The effect of heart rate variability biofeedback on cortical arousal and its subsequent influence on vigilance: a randomized controlled study

Saito, Ryuji; Yoshida, Kazuki; Sawamura, Daisuke · 2026 · Crossref

DOI: 10.21203/rs.3.rs-8939605/v1

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Summary

This randomized controlled study investigates the mechanisms underlying the variable efficacy of heart rate variability biofeedback (HRVBF) on cognitive function, specifically focusing on its impact on cortical arousal and vigilance. While HRVBF is a breathing-based intervention intended to enhance autonomic regulation and executive function, previous meta-analyses have reported inconsistent results. The authors hypothesized that HRVBF modulates cortical arousal toward an optimal level, thereby improving vigilance, and that this relationship follows a non-linear, inverted U-shaped pattern consistent with the Yerkes-Dodson law. Fifty-one healthy young adults were randomly assigned to either an HRVBF group (n = 25) or an active control group (n = 26). The HRVBF group performed 15 minutes of paced breathing at their individual resonant frequency with real-time HRV waveform feedback, while the control group performed sham-paced breathing at a higher respiratory rate without feedback. Participants underwent pre- and post-intervention assessments using multimodal measures: physiological indices including heart rate variability (HRV) and electroencephalography (EEG), behavioral performance on the Sustained Attention to Response Task (SART), and subjective arousal scales. Statistical analyses included mixed-design ANOVAs for group differences and polynomial regression to examine non-linear associations between changes in EEG alpha band power (ABP) and behavioral outcomes. The results indicated no significant differences between the HRVBF and control groups for any primary outcomes. Both groups exhibited increased vagally mediated HRV (RMSSD) and decreased mean reaction times, alongside increased commission error rates and reduced N2 No-Go amplitudes, suggesting a general decline in inhibitory control and vigilance likely due to relaxation-induced hypo-arousal. However, polynomial regression revealed a significant quadratic relationship between changes in ABP and commission error rates exclusively in the HRVBF group (R² = 0.276, p = 0.029). This inverted U-shaped association indicates that both increases and decreases in alpha power were linked to improved vigilance, whereas minimal changes in alpha power correlated with worsened performance. No such relationship was observed in the control group. The study concludes that while a single session of HRVBF does not outperform active control breathing in enhancing vigilance, it uniquely engages a regulatory mechanism linking cortical arousal to performance. The significant quadratic relationship suggests that HRVBF facilitates the optimization of arousal states, where dynamic modulation of alpha oscillations supports adaptive attention. These findings imply that the efficacy of HRVBF may depend on shifting individual arousal toward an optimal range, highlighting the importance of considering non-linear arousal–vigilance dynamics and individual baseline states in future research and clinical applications.

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• neuro workload indices

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• Empirical Findings: physiological data