Effects of exercise on heart rate variability: Inferences from meta-analysis

Introduction: Chronic exercise training produces a resting bradycardia that is thought to be due partly to enhanced vagal modulation. Purpose: The aim of the present study was to determine the effects of exercise training on heart rate and measures of heart rate variability associated with vagal cardiac modulation and to quantify the relationship between changes in these measures. Methods: A random effects model of effect size (d) for change in high frequency (HF) power and RR interval was calculated. Within-group heterogeneity was assessed using the Q statistic. Where heterogenous effects were found, subgroup analyses were performed using the between-group Q statistic. Results: A meta-analysis of 13 studies measuring HE (N = 322 cases) produced an overall effect size of d 0.48 (C.I. 0.26-0.70, P = 0.00003). Twelve studies (298 cases) reported a change in RR interval with an overall effect size of d 0.75 (C.I. 0.51-0.96, P < 0.00001). Effect sizes for RR interval data were significantly heterogenous. Subgroup analysis revealed significantly smaller responses of RR interval to training in older subjects (P < 0.1). Effect sizes for change in HF were homogenous, although a trend toward an attenuated response to training was exhibited in older subjects (P > 0.10). Linear, quadratic, and cubic fits all revealed weak (P > 0.05) relationships between effect sizes for change in HF and RR interval. Discussion: Exercise training results in significant increases in RR interval and HF power. These changes are influenced by study population age. The smaller effect size for HF and weak relationship between HF and RR interval suggest factors additional to increased vagal modulation are responsible for training bradycardia.