By Dr. Frank Lipman
Over the past few decades, how we practice medicine and how our patients approach their health has changed dramatically, for the better. Maintaining wellness is no longer shrouded in mystery. At last, lifestyle adjustments and upgrades have become, for many, the first line of defense versus “there’s-a-pill-for-that”—conventional medicine’s default setting.
As integrative medicine has evolved, patients have seen firsthand how behavioral upgrades like eating a healthy diet, weaving more movement into the day, and practicing gratitude, mindfulness and stress reduction can have a significant impact on how they look and feel now, and reduce the risk of serious disease risk later on.
Technology can play an important role as well. Wearable trackers (married to apps) can help move the self-care process along. One often overlooked but extremely helpful health marker I encourage everyone to track is their heart rate variability (HRV). Learning more about your HRV can give you a better picture of your cardiovascular fitness and your overall resilience, as well as helping to steer you toward more health-supportive daily behaviors and lifestyle tweaks. Think of HRV as a sort of on-demand monitoring and feedback system for doing the stuff that keeps you well. Here’s a top line on this fascinating yet still slightly under-the-radar tool to help guide yourself to optimal health:
HRV is about timing.
Though you may not be familiar with the term, heart rate variability is just a measurement of the elapsed time between heartbeats. If your heart rate clocks in at about 60 beats a minute, it’s not necessarily beating every second. It may be beating 0.5 seconds between two beats and 1.30 seconds between two others—in other words, it’s variable, and that’s actually a good thing, an indicator of better cardiovascular fitness and resilience. In general, in the presence of stressors, there’s less time between beats. When you’re relaxed or sleeping, the time (counted in milliseconds) between beats is longer. The between-beat timing is controlled by your autonomic nervous system, or ANS, as are other functions like heart rate, digestion, blood pressure, respiration and even sexual arousal.
HRV takes orders from your relaxation and your fight-or-flight response.
Driving the ANS are two yin and yang-like components, namely the sympathetic nervous system or SNS, and the parasympathetic nervous system or PSNS. Among the jobs the SNS handles is the fight-or-flight response, while the PSNS handles, among other things, the relaxation response.
So, when SNS activity increases, aka stress is on the rise, your HRV—the time between beats—decreases. When PSNS activity increases—and relaxation is on the rise—HRV increases. When there is more variation between heartbeats, it indicates that the ANS is managing both the SNS and the PSNS without major disruptions and responding to the stimuli of the day with balance and resilience. If you’re doing a good job of managing your diet, sleeping well, exercising, maintaining healthy relationships and staying social, then HRV stays well-tuned to your internal and external environment.
Poor health habits will screw up your HRV.
However, if you’re dealing with classic troublemakers like unremitting stress, chronically poor diet, poor sleep, little movement and/or poor interpersonal relations, the fight-or-flight response can jam the system, keeping the time between beats short. Ever have a super-stressful week, and feel too jacked up to unwind, like you can’t quite come down to normal? That’s a good clue that your HRV needs some monitoring and ultimately, tending to.
Monitoring HRV now may save you from health trouble later.
OK, so you may be asking yourself, what’s HRV got to do with my life? Well, one especially practical application is for health care practitioners. For us, your HRV data provides an easy, noninvasive window into your autonomic nervous system, like helpful intel on how well you respond to stress (or not) and how well your body recovers from it. Low HRV indicates that you’re chronically over-revving, that you likely need to activate your parasympathetic nervous system—the rest-and-digest mode—considerably more than you currently are. Think of your HRV as a sort of canary in the coal mine, which can help alert you if you’re headed toward a less-than-healthy future.
Collect HRV data—and stay honest.
So how to DIY it when it comes to monitoring your HRV? Wearable fitness trackers are a great and convenient way to start collecting your HRV data, in addition to monitoring numerous other key functions. You can see in real time how your body is responding to your lifestyle and behavioral choices, where you’re crushing it, and where you might need a behavioral tweak (or even a major intervention).
To help patients start making sense of the data their bodies generate every day, in my practice we often recommend the Apple Watch or the elegant, health-tech-as-jewelry piece the Oura Ring, a wearable fitness tracker worn unobtrusively on the index finger. Both track HRV in addition to numerous other body readouts and behaviors. Like a mobile version of the old-school EKG—which you might have gotten once a year (if that) at your doc’s office—trackers can give you a pretty comprehensive picture of your day-to-day cardiovascular health. The numbers will help keep you honest, rewarding your efforts when you’re doing well and reminding you to get back on the healthy path should you falter.
Put the power of HRV to work.
Although you can expect some minor variations with accuracy (trackers aren’t infallible yet), another important way to put your HRV data to use is to see patterns. By that I mean: What happens to your HRV with different health adjustments and interventions? What’s the real-time impact of eating less sugar, eating lightly at night, drinking more water throughout the day, meditating more, moving more and different types of exercise? When patients get real-time feedback on how different behaviors affect their nervous system and their HRV, it’s an incredible eye-opener.
Keep in mind however, that unlike some other functions you may be tracking, HRV can vary wildly over the course of the day, so don’t freak out over a very high number or a super-low one. Make sure your tracker bases its HRV data/algorithms on multiple, dynamic readings over the course of several days or even weeks.
Upgrade your HRV game.
To my mind, any tool that helps inspire change and keeps you motivated to stay on the path is worth incorporating into your life. That’s not to say one should live or die by the numbers, but to use them as a guide, to increase your awareness of your body, how it works and how it responds. Being able to track and recognize the behaviors or stimuli that trigger rising stress levels and decrease your HRV gives you the ability to turn the tide before it washes you away. Granted, you won’t stop life’s stresses from happening, but you’ll be less victimized by them, and gain a lot more control over your health and your life.
To up your HRV game, incorporate the essentials to help you move the dial in the right direction, namely: eating well, sleeping well, stress management, meditation/mindfulness and movement, rest and recovery. Ditch sugar and alcohol, try to incorporate saunas and/or cryotherapy into your life, and, in acutely stressful situations, add deep, relaxing breaths to calm and help reset your nervous system. If you are looking for an app to support you, two worth exploring are the HRV4Biofeedback app and the Inner Balance Trainer by HeartMath.