Key result
Heart rate variability biofeedback enhances top-down frontocingulate brain connectivity compared to control.
Why the study?
The directional neural pathways through which heart rate variability biofeedback modulates the central autonomic network remain poorly understood.
Does heart rate variability biofeedback alter directional brain connectivity within the central autonomic network and improve heart rate variability in healthy participants?
RCT (n=32)
randomly assigned
Does heart rate variability biofeedback alter directional brain connectivity within the central autonomic network and improve heart rate variability in healthy participants?
Absolute Event Rate: 0.1701% vs 0%
p-value: p=Bayesian PP = 1
Heart rate variability biofeedback alters directional brain connectivity by enhancing top-down fronto-limbic influence and attenuating bottom-up limbic signaling, providing a mechanistic neural basis for its effects on autonomic regulation.
Heart rate variability biofeedback (HRVB) is a non-pharmacological intervention that trains individuals to breathe at their cardiovascular resonance frequency to enhance autonomic regulation. While HRVB improves cardiovascular function across clinical conditions, the directional neural pathways through which it modulates the central autonomic network (CAN) remain poorly understood. Using a publicly available open-access dataset, we conducted a secondary analysis of effective (directional) neural connectivity (EC) data from 32 healthy participants randomized to an 8-week HRVB intervention (n = 15) or a video game Control intervention (n = 17). Pre- and post-intervention resting-state functional magnetic resonance imaging (fMRI) data were analyzed using spectral dynamic causal modeling (DCM) combined with parametric empirical Bayes to examine group differences in EC changes (ΔEC). We also evaluated whether connectivity changes correlated with changes in peripheral autonomic regulation, indexed by the standard deviation of normal-to-normal intervals (ΔSDNN). Compared with the Control group, HRVB showed strong evidence (posterior-probability = 1) of increased ΔEC from the medial prefrontal cortex to the anterior cingulate cortex and bilateral thalamus post-treatment, along with reduced ΔEC from the right hippocampus to the right ventrolateral prefrontal cortex (VLPFC). Furthermore, the regression coefficient linking hippocampus-to-VLPFC ΔEC with ΔSDNN was more (posterior-probability = 1) negative in the HRVB group than in Controls, indicating an intervention-dependent association between autonomic changes and effective connectivity. These findings indicate that HRVB alters directional fronto-limbic communication within the CAN, providing a circuit-level framework for understanding how resonance breathing modulates central autonomic control.
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Ma et al. (2026) conducted an RCT in Healthy participants (n=32). Heart rate variability biofeedback vs. Control intervention (mobile video games) was evaluated on Change in effective connectivity (EC) from the medial prefrontal cortex to the anterior cingulate cortex (p=Bayesian PP = 1). Heart rate variability biofeedback enhanced top-down effective connectivity from the medial prefrontal cortex to the anterior cingulate cortex (EC = 0.1701 Hz) compared to control in healthy adults.
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