Comparison of acute response of cardiac autonomic modulation between virtual reality-based therapy and cardiovascular rehabilitation: a cluster-randomized crossover trial

ABSTRACT

Objective

To assess the acute response of cardiac autonomic modulation (ACAM) during and after a session of virtual reality-based therapy (VRBT) compared to a session of conventional cardiovascular rehabilitation (CR) and to evaluate the effects of 12 weeks of training on this response.

Methods

We assessed 28 volunteers (63.4 ± 12.5 years). The ACAM was judged by linear indexes of heart rate variability (HRV) in VRBT and CR sessions. Later, patients completed 12 weeks of VRBT+CR and the assessment was repeated at the 12^th week.

Results

Throughout the 1^st VRBT session vagal withdrawal occurred (RMSSD/HFnu); sympathetic nervous system stimulation (LFnu) and progressive decrease of global HRV (SDNN). During the recovery, the SDNN, HFnu, and LFnu improved from the 5^thminute on both therapies. After 12 weeks, the LFnu, HFnu, and the LF/HF-ratio revealed no significant changes in Ex3-Ex4 equated to Rep during VRBT. In recovery, the HFnu and LFnu improved before the 5^thminute on both therapies.

Conclusions

ACAM during and after the VRBT was comparable to CR, yet, the extents were greater in the VRBT. After 12 weeks of VRBT training, the subjects adapted to the exercises from the 15^thminute and exhibited faster recovery of HFnu and LFnu indexes compared to the 1^st week.

KEYWORDS:

• Cardiac rehabilitation
• virtual reality exposure therapy
• sympathetic nervous system
• exercise
• cardiovascular diseases

Acknowledgments

The authors would like to thank the Laboratory of Stress Physiology and Laboratory of the Faculty of São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, for all assistance during this work. The present study was developed under grant support from the Foundation for Research Support of the State of São Paulo (FAPESP) 2018/18276-6 and National Council for Scientific and Technological (CNPq) – Financing Code and 46124.

Conflicts of interest

The authors certify that there is no conflict of interest.

Additional information

Funding

This work was supported by the Foundation for Research Support of the State of São Paulo (FAPESP) [2018/18276-6]; National Council for Scientific and Technological (CNPq) [46124].