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Recovery of the cardiac autonomic nervous and vascular system after maximal cardiopulmonary exercise testing in recreational athletes



The body’s adaptation to physical exercise is modulated by sympathetic and parasympathetic (vagal) branches of the autonomic nervous system (ANS). Heart rate variability (HRV), the beat-to-beat variation of the heart, is a proxy measure for ANS activity, whereas blood pressure (BP) is an indicator for cardiovascular function. Impaired vagal activity and lower BP is already described after exercise. However, inconsistent results exist about how long vagal recovery takes and how long post-exercise hypotension persists. Therefore, the aim of this study was to assess HRV and BP 1 h after maximal cardiopulmonary exercise testing (CPET).

Patients and methods

HRV (Polar RS800CX), peripheral and central BP (Mobil-O-Graph®) were prospectively studied in 107 healthy volunteers (47 female, median age 29.0 years) in supine position, before and 60 min after maximal CPET.


One hour after terminating CPET measures of HRV were still impaired and post-exercise BP was significantly reduced suggesting an improved vascular function compared to pre levels. HRV parameters post-exercise were 34.7% (RMSSD), 67.2% (pNN50), 57.2% (HF), and 42.7% (LF) lower compared to pre-exercise levels (for all p < 0.001). Median reduction in BP was 5 mmHg for systolic BP (p < 0.001), and 4 mmHg for diastolic BP (p = 0.016) and central systolic post-exercise (p = 0.005).


One hour after terminating strenuous exercise, autonomic nervous regulation seems to be postponed which is reflected in reduced HRV, whereas the early recovery of the vasculature, post-exercise hypotension, is still preserved over the recovery period of 1 h.

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Fig. 1



Autonomic nervous system


Blood pressure


Cardiopulmonary exercise test


Diastolic blood pressure


High frequency


Heart rate variability


Low frequency


Normal to normal


Root mean square of successive differences


Systolic blood pressure


Peak oxygen uptake


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We thank our students Danja Schuster, Daniel Wieczorek and Lena Ziegler for their work and effort within the study.

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Correspondence to Jan Müller.

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The authors declare that they have no competing interests.



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Communicated by Massimo Pagani.

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Weberruss, H., Maucher, J., Oberhoffer, R. et al. Recovery of the cardiac autonomic nervous and vascular system after maximal cardiopulmonary exercise testing in recreational athletes. Eur J Appl Physiol 118, 205–211 (2018). https://doi.org/10.1007/s00421-017-3762-2

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  • Heart rate variability
  • Vagal activity
  • Sympathetic activity
  • Blood pressure
  • Post-exercise hypotension