How to use Heart Rate to Engineer the Driver
 

I put this in the data forum, but thought some folks who don't look there might like to see it as well.

I'm really excited to share this video I put together with Dr. David Ferguson of the Spartan Motorsports Performance Lab http://education.msu.edu/kin/smpl/ For people who have not heard of him, he has works with all levels of drivers and is one, if not the leading researchers on physical strain on race car drivers. Dr. Ferguson has worked with teams all across racing and recently published a paper on physical fitness levels of drivers in various series including NASCAR, IMSA, and F1. Most people know his work through Charlie Kimball, the first Indycar driver with Type 1 diabetes. Dr. Ferguson is the guy who worked with him to figure out how to be able to drive a car and not have blood sugar problems. He also wrote the book on driver fitness
The audio isn't perfect, but check out the video and post up any questions!

http://education.msu.edu/kin/smpl/

Edit: Let's try the video again

Thanks for sharing Matt.

Being Type 1 myself, I'd love to know more about Dr Ferguson's work with Charlie Kimball and any other Diabetic athletes if you have any resources?

I don't have much on that, but I'll see what I can get. Dr. Ferguson is the one who helped Charlie figure things out. Charlie has a continuous glucose monitor that shows on the dash. He also has 2 drink bottles - one water and water an orange juice solution - that he uses to keep his sugar in check. I know they have worked up an optimal blood sugar level for his driving that he aims for while on track.The Yellowcog device would work with any device that transmits BT, BTLE, or ANT+ protocols and could be put into any data system with a CAN input available.

Thanks for the info Matt.

This is something I'd love to put more time into as I know the physiological and cognitive effects of my blood sugar levels is significant.

I'll do some more reading.

Cool stuff. I recently got an Apple watch 4, and have been using it to track my heart rate during exercise. Was surprised to see rates as high as 180 bpm, which is about 100%+ of my estimated max based on age; at that heart rate, I'm pushing very hard, but I don't perceive it to be my absolute limit. My resting rate is usually in the 50s. Last night, I tracked my rate while sleeping and saw a number as low as 44 (!). I'm going get my rate next time I'm on track and see how it compares.

I don't think you are too unusual with what you are seeing. Lots of people have really high heart rates when driving. I'm an oddity that stays really low. HR data is a little harder to use than the stress or exertion measures as it has a bit of variable delay in it, but still really good to use. I don't know the Apple Watch 4, but lots of the fitness watches are not accurate in environments like this. There are some really neat devices being developed with body temp, HR, accellerometers, and more built into ear buds.

I emailed over some more info.

For those who may be Type I or have more interest, shoot me an email and I can give you more details. We can monitor blood sugar in the car if you have a CGM. It would be the same as Charlie Kimball does in Indycar. Or if you are super performance/analytical, you could do it to have your blood glucose at the optimum levels (like some teams in IMSA are doing....).

Very interesting. I want to learn more, so will do more reading.

I have worked with some of the nation's top endocrinologists, cardiologists and sports medicine people and have been involved in lots of advancing medtech.

On the diabetes front I was part of an effort to commercialize one of the most famous medical devices for monitoring glucose levels. When we launched it made headlines. That product did not make it... but think the tech has lived on. I am curious about what C.K. is routinely using (if anything) to monitor levels whilst driving.

Our product was a non0invasive monitoring device. It worked and was FDA approved, but the business did not.

The potential use(s) of heart rate variability is a new topic for me. But as with similar measures, the challenge may be finding a useful signal in all of that noise. In this case the "noise" might be one's own natural variability to use as a baseline.

My hypothesis is that it is likely too naturally variable to establish a baseline to which episodic measurements can be compared for Dx, health/fitness or other meaningful purposes.

But if you don't explore breakthroughs may be less likely.

You've done some cool work.

Charlie wears a Dexcom CGM. I know some IMSA teams have worn them and I believe it's a different unit based on what the drivers have said, but I do now know for sure. Some of the studies have been done in Europe and they have some different devices as well. Most of the glucose level research has been done on non-motorsport athletes, but it transfer well.

In regards to HRV, you are correct in that it's completely person specific. To be very detailed in it, you have to monitor it everyday and know a persons trends. That can help you predict their preparation for competition and time their workouts/performance. In the way we showed in the video, over time you will be able to see where a person's normal level is and as it lowers, you'll know their is a stress on them. Their is a large body of research on this and it's easily found. I can point you to some info on it as well.

Matt:

The people that invented and commercialized all current and former forms of continuous glucose monitoring tech are in my network. I worked for a company called Cygnus who commercialized a product called the Glucowatch. The medical director at Cygnus left NIH to join us. He was the PI on the landmark NIH DCCT. He got there around the same time as me, and it was cool to find out that he wrote some papers with my late uncle who ran the NIH's landmark Framingham Heart Study and ran the NIH's non-invasive labs for a long time.

Later in life I worked in a company called Cantimer-- we were developing a new type of medical device that we felt had the promise of delivering a simple way of measuring one's hydration status by measuring the osmolality of saliva in a thermometer like form factor. This was based on unique and proprietary MEMS tech. In my role at Cantimer, I helped recruit a key advisor-- Larry Armstrong at UConn. He and his team (including if I recall correctly, Doug Casa) validated urine color as a marker for hydration. I still have those papers. My role at Cantimer put me in touch with many of the world's leading experts in sports, critical care, occupational and geriatric medicine.

Your statement above "To be very detailed in it" is perhaps a little unclear to some. As you likely know, in the hard core regulated medical world, diagnostic and/or therapeutic benefit is of course assessed along with safety in very rigorous ways. I feel that there is good reason for that.

I will do some reading on HRV in sports medicine, but I am skeptical that one could create a baseline over time from which to draw meaningful and actionable conclusions, at least with the robustness necessary for the FDA to allow marketing claims.

By the way... funny story... I met an EE consultant a couple of years ago when I was working on a consulting project for Yamaha's venture arm. It did not take long before he knew my hobby was racing. He asked if I had ever heard of IMSA. I said yes. He told me that one of his college roommates was one of the Raffauf brothers, and that whichever one it was (I forget whether it was Mark or Martin) pressed him into service a few times in tech inspection back in the day. I told him that I was pretty friendly with Jerry Woods (Jerry considers one or both Raffaufs family). I think at least one of them worked at Garretson-Barbour back in the day with Jerry.

Small world!

What was then even crazier was that when this EE and I spoke about medical stuff, he indicated that his brother runs ODE at FDA. That's the office that is responsible for device clearances and approvals!

If one were to try to commercialize a sports medicine product measuring and leveraging HRV information, and wanted to make certain types of claims regarding effectiveness, ODE is the applicable part of FDA.

Apple (and perhaps others like Fitbit , Samsung and so on) have to be careful about their claims. Most (if not all) of their devices are not FDA cleared. I am sure that they have had lots of interaction with ODE.

Perhaps a little more..

Above I said: "I will do some reading on HRV in sports medicine, but I am skeptical that one could create a baseline over time from which to draw meaningful and actionable conclusions, at least with the robustness necessary for the FDA to allow marketing claims."

So I will start by looking for ACSM position statements on HRV and for review papers in the peer-reviewed literature.

About marketing claims...

As some know, there is what many consider a growing "gray area" with some types of medical devices. I believe that this is in part due to the ongoing development and commoditization of all kinds of sensors and natural evolution of capitalism.

One of the things I looked at at Cantimer was whether we had a path toward success with a device that made more consumer-type claims. As part of my effort on the sports medicine side, I looked at the NFL for obvious reasons. If I recall correctly, I interviewed about 10-12 head trainers, including the trainer that had spent the greatest amount of time and effort in attempting to measure hydration in his players on an ongoing basis.

At the time that was Rick Burkholder. Great guy-- he was very helpful. He had already done a bunch of work that was published in the peer-reviewed sports medicine/training//physiology arenas including some work with Sandra Fowkes Godek at West Chester University when he was with the Eagles.

Through speaking with Rick and others, I concluded that adoption/product success might be most leveraged first on the hard core medical side and later on the consumer side.

You have certainly done some cool things and worked with some smart folks. It's funny you mentioned Larry Armstrong and dehydration. His book is sitting right next to me!

I'm not in the medical field, so I may have used the wrong language or words, but it was unintentional. I think you'll find the use of HRV in athletic training, performance, and evaluation to be pretty well researched and used across many areas. The ratings of many consumer devices are based on HRV (stress readings, body battery, etc). and one of the main players in that tech is Firstbeat. They have a much better explanation of it than I can provide.

There is a great variance in the devices used to collect this info. Consumer devices like FitBit, Apple Watch, etc do not provide accurate or actionable data in a race car. The minimum used here is a standard ANT+ or BTLE chest strap to collect HR data. The top end systems and data is collected either with a Zephyr BioHarness or a Equivital system, both of which are research grade. Some teams have also gone into collecting sweat profiles to see hydration and what type of sweat the driver gives for electrolyte balance, CGM, blood oxygen, and more. How motorsports use the data is slightly different and not as advanced as some of the other sports, but it's being done at the top level.

Think of NASCAR allowing HR watches now, F1 having biometrics in the gloves, Indycar having HR and accellerometers in the earbuds, IMSA drivers were recently banned from using CoreSense core temp pills....

Need to catch up on my reading of sports medicine lit.

Working a bit with Larry as an advisor is great. I often refer folks to his work with caffeine as it relates to hydration-- may have even mentioned it in these forums.

Funny you mentioned CoreSense. Did you mean Coretemp? Fokes Godek and Berkholder did some work with Coretemp back in the day. There has been a lot of work in football on hydration in the past ~20 years, part of it no doubt due to the death of Korey Stringer. I interviewed a trainer involved with that unfortunate situation.

The world is small. When I was researching hydration measurement in sports medicine I quickly found a sport where the appetite for something better was fierce. These folks would work hard for something better than what they had (and likely still have). This was back in 2007-2008. High school and college wrestling is the sport. Not intuitive nor well known.

I quickly got to the National Wrestling Coaches Association. The head man at the time was very excited. He even suggested some "friends of wrestling" that could possible lead to investors. One was Donald Rumsfeld. I was unsure of his connections to the investment space.

One was Ronnie Lott. I figured I could get to him in other ways... in fact we pitched a VC that is an ex-49er lineman with an MD and a super bowl ring. Had to have our clinical act together on that one, which I made sure we did.

The third was a guy named John Mumford at Crosspoint Ventures. Well I remembered very quickly that I had another way in to Crosspoint. Someone I raced with and his son (both PCA folks, and the latter being a pro racing driver at FLM around that time) knew another Crosspoint managing partner.... Seth Neiman.

The world is small.

I'll check out Firstbeat... first glance I don't see any reference to studies. Will dig deeper.

Ahh, yes. CorTemp. I haven't done any work with them. I don't believe their products are available commercially and I have not worked with them at all. The Zephyr BH has an algorithm developed with Natick Soldier Systems Center to calculate core temp. I can send you a paper on that if you would like.