[00:00:00] Welcome friends to the Heart Rate Variability Podcast this week in Heart Rate Variability Edition, each week we explore the latest research and news from the world of hrv. Please consider the information in this podcast for informational purposes only and not as medical advice.
[00:00:16] 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
[email protected] Please enjoy. I'm Matt Bennett. I'm glad you're here. Let's jump straight into the science and then pull practical threads you can use with your clients, your teams, and your own daily routine. Quick reminder before we start, all links to the papers and the article I discuss are in the show Notes. Our lead story comes from the Journal of Medical Internet Research.
[00:00:52] The paper is titled Interventions Based on Biofeedback Systems to Improve Workers Psychological well Being, Ment Health and Safety Systematic Literature Review the authors are Simo Ferreira, Mathilde Rodriguez, Caterina Mateus, Pedro Pereira Rodriguez and Nuno Barbosa. Rocha.
[00:01:10] Set the scene Workplaces are changing fast. Higher cognitive load, constant interruptions. Hybrid schedules can be great for flexibility and challenging for the nervous system. The authors asked a clear question when organizations use biofeedback, especially HRV and respiration based feedback, does it meaningfully improve psychological well being, mental health or even safety outcomes at work?
[00:01:36] It's a systematic review. So they looked across the research landscape and synthesized what's known. The through line is simple. Biofeedback in the workplace does two big things when it's done well. First, it creates awareness real time windows in distress physiology, especially sympathetic activation and vagal withdrawal.
[00:01:56] Second, it enables practice brief repeatable skills that close the loop between what people feel and what their body is actually doing. That's the behavioral engine of biofeedback. Notice a signal, try a regulation strategy, see the metric change and reinforce the learning. The authors highlight a cluster of biofeedback approaches that repeat across studies HRV guided breathing at comfortable slow rates, real time feedback delivered by wearables during the workday, short micro sessions rather than long sessions and importantly, embedding the practice into safety sensitive moments like transitions, pre shift check ins or post incident recovery. The core message for managers and clinicians who partner with workplaces is not teach people to relax, it's teach people to regulate while they work in practice. That looks like 60 to 180 seconds of paced breathing when a meeting ends or a one minute reset before a performance, critical task or a team ritual. Two calm breaths, one intention as a cue to start a shift. If you coach leaders and teams, this paper permits you to keep it simple and repeatable. It also gives you guardrails. Don't build your program as a one time training. Build it as a daily practice with reminders, live feedback, and short wins. 2. Don't only chase self report stress scales. Pair them with an HRV marker, a respiration marker, or a safety metric that matters for the job. That's how you keep alignment between brain, behavior and body. For clinicians supporting employees with burnout or anxiety, a practical protocol might look like this.
[00:03:36] First, assess.
[00:03:38] Use a validated burnout measure and baseline resting HRV captured at home on on two or three mornings. Second, teach one technique, not five. For most adults, that's a comfortable pace, around six to eight breaths per minute without breath holds. Third, define micro practice triggers after email batches, before presentations or between patient visits if you work in care delivery.
[00:04:02] Fourth, reflect with data once a week rather than every day. You're building confidence, not perfectionism.
[00:04:09] And if you run safety programs, add a recovery metric to your dashboard. It might be RMSSD changes during a shift or the percent of staff who completed a two minute regulation break each morning. Pick something you can observe, something you can coach, and something you can celebrate. Let me name the authors again so you can cite them in proposals. Simo Ferreira, Mathilde A. Rodriguez, Catarina Mateus, Pedro Pereira Rodriguez, Alex and Nuno Barbosa Rocha.
[00:04:37] Journal of Medical Internet Research, 2025. You'll find the link in the show notes. Our second story stays with HRV but moves from offices to the gym. This is a scientific reports paper from Nature titled Heart rate Variability response of intensity Match Strength training dependent on body position in females. A pilot randomized crossover study or authors are Johannes Lessing, Florian Wegener, Niels Hoepker, Kuno Hautenrat, Thomas Groenwald, and Roberto faltz. Scientific Reports 2025 I love this study because it does something simple and important. The team asked if you keep the intensity of strength training matched, does body position change the autonomic load? They compared a standing squat in a Smith machine to a seated inclined leg press. Same muscle groups targeted, same relative intensity, different positions and stabilization demands. The participants were young trained women. Here's the key.
[00:05:38] Before exercise, the seated leg press condition had higher vagal activity on average, measured by higher RMSSD than the standing squat condition. That makes sense. Standing asks more of your baroreflex and postural system. During the work, sets differences in HRV narrowed, but after the sets and in short pre post comparisons the the standing squat condition showed clearer evidence of parasympathetic withdrawal and a sympathetic tilt than the seated condition. In other words, when you stand and stabilize, you add a layer of orthostatic stress to the metabolic stress of the lift. What do we do with that? If you're programming strength for someone in cardiac rehab, long Covid recovery pots or autonomic vulnerability, seated or supported variations can be a smart first step.
[00:06:26] You're not lowering intensity forever, you're removing unnecessary autonomic load while you rebuild capacity. If you coach athletes, the same principle applies.
[00:06:37] Standing work adds a healthy tax to the system. When the athlete can tolerate it, you can periodize by position, start supported, progress to standing, then add unstable or unilateral elements later. For mental health clinicians, the translation is simple.
[00:06:53] Not all strength training has the same autonomic signature. If a client's daily HRV is down and recovery is flat, swapping a session from standing squats to a seated leg press may reduce autonomic strain without sacrificing the psychological benefits of moving heavy weight. The body position is a lever. Use it. This paper also reminds us to be careful with post exercise measurements. If you only measure five minutes after a set, you you might miss meaningful within set dynamics.
[00:07:23] For those of you who collect HRV during training, mark phases clearly rest set one, immediate afterload set two, and so on. And look for patterns, not single numbers. Again, that's lessing Wegener, Hoepker, Hottentrat, Grunewald, and Falz in Scientific Reports Link in the show notes Our third research story moves into psychiatry and computation.
[00:07:48] The journal is plos Computational Biology. The paper is titled Deep Learning Approach for Automatic Assessment of Schizophrenia and Bipolar Disorder in Patients using RR Intervals.
[00:08:01] Authors are Krzyszystof Konzek, Wilhelm Masarczyk, prz, Przemislaw Gump, Marcin, Romachevsky, Katarzynabuza, Pawel Sekoua and colleagues. The design is straightforward. The team recorded short ECGs with a low cost wearable and extracted RR intervals. They enrolled 60 participants, individuals diagnosed with schizophrenia or bipolar disorder, and healthy controls. They tested several machine learning models, including support vector machines, gradient boosting, multilayer perceptrons, and gated recurrent units on windows of about one minute and about five minutes. The goal wasn't to declare HRV a diagnostic test.
[00:08:43] The goal was to see whether patterns in RR dynamics contain enough structure to help distinguish clinical groups in a controlled setting. Two things stood out to me. First, even brief RR windows carry useful information when handled carefully Second model performance varied by architecture and window length, which tracks with clinical experience.
[00:09:03] The nervous system is dynamic and context dependent when what matters most is not a single statistic but the pattern and how you frame it.
[00:09:13] Let's be crystal clear for clinicians, this is not a tool you can or should use to diagnose schizophrenia or bipolar disorder. It is proof of concept that the autonomic nervous system carries trait like and state like signals that align with psychiatric conditions.
[00:09:29] If you work in community mental health, the takeaway isn't by an algorithm, it's the body is part of the picture. HRV and related signals can enrich assessment and track change alongside interviews, symptom scales and functioning. How could you use this carefully right now? Consider adding a very short morning HRV collection for clients beginning trauma therapy, CBT for insomnia or mood stabilization work. Frame it as a window into recovery capacity, not a label.
[00:10:00] Use the data to pace exposure to time, skills practice and to celebrate improvements in sleep and self regulation.
[00:10:07] If HRV tanks for three mornings in a row and the client reports agitation or sleep loss, slow the pace or add rest. If HRV stabilizes as mood stabilizes, reflect that win back to the client. That's clinical, ethical and person centered.
[00:10:26] One more note for researchers listening the paper evaluated one and five minute windows for routine care. Those are practical, but in therapy rooms, ultra short windows. 30 seconds during an emotion spike may be informative when paired with voice, movement or self report markers. That sets us up nicely for our fourth story in a moment. Before we go there, a quick mid episode thank you to our sponsor.
[00:10:52] This episode is brought to you by Optimal hrv. Optimal HRV builds tools for clinicians, educators and organizations to measure and train heart rate variability in ways that are simple, ethical and effective within the Optimal HRV ecosystem. You can collect morning HRV data, guide paced breathing sessions, and share clear visualizations with clients and teams. If you support frontline staff, you can deploy brief micro practices and track participation without turning wellness into extra work. If you're a solo therapist, you can bring biofeedback into trauma informed care with confidence.
[00:11:29] Learn
[email protected] and try the Optimal HRV app to put these ideas into practice. Alright. Our fourth research piece is an editorial that speaks to everything we've talked about so far. It was published in the British Journal of Psychiatry. The title is Clinical Breakthroughs or Research Oversights?
[00:11:49] The Imperative of Integrating Modalities to Differentiate Signal from Noise. The authors are Sigal Zilchimano, Amit Chizik, Aviv Nov, Mikal Malka and Yuval o' Dead It's a call to action in mental health science. We now have continuous streams of data, HRV movement, acoustic voice features, session notes, and more. The editorial argues that what looks like noise in a dataset may be exactly where the clinical signal lives. Consider a therapy session where a client is initially calm, then briefly breaks down into tears and then restabilizes. A classic pre processing pipeline might remove those spikes as outliers, but clinically, those are the moments we care about. Those are the moments where reconnection, repair and change happen. The authors push for multimodal integration. Not HRV alone, not voice alone, not symptom checklists alone. Layer them, anchor them in the client's ideographic pattern, then ask what shifts when the work is working. If you're a clinician, this isn't a mandate to run a lab. It's an invitation to hold multiple lenses at once.
[00:12:59] Ask your client what they felt. Notice how they sat. Glance at the breathing or HRV trace. If you collect it, listen to the voice, the pace, the pitch. Put those together in case formulation and in supervision. Over time, you develop a richer sense of the person's change process.
[00:13:18] There's a second challenge in the editorial that I think is vital for trauma informed care. Don't erase hard moments from the data. If a client's HRV plunges during a trauma narrative, but rises again by the end of the session, that isn't a session failure. That might be a session success.
[00:13:36] The autonomic system dipped into activation and then returned towards safety with support. If your pre processing pipeline deletes that dip, you lose the curative arc. For program leaders, this editorial also suggests a direction for quality improvement. Don't measure only endpoints. Measure the dynamics.
[00:13:56] Capture with consent how often a session includes a moment of high activation and successful regulation.
[00:14:03] Ask if those moments become less sharp over time or if recovery becomes faster. Those are embodied signals of progress that symptom scales often miss.
[00:14:13] Again, that's Zilchimeno, Chisik, Knopf, Malka and Oded in the British Journal of Psychiatry. The link is in the show Notes Our final item today is a news piece from Dear Media, written by Jane LaCroix and featuring Dr. Sarah Sall.
[00:14:28] Seven lab tests every woman in her 30s should know, according to Dr. Sarah Sallie. Published September 16, 2025 we don't treat news posts like peer reviewed research, but this one lines up with what many of you see in clinic and it's a helpful conversation starter, especially for women balancing high demand roles at work and at home. The Burnout 7 Dr. Sahl highlights are worth a quick tour. I'll tie each one back to HRV so you can connect the dots for clients.
[00:14:58] First, heart rate variability if you'll only track one metric, HRV is a solid choice. Low or unstable HRV over several consecutive mornings is a sign of reduced recovery capacity. It's not a diagnosis, it's a nudge to ask why poor sleep, high inflammation, grief, conflict, overtraining or the demands of caregiving. The helpful coaching move is to validate the strain and then offer one concrete experiment more consistent Wind down a gentle walk instead of a hard run or the two minute breathing practice we talked about earlier.
[00:15:33] Second progesterone especially in the late 20s and 30s, anovulatory cycles can appear even when bleeding is present. That can pull progesterone down, which often shows up as anxiety, lighter sleep and irritability. Clients sometimes hear your labs are normal when TSH and basic panels are fine. This article reminds us to think about ovulation and luteal phase health in practice. This means collaborating with medical providers when symptoms and HRV indicate strain that basic labs may miss. Third, the cortisol awakening response A single morning cortisol blood draw is not a map of a person's stress system. The pattern matters more than the spot. A blunted or erratic awakening response often mirrors subjective burnout, fragmented sleep and flattened HRV dynamics. If a client is curious and has medical support, a salivary car test can provide a reality check and can motivate lifestyle changes. You can then align HRV practices around morning light movement and short breathing practices rather than only relax at night.
[00:16:39] Fourth free T3 and reverse T3 chronic stress can alter peripheral conversion from T4 to T3, and reverse T3 can rise when the body is trying to tap the brakes. That can amplify the sensation of moving through mud. In counseling work, this is a moment for compassion. The client isn't lazy their system is protecting them. The right step is not to put more pressure it's building capacity with rest, steady nutrition, gentle movement and, when appropriate, medical care.
[00:17:12] 5th Ferritin Think of ferritin as the savings account for iron when it's low oxygen delivery and mitochondrial work. Suffer brain fog and fatigue. Rise HRV can drop if a client's HRV program isn't moving as expected and they report heavy cycles, postpartum depletion or restless legs, ferritin screening through their clinician is reasonable.
[00:17:37] Big caution here. Supplementation belongs under medical guidance.
[00:17:42] Sixth deep sleep time. Not just total sleep, but restorative slow wave sleep. Many clients can fall asleep but wake unrefreshed. For them, an HRV plan that ends with 10 minutes of doom scrolling will fail. Swap screens for simple breathwork or a paper book. Keep the bedroom cool and dark. Consider light strength training during the day rather than late night. High intensity HRV will often rise in parallel with deeper sleep.
[00:18:09] 7th glucose variability Even with a normal A1C, big swings can trigger night wakings, irritability and higher sympathetic tone. Clients can experiment with food, order protein at breakfast or 10 minute walk after meals. You'll often see calmer feelings and over time, steadier hrv. I like this article because it gives a language for multidisciplinary care. Therapy, coaching, hrv, biofeedback and lab guided medicine are not rivals, they are teammates. The right move is rarely do all seven tests. Right now, the right move is Start with one or two questions the client already cares about. Pair with daily HRV and build from there.
[00:18:49] Let's pull it all together with a few practical takeaways from the week. If you work in organizations, treat biofeedback as a behavior change loop, not a novelty. Ferrer and colleagues in the Journal of Medical Internet Research remind us that awareness plus practice drives change. Design short, repeatable micro sessions tie them to work moments and measure something the team values. If you coach, strength or rehab position matters. Lassing and colleagues in scientific reports show that standing work carries a different autonomic load than seated work, even when intensity is matched. Use that to scale training for clients with autonomic vulnerability and to challenge athletes when recovery is ready. If you practice in mental health, consider the body as data you can respect without overclaiming. Kjonczyk and colleagues in plos Computational Biology offer a proof of concept that brief RR windows hold a psychiatric signal. Use HRV to pace and to celebrate change, not to diagnose. If you lead research or quality improvement, keep the messy moments. Zilchimano and colleagues in the British Journal of Psychiatry argue that the dips and spikes we often discard may be the clinical breakthroughs. Integrate modalities and watch the dynamics, not just endpoints. If you support women navigating high demand seasons, the Dear media piece with Dr. Sara Cezell offers a helpful checklist. Start with HRV and sleep. Collaborate on hormone levels, cortisol patterns, thyroid function, iron levels and glucose variability as needed.
[00:20:26] Keep the work compassionate and paced. Let me leave you with a short client ready script you can borrow this week. When stress rises, we'll use data for awareness and skills for change. We'll track your HRV A few mornings a week. We'll practice two minutes of comfortable breathing after stressful blocks. If your HRV is flat or low for three consecutive days, that's not a failure, it's feedback. We'll slow down a bit, support sleep, and try again if symptoms suggest hormonal iron, thyroid or glucose imbalances. I'll recommend that you talk to your medical provider. We'll take one step at a time. Friends. Thank you for listening and for the work you do. If you found this helpful, please subscribe, share with a colleague and check the show notes for links to the specific papers and the article we covered today. A reminder that this podcast is sponsored by Optimal HRV.
[00:21:20] You can learn
[email protected] I'm Matt Bennett. This has been this Week in Heart Rate Variability. I'll see you next week.
