Enhancing Vagal Tone, Modulating Heart Rate Variability with Auricular Acupressure at Point Zero: A Randomized Controlled Trial

Abstract

Introduction:

Point Zero located within the vagus nerve’s auricular branch shows promise in addressing imbalances. This study aims to explore its effects on vagal activity using auricular acupressure (AA), measured through heart rate variability (HRV).

Methods:

This single-blinded randomized controlled trial involved 114 healthy volunteers randomly assigned to receive AA (AA group, n = 57) or sham-AA (SA group, n = 57) at Point Zero. The 30-minute procedure comprised six stages: T1 and T2 (pre-intervention), T3 to T5 (intervention), and T6 (post-intervention). Interventions involving 30-s acupoint pressure stimulations at T3 and T5. The HRV-measured outcomes included heart rate (HR), standard deviation of R-R intervals (SDNN), root mean square of successive RR interval differences (RMSSD), natural logarithm of low-frequency power (LnLF), and natural logarithm of high-frequency power (LnHF). In addition, respiratory rate (RR) was monitored for its stability.

Results:

The AA group demonstrated a significant decrease in HR and increases in SDNN, RMSSD, and LnHF from stages T3 to T6 compared with T1 (baseline), notably prominent at T3 (median changes [25th; 75th percentiles]: −2 [−5; −1], 17.85 [9.65; 31.72], 4.9 [1.08; 10.65], 0.26 [0.00; 0.62], respectively) and T5 (−3 [−6; −1], 19.45 [10.6; 32.89], 6.17 [−0.17; 16.34], 0.40 [−0.14; 0.83], respectively), while the SA group did not. LnLF showed nonsignificant alterations, and RR remained stable in both groups. Despite minor HRV fluctuations, the AA group consistently displayed significantly higher changes in SDNN and RMSSD compared with the SA group from T3 onwards. HR remained unchanged at T6, and LnHF significantly differed only at T5.

Conclusion:

AA at Point Zero may promptly enhance vagal activity, evident in the modulation of HRV, notably pronounced with pressure stimulation, and can be sustained for at least 5 min. Further studies are needed to assess its long-term effectiveness and efficacy in preventing or treating patients.

(Clinical Trial Registration: NCT05586698).

CME available online at www.medicalacupuncture.org/cme Questions on page 213.

INTRODUCTION

Acupuncture, often used as a complementary treatment, is thought to influence nerves and body fluids through the theory of meridians and collaterals, suggesting a connection to the neurohumoral system’s regulatory function.¹ Among these methods, auricular acupuncture is acknowledged for its safety and user-friendly approach, particularly auricular acupressure (AA), due to its noninvasive application.² Auricular therapies are recognized by the World Health Organization as an acupuncture microsystem capable of positively influencing the overall body’s functions. Evidence has demonstrated their potential as promising methods for various disorders, encompassing anxiety, psychological disorders, pain, hypertension, substance addiction, obesity, and numerous other conditions.^2–4

One of the crucial points in auricular acupuncture is Point Zero located on a notch in the crus of the helix. It was initially described by Paul Nogier, who termed it “Point Zero” to convey its role as a balancing point responsible for the body’s homeostasis, drawing an analogy to the “center of the body” as per traditional medicine (TM) principles.⁴ Numerous studies have indicated that acupuncture formulae coordinated with Point Zero demonstrated significant efficacy in managing various disorders, including stress, nausea, and vomiting, preventing postoperative agitation, addressing hot flashes in prostate cancer, and alleviating chronic cervical pain.^5–9 This aligns with the hypothesis regarding its balancing effects.

Moreover, the location of Point Zero lies within the auricular branch of the vagus nerve (ABVN), potentially hypothesizing that it may induce therapeutic effects through mechanisms including increasing parasympathetic tone, akin to previous acupuncture findings.^10,11 Some isolated studies have previously indicated that stimulating certain acupuncture formulae containing Point Zero may modulate heart rate variability (HRV) toward enhancing parasympathetic activity.^8,12 However, whether Point Zero alone can accomplish this remains uncertain.

HRV, representing the variation in time intervals between successive heartbeats, is considered a dependable noninvasive index of autonomic nervous system (ANS) function.¹³ It is widely used to assess the effects of acupuncture on autonomic regulatory forces.¹⁰ In this study, we evaluated the impacts of Point Zero on vagal activity based on the HRV when applying AA in healthy volunteers.

Ethical Statement

This research was reviewed and approved by the institutional review board of the University of Medicine and Pharmacy at Ho Chi Minh City (No. 675/HĐĐĐ-ĐHYD, dated August 31, 2022). Informed consent was obtained from all participants.

MATERIALS AND METHODS

Study Design

This study was a randomized controlled trial, utilizing balanced randomization (1:1), a single-blind design, and a parallel-group evaluation to assess the impacts of Point Zero on vagal activity through HRV modulations between the AA group and the sham-AA (SA) group in healthy volunteers. The study was conducted at the Acupuncture Laboratory of the University of Medicine and Pharmacy at Ho Chi Minh City from October 2022 to June 2023.

The study adhered to the ethical principles outlined in the Declaration of Helsinki and the International Conference on Harmonization-Good Clinical Practice guidelines, as well as the Consolidated Standards of Reporting Trials and the Standards for Reporting Interventions in Clinical Trials of Acupuncture guidelines.¹⁴ All participants had provided written informed consent before participating.

The study protocol had been registered on ClinicalTrials.gov (NCT05586698).

Participants

We recruited healthy volunteers following these inclusion criteria: (1) of age 20 to 29, both males and females, (2) maintaining normal vital signs, including heart rate (HR) of 60–100 bpm with regular and synchronous pulse and heartbeat, blood pressure of 90/60 mmHg to 140/90 mmHg, respiratory rate (RR) of 16 ± 3 bpm, the body temperature of 36.6–37.5°C, and peripheral oxygen saturation (SpO2) of ≥95%, (3) having a body mass index (BMI) between 18.5 and 23 kg/m², (4) no history of cardiovascular disease, diabetes, or thyroid conditions, (5) absence of psychiatric stress confirmed by a stress score of <15 on the depression, anxiety, and stress scales-21 questionnaire (DASS 21) immediately before the intervention, (6) not concurrently involved in other intervention trials, and (7) having no previous experience with acupuncture.

Exclusion criteria included: (1) recent consumption of stimulants including beer, alcohol, coffee, or tobacco within 24 h, (2) engaging in sports activities within 2 h, (3) presence of skin injuries in intervention areas on the ear, (4) women during menstruation, pregnancy, or breastfeeding, and (5) use of medications affecting blood pressure and heart rate within the 1 month.

Randomization and Blinding

Eligible participants were randomly assigned to either the AA or SA group. Nineteen block randomization was employed using SAS software version 9.4, with each block consisting of six participants. Randomization codes were placed inside envelopes labeled with sequential numbers. Participants meeting the eligibility criteria were assigned to receive either AA or SA intervention by the recruitment sequence. A single-blind design was implemented by blinding participants with sham interventions, whereas those performing procedures and assessing the outcomes were not blinded.

Experiment

The study took place in a serene laboratory with a temperature of 26 ± 2°C from 8:00 to 10:00 a.m. Participants were instructed to lie on their backs calmly, stay awake, and refrain from speaking. In both groups, Point Zero in the left ear was the selected auricular acupoint (Fig. 1A). Efferent vagal fibers to the heart are on the right side, and stimulation can lead to cardiac side effects.^15–17 Hence, auriculotherapy in this study was administered on the left ear to minimize potential side effects. AA was administered using a 10-mm square adhesive patch with a Vaccaria seed (diameter of 2 mm), while SA involved using an adhesive patch without any seed (Fig. 1B). The practitioner who performed the technique was a TM physician with over 5 years of experience in AA.

FIG. 1.

(A) Point Zero location. (B) Auricular therapy: (a) auricular acupuncture—the patch with a Vaccaria seed, (b) sham auricular acupuncture—the patch without any seed. (C) Wearable devices for heart rate variability measurement connected to a mobile phone through Bluetooth. (D) Study protocol. AA, auricular acupressure; HRV, heart rate variability; SA, sham auricular acupressure. The HRV measuring device was initiated at the beginning of each stage, with a processing time of 5 min for the device to generate results. Each stage’s respiratory rate was recorded over 5 min and then averaged (bpm).

Immediately after being enrolled in the study, participants rested for 10 min before commencing the 30-min experimental procedure, divided into six stages: T1, T2, T3, T4, T5, and T6, each lasting 5 min. In this context, stages T1 (baseline) and T2 represented the pre-intervention period, whereas T3 to T5 corresponded to the intervention, and T6 indicated the post-intervention. Measurements were continuously taken from stage T1 until the completion of T6. The application of either AA or SA began at T3 and lasted until the end of T5. Two stimulations involved pressing Point Zero with the fingers with sufficient force for 30 s at the beginning of stages T3 and T5 (Fig. 1C). The timing of these periods was designed based on the findings of Gao et al.¹⁸

Outcomes

Primary outcomes involved the fluctuations of HRV-related parameters, encompassing both time-domain components and frequency-domain components. These measurements were taken every 5 min using the photoplethysmography device Kyto HRM-2511B (Kyto Electronic Co., Limited on China Suppliers), attached to the participants’ right earlobe and subsequently connected to the Elite HRV application on a mobile phone through Bluetooth (Fig. 1D).

The time-domain components included the standard deviation of R-R intervals (SDNN, measured in ms), the root mean square of successive R-R interval differences (RMSSD, measured in ms), and the heart rate (HR, measured in bpm). The frequency-domain components encompassed the low-frequency power (LF) at 0.04–0.15 Hz and the high-frequency power (HF) at 0.15–0.40 Hz. Owing to the substantial fluctuations in LF and HF, they were normalized using natural logarithms, denoted as LnLF and LnHF. This enhanced the quality and validity of the research findings by reducing the impact of outliers, skewness, and heteroscedasticity, resulting in more symmetric and homogeneous data. HRV measurement standards were developed in 1996 and have since become a popular measurement standard. These components are commonly used in HRV studies and can be used to assess the cardiac autonomic nervous system.¹⁹ In short-term recordings, SDNN and RMSSD primarily indicate vagal activity. The decrease in HR reflects parasympathetic dominance. In frequency-domain measures, HF signifies parasympathetic involvement. Some authors propose that LF is related to autonomic activity, yet current evidence suggests that LF is complex due to its mixed sympathetic and parasympathetic influences.¹³

RR was documented every 5 min during each stage and then averaged by the investigator because an RR of fewer than 10 breaths per min was deemed unsuitable for HRV analysis, given the respiration-dependent nature of the HF component.^13,20

Sample Size Calculation

The sample size was calculated to detect differences in the primary outcomes, which are HRV components, including HR, SDNN, RMSSD, HF, and LF when comparing the verum and sham stimulations. Based on previous HRV results from studies by Geng et al. and Boehmer et al., comparing control and intervention groups, with a type-1 error of 0.05 and a type-2 error of 0.1, sample sizes corresponding to each HRV parameter were computed.^21,22 Among these, the largest sample size of 45 in each group was determined for LF. Accounting for an estimated dropout rate of 20%, 57 participants per group were chosen.

Statistical Analysis

The values of the outcomes at each time point, including HR, RR, SDNN, RMSSD, LnLF, LnHF, and changes between stages and the baseline (stage T1) were presented as medians (25^th; 75^th percentiles) owing to their non-normal distribution. The Wilcoxon rank-sum test was used to assess differences between the AA and SA groups, while the Wilcoxon signed-rank test was used to evaluate differences within the same group. Correlation between parameters was assessed using Spearman’s correlation coefficient. Statistical analyses were conducted using R version 4.3.2, with a significance level set at 0.05.

RESULTS

From October 2022 to June 2023, 168 volunteers were screened, of which 114 participants were eligible for randomization (Fig. 2). All completed the trial without dropping out.

FIG. 2.

Flow diagram of participant’s selection.

Sample Characteristics

The sex distribution between males and females was equal in both groups, with similar mean ages (SA: 23.5 ± 2.5 vs. AA: 23.8 ± 2.8). Characteristics, including BMI, HR, systolic blood pressure, diastolic blood pressure, RR, body temperature, SpO2, and DASS 21 score were well balanced between the two groups (Table 1).

Table 1.

Sample Characteristics

Characteristics	SA group (n = 57)	AA group (n = 57)
Sex male	30 (52.6%)	29 (50.8%)
Age (years)	23.5 ± 2.5	23.8 ± 2.8
BMI (kg/m2)	20.5 ± 1.3	20.2 ± 1.3
HR/min	72.1 ± 9.0	74.4 ± 8.8
SBP (mmHg)	111.1 ± 8.4	112.0 ± 9.1
DBP (mmHg)	68.7 ± 7.7	70.0 ± 7.0
RR/min	16.2 ± 2.5	16.4 ± 2.3
Body temperature (°C)	36.7 ± 0.1	36.7 ± 0.1
SpO2 (%)	97.3 ± 0.9	97.1 ± 0.9
DASS 21 score	4.63 ± 3.64	5.05 ± 3.38

Summary statistics are mean ± standard deviation or n (%).

AA, auricular acupressure; BMI, body mass index; DASS-21, depression, anxiety, and stress scales-21; DBP, diastolic blood pressure; HR, heart rate; RR, respiratory rate; SA, sham auricular acupressure; SBP, systolic blood pressure; SpO2, saturation of peripheral oxygen.

Measured Parameters

Immediately after the intervention began, HR at stages T3 to T6 significantly decreased compared with stage T1 in the AA group, whereas this decrease was not significant in the SA group (Fig. 3A). The HR reduction in the AA group was significantly greater than in the SA group at stages T3 to T5 (median changes [25th; 75th percentiles]: −2 [−5; −1], −2 [−4; 0], −3 [−6; −1] vs. −1 [−2; 1], −1 [−3; 1], 0 [−3; 2], respectively), particularly at stages T3 and T5 (Table 2). In contrast, there were no significant differences in RR across stages (11–21 bpm) in both groups (Fig. 3B, Table 2).

FIG. 3.

Measured parameters in both groups. *p < 0.05; **p < 0.01; ***p < 0.001; **** p < 0.0001; ns, not significant; compare with T1 within each group. AA, auricular acupressure; HR, heart rate; LnHF, natural logarithm of high-frequency power; LnLF, natural logarithm of low-frequency power; RMSSD, root mean square of successive R-R interval differences; SA, sham auricular acupressure; RR, respiratory rate; SDNN, standard deviation of R-R intervals.

Table 2.

Changes in Parameters from the Baseline (T1)

Parameters	Stages	SA group (n = 57)	AA group (n = 57)	p-valuea
HR (bpm)	T2-T1	0 (−1; 1)	0 (−2; 1)	0.464
	T3-T1	−1 (−2; 1)	−2 (−5; −1)	<0.001
	T4-T1	−1 (−3; 1)	−2 (−4; 0)	0.027
	T5-T1	0 (−3; 2)	−3 (−6; −1)	<0.001
	T6-T1	−1 (−3; 2)	−2 (−5; 1)	0.129
RR (bpm)	T2-T1	0 (−1; 1)	0 (−1; 1)	0.327
	T3-T1	0 (−1; 1)	0 (−1; 1)	0.854
	T4-T1	0 (−1; 1)	0 (−1; 1)	0.414
	T5-T1	0 (−1; 1)	−1 (−1; 1)	0.454
	T6-T1	−1 (−1; 1)	0 (−2; 1)	0.845
SDNN (ms)	T2-T1	1.00 (−6.58; 8.36)	1.98 (−6.42; 11.25)	0.514
	T3-T1	2.12 (−4.99; 11.95)	17.85 (9.65; 31.72)	<0.001
	T4-T1	−0.16 (−8.29; 7.37)	4.37 (−2.73; 18.73)	0.022
	T5-T1	6.03 (−8.37; 14.12)	19.45 (10.6; 32.89)	<0.001
	T6-T1	4.38 (−6.11; 13.5)	11.03 (1.47; 26.7)	0.011
RMSSD (ms)	T2-T1	0.49 (−1.63; 4.08)	0.03 (−2.14; 4.29)	0.675
	T3-T1	0.86 (−3.07; 6.72)	4.90 (1.08; 10.65)	0.013
	T4-T1	0.89 (−4.14; 5.67)	3.04 (−0.99; 11.00)	0.035
	T5-T1	0.58 (−4.47; 5.61)	6.17 (−0.17; 16.34)	0.001
	T6-T1	−0.07 (−5.67; 5.7)	4.86 (−2.48; 9.63)	0.034
LnLF	T2-T1	0.10 (−0.15; 0.38)	0.03 (−0.35; 0.32)	0.369
	T3-T1	0.05 (−0.34; 0.31)	0.04 (−0.27; 0.62)	0.269
	T4-T1	0.05 (−0.34; 0.39)	−0.04 (−0.32; 0.44)	0.896
	T5-T1	0.05 (−0.24; 0.38)	0.09 (−0.28; 0.59)	0.608
	T6-T1	0.09 (−0.24; 0.55)	0.14 (−0.22; 0.59)	0.822
LnHF	T2-T1	0.04 (−0.18; 0.37)	0.03 (−0.26; 0.37)	0.565
	T3-T1	0.13 (−0.33; 0.49)	0.26 (0.00; 0.62)	0.063
	T4-T1	0.01 (−0.32; 0.31)	0.15 (−0.16; 0.76)	0.082
	T5-T1	0.05 (−0.26; 0.48)	0.40 (−0.14; 0.83)	0.033
	T6-T1	−0.01 (−0.29; 0.42)	0.16 (−0.21; 0.81)	0.216

Summary statistics are median (25^th; 75^th percentiles). Bolded p-value indicates significant result.

^acompare between both groups; AA, auricular acupressure; LnHF, natural logarithm of high-frequency power; LnLF, natural logarithm of low-frequency power; RMSSD, root mean square of successive R-R interval differences; RR, respiratory rate; SA, sham auricular acupressure; SDNN, standard deviation of R-R intervals.

The HRV-related measures also displayed notable fluctuations, except for LnLF. Both SDNN and RMSSD showed significant increases immediately upon the application of the AA, from stages T3 to T6 when compared with stage T1. However, the SA did not appear to induce significant changes (Fig. 3C, Fig. 3D). A substantial difference was apparent in the increase of SDNN and RMSSD median change when comparing the AA and SA groups at these stages (Table 2). Particularly at the locations where stimulation was applied to AA, T3, and T5, exhibited a marked increase in SDNN and RMSSD compared with other stages.

There were no significant changes observed afterward in LnLF when compared with stage T1 in both groups (Fig. 3E, Table 2). SA continued to show no significant changes in LnHF, whereas LnHF significantly increased immediately after the application of AA (Fig. 3F). However, when comparing the median change of LnHF between the two groups, a significant difference was observed at the second AA stimulation, stage T5 (AA: 0.40 [−0.14; 0.83] vs. SA: 0.05 [−0.26; 0.48]) (Table 2).

Correlation Between RR, HR, and Other HRV Components

RR showed no significant correlation with HRV. The components SDNN, RMSSD, LnLF, and LnHF exhibited a moderate to high positive correlation among themselves, with correlation coefficients ranging between 0.66 and 0.87. HR demonstrated a moderate negative correlation with these components, with correlation coefficients ranging between −0.69 and −0.43 (Fig. 4).

FIG. 4.

Correlation coefficient between measured parameters. The blank cells represent p-values of the correlation coefficient (rho) ≥0.05. HR, heart rate; LnHF, natural logarithm of high-frequency power; LnLF, natural logarithm of low-frequency power; RMSSD, root mean square of successive R-R interval differences; RR, respiratory rate; SDNN, standard deviation of R-R intervals.

DISCUSSION

The study findings suggest a potential stimulation of vagal activity through AA at Point Zero, as indicated by its observed modulation of HRV, including a significant decrease in HR and significant increases in SDNN, RMSSD, and LnHF. This modulation, especially pronounced during additional acupoint stimulation, persisted for at least 5 min after intervention removal. In contrast, SA showed a nonsignificant impact on these parameters. Despite potential minor random fluctuations in HRV, the AA group consistently demonstrated significantly higher changes in SDNN and RMSSD compared with the SA group during the intervention. Notably, HR exhibited no significant change after intervention removal, and LnHF only significantly differed at the second acupoint stimulation. No significant fluctuations were observed in LnLF for both groups. RR also remained stable in both groups and did not show any significant correlation with other parameters, minimizing its influence on HRV outcomes. These findings suggest a potential role for auricular therapies in augmenting parasympathetic tone, in line with previous research.^10,12,23,24

Our findings indicated that the modulation of HRV was more pronounced at the moments when supplementary stimulation was introduced. This aligns with our previous observations during AA on the Heart point and Sympathetic point.^23,24 A previous study by Sakai et al. also demonstrated a significant positive correlation between HF and the occurrence of the acupuncture sensation.²⁵ AA is a noninvasive therapy, and when applied to the ear, it generates low pressure. To amplify the stimulation, the pressure applied to the Vaccaria seed needs to be increased, commonly achieved through manual pressing. Consequently, the modulation of HRV via AA predominantly arises from the pressure stimulation at the acupoint with sufficient force, and multiple stimulations potentially resulting in a more pronounced effect that persists for a minimum of 5 min, as suggested by our findings.

HRV serves as a dependable, noninvasive marker for assessing the ANS function of the heart, reflecting heartbeat fluctuations. It is linked to various disease risks, with SDNN considered the “gold standard” in predicting cardiovascular risks.²⁶ Evidence indicates that reduced SDNN independently raises the mortality rate from heart disease, while increased SDNN is associated with lower mortality rates.^27–29 Similar associations are found with HR.³⁰ Lower RMSSD is positively linked to sudden death risk in epilepsy patients.³¹ Low HF levels, seen in specific cardiovascular diseases, frequently align with stress, anxiety disorders, and tension, and enhancing HF values positively influences physical health.^32,33 Thus, by favorably modulating HRV components, AA at Point Zero holds the potential to improve the prognosis of these disorders and enhance physical well-being. Studies involving patient populations are essential to further explore this potential.

Stimulations on the auricle influence autonomic activity, typically known to affect the peripheral branch of the vagus nerve on the external ear, distributed across areas including the concha, crus helix, and tragus.^4,34 In this study, as well as in previous research, among the auricular acupoints selected based on TM theories for mental regulation, both the Heart point and Point Zero are also situated in areas linked to the ABVN.²³ In addition, transcutaneous auricular vagus nerve stimulation (taVNS), irrespective of specific acupoint locations, also had been shown to modulate HRV, enhancing parasympathetic activity.^21,35–38 However, Machetanz et al. also demonstrated that taVNS elicits the strongest stimulation at the cymba conchae and fossa triangularis locations, with lesser effect at the inner tragus.³⁷ Therefore, the question arises regarding the effectiveness of stimulation at specific acupoint locations compared with others, and the impact of using electrical or simply pressure-based stimulation. Designing future comparative studies is essential to address this query.

LIMITATIONS

This study presents several limitations. Firstly, the Kyto HRM-2511B is restricted to conventional time and frequency domain HRV assessments, unable to capture changes in HR pattern organization that nonlinear measures, not considered in this study, might detect. Incorporating HRV measures from various domains (time, frequency, nonlinear) could encompass the diverse aspects of cardiac autonomic activity they represent. Secondly, the study solely evaluated short-term effects, lacking evidence regarding long-term impacts.

CONCLUSIONS

This study suggested that stimulating Point Zero through AA may promptly enhance vagal activity as indicated by the modulation of HRV. This modulation is notably pronounced when supplemented with manual pressure and can be sustained for at least 5 min. Further studies are warranted to assess its long-term effectiveness and efficacy in preventing or treating patients. In addition, investigating the difference between stimulating auricular acupoints and stimulating any area within the distribution of the ABVN should also be carried out.

AUTHORS’ CONTRIBUTIONS

D-T.T.T.: Conceptualization (lead), methodology (equal), resources (lead), validation (equal), data curation (equal), supervision (lead), project administration (equal), writing—review and editing (supporting). N.C.N.: Methodology (equal), validation (equal), resources (supporting), investigation (lead), data curation (equal), writing—review and editing (supporting), project administration (equal). A.H.T.: Methodology (equal), software (lead), formal analysis (lead), data curation (equal), writing—original draft (lead), visualization (lead), writing—review and editing (supporting). MM.P.B.: Methodology (equal), investigation (supporting), writing—review and editing (supporting). N.L.V.: Writing—review and editing (lead), visualization (supporting).

PROTOCOL REGISTRY

The full trial protocol can be accessed on the website https://clinicaltrials.gov under registration number NCT05586698 with the trial registry name “Heart Rate Variability During Auricular Acupressure at Zero Point on the Left Ear in Healthy Volunteers.”

DATA AVAILABILITY

The data that support the findings of this study are available from the corresponding authors, upon reasonable request.

AUTHOR DISCLOSURE STATEMENT

No competing financial interests exist.

FUNDING INFORMATION

This study was not supported by any grant funding.

To receive CME credit, you must complete the quiz online at: www.medicalacupuncture.org/cme

CME Quiz Questions

Article learning objectives: After studying this article, participants should be able to explain the relationship between heart rate variability and vagal activity; describe the association between heart rate variability and the risk of cardiovascular disease; and describe the role of acupressure at Point Zero and its effect on vagal activity as it impacts heart rate variability.

Publication date: August 20, 2024

Expiration date: August 31, 2027

Disclosure Information:

None of the authors, editors, or reviewers of this educational activity, have relevant financial relationship(s) with ineligible companies to disclose.

Questions:

• 1.According to the article, which of the following statements best describes Point Zero

  1. Point Zero is a balancing point responsible for the body’s homeostasis.

  2. Point Zero is located in the lateral third of the triangular fossa of the ear.

  3. Point Zero lies within the auricular branch of the vagus nerve and may increase sympathetic tone.

  4. Point Zero modulates its effects most strongly when used on its own.

     Correct answer: A

• 2.According to the article, which of the following best characterizes Heart Rate Variability (HRV)?

  1. HRV is an unreliable index of autonomic nervous system functioning.

  2. HRV is a useful measure to assess effects of acupuncture on autonomic regulatory forces.

  3. Measurement of HRV requires a mildly invasive technique.

  4. Transcutaneous auricular vagus nerve stimulation (taVNS) has been shown to affect HRV and enhance sympathetic activity.

     Correct answer: B

• 3.According to the article, what is the impact of auricular acupressure at Point Zero on vagal activity?

  1. Modulates a significant decrease in heart rate.

  2. Has a similar effect on heart rate variability compared to sham-auricular acupressure.

  3. Modulates a significant increase in heart rate.

  4. Modulates a decrease in respiratory rate.

     Correct answer: A

• 4.Which of the following findings in the research study relates to reduced risk of cardiovascular disease?

  1. Auricular acupressure at Point Zero reduced standard deviation of R-R intervals (SDNN).

  2. Auricular acupressure at Point Zero decreased root mean square of successive RR interval differences (RMSSD).

  3. Auricular acupressure increased natural logarithm of high frequency power (LnHF).

  4. Auricular acupressure at Point Zero increased SDNN and RMSSD.

     Correct answer: D

• 5.The methodology and outcome measurements in this experiment included:

  1. Auriculotherapy administered to Point Zero in either left or right ear.

  2. Baseline measurements of time-domain components taken immediately after the participants were enrolled in the study.

  3. Measurements of fluctuations of HRV-related parameters, including both time-domain components and frequency-domain components.

  4. Six stages, T1- to T6, where T1 is the pre-intervention period, T6 the post-intervention period, and T2 to T5 corresponded to the intervention.

     Correct answer: C

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