What to Consider when Using the Lifestyle Assessment with Clients with Chronic Illnesses

Healthy lifestyle is a central component in the treatment of many illnesses and, therefore, Firstbeat Lifestyle Assessment can provide valuable support and insights both to the client and the professional.

When the client sees, through objective data, how different daily events and choices affect the body, he/she is more likely to commit to important lifestyle changes, such as sleeping more, learning to take breaks or consuming less alcohol. Doctors and other healthcare professionals can benefit from their clients’ Lifestyle Assessment results by getting information about the progress and effectiveness of the treatment plan and client actions. In some cases, Lifestyle Assessment has even played a role in revealing various latent illnesses, from high blood pressure, arrhythmias and sleep apnea to a hyperthyroid condition and chronic obstructive pulmonary disease.

Keep in mind, however, that Lifestyle Assessment should not be regarded as a diagnostic tool! Instead, based on the Lifestyle Assessment result, the client should sometimes be referred for further medical tests or a doctor’s appointment. Underlying illnesses might be discovered if the Lifestyle Assessment result suggests, for example, that the client’s autonomic nervous system does not recover at all, even if there are no obvious, major stress factors.

Typically, a client is referred to a health check if the amount and quality of recovery is exceptionally low or if the heart rate (HR) level is very high at rest and during the day. Or, if there is a lot of unexplained poor-quality data that does not allow us to perform HRV analysis (typically seen as white in the main graph and a light gray line in the RMSSD graph found in the Specialist report).

I can share a personal experience about this. Several years ago, I was conducting frequent measurements on myself as part of our Firstbeat product development, and I started to see increasingly high HR levels and worsening recovery. I was sleeping poorly, feeling tired, losing weight despite eating well and could often feel a shallow, fast heartbeat. I assumed I was simply working too hard and tried to slow down and take better care of myself. Only when my lowest HR in a 3-day measurement was 79 (instead of the typical 49 – 55), nighttime RMSSD was at best 10 ms and there was no recovery during sleep, did I believe that something was wrong and went to the doctor. I had a serious hyperthyroid condition that required immediate action, including beta-blockers and thyroid medicine to settle my heart and overactive thyroid. Over a few months, my bodily functions returned to normal, heart rate slowed down, and HRV improved to a normal level, and I was able to drop the medicines after a while. We’ve had similar and even more dramatic discoveries with clients – people can get so used to feeling tired or “a bit off” that they delay seeing a doctor until they get really sick, or until objective data shows that things are not normal.

Contraindications for Lifestyle Assessment include an uncontrolled thyroid condition (better to get it into balance first), chronic atrial fibrillation or flutter, serious heart conditions, use of a pacemaker and serious, diagnosed mental health conditions. During fever, it’s best to delay the measurement until the fever has come down. In these conditions, the reliability of the Lifestyle Assessment result is weakened, and appropriate or meaningful interpretation of the data can be very challenging because of the illness itself or the medicines being used. As a result, the value of a heart rate variability -based measurement, such as Firstbeat Lifestyle Assessment, is limited in these instances and we do not recommend it.

In the case of bundle branch block (BBB), the measurement can be successful. However, especially if it’s left BBB, we do not recommend measuring because the analysis is usually not successful. This is because the device is not able to reliably detect the R wave, which is the basis of our HRV analysis. Chronic neurologic diseases, such as MS, are not a contraindication for measuring if the illness is in treatment balance and not associated with autonomic neuropathy.

If measuring during pregnancy, be aware of the significantly elevated heart rate (overall HR level and resting HR) affecting the result, which might be quite poor even during the 1st trimester. Pregnancy is a natural, but major physiological stressor and drawing accurate conclusions and comparing to standard reference values can be challenging. In any case, the result is not comparable to a non-pregnancy situation.

In conclusion, Lifestyle Assessment is an excellent tool to support the treatment of many illnesses. Even if the interpretation of results is not always as easy or straight-forward as with healthy people, the small revelations and insights about the patient’s lifestyle can be a significant help to improve their overall condition. As long as common sense and basic guidelines are remembered, the threshold for conducting a measurement for someone with an illness does not need to be excessively high. And if needed, Firstbeat specialists are always happy to help you make meaningful conclusions about the result.

An expanded translation of Satu Tuominen’s original blog in Finnish.

Tiina Hoffman
Exercise Physiologist & Master Trainer