Objective: Although heart rate variability (HRV) has been a useful and accessible tool to monitor recovery from athletes` training, it is not clear if it reflects changes in psychophysiological factors. The aim of these study is to identify, through a systematic review and meta-analyses, whether the psychophysiological factors are associated with alteration in heart rate variability (HRV) in sports. Methods: We searched in four databases (PubMed; Scopus; Cochrane; Web of Science) for studies assessing the association of root mean square of successive differences between normal heartbeats (RMSSD) with a variety of psychophysiological outcomes in athletes of any modality. Results: After initial search, we selected 12 studies with 27 study arms for analysis. First, we combined 19 study arms in a meta-analysis testing the correlation between HRV and the psychophysiological factors at baseline (Meta 1). Second, we combined 9 study arms in a meta-analysis testing the correlation between HRV and changes in psychophysilogical factors within a training period (Meta 2). We analyzed the following psychophysiological factors: stress, sleep deprivation, fatigue, muscular soreness, mood, and hormonal changes (cortisol). summary, there was no significant association between the HRV and the psychophysiological factors in both meta-analyses (Meta 1: r = 0.084, P = 0.167; I² = 20%, P-value for heterogeneity = 0.215; and Meta 2: r = 0.268, P = 0.131, I² = 65.2%, P-value for heterogeneity = 0.003). Conclusion: We were not able to confirm the association between HRV and any psychophysiological factors by meta-analysis, but it could be due to inherent limitations of this type of analyses. To test whether this associations truly exist, future meta-analysis will need to include studies with much larger sample size and standardize the methods between studies to reduce heterogeneity. Longitudinal studies will be fundamental to understand the causal relationship between these factors to ultimately improve training monitoring tools for better recovery in athletes.
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