Interpreting HRV Trends in Athletes: High Isnt Always Good and Low Isnt

Always Bad
Heart rate variability (HRV) monitoring has become increasingly popular in both competitive
and recreational sports and training environments due to the development of smartphone
apps and other affordable field tools. Though the concept of HRV is relatively simple, its
interpretation can be quite complex. As a result, considerable confusion surrounds HRV data
interpretation. I believe much of this confusion can be attributed to the overly simplistic
guidelines that have been promoted for the casual-end, non-expert user.

In the context of monitoring fatigue or training status in athletes, a common belief is that
high HRV is good and low HRV is bad. Or, in terms of observing the overall trend, increasing
HRV trends are good, indicative of positive adaptation or increases in fitness. Decreasing
trends are bad, indicative of fatigue accumulation or overtraining and performance
decrements. In this article I address the common notions of both acute and longitudinal trend
interpretation, and discuss why and when these interpretations may or may not be
appropriate. We will briefly explore where these common interpretations or rules have
come from within the literature, and then discuss some exceptions to these rules.

This article will mostly focus on the log-transformed root mean square of successive R-R
interval differences (lnRMSSD), which is the vagal-HRV index used in popular smartphone
apps. For several important reasons lnRMSSD appears to be the preferred HRV parameter for
athlete monitoring.

1.

It can be easily calculated without specialized software

2.

It is reflective of cardiac-parasympathetic modulation

3.

It demonstrates greater reliability compared to spectral measures (e.g., HF power)

4.

It can be assessed in only 60 seconds

5.

It is less influenced by breathing rate, making it more suitable for field usage

Why a high HRV score is thought to be good and a low HRV score is thought to be bad

HRV-guided endurance training has been shown to be superior to pre-planned endurance

training in healthy1,2 and clinical subjects3 for inducing improvements in aerobic fitness

variables. Essentially, training with higher intensity/volume when HRV is at or above baseline
appears to elicit greater training adaptations. This results in high (or within baseline) HRV
being synonymous with readiness.

Acute decreases in HRV have been reported to occur following intense endurance
training,4 resistance training,5 and competition.6 Therefore, low HRV is commonly thought to
provide a reflection of acute fatigue from training or competing.
Where these interpretations can be misleading

Decreased HRV has been observed in a variety of athletes preceding competition as a result
of heightened levels of excitement or anxiety.6,7 Further, lower vagal-HRV has been reported
to be favorable in sprinters on the day of a race.8

Figure 1. Data I collected from a collegiate sprint swimmer leading up to a

conference championship shows a marked acute decrease on the first day he
competed, when he set a personal record. Wellness scores did not indicate fatigue,
and he tapered his training load in the preceding weeks. The pronounced decrease
in HRV on the day of competition can likely be attributed to anxiety/excitement.

A low HRV score as a result of fatigue also does not necessarily forecast impending
reductions in performance. A small case study of 3 high-level tennis players showed that
performance markers (VO2 max, single-legged counter-movement jump, and drop jump

index) improved following a 30-day overreaching period. The athletes expressed their
improved performance at the end of the training program despite showing decreases in
RMSSD (between -13 and -49%).9

This was also evident in a recent study of ours with a collegiate female soccer team 10 that
assessed changes in HRV (weekly mean and weekly coefficient of variation [CV, a reflection
of the day-to-day fluctuation in HRV scores]) and perceived wellness in response to weeks of
varying training load. During a high-load training week, wellness scores and the HRV weekly
mean were lower, and the HRV coefficient of variation was higher. All these changes indicate
a higher presence of fatigue.

Having devised and implemented the training program, I interacted with and observed the
athletes in terms of behavior, body language, etc. They were definitely experiencing fatigue.
However, they all completed workouts of higher volume and intensity in both the weight
room and during conditioning sessions. This indicates that they were still able to demonstrate
their strength and fitness qualities despite fatigue.

Therefore, in the presence of fatigue reflected by HRV, performance may or may not suffer.
HRV will typically show changes before performance decrements and thus may serve as an
early warning sign of fatigue accumulation. But do not expect your or your athletes
performance to be poor based on a low HRV score, as this certainly is not always the case.
Why an increasing trend is thought to always be a good thing

Increases in aerobic fitness have often been associated with increases in cardiacparasympathetic activity in a variety of individual and team sport athletes. A common
observation is that those who improve fitness also improve HRV, while those who do not
improve fitness show either no change or even decreases. For example, a study by Buchheit
and colleagues11 demonstrated that subjects who improved their 10K run time following a
training program also showed a progressive increase in their HRV, while non-responders
showed no meaningful changes. Large correlations between changes in HRV and maximum
aerobic speed and 10K time trials were found.

A recent study of ours currently in press12 evaluated how early changes in HRV relate to
eventual changes in intermittent running capacity in team-sport athletes. We found that
athletes who demonstrated an increase in their HRV weekly mean and/or a decrease in their
weekly HRV CV at the halfway point of a 5-week training program improved performance to a
greater extent than those showing the opposite HRV changes. In light of studies like these,

interpretation of an increasing HRV trend as being a positive response to training has become
popular.

Figure 2. A progressive increase in this athletes HRV trend can be interpreted as a

positive response due to concurrent progressive improvements in perceived
wellness (sleep quality, soreness, mood, fatigue), improved performance, and a
steady training load.

Why interpreting an increasing HRV trend as always a good thing can be misleading

Unfortunately, an increasing HRV trend throughout training is not always a good thing and
thus should not always be interpreted as such. In fact, several studies have reported
increasing HRV trends in overtrained athletes predominately involved in endurance sports.
For example, Le Meurr et al.13 showed decreased maximal incremental exercise performance
and increased weekly HRV mean values in elite endurance athletes following a 3-week
overload period, compared to a control group who saw no changes. Following a taper,
performance supercompensation was observed along with a return of HRV toward baseline.

Why a decreasing trend is always thought to be a bad thing

The most common response to overload training is a progressive decrease in HRV. This is
your typical alarm response to a stressor, where the sympathetic arm of the autonomic
nervous system is activated. In this situation, resting HR is elevated and HRV decreases. With
insufficient recovery time, HRV may not fully recover to baseline before the next training
stimulus and thus will result in a downward trend when this cycle is perpetuated. An intense
day of training can result in suppressed HRV for up to 72 hours post-exercise. 14 With the
higher training frequencies and training volumes often associated with overload periods, it
makes sense that HRV will show a decreasing trend. Typically, HRV will respond first with a
decreasing trend and performance decrements will follow if the overload period is sustained.

A study by Pichot et al.15 provides a good example of a decreasing HRV trend in response to
overload training. They showed that middle distance runners saw a progressive downward
HRV trend (up to -43%) during a 3-week overload period. In week 4, training loads were
reduced and HRV recovered and exceeded baseline values.

Figure 3. A data set I collected from a collegiate sprint swimmer. A progressive

decrease in this athletes HRV trend is observed during an anaerobic overload

phase with a progressive increase during the taper. The decrease in the trend was
associated with fatigue, assessed via daily wellness questionnaires which also
improved throughout the taper. We can confidently conclude that the decrease in
this athletes trend was due to accumulated training stress.

Why and when a decreasing HRV trend does not necessarily reflect fatigue

Aerobic exercise tends to have a stimulatory effect on parasympathetic modulation, which

can be observed in the HRV score the following morning. This is one reason why moderate
aerobic exercise is often used as an effective recovery modality. However, exercise intensity
is an important mediator of cardiac-parasympathetic responses to the training session. A
recent study by Plews and colleagues4 featuring Olympic-level rowers found that training
phases of high intensity (e.g., above the second lactate threshold) suppressed HRV, while
phases of lower intensities (e.g., below the lactate threshold) increased HRV.

This is important to understand when interpreting an HRV trend over time. Phases involving
moderate intensity aerobic work are likely to cause an increasing HRV trend, while phases of
high intensity conditioning with minimal low intensity work will cause a decrease. The
absence of low intensity aerobic work results in an absence of the stimulatory effects that
this training type has on parasympathetic activity.

Further, the high intensity training will be more disruptive to homeostasis as a result of
greater metabolic demand. In this situation, a progressive decrease in HRV can occur despite
no meaningful increase in levels of fatigue. Therefore, you shouldnt be alarmed if you
observe a decrease in your HRV trend when limiting moderate aerobic work.

Figure 4. Weekly mean HRV trend of a collegiate runner16 showing a progressive

increase in his HRV trend up to week 6, at which point the volume of aerobic work
is reduced and the trend decreases. This decrease was not associated with fatigue
or performance decrements, but simply due to changes in training content.

Figure 5. In this trend, daily HRV oscillates up and down in response to resistance
training. At the middle of the trend, HRV remains elevated with little fluctuation
and then eventually returns to daily oscillations. The middle of the trend

represents a two-week period where daily aerobic work was incorporated into
training and is likely responsible for attenuating typical daily fluctuations. Simply
removing the aerobic training content resulted in a decrease in the HRV trend but
did not include an increase in fatigue.

Conclusion

Monitoring HRV cannot be done effectively when following a black-and-white approach to

trend interpretation (i.e., high = good, low = bad). Further, relying on an HRV score alone to
assess training status will prove to be very difficult. HRV changes must always be taken into
context, by keeping track of training load, training type/content, lifestyle factors (sleep
quality, nutrition, stress, etc), and performance. These variables are complementary and
provide a more complete picture of training status.

Users should therefore observe the HRV trend -> analyze in the context of sport and lifestyle
demands (i.e., training load and psychometrics) -> determine the meaning of the change ->
adjust training or lifestyle factors if necessary according to the goal of the current phase.

REFERENCES:

1. Kiviniemi, A.M., Hautala, A.J., Kinnunen, H., and Tulppo, M.P. (2007). Endurance training
guided individually by daily heart rate variability measurements. European Journal of
Applied Physiology, 101(6), 743-751.

2. Botek, M., McKune, A.J., Krejci, J., Stejskal, P., and Gba, A. (2013). Change in Performance
in Response to Training Load Adjustment Based on Autonomic Activity. International Journal
of Sports Medicine, 35(6), 482-488.

3. Behrens, K., Hottenrott, K., Weippert, M., Montanus, H., Kreuzfeld, S., Rieger, A., and Stoll,
R. (2014). Individualization of exercise load control for inpatient cardiac rehabilitation:
Development and evaluation of a HRV-based intervention program for patients with ischemic
heart failure. Herz.

4. Plews, D.J., Laursen, P.B., Kilding, A.E., and Buchheit, M. (2014). Heart Rate Variability and
Training Intensity Distribution in Elite Rowers. International Journal of Sports Physiology and
Performance.

5. Chen, J.L., Yeh, D.P., Lee, J.P., Chen, C.Y., Huang, C.Y., Lee, S.D., and Kuo, C.H. (2011).
Parasympathetic nervous activity mirrors recovery status in weightlifting performance after
training. The Journal of Strength & Conditioning Research, 25(6), 1546-1552.

6. Edmonds, R.C., Sinclair, W.H., and Leicht, A.S. (2012). The effect of weekly training and a
game on heart rate variability in elite youth Rugby League players.

7. Morales, J., Garcia, V., Garca-Mass, X., Salv, P., Escobar, R., and Busca, B. (2013). The
use of heart rate variability in assessing precompetitive stress in high-standard judo
athletes. Int J Sports Med, 34, 144-151.

8. Merati, G., Maggioni, M.A., Invernizzi, P.L., Ciapparelli, C., Agnello, L., Veicsteinas, A., and
Castiglioni, P. (2015). Autonomic modulations of heart rate variability and performances in
short-distance elite swimmers.European Journal of Applied Physiology, 115(4), 825-835.

9. Thiel, C., Vogt, L., Brklein, M., Rosenhagen, A., Hbscher, M., and Banzer, W. (2011).
Functional overreaching during preparation training of elite tennis professionals. Journal of
Human Knetics, 28, 79-89.

10. Flatt, A.A. and Esco, M.R. Smartphone-derived heart rate variability and training load in a
female soccer team. International Journal of Sports Physiology and Performance. In press.

11. Buchheit, M., Chivot, A., Parouty, J., Mercier, D., Al-Haddad, H., Laursen, P.B., and Ahmaidi,
S. (2010). Monitoring endurance running performance using cardiac parasympathetic
function. European Journal of Applied Physiology, 108(6), 1153-1167.

12. Flatt, A.A., and Esco, M.R. Evaluating individual training adaptation with smartphone
derived heart rate variability in a collegiate female soccer team. J Str Cond Res. In Press.

13. Le Meur, Y., Pichon, A., Schaal, K., Schmitt, L., Louis, J., Gueneron, J. and Hausswirth, C.
(2013). Evidence of parasympathetic hyperactivity in functionally overreached
athletes. Med Sci Sports Exerc, 45(11), 2061-71.

14. Stanley, J., Peake, J.M., and Buchheit, M. (2013). Cardiac parasympathetic reactivation
following exercise: implications for training prescription. Sports Medicine, 43(12), 12591277.

15. Pichot, V., Roche, F., Gaspoz, J. M., Enjolras, F., Antoniadis, A., Minini, P., and Barthelemy,
J.C. (2000). Relation between heart rate variability and training load in middle-distance
runners. Medicine and Science in Sports and Exercise. 32(10), 1729-1736.

16. Flatt, A.A. and Esco, M.R. (2014). Endurance performance relates to resting heart rate
and its variability: A case study of a collegiate male cross-country athlete. J Austral Strength
Cond. 22:48-52, 2014.