Image 1: Energy Supply Score (App View)

The Energy Supply system reflects two distinct metabolic pathways, represented as separate efficiency indices: aerobic efficiency and anaerobic efficiency. To evaluate the metabolic system's readiness for adaptation, OTO uses a complex amplitude-frequency analysis of the ECG, a proven and reliable method for measuring adaptations within the metabolic system.

The functional state of the metabolic system is evaluated according to three indicators:

Image 2: Energy Supply Score / Metabolic System Readiness (Admin Portal View)

Overall Energy Supply is scored on a scale of 1 to 7, with the value influenced by all three of these underlying scores.

When the metabolic system is in an ideal functional state, it is not a limiting factor on the patient's readiness for adaptation. Provided no other system is limiting readiness, the patient is generally well-positioned to build stress resilience across a range of activity levels, and this represents a good window to support positive adaptation.

It's important to note, though, that a strong Energy Supply score doesn't guarantee overall readiness on its own. If the metabolic system is in an ideal state but another system, such as CNS Readiness, is limited, overall readiness is still adversely affected by that limitation. In that case, activity guidance should be shaped by whichever system is the current limiting factor, not by Energy Supply alone.

Image 3: Longitudinal Analysis of the Energy Supply System/Metabolic System Readiness

MRI characterizes the overall metabolic capacity of both the aerobic and anaerobic energy supply mechanisms to support physical exertion of any kind. Measured at rest, it reflects how coordinated and coherent all of the body's energy supply mechanisms are, giving a combined readiness picture that sits alongside the separate aerobic and anaerobic efficiency scores.

MRI can be lowered by things like combining high-volume and high-intensity loads, inadequate recovery, irregular or unbalanced meals, disrupted sleep, or illness. It can be raised through restorative activity, customized recovery protocols, balanced and regular meals, a normal sleep rhythm, and the absence of illness.

Over time, a declining MRI is associated with reduced benefit from recovery activities and lower resistance to stress, while a rising MRI is associated with greater benefit from recovery, better stress resistance, and improved coordination across metabolic processes.

Aerobic Readiness reflects the current state of the aerobic metabolic pathway and the body's ability to perform aerobic work. Aerobic-based effort is defined by longer-duration activity at moderate-to-high output, fueled mainly by aerobic energy sources — for endurance activities, the aerobic system typically supplies at least 70% of the energy required. This pathway underlies endurance capacity and reflects the body's ability to resist stress and fatigue while building adaptation reserves over time.

Aerobic Readiness can be significantly lowered by high-volume or high-intensity aerobic loads, insufficient recovery, unbalanced or irregular meals (especially inadequate carbohydrate intake), or illness. When Aerobic Readiness is low, it's associated with reduced trainability, lower resistance to stress, accumulated fatigue, reduced adaptation reserves, greater risk of illness or injury, and decreased work capacity and performance.

This measurement can be increased through appropriately selected aerobic training loads, adequate and complete recovery, balanced and regular meals, and training at mid-range altitudes. Maintaining an ideal Aerobic Readiness is associated with increased resistance to stress, reduced risk of overreaching or overtraining, greater adaptation reserves, lower risk of illness or injury, and increased work capacity.

Anaerobic Readiness reflects the current ability to perform muscle work using the glycolytic energy system while withstanding a high level of lactate in the blood. Anaerobic-based effort is defined by exercise where anaerobic glycolytic processes account for over 60% of the energy supplied, while mixed anaerobic-aerobic loads are those where both systems contribute roughly equally. Anaerobic Readiness also reflects the anaerobic system's ability to compensate when the aerobic system can't produce enough energy on its own during strenuous work.

Anaerobic Readiness can be significantly lowered by excessive anaerobic-glycolytic load (in volume or intensity), insufficient recovery, or unbalanced or irregular meals, particularly a lack of glycogen and protein. When Anaerobic Readiness is low, it's associated with reduced speed and power endurance, a reduced ability to perform high-intensity exercise in the 0.5–2.5 minute range, reduced anaerobic reserves, and a reduced ability to withstand hypoxia.

Anaerobic Readiness can be increased through regular, appropriately dosed anaerobic training and customized nutrition and supplementation. Maintaining an ideal Anaerobic Readiness is associated with increased speed and power endurance, faster activation of glycolytic processes (reaching maximal output in as little as 5 to 20 seconds), and greater power and capacity within the anaerobic glycolytic system.

These scales are built on OTO's proprietary scoring model and are intended to be interpreted dynamically, over a series of assessments, rather than as a single day snapshot. Trends over time are more valuable than any single reading, since they reveal how the body is learning to adapt and build resilience. Daily habits like sleep, exercise, and nutrition all leave their fingerprint on these scores, and the relationship between them, not just their individual values, is what signals how to adjust activity guidance.

This indicates the patient's capacity to produce anaerobic energy efficiently has become depleted. In this state, high intensity activity is not advisable. Recommend the patient shift toward low intensity recovery activity, such as light walking, easy cycling, or a gentle recovery run, until the anaerobic score recovers.

This suggests improving metabolic efficiency and recovery capacity. Current activity levels are generally well tolerated, and this is a reasonable window to maintain, rather than escalate, the patient's routine, unless other clinical factors suggest otherwise.

Because MRI reflects how efficiently the body's energy systems are supporting the heart and overall physiology, it's worth tracking alongside the aerobic and anaerobic trend patterns above rather than on its own. A rising MRI trend alongside improving aerobic and anaerobic scores reinforces that the patient's system is adapting well and building resilience. A declining MRI trend, even when aerobic and anaerobic scores appear stable, may be an earlier signal that the patient's system is under strain and needs more rest or recovery before it shows up in the other two indices.

Because energy supply is tied to mitochondrial and ATP signaling, sustained inefficiency in either pathway, or a declining MRI trend, may reflect constrained metabolic reserve, a factor linked to oocyte mitochondrial quality and embryo developmental potential. Monitoring this trend can help inform how much physiological load a patient can reasonably absorb during stimulation, retrieval, and the lead up to transfer.