I had a 1 day CPET done a year ago, and still suffering from the relapse that it caused. It is an unethical and harmful test. It should be banned for CFS patients.
This is exactly my point - I don't know who Dr Snell is testing, but it sure isn't the people I know with ME/CFS. The people I know have abnormalities on a 1 day test. It is unthinkable that they could do another test on a second day. Dr Snell is trivialising this illness with very dodgy claims - from the data I have seen his there are serious potential bias issues with respect to not pushing the controls to exhaustion on the 1st day - and it doesn't matter what measure is used peakVO2 or VT RER, that issue is still a problem.
On other message boards this topic has been discussed without a mob attack. Read some of the comments bleow -
http://www.mecfsforums.com/index.php?topic=16831.0
"Some ME/CFS may be able to walk up to test point and cycle for two seconds and then their legs are done. Many of us has seen this many times over. What criteria was used?"
"[The claims by Snell] are not true and it has been known for say 10 years. Deconditioned healty people can't ever have the low performances that you get in ME patients [on day 1]."
"I agree, EJ. I think these people are doing more harm than good. Still, many people who say they have M.E. are saying these people are doing great work."
"That happens to newbies or people who has not done their homework."
"It's very confusing for this group to use UK CFS/ME terminology ... Such sloppy terminology does not inspire confidence in this group."
"Additionally to the "This deconditioned crap is just bullshit" and the criteria concerns, I never liked the idea that they test very sick people like hamsters on a tread mill to establish disability. It is a degrading, ridiculing and medically worthless - even dangerous - procedure."
"I was invited to undergo this testing based on the recommendation of my CFS/ME physician. I believe about 12 patients were seen during this particular testing session. It was my understanding that I was not alone in the patients that were found to be too disabled to continue with the second day of testing."
Yet Snell et al continue to post the claim - "The lack of any significant differences between groups for the first exercise test."
http://ptjournal.apta.org/content/early/2013/06/26/ptj.20110368.short
- who are these people that can exercise fine on day one? Also, if you read some of Snell's other papers, only 50% of his supposed "CFS/ME" patients had a fall in peakVO2 on day 2, they were completely normal.
As I said above, this data is at complete odds with everyone I know who has ME - a single day exercise test is abnormal in ME patients and makes them feel so ill and produces such serious symptoms that a second test the very next day is unthinkable. Snell is trivialising this illness, either with extremely mildly affected patients, or given the issues with his data that I have previously raised, patients who are no different to couch-potato controls.
We all have views on this, some people are in favour of exercise testing, some are not. Personally I think exercise testing can be good, but if we are going to study ME patients, let's use the data from the ME patients who have very serious abnormalities of day one, as the poster said above, some of these patients attended the research - yet Snell ignores them, and writes "lack of any significant differences between groups for the first exercise test".
PS @
Bob you posted a link to a message board, not a peer review artilce. I have read all Snell's peer review articles and all of them have the same methological errors mentioned before. Watts at VT, RER, it doesn't matter, those variable are all dependent on one thing, muscle fatigue - and when Snell is testing a single muscle group (cycle ergonometry) those variables should be worse in couch-potatoes on the second day. Why aren't they? The problem is as Dr Snell repeatedly hints - "On average, controls did slightly better on Day 2." In other words, they didn't try on the first day - and to confirm that we can see they don't reach their true HRmax%. HRmax% does not change from a single day of exercise, if you can reach a certain HRmax% on day two, you certain can on day one. Snell is either not pushing the controls on day one - bias - or they just aren't trying.