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Physical Health

Heart Rate Variability (HRV) and Women's Health

Jasveer Matharu, Dr. Natalie Brown

• 13 min read
heart rate variability (hrv)

With more and more devices available on the market, measuring Heart Rate Variability (HRV) is becoming accessible to most. But what is it? and can it help us improve our overall health?

Understanding Heart Rate Variability (HRV) is like having a window into how your body handles stress and overall well-being.

Let's take Emma for example; Emma, a 35-year-old working mom, always felt tired, like she was running on empty. Between her job and family, she had little time for herself. When she started tracking her HRV, she noticed how different aspects of her life affected her readings. This empowered her to start taking small steps, like practicing deep breathing exercises during her lunch break and opting for a salad instead of fast food. Over time, these changes reflected in her HRV readings – she was genuinely managing her stress better!

We cover Heart Rate Variability (HRV) in great detail below. If you are short on time here are the top 4 points we would like you to take away:

  1. HRV is a holistic health indicator: HRV is a key indicator of the autonomic nervous system's balance, reflecting not only heart health but also how effectively the body manages stress and recovers. Monitoring HRV can offer essential insights for tailoring personal health and wellness strategies.
  2. Lifestyle choices can impact HRV: Daily habits like diet, exercise, and sleep have a significant impact on HRV. Balanced nutrition, regular exercise, and quality sleep improve HRV, indicating better stress resilience and heart health, while poor lifestyle choices can have the opposite effect. As such, measuring HRV can help you quickly assess how different factors and choices in your life are impacting your health. Opposite to heart rate, higher HRV i.e. an increase in variability is positive.
  3. Breathing exercises can positively influence HRV: Regularly practicing breathing exercises, such as diaphragmatic or rhythmic breathing, can positively influence HRV by activating relaxation responses. Integrating these exercises into daily routines can effectively manage stress and improve heart health.

What is Heart Rate Variability (HRV)?

Heart Rate Variability (HRV) refers to the variation in time intervals between consecutive heartbeats. Unlike heart rate, which measures the average number of beats per minute, HRV focuses on the slight variations in time between these beats.

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Note: HRV is not about the heart beating faster or slower, but rather the subtle changes in the timing between each heartbeat. These variations are influenced by the body's autonomic nervous system (ANS) and are a sign of the heart’s ability to respond to various physiological and environmental stimuli.

Difference Between HRV and Heart Rate

  • Heart Rate: This is the average number of heartbeats per minute. It's a straightforward measure that indicates how fast the heart is beating.
  • HRV: HRV analyzes the exact time intervals between heartbeats, which can vary from beat to beat. This variability is a more complex and nuanced measure, reflecting the heart's responsiveness and the balance of the Autonomic Nervous System (ANS).

The Science Behind HRV

HRV is generated primarily by the autonomic nervous system's control over the heart. The ANS adjusts the interval between each heartbeat in response to internal and external factors, such as physical exertion, stress, or relaxation.

Influencing Factors: Various factors can influence HRV, including breathing patterns, hormonal fluctuations, metabolic processes, and even psychological states like stress or happiness.

Understanding the Autonomic Nervous System (ANS)

The Autonomic Nervous System (ANS) controls involuntary body functions like heart rate and digestion. It consists of two main parts:

  • Sympathetic Nervous System (SNS): Activates the body's 'fight or flight' response, increasing heart rate and reducing HRV.
  • Parasympathetic Nervous System (PNS): Promotes 'rest and digest' activities, decreasing heart rate and enhancing HRV.

HRV and The ANS

The balance between SNS and PNS is crucial for Heart Rate Variability (HRV). HRV is a key health indicator – higher HRV signifies better cardiovascular health and stress resilience, while lower HRV can point to increased stress or potential health issues. This balance reflects not just heart health but the overall ability of your body to adapt to stress.

Gender Differences in HRV Readings

(note: when talking about gender, we mean biological sex)

Heart Rate Variability (HRV) differs significantly between men and women, influenced by physiological, hormonal, and lifestyle factors. A meta-analysis showed that:

Findings for Women:

  • Women generally have a faster heart rate and less variation in the time between heartbeats.
  • Their heart rate variability shows more influence from the part of the nervous system associated with rest and digestion (higher high-frequency power).
  • There is less influence from the part of the nervous system associated with stress or 'fight or flight' responses (lower low-frequency power).

Findings for Men:

  • Implied by comparison, men have more variability in the time between heartbeats and a different balance in the nervous system's control over the heart, with relatively more influence from the 'fight or flight' system.

These gender-specific trends in HRV highlight the importance of personalized approaches in monitoring and managing heart health.

HRV and Women's Health

Women's health and HRV are deeply interconnected across different life stages, from the menstrual cycle and pregnancy to menopause, each bringing its unique physiological changes.

Impact of the Menstrual Cycle on HRV

Sex hormones, particularly estrogen and progesterone, play significant roles in modulating heart rate variability (HRV) in women. Estrogen tends to enhance vagal tone, which is associated with the body's rest-and-digest response and is reflected in HRV measurements. Conversely, progesterone, while calming in the brain, can decrease vagal tone, thus affecting HRV. These hormonal fluctuations throughout the menstrual cycle introduce variations in HRV readings.

HRV During the Follicular Phase:

In the follicular phase, when hormone levels are lower, HRV is at its peak (i.e. most variable), indicating a higher resilience to stress.

HRV During the Luteal Phase:

After ovulation, as progesterone levels rise, there is a stimulation of the sympathetic nervous system that results in a lower HRV, indicating reduced stress resilience.

Oral Contraceptives and HRV

The use of hormonal contraception (HC) affects HRV in patterns distinct from natural menstrual cycles. HRV tends to increase at the beginning of HC pill use but decreases over the course of taking active pills. It reaches its lowest point during the first few days of the placebo pill phase. This information is crucial for women using combined oral contraceptive pills to understand their stress resilience and recovery needs, which vary throughout their HC cycle.

HRV Changes During Pregnancy

Pregnancy introduces major bodily changes, including in HRV. Typically, HRV may decrease due to the increased heart rate and cardiac output needed to support the fetus. This is a normal response but requires careful monitoring as significant deviations can indicate health issues.

HRV During Menopause

Menopause marks another significant phase where HRV patterns can change. The decline in estrogen levels during menopause can lead to a reduction in HRV, reflecting changes in the autonomic nervous system’s function. This hormonal shift leads to a decrease in HRV, indicating an increase in fight-or-flight activity and a decrease in rest-and-digest activity. The change in HRV baseline during and after menopause is not typically captured by wearable technology, which can lead to inaccurate recovery predictions.

Moreover, the decrease in HRV is associated with an increased risk of cardiovascular diseases, making it crucial for menopausal women to monitor their heart health.

What is a Good HRV Score for Women

Determining a "good" Heart Rate Variability (HRV) can be quite nuanced, as HRV is highly individualized and influenced by many factors such as genetics, lifestyle, fitness level, and overall health. Additionally, HRV tends to decrease with age. However, there are no universally accepted "good" HRV values for specific ages or genders, including for women at different ages. The following are generalizations, and should not be taken as definitive benchmarks.

  • HRV for a 20-Year-Old Woman: Younger individuals, including women in their 20s, typically have higher HRV. This is due to a more resilient and responsive autonomic nervous system at a younger age. A typical HRV might range anywhere from 55 to 105 milliseconds.
  • HRV for a 30-Year-Old Woman: Women in their 30s may still have relatively high HRV, possibly ranging from 45 to 95 milliseconds, although lifestyle factors like stress, diet, and exercise start to play a more significant role.
  • HRV for a 40-Year-Old Woman: In the 40s, HRV might begin to show a gradual decline, the range might be around 40 to 85 milliseconds.  However, maintaining a healthy lifestyle can significantly influence HRV positively.
  • HRV for a 50-Year-Old Woman: Around this age, women may experience menopause, which can affect HRV due to hormonal changes. A decrease in HRV is not uncommon, for example in the range of 35 to 75 milliseconds, though this can vary.
  • HRV for a 70-Year-Old Woman: In older age, HRV typically decreases, possibly falling in the range of 25 to 65 milliseconds, depending on overall health and fitness levels. However, good health practices can help maintain better HRV levels even at this stage.
table from https://peterattiamd.com/

Measuring HRV: Tools, Techniques, and Personal Tracking

Devices and Apps to Measure HRV

Measuring Heart Rate Variability (HRV) has become more accessible thanks to a variety of devices and apps. These range from sophisticated medical equipment like ECG (Electrocardiogram) machines to consumer-friendly wearables like smartwatches and fitness trackers. Many of these devices use sensors to detect heartbeats and calculate the time intervals between them, providing an HRV score. Popular devices include brands like Apple Watch, Fitbit, and specialized HRV trackers like the Oura Ring.

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Note: each device has its unique way of measuring and presenting HRV data, making it crucial to understand their methodologies and accuracy levels.

Understanding HRV Readings

Interpreting HRV readings can be tricky, especially since a 'good' HRV varies from person to person. Generally, a higher HRV is associated with better cardiovascular fitness and stress resilience, while a lower HRV might indicate stress, fatigue, or health issues. However, it's important to consider personal baselines and trends over time rather than isolated readings.

Personal HRV Tracking

Personal HRV tracking involves regularly measuring and recording your HRV, often using a wearable device. This ongoing monitoring can provide insights into how different aspects of your lifestyle – like exercise, sleep, diet, and stress – impact your HRV. For instance, you might notice that your HRV improves with certain types of exercise or good sleep quality, or it might decrease during periods of high stress or poor diet.

Practical Tips for Accurate HRV Measurement:

  • Consistency in measurement: To get the most reliable data, it's best to measure HRV at the same time each day, typically in the morning right after waking up.
  • Understanding the limitations: While these devices offer valuable insights, they are not foolproof. Factors like device placement, skin contact, and even dehydration can affect the readings.
  • Interpreting the data: Use HRV data as one of many tools to understand your health. It should be considered alongside other factors like mood, energy levels, and overall well-being.

What Do Different HRV Scores Mean?

Interpreting HRV scores can feel like cracking a code. In general, a higher HRV indicates good health, particularly cardiovascular health and stress resilience. It suggests that your body is better at adapting to stress and recovering from it. Conversely, a lower HRV can signal stress, fatigue, or potential health issues.

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However, it's crucial to understand that HRV is highly individual. What's a 'high' or 'low' score can vary greatly from person to person. The key is to track your baseline and changes over time, rather than comparing with others.

One of the most valuable aspects of HRV tracking is identifying patterns and trends in your readings. Over time, you might notice that certain lifestyle factors like lack of sleep, poor diet, or high stress lead to a lower HRV. Alternatively, activities like regular exercise, meditation, or quality sleep might boost your HRV. Recognizing these patterns helps you understand what your body needs for optimal health and can guide you in making healthier lifestyle choices.

When to Seek Medical Advice

While HRV tracking can provide a wealth of information about your health, it's not a diagnostic tool. If you notice persistent low HRV scores or a sudden, significant drop in your HRV that doesn't align with your lifestyle factors, it's wise to seek medical advice. Additionally, if you experience symptoms like chest pain, shortness of breath, or unusual fatigue alongside changes in your HRV, consulting a healthcare professional is crucial. They can help determine if there's an underlying health issue that needs attention.

The Impact of Lifestyle on HRV: Diet, Exercise, and Sleep

By understanding how diet, exercise, and sleep impact HRV, you can take proactive steps to improve your overall heart health and well-being. Although we cover them individually, it's essential to understand that these lifestyle factors are interconnected. For example, exercise can improve sleep quality, which in turn can positively affect HRV.

Moreover, everyone's body responds differently. Monitoring your HRV can help you understand how your diet, exercise, and sleep patterns specifically affect your heart health.

Diet and HRV

Your diet plays a significant role in determining your Heart Rate Variability (HRV). Here's how:

  • Nutrient-Rich Diet: A balanced diet full of fruits, vegetables, whole grains, and lean proteins can positively influence HRV by providing essential nutrients that support heart health.
  • Avoiding Processed Foods: Highly processed foods and those high in sugar can have a negative impact on HRV, potentially leading to increased stress and inflammation in the body.
  • Hydration: Staying well-hydrated is essential. Dehydration can stress the heart and negatively impact HRV.
  • Caffeine and Alcohol: Moderation is key. Excessive consumption of caffeine or alcohol can lead to increased heart rate and reduced HRV.

Exercise and HRV

Regular physical activity is key to improving HRV, but the type and intensity of exercise matter:

  • Aerobic Exercise (Cardio): Activities like walking, running, and cycling, when done regularly, can enhance HRV by strengthening the heart and improving cardiovascular efficiency.
  • Strength Training: Moderate strength training can also positively impact HRV, though excessive high-intensity workouts without adequate recovery might lower HRV temporarily.
  • Rest and Recovery: Allowing adequate recovery time between intense workouts is crucial for HRV improvement. Overtraining can lead to a decrease in HRV.
  • Mind-Body Exercises: Yoga and Pilates, known for their relaxation and breathing focus, can significantly improve HRV by reducing stress and enhancing parasympathetic activity.

Sleep and HRV

Good sleep is crucial for optimal HRV:

  • Quality Over Quantity: It's not just about how long you sleep, but also the quality of sleep. Deep, uninterrupted sleep cycles are beneficial for HRV.
  • Consistent Sleep Schedule: Going to bed and waking up at the same time daily helps regulate your body’s internal clock and improve HRV.
  • Sleep Environment: A comfortable, dark, and quiet sleep environment promotes restorative sleep, positively affecting HRV.
  • Avoiding Stimulants Before Bed: Substances like caffeine and nicotine can disrupt sleep patterns and negatively impact HRV.

Take a Tailored Approach:

Personalized Approach: Everyone’s body responds differently to diet, exercise, and sleep changes. Use HRV tracking to identify what works best for you.

  • Combining Factors: Often, it’s a combination of diet, exercise, and sleep improvements that lead to the most significant HRV enhancements.
  • Mindfulness: Being mindful of how lifestyle choices affect your HRV can guide you in making healthier decisions.
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In short, HRV makes the case for a holistic approach to health. It's not sufficient to workout and eat healthy if we are not also looking at how we manage stress in our lives.
I think this point is really important as we may often feel guilty if we don't workout when actaully our body and mind needs rest. 

Understanding the Stress Response and Its Effect on HRV

Stress affects not just your mind but also your body, especially your Heart Rate Variability (HRV). When you're stressed, the 'fight or flight' response kicks in. This is controlled by your sympathetic nervous system. During this response, your body releases hormones like adrenaline and cortisol, getting you ready to face the stressor. While this is helpful in dangerous situations, too much stress or frequent stress can be harmful. It keeps your sympathetic nervous system active more than it should be, leading to a lower HRV. This lower HRV means your heart isn't adapting as well to changing situations, a sign that your body is under too much stress.

Techniques for Managing Stress

Managing stress effectively is key to improving HRV. Here are some practical ways to manage stress:

  • Mindfulness and Meditation: These practices help in grounding thoughts and emotions, reducing the impact of stress. Mindfulness involves staying present and fully engaging with the current moment without judgment. Meditation often focuses on breath or a mantra to achieve a state of calm.
  • Physical Activity: Regular exercise, particularly aerobic exercises like walking, running, or swimming, can significantly alleviate stress. Exercise releases endorphins, which are natural mood lifters.
  • Social Support: Engaging with a supportive community or talking to friends and family can help mitigate stress. Social interactions can provide a different perspective, emotional support, and a sense of belonging.
  • Time Management: Organizing and prioritizing tasks can reduce the feeling of being overwhelmed. Breaking down tasks into smaller, manageable steps can help in dealing with stress more effectively.
  • Relaxation Techniques: Activities like deep breathing exercises, progressive muscle relaxation, or practicing yoga can activate the parasympathetic nervous system, countering the body's stress response.

Creating a Personalized HRV Improvement Plan:

Assessing Individual Needs and Goals

Creating a personalized HRV improvement plan starts with a thorough assessment of your individual needs and goals. This assessment is crucial because HRV is influenced by a multitude of factors, including age, fitness level, stress, sleep quality, and overall health conditions. Understanding where you currently stand in terms of these factors can help tailor a plan that is both effective and achievable. Consider aspects like your current stress levels, lifestyle habits, and any health concerns you may have. This assessment should also involve recognizing your personal goals – whether it's stress reduction, improving athletic performance, enhancing sleep quality, or overall health improvement.

Building a Sustainable Routine

Once you have a clear understanding of your needs and goals, the next step is to build a sustainable routine that can positively impact your HRV. This routine should encompass various aspects of wellness, including:

  • Diet: Incorporating heart-healthy foods and staying hydrated.
  • Exercise: Including a mix of aerobic and strength training exercises tailored to your fitness level.
  • Stress Management: Employing techniques like mindfulness, meditation, or yoga.
  • Sleep Hygiene: Establishing a regular sleep schedule and creating a conducive sleep environment.

It's important to integrate these elements into your daily life in a way that feels manageable and enjoyable. The goal is not to overhaul your life overnight but to make gradual changes that can be maintained in the long run.

Setting Realistic Expectations

Setting realistic expectations is key to the success of any health improvement plan, including one focused on HRV. Understand that changes in HRV occur over time and are influenced by consistent effort and lifestyle modifications. It's also important to recognize that there will be fluctuations in HRV – daily stressors, illness, and other factors can temporarily impact your readings.

Instead of striving for perfection, focus on overall trends and sustained improvements. Celebrate small victories and be patient with the process. Remember, improving HRV is not just about reaching a number but about enhancing your overall health and well-being.

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Jas Author Note: I have yet to start tracking my HRV. With so many devices on the market, it can sometimes feel overwhelming to choose one. Especially as the cost is considerable. However, after researching HRV in depth, there is a strong case for utilizing this metric to understand better how my lifestyle is impacting my overall health. I will record my journey measuring HRV and report back in a follow-up post!

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