An analysis of 2‐day cardiopulmonary exercise testing to assess unexplained fatigue
Abstract Two consecutive maximal cardiopulmonary exercise tests (CPETs) performed 24 hr apart (2‐day CPET protocol) are increasingly used to evaluate post‐exertional malaise (PEM) and related disability among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This protocol...
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| Format: | Article |
| Language: | English |
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Wiley
2020-09-01
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| Series: | Physiological Reports |
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| Online Access: | https://doi.org/10.14814/phy2.14564 |
| _version_ | 1818330448724492288 |
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| author | Jacob B. Lindheimer Thomas Alexander Wei Qian Jacquelyn C. Klein‐Adams Gudrun Lange Benjamin H. Natelson Dane B. Cook Helene Z. Hill Michael J. Falvo |
| author_facet | Jacob B. Lindheimer Thomas Alexander Wei Qian Jacquelyn C. Klein‐Adams Gudrun Lange Benjamin H. Natelson Dane B. Cook Helene Z. Hill Michael J. Falvo |
| author_sort | Jacob B. Lindheimer |
| collection | DOAJ |
| description | Abstract Two consecutive maximal cardiopulmonary exercise tests (CPETs) performed 24 hr apart (2‐day CPET protocol) are increasingly used to evaluate post‐exertional malaise (PEM) and related disability among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This protocol may extend to other fatiguing illnesses with similar characteristics to ME/CFS; however, 2‐day CPET protocol reliability and minimum change required to be considered clinically meaningful (i.e., exceeding the standard error of the measure) are not well characterized. To address this gap, we evaluated the 2‐day CPET protocol in Gulf War Illness (GWI) by quantifying repeatability of seven CPET parameters, establishing their thresholds of clinically significant change, and determining whether changes differed between veterans with GWI and controls. Excluding those not attaining peak effort criteria (n = 15), we calculated intraclass correlation coefficients (ICCs), the smallest real difference (SRD%), and repeated measures analysis of variance (RM‐ANOVA) at the ventilatory anaerobic threshold (VAT) and peak exercise in 15 veterans with GWI and eight controls. ICC values at peak ranged from moderate to excellent for veterans with GWI (mean [range]; 0.84 [0.65 – 0.92]) and were reduced at the VAT (0.68 [0.37 – 0.78]). Across CPET variables, the SRD% at peak exercise for veterans with GWI (18.8 [8.8 – 28.8]) was generally lower than at the VAT (28.1 [9.5 – 34.8]). RM‐ANOVAs did not detect any significant group‐by‐time interactions (all p > .05). The methods and findings reported here provide a framework for evaluating 2‐day CPET reliability, and reinforce the importance of carefully considering measurement error in the population of interest when interpreting findings. |
| first_indexed | 2024-12-13T13:04:07Z |
| format | Article |
| id | doaj.art-18e21687cb9f4b38a888d8f7df87bf17 |
| institution | Directory Open Access Journal |
| issn | 2051-817X |
| language | English |
| last_indexed | 2024-12-13T13:04:07Z |
| publishDate | 2020-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Physiological Reports |
| spelling | doaj.art-18e21687cb9f4b38a888d8f7df87bf172022-12-21T23:44:53ZengWileyPhysiological Reports2051-817X2020-09-01817n/an/a10.14814/phy2.14564An analysis of 2‐day cardiopulmonary exercise testing to assess unexplained fatigueJacob B. Lindheimer0Thomas Alexander1Wei Qian2Jacquelyn C. Klein‐Adams3Gudrun Lange4Benjamin H. Natelson5Dane B. Cook6Helene Z. Hill7Michael J. Falvo8William S. Middleton Memorial Veterans Hospital Madison WI USAVA Airborne Hazards and Burn Pits Center of Excellence War Related Illness and Injury Study Center VA New Jersey Health Care System East Orange NJ USAVA Airborne Hazards and Burn Pits Center of Excellence War Related Illness and Injury Study Center VA New Jersey Health Care System East Orange NJ USAVA Airborne Hazards and Burn Pits Center of Excellence War Related Illness and Injury Study Center VA New Jersey Health Care System East Orange NJ USADepartment of Neurology Icahn School of Medicine at Mount Sinai New York NY USADepartment of Neurology Icahn School of Medicine at Mount Sinai New York NY USAWilliam S. Middleton Memorial Veterans Hospital Madison WI USANew Jersey Medical SchoolRutgers Biomedical and Health Sciences Newark NJ USAVA Airborne Hazards and Burn Pits Center of Excellence War Related Illness and Injury Study Center VA New Jersey Health Care System East Orange NJ USAAbstract Two consecutive maximal cardiopulmonary exercise tests (CPETs) performed 24 hr apart (2‐day CPET protocol) are increasingly used to evaluate post‐exertional malaise (PEM) and related disability among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This protocol may extend to other fatiguing illnesses with similar characteristics to ME/CFS; however, 2‐day CPET protocol reliability and minimum change required to be considered clinically meaningful (i.e., exceeding the standard error of the measure) are not well characterized. To address this gap, we evaluated the 2‐day CPET protocol in Gulf War Illness (GWI) by quantifying repeatability of seven CPET parameters, establishing their thresholds of clinically significant change, and determining whether changes differed between veterans with GWI and controls. Excluding those not attaining peak effort criteria (n = 15), we calculated intraclass correlation coefficients (ICCs), the smallest real difference (SRD%), and repeated measures analysis of variance (RM‐ANOVA) at the ventilatory anaerobic threshold (VAT) and peak exercise in 15 veterans with GWI and eight controls. ICC values at peak ranged from moderate to excellent for veterans with GWI (mean [range]; 0.84 [0.65 – 0.92]) and were reduced at the VAT (0.68 [0.37 – 0.78]). Across CPET variables, the SRD% at peak exercise for veterans with GWI (18.8 [8.8 – 28.8]) was generally lower than at the VAT (28.1 [9.5 – 34.8]). RM‐ANOVAs did not detect any significant group‐by‐time interactions (all p > .05). The methods and findings reported here provide a framework for evaluating 2‐day CPET reliability, and reinforce the importance of carefully considering measurement error in the population of interest when interpreting findings.https://doi.org/10.14814/phy2.14564cardiopulmonaryexerciseexercise testfatiguefatigue syndrome, chronicpersian gulf fyndrome |
| spellingShingle | Jacob B. Lindheimer Thomas Alexander Wei Qian Jacquelyn C. Klein‐Adams Gudrun Lange Benjamin H. Natelson Dane B. Cook Helene Z. Hill Michael J. Falvo An analysis of 2‐day cardiopulmonary exercise testing to assess unexplained fatigue Physiological Reports cardiopulmonary exercise exercise test fatigue fatigue syndrome, chronic persian gulf fyndrome |
| title | An analysis of 2‐day cardiopulmonary exercise testing to assess unexplained fatigue |
| title_full | An analysis of 2‐day cardiopulmonary exercise testing to assess unexplained fatigue |
| title_fullStr | An analysis of 2‐day cardiopulmonary exercise testing to assess unexplained fatigue |
| title_full_unstemmed | An analysis of 2‐day cardiopulmonary exercise testing to assess unexplained fatigue |
| title_short | An analysis of 2‐day cardiopulmonary exercise testing to assess unexplained fatigue |
| title_sort | analysis of 2 day cardiopulmonary exercise testing to assess unexplained fatigue |
| topic | cardiopulmonary exercise exercise test fatigue fatigue syndrome, chronic persian gulf fyndrome |
| url | https://doi.org/10.14814/phy2.14564 |
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