Hello, everyone. My name is Anthony Guccione. I'm a third year medical student at New York Institute of Technology, College of Osteopathic Medicine. I'm honored to be here at OMEDS 2024 virtual poster presentation, presenting our HRV team's research on heart rate variability and physiological parameters as a measure of stress in medical students. So our research team is working to compare medical students to elite athletes in certain aspects, particularly that they're both able to endure extreme amounts of mental stress. For athletes, analysis of health statistics is becoming increasingly important and has allowed them to optimize their performance under stressful situations such as competitions. Our goal with this study is to begin to view medical students as elite mental athletes and aim to help them optimize their efficiency as well as maximize their physical and mental health while they endure the rigors of a medical school education. For athletes, one health metric gaining particular attention is heart rate variability. Heart rate variability, or HRV for short, is a measurement of the fluctuation between heartbeats, also known as the RR interval, as seen in the EKG graphic below on the screen. This variation of the RR interval is thought to be due to variation of balance between the autonomic nervous system. After a baseline HRV is established for an individual, an increase in HRV is thought to indicate that a person is able to adapt to stressors more effectively. Conversely, a decrease in HRV indicates that the presence of stress, anxiety, depression, or poor lifestyle habits is negatively impacting that individual's HRV value. So our hypothesis for this experiment was that during the exam week for medical students, HRV will show a significant decrease due to the increased stress levels faced by medical students during exam times. This decrease in HRV values would then indicate that medical students have a decreased ability to adapt under these stressful situations. For our experiment, these stressful situations are represented by medical school exam cycle. So for our study, 16 first and second year medical students, 8 male, 8 female, were studied for a period of 6 weeks. Of the 16 participants recruited, 11 were included in the analysis as 5 were excluded due to noncompliance. The average age of the participant was 24.27 years with a standard deviation of 1.54 years. IRB approval was received for the study, data was protected, and all participants signed written informed consent forms, and the inclusion and exclusion criteria are listed below on the slide. As for the methodology of our experiment, each participant was instructed each morning to do a mindfulness session on the Breathe app of their Apple Watch. This took a real-time reading of their HRV value. The participant would then log this value into a REDCap form as well as complete a daily survey to report multiple health variables such as sleep quality, mood, food intake, stress level, and muscle soreness each day. Additionally, the patient would wear their Apple Watch day and night throughout the study, and their health metrics were tracked, specifically recorded whether heart rate, sleep, total steps, exercise minutes, resting energy, and active energy. These data points were all stored via the Apple Watch. This data was then analyzed using SPSS version 28 with a p-value of less than 0.05 indicating significance, and the relationship between HRV and the studied variables were examined through Spearman Rank Correlation Coefficient. If you look at the study timeline in the right box of the screen, we broke the testing cycle up into time periods. Week 1 was just a normal study week for participants, which was used to establish a baseline HRV value for the test subjects. Week 2, the participants had a pre-comprehensive test, which is basically a practice exam, so we expect them to be a little more stressed and baseline that week. Week 3 was kind of the crux of this study, specifically because that was the comprehensive exam week for our participants. This is the week we anticipated the most stress for these students because they have their major medical school exam this week. Week 4, we anticipated a drop of stress levels as the participant had spring break with no classes and minimal studying, followed by weeks 5 and week 6 where they were back to normal study weeks again. As for results, individual trend analysis revealed that 81.8% of participants had an increase in HRV during exam week compared to spring break. This implied an increased ability to handle stress during exam week, which directly contrasted our hypothesis, which is very interesting to us. As a reminder, we had hypothesized that during exam week, medical students' HRV values would decrease due to the stress of their exams. However, as you can see in the bar chart provided during exam week 3, noted by the star, medical students showed the highest level of HRV for any weeks recorded, indicating that medical students were able to adapt to the stress of exam week and perform under these elevated stress circumstances, which both inspired and was curious to us as researchers. Taking a deeper dive into the findings, we analyzed data from the other health metrics recorded and decided to focus on three major correlations for this presentation. The first one is that there was a significant negative correlation between resting heart rate and HRV, as you can see in the graph on the bottom left of the screen. Next, in the middle plot, you can see that there's a significant positive correlation between HRV and increased exercise minutes of the participants. And finally, we actually saw a negative correlation between HRV and increased muscle soreness. So we asked ourselves, what meaningful conclusions can we draw from these statistics? As we just discussed, there are several health metrics we found to be correlated with heart rate variability. First, being that there was a negative correlation between resting heart rate and HRV, showing that as resting heart rate decreases, HRV will increase. This kind of highlights the general medical understanding that a lower resting heart rate coincides with a better overall cardiovascular health, and therefore it makes sense that an HRV value, the HRV value would be better for those with a lower resting heart rate. There was then the positive correlation between HRV and exercise minutes. This indicated that as students increased their exercise minutes, their HRV values improved, indicating an increased ability to cope with stress. And finally, we saw that negative correlation between HRV and muscle soreness, suggesting that in this state of soreness, the body is less capable of handling stressful situations. So this poses an interesting interaction between these last two variables. If increased exercise was good for HRV, but muscle soreness had a deleterious effect on HRV values, it strikes up the interesting question of, is there a balance that needs to be struck between exercise and muscle soreness, given the effects they have on HRV? So following that thought process, if we can optimize the amount of exercise minutes and muscle soreness levels in medical students, would we then be able to improve their HRV values? With these higher HRV values, these students would be better able to cope and adapt during the stress of an exam cycle, and in turn would be able to improve their ability to adapt to stress in medical school as a whole. So our team's vision is that by tracking and further exploring heart rate variability and these physiological parameters that affect it, medical educators will be empowered to begin implementing interventions such as wellness programs to improve the process of medical education and promote the health of our osteopathic community. Thank you all so much for this opportunity. I'm honored to be here presenting at OMED 2024. I look forward to speaking with you all the day of the OMED presentations, and thank you very much for your time and your dedication to our community. Thank you.

heart rate variability

stress adaptation

medical education

exercise impact

wellness programs