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Recovery of upper limb muscle function in chronic fatigue syndrome with and without fibromyalgia

Dolphin

Senior Member
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17,567
Recovery of upper limb muscle function in chronic fatigue syndrome with and without fibromyalgia.

Eur J Clin Invest. 2013 Nov 11. doi: 10.1111/eci.12201. [Epub ahead of print]

Ickmans K1, Meeus M, De Kooning M, Lambrecht L, Nijs J.

Author information

Abstract

BACKGROUND:

Chronic fatigue syndrome (CFS) patients frequently complain of muscle fatigue and abnormally slow recovery, especially of the upper limb muscles during and after activities of daily living.

Furthermore, disease heterogeneity has not yet been studied in relation to recovery of muscle function in CFS.

Here, we examine recovery of upper limb muscle function from a fatiguing exercise in CFS patients with (CFS+FM) and without (CFS-only) comorbid fibromyalgia and compare their results with a matched inactive control group.

DESIGN:

In this case-control study, 18 CFS-only patients, 30 CFS+FM patients and 30 healthy inactive controls performed a fatiguing upper limb exercise test with subsequent recovery measures.

RESULTS:

There was no significant difference among the three groups for maximal handgrip strength of the non-dominant hand.

A significant worse recovery of upper limb muscle function was found in the CFS+FM, but not in de CFS-only group compared with the controls (P < 0·05).

CONCLUSIONS:

This study reveals, for the first time, delayed recovery of upper limb muscle function in CFS+FM, but not in CFS-only patients.

The results underline that CFS is a heterogeneous disorder suggesting that reducing the heterogeneity of the disorder in future research is important to make progress towards a better understanding and uncovering of mechanisms regarding the nature of divers impairments in these patients.

KEYWORDS:

Chronic fatigue syndrome, handgrip strength, maximal voluntary contraction, muscle fatigue, muscle recovery

PMID: 24313704 [PubMed - as supplied by publisher]
 

Dolphin

Senior Member
Messages
17,567
The main data can be seen in Figure 1:
IckmansRecoveryofupperlimbmusclefunctioninCFS_zps0d66f1ec.png


It is a pity that they didn't look at recovery at 24 hours. This was previously found to be abnormal at 24 hours in:
Paul L, Wood L, Behan WM, Maclaren WM. Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome. Eur J Neurol 1999;6:63–9.
 

lauluce

as long as you manage to stay alive, there's hope
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PMID: 24313704 [PubMed - as supplied by publisher]
This describes exactly what happens to me, my legs function quite well, but using my arms get me exhausted, my heartbeat raises and I start to pant, all this specially if I use them while raising them over my head. Those effort test in a bike will never work on me, my legs mostly ignore the fact that I have MECFS.
 

SOC

Senior Member
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7,849
This describes exactly what happens to me, my legs function quite well, but using my arms get me exhausted, my heartbeat raises and I start to pant, all this specially if I use them while raising them over my head. Those effort test in a bike will never work on me, my legs mostly ignore the fact that I have MECFS.
I have heard that's a sign of cardiac issues. Have you been checked for heart problems or dysautonomia?
 

lauluce

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I have heard that's a sign of cardiac issues. Have you been checked for heart problems or dysautonomia?
I also tough that many symptoms I´ve got are due to orthostatic intolerance, POTS, etc... three weeks ago I had a cold. One week later, the cold as gone, but the following two weeks, my fatigue, difficulty to stand, fast heart rate due to minimal activities (135 bpm), dizziness, etc, all those symptoms worsened extremely. I was sure that a simple holter test would have been able to detect abnormalities in my cardiac system, but today, two weeks after they worsened, those symptoms became mild again (except fatigue), so my appointment for a holter is now useless. Its a matter of luck, cardiac studies never detected anything because I had them done when I was feeling mostly fine regarding symptoms like this.
 

SOC

Senior Member
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7,849
I also tough that many symptoms I´ve got are due to orthostatic intolerance, POTS, etc... three weeks ago I had a cold. One week later, the cold as gone, but the following two weeks, my fatigue, difficulty to stand, fast heart rate due to minimal activities (135 bpm), dizziness, etc, all those symptoms worsened extremely. I was sure that a simple holter test would have been able to detect abnormalities in my cardiac system, but today, two weeks after they worsened, those symptoms became mild again (except fatigue), so my appointment for a holter is now useless. Its a matter of luck, cardiac studies never detected anything because I had them done when I was feeling mostly fine regarding symptoms like this.
The doctor has to do the right test to find the abnormality. Some cardiac tests are going to show normal or nearly normal results. The holter test will detect some abnormalities, but not the one you are having apparently. It is not uncommon to have a "normal" holter test with ME/CFS. The most common result for us on the holter test is T-wave flattening, I think. Most cardiologists don't consider that anything to be concerned about and don't report it. As I understand it (and I could be wrong), the T-wave flattening is a difference we have from healthy people, but it's not known to be problem functionally.

What you probably need is to be evaluated for dysautonomia. That's a different sets of tests than the ones they give if they're looking for other heart issues. My guess would be that you, like many people with ME/CFS, have low blood volume. That's not something a cardiologist looks for routinely.
 

lauluce

as long as you manage to stay alive, there's hope
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your response is so useful, thank you SOC. Do you know any resource where I can learn to interpret that holter and look for that T-wave flattening? I'm sure that the doctor who wrote the report on my holter didn't looked for that! what an amazin perspective...
Low blood volume I read about that abnormality in ME/CFS, believe that I can feel it... I feel how my blood flows with much effort from my heart to my upper body. Do you think it's possible that I feel it?
 

Dolphin

Senior Member
Messages
17,567
I forgot to say they used the 2010 Fibromyalgia criteria:

The comorbid diagnosis of FM was identified using a questionnaire to determine whether they fulfilled the American College of Rheumatology (ACR) 2010 criteria for fibromyalgia [17].

17 Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 2010;62:600–10. Free full text: http://onlinelibrary.wiley.com/doi/10.1002/acr.20140/full
These criteria don't require the tender point assessment and are broader. A higher percentage of CFS patients would satisfy these FMS criteria than the Wolfe et al. (1990) criteria that require 11 of 18 tender points, etc.
 
Last edited:

lauluce

as long as you manage to stay alive, there's hope
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I forgot to say they used the 2010 Fibromyalgia criteria:


These criteria don't require the tender point assessment and are broader. A higher percentage of CFS patients would satisfy these FMS criteria than the Wolfe et al. (1990) criteria that require 11 of 18 tender points, etc.
oh I's good to know that, that means that I may fit their criteria as well, I don't have the famous tender points, or so I think. You know, my legs are so much stronger than my arms... I'm able to ride a bike, but washing the dishes or washing my hear is exhausting, anybody here that experiences the same?
 

Dolphin

Senior Member
Messages
17,567
For what it's worth, by the same/similar team:

http://www.sciencedirect.com/science/article/pii/S0303846714001553

Recovery of peripheral muscle function from fatiguing exercise and daily physical activity level in patients with multiple sclerosis: A case-control study

Clinical Neurology and Neurosurgery

Available online 2 May 2014

Kelly Ickmansa, b,
Fauve Simoensa,
Jo Nijsa, b, (corresponding author)
Daphne Kosc, f,
Patrick Crasd,
Barbara Willekensd,
Mira Meeuse, f

a Pain in Motion Research Group, Departments of Human Physiology and Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
b Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
c Pain in Motion Research Group, Division of Occupational Therapy, Artesis University College Antwerp, KU Leuven, Belgium
d Department of Neurology, Faculty of Medicine, Universiteit Antwerpen, Belgium
e Rehabilitation Sciences and Physiotherapy, Faculty of Medicine, Universiteit Antwerpen, Belgium
f Rehabilitation Sciences and Physiotherapy, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium

Received 30 August 2013, Revised 20 March 2014, Accepted 23 April 2014, Available online 2 May 2014

http://dx.doi.org/10.1016/j.clineuro.2014.04.021
________________________________

Abstract

Objectives

Delayed recovery of muscle function following exercise has been demonstrated in the lower limbs of patients with multiple sclerosis (MS). However, studies examining this in the upper limbs are currently lacking. This study compared physical activity level (PAL) and recovery of upper limb muscle function following exercise between MS patients and healthy inactive controls. Furthermore, the relationship between PAL and muscle recovery was examined.

Methods

PAL of 19 MS patients and 32 controls was measured using an accelerometer for 7 consecutive days. Afterwards, recovery of muscle function was assessed by performing a fatiguing upper limb exercise test with subsequent recovery measures.

Results

Muscle recovery of the upper limb muscles was similar in both groups. Average activity counts were significantly lower in MS patients than in the control group. MS patients spent significantly more time being sedentary and less time on activities of moderate intensity compared with the control group. No significant correlation between PAL and recovery of muscle function was found in MS patients.

Conclusions

Recovery of upper limb muscle function following exercise is normal in MS patients. MS patients are less physically active than healthy inactive controls. PAL and recovery of upper limb muscle function appear unrelated in MS patients.

Keywords

Multiple sclerosis;
Muscle recovery;
Physical activity;
Rehabilitation;
Physiotherapy;
Muscle physiology

Copyright © 2014 Published by Elsevier B.V.