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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
The Dilemma:
Graded Exercise Therapy (GET)
- is recommended by NICE
- but patients complain that
symptoms get worse
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/
The ME Association
hasnowcalledfor
GradedExerciseTherapy(GET)
toberemovedfrom
NICEguidelines
http://www.meassociation.org.uk/2015/05/23959/
Unfortunately NICE guidelines are
on the static list
However . . .
there is oneNICE detail that
may helppatients until
guidelines are updated.
Heart Rate Monitors
are recommended by NICE
Yet it seems few medical
professionals suggest HR
monitors to patients.
NICE Guidelines [CG53]
canbefoundhere:
Published date: August 2007
http://www.nice.org.uk/guidance/cg53/chapter/1-recommendations
NICE suggests ME patients
exercise at
50 -70%
of maximumheart rate
andthisonlyaftersucceedingwith
“low-intensity”exercise.
Heart Rate monitoring
is important
because“exercise”withME
looks verydifferent onceadheringto
heart rate limits. . .
Calculating Maximum Heart Rate
220 minusage in years*
For me this is
220 – 52 =
168 bpm(beats per minute)
*UnabletofindNICEguidanceoncalculatingMaxHR,Iusedthiswidelyappliedformula.
Calculating the ME Exercise Zone
50 – 70% of max HR
Usingmy max HR of 168 bpm
my exercisingrangewill be:
84 - 118 bpm
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
Here are the Exercise Zones:
50–70%includesthelowesttwobands
Exercise zones: Fox and Haskell from here
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?
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.
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!
Perhaps the word
“exercise” is misleading
when used in the context of ME
So what can be done?
NICEadvisesthatexerciseshouldbedone
“using a heart rate monitor”
This issomethingmedicalprofessionalsinvolved
withMEallneedtoknowabout,andtoapply.
So let’s spread the word:
“NICE recommends
Heart Rate Monitors for ME”
Hopefullythis waypatients can avoid
harmful un-monitoredexercise advice.
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.
I also think that NICE guidelines
are now very outdated and
long overdue for review.
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.
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
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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Heart rate monitoring and NICE guideline for ME

  • 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. The Dilemma: Graded Exercise Therapy (GET) - is recommended by NICE - but patients complain that symptoms get worse
  • 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/
  • 5. Unfortunately NICE guidelines are on the static list However . . . there is oneNICE detail that may helppatients until guidelines are updated.
  • 6. Heart Rate Monitors are recommended by NICE Yet it seems few medical professionals suggest HR monitors to patients.
  • 7. NICE Guidelines [CG53] canbefoundhere: Published date: August 2007 http://www.nice.org.uk/guidance/cg53/chapter/1-recommendations
  • 8. NICE suggests ME patients exercise at 50 -70% of maximumheart rate andthisonlyaftersucceedingwith “low-intensity”exercise.
  • 9. Heart Rate monitoring is important because“exercise”withME looks verydifferent onceadheringto heart rate limits. . .
  • 10. Calculating Maximum Heart Rate 220 minusage in years* For me this is 220 – 52 = 168 bpm(beats per minute) *UnabletofindNICEguidanceoncalculatingMaxHR,Iusedthiswidelyappliedformula.
  • 11. Calculating the ME Exercise Zone 50 – 70% of max HR Usingmy max HR of 168 bpm my exercisingrangewill be: 84 - 118 bpm
  • 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. Here are the Exercise Zones: 50–70%includesthelowesttwobands Exercise zones: Fox and Haskell from here
  • 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. 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. 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. Perhaps the word “exercise” is misleading when used in the context of ME
  • 18. So what can be done? NICEadvisesthatexerciseshouldbedone “using a heart rate monitor” This issomethingmedicalprofessionalsinvolved withMEallneedtoknowabout,andtoapply.
  • 19. So let’s spread the word: “NICE recommends Heart Rate Monitors for ME” Hopefullythis waypatients can avoid harmful un-monitoredexercise advice.
  • 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. I also think that NICE guidelines are now very outdated and long overdue for review.
  • 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. 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. 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.