Anonymous
Not logged in
Talk
Contributions
Create account
Log in
Search
Editing
Exercise
(section)
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Namespaces
Page
Discussion
More
More
Page actions
Read
Edit
Edit source
History
Warning:
You are not logged in. Your IP address will be publicly visible if you make any edits. If you
log in
or
create an account
, your edits will be attributed to your username, along with other benefits.
Anti-spam check. Do
not
fill this in!
== Effects of exercise in Chronic Fatigue Syndrome == ===Post Exertional Malaise=== [[File:2010 VanNess Post exertional worsening of symptoms chart.png|right|frame|Post-exertional worsening of symptoms, VanNess et al. (2010)|377x377px]] {{Main article| page_name=Post-exertional malaise}}[[File:2015 IOM report PEM chart.png|right|frame|PEM chart from the 2015 Institute of Medicine report|378x378px]] [[myalgic encephalomyelitis|ME]] patients who exercise are likely to experience [[Post-exertional malaise]], a worsening of symptoms following physical, cognitive, or sensory [[exertion]]. ===Pain threshold=== Pain thresholds, or the point at which a stimulus becomes painful, drop in people with [[chronic fatigue syndrome|CFS]] (as per the [[Fukuda criteria]]) after graded exercise. In healthy controls, pain thresholds rise. This phenomenon has been attributed to a dysfunction of the central anti-nociceptive mechanism in [[chronic fatigue syndrome|CFS]] patients.<ref name="Whiteside, 2004">{{Citation | last1 = Whiteside | first1 = Alan | author-link1 = | last2 =Hansen | first2 = Stig | authorlink2 = | last3 = Chaudhuri | first3 = Abhijit | authorlink3 = Abhijit Chaudhuri | title = Exercise lowers pain threshold in chronic fatigue syndrome| journal = Pain | volume = 109 | issue = 3 | page = 497-9| date = 2004 | pmid = 15157711| doi = 10.1016/j.pain.2004.02.029}}</ref> ===Immune System=== [[Histamine]], a chemical that is released in response to cellular damage and inflammation, is released during exercise in healthy individuals. The histamine dilates blood vessels in order to deliver nutrients to working muscles.<ref name="Romero2016">{{Cite journal | last = Romero | first = S.A. | last2 = Hocker | first2 = A.D. | last3 = Mangum | first3 = J.E. | last4 = Luttrell | first4 = M.J. | last5 = Turnbull | first5 =D.W. | last6 = Halliwill | first6 = J.R. | last7 = Struck | first7 = A.J. | last8 = Ely | first8 = M.R. | last9 = Sieck | first9 = D.C. | last10 =Dreyer | first10 = H.C. | last11 = Halliwill | first11 = J.R | date = 2016 | title=Evidence of a broad histamine footprint on the human exercise transcriptome | url =http://doi.org/10.1113/JP272177|journal=The Journal of Physiology|volume=594|issue=17 | pages = 5009-5023|via=}}</ref> However, patients with ME may experience increased histamine release due to increased mast cell populations at baseline.<ref name="Ronnberg2017">{{Cite journal | last = Rönnberg | first = E | last2 = Calounova | first2 = G | last3 = Pejler | first3 = G | date = June 2017 | title = Novel characterisation of mast cell phenotypes from peripheral blood mononuclear cells in chronic fatigue syndrome/myalgic encephalomyelitis patients |url =https://www.ncbi.nlm.nih.gov/pubmed/27362406|journal=Asian Pac J Allergy Immunol|volume=35|issue=2 | pages = 75-81|via=}}</ref> ===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. The study found increased Clostridium in the blood fifteen minutes after exercise and increased Bacilli 48 hours later.<ref name="ShuklaS2015">{{citation | last1 = Shukla | first1 = Sanjay K | author-link1 = Sanjay Shukla | last2 =Cook | first2 = Dane | authorlink2 = Dane Cook | last3 = Meyer | first3 = Jacob | authorlink3 = Jacob Meyer | last4 =Vernon | first4 = Suzanne D | authorlink4 = Suzanne Vernon | last5 = Le | first5 = Thao | authorlink5 = Thao Le | last6 = Clevidence | first6 = Derek | authorlink6 = Derek Clevidence | last7 =Robertson | first7 = Charles E | author-link8 = Charles Robertson | last8 = Schrodi | first8 = Steven J | author-link8 = Steven Schrodi | last9 =Yale | first9 = Steven | author-link9 = Steven Yale | last10 = Frank | first10 = Daniel N | author-link10 = Daniel Frank | title = Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)| journal = PLoS ONE | date = Dec 18, 2015 | pmid = 26683192 | doi = 10.1371/journal.pone.0145453 | url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0145453 }}</ref> === Musculature === Exercise has also been found to induce both early and excessive lactic acid formation in the [[muscle fatigability|muscles]]<ref name="Plioplys1995">{{citation | last1 = Plioplys | first1 = AV | author-link1 = | last2 =Plioplys | first2 = S | authorlink2 = | title = Serum levels of carnitine in chronic fatigue syndrome: clinical correlates| journal = Neuropsychobiology | date = 1995 | volume = 32 | issue = 3 | page = 132-138 | pmid = 8544970| url = http://www.ncbi.nlm.nih.gov/pubmed/8544970 }}</ref> with reduced intracellular concentrations of [[ATP]] and acceleration of [[glycolysis]].<ref name="McCully1996">{{citation | last1 = McCully | first1 = KK | author-link1 = | last2 =Natelson | first2 = BH | authorlink2 = Benjamin Natelson | last3 = Iotti | first3 = S | authorlink3 = | last4 = Sisto | first4 = S | authorlink4 = | last5 = Leigh | first5 = JS Jr. | authorlink5 = | title = Reduced oxidative muscle metabolism in chronic fatigue syndrome | journal = Muscle Nerve | volume = 19 | issue = 5 | page = 621-625 | date = May 1996 | pmid = 8618560 | doi =| url = http://www.ncbi.nlm.nih.gov/pubmed/8618560 }}</ref> Several studies have found abnormal increases in plasma [[lactate]] following short period of moderate exercise that cannot be explained by [[deconditioning]].<ref name="LaneRJ1998">{{citation | last1 = Lane | first1 = R J | author-link1 = Russell Lane | last2 =Barrett | first2 = M C | authorlink2 = Michael Barrett | last3 = Taylor | first3 = D J | authorlink3 = Doris Taylor | last4 = Kemp | first4 = G J | authorlink4 = Graham Kemp | last5 = Lodi | first5 = R | authorlink5 = Raffaele Lodi | title = Heterogeneity in chronic fatigue syndrome: evidence from magnetic resonance spectroscopy of muscle| journal = Neuromuscul Disord | volume = 8 | issue = 3-4 | page = 204-9 | date = May 1998 | pmid = 9631403 | url = http://www.ncbi.nlm.nih.gov/pubmed/9631403 }}</ref> There are abnormalities in pH handling by peripheral muscle, and possible evidence of an increased acidosis and lactate accumulation.<ref name="JonesDE2010">{{citation | last1 = Jones | first1 = David EJ | author-link1 = David Jones | last2 =Hollingsworth | first2 = Kieren G | authorlink2 = Kieren Hollingsworth | last3 = Taylor | first3 = Renee R | authorlink3 = Renee Taylor | last4 = Blamire | first4 = Andrew M | authorlink4 = Andrew Blamire | last5 = Newton | first5 = Julia L | authorlink5 = Julia Newton | title = Abnormalities in pH handling by peripheral muscle and potential regulation by the autonomic nervous system in chronic fatigue syndrome| journal = J Intern Med | volume = 267 | issue = 4 | page = 394-401 | date = Apr 2010 | pmid = 20433583 | doi = 10.1111/j.1365-2796.2009.02160.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2009.02160.x/abstract }}</ref> <ref name="JonesDE2012">{{citation | last1 = Jones | first1 = David EJ | author-link1 = David Jones | last2 =Hollingsworth | first2 = Kieren G | authorlink2 = Kieren Hollingsworth | last3 = Jakovljevic | first3 = Djordje G | authorlink3 = Djordje Jakovljevic | last4 =Fattakhova | first4 = Gulnar | authorlink4 = Gulnar Fattakhova | last5 = Pairman | first5 = Jessie | authorlink5 = Jessie Pairman | last6 = Blamire | first6 = Andrew M | authorlink6 = Andrew Blamire | last7 =Trenell | first7 = Michael I | author-link8 = Michael Trenell | last8 = Newton | first8 = Julia L | author-link8 = Julia Newton| display-authors = | title = Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome | journal = Eur J Clin Invest | volume = 42 | issue = 2 | page = 186-94 | date = Jul 12, 2011 | pmid = 21749371 | doi = 10.1111/j.1365-2362.2011.02567.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2362.2011.02567.x/abstract }}</ref><ref name="LengertN2015">{{citation | last1 = Lengert | first1 = Nicor | author-link1 = Nicor Lengert | last2 =Drossel | first2 = Barbara| authorlink2 = Barbara Drossel | title = In silico analysis of exercise intolerance in myalgic encephalomyelitis/chronic fatigue syndrome| journal = Biophysical Chemistry | volume = 202 | page = 21–31 | date = Jul 2015 | pmid = 25899994 | doi = 10.1016/j.bpc.2015.03.009| url = http://www.sciencedirect.com/science/article/pii/S0301462215000630 }}</ref> There is also evidence of loss of capacity to recover from acidosis on repeat exercise, as demonstrated by the [[two-day cardiopulmonary exercise test|Two-Day Cardiopulmonary Exercise Test]].<ref name="JonesDE2012" /> Finally, there is evidence of abnormalities of [[AMPK]] activation and glucose uptake in cultured skeletal muscle cells in ME/CFS patients.<ref name="BrownAE2015">{{Citation | last1 = Brown | first1 = Audrey E | author-link1 = Audrey Brown | last2 =Jones | first2 = David E | authorlink2 = David Jones | last3 = Walker | first3 = Mark | authorlink3 = Mark Walker | last4 = Newton | first4 = Julia L | authorlink4 = Julia Newton | title = Abnormalities of AMPK activation and glucose uptake in cultured skeletal muscle cells | journal = PLoS One | volume = 10 | issue = 4 | date = Apr 2, 2015 | pmid = 25836975 | doi = 10.1371/journal.pone.0122982 | url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122982 }}</ref> [[File:Light2011-geneexpression-figure3.jpg|right|frame|Gene expression changes following moderate exercise (Light et al, 2011)|516x516px]] === Gene expression === There is evidence of increased expression of certain [[gene]]s following muscular exertion.<ref name="LightAR2009">{{citation | last1 = Light | first1 = Alan R | author-link1 = Alan Light | last2 =White | first2 = Andrea T | authorlink2 = Andrea White | last3 = Hughen | first3 = Ronald W | authorlink3 = Ronald Hughen | last4 =Light | first4 = Kathleen C | authorlink4 = Kathleen Light | title = Moderate exercise increases expression for sensory, adrenergic, and immune genes in chronic fatigue syndrome patients but not in normal subjects| journal = J Pain | volume = 10 | issue = 10 | page = 1099-112 | date = Jul 31, 2009 | pmid = 19647494 | doi = 10.1016/j.jpain.2009.06.003 | url = http://www.jpain.org/article/S1526-5900(09)00574-4/abstract}}</ref> <ref name="LightAR2011">{{citation | last1 = Light | first1 = Alan R | author-link1 = Alan Light | last2 =Bateman | first2 = Lucinda | authorlink2 = Lucinda Bateman | last3 = Jo | first3 = Daehyun | authorlink3 = Daehyun Jo | last4 =Hughen | first4 = Ronald W | authorlink4 = Ronald Hughen | last5 = Vanhaitsma | first5 = TA | authorlink5 = Timothy VanHaitsma | last6 = White | first6 = Andrea T | authorlink6 = Andrea White | last7 =Light | first7 = Kathleen C | author-link8 = Kathleen Light | title = Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome | journal = J Intern Med | volume = 271 | issue = 1 | page = 64-81 | date = Jul 13, 2011 | pmid = 21615807 | doi = 10.1111/j.1365-2796.2011.02405.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02405.x/abstract }}</ref><ref name="WhiteAT2012">{{citation | last1 = White | first1 = Andrea T | author-link1 = Andrea White | last2 =Light | first2 = Alan R | authorlink2 = Alan Light | last3 = Hughen | first3 = Ronald W | authorlink3 = Ronald Hughen | last4 = VanHaitsma | first4 =Timothy A | authorlink4 = Timothy VanHaitsma | last5 = Light | first5 = Kathleen C | authorlink5 = Kathleen Light | title = Differences in metabolite-detecting, adrenergic, and immune gene expression after moderate exercise in patients with chronic fatigue syndrome, patients with multiple sclerosis, and healthy controls | journal = Psychosom Med | volume = 74 | issue = 1 | page = 46-54 | date = Dec 30, 2011 | pmid = 22210239 | doi = 10.1097/PSY.0b013e31824152ed | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256093/}}</ref> 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 (see graph).<ref name="LightAR2011" /> === Second day exercise test === {{Main article| page_name=Two-day cardiopulmonary exercise test}} The seminal study on the response of chronic fatigue syndrome patients to a two-day cardiopulmonary exercise test was published by [[Mark VanNess]], [[Christopher Snell]] and [[Staci Stevens]] in 2007: "Diminished Cardiopulmonary Capacity During Post-Exertional Malaise".<ref name="VanNess2007">{{citation | last1 = VanNess | first1 = J Mark| author-link1 = Mark VanNess | last2 =Snell | first2 = Christopher R | authorlink2 = Christopher Snell | last3 = Stevens | first3 = Staci R | authorlink3 = Staci Stevens| title = Diminished Cardiopulmonary Capacity During Post-Exertional Malaise| journal = Journal of Chronic Fatigue Syndrome | volume = 14 | issue = 2 | page = 77-85 | date = 2007| doi = 10.1300/J092v14n02_07 | url = http://www.tandfonline.com/doi/abs/10.1300/J092v14n02_07 }}</ref> While people with CFS responded similarly to healthy controls on a first test, on a follow-up 24 hours later, they were unable to replicate their original normal results. Instead, they had significantly lower values for VO2 peak and AT; these differences could be used to identify the CFS patient over 90% of the time. A repeat study in 2013 confirmed these results.<ref name="SnellCR2013">{{citation | last1 = Snell | first1 = Christopher R | author-link1 = Christopher Snell | last2 =Stevens | first2 = Staci R | authorlink2 = Staci Stevens | last3 = Davenport | first3 = Todd E | authorlink3 = Todd Davenport | last4 =VanNess | first4 = J Mark | author-link4 = Mark VanNess| title = Discriminative Validity of Metabolic and Workload Measurements for Identifying People With Chronic Fatigue Syndrome | journal = Physical Therapy (APTA) | volume = 93 | issue = 11 | page = 1484-1492 | date = Oct 31, 2013 | pmid = 23813081 | doi = 10.2522/ptj.20110368 | url = https://academic.oup.com/ptj/article-lookup/doi/10.2522/ptj.20110368}}</ref> In a confirmation study, Doctor [[Betsy Keller]] also found that patients could not repeat their performance on a second cardiopulmonary exercise test performed a day after the first.<ref name="KellerBA2014">{{citation | last1 = Keller | first1 = Betsy A | author-link1 = Betsy Keller | last2 =Pryor | first2 = John Luke | authorlink2 = John Pryor | last3 = Giloteaux | first3 = Ludovic| authorlink3 = Ludovic Giloteaux | title = Inability of myalgic encephalomyelitis/chronic fatigue syndrome patients to reproduce VO₂peak indicates functional impairment | journal = J Transl Med | volume = | issue = 12 | page = 104 | date = Apr 23, 2014 | pmid = 24755065 | doi = 10.1186/1479-5876-12-104 | url = http://translational-medicine.biomedcentral.com/articles/10.1186/1479-5876-12-104 }}</ref> 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 in people with ME, ME/CFS, or CFS; see [[#Oxidative_impairement|Oxidative impairment]].<ref name="Nijs2014">{{Citation | last1 = Nijs | first1 = J | author-link1 = Jo Nijs | last2 =Nees | first2 = A | authorlink2 = | last3 = Paul | first3 = L | authorlink3 = | last4 = De Kooning | first4 = M | authorlink4 = | last5 = Ickmans | first5 = K | authorlink5 = | last6 = Meeus | first6 = M | authorlink6 = Mira Meeus | last7 =Van Oosterwijck | first7 = J | author-link8 = Jessica Van Oosterwijck | title = Altered immune response to exercise in patients with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic literature review | url = https://repository.uantwerpen.be/docman/irua/338b0c/9322.pdf | journal = Exercise Immunology Review | volume = | issue = 20 | page = 94-116 | date = 2014 | pmid = 24974723}}</ref> It is important to note that CPET testing oxygen uptake (VO2), carbon dioxide output (VCO2), tidal volume (VT), blood pressure, and oxygen saturation are objective measures, and cannot be invalidated with inadequate effort. {{Main article|Two-day cardiopulmonary exercise test}} ===Oxidative impairment=== DeBecker et al (2000) and VanNess et al (2003) found low VO2 during exercise testing;<ref name="DeBecker2000">{{Citation | last1 = De Becker | first1 = P | author-link1 = Pascale De Becker | last2 =Roeykens | first2 = J | authorlink2 = Johan Roeykens | last3 = Reynders | first3 = M | authorlink3 = Masha Reynders | last4 =McGregor | first4 = N | authorlink4 = Neil McGregor | last5 = De Meirleir | first5 = K | authorlink5 = Kenny de Meirleir| display-authors = | title = Exercise capacity in chronic fatigue syndrome | journal = Archives of Internal Medicine | issn = 0003-9926| volume = 160 | issue = 21| pages = 3270–3277 | date = 2000-11-27 | pmid = 11088089 | doi = 10.1001/archinte.160.21.3270 | url = http://archinte.jamanetwork.com/article.aspx?articleid=485564 }}</ref><ref name="Vanness2003">{{citation | last1 = VanNess | first1 = JM | author-link1 = Mark VanNess | last2 =Snell | first2 = CR | authorlink2 = Christopher Snell | last3 = Strayer | first3 = DR | authorlink3 = David Strayer | last4 = Dempsey | first4 = L | authorlink4 = Line Dempsey | last5 = Stevens | first5 = SR | authorlink5 = Staci Stevens | title = Subclassifying chronic fatigue syndrome through exercise testing | journal = Medicine and Science in Sports and Exercise | issn = 0195-9131| volume = 35 | issue = 6| pages = 908–913 | date = June 2003 | pmid = 12783037 | doi = 10.1249/01.MSS.0000069510.58763.E8 | url = https://www.researchgate.net/profile/Mark_Van_Ness/publication/10728803_Subclassifying_chronic_fatigue_syndrome_through_exercise_testing/links/0c96051793fc9a83e4000000.pdf }}</ref> 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">{{citation | last1 = Wong | first1 = R | author-link1 = Roger Wong | last2 = Lopaschuk | first2 = G | authorlink2 = Gary Lopaschuk | last3 = Zhu | first3 = G | authorlink3 = Gang Zhu | last4 =Walker | first4 = D | authorlink4 = Dorothy Walker | last5 = Catellier | first5 = D | authorlink5 = Dianne Catellier | last6 = Burton | first6 = D | authorlink6 = David Burton | last7 =Teo | first7 = K | author-link8 = Koon Teo | last8 = Collins-Nakai | first8 = R | author-link8 = Ruth Collins-Nakai | last9 =Montague | first9 = T | author-link9 = Terrence Montague | title = Skeletal muscle metabolism in the chronic fatigue syndrome. In vivo assessment by 31P nuclear magnetic resonance spectroscopy| journal = Chest | issn = 0012-3692| volume = 102 | issue = 6| pages = 1716–1722 | date = Dec 1992 | pmid = 1446478 | doi = 10.1378/chest.102.6.1716 | url = http://www.sciencedirect.com/science/article/pii/S0012369216408469}}</ref>
Summary:
Please make sure your edits are consistent with
MEpedia's guidelines
.
By saving changes, you agree to the
Terms of use
, and you irrevocably agree to release your contribution under the
CC BY-SA 3.0 License
and the
GFDL
. You agree that a hyperlink or URL is sufficient attribution under the Creative Commons license.
Cancel
Editing help
(opens in new window)
Navigation
Navigation
Skip to content
Main page
Browse
Become an editor
Random page
Popular pages
Abbreviations
Glossary
About MEpedia
Links for editors
Contents
Guidelines
Recent changes
Pages in need
Search
Help
Wiki tools
Wiki tools
Special pages
Page tools
Page tools
User page tools
More
What links here
Related changes
Page information
Page logs