Category: Exercise

The effect of exercise on gait and balance in patients with chronic fatigue syndrome

Abstract:

This study investigated anecdotal reports of gait and balance abnormalities in subjects with Chronic Fatigue Syndrome (CFS) by examining the effects of a light exercise test on postural sway and various gait parameters. Tests were performed on 11 CFS patients and 11 age- and sex-matched sedentary controls. Results demonstrated that postural sway was not significantly different in both groups before or after the exercise test. There were, however, significant differences in gait parameters between the two groups confirming anecdotal evidence, but these differences were not exacerbated by the exercise test. Heart rate responses demonstrated that both groups were exercising at similar loads, although this was perceived to be higher by the CFS group.

 

Source: Paul LM, Wood L, Maclaren W. Gait Posture. 2001 Jul;14(1):19-27. The effect of exercise on gait and balance in patients with chronic fatigue syndrome. Gait Posture. 2001 Jul;14(1):19-27. http://www.ncbi.nlm.nih.gov/pubmed/11378421

 

Chronic fatigue syndrome: an update

Abstract:

The chronic fatigue syndrome is characterised by a fatigue that is disproportionate to the intensity of effort that is undertaken, has persisted for 6 months or longer, and has no obvious cause. Unless there has been a long period of patient- or physician-imposed inactivity, objective data may show little reduction in muscle strength or peak aerobic power, but the affected individual avoids heavy activity.

The study of aetiology and treatment has been hampered by the low disease prevalence (probably <0.1% of the general population), and (until recently) by a lack of clear and standardised diagnostic criteria. It is unclear how far the aetiology is similar for athletes and nonathletes. It appears that in top competitors, overtraining and/or a negative energy balance can be precipitating factors. A wide variety of other possible causes and/or precipitating factors have been cited in the general population, including psychological stress, disorders of personality and affect, dysfunction of the hypothalamic-pituitary-adrenal axis, hormonal imbalance, nutritional deficits, immune suppression or activation and chronic infection. However, none of these factors have been observed consistently. The prognosis is poor; often disability and impairment of athletic performance are prolonged.

Prevention of overtraining by careful monitoring seems the most effective approach in athletes. In those where the condition is established, treatment should aim at breaking the vicious cycle of effort avoidance, deterioration in physical condition and an increase in fatigue through a combination of encouragement and a progressive exercise programme.

 

Source: Shephard RJ. Chronic fatigue syndrome: an update. Sports Med. 2001;31(3):167-94. http://www.ncbi.nlm.nih.gov/pubmed/11286355

 

Recovery from chronic fatigue syndrome associated with changes in neuroendocrine function

[This is a case study on graded exercise. You can read the full report here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1280066/pdf/11220065.pdf]

 

Source: Sharma A, Oyebode F, Kendall MJ, Jones DA. Recovery from chronic fatigue syndrome associated with changes in neuroendocrine function. J R Soc Med. 2001 Jan;94(1):26-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1280066/ (Full article)

 

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

Abstract:

BACKGROUND: Chronic fatigue syndrome (CFS) patients often complain that physical exertion produces an increase of complaints, leading to a greater need for rest and more time spent in bed. It has been suggested that this is due to a bad physical fitness and that physical deconditioning is a perpetuating factor in CFS. Until now, studies on physical deconditioning in CFS have shown inconsistent results.

METHODS: Twenty CFS patients and 20 matched neighbourhood controls performed a maximal exercise test with incremental load. Heart rate, blood pressure, respiratory tidal volume, O2 saturation, O2 consumption, CO2 production, and blood-gas values of arterialized capillary blood were measured. Physical fitness was quantified as the difference between the actual and predicted ratios of maximal workload versus increase of heart rate. Fatigue, impairment and physical activity were assessed to study its relationship with physical fitness.

RESULTS: There were no statistically significant differences in physical fitness between CFS patients and their controls. Nine CFS patients had a better fitness than their control. A negative relationship between physical fitness and fatigue was found in both groups. For CFS patients a negative correlation between fitness and impairment and a positive correlation between fitness and physical activity was found as well. Finally, it was found that more CFS patients than controls did not achieve a physiological limitation at maximal exercise.

CONCLUSIONS: Physical deconditioning does not seem a perpetuating factor in CFS.

 

Source: 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 Jan;31(1):107-14. http://www.ncbi.nlm.nih.gov/pubmed/11200949

Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome

Abstract:

OBJECTIVE: To assess the efficacy of an educational intervention explaining symptoms to encourage graded exercise in patients with chronic fatigue syndrome.

DESIGN: Randomised controlled trial.

SETTING: Chronic fatigue clinic and infectious diseases outpatient clinic.

SUBJECTS: 148 consecutively referred patients fulfilling Oxford criteria for chronic fatigue syndrome.

INTERVENTIONS: Patients randomised to the control group received standardised medical care. Patients randomised to intervention received two individual treatment sessions and two telephone follow up calls, supported by a comprehensive educational pack, describing the role of disrupted physiological regulation in fatigue symptoms and encouraging home based graded exercise. The minimum intervention group had no further treatment, but the telephone intervention group received an additional seven follow up calls and the maximum intervention group an additional seven face to face sessions over four months.

MAIN OUTCOME MEASURE: A score of >/=25 or an increase of >/=10 on the SF-36 physical functioning subscale (range 10 to 30) 12 months after randomisation.

RESULTS: 21 patients dropped out, mainly from the intervention groups. Intention to treat analysis showed 79 (69%) of patients in the intervention groups achieved a satisfactory outcome in physical functioning compared with two (6%) of controls, who received standardised medical care (P<0.0001). Similar improvements were observed in fatigue, sleep, disability, and mood. No significant differences were found between the three intervention groups.

CONCLUSIONS: Treatment incorporating evidence based physiological explanations for symptoms was effective in encouraging self managed graded exercise. This resulted in substantial improvement compared with standardised medical care.

Comment in:

Patient education to encourage graded exercise in chronic fatigue syndrome. Trial has too many shortcomings. [BMJ. 2001]

ACP J Club. 2001 Sep-Oct;135(2):46.

 

Source: Powell P, Bentall RP, Nye FJ, Edwards RH. Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome. BMJ. 2001 Feb 17;322(7283):387-90. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC26565/ (Full article)

Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment

Abstract:

OBJECTIVE: Changes in physical activity are thought to play an important role in maintaining symptoms in chronic fatigue syndrome (CFS). The aim of this study was to describe intraindividual physical activity patterns in more detail and to identify pervasively passive patients.

METHODS: With help of a movement-sensing device, physical activity levels were registered continuously over a 12-day period in 277 CFS patients. Within this registration period, the 10 largest activity peaks were computed. The intensity and duration of these activity peaks and their subsequent rest periods were described and compared to those of 47 healthy controls. In addition, the patients’ 12 daily activity scores were used to identify patients who were characterised by low levels of physical activity throughout the registration period.

RESULTS: The CFS sample had less intense and shorter activity peaks, while the average rest periods that followed these peaks lasted longer. Approximately one-fourth of the CFS sample differed distinctly from the control group and was labelled as pervasively passive.

CONCLUSION: The measurements and classification of actual physical activity levels were found to reduce heterogeneity in the CFS population and therefore could provide the opportunity to optimise behavioural intervention protocols for CFS.

 

Source: van der Werf SP, Prins JB, Vercoulen JH, van der Meer JW, Bleijenberg G. Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. J Psychosom Res. 2000 Nov;49(5):373-9. http://www.ncbi.nlm.nih.gov/pubmed/11164063

 

Hormonal responses to exercise in chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome (CFS) is a debilitating disease characterized by severe, unexplained fatigue and postexertional exacerbation of symptoms. We examined basal endocrine function in a group of CFS patients and a carefully matched group of sedentary controls. The subjects then completed a graded, maximal exercise test on a treadmill, and additional blood samples were drawn 4 min and a day after the end of exercise.

There were no differences in basal hormone levels before exercise. Plasma adrenocorticotropin, epinephrine, prolactin and thyrotropin responses 4 min after exercise were lower in the CFS group, but the growth hormone response may have been exaggerated, and the plasma norepinephrine response was similar to that in controls.

The next day, there were no differences in hormone levels between the groups, which suggests that long-term changes in endocrine function are unlikely to be a cause of the prolonged fatigue that occurs in CFS patients after a bout of exertion.

 

Source: Ottenweller JE, Sisto SA, McCarty RC, Natelson BH. Hormonal responses to exercise in chronic fatigue syndrome. Neuropsychobiology. 2001 Jan;43(1):34-41. http://www.ncbi.nlm.nih.gov/pubmed/11150897

 

Strength and physiological response to exercise in patients with chronic fatigue syndrome

Abstract:

OBJECTIVE: To measure strength, aerobic exercise capacity and efficiency, and functional incapacity in patients with chronic fatigue syndrome(CFS) who do not have a current psychiatric disorder.

METHODS: Sixty six patients with CFS without a current psychiatric disorder, 30 healthy but sedentary controls, and 15 patients with a current major depressive disorder were recruited into the study. Exercise capacity and efficiency were assessed by monitoring peak and submaximal oxygen uptake, heart rate, blood lactate, duration of exercise, and perceived exertion during a treadmill walking test. Strength was measured using twitch interpolated voluntary isometric quadriceps contractions. Symptomatic measures included physical and mental fatigue, mood, sleep, somatic amplification, and functional incapacity.

RESULTS: Compared with sedentary controls, patients with CFS were physically weaker, had a significantly reduced exercise capacity, and perceived greater effort during exercise, but were equally unfit. Compared with depressed controls, patients with CFS had significantly higher submaximal oxygen uptakes during exercise, were weaker, and perceived greater physical fatigue and incapacity. Multiple regression models suggested that exercise incapacity in CFS was related to quadriceps muscle weakness, increased cardiovascular response to exercise, and body mass index. The best model of the increased exercise capacity found after graded exercise therapy consisted of a reduction in submaximal heart rate response to exercise.

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.

Comment in: Chronic fatigue syndrome: is it physical? [J Neurol Neurosurg Psychiatry. 2000]

 

Source: Fulcher KY, White PD. Strength and physiological response to exercise in patients with chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. 2000 Sep;69(3):302-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737090/ (Full article)

 

Chronic fatigue syndrome: is it physical?

Comment on: Strength and physiological response to exercise in patients with chronic fatigue syndrome. [J Neurol Neurosurg Psychiatry. 2000]

 

It is increasingly recognised that chronic fatigue syndrome (CFS) is heterogeneous. A significant proportion of patients fulfilling operative criteria for a diagnosis of CFS will also fulfill criteria for a psychiatric disorder, such as depression or somatisation. Failure to recognise this heterogeneity prejudices attempts to understand CFS in cross sectional studies. In this issue (pp 302–307) Fulcher et al report a study of muscle strength, aerobic exercise capacity, and functional incapacity in a group of patients with CFS without concurrent psychiatric disorder, compared with patients with major depression and a group of normal but sedentary subjects.1 In an incremental treadmill exercise test, patients with CFS and depressed patients had lower peak oxygen consumption rates, maximal heart rates, and plasma lactate concentrations than the sedentary controls; but this reflected the shorter duration of exercise tolerated by these patients. At submaximal work rates, patients with CFS and depressed patients experienced greater perception of eVort than sedentary controls at the same level of work. This is in keeping with the finding that such patients show greater sensitivity to bodily sensations than normal subjects. Overall, there was little difference between the patients with CFS and the depressed patients in exercise characteristics, yet the patients with CFS reported significantly greater degrees of physical fatigue and physical incapacity.

You can read the full comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737076/pdf/v069p00289.pdf

 

Source: Lane R. Chronic fatigue syndrome: is it physical? J Neurol Neurosurg Psychiatry. 2000 Sep;69(3):289. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737076/

 

Benefits of exercise therapy

Comment on: Acute effects of thirty minutes of light-intensity, intermittent exercise on patients with chronic fatigue syndrome. [Phys Ther. 1999]

 

We were interested to read in the report by Clapp et al (August 1999) that 30 minutes of intermittent walking did not exacerbate symptoms or cause any abnormal physiological response to exercise in subjects with chronic fatigue syndrome (CFS). Clapp and colleagues go on to suggest that “some individuals with CFS may be able to use low-level, intermittent exercise without exacerbating their symptoms.” They also write that “there are no data suggesting that exercises are effective as a primary treatment for patients with CFS.”

These authors do not go far enough in their recommendation and are quite wrong in their assumption regarding exercise as a primary treatment. Our group has published a randomized controlled trial showing that graded aerobic exercise therapy, properly supervised, is a significantly more effective treatment than the same amount of therapist input using only stretching and relaxation exercises.
This study showed that 52 % of patients rated themselves as “much” or “very much” better after 3 months of treatment, analyzed by intention to treat, compared with 27% of those treated with a control treatment. At the 1-year follow-up, the proportion of those who rated themselves as “much” better increased to 63% by intention-to-treat analysis (74% by completed patients’ analysis). Only 1 patient out of 33 patients rated himself “worse” after treatment, the same proportion as in the control treatment. Four patients dropped out of exercise therapy, and 3 patients dropped out of the control treatment. We excluded patients with a comorbid psychiatric disorder. We concluded that “these findings support the use of appropriate prescribed graded aerobic exercise in the management of patients with chronic fatigue syndrome.”

You can read the rest of this comment here: http://ptjournal.apta.org/content/80/1/115.long

 

Source: White P, Fulcher K. Benefits of exercise therapy. Phys Ther. 2000 Jan;80(1):115. http://ptjournal.apta.org/content/80/1/115.long