Main Article Content

Phillip Ebrall


Heart Rate Variability, Consumer Wearable, Watch


Objective: To present a pragmatic narrative of the measurements of my heart rate variability (HRV) gathered over a 6-week period. I propose both a meaning and a role for HRV in the clinical practice of chiropractic.

Methods: A consumer-wearable was used to gather convenience recordings of HRV (cHRV) for 3 weeks leading up to a week in which chiropractic spinal correction was received, and then for 3 weeks after. Data management and analysis occurred via an electronic spreadsheet (Numbers, Apple).

Results: The weekly mean of daily means for 3 weeks following 1 instance of chiropractic spinal correction showed a chance difference to the weekly mean of daily means over 3 weeks beforehand. The variance (VAR) of cHRV measurements taken over any 24h period show a high value of VAR, as do the weekly day-by-day means.

Conclusion: The statistical mean of a gathering of measurements holds more clinical meaning than any single instantaneous measure. It is pointless to take a single reading of HRV in a patient at the time of consultation, whereas considering the mean value of a series of measures provides useful values that may be a marker of change associated with chiropractic spinal correction. The convenience of taking measurements of HRV by a consumer wearable must not overshadow the importance of a reliable method of gathering and interpreting the data it provides.


Download data is not yet available.
Abstract 51 | HEART RATE VARIABILITY Downloads 29


1. Eingorn AM, Muhs GJ. Rationale for assessing the effects of manipulative therapy on autonomic tone by analysis of heart rate variability. J Manipulative Physiol Ther 1999;22(3):161-165. URL http://www.ncbi.nlm.nih.gov/pubmed/10220715?report=citation.
2. Budgell BSm, Igarashi Y. Case study: Response of arrhythmia to spinal manipulation: Monitoring by ECG with analysis of heart-rate variability [case report]. Chiropr J Aust: Sep 2000(30:3): 92-95
3. Kettner NW, Zhang J, Mrozek IB, et al. The effect of thoracic spinal manipulation on heart rate variability and heart rate [Poster resented at the Association of Chiropractic Colleges’ Eleventh Annual Conference]. J Chiropr Educ 2004;18(1):63
4. Nosco D, Zhang J, Pfefer MT. An interim data analysis of a multisite clinical study to determine the effect of chiropractic care on heart rate variability [Poster presented at Association of Chiropractic Colleges’ Eleventh Annual Conference]. J Chiropr Educ 2004;18(1):63
5. Budgell B, Polus BI. The effects of thoracic manipulation on heart rate variability: A controlled crossover trial. J Manipulative Physiol Ther 2006;29(8):603-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Citation&list_uids=17045093
6. Hart J. Optimal level of heart rate variability for spinal adjustment: A case report. J Contemp Chiropr 2019;2:Online access only p 103-8. URL https://journal.parker.edu/index.php/jcc/article/view/41
7. Haas AL, Russell D. Sustained improvement of heart rate variability in patients undergoing a program of chiropractic care: A retrospective case series [case report]. Chiropr J Aust 2017;45(4):Online access only p 338-58. URL http://www.cjaonline.com.au/index.php/cja/article/view/178
8. Caldwell S. Heart rate variability (HRV): What is it, and why does the Apple Watch track it? iMore 26 March 2018. URL https://www.imore.com/heart-rate-variability-hrv-what-it-and-why-does-apple-watch-track-it
9. Hao T, Chang H, Ball M, et al. cHRV Uncovering daily stress dynamics using bio-signal from consumer wearables. Stud Health Technol Inform 2017;245:98-102. PMID: 29295060
10. Plews DJ, Scott B, Altini M, er al. Comparison of heart-rate-variability recording with smartphone photoplethysmography, Polar H7 chest strap, and electrocardiography. Int J Sports Physiol Perform 2017;12(10):1324-1328. DOI 10.1123/ijspp.2016-0668. Epub 2017 Dec 22. PMID: 28290720
11. Plews DJ, Laursen PB, Stanley J, et al. Training adaptation and heart rate variability in elite endurance athletes: opening the door to effective monitoring. Sports Med 2013;43(9):773-781. DOI 10.1007/s40279-013-0071-8. PMID: 23852425
12. HRV4Training. Home. URL https://www.hrv4training.com
13. Altini M. The ultimate guide to heart rate variability (HRV) part 2: you measured. Now what? URL https://medium.com/@altini_marco/the-ultimate-guide-to-heart-rate-variability-hrv-part-2-323a38213fbc
14. Campos M. Heart rate variability: A new way to track well-being. Harvard Health Publishing. Harvard Medical School. 22 November 2017. URL https://www.health.harvard.edu/blog/heart-rate-variability-new-way-track-well-2017112212789
15. What’s The best heart rate variability monitor? Biohackers. URL https://www.biohackerslab.com/reviews/best-hrv-monitor/
16. Tegegne BS, Man T, van Roon AM, et al. Determinants of heart rate variability in the general population: the Lifelines Cohort Study. Heart Rhythm 2018;15(10):1552-1558. DOI 10.1016/j.hrthm.2018.05.006. Epub 2018 May 9. PMID: 29753022
17. Tsuji H, Venditti FJ, Manders ES, et al. Reduced Heart rate variability and mortality risk in an elderly cohort. Circulation 1994;90;2:878-883. URL https://www.ahajournals.org/doi/pdf/10.1161/01.CIR.90.2.878
18. Buccelletti E, Gilardi E, Scaini E, et al. Heart rate variability and myocardial infarction: systematic literature review and metanalysis. Eur Rev Med Pharmacol Sci 2009;13(4):299-307. PMID: 19694345
19. Agelink MW, Malessa R, Baumann B, et al. Standardized tests of heart rate variability: normal ranges obtained from 309 healthy humans, and effects of age, gender, and heart rate. Clin Auton Res 2001;11(2):99-108. DOI 10.1007/BF02322053. PMID: 11570610
20. Moore J. Normative HRV scores by age and gender [Heart rate variability Chart]. Elite HRV. URL https://elitehrv.com/normal-heart-rate-variability-age-gender
21. No author. HRV Demographics, part 1 – age & gender. Elite HRV. URL https://elitehrv.com/hrv-demographics-age-gender
22. Van Deusen . Everything you need to know about Heart rate variability (HRV). Whoop. URL https://www.whoop.com/thelocker/heart-rate-variability-hrv/
23. HRV4training. Heart rate variability (HRV) insights to help you quantify stress, better balance training and lifestyle, and improve performance. URL https://www.hrv4training.com
24. Ebrall PS. A determination of the applied laboratory error of the Metrecom computer-assisted goniometer. Chiropr Tech 1992;4(2):46-51
25. Alevaki H, Cust S, Ebrall PS. An estimation of the measurement error of the Metrecom for computation of sagittal spinal angles. Chiropr Tech 1993;5(3):104-106
26. Ebrall PS. An estimation of the measurement error of the Metrecom computer-assisted goniometer. Chiropr Tech 1993;5(1):1-4
27. 250+ Functions. Statistical. Apple. URL https://www.apple.com/mac/numbers/compatibility/functions.html
28. Steiner N. PDQ Statistics. Toronto: BC Decker. 1986:47-70
29. The slope of the regression line and the correlation coefficient. Thought Co. URL https://www.thoughtco.com/slope-of-regression-line-3126232
30. Interpreting the slope of a line. Statistics. LibreTexts. URL https://stats.libretexts.org/Bookshelves/Introductory_Statistics/Support_Course_for_Elementary_Statistics/Graphing_Points_and_Lines_in_Two_Dimensions/Interpreting_the_Slope_of_a_Line
31. Miyagi R, Sasawaki Y, Shiotani H. The influence of short-term sedentary behavior on circadian rhythm of heart rate and heart rate variability. Chronobiol Int 2019 Mar;36(3):374-380. DOI 10.1080/07420528.2018.1550422. Epub 2018 Dec 3. PMID: 30501447
32. Boudreau P, Dumont G, Kin NM, et al. Correlation of heart rate variability and circadian markers in humans. Annu Int Conf IEEE Eng Med Biol Soc 2011;2011:681-682. DOI 10.1109/IEMBS.2011.6090153. PMID: 22254401
33. Stein PK, Domitrovich PP, Lundequam EJ, et l. Circadian and ultradian rhythms in heart rate variability. Biomed Tech (Berl) 2006;51(4):155-158. DOI 10.1515/BMT.2006.026. PMID: 17061928
34. Chen HY. Circadian patterns of heart rate turbulence, heart rate variability and their relationship. Cardiol Res 2011;2(3):112-118. DOI 10.4021/cr41w. Epub 2011 May 20. PMID: 28352377; PMCID: PMC5358314
35. Singh RB, Weydahl A, Otsuka K, et al. Can nutrition influence circadian rhythm and heart rate variability? Biomed Pharmacother 2001;55 Suppl 1:115s-124s. DOI 10.1016/s0753-3322(01)90016-2. PMID: 11774858
36. Understanding and calculating variance. Scribbr. URL https://www.scribbr.com/statistics/variance/
37. Variance. Investopedia. URL https://www.investopedia.com/terms/v/variance.asp
38. Ernst G. Heart-Rate Variability - more than heart beats? Front Public Health 2017 Sep 11;5:240. DOI 10.3389/fpubh.2017.00240. PMID: 28955705; PMCID: PMC5600971
39. Galaasen Bakken A, Eklund A, Hallman DM et al. The effect of spinal manipulative therapy and home stretching exercises on heart rate variability in patients with persistent or recurrent neck pain: a randomized controlled trial. Chiropr Man Therap 2021;29:48. URL https://doi.org/10.1186/s12998-021-00406-0
40. Steinberg B, Clodgo-Gordon K, Russell DR. Reduction in anxiety & dysautonomia in five adult patients undergoing chiropractic care for vertebral subluxation: a case series & review of the literature. Ann Vert Subluxation Res 2020;:50-58. Abstract at URL https://vertebralsubluxationresearch.com/2020/03/19/reduction-in-anxiety-dysautonomia-in-five-adult-patients-undergoing-chiropractic-care-for-vertebral-subluxation-a-case-series-review-of-the-literature/
41. Santos-de-Araújo AD, Dibai-Filho AV, Dos Santos SN et al. Correlation between chronic neck pain and heart rate variability indices at rest: a cross-sectional study. J Manipulative Physiol Ther 2019;42(4):219-226. DOI 10.1016/j.jmpt.2018.11.010. Epub 2019 Jun 26. PMID: 31255310
42. Caldwell S. How to measure heart rate variability (HRV) on your Apple Watch. iMore. 26 April 2018. URL https://www.imore.com/how-measure-heart-rate-variability-hrv-your-apple-watch
43. Dvanesh. How to measure heart rate variability (HRV) on your Apple Watch. iGeeksblog 15 June 2020. URL https://www.igeeksblog.com/how-to-check-heart-rate-variability-on-apple-watch/
44. Burcon MT. Upper cervical specific pattern analysis utilizing paraspinal thermography, leg length inequality and heart rate variability in two patients with tachycardia [case report]. J Upper Cervical Chiropr Res 2016;2016(1):Online access only p 6-12. Paywall URL https://uppercervicalsubluxation.sharepoint.com/Pages/2016_1417_hrvtachycardia.aspx
45. McDowall D, Emmanuel E, Grace S, et al. Tone as a health concept: An analysis. Complement Ther Clin Pract 2017 Nov;29:27-34. DOI 10.1016/j.ctcp.2017.08.001. Epub 2017 Aug 12. PMID: 29122266
46. Lakusic N, Mahovic D, Kruzliak P et al. Changes in heart rate variability after coronary artery bypass grafting and clinical importance of these findings. Biomed Res Int 2015;2015:680515. DOI 10.1155/2015/680515. Epub 2015 May 20. PMID: 26078960; PMCID: PMC4452832