Normal muscle strength and fatigability in patients with effort syndromes

• Published in: BMJ Vol. 297; no. 6655; pp. 1014 - 1017
• Main Authors: Stokes, M. J., Cooper, R. G., Edwards, R. H.
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 22-10-1988; British Medical Association; BMJ Publishing Group LTD
• Subjects: Adult; Chronic fatigue syndrome; Edwards syndrome; Electric Stimulation; Electromyography; Exercise; Exercise Test; Fatigue; Fatigue - physiopathology; Fatigue - psychology; Fatigue - therapy; Female; Heart Rate; Humans; Male; Men; Middle Aged; Muscle Contraction; Muscles - physiopathology; Neurocirculatory asthenia; Neurocirculatory Asthenia - physiopathology; Neurocirculatory Asthenia - psychology; Neurocirculatory Asthenia - therapy; Skeletal muscle; Symptoms
• ISSN: 0959-8138; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.297.6655.1014

To examine fatigue mechanisms in an unselected series of patients with excess fatigue ("effort syndromes") their muscle function was compared with that of normal subjects. Voluntary performance was assessed with a cycle ergometer to exhaustion and by maximal isometric contractions of the quadriceps femoris. The mean maximal heart rate in patients during ergometry was 89% of the predicted rate, and quadriceps strength was either normal or was inappropriate for the available muscle, which suggested submaximal effort. Contractile performance was examined in the absence of volition with stimulated contractions of the adductor pollicis. During stimulated fatiguing activity patients were neither weaker nor more fatigable than controls; thus the excess fatigue experienced by the patients was not due to a defect of the contractile apparatus. The increased perception of effort must therefore be due to impairment of central rather than peripheral mechanisms. The optimal approach to treatment of effort syndromes combines physical and psychological techniques.