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Charles W. Lapp, M.D., Provides a Response to "Exercise May Help CFS" Study

  [ 371 votes ]   [ Discuss This Article ] • September 8, 2004

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, M.D.
specializing in CFS, ME, FM, and related illnesses. *To read the study, click here:

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