Is physical deconditioning a perpetuting factor in chronic fatigue syndrome? A controlled study on maximal exercise performance and relations with fatigue, impairment, and physical activity

Department of Medical Psychology, University of Nijmegen, The Netherlands.
Psychological Medicine (Impact Factor: 5.94). 02/2001; 31(1):107-14. DOI: 10.1017/S0033291799003189
Source: PubMed


Chronic fatigue syndrome (CFS) patients often complain that physical exertion produces an increase of complaints, leading to a greater need for rest and more time spent in bed. It has been suggested that this is due to a bad physical fitness and that physical deconditioning is a perpetuating factor in CFS. Until now, studies on physical deconditioning in CFS have shown inconsistent results.
Twenty CFS patients and 20 matched neighbourhood controls performed a maximal exercise test with incremental load. Heart rate, blood pressure, respiratory tidal volume, O2 saturation, O2 consumption, CO2 production, and blood-gas values of arterialized capillary blood were measured. Physical fitness was quantified as the difference between the actual and predicted ratios of maximal workload versus increase of heart rate. Fatigue, impairment and physical activity were assessed to study its relationship with physical fitness.
There were no statistically significant differences in physical fitness between CFS patients and their controls. Nine CFS patients had a better fitness than their control. A negative relationship between physical fitness and fatigue was found in both groups. For CFS patients a negative correlation between fitness and impairment and a positive correlation between fitness and physical activity was found as well. Finally, it was found that more CFS patients than controls did not achieve a physiological limitation at maximal exercise.
Physical deconditioning does not seem a perpetuating factor in CFS.

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    • "Symptom exacerbation (i.e., PEM) related to even mild exercise has been reported to occur in greater than 95% of CFS patients.[2] In the literature, the patient reactions associated with PEM have included increased symptoms of pain and fatigue,[3] [4] [5] abnormal cardiopulmonary responses to exercise,[2] [6] [7] decreases in physical activity behaviors,[4] [8] [9] changes in cognitive function,[10] [11] and up-regulation of numerous biological variables.[12] [13] Although a number of studies have been conducted, consistent results and/or replication of findings have been rare.[14] "
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    ABSTRACT: Background: A primary complaint of chronic fatigue syndrome (CFS) patients is post-exertion malaise, which is a worsening of symptoms following activities such as exercise. Purpose: To examine the link between gene expression for metabolite, adrenergic, immune, and glucocorticoid receptors on leukocytes and symptoms (pain, fatigue, and mood) following a maximal exercise test. Methods: Thirteen CFS patients and 11 healthy participants matched on age and fitness underwent blood draws and completed questionnaires immediately before, and 15 minutes, 48 hours, and 72 hours following, maximal exercise. Symptom and genetic measures collected before and after exercise were compared using a doubly multivariate repeated-measures analysis of variance. Results: This comparison of CFS and healthy participants resulted in a significant multivariate main effect for Group (p textless 0.05). Univariate analyses indicated group differences for adrenergic α-2A and glucocorticoid (NR3C1) receptor messenger ribonucleic acid and symptoms of fatigue and confusion. Changes in gene expression were significantly correlated with symptoms. Conclusions: Results suggest that increased glucocorticoid sensitivity may contribute to the symptoms of post-exertion malaise in CFS. As NR3C1 interacts with other transcription factors, investigating the resulting cascades may lead to greater understanding of the biological mechanism of post-exertion malaise. This finding, if confirmed, could lead to novel approaches to prevent symptom exacerbation in CFS.
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    • "From previous studies in patients with CFS compared to healthy controls we know that groups of at least 10, preferably 20 patients per condition are sufficient to detect significant differences in (neuro)physiological parameters measured with sEMG, MRI, and exercise testing.[21,28,50,51] To identify (neuro)physiological characteristics of fatigue, a comparison of baseline measurements with an age, sex, and previous cancer treatment matched group of 20 non-fatigued patients is sufficient. "
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    ABSTRACT: Postcancer fatigue is a frequently occurring, severe, and invalidating problem, impairing quality of life. Although it is possible to effectively treat postcancer fatigue with cognitive behaviour therapy, the nature of the underlying (neuro)physiology of postcancer fatigue remains unclear. Physiological aspects of fatigue include peripheral fatigue, originating in muscle or the neuromuscular junction; central fatigue, originating in nerves, spinal cord, and brain; and physical deconditioning, resulting from a decreased cardiopulmonary function. Studies on physiological aspects of postcancer fatigue mainly concentrate on deconditioning. Peripheral and central fatigue and brain morphology and function have been studied for patients with fatigue in the context of chronic fatigue syndrome and neuromuscular diseases and show several characteristic differences with healthy controls. Fifty seven severely fatigued and 21 non-fatigued cancer survivors will be recruited from the Radboud University Nijmegen Medical Centre. Participants should have completed treatment of a malignant, solid tumour minimal one year earlier and should have no evidence of disease recurrence. Severely fatigued patients are randomly assigned to either the intervention condition (cognitive behaviour therapy) or the waiting list condition (start cognitive behaviour therapy after 6 months). All participants are assessed at baseline and the severely fatigued patients also after 6 months follow-up (at the end of cognitive behaviour therapy or waiting list). Primary outcome measures are fatigue severity, central and peripheral fatigue, brain morphology and function, and physical condition and activity. This study will be the first randomized controlled trial that characterizes (neuro)physiological factors of fatigue in disease-free cancer survivors and evaluates to which extent these factors can be influenced by cognitive behaviour therapy. The results of this study are not only essential for a theoretical understanding of this invalidating condition, but also for providing an objective biological marker for fatigue that could support the diagnosis and follow-up of treatment. The study is registered at (NCT01096641).
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    • "Felitti and colleagues (1998) associated negative health outcomes of adverse childhood experiences with adult health behaviors, including increased levels of smoking and alcohol use, physical inactivity, and obesity in adulthood (see alsoAnda et al., 2006;Dube et al., 2003). In FSS, obesity has been associated with Fm, although not etiologically (Yunus, Arslan, & Aldag, 2002), and research on exercise tolerance and CFS has been mixed (Bazelmans, Bleijenberg, Van Der Meer, & Folgering, 2001;Fischler et al., 1997). Other studies have reported inverse relationships between adverse adult health behaviors such as alcohol and drug use and CFS, Fm, and MCS, and between positive health behaviors such as exercise, and CFS (Harvey, Wadsworth, Wessely, & Hotopf, 2008;Hausteiner et al., 2006;Shaver, Wilbur, Robinson, Wang, & Buntin, 2006;Woolley, Allen, & Wessely, 2004). "
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    ABSTRACT: This study investigated whether childhood physical abuse was associated with functional somatic syndromes (FSS) in women while controlling for age, race, and four clusters of potentially confounding factors: (a) Other childhood adversities, (b) adult health behaviors, (c) socioeconomic status and stressors, and (d) mental health. A regional subsample of the 2005 Canadian Community Health Survey of 7,342 women was used. Women reported whether they had been diagnosed with chronic fatigue syndrome (CFS), fibromyalgia (Fm), irritable bowel syndrome (IBS), or multiple chemical sensitivities (MCS). Fully 749 reported having been physically abused by someone close to them during their youth. When controlling for potentially confounding factors, childhood physical abuse was significantly associated with CFS (OR = 2.11; 95% CI = 1.22, 3.65), Fm (OR = 1.65; 95% CI = 1.08, 2.52), and MCS (OR = 2.82; 95% = CI 1.90, 4.17). Clinicians using reattribution and stepped care approaches in the management of FSS should assess for a history of abuse.
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