title: Exercise heart rate monitors for anxiety treatment in a rural primary care setting: a pilot study.
abstract: OBJECTIVE
  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.
authors.affiliation: Middlesex Hospital Family Medicine Residency Program, Middletown, CT.
authors.forename: Melissa Marotta
authors.initials: MM
authors.lastname: Houser
authors.forename: Lee
authors.initials: L
authors.lastname: Rosen
authors.forename: Martha P
authors.initials: MP
authors.lastname: Seagrave
authors.forename: Don
authors.initials: D
authors.lastname: Grabowski
authors.forename: John D
authors.initials: JD
authors.lastname: Matthew
authors.forename: William A P
authors.initials: WA
authors.lastname: Craig
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000628:therapy*; D001676:Biofeedback, Psychology / Q000295:instrumentation* / Q000379:methods; D001945:Breathing Exercises / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D064866:Mindfulness / Q000379:methods*; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods*; D012064:Relaxation Therapy / Q000379:methods*; D012424:Rural Population; D020377:Self Efficacy; D016896:Treatment Outcome