Few comments after reading the article:
Theory without the evidence:
Frequently, these individuals report a distant flu-like syndrome followed by a period of inactivity, followed by more inactivity in response to the unpleasant sensations they have while standing or doing mild physical activity. Thus, a downward spiral of inactivity and deconditioning occurs.
Like every assertion of deconditioning-caused problems I've seen (excluding the case of extreme bed rest), this statement comes without any referenced evidence. I've been looking for such supporting evidence for over a year without any luck, though have found the same unsupported argument used in numerous illnesses.
Many studies (though not all) in CFS and other illnesses have looked for deconditioning and failed to find it, though that hasn't dampened enthusiasm for the theory. Specifically, a study by Peter White of CFS patients enrolled in a Graded Exercise programme found patients were not deconditioned, and the minor gains in exercise capacity they made during the study did not correlate with improvement in their CFS.
The article specifically includes CFS:
This brings me to a larger question – has deconditioning become medicalized? More importantly should deconditioning be medicalized? In this context, there are a number of other chronic medical conditions, most notably fibromyalgia and chronic fatigue syndrome, that are associated with poor exercise capacity and the patient narratives and physician responses are frequently similar to those outlined above for POTS
... The Shibata study offers hope for these patients [appears to refer to those in above para, inc CFS] and shows that carefully monitored and progressive exercise training in a supportive environment is a treatment option that should be tried first
Exercise is the answer - ALWAYS:
If deconditioning were a recognized syndrome or diagnosis like hypertension, diabetes and POTS, it would be easier to educate the general public and medical community about the one universally effective treatment for it – exercise training.
Again, evidence for this is lacking, or not cited by the author.
As for the
specific study on training POTS patients, I've not yet read the full text, but judging by the abstract the results are not spectacular. However, says the author of the opinion piece, 'with prolonged training, even more dramatic improvement [
note not cure] of symptoms is possible', citing "personal communication" - ie unpublished findings. Hardly compelling.