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Otto Janke, D.C.
Annals of Vertebral Subluxation Research ~ November 10, 2026 ~ Volume 2026 ~ Pages 63-70
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Abstract
Background: Heart rate variability (HRV) reflects autonomic flexibility and is an important predictor of mortality risk. While lower HRV is associated with poorer health outcomes, evidence suggests spinal manipulative therapy (SMT) may produce short-term, low-certainty changes in autonomic activity measured by HRV.
Objective: To propose a testable model linking chiropractic adjustment to HRV and HRV to longevity, while clearly acknowledging the limitations of current evidence.
Methods: Narrative review integrating epidemiologic, clinical, and neurophysiologic findings. Sources include randomized controlled trials, systematic reviews and meta-analyses, mechanistic papers, and selected practice-based observations from the author’s own and other chiropractic settings.
Results: Large cohort studies support an association between HRV and longevity, but evidence that spinal manipulative therapy (SMT) produces meaningful or lasting HRV changes remains limited. Controlled trials report short-term, inconsistent autonomic effects that vary by spinal region, with similar responses observed following osteopathic and physiotherapy manual techniques.
Conclusion: The proposed relationship between chiropractic spinal manipulation, changes in heart rate variability, and healthier aging is biologically plausible but remains unproven. The weakest part of the evidence is whether manipulation reliably produces meaningful changes in HRV. Existing studies are generally small, varied in design, and focused primarily on short-term effects. This model should therefore be viewed as a framework for future prospective, adequately powered research using appropriate sham and attention controls.
Keywords: heart rate variability, spinal manipulative therapy, adjustment, chiropractic, autonomic nervous system, longevity, salutogenesis, neurovisceral integration
