory skills for hypertension.

Detailed Description

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Fragile X-associated tremor ataxia syndrome (FXTAS) is a late onset neurodegenerative disease that affects carriers of the fragile X premutation. This project proposes the evaluation of an innovative intervention program that promotes self-regulatory skills for hypertension in individuals with FXTAS. Using a control-group experimental design, the investigators propose to explore the efficacy of a biofeedback treatment to support self-regulatory processes on the physiological level: Heart Rate Variability (HRV) and respiratory coherence biofeedback.

Chronic hypertension contributes to cardiovascular complications, dementia, and increased risk of stroke. Our results indicate that the risk of hypertension is significantly elevated in male premutation carriers with FXTAS compared with carriers without FXTAS and controls.

Several research studies showed high levels of physiological arousal in individuals with Fragile X-Associated Disorders (FXS/FX-AD), related to a dysregulation of the sympathetic and parasympathetic nervous system. One parameter to measure physiological arousal is cardiovascular activity. It provides an index of parasympathetic and sympathetic involvement of the autonomic nervous system. Heart rate is under the control of efferent sympathetic and vagal activities directed to the sinus node, which are modulated by central brain stem (vasomotor and respiratory centers) and peripheral oscillators (oscillation in arterial pressure and respiratory movements). Spectral analysis of heart rate variability (HRV) is a reliable quantitative method for analyzing the modulatory effects of neural mechanisms on the sinus node.

Biofeedback treatments are reported for over 30 years. Biofeedback provides specific information about internal biological processes (i.e. muscle activity, respiration, heart rate variability, skin temperature and brain electrical activity) in an individual. In general, by enhancing the awareness of these processes and training to volitional control over them, specific parameters can be improved. The internal biological processes can be measured with a specific biofeedback equipment that convert this data into signals, often in the form of auditory, visual or somatosensory events, so that the individual can perceive real-time changes in their physiological activity. As the individual learns to control these events, healthier physiological processes are conditioned. Depending upon the physiological processes targeted, healthier patterns of activity can be achieved by most people after they have participated in 10 to 50 sessions of biofeedback supported with professional coaching and practice. Various biofeedback protocols and assistive electronic technologies such as the NeXus-10, emWave Personal Stress Reliever® or StressEraser® exist to enhance the balance of parasympathetic activity, vagal tone, increase HRV and synchronize respiration with the heart rhythm (i.e., the slowing down and speeding up of the heart over time).

Conditions

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Hypertension FXTAS

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Same intervention will be applied to FXTAS-affected and unaffected (comparison) participants.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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FXTAS-affected

FXTAS-affected participants will receive HRV and respiratory coherence biofeedback training for 20 sessions.

Group Type EXPERIMENTAL

HRV and respiratory coherence biofeedback

Intervention Type DEVICE

Biofeedback treatment to support self-regulatory processes on the physiological level: heart rate variability (HRV) and respiratory coherence.

FXTAS-unaffected

FXTAS-unaffected participants will be assessed to compare the effects of biofeedback based on FXTAS status. This arm will receive HRV and respiratory coherence biofeedback training for 20 sessions.

Group Type ACTIVE_COMPARATOR

HRV and respiratory coherence biofeedback

Intervention Type DEVICE

Biofeedback treatment to support self-regulatory processes on the physiological level: heart rate variability (HRV) and respiratory coherence.

Interventions

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HRV and respiratory coherence biofeedback

Biofeedback treatment to support self-regulatory processes on the physiological level: heart rate variability (HRV) and respiratory coherence.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Males and females between the ages of 50-90 with a molecular documentation of a fragile X premutation, diagnosed with FXTAS.
2. stable current pharmacological treatment regimen for at least 4 weeks.
3. English speaking (the intervention is currently only available in English)
4. Clinically significant hypertension.
5. Normal or corrected to normal vision and hearing.

Exclusion Criteria

1. Significant medical and behavioral problems that would interfere with the study (e.g. not being able to sit and play a computer game for 10 minutes)
2. Participants who plan to initiate or change pharmacologic or non-pharmacologic interventions during the course of the study
3. Individual is non-verbal (has no spoken language)
4. English is not the primary language.
5. Clinically critical Hypertension that requires medical attention
Minimum Eligible Age

50 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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UC Davis MIND Institute

UNKNOWN

Sponsor Role collaborator

UC Davis, Mini-Grant Geriatrics

UNKNOWN

Sponsor Role collaborator

University of California, Davis

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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University of California, Davis, MIND Institute

Sacramento, California, United States

Site Status

Countries

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United States

References

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Bradley RT, McCraty R, Atkinson M, Tomasino D, Daugherty A, Arguelles L. Emotion self-regulation, psychophysiological coherence, and test anxiety: results from an experiment using electrophysiological measures. Appl Psychophysiol Biofeedback. 2010 Dec;35(4):261-83. doi: 10.1007/s10484-010-9134-x.

Reference Type BACKGROUND
PMID: 20559707 (View on PubMed)

Lehrer PM, Vaschillo E, Vaschillo B. Resonant frequency biofeedback training to increase cardiac variability: rationale and manual for training. Appl Psychophysiol Biofeedback. 2000 Sep;25(3):177-91. doi: 10.1023/a:1009554825745.

Reference Type BACKGROUND
PMID: 10999236 (View on PubMed)

Lloyd A, Brett D, Wesnes K. Coherence training in children with attention-deficit hyperactivity disorder: cognitive functions and behavioral changes. Altern Ther Health Med. 2010 Jul-Aug;16(4):34-42.

Reference Type BACKGROUND
PMID: 20653294 (View on PubMed)

Hamlin AA, Sukharev D, Campos L, Mu Y, Tassone F, Hessl D, Nguyen DV, Loesch D, Hagerman RJ. Hypertension in FMR1 premutation males with and without fragile X-associated tremor/ataxia syndrome (FXTAS). Am J Med Genet A. 2012 Jun;158A(6):1304-9. doi: 10.1002/ajmg.a.35323. Epub 2012 Apr 23.

Reference Type BACKGROUND
PMID: 22528549 (View on PubMed)

Pagani M, Rimoldi O, Pizzinelli P, Furlan R, Crivellaro W, Liberati D, Cerutti S, Malliani A. Assessment of the neural control of the circulation during psychological stress. J Auton Nerv Syst. 1991 Jul;35(1):33-41. doi: 10.1016/0165-1838(91)90036-3.

Reference Type BACKGROUND
PMID: 1940025 (View on PubMed)

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. Circulation. 1996 Mar 1;93(5):1043-65. No abstract available.

Reference Type BACKGROUND
PMID: 8598068 (View on PubMed)

Lubar JF, Bahler WW. Behavioral management of epileptic seizures following EEG biofeedback training of the sensorimotor rhythm. Biofeedback Self Regul. 1976 Mar;1(1):77-104. doi: 10.1007/BF00998692.

Reference Type BACKGROUND
PMID: 825150 (View on PubMed)

Other Identifiers

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1151848

Identifier Type: -

Identifier Source: org_study_id

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