Charles W.
Lapp, MD Provides a Response to the "Exercise
May Help Those with CFS" Study
In Dr. Lapp's words:
This
Cochrane review study is a sore subject!
I obtained a copy of the entire review, and
it is just horrible. The author examined 9
studies, accepted only 5, and none were from the
USA. Here are some of the problems:
1. Fatigue was the main outcome measured;
depression and quality of life were secondary
outcome measurements.
2. Fukuda international criteria for Chronic
Fatigue Syndrome (CFS) were used in only two
studies, and it appears that the subjects were
not terribly ill.
3. In two of the studies (Fulcher and
Appleby), 80-92% of subjects were working at the
time of the study; in Powell's study 35% were
working. The others did not report. Obviously
this was not a very sick cohort.
4. Of the 5 studies, the Appleby study was
the only one with a rigorous exercise plan
(70-75% of aerobic capacity for 30 minutes).
This study did NOT show any improvement in
subjects, and had the highest dropout rate. The
4 other studies used a low level of exercise
(40% of aerobic capacity).
5. The so-called "experts' [plural] that were
listed were Dr. Peter White [only], whom I
believe works closely with Wessley and Sharpe.
Read biased.
6. Even though the authors concluded
"patients with CFS who are similar to those in
the trials should be offered exercise therapy,"
the press did not make it clear that these CFS
patients were rather high functioning, and that
most CFS patients could not tolerate such
exercise.
7. The authors also concluded from this same
cohort that "exercise therapy may not worsen
outcomes on average." This is very misleading
since it is part of the Fukuda definition that
exercise causes post-exertional malaise, and all
Persons with Chronic Fatigue Syndrome (PWCs) may
trigger prolonged relapses if they overexert.
Sadly, this
Cochrane
review study once again sends the incorrect
message to primary physicians -- that they
should exercise all PWCs and not worry about
post-exertional sequelae.
Charles W. Lapp, MD
HUNTER-HOPKINS CENTER, P.A.
E-mail
contact
Web site
...specializing in CFS, ME, FM, and related
illnesses.
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