Exploring a 1-Minute Paced Deep-Breathing Measurement of Heart Rate Variability as Part of a Workers' Health Assessment

Heart Rate Variability Biofeedback in Adults with a Spinal Cord Injury: A Laboratory Framework and Case Series

Heart rate variability biofeedback (HRV-F) is a neurocardiac self-regulation therapy that aims to regulate cardiac autonomic nervous system activity and improve cardiac balance. Despite benefits in various clinical populations, no study has reported the effects of HRV-F in adults with a spinal cord injury (SCI). This article provides an overview of a neuropsychophysiological laboratory framework and reports the impact of an HRV-F training program on two adults with chronic SCI (T1 AIS A and T3 AIS C) with different degrees of remaining cardiac autonomic function. The HRV-F intervention involved 10 weeks of face-to-face and telehealth sessions with daily HRV-F home practice. Physiological (HRV, blood pressure variability (BPV), baroreflex sensitivity (BRS)), and self-reported assessments (Fatigue Severity Scale, Generalised Anxiety Disorder Scale, Patient Health Questionnaire, Appraisal of Disability and Participation Scale, EuroQol Visual Analogue Scale) were conducted at baseline and 10 weeks. Participants also completed weekly diaries capturing mood, anxiety, pain, sleep quality, fatigue, and adverse events. Results showed some improvement in HRV, BPV, and BRS. Additionally, participants self-reported some improvements in mood, fatigue, pain, quality of life, and self-perception. A 10-week HRV-F intervention was feasible in two participants with chronic SCI, warranting further investigation into its autonomic and psychosocial effects.

Can heart rate variability be a bio-index of hope? A pilot study

Background

Hope can affect the thinking habits, emotional regulations, and behaviors of individuals. Hope is considered as a positive trait by clinicians, who often assess the level of hope in psychological evaluations. Previous measurements of hope were largely based on self-reported questionnaires leading to the problem of subjectivity. Heart Rate Variability (HRV) is a bio index that is an objective, quick, cost effective, and non-invasive measurement. HRV has been used in the evaluation of physical health and some psychiatric conditions. However, it has not been tested for its potential to be a bio-index of the level of hope.

Method

This pilot cross-sectional observational study aimed to examine the relationships between HRV and the level of hope among adult Chinese people in Hong Kong. Convenience sampling was used and 97 healthy participants were recruited. Their level of hope was measured by the Dispositional Hope Scale-Chinese (DHS-C), and their HRV was quantified by emWave Pro Plus, a reliable sensor of HRV. Spearman's correlation coefficient analysis was performed on the HRV measurements and DHS-C.

Results

The DHS-C's overall mean score was 45.49. The mean scores of the subscale DHS-C (Agency) was 22.46, and the mean scores of DHS-C (Pathway) was 23.03. It was also revealed that there were significant, weak, and negative correlations between the level of hope and four out of ten HRV metrics. One HRV metric was found to have a significant, weak, and positive correlation with the level of hope.

Conclusion

This study provided initial evidence to support the use of HRV as a bio-index of hope. Implications of the current study and recommendations for future research directions are discussed.

Predictive value of Heart Rate Variability measurements and the Brief Resilience Scale for workability and vitality

BACKGROUND

Sustainable employability is increasingly important with current socio-economic challenges. Screening for resilience could contribute to early detection of either a risk, or a protector for sustainable employability, the latter being operationalized as workability and vitality.

OBJECTIVE

To study the predictive value of Heart Rate Variability (HRV) measurements and the Brief Resilience Scale (BRS) for worker self-reported workability and vitality after 2-4 years.

METHODS

Prospective observational cohort study with mean follow-up period of 38 months. 1,624 workers (18-65 years old) in moderate and large companies participated. Resilience was measured by HRV (one-minute paced deep breathing protocol) and the BRS at baseline. Workability Index (WAI), and the Vitality dimension of the Utrecht Work Engagement Scale-9 (UWES-9-vitality) were the outcome measures. Backward stepwise multiple regression analysis (p < 0.05) was performed to evaluate the predictive value of resilience for workability and vitality, adjusted for body mass index, age and gender.

RESULTS

N = 428 workers met inclusion criteria after follow-up. The contribution of resilience, measured with the BRS, was modest but statistically significant for the prediction of vitality (R2 = 7.3%) and workability (R2 = 9.2%). HRV did not contribute to prediction of workability or vitality. Age was the only significant covariate in the WAI model.

CONCLUSION

Self-reported resilience modestly predicted workability and vitality after 2-4 years. Self-reported resilience may provide early insight into the ability of workers to stay at work, although caution must be applied because explained variance was modest. HRV was not predictive.

Following the Rhythm of the Heart: HeartMath Institute's Path to HRV Biofeedback

This paper outlines the early history and contributions our laboratory, along with our close advisors and collaborators, has made to the field of heart rate variability and heart rate variability coherence biofeedback. In addition to the many health and wellness benefits of HRV feedback for facilitating skill acquisition of self-regulation techniques for stress reduction and performance enhancement, its applications for increasing social coherence and physiological synchronization among groups is also discussed. Future research directions and applications are also suggested.

Heart rate variability, perceived stress and willingness to seek counselling in undergraduate students

OBJECTIVE

The primary aim was to determine the level of stress in Czech pharmacy students using both subjective and physiological markers of stress throughout their study. The secondary aim was to investigate association of stress with sociodemographic and clinical characteristics, and to determine the predictors of the likelihood of enrolling in psychotherapy counselling.

METHODS

Design: A prospective observational study.

SETTING

Faculty of Pharmacy in Hradec Kralove, Czech Republic.

SUBJECTS

175 s-year pharmacy students in 2016, 149 students in 2017, and 51 students in 2018.

OUTCOME MEASURES

Perceived stress scale (PSS-10), heart rate variability (HRV, emWavePro), a self-administered survey (sociodemographic and clinical data, likelihood of enrolling in psychotherapy counselling).

RESULTS

The average PSS score was 18.3 ± 6.7. There were no significant changes in PSS-10 and HRV parameters between 2016 and 2018. There was a significant negative correlation between PSS-10 and LF power (p = 0.012). Female gender and poor health status were more frequently observed among the respondents with impaired HRV (p = 0.026 for female gender and p = 0.025 and p = 0.042 for poor health status). Fifty-nine percent of students would be likely to enroll in psychotherapy counselling, with men being significantly less inclined to participate compared to women (p = 0.01).

CONCLUSION

Czech pharmacy students experience moderate levels of stress throughout their studies, which correlates with physiological markers of stress as well as their overall health. Push and pull factors of using mind-body interventions to manage stress should be further examined, especially in high risk groups.

Influence of respiration frequency on heart rate variability parameters: A randomized cross-sectional study

BACKGROUND

Many patients visiting physiotherapists for musculoskeletal disorders face psychosocial challenges which may form a large barrier to recover. There are only a limited number of evidence based psychosocial therapies, but they are mainly based on breathing exercises.

OBJECTIVE

to study which respiration frequency would lead to the highest relaxation, reflected in vagal tone derived from the heart rate variability (HRV) in healthy subjects.

METHODS

A randomized controlled cross sectional study was performed. Respiration cycles of four, five, six, seven and eight breaths per minute (BPM) were delivered in randomized order for two minutes each. HRV metrics were measured during the sessions with electrocardiogram (ECG). Repeated Measures ANOVA's were performed to analyze differences between breathing frequencies.

RESULTS

100 healthy volunteers were included (40 male). Standard Deviation of inter beat intervals (SDNN) values were significantly highest at 5 BPM, whereas the Root Mean Square of Successive Differences (RMSSD) values appeared highest at 7 breaths per minute (p< 0.01). High Frequency (HF) power was lowest at 4 BPM, whereas Low Frequency (LF) power was not significantly influenced by respiration frequency.

CONCLUSIONS

Breathing at a frequency of 5 to 7 breaths per minute leads to highest HRV values, but there is no single respiration ratio that maximizes all metrics. Physiotherapists may use five to seven BPM as guidance to determine ideal breathing frequencies.

Race-Based Stress Reactions and Recovery: Pilot Testing a Racial Trauma Meditation

Twenty-six Black collegians were exposed to a vicarious racial harassment stimulus (VRHS) then randomized into a Black Lives Matter Meditation for Healing Racial Trauma condition or a silence control condition. Heart rate (HR) was recorded throughout the experiment. Semi-structured interviews were then conducted to elicit participants’ appraisal of the VRHS and meditation. Using a Qual:Quan mixed methods experimental design, this pilot study qualitatively categorized how participants (1) described their reactions to the VRHS and (2) appraised the meditation. Participants described three types of race-based stress reactions and reported mostly positive appraisal of the meditation, although some indicated that it would not be a preferred coping strategy. To triangulate the quantitative findings, we found a significant increase in HR during VRHS. The meditation group displayed statistically significant reductions in HR from stimulus to the end of meditation; however, there were no statistically significant differences between the control and meditation groups. Results have implications for understanding and facilitating race-based stress recovery.

Ethical Considerations of Using Machine Learning for Decision Support in Occupational Health: An Example Involving Periodic Workers' Health Assessments

Purpose Computer algorithms and Machine Learning (ML) will be integrated into clinical decision support within occupational health care. This will change the interaction between health care professionals and their clients, with unknown consequences. The aim of this study was to explore ethical considerations and potential consequences of using ML based decision support tools (DSTs) in the context of occupational health. Methods We conducted an ethical deliberation. This was supported by a narrative literature review of publications about ML and DSTs in occupational health and by an assessment of the potential impact of ML-DSTs according to frameworks from medical ethics and philosophy of technology. We introduce a hypothetical clinical scenario from a workers' health assessment to reflect on biomedical ethical principles: respect for autonomy, beneficence, non-maleficence and justice. Results Respect for autonomy is affected by uncertainty about what future consequences the worker is consenting to as a result of the fluctuating nature of ML-DSTs and validity evidence used to inform the worker. A beneficent advisory process is influenced because the three elements of evidence based practice are affected through use of a ML-DST. The principle of non-maleficence is challenged by the balance between group-level benefits and individual harm, the vulnerability of the worker in the occupational context, and the possibility of function creep. Justice might be empowered when the ML-DST is valid, but profiling and discrimination are potential risks. Conclusions Implications of ethical considerations have been described for the socially responsible design of ML-DSTs. Three recommendations were provided to minimize undesirable adverse effects of the development and implementation of ML-DSTs.

Investigating sources of inaccuracy in wearable optical heart rate sensors

As wearable technologies are being increasingly used for clinical research and healthcare, it is critical to understand their accuracy and determine how measurement errors may affect research conclusions and impact healthcare decision-making. Accuracy of wearable technologies has been a hotly debated topic in both the research and popular science literature. Currently, wearable technology companies are responsible for assessing and reporting the accuracy of their products, but little information about the evaluation method is made publicly available. Heart rate measurements from wearables are derived from photoplethysmography (PPG), an optical method for measuring changes in blood volume under the skin. Potential inaccuracies in PPG stem from three major areas, includes (1) diverse skin types, (2) motion artifacts, and (3) signal crossover. To date, no study has systematically explored the accuracy of wearables across the full range of skin tones. Here, we explored heart rate and PPG data from consumer- and research-grade wearables under multiple circumstances to test whether and to what extent these inaccuracies exist. We saw no statistically significant difference in accuracy across skin tones, but we saw significant differences between devices, and between activity types, notably, that absolute error during activity was, on average, 30% higher than during rest. Our conclusions indicate that different wearables are all reasonably accurate at resting and prolonged elevated heart rate, but that differences exist between devices in responding to changes in activity. This has implications for researchers, clinicians, and consumers in drawing study conclusions, combining study results, and making health-related decisions using these devices.