StressHRV DB BB PSSNCT07698652
Diaphragmatic and Box Breathing on Heart Rate Variability and Perceived Stress
A study testing Diaphramatic Breathing Training and Box Breathing Training in people with Stress and Psychological Resilience, run by Cairo University at 1 site in Egypt.
Trial summary
The goal of this clinical trial is to learn if diaphragmatic breathing and box breathing work to enhance resilience and manage stress in physical therapy students. It will also learn about their effects on overall physiological and psychological parameters. Read more about this study
- Who is it for?
- Ages 18 to 25 yearsHealthy volunteers can take part
- Conditions the study is for
- Stress, Psychological Resilience, Healthy Students
- What is being tested?
- Diaphramatic Breathing Training and Box Breathing Training
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 siteEgypt
- Study dates
- 20 Sep 2026to 1 Mar 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 25 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- Academic Status: Currently enrolled, full-time undergraduate Physical Therapy students
- Age Range: 18-25 years
- Health Status: Generally healthy individuals with no known chronic respiratory or cardiovascular diseases.
- Informed Consent: Ability and willingness to provide written informed consent and commit to the 4-week protocol (6 sessions/week).
- Stress Level: A baseline score on the Perceived Stress Scale (PSS) indicating at least moderate stress.
Who cannot join
- Pre-existing Breathing Expertise: Individuals with professional training in yoga (Pranayama), formal meditation, or advanced breath work that might bias the baseline results.
- Medical Conditions: Diagnosed respiratory conditions (e.g., Asthma, COPD).
- Cardiovascular issues (e.g., Arrhythmias, Hypertension).
- Clinical psychological disorders (e.g., Generalized Anxiety Disorder or Panic Disorder) that may require medication.
- Pharmacological Factors: Use of medications that influence the Autonomic Nervous System (e.g., Beta-blockers, antidepressants, or heavy use of stimulants/sedatives).
- Substance Use: Smokers/Vapers
- Excessive Caffeine "Participants consuming more than 400 mg of caffeine per day (equivalent to approximately 4 standard cups of brewed coffee) will be excluded.
- Recent Acute Illness: Any respiratory tract infection or fever within two weeks prior to the start of the study
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Abdelrahman A Mohamed, B.Sc. in Physical Therapy contact
Egypt1 site, 1 recruiting
- Recruiting
Faculty of Physical Therapy, Deraya University
Minya, Minya Province
Alaa N Abdelhameed Abdelmohsen, BSc in Physical Therapy, +201061382864, alaa.nasser1713@gmail.com
About this study
Official title: Enhancing Physiological and Psychological Resilience: A Comparative Study of Diaphragmatic and Box Breathing in Physical Therapy Students.
The goal of this clinical trial is to learn if diaphragmatic breathing and box breathing work to enhance resilience and manage stress in physical therapy students. It will also learn about their effects on overall physiological and psychological parameters. The main questions it aims to answer are:
Do these breathing techniques improve heart rate variability (HRV)?
Read more
How do these interventions affect participants' perceived stress levels, cognitive performance, and academic achievement?
Researchers will compare diaphragmatic breathing and box breathing to a control group to see if these non-invasive methods work to improve physiological adaptation and manage stress.
Participants will:
Be randomly assigned to practice diaphragmatic breathing, practice box breathing, or join a control group Have their heart rate variability (HRV) measured as a primary sign of physiological adaptation Complete assessments to evaluate their perceived stress, cognitive performance, and academic achievement
Read the detailed description
The Challenge: Stress in Healthcare Education University life is a demanding transitional period, and students training in healthcare fields like physical therapy often face immense academic and clinical pressures. Research shows that up to 50.1% of physiotherapy students experience high levels of stress, which can surge even higher during their hands-on clinical rotations. This stress is more than just an emotional burden; it actively impairs working memory, reduces attention span, and often leads to lower grades and poorer overall academic performance.
The Goal of the Study This study aims to discover if simple, accessible breathing exercises can help undergraduate physical therapy students build resilience and better manage their stress. Specifically, the research will compare the effectiveness of two distinct breathing techniques-diaphragmatic breathing and box breathing-to see how they impact both the mind (psychological stress and cognition) and the body (physiological adaptation).
How the Study Works The study will involve 60 undergraduate physical therapy students from Deraya University who are currently experiencing moderate to high levels of academic stress. These participants will be randomly divided into three equal groups: The Diaphragmatic Breathing Group: Participants will practice a relaxing, slow-paced breathing pattern. They will inhale through the nose for 4 seconds and exhale through the mouth for 6 seconds, focusing on expanding their abdomen. The Box Breathing Group: Participants will practice a structured technique often used in high-stress tactical environments to enhance stress tolerance. It involves a "4-4-4-4" cycle: inhaling for 4 seconds, holding the breath for 4 seconds, exhaling for 4 seconds, and holding the breath out for 4 seconds. The Control Group: Participants will simply continue their normal daily routines without any specific breathing interventions so researchers have a baseline for comparison. The two breathing groups will practice their designated techniques for 15 minutes a day, 6 days a week, over a 4-week period. What is Being Measured?To accurately determine if these techniques work, the study will evaluate several key areas:Heart Rate Variability (HRV): Using a highly accurate chest strap sensor (the Polar H10), researchers will measure the subtle variations in time between heartbeats. HRV is a primary indicator of how well the nervous system is regulating stress and keeping the body balanced. Stress and Resilience: Participants will complete standardized questionnaires to evaluate their perceived stress levels and their ability to "bounce back" from daily challenges. Cognitive and Academic Performance: The study will use specialized cognitive tests (like the Stroop Color-Word Test) to measure attention and executive functioning. It will also evaluate the students' confidence in their ability to manage time, prepare for exams, and succeed academically.
Why This Matters Because academic stress is incredibly prevalent among health sciences students, finding practical, non-medication-based ways to support their mental health is critical. By comparing these two breathing methods, this study hopes to identify an effective, non-invasive tool that students can easily use to lower their anxiety, improve their focus, and ultimately thrive in their demanding academic and clinical environments.
- Conditions
- Stress, Psychological Resilience, Healthy Students
- Being tested
- Diaphramatic Breathing Training, Box Breathing Training
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Diaphramatic Breathing TrainingBehavioural
Diaphragmatic Breathing Group:
Participants will sit comfortably with their hands in their abdomen. They will:
- Inhale through the nose for 4 seconds
- Exhale through the mouth for 6 seconds
- Focus on abdominal expansion and relaxation
- Continue for 15 minutes, 6 sessions/week, for 4 weeks
Box Breathing TrainingBehavioural
Box Breathing Group:
Participants will perform a structured breath cycle:
- Inhale for 4 seconds
- Hold for 4 seconds
- Exhale for 4 seconds
- Hold for 4 seconds
| Study group | Role | What they receive |
|---|---|---|
| Diaphragmatic Breathing Group | Experimental | Participants will sit comfortably with their hands in their abdomen. They will:
* Inhale through the nose for 4 seconds
* Exhale through the mouth for 6 seconds
* Focus on abdominal expansion and relaxation
* Continue for 15 minutes, 6 sessions/week, for 4 weeks Receives: Behavioral: Diaphramatic Breathing Training |
| Box Breathing Group | Experimental | Participants will perform a structured breath cycle:
* Inhale for 4 seconds
* Hold for 4 seconds
* Exhale for 4 seconds
* Hold for 4 seconds Sessions will last 15 minutes, 6 sessions/week, for 4 weeks Receives: Behavioral: Box Breathing Training |
| Control Group | No intervention | Participants will continue their normal daily routines and will not receive any breathing intervention during the study period |
What is being measured
The primary outcome is the main question the study is designed to answer.
Heart Rate Variability
HRV will be measured using the Polar H10 sensor and analyzed through Kubios HRV software to evaluate physiological resilience and autonomic nervous system regulation.
Measured: Baseline (pre-intervention) and at the end of the 4-week training period (post-intervention).
Perceived Stress
Stress will be measured using the Perceived Stress Scale (PSS-10). The total score ranges from a minimum of 0 to a maximum of 40. Higher scores indicate higher levels of perceived stress, representing a worse outcome
Measured: Baseline (pre-intervention) and at the end of the 4-week training period (post-intervention).
Resilience
Resilience will be measured using the Brief Resilience Scale (BRS). The score ranges from a minimum of 1 to a maximum of 5. Higher scores indicate higher levels of resilience, representing a better outcome
Measured: Baseline (pre-intervention) and at the end of the 4-week training period (post-intervention).
Secondary outcomes (2)
Cognitive Performance
Cognitive performance will be assessed using the Stroop Color-Word Test. The score represents the number of correct responses. The minimum possible score is 0, with no strictly defined maximum. Higher scores indicate better cognitive performance, representing a better outcome
Measured: Baseline (pre-intervention) and at the end of the 4-week training period (post-intervention).
Academic Achievement
Academic achievement will be assessed using the 9-item Academic Self-Efficacy Scale (ASE). The total score ranges from a minimum of 9 to a maximum of 63. Higher scores indicate higher levels of academic self-efficacy, representing a better outcome
Measured: Baseline (pre-intervention) and at the end of the 4-week training period (post-intervention).
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Jul 2026
- Study start20 Sep 2026
- Primary completion30 Dec 2026 (estimated)
- Study completion1 Mar 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for StressStudies of the same condition, open and under way.
- More trials run by Cairo UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Cairo University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Alaa Naseer Abdelhameed Abdelmohsen, Cairo University
- Investigators
- Rana H Elbanaa, Assoiate Professor, Study chair, Cairo UniversityFatma Y Abdelsalam, Lecturer, Study director, Cairo University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07698652
- Sponsor's protocol ID
- P.T.REC/012/006639
- Acronym
- HRV DB BB PSS
- Status last verified
- Sep 2026
- First submitted
- 7 Jul 2026
- Last updated
- 28 Sep 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: Individual participant data will not be shared to maintain participant privacy and strictly adhere to confidentiality agreements.
Study at a glance
From the registry record, last updated by the sponsor on 28 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Enhancing Physiological and Psychological Resilience: A Comparative Study of Diaphragmatic and Box Breathing in Physical Therapy Students.
- ClinicalTrials.gov ID
- NCT07698652
- Acronym / sponsor ID
- HRV DB BB PSS / P.T.REC/012/006639
- Conditions
- Stress, Psychological Resilience, Healthy Students
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 60 participants (estimated)
- Lead sponsor
- Cairo UniversityUniversity, hospital or other
- Study start
- 20 Sep 2026 (actual)
- Primary completion
- 30 Dec 2026 (estimated)
- Study completion
- 1 Mar 2027 (estimated)
- First posted
- 13 Jul 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this clinical trial is to learn if diaphragmatic breathing and box breathing work to enhance resilience and manage stress in physical therapy students. It will also learn about their effects on overall physiological and psychological parameters. The main questions it aims to answer are:
Do these breathing techniques improve heart rate variability (HRV)?
How do these interventions affect participants' perceived stress levels, cognitive performance, and academic achievement?
Researchers will compare diaphragmatic breathing and box breathing to a control group to see if these non-invasive methods work to improve physiological adaptation and manage stress.
Participants will:
Be randomly assigned to practice diaphragmatic breathing, practice box breathing, or join a control group Have their heart rate variability (HRV) measured as a primary sign of physiological adaptation Complete assessments to evaluate their perceived stress, cognitive performance, and academic achievement
Detailed description
The Challenge: Stress in Healthcare Education University life is a demanding transitional period, and students training in healthcare fields like physical therapy often face immense academic and clinical pressures. Research shows that up to 50.1% of physiotherapy students experience high levels of stress, which can surge even higher during their hands-on clinical rotations. This stress is more than just an emotional burden; it actively impairs working memory, reduces attention span, and often leads to lower grades and poorer overall academic performance.
The Goal of the Study This study aims to discover if simple, accessible breathing exercises can help undergraduate physical therapy students build resilience and better manage their stress. Specifically, the research will compare the effectiveness of two distinct breathing techniques-diaphragmatic breathing and box breathing-to see how they impact both the mind (psychological stress and cognition) and the body (physiological adaptation).
How the Study Works The study will involve 60 undergraduate physical therapy students from Deraya University who are currently experiencing moderate to high levels of academic stress. These participants will be randomly divided into three equal groups: The Diaphragmatic Breathing Group: Participants will practice a relaxing, slow-paced breathing pattern. They will inhale through the nose for 4 seconds and exhale through the mouth for 6 seconds, focusing on expanding their abdomen. The Box Breathing Group: Participants will practice a structured technique often used in high-stress tactical environments to enhance stress tolerance. It involves a "4-4-4-4" cycle: inhaling for 4 seconds, holding the breath for 4 seconds, exhaling for 4 seconds, and holding the breath out for 4 seconds. The Control Group: Participants will simply continue their normal daily routines without any specific breathing interventions so researchers have a baseline for comparison. The two breathing groups will practice their designated techniques for 15 minutes a day, 6 days a week, over a 4-week period. What is Being Measured?To accurately determine if these techniques work, the study will evaluate several key areas:Heart Rate Variability (HRV): Using a highly accurate chest strap sensor (the Polar H10), researchers will measure the subtle variations in time between heartbeats. HRV is a primary indicator of how well the nervous system is regulating stress and keeping the body balanced. Stress and Resilience: Participants will complete standardized questionnaires to evaluate their perceived stress levels and their ability to "bounce back" from daily challenges. Cognitive and Academic Performance: The study will use specialized cognitive tests (like the Stroop Color-Word Test) to measure attention and executive functioning. It will also evaluate the students' confidence in their ability to manage time, prepare for exams, and succeed academically.
Why This Matters Because academic stress is incredibly prevalent among health sciences students, finding practical, non-medication-based ways to support their mental health is critical. By comparing these two breathing methods, this study hopes to identify an effective, non-invasive tool that students can easily use to lower their anxiety, improve their focus, and ultimately thrive in their demanding academic and clinical environments.
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Diaphragmatic Breathing Group | Experimental | Behavioral: Diaphramatic Breathing TrainingParticipants will sit comfortably with their hands in their abdomen. They will: * Inhale through the nose for 4 seconds * Exhale through the mouth for 6 seconds * Focus on abdominal expansion and relaxation * Continue for 15 minutes, 6 sessions/week, for 4 weeks |
| Box Breathing Group | Experimental | Behavioral: Box Breathing TrainingParticipants will perform a structured breath cycle: * Inhale for 4 seconds * Hold for 4 seconds * Exhale for 4 seconds * Hold for 4 seconds Sessions will last 15 minutes, 6 sessions/week, for 4 weeks |
| Control Group | No intervention | –Participants will continue their normal daily routines and will not receive any breathing intervention during the study period |
Who may qualify
- Ages
- 18 to 25 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- Academic Status: Currently enrolled, full-time undergraduate Physical Therapy students
- Age Range: 18-25 years
- Health Status: Generally healthy individuals with no known chronic respiratory or cardiovascular diseases.
- Informed Consent: Ability and willingness to provide written informed consent and commit to the 4-week protocol (6 sessions/week).
- Stress Level: A baseline score on the Perceived Stress Scale (PSS) indicating at least moderate stress.
Key exclusion criteria (8 listed)
- Pre-existing Breathing Expertise: Individuals with professional training in yoga (Pranayama), formal meditation, or advanced breath work that might bias the baseline results.
- Medical Conditions: Diagnosed respiratory conditions (e.g., Asthma, COPD).
- Cardiovascular issues (e.g., Arrhythmias, Hypertension).
- Clinical psychological disorders (e.g., Generalized Anxiety Disorder or Panic Disorder) that may require medication.
- Pharmacological Factors: Use of medications that influence the Autonomic Nervous System (e.g., Beta-blockers, antidepressants, or heavy use of stimulants/sedatives).
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Diaphramatic Breathing TrainingDiaphragmatic Breathing Group: Participants will sit comfortably with their hands in their abdomen. They will: * Inhale through the nose for 4 seconds * Exhale through the mouth for 6 seconds * Focus on abdominal expansion and relaxation * Continue for 15 minutes, 6 sessions/week, for 4 weeks | Behavioural | Diaphragmatic Breathing Group |
| Box Breathing TrainingBox Breathing Group: Participants will perform a structured breath cycle: * Inhale for 4 seconds * Hold for 4 seconds * Exhale for 4 seconds * Hold for 4 seconds | Behavioural | Box Breathing Group |
Primary outcome
Heart Rate Variability
Time frame: Baseline (pre-intervention) and at the end of the 4-week training period (post-intervention).
HRV will be measured using the Polar H10 sensor and analyzed through Kubios HRV software to evaluate physiological resilience and autonomic nervous system regulation.
Perceived Stress
Time frame: Baseline (pre-intervention) and at the end of the 4-week training period (post-intervention).
Stress will be measured using the Perceived Stress Scale (PSS-10). The total score ranges from a minimum of 0 to a maximum of 40. Higher scores indicate higher levels of perceived stress, representing a worse outcome
Resilience
Time frame: Baseline (pre-intervention) and at the end of the 4-week training period (post-intervention).
Resilience will be measured using the Brief Resilience Scale (BRS). The score ranges from a minimum of 1 to a maximum of 5. Higher scores indicate higher levels of resilience, representing a better outcome
2 secondary outcomes
Cognitive Performance
Time frame: Baseline (pre-intervention) and at the end of the 4-week training period (post-intervention).
Academic Achievement
Time frame: Baseline (pre-intervention) and at the end of the 4-week training period (post-intervention).
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Sep 2026.
- Individual participant dataSharing planned: No. Individual participant data will not be shared to maintain participant privacy and strictly adhere to confidentiality agreements.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Abdelrahman A Mohamed, B.Sc. in Physical Therapy contact
Rana H Elbanaa, Assoiate Professor study chair
Cairo University
Fatma Y Abdelsalam, Lecturer study director
Cairo University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Diaphramatic Breathing Training and Box Breathing Training in people with Stress and Psychological Resilience, run by Cairo University at 1 site in Egypt.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 28 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Alaa N Nasser, B.Sc. in Physical Therapy (+201061382864, alaa.nasser1713@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Heart Rate Variability (time frame: Baseline (pre-intervention) and at the end of the 4-week training period (post-intervention).). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Sep 2026.