A patient with a low HRV is thought to be stuck in fight or flight mode and/or have worse cardiovascular health and lower resilience
Assessing a patient’s health within a chiropractic setting typically involves obtaining (and regularly updating) a detailed medical history. An in-depth physical exam is also part of this process. Utilizing this approach provides a thorough look at the issues a patient is facing or will likely face when obtaining and/or maintaining a higher level of health. One additional assessment that could provide great insight into your wellness patient’s health is their heart rate variability.
Understanding heart rate variability
Heart rate variability (or HRV) is the variation of time that occurs between each heartbeat. These intervals vary from one beat to the next. For instance, there could be 0.8 seconds between two beats of your heart, with the third beat not occurring until 1.1 seconds later. On an electrocardiogram, these intervals are the sections between each spike or recorded heartbeat and are measured in milliseconds.
While it may seem like HRV would be dictated by the cardiovascular system, the autonomic nervous system (ANS) actually controls this health factor. The ANS consists of the sympathetic and parasympathetic nervous system. The first is the “fight or flight” portion of the ANS and the second is generally referred to as the “rest and digest” portion.
HRV and health
Harvard Health calls HRV “an interesting and noninvasive way” to better identify whether imbalances exist with the ANS. If the patient is relaxed, for example, their variability will likely be high. Having a high HRV is also associated with having a fit cardiovascular system and being more resistant to stress.
Conversely, a patient with a low HRV is thought to be stuck in fight or flight mode and/or have worse cardiovascular health. They have a more difficult time switching between rest and activity, indicating a lower level of resilience.
Research published by Frontiers in Public Health adds that HRV declines with age and can vary by sex, with women often having higher heart rates with smaller intervals between the beats. There also appears to be a connection between HRV and mental health issues such as stress, depression, and anxiety. Physical issues associated with HRV include diabetes, asthma, insomnia, chronic pain, and inflammation.
Assessing HRV in a chiropractic setting
Some manufacturers are creating technologies that can be utilized in a chiropractic setting to help practitioners determine a patient’s HRV. This type of device or equipment not only assists with obtaining a more advanced patient assessment during a new intake but can also be used to monitor their progress during the treatment sessions.
For instance, chronic pain can impact HRV. Thus, recording a patient’s HRV regularly helps better identify whether the adjustments are positively impacting the patient’s pain levels. Since HRV can also change based on levels of inflammation, tracking this measurement makes it easier to ascertain this internal effect.
Other ways to positively influence heart rate variability
Teaching patients about the connection between HRV and health can help them make better, more informed choices based on their individual variability. And they can track their HRV between sessions by purchasing a low-cost over-the-counter wrist-monitoring device that syncs with their smart phone.
For patients who want to improve their HRV, research reveals that they can do so with diet and supplements. According to an article published in Behavioural Pharmacology in April 2018, eating a Mediterranean diet shows long-term benefits in heart rate variability. Consuming omega 3 fatty acids, vitamin B, and probiotics offer advantages as well.
This article also reports that eating too many saturated fats or trans fats have the opposite effect as these types of diets have been linked to a lower HRV. Diets containing a higher amount of high glycemic carbohydrates negatively impact HRV too.
Patients can also develop a healthier HRV with regular exercise and getting enough sleep. The first improves their cardiovascular fitness and the second reduces stress and heals inflammation.
When to refer patients out
In some cases, testing a patient’s HRV will reveal that an arrhythmia such as atrial fibrillation —also commonly referred to as afib or AF — exists. If this occurs, referring the patient to their primary care physician or cardiologist is the next appropriate step.
The Mayo Clinic reports that patients with atrial fibrillation have a higher risk of developing a blood clot in the upper heart chambers. These clots can travel to other areas of the body, potentially blocking the flow of blood to important organs.
Treating atrial fibrillation is sometimes possible with prescription medications. Other times, more invasive interventions are necessary to improve the electrical system within the heart. For wellness patients, monitoring HRV can open new conversations regarding diet, supplementation and sleep, and further connect patients to their health.