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. 2025 Aug 13;17(1):330.
doi: 10.1186/s13098-025-01862-x.

Effect of slow deep breathing on cardiovascular autonomic neuropathy in type 2 diabetes mellitus patients

Miao Xuan  1 , Yuqin Shen  2 , Wenjun Tang  3 , Ping Fang  1 , Guanghui Liu  1 , Guanghe Li  2 , Qifan Sun  2 , Lingling Pan  4
Affiliations

Effect of slow deep breathing on cardiovascular autonomic neuropathy in type 2 diabetes mellitus patients

Miao Xuan et al. Diabetol Metab Syndr. .

Abstract

Objective: This study aimed to investigate the effects of slow deep breathing (SDB) on heart rate variability (HRV) in patients with type 2 diabetes mellitus (T2DM) patients with cardiovascular autonomic neuropathy (CAN).

Methods: Sixty patients with CAN secondary to type T2DM were randomly assigned to SDB (n = 30) and control (n = 30) groups. All patients were treated with mecobalamin (0.5 mg; times daily). Patients in the SDB group underwent slow deep breathing training against a background of soothing music. Before treatment and 3 months after treatment, height, body weight, heart rate (HR), blood pressure (BP), HbA1c, LDL, TG, heart-rate-variability (HRV), and hart rate recovery (HRR) were measured 1 min after the 6-min walk test in the two groups.

Results: BMI, SBP, DBP, HbA1c, LDL, and TG levels were comparable between the two groups and remained unchanged after treatment in two groups (P > 0.05). In the SDB group, the standard deviation of N-N intervals (SDNN), the square root of the mean squared differences of successive RR (RMSSD), low-frequency power (LF), high-frequency power (HF), and LF/HF ratio changed significantly after treatment (P < 0.05), and these measurements remained statistically significant after adjusting for age (P < 0.05), but HR and the root mean square of the difference between adjacent R-R intervals (PNN50) remained unchanged (P > 0.05). In the control group, HR, SDNN, RMSSD, PNN50, LF, HF, and LF/HF ratio remained unchanged after treatment (P > 0.05). The SBP, SDNN, RMSSD, LF, HF, and LF/HF ratios were significantly different between the two groups after treatment.(P < 0.05), and these measurements remained statistically significant after adjusting for age (P < 0.05). In addition, the HRR1 levels were comparable between the two groups (P > 0.05).

Conclusion: With soothing music as the background, sustained slow deep breathing training can improve heart rate variability in patients with type 2 diabetes mellitus and cardiac autonomic neuropathy, independent of age, providing a new approach for the treatment of cardiac autonomic neuropathy in type 2 diabetes.

Clinical trial number: The study was registered in the Chinese Clinical Trial Registry (ChiCTR2200063260).

Keywords: Cardiovascular autonomic neuropathy (CAN); Deep breathing; Heart rate recovery (HRR); Heart-rate-variability (HRV); Slow breathing; Type 2 diabetes.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of Tongji Hospital, Tongji University (2021-LCYJ-009). The study was conducted according to the Declaration of Helsinki, and written informed consent was obtained from each patient. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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