Re: People want to learn as much as possible from the PACE trial for chronic fatigue syndrome
When I was a teenager I played a lot of sport, and ran in athletic events such as the hurdles, the mile, and the cross country. I also learnt to swim, and I was involved in gymnastics where a wide range of activities included somersaulting from mats, springboards, or trampolines. I was also an instructor where I needed to take into account the varying abilities of younger gymnasts in relation to their age and experience. I didn’t know anything about medicine, but did occasionally suggest modifying exercise for those who were overweight or had asthma etc. I generally recommended that such individuals do what they could, but not be too concerned about keeping up with other members of the group.
However, by the age of 25 I had gradually become more easily fatigued by relatively minor exercise for other reasons.
My doctor was unable to diagnose the cause, and none of the medications were relieving the symptoms, so I decided to study the problem myself.
I considered the possibility that gradually improving my fitness might improve my health, and about a year later, in 1976, I heard about a medically based fitness research organisation called the South Australian Institute for Fitness Research and Training, so I enrolled in one of their courses.
As part of the training each person was medically examined to determine their aerobic capacity at the start, and at 12 weekly intervals.
The measurement was made by having each person ride a stationary cycle while their pulse rate was being recorded as the brake pressure on the wheel was increased at intervals of three minutes of riding and resting. A graph of load over pulse was then drawn to give the level.
I later found that my initial reading was zero, but when I enquired about how that could be so, I was told that normal measurements were made with straight line graphs, and that a curve would be needed at the low end of the graph, in which case my actual reading would be between zero and 100.
I then trained twice a week for 12 weeks, with each session involving 20 minutes of light exercise, 20 minutes of walking or jogging, and 20 minutes of light games. I found that when I just walked I had a minimum of symptoms, but when I began to increase my pace I would have to take from one to three extra deep breaths about ever 30 or more yards. Sometimes I could keep walking, but at other times I would actually have to stop and take the extra deep breaths, and then start again. I therefore walked slowly, or briskly, or jogged, and stopped and started my way around a 400 yard track. I was running last, and by the time I was two thirds around the track every other runner had out-lapped me.
My aerobic capacity was measured again after 12 weeks and it was 350 kps.
I therefore increased the frequency of my training to 3 or 4 times per week at the institute venues, and, or local ovals, and was training at a slightly faster pace, but after 24 weeks my aerobic capacity was still 350 kps.
Nevertheless, I continued to train and increased the frequency to 5-7 times per week, until, in the tenth month, I injured my knee and had to stop.
When I discussed the training with others I found that athletes had capacities of 1200-1400 kps, weekend sportsmen who trained for 2 hours on Wednesday and played for 2 hours on Saturday had a capacity of about 900 kps, and a sedentary worker who did no exercise would be 700 kps.
In other words, despite regular training, my capacity was half that of healthy individuals. I therefore concluded that if I exercised within my limits I would be relatively free of symptoms, and if I reached my limit I would have some trouble with my breathing, and if I exceeded those limits the problem would just get worse. I therefore developed the general policy of exercising within my limits. I also applied that principle to any other aspect of health, by doing things casually instead of hurrying etc.
I also concluded that aerobic testing could be a way of diagnosing the problem, and measuring it’s severity, and that regular exercise could be used as a treatment in some cases.
I continued to study the problem by reading medical books and journals, and some years later found that international researchers were not able to get data on the effects of exercise because the patients could not, or would not train.
I knew that it would be due to the standard exercise programs requiring gradual increases in training to gain improvement, and that as soon as the patients exceeded their limit they would get problems and drop out of the course.
I also found that, in 1980, Russian researchers had measured the aerobic capacity of such patients and found that they were generally below average. In the U.S.A. one of the main names for the ailment was neurocirculatory asthenia. The Russian researchers called it neurocirculatory dystony and placed it in 3 levels for mild, moderate, and severe cases.
Several years later a friend of mine introduced me to the head of the research institute where I had trained.
When I explained how his researchers could solve some of the research problems, he asked them if they would do such a study, but they were busy on other projects, so he asked me to design and co-ordinate a project myself.
I arranged for other patients with similar problems to train in the same manner that I had, and was able to verify that most of them had lower aerobic capacity than normal, and that improvement occurred in the first 12 weeks and began to level out, indicating that they had a limit to their capacity.
The success of the project was reported in newspapers throughout Australia between 1982 and 1983, and although I prepared a research paper and sent it to two medical journals it wasn’t published, so I put it in my filing cabinet where it stayed until recently, when I sent it to BMJ and it was accepted.
References for these comments can be seen in my other responses to the topic in this section of BMJ.
Competing interests:
No competing interests
21 January 2014
Max Allan Banfield
Publisher
None
Unit 6, No.6 Hartman Ave., Modbury, South Australia 5092
Rapid Response:
Re: People want to learn as much as possible from the PACE trial for chronic fatigue syndrome
When I was a teenager I played a lot of sport, and ran in athletic events such as the hurdles, the mile, and the cross country. I also learnt to swim, and I was involved in gymnastics where a wide range of activities included somersaulting from mats, springboards, or trampolines. I was also an instructor where I needed to take into account the varying abilities of younger gymnasts in relation to their age and experience. I didn’t know anything about medicine, but did occasionally suggest modifying exercise for those who were overweight or had asthma etc. I generally recommended that such individuals do what they could, but not be too concerned about keeping up with other members of the group.
However, by the age of 25 I had gradually become more easily fatigued by relatively minor exercise for other reasons.
My doctor was unable to diagnose the cause, and none of the medications were relieving the symptoms, so I decided to study the problem myself.
I considered the possibility that gradually improving my fitness might improve my health, and about a year later, in 1976, I heard about a medically based fitness research organisation called the South Australian Institute for Fitness Research and Training, so I enrolled in one of their courses.
As part of the training each person was medically examined to determine their aerobic capacity at the start, and at 12 weekly intervals.
The measurement was made by having each person ride a stationary cycle while their pulse rate was being recorded as the brake pressure on the wheel was increased at intervals of three minutes of riding and resting. A graph of load over pulse was then drawn to give the level.
I later found that my initial reading was zero, but when I enquired about how that could be so, I was told that normal measurements were made with straight line graphs, and that a curve would be needed at the low end of the graph, in which case my actual reading would be between zero and 100.
I then trained twice a week for 12 weeks, with each session involving 20 minutes of light exercise, 20 minutes of walking or jogging, and 20 minutes of light games. I found that when I just walked I had a minimum of symptoms, but when I began to increase my pace I would have to take from one to three extra deep breaths about ever 30 or more yards. Sometimes I could keep walking, but at other times I would actually have to stop and take the extra deep breaths, and then start again. I therefore walked slowly, or briskly, or jogged, and stopped and started my way around a 400 yard track. I was running last, and by the time I was two thirds around the track every other runner had out-lapped me.
My aerobic capacity was measured again after 12 weeks and it was 350 kps.
I therefore increased the frequency of my training to 3 or 4 times per week at the institute venues, and, or local ovals, and was training at a slightly faster pace, but after 24 weeks my aerobic capacity was still 350 kps.
Nevertheless, I continued to train and increased the frequency to 5-7 times per week, until, in the tenth month, I injured my knee and had to stop.
When I discussed the training with others I found that athletes had capacities of 1200-1400 kps, weekend sportsmen who trained for 2 hours on Wednesday and played for 2 hours on Saturday had a capacity of about 900 kps, and a sedentary worker who did no exercise would be 700 kps.
In other words, despite regular training, my capacity was half that of healthy individuals. I therefore concluded that if I exercised within my limits I would be relatively free of symptoms, and if I reached my limit I would have some trouble with my breathing, and if I exceeded those limits the problem would just get worse. I therefore developed the general policy of exercising within my limits. I also applied that principle to any other aspect of health, by doing things casually instead of hurrying etc.
I also concluded that aerobic testing could be a way of diagnosing the problem, and measuring it’s severity, and that regular exercise could be used as a treatment in some cases.
I continued to study the problem by reading medical books and journals, and some years later found that international researchers were not able to get data on the effects of exercise because the patients could not, or would not train.
I knew that it would be due to the standard exercise programs requiring gradual increases in training to gain improvement, and that as soon as the patients exceeded their limit they would get problems and drop out of the course.
I also found that, in 1980, Russian researchers had measured the aerobic capacity of such patients and found that they were generally below average. In the U.S.A. one of the main names for the ailment was neurocirculatory asthenia. The Russian researchers called it neurocirculatory dystony and placed it in 3 levels for mild, moderate, and severe cases.
Several years later a friend of mine introduced me to the head of the research institute where I had trained.
When I explained how his researchers could solve some of the research problems, he asked them if they would do such a study, but they were busy on other projects, so he asked me to design and co-ordinate a project myself.
I arranged for other patients with similar problems to train in the same manner that I had, and was able to verify that most of them had lower aerobic capacity than normal, and that improvement occurred in the first 12 weeks and began to level out, indicating that they had a limit to their capacity.
The success of the project was reported in newspapers throughout Australia between 1982 and 1983, and although I prepared a research paper and sent it to two medical journals it wasn’t published, so I put it in my filing cabinet where it stayed until recently, when I sent it to BMJ and it was accepted.
References for these comments can be seen in my other responses to the topic in this section of BMJ.
Competing interests: No competing interests