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Post-exertional Symptomology In Chronic Fatigue Syndrome

Discussion in 'Latest ME/CFS Research' started by snowathlete, May 26, 2013.

  1. snowathlete

    snowathlete

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    Post-exertional Symptomology In Chronic Fatigue Syndrome

    This is not a new study. It's from 2007, but I can't find it talked about anywhere on here. Thought it was probably worthy of a discussion...particularly as there seems to be a growing focus by some ME/CFS researchers to do exercise studies in the disease.

    Stiles, Travis L.; Snell, Christopher R.; Stevens, Staci R.; Moran,
    Megan; VanNess, J. Mark (CFS Medicine & Science in Sports & Exercise: Volume
    39(5) Supplement, May 2007, p S445

    Symptom exacerbation following physical stress has been documented in illnesses such
    as multiple sclerosis (MS), lupus and rheumatoid arthritis (RA). Similar
    phenomenology has been reported in CFS but is not well understood.

    PURPOSE:
    The purpose of this study was to explore symptom exacerbation following an exercise
    challenge in CFS patients relative to a sedentary control population.

    METHODS:
    Forty female subjects (n=40), 20 CFS and 20 matched sedentary controls served as
    subjects.
    All participants underwent a graded maximal cardiopulmonary exercise test (CPX).
    Two questionnaires, Short Form-36 (SF-36) and a series of open-ended questions, were
    completed 7 days after the exercise challenge to assess post-exertional differences
    between groups.
    The open-ended questions pertained to symptoms experienced following the test and time
    taken to recover from any testing effects.
    SF-36 data were analyzed using a multivariate analysis.
    Written questionnaire responses were evaluated by determining recovery time in days as
    well as number and type of symptoms experienced.

    RESULTS:
    SF-36 analysis found statistical significance across all 8 health domains measured
    between groups (p <.01), but no effects were found for the exercise test.
    Analysis of the open-ended questionnaires revealed that within 24 hours of the exercise
    challenge, 85% of controls indicated full recovery in contrast to 0% of CFS patients.
    The remaining 15% of controls recovered within 48 hours of the test as opposed to only
    one CFS patient.

    Clear differences in number and type of reported symptoms were also found between
    groups.

    CONCLUSIONS:
    The results of this study indicate that CFS patients suffer symptom exacerbation
    following physical stress. As with MS, lupus and RA, post-exertional symptom
    exacerbation appears to be both a real and incapacitating feature of the syndrome.
    The delayed recovery response evoked by a single bout of exercise stress is distinctly
    different from that of sedentary controls.
    Firestormm and Allyson like this.
  2. Lotus97

    Lotus97 Senior Member

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    By symptom exacerbation are they talking about more than just fatigue? As in whichever symptoms you normally have will be worse from PEM? Because that's what I notice with myself. For example I've had periods of fatigue, but my body's response to fatigue is often more energy or wiredness.
    Allyson likes this.
  3. Simon

    Simon

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    Slightly more recent, and bigger study from the same group:

    Postexertional Malaise in Women with Chronic Fatigue Syndrome (VanNess 2010)


    SOC, Firestormm, snowathlete and 4 others like this.
  4. Allyson

    Allyson *****

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    Yes thanks for posting Snowathlete

    I was just wondering about this too
    and the differenes and overlap between "fatigue" and "crashes" - the various things we cluster under that term - and PEM.
    Not much around in the way of concrete definitions and studies.

    Here is my rudimentary attempt to start analysing from a patient's perspective - but i did not really cover PEM in it - though there is some symptom overlap PEM seems to be a distinct thing again

    http://forums.phoenixrising.me/inde...that-is-the-question.23219/page-2#post-355490

    Thanks again

    Ally
    snowathlete likes this.
  5. Esther12

    Esther12 Senior Member

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    Glad I wasn't doing that study! Now that I do avoid pushing myself so much, it's very rare for activity to leave me feeling worse for more than 48 hours. The exercise test must have pushed them quite hard.

    Thanks for drawing attention to these papers.
    Firestormm and snowathlete like this.
  6. Firestormm

    Firestormm Senior Member

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    Whilst I don't personally place much faith in the science behind questionnaires, as they are used predominantly in those studies that do not generally appeal to our community; it's rather reassuring to read these results.

    Shame PACE didn't extend this far... Also a shame that these studies (above) didn't lead to the authors trying to better quantify what might possible be behind these kind of reactions.

    I wonder if in MS, Lupus and Rheumatoid Arthritis for example - they have arrived at any conclusions in this respect. I'd be interested to read if they had. Or is it always put down to 'common sense' i.e. if you 'push-it' you will suffer as a result?

    Thanks for the insight :)
  7. Valentijn

    Valentijn Activity Level: 3

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    A major difference is that PACE was using therapies designed to alter how symptoms are perceived and interpreted. A "good" patient who is trying hard to do what they have been told, will be ignoring those symptoms. And a patient who wants to please her therapist will tell that therapist what they both know the therapist wants to hear.

    I want objective measurements in every study, but I think it's especially important when the study is measuring the effectiveness of a therapy which primarily consists of cognitive adjustment.
    Little Bluestem, Bob and A.B. like this.
  8. Bob

    Bob

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    Here's another paper (2010) that looks at post-exertional symptoms (the 'symptom complex'), including pain and PEM...

    Pain inhibition and postexertional malaise in myalgic encephalomyelitis⁄chronic fatigue syndrome: An experimental study.
    Van Oosterwijck J, Nijs J, Meeus M, Lefever I, Huybrechts L, Lambrecht L, Paul L.
    2010
    J Intern Med. 2010 Sep;268(3):265-78.
    doi: 10.1111/j.1365-2796.2010.02228.x.
    http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2010.02228.x/pdf

    Extract from the abstract:

    Results.
    In patients with ME⁄CFS, pain thresholds decreased following both types of exercise, whereas they increased in healthy subjects. This was accompanied by a worsening of the ME⁄CFS symptom complex post-exercise. Decreased pressure thresholds during submaximal exercise were associated with postexertional fatigue in the ME⁄CFS group (r = 0.454; P = 0.034).
    Simon likes this.
  9. MeSci

    MeSci ME/CFS since 1995; activity level 6

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    I don't usually feel worse until 2-3 days later. I often feel fine the next day. One day I may have time to analyse my detailed health diary and hazard guesses as to exactly what might be happening biologically at each stage between exertion, PEM and recovery. Maybe this is what is being done in some current US research?
  10. Ember

    Ember Senior Member

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    A 2 consecutive day exercise stress test is needed to test for PENE:
    Little Bluestem and Mij like this.
  11. Mij

    Mij Senior Member

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    I wonder what would be the difference in test results for those of us who get PENE without pain.
    Little Bluestem likes this.

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