Evaluation of stress measurement using a wrist-worn device in volunteer subjects under Thai massage and cardio-exercise treatment

Background: Stress is one of the key factors leading to mood disorders. Screening for stress through questionnaires and heart rate variability (HRV) required delicate consideration and expertise for result interpretation. Nowadays, wrist-worn devices, a non-invasive and real-time monitoring technology for assessing stress levels, are widely used. Objective: To evaluate wrist-worn devices for stress measurement and assess the stress responsiveness of Thai massage (TM) and cardio-exercise in volunteers. Materials and methods: Device verification was inferred before distributing the wrist-worn device to volunteers. Fifty volunteers were randomly assigned to 1.5 hours of TM and 4 weeks of cardio-exercise in zones 1-2 as a stress relaxation program. The stress response rate was compared among 3 different stress measurement tools: an HRV device, cortisol level, and a wrist-worn device. Results: Wrist-worn devices’ step count and heart rate function were verified within an acceptable error of <5% and well correlated with the HRV device before starting the assignment. The significantly decreased value of the stress after TM indicated the responsiveness for stress relaxation within an 85% response rate by HRV (p<0.001) and 75% by wrist-worn devices (p=0.002). ><0.001) and 75% by wrist-worn devices (p=0.002). Higher response outcomes were achieved from the cardio-exercise program, resulting in an 80% response rate by cortisol (p<0.001), 83.3% by HRV device (p=0.001), and 90% by the wrist-worn device (p=0.001). Significant agreement of Kappa values for all paired devices under cardio-exercise reveals an acceptable similar response outcome from wrist-worn devices. The responsive outcome between TM and cardio-exercise programs in similar volunteer groups demonstrates no significant difference measured by HRV devices (p=0.375) and wrist-worn devices (p=0.625) using the McNemar test. Conclusion: The data herein suggest that a wrist-worn device’s stress monitoring provides satisfaction with real-time monitoring and long-term records comparable with HRV devices and cortisol measurements. Cardio exercise for 4 weeks of light and very light cardio is suggested as a continuous approach for stress relaxation. The TM program is a passive intervention that may help temporary relaxation compared to continuous cardio exercise according to subjective preference.