How breathing can help you make better decisions: Two studies on the effects of breathing patterns on heart rate variability and decision-making in business cases

Cardiac vagal modulation predicts decision-making in sacrificial and everyday moral dilemmas

Cardiac vagal modulation indicates the self-regulatory activity of the autonomic nervous system and can thus be used to assess an individual's ability to integrate physiological, cognitive, and emotional responses in the decision-making process. In this paper, cardiac vagal modulation, quantified by heart rate variability (HRV), was used to predict decision-making in two types of moral dilemmas: First, sacrificial dilemmas which create a moral conflict between utilitarian (acting to maximise aggregate well-being by sacrifice) and deontological (rejecting the sacrifice) alternatives; second, everyday dilemmas which create a conflict between altruistic (acting non-selfish) and egoistic (acting self-centered) alternatives. HRV was analysed in 112 healthy participants before, during, and after decision-making, allowing to assess not only self-regulatory ability (resting HRV) but also self-regulatory capacities (HRV during and after decision-making). HRV predicted concrete decisions, but effects were only found in women. In sacrificial dilemmas, deontological women showed a stronger vagal withdrawal but also a faster cardiac vagal recovery compared to high utilitarian women. In everyday moral dilemmas, altruism was associated with reduced vagal outflow and increased sympathetic activity. Findings suggest differences in the acquisition of self-regulatory capacities between decision-makers in both types of moral dilemmas, which can be measured by HRV.

Does heart rate variability predict and improve performance in pediatric CPR?-a simulation study

INTRODUCTION

Out-of-hospital pediatric resuscitation is a severe medical condition with a low survival rate. Providing pediatric resuscitation is a significant stressor for medical teams that may impair performance. The vagal nerve is a crucial moderator of stress responses, and its activation (indexed by heart rate variability, HRV) has been shown to predict and improve performance in various settings. However, there is limited data about vagal activation and performance in medical settings.

METHODS

In a randomized simulation Study, paramedic students and medics were assigned to 3 min of slow-paced breathing or watching an educational 3-minute video. The participant received a scenario describing an unconscious baby without a pulse and with no breathing. The participants then performed CPR (cardiopulmonary resuscitation) on a manikin. During the scenario, every 2 min, the participant was asked a question that tested the recall of information from the scenario, and CPR performance was continuously monitored. HRV and subjective stress were taken 3 times.

RESULTS

Higher baseline HRV predicted better CPR performance. No difference in CPR performance between the groups was found, and explanations for these results will be discussed.

CONCLUSION

HRV may be used to predict CPR performance. Short-term slow-paced breathing does not improve CPR performance. Future studies should investigate the effect of long-term stress reduction interventions on CPR performance.

Yoga, mindfulness and acupuncture impact on burnout: a preliminary meta-analysis

Mindfulness, yoga, and acupuncture are three practices that have received little attention in stress management literature, with scholars suggesting that they can improve physical and mental health, reduce stress and burnout, and boost productivity and job satisfaction. However, while there is growing interest in these practices, many employers remain sceptical about their potential benefits and are hesitant to invest resources in implementing them. This meta-analysis aimed to examine the impact of these practices on burnout and explore potential moderators. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure comprehensive and transparent reporting in the identification of eligible studies. Overall, 21 studies were included (8 on mindfulness, 7 on yoga, and 6 on acupuncture), all involving independent samples, with a total of 1,364 participants. The meta-analytic results showed that all three therapeutic practices have consistent and beneficial effects on reducing burnout. Furthermore, moderation analyses indicated that mindfulness interventions conducted within the work schedule have a significant reduction in burnout, while acupuncture interventions with between 4 or 8 weeks (the more weeks, the better) also reduced burnout. However, no significant moderation effect was observed for yoga interventions. Overall, the findings provide insights into the effectiveness of these complementary practices in reducing burnout and highlight the need for further research in this area.

Comparison of the Acute Effects of Auricular Vagus Nerve Stimulation and Deep Breathing Exercise on the Autonomic Nervous System Activity and Biomechanical Properties of the Muscle in Healthy People

Background/Objectives: We aimed to examine the acute effects of deep breathing exercise and transcutaneous auricular vagus nerve stimulation (taVNS) on autonomic nervous system activation and the characteristics of certain muscle groups and to compare these two methods. Methods: 60 healthy adults between the ages of 18 and 45 were randomly divided into two groups to receive a single session of taVNS and deep breathing exercises. Acute measurements of pulse, blood pressure, perceived stress scale, autonomic activity, and muscle properties were performed before and after the application. Results: A significant decrease was detected in the findings regarding the perceived stress scale, pulse, and blood pressure values as a result of a single session application in both groups (p < 0.05). In addition, it was determined that the findings regarding autonomic measurement values increased in favor of the parasympathetic nervous system in both groups (p < 0.05). In measurements of the structural properties of the muscle, the stiffness values of the muscles examined in both groups decreased (p < 0.05), while the findings regarding relaxation increased (p < 0.05), except for the masseter in the deep breathing (DB) group. As a result of the comparative statistical evaluation between the groups, the increase in parasympathetic activity was found to be greater in the DB group according to root mean square of differences in successive RR intervals (RMSSD), the percent of differences in adjacent RR intervals > 50 ms (pNN50), and stress index parameters (p < 0.05). In the measurements made with the Myoton®PRO device, the increase in the relaxation value was higher in the gastrocnemius muscle of the VNS group (p < 0.05). Conclusions: It has been observed that both methods can increase parasympathetic activity and muscle relaxation in healthy people in a single session. However, DB appears to be slightly superior in increasing parasympathetic activity, and VNS appears to be slightly superior in increasing relaxation.

Vagally Mediated Heart Rate Variability and Mood States in Patients with Chronic Pain Receiving Prolonged Expiration Regulated Breathing: A Randomized Controlled Trial

Reduced vagally mediated heart rate variability (VmHRV) has been reported in patients with chronic pain. In healthy persons, breathing with longer expiration relative to inspiration increases VmHRV at 12 breaths per minute. The present study aimed to determine the immediate effect of breathing with longer expiration relative to inspiration on VmHRV and mood states in patients with chronic pain. Fifty patients with chronic pain aged between 20 and 67 years were prospectively randomized as two groups with an allocation ratio of 1:1. The interventional group practiced breathing with metronome based visual cues, maintaining an inspiration to expiration ratio of 28:72 (i/e ratio, 0.38) at a breath rate of 12 breaths per minute. The average i/e ratio they attained based on strain gauge respiration recording was 0.685 (SD 0.48). The control group, which looked at the metronome without conscious breath modification had an average i/e ratio of 0.745 (SD 0.69). The VmHRV, respiration and self-reported mood states (using the Brief Mood Introspection Scale (BMIS)) were assessed. There was a significant increase in HF-HRV and RMSSD during low i/e breathing (repeated measures ANCOVA, Bonferroni adjusted post-hoc test, p < 0.05; in all cases). Self-reported mood states changed as follows: (i) following low i/e breathing positive-mood states increased while the aroused mood state decreased whereas (ii) following the control intervention the aroused mood state increased (repeated measure ANOVA, p < 0.05; in all cases). Hence breathing with prolonged expiration is possibly useful to increase VmHRV and improve self- reported mood states in patients with chronic pain.

The effect of music therapy and breathing exercise on anxiety and pain in patients undergoing coronary angiography: A randomized controlled study

BACKGROUND

For over 50 years, music therapy and breathing exercises have been widely utilized as interventions to help individuals cope with fatigue, stress and pain globally.

AIM

To analyse the effects of music and breathing exercises on anxiety and pain in patients undergoing coronary angiography.

STUDY DESIGN

This is a single-blind, randomized controlled trial. The sample comprised 165 patients: 55 in the control group, 55 in the breathing exercise group and 55 in the music therapy group. Patients in the music group listened to music during angiography, those in the breathing exercise group practised exercises 30 min before the procedure and the control group received standard treatment. Anxiety levels were assessed before and after the procedure, and pain levels were measured post-procedure. The Consolidated Standards of Reporting Trials (CONSORT) checklist for reporting randomized trials was used to guide reporting.

RESULTS

Anxiety scores rose significantly in the control group from 33.9 ± 4.2 pre-angiography to 37.7 ± 4.9 post-angiography. Conversely, the breathing group's anxiety scores decreased from 34.3 ± 3.5 before angiography to 31.7 ± 1.5 after angiography, and the music group exhibited a reduction from 32.3 ± 3.6 to 30.8 ± 1.6. Post-angiography, the control group reported a mean pain score of 64 ± 0.8 mm, while the breathing and music groups had significantly lower scores of 35 ± 0.6 and 29 ± 0.8 mm, respectively. Statistical analysis showed a highly significant difference in pain scores between the intervention and control groups.

CONCLUSIONS

This study provides support for the beneficial effects of employing breathing exercises and music in alleviating pain and anxiety during coronary angiography procedures.

RELEVANCE TO CLINICAL PRACTICE

Integrating these findings into clinical practice could be significant for improving patients' pain experiences and anxiety, enhancing the tolerance of invasive medical procedures.

Effects of forest bathing (Shinrin-yoku) in stressed people

Aim

This study aims to explore the physiological effect of forest bathing on stress management.

Methods

A total of 29 volunteers participated in this pre-post design, which lacked a control group. Several physiological parameters were recorded, including heart rate (HR), heart rate variability (HRV), electrodermal activity (EDA), blood pressure (BP), immunoglobulin A (IGA), and salivary cortisol (sCort). Additionally, the Perceived Stress Scale (PSS-10) was administered before forest exposure. Measurements were taken before and after participants spent 2 days fully immersed in a forest environment. To further assess stress management, participants completed a Mental Arithmetic Task (MAT) before and after forest immersion, during which EDA, HRV, and HR were monitored using an Empatica E4 wristband. Measurements were taken at baseline, during MAT, and afterward (recovery).

Results

Participants exhibited moderate perceived stress levels before forest immersion (mean PSS-10 = 21.22, SD = 3.78). Post-forest exposure, there was a significant decrease in sCort (p < 0.05) and EDA (p < 0.001), while HRV increased (p < 0.001), and diastolic blood pressure rose (p < 0.05). ANOVA results from the MAT showed a significant increase in parasympathetic activity across all conditions post-immersion (p < 0.05), except during recovery, while EDA decreased in all conditions post-forest exposure (p < 0.05).

Conclusion

Shinrin-yoku significantly improved stress management at a physiological level and could be a valuable intervention for individuals experiencing stress. However, longitudinal studies with a control group are necessary to determine whether these effects are sustained over time. Nonetheless, this study highlights the potential benefits of forest immersion for stress reduction by enhancing sympathovagal balance and the adaptability of the stress response system.

Exploring Heart Rate Variability Biofeedback as a Nonpharmacological Intervention for Enhancing Perioperative Care: A Narrative Review

Heart rate variability biofeedback (HRVBF) is a non-invasive therapeutic technique that aims to regulate variability in heart rate. This intervention has promise in mitigating perioperative stress, a critical factor for surgical patient outcomes. This comprehensive review aimed to explore the current evidence on the perioperative role of HRV biofeedback in improving patient outcomes, reducing perioperative stress, enhancing recovery, and optimizing anaesthesia management. A review of the PubMed and Google Scholar databases was conducted to identify articles focused on HRVBF in relation to the perioperative period. Studies were selected using appropriate keywords in English (MeSH). Ample potential applications of HRVBF in clinical anaesthesia have been identified and proven feasible. It is a non-invasive and an easy method an anaesthesiologists has at its disposal with potential utility in reducing perioperative stress, as a tool of optimization of comorbidities, analgesia supplementation and in predicting catastrophic complications. Although HRVBF has the potential to enhance anaesthesia management and improve patient outcomes, several limitations and challenges must be addressed to maximize its clinical utility. Overcoming these obstacles through research and technological advancements will be crucial for realizing the full benefits of HRVBF in perioperative care.

A Systematic Review of Breathing Exercise Interventions: An Integrative Complementary Approach for Anxiety and Stress in Adult Populations

Aim: Nurses are well-qualified to deliver integrative complementary therapy interventions, a holistic approach to assist individuals experiencing anxiety and stress. Self-regulated, controlled breathing exercises (a clinical approach) are reported to decrease anxiety and increase stress tolerance. The aim of this systematic review was to evaluate the effectiveness of breathing exercise interventions on the psychological and physiologic outcomes of anxiety and stress among adults and assess the state of the science in the post-COVID-19 population. Methods: A systematic review was conducted, and four scientific databases were searched: PubMed, CINAHL, EMBASE, and Web of Science. Inclusion criteria included: (1) peer-reviewed studies, (2) adults over 18, (3) breathing exercise interventions, and (4) anxiety or stress as outcomes. Results: Out of 309 studies identified, 19 were included. Twelve reported significant improvements in anxiety and nine reported significant improvements in stress following varying breathing exercise interventions (p < .05). No adverse events were reported. Conclusions: Breathing exercises were found to be effective in reducing anxiety and stress in adults, however, there continues to be limited evidence that includes large randomized controlled trials. Breathing exercises are a holistic care approach that can be safely implemented by nurses to decrease symptomatology among adults, including the post-COVID population.

Benefits From Different Modes of Slow and Deep Breathing on Vagal Modulation

Slow and deep breathing (SDB) is a relaxation technique that can increase vagal activity. Respiratory sinus arrhythmia (RSA) serves as an index of vagal function usually quantified by the high-frequency power of heart rate variability (HRV). However, the low breathing rate during SDB results in deviations when estimating RSA by HRV. Besides, the impact of the inspiration-expiration (I: E) ratio and guidelines ways (fixed breathing rate or intelligent guidance) on SDB is not yet clear. In our study, 30 healthy people (mean age = 26.5 years, 17 females) participated in three SDB modes, including 6 breaths per minute (bpm) with an I:E ratio of 1:1/ 1:2, and intelligent guidance mode (I:E ratio of 1:2 with guiding to gradually lower breathing rate to 6 bpm). Parameters derived from HRV, multimodal coupling analysis (MMCA), Poincaré plot, and detrended fluctuation analysis were introduced to examine the effects of SDB exercises. Besides, multiple machine learning methods were applied to classify breathing patterns (spontaneous breathing vs. SDB) after feature selection by max-relevance and min-redundancy. All vagal-activity markers, especially MMCA-derived RSA, statistically increased during SDB. Among all SDB modes, breathing at 6 bpm with a 1:1 I:E ratio activated the vagal function the most statistically, while the intelligent guidance mode had more indicators that still significantly increased after training, including SDRR and MMCA-derived RSA, etc. About the classification of breathing patterns, the Naive Bayes classifier has the highest accuracy (92.2%) with input features including LFn, CPercent, pNN50, [Formula: see text], SDRatio, [Formula: see text], and LF. Our study proposed a system that can be applied to medical devices for automatic SDB identification and real-time feedback on the training effect. We demonstrated that breathing at 6 bpm with an I:E ratio of 1:1 performed best during the training phase, while intelligent guidance mode had a more long-lasting effect.

Robots as Mental Health Coaches: A Study of Emotional Responses to Technology-Assisted Stress Management Tasks Using Physiological Signals

The current study investigated the effectiveness of social robots in facilitating stress management interventions for university students by evaluating their physiological responses. We collected electroencephalogram (EEG) brain activity and Galvanic Skin Responses (GSRs) together with self-reported questionnaires from two groups of students who practiced a deep breathing exercise either with a social robot or a laptop. From GSR signals, we obtained the change in participants' arousal level throughout the intervention, and from the EEG signals, we extracted the change in their emotional valence using the neurometric of Frontal Alpha Asymmetry (FAA). While subjective perceptions of stress and user experience did not differ significantly between the two groups, the physiological signals revealed differences in their emotional responses as evaluated by the arousal-valence model. The Laptop group tended to show a decrease in arousal level which, in some cases, was accompanied by negative valence indicative of boredom or lack of interest. On the other hand, the Robot group displayed two patterns; some demonstrated a decrease in arousal with positive valence indicative of calmness and relaxation, and others showed an increase in arousal together with positive valence interpreted as excitement. These findings provide interesting insights into the impact of social robots as mental well-being coaches on students' emotions particularly in the presence of the novelty effect. Additionally, they provide evidence for the efficacy of physiological signals as an objective and reliable measure of user experience in HRI settings.

Fairness: from the guts to the brain - a critical examination by Atlantic fellows of the Global Brain Health Institute

In January 2023, the Global Brain Health Institute (GBHI) at UCSF hosted an online salon to discuss the relationship between fairness and brain health equity. We aimed to address two primary questions: first, how is fairness perceived by the public, and how does it manifest in societal constructs like equity and justice? Second, what are the neurobiological foundations of fairness, and how do they impact brain health? Drawing from interdisciplinary fields such as philosophy, psychology, and neuroscience, the salon served as a platform for participants to share diverse perspectives on fairness. Fairness is a multifaceted concept encompassing equity, justice, empathy, opportunity, non-discrimination, and the Golden Rule, but by delving into its evolutionary origins, we can verify its deep-rooted presence in both human and animal behaviors. Real-world experiments, such as Frans de Waal's capuchin monkey study, have proven enlightening, elucidating many mechanisms that have shaped our neurobiological responses to fairness. Contemporary cognitive neuroscience research further emphasizes the role of neuroanatomical areas and neurotransmitters in encoding fairness-related processes. We also discussed the critical interconnection between fairness and healthcare equity, particularly its implications for brain health. These values are instrumental in promoting social justice and improving health outcomes. In our polarized social landscape, there are rising concerns about a potential decrease in fairness and prosocial behaviors due to isolated social bubbles. We stress the urgency for interventions that enhance perspective-taking, reasoning, and empathy. Overall, fairness is vital to fostering an equitable society and its subsequent influence on brain health outcomes.

Brief structured respiration practices enhance mood and reduce physiological arousal

Controlled breathwork practices have emerged as potential tools for stress management and well-being. Here, we report a remote, randomized, controlled study (NCT05304000) of three different daily 5-min breathwork exercises compared with an equivalent period of mindfulness meditation over 1 month. The breathing conditions are (1) cyclic sighing, which emphasizes prolonged exhalations; (2) box breathing, which is equal duration of inhalations, breath retentions, and exhalations; and (3) cyclic hyperventilation with retention, with longer inhalations and shorter exhalations. The primary endpoints are improvement in mood and anxiety as well as reduced physiological arousal (respiratory rate, heart rate, and heart rate variability). Using a mixed-effects model, we show that breathwork, especially the exhale-focused cyclic sighing, produces greater improvement in mood (p < 0.05) and reduction in respiratory rate (p < 0.05) compared with mindfulness meditation. Daily 5-min cyclic sighing has promise as an effective stress management exercise.

Neuromodulation Applied to Diseases: The Case of HRV Biofeedback

The vagus or “wandering” nerve is the main branch of the parasympathetic nervous system (PNS), innervating most internal organs crucial for health. Activity of the vagus nerve can be non-invasively indexed by heart-rate variability parameters (HRV). Specific HRV parameters predict less all-cause mortality, lower risk of and better prognosis after myocardial infarctions, and better survival in cancer. A non-invasive manner for self-activating the vagus is achieved by performing a slow-paced breathing technique while receiving visual feedback of one’s HRV, called HRV-biofeedback (HRV-B). This article narratively reviews the biological mechanisms underlying the role of vagal activity and vagally mediated HRV in hypertension, diabetes, coronary heart disease (CHD), cancer, pain, and dementia. After searching the literature for HRV-B intervention studies in each condition, we report the effects of HRV-B on clinical outcomes in these health conditions, while evaluating the methodological quality of these studies. Generally, the levels of evidence for the benefits of HRV-B is high in CHD, pain, and hypertension, moderate in cancer, and poor in diabetes and dementia. Limitations and future research directions are discussed.

Pulling the Trigger: The Effect of a 5-Minute Slow Diaphragmatic Breathing Intervention on Psychophysiological Stress Responses and Pressurized Pistol Shooting Performance

This study examined the effect of slow diaphragmatic breathing on psychophysiological stress responses and pressurized performance. Sixty-seven participants (40 female; Mage = 20.17 ± 2.77 years) were randomly assigned to either a diaphragmatic-breathing, paced-breathing, or control group. Participants completed a nonpressurized shooting task and then received instructions about a pressurized version. Next, the diaphragmatic group was told to breathe at 6 breaths/min, the paced group at 12 breaths/min, and the control group received no instructions. Following a 5-min intervention period, participants completed the pressurized task while performance was assessed. Psychophysiological stress responses (e.g., cognitive anxiety, heart rate) were recorded throughout. Results revealed that diaphragmatic breathing had mixed effects on stress responses, with some unaffected (e.g., heart rate) and others reduced (e.g., cognitive anxiety), and little effect on performance. Findings suggested that slow diaphragmatic breathing might not aid pressurized performance but could benefit psychological stress responses.

An Empirical Approach to Analyzing the Effects of Stress on Individual Creativity in Business Problem-Solving: Emphasis on the Electrocardiogram, Electroencephalogram Methodology

In this study, experiments were conducted on 30 subjects by means of electrocardiogram (ECG) and electroencephalogram (EEG) methodologies as well as a money game to examine the effects of stress on creativity in business problem-solving. The study explained the relationship between creativity and human physiological response using the biopsychosocial model of challenge and threat. The subjects were asked to perform a cognitive mapping task. Based on the brain wave theory, we identified the types of brain waves and locations of brain activities that occurred during the creative problem-solving process in a business environment and studied the effects of stress on creativity. The results of the experiments showed significant differences in creativity in business problem-solving depending on whether or not stress was triggered. Differences were found in the time domain (SDNN, RMSSD) and frequency domain (HF, LF/HF ratio) of heart rates, a physiological stress indicator, between the stress group and the no-stress group. A brain wave analysis confirmed that alpha waves increased in the frontal lobe of the brain during creative business problem-solving but decreased when the subjects were under stress, during which beta waves in the brain increased. This study seeks to examine creativity in business problem-solving by studying the effects of stress on human physiological response and cognitive functions in the hope of providing a new and objective interpretation of existing research results.

Breath Tools: A Synthesis of Evidence-Based Breathing Strategies to Enhance Human Running

Running is among the most popular sporting hobbies and often chosen specifically for intrinsic psychological benefits. However, up to 40% of runners may experience exercise-induced dyspnoea as a result of cascading physiological phenomena, possibly causing negative psychological states or barriers to participation. Breathing techniques such as slow, deep breathing have proven benefits at rest, but it is unclear if they can be used during exercise to address respiratory limitations or improve performance. While direct experimental evidence is limited, diverse findings from exercise physiology and sports science combined with anecdotal knowledge from Yoga, meditation, and breathwork suggest that many aspects of breathing could be improved via purposeful strategies. Hence, we sought to synthesize these disparate sources to create a new theoretical framework called “Breath Tools” proposing breathing strategies for use during running to improve tolerance, performance, and lower barriers to long-term enjoyment.

Taking a few deep breaths significantly reduces children's physiological arousal in everyday settings: Results of a preregistered video intervention

This preregistered, randomized field experiment tested the effectiveness of a brief deep breathing intervention on children's concurrent physiological arousal in naturalistic settings (N  = 342; M_age  = 7.48 years; 46% female; 53% Asian, 26% White; 21% other race/ethnicity). The treatment consisted of an animated video that introduced deep breathing as a self-regulation strategy and scaffolded the child in taking a few slow-paced breaths, while the control group watched an informational video featuring similar animated images. Respiratory sinus arrhythmia (RSA) and heart rate (HR) were measured while children were sitting still (baseline) and subsequently while watching 1-min videos. Relative to baseline arousal, RSA increased and HR decreased only in response to the deep-breathing treatment video. Effects were larger in the second 30-s epoch of the video, which included most of the deep breathing practice. RSA fully mediated the intervention's effects on HR. By analyzing all children exposed to intervention video regardless of their engagement in the deep breathing practice (intention-to-treat design) and by using easily scalable treatment videos, the study identifies an effective and pragmatic approach to reducing children's physiological arousal in everyday, group settings. Implications for advancing applied developmental psychophysiological research are discussed.

The experience of nursing leadership in a crisis: A hermeneutic phenomenological study

AIM

This study aimed to understand nursing leaders' experience during the pandemic.

BACKGROUND

COVID-19 is a public health crisis that affects every nation in the world.

METHODS

Purposeful sampling was used to recruit 28 leaders in a large health care system. Data were collected via semi-structured audiotaped interviews. Results were analysed using hermeneutic phenomenology.

RESULTS

The structure in which leaders worked was described as: from the day-to-day grind to derailment and from manning the hospital to manning the frontlines. Five phenomenological themes were as follows: embodied leadership, navigating differently, trusting and earning trust, being the calm voice and envisioning the future.

CONCLUSION

Disaster policies and procedures are needed that will alleviate leadership angst, maximize nursing resources, heighten trust and enhance communications.

IMPLICATIONS FOR NURSING MANAGEMENT

In 2020, we witnessed a previously inconceivable media and public focus on the value of nursing care. Leaders can use this pivotal moment in time as a catalyst towards securing the support needed in planning for the next pandemic.

The Influence of Slow-Paced Breathing on Executive Function

Abstract. The aim of this experiment was to test the immediate effects of slow-paced breathing on executive function. Slow-paced breathing is suggested to increase cardiac vagal activity, and the neurovisceral integration model predicts that higher cardiac vagal activity leads to better executive functioning. In total, 78 participants (41 men, 37 women; Mage = 23.22 years) took part in two counterbalanced experimental conditions: a 3 × 5 min slow-paced breathing condition and a television viewing control condition. After each condition, heart rate variability was measured and participants performed three executive function tasks: the color-word match Stroop (inhibition), the automated operation span task (working memory), and the modified card sorting task (cognitive flexibility). Results showed that performance on executive function tasks was better after slow-paced breathing compared to control, with higher scores observed for Stroop interference accuracy, automated operation span score, and perseverative errors, but not Stroop interference reaction times. This difference in executive function between experimental conditions was not mediated by cardiac vagal activity. Therefore, findings only partially align with predictions of the neurovisceral integration model. Slow-paced breathing appears a promising technique to improve immediate executive function performance. Further studies are recommended that address possible alternative underlying mechanisms and long-term effects.

Autonomic Rehabilitation: Adapting to Change

Adaption to changes of external environment or internal health, the body-mind connection, or autonomic nervous system must be flexible and healthy. Population health studies with wearable technology and remote monitoring will lead to paradigm shifts in how to approach the physiology of emotion. Heart rate variability as a whole health biomarker could emerge as a foundation for a process beginning with objective habits and skills of real-time modulation with focused breathing for healthier decision making and autonomic health trajectory change. Physical medicine and rehabilitation is uniquely poised to refine an autonomic rehabilitation process in an integrative manner to help individuals adapt.