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Breeze: A Gameful Biofeedback Breathing Training for Mental and Physical Well-being

Slow-paced breathing training is an effective method to strengthen cardiac functioning and psychological well-being. It thus addresses two of the most pressing global health challenges: chronic disease and mental illness. Slow-paced breathing training can be self-paced (e.g., during mindfulness meditation), externally-guided by following acoustic, seismic, or visual instructions, or biofeedback-guided where individuals consciously control their heart rate variability or breathing rate by monitoring the bio-signals. In addition to various physiological benefits, biofeedback training, if mastered, can also improve self-efficacy, which is a relevant predictor of health behavior.

There are, however, limitations that hinder both the effectiveness and the reach of slow-paced breathing training. First, biofeedback-guided breathing training is not scalable because it requires trained therapists and additional equipment that senses bio-signals, which is particularly critical in developing countries. Second, the use of interventions that incorporate slow-paced breathing training is less prevalent in males, less-educated individuals, and physically inactive individuals.

To address these limitations, we are developing a mobile application that uses a smartphone’s microphone to continuously detect breathing phases in real-time, i.e., inhalation, exhalation, and pauses. The app is then used to enable a gameful breathing training.The overall vision of this project is to provide a scalable health tool as it relies solely on a smartphone, which is currently available to circa 76% of individuals in high-income countries and to circa 45% of individuals in middle and low-income countries. It should offer the benefits of biofeedback without requiring additional equipment. Moreover, the gameful biofeedback (e.g., a correct slow-paced breathing increases the speed of a sailboat) targets experiential outcomes (e.g., enjoyment) in addition to instrumental outcomes of strengthening cardiac functioning or psychological well-being. This increase in experiential value should then be used to reach those who are less motivated to perform slow-paced breathing training.

Video Clips

Version 4: Revision of the graphics and airflow detection, November 2020

Breeze interview with Yanik Lukic at the Swiss Digital Days 2020

Version 3: Improved guidance elements, better detection, and with added soundscape, 2020

Version 2: Completely new app, 2019

Version 1: Targeting obese children in the project Pathmate 2, 2018

Media

Publications

Lukic, Y., Teepe, G., Fleisch, E., Kowatsch, T. (2022) Breathing as Input Modality in a Gameful Breathing Training App: Development and Evaluation of Breeze 2, Journal of Medical Internet Research Preprints 06/05/2022:39186 Preprint.

Lukic, Y., Klein, S., Brügger, V., Keller, O., Fleisch, E., Kowatsch, T. (2021) The Impact of a Gameful Breathing Training Visualization on Intrinsic Experiential Value, Perceived Effectiveness, and Engagement Intentions: Between-Subject Online Experiment, JMIR Serious Games 9(3):e22803, 10.2196/22803, Visual Abstract by Y. Lukic. [PDF]

Lukic, Y., Shih, I., Hernández, Á., Cotti, A., Fleisch, E., Kowatsch, T. (2021) Physiological Responses and User Feedback on a Gameful Breathing Training App: Within-Subject Experiment, JMIR Serious Games 2021;9(1):e22802 10.2196/22802. [PDF]

Lukic, Y., Klein, S., Shih, I., Tomita, N., Galliker, H., Kowatsch, T. (2021) Breeze, ein spielerisches Biofeedback Atemtraining für das Smartphone: Physiologische Reaktionen und subjektive Einschätzungen aus einem Labor- und Online-Experiment, Fachtagung “Chronisch krank in der digitalen Welt”, 13. Januar 2021, online via Zoom. [PDF]

Stasinaki, A., Büchter, D., Shih, I., Heldt, K., Güsewell, S., Brogle, B., Farpour-Lambert, N., Kowatsch, T., l’Allemand, D. (2021) Effects of a novel mobile health intervention compared to a multi-component behaviour changing program on body mass index, physical capacities and stress parameters in adolescents with obesity: a randomized controlled trial, BMC Pediatrics 21 (308), 10.1186/s12887-021-02781-2. [PDF]

Kowatsch, T., Shih, I., Lukic, Y., Keller, O., Heldt, K., Durrer, D., Stasinaki, A., Büchter, D., Brogle, B., Farpour-Lambert, N., l’Allemand, D. (2021) A Playful Smartphone-based Self-regulation Training for the Prevention and Treatment of Child and Adolescent Obesity: Technical Feasibility and Perceptions of Young Patients, 1st Workshop on Healthy Interfaces (HEALTHI), collocated with the 26th ACM Annual Conference on Intelligent User Interfaces (IUI) – Where HCI meets AI, Virtually Hosted by Texas A&M University, April 13-17, 2021, College Station, USA. [PDF]

Shih, C. H., Tomita, N., Lukic, Y. X., Reguera, Á. H., Fleisch, E., & Kowatsch, T. (2019) Breeze: Smartphone-based Acoustic Real-time Detection of Breathing Phases for a Gamified Biofeedback Breathing Training. Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies (IMWUT), 3(4), 1-30. 10.1145/3369835

Shih, I., Nißen, M.K., Büchter, D., Durrer, D., l’Allemand, D., Fleisch, E., Kowatsch, T. (2018) Smartphone-based Biofeedback Breathing Training for Stress Management, Poster presented at the Applied Maschine Learning Days, EPFL, Lausanne, Switzerland. (PDF)

Shih, I., Kowatsch, T., Tinschert, P., Barata, F., Nißen, M.K. (2016) Towards The Design of a Smartphone-Based Biofeedback Breathing Training: Identifying Diaphragmatic Breathing Patterns from a Smartphone’s Microphone, Proc. of the 10th Mediterranean Conference on Information Systems (MCIS), Paphos, Cyprus. (PDF)

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General Information

Enabling scalable gameful biofeedback breathing training.

Working Group

Yanick X. Lukic MSc M.A, Helen Galliker B.A., Shari Klein, Prof. Dr. Elgar Fleisch, Filipe Barata MSc, Prof. Dr. Tobias Kowatsch

Runtime

2019 Sept – 2022 Nov

Funding
CSS Insurance
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