Saturday, 14 November 2015

Heart Rate Monitoring & NICE Guideline for ME

NICE guidelines for ME contain a little acknowledged recommendation to keep "exercise" at between 50 - 70% of  maximum heart rate.

At first glance this would seem to suggest that patients can exercise at a brisk walk or gentle jog, because that's what healthy people need to do in order to exercise in this zone.

However the guideline clearly states that heart rate monitors should be used to keep exercise within this target zone.


This is important, because people with ME find that small exertions can escalate their heart rate to a much higher level than expected.

Here is some of my own data:

I recently wondered whether any of my ME friends had ever had a heart rate monitor suggested to them - so I asked on FaceBook and from my UK friends responding:

None had ever had a heart rate monitor suggested to them by a health professional.

So perhaps now is the time to insist that any "exercise" patients are advised to take, should only be done with the help of a heart rate monitor.

Perhaps this could this help patients avoid some of the harms reported with Graded Exercise programmes? 

[Edit to add: My own preference would be that patients are NOT ever pushed to exercise at all, but rather encouraged to stay within their limits using pacing techniques. I am aware that NICE pushes for increase. I don't agree. See previous post here.]


I have been monitoring my own heart rate for over a year now using a Mio Alpha heart rate monitor and a phone app called Endomondo. It may not provide the full answer to my dilemmas, but I hope at least it helps me to notice when I'm over doing things and so make me slow up appropriately.

I hope others might also find heart rate monitoring a useful technique.

I created the Slide Share below in hope that this information could be useful to patients and medical professionals until such times that the NICE guidelines are updated.

Post Script: 

Following a comment made below this post, and drawing also on my own experience,  I should mention that there can be times when heart rate appears deceptively low.

In my experience this does not necessarily mean a green light to push a bit more.  Caution is always advisable and only tiny changes to intensity or duration of "exercise" should ever be attempted.

Further Information

Useful Links: 
Pacing By Numbers by Bruce Campbell
Exercise Testing and Using a Heart Rate Monitor by Jennifer Spotila
FaceBook Group ME/CFS - Pacing with a Heart Rate Monitor

Other posts on Just ME:
Starting HR monitoring for ME Dec 2015
Rhythm+ and Endomondo: HR monitoring for ME Aug 2014
A few notes on using a HR Monitor for Pacing Feb 2014

NICE Guideline:  [CG53]

More on NICE guidelines for ME:
Margaret Williams August 2008


Maximum Heart Rate:
220 - (your age in years)

For me:  220 - 52 = 168 bpm  
(bpm = beats per minute) 

Calculating 50% of Maximum Heart rate:  
Max Heart Rate x 0.50
For me 168 x 0.50 = 84 bpm

Calculating 70% of Maximum Heart rate:   
Max Heart Rate x 0.70
For me 168 x 0.70 = 118 bpm

Thus my exercising zone should be between 84 and 118 bpm