The role of exercise in reducing vasovagal syncope recurrence: A systematic review and meta-analysis

Vasovagal syncope (VVS) is the most common cause of transient loss of consciousness, yet effective long-term treatments remain limited. Exercise has been proposed to improve autonomic regulation and lower recurrence rates. This study aims to determine the effect of structured exercise interventions on VVS recurrence and quality of life.

This systematic review and meta-analysis were conducted according to PRISMA guidelines (PROSPERO CRD420251009841). MEDLINE, Embase, and Emcare were searched for studies published between 1 January 1998 and July 2025 for randomized and prospective interventional studies evaluating structured exercise in patients with VVS. Studies of non-exercise interventions or secondary causes of syncope were excluded. The primary outcome was recurrence of syncope; secondary outcomes included quality of life and physiological measures. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool and Newcastle-Ottawa Scale. Random-effects meta-analysis was performed to pool recurrence proportions and mean differences with 95 % confidence intervals.

Eight studies (n = 435) were included (mean age range 21-39 years; 59 % female). The rate of VVS recurrence was lower in the intervention groups (7 %, 95 % CI 0.04-0.11) compared with control groups (24 %, 95 % CI 0.16-0.33). The pooled mean difference in syncopal events was -0.22 (95 % CI -0.42 to -0.02), indicating a statistically significant reduction in syncopal events for the exercise intervention compared with control groups. Quality-of-life scores improved by 30-45 points (p < 0.001), while modest, non-significant changes were observed in heart rate and blood pressure. Adherence exceeded 80 %, with no serious adverse events.

Structured exercise was associated with lower VVS recurrence and improved quality of life. These findings are consistent with potential autonomic and cardiovascular adaptation. It represents a safe, effective, and sustainable adjunct to standard management. However, included studies were small and heterogenous and larger multicenter randomized trials are needed to confirm long-term efficacy.

Structured physical exercise may help reduce fainting episodes in people with vasovagal syncope and improve their day-to-day confidence and wellbeing.