Journal of Paramedical Sciences & Rehabilitation

Journal of Paramedical Sciences & Rehabilitation

Comparison of Endurance, Resistance, and Parallel training On Heart Rate Variability In Male Smokers With Metabolic Syndrome

Document Type : Original Article

Authors
Khashayar Alapour 1
Amin Farzaneh Hesari 2
Hajar Abbaszadeh 2
1 Department of Physical Education, Faculty of Humanities, Azad University, Sari Branch, Sari, Iran
2 Department of Exercise Physiology, Sar.C., Islamic Azad University, Sari, Iran
10.22038/jpsr.2026.92261.2748
Abstract
Purpose:
Heart rate variability (HRV) is a key indicator of autonomic nervous system function and cardiac adaptability, both of which are markedly reduced in smokers with metabolic syndrome. This study aimed to compare the effects of endurance, resistance, and concurrent training on HRV components in male smokers with metabolic syndrome.
Methods:
In this quasi-experimental study, forty male smokers diagnosed with metabolic syndrome were randomly assigned to four groups: endurance, resistance, concurrent, and control. Training programs were performed for 12 weeks, three sessions per week. HRV indices including HF, LF, RMSSD, SDNN, HR, and LF/HF were measured before and after the intervention. Data were analyzed using multivariate analysis of covariance (MANCOVA) and paired t‑tests (p < 0.05).
Results:
The results of the Wilks’ Lambda test indicated that the group effect on the combination of HRV components was significant (p < 0.001). Significant differences were observed between the training groups in HF (p = 0.002), HR (p < 0.001), LF (p < 0.001), LF/HF ratio (p = 0.004), RMSSD (p < 0.001), and SDNN (p < 0.001) (p < 0.05). Aerobic training produced the greatest effects on HF and RMSSD indices, while concurrent training elicited the largest changes in SDNN, HR, LF, and the LF/HF ratio. Resistance training led to more limited improvements in RMSSD and SDNN.
Conclusion:
All three training modalities improved autonomic cardiac regulation, but concurrent training—combining aerobic and resistance elements—showed the most comprehensive effect in enhancing sympatho‑vagal balance. Consequently, concurrent training can be recommended as an effective and non-pharmacological strategy for cardiovascular rehabilitation in smokers with metabolic syndrome.
Keywords
Heart rate variability
Endurance training
Resistance training
Parallel training
Metabolic syndrome
Smoking
Autonomic nervous system
  1. Saklayen MG. The global epidemic of the metabolic syndrome. Current hypertension reports. 2018; 20(2): 1-8.
  2. Ortiz-Guzmán JE, Sánchez-Soler M, Prieto-Mondragón L, Arias-Mutis ÓJ, et al. Effects of Physical Training on Heart Rate Variability in Patients with Metabolic Syndrome: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine 2025; 14(17): 6129.
  3. Serhiyenko A, Baitsar M, Sehin V, Serhiyenko L, et al. Post-traumatic stress disorder, insomnia, heart rate variability, and metabolic syndrome (narrative review). Proceedings of the Shevchenko Scientific Society Medical Sciences 2024; 73(1).
  4. Ortiz-Guzmán JE, Mollà-Casanova S, Arias-Mutis ÓJ, Bizy A, et al. Differences in long-term heart rate variability between subjects with and without metabolic syndrome: a systematic review and meta-analysis. Journal of Cardiovascular Development and Disease 2023; 10(5): 203.
  5. Supriya R, Li F-F, Yang Y-D, Liang W, Baker JS. Association between metabolic syndrome components and cardiac autonomic modulation among children and adolescents: a systematic review and meta-analysis. Biology 2021; 10(8): 699.
  6. CHO Y-J, SONG D-W. Association between heart rate variability and metabolic syndrome. Soonchunhyang Medical Science. 2021; 1-4.
  7. Hutchinson G, Cooper A, Billany R, Nixon D, et al. Effect of high intensity interval training and moderate intensity continuous training on lymphoid, myeloid and inflammatory cells in kidney transplant recipients. 2022.
  8. Mazurek K, Krawczyk K, Zmijewski P, Norkowski H, Czajkowska A. Effects of aerobic interval training versus continuous moderate exercise program me on aerobic and anaerobic capacity, somatic features and blood lipid profile in collegate females. Ann Agric Environ Med 2014; 21(4): 844-849.
  9. Li R, Yan R, Cheng W, Ren H. Effect of resistance training on heart rate variability of anxious female college students. Frontiers in Public Health 2022; 10: 1050469.
  10. Schoenfeld BJ, Grgic J, Ogborn D, Krieger JW. Strength and hypertrophy adaptations between low-vs. high-load resistance training: a systematic review and meta-analysis. The Journal of Strength & Conditioning Research 2017; 31(12): 3508-3523.
  11. Zaki S, Alam MF, Sharma S, Naqvi IH, Nuhmani S. Impact of concurrent training sequence on heart rate variability, glycemic control, body composition, lipid profile, and cardiorespiratory fitness in type 2 diabetes patients with cardiac autonomic neuropathy: A randomized controlled trial. Clinical Epidemiology and Global Health 2024; 29: 101747.
  12. Dungan CM, Brightwell CR, Wen Y, Zdunek CJ, et al. Muscle-specific cellular and molecular adaptations to late-life voluntary concurrent exercise. Function 2022; 3(4): zqac027.
  13. Navarro-Lomas G, Dote-Montero M, Alcantara JM, Plaza-Florido A, et al. Different exercise training modalities similarly improve heart rate variability in sedentary middle-aged adults: the FIT-AGEING randomized controlled trial. European Journal of Applied Physiology 2022; 122(8): 1863-1874.
  14. Isezuo S, Ezunu E. Demographic and clinical correlates of metabolic syndrome in Native African type-2 diabetic patients. Journal of the National Medical Association 2005; 97(4): 557.
  15. Chen K, Lindsey JB, Khera A, Lemos JAD, et al. independent associations between metabolic syndrome, diabetes mellitus and atherosclerosis: observations from the Dallas Heart Study. Diabetes and Vascular Disease Research. 2008; 5(2): 96-101.
  16. Benowitz NL. Nicotine addiction. New England Journal of Medicine. 2010; 362(24): 2295-2303.
  17. Shaffer F, Ginsberg JP. An overview of heart rate variability metrics and norms. Frontiers in public health 2017; 5: 258.
  18. Blaser BL, Weymar M, Wendt J. The Effect of a Single-Session Heart Rate Variability Biofeedback on Attentional Control: Does Stress Matter? Frontiers in psychology 2023; 14: 1292983.
  19. Laborde S, Mosley E, Thayer JF. Heart rate variability and cardiac vagal tone in psychophysiological research–recommendations for experiment planning, data analysis, and data reporting. Frontiers in psychology 2017; 8: 213.
  20. Malik M, Bigger JT, Camm AJ, Kleiger RE, et al. Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. European heart journal 1996; 17(3): 354-381.
  21. Standard KH, Premium KH. Kubios HRV Software. 2023.
  22. Graham JK. Effect of Heart Rate Variability Biofeedback on Prolonged Grief Disorder in Bereavement: A Case Series Study: Saybrook University; 2023.
  23. Riebe D, Ehrman JK, Liguori G, Magal M. ACSM’s guidelines for exercise testing and prescription: American College of Sports Medicine; 2018.
  24. Church TS, Earnest CP, Skinner JS, Blair SN. Effects of different doses of physical activity on cardiorespiratory fitness among sedentary, overweight or obese postmenopausal women with elevated blood pressure: a randomized controlled trial. Jama 2007; 297(19): 2081-2091.
  25. Zhou Y, Wu W, Zou Y, Huang W, et al. Benefits of different combinations of aerobic and resistance exercise for improving plasma glucose and lipid metabolism and sleep quality among elderly patients with metabolic syndrome: a randomized controlled trial. Endocrine journal 2022; 69(7): 819-830.
  26. Kim CS, Kim MK, Jung HY, Kim MJ. Effects of exercise training intensity on cardiac autonomic regulation in habitual smokers. Annals of Noninvasive Electrocardiology 2017; 22(5): e12434.
  27. Electrophysiology TFotESoCtNASoP. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation 1996; 93(5): 1043-1065.
  28. Wulsin LR, Horn PS, Perry JL, Massaro JM, D'Agostino RB. Autonomic imbalance as a predictor of metabolic risks, cardiovascular disease, diabetes, and mortality. The Journal of Clinical Endocrinology & Metabolism 2015; 100(6): 2443-2448.
  29. Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. International journal of cardiology 2010; 141(2): 122-131.
  30. Manresa-Rocamora A, Sarabia JM, Javaloyes A, Flatt AA, Moya-Ramon M. Heart rate variability-guided training for enhancing cardiac-vagal modulation, aerobic fitness, and endurance performance: A methodological systematic review with meta-analysis. International Journal of Environmental Research and Public Health 2021; 18(19): 10299.
  31. Tofas T, Draganidis D, Deli CK, Georgakouli K, et al. Exercise-induced regulation of redox status in cardiovascular diseases: the role of exercise training and detraining. Antioxidants 2019; 9(1): 13.
  32. Da Silva MAR, Baptista LC, Neves RS, De França E, et al. The effects of concurrent training combining both resistance exercise and high-intensity interval training or moderate-intensity continuous training on metabolic syndrome. Frontiers in physiology 2020; 11: 572.
  33. Yan Z. Exercise, PGC-1α, and metabolic adaptation in skeletal muscle. Applied Physiology, Nutrition, and Metabolism 2009; 34(3): 424-427.
  34. Heffernan KS, Fahs CA, Shinsako KK, Jae SY, Fernhall B. Heart rate recovery and heart rate complexity following resistance exercise training and detraining in young men. American Journal of Physiology-Heart and Circulatory Physiology 2007; 293(5): H3180-H3186.
Journal of Paramedical Sciences & Rehabilitation
Volume 15, Issue 1
Spring 2026
Pages 42-55