Key result
Positive expiratory pressure shows no benefit over inspiratory muscle training for post-thoracic surgery HRV recovery.
Why the study?
Heart rate variability reflects autonomic nervous system activity and is sensitive to physiological stress induced by surgery, but changes after major and minor thoracic surgery and effects of postoperative respiratory physiotherapy are unclear.
Does positive expiratory pressure (PEP) compared to inspiratory muscle training (IMT) improve heart rate variability parameters in adults undergoing thoracic surgery?
RCT (n=75)
Randomized
No
Does positive expiratory pressure (PEP) compared to inspiratory muscle training (IMT) improve heart rate variability parameters in adults undergoing thoracic surgery?
p-value: p=≥0.05
Postoperative respiratory physiotherapy with positive expiratory pressure versus inspiratory muscle training did not yield clinically or statistically significant differences in autonomic recovery as measured by HRV after thoracic surgery.
Neither PEP nor IMT shows superiority for HRV recovery after thoracic surgery; confirms equivalent effects of these physiotherapies on autonomic modulation.
Purpose Heart rate variability (HRV) reflects autonomic nervous system activity and is sensitive to physiological stress induced by surgery. This study is a secondary, post hoc analysis of a randomized controlled trial aimed at evaluating changes in HRV following major and minor thoracic surgery, and investigating whether postoperative respiratory physiotherapy can modulate these changes. In a prospective, randomized design, two physiotherapy interventions, including positive expiratory pressure (PEP) and inspiratory muscle training (IMT), were compared to assess their effects on HRV. Methods Electrocardiogram recordings were analyzed from 75 patients undergoing either minor pulmonary (PM) or pulmonary resection (PR) surgery. HRV data were collected preoperatively and during the first two postoperative days, immediately following physiotherapy sessions. Patients were assigned to one of two intervention groups (PEP or IMT). Time‐, frequency‐, and nonlinear‐domain HRV parameters were analyzed longitudinally and compared between surgical and intervention groups. Results Most HRV parameters exhibited a postoperative reduction, with more pronounced changes observed in the PR surgery group. In particular, the root mean square of successive RR interval differences (RMSSD) and high‐frequency (HF) power, which are commonly associated with parasympathetic modulation, showed marked decreases. Recovery toward baseline values varied across surgical groups, interventions, and HRV parameters; however, no clear signs of recovery were observed in the PR surgery group during the observation period. No statistically significant differences were detected between the PEP and IMT interventions ( p ≥ 0.05), with the exception of short‐term detrended fluctuation analysis (DFA α 1 ) in the PM surgery group ( p = 0.04). Conclusion HRV parameters reflected surgery‐induced autonomic alterations, with more pronounced and persistent changes observed in patients undergoing PR compared with PM surgery. No clear recovery toward baseline was detected during the 2‐day postoperative follow‐up, suggesting prolonged autonomic disturbances after thoracic surgery. Trial Registration: ClinicalTrials.gov: NCT02931617
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Miri et al. (2026) conducted an RCT in Minor pulmonary or major pulmonary resection surgery (n=75). Positive expiratory pressure (PEP) vs. Inspiratory muscle training (IMT) was evaluated on Differences in postoperative heart rate variability (HRV) parameters between PEP and IMT interventions (p=≥0.05). Postoperative respiratory physiotherapy with positive expiratory pressure versus inspiratory muscle training showed no significant differences in modulating heart rate variability recovery after thoracic surgery.
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