Heart Rate VariabilityBiofeedback

Part 1 Background and Research

Presented to GGSC Meet-upJuly 10, 2013

By Linda Hartstrom

“If I’d known I was going to live this long, I’d have taken better care of myself”

US comedian Eubie Blake on his 100th birthday

Outline of Presentation

• Heart Facts• Heart Rate Variability

– Why is it important• Vagal Tone• Respiratory Sinus Arrhythmia• Cardiac Coherence• Heart Rate Variability Biofeedback

4

The Heart

Just the facts…

• What is a heart rate?• What determines

heart rate?• What is Heart Rate

Variability?

0 1 2-0.5

0

0.5

1

1.5

2

m V

olts

2.5 seconds of heartbeat data

.859 sec. .793 sec. .726 sec.

70 BPM 76 BPM 83 BPM

Electrocardiograph

Heart Rate Variability (HRV)

High vs Low HRV

Heart Rate Variability (HRV) Why is it important?

• Higher levels of resting HRV have been associated with:– Well balanced ANS– Greater overall health– Greater emotion regulation– Effective stress coping strategies– Increased resilience under stress– Increased attention control

• Low HRV predicts worsening:– Coronary heart disease– Atherosclerosis (Wennerblom, et al 2000)

– Elevated triglycerides (Jensen-Urstad M, et al 1998)

• Low HRV Correlates with:– Diabetes (Laitinen T, et al 1999)

– Obesity (Karason K, et al 1999)

– Multiple metabolic syndrome (Liao D, et al: 1998)

– Hypertension (Schroeder EB, et al 2003)

Heart Rate Variability (HRV) Why is it important?

• Low HRV linked with:– Depression (Carney RM et al. 2001)

– Social isolation (Hughes JW et al. 2000)

– Suppressed anger (Inmaculada L et al. 2009)

• Increased risk of mortality (Framington Heart Study: Singh et al., 1998).

Heart Rate Variability (HRV) Why is it important?

Heart Rate Variability (HRV) Intervention Results

• Reduced blood pressure in hypertension (McConville, 2012)

• Improved asthma (Lehrer, 2000)

• Reduced symptoms of stress (Nolan RP, 2005)

• Increased calmness and well-being (Friedman, 2000)

• Increased emotional stability (McCraty, 2001)

• Improved cognitive performance (McCraty, 2001)

• Improves hormonal balance (McCraty, 1998)

• PTSD symptom reduction (Zucker et al. 2009)

Heart Rate Variability

• Influences– Extrinsic

• Physical Activity• Physical Stress • Mental/Psychological Stress

– Intrinsic• Respiratory Sinus Arrhythmia (breathing)• Baroreceptor reflex (blood pressure)• Hormones

12

HEA

RT R

ATE

(BPM

)

Seconds

100

90

80

70

60

50

40

30

20

10

0 8 10 12 14 16 18 20 22 24

Heart Rate Variability (HRV)

13

Incoherence: Impairs Performance— Drains Energy

Coherence: Promotes Optimal Performance—Builds Resilience

HEA

RT R

ATE

HEA

RT R

ATE

InhibitsBrain Function(Incoherence)

FacilitatesBrain Function(coherence)

TIME (SECONDS)

100 –

90 –

80 –

70 –

60 –

50 –

100 –

90 –

80 –

70 –

60 –

50 –

1 50 100 150 200

Heart Rate Variability (HRV)

Heart Rate Variability- Typical Day

A Police Officer HRV During a High-Speed Pursuit Scenario

A Police Officer HRV During a Domestic Violence Scenario

Vagal ToneDefinition

• Vagal – Referring to the action of the vagus nerve; the 10th

cranial nerve, which relays information between the brainstem and most of the internal organs

• Tone– Tone is a term commonly used to refer to systems in

continuous and partial states activity, such as “muscle tone”

– In this context it means something similar to “tension” or “strength”

Low Vagal Tone

• Linked to high inflammation (Thayer & Sternberg, 2006)

and;• Forecasts higher risk for myocardial infarction

and decreased odds of survival after heart failure (Bibevski & Dunlap, 2011).

High Vagal Tone

• Is associated with superior abilities to regulate emotions (Thayer, Hansen, Saus-Rose, & Johnson, 2009)

• Show greater positive emotionality (Oveis, Cohen,

Gruber, Shiota, Haidt, & Kelther, 2009) and; • Show greater gains over time in their positive

emotions (Kok & Fredrickson, 2010).

Vagal Tone Physiology

RestingHR 70 BPM

MaximumHR 200 BPM

IntrinsicHR 100 BPM Potential

HRV - 30

SNSActivation

PNS VagusNerve

AGE IHR MAX Heart Rate

20 106.7 19430 101.0 18740 95.3 18050 89.6 17360 83.9 16670 78.2 15980 72.5 152

Maximal/Intrinsic HR and Age

20 30 40 50 60 700

50

100

150

200

250

Intrinsic Heart BeatMaximum Heart Beat

Maximal/Intrinsic HR and Age

BPM

AGE

20 30 40 50 60 700

50

100

150

200

250

Intrinsic Heart BeatMaximum Heart Beat

Maximal/Intrinsic HR and Age

BPM

AGE

Resting Heart Beat

20 30 40 50 60 700

50

100

150

200

250

Intrinsic Heart BeatMaximum Heart Beat

Maximal/Intrinsic HR and Age

BPM

AGE

Resting Heart Beat36

8

Improving HRV

• Lifestyle adjustments:– Exercise – Omega-3 intake – Yoga/qigong– Acupuncture– Emotional self- management (positive emotions)– Breathing practices (resonant frequency breathing)– HRV Biofeedback– Wine

Heart Rate Variability

• HRV 3 domains– Sympathetic component;– Parasympathetic component coupled with

respiration (RSA) … bottom-up;– Parasympathetic component independent from

respiration… top-down cortex influence

Top Down Central Autonomic Network (CAN)

PFC

ACC Insula

Amyg

Brain Stem

SympatheticActivation

ParasympatheticSuppression

Inhibits/down-regulates Activation

Bottom Up Respiratory Sinus Arrhythmia (RSA)

TidesBreathing

Inha

le

Exhale

Inha

le

Exhale

Inha

le

Exhale

Oscillations

Respiratory Sinus Arrhythmia(RSA)

• Respiratory = Breath Oscillations• Sinus = Sinus node Oscillations• Arrhythmia = Heart Rate Changes

Inha

le

Inha

le

Exha

le

Exha

le

Oscillations-Heart Rate Variability

Heart Rate

Breathing

Blood Pressure

What is Resonant Frequency?

• Current research suggests that every individual has a “resonant frequency” at which heart rate variability is the greatest.

Cardiac Coherence

12 breaths per minute

7 breaths per minute

5 breaths per minute

Heart Rate Variability Biofeedback

Part 2

Demonstration