This study was funded by the ME Association's Ramsay Research Fund
Eur J Clin Invest. 2012 Feb;42(2):186-94. doi: 10.1111/j.1365-2362.2011.02567.x. Epub 2011 Jul 12.
Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome: a case-control study.
Jones DE, Hollingsworth KG, Jakovljevic DG, Fattakhova G, Pairman J, Blamire AM, Trenell MI, Newton JL.
Institute of Cellular Medicine Newcastle Magnetic Resonance Centre Institute for Ageing and Health The UK NIHR Biomedical Research Centre in Ageing and Age Related Diseases Newcastle Centre for Brain Ageing and Vitality, Newcastle University, Newcastle, UK.
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) patients frequently describe difficulties with repeat exercise. Here, we explore muscle bioenergetic function in response to three bouts of exercise.
METHODS A total of 18 CFS (CDC 1994) patients and 12 sedentary controls underwent assessment of maximal voluntary contraction (MVC), repeat exercise with magnetic resonance spectroscopy and cardio-respiratory fitness test to determine anaerobic threshold.
RESULTS Chronic fatigue syndrome patients undertaking MVC fell into two distinct groups: 8 (45%) showed normal PCr depletion in response to exercise at 35% of MVC (PCr depletion >33%; lower 95% CI for controls); 10 CFS patients had low PCr depletion (generating abnormally low MVC values). The CFS whole group exhibited significantly reduced anaerobic threshold, heart rate, VO(2), VO(2) peak and peak work compared to controls. Resting muscle pH was similar in controls and both CFS patient groups. However, the CFS group achieving normal PCr depletion values showed increased intramuscular acidosis compared to controls after similar work after each of the three exercise periods with no apparent reduction in acidosis with repeat exercise of the type reported in normal subjects. This CFS group also exhibited significant prolongation (almost 4-fold) of the time taken for pH to recover to baseline.
CONCLUSION When exercising to comparable levels to normal controls, CFS patients exhibit profound abnormality in bioenergetic function and response to it. Although exercise intervention is the logical treatment for patients showing acidosis, any trial must exclude subjects who do not initiate exercise as they will not benefit. This potentially explains previous mixed results in CFS exercise trials.
© 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation.
PMID: 21749371 [PubMed – in process]
Interesting research and interesting results (as always from Prof Newton and co) . . . but what are the implications for treatment?
Muscle problems have been known about for years; what is the treatment to improve our health?
I don’t know, Soloman, but I would suggest addressing the issue of supporting faulty mitochondrial function and low intracellular magnesium would be a good start. Dr Sarah Myhill (amongst others, such as Dr Teitelbaum) aims to do this. Some people find supplements including Acetyl-L-Carnitine, D-Ribose and vitamin B3 as niacinamide helpful. Poor transport of magnesium across cell membranes is difficult to rectify, but again, many find magnesium injections, applying magnesium creams to the skin for absorption through the skin, and of course keeping up a good intake of magnesium dietarily can help somewhat.
This didn’t test function the following day or day after which is when most people with genuine ME have post-exertonal weakness and flare up of symptoms. The damage to the mitochondria from a virus or other agent would be a good area to study. What we need most is to find common biomarkers on patients with genuine ME in order to develop a diagnostic test.
Am I right in thinking this study is pro-exercise? That’s why it’s so important to LISTEN to patients and to follow patients over a longer period. Activity causes symptoms flare up that causes the disabilty associated with ME. People with ME cannot sustain activity. When will the researchers get that and that they need to study stricter criteria cohorts?!
I share your concerns, MsJustice, though I welcome mitochondrial research if it is going to get to the bottom of our dysfunction/abnormal recovery – and exercise is clearly not the answer! Just to add, I was helped -temporarily – by intravenous Vitamin C and magnesium infusions in early 90s.