Increased exhalation to inhalation ratio during breathing enhances high-frequency heart rate variability in healthy adults

Psychophysiology. 2021 Nov;58(11):e13905. doi: 10.1111/psyp.13905. Epub 2021 Jul 20.


Heart rate variability (HRV) is a well-established surrogate of cardiac and emotional health that reflects the balance between sympathetic and parasympathetic activity of the autonomic nervous system. We examined the impact of manipulating exhalation to inhalation ratio (E:I) on HRV, without altering the intrinsic breathing rate of healthy individuals. We hypothesized that a longer exhalation relative to inhalation (E:I > 1) would shift HRV metrics in a direction consistent with increased parasympathetic activity. Twenty-eight individuals (16 young [6M, age = 21-28];12 older adults [6M, age = 66-80]) completed a task during which they paced breathing according to their intrinsic respiratory rate, but altered onset of exhalation and inhalation according to 1:1 sound cue (equal exhalation and inhalation duration) or 2:1 cue (exhalation twice as long as inhalation). Paced 1:1 breathing followed these task conditions to examine residual effects. Estimates of actual E:I ratio based on thoracic movement were 1.08(0.16) for 1:1 task and 1.33(0.20) for 2:1 task, which were significantly different from one another. HRV metrics derived from electrocardiogram included root mean square of the successive differences between normal heartbeats (RMSSD) and high-frequency (HF) HRV. Analyses of HRV metrics by block showed that RMSSD and HF-HRV were higher in the 2:1 task condition compared to 1:1. Time series analysis showed that HF-HRV increased after the end of the 2:1 task block and remained elevated for four minutes. These findings suggest that longer duration of exhalation relative to inhalation, without altering breathing rate, acutely increased RMSSD and HF-HRV, consistent with enhancement of cardiac vagal tone.

Keywords: autonomic nervous system; breathing; heart rate variability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Autonomic Nervous System / physiology*
  • Exhalation / physiology*
  • Female
  • Heart Rate / physiology*
  • Humans
  • Inhalation / physiology*
  • Male
  • Respiratory Rate / physiology*
  • Young Adult