Effects of a short-term aquatic exercise intervention on symptoms and exercise capacity in individuals with CFS/ME, 2018, Broadbent et al

Andy

Andy

Senior Member (Voting rights)
Abstract
Purpose

This pilot pre-and post-intervention study investigated the effects of a short-term aquatic exercise programme on physiological outcomes, symptoms and exercise capacity in women with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).

Methods
Eleven women (54.8 ± 12.4 year) volunteered for the 5-week program; an initial 20-min aquatic exercise session then two self-paced 20-min sessions per week for 4 weeks. Pre- and post-intervention outcomes were physiological measures, 6 min Walk Test (6MWT), perceived exertion (RPE), hand grip strength, Sit-to-Stand, Sit-Reach test, Apley’s shoulder test, FACIT questionnaire, and 24-h post-test tiredness and pain scores (0–10 visual analogue scale). Heart rates, RPE, 24- and 48-h post-session tiredness/pain scores were recorded each session.

Results
6MWT distance increased by 60.8 m (p = 0.006), left hand grip strength by 6 kg (p = 0.038), Sit-Reach test by 4.0 cm (p = 0.017), right shoulder flexibility by 2.9 cm (p = 0.026), FACIT scores by 8.2 (p = 0.041); 24-h post-test tiredness and pain decreased by 1.5 and 1.6, respectively (p = 0.002). There were significant post-intervention increases in exercising heart rates (6MWT 4- and 6-min time points), oxygen saturation at 2-min, and reduced RPE at 4-min. Weekly resting and exercising heart rates increased significantly during the study but RPE decreased; immediately post- and 24-h post-session tiredness decreased significantly. There were no reports of symptom exacerbation.

Conclusions
Five weeks of low-moderate intensity aquatic exercise significantly improved exercise capacity, RPE and fatigue. This exercise mode exercise may potentially be a manageable and safe physical activity for CFS/ME patients.
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Paywalled at https://link.springer.com/article/10.1007/s00421-018-3913-0
 
5 weeks seems far too short a time scale to assess whether this is a temporary improvement that will be followed by a crash, or a real improvement.

Surely this should ring alarm bells:
Weekly resting and exercising heart rates increased significantly during the study
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My resting and active heart rate increases coincide with worse symptoms, not better.
 
Sci-hub link here.
Didn't read it yet, but this is what it says about recruiting of participants:

'We recruited patients who had a diagnosis of CFS/ME from their medical practitioner,
according to the updated International Consensus Criteria (Carruthers et al. 2011)
or the 1994 Centres for Disease Control criteria (Fukuda et al. 1994).'
[bolding mine]

I struggle with taking a shower... in no way I could have attended 20 min. of aquatic exercises...
 
It seems clear to me that there are far too many people in the field of sports science. How else to explain all these various groups doing experiments in ME. Don't people who do sports or need rehabilitation need their expert research capabilities?

I'd like to know what flea in their ear encouraged them to say; hey let's do an uncontrolled non-randomised small sample trial using people who have ME? And then only look at other similar trials for confirmation that it's a smashing idea.

But you know what? There's been so much good news coming out that while it's good to know what is still going on elsewhere just maybe my eyeballs will get a rest from all the rolling they do on seeing this nonsense. Can one get PEM from too much eyeball exercise? Now there's a study.:rolleyes:

Given that we don't yet really know what has gone wrong to cause the disease process even small benefits may not be helpful long term to overall health. We just can't know yet. And I expect there are always a number of mild pwme that can and do manage to sustain some level of self paced exercise. But again until more is known the person best suited for knowing how much to do is the pwme learning from their own experience and even having support through groups of others who know.
 
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I exercised 3-4 times a week (mostly in a pool supplemented with the odd bit of cycling) for most of the 4 years I was mildly affected. I would vary which strokes I would do (including life-saving strokes) and which limbs I would use depending on which muscles seemed to be giving me trouble. Anyway, though doing exercise in water is supposed to be gentle on muscles, it definitely had the potential to cause problems for my muscles. This was particularly evident when I had a relapse when a few gentle lengths with breaks could appear to cause mildly strained muscles.

This was when I was in my late teens and early 20s.
 
The inclusion criteria were: between the ages of 18–80 years; a medical diagnosis of CFS/ME, postviral fatigue syndrome or infectious mononucleosis; not participating in a physical activity program or regular exercise; able to communicate in English; able to commit the time to participate in the research; informed consent.
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[My bold]

Does this mean some participants might not have been diagnosed with ME/CFS? If so, what are the implications?
 
Barry said:
[My bold]

Does this mean some participants might not have been diagnosed with ME/CFS? If so, what are the implications?
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I'm trying understand the inclusion criteria. Are they saying that if you have had glandular fever (infectious mononucleosis) in the past then that qualifies for entry, stand-alone? It clearly cannot mean if someone currently had it. But given the 'or' then it looks like someone was eligible if they did not have an ME/CFS diagnosis but did have a GF diagnosis at some point. They also state that ...
Our cohort was physically deconditioned
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I have never had or been diagnosed with ME/CFS, but did contract GF in my late teens. Later in life I had some fatigue-related and spaced-out-feeling issues which I put down as possible GF related, but never ME.

I had by then a very sedentary job and lifestyle, then changed to cycle commuting a fair distance each day, around 12 miles. I was distinctly unfit beforehand, and improved significantly quite quickly. But that would be very unrepresentative of PwME. But could be very representative of people who had previously had GF but not ME.

So the inclusion criteria is important. Did it only include people with a ME/CFS diagnosis? Am I missing something here? If so then what?
 
They all had a 'CFS/ME' diagnosis 'from their medical practioner' as I quoted above, in post #3. Still, as it says on page 4 of the pdf:

'Of the eleven participants, seven also had COPD or respiratory problems,
six had diagnosed FMS,
four reported recurring neurological symptoms (vertigo, migraines),
three had thermal instability,
and one had POTS.'

Wouldn't be too surprised if they were dealing with chronic fatigue, but not with ME...
 
Lisa108 said:
They all had a 'CFS/ME' diagnosis 'from their medical practioner' as I quoted above, in post #3. Still, as it says on page 4 of the pdf:

'Of the eleven participants, seven also had COPD or respiratory problems,
six had diagnosed FMS,
four reported recurring neurological symptoms (vertigo, migraines),
three had thermal instability,
and one had POTS.'
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There is something very wrong with this picture.
 
All exercises were self-paced.
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Participants were asked to not increase their time in the water, or intensity of exercise if they were symptomatic; they were asked to reduce exercise time or intensity if they felt more symptomatic during a session, and any changes in participant health, well-being or symptoms were recorded by the supervisors.
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This is similar to another Broadbent paper:
Intermittent and graded exercise effects on NK cell degranulation markers LAMP-1/LAMP-2 and CD8+CD38+ in chronic fatigue syndrome/myalgic encephalomyelitis.
Broadbent S1, Coutts R
https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28275109/
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The GE protocol was based on the exercise intensity used by previous GE research (Wallman et al. 2004), while the IE protocol was adapted from similar protocols for pulmonary and heart failure patients who are typically deconditioned, and who fatigue quickly, although the mechanisms of fatigue differs to CFS/ME (Butcher and Jones 2006; Piepoli et al. 2011; Puhan et al. 2006).
[..]
The exercise intensity was reduced if any participant reported a worsening in symptoms.
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“on days when symptoms are worse, patients should either shorten the session to a time they consider manageable or, if feeling particularly unwell, abandon the session altogether”

Wallman KE, Morton AR, Goodman C, Grove R. Exercise prescription for individuals with chronic fatigue syndrome. Med J Aust. 2005;183:142-3.
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This contrasts with the protocol in the PACE Trial where what participants are asked to do is determined by “their planned physical activity, and not their symptoms” (p.20); similarly, “a central concept of GET is to MAINTAIN exercise as much as possible during a CFS/ME setback” (p.51) and “if the participant reports an increase in fatigue as a response to a new level of exercise, they should be encouraged to remain at the same level for an extra week or more” (p.66). Bavinton J, Darbishire L, White PD - on behalf of the PACE trial management group. Graded Exercise Therapy for CFS/ME (Therapist manual)

The PACE Trial approach is about breaking the link between symptoms and how much activity is done. It is philosophically quite different.
 
Even if the results are taken at face value, with a improvement, it doesn't mean that people can keep improving.

Not everyone will be at their ceiling of activity: some people may be able to do a little more.

Though the clinical relevance of this is unclear: some people may become a lot worse in which case, the gamble for potentially only small improvements may not be worth it.
 
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