Discussion in 'Latest ME/CFS Research' started by Dolphin, Jun 30, 2011.
* I've made each sentence its own paragraph
Basically, this found it was useful to divide the CFS patients into two groups: those who seemed to have done a "proper" (my words) exercise test and those that didn't.
When the groups were divided up in this way, those who did a proper exercise test had abnormal results while those that didn't do a proper exercise test, did not have abnormal test results.
Unfortunately a lot of the focus is on the group who didn't do a proper exercise test; there is less talk about the group with the abnormal results which is the more interesting group in my mind.
The authors make points about heterogeneity. However, I think they have simplified it too much - I think that simply dividing patients up between those who did the exercise test sufficiently and those that didn't isn't proper heterogeneity and may not be sufficient to explain the results in the literature (e.g. Lane et al., 2003 found that the presence of enterovirus in the tissue was useful).
How the CFS group was divided into two groups
(Note: when one sees Figure 2b, one can see there is a bit of variety within the two groups).
The authors spend more of the paper talking about the low PCr group depletion group than the other group; a lot of this is speculative in my mind. Also, I don't think one can extrapolate from which people may respond to an exercise test to say that one knows who will and won't stick to a GET program, where the exercise is a lot different to these lab tests.
The CFS group with an abnormal pH response
Given it's not an open access article, I can only post so much of the paper. I find the CFS group with an abnormal pH response more interesting so going to concentrate on what is discussed regarding them.
I think the talk about graded exercise therapy is speculative and may be influenced by the NICE guidelines and the culture in the NHS. They may also think the previous trials have been more successful than they really have been. In the introduction, they mention:
End (which also covers the other CFS group):
I'm presuming they're saying it's "logical" because of what happens with other groups with regard to acidosis - but the same effect wasn't found with the CFS patients (repeating a quote from above):
Light study and this study
I think the Lights should take this finding on board when they find increased acid sensors - that it's most likely because there's increased acid!
As in many of these ridiculous papers, they find actual physical pathology and then in the conclusion warp it some way to suggest GET and/or psychogenesis.
The last two sentences are very troubling to me. It says that ME should be treated with 'exercise intervention' (GET) because this is the proper treatment for acidosis. Also says that pw"CFS" who do not normally exercise should be excluded from any study because they may not comply with the GET instructions and thus artificially lower the measured effectiveness of GET in trials like PACE. Obviously, if pw-Oxford defined "CFS" who normally exercise are studied, all of the people in the study will have Idiopathic Chronic Fatigue not ME.
Nice one, Mr D. Thanks for that.
I do love a well controlled study to go with my morning coffee.
Have to admit it is not entirely clear to me what they mean here:
Sorry but the obvious bias in weighting conclusions is like a direct historical repeat of research that got skewed to show non-whites, specific minorities, women, or whatever group were "subnormal", "malingerers" or whatever crap the bigots wanted :/
They are projecting their bias, which is utterly outrageous and unscientific.
if someone's so sick they can't do much exercise, well DUH! Maybe it's 'cause they are sick, and the ones who say otherwise are the ones who are sick in the head
Hey maybe they should see if the bumps on our head have any relevance to it all! yes, let's go back to the wonderful wonderful science of Phrenology! Just as valid as Psychiatry and gets you a free head massage too boot! :innocent1:
"Der good ver nothink ME/CFS patients vould not do ze 3 mile swim through ze shark infested vaters so our tests didn't vork, proving zey are lazy undermensch vho should be shot!"
It's nothing too deep.
Basically their theory is that some people are so phobic about exercise that they won't do an exercise program; and the ones that do exercise have excess acidosis which they claim has a logical treatment, exercise.
As well as the reasons given above, I think part of their reasoning is that the patients get the acid from exercise in the anaerobic phase - if one can get people fitter so they don't hit the anaerobic phase, they won't experience the acid as much (I think that is what they are saying/hinting at) as well as (what I said previously that) they're extrapolating from other groups, where doing exercise may reduce excessive acidosis (but they haven't shown it works in CFS and indeed, their results suggests the opposite happens in CFS to other groups).
I am interested to this article because when I had my 2 days VO2 max test, I was already in acidosis BEFORE starting the test. The next morning, after the first test, my ratio CO2-O2 was still very high and I was discouraged from doing the second test.
I don't have access to the article, not that my brain could understand it all right now anyways...
But I wanted to mention that athletes use "active rest" as a way to flush out the lactic acid from their muscles. Cyclists will go ride slowly, with lower gears, for a much shorter ride.
Exercise physiologists in the like of Staci Stevens or Connie Sol (Miami) will recommend short duration- light exercice like stationary bike or walk at a heart rate lower than your own anaerobic threshold. For some, it may just mean walking to the mailbox and back, or to the washroom and back. And I do not think it is meant to be a curative regimen. Progress is likely measured in months rather than days.
My 2 cents.
Thanks for your analysis Dolphin.
Thanks for that explanation, Dolphin.
Isn't this study a tad on the small size? 18 patients would on the small size for a well-defined disease but for a heterogenous illness like CFS it's very small. By the time you've split the patients into 2 sub-groups the numbers become tiny. And just 12 controls? I'd be interested to know how well matched they were to the patients. Using the PCr levels from such a small group to establish a 'normal' threshold against which to measure patients is suspect, particularly if they were not well matched.
As I understand it, the difference stems from the one CFS group 'not trying hard enough' at the Maximal Voluntary Contraction test. As dolphin says, this is speculation. To spell things out re different exercise test, MVC is a) anaerobic and b) maximal, neither of which apply to Graded Exercise, concluding that you can use MVC to predict willingness to exercise in GET is a little wishful.
My guess is that they didn't necessarily plan to have two groups of CFS patients but noticed there was a division in the amount of acid and investigated.
But if you start off with such a hopelessly small sample you have nowhere to go if there are any problems along the way, such as the one they found.
I see the 'sedentary' controls were defined as 'less than 30mins exercise 3 times a week', which isn't really very sedentary - the recent Suarez study on nitric oxide that you posted made a much better job of selecting sedentary controls. Basically that's 12 poorly-matched controls.
Yes; if more money was raised for research by the ME/CFS community, etc. I'm sure they, like most researchers, would love to use bigger sample sizes.
Yes, not good definition of sedentary.
I don't know whether this is relevant to this thread, but it has been noted that when d-lactic acid and l-lactic acid are found in high amounts, they will cross inhibit each other's metabolism.
From this paper http://hkjpaed.org/details.asp?id=577&show=1234
D-lactic acid producing bacteria were found in higher than normal level's in the Sheedy paper, in CFS patients.
Firstly, my observation from Table 1 posted above by Dolphin is the relatively high BMI of 27/28. Is that typical of ME/CFS? (is there any literature on this?)
Secondly, what is the 'Fatigue Impact Scale' referred to?
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