Cardioscapes: Using Cardiac Biofeedback Through Real-Time Music Generation to Improve Effects of Resonance-Paced Breathing

Resonance-paced breathing (RPB) is a well-established method for modulate and maximise heart rate variability (HRV) through the synchronization of respiratory and cardiovascular rhythms. Although RPB is used as an adjunct tool in different clinical and non-clinical applications, adherence to regular practice remains a challenge, limiting its long-term benefits. Enhancing engagement through music and biofeedback may improve adherence by making the practice more rewarding and sustaining user motivation over time. Here we present a novel methodology that augments RPB with an adaptive system that delivers musical cues to guide the breathing exercise and dynamically modulates musical content in real time contingent on correct performance. In the RPB+ condition, real-time LF-HRV values modulated a pre-composed musical piece via control messages from Python to Ableton Live 12. Two biofeedback parameters were used: music volume, which scaled linearly with LF-HRV, and reverb level, which increased incrementally with sustained HRV levels. In the RPB- condition, participants observed only a visual pacer guiding their breathing. In a randomized crossover design, participants (N = 27) completed both conditions to validate the methodology in terms of preference, usability, and effects on anxiety and mindfulness. Participants reported a significant preference for RPB+ in enjoyment, relaxation, and future use. Music-enhanced RPB also produced larger decreases in anxiety than standard RPB. Stability analyses showed no difference in HRV levels between conditions, indicating that music neither negatively nor positively affected sustained HRV scores. These findings support the feasibility of integrating musical biofeedback into RPB protocols and suggest potential to enhance engagement and adherence through reward-based auditory modulation. This new methodology may help scale RPB as an adjunct clinical tool for at-home use.