In some this can also trigger orthostatic intolerance, complicating the interpretation of results.The main issue with inclines is simply that it takes substantially more power to climb than walking on a flat plane.
In some this can also trigger orthostatic intolerance, complicating the interpretation of results.The main issue with inclines is simply that it takes substantially more power to climb than walking on a flat plane.
In some this can also trigger orthostatic intolerance, complicating the interpretation of results.
If you are going up an incline, like a hill, it might happen. Its not an issue with treadmills at incline because the head is not actually rising. You would most likely have an issue running up stairs though. If the head is physically rising then OI is potentially an issue.Apart from the initial standing process, how exactly?
If you are going up an incline, like a hill, it might happen. Its not an issue with treadmills at incline because the head is not actually rising. You would most likely have an issue running up stairs though. If the head is physically rising then OI is potentially an issue.
Could this explain (amongst others) why taking stairs feels so darn exhaustive?If you are going up an incline, like a hill, it might happen. Its not an issue with treadmills at incline because the head is not actually rising. You would most likely have an issue running up stairs though. If the head is physically rising then OI is potentially an issue.
If I work really hard at resting then I can get my HR down to high 60s, occasionally, more often low to mid 70s, but I have to be well rested for that, and anything more than a few minutes upright will send it at least into the high 90s. Once it's been like that for a few minutes it rises to low 100s even if I'm not doing anything. If I then do stuff it's 115-130. This is an improvement on how it used to be.
And so it goes.
How long this takes may, but only may, depend on how 'rested' I am, but once my HR is high even lying down immobile doesn't cause it to drop much, for quite a while - in fact it's often higher when lying down after 'exertion' (e.g. standing up long enough to make a cuppa - that sort of 'exertion').
I'm still trying to get a handle on what's going on, but it seems to depend, at least partially, on something I am not monitoring.
I've tried seeing what effects eating, different types of food, not eating, altering the timing and duration of sleep, adding in a few seconds of 'high intensity' exercise (a few reps of a minimum weight deadlift every couple of days), varying durations of 'low intensity' exercise (lurching).
The results make no sense e.g. 3 reps of deadlifts actually seem to reset my HR down to high 70s - low 80's, no matter what it was before, but walking, that raises it, and it stays elevated for anything from 5 hours to days, even whilst sleeping.
It's nonsense.
So the above paper, runs counter to my experience. If it is valid for all PwME then I ain't one, no matter what my symptoms suggest..
OI typically kicks in when the head is rising. The brain compensates for falling blood pressure in the head by sending signals via the autonomic nervous system to adjust vascular tone and heart function. When I pass out from OI, complete collapse, its when I am getting up too fast only rarely. Going up stairs is my number one trigger. The brain has failed to perform adequate autonomic regulation. Now some of that might also be from direct peripheral issues, such as small fiber polyneuropathy, heart preload failure, and so on, but that does not change the outcome. Gravity and upward momentum plays its part in orthostatic intolerance.Again, please explain how?
Walking up stairs is likely to be a huge energy demand as well. You are fighting gravity. I don't have the stats, but I bet some exercise physiologists do.Could this explain (amongst others) why taking stairs feels so darn exhaustive?
I'm confused about the interplay between chronotropic incompetence - assuming for a moment that we do have it - and POTS?
The first, if I understand correctly, would lead to HR not increasing enough upon exertion.
The second leads to HR increasing too much upon (orthostatic) exertion.
There seems to be a contradiction here?
Where's the error and what did I forget?
Anyone interested can get paid to stay in bed for 60 days. NASA will research how the body changes in weightlessness.
Not too hard to do![]()
At the end of cycle exercise, CFS patients had a lower peak heart rate (Table 5), a similar finding to that of Montague et al (1989), and reduced lactate levels, suggesting that they were not exercising to their full capacity despite reaching a maximum rate of perceived exertion (RPE) scored on a Borg scale (RPE; Table 5) (Borg 1970).
These data contrast with the findings of Riley et al (1990), who reported a trend towards higher heart rates at rest and a significantly greater heart rate in CFS patients compared to normal subjects and to irritable bowel syndrome controls during submaximal treadmill exercise, but a nonsignificant difference at peak exercise.
Montague et al (1989) attributed their findings in CFS patients to a slow acceleration of heart rate, resulting from a deficit in cardiac pacemaker function or a deficit in sympathetic drive.
Riley et al (1990) attributed their findings to physical deconditioning, with oxygen uptake and lactate levels significantly lower in recovery after exercise, similar to our findings.
‘Deconditioning’ as a result of lack of habitual physical activity reduces exercise capacity (Saltin et al 1968). This is likely to occur in CFS through physical inactivity and may contribute to symptoms, in particular myalgia.
Our findings suggest that CFS patients have a lower threshold for sensation during exercise, or that these patients have an additional burden of ‘fatigue’ at rest over and above that experienced from exercise.
Edwards: ... we did our muscle testing at intervals from five minutes to 48 hours after exercise in all patients and controls (Gibson et al 1993). We have seen some CFS patients who have had similar exercise tests and say that they were so exhausted, they had to stay in bed for three weeks afterwards. This does not make sense from the physiological point of view.
Straus: You appear to be saying that none of these physiological tests identifies an abnormality that would otherwise not be seen in a physically deconditioned individual? Is that right?
Edwards: Our CFS patients were different from normal controls, never mind deconditioned ones. There is of course a vast range of exercise performance in the normal population (from sedentary individuals to long-distance runners). There is a similarly wide range in CFS patients, from people who have the physiological consequences of being in bed (Saltin et al 1968, Greenleaf & Kozlowski 1982) or in a wheelchair for years, to others who are pottering about yet complaining of fatigue sufficient to fulfil the Oxford consensus criteria for chronic fatigue syndrome (Sharpe et al 1991). So the answer is yes.
Straus: To my mind, you have done a great service to this field in resolving this question.
McCluskey: We have done exercise testing to assess aerobic work capacity in patients with CFS, as you mentioned, and there is no doubt that they are deconditioned. Their heart rate at rest and at submaximal levels of exertion, and the whole-blood lactate levels at submaximal exertion, are significantly higher than those of control subjects or patient control groups. So deconditioning plays some part in the syndrome.
Something that strikes me as important is the way the symptoms fluctuate, from day to day and week to week. There are times when CFS patients can exercise with little fatigue; at other times they are bed-bound. So there is some central mechanism, or something going on centrally, which makes them feel fatigued. This is what we have to try to elucidate.
Edwards: Our observations are very similar on this.
Behan: You don’t know, however, Dr McCluskey, whether their deconditioning is a cause of the results that you and others have found. As yet, nobody has taken deconditioned patients and done those physiological studies on them.
Edwards: Actually, my initial expectation was that these patients would prove to be deconditioned, and I have seen CFS patients who are. It so happened that in this particular age-matched group of 12 young patients they were actually similar to controls. But I know that you, Dr McCluskey, have a group of people who were deconditioned. I don’t see a problem here. There is a selection process, and these patients are not always the same in different places.
Straus: So you are saying, Professor Edwards, that they can be deconditioned and yet have normal muscle physiology, but Professor Behan is saying that they have abnormal muscle?
But grateful to find enough brain function to sign up yesterday after following as a guest for a while. Was grateful for your presence during the recent media storm. Glad to be here.
In the GET therapist manual, P.23, they refer to 8 papers to justify the deconditioning rationale, which also appear in the Davenport tables for single CPET. In the the Davenport paper they are reference numbers 29, 30, 37, 43, 45, 48, 61, 64.
wrt Perception of effort:
All of these discussions about deconditioning completely avoid the fluctuating course of the disease, not only long-term but shockingly short-term. There is no such thing as fluctuating deconditioning, an otherwise healthy person cannot be deconditioned in the morning but not in the afternoon, or any variation of this. Some patients experience a very rapid deterioration, within days, into a severe state, for which a deconditioning hypothesis makes no sense.Just unpacking a bit further...
29. De Becker P, Roeykens J, Reynders M, McGregor N, De Meirleir K. Exercise capacity in chronic fatigue syndrome. Arch Intern Med. (2000) 160:3270–77.
"CONCLUSIONS:When compared with healthy sedentary women, female patients with CFS show a significantly decreased exercise capacity. This could affect their physical abilities to a moderate or severe extent. Reaching the age-predicted target heart rate seemed to be a limiting factor of the patients with CFS in achieving maximal effort, which could be due to autonomic disturbances."
30. Sargent C, Scroop GC, Nemeth PM, Burnet RB, Buckley JD. Maximal oxygen uptake and lactate metabolism are normal in chronic fatigue syndrome. Med Sci Sports Exerc. (2002) 34:51–6.
"CONCLUSIONS: In contrast to most previous reports, the present study found that VO(2max), HR(max), and the LT in CFS patients of both genders were not different from the values expected in healthy sedentary individuals of a similar age."
37. Bazelmans E, Bleijenberg G, Van Der Meer JW, Folgering H. Is physical deconditioning a perpetuating factor in chronic fatigue syndrome? A controlled study on maximal exercise performance and relations with fatigue, impairment and physical activity. Psychol Med. (2001) 31:107–14.
"CONCLUSIONS: Physical deconditioning does not seem a perpetuating factor in CFS."
43. Fulcher KY, White PD. Strength and physiological response to exercise in patients with chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. (2000) 69:302–7.
"CONCLUSIONS: Patients with CFS were weaker than sedentary and depressed controls and as unfit as sedentary controls. Low exercise capacity in patients with CFS was related to quadriceps muscle weakness, low physical fitness, and a high body mass ratio. Improved physical fitness after treatment was associated with increased exercise capacity. These data imply that physical deconditioning helps to maintain physical disability in CFS and that a treatment designed to reverse deconditioning helps to improve physical function."
45. Gibson H, Carroll N, Clague JE, Edwards RH. Exercise performance and fatiguability in patients with chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. (1993) 56:993–8.
"Patients with chronic fatigue syndrome show normal muscle physiology before and after exercise. Raised perceived exertion scores during exercise suggest that central factors are limiting exercise capacity in these patients."
48. Inbar O, Dlin R, Rotstein A, Whipp BJ. Physiological responses to incremental exercise in patients with chronic fatigue syndrome. Med Sci Sports Exerc. (2001) 33:1463–70.
"these results could indicate either cardiac or peripheral insufficiency embedded in the pathology of CFS patients.
CONCLUSION: We conclude that indexes from cardiopulmonary exercise testing may be used as objective discriminatory indicators for evaluation of patients complaining of chronic fatigue syndrome."
61. Riley MS, O'Brien CJ, McCluskey DR, Bell NP, Nicholls DP. Aerobic work capacity in patients with chronic fatigue syndrome. BMJ. (1990) 301:953–6.
"CONCLUSIONS: Patients with the chronic fatigue syndrome have reduced aerobic work capacity compared with normal subjects and patients with the irritable bowel syndrome. They also have an altered perception of their degree of exertion and their premorbid level of physical activity."
64. Sisto SA, LaManca J, Cordero DL, Bergen MT, Ellis SP, Drastal S, et al. Metabolic and cardiovascular effects of a progressive exercise test in patients with chronic fatigue syndrome. Am J Med. (1996) 100:634–40.
"CONCLUSION: Compared with normal controls, women with CFS have an aerobic power indicating a low normal fitness level with no indication of cardiopulmonary abnormality. Our CFS group could withstand a maximal treadmill exercise test without a major exacerbation in either fatigue or other symptoms of their illness."
Not sure all 8 justify deconditioning. Seems only the Fulcher and White paper does. Quelle surprise!