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Abstract
Background: Concise methodological directions for administration of serial cardiopulmonary exercise testing (CPET) are needed for testing of patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Maximal CPET is used to evaluate the coordinated metabolic, muscular, respiratory and cardiac contributions to energy production in patients with ME/CFS. In this patient population, CPET also elicits a robust post-exertional symptom flare (termed, post-exertional malaise); a cardinal symptom of the disease. CPET measures are highly reliable and reproducible in both healthy and diseased populations. However, evidence to date indicates that ME/CFS patients are uniquely unable to reproduce CPET measures during a second test, despite giving maximal effort during both tests, due to the effects of PEM on energy production.Methodology: To document and assess functional impairment due to the effects of post-exertional malaise in ME/CFS, a 2-day CPET procedure (2-day CPET) has been used to first measure baseline functional capacity (CPET1) and provoke post-exertional malaise, then assess changes in CPET variables 24 h later with a second CPET to assess the effects of post-exertional malaise on functional capacity. The second CPET measures changes in energy production and physiological function, objectively documenting the effects of post-exertional malaise. Use of CPET as a standardized stressor to induce post-exertional malaise and quantify impairment associated with post-exertional malaise has been employed to examine ME/CFS pathology in several studies. This article discusses the results of those studies, as well as the standardized techniques and procedures for use of the 2-day CPET in ME/CFS patients, and potentially other fatiguing illnesses.Conclusions: Basic concepts of CPET are summarized, and special considerations for performing CPET on ME/CFS patients are detailed to ensure a valid outcome. The 2-day CPET methodology is outlined, and the utility of the procedure is discussed for assessment of functional capacity and exertion intolerance in ME/CFS.
Highlights
Concise methodological directions for administration of serial cardiopulmonary exercise testing (CPET) are needed for testing of patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
A 2-day cardiopulmonary exercise test methodology (2-day CPET) was cited by the Institute of Medicine (IOM) [1] as a potentially useful tool to aid in the diagnosis and assessment of functional capacity in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
Studies of exertion intolerance in ME/CFS using a 2-day CPET methodology indicate an impaired ability of patients to reproduce CPET results
Summary
Concise methodological directions for administration of serial cardiopulmonary exercise testing (CPET) are needed for testing of patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Maximal CPET is used to evaluate the coordinated metabolic, muscular, respiratory and cardiac contributions to energy production in patients with ME/CFS. In this patient population, CPET elicits a robust post-exertional symptom flare (termed, post-exertional malaise); a cardinal symptom of the disease. The fatigue in ME/CFS differs from that experienced by controls and is unlike the fatigue associated with deconditioning It is often described as “flu-like” and frequently includes “brain fog” or cognitive difficulties and other symptoms. This abnormal response to exertion is a hallmark symptom of ME/CFS referred to as post-exertional malaise (PEM). Muscle and/or joint pain often accompany these other symptoms, any of which could force a person with ME/CFS to stop work, avoid physical activity and, further reduce functional ability
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