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. 2025 Jun 12:12:1364905.
doi: 10.3389/fcvm.2025.1364905. eCollection 2025.

The impact of long-term exercise intervention on heart rate variability indices: a systematic meta-analysis

Wenxin Zhang  1 , Siyuan Bi  1 , Lin Luo  1
Affiliations

The impact of long-term exercise intervention on heart rate variability indices: a systematic meta-analysis

Wenxin Zhang et al. Front Cardiovasc Med. .

Abstract

Background: Heart rate variability (HRV) is a critical indicator for assessing autonomic nervous system (ANS) function and is closely associated with both cardiovascular and psychological health. Although previous studies have demonstrated that exercise interventions can improve HRV, their effects vary considerably depending on exercise type, intervention characteristics, and individual differences. This meta-analysis aims to evaluate the impact of long-term exercise interventions on HRV and to explore potential factors that influence these effects.

Methods: A systematic search was conducted in PubMed, Cochrane Library, EBSCO, CINAHL, Web of Science, and Embase up to November 20, 2024, to identify randomized controlled trials (RCTs) examining the effects of long-term exercise interventions on HRV. Studies involving short-term interventions, non-original research, or incomplete data were excluded. Two researchers independently performed data extraction and quality assessment. In total, 34 studies involving 1,434 participants were included.

Results: Long-term exercise interventions significantly reduced the LF/HF ratio (P < 0.05). Subgroup analyses indicated that the intervention effects were more pronounced in populations with existing health conditions and in interventions lasting ≥8 weeks. Aerobic training and resistance training demonstrated significant benefits.

Conclusion: Long-term exercise interventions significantly reduce the LF/HF ratio and improve ANS balance. These effects, however, are influenced by individual health status, intervention design, and control group conditions. The high heterogeneity among the included studies and limited data on certain intervention characteristics warrant cautious interpretation of the findings. Future research should focus on conducting more high-quality RCTs to validate these results.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/myprospero, PROSPERO CRD42024541380.

Keywords: cardiovascular health; exercise modalities; heart rate variability (HRV); long-term exercise interventions; randomized controlled trials.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Procedure for study selection.
Figure 2
Figure 2
Proportion chart of literature quality assessment.
Figure 3
Figure 3
Illustration of literature quantity assessment. Note: A plus sign (+) indicates high methodological quality (low risk of bias); a minus sign (−) indicates low methodological quality (high risk of bias); a question mark (?) indicates unclear methodological quality (insufficient reporting on what occurred during the study).
Figure 4
Figure 4
Forest plot of the meta-analysis on the effects of long-term exercise intervention on SDNN.
Figure 5
Figure 5
Forest plot of the meta-analysis on the effects of long-term exercise intervention on RMSSD.
Figure 6
Figure 6
Forest plot of the meta-analysis on the effects of long-term exercise intervention on LF.
Figure 7
Figure 7
Forest plot of the meta-analysis on the effects of long-term exercise intervention on HF.
Figure 8
Figure 8
Forest plot of the meta-analysis on the effects of long-term exercise intervention on LF/HF ratio.
Figure 9
Figure 9
Sensitivity analysis chart of SDNN.
Figure 10
Figure 10
Sensitivity analysis chart of RMSSD.
Figure 11
Figure 11
Sensitivity analysis chart of LF.
Figure 12
Figure 12
Sensitivity analysis chart of HF.
Figure 13
Figure 13
Sensitivity analysis chart of LF/HF.
Figure 14
Figure 14
Funnel plot of SDNN.
Figure 15
Figure 15
Funnel plot of RMSSD.
Figure 16
Figure 16
Funnel plot of LF.
Figure 17
Figure 17
Funnel plot of HF.
Figure 18
Figure 18
Funnel plot of LF/HF.
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