Wearables and Smartphone Surveys Track Everyday Stress in Real Time to Probe Heart Disease Risk

Stress rarely announces itself in a clinic. It builds during a tense commute, a difficult conversation, a sleepless night, or an afternoon of back-to-back deadlines, and by the time most people sit down with a physician, those fleeting moments have long since dissolved into memory. Researchers at The University of Texas at Arlington are now building a measurement system designed to catch stress as it happens, combining smartphone surveys, wearable sensors and laboratory testing to understand how the small frictions of daily life accumulate in the body and potentially shape the trajectory of cardiovascular disease.

The effort is led by Yue Liao, an associate professor of kinesiology at UT Arlington who directs the university’s Physical Activity and Wearable Sensors Lab. The project is supported by a five-year, $3.82 million grant from the National Institute on Minority Health and Health Disparities, a component of the National Institutes of Health that funds research aimed at reducing health disparities among populations that carry a disproportionate burden of disease. Liao argues that the field’s dominant tools for measuring stress are, in a fundamental sense, looking in the wrong place.

“A lot of studies have investigated the relationship between stress experiences and cardiovascular risk. But most focus on either lifetime exposure to stressful events or a person’s recall of their usual exposure,” Liao said. “New measures are needed to better capture people’s daily experiences, which can be very different from traditional measures of stress.” The distinction matters because the two dominant approaches to stress measurement, cumulative lifetime exposure and retrospective self-report, both rely on memory and aggregation, and both can wash out exactly the dynamics that physiologists believe matter most for the heart.

The stakes are considerable. Heart disease remains the leading cause of death in the United States. In 2023, more than 919,000 people died from it, accounting for one in every three deaths, according to the Centers for Disease Control and Prevention. High blood pressure, which affects nearly half of American adults, is among the most significant modifiable risk factors for heart disease and stroke, and a growing body of research links repeated stress responses, including transient surges in blood pressure and heart rate, to the long-term development of hypertension and vascular damage.

The UT Arlington project unfolds in two phases. The first is devoted to building a new survey instrument designed to capture people’s day-to-day experiences with stress, including their immediate emotional reactions and the coping strategies they deploy in the moment. Rather than asking participants to summarize months or years of hardship, the tool is intended to probe the texture of ordinary days: what happened, how it felt, and what the person did about it. The researchers will apply a psychometric methodology known as item response theory, which allows a survey to be tailored to each participant’s demographic and personal characteristics. In practical terms, item response theory lets researchers calibrate which questions carry the most informational weight for a given individual, improving measurement precision without burdening respondents with endless questionnaires.

Once the measure is established, the team will recruit participants who will be monitored intensively for 14 days. During that window, participants will complete brief daily surveys on their smartphones while wearing devices that track physiological responses such as heart rate. This design belongs to a family of methods often called ecological momentary assessment, in which data are collected repeatedly in the flow of everyday life rather than in a single laboratory session. The approach minimizes recall bias, captures within-person variability that population averages obscure, and allows researchers to align what a person reports feeling with what their body is doing at nearly the same moment.

The third component brings the work back under controlled conditions. The researchers will compare the real-world measurements with participants’ responses to stress-inducing tasks conducted in a laboratory setting, where physiological reactivity can be observed with greater precision and standardized provocation. The goal is to understand how well snapshots of daily stress, gathered passively and repeatedly, correspond to the laboratory responses that have traditionally served as the gold standard for measuring cardiovascular reactivity. If the two diverge, that divergence itself could be informative, suggesting that everyday stress operates through patterns that a brief laboratory challenge cannot reproduce.

“Our study is really focusing on day-to-day experiences,” said Liao. “The idea is to capture in-the-moment experiences of stress, perceptions, feelings, social environments and related factors that will allow us to get snapshots of people’s experiences.” She hopes the research will reveal how daily social experiences and behaviors influence physiological responses, and, ultimately, help researchers develop more targeted strategies to reduce cardiovascular risk. Such strategies could range from timing interventions to moments of highest vulnerability to identifying which coping behaviors are genuinely protective when they occur in natural settings rather than in theory.

The project is deliberately multidisciplinary. The coinvestigators include Rebecca Lee, a community health psychologist at Arizona State University, and Salene Jones, a clinical psychologist at the Fred Hutch Cancer Center, bringing expertise in how social contexts and clinical populations shape stress experiences. On the physiological side, Paul Fadel, associate dean for research at UT Arlington and a researcher in cardiovascular physiology, joins the team, along with Daisha Cipher, a biostatistician and nursing professor at UT Arlington, whose work will underpin the analysis of intensive longitudinal data. The combination reflects the reality that linking subjective experience to cardiovascular outcomes requires simultaneous competence in psychology, sensor-based measurement, physiology and statistics.

The project will also establish a six-member community advisory board representing the study population, a structure intended to keep the research grounded in the priorities and lived realities of the communities whose cardiovascular health it aims to improve. That emphasis aligns with the mission of the National Institute on Minority Health and Health Disparities, which has long emphasized that stress exposure and cardiovascular risk are unevenly distributed across populations, and that measurement tools validated in one group may not transfer cleanly to another. By tailoring its survey instrument to participants’ characteristics and involving community representatives from the outset, the team is betting that better measurement, gathered in the moments where stress actually lives, will be the first step toward interventions that reach the people who need them most.

Subject of Research: Real-time measurement of daily stress using smartphones, wearables and laboratory testing to study cardiovascular health

Article Title: UT Arlington study tracks stress in real time

Article References: UT Arlington study tracks stress in real time. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: stress, cardiovascular health, wearable technology, smartphone surveys, item response theory, hypertension, ecological momentary assessment, heart disease, health disparities, UT Arlington, physiological monitoring, National Institutes of Health