[Options and limitations of heart rate measurement and analysis of heart rate variability by mobile devices: A systematic review]

Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science

This updated guideline replaces the "Guideline for the application of heart rate and heart rate variability in occupational medicine and occupational health science" first published in 2014. Based on the older version of the guideline, the authors have reviewed and evaluated the findings on the use of heart rate (HR) and heart rate variability (HRV) that have been published in the meantime and incorporated them into a new version of this guideline.This guideline was developed for application in clinical practice and research purposes in the fields of occupational medicine and occupational science to complement evaluation procedures with respect to exposure and risk assessment at the workplace by the use of objective physiological workload indicators. In addition, HRV is also suitable for assessing the state of health and for monitoring the progress of illnesses and preventive medical measures. It gives an overview of factors influencing the regulation of the HR and HRV at rest and during work. It further illustrates methods for measuring and analyzing these parameters under standardized laboratory and real workload conditions, areas of application as well as the quality control procedures to be followed during the recording and evaluation of HR and HRV.

Wearable Sensors as a Preoperative Assessment Tool: A Review

Surgery is a common first-line treatment for many types of disease, including cancer. Mortality rates after general elective surgery have seen significant decreases whilst postoperative complications remain a frequent occurrence. Preoperative assessment tools are used to support patient risk stratification but do not always provide a precise and accessible assessment. Wearable sensors (WS) provide an accessible alternative that offers continuous monitoring in a non-clinical setting. They have shown consistent uptake across the perioperative period but there has been no review of WS as a preoperative assessment tool. This paper reviews the developments in WS research that have application to the preoperative period. Accelerometers were consistently employed as sensors in research and were frequently combined with photoplethysmography or electrocardiography sensors. Pre-processing methods were discussed and missing data was a common theme; this was dealt with in several ways, commonly by employing an extraction threshold or using imputation techniques. Research rarely processed raw data; commercial devices that employ internal proprietary algorithms with pre-calculated heart rate and step count were most commonly employed limiting further feature extraction. A range of machine learning models were used to predict outcomes including support vector machines, random forests and regression models. No individual model clearly outperformed others. Deep learning proved successful for predicting exercise testing outcomes but only within large sample-size studies. This review outlines the challenges of WS and provides recommendations for future research to develop WS as a viable preoperative assessment tool.

Assessing mental workload with wearable devices - Reliability and applicability of heart rate and motion measurements

Wearable devices are increasingly used for assessing physiological data. Industry 4.0 aims to achieve the real-time assessment of the workers' condition to adapt processes including the current mental workload. Mental workload can be assessed via physiological data. This paper researches the potential of wearable devices for mental workload assessment by utilizing heart rate and motion data collected with a smartwatch. A laboratory study was conducted with four levels of mental workload, ranging from none to high and during sitting and stepping activities. When sitting, a difference in the heart rate and motion data from the smartwatch was only found between no mental workload and any mental workload task. For the stepping condition, differences were found for the movement data. Based on these results, wearable devices could be useful in the future for detecting whether a mental demanding task is currently performed during low levels of physical activity.

Heart rate variability as a measure of mental stress in surgery: a systematic review

Purpose

There is increasing interest in the use of heart rate variability (HRV) as an objective measurement of mental stress in the surgical setting. To identify areas of improvement, the aim of our study was to review current use of HRV measurements in the surgical setting, evaluate the different methods used for the analysis of HRV, and to assess whether HRV is being measured correctly.

Methods

A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). 17 studies regarding HRV as a measurement of mental stress in the surgical setting were included and analysed.

Results

24% of the studies performed long-term measurements (24 h and longer) to assess the long-term effects of and recovery from mental stress. In 24% of the studies, artefact correction took place.

Conclusions

HRV showed to be a good objective assessment method of stress induced in the workplace environment: it was able to pinpoint stressors during operations, determine which operating techniques induced most stress for surgeons, and indicate differences in stress levels between performing and assisting surgery. For future research, this review recommends using singular guidelines to standardize research, and performing artefact correction. This will improve further evaluation of the long-term effects of mental stress and its recovery.

Electronic supplementary material

The online version of this article (10.1007/s00420-020-01525-6) contains supplementary material, which is available to authorized users.

The Accuracy of Acquiring Heart Rate Variability from Portable Devices: A Systematic Review and Meta-Analysis

BACKGROUND

Advancements in wearable technology have provided practitioners and researchers with the ability to conveniently measure various health and/or fitness indices. Specifically, portable devices have been devised for convenient recordings of heart rate variability (HRV). Yet, their accuracies remain questionable.

OBJECTIVE

The aim was to quantify the accuracy of portable devices compared to electrocardiography (ECG) for measuring a multitude of HRV metrics and to identify potential moderators of this effect.

METHODS

This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles published before July 29, 2017 were located via four electronic databases using a combination of the terms related to HRV and validity. Separate effect sizes (ESs), defined as the absolute standardized difference between the HRV value recorded using the portable device compared to ECG, were generated for each HRV metric (ten metrics analyzed in total). A multivariate, multi-level model, incorporating random-effects assumptions, was utilized to quantify the mean ES and 95% confidence interval (CI) and explore potential moderators.

RESULTS

Twenty-three studies yielded 301 effects and revealed that HRV measurements acquired from portable devices differed from those obtained from ECG (ES = 0.23, 95% CI 0.05-0.42), although this effect was small and highly heterogeneous (I² = 78.6%, 95% CI 76.2-80.7). Moderator analysis revealed that HRV metric (p <0.001), position (p = 0.033), and biological sex (β = 0.45, 95% CI 0.30-0.61; p <0.001), but not portable device, modulated the degree of absolute error. Within metric, absolute error was significantly higher when expressed as standard deviation of all normal-normal (R-R) intervals (SDNN) (ES = 0.44) compared to any other metric, but was no longer significantly different after a sensitivity analysis removed outliers. Likewise, the error associated with the tilt/recovery position was significantly higher than any other position and remained significantly different without outliers in the model.

CONCLUSIONS

Our results suggest that HRV measurements acquired using portable devices demonstrate a small amount of absolute error when compared to ECG. However, this small error is acceptable when considering the improved practicality and compliance of HRV measurements acquired through portable devices in the field setting. Practitioners and researchers should consider the cost-benefit along with the simplicity of the measurement when attempting to increase compliance in acquiring HRV measurements.

A Comparative Study of the Validity and Reliability of Two Wireless Telemetry Electrocardiogram Devices in the Emergency Medicine Department

Background

This study aimed to compare the clinical validity and reliability of two wireless telemetry electrocardiogram (ECG) devices in the Emergency Medicine Department.

Material/Methods

Patients who attended the Emergency Medicine Department underwent wireless telemetry ECG testing (N=245) using the Infron Micro Cor and the Nihon Kohden Cardiofax M 1350 K devices. ECG recordings included heart rate, P-wave amplitude, PR segment length, QRS duration, QT and QTc intervals, ST depression and elevation, the number of ECG artifacts, the ECG diagnosis, and duration. Statistical analysis of reliability included the use of Cohen’s kappa (κ) values.

Results

One hundred women (40.8%) and 145 men (59.2%) were included in the study. The duration for the Infron Micro Cor ECG readings (57.5±0.93 seconds) was significantly shorter compared with the Nihon Kohden Cardiofax M ECG readings (65.2±9.72 seconds) (p=0.0001). The Infron Micro Cor ECG readings contained significantly more lead artifacts (93 or 37.9%) compared with the Nihon Kohden ECG readings (71 or 28.9%) (p=0.01). There was no difference between the two devices in terms of the other ECG parameters. The compatibility of ST-segment elevation detection was found to be almost in complete agreement between the Infron Micro Cor and Nihon Kohden Cardiofax M ECG devices, as determined by the κ-values for ST elevation and ST depression.

Conclusions

Two wireless telemetry ECG devices were found to be reliable for use in the Emergency Medicine Department. The Infron Micro Cor wireless telemetry ECG device provided more rapid results.

[Heart Rate Variability - State of Research and Clinical Applicability]

Heart Rate Variability - State of Research and Clinical Applicability Abstract. Heart rate variability is considered a marker of autonomous nervous system activity. Autonomic imbalance is found as a common component in a wide range of pathologies. It has been found to precede the onset of pathologic states and correlates with therapy response. In addition, heart rate variability at rest is a psychophysiological phenomenon with broad significance. Psychological experience affects physiological homeostasis, including immune processes, via the autonomous nerve system, which biologically underpins psychosomatic effects and makes them measurable by heart rate variability. The autonomous nerve system as the interface of this psychophysiological regulation is becoming increasingly important in heart rate variability research and allows a better understanding of the interactions between psyche, lifestyle, autonomous regulation and chronic illness. It requires a systemic, cross-organ view as well as an orientation towards long-term processes. The assessment and normalization of autonomic imbalance thus represents a novel therapeutic strategy from which numerous interventions and lifestyle modifications can be derived. Interventions that strengthen the vagal tone (aerobic or moderate physical training, relaxation techniques, vagus nerve stimulation, etc.) are becoming increasingly important. Despite the simple non-invasive measurement and popularity as a research instrument, interpretation is complex, and clinical implementation has been reluctant so far. Nevertheless, guidelines and data sets of reference values exist for users to apply.

Ergonomic study of donkeys administered with Pycnogenol® and subjected to packing during the hot-dry season in Northern Nigeria

The aim of the study was to determine some ergonomic parameters of donkeys administered with Pycnogenol® (PYC) and subjected to packing during the hot-dry season in northern Nigeria. Fifteen donkeys served as experimental subjects. Group 1 (n = 5) donkeys were subjected to trekking only (control), group 2 (n = 5) donkeys were subjected to packing (P-PYC), and group 3 (n = 5) were administered with PYC (10 mg/kg) and subjected to packing (P+PYC). Each group covered a distance of 10 km. Some ergonomic parameters were evaluated. The duration of work in control, P-PYC, and P+PYC donkeys were 170.0 ± 10 min (2.8 h), 126.6 ± 6.7 min (2.1 h), and 112.0 ± 3.9 min (1.9 h), respectively. The energy expenditure obtained for P-PYC group (88.3 ± 9.8 KJ/s) was significantly higher than the values of 28.3 ± 3.7 KJ/s and 73.5 ± 9.9 KJ/s obtained in control and P+PYC groups, respectively. The output was significantly higher in P+PYC group with the value of 5263.2 ± 135 m/h. In conclusion, packing the donkeys during the hot-dry season was stressful; however, PYC may have served as a potent antifatigue agent to reduce the stress.

Recording Heart Rate Variability of Dairy Cows to the Cloud-Why Smartphones Provide Smart Solutions

In the last decades, there has been an increasing interest in animal protection and welfare issues. Heart rate variability (HRV) measurement with portable heart rate monitors on cows has established itself as a suitable method for assessing physiological states. However, more forward-looking technologies, already successfully applied to evaluate HRV data, are pushing the market. This study examines the validity and usability of collecting HRV data by exchanging the Polar watch V800 as a receiving unit of the data compared to a custom smartphone application on cows. Therefore, both receivers tap one signal sent by the Polar H7 transmitter simultaneously. Furthermore, there is a lack of suitable methods for the preparation and calculation of HRV parameters, especially for livestock. A method is presented for calculating more robust time domain HRV parameters via median formation. The comparisons of the respective simultaneous recordings were conducted after artifact correction for time domain HRV parameters. High correlations (r = 0.82⁻0.98) for cows as well as for control data set in human being (r = 0.98⁻0.99) were found. The utilization of smart devices and the robust method to determine time domain HRV parameters may be suitable to generate valid HRV data on cows in field-based settings.

Hidden Signals-The History and Methods of Heart Rate Variability

The understanding of heart rate variability (HRV) has increased parallel with the development of modern physiology. Discovered probably first in 1847 by Ludwig, clinical applications evolved in the second part of the twentieth century. Today HRV is mostly used in cardiology and research settings. In general, HRV can be measured over shorter (e.g., 5-10 min) or longer (12 or 24 h) periods. Since 1996, most measurements and calculations are made according to the standard of the Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. As the first step, the series of times between successive R-peaks in the ECG are in milliseconds. It is crucial, however, to identify and remove extrasystoles and artifacts according to standard protocols. The series of QRS distances between successive heartbeats can be analyzed with simple or more sophisticated algorithms, beginning with standard deviation (SDNN) or by the square root of the mean of the sum of squares of differences between adjacent normal RR (rMSSD). Short-term HRV is frequently analyzed with the help of a non-parametric fast Fourier transformation quantifying the different frequency bands during the measurement period. In the last decades, various non-linear algorithms have been presented, such as different entropy and fractal measures or wavelet analysis. Although most of them have a strong theoretical foundation, their clinical relevance is still debated.