Effects of drug, biobehavioral and exercise therapies on heart rate variability in coronary artery disease: a systematic review
Abstract
BACKGROUND: Heart rate variability (HRV) is reported as a surrogate index for clinical outcome in trials of secondary prevention strategies for coronary artery disease (CAD), but a standardized guide for interpreting HRV change is not established. DESIGN: We evaluated HRV change in trials with CAD patients who received conventional medications (beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors), biobehavioral treatment (psychotropics, biofeedback, relaxation) or exercise training. METHODS: Medline, Pubmed, Psycinfo, the Cochrane database, and Embase were searched until July 2007, without language restriction. We identified 33 randomized controlled trials. Two reviewers independently abstracted all trials using a standardized form. A hierarchy of frequency and time domain HRV indices defined outcome. RESULTS: A random-effects model yielded an overall pooled standardized mean difference (SMD) between treatment and control groups of moderate magnitude across treatment classes, based on a composite of time and frequency domain indices (SMD=0.40, P<0.0001), or only time or frequency indices (SMD=0.37 and 0.43, respectively, both P<0.0001). This change was equivalent to an increase in standard deviation of all normal-to-normal RR intervals of 9.0 ms (95% Confidence Interval, CI, 7.3, 10.7 ms) or a relative increase of 15.9% (95% CI, 13.2, 18.6%). To detect HRV change of this magnitude, a hypothetical trial would require a sample size of 660 patients for conventional medications or 1232 patients for all treatment classes. CONCLUSION: Pharmacologic, biobehavioral and exercise strategies for secondary prevention of CAD significantly increase HRV. This review provides a framework to assist efforts to evaluate the contribution of HRV change to CAD prognosis.
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HRV is reflective of vagal tone (parasympathetic activity).
“with HRV reflective of vagal tone (parasympathetic activity; [64]”
From A randomized controlled trial of yoga vs nonaerobic exercise for veterans with PTSD: Understanding efficacy, mechanisms of change, and mode of delivery (2021) · cites this paper as [64]
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- Authors
- Nolan, R. P., Jong, P., Barry-Bianchi, S. M., Tanaka, T. H., & Floras, J. S.
- Affiliations
- University Health Network (CA)
- Tsukuba University of Technology (JP)
- Corresponding author
- Nolan, Robert P.
- Venue
- European Journal of Cardiovascular Prevention & Rehabilitation
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-08
- Volume
- 15
- Issue
- 4
- Pages
- 386-396
- ISSN
- 1741-8267 (ISSN-L)
- OpenAlex
- W2055655271
- Cited by
- 117
- References
- 49
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 7 · 2023: 3 · 2022: 5 · 2021: 4 · 2020: 12 · 2019: 6 · 2018: 5 · 2017: 8 · 2016: 5 · 2015: 6 · 2014: 14 · 2013: 8 · 2012: 8
- FWCI
- 1.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Cardiovascular Prevention & Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Heart and Stroke Foundation of Canada
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Keywords
- heart rate variability, coronary artery disease, secondary prevention, beta-blockers, calcium channel blockers, ACE inhibitors, psychotropic drugs, biofeedback, relaxation training, exercise training, time-domain HRV, frequency-domain HRV indices, sample size determination, surrogate endpoints
- MeSH terms
- Behavior Therapy, Cardiovascular Agents, Coronary Artery Disease, Exercise Therapy, Heart Rate, Humans, Randomized Controlled Trials as Topic
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