Recovery from Exercise in Persons with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
<i>Background and Objectives</i>: Post-exertional malaise (PEM) is the hallmark of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but there has been little effort to quantitate the duration of PEM symptoms following a known exertional stressor. Using a Symptom Severity Scal...
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MDPI AG
2023-03-01
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| Online Access: | https://www.mdpi.com/1648-9144/59/3/571 |
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| author | Geoffrey E. Moore Betsy A. Keller Jared Stevens Xiangling Mao Staci R. Stevens John K. Chia Susan M. Levine Carl J. Franconi Maureen R. Hanson |
| author_facet | Geoffrey E. Moore Betsy A. Keller Jared Stevens Xiangling Mao Staci R. Stevens John K. Chia Susan M. Levine Carl J. Franconi Maureen R. Hanson |
| author_sort | Geoffrey E. Moore |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Post-exertional malaise (PEM) is the hallmark of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but there has been little effort to quantitate the duration of PEM symptoms following a known exertional stressor. Using a Symptom Severity Scale (SSS) that includes nine common symptoms of ME/CFS, we sought to characterize the duration and severity of PEM symptoms following two cardiopulmonary exercise tests separated by 24 h (2-day CPET). <i>Materials and Methods</i>: Eighty persons with ME/CFS and 64 controls (CTL) underwent a 2-day CPET. ME/CFS subjects met the Canadian Clinical Criteria for diagnosis of ME/CFS; controls were healthy but not participating in regular physical activity. All subjects who met maximal effort criteria on both CPETs were included. SSS scores were obtained at baseline, immediately prior to both CPETs, the day after the second CPET, and every two days after the CPET-1 for 10 days. <i>Results</i>: There was a highly significant difference in judged recovery time (ME/CFS = 12.7 ± 1.2 d; CTL = 2.1 ± 0.2 d, mean ± s.e.m., Chi<sup>2</sup> = 90.1, <i>p</i> < 0.0001). The range of ME/CFS patient recovery was 1–64 days, while the range in CTL was 1–10 days; one subject with ME/CFS had not recovered after one year and was not included in the analysis. Less than 10% of subjects with ME/CFS took more than three weeks to recover. There was no difference in recovery time based on the level of pre-test symptoms prior to CPET-1 (F = 1.12, <i>p</i> = 0.33). Mean SSS scores at baseline were significantly higher than at pre-CPET-1 (5.70 ± 0.16 vs. 4.02 ± 0.18, <i>p</i> < 0.0001). Pharmacokinetic models showed an extremely prolonged decay of the PEM response (Chi<sup>2</sup> > 22, <i>p</i> < 0.0001) to the 2-day CPET. <i>Conclusions</i>: ME/CFS subjects took an average of about two weeks to recover from a 2-day CPET, whereas sedentary controls needed only two days. These data quantitate the prolonged recovery time in ME/CFS and improve the ability to obtain well-informed consent prior to doing exercise testing in persons with ME/CFS. Quantitative monitoring of PEM symptoms may provide a method to help manage PEM. |
| first_indexed | 2024-03-11T06:12:26Z |
| format | Article |
| id | doaj.art-890e9a59e41c47189ac319595212eb7c |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
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| last_indexed | 2024-03-11T06:12:26Z |
| publishDate | 2023-03-01 |
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| spelling | doaj.art-890e9a59e41c47189ac319595212eb7c2023-11-17T12:32:33ZengMDPI AGMedicina1010-660X1648-91442023-03-0159357110.3390/medicina59030571Recovery from Exercise in Persons with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)Geoffrey E. Moore0Betsy A. Keller1Jared Stevens2Xiangling Mao3Staci R. Stevens4John K. Chia5Susan M. Levine6Carl J. Franconi7Maureen R. Hanson8Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY 14853, USADepartment of Molecular Biology and Genetics, Cornell University, Ithaca, NY 14853, USAWorkwell Foundation, Ripon, CA 95366, USADepartment of Radiology, Weill Cornell Medical College, New York, NY 10021, USAWorkwell Foundation, Ripon, CA 95366, USAEVMED Research, Torrance, CA 90505, USAMedical Office of Susan Levine, Manhattan, NY 10021, USADepartment of Molecular Biology and Genetics, Cornell University, Ithaca, NY 14853, USADepartment of Molecular Biology and Genetics, Cornell University, Ithaca, NY 14853, USA<i>Background and Objectives</i>: Post-exertional malaise (PEM) is the hallmark of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but there has been little effort to quantitate the duration of PEM symptoms following a known exertional stressor. Using a Symptom Severity Scale (SSS) that includes nine common symptoms of ME/CFS, we sought to characterize the duration and severity of PEM symptoms following two cardiopulmonary exercise tests separated by 24 h (2-day CPET). <i>Materials and Methods</i>: Eighty persons with ME/CFS and 64 controls (CTL) underwent a 2-day CPET. ME/CFS subjects met the Canadian Clinical Criteria for diagnosis of ME/CFS; controls were healthy but not participating in regular physical activity. All subjects who met maximal effort criteria on both CPETs were included. SSS scores were obtained at baseline, immediately prior to both CPETs, the day after the second CPET, and every two days after the CPET-1 for 10 days. <i>Results</i>: There was a highly significant difference in judged recovery time (ME/CFS = 12.7 ± 1.2 d; CTL = 2.1 ± 0.2 d, mean ± s.e.m., Chi<sup>2</sup> = 90.1, <i>p</i> < 0.0001). The range of ME/CFS patient recovery was 1–64 days, while the range in CTL was 1–10 days; one subject with ME/CFS had not recovered after one year and was not included in the analysis. Less than 10% of subjects with ME/CFS took more than three weeks to recover. There was no difference in recovery time based on the level of pre-test symptoms prior to CPET-1 (F = 1.12, <i>p</i> = 0.33). Mean SSS scores at baseline were significantly higher than at pre-CPET-1 (5.70 ± 0.16 vs. 4.02 ± 0.18, <i>p</i> < 0.0001). Pharmacokinetic models showed an extremely prolonged decay of the PEM response (Chi<sup>2</sup> > 22, <i>p</i> < 0.0001) to the 2-day CPET. <i>Conclusions</i>: ME/CFS subjects took an average of about two weeks to recover from a 2-day CPET, whereas sedentary controls needed only two days. These data quantitate the prolonged recovery time in ME/CFS and improve the ability to obtain well-informed consent prior to doing exercise testing in persons with ME/CFS. Quantitative monitoring of PEM symptoms may provide a method to help manage PEM.https://www.mdpi.com/1648-9144/59/3/571myalgic encephalomyelitischronic fatigue syndrome2-day cardiopulmonary exercise testpost-exertional malaisespecific symptom severityexercise recovery |
| spellingShingle | Geoffrey E. Moore Betsy A. Keller Jared Stevens Xiangling Mao Staci R. Stevens John K. Chia Susan M. Levine Carl J. Franconi Maureen R. Hanson Recovery from Exercise in Persons with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Medicina myalgic encephalomyelitis chronic fatigue syndrome 2-day cardiopulmonary exercise test post-exertional malaise specific symptom severity exercise recovery |
| title | Recovery from Exercise in Persons with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) |
| title_full | Recovery from Exercise in Persons with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) |
| title_fullStr | Recovery from Exercise in Persons with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) |
| title_full_unstemmed | Recovery from Exercise in Persons with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) |
| title_short | Recovery from Exercise in Persons with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) |
| title_sort | recovery from exercise in persons with myalgic encephalomyelitis chronic fatigue syndrome me cfs |
| topic | myalgic encephalomyelitis chronic fatigue syndrome 2-day cardiopulmonary exercise test post-exertional malaise specific symptom severity exercise recovery |
| url | https://www.mdpi.com/1648-9144/59/3/571 |
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