Integrating HeartMath Into Treatments

By Ashley Andrews, Therapy Program Manager, Oakwood Care and Rehabilitation, Denver, CO

Recently, I have been integrating HeartMath into treatment sessions here at Oakwood Care and Rehabilitation. Our population here at Oakwood is a heavy behavioral health population that often impacts engagement and performance in therapy sessions.

The intervention utilizes HeartMath, a biofeedback-based self-regulation program designed to support autonomic nervous system regulation in response to both emotional stressors and physical task demands commonly encountered during rehabilitation. Using a wearable sensor, the system measures heart rate variability (HRV) — a clinically relevant marker of physiologic adaptability, stress tolerance, and recovery capacity. Real-time HRV feedback allows residents and therapists to identify sympathetic overactivation and guide regulatory strategies to promote parasympathetic engagement during functional activity.

Residents are instructed in paced breathing, attentional focus, and emotional self-regulation techniques that can be applied immediately before, during, and after therapeutic tasks. This supports improved physiologic regulation during exertion, enhances activity tolerance, and facilitates improved recovery between functional tasks, particularly for individuals whose trauma responses or anxiety contribute to avoidance, behavioral escalation, or reduced carryover in therapy.

Clinical Example 1: PT Group Session Integration

This approach was recently incorporated into a PT group session focused on functional mobility, including sit-to-stand transfer training, lower extremity strengthening, and dynamic balance activities.

• Prior to initiating physical tasks, participants were introduced to HeartMath and completed a brief baseline HRV measurement to establish physiologic state at rest.

• Residents were then coached in diaphragmatic breathing to achieve a more regulated physiologic baseline prior to initiating movement.

• During repetitive sit-to-stand transfers and resisted lower extremity strengthening, HRV feedback was intermittently reviewed to identify signs of escalating physiological stress associated with task difficulty.

• When a participant demonstrated increased sympathetic activation (e.g., decreased HRV accompanied by agitation or verbal distress), the session was briefly paused to reinforce breathing and focus strategies, allowing the resident to self-regulate before continuing the activity.

• This facilitated improved task tolerance, reduced behavioral escalation, and improved endurance across the session, while maintaining therapeutic intensity and safety.

Clinical Example 2: PT Group Session Integration

In another one-on-one session, a resident with significant PTSD-related behavioral responses presented to his PT session with perseveration on revisiting traumatic events and difficulty focusing on PT tasks. With the use of HeartMath during the session, the resident demonstrated an improved ability to remain engaged throughout the session, successfully complete functional task training, and self-initiate regulation strategies when task demand increased — representing a meaningful improvement in functional participation.

Clinical Goals of the Intervention Include:

• Enhancing resident awareness of physiological responses to both emotional stress and physical exertion

• Improving autonomic regulation to support functional performance, activity tolerance, and recovery during rehabilitation

• Providing objective, real-time physiologic data to inform task grading and therapeutic pacing

• Reducing trauma-related behavioral responses that interfere with therapy participation

• Supporting carryover of self-regulation strategies into ADLs, mobility, and interdisciplinary treatment sessions

• Advancing trauma-informed, individualized, non-pharmacological rehabilitation care

This integrated biofeedback approach aligns well with rehabilitation principles focused on neurophysiologic regulation, functional participation, and patient-centered care. It represents a promising adjunct to traditional PT/OT interventions for residents whose mental health conditions create barriers to therapeutic engagement. We will continue to monitor outcomes and explore broader interdisciplinary utilization where clinically appropriate.