Also known as HRV, Heart Rate Variability is a pulse-related measure that has been used in cardiology offices as part of the assessment of cardiac health. HRV has for some time been in the interest of cardiologists, as it has been used as a predictor of negative cardiac events. “…robustness of the HRV cycle is accepted as an accurate measure of mortality risk from all causes.” (1)

However, the more recent thrust of knowledge about actually training for improved HRV has come from the sector of wellness, stress management and mental health, as well as cardiac rehabilitation. Resources for learning more of the HRV research are available at the end of this paper.

HRV is a measurement of the quality, amplitude and regularity of the variation of the cardiac rhythm with respiration. When breathing is optimal, a state of optimal relationship between the breathing and cardiac rhythm is achieved, referred to here as “coherence.” HRV Training is a method of biofeedback in which the participant learns to achieve coherence through conscious attention to breath. The varying cardiac rhythm is “fed back” to the participant on a computer screen, which makes it clear to the participant when the HRV is better or worse. Also, the participant receives training in optimal breathing. By regular practice with biofeedback, and independent regular practice using the methods learned, the person can achieve better heart rate variability.

The autonomic nervous system is the involuntary (unconscious) part of our physiology that controls our level of arousal (sympathetic vs. parasympathetic…also known as fight or flight vs. relaxation mode). Many persons suffering from sleep problems, digestive disorders like irritable bowel, and other stress-related medical problems, as well as anxiety and other mood problems live in a state of overemphasis of the sympathetic state. If a person can use breath-work to achieve coherence, this can bring the autonomic nervous system back into a more balanced state, where the sympathetic state no longer dominates the biology of the individual.

Achieving a balance between the parasympathetic and sympathetic systems is different from typical relaxation work, in which the person practices getting deeply relaxed. The ability to consciously achieve deep relaxation, which represents a parasympathetic dominance, is an excellent skill to have for managing stress and mental states. However, while deep relaxation is a very beneficial state for some purposes, it is not a state in which individuals can lead their daily life. A balanced autonomic state is a functional, alert, relaxed state. This is why one trains to approach coherence working in an eyes-open state.

Because of the wide-ranging positive effects of achieving autonomic nervous system balance, HRV training can be very useful in addressing a large range of problems. These include the list below from the publication The Coherent Heart, referenced at the end of this paper:

It is possible for individuals to improve their mental state, and achieve other health and mental benefits by conscious regular attention to breath. This has been clear to practitioners of yoga, martial arts, and meditation for thousands of years. The problem is that average individuals are not inclined to practice these arts, because of a combination of stress, business, lack of inspiration, and mental symptoms. It is the rare individual with a high level of insight, motivation, and maybe coaching (such as membership in a tai chi group, or a life changing medical event) that has the persistence to engage in the regular practice of paying attention to their breath.

It is my experience that more than half of the patients I have introduced to HRV training are unable initially -- even with clear instruction -- to breathe in coherence even for a few minutes. It takes repeated clear and gentle instruction, and the benefit of seeing the heart rate variability feedback on a screen in front of them, for them to begin to improve their chronically suboptimal breathing pattern. Within several training sessions, most individuals begin to glimpse what it is they need to practice. In addition, they have experienced the difference in the alert relaxed state they can achieve with corrected breathing.

The HRV training program provides a summary graph to monitor progress from session to session (from below normal to normal to a high level of coherence). An individual may require from two to twenty sessions to be well on their way to coherent breathing, depending on how well they practice on their own. With practice on their own, and -- if needed -- repeated sessions to view their progress, they can begin to maintain improved breathing (and therefore improved heart rate variability) more of the time…eventually with less effort and conscious attention to it .

In summary, the HRV biofeedback training program provides education, coaching, biofeedback and graphic displays to provide clarity and motivation to assist individuals in achieving improved breathing and HRV.

For the more scientifically /biologically minded:

When we breathe, inhalation and exhalation alternately create vacuum and pressure within the chest cavity, in which the heart is situated. These cycles of pressure created from respiration interact with / and affect the tone (relaxation or constriction) of our blood vessels and with the pumping action / rate of our heart. So…the rhythm of our heart and the efficiency of our blood flow and thus our lymphatic flow , our blood pressure, and tissue perfusion is affected by how we breathe. Our cardiac rhythm affects our brains also. How our cardiac rhythm varies with our respiration thus affects not only our brain states, but also our autonomic nervous system. (The autonomic nervous system controls our level of psychophysiologic arousal -- fight or flight vs. relaxation, as mentioned above.)

Another interesting fact has to do with the neurologic connections to the brain from the heart. Not only does the heart have its own nervous system for controlling the flow of the contractions of the atria and ventricals….it also has afferent connections with the brain -- that appear to have significant impact on the neural networks in the brain related to emotional and cognitive function. The heart also releases hormones that affect the brain and body, such as oxytocin, which is connected to muscle relaxation. So again, the health and rhythms of the lung - heart relationship have long-ranging effects on the mind and body. (3)

As a medical doctor, it has been interesting for me to read the scientific basis behind the coherence technique used for the HRV biofeedback training. When I was in medical school I was taught that when assessing vital signs, the normal breath rate should be around 12 to 20 breaths a minute. To achieve optimal HRV and the benefits of coherent breathing, most individuals need to breathe at a rate of 5 to 6 breaths per minute! Most Americans breathe too fast, partly because they are stressed. Then that fast breathing keeps them in an over aroused state, which keeps them feeling and acting stressed. Children do better, but in America, they too appear to be learning to breathe at too fast a rate. Teaching them to slow their breathing is often helpful if they are having anxiety and school-related difficulties.

Bottom line: Having a conscious, mindful, attention-based avenue into affecting the dynamics of the lung-heart relationship and thus into the autonomic system balance gives the potential to powerfully steer our own neurophysiology toward an optimum state. What will each of us choose to do with that option? And how might that enhance the ability of individuals including patients to make more of whatever therapy they are utilizing to heal?

References:

1) Elliott, Steve and Dee Edmonson R.N. ; The New Science of Breath: Coherent Breathing for Autonomic Nervous System Balance, Health, and Well-being; Coherence Press; 2006

2) Weil, M.D., Andrew; Natural Health, Natural Medicine; Houghton Mifflin Company, 1998

3) McCraty, Ph.D., Rollin, and Mike Atkinson, Dana Tomasino, and Raymond Trevor Bradley, Ph.D. : The Coherent Heart: Heart-Brain Interaction, Psychophysiological Coherence, and the Emergence of System-Wide Order, HeartMath Research Center, Institute of HeartMath, 2006e-book. (More information on the Institute of heartMath’s scientific e-books, go to: www.heartmath.org/research/e-books

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Dr. Pesaniello uses the HeartMath Program for biofeedback, using the EmWave Program for the PC. This program utilizes a ear-lobe or finger pulse monitor and a computer screen to give patients feedback about their heart rate variability. The program has options including a “coach,” and several graphic displays and / or games that progress better as higher coherence is achieved. Patients can monitor their progress over time, as the computer saves the ratio’s of low / medium / high coherence. Patients can use more frequent or less frequent sessions in combination with home practice and coaching assistance from both the computer and staff at Dr. Pesaniello’s Office. Dr. Pesaniello also offers a hand-held device, which can be used for practice in her resource / waiting room, after intake and teaching the coherence techniques and orientation to the controls of the hand-held.