Workwell Foundation: Difference between revisions

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*2010, [http://ptjournal.apta.org/content/90/4/602.full Conceptual model for physical therapist management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis]<ref name="Davenport2010" />
*2010, [http://ptjournal.apta.org/content/90/4/602.full Conceptual model for physical therapist management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis]<ref name="Davenport2010" />
*2005,[http://iv.iiarjournals.org/content/19/2/387.full.pdf Exercise capacity and immune function in male and female patients with Chronic Fatigue Syndrome (CFS)]<ref name="Snell2005" />
*2005,[http://iv.iiarjournals.org/content/19/2/387.full.pdf Exercise capacity and immune function in male and female patients with Chronic Fatigue Syndrome (CFS)]<ref name="Snell2005" />
*2003, Subclassifying Chronic Fatigue Syndrome through Exercise Testing<ref name="VanNess2003">{{cite journal | last=VanNess | first=J. Mark | author-link = J. Mark VanNess | last2 = Snell | first2=Christopher R. | authorlink2 = Christopher Snell | last3 = Strayer | first3=David R. | authorlink3= David Strayer | last4 = Dempsey | first4 = Line | author-link4  = | last5 = Stevens | first5 = Staci R. | authorlink5 = Staci Stevens | title=Subclassifying Chronic Fatigue Syndrome through Exercise Testing | url = https://doi.org/10.1249%2F01.mss.0000069510.58763.e8 |journal=Medicine & Science in Sports & Exercise | volume=35 | issue=6 | year=2003 | issn=0195-9131 | doi=10.1249/01.mss.0000069510.58763.e8 | pages=908–913}}</ref>
*2003, Subclassifying Chronic Fatigue Syndrome through Exercise Testing<ref name="VanNess2003">{{cite journal | last=VanNess | first=J. Mark | authorlink = J. Mark VanNess | last2 = Snell | first2=Christopher R. | authorlink2 = Christopher Snell | last3 = Strayer | first3=David R. | authorlink3= David Strayer | last4 = Dempsey | first4 = Line | author-link4  = | last5 = Stevens | first5 = Staci R. | authorlink5 = Staci Stevens | title=Subclassifying Chronic Fatigue Syndrome through Exercise Testing | url = https://doi.org/10.1249%2F01.mss.0000069510.58763.e8 |journal=Medicine & Science in Sports & Exercise | volume=35 | issue=6 | year=2003 | issn=0195-9131 | doi=10.1249/01.mss.0000069510.58763.e8 | pages=908–913}}</ref>


==Exercise recommendations for [[ME/CFS]]==
==Exercise recommendations for [[ME/CFS]]==
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*This approach utilises objective measures such as VO2 max testing and heart rate monitoring to guide the level of activity suitable for the individual<ref name="Workwell201512foar" />
*This approach utilises objective measures such as VO2 max testing and heart rate monitoring to guide the level of activity suitable for the individual<ref name="Workwell201512foar" />
==COVID-19 rehabilitation information==
==COVID-19 rehabilitation information==
* May 2020, [https://www.physiosforme.com/covid-19 Post Covid-19 Rehabilitation]<ref name="PhysiosforME-COVID19">{{Cite web|url=https://www.physiosforme.com/covid-19|title=Post Covid-19 Rehabilitation | last =Physio for ME | first = |authorlink=Physios for ME | last2 = Workwell Foundation | first2= | authorlink2 = Workwell Foundation| date = May 2020 | website = Physiosforme|language=en|archive-url=|archive-date=|url-status=|access-date=2020-05-02 | last3 = ME Association|author-link3=ME Association}}</ref> - [[Physios for ME]], Workwell Foundation, and [[ME Association]]
* May 2020, [https://www.physiosforme.com/covid-19 Post Covid-19 Rehabilitation]<ref name="PhysiosforME-COVID19">{{Cite web|url=https://www.physiosforme.com/covid-19 | title = Post Covid-19 Rehabilitation | last =Physio for ME | first = |authorlink=Physios for ME | last2 = Workwell Foundation | first2= | authorlink2 = Workwell Foundation | date = May 2020 | website = Physiosforme|language=en|archive-url=|archive-date=|url-status=|access-date=2020-05-02 | last3 = ME Association | author-link3 = ME Association}}</ref> - [[Physios for ME]], Workwell Foundation, and [[ME Association]]


==Open letters==
==Open letters==
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==References==
==References==
<references>
<references>
<ref name="Davenport2010">{{citation | last1 = Davenport | first1 = Todd E | authorlink1 = Todd Davenport | last2 = Stevens | first2 = Staci R | authorlink2 = Staci Stevens | last3 = VanNess | first3 = J Mark | authorlink3 = Mark VanNess | last4 = Snell | first4 = Christopher R  | authorlink4 = Christopher Snell | last5   = Little | first5 = Tamara | authorlink5 = Tamara Little | title = Conceptual model for physical therapist management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis | journal = Physical Therapy (APTA) | volume = 90 | issue = 4 | page = 602-614 | date = 31 Mar 2010 | pmid = 20185614 | doi = 10.2522/ptj.20090047
<ref name="Davenport2010">{{citation | last1 = Davenport | first1 = Todd E | authorlink1 = Todd Davenport | last2 = Stevens | first2 = Staci R | authorlink2 = Staci Stevens | last3 = VanNess | first3 = J Mark | authorlink3 = Mark VanNess | last4 = Snell | first4 = Christopher R  | authorlink4 = Christopher Snell | last5 = Little | first5 = Tamara | authorlink5 = Tamara Little | title = Conceptual model for physical therapist management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis | journal = Physical Therapy (APTA) | volume = 90 | issue = 4 | page = 602-614 | date = 31 Mar 2010 | pmid = 20185614 | doi = 10.2522/ptj.20090047
| url = http://ptjournal.apta.org/content/90/4/602.full }}</ref>
| url = http://ptjournal.apta.org/content/90/4/602.full }}</ref>
<ref name="Davenport2011">{{citation | last1 = Davenport | first1 = Todd E | authorlink1 = Todd Davenport | last2 = Stevens | first2 = Staci R  | authorlink2 = Staci Stevens | last3 = Baroni | first3 = Katie | authorlink3 = Katie Baroni | last4 = VanNess | first4 = J Mark| authorlink4 = Mark VanNess | last5   = Snell | first5 = Christopher R | authorlink5 = Christopher Snell | title = Diagnostic accuracy of symptoms characterising chronic fatigue syndrome | journal = Disabil Rehabil | volume = 33 | issue= 19-20 | page = 1768-75  | date = 6 Jan 2011 | pmid = 21208154 | doi = 10.3109/09638288.2010.546936
<ref name="Davenport2011">{{citation | last1 = Davenport | first1 = Todd E | authorlink1 = Todd Davenport | last2 = Stevens | first2 = Staci R  | authorlink2 = Staci Stevens | last3 = Baroni | first3 = Katie | authorlink3 = Katie Baroni | last4 = VanNess | first4 = J Mark | author-link4 = Mark VanNess | last5 = Snell | first5 = Christopher R | authorlink5 = Christopher Snell | title = Diagnostic accuracy of symptoms characterising chronic fatigue syndrome | journal = Disabil Rehabil | volume = 33 | issue= 19-20 | page = 1768-75  | date = 6 Jan 2011 | pmid = 21208154 | doi = 10.3109/09638288.2010.546936
| url = http://www.tandfonline.com/doi/abs/10.3109/09638288.2010.546936 }}</ref>
| url = http://www.tandfonline.com/doi/abs/10.3109/09638288.2010.546936 }}</ref>
<ref name="JohnsonC20130730busted">{{citation | last1 = Johnson | first1 = Cort | authorlink1 = Cort Johnson | title = Busted! Exercise Study Finds Energy Production System is Broken in Chronic Fatigue Syndrome | date = 30 Jul 2013
<ref name="JohnsonC20130730busted">{{citation | last1 = Johnson | first1 = Cort | authorlink1 = Cort Johnson | title = Busted! Exercise Study Finds Energy Production System is Broken in Chronic Fatigue Syndrome | date = 30 Jul 2013
| url = http://www.cortjohnson.org/blog/2013/07/30/busted-exercise-study-finds-energy-production-system-is-broken-in-chronic-fatigue-syndrome/  }}</ref>
| url = http://www.cortjohnson.org/blog/2013/07/30/busted-exercise-study-finds-energy-production-system-is-broken-in-chronic-fatigue-syndrome/  }}</ref>
<ref name="Snell2005">{{citation | last1 = Snell | first1 = Christopher R | authorlink1 = Christopher Snell | last2 = VanNess | first2 = J Mark| authorlink2 = Mark VanNess | last3 = Strayer | first3 = David R  | authorlink3 = David Strayer | last4 = Stevens | first4 = Staci R  | authorlink4 = Staci Stevens | title = Exercise capacity and immune function in male and female patients with Chronic Fatigue Syndrome (CFS) | journal = In Vivo | volume = 19 | issue =2 |page = 387-390 | date = 2005 | pmid = 15796202  
<ref name="Snell2005">{{citation | last1 = Snell | first1 = Christopher R | authorlink1 = Christopher Snell | last2 = VanNess | first2 = J Mark | author-link2 = Mark VanNess | last3 = Strayer | first3 = David R  | authorlink3 = David Strayer | last4 = Stevens | first4 = Staci R  | authorlink4 = Staci Stevens | title = Exercise capacity and immune function in male and female patients with Chronic Fatigue Syndrome (CFS) | journal = In Vivo | volume = 19 | issue =2 |page = 387-390 | date = 2005 | pmid = 15796202  
| url = http://iv.iiarjournals.org/content/19/2/387.full.pdf }}</ref>
| url = http://iv.iiarjournals.org/content/19/2/387.full.pdf }}</ref>
<ref name="Snell2013">{{citation | last1 = Snell | first1 = Christopher R | authorlink1 = Christopher Snell | last2 = Stevens | first2 = Staci R  | authorlink2 = Staci Stevens | last3 = Davenport | first3 = Todd E | authorlink3 = Todd Davenport | last4 = VanNess | first4 = J Mark| authorlink4 = Mark VanNess | title = Discriminative Validity of Metabolic and Workload Measurements for Identifying People With Chronic Fatigue Syndrome | journal = Physical Therapy (APTA) | volume = 93 | issue = 11 | page = 1484-1492 | date = 31 Oct 2013 | pmid = 23813081 | doi = 10.2522/ptj.20110368
<ref name="Snell2013">{{citation | last1 = Snell | first1 = Christopher R | authorlink1 = Christopher Snell | last2 = Stevens | first2 = Staci R  | authorlink2 = Staci Stevens | last3 = Davenport | first3 = Todd E | authorlink3 = Todd Davenport | last4 = VanNess | first4 = J Mark | author-link4 = Mark VanNess | title = Discriminative Validity of Metabolic and Workload Measurements for Identifying People With Chronic Fatigue Syndrome | journal = Physical Therapy (APTA) | volume = 93 | issue = 11 | page = 1484-1492 | date = 31 Oct 2013 | pmid = 23813081 | doi = 10.2522/ptj.20110368
| url = http://ptjournal.apta.org/content/93/11/1484 }}</ref>
| url = http://ptjournal.apta.org/content/93/11/1484 }}</ref>
<ref name="Stevens20150524video">{{citation | last1 = Stevens | first1 = Staci R  | authorlink1 = Staci Stevens | last2 = ME/FM Society of British Columbia (Canada) | title = Video: Post-exertional malaise: How to do more with less  | date = 24 May 2015 | place = Vancouver, BC, Canada
<ref name="Stevens20150524video">{{citation | last1 = Stevens | first1 = Staci R  | authorlink1 = Staci Stevens | last2 = ME/FM Society of British Columbia (Canada) | title = Video: Post-exertional malaise: How to do more with less  | date = 24 May 2015 | place = Vancouver, BC, Canada
| url = http://youtu.be/XFz4CK0Js1M }}</ref>
| url = http://youtu.be/XFz4CK0Js1M }}</ref>
<ref name="VanNess2010">{{citation | last1 = VanNess | first1 = J Mark| authorlink1 = Mark VanNess | last2 = Stevens | first2 = Staci R  | authorlink2 = Staci Stevens | last3 = Bateman | first3 = Lucinda  | authorlink3 = Lucinda Bateman | last4 = Stiles | first4 = Travis L | authorlink4 = Travis Stiles | last5   = Snell | first5 = Christopher R | authorlink5 = Christopher Snell | title = Post-exertional malaise in women with chronic fatigue syndrome | journal = J Womens Health (Larchmt) | volume = 19 | issue = 2 | page = 239-244 | date = 4 Jan 2010 | pmid = 20095909 | doi = 10.1089/jwh.2009.1507
<ref name="VanNess2010">{{citation | last1 = VanNess | first1 = J Mark | author-link1 = Mark VanNess | last2 = Stevens | first2 = Staci R  | authorlink2 = Staci Stevens | last3 = Bateman | first3 = Lucinda  | authorlink3 = Lucinda Bateman | last4 = Stiles | first4 = Travis L | authorlink4 = Travis Stiles | last5 = Snell | first5 = Christopher R | authorlink5 = Christopher Snell | title = Post-exertional malaise in women with chronic fatigue syndrome | journal = J Womens Health (Larchmt) | volume = 19 | issue = 2 | page = 239-244 | date = 4 Jan 2010 | pmid = 20095909 | doi = 10.1089/jwh.2009.1507
| url = http://online.liebertpub.com/doi/abs/10.1089/jwh.2009.1507 }}</ref>
| url = http://online.liebertpub.com/doi/abs/10.1089/jwh.2009.1507 }}</ref>
<ref name="VanNess20140205video">{{citation | last1 = VanNess | first1 = J Mark| authorlink1 = Mark VanNess | title = Video: A Realistic Approach to Exercise and Rehabilitation in ME/CFS | date = 5 Feb 2014  | place = Bristol Watershed, UK
<ref name="VanNess20140205video">{{citation | last1 = VanNess | first1 = J Mark | author-link1 = Mark VanNess | title = Video: A Realistic Approach to Exercise and Rehabilitation in ME/CFS | date = 5 Feb 2014  | place = Bristol Watershed, UK
| url = https://www.youtube.com/watch?v=q_cnva7zyKM }}</ref>
| url = https://www.youtube.com/watch?v=q_cnva7zyKM }}</ref>
<ref name="Workwell20140317video">{{citation | author  = Workwell Foundation | title = Video: Cardio-Pulmonary Exercise Test (CPET) | date = 17 Mar 2014  
<ref name="Workwell20140317video">{{citation | author  = Workwell Foundation | title = Video: Cardio-Pulmonary Exercise Test (CPET) | date = 17 Mar 2014  
| url = http://youtu.be/xIDFahiCySw }}</ref>
| url = http://youtu.be/xIDFahiCySw }}</ref>
<ref name="Workwell201404rae">{{citation | last1 = VanNess | first1 = J Mark| authorlink1 = Mark VanNess | last2 = Snell | first2 = Christopher R | authorlink2 = Christopher Snell | last3 = Stevens | first3 = Staci R  | authorlink3 = Staci Stevens | title = A Realistic Approach to Exercise for CFS Patients | journal = The CFS Research Review | date = 2000 | volume = 1
<ref name="Workwell201404rae">{{citation | last1 = VanNess | first1 = J Mark | author-link1 = Mark VanNess | last2 = Snell | first2 = Christopher R | authorlink2 = Christopher Snell | last3 = Stevens | first3 = Staci R  | authorlink3 = Staci Stevens | title = A Realistic Approach to Exercise for CFS Patients | journal = The CFS Research Review | date = 2000 | volume = 1
| issue = 4 | pages = 3-8
| issue = 4 | pages = 3-8
| url = http://www.workwellfoundation.org/wp-content/uploads/2014/04/A-Realistic-Approach-to-Exercise-for-CFS-patients.pdf }}</ref>
| url = http://www.workwellfoundation.org/wp-content/uploads/2014/04/A-Realistic-Approach-to-Exercise-for-CFS-patients.pdf }}</ref>
<ref name="Workwell201404wwodwo">{{citation | last1 = Snell | first1 = Christopher R | authorlink1 = Christopher Snell | last2 = VanNess | first2 = J Mark| authorlink2 = Mark VanNess | last3 = Stevens | first3 = Staci R  | authorlink3 = Staci Stevens | title = When Working Out Doesn't Work Out | journal = The CFIDS Chronicle | volume = 17 |issue = 3 | pages = 6 | date = 2004
<ref name="Workwell201404wwodwo">{{citation | last1 = Snell | first1 = Christopher R | authorlink1 = Christopher Snell | last2 = VanNess | first2 = J Mark | author-link2 = Mark VanNess | last3 = Stevens | first3 = Staci R  | authorlink3 = Staci Stevens | title = When Working Out Doesn't Work Out | journal = The CFIDS Chronicle | volume = 17 |issue = 3 | pages = 6 | date = 2004
| url = http://www.workwellfoundation.org/wp-content/uploads/2014/04/When-Working-Out-Doesnt-Work-Out.pdf }}</ref>
| url = http://www.workwellfoundation.org/wp-content/uploads/2014/04/When-Working-Out-Doesnt-Work-Out.pdf }}</ref>
<ref name="Workwell201512foar">{{citation | last1 = Stevens | first1 = Staci R  | authorlink1 = Staci Stevens | last2 = Davenport | first2 = Todd E | authorlink2 = Todd Davenport
<ref name="Workwell201512foar">{{citation | last1 = Stevens | first1 = Staci R  | authorlink1 = Staci Stevens | last2 = Davenport | first2 = Todd E | authorlink2 = Todd Davenport

Latest revision as of 08:23, April 2, 2023

Workwell Foundation was founded by Staci Stevens and is based in Ripon, California, US. It specialises in two-day cardiopulmonary exercise test (2-day CPET) for people with ME/CFS, Fibromyalgia and other fatiguing illnesses.

Notable people[edit | edit source]

Notable studies[edit | edit source]

Exercise recommendations for ME/CFS[edit | edit source]

Workwell Foundation recommends short periods (eg: 30 seconds) of analeptic exercise, with periods of rest which are 3-6 times longer than the period of exercise. The amount of exercise that the individual undertakes should be guided by VO2 max testing (or a safe heart rate threshold (generally 60% of maximum heart rate)), and the use of a heart rate monitor (both during exercise and to help with pacing) is recommended to ensure that the individual doesn't exceed their capacity. The Foundation also advises against aerobic exercise for people with ME/CFS.[7][8][9]

This approach to exercise differs from graded exercise therapy (GET) in several important ways:

  • There is no claim that the exercise program will cure the condition. The aim is to increase functional strength and flexibility, and to improve quality of life[8]
  • This program is based on a deep understanding of Post-exertional malaise (PEM), and the importance of staying within the energy envelope in order to not trigger PEM[7]
  • There is a recognition that any approach to exercise with people with ME/CFS must be carefully tailored to the individual. There is no one-size fits all[8]
  • This approach utilises objective measures such as VO2 max testing and heart rate monitoring to guide the level of activity suitable for the individual[9]

COVID-19 rehabilitation information[edit | edit source]

Open letters[edit | edit source]

Funding[edit | edit source]

Talks and interviews[edit | edit source]


Online presence[edit | edit source]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. ↑ Snell, Christopher R; Stevens, Staci R; Davenport, Todd E; VanNess, J Mark (October 31, 2013), "Discriminative Validity of Metabolic and Workload Measurements for Identifying People With Chronic Fatigue Syndrome", Physical Therapy (APTA), 93 (11): 1484-1492, doi:10.2522/ptj.20110368, PMID 23813081
  2. ↑ Davenport, Todd E; Stevens, Staci R; Baroni, Katie; VanNess, J Mark; Snell, Christopher R (January 6, 2011), "Diagnostic accuracy of symptoms characterising chronic fatigue syndrome", Disabil Rehabil, 33 (19–20): 1768-75, doi:10.3109/09638288.2010.546936, PMID 21208154
  3. ↑ VanNess, J Mark; Stevens, Staci R; Bateman, Lucinda; Stiles, Travis L; Snell, Christopher R (January 4, 2010), "Post-exertional malaise in women with chronic fatigue syndrome", J Womens Health (Larchmt), 19 (2): 239-244, doi:10.1089/jwh.2009.1507, PMID 20095909
  4. ↑ Davenport, Todd E; Stevens, Staci R; VanNess, J Mark; Snell, Christopher R; Little, Tamara (March 31, 2010), "Conceptual model for physical therapist management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis", Physical Therapy (APTA), 90 (4): 602-614, doi:10.2522/ptj.20090047, PMID 20185614
  5. ↑ Snell, Christopher R; VanNess, J Mark; Strayer, David R; Stevens, Staci R (2005), "Exercise capacity and immune function in male and female patients with Chronic Fatigue Syndrome (CFS)" (PDF), In Vivo, 19 (2): 387-390, PMID 15796202
  6. ↑ VanNess, J. Mark; Snell, Christopher R.; Strayer, David R.; Dempsey, Line; Stevens, Staci R. (2003). "Subclassifying Chronic Fatigue Syndrome through Exercise Testing". Medicine & Science in Sports & Exercise. 35 (6): 908–913. doi:10.1249/01.mss.0000069510.58763.e8. ISSN 0195-9131.
  7. ↑ 7.0 7.1 7.2 VanNess, J Mark; Snell, Christopher R; Stevens, Staci R (2000), "A Realistic Approach to Exercise for CFS Patients" (PDF), The CFS Research Review, 1 (4): 3–8
  8. ↑ 8.0 8.1 8.2 8.3 Snell, Christopher R; VanNess, J Mark; Stevens, Staci R (2004), "When Working Out Doesn't Work Out" (PDF), The CFIDS Chronicle, 17 (3): 6
  9. ↑ 9.0 9.1 9.2 Stevens, Staci R; Davenport, Todd E (2010), "Functional Outcomes of Anaerobic Rehabilitation in a Patient with Chronic Fatigue Syndrome: case report with 1-year follow-up" (PDF), Bulletin of the IACFS/ME, 18 (3): 93-98
  10. ↑ Physio for ME; Workwell Foundation; ME Association (May 2020). "Post Covid-19 Rehabilitation". Physiosforme. Retrieved May 2, 2020.
  11. ↑ Stevens, Staci R; ME/FM Society of British Columbia (Canada) (May 24, 2015), Video: Post-exertional malaise: How to do more with less, Vancouver, BC, Canada
  12. ↑ VanNess, J Mark (February 5, 2014), Video: A Realistic Approach to Exercise and Rehabilitation in ME/CFS, Bristol Watershed, UK
  13. ↑ Workwell Foundation (March 17, 2014), Video: Cardio-Pulmonary Exercise Test (CPET)
  14. ↑ Johnson, Cort (July 30, 2013), Busted! Exercise Study Finds Energy Production System is Broken in Chronic Fatigue Syndrome

two-day cardiopulmonary exercise test (CPET) - A diagnostic test which involves testing an ME/CFS patient exercising on an exercise machine, while monitoring their respiration, especially oxygen consumption. This test is repeated the following day in order to confirm the patient's inability to replicate the first-day performance. This test is thought to be the most objective way to detect post-exertional malaise.

VO2 Max (VO2max) - the maximum amount of oxygen the body can utilize during a specified period of usually intense exercise (Volume of O2 Maximal)

heart rate (HR) - the number of times the heart beats within a certain time period, usually a minute

heart rate monitor (HRM) - A device that measures your heart rate (pulse rate). Heart rate monitors may come as a chest strap, wrist strap, smartwatch, or even as a mobile phone app. Heart rate monitors are often used by ME/CFS patients to pace their exertion, in order to avoid post-exertional malaise (PEM). For more information, see pacing with a heart rate monitor.

graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.

post-exertional malaise (PEM) - A notable exacerbation of symptoms brought on by small physical or cognitive exertions. PEM may be referred to as a "crash" or "collapse" and can last for days or weeks. Symptoms can include cognitive impairments, muscle pain, trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, and others.

Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) - Chronic Fatigue and Immune Dysfunction Syndrome is another term for Chronic Fatigue Syndrome, but one which emphasizes the immunological aspects of the disease. Popular in the 1990s, this term has apparently fallen into disuse.

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