Heartbeat analysis: Continuing professional development

Optimal work performance requires a balance between many work- and lifestyle-related factors, for example, appropriate workload, healthy working conditions, effective stress management, sufficient recovery, a balanced diet and lifestyle, along with a satisfactory level of fitness to deal with the demands of our job and daily life. This article introduces a practical tool that can be used to comprehensively evaluate the overall lifestyle balance, with particular emphasis on stress, recovery and health-enhancing physical activity.

As general background to the topic of optimal performance, some acute health and disease statistics should be highlighted. According to the NHS, Type 2 diabetes is one of the biggest health problems in the UK and worldwide.

The NHS spends £750m on drugs to treat lifestyle diseases (eg, Type 2 diabetes and metabolic syndrome), but at the same time, research has shown that two-thirds of type 2 diabetes cases could be prevented simply – and more effectively than with medication alone – with a healthier lifestyle, including physical activity and proper weight management (official NHS statistics 2008, Knowler et al 2002). Obesity alone is estimated to account for almost 50% of Type 2 diabetes in the UK. Worldwide, the economic burden of physical inactivity is acknowledged to be significant.

Job strain

Stress, particularly job stress or strain is another acute health topic. There is strong, consistent evidence supporting the conclusion that job strain is a major cardiovascular disease risk factor (eg, Belkic et al 2004).

Stress can increase the risk either directly by affecting the body’s neuroendocrine responses (eg, increased activation of the sympathetic nervous system and increased arterial blood pressure) or indirectly by causing us to engage in unhealthy behaviours, such as excessive alcohol use, unbalanced diet or lack of physical activity (eg, Lucini et al 2007, Chandola et al 2007).

In principle, most people know what they should do to support a healthier lifestyle, and to improve their performance, but they don’t always act accordingly. This is why the health and wellbeing field has an acute need for supportive measures, such as motivational tools.

Firstbeat Health software is a sophisticated heartbeat measurement-based analysis system that recognises physiological states of the body from the heartbeat, providing an understanding of the autonomic nervous system and information about physical and psychological stress, recovery, physical activity, energy expenditure and training. It has been designed as a tool for professionals in the fields of occupational and preventive health, as well as wellness and fitness services.

The software can be used to demonstrate how well people recover from daily stress, whether their physical workload is appropriate and what their daily physical activity habits are like. The method gives a detailed view into the health effects of daily life to improve wellbeing and reduce the risk of getting ill. Several studies and scientific publications have been produced during the process of developing the Firstbeat model and analysis system (eg, Saalasti 2003).

Stress reactions, regardless of their origins, can be accessed by measuring a person’s heartbeat, which provides information about heart rate variability (HRV) – the beat-to-beat variation in the length of RR intervals.

Stress and recovery

Large HRV in a resting state is known to be associated with parasympathetic activity of the autonomic nervous system, reflecting recovery and good health, whereas reduced HRV is associated with sympathetic activity and some kind of stress or illness.

Even if the HR level in both conditions is similar, the amount of HRV is dramatically reduced in the stress state. Sophisticated HRV analysis also provides detailed and accurate information about several bodily functions, such as respiration rate, ventilation, oxygen uptake and energy consumption.

Stress can be defined in many ways. Traditionally, stress is a body’s way of responding to a challenging situation via increased sympathetic and reduced parasympathetic activation. In the context of Firstbeat stress measurement, stress means an elevated activation level in the body that can have a range of different sources, positive or negative. Conversely, recovery means a lowered activation level due to an absence or reduction of stressors. Short-term stress is normal and even useful, but it becomes a health risk if it lasts a long time without recovery.

The Firstbeat Health protocol consists of a one- to three-day heartbeat measurement, with the person wearing a heart-rate belt around their chest. The collected heartbeat data is transferred to the computer software for analysis, after which various individual and group reports are created, depending on the aim of the measurement. A trained professional then discusses the reports and their implications with the client.

In the area of stress, the aim of the measurement can be to demonstrate accumulated stress, identify key stress factors and stressful time periods, look at the balance between stress and recovery or develop personal stress management methods. The focus is not on making the days stress-free, but in seeing if the person recovers when the circumstances allow it, ie, during sleep, times of relaxation or days off.

This is demonstrated in the stress report with stress state (red) and recovery state (green).

Figure 3 shows an example of a construction worker’s stress and recovery balance during six measurement days. It is normal that the resources are used up during the day (graph goes down), but if the balance is okay, indicating sufficient recovery, the graph comes back up during the night (days one to five). During day six, there was no recovery: the heart rate remained elevated throughout the sleep period and the stress graph was red, which is demonstrated in this figure by the recovery graph going down during day and night.

If recovery is frequently poor, it can cause accumulated fatigue and problems with health and coping. In this case, the explanation for the poor recovery on night six was a night out, with several servings of alcohol, but it was a concrete message to the subject: repeated several times during the week, it would significantly compromise sufficient recovery. Stress and recovery analysis provides uncompromising information about factors that hinder (eg, alcohol or long work hours) or promote (eg physical activity, peaceful evening activities or pleasant hobbies after the work day) recovery.

Physical activity

When focusing on physical activity, the measurement can be used to show if a person is engaged in enough health-enhancing physical activity (HEPA; moderate intensity or at least 40% of the person’s estimated or measured maximal oxygen uptake) during the day.

The updated physical activity guidelines state that some physical activity is better than none, but for substantial health benefits, adults should do at least 150 minutes a week of moderate physical activity. What makes the all-day measurement especially useful is that instead of just looking at an individual exercise session, the analysis picks out all daily activities that increase the heart rate sufficiently to produce health effects, such as gardening, walking the dog or walking to the shops. Quite typically, people discover that their lifestyle is sedentary and very little actual physical activity accumulates during their daily life. Based on the analysis, appropriate and realistic goals can be set on an individual basis.

Physical workload analysis can be performed during the workday to determine how physically loading the workday or specific work tasks are. Workload analysis can also be combined with stress and recovery analysis – for example, with shift workers or in jobs with a very heavy workload.

The employee wears a heart rate monitor and records their work tasks. The produced physical workload report illustrates how strenuous the work tasks are, identifies the most strenuous work periods, and gives a range of average physiological values (eg heart rate, MET, % VO2 max, and energy expenditure; see Figure 4 below) equivalent, is a unit of measurement that measures how much effort an activity requires from you, while VO2 max is the maximum amount of oxygen in millilitres an individual can use in one minute per kilogram of body weight.

The focus can be on a particular individual or a group of workers and the results can be compared with general guidelines about appropriate physical workload. Heavy physical workload per se is not a very common problem these days, but certain types of work tasks combined with the ageing and less fit work population can result in workloads that are too heavy. If this is the case, measures should be taken to remedy the situation – for example making sure that work equipment and ergonomic factors are in accordance with recommendations, and alternating between light and heavy tasks.

Type 2 diabetes

In the area of diabetes prevention, the key is to interrupt the process that leads to diabetes as early as possible. There is strong evidence that regular physical activity is associated with a lower risk of type 2 diabetes (eg, 2008 Physical Activity Guidelines for Americans). Excessive stress is also believed to be linked to type 2 diabetes, and lowered heart rate variability, one of the symptoms of stress, ‘0/N/15418096/1.html?issn=”>’has been found to be associated with diabetes risk (eg, Schroeder et al 2005).

The Firstbeat diabetes report shows what proportion of all daily activity is of sufficient intensity to have health-enhancing effects and increase the energy expenditure, and gives an estimation of the person’s stress and recovery balance, looking specifically at night-time recovery. In addition to the physical activity, energy expenditure and recovery values, traditional measures of diabetes risk monitoring can be included in the diabetes report, such as blood values, body mass index, waist girth and blood pressure.

One of the central challenges of the health and wellbeing field is to help people see the importance of a comprehensive approach towards their own wellbeing by addressing key lifestyle factors, such as sufficient physical activity, proper stress management and recovery. Optimal performance of any kind requires a good balance of these factors.

However, merely telling someone what they should do is often not enough; people need personalised strategies to help them get started.

The analysis method introduced in this article is a practical tool that can help with this challenge by providing an objective view of real life, illustrating the kinds of lifestyle factors that support or hinder wellbeing. The method is designed to act as a motivator and give information that will help patients, practitioners and organisations who want to take an objective look at optimising health, performance and productivity.

Tina Hoffman, MSc (Exercise Physiology), is Wellness Specialist at Firstbeat Technologies.


1 Belkic K, Landsbergis P, Schnall P, Baker D. Is job strain a major source of cardiovascular disease risk? Scand J Work Environ Health (2004) 3:85-128.

2 Chandola T, Britton A, Brunner E, Hemingway H, Malik M, Kumari M, Badrick E, Kivimaki M, Marmot M. Work stress and coronary heart disease: what are the mechanisms? Eur Heart J (2008) 29:640-648.

3 Knowler W, Barrett-Connor E, Fowler S, Hamman R, Lachin J, Walker E and Nathan D. (2002) Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin, The New England Journal of Medicine (2002) 346 (6):393-403.

4 Lucini D, Riva S, Pizzinelli P, Pagani M. Stress management at the worksite: reversal of symptoms profile and cardiovascular dysregulation. Hypertension (2007) 49:291-297.

5 Saalasti S. Neural networks for heart rate time series analysis. Academic Dissertation, University of Jyväskylä, Finland (2003).

6 Schroeder EB, Chambless LE, Liao D, Prineas RJ, Evans GW, Rosamond WD, Heiss G. Diabetes, glucose, insulin, and heart rate variability: the Atherosclerosis Risk in Communities (ARIC) study. Diabetes Care (2005) 28:668-674.

Firstbeat Technologies

Firstbeat Technologies Ltd. was founded in 2002 and is based in Jyväskylä, Finland. It develops software in the field of heartbeat analysis technology and applications for preventive healthcare,the wellness sector, elite sports and research. Firstbeat’s partner in the UK is the London-based company Optima-Life.

For more information, please see: www.firstbeattechnologies.com and www.optima-life.com

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