Exercise: Difference between revisions

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==Physiological effects of exercise==
==Physiological effects of exercise==


Exercise causes a variety of temporary physiological changes in healthy people. It induces [[hormesis]].
Exercise causes a variety of temporary physiological changes in healthy people. This includes an increase in respiratory rate, heart rate, and blood pressure in order to keep up with higher energy demands.<ref name=":0">{{Cite journal|last=Burton|first=Deborah Anne|last2=Stokes|first2=Keith|last3=Hall|first3=George M|date=01 December 2004|title=Physiological effects of exercise|url=https://academic.oup.com/bjaed/article/4/6/185/314696|journal=Continuing Education in Anaesthesia Critical Care & Pain|publisher=|volume=4|issue=6|pages=185-8|via=BJA Education}}</ref>  The chemical reactions that break down nutrients -- [[glycolysis]], the [[Citric Acid Cycle|Krebs Cycle]], and the [[electron transport chain]] -- move more rapidly to liberate energy, and blood flow to muscles should increase.  In healthy individuals, the amount of oxygen and carbon dioxide present in the blood should not alter significantly.<ref name=":0" />


===Immune system===
===Immune system===


In healthy people, exercise induces a variety of temporary changes to immune markers. Immediately after exercise, [[natural killer cell]] activity is decreased and [[Leukotriene]] B4 (LTB4) increase, along with the LTB4/PGE2 ratio. Exercise elevates levels of [[prostaglandin]] E2 (PGE2) for up to five days.<ref name="GrayJB1994"/>
In healthy people, exercise induces a variety of temporary changes to immune markers. Immediately after exercise, [[natural killer cell]] activity is decreased and [[Leukotriene]] B4 (LTB4) increase, along with the LTB4/PGE2 ratio. Exercise elevates levels of [[prostaglandin]] E2 (PGE2) for up to five days.<ref name="GrayJB1994" />


===Neurotransmitters===
===Neurotransmitters===
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===Pain threshold===
===Pain threshold===
Pain thresholds drop in people with [[CFS]] (as per the [[Fukuda criteria]]) after graded exercise, whereas in healthy controls, pain thresholds rise. This phenomenon is attributed by the study researchers to a dysfunction of the central anti-nociceptive mechanism in [[CFS]] patients.<ref name="Whiteside, 2004"/>
Pain thresholds drop in people with [[CFS]] (as per the [[Fukuda criteria]]) after graded exercise, whereas in healthy controls, pain thresholds rise. This phenomenon is attributed by the study researchers to a dysfunction of the central anti-nociceptive mechanism in [[CFS]] patients.<ref name="Whiteside, 2004" />


===Microbiome===
===Microbiome===


A small study of ten CFS patients found significant changes in the composition of the [[microbiome]] and increased bacterial translocation (movement from the [[intestine]] into the [[blood|bloodstream]] following exercise. In the blood, the study found increased ''[[Clostridium]]'' fifteen minutes after exercise and increased ''[[Bacilli]]'' 48 hours later.<ref name="ShuklaS2015"/>
A small study of ten CFS patients found significant changes in the composition of the [[microbiome]] and increased bacterial translocation (movement from the [[intestine]] into the [[blood|bloodstream]] following exercise. In the blood, the study found increased ''[[Clostridium]]'' fifteen minutes after exercise and increased ''[[Bacilli]]'' 48 hours later.<ref name="ShuklaS2015" />


=== Musculature ===
=== Musculature ===


Exercise has also been found to induce both early and excessive lactic acid formation in the [[muscle fatigability|muscles]]<ref name="Plioplys1995"/> with reduced intracellular concentrations of [[ATP]] and acceleration of [[glycolysis]].<ref name="McCully1996"/> Several studies have found abnormal increases in plasma lactate following short period of moderate exercise that cannot be explained by [[deconditioning]].<ref name="LaneRJ1998"/>
Exercise has also been found to induce both early and excessive lactic acid formation in the [[muscle fatigability|muscles]]<ref name="Plioplys1995" /> with reduced intracellular concentrations of [[ATP]] and acceleration of [[glycolysis]].<ref name="McCully1996" /> Several studies have found abnormal increases in plasma lactate following short period of moderate exercise that cannot be explained by [[deconditioning]].<ref name="LaneRJ1998" />


There is evidence of loss of capacity to recover from acidosis on repeat exercise.<ref name="JonesDE2012"/>  
There is evidence of loss of capacity to recover from acidosis on repeat exercise.<ref name="JonesDE2012" />  


There is evidence of abnormalities of [[AMPK]] activation and glucose uptake in cultured skeletal muscle cells in ME/CFS patients.<ref name="BrownAE2015"/><ref name="Wellness20150420"/>
There is evidence of abnormalities of [[AMPK]] activation and glucose uptake in cultured skeletal muscle cells in ME/CFS patients.<ref name="BrownAE2015" /><ref name="Wellness20150420" />


There is evidence of abnormalities in pH handling by peripheral muscle,<ref name="JonesDE2010"/> and possible evidence of an increased acidosis and lactate accumulation.<ref name="LengertN2015"/>
There is evidence of abnormalities in pH handling by peripheral muscle,<ref name="JonesDE2010" /> and possible evidence of an increased acidosis and lactate accumulation.<ref name="LengertN2015" />


=== Gene expression ===
=== Gene expression ===
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[[File:Light2011-geneexpression-figure3.jpg|right|frame|Gene expression changes following moderate exercise (Light et al, 2011)]]
[[File:Light2011-geneexpression-figure3.jpg|right|frame|Gene expression changes following moderate exercise (Light et al, 2011)]]


There is evidence of increased [[gene expression]] following muscular exertion.<ref name="LightAR2009"/><ref name="LightAR2011"/><ref name="WhiteAT2012"/>
There is evidence of increased [[gene expression]] following muscular exertion.<ref name="LightAR2009" /><ref name="LightAR2011" /><ref name="WhiteAT2012" />


A 2011 study found that moderate exercise in CFS increased the expression of 13 genes (sensory, adrenergic and 1 cytokine) for 48 hours, and the increases correlated with fatigue and pain levels.<ref name="LightAR2011"/> (see graph at right)
A 2011 study found that moderate exercise in CFS increased the expression of 13 genes (sensory, adrenergic and 1 cytokine) for 48 hours, and the increases correlated with fatigue and pain levels.<ref name="LightAR2011" /> (see graph at right)


=== Second day exercise test ===
=== Second day exercise test ===
[[File:Oxidative impairment.png|right|frame|Oxidative impairment on the second day of a two-day CPET, VanNess et al 2007]]
[[File:Oxidative impairment.png|right|frame|Oxidative impairment on the second day of a two-day CPET, VanNess et al 2007]]
The seminal study on the response by CFS patients to a 2-day cardiopulmonary exercise test was published by [[Mark VanNess]], [[Christopher Snell]] & [[Staci Stevens]] in 2007: "Diminished Cardiopulmonary Capacity During Post-Exertional Malaise"<ref name="VanNess2007"/> A repeat study in 2013 confirmed these results.<ref name="SnellCR2013"/>
The seminal study on the response by CFS patients to a 2-day cardiopulmonary exercise test was published by [[Mark VanNess]], [[Christopher Snell]] & [[Staci Stevens]] in 2007: "Diminished Cardiopulmonary Capacity During Post-Exertional Malaise"<ref name="VanNess2007" /> A repeat study in 2013 confirmed these results.<ref name="SnellCR2013" />


In a confirmation study, Doctor [[Betsy Keller]] found that patients could not repeat their performance on a second cardiopulmonary exercise test performed a day after the first.<ref name="KellerBA2014"/>
In a confirmation study, Doctor [[Betsy Keller]] found that patients could not repeat their performance on a second cardiopulmonary exercise test performed a day after the first.<ref name="KellerBA2014" />


A review by [[Jo Nijs|Nijs]] et al. found that multiple studies showed reduced peak heart rate, reduced endurance, reduced peak work rate, reduced peak oxygen uptake, lower blood lactate values, and an increased respiratory exchange ratio;<ref name="Nijs2014"/> see 'Oxidative impairment', below.
A review by [[Jo Nijs|Nijs]] et al. found that multiple studies showed reduced peak heart rate, reduced endurance, reduced peak work rate, reduced peak oxygen uptake, lower blood lactate values, and an increased respiratory exchange ratio;<ref name="Nijs2014" /> see 'Oxidative impairment', below.


Read the main page: '''[[Two-day cardiopulmonary exercise testing]]'''.
Read the main page: '''[[Two-day cardiopulmonary exercise testing]]'''.
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===Oxidative impairment===
===Oxidative impairment===


DeBecker et al (2000) and VanNess et al (2003) found low VO2 during exercise testing;<ref name="DeBecker2000"/><ref name="Vanness2003"/> Fulle et al (2000) demonstrated oxidative damage to DNA.<ref name="Fulle2000"/>; and Wong et al (1992) showed defects in oxidative metabolism and poor recovery of ATP after exercise.<ref name="Wong1992"/>
DeBecker et al (2000) and VanNess et al (2003) found low VO2 during exercise testing;<ref name="DeBecker2000" /><ref name="Vanness2003" /> Fulle et al (2000) demonstrated oxidative damage to DNA.<ref name="Fulle2000" />; and Wong et al (1992) showed defects in oxidative metabolism and poor recovery of ATP after exercise.<ref name="Wong1992" />


== Graded exercise ==
== Graded exercise ==
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===Dr [[Sarah Myhill]]===
===Dr [[Sarah Myhill]]===
Dr Myhill recommends patients who are well enough engage in strength training, specifically [[Body by Science]] created by Dr Doug McGuff and John Little. "If muscle strength is correctly developed, this automatically translates into cardiovascular fitness and increased numbers of mitochondria". Dr Myhill has a page on her web site [http://www.drmyhill.co.uk/wiki/Exercise_-_the_right_sort detailing her recommendations]<ref name="MyhillExercise"/>.
Dr Myhill recommends patients who are well enough engage in strength training, specifically [[Body by Science]] created by Dr Doug McGuff and John Little. "If muscle strength is correctly developed, this automatically translates into cardiovascular fitness and increased numbers of mitochondria". Dr Myhill has a page on her web site [http://www.drmyhill.co.uk/wiki/Exercise_-_the_right_sort detailing her recommendations]<ref name="MyhillExercise" />.


===Dr. [[Lucinda Bateman]]===
===Dr. [[Lucinda Bateman]]===
Dr Bateman encourages her patients to find a way to exercise: "we try to focus on maintaining or improving muscle strength, flexibility and also bit of cardiovascular exercise". She discusses exercise and gene expression in [https://www.youtube.com/watch?v=F1PP21TmUPs an interview]<ref name="Bateman20151103interview"/>.
Dr Bateman encourages her patients to find a way to exercise: "we try to focus on maintaining or improving muscle strength, flexibility and also bit of cardiovascular exercise". She discusses exercise and gene expression in [https://www.youtube.com/watch?v=F1PP21TmUPs an interview]<ref name="Bateman20151103interview" />.


===Dr. [[Nancy Klimas]]===
===Dr. [[Nancy Klimas]]===
Dr Klimas recommends patients engage in exercise or movement without exceeding a certain heart rate, a proxy for an individual's [[anaerobic threshold]], as established by a [[Cardiopulmonary exercise test|VO2 max test]].<ref name="Klimas20110724phoenix"/> She also recommends alternating periods of exercise and rest.<ref name="Klimas2010"/> She says that exercise tends to be better tolerated when performed in a horizontal position, like recumbent bicycling or swimming.
Dr Klimas recommends patients engage in exercise or movement without exceeding a certain heart rate, a proxy for an individual's [[anaerobic threshold]], as established by a [[Cardiopulmonary exercise test|VO2 max test]].<ref name="Klimas20110724phoenix" /> She also recommends alternating periods of exercise and rest.<ref name="Klimas2010" /> She says that exercise tends to be better tolerated when performed in a horizontal position, like recumbent bicycling or swimming.


===Dr. [[Ritchie Shoemaker]]===
===Dr. [[Ritchie Shoemaker]]===
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===[[Workwell Foundation]]===
===[[Workwell Foundation]]===
[[Workwell Foundation]], which specialises in [[two-day cardiopulmonary exercise testing]] ([[CPET]]), recommends short periods (eg: 30 seconds) of analeptic exercise, with periods of rest which are 3-6 times longer than the period of exercise. The amount of exercise that the individual undertakes should be guided by VO2 max testing (or a safe heart rate threshold (generally 60% of maximum heart rate)), and the use of a heart rate monitor (both during exercise and to help with [[pacing]]) is recommended to ensure that the individual doesn't exceed their capacity. The Foundation also advises against aerobic exercise for people with [[ME/CFS]].<ref name="Workwell201404rae"/><ref name="Workwell201404wwodwo"/><ref name="Workwell201512foar"/>
[[Workwell Foundation]], which specialises in [[two-day cardiopulmonary exercise testing]] ([[CPET]]), recommends short periods (eg: 30 seconds) of analeptic exercise, with periods of rest which are 3-6 times longer than the period of exercise. The amount of exercise that the individual undertakes should be guided by VO2 max testing (or a safe heart rate threshold (generally 60% of maximum heart rate)), and the use of a heart rate monitor (both during exercise and to help with [[pacing]]) is recommended to ensure that the individual doesn't exceed their capacity. The Foundation also advises against aerobic exercise for people with [[ME/CFS]].<ref name="Workwell201404rae" /><ref name="Workwell201404wwodwo" /><ref name="Workwell201512foar" />


This approach to exercise differs from [[Graded Exercise Therapy]] ([[GET]]) in several important ways:
This approach to exercise differs from [[Graded Exercise Therapy]] ([[GET]]) in several important ways:
*There is no claim that the exercise program will cure the condition. The aim is to increase functional strength and flexibility, and to improve quality of life, whilst not exacerbating the condition<ref name="Workwell201404wwodwo"/>
 
*This program is based on a deep understanding of [[Post-exertional malaise]] ([[PEM]]), and the importance of staying within the [[energy envelope]] in order to not trigger [[PEM]]<ref name="Workwell201404rae"/>
*There is no claim that the exercise program will cure the condition. The aim is to increase functional strength and flexibility, and to improve quality of life, whilst not exacerbating the condition<ref name="Workwell201404wwodwo" />
*There is a recognition that any approach to exercise with people with [[ME/CFS]] must be carefully tailored to the individual. There is no one-size fits all<ref name="Workwell201404wwodwo"/>
*This program is based on a deep understanding of [[Post-exertional malaise]] ([[PEM]]), and the importance of staying within the [[energy envelope]] in order to not trigger [[PEM]]<ref name="Workwell201404rae" />
*This approach utilises objective measures such as VO2 max testing and heart rate monitoring to guide the level of activity suitable for the individual<ref name="Workwell201512foar"/>
*There is a recognition that any approach to exercise with people with [[ME/CFS]] must be carefully tailored to the individual. There is no one-size fits all<ref name="Workwell201404wwodwo" />
*This approach utilises objective measures such as VO2 max testing and heart rate monitoring to guide the level of activity suitable for the individual<ref name="Workwell201512foar" />


===United States Centers for Disease Control===
===United States Centers for Disease Control===
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===UK NICE Guidelines===
===UK NICE Guidelines===
British blogger, Sally Burch, has written about the The UK [[National Institute for Health and Care Excellence]] (NICE) guidelines on maintaining a lower heart rate.<ref name="BurchS20151114slideshow"/>
British blogger, Sally Burch, has written about the The UK [[National Institute for Health and Care Excellence]] (NICE) guidelines on maintaining a lower heart rate.<ref name="BurchS20151114slideshow" />


==Talks & Interviews==
==Talks & Interviews==
*2016, [https://www.youtube.com/watch?v=FXN6f53ba6k Dr. Mark Van Ness, "Expanding Physical Capability in ME/CFS" Part 1 (of 2)] ([[Mark VanNess]])
*2016, [https://www.youtube.com/watch?v=FXN6f53ba6k Dr. Mark Van Ness, "Expanding Physical Capability in ME/CFS" Part 1 (of 2)] ([[Mark VanNess]])
*2016, [https://www.youtube.com/watch?v=7BceGgEdMpA Dr. Mark Van Ness, "Expanding Physical Capability in ME/CFS" Part 2 (of 2)] ([[Mark VanNess]])
*2016, [https://www.youtube.com/watch?v=7BceGgEdMpA Dr. Mark Van Ness, "Expanding Physical Capability in ME/CFS" Part 2 (of 2)] ([[Mark VanNess]])
*2015, [https://www.youtube.com/watch?v=F1PP21TmUPs 72. Gene-expression and exercise / Gen-expressie en inspanning – dr. Lucinda Bateman] ([[Lucinda Bateman]], [[Science for Patients]])
*2015, [https://www.youtube.com/watch?v=F1PP21TmUPs 72. Gene-expression and exercise / Gen-expressie en inspanning – dr. Lucinda Bateman] ([[Lucinda Bateman]], [[Science for Patients]])
*2014, [https://www.youtube.com/watch?v=q_cnva7zyKM Mark VanNess 'Exercise and ME/CFS' at Bristol Watershed. Part One]<ref name="VanNess20140205video"/> ([[Mark VanNess]])
*2014, [https://www.youtube.com/watch?v=q_cnva7zyKM Mark VanNess 'Exercise and ME/CFS' at Bristol Watershed. Part One]<ref name="VanNess20140205video" /> ([[Mark VanNess]])
*2013, [https://www.youtube.com/watch?v=zZ8aPYihkpQ CFS gene expression after exercise (part 1)] ([[Lucinda Bateman]])
*2013, [https://www.youtube.com/watch?v=zZ8aPYihkpQ CFS gene expression after exercise (part 1)] ([[Lucinda Bateman]])
*2012, [https://www.youtube.com/watch?v=nL49DwGRs30 Clinical exercise testing in CFS/ME research and treatment] ([[Christopher Snell]])
*2012, [https://www.youtube.com/watch?v=nL49DwGRs30 Clinical exercise testing in CFS/ME research and treatment] ([[Christopher Snell]])
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==Studies==
==Studies==
*[https://www.ncbi.nlm.nih.gov/pubmed/27187093 2016, Effect of Acute Exercise on Fatigue in People with ME/CFS/SEID: A Meta-analysis]
*[https://www.ncbi.nlm.nih.gov/pubmed/27187093 2016, Effect of Acute Exercise on Fatigue in People with ME/CFS/SEID: A Meta-analysis]
*2016, [[Cochrane|Cochrane meta-analysis]]
*2016, [[Cochrane|Cochrane meta-analysis]]
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==Learn more==
==Learn more==
*Oct 2, 2017 - [https://www.npr.org/sections/health-shots/2017/10/02/554369327/for-people-with-chronic-fatigue-syndrome-more-exercise-isnt-better For People With Chronic Fatigue Syndrome, More Exercise Isn't Better - by Michaeleen Doucleff for ''Shots: Health News From NPR'']
*Oct 2, 2017 - [https://www.npr.org/sections/health-shots/2017/10/02/554369327/for-people-with-chronic-fatigue-syndrome-more-exercise-isnt-better For People With Chronic Fatigue Syndrome, More Exercise Isn't Better - by Michaeleen Doucleff for ''Shots: Health News From NPR'']
*Aug 12, 2016 - [http://solvecfs.org/neuromuscular-strain-in-mecfs-research-study-conclusion/ Neuromuscular Strain in ME/CFS – Research Study Conclusion] in [[Solve ME/CFS Initiative]] Newsletter
*Aug 12, 2016 - [http://solvecfs.org/neuromuscular-strain-in-mecfs-research-study-conclusion/ Neuromuscular Strain in ME/CFS – Research Study Conclusion] in [[Solve ME/CFS Initiative]] Newsletter
*Jul 6, 2016 - [https://meaustralia.net/2016/07/06/australian-metabolomics-study-of-young-women/ Australian metabolomics study of young women with ME/CFS (CCC)] by Sasha Nimmo for ''ME Australia''  
*Jul 6, 2016 - [https://meaustralia.net/2016/07/06/australian-metabolomics-study-of-young-women/ Australian metabolomics study of young women with ME/CFS (CCC)] by Sasha Nimmo for ''ME Australia''  
*Feb 10, 2016 - [http://www.prohealth.com/library/showarticle.cfm?libid=25096 Lost in Translation - The ME-Polio Connection and the Dangers of Exercise] by [[Nancy Blake]] for ''[[ProHealth]]''<ref name="ProHealth20160210"/>
*Feb 10, 2016 - [http://www.prohealth.com/library/showarticle.cfm?libid=25096 Lost in Translation - The ME-Polio Connection and the Dangers of Exercise] by [[Nancy Blake]] for ''[[ProHealth]]''<ref name="ProHealth20160210" />
*Jan 2016 - [http://www.hindawi.com/journals/jar/2016/2497348/ Review Article: Understanding Muscle Dysfunction in Chronic Fatigue Syndrome] by Gina Rutherford, Philip Manning, and [[Julia Newton|Julia L. Newton]]<ref name="RutherfordG2016"/>
*Jan 2016 - [http://www.hindawi.com/journals/jar/2016/2497348/ Review Article: Understanding Muscle Dysfunction in Chronic Fatigue Syndrome] by Gina Rutherford, Philip Manning, and [[Julia Newton|Julia L. Newton]]<ref name="RutherfordG2016" />
*Dec 19, 2015 - [https://cfsremission.wordpress.com/2015/12/19/exercise-alteration-of-the-cfs-microbiome/ Exercise alteration of the CFS Microbiome] from [[CFS Remission]] blog  
*Dec 19, 2015 - [https://cfsremission.wordpress.com/2015/12/19/exercise-alteration-of-the-cfs-microbiome/ Exercise alteration of the CFS Microbiome] from [[CFS Remission]] blog  
*Nov 7, 2015 - [http://www.jacobspublishers.com/images/Physiology/J_J_Physiology_1_2_007.pdf Deviant Cellular and Physiological Responses to Exercise in Myalgic Encephalomyelitis and Chronic Fatigue Syndrome] by [[Frank Twisk|Frank N.M. Twisk]], and [[Keith Geraghty|Keith J. Geraghty]]<ref name="TwiskF2015"/>
*Nov 7, 2015 - [http://www.jacobspublishers.com/images/Physiology/J_J_Physiology_1_2_007.pdf Deviant Cellular and Physiological Responses to Exercise in Myalgic Encephalomyelitis and Chronic Fatigue Syndrome] by [[Frank Twisk|Frank N.M. Twisk]], and [[Keith Geraghty|Keith J. Geraghty]]<ref name="TwiskF2015" />
*Jan 17, 2015 - [http://sallyjustme.blogspot.co.uk/2015/01/dr-vanness-on-recent-press-reports.html Dr. VanNess on recent press reports] by Sally Burch in [[Just ME]] blog<ref name="BurchS20150117"/>
*Jan 17, 2015 - [http://sallyjustme.blogspot.co.uk/2015/01/dr-vanness-on-recent-press-reports.html Dr. VanNess on recent press reports] by Sally Burch in [[Just ME]] blog<ref name="BurchS20150117" />
*2014 - [https://www.youtube.com/watch?v=kbaW4JKkin4 ME/CFS and Exercise: VO2 Max Testing with Nancy Klimas M.D. - PREVIEW] (this is a preview of a pay-per-view video)
*2014 - [https://www.youtube.com/watch?v=kbaW4JKkin4 ME/CFS and Exercise: VO2 Max Testing with Nancy Klimas M.D. - PREVIEW] (this is a preview of a pay-per-view video)
*May 16, 2014 - [http://www.deseretnews.com/article/865603384/Sufferers-of-chronic-fatigue-fibromyalgia-have-hope-in-new-diagnostic-tool.html Sufferers of chronic fatigue, fibromyalgia have hope in new diagnostic tool] by Wendy Leonard for ''Deseret News''<ref name="DeseretNews20140516"/>
*May 16, 2014 - [http://www.deseretnews.com/article/865603384/Sufferers-of-chronic-fatigue-fibromyalgia-have-hope-in-new-diagnostic-tool.html Sufferers of chronic fatigue, fibromyalgia have hope in new diagnostic tool] by Wendy Leonard for ''Deseret News''<ref name="DeseretNews20140516" />
*Autumn 2011 - [http://www.meresearch.org.uk/our-research/completed-studies/acidosis/ Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome: a case–control study], an essay for [[ME Research UK]]
*Autumn 2011 - [http://www.meresearch.org.uk/our-research/completed-studies/acidosis/ Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome: a case–control study], an essay for [[ME Research UK]]
*2011 - [https://www.youtube.com/watch?v=Suq0dPMUbOk ME/CFS and Exercise: The VO2 Max Based Exercise Program, A Personal View] by [[Dan Moricoli]]
*2011 - [https://www.youtube.com/watch?v=Suq0dPMUbOk ME/CFS and Exercise: The VO2 Max Based Exercise Program, A Personal View] by [[Dan Moricoli]]


== See also ==
== See also ==
*[[Two-day cardiopulmonary exercise testing]]  
*[[Two-day cardiopulmonary exercise testing]]  
*[[Graded exercise therapy]]
*[[Graded exercise therapy]]
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==References==
==References==
<references>
<references>
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| url    = https://www.youtube.com/watch?v=F1PP21TmUPs
| url    = https://www.youtube.com/watch?v=F1PP21TmUPs
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}}</ref>
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| last1  = Brown            | first1 = Audrey E          | authorlink1 = Audrey Brown
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| url    = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122982
| url    = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122982
}}</ref>
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| last1  = Burch          | first1 = Sally              | authorlink1 = Sally Burch
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| url    = http://sallyjustme.blogspot.co.uk/2015/01/dr-vanness-on-recent-press-reports.html  
| url    = http://sallyjustme.blogspot.co.uk/2015/01/dr-vanness-on-recent-press-reports.html  
}}</ref>
}}</ref>
<ref name="BurchS20151114slideshow">{{citation
<ref name="BurchS20151114slideshow">{{citation
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| last1  = Burch            | first1 = Sally              | authorlink1 = Sally Burch
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| url    = http://www.slideshare.net/SallyBurch/heart-rate-monitoring-and-nice-guideline-for-me  
| url    = http://www.slideshare.net/SallyBurch/heart-rate-monitoring-and-nice-guideline-for-me  
}}</ref>
}}</ref>
<ref name="DeBecker2000">{{citation
<ref name="DeBecker2000">{{citation
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| last1  = De Becker        | first1 = P                  | authorlink1 = Pascale De Becker
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| url    = http://archinte.jamanetwork.com/article.aspx?articleid=485564
| url    = http://archinte.jamanetwork.com/article.aspx?articleid=485564
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}}</ref>
<ref name="DeseretNews20140516">{{citation
<ref name="DeseretNews20140516">{{citation
| author  = Deseret News
| author  = Deseret News
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| url    = http://www.deseretnews.com/article/865603384/Sufferers-of-chronic-fatigue-fibromyalgia-have-hope-in-new-diagnostic-tool.html
| url    = http://www.deseretnews.com/article/865603384/Sufferers-of-chronic-fatigue-fibromyalgia-have-hope-in-new-diagnostic-tool.html
}}</ref>
}}</ref>
<ref name="Fulle2000">{{citation
<ref name="Fulle2000">{{citation
| last1  = Fulle            | first1 = S                  | authorlink1 = Stefania Fulle
| last1  = Fulle            | first1 = S                  | authorlink1 = Stefania Fulle
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[[Category:Potential treatments]]
[[Category:Potential treatments]]
[[Category:Tests]]
[[Category:Tests]]

Revision as of 02:57, April 25, 2018

Physiological effects of exercise[edit | edit source]

Exercise causes a variety of temporary physiological changes in healthy people. This includes an increase in respiratory rate, heart rate, and blood pressure in order to keep up with higher energy demands.[1] The chemical reactions that break down nutrients -- glycolysis, the Krebs Cycle, and the electron transport chain -- move more rapidly to liberate energy, and blood flow to muscles should increase. In healthy individuals, the amount of oxygen and carbon dioxide present in the blood should not alter significantly.[1]

Immune system[edit | edit source]

In healthy people, exercise induces a variety of temporary changes to immune markers. Immediately after exercise, natural killer cell activity is decreased and Leukotriene B4 (LTB4) increase, along with the LTB4/PGE2 ratio. Exercise elevates levels of prostaglandin E2 (PGE2) for up to five days.[2]

Neurotransmitters[edit | edit source]

Acetylcholine, an important neurotransmitter that regulates immune response and muscle strength, decreases during exercise.

Effects of exercise in Chronic Fatigue Syndrome[edit | edit source]

Post Exertional Malaise[edit | edit source]

Post-exertional worsening of symptoms, VanNess et al 2010.png
PEM chart from the 2015 Institute of Medicine report

ME patients who exercise are likely to experience Post-exertional malaise which is a worsening of symptoms following physical, mental, emotional or sensory exertion.

Read the main page: Post-exertional malaise.

Pain threshold[edit | edit source]

Pain thresholds drop in people with CFS (as per the Fukuda criteria) after graded exercise, whereas in healthy controls, pain thresholds rise. This phenomenon is attributed by the study researchers to a dysfunction of the central anti-nociceptive mechanism in CFS patients.[3]

Microbiome[edit | edit source]

A small study of ten CFS patients found significant changes in the composition of the microbiome and increased bacterial translocation (movement from the intestine into the bloodstream following exercise. In the blood, the study found increased Clostridium fifteen minutes after exercise and increased Bacilli 48 hours later.[4]

Musculature[edit | edit source]

Exercise has also been found to induce both early and excessive lactic acid formation in the muscles[5] with reduced intracellular concentrations of ATP and acceleration of glycolysis.[6] Several studies have found abnormal increases in plasma lactate following short period of moderate exercise that cannot be explained by deconditioning.[7]

There is evidence of loss of capacity to recover from acidosis on repeat exercise.[8]

There is evidence of abnormalities of AMPK activation and glucose uptake in cultured skeletal muscle cells in ME/CFS patients.[9][10]

There is evidence of abnormalities in pH handling by peripheral muscle,[11] and possible evidence of an increased acidosis and lactate accumulation.[12]

Gene expression[edit | edit source]

Gene expression changes following moderate exercise (Light et al, 2011)

There is evidence of increased gene expression following muscular exertion.[13][14][15]

A 2011 study found that moderate exercise in CFS increased the expression of 13 genes (sensory, adrenergic and 1 cytokine) for 48 hours, and the increases correlated with fatigue and pain levels.[14] (see graph at right)

Second day exercise test[edit | edit source]

File:Oxidative impairment.png
Oxidative impairment on the second day of a two-day CPET, VanNess et al 2007

The seminal study on the response by CFS patients to a 2-day cardiopulmonary exercise test was published by Mark VanNess, Christopher Snell & Staci Stevens in 2007: "Diminished Cardiopulmonary Capacity During Post-Exertional Malaise"[16] A repeat study in 2013 confirmed these results.[17]

In a confirmation study, Doctor Betsy Keller found that patients could not repeat their performance on a second cardiopulmonary exercise test performed a day after the first.[18]

A review by Nijs et al. found that multiple studies showed reduced peak heart rate, reduced endurance, reduced peak work rate, reduced peak oxygen uptake, lower blood lactate values, and an increased respiratory exchange ratio;[19] see 'Oxidative impairment', below.

Read the main page: Two-day cardiopulmonary exercise testing.

Oxidative impairment[edit | edit source]

DeBecker et al (2000) and VanNess et al (2003) found low VO2 during exercise testing;[20][21] Fulle et al (2000) demonstrated oxidative damage to DNA.[22]; and Wong et al (1992) showed defects in oxidative metabolism and poor recovery of ATP after exercise.[23]

Graded exercise[edit | edit source]

Graded exercise therapy is a controversial treatment for ME.

Examples of clinical recommendations[edit | edit source]

While there has been no research on physical therapy alternatives to graded exercise, and many patients find it harmful, many clinicians recommend some exercise or strength training for patients who are able, tending to apply this to non-severely affected patients.

Dr Sarah Myhill[edit | edit source]

Dr Myhill recommends patients who are well enough engage in strength training, specifically Body by Science created by Dr Doug McGuff and John Little. "If muscle strength is correctly developed, this automatically translates into cardiovascular fitness and increased numbers of mitochondria". Dr Myhill has a page on her web site detailing her recommendations[24].

Dr. Lucinda Bateman[edit | edit source]

Dr Bateman encourages her patients to find a way to exercise: "we try to focus on maintaining or improving muscle strength, flexibility and also bit of cardiovascular exercise". She discusses exercise and gene expression in an interview[25].

Dr. Nancy Klimas[edit | edit source]

Dr Klimas recommends patients engage in exercise or movement without exceeding a certain heart rate, a proxy for an individual's anaerobic threshold, as established by a VO2 max test.[26] She also recommends alternating periods of exercise and rest.[27] She says that exercise tends to be better tolerated when performed in a horizontal position, like recumbent bicycling or swimming.

Dr. Ritchie Shoemaker[edit | edit source]

See YouTube video regarding resuming exercise gradually for mold illness aka CIRS patients.

Workwell Foundation[edit | edit source]

Workwell Foundation, which specialises in two-day cardiopulmonary exercise testing (CPET), recommends short periods (eg: 30 seconds) of analeptic exercise, with periods of rest which are 3-6 times longer than the period of exercise. The amount of exercise that the individual undertakes should be guided by VO2 max testing (or a safe heart rate threshold (generally 60% of maximum heart rate)), and the use of a heart rate monitor (both during exercise and to help with pacing) is recommended to ensure that the individual doesn't exceed their capacity. The Foundation also advises against aerobic exercise for people with ME/CFS.[28][29][30]

This approach to exercise differs from Graded Exercise Therapy (GET) in several important ways:

  • There is no claim that the exercise program will cure the condition. The aim is to increase functional strength and flexibility, and to improve quality of life, whilst not exacerbating the condition[29]
  • This program is based on a deep understanding of Post-exertional malaise (PEM), and the importance of staying within the energy envelope in order to not trigger PEM[28]
  • There is a recognition that any approach to exercise with people with ME/CFS must be carefully tailored to the individual. There is no one-size fits all[29]
  • This approach utilises objective measures such as VO2 max testing and heart rate monitoring to guide the level of activity suitable for the individual[30]

United States Centers for Disease Control[edit | edit source]

The Centers for Disease Control in the United States recommends patients perform strength and conditioning exercise.[31]

UK NICE Guidelines[edit | edit source]

British blogger, Sally Burch, has written about the The UK National Institute for Health and Care Excellence (NICE) guidelines on maintaining a lower heart rate.[32]

Talks & Interviews[edit | edit source]

Studies[edit | edit source]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 Burton, Deborah Anne; Stokes, Keith; Hall, George M (01 December 2004). "Physiological effects of exercise". Continuing Education in Anaesthesia Critical Care & Pain. 4 (6): 185–8 – via BJA Education. Check date values in: |date= (help)
  2. Gray, J B; Martinovic, A M (July 1994), "Eicosanoids and essential fatty acid modulation in chronic disease and the chronic fatigue syndrome", Medical Hypotheses, 43 (1): 31–42, doi:10.1016/0306-9877(94)90046-9, PMID 7968718
  3. Whiteside, Alan; Hansen, Stig; Chaudhuri, Abhijit (2004), "Exercise lowers pain threshold in chronic fatigue syndrome", Pain, 109 (3): 497-9, doi:10.1016/j.pain.2004.02.029, PMID 15157711
  4. Shukla, Sanjay K; Cook, Dane; Meyer, Jacob; et al. (December 18, 2015), "Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)", PLoS ONE, doi:10.1371/journal.pone.0145453, PMID 26683192
  5. Plioplys, AV; Plioplys, S (1995), "Serum levels of carnitine in chronic fatigue syndrome: clinical correlates", Neuropsychobiology, 32 (3): 132-8, PMID 8544970
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