Review: Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome. Nelson et al. 2019

https://journals.lww.com/md-journal..._altered_cardiac_autonomic_regulation.36.aspx

 

Thank you for posting this @John Mac.

Great to see the review - at long last.

PwME, knowledgeable clinicians and ME researchers have known for decades we have autonomic cardiac problems.

Most others seem to have dismissed this.

I note the authors didn't include: https://www.amjmedsci.com/article/S0002-9629(15)34232-4/abstract in their reference list.

 

None of these findings are a smoking gun (and there are few questionable statements in the review), but it does suggest a particular hypothesis should be ruled out...

This mention of kinesiophobia is total nonsense as these are patients who agreed to participate in a maximal CPET study. There may be a few patients with kinesiophobia, but those patients would refuse to participate in a study like this by definition.

They claim the presence of 'increased sympathetic cardiac autonomic modulation' (during rest), yet the meta analysis found no difference in low frequency power (LFP), but did find a decrease in high frequency power (HFP). Notably, one of the studies that found an increase in LFP also found a increase in HFP. Hence the difference in LF/HF ratio is likely due to lowered parasympathetic activity, rather than increased sympathetic activity, which rules out Wyller's "Sustained arousal" hypothesis. Secondly, Light et al.'s post exercise gene expression studies found an increase in genes for beta-adrenergic receptors suggesting blunted post-exercise parasympathetic activity.

Of course most of these findings can simply be explained by deconditioning, though there remains the possibility of a minority of patients with a POTS type condition that may explain their symptoms.

The authors state.

Which seems reasonable to me...

 

Yep

 

When all it takes is basic common sense to discredit a theory...

 

They do (my bolding).

In fairness, they do conclude:

 

I will forever be puzzled at how smart people are so confused by the simple fact that people who have previously touched a very hot stove are motivated by not touching the very hot stove again and insist that people should instead be motivated at touching the very hot stove.

False attribution errors are so cheap and stupid.

 

Well, at least we'll all know when science does finally catch up with ME. The studies will all be blaming patients for making themselves worse by pig-headedly doing stuff they know they probably shouldn't.