Heart Rate Variability Biofeedback Improves Emotional and Physical Health and Performance: A Systematic Review and Meta Analysis (2020)

Citation

Lehrer, P., Kaur, K., Sharma, A., Shah, K., Huseby, R., Bhavsar, J., & Zhang, Y. (2020). Heart Rate Variability Biofeedback Improves Emotional and Physical Health and Performance: A Systematic Review and Meta Analysis. Applied Psychophysiology and Biofeedback, 45(3), 109–129. https://doi.org/10.1007/s10484-020-09466-z.

4 FUNDAMENTALS

 

1. Essential Background Material

 

This meta-analysis aimed to examine basically every issue that might be addressed by heart rate variability biofeedback (HRVB) based on previous research.

 

A hallmark of slow breathing is that it increases HRV. It does this by increasing respiratory sinus arrhythmia (RSA), which synchronizes your heart rate with your breathing. When they match, your heart rate increases while you inhale, and it decreases while you exhale.

 

With HRVB, a person’s “ideal” breathing rate is determined—that is, one that maximizes HRV.  And because increases in RSA and HRV are driven by increases in the calming parasympathetic branch of the nervous system, this can reduce harmful stress and increase overall resiliency.  This has wide-reaching positive benefits, such as lowering blood pressure, lessening anxiety, and improved cardio-autonomic function.  Because of this, HRVB has become extremely popular for treating various problems.

 

But here, they wanted to systematically examine which conditions and issues have benefited most from HRVB based on previously-published scientific literature.

 

 

2. What Did this Research Do?

 

To do this, the authors performed an extensive literature review to examine these benefits of HRVB from a broader statistical perspective.  They included papers spanning a wide range of settings, measuring a wide range of outcomes.

 

Although HRVB sounds fancy (and it can be), many of the benefits are achieved by simply breathing at a rate of about 5-6 breaths per minute.

 

Therefore, this meta-analysis also included studies that used 6 breaths per minute without HRVB because it’s likely that this is enough to get most of the benefits without fancy equipment.

 

This might be the most important aspect of this meta-analysis from a practical perspective.

 

After starting with more than 1,500 papers (!), they ended up with 58 studies having a total of 2,485 patients.  This large number of papers is a testament to the power and popularity of HRVB and slow breathing. 

 

 

3. What Were the Major Findings?

 

Their statistical analysis revealed that HRVB and slow breathing significantly improve many health and wellness aspects.

 

The most significant benefits were for:

  • Athletic performance

  • Artistic performance

  • Depression

  • Gastrointestinal problems

  • Anxiety and anger

  • Respiratory disorders

  • Systolic blood pressure

  • Pain

 

Smaller but still meaningful benefits were found for:

  • Self-reported stress

  • Quality of life

  • Diastolic blood pressure

  • PTSD

  • General energy

  • Sleep

 

Interestingly, I would have expected several items on the second list to be on the first. But that’s why meta-analyses like this are so important : ) Also, note that measures like “self-reported stress” are harder to quantify. The authors even mention that these findings might result from how the questionnaires were given.

 

In any case, the overall results of this meta-analysis are quite exceptional: HRVB and slow breathing both have wide-ranging benefits for overall health and wellness.

 

 

4. Why Do These Results Matter?

 

These results are significant because they show that, across studies and disciplines, slow breathing is a valuable tool for improving a variety of outcomes.  Just imagine it helping you with a few things on the lists above.  Even minor improvements on 4 or 5 different things could be life-changing.  Now we see that a broad range of studies suggest it’s possible.

 

 

 

1 BIG TAKEAWAY

 

Slow breathing basically helps everything, with very rare side effects.  This study supports almost any positive statement about slow breathing, as the results show many benefits across studies and disciplines.

 

 

1 PRACTICAL APPLICATION

 

Make slow breathing at around 5-6 breaths per minute part of your daily routine to improve many aspects of your physiological, emotional, and creative health.  Although this study didn’t provide precise guidance on how long these slow breathing sessions must be, we know that at least 10 minutes a day is the bare minimum for improvements.

 

For a deeper application, consider buying an HRV monitor (I use the Elite HRV CorSense®, which cost me $165) and going through a full HRVB protocol.