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

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Abstract

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, Mage: 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, I2 = 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.

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Data availability

De-identified data from this study are not available in a public archive. In light of the meta-analytic nature of this project, data used to calculate effect sizes can be obtained from the original sources cited in this text. Analytic code used to conduct the analyses presented in this study are not available in a public archive. They may be available by emailing the corresponding author. Materials used to conduct the study are not publicly available.

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Funding

The research reported in this paper was supported by the National Center for Complementary and Integrative Health of the National Institutes of Health under award number 5R01AT008815 to Lori A. J. Scott-Sheldon, PhD and Michael P. Carey, PhD (Multiple PIs). Emily C. Gathright, PhD was supported by K23AG061214-01A1 from the National Institute on Aging. Elena Salmoirago-Blotcher, MD, was supported by National Institutes of Health grants R01AG076438 and R01HL149672 and Shufang Sun, PhD was supported by K23AT011173 from the National Center for Complementary and Integrative Health and the Adolescent/Young Adult Biobehavioral HIV Training Grant (T32MH078788; Larry K. Brown, PI) from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Center for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA

    Emily C. Gathright, Laurie E. Storlazzi, Julie DeCosta, Brittany L. Balletto, Michael P. Carey & Elena Salmoirago-Blotcher

  2. Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA

    Emily C. Gathright, Michael P. Carey, Lori A. J. Scott-Sheldon & Elena Salmoirago-Blotcher

  3. Department of Psychological Sciences, Kent State University, Kent, OH, USA

    Joel W. Hughes

  4. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA

    Shufang Sun & Michael P. Carey

  5. Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA

    Elena Salmoirago-Blotcher

Authors
  1. Emily C. Gathright
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  2. Joel W. Hughes
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Contributions

ECG contributed equally to conceptualization, data curation, investigation, and served as lead in formal analysis and writing–original draft. JWH contributed equally to writing–review & editing, and served in a supporting role for conceptualization. SS served in a supporting role for writing-original draft and review & editing. LS contributed equally to data curation and investigation and served in a supporting role for writing–review & editing. JD contributed equally to data curation and investigation and served in a supporting role for validation and for writing–review & editing. BB contributed equally to data curation and investigation and served in a supporting role for writing–review & editing. MPC served as lead for conceptualization and funding acquisition, contributed equally to writing–review & editing and served in a supporting role for supervision. LAJS-S served as lead for conceptualization and funding acquisition, data curation, investigation, methodology, supervision, and served in a supporting role for writing–review & editing. ECS-B served as lead for writing-review & editing, contributed equally to conceptualization, supervision, and served in a supporting role for funding acquisition.

Corresponding author

Correspondence to Emily C. Gathright.

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Not applicable; this is a systematic review and meta-analysis of publicly available literature.

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Gathright, E.C., Hughes, J.W., Sun, S. et al. Effects of stress management interventions on heart rate variability in adults with cardiovascular disease: a systematic review and meta-analysis. J Behav Med 47, 374–388 (2024). https://doi.org/10.1007/s10865-024-00468-4

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