Postexertional Malaise in Women with Chronic Fatigue Syndrome

K

_Kim_

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Vanness JM, Stevens SR, Bateman L, Stiles TL, Snell CR
Pacific Fatigue Laboratory, University of the Pacific , Stockton, California.

J Womens Health (Larchmt). 2010 Jan 24

http://www.ncbi.nlm.nih.gov/pubmed/20095909

Abstract
Objective:
Postexertional malaise (PEM) is a defining characteristic
of chronic fatigue syndrome (CFS) that remains a source of some
controversy. The purpose of this study was to explore the effects of
an exercise challenge on CFS symptoms from a patient perspective.

Methods: This study included 25 female CFS patients and 23 age-matched
sedentary controls. All participants underwent a maximal
cardiopulmonary exercise test. Subjects completed a health and
well-being survey (SF-36) 7 days postexercise. Subjects also provided,
approximately 7 days after testing, written answers to open-ended
questions pertaining to physical and cognitive responses to the test
and length of recovery. SF-36 data were compared using multivariate
analyses. Written questionnaire responses were used to determine
recovery time as well as number and type of symptoms experienced.

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. A significant multivariate effect for the
SF-36 responses (p < 0.001) indicated lower functioning among the CFS
patients, which was most pronounced for items measuring physiological
function.

Conclusions:
The results of this study suggest that PEM is both a real
and an incapacitating condition for women with CFS and that their
responses to exercise are distinctively different from those of
sedentary controls.
 

Advocate

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Way to go, Dr. Snell, Staci Stevens and others! What a clear, excellent report!

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.
I believe we have all these symptoms in the survey that people on this website are working on. (Well, maybe we don't have "trembling/instability.")
 

gracenote

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It doesn't look like the full text is out yet.

This is the first study I know of that checked cognitive function AFTER exertion. The other studies that I've read didn't always show much difference in cognitive function with healthy controls, and yet we all know that cognitive issues are a huge part of our symptom pattern. I think every study done with us needs to be done after exertion or it's not measuring what's really going on.
 
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:thumbsup: to those 25 CFS subjects who were willing to complete a maximal cardiopulmonary test for the sake of science, and the rest of us.
 
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Thanks for formatting & posting that Kim. The layout made it easier to read than the original!

The results of this study suggest that PEM is both a real
and an incapacitating condition for women with CFS and that their
responses to exercise are distinctively different from those of
sedentary controls.
I didn't realize there was any debate about that.
 

Dolphin

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Thanks for formatting & posting that Kim. The layout made it easier to read than the original!

The results of this study suggest that PEM is both a real
and an incapacitating condition for women with CFS and that their
responses to exercise are distinctively different from those of
sedentary controls.
I didn't realize there was any debate about that.
Yes, Peter White and others try to suggest that what people feel are just symptoms of deconditioning that healthy people would also feel. A lot of the clinics in the UK (and probably the Netherlands and Belgium although I haven't read the literature as much) try to persuade patients that the symptoms they feel after they try to exercise are normal symptoms, that unfit people feel.
 
T

thefreeprisoner

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Woop! Go _Kim_!
This study is awesome. Do we have these scientists' email addresses so we can write and thank them personally?

I get trembling and instability, by the way.
I know if I've pushed myself too hard because I get the shakes. Like when you've used a muscle too much and it starts to shake as it fails. My whole body, but particularly my trunk, does that. I look hypothermic.

-Rachel xx
 

Mithriel

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I get trembling and instability too.

This is a good paper. This is the sort of thing we want done in a big study. It is too easy to ignore something done in 25 people, even if the results are compelling.

Mithriel
 
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Yes, Peter White and others try to suggest that what people feel are just symptoms of deconditioning that healthy people would also feel. A lot of the clinics in the UK (and probably the Netherlands and Belgium although I haven't read the literature as much) try to persuade patients that the symptoms they feel after they try to exercise are normal symptoms, that unfit people feel.
Oh, sorry, I totally forgot about that aspect of the disease -- the politics on the other side of the pond :/


I get trembling and instability, by the way
I actually get that, too. Not a lot, but it's there.
 

Dolphin

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tomk said:
Yes, Peter White and others try to suggest that what people feel are just symptoms of deconditioning that healthy people would also feel. A lot of the clinics in the UK (and probably the Netherlands and Belgium although I haven't read the literature as much) try to persuade patients that the symptoms they feel after they try to exercise are normal symptoms, that unfit people feel.
Oh, sorry, I totally forgot about that aspect of the disease -- the politics on the other side of the pond :/
And don't forget that the CDC CFS team have been "making eyes at" and praising the NICE guidelines. And been influenced by Peter White who Bill Reeves says he talks to on the phone regularly. Fingers crossed XMRV "works out" or Graded Exercise Therapy (GET) could be centre stage again.
 

bakercape

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A well needed study unfortunately

Can you believe I went to the doctors today because I am having a relapse and got some bloodwork back.

The Nurse practitioner asked me if I still exercise. I said I did some when I was in remission. But I can't do too much even when I'm feeling better.

Her response to this was" good because some people with CFS use it as an excuse to not execise".:Retro mad:

I was furious!
 

flybro

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i was ridiculously fit when I fell ill, there is no way I was deconditioned, I had such an active job, i fell of ladders, fell down the stairs got clumbsier and clumbsier, more and more accident prone. Constantly feeleing like death and trying to carry on. I also had a few close calls in the car.

When I stopped exerting myself, I had less accidents.

It is dangerous to try to carry on when your body is making you fall down. This for me has been one of the most disabling and frustratingaspects of this disease.
 

Dolphin

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anne said:
Why would they only do this on women?
It was published in the Journal of Women's Health. It was published in the Journal of Women's Health.
Technically that doesn't answer why they just did it on women, that just shows the study is suitable for the publication.

For better or worse, quite a lot of CFS studies are just on women.

Not sure if there was any particular reason in this case.

There is a fairly big female predominance (maybe around 4:1 or so although it varies a bit in different studies).

[Aside: I think there is some rule now that federally funded studies in the US generally have to include at least some women unless there is a good reason. But there is no requirement that they include men which seems unfair. It would be more of an issue if it was 4 more common in men but fortunately that is not the case for researchers in CFS.
 

Dolphin

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I just read this and generally was pleased that it was done.

However, I don't share the authors' enthusiasm for exercise as a treatment or share their view that activity avoidance is a major problem - I think most people do close to what they are able to do:

Introduction:

[..]

"Symptom exacerbation after physical exertion is a common
complaint among people with CFS.4 Indeed, among the various
disease states associated with fatigue, increased symptomatology
and malaise postexercise appear unique to CFS
and are defining characteristics for significant instances of the
illness.5,6 The reality is that many persons with CFS either
continue to engage in physical activity and suffer the consequences
or eschew all types of bodily exertion to avoid subsequent
discomfort.7,8 Ironically, this activity avoidance
behavior can precipitate a cycle of deconditioning wherein
hypokinetic effects further compound the problems manifest
in CFS.9 Consequently, disability levels among people with
CFS are perpetuated beyond those found in other types of
chronic illness.10
Exercise-induced symptoms and activity
avoidance have proven considerable barriers to the integration
of physical activity into rehabilitation programs for CFS
patients.5,11,12 This is particularly significant given the widespread
recommendation for graded exercise therapy as treatment
for CFS.13
Special considerations for women may also
include the confounding effects of pregnancy and childbirth,
which further increase the risk of relapse.14
References (for this section)

4. Komaroff AL, Buchwald D. Chronic fatigue syndrome: An
update. Annu Rev Med 1998;49:1–13.
5. Cook DB, Nagelkirk PR, Peckerman A, Poluri A, Mores J,
Natelson BH. Exercise and cognitive performance in chronic
fatigue syndrome. Med Sci Sports Exerc 2005;37:1460–1467.
6. Sorensen B, Streib, JE, Strand M, et al. Complement activation
in a model of chronic fatigue syndrome. J Allergy Clin
Immunol 2003;112:397–403.
7. 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;59:201–208.
8. Black CD, McCully KK. Time course of exercise-induced
alterations in daily activity in chronic fatigue syndrome.
Dyn Med 2005;28:10.
9. Rowbottom DG, Keast D, Green S, Kakulas B, Morton AR.
The case history of an elite ultra-endurance cyclist who developed
chronic fatigue syndrome. Med Sci Sports Exerc
1998;30:1345–1348.
10. Taylor RR. Quality of life and symptom severity for individuals
with chronic fatigue syndrome: Findings from a
randomized clinical trial. Am J Occup Ther 2004;58:35–43.
11. Blackwood SK, MacHale SM, Power MJ, Goodwin GM,
Lawrie SM. Effects of exercise on cognitive and motor
function in chronic fatigue syndrome and depression. J
Neurol Neurosurg Psychiatry 1998;65:541–547.
12. Cannon JG, Angel JB, Ball RW, Abad LW, Fagioli L, Komaroff
AL. Acute phase responses and cytokine secretion in
chronic fatigue syndrome. J Clin Immunol 1999;19:414–421.
13. Nijs J, Paul L, Wallman K. Chronic fatigue syndrome: An
approach combining self-management with graded exercise
to avoid exacerbations. J Rehabil Med 2008;40;241–247.
14. Allen PR. Chronic fatigue syndrome: Implications for
women and their health care providers during the childbearing
years. J Midwifery Womens Health 2008;53:289–301.
 

Dolphin

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Make sure to check out graph of symptoms

The Hallmark of CFS

By Suzanne D. Vernon, PhD
Scientific Director of the CFIDS Association of America

http://www.cfids.org/cfidslink/2010/020302.asp
Make sure to check out this graph: http://www.cfids.org/cfidslink/2010/020302.pdf - you need to enlarge it.

A patient (or control) scores 1 for the symptom if they mentioned it, 0 if they didn't. These are the nine symptom types.

It's all interesting but one interesting thing is that for some symptoms, the symptom is more likely 1+ day later in CFS patients.

I thought this was interesting (remember that this wasn't a group of active people but instead sedentary people)

In contrast to the experience of the CFS group, of the 20
controls who indicated full recovery within 24 hours, 17
actually reported feeling an increased sense of well-being
relative to before the test, which they directly attributed to
posttesting exercise effect: ‘‘Acouple hours later, my legs were
still tired but I felt great! Energized and ready to go.’’ ‘‘[I felt]
great, normal—ready to do some more exercise.’’ At no point
during the 7 days postexercise did any of our CFS subjects
report experiencing comparable benefit from the exercise
bout.
 

Dolphin

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Looking at lot of symptoms is good

I liked the fact that they looked at lots of symptoms.

Once you start reading full papers, what one generally finds with Graded Exercise Therapy (GET) and CBT based on GET studies is that they only measure fatigue symptoms while of course there are lots of other symptoms.
Other symptoms may not have improved or may even have gotten worse (think this could happen with pain for example) but the readers are not given the information.

Such studies might put pressure on researchers to change this.