I am always ready, if not quite happy, for this time of year. The earth has entered a period of darkness and stillness. In the evening I am ready to retire to bed at an earlier, healthier, hour. After the rush of the holiday season, I am able to spend more time at home with a specific emphasis on enjoying the subtlety of being.

It isn’t easy. Half the time I am wondering what I need to be doing that isn’t getting done. But I do have a little more spare time to relax, since I am not eager to get out into the cold weather. The question that I ask myself is “What do I DO to relax?” Well, isn’t that an oxymoron? The idea of relaxing is NOT to DO anything at all. Oh, yeah, I simultaneously realize and remember that I am not very good at relaxing.

I am just beginning to understand that my health depends not only on being able to have the energy and capacity to perform my activities, but also on my body’s ability to repair and restore itself. 

That is probably the single most important reason for me to learn how to relax. I am just beginning to understand that my health depends not only on being able to have the energy and capacity to perform my activities, but also on my body’s ability to repair and restore itself. I look at this as two sides of the same coin: I need to have active heart strength and passive heart strength, the ability to GO and the ability to SLOW.

Through my introduction to heart rate* in school, I learned that the stronger the muscle of the heart, the more blood it pumps with one beat. The one strong pump gives better “oomph” to the blood to travel to all of the body. When the heart can pump more blood more easily, it can also relax for a little bit longer into rest between pumps. And then I learned about heart rate variability. The healthy heart not only needs to demonstrate a well-paced rhythm and forceful contraction (heart rate), but it also needs to respond to the demands of life throughout the day (heart rate variability). Having the heart at one steady rhythm isn’t always the best thing. For example, less blood needs to be pumped when relaxing reading a book and more needs to be pumped when shoveling the snow. It’s like being able to go from 0 to 60 mph easily, and then return to idle at a gentle hum. One major difference between heart rate and heart rate variability it that the variations in heart rate are in response to the nervous system, and not just in response to the effort.

A person with higher heart rate variability has a heart and body with strong ability to tolerate stress.

Heart rate variability (HRV) is the variation in the length of the interval from one beat to the next. Throughout the day, the heart needs to balance signals to GO (sympathetic) and signals to SLOW (parasympathetic). The truth is, many of us are so busy going and responding to stress that we don’t adequately allow time for the heart to bounce back after a stressful situation by following it with rest. A person with higher heart rate variability has a heart and body with strong ability to tolerate stress. Sadly, this is difficult to measure. An electrocardiogram is the best tool, not readily available for use at a patient’s request.

The amazing thing (to me) is that heart rate changes slightly in every breath. The inhalation causes a slightly increased heart rate, and the exhalation creates a slightly slowed heart rate. So we have an access point to directing heart health since we can consciously control the breath. Yay! Research has begun to reflect that there are breathing, meditation, body awareness and relaxation, and self-compassion practices that can help to increase heart rate variability (despite physical fitness level). Following are two breathing practices to help access the parasympathetic nervous system to rest the heart.

Diaphragmatic breathing is the first technique and is the basis for all other breathing techniques. When the diaphragm participates, the parasympathetic nervous system (the part of the nervous system that tells the body and brain to SLOW) activates. The diaphragm is a muscle between the cavities of the lungs and abdomen that contracts as we inhale and relaxes as we exhale. The goal of this breath is to train the body to be a “belly breather.” To begin, lie down with one hand on the belly and one hand on the chest. As you take a few breaths, try to breathe through the nose. Take note of which hand rises first when you inhale. You will become better at recognizing the pattern as you practice connecting to the sensation of your abdomen and ribs during breathing. Begin to soften the belly with the inhalation and feel the belly-hand rise. During the exhalation, expel the air from the abdomen by tightening the muscles, feeling the hand on the belly descend. Try pursing the lips during the exhalation as if you were blowing out a candle to help instigate the correct muscles. Performing diaphragmatic breathing for 5 to 10 minutes in this way will be effective in accessing the stress-reducing qualities. Hopefully, as you progress, you will find that you can easily do this seated upright. In addition, you might find that you are able to train the body to breathe diaphragmatically rather than from the chest!

Equal length breathing builds upon the diaphragmatic breath. It asks the participant to begin to set a rhythm to the breath making the length of the inhalation match the length of the exhalation. One research study (Lin) showed that the most effective pace for reducing anxiety and increasing HRV was 5.5 breaths per minute. This roughly translates to a 5.5 second inhalation to exhalation ratio, but for the sake of ease, let’s call it 5 seconds. You can set a metronome, listen to a clock ticking, or simply count to yourself. As in the first exercise, find a comfortable position, breath through the nose, and use diaphragmatic breathing. If it is difficult to lengthen the breath to a 5:5 second ratio, start by noting the length that makes you most comfortable. After several breaths at that ratio, begin to lengthen the exhalation by one second for 10 rounds. Once you are comfortable with lengthening the exhaling, match the inhalation to that length. Work up slowly, possibly over several weeks, until 5:5 becomes comfortable. The duration of these breathing practices can begin in a set of 10 rounds (approximately 2 minutes), but may increase to as many as 30 or more breaths (5-6 minutes) to reap greatest benefit. Pay attention to your experience as you practice the exercise, you may feel your mood shift as you breath. One research study (Krygier) even showed that more important than the effect of the technique itself is the positive immersion of the participant in the task. If you find yourself distracted and would rather be somewhere else, the technique won’t help!

These practices are an introduction and a beginning. They can become increasingly effective when combined with body relaxation and meditation practices. They are also most effective for heart benefit when practiced consistently. So, during this season when you might find you truly want rest, take a few minutes in the morning, evening, or after a stressful situation, to try employing one of the above techniques. The health of your whole body will benefit.

~ Courtney Germano PT, DPT

*How to take your heart rate: Find your pulse at the thumb side of your wrist or at the side of your throat using your first two fingers laid gently over the skin. Count the number of pulses in 10 seconds and multiply that number by 6. This is your heart rate at rest. It will be lowest in the morning just at waking, and gets faster as you do more activity. Please see Jeff Clough’s post Walking for Heart Health from May 2016 for more information on heart health.

 

References

Krygier J, Heathers J, Shahrestani S, Abbott M, Gross J, Kemp A. Mindfulness meditation, well-being, and heart rate variability: A preliminary investigation into the impact of intensive Vipassana meditation. 2013 Sept;89(3):305-313.

Lin IM, Tai LY, Fan SY. Breathing at a rate of 5.5 breaths per minute with equal inhalation-to-exhalation ratio increases heart rate variability. Int’l J of Pyschophysiology. 2014 Mar;91(3):206-11.

Arch J, Brown K, Dean D, Landy L, Brown K, Laudenslager M. Self-compassion training modulates alpha-amylase, heart rate variability, and subjective responses to social evaluative threat in women. Psychoneuroendocrinology. 2014 Apr;42;49-58.

Brown RP, Gerbarg PL. Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part I-neurophysiological model. J of Alternative and Complementary Medicine. 2005 Feb;11(1):189-201.

Chandra SS, Sood S, Dogra R, Das S, Shukla SK, Gupta S. Effect of short-term practice of pranayamic breathing exercises on cognition, anxiety, general well being and heart rate variability. J of the Indian Med Assoc. 2013 Oct;111(10):662-5.

Dishman RK, Nakamura Y, Garcia M, Thompson R, Dunn A. Heart rate variability, trait anxiety, and perceived stress among physically fit men and women. International J of Psychophysiology. 2000; 37(2):121-133.

MacArther Research Network on SES & Health. The John D and Katherine T MacArthur Foundation, UCSF. Accessed Jan 17, 2018.

Mark’s Daily Apple, How to Increase Your Heart Rate Variability. Mark Sisson. https://www.marksdailyapple.com/how-to-increase-your-heart-rate-variability/. Accessed Jan 18, 2018.

Miu A, Heilman R, Mircea M. Reduced heart rate variability and vagal tone in anxiety: Trait versus state, and the effects of autogenic training. Autonomic Neuroscience. 2009;145(1-2):99-103.

Russell ME, Scott AB, Boggero, Carlson. Inclusion of a rest period in diaphragmatic breathing increases high frequency heart rate variability: Implications for behavioral therapy. Psychophysiology. 2017 Mar;54 (3):358-365.

Torok T, Rudas L, Kardos A, Paprika D. The effects of patterned breathing and continuous positive airway pressure on cardiovascular regulation in healthy volunteers. Acta Physiol Hung. 1997-1998;85(1):1-10.

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