Effects of Exercise on Autonomic Cardiovascular Function in Older Adults: A Systematic Review and Meta-Analysis

BACKGROUND: Physical exercise has been proposed to enhance cardiovascular autonomic function; however, current evidence in older populations remains controversial. OBJECTIVE: This systematic review and meta-analysis aimed to examine the effects of physical exercise on autonomic cardiovascular function in older adults. METHODS: A systematic literature search was conducted in PubMed, Web of Science, Scopus, and ScienceDirect on March 12, 2025, following PRISMA 2020 guidelines. Two independent reviewers applied the PICOS model to screen randomised controlled trials (RCTs) published since 2010 that investigated the effects of exercise interventions on autonomic cardiovascular function in older adults. Methodological quality was assessed using the PEDro scale. Standardised mean differences (SMD) and 95% confidence intervals (CI) were calculated through random effects models using the Empirical Bayes method. This systematic review and meta-analysis was registered in PROSPERO (CRD420250651364). RESULTS: Fifteen RCTs were included in the meta-analysis. Exercise interventions significantly increased the root mean square of the successive differences (RMSSD) (SMD 0.636, 95% confidence interval CI 0.014-1.258; p = 0.045) and significantly decreased the low-frequency / high-frequency (LF/HF) ratio (SMD - 0.506, 95% CI - 0.954 to - 0.057; p = 0.027). No significant effects were found for the standard deviation of normal-to-normal intervals (SDNN) (SMD 0.718, 95% CI - 0.120 to 1.557; p = 0.093) or baroreflex sensitivity (SMD - 0.137, 95% CI - 0.670 to 0.396; p = 0.614). Although substantial heterogeneity was noted, no evidence of publication bias was observed. CONCLUSION: These results highlight the utility of structured exercise as a nonpharmacological tool to improve autonomic cardiovascular function in older adults, with potential implications for reducing cardiovascular risk and promoting healthy ageing.