#80 - The Science of HRV: Advanced Analysis for Healthcare Providers, Part 2

Hi guys, welcome to another episode of The Factor Podcast. I'm your host, Jessica Riddle. Welcome and thank you for listening. In our last episode, we heard from Dr. David Hopper. a chiropractor and professor of anatomy and physiology at the National University of Health Sciences. He taught us that the science of studying heart rate variability can provide a comprehensive gauge of our nervous system's flexibility and our overall physiological resilience. In today's episode, we'll delve into how HRV, or heart rate variability, functions as a predictive tool for health management, We'll explore its role in differentiating between the sympathetic and parasympathetic nervous systems and discuss how athletes at all levels can use HRV data to fine-tune their training for optimal performance. Dr. Hopper also touches on how you can utilize HRV monitoring in your clinical practice to not only enhance your patient care but to provide an additional revenue stream. Whether you've tuned in today to learn more about using HRV with your patients or to improve your own performance, We've got you covered.

Let's dive in.

Okay, now there is this other thing called frequency domains, and as it shows here, right, if we have white light shining through a prism, right, it breaks into all of its light bands or frequencies. Of light. And it's the same thing with our heartbeats that we can actually take that and we can do a spectral analysis of that and we can determine the sources of power from each of those readings. And it breaks it into 4 different bands. Now, for our purposes, we are talking about short-term measures of HRV. That's those average 3 to 5 minute readings. When we get into longer-term readings, there can be 24-hour readings and whatnot, then we would see things like our ultra-low frequency band. But in a short-term reading, we cannot see that. Those are things that cycle very slowly, so we would not see those things within our short-term readings. We can catch a little bit of our VLF, or our very low frequency, and if we see that power turned on or turning up at times, we can say that that may be an indication. That vagal brake is not applying itself so well. So, that is getting into a bit of polyvagal theory language there, but essentially, it's that our vagus nerve is not acting as strongly as it could. Now, the next one is our LF or our low frequency. And, low frequency is going to be an indication of the power within our baroreceptors or how well our body is doing with adapting to that moment-to-moment change. And that one, if we want to see, we want to see it lower for the most part. Otherwise, again, that can be an indication that our vagus nerve does not have its power to regulate that system as well. And then finally, we have our high frequency and our high frequency power. That one we want to see high, and that is showing, that is reflecting our vagal tone the best with our high frequency power. So baseline readings. Oh, there's that slide I was looking for on the baseline readings. We have our baseline readings, and that's what we need to establish with each patient. And it is the consistency of these readings that is going to help us the most. So we need consistency and we need context. So we need to know what is going on in a person's life around the time of the reading, because that really helps us understand what each reading meant or why we're seeing that. For example, I had a patient who had a huge change in her HRV. And I saw her in this morning and I said, hey, what happened yesterday? So I have the ability to see my patients' readings on a backend dashboard so I can see when they're actually taking their readings. And I said, hey, what happened yesterday? You dipped way down. And she said, oh, I got up and I remembered I had to do all this stuff. So I started doing the laundry and doing the dishes because we had people coming over. And then she said, oh, I forgot to take my HRV. And she said, it rang and I sat down and I took it real quick. And then I ran right back to doing everything else. And I was like, oh, okay, well, that's why it looks so crazy in comparison. Because what did she do?

Right?

She loaded herself down with all these bricks and then took a measurement like that. So it was a very inaccurate look at where she actually was. So we just kicked that reading out, right? And said it's not valid. Right? But if that had been an actual reading for her, we might've said, oh, what's going on?

Right?

Let's let's take a look at everything, right? Where is your temperature at? Are you having sinus pressure? How did you sleep last night? We want to look into all of these things because that might be an indication that this person's nervous system is starting to crash, making them more susceptible to illness, injury, all those kinds of things. One more thing that it said on that last slide that I should mention as well is when we look at HRV, we are we want to know what is normal for you. That is all that matters. So, I wouldn't compare my HRV to Jessica's, and Jessica wouldn't compare her HRV to one of my patients, and so on and so forth, because everybody's experience of life is different. And it is not only your objective experience in life, so what happened to you, but your subjective experience of that as well. So, we can all have the exact same thing happen to us. And each one of us can have a different impact on our nervous systems as a result of whatever event, right? For me, it might be nothing. I might just blow it right off and think nothing of it and never think of it again in my life, right? Whereas Jessica might have the exact same thing happen to her, and that might weigh on her mind night and day for the next 10 years. And that's because we can all have our own unique experience. And just like that, HRV is a unique number to each of us. So we shouldn't be comparing those to each other. It's not a, hey, my HRV is higher than you. This is what it is for me, and that's what it is for you. All right, so with HRV, the power comes in when we start to look at trends. So our day-to-day trends, we can look at that, and you can measure multiple times per day if you would like as well. And you can understand how your power shifts throughout the day. So in the morning, you might be at your most powerful, and as you go throughout the day, you drain that battery down, right? And by the end of the day, you have not much left, and you might feel that because you might be really tired. Or you might see that you power up until lunchtime, and then you start to come back down. And then we can also test things. So we can test things like how food impacts us. We can test things how a workout session impacts our nervous system, any of those things by measuring HRV immediately before, immediately after. All right, and then our weekly trends. So when we zoom out and we start looking at HRV and weekly trends, we can see each week what we are doing, right? So do I start off my week strong and by Friday I'm out of gas, or do I not really wake up until Wednesday and then I'm super powerful on Wednesday And then as the week goes on, I'm doing pretty good, and then I crash for the weekends. So everybody's going to have a different and unique pattern. But what we can do when we start to understand our patterns is we can plan accordingly. So I can place my most important work on my most powerful days at my most important— at my most powerful time of each day. So we can do those kinds of things. Now, we know that that isn't always possible, but we can always shift based on how we can essentially train our physiology. And I'll talk about that in just a second. But we can also use HRV, right? We can zoom out and we can look at monthly trends, yearly trends, seasonal trends, all these kinds of things to help us understand how our physiology shifts throughout those longer cycles. All right, and then the actual application of HRV. So this is where we're talking about taking action. And I see that we're running out of time, so I'm not going to spend a horrible amount of time reading through all of this. But essentially, when we are measuring our HRV, we can avoid pitfalls. So we can avoid those, we can avoid that downtime with sickness, with injury, any of those kinds of things. We can avoid those times when we might have a mental or emotional collapse because we can see it coming and then we can plan for that. We can help ourselves. And of course, we as practitioners can help our patients. Yeah. When we see these things coming as an early warning sign, right? So this is how I like to look at it and how I like to talk to patients about it, is that we have a basin of water and we have our hot water, we have our cold water, and we can imagine that if we have all this hot water coming into our sink, right, all these things piling up on us, we have all this hot water pouring in and we barely have any of that cold water, right? Barely any of that time for those things that help us recharge. Okay, we have 2 options. One is we can pull back and we can turn down the hot water, or the other is we can turn up the cold water. Okay, and either one is going to be valid here. So on any given week, if you see yourself or your patient starting to dive down from that HRV trend, we know that this is going to end poorly. So what can we do? Well, there's always things that can be moved to tomorrow or moved to next week, right? We'll just scratch from the calendar completely. Okay, so we can always get rid of those things. But what about when everything is important? At those times, we need to turn up the cold water. Okay, so what can we do to turn up the cold water to support ourselves? Or maybe that is doing extra time with meditation. Maybe that is extra time with prayer, whatever it is for you. Then maybe it's doing something like yoga, a soothing movement exercise, right? And so that would be not hot yoga. Take a nap, spend some extra time sleeping. Okay, these types of things, a walk in nature, laughing with some friends, going out doing something like that to help fill your cup and help you carry everything that you need, right? So we can always, we can always look at it from those, those 2 angles. We can always turn down the hot or we can at least turn up the cold. And we know that if we don't do that, we will likely have a negative outcome.

Okay.

Now, HRV biofeedback, I want to make sure that I do mention this. So, this is a very powerful process that when we talk about things like meditation, things like turning up that cold water, HRV biofeedback is actually one of the most powerful. And, that is breathing at a frequency, your resonance frequency breathing rate, which is specific to each person. So, you have to actually have a test done for this. And, once you find that rate out, Then you can do breathing at that rate. And you can actually do this with HRV monitoring, and you can see how you can change your own physiology just with breathing. And this is really pretty unbelievable. So highly recommend you check out HRV biofeedback. And actually, not to pat any backs or anything like that, but our app is the only app on the marketplace currently that offers the test within it, developed by Harvard scientists. All right. And then making money with HRV. We want to make sure that we are actually using HRV in a positive way. And how we can do that is within our own practices, we want to make sure that we are charging for HRV and then building it into the exam cost, building in the cost of the device and the cost of the app just right into the exam. So that way it's not a, oh, well, I don't want to use HRV within my care plan. No, it's just part of the plan. And then what's really cool about this is even after you've been seeing a patient, a lot of times They will want you to continue monitoring their HRV, so it can be an ongoing revenue source as well. Okay, and I know we're running out of time here, but what I took you guys through today is these five steps in the basics of using heart rate variability in your practice. So that is that. So I'm going to open up the floor for any questions. So please feel free to. type anything into the chat box now, and that will be it for today.

Wonderful. Thank you so much, Dr. Hopper. We have had a few questions come in during your presentation. One of them was actually very interesting. One of our docs works with high-level athletes, and he had an athlete that actually was doing some heart rate variability monitoring, and his device was able to pick up visceral stress. Essentially, the unit picked up visceral stress in his body 2 days before his appendix burst. And this was independent from his training regimen. So this doc was curious if the Optimal HRV can also pick up that visceral stress. And if you have any similar instances where it's given you indications of something that was completely unrelated to an athlete's training but was a big spike.

I am super curious what device that athlete was using. To pick up that visceral stress specifically. And that, and that is just amazing though, and I want to applaud that doctor and that athlete for being able— for tracking it and being able to recognize that. So that is absolutely an amazing story. But all HRV is picking up visceral stress in that it is measuring your vagus nerve, which is afferent feedback from your viscera.

Yeah.

So, so to a degree, yes, they all are, but I don't know any device that specifically labels it as visceral stress. I would actually be curious what that device was myself.

Absolutely.

Yeah.

Yeah. So I, um, I actually was going to connect you with this doc after the call today. He's one of our other instructors, Dr. Tom Teeter. He has the Rehab to Fitness course and the Clinical Human Performance Practitioner course. He was very interested in the webinar today. He was sad he wasn't able to join us live, but He was asking me, he said, definitely ask him about this. He, he very much sees the clinical applications of HRV, especially when he does a lot of training and the fitness aspect as well. So that kind of leads to the next question.

Yeah.

When you are dealing with high-level athletes, such as those that are training for a marathon, a triathlon, people who have really intense physical workouts on a regular basis, How do you kind of look at the data from a subjective standpoint? And really, how are you able to pick out those areas where you're like, okay, something's going on here? Does it mainly come up in their recovery after workout? And can you very easily kind of chart that on a graph to see how well they're recovering after each and every workout?

So, yes, fortunately, it is a very straightforward And, when you look at the trends, what is happening with an athlete? So, there is functional overreaching and there's nonfunctional overreaching. And, when an athlete is training, most athletes are training to peak at a certain time of their season or for a certain event. And, we want to see functional overreaching happening throughout different periods of their training program. And, that's going to be that we see that HRV trending down but not drastically down, that we see it trending down, but then we allow that time for recovery and we can see them go back up. And a lot of times either go back up to their baseline or go even above their baseline slightly, and then they stay there. Now we know that they're fully recovered and we know that they're ready to be pushed again, and then we can push them back down for another training block essentially. And then once they're— then once we push them down, and we'll— what we'll notice is that it takes a little bit more to to push them down that next time, let them recover and bounce back up. And, we can go through that cycle and then, of course, encourage that cycle to go until we hit where we want to be for our peak time of season or for whatever sporting event it may be. And, on the other end of that can be that nonfunctional overreaching where we see an athlete pushing themselves, pushing themselves, and even though subjectively and objectively we see them going down, down, down, down, down, We don't take that time for recovery. And as a result, we see them completely crash and wind up getting injured or something like that. Unfortunately, it may happen.

Has there been any research or data that you can speak to that has linked some of the things that we know are issues with high-performance athletes, such as rhabdo situations or situations where they're on a really high Essentially, their adrenals are just tanked. Their cortisol is through the roof because they aren't taking that time to recover. Have there been any studies done that have utilized HRV as one of those data points for looking at some of those indications that someone is leading to burnout?

So yes, there, there definitely are those studies out there. And real quick, I do want to mention with this and with the last, this doesn't have to be just about athletes as well. This is high-level CEOs and all of that are using HRV for the same thing, for performance as well. But with that, like you asked about, there's a great study utilizing CrossFit athletes and showing how predictive it is of them reaching that non-functional overreaching and then pushing themselves into injury, where it very clearly displays that they are going into this non-functional space, and then all of a sudden we see them get injured on, on the other side of the coin. Now, with rhabdomyolysis, I am not I'm not familiar with a study that is, that is on that specifically, but I don't spend a ton of time in the athlete realm. So there very well may be, may be one out there on that.

So speaking to your everyday patients, to those that are coming in that maybe are just trying to perform better at work, maybe it's a high-stress job like a stay-at-home mom, which we all know is one of the most stressful jobs there is out there.

Indeed.

How do you start having these conversations in your patient visits? When someone first comes in, you do your initial exam. What does that look like and how do you start introducing this concept of HRV in that conversation?

The first thing that I like to do is if, if it is possible, most of the time it is, I like to have a patient come in and get an HRV device and connect to the app before they even become a patient of mine. So from the, they, I want to become a patient for whatever reason. Well, then I say, okay, please come in and pick up an HRV device, and we're going to give you login for an app, for the app. And we start tracking their physiology before they even come in the door. And the reason why I find that very important is because we know what normal looked like for them before they walked in our door. And that's good because that helps me understand where they were at. But it also is really good because then in another month, I can show them where we've gone, right? So I can say, this is what you looked like before you walked in my door. Here's where you are now. But I explain it as we are going to track your heart rate variability throughout your care plan here, and the heart rate variability is going to guide our care plan and help us understand how your body is reacting to the treatment plan that we are providing. So that can be, for example, with physical therapy, occupational therapy, anything like that. If you walk in the door, and we do take patients, but if we take a patient's HRV Right when they walk in the door and we see that they are down that day, right, or we saw that from their baseline reading that they are down that day, we're not going to challenge them at such a high level. We're going to give them things that they are more used to for their training program that day. Now, the opposite could be true as well, that if they are on a day we would call a green day, right, or a go day, and they walk into our door, then we know that we can challenge them with a novel experience. We know that we can make their, make their correctives a little bit more more challenging that day, you can challenge the nervous system in a new way. So, we use that as our guide.

Perfect. I think that's wonderful. And, in terms of your patients using HRV and giving themselves a little bit of that biofeedback as you discussed, do you find that your patients tend to be a little more compliant with your recommendations because they have that visual feedback kind of letting them know, okay, holy cow, I didn't sleep Well, last night my hydration is awful. I was on the computer a little bit too late last night. Like, do you find that in your time working before using HRV versus seeing patients now using HRV as an integral part of your patient care, that there's a big difference in terms of how your patients are compliant with things?

Yes. And I will say I've never worked without HRV, but I worked with it more on not as regular as an everyday basis before. And having patients use it every day is a total game changer in that yes, it does help with that self-compliance, and they will even call themselves out. You know, I'll have patients walk in and they'll be like, "Look at what I did to myself," and I'll be like, "I went from a 40 to a 20 just because I didn't sleep last night." Whatever it is, and yes, it does help with that compliance piece a bunch, and it becomes kind of a game. How much can I drive my HRV up? I mean, unfortunately for some people as well, it's. Look what I did to my HRV this weekend. But at least they understand what they're doing.

When you have patients that are on weight loss journeys, those that are looking to lose significant amounts of weight or just starting to become active again, do you tend to notice a pretty consistent, steady upward trend? Are there still peaks and valleys along the way based upon any given lifestyle change in an average day? And have you had many patients that utilize the HRV as just another point of feedback as they're on this journey to better health?

Yes, with any significant health change, there is always peaks and valleys. Unfortunately, it's never just a straight shot up, right? So we'll always have those peaks and valleys. There will always be good and bad days, and even when you are doing everything right, it is still a stress on your autonomic nervous system. And stress nonetheless, right? Is it going to be reflected in your in your HRV? So when you are doing all the right things, right? Yeah, we are going to see some down days. But as long as we see that general trend going in the right direction, that is that is a positive. And again, it doesn't always have to be that you shot up dramatically, right? That you doubled your HRV in six months or something like that because a lot of times that's just not realistic. But if you maintain that baseline or you raise it a bit, that is a huge win, especially when we pair it with making positive lifestyle changes. Then we may see that, we may see that larger level raise in the long term.

Absolutely. I can, I can see that for certain. Throughout the years that you've been using HRV in practice with your patients and even some of the The data that I'm sure you've pored over with general studies that you've seen, are there any things that have surprised you? Like any times where you've seen a spike or even a dip in HRV and it was from a cause that you didn't necessarily anticipate would have as big of an impact?

So there's a wonderful lady who used our, who used our app and everything for a study at Villanova. And they were doing a study on anorexia. And, and although this is quite a process. We know that it's doing destructive things to the human body. HRV actually tends to be much higher in those— in that patient population than in the average paid population. And actually, we're trying to understand why that is. We know that fasting will actually raise your HRV. And in that case, I mean, it's kind of an extreme form of fasting, but we can't imagine when it becomes destructive to the body that it would continue to look like a good thing to your autonomic nervous system. So that one is quite puzzling.

Yeah, that's absolutely fascinating. I'm sure that that's got a lot of the scientific community kind of digging into that to find out more. One final question for you. I'm sure you probably get this a lot, especially when you start introducing your patients to HRV. How often are you getting that question, what should my optimal HRV be? How do you explain to patients, like, there's not a magic number that's the same for every single person? Are there ranges that are ideal based upon age groups or is it really just so individualized to each person?

So unfortunately there are norms tables out there. And I say unfortunately because, because then right away, that's all, just go and look and see how they compare to a norms chart. And I can say when it comes to HRV, there is no normal. It's whatever's normal for you. So yeah, you can look at the norms charts, but as you will see, I would say you don't want to be normal. You want to always be above normal. So all that really matters is your norm and your baseline and that you are staying around or above your baseline. Those are the keys. And even to say that, right, we also want to challenge our physiology on a regular basis. So we do want to see that up and down on a regular basis too. It's just that our average is staying about the same or raising throughout our lifetime. And of course, that being said too, with age, HRV naturally will decline as well.

That's wonderful information. Well, I know this has been incredibly educational for our audience today. I think this is a really interesting science and especially one that could be very impactful for The majority of our audience, which of course are chiropractors, our physical therapists, athletic trainers, those people that are working with general populations that are trying to get them to take better care of themselves, to become more active, to have better health. And it sounds like this really creates an incredible opportunity for patients to have that feedback so that they can track their progress over time. So—

Right.

How would someone get in touch with you if they have questions? If you could give me maybe an email address or something I can put here in the chat, I'll let everyone know how they could follow back up with you. Is there a best way that I should tell people to get in touch with you if they have more questions about your device, your trainings, or of course any of the, the research that you've done here?

Yes, absolutely. So optimalhrv.com is our website, and, and that is for our app and our device. And then dave@optimalhrv.com dave@optimalhrv.com is my email. And then also I have no problem with people calling or texting. So my phone is 312-961-7734, and I'm always happy to call or text with anybody at any time to help them out with better understanding HRV or connecting in whatever way they would like.

Wonderful. Thank you so much. We really appreciate you coming on today and sharing this information. Thank you so much, Dr. Harper. We appreciate you coming on today.

That's it for today's episode. Be sure to tune in for episode 81, where we will be kicking off a new training on common conditions and rehab techniques for mixed martial artists with Dr. Nate Stegwis.

You won't want to miss it.

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