Abstract
Decades of physiological and psychological research into human performance and wellness have established a critical role for vagus nerve signaling in peak physical and cognitive performance. We outline models and perspectives that have emerged through neuroscience and psychophysiology studies to elucidate how the vagus nerve governs human performance through its influence on central nervous system functions and autonomic nervous system activity. These functions include the monitoring and regulation of cardio-respiratory activity, emotional responses, inflammation and physical recovery, cognitive control, stress resilience, and team cohesion. We briefly review some useful interventions such as transcutaneous auricular vagus nerve stimulation, heart-rate variability biofeedback, and controlled breathing as accessible tools for enhancing vagal tone, improving executive functioning under pressure, and mitigating fatigue and burnout. We describe how these approaches and their biological underpinnings are rooted by psychological models like the Yerkes-Dodson law and Polyvagal theory to contextualize their effects on athletic performance. These perspectives suppor recent shifts in sports science toward integrating vagal-centered approaches as scalable, evidence-based strategies that can enhance human performance and wellness.
Introduction
Optimal human performance depends on a finely tuned balance between the sympathetic fight-or-flight system and the parasympathetic rest-and-digest brake. This balance is regulated by the 10th cranial nerve (CN X), also commonly known as the vagus nerve. This peripheral nerve provides rapid, bidirectional (afferent and efferent) communication between brain-stem nuclei and other vital organs, including the heart, lungs, spleen, and liver, as well as the small intestines. The structure and the function of the vagus enables swift cardiovascular down-regulation and continuous visceral feedback to the cortex (Berthoud and Neuhuber, ). Some visceral sensory functions of the vagus nerve underlie what many refer to as a sixth sense (Zagon, 2001; Zhao et al., 2022). Vagal regulation of cardiac activity is perhaps best recognized through the iconic mammalian diving reflex, which occurs when sensory fibers of the vagus and trigeminal nerve are stimulated by facial submersion to trigger bradycardia or a reduction in heart rate (Gooden, ; Khurana et al., ; Andersen, ). In this perspective article we briefly describe the anatomy and physiology of the vagus nerve in the context of recent evidence and neurobiological models to illustrate the essential roles of vagal activity in human performance and wellness.
High resting vagal tone, typically indexed by high-frequency heart-rate variability (HRV), is associated with lower resting heart rate (HR), more efficient baroreflexes, and greater neuro-visceral flexibility (Krygier et al., ). Because elite and recreational athletes face repeated exposures to heavy training loads and acute competitive stress, they offer a compelling model for translating vagal physiology into practice. Intense or poorly regulated arousal can erode mental health, slow cognitive processing, and prolong recovery (McLaughlin et al., ; Laborde et al., ), whereas acute elevations in vagal activity, achieved through slow-paced breathing, HRV biofeedback, or transcutaneous auricular vagus-nerve stimulation (taVNS), have been linked to faster post-exercise heart-rate recovery, sharper executive function under pressure, and improved cognitive resilience (., ; Jacobs et al., ; Murphy et al., ). Through ascending pathways, taVNS is known to modulate activity of the locus coeruleus (LC) and norepinephrine (NE), which are involved in regulating fight-or-flight sympathetic responses, cortical arousal, and attention (Urbin et al., 2021; Sharon et al., ; Frangos et al., ). Through the descending cholinergic anti-inflammatory pathway, it has been shown to reduce the production of pro-inflammatory cytokines (Czura and Tracey, ; Pavlov and Tracey, , ). With respect to athletic performance, a recent randomized trial demonstrated that a single week of daily taVNS increased maximal oxygen uptake and blunted exercise-induced inflammation in healthy adults (Ackland et al., ). As further detailed below, taVNS provides a means of modulating the autonomic nervous system to enhance physiological and psychological resilience.
Through the lens of psychophysiological models like Polyvagal theory, a deeper perspective of how vagus activity alters performance unfolds by distinguishing between an evolutionarily older, unmyelinated dorsal vagal pathway that mediates shutdown responses and a newer myelinated ventral branch that supports social engagement and rapid cardiac control (Porges, ). Athletes who can flexibly engage the dorsal vagal brake appear better able to operate within the optimal performance zone of the Yerkes–Dodson performance curve, alert yet composed, thereby avoiding the performance-sapping extremes of under- and over-arousal (Figure 1A) (Porges, ; Yerkes and Dodson, 1908). Mirroring the Yerkes-Dodson law, an inverted-U curve has also been used to model the influence of stress and LC/NE activity on task-based attention and performance (Figure 1B). It has been shown neurons of the LC tonically fire at low frequencies when a subject is bored or has low levels of engagement, while they fire tonically at high frequencies when attention is labile or subjects are hyper-aroused and easily distracted (Aston-Jones et al., ; Aston-Jones and Cohen, ). When subjects are optimally attentive and in a state of peak performance, neurons of the LC fire in a phasic mode reflecting task-based engagement (Aston-Jones et al., ; Aston-Jones and Cohen, ) (Figure 1B). We describe the implications of these models for understanding the role of vagal activity in sports performance, cognition, and mental health below.
Figure 1
Although interest in vagal regulation is growing, much of the existing literature remains fragmented, as most investigations address isolated outcomes such as cognition, inflammation, or team cohesion rather than offering an integrative model. Below, we provide a perspective that summarizes the latest neuro-cardiac research to describe vagal anatomy, physiology, and measurement in athletic contexts. We further provide a description of mechanistic links between vagal tone, cognitive control, emotion regulation, and recovery. Our perspective includes evidence for breathwork, HRV biofeedback, transcutaneous vagus nerve stimulation (tVNS), and environmental stressors acting as performance enhancers through modulation of vagal activity. By framing athletic readiness as a function of vagal tone and cardiac vagal activity, our perspective aims to equip coaches, clinicians, and sport scientists with empirically grounded approaches to optimize the performance of both mind and body.
Vagal physiology and autonomic regulation
The vagus nerve (CN X), the body's largest parasympathetic conduit, contains mixed afferent and efferent fibers that emerge from the brain stem's nucleus ambiguus and dorsal motor nucleus, traverse the neck, and innervate the heart, lungs, and abdominal viscera (Berntson et al.,
Figure 2

Central and peripheral mechanisms of autonomic arousal and the vagal brake. (A) The schematic shows the critical relationship between the environment, mind, and body as mediated by several cranial nerves, including the vagus (CN X), as similarly described by Polyvagal theory (Porges,
Stephen Porges' polyvagal theory refines this picture by describing two distinct vagal subsystems: an evolutionarily older, unmyelinated dorsal branch mediating shutdown and an evolutionarily newer, myelinated ventral branch enabling rapid cardiac regulation and social engagement (Porges,
Breathing mechanics offer a direct handle on this reservoir. Slow diaphragmatic breathing at ≈ 6 breaths·min−1 maximizes respiratory sinus arrhythmia when heart rate accelerates during inspiration as vagal influence momentarily wanes and decelerates on expiration as vagal input rebounds (Gerritsen and Band,
Peripheral somatic triggers can gate the brake even faster. The mammalian diving response epitomizes trigeminal-vagal synergy (Kinoshita et al.,
Vagal tone, cognition, and emotional resilience
Cardiac vagal activity is a peripheral window on central self-regulation. Cross-sectional studies in healthy adults repeatedly shows that higher high-frequency HRV, an index of vagal tone, tracks superior executive performance on tasks requiring sustained attention, working memory, set-shifting, and inhibition (Hansen et al.,
Beyond cognition, vagal tone underwrites emotional stability. Individuals with higher baseline HRV show muted heart rate and cortisol surges during social-evaluative stress and return to baseline more quickly, demonstrating a potent vagal brake on sympathetic arousal (Laborde et al.,
The concept of vagal flexibility refers to the autonomic nervous system's ability to rapidly withdraw parasympathetic (vagal) influence during physical or psychological challenge and to swiftly reinstate it during recovery (de Souza et al.,
Vagal regulation, particularly as indexed by cardiac vagal tone and HRV, extends beyond individual self-regulation to play a critical role in shaping social engagement and group dynamics. According to the polyvagal theory, higher baseline vagal tone supports adaptive self-regulation strategies and promotes prosocial behaviors such as seeking social support and emotional cooperation (Geisler et al.,
Regulation of psychophysiological arousal for functional performance
Athletic performance demands a finely tuned balance between sympathetic drive and parasympathetic restraint. More than a century ago, Yerkes and Dodson (1908) framed this trade-off as an inverted-U performance function with arousal or stress building to improve performance until a tipping point is reached, after which excess performance pressure degrades precision and judgment (Figure 1A). Modern autonomic science locates the fulcrum of that curve in the vagus nerve. Resting cardiac-vagal tone establishes an athlete's baseline arousal; a strong vagal brake keeps resting heart rate low and cortical networks calm, creating physiological headroom to upregulate during competition (Laborde et al.,
Controlled laboratory research supports this mechanistic link. When individuals with high resting HRV undertake a stressor such as timed mental arithmetic, heart rate and catecholamine rises remain proportionally smaller and executive accuracy is preserved; low-HRV counterparts show steeper physiological slopes and more errors (Hansen et al.,
HRV monitoring has therefore become a surrogate gauge of the real-time arousal landscape. Daily waking HRV provides a readiness score in which deviations below an individual's rolling average warn of sympathetic overload, infection, or sleep debt (Schipke and Pelzer,
Importantly, more vagal tone is not always better. While low HRV is consistently linked to poor health outcomes, stress, and overtraining (Bellenger et al.,
Rapid self-regulation strategies can help performers return to an optimal physiological state during competition. Engaging in slow diaphragmatic breathing particularly at a pace of six breaths per minute with extended exhalation, has been shown to enhance vagal activity and reduce systolic blood pressure within minutes (Van Diest et al., 2014; Afify,
Long-term autonomic training targets both tonic vagal tone and phasic flexibility. Regular practice of resonance frequency breathing, typically 10 min daily over a period of several weeks, has been shown to significantly increase resting HRV and enhance baroreflex sensitivity, a marker of improved autonomic regulation (Lehrer et al.,
Taken together, the modern understanding of arousal regulation is no longer defined by a static curve but by a dynamic, adaptable landscape shaped by vagal tone, autonomic flexibility, and situational context. Continuous monitoring tools make this internal terrain visible, while interventions such as resonance breathing, cold exposure, cognitive reappraisal, and HRV biofeedback give athletes the means to navigate it in real time. Anchoring training and recovery decisions to individualized autonomic data allows practitioners to keep performers balanced near the apex of the inverted-U, alert but not anxious, composed yet primed, where physical precision and cognitive clarity optimally converge (Figure 1).
Vagus nerve stimulation: from clinical neuromodulation to applied ergogenics
For decades, invasive VNS has been an accepted therapy for drug-resistant epilepsy and major depression, achieved by surgically wrapping an electrode around the cervical vagus and delivering intermittent pulses (Handforth et al.,
Acting on noradrenergic pathways to subdue sympathetic reactivity, transcutaneous trigeminal and vagal stimulation at tens of kHz has been shown to reduce salivary alpha amylase (a biomarker of NE activity), suppress galvanic skin conductance, increase skin temperature via sympathetic sudomotor relaxation (vasodilation), and decrease subjective stress in response to an electrical shock-mediated fear conditioning paradigm in healthy humans (Tyler et al., 2015). Transcutaneous auricular vagus nerve stimulation (taVNS) devices use different types of surface electrodes ranging from electrode ear-clips to earbud-style electrodes that target ABVN fibers via the external acoustic meatus, tragus, or cymba conchae of the external ear, providing self-directed neuromodulation in a comfortable, modular format (Tyler, 2025) (Figure 3A). Transcutaneous cervical vagus nerve stimulation (tcVNS) devices, first developed as an FDA-cleared treatment for headache, are applied to the side of the neck to stimulate the cervical vagal branches (Figure 3B). Both taVNS and tcVNS have been demonstrated to treat a wide range of clinical indications spanning: mood disorders like depression, anxiety and post-traumatic stress disorder; movement disorders like essential tremor and Parkinson's disease; neurophysical conditions and injuries like traumatic brain injury, spinal cord injury, and stroke; inflammatory conditions including pain and several autoimmune disorders; and other neurologic and neuropsychiatric disorders (Butt et al.,
Figure 3

Transcutaneous electrical nerve stimulation methods of non-invasive vagal modulation. Modern non-invasive vagus nerve stimulation methods enable the targeting of vagal fibers through the skin using compact, user-friendly embodiments of transcutaneous electrical nerve stimulation (TENS) devices designs. These TENS-like devices deliver low-intensity (< 10 mA) pulsed electrical currents through the skin to safely modulate vagal activity. (A) Shown are photographs of a transcutaneous auricular vagus nerve stimulation (taVNS) device (BRAIN Buds; IST, LLC) that utilizes conductive hydrogel earbud electrodes to access the auricular branch of the vagus lining the acoustic meatus of the external ear enabling comfortable and precise self-administration (Tyler, 2025). (B) A transcutaneous cervical vagus nerve stimulation (tcVNS) device (GammaCore; ElectroCore, Inc.) is shown applied to the neck to stimulate the cervical branch of the vagus nerve using metal contact electrodes (Silberstein et al.,
Transcutaneous VNS has recently gained attention for its safely modulate autonomic nervous system activity, inflammation, neuroplasticity, attention, stress, learning, mood, and sleep, by biasing the activity of brain nuclei and neurotransmitters known to regulate these processes, such as the LC and NE, respectively (Urbin et al., 2021; Tyler, 2025; Kim et al.,
Development of high levels of sport-specific executive functioning, including skill learning and memory, task-based attention, and rapid decision making are critical for elite athletes to achieve high levels of performance. Several studies have shown that transcutaneous VNS can enhance learning and memory based on to its ability to modulate human cortical arousal, hippocampal function, and attention (Jacobs et al.,
To enhance learning, reduce stress, or improve sleep, it is critical that tVNS interventions not overstimulate LC/NE activity or produce off-target effects that can arise from excessive or uncomfortable stimulus sensations, thereby overtaking intended taVNS performance outcomes (Tyler et al., 2019; Tyler, 2025; Miyatsu et al.,
Interestingly, kHz high-frequency stimulation (1–20 kHz) can reduce stimulus sensations while enabling higher peak currents to be delivered to cranial nerves in a manner that remains capable of reducing sympathetic activity and triggering widespread changes in cortical activity (Tyler et al., 2015, 2019; Mao et al.,
Other outcomes attributed to taVNS are useful for enhancing athletic performance and recovery. The cholinergic anti-inflammatory pathway (CAIP) involves the signaling of cytokine activity by visceral vagal afferents, which activates homeostatic brain regions and in turn the spleen via cholinergic vagal efferent fibers that act to reduce pro-inflammatory cytokine production. Several lines of evidence demonstrate that electrical VNS, including taVNS and tcVNS, can reduce inflammation by acting on the CAIP (Czura and Tracey,
Another recent study examined the influence of unilateral and bilateral taVNS on performance, pain, fatigue, and lactic acid levels in response to four consecutive days of 30 min of maximal exertion stationary cycling in healthy, young adults (Hatik et al.,
It has been hypothesized that physical exertion is limited by a central governor in the brain that receives afferent inputs from physiological systems, and that the conscious awareness of this activity is the major contributor to fatigue and failure of skeletal muscle (Noakes et al.,
Considering the sum of evidence described, transcutaneous VNS may represent an ultima thule for helping individuals overcome neurophysiological and psychological barriers to achieving peak performance. More rigorous studies are required to advance transcutaneous VNS, particularly for elite athletes. These studies need to evaluate both acute and long-term outcomes across physical, physiological, and psychological variables while standardizing methods of transcutaneous VNS intended to enhance athletic performance and recovery. Currently, from a practical standpoint, the scientific understanding of transcutaneous VNS suggests it is a promising application used alone or as a complementary tool for improving athlete performance and mental health.
Autonomic training strategies: controlled breathing, HRV biofeedback, and environmental exposure
The ability of an elite athlete to self-regulate and control arousal is one of the most critical psychological factors influencing their ability to achieve peak performance (Anderson et al.,
Figure 4

Modulation of autonomic arousal by heart rate variability biofeedback training. (A) The line plots illustrate the specificity of resonance frequency breathing (RF) on autonomic regulation. The top panel shows that participants in the RF group exhibited the greatest increase in LF/HF ratio during the breathing phase, indicative of optimized baroreflex resonance, while the RF+1 and control groups showed minimal or negative changes. The bottom panel shows systolic blood pressure (SBP) trends, where both RF and RF+1 groups exhibited reductions during training, but only the RF group maintained attenuated blood pressure reactivity during a subsequent stressor (Steffen et al.,
Joining rhythmic breathing practices with taVNS has gained attention recently. Some approaches known as respiratory gated auricular VNS (RAVNS) have been shown to differentially alter vagal engagement and brain activity depending on the phase (inhalation vs. exhalation) of the respiratory cycle when stimulation is delivered (Garcia et al.,
Heart rate variability biofeedback training (HRVBFT) is another intervention that teaches individuals to regulate their breathing and HR to increase HRV, thereby enhancing vagal tone and promoting autonomic flexibility (Lehrer and Gevirtz,
Training-related changes in autonomic function are evident in studies comparing HRVBFT to active control interventions. For example, repeated sessions of HRVBFT produce progressive increases in HRV amplitude over time, while control participants engaging in progressive muscle relaxation (PMR) techniques show minimal change (Lehrer and Gevirtz,
Environmental stimuli also represent a category of interventions that can influence autonomic function and vagal tone. The mammalian diving reflex, for instance, is a physiological response triggered by stimuli such as cold-water exposure, particularly during full facial submersion. This response involves a coordinated set of changes, including bradycardia (slowing of HR), peripheral vasoconstriction, and a shift in autonomic balance toward increased parasympathetic activity, mediated by the trigeminal (CN V) and vagus nerve (CN X). A systematic review and meta-analysis confirms that the diving response elicits significantly increased cardiac vagal activity, as measured by HRV root mean square of successive differences (RMSSD), producing moderate to large positive effect sizes during exposure compared to resting conditions (Ackermann et al.,
Contemplative practices and meditation are other natural, autonomic training strategies that have been investigated for their impact on neurophysiological markers and psychological states. Intensive mindfulness meditation training, such as Vipassana, has been associated with improvements in self-reported wellbeing and reductions in measures like depression and stress, alongside complex changes in HRV that may reflect altered autonomic function during meditation practice (Krygier et al.,
Figure 5

Contemplative practice reduces psychophysiological responses to stress. (A) The line plots illustrate how long-term contemplative practice modulates both the hypothalamic pituitary axis (HPA) and autonomic responses to psychosocial stress. The top panels show cortisol levels and subjective stress ratings while the bottom panels illustrate heart rate (HR) and heart rate variability root mean square of successive differences (RMSSD) in response to active and placebo Trier Social Stress Tests (TSST). (B) The histograms illustrate differences in cortisol concentrations for experienced meditation practitioners compared to naïve controls in response to stress (top) and during the recovery period (bottom). The data show acceptance-based coping strategies from meditation experience result in faster cortisol recovery (Taublieb,
Different types of meditation may have distinct effects on cardiac activity. For example, studies comparing breathing meditation, loving-kindness meditation, and observing-thoughts meditation have shown variations in heart rate and HF-HRV responses, suggesting that not all meditation practices elicit the same physiological state and that effects can change with training over time (Lumma et al.,
Autonomic training strategies such as breath control, HRV biofeedback, and meditation, along with targeted environmental exposures like those involved in the diving response, offer evidence-backed, non-pharmacological means of enhancing vagal capacity. These approaches can contribute to improved physiological and psychological regulation, underpinning composure, focus, and recovery. Rather than replacing fundamental physical preparation, these methods serve to create autonomic headroom, potentially allowing training adaptations to occur with fewer setbacks. They allow for mental preparation while being able to support performance by enhancing mastery during skills training and competition. Collectively, these strategies provide compelling evidence that modulation of individual performance and physiological responses can be controlled or influenced through non-invasive techniques, especially those acting through vagal signaling mechanisms.
Conclusion and future directions
The evidence across neuroscience, physiology, and sport science converges on one point: robust vagal tone is a reliable marker and modifiable driver of sharper cognition, steadier emotion, optimized arousal, and faster recovery in athletes. Simple, low-cost tools such as resonance-frequency breathing, HRVBFT, brief facial exposure to cold water, contemplative mindfulness practices, and transcutaneous VNS can enhance autonomic regulation and yield measurable gains, from improved executive function to higher VO2 max. Integrating these techniques with HRV-guided training loads and a polyvagal-informed team culture offers a pragmatic, non-pharmacological routes to enhancing vagal agility.
Wearable sensors and computational methods now provide continuous vagal biometrics and just-in-time coaching, while taVNS approaches offer the promise of on-demand neuromodulation and autonomic tuning. Research and validation can be further advanced by determining optimal taVNS frequency and dosing, evaluating individual moderators (baseline vagal tone, genotype, and training load), and studying seasonal and long-term outcomes. As adoption grows, safeguards around data privacy, informed consent, and balanced biomarker use are essential. The societal and ethical implications of utilizing neurotechnology for sports performance also needs to be given careful consideration. However, many natural top-down and bottom-up strategies discussed are globally available to everyone. These approaches should be implemented under the consultation of coaches, psychologists, and other performance experts to ensure athlete safety. Done properly with appropriate guidance or supervision, vagal-centric strategies can become a cornerstone of next-generation performance science. These approaches link lifestyle foundations to mental health while providing targeted interventions for broadening adaptive positive emotional responses, enhancing decision-making under pressure, and safeguarding the long-term resilience of athletes and other individuals seeking to optimize human performance and wellness.
Statements
Author contributions
CL: Conceptualization, Writing – original draft, Writing – review & editing. WT: Conceptualization, Supervision, Writing – original draft, Writing – review & editing.
Funding
The author(s) declare that financial support was received for the research and/or publication of this article. The development of BRAIN Buds by IST, LLC was funded based on research sponsored by Air Force Research Laboratory under agreement number FA8650-18-2-5402. The U.S. Government is authorized to reproduce and distribute reprints for Government purposes notwithstanding any copyright notation thereon.
Conflict of interest
WT is a co-founder and equity holding member of IST, LLC. WT has several pending and issued patents related to the neuromodulation methods described for enhancing cognition, skill training, learning, and human performance.
The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declare that no Gen AI was used in the creation of this manuscript.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Author disclaimer
The views and conclusions contained herein are those of the authors and should not be interpreted as necessarily representing the official policies or endorsements, either expressed or implied, of Air Force Research Laboratory (AFRL) or the U.S. Government.
References
1
AckermannS. P.RaabM.BackschatS.SmithD. J. C.JavelleF.LabordeS. (2022). The diving response and cardiac vagal activity: a systematic review and meta-analysis. Psychophysiology60:e14183. 10.1111/psyp.14183
2
AcklandG. L.PatelA. B. U.MillerS.Gutierrez del ArroyoA.ThirugnanasambantharJ.RavindranJ. I.et al. (2025). Non-invasive vagus nerve stimulation and exercise capacity in healthy volunteers: a randomized trial. Eur. Heart J.46, 1634–1644. 10.1093/eurheartj/ehaf037
3
AfifyA. M. (2023). Effect of diaphragmatic breathing exercise on cardiovascular parameters following noise exposure in pre hypertensive adults. J. Populat. Therap. Clin. Pharmacol.30:10. 10.47750/jptcp.2023.30.07.010
4
AndersenH. T. (1963). The reflex nature of the physiological adjustments to diving and their afferent pathway. Acta Physiol. Scand.58, 263–273. 10.1111/j.1748-1716.1963.tb02648.x
5
AndersonR.HanrahanS. J.MallettC. J. (2014). Investigating the optimal psychological state for peak performance in Australian elite athletes. J. Appl. Sport Psychol.26, 318–333. 10.1080/10413200.2014.885915
6
ArakakiX.ArechavalaR. J.ChoyE. H.BautistaJ.BlissB.MolloyC.et al. (2023). The connection between heart rate variability (HRV), neurological health, and cognition: a literature review. Front. Neurosci.17:1055445. 10.3389/fnins.2023.1055445
7
Aston-JonesG.CohenJ. D. (2005). An integrative theory of locus coeruleus-norepinephrine function: adaptive gain and optimal performance. Annu. Rev. Neurosci.28, 403–450. 10.1146/annurev.neuro.28.061604.135709
8
Aston-JonesG.RajkowskiJ.CohenJ. (1999). Role of locus coeruleus in attention and behavioral flexibility. Biol. Psychiatry46, 1309–1320. 10.1016/S0006-3223(99)00140-7
9
BellengerC. R.FullerJ. T.ThomsonR. L.DavisonK.RobertsonE. Y.BuckleyJ. D. (2016). Monitoring athletic training status through autonomic heart rate regulation: a systematic review and meta-analysis. Sports Med.46, 1461–1486. 10.1007/s40279-016-0484-2
10
BerntsonG. G.CacioppoJ. T.QuigleyK. S. (1993). Respiratory sinus arrhythmia: Autonomic origins, physiological mechanisms, and psychophysiological implications. Psychophysiology30, 183–196. 10.1111/j.1469-8986.1993.tb01731.x
11
BerthoudH.-R.NeuhuberW. L. (2000). Functional and chemical anatomy of the afferent vagal system. Auton. Neurosci.85, 1–17. 10.1016/S1566-0702(00)00215-0
12
BorgesU.KnopsL.LabordeS.KlattS.RaabM. (2020). Transcutaneous vagus nerve stimulation may enhance only specific aspects of the core executive functions. a randomized crossover trial. Front. Neurosci.14:523. 10.3389/fnins.2020.00523
13
BrethertonB.AtkinsonL.MurrayA.ClancyJ.DeucharsS.DeucharsJ. (2019). Effects of transcutaneous vagus nerve stimulation in individuals aged 55 years or above: potential benefits of daily stimulation. Aging11, 4836–4857. 10.18632/aging.102074
14
ButtM. F.AlbusodaA.FarmerA. D.AzizQ. (2019). The anatomical basis for transcutaneous auricular vagus nerve stimulation. J. Anat.236, 588–611. 10.1111/joa.13122
15
ÇalιA.ÖzdenA. V.CeylanI. (2023). Effects of a single session of noninvasive auricular vagus nerve stimulation on sports performance in elite athletes: an open-label randomized controlled trial. Expert Rev. Med. Devices21, 231–237. 10.1080/17434440.2023.2299300
16
CanslerR.HeidrichJ.WhitingA.TranD.HallP.TylerW. J. (2023). Influence of CrossFit and Deep End Fitness training on mental health and coping in athletes. Front. Sports Active Living5:1061492. 10.3389/fspor.2023.1061492
17
CarnevaliL.SgoifoA. (2014). Vagal modulation of resting heart rate in rats: the role of stress, psychosocial factors, and physical exercise. Front. Physiol.5:118. 10.3389/fphys.2014.00118
18
ChaitanyaS.DattaA.BhandariB.SharmaV. K. (2022). Effect of resonance breathing on heart rate variability and cognitive functions in young adults: a randomised controlled study. Cureus14:e22187. 10.7759/cureus.22187
19
ChenL.TangC.WangZ.ZhangL.GuB.LiuX.et al. (2024). Enhancing motor sequence learning via transcutaneous auricular vagus nerve stimulation (taVNS): an EEG study. IEEE J. Biomed. Health Inform.28, 1285–1296. 10.1109/JBHI.2023.3344176
20
ChenL.ZhangJ.WangZ.ZhangX.ZhangL.XuM.et al. (2022). Effects of transcutaneous vagus nerve stimulation (tVNS) on action planning: a behavioural and EEG study. IEEE Trans. Neural Syst. Rehabilit. Eng.30, 1675–1683. 10.1109/TNSRE.2021.3131497
21
ChenY.LuX.HuL. (2023). Transcutaneous auricular vagus nerve stimulation facilitates cortical arousal and alertness. Int. J. Environ. Res. Public Health20:1402. 10.3390/ijerph20021402
22
ColzatoL. S.WoltersG.PeiferC. (2017). Transcutaneous vagus nerve stimulation (tVNS) modulates flow experience. Exper. Brain Res.236, 253–257. 10.1007/s00221-017-5123-0
23
CroftJ. R.LaMacchiaZ. M.AldereteJ. F.MaestasA.NguyenK.O'HaraR. B. (2025). Transcutaneous auricular vagus nerve stimulation: efficacy, applications, and challenges in mood disorders and autonomic regulation—a narrative review. Military Med. 21:usaf063. 10.1093/milmed/usaf063
24
CsikszentmihalyiM. (1988). “The flow experience and its significance for human psychology,” in Optimal Experience: Psychological Studies of Flow in Consciousness, eds. M. Csikszentmihalyi and I. S. Csikszentmihalyi (Cambridge: Cambridge University Press), 15–35. 10.1017/CBO9780511621956.002
25
CsikszentmihalyiM. (1990). Flow: The Psychology of Optimal Experience. New York: Harper and Row.
26
CzuraC. J.TraceyK. J. (2005). Autonomic neural regulation of immunity. J. Intern. Med.257, 156–166. 10.1111/j.1365-2796.2004.01442.x
27
de SouzaP. M.RosárioN. S. A.de Castro PintoK. M.AssunçãoP. E.de OliveiraF. L. P.BearzotiE.et al. (2020). Vagal flexibility during exercise: impact of training, stress, anthropometric measures, and gender. Rehabil. Res. Pract.2020, 1–8. 10.1155/2020/6387839
28
DergachevaO.GriffioenK. J.NeffR. A.MendelowitzD. (2010). Respiratory modulation of premotor cardiac vagal neurons in the brainstem. Respir. Physiol. Neurobiol. 174, 102–110. 10.1016/j.resp.2010.05.005
29
FallerJ.CummingsJ.SaprooS.SajdaP. (2019). Regulation of arousal via online neurofeedback improves human performance in a demanding sensory-motor task. Proc. Nat. Acad. Sci.116, 6482–6490. 10.1073/pnas.1817207116
30
FisherA. J.SongJ.SoysterP. D. (2021). Toward a systems-based approach to understanding the role of the sympathetic nervous system in depression. World Psychiatry20, 295–296. 10.1002/wps.20872
31
ForteG.CasagrandeM. (2025). The intricate brain–heart connection: the relationship between heart rate variability and cognitive functioning. Neuroscience565, 369–376. 10.1016/j.neuroscience.2024.12.004
32
FrangosE.EllrichJ.KomisarukB. R. (2015). Non-invasive access to the vagus nerve central projections via electrical stimulation of the external ear: fMRI evidence in humans. Brain Stimul.8, 624–636. 10.1016/j.brs.2014.11.018
33
GamaiunovaL.BrandtP.-Y.BondolfiG.KliegelM. (2019). Exploration of psychological mechanisms of the reduced stress response in long-term meditation practitioners. Psychoneuroendocrinology104, 143–151. 10.1016/j.psyneuen.2019.02.026
34
GarciaR. G.CohenJ. E.StanfordA. D.GabrielA.StowellJ.AizleyH.et al. (2021). Respiratory-gated auricular vagal afferent nerve stimulation (RAVANS) modulates brain response to stress in major depression. J. Psychiatr. Res.142, 188–197. 10.1016/j.jpsychires.2021.07.048
35
GarciaR. G.StaleyR.AronerS.StowellJ.ScloccoR.NapadowV.et al. (2022). Optimization of respiratory-gated auricular vagus afferent nerve stimulation for the modulation of blood pressure in hypertension. Front. Neurosci.16:1038339. 10.3389/fnins.2022.1038339
36
GeislerF. C. M.KubiakT.SiewertK.WeberH. (2013). Cardiac vagal tone is associated with social engagement and self-regulation. Biol. Psychol.93, 279–286. 10.1016/j.biopsycho.2013.02.013
37
GerritsenR. J. S.BandG. P. H. (2018). Breath of life: the respiratory vagal stimulation model of contemplative activity. Front. Hum. Neurosci.12:397. 10.3389/fnhum.2018.00397
38
GoesslV. C.CurtissJ. E.HofmannS. G. (2017). The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis. Psychol. Med.47, 2578–2586. 10.1017/S0033291717001003
39
GoodenB. A. (1994). Mechanism of the human diving response. Integr. Physiol. Behav. Sci.29, 6–16. 10.1007/BF02691277
40
GourineA. V.AcklandG. L. (2019). Cardiac vagus and exercise. Physiology.34, 71–80. 10.1152/physiol.00041.2018
41
GullettN.ZajkowskaZ.WalshA.HarperR.MondelliV. (2023). Heart rate variability (HRV) as a way to understand associations between the autonomic nervous system (ANS) and affective states: a critical review of the literature. Int. J. Psychophysiol.192, 35–42. 10.1016/j.ijpsycho.2023.08.001
42
GurelN. Z.WittbrodtM. T.JungH.ShandhiM.d. M. HDriggersE. G.et al. (2020). Transcutaneous cervical vagal nerve stimulation reduces sympathetic responses to stress in posttraumatic stress disorder: a double-blind, randomized, sham controlled trial. Neurobiol. Stress13:100264. 10.1016/j.ynstr.2020.100264
43
HandforthA.DeGiorgioC. M.SchachterS. C.UthmanB. M.NaritokuD. K.TecomaE. S.et al. (1998). Vagus nerve stimulation therapy for partial-onset seizures. Neurology51, 48–55. 10.1212/WNL.51.1.48
44
HansenA. L.JohnsenB. H.ThayerJ. F. (2003). Vagal influence on working memory and attention. Int. J. Psychophysiol.48, 263–274. 10.1016/S0167-8760(03)00073-4
45
HarrisD. J.AllenK. L.VineS. J.WilsonM. R. (2021). A systematic review and meta-analysis of the relationship between flow states and performance. Int. Rev. Sport Exerc. Psychol.16, 693–721. 10.1080/1750984X.2021.1929402
46
HatikS. H.ArslanM.DemirbilekÖ.ÖzdenA. V. (2023). The effect of transcutaneous auricular vagus nerve stimulation on cycling ergometry and recovery in healthy young individuals. Brain Behav.13:e3332. 10.1002/brb3.3332
47
HenriquesG.KefferS.AbrahamsonC.Jeanne HorstS. (2011). Exploring the effectiveness of a computer-based heart rate variability biofeedback program in reducing anxiety in college students. Appl. Psychophysiol. Biofeedback36, 101–112. 10.1007/s10484-011-9151-4
48
HurwitzB. E.FuredyJ. J. (1986). The human dive reflex: an experimental, topographical and physiological analysis. Physiol. Behav.36, 287–294. 10.1016/0031-9384(86)90018-1
49
JacobsH. I. L.RiphagenJ. M.RazatC. M.WieseS.SackA. T. (2015). Transcutaneous vagus nerve stimulation boosts associative memory in older individuals. Neurobiol. Aging36, 1860–1867. 10.1016/j.neurobiolaging.2015.02.023
50
JigoM.CarmelJ. B.WangQ.RodenkirchC. (2024). Transcutaneous cervical vagus nerve stimulation improves sensory performance in humans: a randomized controlled crossover pilot study. Sci. Rep.14:3975. 10.1038/s41598-024-54026-8
51
Jiménez MorganS.Molina MoraJ. A. (2017). Effect of heart rate variability biofeedback on sport performance, a systematic review. Appl. Psychophysiol. Biofeedback42, 235–245. 10.1007/s10484-017-9364-2
52
JongkeesB. J.ImminkM. A.FinisguerraA.ColzatoL. S. (2018). Transcutaneous vagus nerve stimulation (tVNS) enhances response selection during sequential action. Front. Psychol.9:1159. 10.3389/fpsyg.2018.01159
53
KaravidasM. K.LehrerP. M.VaschilloE.VaschilloB.MarinH.BuyskeS.et al. (2007). Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression. Appl. Psychophysiol. Biofeedback32, 19–30. 10.1007/s10484-006-9029-z
54
KellyM. J.BreathnachC.TraceyK. J.DonnellyS. C. (2022). Manipulation of the inflammatory reflex as a therapeutic strategy. Cell Rep. Med.3:100696. 10.1016/j.xcrm.2022.100696
55
KhuranaR. K.WatabikiS.HebelJ. R.ToroR.NelsonE. (1980). Cold face test in the assessment of trigeminal-brainstem- vagal function in humans. Ann. Neurol.7, 144–149. 10.1002/ana.410070209
56
KimA. Y.MarduyA.de MeloP. S.GianlorencoA. C.KimC. K.ChoiH.et al. (2022). Safety of transcutaneous auricular vagus nerve stimulation (taVNS): a systematic review and meta-analysis. Sci. Rep.12:22055. 10.1038/s41598-022-25864-1
57
KinoshitaT.NagataS.BabaR.KohmotoT.IwagakiS. (2006). Cold-water face immersion per se elicits cardiac parasympathetic activity. Circ. J.70, 773–776. 10.1253/circj.70.773
58
KiviniemiA. M.HautalaA. J.KinnunenH.TulppoM. P. (2007). Endurance training guided individually by daily heart rate variability measurements. Eur. J. Appl. Physiol.101, 743–751. 10.1007/s00421-007-0552-2
59
KrausT.HöslK.KiessO.SchanzeA.KornhuberJ.ForsterC. (2007). BOLD fMRI deactivation of limbic and temporal brain structures and mood enhancing effect by transcutaneous vagus nerve stimulation. J. Neural Transm.114, 1485–1493. 10.1007/s00702-007-0755-z
60
KrygierJ. R.HeathersJ. A. J.ShahrestaniS.AbbottM.GrossJ. J.KempA. H. (2013). Mindfulness meditation, well-being, and heart rate variability: A preliminary investigation into the impact of intensive Vipassana meditation. Int. J. Psychophysiol.89, 305–313. 10.1016/j.ijpsycho.2013.06.017
61
LabordeS.MosleyE.MertgenA. (2018a). Vagal tank theory: the three RS of cardiac vagal control functioning – resting, reactivity, and recovery. Front. Neurosci.12:458. 10.3389/fnins.2018.00458
62
LabordeS.MosleyE.ThayerJ. F. (2017). Heart rate variability and cardiac vagal tone in psychophysiological research – recommendations for experiment planning, data analysis, and data reporting. Front. Psychol.08:213. 10.3389/fpsyg.2017.00213
63
LabordeS.MosleyE.UeberholzL. (2018b). Enhancing cardiac vagal activity: factors of interest for sport psychology. Sport Brain240, 71–92. 10.1016/bs.pbr.2018.09.002
64
LagosL.VaschilloE.VaschilloB.LehrerP.BatesM.PandinaR. (2008). Heart Rate Variability Biofeedback as a Strategy for Dealing with Competitive Anxiety: A Case Study.New York: Academic press.
65
LangdeauJ.-B.TurcotteH.DesgagnéP.JobinJ.BouletL.-P. (2000). Influence of sympatho-vagal balance on airway responsiveness in athletes. Eur. J. Appl. Physiol. 83, 370–375. 10.1007/s004210000306
66
Le MeurY.PichonA.SchaalK.SchmittL.LouisJ.GueneronJ.et al. (2013). Evidence of parasympathetic hyperactivity in functionally overreached athletes. Med. Sci. Sports Exerc. 45, 2061–2071. 10.1249/MSS.0b013e3182980125
67
LeeJ.KimJ. K.WachholtzA. (2015). The benefit of heart rate variability biofeedback and relaxation training in reducing trait anxiety. Hanguk Simni Hakhoe Chi Kongang20, 391–408. 10.17315/kjhp.2015.20.2.002
68
LehrerP. M.GevirtzR. (2014). Heart rate variability biofeedback: how and why does it work?Front. Psychol.5:756. 10.3389/fpsyg.2014.00756
69
LehrerP. M.VaschilloE.VaschilloB.LuS.-E.EckbergD. L.EdelbergR.et al. (2003). Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosom. Med.65, 796–805. 10.1097/01.PSY.0000089200.81962.19
70
LiuC.-H.YangM.-H.ZhangG.-Z.WangX.-X.LiB.LiM.et al. (2020). Neural networks and the anti-inflammatory effect of transcutaneous auricular vagus nerve stimulation in depression. J. Neuroinflam.17:54. 10.1186/s12974-020-01732-5
71
LummaA.-L.KokB. E.SingerT. (2015). Is meditation always relaxing? Investigating heart rate, heart rate variability, experienced effort and likeability during training of three types of meditation. Int. J. Psychophysiol.97, 38–45. 10.1016/j.ijpsycho.2015.04.017
72
MachetanzK.BerelidzeL.GuggenbergerR.GharabaghiA. (2021a). Transcutaneous auricular vagus nerve stimulation and heart rate variability: analysis of parameters and targets. Auton. Neurosci.236:102894. 10.1016/j.autneu.2021.102894
73
MachetanzK.BerelidzeL.GuggenbergerR.GharabaghiA. (2021b). Brain–heart interaction during transcutaneous auricular vagus nerve stimulation. Front. Neurosci.15:632697. 10.3389/fnins.2021.632697
74
MalikM. (1996). Heart rate variability. Ann. Noninv. Electrocardiol.1, 151–181. 10.1111/j.1542-474X.1996.tb00275.x
75
MaoY.ChenC.FalahpourM.MacNivenK. H.HeitG.SharmaV.et al. (2022). Effects of sub-threshold transcutaneous auricular vagus nerve stimulation on cingulate cortex and insula resting-state functional connectivity. Front. Hum. Neurosci.16:862443. 10.3389/fnhum.2022.862443
76
McCratyR. (2017). New frontiers in heart rate variability and social coherence research: techniques, technologies, and implications for improving group dynamics and outcomes. Front. Public Health5:267. 10.3389/fpubh.2017.00267
77
McLaughlinK. A.Rith-NajarianL.DirksM. A.SheridanM. A. (2013). Low vagal tone magnifies the association between psychosocial stress exposure and internalizing psychopathology in adolescents. J. Clin. Child Adoles. Psychol.44, 314–328. 10.1080/15374416.2013.843464
78
MeeusenR.DuclosM.FosterC.FryA.GleesonM.NiemanD.et al. (2013). Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the European College of Sport Science and the American College of Sports Medicine. Med. Sci. Sports Exerc. 45, 186–205. 10.1249/MSS.0b013e318279a10a
79
MiyatsuT.OviedoV.ReynagaJ.KaruzisV. P.MartinezD.O'RourkeP.et al. (2024). Transcutaneous cervical vagus nerve stimulation enhances second-language vocabulary acquisition while simultaneously mitigating fatigue and promoting focus. Sci. Rep.14:17177. 10.1038/s41598-024-68015-4
80
MoazzamiK.PearceB. D.GurelN. Z.WittbrodtM. T.LevantsevychO. M.HuangM.et al. (2023). Transcutaneous vagal nerve stimulation modulates stress-induced plasma ghrelin levels: A double-blind, randomized, sham-controlled trial. J. Affect. Disord.342, 85–90. 10.1016/j.jad.2023.09.015
81
MosleyE.LabordeS.KavanaghE. (2017). The contribution of coping related variables and cardiac vagal activity on the performance of a dart throwing task under pressure. Physiol. Behav.179, 116–125. 10.1016/j.physbeh.2017.05.030
82
MurphyA. J.O'NealA. G.CohenR. A.LambD. G.PorgesE. C.BottariS. A.et al. (2023). The effects of transcutaneous vagus nerve stimulation on functional connectivity within semantic and hippocampal networks in mild cognitive impairment. Neurotherapeutics20, 419–430. 10.1007/s13311-022-01318-4
83
NoakesT. D.St Clair GibsonA.LambertE. V. (2005). From catastrophe to complexity: a novel model of integrative central neural regulation of effort and fatigue during exercise in humans: summary and conclusions. Br. J. Sports Med.39, 120–124. 10.1136/bjsm.2003.010330
84
OlsenL. K.SolisE.McIntireL. K.Hatcher-SolisC. N. (2023). Vagus nerve stimulation: mechanisms and factors involved in memory enhancement. Front. Hum. Neurosci.17:1152064. 10.3389/fnhum.2023.1152064
85
OrtegaE.WangC. J. K. (2017). Pre-performance physiological state: heart rate variability as a predictor of shooting performance. Appl. Psychophysiol. Biofeedback43, 75–85. 10.1007/s10484-017-9386-9
86
PaciorekA.SkoraL. (2020). Vagus nerve stimulation as a gateway to interoception. Front. Psychol.11:1659. 10.3389/fpsyg.2020.01659
87
PandžaN. B.PhillipsI.KaruzisV. P.O'RourkeP.KuchinskyS. E. (2020). Neurostimulation and pupillometry: new directions for learning and research in applied linguistics. Annu. Rev. Appl. Linguist.40, 56–77. 10.1017/S0267190520000069
88
PavlovV. A.TraceyK. J. (2012). The vagus nerve and the inflammatory reflex—linking immunity and metabolism. Nat. Rev. Endocrinol.8, 743–754. 10.1038/nrendo.2012.189
89
PavlovV. A.TraceyK. J. (2022). Bioelectronic medicine: preclinical insights and clinical advances. Neuron110, 3627–3644. 10.1016/j.neuron.2022.09.003
90
PeiferC.SchulzA.SchächingerH.BaumannN.AntoniC. H. (2014). The relation of flow-experience and physiological arousal under stress—Can u shape it?J. Exp. Soc. Psychol.53, 62–69. 10.1016/j.jesp.2014.01.009
91
PhillipsI.CallowayR. C.KaruzisV. P.PandŽaN. B.O'RourkeP.KuchinskyS. E. (2021). Transcutaneous auricular vagus nerve stimulation strengthens semantic representations of foreign language tone words during initial stages of learning. J. Cogn. Neurosci.34, 127–152. 10.1162/jocn_a_01783
92
PhillipsI.JohnsM. A.PandŽaN. B.CallowayR. C.KaruzisV. P.KuchinskyS. E. (2025). Three hundred hertz transcutaneous auricular vagus nerve stimulation (taVNS) impacts pupil size non-linearly as a function of intensity. Psychophysiology62:70011. 10.1111/psyp.70011
93
PlewsD. J.LaursenP. B.StanleyJ.KildingA. E.BuchheitM. (2013). Training adaptation and heart rate variability in elite endurance athletes: opening the door to effective monitoring. Sports Med.43, 773–781. 10.1007/s40279-013-0071-8
94
PorgesS. W. (2001). The polyvagal theory: phylogenetic substrates of a social nervous system. Int. J. Psychophysiol.42, 123–146. 10.1016/S0167-8760(01)00162-3
95
PorgesS. W. (2007). The polyvagal perspective. Biol. Psychol.74, 116–143. 10.1016/j.biopsycho.2006.06.009
96
PorgesS. W. (2009). The polyvagal theory: new insights into adaptive reactions of the autonomic nervous system. Cleveland Clinic J. Med.76, S86–S90. 10.3949/ccjm.76.s2.17
97
RufenerK. S.GeyerU.JanitzkyK.HeinzeH.ZaehleT. (2018). Modulating auditory selective attention by non-invasive brain stimulation: differential effects of transcutaneous vagal nerve stimulation and transcranial random noise stimulation. Eur. J. Neurosci.48, 2301–2309. 10.1111/ejn.14128
98
SchipkeJ. D.PelzerM. (2001). Effect of immersion, submersion, and scuba diving on heart rate variability: figure 1. Br. J. Sports Med.35, 174–180. 10.1136/bjsm.35.3.174
99
ScloccoR.GarciaR. G.KettnerN. W.IsenburgK.FisherH. P.HubbardC. S.et al. (2019). The influence of respiration on brainstem and cardiovagal response to auricular vagus nerve stimulation: a multimodal ultrahigh-field (7T) fMRI study. Brain Stimul.12, 911–921. 10.1016/j.brs.2019.02.003
100
SegerstromS. C.NesL. S. (2007). Heart rate variability reflects self-regulatory strength, effort, and fatigue. Psychol. Sci.18, 275–281. 10.1111/j.1467-9280.2007.01888.x
101
ShafferF.MeehanZ. M. (2020). A practical guide to resonance frequency assessment for heart rate variability biofeedback. Front. Neurosci.14:570400. 10.3389/fnins.2020.570400
102
SharonO.FahoumF.NirY. (2020). Transcutaneous vagus nerve stimulation in humans induces pupil dilation and attenuates alpha oscillations. J. Neurosci.41, 320–330. 10.1523/JNEUROSCI.1361-20.2020
103
SilbersteinS. D.MechtlerL. L.KudrowD. B.CalhounA. H.McClureC.SaperJ. R.et al. (2016). Non–invasive vagus nerve stimulation for the ACute treatment of cluster headache: findings from the randomized, double-blind, sham-controlled ACT1 study. Headache56, 1317–1332. 10.1111/head.12896
104
SloanR. P.ShapiroP. A.BagiellaE.BoniS. M.PaikM.BiggerJ. T.et al. (1994). Effect of mental stress throughout the day on cardiac autonomic control. Biol. Psychol.37, 89–99. 10.1016/0301-0511(94)90024-8
105
SommerA.FischerR.BorgesU.LabordeS.AchtzehnS.LiepeltR. (2023). The effect of transcutaneous auricular vagus nerve stimulation (taVNS) on cognitive control in multitasking. Neuropsychologia187:108614. 10.1016/j.neuropsychologia.2023.108614
106
SteffenP. R.AustinT.DeBarrosA.BrownT. (2017). The impact of resonance frequency breathing on measures of heart rate variability, blood pressure, and mood. Front. Public Health5:222. 10.3389/fpubh.2017.00222
107
SunJ.-B.ChengC.TianQ.-Q.YuanH.YangX.-J.DengH.et al. (2021). Transcutaneous auricular vagus nerve stimulation improves spatial working memory in healthy young adults. Front. Neurosci.15:790793. 10.3389/fnins.2021.790793
108
SzeskaC.KlepzigK.HammA. O.WeymarM. (2025). Ready for translation: non-invasive auricular vagus nerve stimulation inhibits psychophysiological indices of stimulus-specific fear and facilitates responding to repeated exposure in phobic individuals. Transl. Psychiatry15:135. 10.1038/s41398-025-03352-0
109
SzulczewskiM. T. (2022). Transcutaneous auricular vagus nerve stimulation combined with slow breathing: speculations on potential applications and technical considerations. Neuromodulation25, 380–394. 10.1111/ner.13458
110
SzulczewskiM. T.D'AgostiniM.Van DiestI. (2023). Expiratory-gated transcutaneous auricular vagus nerve stimulation (taVNS) does not further augment heart rate variability during slow breathing at 0.1 Hz. Appl. Psychophysiol. Biofeedback48, 323–333. 10.1007/s10484-023-09584-4
111
TaubliebP. (2018). “Mind Gurus,” in Enhanced, Taublieb Films and Jigsaw Productions for ESPN Films. Available online at: https://vimeo.com/281118327 (Accessed June 1, 2025).
112
ThayerJ. F.YamamotoS. S.BrosschotJ. F. (2010). The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int. J. Cardiol.141, 122–131. 10.1016/j.ijcard.2009.09.543
113
TrifilioE.ShortellD.OlshanS.O'NealA.CoyneJ.LambD.et al. (2023). Impact of transcutaneous vagus nerve stimulation on healthy cognitive and brain aging. Front. Neurosci.17:1184051. 10.3389/fnins.2023.1184051
114
TylerW. J. (2025). Auricular bioelectronic devices for health, medicine, and human-computer interfaces. Front. Electr.6:1503425. 10.3389/felec.2025.1503425
115
TylerW. J.AdavikottuA.BlancoC. L.MysoreA.BlaisC.SantelloM.et al. (2025). Neurotechnology for enhancing human operation of robotic and semi-autonomous systems. Front. Robot. AI12:1491494. 10.3389/frobt.2025.1491494
116
TylerW. J.BoassoA. M.MortimoreH. M.SilvaR. S.CharlesworthJ. D.MarlinM. A.et al. (2015). Transdermal neuromodulation of noradrenergic activity suppresses psychophysiological and biochemical stress responses in humans. Sci. Rep.5:e13865. 10.1038/srep13865
117
TylerW. J.WyckoffS.HearnT.HoolN. (2019). The safety and efficacy of transdermal auricular vagal nerve stimulation earbud electrodes for modulating autonomic arousal, attention, sensory gating, and cortical brain plasticity in humans. bioRxiv, 732529. 10.1101/732529
118
UrbinM. A.LafeC. W.SimpsonT. W.WittenbergG. F.ChandrasekaranB.WeberD. J. (2021). Electrical stimulation of the external ear acutely activates noradrenergic mechanisms in humans. Brain Stimul.14, 990–1001. 10.1016/j.brs.2021.06.002
119
van der LindenD.TopsM.BakkerA. B. (2021). The neuroscience of the flow state: involvement of the locus coeruleus norepinephrine system. Front. Psychol.12:645498. 10.3389/fpsyg.2021.645498
120
van der ZwanJ. E.de VenteW.HuizinkA. C.BögelsS. M.de BruinE. I. (2015). Physical activity, mindfulness meditation, or heart rate variability biofeedback for stress reduction: a randomized controlled trial. Appl. Psychophysiol. Biofeedback40, 257–268. 10.1007/s10484-015-9293-x
121
Van DiestI.VerstappenK.AubertA. E.WidjajaD.VansteenwegenD.VlemincxE. (2014). Inhalation/exhalation ratio modulates the effect of slow breathing on heart rate variability and relaxation. Appl. Psychophysiol. Biofeedback39, 171–180. 10.1007/s10484-014-9253-x
122
VaschilloE.LehrerP.RisheN.KonstantinovM. (2002). Heart rate variability biofeedback as a method for assessing baroreflex function: a preliminary study of resonance in the cardiovascular system. Appl. Psychophysiol. Biofeedback27, 1–27. 10.1023/A:1014587304314
123
VesterinenV.NummelaA.HeikuraI.LaineT.HynynenE.BotellaJ.et al. (2016). Individual endurance training prescription with heart rate variability. Med. Sci. SportsExer.48, 1347–1354. 10.1249/MSS.0000000000000910
124
VillaniV.TsakirisM.AzevedoR. T. (2019). Transcutaneous vagus nerve stimulation improves interoceptive accuracy. Neuropsychologia134:107201. 10.1016/j.neuropsychologia.2019.107201
125
WeiL.ChenY.ChenX.BaekenC.WuG.-R. (2024). Cardiac vagal activity changes moderated the association of cognitive and cerebral hemodynamic variations in the prefrontal cortex. Neuroimage297:120725. 10.1016/j.neuroimage.2024.120725
126
WellsR.OuthredT.HeathersJ. A. J.QuintanaD. S.KempA. H. (2012). Matter over mind: a randomised-controlled trial of single-session biofeedback training on performance anxiety and heart rate variability in musicians. PLoS ONE7:e46597. 10.1371/journal.pone.0046597
127
YapJ. Y. Y.KeatchC.LambertE.WoodsW.StoddartP. R.KamenevaT. (2020). Critical review of transcutaneous vagus nerve stimulation: challenges for translation to clinical practice. Front. Neurosci.14:284. 10.3389/fnins.2020.00284
128
YerkesR. M.DodsonJ. D. (1908). The relation of strength of stimulus to rapidity of habit-formation. J. Compar. Neurol. Psychol.18, 459–482. 10.1002/cne.920180503
129
YoshidaY.OkayamaS.FujiharaD.TaniyamaM.YamadaA.FukuiM.et al. (2025). Effects of transcutaneous auricular vagus nerve stimulation on hemodynamics and autonomic function during exercise stress tests in healthy volunteers. Circul. Rep.7, 315–322. 10.1253/circrep.CR-24-0136
130
YuanH.SilbersteinS. D. (2015). Vagus nerve and vagus nerve stimulation, a comprehensive review: part I. Headache56, 71–78. 10.1111/head.12647
131
ZagonA. (2001). Does the vagus nerve mediate the sixth sense?Trends Neurosci.24, 671–673. 10.1016/S0166-2236(00)01929-9
132
ZhaoQ.YuC. D.WangR.XuQ. J.Dai PraR.ZhangL.et al. (2022). A multidimensional coding architecture of the vagal interoceptive system. Nature603, 878–884. 10.1038/s41586-022-04515-5
Summary
Keywords
vagus nerve, performance, cognition, stress, autonomic nervous system, sports, recovery
Citation
Lopez Blanco C and Tyler WJ (2025) The vagus nerve: a cornerstone for mental health and performance optimization in recreation and elite sports. Front. Psychol. 16:1639866. doi: 10.3389/fpsyg.2025.1639866
Received
02 June 2025
Accepted
24 June 2025
Published
11 July 2025
Volume
16 - 2025
Edited by
Laszlo Toth, Hungarian University of Sports Science, Hungary
Reviewed by
Ismail Ceylan, Ahi Evran University, Türkiye
Rubén Portes Sánchez, European University of Madrid, Spain
Updates

Check for updates
Copyright
© 2025 Lopez Blanco and Tyler.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: William J. Tyler wjpt@uab.edu
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.