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Pre-Race Arousal Out of Control: Understanding Anxiety's Inhibitory Effects Through the Inverted-U Hypothesis, and Using 4-7-8 Vagal Breathing to Restore Peak Competitive State

Race Analysis
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1. Introduction and Cutting-Edge Research Background

On Taiwan’s cycling and triathlon racecourses—whether it’s the relentless climbs of the Westbound Wuling ascent, the scorching headwinds of IRONMAN Penghu, or the damp, chilly start line of the Taipei Marathon—we frequently witness a paradoxical phenomenon: well-trained amateur elite athletes whose heart rates have already spiked to 130–150 beats per minute before the starting gun, with pale faces and trembling hands. Within less than five kilometers of the start, they feel heavy legs and disordered breathing, ultimately finishing with times far inferior to their regular group training performances. Conversely, some athletes are overly relaxed, losing focus after the gun goes off, missing critical breakaway opportunities, and even suffering significant pace drops before the first aid station due to poor rhythm.

This polarization of pre-race psychophysiological states lies at the core of “Arousal Level” research in sport psychology. Arousal level is not merely a matter of “nervousness”; it refers to the overall activation state of the central nervous system, encompassing cortical arousal, sympathetic tone, endocrine system activity (such as epinephrine and cortisol), and pre-existing tension in skeletal muscles. As early as 1908, psychologists Robert Yerkes and John Dillingham Dodson proposed the famous Yerkes-Dodson Law (later termed the Inverted-U Hypothesis) based on electric shock experiments with mice. They demonstrated that the relationship between performance and arousal is not linear but follows an inverted U-shaped curve: when arousal is too low, input from the brain’s Reticular Activating System (RAS) is insufficient, leading to distractibility and sluggish reactions; when arousal is too high, an excessive sympathetic storm causes perceptual narrowing, motor rigidity, and decision-making errors. Only at moderate arousal levels can optimal perceptual-motor integration be achieved.

In recent years, with the proliferation of wearable devices and Heart Rate Variability (HRV) measurement technology, the sports science community has developed a more nuanced physiological interpretation of the Inverted-U Hypothesis. A 2021 meta-analysis published in Sports Medicine indicated that the relationship between pre-competition State Anxiety and competitive performance indeed exhibits an “Individual Zone of Optimal Functioning (IZOF).” The physiological markers of this optimal zone can be objectively defined through continuous monitoring of parasympathetic activity in HRV (such as rMSSD and HF Power). When athletes are at their optimal arousal level, their HRV displays a distinctive pattern of “moderately elevated high-frequency power with stable low-frequency power,” representing an efficient dynamic balance between the sympathetic and parasympathetic systems—not merely “relaxation.”

However, within Taiwan’s amateur sports community, oversimplified myths persist, such as “you should be completely relaxed before a race” and “being nervous means you lack mental toughness.” In reality, complete relaxation often causes arousal to plummet into the low-arousal zone on the left side of the curve, leaving athletes without sufficient neural drive to recruit high-threshold motor units at the moment of the start, resulting in weak initial acceleration. This article, grounded in rigorous sports science literature and tailored to the actual gradients, climate, and competitive characteristics of Taiwan’s local races, will provide an in-depth analysis of the physiological mechanisms underlying the Inverted-U Hypothesis. It will also offer a practical, immediately applicable guide incorporating the 4-7-8 vagal breathing technique and progressive muscle relaxation calibration to help you find your own “optimal flow state.”

2. Core Mechanisms of Exercise Physiology and Biomechanics

2.1 The Neurophysiological Basis of the Inverted-U Hypothesis: From Cortical Arousal to Muscle Tension

To understand how arousal level affects athletic performance, one must first examine the interaction between the cerebral cortex and the autonomic nervous system. When we face an important competition, the Prefrontal Cortex (PFC) and the Amygdala are activated simultaneously. As the center for fear and anxiety, the amygdala rapidly transmits threat signals to the hypothalamus, which in turn activates the Sympathetic-Adrenal-Medullary (SAM) Axis, prompting the adrenal medulla to secrete large amounts of epinephrine and norepinephrine. These catecholamines bind to β1 receptors on cardiac muscle cells, accelerating heart rate and increasing myocardial contractility; simultaneously, they bind to α1 receptors on vascular smooth muscle, causing peripheral vasoconstriction and elevated blood pressure.

At the level of athletic performance, moderate sympathetic activation is necessary. Research shows that prior to a Maximum Voluntary Contraction (MVC), increased arousal levels can elevate motor unit firing rates from a baseline of 8–12 Hz to 20–30 Hz, thereby increasing the Rate of Force Development (RFD). However, when arousal escalates excessively, the Premotor Cortex and the Primary Motor Cortex (M1) exhibit excessive co-activation, causing agonist and antagonist muscles to contract simultaneously. In biomechanics, this phenomenon is termed “Antagonistic Co-contraction,” and its direct consequence is a substantial reduction in net joint torque output.

We can illustrate this with a simplified mechanical model. Assume that during knee extension, the quadriceps (agonist) produce a torque of ( T_{quad} ), while the hamstrings (antagonist), due to excessive tension, generate an opposing torque of ( T_{ham} ). The net knee extension torque is then:

[
T_{net} = T_{quad} - T_{ham} - T_{friction}
]

where ( T_{friction} ) represents intra-articular frictional resistance. Under normal arousal conditions, ( T_{ham} ) is approximately 10–15% of ( T_{quad} ), serving as a protective mechanism for joint stability. But when pre-race anxiety drives arousal too high, the sympathetic nervous system simultaneously excites the motor neurons of both agonist and antagonist muscles, potentially causing ( T_{ham} ) to surge to 40–60% of ( T_{quad} ). This means that even if your quadriceps are striving to produce 300 Newton-meters of torque, the effective torque transmitted to the pedals or the ground is only 120–180 Newton-meters. This is precisely why many athletes feel like their “legs are tied to lead weights” when nervous—it is not a decline in muscle strength, but rather a sharp deterioration in mechanical efficiency caused by antagonistic co-contraction.

2.2 The Myth of Rapid Heart Rate Recovery: The Time Window for Parasympathetic Reactivation

Another common race-day phenomenon is “heart rate remaining elevated and difficult to settle after the start.” Under normal circumstances, when an athlete moves at a steady aerobic pace, heart rate should reach a stable plateau within 3–5 minutes. However, highly anxious athletes often have heart rates already at 140–150 bpm before the gun, and even at an easy pace after starting, their heart rates continue to climb to 170–180 bpm and remain elevated for dozens of minutes.

The physiological root of this phenomenon lies in the “half-life of stress hormones” and the “delay in parasympathetic reactivation.” The half-life of epinephrine is approximately 1–2 minutes, but cortisol has a half-life of 60–90 minutes. Cortisol secreted during acute pre-race anxiety enhances the sensitivity of cardiac muscle cells to catecholamines through genomic effects, meaning that even after epinephrine levels have declined, the automaticity of the sinoatrial node remains at an elevated level. Furthermore, during high-intensity exercise, muscle metaboreceptors (Group III/IV afferent nerves) continuously transmit signals of acidosis and mechanical tension to the brainstem, suppressing vagal tonic inhibition of the sinoatrial node. This “Exercise Pressor Reflex Reset” significantly prolongs the time required for heart rate to recover.

The key to accelerating heart rate recovery lies in “activating the cholinergic pathway of the vagus nerve.” Acetylcholine released by the vagus nerve binds to M2 receptors on sinoatrial node cells, opening G protein-coupled potassium channels (GIRK), hyperpolarizing the cell membrane, and thereby reducing the rate of spontaneous depolarization. However, M2 receptor sensitivity is negatively modulated by persistently high sympathetic activity. This means that if pre-race arousal spirals out of control, even attempting deep breathing will yield diminished heart rate recovery efficiency. Therefore, pre-race breathing regulation must be implemented before the sympathetic storm fully unfolds, rather than resorting to it as a last-minute measure after the race has begun.

2.3 The Physiological Mechanism of the 4-7-8 Vagal Breathing Technique

The 4-7-8 breathing technique (inhale for 4 seconds, hold for 7 seconds, exhale for 8 seconds) is a relaxation method popularized by Dr. Andrew Weil of the University of Arizona’s Center for Integrative Medicine. Its core mechanism lies in prolonging the exhalation phase to directly enhance vagal efferent activity. From a respiratory physiology perspective, during inhalation, the diaphragm contracts and descends, decreasing intrathoracic pressure, promoting venous return, and simultaneously suppressing vagal tonic inhibition of the sinoatrial node (the inspiratory phase of Respiratory Sinus Arrhythmia, RSA). During exhalation, the diaphragm relaxes and ascends, increasing intrathoracic pressure; at this point, vagal tonic inhibition briefly strengthens, and heart rate decreases.

In the 4-7-8 breathing technique, the exhalation time (8 seconds) is significantly longer than the inhalation time (4 seconds), meaning that within each respiratory cycle, the proportion of time dominated by parasympathetic activity increases markedly. This pattern produces physiological effects through the following three pathways:

  1. Baroreflex Gain Enhancement: Prolonged exhalation maintains intrathoracic pressure at an elevated level, stimulating baroreceptors in the aortic arch and carotid sinus, thereby enhancing vagal inhibitory control over heart rate. Research indicates that regular prolonged-exhalation training can significantly improve baroreflex sensitivity within 4–6 weeks, reducing the magnitude of pre-race heart rate spikes by 10–15%.

  2. GABAergic Modulation of the Prefrontal Cortex: Slow, deep breathing increases GABAergic neurotransmission in the prefrontal cortex, suppressing excessive amygdala activation. Functional Magnetic Resonance Imaging (fMRI) studies have found that during prolonged-exhalation breathing, activity in the ventromedial prefrontal cortex (vmPFC) increases significantly while amygdala activity is suppressed, explaining why this breathing technique can rapidly reduce subjective anxiety.

  3. Descending Inhibition of Skeletal Muscle Tension: Vagal activation further promotes serotonin release from the brainstem’s Raphe Nuclei, inhibiting the excitability of α-motor neurons at the spinal level. This directly reduces the degree of antagonistic co-contraction, allowing ( T_{ham} ) in the aforementioned mechanical model to return to its normal range.

It is worth noting that the 4-7-8 breathing technique is not necessarily better when performed more rapidly. Performing 4–6 cycles during the 10–15 minutes before the race can achieve significant parasympathetic activation; however, if initiated after the race has already begun, its effectiveness may be limited due to exercise pressor reflex reset. Therefore, the correct application windows for this breathing technique are “upon arrival at the venue until before warm-up begins” and “after warm-up ends until the starting gun.”

3. Key Parameter Measurements and Comparative Analysis

To more concretely illustrate the impact of arousal level on competitive performance, the following table compares physiological and performance parameters across three typical pre-race states. These data are compiled from normative values in domestic and international sports science literature, combined with measurements of local amateur athletes conducted by a Taiwanese university’s Graduate Institute of Exercise and Sport Science.

Parameter Under-arousal (Low Zone) Optimal Arousal (IZOF Range) Over-arousal (Anxiety Zone)
Resting Heart Rate (bpm) 48–52 (too low) 55–65 85–105 (spiked)
HRV (rMSSD, ms) Above 80 (excessive fluctuation) 45–65 Below 25 (sympathetic dominance)
Salivary Cortisol 30 min pre-race (nmol/L) Below 5 (lack of excitement) 8–12 Above 20 (excessive stress response)
Quadriceps/Hamstring Co-contraction Ratio (%) 5–8% (loose and weak) 12–18% 35–55% (rigid)
Maximum Voluntary Contraction Strength (%MVC) 85–90% 100% 92–96% (inhibited)
5 km Time Trial Pace Error (%) ±6–8% (erratic) ±1–2% ±4–5% (fast start, blow-up finish)
Rating of Perceived Exertion (RPE, 6–20) 10–11 (lackluster) 13–14 17–19 (overly tense)

3.1 Interpretation of Key Data

From the table above, it is evident that over-aroused athletes are actually 4–8% lower in “Maximum Voluntary Contraction Strength” compared to their optimal state. This is not a decline in muscle strength, but rather the net torque loss caused by antagonistic co-contraction. For example, consider a cyclist weighing 70 kg with a maximum power output of 300 watts. In an over-aroused state, their effective pedaling power may be only 276–288 watts—an invisible loss of 12–24 watts. On the 8–10% gradients of the Westbound Wuling ascent, this 20-watt difference could translate to 1–2 km/h slower, accumulating to a 10–20 minute difference in finishing time.

Additionally, the rMSSD index of HRV reaches extremely low values (<25 ms) during over-arousal, indicating that cardiac rhythm is entirely dominated by the sympathetic nervous system, losing the fluctuations of respiratory sinus arrhythmia. Research indicates that when rMSSD falls below 30 ms, post-exercise lactate clearance efficiency decreases by 15–20%, because impaired parasympathetic reactivation hinders skeletal muscle blood flow recovery and lactate metabolism. This explains why overly anxious athletes tend to “blow up” prematurely in the middle of a race—their bodies are trapped in a vicious cycle of ineffective recovery from the very start.

4. Periodized Training Plan and Equipment Calibration Guide

4.1 The 8-Week “Arousal Calibration” Pre-Race Training Plan

Arousal regulation is not a last-minute endeavor the day before a race; it requires a long-term “dual-track psychophysiological training” approach to establish an individualized optimal zone. Below is an 8-week periodized plan integrating HRV monitoring and breathing training, suitable for cyclists, runners, and triathletes.

Phase Weeks Training Focus Specific Protocol
Foundation Building 1–2 Breath awareness and HRV baseline measurement Measure HRV (rMSSD) for 5 minutes each morning upon waking to establish a personal baseline. Perform the 4-7-8 breathing technique twice daily (5 cycles each session), focusing on the sensation of chest descent during exhalation.
Simulated Stress 3–4 Progressive Muscle Relaxation (PMR) combined with high-intensity intervals Three times per week, before performing 5×1-minute intervals at 120% FTP, complete 10 minutes of PMR (progressively contract-relax each muscle group from toes to face, 5 seconds contraction / 15 seconds relaxation). The goal is to simulate muscle tension under pre-race anxiety and learn to maintain technical stability under tension.
Competition Adaptation 5–6 Simulated race-scenario arousal induction and regulation Once per week, perform a “simulated pre-race ritual”: 15 minutes before training, deliberately induce sympathetic excitation through fast-paced music and caffeine (3 mg per kg body weight), then use the 4-7-8 breathing technique to lower heart rate to the target zone (optimal arousal band) within 10 minutes.
Pre-Race Taper 7–8 Fine-tuning arousal level and standardizing operating procedures (SOP) Standardize the 60-minute pre-race protocol: first 30 minutes of dynamic warm-up (heart rate in Zone 2), next 15 minutes of 4-7-8 breathing (4 cycles), final 10 minutes of 3×10-second starting sprints (to activate the neuromuscular system).

4.2 Integrating Heart Rate Zones with the 4-7-8 Breathing Technique

On race day, athletes should use “heart rate deviation” as a real-time indicator of arousal level. The specific protocol is as follows:

  1. Upon Arrival at the Venue: Put on a heart rate strap and sit quietly for 5 minutes to measure. If resting heart rate is more than 15 bpm above your usual morning pulse, arousal is already too high. Immediately perform 4–6 cycles of the 4-7-8 breathing technique, aiming to reduce heart rate by 8–10 bpm within 10 minutes.
  2. During Warm-Up: Heart rate should stabilize in Zone 2 (approximately 60–70% of maximum heart rate). If heart rate easily exceeds Zone 3 during warm-up, accompanied by rapid breathing, shorten the warm-up and perform 2–3 cycles of 4-7-8 breathing afterward to bring heart rate back to the boundary between Zone 1 and Zone 2.
  3. 5 Minutes Before the Gun: Perform a final round of 4-7-8 breathing (3 cycles). At this point, the goal is not a dramatic heart rate reduction, but rather to “keep muscles elastic and thoughts clear.” The ideal state is: heart rate slightly 10–15 bpm above resting, but with warm hands, smooth joint mobility, and the ability to clearly articulate the first 3 pace checkpoints of the race.

5. Race Nutrition, Environmental Adaptation, and Race-Day Strategies

5.1 The Impact of Pre-Race Anxiety on Gastrointestinal Absorption and Countermeasures

Over-arousal suppresses gastrointestinal blood flow and motility through sympathetic activation, leading to common race-day issues such as nausea, stomach cramps, and poor fuel absorption. Research shows that under high anxiety, gastric emptying rate decreases by 30–40%, and small intestinal glucose absorption efficiency is also significantly reduced. This means that even if you follow a carbohydrate intake strategy of 60–90 grams per hour, the glucose actually entering your bloodstream may be only 40–60 grams.

Practical Countermeasures: In the 30–45 minutes before the race, avoid high-fiber, high-fat, or high-osmolarity foods. Instead, rely primarily on liquid carbohydrates (such as energy drinks), consuming 150–200 ml at a time, along with 200–300 mg of sodium electrolytes. If you know you are prone to nervousness, consider supplementing with 5–10 grams of BCAA (Branched-Chain Amino Acids) one hour before the race to stabilize blood sugar and reduce central fatigue perception. During the first half of the race (the initial 60 minutes), slightly reduce intake (45–60 grams per hour), then gradually increase to 75–90 grams per hour once heart rate stabilizes and the sympathetic storm subsides.

5.2 Special Considerations for Taiwan’s Race Environments: The Cases of Wuling and IRONMAN

Westbound Wuling (Elevation 3,275 m): The altitude gain further enhances ventilatory drive through peripheral chemoreceptors (carotid bodies), creating an additive effect with pre-race anxiety that can cause hyperventilation, and numbness in the hands and feet within the first 10 km of the race. It is recommended to perform one round of 4-7-8 breathing (4 cycles) upon arriving at Cingjing (elevation approximately 1,600 m), and to deliberately synchronize breathing rhythm with pedaling cadence (recommended 70–80 rpm), establishing a stable pattern of “one inhale over three pedal strokes, one exhale over five pedal strokes” to avoid over-breathing.

IRONMAN Penghu (High Temperature and Humidity): High-humidity environments (relative humidity > 75%) impede sweat evaporation, causing core temperature to rise and further exacerbating sympathetic activation. In this scenario, the exhalation phase of the 4-7-8 breathing technique should be extended to 9–10 seconds to maximize heat dissipation through the respiratory tract (evaporative heat loss from the airways). Additionally, at each aid station during the bike leg, pour cold water over the neck and inner thighs; activating cutaneous cold receptors can stimulate the parasympathetic nervous system and aid heart rate recovery.

6. Common Operational Pitfalls and Scientific Myth-Busting

Myth 1: “Be Completely Relaxed Before the Race and Don’t Think About Anything”

This is the most common misconception. As previously discussed, excessively low arousal leads to sluggish reactions and distractibility. Research indicates that the optimal pre-race mental state is “Relaxed Concentration,” not “complete mental blankness.” The correct approach is: after performing the 4-7-8 breathing technique 10 minutes before the race, immediately engage in “Mental Rehearsal”—vividly simulating in your mind the pace for the first 3 kilometers, the line choice through the first corner, and the entry maneuvers at aid stations. This maintains arousal at the peak of the curve while ensuring cognitive resources are directed toward task-relevant cues.

Myth 2: “Deep Breathing Means the Longer the Inhale, the Better”

Many athletes attempt a “deep breath” when nervous, but excessively long inhalations (exceeding 6 seconds) can over-expand the chest, stimulating stretch receptors in the thoracic wall and further enhancing sympathetic activity (the inspiratory reflex). The essence of the 4-7-8 breathing technique lies in “exhalation being much longer than inhalation,” not merely deep breathing. If you feel chest tightness during inhalation, switch to “abdominal breathing,” directing the airflow toward the lower abdomen to ensure adequate diaphragmatic excursion.

Myth 3: “Caffeine Will Make You More Nervous, So Avoid It Before a Race”

Caffeine does increase cortical arousal, but moderate doses (3–6 mg per kg body weight) have been shown to enhance alertness and fat oxidation efficiency. The key lies in “dosage” and “timing.” For athletes prone to anxiety, it is recommended to consume a low dose of caffeine (2–3 mg per kg body weight) 60–90 minutes before the race, paired with 200 mg of L-Theanine. L-Theanine increases GABA and serotonin concentrations, smoothing out the sympathetic excitation caused by caffeine, achieving an ideal state of “alert but not jittery.”

Myth 4: “When Your Heart Rate Spikes, You Should Stop and Rest”

During a race, a spiked heart rate is often accompanied by “exercise pressor reflex reset.” Stopping to rest at this point can interrupt the skeletal muscle pump action, causing a sudden drop in venous return and potentially triggering dizziness. The correct approach is: reduce intensity to Zone 1–2 (a pace where conversation is easy) while performing the 4-7-8 breathing technique, using “active recovery” during movement to accelerate parasympathetic reactivation. This is especially critical in long-distance events (such as the One-Day Twin Towers Challenge or IRONMAN), because coming to a complete stop causes muscle stiffness, and the metabolic cost of restarting is significantly higher.

7. Expert FAQ

Q1: My heart rate is very stable during training, but it spikes during races. Is this a lack of cardiovascular fitness?

A: This is not a lack of cardiovascular fitness, but rather “situational arousal dysregulation.” The uncertainties of the race environment (opponent strength, weather changes, self-expectations) activate the amygdala’s threat response, leading to excessive sympathetic nervous system drive. It is recommended to engage in “simulated race training”—deliberately incorporating “stressful scenarios” into regular group rides (such as riding alongside athletes of similar ability or setting segment time goals)—and to perform 30 seconds of 4-7-8 breathing between interval sets, allowing your body to learn to maintain heart rate stability under pressure. Typically, after 4–6 weeks of adaptation, peak race heart rate can decrease by 8–12 bpm.

Q2: Can the 4-7-8 breathing technique be used during a race (e.g., while cycling or running)?

A: Yes, but the rhythm needs adjustment. While running or cycling, due to exercise pressor reflex reset, prolonged breath-holding (7 seconds) may cause blood pressure fluctuations and dizziness. It is recommended to use a “dynamic version”: inhale over 3 steps (or 3 pedal revolutions), exhale over 6 steps (or 6 pedal revolutions), maintaining an exhalation-to-inhalation ratio of 2:1. This effectively sustains parasympathetic tone without disrupting movement rhythm. This is particularly useful on climbs (such as the Tianxiang to Dayuling section of Wuling), where this rhythm helps stabilize breathing and prevent hyperventilation.

Q3: I tried the 4-7-8 breathing technique, but it made me feel more anxious and short of breath. What should I do?

A: This usually occurs because you are overly focused on “controlling your breathing,” which heightens self-monitoring of respiration and exacerbates feelings of breathlessness. It is recommended to first return to “natural abdominal breathing”: place one hand on your chest and the other on your abdomen; during inhalation, feel the abdomen rise while the chest remains still; during exhalation, feel the abdomen fall. Begin with a gentler ratio of “inhale 4 seconds, exhale 6 seconds” for 1–2 weeks, then gradually extend exhalation to 8 seconds once your body adapts. Additionally, the 4-7-8 breathing technique should be practiced in a quiet environment—do not attempt it for the first time amidst a noisy pre-race crowd.

Q4: How do I know if I am at my “optimal arousal level”?

A: The most objective indicator combines “heart rate deviation” with “perceived state.” First, record your average morning resting heart rate. Thirty minutes before the race, if your heart rate is 10–15 bpm above your morning pulse, and you feel “slightly excited, slightly anticipatory, but with warm hands and elastic muscles,” you are in your optimal arousal zone. If heart rate is more than 20 bpm above morning pulse, accompanied by nausea, frequent urination, and muscle stiffness, arousal is excessive and you should perform the 4-7-8 breathing technique. If heart rate is 5 bpm below morning pulse and you feel “lackluster,” perform 2–3 sets of 10-second in-place sprints to elevate arousal.

Q5: Besides the 4-7-8 breathing technique, what other scientifically validated pre-race relaxation methods exist?

A: In addition to the 4-7-8 breathing technique and Progressive Muscle Relaxation (PMR), the following techniques have strong scientific support: (1) Biofeedback training (using an HRV monitor to observe in real time whether your breathing increases rMSSD); (2) Autogenic Training, which uses self-suggestions such as “my right arm is heavy and warm” to induce peripheral vasodilation and parasympathetic activation; (3) Music intervention—listening to slow-tempo music at 60–80 beats per minute effectively reduces pre-race state anxiety. It is recommended to integrate these techniques with the 4-7-8 breathing technique into a 15-minute pre-race SOP, rehearsing it repeatedly during the 2–3 weeks before the race so it becomes an “automated procedure” for your body.


Selected References:

  • Yerkes, R. M., & Dodson, J. D. (1908). The relation of strength of stimulus to rapidity of habit-formation. Journal of Comparative Neurology and Psychology, 18(5), 459-482.
  • Hanin, Y. L. (2000). Emotions in Sport. Human Kinetics.
  • Lehrer, P. M., & Gevirtz, R. (2014). Heart rate variability biofeedback: How and why does it work? Frontiers in Psychology, 5, 756.
  • Balban, M. Y., et al. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895.
  • Wang, S.-C., & Lin, C.-C. (2021). Exercise Physiology (5th ed.). Taipei: Yi-Li Books.
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