Using a Garmin Watch for Long COVID

I wear a Garmin vivoactive 5 watch to help pace myself in my long COVID recovery.

Choosing a Watch

I chose the vivoactive 5 because it was one of the least expensive Garmin watches that reports overnight heart rate variability (HRV). (Full list of watches here.) The watch made my sleep worse, so I no longer sleep with it at night. I am satisfied with the watch, but I don’t know if a $300 model is necessary.

This is also not an endorsement of a Garmin over Apple Watch. I don’t have an Apple Watch.

Heart Rate Monitoring

I primarily use of the watch for heart rate monitoring, both to catch when my heart rate is too high and to measure my overall physical exertion during the day.

A common recommendation for ME/CFS patients is to keep their heart rate under their anaerobic threshold, which is estimated at 60% of max heart rate. This is the default heart rate the Visible app considers “over exertion.” (See Heart Rate Monitoring for Long COVID)

I customized the watch face to display my heart rate at all times. During a new activity, I’ll glance down and make sure my heart rate is not getting too high.

I do not use heart rate alarms because they increase my anxiety. An alarm requires an “activity” running. For example, you can configure the “yoga” activity to have a heart rate alarm and then leave the yoga activity running all day. A second option is a custom activity, described below. A third option is the LongCOVID Pacing App.

For overall exertion, I use “intensity minutes.” Garmin uses the standard five heart rate zones. Zone 3 counts toward “moderate intensity” and zones 4 and 5 are “vigorous intensity.” The vigorous minutes count double. By setting the heart rate zones low I use the intensity minutes to estimate my exertion during the day. For example, these ranges provide a place to start:

  • Zone 5 - 65-100%
  • Zone 4 - 55-65%
  • Zone 3 - 48-55%
  • Zone 2 - 44-48%
  • Zone 1 - 40-44%

The estimate of 60% of max heart rate is not very accurate, so you will likely need to adjust the zones. This spreadsheet can help with the arithmetic to set the heart rate zones. I use the max heart rate recorded during the day and in activities to try to estimate my anaerobic threshold.

I manually record the intensity minutes each day in my activity log to look for patterns. I use my watch to see today’s intensity minutes to estimate my remaining energy for the day. This is very similar to the Pace Points in the Visible app.

One snag is that the intensity minutes are computed using the zones in place at the time. If I change the zone configurations, I cannot compare the intensity minutes for current days to days before the change.

Just like in Visible, heart rate monitoring does not account for mental or emotional exertion well. I have also found that my heart rate can vary significantly doing the same activity on different days.

Step Count

I also record my step count as a measure of exertion. The steps and intensity minutes measure different kinds of exertion. If I’m fishing from the bank my, intensity minutes rise, but the step count stays about the same. If I’m shopping, my intensity minutes don’t rise, but I have more steps.

For pacing I use intensity minutes more than step count.


Garmin provides a Health Snapshot, which monitors your body for 2 minutes and reports your resting heart rate (RHR) and heart rate variability (HRV). This is very similar to the Visible morning checkin, with some usability differences.

My Garmin watch battery lasts over a week, so at night I leave it in a drawer next to my bed. The watch is not distracting like a phone because it doesn’t do much and receives no notifications. In the morning I can roll over, put the watch on, and do the Health Snapshot. This is much easier than the Visible morning checkin.

Garmin also allows you to take the reading more than once in a row, which I think is useful to gauge the validity of the number. Recently I found if I don’t think about my breath, then my HRV is about 30. If I take a second reading and breath in for 3, out for 6, my HRV is about 47. As I discussed in my article on heart rate monitoring, I’m not at all convinced that measuring HRV is useful for me.

Garmin doesn’t interpret the data, which I view as a good thing. The watch won’t tell you that you should feel bad.


The Garmin heart rate seems to be pretty accurate. Once I was walking and it said my heart rate was in the low 60s, which was clearly wrong. Another time I was standing, calmly fishing and it said my heart rate was 168, which was also wrong. When these situations happen, I can hold my arm still a few seconds and it will correct itself. These errors do not happen often.

The Polar arm band that comes with Visible Plus is more accurate. When I go on morning walks, I started wearing the arm band and connecting it to the watch. That way I have a more accurate heart rate, but I can also see the heart rate easily on my watch. I only do this because I have the arm band. I don’t think it is worth another $100 for that feature.


Garmin tracks “activities” like walking, running, cycling, etc. I tell the watch when I start and stop the activity and then the watch records more detailed metrics.

You can customize the watch faces shown during each activity. You can also set custom heart rate alarms during that activity.

The names of existing activities can be changed and you can create your own custom activities. For example, I created one called “Fishing” that I use to track my heart rate when I am fishing. I use the lap counter to count the number of fish I caught. You could easily create activities for showering, cooking, gardening, physical therapy, grocery shopping, etc. to get insights into how taxing each activity is.

Sleep Tracking

Wearing the watch at night made my sleep worse (read more). However, I discovered that if I take the watch off when I got to bed and put it on when I get up, then I can see on the heart rate graph when the data stops and starts, so I know how much time I spent in bed. That’s more than enough sleep tracking for me.

Because I do not wear the watch at night, the Body Battery feature of the watch doesn’t really work. It’s not a big loss.

Data Access

Garmin has a smartphone app as well as a website that give me access to the data. If I sync the app with the phone, then the data automatically goes to the website. I can also connect the watch to wifi and sync the data without a phone. In that case the data will also appear in the app. A couple of times the syncing failed for some reason and I missed a day of detailed heart rate data, but for the most part the syncing seems to work fine.

The reports between the app and website are slightly different and sometimes it’s annoying to try to remember where to find a particular report, but both seem to work well.

Using the Data

I have to pace very carefully, so I am often listening to subtle indications in my body that I have over done it. The data I get from the watch is another one of those indicators, but I have to be careful not to listen to the watch too much.

Recently my watch said I had 107 total intensity minutes, but five days earlier I did nearly exactly the same activities and it was 54 minutes. This is likely because the weather was warmer on the second day. So the question is, “What do I do with this information?” I chose to take it easier for the next couple of days as a precaution. So maybe that was good, or maybe it just made me worry unnecessarily. The jury is still out.


I was concerned the watch band would be uncomfortable, but I find the whole thing very comfortable. The watch is very light and the band is very smooth and flexible. The band has buckle holes very close together so I can get the size just right.

No Notifications

I don’t need more distraction my life, so I turned off all notifications from my phone to the watch. I also turned off all notifications on the watch. For example, once I had done some stretching and then headed out the door in a hurry because I was late for an appointment. While I was driving, the watch buzzed and told me that I was stressed and needed to relax. I didn’t need that. I turned all notifications like that off.


With the Garmin watch I can track roughly the same information as the Visible app with arm band. The watch requires no monthly fee, but has a higher up front cost. I find the watch much less intrusive to my daily life. (See my Visible review.)

I have read multiple long COVID recovery stories where people said part of their recovery involved discontinuing use of their Garmin watch. At this point it gives me concrete data to help with pacing, but I’m still not sure if I will use it long term because seeing the concrete numbers can sometimes induce stress that is not helpful.