Now that we have looked ANS balance, let's look at how ANS activity translates into real world practice. In HRV testing, ANS activity is commonly measured on a composite scale from 0 through 150. The scale is a composite of multiple studies that address the normal values for HRV in different age groups.¹⁷ HRV values tend to decrease with age. ANS activity is often used to assess the health of the nervous system. Low ANS activity relates to a less healthy nervous system and can be used a predictor for Type II diabetes, and heart disease.8 However, in a chiropractic practice, ANS activity is often used as a predictor of adaptability. In other words, it can tell the doctor how well is this patient going to respond to chiropractic care. For example, a low ANS activity tends to indicate less ability for the nervous system to adapt and can indicate the need to proceed slower in the beginning of care to prevent the patient from getting much worse before improvement occurs. It can also be a valuable indicator of improvement in the patient's condition long before the symptoms have resolved.

Some of the other benefits of using HRV in chiropractic practice include:

1. Non-invasiveness of the test. HRV testing does not require needles, blood draws and produces no radiation.
   


2. Ease of use. HRV can be measured in as little as five minutes and does not require the use of an EKG.
   


3. Relatively low cost of equipment. Currently, the average price of an in-office HRV system is about $2,700.
   


4. Legal defensibility. HRV provides a truly objective measure of the effects of chiropractic care on conditions that can result from an out of balance ANS.
   


5. Ease of explaining the results to patients. Most modern HRV equipment produces reports that allow DC's to easily explain the HRV results to their patients.
   


6. Reimbursable by insurance. A lot of insurance plans cover the costs of HRV testing when billed in the proper manner.

HRV testing in a chiropractic setting is new, and as such, it can be uncomfortable and difficult to explain its value to patients. And a detailed explanation of how to interpret HRV results and relate that to treatment is beyond the scope of this article. That said, adding HRV testing to a chiropractic office doesn't have to be uncomfortable at all. In my practice, for example, I simply explain that chiropractic care focuses on neuromusculoskeletal conditions, and that the palpation and movement tests assess the muscular part, the x-rays assess the skeletal part, and that now we need to look at the neurological part. This is where HRV comes in. I then explain the benefits of the test and that it is noninvasive and very safe. After the test is done, I explain the results during the report of findings, and that I will perform follow-up tests to evaluate their progress. This then becomes a truly objective outcome measure of the patient's progress.

References:

1. Furlan R, Guzetti S, Crivellaro W et al. Continuous 24-hour assessment of the neural regulation of systemic arterial pressure and RR variabilities in ambulant subjects. Circulation 1990; 81: 537–47.
2. Hon EH, Lee ST. Electronic evaluations of the fetal heart rate patterns preceding fetal death, further observations. Am. J. Obstet Gynec 1965; 87: 814–26.
3. Einghorn, 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 Mar-Apr;22(3):161-5.
4. Adlington J, Campeau S, Ciaramitaro K, Drennen T, Oliver A. Pre- and Post Treatment and Heart Rate Variability Readings of Subjects Receiving Logan Basic Technique Apex Contact Versus Table Position. Senior Research Publications Logan College of Chiropractic Library. Spring, 2001 edition.
5. Zhang J, Dean D: "Effect of chiropractic care on heart rate variability and pain in a multisite clinical Study." J Manipulative Physiol Ther. 2006; 29:267-274.
6. Budgell B, Polus B. The Effects of Thoracic Manipulation on Heart Rate Variability: A Controlled Crossover Trial. J Manipulative Physiol Ther. 2006; 29 603-610.
7. Brodal P, The Central Nervous System Structure and Function 3rd edition. Oxford 2004: Pages 82, 397-400.
8. Heart rate variability Standards of measurement, physiological interpretation, and clinical use Task Force of The European Society of Cardiology and The North American Society of Pacing and Electrophysiology. European Heart Journal (1996) 17, 354–381.
9. Stauss, HM., Heart Rate Variability. Am. J. Physiol. Regulatory Integrative Comp Physiol 285:927-931, 2003.
10. Malik, M. Camm, A.J., Heart Rate Variability. Futura Publishing Company; 1995: Page 154.
11. Guyton AC, Hall JE,. Textbook of Medical Physiology 1st Edition. W.B. Sauders; 1998: Pages 769-770.
12. Bastian, G.F., An Illustrated Review of the Anatomy and Physiology of the Nervous System. Harper-Collins; 1993: Pages 124-131
13. Netter, Frank H. Atlas of Human anatomy 9th Edition. Novartis 1997. Plate 153.
14. Masarsky, C.S., Todres-Masarsky, M. Somatovisceral Aspects of Chiropractic an Evidence Based Approach. Churchill Livingstone; 2001: Pages 99-100.
15. Guyton AC, Hall JE,. Textbook of Medical Physiology 1st Edition. W.B. Sauders; 1998: Pages 774-775.
16. Malik, M. Camm, A.J., Heart Rate Variability. Futura Publishing Company; 1995: Pages 245-266.
17. K Umetani, DH Singer, R McCraty, and M Atkinson. Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. JACC Vol. 31, No. 3. March 1, 1998:593–60.

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Dr. Jarod Adlington, DC, CCIHSis the president and CEO of HRV Enterprises, and a clinician in full time Chiropractic practice for over 11 years. He is an educator and author in the field of Heart Rate Variability. He has delivered post graduate seminars to doctors and staff throughout the United States. He is the author of several books, including A Physician's Guide to HRV and ANS Assessment. He can be reached at .