Physiological measures in participants with CFS, multiple sclerosis and healthy controls following repeated exercise, 2017, Hodges et al

[Sasha]

Published back in August but I didn't notice it then.

Small pilot study.

Summary
Purpose
To compare physiological responses of chronic fatigue syndrome (CFS/ME), multiple sclerosis (MS) and healthy controls (HC) following a 24-h repeated exercise test.

Methods
Ten CFS, seven MS and 17 age- and gender-matched healthy controls (10, CFS HC; and seven, MS HC) were recruited. Each participant completed a maximal incremental cycle exercise test on day 1 and again 24 h later. Heart rate (HR), blood pressure (BP), rating of perceived exertion (RPE), oxygen consumption (

), carbon dioxide production and workload (WL) were recorded. Data analysis investigated these responses at anaerobic threshold (AT) and peak work rate (PWR).

Results
On day 2, both CFS and MS had significantly reduced max workload compared to HC. On day 2, significant differences were apparent in WL between CFS and CFS HC (93 ± 37 W, 132 ± 42 W, P<0·042). CFS workload decreased on day 2, alongside a decrease in HR but with an increase in

(ml kg min−1). This was in comparison with an increase in WL, HR and

for CFS HC. MS demonstrated a decreased WL compared to MS HC on both days of the study (D1 81 ± 30 W, 116 ±30 W; D2 84 ± 29 W, 118 ± 36 W); however, patients with MS were able to achieve a higher WL on day 2 alongside MS HC.

Conclusion
These results suggest that exercise exhibits a different physiological response in MS and CFS/ME, demonstrating repeated cardiovascular exercise testing as a valid measure for differentiating between fatigue conditions.

http://onlinelibrary.wiley.com/wol1/doi/10.1111/cpf.12460/abstract

 

[Adrian]

I'm assuming this is an independent replication of the two day exercise testing.

 

[Sasha]

I'm assuming this is an independent replication of the two day exercise testing.

The authors are all in New Zealand, so yes, it seems so.

 

[Hutan]

This study was followed by a CPET study with 48 and 72 hours between CPET measurements.

@Daisybell and I participated in this second study. The results have not yet been published, as far as I know.

 

[Woolie]

So glad to see NZ associated with something other than Keith Petrie and Rona Moss Morris.

 

[Simon M]

Well, certainly a very worthwhile approach but a pilot and only 7 mecfs and 7 MS patients makes the conclusion somewhat overblown

These results suggest that exercise exhibits a different physiological response in MS and CFS/ME, demonstrating repeated cardiovascular exercise testing as a valid measure for differentiating between fatigue conditions.

I’m willing to bet they didn’t correct statistics appropriately for all the many comparisons, which might do for the stat sig results.

Above all, we know that results from previous exercise studies on mecfs patients are all over the place, and until researchers can identify and achieve consistent results for mecfs patients (perhaps by sub groups), it’s likely to be impossible to have a meaningful comparison with other conditions.

 

[Mithriel]

Is the point not that ME patients, even if not all of them, do not have the same results on the second day? It is so taken for granted that everyone has the same results if this test is repeated that patients with heart disease or lung problems are only given the one test.

While it cannot be proved that no MS patient or heart patient will not have different results, a single ME patient who does deteriorate shows this is something that desperately needs to be studied.

 

[Barry]

Well, certainly a very worthwhile approach but a pilot and only 7 mecfs and 7 MS patients makes the conclusion somewhat overblown

It does state it's a pilot study, and suggests rather than claims. A bigger study would be good of course.

 

[Cheshire]

MEA review:

http://www.meassociation.org.uk/201...on-two-day-cpet-in-m-e-and-ms-29-august-2017/

 

[Wonko]

Whilst I can see the value in being able to demonstrate a marked dropoff in performance for pwME I worry, given the sort of linguistic trickery we have seen in the UK, that the use of word "repeated" may be misused.

That we will end up with what bears striking similarity to the old witchfinder trials.

Just keep testing them - if they get better they're okay, if they die they were clearly ill, oops - but at least we don't have to treat them, or put up with them in our nice cosy society. Win win, from one point of view.

Probably just me

 

[Skycloud]

@ Wonko Not something that had occured to me, but I wouldn't be surprised!

 

[Barry]

Whilst I can see the value in being able to demonstrate a marked dropoff in performance for pwME I worry, given the sort of linguistic trickery we have seen in the UK, that the use of word "repeated" may be misused.

That we will end up with what bears striking similarity to the old witchfinder trials.

Just keep testing them - if they get better they're okay, if they die they were clearly ill, oops - but at least we don't have to treat them, or put up with them in our nice cosy society. Win win, from one point of view.

Probably just me

I don't see this as necesarily just about an in-service diagnostics strategy. Initially it is about paving the way for changing people's attitudes, helping them see there really are biological differentiators that distinguish ME from other conditions. Maybe then motivating further research to develop more viable in-service diagnostics. This line of research, especially if replicated on a larger scale, could be a big nail in the BPS coffin. Now where did I put that hammer.

 

[John Mac]

This study was followed by a CPET study with 48 and 72 hours between CPET measurements.

@Daisybell and I participated in this second study. The results have not yet been published, as far as I know.

Is this it?

ABSTRACT
PURPOSE: To investigate the timeline of post-exertional malaise (PEM) using objective and subjective measures in Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

The primary aim was to determine whether PEM extends beyond 24-hours, and if a 48-hour or 72-hour repeated exercise protocol would provide additional information as a diagnostic tool.

The secondary aim was to analyse subjective patterns of fatigue during PEM. METHODS: Sixteen ME/CFS and 16 age and gender matched controls participated in the study.

Participants were randomly assigned to either a 48-hour or 72-hour repeated cardiopulmonary exercise test protocol on a cycle ergometer.

Objective measures were recorded at anaerobic threshold (AT), respiratory exchange ratio (RER) and maximal exercise.

All ME/CFS participants recorded their subjective fatigue 7-days prior to and 10-days post exercise utilising the daily diary of fatigue.

RESULTS:
Results from the 48-hour and 72-hour protocol indicated no decline in functional capacity in any group across days.

There was a significant increase in workload and %VO2max at AT within the 72-hour ME/CFS group only.

Subjective timelines of fatigue showed significant differences between the 48-hour and 72-hour protocol, with the 48-hour ME/CFS group taking significantly longer to recover (mean 11 days) than the 72-hour ME/CFS group (mean 5 days).

Conversely, both control groups were recovered in less than a day.

However, there was high variation across measures of subjective fatigue among ME/CFS participants.

CONCLUSIONS:
The results of this study further support the use of 24-hour repeated protocols to determine functional decline during PEM.

Results also provide new information regarding a potential improvement in function 72-hours after an initial exercise bout in ME/CFS.

Subjective results indicate no identifiable pattern in relation to subjective fatigue during PEM.

Future research should focus on a larger clinical trial to further understand the implications and consistency of the data from this study

pdf:
https://mro.massey.ac.nz/bitstream/handle/10179/14653/02_whole.pdf?sequence=2&isAllowed=y

 

[Hutan]

I'll set up a new thread for this paper, here. The section on CBT and GET looks disappointing.