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Healthy Longevity: How to Enable It With HRV Measurements

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Heart rate variability allows to measure, and therefore foster healthy longevity

We all dream of a long life unencumbered by major illnesses. And for all of us who are willing to invest in that perspective, this saying holds true – “You can only manage what you can measure”. Heart rate variability (HRV) enables us to build a strategy and reach our longevity goals.

Researchers look at centenarians to identify what makes us live longer lives. What are the factors which enable healthy aging, and avoid major age-related diseases? To answer this question, a study was conducted by a team from various universities in Spain. The investigation focused on potential differences in resting HRV between centenarians, octogenarians, and young adults. 

Heart rate variability explained

The time interval between the heartbeats of a healthy heart is constantly fluctuating. This fluctuation reflects the regulation of the heart rate (HR) by the autonomic nervous system (ANS). Intervals over a given time period are referred to as heart rate variability (HRV); this index of autonomic function is applied as a non-invasive tool to measure health and wellbeing. Greater variability indicates that one’s body can greater ability of the autonomic nervous system to regulate itself, whereas low HRV can be a symptom of physical or mental illness.

Among further results, the study from Spain showed a clear decrease with age in the main parasympathetic HRV variables, as well as in the standard deviation of the normal-to-normal interval (SDNN) and in low frequency (LF) heart rate oscillations. Researchers concluded that “HRV indices reflecting parasympathetic outflow as well as SDNN and LF all present an age-related reduction, which could be representative of a natural exhaustion of allostatic systems related to age.” Moreover, SDNN values below 19 ms could be associated with early mortality in centenarians. HRV, researchers emphasize, appears to play a role in exceptional longevity, which could be accounted for by the exposome of centenarians – the measure of all the exposures of an individual in a lifetime and how those exposures relate to health. 

Another study, conducted by a team of the Geriatric Medicine Section of the University of Illinois at the Chicago College of Medicine in the U.S., looks more deeply into findings that aging is associated with a progressive decrease in HRV. Authors state that, whereas research suggests that longevity might depend on preservation of autonomic function, “little is known about late life changes”. The Chicago team assessed the relation between autonomic function and longevity by way of a cross-sectional study of HRV of 344 healthy subjects aged 10 to 99 years. Results showed that “healthy longevity depends on preservation of autonomic function, in particular, HRV-parasympathetic function, despite the early age-related decrease.” In particular, “the eighth (life) decade reversal of the decrease in HRV-parasympathetic function and its subsequent increase are key determinants of longevity. Persistently high HRV in the elderly represents a marker predictive of longevity.”

Let’s build our strategy for longevity

It appears HRV, and the body’s ability to repair itself, decline naturally with age. They generally reach a minimum in the 70s. “Living for longer and remaining healthy seems to depend on a good genetic makeup”, according to an article by Simon Wegerif; so that one’s HRV begins and continues above average levels for one’s age. On the other hand, longevity may depend on “lifestyle choices that boost HRV”. The author suggests that, most likely, a combination of both leads to a healthy long life. 

With the option of influencing our lifestyle in a way that fosters longevity, we may opt to start measuring our HRV as a predictor. Easy-to-use technology is readily available, including apps on smartphones. And guidance by healthcare professionals will support our path towards tapping our full individual life span potential. 

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How to Reduce Anxiety with Breathing Exercises and HRVB

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Anxiety, insomnia, post-traumatic stress disorder, depression, attention deficit disorder: there are so many symptoms that breathing exercises can help to alleviate. More and more studies are providing evidence for the benefits of a therapy that has been around for centuries. And heart rate variability, measured by smartphone, can be combined with breathing exercises, providing a convenient way to take back control of one’s mental state.

How prevalent is anxiety in our societies? As an example, the January 2021 “Stress Snapshot”, conducted by The Harris Poll on behalf of the American Psychological Association, showed an average reported stress level of 5.6 during the preceding month. On this scale, “10” means “great stress”. 84% of the adults reported feeling at least one emotion associated with prolonged stress in the preceding two weeks. Factors contributing to that significant level included the pandemic.

Studies reflect a rise of anxiety levels in adults and the youth

The pandemic, and measures taken to control the spread of the virus, are key contributors to the deterioration of mental health. Children and adolescents are also affected: recent meta research looks at 29 studies which focused on depressive and anxiety symptoms during COVID-19. Based on results from more than 81,000 young people globally, the analysis found estimates of clinically child and adolescent depression and anxiety elevated at 25.2% and 20.5%, respectively. Authors say the prevalence of depression and anxiety symptoms during COVID-19 have doubled in comparison with pre-pandemic estimates. Prevalence rates were higher when collected later in the pandemic, in older adolescents, and in girls.

Lockdowns may be necessary to protect community health, according to one of many studies from Europe. On the other hand, physical isolation may have long-lasting negative consequences, especially for mental health. The Portuguese authors call for strategies which foster mental health. 

Approaches to combat anxiety – during and beyond the pandemic 

In this situation of raised anxiety levels, breathwork can help calm one’s nervous system. This approach encompasses a group of exercises geared towards teaching individuals to manipulate the rate and depth of their breathing. The aim is to bring awareness to one’s breath, and ultimately provide the same benefits one might reap from meditation. Whereas this is rather new to people in the Western world, the Eastern world shows a history of practicing breathwork spanning thousands of years. Zandra Palma, MD, describes the following breathing exercises. 

  • Box Breathing involves focusing on a square shape, and breathing in for a count of four, holding one’s breath for a count of four, and exhaling for a slow count of four. 
  • Diaphragmatic Breathing: taking a breath from between one’s chest and abdomen. This can help individuals achieve deeper and more expansive breathing. 
  • 4-7-8 Breathing is another way to calm and ground oneself by counting inhales and exhales. 
  • Alternate Nostril Breathing involves breathing through one nostril at a time. A study demonstrates that this approach helps to reduce anxiety. One nostril at a time is covered with the thumb, directing inhale and exhale through the other nostril. 

The effects behind these methods

Different from deep breathing, which can lower blood pressure and cortisol levels and increase parasympathetic tone, formal breathwork practices exert some even more impressive positive effects on the body and work in a different and almost opposite way. This is Dr. Palm’s outline:

  • Alkalizing blood PH. Hyperventilation induces “respiratory alkalosis” which means we get rid of more CO2 – of acid in the blood – and shift to a higher, or more alkaline pH. 
  • Increasing muscle tone. With the blood becoming more alkaline, calcium ions bind to albumin. In this short-term low-calcium state, increased firing in sensory and motor neurons. The artificially low blood calcium now manifests in the neurological system as tingling sensations, smooth muscle contractions, and increased muscle tone. Exercising the diaphragm muscle supports one’s breathing also for sports such as long-distance running.
  • Anti-inflammatory effects are induced by neurons in the autonomic nervous system firing more during hyperventilation. This releases epinephrine (also called adrenaline), causing the innate immune system to increase its anti-inflammatory activity.
  • Blood pressure and circulation are improved, reducing the risk factor for hypertension. 
  • Elevating one’s mood and reducing stress. Increased blood pH decreases oxygen delivery to tissues; within one minute of hyperventilation, the vessels in the brain constrict, reducing blood flow and oxygen delivery to the brain by 40 percent. This is probably why breathwork practitioners experience feelings of wellbeing. 

Dr. Palm describes further benefits to breathwork. She mentions a study conducted by Yale University: students who participated in a yoga and breathwork program self-reported improvements in stress, depression, positive affect, mindfulness, and social connectedness. The study compared the breathwork program to an emotional intelligence program, for which students reported only mindfulness as a benefit, and a mindfulness-based stress reduction program, which didn’t show any changes. The breathwork program, Dr. Palm summarizes, is what seemed to have the most positive effect on participants’ overall mental health.

The benefits of HRVB

For anyone interested in using breathing exercises to reduce anxiety, there are numerous apps available. They include Calm, Liberate, and MyLife. Smartphone users can conveniently measure their heart rate variability (HRV): the time interval between the heartbeats of a healthy heart is constantly fluctuating. It indicates how well one’s body handles stress. Intervals over a given time period are referred to as HRV. A high HRV indicates that one’s body can cope well with stress, whereas a low HRV can be a symptom of, e.g., anxiety. 

As an important measure of health and wellbeing, HRV is significantly impacted by mood and mental health. Combined with breathing exercises, HRV biofeedback (HRVB) provides a simple and cost-effective way to take control of body functions – and of one’s mental state. 

Does HRV Biofeedback Work as Treatment for PTSD?

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In the United States, post-traumatic stress disorder (PTSD) affects approximately 3.5 percent of adults every year; an estimated one in 11 people will be diagnosed with PTSD in their lifetime. As a non-invasive treatment of various stress-related disorders, heart rate variability biofeedback (HRVB) has been gaining significant attention from researchers in recent years; will it prove to be efficient in trauma treatment settings?

It is a condition that develops in some people who have experienced a shocking, scary, or dangerous event: PTSD. During and after a traumatic situation, fear comes naturally. In order to help our bodies defend themselves against, or to avoid, danger, fear triggers a “fight-or-flight” response, explains the UK’s National Institute of Mental Health. Following a trauma, most individuals will experience a range of reactions; however, the majority of cases is characterized by natural recovery from symptoms. Individuals who continue to feel stressed or frightened, even when they are not in danger, may be diagnosed with PTSD.

Symptoms usually begin within about three months of the traumatic incident; in some cases, they only emerge after years. In order to be considered PTSD, symptoms must last more than a month and be severe enough to interfere with relationships or work. Whereas some people recover within six months, others experience longer-lasting symptoms. In some patients, the condition becomes chronic.

Diagnosing PTSD

To be diagnosed with PTSD, adults will, for a minimum of one month, need to have at least: one re-experiencing symptom; one avoidance symptom; two arousal and reactivity symptoms; as well as two cognition and mood symptoms. Anyone can develop PTSD at any age; children and teens can also have extreme reactions to trauma, but some of their symptoms may be different from adults. 

Researchers are looking into risk factors which include experiencing dangerous events, getting hurt, and mental illness or substance abuse. Support from friends and family and coping strategies are among the factors which may promote recovery. Thanks to research going on in genetics and neurobiology, it may be possible at some time in the future to predict who is likely to develop PTSD and how to prevent it. 

Treatments and Therapies

PTSD treatment aims at helping individuals regain a sense of control over their lives. While primary treatment is psychotherapy, it is often combined with medication. Combining these treatments can help improve your symptoms by teaching patients useful skills to address symptoms, induce positive thinking, communicating ways to cope if symptoms return, and treating other problems often related, in particular depression, anxiety, or misuse of alcohol or drugs. 

Psychotherapeutic approaches include cognitive therapy. This talk therapy helps individuals recognize the ways of thinking that are keeping you stuck, e.g. negative beliefs about themselves and the risk of traumatic things recurring. 

Exposure therapy helps patients safely face situations as well as memories they find frightening so that individuals can learn to cope with them effectively. This behavioral therapy has been particularly helpful in cases of flashbacks and nightmares. 

Eye movement desensitization and reprocessing (EMDR) is a further treatment option. It combines exposure therapy with guided eye movements, aiming to help patients process traumatic memories and change how they react.

Heart Rate Variability Enabling a Treatment Option

Heart rate variability (HRV) is measured by the variation in time between each heartbeat. Greater variability indicates greater ability of the autonomic nervous system to regulate itself. This measure of the functioning of the autonomic nervous system reflects an individual’s ability to adaptively cope with stress. As a non-invasive treatment, heart rate variability biofeedback (HRVB) helps patients to self-regulate a physiological dysregulated vagal nerve. 

In an example, a study analyzed whether veterans with combat-related PTSD would show significantly different HRV prior to an intervention at baseline compared to controls. It aimed at determining whether the HRV among veterans experiencing PTSD is more depressed than that among veterans without PTSD. The study also assessed the feasibility, acceptability, and potential efficacy of providing HRVB as a treatment for PTSD. The findings suggest that implementing an HRV biofeedback as a treatment for PTSD is effective, feasible, and acceptable for veterans. 

Somewhat more recently, researchers looked into the efficacy of HRVB as an additional psychophysiological treatment for depression and PTSD. A selection from 789 studies showed that, despite an obvious popularity of HRV in literature, HRVB had not really been reviewed systematically. According to the researchers, significant outcomes from six randomized studies indicate there may be a clinical improvement when HRVB training is integrated into treatment of PTSD and depression. This holds true in particular when combined with psychotherapy. More research, study authors underline, needs to be done with larger groups, and further efforts are needed to integrate HRVB into treatment of stress-related disorders. Future research also needs to focus on the psychophysiological mechanisms involved.

The debate about efficacy may be ongoing. Already today, however, patients can use their smartphones to measure HRV. This convenient option provides innovative support of HRVB therapy as an additional psychophysiological treatment for PTSD. 

How Biofeedback Can Help Defeat Chronic Pain

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Weaning patients off opioids and ending pain management visits thanks to cardiorespiratory training.

“The longer you have pain, the better your spinal cord gets at producing danger messages to the brain, even if there is no danger in the tissue”: Dr. Lorimer Moseley, a pain scientist at the University of South Australia, outlines how our brain and nervous system “learn” to keep producing pain. This statement offers hope – because we can also teach them to stop doing so.

Chronic pain is one of the most common reasons why adults seek medical care. Linked to numerous physical and mental conditions, it contributes to high healthcare costs and a decrease in productivity. Studies estimate that the prevalence of chronic pain in the U.S., as an example, ranges from 11 to 40% of the population. In 2016, an estimated 20.4% of U.S. adults had chronic pain; and 8% of U.S. adults suffered from high-impact chronic pain, defined as lasting three months or longer and accompanied by at least one major activity restriction. Authors of a recent case report propose that biofeedback can modulate heart rate variability (HRV) whole-health biomarkers by inducing cardiorespiratory efficiency. This helps to reduce unremitting hyperarousal as a cause for chronic pain, assess for opioid risk behavior, as well as improve overall outcomes.

Measuring pain 

The Pain Catastrophizing Scale (PCS), developed by Chaves and Brown in 1978, consists of 13 items rated on a 5-point scale. Participants are instructed to indicate the degree to which they have specific thoughts and feelings when experiencing pain. PCS assesses the extent of catastrophic thinking due to low back pain according to the key factors of rumination, magnification, and helplessness. Out of these, rumination is most highly correlated with pain outcomes. In this context, a recent case review demonstrates a bidirectional relationship between hyperarousal and pain linked to intrusive thoughts and catastrophizing.

In order to minimize catastrophic thinking, clinicians may work with patients to disengage attention toward pain symptoms. Persistent and inflexible sympathetic dominance appears to play a key role in relieving chronic pain; it can be measured by the variation in time between each heartbeat (HRV). Greater variability indicates greater ability of the autonomic nervous system to regulate itself. 

The case report by Raouf Gharbo et al., referred to above, looks to untangle the relationship between chronic pain and hyperarousal. By disengaging fear ruminations using heart rate variability biofeedback (HRVB), this framework has the potential to reverse the negative effects of helplessness as measured by PCS. This case presents an elderly female with a complex medical history who had suffered from daily axial low back pain for over five years, worsened by physical activity but temporarily ameliorated by opioids. The patient accepted the offer for a program centered on physiological grounding of fear ruminations with regular HRVB practice – a non-invasive therapy training aiming at increasing heart rate oscillations through real-time feedback and slow breathing training. 

The benefits of HRVB

HRVB training has been shown to improve HRV coherence (HRV-c), restore autonomic health, and reduce the severity of symptoms. With cyclical diaphragmatic breathing, HRV-c is achieved when cardiac beat-to-beat intervals increase and decrease in synchrony with respiration, and shift into a smooth sinusoidal rhythm. High HRV-c has been associated with improved mood, cognition, and executive functions. Raouf Gharbo et al., who also run a randomized controlled trial studying HRVB for chronic pain in veterans, describe the positive effects of HRVB training on their patient. Her skills of inducing and maintaining cardiorespiratory synchronization improved and persisted, she was weaned off opioids, and did not require any more pain management visits. These results underline that HRVB can enhance quality of life and reduce healthcare costs.

Today, patients can use their smartphones for managing chronic pain (e.g. Caspar Health, Kaia Health). Smartphones also enable HRV measurement, supporting patients who opt for breathing exercises to provide a simple and cost-effective way to take control of their body functions. The fight against chronic pain can be won, as Dr. Moseley suggested. 

Seasonal Affective Disorders: How to Fight It With Breathing Exercise

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Breathing exercises as a treatment for seasonal affective disorders

Here’s how to deal with the seasonal mental health exacerbation

Long nights, dark days, and chilling temperatures: to quite a few of us, winter comes with major challenges for our mental health. For an estimated five percent of adults in the United States, e.g., the mood changes that occur as the amount of natural sunlight decreases are severe enough to be diagnosed as seasonal affective disorders. And the COVID-19 pandemic has been adding its toll during the previous cold season and the current one in the northern hemisphere: authors of a study published in the Lancet note an increase of more than 129 million cases world-wide of major depression and anxiety disorders compared with pre-pandemic figures. They attribute this to the “combined effects of the spread of the virus, lockdowns, stay-at-home orders, decreased public transport, school and business closures, and decreased social interactions, among other factors.” However, there are effective methods to increase mental health resilience.

Researchers describe seasonal affective disorders (SAD) as a “recurrent major depressive disorder with a seasonal pattern, usually beginning in fall (autumn) and continuing into winter months”. SAD disrupt the body’s internal clock and produce chemical changes in the brain; a sad mood and low energy are key symptoms of the condition. Risk groups include females, and are younger; they live “far from the equator”, and have family histories of depression, bipolar disorder, or SAD. Screening instruments include the Seasonal Pattern Assessment Questionnaire (SPAQ).

Some experts differentiate S-SAD, commonly seen as a subcategory and termed the “winter blues”, from “genuine SAD”. They claim SAD patients need to have experienced symptoms – such as feeling constantly tired, spending longer times in bed, increased appetite, lack of motivation, and disturbed sleep – consecutively for two years. Isabella Lovett counts among the proponents who state that the value of exercise in combating any form of stress, anxiety or depression – including SAD – is beyond doubt. Intense cardio and strength classes should be combined with mindfulness-based exercises and activities such as yoga and meditation.

According to researchers from Carnegie Mellon, for example, just 25 minutes of mindfulness meditation can significantly alleviate stress. For a study, 66 healthy individuals aged 18-30 years participated in a three-day experiment. Some participants went through a brief mindfulness meditation training program; for 25 minutes for three consecutive days, the individuals were given breathing exercises to help them monitor their breath and pay attention to their experiences. A second group completed a matched three-day cognitive training program. As a result, the first group reported reduced stress perceptions of speech and math tasks both groups were given to do, indicating that the mindfulness meditation fostered psychological stress resilience. More interestingly, on the biological side, the mindfulness meditation participants showed greater cortisol reactivity which, researchers assume, may be reduced over longer-term activities. In another example, Adam Borland, PsyD, a psychologist at the Cleveland Clinic, suggests taking ten minutes every morning for deep breathing and stretching to counter SAD.

Experts predict that during this northern winter, with COVID-19 continuing to upend our lives, SAD may become even more prevalent. Persons affected should seek counseling; to monitor effects of therapy, and for self-management in the context of building resilience, modern technology comes into play.

Patients can use their smartphones for measuring heart rate variability (HRV). As an important measure of health and wellbeing, HRV is significantly impacted by mood and mental health, and is increasingly being used as a measure of outcome in psychotherapy studies. To combine this biofeedback data with, e.g. breathing exercises provides a simple and cost-effective way to take control of body functions.

The battle against SAD is on. Let’s reduce the burden on our mental health with breathing exercises, managed through biofeedback.

How HRV Biofeedback Helps Combat Cardiovascular Diseases

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Your heart plays a crucial role in your body. It is a muscle in the center of your circulation system which pumps blood around your body with every beat. This blood sends oxygen and nutrients to all parts of your body, and carries away unwanted carbon dioxide and waste products. Any impairments can lead to cardiovascular diseases.

Conditions of the heart and the circulation system – also called cardiovascular diseases (CVDs) – are a group of disorders which includes, in particular, coronary heart disease, cerebrovascular disease, and rheumatic heart disease. They are the leading cause of death globally. According to the World Health Organization (WHO), they cause an estimated 17.9 million deaths each year. More than four out of five CVD deaths are due to heart attacks and strokes, and one third of these deaths occur in people under 70 years of age. Most important behavioral risk factors are an unhealthy diet, physical inactivity, tobacco use, and harmful use of alcohol. Effects show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity.

The cardiovascular and the respiratory system exist in close vicinity to each other. Breathing directly affects the cardiovascular system. In turn, one of the main symptoms of congestive heart failure is shortness of breath. Cardiopulmonary exercise is one of the best things an individual can do to promote cardiovascular health: The pressure generated by breathing and expanding the lungs influences the volumes and pressures in the chambers of the heart and blood vessels. These changes stimulate sensory nerves that influence the autonomic nervous system (ANS) and the rate and depth of breathing. The pattern generators in the brainstem that drive and regulate heart rate, blood pressure, and breathing are also closely aligned. With exercise, a “central command” from higher brain centers accelerates the activity of both systems, and sends feed‐forward signals to the brain stem in preparation for the increased metabolic demands of exercise.

Where heart rate variability comes in

The analysis of fluctuation in intervals between heartbeats provides important information related to the autonomic modulation of heart rate variability (HRV). 

HRV parameters are considered predictors of morbidity and mortality, and researchers have pointed towards a close relationship between cardiovascular fitness and HRV. While HRV is often impaired in patients with cardiovascular and metabolic diseases, researchers found this relationship to be more pronounced in patients with cardiovascular and metabolic diseases and in aging. This became manifest, in particular, in individuals whose cardiovascular fitness and HRV were below the predicted values for the respective age and gender. Women in reproductive age as well as age-matched men show distinct regulations in cardiac autonomic modulation; and aerobic exercise was one type of training which appeared to attenuate any autonomic impairments.

And in the Journal of the American Heart Association (JAHA), Craighead et al investigated the effect of high‐resistance inspiratory muscle strength training on blood pressure, endothelial function, and arterial stiffness in older adults with mildly elevated systolic blood pressure. For that age group, their double‐blind, randomized, sham‐controlled trial showed that this type of exercise can improve control of blood pressure as well as increase HRV. 

Modern technology enables patients to use their smartphones for measuring HRV and pulse rate. To combine this biofeedback data with, e.g. breathing exercises is a simple and cost-effective way to take control of body functions. Patients will typically conduct these trainings in a setting with professional support. In the case of CVD, training accompanied by HRV measurement can help to prevent cardiovascular issues, to detect developing conditions for early intervention, and to monitor effects of treatment.

Cancer vs Biofeedback: Exercise for Stress Management and Resilience

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Now patients can take control of a key risk factor for tumor progression with HRVB Exercise

Our contemporary lifestyles are particularly inducive of stress-related disorders. For oncology patients, this becomes even more of an issue: when diagnosed with cancer, many of them feel an increase in stress, and it can easily become chronic. And whereas there is no evidence that chronic stress causes cancer, it can make cancer spread faster. Effects of stress can be relevant both before, during, and after treatment. Tools are available which help patients cope.

In the context of cancer pathogenesis, there is growing evidence for biological and clinical implications of psychosocial and biobehavioral influences. Studies have shown the impact of chronic stress on metastasis: stress hormones stimulate angiogenesis, cell migration, and invasion, which leads to increased progression. Metastasis, when resistant to conventional therapy, is the major cause of cancer-related deaths.

Studies show impact of biofeedback training

Biofeedback (BF), including heart rate variability biofeedback (HRVB), appears to be a valuable tool in coping with stress. It can be used to control, and make subtle changes to, a variety of physical functions, such as heart rate. Biofeedback training (BFT) and heart rate variability biofeedback training (HRVBT) are based on three stages: initial conceptualization, skills acquisition and skill rehearsal, as well as transfer of treatment. In each of these phases, exercises aim at cognitive-behavior modification to induce change – patients, or clients, ought to become observers of, and actors on, their behavior and physiological responses.

BFT and HRVBT are effective: A study on BF-based interaction showed significant improvements in psychological test scores and salivary cortisol levels. In addition, results included increased grey matter (GM) volume in regions of the brain which are associated with stress response. According to the research team, the findings suggest that BFT affects the GM structures vulnerable to stress. HRVBT offers a useful tool for treating depressive symptoms in patients with psychological or medical diseases, according to another study published in Nature. This applies also to patients with cancer – depression affects up to 20%, and anxiety 10%.

While conventional BF methods provide information about the body by connecting individuals to electrical sensors, technology from kenkou enables patients to use their smartphones to measure pulse and heart rate variability (HRV). These measurements are accurate biomarkers for stress management. Combination of this data with BF exercises is a simple and cost-effective way to take control of body functions. Patients will typically conduct these trainings in a setting with professional support

Patients can take control

BFT helps to emancipate oncology patients in the context of key risk factors. This includes general stress as well as condition-induced stress after diagnosis and coping with treatment measures such as chemotherapy. Patients benefit from, e.g., slowed tumor progression and optimized monitoring of treatment.

Heart Rate Variability (HRV) – Your “Immunity Booster”

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The link between the autonomic nervous system and immunity / How heart rate variability can be used to detect and prevent disease

Autumn and winter are peak seasons for infectious diseases. Our immune system is challenged by decreasing temperatures and wet weather, and the common cold, flu, and further threats to our health are gaining ground. More time spent inside, with other people around, adds to those risks. The current pandemic illustrates this seasonal trend, with various countries stepping up measures to control rising incidence. Let’s take a closer look at how we can take control of our immune status by measuring heart rate variability (HRV), and provide support to our physicians.

There is extensive communication between our immune system and our nervous system, experts explain. This includes the “hardwiring” of sympathetic and parasympathetic nerves to lymphoid organs – in particular red bone marrow, in which blood and immune cells are produced, and the thymus, where T-lymphocytes mature.

The sympathetic nervous system (SNS, which is responsible for “fight or flight”) and the parasympathetic nervous system (PNS, responsible for “rest and digest”) are the components of the autonomic nervous system (ANS). The ANS is critical in regulating processes required for maintaining physiological homeostasis and responding to acute stressors. Recently, researchers have been studying potential further functions of the ANS: it appears to play an essential role in regulating, integrating, and orchestrating processes between diverse physiological systems.

The modulators of immune activity

Neurotransmitters such as acetylcholine, norepinephrine, vasoactive intestinal peptide, substance P and histamine modulate immune activity. Neurotransmitters, often called the body’s chemical messengers, are molecules used by the nervous system to transmit messages between neurons, or from neurons to muscles.

Central autonomic neural networks are informed of the peripheral immune status via neural and non-neural communicating pathways. While the immune system interacts directly within brain regions that regulate autonomic function, the autonomic nervous system innervates organs that contain immune cells, such as the spleen and bone marrow. Cytokines and other immune factors affect the level of activity and responsivity of discharges in sympathetic and parasympathetic nerves innervating diverse targets.

Heart rate variability (HRV) – biomarker of health

This is where heart rate variability (HRV) comes in. HRV biofeedback (HRVB) allows for measuring the autonomic function, with a host of applications for a variety of conditions.

In the context of immunity, the relation between HRV and inflammatory states has been extensively studied: for example, a meta-analysis of over 51 studies with a total of 2,238 patients demonstrated an inverse relationship between HRV and inflammation. While the precise mechanism of how the immune system and the ANS interact to impact the HRV may still have to be described, the common measure of HRV, the standard deviation of the interval between heartbeats (SDNN), is a viable indicator for monitoring the immune state. SDNN has been shown to correlate inversely with the nonspecific inflammatory marker C-reactive protein (CRP).

For measuring HRV, readily accessible, easy-to-use technology is available. A smartphone camera is the only device required. Its flash illuminates the fingertip, making changes in the blood vessels, which occur due to the natural heartbeat, visible for analysis. When blood is pumped through the vessels, they appear darker; blood being pumped out leads to lighter vessels. Based on these changes the heartbeat is analyzed, and the HRV is determined, providing the basis for computing further vital data indexes.

In the context of the immune system, this approach allows for the improved self-management of our health, and it provides significant support for physicians in diagnosing and monitoring their patients.

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Heart Rate Variability Biofeedback (HRVB): Technique to Boost Wellbeing

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How apps improve the management of chronic diseases, including diabetes

Noncommunicable chronic diseases, including cardiovascular disease, diabetes, and mental health conditions, were responsible for almost 70% of deaths worldwide in 2016. This is an estimate from The World Health Organization (WHO). The prevalence of these illnesses is increasing globally, leading to major social and economic consequences. The U.S. is a prime example: research by the American Action Forum (AAF) from September 2020 shows that chronic conditions in the country – already highly prevalent – are expected to rise over the next several decades among all age groups. The AAF calculates that, including indirect costs associated with lost economic productivity, the total cost of chronic disease in the United States reaches US-D 3.7 trillion each year, approximately 19.6 percent of the gross domestic product. Experts agree that action needs to be taken to reduce health care costs and improve patient wellbeing – and quality and effectiveness of disease management play a major role.

To better manage chronic diseases is key

Chronic diseases are generally linked to an imbalance of the autonomous nervous system (ANS). This results in sympathetic overstimulation and a lack of activity of the vagus nerve, a fundamental component of the parasympathetic branch of the ANS. This phenomenon, called dysautonomia, can both be a consequence of chronic disease as well as a key risk factor in its development. The study by Zalewski et al. emphasizes that ANS dysfunctions should be considered at each stage of the diagnostic and treatment processes. The identification of changes in vagal activity holds the key regarding the management, and detection, of chronic conditions.

heart rate variability biofeedback

Heart rate variability – biomarker of health

This is where heart rate variability (HRV) comes in. Heart rate variability biofeedback (HRVB) allows for the indexing of the autonomic function. Whereas high HRV reflects the ability of the cardiac system to adapt to intrinsic and extrinsic changes (e.g., stress), low HRV is an indicator of risk for cardiovascular morbidity and mortality. A systematic literature analysis by Shaffer et al. showed the feasibility of HRVB in chronic patients; significant positive effects were found in various patient profiles. Researchers concluded that heart rate variability biofeedback could be effective in managing patients with chronic conditions, including diabetes.

kenkou has developed a technology that enables vital data measurement (including HRVB) using just the smartphone camera. This readily accessible, easy-to-use technology serves to enhance treatment and detection of chronic conditions.

Heart Rate Variability (HRV): The Next Big Thing In Mental Health

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Why is measuring mental well-being becoming critical and how can we make it as simple as checking temperature?

Loneliness, stress, anxiety, and depression: the COVID-19 pandemic has been severely impacting our lives. Health challenges affecting ourselves or our loved ones can cause strong emotions, and public health actions such as social distancing can make us feel isolated. The pandemic intensifies mental health challenges that were widespread already before the crisis.

Loneliness, as an example, is not just a painful experience we may go through. It is worse for us than smoking, more harmful than obesity, and it comes with a risk of premature mortality. In the UK, for example, the surging number of lonely people and how feeling alone harms us was presented by a pre-pandemic report by the Jo Cox Commission on Loneliness. According to Making Caring Common, a project of the Harvard Graduate School of Education, 36% of all Americans feel “serious loneliness.”

The World Health Organization raises the alarm: Approximately 280 million people in the world have depression. Survey conducted by The Centers for Disease Control and Prevention (CDC) among adults aged ≥18 years across the United States in June 2020 suggests that 40.9% of respondents reported at least one adverse mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder (30.9%). The waiting lists for psychotherapy are getting longer. “With anxiety and depression on the rise during the pandemic, it has been challenging for people to get the help they need” – writes The New York Times in a recently published article.

These examples illustrate the scope of the issue and the need to support therapy when qualified help is hard to find.

Untapped power of HRV

In light of this high incidence of risk factors and conditions and lack of professional staff to address for help, what can individuals do to find out if they are at risk? Whereas a panic attack may be easy to identify, the slow rise in blood pressure or inflammation is difficult to notice. In this context, heart rate variability (HRV) comes into play. It is a promising biomarker of mental health resilience (MHR).

MHR influences mental well-being and vulnerability to psychiatric disorders. Whereas conventional measurement of resilience is based on subjective reports, HRV can act as an objective biological, physiological biomarker. A study published in the Journal of Affective Disorders showed that HRV might indeed serve as a global index of an individual’s flexibility and adaptability to stressors.

body mind connection

Effective therapy is available, but simple methods of diagnosis are lacking

Cognitive Behavioral Therapy (CBT) is the most widely-used therapy for a wide variety of mental health disorders. Research has shown it to be effective in treating panic disorders, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions. CBT is a “talking therapy” that can help individuals manage their problems by changing the way they think and behave. The therapy aims to help individuals deal with overwhelming problems in a more positive way by breaking them down into smaller parts. CBT is based on the concept that one’s thoughts, feelings, physical sensations, and actions are interconnected, and that negative thoughts and feelings can trap individuals in a vicious cycle.

However, a diagnosis is needed to begin CBT, and this is not always easily available. Accurate tracking of selected biomarkers including HRV can be a game-changer.

As a noninvasive and easily applicable biomarker of MHR in real-life contexts, HRV allows for accurate stress level measurements for CBT. It helps in tracking recovery by identifying the change in behavioral patterns and treatment progress over time. In addition, it serves as an index of cognitive and affective self-regulation. Whereas negative emotions are related to reduced HRV and incoherent heart rhythm patterns, cardiac coherence refers to a high amplitude sinus-like heart rhythm that is characterized by increased vagal activity. This is associated with a psychological state of positive emotion.

HRV biofeedback (HRVB) devices display heart rhythms in real-time. They can be used to teach patients to generate coherent oscillations in the heart rate. A combination of CBT and HRV biofeedback training can help reduce anxiety symptoms while increasing HRV and the ability to sustain cardiac coherence.

When properly applied, digital technologies may prove to be groundbreaking in addressing the problem of early diagnosis and treatment of selected mental illnesses.

Technology developed by kenkou for precision biofeedback

kenkou – a Berlin based startup founded in 2014 – is developing technologies that can revolutionize mobile health and vital-data measurement worldwide. Together with a team of data scientists, the company is exploring the power of HRV in mental health tracking.

mental health app and heart rate variability
Photo by cottonbro from Pexels

The science behind HRV: how does it work?

The time interval between the heartbeats of a healthy heart is constantly fluctuating. It indicates how well your body handles stress. Intervals over a given time period are referred to as HRV. A high HRV indicates that your body can cope well with stress, whereas a low HRV can be a symptom of fatigue, stress, or even illness. There are many values that can be used to measure HRV, including RMSSD and PNN50.

RMSSD (Root Mean Square of Successive Differences) shows how well an individual’s body is recovering from stress and reflects how well the parasympathetic nervous system can help it to regenerate and recover. A high level of stress relief is partly due to a high RMSSD.

PNN50 (correlated with Parasympathetic Nervous System activity) is the fraction of consecutive heartbeats with an interval greater than 50 milliseconds between them. A higher PNN50 value shows that an individual’s heart rate has drastically changed within a brief time period. For healthy individuals aged 25-74 years, the range is -3% to 43%.

Respiratory Sinus Arrhythmia (RSA) Amplitude, sometimes referred to as the HRV amplitude, is the change of heart rate believed to be caused by breathing. Kenkou measures it by breaking up measurements into sections that match the expected breathing interval of the user – ten seconds in length –, calculating the difference between the maximum and minimum heart rates and averaging the results found for each of the sections.

kenkou computes a spectrum of indexes. This includes the Tension Index: this heart rate index is determined by the heart rate variability and is an objective indication of how much stress and tension there is in the body. Recovery Ability is related to an individual’s relaxation ability; it is measured by the parasympathetic nervous system, which controls the body while at rest. The easier it is for the body to calm down, the higher its stress resilience.

How do we make vital signs checkup as simple as possible, accessible to everyone?

kenkou’s team has developed a technology that enables vital signs measurement (including HRV) using just the smartphone camera. Its flash illuminates the fingertip, making changes in the blood vessels, which occur due to the natural heartbeat, visible for analysis. For example, when blood is pumped through the vessels, they appear darker; blood being pumped out leads to lighter vessels. Based on these changes, the heartbeat is detected, the data is analyzed, and the HRV is determined, providing the basis for computing further vital data indexes.

Readily accessible, easy-to-use technology from kenkou enhances treatment of mental health challenges in the pandemic and beyond. The company’s software development kit (SDK) enables cardiovascular vital signs analysis through third-party applications in the digital health and well-being industry as well as for insurance and pharmaceutical companies.