Effects of a Heart Rate Variability Biofeedback Intervention on Athletes Psychological Responses Following Injury: A Pilot Study

Context: In sport, the occurrence of an injury is almost inevitable and the rehabilitation process can take a toll on athletes’ emotions and contribute to psychological distress. Objective: To examine the effects of heart rate variability biofeedback (HRV BFB) training on pain catastrophizing and the psychological response variables of injured athletes. As a manipulation check, HRV BFB effects on athletes physiological indices including frequency-domain HRV and respiration rate were also assessed. Design: A pilot randomized controlled trial. Setting: University laboratory. Participants: Twenty-eight athletes (Mage = 20.82, SD = 3.41, Male = 19) who sustained a moderate to severe musculoskeletal sports injury and underwent rehabilitation were randomized into HRV BFB experimental, placebo, or control conditions. Intervention: Participants in the experimental condition received six 30-min HRV BFB training sessions over a 3-week period. Main outcome measures: Psychological responses to sport injury, pain catastrophizing, and physiological indices were assessed at Baseline, Week 1, Week 2, and Week 3 (post-intervention). Results: Significant training effects on respiration rate and low frequency HRV at rest were found in favour of the experimental group. For pain catastrophizing constructs and psychological responses to sport injury, group differences over time were non-significant; however, the effects were medium to large and consistently favoured the experimental group (η2 range 0.06 0.13). Only isolation reached significance with a large effect in favour of the experimental group group (p = 0.024, η2 = 0.17). Significant, positive associations were found between change in respiration rate-rest and changes in rumination, magnification, devastation, restlessness, and isolation. Conclusion: Preliminary evidence indicates that HRV BFB training may be a promising intervention to improve pain catastrophizing and the psychological responses of injured athletes throughout the rehabilitation process. A large, adequately powered randomized controlled trial is warranted.