����̽̽

Imagine a future where you can optimize your health and well-being by knowing roughly how many hours of sleep to get each night, how many minutes to spend in nature, and how much vigorous exercise to engage in each day. If you’re feeling anxious or sad—simply tune the dial up or down based on your individual biometric profile.

That is what Chris Danforth envisions when talking about the Lived Experiences Measured Using Rings Study (LEMURS)—a longitudinal study he oversees at ����̽̽ that tracks how hundreds of first-year students respond to various health interventions and incentives over the course of their college experience.

Data is collected 24 hours a day using an Oura ring—a wearable biosensor doubling as jewelry—which measures dozens of different variables including a person’s temperature, heart rate, breathing rate, movement, even sleep duration and quality. Over the course of the study participants answer weekly surveys administered through a study app and are randomly assigned to group therapy, an indoor exercise class, activities in nature, or a control arm.

“There are entire fields that have been studying what beneficial effects come from each one of them,” explains Danforth, a professor of applied mathematics and fellow of the Gund Institute for Environment. “But they haven’t ever been compared like this before using passive physiological measurement.”

However, the aim of LEMURS, which started in fall 2022, is not simply to compare the effects of various health interventions, but to determine if it’s possible to detect changes in mental and physical health conditions using data gleaned from a wearable device and, potentially, to prescribe personalized recipes for improvement.

“Personalized health recommendations are something that we could do much better at societally,” Danforth says.

The LEMURS team analyzes dozens of metrics from sleep and heart rate data collected from Oura rings and apps like NatureDose to study the effects of various incentives and nterventions on mental and physical health.

He knows our digital footprints can provide a glimpse into our health and well-being. Danforth and researchers in ����̽̽’s Computational Story Lab, which he co-directs with Peter Dodds, a professor of computer science, routinely gauge a sliver of humanity’s collective emotions by wading through the morass of 10 percent of daily tweets and parsing them using a they developed to provide a snapshot of online happiness in real-time. These digital records, combed through for commonly used words scored for happiness, serve as a measure of society’s mental state. And when zoomed in, our own.

Increasingly, it’s this individual landscape that Danforth wants to explore. He has taught mathematics at ����̽̽ since 2006—one year before the first iPhone dropped—and he’s witnessed the evolution of smart phones from something primarily used by business professionals to devices can’t bear to sleep without (even if we don’t want to admit it). Danforth pivoted from studying fluids and the unemotional work of predicting the weather to concentrating on complex systems with feelings—people. 

“The hedonometer was our effort to try and see ‘what about societal temperature can we infer from the feelings people choose to share online?’” Danforth says. “And it’s a separate question … how healthy is society to the individual? And my interest has gone more in that direction recently. Both of those scales are important.”

Why the shift?

“I had kids, had a family,” Danforth explains. “I realized there are all these other important things that one could work on ....

“Getting serious for a minute,” he continues. “Suicide prediction hasn’t improved in 50 years because we don’t have the data that would help those predictions become more accurate. And expert clinicians who make assessments for how likely someone is to take their life in the next two days, they are basically flipping a coin. It’s a terribly difficult problem.”

The data on your phone or collected in a wearable device could, in theory, help identify individuals at risk or even nudge a person to seek help. Tools like this are needed. The Center for Disease Control and Prevention’s most recent found that 18 percent of high schoolers reported making plans to commit suicide and nearly 60 percent of female students reported feeling persistently sad. Rates of anxiety and depression among American teens were ticking upwards even before the COVID-19 pandemic and do not appear to be going down anytime soon.

LEMURS was conceived, in part, to help young people be healthier versions of themselves. At least, that was part of Danforth’s desire when helping to develop the study. He lives with teenagers. He works with college students, a population with a disproportionately high rate of stress and anxiety. Danforth sees technology as a natural way to reach younger populations.

Oura rings passively collect data such as temperature, heart rate, and sleep duration. Participants in the LEMUR study wear these rings 24 hours a day, every day, to help test how interventions such as exercise, spending time in nature, and group therapy affect their health and well-being.

“There is a latent need for that generation to have support systems acknowledge that they want to have some of their healthcare interactions happen through their phone and not all in person and meet them where they are,” he says.

And since most young people are already using these devices, it’s a bonus if they can provide information that is truly beneficial—and specific—to them. What if they could not only tell a person how well they slept but how many friends they’ve interacted with, he muses? “There are so many ways it’s not helping us now that it could.”

But bringing personalized (and accurate) health feedback to the masses begins with gathering and dissecting a lot of data to see if there are signals to guide our way through.

How LEMURS works

The began in the fall of 2022 with 600 first-year students—about half of whom reported diagnoses of mental health such as depression and/or anxiety—recruited to wear and complete weekly surveys about their well-being. The idea is that they will wear these sleek biosensors for the duration of their college experience—and hopefully afterwards, too. LEMURS is supported by a grant from MassMutual and a second cohort of students was recently recruited for the project.

The Oura rings collect biometric data while participants go about their daily lives. The ring doesn’t have a screen. It doesn’t ping people to check their heart rate or sleep cycles. It’s designed to largely go unnoticed and quietly collect measurements the LEMURS research team uses to determine the effects of various incentives and mental health interventions.

In year one, during the spring 2023 semester, participants were assigned to attend either a weekly exercise class where they learned activities to perform at home, group therapy that integrated mood lifting techniques, or a guided experience in nature. Participants also completed short weekly surveys about their perceived health and behavior, such as how stressed they feel and how many people they talk to about important things.

The LEMURS team has begun analyzing data and is focused, so far, on the relationship between sleep measures and mental health. Preliminary studies have revealed some key differences in heart rates and sleep patterns. For instance, during sleep may be predictors of perceived stress in young adults. The researchers also discovered distinct variations in the patterns by gender as well as between women diagnosed with depression and anxiety or with a reported history of trauma.

Chris Danforth (center) and Laura Bloomfield (right) co-designed the LEMUR study to help young people be better version of themselves using technology to give them personalized health feedback.

Sleep is and linked to cognition, metabolism, chronic disease risk, and mood. A recent analysis of LEMUR sleep data found that people without mental health diagnoses received roughly 10 minutes more deep sleep at night than individuals with them, Danforth explains.

While the taxonomy of sleep patterns is still not well understood, he says, it’s possible that the addition of large data sets like this will help scientists develop new methods for screening in the future.

“We only get maybe an hour of deep sleep in an eight-hour night of sleep,” he says. 

It’s possible those extra 10 minutes could be quite important.

Filling in the gaps

One aim of LEMURS is to try and link biometric indicators of conditions like anxiety and stress with nudges tailored to help individuals feel better. The promise of using technology to reach people in need of mental health services is what attracted Matt Price, the George W. Albee Green & Gold Professor of Psychological Science and director of ����̽̽’s Center for Research on Stress, Emotion, and Technology, to join the LEMURS team.

For years, he has tried to integrate technology into understanding how people recover from traumatic events. One problem is that victims of trauma may not want to—or be able to—answer questions immediately after an event and the development and progression of PTSD often takes time. Technology may help clinicians fill in some of the gaps.

“One of the real hallmarks symptoms [of PTSD] is avoidance,” Price says. “People avoid things they perceive to be scary or dangerous, and one of the key things you are trying to do in treatment is help them to stop avoiding, and it can be really hard to do that. It can be extra hard to do that when you meet with them once a week in the therapy office and you’re encouraging them to stop avoiding things in their day- to-day lives.”

With a wearable, a clinician could theoretically view the physical activity pattern of a person with severe PTSD and get an objective marker of how they are changing over the course of treatment, he explains.

“I think that one of the real challenges we’ve had in mental health, both in doing therapy and in doing assessments, is how we have to rely very heavily on self-report,” Price says. “And self-reports are influenced by a myriad of things. Having more objective markers that can help us understand how someone might be doing and why … is really useful.” 

Devices are also less intrusive than continuously asking a person ‘How are you?’ when the biometric data from something like an Oura ring can potentially tell you that. While Price suspects technology may help uncover previously unknown aspects of mental health, scientists are beginning to piece together what useful things devices can tell us about ourselves and what we can do with that information.

“It’s one of the questions that the LEMUR study is trying to tackle,” he says. “We have developed a lot of phenomenal sensors. Our phones are great at determining lots of different information about us. Our location, our steps. Wearables are really good at characterizing sleep. A lot of the data captured in their partner components, like your mobile phone … can build out this really nice portrait of behaviors.”

LEMURS is the first study to use wearable devices to test health interventions like exercise and time in nature using passive physiological measurement.

The LEMURS team is trying to take that information to the next level. First, by taking measurements. Lots of measurements. Then looking for patterns of how those measurements may link to physical and mental outcomes. And eventually, to find ways to nudge people to make behavior changes and give people greater control over their health. For example, noting when someone might be outside their normal thresholds for average respiration rate and prompting them to explore what could be behind the change.

Price hopes that five years from now, the LEMURS team will have pinned down the relationships between the data and mental health outcomes and potentially shift towards forecasting.

“How much information do I need to know to predict how you are going to be feeling tomorrow?” he asks. Do I need just today’s data? Do I need the last three days of data? Do I need two months of data?

“It would be fantastic, groundbreaking … if we could say, ‘looking at your Oura ring sleep data the night before is perfectly determinant of how you are going to feel the next day,’” Price says with a smile. “I think it’s probably going to be more complicated than that.”

Maybe you should go outside.

When Laura Bloomfield, MD/PhD, research assistant professor of mathematics and statistics and co-principal investigator on the LEMUR study, spent time in Uganda researching land use changes and the spillover effects of zoonotic disease she noticed how the long-term impacts were often psychological. Blood samples contained evidence of human-wildlife interactions, but fear persisted in populations, too. Bloomfield specializes in spatial epidemiology—how land composition affects human behavior and health—and she helped design the LEMUR study to explore how the built environment affects mental health.

Over the decades, numerous studies have shown that time spent in nature can have positive effects on people’s health and well-being, such as lowered cortisol levels. But the mechanism of how exposure to nature is beneficial remains unclear, Bloomfield explains. She hopes the physiological data gathered from the Oura rings and weekly surveys might unveil some clues.

In the spring, LEMUR participants assigned to the nature arm of the study were offered the chance to go snow shoeing, sledding, take nature walks or visit campus greenhouses. Their movements, along with all LEMURS participants, were tracked using NatureDose, an app that measures how much time a person spends outside in green areas using datasets of tree canopy, air quality, noise, and light pollution to calculate a daily nature score. The data will allow the LEMURS team to tell—quantitatively—how much time people spend in nature, Bloomfield explains. “We are starting to input that into models to see if there is any influence on physical and mental well-being.”

Laura Bloomfield aims to learn from the LEMUR study how time outside influences people’s well-being and see if benefits can be equalized through policy.

This is the data she is most excited to examine.

“My passion with the project is to see how time outside is really influencing people’s well-being, and if it is actually comparatively as effective as therapy,” she says, “Because it is way more scalable and potentially something that is of interest to people who don’t have access to mental health care. As someone who cares very deeply about access to health care and mental health care, I know that we are not able to meet that demand. I am very curious to see whether there are alternative stop gaps to support those in need.”

Before designing LEMURS, Bloomfield led focus groups with students and found that many wanted access to mental healthcare. She knows the isolation experienced during COVID-19 pandemic was particularly challenging for young adults.

“And you really see it still with suicide rates in young adults – it’s very troubling,” Bloomfield says.

What if spending 15 minutes sitting in the shade of a maple tree could make a dent in youth anxiety rates? What if there is a quantifiable dose of nature that people benefit from that could be incorporated into city planning or to invest in communities that currently lack green space?

“I don’t think it’s going to come down to one number,” Bloomfield says, “but hopefully we will gain a sense of how much nature benefits mental and physical health. … Also, understanding the relative benefit of nature exposure for people in places that have green areas and those that don’t and further how we can equalize access to natural spaces is something I am very committed to. If this study can start answering this question, I would be very excited and proud.”

The Gund Institute and ����̽̽'s Complex Systems Center are to work on LEMURS. Apply by October 23.