Aerobic work capacity in patients with chronic fatigue syndrome.

[deleder2k]

BMJ: Aerobic work capacity in patients with chronic fatigue syndrome. 1990.

OBJECTIVE--To determine the aerobic work capacity of patients with the chronic fatigue syndrome and compare it with that of two control groups, and to assess the patients' perception of their level of activity before and during illness.

DESIGN--A symptom limited exercise treadmill test with on line gas analysis and blood sampling was used. Subjects were assessed by one investigator, who was blind to the group which they were in. SETTING--Department of medicine, Royal Victoria Hospital, Belfast. SUBJECTS--13 Patients (10 women, three men) who fulfilled the diagnostic criteria for chronic fatigue syndrome. Two control groups of similar age, sex, and body weight: 13 normal subjects (10 women, three men) and seven patients (five women, two men) with the irritable bowel syndrome.

MAIN OUTCOME MEASURES--Aerobic work capacity as assessed by several variables such as length of time on treadmill, heart rate, and biochemical measurements; Borg score; and visual analogue scores of perceived level of physical activity.

RESULTS--The patients with the chronic fatigue syndrome had a reduced exercise capacity compared with that of the other subjects, spending a significantly shorter time on the treadmill. They had a significantly higher heart rate at submaximal levels of exertion and at stage III exertion had significantly higher blood lactate concentrations. Using a Borg score, they showed a significantly altered perception of their degree of physical exertion with a mean score of 8.2 compared with 6.6 and 5.3 for the normal subjects and patients with the irritable bowel syndrome respectively. Using a visual analogue scale they indicated that they had a greater capacity for activity before illness than had the patients with the irritable bowel syndrome, but the scores were not significantly different between the two groups. Both groups of patients indicated reduced activity at the time of testing. Normal controls and patients with the irritable bowel syndrome aspired to a greater level of activity than their current level, but the patients with the chronic fatigue syndrome aspired to a level similar to that which they had had before their illness.

CONCLUSIONS--Patients with the chronic fatigue syndrome have reduced aerobic work capacity compared with normal subjects and patients with the irritable bowel syndrome. They also have an altered perception of their degree of exertion and their premorbid level of physical activity.

They wrote in the study: "In summary, patients with the chronic fatigue syndrome who impaired capacity for exercise despite an increased perception of their exertion. We found no evidence for a deficient cardiovasculat response or peripheral muscle function other than that which would be expected as a result of deconditioning. Other mechanisms, however, such as atrophy of muscle fibre or depletion of muscle enzymes may result in similar findings and merit further investigation".



The Berlin wall had just been demolished. The year was 1990. The Soviet Union was still a country. It was 27 years ago. It was the year I was born. Why on earth didn't one continue this track? What the f*** happened? It looked like they were on the right track back then. Many interesting studies from the late 80's and early 90's. If our symptoms are caused by dysregulation of the enzyme PDH it is all tragicomic. Patients say that they have no energy. Patients say that they feel lactic acid just by standing up, or just by walking a few metres. Can a enzyme crucial for energy be why we can't use utilise energy?
Why investigate that in-depth when one can destroy the path where science was headed with some stupid papers on CBT? Why listen to patients when you can choose not to? Why would having a proper functioning of the energy metabolism be worth investigation further when you can choose not too?

I don't know if how close we are, but one thing is certain: ME will be one the darkest stories in the history of modern medicine.

Lets hope that 2017 will be the year things started really to change.

 

[Snow Leopard]

I have done the 2 day CPET, on the first day and my "aerobic work capacity" it was extremely close to the population mean of those of my age, gender and bodyweight. (eg not reduced compared to normal controls).
(likewise, the VO2 max calculation VO2 max = 15.3 x (MHR/RHR) was almost spot on.)

Yet on the second day I struggled much more to perform a figure of 7% less than the first day. My legs just couldn't put out the torque.

Reduced cardiovascular work capacity can easily be blamed on deconditioning - but normal one day and below normal the next needs far deeper explanation.

 

[Hip]

This was in 1990. 27 years ago. It was the year I was born. Why on earth didn't one continue this track? What the f*** happened?

What happened? It was the corrupt disability insurance industry who purposely and unscrupulously took ME research off track in the 1990s, when they succeeded in deceiving the world by falsely making ME look like a non-physical "all in the mind" disease, even though ME is a physical organic disease.

Why did they do this? As a result of the fivefold to eightfold increase in the incidence of ME that occurred from 1980 to 1989, the disability insurance industry were faced with an enormous payout of disability claims for this huge flood of new ME cases that appeared. According to UNUM insurance (one of the most rogue of companies), claims for disability caused by ME had increased by 500% from 1989 to 1993. The insurance industry's strategy to avoid these payouts was to falsely and deceptively make ME look like it was an "all in the mind" condition, because insurance companies do not need to provide long term disability payouts for psychological conditions.

The disability insurance industry did this by most likely influencing the creation of the new disease category of "chronic fatigue syndrome", which by its dodgy definition could be conveniently considered an "all in the mind" psychologically-caused condition. This contrasts to the definition of ME, which is a physical biologically-caused disease.

The insurance industry also enlisted the help of psychologists and psychiatrists like Sir Simon Wessely and his Wessely School international pals, who for a fee, and in order to help promote their careers, were willing to be complicit in this hugely damaging deception.

 

[alex3619]

the disability insurance industry were faced with an enormous payout of disability claims for this huge flood of ME cases that appeared.

This is correct, but I only just posted a blog looking at the bigger picture. Its less a storm than a storm front backed by a hurricane. My blog is here:

http://forums.phoenixrising.me/index.php?entries/when-will-we-get-enough-research.2077/

 

[alex3619]

have done the 2 day CPET

Would you mind telling me where? I was unaware this testing was being done in Australia.

 

[Snow Leopard]

Would you mind telling me where? I was unaware this testing was being done in Australia.

UniSA Exercise Physiology Clinic as part of a study.

http://www.unisa.edu.au/media-centre/releases/new-high-performance-and-exercise-physiology-clinic/

Disclaimer: Based on my overall health experience since doing the 2-day CPET, I don't really recommend doing the 2 day test unless you are healthy...

 

[Sidereal]

What happened is that several other studies failed to show elevated lactate levels during maximal exertion so instead of thinking outside the box it was concluded that muscle metabolism was normal, move on folks, nothing to see here. It took 20+ years for people who actually listened to patients' descriptions of PEM to figure out to repeat the CPET two days in a row. I don't think most of us have abnormalities on day one which is the standard testing protocol in medicine so instead of studying us with the necessary level of intellectual curiosity / subtlety they simply dismissed us as insane. It is preposterous that it's taken decades to document the obvious problem with PDH. Surreal really.

Btw the other major issue in modern ME/CFS CPET research is chronotropic incompetence. There are studies going back to 1980s or 1990s showing inability to reach max heart rate yet no one gave a shit.

 

[Sing]

Btw the other major issue in modern ME/CFS CPET research is chronotropic incompetence. There are studies going back to 1980s or 1990s showing inability to reach max heart rate yet no one gave a shit.

It is enfuriating, I agree. Move on folks; nothing to see here....

About the second issue you raise, years back I got on an exercise bike that showed your heart rate, and to my deep surprise as I was peddling as long and hard as I could, my heart rate was dropping! That was when I got off--not only because it felt really hard, but because that was too creepy. When normal processes like heart rate turn upside down, it is time to leave the building while you still can!

 

[*GG*]

I have done the 2 day CPET, on the first day and my "aerobic work capacity" it was extremely close to the population mean of those of my age, gender and bodyweight. (eg not reduced compared to normal controls).
(likewise, the VO2 max calculation VO2 max = 15.3 x (MHR/RHR) was almost spot on.)

Yet on the second day I struggled much more to perform a figure of 7% less than the first day. My legs just couldn't put out the torque.

Reduced cardiovascular work capacity can easily be blamed on deconditioning - but normal one day and below normal the next needs far deeper explanation.

I did this as well, here are my results, from 2010.

GG

 

[alex3619]

It took 20+ years for people who actually listened to patients' descriptions of PEM to figure out to repeat the CPET two days in a row.

We might have figured it out in 1956, after investigation into the Royal Free Hospital outbreak. However it is not clear that the 1949 technology was widely available till the 80s.

 

[Kati]

It reminds me of a Canadian study reporting altered blood flow in the brain from 2007 or something like that. You'd think there would be a follow up on this, you know. But no, absolutely no funding for us.

https://www.ncbi.nlm.nih.gov/pubmed/18671793

 

[ash0787]

I noticed this too, increase HR in general especially during crashes, but when I had panic attack it seemed less bad than before, HR was only 120 or so compared to 200 when I used to have them.

" fivefold to eightfold increase in the incidence of ME that occurred from 1980 to 1989, " any clues as to why this might be ? I wonder if we will ever find out ...

 

[Hip]

" fivefold to eightfold increase in the incidence of ME that occurred from 1980 to 1989, " any clues as to why this might be ? I wonder if we will ever find out ...

That was the question I was asking people to suggest answers to on that thread.

My best guess is that the large increase in pesticide usage in the decades prior to 1980 may be the culprit. In the UK, there was research into the link between pesticides and ME/CFS, especially by ME/CFS expert Professor Peter Behan, but as usual, industry acted to try to ridicule the science showing that pesticides greatly increase the risk of ME/CFS. In the case of significant exposure to organophosphate pesticides in sheep dipping farmers, studies found a fourfold increased risk in developing ME/CFS.

See: Guardian: UK Govt. knew of danger of organophosphates, ignored it (Mar quoted)

A recent study found that women who use pesticides domestically have double the risk of autoimmune diseases lupus and rheumatoid arthritis.

 

[ash0787]

how widespread is the use of these pesticides in the modern world ? any large population centers that don't use it ? any studies specifically done on this ? maybe something for the wannabe anthropologists ( psychobabblers ) that they could actually do which would be useful...

I always heard incidence of me/cfs was roughly consistent around the world with no significant racial bias etc. Also would we expect to see a decrease in people that consistently lived in urban areas, or could these pesticides be making their way into food too ?

 

[SilverbladeTE]

how widespread is the use of these pesticides in the modern world ? any large population centers that don't use it ? any studies specifically done on this ? maybe something for the wannabe anthropologists ( psychobabblers ) that they could actually do which would be useful...

I always heard incidence of me/cfs was roughly consistent around the world with no significant racial bias etc. Also would we expect to see a decrease in people that consistently lived in urban areas, or could these pesticides be making their way into food too ?

Yes they are in your food and many other places see Aerotoxic Syndrome
Evidence from Gulf War Syndrome research shows low dosages are massively increased in effect by other toxins, the kind of synergies I keep warning about
And the toxicity of these chemicals make cyanide look like gnat's piss by comparison, weak gnat's piss at that
I did long post on toxicity on someone's post regarding botulism please look at it if wish

Beyond organophosphates theres several other groups of compounds in use, sorry bad day memory is bad, one is based on synthetic nicotines, organocanaboids? Blech something like that
Increasing evidence of horrendous toxicity to wild life and mammals ie Humans, is growing
Kiss the bees and human sexual hormone/glands good by hello sterility and gender damaged babies!

I am so.so sick.of the scum who cover up Big Businesses evils

 

[Snow Leopard]

I did this as well, here are my results, from 2010.

GG

Thanks.

I wouldn't really call that a 2 day CPET as the 2 day test requires performing to VO2Max on both days, rather than steady state riding at 25w for 15 minutes - pedalling peaking at 200w+ is much harder than 25w as you well know.

 

[*GG*]

Thanks.

I wouldn't really call that a 2 day CPET as the 2 day test requires performing to VO2Max on both days, rather than steady state riding at 25w for 15 minutes - pedalling peaking at 200w+ is much harder than 25w as you well know.

Huh? Even though it says Cardiopulmonary Exercise test (CPET and on the 1st page is says I was tested on consecutive days 8/10-11, 2010?

GG

PS Dr Betsy Keller is on our side, an is another center to get this testing done!

 

[medfeb]

The Berlin wall had just been demolished. The year was 1990. The Soviet Union was still a country. It was 27 years ago. It was the year I was born. Why on earth didn't one continue this track? What the f*** happened?
I don't know if how close we are, but one thing is certain: ME will be one the darkest stories in the history of modern medicine.

These studies piss me off for the same reason. Patients have lost decades of their lives and in many cases, never should have gotten ill at all if not for the agenda of a group of shrinks supported by vested insurance interests and enabled by a medical community turning a blind eye.

Here's a study from 1986 that has always struck me the same way. A case of 1 of a Ramsay patient but still 1986.

"Excessive Intracellular Acidosis Of Skeletal Muscle On Exercise In A Patient With A Post-Viral Exhaustion/Fatigue Syndrome"
"During exercise, muscles of the forearm demonstrated abnormally early intracellular acidosis for the exercise performed. This was out of proportion to the associated changes in high-energy phosphates. This may represent excessive lactic acid formation resulting from a disorder of metabolic regulation.
The metabolic abnormality in this patient could not have been demonstrated by traditional diagnostic techniques."​

And from the body of the paper...

"We speculate, therefore, that the defect may invole [sic] the regulation of the relative contributions of glycolytic and oxidative processes to muscle energy provision."​

 

[Snow Leopard]

Huh? Even though it says Cardiopulmonary Exercise test (CPET and on the 1st page is says I was tested on consecutive days 8/10-11, 2010?

The 2 day CPET measures maximum exertion (VO2Max) on both consecutive days.

I could only see one VO2Max figure reported (there should be a number for both days) and the letter states:

Mr ___ completed two exercise cycle ergometer tests on consecutive days, 8/10 and 8/11 to evaluate exercise tolerance and recovery from Test 1. Test 1 was a steady-state test for 14 min at a constant workload of 25 W. Test 2 was a maximum exercise test that began at 25W and increased 25W/stage to a maximum workload of 225W.

I assumed Test 1 was on the first day and Test 2 was on the second day?


There seems to be similar discussion on this thread:
http://forums.phoenixrising.me/inde...tests-results-from-2010-ithaca-college.47906/