In the second part of our iMRS Prime review series, we look at another add-on technology which is central to exploring the system’s full potential: biofeedback. The accessory used with the Prime is the Exagon Sense, an optical measurement sensor (Bifunctional photoplethysmography) which detects blood volume changes in the microvascular tissue of the finger nailbed.
These measurements are fed into an algorithm which detects changes in Heart Rate Variability, one of the most important ways of assessing the state of the user’s Autonomic Nervous System (ANS). This measurement has implications for how well they process stress and for their overall health, especially of the cardiovascular system.
The way this technology is used in the iMRS Prime is fairly unique: not just a one-way source of information but a dynamic feedback loop with the body. The system changes the mat’s PEMF field intensity according to the user’s HRV level, and in turn the changes in the field intensity affect the HRV level. The result is a kind of dynamic dance between the two parameters. The Exagon Sense also delivers on-screen measurements of the user’s heartrate and SpO2, or blood oxygen saturation levels.
We’ll examine the importance of HRV and the ANS in a separate article but for now let’s just say that HRV is one of the most important and promising parameters in the biofeedback field.
At the Life Mat Company, we’ve been investigating and using biofeedback (and brain entrainment) technology since around the year 2000, and it’s been fascinating to watch its development. In the rest of this article, we’ll consider biofeedback’s likely future impact on our lives, and the potential for a system like the iMRS Prime to go even further, on its own and in combination with other technologies.
Biofeedback will change the medical industry
Biofeedback is not a new concept. It developed over the early part of the 20th century and the late-1960s and finally began to affect our everyday lives since around 2005. What has changed recently is our ability to glean important data accurately and remotely for a wide range of physiological and mental health issues.
In the medical world, biofeedback is often used to monitor blood sugar levels, heart rates, muscle tension and body heat. Today it includes everything from reducing anxiety and stress, cutting asthma attacks, lowering high blood pressure, recovering from stroke and even coping with the side effects of chemotherapy. It can help spot multiple health problems early, change personal behaviours, lead to better health outcomes and dramatically improve wellbeing for a large proportion of the population. It has the potential to save lives and could reduce the financial burden on over-stretched national health services in a variety of ways.
In some health systems, data collected is already being shared with health professionals, enabling them to make quicker and more accurate diagnoses. GPs can more readily access information from a patient’s device and make a general assessment before sending the individual for specialist tests. This has also proved invaluable in recent years as clinics seek efficiencies from remote monitoring.Patients with heart disease, for example, can be monitored from a distance using ECG data from a simple and affordable wearable device.
In 2019, many UK national papers were reporting that the NHS was about to give a Fitbit style health monitoring device to people at risk of Type 2 Diabetes, one of the most challenging and expensive of all health conditions. The aim was to improve health outcomes and help overweight individuals lose weight through effective fitness and activity monitoring, a more balanced diet and resulting weight loss.
One of the most popular applications is stress reduction and management. We live in a world where we are constantly bombarded with challenges and exposed to chronic levels of stress that can cause major health problems. Combined with relaxation, meditation and other techniques, our response to stress in everyday life can be monitored through heart rate variability and other parameters and this can then be used to acquire skills that help control stress, including breathing exercises, yoga, and positive imagery.
There is even the potential for biofeedback to help with a wide range of psychiatric and psychological challenges from anxiety and depression to eating disorders and psychoses. Often this involves the use of a headband containing electrodes to measure brainwaves.
How Biofeedback works
According to Psychology Today:
“Biofeedback is a technique that involves monitoring a person’s physiological state and feeding information about it back to that person. Recipients of the feedback are trained to consciously control aspects of their physiology … and this learning is used to help manage symptoms of a variety of medical and psychological conditions.”
Over the last decade or so, this technology has increasingly put control in the hands of users to make their own decisions. Whether they’re looking to lose weight, improve their general activity levels or run a marathon, a range of measurables on personal fitness devices can help them get a inceasingly complete picture of how they’re doing.
In its simplest form biofeedback is based on monitoring a physiological parameter, such as when they are struggling with high levels of stress, and finding strategies to change this through a variety of techniques or behavioural changes. As the measure changes, it reinforces the individual’s actions and provides them with a method of making that change permanently. Over time, the patient can be introduced to coping mechanisms such as meditation, deep breathing and other relaxation techniques to help reduce the stress response.
The types of biofeedback we commonly see today include:
- Stress and emotional assessment through brain wave monitoring using an electroencephalograph (EEG).
- Heart rate measurements using an electrocardiograph (ECG).
- Muscle contractions measured through an electromyograph (EMG).
- Stress and cardiac assessments using a light-based finger or earlobe sensor to measure heart rate variability (HRV).
- Circulatory and sleep apnea assessments using a light-based finger sensor to measure blood oxygen saturation (SpO2).
- Further feedback on emotions and stress can come from sensors tracking temperature, perspiration and galvanic response (changes in skin electrical conductivity).
The introduction of Artificial Intelligence software can provide further support by helping users to make the best choices.
A Brief History of Biofeedback
The birth of biofeedback is often placed in the mid to late 60s, but well before this some notable pioneers were laying the groundwork. These included the American Edmund Jacobson, the German doctor Johan Schultz and the psychologist BF Skinner.
By the 1960’s, several key articles and research studies had been published in respected journals and there was growing evidence that biofeedback had the potential to be a powerful clinical intervention. Pioneers such as Joe Kamiya, Neal Miller and John Basmajian all explored ways in which it could be used for a variety of medical and emotional issues.
“Biofeedback as a model and technique was ready to be born: A scientist applies sensitive electronic instruments to provide meaningful information about physiologic processes to an animal or human subject. In turn, the subject gains greater awareness and control over the physiology and self-regulates more effectively.”
It wasn’t until the second decade of the 2000’s, however, that wearable tech began to change our perception of biofeedback and how it could be used to improve everyday life. Initially, the main wearables were fitness watches which were often treated with scepticism. However, advances in technology recently have lead to much wider acceptance and range of applications.
In recent years, we’ve seen a huge rise in sales of personal wearable technologies such as the Apple Watch, Fitbit and Garmin. These devices allow people to get real-time feedback for their fitness goals and monitor key health parameters to a much greater degree than ever before. In the fourth quarter of 2019 alone, 118 million devices were shipped. Since then, research and development has continued apace and today there are hundreds of devices, including rings, smart glasses and headbands that connect to our smartphones.
Biofeedback Issues and Challenges
1) Does It Work?
Research carried out into the effectiveness of biofeedback has shown some promising results. One systematic review concluded:
“Fitbit devices, included either as the primary component of an intervention or as part of a more comprehensive and complex intervention, have the potential to improve healthy lifestyle behaviours and, in particular, physical activity.”
For most biofeedback devices to work and be effective, it’s not enough to just monitor physiological parameters: there needs to be a plan of what to do in response to them — there needs to be action and therefore constant motivation.
An interesting study in 2016, when fitness trackers were still in their relative infancy, compared people on a weight loss plan and what effect using a fitness device made. The first part of the study involved individuals going on a calorie-controlled diet with a set, 100 minutes of exercise a week. The second part involved half the participants wearing a fitness tracker and the other half self-monitoring. The self-monitoring group ended up losing more weight over two years.
There is a margin of error for most devices on the market today, even those with the most up to date technology. Heart rate monitors on most home-use monitors are not 100% accurate, especially compared to EKGs with electrodes attached to the chest. The danger is that we become distracted by the data, as if it’s a medical diagnostic, rather than treating it as a ballpark figure, a baseline from which we can progress.
The Future of Biofeedback
Wearable technology will undoubtedly move from limited fitness monitoring devices to focused medical devices testing more parameters with more implications for health and wellbeing. Apple first included an ECG on their watch back in 2019. We now have sensors that can measure heart rate variability or oxygen levels in the blood on several products.
We should expect future developments to deliver more accurate and more meaningful health monitoring that can be shared automatically with healthcare providers and furnish users with important information as and when they need it. Sharing would potentially enable GPs to spot health issues before they become more serious – using relevant markers to call a patient in for more formal testing. Wearable tech can also be used to monitor those with existing medical problems such as heart and lung conditions.
Some of the most interesting development is not even in parameters recognised by mainstream medicine and the bio-hacking community but in the field known as Energy Medicine — in some countries, the cutting edges of mainstream and complimentary medicine are increasingly converging (leaving many physicians and alternative therapists alike in the dark about where their industries are headed).
How wearable tech like fitness and health trackers fit into the world of the Internet of Things where everything is connected also remains to be seen. Expect smart wearables to dramatically change over the next decade, becoming ever more accurate, versatile and useful.
There is huge potential here to give people a way to monitor their health on a real-time basis, using it to change behaviour. We are perhaps looking to move well beyond the simplistic step and calorie counters of the past and create technologies that do a whole lot more. When combined into a feedback loop treatment system like the iMRS Prime (where the daily motivation level of the user becomes much less important), we enter some very interesting territory. A health and wellness revolution may have just begun which could have a profound impact on our lives for many years to come.
Bio-feedback is one of several key aspects of the new iMRS Prime systems. For a full overview of everything it offers, see our iMRS Prime Features page.
Bin Yu, Mathias Funk: Biofeedback for Everyday Stress Management: A Systematic Review Frontiers in ICT, 2018
Dana L Frank, BS, Lamees Khorshid, PsyD, Jerome F Kiffer, MA, Christine: Biofeedback in medicine: who, when, why and how? Mental Health in Family Medicine 2010
Donald Moss, Ph.D.: Biofeedback, Mind-Body Medicine, and the Higher Limits of Human Nature Association for Applied Psychophysiology and Biofeedback, 1998
John M. Jakicic, PhD, Kelliann K. Davis, PhD, Renee J. Rogers, PhD et al Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss JAMA, 2016
Mickael Ringeval, Gerit Wagner: Fitbit-Based Interventions for Healthy Lifestyle Outcomes: Systematic Review and Meta-Analysis Journal of Medical Internet Research, 2020
Poppy L A Schoenberg, Anthony S David: Biofeedback for psychiatric disorders: a systematic review National Library of Medicine, 2014
Robert Wang, Gordon Blackburn, Milind Desai et al Accuracy of Wrist-Worn Heart Rate Monitors JAMA, 2017