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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
• QuestionnairesSF36Checklist 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!
