New Podcast Episode: HRV monitoring in team sports

Thanks to Dr. Marc Bubbs for having me on the show to discuss HRV in team sports. Details and episode links below.

In Season 3, Episode 7 Dr. Bubbs interviews Dr. Andrew Flatt PhD to discuss applications of heart rate variability (HRV) monitoring in team sport athletes. Dr. Flatt reviews the basic physiology of HRV, how pre-season testing can inform your training and recovery plans, how in-season monitoring influences decision making, and new findings on HRV results in larger athletes, such as linemen in American football. Dr. Flatt also discusses how the “other 22-hours” in the day – sleep, long-haul travel, mental and emotional stress, etc. – impact the nervous system and HRV measures, and finally provides some practical tips on how to collect HRV measurements, validated apps, and red flags to avoid when interpreting results.

Summary of This Episode

7:00 – What Is HRV?

7:45 – What impacts HRV scores in athletes

11:00 – Pre-season HRV trends in team sport athletes

13:20 – Olympic vs. national level swimmer HRV values

25:00 – In-season monitoring in collegiate football players

33:00 – Strategies for improving recovery as competitive season progresses

40:00 – Monitoring – a tool to start a conversation

46:30 – Different “apps” to implement with clients

57:00 – Evolution of research in HRV and team sports

 

https://www.stitcher.com/podcast/dr-bubbs-performance-podcast/e/58826132?autoplay=true

New Study: Effects of consecutive domestic and international tournaments on HRV in an elite rugby sevens team

A quick summary of our latest paper follows the abstract below…

Effects of consecutive domestic and international tournaments on
heart rate variability in an elite rugby sevens team

JSAMS title HRV rugby

Rugby seven players often compete in 2-day tournaments over consecutive weekends, leaving only 5 days to recover and prepare for the next tournament. Many tournaments are held internationally, adding substantial travel demands to the already-taxing nature of the sport. We hypothesized that the added stress of travel for an international tournament may result in greater decrements in HRV relative to a local tournament.

The main findings were that despite no significant difference in match-physical demands (high speed running, total distance and sRPE), significant reductions in LnRMSSD were observed only in response to the international tournament (see figure below). Despite non-significant p values at other time-points, individual analysis showed that ~80% of the players showed meaningful reductions in LnRMSSD relative to baseline following the local tournament and on the day of travel (see bottom of figure). Thus, it seems that HRV was still affected by these events, though to a lesser magnitude than the international tournament.

The decrements in LnRMSSD at the international tournament were preceded by significant decrements in perceived sleep quality and energy levels reported on or after a chaotic travel day. The travel day involved an earlier than usual wake-time and a missed flight connection. This forced the team to complete the travel by bus, delaying their hotel arrival to 3 am.

Given that HRV is sensitive to a variety of physiological, psychological and environmental factors, we cannot say for certain that travel stress accounted for the differences in HRV responses, though it seems likely. We state: “LnRMSSD responses to the international tournament were therefore likely influenced by a combination of variables associated with, but not limited to altered sleep, a disrupted travel itinerary and the process of relocation which interacted with the physical and psychological stress associated with tournament-play.”

Differences in collision/body contact loads between tournaments may have contributed to differences in LnRMSSD responses, but were not assessed. Additionally, this was the first pair of consecutive tournaments for this team in at least six weeks, which may have served as a relatively novel stimulus. Therefore, we’re not sure if similar LnRMSSD responses would be observed when the team was re-familiarized with consecutive tournaments or when travel isn’t so hectic.

JSAMS Fig 1 HRV rugby 7 consecutive tournaments Flatt et al.

New study: Association between Subjective Indicators of Recovery Status and Heart Rate Variability among Divison-1 Sprint-Swimmers

Our latest study investigates the relationship between subjective indicators of recovery status and HRV among NCAA Division 1 sprint-swimmers. The main findings were:

1) Perceived sleep quality showed the strongest relationship with post-waking LnRMSSD.

2) LnRMSSD demonstrated stronger associations with subjective parameters than resting heart rate.

We report both group and individual relationships. The full text is available here.

Association between Subjective Indicators of Recovery Status and Heart Rate Variability among Divison-1 Sprint-Swimmers

Abstract

Heart rate variability (HRV) is a physiological marker of training adaptation among athletes. However, HRV interpretation is challenging when assessed in isolation due to its sensitivity to various training and non-training-related factors. The purpose of this study was to determine the association between athlete-self report measures of recovery (ASRM) and HRV throughout a preparatory training period. Ultra-short natural logarithm of the root mean square of successive differences (LnRMSSD) and subjective ratings of sleep quality, fatigue, muscle soreness, stress and mood were acquired daily for 4 weeks among Division-1 sprint-swimmers (n = 17 males). ASRM were converted to z-scores and classified as average (z-score −0.5–0.5), better than average (z-score > 0.5) or worse than average (z-score < −0.5). Linear mixed models were used to evaluate differences in LnRMSSD based on ASRM classifications. LnRMSSD was higher (p < 0.05) when perceived sleep quality, fatigue, stress and mood were better than average versus worse than average. Within-subject correlations revealed that 15 of 17 subjects demonstrated at least one relationship (p < 0.05) between LnRMSSD and ASRM variables. Changes in HRV may be the result of non-training related factors and thus practitioners are encouraged to include subjective measures to facilitate targeted interventions to support training adaptations.

Figure 1 Effect Size SPORTS jpeg

Figure 1

Effect sizes ± 90% confidence interval for resting heart rate parameters relative to subjective categorization.

Effects of varying training load on HRV and running performance among an Olympic rugby sevens team

This study is the first of a few collaborations between Dan Howells and I involving HRV in elite rugby sevens players. Here we evaluated HRV and running performance responses  to peak training loads during preparation for the 2016 Olympic games. A practical summary follows the abstract below.

Effects of varying training load on HRV and running performance among an Olympic rugby sevens team

JSAMS Abstract Flatt Howells HRV rugby sevens

How do elite seven’s players respond to substantial increments in training load? Based on previous studies, we’d expect the weekly LnRMSSD mean (LnRMSSDm) to decrease and the coefficient of variation (LnRMSSDcv) to increase relative to baseline. We’ve observed this in collegiate soccer players and sprint-swimmers.

In contrast to this hypothesis, the players showed no change in LnRMSSDmean throughout two weeks of intensified training relative to a baseline week of low loads. LnRMSSDcv demonstrated a small increase during the first week of increased load (expected response) but then showed a moderate decrease during the second week of increased load, which involved greater loads than the previous week (unexpected response).

No change (or an increase) in LnRMSSDm and a reduction in LnRMSSDcv is typically observed when training loads are reduced. Less training stress results in less fluctuations in LnRMSSD. However, these players demonstrated less fluctuation in LnRMSSD despite significant increments in training load.

The discrepancy here appears to be related to how players are tolerating and adapting to the training load. We often assume that increased loads will result in fatigue accumulation and temporary negative responses. However, these elite players demonstrated no reductions in subjective indicators of recovery status during the weeks of increased load. Additionally, there was no significant decrement in running performance (maximum aerobic speed) mid-way through the intensified microcycles.

Thus, the preservation of autonomic activity (no change in LnRMSSDm) and less fluctuations (reduced LnRMSSDcv) seem to reflect a postive coping response to the training. In fact, individuals who demonstrated the lowest LnRMSSDcv during week 1 of increased load showed the most favorable changes in running performance (r = -0.74).

This is yet another study that demonstrates that reduced fluctuations in LnRMSSD (i.e., decrease in LnRMSSDcv) is associated with positive training responses in athletes.

The Practical Implications of the study were:

•When evaluated as a group, LnRMSSDcv may be a more sensitive training response marker than LnRMSSDm during training load variations among elite players.

•LnRMSSDcv did not display a linear dose–response relationship with training load. Rather, LnRMSSDcv seems to reflect an adaptive physiological response to the imposed training stimulus which may be useful for identifying individuals responding undesirably to training.

•Elite rugby players presenting large day-to-day fluctuations in LnRMSSD in response to training load variation should be monitored closely for performance decrements, particularly when nearing important competitions.

 

 

 

 

HRV-guided vs. pre-planned training at altitude in an elite wheelchair marathoner

This new paper is in collaboration with Santi Sanz-Quinto and colleagues from his dissertation work. The case study compares HRV-guided vs. pre-planned training at altitude in an elite wheelchair marathoner with CMT.

Influence of Training Models at 3,900-m Altitude on the Physiological Response and Performance of a Professional Wheelchair Athlete: A Case Study.

Abstract

This case study compared the effects of two training camps using flexible planning (FP) vs. inflexible planning (IP) at 3,860-m altitude on physiological and performance responses of an elite marathon wheelchair athlete with Charcot-Marie-Tooth disease (CMT). During IP, the athlete completed preplanned training sessions. During FP, training was adjusted based on vagally mediated heart rate variability (HRV) with specific sessions being performed when a reference HRV value was attained. The camp phases were baseline in normoxia (BN), baseline in hypoxia (BH), specific training weeks 1-4 (W1, W2, W3, W4), and Post-camp (Post). Outcome measures included the root mean square of successive R-R interval differences (rMSSD), resting heart rate (HRrest), oxygen saturation (SO2), diastolic blood pressure and systolic blood pressure, power output and a 3,000-m test. A greater impairment of normalized rMSSD (BN) was shown in IP during BH (57.30 ± 2.38% vs. 72.94 ± 11.59%, p = 0.004), W2 (63.99 ± 10.32% vs. 81.65 ± 8.87%, p = 0.005), and W4 (46.11 ± 8.61% vs. 59.35 ± 6.81%, p = 0.008). At Post, only in FP was rMSSD restored (104.47 ± 35.80%). Relative changes were shown in power output (+3 W in IP vs. +6 W in FP) and 3,000-m test (-7s in IP vs. -16s in FP). This case study demonstrated that FP resulted in less suppression and faster restoration of rMSSD and more positive changes in performance than IP in an elite wheelchair marathoner with CMT

Podcast Interview: HRV in football and rugby

I recently had the pleasure of discussing HRV in football and rugby on the Rugby Renegade Podcast. Soundcloud and iTunes links below.

 

iTunes link: https://itunes.apple.com/zw/podcast/rugby-renegade-podcast/id1102026866?mt=2

 

Revisiting 60-s HRV recordings vs. Criterion in athletes

I’ve recently had the pleasure of peer-reviewing a few very well-written and carried out studies investigating duration requirements for stabilization preceding HRV recordings by different research groups. I look forward to seeing the published versions as the quality of the papers was very high.

In reviewing these papers it prompted me to reconsider what we all have been using as the criterion period. My colleagues and I have published 5 papers using a 5-min R-R sample preceded by a 5-min ‘stabilization’ period (10 min total duration) as the criterion (as has other groups), which is in line with traditional procedures. But I think we failed to address an important limitation of these procedures…

The issue is that the ‘traditional procedures’ were not devised for the purposes of establishing LnRMSSD specifically (rather, they needed to accommodate spectral analysis), nor were they devised for reflecting fatigue and adaptation to training programs. Therefore, for these specific purposes, it can be argued that the traditional procedures may not be as relevant, or at the very least, calls into question whether the 5-10 min period following the 0-5 min stabilization is in fact a criterion within this context.

Some things to consider:

  • 10 min is a long time to lay or sit still, especially for athletes who struggle to go 30-sec without checking their iPhone (I don’t think anyone disputes this). Are they more relaxed and stable in this situation or are they growing impatient and restless?
  • Are ANS responses and adaptation to training best measured in a completely relaxed state, or perhaps in response to a mild stimulus such as orthostasis (sitting or standing) (previous thoughts on this here)?
  • Should we be as skeptical with the ‘criterion’ recordings as much as as we are with 60-s recordings? How do we know if one is better than the other in the context of monitoring athletes? There’s now numerous studies by different groups showing the usefulness of 60-s measures for reflecting training responses, associating with fitness, etc.
  • Perhaps the question shouldn’t be regarding the optimal duration of the recording but rather, what is the shortest, most convenient procedure possible that still provides meaningful training status information? I don’t think an athlete or coach cares if their 60 sec HRV isn’t the same as the criterion if it’s still providing useful information.
  • I’m doubtful we would have completed any longitudinal training studies where HRV recordings were >60 sec on a near-daily basis. In my experience, >60 sec measures are not feasible with teams. Therefore, it’s ~60 s or we don’t bother.
  • Should future research instead try to determine what are the best ways to perform a ~60 sec HRV measure to limit noise from confounding factors? How can we improve the validity and reliability of 60-sec measures? How long from food/fluid ingestion should we wait? Can we obtain this with PPG rather than HR straps? What is the best position to measure in? etc.

To be clear, I still think that research evaluating stabilization requirements and comparing to the ‘criterion’ is absolutely meaningful and an important starting point. This was not intended to be critical, but rather to open discussion on future research directions.

 

 

The effect of training status on HRV in D-1 collegiate swimmers

When implementing HRV monitoring with a new team, the coach will be quick to point out the inter-individual variability in the athletes’ trends. Some athletes are showing high scores and some are low. Some are showing considerable daily fluctuation while others show very consistent numbers. Or, some show substantial fluctuation during this period but minimal fluctuation during that period. This can be confusing and difficult to interpret, but with some context, the trends (and changes therein) can usually be explained.

Greater fitness levels are associated with higher resting HRV and faster parasympathetic reactivation following exercise. This likely contributes to the smaller coefficient of variation  (CV) we (and others) have observed in athletes with higher VO2max and intermittent running performance. So if we were to categorize athletes of the same sport based on competitive level (i.e., training status), we should see group differences between their average lnRMSSD and CV. What makes our approach different from previous work is the longer observation period (1 month), the use of a finger sensor (PPG) and smartphone application using ultra-short HRV recordings for daily data acquisition and inclusion of the CV in the analysis. This was presented at the NSCA National Conference in New Orleans this July. Full manuscript in production soon.

THE EFFECT OF TRAINING STATUS ON HEART RATE VARIABILITY IN DIVISION-1 COLLEGIATE SWIMMERS

Andrew A. Flatt, Bjoern Hornikel, Michael R. Esco

University of Alabama, Tuscaloosa, AL

Resting heart rate variability (HRV) fluctuates on a daily basis in response to physical and psychological stressors and may provide useful information pertaining to fatigue and adaptation. However, there is limited research comparing HRV profiles between athletes of the same sport who differ by training status. PURPOSE: The purpose of this study was to compare resting heart rate (RHR) parameters between national and conference level Division-1 Collegiate swimmers and to determine if any differences were related to psychometric indices. METHODS: Twenty-four subjects were categorized as national (NAT, n = 12, 4 female) or conference level competitors (CONF, n=12, 5 female). Over 4 weeks, daily HRV was measured in the seated position by the subjects after waking and elimination with a validated smartphone application and pulse-wave finger sensor (app)  utilizing a 55-second recording period. Subjects then completed a questionnaire on the app where they rated perceived levels of sleep quality, muscle soreness, mood, stress and fatigue on a 9-point scale. The HR parameters evaluated by the app include RHR and the log-transformed root-mean square of successive RR interval differences multiplied by 20 (lnRMSSD). The 4-week mean for RHR (RHRm) and lnRMSSD (lnRMSSDm) in addition to the coefficient of variation (CV) for RHR (RHRcv) and lnRMSSD (lnRMSSDcv) were determined for comparison. In addition, psychometric parameters were also averaged between groups and compared. Independent t-tests and effect sizes ± 90% confidence limits (ES± 90% CL) were used to compare the HR and psychometric parameters. RESULTS: NAT was moderately taller (184.9 ± 10.0 vs. 175.5 ± 12.5 cm; p = 0.06, ES ± 90% CL = 0.83 ± 0.70) and heavier (80.4 ± 9.7 vs. 75.2 ± 11.9 kg; p = 0.26, ES ± 90% CL = 0.48 ± 0.67) than CONF, though not statistically significant. The results comparing HR and psychometrics are displayed in Table 1. lnRMSSDm and lnRMSSDcv was moderately higher and lower, respectively, in NAT compared to CONF (p<0.05). CONCLUSION: Higher training status is associated with moderately higher lnRMSSDm and lower lnRMSSDcv compared to those of lower training status. This was observed despite no significant difference in perceived stressors that may affect HR parameters. PRACTICAL APPLICATION: Training status appears to be a determinant of daily HRV and its fluctuation. This may be because higher level athletes are more fit and recover faster from training, resulting in a more stable HRV pattern. This information can be useful to practitioners when interpreting HRV trends in athletes. For example, an increase in HRV with reduced daily fluctuation may indicate improvements in an athletes training status. Alternatively, an athlete with high training status demonstrating reduced HRV and greater daily fluctuation may be showing signs of fatigue or loss of fitness depending on the context of the current training phase and program.

table swim HRV comarison

This figure shows a year of data from two athletes (Olympic level on top vs. Conference level on bottom) to provide a nice visual representation of their trend differences. HRV trend swim comparison

New Study: Agreement between a smart-phone pulse sensor application and ECG for determining lnRMSSD

Here’s a brief overview of our latest study, in press with JSCR.  We compared the ithlete finger sensor with ECG in supine, seated and standing positions. We are continuing our testing with other popular smartphone HRV apps in the near future. Thanks to the Summer 2015 Alabama S&C interns for making up a large portion of the participants in this study.

Agreement between a smart-phone pulse sensor application and ECG for determining lnRMSSD

ABSTRACT

The purpose of this study was to determine the agreement between a smartphone pulse finger sensor (SPFS) and electrocardiography (ECG) for determining ultra-short-term heart rate variability (HRV) in three different positions. Thirty college-aged men (n = 15) and women (n = 15) volunteered to participate in this study. Sixty second heart rate measures were simultaneously taken with the SPFS and ECG in supine, seated and standing positions. lnRMSSD was calculated from the SPFS and ECG. The lnRMSSD values were 81.5 ± 11.7 via ECG and 81.6 ± 11.3 via SPFS (p = 0.63, Cohen’s d = 0.01) in the supine position, 76.5 ± 8.2 via ECG and 77.5 ± 8.2 via SPFS (p = 0.007, Cohen’s d = 0.11) in the seated position, and 66.5 ± 9.2 via ECG and 67.8 ± 9.1 via SPFS (p < 0.001, Cohen’s d = 0.15) in the standing positions. The SPFS showed a possibly strong correlation to the ECG in all three positions (r values from 0.98 to 0.99). In addition, the limits of agreement (CE ± 1.98 SD) were -0.13 ± 2.83 for the supine values, -0.94± 3.47 for the seated values, and -1.37 ± 3.56 for the standing values. The results of the study suggest good agreement between the SPFS and ECG for measuring lnRMSSD in supine, seated, and standing positions. Though significant differences were noted between the two methods in the seated and standing positions, the effect sizes were trivial.

Full Text on Research Gate

FS EKG data

New Study: Intra- and inter-day reliability of ultra-short-term HRV in elite rugby union players

Here’s a look at our latest study in collaboration with Fabio Nakamura and colleagues, now in press with JSCR (Abstract below). In this study, HRV was recorded as a team at the training facility, not immediately after waking. This is the approach that many coaches are interested in using given the issue with compliance when trying to get athletes to perform HRV measures on their own at home after waking. Controlled and supervised measures at the facility appear promising, at least in these high level athletes.

It’s important to understand that autonomic activity is constantly making adjustments to physical, chemical and perceived psychological stimuli. Thus, HRV is inherently not the most reliable metric. However, training status/fitness appear to have a strong affect on day to day variation in HRV. More fit athletes recover faster/tolerate training better and thus tend to show less deviation from baseline compared to less fit athletes, of which will experience much greater homeostatic disruption from training and greater day to day variation. I strongly believe that the amount of daily fluctuation (i.e., lnRMSSDcv) is a very useful indication of fitness, stress and training adaptation.

We currently have a paper in production looking at the effect of training status on HRV. In the mean time, compare the trends below of an Olympic level and a conference level athlete, both short-distance swimmers (similar age and physical characteristics) across 4 consecutive weeks of training.

lnrmssd compareIntra- and inter-day reliability of ultra-short-term heart rate variability in rugby union players.

The aim of this study was to examine the intra-day and inter-day reliability of ultra-short-term vagal-related heart rate variability (HRV) in elite rugby union players. Forty players from the Brazilian National Rugby Team volunteered to participate in this study. The natural log of the root mean square of successive RR interval differences (lnRMSSD) assessments were performed on four different days. HRV was assessed twice (intra-day reliability) on the first day and once per day on the following three days (inter-day reliability). The RR interval recordings were obtained from 2-min recordings using a portable heart rate monitor. The relative reliability of intra- and inter-day lnRMSSD measures were analyzed using the intraclass correlation coefficient (ICC). The typical error of measurement (absolute reliability) of intra- and inter-day lnRMSSD assessments were analyzed using the coefficient of variation (CV). Both intra-day (ICC = 0.96; CV = 3.99%) and inter-day (ICC = 0.90; CV = 7.65%) measures were highly reliable. The ultra-short-term lnRMSSD is a consistent measure for evaluating elite rugby union players, in both intra- and inter-day settings. This study provides further validity to using this shortened method in practical field conditions with highly trained team sports athletes.

Full text on Research Gate