Background Less than 2% of overweight children and adolescents in Switzerland can participate in multi-component behaviour changing interventions (BCI), due to costs and lack of time. Stress often hinders positive health outcomes in youth with obesity. Digital health interventions, with fewer on-site visits, promise health care access in remote regions; however, evidence for their effectiveness is scarce. Methods This randomized controlled not blinded trial (1:1) was conducted in a childhood obesity center in Switzerland. Forty-one youth aged 10–18 years with body mass index (BMI) > P.90 with risk factors or co-morbidities or BMI > P.97 were recruited. During 5.5 months, the PathMate2 group (PM) received daily conversational agent counselling via mobile app, combined with standardized counselling (4 on-site visits). Controls (CON) participated in a BCI (7 on-site visits). We compared the outcomes of both groups after 5.5 (T1) and 12 (T2) months. Primary outcome was reduction in BMI-SDS (BMI standard deviation score: BMI adjusted for age and sex). Secondary outcomes were changes in body fat and muscle mass (bioelectrical impedance analysis), waist-to-height ratio, physical capacities (modified Dordel-Koch-Test), blood pressure and pulse. Additionally, we hypothesized that less stressed children would lose more weight. Thus, children performed biofeedback relaxation exercises while stress parameters (plasma cortisol, stress questionnaires) were evaluated. Results At intervention start median BMI-SDS of all patients (18 PM, 13 CON) was 2.61 (obesity > + 2SD). BMI-SDS decreased significantly in CON at T1, but not at T2, and did not decrease in PM during the study. Muscle mass, strength and agility improved significantly in both groups at T2; only PM reduced significantly their body fat at T1 and T2. Average daily PM app usage rate was 71.5%. Cortisol serum levels decreased significantly after biofeedback but with no association between stress parameters and BMI-SDS. No side effects were observed. Conclusions Equally to BCI, PathMate2 intervention resulted in significant and lasting improvements of physical capacities and body composition, but not in sustained BMI-SDS decrease. This youth-appealing mobile health intervention provides an interesting approach for youth with obesity who have limited access to health care. Biofeedback reduces acute stress and could be an innovative adjunct to usual care.
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.
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 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.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.