Heart rate variability biofeedback methods: a review (Lalanza 2023)

Across 143 studies, three breathing protocols are in use and there is no methodological consensus. Almost two-thirds of studies under-report the protocol.

A plain-language summary from binaural's reading notes, edited by Jude Mc. Last updated 10 November 2026. Not medical advice.

The question: How is heart rate variability biofeedback actually administered across studies?

Summarised from the abstract; not read in full.

What it found

• Heart rate variability biofeedback "is based on breathing at an individual's resonance frequency, which stimulates respiratory sinus arrhythmia and the baroreflex".
• Three protocols are in use: breathing at a previously detected resonance frequency (37 studies), following a device that adapts in real time (48 studies), and a fixed pace where everyone breathes at the same rate, usually 6 breaths per minute (51 studies).
• There is no methodological consensus.
• Almost two-thirds of studies under-report the protocol (breathing duration, inhale/exhale ratio, posture).

Limits

• The field has not standardised how the technique is delivered.
• Under-reporting of protocol details in almost two-thirds of studies limits comparison between them.

Where this sits

More in the library on breathing and heart rate variability. For the wider picture, read Resonance breathing.

This is our plain-language reading of the paper. It is not medical advice, and one study rarely settles a question.