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Broadbent & Coutts: Graded vs Intermittent Exercise Effects on Lymphocytes in CFS

Discussion in 'Latest ME/CFS Research' started by mango, Apr 29, 2016.

  1. mango

    mango Senior Member

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    Graded vs Intermittent Exercise Effects on Lymphocytes in Chronic Fatigue Syndrome.

    Broadbent, Suzanne; Coutts, Rosanne
    School of Health and Human Sciences, Southern Cross University, Lismore NSW, Australia

    Abstract
    Purpose
    : There is increasing evidence of immune system dysfunction in Chronic Fatigue Syndrome (CFS) but little is known of the regular exercise effects on immune cell parameters. This pilot study investigated the effects of graded and intermittent exercise on CD4+ lymphocyte subset counts and activation compared to usual care.

    Methods: 24 CFS patients (50.2 +/- 10 yr) were randomised to Graded exercise (GE), Intermittent exercise (IE) or usual care (UC) groups; 18 sedentary non-CFS participants (50.6 +/- 10 yr) were controls (CTL) for blood and immunological comparisons. Outcome measures were pre- and post-intervention flow cytometric analyses of circulating lymphocyte subset cell counts, expression of CD3+, CD4+, CD25+ and CD134+, full blood counts and V[Combining Dot Above]O2peak

    Results: Pre-intervention, CD3+ cell counts and expression of CD4+, CD25+, CD134+ and CD4+CD25+CD134+ were significantly lower in GE, IE and UC compared to CTL (f < 0.05). Total lymphocyte concentration was significantly lower in GE and IE groups compared to CTL. There were significant post-intervention increases in (i) expression of CD4+ and CD4+CD25+CD134+ for GE and IE, but CD25+ and CD134+ for IE only; (ii) circulating counts of CD3+ and CD4+ for GE, and CD3+, CD4+, CD8+, CD3+CD4+CD8+, CD3-CD16+CD56+, CD19+ and CD45+ for IE; (iii) neutrophil concentration for GE; (iv) V[Combining Dot Above]O2peak and elapsed test time for IE and GE, V[Combining Dot Above]Epeak for IE.

    Conclusions: Twelve weeks of GE and IE training significantly improved CD4+ lymphocyte activation and aerobic capacity without exacerbating CFS symptoms. IE may be a more effective exercise modality with regard to enhanced CD4+ activation in CFS patients.

    (C) 2016 American College of Sports Medicine

    http://journals.lww.com/acsm-msse/A...s_Intermittent_Exercise_Effects_on.97534.aspx
     
  2. Snowdrop

    Snowdrop Rebel without a biscuit

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    This abstract is a Published ahead of Print abstract. So no details--there's nothing to indicate how participants were chosen.
    And this is not S Broadbent's first rodeo. She has done other CFS research http://www.biomedcentral.com/2052-1847/5/16
     
  3. alex3619

    alex3619 Senior Member

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    I want to know about cohort selection. These results are not consistent with other work we have seen on exercise and aerobic capacity. However this might be due to a very different definition and application of GE, we cannot be sure at this point. We also need to know how exacerbation effects on CFS were determined.
     
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  4. Effi

    Effi Senior Member

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    That looks like it's the protocol they used for this study.
     
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  5. alex3619

    alex3619 Senior Member

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    Issues:
    1. Fukuda - risk of heterogeneity in cohort.
    2. No 2 day CPET.
    3. How many patients in the study got worse? They claim it was without exacerbation, but can someone who has seen the full paper please comment on what they measured and actually wrote.
     
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  6. user9876

    user9876 Senior Member

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    I think there is a big issue around what would be natural variability in these measures. I think they have a sample of 8 patients in each group and if there were a degree of variability then this would simply be noise and it would be hard to detect a signal. This result could simply be random. It may depend on the size of the changes but they are not given in the abstract.

    There are also issues as to how they measured compliance to an exercise program. I would have expected some sort of scale as exercised increased if their hypothesis is correct.

    They also do a lot of different tests so it is not clear that they deal with this.

    There controls seem poor - as I understand it and its not clear in the abstract - they use sedentary controls initially but not as part of an exercise program. Hence it is unclear as to whether this would be an expected increase due to activity or something interesting about the way the immune system of people with ME reacts to exercise.
     
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  7. Hutan

    Hutan Senior Member

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    Yes, @user9876, really good points.

    To illustrate the variability in the small samples, the abstract tells us that prior to the treatments:
    So, prior to the treatments, the CFS patients randomly allocated to the 'activity as usual' group had total lymphocyte concentrations that weren't significantly lower than the control group, whereas the CFS patients randomly allocated to the exercise groups did.
     
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  8. Snow Leopard

    Snow Leopard Hibernating

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    I totally missed that on the first reading - no difference in lymphocyte concentration between the healthy controls and the "usual care" group before the intervention. I've never seen any reason why there would be a meaningful difference in total lymphocyte concentration though...

    Also, comparing post-intervention increases is a bit weird, shouldn't they be comparing the difference between the "usual care" group as the control and the intervention groups?
     
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  9. user9876

    user9876 Senior Member

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    I think it is very hard to tell what they are doing from the abstract but yes I think they should be comparing all the groups.
     
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  10. lnester7

    lnester7 Seven

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    We need to organize a BIG study w Dr Nell (the 2 day cpet guy forgot his name) and put all exercise theories to rest. I would donate to that one.
     
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  11. Dolphin

    Dolphin Senior Member

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    Minor point:
    There are other interpretations for some of the findings apart from deconditioning. But I suppose it is not unreasonable to mention it has one possible reason for some findings.
     
  12. Dolphin

    Dolphin Senior Member

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  13. Dolphin

    Dolphin Senior Member

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    This contrasts with the more traditional graded exercise therapy programs which are partly about breaking the link between symptoms and activity levels. With such programmes you are expected to maintain the level of exercise/activity if symptoms increase for 1 week or more.
     
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  14. Dolphin

    Dolphin Senior Member

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  15. Dolphin

    Dolphin Senior Member

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    The rates of compliance were high. However it is unclear to me whether the figure of 89% includes the people who withdrew.
     
  16. Dolphin

    Dolphin Senior Member

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  17. Dolphin

    Dolphin Senior Member

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    These findings were not mentioned in the abstract.

     
    Last edited: Feb 12, 2017
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  18. Dolphin

    Dolphin Senior Member

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    I have minimal knowledge of the immune system. One thing I noticed is that some of the immune measurements post the exercise programmes are a lot higher than those in the healthy controls. Increases are portrayed as a good thing but I wonder whether in any of these cases the now apparently high increases could be problematic?
     
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  19. Dolphin

    Dolphin Senior Member

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  20. Dolphin

    Dolphin Senior Member

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