Highlights
- •While acutely, device-guided slow breathing lowers muscle sympathetic nerve activity, results are minimized long-term.
- •Results from most studies deploying direct and indirect measures of autonomic function are consistent.
- •A small body of evidence also suggests that non-device-guided breathing is effective in improving vascular function.
Abstract
Background
Hypertension is a widespread disease that, if persistent, increases the risks of coronary
heart disease mortality and morbidity. Slow breathing is a recommended blood pressure-lowering
strategy though the mechanisms mediating its effects are unknown.
Objective
This review aims to evaluate autonomic and vascular function as potential mediators
driving BP adaptive responses with slow breathing.
Methods
We searched EBSCO host, Web of Science, Cochrane Central Register of Controlled Trials,
and PubMed using key words for optimized search results.
Results
Nineteen studies were included in this review (11 device-guided; 8 non-device-guided
breathing). Though some studies showed increased vagally mediated components of heart
rate variability during slow breathing, results from acute and long-term studies were
incongruent. Increases in baroreflex sensitivity (BRS) following a single device-guided
slow breathing bout were noted in normotensive and hypertensive adults. Long-term
(4 weeks to 3 months) effects of slow breathing on BRS were absent. Device-guided
breathing resulted in immediate reductions in muscle sympathetic nerve activity (MSNA)
in normo- and hyper-tensive adults though results from long-term studies yielded inconsistent
findings. Non-device-guided slow breathing posed acute and chronic effects on vascular
function with reductions in arterial stiffness in adults with type I diabetes and
increases in microvascular endothelial function in adults with irritable bowel syndrome.
Non-device guided breathing also reduced pro-inflammatory cytokines in healthy and
hypertensive adults in acute and chronic studies. No adverse effects or non-adherence
to treatment were noted in these trials.
Conclusion
Device-guided slow breathing is a feasible and effective modality in improving BRS,
HRV, and arterial stiffness though its long-term effects are obscure. Though less
evidence exists supporting the efficacy of non-device-guided slow breathing, acute
and chronic studies demonstrate improvements in vascular function and inflammatory
cytokines. More studies are needed to further explore the long-term effects of slow
breathing in general and non-device-guided breathing in particular.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Autonomic Neuroscience: Basic and ClinicalAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Device-guided slow breathing reduces blood pressure and sympathetic activity in young normotensive individuals of both sexes.J. Appl. Physiol. (1985). 2019; 127: 1042-1049
- Implications of the new 2017 American College of Cardiology/American Heart Association guidelines for hypertension.Minerva Cardioangiol. 2019; 67: 399-410
- Reduction of sympathetic nervous activity with device-guided breathing.J. Clin. Hypertens. (Greenwich). 2014; 16: 614-615
- Effects of long term device-guided slow breathing on sympathetic nervous activity in hypertensive patients: a randomized open-label clinical trial.Blood Press. 2017; 26: 359-365
- Oxygen-induced impairment in arterial function is corrected by slow breathing in patients with type 1 diabetes.Sci. Rep. 2017; 7: 6001
- Characteristics of yoga users: results of a National Survey.J. Gen. Intern. Med. 2008; 23: 1653-1658
- The hypotensive effect of Yoga's breathing exercises: a systematic review.Complement. Ther. Clin. Pract. 2017; 28: 38-46
- Device and non-device-guided slow breathing to reduce blood pressure: a systematic review and meta-analysis.Complement. Ther. Med. 2019; 45: 179-184
- Effects of paced respiration on anxiety reduction in a clinical population.Biofeedback Self Regul. 1990; 15: 273-284
- Acute effects of device-guided slow breathing on sympathetic nerve activity and baroreflex sensitivity in posttraumatic stress disorder.Am. J. Physiol. Heart Circ. Physiol. 2018; 315: H141-H149
- Eight weeks of device-guided slow breathing decreases sympathetic nervous reactivity to stress in posttraumatic stress disorder.Am. J. Phys. Regul. Integr. Comp. Phys. 2020; 319: R466-R475
- The sympathetic nervous system alterations in human hypertension.Circ. Res. 2015; 116: 976-990
- Re: "RESPeRATE: the role of paced breathing in hypertension treatment".J. Am. Soc. Hypertens. 2015; 9: 656-657
- Effects of acute and long-term slow breathing exercise on muscle sympathetic nerve activity in untreated male patients with hypertension.J. Hypertens. 2013; 31: 739-746
- Endothelial dysfunction and hypertension in aging.Hypertens. Res. 2012; 35: 1039-1047
- Elevated muscle sympathetic nerve activity contributes to central artery stiffness in young and middle-age/older adults.Hypertension. 2019; 73: 1025-1035
- Effects of guided breathing on blood pressure and heart rate variability in hypertensive diabetic patients.Auton. Neurosci. 2013; 179: 131-137
- The effects of slow deep breathing on microvascular and autonomic function and symptoms in adults with irritable bowel syndrome: a pilot study.Neurogastroenterol. Motil. 2021; 34e14275
- Long-term effects of device-guided slow breathing in stable heart failure patients with reduced ejection fraction.Clin. Res. Cardiol. 2019; 108: 48-60
- Effect of deep slow breathing on pain-related variables in osteoarthritis.Pain Res. Manag. 2019; 20195487050
- Preliminary study: comparative effects of lung volume therapy between slow and fast deep-breathing techniques on pulmonary function, respiratory muscle strength, oxidative stress, cytokines, 6-minute walking distance, and quality of life in persons with COPD.Int. J. Chron. Obstruct. Pulmon. Dis. 2018; 13: 3909-3921
- Effects of slow breathing rate on heart rate variability and arterial baroreflex sensitivity in essential hypertension.Medicine (Baltimore). 2018; 97e0639
- Respiratory influences on muscle sympathetic nerve activity and vascular conductance in the steady state.Am. J. Physiol. Heart Circ. Physiol. 2013; 304: H1615-H1623
- Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults.Sci. Rep. 2021; 11: 19267
- Hypertension among adults in the United States: National Health and Nutrition Examination Survey, 2011-2012.NCHS Data Brief. 2013; 133: 1-8
- Sympathetic nerve activity is decreased during device-guided slow breathing.Hypertens. Res. 2010; 33: 708-712
- Respiratory modulation of muscle sympathetic nerve activity in intact and lung denervated humans.Circ. Res. 1993; 72: 440-454
- An overview of heart rate variability metrics and norms.Front. Public Health. 2017; 5: 258
- Role of respiratory motor output in within-breath modulation of muscle sympathetic nerve activity in humans.Circ. Res. 1999; 85: 457-469
- INTERSALT study findings. Public health and medical care implications.Hypertension. 1989; 14: 570-577
- Aging, arterial stiffness, and hypertension.Hypertension. 2015; 65: 252-256
- Effect of sheetali pranayama on cardiac autonomic function among patients with primary hypertension - a randomized controlled trial.Complement. Ther. Clin. Pract. 2020; 39
- Yogic breathing when compared to attention control reduces the levels of pro-inflammatory biomarkers in saliva: a pilot randomized controlled trial.BMC Complement. Altern. Med. 2016; 16: 294
- Inhalation/exhalation ratio modulates the effect of slow breathing on heart rate variability and relaxation.Appl. Psychophysiol. Biofeedback. 2014; 39: 171-180
- Slow deep breathing modulates cardiac vagal activity but does not affect peripheral glucose metabolism in healthy men.Sci. Rep. 2021; 11: 20306
- Long-term effect of device-guided slow breathing on blood pressure regulation and chronic inflammation in patients with essential hypertension using a wearable ECG device.Acta Cardiol. Sin. 2021; 37: 195-203
- Emotional intelligence training: influence of a brief slow-paced breathing exercise on psychophysiological variables linked to emotion regulation.Int. J. Environ. Res. Public Health. 2021; 18
- Deflation-activated receptors, not classical inflation-activated receptors, mediate the Hering-Breuer deflation reflex.J. Appl. Physiol. (1985). 2016; 121: 1041-1046
- Activation of JNK and xanthine oxidase by TNF-alpha impairs nitric oxide-mediated dilation of coronary arterioles.J. Mol. Cell. Cardiol. 2006; 40: 247-257
- Immunity and hypertension.Acta Physiol (Oxford). 2020; 231e13487
- Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.Circulation. 1996; 93: 1043-1065
Article info
Publication history
Published online: November 14, 2022
Accepted:
November 9,
2022
Received in revised form:
November 8,
2022
Received:
June 27,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
