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Int J Sports Med 2022; 43(08): 679-686
DOI: 10.1055/a-1524-2421
Review

Effects of Physical Training on Heart Rate Variability in Children and Adolescents with Chronic Diseases: A Systematic Review and Meta-analysis

Agustín Jesús Estévez-González
1   Faculty of Sport Sciences, Universidad Europea de Madrid Campus de Villaviciosa de Odón, Madrid, Spain
,
Margarita Pérez-Ruiz
1   Faculty of Sport Sciences, Universidad Europea de Madrid Campus de Villaviciosa de Odón, Madrid, Spain
,
Fernando Cobo-Vicente
1   Faculty of Sport Sciences, Universidad Europea de Madrid Campus de Villaviciosa de Odón, Madrid, Spain
,
Márcio Vinícius Fagundes Donadio 
2   Laboratory of Pediatric Physical Activity, Infant Center, PUCRS, Porto Alegre, Brazil. Visiting Professor (2019-2020), Universidad Europea de Madrid, Madrid, Spain.
,
Eneko Larumbe-Zabala
1   Faculty of Sport Sciences, Universidad Europea de Madrid Campus de Villaviciosa de Odón, Madrid, Spain
› Author Affiliations Funding This study was funded by Catedra Fundación Asisa-UE (ref. 2018/ UEM50), XIX Premios Neumomadrid 2019 and Beca Cantera de Investigación Santander - Fundación de la Universidad Europea 2020. MVFD would like to thank Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) – finance code 001, and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) for financial support.
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Abstract

This study analyzed the effects of physical training programs on heart rate variability, as a measure of sympathovagal balance, in children and adolescents with chronic diseases. Relevant articles were systematically searched in Pubmed, Science Direct, Web of Science, Scopus, Google Scholar and Embase scientific databases. We performed a meta-analysis using an inverse variance heterogeneity model. Effect size calculation was based on the standardized mean differences between pre- and post-intervention assessments, assuring at least a single-group repeated-measures model for each extracted group. Ten studies (252 participants) were included, seven in obese subjects, two in type-1 diabetes, and one in cerebral palsy. When time-domain variables were analyzed, exercise was found to moderately increase RMSSD (SMD=0.478; 95%CI: 0.227 to 0.729; p<0.001), SDNN (SMD=0.367; 95%CI: 0.139 to 0.595; p=0.002) and pNN50 (SMD=0.817; 95%CI: 0.139 to 0.595; p=0.002). As for frequency-domain variables, exercise presented a moderate increasing effect on HF (SMD=0.512; 95%CI: 0.240 to 0.783; p<0.001), a negligible effect for LF (SMD=0.077; 95%CI: –0.259 to 0.412; p<0.001) and a non-significant reduction for LF/HF (SMD=–0.519; 95%CI: -1.162 to 0.124; p=0.114). In conclusion, physical training programs are able to modulate heart rate variability in children and adolescents with chronic diseases, affecting mainly the time-domain variables.

Key words

autonomic function - exercise - pediatrics - sympathovagal balance - adolescent - heart rate

Supplementary Material



Publication History

Received: 05 November 2020

Accepted: 27 May 2021

Article published online:
02 February 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Zalewski P, Słomko J, Zawadka-Kunikowska M. Autonomic dysfunction and chronic disease. Br Med Bull 2018; 128: 61-74
    CrossrefPubMedSearch in Google Scholar
  • 2 Fatisson J, Oswald V, Lalonde F. Influence diagram of physiological and environmental factors affecting heart rate variability: An extended literature overview. Heart Int 2016; 11: e32-e40
    CrossrefPubMedSearch in Google Scholar
  • 3 Sessa F, Anna V, Messina G. et al. Heart rate variability as predictive factor for sudden cardiac death. Aging 2018; 10: 166-177
    CrossrefPubMedSearch in Google Scholar
  • 4 Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: An integrative review of the heart’s anatomy and heart rate variability. Front Psychol 2014; 5: 1040
    CrossrefPubMedSearch in Google Scholar
  • 5 McCraty R, Shaffer F. Heart rate variability: New perspectives on physiological mechanisms, assessment of self-regulatory capacity, and health risk. Glob Adv Health Med 2015; 4: 46-61
    CrossrefPubMedSearch in Google Scholar
  • 6 Almeida-Santos MA, Barreto-Filho JA, Oliveira JLM. et al. Aging, heart rate variability and patterns of autonomic regulation of the heart. Arch Gerontol Geriatr 2016; 63: 1-8
    CrossrefPubMedSearch in Google Scholar
  • 7 Bellenger CR, Fuller JT, Thomson RL. et al. Monitoring athletic training status through autonomic heart rate regulation: A systematic review and meta-analysis. Sports Med 2016; 46: 1461-1486
    CrossrefPubMedSearch in Google Scholar
  • 8 Manzi V, Castagna C, Padua E. et al. Dose-response relationship of autonomic nervous system responses to individualized training impulse in marathon runners. Am J Physiol Heart Circ Physiol 2009; 296: H1733-H1740
    CrossrefPubMedSearch in Google Scholar
  • 9 Zimmermann-Viehoff F, Thayer J, Koenig J. et al. Short-term effects of espresso coffee on heart rate variability and blood pressure in habitual and non-habitual coffee consumers – a randomized crossover study. Nutr Neurosci 2016; 19: 169-175
    CrossrefPubMedSearch in Google Scholar
  • 10 Heart rate variability Standards of measurement, physiological interpretation, and clinical use. Task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 1996; 17: 354-381
    PubMedSearch in Google Scholar
  • 11 Nunan D, Sandercock GRH, Brodie DA. A quantitative systematic review of normal values for short-term heart rate variability in healthy adults. Pacing Clin Electrophysiol 2010; 33: 1407-1417
    CrossrefPubMedSearch in Google Scholar
  • 12 Eckberg DL. Parasympathetic cardiovascular control in human disease: A critical review of methods and results. Am J Physiol 1980; 8: H581-H593
    PubMedSearch in Google Scholar
  • 13 Shaffer F, Ginsberg JP. An overview of heart rate variability metrics and norms. Front Public Health 2017; 5: 258
    CrossrefPubMedSearch in Google Scholar
  • 14 Huang J, Lai Q, Wang D. et al. Effects of exercise training with dietary restriction on arterial stiffness, central hemodynamic parameters and cardiac autonomic function in obese adolescents. Diabetes Metab Syndr Obes 2019; 12: 2157-2163
    CrossrefPubMedSearch in Google Scholar
  • 15 Michels N, Clays E, De Buyzere M. et al. Determinants and reference values of short-term heart rate variability in children. Eur J Appl Physiol 2013; 113: 1477-1488
    CrossrefPubMedSearch in Google Scholar
  • 16 Mazurak N, Sauer H, Weimer K. et al. Effect of a weight reduction program on baseline and stress-induced heart rate variability in children with obesity. Obesity (Silver Spring) 2016; 24: 439-445
    CrossrefPubMedSearch in Google Scholar
  • 17 Pearson MJ, Smart NA. Exercise therapy and autonomic function in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 2018; 23: 91-108
    CrossrefPubMedSearch in Google Scholar
  • 18 Da Silva CC, Pereira LM, Cardoso JR. et al. The effect of physical training on heart rate variability in healthy children: a systematic review with meta-analysis. Pediatr Exerc Sci 2014; 26: 147-158
    CrossrefPubMedSearch in Google Scholar
  • 19 Riva P, Martini G, Rabbia F. et al. Obesity and autonomic function in adolescence. Clin Exp Hypertens 2001; 23: 57-67
    CrossrefPubMedSearch in Google Scholar
  • 20 Agashe S, Petak S. Cardiac autonomic neuropathy in diabetes mellitus. Methodist Debakey Cardiovasc J 2018; 14: 251-256
    CrossrefPubMedSearch in Google Scholar
  • 21 Kaufman CL, Kaiser DR, Steinberger J. et al. Relationships of cardiac autonomic function with metabolic abnormalities in childhood obesity. Obesity (Silver Spring) 2007; 15: 1164-1171
    CrossrefPubMedSearch in Google Scholar
  • 22 Farah BQ, Ritti-Dias RM, Balagopal PB. et al. Does exercise intensity affect blood pressure and heart rate in obese adolescents? A 6-month multidisciplinary randomized intervention study. Pediatr Obes 2014; 9: 111-120
    CrossrefPubMedSearch in Google Scholar
  • 23 Gutin B, Barbeau P, Litaker MS. et al. Heart rate variability in obese children: Relations to total body and visceral adiposity, and changes with physical training and detraining. Obes Res 2000; 8: 12-19
    CrossrefPubMedSearch in Google Scholar
  • 24 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: The prisma statement. PLoS Med 2009; 6: e1000097
    Search in Google Scholar
  • 25 Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13
    CrossrefPubMedSearch in Google Scholar
  • 26 Farinatti P, Neto SR, Dias I. et al. Short-term resistance training attenuates cardiac autonomic dysfunction in obese adolescents. Pediatr Exerc Sci 2016; 28: 374-380
    CrossrefPubMedSearch in Google Scholar
  • 27 Borenstein M, Hedges LV, Higgins JPT, et al. (Ed). Introduction to Meta-analysis. Chichester: John Wiley & Sons, 2009: 421
    PubMed
  • 28 Hedges LV, Olkin I (Ed). Statistical Methods for Meta-analysis. Orlando: Academic Press, 1985: 369
    PubMed
  • 29 Cohen J (Ed). Statistical Power Analysis for the Behavioral Sciences. Hillsdale: Lawrence Erlbaum Associates, 1988: 284-288
    PubMed
  • 30 Doi SAR, Barendregt JJ, Khan S. et al. Advances in the meta-analysis of heterogeneous clinical trials I: The inverse variance heterogeneity model. Contemp Clin Trials 2015; 45: 130-138
    CrossrefPubMedSearch in Google Scholar
  • 31 Fisher DJ. Two-stage individual participant data meta-analysis and generalized forest plots. Stata J 2015; 15: 369-396
    CrossrefPubMedSearch in Google Scholar
  • 32 Gamelin FX, Baquet G, Berthoin S. et al. Effect of high intensity intermittent training on heart rate variability in prepubescent children. Eur J Appl Physiol 2009; 105: 731-738
    CrossrefPubMedSearch in Google Scholar
  • 33 Mandigout S, Melin A, Fauchier L. et al. Physical training increases heart rate variability in healthy prepubertal children. Eur J Clin Invest 2002; 32: 479-487
    CrossrefPubMedSearch in Google Scholar
  • 34 Sharma VK, Subramanian SK, Radhakrishnan K. et al. Comparison of structured and unstructured physical activity training on predicted VO2max and heart rate variability in adolescents – a randomized control trial. J Basic Clin Physiol Pharmacol 2017; 28: 225-238
    CrossrefPubMedSearch in Google Scholar
  • 35 Phoemsapthawee J, Prasertsri P, Leelayuwat N. Heart rate variability responses to a combined exercise training program: Correlation with adiposity and cardiorespiratory fitness changes in obese young men. J Exerc Rehabil 2019; 15: 114-122
    CrossrefPubMedSearch in Google Scholar
  • 36 Kingsley JD, Figueroa A. Acute and training effects of resistance exercise on heart rate variability. Clin Physiol Funct Imaging 2016; 36: 179-187
    CrossrefPubMedSearch in Google Scholar
  • 37 Alansare A, Alford K, Lee S. et al. The effects of high-intensity interval training vs. Moderate-intensity continuous training on heart rate variability in physically inactive adults. Int J Environ Res Public Health 2018; 15: 1508
    CrossrefPubMedSearch in Google Scholar
  • 38 McNarry MA, Lewis MJ, Wade N. et al. Effect of asthma and six-months high-intensity interval training on heart rate variability during exercise in adolescents. J Sports Sci 2019; 37: 2228-2235
    CrossrefPubMedSearch in Google Scholar
  • 39 Beckers F, Verheyden B, Aubert AE. Aging and nonlinear heart rate control in a healthy population. Am J Physiol Heart Circ Physiol 2006; 290: H2560-H2570
    CrossrefPubMedSearch in Google Scholar
  • 40 Hirsch JA, Bishop B. Respiratory sinus arrhythmia in humans: How breathing pattern modulates heart rate. Am J Physiol 1981; 241: H620-H629
    PubMedSearch in Google Scholar
  • 41 Koenig J, Thayer JF. Sex differences in healthy human heart rate variability: A meta-analysis. Neurosci Biobehav Rev 2016; 64: 288-310
    CrossrefPubMedSearch in Google Scholar
  • 42 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
    Thieme ConnectPubMedSearch in Google Scholar