HEART RATE VARIABILITY (HRV) BIOFEEDBACK

What is HRV biofeedback?

Heart Rate Variability (HRV) biofeedback is a non-invasive method of matching your breathing to heart rate patterns. Your heart rate speeds up as you inhale and slows down as you exhale. During HRV biofeedback, patients can visually see their beat-by-beat heart rate data and try to slow down their breathing to match their heart rate patterns.¹ The patient receives immediate feedback from the device throughout this process. Patients are trained to breathe from their diaphragm to reduce their respiration rate to about six breaths per minute. Slowing down the heart rate activates the parasympathetic nervous system, which conserves our energy and allows our body to rest and relax.

HRV biofeedback has been used for asthma, depression, anxiety, stress, and muscle relaxation. For individuals looking for non-pharmacological ways of alleviating these symptoms, HRV biofeedback is a reasonable therapy to try first before other methods, such as neurofeedback.

How can HRV biofeedback help alleviate certain long COVID symptoms?

The SARS-CoV-2 virus can lead to heart damage through multiple mechanisms. The binding of the virus to ACE2 receptors can have negative downstream impacts on the cardiovascular system. Direct myocardial damage from vascular inflammation and indirect damage from lack of oxygen, stress-induced heart abnormalities, and increased risk of clotting can all result in cardiovascular dysfunction.

Patients with long COVID have persistent dysfunction of the autonomic nervous system, which is the component of our peripheral nervous system that regulates our heart rate, respiration, and other functions.² This persistent autonomic dysfunction can lead to long COVID symptoms such as fatigue, breathlessness, palpitations, dizziness, and brain fog. As a result, HRV biofeedback can help activate the parasympathetic nervous system and increase cardiac homeostasis, which can reduce the release of inflammatory markers. 

What evidence supports the use of HRV biofeedback for long COVID?

Investigations conducted by the European Society of Cardiology evaluated 434 COVID survivors three months after hospital discharge and found alterations in heart rate variability likely explained by autonomic dysfunction.³ HRV biofeedback training improved autonomic functioning and generated better cardiovascular regulation.

There is an ongoing trial in the UK assessing the use of a four-week HRV biofeedback training intervention for long COVID symptoms.⁴  Overall, HRV biofeedback has been utilized since the 1990s and is a reasonable treatment alternative for long COVID symptoms triggered by autonomic dysfunction.

What should you be aware of with HRV biofeedback?

HRV biofeedback is a safe training method with no serious adverse events reported. Individuals may experience stress when given negative feedback in a session, but there are no other known side effects of HRV biofeedback. HRV biofeedback can also serve as an option for pregnant women who would like a non-pharmacological treatment option for certain long COVID symptoms. Results from a randomized controlled trial indicated a statistically significant beneficial effect on psychological well-being and anxiety for both pregnant and non-pregnant women.⁵

References:

1)      Lehrer PM, Gevirtz R. Heart rate variability biofeedback: how and why does it work? Front Psychol. 2014 Jul 21;5:756. doi: 10.3389/fpsyg.2014.00756

2)      Schnekenberg L, Sedghi A, Schoene D, Pallesen LP, Barlinn J, Woitek F, Linke A, Puetz V, Barlinn K, Mangner N, Siepmann T. Assessment and Therapeutic Modulation of Heart Rate Variability: Potential Implications in Patients with COVID-19. J Cardiovasc Dev Dis. 2023 Jul 12;10(7):297. doi: 10.3390/jcdd10070297

3)      Pelaez-Hernandez V, Luna-Rodriguez GL, Orea-Tejeda A, et al. Heart rate variability disturbances and biofeedback treatment in COVID-19 survivors. ESC. 2021 Sep 29;21(4).

4)      Corrado J, Halpin S, Preston N, Whiteside D, Tarrant R, Davison J, Simms AD, O’Connor RJ, Casson A, Sivan M. HEART rate variability biofeedback for long COVID symptoms (HEARTLOC): protocol for a feasibility study. BMJ Open. 2022 Nov 21;12(11):e066044. doi: 10.1136/bmjopen-2022-066044

5)      van der Zwan JE, Huizink AC, Lehrer PM, Koot HM, de Vente W. The Effect of Heart Rate Variability Biofeedback Training on Mental Health of Pregnant and Non-Pregnant Women: A Randomized Controlled Trial. Int J Environ Res Public Health. 2019 Mar 23;16(6):1051. doi: 10.3390/ijerph16061051

Active Clinical Trials: Long COVID, Heart Rate Variability Biofeedback | Card Results | ClinicalTrials.gov