Effects of stress management interventions on heart rate variability in adults with cardiovascular disease: a systematic review and meta-analysis

• Published in: Journal of behavioral medicine 2024-06, Vol.47 (3), p.374-388
• Main Authors: Gathright, Emily C., Hughes, Joel W., Sun, Shufang, Storlazzi, Laurie E., DeCosta, Julie, Balletto, Brittany L., Carey, Michael P., Scott-Sheldon, Lori A. J., Salmoirago-Blotcher, Elena
• Format: Article
• Language: English
• Subjects: Adults; Biofeedback; Cardiovascular disease; Cardiovascular diseases; Clinical trials; Family Medicine; Feedback; General Practice; Health Psychology; Heart rate; Intervention; Medicine; Medicine & Public Health; Meta-analysis; Quasi-experimental methods; Random effects; Stress management; Systematic review; Variability; Women
• ISSN: 0160-7715; 1573-3521; 1573-3521
• DOI: 10.1007/s10865-024-00468-4

Meta-analysis was used to investigate the potential benefits of stress management interventions (SMIs) on vagally-mediated heart rate variability (HRV) in adults with cardiovascular disease. Electronic bibliographic databases were searched through August 2022. Randomized controlled trials and quasi-experimental studies assessing effects of SMIs on HRV were included. Methodological quality was assessed with a standardized checklist. A pooled effect size was calculated for vagally-mediated HRV indices (standard deviation of normal-to-normal intervals, root mean square of the successive differences, and high frequency power) using random effects models. Fourteen studies (1202 participants, M age : 59 ± 6.25 years; 25% ± 16% women; 61% ± 22% White) were included. Ten studies (11 effects) reported short-term HRV assessment; a small between-group difference emerged for vagally-mediated HRV ( d + = .27, 95% confidence interval [CI] 0.01–0.52, k  = 11). Most interventions examined biofeedback; these studies yielded a small between-group difference on vagally-mediated HRV ( d + = 0.31, 95% CI 0.09–0.53, k  = 7, Q [6] = 3.82, p  = .70, I 2  = 11%). This is the first systematic examination of the effect of SMIs on HRV in adults with CVD. Findings suggest a small effect of SMIs on vagally-mediated HRV, with biofeedback likely driving the effect. More research is required to fully understand whether this benefit on vagally-mediated HRV applies to other SMIs.