Heart Rate Variability Measurement and Training for Corporate Wellness

Stress in the workplace is inevitable so workers have to learn to cope with it one way or another. But how is coping really possible when stress (the problem) is an ambiguous term usually defined by a person's perception of it? Without appropriate coping tools people turn to alcohol and drugs believing they can solve the problems but instead this only adds to their stress!

Thankfully, I can now report about an accepted method to define (quantify stress using physiological variables) and subsequently increase the specificity of interventions and objectively measure outcomes on stress levels. Heart rate variability (HRV) is a valid and reliable measurement of stress and HRV biofeedback an effective intervention.

In a recent report on military special operators, researchers found that acute stress can cause cognitive impairments and cognitive inflexibility. The report suggested that all military personnel should be involved in stress exposure training with a goal of becoming more stress tolerant.

The report also emphasized the importance of physiological control and recommended better methods to determine those that are stress hardy and resilient and whether resiliency can be improved by training.

"an inability to muster resilience compounds the effects of a stressor and can lead to impulsivity, errors in judgment, and even physical and mental disorders…"

-Hill G. MARSOC's failing standards: Revising requirements for the special Operations Capabilities Specialists (SOCS). Marine Corps Gazette. 2015;99(9).

Health care expenditures are nearly 50% greater for workers who report high levels of stress.

-Journal of Occupational and Environmental Medicine

Job Stress and Health: What the Research Tells Us

Cardiovascular Disease
Many studies suggest that psychologically demanding jobs that allow employees little control over the work process increase the risk of cardiovascular disease.

Musculoskeletal Disorders
On the basis of research by NIOSH and many other organizations, it is widely believed that job stress increases the risk for development of back and upper extremity musculoskeletal disorders.

Psychological Disorders
Several studies suggest that differences in rates of mental health problems (such as depression and burnout) for various occupations are due partly to differences in job stress levels. (Economic and lifestyle differences between occupations may also contribute to some of these problems.)

Workplace Injury
Although more study is needed, there is a growing concern that stressful working conditions interfere with safe work practices and set the stage for injuries at work.
Suicide, Cancer, Ulcers, and Impaired Immune Function
Some studies suggest a relationship between stressful working conditions and these health problems. However, more research is needed before firm conclusions can be drawn.

-Encyclopedia of Occupational Safety and Health

Stress, Health, and Productivity

Studies show that stressful working conditions are actually associated with increased absenteeism, tardiness and intentions by workers to quit their jobs-all of which have a negative effect on the bottom line.

Stress Prevention and Job Performance

St. Paul Fire and Marine Insurance Company conducted several studies on the effects of stress prevention programs in hospital settings. Program activities included employee and management education on job stress, changes in hospital policies and procedures to reduce organizational sources of stress, and establishment of employee assistance programs.

In one study, the frequency of medication errors declined by 50% after prevention activities were implemented in a 700-bed hospital. In a second study, there was a 70% reduction in malpractice claims in 22 hospitals that implemented stress prevention activities. In contrast, there was no reduction in claims in a matched group of 22 hospitals that did not implement stress prevention activities.

-Journal of Applied Psychology

According to data from the Bureau of Labor Statistics, workers who must take time off work because of stress, anxiety, or a related disorder will be off the job for about 20 days.

-Bureau of Labor Statistics

The inverted-U hypothesis is considered the most plausible explanation for the stress and performance relationship. The inverted-U hypothesis is founded upon the classic work of Yerkes and Dodson whose law states that for every behavior there is an optimal level of arousal. This optimal level of arousal typically is of moderate intensity in order to produce maximum performance.

The key to minimizing the untoward effects of too much stress, therefore, is to find and apply the optimal effort for tasks without sacrificing personal health. Fortunately, scientists have now developed methods to quantify stress using AI algorithms and sensor technology. Thus, stress associated with tasks can be assessed as well as the impact on an individual's stress level. Once a stress baseline is established guidance can be given on how to build resiliency in the ANS through training and apply these tools during difficult tasks. These results are then compared to this baseline. One valid and reliable method is the quantification of stress using heart rate variability (HRV) analytics and training involving immediate and continuous HRV feedback.

HRV Assessment and Biofeedback Training

Influence diagram of cause of effect factors linked with heart-rate variability (HRV). The direction of the arrows indicates a cause-to- effect link between related factors. While red arrows indicate a deleterious effect and green or blue arrows a beneficial one, purple arrows refer to a link for which the effect can be deleterious or beneficial. Blue arrows are specific to the heart coher ence state. Red, green and blue arrows correspond to significant effects while grey arrows indicate a link for which statistical significance was not achieved. Heart International 2016; 11(1): e32-e40 DOI: 10.5301/heartint.5000232

HRV is a physiological phenomenon involving measures of variations in beat-by-beat heart intervals. HRV is related to many human factors and can therefore produce the following analyses:

Current Measures Produced by HRV

STRESS INDEX - provides an estimation of stress levels.

AUTONOMIC BALANCE - provides an estimation of functional balance between the sympathetic and parasympathetic branches of the autonomic nervous system.

RESTING HEART RATE - an average heart rate reading taken at rest.

HRV INDEX - provides an estimation of the overall activity of the autonomic nervous system.

VAGAL INDEX - provides an estimation of the tone of the Vagus nerve which predominantly represents the function of the parasympathetic nervous system.

ADAPTATION EFFORT - provides an estimation of the intensity of activity of bodily functions adapting to adverse changes inside and outside of the body to maintain its homeostasis.

ADAPTATION RESERVE - provides an estimation of the amount of body's resources available in the body's efforts to restore its homeostasis.

HEALTH STAGE INDEX - provides an estimation of the process of disease development passing several stages from the normal condition to an evident pathology. SpO2 - indicates how well your body is supplied with oxygen.

In a recent systematic review of HRV and occupational stress research scientists concluded that "occupational stress is associated with lowered HRV, specifically with reduced parasympathetic activation. Thus, analysis of HRV can be used as an informative marker for physiological impacts of workplace stressors".

Järvelin-Pasanen S, Sinikallio S, Tarvainen MP. Heart rate variability and occupational stress-systematic review. Ind Health. 2018;56(6):500-511. doi:10.2486/indhealth.2017-0190.

Biofeedback training for stress reduction involves syncing respiration with heart rate and producing a condition referred to as respiratory sinus arrhythmia (RSA) that is known to facilitate a decrease in stress by strengthening the parasympathetic nervous system (PNS) and thereby increasing stress resiliency. In HRV biofeedback a person's RSA setpoint is determined by having them breathe at rates from 8,7,6, and 5 times per minute. The person's setpoint number becomes evident when the greatest increase in power is noted while the person breathes following a breath-pacer set at different rates. Once determined the person trains at their breathing rate until they achieve an optimal level for reducing their stress. They then work to maintain RSA for increasing amounts of time. A training report is recorded and trended. Individuals and designated team leaders can use the HRV data monitor the teams' stress over time and the outcomes of training. Workers may use it at home as often as they want and share their measurements with the team leader. The overall result will be a decrease in stress and its untoward effects in addition to increases in performance and the bottom line. A recent research study* summarizes the potential of this training in the workplace:

"brief workplace stress management intervention (HRV biofeedback) can produce significant reductions in BP and improve emotional health among hypertensive employees... and "may produce a healthier and more productive workforce, enhancing performance and reducing losses to the organization resulting from cognitive decline, illness, and premature mortality"

*McCraty, R., Atkinson, M., Tomasino, B.A. Impact of a Workplace Stress Reduction Program on Blood Pressure and Emotional Health in Hypertensive Employees. Journal of Alternative and Complementary Medicine Volume 9, Number 3, 2003, pp. 355-369© Mary Ann Liebert, Inc.

Additional Readings:

1. Acharya UR, Joseph KP, Kannathal N, Lim CM, Suri JS. Heart rate variability: a review. Medical and Biological Engineering and Computing 2006; 44:1031-1051. PMID: 17111118 2.
2. Baevsky RM, Baranov VM, Funtova II, et al. Autonomic cardiovascular and respiratory control during prolonged spaceflights aboard the International Space Station. J Appl Physiol. 2007;103(1):156-161.
3. Billman GE. Heart rate variability-a historical perspective. Frontiers in Physiology 2011; 2:1-13.
4. Centers for Disease Control and Prevention. Chronic Disease statistics. Retrieved from internet source on November 17, 2019.
5. de Bruyne MC, Kors JA, Hoes AW, Klootwijk P, Dekker JM, Hofman A, et al. Both decreased and increased heart rate variability on the standard 10-second electrocardiogram predict cardiac mortality in the elderly The Rotterdam Study. American Heart Journal 1999; 150:1282-1288. 6.
6. Dekker JM, Schouten EG, Klootwijk P, Pool J, Swenne CA, Kromhout D. Heart rate variability from short electrocardiographic recordings predicts mortality from all causes in middle-aged and elderly men. The Zutphen Study. American Journal of Epidemiology 1997; 145:899-908. PMID: 9149661 7.
7. Delahaij R, Gaillard AWK, Soeters JMLM. Stress training and the new military environment. Human Dimensions in Military Operations - Military Leaders' Strategies for Addressing Stress and Psychological Support 2016:17A-1-17A-10. Accessed June 20, 2016.
8. Folkov, B. Stress, hypothalamic function and neuroendocrine consequences. Acta Med Scand Suppl. 1988: 723; 61-69.
9. Friedman BH, Thayer JF. Autonomic balance revisited: Panic anxiety and heart rate variability. Journal of Psychosomatic Medicine. 1998;44(1):133-151.
10. Gallo D, Robey W, Russoniello C, Fish M, et al. Using heart rate variability as a physiologic marker of stress during the performance of complex tasks presented at: Annual Society for Academic Emergency Medicine Research Meeting; May 2012; Chicago, IL.
11. Hill G. MARSOC's failing standards: Revising requirements for the special Operations Capabilities Specialists (SOCS). Marine Corps Gazette. 2015;99(9). Retrieved from internet source on July 4, 2016.
12. Hjemdahl, P. Stress and the metabolic syndrome. Circulation. 2002:106;2634-2636.
13. Hjortskov N, Rissén D, Blangsted AK, et al. The effect of mental stress on heart rate variability and blood pressure during computer work. Eur J Appl Physiol. 2004;92(1-2):84-89.
14. Hofman, L. F. Human Saliva as a diagnostic specimen. American Society for Nutritional Sciences, 131:1621S-1625S, 2001.
15. Khoury J, Sinar D, Russoniello C, Murray N. Optimizing performance during endoscopic procedures: Physician stress at different levels of training. Gastrointestinal Endoscopy. 2007;65(5):330.
16. Kudielka, B. M. & Kirscbaum, C. Biological basis of the stress response. In al'Abasi, M. (Ed.) Stress and Addiction: Biological and Psychological mechanism. 2007; (pp. 3-18) Elsivier LTD.
17. Laing B, Russoniello C, Bart-Knauer B. The effects of heart rate variability training on marksmanship. Applied Psychophysiology and Biofeedback. 2014:39:314.
18. Liao D, Cai J, Rosamond WD, Barnes RW, Hutchinson RG, Whitsel EA, et al. Cardiac autonomic function and incident coronary heart disease: a population-based case-cohort study. The ARIC study. American Journal of Epidemiology 1997; 145:696-706. PMID: 9125996 5.
19. McKewen BS. Biol Psychiatry, 2003;54(3):200-207.
20. Measurement of cortisol in saliva using a commercial radioimmunoassay developed for serum. Journal of Laboratory Medicine, 2000; 24 (6/7), 314-318.
21. Routledge HC, Chowdhary S, Townend JN. Heart rate variability-a therapeutic target? Journal of Clinical Pharmacy and Therapeutics 2002; 27:85-92. 3.
22. Russoniello, C. V. (2010). A measurement of electrocardiography and photoplethesmography in obese children. Applied Psychophysiology and Biofeedback, 35, 257-259.
23. Russoniello, C. V. (2013). Heart Rate Variability and Biological Age: Implications for Health and Gaming. Cyberpsychology, Behavior, and Social Networking, 16 (4), 302-308.
24. Schwartz M, Andrasik F, eds. Biofeedback: A practitioner's guide. New York, NY: The Guilford Press; 2016.
25. Shaffer F and Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front. Public Health 2017; 5:258. doi: 10.3389/fpubh.2017.00258
26. Sklar, L. S. & Anisman, H. Stress and Tumor Growth. Psychological Bulletin. 1981: 89(3); 369-406.
27. Source: Does Stress Cause Psychiatric Illness? Progress in Psychiatry Carolyn M. Mazure (Ed.) American Psychiatric Publishing, Inc.; 1st ed edition (May 1995) 304 pages.
28. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93:1043-1065.
29. Task Force of the European Society of Cardiology the North American Society of Pacing Electrophysiology. Heart Rate Variability: Standards of Measurement, Physiological Interpretation, and Clinical Use. Circulation 1996; 93:1043-1065. PMID: 8598068 4.
30. Thayer JF, Lane RD. A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders. 2000;61:201-216.
31. Thayer JF, Sternberg E. Beyond heart rate variability: Vagal regulation of allostatic systems. Annals of the New York Academy of Sciences. 2006;1088:361-372.
32. The Mayo Clinic. Stress Management Retrieved from internet source on December 25, 2019.
33. The World Health Organization. Non-communicative diseases and their Risk Factors. Retrieved from Internet Source on November 17, 2019.
34. United States Navy: (2013). Field Medical Service Technician Student Handbook. Retrieved from Internet source on June 15, 2016