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Influence of Symptom Expectancies on Stair-Climbing Performance in CFS: Effect of Study Context

Dolphin

Senior Member
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17,567
http://rd.springer.com/article/10.1007/s12529-012-9253-2

International Journal of Behavioral Medicine

August 2012

Marianne Heins, Hans Knoop, Jo Nijs, Remco Feskens, Mira Meeus, Greta Moorkens, Gijs Bleijenberg

Influence of Symptom Expectancies on Stair-Climbing Performance in Chronic Fatigue Syndrome: Effect of Study Context


Abstract

Background

In patients with chronic fatigue syndrome (CFS), performance of physical activities may be affected by an anticipated increase in symptoms after these activities. Nijs et al. previously studied the influence of symptom expectancies and related psychological processes on the performance of an isolated physical activity [Nijs J, Meeus M, Heins M, Knoop H, Moorkens G, Bleijenberg G. Kinesiophobia, catastrophizing and anticipated symptoms before stair climbing in chronic fatigue syndrome: an experimental study. Disabil Rehabil 2012.

doi:10.3109/09638288.2011.641661.].



Purpose



We aimed to validate the previous findings in a larger group of patients in a different setting. We also extended the possible underlying psychological processes studied.



Method



In 49 CFS patients, we measured performance (duration and increase in heart rate) during self-paced climbing and descending of two floors of stairs. Before this task, patients rated experienced fatigue and anticipated fatigue after stair climbing. In addition, kinesiophobia, catastrophising and focusing on bodily symptoms were measured. Using correlational and regression analyses, we tested whether performance during stair climbing could be explained by experienced and anticipated fatigue and psychological factors.



Results



Longer duration of stair climbing correlated with higher anticipated fatigue, independently of sex, age, body mass index and fatigue before stair climbing. Focusing on bodily symptoms and fatigue-related catastrophising were related to anticipated fatigue.



Conclusion



Symptom expectations affect the performance of physical activity in CFS patients, possibly through focusing on bodily symptoms and catastrophising. These findings partially contradict the findings of the previous study, which stresses the importance of study context in conducting this type of experiments (i.e., patient characteristics, instructions).

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The journal's website has all this other stuff below. References are of course much more interesting when one can see the text but sometimes one can make a guess from them, the sort of points that are being made.
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DOI 10.1007/s12529-012-9253-2
Print ISSN1070-5503
Online ISSN1532-7558
Publisher Springer US
Manuscript Submission Topics» Health Psychology » General Practice / Family Medicine » Medicine/Public Health, general
Keywords Chronic fatigue syndrome Symptom expectancies Physical performance Focusing on symptoms Catastrophising

Authors
Marianne Heins(1) Hans Knoop(1) Jo Nijs(2)(3) Remco Feskens(4) Mira Meeus(2)(3) Greta Moorkens(5) Gijs Bleijenberg(1)

Author Affiliations1. Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, 4628, PO Box 9101, 6500, HB, Nijmegen, The Netherlands 2. Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium 3. Division of Musculoskeletal Physiotherapy, Department of Health Care Sciences, Artesis University College Antwerp, Antwerp, Belgium 4. Department of Methods and Statistics, Utrecht University, Utrecht, The Netherlands 5. Reference Centre for Chronic Fatigue Syndrome, University of Antwerp, Antwerp, Belgium

References:

1 Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994;121(12):953–9.

2.Bazelmans E, Bleijenberg G, Voeten MJ, van der Meer JW, Folgering H. Impact of a maximal exercise test on symptoms and activity in chronic fatigue syndrome. J Psychosom Res. 2005;59(4):201–8.» CrossRef

3.Lapp CW. Exercise limits in chronic fatigue syndrome. Am J Med. 1997;103(1):83–4.» CrossRef

4.VanNess JM, Stevens SR, Bateman L, Stiles TL, Snell CR. Postexertional malaise in women with chronic fatigue syndrome. J Womens Health (Larchmt). 2002;19(2):239–44.» CrossRef

5.Vercoulen JH, Bazelmans E, Swanink CM, et al. Physical activity in chronic fatigue syndrome: assessment and its role in fatigue. J Psychiat Res. 1997;31(6):661–73.» CrossRef

6.Nijs J, Meeus M, Heins M, Knoop H, Moorkens G, Bleijenberg G. Kinesiophobia, catastrophizing and anticipated symptoms before stair climbing in chronic fatigue syndrome: an experimental study. Disabil Rehabil. 2012;doi:10.3109/09638288.2011.641661.

7.Kori S, Miller R, Todd D. Kinesiophobia: a new view of chronic pain behavior. Pain Manage. 1990:35–43.

8.Nijs J, De Meirleir K, Duquet W. Kinesiophobia in chronic fatigue syndrome: assessment and associations with disability. Arch Phys Med Rehabil. 2004;85(10):1586–92.» CrossRef

9.Nijs J, Vanherberghen K, Duquet W, De Meirleir K. Chronic fatigue syndrome: lack of association between pain-related fear of movement and exercise capacity and disability. Phys Ther. 2004;84(8):696–705.

10.Silver A, Haeney M, Vijayadurai P, Wilks D, Pattrick M, Main CJ. The role of fear of physical movement and activity in chronic fatigue syndrome. J Psychosom Res. 2002;52(6):485–93.» CrossRef

11.Petrie K, Moss-Morris R, Weinman J. The impact of catastrophic beliefs on functioning in chronic fatigue syndrome. J Psychosom Res. 1995;39(1):31–7.» CrossRef

12.Nijs J, Van de Putte K, Louckx F, Truijen S, De Meirleir K. Exercise performance and chronic pain in chronic fatigue syndrome: the role of pain catastrophizing. Pain Med. 2008;9(8):1164–72.» CrossRef

13.Vercoulen JH, Swanink CM, Galama JM, et al. The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: Development of a model. J Psychosom Res. 1998;45(6):507–17.» CrossRef

14.Wiborg JF, Knoop H, Prins JB, Bleijenberg G. Does a decrease in avoidance behavior and focusing on fatigue mediate the effect of cognitive behavior therapy for chronic fatigue syndrome? J Psychosom Res. 2011;70(4):306–10.» CrossRef

15.Bergner M, Bobbitt RA, Pollard WE, Martin DP, Gilson BS. The sickness impact profile: validation of a health status measure. Med Care. 1976;14(1):57–67.» CrossRef

16.Jacobsen PB, Azzarello LM, Hann DM. Relation of catastrophizing to fatigue severity in women with breast cancer. Cancer Res Ther Contr. 1999;8:155–64.

17.Ray C, Weir W, Stewart D, Miller P, Hyde G. Ways of coping with chronic fatigue syndrome: development of an illness management questionnaire. Soc Sci Med. 1993;37(3):385–91.» CrossRef

18.Vlaeyen JW, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain. 2012. doi:10.1016/j.pain.2011.12.009.

19.Wilson A, Hickie I, Hadzi-Pavlovic D, et al. What is chronic fatigue syndrome? Heterogeneity within an international multicentre study. Aust N Z J Psychiatry. 2001;35(4):520–7.» CrossRef

20.Cella M, Chalder T, White PD. Does the heterogeneity of chronic fatigue syndrome moderate the response to cognitive behaviour therapy? An exploratory study. Psychother Psychosom. 2011;80(6):353–8. doi:10.1159/000327582.» CrossRef

21.Nisenbaum R, Reyes M, Unger ER, Reeves WC. Factor analysis of symptoms among subjects with unexplained chronic fatigue: what can we learn about chronic fatigue syndrome? J Psychosom Res. 2004;56(2):171–8. doi:10.1016/S0022-3999(03)00039-4.» CrossRef

22.Baden DA, McLean TL, Tucker R, Noakes TD, St Clair Gibson A. Effect of anticipation during unknown or unexpected exercise duration on rating of perceived exertion, affect, and physiological function. Br J Sports Med. 2005;39(10):742–6. discussion -6.» CrossRef

23.Stanley C, Pargman D, Tenenbaum G. The effect of attentional coping strategies on perceived exertion in a cycling task. J Appl Sport Psychol. 2007;19:352–63.» CrossRef

24.Wiborg JF, Knoop H, Stulemeijer M, Prins JB, Bleijenberg G. How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity. Psychol Med.40(8):1281–7.

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Firestormm

Senior Member
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Location
Cornwall England
Apply the same to other conditions and I am sure the results would be similar. You ask anyone with a long term chronic condition to do repetitive exercise and I am pretty sure they will 'confess' to thinking of the likely damage it might do. We're human. It's what we do. It's called risk analysis.

It doesn't mean we don't engage with the task ahead of us and neither does it mean we are avoiding things that we could do if only we engaged. No. I walk my dog through the pain and discomfort. It improves my mood to do things I might otherwise not. It makes me feel better on one level knowing that at least I was capable of doing something today.

It's also relative to an overall assessment of how I am doing at any particular time. That's another assessment. That's human too. I could do nothing every single day, that is true. Equally true is that some days I do far less than others. But so do people without a medical condition.Guess what? That's human too.

Every time I walk the dog I try to do it faster, have less stops, for longer... and it's no different with a relative activity on a 'bad day' - reading, washing, brushing my teeth, remembering shit..

Gods. These people are bloody thick. Yet it is so bloody easy to see why equal idiots sit up and take notice within their own expanding world. From simple and useful counselling they really have built an industry out of non-evidence-based-unblinded-wholly-irrelevant garbage.
 

Firestormm

Senior Member
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5,055
Location
Cornwall England
Now I feel I need to explain about my dog-walking activity. What the hell is that all about? Do other people with similarly debilitating conditions feel the need to have to explain everything they do? To itemise it and break it down? Gods. I despair sometimes. Talk about straight-jacket material :eek: :)
 

alex3619

Senior Member
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Location
Logan, Queensland, Australia
I am currently reading "Skewed" by Martin Walker. Its very heavily based on issue with chemical sensitivity, and the moves that the chemical industry are claimed to have made to distort the science, create doubt, and put the blame back on patients by psychologizing problems. I am very early in the book. but already I recognize parallels in MCS history as with ME history - the same strategies applied to deny disease existence. The book discussed ME later on.

I am not saying I agree with the theories in this book, but there are definitely parallels worth thinking about. One disturbing fact is that a researcher consensus document was produced declaring MCS could not be psychiatric in the late 90s, more than a decade ahead of us. I don't think it got very far.

According to Walker, like the CDC and the Incline Village epidemic, there was an MCS epidemic that a committee decided, after reviewing the case histories of four patients, that it was not a chemical problem but hysteria. Go figure.

Bye, Alex

PS I think they did include personal interviews, unlike the CDC.
 

Enid

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Same after the Royal Free wasn't it alex, quite what the dynamics were allowing these mumbo jumbo(ists) to overrule more knowledgeable medics hope your reading of "Skewed" may find some pointers.
 

alex3619

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Logan, Queensland, Australia
Hi Enid, thats the point. I am looking for parallels. What I am seeing, so far, is the same pattern again and again. It seems it does not matter if we are talking about neurasthenia, ME or MCS, the nineteenth or the twenty-first century. I am seeing it in the case histories of Freud and Charcot as well. The great psychobabblers of the nineteenth century set a tradition which is alive and well today. Similar reasoning was used by the Inquisition. My guess, very very far from substantiated at this point, is that we are looking at pseudoscientific cult thinking masquerading as science. If so, then most of these people probably believe they are right, that they are doing the right thing. Bye, Alex
 

Enid

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UK
Hi alex - I wish I could agree in belief they were doing the right thing, more complex and more devious battle of wills going on here - Magical Medicine - how to make a disease disappear - Prof Hooper.

See tactics of denial. Personally (having been diagnosed all in your mind in earlier days) I agree psychobabble is very much alive and only too well. Docs less belief in patients now it seems due the creep of behaviourism.
 

Seven7

Seven
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Location
USA
NOT TODAY NO!!!

I think we are going to be more active and write to this journals and quote the science that is already out there and make them think twice before publishing this kinda crap. I have noticed that I can measure how I am doing by stairs climbing and shower. I do not dread it, actually I don't think about it until I make it up the stairs ok and then I think wow I am doing better today. The same w shower (my archienemy hardest task) I actually like it so If I do good, I know I am progressing getting out of crash. This does not eliminate that I have some days where the task is hard. Some days it is easy.
 

peggy-sue

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Do you have a seat in your shower? It makes a huge difference to how hard it is!

If you're sitting low down, you don't have your head in the steam (very high humidity), which causes symptom flares via elevated cytokines, and you're not trying to stand still either - which uses more energy than shuffling around a little, and tires out the same, large set of muscles.

To wash your hair, prop your elbows on your knees and drop your head down to your hands - no hard arm raising!

You will need to stand to wash your bum - be careful not to try to sit down again before you have rinsed it - or your soapy posterior will slip right off.

The stool I use is a small plastic "step-stool", it cost about £2 from a budget style homeware shop.
I've got a sturdy sort of rubber mat which sticks to the bottom of the bath, and the stool is kept firmly in place on that.
 

Seven7

Seven
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USA
TX for the tip, I do this when not doing too good. But some days I like to enjoy a shower like a normal person.
 

alex3619

Senior Member
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13,810
Location
Logan, Queensland, Australia
Hi alex - I wish I could agree in belief they were doing the right thing, more complex and more devious battle of wills going on here - Magical Medicine - how to make a disease disappear - Prof Hooper.

See tactics of denial. Personally (having been diagnosed all in your mind in earlier days) I agree psychobabble is very much alive and only too well. Docs less belief in patients now it seems due the creep of behaviourism.

Hi Enid, I love Magical Medicine. I got a kick out of being cited in it too.

I am pursuing a particular strategy for analysis. I want to see where it leads. In general I do not want to make assertions I don't think I can prove, but I will be itemizing spin, PR and other tactics for reasons that will be obvious in time, but I am not ready to discuss much of it yet - too much background reading still to go.

Bye, Alex
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
Do you have a seat in your shower? It makes a huge difference to how hard it is!

If you're sitting low down, you don't have your head in the steam (very high humidity), which causes symptom flares via elevated cytokines, and you're not trying to stand still either - which uses more energy than shuffling around a little, and tires out the same, large set of muscles.

To wash your hair, prop your elbows on your knees and drop your head down to your hands - no hard arm raising!

You will need to stand to wash your bum - be careful not to try to sit down again before you have rinsed it - or your soapy posterior will slip right off.

The stool I use is a small plastic "step-stool", it cost about £2 from a budget style homeware shop.
I've got a sturdy sort of rubber mat which sticks to the bottom of the bath, and the stool is kept firmly in place on that.

Hi peggy-sue, I have heard this advice from so many patients, I know it works. I differ from most in that I have high blood pressure in addition to neurally mediated hypotension, and I have trouble breathing through my nose. I find the steam from a shower (or a bowl of steaming water and a towel) can help me breath. Thats worth considering if someone can tolerate it. What I can't handle though is all the chemicals they say are good to add to steam to help breathing. My advice, don't bother with the chemicals.

Bye, Alex
 

peggy-sue

Senior Member
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Scotland
High BP IS rather unusual in ME.
Another shower strategy I have is not to have too many - I'm down to every 5-6 days. Ok, I get a bit pongy and my hair goes manky, but it does mean I can do something else, like go outside for a wee walk (like a normal person!) - and that's a feelgood thing too.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
HI peggy-sue, I think my high bp is to compensate for my massive bp crashes. My heart stopped on my tilt table test. High bp protects me, but its high enough I have to take meds for it. On my bp meds I am more likely than otherwise to pass out while walking up stairs. I am aware of quite a few ME patients with high pb, its uncommon but I don't know that it is rare. Bye, Alex
 

Snow Leopard

Hibernating
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South Australia
Experienced fatigue was higher than expectations in this group - so behind all the talk, these patients simply predicted their post-activity fatigue slightly more accurately than the previous study and also reduced their performance to compensate. So to me it seems the cognitions of most of these patients were in fact reasonable and accurate.
 

peggy-sue

Senior Member
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Scotland
Enid - it's the cognitive lot who are behind this - NOT behaviourists.
The whole field of psychology needs to drop the last 40-odd years "worth" of dualist, top-down, cognitive garbage, and return to proper behaviourism - which is good, proper, bottom-up science.