Thread by @Dr_M_Guthridge

1/ The problem with Myalgic Encephalomyeltis/Chronic Fatigue Syndrome #MECFS is that it seems so ridiculous that exercise could actually make patients worse

How can exercise be so bad for #pwME but so good for almost every other serious illness?

THREAD

2/ New study by @4WorkWell @sunsopeningband et al shows that #MECFS patients have metabolic defects that cannot be explained by exercise phobias, deconditioning or 'illness beliefs'

#pwME have reduced oxygen consumption during exercise tests
buff.ly/2CXH6Hj

3/ #pwME have an impaired ability to increase their oxygen consumption during exercise

This is entirely different to every other disease we know including cardiovascular disease, lung disease, end-stage renal disease, hypertension & cystic fibrosis

…nslational-medicine.biomedcentral.com/articles/10.11…

4/ And #MECFS patients also show impaired oxygen consumption and reduced anaerobic threshold compared to Multiple Sclerosis

#MECFS are #SickNotDeconditioned, #SickNotTired, #SickNotWeak

onlinelibrary.wiley.com/doi/abs/10.111…

5/ Exercise testing provides an explanation for why #MECFS patients can crash even after modest exertion

The reduced aerobic capacity of #pwME results in a switch to anaerobic #metabolism that likely impacts their ability to do simple daily activities
frontiersin.org/article/10.338…

6/ And #MECFS patients can 'crash' if they over-exert resulting in a post-exertional malaise #PEM

Triggering #PEM reduces the threshold at which anaerobic #metabolism accelerates which impairs the ability of patients to do non-strenuous tasks

…nslational-medicine.biomedcentral.com/articles/10.11…

7/ And exercise that triggers #PEM in #MECFS patients leads to a sustained #immune inflammatory response that is distinct from that in sedentary or deconditioned people

@PLOSONE #MedEd #SickNotTired
journals.plos.org/plosone/articl…

8/ Humans use aerobic metabolism for the majority of daily activities such as walking and seated tasks

But a reduced aerobic capacity of #MECFS patients likely forces a switch to less efficient anaerobic metabolism leading to premature fatigue and #PEM
frontiersin.org/article/10.338…

9/ Exercise studies also show that the increased reliance on anaerobic #metabolism in #MECFS patients results in increased metabolites such as lactic acid which likely leads to an inability to maintain work and a reduction in activity
academic.oup.com/ptj/article/93…

10/ Physical therapists should be aware that post-exertional malaise #PEM in #pwME is due to objectively measurable deficits in metabolism

So yes, exercise is beneficial for nearly every illness...

..but the science shows that #MECFS is the exception

academic.oup.com/ptj/article/93…

This @FrontiersIn review by @4WorkWell discusses how cardiopulmonary exercise testing #CPET can be used to help diagnose & research #MECFS

This table provides a helpful list definitions for patients and doctors to investigate #MECFS

#MedEd #MedTwitter
frontiersin.org/article/10.338…