Dr. Michael Ruscio, DC is a clinician, Naturopathic Practitioner, clinical researcher, author, and adjunct professor at the University of Bridgeport. His work has been published in peer-reviewed medical journals and he speaks at conferences around the globe.
When It Comes to Vagal Stimulation, the Truth Actually Isn’t in the Details
Healthy lifestyle habits like physical activity, mindfulness, and nutrition are foundational to great health, and they also improve vagal tone.
Other research-supported strategies to increase vagal tone include social connection, breathing exercises, and cold showers.
Less-researched exercises that may improve vagal tone include singing, chanting, humming, and massage.
It’s probably best to set the foundation with a healthy lifestyle first before focusing on more specific vagus nerve exercises.
Vagal tone is assessed in the research through heart rate variability (HRV), making it a reliable marker for evaluating vagus nerve exercises.
High HRV is associated with higher vagal tone and better health, while lower HRV is associated with lower vagal tone and worse health.
If you’ve been hearing about the vagus nerve, you may be curious about what, if anything, you can do to specifically optimize its function. But before you add on specific vagus nerve exercises, it’s important to know what the vagus nerve is, how it works, and the healthy habits you may already be practicing that also work to improve its function.
Exercise, mindfulness, and nutrition are foundational for many aspects of our health, and are great for strengthening the vagus nerve. Outside of these healthy foundations, there may be other ways, like breathing exercises, cold showers, and massages to support the vagus nerve.
By jumping straight to highly-specific vagus nerve exercises like chanting, humming, and gargling when the foundations aren’t in place, you likely won’t get the most benefit for your time and energy. That doesn’t mean you can’t add these in later, but starting with the more comprehensive and fundamental practices first is probably going to pay off more in the long run.
Let’s dive right into the research on vagus nerve exercises, which ones are most effective, and the hierarchy I recommend for implementing them.
What is Vagal Tone?
How do you know if your vagus nerve is working the way it should? This is where vagal tone comes in.
Vagal tone is the measure of the activity of your vagus nerve. While vagal tone can’t be measured directly, an indirect measure called heart rate variability (HRV) can be used to indicate how well your vagus nerve may be functioning . HRV represents the fluctuation in time intervals between your heartbeats . An optimal level of HRV means your nervous system is better able to adapt and is more resilient during the stress response. A higher HRV also means your body is able to return to baseline more quickly after a stressful event .
While there aren’t any definitive reference ranges that constitute a normal or healthy HRV , what we do know is a greater activity of the vagus nerve (meaning high vagal tone) is associated with a higher HRV and better health. On the other hand, greater activity in the sympathetic nervous system (fight or flight response) is associated with less vagus nerve activity (low vagal tone), lower HRV, and less robust health [4, 5].
Many studies have linked various gastrointestinal, neurologic, cardiovascular, and metabolic diseases to low vagal tone, here are some of them :
Hypertension (high blood pressure)
Inflammatory bowel disease (IBD)
The association between low vagal tone and various diseases has led to exploration into how stimulation of the vagus nerve can improve physical health. Electrical VNS stimulation seems to be beneficial in certain situations [7, 8], so researchers are looking at more natural ways to stimulate the vagus nerve to see if there’s any significant health impact.
Your Options for Vagus Nerve Exercises
There are no “official” vagus nerve exercises outside of electrical vagus nerve stimulation — a well-studied, research-based treatment for improving vagus nerve function that’s FDA-approved to treat epilepsy and depression [9, 10]. However, there are several lifestyle therapies that are thought to be good for improving vagal tone (the health of this nerve), along with numerous vagus-specific techniques.
With varying degrees of research behind them and other known health benefits, you probably will want to start with the most foundational practices first and work toward more specific techniques as you progress. Jumping straight into the latter can be an uphill battle for healing your vagus nerve if healthy daily habits aren’t already in place.
Vagus Nerve Exercises: Lifestyle
If you’re hoping to target your vagus nerve, lifestyle interventions like nutrition, exercise, yoga, walking, and breathing exercises may be the best place to start, assuming you aren’t already doing these things regularly. Building this foundation shouldn’t be overlooked because if these things aren’t in place, other vagus nerve exercises on their own likely won’t be as successful.
One of the best places to start is by building a healthy diet to support vagus function. A gut-supportive, whole-foods, Mediterranean-type diet rich in omega-3 fatty acids (fish oil) is associated with higher HRV and vagal tone . There is no need to make it overly complicated, as an anti-inflammatory diet that betters your overall health will also be best for your “rest and digest” nerve.
Exercise Your Body and Your Vagus Nerve
Let’s start with exercise since it’s perhaps one of the best natural therapies you can incorporate to target your vagus nerve. If you don’t routinely exercise, walking is a wonderful way to build your endurance and create a base level of fitness.
One randomized controlled trial found people who participated in a progressive walking program had significantly improved heart rate variability (HRV), which is our best measure for vagal tone, when compared to those who weren’t specifically walking for exercise . Once you’ve got a consistent walking routine established, you can begin to branch out to include more cardiovascular and strength training, as well as experiment with high-intensity exercise, which have all been shown to increase HRV and vagal tone [6, 13].
Find Your Parasympathetic State
Additional lifestyle measures you can take to improve your vagus nerve function have to do with balancing the autonomic nervous system, and boosting your parasympathetic function (more on that below).
A couple of randomized controlled trials have found regular yoga sessions to not only improve quality of life, but also improve HRV, vagal tone, and mental resilience [14, 15, 16, 17].
While not technically “exercises”, healthy social connections and laughing both improve overall health outcomes and HRV [18, 19].
Healthy lifestyle modifications like these set the foundation for optimal vagus nerve function and are generally enough to keep the vagus nerve in shape without having to specifically target it with certain exercises. But if you’d like to experiment further, you can try some of the more targeted options.
Vagus Nerve Exercises: Targeted Options
Once the above basics are in place, there are some research-backed (and some less researched) vagus nerve options that you may want to explore. All of these tend to be healthy, fun, and relaxing, so there’s really no downside if you want to try them. Here’s a chart detailing the research findings:
Vagus Nerve Exercise
Vagus nerve massage and soft shoulder massage 
As you can see, there are many different vagus nerve exercises to choose from. Once you’ve set your healthy foundation with the above lifestyle options, I recommend moving on to things like cold showers and massage, both of which have numerous health benefits outside of improving vagal tone.
If you’ve tackled those and want to experiment some more, you can incorporate the less researched vagus nerve exercises like singing, chanting, and humming. These may indeed be helpful for your vagus nerve, we just don’t have enough research yet to say either way, but nevertheless, they’re safe and often promote relaxation, so there’s really no downside.
Now let’s take a closer look at the connection between low vagal tone and various health conditions.
Vagal Tone and Whole-Body Health
While there isn’t a robust body of data on the vagus nerve from a practical, clinical standpoint, research does show correlations between the vagus nerve and disease. And we know electrical vagus nerve stimulation (VNS), which involves a surgically implanted device to stimulate the vagus nerve, does seem to be a very effective treatment for certain conditions [7, 8]. Here’s a look at how vagus nerve function and vagal tone may impact gut, brain, and cardiometabolic health.
The Gut-Vagus Connection
The vagus nerve seems to have a significant impact on the health of the gut. The vagus nerve provides parasympathetic nerve supply to the gut and helps to regulate digestion, the movement of food through the intestines, and the secretion of digestive enzymes . But it’s also involved in the regulation of inflammation in the gut . Additionally, the vagus nerve acts as a communication highway between the brain and the gut to impact appetite, pain, mood, and more .
Since the vagus nerve is so intimately involved in the regulation of the gut, you can see how poor vagal tone could lead to poor gut function. People with gut disorders like irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), have been shown to have reduced vagal tone, which may lead to a reduced ability to modulate inflammation [3, 27]. What we don’t know definitively is if poor gut health leads to reduced vagal tone or if reduced vagal tone leads to poor gut health.
Fortunately, we don’t need to know which comes first because we have a variety of gut-supportive interventions like diet and probiotics that help to lower inflammation and improve microbial balance, which may also improve vagal tone 11, 28]. Using these types of therapies to create a healthy gut environment first will help to set the foundation for healthy vagus nerve function.
The Brain-Vagus Connection
The vagus nerve serves to deliver communication between the brain and the rest of your body. About 80–90% of the fibers that make up the vagus nerve are afferent, so they send information about what’s happening in your organs to your brain. Your brain then sends out an appropriate response based on that information .
If you have low vagal tone, these messages may be interrupted or altered, making you more susceptible to psychiatric conditions like depression and PTSD, Parkinson’s disease, and epilepsy [6, 10, 29].
Breathing exercises and meditation may be very effective for improving the brain-vagus nerve connection. A 2013 randomized controlled trial found healthy college students who practiced slow breathing exercises experienced improvements in HRV and vagal tone, and they also had increased feelings of relaxation . And another study found mindfulness meditation to improve the relaxation response and vagal tone in healthy people with perfectionist traits .
The Heart-Vagus Connection
The vagus nerve regulates important functions like heart rate, respiratory rate, blood pressure, and vessel dilation and constriction. In addition, it plays a key role in controlling HRV . People with cardiovascular disease, high blood pressure, type 2 diabetes, and metabolic syndrome have reduced vagal tone when compared to healthy people [30, 31, 32, 33]. And low vagal tone may be predictive of increased mortality in certain groups of patients .
Improving vagal tone and HRV with foundational lifestyle habits can improve cardiometabolic health outcomes. High-intensity exercise was found to improve heart function in patients with chronic heart failure , and breathwork (like slow breathing) significantly improved blood pressure .
In addition, a heart-healthy Mediterranean-type diet (rich in fish, nuts, and seeds) and supplementation with fish oil (a source of omega-3 fatty acids) can lead to higher HRV and better vagal tone [11, 36]. Practicing mindfulness while eating is another opportunity to support healthy vagus nerve function .
Now that you know what the research says about vagal tone and vagus nerve exercises, let’s review the facts about the vagus nerve.
An In-Depth Look at the Vagus Nerve
The vagus nerve is the 10th and longest cranial nerve in the body, originating in the brainstem (medulla oblongata) and traveling through the neck, chest cavity, and abdomen to impact several organ systems. It’s a paired nerve, meaning it has both right and left branches, and it has both afferent (sensory) and efferent (motor) functions [7, 8].
The vagus nerve carries 75% of all parasympathetic nerve fibers in the body, so it’s the primary player in the parasympathetic nervous system (PNS). The PNS, a part of the autonomic nervous system, is often referred to as the “rest and digest” system as it helps us not only conserve energy but also plays an important role in digestion . The vagus nerve isn’t limited to these two areas, though, here are just some of the many important functions of the vagus nerve [10, 37, 38]:
Involuntary muscle control of the heart, lungs, and esophagus
Practice General Healthy Habits To Improve Your Vagal Tone
The vagus nerve is the primary player in the PNS, which is the part of the nervous system that’s responsible for regulating many bodily functions like digestion, heart rate, blood pressure, respiration, and much more. But how do you know if your vagus nerve is functioning well?
Electrical VNS is one well-studied intervention that’s been shown to improve vagus nerve function and patient outcomes in certain health conditions. Outside of this type of invasive procedure, it appears that activities that are already known to be good for your health, like exercise, nutrition, mindfulness, deep breathing, and cold showers, also seem to be good for improving vagal tone.
Other natural ways to stimulate the vagus nerve may include massage, chanting, singing, laughter, and humming. Working to improve your vagus nerve function with these types of vagus nerve exercises may indeed prove to be beneficial, we just don’t have much research at this time. It’s probably best to build a healthy foundation first before using these to specifically target the vagus nerve.
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