Slow-paced breathing

Practical note

Graded moderate: a 2022 meta-analysis of 223 studies found consistent increases at all three time points; downgraded from high because heart rate variability is a physiological marker rather than a health outcome (indirectness) and many included studies were small. Most studies used rates of about six breaths a minute.

Vegan note

Not diet-related; applies equally to people following a vegan diet.

Safety note

The Fincham 2023 meta-analysis found no reported adverse events or lasting bad effects attributed to breathwork, but only a few trials reported on this, and the authors call for more safety research on fast-paced techniques. Fast or forceful breathing and long breath-holds are a different practice from slow-paced breathing; people who are pregnant or living with heart, lung or mental-health conditions are generally advised to check with a health professional before taking up breathwork.

Sources

• Supports“Results indicate increases in vmHRV with VSB, DURING, IM-AFTER1, and AFTER-INT.” (Abstract) Laborde S, Allen MS, Borges U, Dosseville F, Hosang TJ, Iskra M, Mosley E, Salvotti C, Spolverato L, Zammit N, Javelle F. 2022. Neuroscience and Biobehavioral Reviews. Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
• Context“VSB exercises could be advised as a low-tech and low-cost technique to use in prevention and adjunct treatment purposes, with few adverse effects expected.” (Abstract) Laborde S, Allen MS, Borges U, Dosseville F, Hosang TJ, Iskra M, Mosley E, Salvotti C, Spolverato L, Zammit N, Javelle F. 2022. Neuroscience and Biobehavioral Reviews. Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine

Practical note

Graded low: randomised trials, downgraded for risk of bias (most of the 12 stress trials in Fincham 2023 were at moderate risk of bias, and blinding is not possible) and for inconsistency (heterogeneity was high in the slow-paced subgroup). The pooled effect was small to medium (g = -0.35). Trials in the review ranged from about 80 to over 5,000 minutes of total practice, with no clear dose-response.

Vegan note

Not diet-related; applies equally to people following a vegan diet.

Safety note

The Fincham 2023 meta-analysis found no reported adverse events or lasting bad effects attributed to breathwork, but only a few trials reported on this, and the authors call for more safety research on fast-paced techniques. Fast or forceful breathing and long breath-holds are a different practice from slow-paced breathing; people who are pregnant or living with heart, lung or mental-health conditions are generally advised to check with a health professional before taking up breathwork.

Sources

• Supports“HRV biofeedback training is associated with a large reduction in self-reported stress and anxiety.” (Abstract) Goessl VC, Curtiss JE, Hofmann SG. 2017. Psychological Medicine. The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
• Supports“Moreover, significant effects were yielded when breathwork was primarily focused on slow-paced breathing (but not for fast-paced breathing), taught to individuals alone, and when taught to groups (but not in combination, which comprised only one study).” (Results, subgroup analyses) Fincham GW, Strauss C, Montero-Marin J, Cavanagh K. 2023. Scientific Reports. Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. CC BY 4.0; credit Fincham et al., Scientific Reports 2023
• Context“Most studies were deemed as being at moderate risk of bias.” (Abstract) Fincham GW, Strauss C, Montero-Marin J, Cavanagh K. 2023. Scientific Reports. Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. CC BY 4.0; credit Fincham et al., Scientific Reports 2023

Practical note

Graded low: randomised trials, downgraded for risk of bias and for inconsistency (heterogeneity was moderate and significant for both outcomes in Fincham 2023); Lehrer 2020 notes few studies per outcome and larger effects against inactive than active controls.

Vegan note

Not diet-related; applies equally to people following a vegan diet.

Safety note

The Fincham 2023 meta-analysis found no reported adverse events or lasting bad effects attributed to breathwork, but only a few trials reported on this, and the authors call for more safety research on fast-paced techniques. Fast or forceful breathing and long breath-holds are a different practice from slow-paced breathing; people who are pregnant or living with heart, lung or mental-health conditions are generally advised to check with a health professional before taking up breathwork.

Sources

• Supports“HRVB has the largest effect sizes for anxiety, depression, anger and athletic/artistic performance and the smallest effect sizes on PTSD, sleep and quality of life.” (Abstract) Lehrer P, Kaur K, Sharma A, Shah K, Huseby R, Bhavsar J, Sgobba P, Zhang Y. 2020. Applied Psychophysiology and Biofeedback. Heart Rate Variability Biofeedback Improves Emotional and Physical Health and Performance: A Systematic Review and Meta Analysis. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
• Supports“Meta-analyses for secondary outcomes of self-reported/subjective anxiety (k = 20) and depressive symptoms (k = 18) showed similar significant effect sizes” (Abstract) Fincham GW, Strauss C, Montero-Marin J, Cavanagh K. 2023. Scientific Reports. Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. CC BY 4.0; credit Fincham et al., Scientific Reports 2023
• Context“Effect sizes are larger in comparison to inactive than active control conditions although significant for both.” (Abstract) Lehrer P, Kaur K, Sharma A, Shah K, Huseby R, Bhavsar J, Sgobba P, Zhang Y. 2020. Applied Psychophysiology and Biofeedback. Heart Rate Variability Biofeedback Improves Emotional and Physical Health and Performance: A Systematic Review and Meta Analysis. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine

Practical note

Graded low: a single remote randomised trial, downgraded for imprecision (one modest-sized trial) and risk of bias (unblinded, self-reported mood). The trial used 5 minutes a day for a month.

Vegan note

Not diet-related; applies equally to people following a vegan diet.

Safety note

The Fincham 2023 meta-analysis found no reported adverse events or lasting bad effects attributed to breathwork, but only a few trials reported on this, and the authors call for more safety research on fast-paced techniques. Fast or forceful breathing and long breath-holds are a different practice from slow-paced breathing; people who are pregnant or living with heart, lung or mental-health conditions are generally advised to check with a health professional before taking up breathwork.

Sources

• Supports“Using a mixed-effects model, we show that breathwork, especially the exhale-focused cyclic sighing, produces greater improvement in mood (p < 0.05) and reduction in respiratory rate (p < 0.05) compared with mindfulness meditation.” (Abstract) Balban MY, Neri E, Kogon MM, Weed L, Nouriani B, Jo B, Holl G, Zeitzer JM, Spiegel D, Huberman AD. 2023. Cell Reports Medicine. Brief structured respiration practices enhance mood and reduce physiological arousal. CC BY-NC-ND 4.0; credit Balban et al., Cell Reports Medicine 2023
• Context“Both mindfulness meditation and breathwork groups showed significant reductions in state anxiety and negative affect and increases in positive affect.” (Results) Balban MY, Neri E, Kogon MM, Weed L, Nouriani B, Jo B, Holl G, Zeitzer JM, Spiegel D, Huberman AD. 2023. Cell Reports Medicine. Brief structured respiration practices enhance mood and reduce physiological arousal. CC BY-NC-ND 4.0; credit Balban et al., Cell Reports Medicine 2023

Practical note

Graded very low: only four to six trials in Fincham 2023 actively reported harms (imprecision and likely selective reporting); Laborde 2022 also expects few adverse effects.

Vegan note

Not diet-related; applies equally to people following a vegan diet.

Safety note

The Fincham 2023 meta-analysis found no reported adverse events or lasting bad effects attributed to breathwork, but only a few trials reported on this, and the authors call for more safety research on fast-paced techniques. Fast or forceful breathing and long breath-holds are a different practice from slow-paced breathing; people who are pregnant or living with heart, lung or mental-health conditions are generally advised to check with a health professional before taking up breathwork.

Sources

• Supports“VSB exercises could be advised as a low-tech and low-cost technique to use in prevention and adjunct treatment purposes, with few adverse effects expected.” (Abstract) Laborde S, Allen MS, Borges U, Dosseville F, Hosang TJ, Iskra M, Mosley E, Salvotti C, Spolverato L, Zammit N, Javelle F. 2022. Neuroscience and Biobehavioral Reviews. Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
• Supports“We did not find reported adverse events or lasting bad effects directly attributed to breathwork interventions; four studies (six in total including secondary outcome studies) actively reported on this.” (Discussion) Fincham GW, Strauss C, Montero-Marin J, Cavanagh K. 2023. Scientific Reports. Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. CC BY 4.0; credit Fincham et al., Scientific Reports 2023