This is a modified translation of a blog originally published in Finnish.
With the aging of the population, more and more people have at least one chronic illness or condition. For example, in Finland in 2017, some kind of medical compensation was paid to three million Finns (out of a population of 5.5 million), and medication is also the primary form of treatment with many acute illnesses. In addition to prescribed medicines, pharmacies have more and more prescription-free medicines that people can buy, based on recommendations and their own judgment.
In most cases, use of medicines isn’t a reason not to do a Firstbeat Lifestyle Assessment, but it’s important for both the professional and the client to be aware that certain classes of medicine (and illnesses) can limit the reliability of the Lifestyle Assessment.
A Lifestyle Assessment kickoff meeting held before a wellness project should list the conditions when a measurement is not recommended; this info is available in the Info meeting slide presentation found in the Learning Center. For reliable interpretation, the clients should record their illnesses and the medicines that they are taking via the journal, so the professional can take them into account during analysis and in the feedback discussion.
Medicines that decrease the heart rate
The most common category of medicines that decrease the heart rate (HR) are beta blockers, used typically for coronary artery disease, high blood pressure, congestive heart failure and some arrhythmias. Beta blockers typically decrease the HR level overall and prevent the HR from increasing during exertion (or heavy stress). The medicine’s effect is based on blocking the effects of the hormone epinephrine (adrenaline), causing the heart to beat more slowly and with less force, which lowers blood pressure. As a result, the heart’s need for oxygen is reduced, which is the desired effect in the treatment of the above-mentioned conditions.
If a client has listed a beta blocker in their background information, we typically recommend decreasing the person’s age-estimated max HR by 15-20 bpm. However, keep in mind that there can be large individual differences in how a person’s autonomic nervous system works. Even if we know the general effect of beta blockers on HR, the reactions can vary depending on the effective ingredient, dosage, and individual response. Before decreasing the person’s max HR, take a look at the HR reactions during the 3-day measurement, especially during possible exercise sessions, to see if the HR is very flat or if it increases “normally” when the person is active.
You do not need to manually decrease the person’s resting HR due to use of beta blockers. However, in some cases, the Lifestyle Assessment will automatically decrease the resting HR by a couple of beats (from the lowest measured value), based on acute stress factors, such as alcohol or heavy exercise. You can find more information about this feature in the Learning Center – Materials to download – Evaluating the reliability of results.
Medicines that increase the heart rate
Medicines that increase the HR level are typically allergy or asthma medicines. When the condition is in good treatment balance, the body usually reacts quite normally, and interpretation of the Lifestyle Assessment result in that situation is no different when compared to an unmedicated situation. However, the intraindividual differences (especially in HR level) between measurements with and without a HR-increasing medicine can be significant, and thus, the comparison of these results is not meaningful.
Quite often, the effect of medicines that increase the HR can cause the Lifestyle Assessment result to look worse (“more red”) than normal due to more stress reactions caused by increased sympathetic activity. And vice versa. Medicines that lower the HR can sometimes cause “more green” than normal results, especially in the case of beta blockers. Because of this, before the feedback discussion with your client, it’s important to take a close look at the illnesses and medicines that the client has listed, shown on the Specialist report.
Interpretation of results
In general, if the illness is in good treatment balance, the reliability of Lifestyle Assessment result is good and can be interpreted as usual, even if the client is taking medicines. However, we need to be aware that some illnesses, and the medicines being used to treat them, can cause the result to look weaker, especially if they have an increasing effect on the person’s heart rate. Some antidepressants and mood medicines are an example of this. In these cases, the first priority is always appropriate treatment of the illness, according to the medical professional’s plan. For the client’s well-being, the “more red” Lifestyle Assessment result in that situation is a side effect that can actually mean better overall condition and health.
Even if illnesses and medications can influence the measurement baseline and final result, the effect of the individual’s lifestyle and different daily actions on recovery can still be assessed and demonstrated with a Lifestyle Assessment. Progress – the effectiveness of set goals and action points as part of lifestyle coaching – can be monitored in follow-up assessments, especially if the medications have remained about the same.
On the other hand, if there are a lot of acute and/or chronic illnesses and medications, the professional user needs to be aware that in some cases, it might not be possible to draw reliable conclusions from Lifestyle Assessment, which is based on measurement of HR and HRV. In these cases, Lifestyle Assessment should not be recommended (or repeated), and focus can be switched to other types of treatment and support. Additional information about how to take medicines into consideration as part of your wellness coaching can be found in the Lifestyle Assessment Learning Center.
A modified translation of Satu Tuominen’s original blog in Finnish.
Exercise Physiologist & Master Trainer
Finnish Medicine Statistics (Suomen Lääketilasto 2017). Kela & Fimea
Karjalainen J, Viitasalo M. Fever and Cardiac Rhythm. Arch Intern Med. 1986;146(6):1169–1171. doi:10.1001/archinte.1986.00360180179026