The authors would like to thank Dr. Harpreet Dhanoa for her generous insights toward the design of the breathing and meditation program so that it was safe, therapeutic, and impactful for individuals with stress management issues.
KC, RC, and JH conceived the project. RC and KC performed a literature search, study selection, and data extraction. All authors participated in the development of the manuscript and provided input into the final version.

The protocol was approved by the Institutional Review Board (IRB) and all participants signed an informed consent form. Briefly, twelve healthy, normotensive, nonsmoking subjects (five men, seven women) aged between 31 and 65 years (mean age = 44 &#177; 12 years) volunteered to participate in this study. Brown and Gerbarg3 studied meditation and similar breathing techniques in individuals across a broad age range (14 - 85 years of age) for the management of anxiety, post-traumatic stress disorder,...

<ol>
	<li>Sperduti, M., Martinelli, P., Piolino, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+neurocognitive+model+of+meditation+based+on+activation+likelihood+estimation+(ALE)+meta-analysis.">A neurocognitive model of meditation based on activation likelihood estimation (ALE) meta-analysis.</a> Conscious Cogn. 21 (1), 269-276 (2012).</li><li>Sepp&#228;l&#228;, E. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Breathing-based+meditation+decreases+posttraumatic+stress+disorder+symptoms+in+US+Military+Veterans:+A+randomized+controlled+longitudinal+study.">Breathing-based meditation decreases posttraumatic stress disorder symptoms in US Military Veterans: A randomized controlled longitudinal study.</a> J Trauma Stress. 27 (4), 397-405 (2014).</li><li>Brown, R. P., Gerbarg, P. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Yoga+breathing,+meditation,+and+longevity.">Yoga breathing, meditation, and longevity.</a> Ann N Y Acad Sci. 1172 (1), 54-62 (2009).</li><li>Carter, K. S., Carter, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Breath-based+meditation:+A+mechanism+to+restore+the+physiological+and+cognitive+reserves+for+optimal+human+performance.">Breath-based meditation: A mechanism to restore the physiological and cognitive reserves for optimal human performance.</a> World J Clin Cases. 4 (4), 99-102 (2016).</li><li>Mohan, A., Sharma, R., Bijlani, R. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+meditation+on+stress-induced+changes+in+cognitive+functions.">Effect of meditation on stress-induced changes in cognitive functions.</a> J Altern Complement Med. 17 (3), 207-212 (2011).</li><li>Astin, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stress+reduction+through+mindfulness+meditation.">Stress reduction through mindfulness meditation.</a> Psychother Psychosom. 66 (2), 97-106 (1997).</li><li>Hahn, R. G., Rundgren, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Vasopressin+and+amino+acid+concentrations+in+serum+following+absorption+of+irrigating+fluid+containing+glycine+and+ethanol.">Vasopressin and amino acid concentrations in serum following absorption of irrigating fluid containing glycine and ethanol.</a> Br J Anaesth. 63 (3), 337-339 (1989).</li><li>Keller, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+the+perception+that+stress+affects+health+matter?+The+association+with+health+and+mortality.">Does the perception that stress affects health matter? The association with health and mortality.</a> Health Psychol. 31 (5), 677-684 (2012).</li><li>Gaylord, C., Orme-Johnson, D., Travis, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effects+of+the+transcendental+meditation+technique+and+progressive+muscle+relaxation+on+EEG+coherence,+stress+reactivity,+and+mental+health+in+black+adults.">The effects of the transcendental meditation technique and progressive muscle relaxation on EEG coherence, stress reactivity, and mental health in black adults.</a> Int J Neurosci. 46 (1-2), 77-86 (1989).</li><li>Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., Toney, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+self-report+assessment+methods+to+explore+facets+of+mindfulness.">Using self-report assessment methods to explore facets of mindfulness.</a> Assessment. 13 (1), 27-45 (2006).</li><li>Brown, R. P., Gerbarg, P. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sudarshan+Kriya+yogic+breathing+in+the+treatment+of+stress,+anxiety,+and+depression:+part+I-neurophysiologic+model.">Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part I-neurophysiologic model.</a> J Altern Complement Med. 11 (1), 189-201 (2005).</li><li>Bhatia, M., Kumar, A., Kumar, N., Pandey, R. M., Kochupillai, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electrophysiologic+evaluation+of+Sudarshan+Kriya:+an+EEG,+BAER,+P300+study.">Electrophysiologic evaluation of Sudarshan Kriya: an EEG, BAER, P300 study.</a> Indian J Physiol Pharmacol. 47 (2), 157-163 (2003).</li><li>Lievesley, R., Wozencroft, M., Ewins, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Emotiv+EPOC+neuroheadset:+an+inexpensive+method+of+controlling+assistive+technologies+using+facial+expressions+and+thoughts.">The Emotiv EPOC neuroheadset: an inexpensive method of controlling assistive technologies using facial expressions and thoughts.</a> J Assist Technol. 5 (2), 67-82 (2011).</li><li>Badcock, N. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+the+Emotiv+EPOC(R)+EEG+gaming+system+for+measuring+research+quality+auditory+ERPs.">Validation of the Emotiv EPOC(R) EEG gaming system for measuring research quality auditory ERPs.</a> Peer J. 1, 38 (2013).</li><li>Duvinage, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Performance+of+the+Emotiv+Epoc+headset+for+P300-based+applications.">Performance of the Emotiv Epoc headset for P300-based applications.</a> Biomed Eng Online. 12 (1), 1 (2013).</li><li>Cannesson, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pleth+variability+index+to+monitor+the+respiratory+variations+in+the+pulse+oximeter+plethysmographic+waveform+amplitude+and+predict+fluid+responsiveness+in+the+operating+theatre.">Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre.</a> Br J Anaesth. 101 (2), 200-206 (2008).</li><li>Cannesson, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+the+Pleth+variability+index+indicate+the+respiratory-induced+variation+in+the+plethysmogram+and+arterial+pressure+waveforms.">Does the Pleth variability index indicate the respiratory-induced variation in the plethysmogram and arterial pressure waveforms.</a> Anesth Analg. 106 (4), 1189-1194 (2008).</li><li>Lin, Y., Fisher, M. E., Roberts, S. M., Moser, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deconstructing+the+Emotion+Regulatory+Properties+of+Mindfulness:+An+Electrophysiological+Investigation.">Deconstructing the Emotion Regulatory Properties of Mindfulness: An Electrophysiological Investigation.</a> Front Hum Neurosci. 10, (2016).</li><li>Poh, P. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Respiratory+pump+contributes+to+increased+physiological+reserve+for+compensation+during+simulated+haemorrhage.">Respiratory pump contributes to increased physiological reserve for compensation during simulated haemorrhage.</a> Exp Physiol. 99 (10), 1421-1426 (2014).</li></ol>

The authors declare that they have no competing interests.

The evolution of wearable technology and its ability to accurately track physiological responses can revolutionize the daily management of stress and monitor physical and cognitive performance across a range of interventions18. There has already been a host of clinical applications involving stress interventions that have been analyzed, including but not limited to blood pressure, heart rate, and motion or activity prediction. These technologies are continuously being improved upon by machine lear...

Although stress is an unavoidable and persistent component of life, alternative approaches for the management of physical and emotional stimuli are being considered1,2,3,4. Uninterrupted stress is associated with the early onset and development of chronic conditions such as diabetes, obesity, cardiac, and cerebrovascular disease4,5. In recent years, an increasing percentage of Americans have reported stress has a negative impact on their mental and physical health6, and a sizable proportion did not feel they were doing enough to manage their stress7. Furthermore, a recent study showed that when individuals perceived that stress is negatively impacting their physical health, there was an elevated risk of premature death8.
Traditionally, public health and medical professionals have focused on physical activity as a means to manage stress. However, a significant portion of the United States population develops unhealthy lifestyle habits (i.e., smoking or excessive alcohol consumption) or unhealthy behaviors (i.e., poor diet patterns) as a result of stressful lifestyles. Currently, more Americans are becoming aware of the potential use of various forms of yoga and breathing exercises for stress management4,6,9. However, due to a lack of scientific validation, cultural appropriation, and the requisite physical environments (i.e., yoga studios), a significant portion of the United States population are not considering these alternative approaches for stress management6.
In an attempt to deliver holistic stress management techniques such as yogic breathing and guided relaxation to a broader audience, a protocol was developed and delivered to a small group of individuals in a non-laboratory setting. Previous studies have shown that techniques such as alternate nostril breathing are effective in delivering a more relaxed state of mind and body4.
Until recently, scientific studies of complex physiological measurements such as brain activity, respiration, and tissue perfusion were limited to laboratory settings, and thus studies relied on less complex measures such as ambulatory arterial blood pressure (ABP), respiratory rate (RR), and heart rate (HR). However, with the development of more scientifically accurate, wearable devices, the physiological responses to stress management interventions can be studied in non-laboratory settings.
The goal of this project is to create an accessible, inexpensive management program for stress that is generalizable to both laboratory and non-laboratory settings. Additionally, this article provides the methodology for an evidence-based approach to investigating physiological responses during a stress management protocol in a non-laboratory setting while utilizing commercially available wearable devices.
Recommendations are made to allow investigators to study better stress management interventions, as well as the setup and utilization of the portable electroencephalogram (EEG) system in a systematic way that is easily adaptable to various settings. The details needed to replicate the program are specified.

<table style="border-collapse:collapse;width:808pt" width="1077">
	<tbody>
		<tr>
			<td>Epoc+ 14 channel wireless EEG</td>
			<td>Emotiv Systems</td>
			<td></td>
			<td>&#160;Assemble the headset. Fully saturate the felt pads using 0.5% saline solution. When the headset is placed on the scalp, the pads should feel wet.&#160; Measurements: Brain Waves, Facial Expression, Mental Command</td>
		</tr>
		<tr>
			<td>Fingertip Pulse Oximeter with Bluetooth and Pleth Variability Index</td>
			<td>Masimo Mighty Sat with PVI</td>
			<td></td>
			<td>&#160;Measurements: Pulse Rate, Oxygen Saturation, Perfusion Index, Pleth Variability Index (PVI)</td>
		</tr>
		<tr>
			<td>The 39-item Five Facet Mindfulness Questionnaire</td>
			<td>A psychometric instrument used to assess five facets of mindfulness</td>
			<td></td>
			<td>Questionnaire available in electronic and pencil and paper versions. Measurements: Mood, cognition function</td>
		</tr>
	</tbody>
</table>

a community-based stress management program: using wearable devices to assess whole body physiological responses in non-laboratory settings

A pragmatic breath-based intervention to benefit human performance and stress management is timely and valuable to individuals seeking holistic approaches for emotional regulation and optimizing compensatory reserve mechanisms. This protocol is designed to not only teach mind-body awareness but also to provide feedback utilizing physiological data and survey results. The primary findings of this study showed that heart coherence and alpha variables were significantly correlated after four weeks of the breath-based meditation stress protocol. Meditation and rhythmic breathing produced significant increases in alpha brain activity. These brain physiological responses conformed to the Pleth Variability Index (PVI) changes, suggesting the ability of the human body to enter into a meditative state and effectively manage stress. When assessed after four weeks of daily practicing the techniques employed in the stress management protocol, based on the Five Facet Mindfulness Questionnaire, subjects improved in applying mindfulness skills. The overall mindfulness score, Pleth variability index (PVI), and perfusion index (PI) increased after the 4-week intervention period. Results from electroencephalography (brain waves) were consistent with a meditative state during the post-study follow-up session. This provides evidence that wearable devices are feasible for data collection during a breath-based stress management intervention. This protocol can be easily and efficiently implemented into any study design in which physiological data are desired in a non-laboratory-based setting.

The primary findings of this study showed that heart coherence and alpha variables were significantly correlated after the primary endpoint, the baseline after four weeks, and the endpoint after four weeks of the breath-based meditation stress protocol, but not during the baseline measurement (Figure 1). Based on these findings, it was concluded that this protocol produced significant increases in alpha brain activity consistent with meditative states. These ...

Watch this Scientific Journal Video about A Community-based Stress Management Program: Using Wearable Devices to Assess Whole Body Physiological Responses in Non-laboratory Settings at JoVE.com

A Community-based Stress Management Program: Using Wearable Devices to Assess Whole Body Physiological Responses in Non-laboratory Settings

Stress is an unavoidable and persistent component of life and holistic approaches for its management are being considered. A standardized methodology was created to demonstrate the feasibility of a breath-based stress management protocol that can be used with commercially available portable technology.

A pragmatic breath-based intervention to benefit human performance and stress management is timely and valuable to individuals seeking holistic approaches ...

The overall goal of this intervention is to demonstrate the feasibility of commercially available, wearable, physiological monitoring technology in a non-laboratory setting. To evaluate the effectiveness of intentional rhythmic breathing techniques, and a guided relaxation body scan. This method can help answer key questions in the field of human performance.Such as how breathing and meditation techniques may play a role in preserving compensatory mechanisms to optimize physiological function. The main advantage of this study is that commercially available wearable devices can be utilized to collect physiological data in a non-laboratory setting. The implications of these techniques extend from patients with chronic diseases to healthy individuals interested in optimizing physical and cognitive performance.As these techniques such as shown to balance the autonomic nervous system. I have been practicing rhythmic breathing for 40 years. And with today's technology, we can now study it's underlying physiology.Demonstrating the techniques will be Dr.Robert Carter from UT health. After taking baseline measurements, teaching breathing and relaxing techniques, and completing end point visits with selective participants according to the text protocol. Set up an EEG control panel that allows the user to monitor the status and features of the headset EEG.Including facial expressions and emotions. Before starting the recording of EEG data, switch on the EEG headset and ensure that the battery is fully charged. In preparation for an EEG session, begin by hydrating the 12 sensors.Then, assemble the headset. Use 0.5 saline solution to thoroughly saturate the felt pads. Which should feel wet when the headset is worn.Then place the headset on the users head. And make sure that the EEG electrodes make good contact on the scalp of the operator. Adjust the headset until each sensor impotence is below five kilo-ohms.Indicated by a green color on all of the electrodes. Position the reference sensors to touch the skin behind the ear. It is critical that the reference sensors make contact with the skin behind the ear with the sensor impotence below five kilo-ohms.To capture and record the pulse oximetry, ensure that the volunteer is in an upright position with both feet on the floor. Expose the interior of the pulse oximeter sensor, and insert a non-dominant finger. Then, position the finger, so that the finger tip approaches the sensors end.Gently close the device so that the finger contacts with the sensor pad. And place the hand comfortably on the thigh. Once the portable pulse oximeter is closed on the finger, the device should show heart rate, respiratory rate, profusion index, and the pleth variability index.And can be displayed via bluetooth on a smart tablet or computer. To carry out alternate nostril breathing, sit comfortably with the spine erect. Left hand on the left knee.And the eyes closed. Bring the right hand to the face, and place the index and middle fingers between the eyebrows. Then, place the ring and little fingers gently on the left nostril and place the thumb on the right nostril.Next, take a deep breath in. Then, press the thumb down on the right nostril to close it off. And exhale through the left nostril.Then, inhale through the left side of the nose. Now use the ring finger to press on the left nostril, and close off the left side of the nose. Then, release the thumb, and breathe out through the right side.Before using the right nostril to inhale. Repeat the alternate nostril breathing. Continually alternating inhalations and exhalations for five minutes.Recognize the presence of emotions and thoughts without responding to them in a physical or mental manner. And continue to bring your attention to air entering and exiting the nose. To perform victorious breathing, sit comfortably with the spine erect.Slowly take in a long breath. With the mouth closed, breathe out through the nose. Constricting the back of the throat.This mild constriction of the throat creates resistance to the passage of air. Gently breathe in. Pushing the breath in against the resistance produced by constricting the back of the throat.Then, breathe out against the same constriction. While in a seated posture, continue this breathing cycle for five minutes. Gently inhaling and exhaling slowly and deeply against the constriction at the back of the throat creates a soothing sound like ocean waves rising and falling.Recognize the presence of emotions and thoughts without responding to them physically or mentally. And continue to bring your attention to the air entering and exiting the nose. For bellows breath, sit up tall with relaxed shoulders.Slowly and deeply breathe in through the nose. Then, with eyes closed, breathe out and in from the nose. Flex the arms to bring the elbows close to the rib cage.And place loose fists close to the shoulders. Then, with active inhalation, raise the arms ups above the head while opening the fists. With vigorous exhalation, lower the arms to bring the elbows close the ribcage.And the fists by the shoulders again. Repeat the breathing and arm movements consecutively. 15 to 20 times as one set.Then, pause ten to fifteen seconds before carrying out a second and third set with a pause in between each repetition. The primary findings of the study presented in this video show that heart coherence and alpha variables were significantly correlated after the primary end point. The baseline after four weeks, and the end point after four weeks of the breath based meditation stress protocol.But not during the baseline measurement. As a result, this protocol produced significant increases in alpha brain activity. Consistent with meditative states.The brain's physiological changes were in line with the PVI changes, suggesting the ability of the human body to enter into a meditative state. And effectively manage stress. When participants were assessed after four weeks of daily practice, improvements in all five facets including observing, describing, acting with awareness, non judging of inner experience, and non reactivity to inner experience.Increased on average by 0.9 to 1.3 points on a scale of one, representing never, to five, which represents often. Once mastered, this procedure can be done in 90 minutes if it is performed properly. While attempting this procedure, it's important to remember to minimize any external distractions during the EEG and PVI pulse oximeter recording.As the devices may produce unwanted results and excessive noise to the physiological recordings. Following this procedure, other interventions like bio feedback, meditation, and Qigong can be studied and ordered to answer additional questions, like how does bio feedback in yoga alter brain activity and physiological function. After it's developed this technology paved the way for researchers in the field of human performance or physiological function during exercise or yoga outside of the laboratory.After watching this video, you should have a good understanding of how wearable physiological monitoring devices can be used to study interventions outside of laboratory settings. Don't forget that some individuals have reported moderate discomfort from wearing the EEG headset during extensive periods of time. During this investigation, volunteers should always be observed while performing breathing techniques.As some have reported feeling light headed or mild dizziness.

a-community-based-stress-management-program-using-wearable-devices-to

Research

JoVE Journal

Behavior

7.5K vistas.  The University of Texas Health Science Center. The overall goal of this intervention is to demonstrate the feasibility of commercially available, wearable, physiological monitoring technology in a non-laboratory setting. To evaluate the effectiveness of intentional rhythmic breathing techniques, and a guided relaxation body scan. This method can help answer key questions in the field of human performance.Such as how breathing and meditation techniques may play a role in preserving compensatory mechanisms to optimize physiological f...