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



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.


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.


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.


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).


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.



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


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)


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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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