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Heart rate monitoring and NICE guideline for ME

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It seems that NICE advice for ME patients to use heart rate monitors is often overlooked. This slide share explains why it is important that patients and medical professionals take note of heart rates.

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Heart rate monitoring and NICE guideline for ME

  1. 1. Heart Rate Monitoring & NICE Guideline for ME Is heart rate monitoring advice often ignored? The way I see it. by Sally Burch - http://sallyjustme.blogspot.co.uk
  2. 2. The Dilemma: Graded Exercise Therapy (GET) - is recommended by NICE - but patients complain that symptoms get worse
  3. 3. An ME Association Survey shows: 74% of patients who have done GET report worsening symptoms!* *ME Association Survey: http://www.measso ciation.org.uk/2015/ 05/23959/
  4. 4. The ME Association hasnowcalledfor GradedExerciseTherapy(GET) toberemovedfrom NICEguidelines http://www.meassociation.org.uk/2015/05/23959/
  5. 5. Unfortunately NICE guidelines are on the static list However . . . there is oneNICE detail that may helppatients until guidelines are updated.
  6. 6. Heart Rate Monitors are recommended by NICE Yet it seems few medical professionals suggest HR monitors to patients.
  7. 7. NICE Guidelines [CG53] canbefoundhere: Published date: August 2007 http://www.nice.org.uk/guidance/cg53/chapter/1-recommendations
  8. 8. NICE suggests ME patients exercise at 50 -70% of maximumheart rate andthisonlyaftersucceedingwith “low-intensity”exercise.
  9. 9. Heart Rate monitoring is important because“exercise”withME looks verydifferent onceadheringto heart rate limits. . .
  10. 10. Calculating Maximum Heart Rate 220 minusage in years* For me this is 220 – 52 = 168 bpm(beats per minute) *UnabletofindNICEguidanceoncalculatingMaxHR,Iusedthiswidelyappliedformula.
  11. 11. Calculating the ME Exercise Zone 50 – 70% of max HR Usingmy max HR of 168 bpm my exercisingrangewill be: 84 - 118 bpm
  12. 12. For Healthy Individuals exercise at 50 – 70% of max HR means a brisk walk or gentle jog http://www.howtobefit.com/five-heart-rate-zones.htm
  13. 13. Here are the Exercise Zones: 50–70%includesthelowesttwobands Exercise zones: Fox and Haskell from here
  14. 14. A doctorI saw early inmy illness told me to take 3 short briskwalks a day. Perhaps she was thinkingof the NICE 50 – 70%recommendation. . . without realisinghowdifferent things are for ME patients?
  15. 15. I now use a HR monitor And here are some typical heart rates for me: Activity Typical HR Reached Typical HR as % of my max HR Writing an email 90 54% (Warm-Up) Making a hot drink 115 68% (Fat burn) Walking to bathroom 125 74% (Cardio) Getting dressed 130 77% (Cardio) Brushing my teeth 130 77% (Cardio) Taking a seated shower 140 84% (Hard-core) Some days are better, some worse, but these numbers are quite different to those of a healthy individual.
  16. 16. I use a shower stool, but showeringstill takes my HR above the 50 – 70%rangerecommended by NICE. Yet ask any healthy person if showering counts as “exercise” and their answer would be NO!
  17. 17. Perhaps the word “exercise” is misleading when used in the context of ME
  18. 18. So what can be done? NICEadvisesthatexerciseshouldbedone “using a heart rate monitor” This issomethingmedicalprofessionalsinvolved withMEallneedtoknowabout,andtoapply.
  19. 19. So let’s spread the word: “NICE recommends Heart Rate Monitors for ME” Hopefullythis waypatients can avoid harmful un-monitoredexercise advice.
  20. 20. It is my opinion: that ME patients, rather than needing more exercise . . . actually need help to adjust daily activities to stay within safe heart rate zones.
  21. 21. I also think that NICE guidelines are now very outdated and long overdue for review.
  22. 22. Thank you SallyBurch - MEpatient,formerbiologylecturer.BScPGCE Icanbecontactedat salkeela@live.co.uk Itweetusing @keelatoo Myblogisfoundat http://sallyjustme.blogspot.co.uk/ IamalsoaTrusteeforthecharity Hope4ME&FibroNI Viewsexpressedaremyown,andarenot tobe takenasmedicaladvice. Someusefullinksfollow.
  23. 23. Some Links: Blog Post to accompany this Slide Share: Heart Rate Monitoring & NICE Guideline for ME Previous Slide Share written to highlight the problems faced by ME patients: ME Patients and the problem with NICE advice on exercise Other Heart Rate monitoring posts on Just ME: Rhythm+ and Endomondo: HR monitoring for ME Aug 2014 A few notes on using a HR Monitor for Pacing Feb 2014 Other useful posts related to exercise and ME: Pacing By Numbers by Bruce Campbell Exercise Testing and Using a Heart Rate Monitor by Jennifer Spotila
  24. 24. Post Script: Following a comment on my blog, 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.

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