Deconditioning is the decline in physical function of the body as a result of physical inactivity and disuse. The most important feature of deconditioning is a decline in muscle strength and bulk. It is usually reversible. It is often seen in the elderly and the infirm due to bed rest and inactivity. Risk factors include illness, disability, chronic disease, medical and psychosocial circumstances.
The deconditioning hypothesis proposed by proponents of the biopsychosocial model (BPS) of chronic fatigue syndrome (CFS) claims that the muscle fatigability, chronic fatigue, different types of pain, post-exertional malaise and all other symptoms experienced in ME/CFS, are the result of deconditioning, combined with inappropriate behavioral responses to symptoms. The theory proposes that patient's claims of their inability to exercise or exert themselves is actually due to a "fear of exercise" rather than rooted in reality. It is consequently proposed that psychological interventions such as cognitive behavioral therapy (CBT) should be employed to help the patient overcome their "unhelpful beliefs", while physical programs such as graded exercise therapy (GET) or exercise are employed to help the patient recondition their body.
The deconditioning theory has been used as justification treating ME/CFS with graded exercise therapy to improve fitness, and with cognitive behavioral therapy to address supposed inappropriate fear of exercise.
The deconditioning hypothesis has been largely abandoned due to significant evidence disproving it, combined with high rates of harm and lack of effectiveness of the treatments. Significant abnormal findings in ME/CFS have proved that there is an ongoing disease process rather than simply "symptoms without disease", and cannot explain the degree of orthostatic intolerance found in patients.
Theory[edit | edit source]
Evidence[edit | edit source]
In 2005 Peter White, an influential proponent of the deconditioning hypothesis since the 1990s, stated that:
We do not know whether this deconditioning maintains the illness or is a consequence.
Despite the lack of evidence for the deconditioning hypothesis, White and other members of the Wessely school promoted this belief and developed treatments based on it, which were adopted in a number of countries including the United States, United Kingdom, and Netherlands. In their literature review, Clark and White (2005) found that people with chronic fatigue syndrome were at least as deconditioned as healthy controls with a similar level of physical inactivity, but did not draw conclusions about whether they were more deconditioned. Clarke and White later became authors of the highly controversial PACE trial.
Results from two-day cardiopulmonary exercise tests provide clear evidence that patients with ME/CFS have an abnormal response to exercise, which is not the result of deconditioning. A large Dutch study by van Campen et al. (2018) found that deconditioning could not explain the cardiac index and stroke volume index changes in patients with ME/CFS that occurred during a normal tilt test.
Nakatomi and colleagues (2014) found widespread evidence of neuroinflammation in patients with ME/CFS, and that neuroinflammation was correlated with the severity of neuropsychologic symptoms, while a review by Nijs and colleagues (2014) found evidence of an altered immune response to exercise in patients with ME/CFS.
Notable studies[edit | edit source]
- 1992, Skeletal muscle metabolism in the chronic fatigue syndrome. In vivo assessment by 31P nuclear magnetic resonance spectroscopy
- 2001 - Is physical deconditioning a perpetuating factor in chronic fatigue syndrome? A controlled study on maximal exercise performance and relations with fatigue, impairment and physical activity?
- 2010 - Postexertional Malaise in Women with Chronic Fatigue Syndrome
- 2011 - Tired of being inactive: a systematic literature review of physical activity, physiological exercise capacity and muscle strength in patients with chronic fatigue syndrome
- 2014, Altered immune response to exercise in patients with chronic fatigue syndrome/myalgic encephalomyelitis: A systematic literature review(Full text)
- 2014, Neuroinflammation in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An 11C-(R)-PK11195 PET Study
- 2016 - Unexplained exertional dyspnea caused by low ventricular filling pressures: results from clinical invasive cardiopulmonary exercise testing
The study also indicated neither deconditioning or a reduced maximal effort, both of which have been suspected in ME/CFS, play a role in the exercise intolerance found. In fact, deconditioned people, ironically, exhibit an opposite finding (increased as opposed to decreased filling pressures) to that found in this study.
- 2018 - The Abnormal Cardiac Index and Stroke Volume Index Changes During a Normal Tilt Table Test in ME/CFS Patients Compared to Healthy Volunteers, are Not Related to Deconditioning
- 2021, Deconditioning does not explain orthostatic intolerance in ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) - (Full text)
Learn more[edit | edit source]
- Tired of being inactive: a systematic literature review of physical activity, physiological exercise capacity and muscle strength in patients with chronic fatigue syndrome
See also[edit | edit source]
- Illness beliefs
- Graded Exercise Therapy
- Biopsychosocial model
- Two-day cardiopulmonary exercise test
- Post-exertional malaise
References[edit | edit source]
- "Deconditioning | Encyclopedia.com". www.encyclopedia.com. Retrieved October 23, 2018.
- JL, Rader MC and Vaughen. "Management of the frail and deconditioned patient. - PubMed - NCBI". www.ncbi.nlm.nih.gov. Retrieved October 23, 2018.
- B, Gillis A and MacDonald. "Deconditioning in the hospitalized elderly. - PubMed - NCBI". www.ncbi.nlm.nih.gov. Retrieved October 23, 2018.
- "ME Association challenges 'Lancet' claim about fear of exercise leading to its avoidance in ME/CFS | 14 January 2015". The ME Association. Retrieved October 23, 2018.
- "Re: Tackling fears about exercise is important for ME treatment, analysis indicates". The BMJ. October 23, 2018.
- Clark, Lucy V; White, Peter D (June 2005). "The role of deconditioning and therapeutic exercise in chronic fatigue syndrome (CFS)". Journal of Mental Health. 14 (3): 237–252. doi:10.1080/09638230500136308. ISSN 0963-8237.
- Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS) (February 27, 2019). "Evaluation of a survey exploring the experiences of adults and children with ME/CFS who have participated in CBT and GET interventional programmes. FINAL REPORT" (PDF). Oxford Brookes University.
- NICE Guideline Development Group (October 29, 2021). "Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline". National Institute for Health and Care Excellence.
- White, PD; Goldsmith, KA; Johnson, AL; Potts, L; Walwyn, R; DeCesare, JC; Baber, HL; Burgess, M; Clark, LV; Cox, DL; Bavinton, J; Angus, BJ; Murphy, G; Murphy, M; O'Dowd, H; Wilks, D; McCrone, P; Chalder, T; Sharpe, M; on behalf of the PACE Trial Management Group (March 5, 2011), "Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial", The Lancet, 377 (9768): 823–836, doi:10.1016/S0140-6736(11)60096-2, PMID 21334061
- Snell, C. R.; Stevens, S. R.; Davenport, T. E.; Van Ness, J. M. (June 27, 2013). "Discriminative Validity of Metabolic and Workload Measurements for Identifying People With Chronic Fatigue Syndrome". Physical Therapy. 93 (11): 1484–1492. doi:10.2522/ptj.20110368. ISSN 0031-9023.
- van Campen, CMC; Visser, FC (2018). "The Abnormal Cardiac Index and Stroke Volume Index Changes During a Normal Tilt Table Test in ME/CFS Patients Compared to Healthy Volunteers, are Not Related to Deconditioning". Journal of Thrombosis and Circulation. doi:10.29011/JTC-107.000007.
- Wong, R.; Lopaschuk, G.; Zhu, G.; Walker, D.; Catellier, D.; Burton, D.; Teo, K.; Collins-Nakai, R.; Montague, T. (December 1992). "Skeletal muscle metabolism in the chronic fatigue syndrome. In vivo assessment by 31P nuclear magnetic resonance spectroscopy". Chest. 102 (6): 1716–1722. ISSN 0012-3692. PMID 1446478.
- Bazelmans, Ellen; Bleijenberg, Gijs; Van Der Meer, Jos W.; Folgering, Hans (January 2001). "Is physical deconditioning a perpetuating factor in chronic fatigue syndrome? A controlled study on maximal exercise performance and relations with fatigue, impairment and physical activity". Psychological Medicine. 31 (1): 107–114. ISSN 0033-2917. PMID 11200949.
- VanNess, J. Mark; Stevens, Staci R.; Bateman, Lucinda; Stiles, Travis L.; Snell, Christopher R. (February 2010). "Postexertional Malaise in Women with Chronic Fatigue Syndrome" (PDF). Journal of Women's Health. 19 (2): 239–244. doi:10.1089/jwh.2009.1507. ISSN 1540-9996.
- Nijs, Jo; Aelbrecht, Senne; Meeus, Mira; Van Oosterwijck, Jessica; Zinzen, Evert; Clarys, Peter (January 2011). "Tired of being inactive: a systematic literature review of physical activity, physiological exercise capacity and muscle strength in patients with chronic fatigue syndrome" (PDF). Disability and Rehabilitation. 33 (17–18): 1493–1500. doi:10.3109/09638288.2010.541543. ISSN 0963-8288.
- Oldham, William M.; Lewis, Gregory D.; Opotowsky, Alexander R.; Waxman, Aaron B.; Systrom, David M. (March 2016). "Unexplained Exertional Dyspnea Caused by Low Ventricular Filling Pressures: Results from Clinical Invasive Cardiopulmonary Exercise Testing". Pulmonary Circulation. 6 (1): 55–62. doi:10.1086/685054. ISSN 2045-8932. PMC 4860548. PMID 27162614.
- Johnson, Cort (July 4, 2016). "The Exercise Intolerance in POTS, ME/CFS and Fibromyalgia Explained? - Health Rising". Health Rising. Retrieved October 23, 2018.
chronic disease a disease or condition that usually lasts for 3 months or longer and may get worse over time. Chronic diseases are long-term (typically incurable and requiring long-term management) but are not necessarily severe.
graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.
myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.
postural orthostatic tachycardia syndrome (POTS) - A form of orthostatic intolerance where the cardinal symptom is excessive tachycardia due to changing position (e.g. from lying down to sitting up).