From Tom Kindlon
A Randomized Controlled Trial of the Effect of Aerobic Exercise Training on Feelings of Energy and Fatigue in Sedentary Young Adults with Persistent Fatigue
[I thought the following was interesting because it showed the dramatic effect low-intensity exercise could have on fatigue levels in people who don't have CFS (they were specificially excluded). This would show again how important it is to have "pure" samples for exercise research and the like (e.g. CBT based on increasing activity/exercise) in the ME/CFS area. There are probably many people satisfying the Oxford definition and so-called "empirical" definition (Reeves, 2005) who do not have classic ME/CFS symptoms, who might be similar to the subjects in the study below. Indeed the CDC '94 definition itself doesn't have an requirement for any post-exertional symptoms. Depending on how the data was analysed, this could have a big effect when looking at the effect of exercise in CFS patients. Tom K]
http://www.uga.edu/coenews/features/0802oconnor.html
Low-Intensity Exercise Reduces Fatigue Symptoms by 65 Percent, Study Finds
Sedentary people who complain of fatigue can increase their energy levels and decrease their fatigue by engaging in regular, exercise, according to a new University of Georgia study.
Sedentary people who regularly complain of fatigue can increase their energy levels by 20 percent and decrease their fatigue by 65 percent by engaging in regular, low intensity exercise, according to a new University of Georgia study. "Too often we believe that a quick workout will leave us worn out - especially when we are already feeling fatigued," said researcher Tim Puetz, who recently completed his doctorate at UGA and is the lead author of the study. "However, we have shown that regular exercise can actually go a long way in increasing feelings of energy - particularly in sedentary individuals."
Puetz co-authored the study with professor Patrick O'Connor, co-director of the UGA Exercise Psychology Laboratory, and former UGA student Sara Flowers. The team's results appear in the February issue of the journal Psychotherapy and Psychosomatics. O'Connor said previous studies - including one that he and Puetz co-authored in 2006 - have shown that exercise can significantly improve energy levels and decrease fatigue. Those studies, however, primarily looked at patients with medical conditions such as cancer, heart disease and mental health problems. In this latest study, the researchers used volunteers who had fatigue that was persistent yet didn't meet the criteria for a medical condition such as chronic fatigue syndrome. O'Connor said about 25 percent of the general population experience such fatigue. "A lot of people are overworked and not sleeping enough," O'Connor said. "Exercise is a way for people to feel more energetic. There's a scientific basis for it, and there are advantages to it compared to things like caffeine and energy drinks."
The researchers recruited 36 volunteers who did not exercise regularly and had reported persistent fatigue based on a commonly used health survey. The volunteers were divided into three groups: The first engaged in moderate-intensity aerobic exercise three times a week for six weeks; the second engaged in low-intensity aerobic exercise for the same time period; the control group did not exercise. The low- and moderate-intensity groups had a 20 percent increase in energy levels over the control group. Surprisingly, the low-intensity group had a greater reduction in fatigue levels than the moderate-intensity group, 65 percent compared to 49 percent, respectively. "It could be that moderate-intensity exercise is too much for people who are already fatigued," O'Connor said, "and that might contribute to them not getting as great an improvement as they would had they done the low-intensity exercise."
He adds that energy and fatigue aren't exactly opposites of each other. A student who stays up late to finish a term paper may feel fatigued, for example, but may also feel energized as she nears the end of the paper.
The volunteers in the study used exercise bikes that allowed the researchers to control their level of exertion so that low-intensity exercise was defined as 40 percent of their peak oxygen consumption and moderate-intensity exercise was defined as 75 percent of peak oxygen consumption. For comparison, O'Connor said a leisurely, easy walk is low-intensity exercise, while a fast-paced walk with hills is moderate-intensity exercise. The team's analysis also found that the improvements in energy and fatigue were not related to increases in aerobic fitness that the exercisers experienced. Puetz said the finding suggests that exercise acts directly on the central nervous system to increase energy and reduce fatigue. "Exercise traditionally has been associated with physical health, but we are quickly learning that exercise has a more holistic effect on the human body and includes effects on psychological health," Puetz said. "What this means is that in every workout a single step is not just a step closer to a healthier body, but also to a healthier mind."
----- 1: Psychother Psychosom. 2008 Feb 14;77(3):167-174 A Randomized Controlled Trial of the Effect of Aerobic Exercise Training on Feelings of Energy and Fatigue in Sedentary Young Adults with Persistent Fatigue. Puetz TW, Flowers SS, O'Connor PJ. Department of Kinesiology, University of Georgia, Athens, Ga., USA.
Background: There is growing evidence that chronic exercise is a promising intervention for combating feelings of low energy and fatigue. Although groups with well-defined medical conditions (for example cancer and heart disease) or unexplained fatigue syndromes consistently have reported improved feelings of energy and fatigue after chronic exercise, relatively few exercise training studies have been conducted with people who report persistent fatigue yet neither have a medical condition nor reach diagnostic criteria for an unexplained fatigue syndrome. The purpose of this investigation was to use a randomized controlled design to examine the effects of 6 weeks of chronic exercise training on feelings of energy and fatigue in sedentary, healthy young adults reporting persistent fatigue.
Methods: Thirty-six healthy, young adults who reported persistent feelings of fatigue were randomly assigned to a moderate-intensity exercise, low-intensity exercise or no treatment control group. Participants in each condition then visited the exercise laboratory on 18 occasions over a 6-week period. Exercise laboratory visits occurred 3 days per week. Vigor and fatigue mood state scores were obtained at the beginning of the third exercise session each week for 6 weeks. Aerobic fitness was measured before and after intervention.
Results: The effect of 6 weeks of exercise training on feelings of fatigue was dependent on exercise intensity; however, the effect on feelings of energy was similar for both the low- and moderate-intensity conditions. The changes in feelings of energy and fatigue were independent of changes in aerobic fitness.
Conclusions: Six weeks of low and moderate exercise training performed by sedentary adults without a well-defined medical condition or an unexplained fatigue syndrome but reporting persistent feelings of fatigue resulted in similarly beneficial effects on feelings of energy. The effects for symptoms of fatigue were moderated by exercise intensity, and the more favorable outcome was realized with low-intensity exercise. Changes in feelings of energy and fatigue following exercise training were unrelated to changes in aerobic fitness. Copyright (c) 2008 S. Karger AG, Basel. PMID: 18277063 [PubMed - as supplied by publisher]
Incidentally, Patrick O'Connor was involved in studies which had results which "suggest that a daily "activity limit" may exist in this population" Increased daily physical activity and fatigue symptoms in chronic fatigue syndrome http://www.dynamic-med.com/content/4/1/3 (a related study is: "Time course of exercise induced alterations in daily activity in chronic fatigue syndrome" http://www.dynamic-med.com/content/4/1/10
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The fastest, easiest and cheapest way to diagnose CFS is to send the patient out to exercise. A depressive will return energized, a CFS patient will return on the verge of collapse. Yet, too many doctors still don’t know this, and think that CFS=depression and therefore can be cured with anti-depressants and exercise ... two things that will make a real CFS patient worse.
The pollution of the patient pool in research with people who really do have depression or other illnesses rather than CFS needs to stop so that we can get valid studies to help our people, rather than recommendations to do things that could leave them permanently disabled. Too many of our brothers and sisters in the British Commonwealth became bedridden after enforced exercise programs. Fortunately, that nonsense isn’t a requirement of getting disability benefits in the US. Unfortunately, the US disability system does nothing at all to help patients get better ... in fact, you need to wait 2 years after qualifying for SSDI before you qualify for government medical care. Doing without medical care for that long almost guarantees you’re going to get worse, not better; but on the pittance you get from SSDI, you can’t afford to pay for your own medical bills.
If we activists accomplish nothing else, we need to publicize the notion of a Daily Activity Limit to those people (doctors included) who can’t fathom "if you can do X, why can’t you also do Y?" One doctor extrapolated from the fact that I could remain upright for 5 minutes in his office without passing out that I could remain upright for 8 hours at a job, despite my telling him that after an hour or less sitting/standing, I got very dizzy and had to lie down so that I would not faint.
Other people extrapolate that if I can type a few e-mails a day or make my way to the doctor once a month, that proves that I can work 40 hours a week. In fact, each time I leave the house, I have to rest for a day or two (sometimes three), which means that I do fit the definition of being disabled by virtue of not being able to maintain adequate attendance at a job. As described in a recent article in this blog, a person is not employable if they can go to work on Monday and that sends them to bed the rest of the week. (In fact, according to Redding v. Chater, even the ability to work 4 days a week, but needing to take 1 day off each week to rest, qualifies a person for SSDI. The VocRehab experts will say that makes you unemployable, but the judges don’t believe it.)
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