EC Neurology

Introduction: Prolonged Oral Vibratory Breathing (EVOP), part of the Solarte Psychoneuroimmunotherapy Technique, is a controlled breathing exercise combining prolonged exhalation with vocal vibration. Rooted in contemplative Eastern practices, it is hypothesized that EVOP stimulates the vagus nerve, promoting autonomic self-regulation with benefits across physical, mental, and emotional domains.

Objective: To critically review the scientific evidence regarding the physiological mechanisms, psychophysiological effects, and clinical applications of the EVOP technique, in order to establish its value as a complementary therapeutic tool.

Methods: A narrative review was conducted using comprehensive searches across PubMed, Embase, PsycINFO, and the Cochrane Library, with no language or date restrictions. Included studies were experimental, observational, and theoretical, focusing on variables such as heart rate variability (HRV), autonomic balance, cardiorespiratory synchronization, and emotional modulation. Due to heterogeneity, a qualitative synthesis was performed.

Results: EVOP activates vagal pathways via dual modulation-top-down (voluntary cortical control) and bottom-up (sensory afferents)-resulting in increased HRV, blood pressure reduction (~-5.6 mmHg systolic), and acute and chronic anxiety reduction. It enhances cardiorespiratory coherence, induces calm-alert states, improves sleep quality, and alleviates mild depressive symptoms. Clinical benefits have also been observed in asthma, COPD, dysautonomia, epilepsy, and cardiovascular rehabilitation.

Discussion: EVOP produces measurable systemic effects on autonomic and emotional regulation, supported by robust physiological mechanisms. Regular practice induces lasting increases in vagal tone and executive function. While few studies have investigated EVOP under its specific name, analogous techniques (e.g., bhramari, resonance breathing) provide strong indirect evidence. Success depends on patient education, gradual implementation, and adherence.

 Keywords: Vagus Nerve Stimulation; Heart Rate Variability; Breathing Exercises; Psychophysiology; Mind-Body Therapies

1. Gerritsen RJS and Band GPH. “Breath of life: the respiratory vagal stimulation model of contemplative activity”. Frontiers in Human Neuroscience 12 (2018): 397.
2. Kjaer TW., et al. “Increased dopamine tone during meditation-induced change of consciousness”. Brain Research. Cognitive Brain Research 2 (2002): 255-259.
3. Zaccaro A., et al. “How breath-control can change your life: a systematic review on psycho-physiological correlates of slow breathing”. Frontiers in Human Neuroscience 12 (2018): 353.
4. Chaitanya S., et al. “Effect of resonance breathing on heart rate variability and cognitive functions in young adults: a randomised controlled study”. Cureus2 (2022): e22187.
5. Trivedi G., et al. “Humming (Simple bhramari pranayama) as a stress buster: a Holter-based study to analyze heart rate variability (HRV) parameters during bhramari, physical activity, emotional stress, and sleep”. Cureus 4 (2023): e37527.
6. Heck DH., et al. “Breathing as a fundamental rhythm of brain function”. Frontiers in Neural Circuits 10 (2016): 115.
7. Magnon V., et al. “Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults”. Scientific Reports 1 (2021): 19267.
8. Chaddha A., et al. “Device and non-device-guided slow breathing to reduce blood pressure: A systematic review and meta-analysis”. Complementary Therapies in Medicine 45 (2019): 179-184.
9. Clark MA., et al. “39.4 Transport of Gases in Human Bodily Fluids - Biology 2e”. OpenStax OpenStax (2018).
10. Yuen AWC and Sander JW. “Can slow breathing exercises improve seizure control in people with refractory epilepsy? A hypothesis”. Epilepsy and Behavior 4 (2010): 331-334.
11. Kral TRA., et al. “Slower respiration rate is associated with higher self-reported well-being after wellness training”. Scientific Reports 1 (2023): 15953.
12. Jerath R., et al. “Self-regulation of breathing as an adjunctive treatment of insomnia”. Frontiers in Psychiatry 9 (2018): 780.
13. Yadav R., et al. “Efficacy of Bhramari pranayama and Om chanting on asthma control, quality of life, and airway inflammation in asthmatic children: an open-label randomized controlled trial”. Journal of Asthma 3 (2024): 249-259.
14. Yancey JR and Chaffee D. “The role of breathing exercises in the treatment of COPD”. American Family Physician 1 (2014): 15-16.
15. Vallabhajosyula S and Duggirala S. “Investigating the impact of electrocardiography biofeedback on POTS symptom management”. Journal of Emerging Investigators (2023).
16. Balban MY., et al. “Brief structured respiration practices enhance mood and reduce physiological arousal”. Cell Reports Medicine 1 (2023): 100895.
17. Arakaki X., et al. “The connection between heart rate variability (HRV), neurological health, and cognition: A literature review”. Frontiers in Neuroscience 17 (2023): 1055445.
18. Streeter CC., et al. “Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder”. Medical Hypotheses 5 (2012): 571-579.
19. Laborde S., et al. “The effect of slow-paced breathing on stress management in adolescents with intellectual disability”. Journal of Intellectual Disability Research 6 (2017): 560-567.
20. Ma X., et al. “The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults”. Frontiers in Psychology 8 (2017): 874.
21. Busch V., et al. “The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing--an experimental study”. Pain Medicine (Malden, Mass.) 2 (2012): 215-228.
22. Telles S and Naveen K. “Voluntary breath regulation in yoga: Its relevance and physiological effects” (2008).
23. Sengupta P. “Health impacts of yoga and pranayama: a state-of-the-art review”. International Journal of Preventive Medicine 7 (2012): 444-458.
24. Porges SW. “The polyvagal perspective”. Biological Psychology 2 (2007): 116-143.
25. Bradley RT., et al. “The coherent heart heart-brain interactions, psychophysiological coherence, and the emergence of system-wide order”. Integral Review 2 (2009): 10-115.
26. Brown RP and Gerbarg PL. “Yoga breathing, meditation, and longevity”. Annals of the New York Academy of Sciences 1172 (2009): 54-62.
27. Mooventhan A and Khode V. “Effect of Bhramari pranayama and OM chanting on pulmonary function in healthy individuals: A prospective randomized control trial”. International Journal of Yoga 2 (2014): 104-110.
28. Frontal Eye Fields. ResearchGate (2025).
29. Zambrano DB and Ávila CC. “Las neuronas espejo y su incidencia en el aprendizaje”. RES NON VERBA: Revista Científica 1 (2021): 54-72.
30. Jacob P. “What do mirror neurons contribute to human social cognition?” Mind and Language 2 (2008): 190-223.