The Synergy of Wearable Optical Heart Rate Sensor Technology and Box Breathing in Real-Time Decision Making in Precision, Explosive, and Intermittent Sports
DOI:
https://doi.org/10.17309/tmfv.2026.1.15Keywords:
box breathing, wearable sensors, optical heart rate, decision-making, sports performanceAbstract
Background. Real-time decision-making is a critical determinant of performance in precision, explosive, and intermittent sports, where athletes must operate under high physiological and cognitive stress. Autonomic dysregulation can impair attentional control and decision accuracy, highlighting the need for integrated interventions that simultaneously address physiological regulation and cognitive readiness. Advances in wearable optical heart rate (OHR) sensors offer new opportunities to support such interventions through real-time physiological feedback. Objectives. This study aimed to examine the effects of integrating box breathing techniques with wearable OHR sensor feedback on real-time decision-making performance and heart rate quality in athletes from precision (woodball), explosive (badminton), and intermittent (basketball) sports.
Materials and Methods. A quasi-experimental pre-test–post-test control group design was employed. Sixty-six male athletes (age: 21.3 ± 1.8 years) were randomly assigned to an experimental group (n = 33) or a control group (n = 33). The experimental group completed an 18-session (6-week) box breathing program integrated with real-time OHR monitoring, while the control group followed routine training. Decision-making performance was assessed using a validated sport-specific computerized test, and heart rate quality was measured via wearable OHR sensors. Data were analyzed using paired-sample t-tests and two-way mixed-design ANOVA (group × time) at α = 0.05, with effect sizes reported.
Results. The experimental group demonstrated significant improvements in decision-making performance (3.43 ± 0.42 to 4.48 ± 0.39; +30.59%; p < 0.001; Cohen’s d = 1.96) and heart rate quality, reflected by a reduction in resting heart rate (111.13 ± 8.76 bpm to 97.76 ± 7.94 bpm; −12.03%; p < 0.001; Cohen’s d = 1.57). Substantial time × group interactions were observed for decision-making (F(1,64) = 121.08, p < 0.001, partial η² = 0.65) and heart rate quality (F(1,64) = 78.92, p < 0.001, partial η² = 0.55). No meaningful changes were found in the control group.
Conclusions. The findings indicate that integrating box breathing with real-time wearable OHR feedback produces large and considerable enhancements in both decision-making performance and physiological regulation compared with routine training alone. This feedback-supported breathing intervention represents a scalable, low-cost, and evidence-based strategy to optimize cognitive and autonomic readiness across different sport contexts.
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References
Zeng, H., He, Y., Zhao, R., Li, Z., Wang, W., Yang, M., Li, P., Tao, G., Sun, J., & Hou, C. (2024). Intelligent health and sport: An interplay between flexible sensors and basketball. iScience, 27(3), 109089. https://doi.org/10.1016/j.isci.2024.109089 DOI: https://doi.org/10.1016/j.isci.2024.109089
Montembeau, S. C., Kim, J. H., Baugh, C. M., Campbell, E. G., Baggish, A. L., & Dickert, N. W. (2024a). Physicians approach shared decision-making for sports eligibility decisions heterogeneously. American Heart Journal Plus: Cardiology Research and Practice, 40, 100371. https://doi.org/10.1016/j.ahjo.2024.100371
Indra Kusuma, A., Setijono, H., & Mintarto, E. (2020). Effects of jump rope and high jump training with 1:1 intervals on increasing VO₂max and anaerobic threshold. International Journal of Innovation, Creativity and Change, 12(6), 1–12.
Montembeau, S. C., Kim, J. H., Baugh, C. M., Campbell, E. G., Baggish, A. L., & Dickert, N. W. (2024b). Decision-making under physiological stress in sport-related contexts. American Heart Journal Plus: Cardiology Research and Practice, 40, 100372. https://doi.org/10.1016/j.ahjo.2024.100372 DOI: https://doi.org/10.1016/j.ahjo.2024.100371
Softić, A., Hundur, M., Spahić, L., Ašić, A., & Pokvić, L. G. (2024). Utility of wearable devices in predicting sports performance improvement. Procedia Computer Science, 246, 4909–4915. https://doi.org/10.1016/j.procs.2024.09.447 DOI: https://doi.org/10.1016/j.procs.2024.09.447
Sunstrum, F. N., Khan, J. U., Li, N. W., & Welsh, A. W. (2025). Wearable textile sensors for continuous physiological monitoring. Biosensors and Bioelectronics, 273, 117133. https://doi.org/10.1016/j.bios.2025.117133 DOI: https://doi.org/10.1016/j.bios.2025.117133
Marchant, J., Khazan, I., Cressman, M., & Steffen, P. (2025). Comparing the effects of square, 4–7–8, and slow-paced breathing on heart rate variability and mood. Applied Psychophysiology and Biofeedback. Advance online publication. https://doi.org/10.1007/s10484-025-09688-z DOI: https://doi.org/10.1007/s10484-025-09688-z
Li, X., Song, Y., Wang, H., Su, X., Wang, M., Li, J., Ren, Z., Zhong, D., & Huang, Z. (2023). Evaluation of measurement accuracy of wearable devices for heart rate variability. iScience, 26(11), 108128. https://doi.org/10.1016/j.isci.2023.108128 DOI: https://doi.org/10.1016/j.isci.2023.108128
Ahmed, A., Devi, G., & Priya, J. (2021). Effect of box breathing technique on lung function test. Journal of Pharmaceutical Research International, 33(58A), 25–31. https://doi.org/10.9734/jpri/2021/v33i58A34085 DOI: https://doi.org/10.9734/jpri/2021/v33i58A34085
Viegas, J. M., Dores, H., Freitas, A., Cavigli, L., & D’Ascenzi, F. (2024). Developments in sports cardiology. Revista Portuguesa de Cardiologia, 43(2), 87–89. https://doi.org/10.1016/j.repc.2023.03.020 DOI: https://doi.org/10.1016/j.repc.2023.03.020
Sbrollini, A., Marcantoni, I., Lunghi, T., Morettini, M., & Burattini, L. (2024). Cardiorespiratory DB: Collection of cardiorespiratory data acquired during controlled breathing. Data in Brief, 54, 110406. https://doi.org/10.1016/j.dib.2024.110406 DOI: https://doi.org/10.1016/j.dib.2024.110406
Kittel, A., Lindsay, R., Larkin, P., Spittle, M., & Cunningham, I. (2025). The effectiveness of decision-making training in team-sport officials: A systematic review and meta-analysis. Psychology of Sport and Exercise, 69, 102841. https://doi.org/10.1016/j.psychsport.2025.102841 DOI: https://doi.org/10.1016/j.psychsport.2025.102841
Baskar, S., Czosek, R. J., & Spar, D. S. (2023). A look beyond the sports field: A paradigm of shared decision making in everyday life. Journal of the American College of Cardiology, 82(7), 612–614. https://doi.org/10.1016/j.jacc.2023.06.020 DOI: https://doi.org/10.1016/j.jacc.2023.06.020
Kanwal, A. S., Battle, J., & Friedman, E. M. (2022). Coronary artery disease, cardiac arrest, and shared decision making in a recreational athlete. JACC: Case Reports, 4(17), 1110–1114. https://doi.org/10.1016/j.jaccas.2022.06.005 DOI: https://doi.org/10.1016/j.jaccas.2022.06.005
Bonnechère, B., Poskotinova, L., Khazan, I., Ahmed, B., & Tabor, A. (2022). Comparing heart rate variability biofeedback and simple paced breathing to inform the design of guided breathing technologies. Applied Psychophysiology and Biofeedback, 47, 1–12. https://doi.org/10.1007/s10484-021-09524-4
Cardinal-Fernández, P., Collazo, L., & Villanueva, J. (2024). Identifying the best method for performing a spontaneous breathing trial. Chest, 166(5), 904–905. https://doi.org/10.1016/j.chest.2024.07.153 DOI: https://doi.org/10.1016/j.chest.2024.07.153
Schipke, J. D., Deussen, A., Moeller, F., Hoffmann, U., Zenske, A., & Koch, A. (2022). Oxygen-enriched air reduces breathing gas consumption. Current Research in Physiology, 5, 79–82. https://doi.org/10.1016/j.crphys.2022.01.007 DOI: https://doi.org/10.1016/j.crphys.2022.01.007
Palm, A., Kumm, M., Storm, A., & Lönnermark, A. (2022). Breathing air consumption during different firefighting methods in underground mining environments. Fire Safety Journal, 133, 103661. https://doi.org/10.1016/j.firesaf.2022.103661 DOI: https://doi.org/10.1016/j.firesaf.2022.103661
Vagedes, J., Helmert, E., Kuderer, S., Wildhaber, J., & Andrasik, F. (2021). The Buteyko breathing technique in children with asthma. Complementary Therapies in Medicine, 56, 102582. https://doi.org/10.1016/j.ctim.2020.102582 DOI: https://doi.org/10.1016/j.ctim.2020.102582
Martins Rodrigues, I., Torres Pereira, E., de Castro Lopes, A. L., Massaroni, C., Baroni, G., Cerveri, P., Dickinson, J., & Silvatti, A. P. (2021). Breathing motion patterns associated with aging in physically active women. Journal of Biomechanics, 125, 110582. https://doi.org/10.1016/j.jbiomech.2021.110582 DOI: https://doi.org/10.1016/j.jbiomech.2021.110582
Seleng, J., Celovska, D., Procka, P., Labuda, M., & Borik, S. (2025). Camera-based evaluation of deep breathing effects on microcirculation. Computers in Biology and Medicine, 189, 109996. https://doi.org/10.1016/j.compbiomed.2025.109996 DOI: https://doi.org/10.1016/j.compbiomed.2025.109996
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