Physiological Responses and User Feedback on a Gameful Breathing Training App: Within-Subject Experiment

Area of Science:

• Digital Health
• Biofeedback Technology
• Behavioral Medicine

Background:

• Slow-paced breathing (6 breaths per minute) enhances well-being and relaxation via increased heart rate variability (HRV).
• Traditional breathing training faces low adherence and limited accessibility.
• Scalable, engaging mobile solutions with biofeedback are needed for effective breathing training.

Purpose of the Study:

• To detail the design and implementation of Breeze, a novel mobile gameful breathing training application.
• To conduct an initial validation of Breeze's efficacy in promoting slow-paced breathing and improving HRV.
• To assess user perception and identify areas for improvement in the app's design.

Main Methods:

• Informed design choices based on prior research were applied to develop the Breeze app.
• Iterative refinement occurred through a pretest (n=3) followed by a pilot study (n=16).
• Breathing rates and HRV measures (RMSSD) were recorded and compared across baseline, standard smartphone training, and Breeze interventions.

Main Results:

• Breeze successfully induced a slow breathing rate of 6 BPM, significantly increasing HRV measures (RMSSD) compared to baseline (P<.001).
• Key design elements included cool colors, nature scenes, integrated game mechanics, and a light narrative.
• Participants generally perceived Breeze positively, though clarity of breathing instructions was noted as an area for improvement.

Conclusions:

• The mobile gameful breathing app Breeze effectively maintains the efficacy of slow-paced breathing training.
• The app's gameful elements did not compromise its physiological benefits, indicated by improved HRV.
• Breeze offers a promising, engaging, and positively received approach to scalable breathing training, with potential for further refinement.