Heart Rate Variability (HRV) – A New Standard for Measuring Objective Therapeutic Outcomes with Acupuncture
Researched by Brendan Zachar A.P.
Heart Rate Variability (HRV) is a measurement that has been around for nearly 50 years and is used today by physicians and researchers in prominent universities and clinics to measure the functionality of the autonomic nervous system (ANS). HRV analysis is backed by nearly 20,000 studies worldwide indicating its usefulness in detection and prevention of a wide-range of illnesses. In the paragraphs ahead I will try to illustrate why I believe that incorporating this technology into our curriculum as practitioners will prove to be a worthwhile investment not only for our patients but also for the acupuncture profession in the years ahead.
The next step – a tool that bolsters objective evidence of acupunctures efficacy
Heart rate variability (HRV) is a method of measuring the beat-to-beat fluctuations of the heart, these heart beats can be measured to correlate, precisely, the functionality of the autonomic nervous system and can be used to assess autonomic imbalance, disease and mortality. Additionally a model of autonomic imbalance may provide a unifying framework within which to investigate the impact of risk factors, including psychosocial factors and work stress and how acupuncture by virtue of its ability to stimulate vagal tone can help offset these factors. 123
Variability means adaptability
A high heart rate variability is an excellent indicator of health and suggests adaptability and resilience, meaning the nervous system is able to adjust better to internal or external stimuli. Likewise, a poor HRV score indicates an increased risk of certain disease states and suggests an overall picture of poor health.
Rigidity vs Adaptability
Measuring the HRV score is useful in many clinical scenarios for acupuncturists and other health care providers such as in preventing and assessing disease and contributing risk factors, analyzing the effects of burnout syndrome, mental disorders, and the effects of stress on the body. More and more clinicians are using HRV analysis to quickly and effectively determine the state of health of their patients due to its seamless integration with standard medical testing. For these reasons HRV and the Analysis of the Autonomic nervous system is steadily gaining traction in the medical world.
Interestingly enough although the technology used today to measure HRV is state-of-the-art, the history of heart rate analysis has its beginning in the 3rd century A.D. when a Chinese doctor named Wang Shu-he documented this in his writings known as Mai Ching or The Knowledge of Pulse Diagnosis. One of the sentences he set down is often quoted today:
“If the heartbeat gets as regular as the knocking of the woodpecker or the dripping of the rain on the roof, the patient will die within four days.”
Early pulse checking physicians intuitively recognized how important beat-to-beat variability was as do cardiologists who use HRV scores for disease monitoring and risk assessment. Olympic Athletes track HRV scores to gauge conditioning protocols and optimal functioning in competitive events. Neurologists, acupuncturists, and behavioral therapists are among the class of practitioners who utilize this technology to provide a baseline to determine, scientifically, the overall health of the patient; as therapy progresses these practitioners are able to measure the impact treatment has had on the patients body and organ systems.
“Coherent HRV patterns are associated with increased synchronization between the two branches of the ANS and when sustained for long periods of time result in increased synchronization and entrainment between multiple body systems.” Researchers from this study determined there was strong evidence from randomized placebo control studies that acupuncture modulates HRV.1
As acupuncturist we learn in school that from a Western Medicine perspective acupuncture helps to relax the sympathetic nervous system (SNS) and helps to promote the rest and digest functionality of the parasympathetic nervous system (PNS). This balancing act between the SNS and the PNS results in homeostasis of the organism and the subsequent return to health. Emerging evidence indicates that acupuncture treatment not only activates distinct brain regions in different kinds of diseases caused by imbalance between the sympathetic and parasympathetic activities, but also modulates adaptive neurotransmitter in related brain regions to alleviate autonomic response. 4
To illustrate the possibilities of HRV in an acupuncture practice, figure 1. shows needle acupuncture for 20 minutes over the course of 10 treatments as having a positive effect on the autonomic nervous system by significantly reducing the sympathetic tone of the patient and by raising the parasympathetic tone considerably.
Figure 1. Analysis of an Acupuncture treatment utilizing HRV technology, (copyright ANS Analysis)
In the original sample, before the acupuncture was administered you can see that the sympathetic tone (red) was increasingly disproportionate to the parasympathetic tone (blue). This dysregulation of autonomic balance accounts for the development of many disease states. Therefore, HRV can be used by acupuncturists to determine the functional state of the autonomic nervous system and provide patients and practitioners a therapeutic marker that they can objectively use to validate their treatments.
These results are not anomalies as acupuncture consistently raises parasympathetic tone as demonstrated in The Journal of Autonomic Neuroscience where Sishencong points act to enhance cardiac vagal tone and suppress sympathetic activitity 2 , by stimulation of the median nerve at the level of P6 5 or as demonstrated by He, W. et al during auricular therapy.6
As an Acupuncturist I strive to offer this medicine to as many people as possible, in the most effective way possible and I am a firm believer that when used properly technology can help to create solutions to obstacles. I present this research to other acupuncturists so that they may use these tools to conduct research, demonstrating acupuncture’s efficacy, and paving the way for a future generation of evidence-based practitioners.
I’d like to thank the developers of ANS-Analysis for allowing me to compile this research. All images and software data copyright ans-analysis.com and Dr.Stephen Bortfeldt
Anderson, B., Nielsen, A., McKee, D., Jeffres, A. & Kligler, B. Acupuncture and heart rate variability: a systems level approach to understanding mechanism. Explore (NY)8, 99–106 (2012).
Wang, J. D., Kuo, T. B. J. & Yang, C. C. H. An alternative method to enhance vagal activities and suppress sympathetic activities in humans. Autonomic Neuroscience: Basic and Clinical100, 90–95 (2002).
Streitberger, K. et al. Effects of Verum Acupuncture Compared to Placebo Acupuncture on Quantitative EEG and Heart Rate Variability in Healthy Volunteers. The Journal of Alternative and Complementary Medicine14, 505–513 (2008).
Li, Q.-Q. et al. Acupuncture Effect and Central Autonomic Regulation. Evid Based Complement Alternat Med2013, (2013).
Abad-Alegría, F., Pomarón, C., Aznar, C., Muñoz, C. & Adelantado, S. [Modifications of sympathetic tone induced by acupuncture reflex. Sympathetic electrical response and stimulus of 6PC]. Rev Neurol31, 511–514 (2000).
He, W. et al. Auricular Acupuncture and Vagal Regulation. Evid Based Complement Alternat Med2012, (2012).