Device-Guided Diastolic Stepping During Walking among Older Adults: A Home-Based Feasibility Pilot Study

Background Wearable cardiovascular technologies constitute a promising avenue for self-directed home-based prevention and rehabilitation interventions for older adults at risk. In patients with congestive heart failure, it was recently shown that synchronized stepping to the diastole of the heartbeat during walking (diastolic stepping) increases stroke volume and oxygen delivery. A home-based approach may maximize health benefits, however the level of synchronization achievable in an everyday context remains completely unexplored. This prospective study aims to explore the feasibility of home-based synchronization among physically active older adults using a data-driven approach. Methods The 19 participants were instructed to use a wearable biofeedback device for three weeks that prompts users with an auditory cue to achieve synchronization. We have collected data on the level of synchronization, adherence, quality of life, exercise habits, rhythmic abilities, and physiological baseline and we discuss these results based on interview-based user feedback. Mean and standard deviation were calculated for each parameter of interest. Group comparisons were conducted using t-tests, and paired t-tests were applied for within-group comparisons. Results Our data suggest high feasibility in 58% of participants, as data revealed high-level synchronizers (n = 11), and low-level synchronizers (n = 8), performing diastolic stepping for 83 ± 6% vs. 11 ± 9% (p < 0.01) of the total usage time. Both physiological and rhythmic factors may play a role in the levels of synchronization achieved. Moreover, a high-level of synchronization is achieved with calmness, focus, and warming up. Additional guidance during learning could help find a synchronization ‘flow’ and increase levels of synchronization. Conclusions In conclusion, diastolic stepping is feasible as a self-directed cardiovascular prevention and rehabilitation strategy. Our results inform future research on improving biofeedback devices for prevention in patients at risk of cardiovascular disease, with the goal of improving exercise tolerance, and, in turn, patients’ quality of life.