Hypocapnia is a biological marker for orthostatic intolerance in some patients with chronic fatigue syndrome

CONTEXT: Patients with chronic fatigue syndrome and those with orthostatic intolerance share many symptoms, yet questions exist as to whether CFS patients have physiological evidence of orthostatic intolerance. OBJECTIVE: To determine if some CFS patients have increased rates of orthostatic hypotension, hypertension, tachycardia, or hypocapnia relative to age-matched controls. DESIGN: Assess blood pressure, heart rate, respiratory rate, end tidal CO2 and visual analog scales for orthostatic symptoms when supine and when standing for 8 minutes without moving legs. SETTING: Referral practice and research center. PARTICIPANTS: 60 women and 15 men with CFS and 36 women and 4 men serving as age matched controls with analyses confined to 62 patients and 35 controls showing either normal orthostatic testing or a physiological abnormal test. MAIN OUTCOME MEASURES: Orthostatic tachycardia; orthostatic hypotension; orthostatic hypertension; orthostatic hypocapnia or combinations thereof. RESULTS: CFS patients had higher rates of abnormal tests than controls (53% vs 20%, p < .002), but rates of orthostatic tachycardia, orthostatic hypotension, and orthostatic hypertension did not differ significantly between patients and controls (11.3% vs 5.7%, 6.5% vs 2.9%, 19.4% vs 11.4%, respectively). In contrast, rates of orthostatic hypocapnia were significantly higher in CFS than in controls (20.6% vs 2.9%, p < .02). This CFS group reported significantly more feelings of illness and shortness of breath than either controls or CFS patients with normal physiological tests. CONCLUSION: A substantial number of CFS patients have orthostatic intolerance in the form of orthostatic hypocapnia. This allows subgrouping of patients with CFS and thus reduces patient pool heterogeneity engendered by use of a clinical case definition

Changes in physical health among participants in a multidisciplinary health programme for long-term unemployed persons

Background. The relationship between poor health and unemployment is well established. Health promotion among unemployed persons may improve their health. The aims of this study were to investigate characteristics of non-participants and drop-outs in a multidisciplinary health promotion programme for long-term unemployed persons with health complaints, to evaluate changes in physical health among participants, and to investigate determinants of improvement in physical health. Methods. A longitudinal, non-controlled design was used. The programme consisted of two weekly exercise sessions and one weekly cognitive session during 12 weeks. The main outcome measures were body mass index, blood pressure, cardiorespiratory fitness, abd

The unsupported upper limb exercise test in people without disabilities: assessing the within-day test–retest reliability and the effects of age and gender

Purpose: To estimate the within-day test–retest reliability and standard error of measurement (SEM) of the unsupported upper limb exercise test (UULEX) in adults without disabilities and to determine the effects of age and gender on performance of the UULEX. Method: A cross-sectional study was conducted with 100 adults without disabilities (44 men, mean age 44.2 [SD 26] y; 56 women, mean age 38.1 [SD 24.1] y). Participants performed three UULEX tests to establish within-day reliability, measured using an intra-class correlation coefficient (ICC) model 2 (two-way random effects) with a single rater (ICC[2,1]) and SEM. The effects of age and gender were examined using two-factor mixed-design analysis of variance (ANOVA) and one-way repeated-measures ANOVA. For analysis purposes, four sub-groups were created: younger adults, older adults, men, and women. Results: Excellent within-day reliability and a small SEM were found in the four sub-groups (younger adults: ICC[2,1]=0.88; 95% CI: 0.82, 0.92; SEM∼40 s; older adults: ICC[2,1]=0.82; 95% CI: 0.72, 0.90; SEM∼50 s; men: ICC[2,1]=0.93; 95% CI: 0.88, 0.96; SEM∼30 s; women: ICC[2,1]=0.85; 95% CI: 0.78, 0.91; SEM∼45 s). Younger adults took, on average, 308.24 seconds longer than older adults to perform the test; older adults performed significantly better on the third test (p0.05). Conclusion: The within-day test–retest reliability and SEM values of the UULEX may be used to define the magnitude of the error obtained with repeated measures. One UULEX test seems to be adequate for younger adults to achieve reliable results, whereas three tests seem to be needed for older adults.Objectif : évaluer la fiabilité d'un test-retest en une même journée et l'erreur type de mesure (ETM) du test d'exercice des membres supérieurs sans appui (UULEX) chez des adultes sans incapacités et déterminer les effets de l'âge et du sexe sur leur exécution. Méthodologie : les chercheurs ont réalisé une étude transversale auprès de 100 adultes sans incapacités (44 hommes, d'un âge moyen de 44,2 ans [ÉT 26], et 56 femmes, d'un âge moyen de 38,1 ans [ÉT 24,1]). Les participants ont effectué trois UULEX pour établir la fiabilité du test-retest en une même journée, mesurés à l'aide du modèle 2 de coefficient de corrélation intraclasse (ICC, effets aléatoires bilatéraux) comportant un ICC(2,1) et une ETM à un seul évaluateur. Les chercheurs ont examiné les effets de l'âge et du sexe à l'aide d'une analyse de variance bifactorielle à mesures mixtes et d'une analyse de variance unifactorielle à mesures répétées. Pour les besoins de l'analyse, les chercheurs ont créé quatre sous-groupes: jeunes adultes, adultes plus âgés, hommes et femmes. Résultats : les quatre sous-groupes affichaient une excellente fiabilité en une même journée et une petite ETM (jeunes adultes: ICC[2,1]=0,88 [IC 95% : 0,82, 0,92] et ETM∼40 secondes; adultes plus âgés : ICC[2,1]=0,82 [IC 95 % : 0,72, 0,90] et ETM∼50 secondes; hommes: ICC[2,1]=0,93 [IC 95% : 0,88, 0,96] et ETM∼30 secondes; femmes: ICC[2,1]=0,85 [IC 95 % : 0,78, 0,91] et ETM∼45 secondes). En moyenne, les jeunes adultes ont effectué le test pendant 308,24 secondes de plus que les adultes plus âgés; ceux-ci ont obtenu un résultat nettement meilleur au troisième test (p0,05). Conclusion : il est possible d'utiliser la fiabilité de test-retest en une même journée et les valeurs d'ETM de l'UULEX pour définir l'importance de l'erreur obtenue lors de mesures répétées. Un UULEX semble suffire pour que les jeunes adultes obtiennent des résultats fiables, tandis que trois tests semblent nécessaires chez les adultes plus âgés

Respiratory and immune response to maximal physical exertion following exposure to secondhand smoke in healthy adults

© 2012 The Authors. Published by PLOS. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1371/journal.pone.0031880We assessed the cardiorespiratory and immune response to physical exertion following secondhand smoke (SHS) exposure through a randomized crossover experiment. Data were obtained from 16 (8 women) non-smoking adults during and following a maximal oxygen uptake cycling protocol administered at baseline and at 0-, 1-, and 3- hours following 1-hour of SHS set at bar/restaurant carbon monoxide levels. We found that SHS was associated with a 12% decrease in maximum power output, an 8.2% reduction in maximal oxygen consumption, a 6% increase in perceived exertion, and a 6.7% decrease in time to exhaustion (P<0.05). Moreover, at 0-hours almost all respiratory and immune variables measured were adversely affected (P<0.05). For instance, FEV 1 values at 0-hours dropped by 17.4%, while TNF-α increased by 90.1% (P<0.05). At 3-hours mean values of cotinine, perceived exertion and recovery systolic blood pressure in both sexes, IL4, TNF-α and IFN-γ in men, as well as FEV 1/FVC, percent predicted FEV 1, respiratory rate, and tidal volume in women remained different compared to baseline (P<0.05). It is concluded that a 1-hour of SHS at bar/restaurant levels adversely affects the cardiorespiratory and immune response to maximal physical exertion in healthy nonsmokers for at least three hours following SHS. © 2012 Flouris et al.Published versio