{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T17:28:33Z","timestamp":1791048513578,"version":"4.1.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"John and Ruth Young Clinical Academic Fellowship","award":["RG16738-10"],"award-info":[{"award-number":["RG16738-10"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Burnout is a rising concern among doctors. Heart rate variability (HRV), a non-invasive measure of autonomic nervous system activity, can reflect physiological states of sympathetic (stress) and parasympathetic (recovery) nervous system activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This review aims to evaluate how continuous ambulatory HRV monitoring has been used to understand patterns of stress and recovery in doctors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study protocol was preregistered (PROSPERO CRD42023413282). A comprehensive search was conducted. Studies were eligible if they reported at least one HRV parameter combined with at least one contextual or psychological assessment over a 24-hour period in a doctor population. Methodological quality was assessed using the Joanna Briggs Institute risk of bias assessment for case reports and the Standard for Reporting Diagnostic Accuracy in HRV studies STARDHRV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 805 records of which seven studies met the inclusion criteria. Meta-analysis was carried out for five different HRV parameters. Studies were conducted in seven different countries, ranged in participant numbers from 12 to 54 and each used a different HRV measurement device. There was a statistically significant difference in HRV between stress and recovery periods with four of these five parameters; root mean square of successive differences SMD\u2009=\u2009\u22120.63, P\u2009=\u20090.005, standard deviation of the NN (inter-beat) intervals SMD\u2009=\u2009\u22121.05, P\u2009=\u20090.001, low frequency (LF) Standard Mean Difference (SMD)\u2009=\u20090.54, P\u2009=\u20090.01, LF\/high frequency (HF) SMD\u2009=\u20090.69, P\u2009=\u20090.006. The quality of studies was moderate at best.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Continuous HRV monitoring may offer a viable method for tracking stress and recovery patterns that may contribute to burnout.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/occmed\/kqaf101","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T11:54:13Z","timestamp":1758628453000},"page":"630-639","source":"Crossref","is-referenced-by-count":9,"title":["Continuous heart rate variability monitoring, stress and recovery in doctors: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3989-514X","authenticated-orcid":false,"given":"L","family":"Kane","sequence":"first","affiliation":[{"name":"Academic Primary Care and Health Psychology, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen"},{"name":"Emergency Department, NHS Grampian"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4995-6057","authenticated-orcid":false,"given":"D","family":"Powell","sequence":"additional","affiliation":[{"name":"Academic Primary Care and Health Psychology, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K R","family":"Martin","sequence":"additional","affiliation":[{"name":"Academic Primary Care and Health Psychology, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Rees","sequence":"additional","affiliation":[{"name":"Emergency Department, NHS Grampian"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Curran","sequence":"additional","affiliation":[{"name":"Emergency Department, NHS Grampian"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Ball","sequence":"additional","affiliation":[{"name":"Sports Science, Institute of Education in Healthcare and Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"2026011213301588100_kqaf101-B1","author":"General Medical Council","year":"2022"},{"key":"2026011213301588100_kqaf101-B2","doi-asserted-by":"crossref","first-page":"e018086","DOI":"10.1136\/bmjopen-2017-018086","article-title":"Cross-sectional study of the financial cost of training to the surgical trainee in the UK and Ireland","volume":"7","author":"O\u2019Callaghan","year":"2017","journal-title":"BMJ Open"},{"key":"2026011213301588100_kqaf101-B3","author":"International Classification of Diseases","year":"2021"},{"key":"2026011213301588100_kqaf101-B4","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1108\/02683940710733115","article-title":"The job demands-resources model: state of the art","volume":"22","author":"Bakker","year":"2007","journal-title":"J Manage Psychol"},{"key":"2026011213301588100_kqaf101-B5","article-title":"Need for recovery and physician well-being in emergency departments: national survey findings","author":"Cottey","journal-title":"Eur J Emerg Med"},{"key":"2026011213301588100_kqaf101-B6","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s10484-022-09564-0","article-title":"Review of I. 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