Heart Rate Variability Mainly Relates to Cognitive Executive Functions and Improves Through Exergame Training in Older Adults: A Secondary Analysis of a 6-Month Randomized Controlled Trial

Abstract

Heart rate variability (HRV) mirrors autonomic nervous system activities and might serve as a parameter to monitor health status in older adults. However, it is currently unknown which functional health measures, including cognitive, physical, and gait performance parameters, are most strongly related to HRV indices. This knowledge would enable implementing HRV assessments into health monitoring routines and training planning for older adults. Simultaneous cognitive–motor and exergame training may be effective to improve HRV indices but has not been investigated yet. Eighty-nine healthy older adults (≥70 years of age) were randomized into three groups: (1) virtual reality video game dancing, i.e., exergaming (DANCE); (2) treadmill walking with simultaneous verbal memory training (MEMORY); or (3) treadmill walking only (PHYS). Strength and balance exercises complemented each program. Over 6 months, two weekly 1-h training sessions were performed. HRV indices (standard deviation of N–N intervals, SDNN; root mean square of successive R–R interval differences, RMSSD; and absolute power of high-frequency band (0.15–0.4 Hz), HF power) and various measures of cognitive, physical, and gait performance were assessed at baseline and after 3 months and 6 months. Multiple linear regression analyses with planned comparisons were calculated. At baseline, 8–12% of HRV variance was significantly explained by cognitive executive functions and leg strength (inversely related). Verbal long-term memory, aerobic and functional fitness, and gait performance did not contribute to the model (SDNN: R 2 = 0.082, p = 0.016; RMSSD: R 2 = 0.121, p = 0.013; HF power: R 2 = 0.119, p = 0.015). After 6 months, DANCE improved HRV indices, while MEMORY and PHYS did not (time × intervention interactions: first-contrast DANCE/MEMORY vs. PHYS: SDNN p = 0.014 one-tailed, Δ R 2 = 0.020 and RMSSD p = 0.052 one-tailed (trend), Δ R 2 = 0.007; second-contrast DANCE vs. MEMORY: SDNN p = 0.002 one-tailed, Δ R 2 = 0.035, RMSSD p = 0.017 one-tailed, Δ R 2 = 0.012, and HF power p = 0.011 one-tailed, Δ R 2 = 0.013). We conclude that mainly cognitive executive functions are associated with HRV indices and that exergame training improves global and parasympathetic autonomic nervous system activities in older adults. Periodic assessments of HRV in older citizens could be particularly beneficial to monitor cognitive health and provide indications for preventative exercise measures.

Four Weeks of Detraining Induced by COVID-19 Reverse Cardiac Improvements from Eight Weeks of Fitness-Dance Training in Older Adults with Mild Cognitive Impairment

“…Concerning the HRV-related parameters, previous studies have primarily measured these parameters in a resting state and have revealed contradictory results. Indeed, a significant increase of older adults’ resting HRV has been previously reported following 6 months of aerobic exercise training (31 ± 5 ms) [ 82 ], 6 weeks [ 83 ] or 6 months [ 84 ] of exergaming-based dance training, as well as 12 months of supervised stretching and aerobic exercise training [ 85 ]. However, Jakubec et al [ 86 ] and Shen et al [ 87 ] failed to report clear HRV improvements following 6 months or 10 weeks of aerobic exercise training, respectively.…”

Can Reactivity of Heart Rate Variability Be a Potential Biomarker and Monitoring Tool to Promote Healthy Aging? A Systematic Review With Meta-Analyses

“…Since higher resting HRV was shown to predict better cognitive functioning (Thayer and Lane, 2000 ; Thayer, 2009 ; Lin et al, 2014 ; Crowley Olga et al, 2016 ; Wawrzyniak Andrew et al, 2016 ; Beer Noa et al, 2017 ; Smith et al, 2017 ; Forte et al, 2019 ), higher exercise frequencies might be a central element to be considered in the design of exercise interventions. Regarding the type of training intervention, a recent randomized controlled trial of Eggenberger et al ( 2020 ) has shown, that a cognitive-motor exergame training was able to improve vagally-mediated HRV at rest, whereas a dual-task training paradigm and an exclusively physical training intervention did not affect HRV. Moreover, cognitive executive functioning (i.e., measured by the Trail-Making-Test (TMT)-B) was the most prominent significant predictor of variance in vagally-mediated HRV (i.e., RMSSD, HF; Eggenberger et al, 2020 ).…”

“…Regarding the type of training intervention, a recent randomized controlled trial of Eggenberger et al ( 2020 ) has shown, that a cognitive-motor exergame training was able to improve vagally-mediated HRV at rest, whereas a dual-task training paradigm and an exclusively physical training intervention did not affect HRV. Moreover, cognitive executive functioning (i.e., measured by the Trail-Making-Test (TMT)-B) was the most prominent significant predictor of variance in vagally-mediated HRV (i.e., RMSSD, HF; Eggenberger et al, 2020 ). This is consistent with the findings, that cognitively engaging exercises (i.e., simultaneous cognitive-motor training) appear to have the strongest effect on cognition in HOA (Diamond and Ling, 2016 ; Biazus-Sehn et al, 2020 ; Chen et al, 2020 ) and older adults at risk for cognitive impairment and Dementia (Wu et al, 2019 ; Biazus-Sehn et al, 2020 ).…”

Moving Beyond Disciplinary Silos Towards a Transdisciplinary Model of Wellbeing: An Invited Review

“…While the vagus nerve is one of several responses systems contributing to the experience of wellbeing, it has a regulatory role over many including the sympathetic nervous system (Porges, 2011;Deuchars et al, 2018), hypothalamic-pituitary adrenal axis (Porges, 2011), immune functioning (Tracey, 2002;Pavlov and Tracey, 2012), brain-gut interactions (Bonaz et al, 2018;Fülling et al, 2019) neurogenesis and epigenetic mechanisms (Follesa et al, 2007;Biggio et al, 2009;O'Leary et al, 2018). Research now links vagal function to positive emotions (Geisler et al, 2010;Kok and Fredrickson, 2010;Kok et al, 2013), meaning and purpose in life (Zilioli et al, 2015;Dang et al, 2021), emotion regulation (Geisler et al, 2010;Williams et al, 2015), executive function (Williams et al, 2019;Eggenberger et al, 2020), psychological flexibility (Kashdan and Rottenberg, 2010;Colzato et al, 2018), prosocial behaviours (Kemp et al, 2012;Geisler et al, 2013;Kok et al, 2013), positive health behaviours (Werner et al, 2015;Young and Benton, 2018), biopsychosocial resilience (Dedoncker et al, 2021), time spent in nature (Richardson et al, 2016;De Brito et al, 2020) and future morbidity and mortality (Hillebrand et al, 2013;Jandackova et al, 2016;Fang et al, 2020). Various theoretical models have been proposed within which these findings have been interpreted.…”