Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis

Voluntary slow breathing (VSB) is used as a prevention technique to support physical and mental health, given it is suggested to influence the parasympathetic nervous system (PNS). However, to date, no comprehensive quantitative review exists to support or refute this claim. We address this through a systematic review and meta-analysis of the effects of VSB on heart rate variability (HRV). Specifically, we focus on HRV parameters indexing PNS activity regulating cardiac functioning, referred to as vagally-mediated (vm)HRV: (1) during the breathing session (i.e., DURING), (2) immediately after one training session (i.e., IM-AFTER1), as well as (3) after a multi-session intervention (i.e., AFTER-INT). From the 1842 selected abstracts, 223 studies were suitable for inclusion (172 DURING, 16 IM-AFTER1, and 49 AFTER-INT). Results indicate increases in vmHRV with VSB, DURING, IM-AFTER1, and AFTER-INT. Given the involvement of the PNS in a large range of health-related outcomes and conditions, 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.