Old muscle in young body: an aphorism describing the Chronic Fatigue Syndrome, 2018, Pietrangelo et al

[Andy]

Abstract
The chronic fatigue syndrome (CFS) otherwise known as myalgic encephalomyelitis (ME), is a debilitating syndrome whose identification is very complex due to lack of precise diagnostic criteria. This pathology begins with limitations in duration and intensity of exercise and rapid onset of pain during physical activity. Its etiology is unknown, and symptoms are not limited to the muscles. Epidemiology is rather difficult to delimit, even if it affects mainly young (20-40 years), female subjects.

The results of muscular research show some peculiarities that can justify what has been observed in vivo. In particular, 1. presence of oxidative damage of lipid component of biological membranes and DNA not compensated by the increase of the scavenger activity; 2. Excitation-Contraction (E-C) alteration with modification of Ca2+ transport; 3. passage from slow to fast fiber phenotype; 4. inability to increase glucose uptake; 5. presence of mitochondrial dysfunction; and 6. genes expressed differentially (particularly those involved in energy production). The skeletal muscles of CFS / ME patients show a significant alteration of the oxidative balance due to mitochondrial alteration and of the fiber phenotype composition as shown in sarcopenic muscles of the elderly. Vice versa, the muscle catabolism does not appear to be involved in the onset of this syndrome. The data support the hypothesis that patients with CFS are subjected to some of the problems typical for muscle aging, which is probably related to disorders of muscle protein synthesis and biogenesis of mitochondria.

Patients with CFS can benefit from an appropriate training program because no evidence suggests that physical exercise worsens symptoms. Type, intensity and duration of any physical activity that activates muscle contraction (including Electrical Stimulation) require further investigation even if it is known that non-exhaustive physical activity decreases painful symptomatology.

Open access at https://pagepressjournals.org/index.php/bam/article/view/7688/7470

 

[Wonko]

it was going so well until.....

Patients with CFS can benefit from an appropriate training program because no evidence suggests that physical exercise worsens symptoms.

they'd done some tests, biological tests, and come up with a theory, not necessarily a correct theory, probably not a correct theory, to explain the results, but they seemed to be trying.........and then they come out with that

 

[Peter T]

no evidence suggests that physical exercise worsens symptoms

A remarkably sweeping statement that ignores a significant ammount of research literature, patient survey evidence, the patient experience and the preferred definitions of the condition.

[added - By definition ME/CFS involves post exertional malaise, which is a worsening of symptoms following among other things physical exercise. We can not as yet say that physical exercise increases the muscle features referenced in this review, but my reading is that also on the basis of the evidence presented the authors can not say that it does not.]

 

[Peter T]

Am not sure if I am reading it correctly as the section on treatments is not clear and I have not followed the various references up, but most of the studies cited specifically relating to therapeutic intervention in ME/CFS seemed to have looked at things like nutrition and the only one that looked specifically at exercise was the PACE study.

So my first reading which may prove to be incorrect is that this claim that exercise does no harm is solely based on one profoundly flawed study. Does anyone else interpret this in the same way?

 

[Peter T]

A further thought is that the following

Patients with CFS can benefit from an appropriate training program because no evidence suggests that physical exercise worsens symptoms.

is not a logically justifiable conclusion. Even if evidence existed for the claim physical exercise caused no worsening in symptoms, it does not logically justify the claim that it would result in an improvement in symptoms. It is logically the same as saying wearing pink jumpers does not worsen symptoms of ME/CFS, therefor if we wear pink jumpers our symptoms will improve.

To logically conclude that exercise improves symptoms in ME/CFS you need evidence of that, which they do not present. The authors may feel that this is self evident because they know of but do not mention studies that indicate exercise improves muscle function in 'normal' people, but this is not rational because they have already demonstrate in this context the patients are different to normal people. Alternatively they may be aware of studies that show the elderly benefit from exercise and because they report similarities between muscle function in ME/CFS and the elderly they believe it should help in ME/CFS, but again they do not state this and again they would need some evidence to justify this generalisation between subject groups.

Alternatively they may be concluding this from the PACE study, though they leave it to the reader to fill in this gap in their reasoning. Again there are so many problems with the PACE study that such a conclusion is not justified, we can not conclude from PACE that there was any actual improvement in muscle function, we do not know if they are even looking at the same group of patients. Again it ignores physiological studies and patient surveys that would suggest the opposite.

How sad that even scientists studying the physiological aspects of ME/CFS seem to have taken the appallingly bad science of PACE at face value.

 

[Sean]

Patients with CFS can benefit from an appropriate training program because no evidence suggests that physical exercise worsens symptoms. Type, intensity and duration of any physical activity that activates muscle contraction (including Electrical Stimulation) require further investigation even if it is known that non-exhaustive physical activity decreases painful symptomatology.

*sigh*

 

[Barry]

Patients with CFS can benefit from an appropriate training program because no evidence suggests that physical exercise worsens symptoms.

This puts me in mind of the much used and abused phrase loved by politicians, regarding anything they wish to ignore: "There is no evidence to suggest that ...". The point being in so many cases there is a very good reason there is no evidence to suggest anything - it's because no one has gone looking for it! Or have made very sure they do not find it even if it is there.