{
  "reviewed": "2026-07-15",
  "repositorySource": "/Users/fredericcollin/Documents/Projets/PulseWave/pulsewave-v5.5/src/data/breathingPatterns.ts",
  "levels": {
    "direct": "The named method or its defining phase structure was evaluated in the cited study.",
    "adjacent": "Research supports the broader breathing family or mechanism, not this exact app cadence.",
    "practice": "An editorial practice rhythm without a direct research match. It must not be described as clinically proven."
  },
  "sources": [
    {
      "id": "balban-2023",
      "title": "Brief structured respiration practices enhance mood and reduce physiological arousal",
      "authors": "Balban MY et al.",
      "journal": "Cell Reports Medicine",
      "year": 2023,
      "type": "Randomized controlled trial",
      "participants": "108 enrolled participants",
      "doi": "10.1016/j.xcrm.2022.100895",
      "pmid": "36630953",
      "url": "https://pubmed.ncbi.nlm.nih.gov/36630953/",
      "limit": "The trial studied five minutes per day for 28 days and compared three structured breathing practices with mindfulness. It did not test PulseWave."
    },
    {
      "id": "zaccaro-2018",
      "title": "How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing",
      "authors": "Zaccaro A et al.",
      "journal": "Frontiers in Human Neuroscience",
      "year": 2018,
      "type": "Systematic review",
      "participants": "15 eligible studies",
      "doi": "10.3389/fnhum.2018.00353",
      "pmid": "30245619",
      "url": "https://pubmed.ncbi.nlm.nih.gov/30245619/",
      "limit": "The review addresses slow breathing below 10 breaths per minute as a broad family. It does not establish that one exact inhale-to-exhale ratio is best."
    },
    {
      "id": "lehrer-2014",
      "title": "Heart rate variability biofeedback: how and why does it work?",
      "authors": "Lehrer PM and Gevirtz R",
      "journal": "Frontiers in Psychology",
      "year": 2014,
      "type": "Mechanistic review",
      "participants": "Review article",
      "doi": "10.3389/fpsyg.2014.00756",
      "pmid": "25101026",
      "url": "https://pubmed.ncbi.nlm.nih.gov/25101026/",
      "limit": "HRV biofeedback usually identifies or trains near an individual resonance frequency. A fixed six-breath-per-minute pacer is related, but it is not individualized biofeedback by itself."
    },
    {
      "id": "laborde-2024",
      "title": "Do Longer Exhalations Increase HRV During Slow-Paced Breathing?",
      "authors": "Meehan ZM and Shaffer F",
      "journal": "Applied Psychophysiology and Biofeedback",
      "year": 2024,
      "type": "Original and replication studies with literature review",
      "participants": "N=26 and N=16",
      "doi": "10.1007/s10484-024-09637-2",
      "pmid": "38507210",
      "url": "https://pubmed.ncbi.nlm.nih.gov/38507210/",
      "limit": "The two studies did not find an HRV advantage for a 1:2 over 1:1 inhale-to-exhale ratio at six breaths per minute. Longer exhalation should not be marketed as universally superior."
    },
    {
      "id": "ma-2017",
      "title": "The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults",
      "authors": "Ma X et al.",
      "journal": "Frontiers in Psychology",
      "year": 2017,
      "type": "Randomized study",
      "participants": "40 healthy adults",
      "doi": "10.3389/fpsyg.2017.00874",
      "pmid": "28626434",
      "url": "https://pubmed.ncbi.nlm.nih.gov/28626434/",
      "limit": "This study evaluated a multi-session diaphragmatic-breathing intervention. It does not validate every paced-breathing timer or a short one-off session."
    },
    {
      "id": "kox-2014",
      "title": "Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans",
      "authors": "Kox M et al.",
      "journal": "Proceedings of the National Academy of Sciences",
      "year": 2014,
      "type": "Randomized controlled experiment",
      "participants": "24 healthy male volunteers",
      "doi": "10.1073/pnas.1322174111",
      "pmid": "24799686",
      "url": "https://pubmed.ncbi.nlm.nih.gov/24799686/",
      "limit": "The intervention combined meditation, cyclic hyperventilation with retention and cold exposure before experimental endotoxemia. It is not evidence that PulseWave treats inflammation."
    },
    {
      "id": "eide-2026",
      "title": "Slow breathing techniques before bedtime and the effects on sleep: A systematic review",
      "authors": "Eide EM, Hernes HM and Grønli J",
      "journal": "Sleep Medicine Reviews",
      "year": 2026,
      "type": "Systematic review",
      "participants": "9 studies; 457 participants",
      "doi": "10.1016/j.smrv.2026.102284",
      "pmid": "41886931",
      "url": "https://pubmed.ncbi.nlm.nih.gov/41886931/",
      "limit": "Self-reported sleep outcomes were encouraging, while objective actigraphy and polysomnography findings were inconclusive. The authors call for longer, higher-quality studies."
    }
  ],
  "patterns": [
    {"id":"cyclic_sighing","name":"Cyclic Sighing","level":"direct","sources":["balban-2023"],"note":"The defining double inhale and prolonged exhale match the cyclic-sighing arm. The app itself was not studied."},
    {"id":"micro_reset","name":"Micro Reset 60s","level":"adjacent","sources":["zaccaro-2018","lehrer-2014"],"note":"A short 5–5 slow-breathing cadence. The one-minute product format was not directly evaluated by these reviews."},
    {"id":"coherence","name":"Coherent Breathing","level":"adjacent","sources":["zaccaro-2018","lehrer-2014"],"note":"Six breaths per minute is within the usual resonance-frequency range, but individual resonance varies."},
    {"id":"box","name":"Box Breathing","level":"direct","sources":["balban-2023"],"note":"Balban et al. included an equal-phase box-breathing arm. It does not establish superiority for every use case."},
    {"id":"sleep_478","name":"4-7-8 (Sleep)","level":"practice","sources":["eide-2026"],"note":"A popular wind-down cadence. The sleep review concerns slow breathing broadly and does not validate the precise 4-7-8 count."},
    {"id":"nsdr","name":"Deep mental recovery","level":"practice","sources":[],"note":"An app-authored slow-breathing and relaxation format. No direct paper is claimed for this exact session."},
    {"id":"resonance","name":"Resonance (0.1 Hz)","level":"adjacent","sources":["lehrer-2014","zaccaro-2018"],"note":"Related to HRV-biofeedback literature; a fixed pacer is not individualized biofeedback on its own."},
    {"id":"rhythmic_activation","name":"Rhythmic Activation","level":"adjacent","sources":["kox-2014","balban-2023"],"note":"The studies involved cyclic hyperventilation and retention, with important protocol and safety differences. No immune benefit is claimed for the app."},
    {"id":"extended_exhale_46","name":"Extended Exhale 4-6","level":"adjacent","sources":["zaccaro-2018","laborde-2024"],"note":"Slow breathing has a broader evidence base; current evidence does not show one exhale ratio is universally superior."},
    {"id":"extended_exhale_57","name":"Extended Exhale 5-7","level":"adjacent","sources":["zaccaro-2018","laborde-2024"],"note":"A slow, exhale-biased cadence. The exact 5–7 timing has not been directly validated here."},
    {"id":"anti_panic_36","name":"Anti-Panic 3-6","level":"practice","sources":["zaccaro-2018"],"note":"A conservative no-hold rhythm. The name describes intended use, not a treatment for panic disorder."},
    {"id":"grounding_55","name":"Grounding 5-5","level":"adjacent","sources":["zaccaro-2018","lehrer-2014"],"note":"The cadence falls within slow-breathing literature; “grounding” is product framing."},
    {"id":"cadence_365","name":"Cadence 3-6-5","level":"practice","sources":[],"note":"An app-authored progression rhythm without a direct research match."},
    {"id":"box_5555","name":"Box 5-5-5-5","level":"adjacent","sources":["balban-2023"],"note":"Related to equal-phase box breathing, but the trial does not establish this exact five-second variant."},
    {"id":"tactical_4334","name":"Tactical 4-3-3-4","level":"practice","sources":[],"note":"A performance-oriented app cadence. Operational use is not equivalent to controlled clinical evidence."},
    {"id":"triangle_444","name":"Triangle 4-4-4","level":"practice","sources":[],"note":"A simple three-phase coaching rhythm without a direct research match."},
    {"id":"coherent_56","name":"Coherent 5-6","level":"adjacent","sources":["zaccaro-2018","lehrer-2014","laborde-2024"],"note":"Slow and near the usual resonance range; the mild exhale bias is not proven superior."},
    {"id":"coherent_66","name":"Coherent 6-6","level":"adjacent","sources":["zaccaro-2018","lehrer-2014"],"note":"Five breaths per minute sits in the broad resonance range for many adults, but not necessarily every individual."},
    {"id":"sleep_369","name":"Sleep Ladder 3-6-9","level":"practice","sources":["eide-2026"],"note":"An app-authored bedtime cadence. The review does not validate this exact ladder or its breath hold."},
    {"id":"sleep_6810","name":"Sleep Deep 6-8-10","level":"practice","sources":["eide-2026"],"note":"A demanding app-authored bedtime cadence; objective sleep evidence for slow breathing remains inconclusive."},
    {"id":"nsdr_long","name":"Deep mental recovery (long)","level":"practice","sources":[],"note":"A longer app-authored relaxation format. It should not be described as equivalent to sleep."},
    {"id":"morning_activation_22","name":"Gentle Activation 2-2","level":"practice","sources":[],"note":"A brisk app-authored cadence without a direct research match."},
    {"id":"activation_26","name":"Activation 2-6","level":"practice","sources":[],"note":"An app-authored performance rhythm. “Activation” is an intended feel, not a measured outcome."},
    {"id":"focus_ladder","name":"Focus Ladder 4-5-6","level":"practice","sources":[],"note":"An app-authored cadence. No claim is made that the exact sequence improves cognition."},
    {"id":"pre_speech_46","name":"Pre-Speech 4-6","level":"adjacent","sources":["zaccaro-2018","laborde-2024"],"note":"Related to slow breathing and down-regulation; public-speaking performance was not directly tested."},
    {"id":"anxiety_release_27","name":"Anxiety Release 2-7","level":"practice","sources":["zaccaro-2018","laborde-2024"],"note":"A strongly exhale-biased app cadence. The label is not a claim to treat an anxiety disorder."},
    {"id":"recovery_47","name":"Recovery 4-7","level":"adjacent","sources":["zaccaro-2018","laborde-2024"],"note":"Related to slow breathing; “recovery” is an app goal rather than a clinically validated endpoint."},
    {"id":"low_hrv_support","name":"Low HRV Support 4-8","level":"practice","sources":["lehrer-2014","laborde-2024"],"note":"A fixed cadence is not individualized HRV biofeedback and must not be used for medical decisions."},
    {"id":"jetlag_reset_58","name":"Jetlag Reset 5-8","level":"practice","sources":[],"note":"A travel wind-down rhythm. It has not been shown to reset circadian timing or treat jet lag."},
    {"id":"sinus_relief_46","name":"Nasal Relief 4-6","level":"practice","sources":[],"note":"A gentle nasal-breathing cadence. It is not a treatment for sinus disease or obstruction."}
  ]
}