Trend Changes versus Daily Changes

HRV fluctuates to a certain extent on a daily basis. I’ve seen athletes with coefficient of variations (CV, a marker of deviation from the weekly mean) as low as 2% to >15%. An athlete’s CV changes over time, which itself serves as what I believe to be, an important indication of training adaptation.  The CV is related to individual fitness level and training stress and possibly even performance potential. Measurement position will also affect the CV with lower CV’s observed in the supine position compared to standing.

Here’s an important lesson I’ve learned about interpreting HRV in athletes. A daily change in HRV can occur for a number of reasons, and may or may not have any meaningful impact on acute performance or “readiness”. Putting too much focus on an acute change in HRV without stepping back and observing the overall trend is a bit myopic. This isn’t to say that daily changes aren’t useful, just that a full appreciation of the training process, including the evolution of the trend in response to training will enable better analysis and therefore decision-making. This is because longitudinal changes in an athlete’s HRV trend do not occur for no reason. Increases, decreases, greater fluctuation, less fluctuation, when assessed over time, are all very meaningful.

Observe the screenshot below which details the last 6 months of a high level collegiate sprint-swimmers trend. The data pretty much interprets itself when you compare the changes in the trend to changes in training and life events.

6motrend

What can we observe from this?

  • Greater fluctuation and a decreasing trend during heavy training stress
  • Less fluctuation and an increasing trend during reduced training stress
  • Greater fluctuation and a decreasing trend during normal training with increased academic stress (preparing for and writing exams). Thanks to recent work from Bryan Mann, we know that this increase in non-training related stress may put athletes at greater risk of injury or illness.

I strongly believe that to use HRV effectively, you need to consider the changes in the trend, and not just the day to day stuff. When asked what HRV products are worthwhile or what do I think of App X or product Z, I always suggest that they invest in one that provides the best visualization of the data over time and includes other markers of training status (i.e., load, wellness, etc.). This enables more meaningful interpretation of the data and can therefore be more insightful and useful when determining the appropriate action to take with regards to training program adjustment.

Early changes in HRV relate to eventual fitness changes in collegiate soccer players

Numerous studies have shown that increases in fitness (e.g., VO2max, MAS, Yo-Yo, etc.) are associated with increased cardiac-parasympathetic activity among healthy, athletic and clinical populations. This is one of the reasons why aerobic exercise is considered to be cardio-protective, due to enhanced resting vagal-modulation.

However, there is considerable inter-individual variation in how a given individual responds to an exercise program. Following a standardized endurance training program, some individuals will show significant improvements in aerobic fitness while others will show only small improvements. Some may even regress. Why this occurs is likely due to a variety of potential variables including genetic factors, appropriateness of training stimulus and life style factors (i.e., sufficient recovery, sleep quality, nutrition, stress, etc.). Given the association between fitness changes and HRV changes, monitoring HRV throughout training may be useful in evaluating individual adaptation to a training program.

In our latest study (in press with JSCR), we wanted to determine if changes in HRV mid-way through a training program related to eventual changes in intermittent running performance in a collegiate female soccer team. It would be useful for coaches to be able to identify athletes who may not be coping well with training earlier on rather than waiting until post-testing to realize some athletes didn’t improve much. Coaches can then investigate the potential cause (i.e., fatigue, insufficient sleep, etc.) and intervene accordingly with modifications to training load or life style factors to get athletes back on track.

Before and after a 5-week conditioning program, we tested the team’s intermittent running capacity with the Yo-Yo IRT1. The conditioning program was designed based on the individuals max aerobic speed (MAS) adapted from Dan Baker’s MAS guide (link). Below is a screen shot of the conditioning program (unofficial).

MAS prog. Flatt

During week 1 and week 3, the athletes recorded their resting HRV each morning after waking with their smartphone using the ithlete HRV application which we validated previously (link). The weekly mean and weekly coefficient of variation (CV) for HRV and HR values were calculated. Change variables from week 1 to week 3 of HRV and HR (mean and CV) were correlated with the changes in Yo-Yo IRT1 performance from week 0 to week 5.

We found a very large correlation between the change in HRV CV at week 3 and Yo-Yo IRT1 changes at week 5 (r = -0.74). A large correlation was also found between the change in HRV mean and Yo-Yo IRT1 (r = 0.50). The HR measures showed only moderate correlations with the eventual changes in fitness.

Based on these results, it appears that monitoring HRV throughout training may be useful for evaluating how individual athletes are adapting to training. Specifically, we’re looking for two possible trend changes:

  1. A decrease in day-to-day fluctuation in HRV scores (i.e., decreased HRV CV)
  2. An increase in the weekly mean

Athletes demonstrating the opposite (increased CV and/or decreased weekly mean) may require a little closer attention from coaching personnel  to ensure that the training load is appropriate or that the athlete’s are taking care of the non-training factors that can be effecting their recovery.

Another novel finding of this study was that ultra-short HRV recordings (~1 min) derived from a smartphone app used by the athletes provided meaningful training status information. This indicates that HRV monitoring can be much more affordable and convenient than traditional approaches (i.e., longer recording periods with more expensive HRV tools).

I have plans for a much more elaborate post in the near future on the HRV CV. I’ll cover previous research, post some data and discuss how to interpret changes in the CV with appropriate context.

Link to current study: Evaluating individual training adaptation with Smartphone-derived heart rate variability in a collegiate female soccer team.

New study: Assessing shortened field-based HRV data acquisition in team-sport athletes

Our latest study “Assessing shortened field-based heart rate variability data acquisition in team-sport athletes” is now available ahead of print in IJSPP.

This project was a collaboration with Dr. Fabio Nakamura, Lucas Pereira, Dr. Irineu Loturco and Dr. Rodrigo Ramirez-Campillo. We have several more papers in production, in review and in press, so stay tuned for those.

This study expands on previous work of ours (link, link) that  assessed the agreement between ultra-short (60 s) HRV measures with standard 5 minute measures (following a 5 min stabilization period). This study differs from our previous work in a few key areas:

1. We assessed HRV (LnRMSSD) in the seated position here versus the supine position previously. Having to accommodate to the seated position may take longer than the supine position due to the vertical positioning and extra stress on the heart. Additionally, the seated position has been suggested in recent review papers to be the preferred position for athlete monitoring. Therefore, investigation into the time-course for HRV stabilization (i.e., how long must we wait to achieve a stable R-R signal), in addition to the agreement between ultra-short measures and the criterion (5 min post 5 min stabilization) segment from seated measures is required.

2. This study also evaluated the ratio between LnRMSSD and the R-R interval (LnRMSSD:R-R). Previous work has shown that highly fit athletes can demonstrate “parasympathetic saturation” which is characterized by a decrease in HRV despite very low resting heart rates. Daniel Plews et al. describe this phenomenon in their recent review paper: “The underlying mechanism is likely the saturation of acetylcholine receptors at the myocyte level: a heightened vagal tone may give rise to sustained parasympathetic control of the sinus node, which may eliminate respiratory heart modulation and reduce
HRV.”

3. In our previous studies we used an ECG for HRV analysis which is considered the gold standard, though not very practical for routine monitoring. In this study we used the Polar RS800,  a field tool heart rate monitor system that is more commonly used in practical settings.

4. Lastly, this study included elite level athletes whereas our previous work included collegiate athletes.

Our results show that the first 5 min LnRMSSD value (stabilization period) was not different than the criterion segment (mins 5-10). Additionally, we found that each isolated minute from the stabilization period (i.e., min 0-1, 1-2, 2-3, etc.) showed good agree with the criterion. Therefore, when 5 minute measures cannot be obtained due to time constraints or for compliance reasons, 60 s measures appear suitable for valid assessment, in agreement with our previous investigations.

In our next paper (in press) we assess if ultra-short LnRMSSD measures are sensitive to training effects in elite athletes.

Abstract
Purpose: The aims of this study was to compare the LnRMSSD and the LnRMSSD:RR values obtained during a 5-min stabilization period with the subsequent 5-min criterion period and to determine the time course for LnRMSSD and LnRMSSD:RR stabilization at 1-min analysis in elite team-sport athletes. Methods: Thirty-five elite futsal players (23.9 ± 4.5 years; 174.2 ± 4.0 cm; 74.0 ± 7.5 kg; 1576.2 ± 396.3 m in the YoYo test level 1), took part in this study. The RR interval recordings were obtained using a portable heart rate monitor continuously for 10-min in the seated position. The two dependent variables analyzed were the LnRMSSD and the LnRMSSD:RR. To calculate the magnitude of the differences between time periods, the effect size (ES) analysis was conducted. To assess the levels of agreement the intra-class correlation coefficient (ICC) and the Bland-Altman plots were used. Results: TheLnRMSSD and LnRMSSD:RR values obtained during the stabilization period (i.e., 0-5-min) presented very large to near perfect ICCs with the values obtained during the criterion period (i.e., 5-10-min), with trivial ES. In the ultra-short-term analysis (i.e., 1-min segments) the data showed slightly less accurate results, but only trivial to small differences with very large to near perfect ICCs were found. Conclusion: To conclude, LnRMSSD and LnRMSSD:RR can be recorded in 5-min without traditional stabilization periods under resting conditions in team-sport athletes. The ultra-short-term analysis (i.e., 1-min) also revealed acceptable levels of agreement with the criterion.

If you’re not assessing (the ANS), you’re guessing

“If you’re not assessing, you’re guessing” is a phrase often used by strength and conditioning professionals to explain the importance of movement assessment prior to exercise prescription. Prescribing a program that doesn’t consider the athlete’s movement ability (or lack thereof) can end up causing problems.Essentially, you would be guessing that your exercise prescription is helpful when in fact it could be exacerbating a problem. I wholeheartedly agree with this. However this article has nothing to do with movement assessment. This was just my way of illustrating what my next point is.

I am going to apply the same logic we use for why we assess movement (to influence program design) with monitoring the function of the autonomic nervous system (ANS); if you’re not assessing the ANS, you’re guessing.

If you’re unfamiliar with what the ANS is and why it’s important I suggest you read this. In a nutshell the ANS governs “rest and digest” and “fight or flight” responses in the body. This is done without our conscious control. The two components of the ANS are the parasympathetic branch and sympathetic branch. Sympathetic activity is elevated in response to stress be it physical, or mental. Adrenaline is secreted and catabolic activity (the breakdown of structures) ensues. Parasympathetic activity is elevated in the absence of stress and functions to heal and repair the body.

We can monitor our ANS status non-invasively and inexpensively through heart rate variability (HRV). I explain how you can do this here.

HRV as an indicator of autonomic function can tell you a tremendous amount about your athlete’s responsiveness to training. I shared plenty of research in this post that lends support to HRV as an effective tool for; reflecting recovery status, showing better adaptation to training and even predicting performance. In a separate post I shared my thoughts on HRV as a predictor for injury.

Let me summarize what I shared in my initial research review post;

HRV reflects recovery status in elite Olympic weightlifters (Chen et al 2011), national level rowers (Iellamo et al 2004) and untrained athletes (Pichot et al 2002).

Cipryan et al (2007) showed that hockey players performed better when HRV was high while performance was rated lower when HRV was low.

Endurance athletes who improved vo2 max had consistently high HRV while athletes who did not improve vo2 max had low HRV (Hedelin et al 2001).

Endurance athletes who trained using HRV to determine their training loads had a significantly higher maximum running velocity compared to athletes in a pre planned training group (Kiviniemi et al 2007, Kiviniemi et al 2010).

Female athletes who used HRV to guide their training increased their fitness levels to the same level as females in a pre planned training group but the HRV group had fewer high intensity training days (Kiviniemi et al 2010).

(references for the above articles can be found in my original post here.

I’d now like to show some more research that lends support to the usefulness of HRV in monitoring athletes.

Mourot, L (2004) saw decreased HRV in overtrained aerobic athletes. Uusitalo et al (2000) also saw decreased HRV in overtrained female aerobic athletes.

Huovinen et al (2009) measured HRV and testosterone to cortisol (T-C) ratio in army recruits during their first week of basic training. The training was class room based (not physical) and therefore all stress can be considered mental. The authors found that HRV declined in several soldiers, though not all. This demonstrates that, what can be interpreted as stress is highly variable and dependent on the individual. The authors used the terms “high responders” and “low responders” to describe the differences among soldiers. Immediately I thought about the differences among athletes and how their bodies perceive stress. You can’t assume everyone is responding in kind to a training program. What is stressful for one athlete may not be as stressful to another.

All soldiers that showed decreases in HRV also showed lower T-C ratios. In contrast, soldiers with higher HRV had higher T-C ratio’s. Baseline T-C levels were not recorded so we shouldn’t draw any concrete conclusions however it appears that low HRV (increased sympathetic activity with parasympathetic withdrawl) is associated with a reduced T-C ratio.

Hellard et al. (2011) found that in national level swimmers, as HRV dropped (sympathetic predominance) there was an increased risk of illness. The drops in HRV that lead to illness were preceded by a sudden increase in parasympathetic activity the week prior to illness. The authors speculated that the preceding increase in HRV (parasympathetic/vagal activity) was a reflection of the body experiencing the first incubation period and that an increase in vagal activity was a protective response trying to modulate the magnitude of early immune responses to inflammatory stimuli. The subsequent increase in sympathetic activity and decrease in HRV occurs during the symptomatic phase of the illness.

In humans, increased sympathetic activity is generally associated with inflammatory responses while parasympathetic predominance actually inhibits inflammation. At this point in time I will not elaborate on this for the simple fact that I don’t fully understand it. However, we can speculate that if we’re seeing consistently low HRV scores in ourselves or our athletes there is probably an increase in inflammation occurring. Check out Thayer (2009) for more information regarding HRV and inflammation. Simon from iThlete sent me that paper and I’m still processing it.

When dealing with a team or if we train multiple athletes at the same time we need to be aware of how they are adapting and recovering from training. Work by Hautala et al (2001) shows that athletes will recover from exercise at different rates according to fitness levels (obviously). Basically, fit individuals recover faster and show less HRV fluctuation compared to less fit individuals. In a team setting, some individuals who are highly fit may not be getting a sufficient training stimulus while other athletes who are less fit can be overworked.

Kiviniemi et al (2010) found that females take longer to recover from aerobic training than males. This needs to be considered if you are training a mixed gender group.

Buchheit et al (2009) and Manzi et al (2009) both found HRV to be a predictor of aerobic performance.

I’m well aware that the development of athletes has been taking place without the use of HRV monitoring. There are many great coaches and trainers who have their own systems and methods of monitoring recovery in their athletes that work well.

HRV is a tool to use within your own systems. I have thoughts about how I would implement this in a team setting that I will share another time.

To truly autoregulate the training of ourselves or of athletes, we need as much information about present physiologic status as possible. Based on the research and my own personal experience with HRV, this technology takes much of the guesswork out of load/volume manipulation and training prescription. Training hard when HRV is low can be counterproductive and delay recovery. Training hard when HRV is chronically low can lead to illness, injury, overtraining syndrome and suppressed testosterone. Alternatively, increasing load/volume on days when HRV is high can lead to more favourable adaptation. HRV can tell us how stressful the training was for our athletes based on how long it takes HRV to reach baseline in subsequent days. HRV can indicate how much stress your athlete is experiencing outside of training. There are several indications one can take from a simple HRV measurement. Further research will reveal more correlation between HRV and sports performance.

I believe that to train an athlete optimally, we need to be assessing the state of the autonomic nervous system… otherwise we’re guessing.

References:

Buchheit, M. et al (2009) Monitoring endurance running performance using cardiac parasympathetic function. European Journal of Applied Physiology, DOI 10.1007/s00421-009-1317-x

Hellard, P., et al. (2011) Modeling the Association between HR Variability and Illness in Elite Swimmers. Medicine & Science in Sports & Exercise, 43(6): 1063-1070

Huovinen, J. et al. (2009) Relationship between heart rate variability and the serum testosterone-to-cortisol ratio during military service. European Journal of Sports Science, 9(5): 277-284

Kiviniemi, A.M., Hautala A.J., Kinnunen, H., Nissila, J., Virtanen, P., Karjalainen, J., & Tulppo, M.P. (2010) Daily exercise prescription on the basis of HR variability among men and women. Medicine & Science in Sport & Exercise, 42(7): 1355-1363.

Manzi, V. et al (2009) Dose-response relationship of autonomic nervous system responses to individualized training impulse in marathon runners. American Journal of Physiology, 296(6): 1733-40

Mourot, L. et al (2004) Decrease in heart rate variability with overtraining: assessment by the Poincare plot analysis. Clinical Physiology & Functional Imaging, 24(1):10-8.

Thayer, J. (2009) Vagal tone and the inflammatory reflex. Cleveland Clinic Journal of Medicine, 76(2): 523-526

Uusitalo, A.L.T., et al (2000) Heart rate and blood pressure variability during heavy training and overtraining in the female athlete. International Journal of Sports Medicine, 21(1): 45-53