VO2Max - exercise test

[pemone]

[USER=2825]@Sea[/USER], heartrate is not the bottleneck for the test, therefore you cannot deduce ANY conclusions about heartrate. In his test - forget the Workwell Foundation groups - his body converts to glycolysis way before a maximum heartrate can be achieved.

If Workwell Foundation wants to advance a new hypothesis that CFS patients have bad hearts because they have abnormal VO2Max tests, then they can finance the research and publish the results. Saying it does not make is so. I think that research will fail. Very very few CFS patients ever get diagnosed with weak hearts, other than what is normal for age and overall health conditions.

I do realize some researchers have found interesting abnormalities in an echocardiogram. Again, that doesn't explain his VO2Max result. Said differently, it doesn't matter that his heart can beat 170 or 180 beats per minute because his cellular metabolism cannot use the extra oxygen delivered by those extra heartbeats.

 

[ryan31337]

Thanks for your input guys.

For what its worth I reached ~80% of predicted max HR, the remaining 5% to get to the accepted minimum is likely explained by the beta-blockers. After reading more it appears a treadmill test instead of the bike would likely see another 10%-15% added, so would probably also explain why I subjectively felt I had more left in me.

For those that want more info on CPET I found this resource to be very thorough: http://circ.ahajournals.org/content/122/2/191.full

From that guide I found this graphic a particularly helpful summary for determining outcome:

I had early VT, high CO2/VO2, low VO2/HR. Before beta blockers I was also having abnormal HR and blood pressure. So metabolic myopathy and autonomic dysfunction leading to O2 extraction or utilisation impairment. Sounds about right for us!

 

[ryan31337]

It's a long story but I had another CPET today...yes I enjoy pain

I wanted to see what happened without beta blockers, so tapered them off and had the test 48hrs after the last dose (hopefully that's long enough). Results were better, but not by much:

AT:
VO2 = 14ml/kg/min
HR = 109bpm
RER = 1.05

VO2 Max:
VO2 = 25ml/kg/min
HR = 179bpm
RER = 1.28

As before something was fishy with my respiration values, lots of confused looks and multiple checks to make sure the mask wasn't leaking (it wasn't). Will need to see what the doc has to say about that.

I had a lot more energy this time around, workloads at VT/VO2max were way up and I didn't feel the intense burn until further in. I'm guessing the increased HR gave me more room to play, however the downside was that my aerobic metabolism is still pants and I really felt the extra workload after, more dizzy/tingly with greater muscle fatigue.

Looks like I'm stuck between a rock and a hard place at the moment. On the beta blockers I have reduced exercise capacity (breathless just walking) and more sleepiness. Off the beta blockers I have migraine, episodic severe hypertension, chest pain & worsened POTS with syncope. Hummm,what a choice

 

[MeSci]

I had a lot more energy this time around, workloads at VT/VO2max were way up and I didn't feel the intense burn until further in. I'm guessing the increased HR gave me more room to play, however the downside was that my aerobic metabolism is still pants and I really felt the extra workload after, more dizzy/tingly with greater muscle fatigue.

Looks like I'm stuck between a rock and a hard place at the moment. On the beta blockers I have reduced exercise capacity (breathless just walking) and more sleepiness. Off the beta blockers I have migraine, episodic severe hypertension, chest pain & worsened POTS with syncope. Hummm,what a choice

Sorry if this seems stupid, but I am at reduced capacity at the moment.

Have you tried things to prevent the migraine (e.g. feverfew) and other antihypertensives? (I'm struggling with the latter...and not taking anything at the moment.)

 

[Sushi]

Looks like I'm stuck between a rock and a hard place at the moment. On the beta blockers I have reduced exercise capacity (breathless just walking) and more sleepiness. Off the beta blockers I have migraine, episodic severe hypertension, chest pain & worsened POTS with syncope. Hummm,what a choice

Has your doctor tried you on more than one beta blocker? We can respond very differently to different ones. You could propose experimenting with this to you doc to optimize results.

 

[ryan31337]

Sorry if this seems stupid, but I am at reduced capacity at the moment. Have you tried things to prevent the migraine (e.g. feverfew) and other antihypertensives?

Not stupid at all, thanks for the suggestion. I'm getting my reply in now before it really hits me tomorrow and I'm in a similar state! Back in adolescence I took Pizotifen at a very high dosage for my age, it did get the very severe & frequent migraine + cyclic vomiting under control. Downside being sleepiness & weight gain, much like the beta blockers. A neurologist did recently suggest I try CoQ10, B2 & magnesium for migraine prevention, will probably give those a go as they're low risk.

Has your doctor tried you on more than one beta blocker?

Thanks, that's a good call. The Bisoprolol I have been taking was prescribed by another cardiologist much less knowledgeable, he just wanted to call it vasodepressor syncope and throw something at it without further investigation...

Still waiting for a follow-up from the good POTS doc, I'm interested in asking about Labetalol or Clonidine as both of these seem indicated for hyperadrenergic POTS.

 

[Sushi]

The Bisoprolol I have been taking was prescribed by another cardiologist much less knowledgeable, he just wanted to call it vasodepressor syncope and throw something at it without further investigation...
Still waiting for a follow-up from the good POTS doc, I'm interested in asking about Labetalol or Clonidine as both of these seem indicated for hyperadrenergic POTS.

I had a hard time with Bisoprolol but tolerate another one well. I also made the mistake of trying Clonodine when I had NMH rather than hyperadrenergic POTS--that was a very bad experiment!

 

[Sea]

I wanted to see what happened without beta blockers, so tapered them off and had the test 48hrs after the last dose (hopefully that's long enough). Results were better, but not by much:

That's an interesting comparison, thank you for donating your energy to science and sharing it with us.
It sounds like being on a beta blocker is keeping you from PEM.

Do you have your raw data so that you can see other values like your CO2 as well? Then you could work out ratios like VE/VCO2.

 

[MeSci]

Not stupid at all, thanks for the suggestion. I'm getting my reply in now before it really hits me tomorrow and I'm in a similar state! Back in adolescence I took Pizotifen at a very high dosage for my age, it did get the very severe & frequent migraine + cyclic vomiting under control. Downside being sleepiness & weight gain, much like the beta blockers. A neurologist did recently suggest I try CoQ10, B2 & magnesium for migraine prevention, will probably give those a go as they're low risk.


Thanks, that's a good call. The Bisoprolol I have been taking was prescribed by another cardiologist much less knowledgeable, he just wanted to call it vasodepressor syncope and throw something at it without further investigation...

Still waiting for a follow-up from the good POTS doc, I'm interested in asking about Labetalol or Clonidine as both of these seem indicated for hyperadrenergic POTS.

I took Bisoprolol recently for just 6 days but didn't seem able to tolerate it. I had previously taken Nebivolol for 2 years, with quite good results except that recently I developed unpleasant symptoms, hence (unsuccessful) attempts to try other things.

I appear to have developed symptoms typical of hyperthyroidism (which I understand is more common in women).

 

[SueJohnPat]

Had this done twice. My at was 106 . Not too bad but.....I wonder if they waited an extra day say 36 and 96 hours. My pem seems to " build slowly"Anyone else like this?

. Does not hit until 4 days after exertion. I would become " wobbly" physically but I would have complete emotional meltdowns like a toddler. I " fixed" the emotional part by detoxing using Sodium bicarbonate. Now I am taking NO2 black . And have not had to detox at all. Maybe a subset of us. Has predominant lactic acidosis? Just
putting it out there . I did the fit bit , routine , did not help, but I was not that strict.

Also has a tendency to high blood pressure no pots at all and never get headaches even if bp is 180/90.

 

[pemone]

Looks like I'm stuck between a rock and a hard place at the moment. On the beta blockers I have reduced exercise capacity (breathless just walking) and more sleepiness. Off the beta blockers I have migraine, episodic severe hypertension, chest pain & worsened POTS with syncope. Hummm,what a choice

I have heard people say that beta blockers tend to rob energy and may affect creatine kinase levels. Do you know what is the mechanism for all of that? Can they do permanent damage like statins can?

Have you researched what the Marshall Protocol is doing with chronic fatigue? They are using a beta blocker named olmesartan to treat CFS, and they have reported really interesting results:

Overview of the main ideas in the Marshall Protocol:

The Marshall Protocol uses olmesartan off-label at higher than normal doses, more frequently, than what is used to control blood pressure. They are using a side effect of the drug that enables the vitamin d receptor. This is a key pathway in restoring innate immunity inside the cell, and their hypothesis is that CFS (and other diseases) may be caused by parasitic bacteria inside the cells that have disabled the VDR, disabling innate immunity.

The Marshall Protocol is very controversial, but some of his core ideas look very powerful to me.

 

[pemone]

Had this done twice. My at was 106 . Not too bad but.....I wonder if they waited an extra day say 36 and 96 hours. My pem seems to " build slowly"Anyone else like this?

The number they care about from a CFS point of view is the VO2, not the heartrate. What this test is trying to measure is how much oxygen can your body use. And is the bottleneck to getting that extra oxygen something in your physiology (e.g., bad lungs, bad heart, bad oxygen exchange in lungs) or metabolic (e.g., mitochondria do not work well).

 

[ryan31337]

Sorry for the delay in replying, had nothing left this week after the 2nd test.

I also made the mistake of trying Clonodine when I had NMH rather than hyperadrenergic POTS--that was a very bad experiment!

Thanks for the warning, haven't spoken to the doctor yet but I suspect I have both after the positive tilt table test.

Do you have your raw data so that you can see other values like your CO2 as well?

I have a couple of photos of graphs from the first test, along with a table of key values @AT and @VO2max. I'm just going on what i've read online but it seems VE/VCO2 slope was within upper limits of normal range & VO2/HR was low. If you'd like I'm happy to PM them? I didn't take any photos of the second test, I was pretty braindead and unsteady on my feet. The data I did get was a bit limited as I was trying hard to restart my brain to ask questions & take notes whilst lying down!

My pem seems to " build slowly"Anyone else like this?

Yes, I've been closely observing after the controlled and acute exercise challenges. On the day of exercise I tend to get wired in the evening and have to force myself to rest. The first day after tends to be all day headache, brainfog, blurred vision and lethargy. HR and BP aren't too abnormal. The second day the cognitive symptoms are reduced, perhaps courtesy of the increased HR & BP that I notice. I feel like I can function but then hit the wall pretty quick if I do try to do anything and experience significant OI, adrenaline rush, shortness of breath, chest pain, muscle weakness etc. Provided I don't keep provoking that response, it gradually wanes over the next few days, HR & BP return to previous levels and I'm more stable & able to function. Alongside all that I get postprandial GI issues, disrupted sleep, stuffy nose, post nasal drip, hot/cold & mouth sores. I know from many previous attempts at ignoring my symptoms that if I push on it will progress into insomnia, swollen glands, migraine, laundry list of other symptoms etc. etc.

I have a bottle of NO2 black but haven't wanted to try it until all these tests were done. Once I get stable on a beta blocker again I will give it a go. I have little doubt that circulatory issues have contributed massively to my illness. On one side of my family we pretty much all have hypercoagulation/thrombosis/raynauds/autoimmunity issues. It's on my list to read up more on the theory that a variant of Antiphospholipid antibody syndrome is to blame.

I had previously taken Nebivolol for 2 years, with quite good results except that recently I developed unpleasant symptoms

Would you mind sharing what the symptoms were? I'm concerned the bisoprolol is pushing me over the threshold for central sleep apnea.

Can they do permanent damage like statins can? Have you researched what the Marshall Protocol is doing with chronic fatigue?

I've not come across either of those. I'll definitely look into it when I have a bit more in the tank. Thanks

 

[MeSci]

I said "I took Bisoprolol recently for just 6 days but didn't seem able to tolerate it. I had previously taken Nebivolol for 2 years, with quite good results except that recently I developed unpleasant symptoms"

Would you mind sharing what the symptoms were? I'm concerned the bisoprolol is pushing me over the threshold for central sleep apnea.

I've gone back onto Nebivolol in desperation, as my bp was so high and it was the only thing I had to combat that that doesn't necessarily give me bad symptoms...it doesn't reduce my systolic pressure that well, but will have to do for now.
Bisoprolol may not have been the cause, as I was also taking potassium gluconate for a few days (which doesn't seem to suit me so I've stopped - my potassium tends to come back quite high, although the tests could be misleading).

Without the ability to read my diaries properly, at least at present, I have written that I was twitching really badly, can't tolerate Bisoprolol, and had to stop it. I haven't had central sleep apnea, at least recently.

Sorry not to be more coherent. I suspect that men and women may have different symptoms to the same drugs.

 

[notmyself]

I know this is an old thread ..but i see many of you know a lot about this...i make a Cpet test ..after wich i was diagnosticated with mild Cfs...i don t really understand why..

My vo2 max was 31.7 ( should have been around 40 for my age)
MY lactate threshold/anaerobic threshold was at 164 Heart rate on a vo2 of 26 ..wich is perfectly normal from what i know

THe vo2 max is actually the vo2 from where even if you continue exercising your vo2 don t increase..i didint reach that point..i was in continious increasing.if i was pushing 1 or 2 level..my vo2 max was reaching higher levels..i stop the test at 174 heart rate..my max heart rate is 195..i am really struggling to understand why i was diagnosticate after these results...with a lactate threshold so high

 

[Snow Leopard]

THe vo2 max is actually the vo2 from where even if you continue exercising your vo2 don t increase..i didint reach that point..i was in continious increasing.if i was pushing 1 or 2 level..my vo2 max was reaching higher levels..i stop the test at 174 heart rate..my max heart rate is 195..i am really struggling to understand why i was diagnosticate after these results...with a lactate threshold so high

The fact is that a maximum exercise test is exactly what it sounds like and it is really hard to reach VO2 max if you have ME and are not used to exercising at all!

A rule of thumb (accurate for a first test, not for the second test on a 2 day CPET) is (MAXHR/RestHR)*15.3, so you'd have a VO2Max of something like 12% higher if you reached your max HR.

That lactate threshold does seem high, but it is not a low lactate threshold, nor build up of lactate in the muscles that causes this illness. A single VO2Max test is not really relevant for diagnosis of ME or CFS.

 

[notmyself]

The fact is that a maximum exercise test is exactly what it sounds like and it is really hard to reach VO2 max if you have ME and are not used to exercising at all!

A rule of thumb (accurate for a first test, not for the second test on a 2 day CPET) is (MAXHR/RestHR)*15.3, so you'd have a VO2Max of something like 12% higher if you reached your max HR.

Yes it definatelly not the cause of the illness..but it's seems to be an universal symptom..that's why people get pem..they reach the anaerobic threshold from very little exortion ,..i have lots of Me symptoms ..but never pem..and is definatelly because of my high anaerobic threshold..wich trully make me look for other diagnostic

 

[*GG*]

Digging up an old thread to add my results:

AT:
VO2 = 12.7ml/kg/min
HR = 98bpm
RER = 1.09

VO2 Max:
VO2 = 19.6ml/kg/min
HR = 147bpm
RER = 1.52(!)

Good luck arguing that I didn't try hard enough with an RER of 1.52

This is pretty shocking to me. Right now at the time of the test I am way better than I was a few months ago at the peak of a crash, across a wide spectrum of symptoms/capabilities. I can't imagine what the results would've been if I had taken it back then. Though I could probably guess... some sort of cardiac event!

Looks like testing for just 1 day, correct? I have started a thread on my results, but will share them here as well.

GG

 

[notmyself]

Looks like testing for just 1 day, correct? I have started a thread on my results, but will share them here as well.

GG

your result are not bad, i'm guessing from your test ,that you are not very severe affected..but even if you have a reasonable vo2 max..the problem is the vo2 at AT.wich is little low for you...i have vo2 of 26 at AT.if 31.7 was my real vo2max..that means i reach AT at 87% of vo2 max..the most elite athletes reach AT at 90 % of vo2 max..and i am definatelly not elite athelete..I didint have the money to have 2 test...what i did instead, i run to exhaustion the day before the test,and also made 300 push ups..this should definatelly count as a exortion simmilar to CPET test ( even bigger )...so this values are like a second day test...the day after the CPET test ..wich will be the third day of exortion..i run/walk 20 km on the treadmill ,more than an hour was only running ) should't i be dead with pem after all this??? i feel sick but nothing extra ,regardless of exortion or not..I was so depressed after the diagnostic ,even suicidal..but putting all in balance i don t think the diagnostic is right..it can be so many other things...some better and treateable ,other worse ..like cancer..i need to keep seaching..

 

[*GG*]

your result are not bad, i'm guessing from your test ,that you are not very severe affected..but even if you have a reasonable VO 2 max..the problem is the Vo 2 at AT. which is little low for you...i have Vo2 of 26 at AT.if 31.7 was my real VO 2 max..that means i reach AT at 87% of Vo 2 max..the most elite athletes reach AT at 90 % of Vo2 max..and i am definitely not elite athlete..

I didn't have the money to have 2 test...what i did instead, i run to exhaustion the day before the test,and also made 300 push ups..this should definitely count as a exertion similar to CPET test ( even bigger )...so this values are like a second day test...the day after the CPET test ..which will be the third day of exertion..i run/walk 20 km on the treadmill ,more than an hour was only running ) should't i be dead with PEM after all this???

i feel sick but nothing extra ,regardless of exertion or not..I was so depressed after the diagnostic ,even suicidal..but putting all in balance i don t think the diagnostic is right..it can be so many other things...some better and treatable ,other worse ..like cancer..i need to keep searching..

Broke up your message, hard to read. Testing was done 2 days in a row, on the 5th page, Aug 10th to 11th. Thought you had asked this, but not seeing it now.

GG