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Physiological cost of walking (Rafferty, Marshall, 2009)

Discussion in 'Latest ME/CFS Research' started by WillowJ, Nov 11, 2010.

  1. WillowJ

    WillowJ คภภเє ɠรค๓թєl

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    Rafferty, Marshall "Physiological cost of walking in those those with chronic fatigue syndrome (CFS): a case-control study." Disabil Rehabil. 2009;31(19):1598-604. PMID: 19848558

    Faculty of Medicine, Nursing and Health Care, University of Glasgow, Glasgow, UK.

    Has this been discussed already? It looks really interesting. I can't find the full text anywhere.
     
  2. Dolphin

    Dolphin Senior Member

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    No, I don't have that one to read either.

    I read this one by the same team:
    which is open access: http://www.jneuroengrehab.com/content/5/1/16 which I didn't find that exciting but the one you highlighted does sound more interesting. I may have been slightly prejudiced as I was able to compete and run at a high level before the illness so I feel my gait was not particularly bad before the illness (so not sure about the idea I think they suggested that it might be modifiable). Anyway, going from memory on that but will look up if it gets discussed.
     
  3. Cort

    Cort Phoenix Rising Founder

    That's pretty impressive; a recent study by Vermoulen suggested that oxygen transport to the tissues was the cause of the impaired aerobic functioning during repeat exercise tests. Here we have reduced oxygen transport - I think that's what they are saying - simply during walking!
     
  4. Sean

    Sean Senior Member

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    Papers like the two mentioned above may not seem exciting but I wouldn't underestimate them, I suspect they are giving us some important clues.

    Apart from anything else, they are hard objective evidence, and we need all of that we can get.
     
  5. eric_s

    eric_s Senior Member

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    Yes, i think this is very interesting. Anything that's measurable is very valuable for us, to prove what we are telling people. And especially for me, as i don't walk a lot. This tells me that there seems to be some scientific evidence why walking (and probably every other form of excercise) is different for me than for a healthy person.

    Could those results be the effect of deconditoning? I know this is not our problem but this is the question i'm expecting from "doubters".

    And i like the fact that this comes out of the UK.
     
  6. shannah

    shannah Senior Member

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    Glad to see some studies in this area.

    A number of years ago, both my son and I ended up with pneumonia after walking about a mile. Then trying it again about 5 years ago, we ended up with immediate and severe ear/throat/head infections. His ear drum actually burst. Any sort of increased activity really kicks up some infection going on in us.
     
  7. WillowJ

    WillowJ คภภเє ɠรค๓թєl

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    This is my response to that (from a handout I prepared):

    No, the effects of this disease cannot be caused by deconditioning. In fact, longitudinal studies show that in CF and CFS patients, the fatigue came first and the reduction in activity came second. Again, no, this disease cannot possibly be caused by deconditioning. If these effects were caused by deconditioning, they would likely have already been noticed in some of the other better-studied disabling diseases that result in secondary deconditioning.

    Back to the study, it would be valuable if they used sedentary controls. That should ideally be always a part of the matching process and then this "caused be deconditioning" bologna would be shut up forever. Some of the researchers make a point of doing using sedentary controls (Yammes, for instance, does). I can't tell if these authors did or not.

    Often I can find full text of a study I want to read on one of the sites (MESA or someplace like that), but I couldn't find this one.
     
  8. WillowJ

    WillowJ คภภเє ɠรค๓թєl

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    I didn't find the gait one very interesting, either, particularly since they thought the gait difference could be due to self-selected slow speed of walking. Evidently they must have gotten curious why such a (usually) inefficient walking speed would be preferred. :)
     
  9. Sean

    Sean Senior Member

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    Thanks for that list, Willow. Very useful.
     
  10. WillowJ

    WillowJ คภภเє ɠรค๓թєl

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    no problem :) Edit, use, and distribute as you like.
     
  11. WillBeatCFS

    WillBeatCFS

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    Willow, thanks for the great summation and compilation of research on exercise and pacing. I'd read most of these before but putting them in one place amplifies the findings.

    Singularly, I wouldn't bother bringing these abstracts to my doctor. Together, I will because they provide a clear picture of the physiology of exercise in ME/CFS and they show the real but limited value of pacing.
     
  12. WillowJ

    WillowJ คภภเє ɠรค๓թєl

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    no problem--my pleasure. You're quite right about the amplified effect of multiple studies, especially when produced by different groups. :)
     
  13. IamME

    IamME Too sick for an identity

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    Why does it surprise you to have an abnormality on walking, given that it's a demanding thing for most sufferers?
     
  14. Cort

    Cort Phoenix Rising Founder

    I don't know since I can't walk much - it just seems amazing to me. Maybe my mind even after 30 years - still thinks of exercise as exercise - walking fast, running, swimming. It really shouldn't surprise me at all actually.
     
  15. Dolphin

    Dolphin Senior Member

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    Discussion section

    Here's the discussion section - as one can see, deconditioning is mentioned a few times as a possible explanation so this study doesn't seem to prove much:

     
  16. richvank

    richvank Senior Member

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    Hi, all.

    It amazes me that researchers continue to take seriously the notion that the physical problems in ME/CFS are the result of deconditioning. To me, in view of the evidence we have, the explanation is very clear. It is well-known that by far the biggest user of oxygen in the body is normally the mitochondria. It is also clear, especially from the work of Booth, Myhill and McLaren-Howard, as well as supporting data in the literature, that the mitochondria are dysfunctional in ME/CFS, and that the degree of mito dysfunction correlates well with the degree of physical disability. (In my view, this dysfunction is due mainly to glutathione depletion in the skeletal muscle cells and certain other types of cells, including the neutrophils in which McLaren-Howard has done his measurements).

    Dysfunctioning mitochondria present a lower demand for oxygen (unless they are decoupled, in which case they produce a lot of heat, but this is not observed in ME/CFS, in which the peripheral body temperature is usually lower than normal, rather than higher). The dyfunctional mitochondria also produce ATP at a lower rate. ATP is needed to power muscle contraction. If it is being produced at a lower rate, the person is not going to be able to walk as fast for a sustained period of time. This accounts for the lower preferrred walking speed.

    The inefficiency in oxygen utilization is explained by the fact that because the mitochondria are dysfunctional in the skeletal muscles in ME/CFS, the person has to rely more on anaerobic metabolism to produce their muscle ATP. This produces lactic acid, which must be sent to the liver for reconversion to glucose, via the Cori cycle. The liver, which does not have dysfunctional mitochondria, because it has a complete transsulfuration pathway and can thus convert methionine to cysteine to maintain its glutathione level, has to use oxygen to do this. This cycle is a much less efficient way to produce ATP than the normal oxidation of glucose by the mitochondria.

    I think that this is very consistent with Dr. Paul Cheney's observation that the arterial oxygen percent saturation as monitored by a pulse oximeter does not drop in people with ME/CFS as fast as it does in normal, healthy people when they exhale and then hold their breath for 30 seconds. The mitochondria in people with ME/CFS are simply not demanding as much oxygen as in normal, healthy people, because they are dysfunctional, so the level in the blood stays higher when no additional oxygen is being put into the blood by breathing.

    Best regards,

    Rich
     
    Helen likes this.
  17. mellster

    mellster Marco

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    Hi Rich,

    Having been making good strides of aerobic exercise with methylation (I fit the slightly lower body temp profile) and other protocols I have been wondering why my muscle strength does not seem to decrease even during times of (very) limited exercise. In fact, sometimes I feel stronger (e.g. doing push-ups or presses) than before even though I am only very gradualy increasing the length/intensity of aerobic exercise (if at all). Could the forced takeover of anaerobic fibers account for the presence of relative good muscle strength while aerobic tolerance is lacking and occasional post-exertion muscle-twitch (or even PEM) be due to increased effort of said anaerobic fibers? This is a very interesting topic..
     

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