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HRV effects on cognitive performance and neurological health

Updated: Oct 31, 2023

This article was written by our trainer Maria Vittoria Zulli

Training your Heart Rate Variability (HRV) is one main Biofeedback Method to increase and better performance in many different levels. HRV can be measured using various methods and is used as a tool to monitor and improve physiological and psychological health.

HRV as a Pathway to Enhanced Well-being and Performance

When it comes to well-being and performance optimisation, HRV occupies a central role as a dynamic indicator of our body’s equilibrium. This phenomenon unveils an intricate interplay between our physiological responses and our cognitive and emotional states, offering a promising avenue for enhancing overall well-being and maximising performance potential.

A high HRV is often associated with a well-adapted autonomic nervous system, signifying the body’s ability to navigate diverse challenges.

This plays a pivotal role in determining our capacity to manage stress, emotional fluctuations, and even our propensity for making healthier choices. High HRV has been linked with greater executive function, better dietary choices, controlled social media usage, and improved negativity avoidance (Fung et al., 2017; Mantantzis et al., 2020).

Increasing HRV involves a combination of lifestyle adjustments, mindfulness practices, and intentional choices that collectively contribute to a more harmonious physiological and mental state. There are several interventions that can naturally boost HRV and well-being without the need for biofeedback technology (see next section for in-depth information about biofeedback for increasing HRV).

HRV and Brain Activity

HRV has long been considered a marker of cardiovascular risk but is increasingly studied in relation to neural and cognitive processes. The ANS, which regulates HRV, is closely linked to the central nervous system (CNS), which includes the brain.

A high HRV indicates that there is a lot of variability in the time between heartbeats, which suggests that the autonomic nervous system is functioning well and is in balance.

When HRV is high, brain imaging studies have shown increased activity in areas responsible for cognitive control, attention, and emotion regulation (Arakaki et al., 2023).

This suggests that a flexible autonomic system, reflected in HRV, supports better brain function. Conversely, a low HRV indicates that there is less variability in the time between heartbeats, which may suggest that the autonomic nervous system is imbalanced, and it is often linked to stress or certain health conditions. Low HRV is also associated with altered brain patterns in regions related to emotion processing and cognitive performance (Mather et al., 2018).

Overall, while the exact nature of the relationship between HRV activity and brain activity is still being studied evidence suggests a direct correlation between the two. In simple terms, a healthy HRV coincides with a brain that is more capable of focused thinking, managing emotions, and optimal performance. This emphasises the close connection between our heart and brain, affecting our overall well-being and cognitive abilities.

HRV’s Role in Psychological Conditions and Cognitive Impairments

HRV and mental health

HRV is known to be closely related to psychological conditions such as depression, anxiety, and stress, serving as a valuable bio-signal indicator of mental health (Kim et al., 2018; Gorman & Sloan, 2000). Studies reveal a consistent pattern of significantly reduced HRV in patients with psychiatric disorders, including major depression (Nahshoni et al., 2004; Zhou et al., 2020), anxiety (Chalmers et al., 2014), bipolar disorder (Faurholt-Jepsen et al., 2017), panic disorder (McCraty et al., 2001), posttraumatic stress disorder (Tan et al., 2011) and schizophrenia (Moon et al., 2013) (see table below for study results).

Furthermore, a study conducted on stress showed that HRV variables changed in response to stress induced by various methods. These transformations often reflect low vagal activity and parasympathetic responses, with HRV being linked to cortical regions (e.g., ventromedial prefrontal cortex) involved in evaluating stressful situations (Kim et al., 2018).

HRV and emotional regulation

Alterations in HRV have been shown to influence brain activity in regions linked to emotion regulation, attention, and cognitive functions (Yoo et al., 2022). For instance, research highlights that emotional regulation associated with HRV increases coincide with changes in cerebral blood flow within areas crucial to emotional regulation and inhibitory processes (Lane et al., 2009). Notably, the amygdala and medial prefrontal cortex (mPFC), involved in the perception of threat and safety, show associations with HRV (Thayer et al., 2012). A study showed that greater resting HRV (RMSSD) was associated with stronger connectivity between amygdala-medial prefrontal cortex (mPFC) across age groups and that this increase in HRV was associated with better emotional regulation ability (Sakaki et al., 2016; Thayer et al., 2009). High HRV is thus associated with higher emotional well-being, correlated with lower levels of worry and rumination, lower anxiety, and generally more regulated emotional responding (Beauchaine et al., 2015; Ottaviani et al., 2016).

High resting HRV indicates flexible, dynamic autonomic activity regulation, signalling effective control of emotions based on context. A study has shown that Individuals with higher levels of resting HRV compared to those with lower resting levels exhibit context-appropriate emotional responses as indexed by emotion-modulated startle responses, fear-potentiated startle responses, and phasic heart rate responses in addition to behavioural and self-reported emotional responses (Melzig et al., 2009). Conversely, individuals with low resting HRV show delayed recovery from psychological stressors affecting cardiovascular, endocrine, and immune responses compared to those with higher levels of resting HRV (Weber et al., 2010).

HRV and executive functions

HRV also reflects executive control functions such as inhibiting unwanted responses and updating and monitoring working memory representation (Zahn et al., 2016). Numerous behavioural task studies highlight that higher resting HRV correlates with more adaptive executive control over emotional stimuli. Conversely, lower resting HRV is associated with hyper-vigilant and maladaptive cognitive responses to emotional stimuli, potentially impeding emotion regulation (Park et al., 2014). A study by Lee and colleagues further suggests a link between HRV and executive-function-related neural activity in patients with depressive or anxiety disorders (Lee et al., 2022).

HRV measures hold promise as potential early markers of cognitive impairment (Forte et al., 2019). Further studies have observed a positive relationship between higher resting HF and executive function (William et al., 2019) and higher RMSSD (indicative of greater vagal functioning) with improved working memory, attention, and inhibitory control (Hansen et al., 2003; Ottaviani et al., 2019).

HRV and neurodegenerative diseases

HRV also plays a role in neurodegenerative diseases. For instance, a study looking at HRV among mild cognitive impairment patients compared to patients with Alzheimer’s Disease showed that those who developed dementia with Lewy bodies presented lower HRV levels (including SNDD, RMSSD, LF, HF). These reduced HRV levels were accompanied by lower visuospatial and frontal executive functions (Allan et al., 2007; Kim et al., 2018). Moreover, neurodegenerative diseases, often accompanied by neuropsychiatric symptoms related to prefrontal cortical dysfunction, can alter the integrity of neural networks central to autonomic nervous regulation, which is indexed by HRV. Therefore, HRV emerges as a potential marker mirroring self-regulatory processes within neurodegenerative conditions. Research shows a positive link between higher HRV and improved cognitive and behavioural outcomes in individuals with neurodegenerative conditions (Liu et al., 2022). This suggests the possibility of HRV being a window into the intricate relation between cognitive function, autonomic regulation, and the complexities of neurodegeneration.

Below is a list of studies investigating how HRV biofeedback improves cognition, emotional processes and facilitates peak performance:



Allan, L. M., Ballard, C. G., Allen, J., Murray, A., Davidson, A. W., McKeith, I. G., & Kenny, R. A. (2007). Autonomic dysfunction in dementia. Journal of neurology, neurosurgery, and psychiatry, 78(7), 671–677.

Arakaki, X., Arechavala, R. J., Choy, E. H., Bautista, J., Bliss, B., Molloy, C., Wu, D. A., Shimojo, S., Jiang, Y., Kleinman, M. T., & Kloner, R. A. (2023). The connection between heart rate variability (HRV), neurological health, and cognition: A literature review. Frontiers in neuroscience, 17, 1055445.

Beauchaine, T. P., & Thayer, J. F. (2015). Heart rate variability as a transdiagnostic biomarker of psychopathology. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 98(2 Pt 2), 338–350.

Benarroch E. E. (1993). The central autonomic network: functional organization, dysfunction, and perspective. Mayo Clinic proceedings, 68(10), 988–1001.

Chalmers, J. A., Quintana, D. S., Abbott, M. J., & Kemp, A. H. (2014). Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis. Frontiers in psychiatry, 5, 80.

Diamond, L. M., Fagundes, C. P., & Butterworth, M. R. (2011). Attachment style, vagal tone, and empathy during mother-adolescent interactions. Journal of Research on Adolescence, 22(1), 165–184.

Faurholt-Jepsen, M., Kessing, L. V., & Munkholm, K. (2017). Heart rate variability in bipolar disorder: A systematic review and meta-analysis. Neuroscience and biobehavioral reviews, 73, 68–80.

Forte, G., Favieri, F., & Casagrande, M. (2019). Heart Rate Variability and Cognitive Function: A Systematic Review. Frontiers in neuroscience, 13, 710.

Forte, G., Favieri, F., & Casagrande, M. (2019). Heart Rate Variability and Cognitive Function: A Systematic Review. Frontiers in neuroscience, 13, 710.

Fung, B. J., Crone, D. L., Bode, S., & Murawski, C. (2017). Cardiac Signals Are Independently Associated with Temporal Discounting and Time Perception. Frontiers in behavioral neuroscience, 11, 1.

Goessl, V. C., Curtiss, J. E., & Hofmann, S. G. (2017). The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis. Psychological medicine, 47(15), 2578–2586.

Gorman, J. M., & Sloan, R. P. (2000). Heart rate variability in depressive and anxiety disorders. American heart journal, 140(4 Suppl), 77–83.

Hansen, A. L., Johnsen, B. H., & Thayer, J. F. (2003). Vagal influence on working memory and attention. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 48(3), 263–274.

Kim, H. G., Cheon, E. J., Bai, D. S., Lee, Y. H., & Koo, B. H. (2018). Stress and Heart Rate Variability: A Meta-Analysis and Review of the Literature. Psychiatry investigation, 15(3), 235–245.

Kim, H. G., Cheon, E. J., Bai, D. S., Lee, Y. H., & Koo, B. H. (2018). Stress and Heart Rate Variability: A Meta-Analysis and Review of the Literature. Psychiatry investigation, 15(3), 235–245.

Kim, M. S., Yoon, J. H., & Hong, J. M. (2018). Early differentiation of dementia with Lewy bodies and Alzheimer's disease: Heart rate variability at mild cognitive impairment stage. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 129(8), 1570–1578.

LANE, R., MCRAE, K., REIMAN, E., CHEN, K., AHERN, G., & THAYER, J. (2009). Neural correlates of heart rate variability during emotion. NeuroImage, 44(1), 213–222.

Lee, D., Kwon, W., Heo, J., & Park, J. Y. (2022). Associations between Heart Rate Variability and Brain Activity during a Working Memory Task: A Preliminary Electroencephalogram Study on Depression and Anxiety Disorder. Brain sciences, 12(2), 172.

Liu, K. Y., Elliott, T., Knowles, M., & Howard, R. (2022). Heart rate variability in relation to cognition and behavior in neurodegenerative diseases: A systematic review and meta-analysis. Ageing research reviews, 73, 101539.

Mantantzis, K., Schlaghecken, F., & Maylor, E. A. (2020). Heart Rate Variability Predicts Older Adults' Avoidance of Negativity. The journals of gerontology. Series B, Psychological sciences and social sciences, 75(8), 1679–1688.

Mather, M., & Thayer, J. (2018). How heart rate variability affects emotion regulation brain networks. Current opinion in behavioral sciences, 19, 98–104.

McCraty, R., Atkinson, M., Tomasino, D., & Stuppy, W. P. (2001). Analysis of twenty-four hour heart rate variability in patients with panic disorder. Biological psychology, 56(2), 131–150.

Melzig, C. A., Weike, A. I., Hamm, A. O., & Thayer, J. F. (2009). Individual differences in fear-potentiated startle as a function of resting heart rate variability: implications for panic disorder. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 71(2), 109–117.

Moon, E., Lee, S. H., Kim, D. H., & Hwang, B. (2013). Comparative Study of Heart Rate Variability in Patients with Schizophrenia, Bipolar Disorder, Post-traumatic Stress Disorder, or Major Depressive Disorder. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 11(3), 137–143.

Nahshoni, E., Aravot, D., Aizenberg, D., Sigler, M., Zalsman, G., Strasberg, B., Imbar, S., Adler, E., & Weizman, A. (2004). Heart rate variability in patients with major depression. Psychosomatics, 45(2), 129–134.

Ottaviani, C., Thayer, J. F., Verkuil, B., Lonigro, A., Medea, B., Couyoumdjian, A., & Brosschot, J. F. (2016). Physiological concomitants of perseverative cognition: A systematic review and meta-analysis. Psychological bulletin, 142(3), 231–259.

Ottaviani, C., Zingaretti, P., Petta, A. M., Antonucci, G., Thayer, J. F., & Spitoni, G. F. (2019). Resting heart rate variability predicts inhibitory control above and beyond impulsivity. Journal of Psychophysiology, 33(3), 198–206.

Park, G., & Thayer, J. F. (2014). From the heart to the mind: cardiac vagal tone modulates top-down and bottom-up visual perception and attention to emotional stimuli. Frontiers in psychology, 5, 278.

Sakaki, M., Yoo, H. J., Nga, L., Lee, T. H., Thayer, J. F., & Mather, M. (2016). Heart rate variability is associated with amygdala functional connectivity with MPFC across younger and older adults. NeuroImage, 139, 44–52.

Shaffer, F., & Ginsberg, J. P. (2017). An Overview of Heart Rate Variability Metrics and Norms. Frontiers in public health, 5, 258.

Shaffer, F., McCraty, R., & Zerr, C. 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.

Tan, G., Dao, T. K., Farmer, L., Sutherland, R. J., & Gevirtz, R. (2011). Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): a pilot study. Applied psychophysiology and biofeedback, 36(1), 27–35.

Thayer, J. F., & Lane, R. D. (2009). Claude Bernard and the heart-brain connection: further elaboration of a model of neurovisceral integration. Neuroscience and biobehavioral reviews, 33(2), 81–88.

Thayer, J. F., Åhs, F., Fredrikson, M., Sollers, J. J., & Wager, T. 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(2), 747–756.

Thayer, J. F., Hansen, A. L., Saus-Rose, E., & Johnsen, B. 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 : a publication of the Society of Behavioral Medicine, 37(2), 141–153.

Weber, C. S., Thayer, J. F., Rudat, M., Wirtz, P. H., Zimmermann-Viehoff, F., Thomas, A., Perschel, F. H., Arck, P. C., & Deter, H. C. (2010). Low vagal tone is associated with impaired post stress recovery of cardiovascular, endocrine, and immune markers. European journal of applied physiology, 109(2), 201–211.

Yoo, H. J., Nashiro, K., Min, J., Cho, C., Bachman, S. L., Nasseri, P., Porat, S., Dutt, S., Grigoryan, V., Choi, P., Thayer, J. F., Lehrer, P. M., Chang, C., & Mather, M. (2022). Heart rate variability (HRV) changes and cortical volume changes in a randomized trial of five weeks of daily HRV biofeedback in younger and older adults. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 181, 50–63.

Zahn, D., Adams, J., Krohn, J., Wenzel, M., Mann, C. G., Gomille, L. K., Jacobi-Scherbening, V., & Kubiak, T. (2016). Heart rate variability and self-control--A meta-analysis. Biological psychology, 115, 9–26.

Zhou, H., Dai, Z., Hua, L., Jiang, H., Tian, S., Han, Y., Lin, P., Wang, H., Lu, Q., & Yao, Z. (2020). Decreased Task-Related HRV Is Associated With Inhibitory Dysfunction Through Functional Inter-Region Connectivity of PFC in Major Depressive Disorder. Frontiers in psychiatry, 10, 989.

Economides, M., Lehrer, P., Ranta, K., Nazander, A., Hilgert, O., Raevuori, A., Gevirtz, R., Khazan, I., & Forman-Hoffman, V. L. (2020). Feasibility and Efficacy of the Addition of Heart Rate Variability Biofeedback to a Remote Digital Health Intervention for Depression. Applied psychophysiology and biofeedback, 45(2), 75–86.

Goessl, V. C., Curtiss, J. E., & Hofmann, S. G. (2017). The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis. Psychological medicine, 47(15), 2578–2586.

Henriques, G., Keffer, S., Abrahamson, C., & Horst, S. J. (2011). Exploring the effectiveness of a computer-based heart rate variability biofeedback program in reducing anxiety in college students. Applied psychophysiology and biofeedback, 36(2), 101–112.

Holzman, J. B., & Bridgett, D. J. (2017). Heart rate variability indices as bio-markers of top-down self-regulatory mechanisms: A meta-analytic review. Neuroscience and biobehavioral reviews, 74(Pt A), 233–255.

McCraty, R., & Tomasino, D. (2004). Heart rhythm coherence feedback: A new tool for stress reduction, rehabilitation, and Performance Enhancement. PsycEXTRA Dataset.

Nashiro, K., Yoo, H. J., Cho, C., Min, J., Feng, T., Nasseri, P., Bachman, S. L., Lehrer, P., Thayer, J. F., & Mather, M. (2023). Effects of a Randomised Trial of 5-Week Heart Rate Variability Biofeedback Intervention on Cognitive Function: Possible Benefits for Inhibitory Control. Applied psychophysiology and biofeedback, 48(1), 35–48.

Pagaduan, J. C., Chen, Y. S., Fell, J. W., & Wu, S. S. X. (2020). Can Heart Rate Variability Biofeedback Improve Athletic Performance? A Systematic Review. Journal of human kinetics, 73, 103–114.

Prinsloo, G. E., Derman, W. E., Lambert, M. I., & Laurie Rauch, H. G. (2013). The effect of a single session of short duration biofeedback-induced deep breathing on measures of heart rate variability during laboratory-induced cognitive stress: a pilot study. Applied psychophysiology and biofeedback, 38(2), 81–90.

Prinsloo, G. E., Rauch, H. G., Karpul, D., & Derman, W. E. (2013). The effect of a single session of short duration heart rate variability biofeedback on EEG: a pilot study. Applied psychophysiology and biofeedback, 38(1), 45–56.

Sherlin, L., Gevirtz, R., Wyckoff, S., & Muench, F. (2009). Effects of respiratory sinus arrhythmia biofeedback versus passive biofeedback control. International Journal of Stress Management, 16(3), 233–248.

Sutarto, A. P., Wahab, M. N., & Zin, N. M. (2013). Effect of biofeedback training on operator's cognitive performance. Work (Reading, Mass.), 44(2), 231–243.

Tinello, D., Kliegel, M., & Zuber, S. (2021). Does heart rate variability biofeedback enhance executive functions across the lifespan? A systematic review. Journal of Cognitive Enhancement, 6(1), 126–142.

van der Zwan, J. E., de Vente, W., Huizink, A. C., Bögels, S. M., & de Bruin, E. I. (2015). Physical activity, mindfulness meditation, or heart rate variability biofeedback for stress reduction: a randomized controlled trial. Applied psychophysiology and biofeedback, 40(4), 257–268.


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