[00:00:00] Speaker A: Welcome to the Heart Rate Variability podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness. Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability Podcast is a production of Optimal LLC and optimal HRV. Check us
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Welcome, friends, to the Heart Rate Variability podcast. I am really excited for our guest today.
I met her over LinkedIn, just one of those random things where LinkedIn connected us and started just to look at the research being done by our guests today and got, I think, immediately, maybe the third in our back and forth on LinkedIn. Asked her to be on the podcast because I just couldn't wait to explore her work. So I'm really excited to welcome Rabia to the show and reveal just for our listeners. Can you just give a quick introduction of yourself before. I'm so excited to jump into your research, but just a quick introduction of you before we dive in.
[00:01:21] Speaker B: First of all, thanks very much, Madge, for inviting me here today. It's a pleasure to be here. So, yeah, my name is Rabia and I am a finally a PhD student at Bournemouth University here in the UK. And in terms of my academic background, it's been quite interdisciplinary in nature. I did my undergrad in biotech biotechnology, and then I went on doing masters in environment and human health at the University of Exeter here in the UK. And, yeah, so it's been quite sort of multidisciplinary in nature. And I. Yeah, so for my PhD, I'm looking at the effect of combat injury on heart rate variability in a cohort of british military veterans and personnel. And this PhD project is in collaboration with advanced study that I'll be talking about, you know, in the chat today.
[00:02:09] Speaker A: Awesome.
[00:02:10] Speaker B: So just a disclaimer, sorry, just to disclaimer that I'm not a clinician by any means, so, you know, I'm just, you know, a regular academic student.
[00:02:18] Speaker A: Yeah, that's. Yeah, that we can almost use the term doctor for. So you got my respect there.
So. So just before we dive into the specifics, I just kind of would love to hear when. How did HRV come onto your radar? When, when did you become interested? Because I'm assuming you could have gone a lot of different directions with your, your focus. Why HRV? How did you learn about it? I just love to get a little bit of background on what got you interested.
[00:02:54] Speaker B: Yeah, so I think I'm going to give you a very cheeky answer there. I think HRV found me, as in I landed on this project, so then I joined this project. It was already kind of predefined, as in the aims and the research question and everything. But of course, you know, along the way I sort of informed the, you know, how, the analysis plan and how we're going to be taking from there. So it has definitely evolved. But, yeah, prior to this PhD project, I didn't know much about HIV, so I was kind of, you know, HIV naive before I started working with this project. So whatever I've learned about HIV, it's been, you know.
[00:03:34] Speaker A: Yeah, well, impressive that you have. I'm just kind of looking at your, your page here. Uh, quite a bit of articles published already for someone, someone new to it, so. So let's dive in. So you come, you come into this project, uh, you know, you, you didn't have a whole lot of background on heart rate variability. I would love to get, because when I'm looking at your background, that there seems to be your expertise lying in, you know, heart rate variability as it applies to traumatic brain injuries with military veterans. If I'm kind of drawing that out, and I wonder sort of, what kind of are you learning from the research? I know that's a big question, but I'll give you plenty of room to explore some of the research you've done and the insights that have evolved out of the research.
[00:04:30] Speaker B: Yeah, so, yeah, it's a big question, so I'm just going to break the answer into a piece.
[00:04:35] Speaker A: Absolutely.
[00:04:37] Speaker B: So for you to understand my research, I think it's very important that everybody understands, you know, the advanced study here. So, because that's where, you know, that, that's where I'm using the data from. So advance is an acronym and it stands for armed services from our rehabilitation outcome city. It's a mouthful, but, you know, it's a collaboration between King's College London, Imperial College London and the academic department of Military Rehabilitation here in the UK. So it's a longitudinal perspective cohort study that is designed to span over 20 years and it aims to investigate the long term impact of combat injury on various psychological, physiological and social outcomes in british military veterans and personnel, those who served in Afghanistan. So that's the context.
So in terms of my research, just a correction there that I'm not looking at the, you know, traumatic brain injury and HIV, I'm looking at as a, as a wider aspect of injury, as in it's not just the TBI. So it's, it's a myriad, it's a wide collection of injuries there. We've got blast injuries, we've got gunshot wounds, we've got sores, fractures, burns and, you know, other sorts of injuries. And one interesting aspect about my research is that it's not acute trauma because, you know, in the past we've had loads of studies on acute trauma and HIV, so that's not the case here.
And again, connecting back to the advance, that advanced study is currently in the third wave of data collection. So we've already have two waves done. So I've looked at the baseline and I think I'm happy to share the results of the baseline analysis because that's something that's already published. You know, my papers that you've been reading.
[00:06:23] Speaker A: Yeah, I would love to learn. Yeah, please do share.
[00:06:27] Speaker B: Okay, so in terms of my results, so there, first of all, let me just give you a quick rundown of all the, you know, the themes that I've explored in my PhD so far. So I've looked at the reliability and validity of using ultra short term HRV, the one derived from femur RTA waveforms, as a proxy source for short term ECG HIV. So that's one aspect. And another set of papers I've looked at the association between combat injury and HIV and also looking at the effect of certain mediating factors that could potentially affect this relationship. And then I've also looked at the effect of different types of breathing protocols, like spontaneous breathing and slow paced breathing in the injured. So, yeah, it's been, it's been very sort of, you know, comprehensive, really. So I'm just going to take it one by one.
[00:07:24] Speaker A: Sounds good.
[00:07:27] Speaker B: So in terms of the results, first of all, you need to understand the composition of the groups there. So they've got two groups. We've got injured and the uninjured. So in the injured, we have participants who were injured during the deployment of monosome and they sustained severe combat injuries and that required, you know, aeromedical evacuation to a UK hospital for treatment rehabilitation. Whereas the uninjured group, and as the name implies, you know, they were uninjured and they have been frequency matched to the injured group based on their age, rank and role in theater and deployment periods. So that, you know, they are similar in characteristics, you know, in all those characteristics except the exposure is different, that being, you know, combat injury. So that's the difference between the two groups.
[00:08:19] Speaker A: So probably the psychological impact of being in war would probably be equal, similar. I mean, an injury obviously is the variable you're measuring, but both have been exposed to the psychological challenges or too.
[00:08:35] Speaker B: So both of the, both of the participants in the groups have been exposed to the same operation environment. So it's just the combat injury that's, you know, that's different.
[00:08:45] Speaker A: Gotcha.
[00:08:46] Speaker B: So in terms of the baseline, the reason I had to sort of explore the reliability and validity of, you know, ultra short term HIV was because we know that, you know, PPG has been used as a survey source for, you know, short term ECG based HIV. But this particular signal that I've used for my, you know, for my research had not been used before, so I had to sort of in a work from scratch, right from the scratch and establish its reliability and validity. And the results suggest that, you know, it's as reliable and as valid as the, you know, the ECG based five minute short term HRV. So that's quite interesting. Yeah, so, yeah, so that we have the measure there.
[00:09:26] Speaker A: So can you talk a little bit more? Because, you know, one of the things I was interested about when I was looking at your articles was the ultra short term heart rate variability. So I'm assuming that's the major that you're talking about for us HRV nerds out here. I think when you said, ooh, a valid measure, can you describe that in a little bit more detail for us?
[00:09:52] Speaker B: Yeah. So abuse the femoral altered waveforms to measure ultra short term HIV. And when I say ultra short term HIV abused RMSSD. So why RM SSD? Because, you know, it's a superstar in the HIV world because, you know, it's reliable and invalid in terms of, you know, ultra short term HIV analysis because that's what we've seen in the previous evidence. So informed by that. And of course because the length of that signal was just up to 16 seconds, I could not have gone for, you know, short term HIV and I could not have gone for other frequency based measures of HIV. So RMSSD seemed the most suitable measure of HIV. So that's what I've reported. So in a nutshell, I've looked at the association between ultra short term RMSD and combat injury in these two groups.
[00:10:44] Speaker A: Excellent. Thank you for that. So you're seeing that if I'm hearing you right, 16 2nd RMSSD, you validated that as a major.
Let me just ask the question. Equivalent to a five minute RMSSD measurement.
[00:11:03] Speaker B: Exactly. Yeah.
[00:11:03] Speaker A: Wow.
So would you, would you. So I just want to make sure, because I think everybody who's listening to this is jumping to the conclusion of, oh, that five minute reading that we're doing and have done for years.
We could get the same data in 16 seconds. Question mark. So let me throw that out to you because that's kind of what I'm sure you've got a lot of people listening to, potentially excited about.
[00:11:33] Speaker B: Yeah, I mean, that's. I think that's the, that's the type of question that's always been there, as in, you know, if, if it's as reliable as the short minute, as the short term HIV, is there any need to measure short term HIV? So, of course the answer is yes. I mean, you're looking at two types of things. You're looking at also short term HIV and short term HIV. Short term HIV has its own advantages. Ask a way to ultra short term HIV. You've got more limitations with ultra short term HIV because like I said, you're limited with just, you know, RMSD, whereas for short term, you have, you know, wider collection of other measures, like frequency based. You can tell more about the physiology, you know, with the help of frequency based measures. Not to say that, you know, our MSSD can't say that, but, you know, it's just, you know, that really depends on the type of question that you're trying to answer and the type of data, of course.
[00:12:26] Speaker A: Okay, so we shouldn't necessarily throw out our three, four, five minute approach. You're just, you're just kind of adding something really juicy and exciting to the existing research with looking at it from this perspective.
[00:12:44] Speaker B: Yeah. And of course, having said this, while I've looked at auto, short term HRV at baseline, at the first follow up, I've looked at short term HIV. So it's not like that. You know, I'm just relying on one method. It's better to explore that, you know, the ultra short MHR. We could also do the same thing. But I'm just saying that, you know, we just explore that, you know, there exists another way of looking awesome.
[00:13:10] Speaker A: That's so exciting. So if you just stop there, we would have a great episode that would blow a lot of people's minds. But let's continue into the research with the veterans now.
[00:13:23] Speaker B: Yeah, so this paper that I'm. The results that I'm sharing now. So this was published in BMJ, military health. So in this one, I was looking at the effect of combat injury on HIV ulcerative HIV using the method that I just described in the injured and also, you know, in the uninjured. So using the, you know, the multivariate regression analysis you know, the drug, you look at the associations after adjusting for the confounding variables there. So another interesting point that I'd like to highlight here is that I've not just looked at injury, I've looked at other aspects of injury as well. So I've looked at injury severity and injury mechanism and also the effect of amputation. So we found, through the multivariate regression analysis, we found that as compared to the uninjured code in the injured group, injury, high injury, sorority blast, as a mechanism of injury and amputation, all four of them were independently associated with lower rms.
In other words, it would mean that, you know, the injured group seems to have lower parasympathetic children as compared to the uninjured group. And it's not just, again, it's not just acute trauma. The time lapse since injury, it's been, on average, eight years.
[00:14:46] Speaker A: Okay.
[00:14:48] Speaker B: Yeah, yeah. So it is interesting. So it appears that, you know, even eight years after injury, where the injured participant should have gone, you know, to parasympathetic rebound, you know, in terms of recovery, it seems like it's not. It's not the case, or maybe the recovery time for that rebound is taking longer interest, you know, because it's been eight years in century. So that is an interesting finding. And because of the longitudinal nature of the data, would be interesting to see that, you know, if that's going to be changed, you know, with the upcoming.
[00:15:23] Speaker A: Follow ups, because I, you know, in, I think it's more popular literature, but by real researchers who I respect, it seems like there's this message we get, which, again, we're looking at a very specific population, a very specific injury, but like, oh, if you, if you have an accident, you go through something like an amputation, that basically you rebound.
I think it's like six to eight months, your happiness level and all this kind of rebounds, just like if you win the lottery, you know, you have a short term peak when you get that new car, new house, but then it kind of drops back to baseline. But what you're really finding is, and again, I think the powerful thing about your research is both groups have been in war, so they've experienced these things, but it seems like this trauma associated with a physical injury is lingering in a way that just, just the psychological traumas of war may not be. And that's, that's, that's fascinating. And I'm kind of reading you right with what you're. What you're finding.
[00:16:36] Speaker B: Yeah. Yeah, absolutely. So it's, I think in a nutshell the, the idea is that the effects of combat injury on HIV seems to be lasting rather than, you know, transient.
[00:16:47] Speaker A: Yeah.
[00:16:48] Speaker B: So, I mean, that's at least what the results suggest.
[00:16:54] Speaker A: Did you look at. Because I'm sure quite a few people in both groups may have gotten, like, mental health support for trauma. I'm sure there's PTSD in both groups and other things going on.
Did that variable play, did you study that? Did you see any, um, difference? Uh, if you did study it?
[00:17:21] Speaker B: Yeah, that's an interesting question. And, um, so that leads me to talk about the, the next analysis that I conducted. So, um, this analysis, the results that I'm talking about now, was published in military medicine, if somebody wants to give it a read. Uh, so, um, and this one, basically. So once I had identified that, you know, there is a significant association between combat injury and HIV, I wanted to dig deeper and see if this association was being mediated by the usual suspects. Like you said, depression, anxiety and physical function, like six minute warm and BMI.
I used the structural occasion modeling approach for the mediation analysis, and I found that to my surprise, that bmI, depression and anxiety did not significantly mediate the relationship between, you know, HIV and combine injury, but the six minute walk test did, so.
[00:18:19] Speaker A: Fascinating.
[00:18:20] Speaker B: Yeah. So, in other words, it appears that if there is any factor that could potentially offset the adverse effect of combat injury in HIV, it looks like could be enhanced physical function, or physical function for that matter. So that's quite interesting because we, this is quite a important evidence because we need that evidence to inform, you know, the recovery pathway and to, you know, all the practices, you know, related with the rehabilitation of the injured.
[00:18:51] Speaker A: Wow, boys.
So do you.
My mind's going in like 20 different places, which is not great for a podcast host to be stirring all this around. So, like, what do you think is happening? Let me just ask that question. Cause, I mean, what do you think is going on there? Because, I mean, amputations and injuries are probably. I'm just thinking about, like, what a leg injury versus an arm injury and movement and mobility.
Just give me your, your thoughts on this as I kind of organize a more logical question that I might follow up with, with that, what you just said.
[00:19:35] Speaker B: Yeah, I think that's a fair question. So, of course, like you said, you know, lots of things going on there.
But again, I think you have to be very cautious in terms of the interpretation there because I think the, since there are so many factors, you know, playing their part in this equation, so you need to be very careful. So I've just looked at one wave and, you know, that's what I've been talking to here. So it would be interesting to see that, you know, what we see in the upcoming waves follow ups, because, you know, it could be, you know, like our statistician would say, you know, it would be a blip, you know, yeah, maybe it's going to be change in the next follow, maybe change in the next one. We don't know that. But what it tells us, tells us is that it's preliminary evidence and it is an important evidence, and we need that information to sort of, you know, guide the other questions that we need to sort of answer this question in a holistic manner, if that makes any sense.
[00:20:34] Speaker A: Absolutely. And just out of curiosity, too, did you have. So collecting the ultra. Well, you just have heart rate variability data, but looking at the ultra short term, did you get that?
When did you start collecting that on the group? Was that a pre deployment? Was that a post injury? Like, I'm just curious about when did you kind of start collecting the baseline data?
[00:21:03] Speaker B: So it's been so, like I said, on. At baseline, the time to assessment, the baseline assessment has been, on average, eight years. So whatever data that we've collected in advanced city has been after.
[00:21:17] Speaker A: Okay. Okay. Just, you know, because of all those questions of, like, you know, again, just kind of trying to think about that. The impact on this on everybody and all those pieces, I think would be an interesting thing because of working with folks in the military, which, you know, I've worked with on the psychological end, with PTSD, with vets, especially severe things like addiction, homelessness, a range of kind of issues after the deployment's done, you know, is trying to, you know, what is happening with the psychological pieces of war. How does that, you know, how do both of those groups compare to a non military group or a military group that wasn't deployed into a war zone? All these kind of questions that I think are veterans helping them? You know, is the motivation here to. Yet the curiosity from our perspective is what's going on pre, post deployment, those sort of things.
Just fascinating to see what war does to somebody's autonomic nervous system.
[00:22:32] Speaker B: Exactly. I hear you. And I think it would have been equally interesting to see the pre deployment HRV. Of course, you know, we don't have that, but in the ideal would have been great. You need to see that, you know, how that's changed from pre deployment to, you know, after deployment, after injury, and then, you know, after several years since injury. Yeah. So that would be, you know, a great.
[00:22:56] Speaker A: Yeah, well, hey, you know, you get that doctor, we get fun with this. So I love, I love what you're doing here and how you're thinking about that. So before I move on, because I want to look at another aspect of some of the studies that you've done, but just any other sort of insights, I don't want to move on too quickly if there's more to cover here.
[00:23:21] Speaker B: Yeah. So one insight I've already shared in terms of the mediation, you know, the effect of six minute walk less as a mediating factor on the relationship between combat and drug HIV. So that was quite interesting to see. And the other thing would be, you know, seeing the. Of course, the investigation of different types of breathing protocol was not as such part of my PhD, but I've looked at it anyway because I was supposed to use one of the breathing protocols.
[00:23:48] Speaker A: Yeah, that's going to be my next question to you anyway, so let's dive in.
[00:23:53] Speaker B: I had to make an informed decision that, you know, so in advance at the first follow up and at the first follow we started collecting the ECG data, something that wasn't there at baseline and, you know, because it was all happening during the COVID so, you know, the timelines were disrupted. So that brought these changes.
[00:24:12] Speaker A: Yeah.
[00:24:13] Speaker B: Anyway, so, yeah, so for my other paper, the one published in Emno, I think so I was supposed to, I was supposed to make an informed decision as to which breathing protocol should be used when the aim is to assess the effect of combat injury on HIV. So I looked at spontaneous breathing and slow paced breathing at six cycles per minute, you know, and their factor in HIV.
And of course we know there is, you know, mounting evidence on it that, you know, slow paced breathing as six cycles per minute is associated with, you know, increase in RM'SD. Yeah, that's. And also, you know, other measures of HIV. But yeah. So back to my question, which breathing protocol should be used? So we thought that, you know, since we are trying to understand the, the physiological effect of combat injury on HIV, it would be better to go with spontaneous because, you know, slow paced breathing itself is an intervention.
[00:25:10] Speaker A: Yes.
[00:25:11] Speaker B: We don't want to, you know, cloud the results there. So that was basically idea, the idea behind this particular study. So it's, I think the findings are in agreement with the previous evidence that, you know, six cycles per minute, this breathing protocol does lead to increase in HIV and as compared to these pointing is breathing in the injured.
[00:25:34] Speaker A: So do you see? Oh, go ahead.
[00:25:36] Speaker B: I'm sorry, sorry. I just want to say that, you know, this does give us the preliminary evidence in terms of the use of HIV biofeedback therapy. I know that this is not exactly that, but, you know, the idea is still in the periphery that you could use HIV biofeedback therapy, almost no phase breathing and an intervention in this particular population to elevate HIV.
[00:26:02] Speaker A: So that's awesome. And I guess probably to our audience, not incredibly surprising at this point, as we've explored in the podcast so much on HRV biofeedback. I'm curious know one. Let me ask you a quick how often did you measure the ultra short term heart rate variability? Were you collecting this on a daily basis? Was this more folks coming into a laboratory setting? Just. I would love. I'm sure my audience is thinking, because the HRV nerds out there, like myself, is like, how often did you measure this? And then I got a follow up with the breathing thing. But just like, how did you get this data? How often did you collect it with these veterans?
[00:26:50] Speaker B: Yeah. So for the Oslo shelter matrix, so basically, in terms of the protocol, we've got the pulse wave analysis and pulse wave velocity that's measured using the y coordinate device, and we use the ECG recordings that's measured using the bitu valves. So for ultra short term HRV, because I've used femoral art here, waveforms from the pulse wave velocity measurement that's done using the Y coder. So that's coming from the Y coder. And we do that in a single session. And I forgot to tell you about the numbers. It's, you know, both in the, both in the injured group and the uninjured groups, we have 500 plus participants. So at baseline, the total number was 1145.
[00:27:32] Speaker A: Awesome.
[00:27:32] Speaker B: So it's, you know, lots of participants coming and, you know, it's quite fascinating to have that sort of data.
[00:27:40] Speaker A: Yeah, it's awesome. So when you saw the benefits of the pace breathing on ultra short term HRV, which again.
[00:27:52] Speaker B: Oh, go ahead, sorry, correction. So the pace breathing was on short term HRV.
[00:27:57] Speaker A: Okay. Short term HIV. So you're looking at that kind of like, which, let me see how best ask this question.
I'm curious of, obviously, when you pace your breathing, you're artificially, in some ways improving your heart rate variability scores. I'm curious because you may not have studied this, but did you see any longer term benefits? I don't know if this was. I guess the question is, was just this kind of a one time comparison or did you have a group, or did the group kind of do HRV biofeedback on a regular basis and then you could see improvements over time with this. Just kind of wondering how you looked at the difference in breathing.
[00:28:42] Speaker B: Yeah, that's a fair question. So it was just one time comparison? Yeah, yeah. Because, you know, we're not trying to deduce any intervention, but so we are quite aware that, you know, slow paced breathing is an intervention. So if, you know, the injured group is going to practice low paced breathing, it's going to ultimately affect all other outcomes.
[00:29:04] Speaker A: Absolutely.
[00:29:05] Speaker B: It's just one time thing and it's just in the protocol. So we have five minutes of spontaneous breathing that's followed by five minutes of pace breathing.
[00:29:14] Speaker A: Awesome. So pretty good. I mean, I'm sure probably the hypothesis going in is that we would see increased, but again, with this specific populations, really good to know that the pace breathing could help, I guess, over time. And this is speculation, so I always like to give researchers that heading to work on is that we are seeing improvements in HRV with paced breathing. But you weren't measuring the longer term impacts of an HRV biofeedback practice integrating there. But at least a little preliminary information that, you know, it does improve heart rate variability and in a very short term way to study it.
[00:29:58] Speaker B: Yeah, yeah. I mean, that's exactly the point. And of course it's important to look at that because ultimately the point is to use this information to design and inform interventions, you know, to, you know, to provide best possible care for the injured.
[00:30:15] Speaker A: Awesome. I'm curious about, I assume you're in somewhat of a conversation with folks in the military having access to all this data.
I just kind of interested to see what is your conversations been like. I'm sure people are. If I was in the military, I'd be wondering, okay, it seems like these sort of injuries have a longer term negative impact on our vets.
I'm sure they're asking you what's this mean for us or how can we better support that? P. So I'm curious about conversations you've had after publishing this research about how we might better serve those individuals who protect us.
[00:31:06] Speaker B: Yeah, I think. And that is a very important question to answer, I think. So in terms of my research, it's sort of feedback advanced study, it's feeding into a bigger research. So my project is a part of a bigger research. So it's not the advanced study, it's not just the hiv that we're looking at. We also looking at other aspects like mental health, we're looking at daily functions such as pain stress, perceived social support, and other factors as well, so. And cardiovascular risk outcomes as well. So what I'm trying to say is that it's not just one thing. So we are, all of us, we are trying our best to see and draw, you know, a fair picture of, you know, what the profile looks like for an injured participant as compared to the uninjured, so that we could use that information to sort of understand the long term impact of combat injury. And we are sort of taking that one by one, one thing at a time, in the sense that we don't have that evidence now. So we're trying to build that evidence. So once we had that, you know, evidence base, then we can take it to the next level and see that, you know, if there are any sort of interconnectedness. For example, my. I've recently collaborated with my fellow advanced researcher. We've looked at the association between PTSD and RMsse. So I can't talk about the results, but the results are really interesting because it's still in review. So I'm not going to be sharing the results, but, yeah, so, again, long story. Good short, I think the idea is to see if there is an opportunity to see the interconnectedness of different factors and how that's sort of ultimately affecting the end product.
[00:32:53] Speaker A: We got. Promise me to come back on the show when you are able to share that, that data, because my curiosity, I mean, really got sparked with, like, we have so many different kind of best practice trauma treatments now for psychological trauma, PTSD. And what I'm fascinated with your research is, you seem to be, and again, correct me if my words are off here, but what I see is that we may want to treat people with a physical illness or injury associated with the trauma of just being in war, being in battle, that there may be different ways to approach that group. Maybe it's just a different level of support. Maybe it's how we transition them back to society. You know, I think it opens. It probably opens up more questions, which is what great research does, opens up more questions than it answers. But to me, as a clinic, the clinical part of it is, okay, we're seeing maybe a different level of long term autonomic impact in this specific group.
I don't have any answers, but what questions do we need to be asking about how we could better serve them moving forward? And again, short term, ultra short term or short term, HRV potentially gives us a metric to measure that as we think about it more from that clinical side.
[00:34:25] Speaker B: Exactly. Yeah.
[00:34:27] Speaker A: Awesome. Well, is there anything we've missed because I've got a few final questions for you, but I want to make sure we haven't missed anything big in your research that you've been doing.
[00:34:41] Speaker B: Not really. I think we've covered the major bits and pieces, yeah.
[00:34:45] Speaker A: Awesome. So as somebody who kind of got into this HRV, having become part of this study, I'm just curious, what do you think about heart rate variability? Now? Like, we were outside the research, so we could just put that aside. Let's talk about you. You were new to this metric. I'm sure, having reviewed your work, you are now an expert on this metric.
What's this? What do you think about heart rate variability?
[00:35:19] Speaker B: Oh, gosh, that's an interesting question. So, and I think HIV is such a sensitive marker. I mean, no matter how many confounding variables you adjusting for, you controlling for, there is going to be something that seems to affect it anyway, so it is such a sensitive marker and it is quite fascinating at the same time. So. But, yeah, over the course of these three years, I've learned a lot and it's been, you know, quite a ride in terms of, you know, learning, you know, about HIV, the different methods, the different measures. And one recurring trend is that, you know, if HIV was a theme park that, you know, then RMSse would be, you know, the roller coaster. You can't just ignore it. It's always there. It's like an integral part of it. So no matter how many, you know, HIV measures we look at, it always boils down to RMSSD. So that's quite interesting to know that, because I think it saves you time, because I think it's sort of preferred because of, you know, certain reasons, like, you know, it's got better statistical properties, it's less influenced by the respiratory changes. So I think it's. It's a star because of some. Because of some reasons there, but, yeah, so that's my understanding of HIV now. And I think one more thing that I've learned is that HRV is not just, you know, one size fits all marker, if that makes any sense. So there is no one practical number that's applicable for everybody. So, you know, context matters a lot and it should be taken as a personalized and a bespoke marker, and especially in terms of military.
I mean, I would be a proponent of, you know, going with the HRV daily tracking so that, you know, the participants are able to establish their own baseline norms because, you know, yes, of course, you know, five minute, ultra short term HRV. These, they do tell us about the autonomic state. But, you know, when you do daily tracking, that tells you more. And, you know, you could as an individual, you could see that, you know, how adjustment to different lifestyle factors like, you know, sleep, diet, physical activity, all those things, how they could affect your own baseline HIV value and everything. So I think that's another thing that I've learned that, you know, use HIV as a beast of slash personalized marker and that's going to be more helpful. Yeah, but we can use that. I mean, that's what I'm going to be pitching for maybe in the future, but let's see.
[00:37:59] Speaker A: Yeah, well, that was my kind of follow up. Final question is, you know, now that you've sort of seemed to have the end in sight as far as going through your doctoral program, while what you have done in that process is spectacular. So congratulations. Just looking at your bio page on the university's website, I have seen, I've interviewed some people who've been in the field for 20 years without the publications that you have. So congratulations on really adding so much to our understanding in a relatively, I'm sure it doesn't seem like a short period of time to you, but in a relatively short period of time, where do you see yourself going? Are you going to be like, oh, as soon as I am out of here, I don't ever want to think about HRV ever again? Is it something that you see as part of your future? Are you just like, I got to get through the next few months and then ask me that question, Matt, I'm just kind of curious. Where do you see HRV playing in your future and the direction of your career coming out of school?
[00:39:10] Speaker B: Oh, that's a tricky question. So I haven't really thought about that. Of course, I've invested three years of my life, you know, researching about HIV, so I'm just, I'm not going to be, you know, leaving it and touch.
[00:39:21] Speaker A: Good.
[00:39:22] Speaker B: I am very much interested in looking at, you know, once, you know, with my PhD research, I've looked at, you know, the, how combat injury affects HIV. I think it would be only logical to see that, you know, how we could use HIV as an intervention now that we have seen the evidence. So I would be more interested in looking at, you know, how we could use HIV biofeedback or, you know, resonance frequency or, you know, all sorts of interventions or, and also, you know, looking at HIV, like I said, like HIV daily tracking or profiling and all sorts of things. So.
[00:39:58] Speaker A: Yeah, well, very cool because I was, I was hoping that would be your answer. Because coming out of just with this wealth of knowledge and understanding so early in your career, I was hoping you'd want to stick around and keep teaching us about this aspect because, again, what, the work that you're doing, I think, is what I know, I think will be really incredibly fascinating, not just the ultra short term, which was a new kind of idea for me. I mean, I could pretty much understand what it was. But, you know, just that little nugget was, you know, a huge thing that you are contributed to my understanding and then obviously working with the population that we should all care about really, you know, powerfully and have been through trauma, you know, unpacking this, but the way you have is just so important. So I'm glad you're, you're deciding to maybe continue to stick around and teach us more and more as your career evolves.
[00:41:08] Speaker B: Yeah, definitely. Well, thank you very much for your kind words, and that seems like a plan. And can I just take a quick moment and give a huge shout out to my supervisors? And of course, you know, they have been a huge part of this.
[00:41:21] Speaker A: Please take all the time you would like to give them credit, please.
[00:41:25] Speaker B: Yeah, so, you know, Professor Christina Christopher Boos and Professor Ahmed Pattad and everybody at the advanced city, because it's just on one person's job, really, with these many participants. So I'd like to acknowledge everybody who have played their part, ranging from the admin to the data collection team and to the portrait board and everybody involved. Thanks very much. Thank you for your kind words and the appreciation of the vote.
[00:41:49] Speaker A: Great. Well, I'm going to put a link in the show notes. People can find that, as
[email protected]. dot with all the articles you have written on this, because like I said, your bio is incredible and you're still in school. This is like, so I can't. Your cv coming out incredibly impressive to any future employers that you might have.
But I'm really excited and I am serious about once you publish that post traumatic stress article and you can talk about that research, you may contact your friends and family and tell them there's another article they need to read. But I want to be, like, in the top five people you contact after publication because I can't wait to see you have such a unique data set that I doubt not everybody has access to. So I'm really excited to see what comes out of that work that you do. So let's just count this as the first, hopefully several podcasts we do together. Because I can't wait to. To explore that piece of your research with you.
[00:43:02] Speaker B: Sure. I'd be happy. Be happy to share that in myself.
[00:43:06] Speaker A: Awesome. I'll put your university link in the show notes. Anything else? If somebody wants to get in touch with you or learn more about your work, is that the best place for them to go or any other place that you might recommend?
[00:43:20] Speaker B: No, I think that would be the best place to go. Are you looking at the staff profile?
[00:43:24] Speaker A: Yeah, absolutely.
[00:43:26] Speaker B: That would be the place, yeah.
[00:43:27] Speaker A: Awesome. Well, I will put that link in the show notes. And my friend, I cannot wait to have you back on the show at a later date. So thank you so much. And just as somebody, again, who's worked with veterans, more on the clinical side of things, what you're doing, we have a lot of conversations with the military about how we get special forces to be more special with the heart rate variability and HRv biop feedback.
Your work is so important to like over here we have the veterans administration and helping so many of our vets that have physical and mental health injuries from experiencing war that, you know, this research is just so powerful already pouring into a bunch of people that I know doing the work. So I appreciate you. I appreciate your focus on this. It's a huge gift to anybody who cares about this population, which should be all of us. So thank you so much for your work.
[00:44:29] Speaker B: Thank you very much. And it's been a pleasure to be here. And like I said, you know, I've been an avid listener and I've been following all your posts also. It's been a true pleasure to be here. Thank you very much.
[00:44:39] Speaker A: Thank you so much. And we'll see everybody next week.
