Effects of Mind⁻Body Exercises (Tai Chi/Yoga) on Heart Rate Variability Parameters and Perceived Stress: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Liye Zou, Jeffer Eidi Sasaki, Gao-Xia Wei, Tao Huang, Albert S Yeung, Octávio Barbosa Neto, Kevin W Chen, Stanley Sai-Chuen Hui, Liye Zou, Jeffer Eidi Sasaki, Gao-Xia Wei, Tao Huang, Albert S Yeung, Octávio Barbosa Neto, Kevin W Chen, Stanley Sai-Chuen Hui

Abstract

Background: Heart rate variability (HRV) as an accurate, noninvasive measure of the Autonomous Nervous System (ANS) can reflect mental health (e.g., stress, depression, or anxiety). Tai Chi and Yoga (Tai Chi/Yoga), as the most widely practiced mind⁻body exercises, have shown positive outcomes of mental health. To date, no systematic review regarding the long-lasting effects of Tai Chi/Yoga on HRV parameters and perceived stress has been conducted.

Objective: To critically evaluate the existing literature on this topic.

Methods: Five electronic databases (Web of Science, PubMed, Scopus, SportDiscus and Cochrane Library) were searched from the start of the research project to July 2018. Study selection, data extraction, and study quality assessment were independently carried out by two reviewers. The potentially identified randomized controlled trials (RCT) reported the useful quantitative data that were included only for meta-analysis.

Results: meta-analysis of 17 medium-to-high quality RCTs showed significantly beneficial effects on HRV parameters (normalized low-frequency, Hedge's g = -0.39, 95% CI -0.39 to -0.56, p < 0.001, I2 = 11.62%; normalized high-frequency, Hedge's g = 0.37, 95% CI 0.22 to -0.52, p < 0.001, I2 = 0%; low-frequency to high-frequency ratio, Hedge's g = -0.58, 95% CI -0.81 to -0.35, p < 0.001, I2 = 53.78%) and stress level (Hedge's g = -0.80, 95% CI -1.17 to -0.44, p < 0.001, I2 = 68.54%).

Conclusions: Stress reduction may be attributed to sympathetic-vagal balance modulated by mind⁻body exercises. Tai Chi/Yoga could be an alternative method for stress reduction for people who live under high stress or negative emotions.

Keywords: HRV; Tai Chi; Yoga; autonomous nervous system; mindfulness; psycho-social stress.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The process of selecting randomized controlled trials.
Figure 2
Figure 2
Funnel plot of publication bias for low-frequency power.
Figure 3
Figure 3
Effects of mind–body exercise on the normalized low-frequency power (LF = low frequency power; Ex = Exercise control group, UC = usual care).
Figure 4
Figure 4
Effects of mind–body exercise on the normalized high-frequency power.
Figure 5
Figure 5
Effects of mind–body exercise on the normalized high-frequency power (Ex = exercise control, UC = usual care).
Figure 6
Figure 6
Funnel plot of publication bias for low-frequent to high-frequency ratio.
Figure 7
Figure 7
Effects of mind–body exercises on low-frequency to high-frequency ratio (LF/HF ratio = low frequency to high frequency ratio: Ex = Exercise control, WL = waitlist, UC = usual care).
Figure 8
Figure 8
Effects of mind–body exercises on stress reduction (Ex = exercise control, MF = mindfulness control).

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