The Synergy of Wearable Optical Heart Rate Sensor Technology and Box Breathing in Real-Time Decision Making in Precision, Explosive, and Intermittent Sports

Background. Real-time decision-making is a critical determinant of performance in precision, explosive, and intermittent sports, where athletes must operate under high physiological and cognitive stress. Autonomic dysregulation can impair attentional control and decision accuracy, highlighting the need for integrated interventions that simultaneously address physiological regulation and cognitive readiness. Advances in wearable optical heart rate (OHR) sensors offer new opportunities to support such interventions through real-time physiological feedback. Objectives. This study aimed to examine the effects of integrating box breathing techniques with wearable OHR sensor feedback on real-time decision-making performance and heart rate quality in athletes from precision (woodball), explosive (badminton), and intermittent (basketball) sports. Materials and Methods. A quasi-experimental pre-test–post-test control group design was employed. Sixty-six male athletes (age: 21.3 ± 1.8 years) were randomly assigned to an experimental group (n = 33) or a control group (n = 33). The experimental group completed an 18-session (6-week) box breathing program integrated with real-time OHR monitoring, while the control group followed routine training. Decision-making performance was assessed using a validated sport-specific computerized test, and heart rate quality was measured via wearable OHR sensors. Data were analyzed using paired-sample t-tests and two-way mixed-design ANOVA (group × time) at α = 0.05, with effect sizes reported. Results. The experimental group demonstrated significant improvements in decision-making performance (3.43 ± 0.42 to 4.48 ± 0.39; +30.59%; p < 0.001; Cohen’s d = 1.96) and heart rate quality, reflected by a reduction in resting heart rate (111.13 ± 8.76 bpm to 97.76 ± 7.94 bpm; −12.03%; p < 0.001; Cohen’s d = 1.57). Substantial time × group interactions were observed for decision-making (F(1,64) = 121.08, p < 0.001, partial η² = 0.65) and heart rate quality (F(1,64) = 78.92, p < 0.001, partial η² = 0.55). No meaningful changes were found in the control group. Conclusions. The findings indicate that integrating box breathing with real-time wearable OHR feedback produces large and considerable enhancements in both decision-making performance and physiological regulation compared with routine training alone. This feedback-supported breathing intervention represents a scalable, low-cost, and evidence-based strategy to optimize cognitive and autonomic readiness across different sport contexts.