How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing

Respiratory modulation of beta corticomuscular coherence in isometric hand movements

Respiration is a fundamental physiological function in humans, often synchronized with movement to enhance performance and efficiency. Recent studies have underscored the modulatory effects of respiratory rhythms on brain oscillations and various behavioral responses, including sensorimotor processes. In light of this connection, our study aimed to investigate the influence of different respiratory patterns on beta corticomuscular coherence (CMC) during isometric hand flexion and extension. Utilizing electroencephalogram (EEG) and surface electromyography (sEMG), we examined three breathing conditions: normal breathing, deep inspiration, and deep expiration. Two experimental protocols were employed: the first experiment required participants to simultaneously breathe and exert force, while the other involved maintaining a constant force while varying breathing patterns. The results revealed that deep inspiration significantly enhanced beta CMC during respiration-synchronized tasks, whereas normal breathing resulted in higher CMC compared to deep respiration during sustained force exertion. In the second experiment, beta CMC was cyclically modulated by respiratory phase across all breathing conditions. The difference in the outcomes from the two protocols demonstrated a task-specific modulation of respiration on motor control. Overall, these findings indicate the complex dynamics of respiration-related effects on corticomuscular neural communication and provide valuable insights into the mechanisms underpinning the coupling between respiration and motor function.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11571-025-10245-x.

Heart Rate Variability Modulation Through Slow-Paced Breathing in Health Care Workers with Long COVID: A Case-Control Study

BACKGROUND

Long COVID is a syndrome persisting 12+ weeks after COVID-19 infection, impacting life and work ability. Autonomic nervous system imbalance has been hypothesized as the cause. This study aims to investigate cardiovascular autonomic function in health care workers (HCWs) with Long COVID and the effectiveness of slow-paced breathing (SPB) on autonomic modulation.

METHODS

From December 1, 2022 to March 31, 2023, 6655 HCWs of the University Hospitals of Trieste (Northeast Italy) were asked to participate in the study by company-email. Inclusion/exclusion criteria were assessed. Global health status and psychosomatic disorders were evaluated through validated questionnaires. Heart rate variability was assessed by finger-photoplethysmography during spontaneous breathing and SPB, which stimulate vagal response. Long COVID HCWs (G1) were contrasted with Never infected (G2) and Fully recovered COVID-19 workers (G3).

RESULTS

There were 126 HCWs evaluated. The 58 Long COVID were assessed at a median time because COVID-19 of 419.5 days (interquartile range 269-730) and had significantly more psychosomatic symptoms and lower detectability of spontaneous systolic pressure oscillation at 0.1 Hz (Mayer wave - baroreflex arc) during spontaneous breathing compared with 53 never-infected and 14 fully-recovered HCWs (19%, 42%, and 40%, respectively, P = .027). During SPB, the increase in this parameter was close to controls (91.2%, 100%, and 100%, respectively, P = .09). No other differences in heart rate variability parameters were found among groups.

CONCLUSIONS

Resting vascular modulation was reduced in Long COVID, while during SPB, baroreflex sensitivity effectively improved. Long-term studies are needed to evaluate whether multiple sessions of breathing exercises can restore basal vascular reactivity and reduce cardiovascular risk in these patients.

Complexity of post-concussion syndrome assessment and management: a case for customizing rehabilitation

BACKGROUND

Post-concussion syndrome is a challenging condition to manage for even the most experienced chronic pain experts. Patients' presentations are heterogeneous with symptoms spanning physical, cognitive and emotional domains. The symptoms reported are often non-specific, making it difficult for health professionals to prescribe effective rehabilitation. The aim of the present study was to examine the effectiveness of a customized rehabilitation program based on subgroup determination following a standardized clinical exam in adults with post-concussion syndrome.

METHODS

A total of 16 adults (mean age ± SD, 38.3 ± 12.5 years) with post-concussion syndrome participated in a 6-week rehabilitation program. Participants were recruited from external community concussion clinics around the greater Toronto area, Canada. Participants underwent a comprehensive standardized clinical exam to subgroup the ostensible symptom generators into either autonomic, cervical or vestibulo-ocular. Customized rehabilitation was then prescribed based on their subgroupings. The primary outcome measure was the Rivermead Post-Concussion Questionnaire (RPQ). Secondary outcome measures included the Patient Health Questionnaire-9 (PHQ-9), the Neck Disability Index (NDI), and exercise tolerance as assessed via the Buffalo Concussion Treadmill Test (BCTT).

RESULTS

Following 6 weeks of customized rehabilitation, participants on average experienced a significant and clinically meaningful change with respect to the RPQ-3 and RPQ-13 (p < 0.001). We also observed a significant change in all secondary outcome measures including a reduction in PHQ-9 (p < 0.01), NDI (p < 0.001) and exercise tolerance, expressed as heart rate threshold (p < 0.001).

CONCLUSION

The standardized exam was feasible and useful in assisting the clinician in prescribing effective rehabilitation. The 6-week customized rehabilitation program demonstrated significant changes in patient-reported persistent post-concussion symptoms and exercise tolerance. The implementation of a customized program based on a standardized exam performed to subgroup the ostensible symptom generators may be key to successful management in this population.

Dhyana yoga, the path of meditative being: Psychotherapeutic insights from the east

Eastern spiritual traditions offer insights into the mind-body approaches to enhance health and well-being. These insights focus on self-awareness (the path of knowledge), intrinsically motivated and selfless action (karma yoga) and on faith and compassion (Bhakti yoga). Yogic meditative practices (Dhyana yoga), developed by ancient Hindu and other eastern traditions, are effective tools to implement these pathways to well-being. They involve ethical behavior (yama and niyama), bodily postures, breath-related, and/or other meditative approaches for mastery over the physiological and psychological processes within an individual. Meditative practices require practice (abhyasa) as well as detachment (vairagya), so that the 'ego' of being a 'doer' does not become a hindrance in achieving inner transformations. In this paper, we review the eastern concepts on the nature of these techniques of inner well-being, and then place them in the context of emerging insights in psychology on these behavioral practices. Meditative practices include focused attention (FA), open-monitoring (OM) and transcendental meditation (TM) approaches. We outline current emerging neuroscience findings that suggest somewhat distinctive correlates of these mental states with neural oscillations and brain circuits. These approaches may also be differentially effective across medical and psychiatric disorders. We review gaps in knowledge and offer a framework for further research in developing these interventions, especially as applied in the areas of positive psychology and psychiatry.

ReNeuWell mental well-being app: protocol for a randomised controlled trial

INTRODUCTION

The field of mental well-being interventions includes numerous studies of smartphone app-based programs, but there is a research-to-retail gap where many studies pertain to apps that are not publicly available, not used as standalone programs, or not tested in the general population, and many publicly available apps (or their proprietary in-app measures) have yet to be submitted to empirical testing. Furthermore, few well-being apps offer multicomponent interventions, despite such interventions having demonstrated efficacy outside the smartphone context. In response to these openings in the literature and marketplace, we have developed ReNeuWell, an iPhone app designed to measure the user's mental well-being (via the validated Composure, Own-worth, Mastery, Positivity, Achievement and Satisfaction for Well-being (COMPAS-W) scale) and improve their well-being via a personalised, multicomponent program of activities informed by the peer-reviewed evidence base. This article describes the protocol for the preregistered randomised controlled trial (RCT) of ReNeuWell, to test the app in adult participants from the general population of Apple App Store users. It is hypothesised that ReNeuWell users will experience significant increases in mental well-being and decreases in mental distress over the 6-12-week trial period, relative to users of an active control version of the app.

METHODS AND ANALYSIS

The RCT will recruit participants from Apple Store users who choose to download ReNeuWell in the normal course of browsing the marketplace. Following consent, the app will randomly allocate participants to receive either the full version of the app or the active control version. The full version assesses the user's well-being via the validated COMPAS-W scale, provides feedback on their well-being across six dimensions and creates a personalised schedule of daily positive psychology activities designed to enhance well-being along each dimension. Participants will be instructed to use the app for at least 10 min (at least one activity) per day for the first 6 weeks, and as they wish for the following 6 weeks. Trial outcomes will be measured via in-app surveys administered in weeks 1, 6 and 12. Data collection will begin when the app is officially launched on the Apple Store. Data will be analysed using linear mixed models to estimate condition-by-time interaction effects on the primary and secondary outcomes, and to assess whether any such effects are themselves moderated by other key variables.

ETHICS AND DISSEMINATION

This protocol has been approved by the Human Research Ethics Committee of the University of New South Wales (reference number: HC210302). Trial outcomes will be published in accordance with the preregistered protocol described here, both in the peer-reviewed literature and on the registry website.

TRIAL REGISTRATION NUMBER

This protocol was preregistered with the Australian New Zealand Clinical Trials Registry (registration approved on 4 August 2021; trial ID number: ACTRN12621001014842p).

Global coordination of brain activity by the breathing cycle

Neuronal activities that synchronize with the breathing rhythm have been found in humans and a host of mammalian species, not only in brain areas closely related to respiratory control or olfactory coding but also in areas linked to emotional and higher cognitive functions. In parallel, evidence is mounting for modulations of perception and action by the breathing cycle. In this Review, we discuss the extent to which brain activity locks to breathing across areas, levels of organization and brain states, and the physiological origins of this global synchrony. We describe how waves of sensory activity evoked by nasal airflow spread through brain circuits, synchronizing neuronal populations to the breathing cycle and modulating faster oscillations, cell assembly formation and cross-area communication, thereby providing a mechanistic link from breathing to neural coding, emotion and cognition. We argue that, through evolution, the breathing rhythm has come to shape network functions across species.

Neural activity is modulated by spontaneous and volitionally controlled breathing

Recent studies have provided evidence regarding respiration-brain coupling, but our understanding of how continuously varying dynamics of breathing modulate neural activity remains incomplete. We examined whether the neural state differs between spontaneous and volitionally controlled breathing and across the phases of breathing, inspiration and expiration. Magnetoencephalography (MEG) with a respiratory belt was used to record cortical oscillatory activity during spontaneous, deep, and square breathing (n = 33). Additionally, self-report measures of mood and arousal were applied to assess changes in the psychological state during the breathing techniques. Alpha power was suppressed during inspiration and increased during expiration (p < .01) indicating dynamically fluctuating neural states across the respiratory cycle. This effect was observed in the sensorimotor areas during both spontaneous and volitionally controlled deep breathing. Compared to spontaneous and volitionally controlled square breathing, alpha power increased during deep breathing (p < .01) within a cortical network extending to frontal and temporal areas. We also observed a steeper aperiodic slope and a broadband shift in the power spectrum in the left superior frontal gyrus during square breathing in comparison with spontaneous breathing suggesting that not only oscillatory activity but also the more general spectral characteristics of ongoing neural activity are modulated by the rate, depth, and pattern of breathing. Self-reported mood and arousal did not differ across the breathing techniques. Altogether, we demonstrate that neural activity is modulated by the phases of breathing and can also be volitionally influenced by varying the rate, depth, and pattern of breathing.

Characteristics of brain network after cardiopulmonary phase synchronization enhancement

The central neural mechanism plays an important role in cardiopulmonary coupling. How the brain stem affects the cardiopulmonary coupling is relatively clear, but there are few studies on the cerebral cortex activity of cardiopulmonary coupling. We aim to study the response of the cerebral cortex for cardiopulmonary phase synchronization enhancement. The method of brain network was used and Pearson correlation analysis performed on the global attributes and phase synchronization time (CRPST) in the spontaneous, 2/2 and 4/4 breathing modes. Furthermore, calculated the phase lag index (PLI) among 21 lead EEG signals, and then analyzed the correlation between PLI and the parameters of cardiovascular and respiratory systems. Our results show that the global brain network characteristic parameters are significantly different in the three breath modes in the α (8-14 Hz) band. The global efficiency and feature path length are significantly positively correlated with the phase synchronization and PLI indexes are widely related to CRPST and respiratory depth in the spontaneous breathing mode, while the brain network parameters and PLI indexes are not correlated with CRPST and PLI mainly positively correlated with respiratory rate in the controlled breathing modes. The differences of brain networks in the three modes are mainly caused by the physiological factors of cardiopulmonary coupling. These show that enhanced cardiopulmonary phase synchronization with controlled breathing based on heartbeat has a significant effect on the cardiopulmonary system and maybe provide some ideas for regulating cardiopulmonary function in the future.

Sleep Quality and Cognitive Skills Impact Neurocognitive Function and Reduce Sports-Related Injury Risk

Injury prevention in sports is critically influenced by cognitive factors, particularly sleep quality and cognitive skills. Research has underscored the role of cognitive processes in injury risk and recovery, highlighting that inadequate sleep and poor cognitive functioning can significantly elevate injury susceptibility. Despite the well-documented benefits of adequate sleep and cognitive training in mitigating injury risk, access to sports psychology expertise is limited among athletes and health care providers. This work reviews the literature on the effectiveness of cognitive skills and sleep training in reducing sports-related injuries. Sleep affects musculoskeletal recovery, cognitive function, and immune response, which may further exacerbate injury risk. Neurobiological processes during sleep are crucial for muscle repair, cognitive function, and immune efficiency, all of which are integral to reducing the injury risk in athletes. Environmental factors such as travel schedules, training intensity, and competitive pressures disrupt sleep and increase the risk of injury. Cognitive Behavioral Therapy for Insomnia has shown promise in addressing sleep disturbances by improving sleep habits and addressing cognitive distress related to sleep. In addition, cognitive skills training, including mental skills training and mindfulness, enhances perceptual awareness, decision making, and reaction times, potentially reducing injury incidence by improving cognitive and motor function. Evidence supports the pivotal role of sleep and cognitive skills in preventing sports injuries. Interventions like Cognitive Behavioral Therapy for Insomnia and mental skills training can effectively address these factors, suggesting that integrating these approaches into athlete training programs could significantly enhance injury prevention strategies.

Level of Evidence

Level V, expert opinion.

The efficacy of a virtual and in-person mindfulness-based intervention course on university students' during COVID-19 pandemic

Objective: The purpose of this research was to evaluate the impact of a mindfulness-based intervention (MBI) on university students during the COVID-19 pandemic. Methods and participants: There were 53 participants who voluntarily enrolled in a mindfulness course at a regional state university (24 virtual and 29 in-person) and 56 in the control group. Participants completed surveys at the beginning and end of the course on mindfulness, life satisfaction, and resilience. Results: Results revealed that the in-person group showed significantly higher mindfulness, life satisfaction, and resilience over the course of the semester. The virtual group showed increases across all three variables as well, but only significantly improved on resilience. Conclusion: Results indicate that the inclusion of MBIs in university courses may be a cost-effective and proactive means to support the mental health and well-being of college students, and that in-person delivery may be a more effective modality.

Integrative Functions of the Hypothalamus: Linking Cognition, Emotion and Physiology for Well-being and Adaptability

Background

The hypothalamus, a small yet crucial neuroanatomical structure, integrates external (e.g., environmental) and internal (e.g., physiological/hormonal) stimuli. This integration governs various physiological processes and influences cognitive, emotional, and behavioral outcomes. It serves as a functional bridge between the nervous and endocrine systems, maintaining homeostasis and coordinating bodily functions.

Summary

Recent advancements in the neurobiology of the hypothalamus have elucidated its functional map, establishing a causal relationship between its responses-such as respiration, sleep, and stress-and various physiological processes. The hypothalamus facilitates and coordinates these complex processes by processing diverse stimuli, enabling the body to maintain internal balance and respond effectively to external demands. This review delves into the hypothalamus's intricate connections with cognition, emotion, and physiology, exploring how these interactions promote overall well-being and adaptability.

Key Message

Targeted external stimuli can modulate hypothalamic neuronal activities, impacting the physiological, cognitive, and emotional landscape. The review highlights non-invasive techniques, such as controlled breathing exercises, optimized sleep architecture, and stress management, as potential methods to enhance hypothalamic function. Ultimately, this comprehensive review underscores the multifaceted role of the hypothalamus in integrating signals, maintaining homeostasis, and influencing cognition, emotion, and physiology.

Modulation of EEG by Slow-Symmetric Breathing Incorporating Breath-Hold

The interplay between the brain and lungs involves intricate physiological mechanisms operating bidirectionally. Volitional breathing, unlike spontaneous breathing, offers various benefits with potential therapeutic effects. Volitional breathing involves many variables, such as breathing rate (BR) and breathing patterns. The main objective is to study the neural dynamics during slow-symmetric breathing (SSB) at different rates, with and without incorporating breath-holds post inhalation and exhalation. Electroencephalogram (EEG) is analyzed from 63 healthy adults while breathing at 10, 6, and 4 cycles per minute (cpm) guided by a visual metronome. A significant increase in coherence is observed during SSB at all breathing rates and resonance at 6 cpm (0.1 Hz). We also study EEG band power changes, coupling of the breathing phase with EEG amplitude, and EEG modulation during SSB. The power in alpha and beta bands is significantly higher during breath-hold than during inhalation and exhalation. Compared to the baseline, the modulation index increases significantly during SSB, illustrating the enhanced modulation of brain activity. Interestingly, coherence, phase-amplitude coupling, and modulation index depend mainly on the breathing rate, and the differences between symmetric breathing with and without breath-hold are not statistically significant. The observed similarities in neural dynamics across different breathing patterns suggest that achieving very low breathing rates is feasible with symmetric breathing with breath-holds while retaining the reported benefits of slow breathing.

Benefits of Pilates on Depression, Anxiety, and Stress: An Observational Study Comparing People Practicing Pilates to Non-Active Controls

Background: The positive effects of Pilates on balance, resistance, strength, and flexibility have been described several times. Additionally, positive effects on psychological symptoms, such as anxiety and depression, were documented. However, the change in behaviors at risk for stress-related physical disorders has not yet been validated in a group of people practicing Pilates. In light of these assumptions, changes in risk behaviors for stress-related physical disorders were assessed along with psychological symptoms, comparing a group of people practicing Pilates with non-active controls. Methods: The study was observational. Data from an experimental group of twenty-five people practicing Pilates (five males and 20 females between 50 and 64 years old) were compared to those of a control group of 24 people (seven males and 17 females between 54 and 65 years). Psychological symptoms were assessed through the Symptom Questionnaire (SQ) while the P Stress Questionnaire (PSQ) investigated risk behaviors for stress-related physical disorders. Results: The analyses attested a significant decrease in anxiety (time × group effect: F = 17.38; p < 0.001), depression (time × group effect: F = 5.44; p < 0.05), and somatization (time × group effect: F = 11.25; p < 0.01), as well as an improvement in stress-risk behaviors, especially in the ability to benefit from spare time by "taking one's mind away" from commitments (time × group effect: F = 8.56; p < 0.01). Conclusions: Although the literature describes benefits for anxiety and depression following moderate-intensity sporting activities, our study also noted positive effects from Pilates on stress and psychological symptoms. Our findings suggest that Pilates may be appropriate for people who can perform light to moderate exercise.

Psychophysiological correlates of science communicators

We conducted a study in an ecological setting to evaluate the heart rate variability (HRV) of expert communicators during a live national primetime video interview. The study involved 32 expert science communicators, all with mid- to long-term experience in public speaking and outreach work, who were evaluated by an external jury to assess their communication skills. Prior to the experiment, participants completed an online survey to gather socio-demographic data, work-related information, and psychological profiles. The six indices of communication abilities assessed by jury were: Interest, Agreement, Engagement, Authoritativeness learning, and Clarity. HRV acquisitions were divided into three phases: baseline pre-interview, during the interview, and another baseline recording after the interview. Science communicators were characterized by high levels of self-esteem and prosociality, which were positively correlated with communication indices and inversely correlated with age. Evaluation of physiological responses showed that the total power and low-frequency components of HRV were significantly higher in the post-interview phase compared to both the interview and pre-interview phases. However, when we divided the entire group according to high and low Authoritativeness and Clarity indices, significant interactive effects were detected. Indeed, for the low Authoritativeness and Clarity subgroups, significant differences among all phases were observed, with total power decreasing from the pre-interview to the interview phase and increasing in the post-interview phase. This indicates a clear pattern of stress response and recovery. In contrast, the high Authoritativeness and Clarity subgroup showed less variation across phases, suggesting better stress regulation or less perceived stress during the interview. We provided the psychophysiological basis of science communication expertise that can affect the control of stress regulation during public speaking.

Find your rhythm and regulate: Breath-synced vibration feedback during breath-focused mindfulness reduces respiration variability in trauma-exposed adults

Stress and anxiety are associated with increased autonomic arousal, including altered respiration. Breath-focused mindfulness meditation can reduce stress and anxiety, but trauma-exposed adults with dissociation have difficulty engaging in this practice. Our ongoing clinical trial examines if vibration-augmented breath-focused mindfulness (VABF) can improve outcomes and increase engagement. Here, we tested if VABF reduces respiration rate (RR) or respiration variability (RV), and examined associations between RR, RV, and emotion ratings. 128 trauma-exposed adults (mean age = 30.21 years) with elevated dissociation volunteered and completed at least 50 % of intervention visits. Participants were randomized to one of four mindfulness meditation interventions: VABF (n = 34); breath-focus only (n = 33); vibration only (n = 34); open awareness (no vibration or breath-focus, n = 27). Results from linear mixed-effects models showed that VABF decreased RV across visits while all the other interventions showed increased RV across visits (p = .008; ηp2 = .014), and RV was positively associated with both anxiety and anger ratings (ps < .001; rs > .125). Findings suggest RV is a meaningful metric for examining regulatory processes in clinical populations with elevated autonomic arousal and negative emotionality. They also show that RV is modifiable through VABF, which holds significant promise as an intervention to improve regulatory processes in trauma-exposed populations.

The effects of paced breathing on psychological distress vulnerability and heart rate variability in adults sustaining traumatic injury

BACKGROUND

Traumatic physical injuries can lead to psychological distress and increased risk of psychiatric disorders, often reflected in dysregulated autonomic responses measurable through heart rate variability (HRV). Slow-paced breathing has shown potential in enhancing HRV, but its effectiveness in injured survivors remains unexplored. This study investigates the effect of slow-paced breathing on HRV among injured survivors compared to non-injured individuals and explores the influence of psychological distress and spontaneous respiratory rate on this effect.

METHODS

The study involved 120 injured individuals and 112 non-injured controls with similar age, sex, and education levels. Injured participants with minor-to-moderate injuries from traffic crashes were assessed 3-6 weeks post-injury. Psychological distress was defined as the risk of post-traumatic stress disorder and/or major depression. Physiological assessment (HRV) included a 2-min resting baseline and a 2-min slow-paced breathing session (6 breaths/min). Repeated measure MANCOVA assessed HRV changes between groups, while correlation analyses examined the relationship between these changes.

RESULTS

Injured survivors had significantly lower HRV than non-injured controls. Both groups showed notable HRV increases during slow-paced breathing. Among injured individuals, those with higher psychological distress exhibited greater HRV increases, particularly in parasympathetic activity and overall variability. Higher spontaneous respiratory rates were associated with greater HRV changes, especially in non-injured individuals.

CONCLUSION

Slow-paced breathing demonstrated significant physiological effects for injured survivors, particularly those with higher psychological distress, and supports its potential in improving stress regulation post-injury. Future research should examine the long-term effects of sustained breathing practice and clinical applicability in reducing psychological distress and disability post-injury.

Impact of combined high-intensity bodyweight interval training and breathing exercise on cardiometabolic health in normal-weight middle-aged adults with hypertension

BACKGROUND

High-intensity interval training and breathing exercises alone have well-documented health benefits in people with hypertension. This study aimed to investigated the effects of combining the two methods on physical health among adults with hypertension.

METHODS

Ninety-six adults (59.4 ± 9.1 years; 84% female; BMI 22.7 ± 1.6 kg/m2) with hypertension were randomized into one of four groups: Breathing Exercise (BE), High-Intensity Bodyweight Interval Training (HIBIT), Combined Exercise (CE), or a Non-Exercise Control (CON) group. The intervention lasted 10 weeks, with all exercise groups having the same total training time of 3 days per week (BE: 30 min/day; HIBIT: 60 min/day; CE: BE 30 min/day plus HIBIT 60 min/day). Resting heart rate, resting blood pressure, hand grip strength, cardiorespiratory fitness assessed using 6-Minute Walking Test (6MWT) and blood lipids were measured pre- and post-intervention.

RESULTS

The BE group showed the greatest reduction in systolic blood pressure (SBP) compared to CON, although differences among the exercise groups were not statistically significant. The increase in 6MWT values in the combined exercise group differed significantly compared to the other three groups (p = 0.000 and effect size = 0.296). The combined exercise group showed significant reductions in total cholesterol, LDL and triglyceride levels compared to the control group. The average reduction in total cholesterol levels was 20.8 mg/dL (95% C: -41.9 - 0.4) with an effect size of 0.103. Meanwhile, the decrease in LDL and triglyceride levels was 20.1 mg/dL (95% CI: -37.6--2.5; p = 0.014) and -40.4 mg/dL (95% CI: -82.1-1.3; p = 0.04) with effect sizes of 0.118 and 0.101.

CONCLUSIONS

In conclusion combined exercise for 10 weeks could lower systolic and diastolic blood pressure, increase CRF, and improved lipid profile. As a clinical implication, the results of this study can be an alternative or complementary approach to treatment for hypertension, potentially reducing the need for medications and their associated side effects.

TRIAL REGISTRATION

TCTR20230707003 ( http://www.

CLINICALTRIALS

in.th/ ) registered on 28 January 2023.

From contemplation to serenity: how yoga meditation improves the mental health of female college students?

Objective

This study aims to investigate the impact of yoga meditation on the mental health of female college students, focusing on how meditation improves emotional regulation, alleviates stress and strengthens psychological resilience.

Methods

Employing a combination of quantitative assessment and qualitative analysis, the study measured participants' emotional states, stress levels, and psychological resilience across multiple time points to track participants' mental health changes dynamically. In-depth interviews and analysis of meditation journals were also conducted.

Results

Yoga meditation significantly reduced anxiety, depression, and perceived stress while enhancing emotional regulation and self-awareness. Meditation positively influenced neuroplasticity, inducing beneficial changes in brain regions associated with emotional control and cognitive flexibility. Additionally, improved autonomic nervous system function was observed, with increased parasympathetic activity and reduced sympathetic response. Meditation strengthened psychological resilience in female college students, improved stress-coping strategies, and sustained positive mental health benefits even after the intervention.

Conclusion

Yoga meditation is an effective mental health intervention, bolstering emotional regulation and reducing stress among female college students. Integrating yoga meditation into campus mental health programs is recommended to provide students with greater practice opportunities and personalized guidance.

Heart Rate Variability Biofeedback Training Can Improve Menopausal Symptoms and Psychological Well-Being in Women with a Diagnosis of Primary Breast Cancer: A Longitudinal Randomized Controlled Trial

Breast cancer survivors experience numerous chronic symptoms linked to autonomic dysfunction including anxiety, stress, insomnia, menopausal symptoms, and cognitive impairment. Effective non-pharmacological solutions to address these are currently lacking.

METHODS

Our three-armed longitudinal randomized controlled trial assessed the effectiveness of a 4-week remote smartphone-based heart rate variability biofeedback intervention which involved daily paced breathing at 6 breaths p/min; active (12 breaths p/min) and waitlist controls were included. Heart rate variability and self-reported cancer-related symptoms were assessed at baseline, post-, and 6 months-post intervention. Participants were 60 UK-based women with primary breast cancer history (6 to 60 months post-active treatment).

RESULTS

The intervention group showed significant increases in low-frequency heart rate variability over time (F (4, 103.89) = 2.862, p = 0.027, d = 0.33), long-lasting improvement in sleep quality (F (4, 88.04) = 4.87, p = 0.001, d = 0.43) and cessations in night sweats (X2 (2, N = 59) = 6.44, p = 0.04, Cramer's V = 0.33), and reduced anxiety post-intervention compared to the active and waitlist controls (F (4, 82.51) = 2.99, p = 0.023, d = 0.44). Other findings indicated that the intervention and active control participants reported lasting improvements in cognitive function, fatigue, and stress-related symptoms (all ps < 0.05). The waitlist group reported no symptom changes across time.

CONCLUSION

Heart rate variability biofeedback is a feasible intervention for addressing diverse chronic symptoms commonly reported by breast cancer survivors.

Diaphragmatic Breathing Interfaces to Promote Relaxation for Mitigating Insomnia: Pilot Study

BACKGROUND

Brief behavioral treatment for insomnia is an effective short-term therapy focusing on stimulus control and sleep restriction to enhance sleep quality. As a crucial part of this therapy, diaphragmatic breathing is often recommended when patients fail to fall asleep within 30 minutes. With the rise of health apps and gamification, these tools are increasingly seen as effective ways to boost self-efficacy and user engagement; however, traditional games tend to increase attention, which can negatively impact sleep and contradicts the aim of sleep therapy. This study thus explored the potential for gamification techniques to promote relaxation without disrupting sleep processes.

OBJECTIVE

The study developed 4 breathing guidance mechanisms, ranging from concrete to abstract: number countdown, zoom-in/out, up/down, and color gradients. The objective was to explore the relationship between game mechanics, cognitive load, relaxation effects, and attention as well as to understand how different designs impact users with varying levels of insomnia.

METHODS

The study was conducted in 2 phases. The first phase involved a questionnaire on the 4 guidance mechanisms. In the second phase, 33 participants classified by insomnia severity completed a Sleep Self-Efficacy Scale. They then engaged in 5 minutes of diaphragmatic breathing using each of the 4 interfaces. Relaxation effects were measured using heart rate variability via a smartwatch, attention and relaxation levels via an electroencephalogram device, and respiratory rate via a smartphone. Participants also completed the Game Experience Questionnaire and NASA Task Load Index, followed by user interviews.

RESULTS

The results indicated that competence, immersion, and challenge significantly influenced cognitive load. Specifically, competence and immersion reduced cognitive load, while challenge, negative affect, and positive affect were correlated with relaxation. Negative affect showed a positive correlation with the mean root mean square of successive differences, while positive affect exhibited a negative correlation with the mean root mean square of successive differences. Cognitive load was found to affect both relaxation and attention, with a negative correlation between mental demand and attention and a positive correlation between temporal demand and respiratory rate. Sleep self-efficacy was negatively correlated with temporal demand and negative affect and positively correlated with competence and immersion.

CONCLUSIONS

Interfaces offering moderate variability and neither overly abstract nor too concrete guidance are preferable. The up/down interface was most effective, showing the best overall relaxation effect. Conversely, the number countdown interface was stress-inducing, while the zoom-in/out interface had a significant impact on insomnia-related issues, making them less suitable for insomnia-related breathing exercises. Participants showed considerable variability in their response to the color gradient interface. These findings underscore the importance of carefully considering game design elements in relaxation training. It is essential that breathing guidance designs account for the impact of the game experience to effectively promote relaxation in users.

Effect of motor control training and breathing exercises on pain, disability and core muscle activity in women with postpartum lumbopelvic pain: a study protocol for randomised controlled trial study

INTRODUCTION

Postpartum lumbopelvic pain (LPP) is a prevalent condition among women following childbirth. Due to the importance of respiratory muscles in lumbopelvic stability, and the changes they undergo during pregnancy, this study aims to assess the effects of motor control training and breathing exercises on pain, disability and core muscle activity in women suffering from LPP after childbirth.

METHODS AND ANALYSIS

52 women with postpartum LPP will participate in this two-parallel-armed, superiority randomised controlled trial, comprising 24 treatment sessions. The intervention group consists of motor control training and breathing exercises, and the control group includes motor control training. The diaphragm excursion, pelvic floor and abdominal muscle activity, pain and disability will be evaluated using ultrasound imaging, visual analogue scale and Oswestry Disability Index, before and after the intervention, respectively.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the human research ethics committee of the Iran University of Medical Sciences (IR.IUMS.REC.1403.017). The study results will be submitted to a relevant journal and conferences.

TRIAL REGISTRATION NUMBER

This clinical trial has been registered in the Iranian Registry of Clinical Trials on 21 May 2024 (registration number: IRCT20180916041051N2).

Changes in cognition, coping, pain and emotions after 12-months access to the digital self-management program EPIO

Background

Psychosocial pain self-management interventions can be of support for people living with chronic pain. Since psychosocial support is not always accessible, digital health interventions may increase outreach of these types of evidence-based interventions.

Objectives

To explore participants' experiences from 12-month access to the digital pain self-management program EPIO, particularly in terms of any behavioral and/or psychological changes experienced.

Methods

Participants (N = 25) engaged in individual semi-structured interviews following 12-month access to the EPIO intervention. Qualitative thematic analyses were conducted seeking to identify any behavioral and/or psychological changes experienced through intervention use, and what contributed to these changes.

Results

Participants were predominantly women (72%), median age 46 (range 26-70), with a range of self-reported pain conditions and the majority reporting pain duration >10 years (64%). Analyses identified three main themes and subsequent sub-themes: (1) Changes in Cognition; insight and self-awareness, acceptance and shifting focus, (2) Changes in Coping; pain, emotions, and activity pacing, and (3) Content and Functionality Specific Engagement; breathing and other mind-body exercises, thought-reflection exercises, and functionalities.

Conclusions

People with chronic pain experienced positive behavioral and/or psychological changes in terms of cognition and coping after 12 months access to the EPIO digital pain self-management program. The most prominent changes included increased understanding of the connection between own thoughts, feelings, and behavior, gaining concrete strategies to cope with everyday life living with pain, and utilizing these strategies to reduce pain and interference of pain, as well as to improve emotion regulation and psychological wellbeing.

Does the inspiratory muscle warm-up have an acute effect on wrestling recovery performance?

This study aims to investigate the acute effects of inspiratory muscle warm-up (IMW) in young wrestlers. Wrestling is a high-intensity sport that demands anaerobic metabolism, with rapid recovery and endurance playing crucial roles in subsequent performance. Inspiratory muscle warm-up specifically targets the inspiratory muscles, reducing fatigue during exercise and helping to sustain performance. Our study compares three different warm-up protocols (traditional wrestling warm-up, wrestling warm-up (WWIW) +  IMW, and wrestling warm-up +  placebo (WWPL)) to analyse changes in inspiratory muscle strength and select respiratory function parameters. The study was conducted with 14 male wrestlers aged 15-16. Participants were subjected to the three different warm-up protocols, followed by simulated wrestling bouts. Results showed that the WWIW protocol increased maximal inspiratory pressure by 17.3% compared to the traditional and placebo warm-ups. Additionally, the WWIW protocol delayed fatigue and improved recovery rates among the wrestlers. Specifically, WWIW enabled a faster return to normal heart rate post-competition, accelerating the recovery process. These findings suggest that WWIW can be effectively used in high-intensity sports like wrestling to enhance recovery between matches and improve overall performance. Further studies with larger sample sizes and in different sports are recommended to validate these results.

Exploring the Diagnostic Potential of Video-Based Breathing Control Training: A Sonographic Evaluation of Abdominal Organ Measures

Background

Breathing control training programs have gained attention due to their potential to influence diagnostic procedures. However, the role of video-based tools to demonstrate breathing maneuvers during sonographic quantification of abdominal organs needs to be studied more. This study explores the impact of a video-based breathing training program on sonographic examination of abdominal organs.

Methodology

This quasi-experimental study recruited 49 healthy volunteers at the ultrasound lab of College of Health and Rehabilitation Sciences in Princess Nourah bint Abdul Rahman University. The study employed a video-based breathing control training program that includes diaphragmatic breathing exercises. Sonographic assessments of abdominal organs were conducted before and after the intervention period using standardized protocols. Data was analyzed using SPSS V 28.

Results

The right renal length (p-value <0.001), thickness (p-value 0.025), and volume measured (p-value <0.001) were significantly improved following the video training. Similarly, splenic length (p-value 0.015), width (p-value <0.001), and volume (p-value 0.001). Additionally, the operator time demonstrated a notable decrease from 13.14 ± 3.4 to 8.1 ± 3.5 minutes after the video training intervention (p-value <0.001).

Conclusion

The study provides evidence for the beneficial effects of a video-based breathing control training program on sonographic quantification of abdominal organs. These findings suggest potential clinical utility for integrating video-based breathing interventions into practice, although study limitations require further validation and generalization. Nonetheless, the study highlights the promising role of breathing control training in enhancing the diagnostic accuracy of abdominal sonography.

Paced Breathing Associated With Pupil Diameter Oscillations at the Same Rate and Reduced Lapses in Attention

A dynamical systems model proposes that respiratory, locus coeruleus-noradrenaline (LC-NA), and cortical attentional systems interact, producing emergent states of attention. We tested a prediction that fixing respiratory pace (versus spontaneous respiration) stabilizes oscillations in pupil diameter (LC-NA proxy) and attentional state. Primary comparisons were between 'Instructed Breath' (IB) and 'No Instructed Breath' (NIB) groups. Secondarily, we investigated the effects of shifting respiratory frequency in the IB group from 0.15 to 0.1-0.15 Hz in Experiment 1 (n = 55) and 0.15-0.1 Hz only in Experiment 2 (n = 48) (replication). In the Paced Auditory Cue Entrainment (PACE) task, participants heard two auditory tones, alternating higher and lower pitches, cycling continuously. Tones acted as a breath guide for IB and an attention monitor for both groups. Participants gave rhythmic mouse responses to the transition points between tones (left for high-to-low, right for low-to-high). We derived accuracy of mouse click timing (RTm), variability in click timing (RTVL), and counts of erroneously inverting the left/right rhythm (IRs and Switches). Despite no differences between groups in RTm or RTVL, IB committed significantly fewer IRs and switches, indicating less lapses in attention during paced breathing. Differences in behavioral metrics were present across tone cycle frequencies but not exclusive to IB, so breath frequency did not appear to have a specific effect. Pupil diameter oscillations in IB closely tracked the frequency of the instructed breathing, implicating LC-NA activity as being entrained by the breath intervention. We conclude that pacing respiratory frequency did stabilize attention, possibly through stabilizing fluctuations in LC-NA.

Exhaled Breath Analysis: From Laboratory Test to Wearable Sensing

Breath analysis and monitoring have emerged as pivotal components in both clinical research and daily health management, particularly in addressing the global health challenges posed by respiratory and metabolic disorders. The advancement of breath analysis strategies necessitates a multidisciplinary approach, seamlessly integrating expertise from medicine, biology, engineering, and materials science. Recent innovations in laboratory methodologies and wearable sensing technologies have ushered in an era of precise, real-time, and in situ breath analysis and monitoring. This comprehensive review elucidates the physical and chemical aspects of breath analysis, encompassing respiratory parameters and both volatile and non-volatile constituents. It emphasizes their physiological and clinical significance, while also exploring cutting-edge laboratory testing techniques and state-of-the-art wearable devices. Furthermore, the review delves into the application of sophisticated data processing technologies in the burgeoning field of breathomics and examines the potential of breath control in human-machine interaction paradigms. Additionally, it provides insights into the challenges of translating innovative laboratory and wearable concepts into mainstream clinical and daily practice. Continued innovation and interdisciplinary collaboration will drive progress in breath analysis, potentially revolutionizing personalized medicine through entirely non-invasive breath methodology.

Comparing the Effects of Square, 4-7-8, and 6 Breaths-per-Minute Breathing Conditions on Heart Rate Variability, CO2 Levels, and Mood

Square and 4-7-8 breathing are popularly promoted by psychotherapists but have little empirical support. We hypothesized that breathing at 6 breaths per minute (bpm) would improve HRV, reduce blood pressure, and improve mood more than either square or 4-7-8 breathing. We also hypothesized square and 4-7-8 breathing would increase end-tidal CO2 (PETCO2). Eighty-four college students (60% female) had HRV measured at baseline and during 1) square breathing, 2) 4-7-8 breathing, 3) 6 bpm with a 4:6 inhale-to-exhale ratio, and 4) 6 bpm with a 5:5 ratio. We used a 3-lead electrocardiogram to measure HRV and a capnometer to measure PETCO2. We measured mood using the Scale of Positive and Negative Experience (SPANE) after each breathing condition. We used a repeated measures mixed effects model to examine the effects of each breathing technique on HRV, blood pressure, mood, and PETCO2 levels. Breathing at 6 bpm increased HRV measures more than square or 4-7-8 breathing with small to medium effects. None of the breathing conditions resulted in meaningful changes in blood pressure or mood. Unexpectedly, breathing at 6 bpm led to mild over-breathing. While various breathing techniques are used in psychotherapy, their relative efficacy remains unclear. This study found that breathing at 6 bpm is likely more effective at increasing HRV than square or 4-7-8 breathing, albeit with a higher risk of over-breathing. Future studies could examine whether these effects hold over multiple weeks of breathing practice and attend to the effects of different breathing techniques on CO2 levels.

Optimizing Recovery Strategies in Elite Speedskating: A Comparative Analysis of Different Modalities

Background/Objectives: As short-track speed skaters have to race multiple races to achieve success during competition, optimizing the recovery between efforts is a noteworthy performance determinant. Therefore, we compared three different recovery modalities (active cycling recovery, pneumatic compression boots, and isocapnic breathing protocol) in the context of perceived subjective pain and recovery variables, multiple biochemical and biomechanical indices, CMJ height and power, as well as repeated efforts on the ice track. Methods: Fifteen elite short-track speed skaters (eight males and seven females; age 18.3 ± 1.0 years, height 175.6 ± 7.5 cm, weight 73.7 ± 7.7 kg, 23.8 kg/m2, VO2max 55.5 mL·kg-1·min-1: ♂ 58 20 ± 3.6 mL·kg-1·min-1; and ♀ 53 ± 4.5 mL·kg-1·min-1) completed the study experiment and were included in the analyses. Repeated measures ANOVA with optional post hoc Bonferroni correction was used to assess the association magnitude of changes in variables across the recovery methods. Results: All the investigated protocols were associated with significant changes in multiple recovery indices observed within all the investigated protocols (p ≤ 0.05). However, for this sample, they resulted in analogous effects on subjective variables, hormonal response, creatine kinase, CMJ parameters, and on-ice performance (between-protocol effect: p ≥ 0.002). Changes in creatine kinase were generally higher in males than females (p = 0.05), which might suggest that optimal recovery protocols in short-track are gender-dependent. Conclusions: Since compression and active cycling remain gold standard recovery protocols, a similar response from isocapnic breathing suggests it may be a modality particularly useful in real-world settings.

Common threads: Altered interoceptive processes across affective and anxiety disorders

There is growing attention towards atypical brain-body interactions and interoceptive processes and their potential role in psychiatric conditions, including affective and anxiety disorders. This paper aims to synthesize recent developments in this field. We present emerging explanatory models and focus on brain-body coupling and modulations of the underlying neurocircuitry that support the concept of a continuum of affective disorders. Grounded in theoretical frameworks like peripheral theories of emotion and predictive processing, we propose that altered interoceptive processes might represent transdiagnostic mechanisms that confer common vulnerability traits across multiple disorders. A deeper understanding of the interplay between bodily states and neural processing is essential for a holistic conceptualization of mental disorders.

Effects of Bhramari and Sheetali Pranayama on Cardio Respiratory Function in Post-COVID Patients: A Randomised Controlled Study

Background

The COVID-19 pandemic has led to a range of long-term health issues in recovered patients, collectively known as "post-COVID syndrome."

Purpose

This study aimed to investigate the effects of combined pranayama techniques, specifically Sheetali and Bhramari, on pulmonary function and heart rate variability in post-COVID patients.

Methods

A randomised controlled trial was conducted with 90 post-COVID patients (aged 19-40). Participants were divided into three groups of 30 each: control, Bhramari Pranayama and Sheetali Pranayama. The intervention groups practiced their respective pranayama techniques for 15 minutes twice daily for 6 months. Outcome measures included Pulmonary Function Tests (PFT) and Heart Rate Variability (HRV), assessed at baseline, 3 months and 6 months.

Results

At 3 months, both pranayama groups showed moderate improvements in pulmonary function and HRV compared to baseline. By 6 months, these improvements were significantly enhanced. The Bhramari group showed increased FVC from 3.2 ± 0.5 L to 3.5 ± 0.4 L at 3 months, and to 3.7 ± 0.4 L at 6 months (P < .001). Similarly, the Sheetali group reflected improved FVC from 3.3 ± 0.4 L to 3.5 ± 0.3 L at 3 months, reaching 3.7 ± 0.3 L at 6 months (P < .001). HRV measures showed a similar trend, with SDNN and RMSSD in the Bhramari group and Sheetali pranayama group.

Conclusion

This study provides novel insights into the combined effects of Bhramari and Sheetali Pranayama on post-COVID patients. The findings suggest significant improvements in respiratory function and autonomic nervous system balance.

Usability, acceptance, and the role of realism in virtual humans for breathing exercise training

Breathing exercises are used to address a multitude of issues ranging from mental health to physical well-being. While they are recommended for various health conditions, access to professional support is often limited due to time and cost constraints. Virtual Reality technology offers a promising solution for enhancing mindfulness and relaxation practices, including breathing exercises. In our study, we explored the effectiveness of a computer-generated "virtual breathing coach". Our virtual coach has a human appearance, speaks in a human voice, and displays breathing physiology while guiding the participants through a set of breathing exercises of different cycle lengths. The agent exhibits breathing behaviour with the aim of augmenting the influence the agent exerts through the mechanisms of physiological entrainment known from human-to-human interaction. Our empirical, exploratory study with 20 participants, was conducted using non-immersive VR where the system ran on a web browser. On the one hand, we investigated the perception of the virtual human coach, and on the other hand, we evaluated the usability, acceptability, and adherence of the system. We also evaluated the role of realism in acceptance of and adherence to the virtual coach. Participants' responses were recorded using questionnaires. Participants were influenced by the virtual coach and adhered to it if they perceived the virtual coach as more realistic. The participants reported that the system ran well, and they would be willing to continue using the system in the future. Although the virtual human-to-human interaction experience provided by our system is not on par with the naturalistic human-to-human interaction, the results indicate that people are willing to replace a real human coach with a virtual coach. Systems like this are a step towards improving the affordability and on-demand access to another human, such as a coach in our system, especially where access and affordability are limited such as in healthcare. The qualities such as trust and likeability in an embodied interaction can make this interaction more efficient and effective.

Breathing Modulates Network Activity in Frontal Brain Regions during Anxiety

Anxiety elicits various physiological responses, including changes in the respiratory rate and neuronal activity within specific brain regions such as the medial prefrontal cortex (mPFC). Previous research suggests that the olfactory bulb (OB) modulates the mPFC through respiration-coupled oscillations (RCOs), which have been linked to fear-related freezing behavior. Nevertheless, the impact of breathing on frontal brain networks during other negative emotional responses, such as anxiety-related states characterized by higher breathing rates, remains unclear. To address this, we subjected rats to the elevated plus maze (EPM) paradigm while simultaneously recording respiration and local field potentials in the OB and mPFC. Our findings demonstrate distinct respiratory patterns during EPM exploration: slower breathing frequencies prevailed in the closed arms, whereas faster frequencies were observed in the open arms, independent of locomotor activity, indicating that anxiety-like states are associated with increased respiratory rates. Additionally, we identified RCOs at different frequencies, mirroring the bimodal distribution of respiratory frequencies. RCOs exhibited higher power during open-arm exploration, when they showed greater coherence with breathing at faster frequencies. Furthermore, we confirmed that nasal respiration drives RCOs in frontal brain regions and found a stronger effect during faster breathing. Interestingly, we observed that the frequency of prefrontal gamma oscillations modulated by respiration increased with breathing frequency. Overall, our study provides evidence for a significant influence of breathing on prefrontal cortex networks during anxious states, shedding light on the complex interplay between respiratory physiology and emotional processing.

The Effect of Diaphragmatic Breathing as a Complementary Therapeutic Strategy in Stress of Children and Teenagers 6-18 Years Old

BACKGROUND

Few studies are reported on interventions that have been carried out in children and adolescents using diaphragmatic breathing (DB) together with methods like counseling, muscle relaxation, therapeutic exercise, and music therapy.

OBJECTIVE

The goal of the review is to evaluate the effectiveness of DB as complementary therapy in the stress of the pediatric population (6-18 years old).

METHODS

Detailed research was carried out in the current literature to find relevant studies published from 2010 to October 2024 in PubMed and Cochrane Library. Thirteen studies that fulfilled the inclusion criteria were included in the study. Nine studies involved obese and overweight pediatric populations and the other four involved pediatric patients.

RESULTS

The interventions comprised two 8-week studies in an obese pediatric population, seven studies in healthy children and adolescents with normal weight. The studies were based on DB, muscle relaxation, nutrition, counseling, music therapy, and slow breathing exercises. The participants in the intervention group improved in comparison to those in the control group in terms of stress and depression in most included studies, in terms of school performance in two studies, in terms of better family relationships in one study, and showed improvement in anthropometric indicators in two studies. In four studies that involved pediatric patients, stress and fear of medical procedures were reduced.

CONCLUSIONS

DB can effectively contribute on its own or in combination with other therapeutic methods to improving physiological and psychological indicators in the pediatric population. It is useful to integrate stress management programs that include DB training as clinical practice in primary healthcare and in school schedules for elementary and high-school students.

Using a virtual reality game to train biofeedback-based regulation under stress conditions

Physiological regulation strategies can be effective in reducing anxiety. However, while these strategies are often learned and practised under low-stress conditions, they are more likely to be required under conditions of high stress. We created virtual reality (VR) biofeedback games to both teach participants a breathing technique and then practise that technique under stress. We present two studies: the first provides a proof of concept, demonstrating that participants can apply the breathing technique during stress, with a significant lowering of both respiration rate and increase in heart rate variability (HRV) under stress (p < .001). The second study explicitly evaluated the effectiveness of training by comparing trained and untrained groups. Training was associated with a significantly greater HRV (p = .008) under stress. In within-group comparisons of HRV during stress compared to a baseline stressor presented before training, the trained group showed a significantly greater increase compared to untrained controls (p = .025). Our results show the feasibility and potential effectiveness of VR-based games for biofeedback training under experimentally applied stress. This may offer the opportunity for clinical techniques to more closely reflect the circumstances under which those techniques will be required.

Dissociation in Long-Term Care Home Staff During COVID-19: Challenges and Promising Practices

OBJECTIVES

Long-term care (LTC) staff may develop dissociation due to high-stress work environments and trauma exposures. This study aimed to (1) assess the prevalence of pathological dissociation in LTC home staff during the COVID-19 pandemic; (2) examine the associations of pathological dissociation with demographic characteristics, mental health, insomnia, and professional quality of life; and (3) examine whether pathological dissociation was sensitive to change following a coherent breathing intervention.

DESIGN

We analyzed data from a pre-post breathing intervention study conducted between January and September 2022.

SETTINGS AND PARTICIPANTS

Participants were 254 staff (care aides, nurses, and managers) from 31 LTC homes in Alberta, Canada.

METHODS

We measured pathological dissociation using the Dissociative Experiences Scale-Taxon (DES-T). We conducted χ2 test and t tests to examine the association of pathological dissociation with other variables pre-intervention. We used a 2-level random intercept logistic regression analysis to examine the change in pathological dissociation from pre- to post-intervention.

RESULTS

About 12% and 8% of the sample experienced pathological dissociation pre- and post-intervention, respectively. Pathological dissociation was significantly associated with stress, psychological distress, anxiety, depression, posttraumatic stress disorder, and insomnia (P < .05); it was also significantly associated with language, race, and professional role (P < .05). Participants had lower odds of experiencing pathological dissociation post-intervention compared with pre-intervention (odds ratio, 0.41; P = .045).

CONCLUSIONS AND IMPLICATIONS

LTC home staff exhibited a high prevalence of pathological dissociation during COVID-19, significantly linked to other mental health measures. A coherent breathing intervention showed potential in reducing reports of dissociation. Further research is needed to understand dissociation in LTC staff and its interplay with mental health outcomes, sleep quality, and personal/work-related factors. Understanding the work environment's role and assessing interventions targeting working conditions could mitigate dissociation and promote a trauma-informed workplace. Rigorous study designs are needed to generate stronger evidence for nonpharmacological interventions like coherent breathing.

Hatha yoga reduces momentary stress but does not impact diurnal profiles of salivary cortisol and alpha-amylase: A randomized controlled trial

Does the practice of yoga impact stress? Various studies have suggested that yoga may reduce both self-reported stress and stress biomarkers, but the evidence for such claims remains inconclusive, especially for yoga styles with a focus on physical postures. In a randomized controlled trial with 98 participants, we therefore examined whether an eight-week Hatha yoga intervention (60 min, 3×/week or more) led to reduced levels of diurnal salivary cortisol (sCort), salivary alpha-amylase (sAA), and subjective momentary stress as compared to a waitlist control group. To ensure the concomitant assessment of self-report and biological measures in an ecologically valid setting, and to capture the diurnal profile of cortisol and alpha-amylase, we employed an ecological momentary assessment approach. Five times per day, participants reported their momentary stress levels on a visual analogue scale and collected saliva samples for the assessment of salivary biomarkers. The intervention led to a significant reduction of subjective momentary stress but there was no change in diurnal sCort or sAA levels. There are several potential explanations for these findings: The intervention may have helped participants to cope better with stress while leaving diurnal levels of stress biomarkers unaffected, or the change may at least not have been reflected in sCort and sAA. Alternatively, there may have been a self-report bias, insofar as a favorable disposition towards yoga may have led participants to report reductions in stress in order to indicate positive effects of the intervention. Our findings contribute to a better understanding of the effects of distinct yoga interventions, demonstrating their potential to serve as low-risk stress relief tools.

Brain Bioelectric Responses to Short-Term Heart Rate Variability Biofeedback Training in Indian and Russian University Students Studying in the Russian Arctic

Heart rate variability biofeedback (HRV BF) training aids adaptation to new climatic, geographical, and social environments. Neurophysiological changes during the HRV BF in individuals from tropical regions studying in the Arctic are not well understood. The aim of this study was to research electroencephalographic (EEG) changes during a single short-term HRV BF session in Indian and Russian students studying in the Russian Arctic. The Indian (n = 40) and Russian (n = 40) healthy students (age 19-21 years) at a medical university in Arkhangelsk (64°33' N 40°32' E) were studied. HRV and EEG parameters were measured at baseline (5 min) and during a short-term HRV BF session (5 min) to increase the total power (TP, ms2) of the HRV spectrum. The baseline heart rate and stress index levels were significantly higher in the Indian students. During the HRV BF sessions, the sympathetic activity decreased more significantly in Russian students, while the alpha EEG activity significantly increased across all brain regions in both groups. In Indian students, there was a notable increase in theta and beta1 EEG spectral power in the frontal, central, and temporal regions. HRV BF training in Indian students was associated with a more pronounced activation of brain systems compared with Russian students.

Peer coaching in cardiac surgery: a pilot study on rehabilitation participation and perioperative challenges

Following cardiac surgery, active participation in cardiac rehabilitation (CR) is associated with reduced cardiovascular events and improved survival. However, CR attendance remains persistently low, with only ∼25% of patients participating. The Peer Coaching for Cardiac Patients (PCCP) pilot programme aimed to assess whether peer coaching could enhance CR participation and reduce perioperative anxiety and depression in cardiac surgery patients. Ten patients scheduled for elective cardiac surgery were enrolled, receiving 4 60-min coaching sessions via Zoom, by a coach who had undergone coronary artery bypass grafting in the past. Outcomes were measured by CR participation rates, Patient Health Questionnaire (PHQ)-9 scores, and a post-programme survey. Seven of the 10 patients completed the PCCP programme, all of which attended CR for an average of 19.3 ± 8.70 sessions and 9.57 ± 3.0 weeks. No statistically significant difference in PHQ-9 scores was observed (P = 0.341). Participants rated the programme highly in its role in anxiety reduction (9.0 ± 1.2) and likelihood of participating in CR (9.43 ± 1.05). These results suggests that peer coaching shows potential to support CR participation and address perioperative anxiety and depression. Future studies with larger sample sizes, well-defined control groups and extended follow-up are warranted to validate these preliminary findings.

Cancer and Stress: Understanding the Connections and Interventions

Stress is ubiquitous in our modern society and contributes to many disease states. This narrative review describes the effect of stress/distress on cancer development and progression. Seminal randomized controlled trials, systematic reviews/meta-analyses, and distress management guidelines from the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), and the Society for Integrative LinearOncology (SIO) are highlighted. We describe the physiological effects of distress, distress assessment, and management. Psychological treatments are summarized. Evidence-based lifestyle modifications and integrative therapies are reviewed in detail, including mindfulness-based techniques, yoga, guided imagery, breathing techniques, hypnosis, exercise, music therapy, qigong/Tai Chi, eye movement desensitization and reprocessing, and improving sleep and heart rate variability. Recognition and treatment of distress can improve quality of life. More research is needed to determine the effects of managing distress on cancer outcomes, as well as the best type and duration of intervention, noting that the benefits of interventions may be specific for patients with different cancer types.

Neurological Evidence of Diverse Self-Help Breathing Training With Virtual Reality and Biofeedback Assistance: Extensive Exploration Study of Electroencephalography Markers

BACKGROUND

Recent advancements in virtual reality (VR) and biofeedback (BF) technologies have opened new avenues for breathing training. Breathing training has been suggested as an effective means for mental disorders, but it is difficult to master the technique at the beginning. VR-BF technologies address the problem of breathing, and visualizing breathing may facilitate the learning of breathing training. This study explores the integration of VR and BF to enhance user engagement in self-help breathing training, which is a multifaceted approach encompassing mindful breathing, guided breathing, and breath counting techniques.

OBJECTIVE

We identified 3 common breathing training techniques in previous studies, namely mindful breathing, guided breathing, and breath counting. Despite the availability of diverse breathing training methods, their varying effectiveness and underlying neurological mechanisms remain insufficiently understood. We investigated using electroencephalography (EEG) indices across multiple breathing training modalities to address this gap.

METHODS

Our automated VR-based breathing training environment incorporated real-time EEG, heart rate, and breath signal BF. We examined 4 distinct breathing training conditions (resting, mindful breathing, guided breathing, and breath counting) in a cross-sectional experiment involving 51 healthy young adults, who were recruited through online forum advertisements and billboard posters. In an experimental session, participants practiced resting state and each breathing training technique for 6 minutes. We then compared the neurological differences across the 4 conditions in terms of EEG band power and EEG effective connectivity outflow and inflow with repeated measures ANOVA and paired t tests.

RESULTS

The analyses included the data of 51 participants. Notably, EEG band power across the theta, alpha, low-beta, high-beta, and gamma bands varied significantly over the entire scalp (t ≥1.96, P values <.05). Outflow analysis identified condition-specific variations in the delta, alpha, and gamma bands (P values <.05), while inflow analysis revealed significant differences across all frequency bands (P values <.05). Connectivity flow analysis highlighted the predominant influence of the right frontal, central, and parietal brain regions in the neurological mechanisms underlying the breathing training techniques.

CONCLUSIONS

This study provides neurological evidence supporting the effectiveness of self-help breathing training through the combined use of VR and BF technologies. Our findings suggest the involvement of internal-external attention focus and the dorsal attention network in different breathing training conditions. There is a huge potential for the use of breathing training with VR-BF techniques in terms of clinical settings, the new living style since COVID-19, and the commercial value of introducing VR-BF breathing training into consumer-level digital products. Furthermore, we propose avenues for future research with an emphasis on the exploration of applications and the gamification potential in combined VR and BF breathing training.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06656741; https://clinicaltrials.gov/study/NCT06656741.

Being able to think when caught in the maelstrom - how adolescents used mindfulness when facing exams

PURPOSE

Research indicates that exam anxiety may decline with mindfulness-based interventions but there is a lack of research on adolescents' accounts of the processes involved. We explored high-school students' descriptions of how they perceived and applied mindfulness in managing anxiety-inducing thoughts related to academic performance following an 8-week Mindfulness-Based Stress Reduction (MBSR) course.

METHOD

Post-course individual semi-structured interviews with 22 high school students (2 males, mean age 17.8 years) were transcribed verbatim and analysed using reflexive thematic analysis.

RESULTS

The analyses identified six themes: (1) Noticing and attending to the attention-binding "maelstrom" of anxious thoughts and feelings (2) Attending to the breath to cope with the maelstrom, (3) "removing" and "getting rid of" anxious thoughts (4) Being able to "think" (5) awareness of more helpful thoughts, and (6) Agency and control. The findings are discussed in light of the Buddhist notion of "unwholesome thoughts" and the distinction between thought suppression and the use of breathing as a benign distraction. We propose that mindfulness encompasses both a receptive, nonjudgmental awareness and an active, intentional redirection of attention.

CONCLUSION

Mindfulness training aided participants by enhancing their capacity to disengage from fear-engaging thoughts, thereby maintaining them within their window of tolerance and facilitating cognitive processing.

Central amygdala-to-pre-Bötzinger complex neurotransmission is direct and inhibitory

Breathing behaviour is subject to emotional regulation, but the underlying mechanisms remain unclear. Here, we demonstrate a direct relationship between the central amygdala, a major output hub of the limbic system associated with emotional brain function, and the brainstem pre-Bötzinger complex, which generates the fundamental rhythm and pattern for breathing. The connection between these two sites is monosynaptic and inhibitory, involving GABAergic central amygdala neurons whose axonal projections act predominantly via ionotropic GABAA receptors to produce inhibitory postsynaptic currents in pre-Bötzinger neurons. This pathway may provide a mechanism to inhibit breathing in the context of freezing to assess threats and plan defensive action. The existence of this pathway may further explain how epileptic seizures invading the amygdala cause long-lasting apnea, which can be fatal. Although their ultimate importance awaits further behavioural tests, these results elucidate a link between emotional brain function and breathing, which underlies survival-related behaviour in mammals and pertains to human anxiety disorders.

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.

Addressing Mental Health Symptoms Among COVID-19 Healthcare Workers: A Heart Rate Variability Biofeedback Pilot Study

Psychological stress among frontline healthcare workers (HCWs) increased during the COVID-19 pandemic, elevating mental health risks. Heart rate variability biofeedback (HRV-BF) is an evidence-based intervention with potential to reduce psychological burden on frontline HCWs; however, no studies have examined its use among this population since the pandemic began. We designed a trial to assess the effects of a brief HRV-BF intervention delivered via telemedicine on measures of anxiety, depression and stress, and heart rate variability, compared to an in-person intervention. We hypothesised that the telemedicine intervention would be non-inferior to the in-person intervention. Using a randomized comparison trial design, we tested a 10-day brief heart rate variability biofeedback intervention among frontline HCWs during the COVID-19 pandemic. They received remote, 30-min guided sessions every other day and were taught methods of heart rate variability biofeedback. Depression, anxiety and stress were assessed at baseline, 10 days, and 40 days with additional measures of anxiety measured before and after each session. HRV scores were collected at baseline, as well as during the course of the 10 days. Multilevel modelling was used to examine the change in depression, anxiety, stress and HRV scores across multiple time points and session types (telemedicine vs. in-person). There was no significant differences between telemedicine (n = 32) and in-person (n = 15) interventions on the main outcomes. Both session types showed a significant decrease in depression, anxiety and stress scores across the entire intervention, and HRV scores significantly increased across both groups. Anxiety levels also significantly decreased after each session. The non-inferiority of the telemedicine intervention to a comparable in-person intervention affirms its promise for decreasing anxiety, depression and stress among frontline HCWs and may offer a cost-effective and feasible tool to use in crises situations.

Early life adversity blunts the subjective and physiological relaxation response in healthy adults

While Early Live Adversity (ELA) is a known risk factor for mental and physical diseases, the investigation into the mechanisms behind this connection is ongoing. In the present study, we investigated whether ELA blunts the relaxation response in healthy adults. Using a within-subjects design, we employed a paced breathing exercise (four seconds inhale, six seconds exhale) and a 360° nature video as relaxation interventions while measuring physiological relaxation using heart rate variability and subjective relaxation using the Relaxation State Questionnaire. A total of 103 participants (63.11% female; agemean = 22.73 ± 3.43 years) completed the Parental Bonding Instrument and the Childhood Trauma Questionnaire to assess ELA retrospectively. For subjective relaxation, a blunted relaxation reaction was associated with lower scores of paternal care and higher scores of paternal overprotection, physical abuse, physical neglect, and emotional abuse. For heart rate variability emotional abuse in interaction with nicotine consumption was related to a blunted relaxation response. This indicates that experiencing ELA negatively affects the relaxation capability in a healthy sample and emphasizes the importance of assessing relaxation at a physiological and subjective level.

Testing the impact of hatha yoga on task switching: a randomized controlled trial

Switching attention between or within tasks is part of the implementation and maintenance of executive control processes and plays an indispensable role in our daily lives: It allows us to perform on distinct tasks and with variable objects, enabling us to adapt to and respond in dynamically changing environments. Here, we tested if yoga could benefit switching of attention between distinct objects of one’s focus (e.g., through practicing switching between one’s own body, feelings, and different postures) in particular and executive control in general. We therefore conducted a randomized controlled trial with 98 participants and a waitlisted control group. In the intervention group, healthy yoga novices practiced Hatha yoga 3x a week, for 8 weeks. We conducted two experiments: A purely behavioral task investigating changes in behavioral costs during switching between attentional control sets (74 participants analyzed), and a modality-switching task focusing on electrophysiology (EEG data of 47 participants analyzed). At the electrophysiological level, frequency-tagging indicated no interventional effect on participants’ ability to switch between the auditory and visual modalities. However, increases in task-related frontocentral theta activity, resulting from the intervention, indicated an ability to increasingly deploy executive resources to the prioritized task when needed. At the behavioral level, our intervention resulted in more efficient holding of target representations in working memory, indicated by decreased mixing costs. Again, however, intervention effects on switching costs were missing. We, thus, conclude that Hatha yoga has a positive influence on executive control, potentially through improvements in working memory rather than directly on switching.

Clinical trial registration

clinicaltrials.gov, identifier [NCT05232422].

Clinical effectiveness of guided breathing exercises in reducing anxiety, stress, and depression in COVID-19 patients

The COVID-19 pandemic has led to an increase in the prevalence of anxiety, stress and depression among affected people. This study was conducted with the aim of investigating the clinical effectiveness of guided breathing exercises in reducing anxiety, stress and depression in patients with COVID-19. A quasi-experimental study design was used, involving a sample of COVID-19 patients who underwent guided breathing exercises as a complementary therapy. After simple sampling, eligible subjects were randomly divided into two groups: intervention (30 patients) and control (30 patients) using random block method. The Depression Anxiety Stress Scale-21 (DASS-21) questionnaire was administered before and after the intervention to evaluate changes in anxiety, stress, and depression levels. The results of this study demonstrated that clinically guided breathing exercises had a significant effect on reducing anxiety and stress in COVID-19 patients. The intervention significantly reduced anxiety and stress scores (p < 0.001). However, there was no significant reduction in depression scores among patients who participated in guided breathing exercises (p = 0.946). Guided breathing exercises are an effective complementary technique in reducing the level of anxiety and stress in COVID-19 patients. Moreover, the exercises may provide a worthy non-pharmacological approach to managing psychological distress in COVID-19 patients.

MindScape Study: Integrating LLM and Behavioral Sensing for Personalized AI-Driven Journaling Experiences

Mental health concerns are prevalent among college students, highlighting the need for effective interventions that promote self-awareness and holistic well-being. MindScape explores a novel approach to AI-powered journaling by integrating passively collected behavioral patterns such as conversational engagement, sleep, and location with Large Language Models (LLMs). This integration creates a highly personalized and context-aware journaling experience, enhancing self-awareness and well-being by embedding behavioral intelligence into AI. We present an 8-week exploratory study with 20 college students, demonstrating the MindScape app's efficacy in enhancing positive affect (7%), reducing negative affect (11%), loneliness (6%), and anxiety and depression, with a significant week-over-week decrease in PHQ-4 scores (-0.25 coefficient). The study highlights the advantages of contextual AI journaling, with participants particularly appreciating the tailored prompts and insights provided by the MindScape app. Our analysis also includes a comparison of responses to AI-driven contextual versus generic prompts, participant feedback insights, and proposed strategies for leveraging contextual AI journaling to improve well-being on college campuses. By showcasing the potential of contextual AI journaling to support mental health, we provide a foundation for further investigation into the effects of contextual AI journaling on mental health and well-being.

Interplay of yoga, physical activity, and probiotics in irritable bowel syndrome management: A double-blind randomized study

OBJECTIVES

This study aimed to explore the synergistic impact of online yoga, mindfulness practices, and probiotics on irritable bowel syndrome (IBS) by evaluating changes in physical fitness, mental health, and gut microbiota composition.

DESIGN, SETTING AND INTERVENTIONS

The six-week randomized, double-blinded, placebo-controlled trial included 31 IBS patients categorized into three groups: online yoga with probiotics (EP), online yoga with a placebo (EC), and probiotics only (P). Assessments involved physical fitness tests, subjective questionnaires (IBS-QOL, BSRS-5), and gut microbiome analysis.

MAIN OUTCOME MEASURES

Participants self-collected stool samples and were given a set of questionnaires at baseline and after six weeks of intervention. Their symptoms were measured by changes in the gut microbiota, physical fitness and quality of life, and psychological well-being.

RESULTS

The EP group demonstrated improved cardiovascular endurance (P < 0.001) and a significant reduction in Klebsiella bacterial strains (P < 0.05). Both the EP and EC groups exhibited significantly decreased IBS-QOL scores (P < 0.001 and P < 0.05, respectively), indicating enhanced quality of life. While BSRS-5 scores decreased in both groups, the reduction was statistically insignificant.

CONCLUSION

Integrating online yoga, mindfulness practices, and probiotics demonstrated comprehensive benefits for IBS patients. This intervention improved physical fitness and mental well-being and positively influenced gut microbiota composition. The study highlights the potential of this multifaceted approach in managing IBS symptoms and enhancing overall health, emphasizing the relevance of the gut-muscle-brain axis in understanding and addressing IBS complexities.

TRIAL REGISTRATION

Taiwanese Registry of Institutional Review Board IRBHP210009/CH11000259.

Lightening the mind with audiovisual stimulation as an accessible alternative to breath-focused meditation for mood and cognitive enhancement

In this randomized, controlled, and double-blind experiment with a relatively large sample (n = 262), a novel technique of audiovisual stimulation (AVS) was demonstrated to substantially improve self-reported mood states by reducing several negative affects, including anxiety and depression, and enhancing performance on mood-sensitive cognitive tasks. Most of the AVS effects were highly similar whether binaural beats were present or not and regardless of the duration of experience. Remarkably, the mood benefits from AVS closely aligned with those achieved through breath-focused meditation with additional evidence that a brief AVS exposure of approximately five minutes may be sufficient or even optimal for improving mood to a comparable or greater degree than meditation sessions of equal or longer durations (11-22 min). These exciting findings position AVS as a promising avenue for mood and cognition enhancement and a potentially more accessible "plug-and-play" alternative to meditation, which is especially relevant considering the high attrition rates commonly observed in meditation practices.