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Hoffmann K, Hainzl A, Stingl M, Kurz K, Biesenbach B, Bammer C, Behrends U, Broxtermann W, Buchmayer F, Cavini AM, Fretz GS, Gole M, Grande B, Grande T, Habermann-Horstmeier L, Hackl V, Hamacher J, Hermisson J, King M, Kohl S, Leiss S, Litzlbauer D, Renz-Polster H, Ries W, Sagelsdorff J, Scheibenbogen C, Schieffer B, Schön L, Schreiner C, Thonhofer K, Strasser M, Weber T, Untersmayr E. [Interdisciplinary, collaborative D-A-CH (Germany, Austria and Switzerland) consensus statement concerning the diagnostic and treatment of myalgic encephalomyelitis/chronic fatigue syndrome]. Wien Klin Wochenschr 2024; 136:103-123. [PMID: 38743348 PMCID: PMC11093804 DOI: 10.1007/s00508-024-02372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe, chronic multisystemic disease which, depending on its severity, can lead to considerable physical and cognitive impairment, loss of ability to work and the need for nursing care including artificial nutrition and, in very severe cases, even death.The aim of this D-A-CH (Germany, Austria, Switzerland) consensus statement is 1) to summarize the current state of knowledge on ME/CFS, 2) to highlight the Canadian Consensus Criteria (CCC) as clinical criteria for diagnostics with a focus on the leading symptom post-exertional malaise (PEM) and 3) to provide an overview of current options and possible future developments, particularly with regard to diagnostics and therapy. The D-A-CH consensus statement is intended to support physicians, therapists and valuer in diagnosing patients with suspected ME/CFS by means of adequate anamnesis and clinical-physical examinations as well as the recommended clinical CCC, using the questionnaires and other examination methods presented. The overview of the two pillars of therapy for ME/CFS, pacing and symptom-relieving therapy options, is intended not only to provide orientation for physicians and therapists, but also to support decision-makers from healthcare policy and insurance companies in determining which therapy options should already be reimbursable by them at this point in time for the indication ME/CFS.
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Affiliation(s)
- Kathryn Hoffmann
- Allgemeinmedizin, Public Health und Versorgungsforschung, Abteilung für Primary Care Medicine, Zentrum für Public Health, Medizinische Universität Wien, Kinderspitalgasse 15, 1090, Wien, Österreich.
| | - Astrid Hainzl
- Österreichische Gesellschaft für ME/CFS, Wien, Österreich
| | | | - Katharina Kurz
- Innere Medizin, Universitätsklinik für Innere Medizin II, MedUni Innsbruck, Innsbruck, Österreich
| | - Beate Biesenbach
- Kinder- und Jugendheilkunde, kokon - Reha für junge Menschen, Kinder-Reha Rohrbach-Berg GmbH, Rohrbach-Berg, Österreich
| | - Christoph Bammer
- Innere Medizin, Nephrologie & Geriatrie, a. ö. BKH Kufstein, Kufstein, Österreich
| | - Uta Behrends
- MRI Chronische Fatigue Centrum für junge Menschen (MCFC), Zentrum für Kinder- und Jugendmedizin: eine Kooperation des Klinikums rechts der Isar, Technischen Universität München und der München Klinik gGmbH, München, Deutschland
| | | | - Florian Buchmayer
- Psychiatrie und Psychotherapie, Abteilung für Psychiatrie und Psychotherapie, Krankenhaus der Barmherzigen Brüder, Eisenstadt, Österreich
| | - Anna Maria Cavini
- Fachärztin für Kinder- und Jugendheilkunde, Psychotherapeutische Medizin, St.Veit/Glan, Österreich
| | - Gregory Sacha Fretz
- Department Innere Medizin, Medizinische Poliklinik, Kantonsspital Graubünden, Loestraße 170, 7000, Chur, Schweiz
| | - Markus Gole
- Psychologie und Philosophie, Praxis für Psychologie, Philosophie und Berufskunde, Linz, Österreich
| | - Bettina Grande
- Psychotherapie und Psychoanalyse, Heidelberg, Deutschland
| | - Tilman Grande
- Psychotherapie und Psychoanalyse, Heidelberg, Deutschland
| | | | - Verena Hackl
- Physiotherapie, AUVA Rehabilitationszentrum Meidling, Wien, Österreich
| | - Jürg Hamacher
- Innere Medizin und Pneumologie, Lindenhofspital, Bern, Schweiz
| | - Joachim Hermisson
- Biomathematik, Fakultät für Mathematik, Universität Wien, Wien, Österreich
- Department of Structural and Computational Biology, Max Perutz Labs, Wien, Österreich
| | - Martina King
- Lehrstuhl für Medical Humanities, Mathematisch-Naturwissenschaftliche und Medizinische Fakultät, Universität Fribourg, Fribourg, Schweiz
| | - Sonja Kohl
- #MillionsMissing Deutschland, Bedburg-Hau, Deutschland
| | - Sandra Leiss
- Österreichische Gesellschaft für ME/CFS, Wien, Österreich
| | | | - Herbert Renz-Polster
- Kinder- und Jugendheilkunde, Zentrum für Präventivmedizin und Digitale Gesundheit, Abteilung Allgemeinmedizin, Universitätsmedizin Mannheim, Universität Heidelberg, Heidelberg, Deutschland
| | - Wolfgang Ries
- Nephrologie, Dialyse, DIAKO Krankenhaus gGmbH, Flensburg, Deutschland
| | | | - Carmen Scheibenbogen
- Institut für Med. Immunologie, Sektion Immundefekte und Postinfektiöse Erkrankungen, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland
| | - Bernhard Schieffer
- Klinik für Innere Medizin-Kardiologie- Angiologie und Internistische Intensivmedizin und Zentrums für Notfallmedizin, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland
| | - Lena Schön
- Physiotherapie, Physio Austria: Fachgruppe für komplexe Multisystemerkrankungen, Wien, Österreich
| | - Claudia Schreiner
- Österreichische Gesellschaft für ME/CFS, Wien, Österreich
- #MillionsMissing Deutschland, Bedburg-Hau, Deutschland
| | | | - Maja Strasser
- Neurologie, Neurologische Praxis Solothurn, Solothurn, Schweiz
| | - Thomas Weber
- Schmerzmedizin, Facharzt für Anästhesie und Intensivmedizin, Graz, Österreich
| | - Eva Untersmayr
- Klinische Immunologie, Institut für Pathophysiologie und Allergieforschung, Zentrum für Pathophysiologie, Infektiologie und Immunologie, Medizinische Universität Wien, Wien, Österreich
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Faghy MA, Dalton C, Duncan R, Arena R, Ashton REM. Using cardiorespiratory fitness assessment to identify pathophysiology in long COVID - Best practice approaches. Prog Cardiovasc Dis 2024; 83:55-61. [PMID: 38417769 DOI: 10.1016/j.pcad.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 02/24/2024] [Indexed: 03/01/2024]
Abstract
Cardio-respiratory fitness (CRF) is well-established in the clinical domains as an integrative measure of the body's physiological capability and capacity to transport and utilise oxygen during controlled bouts of physical exertion. Long COVID is associated with >200 different symptoms and is estimated to affect ∼150 million people worldwide. The most widely reported impact is reduced quality of life and functional status due to highly sensitive and cyclical symptoms that manifest and are augmented following exposure to physical, emotional, orthostatic, and cognitive stimuli, more commonly known as post-exertional symptom exacerbation (PESE) which prevents millions from engaging in routine daily activities. The use of cardiopulmonary exercise testing (CPET) is commonplace in the assessment of integrated physiology; CPET will undoubtedly play an integral role in furthering the pathophysiology and mechanistic knowledge that will inform bespoke Long COVID treatment and management strategies. An inherent risk of previous attempts to utilise CPET protocols in patients with chronic disease is that these are compounded by PESE and have induced a worsening of symptoms for patients that can last for days or weeks. To do this effectively and to meet the global need, the complex multi-system pathophysiology of Long COVID must be considered to ensure the design and implementation of research that is both safe for participants and capable of advancing mechanistic understanding.
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Affiliation(s)
- Mark A Faghy
- Biomedical and Clinical Exercise Science Research Theme, University of Derby, Derby, UK; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection Network, Chicago, IL, USA.
| | - Caroline Dalton
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Rae Duncan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Ross Arena
- Biomedical and Clinical Exercise Science Research Theme, University of Derby, Derby, UK; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection Network, Chicago, IL, USA
| | - Ruth E M Ashton
- Biomedical and Clinical Exercise Science Research Theme, University of Derby, Derby, UK; Healthy Living for Pandemic Event Protection Network, Chicago, IL, USA
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Thoma M, Froehlich L, Hattesohl DBR, Quante S, Jason LA, Scheibenbogen C. Why the Psychosomatic View on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Is Inconsistent with Current Evidence and Harmful to Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:83. [PMID: 38256344 PMCID: PMC10819994 DOI: 10.3390/medicina60010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/18/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024]
Abstract
Since 1969, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) has been classified as a neurological disease in the International Classification of Diseases by the World Health Organization. Although numerous studies over time have uncovered organic abnormalities in patients with ME/CFS, and the majority of researchers to date classify the disease as organic, many physicians still believe that ME/CFS is a psychosomatic illness. In this article, we show how detrimental this belief is to the care and well-being of affected patients and, as a consequence, how important the education of physicians and the public is to stop misdiagnosis, mistreatment, and stigmatization on the grounds of incorrect psychosomatic attributions about the etiology and clinical course of ME/CFS.
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Affiliation(s)
- Manuel Thoma
- German Association for ME/CFS, 20146 Hamburg, Germany; (D.B.R.H.); (S.Q.)
| | - Laura Froehlich
- Research Center CATALPA, FernUniversität in Hagen, 58097 Hagen, Germany;
| | | | - Sonja Quante
- German Association for ME/CFS, 20146 Hamburg, Germany; (D.B.R.H.); (S.Q.)
| | - Leonard A. Jason
- Center for Community Research, DePaul University, Chicago, IL 60614, USA;
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin and Berlin Institute of Health (BIH), 10117 Berlin, Germany;
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Vøllestad NK, Mengshoel AM. Post-exertional malaise in daily life and experimental exercise models in patients with myalgic encephalomyelitis/chronic fatigue syndrome. Front Physiol 2023; 14:1257557. [PMID: 38111900 PMCID: PMC10725970 DOI: 10.3389/fphys.2023.1257557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/22/2023] [Indexed: 12/20/2023] Open
Abstract
Post-exertional malaise (PEM) is commonly recognized as a hallmark of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and is often used as one of several criteria for diagnosing ME/CFS. In this perspective paper we want to reflect on how PEM is understood, assessed, and evaluated in scientific literature, and to identify topics to be addressed in future research. Studies show that patients use a wide variety of words and concepts to label their experience of PEM in everyday life, and they report physical or mental exertions as triggers of PEM. They also report that PEM may have an immediate or delayed onset and may last from a few days to several months. When standardized exercise tests are used to trigger PEM experimentally, the exacerbation of symptoms has a more immediate onset but still shows a wide variability in duration. There are indications of altered muscular metabolism and autonomic nervous responses if exercise is repeated on successive days in patients with ME/CFS. The decreased muscular capacity appears to be maintained over several days following such controlled exercise bouts. These responses may correspond to patients' experiences of increased exertion. Based on this background we argue that there is a need to look more closely into the processes occurring in the restitution period following exercise, as PEM reaches the peak in this phase.
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Affiliation(s)
- Nina K. Vøllestad
- Department of Interdisciplinary Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
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Wormgoor MEA, Rodenburg SC. Focus on post-exertional malaise when approaching ME/CFS in specialist healthcare improves satisfaction and reduces deterioration. Front Neurol 2023; 14:1247698. [PMID: 38107643 PMCID: PMC10722442 DOI: 10.3389/fneur.2023.1247698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/31/2023] [Indexed: 12/19/2023] Open
Abstract
Background Post-exertional malaise (PEM) is considered a hallmark characteristic of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This may also apply to subgroups of patients with long COVID-induced ME/CFS. However, it is uncertain to what extent PEM is acknowledged in routine specialist healthcare for ME/CFS patients, and how this affects patient outcomes. Objective This study aims to evaluate to what extent ME/CFS patients experienced focus on PEM in specialist healthcare practice and its significance for outcome and care quality. Methods Data from two online cross-sectional surveys covering specialist healthcare services for ME/CFS patients at rehabilitation institutes in Norway and two regional hospitals, respectively, were analyzed. Evaluations of 788 rehabilitation stays, 86 hospital consultations, and 89 hospital interventions were included. Logistic regression models and Mann-Whitney U-tests were used to quantify the impact of addressing PEM on health and functioning, care satisfaction, or benefit. Spearman's rank correlation and Cronbach's alpha of focus on PEM with the respondents' perception of healthcare providers' knowledge, symptom acknowledgment, and suitability of intervention were assessed as measures for care quality and their internal consistency, respectively. Results PEM was addressed in 48% of the rehabilitation stays, 43% of the consultations, and 65% of the hospital interventions. Failure to address PEM roughly doubled the risk of health deterioration, following rehabilitation (OR = 0.39, 95% CI 0.29-0.52; 40.1% vs. 63.2% P = <0.001) and hospital intervention (OR = 0.34, 95% CI 0.13-0.89; 22.4% vs. 45.2%, p = 0.026). The focus on PEM (PEM-focus) during the clinical contact was associated with significantly higher scores on patients' rated care satisfaction and benefit of both consultation and intervention. Furthermore, addressing PEM was (inter)related to positive views about healthcare providers' level of knowledge of ME/CFS, their acknowledgment of symptoms, obtained knowledge, and the perceived suitability of intervention (Cronbach's alpha ≥0.80). Discussion PEM is still frequently not acknowledged in specialist healthcare practice for ME/CFS patients in Norway. Not addressing PEM substantially increased the probability of a decline in health and functioning following the intervention and was strongly associated with reduced perceived care quality, satisfaction, and benefit. These findings may be related to the applied explanatory models for ME/CFS and are most likely of relevance to long COVID.
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Affiliation(s)
| | - Sanne C. Rodenburg
- Neuroscience and Cognition, Graduate School of Life Sciences, Faculty of Medicine, Utrecht University, Utrecht, Netherlands
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Slavin MD, Bailey HM, Hickey EJ, Vasudevan A, Ledingham A, Tannenbaum L, Bateman L, Kaufman DL, Peterson DL, Ruhoy IS, Systrom DM, Felsenstein D, Kazis LE. Myalgic Encephalomyelitis-Chronic Fatigue Syndrome Common Data Element item content analysis. PLoS One 2023; 18:e0291364. [PMID: 37698999 PMCID: PMC10497138 DOI: 10.1371/journal.pone.0291364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/28/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multisystem chronic disease estimated to affect 836,000-2.5 million individuals in the United States. Persons with ME/CFS have a substantial reduction in their ability to engage in pre-illness levels of activity. Multiple symptoms include profound fatigue, post-exertional malaise, unrefreshing sleep, cognitive impairment, orthostatic intolerance, pain, and other symptoms persisting for more than 6 months. Diagnosis is challenging due to fluctuating and complex symptoms. ME/CFS Common Data Elements (CDEs) were identified in the National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke (NINDS) Common Data Element Repository. This study reviewed ME/CFS CDEs item content. METHODS Inclusion criteria for CDEs (measures recommended for ME/CFS) analysis: 1) assesses symptoms; 2) developed for adults; 3) appropriate for patient reported outcome measure (PROM); 4) does not use visual or pictographic responses. Team members independently reviewed CDEs item content using the World Health Organization International Classification of Functioning, Disability and Health (ICF) framework to link meaningful concepts. RESULTS 119 ME/CFS CDEs (measures) were reviewed and 38 met inclusion criteria, yielding 944 items linked to 1503 ICF meaningful concepts. Most concepts linked to ICF Body Functions component (b-codes; n = 1107, 73.65%) as follows: Fatiguability (n = 220, 14.64%), Energy Level (n = 166, 11.04%), Sleep Functions (n = 137, 9.12%), Emotional Functions (n = 131, 8.72%) and Pain (n = 120, 7.98%). Activities and Participation concepts (d codes) accounted for a smaller percentage of codes (n = 385, 25.62%). Most d codes were linked to the Mobility category (n = 69, 4.59%) and few items linked to Environmental Factors (e codes; n = 11, 0.73%). DISCUSSION Relatively few items assess the impact of ME/CFS symptoms on Activities and Participation. Findings support development of ME/CFS-specific PROMs, including items that assess activity limitations and participation restrictions. Development of psychometrically-sound, symptom-based item banks administered as computerized adaptive tests can provide robust assessments to assist primary care providers in the diagnosis and care of patients with ME/CFS.
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Affiliation(s)
- Mary D. Slavin
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Spaulding Rehabilitation Hospital, Rehabilitation Outcomes Center (ROC), Boston, Massachusetts, United States of America
| | - Hannah M. Bailey
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Emily J. Hickey
- University Center for Excellence in Developmental Disabilities, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Ananya Vasudevan
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Aileen Ledingham
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Linda Tannenbaum
- Open Medicine Foundation, Agoura Hills, California, United States of America
| | - Lucinda Bateman
- Bateman Horne Center of Excellence, Salt Lake City, Utah, United States of America
| | - David L. Kaufman
- Center for Complex Diseases, Mountain View, California, United States of America
| | - Daniel L. Peterson
- Sierra Internal Medicine, Incline Village, Nevada, United States of America
| | - Ilene S. Ruhoy
- Mount Sinai South Nassau, Neurology, Chiari/EDS Center, Oceanside, New York, United States of America
| | - David M. Systrom
- Brigham and Women’s Hospital, Lung Center, Boston, Massachusetts, United States of America
| | - Donna Felsenstein
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lewis E. Kazis
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Spaulding Rehabilitation Hospital, Rehabilitation Outcomes Center (ROC), Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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Joseph P, Singh I, Oliveira R, Capone CA, Mullen MP, Cook DB, Stovall MC, Squires J, Madsen K, Waxman AB, Systrom DM. Exercise Pathophysiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Postacute Sequelae of SARS-CoV-2: More in Common Than Not? Chest 2023; 164:717-726. [PMID: 37054777 PMCID: PMC10088277 DOI: 10.1016/j.chest.2023.03.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
TOPIC IMPORTANCE Postacute sequelae of SARS-CoV-2 (PASC) is a long-term consequence of acute infection from COVID-19. Clinical overlap between PASC and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has been observed, with shared symptoms including intractable fatigue, postexertional malaise, and orthostatic intolerance. The mechanistic underpinnings of such symptoms are poorly understood. REVIEW FINDINGS Early studies suggest deconditioning as the primary explanation for exertional intolerance in PASC. Cardiopulmonary exercise testing reveals perturbations related to systemic blood flow and ventilatory control associated with acute exercise intolerance in PASC, which are not typical of simple detraining. Hemodynamic and gas exchange derangements in PASC have substantial overlap with those observed with ME/CFS, suggestive of shared mechanisms. SUMMARY This review illustrates exercise pathophysiologic commonalities between PASC and ME/CFS that will help guide future diagnostics and treatment.
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Affiliation(s)
- Phillip Joseph
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale-New Haven Hospital, Yale University, New Haven, CT
| | - Inderjit Singh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale-New Haven Hospital, Yale University, New Haven, CT
| | - Rudolf Oliveira
- Division of Respiratory Disease, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Christine A Capone
- Division of Pediatric Cardiology Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra, Manhasset, NY
| | - Mary P Mullen
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Dane B Cook
- Research Service, William S. Middleton Memorial Veterans Hospital & Department of Kinesiology, University of Wisconsin-Madison, Madison, WI
| | - Mary Catherine Stovall
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Johanna Squires
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kristine Madsen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Aaron B Waxman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David M Systrom
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Tabisz H, Modlinska A, Kujawski S, Słomko J, Zalewski P. Whole-body cryotherapy as a treatment for chronic medical conditions? Br Med Bull 2023; 146:43-72. [PMID: 37170956 DOI: 10.1093/bmb/ldad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Whole-body cryotherapy (WBC) is a controlled exposure of the whole body to cold to gain health benefits. In recent years, data on potential applications of WBC in multiple clinical settings have emerged. SOURCES OF DATA PubMed, EBSCO and Clinical Key search using keywords including terms 'whole body', 'cryotherapy' and 'cryostimulation'. AREAS OF AGREEMENT WBC could be applied as adjuvant therapy in multiple conditions involving chronic inflammation because of its potent anti-inflammatory effects. Those might include systemic inflammation as in rheumatoid arthritis. In addition, WBC could serve as adjuvant therapy for chronic inflammation in some patients with obesity. AREAS OF CONTROVERSY WBC probably might be applied as an adjuvant treatment in patients with chronic brain disorders including mild cognitive impairment and general anxiety disorder and in patients with depressive episodes and neuroinflammation reduction as in multiple sclerosis. WBC effects in metabolic disorder treatment are yet to be determined. WBC presumably exerts pleiotropic effects and therefore might serve as adjuvant therapy in multi-systemic disorders, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). GROWING POINTS The quality of studies on the effects of WBC in the clinical setting is in general low; hence, randomized controlled trials with adequate sample size and longer follow-up periods are needed. AREAS ARE TIMELY FOR DEVELOPING RESEARCH Further studies should examine the mechanism underlying the clinical efficacy of WBC. Multiple conditions might involve chronic inflammation, which in turn could be a potential target of WBC. Further research on the application of WBC in neurodegenerative disorders, neuropsychiatric disorders and ME/CFS should be conducted.
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Affiliation(s)
- Hanna Tabisz
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, Bydgoszcz 85-077, Poland
| | - Aleksandra Modlinska
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, Bydgoszcz 85-077, Poland
| | - Sławomir Kujawski
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, Bydgoszcz 85-077, Poland
| | - Joanna Słomko
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, Bydgoszcz 85-077, Poland
| | - Pawel Zalewski
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, Bydgoszcz 85-077, Poland
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Warsaw Medical University, 1b Banacha Street, Warsaw 02-097, Poland
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Komaroff AL, Lipkin WI. ME/CFS and Long COVID share similar symptoms and biological abnormalities: road map to the literature. Front Med (Lausanne) 2023; 10:1187163. [PMID: 37342500 PMCID: PMC10278546 DOI: 10.3389/fmed.2023.1187163] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Some patients remain unwell for months after "recovering" from acute COVID-19. They develop persistent fatigue, cognitive problems, headaches, disrupted sleep, myalgias and arthralgias, post-exertional malaise, orthostatic intolerance and other symptoms that greatly interfere with their ability to function and that can leave some people housebound and disabled. The illness (Long COVID) is similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as well as to persisting illnesses that can follow a wide variety of other infectious agents and following major traumatic injury. Together, these illnesses are projected to cost the U.S. trillions of dollars. In this review, we first compare the symptoms of ME/CFS and Long COVID, noting the considerable similarities and the few differences. We then compare in extensive detail the underlying pathophysiology of these two conditions, focusing on abnormalities of the central and autonomic nervous system, lungs, heart, vasculature, immune system, gut microbiome, energy metabolism and redox balance. This comparison highlights how strong the evidence is for each abnormality, in each illness, and helps to set priorities for future investigation. The review provides a current road map to the extensive literature on the underlying biology of both illnesses.
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Affiliation(s)
- Anthony L. Komaroff
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - W. Ian Lipkin
- Center for Infection and Immunity, Mailman School of Public Health, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, United States
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10
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DeMars J, Brown DA, Angelidis I, Jones F, McGuire F, O'Brien KK, Oller D, Pemberton S, Tarrant R, Verduzco-Gutierrez M, Gross DP. What is Safe Long COVID Rehabilitation? JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:227-230. [PMID: 36315323 PMCID: PMC9628454 DOI: 10.1007/s10926-022-10075-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
| | - Darren A Brown
- Chelsea and Westminster Hospital NHS Foundation Trust, London, England
- Long COVID Physio, London, England
| | | | - Fiona Jones
- Population Health, St Georges University of London, London, UK
| | | | - Kelly K O'Brien
- Long COVID Physio, London, England
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Canada
| | | | | | - Rachel Tarrant
- Leeds Long COVID Community Rehabilitation Service, Leeds, England
| | | | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada.
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11
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Clague-Baker N, Davenport TE, Madi M, Dickinson K, Leslie K, Bull M, Hilliard N. An international survey of experiences and attitudes towards pacing using a heart rate monitor for people with myalgic encephalomyelitis/chronic fatigue syndrome. Work 2023; 74:1225-1234. [PMID: 36938766 DOI: 10.3233/wor-220512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Myalgic encephalomyelitis (ME) is a complex, multi-system neurological condition. The defining feature of ME is post-exertional malaise (PEM) with over 30 symptoms triggered by physical, cognitive, emotional and social activity. The cause of PEM is unclear but one area of research using cardio-pulmonary exercise tests show a reduced ventilatory anaerobic threshold (VAT) with repeated tests leading to PEM. Pacing with heart rate monitoring (HRM) provides feedback to maintain activity intensity below the VAT. There is only one piece of research investigating the use of HRM although a number of guidelines recommend it. OBJECTIVE To identify the experiences and attitudes of people with ME towards HRM. METHODS A 40 question online survey was devised and released on ME websites, Twitter and Facebook pages. People with ME read the information sheet and followed an online link to the survey. The survey was open for three weeks and all answers were anonymous. RESULTS 488 people with ME completed the survey. Most participants were female, 35-50 years and with a reported illness of greater than 5 years. Over 100 types of HR monitor used. Over 30 benefits and over 30 negatives identified. HRM reduced severity of ME and severity and duration of PEM. CONCLUSION Although there are limitations, HRM has many benefits including helping PwME to understand and manage their PEM and support them to increase their activities, including work. There is a need for more research and education of healthcare professionals in the safe use of HRM.
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Affiliation(s)
- Nicola Clague-Baker
- Physiotherapy Department, School of Health Sciences, Institute of Population Health, University of Liverpool, Liverpool, UK.,Physios for ME, UK
| | - Todd E Davenport
- Department of Physical Therapy, School of Health Sciences, University of the Pacific, Stockton, CA, USA
| | - Mohammad Madi
- Department of Physical and Occupational Therapy, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan
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12
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Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Post-COVID Syndrome: A Common Neuroimmune Ground? Diagnostics (Basel) 2022; 13:diagnostics13010066. [PMID: 36611357 PMCID: PMC9818907 DOI: 10.3390/diagnostics13010066] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/19/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating chronic disease of unknown etiology, sharing a similar clinical presentation with the increasingly recognized post-COVID syndrome. We performed the first cross-sectional study of ME/CFS in a community population in Russia. Then we described and compared some clinical and pathophysiological characteristics of ME/CFS and post-COVID syndrome as neuroimmune disorders. Of the cohort of 76 individuals who suggested themselves as suffering from ME/CFS, 56 were diagnosed with ME/CFS by clinicians according to ≥1 of the four most commonly used case definitions. Of the cohort of 14 individuals with post-COVID-19 syndrome, 14 met the diagnostic criteria for ME/CFS. The severity of anxiety/depressive symptoms did not correlate with the severity of fatigue either in ME/CFS or in post-COVID ME/CFS. Still, a positive correlation was found between the severity of fatigue and 20 other symptoms of ME/CFS related to the domains of "post-exertional exhaustion", "immune dysfunction", "sleep disturbances", "dysfunction of the autonomic nervous system", "neurological sensory/motor disorders" and "pain syndromes". Immunological abnormalities were identified in 12/12 patients with ME/CFS according to the results of laboratory testing. The prevalence of postural orthostatic tachycardia assessed in the active orthostatic test amounted to 37.5% in ME/CFS and 75.0% in post-COVID ME/CFS (the latter was higher than in healthy controls, p = 0.02). There was a more pronounced increase in heart rate starting from the 6th minute of the test in post-COVID ME/CFS compared with the control group. Assessment of the functional characteristics of microcirculation by laser doppler flowmetry revealed obvious and very similar changes in ME/CFS and post-COVID ME/CFS compared to the healthy controls. The identified laser doppler flowmetry pattern corresponded to the hyperemic form of microcirculation disorders usually observed in acute inflammatory response or in case of systemic vasoconstriction failure.
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13
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Special Issue “Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: Diagnosis and Treatment”. J Clin Med 2022; 11:jcm11154563. [PMID: 35956178 PMCID: PMC9369998 DOI: 10.3390/jcm11154563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
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Shi X, Chen X, Qiu X, Luo W, Luo X, Liu H, Geng Q, Ma H, Xue L, Guo L. Effect of High-Intensity Interval Training, Moderate Continuous Training, or Guideline-Based Physical Activity on Peak Oxygen Uptake and Myocardial Fibrosis in Patients With Myocardial Infarction: Protocol for a Randomized Controlled Trial. Front Cardiovasc Med 2022; 9:860071. [PMID: 35479268 PMCID: PMC9035926 DOI: 10.3389/fcvm.2022.860071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction High-intensity interval training (HIIT) is an emerging method of cardiac rehabilitation, which is more and more popular in recent years. Research into the effect of HIIT on peak oxygen uptake (VO2 peak) and myocardial fibrosis among patients with myocardial infarction (MI) is lacking. Here, we describe the rationale along with the protocol for a clinical trial to test the following hypotheses: (1) compared with the control group, VO2 peak will be increased in both the moderate-intensity continuous training (MICT) and HIIT groups and (2) compared with the control group, myocardial fibrosis due to MI will be improved by HIIT and MICT. Methods and Analysis This is a single-center, randomized controlled clinical trial. In total, 180 patients with MI are to be recruited for this study. VO2 peak will be tested by cardiopulmonary exercise testing (CPET) and myocardial fibrosis will be evaluated by cardiac MR. A variety of blood and psychometric tests and also the peripheral arterial tonometry, reactive hyperemia index for microvascular endothelial function, and microvascular blockage or digital vasomotor response are included. Ethics and Dissemination The ethics committee of the Guangdong Provincial People's Hospital has authorized this mechanistic clinical research. Peer-reviewed articles and conference presentations will be used to disseminate the findings. Trial Registration Number NCT04863677.
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Affiliation(s)
- Xiaohe Shi
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xianyuan Chen
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinfan Qiu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Luo
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinyi Luo
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui Liu
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qingshan Geng
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huan Ma
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Huan Ma
| | - Ling Xue
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Ling Xue
| | - Lan Guo
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Lan Guo
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15
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Twomey R, DeMars J, Franklin K, Culos-Reed SN, Weatherald J, Wrightson JG. Chronic Fatigue and Postexertional Malaise in People Living With Long COVID: An Observational Study. Phys Ther 2022; 102:pzac005. [PMID: 35079817 PMCID: PMC9383197 DOI: 10.1093/ptj/pzac005] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/08/2021] [Accepted: 11/28/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE People living with long COVID describe a high symptom burden, and a more detailed assessment is needed to inform rehabilitation recommendations. The objectives were to use validated questionnaires to measure the severity of fatigue and compare this with normative data and thresholds for clinical relevance in other diseases; measure and describe the impact of postexertional malaise (PEM); and assess symptoms of dysfunctional breathing, self-reported physical activity, and health-related quality of life. METHODS This was an observational study with a cross-sectional survey design (data collection from February 2021 to April 2021). Eligible participants were adults experiencing persistent symptoms due to COVID-19 that did not predate the confirmed or suspected infection. Questionnaires included the Functional Assessment of Chronic Illness Therapy-Fatigue Scale and the DePaul Symptom Questionnaire-Post-Exertional Malaise. RESULTS After data cleaning, 213 participants were included in the analysis. The total Functional Assessment of Chronic Illness Therapy-Fatigue Scale score was 18 (SD = 10) (where the score can range from 0 to 52, and a lower score indicates more severe fatigue), and 71.4% were experiencing chronic fatigue. Postexertional symptom exacerbation affected most participants, and 58.7% met the PEM scoring thresholds used in people living with myalgic encephalomyelitis/chronic fatigue syndrome. CONCLUSION Long COVID is characterized by chronic fatigue that is clinically relevant and at least as severe as fatigue in several other clinical conditions. PEM is a significant challenge for this patient group. Because of the potential for setbacks and deteriorated function following overexertion, fatigue and postexertional symptom exacerbation must be monitored and reported in clinical practice and in studies involving interventions for people with long COVID. IMPACT Physical therapists working with people with long COVID should measure and validate the patient's experience. Postexertional symptom exacerbation must be considered, and rehabilitation needs to be carefully designed based on individual presentation. Beneficial interventions might first ensure symptom stabilization via pacing, a self-management strategy for the activity that helps minimize postexertional malaise.
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Affiliation(s)
- Rosie Twomey
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O’Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | | | | | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
| | - Jason Weatherald
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, AB, Canada
| | - James G Wrightson
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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16
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Nelson MJ, Buckley JD, Thomson RL, Bellenger CR, Davison K. Markers of Cardiac Autonomic Function During Consecutive Day Peak Exercise Tests in People With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Front Physiol 2022; 12:771899. [PMID: 34970156 PMCID: PMC8713453 DOI: 10.3389/fphys.2021.771899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022] Open
Abstract
Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) have been shown to exhibit altered ventilatory characteristics on the second of two progressive maximal cardiopulmonary exercise tests (CPET) performed on consecutive days. However, maximal exercise can exacerbate symptoms for ME/CFS patients and cause significant post-exertional malaise. Assessment of heart rate (HR) parameters known to track post-exertional fatigue may represent more effective physiological markers of the condition and could potentially negate the need for maximal exercise testing. Sixteen ME/CFS patients and 10 healthy controls underwent a sub-maximal warm-up followed by CPET on two consecutive days. Ventilation, ratings of perceived exertion, work rate (WR) and HR parameters were assessed throughout on both days. During sub-maximal warm-up, a time effect was identified for the ratio of low frequency to high frequency power of HR variability (p=0.02) during sub-maximal warm-up, and for HR at ventilatory threshold (p=0.03), with both being higher on Day Two of testing. A significant group (p<0.01) effect was identified for a lower post-exercise HR recovery (HRR) in ME/CFS patients. Receiver operator characteristic curve analysis of HRR revealed an area under the curve of 74.8% (p=0.02) on Day One of testing, with a HRR of 34.5bpm maximising sensitivity (63%) and specificity (40%) suggesting while HRR values are altered in ME/CFS patients, low sensitivity and specificity limit its potential usefulness as a biomarker of the condition.
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Affiliation(s)
- Maximillian J Nelson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Rebecca L Thomson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.,Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Clint R Bellenger
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Kade Davison
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Murga I, Aranburu L, Gargiulo PA, Gómez-Esteban JC, Lafuente JV. The maintained attention assessment in patients affected by Myalgic encephalomyelitis/chronic fatigue syndrome: a reliable biomarker? J Transl Med 2021; 19:494. [PMID: 34863209 PMCID: PMC8645147 DOI: 10.1186/s12967-021-03153-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
The maintained attention is the cause of great functional limitations in CFS/ME, a disease that mainly affects women in the central period of life. Cognitive function is explored using the Montreal Cognitive Assessment, the maintained attention using the Toulouse-Piéron test with which the Global Index of Attention and Perception (GIAP) is obtained, the fatigue using the visual analog scale and the perception of effort using the modified Borg scale. The final sample were 84 patients (66 women/18 men) who met diagnostic criteria (Fukuda-1994, Carruthers-2011) and 22 healthy controls (14 women/8 men). Most of patients maintain normal cognitive function, showing low or very low attention score in the 70% of patients with a marked cognitive fatigue compared to the control group (p < 0.05). There were no significant differences between genders in GIAP or fatigue for CFS/ME; however, sick women perceive cognitive effort higher than men. Deficits in sustained attention and the perception of fatigue, so effort after performing the proposed test are a sensitive and reliable indicator that allows us to substantiate a clinical suspicion and refer patients for further studies in order to confirm or rule out CFS/ME.
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Affiliation(s)
- Iñigo Murga
- LaNCE-Neuropharm Group, Neuroscience Dep., University of the Basque Country (UPV-EHU), Leioa, Bizkaia Spain
| | - Larraitz Aranburu
- LaNCE-Neuropharm Group, Neuroscience Dep., University of the Basque Country (UPV-EHU), Leioa, Bizkaia Spain
| | - Pascual A. Gargiulo
- Experimental Psychology Laboratory, CONICET, Dep. Pathology, UNC, Mendoza, Argentina
| | - Juan-Carlos Gómez-Esteban
- LaNCE-Neuropharm Group, Neuroscience Dep., University of the Basque Country (UPV-EHU), Leioa, Bizkaia Spain
- Neurodegenerative Disease Group. Biocruces Research Institute, Bizkaia, Spain
| | - José-Vicente Lafuente
- LaNCE-Neuropharm Group, Neuroscience Dep., University of the Basque Country (UPV-EHU), Leioa, Bizkaia Spain
- Neurodegenerative Disease Group. Biocruces Research Institute, Bizkaia, Spain
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Kujawski S, Słomko J, Newton JL, Eaton-Fitch N, Staines DR, Marshall-Gradisnik S, Zalewski P. Network Analysis of Symptoms Co-Occurrence in Chronic Fatigue Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010736. [PMID: 34682478 PMCID: PMC8535251 DOI: 10.3390/ijerph182010736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022]
Abstract
Chronic fatigue syndrome (CFS) is a heterogenous disorder of multiple disabling symptoms with complex manifestations. Network analysis is a statistical and interrogative methodology to investigate the prevalence of symptoms (nodes) and their inter-dependent (inter-nodal) relationships. In the present study, we explored the co-occurrence of symptoms in a cohort of Polish CFS patients using network analysis. A total of 110 patients with CFS were examined (75 females). The mean age of the total sample was 37.93 (8.5) years old while the mean duration of symptoms in years was 4.4 (4). Post-exertional malaise (PEM) was present in 75.45% of patients, unrefreshing sleep was noted in 89.09% and impaired memory or concentration was observed in 87.27% of patients. The least prevalent symptom was tender cervical or axillary lymph nodes, noted in 34.55% of the total sample. Three of the most densely connected nodes were the total number of symptoms, sore throat and PEM. PEM was positively related with impairment in memory or concentration. Both PEM and impairment in memory or concentration presence are related to more severe fatigue measured by CFQ and FIS. PEM presence was positively related with the presence of multi-joint pain and negatively with tender lymph nodes and muscle pain. Sore throat was related with objective and subjective autonomic nervous system impairment. This study helps define symptom presentation of CFS with the pathophysiology of specific systems and links with multidisciplinary contemporary molecular pathology, including comparative MRI.
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Affiliation(s)
- Sławomir Kujawski
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland; (J.S.); (P.Z.)
- Correspondence:
| | - Joanna Słomko
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland; (J.S.); (P.Z.)
| | - Julia L. Newton
- Population Health Sciences Institute, The Medical School, Newcastle University, Newcastle-upon-Tyne NE2 4HH, UK;
| | - Natalie Eaton-Fitch
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute of Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia; (N.E.-F.); (D.R.S.); (S.M.-G.)
- Consortium Health International for Myalgic Encephalomyelitis, Menzies Health Institute Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia
| | - Donald R. Staines
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute of Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia; (N.E.-F.); (D.R.S.); (S.M.-G.)
- Consortium Health International for Myalgic Encephalomyelitis, Menzies Health Institute Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia
| | - Sonya Marshall-Gradisnik
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute of Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia; (N.E.-F.); (D.R.S.); (S.M.-G.)
- Consortium Health International for Myalgic Encephalomyelitis, Menzies Health Institute Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia
| | - Paweł Zalewski
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland; (J.S.); (P.Z.)
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute of Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia; (N.E.-F.); (D.R.S.); (S.M.-G.)
- Consortium Health International for Myalgic Encephalomyelitis, Menzies Health Institute Queensland, Griffith University, Gold Coast, Brisbane, QLD 4222, Australia
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