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The total study sample included 32 volunteers, of whom 16 were institutionalized and 16 were not. The non-institutionalized group consisted of individuals who had been members of a senior citizens’ leisure club for 8.75 ± 8.01 years, of whom four were male and 12 were female, with a mean age of 72.50 (69.00/76.00) years. The institutionalized group lived in an institution for 6.87 ± 6.94 years and included nine women and seven men with a mean age of 69.50 (67.50/75.50) years.

A survey of the characteristics of the two study groups was carried out before starting the interventions and significant differences were found between them. The comparisons are shown in Table 1.

Table 1 Characteristics of the sample before the intervention.

Institutionalized and non-institutionalized groups differed in Assessment 1 with indications of being different groups prior to the start of any intervention. Therefore, it was decided that all subsequent analyzes should be performed separately for each group (institutionalized and non-institutionalized).

After this characterization, we sought to determine whether training with biofeedback was able to promote changes in the assessed variables compared to the control group and, if so, whether these changes persisted after a follow-up period. The data collected before (evaluation 1) and after the 14 training sessions (evaluation 2) and after the follow-up period (evaluation 3) were compared between the biofeedback group and the control group within the non-institutionalized sample and then at the within the institutionalized sample. to taste.

Non-institutionalized group

Anthropometric and aerobic conditioning variables

In the non-institutionalized sample, ANOVAs of anthropometric and aerobic fitness variables showed an effect of time (ratings 1, 2, and 3) on body fat percentage (F(2, 28) = 5.18, p = 0.01, D= 0.27) but not on body mass (F(2, 28) = 2.31, p = 0.11, D= 0.14), BMI (F(2, 28) = 2.39, p = 0.10, D= 0.15), and aerobic test (F(2, 28) = 0.92, p = 0.40, D= 0.06). There was a reduction in body fat percentage in the second and third assessments compared to the first assessment. There was a group effect (control and biofeedback) on body mass (F(1, 14) = 4.62, p = 0.04, D= 0.25) biofeedback group with higher body mass than control group but not on BMI (F(1, 14) = 3.57, p = 0.07, D= 0.20), aerobic test (F(1, 14) = 0.31, p = 0.58, D= 0.02) and body fat percentage (F(1, 14) = 4.29, p = 0.05, D= 0.23). There was no effect of the interaction between time and group on body mass (F(2, 28) = 0.33, p = 0.72, D= 0.02), BMI (F(2, 28) = 0.26, p = 0.76, D= 0.02), aerobic test (F(2, 28) = 0.99, p = 0.38, D= 0.07) and body fat percentage (F(2, 28) = 0.12, p = 0.88, D= 0.009).

Emotional variables

No main effect of time (ratings 1, 2, and 3) was observed in the ANOVAs of emotional variables on loneliness (F(2, 28) = 2.03, p = 0.14, D= 0.13) and total touch (F(2, 28) = 1.24, p = 0.30, D= 0.08). Moreover, there was no group effect (control and biofeedback) on loneliness (F(1, 14) = 0.40, p = 0.53, D= 0.03), total touch (F(1, 14) = 0.86, p = 0.36, D= 0.06) and symptoms of depression (F(1, 14) = 1.75, p = 0.20, D= 0.11). No interaction between time and group was observed on loneliness (F(2, 28) = 2.03, p = 0.14, D= 0.13) and total touch (F(2, 28) = 2.80, p = 0.07, D= 0.17). However, there was a main effect of time (F(2, 28) = 7.00, p = 0.003, D= 0.33) and the time and group interaction (F(2, 28) = 7.00, p = 0.003, D= 0.33) on symptoms of depression, indicating a reduction in symptoms of depression after biofeedback training; moreover, this reduction persisted after the training intervention (follow-up) (Fig. 1).

Figure 1

Depressive symptoms at assessments 1, 2, and 3 in the biofeedback training group (solid black line) and in the control training group (dotted black line) in the non-institutionalized sample. aSignificant difference of assessment 2 and 3 compared to assessment 1 (bsignificant differences between groups (

HRV Components

HRV ANOVAs showed a main effect of time (ratings 1, 2, and 3) on RMSSD (F(2, 28) = 3.78, p = 0.03, D= 0.21), SDNN (F(2.28) = 3.69, p = 0.03, D= 0.20), pNN50 (F(2, 28) = 5.19, p = 0.01, D= 0.27), SD1 (F(2, 28) = 3.78, p = 0.03, D= 0.21) and HF (F(2.28) = 5.55, p D= 0.28). There was no main effect of group (control and biofeedback) on RMSSD variables (F(1, 14) = 0.04, p = 0.83, D= 0.003), SDNN (F(1, 14) = 0.03, p = 0.86, D= 0.002), pNN50 (F(1, 14) = 0.04, p = 0.83, D= 0.003), SD1 (F(1, 14) = 0.04, p = 0.83, D= 0.003) and HF (F(1, 14) = 0.04, p = 0.84, D= 0.003). There was an effect of the interaction between time and group on all variables: RMSSD (F(2, 28) = 14.99, p D= 0.52) (Figure 2A), SDNN (F(2, 28) = 12.88, p = 0.0001, D= 0.47) (Figure 2B), pNN50 (F(2, 28) = 11.62, p = 0.0002, D= 0.45) (Fig. 2C), SD1 (F(2, 28) = 14.99, p D= 0.52) (Fig. 2D) and HF (F(2, 28) = 11.37, p = 0.0002, D= 0.45) (Fig. 2E). Post-tests showed an increase in all of these variables after biofeedback training. This gain was maintained during the follow-up period. Moreover, at the start of the experiment, the RMSSD, SD1 and HF components were higher in the control group than in the biofeedback group, although this difference disappeared after training.

Figure 2
Figure 2

(A) Values ​​of the root mean square of the successive differences between the RR intervals (RMSSD) in ms; (B) logarithmic values ​​of the standard deviation of all RR intervals (log SDNN) in ms; (VS) logarithmic values ​​of the percentage of successive differences between RR intervals that are > 50 ms (log pNN50) in ms; (D) values ​​of standard deviation 1 (SD1) in ms; (E) values ​​of logarithmic high frequency (log HF) in ms2. All of these components were assessed in assessments 1, 2, and 3 in the group that received the biofeedback training (solid black line) and in the group that received the control training (black dashed line) in the sample not institutionalized. aSignificant difference of assessment 2 and 3 compared to assessment 1 (bsignificant differences between groups (

Institutionalized group

Anthropometric and aerobic conditioning variables

In the institutionalized sample, ANOVAs of anthropometric and aerobic fitness variables showed a main effect of time (ratings 1, 2, and 3) on body fat percentage (F(2, 28) = 3.50, p = 0.04, D= 0.20), with higher body fat percentage at last assessment, but not on body mass (F(2, 28) = 0.08, p = 0.91, D= 0.006), BMI (F(2, 28) = 0.11, p = 0.88, D= 0.008) and aerobic test (F(2, 28) = 1.00, p = 0.37, D= 0.07). Additionally, there was no main effect of group (control and biofeedback) on body mass (F(1, 14) = 0.01, p = 0.92, D= 0.0003), BMI (F(1, 14) = 0.003, p = 0.95), aerobic test (F(1, 14) = 0.03, p = 0.85, D= 0.02) and body fat percentage (F(1, 14) = 0.01, p = 0.91, D= 0.0008). Moreover, there was no effect of the interaction between time and group on body mass (F(2, 28) = 0.25, p = 0.77, D= 0.02), BMI (F(2, 28) = 0.19, p = 0.82, D= 0.01), aerobic test (F(2, 28) = 0.06, p = 0.93, D= 0.005) and body fat percentage (F(F(2, 28) = 1.16, p = 0.32, D= 0.08).

Emotional variables

Regarding the ANOVAs of the emotional variables, there was an effect of time (ratings 1, 2 and 3) on loneliness (F(2, 28) = 14.77, p D= 0.51) and symptoms of depression (F(2, 28) = 10.63, p D= 0.43) but not on total touch (F(2, 28) = 1.18, p = 0.32, D= 0.07). Moreover, there was no group effect (control and biofeedback) on total touch (F(1, 14) = 0.16, p = 0.69, D= 0.01), loneliness (F(1, 14) = 1.05, p = 0.32, D= 0.07), or depression (F(1, 14) = 1.07, p = 0.31, D= 0.07). There was no effect of time and group interaction on touch (F(2, 28) = 0.59, p = 0.55, D= 0.04). However, there was an effect of time and group interaction on loneliness (F(2, 28) = 3.76, p = 0.03, D= 0.21) and symptoms of depression (F(2, 28) = 7.67, p = 0.002, D= 0.35) (Fig. 3). In sum, feelings of loneliness and symptoms of depression decreased after biofeedback training and this reduction persisted after training was discontinued.

picture 3
picture 3

(A) Loneliness; (B) symptoms of depression. All scales were assessed in ratings 1, 2, and 3 in the group that received the biofeedback training (solid black line) and in the group that received the control training (dotted black line) in the institutionalized sample . aSignificant difference of assessment 2 and 3 compared to assessment 1 (

HRV Components

ANOVAs of the HRV component variables showed an effect of time (ratings 1, 2, and 3) on the RMSSD (F(2, 28) = 8.77, p = 0.001, D= 0.39), SDNN (F(2, 28) = 5.28, p = 0.01, D= 0.22), and SD1 (F(2, 28) = 8.78, p = 0.001, D= 0.39), the highest values ​​obtained in the second evaluation being for all components, but there is no effect of time until pNN50 (F(2, 28) = 2.82, p = 0.07, D= 0.16) and HF (F(2, 28) = 2.46, p = 0.10, D= 0.15). Additionally, there was a main effect of group (control and biofeedback) on RMSSD (F(1, 14) = 1.01, p = 0.32, D= 0.07), SDNN (F(1, 14) = 2.36, p = 0.14, D= 0.014), pNN50 (F(1, 14) = 1.31, p = 0.27, D= 0.07), and SD1 (F(1, 14) = 1.01, p = 0.33, D= 0.07), but not at HF ​​(F(1, 14) = 1.10, p = 0.31, D= 0.09). Moreover, there was no effect of time and group interaction on the RMSSD variables (F(2, 28) = 0.72, p = 0.49, D= 0.05), SDNN (F(2, 28) = 0.33, p = 0.71, D= 0.02), pNN50 (F(2, 28) = 0.66, p = 0.52, D= 0.04), SD1 (F(2, 28) = 0.72, p = 0.49, D= 0.05), and HF (F(2, 28) = 0.31, p = 0.73, D= 0.02).

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