People living with ME/CFS and LC frequently live with post-exertional malaise (PEM), which is associated with impairments in aerobic metabolism. They often use pacing with a heart rate monitor (HRM) to minimize time spent above the anaerobic threshold; however, there is limited research on the feasibility and efficacy.
Clague-Baker et al (Oct 2025)
Summary
- Heart rate monitoring (HRM) for pacing was found to be a potentially helpful self-management tool for people with ME/CFS and Long Covid (LC).
- Many participants reported that HRM helped them better understand and avoid post-exertional malaise (PEM) by staying within safe exertion limits.
- Participants used a wide range of devices (over 100 types), with varying comfort and accuracy—chest straps were often more accurate but less tolerable.
- Some users reported improvements in symptom severity and a reduced frequency or intensity of crashes.
- Setting appropriate heart rate thresholds was a challenge, especially without medical guidance or with comorbid conditions like POTS.
- Overall, the study supports the feasibility of conducting a larger trial and highlights the need for standardised HRM protocols tailored to this population.
Abstract
Objective:
To establish the acceptability, adherence, outcomes, and adverse events associated with pacing with an HRM for a future definitive study.
Results:
47 participants were recruited; however, recruiting people with LC was difficult due to wanting to use/already using HR monitoring. The interviews identified that the procedure was acceptable, and the majority of the participants completed the outcome measures. There were some changes from baseline to follow-up in all the outcome measures except the 10-minute stand test and accelerometry. There were no serious adverse events. Follow-up interviews identified 89% continued using HRM at 8 weeks and 66% after 6 months.
Conclusion:
Studies of HRM are feasible and acceptable for ME/CFS and LC, although recruitment strategies should be reviewed for LC
MEA Comment
The ME Association works closely with Physios for ME and we fund some of their research.
We are pleased to see that they are now carrying out research into the use of heart rate monitoring to help people with pacing and that this is being done in conjunction with the Workwell Foundation in America.
Dr Charles Shepherd,
Trustee and Hon. Medical Adviser to the ME Association,
Member of the 2018-2021 NICE guideline on ME/CFS committee,
Member of the 2002 Chief Medical Officer's Working Group on ME/CFS
Further Information
- The ME Association: Visible: The pacing app for people with ME/CFS and Long Covid | April 10, 2024
