Performance outcomes

Pagaduan et al. (2020) engaged in a systematic review of 6 studies that utilized HRV biofeedback with university level, state level, and national/professional level athletes from basketball, soccer, long-distance running, and dance.  All athletes involved in the biofeedback training showed improvements in their performance that suggest HRV biofeedback training can improve both gross and fine motor skills.

Jiménez Morgan & Molina Mora (2017) conducted a systematic review to examine evidence for HRV biofeedback’s ability to improve sport performance.  The studies included performance improvements in the venues of:

⬧   Golf – overall strokes on 18 holes, longer average drive, reduced anxiety, stress, anger, & fatigue

⬧   Basketball – improvements including concentration, movement, & throws *as noted in the Paul et al. (2012) also included below in this research summary, along with additional findings of improved dribbling, pass accuracy, & throw accuracy.

⬧   Volleyball – emotional control 

⬧   Dance – technique *as noted in the Gruzelier et al. (2014) also included below in this research summary

⬧   Running – increased speed & VO2 max *as noted in the Choudhary et al. (2016) included below in this research summary 

Zafar et al. (2017) used breathing & HRV biofeedback as an intervention to test how it would affect autonomic function and performance during a stressful cognitive (thinking) task.  The study included 42 users of a challenging mobile e-game.  The results of the intervention showed those engaged in the breathing & HRV biofeedback group (as compared to a control group) improved both autonomic function and mental capabilities (verified with cognitive performance data) during performance.

Aritzeta et al. (2017) studied academic performance and anxiety utilizing a 152-person experimental group and an 81-person control group looking at biofeedback combined with other relaxation techniques.  The experimental group (those engaging in the biofeedback and relaxation techniques) significantly reduced both context-specific and consistent, pervasive anxiety, as well as significantly improved academic performance.

Aritzeta et al. (2017) studied 233 students.  These students were randomly selected to either a biofeedback & self-regulation training group or a control group.  At the end of the timeframe where the biofeedback training took place, results showed biofeedback training significantly reduced both context specific anxiety and consistent, pervasive anxiety.  The group trained in biofeedback also showed significantly better exam performance.

Choudhary et al. (2016) did a study with 24 track athletes, half in a control group and half in the HRV biofeedback intervention.  The goal was to examine its effects of a 10 week HRV biofeedback training program on both physical and physiological outcomes including: 5km run time, VO2 max, autonomic balance, resting heart rate, resting respiration rate, and stress (measured by the body’s sweat response via skin conductance).  The athletes in the HRV experiment group showed significant improvements on all outcome measures: faster 5km run times, increased VO2 max, improved autonomic balance, decreased stress, and lowered resting heart & respiration rates.  

Dupee et al. (2015) showed a correlation between higher world rankings and athletes who have a better ability to self-regulate their physiology.  And Dupee et al. (2016) reported Olympic athletes who used a combination of biofeedback and neurofeedback increased their own experiences of self-awareness and self-regulation.

Paul et al. (2012) used a study group of 30 basketball-playing adults at the university, state, and national level.  Breaking them up into three groups, the researchers were able to examine the effects of HRV biofeedback compared to no intervention and a placebo intervention.  From pre- to post-test, both physiological measures and basketball shooting performance improved in the HRV training group. 

Harvey et al. (2011) published a research paper on the use of a 5-week biofeedback reaction time training program with elite speedskaters at the Canadian Speedskating National Training Center.  Over the course of 5 weeks, there was an overall improvement in reaction time from beginning to the end, with week 4-5 seeing the largest gains in reducing reaction time.

Raymond et al. (2005) found that biofeedback training led to improved performance execution and technique amongst dancers.  

Following up on Raymond et al.’s 2005 study, Gruzelier et al. (2014) found HRV biofeedback training decreased first-year dance students’ scores on the Depression, Anxiety, and Stress Scale (DASS).  This reduction in anxiety also correlated with improved dance technique and artistry in performance.  

Mental Functioning, Physical Functioning, Emotions, & Stress

Park et al. (2020) found significant improvements in all measures of autonomic function in 8 racket sport athletes after 10 sessions of HRV biofeedback.  The measurements Park et al. monitored included SDNN, LF, LF/HF, and respiratory rates.  These data points are all indicative of autonomic nervous system functions and can be acquired through biofeedback monitoring.  From what we know regarding autonomic functioning, when it improves, our ability to self-regulate improves.  This will likely translate to psychophysiological and performance gains.  

Vaschillo et al. (2019) presented findings at the 3rd International Brain Stimulation Conference in Vancouver, Canada showing HRV biofeedback stimulated increased brain blood flow & oxygenation, which is consistent with improved cognitive & physical functioning.

Ma et al. (2017) utilized 40 healthy adults to study the effects of slow diaphragmatic breathing on the mental ability to sustain attention, on emotions & mood, and cortisol (a stress hormone produced by the body). After 8 weeks of biofeedback-based breath training, the research group (as compared to the control), showed significant increases in the ability to sustain attention, significant decreases in in cortisol present in the body, and significant decreases in negative emotion & mood. 

Dziembowska et al. (2016) did a study with 41 healthy male athletes.  Athletes who were randomly put in the HRV biofeedback study group resulted in decreased anxiety, decreased arousal, and increased self-esteem. 

Brown (n.d.) provided a paper on the relationship between emotions and high versus low HRV.  More productive, positive, and regulated emotions—such as appreciation, adaptability, and flexibility—are associated with a higher HRV.  Similarly, anxiety, worry, and stress are less present when HRV is high.  HRV biofeedback training can improve a person’s HRV, leading towards more favorable emotional states.  

Jereth et al. (2015) examines self-regulation of breathing as a treatment for anxiety.  Highlighted in the discussion is how slow-paced breathing inhibits amygdala activity and meditation reduces amygdala excitation.  The amygdala is a major player in the brain’s processing of emotions, particularly fear- and threat-based emotions, which activates the stress response.  By engaging in purposeful self-regulation skills, it is possible to reduce the sensitivity of this brain structure, resulting in higher emotional regulation.  

Life & Performance Anxiety

Prinsloo et al. (2013) studied 18 adult males with work-related and high life stress.  They were randomized into an HRV biofeedback training group or a phony biofeedback training group.  The men in the HRV group had significant increases in feeling rested and refreshed, as well as a large reduction in context-specific anxiety.

Rantanasiripong et al. (2012) studied 30 undergraduates who were in either a counseling only group or a counseling with HRV biofeedback group at the university counseling center.  While both groups showed significant improvements in their anxiety, the students who also received HRV biofeedback had a significantly more improvement in their anxiety scores (lower anxiety reported) than those solely in counseling. 

Henriques et al. (2011) studied HRV biofeedback study with 35 college students found substantial decreases in both context specific and consistent, pervasive anxiety. 

Thurber (2007) studied HRV biofeedback with 14 music students to assess its impact on their performance anxiety.  Both music performance anxiety and other context-specific anxiety were significantly reduced with the HRV training.  

Roome & Romney (1985) studied muscle tension biofeedback effects on gifted children’s anxiety and their view of whether or not their actions make a difference in what they do.  The kids who received muscle tension training had significant decreases in their context-specific anxiety and significant increases in their beliefs that their own actions have an ability to affect outcomes in their lives.