The use of heart rate variability analysis in monitoring sport injuries and its influence on the autonomic balance: a systematic review

Meneghetti, Henrique Geromel; Souza, Gabriela Cotrim de; Santos, João Gabriel Fayyad; Morales, Mariane de Sá Britto; Martins, Rodrigo Alberto Dispato Mendes; Ferreira, Gustavo Dias

doi:10.1590/1809-2950/20022228032021

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ORIGINAL RESEARCH • Fisioter. Pesqui. 28 (3) • Jul-Sep 2021 • https://doi.org/10.1590/1809-2950/20022228032021 copy

The use of heart rate variability analysis in monitoring sport injuries and its influence on the autonomic balance: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The objective of this review was to understand the use of heart rate variability (HRV) to identify its relationship with the occurrence of no contact sports injuries, in addition to indicating patterns of HRV after concussions and to the guidance in the process of returning to sport. A systematic review was carried out on the Pubmed, EMBASE, and PEDRo databases from its origin until December 2020, using the following terms: (((((athletes OR players) AND (Heart Hate Variability OR HRV)) AND (sport OR sports OR exercises OR physical activity)) AND (injuries OR injury)). The PICOS eligibility principles were: P (population): athletes, I (intervention): the use of HRV, C (control): uninjured athletes, O (outcomes): HRV indices and their relationship with sports injuries, and S (study): studies in humans. Of the 62 papers identified in the search, 12 were included in the review, 6 showing that decreased HRV and sympathetic-vagal imbalance are related to fatigue, overtraining, and overreaching; and 6 articles related to the assessment of HRV after a concussion, which identified changes in autonomic modulation in concussion athletes. In conclusion, the HRV may be a tool used in sports to identify a greater risk of no contact sports injuries, identifying situations of fatigue, overtraining, and overreaching, as well as assisting in the process of returning to sport after a cerebral concussion by assessing the autonomic balance.

Keywords:
Sport; Wounds and Injuries; Heart Rate

Author, year and country	Type of study	Participants	Intervention	Measures analyzed	Main results
Lima-Borges 2018 Brazil	observational	Young athletes of the Brazilian national swimming team - Sprint: n=17 (13 men and 4 women) - Endurance: n=13 (7 men and 6 women)	Analysis of HRV at rest and competition, and its relationship to injury during a 20-week macrocycle	- HRV (rMSSD; LF; HF; LF/HF)	Athletes from sprint: decrease in HF and increase in LF, being related to episodes of overtrainning and injuries. Athletes from endurance: decrease in HRV, but with less effect than the group sprint.
Muñoz-López 2020 Spain	observational	23 professional soccer athletes - starters (trained and played more than 60 Minutes =11) - substitutes (only trained n=12)	HRV analysis during preparation for European competition comparing athletes exposed to high intensity games with substitutes.	- HRV (rMSSD);	More fatigued athletes, who performed in games for more than 60 minutes, remained with autonomic alteration (decrease in rMSSD) for up to 72 hours after the match, compared to the control reserves.
Williams 2017 United Kingdom	experimental	CrossFit ™ competitive athletes n=6 (3 men and 3 women)	Interaction between HRV, workloads and risk of overtrainning in a 16-week intervention	- HRV (rMSSD);	Increased risk of injury was related to low rMSSD index and high ACWR index. High loads were well tolerated when the rMSSD remained within the normality standard or was high.
Williams 2017 United Kingdom	experimental	CrossFit ™ competitive athletes n=6 (3 men and 3 women)		- ACWR (acute/chronic workload ratio)
Kajaia 2017 Georgia	observational	n=43 of athletes with overreaching non-functional and overtraining syndrome, n=40 athletes without these characteristics, n=35 sedentary	HRV analysis at rest	HRV at rest	Lower HRV, lower vagal influence and increased sympathetic stimulus during rest were observed in athletes with overreaching and overtraining.
Leti 2013 France	experimental	Senior long distance runner, mean age 51±5 years n=10	Night HRV monitoring over the 12-week period in rest, post-workout and post-competition conditions	- HRV (LF, HF, LF/HF)	Reduction of HF value and increase of LF and LF/HF after one day of competition. Positive correlations were found between fatigue and the LF frequency domain due mainly to the impact of competition.
Leti 2013 France	experimental	Senior long distance runner, mean age 51±5 years n=10		- Fatigue analysis questionnaire
Baumert 2006 Germany	experimental	Track and field and triathlon athletes n=10 (5 men and 5 women)	ECG monitoring for 2 weeks of field training with daily overload	- HRV at rest (rMSSD, LF and HF)	There was a reduction in HRV and vagal modulation during periods of intensified training.

Author, year and country	Type of study	Participants	Intervention	Measures analyzed	Main results
Paniccia 2018; Canada	longitudinal	Adolescent sportsmen from 13 to 18 years followed, from the diagnosis of concussion	Use of HRV with 24-hour monitoring log	- HRV	Parasympathetic modulation drop until Day 30 post-injury, combining with physical, cognitive, emotional and fatigue symptoms. An increase in parasympathetic modulation was observed up to day 90, with minimal symptoms. There was a return to the stability of parasympathetic modulation around 120 days
Johnson 2018 USA	experimental	College athletes with concussion and symptomatic n=11 (5 women and 6 men) and Healthy college athletes n=10 (5 women and 5 men).	Evaluation of HRV during the Face Cooling	- FC;	In post-concussion patients, HR and R-R interval do not change in the first minutes of Face Cooling, unlike healthy ones that increase the parasympathetic response.
				-R-R Interval;
				- rMSSD;
				- HF
Hutchison 2017 Canada	Case-control	College athletes: n=52 (32 men and 20 women): 26 with concussion and 26 healthy as control group.	Analysis in three recovery periods:	Psychological aspects:	Psychological aspects were worse in athletes with concussion in the symptomatic phase. In athletes with concussion there is a reduction in HF during the three periods analyzed, indicating that an autonomic dysregulation may remain even after return to training, especially in women.
			Analysis in three recovery periods:	- Mood
			- Between 2 and 7 days post-injury (symptomatic period)	- Sleep quality
			- At the beginning of the progression of the exercise	- Perceived stress Physiological aspects:
			- 1 week after return to training	- HRV
Senthinathan 2017 Canada	experimental	Athletes diagnosed with concussion n=11, and undiagnosed athletes, as a control group n=11	Analysis in three recovery periods: symptomatic phase, asymptomatic phase, and 1 week after the return to training with the evaluation protocol in the sitting and standing position.	Domain variables frequency and time of HRV in athletes of the sitting and standing protocol.	Athletes with concussion presented in the symptomatic phase increased LF and decreased HF. During the phase of return to training, they presented higher LF/HF when sitting. When moving from sitting to standing position, athletes presented autonomic changes in all phases when compared to control.
Abaji 2016 Canada	transversal	n=12 male athletes with concussion and n=12 control athletes	HRV analysis measured at rest and during isometric hand holding practice	- HRV: (R-R interval, rMSSD, LF, HF, LF/HF)	Asymptomatic athletes with concussion, in the post-acute stage of injury (95 days±63), still present a reduced parasympathetic modulation and higher LF/HF ratio during isometric hand grip test.
Gall 2004 Canada	experimental	=14 hockey athletes with concussion and n=14 control athletes.	Evaluation of HRV at rest and during moderate intensity exercise session on the second and seventh day after injury.	- HRV: (R-R interval, LF, HF, LF/HF)	At rest, no changes were noticed. During exercise, athletes with concussion demonstrated a reduction in the mean of the R-R intervals, and a change in the powers of LF and HF, which indicates that there was no sympathovagal modulation in response to exercise.

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[1] Corresponding address: Dr. Gustavo Dias Ferreira - R. Luís de Camões, 625-Pelotas (RS), Brasil - CEP: 96055-630 - E-mail: gustavo.ferreira@ufpel.edu.br