Slow-paced Breathing Research Articles

Keeping the pace: The effect of slow-paced breathing on error monitoring

Detecting errors is crucial for adapting one's own actions. Moreover, behavior is often optimized by adapting to maladaptive actions, i.e. errors. In this regard, recent studies and models of error monitoring point to an involvement of emotional states in error monitoring. A psychophysiological correlate of the latter is the error negativity or error-related negativity (Ne/ERN), reflecting partly the functional implementation of anterior cingulate cortex functions. In the present study, we aimed to test whether neurophysiological aspects of error monitoring can be altered by a relaxation technique, i.e. slow-paced breathing. Slow-paced breathing has been shown to increase cardiac vagal activity. According to the neurovisceral integration model, cardiac vagal activity is thought to be a marker of the effectiveness of executive functions. We tested the effect of slow-paced breathing on error monitoring, i.e. the Ne/ERN and behavioral adaptation in a modified flanker task, a cognitive task during which performance depends on executive control. The Ne was increased following slow-paced breathing compared to a passive control condition. Furthermore, behavioral results indicate that response variability decreased in the slow-paced breathing condition whereas overall performance remained constant. We conclude that slow-paced breathing improves the ability to focus on the task at hand. Thus, the error monitoring system is being supported in keeping the pace, i.e. tracking responses.

Quantifying the Delays Between Multi-Site Photoplethysmography Pulse and Electrocardiogram R-R Interval Changes Under Slow-Paced Breathing.

Objective: Objective assessment of autonomic function is important, including the investigation of slow-paced breathing to induce associated periodic changes in the cardiovascular system – such as blood pressure and heart rate. However, pulse changes across a range of peripheral body sites have seldom been explored with this challenge. The primary aim of this pilot study was to utilize multi-site photoplethysmography (MPPG) technology to quantify the phase delays, i.e., correlation lags, between changes in heart rate and changes in key pulse features with slow-paced breathing (0.1 Hz).Methods: Waveforms were collected simultaneously from the right and left ear lobes, thumbs, and great toes of 18 healthy adult subjects. Cross correlation lags between reference beat-to-beat changes in electrocardiogram (ECG) R-R wave interval and changes in pulse arrival time (foot of pulse; PATf) and also for pulse amplitude (foot-to-peak; AMP) were determined.Results: Relative to R-R changes, the median ear, thumb, and toe PATf correlation lags were 3.4, 2.9, and 2.1 beats, respectively; contrasting to AMP with 5.7, 6.0, and 6.9 beats, respectively. These PATf correlation lags in beats were significantly lower than for the AMP measure. Segmental differences between sites and timing measure variability have also been quantified.Conclusion: This pilot study has indicated bilateral similarity plus segmental differences for relative delays in PPG pulse timing and amplitude measures relative to R-R interval changes with paced breathing. These correlation and variability data are now available for comparison with cardiovascular patient groups to support development of autonomic function assessment techniques.

Heart Rate Variability Biofeedback Based on Slow-Paced Breathing With Immersive Virtual Reality Nature Scenery.

This study investigated the benefits of using a virtual nature environment to administer immersive heart rate variability biofeedback (HRV-BF) based on slow-paced breathing. We compared the virtual reality (VR)-based HRV-BF with a standard implementation in a randomized controlled experiment with 60 healthy employees. After a cognitive stress induction, the participants performed a single-session of HRV-BF before repeating the cognitive stressor task. VR-based versus standard HRV-BF was comparable in terms of biofeedback performance (cardiac coherence and cardiac vagal tone). However, the VR-based implementation buffered perceived stress in the subsequent stressor task, increased relaxation self-efficacy more, reduced mind wandering, helped participants focus on the present moment, and helped preserve attentional resources. Potential long-term effects and generalizability need to be assessed in future research.

Pilot Study of Subject Education and Oximetry as They Affect Comfort During Slow-Paced Breathing

This study examined the effects of subject education and oximetry on discomfort sometimes associated with slow-paced breathing (dyspnea). This study was performed because some people report anxiety about getting sufficient oxygen while breathing slowly. Clinical experience suggested that reassuring subjects unaccustomed to slow-paced breathing that they are receiving enough oxygen may lead to greater comfort. The study had a sample size of 20 sequentially randomized healthy adults constituting two groups of 10 subjects. Both groups underwent 5 min of video-guided paced breathing at a rate of six breaths per minute. One group was able to view oximetry and hear an educational script, and the other received neither the educational script nor the viewable oximetry. Subjects answered a questionnaire about ease and adequacy of respiration as well as comfort. Analysis of the questionnaire showed that the group who received education about oximetry and viewed an oximeter during training felt significantly greater comfort during slow breathing than the conventional paced breathing group (p < 0.01). While further study is warranted, these preliminary findings suggest the potential need for this dyspneic effect to be taken into account in clinical practice as well as in research.

Influence of Slow-Paced Breathing on Inhibition After Physical Exertion.

This research aims to investigate whether slow-paced breathing (SPB) improves adaptation to psychological stress, and specifically inhibition, when it is performed before or after physical exertion (PE). According to the resonance model, SPB is expected to increase cardiac vagal activity (CVA). Further, according to the neurovisceral integration model, CVA is positively linked to executive cognitive performance, and would thus play a role in the adaptation to psychological stress. We hypothesized that SPB, in comparison to a control condition, will induce a better adaptation to psychological stress, measured via better inhibitory performance. Two within-subject experiments were conducted with athletes: in the first experiment (N = 60) SPB (or control – neutral TV documentary) was realized before PE (“relax before PE”), and in the second experiment (N = 60) SPB (or the watching TV control) was realized after PE (“relax after PE”). PE consisted of 5 min Burpees, a physical exercise involving the whole body. In both experiments the adaptation to psychological stress was investigated with a Stroop task, a measure of inhibition, which followed PE. Perceived stress increased during PE (partial η2 = 0.63) and during the Stroop task (partial η2 = 0.08), and decreased during relaxation (partial η2 = 0.15), however, no effect of condition was found. At the physiological level PE significantly increased HR, RF, and decreased CVA [operationalized in this research via the root mean square of successive differences (RMSSD)] in both experiments. Further, the number of errors in the incongruent category (Stroop interference accuracy) was found to be lower in the SPB condition in comparison to the control condition, however, these results were not mediated by RMSSD. Additionally, the Stroop interference [reaction times (RTs)] was found to be lower overall in “relax before PE,” however, no effect was found regarding SPB and Stroop interference (RTs). Overall, our results suggest that SPB realized before or after PE has a positive effect regarding adaptation to psychological stress and specifically inhibition, however, the underlying mechanisms require further investigation.

Training of paced breathing at 0.1 Hz improves CO2 homeostasis and relaxation during a paced breathing task.

Volitional control of breathing often leads to excessive ventilation (hyperventilation) among untrained individuals, which disrupts CO2 homeostasis and may elicit a set of undesirable symptoms. The present study investigated whether seven days of training without any anti-hyperventilation instructions improves CO2 homeostasis during paced breathing at a frequency of 0.1 Hz (6 breaths/minute). Furthermore, the present study investigated the effects of training on breathing-related changes in affective state to examine the hypothesis that training improves the influence of slow paced breathing on affect. A total of 16 participants performed ten minutes of paced breathing every day for seven days. Partial pressure of end-tidal CO2 (PetCO2), symptoms of hyperventilation, affective state (before and after breathing), and pleasantness of the task were measured on the first, fourth, and seventh days of training. Results showed that the drop in PetCO2 significantly decreased with training and none of the participants experienced a drop in PetCO2 below 30 mmHg by day seven of training (except one participant who already had PetCO2 below 30 mmHg during baseline), in comparison to 37.5% of participants on the first day. Paced breathing produced hyperventilation symptoms of mild intensity which did not decrease with training. This suggests that some participants still experienced a drop of PetCO2 that was deep enough to produce noticeable symptoms. Affective state was shifted towards calmness and relaxation during the second and third laboratory measurements, but not during the first measurement. Additionally, the breathing task was perceived as more pleasant during subsequent laboratory measurements. The obtained results showed that training paced breathing at 0.1 Hz led to decrease in hyperventilation. Furthermore, the present study suggests that training paced breathing is necessary to make the task more pleasant and relaxing.

Slow paced breathing (SPB) in dental phobia – A controlled randomized study using a tactile rhythm device

New treatment algorithms for periprosthetic joint infections (PJIs) show high success rates in achieving permanent infection eradication with some degree of failure. Different salvage procedures are described, but there is no evidence for persistent fistula (PF). The purpose of this study was to analyze PF as a salvage procedure in patients with therapy-resistant PJIs.This retrospective analysis included all patients treated with PF (2005-2018) in a maximum care center with PJI (knee or hip). The baseline parameters (age, sex, BMI) and other data (number of surgeries, pathogen spectrum, American Society of Anesthesiologists classification) were recorded. The function was documented using the Harris Hip Score, the Knee Society Score, and the quality of life using the SF-36 Health Survey.A total of 159 patients were included (80 ± 12 years) and subdivided into four groups: hip (n = 66), knee (n = 13), Girdlestone resection arthroplasty (n = 50), knee arthrodesis (n = 27). Patients stayed 111 ± 87 days in the hospital, underwent six operations and three revisions after establishing PF. The mean American Society of Anesthesiologists score was 2.7. The BMI was 31 ± 3 kg/m2 (P = .1). The follow-up was 2.8 ± 0.5 years including 27 patients. The Harris Hip Score and Knee Society Score were 38 and 34, respectively. SF-36 showed no significant difference.The study showed poor outcomes regarding quality of life and the function of the infected joint. Therefore, the indication for establishing a PF in the treatment of PJI must be assessed very critically. PF is only an option for multimorbid patients with a limited life expectancy.

Slow paced breathing (SPB) in asthma patients – A controlled randomized study using a tactile rhythm device

Anecdotal accounts by eminent creators have led to the idea that setting a creative problem aside during an incubation period may help the creator solve it. Originally, the term “incubation” referred to the theory that unconscious processes may be at work, but several other explanations have subsequently been proposed. Empirical evidence supports the existence of several problem-specific types of incubation effects. There is no converging evidence for any singular theory, but there is support for problem-specific incubation effects caused by different mechanisms, such as mind wandering, opportunistic encounters with facilitating cues, and the forgetting of fixating elements.

Influence of a 30-Day Slow-Paced Breathing Intervention Compared to Social Media Use on Subjective Sleep Quality and Cardiac Vagal Activity.

Breathing techniques are part of traditional relaxation methods; however, their influence on psychophysiological variables related to sleep is still unclear. Consequently, the aim of this paper was to investigate the influence of a 30-day slow-paced breathing intervention compared to social media use on subjective sleep quality and cardiac vagal activity (CVA, operationalized via high-frequency heart rate variability). Healthy participants (n = 64, 33 male, 31 female, M = 22.11, SD = 3.12) were randomly allocated to an experimental or control group. In the experimental group, they had to perform slow-paced breathing for 15 min each evening across a 30-day period. This was administered through a smartphone application. The control group used social media (e.g., Facebook, Instagram, Whatsapp) for the same duration. The night before and after the intervention, their CVA was assessed via a light portable Electrocardiogram (ECG) device, and they had to fill out the Pittsburgh Sleep Quality Index questionnaire. Results showed that in comparison to the use of social media, the slow-paced breathing technique improved subjective sleep quality and increased overnight CVA, while a tendency was observed for morning awakening CVA. Slow-paced breathing appears a promising cost-effective technique to improve subjective sleep quality and cardiovascular function during sleep in young healthy individuals.

Theta-burst stimulation and prefrontal regulation of cardiovascular autonomic outputs: the role of state anxiety

Cortical regions including the prefrontal and insular cortices may be involved in tonic regulation of cardiovascular autonomic outflows. Yet, the neurophysiological mechanisms of how the cortex exerts this top-down control remains unclear. Transcranial magnetic stimulation (TMS) may be a promising approach to assess functional relationships between the cortex and visceromotor effectors. However, there is inconsistent evidence as to whether TMS applied to the cortex can alter cardiovascular autonomic states. This inconsistency may partly be explained by participant state anxiety with respect to the stimulation procedures- an issue which has not received attention in TMS studies of neurocardiac interactions. To this aim, we evaluated the effects of intermittent and continuous theta-burst stimulation (TBS) to the right ventrolateral prefrontal cortex on cardiovascular responses in 24 healthy adults in a sham-controlled, within-subjects study. We additionally measured state anxiety in response to stimulation. State anxiety significantly increased for both intermittent and continuous TBS relative to sham. Intermittent TBS also significantly increased heart-rate variability at natural and slow-paced breathing rates. However, these effects were suppressed after accounting for stimulation-induced anxiety. This suggests that cardiac vagal reactivity may reflect a response to a transient stressor (i.e., the stimulation itself), rather than TBS effects on visceromotor networks. Yet, continuous TBS significantly increased pulse transit time latency, an effect that was enhanced after accounting for state anxiety. While TMS may be able to alter fronto-limbic interactions related to cardiovascular autonomic regulation, additional studies are still required. The results here emphasize that future non-invasive brain stimulation studies of neurocardiac interactions should account for participants' acute stress responses to the stimulation procedures per se.

The effects of breathing at a frequency of 0.1 Hz on affective state, the cardiovascular system, and adequacy of ventilation.

The present study aimed to investigate changes induced by breathing at 0.1Hz in affective state, cardiovascular activity, and adequacy of ventilation as well as the relation between changes in peripheral physiological processes and alteration of affect. Eighty-three participants were randomly assigned to one of three groups: Two groups doing paced breathing at 0.1Hz, one with and the other without a cover story hiding the goal of the experiment, and, as a control, paced breathing at 0.28Hz. We measured the effects of breathing at 0.1Hz on affective state (unpleasant and pleasant arousals), respiratory sinus arrhythmia (RSA), sympathetic control of the heart (preejection period, PEP), and adequacy of ventilation as measured by partial pressure of end-tidal CO2 (PetCO2 ). The use of a cover story did not influence the effects of paced breathing on the study outcomes. In the 0.1Hz groups, unpleasant arousal decreased only among men. Changes in RSA were not related to changes in affect. Respiratory frequency did not influence PEP. However, changes in PEP were inversely related to changes in pleasant arousal. PetCO2 decreased in all conditions, and a larger drop in PetCO2 predicted a greater decrease in unpleasant arousal. The results obtained corroborate previous findings showing that slow paced breathing may lead to moderate hyperventilation among untrained participants and suggest that hyperventilation during breathing at 0.1Hz is not deep enough to produce an increase in affective arousal.

Vagal Mediation of Low-Frequency Heart Rate Variability During Slow Yogic Breathing.

Changes in heart rate variability (HRV) associated with breathing (respiratory sinus arrhythmia) are known to be parasympathetically (vagally) mediated when the breathing rate is within the typical frequency range (9-24 breaths per minute [bpm]; high-frequency HRV). Slow yogic breathing occurs at rates below this range and increases low-frequency HRV power, which may additionally reflect a significant sympathetic component. Yogic breathing techniques are hypothesized to confer health benefits by increasing cardiac vagal control, but increases in low-frequency HRV power cannot unambiguously distinguish sympathetic from parasympathetic contributions. The aim of this study was to investigate the autonomic origins of changes in low-frequency HRV power due to slow-paced breathing. Six healthy young adults completed slow-paced breathing with a cadence derived from yogic breathing patterns. The paced breathing took place under conditions of sympathetic blockade, parasympathetic (vagal) blockade, and placebo. HRV spectral power was compared under 11 breathing rates during each session, in counterbalanced order with frequencies spanning the low-frequency range (4-9 bpm). HRV power across the low-frequency range (4-9 bpm) was nearly eliminated (p = .016) by parasympathetic blockade (mean (SD) spectral power at breathing frequency = 4.1 (2.1)) compared with placebo (69.5 (8.1)). In contrast, spectral power during sympathetic blockade 70.2 (9.1) and placebo (69.5 (8.1)) was statistically indistinguishable (p = .671). These findings clarify the interpretation of changes in HRV that occur during slow-paced breathing by showing that changes in low-frequency power under these conditions are almost entirely vagally mediated. Slow-paced breathing is an effective tool for cardiac vagal activation.

The effects of slow-paced versus mechanically assisted breathing on autonomic function in fibromyalgia patients.

Paced breathing has shown efficacy in fibromyalgia (FM), but the mechanisms associated with symptom change are largely unknown. We investigated whether changes in respiratory rate (RR) alone resulted in autonomic changes during normal, paced, and mechanically assisted breathing in untrained FM patients and controls. Participants included 20 FM patients and 14 controls matched for age and body mass index. During a single visit, participants completed three 15-minute breathing sessions: 1) normal breathing, 2) slow-paced breathing, and 3) mechanically assisted breathing (continuous positive airway pressure) while supine. Continuous blood pressure and electrocardiogram were recorded, and measures of heart rate variability (HRV) and spontaneous baroreceptor sensitivity (sBRS) were calculated. During normal breathing, FM patients had higher heart rate (HR), but lower HRV and sBRS variables compared to controls with no difference in RR. Compared to the paced breathing condition, FM patients had significantly lower HR with higher HRV and sBRS variables during mechanically assisted breathing, despite no significant change in RR. Mechanically assisted breathing provided greater benefits in autonomic function than paced breathing in untrained FM patients. Future research will be needed to elucidate the central pathways involved in these autonomic changes and whether training in paced breathing can eventually replicate the results seen in mechanically assisted patients.

The influence of slow vs. normal paced breathing training on relaxation and stress reactivity and recovery in high worriers

The influence of slow vs. normal paced breathing training on relaxation and stress reactivity and recovery in high worriers

A Pilot Study on the Effects of Slow Paced Breathing on Current Food Craving

Heart rate variability biofeedback (HRV-BF) involves slow paced breathing (approximately six breaths per minute), thereby maximizing low-frequent heart rate oscillations and baroreflex gain. Mounting evidence suggests that HRV-BF promotes symptom reductions in a variety of physical and mental disorders. It may also positively affect eating behavior by reducing food cravings. The aim of the current study was to investigate if slow paced breathing can be useful for attenuating momentary food craving. Female students performed paced breathing either at six breaths per minute (n = 32) or at nine breaths per minute (n = 33) while watching their favorite food on the computer screen. Current food craving decreased during a first resting period, increased during paced breathing, and decreased during a second resting period in both conditions. Although current hunger increased in both conditions during paced breathing as well, it remained elevated after the second resting period in the nine breaths condition only. Thus, breathing rate did not influence specific food craving, but slow paced breathing appeared to have a delayed influence on state hunger. Future avenues are suggested for the study of HRV-BF in the context of eating behavior.

The effect of slow-paced breathing on stress management in adolescents with intellectual disability.

Intellectual disabilities often create a state of chronic stress for both the person concerned and their significant others (family, caregivers). The development of stress management methods is therefore important for the reduction of stress in persons with intellectual disability. The aim of this experiment was to investigate the effect of slow-paced breathing on stress symptoms experienced by adolescents with intellectual disabilities during a cognitive task under time pressure. Fourteen adolescents with intellectual disabilities (Mage =17.39years, range 15-19years) took part in two laboratory sessions - a slow-paced breathing session (experimental condition) and an audiobook session (control condition) - the order of which was counterbalanced across participants. Vagal tone was measured through heart rate variability to index stress management. No difference in vagal tone was observed at baseline between experimental and control conditions. Compared with the control condition, vagal tone was significantly higher during the experimental condition. The slow-paced breathing task enhanced stress management to a greater extent than did listening to an audiobook. Slow-paced breathing seems to be an easy to learn stress management technique that appears as an effective auxiliary method of lowering stress in adolescents with intellectual disabilities.

Could slow abdominal paced breathing change EEG parameters?

Could slow abdominal paced breathing change EEG parameters?

Development of a Wearable Cardiac Monitoring System for Behavioral Neurocardiac Training: A Usability Study.

BackgroundElevated blood pressure is one of the main risk factors for death globally. Behavioral neurocardiac training (BNT) is a complementary approach to blood pressure and stress management that is intended to exercise the autonomic reflexes, improve stress recovery, and lower blood pressure. BNT involves cognitive-behavioral therapy with a paced breathing technique and heart rate variability biofeedback. BNT is limited to in-clinic delivery and faces an accessibility barrier because of the need for clinical oversight and the use of complex monitoring tools.ObjectiveThe objective of this project was to design, develop, and evaluate a wearable electrocardiographic (ECG) sensor system for the delivery of BNT in a home setting.MethodsThe wearable sensor system, Beat, consists of an ECG sensor and a mobile app. It was developed iteratively using the principles of test-driven Agile development and user-centered design. A usability study was conducted at Toronto General Hospital to evaluate feasibility and user experience and identify areas of improvement.ResultsThe Beatsensor was designed as a modular patch to be worn on the user’s chest and uses standard ECG electrodes. It streams a single-lead ECG wirelessly to a mobile phone using Bluetooth Low Energy. The use of small, low-power electronics, a low device profile, and a tapered enclosure allowed for a device that can be unobtrusively worn under clothing. The sensor was designed to operate with a mobile app that guides users through the BNT exercises to train them to a slow-paced breathing technique for stress recovery. The BNT app uses the ECG captured by the sensor to provide heart rate variability biofeedback in the form of a real-time heart rate waveform to complement and reinforce the impact of the training. Usability testing (n=6) indicated that the overall response to the design and user experience of the system was perceived positively. All participants indicated that the system had a positive effect on stress management and that they would use it at home. Areas of improvement were identified, which focused primarily on the delivery of training and education on BNT through the app.ConclusionsThe outcome of this project was a wearable sensor system to deliver BNT at home. The system has the potential to offer a complementary approach to blood pressure and stress management at home and reduce current accessibility barriers.

Heart rate autonomic regulation system at rest and during paced breathing among patients with CRPS as compared to age-matched healthy controls.

The objective of this study is to assess the autonomic nerve heart rate regulation system at rest and its immediate response to paced breathing among patients with complex regional pain syndrome (CRPS) as compared with age-matched healthy controls. Quasiexperimental. Outpatient clinic. Ten patients with CRPS and 10 age- and sex-matched controls. Participants underwent Holter ECG (NorthEast Monitoring, Inc., Maynard, MA, USA) recording during rest and biofeedback-paced breathing session. Heart rate variability (HRV), time, and frequency measures were assessed. HRV and time domain values were significantly lower at rest among patients with CRPS as compared with controls. A significant association was noted between pain rank and HRV frequency measures at rest and during paced breathing; although both groups reduced breathing rate significantly during paced breathing, HRV time domain parameters increased only among the control group. The increased heart rate and decreased HRV at rest in patients with CRPS suggest a general autonomic imbalance. The inability of the patients to increase HRV time domain values during paced breathing may suggest that these patients have sustained stress response with minimal changeability in response to slow-paced breathing stimuli.

RR interval–respiratory signal waveform modeling in human slow paced and spontaneous breathing

Our aim was to model the dependence of respiratory sinus arrhythmia (RSA) on the respiratory waveform and to elucidate underlying mechanisms of cardiorespiratory coupling. In 30 subjects, RR interval and respiratory signal were recorded during spontaneous and paced (0.1Hz/0.15Hz) breathing and their relationship was modeled by a first order linear differential equation.This model has two parameters: a0 (related to the instantaneous degree of abdominal expansion) and a1 (referring to the speed of abdominal expansion). Assuming that a0 represents slowly adapting pulmonary stretch receptors (SARs) and a1 SARs in coordination with other stretch receptors and central integrative coupling; then pulmonary stretch receptors relaying the instantaneous lung volume are the major factor determining cardiovagal output during inspiration.The model's results depended on breathing frequency with the least error occurring during slow paced breathing. The role of vagal afferent neurons in cardiorespiratory coupling may relate to neurocardiovascular diseases in which weakened coupling among venous return, arterial pressure, heart rate and respiration produces cardiovagal instability.