The Influence of Exercise and Physical Activity on Autonomic Nervous System Function Measured by Heart Rate Variability in Individuals with Type 1 Diabetes Mellitus—A Systematic Review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Type 1 diabetes mellitus. Intervention: Exercise and physical activity vs. Control group or lower physical activity. Primary outcome: Heart rate variability (HRV) parameters.

Q: What does this research mean for the field?

Exercise may enhance heart rate variability in individuals with type 1 diabetes mellitus by increasing parasympathetic activity, though current evidence is based on methodologically weak studies. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Isabel Bekker; A.M.D. Kooistra; Peter R. van Dijk; Joop D. Lefrandt; Nic J.G.M. Veeger; André P. van Beek

doi:10.3390/ijms26157096

July 23, 2025International Journal of Molecular SciencesOpen Access

The Influence of Exercise and Physical Activity on Autonomic Nervous System Function Measured by Heart Rate Variability in Individuals with Type 1 Diabetes Mellitus—A Systematic Review

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Key result

Exercise improves heart rate variability in type 1 diabetes, driven by enhanced parasympathetic activity.

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Why the study?

Strategies beyond pharmacotherapy are essential for managing type 1 diabetes mellitus, leading to this review examining the effects of exercise on heart rate variability.

Does exercise or physical activity improve autonomic nervous system function measured by heart rate variability in individuals with type 1 diabetes mellitus?

Key Points

To assess the retrospective and prospective effects of exercise and physical activity on heart rate variability parameters in individuals with type 1 diabetes mellitus.
Conducted a systematic search following PRISMA guidelines across PubMed, Embase, Cochrane, and CINAHL through March 2024.
Identified studies evaluating physical activity or exercise interventions with heart rate variability outcomes in type 1 diabetes, excluding individuals with cardiac autonomic neuropathy or cardiovascular disease.
Extracted data from seven eligible studies and evaluated methodological quality using the Effective Public Health Practice Project tool with best evidence synthesis.
All seven included studies were classified as methodologically weak according to the quality assessment framework.
Moderate evidence indicates that exercise interventions improve heart rate variability, predominantly by enhancing parasympathetic modulation and improving sympathovagal balance.
Evidence remains insufficient to establish the optimal exercise modality, intensity, frequency, or duration needed to maximize autonomic benefits.

Study Design

Type

Systematic Review

Structured PICO

Does exercise or physical activity improve autonomic nervous system function measured by heart rate variability in individuals with type 1 diabetes mellitus?

P

Population

A systematic review of 7 studies evaluating the impact of exercise or physical activity on heart rate variability in individuals with type 1 diabetes mellitus.

I

Intervention

Exercise or physical activity (various types, frequencies, and intensities).

C

Comparator

Healthy controls, untrained individuals with type 1 diabetes mellitus, or pre-intervention baseline (within-group analysis).

O

Outcome

Heart rate variability (HRV) parameters, including time-domain (e.g., RMSSD, SDNN) and frequency-domain (e.g., HF, LF, LF/HF ratio) measures.surrogate

Exercise and physical activity may improve autonomic nervous system function, specifically parasympathetic activity and sympathovagal balance, in individuals with type 1 diabetes mellitus, though current evidence is limited by low methodological quality.

Limitations

Lack of analysis on glycemic control and body composition
Absence of obese individuals in the included studies
Sex-specific differences in HRV were not addressed
Most studies focused on children and adolescents
Heterogeneity of study designs, interventions and outcomes precluded meta-analysis
Methodological quality of the included studies was generally low
Publication bias was not addressed
Heterogeneity of study designs, interventions, and outcomes precluded meta-analysis.
Low methodological quality of all included studies.
Lack of analysis on glycemic control and body composition.
Absence of obese individuals and failure to address sex-specific differences.
Most studies focused on children and adolescents, limiting generalizability to adults.
Publication bias was not addressed.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May support exercise for autonomic benefits in type 1 diabetes; weak study quality leaves optimal regimens undetermined.

Abstract

Non-pharmacological interventions, such as physical activity and exercise, are essential in managing type 1 diabetes mellitus by improving glycemic control, cardiovascular health and autonomic function. Given the chronic nature and long-term complications associated with type 1 diabetes, strategies beyond pharmacotherapy are essential. This review examines the effects of exercise on heart rate variability, a key indicator of autonomic nervous system activity. A systematic search was conducted in March 2024 across PubMed, Embase, Cochrane and CINAHL databases. Studies evaluating the retrospective or prospective impact of exercise or physical activity on heart rate variability parameters were included. Utilizing best evidence synthesis, the methodological quality of the included studies was evaluated. Seven studies met the inclusion criteria, all of which were rated as methodologically weak. Moderate evidence suggests that exercise may enhance heart rate variability, particularly by increasing parasympathetic activity and improving sympathovagal balance. However, evidence remains limited regarding the optimal type, frequency and intensity of exercise. Exercise appears to support autonomic function in individuals with type 1 diabetes mellitus. Nonetheless, further high-quality research is needed to determine the most effective exercise modalities and to inform evidence-based clinical guidelines.

Discussion

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Cite This Study

Bekker et al. (2025) conducted a systematic review in Type 1 diabetes mellitus. Exercise and physical activity vs. Control group or lower physical activity was evaluated on Heart rate variability (HRV) parameters. Exercise and physical activity may enhance heart rate variability in individuals with type 1 diabetes mellitus, particularly by increasing parasympathetic activity and improving sympathovagal balance.

synapsesocial.com/papers/6a18bbc7673175fe754ad6c5 https://doi.org/10.3390/ijms26157096

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The Influence of Exercise and Physical Activity on Autonomic Nervous System Function Measured by Heart Rate Variability in Individuals with Type 1 Diabetes Mellitus—A Systematic Review

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Key Points

Study Design

Structured PICO

Limitations

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Implication

Abstract

Discussion

Cite This Study

The Influence of Exercise and Physical Activity on Autonomic Nervous System Function Measured by Heart Rate Variability in Individuals with Type 1 Diabetes Mellitus—A Systematic Review

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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