Cardiac vagal recovery following acute psychological stress in human adults: A scoping review.

Abstract

Vagally mediated heart rate variability (vmHRV) recovery following acute psychological stress reflects parasympathetic function and stress resilience, yet there is no synthesis on how it is measured and influenced by key factors. This scoping review mapped methodologies used to assess vmHRV recovery and examined clinical, demographic, psychological, physiological and environmental influences. Following PRISMA-ScR guidelines, a comprehensive search of MEDLINE, PsycINFO, and EMBASE databases identified empirical peer-reviewed studies on cardiac vagal recovery in adults published since 2000 that reported vmHRV post-stress. Key data, including recovery operationalization, stressor types, and factors influencing recovery, were extracted and synthesized. A total of 291 journal articles, covering 294 studies (N = 23,533 participants across 33 countries; 56.1% female), met inclusion criteria. Evidence indicated that enhanced vmHRV recovery was associated with greater levels of resilience, attentional control, habitual use of cognitive reappraisal, and exposure to nature elements. In contrast, blunted vmHRV recovery was linked with clinical depression, cardiovascular disease risk, and emotion dysregulation. Methodological challenges included variability in recovery timing (e.g., 5- vs. 30-minute windows) and inconsistent reporting of recovery conditions (e.g., posture). Aggregation of recovery data across dissimilar stressors without justification also contributed to interpretation issues. This review highlights substantial variability in how vmHRV recovery is measured and reported, limiting comparability across studies. Core recommendations include justifying recovery timing, standardizing recovery conditions, and prioritizing non-normalized vmHRV metrics to improve consistency. These methodological improvements will enhance cross-study comparisons, facilitate meta-analyses, and advance understanding of the role of cardiac vagal recovery in stress resilience and health outcomes.