Two-day cardiopulmonary exercise testing

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Two-day cardiopulmonary exercise testing or 2-day CPET is an accepted, reliable test for post-exertional malaise (PEM), one of the cardinal symptoms that distinguishes between individuals with and without ME/CFS.[1] The hypothesis is that ME/CFS patients are almost unique in having a severe deterioration in the second of the two cardiopulmonary exercise tests performed on consecutive days.[2]

The CPET is the same non-invasive test given to measure the fitness levels of athletics, as well as, people with cardiopulmonary illness.[3] However, if the test is repeated 24 hours later, ME/CFS patients will fare significantly worst than they did on the first day. The Institute of Medicine report states that: "ME/CFS patients have significantly lower results on CPET 2 than on CPET 1 on one or more of the following parameters: VO2max (Keller et al., 2014; VanNess et al., 2007; Vermeulen et al., 2010),[4] VO2 at ventilatory threshold (Keller et al., 2014), and maximal workload or workload at ventilatory threshold (Keller et al., 2014; Snell et al., 2013)."[5]

Although the Institute of Medicine report states that 2-day CPET is very reliable to objectively measure PEM, the IOM committee emphasized "that the CPET is not required to diagnose patients with ME/CFS. Further, this test carries substantial risk for these patients as it may worsen their condition (Nijs et al., 2010; VanNess et al., 2010)."[6]

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  1. Davenport TE, Stevens SR, Baroni K, Van Ness M, Snell CR. (2011). Diagnostic accuracy of symptoms characterising chronic fatigue syndrome. Disability and Rehabilitation, 33(19-20):1768-75. doi: 10.3109/09638288.2010.546936. Epub 2011 Jan 6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21208154
  2. Logan, Russell. 2-Day CPET: A gold standard test for ME fatigue. (24 Sept 2014). Shoutout About ME blog. Retrieved from http://www.shoutoutaboutme.com/testing/the-2-day-cpet-a-gold-standard-test-for-mecfs/
  3. K Albouaini, M Egred, and A Alahmar, D J Wright. (2007). Cardiopulmonary exercise testing and its application. Postgraduate Medical Journal, 83(985): 675–682. doi: 10.1136/hrt.2007.121558 PMCID: PMC2734442 Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734442/
  4. Vermeulen, RC; Kurk, RM; Visser, FC; Sluiter, W; Scholte, HR (October 2010), "Patients with chronic fatigue syndrome performed worse than controls in a controlled repeated exercise study despite a normal oxidative phosphorylation capacity", J Transl Med, PMID 20937116, doi:10.1186/1479-5876-8-93 
  5. Chapter 4, Review of the Evidence on Major ME/CFS Symptoms and Manifestations." Institute of Medicine. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press, 2015. doi:10.17226/19012. Retrieved from http://www.nap.edu/read/19012/chapter/6?term=CPET#83
  6. Chapter 4, Review of the Evidence on Major ME/CFS Symptoms and Manifestations." Institute of Medicine. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press, 2015. doi:10.17226/19012. Retrieved from http://www.nap.edu/read/19012/chapter/6?term=CPET#83
  7. Hodges, Lynette; Nielsen, T.; Baken, D. (Aug 2017), "Physiological measures in participants with chronic fatigue syndrome, multiple sclerosis and healthy controls following repeated exercise: a pilot study", Clinical Physiology and Functional Imaging, Aug 2017, doi:10.1111/cpf.12460 


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From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history