Cardiac autonomic modulation did not differ between normal weight and overweight adults if they reach recommended levels of physical activity

Introduction: Overweight individuals present increased sympathetic modulation and decreased parasympathetic modulation of the heart, as evidenced by several heart rate variability (HRV) indices [1]. This condition has been associated with cardiovascular risk in the adult population. Moderate-to-vigorous physical activity (MVPA) has been associated with improved HRV indices in healthy adults [2]. Similar results have also been observed in the obese population [3]. A recent meta-analysis reported that MVPA levels were associated with a 24% lower risk of cardiovascular mortality and a 21% lower risk of all-cause mortality [4]. Additionally, an inverse dose–response relationship between physical activity levels and mortality risk was observed, regardless of weight status, with no survival beneft from being normal weight if physical activity levels were low [5]. The literature supports that the mortality risk attributed to obesity is signifcantly mitigated by MVPA, with obesityrelated cardiometabolic risk markers improving through MVPA interventions, even in the absence of weight loss [6]. In this context, our previous study analyzed the association between cardiac autonomic modulation, measured through HRV indices, and cardiovascular parameters in adults, based on weight status and MVPA levels. Similar associations were observed between the normal weight/ active and overweight/active groups, compared to the overweight/insufciently active group [7]. Although HRV indices and blood pressure levels were more strongly associated in physically active groups regardless of weight status, it remains unclear whether the simultaneous condition of overweight/obesity and sufcient MVPA levels could be distinctly linked to diferent HRV indices in adults. This study compared HRV indexes of adults according to joint association of nutritional status (normal weight vs. overweight) and physical activity levels (physically active vs. insufciently active) in a randomly selected sample of adults, independent of sex, age, and socioeconomic status