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Sports Medicine

, Volume 49, Issue 5, pp 719–729 | Cite as

Exercise Frequency Determines Heart Rate Variability Gains in Older People: A Meta-Analysis and Meta-Regression

  • Jérémy RaffinEmail author
  • Jean-Claude Barthélémy
  • Caroline Dupré
  • Vincent Pichot
  • Mathieu Berger
  • Léonard Féasson
  • Thierry Busso
  • Antoine Da Costa
  • Alain Colvez
  • Claude Montuy-Coquard
  • Rémi Bouvier
  • Bienvenu Bongue
  • Frédéric Roche
  • David Hupin
Systematic Review

Abstract

Background

Previous studies have suggested that exercise training improves cardiac autonomic drive in young and middle-aged adults. In this study, we discuss the benefits for the elderly.

Objectives

We aimed to establish whether exercise still increases heart rate variability (HRV) beyond the age of 60 years, and to identify which training factors influence HRV gains in this population.

Methods

Interventional controlled and non-controlled studies were selected from the PubMed, Ovid, Cochrane and Google Scholar databases. Only interventional endurance training protocols involving healthy subjects aged 60 years and over, and measuring at least one heart rate global or parasympathetic index, such as the standard deviation of the normal-to-normal intervals (SDNN), total frequency power (Ptot), root mean square of successive differences between adjacent NN intervals (RMSSD), or high frequency power (HF) before and after the training intervention, were included. HRV parameters were pooled separately from short-term and 24 h recordings for analysis. Risks of bias were assessed using the Methodological Index for Non-Randomized Studies and the Cochrane risk of bias tool. A random-effects model was used to determine effect sizes (Hedges’ g) for changes, and heterogeneity was assessed using Q and I statistics.

Results

Twelve studies, seven of which included a control group, including 218 and 111 subjects, respectively (mean age 69.0 ± 3.2 and 68.6 ± 2.5), were selected for meta-analysis. Including the 12 studies demonstrated homogeneous significant effect sizes for short-term (ST)-SDNN and 24 h-SDNN, with effect sizes of 0.366 (95% CI 0.185–547) and 0.442 (95% CI 0.144–0.740), respectively. Controlled study analysis demonstrated homogeneous significant effect sizes for 24 h-SDNN with g = 0.721 (95% CI 0.184–1.257), and 24 h-Ptot with g = 0.731 (95% CI 0.195–1.267). Meta-regression analyses revealed positive relationships between ST-SDNN effect sizes and training frequency (\({\text{Tau}}_{\text{res}}^{2}\) = 0.000; \(I_{\text{res}}^{2}\) = 0.000; p = 0.0462).

Conclusion

This meta-analysis demonstrates a positive effect of endurance-type exercise on autonomic regulation in older adults. However, the selected studies expressed some risks of bias. We conclude that chronic endurance exercise leads to HRV improvements in a linear frequency–response relationship, encouraging the promotion of high-frequency training programmes in older adults.

Notes

Acknowledgements

The authors acknowledge Dominique Letourneau (President) and Rémi Poillerat and Marc Thillays (Heads of the Research, Innovation and Scientific Information Division) of the Avenir Foundation, as well as Paul Calmels and Jocelyn Dutil of the University Hospital of Saint-Etienne, for their contributions to this work.

Compliance with Ethical Standards

Funding

This work was supported by the Mutualité Française Loire—Haute Loire Services de Soins et d’Accompagnement des Mutualistes (SSAM), the Paul Bennetot Foundation of the Mutuelle Assurance des Travailleurs MUTualistes (MATMUT; Paris), the Aide à la REcherche médicale de proximité (AIRE; Saint-Etienne), and the Foundation of Jean Monnet University (Saint-Etienne).

Conflict of interest

Jérémy Raffin, Jean-Claude Barthélémy, Caroline Dupré, Vincent Pichot, Mathieu Berger, Léonard Féasson, Thierry Busso, Antoine Da Costa, Alain Colvez, Claude Montuy-Coquard, Rémi Bouvier, Bienvenu Bongue, Frédéric Roche and David Hupin declare they have no conflicts of interest with regard to the content of this article.

Supplementary material

40279_2019_1097_MOESM1_ESM.docx (112 kb)
Supplementary material 1 (DOCX 111 kb)
40279_2019_1097_MOESM1_ESM.docx (112 kb)
Supplementary material 1 (DOCX 111 kb)

References

  1. 1.
    Malik M. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Eur Heart J. 1996;1(2):151–81.Google Scholar
  2. 2.
    Dekker JM, Schouten EG, Klootwijk P, et al. Heart rate variability from short electrocardiographic recordings predicts mortality from all causes in middle-aged and elderly men. The Zutphen study. Am J Epidemiol. 1997;145(10):899–908.Google Scholar
  3. 3.
    Dekker JM, Crow RS, Folsom AR, et al. Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC Study. Atherosclerosis risk in communities. Circulation. 2000;102(11):1239–44.Google Scholar
  4. 4.
    Tsuji H, Larson MG, Venditti FJ, et al. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation. 1996;94(11):2850–5.Google Scholar
  5. 5.
    Hupin D, Edouard P, Gremeaux V, et al. Physical activity to reduce mortality risk. Eur Heart J. 2017;38(20):1534–7.Google Scholar
  6. 6.
    Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol. 2010;141(2):122–31.Google Scholar
  7. 7.
    Kleiger RE, Miller JP, Bigger JT, et al. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987;59(4):256–62.Google Scholar
  8. 8.
    Lampert R, Bremner JD, Su S, et al. Decreased heart rate variability is associated with higher levels of inflammation in middle-aged men. Am Heart J. 2008;156(4):759.e1–7.Google Scholar
  9. 9.
    Hamaad A, Lip GYH, MacFadyen RJ. Heart rate variability estimates of autonomic tone: relationship to mapping pathological and procedural stress responses in coronary disease. Ann Med. 2004;36(6):448–61.Google Scholar
  10. 10.
    Soares-Miranda L, Sattelmair J, Chaves P, et al. Physical activity and heart rate variability in older adults: the cardiovascular health study. Circulation. 2014;129(21):2100–10.Google Scholar
  11. 11.
    Kiviniemi AM, Tulppo MP, Eskelinen JJ, et al. Cardiac autonomic function and high-intensity interval training in middle-age men. Med Sci Sports Exerc. 2014;46(10):1960–7.Google Scholar
  12. 12.
    Pichot V, Roche F, Denis C, et al. Interval training in elderly men increases both heart rate variability and baroreflex activity. Clin Auton Res. 2005;15(2):107–15.Google Scholar
  13. 13.
    Madden KM, Levy WC, Stratton JK. Exercise training and heart rate variability in older adult female subjects. Clin Investig Med Med Clin Exp. 2006;29(1):20–8.Google Scholar
  14. 14.
    Levy WC, Cerqueira MD, Harp GD, et al. Effect of endurance exercise training on heart rate variability at rest in healthy young and older men. Am J Cardiol. 1998;82(10):1236–41.Google Scholar
  15. 15.
    McKune AJ, Peters B, Ramklass SS, et al. Autonomic cardiac regulation, blood pressure and cardiorespiratory fitness responses to different training doses over a 12 week group program in the elderly. Arch Gerontol Geriatr. 2017;70:130–5.Google Scholar
  16. 16.
    Chin A, Paw MJM, van Poppel MNM, Twisk JWR, et al. Once a week not enough, twice a week not feasible? Patient Educ Couns. 2006;63(1–2):205–14.Google Scholar
  17. 17.
    Verheyden B, Eijnde BO, Beckers F, et al. Low-dose exercise training does not influence cardiac autonomic control in healthy sedentary men aged 55–75 years. J Sports Sci. 2006;24(11):1137–47.Google Scholar
  18. 18.
    Sandercock GRH, Bromley PD, Brodie DA. Effects of exercise on heart rate variability: inferences from meta-analysis. Med Sci Sports Exerc. 2005;37(3):433–9.Google Scholar
  19. 19.
    Albinet CT, Abou-Dest A, André N, et al. Executive functions improvement following a 5-month aquaerobics program in older adults: role of cardiac vagal control in inhibition performance. Biol Psychol. 2016;115:69–77.Google Scholar
  20. 20.
    Filliau C, Younes M, Blanchard A-L, et al. Effect of “touch rugby” training on the cardiovascular autonomic control in sedentary subjects. Int J Sports Med. 2015;36(07):567–72.Google Scholar
  21. 21.
    Wanderley FAC, Moreira A, Sokhatska O, et al. Differential responses of adiposity, inflammation and autonomic function to aerobic versus resistance training in older adults. Exp Gerontol. 2013;48(3):326–33.Google Scholar
  22. 22.
    Karavirta L, Costa MD, Goldberger AL, et al. Heart rate dynamics after combined strength and endurance training in middle-aged women: heterogeneity of responses. PLoS One. 2013;8(8):e72664.Google Scholar
  23. 23.
    Earnest CP, Blair SN, Church TS. Heart rate variability and exercise in aging women. J Womens Health. 2012;21(3):334–9.Google Scholar
  24. 24.
    Cozza IC, Di Sacco THR, Mazon JH, et al. Physical exercise improves cardiac autonomic modulation in hypertensive patients independently of angiotensin-converting enzyme inhibitor treatment. Hypertens Res. 2012;35(1):82–7.Google Scholar
  25. 25.
    Cornelissen VA, Goetschalckx K, Verheyden B, et al. Effect of endurance training on blood pressure regulation, biomarkers and the heart in subjects at a higher age: blood pressure regulation and the heart. Scand J Med Sci Sports. 2011;21(4):526–34.Google Scholar
  26. 26.
    Cornelissen VA, Verheyden B, Aubert AE, et al. Effects of aerobic training intensity on resting, exercise and post-exercise blood pressure, heart rate and heart-rate variability. J Hum Hypertens. 2010;24(3):175–82.Google Scholar
  27. 27.
    Albinet CT, Boucard G, Bouquet CA, et al. Increased heart rate variability and executive performance after aerobic training in the elderly. Eur J Appl Physiol. 2010;109(4):617–24.Google Scholar
  28. 28.
    Collier SR, Kanaley JA, Carhart R Jr, et al. Cardiac autonomic function and baroreflex changes following 4 weeks of resistance versus aerobic training in individuals with pre-hypertension. Acta Physiol. 2009;195(3):339–48.Google Scholar
  29. 29.
    Earnest CP, Lavie CJ, Blair SN, et al. Heart rate variability characteristics in sedentary postmenopausal women following six months of exercise training: the DREW study. PLoS One. 2008;3(6):e2288.Google Scholar
  30. 30.
    Audette JF, Jin YS, Newcomer R, et al. Tai chi versus brisk walking in elderly women. Age Ageing. 2006;35(4):388–93.Google Scholar
  31. 31.
    Okazaki K. Dose-response relationship of endurance training for autonomic circulatory control in healthy seniors. J Appl Physiol. 2005;99(3):1041–9.Google Scholar
  32. 32.
    Foster C, Wright G, Battista RA, et al. Training in the aging athlete. Curr Sports Med Rep. 2007;6(3):200–6.Google Scholar
  33. 33.
    Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.Google Scholar
  34. 34.
    Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.Google Scholar
  35. 35.
    Slim K, Nini E, Forestier D, et al. Methodological Index for Non-Randomized Studies (MINORS): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–6.Google Scholar
  36. 36.
    World Health Organization. Mental health of older adults. http://www.who.int/mediacentre/factsheets/fs381/en/. Accessed 22 Oct 2017.
  37. 37.
    Tentolouris N, Argyrakopoulou G, Katsilambros N. Perturbed autonomic nervous system function in metabolic syndrome. Neuromol Med. 2008;10(3):169–78.Google Scholar
  38. 38.
    Buccelletti E, Gilardi E, Scaini E, et al. Heart rate variability and myocardial infarction: systematic literature review and metanalysis. Eur Rev Med Pharmacol Sci. 2009;13(4):299–307.Google Scholar
  39. 39.
    Licht CMM, Vreeburg SA, van Reedt Dortland AKB, et al. Increased sympathetic and decreased parasympathetic activity rather than changes in hypothalamic-pituitary-adrenal axis activity is associated with metabolic abnormalities. J Clin Endocrinol Metab. 2010;95(5):2458–66.Google Scholar
  40. 40.
    Christensen JH. Cardiac autonomic dysfunction in hemodialysis patients assessed by heart rate variability. Miner Urol Nefrol. 2012;64(3):191–8.Google Scholar
  41. 41.
    Licht CMM, de Geus EJC, Penninx BWJH. Dysregulation of the autonomic nervous system predicts the development of the metabolic syndrome. J Clin Endocrinol Metab. 2013;98(6):2484–93.Google Scholar
  42. 42.
    Seibert E, Zohles K, Ulrich C, et al. Association between autonomic nervous dysfunction and cellular inflammation in end-stage renal disease. BMC Cardiovasc Disord. 2016;16(1):210.Google Scholar
  43. 43.
    Antoine S, Vaidya G, Imam H, et al. Pathophysiologic mechanisms in heart failure: role of the sympathetic nervous system. Am J Med Sci. 2017;353(1):27–30.Google Scholar
  44. 44.
    Ueno LM, Moritani T. Effects of long-term exercise training on cardiac autonomic nervous activities and baroreflex sensitivity. Eur J Appl Physiol. 2003;89(2):109–14.Google Scholar
  45. 45.
    Weippert M, Kumar M, Kreuzfeld S, et al. Comparison of three mobile devices for measuring RR intervals and heart rate variability: polar S810i, Suunto t6 and an ambulatory ECG system. Eur J Appl Physiol. 2010;109(4):779–86.Google Scholar
  46. 46.
    Furlan R, Piazza S, Dell’Orto S, et al. Early and late effects of exercise and athletic training on neural mechanisms controlling heart rate. Cardiovasc Res. 1993;27(3):482–8.Google Scholar
  47. 47.
    Rajendra Acharya U, Kannathal N, Mei Hua L, et al. Study of heart rate variability signals at sitting and lying postures. J Bodyw Mov Ther. 2005;9(2):134–41.Google Scholar
  48. 48.
    Berntson GG, Bigger JT Jr, Eckberg DL, Grossman P, Kaufmann PG, Malik M. Heart rate variability: origins, methods, and interpretive caveats. Pyschophysiology. 1997;34(6):623–48.Google Scholar
  49. 49.
    Hedges LV. Distribution theory for Glass’s estimator of effect size and related estimators. J Educ Stat. 1981;6(2):107–28.Google Scholar
  50. 50.
    Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: L. Erlbaum Associates; 1988. p. 567.Google Scholar
  51. 51.
    Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63.Google Scholar
  52. 52.
    Schuit AJ, Van Amelsvoort LG, Verheij TC, et al. Exercise training and heart rate variability in older people. Med Sci Sports Exerc. 1999;31(6):816–21.Google Scholar
  53. 53.
    Stein PK, Ehsani AA, Domitrovich PP, et al. Effect of exercise training on heart rate variability in healthy older adults. Am Heart J. 1999;138(3):567–76.Google Scholar
  54. 54.
    Perini R, Fisher N, Veicsteinas A, et al. Aerobic training and cardiovascular responses at rest and during exercise in older men and women. Med Sci Sports Exerc. 2002;34(4):700–8.Google Scholar
  55. 55.
    Gulli G, Cevese A, Cappelletto P, et al. Moderate aerobic training improves autonomic cardiovascular control in older women. Clin Auton Res. 2003;13(3):196–202.Google Scholar
  56. 56.
    Carter JB, Banister EW, Blaber AP. The effect of age and gender on heart rate variability after endurance training. Med Sci Sports Exerc. 2003;35(8):1333–40.Google Scholar
  57. 57.
    Cadore E. Strength and endurance training prescription in healthy and frail elderly. Aging Dis. 2014;5(3):183.Google Scholar
  58. 58.
    Stein PK, Domitrovich PP, Hui N, et al. Sometimes higher heart rate variability is not better heart rate variability: results of graphical and nonlinear analyses. J Cardiovasc Electrophysiol. 2005;16(9):954–9.Google Scholar
  59. 59.
    Sharma V. Deterministic chaos and fractal complexity in the dynamics of cardiovascular behavior: perspectives on a new frontier. Open Cardiovasc Med J. 2009;3:110–23.Google Scholar
  60. 60.
    Lipsitz LA, Goldberger AL. Loss of ‘complexity’ and aging: potential applications of fractals and chaos theory to senescence. JAMA. 1992;267(13):1806–9.Google Scholar
  61. 61.
    Nicolini P, Ciulla MM, Asmundis CD, et al. The prognostic value of heart rate variability in the elderly, changing the perspective: from sympathovagal balance to chaos theory: the prognostic value HRV in the elderly. Pacing Clin Electrophysiol. 2012;35(5):621–37.Google Scholar
  62. 62.
    Kleiger RE, Bigger JT, Bosner MS, et al. Stability over time of variables measuring heart rate variability in normal subjects. Am J Cardiol. 1991;68(6):626–30.Google Scholar
  63. 63.
    Herzig D, Asatryan B, Brugger N, et al. The association between endurance training and heart rate variability: the confounding role of heart rate. Front Physiol. 2018;9:756.Google Scholar
  64. 64.
    Armstrong LE, VanHeest JL. The unknown mechanism of the overtraining syndrome. Sports Med. 2002;32(3):185–209.Google Scholar
  65. 65.
    Kreider RB, O’Toole ML, Fry AC, et al. Overtraining in sport. Med Sci Sports Exerc. 1998;30(5):225.Google Scholar
  66. 66.
    Fry RW, Morton AR, Keast D. Overtraining in athletes. An update. Sports Med. 1991;12(1):32–65.Google Scholar
  67. 67.
    Banister EW. Modeling elite athletic performance. In: MacDougall JD, Wenger HA, Green HJ, editors. Physiological testing of the high-performance athlete. 2nd ed. Champaign: Human Kinetics; 1991. p. 403–25.Google Scholar
  68. 68.
    Tsuji H, Venditti FJ, Manders ES, et al. Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study. Circulation. 1994;90(2):878–83.Google Scholar
  69. 69.
    Huikuri HV, Mäkikallio TH, Airaksinen KE, et al. Power–law relationship of heart rate variability as a predictor of mortality in the elderly. Circulation. 1998;97(20):2031–6.Google Scholar
  70. 70.
    Almeida-Santos MA, Barreto-Filho JA, Oliveira JLM, et al. Aging, heart rate variability and patterns of autonomic regulation of the heart. Arch Gerontol Geriatr. 2016;63:1–8.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jérémy Raffin
    • 1
    • 2
    • 3
    Email author
  • Jean-Claude Barthélémy
    • 1
    • 3
  • Caroline Dupré
    • 1
    • 6
  • Vincent Pichot
    • 1
    • 3
  • Mathieu Berger
    • 1
  • Léonard Féasson
    • 3
    • 4
  • Thierry Busso
    • 4
  • Antoine Da Costa
    • 1
    • 5
  • Alain Colvez
    • 6
  • Claude Montuy-Coquard
    • 2
  • Rémi Bouvier
    • 2
  • Bienvenu Bongue
    • 6
    • 7
  • Frédéric Roche
    • 1
    • 3
  • David Hupin
    • 1
    • 3
  1. 1.Univ Lyon, UJM-Saint-Etienne Autonomic Nervous System Research Laboratory, EA 4607 SNA-EPISSaint-ÉtienneFrance
  2. 2.Loire-Haute Loire Mutualité SSAMSaint-ÉtienneFrance
  3. 3.Department of Clinical and Exercise PhysiologyUniversity Hospital of Saint-EtienneSaint-Étienne Cedex 2France
  4. 4.Univ Lyon, UJM-Saint-Etienne Inter-University Laboratory of Human Movement BiologySaint-ÉtienneFrance
  5. 5.Department of CardiologyUniversity Hospital of Saint-EtienneSaint-Étienne Cedex 2France
  6. 6.National Centre for Health Examination Prevention, CETAFSaint-ÉtienneFrance
  7. 7.Chaire Santé des Ainés, Univ. LyonSaint-ÉtienneFrance

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