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

Andy

Andy

Senior Member (Voting rights)
"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:
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.
 
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.
 
Jonathan Edwards said:
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.
Click to expand...

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.
 
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
 
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.
 
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:
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.
 
strategist said:
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.
Click to expand...

@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.
 
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?
 
DokaGirl said:
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?
Click to expand...

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.
 
MEMarge said:
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.
Click to expand...
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.
 
MEMarge said:
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.
Click to expand...

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.
 
You must log in or register to reply here.
Back
Top