From Physical Therapy Reviews, 25 May, 2017.
Understanding severely affected chronic fatigue syndrome (CFS): the gravity of the situation
Victoria Strassheim, Robert Ballantine, Katie L. Hackett, James Frith & Julia L. Newton
Objective: To describe how the effects of gravity may adversely affect the neuro-cardiovascular physiology of individuals with severe Chronic Fatigue Syndrome (CFS).
Design: A narrative review of the literature relating to microgravity, orthostatic intolerance and severe CFS. Emphasis is placed on the clinical significance and implications for the management of patients with severe CFS, with suggestions for future rehabilitation and physical interventions.
Results: Physiological functions in humans have evolved to counter the effects of gravity, in particular the neuro-cardiovascular system. Reducing exposure to gravity will result in deconditioning of these systems. Many of the symptoms experienced by astronauts returning to Earth are shared by those with severe CFS.
Prolonged periods in the supine position create an environment similar to microgravity – the mechanism through which we propose orthostatic intolerance develops in CFS. However, there are also some physiological changes present in CFS which may exacerbate these changes.
Studies have shown that some CFS individuals have hypovolaemia unrelated to deconditioning. This pre-existing hypovolaemia may make the neuro-cardiovascular system more vulnerable to the effects of bed rest in those individuals with CFS.
Conclusion: Severely affected CFS individuals may be more susceptible to a specific type of deconditioning, related to reduced exposure to gravity, due to pre-existing vulnerabilities in their cardiovascular and autonomic nervous systems. Rehabilitation which targets the neuro-cardiovascular system and its response to upright posture may improve function and symptoms of severely affected CFS individuals.
Conclusion (Taken from the full paper – for additional information):
Given the nature of the severely affected CFS population, their involvement in research has been limited. Existing evidence may not therefore apply to this group.
There are several physiological changes which occur in those who become bedbound. These changes are similar to those seen in astronauts who return to Earth. Some individuals may have contributing factors to developing CFS which may make them more vulnerable to the effects of bed rest physiology such as changes in plasma volume. These contributing factors may make the symptoms of orthostatic exposure more profound.
When developing rehabilitation or physical activity interventions for the severely affected CFS population, an understanding of these changes may improve outcomes. Progressive gravitational challenges may, in theory, improve the effectiveness of the neurocardiovascular system and improve orthostatic intolerance.
Journal of Health Psychology, May 29, 2017.
Bias, misleading information and lack of respect for alternative views have distorted perceptions of myalgic encephalomyelitis/chronic fatigue syndrome and its treatment
Ellen Goudsmit, Sandra Howes
The PACE trial is one of the most recent studies evaluating cognitive behavioural therapy and graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome. These interventions are based on a model which assumes that symptoms are perpetuated by factors such as misguided beliefs and a lack of activity. Our analysis indicates that the researchers have shown significant bias in their accounts of the literature and may also have overstated the effectiveness of the above treatments. We submit that their approach to criticisms undermines the scientific process and is inconsistent with best practice.
Article is open access.
Archived as part of the series of PACE trial critiques, here.