Heart rate and heart rate variability as outcomes and longitudinal moderators of treatment for pain across follow-up in Veterans with Gulf War illness.
Study Goal
The researchers aimed to determine whether yoga (which includes mindfulness) or cognitive behavioral therapy (CBT) improved autonomic dysfunction (HR and HRV) and whether baseline autonomic function predicted pain outcomes in Veterans with Gulf War illness (GWI).
Results Summary
Veterans who received CBT showed a tendency toward higher mean HR post-treatment, while baseline autonomic function (lower HR, higher HRV) predicted greater pain reduction across both treatments. Better baseline autonomic function predicted greater pain reduction with yoga, whereas worse baseline function predicted better outcomes with CBT.
Population
Veterans with Gulf War illness (GWI)
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
cognitive behavioural therapy (CBT) for pain | increase | mean HR | Veterans with GWI | - | tended towards higher | #1 |
- | decrease | pain | Veterans with GWI | - | predicted greater reductions | #2 |
yoga | decrease | pain | Veterans with GWI | - | predicted greater pain reductions | #3 |
cognitive behavioural therapy (CBT) | decrease | pain | Veterans with GWI | - | predicted greater pain reductions | #4 |
cognitive behavioural therapy (CBT) | increase | HR | Veterans with GWI | - | may increase | #5 |
yoga | no change | HR | Veterans with GWI | - | remain stable | #6 |
AIMS: Accumulating evidence suggests Gulf War illness (GWI) is characterised by autonomic nervous system dysfunction (higher heart rate [HR], lower heart rate variability [HRV]). Yoga - an ancient mind-body practice combining mindfulness, breathwork, and physical postures - is proposed to improve autonomic dysfunction yet this remains untested in GWI. We aimed to determine (i) whether HR and HRV improve among Veterans with GWI receiving either yoga or cognitive behavioural therapy (CBT) for pain; and (ii) whether baseline autonomic functioning predicts treatment-related pain outcomes across follow-up. MAIN METHODS: We present secondary analyses of 24-hour ambulatory cardiac data (mean HR, square root of the mean squared differences between successive R-R intervals [RMSSD], high frequency power [HF-HFV], and low-to-high frequency ratio [LF/HF] extracted from a 5-min window during the first hour of sleep) from our randomised controlled trial of yoga versus CBT for pain among Veterans with GWI (ClinicalTrials.govNCT02378025; N = 75). KEY FINDINGS: Veterans who received CBT tended towards higher mean HR at end-of-treatment. Better autonomic function (lower mean HR, higher RMSSD/HF-HRV) at baseline predicted greater reductions in pain across follow-up, regardless of treatment group. Better baseline autonomic function (mid-range-to-high RMSSD/HF-HRV) also predicted greater pain reductions with yoga, while worse baseline autonomic function (higher mean HR, lower RMSSD/HF-HRV) predicted greater pain reductions with CBT. SIGNIFICANCE: To our knowledge, this is the first study to suggest that among Veterans with GWI, HR may increase with CBT yet remain stable with yoga. Furthermore, HR and HRV moderated pain outcome across follow-up for yoga and CBT.