Can pacing self-management alter physical behaviour and symptom severity in chronic fatigue syndrome? : a case series

Given the lack of evidence in support of pacing self-management for patients with chronic fatigue syndrome (CFS), we examined whether physical behavior and health status of patients with CFS Would improve in response to a pacing self-management program. We performed an observational study of pacing self-management in seven CFS patients using a single-case study design. Stages A1 and A2 (7-day assessment periods) of the A1-B-A2 design corresponded to the baseline and posttreatment measurements of physical behavior (real-time activity monitoring) and health status (self-reported measures), respectively. Stage B (3 weeks of treatment) consisted of three individual treatment sessions of pacing self-management. When comparing pre- versus posttreatment data, we found that the patients' ability to perform daily activities and the severity of their symptom complexes were improved (p = 0.043). Concentration difficulties, mood swings, muscle weakness, and intolerance to bright light improved as well. A statistically significant decrease in the mean time spent doing light activity (<3 metabolic equivalents) was observed, but a change in the way physical activity was spread throughout the day was not. We found that 3 weeks of pacing self-management was accompanied by a modest improvement in symptom severity and daily functioning. The outcome of the present study calls for a randomized controlled clinical trial to examine the effectiveness of pacing self-management for people with CFS

Multiscale socio-ecological networks in the age of information

Interactions between people and ecological systems, through leisure or tourism activities, form a complex socio-ecological spatial network. The analysis of the benefits people derive from their interactions with nature—also referred to as cultural ecosystem services (CES)—enables a better understanding of these socio-ecological systems. In the age of information, the increasing availability of large social media databases enables a better understanding of complex socio-ecological interactions at an unprecedented spatio-temporal resolution. Within this context, we model and analyze these interactions based on information extracted from geotagged photographs embedded into a multiscale socio-ecological network. We apply this approach to 16 case study sites in Europe using a social media database (Flickr) containing more than 150,000 validated and classified photographs. After evaluating the representativeness of the network, we investigate the impact of visitors’ origin on the distribution of socio-ecological interactions at different scales. First at a global scale, we develop a spatial measure of attractiveness and use this to identify four groups of sites. Then, at a local scale, we explore how the distance traveled by the users to reach a site affects the way they interact with this site in space and time. The approach developed here, integrating social media data into a network-based framework, offers a new way of visualizing and modeling interactions between humans and landscapes. Results provide valuable insights for understanding relationships between social demands for CES and the places of their realization, thus allowing for the development of more efficient conservation and planning strategies

Chronischevermoeidheidssyndroom en fibromyalgie: recente ontwikkelingen en fysiotherapeutische implicaties

Chronisch vermoeidheid syndroom (CVS) en fibromyalgie zijn ernstig invaliderende chronische aandoeningen met veel gemeenschappelijke kenmerken. Een groot aantal patiënten voldoet aan de diagnostische criteria van beide aandoeningen. CVS en fibromyalgie blijven controversiële onderwerpen, en fysiotherapie voor deze patiënten des te meer. In deze bijdrage integreren we de recente klinische en fundamentele onderzoeksresultaten in het klinisch redeneringsproces van CVS- en fibromyalgie-patiënten. Daarbij is het van belang om rekening te houden met het erger worden van de klachten onder invloed van lichamelijke inspanning, hetgeen gerelateerd is aan het verder ontregelen van het immuunstelsel door overdreven inspanning. Daarom zijn oefentherapieën met een lage tot matige intensiteit met korte oefenblokken en lange rustpauzes aangewezen, temeer om tegemoet te komen aan het vertraagd recuperatievermogen na inspanning. Deze principes dienen ook toegepast te worden in het dagelijks leven van de patiënt, hetgeen mogelijk is door het aanleren van pacing zelfmanagement. Voor fysiotherapie bij patiënten met een (comorbide) fibromyalgie is het van belang te beseffen dat er zowel perifere als centrale oorzaken zijn van de chronische veralgemeende pijnklachten. Perifeer is er in de musculatuur van patiënten met fibromyalgie een verstoorde vascularisatie, een verlaagde pijndrempel en een slechte energielevering, hetgeen resulteert in een musculaire hypoxie. De centrale pijnverwerkingsprocessen zijn bovendien ontregeld (centrale sensitisatie). Voor de fysiotherapie betekent dit dat oefentherapieën aan een lage intensiteit moeten voldoen en indien mogelijk in warm water moeten uitgevoerd worden. Ter desensitisatie van het centraal zenuwstelsel is het geven van educatie over pijnfysiologie aangewezen

Is the International Physical Activity Questionnaire-Short Form (IPAQ-SF) valid for assessing physical activity in chronic fatigue syndrome?

PURPOSE: To evaluate the criterion validity and internal consistency of the International Physical Activity Questionnaire-short form (IPAQ-sf) in Chronic Fatigue Syndrome (CFS) patients. METHOD: Fifty-six CFS patients completed the IPAQ-sf after they wore a tri-axial accelerometer and filled out activity diaries during 1 week. Spearman rank correlation coefficients and Cronbach's Alpha were calculated. RESULTS: The IPAQ-sf correlated significantly with the energy expenditure and Metabolic Equivalents (METs) minutes spent moderately to vigorously active following the activity diary and accelerometer. These correlation coefficients were however low (r varying between 0.282 and 0.426) and rather irrelevant, since CFS patients hardly reach moderate or vigorous activity levels. Internal consistency between the three subitems used for the total score of the IPAQ-sf was 0.337. CONCLUSION: The observed associations between the IPAQ-sf data and the data obtained from the accelerometer (gold standard) and the diaries were too low to be in support of the use of the IPAQ-sf in patients with CFS. The IPAQ-sf does not seem an appropriate tool to assess physical activity in CFS patients. Further study is required to seek for a valid, practical and affordable tool.status: publishe

Is the International Physical Activity Questionnaire-Short Form (IPAQ-SF) valid for assessing physical activity in chronic fatigue syndrome?

Purpose. To evaluate the criterion validity and internal consistency of the International Physical Activity Questionnaire-short form (IPAQ-sf) in Chronic Fatigue Syndrome (CFS) patients. Method. Fifty-six CFS patients completed the IPAQ-sf after they wore a tri-axial accelerometer and filled out activity diaries during 1 week. Spearman rank correlation coefficients and Cronbach's Alpha were calculated. Results. The IPAQ-sf correlated significantly with the energy expenditure and Metabolic Equivalents (METs) minutes spent moderately to vigorously active following the activity diary and accelerometer. These correlation coefficients were however low (r varying between 0.282 and 0.426) and rather irrelevant, since CFS patients hardly reach moderate or vigorous activity levels. Internal consistency between the three subitems used for the total score of the IPAQ-sf was 0.337. Conclusion. The observed associations between the IPAQ-sf data and the data obtained from the accelerometer (gold standard) and the diaries were too low to be in support of the use of the IPAQ-sf in patients with CFS. The IPAQ-sf does not seem an appropriate tool to assess physical activity in CFS patients. Further study is required to seek for a valid, practical and affordable tool

Fysiotherapie voor patiënten met het chronische vermoeidheidssyndroom: een casus ter illustratie van het klinisch redeneren

Overmatige fysieke inspanning maakt patiënten met het chronische vermoeidheidssyndroom (cvs) zieker. Dit is een typisch kenmerk van deze onderschatte aandoening. De kennis over de oorzaak van de slechte reactie van cvs-patiënten op lichamelijke inspanning raakt beetje bij beetje ontrafeld. Deze nieuwe inzichten vormen de theoretische basis voor een fysiotherapeutische behandeling op maat van iedere patiënt met cvs. Dit wordt praktisch geïllustreerd in deze casusbespreking. We doorlopen het klinisch redeneringsproces vanaf de aanmelding, via de definiëring van de behandeldoelstellingen tot het implementeren van de behandeling. De fysiotherapeutische behandeling wordt daarbij opgedeeld in twee fasen: een stabilisatiefase en een opbouwfase. Deze vorm van fysiotherapie kan cvs niet genezen, maar kan wel de functionaliteit van de patiënt verbeteren en de medische behandeling ondersteunen en aanvullen