The ambulatory measurement of posture, thigh acceleration, and muscle tension and their relationship to heart rate

Prolonged Non-metabolic Heart Rate Variability Reduction as a Physiological Marker of Psychological Stress in Daily Life

Background

Prolonged cardiac activity that exceeds metabolic needs can be detrimental for somatic health. Psychological stress could result in such “additional cardiac activity.”

Purpose

In this study, we examined whether prolonged additional reductions in heart rate variability (AddHRVr) can be measured in daily life with an algorithm that filters out changes in HRV that are purely due to metabolic demand, as indexed by movement, using a brief calibration procedure. We tested whether these AddHRVr periods were related to worry, stress, and negative emotions.

Methods

Movement and the root of the mean square of successive differences (RMSSD) in heart rate were measured during a calibration phase and the subsequent 24 h in 32 participants. Worry, stress, explicit and implicit emotions were assessed hourly using smartphones. The Levels of Emotional Awareness Scale and resting HRV were used to account for individual differences. During calibration, person-specific relations between movement and RMSSD were determined. The 24-h data were used to detect prolonged periods (i.e., 7.5 min) of AddHRVr.

Results

AddHRVr periods were associated with worrying, with decreased explicit positive affect, and with increased tension, but not with the frequency of stressful events or implicit emotions. Only in people high in emotional awareness and high in resting HRV did changes in AddHRVr covary with changes in explicit emotions.

Conclusions

The algorithm can be used to capture prolonged reductions in HRV that are not due to metabolic needs. This enables the real-time assessment of episodes of potentially detrimental cardiac activity and its psychological determinants in daily life.

Psychological Stress Tasks in the Prediction of Blood Pressure Level and Need for Antihypertensive Medication: 9-12 Years of Follow-Up

Increased blood pressure (BP) reactivity to subtypes of psychological stimuli may differentially predict the development of future BP elevation or hypertension. The authors present the 9-12-year follow-up results of 82 (86%) of 95 male participants with different BP levels. They were healthy, untreated, and age-matched volunteers from a routine health checkup carried out on all 35-, 40-, and 45-year-olds from a medium-sized city. Intra-arterial systolic blood pressure (SBP) during the psychological tasks improved the prediction of future casual SBP and noninvasive 24-hr ambulatory SBP compared with predictions from casual diagnostic measurements. Diastolic blood pressure (DBP) was very useful when added to casual DBP in predicting the need for antihypertensive medication. Reactivity to active tasks especially predicts the need for antihypertensive medication.

Measuring daily behavior using ambulatory accelerometry: the Activity Monitor

Advanced ambulatory systems that measure aspects of overt human behavior during normal daily life have become feasible, owing to developments in data recording and sensor technology. One such instrument is the Activity Monitor (AM). This paper provides a technical description of the AM and information about its validity and current applications. The AM is based on ambulatory accelerometry, the aim of which is to assess postures and motions for long-term (> 24-h) measurement periods during normal daily life. Accelerometers are attached to the thighs, trunk, and lower arms, and signals are continuously stored in a digital portable recorder. In the postmeasurement analysis, postures and motions are detected by means of custom-made software programs. Validity studies performed on different populations showed high agreement scores between the computerized and automatic AM output and the visually analyzed video recordings. The AM has so far been applied in rehabilitation, psychophysiology, and cardiology but has many possibilities in behavioral research.

TERVA: system for long-term monitoring of wellness at home

Long-term monitoring of physiological and psychosocial variables in out-hospital conditions would be beneficial for investigating changes in wellness status of an individual or to understand interaction between physiological and behavioral processes. We aimed to design a personal wellness monitoring system (TERVA), which would allow monitoring of wellness-related variables at home for several weeks or even months. The designed TERVA system runs on a laptop computer and interfaces with different measurement devices through a serial interface. Measured variables include beat-to-beat heart rate, motor activity, blood pressure, weight, body temperature, respiration, ballistocardiography, movements, and sleep stages. In addition, self-assessments of daily well-being and activities are stored by keeping a behavioral diary. To test the system, one healthy man used the system for 10 weeks. The system was successfully applied in out-hospital conditions. The success rate of the measurements was 70-91%, depending on the variable under consideration. The pilot study indicated that the recorded data accurately reflected the health status of the subject. The TERVA system provides a method to record and investigate wellness-related data over several weeks, or even months, outside the hospital among subjects capable of using a personal computer. Several applications of the system are discussed.

Measuring physical strain during ambulation with accelerometry

PURPOSE

To study the feasibility of ambulatory accelerometry in the evaluation of physical strain in walking at different speeds and different levels of economy.

METHODS

Twelve able-bodied subjects performed a walking test on a treadmill with increasing walking speed. After a 6-wk period, these measurements were repeated, with an additional test of perturbed walking. Motility (the intensity of body segment movements, measured with accelerometry), heart rate, and oxygen uptake were simultaneously recorded. Feasibility was determined by comparing motility with percentage heart rate reserve (%HRR), using oxygen uptake (VO2) as reference. The relation with oxygen uptake, the sensitivity to change when walking speed increased and gait was perturbed, and intrasubject and intersubject variability were studied.

RESULTS

Walking with increasing walking speed resulted in a higher pooled r2 value (0.91) and a lower residual standard deviation (1.44 mL x kg(-1) x min(-1)) for the motility-VO2 relation than for the %HRR-VO2 relation (0.84 and 1.92 mL x kg(-1) x min(-1), respectively). Furthermore, the motility-VO2 relation for this part of the protocol showed lowest interindividual differences. The sensitivity to changes due to an increase in walking speed, and the test-retest reliability were the highest for motility. Walking with a brace resulted in a lower pooled r2 value for the motility-VO2 relation than for the %HRR-VO2 relation (0.31 and 0.67, respectively); the sensitivity to changes due to walking with a brace was lower for motility than for %HRR.

CONCLUSION

Compared with heart rate, accelerometry allows accurate measurement with little error in any able-bodied individual, without the need for individual calibration. The response of motility to changes and differences in economy in patients requires further study.

Motion pattern and posture: correctly assessed by calibrated accelerometers

Basic motion patterns and posture can be distinguished by multichannel accelerometry, as recently shown. A refinement of this method appeared to be desirable to further increase its effectiveness, especially to distinguish walking and climbing stairs, and body rotation during sleep. Recordings were made of 31 subjects, according to a standard protocol comprising 13 motions and postures. This recording was repeated three times with appropriate permutation. Five uni-axial sensors and three sites of placement (sternum with three axes, right and left thigh) were selected. A hierarchical classification strategy used a standard protocol (i.e., individual reference patterns) to distinguish subtypes of moving behaviors and posture. The analysis method of the actometer signals reliably detected 13 different postural and activity conditions (only 3.2% misclassifications). A minimum set of sensors can be found for a given application; for example, a two-sensor configuration would clearly suffice to differentiate between four basic classes (sitting, standing, lying, moving) in ambulatory monitoring.

Ambulatory accelerometry to quantify motor behaviour in patients after failed back surgery: a validation study

In the treatment of patients with pain, measures related to (pain) behaviour are of major importance. Ambulatory activity monitoring can be used to obtain insight into actual behaviour. This study was designed to validate the Activity Monitor (AM), an instrument based on long-term ambulatory monitoring of accelerometer signals, to assess several physical activities during normal daily life. Ten failed back surgery (FBS) patients performed a number of functional activities in and around their own houses. During the measurements, continuous ambulatory registrations of accelerometer signals were made, based on four body-mounted accelerometers (one on each upper leg, two on the trunk). Video recordings made simultaneously with the measurements were used as a reference. The continuous output of the AM (postures, transitions, dynamic activities) was compared with visual analysis of the videotapes. The overall results showed an agreement between AM output and video analysis of 87% (inter subject range: 83-88%). The maximal error in the determination of the duration of activities was 0.3%. The overall number of dynamic periods was determined well (AM: 359; video: 368), while the number of transitions was slightly overestimated (AM: 228; video: 205). The results when using the three-sensor version of the AM were somewhat less accurate (overall agreement from 87% to 82%). The AM appeared to be a valid instrument to quantify aspects of behaviour of FPS patients, such as duration of activities and number of transitions. This new technique of ambulatory measurement of mobility activities seems to be a relevant and promising extension of the techniques currently used in the evaluation of pain treatment.

Assessment of posture and motion by multichannel piezoresistive accelerometer recordings

Modern assessment of posture and motion involves the use of wide bandwidth piezoresistive accelerometers. The direct current (DC) component allows for assessment of slow motion and change in position referring to the gravitational axis: the alternating current (AC) component, calibrated in g. represents acceleration along the sensitive axis of the device. A method study was designed to evaluate the division in DC and AC components, reliabilities, discrimination between conditions, and detection of types of physical activities. Recordings were made in 26 student participants for eight conditions: sitting, standing, lying supine, sitting and typing on a PC keyboard, walking, climbing stairs, walking downstairs, and cycling. This procedure was repeated in reversed order. A classification of physical activities according to the eight conditions (first trial) and based on four parameters, that is DC components trunk, thigh, and lower leg and AC component trunk, was correct in almost 100% of patterns, when applied to the second trial.

Non-invasive estimations of ventricular ejection time and stroke volume: comparison of impedance cardiography and the Portapres 2

Stroke volume estimates and left ventricular ejection time (1) derived from calibrated finger pulse pressure recordings (Portapres 2, TNO-BMI, Amsterdam) based on the Model Flow method and (2) derived from impedance cardiography were compared in 20 student subjects. The recordings were made for seven conditions: supine rest, standing, mental arithmetic, ergometer exercise 50 W, motor performance test, reading aloud, and walking. Findings indicated that caution is required in assuming concurrent validity for both methods in tracking haemodynamic changes. Within-subject correlations were low or even negligible. Basic discrepancies were evident regarding the estimation of left ventricular ejection time but obviously more sources of measurement error exist which necessitate further research.