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 is used as justification treating ME/CFS with GET.
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.
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.
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 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.
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
- 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
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 Oct 23, 2018.
- JL, Rader MC and Vaughen. "Management of the frail and deconditioned patient. - PubMed - NCBI". www.ncbi.nlm.nih.gov. Retrieved Oct 23, 2018.
- B, Gillis A and MacDonald. "Deconditioning in the hospitalized elderly. - PubMed - NCBI". www.ncbi.nlm.nih.gov. Retrieved Oct 23, 2018.
- "ME Association challenges 'Lancet' claim about fear of exercise leading to its avoidance in ME/CFS | 14 January 2015". www.meassociation.org.uk. Retrieved Oct 23, 2018.
- "Re: Tackling fears about exercise is important for ME treatment, analysis indicates". The BMJ. Oct 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.
- Snell, C. R.; Stevens, S. R.; Davenport, T. E.; Van Ness, J. M. (Jun 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. (Dec 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 (Jan 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. (Feb 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 (Jan 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 . PMID 27162614.
- Johnson, Cort (Jul 4, 2016). "The Exercise Intolerance in POTS, ME/CFS and Fibromyalgia Explained? - Health Rising". Health Rising. Retrieved Oct 23, 2018.
chronic disease a disease or condition that usually lasts for 3 months or longer and may get worse over time
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.
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).
BMJ The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.