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CLINICAL STUDIES

Effects of controlled breathing, mental activity and mental stress with or without verbalization on heart rate variability

Luciano Bernardi, MD^*, Joanna Wdowczyk-Szulc, MD, Cinzia Valenti, MD^*, Stefano Castoldi, BS^*, Claudio Passino, MD^*, Giammario Spadacini, MD^* and Peter Sleight, MD, FRCP

^* Department of Internal Medicine, IRCCS S. Matteo-University of Pavia, Pavia, Italy
Department of Cardiology, Gdansk, Poland
Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom

Manuscript received September 15, 1998; revised manuscript received October 15, 1999, accepted January 17, 2000.

Reprint requests and correspondence: Dr. Luciano Bernardi, Clinica Medica 1 IRCCS. Policlinico S. Matteo, Universita’ di Pavia 27100 Pavia, Italy

OBJECTIVES

To assess whether talking or reading (silently or aloud) could affect heart rate variability (HRV) and to what extent these changes require a simultaneous recording of respiratory activity to be correctly interpreted.

BACKGROUND

Sympathetic predominance in the power spectrum obtained from short- and long-term HRV recordings predicts a poor prognosis in a number of cardiac diseases. Heart rate variability is often recorded without measuring respiration; slow breaths might artefactually increase low frequency power in RR interval (RR) and falsely mimic sympathetic activation.

METHODS

In 12 healthy volunteers we evaluated the effect of free talking and reading, silently and aloud, on respiration, RR and blood pressure (BP). We also compared spontaneous breathing to controlled breathing and mental arithmetic, silent or aloud. The power in the so called low- (LF) and high-frequency (HF) bands in RR and BP was obtained from autoregressive power spectrum analysis.

RESULTS

Compared with spontaneous breathing, reading silently increased the speed of breathing (p < 0.05), decreased mean RR and RR variability and increased BP. Reading aloud, free talking and mental arithmetic aloud shifted the respiratory frequency into the LF band, thus increasing LF% and decreasing HF% to a similar degree in both RR and respiration, with decrease in mean RR but with minor differences in crude RR variability.

CONCLUSIONS

Simple mental and verbal activities markedly affect HRV through changes in respiratory frequency. This possibility should be taken into account when analyzing HRV without simultaneous acquisition and analysis of respiration.

Abbreviations and Acronyms   BP = blood pressure   HF = high frequency   HRV = heart rate variability   LF = low frequency   nu = normalized units   RR = RR interval   SEM = standard error of the mean

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