Tero Myllymäki

Mobile Mental Wellness Training for Stress Management: Feasibility and Design Implications Based on a One-Month Field Study

Background Prevention and management of work-related stress and related mental problems is a great challenge. Mobile applications are a promising way to integrate prevention strategies into the everyday lives of citizens. Objective The objectives of this study was to study the usage, acceptance, and usefulness of a mobile mental wellness training application among working-age individuals, and to derive preliminary design implications for mobile apps for stress management. Methods Oiva, a mobile app based on acceptance and commitment therapy (ACT), was designed to support active learning of skills related to mental wellness through brief ACT-based exercises in the daily life. A one-month field study with 15 working-age participants was organized to study the usage, acceptance, and usefulness of Oiva. The usage of Oiva was studied based on the usage log files of the application. Changes in wellness were measured by three validated questionnaires on stress, satisfaction with life (SWLS), and psychological flexibility (AAQ-II) at the beginning and at end of the study and by user experience questionnaires after one week’s and one month’s use. In-depth user experience interviews were conducted after one month’s use to study the acceptance and user experiences of Oiva. Results Oiva was used actively throughout the study. The average number of usage sessions was 16.8 (SD 2.4) and the total usage time per participant was 3 hours 12 minutes (SD 99 minutes). Significant pre-post improvements were obtained in stress ratings (mean 3.1 SD 0.2 vs mean 2.5 SD 0.1, P=.003) and satisfaction with life scores (mean 23.1 SD 1.3 vs mean 25.9 SD 0.8, P=.02), but not in psychological flexibility. Oiva was perceived easy to use, acceptable, and useful by the participants. A randomized controlled trial is ongoing to evaluate the effectiveness of Oiva on working-age individuals with stress problems. Conclusions A feasibility study of Oiva mobile mental wellness training app showed good acceptability, usefulness, and engagement among the working-age participants, and provided increased understanding on the essential features of mobile apps for stress management. Five design implications were derived based on the qualitative findings: (1) provide exercises for everyday life, (2) find proper place and time for challenging content, (3) focus on self-improvement and learning instead of external rewards, (4) guide gently but do not restrict choice, and (5) provide an easy and flexible tool for self-reflection.

Effects of vigorous late‐night exercise on sleep quality and cardiac autonomic activity

Sleep is the most important period for recovery from daily load. Regular physical activity enhances overall sleep quality, but the effects of acute exercise on sleep are not well defined. In sleep hygiene recommendations, intensive exercising is not suggested within the last 3 h before bed time, but this recommendation has not been adequately tested experimentally. Therefore, the effects of vigorous late‐night exercise on sleep were examined by measuring polysomnographic, actigraphic and subjective sleep quality, as well as cardiac autonomic activity. Eleven (seven men, four women) physically fit young adults (VO2max 54 ± 8 mL·kg−1·min−1, age 26 ± 3 years) were monitored in a sleep laboratory twice in a counterbalanced order: (1) after vigorous late‐night exercise; and (2) after a control day without exercise. The incremental cycle ergometer exercise until voluntary exhaustion started at 21:00 ± 00:28 hours, lasted for 35 ± 3 min, and ended 2:13 ± 00:19 hours before bed time. The proportion of non‐rapid eye movement sleep was greater after the exercise day than the control day (P < 0.01), while no differences were seen in actigraphic or subjective sleep quality. During the whole sleep, no differences were found in heart rate (HR) variability, whereas HR was higher after the exercise day than the control day (54 ± 7 versus 51 ± 7, P < 0.01), and especially during the first three sleeping hours. The results indicate that vigorous late‐night exercise does not disturb sleep quality. However, it may have effects on cardiac autonomic control of heart during the first sleeping hours.

Feasibility of a Personal Health Technology-Based Psychological Intervention for Men with Stress and Mood Problems: Randomized Controlled Pilot Trial

Background Work-related stress is a significant problem for both people and organizations. It may lead to mental illnesses such as anxiety and depression, resulting in increased work absences and disabilities. Scalable interventions to prevent and manage harmful stress can be delivered with the help of technology tools to support self-observations and skills training. Objective The aim of this study was to assess the feasibility of the P4Well intervention in treatment of stress-related psychological problems. P4Well is a novel intervention which combines modern psychotherapy (the cognitive behavioral therapy and the acceptance and commitment therapy) with personal health technologies to deliver the intervention via multiple channels, includinggroup meetings, Internet/Web portal, mobile phone applications, and personal monitoring devices. Methods This pilot study design was a small-scale randomized controlled trial that compared the P4Well intervention with a waiting list control group. In addition to personal health technologies for self-assessment, the intervention consisted of 3 psychologist-assisted group meetings. Self-assessed psychological measures through questionnaires were collected offline pre- and post-intervention, and 6 months after the intervention for the intervention group. Acceptance and usage of technology tools were measured with user experience questionnaires and usage logs. Results A total of 24 subjects were randomized: 11 participants were followed up in the intervention group (1 was lost to follow-up) and 12 participants did not receive any intervention (control group). Depressive and psychological symptoms decreased and self-rated health and working ability increased. All participants reported they had benefited from the intervention. All technology tools had active users and 10/11 participants used at least 1 tool actively. Physiological measurements with personal feedback were considered the most useful intervention component. Conclusions Our results confirm the feasibility of the intervention and suggest that it had positive effects on psychological symptoms, self-rated health, and self-rated working ability. The intervention seemed to have a positive impact on certain aspects of burnout and job strain, such as cynicism and over-commitment. Future studies need to investigate the effectiveness, benefits, and possible problems of psychological interventions which incorporate new technologies. Trial Registration The Finnish Funding Agency for Technology and Innovation (TEKES), Project number 40011/08

The effectiveness and applicability of different lifestyle interventions for enhancing wellbeing: the study design for a randomized controlled trial for persons with metabolic syndrome risk factors and psychological distress

BackgroundObesity and stress are among the most common lifestyle-related health problems. Most of the current disease prevention and management models are not satisfactorily cost-effective and hardly reach those who need them the most. Therefore, novel evidence-based controlled interventions are necessary to evaluate models for prevention and treatment based on self-management. This randomized controlled trial examines the effectiveness, applicability, and acceptability of different lifestyle interventions with individuals having symptoms of metabolic syndrome and psychological distress. The offered interventions are based on cognitive behavioral approaches, and are designed for enhancing general well-being and supporting personalized lifestyle changes.Methods/Design339 obese individuals reporting stress symptoms were recruited and randomized to either (1) a minimal contact web-guided Cognitive Behavioral Therapy-based (CBT) intervention including an approach of health assessment and coaching methods, (2) a mobile-guided intervention comprising of mindfulness, acceptance and value-based exercises, (3) a face-to-face group intervention using mindfulness, acceptance and value-based approach, or (4) a control group. The participants were measured three times during the study (pre = week 0, post = week 10, and follow-up = week 36). Psychological well-being, lifestyles and habits, eating behaviors, and user experiences were measured using online surveys. Laboratory measurements for physical well-being and general health were performed including e.g. liver function, thyroid glands, kidney function, blood lipids and glucose levels and body composition analysis. In addition, a 3-day ambulatory heart rate and 7-day movement data were collected for analyzing stress, recovery, physical activity, and sleep patterns. Food intake data were collected with a 48 -hour diet recall interview via telephone. Differences in the effects of the interventions would be examined using multiple-group modeling techniques, and effect-size calculations.DiscussionThis study will provide additional knowledge about the effects of three low intensity interventions for improving general well-being among individuals with obesity and stress symptoms. The study will show effects of two technology guided self-help interventions as well as effect of an acceptance and value–based brief group intervention. Those who might benefit from the aforesaid interventions will increase knowledge base to better understand what mechanisms facilitate effects of the interventions.Trial registrationCurrent Clinical Trials NCT01738256, Registered 17 August, 2012.

P4Well concept to empower self-management of psychophysiological wellbeing and load recovery

Chronic health problems related to mental wellbeing are rapidly growing, calling for novel solutions focusing on individual as a psychophysiological being. We describe a novel technology-based concept for empowering citizen towards holistic self-management of her wellbeing: “P4Well” (Pervasive Personal and PsychoPhysiological management of WELLness). The primary focus of the concept is on management of stress and recovery from stress caused by daily life through improved health management strategies. The P4Well concept combines modern psychological methods with personal health technologies. The technologies include a web-portal and web-based tools, mobile phone with mobile client applications, wearable health monitoring devices, and different analysis methods based on physiological models for interpretation and feedback. The concept supports secured private expert consultation and peer-support through social media. Our driving principle is to recognize that an individual is the best master of her own wellness, and we target to empower her for realizing the fact.

Physical Activity: Absolute Intensity versus Relative-to-fitness-level Volumes

Purpose This study aimed to investigate in a real-life setting how moderate- and vigorous-intensity physical activity (PA) volumes differ according to absolute intensity recommendation and relative to individual fitness level by sex, age, and body mass index. Methods A total of 23,224 Finnish employees (10,201 men and 13,023 women; ages 18–65 yr; body mass index = 18.5–40.0 kg·m−2) participated in heart rate recording for 2+ d. We used heart rate and its variability, respiration rate, and on/off response information from R-R interval data calibrated by participant characteristics to objectively determine daily PA volume, as follows: daily minutes of absolute moderate (3–<6 METs) and vigorous (≥6 METs) PA and minutes relative to individual aerobic fitness for moderate (40%–<60% of oxygen uptake reserve) and vigorous (≥60%) PA. Results According to absolute intensity categorization, the volume of both moderate- and vigorous-intensity PA was higher in men compared with women (P < 0.001), in younger compared with older participants (P < 0.001), and in normal weight compared with overweight or obese participants (P < 0.001). When the volume of PA intensity was estimated relative to individual fitness level, the differences were much smaller. Mean daily minutes of absolute vigorous-intensity PA were higher than those of relative intensity minutes in normal weight men ages 18–40 yr (17.7, 95% confidence interval [CI] = 16.9–18.6, vs 8.6, 95% CI = 8.0–9.1; P < 0.001), but the reverse was the case for obese women ages 41–65 yr (0.3, 95% CI = 0.2–0.4, vs 7.8, 95% CI = 7.2–8.4; P < 0.001). Conclusion Compared with low-fit persons, high-fit persons more frequently reach an absolute target PA intensity, but reaching the target is more similar for relative intensity.

A concept to empower self-management of psychophysiological wellbeing: Preliminary user study experiences

In prevention of chronic diseases, health promotion and early interventions based on self-management should be emphasized. Mental health problems and stress cause a significant portion of healthcare costs, and also complicate the management of other chronic conditions. In addition to physical health, psychophysiological and social wellbeing should be equally promoted. Thus, we have previously designed and reported the P4Well or Pervasive Personal and PsychoPhysiological management of WELLness concept for working-age citizens. The concept supports the stress and recovery management on a daily basis through improved health management strategies, and combines psychological methods with personal health technologies. In this paper, we discuss the preliminary user study experiences of ongoing evaluations with two different user groups consisting of: 1) middle-aged men who are using the concept for managing their mental wellbeing or mild depression; and 2) entrepreneurs who are using the concept for coping with stress. Our results provide a preliminary assessment of the role and importance of experts, technologies, and peer-support in the concept.

Exploratory analysis of associations between individual lifestyles and heart rate variability -based recovery during sleep

Sleep is the most important period for recovering from daily stress and load. Assessment of the stress recovery during sleep is therefore, an important metric for care and quality of life. Heart rate variability (HRV) is a non-invasive marker of autonomic nervous system (ANS) activity, and HRV-based methods can be used to assess physiological recovery, characterized by parasympathetic domination of the ANS. HRV is affected by multiple factors of which some are unmodifiable (such as age and gender) but many are related to daily lifestyle choices (e.g. alcohol consumption, physical activity, sleeping times). The purpose of this study was to investigate the association of these aforementioned factors on HRV-based recovery during sleep on a large sample. Variable importance measures yielded by random forest were used for identifying the most relevant predictors of sleep-time recovery. The results emphasize the disturbing effects of alcohol consumption on sleep-time recovery. Good physical fitness is associated to good recovery, but acute physical activity seems to challenge or delay the recovery process for the next night. Longer sleeping time enables more recovery minutes, but the proportion of recovery (i.e. recovery efficiency) seems to peak around 7.0-7.25 hours of sleep.

Physical activity, heart rate variability–based stress and recovery, and subjective stress during a 9-month study period

The aim of this study was to investigate the association between physical activity (PA) and objective heart rate variability (HRV)‐based stress and recovery with subjective stress in a longitudinal setting. Working‐age participants (n = 221; 185 women, 36 men) were overweight (body mass index, 25.3–40.1 kg/m2) and psychologically distressed (≥3/12 points on the General Health Questionnaire). Objective stress and recovery were based on HRV recordings over 1–3 work days. Subjective stress was assessed with the Perceived Stress Scale and PA level with a questionnaire. Data were collected at three time points: baseline, 10 weeks post intervention, and at the 36‐week follow‐up. We adopted a latent growth model to investigate the initial level and change in PA, objective stress and recovery, and subjective stress at the three measurement time points. The results showed that initial levels of PA (P < 0.001) and objective stress (P = 0.001) and recovery (P < 0.01) were associated with the change in subjective stress. The results persisted after adjustment for intervention group. The present results suggest that high PA and objectively assessed low stress and good recovery have positive effects on changes in subjective stress in the long‐term.

Acute Effect of Alcohol Intake on Cardiovascular Autonomic Regulation During the First Hours of Sleep in a Large Real-World Sample of Finnish Employees: Observational Study

Background Sleep is fundamental for good health, and poor sleep has been associated with negative health outcomes. Alcohol consumption is a universal health behavior associated with poor sleep. In controlled laboratory studies, alcohol intake has been shown to alter physiology and disturb sleep homeostasis and architecture. The association between acute alcohol intake and physiological changes has not yet been studied in noncontrolled real-world settings. Objective The aim of this study was to assess the effects of alcohol intake on the autonomic nervous system (ANS) during sleep in a large noncontrolled sample of Finnish employees. Methods From a larger cohort, this study included 4098 subjects (55.81%, 2287/4098 females; mean age 45.1 years) who had continuous beat-to-beat R-R interval recordings of good quality for at least 1 day with and for at least 1 day without alcohol intake. The participants underwent continuous beat-to-beat R-R interval recording during their normal everyday life and self-reported their alcohol intake as doses for each day. Heart rate (HR), HR variability (HRV), and HRV-derived indices of physiological state from the first 3 hours of sleep were used as outcomes. Within-subject analyses were conducted in a repeated measures manner by studying the differences in the outcomes between each participant’s days with and without alcohol intake. For repeated measures two-way analysis of variance, the participants were divided into three groups: low (≤0.25 g/kg), moderate (>0.25-0.75 g/kg), and high (>0.75 g/kg) intake of pure alcohol. Moreover, linear models studied the differences in outcomes with respect to the amount of alcohol intake and the participant’s background parameters (age; gender; body mass index, BMI; physical activity, PA; and baseline sleep HR). Results Alcohol intake was dose-dependently associated with increased sympathetic regulation, decreased parasympathetic regulation, and insufficient recovery. In addition to moderate and high alcohol doses, the intraindividual effects of alcohol intake on the ANS regulation were observed also with low alcohol intake (all P<.001). For example, HRV-derived physiological recovery state decreased on average by 9.3, 24.0, and 39.2 percentage units with low, moderate, and high alcohol intake, respectively. The effects of alcohol in suppressing recovery were similar for both genders and for physically active and sedentary subjects but stronger among young than older subjects and for participants with lower baseline sleep HR than with higher baseline sleep HR. Conclusions Alcohol intake disturbs cardiovascular relaxation during sleep in a dose-dependent manner in both genders. Regular PA or young age do not protect from these effects of alcohol. In health promotion, wearable HR monitoring and HRV-based analysis of recovery might be used to demonstrate the effects of alcohol on sleep on an individual level.