This contribution highlights the significance of using vagally-mediated heart rate variability (vmHRV), a general indicator of adaptation, as an actionable biomarker to assess and enhance self-regulation abilities in individuals and organizations. The paper reviews the state-of-the-art on vmHRV and introduces various techniques to enhance vmHRV, including slow-paced breathing, the diving reflex, transcutaneous vagus nerve stimulation (tVNS), transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS). The recommendations for policymaking are based on recent systematic reviews and meta-analyses related to the implementation of these techniques in diverse settings, such as clinical, organizational, and educational contexts. The discussion emphasizes the efficacy, accessibility, and cost-effectiveness of vmHRV assessments and offers practical tools for individuals and organizations through a three-part framework—assessment, intervention, and evaluation—ultimately fostering self-regulation abilities at both individual and societal levels.
AckermannS. P.RaabM.BackschatS.SmithD. J. C.JavelleF.LabordeS. (2022). The diving response and cardiac vagal activity: A systematic review and meta-analysis. Psychophysiology, e14183. https://doi.org/10.1111/psyp.14183
2.
AltiniM.PlewsD. (2021). What Is behind Changes in Resting Heart Rate and Heart Rate Variability? A large-scale analysis of longitudinal measurements acquired in free-living. Sensors, 21(23). https://doi.org/10.3390/s21237932
3.
BalzarottiS.BiassoniF.ColomboB.CiceriM. R. (2017). Cardiac vagal control as a marker of emotion regulation in healthy adults: A review. Biological Psychology, 130, 54–66. https://doi.org/10.1016/j.biopsycho.2017.10.008
4.
BeauchaineT. P.ThayerJ. F. (2015). Heart rate variability as a transdiagnostic biomarker of psychopathology. International Journal of Psychophysiology, 98(2 Pt 2), 338–350. https://doi.org/10.1016/j.ijpsycho.2015.08.004
5.
BenichouT.PereiraB.MermillodM.TauveronI.PfabiganD.MaqdasyS.DutheilF. (2018). Heart rate variability in type 2 diabetes mellitus: A systematic review and meta-analysis. PLoS ONE, 13(4), e0195166. https://doi.org/10.1371/journal.pone.0195166
6.
BonazB.SinnigerV.PellissierS. (2017). The vagus nerve in the neuro-immune axis: Implications in the pathology of the gastrointestinal tract. Frontiers in Immunology, 8, 1452. https://doi.org/10.3389/fimmu.2017.01452
7.
BuchheitM. (2014). Monitoring training status with HR measures: Do all roads lead to Rome?Frontiers in Physiology, 5, 73. https://doi.org/10.3389/fphys.2014.00073
8.
BurgerA. M.D'AgostiniM.VerkuilB.Van DiestI. (2020). Moving beyond belief: A narrative review of potential biomarkers for transcutaneous vagus nerve stimulation. Psychophysiology, 57(6), e13571. https://doi.org/10.1111/psyp.13571
9.
ChengY. C.HuangY. C.HuangW. L. (2020). Heart rate variability in individuals with autism spectrum disorders: A meta-analysis. Neuroscience & Biobehavioral Reviews, 118, 463–471. https://doi.org/10.1016/j.neubiorev.2020.08.007
10.
ChengY. C.HuangY. C.HuangW. L. (2022). Heart rate variability in patients with dementia or neurocognitive disorders: A systematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry, 56(1), 16–27. https://doi.org/10.1177/0004867420976853
11.
ChouchouF.DesseillesM. (2014). Heart rate variability: A tool to explore the sleeping brain?Frontiers in Neuroscience, 8, 402. https://doi.org/10.3389/fnins.2014.00402
12.
D'AgostiniM.ClaesN.FranssenM.von LeupoldtA.Van DiestI. (2022). Learn to breathe, breathe to learn? No evidence for effects of slow deep breathing at a 0.1 Hz frequency on reversal learning. International Journal of Psychophysiology, 174, 92–107. https://doi.org/10.1016/j.ijpsycho.2022.01.008
13.
De SmetS.OttavianiC.VerkuilB.KappenM.BaekenC.VanderhasseltM. A. (2023). Effects of non-invasive vagus nerve stimulation on cognitive and autonomic correlates of perseverative cognition. Psychophysiology, 60(6), e14250. https://doi.org/10.1111/psyp.14250
14.
DruryR. L.JarczokM.OwensA.ThayerJ. F. (2021). Wireless heart rate variability in assessing community COVID-19. Frontiers in Neuroscience, 15, 564159. https://doi.org/10.3389/fnins.2021.564159
15.
FarmerA. D.StrzelczykA.FinisguerraA.GourineA. V.GharabaghiA.HasanA.KoenigJ. (2020). International Consensus Based Review and Recommendations for minimum reporting standards in research on transcutaneous vagus nerve stimulation (version 2020). Frontiers in Human Neuroscience, 14, 568051. https://doi.org/10.3389/fnhum.2020.568051
16.
FatissonJ.OswaldV.LalondeF. (2016). Influence diagram of physiological and environmental factors affecting heart rate variability: An extended literature overview. Heart International, 11(1), e32–e40. https://doi.org/10.5301/heartint.5000232
17.
ForteG.TroisiG.PazzagliaM.PascalisV.CasagrandeM. (2022). Heart rate variability and pain: A systematic review. Brain Sciences, 12(2). https://doi.org/10.3390/brainsci12020153
18.
FosterG. E.SheelA. W. (2005). The human diving response, its function, and its control. Scandinavian Journal of Medicine & Science in Sports, 15(1), 3–12. https://doi.org/10.1111/j.1600-0838.2005.00440.x
19.
HillL. K.HuD. D.KoenigJ.SollersJ. JIIIKapukuG.WangX.ThayerJ. F. (2015). Ethnic differences in resting heart rate variability: A systematic review and meta-analysis. Psychosomatic Medicine, 77(1), 16–25. https://doi.org/10.1097/PSY.0000000000000133
20.
HillebrandS.GastK. B.de MutsertR.SwenneC. A.JukemaJ. W.MiddeldorpS.DekkersO. M. (2013). Heart rate variability and first cardiovascular event in populations without known cardiovascular disease: Meta-analysis and dose-response meta-regression. EP Europace, 15(5), 742–749. https://doi.org/10.1093/europace/eus341
21.
HolzmanJ. B.BridgettD. J. (2017). Heart rate variability indices as bio-markers of top-down self-regulatory mechanisms: A meta-analytic review. Neuroscience & Biobehavioral Reviews, 74(Pt A), 233–255. https://doi.org/10.1016/j.neubiorev.2016.12.032
22.
JarczokM. N.WeimerK.BraunC.WilliamsD. P.ThayerJ. F.GündelH. O.BalintE. M. (2022). Heart rate variability in the prediction of mortality: A systematic review and meta-analysis of healthy and patient populations. Neuroscience & Biobehavioral Reviews, 143, https://doi.org/10.1016/j.neubiorev.2022.104907
23.
Jarvelin-PasanenS.SinikallioS.TarvainenM. P. (2018). Heart rate variability and occupational stress-systematic review. Industrial Health. https://doi.org/10.2486/indhealth.2017-0190
24.
KaremakerJ. M. (2020). Interpretation of heart rate variability: The art of looking through a keyhole. Frontiers in Neuroscience, 14, 609570. https://doi.org/10.3389/fnins.2020.609570
25.
KoenigJ.ThayerJ. F. (2016). Sex differences in healthy human heart rate variability: A meta-analysis. Neuroscience & Biobehavioral Reviews, 64, 288–310. https://doi.org/10.1016/j.neubiorev.2016.03.007
26.
LabordeS.AllenM. S.BorgesU.DossevilleF.HosangT. J.IskraM.JavelleF. (2022). Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis. Neuroscience & Biobehavioral Reviews, 138, 104711. https://doi.org/10.1016/j.neubiorev.2022.104711
27.
LabordeS.AllenM. S.BorgesU.IskraM.ZammitN.YouM.DossevilleF. (2021). Psychophysiological effects of slow-paced breathing at six cycles per minute with or without heart rate variability biofeedback. Psychophysiology, 59(1), e13952. https://doi.org/10.1111/psyp.13952
28.
LabordeS.HosangT.MosleyE.DossevilleF. (2019). Influence of a 30-day slow paced breathing intervention compared to social media use on subjective sleep quality and cardiac vagal activity. Journal of Clinical Medicine, 8(2). https://doi.org/10.3390/jcm8020193
29.
LabordeS.MosleyE.BellengerC. R.ThayerJ. F. (2022). Editorial: Horizon 2030: Innovative applications of heart rate variability. Frontiers in Neuroscience.
30.
LabordeS.MosleyE.MertgenA. (2018a). A unifying conceptual framework of factors associated to cardiac vagal control. Heliyon, 4(12), e01002. https://doi.org/10.1016/j.heliyon.2018.e01002
31.
LabordeS.MosleyE.MertgenA. (2018b). Vagal tank theory: The three Rs of cardiac vagal control functioning—Resting, reactivity, and recovery. Frontiers in Neuroscience, 12, https://doi.org/10.3389/fnins.2018.00458
32.
LabordeS.MosleyE.ThayerJ. F. (2017). Heart rate variability and cardiac vagal tone in psychophysiological research—Recommendations for experiment planning, data analysis, and data reporting. Frontiers in Physiology, 8, 213. https://doi.org/10.3389/fpsyg.2017.00213
33.
LehrerP.KaurK.SharmaA.ShahK.HusebyR.BhavsarJ.ZhangY. (2020). Heart rate variability biofeedback improves emotional and physical health and performance: A systematic review and meta-analysis. Applied Psychophysiology & Biofeedback, 45(3), 109–129. https://doi.org/10.1007/s10484-020-09466-z
34.
LiuK. Y.ElliottT.KnowlesM.HowardR. (2022). Heart rate variability in relation to cognition and behavior in neurodegenerative diseases: A systematic review and meta-analysis. Ageing Research Reviews, 73. https://doi.org/10.1016/j.arr.2021.101539
35.
MagnonV.ValletG. T.BensonA.MermillodM.ChausseP.LacroixA.DutheilF. (2022). Does heart rate variability predict better executive functioning? A systematic review and meta-analysis. Cortex, 155, 218–236. https://doi.org/10.1016/j.cortex.2022.07.008
36.
MakovacE.ThayerJ. F.OttavianiC. (2017). A meta-analysis of non-invasive brain stimulation and autonomic functioning: Implications for brain-heart pathways to cardiovascular disease. Neuroscience & Biobehavioral Reviews, 74(Pt B), 330–341. https://doi.org/10.1016/j.neubiorev.2016.05.001
37.
MalikM. (1996). Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. European Heart Journal, 17, 354–381. https://doi.org/10.1093/oxfordjournals.eurheartj.a014868
38.
McIntoshR. C. (2016). A meta-analysis of HIV and heart rate variability in the era of antiretroviral therapy. Clinical Autonomic Research, 26(4), 287–294. https://doi.org/10.1007/s10286-016-0366-6
39.
MoonS. J. E.SchlenkE. A.LeeH. (2023). Heart rate variability in adults with substance use disorder: A comprehensive narrative review. Journal of the American Psychiatric Nurses Association, 10783903221145142. https://doi.org/10.1177/10783903221145142
40.
MosleyE.LabordeS. (2022). A scoping review of heart rate variability in sport and exercise psychology. International Review of Sport and Exercise Psychology, 1–75. https://doi.org/10.1080/1750984X.2022.2092884
41.
QueirozM. G.PradoA. G. K.Alves-SantosE. T.AraujoJ. A.DamazoA. S.CambriL. T. (2022). Influence of family history of hypertension on blood pressure and heart rate variability in young adults: A meta-analysis. Blood Pressure Monitoring, 27(4), 259–271. https://doi.org/10.1097/MBP.0000000000000599
42.
SchmaußerM.HoffmannS.RaabM.LabordeS. (2022). The effects of noninvasive brain stimulation on heart rate and heart rate variability: A systematic review and meta-analysis. Journal of Neuroscience Research, 100(9), 1664–1694. https://doi.org/10.1002/jnr.25062
43.
SchneiderM.SchwerdtfegerA. (2020). Autonomic dysfunction in posttraumatic stress disorder indexed by heart rate variability: A meta-analysis. Psychological Medicine, 50(12), 1937–1948. https://doi.org/10.1017/S003329172000207X
44.
Sevoz-CoucheC.LabordeS. (2022). Heart rate variability and slow-paced breathing: When coherence meets resonance. Neuroscience & Biobehavioral Reviews, 135, 104576. https://doi.org/10.1016/j.neubiorev.2022.104576
45.
ShafferF.McCratyR.ZerrC. L. (2014). A healthy heart is not a metronome: An integrative review of the heart's anatomy and heart rate variability. Frontiers in Psychology, 5, 1040. https://doi.org/10.3389/fpsyg.2014.01040
46.
SmithT. W.Deits-LebehnC.WilliamsP. G.BaucomB. R. W.UchinoB. N. (2020). Toward a social psychophysiology of vagally mediated heart rate variability: Concepts and methods in self-regulation, emotion, and interpersonal processes. Social and Personality Psychology Compass, 14(3). https://doi.org/10.1111/spc3.12516
47.
StoneJ. D.UlmanH. K.TranK.ThompsonA. G.HalterM. D.RamadanJ. H.HagenJ. A. (2021). Assessing the accuracy of popular commercial technologies that measure resting heart rate and heart rate variability. Frontiers in Sports and Active Living, 3, https://doi.org/10.3389/fspor.2021.585870
48.
ThayerJ. F.AhsF.FredriksonM.SollersJ. J.WagerT. D. (2012). A meta-analysis of heart rate variability and neuroimaging studies: Implications for heart rate variability as a marker of stress and health. Neuroscience & Biobehavioral Reviews, 36, 747–756. https://doi.org/10.1016/j.neubiorev.2011.11.009
49.
ThayerJ. F.HansenA. L.Saus-RoseE.JohnsenB. H. (2009). Heart rate variability, prefrontal neural function, and cognitive performance: The neurovisceral integration perspective on self-regulation, adaptation, and health. Annals of Behavioral Medicine, 37, 141–153. https://doi.org/10.1007/s12160-009-9101-z
Van DiestI.VerstappenK.AubertA. E.WidjajaD.VansteenwegenD.VlemincxE. (2014). Inhalation/exhalation ratio modulates the effect of slow breathing on heart rate variability and relaxation. Applied Psychophysiology & Biofeedback, 39(3–4), 171–180. https://doi.org/10.1007/s10484-014-9253-x
52.
WangL.MillerL. C. (2020). Just-in-the-Moment Adaptive Interventions (JITAI): A meta-analytical review. Health Communication, 35(12), 1531–1544. https://doi.org/10.1080/10410236.2019.1652388
53.
WangZ.LuoY.ZhangY.ChenL.ZouY.XiaoJ.ZouZ. (2023). Heart rate variability in generalized anxiety disorder, major depressive disorder and panic disorder: A network meta-analysis and systematic review. Journal of Affective Disorders, 330, 259–266. https://doi.org/10.1016/j.jad.2023.03.018
54.
WilliamsD. P.KoenigJ.CarnevaliL.SgoifoA.JarczokM. N.SternbergE. M.ThayerJ. F. (2019). Heart rate variability and inflammation: A meta-analysis of human studies. Brain, Behavior, and Immunity, 80, 219–226. https://doi.org/10.1016/j.bbi.2019.03.009
55.
WolfV.KuhnelA.TeckentrupV.KoenigJ.KroemerN. B. (2021). Does transcutaneous auricular vagus nerve stimulation affect vagally mediated heart rate variability? A living and interactive Bayesian meta-analysis. Psychophysiology, 58(11), e13933. https://doi.org/10.1111/psyp.13933
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
