Biofeedback of Heart Rate Variability in the treatment of chronic diseases: A Systematic Review


  • Saad Majeed Al-Tamimi Consultant Internist and Cardiologist, College of Dentistry, Al-Farahidi University, Baghdad, Iraq.



Biofeedback, Psychology, Heart Rate, Chronic Disease


Background: HRVB (heart rate variability biofeedback) is a non-pharmacological method for chronic diseases evaluation.

Method: Adults chronic sufferers, HRVB as the primary therapy with or without controlled circumstances, and psycho - physiological results as regression analysis were all included in a systematic search.

Results: There were 21 publications in overall. HRVB was found to be feasible in chronic patients with no adverse reactions, according to the findings. Significant favourable impacts on hypertension and cardiovascular prognostic, inflammation condition, asthma issues, depression and anxiety, sleeping disruptions, cognitive function, and pain were reported in diverse patient characteristics that could be linked to enhanced quality of life. Increases in treatment practice were accompanied by increases in heart rate variability, implying that HRVB may have a regulatory influence on autonomic function.

Conclusions: HRVB has the potential to help individuals with chronic conditions. More research is needed to reinforce these findings as well as identify the most efficient strategy.


Lehrer P, Kaur K, Sharma A, Shah K, Huseby R, Bhavsar J, et al. Heart rate variability biofeedback improves emotional and physical health and performance: A systematic review and meta analysis. Applied Psychophysiology and Biofeedback. 2020;45(3):109-29.

Reneau M. Heart rate variability biofeedback to treat fibromyalgia: an integrative literature review. Pain Management Nursing. 2020;21(3):225-32.

Economides M, Lehrer P, Ranta K, Nazander A, Hilgert O, Raevuori A, et al. Feasibility and efficacy of the addition of heart rate variability biofeedback to a remote digital health intervention for depression. Applied psychophysiology and biofeedback. 2020;45(2):75-86.

Pizzoli SF, Marzorati C, Gatti D, Monzani D, Mazzocco K, Pravettoni G. A meta-analysis on heart rate variability biofeedback and depressive symptoms. Scientific reports. 2021;11(1):1-10.

Prinsloo GE, Rauch HL, Derman WE. A brief review and clinical application of heart rate variability biofeedback in sports, exercise, and rehabilitation medicine. The Physician and sportsmedicine. 2014;42(2):88-99.

Burch JB, Ginsberg J, McLain AC, Franco R, Stokes S, Susko K, et al. Symptom management among cancer survivors: Randomized pilot intervention trial of heart rate variability biofeedback. Applied psychophysiology and biofeedback. 2020;45(2):99-108.

Park SM, Jung HY. Respiratory sinus arrhythmia biofeedback alters heart rate variability and default mode network connectivity in major depressive disorder: a preliminary study. International Journal of Psychophysiology. 2020;158:225-37.

Amjadian M, Bahrami Ehsan H, Saboni K, Vahedi S, Rostami R, Roshani D. A pilot randomized controlled trial to assess the effect of Islamic spiritual intervention and of breathing technique with heart rate variability feedback on anxiety, depression and psycho-physiologic coherence in patients after coronary artery bypass surgery. Annals of General Psychiatry. 2020;19(1):1-10.

Dell’Acqua C, Dal Bò E, Benvenuti SM, Palomba D. Reduced heart rate variability is associated with vulnerability to depression. Journal of Affective Disorders Reports. 2020;1:100006.

Wang S-Z, Li S, Xu X-Y, Lin G-P, Shao L, Zhao Y, et al. Effect of slow abdominal breathing combined with biofeedback on blood pressure and heart rate variability in prehypertension. The Journal of Alternative and Complementary Medicine. 2010;16(10):1039-45.

Hasuo H, Kanbara K, Fukunaga M. Effect of heart rate variability biofeedback sessions with resonant frequency breathing on sleep: a pilot study among family caregivers of patients with cancer. Frontiers in Medicine. 2020;7:61.

Pagaduan JC, Chen Y-S, Fell JW, Wu SSX. Can heart rate variability biofeedback improve athletic performance? A systematic review. Journal of Human Kinetics. 2020;73:103.

Lin I-M, Lin P-Y, Fan S-Y. The Effects of Heart Rate Variability (HRV) Biofeedback on HRV Reactivity and Recovery During and After Anger Recall Task for Patients with Coronary Artery Disease. Applied Psychophysiology and Biofeedback. 2022:1-12.

Pinna T, Edwards DJ. A systematic review of associations between interoception, vagal tone, and emotional regulation: Potential applications for mental health, wellbeing, psychological flexibility, and chronic conditions. Frontiers in psychology. 2020;11:1792.

Reneau M. Feasibility and acceptability of heart rate variability biofeedback in a group of Veterans with fibromyalgia. The Journal of Alternative and Complementary Medicine. 2020;26(11):1025-31.

Karavidas MK, Lehrer PM, Vaschillo E, Vaschillo B, Marin H, Buyske S, et al. Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression. Applied psychophysiology and biofeedback. 2007;32(1):19-30.

Schuman DL, Killian MO. Pilot study of a single session heart rate variability biofeedback intervention on veterans’ posttraumatic stress symptoms. Applied psychophysiology and biofeedback. 2019;44(1):9-20.

Climov D, Lysy C, Berteau S, Dutrannois J, Dereppe H, Brohet C, et al. Biofeedback on heart rate variability in cardiac rehabilitation: practical feasibility and psycho-physiological eff ects. Acta cardiologica. 2014;69(3):299-307.

de Bruin EI, Van der Zwan J, Bögels SM. A RCT comparing daily mindfulness meditations, biofeedback exercises, and daily physical exercise on attention control, executive functioning, mindful awareness, self-compassion, and worrying in stressed young adults. Mindfulness. 2016;7(5):1182-92.

Tan G, Dao TK, Farmer L, Sutherland RJ, Gevirtz R. Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): a pilot study. Applied psychophysiology and biofeedback. 2011;36(1):27-35.

Greenberg BR, Grossman EF, Bolwell G, Reynard AK, Pennell NA, Moravec CS, et al. Biofeedback assisted stress management in patients with lung cancer: a feasibility study. Applied psychophysiology and biofeedback. 2015;40(3):201-8.

Jester DJ, Rozek EK, McKelley RA. Heart rate variability biofeedback: implications for cognitive and psychiatric effects in older adults. Aging & Mental Health. 2019;23(5):574-80.

Trousselard M, Canini F, Claverie D, Cungi C, Putois B, Franck N. Cardiac coherence training to reduce anxiety in remitted schizophrenia, a pilot study. Applied Psychophysiology and Biofeedback. 2016;41(1):61-9.

Chang W-L, Lee J-T, Li C-R, Davis AH, Yang C-C, Chen Y-J. Effects of heart rate variability biofeedback in patients with acute ischemic stroke: A randomized controlled trial. Biological Research for Nursing. 2020;22(1):34-44.

Nolan RP, Floras JS, Harvey PJ, Kamath MV, Picton PE, Chessex C, et al. Behavioral neurocardiac training in hypertension: a randomized, controlled trial. Hypertension. 2010;55(4):1033-9.

Nolan R, Floras J, Ahmed L, Harvey P, Hiscock N, Hendrickx H, et al. Behavioural modification of the cholinergic anti‐inflammatory response to C‐reactive protein in patients with hypertension. Journal of internal medicine. 2012;272(2):161-9.

Lehrer PM, Irvin CG, Lu S-E, Scardella A, Roehmheld-Hamm B, Aviles-Velez M, et al. Heart rate variability biofeedback does not substitute for asthma steroid controller medication. Applied psychophysiology and biofeedback. 2018;43(1):57-73.

Hartogs BM, Bartels-Velthuis AA, Van der Ploeg K, Bos EH. Heart rate variability biofeedback stress relief program for depression. Methods of information in medicine. 2017;56(06):419-26.

Caldwell YT, Steffen PR. Adding HRV biofeedback to psychotherapy increases heart rate variability and improves the treatment of major depressive disorder. International Journal of Psychophysiology. 2018;131:96-101.

Lin I-M, Fan S-Y, Yen C-F, Yeh Y-C, Tang T-C, Huang M-F, et al. Heart rate variability biofeedback increased autonomic activation and improved symptoms of depression and insomnia among patients with major depression disorder. Clinical Psychopharmacology and Neuroscience. 2019;17(2):222.

Dobbin A, Dobbin J, Ross S, Graham C, Ford M. Randomised controlled trial of brief intervention with biofeedback and hypnotherapy in patients with refractory irritable bowel syndrome. The journal of the Royal College of Physicians of Edinburgh. 2013;43(1):15-23.

Van Der Zwan JE, De Vente W, Huizink AC, Bögels SM, De Bruin EI. Physical activity, mindfulness meditation, or heart rate variability biofeedback for stress reduction: a randomized controlled trial. Applied psychophysiology and biofeedback. 2015;40(4):257-68.

Meyer P-W, Friederich H-C, Zastrow A. Breathe to ease-Respiratory biofeedback to improve heart rate variability and coping with stress in obese patients: A pilot study. Mental Health & Prevention. 2018;11:41-6.

Kim S, Zemon V, Cavallo MM, Rath JF, McCraty R, Foley FW. Heart rate variability biofeedback, executive functioning and chronic brain injury. Brain injury. 2013;27(2):209-22.

Hallman DM, Olsson EM, Von Schéele B, Melin L, Lyskov E. Effects of heart rate variability biofeedback in subjects with stress-related chronic neck pain: a pilot study. Applied Psychophysiology and Biofeedback. 2011;36(2):71-80.

Weeks DL, Whitney AA, Tindall AG, Carter GT. Pilot randomized trial comparing intersession scheduling of biofeedback results to individuals with chronic pain: Influence on psychologic function and pain intensity. American Journal of Physical Medicine & Rehabilitation. 2015;94(10S):869-78.

Ginsberg JP, Berry ME, Powell DA. Cardiac coherence and posttraumatic stress disorder in combat veterans. Alternative Therapies in Health & Medicine. 2010;16(4).

McCraty R, Childre D. Coherence: bridging personal, social, and global health. Altern Ther Health Med. 2010;16(4):10-24.

Schwerdtfeger AR, Schwarz G, Pfurtscheller K, Thayer JF, Jarczok MN, Pfurtscheller G. Heart rate variability (HRV): From brain death to resonance breathing at 6 breaths per minute. Clinical neurophysiology. 2020;131(3):676-93.

Richard Gevirtz PhD B. The promise of heart rate variability biofeedback: Evidence-based applications. Biofeedback (Online). 2013;41(3):110.

Shaffer F, McCraty R. Zerr Ch.(2014) A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability. Frontiers in Psychology.5.

Shaffer F, Ginsberg J. An overview of heart rate variability metrics and norms. Front Public Health. 2017; 5: 258. Epub 2017/10/17. https://doi. org/10.3389/fpubh. 2017.00258 PMID: 29034226; 2017.

Laborde S, Mosley E, Thayer JF. Heart rate variability and cardiac vagal tone in psychophysiological research–recommendations for experiment planning, data analysis, and data reporting. Frontiers in psychology. 2017;8:213.

Kromenacker BW, Sanova AA, Marcus FI, Allen JJ, Lane RD. Vagal mediation of low-frequency heart rate variability during slow yogic breathing. Psychosomatic medicine. 2018;80(6):581-7.

Larsen P, Tzeng Y, Sin P, Galletly D. Respiratory sinus arrhythmia in conscious humans during spontaneous respiration. Respiratory physiology & neurobiology. 2010;174(1-2):111-8.

Fatisson J, Oswald V, Lalonde F. Influence diagram of physiological and environmental factors affecting heart rate variability: an extended literature overview. Heart international. 2016;11(1):heartint. 5000232.

Yu L-C, Lin I-M, Fan S-Y, Chien C-L, Lin T-H. One-year cardiovascular prognosis of the randomized, controlled, short-term heart rate variability biofeedback among patients with coronary artery disease. International Journal of Behavioral Medicine. 2018;25(3):271-82.

Feldman JM, Matte L, Interian A, Lehrer PM, Lu S-E, Scheckner B, et al. Psychological treatment of comorbid asthma and panic disorder in Latino adults: Results from a randomized controlled trial. Behaviour research and therapy. 2016;87:142-54.

Lin I-M, Ko J-M, Fan S-Y, Yen C-F. Heart rate variability and the efficacy of biofeedback in heroin users with depressive symptoms. Clinical Psychopharmacology and Neuroscience. 2016;14(2):168.

Lehrer P, Vaschillo B, Zucker T, Graves J, Katsamanis M, Aviles M, et al. Protocol for heart rate variability biofeedback training. Biofeedback. 2013;41(3).

Szulczewski MT. An anti-hyperventilation instruction decreases the drop in end-tidal CO2 and symptoms of hyperventilation during breathing at 0.1 Hz. Applied Psychophysiology and Biofeedback. 2019;44(3):247-56.

Modesti PA, Ferrari A, Bazzini C, Boddi M. Time sequence of autonomic changes induced by daily slow-breathing sessions. Clinical Autonomic Research. 2015;25(2):95-104.

Lin I-M, Tai L, Fan S-Y. Breathing at a rate of 5.5 breaths per minute with equal inhalation-to-exhalation ratio increases heart rate variability. International Journal of Psychophysiology. 2014;91(3):206-11.

Wheat AL, Larkin KT. Biofeedback of heart rate variability and related physiology: A critical review. Applied psychophysiology and biofeedback. 2010;35(3):229-42.

Goessl VC, Curtiss JE, Hofmann SG. The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis. Psychological medicine. 2017;47(15):2578-86.

Patron E, Messerotti Benvenuti S, Favretto G, Valfre C, Bonfa C, Gasparotto R, et al. Biofeedback assisted control of respiratory sinus arrhythmia as a biobehavioral intervention for depressive symptoms in patients after cardiac surgery: a preliminary study. Applied psychophysiology and biofeedback. 2013;38(1):1-9.

Tatschl JM, Hochfellner SM, Schwerdtfeger AR. Implementing mobile HRV biofeedback as adjunctive therapy during inpatient psychiatric rehabilitation facilitates recovery of depressive symptoms and enhances autonomic functioning short-term: A 1-year pre–post-intervention follow-up pilot study. Frontiers in Neuroscience. 2020;14:738.

Wu JK, Huang Z, Zhang Z, Xiao W, Jiang H. Quantitative assessment of autonomic regulation of the cardiac system. Journal of healthcare engineering. 2019;2019.



How to Cite

Al-Tamimi, S. M. . (2022). Biofeedback of Heart Rate Variability in the treatment of chronic diseases: A Systematic Review. Journal of Contemporary Medical Sciences, 8(5).