Using Smartphone-Based Ambulatory Training to Maintain Biofeedback-Triggered Blood Pressure Reduction
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Abstract
Background
Cardiovascular diseases are leading causes of mortality in developed countries. One major risk factor for cardiovascular diseases is hypertension. Different blood pressure-reducing interventions, mostly pharmacological therapies, have been developed. However, the majority of these treatments require ongoing and regular medication intake. Biofeedback (i.e. the process of gaining greater awareness of physiological functions, using an instrument that provides information on the activity of those same systems, with the goal of being able to manipulate them at will) has been proposed as a non-pharmacological treatment alternative to reduce blood pressure. However, results of previous studies are conflicting, demonstrating no clear benefits of biofeedback in reducing hypertension, and there is a lack of data on long-term effectiveness. To sustain biofeedback success, ongoing ambulatory training may be essential. One important aspect of sustained therapy effects may be the maintenance of biofeedback training-related changes beyond the biofeedback training session itself.
Objective
We will conduct a study aiming at maintaining biofeedback-training-related changes in blood pressure by using smartphone-based ambulatory training.
Methods
Within this study, we will follow up 30 healthy adult volunteers that have received a standardized laboratory-based contingent biofeedback training (n=15, active condition) or non-contingent/sham-biofeedback training (n=15, control condition) to attain volitional control over their baseline and stress-responsive blood pressure. Over the course of two weeks, all subjects will receive standardized daily prompts, inviting them to participate in a short ambulatory smartphone-based training session (one session daily, approx. 10-15 minute duration), aiming at recapturing and refining previously learned strategies to reduce their blood-pressure and blood-pressure responses. In parallel, information regarding participation in the training sessions (training quantity) and evaluation of the training sessions (training quality) will be collected, using tailored scales. Afterwards, all individuals will again be assessed in the laboratory for their ability to volitionally control their baseline and stress-responsive blood pressure in the absence of feedback (as indicator of transfer), by assessing their ability to reduce their blood pressure during a standardized stressor. We will determine i) training quantity and quality (as indicators of study feasibility) and its predictors, as well as ii) the associations of training quantity and quality with blood pressure control in the absence of feedback, by using statistical methods based on generalized linear models.
Results
We will present process details of the study and its different components, with a focus on the ambulatory training sessions, experiences with the training and may report first preliminary results.
Conclusion
With the outlined study, we expect to provide information on the feasibility and usefulness of ambulatory smartphone-based interventions to maintain effects of laboratory-based biofeedback therapies. If this approach proves useful, it may represent a new way to increase the effectiveness and sustainability of biofeedback therapies for blood pressure regulation and beyond.
Cardiovascular diseases are leading causes of mortality in developed countries. One major risk factor for cardiovascular diseases is hypertension. Different blood pressure-reducing interventions, mostly pharmacological therapies, have been developed. However, the majority of these treatments require ongoing and regular medication intake. Biofeedback (i.e. the process of gaining greater awareness of physiological functions, using an instrument that provides information on the activity of those same systems, with the goal of being able to manipulate them at will) has been proposed as a non-pharmacological treatment alternative to reduce blood pressure. However, results of previous studies are conflicting, demonstrating no clear benefits of biofeedback in reducing hypertension, and there is a lack of data on long-term effectiveness. To sustain biofeedback success, ongoing ambulatory training may be essential. One important aspect of sustained therapy effects may be the maintenance of biofeedback training-related changes beyond the biofeedback training session itself.
Objective
We will conduct a study aiming at maintaining biofeedback-training-related changes in blood pressure by using smartphone-based ambulatory training.
Methods
Within this study, we will follow up 30 healthy adult volunteers that have received a standardized laboratory-based contingent biofeedback training (n=15, active condition) or non-contingent/sham-biofeedback training (n=15, control condition) to attain volitional control over their baseline and stress-responsive blood pressure. Over the course of two weeks, all subjects will receive standardized daily prompts, inviting them to participate in a short ambulatory smartphone-based training session (one session daily, approx. 10-15 minute duration), aiming at recapturing and refining previously learned strategies to reduce their blood-pressure and blood-pressure responses. In parallel, information regarding participation in the training sessions (training quantity) and evaluation of the training sessions (training quality) will be collected, using tailored scales. Afterwards, all individuals will again be assessed in the laboratory for their ability to volitionally control their baseline and stress-responsive blood pressure in the absence of feedback (as indicator of transfer), by assessing their ability to reduce their blood pressure during a standardized stressor. We will determine i) training quantity and quality (as indicators of study feasibility) and its predictors, as well as ii) the associations of training quantity and quality with blood pressure control in the absence of feedback, by using statistical methods based on generalized linear models.
Results
We will present process details of the study and its different components, with a focus on the ambulatory training sessions, experiences with the training and may report first preliminary results.
Conclusion
With the outlined study, we expect to provide information on the feasibility and usefulness of ambulatory smartphone-based interventions to maintain effects of laboratory-based biofeedback therapies. If this approach proves useful, it may represent a new way to increase the effectiveness and sustainability of biofeedback therapies for blood pressure regulation and beyond.
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