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Deconditioning
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'''Deconditioning''' is the decline in physical function of the body as a result of physical inactivity and disuse. The most important feature of deconditioning is a decline in muscle strength and bulk. It is usually reversible.<ref>{{Cite web | url = http://www.encyclopedia.com/doc/1G2-3402200094.html | title = Deconditioning {{!}} Encyclopedia.com | website = encyclopedia.com|language=en|access-date=2018-10-23}}</ref> It is often seen in the elderly and the infirm due to bed rest and inactivity. Risk factors include illness, disability, chronic disease, medical and psychosocial circumstances.<ref>{{Cite web | url = http://www.ncbi.nlm.nih.gov/pubmed/8178204 | title = Management of the frail and deconditioned patient. - PubMed - NCBI | last = JL|first = Rader MC and Vaughen | website = ncbi.nlm.nih.gov|language=en|access-date=2018-10-23}}</ref><ref>{{Cite web | url = http://www.ncbi.nlm.nih.gov/pubmed/16121472/ | title = Deconditioning in the hospitalized elderly. - PubMed - NCBI | last = B|first = Gillis A and MacDonald | website = ncbi.nlm.nih.gov|language=en|access-date=2018-10-23}}</ref> The '''deconditioning hypothesis''' proposed by proponents of the [[biopsychosocial model]] (BPS) of [[chronic fatigue syndrome]] (CFS) claims that the [[muscle fatigability]], [[chronic fatigue]], different types of [[pain]], [[post-exertional malaise]] and all [[Common symptoms in ME/CFS|other symptoms]] experienced in [[ME/CFS]], are the result of deconditioning, combined with inappropriate [[Cognitive behavioral therapy|behavioral]] responses to symptoms. The theory proposes that patient's claims of their inability to [[exercise]] or exert themselves is actually due to a "fear of exercise" rather than rooted in reality. It is consequently proposed that psychological interventions such as [[cognitive behavioral therapy]] (CBT) should be employed to help the patient overcome their [[Illness beliefs|"unhelpful beliefs"]], while physical programs such as [[graded exercise therapy]] (GET) or [[exercise]] are employed to help the patient recondition their body.<ref>{{Cite web | url = http://www.meassociation.org.uk/2015/01/me-association-challenges-lancet-claim-about-fear-of-exercise-leading-to-its-avoidance-in-mecfs-14-january-2014/ | title = ME Association challenges βLancetβ claim about fear of exercise leading to its avoidance in ME/CFS {{!}} 14 January 2015 | website = [[The ME Association]]|language=en-US|access-date=2018-10-23}}</ref><ref>{{Cite journal | date = 2018-10-23 | title = Re: Tackling fears about exercise is important for ME treatment, analysis indicates |url = https://www.bmj.com/content/350/bmj.h227/rr-13|journal=The BMJ|language=en}}</ref> The deconditioning theory has been used as justification treating ME/CFS with [[graded exercise therapy]] to improve fitness, and with [[cognitive behavioral therapy]] to address supposed [[illness beliefs|inappropriate fear of exercise]].<ref name=":1" /> The deconditioning hypothesis has been largely abandoned due to significant evidence disproving it, combined with high rates of harm and lack of effectiveness of the treatments.<ref name="OxfordBrookesSurvey">{{Cite web | url = https://www.meassociation.org.uk/wp-content/uploads/NICE-Patient-Survey-Outcomes-CBT-and-GET-Final-Consolidated-Report-03.04.19.pdf | title =Evaluation of a survey exploring the experiences of adults and children with ME/CFS who have participated in CBT and GET interventional programmes. FINAL REPORT | last = Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS)|location=Oxford Brookes University | date = Feb 27, 2019}}</ref> Significant [[List of abnormal findings in chronic fatigue syndrome and myalgic encephalomyelitis|abnormal findings]] in ME/CFS have proved that there is an ongoing disease process rather than simply "symptoms without disease", and cannot explain the degree of [[orthostatic intolerance]] found in patients.<ref name="vanCampen2021" /> ==Theory== == Evidence == In 2005 [[Peter White]], an influential proponent of the deconditioning hypothesis since the 1990s, stated that: {{Quote|We do not know whether this deconditioning maintains the illness or is a consequence.}} Despite the lack of evidence for the deconditioning hypothesis, White and other members of the [[Wessely school]] promoted this belief and developed treatments based on it, which were adopted in a number of countries including the [[United States]], [[United Kingdom]], and [[Netherlands]].<ref name="niceng206">{{Cite web | url = https://www.nice.org.uk/guidance/ng206 | title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline. | last = NICE Guideline Development Group|first = | authorlink = | publisher = [[National Institute for Health and Care Excellence]] | date = 2021-10-29}}</ref> In their literature review, [[Lucy Clark|Clark]] and [[Peter White|White]] (2005) found that people with chronic fatigue syndrome were at least as deconditioned as healthy controls with a similar level of physical inactivity, but did not draw conclusions about whether they were more deconditioned.<ref name=":1">{{Cite journal | last = Clark|first = Lucy V | authorlink = Lucy Clark | last2 = White | first2 = Peter D | authorlink2 = Peter White | date = June 2005 | title = The role of deconditioning and therapeutic exercise in chronic fatigue syndrome (CFS) | url = https://www.tandfonline.com/doi/abs/10.1080/09638230500136308|journal=Journal of Mental Health|language=en|volume=14|issue=3 | pages = 237β252|doi=10.1080/09638230500136308|issn=0963-8237|via=}}</ref> Clarke and White later became authors of the highly controversial [[PACE trial]].<ref name="pace2011a">{{citation | last1 = White | first1 = PD | author-link1 = Peter White | last2 = Goldsmith | first2 = KA | authorlink2 = Kimberley Goldsmith | last3 = Johnson | first3 = AL | authorlink3 = Anthony Johnson | last4 =Potts | first4 = L | author-link4 = Laura Potts | last5 = Walwyn | first5 = R | author-link5 = Rebecca Walwyn | last6 = DeCesare | first6 = JC | author-link6 = Julia DeCesare | last7 = Baber | first7 = HL | author-link8 = Hannah Baber | last8 = Burgess | first8 = M | author-link8 = Mary Burgess | last9 = Clark | first9 = LV | author-link9 = Lucy Clark | last10 = Cox | first10 = DL | author-link10 = Diane Cox | last11 = Bavinton | first11 = J | author-link11 = Jessica Bavinton | last12 = Angus | first12 = BJ | author-link12 = BJ Angus | last13 = Murphy | first13 = G | author-link13 = Gabrielle Murphy | last14 = Murphy | first14 = M | author-link14 = Maurice Murphy | last15 = O'Dowd | first15 = H | author-link15 = Hazel O'Dowd | last16 = Wilks | first16 = D | author-link16 = David Wilks | last17 = McCrone | first17 = P | author-link17 = Paul McCrone | last18 = Chalder | first18 = T | author-link18 = Trudie Chalder | last19 = Sharpe | first19 = M | author-link19 = Michael Sharpe | last20 = on behalf of the PACE Trial Management Group| authorlink20 = PACE Trial Management Group | title = Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial| journal = The Lancet | volume = 377 | issue = 9768 | pages = 823β836 | date = March 5, 2011 | pmid = 21334061| doi = 10.1016/S0140-6736(11)60096-2 | url = http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60096-2/}}</ref> Results from [[Two-day cardiopulmonary exercise test|two-day cardiopulmonary exercise tests]] provide clear evidence that patients with ME/CFS have an abnormal response to exercise, which is not the result of deconditioning.<ref name="Snell2013">{{Cite journal | last = Snell|first = C.R. | authorlink = Christopher Snell | last2 = Stevens | first2 = S.R. | authorlink2 = Staci Stevens | last3 = Davenport | first3 = T.E. | author-link3 = Todd Davenport | last4 = Van Ness | first4 = J.M. | author-link4 = Mark VanNess | author-link5 = | date = 2013-06-27 | title = Discriminative Validity of Metabolic and Workload Measurements for Identifying People With Chronic Fatigue Syndrome | url = https://academic.oup.com/ptj/article/93/11/1484/2735315|journal=Physical Therapy|language=en|volume=93|issue=11 | pages = 1484β1492|doi=10.2522/ptj.20110368|issn=0031-9023|quote=|via=}}</ref> A large Dutch study by van Campen et al. (2018) found that deconditioning could not explain the cardiac index and stroke volume index changes in patients with ME/CFS that occurred during a normal tilt test.<ref name=":<ref name="vanCampen2018" /> Nakatomi and colleagues (2014) found widespread evidence of [[neuroinflammation]] in patients with [[ME/CFS]], and that neuroinflammation was correlated with the severity of neuropsychologic symptoms,<ref name="Nakatomi2014"/> while a review by Nijs and colleagues (2014) found evidence of an altered immune response to [[exercise]] in patients with ME/CFS.<ref name="Nijs2014"/> == Notable studies == *1992, Skeletal muscle metabolism in the chronic fatigue syndrome. In vivo assessment by 31P nuclear magnetic resonance spectroscopy<ref name="Wong1992">{{Cite journal | last = Wong|first = R. | authorlink = | last2 = Lopaschuk | first2 = G. | authorlink2 = | last3 = Zhu | first3 = G. | author-link3 = | last4 = Walker | first4 =D. | author-link4 = | last5 = Catellier | first5 =D. | author-link5 = | last6 = Burton | first6 =D. | last7 = Teo | first7 = K. | last8 = Collins-Nakai | first8 = R. | last9 = Montague | first9 = T. | date = Dec 1992 | title = Skeletal muscle metabolism in the chronic fatigue syndrome. In vivo assessment by 31P nuclear magnetic resonance spectroscopy | url = https://www.ncbi.nlm.nih.gov/pubmed/1446478|journal=Chest|volume=102|issue=6 | pages = 1716β1722|issn=0012-3692|pmid=1446478|quote=|via= | author-link6 = | author-link8 = | author-link8 = | author-link9 = }}</ref> *2001 - [https://www.tandfonline.com/doi/abs/10.3109/09638288.2010.541543 Is physical deconditioning a perpetuating factor in chronic fatigue syndrome? A controlled study on maximal exercise performance and relations with fatigue, impairment and physical activity?]<ref name="Bazelmans2001">{{Cite journal | last = Bazelmans | first = Ellen | last2 = Bleijenberg | first2 = Gijs | last3 = Van Der Meer | first3 = Jos W. | last4 = Folgering | first4 = Hans | date = Jan 2001 | title = Is physical deconditioning a perpetuating factor in chronic fatigue syndrome? A controlled study on maximal exercise performance and relations with fatigue, impairment and physical activity | url = https://www.ncbi.nlm.nih.gov/m/pubmed/11200949/|journal=Psychological Medicine|volume=31|issue=1 | pages = 107β114|issn=0033-2917|pmid=11200949|via=|quote= | authorlink = Ellen Bazelmans | authorlink2 = Gijs Bleijenberg | authorlink3 = Jos van der Meer | author-link4 = Hans Folgering | author-link5 = }}</ref> *2010 - [https://www.researchgate.net/profile/Mark_Van_Ness/publication/41121299_Postexertional_Malaise_in_Women_with_Chronic_Fatigue_Syndrome/links/00b49521532730549e000000/Postexertional-Malaise-in-Women-with-Chronic-Fatigue-Syndrome.pdf Postexertional Malaise in Women with Chronic Fatigue Syndrome]<ref name="VanNess2010">{{Cite journal | last = VanNess | first = J. Mark | authorlink = Mark VanNess | last2 = Stevens | first2 = Staci R. | authorlink2 = Staci Stevens | last3 = Bateman | first3 = Lucinda | authorlink3 = Lucinda Bateman | last4 = Stiles | first4 = Travis L. | author-link4 = Travis Stiles | last5 = Snell | first5 = Christopher R. | author-link5 = Christopher Snell | date = Feb 2010 | title = Postexertional Malaise in Women with Chronic Fatigue Syndrome | url = https://www.researchgate.net/profile/Mark_Van_Ness/publication/41121299_Postexertional_Malaise_in_Women_with_Chronic_Fatigue_Syndrome/links/00b49521532730549e000000/Postexertional-Malaise-in-Women-with-Chronic-Fatigue-Syndrome.pdf | journal=Journal of Women's Health|language=en|volume=19|issue=2 | pages = 239β244|doi=10.1089/jwh.2009.1507|issn=1540-9996|quote=|via=}}</ref> *2011 - [http://emerge.org.au/wp-content/uploads/2014/11/Nijs-J.-et-al.-Tired-of-being-inactive.-Disabil-Rehabil-2011-3317-18.1493-1500.pdf Tired of being inactive: a systematic literature review of physical activity, physiological exercise capacity and muscle strength in patients with chronic fatigue syndrome]<ref name="Nijs2011">{{Cite journal | last = Nijs | first = Jo | authorlink = Jo Nijs | last2 = Aelbrecht | first2 = Senne | authorlink2 = Senne Aelbrecht | last3 = Meeus | first3 = Mira | last4 = Van Oosterwijck | first4 = Jessica | last5 = Zinzen | first5 = Evert | last6 = Clarys | first6 = Peter | date = Jan 2011 | title = Tired of being inactive: a systematic literature review of physical activity, physiological exercise capacity and muscle strength in patients with chronic fatigue syndrome | url = http://emerge.org.au/wp-content/uploads/2014/11/Nijs-J.-et-al.-Tired-of-being-inactive.-Disabil-Rehabil-2011-3317-18.1493-1500.pdf | journal=Disability and Rehabilitation|language=en|volume=33|issue=17-18 | pages = 1493β1500|doi=10.3109/09638288.2010.541543|issn=0963-8288|via=|quote= | authorlink3 = Mira Meeus | author-link4 = Jessica Van Oosterwijck | author-link5 = Evert Zinzen | author-link6 = Peter Clarys}}</ref> *2014, Altered immune response to exercise in patients with chronic fatigue syndrome/myalgic encephalomyelitis: A systematic literature review<ref name="Nijs2014">https://pubmed.ncbi.nlm.nih.gov/24974723/</ref> [https://doc.anet.be/docman/docman.phtml?file=.irua.338b0c.9322.pdf (Full text)] *2014, Neuroinflammation in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An 11C-(R)-PK11195 PET Study <ref name="Nakatomi2014">https://doi.org/10.2967/jnumed.113.131045</ref> - [https://doi.org/10.2967/jnumed.113.131045 (Full text)] *2016 - Unexplained exertional dyspnea caused by low ventricular filling pressures: results from clinical invasive cardiopulmonary exercise testing<ref name="Oldham2016">{{Cite journal | last = Oldham|first = William M. | authorlink = William Oldham | last2 = Lewis | first2 = Gregory D. | authorlink2 = Gregory Lewis | last3 = Opotowsky | first3 = Alexander R. | author-link3 = Alexander Opotowsky | last4 = Waxman | first4 = Aaron B. | author-link4 = Aaron Waxman | last5 = Systrom | first5 = David M. | author-link5 = David Systrom | date = March 2016 | title = Unexplained Exertional Dyspnea Caused by Low Ventricular Filling Pressures: Results from Clinical Invasive Cardiopulmonary Exercise Testing | url =http://www.journals.uchicago.edu/doi/pdfplus/10.1086/685054|journal=Pulmonary Circulation|language=en|volume=6|issue=1 | pages = 55β62|doi=10.1086/685054|issn=2045-8932|pmc=4860548|pmid=27162614|via=}}</ref> :* [[Cort Johnson]] breaks down the study in [[Health Rising]] article ''The Exercise Intolerance in POTS, ME/CFS and Fibromyalgia Explained?''<ref name=":0" /> Article Heading: "Not Deconditioning" :<blockquote>The study also indicated neither deconditioning or a reduced maximal effort, both of which have been suspected in ME/CFS, play a role in the exercise intolerance found. In fact, deconditioned people, ironically, exhibit an opposite finding (increased as opposed to decreased filling pressures) to that found in this study.<ref name=":0">{{Cite news |url = http://www.healthrising.org/blog/2016/07/04/exercise-intolerance-fibromyalgia-chronic-fatigue-pots-explained/ | title = The Exercise Intolerance in POTS, ME/CFS and Fibromyalgia Explained? - Health Rising | last = Johnson | first = Cort | date = 2016-07-04|work=Health Rising|access-date=2018-10-23| archive-url = | archive-date = |url-status = | language=en-US|quote= | authorlink = Cort Johnson}}</ref></blockquote> * 2018 - [https://www.gavinpublishers.com/articles/Research-Article/Journal-of-Thrombosis-and-Circulation/The-Abnormal-Cardiac-Index-and-Stroke-Volume-Index-Changes-During-a-Normal-Tilt-Table-Test-in-ME-CFS-Patients-Compared-to-Healthy-Volunteers-are-Not-Related-to-Deconditioning The Abnormal Cardiac Index and Stroke Volume Index Changes During a Normal Tilt Table Test in ME/CFS Patients Compared to Healthy Volunteers, are Not Related to Deconditioning]<ref name="vanCampen2018">{{Cite journal | last = van Campen | first = CMC | authorlink = Linda van Campen | last2 = Visser | first2 = FC | authorlink2 = Frans Visser | date = 2018 | title = The Abnormal Cardiac Index and Stroke Volume Index Changes During a Normal Tilt Table Test in ME/CFS Patients Compared to Healthy Volunteers, are Not Related to Deconditioning | url =https://www.gavinpublishers.com/articles/Research-Article/Journal-of-Thrombosis-and-Circulation/The-Abnormal-Cardiac-Index-and-Stroke-Volume-Index-Changes-During-a-Normal-Tilt-Table-Test-in-ME-CFS-Patients-Compared-to-Healthy-Volunteers-are-Not-Related-to-Deconditioning|journal=Journal of Thrombosis and Circulation|volume=|issue= | pages = |doi=10.29011/JTC-107.000007|via=|quote=}}</ref> *2021, Deconditioning does not explain orthostatic intolerance in ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome)<ref name="vanCampen2021">https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-02819-0</ref> - [https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-02819-0 (Full text)] == Learn more == * [https://www.researchgate.net/publication/49691388_Tired_of_being_inactive_A_systematic_literature_review_of_physical_activity_physiological_exercise_capacity_and_muscle_strength_in_patients_with_chronic_fatigue_syndrome Tired of being inactive: a systematic literature review of physical activity, physiological exercise capacity and muscle strength in patients with chronic fatigue syndrome] ==See also== *[[Illness beliefs]] *[[Graded exercise therapy|Graded Exercise Therapy]] *[[Biopsychosocial model]] *[[Two-day cardiopulmonary exercise test]] *[[Post-exertional malaise]] *[[Exercise]] == References == {{Reflist}} [[Category:Diagnoses]] [[Category:Psychological paradigm]] [[Category:Medical hypotheses]]
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