Wearable Derived Cardiovascular Responses to Stressors in Free-living Conditions

David M. Presby, Summer R. Jasinski, Emily R. Capodilupo.



Stress contributes to the progression of many diseases. Despite stress’ contribution towards disease, few methods for continuously measuring stress exist. We investigated if continuously measured cardiovascular signals from a wearable device can be used as markers of stress. Using wearable technology (WHOOP Inc, Boston, MA) that continuously measures and calculates heart rate (HR) and heart rate variability (root-mean-square of successive differences; HRV), we assessed duration and magnitude of deviations in HR and HRV around the time of a run (from 23665 runs) or high-stress work (from 8928 high-stress work events) in free-living conditions.


Stress has been implicated as a contributing factor to numerous diseases, including cardiovascular disease, depression, and certain types of cancers [1, 2]. The number of stressful events, the degree to which someone responds to a stressful event, and the time it takes to recover from a stressful event have been found to be associated with mortality and poor mental and physical health.


Data collection

Since data were not identifiable and were stored on a secure server, this study was deemed exempt from Institutional Review Board (IRB) oversight by Advarra’s IRB (Columbia, MD). Participants were excluded from the study if they were under the age of 21 and if they indicated a gender other than male or female.

Data calculation

Resting heart rate and heart rate variability.

Heart rate (HRmotionless) and heart rate variability (HRV) were calculated during periods that lacked motion detected by the accelerometer. Moving-block sub-sampling was used to calculate HRmotionless and HRV


The response to a stressor can be measured via reactivity–how much the system deviates from baseline–and recovery–how long it takes the system to return to baseline [14]–and both reactivity and recovery can be quantified using cardiovascular parameters [15]. Improving awareness into how the body responds to stress, termed interoception, may lead to healthier stress responses.


We would like to thank Peter Belanger and Fernando Cerullo for their assistance in assembling the data. We would also like to thank Harrison Gill and Torey Lee for their critical review of the manuscript.

Citation: Presby DM, Jasinski SR, Capodilupo ER (2023) Wearable derived cardiovascular responses to stressors in free-living conditions. PLoS ONE 18(6): e0285332. https://doi.org/10.1371/journal.pone.0285332

Editor: Jerritta Selvaraj, Vels Institute of Science, Technology and Advanced Studies (VISTAS), MALAYSIA

Received: September 30, 2022; Accepted: April 20, 2023; Published: June 2, 2023.

Copyright: © 2023 Presby et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The minimal data set is available on Figshare (DOI: 10.6084/m9.figshare.22415482.v1).

Funding: D.M.P., S.R.J., and E.R.C. are employed by WHOOP Inc. All authors are affiliated with the commercial company WHOOP, Inc., which provided support in the form of salaries but did not otherwise play a role in the study design, data collection or analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.

Competing interests: D.M.P., S.R.J., and E.R.C. are employed by WHOOP Inc. All authors are affiliated with the commercial company WHOOP, Inc. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.