Key result
Slow-paced breathing increases heart rate variability by ~12 ms, with greater gains at higher baseline respiratory rates.
Why the study?
Slow-paced breathing improves autonomic balance and heart rate variability, but the influence of combat-related traumatic injury, baseline respiratory rate, and physical function or activity on this relationship had not been examined previously.
Does slow-paced breathing at six breaths/minute improve short-term heart rate variability in male British combat veterans, and is this relationship moderated by combat-related traumatic injury, baseline respiratory rate, physical function, or physical activity?
Cohort (n=962)
No
Does slow-paced breathing at six breaths/minute improve short-term heart rate variability in male British combat veterans, and is this relationship moderated by combat-related traumatic injury, baseline respiratory rate, physical function, or physical activity?
Mean Difference: 12.12 (95% CI 10.75–13.61)
Absolute Event Rate: 56.01% vs 40.06%
p-value: p=<0.0001
Slow-paced breathing significantly improves short-term heart rate variability in male military personnel regardless of combat injury status or physical function, with the greatest autonomic benefit seen in individuals with higher baseline respiratory rates (≥15 breaths/minute).
Slow-paced breathing may acutely increase HRV independent of injury; hypothesis-generating for respiratory rate-stratified use in prospective trials.
Purpose Slow-paced breathing (SPB) improves autonomic balance and increases heart rate variability (HRV). The influence of combat-related traumatic injury (CRTI), baseline respiratory rate (RR), and physical function/activity on the relationship between SPB and HRV has not been examined previously and was the aim of this study. Methods We analysed the first follow-up data from the ongoing ArmeD serVices trAuma rehabilitatioN outComE (ADVANCE) Cohort study. Short-term HRV was measured using a single-lead electrocardiogram during five minutes of spontaneous breathing, followed by five minutes of SPB (six breaths/minute). We examined the effect modification of SPB on HRV by CRTI (yes/no), RR during spontaneous breathing (< 15/ ≥ 15 breaths/minute), weekly moderate-to-vigorous physical activity (MVPA) using the International Physical Activity Questionnaire and physical function (6-minute-walk-distance; 6MWD). Linear models for panel data were run, adjusting for age, sampling rank, ethnicity, and cardiovascular and respiratory medication. Results A total of 962 male participants (median age: 37.6 years; n = 487 injured, n = 495 uninjured; mean 11years post-injury/deployment) with paired spontaneous-SPB HRV data were included. All short-term HRV measures increased during SPB when compared to spontaneous breathing. CRTI, 6MWD and MVPA did not significantly moderate the effect of SPB on HRV, but baseline RR ≥ 15 breaths/minute did, with Root-Mean-Square-Of-Successive-Difference (RMSSD) increasing from 15.57ms to 21.89ms ( p < 0.001) during SPB. Conclusion SPB improves HRV regardless of CRTI status. Those with higher baseline RR are more likely to obtain a significant improvement in HRV during SPB. SPB-based interventions may be introduced for the rehabilitation of military personnel following injury/deployment.
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Maqsood et al. (2026) conducted a cohort in Combat-related traumatic injury and autonomic regulation (n=962). Slow-paced breathing (SPB) vs. Spontaneous breathing at rest was evaluated on Short-term heart rate variability measured by Root Mean Square of Successive Differences (RMSSD, ms) (Median difference 12.12 ms, 95% CI 10.75-13.61, p=<0.0001). Slow-paced breathing significantly increased heart rate variability (median RMSSD difference 12.12 ms, p<0.0001) regardless of combat injury status, with greater gains when baseline respiratory rate was ≥15 breaths/min.
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