Concurrent exercise training reduces syncope burden in vasovagal syncope associated with autoimmune disease: a comparative study of continuous vs interval training

Abstract

Vasovagal syncope associated with autonomic dysfunction is frequently observed in patients with autoimmune diseases, yet optimal non-pharmacological management remains unclear. Exercise training may improve autonomic regulation and functional capacity. We evaluated the effects of moderate continuous versus interval concurrent training on syncope burden and cardiopulmonary performance.

Forty-eight patients with vasovagal syncope type 1 (without cardioinhibition) and confirmed autoimmune disease underwent a 6-week supervised concurrent training program (600–900 MET-min/week). Thirty-nine participants were women and nine were men. Patients were randomized to moderate continuous training (60–70% peak VO₂) or interval training alternating moderate and high intensity (>80% peak VO₂), determined by cardiopulmonary exercise testing (CPET).

The primary endpoint was the number of syncope events during 6-month follow-up. Secondary endpoints included changes in peak VO₂, ventilatory parameters, and autonomic indices.

Results

Both training modalities produced substantial reductions in syncope burden, with similar outcomes between groups (0–3 events in the interval group vs 0–4 in the continuous group).

However, interval training yielded superior physiological improvements:Peak VO₂ increased by 16% more than in the continuous groupTidal volume improved by 21% moreVE/VCO₂ improved by 7% moreHeart rate reserve increased by 18% more

These findings suggest enhanced cardiorespiratory efficiency and autonomic adaptation with interval training.

Conclusions

Concurrent exercise training is effective in reducing syncope burden in patients with vasovagal syncope associated with autoimmune disease. Interval training provides additional improvements in functional capacity, ventilatory efficiency, and autonomic reserve without compromising clinical outcomes, supporting its use as a preferred rehabilitation strategy in this population.Survival curve: syncopeComp. continuous and interval training