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Speer KE, Naumovski N, McKune AJ. Heart rate variability to track autonomic nervous system health in young children: Effects of physical activity and cardiometabolic risk factors. Physiol Behav 2024; 281:114576. [PMID: 38692385 DOI: 10.1016/j.physbeh.2024.114576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/03/2024]
Abstract
Evidence for a key role of dysregulated autonomic nervous system (ANS) activity in maladaptive stress response/recovery and non-communicable disease development is extensive. Monitoring ANS activity via regular heart rate variability (HRV) measurement is growing in popularity in adult populations given that low HRV has been associated with ANS dysregulation, poor stress response/reactivity, increased cardiometabolic disease risk and early mortality. Although cardiometabolic disease may originate in early life, regular HRV measurement for assessing ANS activity in childhood populations, especially those consisting of children < 6 years of age, remains largely unpractised. A greater understanding of ANS activity modifiers in early life may improve analysis and interpretation of HRV measurements, thereby optimising its usefulness. Taking into consideration that HRV and ANS activity can be improved via daily engagement in physical activity (PA), this review will discuss the ANS and HRV, ANS activity modifiers, cardiometabolic disease risk factors and PA as they relate to childhood/adolescent populations (≤ 18 years old).
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Affiliation(s)
- Kathryn E Speer
- Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Research Institute of Sport and Exercise, University of Canberra, 11 Kirinari Street, Bruce, 2617, Australia.
| | - Nenad Naumovski
- Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Research Institute of Sport and Exercise, University of Canberra, 11 Kirinari Street, Bruce, 2617, Australia; Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, 17671, Greece
| | - Andrew J McKune
- Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia; Research Institute of Sport and Exercise, University of Canberra, 11 Kirinari Street, Bruce, 2617, Australia; Discipline of Biokinetics, Exercise and Leisure Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, 4000, South Africa
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Orgil Z, Heisterberg LM, Froass D, Karthic A, Williams SE, Ding L, Kashikar-Zuck S, King CD, Olbrecht VA. The need for a true biofeedback-based virtual reality system for achievement of target heart rate variability for children undergoing surgery. Paediatr Anaesth 2024; 34:577-579. [PMID: 38567441 DOI: 10.1111/pan.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/05/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Zandantsetseg Orgil
- Department of Clinical Research Services, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lisa M Heisterberg
- School of Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Dillon Froass
- School of Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Anitra Karthic
- School of Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sara E Williams
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Lili Ding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Susmita Kashikar-Zuck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher D King
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Vanessa A Olbrecht
- Department of Anesthesiology and Perioperative Medicine, Nemours Children's Health, Wilmington, Delaware, USA
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Hirten RP, Danieletto M, Landell K, Zweig M, Golden E, Pyzik R, Kaur S, Chang H, Helmus D, Sands BE, Charney D, Nadkarni G, Bagiella E, Keefer L, Fayad ZA. Remote Short Sessions of Heart Rate Variability Biofeedback Monitored With Wearable Technology: Open-Label Prospective Feasibility Study. JMIR Ment Health 2024; 11:e55552. [PMID: 38663011 PMCID: PMC11082734 DOI: 10.2196/55552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Heart rate variability (HRV) biofeedback is often performed with structured education, laboratory-based assessments, and practice sessions. It has been shown to improve psychological and physiological function across populations. However, a means to remotely use and monitor this approach would allow for wider use of this technique. Advancements in wearable and digital technology present an opportunity for the widespread application of this approach. OBJECTIVE The primary aim of the study was to determine the feasibility of fully remote, self-administered short sessions of HRV-directed biofeedback in a diverse population of health care workers (HCWs). The secondary aim was to determine whether a fully remote, HRV-directed biofeedback intervention significantly alters longitudinal HRV over the intervention period, as monitored by wearable devices. The tertiary aim was to estimate the impact of this intervention on metrics of psychological well-being. METHODS To determine whether remotely implemented short sessions of HRV biofeedback can improve autonomic metrics and psychological well-being, we enrolled HCWs across 7 hospitals in New York City in the United States. They downloaded our study app, watched brief educational videos about HRV biofeedback, and used a well-studied HRV biofeedback program remotely through their smartphone. HRV biofeedback sessions were used for 5 minutes per day for 5 weeks. HCWs were then followed for 12 weeks after the intervention period. Psychological measures were obtained over the study period, and they wore an Apple Watch for at least 7 weeks to monitor the circadian features of HRV. RESULTS In total, 127 HCWs were enrolled in the study. Overall, only 21 (16.5%) were at least 50% compliant with the HRV biofeedback intervention, representing a small portion of the total sample. This demonstrates that this study design does not feasibly result in adequate rates of compliance with the intervention. Numerical improvement in psychological metrics was observed over the 17-week study period, although it did not reach statistical significance (all P>.05). Using a mixed effect cosinor model, the mean midline-estimating statistic of rhythm (MESOR) of the circadian pattern of the SD of the interbeat interval of normal sinus beats (SDNN), an HRV metric, was observed to increase over the first 4 weeks of the biofeedback intervention in HCWs who were at least 50% compliant. CONCLUSIONS In conclusion, we found that using brief remote HRV biofeedback sessions and monitoring its physiological effect using wearable devices, in the manner that the study was conducted, was not feasible. This is considering the low compliance rates with the study intervention. We found that remote short sessions of HRV biofeedback demonstrate potential promise in improving autonomic nervous function and warrant further study. Wearable devices can monitor the physiological effects of psychological interventions.
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Affiliation(s)
- Robert P Hirten
- The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Matteo Danieletto
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- The Hasso Plattner Institute for Digital Health at the Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kyle Landell
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- The Hasso Plattner Institute for Digital Health at the Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Micol Zweig
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- The Hasso Plattner Institute for Digital Health at the Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Eddye Golden
- The Hasso Plattner Institute for Digital Health at the Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Renata Pyzik
- The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sparshdeep Kaur
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- The Hasso Plattner Institute for Digital Health at the Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Helena Chang
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Drew Helmus
- The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bruce E Sands
- The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Dennis Charney
- Office of the Dean, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Girish Nadkarni
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emilia Bagiella
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Laurie Keefer
- The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Zahi A Fayad
- The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Ruchiwit M, Vuthiarpa S, Ruchiwit K, Muijeen K, Phanphairoj K. A Synthesized Model for Applying Stress Management and Biofeedback Interventions in Research Utilization: A Systematic Review and Meta-analysis. Clin Pract Epidemiol Ment Health 2024; 20:e17450179276691. [PMID: 38660573 PMCID: PMC11037511 DOI: 10.2174/0117450179276691231229071003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 04/26/2024]
Abstract
Background Stress management and biofeedback interventions have been shown to be effective in improving mental and physical health outcomes. However, previous research studies and synthesized models for applying these interventions in research utilization are insufficient. Objective This study aimed to synthesize a model for applying stress management and biofeedback interventions in research utilization. Methods A systematic review and meta-analysis were conducted according to the PRISMA guidelines.Multiple studies were used to assess the effectiveness of applying stress management and biofeedback interventions published from 2017 to 2023. The process included identifying the research questions, conducting a comprehensive literature search, assessing study quality, extracting data, synthesizing the data, analyzing and interpreting the findings, drawing conclusions, and making recommendations. Results The results indicated a significant mean effect size without evidence of publication bias. The effect sizes of the subgroups among the study variables were not significantly different [Q = 4.02, p = .26]. However, there were significant differences regarding the mean effect sizes among the studies [Q = 63.59, p < .001] and also in terms of the test of subgroups among the participants [Q = 8.49, p = .04]. Conclusion The results emphasize the importance of evidence-based practice and highlight the need for ongoing evaluation and refinement of interventions. The proposed model was supported by related theories and research studies in order to ensure the robustness and reliability to guide practice and future research in the field of biofeedback interventions. By following this model, researchers and practitioners can ensure that stress management and biofeedback interventions are evidence-based and are effective in improving mental and physical health outcomes.
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Affiliation(s)
- Manyat Ruchiwit
- Faculty of Nursing, Rattana Bundit University, Pathumthani, Thailand
| | - Sararud Vuthiarpa
- Faculty of Nursing, Rattana Bundit University, Pathumthani, Thailand
| | - Kampol Ruchiwit
- Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
| | - Kasorn Muijeen
- Faculty of Nursing, Thammasat University, Pathumthani, Thailand
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Jerath R, Syam M, Ahmed S. The Future of Stress Management: Integration of Smartwatches and HRV Technology. SENSORS (BASEL, SWITZERLAND) 2023; 23:7314. [PMID: 37687769 PMCID: PMC10490434 DOI: 10.3390/s23177314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 09/10/2023]
Abstract
In the modern world, stress has become a pervasive concern that affects individuals' physical and mental well-being. To address this issue, many wearable devices have emerged as potential tools for stress detection and management by measuring heart rate, heart rate variability (HRV), and various metrics related to it. This literature review aims to provide a comprehensive analysis of existing research on HRV tracking and biofeedback using smartwatches pairing with reliable 3rd party mobile apps like Elite HRV, Welltory, and HRV4Training specifically designed for stress detection and management. We apply various algorithms and methodologies employed for HRV analysis and stress detection including time-domain, frequency-domain, and non-linear analysis techniques. Prominent smartwatches, such as Apple Watch, Garmin, Fitbit, Polar, and Samsung Galaxy Watch, are evaluated based on their HRV measurement accuracy, data quality, sensor technology, and integration with stress management features. We describe the efficacy of smartwatches in providing real-time stress feedback, personalized stress management interventions, and promoting overall well-being. To assist researchers, doctors, and developers with using smartwatch technology to address stress and promote holistic well-being, we discuss the data's advantages and limitations, future developments, and the significance of user-centered design and personalized interventions.
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Aranberri-Ruiz A, Aritzeta A, Olarza A, Soroa G, Mindeguia R. Reducing Anxiety and Social Stress in Primary Education: A Breath-Focused Heart Rate Variability Biofeedback Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10181. [PMID: 36011817 PMCID: PMC9407856 DOI: 10.3390/ijerph191610181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Primary school students suffer from high levels of anxiety and stress. Having emotional regulation abilities can help them to manage challenging emotional situations. Conscious and slow breathing is a physiological, emotional regulation strategy that is feasible for primary school students to learn. Following Polyvagal Theory and PMER Theory, this research presents the results of a breath-focused heart rate variability biofeedback intervention. The intervention aimed to reduce anxiety and physiological and social stress in primary school children. A total of 585 students (46.4% girls and 53.6% boys) from the same public school, aged between 7 and 12 years (M = 8.51; SD = 1.26), participated in this study. To assess the impact of training, a mixed design was used with two groups (Treatment and Control groups), two evaluation phases (Pretest and Post-test), and three educational cycles (first, second and third cycles). To examine heart rate variability, emWave software was used and anxiety and social stress were measured by the BASC II test. The results showed that after the intervention, the students learned to breathe consciously. Moreover, they reduced their levels of anxiety (M(SD)pretest = 12.81(2.22) vs. M(SD)posttest = 13.70(1.98)) and stress (M(SD)pretest = 12.20(1.68) vs. M(SD)posttest = 12.90(1.44)). The work also discusses the limitations and benefits of this type of intervention in primary schools.
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Affiliation(s)
- Ainara Aranberri-Ruiz
- Department of Basic Psychological Process and Development, University of the Basque Country (UPV/EHU), 20018 San Sebastian, Gipuzkoa, Spain
| | - Aitor Aritzeta
- Department of Basic Psychological Process and Development, University of the Basque Country (UPV/EHU), 20018 San Sebastian, Gipuzkoa, Spain
| | - Amaiur Olarza
- Department of Basic Psychological Process and Development, University of the Basque Country (UPV/EHU), 20018 San Sebastian, Gipuzkoa, Spain
| | - Goretti Soroa
- Department of Clinical and Health Psychology and Research Methodology, University of the Basque Country (UPV/EHU), 20018 San Sebastian, Gipuzkoa, Spain
| | - Rosa Mindeguia
- Department of Basic Psychological Process and Development, University of the Basque Country (UPV/EHU), 20018 San Sebastian, Gipuzkoa, Spain
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