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“Survivor” host Jeff Probst reacts to Dee and Rick Devens’ “Big Brother” success
Plus: We nominate the Survivor we’d like to see play next.
Texas Senate race focuses on high prices — but what can candidates actually do about it?
Affordability has dominated the U.S. Senate race in Texas. Both James Talarico and Ken Paxton have promised to help voters' pocketbooks.
Scientists tested the five-second rule by dropping food onto contaminated surfaces 2,560 times — bacteria could transfer almost instantly, and watermelon picked up as much as 97 percent of what it landed on
The bacteria transfer begins before you can blink, and some foods absorb pathogens as readily as a sponge absorbs water.
New Digital Maternal Health Hub Aims to Close Critical Gaps in Maternal Health Care Across Pennsylvania
AUDUBON, Pa., September 22, 2026--The Lincoln Center for Family and Youth (TLC), a nonprofit leader in community-based mental health services, has partnered with Greenspace Health to develop Bloom, a centralized digital platform designed to streamline access to maternal health care and social determinants of health (SDoH) resources and services for underserved communities across Pennsylvania.
Wendy’s moves to take 314 restaurants from bankrupt Meritage
Wendy’s terminated Meritage Hospitality Group’s franchise agreements for 314 restaurants, citing about $147 million in unpaid royalties and fees.
USA TODAY Sports Super 10 Alabama high school flag football rankings, Week 5
See which Alabama high school flag football teams are dominating the field as the season enters its final month of play.
Comptroller fires dozens of employees in Don Huffines' first month
The Texas comptroller terminated 41 employees as Don Huffines campaigns on shrinking the size of the state’s government and ending unnecessary spending.
The Giants’ season is already in danger, plus an early NHL preview
The Pulse Newsletter 📣 | This is The Athletic’s daily sports newsletter. Sign up here to receive The Pulse directly in your inbox. Good morning! Talk to your friends about EPA today. Coming up: 🔀 Vibe shift in L.A. 🤓 The WNBA’s spectacle 📕 We’re all football nerds Football season can be so fickle. Vibes can turn on a dime. Last week, we marveled at how the new-look Giants dominated the Cowboys in primetime. We wondered if New York’s ceiling could be higher than previously thought under coaching legend John Harbaugh. And we wondered if the Rams’ dream season...
Can the States Stop the Corporate Domination of Our Politics?
States giveth corporations the right to exist, so the states can taketh away their political spending power—or at least, Hawaii and Montana are trying.
How lip-syncing to AI let Forced Entertainment ‘play the game of theatre’
Today we have a fascinating piece by long-time Forced Entertainment fan Ben Kulvichit, speaking to Tim Etchells about their latest show Cold Sweat, how they are integrating lip-sync and AI voices into their work, the question of ‘authenticity’ on stage, and how lip-sync has even opened the door for them to make “something a little bit like drama”. This piece is a paid partnership with the Southbank Centre, where you can see Cold Sweat next month – we’re very grateful to the Southbank Centre for their ongoing support for Exeunt. Holly Williams ‘It was immediately interesting and uncanny’ **By Ben Kulvichit** “Is the microphone on?” So goes one of the opening lines of Signal to Noise, delivered by a human performer lip-syncing to an AI-generated voice. The voice is American, cheery but sluggish, slowed down into a gelatinous drawl. It repeats ad infinitum in a farce of stuckness; an answer never materialises. I find myself asking the same question as I hop on a Google Meet call with Tim Etchells, the artistic director of Forced Entertainment. We spend five or ten minutes frowning at each other, muting and unmuting, me gesticulating in semaphore into my webcam, checking if I am coming through now, restarting the laptop. To Etchells, I appear exaggeratedly mouthing words, my voice missing. In this gloopy purgatory of broken communication, life imitates art imitates life imitates art. We try a Zoom instead. Forced Entertainment, the pioneering British theatre company who have been at the avant-garde of performance since the 1980s, turned an interesting artistic corner with Signal to Noise, created on the occasion of their 40th anniversary. The whole performance employed this lip-sync technique to AI voices; on the face of it a left-field move from a company whose identity has long been grounded in the earthy, immediate presences of its performers and its unassuming, low-tech approach to theatricality. The technique, however, turned out to provide the company with a “rich new seam” of artistic enquiry, and has now spawned a trilogy of works. The second instalment, Cold Sweat, plays at Sheffield Theatres, Southbank Centre, and Lancaster Arts in October, while the third part, Everything Must Go, has been touring in Europe and is slated to come to the UK in 2027. As is often the case with Forced Entertainment shows, the main conceit for this work didn’t arrive until quite late. They were “four or five weeks into rehearsals for Signal to Noise,” Etchells recalls, and getting nowhere. Away from rehearsals, he had been playing around with feeding “weird texts” to AI voices to see how they would cope with them – “basically for my own amusement” – and was compelled by the uniformly “serviceable, benign, good-natured” tone they would read in, no matter how poetic, fractured or experimental the writing. On a hunch, he brought some examples into rehearsals and the performers gave lip-syncing a go. “It was immediately interesting and uncanny,” he recalls, with the performers having to deal in the moment with the problem of mapping themselves onto another artificial ‘performer,’ which itself was dealing with the problem of a very human text. “Almost all the writing for these projects would be useless to us unless it was done in this way,” says Etchells. “We wouldn’t know what to do with it. It’s too poetic. It’s too fictional. It’s too tangled.” But exploring lip-syncing along to the text has opened “an enormous reservoir of ways of thinking about writing and performing.” Subscribe to Exeunt, and get two in-depth pieces on theatre a week, direct to your inbox Subscribe Forced Entertainment have long been sifting through the detritus of popular culture, from daytime TV to end-of-the-pier vaudeville, magic acts and clown shows, to find frameworks for their own unusual entertainments. Lip-syncing, then, makes sense for them to experiment with. As a mode of performance, it’s wired into popular consciousness through pop stars trying to convince stadium audiences of their liveness, or those same voices as channeled through the made-up lips of contestants on RuPaul’s Drag Race, or movie dialogue spreading virally through the host bodies of TikTok users. For Etchells, lip-syncing is often about “approaching real voices and trying to take on their aura,” subsuming that original human presence into yours. “There’s a very basic, elemental sort of theatre magic to it, produced in this very easy way.” This broad approach resonates with instances of lip-syncing within contemporary performance, too. In works like Re-Member Me and Showmanism, performance artist Dickie Beau acts as a kind of spirit medium for archival recordings (this process of re-membering – as in, giving corporeal form to voices – relies on his masterfully precise actor’s technique), while Frankie Thompson is similarly possessed by a host of characters ranging from a nine-year-old Jacob Rees-Mogg to Cliff Richards, all of whom she finds compellingly nauseating, in the exorcism ritual that is her latest show, Horrible Things. What’s different about Forced Entertainment’s use of lip-syncing is that here, there is no original presence to be channeled. The performers are instead taking on what Etchells describes as “the voices of nobody,” or rather the “phantasmic, aggregated echoes” of the many many voices on whose data the AI has been trained, and which are now conjuring into existence words they never actually said. There is a sort of mournful, empty quality to these voices, having “washed up” far away from the people they originally belonged to, to find themselves in stranger’s mouths listing objects, wondering if anyone can hear them and glitching in interminable loops. There is a cold, sad anonymity to it all. Etchells remarks that occasionally the software company he used has notified him that particular people are withdrawing their voices from the platform, instructing him to cease use of those voices. Using these technologies in performance certainly brings up ethical questions around digital rights, consent, identity and ownership, although in the grand scheme of things, Etchells is fairly blasé about it: of all the purposes someone’s voice might be put to without their knowledge, “an avant-garde performance is probably the least of their worries.” [ ](https://exeuntmagazine.substack.com/p/frankie-thompson-horrible-things-essay-mental-health-compulsive-behaviours-pleasance-courtyard-soho-theatre) [ Frankie Thompson: How I manage my own ‘horrible things’ at the Edinburgh Fringe ](https://exeuntmagazine.substack.com/p/frankie-thompson-horrible-things-essay-mental-health-compulsive-behaviours-pleasance-courtyard-soho-theatre) Exeunt · Aug 25 [ Read full story ](https://exeuntmagazine.substack.com/p/frankie-thompson-horrible-things-essay-mental-health-compulsive-behaviours-pleasance-courtyard-soho-theatre) For the performers, though, lip-syncing to these strange, artificial voices is an odd task, requiring them to bend their live, human presence into the shapes produced by machines. Politically, it mirrors processes that are already at play in the continued computational automation of human life. Etchells brings up James Bridle’s writings on new technologies as a reference point: one example Bridle gives is of “chaotic storage”, a logistics technique employed by Amazon fulfilment centres whereby items are stored not according to traditional methods of categorisation or alphabetisation, but in a way that an algorithm determines to produce the most efficient routes for ‘picking’ based on customer purchase patterns. This appears completely random and incomprehensible to humans, with paddling pools sitting next to USB sticks sitting next to blowtorches, and so for the warehouse workers, the process of picking items becomes completely reliant on technology which tells them where to go. Our world is increasingly being designed not with humans in mind, but rather machines. As Etchells puts it, “technology malforms the space, and then you end up having to live in it.” Initially, Forced Entertainment tried their best to live in the world of machines: “I was in the it’s-got-to-be-perfect school of lip-sync,” says Etchells. But with their aesthetic being so tied to the failing act, the slipping mask, the shoddy costume, “it’s no surprise really that that didn’t last.” Instead, the performers got to enjoy being late for a line, or playing games with each other, “stealing” each other’s voices. Etchells compares it to the principles of ventriloquism, in which a free-floating voice unattached to a body is fundamentally discomforting and “sort of traumatic”. That discomfort is equally as alluring to Forced Entertainment as the satisfaction of precision, the pretence of authenticity only interesting if shown to be a pretence. Lip-sync has also opened up new avenues for the company. Having been allergic all their lives to Plays-with-a-capital-P, with Cold Sweat Forced Entertainment find themselves approaching something a little bit like drama. Rather than the presentational arena of Signal to Noise’s open white stage, Cold Sweat places us more decisively in a “fictional locale”: what appears to be “the aftermath of some disastrous party or backyard drinking binge” where three figures – family members, or neighbours, perhaps – are the last ones standing. “It’s all quite acrimonious and accusatory, everyone’s talking over each other.” For Etchells, this more fictional mode is “a door that we’ve never been able to open. We’ve just never really gone there.” Perhaps it is the technique of lip-syncing, an extra buffer of mediation, that allows them to venture away from the here-and-now without feeling that they have to commit to the “psychological claptrap” that comes along with acting; to be able to “play the game of theatre, without getting one’s hands too dirty.” As I wonder how else the impulses behind Forced Entertainment’s work have changed over time, it occurs to me that over the last ten years of new creations, with the exception of If All Else Fails, the company’s performers haven’t ever spoken on stage: there were two shows without any language at all, Out of Order and Under Bright Light, and then this trilogy of lip-sync works. Etchells agrees it’s a shift away from earlier productions, that were so often about “the actual voices of the performers and their actual presences. We had a lot of money, in some ways, on an authentic approach to what it might mean to speak on the stage.” But this sense of authentic presence itself had a fakeness to it; these days, Etchells can’t stand that mode of being onstage where performers “are here to be cheeky and witty versions of themselves. I don’t want to be charmed.” Pulling back into a more anonymous space has resulted in works that feel slightly sharper-edged, more brutal in a way. “All of these shows are post-Brexit, post-Trump, post-truth, post-everything,” Etchells notes. Speech, charisma, authenticity – these things feel politically loaded, and perhaps warmth and openness just don’t feel like the right tools to reflect the world we’re living in. “It feels like the space is closing down, and we’re trying to deal with the fact that the system, the structure that you’re in, is more oppressive and more powerful. It probably always was, but I think we’re just more tuned to it now.” Yet even without their voices, the performers’ distinctive presences – ones that many audiences have followed around for years, if not decades – still, inevitably, shine through as they physically navigate whatever unending task the system of the piece has set for them. They’re still trying to keep up with the onslaught of text, still running about, changing costumes, moving stuff around. The human is always stuck in the teeth of the machine, jamming the smooth, frictionless cheeriness of the not-real, gesticulating silently, trying desperately to communicate. Cold Sweat is at Sheffield Theatres, 2 to 3 October; Southbank Centre, London, 9 to 10 October; Lancaster Arts, 14 October [ ](https://exeuntmagazine.substack.com/p/exeunt-recommends-the-best-autumn-theatre-2026-lives-of-others-standard-of-living-our-friends-in-the-north-lanny-) [ Exeunt recommends... the best autumn theatre ](https://exeuntmagazine.substack.com/p/exeunt-recommends-the-best-autumn-theatre-2026-lives-of-others-standard-of-living-our-friends-in-the-north-lanny-) Exeunt · Sep 16 [ Read full story ](https://exeuntmagazine.substack.com/p/exeunt-recommends-the-best-autumn-theatre-2026-lives-of-others-standard-of-living-our-friends-in-the-north-lanny-) This piece was paid for by the Southbank Centre. Such support helps Exeunt to keep publishing the most interesting writing, about the most exciting theatre. Interested in partnering with Exeunt? Visit our Advertise with Exeunt page, where you can get more information, download an advertising pack, and find our contact details.
Jiang Feng: The Unravelling of German & European Politics
A state election in eastern Germany has become a revealing test of the changing political landscapes of Germany and Europe, writes Jiang Feng, Professor and Chairman of the Council of the Shanghai Academy of Global Governance and Area Studies (SAGGAS) at Shanghai International Studies University. His analysis follows the decisive victory of the Alternative for Germany (AfD) (which has been classified as right-wing extremist by German authorities)in the state of Saxony-Anhalt on 6 September, in which it finished far ahead of its mainstream rivals. Jiang previously served as Minister-Counsellor at the Chinese Embassy in Berlin. The following article was published on 8 September 2026 on huanqiu.com, the online platform of the Global Times. On 6 September, the results of the state election in Saxony-Anhalt, Germany, were announced. The Alternative for Germany (AfD), classified as far-right by German authorities, made history by becoming the largest party in the state parliament, winning 43.8 per cent of the vote — twice its share in the previous election. The Christian Democratic Union (CDU), which had governed the state continuously for 24 years, won just 17.2 per cent, its worst result ever in Saxony-Anhalt. On the night the results were announced, the atmosphere at the CDU gathering was unusually calm. There was neither shock nor argument, as if the defeat had long been expected. Several veteran party members who had spent years working in the state government said: “Defeat is not a bad thing. It is time to make changes.” This state election has not only upended Saxony-Anhalt’s political landscape, but also laid bare the deep tensions between Germany’s traditional party structure and model of governance, on the one hand, and an increasingly polarised society on the other. Its repercussions are already being felt at the federal level, making Saxony-Anhalt a useful case study of the broader trend towards political polarisation and realignment in Europe. Governing Difficulties after Electoral Victory The most immediate consequence of the election is a historic setback for the mainstream party order that took shape in post-war Germany. In Saxony-Anhalt, the AfD has leapt from a peripheral party to the largest political force in the state. Its electoral base has expanded beyond the traditional category of “marginal protest voters” to take on the characteristics of a cross-class coalition. The party has not only consolidated its support in rural areas, but also attracted many middle-class voters and even members of the social elite with stable jobs, their own homes, and substantial incomes. It has thus evolved from a “protest party” into one with the potential to govern. Despite its commanding lead in the vote, however, the AfD faces an institutional obstacle to governing the state: the mainstream parties’ long-standing “firewall” against it. Neither of the two potential routes to forming a government appears likely to break the current political deadlock. The first would be a coalition of establishment parties, led by the CDU and bringing together the Social Democratic Party (SPD), the Greens, the Left Party (Die Linke) and the Sahra Wagenknecht Alliance (BSW) in a cross-camp government. In terms of parliamentary arithmetic, such a coalition could prevent the AfD from forming a government and preserve the outward stability of the traditional political order. Yet these parties are fundamentally divided over key issues including immigration, the energy transition, economic management, and cultural and education policy. Coalition negotiations would therefore be extremely difficult, and even if a government could be formed, it would most likely prove short-lived. More importantly, an alliance of establishment parties aimed at keeping the largest party out of government would play directly into the AfD’s narrative that “political elites are suppressing public opinion”. It could deepen perceptions of political unfairness, further strengthening the AfD’s political capital, and creating a dynamic in which “the more it is suppressed, the more people vote for it”. Ulrich Siegmund, the AfD’s candidate for state premier, has said that if efforts to form a government fail because other parties refuse to cooperate, the AfD will push for a fresh election, which he believes could deliver the party an absolute majority of seats. This points to more intense political battles ahead. The second option would be a coalition between the AfD and the BSW. Together, the two parties would command a simple majority in parliament, making this, on paper, the quickest route to forming a government. The BSW is the only elected party that has not ruled out cooperation with the AfD, and the two parties share some common ground, including on policy towards Russia. There is therefore a degree of political basis for cooperation. Were such a coalition to materialise, Germany would see its first state government jointly formed by a party defined as far-right and one with a far-left background, creating what might be called a “bipolar anti-establishment alliance”. Such an outcome would fundamentally break with the ideological boundaries of post-war German party politics. It is worth noting that even if the AfD ultimately fails to enter the state government, its roughly 47 per cent share of parliamentary seats would give it a powerful blocking minority. Without its consent, major decisions requiring a two-thirds majority — including constitutional amendments, significant budgetary adjustments, and state-level institutional reforms — would be extremely difficult to pass. Therefore, whoever ultimately forms the government, the AfD will be an unavoidable force in Saxony-Anhalt politics, with a direct influence on the state’s legislative process. Systemic Failures in Germany’s Governance Model The Saxony-Anhalt election result reflects a systemic failure of Germany’s post-war mainstream-party model of governance to adapt to rapidly changing socioeconomic conditions. It stems from multiple, mutually reinforcing structural tensions and highlights the existing political system’s difficulty in adapting to “an increasingly polarised society First, collective anxiety has replaced individual material hardship as a central driver of political mobilisation. The rise of the AfD can no longer be explained simply by poverty or social marginalisation. Its increasingly cross-class electoral base suggests that what is driving voters towards the party is, above all, concern about the broader direction of society. This anxiety about the future of the political community goes beyond individual gains and losses. In political discourse, economic anxiety has become closely intertwined with immigration, while immigration and refugee issues are, in essence, questions of social fairness. This perception turns conflicts over the distribution of social resources into negative assessments of governing parties, providing a broad social basis for far-right political narratives. Second, regional disparities and East German identity have undermined the strategy of addressing eastern Germany’s structural challenges at the regional level. More than three decades after German reunification, eastern states such as Saxony-Anhalt have experienced periods of economic growth, but their underlying economic structures remain weak, and household incomes and wealth remain significantly below those in western Germany. At the same time, they continue to face population outflow, an ageing population, labour shortages, and other structural challenges. At a deeper level, historical experiences — including the collapse of the former East German economic system, mass unemployment during the transition, and the westward shift of decision-making power over major issues — have left some residents with a sense of being “second-class citizens” and of being excluded. For years, the German government treated the “syndrome” of reunification as a regional problem to be gradually addressed at the local level. That approach is becoming increasingly unsustainable, as regional development disparities emerge as a core structural factor shaping national politics. Third, the erosion of institutional trust is perhaps the most decisive factor. AfD supporters tend to distrust establishment institutions, including parliament, government, and the mainstream media. Their concerns about economic security, pensions, and social fairness are significantly greater than the social average. Increasingly, their support for the AfD reflects not an expectation that the existing system can be improved, but a search for an alternative to the current political order. Such a systemic deficit of trust will be extremely difficult for the traditional parties to repair in the short term. Fourth, a generational shift in political mobilisation has amplified political polarisation. Unlike traditional parties, which rely heavily on offline rallies and mainstream media coverage, the AfD has developed a social-media mobilisation strategy built around “raising an issue — identifying who is responsible — offering a simplified solution — building a shared identity”. It turns complex social tensions into concise political narratives, rapidly channelling public sentiment into political support. The contrast on the eve of the election was particularly telling. The establishment parties, together with trade unions and churches, organised an offline march attended by more than 10,000 people, but its reach was largely confined to those present and to traditional media coverage. The AfD held a much smaller indoor event, yet livestreaming on TikTok, YouTube, and other platforms, combined with the involvement of online influencers, gave it a reach and mobilising capacity far beyond that of the march. The contrast illustrates how the traditional parties’ methods of political mobilisation are increasingly struggling to keep pace with a political environment transformed by changes in media technology. A Microcosm of Structural Political Change in Europe The shockwaves from the Saxony-Anhalt election quickly travelled beyond the state to the federal level. Calls for political accountability followed immediately after the results were announced. The governing CDU and SPD are now under enormous pressure, while Chancellor Friedrich Merz and Vice Chancellor Lars Klingbeil face an unprecedented test. Political polarisation in Germany is no longer simply a regional phenomenon. The post-war model of multiparty government by establishment parties is breaking down and being reshaped. Viewed in a broader European context, the Saxony-Anhalt election is part of a continent-wide wave of party polarisation, mainstream-party decline, and rising right-wing forces. Far from an isolated phenomenon, it is a microcosm of the structural political changes unfolding across Europe. Weak economic growth, cultural tensions over immigration, and declining trust in institutions are fuelling the rise of right-wing forces in several countries, challenging the liberal internationalist order established in post-war Europe. As a core member state of the European Union, Germany’s ability to adapt its political system and the direction of its politics will have profound implications for both European integration and the evolution of the international order. Subscribe [ Pekingnology China’s Germany watchers take stock of Berlin’s uneasy turn On 7 December 2025, nearly 50 Chinese scholars and policy researchers gathered in Beijing for the 2025年德国形势年终研讨会 “2025 Year-End Seminar on the Situation in Germany… Read more 9 months ago · 31 likes · 1 comment · YIRUI LI and Yuxuan JIA ](https://www.pekingnology.com/p/chinas-germany-watchers-take-stock?utm_source=substack&utm_campaign=post_embed&utm_medium=web&embedding_publication_id=1151841) [ Jiang Feng on Germany's 2025 and beyond: no easy exit ](https://www.eastisread.com/p/jiang-feng-on-germanys-2025-and-beyond) Yirui LI and Yuxuan JIA · Jan 24 The following is an op-ed by Jiang Feng, published on 29 December 2025 at Shanghai Observer 上观新闻, the digital platform of Jiefang Daily, the official newspaper of the Shanghai Municipal Committee of the Communist Party of China (CPC). [ Read full story ](https://www.eastisread.com/p/jiang-feng-on-germanys-2025-and-beyond)
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The Big Holes in Wearable Heart Rate Variability And Readiness Scores
On September 9th, Apple announced it was revamping its Apple Watch Health Sensing System, rolling out a Readiness score (0 to 10), and increasing the frequency of heart rate variability (HRV) outputs 24-fold. This can be viewed as upping its competition with various other consumer wearable sensors. These “readiness scores” as a composite of multiple metrics, with heart rate variability (HRV) being front and center for most. The majority of Americans are now using wearable sensors, which equates to well over 100 million adults. HRV and Readiness scores are increasingly being marketed as a measurement of autonomic nervous system health, a digital marker for future disease, a clock for biological age, and a holistic metric to promote healthspan and even longevity. (Apple also introduced a new longevity tab and “Health Age”.) None of this has been proven. In this edition of Ground Truths I am going to review what we know about heart rate variability and readiness scores. Heart Rate Variability HRV is the variation in normal heart cycle timing. The variability of the heart rate, the barely perceptible millisecond changes in time between consecutive heart beats (see R-R intervals in the Figure below, left panel), is due to interplay between the sympathetic and parasympathetic (vagal nerve) inputs. Distinct from heart rate, individuals with the same heart rate can have very different HRVs. It is a rough reflection of the autonomic nervous system (ANS) activity, inadequate to say whether a person’s ANS function is abnormal. For more than three decades, heart rate variability (HRV) has been measured and several studies have found an association of low HRV and clinical outcomes, particularly a link with higher all-cause and cardiovascular mortality. There have also been less well established links of low HRV to risk of early cognitive impairment, dementia, mental illness, Type 2 diabetes and substance abuse. An important reminder is that HRV is a surrogate marker without any established cause-and-effect relationship. If you increase your HRV, that doesn’t mean it will improve health outcomes. In fact, there is no hard evidence for that. All that work linking to health outcomes was done with electrocardiogram (ECG) derived HRV. Now, in the era of consumer wearables, this is getting assessed differently, by optical pulse (yes, the lights you see) plethysmography (PPG) or what is called pulse rate variability (PRV). They are not the same, as shown below (right panel) and only concordant when the delay between the ECG and pulse is kept constant, which basically means at rest. I should mention there’s also what I will call MPV, a mattress mechanical movement sensor, a derived heart rate variability, that companies like Eight Sleep use, even further away from directly measuring HRV. HRV has not one uniform measurement but many different types of quantification, such as RMSSD, the magnitude of difference between successive R-R intervals of normal sinus beats (N-N) or SDNN, the standard deviation of NN intervals, both in milliseconds. SDNN is one of the so-called frequency domain HRVs (others are LF, HF, LF/HF). Different wearable sensors use different metics; Apple has relied on SDNN and nearly all of the others use RMSSD, which is generally considered the more accurate metric. There’s also the different length of time measured, such as for a matter of minutes, all day, or an overnight’s sleep. Short measurements are especially problematic since they don’t capture enough of respiratory modulation and other factors that influence HRV. Share Ground Truths How well does HRV correlate with PRV? There are very limited studies, especially independently done. One that is commonly cited was conducted by Air Force researchers in only 13 healthy adults assessing Oura ring 3 and 4, Whoop 4.0, and Garmin Fenix 6 and showed a correlation coefficient of 0.88 to 0.97 and a mean absolute percentage error from 6 to 10%. The correlation is not a perfect 1.0, but there’s at least a fairly high level of correlation. HRV is supposed to increase during the night due to takeover of the parasympathetic nervous system, and higher during deep sleep. A recent example of my 1 week, all day “HRV,” and one during sleep is shown below. As you can see, the N of 1 data are inconsistent for the same days from different sensors (Oura, AppleWatch, Fitbit Air, and Eight Sleep) by patterns, absolute numbers, and comparison with prior days and weeks. The largest study in over 8 million Fitbit users (the old version, not Google Fitbit Air, introduced in May 2026) gives you a sense of the effect of age, sex, and the 2 different main HRV (here PRV) metrics, with RMSSD on the left and SDRR (=SDNN) on the right below. That study, from data collected in 2018, is a major outlier, since all the more recent ones are tiny with respect to sample size. Many of the companies have not had independent evaluation of their HRV, such as Eight Sleep, but have published a low standard error on their website. There are some other published studies on the correlation between HRV and PRV, but they are all small and only in healthy adults. A scoping review emphasized the lack of study in underrepresented individuals, including the aged, people of color (which affects the PPG signal), and individuals who are underweight or obese. Add the typical adult age 60 plus with one or more chronic diseases. For example, one study in over 900 adults found poor correlation of HRV and PRV, non-uniformly underestimated across many chronic diseases (cardiovascular, endocrine, neurological, respiratory, and others), concluding PRV is “an invalid surrogate for HRV.” A recent systematic review of 43 studies comparing HRV and PRV found reasonable pooled absolute standardized error (HRV as gold standard) but only 10 of the studies provided quantitative synthesis in ideal conditions. Their main conclusion was similarly cautious: “PPG-derived HRV [PRV] should not be regarded as universally interchangeable with ECG-derived HRV across all devices, populations, and recording contexts.” Factors Affecting HRV and PRV That gets me to the long list of factors that affect HRV (and PRV) besides the device, the type of measurement (RMSSD, SDNN or others), the person’s signal, the sensor site, the duration of data capture, if weighting by sleep stage is used, how artifact is processed and corrected. And this list is not complete!: Oura puts out data from their community of users (who input data) on what affects their overnight HRV. The factors currently provided are: no alcohol (increase 8%), melatonin (increase 2%, float tank (increase 2%), wine (decrease 4%), and party (decrease 14%) in overnight HRV. Must be some big parties! Subscribe What is a PRV measurement good for? It has been falsely characterized as an index of “autonomic balance” and a specific indicator of stress. A 2018 review of the studies available for HRV and its relationship to stress, not using any of the current wearables, found that stress can lower HRV. But so can many other factors. The non-specificity of the signal, indexed to the table above, is striking. Evidence from a UK Biobank study of over 46,000 participants with actual HRV looked at genetically predicted HRV, a genetic risk score, that failed to show the expected HRV-mortality link, indicating that _HRV is likely not causa_l, but rather a reflection of person’s physiologic state. A review of consumer wearable HRV data from 5 longitudinal studies showed that nighttime PRV was not associated with perceived stress, and surprisingly higher HRV, in the largest cohort (N=717 participants), was correlated with higher stress. An Oura ring cohort of 525 first-year college students found a link between overnight PRV and perceived stress, but that was also seen with resting heart rate, sleep, and respiratory rate. Several very small studies have examined the relationship of HRV and athletic injuries or guiding training with mixed, and predominantly negative results. HRV biofeedback training with paced breathing had no significant effect on reducing stress or raising HRV, as demonstrated with sham controlled trials. When HRV for multiple days showed a decline in conjunction with body temperature, the Oura ring published data for prediction of Covid. The WHOOP company sponsored an observational study, published in 2026, of 30,000 users for 72 weeks, without a control group, that reported reduced alcohol intake (5.8 % points) by self-report. That doesn’t tell us much, and particularly about the merits of HRV for behavioral change. If you use the same device and conditions as longitudinal trends for multiple (at least 2-3) weeks that may be the one way to get something useful from the measurements. Data for overnight sleep with minimal motion and using RMSSD is the best proxy for real HRV. The reason to look at trends rather than any given night is that it more likely represents something, even though you won’t know with certainty what the “it” is. Keep in mind there are no data, no peer-reviewed evidence, to show that HRV fluctuation in-person has any correlation with health outcomes. Share Readiness Scores These are proprietary scores that integrate different metrics for each of the wearables: no algorithms have been disclosed. They are unvalidated against health outcomes. In a review of 14 composite health scores of readiness and recovery, HRV contributed 86% to the scores, followed by reading heart rate (79%), physical activity and sleep duration (both at 71%). That review noted the substantial variability in measurement protools and lack of standardization. Sleep staging is notoriously inconsistent and inaccurate by these sensors, which adds further to the HRV uncertainties for what the scores, which use sleep stage data, mean. Only resting heart rate has been shown consistently across devices to be extremely accurate. I’ve made a Table to summarize what we know about which metrics are included, the scores, any peer-reviewed studies that compared the readiness score with health outcomes, and the corresponding (if any, NA-not available) citation. You will note that some companies do not use the term “readiness," such as WHOOP for recovery, and Garmin, which has 2 different scores, one of which is Body Battery. Eight Sleep uses the term “Fitness Score.” They all include HRV; Apple includes a new metric they call “Recovery HRV” which among other components uses 7-days of sleep, but it is unclear what this means or how it is differentiated from other scores (there are clearly no data for outcomes). We have no knowledge of how the different components are weighted or whether any of these scores are better than resting heart rate, HRV alone, physical activity, or any other single metric. Since none of these are standardized, they are not interchangeable, so if you get a 90 for Oura that has no relationship to a 90 on a Google Fitbit Air. Notably, the company can update its algorithm for readiness score at any point without notification to device users. Without any useful evidence of actionability for these scores or established relationship with health outcomes, it is hard to make a case for their value. At the Apple recent announcement they showed their Readiness score (0-10) on the watch (Figure below) but there are no published data on this score, not even on their website. It’s available only on their new Watch Series 12 or Ultra 4 [of course, ;-)]. That exemplifies the problems with these scores, lack of data and evidence for being meaningful to promote health. Perhaps the best study (which isn’t saying much) is the WHOOP Recovery for golfer performance, because it did correlate with an objective outcome, even though there was no control group and the authors were all from the company. Among the 389 pro golfers, an absolute 10-per cent point increase in Recovery score was associated with about 0.5 fewer strokes per round. But that’s hardly a health outcome! WHOOP is also conducting a study in over 2,700 runners to see if their recovery score will be linked to less injuries and improved performance, but that is not yet published and has no control group or randomization. Putting This in Context For two decades I’ve been enthusiastic about the potential for digital health and particularly wearable biosensors. Over the years, we’ve seen some great progress for their ability to promote physical activity and accurately detect atrial fibrillation (the first FDA cleared deep learning AI for consumers). That work was the subject of rigorous research. But there are holes in the data and evidence for other metrics. One notable one is the “VO2 max” story that I wrote about earlier this year. At that time many subscribers asked me to cover heart rate variability, which I finally got to here. When I dived into the research and publication for HRV and readiness scores, I expected to find at least some that were of high quality and demonstrated their utility by linkage to health outcomes. To my surprise, I found none. The wearable sensor measurements for HRV (PRV) are, for the most part, accurate, but that validation work has only been done in small studies of healthy adults and does not take into account the long list of factors, from the device, software side, and the user side, that affect HRV measurements. Moreover, this metric chiefly relies on optical sensing and, as we have learned for heart rate PPG sensing, may be less accurate in people of color. Keep in mind that all of the health outcome association evidence comes from ECG-derived HRV; none are from wearable sensor data. I will repeat the key point: there's no peer-reviewed evidence to show that in-person HRV fluctuation—or efforts to raise your HRV— has any correlation with health outcomes. For those of you who look at your HRV on awakening, or even 2+ week trends of it being low, I hope this context helps to relieve any anxiety. Yes, low HRV (not PRV) has been shown to increase risk of some diseases as summarized above. But efforts to raise your HRV—a surrogate metric— has not been established for improving any health outcomes. HRV does not have any evidence of causality (the genetic evidence actually goes against this possibility). In this summary, I have not included data for other wearable sensors such as Polar, Samsung, Withings, Suunto, Amazfit, Coros, Ultrahuman, or additional mattress sensors. These are beyond my first-hand experience, and as far as I know from my in-depth review none have any peer-reviewed published data that differ from the 6 sensors I’ve reviewed here. From the points I’ve gone over above, we’re not ready for readiness scores. Besides being proprietary, they are predominantly based on metrics that have their own issues. It’s compounding the problem, like building a house without a solid foundation that has never undergone a rigorous inspection, and then selling it. Like I mentioned for PRV, you can look at trends over weeks rather than any single day, to get a handle, but even that may not be helpful. There’s simply no evidence that these scores meaningfully relate to health outcomes. I’d emphasize they might, but that requires doing prospective or randomized studies to prove it. None exist. There’s great promise for HRV/PRV utility_. For example**,**_ Prof Maiken Nedergaard, who discovered the brain glymphatics that are essential in eliminating metabolic waste products from the brain during sleep, has posited that HRV could be a non-invasive marker for neuromodulator oscillations, brain-body regulatory circuits, and brain clearance. That would be extremely useful, but like everything else on HRV and readiness scores it requires solid research and validation. The lay media isn’t helping much to get the story straight. Earlier this year The Economist published a piece entitled “The most useful indicator of your overall health” which ordained HRV as an “accumulated stress score.” That’s akin to the false assertion about VO2max: “V02 max is the singular most powerful marker for longevity.” As I’ve summarized here, that is not established. The fact is that so many things can lower HRV, including physical exercise (especially an intense workout), reduced sleep quality, stress, the list above, no less the device, signal, and software. Whatever fluctuations observed have not been correlated with any health outcome. Sadly, “datamaxxers” are widely using HRV and readiness scores that have never been validated to mean anything. We already know that for some people using the sensors for sleep metrics, it can induce “orthosomnia,” an obsession to get high sleep quality, with associated high levels of anxiety. In an experiment done by a company to promote sleep quality for its employees, “For those employees who did use the trackers, many reported feeling perfectly rested until their tracker told them they had had a terrible night. Others were told that they had slept like a baby when they had actually been lying awake worrying about the quality of their sleep. “ The same problem can result from preoccupation with HRV or readiness scores, with anxiety that would lead to further reduction in both. It you are using a wearable like >100 million American adults, it’s OK to look at these data, but contextualized with the major caveats reviewed here. If you are one to require evidence that HRV or readiness scores are linked to health outcomes, you may not even want to look. The companies make it hard to turn them off! Let me end with the companies that make and sell wearables. Apple’s doubling down on HRV (24-fold more reporting and heart rate very 5 seconds) and introduction of a Readiness score tells us that consumers have bought into these metrics and they are joining the club. However, all of this is occurring with a backdrop of tens millions of users, claims about the data that are not backed up by adequate evidence, marketing way out in front of whatever limited data exists, and not being transparent about their readiness score algorithms. The companies can well afford to do the research that is needed to connect these metrics with health outcomes show, once and for all, that increasing HRV or using readiness scores promotes our health. If they believed and invested in the products they are selling, we’d not be in this position of not knowing. That’s essentially where we are with HRV and readiness scores. Perhaps someday this will change and we’ll have good reason to embrace them. NB: I wrote this post. No AI. I have no conflicts of interest with any of its content. Loading... Ground Truths has 215,000 subscribers from every US state and 214 countries. There are over 300,000 followers of Ground Truths so more than 90,000 folks who can easily convert to be free subscribers. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. If you’re not a subscriber, please join! If you found this interesting PLEASE share it! Share Ground Truths The proceeds from all voluntary paid subscriptions go to support our summer internship program. It enabled us to accept and support a record number of 62 summer interns that joined us in 2026! These are high school, college and medical students selected from thousands of applicants. We couldn’t do this expanded program without the funds coming in through Ground Truths. Thank you!
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