Three Breathing Techniques for Heart Rate Variability, Attention, Reaction Time, and Anxiety
September 3, 2026 updated by: Atlas University
Comparative Effects of Three Breathing Techniques on Heart Rate Variability, Attention, Reaction Time, and Anxiety in Healthy Adults: A Randomized Controlled Trial
This randomized controlled trial compared the effects of Mindfulness Breathing, Box Breathing, and Nadi Shodhana Pranayama on heart rate variability, attention performance, reaction time, and anxiety in healthy adults aged 18-40 years.
Participants were randomly assigned to one of three breathing intervention groups and practiced their assigned technique daily for six weeks.
Primary outcomes included resting heart rate, RMSSD, and respiratory rate derived from 5-minute heart rate variability recordings.
Secondary outcomes included attention performance assessed by the Digit Cancellation Test, reaction time assessed using the BlazePod system, and state and trait anxiety assessed using the State-Trait Anxiety Inventory.
Participants received standardized face-to-face instruction, home practice videos, and daily WhatsApp reminders throughout the intervention.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
Healthy adults aged 18-40 years were recruited using convenience sampling and randomly assigned in a 1:1:1 ratio to Mindfulness Breathing, Box Breathing, or Nadi Shodhana Pranayama. Participants received an individual face-to-face training session delivered by the same physiotherapist, practiced their assigned breathing technique under supervision until correct performance was confirmed, and subsequently performed daily home-based practice for six weeks using standardized instructional videos. Daily WhatsApp reminders containing the appropriate video link were sent to support adherence.
Heart rate variability was assessed using a Polar H10 heart rate monitor with 5-minute resting recordings analyzed using Kubios HRV software. Attention performance was measured using the Digit Cancellation Test, reaction time was assessed using the BlazePod wireless reaction system, and anxiety outcomes were evaluated using the State-Trait Anxiety Inventory. Assessments were performed at baseline and after six weeks.
Study Type
Interventional
Enrollment (Actual)
48
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Kagıthane
-
Istanbul, Kagıthane, Turkey (Türkiye)
- Istanbul Atlas University
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
Yes
Description
Inclusion Criteria:
- Healthy adults aged 18 to 40 years.
- Ability to provide written informed consent.
- Ownership of a smartphone with internet access.
- Willingness to participate in daily breathing practice for six weeks.
Exclusion Criteria:
- Respiratory disease.
- History of lung transplantation.
- Pregnancy or suspected pregnancy.
- Previous experience with yoga, Qigong, breath therapy, or other structured breathing practices.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Active Comparator: Mindfulness Breathing
Participants practiced mindful awareness of their natural breathing without intentionally altering breathing rhythm during daily home sessions for six weeks.
|
Participants received an individual face-to-face training session from the same physiotherapist, practiced under supervision until correct performance was confirmed, and subsequently performed daily home-based mindfulness breathing for six weeks using standardized instructional videos and daily WhatsApp reminders.
|
|
Experimental: Box Breathing
Participants performed a structured 4-4-4-4 breathing cycle consisting of 4 seconds of inhalation, 4 seconds of breath holding, 4 seconds of exhalation, and a 4-second post-exhalation pause during daily home practice for six weeks.
|
Participants received standardized face-to-face instruction and performed daily home-based Box Breathing using a 4-second inhalation, 4-second breath hold, 4-second exhalation, and 4-second pause for six weeks, supported by instructional videos and daily WhatsApp reminders.
|
|
Experimental: Nadi Shodhana Pranayama
Participants performed alternate nostril breathing with controlled inhalation and exhalation while maintaining a slow and rhythmic breathing pattern during daily home practice for six weeks.
|
Participants received standardized face-to-face instruction and performed daily home-based alternate nostril breathing for six weeks using instructional videos and daily WhatsApp reminders.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Resting Heart Rate
Time Frame: Baseline and Week 6
|
Resting heart rate (beats per minute) measured from a 5-minute seated recording using the Polar H10 heart rate monitor (Polar Electro, Kempele, Finland).
|
Baseline and Week 6
|
|
Root Mean Square of Successive Differences (RMSSD)
Time Frame: Baseline and Week 6
|
RMSSD (milliseconds), a vagally mediated heart rate variability parameter, derived from 5-minute RR interval recordings analyzed using Kubios HRV software.
|
Baseline and Week 6
|
|
Respiratory Rate
Time Frame: Baseline and Week 6
|
Respiratory rate (breaths per minute) obtained from the 5-minute Polar H10 recording.
|
Baseline and Week 6
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Digit Cancellation Test Score
Time Frame: Baseline and Week 6
|
Attention performance assessed using the Digit Cancellation Test by recording the number of correctly identified targets within 30 seconds.
|
Baseline and Week 6
|
|
BlazePod Reaction Time
Time Frame: Baseline and Week 6
|
Reaction time assessed using a single BlazePod wireless light-based reaction system with the dominant hand.
The system recorded average reaction time, number of successful responses, and number of errors.
|
Baseline and Week 6
|
|
Anxiety
Time Frame: Baseline and Week 6
|
Anxiety assessed using the Staterait Anxiety Inventory
|
Baseline and Week 6
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
September 1, 2025
Primary Completion (Actual)
June 20, 2026
Study Completion (Actual)
June 20, 2026
Study Registration Dates
First Submitted
September 3, 2026
First Submitted That Met QC Criteria
September 3, 2026
First Posted (Actual)
September 9, 2026
Study Record Updates
Last Update Posted (Actual)
September 9, 2026
Last Update Submitted That Met QC Criteria
September 3, 2026
Last Verified
September 1, 2026
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- E 22686390 050.99 62685
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
IPD Plan Description
Individual participant data will not be made publicly available.
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.