PDF(Pubmed)
Abstract：
BACKGROUND: Post-exertional malaise (PEM), the hallmark symptom of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), represents a constellation of abnormal responses to physical, cognitive, and/or emotional exertion including profound fatigue, cognitive dysfunction, and exertion intolerance, among numerous other maladies. Two sequential cardiopulmonary exercise tests (2-d CPET) provide objective evidence of abnormal responses to exertion in ME/CFS but validated only in studies with small sample sizes. Further, translation of results to impairment status and approaches to symptom reduction are lacking.
METHODS: Participants with ME/CFS (Canadian Criteria; n = 84) and sedentary controls (CTL; n = 71) completed two CPETs on a cycle ergometer separated by 24 h. Two-way repeated measures ANOVA compared CPET measures at rest, ventilatory/anaerobic threshold (VAT), and peak effort between phenotypes and CPETs. Intraclass correlations described stability of CPET measures across tests, and relevant objective CPET data indicated impairment status. A subset of case-control pairs (n = 55) matched for aerobic capacity, age, and sex, were also analyzed.
RESULTS: Unlike CTL, ME/CFS failed to reproduce CPET-1 measures during CPET-2 with significant declines at peak exertion in work, exercise time, V ˙ e, V ˙ O2, V ˙ CO2, V ˙ T, HR, O2pulse, DBP, and RPP. Likewise, CPET-2 declines were observed at VAT for V ˙ e/ V ˙ CO2, PetCO2, O2pulse, work, V ˙ O2 and SBP. Perception of effort (RPE) exceeded maximum effort criteria for ME/CFS and CTL on both CPETs. Results were similar in matched pairs. Intraclass correlations revealed greater stability in CPET variables across test days in CTL compared to ME/CFS owing to CPET-2 declines in ME/CFS. Lastly, CPET-2 data signaled more severe impairment status for ME/CFS compared to CPET-1.
CONCLUSIONS: Presently, this is the largest 2-d CPET study of ME/CFS to substantiate impaired recovery in ME/CFS following an exertional stressor. Abnormal post-exertional CPET responses persisted compared to CTL matched for aerobic capacity, indicating that fitness level does not predispose to exertion intolerance in ME/CFS. Moreover, contributions to exertion intolerance in ME/CFS by disrupted cardiac, pulmonary, and metabolic factors implicates autonomic nervous system dysregulation of blood flow and oxygen delivery for energy metabolism. The observable declines in post-exertional energy metabolism translate notably to a worsening of impairment status. Treatment considerations to address tangible reductions in physiological function are proffered.
BACKGROUND: ClinicalTrials.gov, retrospectively registered, ID# NCT04026425, date of registration: 2019-07-17.
METHODS: Participants with ME/CFS (Canadian Criteria; n = 84) and sedentary controls (CTL; n = 71) completed two CPETs on a cycle ergometer separated by 24 h. Two-way repeated measures ANOVA compared CPET measures at rest, ventilatory/anaerobic threshold (VAT), and peak effort between phenotypes and CPETs. Intraclass correlations described stability of CPET measures across tests, and relevant objective CPET data indicated impairment status. A subset of case-control pairs (n = 55) matched for aerobic capacity, age, and sex, were also analyzed.
RESULTS: Unlike CTL, ME/CFS failed to reproduce CPET-1 measures during CPET-2 with significant declines at peak exertion in work, exercise time, V ˙ e, V ˙ O2, V ˙ CO2, V ˙ T, HR, O2pulse, DBP, and RPP. Likewise, CPET-2 declines were observed at VAT for V ˙ e/ V ˙ CO2, PetCO2, O2pulse, work, V ˙ O2 and SBP. Perception of effort (RPE) exceeded maximum effort criteria for ME/CFS and CTL on both CPETs. Results were similar in matched pairs. Intraclass correlations revealed greater stability in CPET variables across test days in CTL compared to ME/CFS owing to CPET-2 declines in ME/CFS. Lastly, CPET-2 data signaled more severe impairment status for ME/CFS compared to CPET-1.
CONCLUSIONS: Presently, this is the largest 2-d CPET study of ME/CFS to substantiate impaired recovery in ME/CFS following an exertional stressor. Abnormal post-exertional CPET responses persisted compared to CTL matched for aerobic capacity, indicating that fitness level does not predispose to exertion intolerance in ME/CFS. Moreover, contributions to exertion intolerance in ME/CFS by disrupted cardiac, pulmonary, and metabolic factors implicates autonomic nervous system dysregulation of blood flow and oxygen delivery for energy metabolism. The observable declines in post-exertional energy metabolism translate notably to a worsening of impairment status. Treatment considerations to address tangible reductions in physiological function are proffered.
BACKGROUND: ClinicalTrials.gov, retrospectively registered, ID# NCT04026425, date of registration: 2019-07-17.
摘要：
背景：运动后不适（PEM），肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）的标志症状，代表了一系列对身体的异常反应，认知，和/或情绪消耗，包括深度疲劳，认知功能障碍，和不容忍劳累，在许多其他疾病中。两次连续的心肺运动测试（2-dCPET）提供了ME/CFS对劳累反应异常的客观证据，但仅在小样本量的研究中得到了验证。Further,缺乏将结果转化为损害状态和减轻症状的方法。
方法：ME/CFS（加拿大标准；n=84）和久坐对照（CTL；n=71）的参与者在间隔24小时的周期测功机上完成了两个CPET。双向重复测量ANOVA比较了休息时的CPET测量，通气/无氧阈值（VAT），表型和CPET之间的峰值努力。组内相关性描述了跨测试的CPET措施的稳定性，和相关客观CPET数据表明减值状况。与有氧能力相匹配的病例对照对（n=55）的子集，年龄,和性,也进行了分析。
结果：与CTL不同，ME/CFS未能在CPET-2期间重现CPET-1措施，在工作高峰期显着下降，锻炼时间,V•e,V•O2,V•CO2,V•T,HR,O2脉冲，DBP,和RPP。同样，在VAT下观察到CPET-2的下降，包括V-e/V•CO2，PetCO2，O2脉冲，工作,V•O2和SBP。在两个CPET上，努力感知（RPE）都超过了ME/CFS和CTL的最大努力标准。配对的结果相似。组内相关性显示，由于ME/CFS的CPET-2下降，与ME/CFS相比，CTL中的CPET变量在整个测试日的稳定性更高。最后,与CPET-1相比，CPET-2数据表明ME/CFS的损伤状态更严重。
结论：目前，这是对ME/CFS进行的最大的2-dCPET研究，以证实在劳累应激源后ME/CFS恢复受损。与有氧能力匹配的CTL相比，运动后CPET反应异常持续存在，表明健康水平不会导致ME/CFS不耐受。此外，心脏中断对ME/CFS劳累不耐受的贡献，肺,和代谢因素暗示自主神经系统的血流失调和能量代谢的氧气输送。运动后能量代谢的可观察到的下降显着转化为损伤状态的恶化。提出了解决生理功能明显下降的治疗考虑。
背景：ClinicalTrials.gov，追溯注册，ID#NCT04026425，注册日期：2019-07-17。
方法：ME/CFS（加拿大标准；n=84）和久坐对照（CTL；n=71）的参与者在间隔24小时的周期测功机上完成了两个CPET。双向重复测量ANOVA比较了休息时的CPET测量，通气/无氧阈值（VAT），表型和CPET之间的峰值努力。组内相关性描述了跨测试的CPET措施的稳定性，和相关客观CPET数据表明减值状况。与有氧能力相匹配的病例对照对（n=55）的子集，年龄,和性,也进行了分析。
结果：与CTL不同，ME/CFS未能在CPET-2期间重现CPET-1措施，在工作高峰期显着下降，锻炼时间,V•e,V•O2,V•CO2,V•T,HR,O2脉冲，DBP,和RPP。同样，在VAT下观察到CPET-2的下降，包括V-e/V•CO2，PetCO2，O2脉冲，工作,V•O2和SBP。在两个CPET上，努力感知（RPE）都超过了ME/CFS和CTL的最大努力标准。配对的结果相似。组内相关性显示，由于ME/CFS的CPET-2下降，与ME/CFS相比，CTL中的CPET变量在整个测试日的稳定性更高。最后,与CPET-1相比，CPET-2数据表明ME/CFS的损伤状态更严重。
结论：目前，这是对ME/CFS进行的最大的2-dCPET研究，以证实在劳累应激源后ME/CFS恢复受损。与有氧能力匹配的CTL相比，运动后CPET反应异常持续存在，表明健康水平不会导致ME/CFS不耐受。此外，心脏中断对ME/CFS劳累不耐受的贡献，肺,和代谢因素暗示自主神经系统的血流失调和能量代谢的氧气输送。运动后能量代谢的可观察到的下降显着转化为损伤状态的恶化。提出了解决生理功能明显下降的治疗考虑。
背景：ClinicalTrials.gov，追溯注册，ID#NCT04026425，注册日期：2019-07-17。
