{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T19:05:32Z","timestamp":1793127932542,"version":"4.5.0"},"reference-count":50,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T00:00:00Z","timestamp":1737676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Key R&amp;D Program of China","award":["2023YFE0110200"],"award-info":[{"award-number":["2023YFE0110200"]}]},{"name":"National Key R&amp;D Program of China","award":["2023A03J0170"],"award-info":[{"award-number":["2023A03J0170"]}]},{"name":"National Key R&amp;D Program of China","award":["2024B03J1245"],"award-info":[{"award-number":["2024B03J1245"]}]},{"name":"National Key R&amp;D Program of China","award":["LNZDPY-2023-01"],"award-info":[{"award-number":["LNZDPY-2023-01"]}]},{"name":"Science and Technology Projects in Guangzhou","award":["2023YFE0110200"],"award-info":[{"award-number":["2023YFE0110200"]}]},{"name":"Science and Technology Projects in Guangzhou","award":["2023A03J0170"],"award-info":[{"award-number":["2023A03J0170"]}]},{"name":"Science and Technology Projects in Guangzhou","award":["2024B03J1245"],"award-info":[{"award-number":["2024B03J1245"]}]},{"name":"Science and Technology Projects in Guangzhou","award":["LNZDPY-2023-01"],"award-info":[{"award-number":["LNZDPY-2023-01"]}]},{"name":"Science and Technology Projects in Guangzhou","award":["2023YFE0110200"],"award-info":[{"award-number":["2023YFE0110200"]}]},{"name":"Science and Technology Projects in Guangzhou","award":["2023A03J0170"],"award-info":[{"award-number":["2023A03J0170"]}]},{"name":"Science and Technology Projects in Guangzhou","award":["2024B03J1245"],"award-info":[{"award-number":["2024B03J1245"]}]},{"name":"Science and Technology Projects in Guangzhou","award":["LNZDPY-2023-01"],"award-info":[{"award-number":["LNZDPY-2023-01"]}]},{"name":"Key Laboratory of Geriatric Long-term Care (Naval Medical University), Ministry of Education","award":["2023YFE0110200"],"award-info":[{"award-number":["2023YFE0110200"]}]},{"name":"Key Laboratory of Geriatric Long-term Care (Naval Medical University), Ministry of Education","award":["2023A03J0170"],"award-info":[{"award-number":["2023A03J0170"]}]},{"name":"Key Laboratory of Geriatric Long-term Care (Naval Medical University), Ministry of Education","award":["2024B03J1245"],"award-info":[{"award-number":["2024B03J1245"]}]},{"name":"Key Laboratory of Geriatric Long-term Care (Naval Medical University), Ministry of Education","award":["LNZDPY-2023-01"],"award-info":[{"award-number":["LNZDPY-2023-01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Cardiovascular diseases pose a significant threat to global health, and cardiac rehabilitation (CR) has become a critical component of patient care. Heart Rate Variability Biofeedback (HRVB) is a non-invasive approach that helps modulate the Autonomic Nervous System (ANS) through Resonance Frequency (RF) breathing, supporting CR for cardiovascular patients. However, traditional HRVB techniques rely heavily on manual RF selection and face-to-face guidance, limiting their widespread application, particularly in home-based CR. To address these limitations, we propose a remote human-computer collaborative HRVB system, \u201cFreeResp\u201d, which features autonomous RF adjustment through a simplified cognitive computational model, eliminating the reliance on therapists. Furthermore, the system integrates wearable technology and the Internet of Things (IoT) to support remote monitoring and personalized interventions. By incorporating tactile guidance technology with an airbag, the system assists patients in performing diaphragmatic breathing more effectively. FreeResp demonstrated high consistency with conventional HRVB methods in determining RF values (22\/24) from 24 valid training samples. Moreover, a one-month home-based RF breathing training using FreeResp showed significant improvements in Heart Rate Variability (HRV) (p &lt; 0.05). These findings suggest that FreeResp is a promising solution for home-based CR, offering timely and precise interventions and providing a new approach to long-term cardiovascular health management.<\/jats:p>","DOI":"10.3390\/s25030690","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T03:26:31Z","timestamp":1737689191000},"page":"690","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Implementation of Wearable Technology for Remote Heart Rate Variability Biofeedback in Cardiac Rehabilitation"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1876-9042","authenticated-orcid":false,"given":"Tiehan","family":"Hu","sequence":"first","affiliation":[{"name":"School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9910-3506","authenticated-orcid":false,"given":"Xianbin","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7970-9615","authenticated-orcid":false,"given":"Richard C.","family":"Millham","sequence":"additional","affiliation":[{"name":"Department of Information Technology, Durban University of Technology, Durban 4001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7750-8011","authenticated-orcid":false,"given":"Lin","family":"Xu","sequence":"additional","affiliation":[{"name":"General Hospital of the Southern Theatre Command, Guangzhou 510010, China"},{"name":"The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7594-1487","authenticated-orcid":false,"given":"Wanqing","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.jacc.2012.11.002","article-title":"The worldwide environment of cardiovascular disease: Prevalence, diagnosis, therapy, and policy issues: A report from the American College of Cardiology","volume":"60","author":"Laslett","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","first-page":"318","article-title":"An Interactive Fuzzy Inference System for Teletherapy of Older People","volume":"8","author":"Roda","year":"2015","journal-title":"Cognit Comput."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2529","DOI":"10.1016\/j.jacc.2019.10.009","article-title":"The Global Burden of Cardiovascular Diseases and Risk Factors: 2020 and Beyond","volume":"74","author":"Mensah","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1007\/s12559-022-10042-2","article-title":"Cognitive Computing in Mental Healthcare: A Review of Methods and Technologies for Detection of Mental Disorders","volume":"14","author":"Singh","year":"2022","journal-title":"Cognit Comput."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1007\/s12559-023-10151-6","article-title":"Improving Coronary Heart Disease Prediction Through Machine Learning and an Innovative Data Augmentation Technique","volume":"15","author":"Alsorori","year":"2023","journal-title":"Cognit Comput."},{"key":"ref_6","unstructured":"World Health Organization (2018). Noncommunicable Diseases Country Profiles 2018, WHO."},{"key":"ref_7","first-page":"CD001800","article-title":"Exercise-based cardiac rehabilitation for coronary heart disease","volume":"7","author":"Heran","year":"2011","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_8","first-page":"CD007130","article-title":"Home-based versus centre-based cardiac rehabilitation","volume":"6","author":"Anderson","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1016\/j.jacc.2008.01.030","article-title":"Current status of cardiac rehabilitation","volume":"51","author":"Wenger","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1038\/s41569-021-00611-7","article-title":"The role of cardiac rehabilitation in improving cardiovascular outcomes","volume":"19","author":"Taylor","year":"2022","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1097\/HJR.0b013e328334f42d","article-title":"Cardiac rehabilitation in Europe: Results from the European cardiac rehabilitation inventory survey","volume":"17","author":"McGee","year":"2010","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.gheart.2016.09.004","article-title":"Availability, use, and barriers to cardiac rehabilitation in LMIC","volume":"12","author":"Ragupathi","year":"2017","journal-title":"Glob. Heart"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1093\/fampra\/cmm021","article-title":"\u2018DNA\u2019 may not mean \u2018did not participate\u2019: A qualitative study of reasons for non-adherence at home- and centre-based cardiac rehabilitation","volume":"24","author":"Jones","year":"2007","journal-title":"Fam. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.ijcard.2011.12.107","article-title":"The impact on kinesiophobia (fear of movement) by clinical variables for patients with coronary artery disease","volume":"167","author":"Back","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"102750","DOI":"10.1016\/j.ctim.2021.102750","article-title":"Heart rate variability biofeedback in chronic disease management: A systematic review","volume":"60","author":"Chouchou","year":"2021","journal-title":"Complement. Ther. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Gabella, G. (2012). Structure of the Autonomic Nervous System, Springer Science & Business Media.","DOI":"10.1002\/9780470015902.a0000081.pub2"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1023\/A:1009554825745","article-title":"Resonant frequency biofeedback training to increase cardiac variability: Rationale and manual for training","volume":"25","author":"Lehrer","year":"2000","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"240009-1","DOI":"10.29026\/oes.2024.240009","article-title":"Smart photonic wristband for pulse wave monitoring","volume":"3","author":"Kuang","year":"2024","journal-title":"Opto-Electron. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"16623","DOI":"10.1109\/JIOT.2021.3075167","article-title":"mmHRV: Contactless heart rate variability monitoring using millimeter-wave radio","volume":"8","author":"Wang","year":"2021","journal-title":"IEEE Internet Things J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1177\/09727531211063426","article-title":"Efficacy of non-contact ballistocardiographysystem to determine heart rate variability","volume":"29","author":"Parchani","year":"2022","journal-title":"Ann. Neurosci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e55552","DOI":"10.2196\/55552","article-title":"Remote Short Sessions of Heart Rate Variability Biofeedback Monitored With Wearable Technology: Open-Label Prospective Feasibility Study","volume":"11","author":"Hirten","year":"2024","journal-title":"JMIR Ment. Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s10484-009-9077-2","article-title":"The effect of biofeedback on function in patients with heart failure","volume":"34","author":"Swanson","year":"2009","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1080\/AC.69.3.3027833","article-title":"Biofeedback on heart rate variability in cardiac rehabilitation: Practical feasibility and psycho-physiological effects","volume":"69","author":"Climov","year":"2014","journal-title":"Acta Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s12529-017-9707-7","article-title":"One-year cardiovascular prognosis of the randomized, controlled, short-term heart rate variability biofeedback among patients with coronary artery disease","volume":"25","author":"Yu","year":"2018","journal-title":"Int. J. Behav. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"26","DOI":"10.5298\/1081-5937-41.1.02","article-title":"How does heart rate variability biofeedback work? Resonance, the baroreflex, and other mechanisms","volume":"41","author":"Lehrer","year":"2013","journal-title":"Biofeedback"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s10484-023-09582-6","article-title":"Methods for Heart Rate Variability Biofeedback (HRVB): A Systematic Review and Guidelines","volume":"48","author":"Lalanza","year":"2023","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/JOM.0000000000002097","article-title":"Impacts of working from home during COVID-19 pandemic on physical and mental well-being of office workstation users","volume":"63","author":"Xiao","year":"2021","journal-title":"J. Occup. Environ. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1089\/acm.2020.0071","article-title":"Feasibility and Acceptability of Heart Rate Variability Biofeedback in a Group of Veterans with Fibromyalgia","volume":"26","author":"Reneau","year":"2020","journal-title":"J. Altern. Complement. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s12559-013-9239-7","article-title":"Classification of Music-Induced Emotions Based on Information Fusion of Forehead Biosignals and Electrocardiogram","volume":"6","author":"Naji","year":"2013","journal-title":"Cognit Comput."},{"key":"ref_30","first-page":"299","article-title":"Assistive Technologies for Older Adults in Urban Areas: A Literature Review","volume":"8","author":"Weyers","year":"2015","journal-title":"Cognit. Comput."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"119407","DOI":"10.1016\/j.eswa.2022.119407","article-title":"Implementing ultra-lightweight co-inference model in ubiquitous edge device for atrial fibrillation detection","volume":"216","author":"Chen","year":"2023","journal-title":"Expert. Syst. Appl."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1007\/s12559-021-09856-3","article-title":"A Novel IoT-Fog-Cloud-based Healthcare System for Monitoring and Preventing Encephalitis","volume":"14","author":"Bhatia","year":"2021","journal-title":"Cognit Comput."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.jjcc.2021.01.010","article-title":"Feasibility of home-based cardiac rehabilitation using an integrated telerehabilitation platform in elderly patients with heart failure: A pilot study","volume":"78","author":"Kikuchi","year":"2021","journal-title":"J. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.inffus.2019.06.004","article-title":"Online heart monitoring systems on the internet of health things environments: A survey, a reference model and an outlook","volume":"53","author":"Santos","year":"2020","journal-title":"Inf. Fusion."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"22823","DOI":"10.1007\/s00521-021-06693-1","article-title":"Hybrid feature fusion for classification optimization of short ECG segment in IoT based intelligent healthcare system","volume":"35","author":"Zhang","year":"2021","journal-title":"Neural Comput. Appl."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"5772","DOI":"10.1109\/JBHI.2022.3171918","article-title":"Edge2Analysis: A Novel AIoT Platform for Atrial Fibrillation Recognition and Detection","volume":"26","author":"Chen","year":"2022","journal-title":"IEEE J. Biomed. Health Inform."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"5661","DOI":"10.1007\/s00521-022-07212-6","article-title":"Impact of sampling rate and interpolation on photoplethysmography and electrodermal activity signals\u2019 waveform morphology and feature extraction","volume":"35","author":"Silva","year":"2022","journal-title":"Neural. Comput. Appl."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Shaffer, F., and Meehan, Z.M. (2020). A practical guide to resonance frequency assessment for heart rate variability biofeedback. Front. Neurosci., 14.","DOI":"10.3389\/fnins.2020.570400"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"57","DOI":"10.3991\/ijoe.v15i15.11860","article-title":"Design and implementation of a low cost wireless ambulatory ECG monitoring system for deployment in rural communities","volume":"15","author":"Ali","year":"2019","journal-title":"Int. Assoc. Online Eng."},{"key":"ref_40","first-page":"4000713","article-title":"Joint HW\/SW Signal Co-conditioning Strategy for Unobtrusive Single-Arm Cardiac Surveillance","volume":"74","author":"Huang","year":"2024","journal-title":"IEEE Trans. Instrum. Meas."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Hamasaki, H. (2020). Effects of Diaphragmatic Breathing on Health: A Narrative Review. Medicines, 7.","DOI":"10.3390\/medicines7100065"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Capdevila, L., Parrado, E., Ramos-Castro, J., Zapata-Lamana, R., and Lalanza, J.F. (2021). Resonance frequency is not always stable over time and could be related to the inter-beat interval. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-87867-8"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s10484-021-09524-0","article-title":"A Method for More Accurate Determination of Resonance Frequency of the Cardiovascular System, and Evaluation of a Program to Perform It","volume":"47","author":"Fisher","year":"2022","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.ijhcs.2019.06.011","article-title":"Virtual reality in the application of heart rate variability biofeedback","volume":"130","author":"Rockstroh","year":"2019","journal-title":"Int. J. Hum. Comput. Stud."},{"key":"ref_45","unstructured":"Winstead, J.P. (2019). Role of Heart Rate Variability Biofeedback in Cognitive Performance, Chronic Pain, and Related Symptoms. [Ph.D. Thesis, University of South Carolina]."},{"key":"ref_46","first-page":"2065","article-title":"Adaptive neuro-fuzzy estimation of autonomic nervous system parameters effect on heart rate variability","volume":"21","year":"2011","journal-title":"Neural Comput. Appl."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Shaffer, F., and Ginsberg, J.P. (2017). An Overview of Heart Rate Variability Metrics and Norms. Front. Public. Health, 5.","DOI":"10.3389\/fpubh.2017.00258"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Liu, J., Liu, M., Bai, Y., Zhang, J., Liu, H., and Zhu, W. (2020). Recent progress in flexible wearable sensors for vital sign monitoring. Sensors, 20.","DOI":"10.3390\/s20144009"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.future.2018.04.024","article-title":"Optimization of signal quality over comfortability of textile electrodes for ECG monitoring in fog computing based medical applications","volume":"86","author":"Wu","year":"2018","journal-title":"Future Gener. Comput. Syst."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1093\/ehjqcco\/qcab032","article-title":"Peak oxygen consumption achieved at the end of cardiac rehabilitation predicts long-term survival in patients with coronary heart disease","volume":"8","author":"Carbone","year":"2022","journal-title":"Eur. Heart J. Qual. Care Clin. Outcomes"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/3\/690\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:35:08Z","timestamp":1759919708000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/3\/690"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,24]]},"references-count":50,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["s25030690"],"URL":"https:\/\/doi.org\/10.3390\/s25030690","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,24]]}}}