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Maqsood R, Schofield S, Bennett AN, Khattab A, Bull AMJ, Fear NT, Boos CJ. Exploratory analysis of spontaneous versus paced breathing on heart rate variability in veterans with combat-related traumatic injury. PM R 2024. [PMID: 38634349 DOI: 10.1002/pmrj.13164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Respiration is a crucial determinant of autonomic balance and heart rate variability (HRV). The comparative effect of spontaneous versus paced breathing on HRV has been almost exclusively explored in healthy adults and never been investigated in an injured military cohort. OBJECTIVE To examine the effect of spontaneous versus paced breathing on HRV in veterans with combat-related traumatic injury (CRTI). DESIGN Observational cohort study. SETTING ArmeD serVices trAuma rehabilitatioN outComE (ADVANCE) study, Stanford Hall, UK. PARTICIPANTS The sample consisted of 100 randomly selected participants who sustained CRTI (eg, amputation) during their deployment (Afghanistan 2003-2014) and were recruited into the ongoing ADVANCE prospective cohort study. INTERVENTION Not applicable. MAIN OUTCOME MEASURE HRV was recorded using a single-lead ECG. HRV data were acquired during a sequential protocol of 5-minute spontaneous breathing followed immediately by 5 minutes of paced breathing (six cycles/minute) among fully rested and supine participants. HRV was reported using time domain (root mean square of successive differences), frequency domain (low frequency and high frequency) and nonlinear (sample entropy) measures. The agreement between HRV during spontaneous versus paced breathing was examined using the Bland-Altman analysis. RESULTS The mean age of participants was 36.5 ± 4.6 years. Resting respiratory rate was significantly higher with spontaneous versus paced breathing (13.4 ± 3.4 vs. 7.6 ± 2.0 breaths/minute; p < .001), respectively. Resting mean heart rate and root mean square of successive differences were significantly higher with paced breathing than spontaneous breathing (p < .001). Paced breathing significantly increased median low frequency power than spontaneous breathing (p < .001). No significant difference was found in the absolute power of high frequency between the two breathing protocols. The Bland-Altman analysis revealed poor agreement between HRV values during spontaneous and paced breathing conditions with wide limits of agreement. CONCLUSION Slow-paced breathing leads to higher HRV than spontaneous breathing and could overestimate resting "natural-state" HRV.
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Affiliation(s)
- Rabeea Maqsood
- Department of Medical Sciences and Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Susie Schofield
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Alexander N Bennett
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Loughborough, UK
| | - Ahmed Khattab
- Department of Medical Sciences and Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK
| | - Nicola T Fear
- The Academic Department of Military Mental Health, King's College London, London, UK
| | - Christopher J Boos
- Department of Medical Sciences and Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
- Department of Cardiology, University Hospitals Dorset, Poole Hospital, Poole, UK
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You M, Laborde S, Ackermann S, Borges U, Dosseville F, Mosley E. Influence of Respiratory Frequency of Slow-Paced Breathing on Vagally-Mediated Heart Rate Variability. Appl Psychophysiol Biofeedback 2024; 49:133-143. [PMID: 38063977 DOI: 10.1007/s10484-023-09605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 02/16/2024]
Abstract
Breathing techniques, particularly slow-paced breathing (SPB), have gained popularity among athletes due to their potential to enhance performance by increasing cardiac vagal activity (CVA), which in turn can help manage stress and regulate emotions. However, it is still unclear whether the frequency of SPB affects its effectiveness in increasing CVA. Therefore, this study aimed to investigate the effects of a brief SPB intervention (i.e., 5 min) on CVA using heart rate variability (HRV) measurement as an index. A total of 75 athletes (22 female; Mage = 22.32; age range = 19-31) participated in the study, attending one lab session where they performed six breathing exercises, including SPB at different frequencies (5 cycles per minute (cpm), 5.5 cpm, 6 cpm, 6.5 cpm, 7 cpm), and a control condition of spontaneous breathing. The study found that CVA was significantly higher in all SPB conditions compared to the control condition, as indexed by both root mean square of the successive differences (RMSSD) and low-frequency HRV (LF-HRVms2). Interestingly, LF-HRVms2 was more sensitive in differentiating the respiratory frequencies than RMSSD. These results suggest that SPB at a range of 5 cpm to 7 cpm can be an effective method to increase CVA and potentially improve stress management and emotion regulation in athletes. This short SPB exercise can be a simple yet useful tool for athletes to use during competitive scenarios and short breaks in competitions. Overall, these findings highlight the potential benefits of incorporating SPB into athletes' training and competition routines.
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Affiliation(s)
- Min You
- School of Teacher Education, University of Weifang, Weifang, China.
- UFR Psychologie, UR 3918 CERREV, Université de Caen Normandie, Caen, 14032, France.
| | - Sylvain Laborde
- Department of Performance Psychology, Institute of Psychology, German Sport University, Cologne, Germany
- UFR STAPS, UR 7480 VERTEX, Université de Caen Normandie, Caen, 14032, France
| | - Stefan Ackermann
- Department of Performance Psychology, Institute of Psychology, German Sport University, Cologne, Germany
| | - Uirassu Borges
- Department of Health & Social Psychology, Institute of Psychology, German Sport University, Cologne, Germany
| | - Fabrice Dosseville
- UFR STAPS, UR 7480 VERTEX, Université de Caen Normandie, Caen, 14032, France
- CNDAPS, Colombelles, F-14460, France
| | - Emma Mosley
- Department of Rehabilitation and Sport Sciences, School of Sport, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB, UK
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Gerbarg PL, Dickson F, Conte VA, Brown RP. Breath-centered virtual mind-body medicine reduces COVID-related stress in women healthcare workers of the Regional Integrated Support for Education in Northern Ireland: a single group study. Front Psychiatry 2023; 14:1199819. [PMID: 37377478 PMCID: PMC10291294 DOI: 10.3389/fpsyt.2023.1199819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Background During the COVID-19 pandemic, healthcare workers endured prolonged stress affecting their psychological well-being. Objectives: (1) Evaluate the effects of the Breath-Body-Mind Introductory Course (BBMIC) on COVID-related stress among employees of the Regional Integrated Support for Education, Northern Ireland, (2) Reduce the risk of adverse effects from COVID-related stress, and (3) Evaluate the effects of BBMIC on indicators of psychophysiological states and the consistency with hypothesized mechanisms of action. Methods In this single group study, a convenience sample of 39 female healthcare workers completed informed consent and baseline measures: Perceived Stress Scale (PSS), Stress Overload Scale-Short (SOS-S), and Exercise-Induced Feelings Inventory (EFI). Following the online BBMIC 4 h/day for 3 days and the 6 week solo (20 min/day) and group practice (45 min weekly), repeat testing plus the Indicators of Psychophysiological State (IPSS) and Program Evaluation were obtained. Results Baseline (T1) mean PSS score was significantly elevated compared to a normative sample: PSS = 18.2 vs. 13.7 (p < 0.001) and improved significantly 11 weeks post-BBMIC (T4). SOS-S mean score declined from 10.7(T1) to 9.7 at 6 week post-test (T3). The SOS-S proportion of High Risk scores found in 22/29 participants (T1), dropped to 7/29 (T3). EFI mean subscale scores improved significantly from T1 to T2 and T3 for Revitalization (p < 0.001); Exhaustion (p < 0.002); and Tranquility (p < 0.001); but not Engagement (p < 0.289). Conclusion Among RISE NI healthcare workers affected by COVID-related stress, participation in the BBMIC significantly reduced scores for Perceived Stress, Stress Overload, and Exhaustion. EFI Revitalization and Tranquility scores significantly improved. More than 60% of participants reported moderate to very strong improvements in 22 indicators of psychophysiological state, e.g., tension, mood, sleep, mental focus, anger, connectedness, awareness, hopefulness, and empathy. These results are consistent with the hypothesized mechanisms of action whereby voluntarily regulated breathing exercises change interoceptive messaging to brain regulatory networks that shift psychophysiological states of distress and defense to states of calmness and connection. These positive findings warrant validation in larger, controlled studies to extend the understanding of how breath-centered Mind-body Medicine practices could mitigate adverse effects of stress.
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Affiliation(s)
- Patricia L. Gerbarg
- Department of Psychiatry, New York Medical College, Valhalla, NY, United States
| | - Felicity Dickson
- Regional Integrated Support for Education, Belfast, United Kingdom
| | - Vincent A. Conte
- Management Department, Hofstra University, Hempstead, NY, United States
| | - Richard P. Brown
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
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Sánchez-Solís AM, Peláez-Hernández V, Santiago-Fuentes LM, Luna-Rodríguez GL, Reyes-Lagos JJ, Orea-Tejeda A. Induced Relaxation Enhances the Cardiorespiratory Dynamics in COVID-19 Survivors. ENTROPY (BASEL, SWITZERLAND) 2023; 25:874. [PMID: 37372218 DOI: 10.3390/e25060874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023]
Abstract
Most COVID-19 survivors report experiencing at least one persistent symptom after recovery, including sympathovagal imbalance. Relaxation techniques based on slow-paced breathing have proven to be beneficial for cardiovascular and respiratory dynamics in healthy subjects and patients with various diseases. Therefore, the present study aimed to explore the cardiorespiratory dynamics by linear and nonlinear analysis of photoplethysmographic and respiratory time series on COVID-19 survivors under a psychophysiological assessment that includes slow-paced breathing. We analyzed photoplethysmographic and respiratory signals of 49 COVID-19 survivors to assess breathing rate variability (BRV), pulse rate variability (PRV), and pulse-respiration quotient (PRQ) during a psychophysiological assessment. Additionally, a comorbidity-based analysis was conducted to evaluate group changes. Our results indicate that all BRV indices significantly differed when performing slow-paced breathing. Nonlinear parameters of PRV were more appropriate for identifying changes in breathing patterns than linear indices. Furthermore, the mean and standard deviation of PRQ exhibited a significant increase while sample and fuzzy entropies decreased during diaphragmatic breathing. Thus, our findings suggest that slow-paced breathing may improve the cardiorespiratory dynamics of COVID-19 survivors in the short term by enhancing cardiorespiratory coupling via increased vagal activity.
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Affiliation(s)
| | - Viridiana Peláez-Hernández
- Cardiology Service, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Mexico City 14080, Mexico
| | - Laura Mercedes Santiago-Fuentes
- School of Medicine, Universidad Autónoma del Estado de México (UAEMéx), Toluca de Lerdo 50180, Mexico
- Health Sciences Department, Universidad Autónoma Metropolitana Unidad Iztapalapa (UAM-I), Mexico City 09340, Mexico
| | | | - José Javier Reyes-Lagos
- School of Medicine, Universidad Autónoma del Estado de México (UAEMéx), Toluca de Lerdo 50180, Mexico
| | - Arturo Orea-Tejeda
- Cardiology Service, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Mexico City 14080, Mexico
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Nikolovski Z, Vrdoljak D, Foretić N, Perić M, Marić D, Fountoulakis C. Acute and Long-Lasting Effects of Slow-Paced Breathing on Handball Team Coach's Match Stress. Healthcare (Basel) 2023; 11:healthcare11091242. [PMID: 37174784 PMCID: PMC10178344 DOI: 10.3390/healthcare11091242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Stress was previously defined as a response to any demand for change. These demands are noticeable during sport events, not only in athletes but also in coaches. Therefore, this study aimed to determine the influence of slow-paced breathing (SPB) on acute stress to handball coaches during official matches. One professional handball coach, aged 37 (height, 180 cm; weight, 80 kg), took part in the study. His salivary cortisol (C) concentration and alpha-amylase (AA) activity were measured, and his heart rate (HR) was monitored during six official matches. In the first three matches the SPB training protocol was not followed. From match four to match six, the coach performed SPB training every day and directly before the match. The decrease observed in AA was statistically significant with a large effect size (1.80). The trend of change in HR is visible and similar for matches with and without SPB. However, for SPB matches, there is a lower starting point compared to matches without SPB (89.81 ± 6.26 and 96.62 ± 8.10, respectively). Moreover, values of AA on SPB matches were smaller before the match (93.92 ± 15.89) compared to the same time point in non-SPB matches (115.30 ± 26.00). For AA, there is a significant effect size in the half-time (2.00) and after the match (-2.14). SPB matches showed a lower increase in AA. SPB might be used as one of the possible tools that could help coaches in achieving a desirable mental state during the match.
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Affiliation(s)
- Zoran Nikolovski
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia
- High Performance Sport Center, Croatian Olympic Committee, 10000 Zagreb, Croatia
| | - Dario Vrdoljak
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia
| | - Nikola Foretić
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia
- High Performance Sport Center, Croatian Olympic Committee, 10000 Zagreb, Croatia
| | - Mia Perić
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia
| | - Dora Marić
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia
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Slow breathing for reducing stress: The effect of extending exhale. Complement Ther Med 2023; 73:102937. [PMID: 36871835 PMCID: PMC10395759 DOI: 10.1016/j.ctim.2023.102937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023] Open
Abstract
INTRODUCTION Slow breathing techniques are commonly used to reduce stress. While it is believed by mind-body practitioners that extending the exhale time relative to inhale increases relaxation, this has not been demonstrated. METHODS We conducted a 12-week randomized, single-blinded trial among 100 participants to compare if yoga-based slow breathing with an exhale greater inhale versus an exhale equals inhale produces measurable differences in physiological and psychological stress among healthy adults. RESULTS Participants mean individual instruction attendance was 10.7 ± 1.5 sessions out of 12 offered sessions. The mean weekly home practice was 4.8 ± 1.2 practices per week. There was no statistical difference between treatment groups for frequency of class attendance, home practice, or achieved slow breathing respiratory rate. Participants demonstrated fidelity to assigned breath ratios with home practice as measured by remote biometric assessments through smart garments (HEXOSKIN). Regular slow breathing practice for 12 weeks significantly reduced psychological stress as measured by PROMIS Anxiety (-4.85 S.D. ± 5.53, confidence interval [-5.60, -3.00], but not physiological stress as measured by heart rate variability. Group comparisons showed small effect size differences (d = 0.2) with further reductions in psychological stress and physiological stress from baseline to 12 weeks for exhale greater than inhale versus exhale equals inhale, however these differences were not statistically significant. CONCLUSION While slow breathing significantly reduces psychological stress, breath ratios do not have a significant differential effect on stress reduction among healthy adults.
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Tatschl JM, Schwerdtfeger AR. Squeeze the beat: Enhancing cardiac vagal activity during resonance breathing via coherent pelvic floor recruitment. Psychophysiology 2022; 59:e14129. [PMID: 35722933 PMCID: PMC9786605 DOI: 10.1111/psyp.14129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 12/30/2022]
Abstract
Resonance breathing (RB) has been shown to benefit health and performance within clinical and non-clinical populations. This is attributed to its baroreflex stimulating effect and the concomitant increase in cardiac vagal activity (CVA). Hence, developing methods that strengthen the CVA boosting effect of RB could improve its clinical effectiveness. Therefore, we assessed whether supplementing RB with coherent pelvic floor activation (PRB), which has been shown to entrain the baroreflex, yields stronger CVA than standard RB. N = 32 participants performed 5-min of RB and PRB, which requires to recruit the pelvic floor during the complete inspiratory phase and release it at the initiation of the expiration. CVA was indexed via heart rate variability using RMSSD and LF-HRV. PRB induced significantly larger RMSSD (d = 1.04) and LF-HRV (d = 0.75, ps < .001) as compared to RB. Results indicate that PRB induced an additional boost in CVA relative to RB in healthy individuals. However, subsequent studies are warranted to evaluate whether these first findings can be replicated in individuals with compromised health, including a more comprehensive psychophysiological assessment to potentially elucidate the origin of the observed effects. Importantly, longitudinal studies need to address whether PRB translates to better treatment outcomes.
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Liang WM, Bai ZM, Aihemaiti M, Yuan L, Hong ZM, Xiao J, Ren FF, Rukšėnas O. Women's Respiratory Movements during Spontaneous Breathing and Physical Fitness: A Cross-Sectional, Correlational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12007. [PMID: 36231308 PMCID: PMC9566329 DOI: 10.3390/ijerph191912007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Abdominal/diaphragmatic breathing exercises are popular worldwide and have been proven to be beneficial for physical performance. Is abdominal motion (AM) during spontaneous breathing correlated with physical fitness? The present study aimed to answer this question. METHODS 434 women (aged 20-59) were enrolled and participated in respiration tests using two respiration belts (one was tied at the height of the xiphoid and another at the navel) to detect AM and thoracic motion (TM). They also performed physical fitness tests to measure body size, muscular strength, muscular power, muscular endurance, balance, flexibility, reaction time, and cardiorespiratory endurance. RESULTS All the correlation coefficients between respiratory movements (AM, TM, AM + TM, AM/(AM + TM)) and physical fitness outcomes were less than 0.4/-0.4. Only AM and muscular power (countermovement jump height) had a weak correlation, with a correlation coefficient close to 0.4 in the 20-29-year age group (rs = 0.398, p = 0.011, n = 40). CONCLUSIONS Women's respiratory movements during spontaneous breathing were not correlated with physical fitness. Future studies may focus on the relationship between AM and countermovement jump height in young women with a larger sample size and using ultrasound to directly test the excursion of the diaphragm.
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Affiliation(s)
- Wen-Ming Liang
- Life Sciences Center, Vilnius University, LT-10257 Vilnius, Lithuania
- Department of Physiotherapy and Rehabilitation, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Zhen-Min Bai
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Maiwulamu Aihemaiti
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Lei Yuan
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Zhi-Min Hong
- School of Science, Inner Mongolia University of Technology, Hohhot 010051, China
| | - Jing Xiao
- Department of Physiotherapy and Rehabilitation, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Fei-Fei Ren
- Department of Physical Education, Beijing Language and Culture University, Beijing 100083, China
| | - Osvaldas Rukšėnas
- Life Sciences Center, Vilnius University, LT-10257 Vilnius, Lithuania
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