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Post-exertional Symptomology In Chronic Fatigue Syndrome

snowathlete

Senior Member
Messages
5,374
Location
UK
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.
 

Lotus97

Senior Member
Messages
2,041
Location
United States
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.
 

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
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.

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

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


Results
Written questionnaires revealed that within 24 hours of the test, 85% of controls indicated full recovery, in contrast to 0 CFS patients. The remaining 15% of controls recovered within 48 hours of the test. In contrast, only 1 CFS patient recovered within 48 hours. Symptoms reported after the exercise test included fatigue, light-headedness, muscular/joint pain, cognitive dysfunction, headache, nausea, physical weakness, trembling/instability, insomnia, and sore throat/glands.
http://www.ncbi.nlm.nih.gov/pubmed/20095909
 

Allyson

Senior Member
Messages
1,684
Location
Australia, Melbourne
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.


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.


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
 
Messages
13,774

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
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 :)
 
Messages
15,786
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.
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.
 

Bob

Senior Member
Messages
16,455
Location
England (south coast)
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).
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
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.

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?
 

Ember

Senior Member
Messages
2,115
All participants underwent a graded maximal cardiopulmonary exercise test (CPX).
A 2 consecutive day exercise stress test is needed to test for PENE:
PENE: A 2 consecutive day comprehensive 8-12 minute cardiopulmonary exercise stress test (measuring heart, lung, and metabolic function) - only ME patients have significantly worse scores the second day & abnormal recovery from exertion. * Exercise tolerance test with expired gas exchange - (2 consecutive days) – measure cardiovascular, pulmonary & metabolic responses at rest & during exercise: peak oxygen consumption VO2 or VO2 at anaerobic threshold (AT) - decline of 8% or greater on test 2 indicates metabolic dysfunction, post-exercise blood analysis - increase in sensory, adrenergic and immune genes - increase in metabolite receptors unique to ME