Cardiopulmonary and metabolic responses during a 2-day CPET in myalgic encephalomyelitis/chronic fatigue syndrome: translating reduced oxygen consumption to impairment status to treatment considerations.

Autor: Keller B; Department of Exercise Science and Athletic Training, Ithaca College, Ithaca, NY, 14850, USA. keller@ithaca.edu., Receno CN; Department of Exercise Science and Athletic Training, Ithaca College, Ithaca, NY, 14850, USA., Franconi CJ; Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, 14853, USA., Harenberg S; Department of Human Kinetics, St. Francis Xavier University, Antigonish, NS, B2G 2W5, Canada., Stevens J; Department of Radiology, Weill Cornell Medicine, New York, NY, 10065, USA., Mao X; Workwell Foundation, Ripon, CA, 95366, USA., Stevens SR; Department of Radiology, Weill Cornell Medicine, New York, NY, 10065, USA., Moore G; Department of Exercise Science and Athletic Training, Ithaca College, Ithaca, NY, 14850, USA.; Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, 14853, USA., Levine S; Susan Levine, MD Clinical Practice, New York, NY, 10021, USA., Chia J; ID Med, Torrance, CA, 90505, USA., Shungu D; Workwell Foundation, Ripon, CA, 95366, USA., Hanson MR; Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, 14853, USA.
Jazyk: angličtina
Zdroj: Journal of translational medicine [J Transl Med] 2024 Jul 05; Vol. 22 (1), pp. 627. Date of Electronic Publication: 2024 Jul 05.
DOI: 10.1186/s12967-024-05410-5
Abstrakt: 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 ˙ O 2 , V ˙ CO 2 , V ˙ T , HR, O 2 pulse, DBP, and RPP. Likewise, CPET-2 declines were observed at VAT for V ˙ e/ V ˙ CO 2 , PetCO 2, O 2 pulse, work, V ˙ O 2 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.
Trial Registration Number: ClinicalTrials.gov, retrospectively registered, ID# NCT04026425, date of registration: 2019-07-17.
(© 2024. The Author(s).)
Databáze: MEDLINE
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