Can exercise limits prevent post-exertional malaise in chronic fatigue syndrome? An uncontrolled clinical trial

Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium.
Clinical Rehabilitation (Impact Factor: 2.24). 06/2008; 22(5):426-35. DOI: 10.1177/0269215507084410
Source: PubMed


It was hypothesized that the use of exercise limits prevents symptom increases and worsening of their health status following a walking exercise in people with chronic fatigue syndrome.
An uncontrolled clinical trial (semi-experimental design).
Outpatient clinic of a university department.
Twenty-four patients with chronic fatigue syndrome.
Subjects undertook a walking test with the two concurrent exercise limits. Each subject walked at an intensity where the maximum heart rate was determined by heart rate corresponding to the respiratory exchange ratio = 1.0 derived from a previous submaximal exercise test and for a duration calculated from how long each patient felt they were able to walk.
The Short Form 36 Health Survey or SF-36, the Chronic Fatigue Syndrome Symptom List, and the Chronic Fatigue Syndrome -Activities and Participation Questionnaire were filled in prior to, immediately after and 24 hours after exercise.
The fatigue increase observed immediately post-exercise (P= 0.006) returned to pre-exercise levels 24 hours post-exercise. The increase in pain observed immediately post-exercise was retained at 24 hours post-exercise (P=0.03). Fourteen of the 24 subjects experienced a clinically meaningful change in bodily pain (change of SF-36 bodily pain score > or =10); 6 indicated that the exercise bout had slightly worsened their health status, and 2 had a clinically meaningful decrease in vitality (change of SF-36 vitality score > or =20). There was no change in activity limitations/participation restrictions.
It was shown that the use of exercise limits (limiting both the intensity and duration of exercise) prevents important health status changes following a walking exercise in people with chronic fatigue syndrome, but was unable to prevent short-term symptom increases.

Download full-text


Available from: Lorna Paul,

  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic liver disease (CLD) is increasing worldwide (World Health Organisation 2004). The symptoms that affect people with CLD are nonspecific and include joint pain, fatigue, anxiety, depression and cognitive difficulties. In many chronic diseases, such as chronic fatigue syndrome/myalgic encephalomyelitis and cancer, evidence is available to inform the management of these nonspecific symptoms and the role of the occupational therapist. No literature is available, however, on the role of the occupational therapist in clients with CLD. This opinion piece discusses occupational therapy in other chronic conditions and its applicability in the investigation and management of the symptom burden in people with CLD. It concludes that there is a need for occupational therapists to be at the forefront of research in this clinical area, appreciating the symptoms affecting clients with CLD and working towards developing services and interventions appropriate to this client group.
    03/2009; 72(3):133-136. DOI:10.1177/030802260907200309
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Benign Myalgic Encephalomyelitis (ME) / Chronic Fatigue Syndrome (CFS) is a debilitating disease which, despite numerous biological abnormalities has remained highly controversial. Notwithstanding the medical pathogenesis of ME/CFS, the (bio)psychosocial model is adopted by many governmental organizations and medical profes-sio-nals to legitimize the combination of Cognitive Behavioral Therapy (CBT) and Graded Exercise Therapy (GET) for ME/CFS. Justified by this model CBT and GET aim at eliminating presumed psychogenic and socially induced maintaining factors and reversing deconditioning, respectively. In this review we invalidate the (bio)psychosocial model for ME/CFS and demonstrate that the success claim for CBT/GET to treat ME/CFS is unjust. CBT/GET is not only hardly more effective than non-interventions or standard medical care, but many patients report that the therapy had affected them adversely, the majority of them even reporting substantial deterioration. Moreover, this review shows that exertion and thus GET most likely have a negative impact on many ME/CFS patients. Exertion induces post-exertional malaise with a decreased physical performan-ce/aerobic capacity, increased muscoskeletal pain, neurocognitive impairment, "fatigue", and weakness, and a long lasting "recovery" time. This can be explained by findings that exertion may amplify pre-existing pa-thophysiological abnormalities underpinning ME/CFS, such as inflammation, immune dysfunction, oxidative and nitrosative stress, channelopathy, defec-tive stress response mechanisms and a hypoactive hypothalamic-pituitary-adrenal axis. We conclude that it is unethical to treat patients with ME/CFS with ineffective, non-evidence-based and potentially harmful "rehabilitation therapies", such as CBT/GET.
    Neuro endocrinology letters 08/2009; 30(3):284-99. · 0.80 Impact Factor
Show more