Health rising treatment resources blog post, by Karmin, 24 Oct 2017:

Karmin continues her series on heart rate variability (HRV) testing. Everyone concerned with pacing – a subject everyone with ME/CFS/FM has reason to be concerned with – will find vital information in Karmin’s blogs. Among the highlights:

  • Tracking your heart rate is a good idea, but tracking your HRV can provide a deeper, more informative cut particularly with regard to cognitive activities
  • As others (Dr. Pocinki, Staci Stevens, Dan Neuffer) have asserted, Karmin’s data suggests there’s more to the autonomic nervous system problems in ME/CFS/FM that an over-active fight or flight system.
  • How to watch out for injurious parasympathetic nervous system spikes.
  • How slow improvements with HRV are better than rapid shifts.
  • Why exercises like yoga may be better for ME/CFS/FM patients than isometric exercises.

Heart Rate Variability (HRV) – An Under-Utilized ME/CFS/FM Management Tool: PART II – Surveying the Landscape by Karmin

This series of blogs is meant as a beginner’s guide to using Heart Rate Variability (HRV) to manage ME/CFS. In my last blog I explained how HRV measurement can provide a window into the function of the Autonomic Nervous System (ANS) and I detailed how to begin measuring HRV.

See “Your Crash in a Graph: How Heart Rate Variability Testing Could Help You Improve Your Health”

Once familiar with measuring HRV, you can begin using it to survey your ANS landscape. I have found it to be an eye opening experience!

Data Collection

It is important to first think about what data you want to collect.

In my initial enthusiasm for HRV, I was collecting lots of data whilst doing all sorts of activities. All that measuring did give me interesting information, but for the most part it didn’t change how I managed my illness. As well – being at the severe end of the ME/CFS spectrum – I felt I needed to get the most value out of my data for the least amount of work.

There were other factors I also considered. There is a tendency in ME/CFS for the ANS to over-respond or over-correct following an activity. For example, when the Parasympathetic Nervous System (PNS) is activated, there is sometimes a reflex Sympathetic Nervous System (SNS) response that follows, and sometimes even further PNS and SNS responses after that. Recording HRV during an activity does not tell me what ultimate effect that activity will have.

For more on this see Dysfunction Junction by Dr. Alan Pocinki

The Key Data Point – Morning Resting HRV

HRV’s strength is as an indicator of recovery. And it is morning HRV that gives that information. (In my opinion, heart rate monitoring is more suited to monitoring during activity). I, therefore, believe that the most useful HRV data comes from assessing the carryover effect that various activities and treatments have on my next morning HRV numbers. So my focus is on measuring recovery by tracking morning resting HRV. Using HRV in this way brings me huge benefits for a tiny amount of time and effort.


Read more for a discussion of how to use an app with illustrations from:

  • (iOS) LogsAll “Track Anything” app
  • Elite
  • SweetBeat



  • Don’t always test the same treatments together.
  • Always take your readings at about the same time each morning
  • use a good quality chest strap
  • check signal quality in your HRV apps, and
  • regularly replace the batteries in your equipment.

Cognitive Pacing

I find that one big advantage that HRV monitoring has over Heart Rate monitoring is that for me it better identifies problems with non-physical overdoing. My heart rate is not usually adversely affected by cognitive exertion but the adverse effects do show up in my next morning HRV. A useful tool!

Graded Exercise Therapy (GET)

I believe HRV monitoring may be a great defense against PACE-style Graded Exercise Therapy (GET) – or at least a way of determining whether GET is helping or harming a particular patient. Trying to argue that a patient should continue a particular GET programme when their HRV numbers are clearly being adversely affected surely leaves a GET proponent without a leg to stand on. I only wish I had known about HRV tracking when I was prescribed GET years ago!


I have always felt there was something different about yoga that makes it more tolerable (and beneficial) to ME/CFS patients. It feels like I am working with my body, not against it. Yoga was the last exercise I was able to do as I slid down to becoming bedridden, and it has been the first exercise I have been able to add back in.

At the beginning of this Blog, I explained that I no longer monitor HRV during activities, but rather use morning HRV as my foundation for determining an appropriate and sustainable level of daily activity. However, to finish, I am going to share the results of an interesting experiment I did some years ago, during an exercise activity.

I divided a very short exercise session into two halves. In the first half I did a low level lying yoga pose, then in the second half I did a low level lying isometric type exercise of similar difficulty. I was blown away by the resultant graph:

SweetBeat graph: First half showing sympathetic/parasympathetic balance whilst doing low level yoga, second half showing sympathetic activation whilst doing a low level isometric exercise

Despite the fact that my heart rate was well within the anaerobic threshold during both exercises, the graph shows how much more the isometric exercise activated my sympathetic nervous system. Any wonder it feels like there’s something different about yoga!

Importantly, not only does yoga give better autonomic balance during the activity, but for me the positive effects also carry over to the next day – as evidenced by improved next morning HF (parasympathetic) numbers.

I find this graph especially interesting in light of Georgetown University research showing that increased SNS activation with exercise can temporarily cause POTS

Heart Rate Monitors

Many heart rate monitors are available.

  • Karmin uses the Wahoo TICKR Heart Rate Monitor for iPhone & Android which has center front clasp which makes it much easier for someone with ME/CFS to put on!
  • The Polar H7 Bluetooth Heart Rate Sensor and Fitness Tracker has been considered the gold standard but her frame was too small.

More Resources

Part I: Check out Part ! – “Your Crash in a Graph: How Heart Rate Variability Testing Could Help You Improve Your Health” – of Karmin’s HRV blog series for ME/CFS and FM for the basics of HRV testing and the apps she uses:

Pacing and Activity Management – See Health Rising’s Pacing, Exercise and Activity Management Resource Section

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