Effects of brief remote high ventilation breathwork with retention on mental health and wellbeing: a randomised placebo-controlled trial

Abstract

High ventilation breathwork with retention (HVBR) has been growing in popularity over the past decade and might be beneficial for mental and physical health. However, little research has explored the potential therapeutic effects of brief, remotely delivered HVBR and the tolerability profile of this technique. Accordingly, we investigated the effects of a fully-automated HVBR protocol, along with its tolerability, when delivered remotely in a brief format. This study (NCT06064474) was the largest blinded randomised-controlled trial on HVBR to date in which 200 young, healthy adults balanced for gender were randomly allocated in blocks of 2 by remote software to 3 weeks of 20 min daily HVBR (fast breathing with long breath holds) or a placebo HVBR comparator (15 breaths/min with short breath holds). The trial was concealed as a 'fast breathwork' study wherein both intervention and comparator were masked, and only ~ 40% guessed their group assignment with no difference in accuracy between groups. Both groups reported analogous credibility and expectancy of benefit, subjective adherence, positive sentiment, along with short- and long-term tolerability. At post-intervention (primary timepoint) for stress level (primary outcome), we found no significant group × time interaction, F(1,180) = 1.98, p = 0.16, η_p² = 0.01, d = 0.21), nor main effect of group, (F = 0.35, p = 0.55, η_p² < 0.01) but we did find a significant main effect of time, (F = 13.0, p < 0.01, η_p² = 0.07). There was a significant improvement in stress pre-post-intervention in both groups, however there was no significant difference in such improvement between groups. In addition to stress at follow-up, we found no significant group x time interactions for secondary trait outcomes of anxiety, depression, mental wellbeing, and sleep-related impairment. This was also the case for state positive and negative affect after the first session of breathwork and at post-intervention. Brief remote HVBR therefore may not be more efficacious at improving mental health than a well-designed active comparator in otherwise healthy, young adults.

Figure 1

Study participant flow.

Figure 2

Score distribution for primary outcome stress across all timepoints (pre-post-follow-up) for both intervention (green) and control (red) conditions. Means (± 95% CI error bars) in white and medians are middle lines within boxes, with higher scores inferring greater stress (score range 0–42). Boxplots also display quartiles and black circles represent outliers. Primary timepoint is post-intervention. Figure produced using R (version 4.3.2).