Tension Tamer: Delivering Meditation With Objective Heart Rate Acquisition for Adherence Monitoring Using a Smart Phone Platform

Abstract

Objectives: This brief report demonstrates the proof of concept of the Tension Tamer (TT) smartphone application, which integrates photoplethysmograph capabilities with breathing awareness meditation (BAM), to reduce stress and measure heart rate and adherence. Design: Methods for objectively measuring heart rate and adherence to BAM were developed as part of a future randomized controlled trial. Setting/Location: The study was conducted at Jerry Zucker Middle School of Science and the Medical University of South Carolina, Charleston. Subjects: The subjects were three prehypertensive male teachers. Intervention: The method used was smartphone delivered BAM. Outcome measures: Objective measures included heart rate, adherence, and ambulatory blood pressure (BP). Results: Adherence data was successfully collected by the TT application. Increased adherence to TT coincided with increased improvements in ambulatory BP over a 3-month period. Conclusions: TT shows promise as a simple inexpensive program for administering BAM and capturing adherence data in future clinical trials.

Formative evaluation on cultural tailoring breathing awareness meditation smartphone apps to reduce stress and blood pressure

“…Over the past 6 years, we have incorporated a patientcentered, behavioral theory-guided, iterative design process to deliver BAM through TT on Android and iOS platforms (37). Very little evidence is available on the efficacy of other meditation/BAM apps in developing effective habits and mindfulness, and none have documented outcomes on BP besides TT (38).…”

“…A proprietary software program was developed to enable validated realtime HR acquisition during TT sessions using the built-in LED and video camera as a reflective photoplethysmograph (39,40). We have observed promising results from two 3-month smartphone delivered TT trials (37,41,42), where TT was found to be highly acceptable and intuitive in its use. In addition, clinically meaningful reductions in resting BP, ambulatory BP and reductions in SNS activation (i.e., reduced morning awakening curve of salivary alpha amylase) have been observed in preEH White and African American adults outlining a biological mechanistic pathway for BAM and resultant stress reduction (15,41,42).…”

mHealth medication and blood pressure self-management program in Hispanic hypertensives: a proof of concept trial

“…22 These concepts have been useful in our team's development and implementation for both face-to-face and mHealth-delivered cognitive behavioral change programs, resulting in sustained behavior changes and improvements in associated biofunction indices. 28,[39][40][41] This repeated contact with Hispanic patients and their health care teams enabled us to develop and refine our approach to implement a personalized program aimed at initiating and sustaining motivation to adhere to medical regimens by improving self-efficacy and autonomous regulation. 30 Physicians determined when their clinic nurse coordinator should be immediately contacted if and when a patient's BP exceeded threshold levels.…”

“…Our research involving ethnic minorities has found that cultural heritage, attitudes, beliefs of treatment efficacy, and buy-in play significant roles in the degree to which an intervention is adopted. 28,29,39,41 This information has and will continue to guide the iterative design, evaluation, and refinement process of the SMASH program. With newly capable data management systems in place to automate personalized messages, this intervention can be scaled to a large population.…”

Effects of Hatha Yoga on Blood Pressure, Salivary α-Amylase, and Cortisol Function Among Normotensive and Prehypertensive Youth

“…Recent advances in wireless mobile health technologies can objectively monitor adherence to yoga and meditation programs by measuring heart rate and body movement patterns. 58,59 Other ecologic momentary assessment tactics (e.g., frequency, severity, and type of stress exposures; cognitive and affective state responses) can be captured by using this technology. Future yoga BP control studies would benefit from repeated 24-hour BP evaluations in conjunction with smartphone-enabled ecologic momentary assessment techniques to monitor the frequency and intensity of the participants' intrinsic and extrinsic stressor exposure, fluctuations in affective states, and use of components of yoga asanas and/or breathing techniques when feeling stressed.…”