Utilising Continuous HRV Biofeedback Data for Autonomic Nervous System Regulation in ME/CFS Relapse Management, 2026, Duder and Catchpole

[Dolphin]

Utilising Continuous HRV Biofeedback Data for Autonomic Nervous System Regulation in ME/CFS Relapse Management

Background: Myalgic Encephalomyelitis (ME/CFS), is a long-term, multi system disease characterised by profound, unrefreshing fatigue, pain, cognitive dysfunction, and post exertional malaise (PEM). Heart rate variability (HRV) measures the variation in time intervals between h...

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Case Report

Utilising Continuous HRV Biofeedback Data for Autonomic Nervous System Regulation in ME/CFS Relapse Management​

Kate Duder, Leanne Catchpole

This is a preprint; it has not been peer reviewed by a journal.

Utilising Continuous HRV Biofeedback Data for Autonomic Nervous System Regulation in ME/CFS Relapse Management

Background: Myalgic Encephalomyelitis (ME/CFS), is a long-term, multi system disease characterised by profound, unrefreshing fatigue, pain, cognitive dysfunction, and post exertional malaise (PEM). Heart rate variability (HRV) measures the variation in time intervals between h...

doi.org

Abstract​

Background: Myalgic Encephalomyelitis (ME/CFS), is a long-term, multi system disease characterised by profound, unrefreshing fatigue, pain, cognitive dysfunction, and post exertional malaise (PEM). Heart rate variability (HRV) measures the variation in time intervals between heartbeats to provide an objective indicator of autonomic nervous system (ANS) regulation and resilience. HRV tracking is used to assess autonomic dysfunction in ME/CFS and hypothesised to serve as an early warning system for predicting PEM and prioritising rest. To date there is little research on the use of continuous HRV (C-HRV) tracking, versus baseline HRV and HR monitoring as a pacing and ANS management tool.

This case reports a 63 year old female with a 7 year history of stable ME/CFS who experienced a severe symptomatic relapse following a period of physical and psychosocial stress. The patient’s primary concerns were reduced functional capacity, frequent PEM and immune system flares.

Method: The subject used real time C-HRV tracking using an electrocardiogram (ECG) grade Firstbeat Life device and engaged in regular health coaching with an HRV trained coach for lifestyle support and HRV data interpretation. The aim of this study was to assess the effectiveness of C-HRV tracking with expert HRV analysis for understanding and improving ANS regulation to help manage energy, and improve functional capacity.

Results: Over the 11-week intervention, C-HRV biofeedback showed enhanced ANS regulation, increased baseline HRV, and improvements in perceived cognitive stability and energy. The patient improved her autonomic awareness, PEM predictability, identification of recovery barriers, and effectiveness of specific ANS strategies. A key finding was a lagging HRV response during immune system flares, despite immediate flu-like symptoms, which aligns with established neuroimmune models. This suggests HRV’s role as an early warning system is state and system dependent, and the ANS and immune system may generate different HRV responses.

Physiology
Cardiac & Cardiovascular Systems
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
Post exertional malaise (PEM)
Heart rate variability (HRV)
Autono

 

[Hutan]

From Linked In - Kate Duder

If you're ready to cut through the noise and be more strategic with your health book a FREE discovery call to explore how my health coaching can help you achieve your goals.

I'm a certified Health and Nutrition Coach who specialises in supporting clients to prevent burnout and navigate chronic illness - something I understand deeply from personal experience with Ehlers Danlos Syndrome and ME/CFS.

I have a focus on heart rate variability tracking and use this as a tool to help clients better understand and improve how their body responds to sleep, exercise, stress, and daily activities.

My approach is collaborative, compassionate, strategic and focused on you! I’m a good listener who meets you where you are, and together, we’ll find simple, realistic next steps and practical tools that give back a sense of control, so you can move forward to improved energy and living your best life.

I have worked with individuals with burnout, Long COVID, ME/CFS, Ehlers Danlos Syndrome, Cancer and other conditions and working online enables me to work remotely with clients in New Zealand and abroad.

My purpose is to help people find clarity to make informed choices that improve their health with credible information, tools, holistic coaching and support.

Human health is the result of the complex interaction between interconnected bodily systems and external life factors and improving health with chronic illness often relies on more than one thing. My approach looks at you and your lifestyle as a whole. including sleep, stress management, movement habits, diet and gut health, along with how your values, beliefs and environment impact your day to day wellbeing.

Every journey is different and therefore every plan is tailored to you and led by you.

Inside Matters isn’t just about providing services, it’s about empowering individuals with the tools and knowledge they need to take charge of their health.

This is a case study, consisting of a HRV coach and a person with ME/CFS. The person had a period of decreased function, did the HRV monitoring with the coach and seems to have had a period of improved function.

I don't think we have seen good evidence that HRV monitoring is a useful part of pacing although I may have missed something.

This suggests HRV’s role as an early warning system is state and system dependent, and the ANS and immune system may generate different HRV responses.

 

[Trish]

Heaven preserve us from wellness coaches and 'certified health and nutrition coaches' messing about with sick people's lives.

There's something quite sinister about all these unregulated coaching organisations which escape regulation by offering 'coaching' instead of 'therapy'. Though come to think of it therapy is just as bad. A pox on all their houses.

This looks to me from the abstract like a sales pitch or market research, not science.