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, and overall wellness and lifestyle management.
1. Participant Selection
<ol>
	<li>Perform the following for all participants: a telephone screening, a baseline visit (home), a 4-week intervention period, and an endpoint visit (same or similar setting as the baseline visit).
	<ol>
		<li>Arrange telephone screenings with interested volunteers. During the call, determine eligibility by asking questions about medical history and medications.</li>
		<li>Schedule a baseline visit for eligible and interested volunteers (home or similar setting). Deliver consent forms for review before the visit. 
		NOTE: It is well described in the literature that a human undergoing study in a laboratory can be associated with environmental and cognitive stress due to their awareness of being observed (e.g., the Hawthorne effect). One of the primary advantages of the home-based protocol is the ability to minimize the potential impact of foreign environments, such as a clinical or laboratory setting, on the physiological measures. Additionally, investigators may be able to extend research protocols to community-based interventions without having to request participants come to a laboratory.</li>
		<li>Arrive at the home or pre-intervention setting and explain the purpose, procedures, risks and discomforts, benefits, confidentiality, and liability of the study both in writing and verbally before participants sign the consent form.</li>
		<li>Confirm inclusion and exclusion criteria.</li>
		<li>Have participant complete the subjective questionnaire on mindfulness10.&#160;Equip participant with physiological devices.</li>
		<li>Record baseline measurements for 10 min in a comfortable seated posture, for 10 min after the initial intervention, a 10 min baseline after the 4-week intervention, and a 10 min period after the individual completes the breathing and meditation protocol. 
		NOTE: The data collection setting was the same pre- and post-intervention within a given individual. The 10 min data recording periods were stored for further analysis and reported as a 10 min average.</li>
		<li>Immediately after completing the consenting procedures, teach three breathing techniques immediately followed by listening to pre-recorded audio of the 20 min guided relaxation3,11,12. Repeat four times to establish a baseline.</li>
		<li>Report only the final breathing and meditation protocol data as the initial intervention time point. Give all participants a compact disc (CD) with the breathing technique instructions and 20 min guided relaxation audio.</li>
		<li>Provide each person with detailed instructions for the four weeks of self-guided daily breathing techniques and instruct him or her to complete the breathing exercises, along with the 20 min of guided relaxation, each morning for four weeks.</li>
		<li>Have a member of the study team follow up with each person to ensure that the protocol was being followed and to assist with any instructional issues.</li>
		<li>After the 4-week intervention period, return to the participant&#39;s home to complete the endpoint visit, proceeding in the same manner as the baseline visit. Also, have participants complete the 39-item Five Facet Mindfulness Questionnaire. 
		NOTE: The purpose of this paper was to describe the methodology of the breathing protocol and the use of physiological monitoring in a non-laboratory setting. Investigators utilizing the breath-based meditation stress management protocol and physiological monitoring devices described in this paper may need to employ a control group for internal validity. Previous studies examining the benefit of meditation and controlled breathing have utilized a variety of control groups such as a time-matched aerobic exercise, other meditation practices, biofeedback techniques, serious gaming along with guided meditation yoga routines, and a time control without intervention.</li>
	</ol>
	</li>
</ol>
2. Setup for Research Grade Wireless Electroencephalography (EEG) System
<ol>
	<li>To export, evaluate, and analyze the data, provide/equip a personal laptop with a serial port to participants.
	<ol>
		<li>Set up an EEG Control Panel that allows the user to monitor the status and features of the headset EEG, including facial expressions and emotions13. Data collection will take place in real time, while the subject wears the EEG headset.</li>
		<li>Before starting the recording of EEG data, switch on the EEG headset and ensure that the battery is fully charged. The device can now be set up for the user.</li>
	</ol>
	</li>
	<li>Before recording an EEG session, perform the following steps.
	<ol>
		<li>Hydrate the twelve sensors. Assemble the headset. Thoroughly saturate the felt pads using 0.5% saline solution. When the headset is placed on the scalp, the pads should feel wet.</li>
		<li>Put on the headset. Place the headset on the user&#39;s head and make sure that the EEG electrodes make good contact (defined as below five k&#937;) on the scalp of the operator. Adjust the headset until each sensor impedance is below five k&#937;.</li>
		<li>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 a sensor impedance of below five k&#937;.</li>
		<li>Plug the dongle into the device&#39;s USB port. When a headset is paired, the indicator light should flicker rapidly. If this is not the situation, reinsert the dongle and try again.</li>
	</ol>
	</li>
	<li>Launch the software on the laptop.</li>
	<li>Turn on the headset. The power switch is at the rear of the headset. A light indicates when the headset is on.</li>
	<li>Verify signal quality by examining the engine status on the control panel. 
	NOTE: Because EEG data is being recorded, it is possible to utilize a software platform for additional research quality analysis on emotional states and facial expression13,14,15.</li>
</ol>
3. Setup of the Bluetooth-Enabled Pulse Oximeter
<ol>
	<li>Capture and record the pulse oximetry using a pulse oximeter, attached to a right or left ring finger, which is activated when connected.
	<ol>
		<li>Ensure that the volunteer is in the upright position with both feet on the floor. Place the hand with the pulse oximeter comfortably on the thigh.</li>
	</ol>
	</li>
	<li>Expose the interior of pulse oximeter sensor and insert a non-dominant finger. Position the finger so that the fingertip approaches the sensor&#39;s end. Close the device gently so that the finger contacts with the sensor pad. 
	NOTE: Once the portable pulse oximeter is closed on the finger, the device should show heart rate (HR), respiratory rate (RR), perfusion index (PI), and the Pleth variability index (PVI)16,17. HR, RR, PI, and PVI are displayed on the pulse oximeter device and can be displayed via Bluetooth on a smart tablet or computer.</li>
</ol>
4. Overview Five Facet Mindfulness Questionnaire
Note: This questionnaire is available in both paper and electronic format for administration10. The paper form is provided in Appendix A. Each of the five facets are based on a scale of mindfulness from 1 to 5. There is no cutoff score for being mindful or not mindful; rather it is a continuum from low to high. Each of the subscales related to the five facets of mindfulness is below.
<ol>
	<li>Observe the ability to stay and be present and not be preoccupied with body sensations, feelings, and thoughts on a scale from 1 to 5, with five being the easiest to accomplish this task and one being the most difficult to accomplish this task.</li>
	<li>Assess the ability to define emotions and expectations, past or present on a scale from 1 to 5, with five being the easiest to accomplish this task and one being the most difficult to accomplish this task.</li>
	<li>Assess the ability to stay present with whatever is going on physically or mentally without disturbance, on a scale from 1 to 5, with five being the easiest to accomplish this task and one being the most difficult to accomplish this task.</li>
	<li>Assess the ability to remain nonjudgmental of any past experiences or attempt to cognitively criticize the present experience, on a scale from 1 to 5, with five being the easiest to accomplish this task and one being the most difficult to accomplish this task.</li>
	<li>Assess the ability to recognize the presence of emotions and thoughts without responding to them physically or mentally, on a scale from 1 to 5, with five being the easiest to accomplish this task and one being the most difficult to accomplish this task.</li>
</ol>
5. Alternate Nostril Breath Protocol (5 min)
<ol>
	<li>Sit comfortably with the spine erect, the left hand on the left knee and the eyes closed.</li>
	<li>Bring the right hand to the face. Place the index and middle fingers between the eyebrows. Place the ring and little fingers gently on the left nostril, and place the thumb on the right nostril.</li>
	<li>Take a deep breath in.</li>
	<li>Press the thumb down on the right nostril to close it off and exhale through the left. Inhale through the left side of the nose.</li>
	<li>After that, by pressing the nostril with the ring finger, close that side of the nose. Release the thumb and breathe out through the right side. Then, inhale using the right nostril.</li>
	<li>Repeat 5.4 - 5.5, continually alternating inhalations and exhalations, for 5 min.</li>
	<li>Recognize the presence of emotions and thoughts without responding to them in a physical or mental manner and continue to bring your attention to the air entering and exiting the nose.</li>
</ol>
6. Victorious Breath Protocol (5 min)
<ol>
	<li>Sit comfortably with the spine erect.</li>
	<li>Take a long, deep breath in slowly.</li>
	<li>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.</li>
	<li>Breathe in gently, pushing the breath in against the resistance produced by constricting the back of the throat.</li>
	<li>Gently inhaling and exhaling slowly and deeply against this constriction at the back of the throat creates a soothing sound like ocean waves rising and falling.</li>
	<li>Continue this breathing cycle for 5 min while in a seated posture.</li>
	<li>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.</li>
</ol>
7. Bellows Breath Protocol (5 min)
<ol>
	<li>Sit up tall with relaxed shoulders.</li>
	<li>Breathe in slowly and deeply through the nose.</li>
	<li>Breath in and out from the nose with the eyes closed.</li>
	<li>Flex the arms to bring elbows close to the rib cage and loose fists close to the shoulders.</li>
	<li>With active inhalation, raise the arms up above the head while opening the fists.</li>
	<li>With vigorous exhalation, bring the arms down to bring the elbows close to the rib cage and the fists by the shoulders.</li>
	<li>Repeat steps 7.1 to 7.3 consecutively 15 to 20 times, making one set.</li>
	<li>Do 3 sets with a pause of 10 to 15 s between each set.</li>
</ol>
8. Guided Relaxation Body Scan (8 - 10 min)
NOTE: Read these instructions to the participants: &#34;The purpose of this guided relaxation is to bring the attention to different areas of the body and may assist with better awareness of physical sensations in various areas of the body. Drawing attention to various regions of the body trains the mind to be more attentive to these feelings.&#34;
<ol>
	<li>Have a seat in a comfortable chair or the floor and after 15 seconds close the eyes. Be sure that the environment is safe, quiet, and free of distractions.</li>
	<li>Observe how the mind and body are feeling right now. Observe any sensations in the body or any thoughts in mind. Continue to notice how the body is feeling and observe any thoughts on the mind.</li>
	<li>Start to scan the body: With the eyes closed, mentally scan the body. Remember to take a deep breath in and let it go periodically. 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.
	<ol>
		<li>Start scanning with the right foot; move to the right leg and right hip. Repeat scanning with the left foot, leg, and hip. Move slowly through each part of the body. Repeat this again starting with the right side and moving to the left side.</li>
		<li>Continue scanning the body by moving slowly to the stomach, the left aspect of the body, the right aspect of the body, the upper to the lower back and finally to the chest, starting at the neck and moving down to the stomach.</li>
		<li>Continue to mentally scan the left hand, left arm and left shoulder; continue by examining the right hand, right arm, and right shoulder.</li>
		<li>Slowly scan the head, starting with the face and moving to the neck, back of the head, and top of the head.</li>
		<li>Observe any tension in the body and bring the mental attention to that region and rescan it.</li>
		<li>Finally, before opening the eyes, take a moment to observe thoughts, feelings, and sensations. What are the thoughts right now about the body scan? Try not to judge the scan; just observe the breath and body.</li>
		<li>Take one final deep breath in, hold it for 4 seconds and let it go. Now slowly open the eyes.</li>
	</ol>
	</li>
</ol>

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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. 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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 ...

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Research

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7.5K Views.  The University of Texas Health Science Center. 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.

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

Use of Galvanic Skin Responses, Salivary Biomarkers, and Self-reports to Assess Undergraduate Student Performance During a Laboratory Exam Activity

Typically, self-reports are used in educational research to assess student response and performance to a classroom activity. Yet, addition of biological and physiological measures such as salivary biomarkers and galvanic skin responses are rarely included, limiting the wealth of information that can be obtained to better understand student performance. A laboratory protocol to study undergraduate students&#39; responses to classroom events (e.g., exams) is presented. Participants were asked to complete a representative exam for their degree. Before and after the laboratory exam session, students completed an academic achievement emotions self-report and an interview that paralleled these questions when participants wore a galvanic skin sensor and salivary biomarkers were collected. Data collected from the three methods resulted in greater depth of information about students&#39; performance when compared to the self-report. The work can expand educational research capabilities through more comprehensive methods for obtaining nearer to real-time student responses to an examination activity.

Research on undergraduate students' academic achievement emotions have primarily relied on self-reports in laboratory settings. Studies rarely include bio-physiological measures to these self-reports. This protocol will describe a methodology that integrates self-reports with and bio-physiological measures to assess student response and performance during a laboratory examination activity.

Typically, self-reports are used in educational research to assess student response and performance to a classroom activity. Yet, addition of biological ...

Methodology for Establishing a Community-Wide Life Laboratory for Capturing Unobtrusive and Continuous Remote Activity and Health Data

An end-to-end suite of technologies has been established for the unobtrusive and continuous monitoring of health and activity changes occurring in the daily life of older adults over extended periods of time. The technology is aggregated into a system that incorporates the principles of being minimally obtrusive, while generating secure, privacy protected, continuous objective data in real-world (home-based) settings for months to years. The system includes passive infrared presence sensors placed throughout the home, door contact sensors installed on exterior doors, connected physiological monitoring devices (such as scales), medication boxes, and wearable actigraphs. Driving sensors are also installed in participants' cars and computer (PC, tablet or smartphone) use is tracked. Data is annotated via frequent online self-report options that provide vital information with regard to the data that is difficult to infer via sensors such as internal states (e.g., pain, mood, loneliness), as well as data referent to activity pattern interpretation (e.g., visitors, rearranged furniture). Algorithms have been developed using the data obtained to identify functional domains key to health or disease activity monitoring, including mobility (e.g., room transitions, steps, gait speed), physiologic function (e.g., weight, body mass index, pulse), sleep behaviors (e.g., sleep time, trips to the bathroom at night), medication adherence (e.g., missed doses), social engagement (e.g., time spent out of home, time couples spend together), and cognitive function (e.g., time on computer, mouse movements, characteristics of online form completion, driving ability). Change detection of these functions provides a sensitive marker for the application in health surveillance of acute illnesses (e.g., viral epidemic) to the early detection of prodromal dementia syndromes. The system is particularly suitable for monitoring the efficacy of clinical interventions in natural history studies of geriatric syndromes and in clinical trials.

Unobtrusive sensors and pervasive computing technology incorporated into the daily home life of older adults enables meaningful health and activity changes to be recorded continuously for months to years, providing ecologically valid, high frequency, multi-domain data for research or clinical use.

An end-to-end suite of technologies has been established for the unobtrusive and continuous monitoring of health and activity changes occurring in the ...

A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program

Despite the evidence that cardiac rehabilitation (CR) reduces the risk of recurrent cardiac events, only a minority of eligible patients are willing to join existing programs at cardiac rehabilitation centers. The unique remote patient monitoring system presented here enables healthcare providers to monitor CR patients at home in real-time and at low cost. The system combines mobile technology, artificial intelligence, and supportive services, expanding the delivery of medical care to the patient&#39;s home. The primary aim of the study is to increase the long-term adherence to physical activity in patients who participate in CR via the addition of a home-based digitally monitored CR component to the standard CR program in patients with ischemic heart disease (IHD), with the idea of forming new habitual health behaviors and increasing the long-term motivation for physical exercise (PE) habits at home. Secondary aims are to assess the program&#39;s impact on the physical activity level measured by average steps per day, minutes of exercise per week, blood pressure, metabolic parameters, body mass index, and waist-to-hip ratio, as well as a quality-of-life (QoL) questionnaire.The study has two arms: (1) home-based monitored exercise using a smart digital garment and wristband, in addition to motivation and reinforcement via text messages; (2) standard CR facility-based exercise. The study design is a randomized, controlled trial comparing standard CR to a home-based monitoring and reinforcement program. The study program is designed for 12 weeks.Clinical tests and anthropometric measurements are performed before and after the study, measuring height, weight, waist circumference, visceral fat and body mass index (BMI), blood pressure, and HbA1c and lipid profile. Patients have to complete a baseline survey including socio-demographic characteristics and QoL questionnaire SF-36. At the end of the study, patients complete a survey regarding the use of the smart digital garment&#39;s benefits and usability. The study is currently underway.

The aim is to promote a new approach to cardiac rehabilitation (CR), using a unique remote patient monitoring system that will enable healthcare providers to monitor CR patients at home at low cost, with the intention of making CR services more accessible and improving compliance. The study is currently underway.

Despite the evidence that cardiac rehabilitation (CR) reduces the risk of recurrent cardiac events, only a minority of eligible patients are willing to ...

Evaluation of Commercial-Off-The-Shelf Wrist Wearables to Estimate Stress on Students

Wearable commercial-off-the-shelf (COTS) devices have become popular during the last years to monitor sports activities, primarily among young people. These devices include sensors to gather data on physiological signals such as heart rate, skin temperature or galvanic skin response. By applying data analytics techniques to these kinds of signals, it is possible to obtain estimations of higher-level aspects of human behavior. In the literature, there are several works describing the use of physiological data collected using clinical devices to obtain information on sleep patterns or stress. However, it is still an open question whether data captured using COTS wrist wearables is sufficient to characterize the learners' psychological state in educational settings. This paper discusses a protocol to evaluate stress estimation from data obtained using COTS wrist wearables. The protocol is carried out in two phases. The first stage consists of a controlled laboratory experiment, where a mobile app is used to induce different stress levels in a student by means of a relaxing video, a Stroop Color and Word test, a Paced Auditory Serial Addition test, and a hyperventilation test. The second phase is carried out in the classroom, where stress is analyzed while performing several academic activities, namely attending to theoretical lectures, doing exercises and other individual activities, and taking short tests and exams. In both cases, both quantitative data obtained from COTS wrist wearables and qualitative data gathered by means of questionnaires are considered. This protocol involves a simple and consistent method with a stress induction app and questionnaires, requiring a limited participation of support staff.

A protocol to evaluate solutions based on commercial-off-the-shelf (COTS) wrist wearables to estimate stress in students is proposed. The protocol is carried out in two phases, an initial laboratory-based stress induction test, and a monitoring stage taking place in the classroom while the student is performing academic activities.

Wearable commercial-off-the-shelf (COTS) devices have become popular during the last years to monitor sports activities, primarily among young people. ...

Engineering

An Application for Pairing with Wearable Devices to Monitor Personal Health Status

The current protocol aims to showcase the technology integration, providing a detailed description of adopting the HealthCloud app, developed by the Healthy Landscape and Healthy People Lab, National Taiwan University (HLHP-NTU), on smartphones and smartwatches to collect data on users' real-time psychological and physiological responses and environmental information. A flexible and integrated research method was proposed because it can be difficult to measure multi-dimensional aspects of personal data in on-site studies in landscape and outdoor recreation research. An on-site study conducted in 2020 at the National Taiwan University campus was used as an application example. A dataset of 385 participants was used after excluding invalid samples. During the experiment, participants were asked to walk around campus for 30 min when their heart rate and psychological-scale items were measured, together with several environmental metrics. This work aimed to provide a possible solution to help on-site studies track real-time human responses that match ambient factors. Due to the app's flexibility, its use on wearable devices shows excellent potential for multidisciplinary research studies.

The present protocol introduces a non-commercial self-developed application for collecting real-time on-site data, including psychological scales, GPS location, heart rate, and blood-oxygen saturation level, as well as the application's operating procedures. An empirical study conducted in Taiwan in 2020 was used as an application example.

The current protocol aims to showcase the technology integration, providing a detailed description of adopting the HealthCloud app, developed by the ...

Environment

Measuring Biophysical and Psychological Stress Levels Following Visitation to Three Locations with Differing Levels of Nature

Visitation to natural environments has been linked to psychological stress reduction. Although most stress-related research has relied on self-report formats, a growing number of studies now incorporate biological stress-related hormones and catalysts, such as cortisol and &#945;-amylase, to measure levels of stress. Presented here is a protocol to examine the effects on levels of biophysical and psychological stress following visitation to three different locations with differing levels of nature. Biophysical and self-reported psychological stress levels are measured immediately upon entering the selected locations and just prior to the visitors leaving the site. Using a &#34;drool&#34;&#160;method, the biophysical measure consists of 1-2 mL samples of saliva provided by study subjects upon entry to one of three study locations. As prescribed by extant literature, the saliva is collected within a 45 minute time frame following the end of the visitor&#8217;s engagement at the location. Following saliva collection, the samples are labeled and transported to a biological lab. Cortisol is the biophysical variable of interest in this study and measured using an ELISA process with a TECAN plate reader. To measure self-reported stress, the Perceived Stress Questionnaire (PSQ), which reports levels of worry, tension, joy, and perceived demands. Data are collected at all three sites in the late afternoon through early evening. When compared across all three settings, stress levels, as measured by both the biological markers and self-reports, are significantly lower after visitation to the most natural setting.

The purpose of this paper is to identify changes in stress levels after visitation to three different settings and to describe the methods used in identifying stress levels based on measures of salivary cortisol, &#945;-amylase, and a psychological self-report instrument.&#160;

Visitation to natural environments has been linked to psychological stress reduction. Although most stress-related research has relied on self-report ...

Psychophysiological Stress Assessment Using Biofeedback 

In the last half century, research in biofeedback has shown the extent to which the human mind can influence the functioning of the autonomic nervous system, previously thought to be outside of conscious control. By letting people observe signals from their own bodies, biofeedback enables them to develop greater awareness of their physiological and psychological reactions, such as stress, and to learn to modify these reactions. Biofeedback practitioners can facilitate this process by assessing people s reactions to mildly stressful events and formulating a biofeedback-based treatment plan. During stress assessment the practitioner first records a baseline for physiological readings, and then presents the client with several mild stressors, such as a cognitive, physical and emotional stressor. Variety of stressors is presented in order to determine a person's stimulus-response specificity, or differences in each person's reaction to qualitatively different stimuli. This video will demonstrate the process of psychophysiological stress assessment using biofeedback and present general guidelines for treatment planning.

Psychophysiological Stress Assessment Using Biofeedback

In this video we will describe one method of assessing person's psychophysiological reaction to stress using biofeedback. We will also present general guidelines for treatment planning.

In the last half century, research in biofeedback has shown the extent to which the human mind can influence the functioning of the autonomic nervous ...

Biology

Setup of Consumer Wearable Devices for Exposure and Health Monitoring in Population Studies

Wearable sensors, which are often embedded in commercial smartwatches, allow for continuous and non-invasive health measurements and exposure assessments in clinical studies. Nevertheless, the real-life application of these technologies in studies involving a large number of participants for a significant observation period may be hindered by several practical challenges. 
In this study, we present a modified protocol from a previous intervention study for the mitigation of health effects from desert dust storms. The study involved two distinct population groups: asthmatic children aged 6-11 years and elderly patients with atrial fibrillation (AF). Both groups were equipped with a smartwatch for the assessment of physical activity (using a heart rate monitor, pedometer, and accelerometer) and location (using GPS signals to locate individuals in indoor "at home" or outdoor microenvironments). The participants were required to wear the smartwatch equipped with a data collection application on a daily basis, and data were transmitted via a wireless network to a centrally administered data collection platform for the near real-time assessment of compliance. 
Over a period of 26 months, more than 250 children and 50 patients with AF participated in the aforementioned study. The main technical challenges identified included restricting access to standard smartwatch features, such as gaming, internet browser, camera, and audio recording applications, technical issues, such as loss of GPS signal, especially in indoor environments, and the internal smartwatch settings interfering with the data collection application.
The aim of this protocol is to demonstrate how the use of publicly available application lockers and device automation applications made it possible to address most of these challenges in a simple and cost-effective way. In addition, the inclusion of a Wi-Fi received signal strength indicator significantly improved indoor localization and largely minimized GPS signal misclassification. The implementation of these protocols during the roll-out of this intervention study in the spring of 2020 led to significantly improved results in terms of data completeness and data quality.

Commercial smartwatches equipped with wearable sensors are increasingly being used in population studies. However, their utility is often constrained by their limited battery duration, memory capacity, and data quality. This report provides examples of cost-effective solutions to real-life technical challenges encountered during studies involving asthmatic children and elderly cardiac patients.

Wearable sensors, which are often embedded in commercial smartwatches, allow for continuous and non-invasive health measurements and exposure assessments ...

Bioengineering

Assessing the Accuracy of Fitness Smartwatch Data for Cardiovascular and Physical Activity Monitoring: A Validation Study in Digital Health

This study aims to validate the accuracy of low-cost fitness smartwatches by comparing their data with gold-standard measurements for cardiovascular and physical activity parameters. The study enrolled 50 subjects, 26 undergoing validation testing for heart rate, blood oxygen saturation (SpO2), and sleep data against polysomnography (PSG). Additionally, 24 subjects participated in the 3-Minute Walk Test (3MWT) and Stairs Climbing (SC), with step counts validated against manual video calculations. Results showed no significant difference between the device&#39;s measurements and gold standard values for shallow sleep, deep sleep, REM time, mean heart rate, minimum heart rate, and SpO2. However, the device significantly underestimated manually counted steps (p = 0.009 (3MWT); p = 0.012 (SC)), total sleep duration (p = 0.004), and wake time (p = 8.94&#160;&#215; 10-8) while overestimating maximum heart rate (p = 0.011). These findings highlight the importance of accurate validation and interpretation of wearable device data in clinical contexts. Given these limitations, excluding the device&#39;s readings in future analyses is recommended to maintain data reliability and research integrity. This study underscores the need for ongoing validation and improvement of wearable technology to ensure its reliability and effectiveness in healthcare.

Wearable technology has low cost and offers convenient monitoring of physiological data. However, the accuracy and reliability of these devices require cautious assessment to ensure their effectiveness and safety for users. This report describes the validation process of a commercial smartwatch in monitoring physiological data and physical activity.

This study aims to validate the accuracy of low-cost fitness smartwatches by comparing their data with gold-standard measurements for cardiovascular and ...