pp 1–13 | Cite as

Heart Rate Variability of Various Video-Aided Mindful Deep Breathing Durations and Its Impact on Depression, Anxiety, and Stress Symptom Severity

  • Kok Suen Cheng
  • Paul E. Croarkin
  • Poh Foong LeeEmail author



Deep breathing (DB) is known to elicit positive changes to the heart rate variability (HRV) measurement and improve the quality of well-being. However, literature reporting on the effects of the mindful DB duration is scant. This study investigated the HRV indices and its correlation with the mental health scores of three different mindful DB durations.


Fifty participants were recruited and assigned to the control (Con, n = 13), mindful DB for 5 min (DB5, n = 14), 7 min (DB7, n = 11), or 9 min (DB9, n = 12) group. The HRV was measured during the baseline, mindful DB intervention, post-intervention, and a follow-up session after 7 days of practicing the DB daily. The mental health state was screened during the baseline and follow-up session.


During the intervention, all three DB groups had a significantly larger standard deviation of the normal-to-normal interval and normalized low frequency power whereas the normalized high frequency power (nHF) was significantly smaller than the control group. The depression score for the DB7 and DB9 participants was significantly smaller than the control group (p = 0.024 and p = 0.021, respectively). A significant negative correlation was obtained for the depression score and nHF of the DB9 group (r = − 0.673, p = 0.016).


The mindful DB duration plays a role in the shifting of the autonomic nervous system such that only the reduction in depression for the DB9 group was associated with the greater activation of the parasympathetic nervous system.


Heart rate variability Mindful deep breathing duration Depression High frequency power 



Special thanks to ICaterpillar Sdn. Bhd. for sponsoring the HRV device. We also wish to thank all the of the study participants.

Author Contributions

KSC assisted in the designing of the study, executed the study, analyzed the data, and wrote the paper. PEC collaborated in the writing and editing of the final manuscript. PFL formulated the research question, designed the study, and provided expert knowledge for the interpretation of the results. All authors approved the final version of the manuscript for submission.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee of University of Tunku Abdul Rahman and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

12671_2019_1178_MOESM1_ESM.docx (26 kb)
ESM 1 (DOCX 26 kb)


  1. Agelink, M. W., Boz, C., Ullrich, H., & Andrich, J. (2002). Relationship between major depression and heart rate variability. Clinical consequences and implications for antidepressive treatment. Psychiatry Research, 113(1–2), 139–149.Google Scholar
  2. Aysin, B., & Aysin, E. (2006). Effect of respiration in heart rate variability (HRV) analysis. Conference proceeding: Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 1, 1776–1779.
  3. Baer, R. A. (2015). Mindfulness-based treatment approaches: clinician's guide to evidence base and applications. New York, NY: Elsevier.Google Scholar
  4. Becker, B. J. (1988). Synthesizing standardized mean-change measures. British Journal of Mathematical and Statistical Psychology, 41(2), 257–278.Google Scholar
  5. Billman, G. E. (2011). Heart rate variability—a historical perspective. Frontiers in Physiology, 2, 86. Scholar
  6. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241. Scholar
  7. Bower, J. E., Crosswell, A. D., Stanton, A. L., Crespi, C. M., Winston, D., Arevalo, J., et al. (2015). Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer, 121(8), 1231–1240. Scholar
  8. Brown, R. P., & Gerbarg, P. L. (2005). Sudarshan Kriya Yogic breathing in the treatment of stress, anxiety, and depression. Part II—clinical applications and guidelines. Journal of Alternative and Complementary Medicine, 11(4), 711–717. Scholar
  9. Brown, R. P., & Gerbarg, P. L. (2009). Yoga breathing, meditation, and longevity. Annals of the New York Academy of Sciences, 1172, 54–62. Scholar
  10. Buccelletti, E., Gilardi, E., Scaini, E., Galiuto, L., Persiani, R., Biondi, A., et al. (2009). Heart rate variability and myocardial infarction: systematic literature review and metanalysis. European Review for Medical and Pharmacological Sciences, 13(4), 299–307.Google Scholar
  11. Busch, V., Magerl, W., Kern, U., Haas, J., Hajak, G., & Eichhammer, P. (2012). The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing—an experimental study. Pain Medicine (Malden, Mass), 13(2), 215–228.Google Scholar
  12. Button, K. S., Ioannidis, J. P., Mokrysz, C., Nosek, B. A., Flint, J., Robinson, E. S., et al. (2013). Power failure: why small sample size undermines the reliability of neuroscience. Nature Review Neuroscience, 14(5), 365–376. Scholar
  13. Carney, R. M., Blumenthal, J. A., Stein, P. K., Watkins, L., Catellier, D., Berkman, L. F., et al. (2001). Depression, heart rate variability, and acute myocardial infarction. Circulation, 104(17), 2024–2028.Google Scholar
  14. Cheng, K. S., Chang, Y. F., Han, R. P. S., & Lee, P. F. (2017). Enhanced conflict monitoring via a short-duration, video-assisted deep breathing in healthy young adults: an event-related potential approach through the Go/NoGo paradigm. PeerJ, 5, e3857. Scholar
  15. Chessa, M., Butera, G., Lanza, G. A., Bossone, E., Delogu, A., De Rosa, G., et al. (2002). Role of heart rate variability in the early diagnosis of diabetic autonomic neuropathy in children. Herz, 27(8), 785–790. Scholar
  16. Chung, L. J., Tsai, P. S., Liu, B. Y., Chou, K. R., Lin, W. H., Shyu, Y. K., et al. (2010). Home-based deep breathing for depression in patients with coronary heart disease: a randomised controlled trial. International Journal of Nursing Studies, 47(11), 1346–1353. Scholar
  17. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159.Google Scholar
  18. Farnia, V., Gharehbaghi, H., Alikhani, M., Almasi, A., Golshani, S., Tatari, F., et al. (2018). Efficacy and tolerability of adjunctive gabapentin and memantine in obsessive compulsive disorder: double-blind, randomized, placebo-controlled trial. Journal of Psychiatric Research, 104, 137–143. Scholar
  19. Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191.Google Scholar
  20. Gellis, Z. D., & Kang-Yi, C. (2012). Meta-analysis of the effect of cardiac rehabilitation interventions on depression outcomes in adults 64 years of age and older. American Journal of Cardiology, 110(9), 1219–1224. Scholar
  21. Guzik, P., Piskorski, J., Krauze, T., Schneider, R., Wesseling, K. H., Wykretowicz, A., et al. (2007). Correlations between the Poincare plot and conventional heart rate variability parameters assessed during paced breathing. The Journal of Physiological Sciences, 57(1), 63–71. Scholar
  22. Hayama, Y., & Inoue, T. (2012). The effects of deep breathing on ‘tension-anxiety’ and fatigue in cancer patients undergoing adjuvant chemotherapy. Complementary Therapies in Clinical Practice, 18(2), 94–98. Scholar
  23. Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44(Pt 2, 227–239. Scholar
  24. Isler, Y., & Kuntalp, M. (2007). Combining classical HRV indices with wavelet entropy measures improves to performance in diagnosing congestive heart failure. Computers in Biology and Medicine, 37(10), 1502–1510. Scholar
  25. Jacobsen, P. B., Meade, C. D., Stein, K. D., Chirikos, T. N., Small, B. J., & Ruckdeschel, J. C. (2002). Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy. Journal of Clinical Oncology, 20(12), 2851–2862. Scholar
  26. Jacobson, N. C., & Newman, M. G. (2017). Anxiety and depression as bidirectional risk factors for one another: a meta-analysis of longitudinal studies. Psychological Bulletin, 143(11), 1155–1200. Scholar
  27. Jensen-Urstad, K., Storck, N., Bouvier, F., Ericson, M., Linbland, L. E., & Jensen-Urstad, M. (1997). Heart rate variability in healthy subjects is related to age and gender. Acta Physiologica Scandinavica, 160(3), 235–241. Scholar
  28. Julious, S. A. (2005). Sample size of 12 per group rule of thumb for a pilot study. Pharmaceutical Statistics, 4(4), 287–291. Scholar
  29. Katz, A., Liberty, I. F., Porath, A., Ovsyshcher, I., & Prystowsky, E. N. (1999). A simple bedside test of 1-minute heart rate variability during deep breathing as a prognostic index after myocardial infarction. American Heart Journal, 138(1 Pt 1), 32–38.Google Scholar
  30. Kim, K. S., Lee, S. W., Choe, M. A., Yi, M. S., Choi, S., & Kwon, S.-H. (2005). Effects of abdominal breathing training using biofeedback on stress, immune response and quality of life in patients with a mastectomy for breast cancer. Taehan Kanho Hakhoe Chi, 35(7), 1295–1303.Google Scholar
  31. Kim, S. H., Schneider, S. M., Bevans, M., Kravitz, L., Mermier, C., Qualls, C., et al. (2013). PTSD symptom reduction with mindfulness-based stretching and deep breathing exercise: randomized controlled clinical trial of efficacy. The Journal of Clinical Endocrinology & Metabolism, 98(7), 2984–2992. Scholar
  32. Kim, J.-H., Bae, H.-S., & Park, S.-S. (2016). The effects of breath-counting meditation and deep breathing on heart rate variability. Journal of Korean Medicine, 37(2), 36–44.Google Scholar
  33. Kjellgren, A., Bood, S. A., Axelsson, K., Norlander, T., & Saatcioglu, F. (2007). Wellness through a comprehensive yogic breathing program—a controlled pilot trial. BMC Complementary and Alternnative Medicine, 7, 43. Scholar
  34. Lin, I. M., Tai, L. Y., & Fan, S. Y. (2014). Breathing at a rate of 5.5 breaths per minute with equal inhalation-to-exhalation ratio increases heart rate variability. International Journal of Psychophysiology, 91(3), 206–211.Google Scholar
  35. Malliani, A. (2005). Heart rate variability: from bench to bedside. European Journal of Internal Medicine, 16(1), 12–20. Scholar
  36. McCorry, L. K. (2007). Physiology of the autonomic nervous system. American Journal of Pharmaceutical Education, 71(4), 78.Google Scholar
  37. Milicevic, G. (2005). Low to high frequency ratio of heart rate variability spectra fails to describe sympatho-vagal balance in cardiac patients. Collegium Antropologicum, 29(1), 295–300.Google Scholar
  38. Offen, W., Chuang-Stein, C., Dmitrienko, A., Littman, G., Maca, J., Meyerson, L., et al. (2007). Multiple co-primary endpoints: medical and statistical solutions: a report from the multiple endpoints expert team of the Pharmaceutical Research and Manufacturers of America. Drug Information Journal, 41(1), 31–46. Scholar
  39. Park, E., Oh, H., & Kim, T. (2013). The effects of relaxation breathing on procedural pain and anxiety during burn care. Burns, 39(6), 1101–1106. Scholar
  40. Patel, V. N., Pierce, B. R., Bodapati, R. K., Brown, D. L., Ives, D. G., & Stein, P. K. (2017). Association of holter-derived heart rate variability parameters with the development of congestive heart failure in the Cardiovascular Health Study. JACC: Heart Failure, 5(6), 423–431. Scholar
  41. Ponikowski, P., Anker, S. D., Chua, T. P., Szelemej, R., Piepoli, M., Adamopoulos, S., et al. (1997). Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. The American Journal of Cardiology, 79(12), 1645–1650.Google Scholar
  42. Prinsloo, G. E., Rauch, H. G. L., Lambert, M. I., Muench, F., Noakes, T. D., & Derman, W. E. (2011). The effect of short duration heart rate variability (HRV) biofeedback on cognitive performance during laboratory induced cognitive stress. Applied Cognitive Psychology, 25(5), 792–801. Scholar
  43. Prinsloo, G. E., Derman, W. E., Lambert, M. I., & Laurie Rauch, H. G. (2013a). The effect of a single session of short duration biofeedback-induced deep breathing on measures of heart rate variability during laboratory-induced cognitive stress: a pilot study. Applied Psychophysiology and Biofeedback, 38(2), 81–90.Google Scholar
  44. Prinsloo, G. E., Rauch, H. G. L., Karpul, D., & Derman, W. E. (2013b). The effect of a single session of short duration heart rate variability biofeedback on EEG: a pilot study. Applied Psychophysiology and Biofeedback, 38(1), 45–56.Google Scholar
  45. Ramshur, J. (2010). Design, evaluation, and application of heart rate variability analysis software (HRVAS). Memphis, TN: University of Memphis.Google Scholar
  46. Sanderson, J. E., Yeung, L. Y., Yeung, D. T., Kay, R. L., Tomlinson, B., Critchley, J. A., et al. (1996). Impact of changes in respiratory frequency and posture on power spectral analysis of heart rate and systolic blood pressure variability in normal subjects and patients with heart failure. Clinical Science (London), 91(1), 35–43.Google Scholar
  47. Song, H.-S., & Lehrer, P. M. (2003). The effects of specific respiratory rates on heart rate and heart rate variability. Applied Psychophysiology and Biofeedback, 28(1), 13–23.Google Scholar
  48. Sridhar, B., Haleagrahara, N., Bhat, R., Kulur, A. B., Avabratha, S., & Adhikary, P. (2010). Increase in the heart rate variability with deep breathing in diabetic patients after 12-month exercise training. The Tohoku Journal of Experimental Medicine, 220(2), 107–113. Scholar
  49. Stein, P. K., Bosner, M. S., Kleiger, R. E., & Conger, B. M. (1994). Heart rate variability: a measure of cardiac autonomic tone. American Heart Journal, 127(5), 1376–1381.Google Scholar
  50. Task Force of The European Society of Cardiology and The North American Society of Pacing and Electrophysiology. (1996). Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. European Heart Journal, 17(3), 354–381. Scholar
  51. Tharion, E., Samuel, P., Rajalakshmi, R., Gnanasenthil, G., & Subramanian, R. K. (2012). Influence of deep breathing exercise on spontaneous respiratory rate and heart rate variability: a randomised controlled trial in healthy subjects. Indian Journal of Physiology and Pharmacology, 56(1), 80–87.Google Scholar
  52. Tsai, S. H., Wang, M. Y., Miao, N. F., Chian, P. C., Chen, T. H., & Tsai, P. S. (2015). The efficacy of a nurse-led breathing training program in reducing depressive symptoms in patients on hemodialysis: a randomized controlled trial. American Journal of Nursing, 115(4), 24–32; quiz 33, 42. Scholar
  53. Udupa, K., Sathyaprabha, T. N., Thirthalli, J., Kishore, K. R., Lavekar, G. S., Raju, T. R., et al. (2007). Alteration of cardiac autonomic functions in patients with major depression: a study using heart rate variability measures. Journal of Affective Disorders, 100(1–3), 137–141. Scholar
  54. Umetani, K., Singer, D. H., McCraty, R., & Atkinson, M. (1998). Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. Journal of the American College of Cardiology, 31(3), 593–601. Scholar
  55. Van Dongen, H. P., Olofsen, E., Van Hartevelt, J. H., & Kruyt, E. W. (1999). Searching for biological rhythms: peak detection in the periodogram of unqueally spaced data. Biological Rhythm Research, 30(2), 149–177.Google Scholar
  56. van Schaik, D. J., Klijn, A. F., van Hout, H. P., van Marwijk, H. W., Beekman, A. T., de Haan, M., et al. (2004). Patients’ preferences in the treatment of depressive disorder in primary care. General Hospital Psychiatry, 26(3), 184–189. Scholar
  57. Vaschillo, E. G., Vaschillo, B., & Lehrer, P. M. (2006). Characteristics of resonance in heart rate variability stimulated by biofeedback. Applied Psychophysiology and Biofeedback, 31(2), 129–142. Scholar
  58. Veith, R. C., Lewis, N., Linares, O. A., Barnes, R. F., Raskind, M. A., Villacres, E. C., et al. (1994). Sympathetic nervous system activity in major depression. Basal and desipramine-induced alterations in plasma norepinephrine kinetics. Archives of General Psychiatry, 51(5), 411–422.Google Scholar
  59. Wang, S. Z., Li, S., Xu, X. Y., Lin, G. P., Shao, L., Zhao, Y., et al. (2010). Effect of slow abdominal breathing combined with biofeedback on blood pressure and heart rate variability in prehypertension. Journal of Alternative and Complementary Medicine, 16(10), 1039–1045. Scholar
  60. Whooley, M. A., & Wong, J. M. (2013). Depression and cardiovascular disorders. Annual Review of Clinical Psychology, 9, 327–354. Scholar
  61. Yu, W. J., & Song, J. E. (2010). Effects of abdominal breathing on state anxiety, stress, and tocolytic dosage for pregnant women in preterm labor. Journal of Korean Academy of Nursing, 40(3), 442–452. Scholar
  62. Zhang, J. (2007). Effect of age and sex on heart rate variability in healthy subjects. Journal of Manipulative Physiological Therapeutics, 30(5), 374–379. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Lee Kong Chien Faculty of Engineering and ScienceUniversity Tunku Abdul RahmanKajangMalaysia
  2. 2.Mayo Clinic Depression CenterRochesterUSA
  3. 3.Department of Mechanical and Material EngineeringUniversity Tunku Abdul RahmanKajangMalaysia

Personalised recommendations