Heart rate variability biofeedback therapy and GET in management of CFS: A pilot study

[hixxy]

Heart rate variability biofeedback therapy and graded exercise training in management of chronic fatigue syndrome: An exploratory pilot study.
Windthorst P, Mazurak N, Kuske M, Hipp A, Giel KE, Enck P, Nieß A, Zipfel S, Teufel M.

Abstract

OBJECTIVE:
Chronic fatigue syndrome (CFS) is characterised by persistent fatigue, exhaustion, and several physical complaints. Research has shown cognitive behavioural therapy (CBT) and graded exercise training (GET) to be the most effective treatments. In a first step we aimed to assess the efficacy of heart rate variability biofeedback therapy (HRV-BF) as a treatment method comprising cognitive and behavioural strategies and GET in the pilot trial. In a second step we aimed to compare both interventions with regard to specific parameters.

METHODS:
The study was conducted in an outpatient treatment setting. A total of 28 women with CFS (50.3±9.3years) were randomly assigned to receive either eight sessions of HRV-BF or GET. The primary outcome was fatigue severity. Secondary outcomes were mental and physical quality of life and depression. Data were collected before and after the intervention as well as at a 5-month follow-up.

RESULTS:
General fatigue improved significantly after both HRV-BF and GET. Specific cognitive components of fatigue, mental quality of life, and depression improved significantly after HRV-BF only. Physical quality of life improved significantly after GET. There were significant differences between groups regarding mental quality of life and depression favouring HRV-BF.

CONCLUSION:
Both interventions reduce fatigue. HRV-BF seems to have additional effects on components of mental health, including depression, whereas GET seems to emphasise components of physical health. These data offer implications for further research on combining HRV-BF and GET in patients with CFS.

TRIAL REGISTRATION:
The described trial has been registered at the International Clinical Trials Registry Platform following the number DRKS00005445.

Copyright © 2016 Elsevier Inc. All rights reserved.

KEYWORDS:
Chronic fatigue syndrome; Depression; Graded exercise training; Heart rate variability biofeedback; Quality of life

PMID: 28107894
DOI: 10.1016/j.jpsychores.2016.11.014

https://www.ncbi.nlm.nih.gov/pubmed/28107894
http://www.jpsychores.com/article/S0022-3999(16)30546-3/abstract

 

[Denise]

Trial listing
So fatigue is required for 6 or more months and as for other Fukuda symptoms no duration is specified.
And the listing says:

"Health Condition(s) or Problem(s) studied

depression, quality of life

F48.0 - Neurasthenia"


As for the article (abstract):
The publication history is interesting in that it was originally submitted in Dec 2015, but not published until Dec 2016 (revisions received submitted Nov 2016).
I wonder what revisions were made and why...

 

[eljefe19]

Garbage

 

[ash0787]

https://thequantifiedbody.net/heart-rate-variability-biofeedback-richard-gevirtz/

at a glance it seems like pseudoscience rather than a established physiotherapy technique,
at best comparable to something like acupuncture

 

[AndyPR]

Sci Hub link to full paper http://sci-hub.cc/10.1016/j.jpsychores.2016.11.014

 

[Denise]

Sci Hub link to full paper http://sci-hub.cc/10.1016/j.jpsychores.2016.11.014

(pardon my attitude) Do we really want to see it?

 

[AndyPR]

(pardon my attitude) Do we really want to see it?

Lack of information hinders advocacy efforts, should we need to argue against any study on us we need to know how that study was done and with what criteria. I don't recommend looking but there are those who will probably be interested, I just dumped the link here as I don't, currently, have the energy to try to pick it apart myself.

 

[Murph]

The sample sizes are tiny. 15 for GET, 13 for HRVBF.

Then they lose some:

"In the GET group, four patients dropped out and terminated therapy prematurely (receiving four or fewer sessions). Two quit after one training session, and two others quit after four sessions; data from these participants were not included in the analysis. All four noted a lack of benefit as the major reason for quitting."

This is terrible practice. They note that these people got no benefit (probably went backward) and still exclude them from anaylsis! And still the GET results show nothing with a p value under .01.

Heartrate variability biofeedback (HRVBF) technique does show quite positive results though. It is just a breathing technique, but it actually seems interesting. I've not heard of it before, but I'm unable to dismiss it out of hand. Perhaps it could be the cause of any improvements?

I found a paper that talks about HRVBF here that mentions some systems I consider relevant to me/cfs and so I'm interested to hear more about it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104929/

If my understanding based on a quick read is right:

1. heart rates vary, based on a number of systems that all have different patterns of oscillations.
2. studies have shown that by changing the rate of your breathing you can make those oscillations line up, increasing their amplitude.
3. Higher amplitude means your body can adjust your heart rate better.

This quote is especially interesting.
"We have found that HRV biofeedback restores autonomic function that is suppressed when people are exposed experimentally to inflammatory cytokines (Lehrer et al., 2010). All frequencies are suppressed by these cytokines, much as happens when we catch the flu or are subjected to another inflammatory condition."

If the theory is right it could help explain the upsides of meditation and other breathing techniques. The warning sign for this research is it mostly seems to come from one motivated researcher. Certainly has whiffs of pseudoscience to it, but you never know. At least it looks like a low-cost, low-risk intervention!

-
I'm particularly interested in anything to do with blood pressure and heart beat because my own experience suggests that in me, the trigger for PEM is probably vasodilatory experiences like alcohol, stress, heat and exercise. I suspect PEM follows the endothelium losing control (or perceiving it has lost control) of blood vessel tone and signalling for a more complete body shutdown (mediated by other systems) to help regain homeostasis. So I suspect that if my body could control blood vessel tone properly I might suffer less PEM.

 

[hixxy]

Lack of information hinders advocacy efforts, should we need to argue against any study on us we need to know how that study was done and with what criteria. I don't recommend looking but there are those who will probably be interested, I just dumped the link here as I don't, currently, have the energy to try to pick it apart myself.

I wish I could post more clinically useful research more often, but this is the kind of crap that keeps arriving in my email.

 

[AndyPR]

I did have a brief skim through this and found this on page 23

Bearing in mind that there where no, that I could see, objective results measured, this graph shows that those who took part in the GET portion of the study say that their physical QOL improved but that their mental QOL took a nose dive. Also, the SF36 scores are a standardised rating system I believe? If that is the case, then these people are way below an average population functioning level (which is I believe 95+) and any improvement is from crap to just slightly less crap functioning. As far as I saw, the only discussion, unsurprisingly, is about the positive results, not the negative ones.

 

[Denise]

Lack of information hinders advocacy efforts, should we need to argue against any study on us we need to know how that study was done and with what criteria. I don't recommend looking but there are those who will probably be interested, I just dumped the link here as I don't, currently, have the energy to try to pick it apart myself.

I understand what you are saying @AndyPR. Like @hixxy, I get frustrated at the stuff that is passed off as research having something to do with ME. So prefacing my question with acknowledgement of my attitude, was my way of letting off some steam.
I don't have the time or energy to pick the whole thing apart either but did do small things like look up and made a couple of comments on the trial registry.

 

[M Paine]

This study is indeed garbage, but there's certainly some therapeutic value to breathing exercises, or any sort of relaxation. A bit of meditation, a massage, whatever.

It just boggles my mind that researchers are so incompetent to design such a moronic trial.

we hypothesize that HRV-BF might help to normalise individual physiological reactions, to reflect specific dysfunctional beliefs about fatigue and activity

How about you pull your head out of your ass to help normalise your dysfunctional beliefs about how to treat biological diseases

 

[Sean]

Just an endless game of whack-a-mole with these idiots, isn't it.

 

[Snow Leopard]

Pilot studies are not intended to test efficacy but feasibility (hence this study had not control group). But why did they not bother using objective measures of improvement (actigraphy)? As that will be a necessary part of any larger trial testing the efficacy of this 'HRVBT'.

 

[M Paine]

What bothers me, is that HRV is objectively measurable. So far as I can tell, they didn't employ any HRV measurements.

Imagine a paper that take patients using Canadian Consensus Criteria, gives them all wearable HRV trackers, and gave them training on stress reduction through breathing and relaxation techniques. There are probably statistically significant, objective endpoints which I would suspect they might even achieve.