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The Impact of a Structured Exercise Programme upon Cognitive Function in Chronic Fatigue Syndrome Patients, 2019, Zalewski, Morten, Newton et al

Discussion in 'Psychosomatic research - ME/CFS and Long Covid' started by Andy, Dec 19, 2019.

  1. Andy

    Andy Committee Member

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    Open access to PDF, https://www.mdpi.com/2076-3425/10/1/4

    Note: Fukuda selection criteria.

    ETA: I was conflicted whether this should go in the Biomedical or the Psychosocial sub-forum as, to my mind, there are elements of both about it.
     
  2. Andy

    Andy Committee Member

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    Michelle, Hutan, Simon M and 2 others like this.
  3. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

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    Lack of a control group prevents the generalisability of these findings, the improved results on the third SRT may simply be a learning/experience effect.
     
    Last edited: Dec 20, 2019
    Kitty, EzzieD, Robert 1973 and 17 others like this.
  4. Trish

    Trish Moderator Staff Member

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    ''Sixty nine patients were invited to attend a second day of assessment which consisted of cardiopulmonary exercise testing (CPET) and explanation of the SEP protocol. However, 16 described themselves as unable to undergo CPET because of the anticipated post-exertional malaise symptoms during and after exertion. In total, 53 patients underwent a SEP protocol of 16 weeks. Thirty four 64.2% patients completed the intervention and underwent a follow up assessment that included fatigue, CPET and autonomic nervous system assessments...''

    So they started with 69 patients who met Fukuda criteria, but only 34 were able to do the CPET and the exercise program. That sounds to me as though the half who didn't complete were ME patients with PEM, and the other half probably didn't have PEM, so would not have met ME criteria such as IOM, ICC and CCC.

    From the discussion:
    (The false discovery rate (FDR) is a method of conceptualizing the rate of type I errors in null hypothesis testing when conducting multiple comparisons. FDR-controlling procedures are designed to control the expected proportion of "discoveries" (rejected null hypotheses) that are false (incorrect rejections).)

    So we have a study that claims effectiveness on the basis of a few minor improvements in reaction time in a few patients that are no longer significant when corrected for multiple comparisons. And looking at the graphs, it looks to me like a lot of people actually got worse, but the averages moved in the 'right' direction because of a few outliers.

    The abstract is highly misleading.
     
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  5. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    disappointed that K.Morton, J.Newton and EUROMENE are involved in this

    eta:
    eta2:
     
    Last edited: Dec 19, 2019
  6. Andy

    Andy Committee Member

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    Last edited: Dec 20, 2019
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  7. Hoopoe

    Hoopoe Senior Member (Voting Rights)

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    Can we see the CPET results for before and after?

    It has been suggested that GET leads to a decrease in fitness on the CPET and I would like to see if this was observed.
     
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  8. Hoopoe

    Hoopoe Senior Member (Voting Rights)

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    I'm sorry dear authors but this is a bit hard to believe. I think it's unlikely that you succeeded where others tried for 30 years with far more resources and failed. There is a discrepancy between what this paper seems to suggest (meaningful improvement in ability to exert) and what PACE showed (no increase in fitness, no improvemend on BORG scale, no clinically significant increase in walking speed).

    At the end, patients supposedly did 40 minutes of exercise of more than double the intensity (judging by heart rate), with additional stretching, for 5 times a week.
     
    Last edited: Dec 19, 2019
  9. ME/CFS Skeptic

    ME/CFS Skeptic Senior Member (Voting Rights)

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    Who suggested that?
     
  10. Hoopoe

    Hoopoe Senior Member (Voting Rights)

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    One of the people at Workwell. I'm not sure if it was GET or just some exercise program.
     
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  11. Trish

    Trish Moderator Staff Member

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  12. Barry

    Barry Senior Member (Voting Rights)

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    I would think it important to have more understanding and reporting of the dropouts. Else it's like doing a study on 69 cars to see if they pass an MOT test, and not knowing it some of the 50% dropped out because they couldn't make it to the test centre.
     
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  13. ME/CFS Skeptic

    ME/CFS Skeptic Senior Member (Voting Rights)

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    @strategist and @Trish Thanks.

    I've rewatched it and it seems that they simply mention an anecdote of a patient doing GET and having worsened values on CPET.

    The Belgian report had CPET info on patients who did GET and/or CBT with graded activity and the results were stable, rather than showing a decrease (there was no control group though).
     
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  14. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    Respiration key to increase oxygen in the brain
    https://news.psu.edu/story/600381/2019/12/04/research/respiration-key-increase-oxygen-brain

    Would it not be possible to try increasing oxygen saturation without exercise?
    From a bit of googling, oxygen saturation at night would also be something that could be looked at in pwME.

    BUT not to test the 'deconditioning/fear of exercise' theory which should have been abandoned long ago.
     
    Last edited: Dec 19, 2019
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  15. Trish

    Trish Moderator Staff Member

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    Trouble is, I think they would consider it unethical to put patients through a program of GET just to find out if their CPET gets worse.
     
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  16. dave30th

    dave30th Senior Member (Voting Rights)

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    yes, that's what I was wondering--whether people get better on cognitive tests through familiarity with the test rather than legitimate improvements.
     
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  17. JemPD

    JemPD Senior Member (Voting Rights)

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    I'd say yes, certainly in my experience, when i'm not good I can read & understand a short paragraph or a question that i've read/been asked before, but show me something new & i'm useless.
     
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  18. rvallee

    rvallee Senior Member (Voting Rights)

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    This is a self-selection process that filters out ME patients and leaves idiopathic chronic fatigue patients. Sampling uncertainty is a fundamental problem in ME research and researchers are expected to know better.
    This is not a valid conclusion without validating whether the tests have any meaningful significance, whereas they seem reductive and arbitrary.
     
  19. Hoopoe

    Hoopoe Senior Member (Voting Rights)

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    On further reflection, I think the correct interpretation is that it is impossible to say what is really occurring, but the lack of a control group allows the possibility of all positive effects being merely regression to the mean. Prolonged postinfectious fatigue/symptoms is quite common but tends to resolve itself over time. It's possible that their cohort contains a relatively high percentage of these kind of patients.
     
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  20. Trish

    Trish Moderator Staff Member

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    Thread here:
    https://www.s4me.info/threads/preva...cross-sectional-study-2019-slomko-et-al.8484/
     
    Kitty and Andy like this.

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