Exercise and chronic fatigue, 2021, Wrightson & Twomey

Dolphin

Dolphin

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Chapter 18
Exercise and Chronic Fatigue

James G. Wrightson1 and Rosemary Twomey2

1Department of Clinical Neurosciences, University of Calgary, Canada 2Cumming School of Medicine, University of Calgary, Canada

Please cite as: Wrightson, J. G., & Twomey, R. (2021). Exercise and chronic fatigue. In Z. Zenko & L. Jones (Eds.), Essentials of exercise and sport psychology: An open access textbook (pp. 409–428). Society for Transparency, Openness, and Replication in Kinesiology. https://doi.org/10.51224/B1018

CC-By Attribution 4.0 International This content is open access and part of Essentials of Exercise and Sport Psychology: An Open Access Textbook. All other content can be accessed at https://doi.org/10.51224/B1000

Chapter Overview

Fatigue is a symptom that can be experienced by anyone, whether through extended physical or mental activity, sleep deprivation or other environmental and social factors. Typically, fatigue is temporary and can be alleviated by rest or sleep. However, for some people, fatigue is an ever-present symptom that causes considerable distress and negatively impacts quality of life. Fatigue that is pathological, persistent and not resolved by rest can be called chronic fatigue. One of the most striking things about chronic fatigue is that it is common in people with many different diseases and disorders. Even though the underlying causes of fatigue may be different from one disease to the next, there are remarkable similarities in the experience of chronic fatigue. One consequence is that treatments and therapies which reduce fatigue in people with one disease may also be effective in reducing fatigue in people with a completely different disease. Exercise is one such treatment. Perhaps because of the historical (and incorrect) view that fatigue is caused by the depletion of an unspecified physiological source of energy (Hockey, 2013), exercise has long been examined as a possible treatment for chronic fatigue. Interestingly, there is growing evidence that exercise is an effective treatment to reduce chronic fatigue, at least in some cases. In this chapter, we will present the evidence for exercise as a treatment for chronic fatigue in four different patient groups; people living with and beyond cancer, people with multiple sclerosis, people who have had a stroke, and people with myalgic encephalomyelitis/chronic fatigue syndrome. First, it is important to understand what is meant by the word fatigue, both in general and in relation to these clinical populations.
 
Dolphin said:
One of the most striking things about chronic fatigue is that it is common in people with many different diseases and disorders. Even though the underlying causes of fatigue may be different from one disease to the next, there are remarkable similarities in the experience of chronic fatigue. One consequence is that treatments and therapies which reduce fatigue in people with one disease may also be effective in reducing fatigue in people with a completely different disease. Exercise is one such treatment.
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Hard to find nonsense as distilled as that.

The basic problem that I see more and more is that exercise therapy is somehow built in to the establishment model and immune to the charge of quackery.

People want pills. People want exercises. Other people will sell both. But exercise is unregulated.
 
Jonathan Edwards said:
Hard to find nonsense as distilled as that.
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Did you read the bit on ME/CFS?

Here is a part:
Wrightson and Twomey said:
Most patients do not think that graded exercise therapy is appropriate for their needs, andpeople with more severe ME/CFS report that exercise can have a negative impact (Geraghty et al., 2019a). Because the results of the PACE trial conflicted with a patient's experience of managing their condition, and due to the previously mentioned methodological issues, the researchers were challenged to release the study data for reanalysis by independent scientists. Eventually, the controversy culminated in a UK court tribunal, where the researchers were ordered to share their data. A reanalysis of the data found that if the researchers had used their original criteria for recovery, only 4% of patients who received graded exercise therapy would have met the threshold, compared to 3% of patients who received standard medical care (Wilshire et al., 2018). This is an interesting case to consider because this published research not only distorted the scientific record (i.e. indicated that graded exercise therapy was more beneficial than is likely the case) but was so influential that it directly affected standard treatment recommendations for people with ME/CFS. Some organizations have now removed these recommendations from their guidance for people with ME/CFS, and an updated Cochrane systematic review is underway due to the limited applicability of previous reviews (Larun et al., 2019). Currently, increases in activity are only advised if patients feel they are coping with current activity levels (Bested & Marshall, 2015). Any program involving exercise must be tailored to the individual, with awareness and understanding that worsening of symptoms is possible, and symptoms must be monitored over several days (not only immediately after exercise).
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And in their conclusion, about ME:

" However, as we have also shown in the case of ME/CFS, extreme caution should be exercised in recommending exercise to people with chronic fatigue. Without knowing the causes of the symptom, it is possible that a therapy that alleviates fatigue in one group of patients could make it worse in another. It is often said that exercise is medicine (Pedersen & Saltin, 2015). For this to be true, then just like a drug, it is vital to understand the mechanisms of action and the dose of safe and beneficial exercise. "

Surprising. More nuanced than it appeared in the summary.
 
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