HRV in Stress Monitoring by AI: A Scoping Review

Giovanna Zimatore, Samuele Russo, Maria Chiara Gallotta, Giordano Passalacqua, Victoria Zaborova, Matteo Campanella, Francesca Fiani, Carlo Baldari, Christian Napoli, Cristian Randieri

Abstract: Despite the growing interest in physiological stress monitoring, an objective measure of stress is currently lacking, especially in clinical and rehabilitation contexts. With the emerging integration of artificial intelligence (AI) in data analytics, heart rate variability (HRV) has gained attention as an effective biomarker; however, the literature remains fragmented across disciplines, stress types, and methodological approaches. This scoping review aims to investigate how AI techniques are applied to HRV analysis for stress detection and prediction in adult populations. Although this review does not focus on a specific subtype of stress, its primary objective is to explore the current methodological state of the art as reported in the literature, without restrictions on stress typology. Following PRISMA-ScR guidelines, a systematic search was conducted across PubMed, Scopus, and Google Scholar for studies published between 2005 and 2025, using MeSH terms including “HRV”, “Rehabilitation”, “SCI” (for Spinal Cord Injury), “Stress”, “Sympathetic”, “Parasympathetic”, “Non-linear”, “Gamification”, “AI” and “Machine Learning”. Inclusion criteria targeted adult human populations and studies employing HRV features as input for AI and machine learning techniques for psychophysical stress assessment. Of the 566 records identified, 15 studies met the eligibility criteria. The reviewed studies exhibit substantial heterogeneity in terms of settings, populations, sensors, and algorithms with most employing supervised methods (e.g., random forest, support vector machine), alongside several applications of deep learning and explainable AI. Only one study focused specifically on physiological stress, none focused on SCI populations, and rehabilitation-related research was scarce, thereby underscoring important gaps in the current literature. Overall, HR variability analysis, especially when combined with artificial intelligence techniques, represents a promising approach for stress assessment; however, the field is methodologically fragmented and clinically underdeveloped in critical areas, underscoring the need for a multidisciplinary methodological framework.

External IDs:doi:10.3390/app16010023