Key result
Breathing at 5 to 7 breaths per minute produced the highest heart rate variability values, with SDNN peaking at 5 BPM and RMSSD peaking at 7 BPM (p<0.01).
Why the study?
Evidence-based psychosocial therapies for musculoskeletal disorders are limited and mainly rely on breathing exercises, but the respiration frequency that maximizes relaxation and vagal tone derived from HRV was unclear.
Does varying respiration frequency between 4 and 8 breaths per minute affect heart rate variability parameters in healthy subjects?
RCT (n=100)
Randomized order
Does varying respiration frequency between 4 and 8 breaths per minute affect heart rate variability parameters in healthy subjects?
p-value: p=<0.01
Breathing at a frequency of 5 to 7 breaths per minute maximizes different heart rate variability parameters in healthy subjects, suggesting this range is ideal for relaxation therapies.
Slow breathing may optimize HRV parameters; hypothesis-generating and requires prospective trials before clinical adoption.
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.
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Soer et al. (2021) conducted an RCT in Healthy (n=100). Respiration frequencies of 4, 5, 6, 7, and 8 breaths per minute vs. Within-subject comparison across frequencies was evaluated on Heart rate variability (HRV) metrics including SDNN, RMSSD, HF power, and LF power (p=<0.01). Breathing at 5 to 7 breaths per minute produced the highest heart rate variability values, with SDNN peaking at 5 BPM and RMSSD peaking at 7 BPM (p<0.01).
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