Sign up Latest Topics
 
 
 


Reply
  Author   Comment  
AJ

Development Team Member
Registered:
Posts: 6
 #1 

I am in the early phases of working with a client with chronic fatigue and I was interested to see the response to aerobic exercise. The individual had an background in recreational cycling but has been extremely limited as a result of ongoing fatigue.
So we started at 35w after a calibration period and moved up in 25w increments. Final stage was 115w where the subject had an RPE of 8.
G test graph.png What's most striking is the poor utilisation in VL and very little overshoot in recovery. Only 9% changes over the entire test. Medial deltoid SM02 shows much greater variation.
Medial delt THb seems to steadily decline at each stage suggesting blood flow is diverted elsewhere and there in an accompanying increase in VL THb. No signs of an outflow restriction looking at the VL THb trend at the end of each stage. VL SM02 ( see below) does not return to the levels seen during the first 1 min recovery. Suggests to me the early onset of a respitory limitation.
Adjusting the scale to focus on SM02 looks like this
G test graph scaled.png
Thoughts and suggestions welcome   .


CraigMahony

Development Team Member
Registered:
Posts: 178
 #2 
Interesting.
A first thought is that a lack of desaturation in some posts in here suggested that there was an abnormally high level of myoglobin present which desaturates at a much lower pO2. 
A second thought is that since the wattage is low, maybe there is little need to desaturate and the RPE of 8 is being not being caused by muscular energetics.
A third thought is that maybe as a recreational cyclist they are not using their VL. So maybe try putting the Moxy on another muscle, eg RF or Hamstrings.
AJ

Development Team Member
Registered:
Posts: 6
 #3 
Craig, thanks for the input, interesting points to consider.
I should clarify the RPE of 8 was on a 1-10 scale, not the traditional Borg scale. I will repeat the test looking at both RF as the subject did mention having a stronger leg, which is the one we tested. Still, the lack of desaturation is surprising to me given the perception of exception. This individual is in their mid 50s and hasn't cycled regularly in a couple of years on account of chronic fatigue. Before that, cycling anywhere from 40-120km a week was common place.
bjrmd

Development Team Member
Registered:
Posts: 44
 #4 
A couple of comments.
If the max power was only 115w, we shouldn't expect much leg desaturation in a normal male. That's a very poor output for any adult male, but heart rate is high. Makes one wonder if they have pump failure, but if so, CHF patients desaturate relatively higher. Hyperthyroid patients will present with higher HR and poor physical ability.
As you know, desaturation relates to usage and flow, so some really good cyclists with great cardiac output just don't desatuate much.
If they have central fatigue (perhaps consistent with CFS) you wouldn't have seen such a good heart rate response. But if one does have central CNS fatigue this is what one would see (except HR).

What about further information:
Did the doctors check him thoroughly? Cbc, metabolic panel, thyroid, ESR, ferritin, b12 etc (I'm an endocrinologist so this work up is very routine for me).
Resting Heart rate?
Subjective muscle weakness?
Weight loss?


AJ

Development Team Member
Registered:
Posts: 6
 #5 
Thank you for your contribution.

The individual is female, mid 50s. Resting morning heart rate is 70 bpm and low blood pressure has been a feature of recent Dr's visits, was 120/80, now less than 100. Thyroid has been tested previously but has come back normal. I will private message other results she is happy to share. I have not performed subjective muscle tests but she reports the left leg is weaker due to a knee injury several years ago. No weight loss, body weight is healthy. Initially (6yr ago) thought to have had a parasite and was give anti micobial meds by a family dr but some months later a gastrologist ruled this out. A year later diagnosis was switched to Epstein Barr Virus and then in the last 6 months chronic fatigue, though she herself is not convinced by this diagnosis. Main symptoms were chronically low energy and disrupted sleep with multiple wake ups and sometimes unable to fall back to sleep for long periods. BMR was tested and she was advised that a diet around 1000kcal was advisable. Further recent dietary intervention in the last two to three weeks has vastly improved energy by the elimination of GI discomfort from limiting certain food groups.

We were cautious with the assessment as the last time she had a significantly elevated heart and respiratory rate from exercise (a brisk 15 min walk uphill) she was wiped out for a day or so. Post assessment (conducted at around 5pm) she had difficulty falling asleep.
bobbyjobling

Development Team Member
Registered:
Posts: 211
 #6 
Could it be a lack 2,3 BPG? Low level of 2,3BPG can make the hemoglobin oxygen dissociation curve shift to the left.
http://www.aklectures.com/lecture/high-altitude-and-2-3-bgp

That could explain the lack of Smo2 desaturation, HR and respiratory rate will still raise due to different energy path...maybe lactate and CO2 is high.
Previous Topic | Next Topic
Print
Reply

Quick Navigation:

Easily create a Forum Website with Website Toolbox.

HTML hit counter - Quick-counter.net