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Cited by 219Heart Rate Variability and Autonomic ControlCardiac Health and Mental HealthVagus Nerve Stimulation Research

Heart rate variability biofeedback as a behavioral neurocardiac intervention to enhance vagal heart rate control

Nolan, Robert P., Kamath, Markad V., Floras, John S., Stanley, Jill, Pang, Clement, Picton, Peter, Young, Quincy R.·2005·American Heart Journal
DOI 10.1016/j.ahj.2005.03.015
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Abstract

Background Patients with coronary heart disease (CHD) who experience depressed mood or psychological stress exhibit decreased vagal control of heart rate (HR), as assessed by spectral analysis of HR variability (HRV). Myocardial infarction and sudden cardiac death are independently associated with depression and stress, as well as impaired vagal HR control. This study examined whether a behavioral neurocardiac intervention to reduce stress or depression can augment cardiovagal modulation in CHD patients. We hypothesized that (1) cognitive-behavioral training with HRV biofeedback would augment vagal recovery from acute stress, and (2) vagal regulation of HR would be inversely associated with stress and depression after treatment.Methods This randomized controlled trial enrolled 46 CHD patients from 3 clinics of CHD risk reduction in Toronto and Vancouver, Canada. Subjects were randomized to five 1.5-hour sessions of HRV biofeedback or an active control condition. Outcome was assessed by absolute and normalized high-frequency spectral components (0.15-0.50 Hz) of HRV, and by the Perceived Stress Scale and Centre for Epidemiologic Studies in Depression scale.Results Both groups reduced symptoms on the Perceived Stress Scale (P = .001) and Centre for Epidemiologic Studies in Depression scale (P = .004). Hierarchical linear regression determined that improved psychological adjustment was significantly associated with the high-frequency index of vagal HR modulation only in the HRV biofeedback group. Adjusted R 2 was as follows: HRV biofeedback group, 0.86 for stress (P = .02) and 0.81 for depression (P = .03); versus the active control group, 0.04 (P = .57) and 0.13 (P = .95), respectively.Conclusion A novel behavioral neurocardiac intervention, HRV biofeedback, can augment vagal HR regulation while facilitating psychological adjustment to CHD.

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  • Behavioral modification, meditation, hypnosis, biofeedback, and cognitive and relaxation therapies can stimulate vagus nerve activity.

    “Behavioral modification, meditation, hypnosis, biofeedback, and cognitive and relaxation therapies, which have been advocated for treatment of inflammation, can stimulate vagus nerve activity (69)(70)(71)(72)(73)(74)(75).”

    From Physiology and immunology of the cholinergic antiinflammatory pathway (2007) · cites this paper as [69]

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Authors
Nolan, R. P., Kamath, M. V., Floras, J. S., Stanley, J., Pang, C., Picton, P., & Young, Q. R.
Affiliations
  • University Health Network (CA)
  • McMaster University (CA)
  • Mount Sinai Hospital (CA)
  • York University (CA)
  • St. Paul's Hospital (CA)
Corresponding author
Nolan, Robert P.
ORCID
Venue
American Heart Journal
Publisher
Elsevier BV
Published
2005-06
Volume
149
Issue
6
Pages
1137.e1-1137.e7
ISSN
0002-8703 (ISSN-L)
DOI
10.1016/j.ahj.2005.03.015
OpenAlex
W2076319688
Cited by
219
References
35
Citations by year
2026: 9 · 2025: 4 · 2024: 7 · 2023: 6 · 2022: 10 · 2021: 10 · 2020: 10 · 2019: 10 · 2018: 10 · 2017: 12 · 2016: 15 · 2015: 18 · 2014: 13 · 2013: 21 · 2012: 14
FWCI
4.77
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
Keywords
heart rate variability biofeedback, coronary artery disease, depression, psychological stress, cognitive-behavioral training, sudden cardiac death risk, psychological adjustment
MeSH terms
Biofeedback, Psychology, Coronary Disease, Depression, Female, Heart Rate, Humans, Male, Middle Aged, Stress, Psychological, Cognitive Behavioral Therapy

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