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Time for the Big Talk. How's the CAA doing?

Messages
74
The tremendous advantage of the SolveCFS BioBank is that it is completely scalable. As our resources permit, we will be able to expand the number of patients and controls included in the BioBank. I would like to see every willing CFS patient be able to contribute blood and clinical information to the BioBank. The only thing preventing us from doing that today is money.

I know this might be kind of a stupid question but is the CAA going to have the patient samples categorized so that researchers have an idea of what kind of patient submitted them?

For example, categorize the Fukuda and the Canadian Samples in two different groups? And more specially categorize samples based on things like illness duration at the time of sample, what the patient reported to be their most severe symptom (Post Exertional Malaise vs. Cognitive Difficulty), degree of impairment and so on (Maybe the patients can rate their symptoms in terms of severity such as 1.) Cognitive 2.) Sleep 3.) Post Exertional Malaise to give an example).

I would imagine something like this is already set up but if you could give us more details that would be great.

Thanks!
 

jspotila

Senior Member
Messages
1,099
I know this might be kind of a stupid question but is the CAA going to have the patient samples categorized so that researchers have an idea of what kind of patient submitted them?

For example, categorize the Fukuda and the Canadian Samples in two different groups? And more specially categorize samples based on things like illness duration at the time of sample, what the patient reported to be their most severe symptom (Post Exertional Malaise vs. Cognitive Difficulty), degree of impairment and so on (Maybe the patients can rate their symptoms in terms of severity such as 1.) Cognitive 2.) Sleep 3.) Post Exertional Malaise to give an example).

I would imagine something like this is already set up but if you could give us more details that would be great.

Thanks!

Yes!!! This capability is built into the BioBank. Patients will complete lengthy questionnaires about illness history, severity, duration, medications and much much more. In fact, our questionnaires are FAR more extensive than any questionnaires Genetic Alliance has done before. Dr. Jason is assisting us in refining these questionnaires to ensure we ask questions that will collect specific, accurate answers. Researchers who apply to the BioBank will be able to restrict samples to certain cohort characteristics. This will become more powerful as our resources permit the inclusion of more samples.
 

Cort

Phoenix Rising Founder
Dr Yes, I agree with you completely.

I am especially against all these things which advocate exercise without strong warinings because I have not walked more than a few steps since I over did walking in 1990. We are not arguing from a philosophical viewpoint, we are living with the consequences. I do not want anyone else to endure my life. I put a brave face on it, I look on the bright side, I am grateful I am not worse, but I never pushed my grandson's pram, never took him to the park, have never doen so much.

I CANNOT sit here and let a PATIENT organisation recommend the very thing that did this to me.

Mithriel

??? Are you saying that Dr. Bateman or Dr. Lapp or the CAA recommends that you push yourself into a crash by exercising? My understanding is that all of these doctors and the CFIDS Association recommend that patients start very very slowly and keep within their limits at all times. Can you show me where they recommend that you stick to a rigid schedule of exercise? Where you are advised to ignore your symptoms?
 

Cort

Phoenix Rising Founder
I don't know a lot about Mike Dessin's story, but are you suggesting that at his sickest, he should have been trying to stretch? Was there really any way for Mike to be doing any more than he was at the time without making himself worse?

When Mike Dessin was at his worst he was hardly able to do anything. But he was able to walk stooped over from the car to the doctor's office ( earplugs in and eyeglasses on). After he had his lungs collapse this he was down to about 100 pounds - he was basically almost dead - and I imagine that he really couldn't do much of anything. I would think that many of the more debilitated patients can do hand and arm stretching and things like that.

Are you suggesting not recommending stretching for everybody because of the unfortunate few who can't move at all? physicians, in general, recommend aerobic exercise for heart patients. I'm sure there are some for whom that is not appropriate but for most it is.
 

jackie

Senior Member
Messages
591
I don't think this is about knowingly or unknowingly PUSHING yourself into a crash. "Overdoing it walking" might have been slowly walking around one's house, from room to room, just a bit too much! A few steps might be all it takes for many of us...hard to believe, I know! (and, for many of us "exercising" translates to attempting to simply WALK.)
 

Cort

Phoenix Rising Founder
There is no indication that people can just do more after finding their "baseline" (which in effect varies). This is the view of the CBT/GET school. Just because it sounds like a nice theory, doesn't mean it works - doctors shouldn't be given the impression that it will work.

(Apologies for having this down twice for a while)

Tom are you really putting Staci Stevens in the CBT box? I'm not talking about study evidence - altho stated that one study did show improvement - I'm talking about her experience with her patients. I would note that what you say also contradicts what Bruce Campbell at the CFIDS Self Help Website - with his years of administering that program - asserts - that if you do this correctly some patients can increase their functionality over time. Not everybody but some.
 
R

Robin

Guest
??? Are you saying that Dr. Bateman or Dr. Lapp or the CAA recommends that you push yourself into a crash by exercising? My understanding is that all of these doctors and the CFIDS Association recommend that patients start very very slowly and keep within their limits at all times. Can you show me where they recommend that you stick to a rigid schedule of exercise? Where you are advised to ignore your symptoms?

http://www.cfids.org/sparkcfs/exercise.pdf

Levine: Exercise is often a dirty word to the
CFS patient. But if I phrase it in a way that sets
limits on what I expect, they are usually comfortable.
For instance, I define regular exercise
for CFS patients, initially, as three to five minutes
daily of mild aerobic activity, such as walking
on a flat treadmill or walking around the block.
There are also ways to make exercise less
threatening for the patient. Taking a small pet
on a walk or going out with a spouse for a short
stroll can be beneficial and enjoyable.
The key is a regular program, no matter
how short a duration, at about the same time
every day.

Once
again, I think the emphasis should be on short,
regular, aerobic activity interspersed with yoga,
stretching or light weights.
In fact, if the latter
activities are being done, the patient doesnt
need to perform cardio exercise on those days
but should have at least four weekly sessions
of a minimum of three to five minutes of cardio
as a goal.

I would also like to note that not once in that booklet is it mentioned that patients can have unexpected, severe and possibly permanent loss of function from exertion. The danger is downplayed. Even severely afflicted patients are expected to condition, and they are the most at risk. That's my problem with the CAA material.

Exercise can be a tricky topic in the care of
patients with CFS. On the one hand, exercise
can lessen pain, improve sleep and increase
energy levels. Deconditioning due to lack of
activity only serves to undermine an already
challenged body. On the other hand, one of the
classifying symptoms of CFS is postexertional
malaise, with significant exacerbation of symptoms
following heightened activity. At times,
these increased symptom levels can last for
days following exertion
.

In truth, it can be for weeks, months, or even permanent. (see Kim's thread!)

Patients tend to quickly learn what they can tolerate. If patients want to exercise and manage do so safely, that's great. However, if patients and doctors are to be told than an exercise program is safe, an emphasis should be made on the risks. It's not worth it to lose functioning over "gentle walking" and "yoga".
 

Cort

Phoenix Rising Founder
I have silently watched as some of our sickest members have provided testimonials about the firsthand harm that CBT/GET has caused only to be countered by Cort's responses. His lack of acceptance of the inherent dangers of exercise and lack of compassion to our members who have spoken out has left me dumbfounded.

It breaks my heart to read the enormous efforts put forth by these members in an effort to convince Cort that their experience contradicts what is endorsed by the CAA and by some of the doctors who treat people with ME/CFS.

Not long ago, on the Medic thread, I posted this

And Cort replied
But his recent posts about deconditioning on this thread tell me that no, Cort didn't ''get it".

Cort, can you explain to our sickest members why you insist on negating their experience? Do you believe that these members are perpetuating "rackets"? As someone who has had extensive training (8 yrs) in est/ Landmark Forum, you would know the language and what I mean, but for those less familiar with the program, here is a summary that I found to describe that term adequately: If you believe our members to be perpetuating "rackets", it would be kind of you to say so and not to waste their very precious energy and resources engaging in a debate that they can never win.

I'm pretty dumbfounded as well Kim. I'm afraid I'd have to place myself in the racket category since I have had this disease for over 30 yearsIt was after - that was after - as you noted 8 years embedded in an environment that made something like CBT look like a walk in the park. Yet I still had this disorder and it do to this day. So, I reject your notion that I believe that the members of this form are engaged a racket. I also reject your attempt to turn me into something that I am not -

I would ask you why I would devote the last eight years to trying to explicate the physiology and and treatments for chronic fatigue syndrome on my website if I believed this is all a frigging racket. Why I would put out a newsletter after newsletter and blog after blog examining a racket like CFS. I ask you to consider that a website devoted to the explication that CFS is a racket would look like and then see if mine is anything like that.

I'm amazed at often how my comments are taken out of context and used to justify interpretations that I don't intend. How often my modifiers such as 'some' are completely ignored.

Your overstating of my comments is absolutely appalling to me. To suggest that I do not understand the inherent dangers of exercise honestly makes my blood boil. I would refer you to this paper I wrote outlining how researchers have finally begun to understand what dangers exercise play in CFS.

http://www.aboutmecfs.org/News/PRJan09Pacific.aspx

Staci Stevens, the founding Executive Director of the Pacific Fatigue Lab explained. “Many researchers look at ME/CFS patients when they’re at rest- at baseline. But as any ME/CFS patient knows, the real problems occur when their systems are under stress due to too much activity. We’re taking a close look the physiology of CFS patients as they undertake the most stressful activity of all – exercise.”

One side, lead by the producers of the Canadian Consensus Definition of ME/CFS, believes that post-exertional malaise (PEM) is a hallmark symptom that reflects unique physiological processes. They believe that allowing people without this problem to participate in chronic fatigue syndrome (ME/CFS) studies may have greatly hampered efforts to understand this disease.

The other side, exemplified in the Center for Disease Control’s (CDC) empirical definition of 2005, believes that post-exertional malaise (PEM) is one of many symptoms present in the disease. They argue that the most important feature of the disease is unexplained degrees of ‘unwellness’ that interfere significantly with people’s work, personal, social, etc. activities. They believe some different process is at work.

The Pacific Fatigue Lab’s results suggest that the Canadian Consensus group is correct; during either the first or second exercise test a large subset of patients demonstrates significant physiological abnormalities in their ability to produce energy. Another subset of patients does not. The Lab’s findings suggest that these two groups should be separated in research studies.

This is the same person, Staci Stevens, who work you are slamming. She developed 'exercise programs' that rely on patients staying within their anerobic safety zones. As I have noted repeated - but which you have chosen in your rush to have me fit a certain label - Dr. Stevens states that most patients are doing too much exercise/activity.
 
G

Gerwyn

Guest
When Mike Dessin was at his worst he was hardly able to do anything. But he was able to walk stooped over from the car to the doctor's office ( earplugs in and eyeglasses on). After he had his lungs collapse this he was down to about 100 pounds - he was basically almost dead - and I imagine that he really couldn't do much of anything. I would think that many of the more debilitated patients can do hand and arm stretching and things like that.

Are you suggesting not recommending stretching for everybody because of the unfortunate few who can't move at all? physicians, in general, recommend aerobic exercise for heart patients. I'm sure there are some for whom that is not appropriate but for most it is.

In anyone with a mitochondrial disorder the amount odf eaerobic excercise they can tolerate is limited by the degree of mitochondrial damage.Push them beyond that limit will further damage the mitochondria possibly irreparably.About 25% of ME sufferers are either housebound or bedbound

The following is from the 25% ME group and may give a small insight of the suffering of people severely affected by ME..

It has personal resonance for me as I have been there



People with severe ME will need help with personal care. When you are helping them, remember that all their muscles are very painful to touch. Please be very gentle. Try to work quickly and quietly, so they don't get tired... and be sure to keep them warm.

Depression in M.E. is usually a result of expending too much energy and is different from other types of depression, in that the person is most helped by rest and not by being encouraged to undertake more activity. This is because the depression is a result of doing too much. If the person does even more, the depression will increase.

Please remember that people with severe M.E. have difficulty propelling a manual chair due to weak arm muscles. If a manual chair is used, they would need to be pushed in it.

Imagine how you would feel if ...

... you got a bad virus: were so weak you could hardly walk; felt as if you had lead strapped all over your body; felt ill, in pain and sick all the time; and didn't even have the strength to get off the bed to go to the toilet... You'd expect to be better in a week or two, wouldn't you? So did I, but I was still the same years later.

... you wake up every morning feeling as if you'd been run over by a bus and had a general anaesthetic the day before.

... every muscle and joint in your body aches - your arms, your fingers, your legs, your neck. You have frequent headaches. You feel heavy as though extra gravity is pulling you down all the time. You feel dizzy if you stand or sit upright for any time, and there are no magic pills to make you feel better.

... you are cold and shivery a lot of the time - even with central heating and hot water bottles

... you constantly feel sick and dizzy and it gets much worse when you try to read, listen to music or radio, watch TV or have a conversation.

... any movement - even moving your arm - causes extra pain, saps you and makes you feel sick

... you're thirsty all the time, but reaching for a cup is impossible, or causes malaise or severe pain.

... you need to go to the toilet a lot, but you're often so weak you can't even turn over in bed

... you wake up in the night drenched with sweat, and shivering, but are too weak to have the bedclothes or your nightwear changed.

... you require help from other people just to cover your basic needs, but you get exhausted from the interaction this requires - sometimes you're so weak that they can't hear your voice. Even if you write things down for them, they still have questions.

... even with help from other people, having a bath or shower totally exhausts you, and sometimes you are suffering so much pain or weakness, that you can't even be washed in bed.

... your brain can't process information going in - so noise, movement and other stimulants make you feel sick, dizzy, and stressed. Even on good days - TV, music, people talking/moving can be like torture.

... you sometimes can't remember things like your name, your family and don't recognise people.

... you have to read things over and over, because you can't remember the beginning by the time you get to the end.

... it's a major achievement to make a short shopping list

... if someone asks you if you want blackcurrant or orange juice, you would get confused, because you can't remember both the options

... you can never find anything, because you forget what you're looking for as soon as you move your body to look for it. Even if you don't forget, just scrabbling about the bed for a pen can make you so exhausted that you have to lie flat for 20 mins

... Light can cause a dreadful migraine-type headache, nausea and acute pain in your eyes;

... Everyday sounds, like voices, can thunder through your head causing thumping pain;

... you constantly try to explain to people what your limitations are, so that they'll be a bit more sensitive to your needs, and they just think you're moaning...

... you have abnormal reactions to foods, dust, chemicals etc. which cause severe malaise and nausea.

... minor infections and viruses render you so ill that you require 24-hour care for months

... you have to struggle with feelings of frustration, despair and anger caused by healthy, active people saying things like "lucky you - not having to work" or "everyone gets tired - that's normal!"

... If you push yourself at all you develop worse problems e.g. blistered eyes and joints, acute pain, vomiting, migraine, muscle spasms, neuralgia, convulsions, faints, anaphylactic shock episodes, etc. At times your whole body seems to stop working... menstrual cycle, digestive processes, etc.

... People who know nothing about the condition keep telling you to try harder

... you spend each day yearning for all the things you've lost - independence, working life, hobbies, relationships, interaction with others. You'd love to be able to do more or go out, but it exhausts you so much that it can take days or months to recover. You can be stuck at home for months or years. ... Children can have ME too, and miss going to school, seeing their friends and playing.

Those are only some of the problems which face people with severe ME every day of their lives.


I know because I have been there every movement was agony and i could not lift my arma let alone stretch.

As for aerobic excercise and heart conditions if you push someone with stable or unstable angina,ventriculat tachcardia and so on to engage in aerobic excercise you could kill them
 

Cort

Phoenix Rising Founder
I don't think this is about knowingly or unknowingly PUSHING yourself into a crash. "Overdoing it walking" might have been slowly walking around one's house, from room to room, just a bit too much! A few steps might be all it takes for many of us...hard to believe, I know! (and, for many of us "exercising" translates to attempting to simply WALK.)

Then I suggest that you look at these programs more carefully. My understanding is that the CFIDS recommendations and Dr. Batemans recommendations and Bruce Campbell's recommendations and others recommendations ALL make sure that whatever type of activity you do that it does not exacerbate your symptoms. The gist of the CFIDS CME course is to get people out of the push/crash cycle - ie overactivity/underactivity cycle. I have here and elsewhere stated that 'exercise' in CFS should be called 'activity' and that's what the CFIDS Association Course recommends. I should know. I have been unable to do more than walking without exacerbating my symptoms for more than 30 years.

Here's from the CME Course:

Pacing, an energy management technique, can be especially beneficial for CFS patients[74,69] and should be considered for most CFS patients. Pacing involves moderating activity to minimize the push-crash cycle and reduce the stress and frustration that occur with relapse.[75]

Encourage patients to be aware of their own personal threshold of relapse, even when it seems like a moving target, [I]and learn to avoid triggering relapse symptoms by keeping activity within a safe limit.[/I] Patients who learn to adapt to a changing threshold of activity and pace activity accordingly will be more successful at managing the illness and increasing function.

Advise patients to consider all the movement and activity they engage in, including personal grooming, grocery shopping, household chores, tasks performed during full- or part-time employment, anaerobic exercise, and aerobic exercise, when developing an energy management program.

Instruct patients to pace activity, performing specific activities, such as household tasks, in small, manageable chunks with rest breaks, rather than in a single energy-depleting effort. Activity should be spread evenly throughout the day, and it should not exacerbate fatigue or other symptoms. Once patients are stabilized, activity is incrementally increased.[76]

Instruct patients to view their available energy as if it were a bank account. If they overexert themselves, it is like being overdrawn at the bank, and they have to pay it back by resting more the next day. As time passes, patients learn how much energy they can expend without experiencing the characteristic postexertional malaise.[77]

The energy bank idea - the idea that one can by reducing one's activities create a bank of energy that one can build up and then, yes, for some increase a bit over time. (I know and I know exactly exactly how some people (Kim?) are going to interpret that statement - they are going to say that all Cort says is that you can get well by resting. I didn't say that. I said that, irrespective of the experiences of some people, that patient accounts have shown that if you do this correctly, some people can improve. it's a mild statement I believe.
 

Cort

Phoenix Rising Founder
I would note that the Medscape CME course states this:

Severely Ill Patients

A subset of people with CFS are so severely ill that they are largely housebound or bedbound. They require special attention, including a modified approach to exercise. Hand stretches and picking up and grasping objects may be all that can be managed at first. Gradually increasing activity to the point that patients can handle essential activities of daily living -- getting up, personal hygiene, and dressing -- is the next step.
 

Cort

Phoenix Rising Founder
Levine: Exercise is often a dirty word to the
CFS patient. But if I phrase it in a way that sets
limits on what I expect, they are usually comfortable.
For instance, I define regular exercise
for CFS patients, initially, as three to five minutes
daily of mild aerobic activity, such as walking
on a flat treadmill or walking around the block.
There are also ways to make exercise less
threatening for the patient. Taking a small pet
on a walk or going out with a spouse for a short
stroll can be beneficial and enjoyable.
The key is a regular program, no matter
how short a duration, at about the same time
every day.

We're back to Sparks and I would note that I don't believe that the CME states that the key is a regular program. Maybe I'm just way out of the loop here and atypical of most people on the Forum but they are talking about 3-5 minutes a day of walking or yoga. Nobody is saying walk a mile or start jogging or start pumping weights. Dr. Levine - who, if this is who I think it is, has been one of our most stalwart advocates over the years - and is heavily interested in the viral component. This is 3-5 minutes a day of mild aerobic activity.

Is that recommendation so bad? Maybe its the fact that there's a recommendation at all.
 

Cort

Phoenix Rising Founder
Thanks for your contribution.

I'm not 100% sure what you are saying but you may be saying that you have heard an exercise strategy that seems plausible but you are not doing it at this moment.

This is the core issue that many agreed to: that balancing activities and energy expenditure in people's lives should be what everyone should try to do. If people are in a position where they want to, they could be given very CFS-specific exercise strategies they could do within this. But people should be free not to use up their energy on exercise if they don't want to. That doesn't mean they should necessarily do nothing - people should do up to what they feel capable of. But "doing up to what one feels capable of" should include any activity rather than specifically exercise.

I think we're getting too caught up in the 'exercise' word. As the CME states all activity should be regarded as 'exercise

Advise patients to consider all the movement and activity they engage in, including personal grooming, grocery shopping, household chores, tasks performed during full- or part-time employment, anaerobic exercise, and aerobic exercise, when developing an energy management program.

Its all part of the bag. For many patients daily activities preclude doing any further exercise. I would say for me that they preclude 'exercise' (a five to 10 minute walk) on about half my days.
 
G

Gerwyn

Guest
I would note that the Medscape CME course states this:

For patients with severe ME there is no step let alone a next step.whoever wrote that has no knowledge of the severe from of the illness.Gradually increasing activity for these people is a sick joke
 
Messages
74
The energy bank idea - the idea that one can by reducing one's activities create a bank of energy that one can build up and then, yes, for some increase a bit over time. (I know and I know exactly exactly how some people (Kim?) are going to interpret that statement - they are going to say that all Cort says is that you can get well by resting. I didn't say that. I said that, irrespective of the experiences of some people, that patient accounts have shown that if you do this correctly, some people can improve. it's a mild statement I believe.

I haven't read all of this thread (it's pretty long!) but based what I have read when mentioning CBT and GET it should be at least stated for some people there are very mild benefits (as likely), for other persons there are no benefits and for other people they are harmed.

What bothers me most of all though is using the words "CBT" and "GET" which automatically allows all of our enemies in the Psychiatric Lobby to point to the CAA and say something equivalent of "See even the largest patient advocacy group supports it!"

If CAA used words like:
"encourage patients to be active within their "Energy Envelope" whether this is for them short exercise (personal comment: don't know too many of us who can handle "short aerobic exercise) or light stretching for a few minutes. Many patients will not be able to benefit from this particular aspect of supportive therapy. The CAA does not recommend CBT & or GET as defined by Wessely et. al as their cohort of patients is unrepresentative of the disorder "ME/CFS" "'​

... I would feel much better about it.

Why use the names "CBT" and "GET"?... it's like setting ourselves up to lose...
 
G

Gerwyn

Guest
We did another little study with bicycle exercise. Twenty patients had CFS, mostly in the 20- to 45-year-old range. Then we matched 20 de-conditioned female controls – other females who just didn’t do any exercise, but weren’t chronically ill. We did cardiopul*monary and neurocognitive testing before, during, and after their exercise. The treadmill test showed what we thought. The CFS patients had lower results than controls, but the de-conditioned controls showed well below normal values, with an average peak O2 of 29.8. If you look at the normal values for age 36 to 45, anything under the 30 is considered pretty de-conditioned. We found a good de-conditioned group, that is, a good control group.
Does Dr Bateman make home visits.Patients with severe ME and bicycles.They would be lucky to recognise a bicycle!
 
G

Gerwyn

Guest
Tom are you really putting Staci Stevens in the CBT box? I'm not talking about study evidence - altho stated that one study did show improvement - I'm talking about her experience with her patients. I would note that what you say also contradicts what Bruce Campbell at the CFIDS Self Help Website - with his years of administering that program - asserts - that if you do this correctly some patients can increase their functionality over time. Not everybody but some.

Dr Cambell is welcome to his opinion but opinion is not scientific evidence.The weight of scientific evidence states that there is no objective improvement in functionality.
 

Cort

Phoenix Rising Founder
Strength and Conditioning

http://cme.medscape.com/viewarticle/581527_8

Kim, will no doubt, think that I am discounting everyone's experience but the truth is that I think I could benefit from this. I've had CFS for about thirty - a relatively mild case - but still unable to do any 'real exercise'. All I've done is walk. But I have shoulder, neck and head pain and knee pain. My muscles are all flaccid. I imagine that if I did this right - strengthening exercises with small weights - in very short time periods - it could help with that. Every time I've tried to do weights or anything like situps - I've had an immediate bad reaction but I've never tried to do it at such a slow pace. I imagine that if I got small hand weights and used them very slowly I would feel better. I think this is pretty darn mild stuff. Nobody says its going to make you well.

Swimming I don't about it :)

Strength and Conditioning

  • A strengthening and conditioning program can reduce pain, prevent muscle spasms, increase strength and flexibility, improve balance, reduce falls, and enhance stamina and function in CFS patients.[78] Low-level exercise, including stretching, strength training, and simple resistance training, appears to
be reasonably well tolerated by most patients, as long as they learn to avoid overexertion.

(note the qualifier - reasonably well tolerated (not completely tolerate) by most patients (most not all - that's their experience) - so long as they avoid overdoing it. A very important qualifier).

  • Encourage patients to start with simple stretching and strengthening exercise, using only body weight for resistance. Gradually add wall push-ups, modified chair dips, and toe raises to the routine. Increase repetitions gradually. Patients can begin with a set of 2-4 repetitions and build to a maximum of 8.
  • Add resistance exercise as strength improves. Exercise bands or light weights are both good options for simple resistance training that increases muscle mass and metabolic rate without overtaxing CFS patients.
  • Add a focus on strengthening core abdominal muscles to relieve back pain and improve overall circulation.
  • Advise patients who do not tolerate an upright position to use other positions rather than standing. Stretching and strengthening exercises can be performed on a floor mat or in water.
  • Be aware that for patients who are severely deconditioned, it may be advisable to begin with a physical conditioning program, which is primarily anaerobic exercise, before introducing aerobic activities.
  • Encourage patients who can tolerate greater levels of exercise to engage in movement therapies like yoga, tai chi, and qigong and light aerobic activity like short walks and swimming.
  • Educate patients about the role that even modest strength-building exercise can play in increasing muscle mass and setting metabolic rate. Since many CFS patients have a very low metabolic rate, and metabolic syndrome is a common comorbid condition, building muscle mass is important
.
 

Cort

Phoenix Rising Founder
Dr Cambell is welcome to his opinion but opinion is not scientific evidence.The weight of scientific evidence states that there is no objective improvement in functionality.

Again - please note that I said SOME PATIENTS. Dr. Jason's study on Pacing certainly found improvements in quality of life and symptoms. I'm not sure about functioning. I would point out that nobody is saying 'wellness' or getting well - they are saying 'some improvements'.