“Markers of benefit”: the influence of physiological and physical factors on the relationship between slow-paced breathing and heart rate variability
Published October 24, 2026. Short-term HRV measures increased during five minutes of slow breathing in a large military cohort, regardless of combat-injury status. People breathing at least 15 times per minute at baseline showed a larger RMSSD change, but the study did not test symptom relief, durability or a clinical treatment program.
Maqsood R, Schofield S, Bull AMJ, Fear NT, Kemp H, Bennett AN, Boos CJ.
European Journal of Applied Physiology · Publication date: 2026-10-24
Added to site: 2026-10-25
DOI: 10.1007/s00421-026-06470-9
Published October 24, 2026. Added to Neurofeedback.com October 25, 2026.
- Modalities
- HRV, Slow-paced breathing, Biofeedback-related physiology
- Clinical focus
- Autonomic physiology, Military injury rehabilitation, Respiratory rate
- Population
- Male United Kingdom military personnel, with and without combat-related traumatic injury
- Sample
- 962 participants with paired spontaneous- and slow-paced-breathing HRV data: 487 injured and 495 uninjured
- Intervention / method
- Five minutes of spontaneous breathing followed by five minutes at six breaths per minute, with single-lead ECG HRV measurement and adjusted moderator analyses
- Comparator
- Within-participant slow-paced versus spontaneous breathing, with moderation by injury status, baseline respiratory rate, physical activity and six-minute walk distance
Clinician summary
All measured short-term HRV indices increased during six-breaths-per-minute pacing versus spontaneous breathing. Combat-related injury, six-minute walk distance and activity did not significantly moderate the response. Baseline respiratory rate of at least 15 breaths per minute did, with RMSSD increasing from 15.57 to 21.89 ms during paced breathing, p<.001.
How to interpret the findings
The analysis used a fixed sequence rather than randomized breathing order and measured an acute physiological response, not a clinical outcome or longitudinal rehabilitation benefit. The cohort included only men and was assessed about 11 years after injury or deployment. Breathing at six breaths per minute is not equivalent to individualized resonance-frequency training, and a short-term HRV increase does not by itself establish improved health.
Equipment and disclosures
HRV was recorded with single-lead ECG. The checked abstract does not name a manufacturer or describe a commercial biofeedback platform; no equipment is attributed to BrainMaster.
Funded by the ADVANCE charity, award ADV-ADMR-03. One author is a serving Royal Air Force member; another is a Help for Heroes trustee and partly funded by the United Kingdom Ministry of Defence. The authors state that views are their own, not necessarily those of the Ministry of Defence, and the remaining authors declared no conflicts. No indexed correction, retraction or expression-of-concern relation appeared in the retained records; this is a bounded check. AI-assisted source review.
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Summary prepared with AI assistance. Source verification does not imply an independent replication or a clinician's endorsement. Read our review method.