JMIR Publications

ABSTRACT

Background:

Heart rate variability (HRV) biofeedback is often performed with structured education, lab-based assessments, and practice sessions. It has been shown to improve psychological and physiological function across populations. However, a means to remotely employ and monitor this approach would allow for wider utilization of this technique. Advancements in wearable and digital technology presents 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. 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 healthcare workers across seven hospitals in New York City, NY, USA. Subjects downloaded our study app, watched brief educational videos about HRV biofeedback and employed a well-studied HRV biofeedback program remotely through their smartphone. HRV biofeedback sessions were employed for 5 minutes per day for 5 weeks. Subjects were then followed for 12 weeks after the intervention period. Psychological measures were obtained over the study period and subjects wore an Apple Watch for at least 7 weeks to monitor the circadian features of HRV.

Results:

A total of 127 subjects were enrolled in the study. Numerical improvement in psychological metrics was observed over the 17-week study period, though it did not reach statistical significance. Using a mixed effect cosinor model, the mean Mesor of the circadian pattern of the standard deviation of the interbeat interval of normal sinus beats (SDNN), a HRV metric, was observed to increase over the first 4 weeks of the biofeedback intervention in subjects who were at least 50% compliant.

Conclusions:

In conclusion, remote short sessions of HRV biofeedback may improve psychological well-being and autonomic nervous function and warrant further study. Wearable devices are able to monitor physiological effects of psychological interventions.