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

Hand and torso pre-cooling does not enhance subsequent high-intensity cycling or cognitive performance in heat

The purpose of this study was to compare the separate and combined effects of two practical cooling methods (hand and torso) used prior to exercise on subsequent high-intensity cycling performance in heat. Ten trained male cyclists (V̇O2peak: 65.7 ± 10.7 ml.kg−1.min−1) performed four experimental trials (randomised within-subjects design) involving 30-min of pre-cooling (20-min seated; PRE-COOL, 10 min warm-up; PRE-COOL+WUP), while using a: (1) hand-cooling glove (CG); (2) cooling jacket (CJ); (3) both CG and CJ (CG+J); or (4) no-cooling (NC) control, followed by a cycling race simulation protocol (all performed in 35.0 ± 0.6°C and 56.6 ± 4.5% RH). During the 30-min of pre-cooling, no reductions in core (Tc) or mean skin temperature (Tsk) occurred; however, Tsk remained lower in the CJ and CG+J trials compared to NC and CG (p = 0.002–0.040, d= 0.55–1.01). Thermal sensation ratings also indicated that participants felt “hotter” during NC compared to all other trials during both PRE-COOL and PRE-COOL+WUP (p = 0.001–0.015, d= 1.0–2.19), plus the early stages of exercise (sets 1–2; p = 0.005–0.050, d= 0.56–1.22). Following cooling, no differences were found for absolute Tc and Tsk responses between trials over the entire exercise protocol (p > 0.05). Exercise and cognitive (working memory) performance also did not differ between trials (p = 0.843); however, cognitive performance improved over time in all trials (p < 0.001). In summary, pre-cooling (20-min seated and 10-min warm-up) in heat did not improve subsequent high-intensity cycling performance, cognitive responses and associated thermoregulatory strain (Tc and Tsk) compared to control

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

Effect of Beta Alanine and Sodium Bicarbonate Supplementation on Repeated-Sprint Performance

This study aimed to investigate if combining beta alanine (BA) and sodium bicarbonate (NaHCO3) supplementation could lead to enhanced repeated-sprint performance in team-sport athletes, beyond what is possible with either supplement alone. Participants (n = 24) completed duplicate trials of a repeated-sprint test (3 sets; 6 × 20 m departing every 25 seconds, 4 minutes active recovery between sets) and were then allocated into 4 groups as follows: BA only (n = 6; 28 days BA, acute sodium chloride placebo); NaHCO3 only (n = 6; 28 days glucose placebo, acute NaHCO3); BA/NaHCO3 (n = 6; 28 days BA, acute NaHCO3); placebo only (n = 6; 28 days glucose placebo, acute sodium chloride placebo), then completed duplicate trials postsupplementation. Sodium bicarbonate alone resulted in moderate effect size (d = 0.40–0.71) and “likely” and “very likely” benefit for overall total sprint times (TST) and for each individual set and for first sprint (sets 2 and 3) and best sprint time (sets 2 and 3). Combining BA and NaHCO3 resulted in “possible” to “likely” benefits for overall TST and for sets 2 and 3. First sprint (set 3) and best sprint time (sets 2 and 3) also showed “likely” benefit after this trial. The BA and placebo groups showed no differences in performance after supplementation. In conclusion, these results indicate that supplementation with acute NaHCO3 improved repeated-sprint performance more than either a combination of NaHCO3 and BA or BA alone