"Pacing" with wearable device for ME/CFS

[bob sterman]

Now I know there's a lot of controversy about graded exercise therapy in ME/CFS. This is not about that - it's about the opposite...

There's a company selling a wearable device (HR monitor) with an app - to help people "pace" themselves - i.e. to avoid increases in activity.

https://www.makevisible.com/

Essentially - it measures HR with daily activities as a proxy for levels of exertion. And through graphs and alerts - encourages people to avoid exceeding some fixed level of "exertion" either at a particular moment, or total exertion over a day - giving a measure of "stability".

So for example, it might record HR increases due to daily activites around the house and then later suggest not going for a walk to avoid exceeding some set fixed amount of total exertion for the day. There are many promotional "influencer" type videos out there with users doing just this - e.g. having a busy morning around the house, looking at their app and then deciding they cannot do something later.

This is really quite concerning - while there might be controversy about whether graded increases in exercise are helpful - there certainly isn't an evidence base to support the opposite - i.e. avoiding increases in activity by avoiding HR increases, rather than based on perceived levels of exhaustion. This would seem almost certain to promote deconditioning.

(Also concerning is some hype in the marketing about measuring heart rate variability. It's an oximeter. It can only really measure pulse rate variability - not true R-R HRV as measured by ECG which is what most epidemiological studies on the importance of HRV have measures).

[Tristan]

I just completed their survey to see if I'm a fit. I told it I don't experience any of the symptoms listed, that I don't have any of the illnesses listed, and when it asks why I want to use it I selected "to see what's making me better" which was the most generic sounding option.

And guess what...

Good news, you’re a great fit for Visible
Based on what you've told us, you’ll likely see significant benefits from Visible. It's designed specifically to help people like you.

I doubt there's any combination of answers that says I wouldn't be a "great fit"!

[bob sterman]

Wish I could say I was surprised.

Putting aside use with recognised medical conditions - using a wearable device to promote activity limitation in the general population will surely lead to negative health outcomes.

In the general population - avoidance of exertion because it feels uncomfortable - contributes to the development of all sorts of chronic diseases.

[Tristan]

I agree on the general population thing. I can potentially see benefit here for certain conditions, but it would have to be diagnosed to avoid general public use.

[dyqik]

Garmin watches give a "body battery" statistic that is roughly this, although it recovers over time during the day, particularly if you are logging meals/calories in in a way that the Garmin app can see.

Screenshot_20260112-062917.png

It's not clear to me that this is any different.

[bob sterman]

Garmin watches give a "body battery" statistic that is roughly this, although it recovers over time during the day, particularly if you are logging meals/calories in in a way that the Garmin app can see.

It's not clear to me that this is any different.

Technology is similar - but it's what it's being pushed for and how users are being encouraged to behave. The Garmin site emphasises "challenging activities are essential parts of a healthy lifestyle".

This Visible thing is being pushed as an activity limiter for illness - not improved fitness...

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