Postexertional Malaise in Women with Chronic Fatigue Syndrome
Publication: Journal of Women's Health
Volume 19, Issue Number 2
Abstract
Objective: Postexertional malaise (PEM) is a defining characteristic of chronic fatigue syndrome (CFS) that remains a source of some controversy. The purpose of this study was to explore the effects of an exercise challenge on CFS symptoms from a patient perspective.
Methods: This study included 25 female CFS patients and 23 age-matched sedentary controls. All participants underwent a maximal cardiopulmonary exercise test. Subjects completed a health and well-being survey (SF-36) 7 days postexercise. Subjects also provided, approximately 7 days after testing, written answers to open-ended questions pertaining to physical and cognitive responses to the test and length of recovery. SF-36 data were compared using multivariate analyses. Written questionnaire responses were used to determine recovery time as well as number and type of symptoms experienced.
Results: Written questionnaires revealed that within 24 hours of the test, 85% of controls indicated full recovery, in contrast to 0 CFS patients. The remaining 15% of controls recovered within 48 hours of the test. In contrast, only 1 CFS patient recovered within 48 hours. Symptoms reported after the exercise test included fatigue, light-headedness, muscular/joint pain, cognitive dysfunction, headache, nausea, physical weakness, trembling/instability, insomnia, and sore throat/glands. A significant multivariate effect for the SF-36 responses (p < 0.001) indicated lower functioning among the CFS patients, which was most pronounced for items measuring physiological function.
Conclusions: The results of this study suggest that PEM is both a real and an incapacitating condition for women with CFS and that their responses to exercise are distinctively different from those of sedentary controls.
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References
1.
U.S. Centers for Disease Control and PreventionCFS Toolkit for health care professionalsAtlanta, GADepartment of Health and Human Serviceswww.cdc.gov/cfs/toolkit.htmNovember42008. 1. U.S. Centers for Disease Control and Prevention. CFS Toolkit for health care professionals. Atlanta, GA: Department of Health and Human Services. Available at www.cdc.gov/cfs/toolkit.htm Accessed November 4, 2008.
2.
Reeves WCJones JFMaloney E et al. Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural GeorgiaPopul Health Metr200755. 2. Reeves WC, Jones JF, Maloney E, et al. Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural Georgia. Popul Health Metr 2007;5:5.
3.
Larun LMalterud K. Identity and coping experiences in chronic fatigue syndrome: A synthesis of qualitative studiesPatient Educ Couns20076920-28. 3. Larun L, Malterud K. Identity and coping experiences in chronic fatigue syndrome: A synthesis of qualitative studies. Patient Educ Couns 2007;69:20–28.
4.
Komaroff ALBuchwald D. Chronic fatigue syndrome: An updateAnnu Rev Med1998491-13. 4. Komaroff AL, Buchwald D. Chronic fatigue syndrome: An update. Annu Rev Med 1998;49:1–13.
5.
Cook DBNagelkirk PRPeckerman APoluri AMores JNatelson BH. Exercise and cognitive performance in chronic fatigue syndromeMed Sci Sports Exerc2005371460-1467. 5. Cook DB, Nagelkirk PR, Peckerman A, Poluri A, Mores J, Natelson BH. Exercise and cognitive performance in chronic fatigue syndrome. Med Sci Sports Exerc 2005;37:1460–1467.
6.
Sorensen BStreib JEStrand M et al. Complement activation in a model of chronic fatigue syndromeJ Allergy Clin Immunol2003112397-403. 6. Sorensen B, Streib, JE, Strand M, et al. Complement activation in a model of chronic fatigue syndrome. J Allergy Clin Immunol 2003;112:397–403.
7.
Bazelmans EBleijenberg GVoeten MJVan der Meer JWFolgering H. Impact of a maximal exercise test on symptoms and activity in chronic fatigue syndromeJ Psychosom Res200559201-208. 7. Bazelmans E, Bleijenberg G, Voeten MJ, Van der Meer JW, Folgering H. Impact of a maximal exercise test on symptoms and activity in chronic fatigue syndrome. J Psychosom Res 2005;59:201–208.
8.
Black CDMcCully KK. Time course of exercise-induced alterations in daily activity in chronic fatigue syndromeDyn Med20052810. 8. Black CD, McCully KK. Time course of exercise-induced alterations in daily activity in chronic fatigue syndrome. Dyn Med 2005;28:10.
9.
Rowbottom DGKeast DGreen SKakulas BMorton AR. The case history of an elite ultra-endurance cyclist who developed chronic fatigue syndromeMed Sci Sports Exerc1998301345-1348. 9. Rowbottom DG, Keast D, Green S, Kakulas B, Morton AR. The case history of an elite ultra-endurance cyclist who developed chronic fatigue syndrome. Med Sci Sports Exerc 1998;30:1345–1348.
10.
Taylor RR. Quality of life and symptom severity for individuals with chronic fatigue syndrome: Findings from a randomized clinical trialAm J Occup Ther20045835-43. 10. Taylor RR. Quality of life and symptom severity for individuals with chronic fatigue syndrome: Findings from a randomized clinical trial. Am J Occup Ther 2004;58:35–43.
11.
Blackwood SKMacHale SMPower MJGoodwin GMLawrie SM. Effects of exercise on cognitive and motor function in chronic fatigue syndrome and depressionJ Neurol Neurosurg Psychiatry199865541-547. 11. Blackwood SK, MacHale SM, Power MJ, Goodwin GM, Lawrie SM. Effects of exercise on cognitive and motor function in chronic fatigue syndrome and depression. J Neurol Neurosurg Psychiatry 1998;65:541–547.
12.
Cannon JGAngel JBBall RWAbad LWFagioli LKomaroff AL. Acute phase responses and cytokine secretion in chronic fatigue syndromeJ Clin Immunol199919414-421. 12. Cannon JG, Angel JB, Ball RW, Abad LW, Fagioli L, Komaroff AL. Acute phase responses and cytokine secretion in chronic fatigue syndrome. J Clin Immunol 1999;19:414–421.
13.
Nijs JPaul LWallman K. Chronic fatigue syndrome: An approach combining self-management with graded exercise to avoid exacerbationsJ Rehabil Med200840241-247. 13. Nijs J, Paul L, Wallman K. Chronic fatigue syndrome: An approach combining self-management with graded exercise to avoid exacerbations. J Rehabil Med 2008;40;241–247.
14.
Allen PR. Chronic fatigue syndrome: Implications for women and their health care providers during the childbearing yearsJ Midwifery Womens Health200853289-301. 14. Allen PR. Chronic fatigue syndrome: Implications for women and their health care providers during the childbearing years. J Midwifery Womens Health 2008;53:289–301.
15.
Fukuda KStraus SEHickie ISharpe MCDobbins JGKomaroff A. Chronic fatigue syndrome: A comprehensive approach to its definition and studyAnn Intern Med1994121953-959. 15. Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. Chronic fatigue syndrome: A comprehensive approach to its definition and study. Ann Intern Med 1994;121:953–959.
16.
Chandler HKCiccone DMacBride RJNatelson B. Medically unexplained illness in short- and long-term disability applicants: Prevalence and cost of salary reimbursementDisabil Rehabil2008301185-1191. 16. Chandler HK, Ciccone D, MacBride RJ, Natelson B. Medically unexplained illness in short- and long-term disability applicants: Prevalence and cost of salary reimbursement. Disabil Rehabil 2008;30:1185–1191.
17.
Lawrie SMMacHale SMPower MJGoodwin GM. Is chronic fatigue syndrome best understood as a primary disturbance of the sense of effort?Psychol Med199727995-999. 17. Lawrie SM, MacHale SM, Power MJ, Goodwin GM. Is chronic fatigue syndrome best understood as a primary disturbance of the sense of effort? Psychol Med 1997;27:995–999.
18.
Rosen SDKing JCWilkinson JBNixon PG. Is chronic fatigue syndrome synonymous with effort syndrome?J R Soc Med199383761-764. 18. Rosen SD, King JC, Wilkinson JB, Nixon PG. Is chronic fatigue syndrome synonymous with effort syndrome? J R Soc Med 1993;83:761–764.
19.
De Meirleir KDBisbal CCampine K et al. A 37kDa 2–5A binding protein as a potential biochemical marker for chronic fatigue syndromeAm J Med200010899-105. 19. De Meirleir KD, Bisbal C, Campine K, et al. A 37kDa 2–5A binding protein as a potential biochemical marker for chronic fatigue syndrome. Am J Med 2000;108:99–105.
20.
Engelbienne PHerst CVDeSmet K et al. Interactions between RNaseL ankyrin-like domain and ABC transporters as a possible origin for pain, ion transport, CS and immune disorders of chronic fatigue immune dysfunction syndromeJ CFS2001883-102. 20. Engelbienne P, Herst CV, DeSmet K, et al. Interactions between RNaseL ankyrin-like domain and ABC transporters as a possible origin for pain, ion transport, CS and immune disorders of chronic fatigue immune dysfunction syndrome. J CFS 2001;8:83–102.
21.
Van Houdenhove BVerheyen LPardaens KLuyten PVan Wambeke P. Rehabilitation of decreased motor performance in patients with chronic fatigue syndrome: Should we treat low effort capacity or reduced effort tolerance?Clin Rehabil2007211121-1142. 21. Van Houdenhove B, Verheyen L, Pardaens K, Luyten P, Van Wambeke P. Rehabilitation of decreased motor performance in patients with chronic fatigue syndrome: Should we treat low effort capacity or reduced effort tolerance? Clin Rehabil 2007;21:1121–1142.
22.
Whistler TJones JFUnger ERVernon SD. Exercise responsive genes measured in peripheral blood of women with chronic fatigue syndrome and matched control subjectsBMC Physiol200555-14. 22. Whistler T, Jones JF, Unger ER, Vernon SD. Exercise responsive genes measured in peripheral blood of women with chronic fatigue syndrome and matched control subjects. BMC Physiol 2005;5:5–14.
23.
White PDNye KEPinching AJ et al. Immunological changes after both exercise and activity in chronic fatigue syndrome: A pilot studyJ CFS20041251-66. 23. White PD, Nye KE, Pinching AJ, et al. Immunological changes after both exercise and activity in chronic fatigue syndrome: A pilot study. J CFS 2004;12:51–66.
24.
LaManca JJSisto SADeLuca J et al. Influence of exhaustive treadmill exercise on cognitive functioning in chronic fatigue syndromeAm J Med199810559S-65S. 24. LaManca JJ, Sisto SA, DeLuca J, et al. Influence of exhaustive treadmill exercise on cognitive functioning in chronic fatigue syndrome. Am J Med 1998;105:59S–65S.
25.
VanNess JMSnell CRStrayer DLStevens SR. Subclassifying chronic fatigue syndrome through exercise testingMed Sci Sports Exerc200335908-913. 25. VanNess JM, Snell CR, Strayer DL, Stevens SR. Subclassifying chronic fatigue syndrome through exercise testing. Med Sci Sports Exerc 2003;35:908–913.
26.
Ware JESherbourne CD. The MOS 36-item short form health survey (SF-36): Conceptual framework and item selectionMed Care199230473-483. 26. Ware JE, Sherbourne CD. The MOS 36-item short form health survey (SF-36): Conceptual framework and item selection. Med Care 1992;30:473–483.
27.
Komaroff ALFagioli LRDoolittle TH et al. Health status in patients with chronic fatigue syndrome and in general population and disease comparison groupsAm J Med1996101281-290. 27. Komaroff AL, Fagioli LR, Doolittle TH, et al. Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups. Am J Med 1996;101:281–290.
28.
Reeves WCWagner DNisenbaum R et al. Chronic fatigue syndrome—A clinically empirical approach to its definition and studyBMC Med200531741-7015. 28. Reeves WC, Wagner D, Nisenbaum R, et al. Chronic fatigue syndrome—A clinically empirical approach to its definition and study. BMC Med 2005;3:1741–7015.
29.
Ciccone DSBusichio KVickroy MNatelson B. Psychiatric morbidity in the chronic fatigue syndrome. Are patients with personality disorder more physically impaired?J Psychosom Res200354445-452. 29. Ciccone DS, Busichio K, Vickroy M, Natelson B. Psychiatric morbidity in the chronic fatigue syndrome. Are patients with personality disorder more physically impaired? J Psychosom Res 2003;54:445–452.
30.
Silver AHaeney MVijayadurai PWilks DPattrick MMain CJ. The role of fear of physical movement and activity in chronic fatigue syndromeJ Psychosom Res200252485-493. 30. Silver A, Haeney M, Vijayadurai P, Wilks D, Pattrick M, Main CJ. The role of fear of physical movement and activity in chronic fatigue syndrome. J Psychosom Res 2002;52:485–493.
31.
Anderson JFerrans C. The quality of life of persons with chronic fatigue syndromeJ Nerv Ment Dis1997185359-367. 31. Anderson J, Ferrans C. The quality of life of persons with chronic fatigue syndrome. J Nerv Ment Dis 1997;185:359–367.
32.
Griffiths PMunson P. Valley of shadows: Journal entriesStricken: Voices for the hidden epidemic of chronic fatigue syndromeNew YorkHaworth Press200053-60. 32. Griffiths P. Valley of shadows: Journal entries. In: Munson P, ed. Stricken: Voices for the hidden epidemic of chronic fatigue syndrome. New York: Haworth Press, 2000, 53–60.
33.
MacKenzie MDechene LFriedberg FFontanetta R. Coping reports for patients with long-term CFSJ CFS1995159-67. 33. MacKenzie M, Dechene L, Friedberg F, Fontanetta R. Coping reports for patients with long-term CFS. J CFS 1995;1:59–67.
34.
Fulle SMecocci PFano G et al. Specific oxidative alterations in vastus lateralis muscle of patients with the diagnosis of chronic fatigue syndromeFree Radical Biol Med2000291252-1259. 34. Fulle S, Mecocci P, Fano G, et al. Specific oxidative alterations in vastus lateralis muscle of patients with the diagnosis of chronic fatigue syndrome. Free Radical Biol Med 2000;29:1252–1259.
35.
Lane RJBarrett MCTaylor DJKemp GJLodi R. Heterogeneity in chronic fatigue syndrome: Evidence from magnetic resonance spectroscopy of muscleNeuromusc Dis19988204-209. 35. Lane RJ, Barrett MC, Taylor DJ, Kemp GJ, Lodi R. Heterogeneity in chronic fatigue syndrome: Evidence from magnetic resonance spectroscopy of muscle. Neuromusc Dis 1998;8:204–209.
36.
Yamamoto YLaManca JJNatelson BH. A measure of heart rate variability is sensitive to orthostatic challenge in women with chronic fatigue syndromeExp Biol Med2003228167-174. 36. Yamamoto Y, LaManca JJ, Natelson BH. A measure of heart rate variability is sensitive to orthostatic challenge in women with chronic fatigue syndrome. Exp Biol Med 2003;228:167–174.
37.
Nijs JDeMeirleir KDuquet W. Kinesiophobia in chronic fatigue syndrome: Assessment and associations with disabilityArch Phys Med Rehabil2004851586-1592. 37. Nijs J, DeMeirleir K, Duquet W. Kinesiophobia in chronic fatigue syndrome: Assessment and associations with disability. Arch Phys Med Rehabil 2004;85:1586–1592.
38.
Mahurin RKClaypoole KHGoldberg JHArguelles LAshton SBuckwald D. Cognitive processing in monozygotic twins discordant for chronic fatigue syndromeNeuropsychology200418232-239. 38. Mahurin RK, Claypoole KH, Goldberg JH, Arguelles L, Ashton S, Buckwald D. Cognitive processing in monozygotic twins discordant for chronic fatigue syndrome. Neuropsychology 2004;18:232–239.
39.
Carruthers BMJain AKDe Meirleir KL et al. Myalgic encephalomyelitis/chronic fatigue syndrome: Clinical working case definition, diagnostic and treatment protocolsJ CFS2003117-36. 39. Carruthers BM, Jain AK, De Meirleir KL, et al., Myalgic encephalomyelitis/chronic fatigue syndrome: Clinical working case definition, diagnostic and treatment protocols. J CFS 2003;11:7–36.
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Copyright 2010, Mary Ann Liebert, Inc.
History
Published online: 19 February 2010
Published in print: February 2010
Published ahead of print: 24 January 2010
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