Exercise Testing in Children and Adolescents with Chronic Fatigue Syndrome

Abstract

The objective of this study was to evaluate exercise capacity in children and adolescents diagnosed with Chronic Fatigue Syndrome (CFS). We examined 20 patients (12 girls and 8 boys; mean age 14.9 ± 3.7 years) diagnosed with CFS. Exercise capacity was measured using a maximal exercise test on a bicycle ergometer and an expired gas analysis system. Fatigue was assessed using a questionnaire and a daily activity diary was used to describe activities for three days. Z-scores were calculated using age- and sex-matched reference values. Z-scores in children and adolescents with CFS were - 0.33 ± 1.0 (p = 0.17) for peak oxygen uptake, - 1.13 ± 1.41 (p = 0.002) for relative peak oxygen uptake [ml/kg/min] and - 0.93 ± 1.29 (p = 0.07) for maximal work load. Both heart rate and blood pressure at peak performance were significantly reduced compared to reference values. Fatigue levels were significantly positively associated with age and negatively with blood pressure at peak exercise (p < 0.05). In conclusion maximum exercise testing was feasible in young people with CFS. Maximal exercise capacity was only reduced in a minority of the patients and was related to current physical activity levels.

chronic fatigue syndrome - children - exercise capacity - blood pressure

References

• 1 Arav-Boger R, Spirer Z. Chronic fatigue syndrome: pediatric aspects.  Isr J Med Sci. 1995;  31 330-334
• 2 Armstrong N, Welsman J, Winsley R. Is peak V·O₂ a maximal index of children's aerobic fitness?.  Int J Sports Med. 1996;  17 356-359
• 3 ATS/ACCP . ATS/ACCP Statement on cardiopulmonary exercise testing.  Am J Respir Crit Care Med. 2003;  167 211-277
• 4 Bazelmans E, Bleijenberg G, Meer van der J, Folgering H. Is physical deconditioning a perpetuating factor in chronic fatigue syndrome? A controlled study on maximal exercise performance and relations with fatigue, impairment and physical activity.  Psychol Med. 2001;  31 107-114
• 5 Becker de P, Roekens J, Reynders M, McGregor N, Meirleir de K. Exercise capacity in chronic fatigue syndrome.  Arch Intern Med. 2000;  160 3270-3277
• 6 Binkhorst R A, van 't Hof M A, Saris W HM. Maximale inspanning door kinderen; referentiewaarden voor 6 - 18 jarige meisjes en jongens (Maximal exercise in children reference values girls and boys, 6 - 18 year of age). Den-Haag; Nederlandse Hartstichting 1992
• 7 Bouchard C, Tremblay A, LeBlanc C, Lortie G, Savard R. A method to assess energy expenditure in children and adults.  Am J Clin Nutr. 1983;  37 461-467
• 8 Buchfuhrer M J, Hansen J E, Robinson T E, Sue D Y, Wasserman K, Whipp B J. Optimizing the exercise protocol for cardiopulmonary assessment.  J Appl Physiol. 1983;  55 1558-1564
• 9 Cooper D M, Weiler-Ravell D, Whipp B J, Wasserman K. Aerobic parameters of exercise as a function of body size during growth in children.  J Appl Physiol. 1984;  56 628-634
• 10 Dwyer D B. A standard method for the determination of maximal aerobic power from breath-by-breath V·O₂ data obtained during a continuous ramp test on a bicycle ergometer.  J Exerc Physiol. 2004;  7 1-9
• 11 Farquhar W B, Hunt B E, Taylor A, Darling S E, Freeman R. Blood volume and its relation to peak O₂ consumption and physical activity in patients with chronic fatigue.  Am J Physiol. 2002;  282 H66-H72
• 12 Fischler B, Dendale P, Michiels V, Cluydts R, Kaufman L, De Meirleir K. Physical fatigability and exercise capacity in chronic fatigue syndrome: association with disability, somatization and psychopathology.  J Psychosom Res. 1997;  42 369-378
• 13 Fukuda K, Straus S, Hickie I, Sharpe M, Dobbins J, Komaroff A. The chronic fatigue syndrome. A comprehensive approach to its definition and study.  Ann Intern Med. 1994;  121 953-959
• 14 Fulcher K, White P. Strength and physiological response to exercise in patients with chronic fatigue syndrome.  J Neurol Neurosurg Psychiatry. 2000;  69 302-307
• 15 Gill A C, Dosen A, Ziegler J B. Chronic fatigue syndrome in adolescents: a follow-up study.  Arch Pediatr Adolesc Med. 2004;  158 225-229
• 16 Howley E T, Bassett D RJ, Welch H G. Criteria for maximal oxygen uptake: review and commentary.  Med Sci Sports Exerc. 1995;  27 1292-1301
• 17 Lask B, Dillon M. Postviral fatigue syndrome.  Arch Dis Child. 1990;  65 1198
• 18 Latin R W. Surface anatomy. Roitman JL ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription. 3rd edn. Baltimore; Williams and Wilkins 1998: 89-100
• 19 Lees S J, Booth F W. Sedentary death syndrome.  Can J Appl Physiol. 2004;  29 447-460
• 20 Lucas K E, Rowe P C, Coresh J, Klag M J, Meoni L A, Ford D E. Prospective association between hypotension and idiopathic chronic fatigue.  J Hypertens. 2004;  22 691-695
• 21 Meeusen R, Piacentini M F, Busschaert B, Buyse L, De Schutter G, Stray-Gundersen J. Hormonal responses in athletes: the use of a two bout exercise protocol to detect subtle differences in (over)training status.  Eur J Appl Physiol. 2004;  91 140-146
• 22 Owens S, Gutin B. Exercise testing of the child with obesity.  Pediatr Cardiol. 1999;  20 79-83 84
• 23 Peckerman A, LaManca J J, Smith S L, Taylor A, Tiersky L, Pollet C, Korn L R, Hurwitz B E, Ottenweller J E, Natelson B H. Cardiovascular stress responses and their relation to symptoms in gulf war veterans with fatiguing illness.  Psychosom Med. 2000;  62 509-516
• 24 Pollack M L, Schmidt D H, Jackson A S. Measurement of cardio-respiratory fitness and body composition in the clinical setting.  Compr Ther. 1980;  6 12-27
• 25 Riley M, O'Brien C, McCluskey D, Bell N, Nicholls D. Aerobic capacity in patients with chronic fatigue syndrome.  BMJ. 1990;  301 953-956
• 26 Rowbottom D G, Keast D, Green S, Kakulas B, Morton A R. The case history of an elite ultra-endurance cyclist who developed chronic fatigue syndrome.  Med Sci Sports Exerc. 1998;  30 1345-1348
• 27 Rowe P C, Calkins H. Neurally mediated hypotension and chronic fatigue syndrome.  Am J Med. 1998;  105 15S-21S
• 28 Rowland T W. Effect of prolonged inactivity on aerobic fitness of children.  J Sports Med Phys Fitness. 1994;  34 147-155
• 29 Saltin B, Blomqvist G, Mitchell J H, Johnson Jr R L, Wildenthal K, Chapman C B. Response to exercise after bed rest and after training.  Circulation. 1968;  38 VII1-78
• 30 Sargent C, Scroop G C, Nemeth P M, Burnet R B, Buckley J D. Maximal oxygen uptake and lactate metabolism are normal in chronic fatigue syndrome.  Med Sci Sports Exerc. 2002;  34 51-56
• 31 Sisto S, LaManca J, Cordere D, Bergen M, Ellis S, Drastal S, Boda W, Tapp W, Natelson B. Metabolic and cardiovascular effects of a progressive exercise test in patients with chronic fatigue syndrome.  Am J Med. 1996;  100 634-640
• 32 Sisto S, Tapp W, LaManca J, Ling W, Korn L R, Nelson A J. Physical activity before and after exercise in woman with chronic fatigue syndrome.  QJM. 1998;  91 465-473
• 33 Taylor H L, Buskirk E, Henschel A. Maximal oxygen uptake as an objective measure of cardio-respiratory performance.  J Appl Physiol. 1955;  8 73-80
• 34 van de Putte E M, Engelbert R H, Kuis W, Kimpen J L, Uiterwaal C S. How fatigue is related to other somatic symptoms.  Arch Dis Child. 2006;  91 824-827
• 35 Vercoulen J, Bazelmans E, Swanink C, Fennis J, Galama J, Jongen P, Hommes O, Meer van der J, Bleijenberg G. Physical activity in chronic fatigue syndrome: assessment and its role in fatigue.  J Psychiat Res. 1997;  31 661-673
• 36 Vercoulen J HMM, Alberts M, Bleijenberg G. De checklist individual strength (CIS).  Gedragstherapie. 1999;  32 131-136
• 37 Vereker M I. Chronic fatigue syndrome: a joint paediatric-psychiatric approach.  Arch Dis Child. 1992;  67 550-555
• 38 Wagenmakers A J. Chronic fatigue syndrome: the physiology of people on the low end of the spectrum of physical activity?.  Clin Sci (Lond). 1999;  97 611-613
• 39 Wagner P D. New ideas on limitations to VO2max.  Exerc Sport Sci Rev. 2000;  28 10-14
• 40 Wallman K E, Morton A R, Goodman C, Grove R. Physiological responses during a submaximal cycle test in chronic fatigue syndrome.  Med Sci Sports Exerc. 2004;  36 1682-1688
• 41 Washington R L, van Gundy J C, Cohen C, Sondheimer H M, Wolfe R R. Normal aerobic and anaerobic exercise data for North American school-age children.  J Pediatr. 1988;  112 223-233