Valentijn basically covered it. The post-exertional symptoms are mainly attributed to DOMS or the "normal" effects of unaccustomed activity. In the therapy manuals, DOMS is also regarded as a sign of progress. The hypothesis is that patients initially avoid activity because of symptoms in general, then become deconditioned, then experience increased sense of effort and DOMS when they do too much, mis-attribute this as a sign of disease pathology or damage, then become fearful of activity, leading to a 'vicious' cycle of fear avoidance which maintains symptoms and disability.
The PACE results are dangerously presented to us as evidence that our "fear" is misplaced (if you can call it that) and is the most important factor to overcome for improvement, but as Sidereal said, the PACE results actually support the alternative hypothesis that there is a physiological activity ceiling which cannot be overcome by simply pushing through the symptoms.
IIRC, someone mentioned earlier on this thread or related thread, much criticism has been limited to case definitions. While there are other important factors to highlight, the importance of diagnosis should not be underestimated, since PACE:
- excluded 80% of candidates who had either a definite or provisional diagnosis of CFS,
- excluded severely affected patients and anyone with contraindications to exercise,
- 22% of the exclusions were because the candidate declined research assessment or randomisation, and the most commonly stated reason for refusing this was "a clear preference for a specific PACE trial treatment",
- did not appropriately use either the CDC criteria for CFS or the London criteria for ME,
- is no doubt an Oxford criteria study, which other definitions of ME or CFS regard as idiopathic chronic fatigue, not ME or CFS, and with the IOM/P2P efforts concluding that (research using) the Oxford criteria could be seriously flawed,
- did not require PEM or PENE from participants,
- did not adequately measure PEM or PENE, and did not report its association with outcomes.
The PACE results are dangerously presented to us as evidence that our "fear" is misplaced (if you can call it that) and is the most important factor to overcome for improvement, but as Sidereal said, the PACE results actually support the alternative hypothesis that there is a physiological activity ceiling which cannot be overcome by simply pushing through the symptoms.
IIRC, someone mentioned earlier on this thread or related thread, much criticism has been limited to case definitions. While there are other important factors to highlight, the importance of diagnosis should not be underestimated, since PACE:
- excluded 80% of candidates who had either a definite or provisional diagnosis of CFS,
- excluded severely affected patients and anyone with contraindications to exercise,
- 22% of the exclusions were because the candidate declined research assessment or randomisation, and the most commonly stated reason for refusing this was "a clear preference for a specific PACE trial treatment",
- did not appropriately use either the CDC criteria for CFS or the London criteria for ME,
- is no doubt an Oxford criteria study, which other definitions of ME or CFS regard as idiopathic chronic fatigue, not ME or CFS, and with the IOM/P2P efforts concluding that (research using) the Oxford criteria could be seriously flawed,
- did not require PEM or PENE from participants,
- did not adequately measure PEM or PENE, and did not report its association with outcomes.
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