Koster M1
1Hochschule Fulda, Pflege und Gesundheit, Fulda, Germany
Background: Heart rate variability (HRV) is a noninvasive, practical and reproducible measure of autonomic nervous system function. Patients in different clinical conditions of coronary heart disease reveal a reduced cardiac autonomic modulation, which is associated with further cardiac events and rehospitalization. Exercise training is the most recommended complimentary therapy for patients with cardiovascular disease.
Purpose: The primary objective of this systematic review and metaanalysis was to determine the extent of the effectiveness of exercise training on autonomic heart function. Public confounders of the analysis were controlled by metaregression.
Methods: Randomised and quasi-randomised controlled trails that compared exercise training with no or sham intervention in any clinical condition of coronary heart disease were included in the review. The author searched the Cochrane database of systematic review, Cochrane central register of controlled trials (CENTRAL), PubMed, CINAHL, PsycINFO, Web of Science, Physiotherapy Evidence Database (PEDro), reference lists and conference proceedings containing an observation period from 1963/01/01 to 2015/08/31. Search results were examined by the author to identify studies meeting the inclusion criteria. Mean effect size (hedges´s g) and standard deviation (SD) was calculated using random effects model in the well-established parameters of heart rate variability HF, LF/HF (primary endpoints) and LF, SDNN (secondary endpoints) for each category and subcategory to evaluate the real gain of exercise training in different clinical conditions of coronary heart disease.
Results: 26 studies with a total of 1247 participants were included in the metaanalysis. Between- study variations limited the extent to which studies could be compared. However, exercise training was found to have remarkable benefits on parasympathetic activity (HF) with an effect size of 0.572 (adjusted for publication bias effect size increase to 0.657). The sympathetic-vagal balance (LF/HF) shifted towards a higher parasympathetic level (effect size -0.269; adjusted for publication bias effect size increased to -0.409). Referring to the secondary endpoints the sympathetic activity level (LF) revealed no significant differences between intervention and control. Total heart rate variability (SDNN) delivered an effect size of 0.420. Results by metaregression evidenced patients after myocardial infarction to have a possible five times higher benefit from exercise training intervention on parasympathetic activity than patients in any other clinical conditions of coronary heart disease.
Conclusion(s): The available findings of this systematic review and metaanalysis underpinning the results of previous studies. Exercise training is one of the most valuable complimentary therapy for regulation of the autonomic heart function. For the first time it succeeded to evaluate the extent of exercise training intervention on that regulation ability in different clinical condition of coronary heart disease.
Implications: At the present time less than 30% of patients with coronary heart disease in Germany are engaged in a structured exercise training program. The findings of this metaanalysis serve a motivational basis for these patients to regulate their autonomic heart function by doing exercise in a favorable direction and prevent them from further cardiac events.
Keywords: exercise training, autonomic heart function, heart rate variability
Funding acknowledgements: None
Purpose: The primary objective of this systematic review and metaanalysis was to determine the extent of the effectiveness of exercise training on autonomic heart function. Public confounders of the analysis were controlled by metaregression.
Methods: Randomised and quasi-randomised controlled trails that compared exercise training with no or sham intervention in any clinical condition of coronary heart disease were included in the review. The author searched the Cochrane database of systematic review, Cochrane central register of controlled trials (CENTRAL), PubMed, CINAHL, PsycINFO, Web of Science, Physiotherapy Evidence Database (PEDro), reference lists and conference proceedings containing an observation period from 1963/01/01 to 2015/08/31. Search results were examined by the author to identify studies meeting the inclusion criteria. Mean effect size (hedges´s g) and standard deviation (SD) was calculated using random effects model in the well-established parameters of heart rate variability HF, LF/HF (primary endpoints) and LF, SDNN (secondary endpoints) for each category and subcategory to evaluate the real gain of exercise training in different clinical conditions of coronary heart disease.
Results: 26 studies with a total of 1247 participants were included in the metaanalysis. Between- study variations limited the extent to which studies could be compared. However, exercise training was found to have remarkable benefits on parasympathetic activity (HF) with an effect size of 0.572 (adjusted for publication bias effect size increase to 0.657). The sympathetic-vagal balance (LF/HF) shifted towards a higher parasympathetic level (effect size -0.269; adjusted for publication bias effect size increased to -0.409). Referring to the secondary endpoints the sympathetic activity level (LF) revealed no significant differences between intervention and control. Total heart rate variability (SDNN) delivered an effect size of 0.420. Results by metaregression evidenced patients after myocardial infarction to have a possible five times higher benefit from exercise training intervention on parasympathetic activity than patients in any other clinical conditions of coronary heart disease.
Conclusion(s): The available findings of this systematic review and metaanalysis underpinning the results of previous studies. Exercise training is one of the most valuable complimentary therapy for regulation of the autonomic heart function. For the first time it succeeded to evaluate the extent of exercise training intervention on that regulation ability in different clinical condition of coronary heart disease.
Implications: At the present time less than 30% of patients with coronary heart disease in Germany are engaged in a structured exercise training program. The findings of this metaanalysis serve a motivational basis for these patients to regulate their autonomic heart function by doing exercise in a favorable direction and prevent them from further cardiac events.
Keywords: exercise training, autonomic heart function, heart rate variability
Funding acknowledgements: None
Topic: Cardiorespiratory
Ethics approval required: No
Institution: Hochschule Fulda
Ethics committee: Hochschule Fulda
Reason not required: non invasive, literature review
All authors, affiliations and abstracts have been published as submitted.
