Sense of effort associated with exercise in the chronic fatigue syndrome

Investigations into the mediators of effort sensation have indicated that central mechanisms related to corollary discharges may be responsible for an increased sense of effort during fatiguing isometric exercise. The role for central mediators for sense of effort have been objectively demonstrated through use of contralateral limb matching tasks. Subjects diagnosed with chronic fatigue syndrome (CFS) often report prevalent fatigue associated with a greater sense of effort when involved in exercise. This study employed a fatiguing contralateral limb-matching task in order to determine if CFS subjects (n == 6) experienced an altered sense of effort associated with the task when compared to control group (n = 6). The task involved subjects performing an intermittent sub-maximal contraction in their reference (non-dominant) arm for a 45 minute period. Subjects attempted to match the force in their reference arm (30% MVC) with their dominant arm every minute, except for every fifth minute, when a maximal voluntary contraction (MVC) was performed in the reference arm. Associated electromyography (EMG), force, and rate of perceived exertion (RPE) were recorded on a regular basis. Results indicated that while there were no significant difference between groups for matching force, rmsEMG amplitude, and MVC force, there was a significant difference in reported RPE scores (P \u3c 0.05) during the fatiguing task, as well as during baseline measurements. Elevated RPE scores, combined with trends indicating that a longer protocol may have produced a significant difference in matching force, provide evidence demonstrating thdt CFS subjects experienced a greater sense of effort relative to controls. This study demonstrates that the symptom of fatigue experienced in CFS may be better defined employing mediators for sense of effort than the regular application of a neurophysiological definition of fatigue concerned with the loss of force generating capacity

Sense of effort associated with exercise in the chronic fatigue syndrome

Investigations into the mediators of effort sensation have indicated that central mechanisms related to corollary discharges may be responsible for an increased sense of effort during fatiguing isometric exercise. The role for central mediators for sense of effort have been objectively demonstrated through use of contralateral limb matching tasks. Subjects diagnosed with chronic fatigue syndrome (CFS) often report prevalent fatigue associated with a greater sense of effort when involved in exercise. This study employed a fatiguing contralateral limb-matching task in order to determine if CFS subjects (n == 6) experienced an altered sense of effort associated with the task when compared to control group (n = 6). The task involved subjects performing an intermittent sub-maximal contraction in their reference (non-dominant) arm for a 45 minute period. Subjects attempted to match the force in their reference arm (30% MVC) with their dominant arm every minute, except for every fifth minute, when a maximal voluntary contraction (MVC) was performed in the reference arm. Associated electromyography (EMG), force, and rate of perceived exertion (RPE) were recorded on a regular basis. Results indicated that while there were no significant difference between groups for matching force, rmsEMG amplitude, and MVC force, there was a significant difference in reported RPE scores (P \u3c 0.05) during the fatiguing task, as well as during baseline measurements. Elevated RPE scores, combined with trends indicating that a longer protocol may have produced a significant difference in matching force, provide evidence demonstrating thdt CFS subjects experienced a greater sense of effort relative to controls. This study demonstrates that the symptom of fatigue experienced in CFS may be better defined employing mediators for sense of effort than the regular application of a neurophysiological definition of fatigue concerned with the loss of force generating capacity

Pacing as a strategy to improve energy management in myalgic encephalomyelitis/chronic fatigue syndrome: a consensus document

Purpose: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition characterized by a number of symptoms which typically worsen following minimal exertion. Various strategies to manage the limited energy levels have been proposed. Of these, pacing has been consistently rated as one of the most helpful in surveys conducted by patient groups. This review is a response to the paucity of the information on pacing in the scientific literature. Method: We describe the principle of pacing and how this can be adapted to meet individual abilities and preferences. A critical evaluation of the research was conducted to ascertain the benefits and limitations of this strategy. Results: Based on various studies, it is proposed that pacing can help to stabilize the condition and avoid post-exertional malaise. Conclusion: Pacing offers practitioners an additional therapeutic option which is acceptable to the majority of patients and can reduce the severity of the exertion-related symptoms of ME/CFS

Characteristics and quality of life of patients presenting to cancer support centres: Patient rated outcomes and use of complementary therapies

Background: In order to effectively target and provide individualised patient support strategies it is crucial to have a comprehensive picture of those presenting for services. The purpose of this study was to determine the characteristics and patient rated outcomes of individuals presenting to SolarisCare cancer support centres and their choices regarding complementary and integrated therapies (CIT).Methods: A cohort with a current or previous cancer diagnosis aged 18 - 87 years presenting to a SolarisCare centre during a 5-day period completed a questionnaire. Four SolarisCare centres participated in the trial including regional and metropolitan locations. Outcomes included medical and demographic characteristics, CIT variables and patient rated outcomes (PROs) including quality of life (QoL).Results: Of the 95 participants (70.3%) who completed the survey, the mean age was 60.5 years with 62% currently receiving treatment. Eighty percent of the sample had at least one other comorbid condition, with the most popular CIT being relaxation massage. Of the PROs, QoL was significantly lower than norms for the Australian population and other mixed cancer populations. No notable differences were seen between genders, however significantly poorer outcomes were found for the younger age group. Fifty percent of the population did not meet physical activity recommendations, and musculoskeletal symptoms explained between 25-27% of variance in QoL.Conclusions: A greater understanding of the health profiles of patients presenting to supportive care centres and their use of CIT, provides Western Australian health professionals with key information to ensure the safety of supportive care practices, as well as fosters optimal patient outcomes and enhances the integration of supportive care strategies within mainstream medical care

Positive patient experiences in an Australian integrative oncology centre

Background: The purpose of this study was to explore the experiences of cancer patients\u27 utilising complementary and integrative therapies (CIT) within integrative oncology centres across Western Australia.Methods: Across four locations 135 patients accessed CIT services whilst undergoing outpatient medical treatment for cancer. Of the 135 patients, 66 (61 ± 12 y; female n = 45; male n = 21) agreed to complete a personal accounts questionnaire consisting of open-ended questions designed to explore patients\u27 perceptions of CIT. All results were transcribed into nVivo (v9) and using thematic analysis, key themes were identified.Results: Of the 66 participants, 100% indicated they would recommend complementary therapies to other patients and 92% stated CIT would play a significant role in their future lifestyle . A mean score of 8 ± 1 indicated an improvement in participants\u27 perception of wellbeing following a CIT session. Three central themes were identified: empowerment, support and relaxation. Fourteen sub-themes were identified, with all themes clustered into a framework of multifaceted views held by cancer patients in relation to wellbeing, role of significant others and control.Conclusions: Exploration of patients\u27 experiences reveals uniformly positive results. One of the key merits of the environment created within the centres is patients are able to work through their cancer journey with an increased sense of empowerment, without placing them in opposition to conventional medical treatment. In order to effectively target integrative support services it is crucial to explore the experiences of patients in their own words and use those forms of expression to drive service delivery

EFFECTS OF CAFFEINE ON EXERCISE PERFORMANCE IN SEDENTARY FEMALES

The purpose of the study was to examine the effect of caffeine ingestion on total work, average power, oxygen consumption (VO2), respiratory exchange ratio (RER), ratings of perceived exertion (RPE), heart rate (HR) and energy expenditure (kJ) during stationary cycling at a standardised power output, as well as during a set time period where participants were required to cycle as fast as they could. Ten healthy, sedentary, female, non- regular caffeine users completed 15 min of stationary cycling at a standardised power output equating to 65% HRmax (Phase A), followed by 10 min of stationary cycling where they were required to cycled as fast as they could (Phase B) after ingesting 6.0 mg·kg-1 of caffeine or placebo 60 min prior to exercise. VO2 and energy expenditure were significantly higher at the end of Phase A (p = 0.008 and p = 0.011, respectively). All other variables examined in Phase A were similar between trials. In Phase B, there were no significant differences found for any variable assessed. While caffeine ingestion resulted in significant increases in VO2 and energy expenditure during steady-state exercise, it did not improve cycling performance during a 10 min trial where participants were required to cycle as fast as they coul

RELIABILITY OF PHYSIOLOGICAL, PSYCHOLOGICAL AND COGNITIVE VARIABLES IN CHRONIC FATIGUE SYNDROME AND THE ROLE OF GRADED EXERCISE

The objective of this study was to assess variability in symptoms and physical capabilities in chronic fatigue syndrome (CFS) participants both before and after a graded exercise intervention. Sixty-one CFS subjects participated in a 12-week randomized controlled trial of either graded exercise (n =32) or relaxation/stretching therapy (n = 29). Specific physiological, psychological and cognitive variables were assessed once weekly over a four-week period both prior to and after the intervention period. All scores were assessed for reliability using an intraclass correlation coefficient (ICC). Apart from mental and physical fatigue, baseline ICC scores for all variables assessed were moderately to highly reliable, indicating minimal variability. Baseline scores for mental and physical fatigue were of questionable reliability, indicating a fluctuating nature to these symptoms (R1 = 0.64 and 0.60, respectively). Variability in scores for mental fatigue was reduced after graded exercise to an acceptable classification (R1 = 0.76). Results from this study support a variable nature to the symptoms of mental and physical fatigue only. Consequently, in order to more accurately report the nature of mental and physical fatigue in CFS, future studies should consider using repeated-measures analysis when assessing these symptoms. Graded exercise resulted in the reclassification of scores for mental fatigue from questionable to acceptable reliabilit