Slow-paced biofeedback-guided breathing training has been shown to improve cardiac functioning and psychological wellbeing. Current training options, however, attract only a fraction of individuals and are limited in their scalability as they require dedicated biofeedback hardware. In this work, we present Breeze, a mobile application that uses a smartphone's microphone to continuously detect breathing phases, which then trigger a gamified biofeedback-guided breathing training. Circa 2.76 million breathing sounds from 43 subjects and control sounds were collected and labeled to train and test our breathing detection algorithm. We model breathing as inhalation-pause-exhalation-pause sequences and implement a phase-detection system with an attention-based LSTM model in conjunction with a CNN-based breath extraction module. A biofeedback-guided breathing training with Breeze takes place in real-time and achieves 75.5% accuracy in breathing phases detection. Breeze was also evaluated in a pilot study with 16 new subjects, which demonstrated that the majority of subjects prefer Breeze over a validated active control condition in its usefulness, enjoyment, control, and usage intentions. Breeze is also effective for strengthening users' cardiac functioning by increasing high-frequency heart rate variability. The results of our study suggest that Breeze could potentially be utilized in clinical and self-care activities. Sailboat In h a le P a u se E xh a le P a u se … Nose Mouth R e p e a te d a co u st ic b re a th in g se q u e n ce Fig. 1. Overview of Breeze, a mobile gamified biofeedback breathing training.
Background Slow-paced breathing training (6 breaths per minute [BPM]) improves physiological and psychological well-being by inducing relaxation characterized by increased heart rate variability (HRV). However, classic breathing training has a limited target group, and retention rates are very low. Although a gameful approach may help overcome these challenges, it is crucial to enable breathing training in a scalable context (eg, smartphone only) and ensure that they remain effective. However, despite the health benefits, no validated mobile gameful breathing training featuring a biofeedback component based on breathing seems to exist. Objective This study aims to describe the design choices and their implementation in a concrete mobile gameful breathing training app. Furthermore, it aims to deliver an initial validation of the efficacy of the resulting app. Methods Previous work was used to derive informed design choices, which, in turn, were applied to build the gameful breathing training app Breeze. In a pretest (n=3), design weaknesses in Breeze were identified, and Breeze was adjusted accordingly. The app was then evaluated in a pilot study (n=16). To ascertain that the effectiveness was maintained, recordings of breathing rates and HRV-derived measures (eg, root mean square of the successive differences [RMSSDs]) were collected. We compared 3 stages: baseline, standard breathing training deployed on a smartphone, and Breeze. Results Overall, 5 design choices were made: use of cool colors, natural settings, tightly incorporated game elements, game mechanics reflecting physiological measures, and a light narrative and progression model. Breeze was effective, as it resulted in a slow-paced breathing rate of 6 BPM, which, in turn, resulted in significantly increased HRV measures compared with baseline (P<.001 for RMSSD). In general, the app was perceived positively by the participants. However, some criticized the somewhat weaker clarity of the breathing instructions when compared with a standard breathing training app. Conclusions The implemented breathing training app Breeze maintained its efficacy despite the use of game elements. Moreover, the app was positively perceived by participants although there was room for improvement.
BACKGROUND Slow-paced breathing trainings (6 breaths/min) improve physiological and psychological well-being by inducing relaxation characterized through an increased heart rate variability (HRV). However, classical breathing trainings have a limited target group and retention rates are very low. While a gamified approach may help to overcome these challenges, it is crucial to enable them in a scalable context (e.g., smartphone-only) and ensure a balance between experiential (user experience) and instrumental (increased HRV) values. Nevertheless, well-founded design principles (DPs) that lead to this outcome remain largely unexplored, especially in the context of mobile applications. OBJECTIVE This study aims to identify and evaluate DPs for mobile gamified biofeedback-guided breathing trainings that balance between instrumental and experiential values. METHODS Prior work was used to derive informed DPs, which, in turn, were applied to build the breathing training application Breeze. Then, through a pretest (N=3), mobile-specific design principles (M-DPs) have been formulated and Breeze adjusted accordingly. The DPs were then qualitatively evaluated in a pilot study (N=16). To ascertain that the instrumental values are maintained despite the introduction of gamified elements, recordings of breathing rates and HRV derived measures (e.g., RMSSD) were collected. For each participant, the recordings were then compared during baseline, a standard breathing training deployed on a smartphone, and Breeze. RESULTS Overall, 5 DPs were identified that propose to use cool colors, natural settings, tightly incorporated gamified elements, game mechanics that reflect physiological measures, and a light narrative and progression model. Moreover, 2 M-DPs were proposed that focus on the visual accentuation and alignment of guidance and biofeedback elements. Also, Breeze was effective as it resulted in a slow-paced breathing rate of 6 breaths per minute, which, in turn, resulted in significantly increased HRV measures compared to baseline (P<.001 for RMSSD). CONCLUSIONS The implemented DPs have a positive resonance in respondents but require further substantiation. Nevertheless, when compared to a standard breathing training, they lead to an increase in experiential value while maintaining the instrumental value.
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