Download here - Cathcart ME Support Group

Understanding Fatigue After
Daily Activities
Dr Lorna Paul,
Physiotherapist
Reader in Rehabilitation
Fatigue after daily activities
• Post-exertional fatigue is one of the main
symptoms of ME
• Lots of studies of exercise tests where
people manage the exercise at the time
but are not followed up for 24 or 48 hours
later
• Post-exertional fatigue/malaise not just
after strenuous activity
• Update of study funded by ME
Association
Purpose of the study
• What goes wrong within the body which
leads to post exertional malaise/fatigue in
ME?
• Examining three things 1) HPA function 2)
autonomic functioning 3) inflammatory
response
• Examining these 3 things before and after 3
different tasks 1) cognitive task 2) cycling
task 3) daily task (vacuuming)
Participant Groups
4 groups of people – 30 people in each
group
• ME
• MS
• Post breast cancer (within one year of end
of treatment)
• Healthy controls
Immunological response to exercise
Hypothalamic-Pituitary Axis (HPA axis)
What is cortisol?
Cortisol (or hydrocortisone) is
• a steroid hormone
• released in response to stress
• increases blood sugar
• suppresses the immune system
• aids in fat, protein and carbohydrate
metabolism
Autonomic Function
• The autonomic nervous system is part of the
peripheral nervous system
• It controls many systems subconsciously eg
The ANS affects heart rate, breathing,
digestion, perspiration, size of pupils
• The hypothalamus ‘central control area’ for
the autonomic nervous system
• Split into sympathetic and parasympathetic
nervous systems
Immunological response to exercise
Immune response
Immune cells produce cytokines which would
be pro-inflammatory or anti-inflammatory
Each person attends four times
• Introduction and Induction
• 3 ‘fatiguing’ tests
a) Computer based cognitive task
b) Submaximal exercise bicycle task
c) Standardised daily physical activity task
(vacuuming)
Computer based cognitive task - PASAT
• Paced Auditory Serial Addition Test
• The PASAT is a measure of cognitive
function that assesses auditory information
processing speed and flexibility, as well as
calculation ability.
• Single digits are presented every 3 seconds
and the patient must add each new digit to
the one immediately prior to it.
• The PASAT is presented on CD to ensure
standardisation
Submaximal exercise bicycle task
The Aerobic Power Index test
is a submaximal exercise
test on a static bicycle
It consists of gradual
increments in power
output
The test is stopped when
people reach 75% of their
predicted maximum heart
rate (220-age)
Standardised daily physical activity task
(vacuuming)
Outcome Measures – First visit
• Basic demographic details – age, height,
weight, medications
• Questionnaires – eg. Hospital Anxiety and
Depression Scale (HADS)
• Autonomic assessment
Outcome measures – Autonomic regulation
Outcome measures (cont)
• Heart rate and blood pressure monitoring
during and after the task
• Questionnaires
SF36
Checklist individual strength (CIS) contains 20 items that measure 4 aspects
of fatigue: 1. Subjective Fatigue; 2.
Concentration; 3. Motivation; 4. Activity.
• Physical activity monitoring (7 days
between tests)
Immunological markers - cytokines
Bloods have been
taken and frozen
Still deciding on which
cytokines to test
Expensive tests to do!
[email protected]
0141 330 6876