Growing Your Business (or Practice) with HRV

by | Nov 29, 2018

This post is for anyone who helps clients improve their health, fitness and stress management, including:

  • Coaches, sports scientists and sports teams
  • Physicians and functional medicine practitioners
  • Wellness clinics (yoga, massage, meditation, cryo, etc)
  • Performance consultants
  • First responders
  • And others

It is a summary of our learnings from interactions with thousands of businesses that implemented heart rate variability (HRV) in boosting their services to their clients.

Before reading ahead, we recommend getting familiar with HRV: what it is, how it works, and how it is tracked (link). We also recommend downloading our free app (link) to receive an explanatory email series.

How Can HRV Assessments Help?

Businesses and practices have successfully used HRV assessments for:

  • Individualized training and performance: optimizing recovery and training while minimizing injury risk. Applies for endurance, power and mixed-modal sports
  • Individualized health improvement: identifying and tackling underlying health issues
  • Managing mental stress: teaching more effective meditation practices and resilience via HRV biofeedback
  • Objective measurable feedback: convincing clients of short or long-term impact of services (eg. chiropractic adjustments, yoga, meditation, psychiatric sessions, virtual reality sessions, massages, etc.)

And by doing so, these coaches, practitioners and consultants have seen improvements in:

  • Client empowerment and accountability: encouraging clients to track their HRV on their own, and actively participating in their improvement journey
  • Business revenue: growing revenue by a) keeping clients happier and longer; and b) offering HRV-services as an add-on charge
  • Standing out from the crowd: differentiating their business with new services and customized therapy.

How Can I Incorporate HRV Assessments?

We’ve compiled our experience into three broad categories.

1. Long-term Tracking of the Client’s Health and Training Impact

This involves having the client take HRV readings that are:

  • short (~2-minutes)
  • consistent (3-7 times per week)
  • typically done at home

HRV by itself is helpful, but benefits heavily from context: what exactly is the client doing that changes health or performance?

So HRV readings should be tracked along with lifestyle, training and treatment behaviors and events that put the HRV reading in context. These include lab values, perceived stress, mood, workouts (exercise), sleep, and other information from your intake forms.

By tracking HRV consistently and matching it up against useful context, HRV informs how your health, stress or training protocols are working for your client.

Every 1-3 months (or unless the HRV data shows a major deviation), the client could have a consult. During the consult, the data is reviewed and health/stress/training protocols are adjusted.

If you’re interested in learning more, click below:

How to set this up: important questions

This process requires clients to track HRV and other aspects of their training and lifestyle at home – on their own. How will you provide the right training for your clients to do this without your supervision?

  • An excellent “teaching moment” is taking the client’s reading while they are in the office with you
  • A typical time for this is after the new client intake process

How will you provide the tools for your clients to do this at home?

  • Clients require an HRV tracking app and appropriate sensor. Some businesses choose to sell the sensors on-site to clients, or incorporate the cost of the sensor into a service fee
  • Ideally, the app also easily captures the clients’ lifestyle, treatment or training context as well – so you don’t have to ask for this during a consult.

How will you track the results of each clients’ HRV tracking?

  • We do not recommend asking clients to manually bring in their results
  • Our online Dashboard tool aggregates client data for you, and allows for easy trending and reporting
  • Beginner clients will need more frequent monitoring than advanced clients, where tools like coefficient of variation (link) would be more useful

How many readings will you ask clients to take to create a “baseline” for comparison to your treatment impact?

  • We recommend a minimum of 5 readings within a 10-day period to create an accurate baseline
  • More readings may be required if the client is undergoing unusual stress load at the time

How often do clients have to take readings each week?

  • It depends on how often you plan to analyze the data and what you’re trying to learn:
    • If you’re looking at progress on a weekly basis, you’ll want them to take 4-7 readings per week to give you enough basis for advice.
    • If you only want to see big picture changes over months, you may only need quarterly or monthly HRV “check-ins”: 5-10 readings in a 10-day period

What will you do if a clients’ home readings show a “red flag” (like a sudden change in HRV)?

  • A “red flag” could have different definitions for different businesses or clients within a business
  • Our dashboard automatically highlights members with the largest relative changes in HRV (as measured by Morning Readiness Indicator)

It is best to have a plan-of-action to change a treatment/training-regimen or arrange for the client to have a consult.

A plan of action that addresses health should typically manage:

  • Sleep quality and quantity
  • Nutrition, in terms of adequate macro and micronutrient intake and also avoidance of inflammatory foods
  • Mental stress, at home and work
  • Environmental toxins like mold or pollution
  • In some cases, underlying infection or chronic conditions, which might require testing

A plan of action that addresses training should typically manage over- or under-training by manipulating:

  • The above factors that address health, plus:
  • Volume (distance, time, sets, reps)
  • Intensity (speed, weight, target-heart-rate, rest period, movement complexity)
  • Tailoring schedule (daily vs weekly or cyclical changes to training)

How will you document the results for each client?

  • Documentation is smart business, and most are required to do so.
  • Documentation also helps when giving difficult feedback to clients, since you have objective reports and data to back up your recommendations.
  • Our online Dashboard includes easy methods to generate charts, trends and reports for each client, that can easily be printed or stored for documentation and consults.

2. HRV Assessments Before and After Therapy

With this option, you take the client’s HRV readings immediately before and after your intervention/therapy. This acute difference in HRV could demonstrate the effectiveness of that therapy.

Therapies that up-regulate parasympathetic activation may show short-term increases in HRV. Examples include chiropractic adjustments, massages, virtual-reality therapy, infrared-laser treatment, meditation and psychiatric counseling.

In some cases, these therapies may stimulate a stress reaction (sympathetic response), which may be desired in some circumstances. In all cases, you still receive important feedback about your therapy.

By providing these before-and-after HRV scores, you:

  • Demonstrate to clients the impact of your therapy – with objective quantifiable data
  • Collect this data to build your case studies and marketing of your services
  • Get immediate feedback to tailor your therapy

If you’re interested in learning more, click below:

How to set this up: important questions
What aspect of HRV will you measure?

  • Our HRV score is based on RMSSD, one of the most researched markers of autonomic nervous system activation
  • Our platform offers flexible analysis of other HRV values, like frequency and non-linear methods (Poincare plots, etc). These alternatives have also been validated in peer-reviewed research for various applications.

What tools will you use?

How will you track the results?

  • Your tool should include a dashboard (link) that aggregates client data for you, and allows for easy comparisons and reporting
  • Beginner clients might show different patterns than advanced clients

How will you show the data to your clients?

  • Your tool (link) should include an easy method to generate charts, trends and reports for each client, that can easily be printed or stored for documentation and consults.

What will you do if a client or therapy does not show expected HRV changes?

  • HRV is impacted by many factors. It does not always implicate your therapy. These factors include:
    • The therapy did not have a large or systemic enough impact on the clients’ autonomic nervous system. In some cases, a multi-factor approach is required, such as therapy PLUS sleep or diet changes
    • Some other health factor plays an overwhelming role (for example, alcohol intake). This is where input questionnaires are helpful
  • HRV is one of many inputs collected by you. Always compare to other inputs (eg. from your intake forms). Sometimes it might make sense to go over the intake form again.

3. HRV “Live” Biofeedback During Therapy

Certain deep breathing patterns have a strong effect on HRV by activating the parasympathetic nervous system.

By tracking HRV “live” during these guided breathing sessions, you give clients get real-time feedback on the effectiveness of their breathing, mindfulness, and other stress-management techniques.

Depending on your goals, an effective session should show a gradual increase in resting HRV.

Over time, they learn faster, making their future sessions more valuable and helpful. They also develop a useful skill to use on their own.

This biofeedback is useful for a wide range of applications like stress management and resilience, tactical breathing/focus, increasing mental performance, PTSD, pain management, anxiety treatment and more.

If you’re interested in learning more, click below:

How to set this up: important questions

What aspect of HRV will you measure?

  • Our live HRV score (link) relies on RMSSD, one of the most researched markers of parasympathetic activation.
  • Other options include HF (high frequency), total power density, PNN50 and Poincare plots.
  • Ideally, you’ll be able to look at all these options.

Will you measure HRV “live” during a session? Our app allows for live-charting so you or the client can see HRV patterns in-session

Will you educate, train and provide tools for clients to do this at home?

  • Clients would need our free app and an HRV sensor (like the CorSense finger sensor)
  • Some businesses re-sell the sensors on-site to clients, charging either a unit price, or incorporating the cost of the sensor into a separate fee for HRV biofeedback services

Conclusion

There is no single answer to what HRV assessments may work best for your clients.

It depends on the nature of your business, types of clients, and specific goals. In many cases, a combination of the above three strategies may work best.

But it’s simply to give HRV assessments a try since:

We’ll update this post as more information comes our way. Please let us know your own experience at support@elitehrv.com, we’d like to learn from you!