Development of a modular stress management platform (Performance Edge VR) and a pilot efficacy trial of a bio-feedback enhanced training module for controlled breathing

Kluge, Murielle G.; Maltby, Steven; Walker, Nicole; Bennett, Neanne; Aidman, Eugene; Nalivaiko, Eugene; Walker, Frederick R.

doi:10.1371/journal.pone.0245068

Cited by 17 publications

(32 citation statements)

References 56 publications

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“…Of the 32 studies, 24 involved healthy individuals [ 6 , 8 , 10 , 24 , 26 , 28 - 38 , 40 , 41 , 43 - 48 ], 1 involved individuals at high risk of developing anxiety disorders [ 39 ], 1 involved patients with lung cancer [ 7 ], 1 involved patients with pneumonia [ 49 ], 2 involved patients with COPD [ 27 , 42 ], 2 involved patients with COVID-19 [ 49 , 50 ], and 1 involved patients with asthma [ 5 ]. The breathing exercises were mostly related to breathing therapy (9/32) [ 5 , 6 , 10 , 25 , 27 , 33 , 48 , 49 , 54 ] and anxiety management (13/32) [ 8 , 28 , 29 , 32 , 34 , 36 , 37 , 39 - 41 , 43 - 45 ]. Most of the reviewed papers based their research on pilot (16/32) or control studies (11/32), while some of the papers (4/32) only described the design and development processes of their systems.…”

Section: Resultsmentioning

confidence: 99%

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Virtual Reality for Pulmonary Rehabilitation: Comprehensive Review

Pittara¹,

Matsangidou²,

Petkov³

et al. 2023

JMIR Rehabil Assist Technol

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Background Pulmonary rehabilitation is a vital component of comprehensive care for patients with respiratory conditions, such as lung cancer, chronic obstructive pulmonary disease, and asthma, and those recovering from respiratory diseases like COVID-19. It aims to enhance patients’ functional ability and quality of life, and reduce symptoms, such as stress, anxiety, and chronic pain. Virtual reality is a novel technology that offers new opportunities for customized implementation and self-control of pulmonary rehabilitation through patient engagement. Objective This review focused on all types of virtual reality technologies (nonimmersive, semi-immersive, and fully immersive) that witnessed significant development and were released in the field of pulmonary rehabilitation, including breathing exercises, biofeedback systems, virtual environments for exercise, and educational models. Methods The review screened 7 electronic libraries from 2010 to 2023. The libraries were ACM Digital Library, Google Scholar, IEEE Xplore, MEDLINE, PubMed, Sage, and ScienceDirect. Thematic analysis was used as an additional methodology to classify our findings based on themes. The themes were virtual reality training, interaction, types of virtual environments, effectiveness, feasibility, design strategies, limitations, and future directions. Results A total of 2319 articles were identified, and after a detailed screening process, 32 studies were reviewed. Based on the findings of all the studies that were reviewed (29 with a positive label and 3 with a neutral label), virtual reality can be an effective solution for pulmonary rehabilitation in patients with lung cancer, chronic obstructive pulmonary disease, and asthma, and in individuals and children who are dealing with mental health–related disorders, such as anxiety. The outcomes indicated that virtual reality is a reliable and feasible solution for pulmonary rehabilitation. Interventions can provide immersive experiences to patients and offer tailored and engaging rehabilitation that promotes improved functional outcomes of pulmonary rehabilitation, breathing body awareness, and relaxation breathing techniques. Conclusions The identified studies on virtual reality in pulmonary rehabilitation showed that virtual reality holds great promise for improving the outcomes and experiences of patients. The immersive and interactive nature of virtual reality interventions offers a new dimension to traditional rehabilitation approaches, providing personalized exercises and addressing psychological well-being. However, additional research is needed to establish standardized protocols, identify the most effective strategies, and evaluate long-term benefits. As virtual reality technology continues to advance, it has the potential to revolutionize pulmonary rehabilitation and significantly improve the lives of patients with chronic lung diseases.

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Section: Resultsmentioning

confidence: 99%

“…All the reviewed studies (32/32) collected participants’ demographic information (eg, age, sex, ethnicity, educational level, etc). Half of the reviewed studies (14/32) examined the effect of VR breathing training on mental health (ie, anxiety) [ 6 , 25 , 26 , 28 - 30 , 32 , 34 , 36 , 37 , 39 - 41 ].…”

Section: Resultsmentioning

confidence: 99%

Virtual Reality for Pulmonary Rehabilitation: Comprehensive Review

Pittara¹,

Matsangidou²,

Petkov³

et al. 2023

JMIR Rehabil Assist Technol

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“…It is also important to note that XR technology has limitations and may be suited for some teaching and learning objectives more than others. Evidence highlights that XR teaching tools can effectively improve practical skills development (Bouaicha et al, 2020;Canto et al, 2013;Falah et al, 2015;Garfjeld Roberts et al, 2017;Kluge et al, 2021;Legault et al, 2019;Nicholson et al, 2006;Vieira et al, 2017). An XR tool addressing practical skills has the most value when otherwise ethically inappropriate, expensive, and/ or logistically impossible to provide.…”

Section: Focus On Learning Objectives and Priority Areasmentioning

confidence: 99%

“…In these areas procedural training using XR is particularly beneficial for the development of practical skills (Bouaicha et al, 2020;Canto et al, 2013;Falah et al, 2015;Garfjeld Roberts et al, 2017;Kluge et al, 2021;Legault et al, 2019;Nicholson et al, 2006;Vieira et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Comparing approaches for selection, development, and deployment of extended reality (XR) teaching applications: A case study at The University of Newcastle Australia

et al. 2022

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The use of extended reality (XR) technology in education offers many advantages for transferring knowledge and practical skills training at the higher education level. As a result, many Universities over the past 5 + years have undertaken pilot programs to both develop XR content and assess how to best implement it within existing teaching and learning systems. Unfortunately, very few of these efforts have included structured evaluation or documentation. As such, limited published evidence exists to inform processes and approaches that may assist or hinder broad scale implementation. This leads many Universities to unnecessarily commit significant time and resources to testing identical or similar approaches, resulting in repeated identification of the same or similar challenges. In response to this situation, The University of Newcastle, Australia decided to systematically document the approach for selection, development and implementation of four new virtual-reality (VR) teaching applications. The current paper contains a detailed intrinsic case study, outlining the process and critical elements that shaped the selection of suitable teaching content, software development, hardware solutions and implementation. Details are provided on how decisions were made, what components were considered helpful, challenges identified, and important lessons outlined. These findings will be useful to organisations and individuals as they look to develop pathways and processes to integrate XR technology, particularly within their existing training and educational frameworks.

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“…One of the easiest methods for managing stress-related symptoms is deep breathing exercises [ 3 ]; these exercises have been proposed as first-line and supplemental treatments for emotional disorders [ 35 ]. Several studies reported that the use of different breathing techniques showed significant improvement in mood states and perceived stress [ 36 , 37 ] resulting in an effective improvement in the management of stress in daily life [ 36 ]. Slow and deep breathing can have a significant impact on reducing stress feelings and activating the relaxation response.…”

Section: Introductionmentioning

confidence: 99%

Association of Digital Engagement With Relaxation Tools and Stress Level Reduction: Retrospective Cohort Study

Breuer-Asher,

Ritholz,

Horwitz

et al. 2024

JMIR Form Res

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Background Stress is an emotional response caused by external triggers and is a high-prevalence global problem affecting mental and physical health. Several different digital therapeutic solutions are effective for stress management. However, there is limited understanding of the association between relaxation components and stress levels when using a digital app. Objective This study investigated the contribution of relaxation tools to stress levels over time. We hypothesized that participation in breathing exercises and cognitive behavioral therapy–based video sessions would be associated with a reduction in stress levels. We also hypothesized a significant reduction specifically in participants’ perceived sense of burden and lack of productivity when engaged with breathing exercises and video sessions. Methods Stress levels were evaluated in a real-world data cohort using a behavioral health app for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform–based treatment followed users (N=490) who started with moderate and above levels of stress and completed at least 2 stress assessments. The levels of stress were tracked throughout the first 10 weeks. A piecewise mixed effects model was applied to model the trajectories of weekly stress mean scores in 2 time segments (1-6 weeks and 6-10 weeks). Next, a simple slope analysis was used for interpreting interactions probing the moderators: breathing exercises and video sessions. Piecewise mixed-effects models were also used to model the trajectories of specific perceived stress item rates in the stress questionnaire in the 2 segments (1-6 weeks and 6-10 weeks) and whether they are moderated by the relaxation engagements. Simple slope analysis was also used here for the interpretation of the interactions. Results Analysis revealed a significant decrease in stress symptoms (β=–.25; 95% CI –0.32 to –0.17; P<.001) during the period of 1-6 weeks of app use that was maintained during the period of 6-10 weeks. Breathing exercises significantly moderated the reduction in stress symptoms during the period of 1-6 weeks (β=–.07; 95% CI –0.13 to –0.01; P=.03), while engagement in digital video sessions did not moderate stress scores. Engagement in digital video sessions, as well as breathing exercises, significantly moderated the reduction in perceived sense of burden and lack of productivity during weeks 1-6 and remained stable during weeks 6-10 on both items. Conclusions This study sheds light on the association between stress level reduction and specific components of engagement in a digital health app, breathing exercises, and cognitive behavioral therapy–based video sessions. Our findings provide a basis for further investigation of current and moderating factors that contribute to the personalization of digital intervention. In addition, results may aid in developing a more comprehensive understanding of how digital intervention tools work for mental health and for whom they are most effective.

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Development of a modular stress management platform (Performance Edge VR) and a pilot efficacy trial of a bio-feedback enhanced training module for controlled breathing

Cited by 17 publications

References 56 publications

Virtual Reality for Pulmonary Rehabilitation: Comprehensive Review

Virtual Reality for Pulmonary Rehabilitation: Comprehensive Review

Comparing approaches for selection, development, and deployment of extended reality (XR) teaching applications: A case study at The University of Newcastle Australia

Association of Digital Engagement With Relaxation Tools and Stress Level Reduction: Retrospective Cohort Study

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