Neuromodulation Applied to Diseases: The Case of HRV Biofeedback

Asaf Gitler, Leen Vanacker, Marijke De Couck, Inge De Leeuw, Yoram Gidron

Research output: Contribution to journalReview articlepeer-review


The vagus or “wandering” nerve is the main branch of the parasympathetic nervous system (PNS), innervating most internal organs crucial for health. Activity of the vagus nerve can be non-invasively indexed by heart-rate variability parameters (HRV). Specific HRV parameters predict less all-cause mortality, lower risk of and better prognosis after myocardial infarctions, and better survival in cancer. A non-invasive manner for self-activating the vagus is achieved by performing a slow-paced breathing technique while receiving visual feedback of one’s HRV, called HRV-biofeedback (HRV-B). This article narratively reviews the biological mechanisms underlying the role of vagal activity and vagally mediated HRV in hypertension, diabetes, coronary heart disease (CHD), cancer, pain, and dementia. After searching the literature for HRV-B intervention studies in each condition, we report the effects of HRV-B on clinical outcomes in these health conditions, while evaluating the methodological quality of these studies. Generally, the levels of evidence for the benefits of HRV-B is high in CHD, pain, and hypertension, moderate in cancer, and poor in diabetes and dementia. Limitations and future research directions are discussed.

Original languageEnglish
Article number5927
JournalJournal of Clinical Medicine
Issue number19
StatePublished - 8 Oct 2022

Bibliographical note

Publisher Copyright:
© 2022 by the authors.


  • biofeedback
  • cancer
  • clinical outcomes
  • coronary heart disease
  • heart-rate-variability (HRV)
  • hypertension
  • pain
  • vagally mediated HRV (vmHRV)
  • vagus nerve

ASJC Scopus subject areas

  • General Medicine


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