Editor's Choice | This Week in BMJ | Press releases
BMJ No 7113 Volume 315 Letters Saturday 11 October 1997
Graded exercise in chronic fatigue syndromeAuthors' replyEditor,We cannot tell Charles Shepherd and Anne Macintyre whether the treatment reduced the number of patients claiming benefits, but we did find that a significantly greater proportion had returned to work or study, compared to before treatment. An early return to activity or exercise after infections is probably beneficial rather than harmful,(1-2) so rest is probably inappropriate advice, as long as fever has abated. We treat severely disabled patients in hospital using the same principle of appropriately prescribed exercise, agreed beforehand with the patient. The first 'exercise' prescribed might be sitting up in bed for five minutes. We agree that aetiology is still uncertain in the chronic fatigue syndrome. However, McCully et al themselves suggested that reduced oxidative metabolism may be secondary to inactivity,(3) while others have suggested that sleep disturbance may be the cause of hypocortisolaemia.(4) We can reassure Allan J Franklin and Mike Sadler that we categorised 'a little better' as a negative outcome before we collected any data, believing that this particular rating was not clinically important. We cannot agree that we treated an unusual or small subgroup of patients. All 167 screened patients were referred to a chronic fatigue clinic established 12 years ago. Two fifths of these patients were recruited into the trial. The commonest reason for exclusion was having a comorbid psychiatric disorder (77% of those excluded), treatment of which usually led to resolution of fatigue, which suggests that the psychiatric disorder was the main cause of fatigue rather than the chronic fatigue syndrome itself.(5) Ellen M Goudsmit can be reassured that neither a history of a triggering infection nor taking antidepressants affected the response to treatment. Antidepressants were being taken by 20 subjects to prevent a relapse of their previous comorbid depressive illness. We agree with Sandler that randomisation should account for confounders, which is why we omitted the table (printed above) giving the data he requested, so that the paper was shorter, as requested by the journal. Analysis of covariance showed that longer duration of illness in the exercise group had no significant effect on outcome (ß=-0.10, t=-0.72, P=0.47).
Peter D White Senior lecturer Department of Psychological Medicine, Kathy Y Fulcher Laboratory director National Sports Medicine Institute, References 1 Dalrymple W. Infectious mononucleosis. 2. Relation of bed rest and activity to prognosis. Postgrad Med 1964;35:345-9. 2 Repsher L H, Freehern R K. Effects of early and vigorous exercise on recovery from infectious hepatitis. N Engl J Med 1969;281:1393-6. 3 McCully K K, Natelson B H, Iotti S, Sisto S, Leigh J S Jr. Reduced oxidative muscle metabolism in chronic fatigue syndrome. Muscle Nerve 1996;19:621-5. 4 Leese G, Chattington P, Fraser W, Vora J, Edwards R, Williams G. Short-term night-shift working mimics the pituitary-adrenocortical dysfunction in chronic fatigue syndrome. J Clin Endocrinol Metab 1996;81:1867-70. 5 Lane T J, Manu P, Matthews D A. Depression and somatization in the chronic fatigue syndrome. Am J Med 1991;91:335-44.
Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline
|
||||||||||||||||||||||||||||