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Cardiopulmonary Exercise Test Methodology for Assessing Exertion Intolerance in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Staci Stevens1, Chris Snell1, Jared Stevens1, Betsy keller2 and
J. Mark VanNess3*
https://www.frontiersin.org/articles/10.3389/fped.2018.00242/abstract
Cardiopulmonary Exercise Test Methodology for Assessing Exertion Intolerance in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Staci Stevens1, Chris Snell1, Jared Stevens1, Betsy keller2 and
- 1Workwell Foundation, United States
- 2Department of Exercise & Sport Sciences, Ithaca College, United States
- 3Health and Exercise Science, University of the Pacific, United States
Background: Concise methodological directions for administration of serial cardiopulmonary exercise testing (CPET) for is needed for testing of patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Maximal CPET is used to evaluate the coordinated muscular, metabolic, respiratory and cardiac contributions to energy production in patients with ME/CFS.
In this patient population, CPET also elicits a robust post-exertional symptom flare (termed, post-exertional malaise); a cardinal symptom of the disease. CPET measures are highly reliable and reproducible in both healthy and diseased populations. However, evidence to date indicates that ME/CFS patients are uniquely unable to reproduce CPET measures during a second test, despite giving maximal effort during both tests, due to the effects of PEM on energy production.
Results: To document and assess functional impairment due to the effects of post-exertional malaise in ME/CFS, a two-day CPET procedure (2-day CPET) has been used to first measure baseline functional capacity (CPET1) and provoke post-exertional malaise, then assess changes in CPET variables 24 hours later with a second CPET to assess the effects of post-exertional malaise on functional capacity. The second CPET measures changes in energy production and physiological function thus objectively documenting the effects of post-exertional malaise.
Use of CPET as a standardized stressor to induce post-exertional malaise and quantify impairment associated with post-exertional malaise has been employed to examine ME/CFS pathology in several studies. This article discusses the results of those studies, as well as the standardized techniques and procedures for use of the 2-day CPET in ME/CFS patients, and potentially other fatiguing illnesses.
Conclusions: Basic concepts of CPET are summarized, and special considerations for performing CPET on ME/CFS patients are detailed to ensure a valid outcome. The 2-day CPET methodology is outlined, and the utility of the procedure is discussed for assessment of functional capacity and exertion intolerance in ME/CFS.
https://www.frontiersin.org/articles/10.3389/fped.2018.00242/abstract