What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Nonclinical populations (n=1133). Intervention: Slow-paced breathing. Primary outcome: systolic blood pressure (SMD -0.45, 95% CI -0.86, -0.04, p=< 0.01).

January 1, 2024Open Access

The Effect of Slow-Paced Breathing on Cardiovascular and Emotion Functions: A Meta-Analysis and Systematic Review

Q: What are the key findings of this study?

Slow-paced breathing significantly reduced systolic blood pressure (SMD -0.45; 95% CI -0.86 to -0.04; p<0.01) and improved heart rate variability, though long-term efficacy remains unestablished.

Key Result

Slow-paced breathing significantly reduced systolic blood pressure (SMD -0.45; 95% CI -0.86 to -0.04; p<0.01) and improved heart rate variability, though long-term efficacy remains unestablished.

Study Design

Type

Meta-Analysis (n=1,133)

Structured PICO

Does slow-paced breathing improve cardiovascular and emotion functions in nonclinical adult populations?

Population

31 studies (total n = 1133) of nonclinical adult samples naïve to breathing techniques, without known cardiovascular diseases.

Intervention

Slow-paced breathing (voluntarily controlling breathing rate to ≤ 10 breaths/min, duration ≥ 5 min).

Comparator

Different intervention, no intervention, or baseline.

Outcome

Cardiovascular measures (systolic blood pressure, heart rate, time-domain heart rate variability [RMSSD, SDNN]) and emotion measures (negative emotion, perceived stress) immediately after or during intervention.surrogate

Slow-paced breathing provides reliable short-term improvements in cardiovascular physiological markers, including blood pressure and heart rate variability, in nonclinical populations.

Main Result

Effect estimate: SMD -0.45 (95% CI -0.86, -0.04)

p-value: p=< 0.01

Limitations

Long-term efficacy in improving cardiovascular functions remains to be established

Abstract

Abstract Objectives Slow-paced breathing entails voluntarily controlling one’s breathing rate to a frequency close to the oscillation frequency of the cardiovascular system. Accumulating evidence indicates slow-paced breathing improves cardiovascular and emotion functions. However, there is no meta-analysis that quantifies pooled effect of slow-paced breathing across studies with nonclinical populations. Method In this meta-analysis and systematic review, we synthesized the findings of 31 studies (total n = 1133) which investigated the effect of slow-paced breathing on cardiovascular and emotion measures. PsycINFO, PubMed, Web of Science, and PsycARTICLES electronic databases were searched up to August 1, 2023. Random-effect modelling was conducted to compute pooled effect size across studies. Results Slow-paced breathing showed significant immediate effects in reducing systolic blood pressure (Standardized Mean Difference or SMD = -0.45, 95% CI = -0.86, -0.04, p < 0.01), increasing time-domain heart rate variability (the root-mean-square-of-successive-differences-between-normal-heartbeats, or RMSSD, SMD = 0.37, 95% CI = 0.16, 0.58, p < 0.01; Standard Deviation of NN Intervals, or SDNN, SMD = 0.77, 95% CI = 0.26, 1.28, p < 0.01), and decreasing heart rate ( SMD = -0.10, 95% CI = -0.19, -0.01, p < 0.05). The effect in reducing negative emotion, particularly perceived stress, was marginal ( SMD = -0.51, 95% CI = -1.06, 0.03, p = 0.06). Limited evidence indicated persistent reduction of blood pressure 3 months post-intervention among prehypertensive samples. Preliminary analysis showed moderate association of the physiological and emotion effects of slow-paced breathing. Conclusions Slow-paced breathing demonstrated reliable effects in inducing short-term improvements in cardiovascular functions, and modest effect in reducing negative emotions, but its long-term efficacy in improving cardiovascular functions remains to be established. Future studies should continue to investigate the interrelations among the multifaceted effects of slow-paced breathing. Preregistration This review was preregistered on PROSPERO (Ref No: CRD42023450175).

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