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studies have shown that slow breathing exercise promotes a breathing (around 7.5 breaths/minute) with equal times of
state of relaxation as well as positive psychological and inspiration and expiration (four seconds for inspiration and
emotional states and is considered an effective method for four seconds for expiration).
reducing stress and promoting physical and mental health. 5 Diaphragmatic breathing teaching was performed firstly
Our study was guided by the following questions: (1) with the children in a supine position. The children were
Would preschool children be able to learn a simple breathing instructed to direct their attention, watching the abdomen
technique in order to generate a significant effect on their move “up” and “down” during inhalation and exhalation,
ANS? (2) What specific effects does the breathing modulation respectively. Diaphragmatic breathing was then performed
generate on the ANS and on the heart rhythm patterns of with children sitting on the floor with crossed legs and an
preschool children? upright back, comfortably, with one hand on the chest and
In order to answer these questions, we used heart rate another on the abdomen, so that they could feel the breathing
patterns, heart rate variability (HRV), which is a simple and movement. Learning of the slow and rhythmic breathing
non-invasive form of autonomic pattern analysis that reveals occurred through the practice of counting one to four during
stress or relaxation status. Therefore, we evaluated the inspiration and during expiration.
6,7
effects of slow breathing exercise training on heart rate The training was conducted daily (Monday to Friday),
autonomic control and cardiorespiratory coherence in led by an experienced teacher, with 8 to 10 children per room
pre-school children. and lasting 20 minutes each meeting. Approximately half of
this time was for the guidelines and group practice, while the
METHOD other half was designated to provide personalized guidance
Study Population to each child in order to help them with particular difficulties

This prospective clinical study randomly enrolled that would occur.
127 pre-school children between five and six years old from In order to discard the influence of body position

middle-class family in Campinas, SP, Brazil. The parent’s (supine or sitting) on the ANS we evaluated a control group,
signed a consent letter after agreed with the study protocols. in which 33 children of the same age and the same school had
We excluded 52 children from the intervention group HRV assessed at the same conditions, without the practice of
according to the facts presented in Figure 1. Finally, the slow breathing exercise training.
experimental group was composed by 42 children aged
5.7 ± 0.3 years old; 27 (64.3%) were female. A control group Variables Measurement
was also selected with children from the same school and the Three data collection sessions were performed in the
same eligibility criteria. These groups were composed of 33 first, fourth and eighth week after the beginning of slow
preschool children aged 6.2 ± 0.3 years old; 21 (63.6%) were breathing exercise training. To minimize possible effects of
female. No participant from the control group was excluded. anxiety all children were exposed to the device before the
All procedures were followed the 466/2012 National first measurement. On the days of measurement, data were
Resolution and were approved by the Ethics Committee in collected from two to four children at a time. The number of
Research of UNESP/Botucatu. children in each measurement varied depending on the
availability of children and specific computers on which each
Exclusion criteria was registered, as well as the availability of measuring
We did not include subjects under the following instruments.
conditions: previous experience with techniques involving When children reached the room, we asked them to take
slow breathing exercise, infections, metabolic diseases, off their shoes and lie down on one of the four mats arranged
obesity, cardiopulmonary, psychological and neurological parallel to the ground, with the head turned toward the
related disorders, impairments that prevented the subject to computer (at the end of each mat was arranged a lap top
perform the protocols, those who reported acute clinical computer connected to a pulse sensor). Then we connected
diseases that require hospitalization, continue use of drugs one ear of each child’s ear lobe to a sensor.
that influence cardiac autonomic regulation, such as Data were collected in two phases with five minutes
propranolol and atropine and children who presented RR duration each. At first, children remained in a supine position
interval series with artifacts higher than 5%. and were instructed to close their eyes, relax and breathe
spontaneously. Variables (HRV and cardiorespiratory
Slow Breathing Exercise Training coherence) were measured during spontaneous breathing.
The preschool children performed a daily training over Then, children were asked to sit and breath in the rhythm of
eight weeks. They received instructions for practicing a 4 to 5 seconds of inhalation and 4 to 5 seconds of expiration,
breathing technique similar to a pranayama technique while data were collected. Data were collect at the end of the
(Sama-vritti), consisting of slow breathing, inhaling and 1st, 4th and 8th week of training. During variables measurement
exhaling in equal timeframes, which is the simplest technique we used background music for relaxation (Artist: Aurio Corrá)
recommended for beginners in breathing exercise. The slow in order to minimize sounds coming from the outside area and
breathing technique consisted of nasal, diaphragmatic, slow maintain a sonically homogeneous environment.

Zuanazzi Cruz—Slow Breathing Exercise on Heart Rate ALTERNATIVE THERAPIES, JUL/AUG 2020 VOL. 26 NO. 4 15