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Clinical Autonomic Research
Published in: Clinical Autonomic Research 2/2021

01-04-2021 | Arterial Diseases | Review Article

Exercise-based cardiac rehabilitation and parasympathetic function in patients with coronary artery disease: a systematic review and meta-analysis

Authors: Agustín Manresa-Rocamora, Fernando Ribeiro, José Manuel Sarabia, Javier Íbias, Nórton Luís Oliveira, Francisco José Vera-García, Manuel Moya-Ramón

Published in: Clinical Autonomic Research | Issue 2/2021

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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.
Appendix
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Metadata
Title
Exercise-based cardiac rehabilitation and parasympathetic function in patients with coronary artery disease: a systematic review and meta-analysis
Authors
Agustín Manresa-Rocamora
Fernando Ribeiro
José Manuel Sarabia
Javier Íbias
Nórton Luís Oliveira
Francisco José Vera-García
Manuel Moya-Ramón
Publication date
01-04-2021
Publisher
Springer Berlin Heidelberg
Published in
Clinical Autonomic Research / Issue 2/2021
Print ISSN: 0959-9851
Electronic ISSN: 1619-1560
DOI
https://doi.org/10.1007/s10286-020-00687-0

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