John Mac
Senior Member
- Messages
- 321
- Location
- Liverpool UK
Sorry Research 1st but most of the medical aspects go right over my head. I'll read through it to see if anything sticks.
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What about this device John, one in the device review you linked (thanks): EKF Lactate Scout +
I think the patient's severity of ME/CFS (mild, moderate or severe) needs to be noted in the results, but I think this test should be open to all severity levels. The intensity of exercise needed to trigger a bit of PEM would be different for each patient though.
For very severe patients like Mark Vink, it was just the 5 or 6 yard walk to his bathroom. For a moderate patient, some PEM may be triggered from a 10 minute walk.
ME/CFS patients are normally quite good at knowing what level of exercise will begin to trigger PEM. So each participant in our informal study would have to choose their own level of PEM-inducing exercise; they would need to do just enough exercise to trigger some PEM (but obviously you don't want to do too much and trigger a major crash).
I believe this sort of lactate testing normally uses a short bout (ie, one to two minutes) of intense exercise, and then measures the lactate levels in the minutes following this short bout.
So for a moderate patient, instead of a 10 minute walk, in order to "compress" their exercise into a short 2 minute intense bout, they may need to do two minutes of running, and then measure their lactate 5 minutes after this exercise, and then 30 minutes after this exercise.
For a severe patient, perhaps just walking up and down the stairs once or twice will be enough to trigger some PEM.
For a mild patient, it's possible that they would have to do very intense exercise for two minutes (like sprinting at absolute top speed) in order to trigger some PEM.
If we did replicate this (and even if we did not), I think we could then post up the results as an informal study in a PR forum thread, and then email a few ME/CFS researchers that are interested in the PEM and exercise aspects of ME/CFS. This may well help get more research done in this area.
What I am (optimistically) thinking is that if many ME/CFS patients exhibit this exaggerated production of lactate after a short bout of exercise, then ultimately this might become the basis of a useful diagnostic test for ME/CFS.
It would be much simpler and cheaper (and much less strenuous on the patient) than the 2-day CPET test. If it were viable, this lactate test could even be done in a primary care doctor's surgery: the doctor would simply ask a (say moderate) ME/CFS patient to jog on the spot for two minutes in the doctor's office, then measure their lactate level 5 and 30 minutes later. It could be a quick and easy diagnosis.
I don't think that is the case, unless patients are pushing themselves past their limits.
I only consider myself moderate, but I don't think I could run for 2 minutes! I tend to take things slowly, for example cutting my hedge for half an hour. That is quite likely to give me some PEM. Ditto my weekly shopping trip. I have a huge amount to do, and constantly struggling to get through that, so don't want to do any exercise for the sake of it. If I could just do the tests following my essential activities I am interested.I believe this sort of lactate testing normally uses a short bout (ie, one to two minutes) of intense exercise, and then measures the lactate levels in the minutes following this short bout.
So for a moderate patient, instead of a 10 minute walk, in order to "compress" their exercise into a short 2 minute intense bout, they may need to do two minutes of running, and then measure their lactate 5 minutes after this exercise, and then 30 minutes after this exercise.
For a severe patient, perhaps just walking up and down the stairs once or twice will be enough to trigger some PEM.
For a mild patient, it's possible that they would have to do very intense exercise for two minutes (like sprinting at absolute top speed) in order to trigger some PEM.
I would say its the ratio of aerobic/anaerobic. A mild cfs.patient might have 50/50 energy production..a severe patient almost all anaerobic.and little.aerobic.
I think the gregh286 is probably referring to V02 max?
Note: VT = ventilatory threshold. The ventilatory threshold is used to measure the arrival of the anaerobic threshold — the point during intense exercise when you oxygen-based energy system begins to run out of steam, and you start switch from aerobic to anaerobic energy production (the latter involves the production of lactate).The VT is also an important measure for understanding the activity limitations in CFS. Under normal circumstances, most activities of daily living require energy levels below the VT. However, if the VT occurs at very low levels of oxygen consumption, very low workloads, or both, even normal activities of daily living may exceed the VT. Therefore, it is possible that in CFS the increased stress of requiring anaerobic energy even for normal activities of daily living precipitates the symptom exacerbation seen in PEM.
I would definitely be interested but it would have to be controlled somehow. We all have different and highly variable exercise limits, even within the same categories of mild/mod/severe.
@Hip - Where are you located? UK? US?