Exercise Heart Rate Monitors for Anxiety Treatment in a Rural Primary Care Setting: A Pilot Study

摘要

Background and Objectives: Rural patients with anxiety often lack access to traditional biofeedback modalities. Exercise heart rate monitors (HRMs) are tools used in the fitness industry to provide athletes with feedback on heart rate and regulatory breathing strategies. HRMs are inexpensive, discrete, and publicly accessible. This randomized controlled pilot study explored whether use of HRMs for biofeedback during guided mindfulness, diaphragmatic breathing, and progressive muscle relaxation techniques could facilitate anxiety reduction as compared to these techniques alone.Methods: Fifty-three rural anxiety patients were randomized to HRM or control groups for four weekly 20-minute, scripted sessions with a non-behaviorist wherein they practiced these techniques; the HRM group received feedback on their heart rate response.Results: The HRM group had significantly greater improvement in state anxiety (State-Trait Anxiety Inventory) and self-efficacy (General Self Efficacy Scale), and a greater percentage of the group indicated that they “felt in control of their anxiety.”Conclusions: This pilot study demonstrates that this novel, inexpensive, and accessible tool may be a useful clinical intervention for anxiety and can be easily incorporated by both behaviorists and non-behaviorist primary care clinicians into individual or group biofeedback treatment for patients with anxiety. This tool has additional potential for patients to use for anxiety self-management. Further study with a larger sample and blinded design is warranted.(Fam Med 2013;45(9):615-21.)Anxiety is among the most common presenting complaints in primary care and causes significant functional impairment to patients.1 Family medicine clinicians, particularly those practicing in settings without extensive behavioral health resources, often find themselves seeking effective treatments to best serve their patients, including complimentary modalities such as biofeedback. The utility of clinical biofeedback for the treatment of anxiety and a variety of other medical conditions is well-supported in the literature.2,3 Biofeedback is a process whereby patients are presented with precise, real-time measurements of physiological variables such as heart rate, body temperature, or neuromuscular activity and are taught to regulate these variables through self-correction. They then learn to link these changes with their cognitive, emotional, and behavioral states.4,5 We know that perception of voluntary control over heart rate, specifically, is important for anxiety patients.6-8 Heart rate can be regulated with respiratory strategies,9,10 isometric muscle contractions,11 and even mindful attention.12 Biofeedback, then, can be used to teach patients these strategies for regulating heart rate, which they can then generalize to other contexts and improve the quality of their everyday lives.While rural anxiety patients’ access to biofeedback has not been specifically assessed, we know that some rural populations experience barriers to accessing specialized mental health practitioners and mental health technology.13-15 There have been attempts to seek alternatives to traditional biofeedback for health care settings without behavioral health resources and for direct patient use. For example, a previous pilot study demonstrated the efficacy of a portable respiratory device in reducing anxiety in an urban population,16 and the concept has been applied to several commercially available home computer programs such as the well-studied HeartMath? series.17 That said, the cost ($160–$180) and technological sophistication of these devices may render them inaccessible to some patients in rural communities.Exercise heart rate monitors (HRMs), commonly used in the fitness industry by both recreational and competitive athletes and coaches, are used during training to provide feedback on exertional intensity as manifested by heart rate. In so doing, HRMs also provide feedback on performance str