1. Guest, the 'News in Brief' for the week beginning 7th June 2021 is here.
    Dismiss Notice
  2. Welcome! To read the Core Purpose and Values of our forum, click here.
    Dismiss Notice
  3. Contribute to feedback on the CDC Evidence Review, for more details click here
    Dismiss Notice

Anticipation of and response to exercise in adolescents with CFS: An experimental study, 2021, Loades, Chalder et al

Discussion in 'PsychoSocial ME/CFS Research' started by Andy, Apr 20, 2021.

  1. Andy

    Andy Committee Member (& Outreach when energy allows)

    Messages:
    13,251
    Likes Received:
    95,751
    Location:
    Hampshire, UK
    "Highlights
    • Adolescents with CFS, asthma and healthy controls undertook an exercise task.
    • Those with CFS took longer to complete a laboratory-based exercise task than controls.
    • They (and their parents) expected to perform worse.
    • They were more anxious pre-task and rated their performance as worse afterwards.
    • Pre-exercise expectations and post-exercise appraisals may be important in CFS.

    Abstract

    Background
    Using a laboratory-based exercise task, this study investigated objective exercise performance as well as expectations, anxiety and perceived task performance ratings in adolescents with CFS compared to healthy controls and illness controls.

    Method
    Trials of a sit-stand exercise task (SST) were undertaken (CFS: n = 61, asthma (AS): n = 31, healthy adolescents (HC): n = 78). Adolescents rated their expectations, pre- and post-task anxiety, and perceived task difficulty. Their parents independently rated their performance expectations of their child.

    Results
    The CFS group took significantly longer to complete the SST than the AS group (MD 3.71, 95% CI [2.41, 5.01] p < .001) and HC (MD 3.61, 95% CI [2.41, 4.81], p < .001). Adolescents with CFS had lower expectations for their performance on the exercise task than AS participants (MD -11.79, 95% CI [−22.17, −1.42] p = .022) and HC (MD -15.08, 95% CI [−23.01, −7.14] p < .001). They rated their perceived exertion as significantly greater than AS (MD 3.04, 95% CI [1.86, 4.21] p < .001) and HC (MD 2.98, 95% CI [1.99, 3.98], p < .001). The CFS group reported greater anxiety pre-task than AS (MD 14.11, 95% CI [5.57, 22.65] p < .001) and HC (MD 11.20, 95% CI [2.64, 19.75], p. = 007). Parental group differences showed similar patterns to the adolescents'.

    Conclusions
    Lower expectations and greater anxiety regarding exercise may reflect learning from previous difficult experiences which could impact future exercise performance. Further examination of pre-exercise expectations and post-exercise appraisals could improve our understanding of the mechanisms by which fatigue is maintained."

    Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0022399921001355
     
    Last edited: Apr 20, 2021
  2. Lidia

    Lidia Senior Member (Voting Rights)

    Messages:
    154
    Likes Received:
    1,008
    So the CFS group expected their performance to be lower than the two other groups, and their performance was lower than the other groups. And this was because of the expectations, which will be proven by talking more about expectations.

    I just read the abstract but maybe the full article is better.

    I find asthma to be an interesting comparison group in these studies given the myriad effective treatments for asthma in children and the easy availability of these treatments to families with children who suffer from asthma.
     
    Woolie, inox, Hutan and 14 others like this.
  3. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

    Messages:
    1,562
    Likes Received:
    15,733
    Alternatively ‘Lower expectations and greater anxiety regarding exercise may reflect’ a realistic interpretation of what they are able to do without triggering PEM or a reasonable fear of exertion worsening their health.

    The conclusion appears to be yet more failing to justify the leap from association to causation, and then an arbitrary judgement on the direction of that causality without evidence and selecting the direction of causality that to the patient population seems counter intuitive.
     
    Chezboo, JohnTheJack, inox and 16 others like this.
  4. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

    Messages:
    9,099
    Likes Received:
    97,277
    I wonder what the results would have been if the control group was children awaiting heart-lung transplant for severe genetic lung disease? It might have been considered unethical to include really sick children in a control group I suppose.
     
    Chezboo, JohnTheJack, inox and 19 others like this.
  5. Amw66

    Amw66 Senior Member (Voting Rights)

    Messages:
    4,513
    Likes Received:
    21,542
    How aerobic was the exercise task ?
    @PhysiosforME may be of interest

    Eta had they done a cpet / used heart monitors to inform risk/ worked out aerobic threshold ?
     
    Last edited: Apr 20, 2021
  6. Adrian

    Adrian Administrator Staff Member

    Messages:
    5,298
    Likes Received:
    27,866
    Location:
    UK
    It would be interesting to see the request they put in for ethics approval considering that PwME can relapse with exercise - I wonder if they warned their subects (but of course that would effect results). I don't see how they could argue any possible value comes from this type of research - Their experiment seems to be take a group of people who according to one diagnosic criteria are exertion intolerant and see if they are more anxious and perform worse in exercise than two groups who aren't.
     
    Chezboo, JohnTheJack, inox and 15 others like this.
  7. Amw66

    Amw66 Senior Member (Voting Rights)

    Messages:
    4,513
    Likes Received:
    21,542
    How much was funding for this?
     
    Hutan, Missense, alktipping and 4 others like this.
  8. Amw66

    Amw66 Senior Member (Voting Rights)

    Messages:
    4,513
    Likes Received:
    21,542
    Looks like @dave30th could have a similar relationship with Loades as he does with EC- Loades now has a plethora of papers in a similar ilk.

    What would Workwell/ Jason / Rowe make of this I wonder ?

    If anyone can flag this up to Davenport on twitter it may be interesting. Or to longCOVIDkids
     
    Missense, alktipping, MEMarge and 6 others like this.
  9. Trish

    Trish Moderator Staff Member

    Messages:
    32,938
    Likes Received:
    156,993
    Location:
    UK
    I think the pairing of Crawley with Maria Loades on ME/ CFS research in children is catastrophic. Loades is a clinical psychologist with extra diplomas in CBT and is at Bath University running a PhD program, which means she has an endless stream of PhD students needing projects to do. Hence this stream of awful harmful drivel that shows no understanding that the kids she is messing about with are sick, and that anxiety they show at being asked to exercise is entirely rational and justified.
     
    Chezboo, inox, Hutan and 24 others like this.
  10. strategist

    strategist Senior Member (Voting Rights)

    Messages:
    3,669
    Likes Received:
    37,454
    My theory why we see so much psychologizing of chronic illness:

    Healthy people often don't understand chronic illness. To them it looks like weird behaviours, people letting themselves go, silly and obviously unjustified anxieties, catastrophizing. They cannot comprehend the symptoms because they're trying to extrapolate from their mostly normal life experiences to chronic illness which by definition is abnormal. Those that misunderstand don't realize they are misunderstanding.
     
    Last edited: Apr 20, 2021
    Chezboo, Hutan, Missense and 16 others like this.
  11. It's M.E. Linda

    It's M.E. Linda Senior Member (Voting Rights)

    Messages:
    644
    Likes Received:
    5,043


    @Amw66 brainfog time, ‘Jason/Rowe’, I am so, so sorry, give me more and I will try to find/tag them too :unsure: :thumbsdown:
     
    Missense, alktipping, MEMarge and 9 others like this.
  12. Amw66

    Amw66 Senior Member (Voting Rights)

    Messages:
    4,513
    Likes Received:
    21,542
    Thank you
     
    Missense, alktipping, MEMarge and 4 others like this.
  13. Sly Saint

    Sly Saint Senior Member (Voting Rights)

    Messages:
    6,127
    Likes Received:
    50,287
    Location:
    UK
    alktipping and MEMarge like this.
  14. rvallee

    rvallee Senior Member (Voting Rights)

    Messages:
    6,432
    Likes Received:
    52,270
    Location:
    Canada
    So as usual, patients are actually much better at predicting their own state than is expected by medical professionals. So this is not about the patients' expectations but the researchers', who somehow expect CFS patients, whatever it means here, to do just as well on a trivial exertion task than healthy controls.

    I have no idea what asthma is doing there, other than perhaps just some need to reinforce belief in a psychosomatic role for asthma. Asthma patients are not expected to be limited by exertion on such a trivial task, but by difficulty breathing, which would make them slow down to avoid risking an asthma attack, a perfectly reasonable risk assessment, one that is even accepted by the researchers, somehow in contrast to expectations about CFS, where theirs reject reality and substitute their own. Completely unrelated problems that show their complete misunderstanding of the illness.

    The very same of CFS patients, who are quite good at predicting their own capacities, and limit their exertion to avoid deterioration, a behavior so basic it would be expected of actual robots of even limited intelligence. Again, entirely normal and expected. Contrary to expectations in medical research, people who don't have a medical degree are not complete idiots. They know it will hurt, just the same as someone being asked whether touching a burning hot stove will know it will hurt. Usually based on learned experience. Again, entirely as expected.

    So things went exactly as expected, but the researchers have delusions in lieu of understanding and so expect outcomes to differ from actual reality.

    As for the extremely bizarre conclusions of appraisal, it can only be properly described with a slurry of curses so let's just chalk it all up to, again, extremely bizarre expectations from people who have claimed expertise on this very topic and yet continue to have fully delusional expectations that when reality disagrees with them, it is reality that is wrong.

    It is also a study in ineptitude, not only the researchers' but an entire system gone wrong, incapable of providing oversight or accountability to junk pseudoscience. Everyone involved in this in any capacity should be ashamed of themselves for wasting limited resources satisfying their own hubris and delusional beliefs.
     
    Lidia, Hutan, Mithriel and 10 others like this.
  15. DokaGirl

    DokaGirl Senior Member (Voting Rights)

    Messages:
    2,246
    Likes Received:
    14,232
    @strategist I think your explanation is accurate. Debilitating chronic illness viewed by the healthy just doesn't compute. Therefore, it's the sick person's own fault. If only they would see the error of their ways and change their behaviour.
     
  16. DokaGirl

    DokaGirl Senior Member (Voting Rights)

    Messages:
    2,246
    Likes Received:
    14,232
    After noting these numerous studies on children, a couple prominent issues strike me: studies on children should not be done at all, unless absolutely necessary. A committe of unbiased logical folks should judge what are absolutely necessary studies. And, where are the children's services groups when these things are going on? They scoop sick kids from desperately well meaning parents. Are they blind to the potential harms caused by these studies?
     
    inox, Hutan, Mithriel and 7 others like this.
  17. MEMarge

    MEMarge Senior Member (Voting Rights)

    Messages:
    2,054
    Likes Received:
    12,479
    Looks as though this is usually a 30 second test. As many sit to stands as possible in the time, from a dining -type chair.
    Re funding. It's probably just from Chalder's NIHR pot.
     
    Hutan, Missense, alktipping and 5 others like this.
  18. MEMarge

    MEMarge Senior Member (Voting Rights)

    Messages:
    2,054
    Likes Received:
    12,479
    Parents in the UK are too scared of being referrred to SS (social services) and accused of FII (Fabricated Induced Illness).
    They generally try to keep below the radar, avoid trials where possible, unless they are v new to ME and stay on the Clinics books to access letters for schools etc.
     
    Missense, alktipping, JoanneS and 6 others like this.
  19. rvallee

    rvallee Senior Member (Voting Rights)

    Messages:
    6,432
    Likes Received:
    52,270
    Location:
    Canada
    Of all the things, I still have enough issues with calling this "exercise" that it should be raised on top of all the other issues. Words clearly mean nothing at all whenever psychosomatic stuff is concerned, they're just tools to manipulate people with.
     
    Chezboo, Missense, alktipping and 5 others like this.
  20. DokaGirl

    DokaGirl Senior Member (Voting Rights)

    Messages:
    2,246
    Likes Received:
    14,232
    I totally understand. Awful situation! I was meaning the SS should watch the studies to see that no harm is done. And/or be consulted about the studies. And better yet - no studies of this kind at all.
     
    Missense, alktipping, MEMarge and 2 others like this.

Share This Page