Current Research Provides Insight into the Biological Basis and Diagnostic Potential for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

Eiren Sweetman, Alex Noble, Christina Edgar, Angus Mackay, Amber Helliwell, Rosamund Vallings, Margaret Ryan and Warren Tate
Commentary published in Diagnostics, 10 July 2019
https://doi.org/10.3390/diagnostics9030073

A compromised paraventricular nucleus within a dysfunctional hypothalamus: A novel neuroinflammatory paradigm for ME/CFS

Article by Angus Mackay, Warren P Tate
Published in International Journal of Immunopathology and Pharmacology, 6 December 2018
https://doi.org/10.1177/2058738418812342

Discussed in HealthRising blog, 27 May 2020.

to top

Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT

Carolyn E. Wilshire, Tom Kindlon, Robert Courtney, Alem Matthees, David Tuller, Keith Geraghty and Bruce Levin
Published in BMC Psychology, 2018 6:6
https://doi.org/10.1186/s40359-018-0218-3

Why does the research matter?

The PACE Trial was a highly influential trial which suggested that ME/CFS could be treated through Graded Exercise Therapy (GET) alongside CBT. CBT was used to treat patients for an assumed aversion to exercise. The PACE Trial was conducted by a group of researchers who felt ME/CFS could be treated as a psychosomatic disorder (a mental illness) rather than as a disease.

The reanalysis conducted by Wilshire, Kindlon, Courtney, Matthees, Tuller, Geraghty and Levin confirmed the concerns expressed by many clinicians, researchers and people with ME regarding notable flaws in the PACE Trial’s methodology. This analysis, Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT, concludes that the Trial data does not support the idea that GET/CBT is an effective treatment for ME. The reanalysis also discusses the likelihood Graded Exercise Therapy (GET) is harmful for large numbers of people with ME.

to top

Statement: ME/CFS and exercise

Statement by Dr Lynette Hodges, Senior Lecturer in Sport and Exercise, Massey University, on ‘ME/CFS and Exercise’, 2 September 2021

Research Seminar series - otago university, Christchurch campus

“The abnormal physiological responses to exercise in ME/CFS”
Dr Lynette Hodges, Senior Lecturer in Sport and Exercise, Massey University.
Research Seminar Series, Virtual event, 26th August 2021.

Effects of Post-Exertional Malaise on Markers of Arterial Stiffness in Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

by Joshua Bond, Tessa Nielsen and Lynette Hodges
Published in Environmental Research and Public Health, 28 February 2021
https://doi.org/10.3390/ijerph18052366

Conclusions:

The current study builds upon the growing evidence that patients with ME/CFS may suffer from impaired vascular function which remains unchanged following exercise. We have shown that ME/CFS patients may experience altered vascular responses following aerobic exercise, contrary to what is seen in healthy populations. This is thought to be a result of the increased presence of oxidative stress and low-grade vascular inflammation, which may be exacerbated by exercise and contribute to the onset of PEM. This information can be further elaborated upon to be potentially used as a diagnostic tool and determine levels of cardiovascular risk in this population. Further research into the effects of exercise on oxidative stress and vascular inflammation is required to verify these claims for ME/CFS.

Presentation - Exercise and ME/CFS

Dr Lynette Hodges, PhD, School of Sport, Exercise and Nutrition, Massey University
to ME Auckland, 10th October 2020
https://www.youtube.com/watch?v=qPI576KVgV4

Prediction of Discontinuation of Structured Exercise Programme in Chronic Fatigue Syndrome Patients

by Sławomir Kujawski, Jo Cossington, Joanna Słomko, Helen Dawes, James W.L. Strong, Fernando Estevez-Lopez, Modra Murovska, Julia L. Newton, Lynette Hodges and Paweł Zalewski
Published in Journal of Clinical Medicine, 26 October 2020
https://doi.org/10.3390/jcm9113436

In conclusion, this study is the first to demonstrate possible physiological reasons for participant withdrawal from studies which use the NICE endorsed physical exercise programme. However, due to the small sample size in this study, this study should be replicated.

This study demonstrated that structured exercise programmes may not be suitable for all individuals with ME/CFS. It is apparent that there may be a subgroup of individuals who have chronotropic intolerance, as demonstrated through a single CPET test. Further studies should focus on whether these individuals should avoid supervised exercise programmes as well as elucidating other important markers such as CPET testing results, autonomic and cognitive function, amongst others which may further help in personalizing therapy for ME/CFS subgroups.

The physiological timeline of post‐exertional malaise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

By Lynette Hodges, Tessa Nielsen, Darryl Cochrane, Donald Baken
Published in Translational Sports Medicine, 08 January 2020 (paywalled)
https://doi.org/10.1002/tsm2.133

With fatigue being such a dominant feature, it is important to define the time line and its impact following exertion in individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This study aimed to investigate the physiological effects of repeated graded maximal exercise testing at 48 and 72 hours, along with analyzing the reported time to recover from repeated graded exercise tests (PEM). ME/CFS (n = 16), age‐ and gender‐matched controls (n = 16) were randomly assigned to either a 48‐hour protocol or a 72‐hour protocol. Each participant completed a maximal incremental cycle exercise test on day one and again at either 48 hours (48‐h) or 72 hours (72‐h) later. Physiological responses were analyzed at peak work rate (PWR). There were significant differences in both peak VO2 and workload (P < .05) in the 48‐h ME/CFS group compared with the 48‐h controls in both test 1 and test 2. Significant differences in peak VO2 and workload were only demonstrated in test 2 in participants in the ME/CFS 72‐h group. There was a small but insignificant decrease in both peak VO2 and workload in the ME/CFS group at 48‐h. Interestingly those in the 72‐h ME/CFS protocol demonstrated an increase in workload (10 Watts), despite no change in VO2peak. Subjective data demonstrated the 48‐hour ME/CFS group reported significantly longer time to recover.

Physiological measures in participants with chronic fatigue syndrome, multiple sclerosis and healthy controls following repeated exercise: a pilot study

Dr Lynette Hodges, T. Nielsen, D. Baken
Published in Clinical Physiology and Functional Imaging, 7 August 2017
https://doi.org/10.1111/cpf.12460

Why Does the Research Matter?

Hodges, Nielsen and Baken compared the Physiological Responses to Exercise of ME/CFS and MS Patients to that of age-matched, healthy controls during an exercise test. They then repeated the test 24 hours later. The test uses objective measures. This study was a small pilot study. Healthy controls and MS patients improved their workload on the second day. In contrast, the workload decreased for ME/CFS patients on the second day. This is helpful as the cardinal feature of ME/CFS is Post-Exertion Malaise (PEM). Twenty-four hour repeat exercise tests can therefore objectively measure physiological changes in the bodies of people with ME at the point they are experiencing PEM, the onset of which is often delayed 24 hours after exertion. The authors noted the ME/CFS patients took 2 to 4 weeks to recover from the repeat test. The research:

1. Replicated other studies objectively measuring physiological changes that occur during PEM.

2. Reiterates the likely harm that exercise might cause to people with ME.

3. Indicated ME/CFS patients exhibit a different response to 24-hour repeat exercise tests compared to MS patients therefore offering a method of differentiating two conditions that can be misdiagnosed.

to top

Stigma in Myalgic Encephalomyelitis and its association with functioning

Don M. Baken, Shane T. Harvey, David L. Bimler & Kirsty J. Ross
Published in Fatigue: Biomedicine, Health & Behavior, 4 January 2018
https://doi.org/10.1080/21641846.2018.1419553

Why Does the Research Matter?

Dr Baken, Harvey, Bimler and Ross discover that people with ME/CFS perceive a higher level of negative attitudes and responses directed at them due to their illness when compared to similar surveys conducted with people with other neurological disorders. The self-report survey found an association between the stigma reported by research participants and health and functional ability. The research suggests that negative attitudes are deeply felt by people with ME/CFS and they have far-reaching implications on their ability to participate in social roles and activities. People with ME/CFS participating in the survey also reported lower levels of satisfaction in their participation in these roles and activities. The survey reaffirms a body of research that has consistently found low quality of life with people with ME/CFS compared with other serious health conditions.