Institute of HeartMath Newsletter
HeartMath Helps After Treatment

HeartMath Helps After Treatment, Breast Cancer Study Shows

Although nearly 40,000 U.S. women were expected to lose the battle with breast cancer in 2010, the mortality rates of women with the disease gradually have decreased in many parts of the world over the last two decades. In the U.S. alone, there were more than 2.5 million breast-cancer survivors last year.

Women going through the physical, mental and emotional ordeal and drain of having breast cancer and then undergoing treatment, face sometimes monumental challenges afterward. An independent 2009 study whose results were published in 2010, found that HeartMath techniques and HeartMath and other forms of coherence training offered effective interventions among women treated for breast cancer. (The study, Finding a New Normal: Using Recreation Therapy to Improve the Well-Being of Women With Breast Cancer, was published in the American Therapeutic Recreation Association’s The Annual in Therapeutic Recreation.)

"Women with breast cancer face numerous physical and psychosocial challenges during and post-cancer treatment that may decrease functioning and reduce overall well-being," the authors of the study – Diane Groff, Claudio Battaglini, Cathy O’Keefe, Cari Edwards and Jeffery Peppercorn – wrote in 2009.

The tools participants used in the study "provide a promising way to increase coping skills, decrease stress, and improve immune functioning by increasing heart-rate coherence (HRC)."

The Get REAL & HEEL program for women who have received treatment for breast cancer, includes six months of exercise and recreation therapy three times per week.

The exercise component comprises individualized prescriptive exercise that includes cardiovascular activities on the treadmill, cross-trainer, stepper and cycle ergometer, resistance exercises on exercise machines, dumbbells, rubber bands and fit balls, and a variety of flexibility exercises designed to assist patients in regaining upper body range of motion usually compromised by surgery.

The recreation therapy component includes individual and group activities designed to accomplish the goals and objectives identified in each participant’s individualized treatment plan. Individual recreational interventions include cognitive and behavioral interventions for stress management, relaxation training, creative writing, expressive arts, leisure counseling, journaling, biofeedback and HeartMath interventions. Group recreational interventions include dance, expressive arts, group outings and a ropes course.

The Study

Six women, ages 42 to 66, who completed breast-cancer treatment within the previous six months and voluntarily enrolled in the Get REAL & HEEL program for breast-cancer patients in North Carolina (see accompanying box for details), participated in the study, which sought to determine:

  1. Does participation in a six-week HeartMath intervention, used in conjunction with other coherence training programs, improve the heart-rate coherence of women with breast cancer?
  2. Do breast-cancer survivors perceive any benefit from participation in recreation therapy using HeartMath in conjunction with other coherence training programs post-breast cancer treatment?

A central purpose of this study was to further prove the efficacy of recreation therapy for women with breast cancer. Thus this study was closely associated with another study – Lessons of Breast Cancer Survivors: The Role of Recreational Therapy in Facilitating Spirituality and Well-Being. The results – the researchers were the same for both studies – were published separately.

The authors of the Lessons of Breast Cancer Survivors study sought to increase understanding of the relationship between spirituality and recreation therapy. They acknowledged that the small sample of women in this study, who also were part of the Finding a New Normal study, was too limited for conclusive findings on the subject, and a larger sampling would be needed for more definitive conclusions.

Finding a New Normal study Participants in the Finding a New Normal study used HeartMath’s Quick Coherence® Technique, focusing on positive emotions such as love and appreciation, to establish, heart-rate coherence and the Heart Lock-In® Technique to sustain it. The importance of the body maintaining this optimal state, also known as heart-rhythm coherence, is many-faceted. Studies have shown it leads to mental, emotional and physical improvements, including greater cognitive abilities such as decision-making, enhancement of the immune system, which in turn can mean better health, and many other benefits.

Researchers measured participants’ baseline heart-rate coherence (HRC) before the six-week study and final HRC after its completion incorporating two key conditions: just be, 10 minutes of HRC monitoring when no HeartMath intervention was used; and manage stress, 5 minutes of HRC monitoring when participants used a HeartMath technique to manage stress.

During the actual study period, participants engaged in 30 minutes of recreational therapy using HeartMath and various biofeedback software, including the Wild Divine’s Journey to Wild Divine and Healing Rhythms programs.

Participants also used HeartMath’s handheld emWave® PSR (now the emWave2®) to monitor how their daily activities affected their HRC levels.

Researchers said the study findings and conclusions were elicited from:

  1. qualitative results – the objective outcomes of treatment, including participants’ beginning, ongoing and final heart-rate-coherence levels.
  2. qualitative results – the subjective comments of participants during treatment regarding how they felt about the effectiveness of the HeartMath interventions and how they were progressing.

Quantitative Results

The quantitative results, all of which were based on HeartMath’s HRC measurement protocol, show that a significant increase in heart-rate coherence (HRC) was established quickly after the first HeartMath intervention and that this was sustained through subsequent sessions over the course of the study.

At the start of the study, participants showed various levels of heart-rhythm coherence – what researchers called low, medium and high levels of HRC. They said the results clearly showed a significant decrease in the amount of low HRC, which, of course, was an improvement; and significant increases in the amount of high HRC.

U.S. Breast cancer statistics from

  • About 1 in 8 women in the United States (12%) will develop invasive breast cancer over the course of her lifetime.
  • In 2010, an estimated 207,090 new cases of invasive breast cancer were expected to be diagnosed in women in the U.S.
  • About 39,840 women in the U.S. were expected to die in 2010 from breast cancer, though death rates have been decreasing since 1990.
  • In 2010, there were more than 2.5 million breast cancer survivors in the U.S.
  • A woman’s risk of breast cancer approximately doubles if she has a first-degree relative – mother, sister, daughter – who has been diagnosed with it.
  • About 70% to 80% of breast cancers occur in women who have no family history of breast cancer.

More facts about BC for the site’s complete list of breast cancer statistics.

Qualitative Results

The researchers said several themes – 1) feeling in control 2) integrating processes into everyday life 3) emotional transformation – ran through the women’s subjective comments, which comprise the substance of the qualitative results.

The following are among the many participant comments – grouped by the key themes – that researchers recorded over the course of the study:

Feeling in control Feeling in control

  • "This was the best session yet. I feel really good about how I am changing. I know that I am really responsive to stress. I know that I can control that stress by getting into heart-rate coherence. I just need to be less self-critical."
  • "If nothing else, I am learning to control my emotions and that is having a tremendous impact on my life."

Integrating processes into everyday life

  • "I feel great! I could do this all day," one participant said after completing a seven-minute balloon game session on the emWave. "Now I just need to integrate this into my everyday life."      
  • "I know that happiness is a choice. I am going to try to track my feelings, thoughts, actions and start each day and end each day in a positive manner."

Emotional transformation

  • "Remember when I used to cry a lot. I have noticed that I am not doing that now. I feel more centered."
  • "You know, it is amazing in our society that we spend all this time and money on things, but we don’t take the time to work on our greatest gifts: our heart and mind."

Discussion and Implications

"Findings from the case study present preliminary evidence," researchers noted, "that a six-week RT (recreation therapy) intervention using HeartMath techniques and coherence training programs and other biofeedback programs can result in significant improvements in HRC ratios and lead to subjective perceptions of improved quality of life."

Despite the small sample of women used for this study, the researchers said, the "significant changes observed" would be clinically relevant if replicated in a larger sampling.

They said the almost immediate improvement in HRC levels using HeartMath’s Quick Coherence Technique for establishing baseline HRC levels was very promising for recreation therapists who typically have a short amount of time to work with patients in managing stress and developing coping skills.

"It is also exciting," they wrote, "that the Quick Coherence Technique fits within a positive emotion-focused explanatory style and therefore may be instrumental in facilitating the well-being of individuals in the midst of negative life experiences."