A Randomized Sham-Controlled Study of Heart Rate Variability Biofeedback in an Older Adult Sample

Heart rate variability biofeedback (HRV biofeedback) is a promising treatment for improving autonomic regulation and health outcomes. Although HRV biofeedback has demonstrated benefits in younger adults, its efficacy in older adult samples remains unclear. Given age-related declines in heart rate variability (HRV) and corresponding risk for heart disease, stress-related difficulties, and cognitive decline, HRV biofeedback could be an intervention to enhance HRV and improve emotional functioning, sleep, and cognitive performance in older adults. We conducted a randomized, sham-controlled trial wherein 53 healthy older adults were randomized to active HRV biofeedback treatment or sham. Participants completed a five-week HRV biofeedback intervention with assessments measuring HRV at rest, during stress recovery, along with measures of emotional functioning, sleep, and cognitive performance and completed pre- and post-testing along with a 5-week intervention. No significant differences were detected in resting HRV between groups. However, the HRV biofeedback group showed a significant increase in LF during recovery from an acute laboratory stressor (Paced Auditory Serial Addition Test), suggesting potential modulation of HRV during recovery, particularly in low frequency oscillatory ranges. Both HRV biofeedback and sham conditions reported improved sleep quality as well as improvements in HF, RMSSD, and SDNN HRV measures, but no significant differences were present for measures of emotional functioning or cognitive performance. High adherence rates in both conditions did not moderate HRV outcomes. Findings suggest HRV biofeedback may enhance aspects of HRV during stress recovery in older adults but there were not specific improvements in resting HRV, emotional health, or cognition.