Effect of breathing exercises on blood pressure and heart rate: A systematic review and meta-analysis

Author: Piyush Garg1,2, Ayushi Mendiratta2,3, Akshat Banga2,4, Anna Bucharles2,5, Piccoli Victoria2,5, Balakrishnan Kamaraj2,6, Rakhtan K Qasba2,7, Vikas Bansal2,8, Jayaraman Thimmapuram9, Robert Pargament9, Rahul Kashyap2,8,10,11
1 Medanta-The Medicity, Gurgaon, HR, India.
2 Global Clinical Scholars Research Trainee, Harvard Medical School, Boston, MA, USA.
3 Parkview Health System, USA.
4 Sawai Man Singh Medical College, Jaipur, RJ, India.
5 Universidade Positivo, Curitiba, Brazil.
6 Madurai Medical College, Madurai, TN, India.
7 Green Life Medical College and Hospital, Dhaka, Bangladesh.
8 Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
9 Department of Medicine, WellSpan Health, York, PA, USA.
10 Medical Director, Research, WellSpan Health, York, PA, USA.
11 GCSRT, Harvard Medical School, Boston, MA, USA.
Conference/Journal: Int J Cardiol Cardiovasc Risk Prev
Date published: 2023 Dec 27
Other: Volume ID: 20 , Pages: 200232 , Special Notes: doi: 10.1016/j.ijcrp.2023.200232. , Word Count: 258

Breathing exercises have been reported to have positive physiological effects on the body. The incidence of hypertension has become a major risk factor for cardiac complications leading to higher morbidity and mortality. Our aim was to conduct a systematic review and meta-analysis to study the effect of breathing exercises on blood pressure (BP) and heart rate (HR).

A systematic review and meta-analysis analyzing randomized clinical trials (RCTs) about the effect of breathing exercises on blood pressure was conducted (PROSPERO Registration ID: CRD42022316413). PubMed, ScienceDirect, WebofScience, and Cochrane Library databases were screened for RCTs from January 2017 to September 2022. The main search terms included "breathing exercise", "Pranayam", "Bhramari", "alternate nostril breathing", "deep breathing", "slow breathing", "hypertension", and "high blood pressure". The primary outcome was the value of the systolic blood pressure and diastolic blood pressure after the intervention. The effect on heart rate was also analyzed as a secondary outcome.

A total of 15 studies were included in the meta-analysis. Breathing exercises have a modest but significant effect on decreasing systolic blood pressure (-7.06 [-10.20, -3.92], P = <0.01) and diastolic blood pressure (-3.43 [-4.89, -1.97], P = <0.01) mm Hg. Additionally, breathing exercises were also observed to cause a significant decrease in the heart rate (-2.41 [-4.53, -0.30], P = 0.03) beats/minute.

In a comprehensive systematic review and meta-analysis of breathing exercises and its effect on BP and HR, there is a moderate but significant positive effect. The studies are not deprived of bias.

Keywords: Blood pressure; Breathing exercises; Hypertension; Pranayam; Systematic review.

PMID: 38179185 PMCID: PMC10765252 DOI: 10.1016/j.ijcrp.2023.200232