Does Heart Rate Variability Biofeedback Enhance Executive Functions Across the Lifespan? A Systematic Review

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Abstract

The scope of this systematic review was to summarize the existing literature on the effects of heart rate variability biofeedback (HRV-BF) on executive functions (EFs) across the lifespan. Specifically, it aimed to investigate the factors that may affect the efficacy of HRV-BF interventions, such as the study population, duration and intensity of the intervention, or the technical equipment. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that measured and presented at least one EF were included. We included controlled and uncontrolled trials involving clinical and general populations. From the initial list of 137 papers, 16 final studies were reviewed, with 777 participants. Fifty-six percent of the studies included in this review reported significant positive effects of HRV-BF intervention on at least one EF. Attention was the domain that most often benefited from the intervention. The majority of EF improvements (78%) occurred in studies that addressed patient populations or individuals that may present particular profiles: individuals exposed to stress, professional athletes, war veterans, children and adults with ADHD, and clinical older patients. The remaining studies (22%) that reported significant improvements focused on the general population. Efficacy was neither related to the duration or intensity of the intervention nor related to the technical equipment. Overall, our review shows that HRV-BF may be beneficial (a) to increase attentional skills, inhibition, and working memory and (b) when targeting more vulnerable individuals or individuals with particular profiles. However, further development of standardized, controlled protocols and consistent reporting of effect sizes may contribute to establishing the relevance of HRV-BF biofeedback interventions within the field of cognitive enhancement.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41465-021-00218-3.

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Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

David Moher, Larissa Shamseer, Mike Clarke … (2017)

Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.

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Executive Functions

Adele Diamond (2013)

Executive functions (EFs) make possible mentally playing with ideas; taking the time to think before acting; meeting novel, unanticipated challenges; resisting temptations; and staying focused. Core EFs are inhibition [response inhibition (self-control—resisting temptations and resisting acting impulsively) and interference control (selective attention and cognitive inhibition)], working memory, and cognitive flexibility (including creatively thinking “outside the box,” seeing anything from different perspectives, and quickly and flexibly adapting to changed circumstances). The developmental progression and representative measures of each are discussed. Controversies are addressed (e.g., the relation between EFs and fluid intelligence, self-regulation, executive attention, and effortful control, and the relation between working memory and inhibition and attention). The importance of social, emotional, and physical health for cognitive health is discussed because stress, lack of sleep, loneliness, or lack of exercise each impair EFs. That EFs are trainable and can be improved with practice is addressed, including diverse methods tried thus far.

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Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs

Daniël Lakens (2013)

Effect sizes are the most important outcome of empirical studies. Most articles on effect sizes highlight their importance to communicate the practical significance of results. For scientists themselves, effect sizes are most useful because they facilitate cumulative science. Effect sizes can be used to determine the sample size for follow-up studies, or examining effects across studies. This article aims to provide a practical primer on how to calculate and report effect sizes for t-tests and ANOVA's such that effect sizes can be used in a-priori power analyses and meta-analyses. Whereas many articles about effect sizes focus on between-subjects designs and address within-subjects designs only briefly, I provide a detailed overview of the similarities and differences between within- and between-subjects designs. I suggest that some research questions in experimental psychology examine inherently intra-individual effects, which makes effect sizes that incorporate the correlation between measures the best summary of the results. Finally, a supplementary spreadsheet is provided to make it as easy as possible for researchers to incorporate effect size calculations into their workflow.

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Author and article information

Contributors

Doriana Tinello: Doriana.Tinello@unige.ch

Journal

Journal ID (nlm-ta): J Cogn Enhanc

Journal ID (iso-abbrev): J Cogn Enhanc

Title: Journal of Cognitive Enhancement

Publisher: Springer International Publishing (Cham )

ISSN (Print): 2509-3290

ISSN (Electronic): 2509-3304

Publication date (Electronic): 30 June 2021

Publication date PMC-release: 30 June 2021

Publication date (Print): 2022

Volume: 6

Issue: 1

Pages: 126-142

Affiliations

[1 ]GRID grid.8591.5, ISNI 0000 0001 2322 4988, Department of Psychology, Faculty of Psychology and Sciences of Education, , University of Geneva, ; 28 Boulevard du Pont d’Arve, 1205 Geneva, Switzerland

[2 ]GRID grid.425888.b, ISNI 0000 0001 1957 0992, Swiss National Centre of Competence in Research LIVES Overcoming Vulnerability: Life Course Perspectives, Lausanne and Geneva, ; Geneva, Switzerland

[3 ]GRID grid.8591.5, ISNI 0000 0001 2322 4988, Centre for the Interdisciplinary Study of Gerontology and Vulnerability, , University of Geneva, ; Geneva, Switzerland

Article

Publisher ID: 218

DOI: 10.1007/s41465-021-00218-3

PMC ID: 8901517

PubMed ID: 35299845

SO-VID: d858112e-8ed9-4562-bab4-1078c8913eac

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 19 January 2021

Date accepted : 25 May 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001711, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung;

Funded by: Université de Genève

Open Access :

Open Access funding provided by Université de Genève.

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Keywords: heart rate variability,biofeedback,executive functions,systematic review,cognitive enhancement,intervention

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Keywords: heart rate variability, biofeedback, executive functions, systematic review, cognitive enhancement, intervention

Does Heart Rate Variability Biofeedback Enhance Executive Functions Across the Lifespan? A Systematic Review

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Supplementary Information

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REPO4EU WP2 Systematic Reviews

Most cited references 51

Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

Executive Functions

Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs

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