Breathing Training for Cognitive Impairment

Overseen By Feng Lin, PhD

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: University of Rochester

Disqualifiers: Major depression, Cardiovascular diseases, Neurological diseases, others

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: Unknown

Duration: 8 weeks

114 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether adding a special breathing exercise to cognitive training can slow memory and thinking problems in older adults with mild cognitive impairment (MCI). Participants will try different combinations of training and breathing exercises, including Resonance Frequency Breathing (RFB), to determine which is most effective. Individuals diagnosed with mild memory issues related to Alzheimer's and who maintain a stable medication routine might be suitable for this study. The goal is to assess if these exercises can improve brain function and delay dementia symptoms. As a Phase 2 trial, this research measures the treatment's effectiveness in an initial, smaller group.

Will I have to stop taking my current medications?

The trial requires that if you are on Alzheimer's disease medication, antidepressants, anxiolytics, or medications for vascular risk or diseases, your dose should be stable for 3 months before joining. You don't need to stop these medications, but you should not change the dose during this period.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that a breathing technique called resonance frequency breathing (RFB) is generally safe. Studies suggest that slow breathing methods like RFB can improve heart rate variability, indicating better heart health. Proper instruction is important to ensure safety.

For the cognitive training part, known as VSOP, research indicates it significantly improves processing speed and attention in older adults. This training is often used for individuals with mild cognitive impairment (MCI) and is considered safe.

Participants in studies have well-tolerated both RFB and VSOP. There have been no significant reports of serious side effects for either treatment, making them promising options for those considering joining a trial. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about the breathing training for cognitive impairment because it offers a novel, non-invasive approach that could improve cognitive function. Unlike standard care options like medications, which often target neurotransmitters, this method utilizes Resonance Frequency Breathing (RFB) combined with Visual and Sensory Oriented Processing (VSOP) to potentially enhance brain health through focused breathing and visual exercises. This technique is unique as it harnesses the body's natural rhythms and may promote neuroplasticity, providing a fresh angle on tackling cognitive decline. Additionally, the use of app-guided exercises makes it accessible and easy to incorporate into daily routines, which could improve adherence and outcomes.

What evidence suggests that this trial's treatments could be effective for mild cognitive impairment?

Research has shown that combining a special breathing technique called resonance frequency breathing (RFB) with brain exercises can improve thinking skills in older adults with mild memory problems. In this trial, participants in the RFB+VSOP (MCI) arm will engage in this combination of treatments. Studies have found that deep, slow breathing like RFB enhances the effectiveness of brain exercises. Additionally, activities that connect the mind and body, including RFB, have been shown to help older adults with mild memory issues improve their thinking and daily activities. For the VSOP (Vision-based Speed of Processing) training, research has demonstrated that it helps people with mild memory problems think faster and pay better attention. Together, these treatments may improve brain function and slow memory decline. Participants in the IR+VSOP (MCI) arm will receive a control strategy using Guided Imagery Relaxation (IR) instead of RFB, while the IR only (MCI) arm will focus solely on IR. ^{1 2 3 6 7}

Are You a Good Fit for This Trial?

This trial is for older adults aged 60-89 with mild cognitive impairment due to Alzheimer's, who score within a specific range on cognitive assessments and can handle daily activities. They must be stable on certain medications if taken, speak English, have good vision and hearing for app use, and not have major cardiovascular diseases or other disqualifying conditions.

Inclusion Criteria

I am between 60 and 89 years old.

I live in my own home or with family.

English-speaking,

Exclusion Criteria

Current enrollment in another cognitive improvement study;

You have difficulty distinguishing colors.

You have had a problem with alcohol abuse that has affected your ability to think clearly within the last 5 years.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive an 8-week combined intervention of RFB+VSOP or control interventions with periodical booster training sessions

8 weeks

Weekly in-person check-in visits

Follow-up

Participants are monitored for long-term effects on ANS flexibility and cognitive function

14 months

Booster Sessions

Periodical booster training sessions to reinforce treatment effects

Throughout follow-up period

What Are the Treatments Tested in This Trial?

Interventions

• IR
• RFB
• VSOP

Trial Overview The study tests whether adding resonance frequency breathing (RFB) to processing speed/attention training (VSOP) enhances brain function in those with mild cognitive impairment. Participants are randomly assigned to combined RFB+VSOP intervention, VSOP with relaxation control, or waitlisted. The goal is to improve autonomic nervous system flexibility and slow dementia progression.

How Is the Trial Designed?

Group I: RFB+VSOP (MCI) Experimental Treatment 2 Interventions

For home-based RFB+VSOP: The investigators will instruct subjects to do 10-minutes of app- guided paced breathing at RF daily; for select days, there will be VSOP training immediately following RFB. A total of 8 weeks intervention. The investigators will extend the intervention for additional two weeks for make-up sessions.

Group II: RFB+VSOP (HC) Experimental Treatment 2 Interventions

this is a new healthy control intervention arm used for testing adherence related items. For home-based RFB+VSOP: The investigators will instruct subjects to do 10-minutes of app- guided paced breathing at RF daily; for select days, there will be VSOP training immediately following RFB. A total of 8 weeks intervention. The investigators will extend the intervention for additional two weeks for make-up sessions.

Group III: IR+VSOP (MCI) Active Control 2 Interventions

The control IR strategy will be used, set-up of which will be the same as the RFB + VSOP intervention group with IR replacing RFB. A total of 8 weeks intervention. The investigators will extend the intervention for additional two weeks for make-up sessions.

Group IV: IR only (MCI) Placebo Group 1 Intervention

Participants randomized to this condition will receive weekly in-person check-in visits, and perform daily 10-minute IR, so that the number of treatment contacts (though not duration) will be equivalent. A total of 8 weeks intervention. The investigators will extend the intervention for additional two weeks for make-up sessions.

Who Is Running the Clinical Trial?

University of Rochester

Lead Sponsor

Trials

883

Recruited

555,000+

National Institute of Nursing Research (NINR)

Collaborator

Trials

623

Recruited

10,400,000+

Stanford University

Collaborator

Trials

2,527

Recruited

17,430,000+

Published Research Related to This Trial

Slow breathing techniques (less than 10 breaths per minute) significantly enhance autonomic and central nervous system activities, leading to increased heart rate variability and changes in brain activity, as evidenced by EEG and fMRI studies.

These techniques are associated with improved psychological outcomes, such as increased relaxation and reduced anxiety and depression, suggesting that slow breathing can promote overall emotional well-being in healthy individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. Zaccaro, A., Piarulli, A., Laurino, M., et al.[2020]

Deep and slow breathing (DSB) significantly improved cognitive functions such as retention, attention, working memory, and spatial perception in elderly subjects, suggesting its potential as a dementia prevention strategy.

The study involved 45 elderly participants divided into three groups, with cognitive abilities measured before and after learning new skills, demonstrating that DSB before learning enhances cognitive performance compared to resting.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effect of Deep and Slow Breathing on Retention and Cognitive Function in the Elderly Population. Lee, SH., Park, DS., Song, CH.[2023]

Breathing at resonance frequency (RF) and RF + 1 breath per minute both significantly reduced muscle sympathetic nervous activity (MSNA) and improved cardiac baroreflex efficiency in ten healthy men, indicating beneficial effects on autonomic regulation.

While both breathing rates lowered systolic blood pressure, only RF showed a significant decrease, suggesting that breathing at RF may have a slightly greater impact on cardiovascular regulation compared to RF + 1.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acute effects of resonance frequency breathing on cardiovascular regulation. Pagaduan, J., Wu, SS., Kameneva, T., et al.[2023]

Participants who underwent eight sessions of an adaptive neurofeedback protocol focused on modulating frontal-midline theta (FMθ) oscillations were able to significantly increase FMθ activity, indicating that neurofeedback can effectively enhance this brain activity associated with cognitive control.

The training led to improved cognitive performance, as evidenced by significantly faster reaction times on a working memory task, while no such improvements were observed in participants receiving sham neurofeedback, suggesting the efficacy of the FMθ-meditation neurofeedback protocol.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Closed-Loop Frontal Midlineθ Neurofeedback: A Novel Approach for Training Focused-Attention Meditation. Brandmeyer, T., Delorme, A.[2020]

Heart rate variability biofeedback (HRVB) training, particularly through resonance frequency (RF) breathing, significantly improves heart rate variability (HRV) and positive mood, as shown in a study with three groups of participants.

The RF breathing group exhibited a higher LF/HF HRV ratio and lower systolic blood pressure compared to the control group, indicating that RF breathing is an effective method for enhancing HRV and reducing stress responses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Impact of Resonance Frequency Breathing on Measures of Heart Rate Variability, Blood Pressure, and Mood. Steffen, PR., Austin, T., DeBarros, A., et al.[2020]

A study with 64 participants showed that 4 weeks of heart rate variability biofeedback (HRVB) training significantly increased heart rate variability (HRV) indices and decreased breathing rates compared to relaxation training.

The results indicated that at least 3 weeks of HRVB training is necessary to see improvements in HRV and breathing rates, highlighting the effectiveness of this intervention for enhancing autonomic nervous system function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Four Sessions of Combining Wearable Devices and Heart Rate Variability (HRV) Biofeedback are Needed to Increase HRV Indices and Decrease Breathing Rates. Lin, IM., Chen, TC., Tsai, HY., et al.[2023]

In a study with 50 healthy participants, neurofeedback training (NFT) targeting the alpha rhythm significantly increased alpha amplitude and duration in the frontoparietal region, suggesting that alpha rhythm can be effectively trained.

Participants who underwent alpha NFT showed notable improvements in both working and episodic memory, particularly those with the greatest increases in alpha amplitude, indicating that this training may enhance cognitive functions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neurofeedback training of EEG alpha rhythm enhances episodic and working memory. Hsueh, JJ., Chen, TS., Chen, JJ., et al.[2023]

In a study of 58 healthy older adults, cognitive training significantly improved performance on tasks, particularly in divided attention and speed-of-processing, with the most notable improvement seen in the Double Decision task.

The training led to strengthened connectivity in the frontoparietal control network, which was associated with better task performance, suggesting that this brain network plays a key role in the benefits of cognitive training.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Proximal improvement and higher-order resting state network change after multidomain cognitive training intervention in healthy older adults. Hardcastle, C., Hausman, HK., Kraft, JN., et al.[2023]

A four-week training program of resonance breathing significantly improved heart rate variability (HRV) in young adults, indicating better health and stress adaptation, with specific improvements in HRV parameters like SDNN and pNN50.

Participants practicing resonance breathing also showed enhanced cognitive performance and reduced perceived stress levels, suggesting that this simple breathing technique can effectively alleviate anxiety and improve mental well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Resonance Breathing on Heart Rate Variability and Cognitive Functions in Young Adults: A Randomised Controlled Study. Chaitanya, S., Datta, A., Bhandari, B., et al.[2022]

In a study of 21 participants, the optimal breathing rate (resonance frequency, RF) for Heart Rate Variability Biofeedback (HRVB) was found to be unstable, changing in 66.7% of participants between test sessions, which suggests the need for individual assessment before each HRVB session.

Breathing at the individualized RF significantly increased heart rate variability (HRV) parameters (SDNN and RMSSD) compared to other breathing rates, indicating that personalized breathing techniques can maximize cardiovascular benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resonance frequency is not always stable over time and could be related to the inter-beat interval. Capdevila, L., Parrado, E., Ramos-Castro, J., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11247687/

“Brain‐IT”: Exergame training with biofeedback breathing in ... We proposed a novel intervention approach for mild neurocognitive disorders. It combines exergame‐based training with biofeedback‐guided resonance breathing.

2. trialx.com trialx.com/clinical-trials/listings/231337/breathing-relaxation-attention-training-health-in-older-adults-breathe/

Breathing, Relaxation, Attention Training, & Health in Older ... Clinical trial for Healthy Aging | Mild Cognitive Impairment , Breathing, Relaxation, Attention Training, & Health in Older Adults (BREATHE)

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10047962/

The Effect of Deep and Slow Breathing on Retention and ... These findings suggest that deep and slow breathing training could serve as a simple yet effective method for developing cognitive training ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S1041610224022865

Impact of mind-body interventions in older adults with mild ... Results indicated that mind-body interventions improved cognitive function, everyday activities functioning, and mindfulness, as well as resulting in a moderate ...

5. alzres.biomedcentral.com alzres.biomedcentral.com/articles/10.1186/s13195-025-01835-2

Structural brain improvements following individually tailored ... Structural brain improvements following individually tailored serious exergame-based training in mild neurocognitive disorders: exploratory ...

6. alzdiscovery.org alzdiscovery.org/uploads/cognitive_vitality_media/Breathing_Techniques.pdf

Breathing Techniques Resonant breathing can improve heart rate variability. Safety: Slow breathing techniques are safe but proper training is required. Page 2. 2. Last updated on ...

7. withpower.com withpower.com/trial/phase-3-cognitive-dysfunction-7-2020-18168

Breathing Training for Cognitive Impairment Is breathing training safe for humans? Research on slow breathing techniques, including resonance frequency breathing, shows they are generally safe for humans.