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      Submaximal exercise testing with near-infrared spectroscopy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients compared to healthy controls: a case–control study

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          Abstract

          Background

          Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating illness. Symptoms include profound fatigue and distinctive post-exertional malaise (PEM). We asked whether a submaximal exercise test would prove useful for identifying different patterns of tissue oxygen utilization in individuals with ME/CFS versus healthy subjects. Such a test has potential to aid with ME/CFS diagnosis, or to characterize patients’ illness.

          Methods

          A case–control study of 16 patients with ME/CFS compared to 16 healthy controls completing a 3-min handgrip protocol was performed. Response was measured using near-infrared spectroscopy, resulting in measurements of oxygenated (O 2Hb) and deoxygenated hemoglobin (HHb) over wrist extensors and flexors. Changes in O 2Hb (delta (d)O 2Hb) and HHb (dHHb) absorbance between the first and last contraction were calculated, as were the force–time product of all contractions, measured as tension-time index (TTI), and ratings of perceived exertion (RPE).

          Results

          Individuals with ME/CFS demonstrated smaller dO 2Hb and dHHb than controls. However, after adjusting for TTI and change in total hemoglobin (delta (d)tHb), differences in dO 2Hb and dHHb were reduced, with large overlapping variances. RPE was significantly higher for cases than controls, particularly at rest.

          Conclusions

          Relative to controls, participants with ME/CFS demonstrated higher RPE, lower TTI, and reduced dO 2Hb and dHHb during repetitive handgrip exercise, although considerable variance was observed. With further study, submaximal exercise testing may prove useful for stratifying patients with a lower propensity for inducing PEM, and have the ability to establish baseline intensities for exercise prescription.

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          Most cited references29

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          Pain catastrophizing: a critical review.

          Pain catastrophizing is conceptualized as a negative cognitive-affective response to anticipated or actual pain and has been associated with a number of important pain-related outcomes. In the present review, we first focus our efforts on the conceptualization of pain catastrophizing, highlighting its conceptual history and potential problem areas. We then focus our discussion on a number of theoretical mechanisms of action: appraisal theory, attention bias/information processing, communal coping, CNS pain processing mechanisms, psychophysiological pathways and neural pathways. We then offer evidence to suggest that pain catastrophizing represents an important process factor in pain treatment. We conclude by offering what we believe represents an integrated heuristic model for use by researchers over the next 5 years; a model we believe will advance the field most expediently.
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            Submaximal exercise testing: clinical application and interpretation.

            Compared with maximal exercise testing, submaximal exercise testing appears to have greater applicability to physical therapists in their role as clinical exercise specialists. This review contrasts maximal and submaximal exercise testing. Two major categories of submaximal tests (ie, predictive and performance tests) and their relative merits are described. Predictive tests are submaximal tests that are used to predict maximal aerobic capacity. Performance tests involve measuring the responses to standardized physical activities that are typically encountered in everyday life. To maximize the validity and reliability of data obtained from submaximal tests, physical therapists are cautioned to apply the tests selectively based on their indications; to adhere to methods, including the requisite number of practice sessions; and to use measurements such as heart rate, blood pressure, exertion, and pain to evaluate test performance and to safely monitor patients.
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              Chronic fatigue syndrome: a review.

              Chronic fatigue syndrome is an illness characterized by disabling fatigue of at least 6 months, accompanied by several other symptoms. This review summarizes the current state of knowledge about chronic fatigue syndrome. The case definition, prevalence, clinical presentation, evaluation, and prognosis of chronic fatigue syndrome are discussed. Research on the pathophysiology and treatment of chronic fatigue syndrome is reviewed. Chronic fatigue syndrome is diagnosed on the basis of symptoms. Patients with chronic fatigue syndrome experience significant functional impairment. Pathophysiological abnormalities exist across many domains, suggesting that chronic fatigue syndrome is a heterogeneous condition of complex and multifactorial etiology. Evidence also is beginning to emerge that chronic fatigue syndrome may be familial. Although chronic fatigue syndrome has significant symptom overlap and comorbidity with psychiatric disorders, several lines of research suggest that the illness may be distinct from psychiatric disorders. Patients' perceptions, attributions, and coping skills, however, may help perpetuate the illness. Treatment for chronic fatigue syndrome is symptom-based and includes pharmacological and behavioral strategies. Cognitive behavior therapy and graded exercise can be effective in treating the fatigue and associated symptoms and disability. Chronic fatigue syndrome is unlikely to be caused or maintained by a single agent. Findings to date suggest that physiological and psychological factors work together to predispose an individual to the illness and to precipitate and perpetuate the illness. The assessment and treatment of chronic fatigue syndrome should be multidimensional and tailored to the needs of the individual patient.
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                Author and article information

                Contributors
                ruth.miller@bccdc.ca
                darlene.reid@utoronto.ca
                amattman@providencehealth.bc.ca
                cristiyama@gmail.com
                flagellin@gmail.com
                sparker@cheos.ubc.ca
                jennifer.gardy@bccdc.ca
                Patrick.tang@bccdc.ca
                david.patrick@ubc.ca
                Journal
                J Transl Med
                J Transl Med
                Journal of Translational Medicine
                BioMed Central (London )
                1479-5876
                20 May 2015
                20 May 2015
                2015
                : 13
                : 159
                Affiliations
                [ ]School of Population and Public Health, British Columbia Centre for Disease Control, University of British Columbia, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
                [ ]Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7 Canada
                [ ]Adult Metabolic Disease Clinic, Vancouver General Hospital, Level 4, 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
                [ ]Muscle Biophysics Laboratory, Department of Physical Therapy, University of British Columbia, 828 West 10th Avenue, Vancouver, BC V5Z 3P1 Canada
                [ ]Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 3J5 Canada
                [ ]Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
                [ ]British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
                Article
                527
                10.1186/s12967-015-0527-8
                4438583
                25990639
                53b78c08-6332-4d9f-99d2-eb5d7e724afc
                © Miller et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 26 March 2015
                : 9 May 2015
                Categories
                Research
                Custom metadata
                © The Author(s) 2015

                Medicine
                near-infrared spectroscopy (nirs),myalgic encephalomyelitis/chronic fatigue syndrome (me/cfs),tissue oxygen utilization

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