Yes, modestly. A 2020 review of 58 randomised controlled trials found a small to moderate benefit from HRV biofeedback HRV biofeedback A breathing practice in which you watch your heart rate live and breathe slowly, often near 6 breaths a minute, to make the heart's rise and fall with each breath as large as possible. More about HRV biofeedback , largest for anxiety, depression, anger and athletic or artistic performance (Lehrer and colleagues, 2020). To find your own resonance pace, breathe for 2 minutes at each rate from 6.5 down to 4.5 breaths a minute and keep the one where your heart rate swings most.
What HRV biofeedback is
Your heart speeds up a little when you breathe in and slows when you breathe out. At about 6 breaths a minute that swing lines up with a slower rhythm of the blood-pressure reflex, which cycles about every 10 seconds, and the two add up. Lehrer and Gevirtz (2014) explain this as resonance. They report that large swings appear “within a fraction of a minute”, even in people trying it for the first time, and that the reflex itself grew stronger after about 3 months of home practice twice a day.
Biofeedback means doing this while watching your heart rate on a screen, so you can see the wave and keep it large. Slide the pace below from 15 down to 6 and watch the swings in the gaps between beats grow.
Breathe and watch your heart
A teaching model, not a measurement
- Heart rate
- 60 bpm
- RMSSD
- 46 ms
Last 30 seconds
This picture moves when JavaScript is on.
A breathing circle grows on each in-breath and shrinks on each out-breath. A strip of heartbeats below it shows the beats bunching closer together during the in-breath, which is shaded, and spreading apart during the out-breath. A line under the strip plots the gap before each beat: it dips on the in-breath and rises on the out-breath. A slider sets the pace from 4 to 15 breaths a minute, and readouts give heart rate and RMSSD for the last 30 seconds. The swing is largest at about 6 breaths a minute.
What the trials show
| Review | What it pooled | What it found |
|---|---|---|
| Goessl and colleagues, 2017 | 24 studies, 484 people | A large drop in self-reported stress and anxiety; more well-controlled studies needed |
| Lehrer and colleagues, 2020 | 58 randomised controlled trials | A small to moderate effect overall; largest for anxiety, depression, anger and performance; smallest for PTSD, sleep and quality of life |
Lehrer and colleagues add three cautions. Each condition rests on a small number of trials. Effects were larger against no treatment than against another active treatment, although they were significant for both. And more research is needed before biofeedback can be recommended for specific uses.
How to find your resonance pace
Shaffer and Meehan (2020) put the resonance pace of adults anywhere from 4.5 to 6.5 breaths a minute (6.5 to 9.5 for children). Their practical guide, after Lehrer, works like this:
- Practise first. Breathe at 5.5 to 6 breaths a minute until it feels easy. Breathe out for longer than you breathe in, and keep each breath relaxed rather than deep; overbreathing can make you light-headed.
- Test each rate. Breathe for 2 minutes at 6.5, 6, 5.5, 5 and 4.5 breaths a minute, with 2 minutes of rest in between. Repeat a trial if you drifted more than a quarter of a breath a minute off the pace.
- Compare. The strongest sign is heart rate and breathing moving exactly in step. Next come the size of the swing from highest to lowest heart rate, LF power LF power The variance of the heartbeat intervals that falls in the 0.04 to 0.15 Hz band, in ms²: rhythms repeating every 7 to 25 seconds. Once read as sympathetic activity, which is now disputed. More about LF power , the biggest LF peak Peak frequency The frequency, in Hz, at which a band of the HRV spectrum has its highest power. The HF peak is usually the breathing rate; the LF peak is usually near 0.1 Hz. More about Peak frequency and how smooth the wave looks. The authors note that these weights have not been validated.
- Check the edges. If the best rate is 4.5 or 6.5, test half a breath a minute beyond it.
- Confirm it. Breathe for 3 to 5 minutes at the chosen rate and at half a breath a minute either side, and compare again. If two rates tie, pick the one that feels most comfortable.
The chest-strap test on this site runs a short version: it paces you through the five rates with a Bluetooth chest strap and ranks them by the swing in heart rate from highest to lowest.
How to practise
There is no agreed dose. One programme in Lehrer and Gevirtz’s review used practice twice a day at home for about 3 months. Shaffer and Meehan cite trials that ran for weeks. A sensible start is a few minutes once or twice a day at your resonance pace, well away from your daily HRV reading, judged over weeks on how you feel and on your 7-day average.
When to talk to someone
Stop and breathe normally if you feel dizzy, light-headed or anxious. If you have a heart or lung condition, ask your doctor first. Biofeedback can support treatment for anxiety, depression or other conditions, but it should not replace it. For the bigger picture of breathing and stress, see the lesson HRV, stress and breathing and can breathing exercises raise HRV?