Mobile Evaluation of Heart Rate Variability using the Diver's Reflex

Mobile Evaluation of HRV

  • Harrison Seltzer Western Michigan Homer Stryker M.D. School of Medicine
  • Melissa Pellman, M.S. Western Michigan Homer Stryker M.D. School of Medicine
  • Raechel Warchock, B.S. Western Michigan M.D. School of Medicine
  • Joseph Billian, M.S. Western Michigan Homer Stryker M.D. School of Medicine Department of Epidemiology and Biostatistics
  • Robert Baker, M.D. PhD Western Michigan Homer Stryker M.D. School of Medicine Department of Sports Medicine and Orthopedic Surgery
Keywords: HRV, RMSSD, LF/HF ratio, Elite HRV, Cor-Sense, Concussion



HRV is considered a marker of ANS function. It has become a marker of interest in evaluating nervous system function following traumatic brain injury. This study validates prior research using larger sample sizes proposes a model for establishing baseline HRV reactivity in healthy participants.


62 healthy college athletes were recruited for this study. Following an informed consent process they were evaluated supine using the Elite HRV Cor-sense monitor and platform to record LF/HF ratio and RMSSD over 5 minutes. A bag of ice was placed on their face, then RMSSD and LF/HF ratio were collected over 3 successive 1-minute intervals.


RMSSD was elevated at 1 and 2 minutes (+47.4 ms, P <.0001; +16.5 ms P = .014) following face cooling and fell to baseline at 3 minutes (+4.6 ms, P = 0.52). LF/HF ratio decreased following face cooling at 2 and 3 minutes (change from rest %: 2 minutes: -33%, P=.007; 3 minutes -50%, P=<.0001).


The Elite HRV platform can detect an elevation in RMSSD in the first minute following face cooling with a successive return to baseline in the second and third minutes. It can also detect a consistent decrease in LF/HF following face cooling.

Author Biographies

Melissa Pellman, M.S., Western Michigan Homer Stryker M.D. School of Medicine

Medical Student

Raechel Warchock, B.S., Western Michigan M.D. School of Medicine

Medical Student

Joseph Billian, M.S., Western Michigan Homer Stryker M.D. School of Medicine Department of Epidemiology and Biostatistics

Biostatistician & Consultant

Robert Baker, M.D. PhD, Western Michigan Homer Stryker M.D. School of Medicine Department of Sports Medicine and Orthopedic Surgery

Fellowship Program Director, Sports Medicine Fellowship Program, Department of Family and Community Medicine

Professor, Department of Family and Community Medicine

Professor, Department of Orthopaedic Surgery


Abhishekh, H. A., Nisarga, P., Kisan, R., Meghana, A., Chandran, S., Trichur Raju, & Sathyaprabha, T. N. (2013). Influence of age and gender on autonomic regulation of heart. Journal of Clinical Monitoring and Computing, 27(3), 259–264.
Berkoff, D. J., Cairns, C. B., Sanchez, L. D., & Moorman, C. T. (2007). Heart rate variability in elite american track-and-field athletes. Journal of Strength and Conditioning Research.
Blake, T. A., McKay, C. D., Meeuwisse, W. H., & Emery, C. A. (2016). The impact of concussion on cardiac autonomic function: A systematic review. Brain Injury, 30(2), 132–145.
Collins, M. W., Kontos, A. P., Okonkwo, D. O., Almquist, J., Bailes, J., Barisa, M., … Zafonte, R. (2016). Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015. Neurosurgery, 79(6), 912–929.
Esterov, D., & Greenwald, B. D. (2017). Autonomic Dysfunction after Mild Traumatic Brain Injury. Brain Sciences, 7(8).
Gall, B., Parkhouse, W., & Goodman, D. (2004). Heart rate variability of recently concussed athletes at rest and exercise. Medicine and Science in Sports and Exercise, 36(8), 1269–1274.
Garabelli, P., Stavrakis, S., & Po, S. (2017). Smartphone-based arrhythmia monitoring. Current Opinion in Cardiology, 32(1), 53–57.
Guzik, P., Piekos, C., Pierog, O., Fenech, N., Krauze, T., Piskorski, J., & Wykretowicz, A. (2018). Classic electrocardiogram-based and mobile technology derived approaches to heart rate variability are not equivalent. International Journal of Cardiology, 258, 154–156.
Harmon, K. G., Clugston, J. R., Dec, K., Hainline, B., Herring, S. A., Kane, S., … Roberts, W. O. (2019). American Medical Society for Sports Medicine Position Statement on Concussion in Sport. Clinical Journal of Sport Medicine, 29(2). Retrieved from
Johnson, B. D., O’Leary, M. C., McBryde, M., Sackett, J. R., Schlader, Z. J., & Leddy, J. J. (2018). Face cooling exposes cardiac parasympathetic and sympathetic dysfunction in recently concussed college athletes. Physiological Reports, 6(9), e13694.
Katz-Leurer, M., Rotem, H., Keren, O., & Meyer, S. (2010). Heart rate and heart rate variability at rest and during exercise in boys who suffered a severe traumatic brain injury and typically-developed controls. Brain Injury, 24(2), 110–114.
Kleiger, R. E., Stein, P. K., & Bigger, J. T. (2005). Heart rate variability: Measurement and clinical utility. Annals of Noninvasive Electrocardiology.
Leddy, J., Baker, J. G., Haider, M. N., Hinds, A., & Willer, B. (2017). A Physiological Approach to Prolonged Recovery From Sport-Related Concussion. Journal of Athletic Training, 52(3), 299–308.
Leddy, J. J., Sandhu, H., Sodhi, V., Baker, J. G., & Willer, B. (2012). Rehabilitation of Concussion and Post-concussion Syndrome. Sports Health, 4(2), 147–154.
McCrea, M., Meier, T., Huber, D., Ptito, A., Bigler, E., Debert, C. T., … McAllister, T. (2017). Role of advanced neuroimaging, fluid biomarkers and genetic testing in the assessment of sport-related concussion: A systematic review. British Journal of Sports Medicine.
Miranda, N. A., Boris, J. R., Kouvel, K. M., & Stiles, L. (2018). Activity and Exercise Intolerance After Concussion: Identification and Management of Postural Orthostatic Tachycardia Syndrome. Journal of Neurologic Physical Therapy : JNPT, 42(3), 163–171.
Patricios, J. S., Ardern, C. L., Hislop, M. D., Aubry, M., Bloomfield, P., Broderick, C., … Raftery, M. (2018). Implementation of the 2017 Berlin Concussion in Sport Group Consensus Statement in contact and collision sports: a joint position statement from 11 national and international sports organisations. British Journal of Sports Medicine, 52(10), 635 LP – 641.
Perrotta, A. S., Jeklin, A. T., Hives, B. A., Meanwell, L. E., & Warburton, D. E. R. (2017). Validity of the Elite HRV Smartphone Application for Examining Heart Rate Variability in a Field-Based Setting. Journal of Strength and Conditioning Research, 31(8), 2296–2302.
Senthinathan, A., Mainwaring, L. M., & Hutchison, M. (2017). Heart Rate Variability of Athletes Across Concussion Recovery Milestones: A Preliminary Study. Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine, 27(3), 288–295.
Shaffer, F., & Ginsberg, J. P. (2017). An Overview of Heart Rate Variability Metrics and Norms. Frontiers in Public Health, 5, 258.
Stein, P. K., Domitrovich, P. P., Hui, N., Rautaharju, P., & Gottdiener, J. (2005). Sometimes higher heart rate variability is not better heart rate variability: Results of graphical and nonlinear analyses. Journal of Cardiovascular Electrophysiology.
Vistisen, S. T., Hansen, T. K., Jensen, J., Nielsen, J. F., & Fleischer, J. (2014). Heart rate variability in neurorehabilitation patients with severe acquired brain injury. Brain Injury, 28(2), 196–202.
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