Background: Adequate adaptation of the autonomic nervous system (ANS) is crucial in potentially life-threatening situations. The defence cascade provides a descriptive model of progressing dominant physiological reactions in such situations, including cardiovascular parameters and body mobility. The empirical evidence for this model is scarce, and the influence of physiological reactions in this model for predicting trauma-induced intrusions is unresolved.Objectives: Using a trauma-film paradigm, we aimed to test physiological reactions to a highly stressful film as an analogue to a traumatic event along the defence cascade model. We also aimed to examine the predictive power of physiological activity for subsequent intrusive symptoms.Method: Forty-seven healthy female participants watched a stressful and a neutral film in randomized order. Heart rate (HR), heart rate variability (HRV), and body sway were measured. Participants tracked frequency, distress, and quality of subsequent intrusions in a diary for 7 consecutive days.Results: For the stressful film, we observed an initial decrease in HR, followed by an increase, before the HR stabilized at a high level, which was not found during the neutral film. No differences in HRV were observed between the two films. Body sway and trembling frequency were heightened during the stressful film. Neither HR nor HRV predicted subsequent intrusions, whereas perceived distress during the stressful film did.Conclusions: Our results suggest that the physiological trauma-analogue response is characterized by an orientation response and subsequent hyperarousal, reaching a high physiological plateau. In contrast to the assumptions of the defence cascade model, the hyperarousal was not followed by downregulation. Potential explanations are discussed. For trauma-associated intrusions in the subsequent week, psychological distress during the film seems to be more important than physiological distress. Understanding the interaction between physiological and psychological responses during threat informs the study of ANS imbalances in mental disorders such as post-traumatic stress disorder.
We used a trauma-film analogue to examine the defence cascade model and to investigate the influence of psychophysiological response on subsequent intrusions.While we found an orientation phase, upregulation phase, and coactivation indicated by heart rate, no downregulation phase was observed.None of the physiological parameters examined predicted subsequent intrusions, whereas subjective distress during the film did.

Background: Cumulative exposure to violence can change the regulation of epigenetic and physiological markers. Although violence has been associated with accelerated cellular aging, little is known about associations with cardiac autonomic activity.Objective: The current study aimed to investigate the relationship of exposure to community and domestic violence (CDV) with vagal activity and epigenetic aging acceleration.Methods: A total of 86 adolescents (57% female) were evaluated and interviewed at two time-points in São Gonçalo (2014-2019), a Brazilian city with high levels of violence. Exposure to CDV was assessed in both time-points. GrimAge acceleration was calculated from saliva DNA methylation using Infinium HumanMethylation450K (Illumina) collected in the first assessment. Heart rate variability (HRV) was collected during two stress tasks at the second assessment.Results: The exposure to violence witnessed or directly experienced at home and in the community increased significantly (t = 4.87, p < .01) across two-time points, and males had reported higher violence exposure (t = 2.06, p = .043). Violence at 1st assessment was significantly associated with GrimAge acceleration (B = .039, p value = .043). Violence at both assessments were associated with HRV measured during the narration of the worst trauma (traumaHRV) (B = .009, p value = .039, and B = .007, p value = .024, 1st and 2nd assessment respectively). GrimAge acceleration was significantly associated with traumaHRV (B = .043, p value = .049), and HRV measured during a 3D roller coaster video (B = .061, p value = .024).Conclusions: We found relevant evidence that experiencing violence during adolescence is associated with epigenetic aging and stress-related vagal activity. Understanding these factors during this period could contribute to the development of early interventions for health promotion.HIGHLIGHTS Higher exposure to Community and domestic violence is associated with increased GrimAge acceleration.Higher GrimAge acceleration is associated with increased stress-related vagal activity.Exposure to community and domestic violence increased significantly over time.

The COVID-19 pandemic has significantly disrupted research activities globally. Researchers need safe and creative procedures to resume data collection, particularly for projects evaluating infant mental health interventions. Remote research is uniquely challenging for psychophysiological data collection, which typically requires close contact between researchers and participants as well as technical equipment frequently located in laboratory settings. In accordance with public health guidance, we adapted procedures and developed novel protocols for a \"virtual assessment\" in which women and infants provided behavioral and psychophysiological data from their own homes while researchers coordinated remotely. Data collected at virtual visits included video-recorded parent-child interactions and autonomic nervous system data. Adaptations were designed to optimize safety and data quality while minimizing participant burden. In the current paper, we describe these adaptations and present data evaluating their success across two sites in the United States (University of Delaware and University of Utah), focusing specifically on autonomic nervous system data collected during the well-validated Still-Face Paradigm (SFP). We also discuss advantages and challenges of translating traditional lab procedures into the virtual assessment model. Ultimately, we hope that disseminating these procedures will help other researchers resume safe data collection related to infant mental health during the COVID-19 pandemic and beyond.
La pandemia del COVID-19 ha interrumpido significativamente las actividades de investigación globalmente. Los investigadores necesitan procedimientos seguros y creativos para reasumir la recolección de información, particularmente para proyectos con los que se evalúan intervenciones de salud mental infantil. La investigación remota es particularmente desafiante para recoger información psicofisiológica, lo cual típicamente requiere contacto cercano entre investigadores y participantes, así como también equipo técnico frecuentemente localizado en centros de laboratorio. De acuerdo con las directrices de salud pública, adaptamos procedimientos y desarrollamos protocolos novedosos para una “evaluación virtual,” en la cual mujeres e infantes aportaron datos de conducta y psicofisiológicos desde sus propias casas mientras que los investigadores coordinaban remotamente. La información recogida en las visitas virtuales incluyó interacciones progenitor-niño grabadas en video e información del sistema nervioso autónomo. Se diseñaron las adaptaciones para optimizar la seguridad y la calidad de la información mientras que se reducía al mínimo la carga que conlleva la participación. En el presente estudio, describimos estas adaptaciones y presentamos información evaluativa del éxito en dos lugares de Estados Unidos (la Universidad de Delaware y la Universidad de Utah), con enfoque específico en la información obtenida acerca del sistema nervioso autónomo durante el ya bien validado Paradigma del Rostro Inmóvil. Discutimos también las ventajas y retos para transferir los procedimientos tradicionales de laboratorio al modelo de evaluación virtual. En última instancia, esperamos que al diseminar estos procedimientos ayudaremos a otros investigadores a reasumir la segura recolección de información relacionada con la salud mental infantil durante la pandemia del COVID-19 y posteriormente.
La pandémie du COVID-19 a perturbé de manière importante les activités de recherche au niveau global. Les chercheurs ont besoin de procédures sûres et créatives pour reprendre la collecte de données, particulièrement pour des projets évaluant des interventions en santé mentale du nourrisson. Les recherches à distance présentent un défi unique pour la collecte de données psychophysiologiques, qui typiquement exige un contact proche entre les chercheurs et les participants ainsi qu\'un équipement technique fréquemment situé en contextes de laboratoire. En accord avec les directives de santé publique nous avons adapté les procédures et développés de nouveaux protocoles pour une « évaluation virtuelle » durant laquelle les femmes et les bébés ont présenté des données comportementales et psychophysiologiques depuis leurs propres domiciles alors que les chercheurs coordonnaient le tout à distance. Les données recueillies durant les visites virtuelles ont inclus des interactions parent-enfant enregistrées à la vidéo et des données liées au système nerveux autonome. Les adaptations ont été conçues afin d\'optimiser la sécurité et la qualité des données tout en minimisant le fardeau pour les participants. Dans cet article nous décrivons ces adaptations et présentons les données évaluant leur succès au travers de deux sites aux Etats-Unis (University of Delaware et University of Utah), en s\'attachant plus spécifiquement aux données sur le système nerveux autonome obtenues durant le Paradigme de Visage Inexpressif, qui est bien validé. Nous discutons également les avantages et des défis qu\'il y a à traduire des procédures traditionnelles de laboratoire en un modèle d’évaluation virtuel. Finalement nous espérons que le fait de disséminer ces procédures aidera d\'autres chercheurs à reprendre de manière sûre la collecte de données liées à la santé mentale du nourrisson durant la pandémie du COVID-19 et plus loin.
Die Anpassung psychophysiologischer Datenerhebung an COVID-19: Die „virtuelle Untersuchung“ Die COVID-19-Pandemie hat Forschungsaktivitäten weltweit erheblich beeinträchtigt. Forschende brauchen sichere und kreative Verfahren, um die Datenerhebung wieder aufzunehmen, insbesondere für Projekte zur Beurteilung von Interventionen zur psychischen Gesundheit von Kindern. Bei der psychophysiologischen Datenerhebung, die in der Regel einen engen Kontakt zwischen Forschenden und Teilnehmenden sowie eine häufig in Laboren befindliche technische Ausrüstung erfordert, stellt die Fernforschung eine besondere Herausforderung dar. In Übereinstimmung mit den Richtlinien des öffentlichen Gesundheitswesens haben wir die Verfahren angepasst und neue Protokolle für eine “virtuelle Untersuchung” entwickelt. Frauen und Säuglinge lieferten von zu Hause aus Verhaltens- und psychophysiologische Daten, während die Forschenden diesen Prozess aus der Ferne koordinierten. Die bei den virtuellen Visiten gesammelten Daten umfassten Videoaufzeichnungen von Eltern-Kind-Interaktionen und Daten des autonomen Nervensystems. Es wurden Anpassungen vorgenommen, um die Sicherheit und Datenqualität zu optimieren und gleichzeitig die Belastung der Teilnehmenden zu minimieren. Im vorliegenden Beitrag beschreiben wir diese Anpassungen und stellen Daten vor, die ihren Erfolg an zwei Standorten in den Vereinigten Staaten (University of Delaware und University of Utah) untersuchen, wobei wir uns speziell auf Daten des autonomen Nervensystems konzentrieren, die während des gut validierten Still-Face-Paradigmas erhoben wurden. Wir erörtern außerdem die Vorteile und Herausforderungen bei der Übertragung traditioneller Laborverfahren in das virtuelle Untersuchungsmodell. Letztendlich hoffen wir, dass die Verbreitung dieser Verfahren anderen Forschenden helfen wird, sichere Datenerhebung im Zusammenhang mit der psychischen Gesundheit von Kindern während der COVID-19-Pandemie und darüber hinaus wieder zu ermöglichen.
COVID-19に対する精神生理学的データ収集の適応　:「仮想評価」モデル COVID-19パンデミックは世界的に研究活動の大きな妨げとなった。研究者は、データ収集を再開するための安全で創造的な手順を必要としており、特に乳幼児のメンタルヘルスへの介入を評価するプロジェクトにおいてはその必要性が高まっている。遠隔研究は、研究者と被験者が綿密な連絡を取り合い、実験室に設置されていることの多い技術的な装置を必要とする精神生理学的データ収集には独特の難しさがある。そこで私たちは、公衆衛生上の指針に基づき、女性と乳児が行動や精神生理学的なデータを自宅から提供し、研究者が遠隔で対応するという「仮想評価」の手順を応用し、新しいプロトコルを開発した。仮想訪問で収集されたデータには、ビデオ録画された親-子の相互作用と自律神経系データが含まれていた。本研究では、参加者の負担を最小限に抑えながら、安全性とデータ品質を最適化するように工夫された。今回の論文では、これらの適応について説明するとともに、米国の2つのサイト (デラウェア大学とユタ大学) における適応の成功を評価するデータを提示し、特に十分に検証された「Still-FaceParadigm」で収集された自律神経系データに焦点を当てる。我々は、従来の研究室での手順から仮想評価モデルに変換することの利点と課題も検討している。最終的には、これらの手順を広めることで、他の研究者がCOVID-19パンデミック中やそれ以降の乳児のメンタルヘルスに関連する安全なデータ収集を再開するのに役立つことを願っている。.
COVID-19大流行严重扰乱了全球的研究活动。研究人员需要安全和创造性的程序来恢复数据收集, 特别是在评估婴儿心理健康干预措施的项目中。远程研究对于心理生理学数据收集来说具有独特的挑战性, 这通常需要研究人员和参与者之间的密切联系以及经常位于实验室环境中的技术设备。根据公共卫生指南, 我们调整了程序并制定了新的“虚拟评估”协议, 其中妇女和婴儿从自己家中提供行为和心理生理数据, 而研究人员则进行远程协调。在虚拟访问中收集的数据包括视频记录的亲子互动和自主神经系统数据。调整旨在优化安全性和数据质量, 同时最大限度地减少参与者的负担。在本文中, 我们描述了这些调整, 并提供了评估其在美国两个地点 (特拉华大学和犹他大学) 成功的数据, 特别关注了在经过充分验证的“静止面孔试验范式”期间收集的自主神经系统数据。我们还讨论了将传统实验室程序转换为虚拟评估模型的优势和挑战。最终, 我们希望, 推广这些程序以帮助其他研究人员在COVID-19大流行期间及疫后恢复与婴儿心理健康相关的安全数据收集。.
تكييف نموذج جمع البيانات النفسية والفسيولوجية لكوفيد -19: نموذج “التقييم الافتراضي” تسببت جائحة كوفيد-19 في تعطيل أنشطة البحث بشكل كبير على مستوى العالم. يحتاج الباحثون إلى إجراءات آمنة ومبتكرة لاستئناف جمع البيانات ، لا سيما فيما يتعلق بمشاريع تقييم تدخلات الصحة النفسية للرضع. يمثل البحث عن بُعد تحديًا فريدًا لجمع البيانات النفسية والفسيولوجية ، والذي يتطلب عادةً اتصالًا عن قرب بين الباحثين والمشاركين بالإضافة إلى المعدات التقنية الموجودة في كثير من الأحيان في المعامل. وفقًا لإرشادات الصحة العامة ، قمنا بتكييف الإجراءات وطورنا بروتوكولات جديدة لـ “التقييم الافتراضي” حيث ساهمت النساء والرضع بتقديم بيانات سلوكية ونفسية فسيولوجية من المنزل بينما كان الباحثون ينسقون عن بُعد. تضمنت البيانات التي تم جمعها في الزيارات الافتراضية التفاعلات المسجلة بالفيديو بين الوالدين والطفل وبيانات الجهاز العصبي اللاإرادي. تم تصميم عمليات التكييف لتحسين السلامة وجودة البيانات مع تقليل عبء المشاركين. في هذا البحث ، نصف هذه التعديلات ونقدم البيانات التي تم تقييم نجاحها عبر موقعين في الولايات المتحدة (جامعة ديلاوير وجامعة يوتا) ، مع التركيز بشكل خاص على بيانات الجهاز العصبي اللاإرادي التي تم جمعها خلال نموذج الوجه الثابت الذي تم التحقق من صحته جيدًا. نناقش أيضًا مزايا وتحديات ترجمة إجراءات المعمل التقليدية إلى نموذج التقييم الافتراضي. في النهاية ، نأمل أن يساعد نشر هذه الإجراءات الباحثين الآخرين على استئناف جمع البيانات المتعلقة بالصحة النفسية للرضع بشكل آمن أثناء جائحة كوفيد-19 وما بعدها.

The human circadian system creates and maintains cellular and systemic rhythmicity essential for the temporal organization of physiological processes promoting homeostasis and environmental adaptation. Sleep disruption and loss of circadian rhythmicity fundamentally affects master homeostasic regulating systems at the crossroads of peripheral and central susceptibility pathways, similar to acute or chronic stress and, thus, may play a central role in the development of stress-related disorders. Direct and indirect human and animal PTSD research accordingly suggests circadian-system-linked sleep, neuroendocrine, immune, metabolic and autonomic dysregulation, linking circadian misalignment to PTSD pathophysiology. Additionally, there is evidence that sleep and circadian disruption may represent a vital pre-existing risk factor in the prediction of PTSD development, while sleep-related symptoms are among the most prominent in trauma-associated disorders. These facts may represent a need for a shift towards a more chronobiological understanding of traumatic sequel and could support better prevention, evaluation and treatment of sleep and circadian disruption as first steps in PTSD management. In this special issue, we highlight and review recent advances from human sleep and chronobiological research that enhances our understanding of the development and maintenance of trauma-related disorders.
El sistema circadiano humano crea y mantiene la ritmicidad celular y sistémica esencial para la organización temporal de los procesos fisiológicos que promueven la homeostasis y la adaptación ambiental. La alteración del sueño y la pérdida del ritmo circadiano afectan fundamentalmente a los sistemas de regulación homeostáticos maestros en la encrucijada de las vías de susceptibilidad periféricas y centrales, similar al estrés agudo o crónico y, por lo tanto, pueden desempeñar un papel central en el desarrollo de trastornos relacionados con el estrés. Investigación directa e indirecta en TEPT en humanos y animales respectivamente, sugiere que el sueño ligado al sistema circadiano, la desregulación neuroendocrina, inmune, metabólica y autónoma vincula la desalineación circadiana con la fisiopatología del TEPT. Además, existe evidencia que el sueño y la alteración circadiana pueden representar un factor de riesgo vital preexistente en predicción del desarrollo de TEPT, mientras que los síntomas relacionados con el sueño se encuentran entre los mas importantes en los trastornos asociados a trauma. Estos hechos pueden representar la necesidad de un cambio hacia una comprensión más cronobiológica de la secuela traumática y podría apoyar una mejor prevención, evaluación y tratamiento del sueño y la alteración circadiana como primeros pasos en el manejo del TEPT. En este número especial, destacamos y revisamos los avances recientes del sueño en el ser humano y la investigación cronobiológica que pueda mejorar nuestra comprensión del desarrollo y mantenimiento de los trastornos relacionados con el trauma.
人类昼夜节律系统创造并维持细胞和全身节律FF0C这对于促进内稳态和环境适应生理过程的时间组织至关重要。类似于急性或慢性应激FF0C睡眠中断和昼夜节律的丧失从根本上影响外周和中枢易感性通路交叉的主要内稳态调节系统FF0C因此可能在应激相关疾病的发展中发挥核心作用。直接和间接的人类和动物 PTSD 研究表明FF0C昼夜节律系统相关的睡眠、神经内分泌、免疫、代谢和自主神经失调FF0C将昼夜节律失调与 PTSD 病理生理学联系起来。此外FF0C有证据表明FF0C睡眠和昼夜节律紊乱可能是预测 PTSD 发展的重要先存风险因素FF0C而睡眠相关症状在创伤相关疾病中最为突出。这些事实可能代表需要转向对创伤后遗症的更多时间生物学理解FF0C并且可以支持对睡眠和昼夜节律紊乱更好的预防、评估和治疗作为 PTSD 管理的第一步。在本期特刊中FF0C我们重点介绍并回顾了增强我们对创伤相关疾病发展和维持理解的人类睡眠和时间生物学研究的最新进展。.

OBJECTIVE: Alterations of the sympathetic and parasympathetic nervous system have been proposed as precursors of the genesis and perpetuation of atherosclerosis for a long time. The objective of this study is to determine if there is an association between the presence of carotid atherosclerosis and the reduction in heart rate variability.
METHODS: Using a prospective case-control design, the heart rate variability and the presence of carotid atherosclerosis was investigated in 54 patients, divided into 2groups according to the presence or absence of carotid atherosclerosis. An analysis was made of the heart rate variability variables of the frequency (spectral) domain in high frequency band, low frequency band, parasympathetic autonomic balance, and the total spectral band.
RESULTS: Of the 54 individuals evaluated without previous cardiovascular disease consecutively, 26 of them (48%) presented with subclinical carotid atherosclerosis (ATE+). A reduction in heart rate variability was observed in the ATE+group represented by the low frequency (LF) spectrum (P<.0001). The parasympathetic activity specifically represented in the high frequency (HF) band was also lower in the ATE+group in the univariate analysis (P<.0001), same as the total spectral power (P<.0001), an index of integral autonomic regulation. No significant differences were found in the LF/HF analysis (P=.1598). After analysing variables with significant differences in the univariate analysis with a logistic regression model, only systolic blood preassure and the total spectral power were shown to be independent predictors of ATE+.
CONCLUSIONS: A reduction in heart rate variability was found in subjects with carotid atherosclerosis. Some spectral components of heart rate variability, like low frequency or total spectral power, were better predictors of carotid atherosclerosis than the parasympathetic autonomic balance. In this study it seems that total spectral power is an adequate measurement for analysing autonomic function.

A precise understanding of the autonomic innervation of the urinary tract is crucial to successful management of urologic disease given the important role that neurophysiology plays in genitourinary pathology. Recent studies using a combination of contemporary histopathology and imaging technologies have furthered our understanding of the spatial nerve distribution in the kidneys, ureters, and bladder. The findings of these recent studies may have important clinical applications in expanding our knowledge of the etiology and treatment of disease processes affecting the urinary tract. In this narrative review, our goal is to provide an overview of the autonomic innervation of the urinary tract. Specifically, we aim to provide a three-dimensional gender-specific description of renal, ureteral and vesical innervation. We also highlight some possible opportunities for clinical and investigational application of this new knowledge.

Autonomic nervous system (ANS) dysfunction in patients with spinal cord injury (SCI) severely impacts morbidity and mortality. However, research initiatives aiming to gain insight into the direct impact of ANS dysfunction on health outcomes in persons with SCI are still lacking. Thus, this study had 2main objectives: 1) to translate into Spanish the revised edition of the International Standards on documentation of remaining Autonomic Function after SCI (ISAFSCI), and 2) to describe the impact of ANS dysfunction in a sample of SCI patients.
Cross-sectional observational pilot study in 51 traumatic SCI patients (> 1 year after injury). Demographic, medical and ISAFSCI data were studied.
The Spanish version of the ISAFSCI showed that the most altered systems in the sample were sweating control (above-lesion hyperhidrosis in 33.3%; below-lesion hyperhidrosis in 17.6%; below-lesion hypohidrosis in 21.6%) and temperature control (hyperthermia in 76.5%). In addition, 74.5% of the sample had complete loss of control of the lower urinary tract, and 82.4% had no control of the bowel. Finally, genital arousal was reflex in 47.1% and orgasm and ejaculation were reduced or altered in most of the patients (92.2% and 84.3%, respectively).
The Spanish version of the ISAFSCI is a useful and practical tool, and can be employed in clinical practice to assess ANS function in patients with SCI. Understanding the role of ANS in persons with SCI is crucial to improve their health status and reduce secondary complications post-SCI, and consequently help to improve the clinical management in these individuals.

Research on human intersubjectivity has found that humans participate in a dialogue throughout their life, and that this is manifested not only via language, but also nonverbally, with the entire body. Such an understanding of human life has brought into focus some basic systemic ideas concerning the human relational mind. For Gregory Bateson, the mind works as a system, formed from components that are in continuous interaction with each other. In our Relational Mind research project, we followed twelve couple therapy processes involving two therapists per session, looking at the ways in which the four participants attuned to each other with their bodies, including their autonomic nervous system activity. Using observations from the project, we here describe the ways through which the relational and embodied mind can be realized in a couple therapy setting.

OBJECTIVE: The emotional evaluation of the causes of vertigo is made using the clinical records and several subjective questionnaires. The aim of the present study is to evaluate the emotional response objectively, in normal subjects, during an induced vertigo crisis.
METHODS: A caloric vestibular test with cold water was performed on 30 healthy subjects. The following physiological parameters were monitored during the 60seconds prior to and the 60seconds after the stimulation: Skin Conductivity, Peripheral Pulse Volume, Body Temperature, Muscle Contraction, Heart Rate, and Respiratory Rate. The maximum angular speed of the nystagmus slow phase at each stimulation was assessed.
RESULTS: Skin conductance presented a statistically significant increase during the vertigo crisis in relation to the prior period while the peripheral pulse volume presented a statistically significant decrease. There was no relationship between the slow phase of the provoked nystagmus angular speed and skin conductance and peripheral pulse volume changes. The decrease in peripheral pulse volume was significantly higher in the second vertigo crisis.
CONCLUSIONS: Skin conductance and peripheral pulse volume changed significantly during a vertigo crisis. There was no relation between the provoked vertiginous crisis intensity and the changes produced in those variables. The stress generated by the caloric stimulation is higher in the second crisis, when the subject has experience of the vertigo caused by the stimulation.

Cardiovascular diseases are a significant cause of morbidity and mortality in the general population. In this sense, the autonomic imbalance is the cornerstone of the pathophysiology underlying the development of these diseases. The aim of this study was to determine the efficacy of exercise training on heart rate variability (HRV) in adult patients with chronic heart failure.
METHODS: A systematic literature review was conducted in electronic databases. The considered studies were randomised clinical trials, quasi-experimental studies with non-randomised control group, quasi-experimental studies with analysis of pre- and post- intervention, and crossover studies with randomly assigned training and non-training periods. The standardised mean differences were calculated between pre- and post-intervention in both the control and experimental group.
RESULTS: Within-subject analysis of the control group showed no statistical significance in the standardised mean differences of HRV. In the experimental group, the standardised mean differences were positive for the root mean square of successive difference (+0.468±0.215; P=.032), high frequency band (HF) (0.934±0.256; P < .001) and low frequency band (LF) (< 0.415±0.096; P=.001). Moreover, the standardised mean difference was negative for LF/HF (-0.747±0.369, P=<.044). On the other hand, only 3 studies entered the comparative meta-analysis. The effect of exercise training was favourable for the experimental group in LF/HF (-2.21±95% CI: -3.83 to -0.60), HF, and LF.
CONCLUSIONS: The exercise training was effective in increasing HRV and restoring the autonomic balance in patients with heart failure.