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

Article (PDF Available)inPsychological Medicine 31(1):107-14 · February 2001with59 Reads
DOI: 10.1017/S0033291799003189 · Source: PubMed
Abstract
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.
    • "And Shafran noted " There is no consistent evidence for myopathy or physical deconditioning " [47]. Paul et al. objectified the delayed muscle recovery from fatiguing exercise in ME/CFS [12], Black et al. found that people with ME/CFS, contrary to sedentary controls are unable to reach exercise targets because of exercise intolerance and that GET causes " pronounced worsening of symptomology " which means that " subjects with CFS had reached their activity limit " [31] and Bazelmans et al. concluded that " Physical deconditioning does not seem a perpetuating factor in CFS " [48]. And a review by Twisk showed that a number of studies using two day CPET implicate that the aerobic oxidative phosphorylation fails to respond adequately to exercising in ME/CFS [49]. "
    [Show abstract] [Hide abstract] ABSTRACT: Abstract Background: In this study the muscle bioenergetic function in response to exercise in severe ME was explored to see if the underlying metabolic problem in ME, responsible for the severe difficulties with trivial exercise, and the severe loss of muscle power, could be discovered. Methods: Inorganic phosphate, creatine kinase and lactate were measured in a former Dutch National Field Hockey Champion, who is now a patient bedridden with severe ME, before and 5 minutes after very trivial “exercise”, from which his muscles needed 12 hours to recover. Results: Inorganic phosphate and creatine kinase were both normal, however, lactate after this trivial exercise was very high, and further testing showed that a second batch of lactic acid was excreted after the same exercise with a 6-fold delay, showing that the lactic acid excretion was impaired and split into two. And this was delayed up to 11- fold by eating closer to the exercise. Conclusion: This study found that in severe ME, both the oxidative phosphorylation and the lactic acid excretion are impaired, and the combination of these two is responsible for the main characteristic of ME, the abnormally delayed muscle recovery after doing trivial things. The muscle recovery is further delayed by immune changes, including intracellular immune dysfunctions, and by lengthened and accentuated oxidative stress, but also by exercise metabolites, which work on the sensitive receptors in the dorsal root ganglions, which in severe ME are chronically inflamed, and are therefore much more sensitive to these metabolites, which are produced in high quantities in response to trivial exercise, which for ME patients, due to the underlining metabolic problem, is strenuous exercise. And a similar problem is most likely responsible for the abnormally delayed brain recovery after doing trivial things. This study also shows that the two metabolic problems are the result of an impaired oxygen uptake into the muscle cells or their mitochondria and in combination with the Norwegian Rituximab studies, which suggest that ME is an autoimmune disease, it is suggestive that antibodies are directly or indirectly blocking the oxygen uptake into the muscle cells or their mitochondria. Keywords Myalgic encephalomyelitis; Chronic fatigue syndrome; Exercise; Muscle fatigue; Muscle pain; Lactate; Lactic acid; Immune dysfunction; Inorganic phosphate; Creatine kinase
    Full-text · Article · Sep 2015 · Clinical Rheumatology
    • "Although contradicted by some studies, e.g. [8] and [9], several studies (Table 1) have observed an extremely low exercise capacity when compared to sedentary healthy controls as illustrated inFigure 1. This is reflected by the low power output and oxygen uptake at the anaerobic threshold (W AT, respectively VO2 AT) or at the ventilatory threshold (W VT, respectively VO2 VT) and at exhaustion (Wmax and VO2max) at a CPET, despite sufficient effort, as implicated by the respiratory exchange ratio at exhaustion (RERmax). "
    Full-text · Article · Jan 2015
    • "Based on the preliminary evidence, the results suggest that important differences might exist between the ME, 2003 Canadian criteria, and 1994 CDC criteria and that further investigations are warranted, particularly investigations employing objective measures. Indeed, it has been shown repeatedly that CFS patients perform less habitual physical activity [16] and have delayed muscle recovery following exercise [17] , reduced psychomotor speed, and impaired cognitive performance [18]. But, it is not clear whether these symptoms and dysfunctions are present in all CFS patients irrespective of criteria or, indeed, Clin Rheumatol "
    [Show abstract] [Hide abstract] ABSTRACT: The current study had two objectives. (1) to compare objective and self-report measures in patients with chronic fatigue syndrome (CFS) according to the 1994 Center for Disease Control (CDC) criteria, patients with multiple sclerosis (MS), and healthy controls, and (2) to contrast CFS patients who only fulfill CDC criteria to those who also fulfill the criteria for myalgic encephalomyelitis (ME), the 2003 Canadian criteria for ME/CFS, or the comorbid diagnosis of fibromyalgia (FM). One hundred six participants (48 CFS patients diagnosed following the 1994 CDC criteria, 19 MS patients, and 39 healthy controls) completed questionnaires assessing symptom severity, quality of life, daily functioning, and psychological factors. Objective measures consisted of activity monitoring, evaluation of maximal voluntary contraction and muscle recovery, and cognitive performance. CFS patients were screened whether they also fulfilled ME criteria, the Canadian criteria, and the diagnosis of FM. CFS patients scored higher on symptom severity, lower on quality of life, and higher on depression and kinesiophobia and worse on MVC, muscle recovery, and cognitive performance compared to the MS patients and the healthy subjects. Daily activity levels were also lower compared to healthy subjects. Only one difference was found between those fulfilling the ME criteria and those who did not regarding the degree of kinesiophobia (lower in ME), while comorbidity for FM significantly increased the symptom burden. CFS patients report more severe symptoms and are more disabled compared to MS patients and healthy controls. Based on the present study, fulfillment of the ME or Canadian criteria did not seem to give a clinically different picture, whereas a diagnosis of comorbid FM selected symptomatically worse and more disabled patients.
    Full-text · Article · Oct 2014
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