Friday, October 14, 2011

Study using cycle ergometers shows that exercise exacerbates ME/CFS

Exercise testing to quantify effects of fatigue on functional capacity in patients with CFS.
Keller BA, Micale FG.:


The purpose of this study was to assess
the effects of post-exertional malaise (PEM) on
functional capacity and anaerobic threshold
in subjects diagnosed with chronic fatigue syndrome (CFS).


Subjects were
10 females and 2 males (41.3+1.11 yrs) diagnosed with CFS
by a physician experienced in the diagnosis of CFS.

To induce PEM, each subject completed a maximum exercise test on a cycle ergometer.

A second maximum exercise test was performed 24 hrs later
to assess the effects of exercise-induced PEM on functional capacity.

Maximum oxygen consumption (VO2max), maximum heart rate (HRmax),
anaerobic threshold (AT), maximum workload (Wmax),
workload at AT (ATwork), and respiratory exchange ratio (RER)
were measured.

RER is an objective indicator of
substrate utilization and subject effort during exercise.


Significant decreases
from test 1 to test 2 were
13.5% for VO2max (21.5 to 18.6; p<0.01),
8 bpm for HRmax (p<0.01),
18.8% for AT (12.0 to 9.7; p<0.05),
9.4% for Wmax (121 to 109 W, p<0.05), and
17.3% for ATwork (58.3 to 48.2 W; p<0.05).

However, there was no change in maximum RER
indicating that subject effort was maximum and also comparable during both tests.


Results indicate that
PEM decreased maximum functional capacity by more than 13% to below 5 METS;
a level at or below that which is required by many job-related activities and IADLs.

To compare,
VO2max in healthy individuals is highly reproducible
over days and even months (r>.95), with a SEM of < 6%.

Thus, for subjects in this study,
an expected variation between tests would be ±1.29
in contrast to the observed decrease of 2.9

PEM decreased AT to below 3 METS
(e.g., light-moderate speed walking),
which is a level of many activities considered to be sedentary in nature.

completion of sedentary ADLs and IADLs for those with CFS
requires production of energy via anaerobic processes
that will further contribute to PEM and exacerbate symptoms of CFS.

Since many daily activities fall into the 3-5 MET range,
individuals with CFS will exacerbate symptoms associated with PEM
simply by completing normal daily activities.

See also: The main characteristic of ME is an abnormally delayed muscle recovery after doing trivial things, if you don't have that, you don't have ME 
See also: GET (graded exercise therapy) is torture for ME patients and directly contravenes the do NO Harm principle of the GMC
See also: Post-exercise acid exposure 50 times higher in ME/CFS patients vs healthy controls, with no reduction with repeat exercise 
See also: CFS Patients Try to Help Researchers Despite The Fact that Researchers try To Kill Them with CBT and GET
See also: Pacific Labs in California (Snell, Stevens et al): it is dangerous to put patients with M.E. through a graded exercise program
See also: PACE trial's Prof Peter White: Exercise causes Immunological damage in Chronic Fatigue Syndrome and is NOT safe
See also: Jan 2011, Spanish study shows that CBT and GET make things WORSE in ME/CFS !!! See also: Journal for Psychotherapy 2011: CBT and GET are ineffective and potentially harmful for many ME/CFS patients


leelaplay said...

Fantastic post DrS. I love the clarity that "CFS will exacerbate symptoms associated with PEM
simply by completing normal daily activities."

And appreciate your list of links to other studies that demonstrate similar results.

Thank you. Will share.

leelaplay said...

ps A friend asked if this has been published yet. From what I can see - this has not been published yet. It was a paper included at the IACFSME 2011 conference in the Importance of Exercise Sat session chaired by Staci Stevens. pg 28

Hope they do publish soon.


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