Effect of exercise training on heart rate variability in type 2 diabetes mellitus patients: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Cardiac autonomic neuropathy is a common complication of type 2 diabetes mellitus (T2DM), that can be measured through heart rate variability (HRV)-known to be decreased in T2DM. Physical exercise can improve HRV in healthy population, however results are under debate in T2DM. We conducted a systemic review and meta-analysis to assess the effects of physical exercise on HRV in T2DM patients. METHOD: PubMed, Cochrane, Embase, and ScienceDirect databases were searched for all studies reporting HRV parameters in T2DM patients before and after exercise training, until September 20th 2020, without limitation to specific years. We conducted random-effects meta-analysis stratified by type of exercise for each of the HRV parameters: RR-intervals (or Normal to Normal intervals-NN), standard deviation of RR intervals (SDNN), percentage of adjacent NN intervals varying by more than 50 milliseconds (pNN50), root mean square of successive RR-intervals differences (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio. Sensitivity analyses were computed on studies with the highest quality. RESULTS: We included 21 studies (9 were randomized) for a total of 523 T2DM patients: 472 had an exercise training and 151 were controls (no exercise). Intervention was endurance (14 studies), resistance (2 studies), endurance combined with resistance (4 studies), and high intensity interval training (HIIT) (4 studies). After exercise training, all HRV parameters improved i.e. an increase in SDNN (effect size = 0.59, 95%CI 0.26 to 0.93), RMSSD (0.62, 0.28 to 0.95), pNN50 (0.62, 0.23 to 1.00), HF (0.58, -0.16 to 0.99), and a decrease in LF (-0.37, -0.69 to -0.05) and LF/HF (-0.52, -0.79 to -0.24). There were no changes in controls. Stratification by type of exercise showed an improvement in most HRV parameters (SDNN, RMSSD, pNN50, LF, HF, LF/HF) after endurance training, whereas mostly LF/HF was improved after both resistance training and HIIT. Supervised training improved most HRV parameters. Duration and frequency of training did not influence the benefits on HRV. CONCLUSION: Exercise training improved HRV parameters in T2DM patients which may reflect an improvement in the activity of the autonomic nervous system. The level of proof is the highest for endurance training. Supervised training seemed beneficial.
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Exercise training improves cardiac autonomic neuropathy in type 2 diabetes.
“exercise training improves cardiac autonomic neuropathy in type 2 diabetes (15,16).”
From Obstructive Sleep Apnea, Resting Heart Rate, and Glycemic Variability in Adults With Maturity-Onset Diabetes of the Young (2026) · cites this paper as [15]
The Discussion (§4.1; page not provided) reports strong evidence that exercise training improves heart rate variability in people with type 2 diabetes, but says it *could* prevent or slow cardiac autonomic neuropathy progression. The Conclusion (§5; page not provided) says improved heart rate variability *may* reflect better autonomic nervous system activity. Neither establishes that exercise improves the neuropathy itself, as the citing sentence states. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAerobic, resistance, and high-intensity interval training decrease sympathetic activity and increase parasympathetic activity as measured by heart-rate variability.
“As measured through heart-rate variability, aerobic, resistance, and high intensity interval training have all been shown to decrease sympathetic activity and increase parasympathetic activity.”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [18]
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Southall, H. G., DeYoung, S. E., & Harris, C. A. (2017) · Frontiers in Public Health · doi:10.3389/fpubh.2017.00005 · Cited by 23 · see citing works
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The Impact of Physical Activity in Patients With Type 2 Diabetes
Bassin, S. R., & Srinath, R. (2025) · American Journal of Lifestyle Medicine · doi:10.1177/15598276231180541 · Cited by 17 · see citing works
Arosemena, M., Chopra, K., Salguero, M. V., Reyes, D., Naylor, R. N., Wroblewski, K., Tasali, E., & Philipson, L. H. (2026) · Diabetes · doi:10.2337/db24-0787 · Cited by 2 · see citing works
- Authors
- Picard, M., Tauveron, I., Magdasy, S., Benichou, T., Bagheri, R., Ugbolue, U. C., Navel, V., & Dutheil, F.
- Affiliations
- Centre Hospitalier Universitaire de Clermont-Ferrand (FR)
- Centre National de la Recherche Scientifique (FR)
- University of Isfahan (IR)
- University of Strathclyde (GB)
- Corresponding author
- Dutheil, Frédéric
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-05-17
- Volume
- 16
- Issue
- 5
- Pages
- e0251863
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC8128270
- OpenAlex
- W3161318300
- Cited by
- 130
- References
- 98
- Citations by year
- 2026: 28 · 2025: 35 · 2024: 34 · 2023: 17 · 2022: 11 · 2021: 5
- FWCI
- 3.27
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- The UWS Academic Portal (University of the West of Scotland) (publishedVersion, cc-by)
- HAL (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Université Clermont-Auvergne
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- type 2 diabetes, heart rate variability, cardiac autonomic neuropathy, exercise training, endurance training, resistance training, high-intensity interval training, autonomic function, diabetes complications, spectral analysis of HRV, LF/HF ratio, pNN50, RMSSD, SDNN, exercise type comparison, exercise intensity and frequency
- MeSH terms
- High-Intensity Interval Training, Endurance Training, Diabetes Mellitus, Type 2, Diabetic Neuropathies, Female, Heart, Heart Rate, Humans, Male, Exercise, Randomized Controlled Trials as Topic, Resistance Training
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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