Session Information
Session Title: AA 2022 Posters - Neurological Rehabilitation
Session Time: None. Available on demand.
Disclosures: Raouf Gharbo, DO, FAAPMR: Lief Therapeutics (Products/Services: Yes) (Consultant/Advisory Board)
Case Diagnosis: 19-year-old female impaired by Postural Orthostatic Tachycardia Syndrome (POTS).
Case Description: A 19-year-old female, sedentary for over 6 months, with tilt table-confirmed POTS. Symptoms included exertional, global, and post-meal fatigue, nonrestorative sleep, palpitations, and anxiety. Longitudinal, nocturnal heart rate variability (LN-HRV) with remote physiological monitoring (RPM) using BiostrapTM wrist plethysmography (PPG). She was prescribed baroreceptor exercise with Heart Rate Variability Biofeedback (HRV-B) using a wearable ECG device (Lief TherapeuticsTM).
Setting: PM&R Telehealth
Assessment/Results: Eight weeks of sedentary HRV-B training improved LN-HRV and then gradated physical therapy (PT) resulted in irregular progression over 4 months. Her General Anxiety Score (GAD2) improved from 4/6 to 0.5/6. She was able to self-manage fatigue and anxiety with her breath, jog regularly, normalize her weight, work, and attend college. After six months she tolerated regular treadmill jogging and resistance exercises.
Discussion: Energy conservation techniques are the gold standard for chronic fatigue since exercise frequently worsens fatigue and is a common cause of noncompliance in dysautonomia therapy, resulting in the Exercise-Fatigue Paradox (EFP). This case illustrates three methods to reduce dropout rates; 1) initial baroreceptor exercise by inducing cardiorespiratory synchronization with HRV-B, 2) LN-HRV to gauge physiological recovery capacity objectively and clarify the EFP during autonomic rehabilitation, and 3) the use of intravenous fluids for dehydration if LN-HRV remains low.
Conclusion: LN-HRV RPM can be used to safely titrate exercise and enhance autonomic rehabilitation of chronic fatigue.
Level of Evidence: Level IV
To cite this abstract in AMA style:
Gharbo R, Cifu D, Saku D, Miller AR. Remote Physiological Monitoring-Guided Therapy for Exercise-Fatigue Paradox [abstract]. PM R. 2022; 14(S1)(suppl 1). https://pmrjabstracts.org/abstract/remote-physiological-monitoring-guided-therapy-for-exercise-fatigue-paradox/. Accessed May 20, 2025.« Back to AAPM&R Annual Assembly 2022
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/remote-physiological-monitoring-guided-therapy-for-exercise-fatigue-paradox/