Stevens Staci, Snell Chris, Stevens Jared, Keller Betsy, VanNess J Mark
Workwell Foundation, Ripon, CA, United States.
Department of Exercise and Sport Sciences, Ithaca College, Ithaca, NY, United States.
Front Pediatr. 2018 Sep 4;6:242. doi: 10.3389/fped.2018.00242. eCollection 2018.
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. 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. 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.
对肌痛性脑脊髓炎/慢性疲劳综合征(ME/CFS)患者进行检测时,需要简明的系列心肺运动试验(CPET)管理方法指导。最大CPET用于评估ME/CFS患者能量产生过程中代谢、肌肉、呼吸和心脏的协同作用。在这一患者群体中,CPET还会引发强烈的运动后症状发作(称为运动后不适),这是该疾病的主要症状。CPET测量在健康人群和患病群体中都具有高度可靠性和可重复性。然而,迄今为止的证据表明,尽管ME/CFS患者在两次测试中都尽了最大努力,但由于运动后不适对能量产生的影响,他们在第二次测试中无法重现CPET测量结果。为了记录和评估ME/CFS中运动后不适影响导致的功能损害,采用了为期2天的CPET程序(2天CPET),首先测量基线功能能力(CPET1)并引发运动后不适,然后在24小时后通过第二次CPET评估CPET变量的变化,以评估运动后不适对功能能力的影响。第二次CPET测量能量产生和生理功能的变化,客观记录运动后不适的影响。在多项研究中,已采用CPET作为标准化应激源来诱发运动后不适并量化与运动后不适相关的损害,以研究ME/CFS的病理。本文讨论了这些研究的结果,以及在ME/CFS患者中使用2天CPET的标准化技术和程序,以及可能适用于其他疲劳性疾病的情况。总结了CPET的基本概念,并详细说明了对ME/CFS患者进行CPET时的特殊注意事项,以确保获得有效的结果。概述了2天CPET方法,并讨论了该程序在评估ME/CFS患者功能能力和运动不耐受方面的效用。