From BMJ Open, 4 July 2016.
Managed Activity Graded Exercise iN Teenagers and pre-Adolescents (MAGENTA) feasibility randomised controlled trial: study protocol
Amberly Brigden(1), Lucy Beasant(1), William Hollingworth(1), Chris Metcalfe(2), Daisy Gaunt(2), Nicola Mills(1), Russell Jago(3), Esther Crawley(1)
1) School of Social and Community Medicine, University of Bristol, Bristol, UK
2) Bristol Randomised Trials Collaboration & School of Social and Community Medicine, University of Bristol, Bristol, UK
3) Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, Bristol, UK
Dr Esther Crawley; Esther.email@example.com
Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and disabling condition, yet there is a limited evidence base for treatment. There is good evidence that graded exercise therapy is moderately effective in adults with CFS/ME, but there is little evidence for the effectiveness, cost-effectiveness, acceptability or best method of delivery for paediatric CFS/ME. This study aims to investigate the acceptability and feasibility of carrying out a multicentre randomised controlled trial investigating the effectiveness of graded exercise therapy compared with activity management for children/teenagers who are mildly or moderately affected with CFS/ME.
METHODS AND ANALYSIS
100 paediatric patients (8–17 years) with CFS/ME will be recruited from 3 specialist UK National Health Service (NHS) CFS/ME services (Bath, Cambridge and Newcastle). Patients will be randomised (1:1) to receive either graded exercise therapy or activity management. Feasibility analysis will include the number of young people eligible, approached and consented to the trial; attrition rate and treatment adherence; questionnaire and accelerometer completion rates. Integrated qualitative methods will ascertain perceptions of feasibility and acceptability of recruitment, randomisation and the interventions. All adverse events will be monitored to assess the safety of the trial.
ETHICS AND DISSEMINATION
The trial has received ethical approval from the National Research Ethics Service (South West—Frenchay 15/SW/0124).
Trial registration number ISRCTN23962803; Pre-results.
Strengths and limitations of this study
* This feasibility study is the first trial to investigate graded exercise therapy in children with chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) in the outpatient setting.
* Integrated qualitative methodology is being used to optimise recruitment and retention, and to investigate the feasibility and acceptability of the study processes and interventions.
* This is a multicentre study which will test the feasibility of running this trial in different National Health Service (NHS) settings.
* The participants and clinicians will not be blinded to allocation.
* Participant outcomes are self-reported.
From Clinical Science, 7 July 2016.
Exercise-induced mitochondrial dysfunction: a myth or reality?
Sergej M. Ostojic
Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad 21000, Serbia
School of Medicine, University of Belgrade, Belgrade 11000, Serbia
Correspondence: Sergej M. Ostojic (email firstname.lastname@example.org).
Beneficial effects of physical activity on mitochondrial health are well substantiated in the scientific literature, with regular exercise improving mitochondrial quality and quantity in normal healthy population, and in cardiometabolic and neurodegenerative disorders and aging. However, several recent studies questioned this paradigm, suggesting that extremely heavy or exhaustive exercise fosters mitochondrial disturbances that could permanently damage its function in health and disease.
Exercise-induced mitochondrial dysfunction (EIMD) might be a key proxy for negative outcomes of exhaustive exercise, being a pathophysiological substrate of heart abnormalities, chronic fatigue syndrome (CFS) or muscle degeneration. Here, we overview possible factors that mediate negative effects of exhaustive exercise on mitochondrial function and structure, and put forward alternative solutions for the management of EIMD.
From Molecular Medicine Reports, 7 July 2016.
Potential use of visible and near-infrared spectroscopy for the analysis and diagnosis of chronic fatigue syndrome (Review)
Laboratory of Biometabolic Chemistry, School of Health Sciences, Faculty of Medicine, University of The Ryukyus, Nishihara, Okinawa 903‑0215, Japan
At present, chronic fatigue syndrome (CFS) is diagnosed on the basis of clinical symptoms. Although various psychological, endocrinological and immunological abnormalities of patients with CFS have been reported, no clear consensus exists regarding the symptoms for this disorder. Thus, an objective diagnostic method for CFS is urgently required.
The present study investigated the diagnosis and analysis of CFS using visible and near‑infrared (Vis‑NIR) spectroscopy. Previous studies have demonstrated the potential of Vis-NIR spectroscopy for diagnosing CFS by analyzing either serum samples as an invasive approach or thumbs as a non‑invasive approach. Analysis of the Vis‑NIR spectra of blood and thumbs suggested that factors absorbing in this spectral region are altered in patients with CFS compared with healthy individuals.
These findings are likely to facilitate the search for biomarkers associated with CFS and to increase our understanding of the pathophysiology of the disorder. The current review aimed to outline the latest studies and discuss the future perspectives for CFS made possible by Vis-NIR spectroscopy.
* Visible and near-infrared spectral changes in plasma of psychiatric patients
* Spectroscopic characterization of human immunodeficiency virus type-1-infected plasma by principal component analysis and soft independent modeling of class analogy of visible and near-infrared spectra
* Portable visible and near-infrared spectrophotometer for triglyceride measurements
* Dehydroepiandrosterone sulfate deficiency in chronic fatigue syndrome.
* Autoantibodies against muscarinic cholinergic receptor in chronic fatigue syndrome
From PLoSOne, 26 May 2015.
Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome – Prospective Clinical Trial
Shai Efrati, Haim Golan, Yair Bechor, Yifat Faran, Shir Daphna-Tekoah, Gal Sekler, Gregori Fishlev, Jacob N. Ablin, Jacob Bergan, Olga Volkov, Mony Friedman, Eshel Ben-Jacob, Dan Buskila
Fibromyalgia Syndrome (FMS) is a persistent and debilitating disorder estimated to impair the quality of life of 2–4% of the population, with 9:1 female-to-male incidence ratio. FMS is an important representative example of central nervous system sensitization and is associated with abnormal brain activity. Key symptoms include chronic widespread pain, allodynia and diffuse tenderness, along with fatigue and sleep disturbance. The syndrome is still elusive and refractory. The goal of this study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on symptoms and brain activity in FMS.
METHODS AND FINDINGS
A prospective, active control, crossover clinical trial. Patients were randomly assigned to treated and crossover groups: The treated group patients were evaluated at baseline and after HBOT. Patients in the crossover-control group were evaluated three times: baseline, after a control period of no treatment, and after HBOT. Evaluations consisted of physical examination, including tender point count and pain threshold, extensive evaluation of quality of life, and single photon emission computed tomography (SPECT) imaging for evaluation of brain activity. The HBOT protocol comprised 40 sessions, 5 days/week, 90 minutes, 100% oxygen at 2ATA. Sixty female patients were included, aged 21–67 years and diagnosed with FMS at least 2 years earlier. HBOT in both groups led to significant amelioration of all FMS symptoms, with significant improvement in life quality. Analysis of SPECT imaging revealed rectification of the abnormal brain activity: decrease of the hyperactivity mainly in the posterior region and elevation of the reduced activity mainly in frontal areas. No improvement in any of the parameters was observed following the control period.
The study provides evidence that HBOT can improve the symptoms and life quality of FMS patients. Moreover, it shows that HBOT can induce neuroplasticity and significantly rectify abnormal brain activity in pain related areas of FMS patients.