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HRV, Doctoring, and Entrepreneurship

11/20/2017

 
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Guest post by Josh Emdur. Josh is a board-certified Family Medicine physician (practicing for over 10 years) and 2:53 marathoner with a passion for providing personal, high value medical care that embraces the use of technology.


​It was April 12, 2017, 5 days out from the 2017 Boston Marathon when my coach (Adam St. Pierre Carmichael Training Systems) first introduced me to HRV4Training.

As a physician, runner, and gadget geek I was immediately intrigued by this quantitative metric of stress. Both personally and professionally my stress over the past ten years of life has been both manageable and predictable. My professional time was spent working shifts at my local hospital. While my shifts were often stressful, I was able to leave my stress where it belonged (at work). When I was off I was off, and could sleep well knowing that my partners would provide great care for the patients I had handed off to them. After a tough shift, I would intuitively know that my body and mind needed rest. Easy runs after hard shifts were the norm.

As life would have it, one month after learning about HRV4Training my career took a dramatic change. I was laying awake at 3AM at the hospital when I came across a posting on my Facebook feed asking if I would be interested in founding an online primary care practice especially for runners called SteadyMD. I was immediately hooked and found myself on a plane bound for St. Louis to meet with the founders of the company. The day after my meeting in St. Louis I embraced entrepreneurship and began monitoring my HRV.

My life of predictable stress as a physician, parent, and athlete quickly morphed into a life of unpredictable stress by adding the additional role of startup entrepreneur. Many of my friends are founders of companies. For years they have shared their stresses with me, but it wasn’t until recently that I could relate to what they had been going through.

Challenge has always been my main motivator in life. Easy tasks don’t engage me. Medical school, mountaineering, big wall climbing, backcountry skiing, marathons, and raising a family have all been my objectives. Starting a business is hands down the hardest thing I have done to date.

As an entrepreneur my work is no longer confined to the walls of the hospital. My sleep has become more erratic with late nights responding to emails followed by early mornings waking with epiphanies and excitement. Despite my increased workload, balance is of paramount importance to me. Falling into the trap of neglecting family, career, and workouts is not an option. HRV tracking has been a useful tool to achieve this balance.

Metrics aside, spending 60 seconds every morning checking HRV provides a valuable opportunity to build self-awareness. Learning to listen to your body is an invaluable skill. I use the HRV testing interval as a daily ritual to check in with myself and simply be mindful of my situation.

My HRV consistently drops after busy hospital shits, nights of restless sleep, and periods of consistent hard training. As a runner I train with heart rate and power. Many argue that these metrics are inferior to pacing based on perceived exertion. I agree that self-awareness is the ultimate measure, but for most people objective quantitative metrics are a means to help better understand ones body.

Since partnering with SteadyMD I have found utility in using HRV4Training as a means to coach my patients to a healthy stress/rest balance. In the recent book Peak Performance by Magness and Stulberg the authors present a growth equation that is defined as growth=stress+rest. HRV is a great way to quantify the rest portion of the equation. HRV provides me as a physician a window into my patients’ progress towards growth.

For years I have seen athletes over train and suffer the consequences of deteriorating performances, injuries, and even development of chronic medical conditions.

My goal at SteadyMD is to keep my patients healthy and performing to their potential. To learn more about my innovative primary care practice for runners that provides you access to me from the convenience of your Smartphone go my website www.steadymd.com/hrv or follow me on Facebook, Instagram, or Twitter @steadymdrunning

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    This blog is curated by
    Marco Altini, founder of HRV4Training


    ​Blog Index
    ​
    The Ultimate Guide to HRV
    1: Measurement setup
    2: Interpreting your data
    3: Case studies and practical examples

    How To
    1. Intro to HRV
    ​2. How to use HRV, the basics
    3. HRV guided training
    ​4. HRV and training load
    ​
    5. HRV, strength & power
    6. Overview in HRV4Training Pro​
    7. HRV in team sports
    ​

    HRV Measurements
    Best Practices

    1. Context & Time of the Day
    2. Duration
    ​
    3. Paced breathing
    4. Orthostatic Test
    5. Slides HRV overview
    6. Normal values and historical data
    ​7. HRV features
    ​
    Data Analysis
    1a. Acute Changes in HRV
    (individual level)

    1b. Acute Changes in HRV (population level)
    ​
    1c. Acute Changes in HRV & measurement consistency
    1d. Acute Changes in HRV in endurance and power sports​
    2a. Interpreting HRV Trends
    2​b. HRV Baseline Trends & CV
    3. ​Tags & Correlations​
    4. Ectopic beats & motion artifacts
    5. HRV4Training Insights
    6. HRV4Training & Sports Science
    7. HRV & fitness / training load
    ​8. HRV & performance
    9. VO2max models
    10. Repeated HRV measurements
    11. VO2max and performance
    12. HR, HRV and performance
    13. Training intensity & performance​
    14. Publication: VO2max & running performance
    ​
    15. Estimating running performance
    16. Coefficient of Variation
    17. More on CV and the big picture
    ​​​​​18. Case study marathon training
    19. Case study injury and lifestyle stress
    20. HRV and menstrual cycle
    21. Cardiac decoupling
    22. FTP, lactate threshold, half and full marathon time estimates
    ​23. Training Monotony
    ​
    Camera & Sensors
    1. ECG vs Polar & Mio Alpha
    2a. Camera vs Polar
    2b. Camera vs Polar iOS10
    2c. iPhone 7+ vs Polar
    2d. Comparison of PPG sensors
    3. Camera measurement guidelines
    4. Validation paper
    ​5. Android camera vs Chest strap
    ​6. Scosche Rhythm24
    ​7. Apple Watch
    8. CorSense
    ​
    9. Samsung Galaxy
    ​
    App Features
    ​1. Features and Recovery Points
    2. Daily advice
    3. HRV4Training insights
    4. Sleep tracking
    5. Training load analysis
    ​6a. Integration with Strava
    6b. Integration with TrainingPeaks
    6c. Integration with SportTracks
    6d. Integration with Genetrainer
    ​
    6e. Integration with Apple Health
    ​
    ​6f. Integration with Todays Plan
    7. Acute HRV changes by sport
    8. Remote tags in HRV4T Coach
    9. VO2max Estimation
    ​
    10. Acute stressors analysis
    11. Training Polarization
    ​
    12. Lactate Threshold Estimation
    13. Functional Threshold Power(FTP) Estimation for cyclists
    14. Aerobic Endurance analysis
    15. Intervals Analysis
    ​​​16. Training Planning
    17. Integration with Oura
    18. Aerobic efficiency and cardiac decoupling
    ​
    Other
    1. HRV normal values​
    ​2. HRV normalization by HR
    ​
    3. HRV 101

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