Changes in Heart Rate Variability During an EHealth Behavior Change Intervention Program in Patients with Cardiovascular Disease

Overview

Journal Int J Cardiol Heart Vasc

Date 2024 Dec 9

PMID 39649024

Authors

T Roovers

M Habibovic

P Lodder

J W Widdershoven

W J Kop

Affiliations

Soon will be listed here.

Abstract

Background: Cardiovascular disease (CVD) risk is associated with health behaviors such as physical inactivity, dietary habits, and smoking. The autonomic nervous system plays a key role in this association. The present longitudinal study examines whether ECG-based indices of autonomic nervous system activity change during an eHealth-based behavior intervention program and assesses whether improvements in health behaviors are associated with increases in parasympathetic autonomic nervous system activity.

Methods: Data from the DoCHANGE-2 (https://clinicaltrials.gov/study/NCT03178305) eHealth-based behavior intervention study in patients with CVD were analyzed for participants with valid ECG recordings (N = 58, mean age = 58.9 [SD = 12.7] years, 21 % women). Heart rate variability (indexed as RMSSD) was calculated from home-recorded (40 s) ECGs over 5-day periods at baseline, 3, and 6 months. Health behaviors, clinical, and psychosocial information was obtained from questionnaires and medical records. Data were analyzed using linear mixed models and general linear models.

Results: Over the 6-month period, RMSSD decreased significantly, with the lowest values at six months (B = -19.336 [95 %CI -36.291; 2.381], p = 0.026). Health behaviors improved significantly during the active (0-3 months) intervention period (B = 13.360 [95 %CI 6.931 19.789], p < 0.001). Higher BMI (B = -0.369 [-0.739; 0.000]; p = 0.05) and older age (B = -0.404 [95 % CI -0.597; - 0.211]; p < 0.001) were associated with lower RMSSD across the three timepoints. No consistent associations were found between changes in health behaviors and changes in RMSSD.

Conclusion: This study shows that changes in HRV during an eHealth-based behavioral intervention were not associated with the observed improvements in health behaviors. These findings require replication in larger well-controlled investigations.

References

Bodin F, McIntyre K, Schwartz J, McKinley P, Cardetti C, Shapiro P . The Association of Cigarette Smoking With High-Frequency Heart Rate Variability: An Ecological Momentary Assessment Study. Psychosom Med. 2017; 79(9):1045-1050. PMC: 5675783. DOI: 10.1097/PSY.0000000000000507. View

Kopp W . Chronically increased activity of the sympathetic nervous system: our diet-related "evolutionary" inheritance. J Nutr Health Aging. 2009; 13(1):27-9. DOI: 10.1007/s12603-009-0005-1. View

Cockerham W . Health lifestyle theory and the convergence of agency and structure. J Health Soc Behav. 2005; 46(1):51-67. DOI: 10.1177/002214650504600105. View

Grol M, De Raedt R . The link between resting heart rate variability and affective flexibility. Cogn Affect Behav Neurosci. 2020; 20(4):746-756. DOI: 10.3758/s13415-020-00800-w. View

Wang H, Gao X, Shi Y, Wu D, Li C, Wang W . Effects of trunk posture on cardiovascular and autonomic nervous systems: A pilot study. Front Physiol. 2022; 13:1009806. PMC: 9623330. DOI: 10.3389/fphys.2022.1009806. View

Broers E, Gavidia G, Wetzels M, Ribas V, Ayoola I, Piera-Jimenez J . Usefulness of a Lifestyle Intervention in Patients With Cardiovascular Disease. Am J Cardiol. 2019; 125(3):370-375. DOI: 10.1016/j.amjcard.2019.10.041. View

Stahle A, Nordlander R, Bergfeldt L . Aerobic group training improves exercise capacity and heart rate variability in elderly patients with a recent coronary event. A randomized controlled study. Eur Heart J. 1999; 20(22):1638-46. DOI: 10.1053/euhj.1999.1715. View

Thayer J, Lane R . A model of neurovisceral integration in emotion regulation and dysregulation. J Affect Disord. 2001; 61(3):201-16. DOI: 10.1016/s0165-0327(00)00338-4. View

Mokdad A, Remington P . Measuring health behaviors in populations. Prev Chronic Dis. 2010; 7(4):A75. PMC: 2901573. View

10.

Noordam R, van den Berg M, Niemeijer M, Aarts N, Hofman A, Tiemeier H . Antidepressants and heart-rate variability in older adults: a population-based study. Psychol Med. 2015; 46(6):1239-47. DOI: 10.1017/S0033291715002779. View

11.

Carney R, Freedland K . Depression and coronary heart disease. Nat Rev Cardiol. 2016; 14(3):145-155. DOI: 10.1038/nrcardio.2016.181. View

12.

Thayer J, Yamamoto S, Brosschot J . The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol. 2009; 141(2):122-31. DOI: 10.1016/j.ijcard.2009.09.543. View

13.

Speer K, Semple S, Naumovski N, McKune A . Heart rate variability for determining autonomic nervous system effects of lifestyle behaviors in early life: A systematic review. Physiol Behav. 2020; 217:112806. DOI: 10.1016/j.physbeh.2020.112806. View

14.

Lloyd-Jones D, Allen N, Anderson C, Black T, Brewer L, Foraker R . Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation. 2022; 146(5):e18-e43. PMC: 10503546. DOI: 10.1161/CIR.0000000000001078. View

15.

Pine K, Fletcher B . Time to shift brain channels to bring about effective changes in health behaviour. Perspect Public Health. 2014; 134(1):16-7. DOI: 10.1177/1757913913514705. View

16.

Magnon V, Vallet G, Benson A, Mermillod M, Chausse P, Lacroix A . Does heart rate variability predict better executive functioning? A systematic review and meta-analysis. Cortex. 2022; 155:218-236. DOI: 10.1016/j.cortex.2022.07.008. View

17.

Jeyhani V, Mantysalo M, Noponen K, Seppanen T, Vehkaoja A . Effect of Different ECG Leads on Estimated R-R Intervals and Heart Rate Variability Parameters. Annu Int Conf IEEE Eng Med Biol Soc. 2020; 2019:3786-3790. DOI: 10.1109/EMBC.2019.8857954. View

18.

Dekker J, Schouten E, Klootwijk P, Pool J, Swenne C, Kromhout D . Heart rate variability from short electrocardiographic recordings predicts mortality from all causes in middle-aged and elderly men. The Zutphen Study. Am J Epidemiol. 1997; 145(10):899-908. DOI: 10.1093/oxfordjournals.aje.a009049. View

19.

. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996; 93(5):1043-65. View

20.

van Zyl L, Hasegawa T, Nagata K . Effects of antidepressant treatment on heart rate variability in major depression: a quantitative review. Biopsychosoc Med. 2008; 2:12. PMC: 2478652. DOI: 10.1186/1751-0759-2-12. View