By Stewart Levy, RPh and Chuck Hazzard, JD

Can you imagine trying to run a race without a clock, play a NFL Game without a scoreboard or lose weight without a scale? One of the proven, but often underutilized strategies for evidence-based corporate wellness programs, is incorporating biofeedback utilizing wearable devices. Specific types of biofeedback such as using Heart Rate Variability,  have been proven in numerous employer studies to provide improvement in mental and physical health, create sustainable lifestyle changes, and provide improved financial claims and productivity outcomes when combined with a trained coach.1

Biofeedback is a process that allows people to alter their physiological status to improve health and/or performance.2 It typically utilizes hearing and/or visual feedback to help individuals recognize physical signs within their body, including increased muscle tension, heart rate, or changes in body temperature. Through the use of a wearable device or mobile app, the individual learns how to control their physiological responses to stress and can then relax their body and their minds. These positive changes often have downstream effects on blood pressure, heart rate(speed and variability), muscle tension, and pain.

Types of Biofeedback

  1. Heart Rate Variability- There are over 200 studies in all demographics demonstrating the effectiveness of Heart Rate Variability (HRV) monitoring to help improve stress, resilience, coherence, and numerous medical conditions such as asthma and depression. 3
  2. Respiratory Biofeedback – In conjunction with paced breathing is proven in numerous studies to reduce anxiety.
  3. Galvanic Skin Response- Is a type of biofeedback that involves measuring the amount of sweat on the surface of the skin. These sensors can be a useful indicator of anger and risk for addiction relapses.
  4. Blood Pressure- Can provide the employee with important and measurable feedback to help with relaxation techniques. Stress is well known to increase blood pressure. A good example is known as the White Coat Effect when having your blood pressure checked in a doctor’s office. White Coat Hypertension
  5. Temperature Feedback- Individuals have a drop in body temperature during stress.
  6. Neurofeedback- Involves using an EEG device on the scalp which can help treat ADHD, addiction, anxiety, and depression. This is a type of digital therapeutic.


Since biofeedback is considered training rather than a treatment, it can be used to help people change and develop new lifestyle management skills. This is a proven and important opportunity to work with a health coach4. To be successful, employees must play an active role during the training and learn to practice on their own.

As an example, during a HeartMath session, a proven system to monitor Heart Rate Variability, a trained HeartMath coach works with their client to develop skills that enable the employee to anticipate and mitigate stress before it impacts their health. The training offered by HeartMath is important to support the use of biofeedback in an effective coaching program. Depending on the credentials and objectives the training can be 16 to 32 hours.

Wearable Devices

There are hundreds of wearable devices and mobile apps available for measuring individual biometric values. They are categorized by function and by body parameters including wristwatches, eyewear, clothing, activity tracking, etc. Individuals can typically upload their data into their own device reporting software or a wellness portal to track their overall health. These devices along with AI can be incorporated into a comprehensive wellness program, Emotional Assistance Program ( EAP ) and support remote patient monitoring for high-risk case management services.

The following is a summary and comparison of some popular devices.


Biofeedback utilizing wearable devices can be an important component of a corporate wellness program, especially when combined with a health coach. As more wearable technology becomes available it will be important to have training programs, platform integration, and outcomes studies with employers and corporate wellness organizations to demonstrate the impact on employee health.


Additional Resources

1 The Impact of HeartMath’s Stress Resilience Programs on Health, Culture and Organizational Outcomes in Health care

2 The Association for Applied Psychophysiology and Biofeedback, Inc. About Biofeedback. 2020

Lehrer PM, Gevirtz R. Heart rate variability biofeedback: How and why does it work?Front Psychol. 2014;5:756. doi:10.3389/fpsyg.2014.00756

4Giggins OM, Persson UM, Caulfield B. Biofeedback in rehabilitationJ Neuroeng Rehabil. 2013;10:60. doi:10.1186/1743-0003-10-60