Objective: The purposed of this study was to valuate the effect of osteopathic manipulative treatment (OMT) on flow-mediated dilation and heart rate variability of patients with heart failure.

Background: Osteopathic manipulative treatment modulates both the vascular and autonomic nervous system (ANS) in healthy volunteers. However, the acute and time-course effects of the OMT on patients with an overactive ANS remain unclear.

Methods: This randomized controlled trial study included 20 patients with heart failure aged 50 to 60 years, allocated to a single session of OMT (base of the skull, retromaxillary region, heart, and thoracic duct) or sham. Flow-mediated dilation (FMD) at the brachial artery, hemodynamic measures, and heart rate variability were assessed in 3 periods (baseline, immediately after the intervention, and after 15 minutes). Multivariate analysis of variance procedure was used to compare intervention and periods.

Results: The OMT group had a greater FMD modulation compared with the sham (FMD,% = 9.5 vs. -5.6, 95% confidence interval (CI): [6.6, -12.35] vs. [-14.25, 2.8]; p = 0.001) and grater peak diameter (PD, mm = 0.77 vs -0.16 mm, 95% CI: [0.31,-1.24] vs [-0.63, 0.29]; P = 0.001), suggesting an important acute and time-course vascular effect from OMT. We also found some relevant heart rate variability modulation after 15 minutes from OMT: high frequency (HF, ms² = 295 vs -354, 95% CI: [144.2, -769]; P = .001) and low frequency (LF, ms²) = 670 vs 775, 95% CI: [-98, 3591]; P = .001), suggesting a time-course ANS modulation after OMT.

Conclusions: Osteopathic manipulative treatment was effective at increasing brachial blood flow and stimulating the vagal system in patients with heart failure. Moreover, vascular changes seem to precede the autonomic modulation.

Author keywords: Osteopathic Manipulative Treatment; Heart Failure; Autonomic Nervous System; Vasodilatation

Author affiliations: FA: Madrid Osteopathic School, Brasília, DF, Brazil; ACGBdL, GFBC, GCJ: Health Sciences and Technology Program, University of Brasília, Brasília, DF, Brazil; MLDS: Health Sciences Unit, Federal University of Goiás, Jataí, GO, Brazil; AMC: Physical Therapy Department, Federal University of São Carlos, São Carlos, SP, Brazil; LPC: Physical Therapy Division, University of Miami, Miami, Florida; GC: Centro Universitário de Anápolis, Anápolis, Anápolis, GO, Brazil
Corresponding author: Fellipe Amatuzzi—famatuzzi@gmail.com

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