Agustín Manresa-Rocamora1, Fernando Ribeiro2, José Manuel Sarabia1,3, Javier Íbias4, Nórton Luís Oliveira5, Francisco José Vera-García1, Manuel Moya-Ramón6,7. 1. Sport Research Centre, Miguel Hernandez University, Avenida de la Universidad s/n, 03202, Elche, Spain. 2. School of Health Sciences and Institute of Biomedicine-iBiMED, University of Aveiro, Building 30, Agras do Crasto-Campus Universita ́rio de Santiago, 3810-193, Aveiro, Portugal. 3. Department of Sport Sciences, Miguel Hernandez University, Elche, Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain. 4. Department of Behavioral Sciences and Methodology, Faculty of Psychology, National Distance Education University (UNED), Juan del Rosal 10, 28040, Madrid, Spain. 5. National Institute of Science and Technology for Health Technology Assessment (IATS/HCPA) and Exercise Pathophysiology Laboratory, Hospital de Clínicas de Porto Alegre, Clinical Research Center, Rua Ramiro Barcelos 2350, Porto Alegre, RS, Brazil. 6. Sport Research Centre, Miguel Hernandez University, Avenida de la Universidad s/n, 03202, Elche, Spain. mmoya@umh.es. 7. Department of Sport Sciences, Miguel Hernandez University, Elche, Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain. mmoya@umh.es.
Abstract
PURPOSE: The effects of exercise-based cardiac rehabilitation (CR) on parasympathetic modulation are controversial. This systematic review and meta-analysis aims to (a) determine the effect of exercise-based CR on heart-rate-derived indices associated with cardiac parasympathetic modulation in resting and post-exercise conditions in coronary artery disease (CAD) patients and (b) identify the possible moderator variables of the effect of exercise-based CR on parasympathetic modulation. METHODS: We searched CENTRAL and Web of Science up to November 2018 for the following terms: adult CAD patients, controlled exercise-based CR interventions and parasympathetic modulation measured in resting (vagal-related heart rate variability [HRV] indices of the root mean square of the differences in successive in RR interval [RMSSD] and high frequency [HF]) and post-exercise (heart rate recovery [HRR]) pre- and post-intervention. We estimated a random-effects model of standardised mean difference (SMD) and mean difference (MD) for vagal-related HRV indices and HRR, respectively. We assessed the influence of categorical and continuous variables. RESULTS: The overall effect size showed significant differences in RMSSD (SMD+ = 0.30; 95% confidence interval [CI] = 0.12-0.49) and HRR (MD+ = 5.35; 95% CI = 4.08-6.61 bpm) in favour of the exercise-based CR group. The overall effect size showed no differences in HF between groups (SMD+ = 0.14; 95% CI, -0.12-0.40). Heterogeneity analyses reached statistical significance, with high heterogeneity for HF (p < 0.001; I2 = 70%) and HRR (p < 0.001; I2 = 85%). Analysis of the moderator variables showed that the effect on HRR is greater in young patients (p = 0.008) and patients treated with percutaneous intervention (p = 0.020). CONCLUSIONS: Exercise-based CR improves the post-exercise parasympathetic function, with greater effects in younger CAD patients and in those who were revascularised with percutaneous intervention. The effects on resting parasympathetic function are more controversial due to methodological inconsistencies in measuring HRV, with the use of RMSSD recommended instead of HF because its results show higher consistency. Future studies involving women, focusing on methodological issues, and performing other training methods are needed to increase our knowledge about this topic.
PURPOSE: The effects of exercise-based cardiac rehabilitation (CR) on parasympathetic modulation are controversial. This systematic review and meta-analysis aims to (a) determine the effect of exercise-based CR on heart-rate-derived indices associated with cardiac parasympathetic modulation in resting and post-exercise conditions in coronary artery disease (CAD) patients and (b) identify the possible moderator variables of the effect of exercise-based CR on parasympathetic modulation. METHODS: We searched CENTRAL and Web of Science up to November 2018 for the following terms: adult CADpatients, controlled exercise-based CR interventions and parasympathetic modulation measured in resting (vagal-related heart rate variability [HRV] indices of the root mean square of the differences in successive in RR interval [RMSSD] and high frequency [HF]) and post-exercise (heart rate recovery [HRR]) pre- and post-intervention. We estimated a random-effects model of standardised mean difference (SMD) and mean difference (MD) for vagal-related HRV indices and HRR, respectively. We assessed the influence of categorical and continuous variables. RESULTS: The overall effect size showed significant differences in RMSSD (SMD+ = 0.30; 95% confidence interval [CI] = 0.12-0.49) and HRR (MD+ = 5.35; 95% CI = 4.08-6.61 bpm) in favour of the exercise-based CR group. The overall effect size showed no differences in HF between groups (SMD+ = 0.14; 95% CI, -0.12-0.40). Heterogeneity analyses reached statistical significance, with high heterogeneity for HF (p < 0.001; I2 = 70%) and HRR (p < 0.001; I2 = 85%). Analysis of the moderator variables showed that the effect on HRR is greater in young patients (p = 0.008) and patients treated with percutaneous intervention (p = 0.020). CONCLUSIONS: Exercise-based CR improves the post-exercise parasympathetic function, with greater effects in younger CADpatients and in those who were revascularised with percutaneous intervention. The effects on resting parasympathetic function are more controversial due to methodological inconsistencies in measuring HRV, with the use of RMSSD recommended instead of HF because its results show higher consistency. Future studies involving women, focusing on methodological issues, and performing other training methods are needed to increase our knowledge about this topic.
Authors: Ali Morshedi-Meibodi; Martin G Larson; Daniel Levy; Christopher J O'Donnell; Ramachandran S Vasan Journal: Am J Cardiol Date: 2002-10-15 Impact factor: 2.778
Authors: Heikki V Huikuri; Derek V Exner; Katherine M Kavanagh; Sandeep G Aggarwal; L Brent Mitchell; Marc D Messier; Daniel Becker; Robert S Sheldon; Poul-Erik Bloch Thomsen Journal: Heart Rhythm Date: 2009-11-10 Impact factor: 6.343
Authors: T G Farrell; Y Bashir; T Cripps; M Malik; J Poloniecki; E D Bennett; D E Ward; A J Camm Journal: J Am Coll Cardiol Date: 1991-09 Impact factor: 24.094
Authors: Lindsey Anderson; Neil Oldridge; David R Thompson; Ann-Dorthe Zwisler; Karen Rees; Nicole Martin; Rod S Taylor Journal: J Am Coll Cardiol Date: 2016-01-05 Impact factor: 24.094
Authors: Grace Dibben; James Faulkner; Neil Oldridge; Karen Rees; David R Thompson; Ann-Dorthe Zwisler; Rod S Taylor Journal: Cochrane Database Syst Rev Date: 2021-11-06
Authors: Agustín Manresa-Rocamora; José Manuel Sarabia; Silvia Guillen-Garcia; Patricio Pérez-Berbel; Beatriz Miralles-Vicedo; Enrique Roche; Néstor Vicente-Salar; Manuel Moya-Ramón Journal: Int J Environ Res Public Health Date: 2022-08-23 Impact factor: 4.614
Authors: Francesco Giallauria; Giuseppe Vitale; Mario Pacileo; Anna Di Lorenzo; Alessandro Oliviero; Francesco Passaro; Roberta Calce; Alessandro Parlato; Crescenzo Testa; Giuseppe D'Ambrosio; Giuseppe Romano; Francesco Clemenza; Silvia Sarullo; Elio Venturini; Marco Gentile; Cinzia Nugara; Gabriella Iannuzzo; Antonello D'Andrea; Carlo Vigorito; Filippo M Sarullo Journal: J Clin Med Date: 2020-06-17 Impact factor: 4.964
Authors: Carles Blasco-Peris; Laura Fuertes-Kenneally; Tomas Vetrovsky; José Manuel Sarabia; Vicente Climent-Paya; Agustín Manresa-Rocamora Journal: Int J Environ Res Public Health Date: 2022-03-15 Impact factor: 3.390