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Can exercise limits prevent post-exertional malaise in chronic fatigue syndrome? An uncontrolled clinical trial

Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, j.nijs{at}ha.be, Division of Musculoskeletal Physiotherapy, Department of Health Care Sciences, University College Antwerp

Freya Almond

Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel

Pascale De Becker

Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel

Steven Truijen

Division of Musculoskeletal Physiotherapy, Department of Health Care Sciences, University College Antwerp, Belgium

Lorna Paul

Division of Nursing and Health Care, Faculty of Medicine, University of Glasgow, Glasgow, UK

Objective: It was hypothesized that the use of exercise limits prevents symptom increases and worsening of their health status following a walking exercise in people with chronic fatigue syndrome.

Design: An uncontrolled clinical trial (semi-experimental design).

Setting: Outpatient clinic of a university department.

Subjects: Twenty-four patients with chronic fatigue syndrome.

Interventions: Subjects undertook a walking test with the two concurrent exercise limits. Each subject walked at an intensity where the maximum heart rate was determined by heart rate corresponding to the respiratory exchange ratio = 1.0 derived from a previous submaximal exercise test and for a duration calculated from how long each patient felt they were able to walk.

Main outcome measures: The Short Form 36 Health Survey or SF-36, the Chronic Fatigue Syndrome Symptom List, and the Chronic Fatigue Syndrome — Activities and Participation Questionnaire were filled in prior to, immediately after and 24 hours after exercise.

Results: The fatigue increase observed immediately post-exercise (P= 0.006) returned to pre-exercise levels 24 hours post-exercise. The increase in pain observed immediately post-exercise was retained at 24 hours post-exercise (P=0.03). Fourteen of the 24 subjects experienced a clinically meaningful change in bodily pain (change of SF-36 bodily pain score 10); 6 indicated that the exercise bout had slightly worsened their health status, and 2 had a clinically meaningful decrease in vitality (change of SF-36 vitality score 20). There was no change in activity limitations/participation restrictions.

Conclusion: It was shown that the use of exercise limits (limiting both the intensity and duration of exercise) prevents important health status changes following a walking exercise in people with chronic fatigue syndrome, but was unable to prevent short-term symptom increases.

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