Slow-Paced Breathing: Influence of Inhalation/Exhalation Ratio and of Respiratory Pauses on Cardiac Vagal Activity

Do Longer Exhalations Increase HRV During Slow-Paced Breathing?

Slow-paced breathing at an individual's resonance frequency (RF) is a common element of heart rate variability (HRV) biofeedback training (Laborde et al. in Psychophysiology 59:e13952, 2022). Although there is strong empirical support for teaching clients to slow their respiration rate (RR) to the adult RF range between 4.5 and 6.5 bpm (Lehrer & Gevirtz, 2014), there have been no definitive findings regarding the best inhalation-to-exhalation (IE) ratio to increase HRV when breathing within this range. Three methodological challenges have frustrated previous studies: ensuring participants breathed at the target RR, IE ratio, and the same RR during each IE ratio. The reviewed studies disagreed regarding the effect of IE ratios. Three studies found no IE ratio effect (Cappo & Holmes in J Psychosom Res 28:265-273, 1984; Edmonds et al. in Biofeedback 37:141-146, 2009; Klintworth et al. in Physiol Meas 33:1717-1731, 2012). One reported an advantage for equal inhalations and exhalations (Lin et al. in Int J Psychophysiol 91:206?211, 2014). Four studies observed an advantage for longer exhalations than inhalations (Bae et al. in Psychophysiology 58:e13905, 2021; Laborde et al. in Sustainability 13:7775, 2021; Strauss-Blasche et al. in Clin Exp Pharmacol Physiol 27:601?60, 2000; Van Diest et al. in Appl Psychophysiol Biofeedback 39:171?180, 2014). One study reported an advantage for longer inhalations than exhalations (Paprika et al. in Acta Physiol Hung 101:273?281, 2014). We conducted original (N = 26) and replication (N = 16) studies to determine whether a 1:2 IE ratio produces different HRV time-domain, frequency-domain, or nonlinear metrics than a 1:1 ratio when breathing at 6 bpm. Our original study found that IE ratio did not affect HRV time- and frequency-domain metrics. The replication study confirmed these results and found no effect on HRV nonlinear measurements.

Influence of Respiratory Frequency of Slow-Paced Breathing on Vagally-Mediated Heart Rate Variability

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.

Closed-Loop Auditory Stimulation to Guide Respiration: Preliminary Study to Evaluate the Effect on Time Spent in Sleep Initiation during a Nap

Various stimulation systems to modulate sleep structure and function have been introduced. However, studies on the time spent in sleep initiation (TSSI) are limited. This study proposes a closed-loop auditory stimulation (CLAS) to gradually modulate respiratory rhythm linked to the autonomic nervous system (ANS) activity directly associated with sleep. CLAS is continuously updated to reflect the individual's current respiratory frequency and pattern. Six participants took naps on different days with and without CLAS. The average values of the TSSI are 14.00 ± 4.24 and 9.67 ± 5.31 min in the control and stimulation experiments (p < 0.03), respectively. Further, the values of respiratory instability and heart rate variability differ significantly between the control and stimulation experiments. Based on our findings, CLAS supports the individuals to gradually modulate their respiratory rhythms to have similar characteristics observed near sleep initiation, and the changed respiratory rhythms influence ANS activities, possibly influencing sleep initiation. Our approach aims to modulate the respiratory rhythm, which can be controlled intentionally. Therefore, this method can probably be used for sleep initiation and daytime applications.

Sports Performance and Breathing Rate: What Is the Connection? A Narrative Review on Breathing Strategies

Breathing is a natural and necessary process for humans. At the same time, the respiratory pace and frequency can vary so much, depending on the status of the subject. Specifically, in sports, breathing can have the effect of limiting performance from a physiological point of view, or, on the other hand, breathing can regulate the psychological status of the athletes. Therefore, the aim of this narrative review is to focus on the literature about the physiological and psychological aspects of breathing pace in sports performance, merging these two aspects because they are usually considered split, in order to create a new integrated vision of breathing and sports performance. Voluntary breathing can be divided into a slow or fast pace (VSB and VFB, respectively), and their effects on both the physiological and psychological parameters are very different. VSB can benefit athletes in a variety of ways, not just physically but mentally as well. It can help improve cardiovascular fitness, reduce stress and anxiety, and improve overall health and well-being, allowing athletes to maintain focus and concentration during training and competition. VFB is normal during physical training and competition, but away from training, if it is not voluntary, it can cause feelings of anxiety, panic, dizziness, and lightheadedness and trigger a stress response in the body, affecting the athlete's quality of life. In summary, the role of breathing in the performance of athletes should be considered, although no definitive data are available. The connection between breathing and sports performance is still unclear, but athletes can obtain benefits in focus and concentration using slow breathing strategies.

Squeeze the beat: Enhancing cardiac vagal activity during resonance breathing via coherent pelvic floor recruitment

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 &lt; .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.

A BLE-Connected Piezoresistive and Inertial Chest Band for Remote Monitoring of the Respiratory Activity by an Android Application: Hardware Design and Software Optimization

Breathing is essential for human life. Issues related to respiration can be an indicator of problems related to the cardiorespiratory system; thus, accurate breathing monitoring is fundamental for establishing the patient’s condition. This paper presents a ready-to-use and discreet chest band for monitoring the respiratory parameters based on the piezoresistive transduction mechanism. In detail, it relies on a strain sensor realized with a pressure-sensitive fabric (EeonTex LTT-SLPA-20K) for monitoring the chest movements induced by respiration. In addition, the band includes an Inertial Measurement Unit (IMU), which is used to remove the motion artefacts from the acquired signal, thereby improving the measurement reliability. Moreover, the band comprises a low-power conditioning and acquisition section that processes the signal from sensors, providing a reliable measurement of the respiration rate (RR), in addition to other breathing parameters, such as inhalation (TI) and exhalation (TE) times, inhalation-to-exhalation ratio (IER), and flow rate (V). The device wirelessly transmits the extracted parameters to a host device, where a custom mobile application displays them. Different test campaigns were carried out to evaluate the performance of the designed chest band in measuring the RR, by comparing the measurements provided by the chest band with those obtained by breath count. In detail, six users, of different genders, ages, and physical constitutions, were involved in the tests. The obtained results demonstrated the effectiveness of the proposed approach in detecting the RR. The achieved performance was in line with that of other RR monitoring systems based on piezoresistive textiles, but which use more powerful acquisition systems or have low wearability. In particular, the inertia-assisted piezoresistive chest band obtained a Pearson correlation coefficient with respect to the measurements based on breath count of 0.96 when the user was seated. Finally, Bland–Altman analysis demonstrated that the developed system obtained 0.68 Breaths Per Minute (BrPM) mean difference (MD), and Limits of Agreement (LoAs) of +3.20 and −1.75 BrPM when the user was seated.

Single Slow-Paced Breathing Session at Six Cycles per Minute: Investigation of Dose-Response Relationship on Cardiac Vagal Activity

The practice of slow-paced breathing (SPB) has been linked to a range of positive outcomes, such as decreasing symptoms of depression, anxiety, and stress, as well as increasing well-being. Among the suggested mechanisms of action, SPB has been shown to increase cardiac vagal activity (CVA). The present study aimed to investigate whether there is a dose-response relationship modulating the effects of SPB on CVA. A total of 59 participants were involved in this study. In a within-subject design, participants attended the lab five times, and realized SPB at six cycles per minute with different durations (5, 10, 15, and 20 min), as well as a control condition without SPB. CVA was indexed via the root mean square of successive differences (RMSSD). During SPB, findings showed an increase in RMSSD in all conditions compared to the control condition. However, no differences were found in RMSSD among the different session durations, during SPB or during the resting measurement completed immediately after SPB. Noteworthily, session duration showed an influence on the spontaneous respiratory frequency in the resting measurement occurring immediately after SPB. Specifically, respiratory frequency appears to decrease with session duration, thus potentially contributing to additional relaxing effects.

Psychophysiological effects of slow-paced breathing at six cycles per minute with or without heart rate variability biofeedback

Heart rate variability (HRV) biofeedback, referring to slow-paced breathing (SPB) realized while visualizing a heart rate, HRV, and/or respiratory signal, has become an adjunct treatment for a large range of psychologic and medical conditions. However, the underlying mechanisms explaining the effectiveness of HRV biofeedback still need to be uncovered. This study aimed to disentangle the specific effects of HRV biofeedback from the effects of SPB realized alone. In total, 112 participants took part in the study. The parameters assessed were emotional (valence, arousal, and control) and perceived stress intensity as self-report variables and the root mean square of the successive differences (RMSSD) as a physiologic variable. A main effect of condition was found for emotional valence only, valence being more positive overall in the SPB-HRVB condition. A main effect of time was observed for all dependent variables. However, no main effects for the condition or time x condition interaction effects were observed. Results showed that for PRE and POST comparisons (referring, respectively, to before and after SPB), both SPB-HRVB and SPB-NoHRVB conditions resulted in a more negative emotional valence, lower emotional arousal, higher emotional control, and higher RMSSD. Future research might investigate psychophysiological differences between SPB-HRVB and SPB-NoHRVB across different time periods (e.g., long-term interventions), and in response to diverse psychophysiological stressors.