Implementation of supervised physical training to reduce vasovagal syncope recurrence: A randomized controlled trial

Abstract

Introduction: Physical techniques used for the prevention of vasovagal syncope have limited evidence for efficacy. We aimed to evaluate multimodal supervised physical training as a treatment approach. Methods: In this 1:1 randomized trial, patients with ≥2 episodes of clinically diagnosed vasovagal syncope were included. On top of standard care, the intervention arm performed supervised tilt training and aerobic exercise in six sessions at a cardiac rehabilitation center (three sessions during the first month, and then at 3-month intervals), plus home tilt training. The control arm received standard care with a similar protocol of home tilt training. The primary outcome was time to first syncopal recurrence during 1 year of follow-up.Results: Fifty participants were randomized (mean age: 34.5 ± 14.8 years; 64% female). The rate of syncopal recurrence was 28% and 64% within the intervention and control arms, respectively, with significantly higher syncope-free survival at 1 year in the intervention arm (Log-rank p = .003). The frequency of recurrent syncopal events was significantly lower with physical training (p = .017). Participants in the intervention arm reported significantly higher adherence to the home tilt training program (80% vs. 52%; p = .037).Conclusion: Among patients with recurrent vasovagal syncope, a supervised program of tilt training and aerobic exercise reduced syncopal recurrence. Future trials are warranted to further investigate multimodal supervised physical techniques as a therapeutic approach in treating vasovagal syncope.

Therapeutic options for neurocardiogenic syncope: a meta-analysis of randomised trials with and without blinding

“…This included 17 trials randomising 1793 patients testing pharmacological therapies, 5-19 21-23 14 trials randomising 1015 patients testing pacing therapies 24-30 32-39 and 8 trials randomising 690 patients which tested other interventions which can be broadly described as physical interventions. [45][46][47][48][49][50][51][52][53] Across all studies, 55.8% of participants were female, the mean age was 46.8 and the mean follow-up time was 15.5 months (online supplemental eTable 3).…”

“…We included all randomised studies which prospectively evaluated the effect of any pharmacological, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] devicebased or supportive interventions [45][46][47][48][49][50][51][52][53] for neurocardiogenic, reflex, vasovagal, carotid sinus or orthostatic syncope (online supplemental eTable 1a-i). Abstracts were reviewed for suitability and full-text articles evaluated accordingly.…”

Application of mind map can promote the health education effect of children with vasovagal syncope

“…Syncope and pre-syncope symptoms can be effectively reduced through health education and some lifestyle changes (e.g., recognizing syncope prodromal symptoms, increasing water intake, anti-resistance training and physical exercise, etc. ), thereby improving the quality of life and learning for children with VVS ( 11 ). It can be seen that effective health education and lifestyle guidance are crucial in VVS rehabilitation.…”

Association between vitamin D deficiency and vasovagal syncope: A systematic review and meta‐analysis

“…In patients with a diagnosis of VVS, the management ranges from lifestyle modifications and counterpressure maneuvers to pharmacologic prevention 6 . Lifestyle changes are the first line of treatment in most patients 7 . VVS triggers include but are not limited to a standing posture, heat exposure, the sight of blood, and fear 8 .…”

“… 6 Lifestyle changes are the first line of treatment in most patients. 7 VVS triggers include but are not limited to a standing posture, heat exposure, the sight of blood, and fear. 8 Although triggers of VVS are well‐known, there is a lack of evidence regarding predisposing factors in these patients.…”