Families sought for trial of classroom robot as avatar for child with ME

Invest in ME Research newsletter, November 2017: Removing isolation from young people with ME

IiMER invites families that:

  • have a child who has been forced to stay at home due to ME,
  • and who would like to participate in a trial of a robot at their school
  • and work with IiMER and No Isolation to describe the results, then please contact them.

There will be three robots to trial.

About the project:

The Norwegian start up – No isolation – has developed a robot that helps children and young people with long-term illness participate in the classroom on their own terms.

Initially, a trial of three AV1 robots will be set up involving families who currently have a child with ME who is unable to attend school, or whose regular attendance is compromised by ME.

Children and young people with long-term illness such as ME do not need to be excluded from their friends’ activities and progress and schools have a responsibility not to ignore them – something which can lead to long term discrimination.

The robot, called AV1, acts as the students’ eyes, ears and voice in the classroom on days where they cannot be physically present.

The student controls the robot with an app on a tablet. When the student raises their hand, a light flashes on AV1’s head.

The robot can be turned 360 degrees, so the student can see the entire classroom and talk to other students.

If the student does not feel like actively participating, they communicate it by turning on a blue light on AV1’s head.

Research fellow Jorun Børsting and senior lecturer Alma Leora Culén at the Institute for Informatics, University of Oslo, are researching the technology needs of ME-patients. Having studied the use of AV1 among nine children and youths suffering from ME they see a big advantage in the fact that the robot is designed with ME-patients in mind. Børsting stresses that the robot cannot fully replace normal attendance at school or home teaching, but act as a supplement.

More info in November newsletter   02380 643736 or email at info@investinme.org

 

 

 

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BMJ Best practice guide on CFS

BMJ Best Practice Guide, updated Nov 2017: Chronic fatigue syndrome

Written by Dr James N Baraniuk
Reviewed by Dr Rosemary Vallings, Dr Abijhit Chaudhuri

Summary:
Chronic fatigue syndrome (CFS) is characterised by a sudden or gradual onset of persistent disabling fatigue, post-exertional malaise (PEM, exertional exhaustion), unrefreshing sleep, cognitive and autonomic dysfunction, myalgia, arthralgia, headache, and sore throat and lymph nodes, with symptoms lasting at least 6 months.

Exertional exhaustion is the critical aspect that distinguishes myalgic encephalomyelitis/CFS from other nociceptive, interoceptive, and fatiguing illnesses.

The lack of energy may be caused by autoimmune and metabolomic dysfunction that reduces mitochondrial ATP production.

The primary goals of management are to provide a supportive healthcare environment with a team of occupational, physio, and other appropriate therapists who will manage symptoms and improve functional capacity.

The chronic but fluctuating disabilities require substantial lifestyle changes to plan each day’s activities carefully, conserve energy resources for the most important tasks, schedule rest periods to avoid individuals overtaxing themselves, and to improve the quality of sleep.

Medications are not curative. Pharmacotherapy is indicated to treat pain, migraine, sleep disturbance, and comorbid conditions such as irritable bowel syndrome, anxiety, or depression.

More information (mostly behind a paywall) on:

Definition

Theory: Epidemiology; Aetiology; Case history

Diagnosis: Approach; History and exam; Investigations; Differentials; Criteria

Management:  Approach; Treatment algorithm; Emerging; Patient discussions

Follow up: Monitoring; Complications; Prognosis

Resources: Guidelines; References; Patient leaflets; Evidence

 

Comment:

Virology blog post, by Steven Lubet and David Tuller, 13 Nov 2017: Trial By Error : The Surprising New BMJ Best Practice Guide

Something has changed.

That’s the only explanation for the recent publication of a “Best Practice” guide for “chronic fatigue syndrome” (behind a paywall, unfortunately) from the BMJ Publishing Group. This thing is good. It’s very good, in fact. One bottom line at this stage for any treatment guide is the following: Would it lead a clinician to prescribe cognitive behavior therapy or graded exercise therapy for patients with ME, as opposed to those suffering from a vague fatiguing illness? The answer here is an unequivocal no.

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Vitamin D status in CFS/ME

Research abstract:

Vitamin D status in chronic fatigue syndrome/myalgic encephalomyelitis: a cohort study from the North-West of England, by KE Earl, et al in BMJ Open 2017 Nov 8;7(11)

OBJECTIVE:
Severe vitamin D deficiency is a recognised cause of skeletal muscle fatigue and myopathy. The aim of this study was to examine whether chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with altered circulating vitamin D metabolites.

DESIGN:
Cohort study.

SETTING:
UK university hospital, recruiting from April 2014 to April 2015.

PARTICIPANTS:
Ninety-two patients with CFS/ME and 94 age-matched healthy controls (HCs).

MAIN OUTCOME MEASURES:
The presence of a significant association between CFS/ME, fatigue and vitamin D measures.

RESULTS:
No evidence of a deficiency in serum total 25(OH) vitamin D (25(OH)D2 and 25(OH)D3 metabolites) was evident in individuals with CFS/ME. Liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis revealed that total 25(OH)D was significantly higher (p=0.001) in serum of patients with CFS/ME compared with HCs (60.2 and 47.3 nmol/L, respectively). Analysis of food/supplement diaries with WinDiets revealed that the higher total 25(OH) vitamin D concentrations observed in the CFS/ME group were associated with increased vitamin D intake through use of supplements compared with the control group. Analysis of Chalder Fatigue Questionnaire data revealed no association between perceived fatigue and vitamin D levels.

CONCLUSIONS:
Low serum concentrations of total 25(OH)D do not appear to be a contributing factor to the level of fatigue of CFS/ME

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The presence of co-morbid mental health problems in a cohort of adolescents with CFS

Research abstract:

The presence of co-morbid mental health problems in a cohort of adolescents with chronic fatigue syndrome, by Maria Elizabeth Loades, Katharine A Rimes, Sheila Ali, Kate Lievesley, Trudie Chalder in Clinical Child Psychology and Psychiatry [Preprint November 2, 2017]

Objective:
To report on the prevalence of mental health disorders in adolescents with chronic fatigue syndrome (CFS) and to compare the diagnoses identified by a brief clinician-administered psychiatric interview with self-report screening questionnaires.

Design:
Cross-sectional study.

Setting:
Consecutive attenders to specialist CFS clinics in the United Kingdom.

Patients:
N = 52 adolescents, age 12-18 years with CFS.

Measures:
Self-report questionnaires and a brief structured psychiatric diagnostic interview, administered by a researcher.

Results:
On the psychiatric interview, 34.6% met a diagnosis of major depressive disorder and 28.8% had an anxiety disorder. Of these, 15% had co-morbid anxiety and depression.

Those with a depression diagnosis reported significantly greater interference on the school and social adjustment scale. They also scored significantly higher on trait anxiety, but not
on state anxiety.

There were no differences between those who had an anxiety disorder and those who did not on fatigue, disability or depressive symptoms. Children’s Depression Inventory (CDI) score was associated with a depression diagnosis on the psychiatric interview. However, neither the state nor the trait subscale of the State-Trait Anxiety Inventory (STAI) was associated with an anxiety diagnosis.

Conclusion:
Clinicians should assess for the presence of anxiety and depressive disorders in adolescents with CFS using a validated psychiatric interview. Treatment should be flexible enough to accommodate fatigue, depression and anxiety. Transdiagnostic approaches may suit this purpose. Goals should include pleasurable activities particularly for those who are depressed.

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Brain chemistry profiles shows CFS & Gulf War Illness as unique disorders

Georgetown Medical Centre Press Release, 10 November 2017: Brain Chemistry Profiles Shows Chronic Fatigue Syndrome and Gulf War Illness as Unique Disorders

Researchers at Georgetown University Medical Center have found distinct molecular signatures in two brain disorders long thought to be psychological in origin — chronic fatigue syndrome (CFS) and Gulf War Illness (GWI).

In addition, the work supports a previous observation by GUMC investigators of two variants of GWI. The disorders share commonalities, such as pain, fatigue, cognitive dysfunction and exhaustion after exercise.

Their study, published in Scientific Reports, lays groundwork needed to understand these disorders in order to diagnosis and treat them effectively, says senior investigator, James N. Baraniuk, MD, professor of medicine at Georgetown University School of Medicine. Narayan Shivapurkar, PhD, assistant professor of oncology at the medical school, worked with Baraniuk on the research.

The changes in brain chemistry — observed in levels of miRNAs that turn protein production on or off — were seen 24 hours after riding a stationary bike for 25 minutes.

“We clearly see three different patterns in the brain’s production of these molecules in the CFS group and the two GWI phenotypes,” says Baraniuk. “This news will be well received by patients who suffer from these disorders who are misdiagnosed and instead may be treated for depression or other mental disorders.”

Chronic fatigue syndrome affects between 836,000 and 2.5 million Americans, according to a National Academy of Medicine report. The disorder was thought to be psychosomatic until a 2015 review of 9,000 articles over 64 years of research pointed to unspecified biological causes. Still, no definitive diagnosis or treatment is available.

Gulf War Illness has developed in more than one-fourth of the 697,000 veterans deployed to the 1990-1991 Persian Gulf War, Baraniuk and his colleagues have reported in earlier work.

Gulf War veterans were exposed to combinations of nerve agents, pesticides and other toxic chemicals that may have triggered the chronic pain, cognitive, gastrointestinal and other problems, Baraniuk says. Although the mechanisms remain unknown, the study provides significant insights into brain chemistry that can now be investigated.

This study focused on spinal fluid of CFS, GWI and control subjects who agreed to have a lumbar puncture. Spinal taps before exercise showed miRNA levels were the same in all participants. In contrast, miRNA levels in spinal fluid were significantly different after exercise. The CFS, control and two subtypes of GWI groups had distinct patterns of change. For example, CFS subjects who exercised had reduced levels of 12 different mRNAs, compared to those who did not exercise.

The miRNA changes in the two GWI subtypes add to other differences caused by exercise. One subgroup developed jumps in heart rate of over 30 beats when standing up that lasted for two to three days after exercise. Magnetic resonance imaging showed they had smaller brainstems in regions that control heart rate, and did not activate their brains when doing a cognitive task. In contrast, the other subgroup did not have any heart rate or brainstem changes, but did recruit additional brain regions to complete a memory test. The two groups were as different from each other as they were from the control group.

Finding two distinct pathophysiological miRNA brain patterns in patients reporting Gulf War disease “adds another layer of evidence to support neuropathology in the two different manifestations of Gulf War disease,” he says.

Baraniuk adds that miRNA levels in these disorders were different from the ones that are altered in depression, fibromyalgia, and Alzheimer’s disease, further suggesting CFS and GWI are distinct diseases.

The study was supported by funding from The Sergeant Sullivan Center, Dr. Barbara Cottone, Dean Clarke Bridge Prize, Department of Defense Congressionally Directed Medical Research Program (CDMRP) W81XWH-15-1-0679, and National Institute of Neurological Diseases and Stroke R21NS088138 and RO1NS085131.

Baraniuk and Shivapurkar are named as inventors on a patent application that has been filed by Georgetown University related to the technology described.

Research paper: Exercise – induced changes in cerebrospinal fluid miRNAs in Gulf War Illness, Chronic Fatigue Syndrome and sedentary control subjects

Science blog: Chronic fatigue syndrome, Gulf War illness unique disorders

Daily Mail: Chronic fatigue syndrome is NOT all in the mind- but caused by changes in brain chemistry, a study finds

  • Chronic fatigue syndrome and Gulf War Illness are caused by changes in brain chemistry and are not  psychological disorders
  • Both disorders cause pain, physical and mental fatigue, cognitive dysfunction and flu-like symptoms
  • Controversy has raged for nearly 30 years on whether the disorders were genuine illnesses
  • Now researchers from Georgetown University have found changing levels in molecules in sufferers’ brains

Health rising: Different Triggers – Different Illnesses: Exercise Affects Brains of ME/CFS and GWI Patients Differently

Psychology today: Chronic Fatigue Syndrome: More Research Backs Up Patients

ME Association: MEA Summary Review: Changes in ‘brain chemistry’ after exercise in CFS, Gulf War Illness and sedentary controls 

 

 

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Brain imaging study crowdfunding request – Dr Michael VanElzakker

Massachusetts General Hospital press release, 11 November 2017: Support research into Myalgic Encephalomyelitis (Chronic Fatigue Syndrome)

Goal: USD $29,900 / £22,854

About the Campaign:

Myalgic Encephalomyelitis (Chronic Fatigue Syndrome) represents a challenging intersection of immunology, neurology, endocrinology, and other fields. Investigating such a broad and complex condition requires access to technology, instrumentation, and methods that are not available at the average doctor’s office.

The Martinos Center for Biomedical Imaging in Boston is one of the world’s premier research centers. This unique facility consistently produces high-impact research largely due to a highly collaborative organization and culture. Clinical researchers such as neuroscientists, neurologists, and immunologists are able to push the envelope in their respective fields because they work alongside bioengineers, radiologists, and physicists with expertise in imaging technology. Thus we have the ability to answer challenging research questions due to the advances in the technology that are happening on our own campus.

Dr. Michael VanElzakker is a Martinos Center research fellow affiliated with Massachusetts General Hospital, Harvard Medical School, and Tufts University. He has a background in neuroendocrinology and clinical neuroscience and is known for an influential hypothesis of ME (CFS) that centers on the intersection between the nervous and immune systems.

Our ongoing research program includes three projects:

1. Neuroinflammation scanning

2. Scanning before and after exercise challenge

3. Targeting cellular activity in the Nucleus of the Solitary Tract

Your contribution will fund these studies. Each answers novel questions in novel ways, elucidating the mechanisms of ME (CFS) pathology.

(We’ve set a goal of paying for 5 scans, which will be enough to use for pilot data in applying for more funding to finish a well-powered study. If someone with a lot of resources wants to fund the whole study, contact me.)

More about Michael VanElzakker

8% of goal reached on 12 November 2017      Find out how to donate

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What it’s like to travel again after 14 years of being housebound

The Telegraph blog post, by Juliette Llewellyn, 10 Nov 2017: What it’s like to travel again after 14 years of being housebound

It was the summer of 1995. I was 24 and in the GP surgery waiting room about to get travel vaccinations ahead of a year-long trip to Nepal and India, where I was planning to work as a tree-planting volunteer in Uttar Pradesh. I had never been and I couldn’t wait. Trekking in the Himalayas was at the top of my bucket list and I had already been imagining how I would capture the snow-capped mountains from atop the pinnacle. But the holiday never materialised.

My multiple jabs, which were administered over the course of two months, went terribly wrong. Instead of protecting me against infections, the cocktail of vaccinations triggered an adverse reaction. What should have helped me travel the world prevented me doing so – and no one could tell me for how long.

For the first few days following the initial set of jabs, I had severe muscular pain all over my body and was almost paralysed on my right side. Weak and fatigued, I stayed in bed for several days. I tried every painkiller available at the chemist’s but nothing was working. This obviously wasn’t just a simple case of the flu, so I went back to my GP, but he couldn’t work out what was wrong either. As a last resort, I saw other physicians for a second opinion but even they couldn’t establish an accurate prognosis.

Finally, one doctor referred me to the University Hospital of Wales where a consultant did an extensive investigation. I was diagnosed with myalgic encephalomyelitis (ME) and fibromyalgia, and I also developed multiple chemical sensitivity or MCS, an allergic-type reaction to low levels of chemicals in everyday products, which is a symptom of ME. All these conditions combined meant that I was unable to lift my body off the bed or even feed myself.

The consultant was unable to confirm that my ailments were the direct consequence of the vaccinations, however he was unable to find any other probable cause. The initial symptoms appeared when I had my first few jabs and progressed rapidly during the two months while having the rest.

Travel was impossible as I struggled to remaster the basics of daily living. I was housebound for a long time and only glimpsed the world through friends’ postcards. My preoccupations for the day were rudimentary: How was I going to get dressed? How was I going to eat? Life before then was adventure-filled, with trips to Europe and destinations further afield such as Egypt and Russia. I wanted desperately to again explore beyond the four walls of my bedroom.

Finally, in 2009, after 14 long years of rehabilitation and therapy, I got the chance. It had been more than a decade since I had last seen the sea, so I organised a trip to Findhorn near Inverness for a coastal retreat and walks along the beach.

When I arrived, I was like a child – full of joy and excitement at the sight and sound of water lapping against the shore. I dipped my feet in the cool water and felt so grateful that I was less restricted than before. Sure, I still packed a walking stick, but I could walk on my own.

The distances were modest and I ambled along small stretches of the six-mile sands. There was a real sense of freedom exploring alone for the first time in so long. My newfound confidence was bolstered by a lot of preparation: several weeks of mapping out my itinerary, extra support from a personal assistant, researching accommodation that was suitable given my chemical sensitivities, contacting proprietors beforehand with health requests and booking travel assistance at the airport.

Read more about her travels

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A comparison of case definitions for ME & CFS

Research abstract:

A Comparison of Case Definitions for Myalgic Encephalomyelitis and Chronic Fatigue Syndrome, by Madison Sunnquist, Leonard A Jason, P Nehrke, Ellken M Goudsmit in Chronic Dis Manag. 2017;2(2). pii: 1013. Epub 2017 May 21

Many professionals have described the clinical presentation of myalgic encephalomyelitis (ME), but recent efforts have focused on the development of ME criteria that can be reliably applied.

The current study compared the symptoms and functioning of individuals who met the newly-developed Institute of Medicine (IOM) clinical criteria to a revised version of the London criteria for ME. While 76% of a sample diagnosed with chronic fatigue syndrome (CFS) met the IOM criteria, 44% met the revised London criteria. The revised London criteria identified patients with greater physical impairment.

The results of this study indicate the need for a standard case definition with specific guidelines for operationalization. The application of case definitions has important implications for the number of individuals identified with ME, the pattern of symptoms experienced by these individuals, and the severity of their symptoms and functional limitations. Sample heterogeneity across research studies hinders researchers from replicating findings and impedes the search for biological markers and effective treatments.

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I made a film from my bed to prove my illness is real

BBC news article, 9 Nov 2017: I made a film from my bed to prove my illness is real

Five years ago, Jennifer Brea was struck down by ME (Myalgic Encephalomyelitis), and found herself bed-bound, a prisoner in her own body. Now, she has invited the world on an intimate journey into a condition that some deny even exists, interviewing fellow patients from all over the world – from her sickbed. She spoke to the BBC’s Natasha Lipman.

As the opening credits roll on the documentary, Unrest, we see filmmaker Jennifer Brea lying on the floor of her bedroom, eyes glazed over, as she stares apparently peacefully at the camera. Then, with arms shaking, gasping for breath, she tries to pull herself up, managing only a few inches before she collapses back on the floor. Eventually she is able to crawl slowly to her bed, before dropping the camera, collapsing with relief and fatigue.

Episodes like this initially came as a shock for Brea. Seemingly out of nowhere, she would suddenly lose all muscle force, unable to move her body, or even lift her head. She struggled to get words out, let alone form sentences, and even the smallest exertion would have knock-on effects that lasted for days, weeks, or even months.

“I’d never been sick before and so I had this sense of abundance of health and body and life. I had never really heard about ME or people becoming ill in their 20s – it just wasn’t a part of my awareness. So I never imagined that something like this could happen to me.”

While studying for a PhD in Political Economy and Statistics at Harvard, she met fellow student, Omar Wasow, an internet analyst and entrepreneur who once taught Oprah Winfrey how to surf the net. They married in 2012. Home videos show the life Brea and Wasow led before she became sick – travelling the world, scuba diving, candlelit dinners with friends – a perfect vision of a carefree young couple in love.

Shortly before their wedding, they both contracted a virus, coming down with a high fever. Wasow recovered completely, but afterwards Brea remained plagued by strange symptoms. Whenever she got a sore throat or a cold she would have dizzy spells and crash out for days at a time. She suffered from insomnia, and memory loss – symptoms she now recognises as a mild form of ME. They all seemed to get worse after exercise.

“Omar and I used to always do this bike ride along the river – six miles out, six miles back -and I noticed that while I could make it six miles out, then I had to call a taxi to get back home. Or I would go skiing with my family, and suddenly feel my legs giving out,” she says.

“I didn’t know why.”

She suspected there might be something wrong with her immune system and went to her doctor, but the lab tests always came back normal.

“I was told that either I wasn’t really sick or that maybe I was just depressed or that it was all in my head,” she says.

Brea was eventually diagnosed with Conversion Disorder, a mental condition with unexplained physical symptoms – formerly known as hysteria – and told it was due to a childhood trauma she couldn’t even remember.

It wasn’t until she showed doctors the disturbing footage of her symptoms from the video diary she’d been recording on her phone that she was finally taken seriously and sent for a battery of physical tests.

“I still had hope that I just had a rare disease – that if I could just get to the right specialist they would figure out what was wrong with me,” says Brea.

It turned out that what she had is actually very common – ME, a condition that affects up to 17 million people worldwide, according to some estimates. Now her illness had a name, but she discovered that there was very little medical research into, much controversy over treatments, and no cure.

“That was something that I never imagined could happen. I always thought that medicine would be there to help me,” says Brea. “In some ways getting the diagnosis was a bit of a relief but it also gave me this sense of: ‘Oh my gosh, what I have to deal with is actually much more complicated than I imagined.'”

What is ME?

  • ME – also called Chronic Fatigue Syndrome – is a medical condition characterised by profound and disabling fatigue
  • Symptoms include: loss of muscle power, debilitating pain, difficulty sleeping and cognitive dysfunction affecting memory and concentration
  • The cause of ME is unknown, but many patients contract it after a viral infection
  • Women are four times as likely to have ME than men
  • The NHS guidelines on ME treatment are currently being revised

Read more about Jen and Omar, the film and ME

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Heart rate variability (HRV) an underused ME/CFS/FM management tool

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

 

Tips:

  • 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!

Yoga

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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