Home orthostatic training in vasovagal syncope modifies autonomic tone: results of a randomized, placebo-controlled pilot study
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AIMS: To detect possible autonomic changes due to home orthostatic training (HOT) and to assess the feasibility of a larger, placebo-controlled study of HOT in vasovagal syncope (VVS). METHODS AND RESULTS: Twenty-two consecutive patients, aged 18-85, diagnosed with VVS following a positive head-up tilt-table test were randomized to 40 min of HOT (n = 12) or 10 min of sham training (n = 10) daily for 6 months. Baroreflex sensitivity (BRS) and heart rate variability (HRV) were measured at weeks 0, 1, 4, and 24. Symptom response was assessed by event diaries. Home orthostatic training resulted in increases in up and down slope BRS at week 4 (e(log difference) = 1.59, 95% CI = 0.84-3.03 and 1.79, 95% CI = 1.00-3.22) and week 24 (e(log difference) = 1.75, 95% CI = 1.01-3.06 and 1.53, 95% CI = 0.66-2.68) compared with placebo. Relative improvements in low- and high-frequency HRV were also observed in the HOT group compared with placebo at week 4 (e(log difference) = 3.22, 95% CI = 1.06-9.86 and 3.19, 95% CI = 1.03-10.59) and week 24 (e(log difference) = 2.11, 95% CI = 0.72-6.17 and 2.13, 95% CI = 0.52-8.79). Fifty percentage of HOT subjects and 20% of control subjects were syncope-free at 6 months. CONCLUSION: This was the first placebo-controlled study in orthostatic training which has demonstrated that such a study is indeed feasible. An enhancement in overall autonomic tone is observed with HOT in tandem with a non-significant trend in symptom improvement. A larger, adequately powered, randomized controlled trial of tilt-training is now needed.
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Most controlled trials reported no significant effect of tilt training.
“most controlled trials reported no significant effect. 268-272”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [272]
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Sutton, R. (2010) · EP Europace · doi:10.1093/europace/eup426
Tilt training as a treatment for reflex syncope: a multimodal approach!?
Hornikx, M., Haemers, P., Stans, L., Robyns, T., Garweg, C., Ector, J., Vandenberk, B., & Willems, R. (2024) · Frontiers in Neuroscience · doi:10.3389/fnins.2024.1473687
Tadros, G. S., Valani, F. G. A., Lei, L. Y., Raj, S. R., & Sheldon, R. S. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-15734-9.00029-7
Bai, Y., Chen, T., Li, Y., Fu, J., Wu, N., & Wu, X. (2026) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2026.1780380
From Mechanism to Management in Vasovagal Syncope: An Integrative Review
Laranjo, S. M., Oliveira, M., & Rocha, I. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15197360
- Authors
- Tan, M. P., Newton, J. L., Chadwick, T. J., Gray, J. C., Nath, S., & Parry, S. W.
- Affiliations
- Newcastle University (GB)
- Royal Victoria Infirmary (GB)
- North Tyneside General Hospital (GB)
- Corresponding author
- Parry, S. W.
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-11-17
- Volume
- 12
- Issue
- 2
- Pages
- 240-246
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2131668656
- Cited by
- 58
- References
- 42
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 1 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 4 · 2018: 4 · 2017: 4 · 2016: 3 · 2015: 3 · 2014: 7 · 2013: 5 · 2012: 2
- FWCI
- 3.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Institute for Health and Care Research
- British Geriatrics Society
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- Keywords
- vasovagal syncope, autonomic tone, baroreflex sensitivity, heart rate variability, tilt training, sham training, syncope prevention
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Autonomic Nervous System, Dizziness, Postural Balance, Feasibility Studies, Female, Heart Rate, Humans, Male, Middle Aged, Patient Compliance, Pilot Projects, Treatment Outcome, Baroreflex, Tilt-Table Test, Monitoring, Ambulatory, Syncope, Vasovagal, Young Adult
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