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Strong Medicine

Exploring the Science, Art and Practice of Sustainable Health and Strength

Rest and Recovery

HRV and the Self-Rated Health Scale

September 8, 2016 By Dr. Chris Hardy Leave a Comment

HRV and Self-Rated Health

This is the fourth in a series of articles developed from Dr. Chris Hardy’s live presentation at Dragon Door’s Inaugural Health and Strength Conference. Click here to read the first article of the series.

In the previous posts of this series we were estimating the size of the stress cup. But, there’s a more reliable way to measure it. We’ll use the interrelationship of the brain, the cardiovascular system, and the musculo-skeletal system for another window into the stress cup. The first window is heart rate variability, the beat to beat variation of the heart rate.

We will use HRV as a window into the autonomic nervous system and how it relates to the heart. This will show us the stress load on a given day. On a high stress day, the sympathetic nervous system is dominant—the fight or flight system will drive the heart with a machine-like precision (low variability). This indicates a state of allostatic overload, poor health, and an overflowing stress cup.

Caption: In this chart, the beats are the same distance apart. That machine-like precision is not good. It's a sign of bad health and stress to the system.
In this chart, the beats are the same distance apart. That machine-like precision is not good. It’s a sign of bad health and stress to the system.

Now, in the normal state—when you have good readiness and a manageable stress cup—you’re in parasympathetic dominance and will have that good, high variability.

In this chart, the time between each beat is slightly different. That's how a healthy heart and nervous system actually works. It's imperceptible, but if you measure it accurately you'll see the variability between beats.
In this chart, the time between each beat is slightly different. That’s how a healthy heart and nervous system actually works. It’s imperceptible, but if you measure it accurately you’ll see the variability between beats.

There are several apps that calculate HRV and will give you a score. There’s also a section in Strong Medicine that shows you how to do that in training. It’s a very simplistic approach, but its good for our purposes.

Joel Jamieson, a Seattle area MMA trainer uses HRV in training in a very sophisticated way so definitely look him up if you want to learn even more. But, I prefer a more simplistic and intuitive approach. But, before I show you my approach I want to quickly review another simple way to assess the state of the nervous system.

MiniHomuncDiagA homunculus is a representation of what we would look like if we were physically configured according to the proportion of brain required to operate our body parts. Do you see how big the hands are? A huge portion of the brain is involved with the sensation and motor control of the hands. For example, grip training has a huge impact on the nervous system. Grip strength is also a good way to tell the status of the nervous system. This idea has been used in the former Eastern bloc countries for a long time, and Charles Poliquin wrote about it pretty recently.

Charles Poliquin’s protocol starts with recording a baseline using a Dynamometer. You can get them pretty cheaply on Amazon. Be sure to measure grip strength in kilos when you (or your client, if you are training others) are feeling good. Then on the morning of training, measure it again, and if you drop 2kg, then you may want to reconsider training. If you drop 4kg from the baseline, then you might even consider taking a rest day. it’s a simple way to do it. Do you have to continually measure grip strength or HRV with all your clients? No, that would be ridiculous, fortunately there’s another method.

 

The Self-Rated Health Scale

In terms of predictors of who will develop chronic diseases, and who is at risk of dying, what is the best marker to use? We’ve used all kinds of blood tests, and every other imaginable test, but the best predictor we’ve found is to ask this one question:

“In general, would you say your health is on a one to five scale? With one being the best and five being the worst?”

Believe it or not, that self-rated health question was more accurate than any medical test in predicting if someone would develop a chronic disease in the next 5-10 years. There’s a new area of neuroscience intensely studying interoception, the brain’s subconscious awareness of our organ systems. Many of you who read Strong Medicine know that our gut and intestinal tract has just as many neurons and nerve cells as the spinal cord. Some even call it the “second brain”. When you have a gut feeling about something or butterflies in your stomach, that’s the brain actually monitoring the state of our organ systems on a subconscious level. It can also induce stress responses, which is why diabetics have an on-going low-level “fight or flight response” due to this interceptive process monitoring the state of the internal organs and immune system. The brain knows something bad is happening and that we need to be on alert. This system also gives you an intuitive sense of how you are doing.

A new study came out about HRV and focused on measuring what correlated best to Self-Rated Health. We already know the question predicts disease very well—they measured every blood test, cholesterol, inflammatory monitors, and many other tests, but what correlated best with Self-Graded Health was heart rate variability. People with high HRV (good) usually said that their health was about 4-5 on the scale (the highest health scores). So, how you intuitively feel physically and mentally is very predictive of your stress cup. This is why an intuitive approach to a given day’s training could be very valid. Even though there are some really sophisticated tools such as the Recovery Stress Questionnaire For Athletes—which is a validated tool—I guarantee that none of your clients will want to sit down and answer 76 questions.

If you’re training elite athletes, it’s great, but it is not practical for those of us in the trenches. My next suggestion is not validated, and I haven’t tried it out—so you can be the test group—what if we replaced the Self-Rated Health question with the following:

“In general, would you say your readiness to train is… excellent, very good, good, fair, or poor?”

I would also suggest verifying it by testing grip strength and heart rate variability first before asking the question to see how they correlate. Over time it will help them get an intuitive sense of how they are and fine tune their conscious awareness of interoception. So, when they give you a rating, you can also look at the data (grip strength and HRV), and over time this will be a pretty good window into how they’re doing.

 

Getting Your Clients Onboard with Smart Programming and Recovery

How do you convince your client that this stuff really matters? It’s essential. If you want to train hard, you’ve got to recover harder. You need to tell your clients that they need to reduce their stress cup and earn the ability to train hard. The results they want will only happen with a proper balance of training and recovery.

The first thing they have to fix is their sleep, and there’s a whole chapter in Strong Medicine about doing that. Stress management, meditation, yoga, whatever you want to do is fantastic. Massage and acupuncture are unbelievable for helping to reduce stress and enhance the parasympathetic nervous system. If you like qigong, tai chi, all that stuff is fantastic as well to achieve the same goal.

Obviously, cleaning up the nutrition is a whole lecture into itself. As is feeding your activity levels. If you are going to crush yourself with high intensity training, you need to replace that muscle glycogen. If you’re only doing a walking and strength-based program, you can go very low carb and be fine. But if you want to push that anaerobic threshold, then you will need to feed that activity or you will overtrain.

 

Summary:

First, estimate their stress cup size. Then, estimate what is filling it today, since it will be different that what fills it tomorrow. Then, we will prescribe an appropriate exercise volume and intensity—and that’s what you guys as trainers know how to do well already. Now, you have the extra information to help you adjust the sets and reps, intervals and modalities. And while you don’t have to assess the stress cup every time you train your clients, I think you should always ask the self-report scale question and then prescribe the appropriate amount of training.

I don’t think you need to use HRV on the average client. But, if you are working with elite athletes, you will need to cover all those bases. The most important thing for everyone is to always emphasize the importance of recovery.

Now, using this approach is very simple, and I provided the scientific foundation for how we came up with this very easy system. If you train someone this way, they will meet their goals. It will be sustainable, unlike those three or four weeks crash diets and radical exercise routines. With this method, every New Year, instead of starting over with a resolution, they can just continue building on the success of the previous year. This is just a framework, so use your expertise as a trainer to customize your programs.

The final post in this series will be the best of the question and answer portion of Dr. Chris Hardy’s presentation.

 

***

Chris Hardy, D.O., M.P.H., CSCS, is the author of Strong Medicine: How to Conquer Chronic Disease and Achieve Your Full Genetic Potential. He is a public-health physician, personal trainer, mountain biker, rock climber and guitarist. His passion is communicating science-based lifestyle information and recommendations in an easy-to-understand manner to empower the public in the fight against preventable chronic disease.

Filed Under: Cardiovascular training, Rest and Recovery Tagged With: Dr. Chris Hardy, exercise programming, exercise recovery, grip strength, Heart Rate Variability, HRV, Self Rated Health, Self-Rated Health Scale, Strong Medicine, training others

Don’t Fear the Sleeper!

November 12, 2015 By Michael Krivka 6 Comments

Don't Fear the Sleeper by Mike Krivka

Want to lose fat and gain muscle? Want to improve your cognitive ability and decrease reaction time? Want to increase your ability to heal from illness and injury? Want to do it without taking expensive supplements or complicated diets? Sure, everyone does! Then let me tell you a little secret: Sleep is one of the key factors in losing fat, gaining muscle, staying sharper, and living longer.

We live in an environment where sleep is the enemy and something that is actively avoided and delayed. Is there a cost to this habit? There sure is, and it’s a high one at that! From the increase in chronic illnesses (heart disease, cancer, diabetes, obesity, etc.) to deaths due to sleep deprivation, we are paying a high price.

SM_DTFS_002“Red Bull Nation”

Man is the only mammal that willingly delays sleep and goes to extremes to avoid it. The increase in the consumption of coffee and energy drinks (the fastest growing market segment for soft drinks) should be some indication that people are either avoiding sleep or are trying to cope with the aftermath of not getting enough of it.

If you are an athlete you may have your nutrition and exercise dialed in, but if you don’t get the commensurate recovery (i.e. sleep) it is all for naught. In no uncertain terms, sleep is just as important as diet and exercise. Consider this: your body does not make changes or adaptations during a workout; your body only makes organic changes during sleep. Repair of damaged cells, the regeneration of DNA, the release and regulation of critical hormones are all reliant upon one thing–sleep.

Too Little Too Late

In general, most healthy adults need between seven to nine hours of sleep a night; but if you are regularly training hard, your requirements might be higher. Professional athletes like Roger Federer, Lebron James, Lindsey Vohn and Michelle Wie, regularly get between nine and twelve (yes, twelve!) hours of sleep! There are many factors that contribute to the amount of sleep you will need: environment, diet, medications, stress, etc. The trick is finding the right amount of sleep you need and getting it on a consistent basis. Regardless if it is seven or ten hours, you need every minute of it to meet your potential!

The Benefits of Sleep

Testosterone and growth hormone levels, as well as other key hormones, elevate during sleep. This is part of the body’s physical and mental repair system. These hormones assist in recovery as well as strength and fitness gains. These hormones start to release after being asleep for about 30 minutes. These hormone levels elevate every time you go thru a certain phase of your sleep cycle. The longer you sleep, the more cycles you go thru, and the more of these recovery promoting hormones will be pumping through your body.

Setting the Stage for a Perfect Night’s Sleep

Hopefully it won’t take a lot of convincing to get you to devote a little more effort to getting more and better quality, sleep. So, what do you need to do to get a good night’s sleep? You really need to make the effort to “set the stage” to stack the odds in your favor. The following are some things you can do to give you the best chance at getting a restful and productive (yes productive) night’s sleep:

  • Go to bed and get up at the same time every day – …Even if you are on the road or in a different time zone. You should try to follow this, within reason, so that you don’t disrupt your set sleep cycle. My instructor, Guro Dan Inosanto, travels somewhere every weekend teaching workshops. He gets up at the same time every day, around 4:00AM PST, so that even when he is on the East Coast he will be getting up in time to be at a workshop that usually starts at 10:00AM. While he should be suffering from horrible sleep deprivation because of his teaching, training, and traveling schedule, he is still going strong at 78 years old.
  • Use “sleep aids” sparingly if at all – Some studies show promise for the use of melatonin in shortening the time it takes to fall asleep and reducing the number of awakenings, but not necessarily total sleep time. Other studies show no benefit at all with melatonin supplementation. If you are traveling or trying to recover your natural sleep cycle, then a dose of a melatonin supplement might be just what you need to get you back on track… but it might not be beneficial to take it every night. How important is melatonin? Extremely! Melatonin holds the key to not only sleep but also cellular and DNA regeneration, the release of growth hormones, and is a natural anti-inflammatory. Do you really think that missing sleep isn’t important now?
  • Sleep in a dark room – Block out all of the light sources in the room… and that includes ambient light from clocks, night lights, phone chargers, etc. “Black out” curtains are another option if you live in an urban environment and have a lot of “light pollution” from the outside invading your sleep space. Can’t block out all of the light in the room? Then get yourself a high quality sleep mask that will block out all light.SM_DFTS_005
  • Eliminate sources of noise – One of the best investments I’ve made in the past few years was replacing the windows in my bedroom. The old ones allowed as much noise into the bedroom when they were closed as when they were open! Try to make your sleep space as quiet as possible, but a little noise might be a good thing. White noise from a fan or even a white noise machine (or an app on your phone) can help you drop into sleep faster. Another alternative is getting ear plugs. There are a number of different configurations on the market, from wax to foam, and you’ll need to find ones that are the most comfortable for your ear configuration and which block an acceptable amount of noise.
  • Cool is better than warm – Keep your bedroom as cool as possible (somewhere between 65-72 degrees is optimal). Even if you are sleeping under several blankets, you need to have the ambient air as cool as possible. This will help you fall into a deeper sleep and fall to sleep much faster.
  • Ice, ice baby – If you are up to something a little more extreme, try taking a ten minute ice bath one hour before bedtime. After your body has returned to normal temperature from an ice bath, the aftereffects of the cold will help you drop into a deep slumber. Another use for ice is to go bed with an ice pack, “ice cape”, or blanket. I was told by several people that an ice pack, ice blanket, or cape across your shoulders will reduce the time it takes to fall to sleep. Tim Ferris mentions this in The Four Hour Body and I’ve heard it from athletes as well.
  • SM_DFTS_003Establish a sleep ritual – Create a routine that allows you to relax and transition into sleep mode. Turn off the television, phone and iPad–get away from all electronics. Read a book, listen to relaxing music, or do something that is not too stimulating. Remove any blue light generating items from your environment prior to sleep. Dr. Chris Hardy, author of Strong Medicine, recommends wearing “blue blocker” sunglasses in the evening as well as switching the lights in the bedroom over to “bug lights” or any type of light bulb that doesn’t generate blue light.
  • Just say no to drugs – Regular use of prescription sleep medications can lead to long term problems. I have talked to a number of doctors about if and when they prescribe sleep medications, and they all do so with great hesitation. Instead of prescription medication, you can always try natural sleep aids–at least they don’t come with several pages of warning and possibly fatal side effects. NOTE: Tim Ferris recommends Yogi Soothing Caramel Bedtime Tea and there are other brands that seem to work as well. I have had several people recommend aromatic oils as well.
  • Don’t go to the (blue) light! – Light is the most powerful stimulator of the circadian system and can have positive or negative effects. Broad spectrum light stops the production of melatonin and pushes us into a waking state. This spectrum of light, in particular blue light, has the most impact on our circadian clock. So how much blue light do you get? If you have incandescent lights going, are watching television or using your computer or phone, you are bathing in the stuff.
  • Sunglasses at night? – How can you minimize blue light in the evening so that you can make a smoother transition into sleep? There are two easy ways that are not only inexpensive but effective. First, eliminate your exposure to blue light 2-3 hours before your bedtime by turning off the television, phone, and computer, and by installing lights in your evening living space that have a low blue light emission. Low blue light bulbs are those that have a yellow or orange color to them and are have a low CCT (Correlated Color Temperature). Inexpensive “bug lights” work well but there are other low cost alternatives on the market that you can find with a little research. The second way is to wear “blue blocker” glasses. Yeah, I know the old “sunglasses at night-thing” sounds a little weird but they work.

SM_DFTS_006

Sleep Like a Baby

There you go! Ten tips that will have you sleeping like a baby in no time at all. Try one or several to see if they work for you. I would recommend first setting up your sleeping space to be optimal, and working from there. If you have any tips or thoughts on how to get to sleep faster and easier I’d love to hear about them in the comments section below.

Until we meet again, Sleep Well!

***

Michael Krivka is a Senior RKC with Dragon Door and has been training with, teaching, and sharing the gospel of the kettlebell for over a decade. As a life-long martial artist, he is a Full Instructor under Guro Dan Inosanto in Jeet Kune Do (JKD); the Filipino Martial Arts of Kali, Escrima and Arnis; and Maphilindo Silat. He lives in Gaithersburg, Maryland with his wife and two sons. He owns CrossFit Koncepts where he runs strength and conditioning classes with an emphasis on kettlebell training, mobility and longevity. Follow him on Facebook.com/CrossFitKoncepts or Instagram.com/Michael_Krivka

Filed Under: Rest and Recovery Tagged With: how to sleep better, importance of sleep, Michael Krivka, Mike Krivka, recovery, rest, sleep

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