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

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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.

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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.

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Authors and Affiliations

  1. Univ Lyon, UJM-Saint-Etienne Autonomic Nervous System Research Laboratory, EA 4607 SNA-EPIS, 42023, Saint-Étienne, France

    Jérémy Raffin, Jean-Claude Barthélémy, Caroline Dupré, Vincent Pichot, Mathieu Berger, Antoine Da Costa, Frédéric Roche & David Hupin

  2. Loire-Haute Loire Mutualité SSAM, 42100, Saint-Étienne, France

    Jérémy Raffin, Claude Montuy-Coquard & Rémi Bouvier

  3. Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, 42055, Saint-Étienne Cedex 2, France

    Jérémy Raffin, Jean-Claude Barthélémy, Vincent Pichot, Léonard Féasson, Frédéric Roche & David Hupin

  4. Univ Lyon, UJM-Saint-Etienne Inter-University Laboratory of Human Movement Biology, EA 7424, 42023, Saint-Étienne, France

    Léonard Féasson & Thierry Busso

  5. Department of Cardiology, University Hospital of Saint-Etienne, 42055, Saint-Étienne Cedex 2, France

    Antoine Da Costa

  6. National Centre for Health Examination Prevention, CETAF, 42100, Saint-Étienne, France

    Caroline Dupré, Alain Colvez & Bienvenu Bongue

  7. Chaire Santé des Ainés, Univ. Lyon, Saint-Étienne, France

    Bienvenu Bongue

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  1. Jérémy Raffin
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Correspondence to Jérémy Raffin.

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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.

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Raffin, J., Barthélémy, JC., Dupré, C. et al. Exercise Frequency Determines Heart Rate Variability Gains in Older People: A Meta-Analysis and Meta-Regression. Sports Med 49, 719–729 (2019). https://doi.org/10.1007/s40279-019-01097-7

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