Influence of respiration frequency on heart rate variability parameters: A randomized cross-sectional study

Abstract

BACKGROUND: Many patients visiting physiotherapists for musculoskeletal disorders face psychosocial challenges which may form a large barrier to recover. There are only a limited number of evidence based psychosocial therapies, but they are mainly based on breathing exercises. OBJECTIVE: to study which respiration frequency would lead to the highest relaxation, reflected in vagal tone derived from the heart rate variability (HRV) in healthy subjects. METHODS: A randomized controlled cross sectional study was performed. Respiration cycles of four, five, six, seven and eight breaths per minute (BPM) were delivered in randomized order for two minutes each. HRV metrics were measured during the sessions with electrocardiogram (ECG). Repeated Measures ANOVA’s were performed to analyze differences between breathing frequencies. RESULTS: 100 healthy volunteers were included (40 male). Standard Deviation of inter beat intervals (SDNN) values were significantly highest at 5 BPM, whereas the Root Mean Square of Successive Differences (RMSSD) values appeared highest at 7 breaths per minute (p< 0.01). High Frequency (HF) power was lowest at 4 BPM, whereas Low Frequency (LF) power was not significantly influenced by respiration frequency. CONCLUSIONS: Breathing at a frequency of 5 to 7 breaths per minute leads to highest HRV values, but there is no single respiration ratio that maximizes all metrics. Physiotherapists may use five to seven BPM as guidance to determine ideal breathing frequencies.

Investigating the Dose-Response Relationship between Deep Breathing and Heart Rate Variability in Healthy Participants and Across-Days Reliability in Patients with Rheumatoid Arthritis and Systemic Lupus Erythematosus

“…To our knowledge, no other studies examined the dose-response relationship of DB on HRV in healthy participants. One study found an increase in HRV during breathing at a frequency of 5-7 breaths/minute for 2 min [10] and another study during 10 min of guided breathing exercises [25]. However, both studies measured HRV during the breathing exercises, which is debatable since respiration itself can be a confounding factor in HRV evaluation [37].…”

“…HRV is a method used to evaluate cardiac autonomic nervous system function [8], especially vagus nerve tone [9]. A high HRV indicates good health and vitality [10], and reduced HRV, which is seen in patients with RA and SLE, is associated with increased mortality [7,8]. Autonomic imbalance precedes the development of RA in individuals at risk of developing arthritis [11], and seropositivity, disease activity, and pro-inflammatory cytokine levels are predictive of autonomic dysfunction [12].…”

Modulating Heart Rate Variability through Deep Breathing Exercises and Transcutaneous Auricular Vagus Nerve Stimulation: A Study in Healthy Participants and in Patients with Rheumatoid Arthritis or Systemic Lupus Erythematosus

“…The DB exercises were based on a procedure described in previous studies [ 33 , 36 , 37 , 45 ], and they consisted of 4 s of inspiration and 6 s of expiration with a total duration of 30 min. Initially, participants received verbal instructions, and during the exercise, they were guided by a visual cue.…”

“…Another way to stimulate the VN is through deep breathing (DB) exercises [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. The mechanisms through which DB stimulates the VN are not well established, but are believed to include peripheral factors, such as the baroreflex, the peripheral chemoreflex, the Bainbridge reflex, and the Heuring–Breuer reflex, as well as such central elements as the respiratory and cardiovascular centers in the brainstem [ 38 ].…”

Heart Rate Variability and Respiration Rates during a Mindfulness Based Intervention for Health Care Professionals: Mindfulness in Motion

“…As mentioned, paced and relaxed breathing has been historically found to alter HRV (Bernardi et al 2000;Peng et al 2004;Soer et al 2021;Yasuma and Hayano 2004). However, it is important to understand that certain HRV metrics are more in uenced and representative of changes in respiration (Shaffer and Ginsberg 2017; Stephenson et al 2021).…”