presented by Todd Davenport, Mark VanNess & Staci Stevens
This lesson is part one of a two-course series. Proceed to Part Two after completing this course.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) causes severely disabling fatigue within the context of a constellation of unusual signs and symptoms, which are associated with over-exertion. Because people with ME/CFS present with a whole host of clinical findings, there are multiple reasons for entry into medical and rehabilitation settings. The multifactorial clinical presentation of ME/CFS emphasizes the need for clinicians to recognize ME/CFS, in order to advocate for patients/clients with possible ME/CFS and to direct its appropriate management. The pathoetiology of ME/CFS is becoming better understood, and there is emerging evidence based on this pathoetiological evidence to support best practices in analeptic management strategies for people with ME/CFS.
This two-part course series provides the opportunity for attendees to receive the latest information in recognition, etiology, and analeptic management of patients with ME/CFS from a panel of established researchers and clinicians. In this session, the presenters will (i) summarize the clinical features ME/CFS with respect to optimal identification and differential diagnosis; (ii) describe the pathoetiology underlying the clinical features of ME/CFS; and (iii) provide an actionable framework for optimal analeptic management of individuals with ME/CFS that is based on current scientific evidence.
Todd serves as a tenured associate professor in the Department of Physical Therapy in the Thomas J. Long School of Pharmacy and Health Sciences at the University of the Pacific in Stockton, California, where he teaches in the Doctor of Physical Therapy (DPT) program. Todd is a graduate of the University of Southern California’s DPT and Orthopaedic Physical Therapy Residency programs. He is a past clinical research fellow at the Warren G. Magnusson Clinical Center at the National Institute of Health in Bethesda, Maryland. Todd is a graduate of the Master of Public Health program at the Berkeley campus of the University of California. He has been continuously recognized as a Board-Certified Orthopedic Clinical Specialist by the American Board of Physical Therapy Specialties since 2005. Todd has worked to translate evidence from scientific research into best practices for physical therapy. He is a member of the Evidence-Based Documents Task Force of the Orthopedic Section of the American Physical Therapy Association (APTA), through which he has been involved with authoring two CPGs to date with emphasis on foot and ankle health conditions. He also has served on the multidisciplinary Primer Writing Committee of the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (IACFS/ME) and as a content reviewer for clinical practice guidelines created by the American College of Occupational and Environmental Medicine. Todd is an associate editor of the Journal of Orthopaedic and Sports Physical Therapy, as well as a reviewer for several journals in the fields of rehabilitation and rheumatology. In addition to his teaching, scholarship, and service work, Todd practices clinically at the Kaiser Permanente offices in Stockton, California.
J. Mark VanNess, PhD, is a cardiovascular biologist and Distinguished Professor in the department of Health and Exercise Science at the University of the Pacific. He studied biology, chemistry, and exercise science as an undergraduate student and exercise physiology for his master’s degree. He received his doctoral degree from the program in Neuroscience at Florida State University. He has postdoctoral training from the University of Texas Health Science Center in San Antonio in Pharmacology and Physiology, and presently teaches at the University of the Pacific. His primary research interest focuses on ME/CFS and the cardiovascular and metabolic abnormalities that are unmasked by exercise testing in the illness. His collaboration with the Workwell Foundation has helped in the identification and description of post-exertional malaise in ME/CFS. Objective evidence documenting illness severity helps with treatment and efficacy for interventions.
Staci Stevens holds a bachelor's degree in Sports Medicine and a master's degree in Exercise Physiology from the University of the Pacific in Stockton, California. Ms. Stevens, in conjunction with Workwell Foundation’s research team, pioneered the use of two-day cardiopulmonary exercise testing (CPET) in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) to document the hallmark clinical feature of the illness, post-exertional malaise. She served on the Department of Health and Human Services’s Chronic Fatigue Syndrome Advisory Committee and as vice president of the International Association of CFS/ME. Ms. Stevens co-authored a ME/CFS primer for clinical practitioners, ME International Consensus Criteria, and is a co-recipient of two publication awards from the California Physical Therapy Association for research in ME/CFS. Workwell is a collaborator with the National Institute of Health’s (NIH) ME/CFS Intramural Study, NIH ME/CFS Collaborative Research Center, and a member of Cornell’s Center for Innervating Neuroimmune Disease. Her clinical experience includes utilizing CPET for disability evaluation and activity management programs. She aims to functionally characterize ME/CFS, educate health care professionals, and improve quality of life for patients.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is identified on the basis of case definition criteria. Over time, several sets of case definition criteria have been developed. The purpose of this section is to describe the epidemiological background of case definition criteria, present the common contemporary case definition criteria for ME/CFS for use in the clinic, and discuss the relative utility of contemporary case definition criteria to identify ME/CFS.
The provocation of symptoms and signs in ME/CFS in response to exertion suggests the presence of measurable physiological deficits in the post-exertional state. A 2-day maximal cardiopulmonary exercise test (CPET) paradigm was devised, which has revealed a whole host of cardiac, pulmonary, metabolic, and symptomatic differences between people with ME/CFS and sedentary people after an initial bout of exertion. The purposes of this chapter are to acquaint the learner with the 2-day maximal CPET paradigm and to describe the scientific research it has generated regarding the physiological basis of post-exertional malaise.