Heart rate variability: are you using it properly? Standardisation checklist of procedures
Open accessAbstract
Background Heart rate variability is used as an assessment method for cardiac autonomic modulation. Since the Task Force's publication on heart rate variability in 1996, the European Heart Rhythm Association Position Paper in 2015 and a recent publication in 2017, attention has been paid to recommendations on using heart rate variability analysis methods, as well as their applications in different physiological conditions and clinical studies. This analysis has proved to be useful as a complementary tool for clinical evaluation and to assess the effect of non-pharmacological therapeutic interventions, such as physical exercise programmes, on cardiac autonomic modulation.Objective The aim of this article is to make recommendations and to develop a checklist of normalisation procedures regarding the use of heart rate variability data collection and analysis methodology, focusing on the cardiology area and cardiac rehabilitation.Methods Based on previous heart rate variability publications, this paper provides a description of the most common shortcomings of using the analysis methods and considers recommendations and suggestions on how to minimise these occurrences by using a specific checklist.Conclusions This article includes recommendations and a checklist regarding the use of heart rate variability collection and analysis methods. This work could help improve reporting on clinical evaluation and therapeutic intervention results and consequently, disseminate heart rate variability knowledge.
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RMSSD is considered one of the best indicators of cardiac parasympathetic modulation, especially useful for post-exercise evaluation.
“Therefore, RMSSD is considered one of the best indicators of cardiac parasympathetic modulation, especially useful for post-exercise evaluation when this activity is crucial for recovery.”
From Impact of Caffeine Intake Strategies on Heart Rate Variability during Post-Exercise Recovery: A Systematic Review and Meta-Analysis (2024) · cites this paper as [32]
The Comments/Suggestions section (page unavailable) lists RMSSD as a time-domain HRV index and discusses HRV returning to baseline after exercise in athletes and physically active people. It does not identify RMSSD specifically as one of the best indicators of cardiac parasympathetic modulation or say it is especially useful for post-exercise evaluation. (LLM, conf=0.78)
Experimental — accuracy not yet measuredRMSSD is more sensitive to changes in parasympathetic activity than SDNN because rapid fluctuations in RR intervals are predominantly mediated by the parasympathetic nervous system.
“Unlike other indices like SDNN, which reflect both sympathetic and parasympathetic influences on the heart, RMSSD is more sensitive to changes in parasympathetic activity. This is because rapid fluctuations in RR intervals are predominantly mediated by the parasympathetic nervous system.”
From Impact of Caffeine Intake Strategies on Heart Rate Variability during Post-Exercise Recovery: A Systematic Review and Meta-Analysis (2024) · cites this paper as [32]
The Comments/Suggestions section identifies RMSSD and SDNN as time-domain indices and describes high-frequency fluctuations as reflecting vagal modulation. The Poincaré plot indexes section likewise describes instantaneous beat-to-beat variability as a marker of parasympathetic modulation. Neither passage says that RMSSD is more sensitive than SDNN or specifically explains their difference in autonomic influences. Page numbers are not available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe high-frequency (HF) component in HRV spectral analysis is closely related to respiratory variability and is predominantly modulated by the parasympathetic nervous system.
“HF: The high-frequency component in HRV spectral analysis is closely related to respiratory variability (sinusoidal breathing) and is predominantly modulated by the parasympathetic nervous system.”
From Impact of Caffeine Intake Strategies on Heart Rate Variability during Post-Exercise Recovery: A Systematic Review and Meta-Analysis (2024) · cites this paper as [32]
HF is more specific to parasympathetic activity than LF.
“While indices like LF (low frequency) can be influenced by both sympathetic and parasympathetic activity, HF is more specific to parasympathetic activity.”
From Impact of Caffeine Intake Strategies on Heart Rate Variability during Post-Exercise Recovery: A Systematic Review and Meta-Analysis (2024) · cites this paper as [32]
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How to properly evaluate cardiac vagal tone in oncology studies: a state-of-the-art review
Martinez, P., Grinand, M., Cheggour, S., Taieb, J., & Gourjon, G. (2024) · Journal of the National Cancer Center · doi:10.1016/j.jncc.2024.02.002 · Cited by 9 · see citing works
Brandl, A., Engel, R., Egner, C., Schleip, R., & Schubert, C. (2024) · Journal of Medical Case Reports · doi:10.1186/s13256-024-04935-z · Cited by 9 · see citing works
Heart Rate Variability (HRV) in Patients with Sleep Apnea and COPD: A Comprehensive Analysis
Antal, A. Z., Crișan-Dabija, R. A., Arcana, R. I., Melinte, O. E., Pintilie, A.-L., Grosu, I.-A., Zabara, M., & Trofor, A. C. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14134630 · Cited by 9 · see citing works
Christófaro, D. G. D., Tebar, W. R., Vanderlei, L. C. M., Fernandes, R. A., Mota, J. A. P. S., Mielke, G. I., & Ritti‐Dias, R. M. (2022) · European Journal of Sport Science · doi:10.1080/17461391.2022.2044913 · Cited by 9 · see citing works
Self-citation
- Authors
- Catai, A. M., Pastre, C. M., Godoy, M. F. D., Silva, E. D., Takahashi, A. C. D. M., & Vanderlei, L. C. M.
- Affiliations
- Universidade Federal de São Carlos (BR)
- Universidade Estadual Paulista (Unesp) (BR)
- Faculdade de Medicina de São José do Rio Preto (BR)
- Corresponding author
- Catai, Aparecida Maria
- Venue
- Brazilian Journal of Physical Therapy
- Publisher
- Elsevier BV
- Published
- 2020-03
- Volume
- 24
- Issue
- 2
- Pages
- 91-102
- ISSN
- 1413-3555 (ISSN-L)
- PMC
- PMC7082649
- OpenAlex
- W2917146357
- Cited by
- 423
- References
- 80
- Citations by year
- 2026: 54 · 2025: 77 · 2024: 80 · 2023: 80 · 2022: 65 · 2021: 44 · 2020: 19 · 2019: 4
- FWCI
- 5.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Brazilian Journal of Physical Therapy (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UNESP Institutional Repository (São Paulo State University) (submittedVersion)
- Funders
- Conselho Nacional de Desenvolvimento CientÃfico e Tecnológico (3121938/2013-2)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Keywords
- heart rate variability, cardiac autonomic modulation, heart rate variability analysis, cardiac rehabilitation, physical activity, non-pharmacological treatment, reporting recommendations
- MeSH terms
- Autonomic Nervous System, Cardiology, Heart Rate, Humans, Exercise, Checklist
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