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For the detection of sympathetic nervous system weakness

If the parasympathetic values are conspicuously high and the patient’s state of well-being is disturbed in the direction of exhaustion and lack of energy, the question arises as to whether a regulatory disorder with a hyperactive parasympathetic nervous system and a weakened sympathetic nervous system is involved.

To better assess these patients, an orthostasis test or position change test should be performed. 130 RR intervals are measured with the patient lying down. This is followed by an acoustic signal and the message: “Stand up now”. After that, 210 RR intervals are still measured while standing.

In contrast to cycle breathing, with which one can control the switching on of the parasympathetic nervous system, the change of position exerts a stress stimulus with which one can control the switching off of the parasympathetic nervous system. In the comparison, a clear difference between the lying and standing position should be recognizable. Heart rate (HR) and stress index (SI, red bar) should increase, whereas parasympathetic nervous system (RMSSD, blue bar) should decrease.

No change or only a very slight change in the parameters, is an indication of a regulatory disorder with a dominant parasympathetic nervous system and a weakened sympathetic nervous system.

The following graphs show an ideal result of the orthostasis test. The standing phase is clearly different from the lying phase.

1. HRV recording with course of the parasympathetic nervous system.

2. HRV recording with display of the rhythmogram, histogram as well as the scatter diagram.

3. comparison of parameters: Pulse, sympathetic and parasympathetic index in lying as well as standing position.


Someone should always remain with the patient during the measurement.

The patient is first measured while lying down. After a preset time, the VNS analysis gives the signal “Please stand up”. The rest of the measurement is then performed in the standing position. The total measurement time is 340 RR intervals, approximately 5 minutes.

After the measurement is finished, the lying position is compared with the standing position.

Training control

To be able to answer this question, the question of what I want to use it for must first be clarified.

At the 7th HRV Symposium in Halle, the measurement of the autonomic nervous system was presented as a possibility for training control. Laura Hottenrott, daughter of Prof. Dr. Kuno Hottenrott and German runner-up over 10,000 meters, reported on the optimized possibilities for training control with measurement of HRV during the change of position.

Laura Hottenrott explained that a normal rest measurement is often not sufficient for competitive athletes.
The normal resting measurement in the course of training often shows no differences to the baseline measurement taken at the beginning of training and thus offers no real possibility for training control.
Only the orthostasis test makes it clear that the standing phase differs significantly from the initial measurement and thus provides information about the training condition.
Before the start of training, several measurements should be taken in order to be able to optimally assess the athlete.

This measurement is a baseline measurement of an athlete in the non-training phase, which represents well his actual condition.

In this measurement, it is easy to see that the lying position has hardly changed from the initial measurement. However, in the standing position, the heart rate and sympathetic nervous system increased significantly and the parasympathetic nervous system decreased significantly. This could be an indication of too intensive training.

However, there is also a definite “vagus depression,” or overtraining, according to Laura Hottenrott. In this case, the orthostasis test is not absolutely necessary, since a significantly reduced vagus activity can already be detected in the normal resting measurement compared to the initial measurement.

A clear “vagus overshoot” or parasympathetic overtraining is present if the normal resting measurement shows a significantly increased vagus compared to the baseline measurement. The cause would usually be a too little intensive training or a training that is designed increasingly in the endurance area with a low heart rate.

Get to know the new VNS Analysis Software now – arrange a no-obligation and free demonstration in your practice or request free information material.

VNS analysis long-term measurement with marker function

For even more detailed therapy control

In this video we show the VNS analysis add-on module of the long-term measurement. It allows to perform measurements without time limit. Moreover, in addition to displaying heart rate variability, parasympathetic activity is visualized in real time as a blue line. With the special marker and note function, individual markers can be created and set before but also during the measurement. The effect of therapeutic interventions on the autonomic nervous system can thus be visualized for even more detailed therapy control during measurement.

VNS Analysis IHHT

Realtime RMSSD during IHHT

The IHHT (Interval Hypoxia Hyperoxia Therapy) add-on module allows des to perform real-time measurement of parasympathetic activity during an IHHT session. Because the vegetative system responds directly and variably to hypoxia, the intensity of therapy and the duration of hypoxic and hyperoxic intervals should be matched to VNS regulation. Thus, an excessive drop of the parasympathetic nervous system can be avoided and patient safety can be increased at the same time.

In order to best assess the changes in parasympathetic activity, the duration of the hypoxia and hyperoxia phases, as well as the number of cycles, are adjusted according to the settings made on the IHHT device.