Let me set the scene: 47 tabs open. A grant application due in one hour. Emails and texts unread. More patient visits dropping into my calendar. Grad students asking to meet. And my coffee—a flat white—cold for hours.

Leg tapping. Blink rate high. I’ve been staring at my screen for hours and I need to submit this grant application, but I’m struggling to focus and my heart rate is climbing.

Sound familiar?

What I should have done was hit pause, close my eyes, and slow my breathe to the resonant frequency of my baroreflex. Ten long slow breathes. That’s it.

Here’s what science has taught me about how 6 breathes per minute changes how your heart and brain function under stress. It helps me and I hope it will help you too!

TLDR:
Practicing slow breathing often can regulate your blood pressure, improve your stress tolerance and promote heart-brain health for peak performance.

Workplace Relevance: Why Breathing is a Performance Strategy

The hidden cost of being “always on” is real, especially in high-pressure environments like the hospital neurology department. I see doctors grab a Coca-Cola for lunch, speed walk from clinic to procedures to labs and back, and stack meetings until there’s no air left in the day.

When stress takes over, your brain and body become inefficient. Energy gets burned on overdrive. Burnout isn’t just emotional, it’s been linked to higher rates of heart disease and impaired decision-making. Chronic tension and poor emotional regulation can quietly erode your effectiveness as a leader, clinician or team member.

Here’s the good news: 
Breathing is one of the most powerful – and free – tools we have to shift physiology back into balance. It takes only minutes, costs nothing, and reliably improves heart rate variability and physiological outcomes.

The Physiology: What Is Resonant Breathing?

Heart Rate Variability (HRV) refers to the subtle, beat-to-beat changes in your heart rhythm. It is a key indicator of an adaptable and resilient your nervous system. High HRV reflects adaptability, resilience and readiness to perform. Low HRV, is a red flag for chronic stress, burnout, and increased cardiovascular risk.

High = good, low = bad.

When I first heard this, it sounded counterintuitive. Wouldn’t high variability be bad? So let’s break it down:

Heart rate variability (HRV) is tightly linked to breathing through a phenomenon called respiratory sinus arrhythmia (RSA). Your heart rate naturally speeds up when you inhales, and slows down when you exhale. That variability is healthy. It reflects strong communication between your heart, lungs, and brain via the vagus nerve.

So, normal function looks like your heart rate rising during inhalation and falling during exhalation. That creates the variability. And this effect becomes strongest during slow, deep breathing. 

Baroreflex 101: (The fastest feedback loop you have)

The baroreflex (or baroreceptor reflex) is your ody’s internal blood-pressure thermostat. Stretch receptors in your carotid arteries and aorta detect pressure changes and send signals directly to the brainstem.

Within milliseconds—faster than any hormone system—the brain adjusts your autonomic nervous system: either activating the parasympathetic branch (to calm things down) or the sympathetic branch (to ramp things up).

It is essential for buffering sudden changes in blood pressure, such as when standing up quickly (preventing postural hypotension).

🧘‍♀️ Why 6 Breaths Per Minute?

Most people naturally breathe 12–20 times per minute. Slowing that down to around between 4.5–6.5 breaths per minute, hits the resonance frequency of the baroreflex for many adults*. This is about a 5-second inhale and a 5-second exhale.

At this pace, breathing:

• Lowers blood pressure
• Maximally stimulates the baroreflex
• Increases vagal tone
• Improves HRV

Slow, deep breathing – especially around 6 breaths per minute – optimally stimulates this baroreflex, increasing vagal tone and HRV

*See this paper on how the exact resonant frequency may vary depending on age and individuals.

Key & Consistent Findings:

A growing body of studies support both physiological mechanisms and health benefits of slow breathing and how it strengthens the baroreflex.

Slow Breathing Increases Baroreflex Sensitivity (BRS) and HRV

• Multiple studies demonstrate that slow breathing at around 6 breaths per minute increases parasympathetic activity, enhances baroreflex sensitivity, and improves HRV in both healthy individuals and those with hypertension or other conditions.

Health Benefits and Clinical Implications

• Improved baroreflex sensitivity is linked to better blood pressure regulation, reduced sympathetic tone, and lower cardiovascular risk.
• In hypertensive patients, slow breathing not only increased BRS but also significantly reduced systolic and diastolic blood pressure.
• Increased vmHRV is associated with better stress resilience and emotional regulation

Brain Health and Neural oscillations for Plasticity

• There is preliminary data to suggest increased vmHRV is associated with neural oscillations that indicate larger brain network changes and plasticity.

Letting the data tell the story

The most comprehensive recent meta-analysis on voluntary slow breathing and heart rate variability (HRV) was done by Laborde, Brown, and colleagues in 2022 and published in Neuroscience and Biobehavioral Reviews, a high-ranking peer-reviewed journal. To save you time, here’s the summary, with a link to the full article below.

• Scope:
  The review screened 1,842 abstracts and included 223 studies:
  • 172 studies measured HRV during a voluntary slow-breathing (VSB) session
  • 16 studies measured HRV immediately after one session
  • 49 studies measured HRV after a multi-session intervention
• Participants:
  • With 223 studies included, the review covers thousands of individuals across diverse populations and settings.
• Main Results:
  • Voluntary slow breathing reliably increases vagally-mediated HRV (vmHRV) both during the session, immediately after, and after multi-session interventions.
  • The effect is robust across healthy and clinical populations.
  • The findings support the use of slow breathing sessions as a low-cost, low-risk intervention to enhance parasympathetic (vagal) activity, which is linked to improved physical and mental health outcomes.
• Health Implications:
  • The review suggests that VSB could be widely recommended for health promotion and disease prevention.

How to Practice: A 5–10 Minute Daily Protocol

You don’t need special equipment. Just a timer and a few minutes.

A VSB session (Voluntary Slow Breathing session) is a structured period during which an individual intentionally slows their breathing rate to 6 cycles per minute, which is much slower than the normal adult breathing rate of 12–20 cycles per minute. This is usually achieved by consciously controlling both the inhalation and exhalation phases, often using a timer, app, or visual/audio cues. Sessions can vary (e.g., 5, 10, 15, or 20 minutes), and frequency (e.g., daily or 1-2 times per week) but even a single session can have measurable effects on heart rate variability (HRV) and vagal tone. Below is a guide for a breathe-work session of 5-10 minutes that can be done anywhere. I’ve included options for variability to you can tailor it to your needs. The basic resonant breathing is most simply 5 seconds in, 5 seconds out, repeat 10 times.

1. Settle (1–2 minutes) 🧘‍♂️

• Sit or lie comfortably
• Close your eyes or soften your gaze
• Notice your natural breath without changing it
• Release tension in the jaw, shoulders, and belly
• (I often stretch my arms overhead or side-bend first—yawning or coughing is a good sign.)
• Use a phrase like “this moment, this breath” or “aware, at ease” silently.

2. Choose a Breathing Pattern

• Option A: Resonant Breathing (5–5)
• Inhale 5 sec → Exhale 5 sec
• Best for baroreflex activation
• Breathing should be diaphragmatic (belly expands, chest quiet)
  
• Option B: Box Breathing (4–4–4–4)
• Inhale → Hold → Exhale → Hold
• Slightly faster than 6 bpm, but great for focus & calming before slowing further.
• Used by Navy Seals and first responders, this is also my personal favourite.
• Visualization: Imaging a square in front of you. You’re walking up the left side as you inhale. You walk along the top as you hold. You walk down the right side as you exhale. You walk along the bottom as you hold. Continue walking mindfully around the box.
  
• Option C: Extended Exhale (3–7)
• Inhale 3 sec → Exhale 7 sec
• Evidence shows longer exhales increase vagal activity
  
• Option D: 4–7–8 Breathing
• Popularized by Dr. Andrew Weil, this technique is designed for rapid stress relief, but it less rhythmic.
  
  If you’re new, start with 5–5 breathing.

Set the timer for 2-10 minutes, and begin.

🧘‍♂️ 3. Closing Down (1 minute)

• Return to natural breathing and place a hand on your chest or belly to reconnect with sensation
• Mentally note any shift in how you feel: calm, focused, grounded, buzzing, light.
• If you have a wearable HRV tracker, note the time and date so you can come back layer and see if it lowered your HRV and for how long.

Peak Performance Starts with the Baroreflex: Slow Breathing for Resilience and Recover

The best leaders don’t just think fast. They breathe slow.

As if this wasn’t enough, it may even change the brain. Imaging studies suggest breathing practices can increase connectivity in emotion-regulating areas like the insula and anterior cingulate cortex.

Already tried breathe work or tracked your HRV? What’s worked for you?

Sources

Laborde, S., Mosley, E., Mertgen, A., Thayer, J. F., & Brown, R. P. (2022). Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews, 138, 104729. https://doi.org/10.1016/j.neubiorev.2022.1